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PubMed1993

Population growth and economic development revisited with reference to Asia.

"This article takes another look at the old issue of population growth and economic development in the context of recent developments and with the benefit of the increasing stock of knowledge on the subject. It first presents a demographic perspective; then it analyzes the implications of population growth with respect to such integral aspects of economic development as human capital accumulation, income distribution and poverty, the environment, and sustainable economic growth. The approach in each case is to review the theoretical considerations, survey the empirical evidence, and then draw policy implications. An overall conclusion with implications for policy caps the paper." The geographical focus is on Asia.

Asia↗
PubMed1997

Analysis of continued economic progress in China.

"This paper uses...historic and theoretical points of view to explain continued economic progress [and to refute] some incorrect views regarding China's economic progress. One view in this paper deals with how China's continued economic progress could burden and threaten [the world]. Another view...analyzes the government's improper policy toward the relationship among China's modern population, resources, and environment."

Asia↗
PubMed1998

The economic and demographic restructuring of nonmetropolitan counties in the Mountain West.

"The purpose of this paper is to examine the fluctuating economic and demographic landscapes within nonmetro Mountain West counties [of the United States], describe relationships between the economic restructuring and shifting demographic patterns, and to discuss the potential significance of these transformations for the Mountain West nonmetro region. We begin by articulating a conceptual framework linking economic restructuring (development) and population change due to migration. The remainder of the paper empirically examines these linkages. A concluding section summarizes our findings and provides suggestions for future research."

Americas↗
PubMed1982

Population growth and economic growth: any connection?

The author examines the current evidence concerning the relationship between population growth and economic growth, with particular reference to the justification for U.S. assistance to programs designed to slow rates of population growth in developing countries. It is concluded that "the results of economic theory and research do not support the oft-repeated claims that population growth inhibits economic growth." The author suggests that the reason for continued U.S. support for population programs is the effectiveness of a population lobby that has a vested interest in the continuation of such assistance.

Americas↗
PubMed1999

Economic analysis of low-dose heparin vs the low-molecular-weight heparin enoxaparin for prevention of venous thromboembolism after colorectal surgery.

BACKGROUND: Low-dose heparin and low-molecular-weight heparin are effective strategies for preventing venous thromboembolism in colorectal surgery. The economic attractiveness of these 2 strategies in North America is unknown. We conducted an economic analysis of low-dose heparin calcium compared with enoxaparin sodium, a low-molecular-weight heparin, for thromboembolism prophylaxis after colorectal surgery. METHODS: We used decision analysis, with an economic perspective of a third-party payer. Efficacy data were obtained from the Canadian Multicentre Colorectal Deep Vein Thrombosis Prophylaxis Trial and a literature review. Canadian costs for diagnosis and treatment of deep vein thrombosis (DVT), pulmonary embolism (PE), and major bleeding were obtained from chart review and a national hospital database of colorectal surgery; American costs were obtained from published literature. The main outcomes were incremental benefits (symptomatic DVTs, symptomatic PEs, and major bleeding events avoided) and incremental costs for every 1000 patients treated. RESULTS: In the Canadian Colorectal Trial, the relative risk of DVT and PE for enoxaparin compared with low-dose heparin was 1.0 (95% confidence interval, 0.7-1.5), and the relative risk of major bleeding was 1.8 (95% confidence interval, 0.8-3.9). With the use of these data in the baseline analysis, a strategy of enoxaparin prophylaxis was associated with equal numbers of symptomatic DVTs and PEs, and an excess of 12 major bleeding episodes for every 1000 patients treated, with an additional cost of $86 050 (Canadian data) or $145 667 (US data). In a sensitivity analysis using optimal assumptions for efficacy and safety of enoxaparin (relative risk of DVT, 0.8; relative risk of PE, 0.4; relative risk of major bleeding, 1.0), a strategy of enoxaparin prophylaxis was associated with 0.8 fewer symptomatic DVT, 3 fewer symptomatic PEs, and equal numbers of major bleeding episodes for every 1000 patients treated, with an additional cost of $15 217 (Canadian data) or $107 614 (US data). CONCLUSION: Although heparin and enoxaparin are equally effective, low-dose heparin is a more economically attractive choice for thromboembolism prophylaxis after colorectal surgery.

Anticoagulants↗
PubMed1998

Health economic benefits and quality of life during improved glycemic control in patients with type 2 diabetes mellitus: a randomized, controlled, double-blind trial.

CONTEXT: Although the long-term health benefits of good glycemic control in patients with diabetes are well documented, shorter-term quality of life (QOL) and economic savings generally have been reported to be minimal or absent. OBJECTIVE: To examine short-term outcomes of glycemic control in type 2 diabetes mellitus (DM). DESIGN: Double-blind, randomized, placebo-controlled, parallel trial. SETTING: Sixty-two sites in the United States. PARTICIPANTS: A total of 569 male and female volunteers with type 2 DM. INTERVENTION: After a 3-week, single-blind placebo-washout period, participants were randomized to diet and titration with either 5 to 20 mg of glipizide gastrointestinal therapeutic system (GITS) (n = 377) or placebo (n = 192) for 12 weeks. MAIN OUTCOME MEASURES: Change from baseline in glucose and hemoglobin A1c (HbA1c) levels and symptom distress, QOL, and health economic indicators by questionnaires and diaries. RESULTS: After 12 weeks, mean (+/-SE) HbA1c and fasting blood glucose levels decreased with active therapy (glipizide GITS) vs placebo (7.5% 0.1% vs 9.3%+/-0.1% and 7.0+/-0.1 mmol/L [126+/-2 mg/dL] vs 9.3+/-0.2 mmol/L [168+/-4 mg/ dL], respectively; P<.001). Quality-of-life treatment differences (SD units) for symptom distress (+0.59; P<.001), general perceived health (+0.36; P= .004), cognitive functioning (+0.34; P=.005), and the overall visual analog scale (VAS) (+0.24; P=.04) were significantly more favorable for active therapy. Subscales of acuity (+0.38; P=.002), VAS emotional health (+0.35; P=.003), general health (+0.27; P=.01), sleep (+0.26; P=.04), depression (+0.25; P=.05), disorientation and detachment (+0.23; P= .05), and vitality (+0.22; P=.04) were most affected. Favorable health economic outcomes for glipizide GITS included higher retained employment (97% vs 85%; P<.001), greater productive capacity (99% vs 87%; P<.001), less absenteeism (losses = $24 vs $115 per worker per month; P<.001), fewer bed-days (losses = $1539 vs $1843 per 1000 person-days; P=.05), and fewer restricted-activity days (losses = $2660 vs $4275 per 1000 person-days; P=.01). CONCLUSIONS: Improved glycemic control of type 2 DM is associated with substantial short-term symptomatic, QOL, and health economic benefits.

Absenteeism↗
PubMed2002

Economic and health consequences of selling a kidney in India.

CONTEXT: Many countries have a shortage of kidneys available for transplantation. Paying people to donate kidneys is often proposed or justified as a way to benefit recipients by increasing the supply of organs and to benefit donors by improving their economic status. However, whether individuals who sell their kidneys actually benefit from the sale is controversial. OBJECTIVE: To determine the economic and health effects of selling a kidney. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional survey conducted in February 2001 among 305 individuals who had sold a kidney in Chennai, India, an average of 6 years before the survey. MAIN OUTCOME MEASURES: Reasons for selling kidney, amount received from sale, how money was spent, change in economic status, change in health status, advice for others contemplating selling a kidney. RESULTS: Ninety-six percent of participants sold their kidneys to pay off debts. The average amount received was 1070 US dollars. Most of the money received was spent on debts, food, and clothing. Average family income declined by one third after nephrectomy (P<.001), and the number of participants living below the poverty line increased. Three fourths of participants were still in debt at the time of the survey. About 86% of participants reported a deterioration in their health status after nephrectomy. Seventy-nine percent would not recommend that others sell a kidney. CONCLUSIONS: Among paid donors in India, selling a kidney does not lead to a long-term economic benefit and may be associated with a decline in health. Physicians and policy makers should reexamine the value of using financial incentives to increase the supply of organs for transplantation.

Cross-Sectional Studies↗
PubMed1998

Nutritional status and socio-economic conditions as prognostic factors in the outcome of therapy in childhood acute lymphoblastic leukemia.

The majority of children on earth are to be found in the developing world, many of them malnourished members of impoverished families. Thus, the effects of socio-economic status (SES) on the therapeutic response of children with cancer are obviously relevant. The outcome of treatment in patients with the commonest form of cancer in childhood (acute lymphoblastic leukemia, ALL) is clearly related to their SES. Studies conducted mainly in developing countries have shown malnutrition to be an important prognostic factor in such children. However, other socio-economic conditions could affect the outcome of therapy in patients with ALL: access to communications, transportation, laboratory studies and therapy. Even in children with an "adequate" SES, malnutrition is still an adverse prognostic factor. Nutritional supplementation appears to be a valuable addition to chemotherapy in undernourished children with ALL. The choice of treatment for these children should accommodate the cultural, economic and nutritional status of the patients and their families. Protocols must be created for testing methods of nutritional intervention and their influence on pharmacology, drug tolerance and survival in ALL. The influences of poverty and illiteracy on compliance with treatment, especially oral medication, need to be evaluated. Such investigations are essential to improve results of treatment of socio-economically disadvantaged children suffering from ALL and other forms of cancer.

Child↗
PubMed1996

Economic evaluation of prenatal diagnosis: a methodological review.

This paper discusses the role of economic evaluation in prenatal diagnosis. As the availability of new and improved techniques of prenatal diagnosis increases, so does the relevance of economic evaluation. The various methods of economic evaluation are discussed in the context of amniocentesis and chorionic villus sampling. It is argued that in view of the potentially wide range of benefits from prenatal diagnosis, more sophisticated measures of benefit should be incorporated into economic evaluations. Further development of utility-based measures and monetary valuation is suggested.

Adult↗
PubMed1989

Economics of intellectual property rights in the international arena.

Many issues relating to the protection of intellectual property are economic in nature. This article applies economic analysis to several of those issues that arise in an international context. The first model concerns how one nation's choice of a particular form of protection will affect the economic welfare of its trading partners. Then the economics of unilateral, bilateral, and multilateral action are compared. The final analyses cover the optimal number of members in a multilateral agreement and the choice between mutually exclusive international agreements.

Cognition↗
PubMedDate not supplied

An exercise on the feasibility of carrying out secondary economic analyses.

Purchasers of health services need up to date information on cost-effectiveness of interventions to help in prioritising spending. But economists have not yet developed a formal methodology for reviewing and summing up evidence from individual economic evaluations which may have been conducted at different times and in different places, or indeed for assessing whether such systematic reviews are possible in this context. This paper discusses the problems of reviewing available economic information, using a body of literature on the economics of influenza vaccination to illustrate some relevant issues. First, the paper examines alternative methods for adjusting prices to take into account differences in currency and time periods: Retail Price Indices are compared with health specific inflation indices, and exchange rates are compared with Purchasing Power Parity (PPP) data. For the studies reviewed, the choice of conversion method made little practical difference. Secondly, the paper explores the possibility of summarising the results of a review in terms of quantities of resources used, rather than prices. This method is constrained by the available data, but could be more generally useful as it allows direct comparison of underlying technologies, and calculation of costs by attaching local unit costs to the resources associated with an intervention. These two exercises highlight many of the problems that arise in generalising from economic studies. Both methods need to be developed further if they are to be useful to decision makers.

Cost-Benefit Analysis↗
PubMedDate not supplied

Economic evaluation of mental health care interventions. A review.

Due to rising costs, the economic aspects of the mental health care sector are receiving increasing attention. This article scrutinizes 91 published studies in the field of mental health care, applying methodological criteria drawn from epidemiology and economics. The purpose of this study is to provide some insight into the quality of economic evaluation in the field of mental health care. The article shows that few good full economic evaluations studies have been undertaken in the domain of mental health care. One reason for this could be that the measurement of effectiveness in mental health care is complicated because of the known difficulties with the reliability of psychiatric diagnosis and the lack of consensus about the etiology and appropriate treatment for many psychiatric illnesses.

Canada↗
PubMed1998

The economic costs of illicit drug use in Ontario, 1992.

The use of illicit drugs causes health and social problems which imply economic costs to society. This paper uses the cost-of-illness method, in particular, the human-capital approach to estimate the prevalence-based economic costs of illicit drug use in Ontario in 1992. This methodology is consistent with international guidelines formulated at the 1994 International Symposium on Economic and Social Costs of Substance Abuse. The economic cost of illicit drug use is estimated at $489.29 million (Canadian dollars) in 1992. Associated with these costs are health-related harms: 211 deaths, half of which occur before the age of 35; and 20 690 days stay in public hospitals.

Cost of Illness↗
PubMed2000

Economic evaluation of communicable disease interventions in developing countries: a critical review of the published literature.

Limited health care budgets have emphasized the need for providers to use resources efficiently. Accordingly, there has been a rapid increase in the number of economic evaluations of communicable disease health programmes in developing countries, as there is a need to implement evidence-based policy decisions. However, given the prohibitive cost of many economic evaluations in low-income countries, interest has also been generated in pooling data and results of previously published studies. Yet, our review demonstrated that very few published economic evaluations have been performed during 1984-1997 (n=107). Certain diseases and geographical areas have also been neglected. Of those studies published, appropriate analytic techniques have been inconsistently applied. In particular, there are four immediate concerns: the narrow perspective taken-dominance of the health care provider viewpoint and reliance on intermediate outcomes measures; bias-some costs were excluded from estimates; the lack of transparency-sources of data not identified; and the absence of a critical examination of findings-many papers failed to perform a sensitivity analysis. The usefulness of previously published economic evaluations to help make resource allocation choices on an individual basis and, therefore, for the purpose of international comparisons, pooling or meta-analysis, has to be questioned in light of the results from this study.

Bias↗
PubMed1988

Maternal serum alpha-fetoprotein screening for Down syndrome: economic considerations.

The economic consequences of using an index of maternal age and maternal serum alpha-fetoprotein (MSAFP) screening to indicate risk of Down syndrome (DS) are examined. If DS screening indicated solely by a given maternal age is economically justifiable, then amniocentesis indicated by a DS risk equivalent to that maternal age cutoff, but based on an index of maternal age (for ages below the cutoff) and low MSAFP results, is also economically justifiable. It is concluded that the extant use of MSAFP screening for DS is a move toward the cost-effective use of scarce resources that can be made available with coordinated planning. However, increased professional and public awareness may result in significant increases in aggregate demand for these services. While MSAFP screening for DS is economically justifiable, there exists some potential for bottlenecks at the aggregate level, and these should be considered in conjunction with recommendations that the technology be adopted on a widespread basis.

Adult↗
PubMed2004

Sedentism, seasonality, and economic status: A multivariate analysis of maternal dietary and health statuses between pastoral and agricultural Ariaal and Rendille communities in northern Kenya.

This paper examines longitudinal data to assess the effects of the recent transition from pastoralism to sedentary agriculture for Ariaal and Rendille mothers in northern Kenya. Dietary, morbidity, and anthropometric data resulting from bimonthly repeated surveys of the pastoral community of Lewogoso and the sedentary agricultural community of Songa, covering the period from September 1994-July 1995, were used to test two hypotheses: 1) that sedentism is associated with changes in diet, seasonality, morbidity, and socioeconomic differentiation, and 2) that these changes affect maternal body composition. The first hypothesis is partly supported, with starch replacing milk in the sedentary diet. Repeated-measures multivariate analysis of variance revealed no seasonal effects for diet in the agricultural sample, while starch consumption was significantly affected by seasonality for the pastoral sample. The agricultural community also featured economic dietary disparities favoring wealthier mothers, while no such effect was found in the pastoral community. However, no seasonal or economic effects were found for morbidity patterns in either sample. The second hypothesis is also partially supported, as a generalized estimating equations analysis revealed differences in the way diet and economic strata influence maternal anthropometric values. Economic status was significantly associated with maternal arm-fat area in Lewogoso. Milk was a significant factor associated with maternal weight and arm-muscle area in Songa. These findings are discussed in light of development policy implications.

Adipose Tissue↗
PubMed2008

Human and economic burden of generalized anxiety disorder.

The goal of the current work is to provide a comprehensive review and interpretation of the literature on the human and economic burden of generalized anxiety disorder (GAD) and how it compares with that of other mental disorders. The term "human burden" is used to describe quantified impairments in role functioning and quality of life (QOL). "Economic burden" describes costs related to health care resource utilization and lost work. A review of 34 studies reporting original quantitative data on associations between GAD and role functioning, QOL, and/or economic costs was undertaken. GAD was defined by DMS-III-R, DSM-IV, or ICD-10 DCR. Persons with GAD (both with and without a comorbid mental disorder) described significant impairments due to both physical and emotional problems. Studies typically showed that role and QOL impairments of GAD were at least comparable in magnitude to those of other anxiety disorders, somatoform disorders, and physical conditions, and greater than those of substance use disorders. Large representative studies showed that role impairments of pure GAD were similar in magnitude to those of pure MDD. Studies of DSM-IV disorders showed that QOL impairments of GAD were at least comparable in magnitude to those of MDD; studies of DSM-III-R disorders showed the opposite pattern. GAD was associated with considerable economic costs owing to lost work productivity and high medical resource use. Quality of care initiatives that have been implemented to increase recognition and improve treatment outcomes for persons with MDD should be extended to the effective management of GAD.

Anxiety Disorders↗
PubMed2007

The relationship between road traffic accidents and real economic activity in Spain: common cycles and health issues.

This paper analyses the aggregate relationships between traffic accidents and real economic activity in Spain during the last 30 years. Our general approach is based on two basic assumptions: (1) the number of accidents depends on the use of cars and other exogenous variables, and (2) the level of economic activity affects variation in the stock of cars, as well as degree of utilization. We propose a novel turning point characterization for monthly seasonal data that allows to check whether economic and road accident cycles coincide and, to date the beginning and end of their respective cycles. Empirical results from this section are important in establishing posterior causal models and whether or not economic activity and road accidents have a common component in the long run and a varying lead-lag relationship, depending on the cycles. These models will be the basis to check when Spain will achieve the European Union figures in terms of the fatalities/accidents ratio under different scenarios. Empirical results as well as historical experiences from other European countries proved that reducing fatalities is not only a question of diminishing accidents rates.

Accidents, Traffic↗