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At least 1,297 records · Page 72Linked to original sources
PubMed1999

Pharmacoeconomic issues related to selection of neuromuscular blocking agents.

Pharmacoeconomic issues related to the selection of neuromuscular blocking agents are described. Five models of economic analysis are commonly used in health care: cost-minimization, cost-benefit, cost-effectiveness, cost-utility, and cost-of-illness. The model used most commonly in anesthesiology is the cost-effectiveness model, in which outcomes are measured in nonmonetary terms that are then translated into units of success or failure. The true cost of anesthetic drugs and techniques should include more than acquisition cost. Factors typically included in economic analyses include resources used and humanistic factors. Six specific indirect costs should be included in pharmacoeconomic analyses of neuromuscular blocking agents: cost of residual muscle blockade, cost of prolonged time to extubation, inability of patients to resume normal activities because of postoperative myalgia, cost of additional postoperative monitoring for arrhythmia associated with reversal drugs, and risk of nausea and vomiting associated with reversal drugs. The availability of rapid-onset, shorter-duration anesthetics, analgesics, and neuromuscular blocking agents with fewer adverse effects and the availability of less invasive surgical techniques have made it possible to accelerate the movement of patients in and out of the operating room and have shortened lengths of stay in the postanesthesia care unit (PACU) and the intensive care unit (ICU). Decreased length of stay in the PACU and the ICU can save hundreds of dollars per case because these areas have high personnel costs. If reversal drugs like neostigmine can be avoided, fewer patients may experience postoperative nausea and vomiting and the resulting complications. In searching for the best outcome at the most reasonable cost, practitioners should look for meaningful cost reductions, bearing in mind that the use of newer, shorter-acting drugs has led to improved perioperative efficiency in clinical practice.

Ambulatory Care↗
PubMed1996

Beyond the public-private debate: the mixed economy of health.

Can or should private organisations provide public healthcare services? What is the scope for private finance in public healthcare services? This paper reviews some of the arguments for and against public or private ownership management and financing of public healthcare services. It concentrates on health services, where non-economic values and ethical questions are as important as the efficiency considerations, and on health purchasing or funding organisations. The paper describes the increasingly complex interrelationship and forms of competition between public and private providers, purchasers and financiers in the UK health sector. It argues that the simple private/public distinction never did describe well the many different forms of financing ownership and operation of health services in any country and is now a handicap to both scientific and lay policy debate about future options. It proposes a framework for describing the main forms of ownership and operations of health services and considers the future for health service purchasing and funding.

Contract Services↗
PubMed1996

Do cigarette producers price-discriminate by state? An empirical analysis of local cigarette pricing and taxation.

This study analyzes the interactive effects of oligopoly pricing, state taxation, and anti-smoking regulations on retail cigarette prices by state, using panel data for the 50 US states between 1960 and 1990. The results indicate that cigarette producers do price-discriminate by state, though the effect is not large relative to the final retail price. There are two further results: (1) state taxes are more than passed on - a 1-cent state tax increase results in a price increase of 1.11 cents, and (2) sellers offset state and local anti-smoking laws with lower prices, thereby blunting effects of the regulations.

Commerce↗
PubMed2005

A hermeneutic science: health economics and Habermas.

PURPOSE: Mainstream health economics labours under a misleading understanding of the nature of the topic area and suffers from a concomitant poverty of thinking about theory and method. The purpose here is to explore this critical position and argue that health economics should aspire to being more than a technical discipline. It can, and should, engage with transformative discourse. DESIGN/METHODOLOGY/APPROACH: It is argued that the hermeneutic sciences, emphasising interpretation not instrumentality or domination, offer a route into the change to which one seeks to contribute. The article specifically focuses on the way Habermas provides insights in his approach to knowledge, reason and political economy. How he emphasises complexity and interaction within cultural milieu is explored and primacy is given to preserving the life-world against the encroachments of a narrow rationalization. FINDINGS: The argument for a critical re-imagining of health economics is presented in three stages. First, the antecedents, current assumptions and critical voices from contemporary economics and health economics are reviewed. Second, the way in which health is best understood via engaging with the complexity of both the subject itself and the society and culture within which it is embedded is explored. Third, the contribution that hermeneutics, and Habermas' critical theory, could make to a new health economics is examined. ORIGINALITY/VALUE: The paper offers a radical alternative to health economics. It explores the shortcomings of current thinking and argues an optimistic position. Progress via reason is possible if one reframes both in the direction of communication and in the appreciation of reflexivity and communality. This is a position that resonates with many who challenge prevailing paradigms, in economics and elsewhere.

Economics, Medical↗
PubMed2006

What affects the quality of economic analysis for life-saving investments?

Economic analysis of life-saving investments in both the public and private sectors has the potential to dramatically improve longevity and the quality of life, but only if the analyses on which decisions are based are done well. In this article, we analyze a data set that provides information on the content and quality of journal articles that measure the cost-effectiveness of life-saving investments. Our study is the first to provide a detailed multivariate analysis of factors affecting objective measures of quality. We also explore whether a series of recommendations by an expert panel convened by the U.S. Public Health Service affect the way analyses of specific life-saving investments are done. Our results suggest that four factors are positively correlated with an index we construct to measure analytical quality: (1) having at least one author affiliated with a university, (2) publication in a journal that has experience in publishing these analyses, (3) if the life-saving investment is located in the United States, and (4) if the analysis considers a measure of social costs or benefits. Somewhat surprisingly, a study's funding source and whether it is affiliated with industry are not significantly correlated with the quality index. Finally, neither time nor the panel guidelines had an impact on the index.

Cost-Benefit Analysis↗
PubMed2004

The relative impact of inadequate primary and secondary prevention on cardiovascular mortality in the United States.

BACKGROUND AND PURPOSE: We developed a model to estimate the costs incurred by ineffective primary and secondary prevention in terms of excess cardiovascular disease (CVD) mortality in a nationally representative sample of the US population. METHODS: Cox proportional hazards analyses were used to examine the effect of inadequate risk factor control on the incidence of fatal stroke and myocardial infarction (MI) during a follow-up period of 13.4+/-3.6 years after adjusting for differences in age, gender, and ethnicity in a national cohort of 9252 adults who participated in the Second National Health and Nutrition Examination Survey (NHANES) Mortality Follow-up Study. Inadequate risk factor modification was defined by presence of either blood pressure >140/90 mm Hg, serum cholesterol >200 mg/dL, or active cigarette smoking. Using the data from 4115 adults screened in the NHANES 1999 to 2000, population attributable risk (PAR) percent and associated cost incurred (expressed as proportion of total 1-year cost incurred for CVD mortality in year 2001) was estimated. RESULTS: CVD mortality risk increased in a stepwise manner for persons with no previous MI or stroke and > or =2 inadequately controlled risk factors (2x); and previous history of MI and stroke and adequately controlled risk factors (2.6x), 1 inadequately controlled risk factor (4.3x), and > or =2 inadequately controlled risk factors (5.7x). The PAR was 14% (estimated cost incurred 13.2 billion dollars) among persons with > or =2 inadequately controlled risk factors without previous MI or stroke (estimated 17% of total US population). Among persons with previous MI or stroke, the PAR was 7% (cost incurred 6.2 billion dollars) and 8% (cost incurred 7.4 billion dollars) for 1 inadequately controlled risk factor and > or =2 inadequately controlled risk factors, respectively. An excess of cost of 13.6 billion dollars was spent on 4% of the total population (persons with inadequate secondary prevention). CONCLUSIONS: The model demonstrates the differential risk of mortality from inadequately controlled cardiovascular risk factors in primary and secondary prevention settings. The large financial cost incurred by inadequate primary and secondary prevention justifies intensive efforts directed toward detection and treatment of cardiovascular risk factors.

Actuarial Analysis↗
PubMed2004

Drug costs: research and development costs: the great illusion.

(1) The commonly stated average cost of researching and developing a new drug is 802 million dollars. (2) This figure comes from an institute largely funded by the pharmaceutical industry, and is based on confidential information also provided by industry sources. (3) It includes the cost of failures and financial charges, and is the pre-tax figure. Out-of-pocket spending actually represents only half this sum, and the true costs are halved again when tax is deducted. A detailed analysis of this estimate reveals many other methodological flaws. (4) This estimate only concerns new chemical entities entirely developed by the company in question. (5) It is based on clinical development costs which are far higher than those quoted by other sources. (6) Drug companies claim this estimate is the "official" figure. (7) Data on the many drugs that are not fully developed by the company in question are even less consistent. (8) The true costs of research and development must be determined transparently if national authorities are to make rational decisions on patents, data protection, and drug pricing. (9) Research and development costs must be viewed in the light of drug company profits, which remain the highest of any economic sector.

Clinical Trials as Topic↗
PubMed1995

Pharmaceutical decisionmaking: pharmacoepidemiology or pharmacoeconomics--who's in the driver's seat?

Although it is well known that clinical trial findings and actual clinical experience can differ substantially in pharmaceutical decisionmaking, it is our working hypothesis that this divergence is critically important in the area of psychopharmacology. We support this contention with a discussion of recent findings from post-marketing pharmacoepidemiologic and pharmacoeconomic investigations of clozapine. The pharmacoeconomic evaluations purport to show cost savings of clozapine versus standard neuroleptic therapy but these conclusions are flawed, in large part because the epidemiologic investigations on which they are based are inadequate. To correct this situation, long-term, randomized field trials (usual practice settings) are needed to compare costs and outcomes of clozapine versus standard therapy. The design of these studies should incorporate multidimensional outcomes, including social function, employment, and rehospitalization, as well as measures of symptoms and self-reported quality of life. Pharmacoeconomic evaluations that adopt the designs of typical clinical trials with limited outcome measures, such as symptoms or self-reported quality of life measures, will not be sufficient to determine cost-effectiveness for psychopharmacologic therapies of severe mental disorders.

Decision Making↗
PubMed1996

Slow-fast dynamics in a model of population and resource growth.

"Models of the interaction of population, the economy, and the environment often contain nonlinear functional relationships and variables that move at different speeds. These properties foster apparent unpredictabilities in system behaviour. Using a simple deterministic model of demographic, economic and environmental interactions we illustrate the usefulness of geometric singular perturbation theory in environmental population economics. In contrast to local stability analysis, the theory of slow-fast dynamics helps to gain new insights into the global behaviour of the system. In particular, the knowledge of the basins of attraction of the stationary states enables one to determine the regions of sustainable future paths of resources and population." (SUMMARY IN FRE)

Conservation of Natural Resources↗
PubMed1999

Economic consequences of the progression of rheumatoid arthritis in Sweden.

OBJECTIVE: To develop a simulation model for analysis of the cost-effectiveness of treatments that affect the progression of rheumatoid arthritis (RA). METHODS: The Markov model was developed on the basis of a Swedish cohort of 116 patients with early RA who were followed up for 5 years. The majority of patients had American College of Rheumatology (ACR) functional class II disease, and Markov states indicating disease severity were defined based on Health Assessment Questionnaire (HAQ) scores. Costs were calculated from data on resource utilization and patients' work capacity. Utilities (preference weights for health states) were assessed using the EQ-5D (EuroQol) questionnaire. Hypothetical treatment interventions were simulated to illustrate the model. RESULTS: The cohort distribution among the 6 Markov states clearly showed the progression of the disease over 5 years of followup. Costs increased with increasing severity of the Markov states, and total costs over 5 years were higher for patients who were in more severe Markov states at diagnosis. Utilities correlated well with the Markov states, and the EQ-5D was able to discriminate between patients with different HAQ scores within ACR functional class II. CONCLUSION: The Markov model was able to assess disease progression and costs in RA. The model can therefore be a useful tool in calculating the cost-effectiveness of different interventions aimed at changing the progression of the disease.

Arthritis, Rheumatoid↗
PubMed2001

Assessment of economic losses from marine pollution: an introduction to economic principles and methods.

This paper introduces economic concepts and theory pertaining to public policy issues and concerns about pollution in marine environments. Many of these concepts and theories are unfamiliar to individuals and professionals outside the field of economics, such as biologists, ecologists, environmental lawyers, and even public policymakers. Yet many of these individuals observe economics in action, often for the first time, within a public policy arena. Exposure and a better understanding of the concepts and ideas in economics that are particularly relevant for public policies can help to achieve efficiencies in the form of better designed policies, and help to bridge communications gaps across other professions and the economics profession.

Environment↗
PubMed2006

The effect of rural hospital closures on community economic health.

OBJECTIVE: To examine the effect of rural hospital closures on the local economy. DATA SOURCES: U.S. Census Bureau, OSCAR, Medicare Cost Reports, and surveys of individuals knowledgeable about local hospital closures. STUDY DESIGN: Economic data at the county level for 1990-2000 were combined with information on hospital closures. The study sample was restricted to rural counties experiencing a closure during the sample period. Longitudinal regression methods were used to estimate the effect of hospital closure on per-capita income, unemployment rate, and other community economic measures. Models included both leading and lagged closure terms allowing a preclosure economic downturn as well as time for the closure to be fully realized by the community. DATA COLLECTION: Information on closures was collected by contacting every state hospital association, reconciling information gathered with that contained in the American Hospital Association file and OIG reports. PRINCIPAL FINDINGS: Results indicate that the closure of the sole hospital in the community reduces per-capita income by 703 dollars (p<0.05) or 4 percent (p<0.05) and increases the unemployment rate by 1.6 percentage points (p<0.01). Closures in communities with alternative sources of hospital care had no long-term economic impact, although income decreased for 2 years following the closure. CONCLUSIONS: The local economic effects of a hospital closure should be considered when regulations that affect hospitals' financial well-being are designed or changed.

Health Facility Closure↗