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PubMed2005

Geomedical warning system against epidemics.

We describe aims, usage and evaluation of the computer-based early warning system telecommunication on medical events (TeCoMed), which achieves tracking down of temporal and spatial spread of epidemics for seasonal communicable diseases. It uses experiences from former waves of communicable diseases down to fine-grained local areas. Data is delivered by the biggest German insurance scheme. The results are presented by means of a commercial, geomedical information system. The evaluation of the system's performance concerning influenza shows that timely risk assessment and warnings are possible.

Communicable Disease Control↗
PubMed2005

Perspectives on use and protection of genetic information in work settings: results of a preliminary study.

The societal use of genetic information raises ethical concerns, and the views of working persons regarding genetic information have received little attention. We performed an empirical project to characterize perspectives of 63 employees at two sites who expressed strong interest in learning about and protecting their personal genetic information. Genetic data were seen as more sensitive than other health data, and disclosure of genetic susceptibility was perceived as having negative consequences. This study suggests the value of exploring the perspectives of key stakeholders most directly affected by genetic applications across diverse societal settings.

Adult↗
PubMed2003

A cost-utility analysis of mitoxantrone hydrochloride and interferon beta-1b in the treatment of patients with secondary progressive or progressive relapsing multiple sclerosis.

BACKGROUND: Information on the cost utility of interferon beta-1b and mitoxantrone hydrochloride, 2 disease-modifying agents approved by the US Food and Drug Administration for the treatment of secondary progressive (SP) multiple sclerosis (MS), is limited. OBJECTIVE: The aim of this study was to compare the cost utility of i.v. mitoxantrone hydrochloride administered every 3 months, s.c. interferon beta-1b administered every other day, and routine supportive care from the perspectives of both the insurer and society. METHODS: We used a Markov model with health states based on the Kurtzke Expanded Disability Status Scale (EDSS) scores from both an insurer's and a societal perspective (including direct and total costs, respectively). Theoretical patients entered the model with an EDSS score of 3; their progression was followed for 10 years. Transition probabilities were derived from clinical trial data. Cost and utility inputs were taken from the literature. Sensitivity analyses were conducted on all variables. RESULTS: From the insurer's perspective, the incremental cost-utility ratio of mitoxantrone hydrochloride therapy compared with routine supportive care was 58,272 dollars per quality-adjusted life year (QALY) gained. From a societal perspective, mitoxantrone hydrochloride was more effective and less costly than supportive care. From the perspectives of insurers and society, the cost-utility ratios of interferon beta-1b compared with routine supportive care were 338,738 dollars and 245,700 dollars per QALY gained, respectively. When compared with mitoxantrone hydrochloride, interferon beta-1b had an incremental cost-utility ratio of 741,331 dollars and 658,402 dollars per QALY from the insurer's and society's perspectives, respectively. Cost-utility ratios for mitoxantrone hydrochloride were sensitive to acquisition and administration costs of therapy and to effectiveness at slowing disease progression. Cost-utility ratios for interferon beta-1b were not sensitive to any of the variables included in the model. CONCLUSIONS: Mitoxantrone hydrochloride is likely to be a cost-effective treatment for patients with SPMS or progressive relapsing MS from an insurer' perspective and is cost saving from a societal perspective. Interferon beta-1b is not likely an efficient treatment using conventional comparisons for cost-effectiveness. This analysis has potentially important implications for policy implementation; however, decisions about which agent to use for each patient should consider the treatment's adverse-event profile, the method of administration, and the patient's preferences for these factors.

Adjuvants, Immunologic↗
PubMed1999

What is a genetic test, and why does it matter?

How the term 'genetic test' is defined, matters for social policy. The past few years have witnessed many efforts to enact legal barriers specifically against genetic discrimination. To the extent that information derived from genetic tests receives special protection, both enthusiasts for genetic medicine and those who stress its perils have an incentive to adopt a broad interpretation of genetic testing. However, the consequences have not always been those anticipated.

Confidentiality↗
PubMed1994

Insurance--a dental viewpoint. Part I: An introduction.

Current changes in the market are likely to alter our perception of insurance companies and brokers. Brokers will soon be required to disclose the amounts of commission earned and this may drive individuals back into the arms of the salesmen from individual companies. This series of articles sets out to show the options that are available to the dentist and to show how to use the range of expert advice available.

Dentists↗
PubMed2004

[Outpatient rehabilitation as mirrored by the users--findings on the quality of outpatient orthopaedic rehabilitation provided by the Federal Insurance Institute for Employees, BfA].

This article presents the central results of a survey including all persons insured by the BfA (Bundesversicherungsanstalt für Angestellte, German Federal Insurance Institute for Employees) who had participated in outpatient orthopaedic rehabilitation between March and August of 2002. A total of 3838 insured persons were addressed, 69 % replied (n = 2660 questionnaires). The standardized survey included an appraisal of the outpatient rehabilitation measure, the care provided by physicians, psychologists and therapists, the organisation and performance of the rehabilitation measure, as well as of the stressors and general conditions specific to various outpatient measures. The assessment of treatment outcome, physical and psychosocial improvements, and the attainment of therapy goals were of particular importance. Overall, the results show a positive appraisal of outpatient rehabilitation but also indicate the necessity for optimisation--particularly with regard to resting rooms, physician and psychological care, as well as the suitability of the therapy for everyday life. Above all, however, the comparison of the rehabilitation centres shows a great variance in quality of care. Some rehabilitation centres show extraordinary results in many aspects of quality, whereas others reveal systematic deficits of quality.

Ambulatory Care↗
PubMed1994

Campaign contributions from the American Medical Political Action Committee to Members of Congress. For or against the public health?

BACKGROUND: The American Medical Political Action Committee (AMPAC), the political arm of the American Medical Association (AMA), contributed $2.4 million to candidates for Congress during the 1989-1990 campaign and $2.9 million during the 1991-1992 campaign. It is not known whether these funds preferentially benefited representatives who supported the AMA's positions on public health issues. METHODS: We analyzed AMPAC contributions to members of the House of Representatives during the 1989-1990 and 1991-1992 campaigns according to their votes on three health-related issues: the promotion of tobacco exports, the institution of a mandatory waiting period before a handgun purchase, and the so-called gag rule, which limited physicians' speech on abortion in federally funded clinics. For each issue, we determined whether AMPAC had contributed more on average to opponents or to supporters of the official AMA position. RESULTS: AMPAC contributed more on average to opponents of the AMA positions on all three public health issues. From 1989 to 1992, AMPAC gave significantly larger average contributions to House members who favored tobacco-export promotion than to those opposed it ($11,549 vs. $9,842, P = 0.04) and contributed significantly less on average to supporters of handgun control than to their opponents ($9,022 vs. $11,250, P = 0.001). During the same period, AMPAC's contributions revealed a marked preference for House members who supported the gag rule over those who opposed it ($10,961 vs. $9,611, P = 0.05). House members who supported the AMA positions on all three votes received an average of $8,800 from AMPAC from 1989 through 1992, whereas members who opposed all three positions received an average of $13,270 (correlation between the number of votes for AMA positions and AMPAC contributions, -0.21; P < 0.001). CONCLUSIONS: AMPAC's contributions to members of the House of Representatives belie the AMA positions on some important public health issues.

American Medical Association↗