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At least 1,405 records · Page 78Linked to original sources
PubMed1997

A murine model of laparoscopic-assisted intervention.

BACKGROUND: In order to better investigate the effects of laparoscopic surgery, it is necessary to establish reliable, reproducible, and economical animal models of laparoscopic intervention. Here we describe a mouse model of laparoscopic-assisted colon resection. METHODS: After successful induction of anesthesia the mouse is placed in Trendelenburg position and the peritoneal cavity is insufflated with carbon dioxide gas through an angiocatheter placed in the right upper quadrant. A 4-mm rigid scope with camera attachment is then inserted through a midline port created just caudal to the xiphoid. A second port is then created in the right lower quadrant to allow introduction of laparoscopic forceps into the peritoneal cavity. The cecum, which extends 1.5 cm beyond the ileocecal valve, is grasped with forceps and exteriorized through the operative port. Extracorporeally, the cecum is ligated and resected before the cecal stump is returned to the peritoneal cavity. The abdominal wall defects are then stapled closed. RESULTS: This simple model can be mastered by individuals with very limited surgical experience. This laparoscopic model has been used successfully in our laboratory in a number of experiments with an intraoperative complication rate of 3. 2% (3/94), which was similar to the open surgery group rate of 2.1% (2/95, p = 0.99 by chi square). We observed no postoperative leaks in either group. The only postoperative death occurred in the open resection group due to dehiscence of the laparotomy wound. CONCLUSIONS: We propose that this model may be useful for comparing the effects of open to laparoscopic surgery.

Animals↗
PubMed2003

The economic burden of stroke in the United Kingdom.

AIM: To estimate the cost of treating stroke in the UK. METHODS: A cost-of-illness model was constructed to estimate stroke-related costs over a 5-year period. The cost estimates were based on data from a large, randomised, prospective study comparing alternative strategies of stroke care. The study collected detailed data on resource use in hospital, primary care, healthcare contacts, and utilisation of social services over a period of 1 year following stroke. A Markov framework was used to extrapolate 1-year costs over 5 years. RESULTS: The model estimated that, for every patient who experiences a stroke, the cost to the NHS in the UK is pound 15306 over 5 years and, when informal care costs are included, the amount increases to pound 29405 (2001/2002 prices). The robustness of the cost findings was explored with the use of sensitivity analysis. This focused on the key variables of rates of recurrent stroke, the estimated acute costs, and costs attached to institution and home care. CONCLUSION: As well as being a considerable cause of morbidity and mortality, stroke is also a huge cost burden to both the UK's NHS and the carers of stroke victims.

Aged↗
PubMed2006

[Health economics of psychological diseases].

This article provides an overview of the characteristics and problems of the economic evaluation of mental health care. At first, the problems and methods of measuring direct and indirect costs of mental illness are discussed using cost of illness studies for depression and schizophrenia from the literature as examples. It is shown that, due to methodological problems of measuring costs of the wide range of mental health services as well as productivity losses, various cost of illness studies rendered very different results. Thereafter, the measurement of effects in the economic evaluation of mental health services is discussed whereby the problems of measuring quality-adjusted life years (QALYs) are addressed in particular. Despite the subjectivity of symptoms, preference-based valuation of health-related quality of life has rarely been attempted in psychiatric patients. Finally, frequent flaws of published cost-effectiveness analyses of mental health care are presented. These flaws make the interpretation and comparison of study results difficult. As there are hardly any German cost-effectiveness analyses of mental health care, more research efforts in this field seem to be necessary in Germany.

Cost-Benefit Analysis↗
PubMed2006

Economic implications of growth hormone use in patients with short bowel syndrome.

OBJECTIVE: Short bowel syndrome is a rare, life-threatening condition that can result in nutritional malabsorption. Parenteral nutrition provides life-saving support but can lead to complications and affect quality of life. Recombinant human growth hormone, somatropin (rDNA origin), has been shown to significantly reduce dependence on nutritional support (p < 0.05). This study evaluates the economic impact of somatropin use in the management of short bowel syndrome. METHODS: A discrete event simulation (DES) model was developed to estimate the benefits and costs associated with somatropin use. Risks of treatment complications and of disease-related events were modeled in identical patient pairs--one receiving parenteral nutrition alone, the other receiving 4 weeks of somatropin--for 2 years following initiation of treatment. Life expectancy was assumed equivalent. Risk functions were estimated from the literature and one randomized clinical trial. Total and component costs associated with each strategy were determined. The distribution of patients reducing parenteral nutrition need and the final parenteral nutrition frequency were also estimated. Sensitivity analyses were completed for key inputs. Direct medical costs are reported in US 2004 dollars. RESULTS: The model predicted that 96.0% of patients receiving somatropin reduce or eliminate parenteral nutrition within 6 weeks: average use was reduced by 2.8 days and one-third weaned completely. Based on 1.9 L of parenteral nutrition per day, estimated costs were 118,098 dollars in year one and 132,935 dollars in year two. With somatropin, costs dropped to 84,309 dollars in year one--despite the 17,459 dollars cost of somatropin treatment--and 81,250 dollars in year two. Over 2 years savings totaled 85,474 dollars. LIMITATIONS: Insufficient data required that assumptions be made for some inputs. DES is new in pharmacoeconomics and may be perceived as a limitation. CONCLUSIONS: Somatropin use improves quality of life by reducing the need for parenteral nutrition and results in health care cost savings.

Cost of Illness↗
PubMed1996

Economic analysis of treating depression with nefazodone v. imipramine.

BACKGROUND: It is estimated that treating diagnosed depression costs 420 pounds million annually in England and Wales. This economic study analyses treatment of major depression with nefazodone v. imipramine. METHOD: The study updates a previously published model using data obtained from the continuation phase of a double-blind one-year placebo-controlled comparison of nefazodone with imipramine. RESULTS: Annual costs for nefazodone are lower than those for imipramine, 218 pounds compared to 254 pounds; the cost per successfully treated patient is also lower for nefazodone than for imipramine, 242 pounds v. 323 pounds. Varying the resources included in the treatment patterns still results in lower costs for nefazodone treatment. CONCLUSIONS: Based on clinical trial data for patients completing six to eight weeks of depression treatment and followed for at least one year, the model shows that the annual costs of nefazodone are lower than those for the less expensive imipramine.

Antidepressive Agents, Second-Generation↗
PubMedDate not supplied

An educational tool to illustrate cost-effectiveness in diagnostic pathways for coronary artery disease.

Rapid increases in healthcare costs have led to increased interest in the cost-effectiveness of medical interventions. Coronary artery disease is responsible for a significant share of total healthcare spending, and therefore economic evaluations of medical procedures to treat the condition are potentially very important. We have developed a spreadsheet model as an educational tool that can be used to illustrate cost-effectiveness in the selection of diagnostic pathways (a "work-up" strategy of tests designed to reach a final diagnosis) for coronary artery disease. The model, in Microsoft Excel, is easy to use, requiring no specialist computer knowledge. It is menu-driven and the user navigates the model via a number of on-screen buttons. A data entry screen allows the user to customize the data for the key model parameters, making it possible to take into account location-specific features. The data entry screen also allows the user to undertake sensitivity analysis and rate "what if" scenarios. The model demonstrates how sensitive the cost-effectiveness of different diagnostic pathways is to the pretest probability of disease. This package could also be used as a decision support tool, although it is important to recognize some of its limitations for this purpose.

Coronary Disease↗
PubMedDate not supplied

Community benefits: how do for-profit and nonprofit hospitals measure up?

The rise of the for-profit hospital industry has opened a debate about the level of community benefits provided by non-profit hospitals. Do nonprofits provide enough community benefits to justify the community's commitment of resources to them, and the tax-exempt status they receive? If nonprofit hospitals convert to for-profit entities, would community benefits be lost in the transaction? This debate has highlighted the need to define and measure community benefits more clearly. In this Issue Brief, the authors develop a new method of identifying activities that qualify as community benefits, and propose a benchmark for the amount of benefit a nonprofit hospital should provide.

Benchmarking↗
PubMed2002

Quality standards and incentives in managed care organizations' specialty contracts for behavioral health.

BACKGROUND: In the US, most privately insured individuals are enrolled with managed care organizations (MCOs), and a majority of these organizations have subcontracted responsibility for behavioral health care to specialized vendors. Based on economic theory, we anticipate that MCOs should be more likely to require quality standards in contracts that transfer all financial risk to the vendor. AIMS OF THE STUDY: To test whether use of quality standards in behavioral health subcontracts differs between MCOs that transfer full financial risk and other MCOs. Similarly, to test for differences between for-profit and nonprofit MCOs. METHODS: Bivariate tests and logistic regression analysis of the use of five quality-related standards, and the use of any standard, in a nationally representative sample of commercial MCO products in 60 US market areas. Statistical controls include MCO size, chain affiliation, region and market size. RESULTS: All five standards we examined were widely used in behavioral health subcontracts (varying from 47% to 70% of products). However, contrary to our hypothesis, the standards are not more commonly used by MCO products with unlimited capitated contracts for behavioral health. In most cases the opposite is true. In addition, for-profit plans were more rather than less likely to use several of the standards. DISCUSSION: MCOs that transfer full risk may be using mechanisms other than quality standards (e.g. periodic rebidding) to prevent skimping; may be less concerned about quality anyway; or may be more skeptical about the value of existing standards. The fact that for-profit plans are equally or more likely to use these standards may reveal that their objectives are not different from those of nonprofits, or that competition is constraining them to adopt standards anyway. Limitations of this study include the lack of more detailed data on the nature of financial risk-sharing, and on the types of financial penalties associated with each standard. IMPLICATIONS FOR HEALTH POLICY: Pressure for accreditation appears to be an effective vehicle for encouraging the spread of standards. It would be useful to know how far use of these quality standards in contracts is linked to better quality of care. IMPLICATIONS FOR FUTURE RESEARCH: Further studies should examine the relationship between quality standards and quality of care

Behavior Therapy↗
PubMedDate not supplied

[Cost-minimisation analysis of the pharmacological treatment of epilepsy in Spain].

AIM: To use a model of economic evaluation to analyse the efficiency of therapy with the antiepileptic drugs indicated in recently diagnosed partial and generalised epilepsy. MATERIALS AND METHODS: The treatment of partial epilepsy and generalised epilepsy in Spain was taken as the basis to design two flexible simulation models of the decision tree type. The time horizon of the study was one year and the perspective was that of the Spanish National Health System, and indirect costs were also included. Clinical effectiveness data were obtained from a review of the literature on clinical trials. Information about resources was obtained from the opinions of a panel of experts. Unitary costs of resources were drawn from Spanish databases (euro 2003). The findings of the study were expressed in terms of average cost per patient with each therapeutic strategy, as well as the incremental cost of the different treatment strategies with respect to valproic acid. RESULTS: According to the literature that was reviewed, there are no differences in effectiveness from one antiepileptic drug to another. The incremental cost of the different therapeutic strategies, with respect to valproic acid, lies between 211 and 911 euros per patient and year in partial epilepsy, and between 1,355 and 1,297 euros per patient and year in the case of generalised epilepsy. CONCLUSIONS: The use of sustained-release valproic acid in recently diagnosed partial and generalised epilepsy would allow savings to be made in resources, with respect to the other antiepileptic drugs, and can therefore be considered to be the most effective therapeutic option.

Anticonvulsants↗
PubMed2002

NitroGenius: a nitrogen decision support system. A game to develop the optimal policy to solve the Dutch nitrogen pollution problem.

A nitrogen decision support system in the form of a game (NitroGenius) was developed for the Second International Nitrogen Conference. The aims were to: i) improve understanding among scientists and policy makers about the complexity of nitrogen pollution problems in an area of intensive agricultural, industrial, and transportation activity (The Netherlands); and ii) search for optimal policy solutions to prevent pollution effects at lowest economic and social costs. NitroGenius includes a model of nitrogen flows at relevant spatial and temporal scales including emissions of ammonia and nitrogen oxides and contamination of surface- and groundwaters. NitroGenius also includes an economic model describing relationships for important sectors and impacts of different nitrogen control measures on Gross Domestic Product (GDP), unemployment, energy use, and environmental costs. About 50 teams played NitroGenius during the Second International Nitrogen Conference. The results show that careful planning and selection of abatement options can solve Dutch nitrogen problems at reasonable cost.

Cost Control↗
PubMed1975

A simulation model for determination of the economic production rate of the auto analyzer system.

1. The problem is considered of determining the appropriate rate of operation of an Auto Analyzer System. A computer model is presented which simulates the operation of the system, so as to describe the frequency of such events as repeated samples. 2. Estimates may be obtained of average total running costs, incorporating those of consumables and technician time and the rate which minimises the average cost, subject to stated test quality constraints, may then be calculated.

Autoanalysis↗