Search PubMed⌕ Search

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.

At least 1,567 records · Page 87Linked to original sources
PubMed2004

Economic evaluation of etoricoxib versus non-selective NSAIDs in the treatment of osteoarthritis and rheumatoid arthritis patients in the UK.

INTRODUCTION: The objective of this study was to evaluate the potential economic implications of using etoricoxib versus non-selective NSAID alternatives in the treatment of patients with osteoarthritis (OA) or rheumatoid arthritis (RA) in the UK. STUDY DESIGN: Decision-analytical modelling was used to calculate the expected costs and consequences of the use of etoricoxib compared with non-selective NSAIDs alone, NSAIDs plus proton pump inhibitors (PPIs), NSAIDs plus histamine H2 receptor antagonists and NSAIDs plus misoprostol over a continuous treatment period of 1 year. METHODS: The model considered direct medical costs from the perspective of the UK National Health Service (NHS) and used data from phase IIb and III clinical trials of etoricoxib to determine probabilities of gastrointestinal (GI) events. Model outcomes were defined as resource-consuming GI-related events, including clinically evident gastroduodenal perforations, symptomatic gastroduodenal ulcers, or upper GI bleeding (collectively, PUBs ['perforation, ulcers and/or bleeding']). Resource utilisation and costs (2002 values) for the treatment of OA and RA as well as GI events were based on published literature and information available from UK-specific sources. MAIN OUTCOME MEASURES AND RESULTS: The model suggests that etoricoxib is cost saving compared with non-selective NSAIDs plus PPIs or non-selective NSAIDs plus misoprostol. The model also suggests that etoricoxib is cost effective in terms of the incremental cost per QALY gained for non-selective NSAIDs alone (pound 19,766) and for non-selective NSAIDs plus H2 antagonists (pound 9350). The incremental cost of etoricoxib per PUB avoided was pound 12,446 versus non-selective NSAIDs alone and pound 6438 versus NSAIDs co-prescribed with H2 antagonists. For patients without the presence of specific GI risk factors (history of GI event, corticosteroid use or disability), etoricoxib may be cost effective for patients over age 56 years, assuming a cost-effectiveness threshold of pound 30,000 per QALY gained. Etoricoxib may also be cost effective in patients of all ages who had at least one specific GI risk factor. CONCLUSIONS: The model suggests, with its underlying assumptions and data, that etoricoxib is a cost-effective alternative to therapeutic regimens involving non-selective NSAIDs for OA or RA, from the UK NHS perspective. Etoricoxib may be cost saving and dominant over non-selective NSAIDs used together with a PPI or misoprostol. When compared with non-selective NSAIDs alone or non-selective NSAIDs co-prescribed with H2 antagonists, the incremental cost per QALY gained with use of etoricoxib was within the generally accepted threshold for cost effectiveness (less than pound 30,000 per QALY gained).

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2005

Health economic research on vaccinations and immunisation practices--an introductory primer.

The economic importance of vaccines lies partly in the burden of disease that can be avoided and partly in the competition for resources between vaccines and other interventions. Up to the 1980s only few economic evaluations had been carried out. Since then the confrontation of most countries with escalating health care costs and tighter budgets have awakened the interest in pharmacoeconomic analysis. Resources used to provide health care are vast but not limitless. When clinicians are asked to participate in decisions for large groups of patients (in a managed care context, in an institution, or at the level of local health authorities), the balance between consumption of resources and the benefits of an intervention is important. Clinicians may use cost-effectiveness and cost-benefit studies to inform such decisions (but not to make them). Because of differences in methods, the presentation of results, and country-specific parameters, economic evaluations of the same vaccination strategy by different groups may have divergent results. Vaccines differ from classical medicines in at least three ways: firstly, there is a longer tradition of economic evaluations for vaccines than for medicines. Some of the most earliest economic studies were carried out in the field of vaccines in the public health arena. Secondly, comparatively fewer central decision makers need to be convinced as compared to drugs. The reason for this being a more centralised process of recommending vaccines and vaccination policies. Thirdly, externalities are more relevant in the field of vaccines. Such externalities may be positive or negative. Positive externalities are present in the case where herd immunity prevents the spread of the disease in the community. We are now undoubtedly in an era of assessment and accountability for all new technologies in healthcare. However, sufficient economic data are still lacking to support the formulation of health policy and a particular challenge for the future is to conduct further health economic research on immunisation. Specific areas for such study include: effectiveness under field conditions (i.e., not under the conditions of a randomised controlled trial); the real value of economic production losses; the conditions for implementing novel immunization programmes; cost estimates for more ambitious immunization programmes; the economic benefits of combination vaccines. From this research, it will be important to disseminate the data and to adapt the findings to other countries. Nevertheless, the source of funding for research and its application in clinical trials programmes represent some of the practical problems faced by medical economics today within academia and the industry.

Adult↗
PubMed2005

Quality appraisal of pediatric health economic evaluations.

OBJECTIVES: This study was undertaken to appraise the quality of published pediatric economic evaluations. METHODS: Two independent reviewers appraised 149 randomly selected pediatric health economic studies. Data were collected from full economic evaluations published between 1980 and 1999. Economic evaluations of interventions, programs, and services aimed at neonates to adolescents were included. The Pediatric Quality Appraisal Questionnaire (PQAQ) was used for appraisal. The PQAQ is a 57-item instrument with 13 domains scored from 0 to 1 and one descriptive domain, each corresponding to a key aspect of health economic methodology. The primary outcome was the score for each domain. Additional analyses examined the global rating, the distribution of analytic technique, and the association between domain score and analytic technique. RESULTS: A total of 38 percent of publications were very good to excellent, whereas 43 percent were fair or worse. Although the Discounting, Target Population, Economic Evaluation, Conclusions, and Comparators domains exhibited good quality (0.74 to 0.78), the papers were of poor quality for Conflict of Interest, Incremental Analysis, and Perspective (0.32 to 0.39). Analytic technique was a significant predictor of quality for study design-related domains, with cost-utility analyses demonstrating the highest domain scores. CONCLUSIONS: Domains closely related to the elements of economic evaluation demonstrated medium to high quality. However, domains related to analysis fared poorly and are worthy of further methodological research to improve the use of health economic methods in children.

Adolescent↗
PubMed1998

The role of government in health insurance markets with adverse selection.

This paper analyzes the welfare economics of three arrangements for purchasing health insurance: competitive markets in which consumers are free to choose among options with different levels of coverage and prices; systems with compulsory partial pooling which permit private firms to sell supplementary coverage; and government-run pools that purchase comprehensive coverage at a single price for all consumers. Competitive insurance markets are assumed to face the problem of 'adverse selection'. This refers to a situation in which the insurer cannot observe characteristics of individuals that affect the cost of insurance and that are known to the individuals. Competitive markets with adverse selection are not efficient because low risks cannot purchase comprehensive insurance coverage. However, government-run pools with comprehensive coverage are an inefficient solution to the problem of adverse selection. Compulsory partial coverage may represent an attractive alternative to both competitive markets and comprehensive pools. We discover two situations when government intervention of this type will succeed: when there are not many high risks in the population, and when the risk types are similar. We discuss the implications of these results for health insurance programs in several countries. Our results also have implications for the allocation of public funds for disease-prevention projects. A project targeted at high risks will produce external benefits for low risks, even though they are not directly affected by the program. However, a successful project might eliminate the market for private insurance; in this case the government should consider mandating partial insurance coverage.

Canada↗
PubMed1996

Decision making in quasi-markets: a pedagogic analysis.

The objective of the 1991 NHS reforms was to reduce "excessive" vertical integration by constructing a quasi-market in which incentive structures and increased availability of information would enable decision makers make better use of resources. There is, however, no overall framework in which to consider the welfare gains which result from the introduction of a quasi-market or the welfare losses which arise from distortions in a quasi-market. This paper offers an analysis which can be applied to illustrate the difficulty of estimating the welfare loss from cream skimming and also to consider the impact of local monopoly.

Budgets↗
PubMed2006

MR thermometry characterization of a hyperthermia ultrasound array designed using the k-space computational method.

BACKGROUND: Ultrasound induced hyperthermia is a useful adjuvant to radiation therapy in the treatment of prostate cancer. A uniform thermal dose (43 degrees C for 30 minutes) is required within the targeted cancerous volume for effective therapy. This requires specific ultrasound phased array design and appropriate thermometry method. Inhomogeneous, acoustical, three-dimensional (3D) prostate models and economical computational methods provide necessary tools to predict the appropriate shape of hyperthermia phased arrays for better focusing. This research utilizes the k-space computational method and a 3D human prostate model to design an intracavitary ultrasound probe for hyperthermia treatment of prostate cancer. Evaluation of the probe includes ex vivo and in vivo controlled hyperthermia experiments using the noninvasive magnetic resonance imaging (MRI) thermometry. METHODS: A 3D acoustical prostate model was created using photographic data from the Visible Human Project. The k-space computational method was used on this coarse grid and inhomogeneous tissue model to simulate the steady state pressure wavefield of the designed phased array using the linear acoustic wave equation. To ensure the uniformity and spread of the pressure in the length of the array, and the focusing capability in the width of the array, the equally-sized elements of the 4 x 20 elements phased array were 1 x 14 mm. A probe was constructed according to the design in simulation using lead zerconate titanate (PZT-8) ceramic and a Delrin plastic housing. Noninvasive MRI thermometry and a switching feedback controller were used to accomplish ex vivo and in vivo hyperthermia evaluations of the probe. RESULTS: Both exposimetry and k-space simulation results demonstrated acceptable agreement within 9%. With a desired temperature plateau of 43.0 degrees C, ex vivo and in vivo controlled hyperthermia experiments showed that the MRI temperature at the steady state was 42.9 +/- 0.38 degrees C and 43.1 +/- 0.80 degrees C, respectively, for 20 minutes of heating. CONCLUSION: Unlike conventional computational methods, the k-space method provides a powerful tool to predict pressure wavefield in large scale, 3D, inhomogeneous and coarse grid tissue models. Noninvasive MRI thermometry supports the efficacy of this probe and the feedback controller in an in vivo hyperthermia treatment of canine prostate.

Acoustics↗
PubMed2001

Organizational economics and health care markets.

As health policy emphasizes the use of private sector mechanisms to pursue public sector goals, health services research needs to develop stronger conceptual frameworks for the interpretation of empirical studies of health care markets and organizations. Organizational relationships should not be interpreted exclusively in terms of competition among providers of similar services but also in terms of relationships among providers of substitute and complementary services and in terms of upstream suppliers and downstream distributors. This article illustrates the potential applicability of transactions cost economics, agency theory, and organizational economics more broadly to horizontal and vertical markets in health care. Examples are derived from organizational integration between physicians and hospitals and organizational conversions from nonprofit to for-profit ownership.

Data Collection↗
PubMed1990

[Theories of demographic transition: toward a certain convergence?].

"The aim of this paper is to present, in their points of convergence and opposition, the main theoretical currents which have arisen around the concept of demographic transition in its application to Third World countries. Four currents are identified: structural functionalism, culturalism, Marxism and feminism. The authors identify two main trends in recent debates surrounding the question of transition in demography: on the one hand, convergence of macro-structural approaches and, on the other, greater opposition between the latter and those which favor cultural factors." (SUMMARY IN ENG AND SPA)

Communism↗
PubMed1994

Specialists/primary care professionals: striking a balance.

Even before the recent movement toward managed care, there was mounting evidence of excessive numbers of many medical and surgical specialists. Generalist physicians are now in short supply, as are nonphysician providers. The ideal correction for the current problems of specialty surplus and total physician excess would be based on economics or the marketplace. However, a rapid correction is unlikely in a voluntary system. A national commission has been suggested by several bodies. This commission could make recommendations for the total number of training positions and, subsequently, the subspecialty trainees needed. Implementation of the recommendations could be through large multistate regional consortia.

Economic Competition↗
PubMed1998

Economic evaluation of programmes aiming at eradicating infectious diseases.

The subject of this article is to discuss the global and regional economic aspects of programmes for eradicating infectious diseases. The perspective on the issue is that scarce health care resources should be employed in the best possible way. The task is then to examine what the best possible use might be. A starting point is by asking the relevant policy questions attached to eradications: Is there a suitable technique, what are the costs, and what are the benefits? Of particular importance is the opportunity cost of using resources on eradication when other health care problems may require more urgent donation of resources. The paper attempts to set up a generic model for economic evaluation of eradication programmes. But, as there are many different treatment strategies varying from one country to another, such a generic model may need modifications to suit a particular strategy. However, the paper is contextual and should only be viewed as guidance for those wishing to conduct an economic analysis of eradication programmes, or as a initiative to create discussion among health care decision makers.

Communicable Disease Control↗
PubMed1995

The edge of chaos: caring and the bottom line.

Nurse managers need to provide quality health care within a framework of human caring with limited economic resources. Seeking only "bottom line" solutions would seriously affect the well-being of nurses and clients. On the other hand, seeking only human caring solutions would seriously influence the well-being of health care organizations. A composite model balances economics or the "bottom line" and human caring.

Empathy↗
PubMed2005

Comparing costing results in across country economic evaluations: the use of technology specific purchasing power parities.

The number of economic evaluations conducted on a multinational basis is increasing. Therefore, techniques are required to compare the results of such studies in a meaningful manner. This paper explores different approaches to comparing across country cost data applied to a European study of dialysis therapy for end-stage renal disease. A price and volume index is created at the level of the individual health care technology and compared to an exchange rate conversion and published purchasing power parities (PPPs). Both exchange rate and PPP conversions when published rates are used fail to accurately reflect the true resource use of the applied health care example. These differences can be related to specific issues of input mix and price variation. Alternatively, the use of technology specific PPPs provided a more robust approach for international comparisons and also have the potential for use in multi-centre economic evaluations within the same country.

Cost-Benefit Analysis↗
PubMed1994

Establishing a resuscitation model in rabbits with closed-thoracic cardiopulmonary by-pass.

This study aims to establish an animal model of resuscitation in rabbits by using closed-thoracic cardiopulmonary by-pass (CTCPB). The rabbits were randomly divided into four groups according to cardiac arrest times which were 8, 10, 12, and 15 min. Neurologic outcome and blood lactate were determined within 150 min after resuscitation. It was indicated that the rabbits' neurologic functions were progressively injured with prolonged cardiac arrest time. The threshold of circulatory arrest time that induced a vegetative state in the rabbits was between 10 and 12 min. There were no significant differences in cardiac resuscitability among the four groups, as was so for plasma lactate, although it increased significantly from the control levels. The establishment of a small-animal model of resuscitation by using CTCPB, and the problems in dealing with it are also described and discussed in detail in this paper. Our experience indicated that this is a simple, convenient, and economical animal model for the study of resuscitation.

Animals↗
PubMed2003

Biodiesel production from waste cooking oil: 2. Economic assessment and sensitivity analysis.

The economic feasibilities of four continuous processes to produce biodiesel, including both alkali- and acid-catalyzed processes, using waste cooking oil and the 'standard' process using virgin vegetable oil as the raw material, were assessed. Although the alkali-catalyzed process using virgin vegetable oil had the lowest fixed capital cost, the acid-catalyzed process using waste cooking oil was more economically feasible overall, providing a lower total manufacturing cost, a more attractive after-tax rate of return and a lower biodiesel break-even price. On the basis of these economic calculations, sensitivity analyses for these processes were carried out. Plant capacity and prices of feedstock oils and biodiesel were found to be the most significant factors affecting the economic viability of biodiesel manufacture.

Biotechnology↗