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At least 1,243 records · Page 69Linked to original sources
PubMed2005

Pharmacoeconomic evaluation of schizophrenia in Taiwan: model comparison of long-acting risperidone versus olanzapine versus depot haloperidol based on estimated costs.

Antipsychotics are the keystone in schizophrenia treatment. Although the benefits of the new generation of antipsychotics has been demonstrated over the last decade, the issues of patient compliance and higher purchasing price of atypical antipsychotics remain unresolved. Risperidone is the only atypical antipsychotic agent with long-acting formulation. Long-acting risperidone is a water-based injection and it has been associated with a low level of pain. The aim of the present study was to test whether an improvement in compliance with the use of a long-acting risperidone, compared with olanzapine and depot haloperidol, can increase the effectiveness and the cost-effectiveness indexes. An economic comparison model with decision tree, rather than a prospective design with real clinical drug trial, was applied. The unit cost for each medical procedure was obtained from the claimed-database of the Bureau of National Health Insurance in Taiwan. An executive committee simulated the incidence of extrapyramidal side-effects and proposed a therapeutic model for each strategy based on a literature review. The probabilities of treatment response of different agents and those of different mental health states were estimated by the executive committee and 10 senior psychiatrists who were randomly selected. Sensitivity analysis was performed for drug cost-effectiveness and compliance improvement for using long-acting risperidone. The results showed that long-acting risperidone is more cost-effective than either olanzapine or depot haloperidol for treating schizophrenia patients whose conditions are stable and whose illness duration ranges from 1 to 5 years. The comparison model with the Kaplan-Meier decision tree may serve as an alternative to prospectively designed studies for cost-effectiveness of atypical antipsychotics.

Adult↗
PubMed1998

A model to estimate the potential economic benefits of measles eradication for the United States.

Measles incidence is at a nadir in many parts of the world due to vaccination efforts. Although the technical feasibility of eradication has been acknowledged, financial and political commitment need to be concomitantly identified on the national and global level. We demonstrate the potential value of measles eradication by identifying the potential cost-savings to one country resulting from measles eradication. For the US, measles eradication would save $45 million annually. If achieved by the year 2010, the US would save $500 million to $4.1 billion depending on the year of elimination, post-eradication schedule and discount rate. Intensification of measles control efforts in the US beyond current levels would have minimal marginal benefits on disease burden reduction. Allocation of resources to achieve global measles eradication is the next level of efficiency which would provide substantial savings. Countries may adapt this model to estimate their savings for consideration of the required political and financial contribution towards a global measles eradication program.

Adolescent↗
PubMed2003

The economics of abrupt climate change.

The US National Research Council defines abrupt climate change as a change of state that is sufficiently rapid and sufficiently widespread in its effects that economies are unprepared or incapable of adapting. This may be too restrictive a definition, but abrupt climate change does have implications for the choice between the main response options: mitigation (which reduces the risks of climate change) and adaptation (which reduces the costs of climate change). The paper argues that by (i) increasing the costs of change and the potential growth of consumption, and (ii) reducing the time to change, abrupt climate change favours mitigation over adaptation. Furthermore, because the implications of change are fundamentally uncertain and potentially very high, it favours a precautionary approach in which mitigation buys time for learning. Adaptation-oriented decision tools, such as scenario planning, are inappropriate in these circumstances. Hence learning implies the use of probabilistic models that include socioeconomic feedbacks.

Adaptation, Psychological↗
PubMedDate not supplied

Projecting future medical care costs using four scenarios of lifestyle risk rates.

PURPOSE: This study predicts medical care expenditures over 10 years for Union Pacific Railroad (UPRR) under alternative health risk factor scenarios for the UPRR workforce. DESIGN: This paper describes the development of an economic forecasting model to predict medical care expenditures assuming four different scenarios of population risk. The variables used to predict medical care expenditures are employee demographics and health risk profiles. SETTING: UPRR is a transportation company with more than 56,000 employees in 25 states west and south of the Mississippi River. SUBJECTS: Employees of UPRR. MEASURES: Intermediate outcomes included health risk measures related to exercise patterns, body weight, eating habits, smoking, alcohol consumption, total cholesterol, blood glucose, blood pressure, stress, and depression. Major outcome measures included projected total annual payments by UPRR for medical care services for the decade following 1998. RESULTS: The UPRR work force is projected to grow by 500 employees per year over the 10-year study period. The average age is expected to increase from 44 to 48 years. Without further health promotion intervention, 7 of the 11 risk factors assessed would likely worsen among UPRR's workforce. Medical care cost increases are projected to range from $22.2 million to $99.6 million in constant 1998 dollars over the next decade, depending on the effectiveness of risk factor modification programs. With an expected health promotion budget averaging $1.9 million annually over 10 years, health risks must decline at least 0.09% per year for the program to pay for itself. CONCLUSIONS: Estimating various risk and cost scenarios can facilitate program planning and produce an economic justification for worksite health programs.

Adult↗
PubMed2006

The economic costs of dementia in Korea, 2002.

OBJECTIVE: To estimate the economic costs of dementia in 2002 using an economic evaluation model for dementia care. METHODS: Data were from the Korea National Survey of the Long-Term Care Need (LTC survey) (n = 5058), two prospective 1-year studies [one clinical trial (n = 234), one naturalistic community cohort study (n = 107)], and two epidemiologic community studies for prevalence of dementia (n = 1037 + 1481). Daily costs and proportions of different levels of institutional service provided were collected from the LTC survey. Resource use in the community included health care services, social care services, out-of-pocket purchase for self-support, caregiver time and missed work of caregiver. Costs in community were calculated based on resource utilization multiplied by the unit costs for each resource. RESULTS: Total annual costs of dementia were estimated to be over 2.4 billion US dollars for 272,000 dementia sufferers. Costs in community represent 96% of the total annual costs, while costs of informal care and missed work of caregivers were 1.3 billion US dollars, or 55% of total annual cost. Average annual costs of full time care (FTC) and pre-FTC in community LTC were 44 121 US dollars and 13 273 US dollars per person, whereas cost per patient who did not need community LTC was 3,986 US dollars. CONCLUSION: Given that the number of dementia sufferers is projected to increase in the near future and that larger part of the costs are subsidized by the government, the economic and social costs of dementia is significant not only for dementia sufferers and their caregivers, but also for society.

Aged↗
PubMedDate not supplied

Comparison of health care financing in Egypt and Cuba: lessons for health reform in Egypt.

Egypt and Cuba are both lower-middle income countries with a history of socialist rule, which have embarked on economic liberalization since the 1990s. Cuba has achieved exemplary health status whereas health status in Egypt is lower than could be expected for its level of income. In this article, health care financing mechanisms in both countries are analysed on their effectiveness, efficiency, and equity, with the objective of identifying the determinants of success in the Cuban health system from which valuable lessons for current health reforms in Egypt may be derived.

Cross-Cultural Comparison↗
PubMed1998

Shortcomings of current genetic evaluation systems.

Genetic evaluation, as the term is used today in the beef cattle and sheep industries, refers to the calculation and dissemination of genetic predictions for individual traits. If genetic predictions are to be used wisely, however, genetic evaluation should be broadened to include multiple-trait selection technology, preferably technology that is customized for individual commercial and seedstock producers. Most of the recent research in the area of genetic prediction/multiple-trait selection has focused on the use of economic selection indexes that incorporate genetic predictions produced within breeds. This approach is complicated by genotype x genotype, genotype x environment, and more complex interactions, and the changing correlations they create. The use of a mechanistic technology, bioeconomic simulation, to calculate economic weights can avoid some of the problems caused by interactions, but to implement this technology, academic animal breeders must accept the mechanistic concept of genetic potential and devise ways to translate current within-breed genetic predictions to predictions of this new measure. Sire selection by simulation, a multiple-trait selection technology described in detail in this article, uses bioeconomic simulation in a way that offers advantages over traditional selection indexes in terms of both functionality and appeal. For any customized technology to be applied on a meaningful scale, research priorities must change, and the business relationships between research groups and animal breeding industries must be restructured.

Animals↗
PubMed2001

When should an effective treatment be used? Derivation of the threshold number needed to treat and the minimum event rate for treatment.

Clinicians and patients must decide when treatment effects are large enough to more than offset the adverse effects and costs of therapy. Calculation of the number of patients one needs to treat (NNT) in order to prevent one patient from having the target event is one tool to help with this decision. Clinicians should treat patients when the NNT is lower than a threshold NNT at which point the therapeutic risk equals the therapeutic benefit. We aimed: (1) to identify the determinants of the threshold NNT, and (2) to derive equations for the explicit estimation of the threshold NNT and of the minimum expected rate of target event, without treatment, above which treatment is justified. We conceived the threshold number needed to treat to prevent one target event as the point at which the benefits of treating that number of patients equal the negative consequences of treating that same number of patients. After identifying the various elements comprising the treatment impact, we equated the benefits and negative consequences and solved the equation for threshold NNT. We then derived the minimum expected rate of target event which would justify treatment. We derived an equation that relates the threshold NNT to the treatment-attributable adverse event rates (AER) and the relative values (RV) of the adverse events compared to that of the target event prevented. Specifically, the threshold NNT, denoted NNT(T) is given by NNT(T) = 1/(AER(1).RV(1) +...+ AER(n).RV(n)). We also derived a more complex equation which addresses the costs incurred by treatment and costs avoided by preventing target events. Solving the equation that includes costs requires specifying both the value of preventing a target event and the values of adverse treatment effects in economic units. The threshold NNT and the relative risk reduction (RRR) for the target event determine the minimum target event rate above which treatment is justified. This minimum event rate for treatment is 1/(NNT(T).RRR). The values that clinicians and patients use determine the threshold NNT and therefore also the minimum target event rate, without treatment, above which treatment is justified. Quantification of the determinants of the threshold NNT and of the minimum event rate to justify treatment can assist clinicians and patients in the explicit use of underlying values when making treatment decisions.

Cost-Benefit Analysis↗
PubMed1998

The effects of treatment on the direct costs of diabetes.

Treatment of diabetic complications consumes health care resources. Intensive therapy was shown by the Diabetes Control and Complications Trial (DCCT) to avert complications. Economic analyses and models have been used to evaluate the cost-effectiveness of intensive therapy for people with type 1 and type 2 diabetes. An economic analysis of the DCCT estimated the cost of intensive therapy to be two to three times greater than that of conventional therapy. In contrast, an economic model predicts that intensive therapy, as compared with conventional therapy, could reduce blindness from 34 to 20% or by 41%, end-stage renal disease from 24 to 7% or by 71%, and lower-extremity amputations from 7 to 4% or by 43%. Although intensive therapy is more expensive, when the costs of complications are factored in, it becomes cost-effective for treatment of type 1 diabetes. Similarly, a model to evaluate the cost-effectiveness of intensive therapy for people with type 2 diabetes found that the lifetime costs of general and diabetes-related medical care would be approximately two times greater. However, the reduction in lifetime costs of complications, which would produce substantial reductions in costs of treatment, largely offsets the difference. Intensive therapy for type 1 and type 2 diabetes may be more expensive than conventional therapy, but from an economic perspective, it is comparable in cost to pharmacological therapies for people with hypertension and hypercholesterolemia. From a health system viewpoint, intensive therapy represents a fruitful long-term financial investment.

Amputation, Surgical↗
PubMedDate not supplied

Economic evaluation for hepatitis C.

This paper describes the methods used in economic evaluation and illustrates the challenges of assessing the cost-effectiveness of new interventions in Hepatitis C (HCV), where the impact of interventions needs to be assessed over the patient's lifetime. This paper provides an example of an economic evaluation in HCV using a model estimating the cost-effectiveness of combination therapy (CMB) for patients with mild HCV. The preliminary results from the model suggested that for 1000 cases with mild disease CMB lead to 55 fewer deaths from liver disease compared to no treatment, an average gain of 1.2 life years. Although CMB lead to additional costs of 14,882 EURO's, the cost-effectiveness ratio was 8,490 EURO's per Quality Adjusted Life Year (QALY), which suggests the intervention is relatively cost-effective. The sensitivity analysis showed that the cost-effectiveness ratio was sensitive to the effectiveness of the intervention, and the progression rates between mild disease and cirrhosis. A large UK study is collecting data on the effectiveness of CMB for patients with mild disease, and the costs and quality of life for patients at different stages of HCV. These data will be used to improve the projections of the model. In general, economic evaluations can provide information to help decide where priorities lie both in HCV, and other disease areas.

Cost-Benefit Analysis↗
PubMed1997

Disruptive behavior and the determinants of costs in the public mental health system.

Efforts to increase the cost-effectiveness of public mental health systems are hindered by inadequate information about the determinants of use and cost. This paper reviews empirical research and theory suggesting that costs in the public health system are affected more by the disruptive behavior of persons with severe mental illness than by their age, sex, race, and diagnosis, which have been the focus of most economic studies. The author proposes modifications of traditional theories of health service use to explicitly account for the role of disruptive behavior in determining public mental health system costs. He describes a help-seeking pathway in the public mental health system in which the decision to seek treatment is initiated not by the mentally ill person but by others affected by the person's disruptive behavior. This "other-determined" pathway into treatment is contrasted with the self-determined pathway in which an individual with distressing symptoms makes a rational choice to seek help. Empirical research consistent with the other-determined perspective will help target clinical interventions and system reforms to the factors responsible for high-cost mental health care and will improve the ability to predict resource use from observable clinical characteristics of consumers.

Cost-Benefit Analysis↗
PubMed2003

Risk-adjusted expected return for selection decisions.

The results of genetic evaluation are predictions of breeding values for the selection candidates, and these involve uncertainty with regard to future returns from the use of those selected individuals. This uncertainty is due to differential variability in BLUP of breeding values and can be translated into risk: High fluctuations mean greater risk, which is not taken into account by just looking at expected return. In this research, the methodology of value at risk (VaR) and expected shortfall is introduced for animal breeding decisions as a means to adjust the expected return for the cost of uncertainty in prediction of breeding values. This methodology has recently received a great deal of attention from financial institutions. Given a specified probability alpha, VaR is the alpha-quantile of the distribution of economic returns. The conditional value at risk (CVaR), or expected shortfall, is the expectation of the economic returns, which are less or equal to the VaR. By subtracting the CVaR from the predicted aggregate genotype (muR), a risk-adjusted expected return (RAER) measure was obtained. The measures muR, VaR, and RAER were calculated for a data set with progeny of 161 Polled Hereford bulls belonging to a beef cattle company. The Pearson and Spearman correlations between muR and RAER were 0.89 (P < 0.001) and 0.90 (P < 0.001), respectively. Even though the latter correlation was high, some bulls ranked differently for muR compared with RAER. The Pearson correlation between muR and VaR was low (0.124) and nonsignificant (P > 0.05), whereas the correlation between VaR and RAER was -0.31 (P < 0.0001). The results indicate the need to take into account the adjustment for risk in expected return in order to alleviate the effects of possible losses when overrated animals are selected.

Algorithms↗
PubMed1997

Cost-utility analysis from a societal perspective.

In this paper, we outline how to use cost-utility analysis from a societal perspective and the arguments that could be made for using data such as a model for economic evaluation of health care. We show that to include all the costs in the analysis, a price per quality-adjusted life years (QALY) gained rather than a given budget should be used as the decision rule. Using cost-utility analysis this way is based on a willingness to pay per QALY gained that is constant and the same for everyone. To use a fixed price per QALY gained is consistent with societal utility maximization if aggregated QALYs are a measure of societal utility and if the mix of financing sources is the same for all health care programmes. If, furthermore, the price per QALY gained is set at the optimal level, cost-utility analysis will lead to a maximization of societal utility. To get more information on the willingness to pay per QALY gained so as to provide cost-utility analysis with a useful decision rule should be a research priority.

Budgets↗
PubMed1992

Industrial input-output analysis: implications for industrial ecology.

Industrial ecology will need to develop fundamentally new approaches to reducing, reusing, and recycling wastes. Industrial ecology will also require an analytic framework for examining the implications for the economic system as a whole of each potential web of industrial changes. A suitable framework is furnished by structural economics, which situates the economy within the physical world. This approach is based on dynamic analysis rather than static concepts of equilibrium, and optimization assumptions are used selectively rather than as the general solution mechanism. Input-output economics, an important formal model within structural economics, can trace the stocks and flows of energy and other materials from extraction through production and consumption to recycling or disposal. An input-output computation, including wastes, is presented; it illustrates the separate but integrated analysis of physical stocks and flows and of prices and costs. This paper also describes the major advances that have been made in the last decade in the extension of input-output economics to address increasingly complex questions, notably the fully dynamic physical/price/income model and the engineering/input-output data base. Economists need to be able to assess the costs of cleaning up and to develop incentive schemes to increase the likelihood this will happen. To do this, economists need to take on the difficult "how" questions that concern industrial ecologists since the cost, and indeed the wider implications, of cleaning up depends upon how it is done. Structural economics, and modern input-output models and data bases, in particular, can help meet this challenge.

Journal Article↗
PubMed2004

Weed genomics: new tools to understand weed biology.

In spite of the large yield losses that weeds inflict on crops, we know little about the genomics of economically important weed species. Comparative genomics between plant model species and weeds, map-based approaches, genomic sequencing and functional genomics can play vital roles in understanding and dissecting weedy traits of agronomically important weed species that damage crops. Weed genomics research should increase our understanding of the evolution of herbicide resistance and of the basic genetics underlying traits that make weeds a successful group of plants. Here, we propose specific weed candidates as genomic models, including economically important plants that have evolved herbicide resistance on several occasions and weeds with good comparative genomic qualities that can be anchored to the genomics of Arabidopsis and Oryza sativa.

Arabidopsis↗
PubMedDate not supplied

Economic distress and cause-of-death patterns for black and non-black men in Chicago: reconsidering the relevance of classic epidemiological transition theory.

The mortality disadvantage of African Americans is well documented, but previous studies have not considered its implications for population theory in the general case of industrialized nation states with high levels of income inequality. This paper examines the relevance of classic epidemiological theory to the extremes of income and mortality observed in Chicago, one of America's most racially divided cities. We analyze cause-specific death rates for black and non-black male populations residing in Chicago's community areas by using linked data from the 1990 Census and from 1989-1991 individual death certificates. The same cause-of-death patterns explain much of the mortality of black and non-black men. These two major structures include one, degenerative diseases, the other, "tough-living" causes (accidents, homicides, and liver disease). Community socioeconomic status is strongly related to tough-living deaths within each racial group, and to degenerative deaths for African Americans. Black men's tough-living mortality is much greater than non-blacks', but their younger age structure suppresses their degenerative death rates. Aggregate unemployment and social disorganization account for the most salient disparities in mortality across racial groups. This patterning of mortality along a socioeconomic continuum supports epidemiological theory and extends its applicability to highly unequal populations within industrialized countries.

Black or African American↗
PubMed2003

Modelling cereal root systems for water and nitrogen capture: towards an economic optimum.

A quantitative model of wheat root systems is developed that links the size and distribution of the root system to the capture of water and nitrogen (which are assumed to be evenly distributed with depth) during grain filling, and allows estimates of the economic consequences of this capture to be assessed. A particular feature of the model is its use of summarizing concepts, and reliance on only the minimum number of parameters (each with a clear biological meaning). The model is then used to provide an economic sensitivity analysis of possible target characteristics for manipulating root systems. These characteristics were: root distribution with depth, proportional dry matter partitioning to roots, resource capture coefficients, shoot dry weight at anthesis, specific root weight and water use efficiency. From the current estimates of parameters it is concluded that a larger investment by the crop in fine roots at depth in the soil, and less proliferation of roots in surface layers, would improve yields by accessing extra resources. The economic return on investment in roots for water capture was twice that of the same amount invested for nitrogen capture.

Models, Theoretical↗