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PubMed2004

Cost-effectiveness of thrombolysis with recombinant tissue plasminogen activator for acute ischemic stroke assessed by a model based on UK NHS costs.

BACKGROUND AND PURPOSE: Thrombolytic therapy is licensed for use in highly selected patients with acute ischemic stroke. We aimed to model the health economic impact of limited use of thrombolytic therapy and to assess whether it was likely to be cost-effective when used more widely in the UK National Health Service (NHS). METHODS: The authors formed a discussion panel to develop the decision-analysis model of acute stroke care. It consisted of Markov state-transition processes, with probabilities of different health states determined by certain key variables. The range of estimates of efficacy of recombinant tissue plasminogen activator (rt-PA) was taken from an update to a Cochrane systematic review of randomized trials of thrombolysis. Data on outcome after stroke were taken from our hospital-based stroke register, supplemented by data derived from relevant literature sources. RESULTS: The model suggested that compared with standard care, if eligible patients were treated with rt-PA up to 6 hours, there was a 78% probability of a gain in quality-adjusted survival during the first year, at a cost of pound 13 581 per quality-adjusted life-year (QALY) gained. Over a lifetime, rt-PA was associated with cost-savings of pound 96 565 per QALY. However, the estimates were imprecise and highly susceptible to the assumptions used in the economic model; under several plausible assumptions, rt-PA was much less cost-effective than standard care, and under others, a great deal more cost-effective. CONCLUSIONS: The estimates of effectiveness and cost-effectiveness were imprecise. Although the benefits appeared promising, the data did not support the widespread use of thrombolytic therapy outside the terms of the current restricted license in routine clinical practice in the NHS. There is a case for new large-scale randomized trials comparing thrombolytic therapy with control up to 6 hours to determine more precisely the effects of rt-PA on short-term and long-term survival and its cost-effectiveness when used in a wider range of patients.

Acute Disease↗
PubMed2005

The economic value of an improved malaria treatment programme in Zambia: results from a contingent valuation survey.

BACKGROUND: Zambia is facing a double crisis of increasing malaria burden and dwindling capacity to deal with the endemic malaria burden. The pursuit of sustainable but equity mechanisms for financing malaria programmes is a subject of crucial policy discussion. This requires that comprehensive accounting of the economic impact of the various malaria programmes. Information on the economic value of programmes is essential in soliciting appropriate funding allocations for malaria control. AIMS AND OBJECTIVES: This paper specifically seeks to elicit a measure of the economic benefits of an improved malaria treatment programme in Zambia. The paper also studies the equity implications in malaria treatment given that demand or malaria treatment is determined by household socio-economic status. METHODS: A contingent valuation survey of about 300 Zambian households was conducted in four districts. Willingness-to-pay (WTP) was elicited for an improved treatment programme for malaria in order to generate a measure of the economic benefits of the programme. The payment card method was used in eliciting WTP bids. FINDINGS: The study reports that malaria treatment has significant economic benefits to society. The total economic benefits of an improved treatment programme were estimated at an equivalent of USD 77 million per annum, representing about 1.8% of Zambia's GDP. The study also reports the theoretically anticipated association between WTP and several socio-economic factors. Our income elasticity of demand is positive and similar in magnitude to estimates reported in similar studies. Finally, from an equity standpoint, the constraints imposed by income and socio-economic status are discussed.

Adult↗
PubMed2005

Is promotion of physical activity a wise use of societal resources? Issues of cost-effectiveness and equity in health.

Physical activity creates health benefits, and society makes large contributions in order to promote physical activity within the population. However, the cost-effectiveness and equity-in-health effect of these efforts is seldom evaluated. A model for economic evaluation of community-promoted physical activity has been constructed based on referenced works on the health effects of physical activity, standard methods of economic evaluation, and targets for equity in health. This model was then used to assess published evaluations. A search for programs of community-promoted physical activity aimed to promote health or prevent illness found only eight economic evaluations. Three were based on models, and five evaluated actual interventions. Almost every aspect of the model proposed in this article is included in some of the earlier studies, but several important aspects were excluded in each previous study. A cost-effectiveness analysis of community-promoted physical activity is possible, but adequate knowledge of the components of cost-effectiveness and equity-in-health effect are still limited. The most important determinants of cost-effectiveness are adherence to new habits, experience and value of time spent on physical activity, and selection of the target group.

Attitude to Health↗
PubMed2002

A statistical human resources costing and accounting model for analysing the economic effects of an intervention at a workplace.

The study had two primary aims. The first aim was to combine a human resources costing and accounting approach (HRCA) with a quantitative statistical approach in order to get an integrated model. The second aim was to apply this integrated model in a quasi-experimental study in order to investigate whether preventive intervention affected sickness absence costs at the company level. The intervention studied contained occupational organizational measures, competence development, physical and psychosocial working environmental measures and individual and rehabilitation measures on both an individual and a group basis. The study is a quasi-experimental design with a non-randomized control group. Both groups involved cleaning jobs at predominantly female workplaces. The study plan involved carrying out before and after studies on both groups. The study included only those who were at the same workplace during the whole of the study period. In the HRCA model used here, the cost of sickness absence is the net difference between the costs, in the form of the value of the loss of production and the administrative cost, and the benefits in the form of lower labour costs. According to the HRCA model, the intervention used counteracted a rise in sickness absence costs at the company level, giving an average net effect of 266.5 Euros per person (full-time working) during an 8-month period. Using an analogue statistical analysis on the whole of the material, the contribution of the intervention counteracted a rise in sickness absence costs at the company level giving an average net effect of 283.2 Euros. Using a statistical method it was possible to study the regression coefficients in sub-groups and calculate the p-values for these coefficients; in the younger group the intervention gave a calculated net contribution of 605.6 Euros with a p-value of 0.073, while the intervention net contribution in the older group had a very high p-value. Using the statistical model it was also possible to study contributions of other variables and interactions. This study established that the HRCA model and the integrated model produced approximately the same monetary outcomes. The integrated model, however, allowed a deeper understanding of the various possible relationships and quantified the results with confidence intervals.

Accounting↗
PubMed1994

A bioeconomic model for comparing beef cattle genotypes at their optimal economic slaughter end point.

A bioeconomic model of a feedlot was developed for the comparison of beef cattle genotypes under specified management and marketing conditions. The optimization behavior of commercial feedlot managers is incorporated into the model using optimum economic rotation theory. The days spent in the feedlot (rotation) by a group of animals are derived using this theory so as to maximize an objective function. Differences among breeds in the present value of profits from a single rotation, expressed per animal, represent the expected price premium paid for a feeder animal of a particular breed. Feed requirements and growth rates for a genotype are predicted over time for a specified diet from estimated mature size. Estimates of carcass fatness over time as a function of the energy content of the diet and estimates of dressing percentage over time are used for each genotype. A base model is described that incorporates biological parameters estimated for 11 breeds from a major breed comparison experiment and uses prices of inputs and outputs for Ontario feedlots. Sensitivity of the model to these biological and economic assumptions is shown. When breeds are compared at constant days fed, weight, or fat depth slaughter points, rankings are inconsistent, relative to those when each breed is slaughtered at its optimal economic point. The model can be used to establish appropriate slaughter end points for comparing beef cattle breeds and crosses and to evaluate breeding objectives for feedlot traits in genetic improvement programs.

Agriculture↗
PubMed1996

The quest for value in health care.

Purchasers and consumers of health care will increasingly refine their definitions of "quality" and the "cost" associated with treatment. The beneficial relationship of these concepts is "value." In the new era of managed care, those providers who offer the best value will succeed. Low-value producers will fail. Understanding buyer perceptions and expectations of value will become increasingly important as markets mature and integrated systems vie for dominance.

Capitation Fee↗
PubMed2000

[Stent implantation as initial coronary interventional therapy? A theoretical model on clinical and economical consequences of in-stent restenosis].

The reduction of acute complications and late restenosis compared to conventional PTCA has led to a rapid increase in stent implantation as initial treatment for coronary stenosis. As a result, in-stent restenosis has become an important clinical and economical problem, especially the diffuse form, which is much more likely to reappear. In order to compare the consequences of initial stenting and initial angioplasty, we developed an analytic model, considering the differences between diffuse and focal in-stent restenosis. The simulation based on the optimized therapeutic proceeding following an elective 1-vessel revascularization of a 60-year-old patient, dealing with probabilities for acute complications and late restenosis taken from the literature and in-hospital costs obtained from 200 elective interventions. In the stent group 71.0% of patients were free of any target lesion-related event, compared to 60.2% in the PTCA group. Catheter reintervention was necessary for 32.1% of the patients initially treated with angioplasty and for 17.6% of the initially stented patients, whereas 7.7% of the stent patients had to undergo elective bypass surgery as final treatment compared to 2.8% in the PTCA arm. Long-term medical costs for initial stenting (6,237 Euros) were 14% higher than for conventional PTCA (5,345 Euros). Taking also into consideration the indirect costs (loss of productivity) for a collective with an employment rate of 50%, the difference between stent implantation (9,067 Euros) and angioplasty (8,581 Euros) is smaller. Initial treatment of coronary stenosis by stent implantation decreases the rate of repeat revascularization compared to initial PTCA, but there is a greater likelihood that elective bypass surgery will become necessary. This difference in following treatment is related to the occurrence of diffuse in-stent restenosis. When calculating the long-term costs stenting still appeared to be more expensive than PTCAA because the savings in following costs can not compensate for the higher primary in-hospital costs. An empirical study which collects cost data in different hospitals as well as in the outpatient setting over 1 year is necessary to confirm this preliminary result.

Angioplasty, Balloon, Coronary↗
PubMed2002

Do pharmaceutical prices respond to potential patient out-of-pocket expenses?

Despite the importance of patient insurance in the market for prescription pharmaceuticals, little is known about the impact of patient reimbursement on the pricing behavior of pharmaceutical firms. I examine the link between potential patient out-of-pocket expenses and pharmaceutical pricing using a unique policy experiment from Germany. Starting in 1989, a maximum reimbursement for a given medicine replaced a flat prescription fee. This change in reimbursement exposes the patient to the price of a prescribed product. Using a product-level panel data set covering several therapeutic categories before and after the policy change, I find that producers significantly decrease prices after the change in potential patient out-of-pocket expenses. Price declines are most pronounced for brand-name products. Moreover, branded products that face more generic competitors reduce prices more.

Drug Costs↗
PubMedDate not supplied

Why a well-paid nurse is a better nurse.

In an article subtitled "Why is a Badly Paid Nurse a Good Nurse?" economist Anthony Heyes argues that nursing wages should be kept low. Counter arguments are provided based on what the authors consider more adequate economic analysis.

Altruism↗
PubMed2000

Use of the ACCES model to predict the health economic impact of celecoxib in patients with osteoarthritis or rheumatoid arthritis in Norway.

A Norwegian customization of the Arthritis Cost Consequence Evaluation System (ACCES) pharmacoeconomic model was used to predict the economic and health impact of the introduction of celecoxib in Norway. The model predicts that use of celecoxib can be expected to result in a reduction in gastrointestinal events with concomitant annual net savings of at least Norwegian krone (NOK) 580 per osteoarthritis (OA) patient and NOK 514 per rheumatoid arthritis (RA) patient. In a cost-effectiveness analysis, celecoxib demonstrated economic dominance (i.e. improved health at reduced cost) compared with the currently available alternatives. In sensitivity analyses, the results of this model have been shown to be relatively robust, with celecoxib demonstrating economic dominance or favourable cost-effectiveness ratios in all analyses. Based on these data, it can be concluded that the introduction of celecoxib into the Norwegian non-steroidal anti-inflammatory drug market, and its use as a first-line agent, will provide societal benefits by improving health care at reduced cost in patients with OA and RA.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2005

Economic evaluation: what does a nurse manager need to know?

This paper considers how health economists can assist nurse managers, using the concepts and tools of economic evaluation. We aim to clarify these and also explode some of the myths about economic evaluation and its role in health care decision-making. Economic evaluation techniques compare alternative courses of action in terms of their costs and consequences. There are four principal methods; cost-minimization, cost-effectiveness, cost-utility and cost-benefit analysis, all of which synthesize costs and outcomes, at different levels of outcome. Economic evaluation is an intrinsic part of national decision-making about the efficient provision of effective treatments and services, and increasingly, organizational matters. In the UK, such technology evaluation is disseminated in guidelines from the National Institute for Clinical Effectiveness (NICE), having a top-down impact on the nurse manager. But economic evaluation is increasingly relevant to the nurse manager at local level, through newer techniques such as Programme Budgeting Marginal Analysis (PBMA), which facilitates explicit, transparent decisions, from the bottom-up. Nurse managers need to weigh up competing demands on resources and decide in ways which maximize health gain. Economic evaluation can help here because it presents evidence to challenge or support existing allocations, and provides a systematic framework to analyse health care decisions. In the current context of competition for scarce resources, we suggest that nurse managers need to embrace these techniques, or be marginalized from the resource allocation process.

Cost Control↗
PubMed2002

A model to estimate the cost benefit of an occupational vaccination programme for influenza with Influvac in the UK.

OBJECTIVES: To model the economic impact of introducing an occupational vaccination programme for influenza with an inactivated influenza subunit vaccine (Influvac) in the UK. DESIGN AND SETTING: Using published sources, a decision tree was constructed which modelled the costs and benefits of introducing an influenza vaccine in a business in the UK from the perspective of an employer. STUDY PARTICIPANTS AND INTERVENTIONS: The model considered the implementation of an occupational vaccination programme with Influvac in a business employing 1000 normal healthy adults earning the national average wage in the UK. The model assumed that 95% of employees would be absent from work after contracting influenza for a mean of 5 days and that the level of productivity would be reduced by 60% for one day by 85% of sick employees returning to work. MAIN OUTCOME MEASURES AND RESULTS: The expected probability of an employee being absent from work following an influenza vaccination would be reduced from 5.7 to 1.8% when the incidence of influenza in the community is 6%. Accordingly, if all 1000 employees were vaccinated, a business would be expected to reduce absenteeism from work attributable to an influenza outbreak by 220 days. Moreover, the expected return on every pound invested by an employer would be UK pounds 1.03, UK pounds 3.09 and UK pounds 5.15 (2000 values) when the annual incidence of influenza in the community is 2, 6 and 10%, respectively. CONCLUSIONS: Implementation of an occupational vaccination programme with Influvac would be expected to reduce the incidence of influenza among a workforce leading to less absenteeism from work and averted lost productivity. Even if the incidence of influenza was as low as 2% it may be a worthwhile investment for UK employers to vaccinate their employees with Influvac.

Efficiency↗
PubMed2003

The use of health economic information by reimbursement authorities.

The increasing costs of health-care and the need for cost containment have resulted in a 'fourth hurdle' in the establishment of drug approval and reimbursement policies. This hurdle is the demonstration of a drug's cost-effectiveness through the process of economic evaluation. The role of models in the economic evaluation of pharmaceuticals is becoming increasingly accepted with the recent trend towards developing models with greater transparency and clinical relevance. However, health-care decisions do not, and should not, rely solely on the cost-effectiveness of a drug or intervention. Factors such as disease severity, availability of alternative treatment strategies, cost of drugs to patients, compliance with therapy and patients' satisfaction with overall treatment effectiveness should also be considered, and in some cases can be incorporated into economic evaluation. The Arthritis Cost Consequences Evaluation System (ACCES) is provided as an example of the attributes and limitations that should be considered in determining the usefulness of a model for economic evaluations with the purpose of determining reimbursement policy decisions.

Cost-Benefit Analysis↗
PubMed2006

Policy adjustment in a dynamic economic game.

Making sequential decisions to harvest rewards is a notoriously difficult problem. One difficulty is that the real world is not stationary and the reward expected from a contemplated action may depend in complex ways on the history of an animal's choices. Previous functional neuroimaging work combined with principled models has detected brain responses that correlate with computations thought to guide simple learning and action choice. Those works generally employed instrumental conditioning tasks with fixed action-reward contingencies. For real-world learning problems, the history of reward-harvesting choices can change the likelihood of rewards collected by the same choices in the near-term future. We used functional MRI to probe brain and behavioral responses in a continuous decision-making task where reward contingency is a function of both a subject's immediate choice and his choice history. In these more complex tasks, we demonstrated that a simple actor-critic model can account for both the subjects' behavioral and brain responses, and identified a reward prediction error signal in ventral striatal structures active during these non-stationary decision tasks. However, a sudden introduction of new reward structures engages more complex control circuitry in the prefrontal cortex (inferior frontal gyrus and anterior insula) and is not captured by a simple actor-critic model. Taken together, these results extend our knowledge of reward-learning signals into more complex, history-dependent choice tasks. They also highlight the important interplay between striatum and prefrontal cortex as decision-makers respond to the strategic demands imposed by non-stationary reward environments more reminiscent of real-world tasks.

Adult↗
PubMed2003

Anticipating market effects of new uses for whey and evaluating returns to research and development.

As U.S. dairy farms continue to become more productive, increasing demand is a key to improved economic prospects for the dairy industry. One way to expand demand for dairy products is to find new, economically viable uses for milk. Ex ante economic analysis of new uses for agricultural products anticipates the potential market effects of innovations, and provides a basis for evaluating investment in research and development and setting research priorities. This study evaluated potential economic effects of new applications of films and coatings made from whey protein. An economic simulation model was used to predict the likely effects of the innovations on dairy markets. Cost comparisons with existing technologies and interviews with industry officials were the basis for evaluating potential for commercial adoption of the innovations. The economic simulation model traces the projected increased demand for whey through the markets for dairy products and milk. The associated increased demand for milk could result in benefits to U.S. milk producers of $123.0 million in present value terms, compared to a research cost of $ 4.9 million, with the dairy industry, consumers, and taxpayers all contributing. Interpreting the cost of the research program as an investment on behalf of milk producers, the benefits to producers from development of new whey uses represent an annual rate of return between 28 and 33%. These results are useful for evaluating further investment in the whey research program. The methods illustrated here are applicable to the evaluation of a wide range of research and promotion efforts.

Commerce↗
PubMed1983

Factor rewards and the international migration of unskilled labor: a model with capital mobility.

"Conventional economic wisdom holds that the migration of unskilled labor from less developed countries to neighboring developed countries should be expected to narrow the wage gap between those countries, and thereby reduce the incentive for further migration. [The authors suggest that] if capital is mobile internationally this reasoning may be inappropriate. Instead, emigration of unskilled labor out of the less developed country provides an incentive for capital to leave the country, too. As a consequence, wage rates move in the same direction in each country, and the gap between wage rates across countries even may increase."

Demography↗