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PubMed2004

An economic analysis of leachate purification through willow-coppice vegetation filters.

In this study an economic analysis of the purification of integrated solid waste treatment facility leachates through a willow-coppice (Salix) vegetation filter in southern Sweden was carried out. Calculations were based on the use of two computer models that were initially used in estimating a pump-and-pipe irrigation system for a 36-ha willow-coppice plantation to purify an average annual quantity of 195,000 m(3) of leachate with an average nitrogen content of 24 g/m(3). Results showed that facility leachates could be purified at US dollars 0.34/m(3) compared with US dollars 0.62/m(3) for that of conventional leachate treatment at a wastewater treatment plant. Furthermore, results revealed that the increased income from willow growing and sale of the biomass chips represented only a small factor in the overall cost of the purification technique--decreasing purification costs to US dollars 0.326/m(3). Sensitivity analyses also demonstrated that, because of the large leachate holding pond expense, only a fraction of facility leachate should be treated through a vegetation filter.

Forestry↗
PubMed1996

Initial cost of primary angioplasty for acute myocardial infarction.

OBJECTIVES: We sought to evaluate the initial economic cost of primary angioplasty for acute myocardial infarction under varying assumptions about whether a cardiac catheterization laboratory exists, whether services are provided during night and weekend hours and how cardiovascular surgical backup is arranged. BACKGROUND: Primary angioplasty for acute myocardial infarction has resulted in clinical outcomes superior or equal to those obtained with thrombolysis in recent studies, but its future implementation depends greatly on its cost and cost-effectiveness. There is a gap in knowledge about the true economic costs of this procedure, and understanding costs under a variety of hypothetic scenarios is important in planning whether and how the procedure should be offered to broad groups of patients. METHODS: A generalizable spreadsheet model was constructed to calculate the cost of primary angioplasty at a single hospital with assumptions based on data from a large nonprofit health maintenance organization (Kaiser Permanente). The following baseline assumptions were made: 1) A total of 200 patients with myocardial infarction presented to the hospital each year; 2) primary angioplasty was offered for 10 years; 3) the hospital had a cardiac catheterization laboratory; 4) costs of night call for technical personnel and cardiovascular surgical backup were already covered. Other scenarios were modeled to represent different assumptions about existing resources. RESULTS: Under the baseline assumptions, primary angioplasty cost $1,597/procedure. If night call for technical personnel were a new expense, the average cost would be > or = $3,206. If a new cardiac catheterization laboratory needed to be built, costs would range from $3,866 to $14,339/procedure, depending on how cardiovascular surgical backup was provided. Results were sensitive to assumptions about the annual volume of myocardial infarctions, the number of years the procedure was offered and the costs of labor, construction and equipment. CONCLUSIONS: The initial cost of providing primary angioplasty for acute myocardial infarction varies greatly, depending on the setting in which it is provided. To provide information for clinical policy decisions, a cost-effectiveness model is needed that combines these initial costs with data on survival, quality of life and rates and costs of subsequent cardiac procedures.

Angioplasty, Balloon, Coronary↗
PubMed1996

A cost-utility analysis of laser-assisted angioplasty for peripheral arterial occlusions.

Despite the perception of many people that lasers represent the cutting edge of high-technology medicine, this form of medical technology has been subject to relatively little rigorous evaluation. This dearth of research relates particularly to economic evaluation, where there have been few attempts to justify the high cost of laser equipment. This paper details an economic evaluation of the use of laser technology as a secondary adjunct to angioplasty to treat peripheral arterial occlusions. Using data from a range of sources, including a published randomized trial, a cost-utility model is developed to estimate the costs and benefits of the laser, relative to standard angioplasty. The best available data indicate a cost-effective role for the laser, but important areas of uncertainty exist, including the laser's secondary recanalization rate, which has been estimated on the basis of limited numbers of patients. This uncertainty suggests that further research is required before widespread diffusion of the laser for use in this clinical context.

Adult↗
PubMed2003

The economic impact of HIV/AIDS on the education sector in Zambia.

OBJECTIVES: To estimate and project the economic impact of HIV/AIDS on the supply of education in Zambia. DESIGN: An analysis of the financial implications of HIV/AIDS for the Ministry of Education (MoE) and donors funding education in Zambia. METHODS: A mathematical model was used to project the number of primary school teachers and their HIV status under current plans for teacher training and recruitment. Cost data were compiled from the MoE, the Teacher Education Department, teacher training colleges and the donor consortium BESSIP (Basic Education Sub-Sector Investment Programme). Multivariate sensitivity analyses were performed. RESULTS: The impact of HIV/AIDS on the supply of primary education imply costs to the MoE and BESSIP estimated at US$1.3-3.1 million in 1999, and projected at $10.6-41.3 million over the period 1999-2010. These costs include salaries paid to teachers absent as a result of HIV-associated illness (71%), additional training of teachers to cope with AIDS-related attrition (22%) and funeral costs contractually met by the MoE (7%). They do not include the additional costs of an active care and prevention response by the MoE, or the burden of ensuring enrolment of AIDS orphans. The annual cost of HIV/AIDS is a relatively small fraction of the overall MoE budget (2.5% in 1999) but has substantial implications for resource allocation to some functions. Expenditure on teacher training will need to increase by 26% if Education for All targets are to be met in the face of AIDS. CONCLUSIONS: HIV/AIDS has significant implications for resource allocation in the education sector in Zambia.

Absenteeism↗
PubMed2005

[Economic efficiency and fairness: two ethical criteria? A basic reflection].

Many statements on the allocation of health care resources show an appreciation of the two criteria "efficiency" and "fairness" as two values which are to be weighed against each other in case of conflict. This article provides a critique of this model, which is conceived to rest on a hybrid (partly utilitarian, partly counter-utilitarian) basis. The most important fairness-related argument, or so it is argued, is of a sort which is incompatible with the reasons utilitarianism (or, indeed, consequentialism) provides as a basis for the efficiency criterion. If the argument is right, we have to provide another basis, at least as far as moral inhibitions are strong about taking efficiency into account. The present article does not go into detail about such an alternative. It relates to the on-going discussion on John Taurek's (1977) article about "numbers", especially on the so-called aggregation argument against Taurek's "no-worse-claim", and argues against the majority of commentators, consequentialist and deontological alike, that Taurek was right.

Decision Support Techniques↗
PubMedDate not supplied

Markov modeling analysis of health and economic outcomes of therapy with valsartan versus amlodipine in patients with type 2 diabetes and microalbuminuria.

OBJECTIVE: To estimate 8-year health and economic outcomes of the angiotensin II receptor blocker valsartan versus the calcium channel blocker amlodipine in therapy of patients with type 2 diabetes and microalbuminuria based on clinical endpoints from a 6-month randomized controlled clinical trial, the MicroAlbuminuria Reduction With VALsartan (MARVAL) study. METHODS: We developed a Markov model that utilized urinary albumin excretion rate data to project patient distributions to 7 possible health states over 8 years. For each health state, we identified quality-adjustment weights (health utilities) and medical care costs from public sources. The model then calculated mean quality-adjusted survival, medical care costs, and cost-effectiveness ratios for each treatment arm. Treatment arms were compared with the incremental cost-effectiveness ratio. RESULTS: Patients treated with valsartan gained 7 months (mean) per patient of quality-adjusted survival relative to patients treated with amlodipine (77 versus 70 months; P<0.01); valsartan patients also incurred 32,412 dollars (mean) per patient lower medical costs than amlodipine patients (92,058 dollars versus 124,470 dollars; P<0.01). Model results were consistent for each year of analysis and robust to changes in key model parameters. CONCLUSION: This research (1) extends 6-month clinical trial outcomes to an 8-year period, (2) translates health outcomes from technical clinical endpoints to quality-adjusted survival, and (3) estimates economic consequences of therapeutic outcomes. The results quantify the favorable long-term health (i.e., quality-adjusted survival) and economic benefits (i.e., lower total medical costs) of therapy with valsartan, an angiotensin II receptor blocker, versus amlodipine, a calcium channel blocker, in the treatment of patients with type 2 diabetes and microalbuminuria based on an extension of the results of a short-term clinical (MARVAL) trial. These research findings are important to the extent patients with type 2 diabetes and microalbuminuria do not receive the recommended antihypertensive agents that block the renin-angiotensin system (angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers).

Albuminuria↗
PubMedDate not supplied

Perspectives in health economics.

This paper, originally presented at the Institute d'Etudes Politiques de Paris, October 12, 1993, provides a perspective on envisioned changes in the practice of health economics. Foreseen changes include: (1) Study of more homogeneous units of analysis; (2) More original data gathering; (3) Increased attention to uncertainty and the supply of and demand for information; (4) Increased attention to institutional structures and their effects on economic behaviour; (5) Expansion of relevant tools for studying economic issues in health care; and (6) Continuing breakdown of disciplinary barriers between health economics and other disciplines. Of these, the two overriding features will be increased emphasis on understanding the many roles of uncertainty in economic behaviour, institutions, and outcomes in health care, and in the use of more and more 'micro' data to study these issues.

Data Collection↗
PubMed2004

Economic valuation of informal care. An overview of methods and applications.

Informal care makes up a significant part of the total amount of care provided to care recipients with chronic and terminal diseases. Still, informal care is often neglected in economic evaluations of health care programs. Probably this is related to the fact that the costs of informal care are to an important extent related to time inputs by relatives and friends of care recipients and time is not easy to value. Development of theoretically sound, yet easily applicable valuation methods is therefore important since ignoring the costs of informal care may lead to undesirable shifts between formal and informal care. Moreover, there is increasing evidence that providing informal care may lead to health problems for the caregiver, both in terms of morbidity and mortality. Until now these health effects have not been incorporated in economic evaluations. More attention for the identification and valuation of the full costs and (health) effects of informal care for the informal caregiver seems needed therefore. This contribution presents a critical evaluation of the available methods to incorporate informal care in economic evaluations.

Activities of Daily Living↗
PubMed1996

A cost-benefit analysis of voluntary routine HIV-antibody testing for hospital patients.

The objectives of this paper are threefold: first, to develop a taxonomy of potential benefits from voluntary, routine HIV-antibody testing of hospital patients; second, to inform attending healthcare workers, hospital patients and policy makers of the potential benefits from such testing; and third, to make inferences about whether such testing is warranted by a cost-benefit criterion. Benefits stemming from information about a patient's HIV serostatus accrue to: (1) healthcare workers if extra precautions reduce their HIV-exposure rate; (2) the patient if knowledge of HIV serostatus allows life-extending prophylactic treatment to be initiated; and (3) the patient's sex partners if the patient is less likely to transmit HIV after undergoing HIV testing. Using recent estimates on the value of life, hospital-specific HIV-prevalence rates, the effectiveness of prophylactic treatment, rates of HIV exposure and conversion by healthcare workers, and reduction in high-risk sexual behaviors by seropositive patients, we estimate the benefits of testing as the value of statistical life saved. The opportunity cost of HIV testing is calculated as the reported cost of a standard HIV-test protocol with pre- and post-test counseling. Information about a patient's HIV serostatus provides small expected benefits to healthcare workers ($3.34) because the risk of HIV transmission is small; benefits to attending healthcare workers are insufficient to warrant routine HIV testing on a stand-alone basis even in high HIV-prevalence hospitals. However, an HIV-seropositive test result provides large expected benefits to the patient ($11,202) and to the patient's sex partners ($5271). Adding these nonrivalrous benefits, we find that routine, voluntary HIV-testing of hospital patients passes a cost-benefit test even in low HIV-prevalence hospitals. Four major qualifications of the cost-benefit analysis should be considered. (1) The benefits to some parties can only be achieved if the patient's serostatus is disclosed to them. (2) The net benefits may be negative if HIV-testing induces riskier behavior. (3) The analysis does not incorporate the significant potential for third-parties (employers, insurers, healthcare workers) to use the test to impose costs on HIV-seropositive patients. (4) The sample of inpatients choosing voluntary HIV testing may not be representative of the overall hospital population. These unmeasured factors suggest that policymakers should exercise caution in implementing a voluntary HIV-testing program.

AIDS Serodiagnosis↗
PubMed1998

Managed health care coverage for infertility services: understanding adverse selection.

Insurance is an economic tool that individuals can use to reduce or eliminate financial risk. Health insurance provides risk reduction for economic loss caused by the need to pay for health care services. Insurance for any circumstance makes economic sense provided that administrative expenses to the insurer (insurance company or health plan) are no larger than the risk-premium or the value to the insured of having economic risk reduced or eliminated. Infertility has generally been regarded as a social problem rather than a medical one. Insurance companies and health plans have been reluctant to cover infertility services because of a lack of societal agreement that these services should be included and because accurate information about both the appropriate sequence of care and its cost effectiveness has not been available. Some health plans that have extended coverage for infertility services have experienced poor economic outcomes because of adverse selection. Adverse selection occurs when asymmetrical information exists, i.e. when those insured have privately held information about whether they will need the covered services or not. There are ways that the private sector can reduce or eliminate adverse selection without government mandates. These include limited coverage, experience rating, exclusion for pre-existing conditions, mandatory wait provisions, medical examinations and group coverage. When private sector efforts to control for adverse selection fail, government intervention may make sense. Governmental mandates are favoured by some because they compel wide coverage, which reduces overall economic risk. Even this can fail to eliminate adverse selection if individuals or couples who are higher risk for infertility move to areas where coverage is mandated. Given societal acceptance of the need for universal coverage for infertility services, the private sector should be able to create an economically beneficial insurance market for this coverage provided that they avoid adverse selection.

Female↗
PubMed1995

Cost-effectiveness analysis of hepatitis B vaccination strategies in Catalonia, Spain.

Hepatitis B virus (HBV) infection is an important public health problem all over the world. Vaccination is one way to prevent it, and several strategies can be used depending on endemicity, the main pattern of HBV transmission and the demographic structure of the population. In this study, an economic comparison of 3 vaccination strategies (mass adolescent vaccination, mass infant vaccination and mass combined vaccination) was performed in Catalonia, Spain. Screening pregnant women for HBV infection in combination with these strategies was also evaluated. Epidemiological models to analyse patterns of HBV infection with and without vaccination and to calculate HBV-associated costs were designed. Comparison between strategies was done using cost-effectiveness analysis from the perspective of the healthcare system. Epidemiological model results indicate that implementation of HBV vaccination could prevent as many as 104,778 new acute infections, and avoid up to 5239 chronic infections, 2096 cases of cirrhosis and 419 cases of hepatocarcinoma over a 20-year period in Catalonia. Cost-effectiveness analysis shows that mass adolescent vaccination is the most efficient strategy, with lower costs per avoided case than the other 2 strategies. When any of these strategies is complemented by screening for HBV in pregnant women, the number of avoided cases is always higher and the cost per avoided case decreases or remains unchanged.

Adolescent↗
PubMed1996

Effect of mergers on health maintenance organization premiums.

This study estimated the effect of mergers on health maintenance organization (HMO) premiums, using data on all operational non-Medicaid HMOs in the United States from 1985 to 1993. Two critical issues were examined: whether HMO mergers increase or decrease premiums; and whether the effects of mergers differ according to the degree of competition among HMOs in local markets. The only significant merger effect was found in the most competitive markets, where premiums increased, but only for 1 year after the merger. Our research does not support the argument that consolidation of HMOs in local markets will benefit consumers through lower premiums.

Capitation Fee↗
PubMed2002

[Ecological economic analysis of a rice-crab model].

Based on field investigation and experimental data analysis, ecological economic principles were applied to study the structure and function, the characteristics of material and energy flows, and the economic and ecological benefits of a rice-crab model. The results show that rice-crab model had a higher integral benefit than rice model, and its net income, cost-benefit ratio, and labor productivity were increased by 382%, 67.7% and 295%, respectively. In view of the ecological benefits produced, the total nitrogen, alkaline-hydrolyzal nitrogen, total phosphorus, rapidly available phosphorus, rapidly available potassium, and organic matter in the soil after 1-year carb breeding were increased by 10.6%, 3.3%, 5.8%, 11.7%, 3.5% and 10.5%, respectively. Moreover, 6.375 kg N.hm-2 of non-point source pollution load could be cut down annually.

Agriculture↗