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At least 19 recordsLinked to original sources
PubMed2002

Epidemiological modelling (including economic modelling) and its role in preventive drug therapy.

In contrast to curative therapies, preventive therapies are administered to largely healthy individuals over long periods. The risk-benefit and cost-benefit ratios are more likely to be unfavourable, making treatment decisions difficult. Drug trials provide insufficient information for treatment decisions, as they are conducted on highly selected populations over short durations, estimate only relative benefits of treatment and offer little information on risks and costs. Epidemiological modelling is a method of combining evidence from observational epidemiology and clinical trials to assist in clinical and health policy decision-making. It can estimate absolute benefits, risks and costs of long-term preventive strategies, and thus allow their precise targeting to individuals for whom they are safest and most cost-effective. Epidemiological modelling also allows explicit information about risks and benefits of therapy to be presented to patients, facilitating informed decision-making.

Australia↗
PubMedDate not supplied

A comparison of economic modelling and clinical trials in the economic evaluation of cholesterol-modifying pharmacotherapy.

There are various ways in which data for economic evaluations may be obtained, including via clinical trials and via economic modelling. There are numerous advantages and disadvantages associated with each method, although it is generally assumed that economic models lack the accuracy required for the calculation of meaningful cost-effectiveness data. In order to assess the predictive accuracy of economic modeling in the context of cholesterol-modifying pharmacotherapy it is possible to compare predicted coronary heart disease (CHD) incidence estimates obtained using CHD risk equations derived from the Framingham Heart Study (FHS) with actual CHD incidence rates achieved in a major clinical trial, the West of Scotland Coronary Prevention Study (WOSCOPS). FHS-derived CHD risk equations substantially underestimate the actual risks of nonfatal myocardial infarction obtained by WOSCOPS. However, in predicting risks of death from CHD, FHS-derived CHD risk equations estimate extremely accurately the incidence obtained by WOSCOPS. For example, from WOSCOPS the risk of an individual fulfilling the trial entry criteria incurring nonfatal myocardial infarction or CHD death in 4.9 years is 0.079 for placebo group and 0.055 for the intervention group. Therefore, the relative risk for the intervention group relative to placebo group is 0.696, implying a risk reduction of 30%. Comparable risks predicted using FHS-derived CHD risk equations are 0.116 for the placebo group and 0.088 for the intervention group. Consequent relative risks and risk reductions for the intervention relative to placebo are 0.757 and 24%, respectively. Using both model and trial estimates of CHD incidence in an economic evaluation of cholesterol-modifying pharmacotherapy, incremental costs per life year gained are 41,707 Pounds using WOSCOPS data and 36,480 Pounds using FHS-derived CHD risk equations.

Anticholesteremic Agents↗
PubMed1988

Understanding economic modeling aids in decision making.

With the problems some hospitals are facing in raising capital, the importance of careful economic analyses increases. Four economic models, the demand model, economic feasibility model, economic impact model, and econometric model, can all be used by the healthcare industry to perform a thorough analysis. By doing economic analyses, hospitals will be able to more effectively allocate scarce financial resources and identify potential returns and risks associated with investments.

Decision Making, Organizational↗
PubMed1998

Development of an economic model for the management of upper gastrointestinal disease in primary care. Preliminary findings.

Health economic models for identifying therapeutic options that maximise health benefits from limited healthcare resources are being developed in a number of therapeutic areas. The development of such a model for upper gastrointestinal (UGI) symptoms to support decision-making by primary care clinicians is of particular importance, given the prevalence of this symptomatology. This economic model was based upon the clinical guidelines aimed at improving the management of UGI disorders at the primary care level that were developed by the International Gastro Primary Care Group. This paper discusses the derivation, methodology and results of the economic model developed to assess the resource implications arising from these clinical guidelines. In order to construct the economic model, it was necessary to identify the following: every therapeutic pathway followed by patients resource use along each pathway the probabilities of following alternative pathways. One crucial factor underlying the interpretation of results obtained from any economic model is the time period covered by the model. The model presented here analysed the initial 12-month treatment period of 'new' patients presenting with UGI symptoms. In order to test the implications of a longer term perspective, the model is currently being developed to analyse resource use over a 24-month period. The model demonstrates that utilising the predominant symptom approach to the diagnosis and treatment of patients with UGI disorders appears to provide significant benefits in terms of patient management and effective resource use. This factor, together with the more intensive use of Helicobacter pylori eradication therapy, provides the potential to reduce the cost of drugs for the treatment of UGI disorders by approximately 15% in the UK. A major strength of the model is its adaptability to a wide range of clinical and cost scenarios. Such adaptability enables the model to effectively reflect the potential resource implications in countries exhibiting significantly different levels of cost and patient management. In this manner, the model provides one valuable method by which clinicians can be supported in optimising the management of UGI disorders within current resource constraints.

Cost-Benefit Analysis↗
PubMed1996

Economic evaluation of influenza vaccination and economic modelling. Can results be pooled?

Scientific reviewing methods were applied to economic studies of influenza vaccination, and an economic model of influenza vaccination was developed from these primary sources. Issues arising from the secondary literature review include the quality of evidence on the effectiveness of the vaccines, the absence of a traditional population-based approach to reviewing economic data, confusion in terminology, and how to generalise from resource data contained in primary evaluations. Data from the literature review were summarised in terms of resource units used in the prevention and treatment of influenza. An economic model was constructed using local unit costs (from the Emilia region of Italy) and applying the data to a notional population. The model was sensitive to length of stay in hospital but not to variation in incidence of influenza, days off work or number of medical consultations. The model was predicated on and is sensitive to an estimate of 80% vaccine effectiveness. The approach is constrained by the available data, but could be more generally useful in that it allows variations in the quantity of inputs to be considered separately from variations in their values. The model may be used locally as a decision-making tool, although the method needs further development.

Humans↗
PubMed1988

Demographics in demographic-economic models: a note on the basic activity-commodity framework.

The authors present a critique of an early basic formulation for the development of demographic-economic models by M. Madden and P. W. J. Batey in 1980. They assert that more attention needs to be paid to the demographic components of these models and that "distinctions between household types must be treated more adequately, and mechanisms for changes in household type must be articulated and refined." A reply by M. Madden (pp. 1,537-42) is included, as well as a response by the authors (pp. 1,543-5).

Demography↗
PubMed2001

An economic model to calculate farm-specific losses due to bovine respiratory disease in dairy heifers.

This paper describes a personal-computer-based model estimating the economic losses associated with clinical bovine respiratory disease in replacement heifers raised on individual dairy farms. The model is based on the partial-budgeting technique, and calculates the losses for two types of the disease separately: calf pneumonia and a seasonal outbreak. Model input includes farm-specific data such as the incidence of bovine respiratory disease, prices, and effects of the disease on the heifers' productivity. The input database was linked directly with the economic model. For all input parameters, default values used are available to the user and can be modified easily. Losses considered by the model include treatment expenditures and costs associated with increased mortality, increased premature culling, reduced growth, reduced fertility and reduced milk production in first lactation. Uncertainty is taken into account for parameters related to disease incidence, mortality and culling.Basic calculations for a typical Dutch dairy farm with 60% of the heifers (<3 months) affected, indicated total annual losses due to pneumonia average 31.2 per heifer present on the farm (range 18.4-57.1). The estimated losses for one seasonal outbreak with heifers up to 15-months old affected were 27.0 per heifer present (range 17.2-43.1). For both BRD types, the model's outcome was most sensitive to the number of heifers affected. Most of the parameters that had a major impact on the total losses were related to treatment or to the effects on the heifers' productivity. The model is user-friendly and flexible, and can be used as an interactive tool by farmers and veterinarians in the (economic) decision-making process regarding on-farm prevention and control of bovine respiratory disease.

Animals↗
PubMed1995

Economic modeling to assess the costs of treatment with finasteride, terazosin, and transurethral resection of the prostate for men with moderate to severe symptoms of benign prostatic hyperplasia.

OBJECTIVES: We developed a decision analytic model to compare the costs of treatment for an initial 2-year period with finasteride, terazosin, and transurethral resection of the prostate (TURP) in men with at least moderate symptoms of benign prostatic hyperplasia (BPH). Outcome measures were BPH treatment costs, duration of symptomatic improvement, and lost productivity days (work or other customary activity). METHODS: Patterns of health care resource use associated with the treatment of moderate to severe BPH and BPH-related complications were evaluated by a survey of urologists and validated by a urology consensus panel. BPH safety and efficacy studies in the published literature were used to provide probabilities of treatment success. Both a national health care resource database (Systemetrics) and Medicare data were used to estimate the costs of specific health care services (such as physician services and laboratory tests). RESULTS: The probabilities of first-year success (defined as symptomatic improvement) for surgery, finasteride, and terazosin were 88%, 67%, and 74%, respectively. The most expensive intervention was surgery, followed by finasteride and terazosin, at estimated 24-month costs of $6411, $2860, and $2422 for private insurance and $3874, $2161, and $1820 for Medicare, respectively. Duration of symptom improvement was comparable for the three treatments. Estimates of usual activity days lost (work or other customary activity) were 22, 8, and 8 days for surgery, finasteride, and terazosin, respectively. CONCLUSIONS: As a primary intervention for patients considering conventional clinical approaches to BPH treatment, pharmacotherapy is expected to be less expensive than TURP over the initial 2 years of therapy.

Adrenergic alpha-Antagonists↗
PubMed2002

Cost effectiveness of treatment for benign prostatic hyperplasia: an economic model for comparison of medical, minimally invasive, and surgical therapy.

PURPOSE: To evaluate the cost effectiveness of minimally invasive therapy relative to medical (alpha-blocker) therapy and transurethral resection (TURP) for patients with moderate to severe symptoms of benign prostatic hyperplasia (BPH). METHODS: We constructed a decision-analytic Markov model for a hypothetical cohort of 65-year-old men with moderate to severe BPH symptoms. Microwave thermotherapy was selected to represent minimally invasive treatment. Cost-effectiveness analysis was performed with 25 health states using the 3 treatments, 5 short-term clinical events, and 17 possible long-term outcomes. Each health state had an associated cost and utility. Quality of life (QoL) and utility estimates were obtained by interviewing 13 men with BPH symptoms using the standard gamble reference methods. Patients were classified as risk averse (RA) or non-risk averse (NRA) on the basis of their attitudes to risk. We calculated the incremental cost effectiveness of microwave thermotherapy relative to medical therapy and TURP over 5 years after treatment initiation. Event probabilities were obtained from the literature, a consensus panel, and published randomized clinical trials. RESULTS AND CONCLUSIONS: The utility values generated were internally consistent and externally valid for a hypothetical cohort of 10,000 RA patients. Microwave thermotherapy was preferred by the NRA group, while medical therapy was preferred by the RA group. Surgery was least preferred by both groups. Microwave thermotherapy had a small incremental cost but improved QoL in comparison with medical therapy. Microwave thermotherapy had a higher utility and lower cost than TURP and thus was dominant over TURP. This analytical method can be applied to evaluate the cost effectiveness of any BPH therapy.

Aged↗