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PubMed2001

Estimating the Bayesian loss function. A conjoint analysis approach.

Current health economic literature does not provide clear guidelines on how uncertainty around cost-effectiveness estimates should be incorporated into economic decision models. Bayesian analysis is a promising alternative to classical statistics for incorporating uncertainty in economic analysis. Estimating a loss function that relates outcomes to societal welfare is a key component of Bayesian decision analysis. Health economists commonly compute the loss function based on the quality-adjusted life-years associated with each outcome. However, if welfare economics is adopted as the theoretical foundation of the analysis, a loss function based in cost-benefit analysis (CBA) may be more appropriate. CBA has not found wide use in health economics due to practical issues associated with estimating such a loss function. In this paper, we present a method based in conjoint analysis for estimating the CBA loss function that can be applied in practice. We illustrate the use of the methodology using data from a pilot study.

Acute Disease↗
PubMed2001

On the biopsychosocial model: the example of political economic causes of diabetes in the Marshall Islands.

Biomedical reductionism, the unwritten theory underlying the practice of medicine, is being supplanted by the biopsychosocial model. The explanatory power of the biopsychosocial model, however, is hampered by an inadequate mechanism to account for the social production of disease. We examine diabetes in the Marshall Islands to explore a conceptual approach that incorporates ecology, history, and political economy into the biopsychosocial model. The use of the Marshall Islands by the United States as testing grounds for nuclear war has led to ecological destruction, population displacement, and economic dependency. The consequence at the biological level has been an epidemic of weight gain, altered metabolism, and diabetes. A political economic perspective reveals that such outcomes are the result of decisions made by those who do not live with these decisions. Such a perspective points the way for social engagement and political work toward justice and health.

Comorbidity↗
PubMed2006

[Health economic aspects of the use of blood and blood products].

An adequate supply of blood components for patients depends on the population's willingness to donate blood as well as on a well-organized blood donation system. In order to ensure the blood supply, a high expenditure is necessary. The article at hand describes two areas of the use of blood and blood products. First, it considers the application of factor concentrates in haemophiliacs (approximately 3000-4000 patients are regularly in need of treatment). For the German statutory health insurance, the estimated yearly expenses for factor concentrates is approx. 450 million Euros, the average costs per patient and year and per treatment center range between 40,903 and 117,597 Euros. The costs for an immune tolerance therapy (ITT) for patients with inhibitors are estimated to be between 70,300 and 3,800,000 Euros for children, depending on the length of the therapy and the degree of severity. In the second part of the article, the authors outline the status quo of the economic evaluation of cellular blood products and present the results of a German cross-sectional survey on the use of erythrocytes in orthopaedic surgery. Within the scope of this hemotherapy study, the transfusion rates vary considerably within the participating treatment centers [elective hip joint replacement (THR): 17 and 94%]. The average blood loss also differs significantly. Comparing the treatment centers, the calculated blood loss during THR shows considerable differences (median blood loss in treatment center with lowest/treatment center with highest blood loss: 883 ml/2,975 ml). The acceptance of low intraoperative hemoglobin values in the clinics is high and diverse. These differences in transfusion procedures between the treatment centers clearly show the need to take effective action in the area of quality assurance in order to make the most of the existent savings potential. Transparency of treatment processes is a necessary condition for an economic assessment and for optimal resource allocation.

Blood Banks↗
PubMed2006

[Health economic research in rheumatic diseases].

Thorough health economic research of budget-relevant diseases should be one of the major tasks in the German health care system. Up to now cost studies were only performed for special research questions and/or with very limited focuses, e.g. the patients' view. Hence, federal programmes, like competence networks for certain diseases, which were introduced by the German Ministry for Research and Education in the late 1990s, should give a broader focus on health services research. With such an approach health politicians may obtain a deeper insight into areas of the health care sector which are likely to be more efficient after reorganisation. The process of a structured analysis of certain diseases will be demonstrated using the example of rheumatoid arthritis (RA). To this end, the results of a research programme sponsored within the Competence Network for Musculoskeletal Diseases will be presented. Direct costs, indirect costs as well as values for health-related quality of life of German RA patients in routine care by generalists and specialists will be discussed.

Arthritis, Rheumatoid↗
PubMed2004

Rice octadecanoid pathway.

Plant jasmonic acid (JA) and structurally similar animal prostaglandins play pivotal roles in regulating cellular responses against environmental cues, including the innate immune response(s). In plants, JA and its immediate precursor 12-oxo-phytodienoic acid (OPDA) are synthesized by the octadecanoid pathway, which employs at least five enzymes (lipase, lipoxygenase, allene oxide synthase and cyclase, and OPDA reductase), in addition to the enzymes involved in the beta-oxidation steps. Genetic, molecular, and biochemical analyses have led to the identification of almost all the genes of the octadecanoid pathway in Arabidopsis--a model dicotyledonous plant. In this regard, rice (Oryza sativa L.)--an important socio-economic monocotyledonous model research plant--remains poorly characterized. Until now, no gene has been specifically associated with this pathway. It is therefore of utmost importance to identify, characterize, and assign the pathway specific genes in rice. In this review, we have surveyed the rice genome, extracted a large number of putative genes of the octadecanoid pathway, and discussed their relationship with the known pathway genes from other plant species. Moreover, the achievements made so far on the rice octadecanoid pathway have also been summarized to reflect the contribution of rice towards extending our knowledge on this critical pathway in plants.

Animals↗
PubMed2003

Economic analysis of contraceptives for women.

OBJECTIVE: To examine from the health care services payer perspective the economic consequences of contraceptives available to women in the United States. METHODS: A Markov model was constructed to compare effectiveness and costs among nine contraceptive methods (including 3-month injectable, oral contraceptives, intrauterine device (IUD), intrauterine system (IUS), barrier methods and surgical methods). Primary health states included initial/continued use, method failure and method discontinuation with transitions every year for 5 years. Plan disenrollment was also incorporated in the model. Estimates for probabilities of events, resource used, and costs for the base-case were derived from a comprehensive literature review, average wholesale drug prices, the 2000 Medicare Reimbursement Fee Schedule and MEDSTAT's 2000 DRG Guide, in conjunction with expert opinion. Sensitivity analyses were performed on all variables. RESULTS: Aside from vasectomy, which was outside the scope of this study, the most effective methods were tubal ligation, levonorgestrel (LNG)-20 IUS and copper T 380A IUD. The least expensive methods (accounting for all costs) were LNG-20 IUS, copper T 380A IUD and 3-month injectable; the 5-year cost/person were $1646, $1678 and $2195, respectively. CONCLUSION: From a third-party payer perspective, LNG-20 IUS and copper T 380A IUD dominated all reviewed methods, except for tubal ligation. However, the small increase in contraceptive efficacy with tubal ligation has a high cost. IUD and IUS device costs have a significant impact on the relative cost-effectiveness of these two methods.

Adult↗
PubMed2002

Antipsychotic therapy: a pharmacoeconomic perspective.

The pharmacoeconomics of antipsychotic therapy is discussed. Schizophrenia is a chronic illness that develops early in life and has a long-term impact on the health care system, including costs. Treatment goals therefore include a reduction in the rate of rehospitalization, a primary source of the health care costs related to this disease. Atypical antipsychotics are often associated with improved efficacy and better tolerability than the older, conventional antipsychotic agents, and their use in schizophrenia has increased. However, the atypical drugs have higher acquisition costs that may limit their use in the cost-influenced health care environment. These acquisition costs vary widely among drugs and are often dependent on dosage. Analysis of the use of atypical antipsychotics in the Veterans Affairs Health System and other health systems demonstrates that, despite their higher acquisition costs, significant health and economic benefits can be obtained compared with conventional agents. Given the approximately equivalent efficacy demonstrated thus far by atypical antipsychotics, an appropriate cost-reduction strategy may include using the agent with the lowest acquisition cost.

Adolescent↗
PubMed1994

The impact of intra-DRG severity of illness on hospital profitability: implications for payment reform.

We examined the relationship between variations in intra-DRG severity of illness classifications and hospital profitability. Unlike in previous studies, we created a direct hospital-level measure of severity, formed from MedisGroup severity scores. We estimated separate regression equations for total margin, operating margin, net revenue per admission, and expense per admission. We examined data for 201 Pennsylvania hospitals and found that hospital profits were inversely related to the severity of illness index. Expense per admission was positively related to severity; however the relationship between severity and net revenue per admission was not significant. The results suggest that hospitals with a more severe case mix may not recover the full costs of providing services. Thus payment reform should include adjustments for severity of illness.

Economics, Hospital↗
PubMed1998

Methodology puts science behind capping chiropractic care.

An Atlanta-based firm is capitalizing on the movement to capitate chiropractic care as an alternative to costly specialty services. Other specialty practices can learn from their strategy--and get motivated by their results.

Blue Cross Blue Shield Insurance Plans↗
PubMed2002

The management of actinic keratoses in the United States with topical fluorouracil: a pharmacoeconomic evaluation.

Actinic keratosis (AK) may be an early stage of carcinoma in situ and invasive carcinoma. Excision or destruction of AKs is one of the most frequently performed procedures in dermatology. The most common treatments for AKs in the United States are liquid nitrogen cryotherapy and 5-fluorouracil. This paper focuses on the topical 5% fluorouracil cream (Efudex), 1% fluorouracil cream (Fluoroplex), and 0.5% fluorouracil cream (Carac) formulations. Our objective was to evaluate the cost-effectiveness of topical fluorouracil cream formulations for managing facial AKs from the perspective of the third-party payer, with a one-year time period. Initial estimates were based on the treatment of facial AKs only, using topical fluorouracil regimens approved by the US Food and Drug Administration. Analysis was based on the efficacy rates of each regimen as found in the literature and summarized using meta-analysis. The cost of therapy included drug-acquisition costs and medical management costs for 1 or 2 topical fluorouracil treatments per calendar year. Sensitivity analysis was performed by evaluating the cost per cured facial AK and the number of patients cured of AK (cost-effectiveness of treatment) for patients with 1 to 20 facial AKs. For one treatment cycle, the average efficacy rates of a topical fluorouracil treatment based on lesional response (proportion of facial AKs cured in a given patient) or patient cure (number of patients whose facial AKs were completely cured) were 87.8% and 62.5%, respectively. For more than 6 AKs, 0.5% fluorouracil cream may be more cost-effective than the 1% and 5% formulations. The true costs of therapy are underestimated however, as the costs of managing adverse events are not included. Our study suggests that once-daily use of 0.5% fluorouracil cream is a cost-effective way of managing a patient with multiple facial AKs.

Administration, Topical↗