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At least 1,333 records · Page 74Linked to original sources
PubMed1998

Cost-effectiveness of tissue plasminogen activator for acute ischemic stroke. NINDS rt-PA Stroke Study Group.

Tissue plasminogen activator (tPA) has been shown to improve 3-month outcome in stroke patients treated within 3 hours of symptom onset. The costs associated with this new treatment will be a factor in determining the extent of its utilization. Data from the NINDS rt-PA Stroke Trial and the medical literature were used to estimate the health and economic outcomes associated with using tPA in acute stroke patients. A Markov model was developed to estimate the costs per 1,000 patients eligible for treatment with tPA compared with the costs per 1,000 untreated patients. One-way and multiway sensitivity analyses (using Monte Carlo simulation) were performed to estimate the overall uncertainty of the model results. In the NINDS rt-PA Stroke Trial, the average length of stay was significantly shorter in tPA-treated patients than in placebo-treated patients (10.9 versus 12.4 days; p = 0.02) and more tPA patients were discharged to home than to inpatient rehabilitation or a nursing home (48% versus 36%; p = 0.002). The Markov model estimated an increase in hospitalization costs of $1.7 million and a decrease in rehabilitation costs of $1.4 million and nursing home cost of $4.8 million per 1,000 eligible treated patients for a health care system that includes acute through long-term care facilities. Multiway sensitivity analysis revealed a greater than 90% probability of cost savings. The estimated impact on long-term health outcomes was 564 (3 to 850) quality-adjusted life-years saved over 30 years of the model per 1,000 patients. Treating acute ischemic stroke patients with tPA within 3 hours of symptom onset improves functional outcome at 3 months and is likely to result in a net cost savings to the health care system.

Acute Disease↗
PubMed2006

[The future economic burden of dementia on health and social services].

INTRODUCTION: Demographic changes in Denmark over the next 15 years will result in an increased number of elderly people and of individuals with dementia. As a result this will increase the demand for health care and social services. The aim of this study was to shed light on the likely economic consequences of this development. MATERIALS AND METHODS: A simple static, comparative model based on Danish incidence and cost data for different age groups and different levels of dementia severity was developed. The model projected the costs of the health and social services for treatment and care of people with dementia up to the year 2020. RESULTS: The future demographic changes and an increasing number of people with dementia will result in a 30% increase in health and social service costs due to dementia. This increase will be lower if individuals with dementia have a higher mortality rate than other individuals. If annual productivity gains of 1-3% can be achieved, the future cost (in real prices) could be reduced. CONCLUSION: The Danish health and social services will in the future be faced with increased costs for the treatment and care of people with dementia. This could be achieved through productivity gains, an increased level of financing or prioritisation of services that provide good value for money.

Aged↗
PubMedDate not supplied

Physician income targets: new evidence on an old controversy.

This study uses a unique set of data to identify the factors that affect physician income targets among a nationally representative sample of young (under age 40) physicians in 1987. The study reveals that income targets respond directly to actual income, but that this relationship is rather inelastic. Among self-employed physicians, for example, a 10% decline in actual income would reduce the target by only 3%. Thus, our study provides the first direct evidence to quantify how a decline in income will increase the divergence between actual and target income. Moreover, in quantifying this divergence, our results provide an upper bound on the dollar value of any demand inducement that may ensue. The results suggest that targets are set, at least in part, to compensate physicians for pecuniary and nonpecuniary costs associated with medical practice. Discrimination, dissatisfaction, financial risks, and training costs all appear to raise income targets. Physicians may desire higher incomes to compensate them for discrimination or other difficulties they have encountered in practicing medicine.

Adult↗
PubMed1999

Economic impact of providing workplace influenza vaccination. A model and case study application at a Brazilian pharma-chemical company.

OBJECTIVE: To develop and apply a model to assess the economic value of a workplace influenza programme from the perspective of the employer. DESIGN: The model calculated the avoided costs of influenza, including treatment costs, lost productivity, lost worker added value and the cost of replacing workers. Subtracted from this benefit were the costs associated with a vaccination programme, including administrative costs, the time to give the vaccine, and lost productivity due to adverse reactions. The framework of the model can be applied to any company to estimate the cost-benefit of an influenza immunisation programme. SETTING: The model developed was applied to 4030 workers in the core divisions of a Brazilian pharma-chemical company. RESULTS: The model determined a net benefit of $US121,441 [129,335 Brazilian reals ($Brz)], or $US35.45 ($Brz37.75) per vaccinated employee (1997 values). The cost-benefit ratio was 1:2.47. The calculations were subjected to a battery of 1-way and 2-way sensitivity analyses that determined that net benefit would be retained as long as the vaccine cost remained below $US45.40 ($Brz48.40) or the vaccine was at least 32.5% effective. Other alterations would retain a net benefit as well, including several combinations of incidence rate and vaccine effectiveness. CONCLUSIONS: The analysis suggests that providing an influenza vaccination programme can incur a substantial net benefit for an employer, although the size of the benefit will depend upon who normally absorbs the costs of treating influenza and compensating workers for lost work time due to illness, as well as the type of company in which the immunisation programme is applied.

Adolescent↗
PubMedDate not supplied

A computer simulation model of the natural history and economic impact of chronic obstructive pulmonary disease.

OBJECTIVE: Chronic obstructive pulmonary disease (COPD) is a major health problem with high societal costs. The Global Initiative for Chronic Lung Disease (GOLD) has identified a need for health economics data for COPD. For chronic diseases, such as COPD, where the natural history of disease is lifetime, a modeling approach for economic evaluation may be more realistic than prospective, piggy-backed clinical trials or specific COPD cohort studies. Simulation models can be used to extrapolate clinical data beyond the limited time frame of clinical trials, to analyze subgroups of patients or to explore uncertainty regarding the results by using sensitivity analysis techniques. Our purpose has been to develop a flexible computer simulation model for COPD that will represent disease progression and GOLD recommendations, useful for economic evaluations of new medicines to meet the needs of various payer requirements for reimbursement and resource allocation. METHODS: This article describes a two-dimensional Markov model, which uses data from multiple sources about disease progression, exacerbation frequency and duration, mortality, costs, burden of illness, and the relationships between those variables. The model is evaluated using stochastic uncertainty analysis, it allows comparison of treatments affecting different disease mechanisms, and it uses primary data validated against published sources. RESULTS: We have evaluated two hypothetical interventions treating different features of the disease (lung function decline and acute exacerbations). These analyses show that reducing lung function decline must be a long-term strategy compared to reducing the number of exacerbations. It was necessary to have a long term like 30 years, with 10,000 patients and 20% increase in price, or 20 years with equal prices to show cost-effectiveness with statistical significance for a treatment that reduces lung function decline. CONCLUSIONS: Our study shows the value of modeling as a tool for evaluating different scenarios and for combining several sources of data, to provide estimates that would otherwise be unavailable. Clinical trials of this size and duration would be unrealistic.

Computer Simulation↗
PubMed1981

Economic reform and migration in Yugoslavia: an econometric model.

"The paper analyzes the impact of external migration on the Yugoslav economy during the period 1965-1972. This is done by means of a macroeconometric model embodying various dualistic characteristics of Yugoslavia. A counterfactual simulation of the model is used to judge the impact of external migration. According to the indicators utilized, the simulation suggests that migration has been beneficial to Yugoslavia."

Demography↗
PubMed2004

Modeling pandemic preparedness scenarios: health economic implications of enhanced pandemic vaccine supply.

Influenza pandemic planning is a complex, multifactorial process, which involves public health authorities, regulatory authorities, academia and industry. It is further complicated by the unpredictability of the time of emergence and severity of the next pandemic and the effectiveness of influenza epidemic interventions. The complexity and uncertainties surrounding pandemic preparedness have so far kept the various stakeholders from joining forces and tackling the problem from its roots. We developed a mathematical model, which shows the tangible consequences of conceptual plans by linking possible pandemic scenarios to health economic outcomes of possible intervention strategies. This model helps to structure the discussion on pandemic preparedness and facilitates the translation of pandemic planning concepts to concrete plans. The case study for which the model has been used shows the current level of global pandemic preparedness in an assumed pandemic scenario, the health economic implications of enhanced pandemic vaccine supply and the importance of cell culture-based influenza vaccine manufacturing technologies as a tool for pandemic control.

Disease Outbreaks↗
PubMed2003

A simulation model for evaluating the medical and economic outcomes of screening strategies for colorectal cancer.

Mathematical models have been shown to be useful in predicting the cost-effectiveness of cancer screening programmes. We designed a computer macro-simulation model aimed at predicting the cost-effectiveness of alternative colorectal cancer screening strategies. This model was built to determine the cost-effectiveness of a biennial screening programme using the Hemoccult test in Burgundy (France). It was validated with data from the Danish randomized study. Estimates of our model showed an extremely close concordance with observed results in the Danish study. The observed mortality reduction was 18.0% and the estimated mortality reduction was 18.4%. Preliminary data from the Burgundy study predict a 14.6% colorectal cancer mortality reduction after 10 years. Sensitivity analyses were performed with different assumptions regarding the participation rates and the lead-time. This model can serve to assess the cost-effectiveness of a variety of screening modalities.

Aged↗