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PubMed1997

Measuring the human cost of a weak economy: does unemployment lead to alcohol abuse?

This paper uses two-stage instrumental variables methods to examine whether unemployment affects alcohol use and symptoms of dependence, and if so, in which direction. Data were obtained from the 1988 National Health Interview Survey. The outcomes examined were average daily consumption during the previous two weeks and a summary measure of the number of symptoms related to alcohol dependence during the previous year. After eliminating potential bias due to reverse causality, evidence was found that non-employment significantly reduces both alcohol consumption and dependence symptoms, probably due to an income effect. Involuntary unemployment had a mixed effect-job loss increased the consumption of alcohol in the overall sample but reduced dependence symptoms among single respondents. Studies of the impact of alcohol use on economic outcomes should take potential reverse causality into account.

Adult↗
PubMed1997

Managed care: the next generation.

Managed care today affects most Americans. Of the 160 million Americans receiving employee coverage, 120 million are in a managed care setting. HMO development to date has been driven by the desire to reduce health benefit costs for employers. Employees, the real consumers, perceive a clash between "good care and good profits." Health plans have generated profits by reducing utilization and keeping a portion of the savings. In the future, market conditions will force plans to develop new ways of maintaining profitability. Also, plans will survive by focusing on factors that matter most to consumers-such as overall care quality and access. Care systems that combine the benefits of open-access systems with the benefits of point-of-service products represent the next generation of consumer-driven healthcare.

Community Participation↗
PubMed2002

Introduction of lamivudine for the treatment of chronic hepatitis B: expected clinical and economic outcomes based on 4-year clinical trial data.

BACKGROUND: Chronic hepatitis B (CHB) is associated with a significant burden of illness and treatment involves substantial health-care costs. This study estimates clinical outcomes and cost-effectiveness of lamivudine compared with other treatment scenarios for CHB, from an Australian health-care provider perspective. METHODS: A two-step modeling approach depicted clinical progression of hepatitis B in hypothetical patient cohorts using three different treatment scenarios: scenario A, lamivudine and alpha-interferon (IFN-alpha) available; scenario B, IFN-alpha available only; and scenario C, no treatment available. Assumptions were based on clinical trials, published studies, a hepatologist's questionnaire and an expert panel follow up. One-year clinical outcomes and costs were estimated using a decision tree, while lifetime costs and outcomes were estimated using available clinical trial data for lamivudine (up to 4 years therapy duration) and a Markov model. RESULTS: The analysis considered only patients with pretreatment elevated alanine aminotransferase levels > or = 2 x upper limit of normal. In the short term, the introduction of lamivudine is expected to result in almost 3.5 times more CHB patients receiving therapy (lamivudine or IFN-alpha) compared to IFN-alpha only (67% compared to 20%, respectively). Hence, scenario A subsequently doubled the seroconversion rate. The incremental cost-effectiveness ratio was $3341 Australian per additional seroconversion. Also, non-seroconverted lamivudine patients are less likely to progress to cirrhosis than those receiving IFN-alpha/no treatment. One-year progression to cirrhosis was estimated at 5.1% with scenario A, compared to 12.2% and 12.7%, scenarios B and C, respectively. From the long-term analysis, lamivudine is expected to increase life expectancy by years and reduce the lifetime risk of compensated cirrhosis, decompensated cirrhosis and hepatocellular carcinoma by 6%, 12% and 12%, respectively. Additionally, the introduction of lamivudine decreases lifetime costs by $548, thus making it a cost-saving and life-extending strategy. In both short- and long-term models, worst case scenarios in sensitivity analyses still associate lamivudine with a favorable cost-effectiveness ratio. CONCLUSION: Introduction of lamivudine is expected to improve health outcomes in CHB patients, resulting in overall savings in health-care costs. In this model, compared with IFN-alpha only and no treatment, lamivudine allowed more CHB patients to be treated, increased the seroconversion rate, delayed disease progression and prolonged life expectancy.

Antiviral Agents↗
PubMed2000

Competitive coexistence in antiviral immunity.

Adaptive immunity to viruses in vertebrates is mediated by two distinct but complementary branches of the immune system: the cellular response, which eliminates infected cells, and the humoral response, which eliminates infectious virus. This leads to an interesting contest, since the two responses compete, albeit indirectly, for proliferative stimuli. How can a host mount a coordinated antiviral campaign? Here we show that competition may lead to a state of "competitive coexistence" in which, counterintuitively, each branch complements the other, with clinical benefit to the host. The principle is similar to free-market economics, in which firms compete, but the consumer benefits. Experimental evidence suggests this is a useful paradigm in antiviral immunity.

Animals↗
PubMedDate not supplied

Between economics and ecology: some historical and philosophical considerations for modelers of natural capital.

Natural capital models attempt to remediate the relationship between economics and ecology either by conjoining models and theories from each discipline or by finding a type of phenomena that can be meaningfully measured by both fields. The development of a widely accepted model that integrates economics and ecology has eluded researchers since the early 1970s. This paper offers an historical and philosophical perspective on some of the conceptual problems or obstacles that hinder the development of natural capital models. In particular, the disciplinary assumptions of economic science and ecological science are examined and it is argued that these assumptions are antithetical. Hence, the development of an effective and accepted natural capital model will require that economics and ecology reconsider their self-conceptions as sciences. For the purposes of theoretical research and practical policy, the paper cautions against confusing the issue of whether or not economic models accord with ecological models with the issue of whether or not economic activities accord with ecological realities.

Conservation of Natural Resources↗
PubMed1987

Economics of Brucella ovis control in sheep: epidemiologic simulation model.

The epidemiology and economics of Brucella ovis control in a hypothetical, commercial sheep flock (100 rams and 2,500 ewes) were investigated. The investigation consisted of an epidemiologic simulation model, reported here, and a decision-tree analysis, reported in a companion paper. The epidemiologic model was designed to simulate the transmission and persistence of B ovis in a ram flock during the mating season as well as the nonmating (isolation) season. A constant contact rate was selected for the nonmating season and a varying contact rate was selected for the mating season to reflect changes in numbers of ewes in estrus. These contact rates were used to evaluate all possible combinations of 5 control alternatives for flock infection rates ranging from 0% to 38%. Vaccination was found to be more effective as a control strategy when the prevalence of flock infection was high (greater than 15%); however, it did not substantially reduce B ovis transmission when the prevalence of flock infection was low (less than 10%). The effect of increasing vaccine efficacy from 40% to 80% had minimal effect on incidence of new cases. The speed with which B ovis could be eradicated depended on the initial prevalence of infection and the screening tests used (palpation, semen testing for leukocytes, and ELISA). All combinations of screening tests verified the usefulness of palpation. Simulation model results indicated that it may be feasible to eradicate B ovis from flocks with moderate to high (10% to 38%) prevalence of infection by culling on the basis of 2 sequential tests.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMedDate not supplied

Using conjoint analysis to assess women's preferences for miscarriage management.

To date, standard gamble, time trade-off, visual analogue and, more recently, willingness to pay, have been most commonly employed in health economics to assess utilities from various health care interventions. This article considers the use of conjoint analysis as an alternative technique to assess utilities. The technique is applied to assess women's preferences for the management of miscarriage. The paper addresses methodological issues in the application of the technique to health care and demonstrates its use in estimating willingness to pay and utilities. It is concluded that conjoint analysis is potentially a very useful tool and that future research should investigate more thoroughly the potential application of the technique in health economics.

Abortion, Spontaneous↗
PubMed1999

Economic evaluation of pharmacy services--fact or fiction?

Previous attempts to conduct economic evaluation of pharmacy services are almost exclusively from the US and the UK. Studies from the US concentrate largely on the drug cost savings realised by pharmacists. Few detail the costs of service provision and even fewer give an estimate of service benefits other than decreased drug expenditure. UK evaluation to date focuses on quantifying pharmacists' interventions, but there is no clear indication of the quality or the impact of these. This article proposes a model for economic evaluation and discusses the factors which make evaluation results useful to decision makers. The costs and outcomes, that need to be considered for economic evaluation, are discussed and the example of a pharmacist led anticoagulation clinic is used. The nature of modern health care systems demands that services are effective and, increasingly, cost-effective. If pharmacy as a profession is to develop, decision makers must decide that pharmaceutical care delivered by pharmacists is a cost-effective use of health care resources. Politics, education and cost pressures will mean that decision makers are likely to put more weight on the results of economic evaluation in future. If pharmacists do not start to provide good quality data about the costs and outcomes of pharmacy services then other evaluators will.

Clinical Trials as Topic↗
PubMed2006

A method to define breeding goals for sustainable dairy cattle production.

The objective of this study was to present a method to define breeding goals for sustainable dairy cattle production by adding nonmarket values to market economic values for functional traits in the breeding goal. A nonmarket value can represent the value of improved animal welfare or societal influences for animal production. The nonmarket value for mastitis resistance, conception rate, and stillbirth were derived based on how much farmers or breeding companies were willing to lose in selection response for milk yield to improve functional traits. The desired response for milk yield corresponding to a given percent loss was obtained using desired gain indices. By allowing a 5% loss in the selection response for milk yield, the nonmarket value was found to be 40.4 euro for mastitis resistance, 16.1 euro for conception rate, and 9.7 euro for stillbirth. The nonmarket value increased proportionally with increasing loss in the selection response for milk yield, but the selection response was lower for conception rate than for mastitis resistance because of differences in market economic value and heritability. To increase the response for conception rate, the nonmarket value was also derived for 2 situations, in which the desired responses for milk yield, mastitis resistance, and conception rate were specified. The method can be used to define breeding goals for sustainable production and to increase the response for traits that are at critically low levels. When defining breeding goals for sustainable production, breeding organizations should predict the selection response based on market economic value and add non-market value for traits with unacceptable selection responses.

Animals↗
PubMed1997

Components of the costs of controlling quality: a transaction cost economics approach.

This article identifies the components that contribute to a healthcare organization's costs in controlling quality. A central tenet of our argument is that at its core, quality is the result of a series of transactions among members of a diverse network. Transaction cost economics is applied internally to analyze intraorganizational transactions that contribute to quality control, and questions for future research are posed.

Cost Allocation↗
PubMed1993

Creating a market: an economic analysis of the purchaser-provider model.

The focus of this paper is the extent to which the purchaser-provider split and the creation of a market in the provision of health care can be expected to bring about greater efficiency within the new NHS. The starting point is a theoretical discussion of markets and competition. In particular, emphasis is placed upon the economic model of perfect competition. It is argued that because of the existence of externalities, uncertainty and a lack of perfect information, an unregulated market in health care will almost certainly fail. In view of this, the imperfect provider markets of monopoly and contestable markets, which are of particular relevance to health care, are discussed. A description of the new health care market and the principal actors within it is followed by an evaluation of the new health care market. It is argued that in view of the restrictions to competition that exist between providers, some form of price regulation will be necessary to prevent monopolistic behaviour in the hospital sector. Regulation of purchasers is also suggested as a means of improving efficiency. It is concluded that competition may be a necessary condition for increased efficiency in health care provision, but is not sufficient in itself. Other incentives in the hospital sector are necessary to assist the market process and to enhance its impact on efficiency.

Contract Services↗
PubMed2006

Cost-effectiveness of using recombinant human TSH prior to radioiodine ablation for thyroid cancer, compared with treating patients in a hypothyroid state: the German perspective.

OBJECTIVE: This investigation evaluated the cost-effectiveness of radioiodine remnant ablation following preparation with recombinant human TSH (rhTSH), compared with the standard preparation, whereby patients are rendered hypothyroid. DESIGN: The economic evaluation relates to patients with well differentiated thyroid cancer who have undergone thyroidectomy, but have no metastases. The evaluation takes a societal perspective, considering costs and benefits to all parties. The benefits were expressed in units of quality-adjusted life years (QALY), so differences in life expectancy were captured with consideration of quality of life. METHODS: A lifetime Markov model with Monte Carlo simulation of 100,000 patients was used to assess cost per QALY gained. The clinical inputs were sourced from a multi-centre, randomised controlled trial comparing remnant ablation success after rhTSH-preparation with hypothyroid preparation. The model applied German unit costs, however, the structure is generalisable to other jurisdictions. The additional cost of rhTSH procurement and administration is considered relative to the clinical benefits and cost offsets. These included avoidance of hypothyroidism, increased work productivity, earlier discharge from radioprotection and a theoretical reduction in the risk of secondary malignancy. The latter two benefits relate to faster radioiodine clearance after rhTSH preparation. RESULTS: The additional benefits of rhTSH (0.0495 QALY) are obtained with an incremental societal cost of 47 euro, equating to an incremental cost per QALYof 958 euro. Sensitivity analyses had only a modest impact upon cost-effectiveness, with all one-way sensitivity results remaining under 15,000 euro/QALY. CONCLUSIONS: The use of rhTSH prior to radioiodine ablation represents good value-for-money with the benefits to patient and society obtained at modest net cost.

Combined Modality Therapy↗
PubMed2001

[Polish Multicenter Study on Diabetes Epidemiology (PMSDE)--1998-2000].

Diabetes mellitus is a growing health problem at all ages in all countries. The Saint Vincent Declaration signed by the representatives of all European countries--among them by Poland--indicated the main goals to reduce this burden. This may be achieved by elaboration and initiation of the nation-wide programme for early detection and control of diabetes on the population level. The Polish Task Force for Diabetes Management worked out and put into operation in 1998 the project commissioned by the Ministry of Health funded by the Polish State Committee for Research (PBZ-018-11). The urgent need for the implementation of this programme was a result of the increasing number of diabetic patients on the primary health care level, diabetic complications and hospitalisations. The programme was based on the assumption that primary and secondary prevention of NIDDM may eliminate or reduce its risk factors and therefore decrease its prevalence and morbidity and should integrate epidemiology, identification of risk factors, education, intervention models and economics of diabetes. This issue of the Polish Archives of Internal Medicine contains the main results of the programme and reflects an actual situation of diabetes in Poland creating a rational basis for intervention on the population level. Evaluation of the incidence rate of the diabetes type 1 in 10 selected areas (population basis 30% of age group 0-29) revealed values from 8.4 to 14.7/100,000 in the age group 1-14 and from 4.4 to 11.2/100,000 in the age group 15-29. It accounts for the 2-3 fold increase in comparison with the results achieved in 1986 (Z. Szybinski). However an ascertainment of the register in the age group 15-29 dropped down during the last 10 years and additional sources of data must be involved in the survey. Prevalence of diabetes type 2 in 3 selected areas Krakow 10.77% (M. Szurkowska), Lublin 15.6% (J. Łopatynski) and Łódź 15.7% (J. Drzewoski) based on the population random sample over 35 years of age, constitutes over 90% of all patients with diabetes. When standardized to the Polish population the prevalence of diabetes type 2 accounts for 5.37% and reflects a true endemic state. With comparison to a similar survey carried out in 1986 in Wrocław the prevalence 3.71% of the diabetes type 2 increased 2-3 times. It allowed to calculate an actual number of patients with diabetes type 2--over 2 million and around 50% of them represents "unknown" diabetes. Such high contribution of the unknown non-diagnosed diabetes has been confirmed in the survey carried out in Poznań on the non-randomized professional group of persons (B. Wierusz-Wysocka) in investigation on the first-degree relatives of patients with known diabetes in Warsaw (T. Kasperska-Czyzyk) and in Wroclaw (R. Wasikowa). This raises the question about the criteria of diagnosis for unknown diabetes. Comparative analysis carried out in Krakow revealed that fasting glycemia 7.0 mmol/L allowed to diagnose diabetes with 50% with respect to the 2 hours oral glucose tolerance test (WHO 1985) and shouldn't be use as a tool for early diagnosis of diabetes type 2 (Z. Szybinski, M. Szurkowska) Identification of the risk factors in PMSDE for diabetes type 2 allowed to introduce the term "global risk factors", divided into two groups primary (obesity, age, pregnancy and genetic background) and secondary (hyperinsulinemia, hyperglycemia, dyslipidemia and hypertension). In the multifactor analysis obesity and hyperinsulinemia are the strongest predictors and modifiable risk factors of the development of diabetes type 2 and late complications. Especially hyperinsulinemia as an independent secondary risk factor for hypertension, dyslipidemia--in consequences late diabetic complications and perhaps carcinogenesis may play an important role as a predictor of diabetes type 2 and biochemical marker of effectiveness of non-pharmacological and pharmacological approach in the global concept of diabetes type 2 treatment (Z. Szybinski). Analysis of the late complications of diabetes were focussed on visual disability and lower extremity amputation due to diabetic foot development. Analysis of prevalence (PR) of visual disability due to diabetes in Krakow (J. Pantoflinski) and Olsztyn (E. Bandurska-Stankiewicz) revealed similar values, in the both areas around 6% of general visual disability in population. Monitoring of the visual disability in diabetic patients seems to be a good indicator of the quality level of the diabetic care. Analysis of the lower extremity amputation carried out in Krakow district (A. Nazim) revealed that incidence rate of amputation in diabetics was 15 times higher than in non-diabetics and in 10.8% of cases amputation was performed in unknown diabetes type 2. The preventive measures and non-pharmacological and pharmacological management approximately in diabetes should be solved with education based on the separate post of a diabetic educator within a diabetic team and on the primary health care level. The articles presenting elaborated educational model in diabetes are published in "Diabetologia Polska" (A. Czyzyk). Intervention model was tested in Krakow in the groups of obese patients with newly diagnosed "unknown" diabetes and was based on the 12 weeks supervised dietician education with standardized physical activity programme. In obese diabetic patients the weight loss less than 10% of the initial body weight can markedly improve biochemical parameters like hyperglycemia dyslipidemia and hyperinsulinemia without pharmacological therapy and 45% of patients has been transferred to the group of Impaired Glucose Tolerance (A. Gilis-Januszewska). Another model of intervention may be applied in menopausal women (J. Nadel, K. Cypryk) treated with hormonal replacement therapy as a complementary factor to education and if necessary to anti-diabetic drugs. Increase number of diabetic patients especially of the "unknown" type 2 has serious economic aspect by increasing a burden of patients, theirs families, society and health care system. Within PMSDE programme elaboration of the model for calculation the direct costs about of diabetes and burden in terms of years of life lost using DALY measure was performed (K. Kissimova-Skarbek). Average diabetes type 1 patients costs 7 times and type 2 over 3 times higher than average health care cost and 95% of total time lost due to disability is caused by diabetes type 2. Therefor primary and secondary prevention of diabetes typ 2 have highest priority among strategic preventive targets. The Review Conference held in Warsaw at 24-25 February 2001 in the presence of WHO Experts formulated the recommendations focused on: 1. Elaboration of high risk strategy for early diagnosis of unknown diabetes type 2 based on the 2-hours OGTT (WHO 1985) 2. Continuation of the epidemiologic study in diabetes 3. Instituting the professional post for diabetes educator on the specialized and primary health care levels. 4. Further research are recommended for evaluation of the role of fasting glycemia and hyperinsulinemia as predictors and risk factors of diabetes type 2, for development of preventive models in diabetes type 2 and for development of the economical models to asses the costs of diabetes (Recommendations).

Adult↗
PubMed2004

Neuroeconomics: the consilience of brain and decision.

Economics, psychology, and neuroscience are converging today into a single, unified discipline with the ultimate aim of providing a single, general theory of human behavior. This is the emerging field of neuroeconomics in which consilience, the accordance of two or more inductions drawn from different groups of phenomena, seems to be operating. Economists and psychologists are providing rich conceptual tools for understanding and modeling behavior, while neurobiologists provide tools for the study of mechanism. The goal of this discipline is thus to understand the processes that connect sensation and action by revealing the neurobiological mechanisms by which decisions are made. This review describes recent developments in neuroeconomics from both behavioral and biological perspectives.

Animals↗
PubMed2006

Economic gains and health benefits from a new cigarette tax scheme in Taiwan: a simulation using the CGE model.

BACKGROUND: This study evaluates the impact of an increase in cigarette tax in Taiwan in terms of the effects it has on the overall economy and the health benefits that it brings. METHODS: The multisector computable general equilibrium (CGE) model was used to simulate the impact of reduced cigarette consumption resulting from a new tax scheme on the entire economy gains and on health benefits. RESULTS: The results predict that because of the new tax scheme, there should be a marked reduction in cigarette consumption but a notable increase in health benefits that include saving between 28,125 and 56,250 lives. This could save NTD 1.222 approximately 2.445 billion (where USD 1 = NTD 34.6) annually in life-threatening, cigarette-related health insurance expenses which exceeds the projected decrease of NTD 1.275 billion in Gross Domestic Product (GDP) because of reduced consumption and therefore tax revenue. CONCLUSION: Overall, the increased cigarette excise tax will be beneficial in terms of both the health of the general public and the economy as a whole.

Adult↗
PubMedDate not supplied

Nurse-supported breastfeeding promotion: a framework for economic evaluation.

Increasingly, economic evaluation results are considered by policymakers, although few nurse-led interventions have undergone such an evaluation. Nurse-supported breastfeeding promotion is used as an exemplar to illustrate economic evaluation. Past work is critiqued and lessons learned are described.

Attitude to Health↗
PubMedDate not supplied

An organizational and economic framework for restructuring psychiatric nurse labor use.

A conceptual framework of psychiatric nurse labor use is developed based on organizational and economic theories. The relationship between staffing decisions and quality of care is presented. Implications for restructuring the workforce within the context of managed care and increased cost containment pressures are discussed. The importance of using a conceptual framework to guide staffing evaluations, research, and management decisions is emphasized.

Cost Control↗