A financial planning model for evaluating the economic viability of health maintenance organizations.
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Cost-Benefit Analysis↗
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A new experimental hypertrophic scar model in guinea pigs.
Many aspects of the biology and effective therapy of proliferative scars remain undefined, in part due to a lack of an accurate, practical, reproducible, and economical animal model for systematically studying hypertrophic scars. This study was designed to investigate whether hypertrophic scar formation could be induced in guinea pigs by removal of the panniculus carnosus alone, and by a combination of the removal of the panniculus carnosus with application of coal tar afterwards. Whole thickness skin excision or deep partial thickness injury was used to create the lesions on intact skin. Different anatomic locations were tested in different groups. Scars thus developed were examined morphologically by light microscopy and electron microscopy (TEM and SEM) and biochemically by measuring the activity of glucose-6-phosphate dehydrogenase (G6PD) to check whether these scars had morphological and biochemical properties specific to hypertrophic scars. The albino guinea pigs used in this study were divided into three groups. Removal of the panniculus carnosus was performed from the ventral aspect of the torso in animals in groups I and II. On the skin overlying the area of panniculectomy, circular skin excision was performed in group I, and deep partial thickness burn injury was inflicted in group II, to see whether wounds would heal with hypertrophic scars. In group III, dorsal aspect of the torso were used and wounds were produced by circular skin excisions followed by panniculectomy on both sides but coal tar was applied to only one side. Tissue samples were taken from the scars that were hypertrophic in appearance, and from normal scars and normal skin for comparison. Light and electron microscopic examinations and G6PD activity measurements were performed on these samples. While hypertrophic scar development was not seen in group I and group II, scars with morphological and biochemical properties specific to hypertrophic scars developed in one third of animals in group III after healing of the wounds treated with coal tar. In conclusion, it is shown that it is possible to develop experimental hypertrophic scars in guinea pigs with morphological and biochemical properties similar to those of human proliferative scars. Therefore this model is a new, practical, and economical experimental animal model to study proliferative scars, although improvements are needed to increase yield.
Animals↗
On economic justifications of bioterrorism defense spending.
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Bioterrorism↗
Paying patients to comply: an economic analysis.
A significant proportion of patients do not complete prescribed treatment or do not follow medical advice. There is evidence that financial incentives can increase compliance. We present a model of patient compliance and use it to examine the circumstances in which patients should be paid to comply with treatment and discuss the factors determining the optimal level of payment to patients.
Cost-Benefit Analysis↗
Modelling programme costs in economic evaluation.
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Cost-Benefit Analysis↗
Marriage and labor market discrimination in Japan.
"Many Japanese firms have engaged in the practice of compulsory retirement upon a female employee's marriage. In 1966, this practice was ruled as being contrary to provisions in Japan's Civil Code. [The authors] have specified and estimated a model of the economic determinants of age at marriage in order to analyze the effect that this discrimination has had on nuptiality in Japan. [The] results indicate that on average, after accounting for an upward trend, women who married after the 1966 court decision married about one year younger than women who married before 1966." It is also found that age at marriage is influenced by several socioeconomic variables, including wife's wage and educational level, husband's income and educational level, and wife's family background. Data are from a 1975 survey of women aged 20-59 who were living in the Tokyo metropolitan area.
Asia↗
Japanese migration in contemporary Japan: economic segmentation and interprefectural migration.
This paper examines the economic segmentation model in explaining 1985-86 Japanese interregional migration. The analysis takes advantage of statistical graphic techniques to illustrate the following substantive issues of interregional migration: (1) to examine whether economic segmentation significantly influences Japanese regional migration and (2) to explain socioeconomic characteristics of prefectures for both in- and out-migration. Analytic techniques include a latent structural equation (LISREL) methodology and statistical residual mapping. The residual dispersion patterns, for instance, suggest the extent to which socioeconomic and geopolitical variables explain migration differences by showing unique clusters of unexplained residuals. The analysis further points out that extraneous factors such as high residential land values, significant commuting populations, and regional-specific cultures and traditions need to be incorporated in the economic segmentation model in order to assess the extent of the model's reliability in explaining the pattern of interprefectural migration.
Adolescent↗
On the long-run average growth rate of chaotic systems.
For a discrete dynamical process defined by Xt=F(X(t-1),X(t-2),...,X(t-k)), where Xt subset R+n, the growth rate for the ith endogenous variable is conventionally defined as g(it) identical with (x(it+1)-x(it))/x(it). It is shown that, when the trajectories of x(it) exhibit periodic or aperiodic (chaotic) fluctuations within a bounded range, the long-run average growth rates are always positive, that is, g(it) identical with lim(T--> infinity )1/TSigmaTt=1 g(it) > 0, for all i, so as to induce an illusion of growth. The fact is generic in the sense of being irrespective of the dynamic structure of F. Moreover, the same characteristic exists even if the process is reversed. Economic implications and applications are discussed. It is concluded that the statistical inequalities provide additional measures to check the validity of different discrete models or to test different specifications from empirical time series.
Computer Simulation↗
Economic implications of evidence-based caries prevention in pediatric dental practice: a model-based approach.
OBJECTIVES: This paper presents an economic model which can be used to assess the potential implications of evidence-based caries prevention in pediatric dental practice. METHODS: Assessment of the evidence indicated that most children in the United States were likely to experience dental caries, though the severity of the disease would be minimal in most of them. Based on the evidence, it was concluded that annual recall examination and topical fluoride application would suffice as the norm for caries prevention. A model was developed to estimate the extent and cost of caries prevention in a traditional and an evidence-based pediatric dental practice. RESULTS: The model showed that evidence-based caries prevention resulted in a one-third decline in the number of recall examination visits provided, while the ensuing patient revenues from recall appointments declined by two-thirds in a calendar year. CONCLUSIONS: Evidence-based caries prevention will likely result in a significant decline in preventive services revenues and create additional capacity in pediatric dental practices. This economic impact will likely be absorbed by the current undersupply of pediatric dentists and by the reformulation of practice revenue streams.
Appointments and Schedules↗
[How to measure efficiency of health investments in enterprises: selected issues].
BACKGROUND: World trends and international organization recommendations point out the necessity of OHS economic appraisal methods improvement in order to ensure effective resources management in companies. MATERIALS AND METHODS: Published world literature on economic appraisal results, recommendations of international organizations, results of the own studies on economic appraisal in the field of health and safety at work in the companies in Poland were the background of the economic appraisal model for Polish companies. Several project assumptions have been adopted. The model of the return of the investment, model based on the company participation and some elements of the net costs formula are recommended for Polish companies in order to appraise efficiency of the health investment. The basic ratio in economic evaluation should be cost/benefit ratio. The project of the economic evaluation algorithm has been elaborated. RESULTS AND CONCLUSIONS: The economic analysis of the health protection and safety at work should include clear division between the internal and external costs. The proposed model could be used for the companies management needs in two directions: to microeconomic efficiency appraisal of investment in programs/intervensions in health and safety at workplace and to analyze the influence of the costs of accidents and occupational diseases and costs of preventive programs on finance management on the company level.
Health Promotion↗
A Bayesian analysis of pharmacoeconomic data from a clinical trial on schizophrenia.
Pharmacoeconomic studies are performed in a higher frequency to assess the economic interest of new drugs. However, a standard methodology does not still completely exist. We present here the principles and results of a cost-effectiveness Bayesian analysis on data from 146 patients (interim analysis) collected during a clinical trial. This trial was originally planned to enrol 245 patients with predominantly negative schizophrenia symptoms and involved four treatment groups (a new treatment given at low dose and high dose, a comparator and a placebo). First, some prior distributions of the cost-effectiveness ratio were numerically deduced from the effectiveness parameter clinical priors (based on investigators' opinions and questionnaires before going to blind breaking) and from cost function priors. The costs taken into account were hospitalizations, sick leave days, treatments, visits to the doctor, laboratory exams and suicide attempts. The effectiveness parameter was the change from baseline on SANS (scale for the assessment of negative symptoms). Posterior distributions were elaborated for the cost-effectiveness ratio by combining the cost-effectiveness ratio priors and likelihood together using the Bayes theorem. Results lead to a conclusion in favour of the new treatment given at high dose.
Antipsychotic Agents↗
Bayesian evidence synthesis to extrapolate survival estimates in cost-effectiveness studies.
This paper is concerned with survival extrapolation that represents an integral part of cost-effectiveness analysis. In the absence of long-term survival estimates from randomized clinical trials or meta-analysis we show how age-sex matched U.K. population data can additionally be used to estimate survival patterns. We adopt a Bayesian approach and we synthesize evidence from different sources such as patient registries, U.K. population statistics and meta-analyses. We also present methodology for Bayesian analysis of the additive hazards model and we show how to apply the techniques using freely available software. The methods are illustrated using data from a cohort of cardiac arrhythmia patients.
Aged↗
[Cost of illness studies as a basis for decision making].
Definitions and methods for cost of illness studies are explained: costs, direct costs, indirect costs, intangible costs, the human capital method and the willingness to pay approach. Devaluing the long-term health benefits from prevention by constant discount rates is questioned. The development and the state of the art of cost of illness studies at a national level in Germany are discussed. As an example the newly developed cost of illness study of the Federal Statistical Office with direct and indirect costs of circulatory diseases is presented. Reasons for the benefit of cost of illness studies for decision making are given in the context of costs of illness and aging.
Cost of Illness↗
The hazard of starting smoking: estimates from a split population duration model.
Understanding the determinants of the hazard of starting smoking is of great importance in developing policy to reduce the number of smokers. This paper develops a split population duration model of the decision to start smoking. Using data from the 1978 and 1979 Smoking Supplements to the National Health Interview Survey, we find some evidence that lifetime educational attainment, gender, and race are important determinants of both whether and when the smoking habit is initiated. The study finds no evidence that higher cigarette prices would have a significant impact on teenage decisions to pick up the smoking habit.
Adolescent↗
On the ideal market structure for third-party purchasing of health care.
The ideal market structure would give each medical care organization effective incentives to produce maximum value for money for enrolled subscribers. It should be based on integrated financing and delivery systems--partnerships that link doctors, hospitals and insurers--with per capita prepayment, with providers at risk for cost of care and cost of poor quality, publicly accountable for quality and per capita costs. The ideal market structure must be managed by active intelligent collective purchasing agents, called sponsors, that contract with health care systems and set the rules of competition. Sponsors structure and manage the enrollment process; they create price-elastic demand; they manage risk selection; and they create and administer equitable rules of coverage. Microeconomic theory tells us what sponsors should do to get the market incentives right. There is no comparable political theory to tell us how their boards of directors should be constituted. The paper offers a list of undesirable political arrangements to be avoided and some desirable features of sponsor constitutions.
Delivery of Health Care↗
Balancing the benefits and costs of colony-stimulating factors: a current perspective.
Neutropenia is the most common dose-limiting toxicity associated with cancer chemotherapy. Neutropenic complications, including febrile neutropenia, occur in a substantial proportion of patients with chemotherapy-induced neutropenia. Although neutropenia and its complications can be reduced with colony-stimulating factors (CSFs), it is not considered cost-effective to administer them prophylactically to all patients. The current American Society of Clinical Oncology guidelines recommend primary prophylaxis with the CSFs in patients receiving chemotherapy regimens that produce febrile neutropenia in 40% or more of those treated. This recommendation was supported by an early economic analysis based on a decision model incorporating hospital cost data to determine the risk threshold for the cost-saving use of the CSFs. Updating this model to include current estimates of hospitalization costs, indirect costs such as productivity losses, and out-of-pocket patient expenses reduced the risk threshold for cost savings with CSF to 18%. Recent efforts have focused on identifying individual patient characteristics that might be used to target prophylactic CSF in patients who are at greatest risk. Should such factors be identified and validated, assessing each patient's individual risk for neutropenic complications may prove to be a better strategy for the cost-effective use of the CSFs than the risk threshold approach. Preliminary results suggest that the targeted application of CSF support based on a risk model may improve the associated cost savings.
Antineoplastic Agents↗
[Potential impact of measures to minimise costs of pharmaceutical provision in the province of Toledo].
OBJECTIVE: To analyze the potential saving in the pharmaceutical cost that would suppose the use of equivalent pharmaceutical specialties and smaller price, in the main groups of pharmaceutical cost in 1998. DESIGN: Pharmacoepidemiologic study of drug utilization and a pharmaeconomic analysis of minimisation costs. LOCATION: Primary care of the province of Toledo. PARTICIPANTS: Prescriptions with official medical prescription of the pharmaceutical groups of greater cost during 1998 (peptic antiulcer, hipolipemiants, antagonists of calcium, hipotensors, peripheral vasodilators, macrolids, nonsteroidal antiinflamatories and antirheumatics, antidepressants and bronchodilatadors). MAIN MEASUREMENTS: Calculation of consumption by means of defined daily doses, cost of treatment to the day and potential saving. RESULTS: The potential saving in 1998 in the province of Toledo was 1405 million pesetas, which supposes 25% of the total amount of the pharmaceutical cost. Omeprazol, ranitidin and enalapril with 44.65, 46.02 and 32.84% of variation between prescribed and the cheapest alternative, were the specialties with a greater potential of saving. CONCLUSIONS: The alternative to prescribe equivalent pharmaceutical specialties and of smaller price has a great potential of saving.
Costs and Cost Analysis↗
Thermodynamic accounting of ecosystem contribution to economic sectors with application to 1992 U.S. economy.
Incorporation of ecological considerations in decision-making is essential for sustainable development, but is hindered by inadequate appreciation of the role of ecosystems, and lack of scientifically rigorous techniques for including their contribution. This paper develops a novel thermodynamic accounting framework for including the contribution of natural capital via thermodynamic input-output analysis. This framework is applied to the 1992 US economy comprising 91 industry sectors, resulting in delineation of the myriad ways in which sectors of the US economy rely on ecosystem products and services. The contribution of ecosystems is represented via the concept of ecological cumulative exergy consumption (ECEC), which is related to emergy analysis but avoids any of its controversial assumptions and claims. The use of thermodynamics permits representation of all kinds of inputs and outputs in consistent units, facilitating the definition of aggregate metrics. Total ECEC requirement indicates the extent to which each economic sector relies directly and indirectly on ecological inputs. The ECEC/money ratio indicates the relative monetary versus ecological throughputs in each sector, and indicates the relationship between the thermodynamic work needed to produce a product or service and the corresponding economic activity. This ratio is found to decrease along economic supply chains, indicating industries that are higher up in the economic food chain price ecosystem contribution more than the basic infrastructure industries such as mining and manufacturing. The ratio of CEC with and without inclusion of ecosystems indicates the extent to which conventional thermoeconomic analysis underestimates the contribution of ecosystems. Such ratios, made available for the first time, provide unique insight into the importance of natural capital, and are especially useful in hybrid thermodynamic life cycle analysis of industrial systems. The approach, data compiled in this work, and the resulting insight provide a more ecologically conscious tool for environmental decision-making, and has potential applications at micro as well as macro scales.
Accounting↗