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At least 1,135 records · Page 63Linked to original sources
PubMed2006

Delay discounting and the behavioural economics of cigarette purchases in smokers: the effects of nicotine deprivation.

RATIONALE: In smokers, nicotine deprivation may increase impulsive decision-making and the demand for cigarettes. OBJECTIVES: To investigate the effects of acute nicotine deprivation on (a) the delay discounting of monetary and cigarette rewards, and (b) the behavioural economics of hypothetical cigarette purchases. MATERIALS AND METHODS: A repeated measures design was employed, with participants (daily cigarette smokers, N=30) repeating experimental tasks in two different sessions, once after at least 13 h of abstinence from smoking and once after ad lib smoking. Participants completed measures of cigarette craving, impulsivity, delay discounting and a behavioural economic simulation in which participants made hypothetical purchases of cigarettes and other commodities as the price of cigarettes was systematically varied. RESULTS: Participants showed more pronounced delay discounting of both cigarette and monetary rewards after abstinence compared to after ad lib smoking. In the behavioural economic simulation, nicotine deprivation had no influence on hypothetical cigarette purchases. However, spending on some commodities (alcohol, clothing, household goods, leisure activities and long-distance travel) was reduced as the price of cigarettes increased in order to fund increased spending on cigarettes, although the number of packs of cigarettes purchased actually decreased. CONCLUSIONS: Nicotine deprivation increases impulsive choices for both cigarette and monetary rewards in a delay-discounting task. Results from a behavioural economic simulation suggest that increases in the price of cigarettes may increase smokers' spending on cigarettes, while also reducing the number of cigarettes purchased.

Humans↗
PubMed2005

Cardiovascular drug utilisation and socio-economic inequalities in 20 districts of the Czech Republic.

OBJECTIVE: To analyse whether there exists a socio-economic gradient in utilisation of cardiovascular drugs at the district level in the Czech Republic. METHODS: The aggregated data on drug utilisation during the period 1997-2000, expressed in defined daily doses per 1000 inhabitants per day, were obtained from the General Health Insurance Company. Socio-economic characteristics of the districts in year 2000 (percentage of university-educated inhabitants, percentage of single-member households, number of ambulatory physicians per 10,000 inhabitants, unemployment rate and mean monthly income) were used as single unadjusted predictor variables. Partial correlation controlling for age in districts was used to analyse the relationship of cardiovascular disease (CVD) drug utilisation and several socio-economic variables. RESULTS: There were considerable differences in the utilisation of CVD drugs within the districts studied. Significantly higher utilisation of dihydropyridine Ca-channel blockers and statins was found in the districts with a higher percentage of university-educated inhabitants and more ambulatory physicians. CVD drug utilisation (nitrates, fibrates, selective beta-blockers, verapamil and diltiazem and statins) correlated significantly with the percentage of single-member households. The five socio-economic variables explained more than 60% of the variability in use of dihydropyridine Ca-channel blockers, verapamil and diltiazem, ACE inhibitors and statins. CONCLUSION: There exists a significant gradient in the utilisation of mainly newer CVD drug groups within districts of the Czech Republic that can be, at least partly, explained by social characteristics of the districts.

Cardiovascular Agents↗
PubMed1998

Intra-urban variation of antibiotic utilization in children: influence of socio-economic factors.

OBJECTIVE: The aim of this study was to investigate the intra-urban variation of antibiotic utilization in children in Malmö and to evaluate the influence of socio-economic factors on this variation. METHODS: In an ecological analysis, the variations in antibiotic utilization in children, expressed as defined daily dose (DDD) or as the number of prescriptions per 1000 inhabitants per day, were compared with variations in socio-economic and demographic factors in the 17 administrative districts of the Swedish city of Malmö (235000 inhabitants). RESULTS: There were large between-area differences in antibiotic utilization, especially in children aged 0-6 years. Socio-economic factors reflecting a privileged situation correlated positively with antibiotic utilization. Thus, in districts with a high median family income and a high employment rate, the utilization of antibiotics was higher than in other districts. Conversely, in districts with a high proportion of blue-collar workers, people with foreign backgrounds and recipients of social benefit, antibiotic utilization was comparatively low. In contrast, the utilization of penicillin V relative to other antibiotics showed an opposite pattern, including positive correlations with the proportion of social benefit, immigrants and blue-collar workers and a negative correlation with employment rate. Conversely, the utilization of macrolides in relation to other antibiotics in children aged 0-6 years was highest in districts inhabited by those who were socio-economically privileged. INTERPRETATION: The findings suggest that utilization of antibiotics in children may vary considerably within a city, that it may increase with the degree of parental affluence, and that such affluence may reduce the utilization of penicillin V relative to other antibiotics.

Adolescent↗
PubMed2004

The on-ranch economics of riparian zone cattle grazing management.

A simulation model of a cattle ranch based in southern Alberta, Canada was developed to evaluate the on-ranch economics of adopting different grazing management strategies to improve riparian grazing capacity in natural grass rangeland. Under low-cost scenarios, there are positive economic incentives to adopt strategies to maintain riparian zones that already have high grazing capacity. However, riparian zones that have declined to moderate or low grazing capacity may require additional economic incentives to encourage ranches to adopt more costly management strategies to improve the grazing capacity. The economic incentives to adopt costly management strategies are highly sensitive to the size and shape of the riparian zone and rates of grazing capacity decline or improvement.

Animal Husbandry↗
PubMed2004

Development of indicators to assess economic vulnerabilities to changes in ecosystem services: case study of counties in Maryland, USA.

We develop indicators showing the relative environmental burdens that human activities place on locales for a given level of economic benefits. The main purpose is to develop tools that allow us to examine the potential vulnerabilities within economies to changes in resource conditions. The indicators of pollution emission or resource consumption per job can be used to identify potential challenges to resource and industry managers and to compare areas in terms of their ability to adapt to change. For example, if a large number of area jobs are dependent on abundant water, this indicates a vulnerability to a reduction in water availability for industrial use. We develop a case study for 23 counties and 1 city in Maryland to examine the usefulness and limitations of the indicators. Our case study demonstrates that the indicators provide an informative view into patterns of local economic activity and use of an area's environmental goods and services. In contrast to patterns for total environmental burdens (e.g., total SO2 emissions) that are typically reported, the rates of environmental burden per job are not simply correlated with high or low economic output. Thus, the indicators represent distinct patterns of environmental burdens per job that reflect reliance on environmental services. The indicators have some limitations when used at this fine scale because they can misrepresent conditions in counties in which economic sectors are dominated by one or a few businesses. For this reason, the indicators are best used as a regional screening tool.

Agriculture↗
PubMed1999

Principles of economic evaluation in surgery.

This document reviews the key principles of economic evaluation as they pertain to the evaluation of surgical questions. It addresses the role of economic evaluation in health care decision making, describes the central issues in performing or evaluating an economic evaluation, and finally offers several examples of recent economic evaluations from the surgical literature. A concise annotated reference section is provided for those wishing to read further.

Cost-Benefit Analysis↗
PubMed2002

Economic costs of HIV infection: an employer's perspective.

The introduction of highly active antiretroviral therapy has proven highly effective in treating patients with HIV/AIDS. However, the high cost of the advanced antiretroviral therapy has led to increased financial constraints on both patients and payers. From business firms'perspective, especially those with operations in developing countries, it is crucial to determine the long-term economic cost implications of alternative employment and benefit policies for HIV-infected workers or those at high risk for the disease. A simulation model is developed to predict the comprehensive lifetime economic costs of HIV-infected workers to an employer. This model employs age,CD4(+) cell counts,and plasma HIV-1 RNA level as major predictors of the disease progression and patient survival in the determination of various cost functions. Major cost components considered include direct expenses on health insurance premium,life insurance premium, short-term disability benefits, long-term disability benefits, hiring/training expenses, and indirect costs resulting from reduced or lost productivity at work. An individual model and a group model are derived to estimate the costs of an individual and a group of HIV-infected patients, respectively. Over a 10-year period, following the nonadvanced antiretroviral treatment regimen, the group model predicts that the total lifetime cost of an HIV-infected worker can be as high as U.S. 90,000 dollars to his/her employer, of which 60,000 dollars would be various explicit costs and 30,000 dollars lost work productivity. Sensitivity analysis further demonstrated that changes in the initial level of age,CD4(+) cell count, HIV-1 RNA viral load,CD4(+) cell decline rate, and the costs of medical care influence the dynamics of the cost functions. HIV infection can result in sizable economic costs to an employer over the lifetime course of an infected employee if not treated with the advanced antiretroviral therapy. These cost estimates provide a rational economic basis for an employer to optimally assess the longrun costs and benefits of alternative employment and insurance policies in the care of employees with HIV infection.

Journal Article↗
PubMed2004

Priority setting for pharmaceuticals. The use of health economic evidence by reimbursement and clinical guidance committees.

Authorities in a number of countries rely increasingly on cost-effectiveness analysis to determine reimbursement status or clinical guidance for pharmaceuticals. This study compared the use of health economic evidence across five reimbursement committees (Australia, Ontario and British Columbia in Canada, Finland, and France) and one clinical guidance committee (England and Wales). Health economic evidence was found to support decision making, although cost-effectiveness is less important in some identifiable situations. Since the relative importance of cost-effectiveness varies, it will be difficult to implement a single explicit threshold. Further research may make patterns of decision making, distributional concerns, and the importance of different criteria more transparent, which would help to narrow the gap between the theory and practice of health economic evaluations. While the use of health economic evidence and the outcome of decision making are similar across committees, there is presently only limited knowledge to what extent prescribing patterns are influenced by decisions.

Advisory Committees↗
PubMed2007

Impact of a programme of mass mammography screening for breast cancer on socio-economic variation in survival: a population-based study.

BACKGROUND: After a systematic mass mammography breast cancer screening programme was implemented between 1991 and 1996 (attendance 80%), we evaluated its impact on survival according to socioeconomic status (SES). METHODS: We studied survival rates up to 1-1-2005 for all consecutive breast cancer patients aged 50-69 and diagnosed in the period 1983-2002 in the area of the Eindhoven Cancer Registry (n = 4939). Multivariate analyses were performed using Cox regression analysis. RESULTS: The proportion of breast cancer patients with a low SES decreased from 22% in 1983-1990 to 14% in 1997-2002 when attendance was 85%. The proportion of newly diagnosed patients with stage III or IV disease in 1997-2002 was only 10% compared to 14% in 1991-1996 and 26% in 1983-1989 (P < 0.0001). Stage distribution improved for all socio-economic groups (P = 0.01). Survival was similar for all socio-economic groups in 1983-1990, but after the introduction of the screening programme women with low SES had lower age- and stage-adjusted survival rates (HR 2.0, 95%CI: 1.3-3.0). Survival was better for patients diagnosed in 1997-2002 compared to 1983-1990 for all socioeconomic strata; it was substantially better for the high SES group (HR 0.36, 0.2-0.5) compared to the lowest SES (HR 0.77, 0.6-1.1). CONCLUSION: Although survival improved for women from each of the socio-economic strata, related to the high participation rate of the screening programme, women from lower socio-economic strata clearly benefited less from the breast cancer screening programme. That is also related to the higher prevalence of comorbidity and possibly suboptimal treatment.

Aged↗
PubMed2006

Patterns of disparity: ethnic and socio-economic trends in breast cancer mortality in New Zealand.

OBJECTIVE: To test whether trends in breast cancer mortality varied by ethnicity and socio-economic position during the 1980s and '90s in New Zealand. METHODS: Four cohorts of the entire New Zealand population for 1981-84; 86-89; 91-94 and 96-99 allowed direct determination of socio-economic trends in breast cancer mortality. For ethnicity, unlinked routine census and mortality data were used with adjustment factors for undercounting of Māori and Pacific deaths. RESULTS: Māori and non-Māori non-Pacific mortality rates changed little until mid-1990s with Māori experiencing 25% higher mortality. In 1996-99, Māori rates increased notably to become 68% higher than non-Māori non-Pacific (SRR 1.68; 95% CI: 1.49-1.90). Pacific women experienced an approximate three-fold increase in breast cancer mortality over time. There appeared to be reducing mortality among higher income and education groups but trends within socio-economic groups were not statistically significant. Nevertheless, by 1996-99, there was a significant 22% excess mortality (SRR 1.22; 95% CI: 1.01-1.49) for low compared with high-income groups. CONCLUSIONS: Widening ethnic, and probably, socio-economic disparities in breast cancer mortality are likely due to both underlying incidence and differential survival trends. Disparities are likely to increase once the full differential mortality benefits of screening impact on the population.

Adolescent↗
PubMed2006

Synthesis evaluation with entire-array-polygon method to ecological economic system of Funing County in Jiangsu Province.

Based on the theory of ecological footprint this paper analyzed the ecological economic system in Funing County in the view of demands of economic system to natural resource and supply of ecosystem for natural resources. It was proposed that the concept of ecological deficit (ecological remainder) per ten thousands yuan GDP be used to evaluate development of ecological economic system. With a synthesis appraisement to the ecological economic system using entire-array-polygon method combined with Ulanowicz development ability and with ecological deficit (ecological remainder) per ten thousands yuan GDP, it provides a theoretical base for reconstructing and managing of demonstration eco-region.

China↗
PubMed1990

Assessing the economic burden of injuries due to accidents: methodological problems illustrated with some examples from the literature.

This paper provides a survey of methodological problems encountered in an assessment of the economic consequences of accidents in The Netherlands. A sound epidemiological basis for such calculations appears to be lacking due to inadequate data-registration systems. We also discuss some studies of the economic costs of injuries due to accidents for other countries, which have used either a prevalence or an incidence-based approach. It is highlighted that they may be helpful in indicating the relative economic burden posed on society but that they cannot guide priority setting in health care resource allocation. Economic evaluation studies using incidence-based scenario comparisons may be more promising in that respect.

Accidents↗
PubMed1990

Promoting healthy behaviour: the importance of economic analysis in policy formulation for AIDS prevention.

Considerable attention has been paid in the literature to modification of high-risk behaviours as a means to control the spread of the Human Immunodeficiency Virus. The success of such policies will depend crucially on the underlying causal mechanisms of these high-risk behaviours. To date the application of economics to the problem of AIDS has tended to focus on estimating the economic burden of the condition and the resource consequences of clinical strategies for care. Yet as a behavioural science economics should provide a useful input into the policy process aimed at behaviour modification. In this paper we extend the application of economic analysis to the determinants of individual behaviour to identify (i) the implications of current policies for the incidence of high-risk behaviour and (ii) the wider determinants of behaviour warranting greater attention in the policy-making process.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Economic evaluation of osteoporosis prevention.

In this paper economic evaluation of osteoporosis prevention is discussed. So far economic evaluation in this area has been limited to cost-effectiveness analysis. Four cost-effectiveness analyses of osteoporosis prevention are reviewed. It is noted that the major problem with these studies is the lack of reliable and valid data to base the cost-effectiveness analyses on, which precludes clear-cut conclusions about the cost-effectiveness of osteoporosis prevention. The studies, however, form a basis for future cost-effectiveness analyses in this field and as new data become available it should be possible to improve the accuracy and precision of the analyses. Due to the methodological problems of cost-effectiveness analysis and the decision-maker approach to economic evaluation, it is also argued that the contingent valuation (CV) method of measuring willingness to pay should be tested in this area. The CV method can be used both to value an actual treatment and the outcome of that treatment and the resulting amount can be compared with the costs (including the costs of externalities) to carry out cost-benefit analysis. It is concluded that a lot of work remains to be done in this area before economic evaluations can give a real contribution to policy, but such work may well be worthwhile due to the importance of this public health problem.

Aged↗
PubMed1996

Incorporating quality of life changes into economic evaluations of health care: an overview.

The demand for economic evaluations of health care programs, especially pharmaceuticals, is steadily increasing. One of the most important issues in this field is how to measure, value and incorporate changes in quality of life into the economic evaluation. We provide an overview of the different approaches to measure changes in quality of life: quality of life instruments, the quality-adjusted life-year (QALY) approach and the willingness to pay approach. Quality of life instruments have major practical advantages since they are easy to administer. The results of these instruments cannot, however, be used in economic evaluations. In economic evaluations, the quality of life has to be measured on the 0 (death) to 1 (full health) scale necessary to construct QALYs, or the willingness to pay for the changes in quality of life has to be measured. Such measurements are, however, much less straightforward to carry out. It would therefore be a major advance if it would be possible to directly translate the quality of life score into a QALY weight or the willingness to pay. It is recommended that more systematic research should be carried out on the relationship between quality of life, QALY weights, and willingness to pay.

Cost-Benefit Analysis↗
PubMed1984

Economic analysis and clinical trials.

Given the increasing interest in the economics of health care, the incorporation of economic analysis in clinical trials is more often being considered, both by medical researchers and by research funding bodies. This article proposes criteria for judging the appropriateness of including economic analysis in a given trial, suggests how that analysis could be phased in order to minimize the work involved, and discusses the wider implications for medical research of more frequent attention to economic concepts.

Clinical Trials as Topic↗
PubMed1982

Economic change and sex-specific cardiovascular mortality in Britain 1955-1976.

Analyses directed toward recent declines in cardiovascular disease mortality rates have typically focused on alterations in important physiological and behavioral risk factors resulting from lifestyle changes and medical advances. In this study, a multivariate model of the impact of more fundamental changes in the socioeconomic and bio-physical environments has been developed and applied to cardiovascular disease mortality rates, by sex, in England and Wales and Scotland during 1955-1976. The predictive model includes factors associated with (1) long-term growth in the economy, (2) deleterious behavioral risk factors loosely associated with economic growth--especially cigarette consumption per capita, (3) economic instability--especially recession as indicated by factors related to unemployment, income loss, and recessional declines in average weekly hours worked in manufacturing industries, (4) health care, and (5) physical environmental disturbances--especially very cold temperatures. This model proves to be an excellent instrument for the statistical explanation of trends and fluctuations in CVD mortality rates for both sexes and both regions in Britain in the post-War period. In general, the overall exponential rate of economic growth is found to be the most powerful factor in the long-term decline in CVD mortality rates. Similarly, disturbances to the national and regional economic situations--especially recessions--have regularly been associated with elevated death rates for all populations observed. Cigarette and unusually high spirits consumption, as well as particularly cold winter temperatures, have also had important deleterious effects on CVD mortality. The proportion of government expenditures devoted to health care is associated with a reduction in CVD mortality in England and Wales.

Adult↗
PubMed1983

Unemployment and health in the context of economic change.

Evidence relating unemployment to health is found at every level of social science analysis from national population rates to individual psychophysiological stress response. At the population level of analysis, increase in the unemployment rate indicates recession and/or structural economic decline. At the individual level, unemployment is interpreted as a stressful life event. In both cases, inverse associations are found between measures of unemployment and indicators of health. We identify social science literatures associating health indicators with each of the following: economic growth, socioeconomic status, sociocultural change, economic instability, the status of being unemployed, social stress and work stress. Outstanding research issues include the requirements to identify and measure the effects of conditional factors and control variables in multivariate analysis and to examine a broader range of both severity of unemployment and severity of health outcomes. A research agenda proposes studies at the macro, meso and micro levels of analysis. We urge such research for its potential contribution both to analytic social science and to economic and social policy.

Health↗