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At least 109 records · Page 6Linked to original sources
PubMed2002

Assessing the impact of antidrug advertising on adolescent drug consumption: results from a behavioral economic model.

OBJECTIVES: This study examined whether adolescents' recall of antidrug advertising is associated with a decreased probability of using illicit drugs and, given drug use, a reduced volume of use. METHODS: A behavioral economic model of influences on drug consumption was developed with survey data from a nationally representative sample of adolescents to determine the incremental impact of antidrug advertising. RESULTS: The findings provided evidence that recall of antidrug advertising was associated with a lower probability of marijuana and cocaine/crack use. Recall of such advertising was not associated with the decision of how much marijuana or cocaine/crack to use. Results suggest that individuals predisposed to try marijuana are also predisposed to try cocaine/crack. CONCLUSIONS: The present results provide support for the effectiveness of antidrug advertising programs.

Adolescent↗
PubMed2000

Remarks on the role of economic modeling.

BACKGROUND: Despite the growing scholarly acceptance of quantitative evaluation methods, modelers still struggle to define an appropriate role for their work at the decision-making level. GOAL: To make observations about the policy relevance of mathematical and economic policy modeling in HIV and sexually transmitted disease prevention and treatment. RESULTS: The debate is framed within the context of the inevitability of decision making. Viewed in this light, models can inform choices between competing alternatives by leveraging existing information, integrating data from multiple sources, addressing "what if" questions, evaluating future scenarios, and providing a uniform metric for evaluation. CONCLUSIONS: The goal of model-based evaluation should not be to supplant the decision maker, but rather to redefine the terms of the debate using quantitative methods that make the beliefs and values that lie at the heart of all difficult choices explicit.

HIV Infections↗
PubMed1993

Assessing cost-effectiveness in asthma care: building an economic model to study the impact of alternative intervention strategies.

Expenditures for medical care services continue to rise as a proportion of the total Gross Domestic Product (GDP) in most countries. Because a large share of resources are increasingly being spent on medical care services, there is a need to more closely examine the quality, cost and efficiency of all aspects of health care delivery. One method for assessing efficiency is cost-effectiveness analysis. Many of the elements of a basic cost-effectiveness model for asthma care are available, including accepted relevant studies on societal cost-of-illness, accepted health outcomes relevant to good clinical care, and a selection of potential intervention strategies, both for prevention and control. The purpose of this paper is to illustrate how an economic approach to decision-making can be used to assess the potential impact of alternative intervention strategies for asthma care. Two case studies are developed including a new management strategy for the chronic care of stable moderate asthma and a management strategy for the early detection and prevention of childhood asthma. It is proposed that economic modeling of possible intervention strategies can serve as a useful method for determining the potential impact (in terms of cost-effectiveness) of a proposed intervention strategy well in advance of any empiric clinical trials. Analysis such as these may prove valuable in protecting researchers from developing intervention strategies that are clinically efficacious but cost-ineffective and, therefore, are unlikely to be adopted by providers/payers of medical care services for asthmatics.

Asthma↗
PubMed1993

[Socio-economic model and the quality of life: an approximation to the concept of social health].

After a brief analysis of the principal contradictions in the model of the National Health Service in the industrialised, capitalist countries which, after the second world war, acceded to the Welfare State, we shall study, within the framework of the so-called "epidemiological revolution", the way in which a degradation of the medical model of Social Security and the configuration of an ideological view directed at the individualisation of health problems, is recorded following a crisis in the Welfare State. Finally the concept of Social Health shall be expounded as a category of analysis which may permit the understanding of the methodological inexactitude which involves creating the characteristics and possibilities of a health service outside the socio-economic model.

Health↗
PubMed2004

An economic model of haemophilia in Mexico.

A model was developed to assess the lifetime costs and outcomes associated with haemophilia in Mexico. A retrospective chart review of 182 type A haemophiliacs was conducted for patients aged 0-34 years receiving one of three treatments: (i) cryoprecipitate at clinic; (ii) concentrate at home; or (iii) concentrate at clinic. Patients treated at home experienced 30% less joint damage, used 13-54% less factor VIII, had four times fewer clinic visits, and utilized half as many hospital days than those treated at a clinic. For cryoprecipitate at clinic patients, the annual incidence rates of HCV and HIV were calculated to be 3.6% and 1.4% respectively. The life expectancy for patients receiving cryoprecipitate and those receiving concentrate was estimated to be 49 years and 69 years respectively, with 58% of cryoprecipitate patients predicted to die of AIDS before age 69. Across the lifespan, the average annual cost of care was US$11,677 (MN$110,464) for cryoprecipitate at clinic patients, US$10,104 (M$95,580) for concentrate at home patients and US$18,819 (MN$178,027) for concentrate at clinic patients. Using a 5% discount rate, the incremental lifetime cost per year of life added for treatment with concentrate at home compared with cryoprecipitate at a clinic was US$738 (MN$6981). Rank order stability analysis demonstrated that the model was most sensitive to the cost of fVIII. These results indicate that treatment with concentrate at home compared with cryoprecipitate at a clinic substantially improves clinical outcomes at reduced annual cost levels.

Adolescent↗
PubMed1991

Economic models of fertility dynamics: a study of Swedish fertility.

"This paper estimates semiparametric reduced-form neoclassical models of life-cycle fertility in Sweden. Rising female wages delay times to all conceptions and reduce total conceptions. These results are robust across a variety of empirical specifications. We find a particular neoclassical model that predicts fertility attained at different ages as well as the aggregate time series of birth rates. A model that excludes wages and incomes predicts fertility attained at different ages but fails to predict the aggregate time series, and is dominated by the neoclassical model in terms of non-nested test criteria. Cohort drift found in estimated parameters is consistent with the expansion of pronatal social programs. The estimated neoclassical model produces strong short-run responses of birth rates to wages and incomes of the sort that have been found in the time series literature on fertility while generating the relatively weak long-run responses to economic variables found in the cross-sectional literature on completed fertility."

Age Factors↗
PubMedDate not supplied

Developing better economic models of osteoporosis: considerations for the calculation of the relative risk of fracture.

OBJECTIVE: Simulation models are often used to assess cost-effectiveness of osteoporosis therapies. Many cost-effectiveness analyses are interested in a subset of the general population, such as high-risk patients. As the analyses are very sensitive to the assumed risk of fracture, it is imperative that the rates accurately reflect the fracture risk in the specified target population. The objective of this study was to describe the methodological difficulties and present some possible solutions for calculating the risk of fracture in target populations of interest. METHODS: For binary risk factors, a method for converting from a relative risk (RR) for people with a risk factor relative to those without, to an RR in the target population compared with the general population, is described. For continuous risk factors (i.e., bone mineral density [BMD]), data are often provided as an RR of fracture per SD decrease. A method for converting from an RR per SD decrease to an RR in those below a certain BMD threshold, compared with the general population, is presented. RESULTS: These results should allow future economic models to more accurately incorporate existing knowledge of risk factors by introducing methods to calculate fracture risk estimates in a target population. CONCLUSION: It illustrates the importance of considering the prevalence of risk factors in the general population when calculating RR in a target population.

Aged↗
PubMed2004

The effectiveness and cost-effectiveness of microwave and thermal balloon endometrial ablation for heavy menstrual bleeding: a systematic review and economic modelling.

OBJECTIVES: To estimate the clinical effectiveness and cost-effectiveness of microwave endometrial ablation (MEA) and thermal balloon endometrial ablation (TBEA) for heavy menstrual bleeding (HMB), compared with the existing (first-generation) endometrial ablation (EA) techniques of transcervical resection (TCRE) and rollerball (RB) ablation, and hysterectomy. DATA SOURCES: Electronic databases, bibliographies of articles, and also experts in the field and relevant industry bodies were asked to provide information. REVIEW METHODS: A detailed search strategy was carried out to identify systematic reviews and controlled trials of MEA and TBEA versus first-generation techniques for EA. In addition to electronic database searching, reference lists were hand-searched and information sought from manufacturers of EA devices and by experts in the field. A deterministic Markov model was developed to assess cost-effectiveness. Data for the model were taken from a range of sources. RESULTS: The systematic review of first-generation EA techniques versus hysterectomy found that EA offered an alternative to hysterectomy for HMB, with fewer complications and a shorter recovery period. Satisfaction and effectiveness were high for both MEA and TBEA. Costs were lower with EA although the difference narrows over time. Second-generation EA techniques are an alternative treatment to first-generation techniques for HMB, and first-generation techniques are known to offer an alternative to hysterectomy. Although no trials of second-generation techniques and hysterectomy have been undertaken, it seems reasonable to assume that second-generation techniques also offer an alternative surgical treatment. Using the model to assess cost-effectiveness, costs were very slightly higher for MEA when compared to TBEA, and differences in quality-adjusted life-years (QALYs) were negligible. For MEA compared with transcervical resection of the endometrium (TCRE) and RB ablation, costs were slightly lower with MEA and MEA accrued very slightly more QALYs. Compared with hysterectomy, MEA costs less and accrues slightly fewer QALYs. For TBEA compared with TCRE and RB ablation, costs were lower with TBEA and TBEA accrued slightly more QALYs. Compared with hysterectomy, TBEA costs moderately less and accrues moderately fewer QALYs. CONCLUSIONS: Overall, there were few significant differences between the outcomes of first- and second-generation techniques including bleeding, satisfaction and QoL measures and repeat surgery rates. Second-generation techniques had significantly shorter operating and theatre times and there appear to be fewer serious perioperative adverse effects with second-generation techniques and postoperative effects are similar. Compared with hysterectomy, TCRE and RB are quicker to perform and result in shorter hospitalisation and faster return to work. Hysterectomy results in more adverse effects and is more expensive, although the need for retreatment leads this difference to decrease over time. Satisfaction with hysterectomy is initially higher, but there is no significant difference after 2 years. The economic model suggests that second-generation techniques are more cost-effective than first-generation techniques of EA for HMB. Both TBEA and MEA appear to be less costly than hysterectomy, although the latter results in more QALYs. Further research is suggested to make direct comparisons of the cost-effectiveness of second-generation EA techniques, to carry out longer term follow-up for all methods of EA in RCTs, and to develop more sophisticated modelling studies. Further research is also recommended into HMB to establish health-state utility values, its surgical treatment, convalescence, complications of treatment, symptoms and patient satisfaction.

Adult↗
PubMed1998

An economic model for a novel viral influenza diagnostic.

The authors present a model that tests the economic value of a new diagnostic test that can identify type A and B influenza. Compared with traditional treatment without trying to objectively differentiate viral from bacterial infection, substantial cost savings may be achieved if diagnostic testing is appropriately utilized in a comprehensive influenza management program.

Cost Savings↗
PubMed2004

The RTOG Outcomes Model: economic end points and measures.

Recognising the value added by economic evaluations of clinical trials and the interaction of clinical, humanistic and economic end points, the Radiation Therapy Oncology Group (RTOG) has developed an Outcomes Model that guides the comprehensive assessment of this triad of end points. This paper will focus on the economic component of the model. The Economic Impact Committee was founded in 1994 to study the economic impact of clinical trials of cancer care. A steep learning curve ensued with considerable time initially spent understanding the methodology of economic analysis. Since then, economic analyses have been performed on RTOG clinical trials involving treatments for patients with non-small cell lung cancer, locally-advanced head and neck cancer and prostate cancer. As the care of cancer patients evolves with time, so has the economic analyses performed by the Economic Impact Committee. This paper documents the evolution of the cost-effectiveness analyses of RTOG from performing average cost-utility analysis to more technically sophisticated Monte Carlo simulation of Markov models, to incorporating prospective economic analyses as an initial end point. Briefly, results indicated that, accounting for quality-adjusted survival, concurrent chemotherapy and radiation for the treatment of non-small cell lung cancer, more aggressive radiation fractionation schedules for head and neck cancer and the addition of hormone therapy to radiation for prostate cancer are within the range of economically acceptable recommendations. The RTOG economic analyses have provided information that can further inform clinicians and policy makers of the value added of new or improved treatments.

Clinical Trials as Topic↗
PubMedDate not supplied

The economic model for health care delivery. A business plan to create the virtual clinic.

This paper reviews briefly the history of managed care, and then analyzes the economic rationale underlying the present dynamics of the marketplace. With this background, the paper postulates what the ultimate delivery system should be: the virtual clinic. It includes a proposed micro-model that could evolve into a macro-institution driven by the two essential elements of the market: equity and efficiency.

Computer Communication Networks↗
PubMedDate not supplied

A health economic model to assess the long term effects and cost-effectiveness of PEG IFN alpha-2a in hepatitis C virus infected patients.

OBJECTIVES: Chronic Hepatitis C (CHC) is associated with long-term complications. Treating CHC with Pegylated interferon alpha-2a (PEG IFN alpha-2a) improves response rates and may contribute to less morbidity and mortality compared to standard interferon therapy. The objectives of this study were to estimate the long-term clinical consequences of such treatment as well as the resulting cost-effectiveness. RESEARCH DESIGN AND METHODS: A Markov model was developed in order to predict the clinical and economic outcomes over a 25 year period. Three analyses were conducted: 1. for all Hepatitis C Virus (HCV) genotypes where PEG IFN alpha-2a was compared to interferon alpha-2a (IFN alpha-2a) in monotherapy for 48 weeks; 2. for the HCV genotypes 1-4-5-6 comparing PEG IFN alpha-2a with interferon alpha-2b (IFN alpha-2b) both combined with ribavirin 1000/1200 mg for 48 weeks; and 3, where PEG IFN alpha-2a with 800 mg ribavirin was compared to IFN alpha-2b with ribavirin 1000/1200 mg for 24 weeks in genotypes 2 and 3. RESULTS: In analysis one the cost-effectiveness of PEG IFN alpha-2a is 4,569/quality adjusted life year (QALY) gained. In the second analysis, the result was 14,763 euros/QALY, while for the 24 weeks therapy (analysis 3) the result was 903 per QALY gained. In an extensive sensitivity analysis cost-effectiveness was confirmed within reasonable assumptions. CONCLUSIONS: These results suggest that PEG IFN alpha-2a is cost-effective in the management of all CHC patients. Real life evidence about longer term benefits of PEG IFN alpha-2a will be of importance for future decision making.

Antiviral Agents↗