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PubMed2001

Economic evaluations of hepatitis B immunization: a global review of recent studies (1994-2000).

A search was carried out for economic evaluations of hepatitis B (HBV) vaccination, published between 1994 and 2000. The results of these studies are discussed according to the level of HBV endemicity. The great majority of these evaluations were carried out for industrialized countries, for the most part situated in areas of low to very low HBV endemicity. In countries of very low endemicity economic evaluations have yielded contradictory results, depending on the type of epidemiological model they used. The cost-effectiveness of adding universal to selective vaccination strategies in these countries depends on the selective strategies' ability to sufficiently identify, reach and fully vaccinate persons in various risk groups. In areas of low, intermediate and high endemicity, universal vaccination seems justifiable on the basis of economic evaluation. In general, the accuracy of the models has improved over the years, but still the transparency, completeness and comparability of analyses could improve considerably. By noting this, the suitability of different methodologies for different areas of endemicity and vaccination strategies is discussed. It is recommended that specific guidelines for economic evaluation of the prevention of infectious diseases be developed to guarantee the relevance of and to improve the comparability between studies.

Cost-Benefit Analysis↗
PubMed2002

Superbugs II: how should economic evaluation be conducted for interventions which aim to contain antimicrobial resistance?

To date, there has been little examination of the problems associated with conducting economic evaluation for interventions designed to contain antimicrobial resistance. There are two quite different types of intervention aimed at containing antimicrobial resistance: interventions which are designed to avoid the emergence of resistant organisms; and interventions that are designed to avoid the transmission of resistance organisms. Four aspects of economic evaluation where the ease of assessment might be expected to differ across evaluations for these different types of intervention are examined: problems associated with the identification of diffuse impacts, problems associated with comparing current and future impacts, problems associated with uncertainty, and problems associated with difficulties in measurement and valuation. The paper suggests that it may be much easier to conduct rigorous economic evaluations for interventions designed to avoid transmission of resistance, than for those intended to avoid emergence. Unfortunately, the transmission policies, which are likely to be the easiest to evaluate, are not likely to produce an optimal long-term outcome given the apparent irreversibility of much resistance and the potentially severe harms which could be imposed as a result. Given the desirability of avoiding a scenario where, in the evidence-based medicine culture, the most rigorously evaluated policies are followed even though they may be less important, there is the need to consider carefully what, and how, economic evaluation should be conducted in the area of antimicrobial resistance. It is suggested that research should focus on the use of modelling as a means of evaluating optimal policy responses and on trying to resolve some of the difficulties associated with measurement and valuation.

Anti-Infective Agents↗
PubMed2006

A guide to economic evaluation: methods for cost-effectiveness analysis of person-level data.

The authors introduce economic evaluation with particular attention to cost-effectiveness analysis. They begin by establishing why health care decisions should be guided by economics. They then explore different types of economic evaluations. To illustrate how to conduct and evaluate a cost-effectiveness analysis, a hypothetical study about the treatment of posttraumatic stress disorder with psychotherapy versus pharmacotherapy is considered. The authors conclude with recommendations for increasing the strength and relevance of economic evaluations.

Cost-Benefit Analysis↗
PubMed2002

Assessing the longitudinal course of depression and economic integration of south-east Asian refugees: an application of latent growth curve analysis.

This paper has both methodological and substantive application for mental-health researchers. Methodologically, it presents the latent growth curve (LGC) technique within a structural equation modelling (SEM) framework as a powerful tool to analyse change in depressive symptoms and potential correlates of such changes. The rationale for LGC analysis and subsequent elaboration of this statistical approach are presented. The limitations of traditional analytical methods are also addressed. Substantively, the paper considers socio-contextual factors as correlates of change in symptoms, and examines the dynamic systematic relationship with the degree of economic integration of south-east Asian immigrants in Canada over time. Using the LGC technique, this study also investigated how the longitudinal course of subclinical depression places individuals at risk for developing full-blown major depression. The LGC results provided strong evidence for the reciprocal influence between economic integration and subclinical depression of immigrants. The initial level of economic integration negatively influenced the rate of change in subclinical depression whereas the initial level of subclinical depression negatively influenced the rate of change in economic integration. Both initial level and the rate of change in subclinical depression placed individuals at risk for full-blown major depression. However, traditional auto-regressive models were not capable of revealing these dynamic associations. Thus, an investigation of within-individual change in symptoms and potential correlates of such changes is necessary to understand the process that results in full-blown mental disorder.

Asia, Southeastern↗
PubMed2003

Assessing the appropriateness of combining economic data from multinational clinical trials.

Because of the potential for large variability among countries in the utilization and cost of health care resources, it is important to assess the appropriateness of combining economic data across the countries in a multinational clinical economic trial. We show how available tests for interaction can be applied to economic endpoints, including cost-effectiveness ratios and net health benefits. This analysis includes a characterization of possible interactions being quantitative or qualitative in nature. In the absence of interaction, a pooled estimate of the economic endpoint should be representative of the participating countries. We explore the analytic issues by further analysing data from the Scandinavian Simvastatin Survival Study (4S).

Anticholesteremic Agents↗
PubMed2002

Integrated economic-ecological analysis and evaluation of management strategies on nutrient abatement in the Rhine basin.

Management of river basins involves the making of informed choices about the desired levels of economic activities and ecosystem functioning in the catchment. Information on the economic and ecological effects of measures as well as their spatial distribution is therefore needed. This paper proposes the following instruments to support decision-making in river basins: (1) the linking of models and indicators to describe the economic and ecological effects of management actions and their spatial distribution and (2) an extended evaluation framework that aims to evaluate management actions on three objectives for sustainable river management. These are cost-effectiveness, spatial equity, and environmental quality. This paper illustrates the potential of these instruments for river basin management by a case-study on nutrient management in the Rhine basin. In this case-study four nutrient abatement strategies are formulated, based on policies of the International Commission for the Protection of the Rhine and the North Sea Commission. These strategies are analysed and evaluated on their contribution to the three management objectives. Results show that none of these strategies score highest on cost-effectiveness, spatial equity and environmental quality simultaneously. It appears that cost-effectiveness is in conflict with environmental quality, whereas spatial equity and cost-effectiveness show quite close correspondence. This means that a trade-off has to be made between costs and spatial equity on the one hand, and environmental standards on the other hand. This paper offers a framework to make these trade-offs more explicit and provides quantitative information on cause-effect relationships, economic and environmental effects and the spatial distribution of these effects for various management strategies. This information can be particularly useful in the development of compromises required to establish international agreement and co-operation.

Conservation of Natural Resources↗
PubMed2001

The socio-economics of asthma.

Is it healthy to be wealthy? The answer to this simple but provocative question can be found in a wide variety of published studies, which evaluate the socio-economic equity of healthcare and the socio-economic impact of diseases. Studies have focused on avoidable mortality, race and ethnicity, environment and access to healthcare services, and many found supporting facts of the above thesis, mostly based on cardiovascular diseases. But what about asthma? Additional factors such as risk behaviours e.g. smoking, excessive use of beta-agonists or general non-compliance with asthma medication have been investigated and found to be contributing to adverse health outcomes. Prevalence and incidence of asthma is higher in people with high socio-economic status (SES), but disease severity and premature mortality is more than twice as common in populations with low SES. The key to reduce the large socio-economic impact is, therefore, to improve the management of patients with more severe diseases. Because those patients are found more often in low SES groups, new approaches such as community disease management programmes, probably provided by a multi-disciplinary care team, have to be established. Current financial incentives within the largely sectored healthcare system are counterproductive. Furthermore, a better co-ordination of the goals of public healthcare experts with those providing individual 'clinical' healthcare is needed. Clearly communicated healthcare goals are needed to create common incentives and shared visions. Cornerstones of the new disease management efforts are co-ordinated care, high quality innovative medicines and a well-educated patient. This might help improve the implementation of current asthma management knowledge into practice.

Asthma↗
PubMed1996

A new approach to risk assessment integrating scientific evaluation and economic assessment of costs and benefits.

Traditional quantitative risk assessment based on conservative generic assumptions led to an upper-bound risk value with minimum or no consideration of costs and benefits. There is a growing consensus for a new approach to risk assessment based on a combination of scientific risk assessment and economic cost-benefit analysis. Scientific evaluation would be improved to support the economic cost-benefit analysis. The objective is to demonstrate whether the benefits justify the costs. The move in the new direction is shown by Executive Order 12866 and the Office of Management and Budget implementing document, the proposed regulatory reform legislation in Congress, the draft report of the Risk Assessment and Risk Management Commission, and the Safe Drinking Water Act Amendments of 1996 that enacted the new approach combining scientific and economic assessment of risk. This Commentary discusses these developments with particular reference to contemplated changes in scientific risk assessment to support a parallel economic risk-benefit analysis.

Cost-Benefit Analysis↗
PubMed2001

Using cost and financing instruments for economic evaluation of substance abuse treatment services.

Standardized economic evaluation instruments are an important tool in the analysis of change and performance of addiction treatment. Nevertheless, compared to other health care sectors, economic evaluation of addiction treatment is still rare. The present paper proposes two comprehensive economic evaluation instruments that are methodologically sound and that meet the objectives of comprehensiveness, standardization, and comparability. The Drug Abuse Treatment Cost Analysis Program (DATCAP) can be used to estimate the economic cost of treatment services; the Drug Abuse Treatment Financing Analysis Program (DATFin) is a companion instrument and analyzes the complexity and change of treatment financing. This paper outlines the contents of each instrument and, for illustrative purposes, presents results from several case studies. Suggestions for updates and enhancements for each instrument are also discussed.

Cost Control↗
PubMed2007

Ethanol production: energy, economic, and environmental losses.

The prime focus of ethanol production from corn is to replace the imported oil used in American vehicles, without expending more fossil energy in ethanol production than is produced as ethanol energy. In a thorough and up-to-date evaluation of all the fossil energy costs of ethanol production from corn, every step in the production and conversion process must be included. In this study, 14 energy inputs in average U.S. corn production are included. Then, in the fermentation/distillation operation, 9 more identified fossil fuel inputs are included. Some energy and economic credits are given for the by-products, including dried distillers grains (DDG). Based on all the fossil energy inputs, a total of 1.43 kcal fossil energy is expended to produced 1 kcal ethanol. When the energy value of the DDG, based on the feed value of the DDG as compared to that of soybean meal, is considered, the energy cost of ethanol production is reduced slightly, to 1.28 kcal fossil energy input per 1 kcal ethanol produced. Several proethanol investigators have overlooked various energy inputs in U.S. corn production, including farm machinery, processing machinery, and the use of hybrid corn. In other studies, unrealistic, low energy costs were attributed to such inputs as nitrogen fertilizer, insecticides, and herbicides. Controversy continues concerning the energy and economic credits that should be assigned to the by-products. The U.S. Department of Energy reports that 17.0 billion L ethanol was produced in 2005. This represents only less than 1% of total oil use in the U.S. These yields are based on using about 18% of total U.S. corn production and 18% of cornland. Because the production of ethanol requires large inputs of both oil and natural gas in production, the U.S. is importing both oil and natural gas to produce ethanol. Furthermore, the U.S. Government is spending about dollar 3 billion annually to subsidize ethanol production, a subsidy of dollar 0.79/L ethanol produced. With the subsidy, plus the cost of production, the cost of ethanol is calculated to be dollar 1.21/L. The subsidy for a liter of ethanol is 45-times greater than the subsidy per liter of gasoline. The environmental costs associated with producing ethanol are significant but have been ignored by most investigators in terms of energy and economics. The negative environmental impacts on cropland, and freshwater, as well as air pollution and public health, have yet to be carefully assessed. These environmental costs in terms of energy and economics should be calculated and included in future ethanol analyses. General concern has been expressed about taking 18% of U.S. corn, and more in the future, to produce ethanol for burning in automobiles instead of using the corn as food for the many malnourished people in the world. The World Health Organization reports that more than 3.7 billion humans are currently malnourished in the world--the largest number ever in history.

Bioelectric Energy Sources↗
PubMed1998

Clinical response of salaried consultants to economic incentives.

Several studies have found a relation between economic incentives and physicians' clinical decisions. The bulk of these studies deals with data from private organisations providing medical care. The purpose of the present study is to explore whether a similar relationship is valid in a system where hospital care is provided by salaried physicians in the public sector. A distinction is made between medical and economic prioritysetting. If the relative fees influence the proportion of outpatient surgery or the compositions of treatments, economic prioritysetting is said to take place. Data were collected from a sample of Norwegian hospitals. The main findings of the empirical section can be summarised in two points: (i) Economic prioritysetting seems to be applied in the choice between inpatient and outpatient surgical treatment for patients with an identical diagnosis. (ii) Medical priority setting seems to be applied in the priority among patients with different diagnoses.

Ambulatory Surgical Procedures↗
PubMed1997

Alternatives to the QALY measure for economic evaluations.

Economic analyses (i.e., analyses that are concerned primarily with questions of resource allocation) are becoming more common in health care in general and care of cancer patients in particular. The most commonly used measure for the valuation of outcome in such analyses is the QALY (quality-adjusted life-years), which combines qualitative (i.e., quality of life) and quantitative (i.e., survival) aspects of the outcome into one dimension. Using economics (i.e., the discipline) as the mode of thinking to help solve problems of resource allocation in health, this paper describes a framework to evaluate the appropriateness of use of a measure of outcome in the context of an economic evaluation. This framework will be used to critically appraise the use of the QALY measure and of two alternative measures, HYE (healthy years equivalent) and WTP (willingness to pay), in economic evaluations of health care interventions. The paper also describes a practical tool that can be used to measure individuals' WTP in the context of public decision making. This tool involves modifying the decision board, a tool develop (originally in the cancer area) to help clinicians present information to patients. The intent is to show that the use of a theoretically superior measure of outcome need not always be empirically restrictive.

Algorithms↗
PubMed1997

Economic aspects of treatment for fungal infections in cancer patients.

Although health care expenditure has increased steadily over the past decennium, the general feeling is that resources are more limited than ever. One reason for this may be that the range of treatment options has grown so wide that the need to make rational choices has become apparent. Since treatments vary with respect to both effectiveness and cost, economic evaluations are becoming an important tool for assessing new and existing treatment strategies. The basic concepts of economic evaluation will be introduced here and the key economic questions with respect to treatment of fungal infections in cancer patients identified. Some of these concepts are explained using findings from a pilot survey carried out among participants in the symposium "Trends in Invasive Fungal Infections-3" 7-9 held September, 1995, in Brussels, Belgium. The conclusion will offer recommendations for assessing economic evaluations.

Antibiotic Prophylaxis↗
PubMed1985

Socio-economic factors in relation to lipid profiles in young girl athletes.

The influence of socio-economic factors on blood lipid values was studied in 4 groups of young female athletes. Based on type of sport (gymnastics and swimming) and of training intensity, the participants were subdivided into 25 talented, high achievement gymnasts (age 12.3 +/- 1.6 (SD) year), 42 non-talented, low achievement gymnasts (age 12.0 +/- 1.2 (SD) year), 12 high achievement swimmers (age 10.3 +/- 1.6 (SD) year), and 24 low achievement swimmers (age 10.8 +/- 1.6 (SD) year). With respect to socio-economic factors, no significant differences were observed between the two gymnastic groups nor between the two swimming groups. The blood lipid values revealed a significantly higher low density lipoprotein-cholesterol level and significantly lower high density lipoprotein-cholesterol/total cholesterol and high density lipoprotein-cholesterol/low density lipoprotein cholesterol ratios in the talented gymnasts as compared to the non-talented gymnasts. In the high achievement swimmers, low density lipoprotein-cholesterol and triglyceride levels were significantly lower and high density lipoprotein-cholesterol/total cholesterol was significantly higher as compared to the other swimmers. The Spearman rank order correlation coefficients for the relationships between socio-economic factors and blood lipid values were mostly weak or inconsistent. Therefore, no major influence of socio-economic factors on blood lipid values could be demonstrated in the groups investigated.

Adolescent↗
PubMed1998

From selfish individualism to citizenship: avoiding health economics' reputed 'dead end'.

Recent interpretations of citizenship are firmly rooted in the value of social membership and social participation. Citizens are described as having a moral right to draw upon the support of the community, but at the same time have a responsibility to contribute to the provision of social services such as health care. In contrast, contemporary health economics has been criticised for taking a narrow and individualistic view of human behaviour. This paper examines the extent to which economic theory and practice have been developed to accommodate a more 'civic' view, namely, the notions of mutual concern for community members, social participation and social rights. It is argued that because the provision of health care is often linked to feelings of compassion and social responsibility and not just to individual well-being, this sort of insight may enrich economic analysis and, in turn, provide a way around health economics' reputed 'dead end'.

Altruism↗
PubMed2006

[Health economics studies in dermatology].

Because of reduced resources for health care, provision of modern effective dermatologic care for patients with German public health insurances has become more and more difficult. This survey is designed to aid in the assessment of published health economic studies as well as encourage participation in health economic evaluations. These studies should analyze and optimize the allocation of the available resources. Four main approaches can be used to calculate the incidental expenses; they differ in their methods of evaluation and assessment of health services. They all offer methods to calculate the anticipated costs and consequences. The methods include cost minimization analysis (CMA), cost effectiveness analysis (CEA), cost utility analysis (CUA) or cost benefit analysis (CBA). Many subgroups also exist. Important criteria for the evaluation of health economic trials and hints for the publication of the results are provided on the basis of the recommendations for health economic evaluations.

Clinical Trials as Topic↗
PubMed2003

Variations in process and outcomes of diabetes care by socio-economic status in Salford, UK.

AIMS/HYPOTHESIS: Our aim was to investigate trends in provision and outcomes of care by socio-economic status among patients with diabetes in Salford, United Kingdom. METHODS: Salford is a deprived urban area in North West England. Data for people with diabetes who were younger than 20 years of age (4034 patients in the year 1993 and 5671 by the year 2000) were extracted from the Diabetes Information System. Age-standardised means, proportions and attainment of targets were calculated for: processes of care indicators, intermediate outcomes and prescribing of preventive drug treatments in 1993 to 1994 and in 2000 to 2001 by quintiles of Townsend deprivation score. We did comparisons of means and proportions using age-adjusted linear regression and of trends using generalised estimating equations. Rate ratios for first microvascular and first macrovascular complication were estimated from proportional hazards models. RESULTS: Marked improvements occurred in all indicators. For patients managed in primary care, blood pressure and cholesterol measurement increased from 53% to 64% (p<0.001) and 27% to 61% (p<0.001) respectively; whilst mean systolic blood pressure decreased from 147 to 140 mmHg (p<0.001) and cholesterol concentrations from 6.0 to 5.1 mmol/l (p<0.001). Mean HbA(1c) increased from 7.8 to 8.1% (p<0.001). Prescribing of aspirin, anti-hypertensive and lipid-lowering drugs increased greatly. Trends varied little by socio-economic status. Patients from more affluent areas generally received more frequent clinical monitoring and preventive treatments, and had a lower BMI (29.5 vs 30.2 kg/m(2); p=0.009) and HbA(1c) (7.8 vs 8.2% p=0.006), though risks of first microvascular or macrovascular complications were similar. CONCLUSION/INTERPRETATION: Improvements in process and outcomes of care are possible for patients from all socio-economic groups. Socio-economic deprivation does not preclude high quality diabetes care.

Adult↗
PubMed2006

Incidence of schizophrenia does not vary with economic status of the country: evidence from a systematic review.

BACKGROUND: A recent systematic review found that the prevalence of schizophrenia was lower in developing nations compared to developed nations. However, there is a lack of information about the association between economic status and the incidence of schizophrenia. The aim of this study was to examine the association between economic status and the underlying incidence of schizophrenia based on a recently published systematic review of the incidence of schizophrenia. METHODS: The analyses were based on 167 discrete incidence rates from 52 studies. Nations were divided into three categories according to per capita gross national product. Based on these categories, we compared the incidence rates for schizophrenia when adjusted for within-study variation. RESULTS: The median (and 10-90% quantiles) incidence rates per 100,000 persons for Least Developed Countries (three studies), Emerging Economies (nine studies), and Developed Countries (42 studies) were 20.0 (0.4-35.0), 11.0 (5.0-26.0) and 16.0 (8.0-48.0) respectively. There was no significant difference in incidence rates between these groups. CONCLUSIONS: While there is a lack of information on the incidence of schizophrenia in the developing world, there is no evidence to suggest that the incidence of schizophrenia varies by economic status. In light of the evidence that the prevalence of schizophrenia is higher in developed countries, more research is warranted focused on the interaction between economic measures, and the incidence, prevalence and course of schizophrenia.

Developed Countries↗