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At least 1,459 records · Page 81Linked to original sources
PubMed2001

Continuous subglottic suctioning for the prevention of ventilator-associated pneumonia : potential economic implications.

STUDY OBJECTIVE: To determine the cost-effectiveness of continuous subglottic suctioning (CSS) as a strategy to decrease the incidence of ventilator-associated pneumonia (VAP). DESIGN: Decision-model analysis of the cost and efficacy of endotracheal tubes that allow CSS at preventing VAP. The primary outcome was cases of VAP averted. Model estimates were based on data from published prospective trials of CSS and other prospective studies of the incidence of VAP. SETTING AND PATIENTS: Hypothetical cohort of 100 patients requiring nonelective endotracheal intubation and management in an ICU. INTERVENTIONS: In the model, patients were managed with either traditional endotracheal tubes (ETs) or ETs capable of CSS. MEASUREMENTS AND MAIN RESULTS: The marginal cost-effectiveness of CSS was calculated as the savings resulting from cases of VAP averted minus the additional costs of CSS-ETs, and expressed as cost (or savings) per episode of VAP prevented. Sensitivity analysis of the impact of the major clinical inputs on the cost-effectiveness was performed. The base case assumed that the incidence of VAP in patients requiring > 72 h of mechanical ventilation (MV) was 25%, that CSS-ETs had no impact on patients requiring MV for < 72 h, and that CSS-ETs resulted in a relative risk reduction of VAP of 30%. Despite the higher costs of ETs capable of CSS, this tactic yielded a net savings of $4,992 per case of VAP prevented. For sensitivity analysis, model inputs were adjusted by 50% individually and then simultaneously. This demonstrated the model to be only moderately sensitive to the calculated cost of VAP. With the relative risk reduction at 50% of the base-case estimate, CSS resulted in $1,924 saved per case of VAP prevented. When all variables were skewed against CSS, total outlays were trivial (approximately $14 per patient in the cohort). CONCLUSIONS: CSS represents a strategy for the prevention of VAP that may result in savings. Further studies are warranted to confirm the efficacy of CSS.

Cohort Studies↗
PubMed2003

Cost-effectiveness of hip protectors in institutional dwelling elderly.

OBJECTIVE: To assess the effectiveness and cost-effectiveness of hip protectors in the prevention of hip fracture in an elderly population living in institutions. DESIGN AND SETTING: Meta-analysis followed by economic analysis. METHODS: The meta-analysis of randomized controlled clinical trials was based on the recommendations of the Cochrane Collaboration. Model-based economic analysis was conducted using estimates of transition probabilities, costs, and utilities relevant to Canada. RESULTS: The results indicate that hip protectors compared with control results in a relative risk of hip fracture of 0.40 (95% Confidence Interval 0.23-0.70). The economic analysis found that the use of hip protectors is expected to be both effective and cost saving. Results were robust to a range of analysis exploring the uncertainty of input parameters. CONCLUSIONS: There is sufficient clinical and economic evidence to support the use of hip protectors for institutional dwelling elderly.

Aged↗
PubMed2002

A cost--utility analysis of treatment options for inguinal hernia in 1,513,008 adult patients.

BACKGROUND: The controversial issue of the cost-effectiveness of laparoscopic inguinal hernia repair is examined, employing a decision analytic method. MATERIALS AND METHODS: The NSAS, NHDS (National Center for Health Statistics), HCUP-NIS (Agency for Healthcare Research and Quality) databases and 51 randomized controlled trials were analyzed. The study group constituted of a total of 1,513,008 hernia repairs. Projection of the clinical, economic, and quality-of-life outcomes expected from the different treatment options was done by using a Markov Monte Carlo decision model. Two logistic regression models were used to predict the probability of hospital admission after an ambulatory procedure and the probability of death after inguinal hernia repair. Four treatment strategies were modeled: (1) laparoscopic repair (LR), (2) open mesh (OM), (3) open non-mesh (ONM), and (4) expectant management. Costs were expressed in US dollars and effectiveness in quality-adjusted life years (QALYs). The main outcome measures were the average and the incremental cost-effectiveness (ICER) ratios. RESULTS: Compared to the expectant management, the incremental cost per QALY gained was 605 dollars (4086 dollars, 9.04 QALYs) for LR, 697 dollars (4290 dollars, 8.975 QALYs) for OM, and 1711 dollars (6200 dollars, 8.546 QALYs) for ONM. In sensitivity analysis the two major components that affect the cost-effectiveness ratio of the different types of repair were the ambulatory facility cost and the recurrence rate. At a LR ambulatory facility cost of 5526 dollars the ICER of LR compared to OM surpasses the threshold of 50,000 dollars/QALY. CONCLUSIONS: On the basis of our assumptions this mathematical model shows that from a societal perspective laparoscopic approach can be a cost-effective treatment option for inguinal hernia repair.

Adult↗
PubMed1995

The effect of market structure on HMO premiums.

We examine the effects of HMO market structure on HMO premiums from 1988 to 1991. More competition, measured by the number of HMOs in the market area, reduces HMO premiums. Although this effect does not appear for IPAs before the highest level of competition is reached, it appears throughout the competitive range for Group HMOs. More market penetration, measured by the percent of the market area population enrolled in HMOs, reduces premiums for IPAs. Since the goal of managed competition is to reduce health care costs by creating competition among managed health care plans, our results offer encouragement for managed competition advocates.

Capitation Fee↗
PubMed2006

Cost-effectiveness of healthcare-based interventions aimed at improving physical activity.

AIM: This article aims to review current knowledge concerning the cost-effectiveness of healthcare-based interventions aimed at improving physical activity. METHOD: A search was performed for economic evaluations containing the terms "physical activity", "exercise", or "fitness". Cost-effectiveness for the articles found was described based on a model for evaluating interventions intended to promote physical activity. RESULTS: A total of 26 articles were found in the search. Nine of them concern a general population, 7 evaluated older people, and 10 studied disease-specific populations. A preventive perspective is most common, but some have a treatment perspective. Around 20 of the interventions studied were cost-effective according to their authors, but all analyses had some shortcomings in their evaluation methods. CONCLUSION: This review found many examples of cost-effective interventions. There is a lack of evidence for the cost-effectiveness of interventions aimed at those whose only risk factor for illness is a sedentary lifestyle. There is more evidence, although it is limited, for the cost-effectiveness of interventions aimed at high-risk groups or those who manifest poor health related to physical inactivity. Most of the evidence for cost-effectiveness is for older people and those with heart failure. Promotion of physical activity can be cost-effective with different methods and in different settings, but there remains a lack of evidence for specific methods in specific populations.

Aged↗
PubMed2004

Tackling regional health inequalities in france by resource allocation : a case for complementary instrumental and process-based approaches?

This article aims to evaluate the results of two different approaches underlying the attempts to reduce health inequalities in France. In the 'instrumental' approach, resource allocation is based on an indicator to assess the well-being or the quality of life associated with healthcare provision, the argument being that additional resources would respond to needs that could then be treated quickly and efficiently. This governs the distribution of regional hospital budgets. In the second approach, health professionals and users in a given region are involved in a consensus process to define those priorities to be included in programme formulation. This 'procedural' approach is employed in the case of the regional health programmes. In this second approach, the evaluation of the results runs parallel with an analysis of the process using Rawlsian principles, whereas the first approach is based on the classical economic model.At this stage, a pragmatic analysis based on both the comparison of regional hospital budgets during the period 1992-2003 (calculated using a 'RAWP [resource allocation working party]-like' formula) and the evolution of regional health policies through the evaluation of programmes for the prevention of suicide, alcohol-related diseases and cancers provides a partial assessment of the impact of the two types of approaches, the second having a greater effect on the reduction of regional inequalities.

Budgets↗
PubMed2000

Trends in financial satisfaction among middle-age and old-age Americans, 1972-1996.

Using data from the General Social Surveys (1972-1996), this study decomposes the trends in financial satisfaction into intercohort and intracohort patterns to assess the intracohort change and cohort replacement effects on financial satisfaction. The results suggest that a positive intracohort component of financial satisfaction trends, indicating more financial satisfaction with time; and a negative intercohort component, indicating that younger cohorts are less satisfied financially. The multivariate analysis further suggests that the change in financial satisfaction trends is mostly due to a strong intercohort replacement effect. That is, the change in financial satisfaction trends can be largely accounted for by the intercohort replacement effect of younger cohorts' being less satisfied financially.

Aged↗
PubMed2005

Has price competition changed hospital revenues and expenses in New York?

This study analyzes the factors that influenced hospital expenses and revenues prior to and following the enactment of the New York State Health Care Reform Act of 1996 (HCRA)-the period from 1994-1999. HCRA was expected to encourage price competition which in turn was anticipated to lower hospital revenues and expenses. We measured the differential effects on hospital revenues and expenses in markets with varying degrees of competition. We also measured the relationship between hospital revenues and expenses and the increased concentration resulting from the formation of local hospital systems. We found that revenues and expenses both grew more slowly for hospitals located in more competitive markets; hospital systems that increased concentration tended to have higher revenues. In the short run at least, price competition induced by HCRA did constrain both hospital expense and revenue growth, although the increase in hospital mergers countered this trend.

Costs and Cost Analysis↗
PubMed1992

[The economic evaluation of the early diagnosis of breast carcinoma: a review of the literature].

This paper reviews the economic aspects of screening for breast cancer: from a bibliographic search we identified studies on complete economic evaluation of screening programs in different parts of the world. At the methodological level, it goes as far as proposing a reference model for economic evaluation. An examination of the results obtained from various studies indicates that the introduction of screening program involves a cost per life-year saved of between 3,800 and 88,000 dollars. Allowing for quality of life, the range is 4,050 to 91,650 dollars. A discussion of some examples of sensitivity analysis shows how, and how much, the results change as a consequence of different assumptions regarding crucial variables: discount rate, reference period of the analysis, frequency of screening, age of the target population, volume of activity of each screening unit, compliance, sensitivity and specificity of the test.

Breast Neoplasms↗
PubMedDate not supplied

[Use of probabilistic methods in economic evaluation of health technologies].

The present article illustrates the advantages of probabilistic methods in health technology assessment. Using probabilistic distributions for parameters, these methods represent parameter uncertainty more effectively than deterministic models. The results of this simulation process represent the joint distribution of cost and effects in the cost-effective plane. More precisely, the cost-effectiveness ratio of each simulation is used to determine whether the ratio is cost effective in relation to the ceiling ratio. This kind of information is represented in the cost-effectiveness acceptability curve, which indicates the probability of a health technology being cost-effective for a particular quality-adjusted life year value.

Biomedical Technology↗