The implications of socio-economic model of fertility.
Explore the source record for details and available documents.
Culture↗
SEARCH · Search PubMed
Results for “Economic Model”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
An economic model for on-farm decision support of management to prevent infectious disease introduction into dairy farms.
A more-closed farming system can be a good starting point for eradication of infectious diseases from within a herd. The economic implications of a more-closed farming system will not always be obvious to farmers. The management decisions are related to different parts of the farm and are farm-specific. To support these decisions, a model was developed of the economic consequences of a more-closed system (a simple static and deterministic design was used). The risk factors in the model were based solely on bovine herpesvirus type 1 (BHV1) but losses due to introduction of BVDV, L. hardjo, and S. dublin were added to the model. The model was verified and partly validated and a sensitivity analysis was done. The cost to one 55-cow dairy farm that refrained from purchasing cattle, provided protective clothing to professional visitors and a temporary employee, and built and maintained a double fence around 6 ha of land to prevent over-the-fence contacts was Dfl. 4495 over 5 years. The probability of disease introduction was decreased by 74%. The prevented losses for disease introduction amounted to Dfl. 7033 over 5 years (net benefits of Dfl. 2538 over 5 years).A more-closed system would be still beneficial when a sanitary barrier was used instead of just protective clothing, when the probability of introduction of infectious diseases was decreased, and when odds ratios in the model were replaced by more-conservative relative risks. The benefits became negative when a farm had to build and maintain a double fence around 12 ha instead of 6 ha, when the probability of introduction of all diseases was decreased by 50%, and when the estimations were based solely on BHV1.
Animal Husbandry↗
A one year health economic model comparing transdermal fentanyl with sustained-release morphine in the treatment of chronic noncancer pain.
A Markov model was constructed to simulate the resource use and health outcomes of one year of treatment comparing the fentanyl transdermal therapeutic system (fentanyl-TTS) with oral sustained-release (SR) morphine in outpatients with noncancer pain in Denmark. Effectiveness was assessed in terms of days of good pain control and days on initial treatment. Costs included those of baseline pain management, including breakthrough pain; co-medication costs; and control of adverse events. Fentanyl-TTS was more effective than SR-morphine in achieving good pain control (99 vs. 64 days, respectively) and the incremental cost-effectiveness of fentanyl-TTS was US dollars 10.26 per extra day of good pain control. Patients treated with fentanyl-TTS remained considerably longer on initial treatment compared with those treated with SR-morphine (166 days vs. 117 days, respectively). The results of this study suggest that fentanyl-TTS is a competitive therapeutic and economic choice for the treatment of chronic noncancer pain.
Administration, Cutaneous↗
A lifetime modelled economic evaluation comparing pioglitazone and rosiglitazone for the treatment of type 2 diabetes mellitus in the UK.
INTRODUCTION: Adding pioglitazone or rosiglitazone to existing therapy are alternative treatment options for patients with type 2 diabetes mellitus who have insufficient glycaemic control while receiving the maximal tolerated dose of metformin monotherapy. Our objective was to develop a lifetime model of type 2 diabetes mellitus and its sequelae in order to compare the costs and benefits of pioglitazone versus rosiglitazone in combination with metformin. METHODS: A decision-analytic model employing a first order Monte Carlo simulation of a Markov process was constructed. The model incorporated surrogate outcome measures from a large randomised controlled trial (RCT) [n = 802] that compared the glycaemic and lipid control of pioglitazone and rosiglitazone monotherapy. These efficacy data were used with a recently validated and peer-reviewed UKPDS (UK Prospective Diabetes Study) algorithm to simulate the progression of these surrogate outcomes to final health outcomes, including quality of life (QOL) and mortality, and to calculate the risks of diabetic complications and death. The model perspective was of the UK NHS and included direct healthcare costs only (pounds, 2004/5 values). Patient outcomes measured in the model included life-expectancy (LE) and QALYs. The base-case analysis was run for 56-year-old male Caucasions with a haemoglobin A(1c) (HbA(1c)) of 7.57% and a body mass index of 33.14 kg/m(2). RESULTS: Patients treated with pioglitazone experienced a reduction in the total cholesterol to high-density lipoprotein-cholesterol (TC : HDL-C) ratio of 0.34, whereas the TC : HDL-C ratio increased by 0.65 in those receiving rosiglitazone (p < 0.001). The HbA(1c) profile was similar between the treatment groups (p = 0.13), as were other known risk factors for diabetes complications. The lifetime healthcare costs per patient estimated by the model were 9585 pounds for pioglitazone and 10,299 pounds for rosiglitazone. Patients treated with pioglitazone had a discounted LE of 8.83 years versus 8.79 years for those treated with rosiglitazone. Patients treated with pioglitazone also gained additional QALYs (6.8070 vs 6.7686). With improved health outcomes and lower costs, treatment with pioglitazone dominated rosiglitazone treatment. CONCLUSION: Evidence from the only large head-to-head RCT comparing rosiglitazone and pioglitazone suggests that more favourable changes in serum lipid profiles in patients treated with pioglitazone translate into improved health outcomes in terms of reduced morbidity and mortality and greater gains in QOL. In addition, this analysis indicates that treatment with pioglitazone is associated with lower costs than rosiglitazone. Therefore, in the UK, adjunctive pioglitazone may represent a cost-effective treatment choice for patients with type 2 diabetes who have insufficient glycaemic control while receiving the maximal tolerated dose of metformin monotherapy.
Blood Glucose↗
Applying an economic model to nursing management.
Explore the source record for details and available documents.
Costs and Cost Analysis↗
[Practicability of cataract surgery at university hospitals: searching for an economic model].
UNLABELLED: Resources available for health care all over the world are not enough to cover all the demand in this sector. Cataract Free Zones conducted in many regions of the country show that only 10% to 20% of blind patients caused by senile cataract can get operated on. PURPOSE: To demonstrate feasibility of a model for cataract surgery with intraocular lens implantation at the Clinical Hospital from the University of Campinas, Unicamp, São Paulo, when considering the remuneration payed by the government for universitary services. METHODS: Costs with disposable material were collected for extracapsular cataract surgery, with posterior intraocular lens implant, at the Clinical Hospital, Unicamp. The model includes outpatient surgery under local anesthesia, and costs rationalization in acquisition and wear of material. University Hospitals have a different situation in the health system, where fixed costs and part of the variable costs of cataract surgery are subsidized by the State government. RESULTS: Cataract surgery performed under the proposed methodology is economically feasible, considering disposable components only, and the price achieved was US$ 77 with government payment of US$ 474. More surgical interventions increases the efficiency of the institution, provides more surgical training to residents and better community health care. CONCLUSION: The authors consider that it is an obligation of University Hospitals, regard their commitment with training, research and quality of eye care deliverance, to increase the number of cataract surgeries for the lowest possible price.
Ambulatory Surgical Procedures↗
Modeling economic aspects of hospital information systems to give decision support for strategic information management.
Information systems require strategic planning in order to adapt their functionality and quality to the needs of health care organizations. Next to effectivity, cost efficiency in supplying and operating information systems is a particular objective. Hospital information systems with their technical infrastructure, their application systems and the hereby supported business functions can be described with the help of the meta model 3LGM2 and the 3LGM2 tool. The meta model and the 3LGM2 tool are extended by a generic approach to show supply and operation cost for all components of the information system and for the cost calculation between these components. This leads to the fact that all executives in hospitals are enabled to get the cost transparent which were caused by the support of the functions by the information system. The effects of planned extensions and modification of the information system can be analyzed in term of cost. In a prototypical modelling, the information system of a hospital of regular standards has been evaluated in nearly all its components and cost. An evaluation could show that information managers and executives are now delivered relevant cost information for planning, operating and control of information systems.
Decision Making, Organizational↗
[Productive life-span of dairy cows and its economic significance. II. The replacement of dairy cows: an economic model (author's transl)].
A model, initially based on the work of Zeddies (10), is presented , by which the economic aspects of the replacement problem may be studied. First, the principle underlying the replacement decision is discussed. Then, the data to be included in the model are determined. This mainly concerns the elements associated with age, such as milk production, the value of newborn calves, the slaughter of the cows, the feed cost and the cost of a pregnant heifer just before calving. The age-associated probability of culling is also included in the model. A number of questions regarding the economic importance of the duration of herd life have been studied using this model. In the third paper, the results of this application of the model will be presented.
Animal Feed↗
Direct medical costs associated with using vancomycin in methicillin-resistant Staphylococcus aureus infections: an economic model.
OBJECTIVES: To quantify the direct medical costs associated with using vancomycin, as inpatient treatment, in methicillin-resistant Staphylococcus aureus infections, in four clinical indications: complicated skin and soft tissue infections (SSTI), bacteremia, infective endocarditis (IE), and hospital-acquired pneumonia (HAP). RESEARCH DESIGN AND METHODS: A decision-analytic model was constructed to evaluate the cost of administering intravenous vancomycin. Cost inputs included hospitalization, drug procurement, materials, preparation and administration, renal function and drug monitoring, treating adverse events, and treatment failure. Probabilities and lengths of stay and treatment were obtained from the literature, an antimicrobial therapy database and clinical expert opinion. Univariate and multivariate sensitivity analyses were conducted to confirm the robustness of the baseline scenario. MAIN OUTCOME MEASURES: The cost of using vancomycin in the four indications, including and excluding hospital cost. RESULTS: Whereas the drug acquisition price of vancomycin 1g is US dollars 9.01 per dose, when all costs associated with using vancomycin were included, the cost per dose rose to US dollars 29-US dollars 43 per patient. Total costs per patient receiving multiple doses in a single course of treatment, excluding hospital room costs, were for SSTI, bacteremia, IE, and HAP,US dollars 779, US dollars 749, US dollars 2261, and US dollars 768, respectively. Total costs, including hospital length of stay, were for SSTI US dollars 23616, bacteremia US dollars 26446, IE US dollars 48925, and HAP US dollars 22493. In univariate analyses varying per diem hospital costs and length of stay had the greatest impact. Results of the multivariate analysis were comparable to the costs in the baseline scenario for all indications. CONCLUSIONS: This analysis highlights the importance of capturing all costs associated with using a drug and not simply focusing on drug acquisition cost. Future economic analyses should identify and account for the key cost burdens of a particular treatment to calculate its true cost.
Anti-Bacterial Agents↗
Population aging and social security: a politico-economic model of state pension financing.
"The present paper attempts to provide a positive, politico-economic explanation of actual social security policies [in developed countries]. A theoretical framework is devised which integrates individual utility maximization and governmental maximization of expected political support. Individual support depends on how net economic benefit from a pay-as-you-go financed state pension scheme is translated into a probability of voting for the government. The relation between net economic positions, public policy parameters, and voting probabilities is made explicit by referring to the logit model of qualitative choice. The analysis is set in an overlapping generations framework. Optimal state pension policies are characterized, relating such diverse factors as population aging, political power distribution, social solidarity, and income taxation." (SUMMARY IN FRE AND GER)
Demography↗
Work-site health promotion: an economic model.
Despite a burgeoning interest in and acceptance of corporate health promotion, the overall economic effects of these programs are not clear. Although ultimate resolution of this question awaits detailed empiric research, a theoretical approach can be useful in structuring the problem and understanding the critical issues. The financial model presented views the firm as a value-maximizing enterprise and evaluates health promotion as a use of corporate assets. The model projects the benefits and costs to the firm of a 7-year health promotion program under a variety of assumptions regarding the employee mix and the effects of the health promotion program on health and productivity. The analysis reveals that the base case assumptions result in a program that creates value for the firm when the cost is less than $193 per participating employee per year. Firms with a highly productive, difficult to replace, and older employee group are most likely to find health promotion to be a good investment. Productivity gains produce the majority of the economic benefits of the program. Effects on health care expense alone are projected to be relatively small. Gains from reduction in employee mortality or retiree health expense are found to be insignificant in this model.
Absenteeism↗
Applications of economic models in healthcare: the introduction of pioglitazone in Sweden.
Type 2 diabetes mellitus (T2DM) is a common disorder that is estimated to affect approximately 100 million people worldwide. Forecasts have suggested a substantial increase in incidence, mainly in Asia, Africa and North America. Thus, an increasing number of people with diabetes-related complications will have to be cared for in the future. This development will be a major health problem for the people affected, as well as a major health economic challenge for many countries. Thiazolidinediones represent a new class of drugs with a novel mechanism of action that addresses the root cause of T2DM. Their mode of action targets the core defect of T2DM, namely, insulin resistance. One of these drugs, pioglitazone, was recently approved by the Swedish authorities. To evaluate the cost effectiveness of this new drug, a published mathematical simulation model was used. This model was adapted to Swedish conditions, and local Swedish unit costs were put into the model. Modelling is necessary when performing economic evaluations in diabetes because of the complexity of the disease and its long time horizon. The cost-effectiveness analyses showed that the cost per life-year gained with pioglitazone combination therapy compared with current treatment ranged from 37,000 Swedish kronor (SEK) to SEK149,000. Although there is no threshold value for cost effectiveness in Sweden, the values presented would normally be regarded as cost effective in the Swedish healthcare system. Modelling studies are a good starting point, but long-term naturalistic studies are needed to establish the cost effectiveness of these new drugs.
Diabetes Mellitus, Type 2↗
Economic modelling of the gateway effect.
Although a significant number of empirical studies provide evidence of sequencing in drug use, economic theory remains focused on addiction to a single substance. This paper presents a general model of substance use that allows for the possibility of multi-commodity habit formation and can be used to analyse the intertemporal relationship between the consumption of legal and illicit drugs, or the gateway effect. A simple two-drug model is analysed and conditions for the existence of multi-commodity habit formation are examined. It is found in the case of multi-commodity habit formation that the marginal utility of initiating a new drug is higher when there is prior consumption of the other drug. Further, it is found that the individual will initiate drug consumption with that drug that has the lowest marginal cost. The particular sequencing of drug use that is observed in empirical data is explained by differences in the marginal cost of consuming legal and illegal drugs.
Alcoholism↗
Economic modeling of the use of gonadotropin-releasing hormone at insemination to improve fertility in dairy cows.
Economic and sensitivity analysis methods were used to evaluate financial returns from use of gonadotropin-releasing hormone (GnRH) at the time of insemination to enhance fertility of dairy cows. A computer spread sheet was used to determine the best service(s) for GnRH treatment, the increase in conception rate required for economic benefit from treatment, and how profits from GnRH treatment are affected by drug cost, herd reproductive efficiency, and production costs. Financial returns increased from use of GnRH at insemination under most herd conditions. Herds with conception rates less than or equal to 45% benefited from GnRH treatment at any 1 or 2 inseminations. Herds with conception rates greater than or equal to 60% benefited from GnRH treatment only at second or later services. Selection of second and/or third insemination as the GnRH treatment service usually resulted in the greatest total return. The enhancement of fertility necessary to achieve the break-even point with GnRH treatment at third service was 2% for low- and 5% for high-conception-rate herds. Base-line herd conception rates, estrus detection efficiency, replacement costs, value of excess days not pregnant, and cost of treatment had the greatest effect on returns from treatment. Herds with high conception rates and low replacement costs were likely to realize the least benefit from GnRH treatment at insemination. On the basis of our findings, we concluded that GnRH treatment at insemination is a profitable procedure under most herd conditions. Optimal treatment regimens for specific herds may best be determined by using herd performance and management data for calculating returns.
Animals↗
An economic model of contraceptive choice: analysis of family planning acceptors in Bogotá.
Explore the source record for details and available documents.
Choice Behavior↗
Implications of an SSRI generic step therapy pharmacy benefit design: an economic model in anxiety disorders.
As the antidepressant market continues to expand, it is important for healthcare decision makers to develop clinically and economically sound drug benefit designs. As such, the purpose of this study was to determine the economic implications of a generic step therapy (GST) formulary compared with an open formulary for selective serotonin reuptake inhibitors (SSRIs) in patients with anxiety disorders. A model simulating the SSRI treatment patterns of patients diagnosed with an anxiety disorder in a hypothetical health plan with 1 million members was developed. Treatment options were generic SSRI agents (ie, fluoxetine, paroxetine immediate release, and citalopram) and branded SSRI agents (ie, sertraline, paroxetine controlled release, and escitalopram). After treatment initiation, patients could achieve 180 days or more of continuous therapy with no evidence of therapy change, achieve less than 180 days of therapy with no evidence of therapy change, or have a change in therapy. Consequently, patients incurred differential average annual medical and prescription costs. Model probabilities and costs were estimated from published literature and database analyses. The GST formulary resulted in a greater frequency of therapy change than the open formulary (41.3% vs 36.8%) and a lower frequency of continuous therapy for at least 6 months (25.3% vs 29.8%). Costs of SSRI medication were lower for the GST formulary than for the open formulary (11.6 million US dollars vs 14.8 million US dollars ). Medical costs were considerably greater for the GST formulary than for the open formulary, however (178.7 US dollars million vs 174.9 million US dollars, respectively), with a total cost of 190.3 US dollars million for the GST formulary versus 189.6 US dollars million for the open formulary. The incremental cost of implementing a GST formulary over 1 year was 684 360 US dollars , or 0.06 US dollars per member per month. A sensitivity analysis indicated that the model was most sensitive to changes in the cost of SSRI drug therapy and the average annual medical costs for patients with evidence of therapy change. The results of this model indicate that implementing a GST formulary for SSRIs in patients with anxiety disorders may be associated with an increased amount of therapy change and early treatment discontinuation, resulting in an overall cost increase to a health plan.
Anxiety Disorders↗
A survey of economic models of hospitals.
Explore the source record for details and available documents.
Administrative Personnel↗
Results of an economic model to assess the cost-effectiveness of enoxaparin, a low-molecular-weight heparin, versus warfarin for the prophylaxis of deep vein thrombosis and associated long-term complications in total hip replacement surgery in the United States.
BACKGROUND: Premature death due to pulmonary embolism is a short-term complication of deep vein thrombosis (DVT). The long-term clinical course after DVT can be further complicated by excess mortality, recurrent venous thromboembolism (VTE), and the post-thrombotic syndrome (PTS), which may produce sizable long-term economic burdens. OBJECTIVE: The goal of this study was to determine the cost-effectiveness of the low-molecular-weight heparin (LMWH) enoxaparin versus warfarin for the universal prophylaxis of DVT and associated long-term complications in US patients undergoing total hip replacement surgery (THRS). METHODS: A model was constructed to assess the long-term cost-effectiveness of the 2 treatments. Patients undergoing THRS were exposed to a short-term risk of developing a DVT. Patients surviving a DVT were exposed to increased risk of long-term complications of DVT, including PTS, recurrent VTE, and increased mortality. Published literature, augmented by expert opinion, served as input for the model's resource use and costs for DVT prophylaxis, clinical diagnosis, and treatment of DVT, VTE, and PTS. RESULTS: When the analysis included only the short-term consequences of DVT, therapy with enoxaparin resulted in a net cost of $133 per patient and a net increase of 0.04 quality-adjusted life-years (QALYs) per patient. Thromboprophylaxis with enoxaparin versus warfarin resulted in $3733 per QALY saved. In contrast, when the long-term consequences of DVT were included, enoxaparin resulted in net lifetime savings of $89 per patient and net QALY benefits of 0.16 per patient. CONCLUSIONS: To the best of our knowledge, this is the first US economic analysis comparing DVT prophylaxis with the LMWH enoxaparin versus warfarin that included the long-term complications of DVT. Our model suggests that use of enoxaparin in patients undergoing THRS reduces the economic burden associated with these long-term complications.
Aged↗