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PubMed2004

Systematic review and economic evaluation of a long-acting insulin analogue, insulin glargine.

OBJECTIVES: To evaluate the use of insulin glargine in its licensed basal-bolus indication in terms of both clinical and cost-effectiveness. DATA SOURCES: Electronic databases. REVIEW METHODS: A systematic review of the literature, involving a range of databases, was performed to identify all papers relating to insulin glargine. RESULTS: Nineteen studies met the inclusion criteria but full reports were available for only six. For type 1 diabetes patients, insulin glargine appears to be more effective than neutral protamine Hagedorn (NPH) in reducing fasting blood glucose (FBG) but not in reducing glycosylated haemoglobin (HbA1c) and there is some evidence that both insulins are as effective as each other in both FBG and HbA1c control. For type 2 patients for whom oral antidiabetic agents provide inadequate glycaemic control, there is no evidence that insulin glargine is more effective than NPH in reducing either FBG or HbA1c and some evidence that both insulins are as effective as each other in both FBG and HbA1c control. Evidence for control of hypoglycaemia is equivocal. In studies where insulin glargine is demonstrated to be superior to NPH in controlling nocturnal hypoglycaemia, this may be only apparent when compared with once-daily NPH and not twice-daily NPH. Further, this superiority of glargine over NPH in the control of nocturnal hypoglycaemia may relate to one formulation of insulin glargine (HOE901[80]) and not another (HOE901[30]). There is no conclusive evidence that insulin glargine is superior to NPH in controlling symptomatic hypoglycaemia and severe hypoglycaemia. Insufficient data are available to conclude whether insulin glargine is different from each of the commonly used NPH dosing regimens: once daily and more than once daily. Given the lack of a published evidence base for the cost-effectiveness of insulin glargine, the economic review concentrates on a review of the industry submission and an amended model. Three economic models are provided in the submission, two relating to type 1 diabetes and one relating to type 2 diabetes. All three models compare the cost--utility of insulin glargine against NPH insulin. In general, the structures of the models are poor and in all three models, mistakes relating to assumptions and calculations have been made. The assessment team believe that the cost per QALY estimates generated by the Aventis model may be an underestimate for several reasons. The cost-effectiveness of insulin glargine in both type 1 and type 2 diabetes is highly sensitive to the amount of utility associated with reducing the fear of hypoglycaemia. CONCLUSIONS: The evidence suggests that, compared with NPH insulin, insulin glargine is effective in reducing the number of nocturnal hypoglycaemic episodes, especially when compared with once-daily NPH. There appears to be no improvement in long-term glycaemic control and therefore insulin glargine is unlikely to reduce the incidence of the long-term microvascular and cardiovascular complications of diabetes. Further research into insulin glargine is needed that addresses the quality of life issues associated with fear of hypoglycaemia and also the economic impact of balance of HbA1c control and incidence of hypoglycaemia achieved in practice. Studies examining the economic evidence on insulin glargine should be published.

Adult↗
PubMed2005

Clinical and cost-effectiveness of electroconvulsive therapy for depressive illness, schizophrenia, catatonia and mania: systematic reviews and economic modelling studies.

OBJECTIVES: To establish the clinical effectiveness and cost-effectiveness of electroconvulsive therapy (ECT) for depressive illness, schizophrenia, catatonia and mania. DATA SOURCES: Electronic bibliographic databases. The reference lists of relevant articles and health services research-related resources were consulted via the Internet. REVIEW METHODS: Identified studies were examined to ascertain whether they met the inclusion criteria for the review. The study quality of relevant articles was assessed using standard checklists and data were abstracted using standardised forms into a database. Where relevant, results from studies were pooled for meta-analysis. Two economic models were developed primarily based on evidence from the clinical effectiveness analysis and limited quality of life studies. RESULTS: Two good-quality systematic reviews of randomised evidence of the efficacy and safety of ECT in people with depression, schizophrenia, catatonia and mania were identified. Four systematic reviews on non-randomised evidence were also identified, although only one of these could be described as good quality. There was no randomised evidence of the effectiveness of ECT in specific subgroups including older people, children and adolescents, people with catatonia and women with postpartum exacerbations of depression or schizophrenia. The economic modelling results for depression did not demonstrate that any of the scenarios had a clear economic benefit over the others, mainly because of the uncertainty surrounding the clinical effectiveness of the different treatments and the quality of life utility gains. Sensitivity analysis surrounding the cost of ECT and the quality of life utility values had little effect on the overall results. The results of the model for schizophrenia adapted to include ECT suggest that clozapine is a cost-effective treatment compared with ECT. For patients who fail to respond to clozapine, ECT treatment may be preferred to the comparative treatment of haloperidol/chlorpromazine. CONCLUSIONS: Real ECT is probably more effective than sham ECT, but as stimulus parameters have an important influence on efficacy, low-dose unilateral ECT is no more effective than sham ECT. ECT is probably more effective than pharmacotherapy in the short term and limited evidence suggests that ECT is more effective than repetitive transcranial magnetic stimulation. Tricyclic antidepressants (TCAs) may improve the antidepressant effect of ECT during the course of treatment. Continuation pharmacotherapy with TCAs combined with lithium in people who have responded to ECT reduces the rate of relapses. Overall, gains in the efficacy of the intervention depending on the stimulus parameters of ECT are achieved only at the expense of an increased risk of cognitive side-effects. Limited evidence suggests these effects do not last beyond 6 months, but there is no evidence examining the longer term cognitive effects of ECT. There is little evidence of the long-term efficacy of ECT. ECT either combined with antipsychotic medication or as a monotherapy is not more effective than antipsychotic medication in people with schizophrenia. More research is needed to examine the long-term efficacy of ECT and the effectiveness of post-ECT pharmacotherapy, the short-term and longer term cognitive side-effects of ECT, and the impact of ECT on suicide and all-cause mortality. Further work is needed to examine the information needs of people deciding whether to accept ECT and how their decision-making can be facilitated. More research is also needed on the mechanism of action of ECT. Finally, the quality of reporting of trials in this area would be vastly improved by strict adherence to the Consolidated Standards of Reporting Trials recommendations. Economic analysis may identify areas in which research would be best targeted by identifying parameters where reducing the level of uncertainty would have the most effect in helping to make the decision on whether ECT is a cost-effective treatment.

Adolescent↗
PubMed1991

Economic analysis in health care antitrust.

The Federal Trade Commission (FTC or Commission) has been very active in enforcing antitrust laws in the health care field for the past two decades. The staff has investigated a wide variety of cases covering a broad range of restrictions on competition. These cases can be divided into three basic types of cases in health care: (1) mergers and acquisitions, (2) horizontal restraints cases or agreements among competitors, and (3) input market monopolization cases, such as hospital privileges cases. The Commission relies on both legal and economic analysis in all of these cases. As Chairman Steiger of the Federal Trade Commission has stated, antitrust policy has been "increasingly reshaped by analysis based on economic theory." This article attempts to explain the economic analysis used in antitrust enforcement as applied to the first two of the three types of health care cases. Section I presents the basic economic framework that is used to assess the competitive implications of health care mergers and acquisitions. Section II describes the analysis applied to other agreements among competitors in the health care field and briefly explains how this analysis differs in other health care cases.

Antitrust Laws↗
PubMed1994

Physicians and economics: a commentary.

This article discusses the physician in the United States in relationship to economics. Because economics forms the basis of most of the debate concerning health care in this country, it is important to look at the physician's background, position, and future as they relate to this important area. Eight economic encounters met by the physician are considered: the physician's relationships with knowledge, patients, peers, hospitals, medical technology, malpractice, managed care, and the future. The purpose is to encourage discussion and introspection and to suggest possible future avenues of education and training to address more completely the economic necessities that now are so closely entwined with the profession.

Delivery of Health Care↗
PubMed2002

[Pharmaco-economic evaluations of new drugs: potential key to a more efficient allocation of the health care budget].

In the light of rising expenditure on drugs and health care, a transparent, rational and careful decision-making process is required for the reimbursement of drugs. In the Netherlands, the Ministry of Health intends using pharmaco-economics in this process, i.e., new drugs will not only be judged on their clinical efficacy but also on their cost-effectiveness. Guidelines for pharmaco-economic research in the Netherlands have been published. According to these guidelines, a pharmaco-economic study must contain a cost-effectiveness analysis and/or a cost-utility analysis. In addition, a budgetary impact analysis is required. By 2005, all new drugs with therapeutic added value must supply a pharmaco-economic evaluation in order to apply for reimbursement. It will be the Minister of Health who decides whether a new drug will be reimbursed.

Budgets↗
PubMed2003

[Economic value of ecosystem services in Mangcuo Lake drainage basin].

In this article, the economic value of ecosystem services in Mangcuo Lake drainage basin was estimated with the table of equivalent weight factor of economic value of ecosystem services of China, and the economic value of food production per hectare was supplied by cropland ecosystem and land-use situation in 1990 and 2000. The results showed that the economic value of ecosystem services in Mangcuo Lake drainage basin was 3.10 x 10(9) yuan.yr.-1 in 2000, and 3.05 x 10(9) yuan.yr.-1 in 1990, and the decreased quantity was 4.71 x 10(7) yuan.yr.-1. At the same time, the causes of the change of ecosystem services were discussed.

Crops, Agricultural↗
PubMed2003

Effects of malnutrition on economic productivity in China as estimated by PROFILES.

OBJECTIVE: To calculate the effects of malnutrition on economic productivity in China. METHODS: PROFILES was used to quantify the function consequences of malnutrition in term of protein energy malnutrition, iron deficiency and iodine deficiency. RESULTS: Productivity gained due to improved iodine nutrition. The reduction in the TGR in 1992 to 2001 increased the net present value of further economic productivity by yen 142 billion. Reduction of the TGR rate to 5% over next 10 years would result in future productivity gains with value of yen 40 billion. Productivity gain due to reductions in child stunting would result in future economic productivity gains with the value of yen 101 billion. Reducing stunting further over the next 10 years would gain yen 20 billion. Productivity gain due to reduction of iron deficiency anemia reduced by 30% over the next 10 years would gain worth yen 107 billion and if childhood anemia reduced by 30% over next 10 years would gain yen 348 billion. CONCLUSION: These interventions have huge economic payoff. That is likely to exceed their costs many times over.

Adult↗
PubMed2004

Economics and the education of nurse anesthetists: Part 2.

Economic assumptions and other factors affecting the economics of nurse anesthesia education are presented in Part 2 of this 2-part column. In Part 1, published in the October 2004 issue of the AANA Journal, general economic principles and healthcare economic principles in particular were described, explained, and related to the current US healthcare system.

Delivery of Health Care↗
PubMed2004

Integrated epidemiology and economics modelling for the management of animal health.

This paper discusses the role of integrated epidemiology and economics modelling in animal health planning, with particular reference to the evaluation of national level interventions that involve the vaccination of livestock. Well-integrated epidemiology and economics is considered essential if model outputs are to be of value in national animal disease control planning. The different approaches to the use of modelling in priority setting and resource allocation in animal health are reviewed and discussed. The authors conclude that this particular application of modelling is poorly developed, due in part to the complexities involved. Much more has been done to develop models that evaluate the merits of different intervention scenarios for a given single disease, and examples of these are presented. However, the authors conclude that despite the widespread use of such models, there is still considerable scope for the development of a more standardised approach, incorporating consideration of both direct and indirect implications of intervention options. In discussing the changing demands on animal health economics modelling, the authors propose that increased attention should be given to the valuation of "externalities", the calculation and interpretation of the distribution of costs and benefits, the evaluation of the impact of disease control on poverty reduction, and the development of real-time economics modelling techniques, to assist particularly in the effective management of disease outbreaks.

Animal Welfare↗
PubMed2004

The macro-economic impact of a foot-and-mouth disease incursion in New Zealand.

The 2001 outbreak of Foot-and-Mouth Disease (FMD) in the United Kingdom heightened public concern in New Zealand about the economic consequences of an outbreak of FMD, and resulted in the Reserve Bank and Treasury conducting an assessment of the macro-economic impact of a small FMD outbreak in New Zealand. The study was based on a relatively small outbreak in which 50 properties were infected over a period of two months. Cumulative losses calculated over two years from the beginning of the hypothetical outbreak were estimated at around NZ dollars 10 billion, a figure twice as large as the initial Ministry of Agriculture and Forestry estimate. The main reason for this difference is that the Reserve Bank study included the additional macro-economic effects of a slump in domestic demand. The study also demonstrated that in New Zealand under the conditions of the current OIE Terrestrial Animal Health Code for FMD, the economic impact of any programme to control FMD by vaccination in which vaccinated animals are not slaughtered, is significantly worse than rapid eradication by stamping out.

Animals↗
PubMed2005

A review of economic tools for the assessment of animal disease outbreaks.

This paper demonstrates how currently underutilised economic modelling techniques can enrich the analysis of animal disease problems. Increasingly, analyses of animal health programmes are expected to address a range of economic and social questions. These expectations can be addressed by better integration of epidemiological modelling with economic techniques whose application to animal health has not been thoroughly discussed in past reviews. This paper describes a range of economic models that can be applied in animal health research and provides guidance for determining the appropriate method given the issues at hand. The complexity of some of these approaches underlines the importance of multidisciplinary research and education.

Animal Diseases↗
PubMed2006

Economic evaluation.

Given the need to assess the value for money of healthcare treatments, economic evaluation has been gaining popularity over the past ten years. Studies comparing the costs and consequences of alternative healthcare interventions have been published in all fields of healthcare. This article describes the basic forms of economic evaluation and outlines the key methodological features to be considered in the critical appraisal of studies. Issues such as the appropriateness of the study question, the selection of alternatives to be compared, the measurement of costs and consequences, and the assessment of uncertainty are discussed. Additionally, an analytical critique of economic evaluations undertaken in Singapore is provided, and the prospects for economic evaluation in the future are discussed.

Cost-Benefit Analysis↗
PubMed2006

The economics of dental practice--present and future.

The combination of increased practitioner income, increases in the proportion of the population reporting visits for dental services, decreases in the number of dental school graduates, decreases in the dentist-to-population ratio, and increases in the number of female students and practitioners (many of whom report significantly fewer work hours than their male counterparts), portends favorable economics for dental practices. However, the cost of dental care is "felt" to a greater extent than for other health services. Current and future funding arrangements for dental services could be vulnerable to economic downturns, efforts to control business overhead costs and continued minimal government support. There may need to be concern regarding the infrastructure of economics of dental practice. A series of favorable developments, including increasing dental practitioner income, an increasing use of dental services, decreasing numbers of graduates and decreasing practitioner-to-population ratios would seem to favor continued encouraging prospects for the future of dental practices. However, compared to other health services, the reliance on (1) out-of-pocket funding for a major share of dental expenditures, and (2) limited government support for dental services raise questions regarding the infrastructure of dental economics. These subjects are reviewed in the following presentation.

Dentists↗
PubMedDate not supplied

[Economic development and health].

The purpose of this work is to examine the relationship between economic development and the population's level of health. Consequently, we will establish a comparison between Mexico and other countries in various stages of development. The interrelationship between economic development and health is a complex problem which is little understood, even though it is acknowledged that at increased levels of economic development the levels of health of a population will also increase. These considerations can be taken into account when we accept the fact that the health conditions in industrialized countries are generally better than the health conditions in non-industrialized countries. In the case of Mexico, the problems relating to social disparities due to the type of economic development are reflected in the country's level of health. Poor health conditions and the deterioration of health services in Mexico, based on international references, are matters that must be resolved by means of a clear political decision accompanied by the appropriate corresponding resources so that the strategies put forth by the National Health Program (1989-1994) can be carried out.

Colombia↗
PubMedDate not supplied

An economic model for nurse manpower planning in the Caribbean: Part II--Strategies.

Figure 5 illustrates the key ingredients of manpower planning. Whatever model or framework that have or will be considered for the Region must be based on cost containment necessitated by the scarcity of resources. Since the health sector is labour intensive, health manpower is critical for its successful functioning. Approximately 65-70% of the Ministries of Health's recurrent budget is allocated for health personnel. Budgetary restrictions as a result of economic downturn have therefore impacted severely on the manpower resources resulting in a decreased supply of all categories of health workers in the health service. Even the most minimum level of services is therefore jeopardized. Most countries of the Region are at present suffering from a net loss in most of the health professional groups and some countries are without auxiliary groups. In providing quality care, certain questions need to be answered. In the light of decreasing economic resources and accompanying decreasing nurse manpower resources: 1. What degree of substitutability between categories of health manpower generally and specifically, between different categories of nurses will affect their efficient use and provide quality care? 2. What are the least cost combinations of nurse manpower that will ensure greater productivity and quality care? 3. What are the policy restrictions that may hinder substitutability? 4. What are the market forces that affect the demand and supply of nurses? In all of the above, it is necessary to understand that the basis of any nurse manpower policy and plan and the economic analysis of these is guided by the demand for health care and services as well as economics within a given country.

Economics, Nursing↗
PubMed1995

[Economic evaluation of medical therapy--methodological principles].

Economic evaluations represent an excellent instrument to prepare decisions in health care with special reference to the allocation of resources as well as the utilisation of new and existing medical interventions and therapies. These evaluations require the identification and assessment of the costs and benefits of the various options prior to their integration in the economic calculations. The basic principles and concepts of economic evaluations are reviewed and discussed. In addition the significance of clinical, resp. medical economics will be reviewed as an important tool for the clinician.

Cost-Benefit Analysis↗
PubMed1995

Introduction to clinical economics: assessment of cancer therapies.

Recent changes in the health care environment have led to the assessment of the costs and benefits of cancer treatment as criteria for the evaluation of new cancer therapies. The methodological framework for these assessments is provided by the field of clinical economics, a discipline that combines the techniques from clinical medicine, economics, epidemiology, and biostatistics. This article reviews the concepts of clinical economics and issues related to economic analysis of new therapies. This type of information is increasingly important to patients, clinicians, and health policy decision makers to help assure patients' access to effective cancer therapies.

Economics, Medical↗
PubMed1994

[Economical evaluation of drugs. A steering method for the pharmaceutical sector of the 1990's?].

Pharmaceutical products are important welfare goods both to individuals and to societies. Political authorities in Norway have high ambitions: pharmaceutical products should be of the best quality and available to people independent of their financial means. However, decreased economic growth, an increasing proportion of the health care needed by the elderly and accelerating developments in the medical field have led to a closer scrutiny of prices, costs and the extent of the public sector's responsibility in different parts of the health care system. Economic evaluation of pharmaceuticals is a supplement to the extensive and expensive clinical evaluations that have been going on for many years in the pharmaceutical industry. Information on cost-effectiveness of new products has internationally become more important and is needed in connection with subsidizing, prescriptions and distribution of drugs. The purpose of this article is to show how economic evaluation of pharmaceuticals could be used to increase efficiency in the Norwegian drug sector. The article also suggests how public guidelines could be established and how economic evaluations should be used, and considers the organisational consequences for the public sector.

Cost Savings↗