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PubMed2002

Cost effectiveness of aspirin, clopidogrel, or both for secondary prevention of coronary heart disease.

BACKGROUND: Both aspirin and clopidogrel reduce the rate of cardiovascular events in patients with coronary heart disease. We estimated the cost effectiveness of the increased use of aspirin, clopidogrel, or both for secondary prevention in patients with coronary heart disease. METHODS: We used the Coronary Heart Disease Policy Model, a computer simulation of the U.S. population, to estimate the incremental cost effectiveness (in dollars per quality-adjusted years of life gained) of four strategies in patients over 35 years of age with coronary disease from 2003 to 2027: aspirin for all eligible patients (i.e., those who were not allergic to or intolerant of aspirin), aspirin for all eligible patients plus clopidogrel for patients who were ineligible for aspirin, clopidogrel for all patients, and the combination of aspirin for all eligible patients plus clopidogrel for all patients. RESULTS: The extension of aspirin therapy from the current levels of use to all eligible patients for 25 years would have an estimated cost-effectiveness ratio of about $11,000 per quality-adjusted year of life gained. The addition of clopidogrel for the 5 percent of patients who are ineligible for aspirin would cost about $31,000 per quality-adjusted year of life gained. Clopidogrel alone in all patients or in routine combination with aspirin had an incremental cost of more than $130,000 per quality-adjusted year of life gained and remained financially unattractive across a wide range of assumptions. However, clopidogrel alone or in combination with aspirin would cost less than $50,000 per quality-adjusted year of life gained if its price were reduced by 70 to 82 percent, to $1.00 and $0.60 per day, respectively. CONCLUSIONS: Increased prescription of aspirin for secondary prevention of coronary heart disease is attractive from a cost-effectiveness perspective. Because clopidogrel is more costly, its incremental cost effectiveness is currently unattractive, unless its use is restricted to patients who are ineligible for aspirin.

Adult↗
PubMed2000

Distributional impact of higher patient contributions to Australia's Pharmaceutical Benefits Scheme.

This paper uses NATSEM's Pharmaceutical Benefits Model to analyse the effects of a hypothetical 25 per cent rise in patient contributions to prescribed medicines under Australia's Pharmaceutical Benefits Scheme (PBS). The model, based on microsimulation techniques, is able to provide a much broader range of outcomes information, at a much greater level of detail, than is possible with traditional methods. Higher patient contributions are analysed in terms of their impact on the government to patient split in PBS costs, as well as the distribution of such costs across age groups, family incomes, family types and 36 prescribed medicine types. Also considered are changes in the shares of family disposable incomes spent on prescribed drugs arising from the higher patient contributions.

Adolescent↗
PubMed2000

Funding issues for Victorian hospitals: the risk-adjusted vision beyond casemix funding.

This paper discusses casemix funding issues in Victoria impacting on teaching hospitals. For casemix payments to be acceptable, the average price and cost weights must be set at an appropriate standard. The average price is based on a normative, policy basis rather than benchmarking. The 'averaging principle' inherent in cost weights has resulted in some AN-DRG weights being too low for teaching hospitals that are key State-wide providers of high complexity services such as neurosurgery and trauma. Casemix data have been analysed using international risk adjustment methodologies to successfully negotiate with the Victorian State Government for specified grants for several high complexity AN-DRGs. A risk-adjusted capitation funding model has also been developed for cystic fibrosis patients treated by The Alfred, called an Australian Health Maintenance Organisation (AHMO). This will facilitate the development of similar models by both the Victorian and Federal governments.

Benchmarking↗
PubMed2000

Casemix funding for a specialist paediatrics hospital: a hedonic regression approach.

This paper inquires into the effects that Diagnosis Related Groups (DRGs) have had on the ability to explain patient-level costs in a specialist paediatrics hospital. Two hedonic models are estimated using 1996/97 New Children's Hospital (NCH) patient level cost data, one with and one without a casemix index (CMI). The results show that the inclusion of a casemix index as an explanatory variable leads to a better accounting of cost. The full hedonic model is then used to simulate a funding model for the 1997/98 NCH cost data. These costs are highly correlated with the actual costs reported for that year. In addition, univariate regression indicates that there has been inflation in costs in the order of 4.8% between the two years. In conclusion, hedonic analysis can provide valuable evidence for the design of funding models that account for casemix.

Accounting↗
PubMed2003

Will health fund rationalisation lead to significant premium reductions?

It has been suggested that rationalisation of health funds will generate significant albeit unquantified cost savings and thus hold or reduce health fund premiums. 2001-2 Private Health Industry Administration Council (PHIAC) data has been used to analyse these suggestions. Payments by funds for clinical services will not vary after fund rationalisation. The savings after rationalisation will arise from reductions in management expenses, which form 10.9% of total fund expenditure. A number of rationalisation scenarios are considered. The highest theoretical industry wide saving found in any plausible scenario is 2.5%, and it is uncertain whether this level of saving could be achieved in practice. If a one off saving of this order were achieved, it would have no medium and long term impact on fund premiums increases given funds are facing cost increases of 4% to 5% per annum due to demographic changes and age standardised utilization increases. It is suggested discussions on fund amalgamation divert attention from the major factors increasing fund costs, which are substantially beyond fund control.

Australia↗
PubMed2005

Combining DRGs and per diem payments in the private sector: the Equitable Payment Model.

The many types of payment models used in the Australian private sector are reviewed. Their features are compared and contrasted to those desirable in an optimal private sector payment model. The EPM(TM) (Equitable Payment Model) is discussed and its consistency with the desirable features of an optimal private sector payment model outlined. These include being based on a robust classification system, nationally benchmarked length of stay (LOS) results, nationally benchmarked relative cost and encouraging continual improvement in efficiency to the benefit of both health funds and private hospitals. The advantages in the context of the private sector of EPM(TM) being a per diem model, albeit very different to current per diem models, are discussed. The advantages of EPM(TM) for hospitals and health funds are outlined.

Acute Disease↗
PubMed1996

The annual variation in activity and funding for acute public hospitals in NSW, 1988-89 to 1992-93.

Casemix-based funding was introduced into the Victorian health system without an assessment of the annual variation in inpatient activity. Before undertaking such a funding reform, it would be appropriate to determine the level of annual variation in inpatient activity for individual hospitals that could be attributable to chance or random variation. If the annual random variation is not accounted for, then casemix-based funding may actually lead to inefficiencies. For this study, hospital inpatient activity and funding data for 120 acute public hospitals from New South Wales for the years 1988-89 to 1992-93 were used to estimate the standard deviation of the annual random variation in activity and gross operating payment. Through linear regression, estimates of the standard deviation of random variation about the underlying trend were obtained for each hospital. The results showed that, depending on the size of the hospital, total diagnosis related group cost weights have a standard deviation in the range of 2 to 16 per cent of total activity, whilst gross operating payment has an equivalent standard deviation that ranges from 1 to 10 per cent annually. The magnitude of the variation would suggest that funding of hospitals should either be based on average activity over several years or based on bands of activity in order to reduce the potential random variation in funding levels.

Bed Occupancy↗
PubMed1998

Future financial impact of the current health financing system.

Major political parties remain publicly committed to Medicare and community-rated voluntary health insurance. It is important to understand the future financial consequences of this policy in order to assist community debate about whether such a commitment is appropriate or some other policy should be developed. This paper describes development of, and results from, the APHA health financing model. It suggests that health expenditure would represent 12.9% of gross domestic product by 2021, compared to 8.5% in 1995. Increasing per capita expenditure is the major contributor to the growth, with demographic changes responsible for only 14.3%.

Australia↗
PubMed1998

Developing a funding model for an after-hours primary medical care service in a rural town.

The study described in this paper aimed to determine a funding model for an after-hours primary medical care service in the rural town of Moe, a socioeconomically disadvantaged area of Victoria suffering the rigours of industry restructuring and privatisation. It has 12.5 equivalent full-time general practitioners servicing 21,966 persons. A break-even analysis of the financial viability compared the expected costs of providing the service with the anticipated income. A mixed funding model is recommended. This would incorporate a general practitioner incentive scheme and State Government underwriting of infrastructure and basic non-medical staffing costs during the business development phase to supplement the income from the Health Insurance Commission.

Demography↗
PubMed1999

Privatising general practice in Mongolia: a trial of needs-adjusted capitation.

Mongolia's family doctors have long been salaried government employees. The crisis caused by the break-up of the Soviet Bloc required the government to seek a balance between command and market economies, and this influenced the decision to introduce capitated private practice for family doctor services on a trial basis. This article explains why and how a risk-adjusted capitation model was developed by a blend of empirical analysis and expert judgement, which comprises ten classes of clients defined by age-sex and poverty groupings. Payment relativities across the classes were set in proportion to a desirable (or target) number of contacts per year. Separate processes were used to set the targets for patient-initiated and active (health promotion and illness prevention) contacts. The model is intended to lead to greater equity of service access and provision. It should also encourage a greater concern for health outcomes, sensitivity to clients' views, and operational efficiency.

Age Factors↗
PubMed2006

Risk assessment for invasive species produces net bioeconomic benefits.

International commerce in live organisms presents a policy challenge for trade globalization; sales of live organisms create wealth, but some nonindigenous species cause harm. To reduce damage, some countries have implemented species screening to limit the introduction of damaging species. Adoption of new risk assessment (RA) technologies has been slowed, however, by concerns that RA accuracy remains insufficient to produce positive net economic benefits. This concern arises because only a small proportion of all introduced species escape, spread, and cause harm (i.e., become invasive), so a RA will exclude many noninvasive species (which provide a net economic benefit) for every invasive species correctly identified. Here, we develop a simple cost:benefit bioeconomic framework to quantify the net benefits from applying species prescreening. Because invasive species are rarely eradicated, and their damages must therefore be borne for long periods, we have projected the value of RA over a suitable range of policy time horizons (10-500 years). We apply the model to the Australian plant quarantine program and show that this RA program produces positive net economic benefits over the range of reasonable assumptions. Because we use low estimates of the financial damage caused by invasive species and high estimates of the value of species in the ornamental trade, our results underestimate the net benefit of the Australian plant quarantine program. In addition, because plants have relatively low rates of invasion, applying screening protocols to animals would likely demonstrate even greater benefits.

Commerce↗
PubMed1999

Behavioral economics: reunifying psychology and economics.

"Behavioral economics" improves the realism of the psychological assumptions underlying economic theory, promising to reunify psychology and economics in the process. Reunification should lead to better predictions about economic behavior and better policy prescriptions.

Behavior↗
PubMed2002

Non-fatal violence-related injuries in Kingston, Jamaica: a preventable drain on resources.

Using data for a one-year period from the Kingston Public Hospital (KPH) in Jamaica, we describe patterns of non-fatal violence-related injuries, and carry out simulation analysis to estimate rates of hospital admission under various injury reduction scenarios, and the potential savings that can be realized by reducing violent crimes. In this period there were 6107 registered violence-related visits to the KPH representing 11.5% of all recorded visits. Of these 16.6% (1001) were admitted. The most common methods of inflicting injury was by stabbing (52.1%), blunt injuries (37.9%) and gunshot wounds (7.3%). Multivariate analyses indicated that gunshot injuries, stab injuries, being male between the ages of 15 and 44 years, receiving the injury in November or December, and being injured by a stranger or unknown assailant, were significant correlates of a higher probability of admission. Simulation analysis with various injury reduction scenarios indicated decreases in the probability of admission ranging from 12% to 44%, with estimated savings of up to 31% of the annual supplies budget of KPH.

Adolescent↗
PubMed1999

Benchmarking pathology services: implementing a longitudinal study.

This paper details the benchmarking process and its application to the activities of pathology laboratories participating in a benchmark pilot study [the Royal College of Pathologists of Australasian (RCPA) Benchmarking Project]. The discussion highlights the primary issues confronted in collecting, processing, analysing and comparing benchmark data. The paper outlines the benefits of engaging in a benchmarking exercise and provides a framework which can be applied across a range of public health settings. This information is then applied to a review of the development of the RCPA Benchmarking Project. Consideration is also given to the nature of the preliminary results of the project and the implications of these results to the on-going conduct of the study.

Australia↗
PubMedDate not supplied

Costs and consequences of hip fracture occurrence in old age: an economic perspective.

PURPOSE: To summarize the reported short- and long-term costs associated with hip fracture occurrence in old age, based on a systematic literature review of published studies. A further aim is to provide a clinician-oriented discussion of the different types of economic evaluations, with an emphasis on studies that examined potential determinants of the costs of care after hip fracture. METHOD: Literature review. MAIN RESULTS: Even after the initial hospitalization, hip fractures continue to generate significant costs throughout the one-year period after discharge, but particularly during the first three months. Cost estimates based on data obtained prospectively from hip-fracture patients and matched controls showed that the costs associated with the treatment of hip-fracture patients are about three times greater than those resulting from the treatment of age and residence-matched controls without a fracture. Two-fifths of these excess costs are incurred during the first three months following hospital discharge. Increasing age at the time of injury and living in an institution before the fracture are among the most important determinants of an increased cost of care after hospital discharge. Programs that focus on continuity of care, adopt a multidisciplinary approach, and accelerate rehabilitation have shown to be able to reduce the cost of care after hip fracture. CONCLUSIONS: This review emphasizes the importance of current and future interventions to decrease the incidence of hip fracture. While the current review cannot provide definite answers to the questions of cost containment, our review provides critically important evidence about the need to base health policy decisions on empirical observations. Comprehensive economic analyses of financial costs and health outcomes are needed to develop cost-effective strategies.

Age Factors↗
PubMed2006

A preliminary economic evaluation of percutaneous neuromuscular electrical stimulation in the treatment of hemiplegic shoulder pain.

OBJECTIVE: The objective of this study was to compare the cost-effectiveness of various treatment modalities for hemiplegic shoulder pain. DESIGN: A stage II economic evaluation. MAIN OUTCOME MEASURES: Incremental cost effectiveness ratio of P-NMES, compared to slings and anti-inflammatory injections. RESULTS: The incremental cost effectiveness ratio (ICER) of p-NMES, compared to anti-inflammatory injections is 6,061 euro(+/-3,285). The incremental cost of the first quality-adjusted life year after implantation of the P-NMES device compared to anti-inflammatory injections is 33,007 euro (+/-5,434). This decreases to approximately 7,000 euro after 5 years, and to approximately 5,000 euro after 10 survival years. CONCLUSION: In this early evaluation, P-NMES seems to be cost-effective according to known guidelines. Treatment with P-NMES is recommended for patients with chronic HSP.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2006

Multivariate causal attribution and cost-effectiveness of a national mass media campaign in the Philippines.

Cost-effectiveness analysis is based on a simple formula. A dollar estimate of the total cost to conduct a program is divided by the number of people estimated to have been affected by it in terms of some intended outcome. The direct, total costs of most communication campaigns are usually available. Estimating the amount of effect that can be attributed to the communication alone, however is problematical in full-coverage, mass media campaigns where the randomized control group design is not feasible. Single-equation, multiple regression analysis controls for confounding variables but does not adequately address the issue of causal attribution. In this article, multivariate causal attribution (MCA) methods are applied to data from a sample survey of 1,516 married women in the Philippines to obtain a valid measure of the number of new adopters of modern contraceptives that can be causally attributed to a national mass media campaign and to calculate its cost-effectiveness. The MCA analysis uses structural equation modeling to test the causal pathways and to test for endogeneity, biprobit analysis to test for direct effects of the campaign and endogeneity, and propensity score matching to create a statistically equivalent, matched control group that approximates the results that would have been obtained from a randomized control group design. The MCA results support the conclusion that the observed, 6.4 percentage point increase in modern contraceptive use can be attributed to the national mass media campaign and to its indirect effects on attitudes toward contraceptives. This net increase represented 348,695 new adopters in the population of married women at a cost of U.S. $1.57 per new adopter.

Causality↗
PubMed2006

To legalize or not to legalize? Economic approaches to the decriminalization of drugs.

Drug legalization is gaining ever-widening support in most Western societies. A liberalization of current drug laws will most probably lead to a fall in drug prices. The present article focuses on recent economic studies examining the effects of a fall in prices on quantities consumed and recruitment. Estimates of price elasticities indicate that a substantial increase in consumption by current drug users should be expected if prices decrease, whereas estimates of participation elasticities suggest an increase in the number of users. Tests of the so-called gateway theory (i.e., whether the use of a less harmful drug increases the risk of future use of more harmful drugs) offers less unambiguous results.

Civil Rights↗