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PubMed2004

Economics of the clinical management of lung cancer in France: an analysis using a Markov model.

To evaluate, according to the histologic type and initial stage, the mean cost (MC) of managing patients with lung cancer and the costs of the different management phases. A Markov approach was used to model these costs, based on the management of a representative nation-wide sample of 428 patients with newly diagnosed lung cancer. The 18-month MC ranged from US$ 20 691 (95% CI: 5777-50 380 for diffuse non-small-cell lung cancer (NSCLC) to US$ 31 833 (95% CI: 15 866-64 455) for localised small-cell lung cancer (SCLC); first-line treatment costs ranged from 33.8% of MC for medically inoperable localised NSCLC to 74.6% for diffuse SCLC; second- or third-line treatment costs ranged from 7.8% of MC for surgically treated localised NSCLC to 32% for locally advanced NSCLC; and the cost of palliative care ranged from 9.1% of MC for locally advanced NSCLC to 39.9% for medically inoperable localised NSCLC. The cost of first-line chemotherapy and the percentage of actively treated patients impacted more on MC than did the cost of second- or third-line chemotherapy regimens or the cost of palliative care. In conclusion, this model provides a robust economic analysis of the cost of lung cancer management, and will be useful for assessing the economic consequences of future changes in patient management.

Aged↗
PubMed1998

Fertility and labour supply in Femina economica.

This paper sets out a formal framework for the biological-evolutionary study of human economic behaviour. Femina economica is a hypothetical parthenogenetic species with a simple economy. Individuals make decisions about labour supply and fertility subject to time and resource constraints. Labour is of differing types and a parent determines the type of her offspring's labour. Wages are determined as marginal productivities from an economy-wide production function. Three propositions are proved, of which the first shows that under very general conditions there exists a population genetic equilibrium, in which individuals' decisions are assumed to be under genetic control. The second shows that at a population genetic equilibrium, individuals have the same behaviour as they would at an economic equilibrium, in which individuals are assumed to maximise a common utility function. The third proposition shows that if the common utility function fulfils certain conditions, the attainment of an economic equilibrium brings about the same behaviour as a population genetic equilibrium. This suggests a way in which evolutionarily stable behaviour can be brought about without the necessity for changes in gene frequencies. Demographic implications include the possibility of interpreting in Darwinian terms the reductions in offspring number that occur in fertility transitions, and the weak or even negative correlation in economically developed societies between control of resources and offspring number. There are implications for economics of deriving utility maximisation from population genetics.

Biological Evolution↗
PubMed1980

Migration and the development of multiregional economic systems.

"This paper outlines a model which simultaneously characterizes economically induced migration and discretionary migration [in the United States]. The model is articulated for a multiregional system, and an attempt is made to characterize simultaneously demographic and economic change."

Americas↗
PubMedDate not supplied

Trials, tribulations, and trends in tumor modeling in mice.

Selection of mouse models of cancer is often based simply on availability of a mouse strain and a known compatible tumor. Frequently this results in use of tumor models long on history but short on homology and quality control. Other factors including genetics, sex, immunological status, method and site of tumor implantation, technical competence, biological activity of the tumor, protocol sequence and timing, and selection of endpoints interact to produce outcomes in tumor models. Common reliance on survival and tumor burden data in a single mouse model often skews expectations towards high remission and cure rates; a finding seldom duplicated in clinical trials. Inherent limitations of tumor models coupled with the advent of new therapeutic targets reinforce need for careful attention to design, conduct, and stringent selection of in vivo and ex vivo endpoints. Preclinical efficacy testing for anti-tumor therapies should progress through a series of models of increasing sophistication that includes incorporation of genetically engineered animals, and orthotopic and combination therapy models. Pharmacology and safety testing in tumor-bearing animals may also help to improve predictive value of these models for clinical efficacy. Trends in bioinformatics, genetic refinements, and specialized imaging techniques are helping to maintain mice as the most scientifically and economically powerful model of malignant neoplasms.

Animals↗
PubMed1997

Productivity growth in health-care delivery.

OBJECTIVES: The authors compute and compare productivity growth in the health-care sectors for a sample of Organization for Economic Cooperation and Development countries over the period from 1974 to 1989. The authors compute Malmquist productivity indexes, which allow productivity growth to be decomposed into efficiency changes and technical change. These indexes also allow the use of primary quantity data (recently available from the Organization for Economic Cooperation and Development), rather than expenditure data, which the authors argue reduces bias resulting from distorted prices. METHODS: The authors specify two models. The first model focuses on the hospital sector; inputs include physicians and medical care beds, whereas outputs are the "intermediate" type used in hospital efficiency studies, namely, inpatient days and discharges. RESULTS: For the 19 countries with complete data, the authors found little productivity growth based on this model (with the exception of Denmark, with 15.4% cumulated growth, and the United States, with about 5% from 1974 to 1989). The authors did find, however, that the highest productivity levels are found in the United States (Italy and Finland were also on the frontier of technology in the base period, 1974). The second model uses the same inputs as the first (but in per capita terms), but it specifies simple proxies of health outcomes as outputs: life expectancy of women at age 40 and the reciprocal of the infant mortality rate. CONCLUSIONS: For the 10 countries with complete data for this model, the authors found evidence of much more widespread and rapid productivity growth: Denmark's cumulated growth was close to 33%, with the United States close behind. In both these countries, this growth was due solely to technical change over this period.

Canada↗
PubMed2004

Evaluating the efficiency of treatment in the allergic rhinitis market.

BACKGROUND: In the present era of increasing health care expenditures, economic comparisons of therapeutic products play an important role in ensuring that limited health care resources are used appropriately. OBJECTIVE: To provide a model for the comparative analysis of alternative treatments, in terms of both cost and efficacy, in allergic rhinitis that will provide decision makers in a managed care environment an additional tool to help maximize health care benefit per dollar spent. We also review current treatments in the allergic rhinitis market and their impact on cost, availability, and utilization. SUMMARY: Efficacy estimates were derived from published reviews, meta-analyses, and guidelines, and cost data are based on average wholesale prices. Our results indicate that when cost and efficacy data are plotted on a cost-effectiveness plane, the intranasal corticosteroids appear to be the most efficient use of health care resources. Moreover, budesonide aqueous nasal spray was found to be the most efficient treatment for allergic rhinitis when compared with 3 other leading intranasal corticosteroids used at their recommended starting doses, the less-sedating/nonsedating antihistamines, and a leukotriene receptor antagonist. CONCLUSION: Evaluating products on an efficiency frontier platform, which integrates both the effectiveness and cost of products, will allow health plan decision makers to ensure the appropriate allocation of health care resources.

Cost-Benefit Analysis↗
PubMed2005

Economic evaluation of pneumococcal conjugate vaccination in Finland.

The aim of this study was to evaluate cost-effectiveness of pneumococcal conjugate vaccine (PCV7) in children <5 y of age. A Markov simulation model was used to compare the cost-effectiveness of 4 doses (assumed 50.5 euros per dose) of PCV7 with no intervention. Only direct effects of the vaccine were taken into account. In Finland, vaccination of a birth cohort of 57,500 healthy infants would potentially prevent annually 60 cases of invasive PD, 1,400 cases of pneumococcal pneumonia, 15,000 episodes of acute otitis media, 3,000 otological surgery procedures and 0.9 deaths in children aged <5 y. Investing 12.0 million euros to vaccinate a birth cohort would save annually 6.3 million euros in medical, and 2.0 million euros in productivity and other, costs. Therefore, investing 1 euros in a vaccination programme would return 0.53 euros in medical costs and 0.70 euros in societal costs. In the base case, vaccination would cost society 139,986 euros per life y gained. To achieve cost savings from a health care provider (societal) perspective, without considering herd effects or replacement phenomenon, the price of PCV7 should be 50% (70%) of the price used in the base case.

Child, Preschool↗
PubMed1995

The Cuban health care system and factors currently undermining it.

This paper explores the dynamics of health and health care in Cuba during a period of severe crisis by placing it within its economic, social, and political context using a comparative historical approach. It outlines Cuban achievements in health care as a consequence of the socialist transformations since 1959, noting the full commitment by the Cuban state, the planned economy, mass participation, and a self-critical, working class perspective as crucial factors. The roles of two external factors, the U.S. economic embargo and the Council of Mutual Economic Cooperation (CMEA), are explored in shaping the Cuban society and economy, including its health care system. It is argued that the former has hindered health efforts in Cuba. The role of the latter is more complex. While the CMEA was an important source for economic growth, Cuban relations with the Soviet bloc had a damaging effect on the development of socialism in Cuba. The adoption of the Soviet model of economic development fostered bureaucracy and demoralization of Cuban workers. As such, it contributed to two internal factors that have undermined further social progress including in health care: low productivity of labor and the growth of bureaucracy. While the health care system is still consistently supported by public policy and its structure is sound, economic crisis undermines its material and moral foundations and threatens its achievements. The future of the current Cuban health care system is intertwined with the potentials for its socialist development.

Aged↗
PubMed1983

The feasibility of economic evaluation of diagnostic procedures.

This paper reviews the principles of cost-benefit and cost-effectiveness analysis as they are applied to diagnostic procedures. These medical procedures present particularly thorny problems to those who would subject them to economic evaluation. Five specific problem areas encountered in attempting to apply economic evaluation to diagnostic procedures are discussed in detail. They are: defining homogeneous patient groups for analysis; specifying the relevant diagnostic alternatives; measuring diagnostic accuracy; measuring diagnostic costs; and specifying the measured outcomes of the diagnostic process. The economic evaluation literature on two diagnostic procedures--the skull X-ray and computed tomographic (CT) scanning is reviewed within the context of a model of economic evaluation. Two studies were found to successfully apply the principles of economic evaluation to CT scanning; none were found for skull X-rays. The most common approaches to evaluating the usefulness of these procedures, and the limitations of these approaches, are summarized.

Cost-Benefit Analysis↗
PubMed2000

Economic assessment of troglitazone as an adjunct to sulfonylurea therapy in the treatment of type 2 diabetes.

OBJECTIVE: To assess the economic efficiency of adding troglitazone to sulfonylurea therapy to improve glycemic control. BACKGROUND: Despite the high prevalence of type 2 diabetes, existing treatment strategies often fail. New oral agents give a wider segment of the population with type 2 diabetes hope of achieving near-normal blood-glucose levels. Troglitazone, a novel chemical entity, is one promising new agent. METHODS: We conducted an economic analysis based on glycemic-control data from a randomized clinical trial comparing troglitazone with placebo, each added to glyburide. A patient simulation model was used to translate these data to long-term outcomes associated with diabetes. Patients had poorly controlled type 2 diabetes mellitus despite glyburide therapy. Risk functions of developing and progressing through nephropathy, retinopathy, neuropathy, hypoglycemia, and macrovascular disease were developed from the Diabetes Control and Complications Trial and large epidemiologic studies. Cost estimates were based on data from 5 states, all payor databases, surveys, and literature. The main outcomes of the model were cost-consequences, number of patients developing each type of complication, mean time to development of the complication, cost per life-year gained (LYG), and cost per quality-adjusted life-year. RESULTS: The model predicts that for every 1000 patients treated with troglitazone, the improved glycemic control could mean that 95 to 140 fewer patients would experience one of the most severe diabetic complications (eg, blindness, end-stage renal disease, amputation), which may increase life expectancy by 2.0 years. These benefits are obtained at an additional $2100 per LYG (undiscounted). The ratio remains <$50,000 per LYG for most variations in input. CONCLUSIONS: The clinical trial demonstrated that troglitazone + glyburide improves glycemic control compared with glyburide alone. Based on these results, the model estimates fewer diabetic complications at a cost well below accepted cost-effective thresholds.

Adult↗
PubMed2006

Economic evaluation of sublingual immunotherapy vs symptomatic treatment in adults with pollen-induced respiratory allergy: the Sublingual Immunotherapy Pollen Allergy Italy (SPAI) study.

BACKGROUND: Few data are available on the pharmacoeconomic aspects of immunotherapy. OBJECTIVE: To evaluate, from the health care system and societal perspectives, the costs and consequences of sublingual immunotherapy (SLIT) added to pharmacotherapy compared with drugs alone for respiratory allergy. METHODS: This study compared costs, clinical outcomes, and cost-effectiveness ratios of 2 strategies in the management of allergic rhinitis and asthma, namely, SLIT associated with pharmacotherapy and pharmacotherapy alone (no SLIT). A decision tree was developed and populated with epidemiologic and resource utilization data concerning approximately 2,200 patients. Direct costs included visits, tests, pharmacotherapy, immunotherapy, and hospitalizations. Indirect costs and out-of-pocket drugs were also included. Outcome was calculated as the number of improved patients and asthma cases avoided at 6 years. Sensitivity analysis was performed by varying costs and epidemiologic data. RESULTS: SLIT improved the symptoms of 399 of 1,000 patients and prevented asthma in 229 of 1,000 patients compared with drugs alone. For SLIT added to pharmacotherapy and pharmacotherapy alone, the direct cost per patient at more than 6 years was Euro2,400 and Euro3,026, whereas the indirect cost was Euro1,913 and Euro3,400. CONCLUSION: From both perspectives and for both effectiveness end points, SLIT is less expensive and more effective than pharmacotherapy alone.

Administration, Sublingual↗
PubMed1995

The impact of environmental turbulence on American hospital strategies.

It is clear that dramatic changes are taking place in the way health care organizations are being managed. Health care executives are having to make the transition from managing with a "pass the cost along to the consumer" perspective to one of extreme competitive pressure to reduce costs while maintaining appropriate levels of quality. Reports the results of a survey of 135 American hospitals' executives. Uses factor analysis to uncover four distinct strategies being operationalized. Classifies hospitals' strategies as: strategic analysers, externally focused and offensively proactive; quality providers, internally-focused and defensive reactors; price negotiators, externally-focused and offensively reactive; or cost efficiency providers, internally focused and defensively proactive.

Cost-Benefit Analysis↗