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PubMed2005

An economic analysis of a pneumococcal vaccine programme in people aged over 64 years in a developed country setting.

BACKGROUND: Polysaccharide pneumococcal vaccination for older adults is being introduced in developed country settings. Evidence of protection by this vaccine against pneumococcal pneumonia, or confirmation that illness and death from bacteraemia are prevented, is currently limited. Decisions are often made based on partial information. We examined the policy implications by exploring the potential economic benefit to society and the health sector of pneumococcal vaccination in older adults. METHODS: A model to estimate the potential cost savings and cost-effectiveness of a polysaccharide pneumococcal vaccine programme was based on costs collected from patients, the literature, and routine health-services data. The effect of a pneumococcal vaccine (compared with no vaccination) was examined in a hypothetical cohort aged over 64 years. The duration of protection was assumed to be 10 years, with or without a booster at 5 years. RESULTS: If it were effective against morbidity from pneumococcal pneumonia, the main burden from pneumococcal disease, the vaccine could be cost-neutral to society or the health sector at low efficacy (28 and 37.5%, respectively, without boosting and with 70% coverage). If it were effective against morbidity from bacteraemia only, the vaccine's efficacy would need to be 75 and 89%, respectively. If protection against both morbidity and mortality from pneumococcal bacteraemia was 50%, the net cost to society would be 2500 pounds per year of life saved ( 3365 pounds from the health-sector perspective). Results were sensitive to incidence, case-fatality rates, and costs of illness. CONCLUSIONS: A vaccine with moderate efficacy against bacteraemic illness and death would be cost-effective. If it also protected against pneumonia, it would be cost-effective even if its efficacy were low.

Aged↗
PubMed1999

Cost-minimization analysis of piperacillin/tazobactam versus imipenem/cilastatin for the treatment of serious infections: a Canadian hospital perspective.

BACKGROUND: In 1998 we reported the first Canadian double-blind, randomized, clinical trial involving a comparison of piperacillin/tazobactam (P/T) with imipenem/cilastatin (I/C). The present study was conducted to determine the feasibility of replacing I/C at our institution. OBJECTIVE: To describe the outcome of a pharmacoeconomic analysis of the clinical trial from the perspective of a tertiary acute-care institution. METHODS: A total of 150 consenting adults originally prescribed I/C were randomly assigned to receive either P/T 4.5 g i.v. (n = 75) or I/C 500 mg i.v. (n = 75) every six hours. Actual direct medical resources used in relation to the treatment of bacterial infections were prospectively assessed during a clinical trial; these included cost of study and ancillary antibiotics, hospitalization, diagnostic testing (radiology, laboratory assessments), and labor, as well as treatment of adverse drug reactions, antibiotic failures, and superinfections. RESULTS: While costs for successful treatment courses were similar across treatment arms, hospitalization costs for treatment course failures were higher for P/T recipients. Direct medical costs for treatment courses associated with a superinfection were also higher in the P/T arm. Overall costs for treatment failures with either study drug were at least twofold those observed for successful treatment courses. Mean total management cost per patient in the P/T group was $15,211 ($ CDN throughout) (95% CI $11,429 to $18,993), compared with $14,232 (95% CI $11,421 to $17,043) in the I/C group (p = 0.32), resulting in a mean cost difference of $979. Sensitivity analyses revealed that the superiority of I/C over P/T for successful treatment of serious infections was sensitive to changes in the cost of hospitalization and drug efficacy for either drug. CONCLUSIONS: Based on the results of the clinical trial, P/T and I/C offer similar clinical, microbiologic, and toxicity outcomes in hospitalized patients with serious infections. Under base-case conditions, our pharmacoeconomic analysis showed that I/C was a cost-effective alternative to P/T at the dosage regimens studied. However, this finding was sensitive to plausible changes in both clinical and economic parameters.

Adult↗
PubMed2004

The economics of adjunctive therapies in coronary angioplasty: drugs, devices, or both?

BACKGROUND: Abciximab reduces the number of ischemic events in patients undergoing angioplasty compared to standard therapy. Coronary stenting reduces the need for repeat procedures. Abciximab or stents individually are considered cost effective interventions. There is a need to quantify the economic value of the combination of abciximab and stenting over stenting alone. METHODS: A decision analytic model was developed incorporating the outcomes from the EPISTENT study. Costs from Canadian sources for hospitalization, procedures and medications were used. Life expectancy was estimated using a Markov model. Total expected costs and outcomes of the abciximab and stent vs. stent alone were compared in an incremental analysis. The perspective of the analysis was a Canadian teaching hospital. RESULTS: The acquisition cost for abciximab was partially offset by reduced costs for managing clinical events resulting in a net incremental cost of 1,076 dollars per patient over one year (8,617 dollars combination vs. 7,541 dollars stent alone). This added cost was accompanied by a reduction in large MI or death by an absolute rate of 5.7% at one year (5.3% combination vs. 11.0% stent alone), yielding an incremental cost-effectiveness ratio of 18,877 dollars per death or large MI averted. The long-term survival gain was 0.15 to 0.37 years yielding an attractive incremental cost effectiveness ratio of 2,832 dollars to 7,173 dollars per life year gained. CONCLUSIONS: The combination of abciximab and stenting versus stenting alone provides improved clinical outcomes at a very reasonable cost from the Canadian hospital perspective.

Abciximab↗
PubMed1993

Population growth and optimality: when does serendipity hold?

"This note gives the conditions under which there is an interior optimum rate of population growth in a two-generations-overlapping model. These conditions imply complementarity both in production and in consumption. They also validate Samuelson's serendipity theorem."

Demography↗
PubMed2001

Veterinary epidemiology--a key to sustainable pig production in Switzerland.

Sustainable animal production requires a healthy production system including healthy animals producing wholesome products. Epidemiology as a discipline is concerned with the occurrence of disease or disease indicators in populations as well as with factors influencing disease occurrence. By providing this information, epidemiology contributes significantly to the development and maintenance of healthy livestock. This is illustrated with the example of the enzootic pneumonia (EP) eradication programme of Switzerland. A series of observational studies were conducted in order to obtain the necessary knowledge to implement an area-wide EP eradication programme. The issues of economical eradication strategies at the herd level and the risk of re-infections were addressed. Simulation modelling and economical analysis were also applied. These research projects led to the successful start of a national eradication programme. The example of the EP eradication programme illustrates that applied epidemiological research provides critical information for the planning, implementation and evaluation of disease control programmes and is thus a key tool in developing sustainable animal production.

Animal Husbandry↗
PubMed2004

Economic analysis of an intraoperative cell salvage service.

UNLABELLED: In the United States, the cost of erythrocyte transfusion exceeds 1.3 billion dollars annually. The fear of viral disease transmission popularized intraoperative salvage to reduce the use of banked blood. Although the economics of this technique have been questioned, the financial variables in providing an intraoperative autotransfusion service have not been analyzed. We designed mathematical models to determine the most cost-effective strategy based on hospital caseload. Four models were analyzed with a spreadsheet to project costs of an intraoperative autotransfusion service when fully or partially outsourced, performed by a full-time technician employee, or performed by a cross-trained employee. The Partially Outsourced model was more economical than the Fully Outsourced model when the annual caseload exceeded 185 cases. The New Employee model became more economical than the Fully Outsourced model when the annual caseload exceeded 110 cases. The Cross-Trained model was the most economical when annual caseload exceeded 55 cases. IMPLICATIONS: Cross-training an employee as a cell salvage technician is more economical than outsourcing when caseload exceeds 55 per year.

Blood Loss, Surgical↗
PubMed1986

John Turner revisited: an intra-urban migration model for colonial-type cities in Latin America.

The author uses the intra-urban migration model developed by John Turner in the early 1960s to examine population movements in the city of Arequipa, Peru. Ways in which the model applies in the case of Arequipa are summarized, as are quantitative and qualitative differences between the model and the Arequipa study. The Turner model employs economic (industrialization level), demographic (level of rural-to-urban migration), and political (housing policy) criteria to distinguish a city's transitional phase. "According to these criteria Arequipa clearly belongs to the mid-transitional phase. The pattern of intra-urban migration, however, shows a mixture of Turner's mid and late transitional phases (e.g. center acts still as a reception area, but at the same time a major number of migrants settle directly in the periphery).... The town itself has a limited industrial development and hardly any municipal housing policy worth mentioning.... It is above all the demographic factor in combination with the town's morphology (a large colonial-type center, etc.) which in the case of Arequipa regulates the pattern of intra-urban migration."

Americas↗
PubMed2005

Pharmacoeconomic analyses using discrete event simulation.

To date, decision trees and Markov models have been the most common methods used in pharmacoeconomic evaluations. Both of these techniques lack the flexibility required to appropriately represent clinical reality. In this paper an alternative, more natural, way to model clinical reality--discrete event simulation--is presented and its application is illustrated with a real world example.A discrete event simulation represents the course of disease very naturally, with few restrictions. Neither mutually exclusive branches nor states are required, nor is a fixed cycle. All relevant aspects can be incorporated explicitly and efficiently. Flexibility in handling perspectives and carrying out sensitivity analyses, including structural variations, is incorporated and the entire model can be presented very transparently. The main limitations are imposed by lack of data to fit realistic models. Discrete event simulation, though rarely employed in pharmacoeconomics today, should be strongly considered when carrying out economic evaluations, particularly those aimed at informing policy makers and at estimating the budget impact of a pharmaceutical intervention.

Computer Simulation↗
PubMed1986

An economic analysis of recent fertility in Japan: an application of the Butz-Ward model.

The authors apply the Butz-Ward version of the new home economics model of fertility to Japan, using annual time-series data for 1963-1984. This model postulates that "both men's and women's current wages operate independently in explaining fertility movements in the United States." Some of the theoretical and technical problems with this model are discussed. The authors then propose five alternative specifications to the Butz-Ward model and test the applicability of each specification to Japan (SUMMARY IN JPN)

Asia↗
PubMed2002

Health economic evaluations using decision analytic modeling. Principles and practices--utilization of a checklist to their development and appraisal.

OBJECTIVES: Decision analytic modeling allows a rational, feasible, scientific, and timely approach to measure the efficiency of new medical technologies in health care by using the best available evidence of different sources to produce detailed estimates of the clinical and economic consequences of different healthcare interventions. The aim of this article has been twofold: first, to state the benefit, usefulness, and limitations of decision analytic modeling; and second, to propose a list of steps that should be considered when carrying out this sort of analysis in order to increase its credibility and validity for medical decision making. METHODS: After having read the published literature about decision analytic models, a checklist was created, listing the paramount items and points that should always be followed when carrying out disease modeling. RESULTS: A checklist with 3 items and steps to be taken was drawn up to ensure that all important methodologic aspects are considered when performing and assessing decision analytic modeling, thereby constituting a standard guide to good modeling practices. In addition, a set of limitations inherent to the use of decision analytic models is also contemplated, along with a list of recommendations increasing their validity and utility. CONCLUSIONS: Health economic assessments will continue to be an important tool for the correct allocation of resources, and disease analytic modeling will be a potentially invaluable tool in assisting decision makers in this task.

Cost-Benefit Analysis↗