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PubMed2006

What motivates daily cigarette smokers to quit? Retrospective annual discrete duration analysis.

This article analyzes retrospective information reported in an individual specific cross-sectional data set to examine who among daily cigarette smokers is likely to quit. In general, current quitting information is quite different from retrospective information. Cigarette price parameter estimates suggest that females are more forward looking than males and that males who start smoking daily at a young age are unlikely to quit. Furthermore, the birth of a child seems to encourage a mother and father to quit, and when a person receives some postsecondary education, they to are more likely to quit.

Adult↗
PubMed2006

Economic modeling of the rational consumption of addictive substances.

This article gives an overview of the way economists model the decision to consume addictive commodities and reviews some of the relevant literature testing aspects of the model. It aims to answer the question of how it is that economists can speak of the consumption of addictive harmful commodities as a rational decision. Health economics treats the consumption of commodities that have beneficial (or harmful) effects on health, and therefore on utility or well-being, as intertemporal decisions with regard to investment decisions. In investment in health, the payoff to an action comes appreciably later than the action itself. The decision to consume harmful, and even addictive, commodities fits into the investment in health framework, with the benefit comes now, in the form of the pleasure derived from consuming them, and the costs, in terms of damage to the individual's health, comes later. The value that a person places on the future vs. the present is called time preference or subjective rate of time discounting, which represents the weight he places on the future relative to the present when he makes decisions that have future consequences. The more they discount the future, the more myopic they are and the more likely to undertake risky behaviors, including smoking or using drugs such as amphetamines or heroin, as well as dropping out of school or taking on high risk jobs.

Behavior, Addictive↗
PubMed2006

Economic man and the consumption of addictive goods: the case of two goods.

It is well known that cigarette smoking and the use of other addictive goods is harmful to health. Still, some people smoke cigarettes and drink alcohol in their daily lives. The consumption of addictive goods seems, therefore, to be the antithesis of rational behavior. In this article, however, it is demonstrated that a rational individual, in the sense that he or she maximizes his or her well-being while anticipating the future consequences of his or her choices, may in fact choose to consume addictive goods. Specifically, the two-good extension of the rational addiction model is demonstrated and related to relevant policy questions. For instance, should one encourage the use of smokeless tobacco in smoking cessation programs? According to the empirical results, the answer is no. Further, should one discourage smoking by increasing the tax on cigarettes? Again, the answer is no.

Behavior, Addictive↗
PubMed2005

Cost-effectiveness of primary percutaneous coronary intervention versus thrombolytic therapy for acute myocardial infarction.

OBJECTIVES: We sought to determine the long-term cost-effectiveness of two reperfusion modalities in patients with acute ST-segment elevation myocardial infarction: primary percutaneous coronary intervention (PCI) versus thrombolytic therapy. DESIGN: A state-transition model that follows patients from when they develop STEMI until they die was developed. The model encompassed events and health states. Sensitivity analyses were undertaken. RESULTS: For a 65-year old man, life expectancy was 8.3 years with primary PCI and 7.6 years with thrombolytic therapy. The lifetime costs were 19,250 euros (NOK 154,000) and 29,250 euros (NOK 234,000), respectively, for patients living close to an invasive unit. Cost savings from PCI were mainly due to the reduction in future coronary interventions. For patients needing helicopter transport to arrive in time to an invasive unit for PCI, the costs were 24,000 euros (NOK 192,000) and 29,250 euros (NOK 234,000), respectively (all costs undiscounted). For women, the estimates were somewhat higher due to lower mortality. CONCLUSION: Compared with thrombolytic therapy, reperfusion by primary PCI results in greater health benefits at reduced lifetime costs. These findings may have important clinical implications in an increasing cost-conscious health care environment.

Aged↗
PubMed2004

Developing the formula for state subsidies for health care in Finland.

AIM: The aim was to generate a research-based proposal for a new subsidy formula for municipal healthcare services in Finland. METHODS: Small-area data on potential need variables, supply of and access to services, and age-, sex- and case-mix-standardised service utilisation per capita were used. Utilisation was regressed in order to identify need variables and the cost weights for the selected need variables were subsequently derived using various multilevel models and structural equation methods. RESULTS: The variables selected for the subsidy formula were as follows: age- and sex-standardised mortality (age under 65 years) and income for outpatient primary health services; age- and sex-standardised mortality (all ages) and index of overcrowded housing for elderly care and long-term inpatient care; index of disability pensions for those aged 15-55 years and migration for specialised non-psychiatric care; and index of living alone and income for psychiatric care. CONCLUSION: Decisions on the amount of state subsidies can be divided into three stages, of which the first two are mainly political and the third is based on the results of this study.

Adolescent↗
PubMed2003

Faces of poverty: sensitivity and specificity of economic classifications in rural Vietnam.

AIMS: Poverty concepts and measurements have occupied philosophers for centuries and are subject to debate by researchers. A wide range of possible measures have been developed and used. Most research is country specific and different methods produce different pictures of poverty. This study aimed to compare measures of poverty within an epidemiological field laboratory in Bavi District, northern Vietnam (FilaBavi) and specifically to find out whether the official economic classification made by the local authority matched other measurements of socioeconomic status. METHODS: Structured questionnaires were used to collect socioeconomic information in 11,547 households. In addition, the official classification for individual households was recorded. Five economic indicators were constructed: income, expenditure, household assets, housing conditions, and local authority's estimation. RESULTS: Official economic classification and housing score were symmetrically distributed, while assets score and particularly income were highly skewed. Design effects were high because of high intra-cluster correlations. No indicator was closely correlated with any other. Sensitivity and positive predictive value for poverty were generally low for all indicators. DISCUSSION: The authors' findings do not suggest that any of the indicators used is substantially better than the other or better than the Official Economic Classification made by local authority. The results also show that no indicator is particularly useful to predict the values of any other indicator and different poverty indicators may classify different socioeconomic groups as poor.

Developing Countries↗
PubMed1998

A risk/cost analysis of alternative screening intervals for occupational tuberculosis infection.

The Centers for Disease Control and Prevention (CDC) recommends that new health care employees receive a baseline skin test for Mycobacterium tuberculosis (M. tb) infection and that testing be repeated periodically. However, CDC does not explain the quantitative basis for its suggested screening intervals. This article examines the efficacy of alternative screening intervals for workers subject to different annual rates of M. tb infection and estimates the costs. An equation is developed for the cumulative risk of tuberculosis (TB) at 12 years given a specified annual rate of infection (ARI), screening interval, and a combined proportion (p) of successful skin testing and antibiotic prophylaxis. Equations for total cost of screening and cost per disease case prevented are provided. Results assume: (a) costs of $10 per skin test and $10,000 per TB disease case; (b) p = 0.88; and (c) and acceptable cumulative TB risk of 1 per 1000. For ARIs that might be deemed low (0.2% to 0.5%) and medium (1%), CDC screening intervals of 12 months and 6-12 months, respectively, minimize the cost per disease case prevented but permit residual disease risks greater than 1 per 1000. Recommended screening intervals are (i) 6 months for low-risk employee groups and (ii) 3 months for medium- and high-risk (e.g., ARIs of > or = 5%) groups. Interval (i) limits risk to 1 per 1000 and is approximately 50% shorter than the CDC interval for a low-risk group. Interval (ii), which is 67% shorter than the CDC interval for medium-risk groups but equal to that recommended for high-risk groups, permits a risk above 1 per 1000, but is likely the shortest feasible interval.

Antibiotic Prophylaxis↗
PubMedDate not supplied

Unemployment and marital status in Great Britain.

During the past decade, the marriage rate has declined and the divorce rate has increased in Great Britain. Becker (1981) attributes such changes to improvements in the economic status of women, in that high-wage women gain less from marriage relative to other women. However, an empirical analysis of data from the General Household Survey 1985 in Great Britain shows that male unemployment is another important determinant of changes in marital status. High rates of male unemployment reduce the incidence of marriage and increase the likelihood of divorce.

Adult↗
PubMed1999

Resampling and multiplicity in cost-effectiveness inference.

We compare published methods for placing statistical confidence limits around incremental cost-effectiveness ratio statistics and show that only a nonparametric, bootstrap approach using polar angles gives completely reasonable results when neither treatment has significant advantages in cost or effectiveness. We also discuss alternative ways to report analytical results using plots, confidence or tolerance limits, and quadrant acceptability fractions. Finally, we use simulation to study the multiplicity bias that can be introduced into ICER confidence limits when only the most favorable results are reported over several possible choices of numerator cost measure and denominator effectiveness measure.

Confidence Intervals↗
PubMed2003

Evaluating disease management program effectiveness: an introduction to time-series analysis.

Currently, the most widely used method in the disease management (DM) industry for evaluating program effectiveness is referred to as the "total population approach." This model is a pretest-posttest design, with the most basic limitation being that without a control group, there may be sources of bias and/or competing extraneous confounding factors that offer a plausible rationale explaining the change from baseline. Furthermore, with the current inclination of DM programs to use financial indicators rather than program-specific utilization indicators as the principal measure of program success, additional biases are introduced that may cloud evaluation results. This paper presents a non-technical introduction to time-series analysis (using disease-specific utilization measures) as an alternative, and more appropriate, approach to evaluating DM program effectiveness than the current total population approach.

Disease Management↗
PubMed2004

Diagnosing Crohn's disease: an economic analysis comparing wireless capsule endoscopy with traditional diagnostic procedures.

The purpose of this study was to review economic considerations related to establishing a diagnosis of Crohn's disease, and to compare the costs of a diagnostic algorithm incorporating wireless capsule endoscopy (WCE) with the current algorithm for diagnosing Crohn's disease suspected in the small bowel. Published literature, clinical trial data on WCE in comparison to other diagnostic tools, and input from clinical experts were used as data sources for (1) identifying contributors to the costs of diagnosing Crohn's disease; (2) exploring where WCE should be placed within the diagnostic algorithm for Crohn's; and (3) constructing decision tree models with sensitivity analyses to explore costs (from a payor perspective) of diagnosing Crohn's disease using WCE compared to other diagnostic methods. Literature review confirms that Crohn's disease is a significant and growing public health concern from clinical, humanistic and economic perspectives, and results in a long-term burden for patients, their families, providers, insurers, and employers. Common diagnostic procedures include radiologic studies such as small bowel follow through (SBFT), enteroclysis, CT scans, ultrasounds, and MRIs, as well as serologic testing, and various forms of endoscopy. Diagnostic costs for Crohn's disease can be considerable, especially given the cycle of repeat testing due to the low diagnostic yield of certain procedures and the inability of current diagnostic procedures to image the entire small bowel. WCE has a higher average diagnostic yield than comparative procedures due to imaging clarity and the ability to visualize the entire small bowel. Literature review found the average diagnostic yield of SBFT and colonoscopy for work-up of Crohn's disease to be 53.87%, whereas WCE had a diagnostic yield of 69.59%. A simple decision tree model comparing two arms--colonoscopy and SBFT, or WCE--estimates that WCE produces a cost savings of 291dollars for each case presenting for diagnostic work-up for Crohn's. Sensitivity analysis varying diagnostic yields of colonoscopy and SBFT vs. WCE demonstrates that WCE is still less costly than SBFT and colonoscopy even at their highest reported yields, as long as the diagnostic yield of WCE is 64.10% or better. Employing WCE as a first-line diagnostic procedure appears to be less costly, from a payor perspective, than current common procedures for diagnosing suspected Crohn's disease in the small bowel. Although not addressed in this model, earlier diagnosis with WCE (due to higher diagnostic yield) also could lead to earlier management, improved quality of life and workplace productivity for people with Crohn's disease.

Algorithms↗
PubMed2004

Time to death and health expenditure: an improved model for the impact of demographic change on health care costs.

BACKGROUND: Obtaining well-founded estimates of the effect of demographic change on future health expenditures is a pressing issue in all developed countries. Thus far, expenditure projections have examined the effect of age on health care costs, but fail to account for the influence of remaining life expectancy on costs. OBJECTIVE: This paper seeks to create a more accurate projection model that considers the concentration of costs towards the end of life, and to compare this model with the more traditional approach that holds age- and sex-specific per capita expenditures constant. METHODS: We used a longitudinal hospital dataset which followed 90 929 patients aged 65 and older from 1970 to death, to create an economic model of hospital costs based on patient age and time remaining to death. We then applied the model to England population projections to predict the effect of demographic changes on hospital expenditures from 2002 to 2026. RESULTS: The decline in age-specific mortality rates over time postpones death to later ages, pushing back death-related costs. Accounting for this in expenditure projections gave a predicted annual growth rate of 0.40%-half of the rate predicted with a traditional method. CONCLUSIONS: Using richer data and more refined methods than have hitherto been employed, this study strongly confirms that the pressure of population increases and ageing demographic structure on hospital expenditures will be partially countered by the postponement of death-related hospital costs to later in life-a finding consistent with emerging epidemiological evidence, and heartening for policy makers and physicians alike.

Adolescent↗
PubMed1995

Overview of pharmacoeconomics and pharmaceutical outcomes evaluations.

The principles, methods, and applications of pharmacoeconomics and pharmaceutical outcomes evaluations are discussed. Pharmacoeconomics may be defined as balancing the cost with the consequences (outcomes) of pharmaceutical therapies and services. As a type of outcomes evaluation, pharmacoeconomics looks beyond just the direct or acquisition cost of a pharmaceutical by including its impact on total health resource utilization and costs. Outcomes research attempts to answer the question, What difference does the pharmaceutical make in patient outcomes under real-world conditions? The economic, clinical, and humanistic outcomes (ECHO) model for a pharmacoeconomic evaluation views the drug as some combination of its clinical, economic, and humanistic attributes. Safety and effectiveness are no longer the only salient attributes of a drug; the effect on total health resource utilization, cost, and quality of life must also be evaluated. The four types of pharmacoeconomic methods are cost-minimization analysis, cost-benefit analysis, cost-effectiveness analysis, and cost-utility analysis. As disease state management continues to emerge as a cost-management, quality assurance strategy, formularies per se will wane in importance and pharmacoeconomic and outcomes data will increase in relevance as health professionals endeavor to find the most efficient and effective combinations of medical care. Pharmacoeconomics as a component of outcomes research will help pharmacists decide which clinical circumstances, patient characteristics, and practice settings are most suitable for particular interventions.

Costs and Cost Analysis↗