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Tang L, Nong S, Chen K, Liu Q, Yu X, Zeng X. Cost-effectiveness and cost-benefit analyses of fluoride varnish for caries prevention in Guangxi, China. BMC Oral Health 2024; 24:534. [PMID: 38724990 PMCID: PMC11080295 DOI: 10.1186/s12903-024-04220-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 04/02/2024] [Indexed: 05/13/2024] Open
Abstract
OBJECTIVES The objectives of this study were to evaluate the cost-effectiveness and cost-benefit of fluoride varnish (FV) interventions for preventing caries in the first permanent molars (FPMs) among children in rural areas in Guangxi, China. METHODS This study constituted a secondary analysis of data from a randomised controlled trial, analysed from a social perspective. A total of 1,335 children aged 6-8 years in remote rural areas of Guangxi were enrolled in this three-year follow-up controlled study. Children in the experimental group (EG) and the control group (CG) received oral health education and were provided with a toothbrush and toothpaste once every six months. Additionally, FV was applied in the EG. A decision tree model was developed, and single-factor and probabilistic sensitivity analyses were conducted. RESULTS After three years of intervention, the prevalence of caries in the EG was 50.85%, with an average decayed, missing, and filled teeth (DMFT) index score of 1.12, and that in the CG was 59.04%, with a DMFT index score of 1.36. The total cost of caries intervention and postcaries treatment was 42,719.55 USD for the EG and 46,622.13 USD for the CG. The incremental cost-effectiveness ratio (ICER) of the EG was 25.36 USD per caries prevented, and the cost-benefit ratio (CBR) was 1.74 USD benefits per 1 USD cost. The results of the sensitivity analyses showed that the increase in the average DMFT index score was the largest variable affecting the ICER and CBR. CONCLUSIONS Compared to oral health education alone, a comprehensive intervention combining FV application with oral health education is more cost-effective and beneficial for preventing caries in the FPMs of children living in economically disadvantaged rural areas. These findings could provide a basis for policy-making and clinical choices to improve children's oral health.
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Affiliation(s)
- Liying Tang
- College of Stomatology, Hospital of Stomatology, Guangxi Medical University, Nanning, Guangxi, China
| | - Shengjie Nong
- College of Stomatology, Hospital of Stomatology, Guangxi Medical University, Nanning, Guangxi, China
- Department of Oral Health Policy Research, Guangxi Medical University, Nanning, Guangxi, China
| | - Kun Chen
- College of Stomatology, Hospital of Stomatology, Guangxi Medical University, Nanning, Guangxi, China
| | - Qiulin Liu
- College of Stomatology, Hospital of Stomatology, Guangxi Medical University, Nanning, Guangxi, China
- Department of Oral Health Policy Research, Guangxi Medical University, Nanning, Guangxi, China
| | - Xueting Yu
- College of Stomatology, Hospital of Stomatology, Guangxi Medical University, Nanning, Guangxi, China
- Department of Oral Health Policy Research, Guangxi Medical University, Nanning, Guangxi, China
| | - Xiaojuan Zeng
- College of Stomatology, Hospital of Stomatology, Guangxi Medical University, Nanning, Guangxi, China.
- Department of Oral Health Policy Research, Guangxi Medical University, Nanning, Guangxi, China.
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Nair V, Lewis J, Daccarett M, Dirschl D, Hynes K, Strelzow J. Efficacy of Postoperative Radiographs After Intramedullary Nailing of the Tibia and Femur: When Are They Useful? J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202306000-00002. [PMID: 37285510 DOI: 10.5435/jaaosglobal-d-23-00069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/06/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Postoperative radiographs are used to monitor fractures of the tibia and femur after intramedullary fixation. This study sought to examine how frequently these radiographs change management. METHODS This was a single-center chart review of patients over a 4-year period at a level I trauma center. Radiographs were defined as either performed for routine surveillance or performed with some clinical correlate on history and examination. Participants received intramedullary nailing for diaphyseal fractures of the femur or tibia. Patients required at least one postoperative radiograph. All patients were subject to our institution's follow-up protocol: visits at 2, 6, 12, and 24 weeks. Radiographs that changed management were those that led to alterations in follow-up, directed counseling, or contributed to the decision to proceed with revision surgery. RESULTS A total of 374 patients were found. Two hundred seventy-seven received at least one post-op radiograph. The median follow-up was 23 weeks. Six hundred seventeen total radiographs were reviewed. Nine radiographs contributed to a change in management (9/617 = 1.5%). No surveillance radiograph taken before 14 weeks resulted in changes in management. DISCUSSION Our results suggest that radiographs taken in the first 3 months post-op in asymptomatic patients treated with lower extremity intramedullary rods do not result in changes to clinical management.
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Affiliation(s)
- Vivek Nair
- From the University of Chicago Pritzker School of Medicine, Chicago, IL (Mr. Nair), and the UChicago Medicine Department of Orthopaedic Surgery and Rehabilitation Medicine, Chicago, IL (Ms. Lewis, Dr. Daccarett, Dr. Dirschl, Dr. Hynes, and Dr. Strelzow)
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Lévesque MH, Trépanier J, Sirois MJ, Levasseur M. [Effects of Lifestyle Redesign on older adults: A systematic review]. The Canadian Journal of Occupational Therapy 2019; 86:48-60. [PMID: 30884959 DOI: 10.1177/0008417419830429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND. The Lifestyle Redesign® (LR) aims to support health, functioning, and quality of life of older adults through the development of healthy and meaningful routines. However, evidence concerning the effectiveness and cost-effectiveness of this intervention is scattered. PURPOSE. This study aimed to synthetize the clinical effects and cost-effectiveness of the LR as well as to verify the applicability of the results in a community-based setting in Quebec. METHOD. A systematic review of the literature was conducted, followed by a focus group with four occupational therapists. FINDINGS. Considered as cost-effective (under $50,000 in quality-adjusted life-years), the LR offers benefits for both mental and physical health. According to occupational therapists, the LR is clearly relevant for their practice but involves some challenges. IMPLICATIONS. The LR is an occupational therapy intervention with promising clinical effects and cost-effectiveness for older adults living in the community.
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Finkel AM. Demystifying Evidence-Based Policy Analysis by Revealing Hidden Value-Laden Constraints. Hastings Cent Rep 2018; 48 Suppl 1:S21-S49. [PMID: 29453834 DOI: 10.1002/hast.818] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Consider any choice that affects some social policy. A decision that considers evidence will, at its heart, contain some kind of explicit or implicit "because" statement: "We are doing X because the evidence says Y." But can evidence ever truly speak for itself, in the sense of being reducible to objective utterances that are either correct or in need of correction? Before answering, consider what you'd prefer. Would you rather receive evidence that was free of any value judgments imposed by human actors, that was laden with value judgments that you agree with, or laden with value judgments that you disagree with? The central assertion of this essay is that, throughout policy analysis but especially in assessments of the costs and benefits of regulating versus encouraging new technologies (cost-benefit analysis, or CBA), the first possibility above is a mirage, and the second and third are self-contradictory. Instead, we are overwhelmingly confronted with a fourth possibility: we receive evidence that appears to be (or is deliberately touted as) value neutral but is suffused with hidden value judgments. In the second part of this essay, entitled "A Guided Tour through Inevitable Value Judgments," I identify in a systematic way approximately sixty-five value judgments that are routinely (in some cases, invariably) made in CBA, but that are kept hidden. For each judgment, I discuss its genesis as it is most commonly invoked in CBA, explain how it is hidden in plain sight, and offer one or more value judgments that could be made instead of or in addition to the conventional one. The alternative judgments highlight the width of the spectrum of reasonable conclusions an analyst could reach merely by substituting other judgments for the ones currently embedded. Bringing hidden value judgments to light is doubly valuable. First, it allows discussion to ensue on a level playing field; instead of conclusory statements about what the evidence says, transparency permits statements taking the form of "when channeled through these value judgments, the evidence says this." Perhaps more importantly, transparency about value judgments permits participants in the discussions to offer interpretations of evidence contingent on there being different value judgments chosen at one or more points in the analysis, interpretations that may suggest that alternative course(s) of action are preferable to the one being championed.
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Cox C, Andersen M, Santucci A, Robison L, Hudson M. Increasing Cardiomyopathy Screening in Childhood Cancer Survivors: A Cost Analysis of Advanced Practice Nurse Phone Counseling. Oncol Nurs Forum 2016; 43:E242-E250. [DOI: 10.1188/16.onf.e242-e250] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Dinh MM, Bein KJ, Hendrie D, Gabbe B, Byrne CM, Ivers R. Incremental cost-effectiveness of trauma service improvements for road trauma casualties: experience of an Australian major trauma centre. AUST HEALTH REV 2015; 40:385-390. [PMID: 26363826 DOI: 10.1071/ah14205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 07/31/2015] [Indexed: 11/23/2022]
Abstract
Objective The aim of the present study was to estimate the cost-effectiveness of trauma service funding enhancements at an inner city major trauma centre. Methods The present study was a cost-effectiveness analysis using retrospective trauma registry data of all major trauma patients (injury severity score >15) presenting after road trauma between 2001 and 2012. The primary outcome was cost per life year gained associated with the intervention period (2007-12) compared with the pre-intervention period (2001-06). Incremental costs were represented by all trauma-related funding enhancements undertaken between 2007 and 2010. Risk adjustment for years of life lost was conducted using zero-inflated negative binomial regression modelling. All costs were expressed in 2012 Australian dollar values. Results In all, 876 patients were identified during the study period. The incremental cost of trauma enhancements between 2007 and 2012 totalled $7.91million, of which $2.86million (36%) was attributable to road trauma patients. After adjustment for important covariates, the odds of in-hospital mortality reduced by around half (adjusted odds ratio (OR) 0.48; 95% confidence interval (CI) 0.27, 0.82; P=0.01). The incremental cost-effectiveness ratio was A$7600 per life year gained (95% CI A$5524, $19333). Conclusion Trauma service funding enhancements that enabled a quality improvement program at a single major trauma centre were found to be cost-effective based on current international and Australian standards. What is known about this topic? Trauma quality improvement programs have been implemented across most designated trauma hospitals in an effort to improve hospital care processes and outcomes for injured patients. These involve a combination of education and training, the use of audit and key performance indicators. What does this paper add? A trauma quality improvement program initiated at an Australian Major Trauma Centre was found to be cost-effective over 12 years with respect to years of life saved in road trauma patients. What are the implications for practitioners? The results suggest that adequate resourcing of trauma centres to enable quality improvement programs may be a cost-effective measure to reduce in-hospital mortality following road trauma.
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Affiliation(s)
- Michael M Dinh
- Department of Trauma Services, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia.
| | - Kendall J Bein
- Department of Trauma Services, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia.
| | - Delia Hendrie
- Centre for Population Health Research, Curtin University, Bentley, WA 6102, Australia. Email
| | - Belinda Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, Melbourne, Vic. 3004, Australia. Email
| | - Christopher M Byrne
- Department of Trauma Services, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia.
| | - Rebecca Ivers
- Injury Division, The George Institute for Global Health, The University of Sydney, Sydney Medical School, 321 Kent Street, Sydney, NSW 2000, Australia. Email
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Puzniak LA, Gillespie KN, Leet T, Kollef M, Mundy LM. A Cost-Benefit Analysis of Gown Use in Controlling Vancomycin-ResistantEnterococcusTransmission Is It Worth the Price? Infect Control Hosp Epidemiol 2015; 25:418-24. [PMID: 15188849 DOI: 10.1086/502416] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AbstractObjective:To determine the net benefit and costs associated with gown use in preventing transmission of van-comycin-resistantEnterococcus(VRE).Design:A cost-benefit analysis measuring the net benefit of gowns was performed. Benefits, defined as averted costs from reduced VRE colonization and infection, were estimated using a matched cohort study. Data sources included a step-down cost allocation system, hospital informatics, and microbiology databases.Setting:The medical intensive care unit (MICU) at Barnes-Jewish Hospital, St. Louis, Missouri.Patients:Patients admitted to the MICU for more than 24 hours from July 1, 1997, to December 31, 1999.Interventions:Alternating periods when all healthcare workers and visitors were required to wear gowns and gloves versus gloves alone on entry to the rooms of patients colonized or infected with VRE.Results:On base-case analysis, 58 VRE cases were averted with gown use during 18 months. The annual net benefit of the gown policy was $419,346 and the cost per case averted of VRE was $1,897. The analysis was most sensitive to the level of VRE transmission.Conclusions:Infection control policies (eg, gown use) initially increase the cost of health services delivery. However, such policies can be cost saving by averting nosocomial infections and the associated costs of treatment. The cost savings to the hospital plus the benefits to patients and their families of avoiding nosocomial infections make effective infection control policies a good investment.
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Affiliation(s)
- Laura A Puzniak
- Department of Community Health, Saint Louis University School of Public Health, St. Louis, Missouri, USA
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Grosse SD. Assessing cost-effectiveness in healthcare: history of the $50,000 per QALY threshold. Expert Rev Pharmacoecon Outcomes Res 2014; 8:165-78. [DOI: 10.1586/14737167.8.2.165] [Citation(s) in RCA: 487] [Impact Index Per Article: 48.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Weir S, Salkever DS, Rivara FP, Jurkovich GJ, Nathens AB, Mackenzie EJ. One-year treatment costs of trauma care in the USA. Expert Rev Pharmacoecon Outcomes Res 2014; 10:187-97. [DOI: 10.1586/erp.10.8] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Uddin Khan S, Atanasova KR, Krueger WS, Ramirez A, Gray GC. Epidemiology, geographical distribution, and economic consequences of swine zoonoses: a narrative review. Emerg Microbes Infect 2013; 2:e92. [PMID: 26038451 PMCID: PMC3880873 DOI: 10.1038/emi.2013.87] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 11/22/2013] [Accepted: 11/25/2013] [Indexed: 01/19/2023]
Abstract
We sought to review the epidemiology, international geographical distribution, and economic consequences of selected swine zoonoses. We performed literature searches in two stages. First, we identified the zoonotic pathogens associated with swine. Second, we identified specific swine-associated zoonotic pathogen reports for those pathogens from January 1980 to October 2012. Swine-associated emerging diseases were more prevalent in the countries of North America, South America, and Europe. Multiple factors were associated with the increase of swine zoonoses in humans including: the density of pigs, poor water sources and environmental conditions for swine husbandry, the transmissibility of the pathogen, occupational exposure to pigs, poor human sanitation, and personal hygiene. Swine zoonoses often lead to severe economic consequences related to the threat of novel pathogens to humans, drop in public demand for pork, forced culling of swine herds, and international trade sanctions. Due to the complexity of swine-associated pathogen ecology, designing effective interventions for early detection of disease, their prevention, and mitigation requires an interdisciplinary collaborative “One Health” approach from veterinarians, environmental and public health professionals, and the swine industry.
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Affiliation(s)
- Salah Uddin Khan
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida , Gainesville, FL 32611, USA ; Emerging Pathogens Institute, University of Florida , Gainesville, FL 32611, USA
| | - Kalina R Atanasova
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida , Gainesville, FL 32611, USA ; Emerging Pathogens Institute, University of Florida , Gainesville, FL 32611, USA
| | - Whitney S Krueger
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida , Gainesville, FL 32611, USA ; Emerging Pathogens Institute, University of Florida , Gainesville, FL 32611, USA
| | - Alejandro Ramirez
- Veterinary Diagnosis and Production Animal Medicine, Iowa State University , Iowa, IA 5011, USA
| | - Gregory C Gray
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida , Gainesville, FL 32611, USA ; Emerging Pathogens Institute, University of Florida , Gainesville, FL 32611, USA
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Pillai RK. Health economics: Theoretical considerations and scope for application in the Indian context. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2013. [DOI: 10.1016/j.cegh.2013.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Epidural analgesia versus patient-controlled analgesia for pain relief in uterine artery embolization for uterine fibroids: a decision analysis. Cardiovasc Intervent Radiol 2013; 36:1514-1520. [PMID: 23576212 DOI: 10.1007/s00270-013-0607-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Accepted: 02/11/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE This study was designed to compare the costs and effects of epidural analgesia (EDA) to those of patient-controlled intravenous analgesia (PCA) for postintervention pain relief in women having uterine artery embolization (UAE) for systematic uterine fibroids. METHODS Cost-effectiveness analysis (CEA) based on data from the literature by constructing a decision tree to model the clinical pathways for estimating the effects and costs of treatment with EDA and PCA. Literature on EDA for pain-relief after UAE was missing, and therefore, data on EDA for abdominal surgery were used. Outcome measures were compared costs to reduce one point in visual analogue score (VAS) or numeric rating scale (NRS) for pain 6 and 24 h after UAE and risk for complications. RESULTS Six hours after the intervention, the VAS was 3.56 when using PCA and 2.0 when using EDA. The costs for pain relief in women undergoing UAE with PCA and EDA were <euro>191 and <euro>355, respectively. The costs for EDA to reduce the VAS score 6 h after the intervention with one point compared with PCA were <euro>105 and <euro>179 after 24 h. The risk of having a complication was 2.45 times higher when using EDA. CONCLUSIONS The results of this indirect comparison of EDA for abdominal surgery with PCA for UAE show that EDA would provide superior analgesia for post UAE pain at 6 and 24 h but with higher costs and an increased risk of complications.
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De Cock E, Miravitlles M, González-Juanatey JR, Azanza-Perea JR. Valor umbral del coste por año de vida ganado para recomendar la adopción de tecnologías sanitarias en España: evidencias procedentes de una revisión de la literatura. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/bf03320930] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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García-Altés A, Suelves JM, Barbería E. Cost savings associated with 10 years of road safety policies in Catalonia, Spain. Bull World Health Organ 2012; 91:28-35. [PMID: 23397348 DOI: 10.2471/blt.12.110072] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 10/29/2012] [Accepted: 10/29/2012] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To determine whether the road safety policies introduced between 2000 and 2010 in Catalonia, Spain, which aimed primarily to reduce deaths from road traffic collisions by 50% by 2010, were associated with economic benefits to society. METHODS A cost analysis was performed from a societal perspective with a 10-year time horizon. It considered the costs of: hospital admissions; ambulance transport; autopsies; specialized health care; police, firefighter and roadside assistance; adapting to disability; and productivity lost due to institutionalization, death or sick leave of the injured or their caregivers; as well as material and administrative costs. Data were obtained from a Catalan hospital registry, the Catalan Traffic Service information system, insurance companies and other sources. All costs were calculated in euros (€) at 2011 values. FINDINGS A substantial reduction in deaths from road traffic collisions was observed between 2000 and 2010. Between 2001 and 2010, with the implementation of new road safety policies, there were 26 063 fewer road traffic collisions with victims than expected, 2909 fewer deaths (57%) and 25 444 fewer hospitalizations. The estimated total cost savings were around €18 000 million. Of these, around 97% resulted from reductions in lost productivity. Of the remaining cost savings, 63% were associated with specialized health care, 15% with adapting to disability and 8.1% with hospital care. CONCLUSION The road safety policies implemented in Catalonia in recent years were associated with a reduction in the number of deaths and injuries from traffic collisions and with substantial economic benefits to society.
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Affiliation(s)
- Anna García-Altés
- Catalan Agency for Health Information, Assessment and Quality, Roc Boronat 81-95 2nd floor, Barcelona 08005, Spain.
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Rizza SA, MacGowan RJ, Purcell DW, Branson BM, Temesgen Z. HIV screening in the health care setting: status, barriers, and potential solutions. Mayo Clin Proc 2012; 87:915-24. [PMID: 22958996 PMCID: PMC3538498 DOI: 10.1016/j.mayocp.2012.06.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 06/27/2012] [Accepted: 06/29/2012] [Indexed: 10/27/2022]
Abstract
Thirty years into the human immunodeficiency virus (HIV) epidemic in the United States, an estimated 50,000 persons become infected each year: highest rates are in black and Hispanic populations and in men who have sex with men. Testing for HIV has become more widespread over time, with the highest rates of HIV testing in populations most affected by HIV. However, approximately 55% of adults in the United States have never received an HIV test. Because of the individual and community benefits of treatment for HIV, in 2006 the Centers for Disease Control and Prevention recommended routine screening for HIV infection in clinical settings. The adoption of this recommendation has been gradual owing to a variety of issues: lack of awareness and misconceptions related to HIV screening by physicians and patients, barriers at the facility and legislative levels, costs associated with testing, and conflicting recommendations concerning the value of routine screening. Reducing or eliminating these barriers is needed to increase the implementation of routine screening in clinical settings so that more people with unrecognized infection can be identified, linked to care, and provided treatment to improve their health and prevent new cases of HIV infection in the United States.
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Affiliation(s)
| | - Robin J. MacGowan
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - David W. Purcell
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Bernard M. Branson
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Abstract
Screening can identify individuals at increased risk of or in the early stage of a disease at a time when intervention can reduce the risk of morbidity and mortality. There are many ethical issues that have arisen as a result of screening. These can relate to the process of screening in general or to specific screening programs. Examples of the former include issues related to consent for screening, the utility of the screening tests employed and issues of funding of screening programs and equity of access to screening. Ethical issues related to three specific areas of screening are explored in more detail: reproductive screening, screening for disease with onset in adulthood and newborn screening. It is critical that ethical issues are considered in planning screening programs so as to ensure that the main focus of screening, preventing morbidity, is maximised. There are many lessons to be learnt from the many screening programs that have been conducted worldwide. No doubt new ethical issues will arise as new technologies and new treatments are developed, enabling screening for more conditions at lower relative costs.
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Rhoads JK. The effect of comprehensive state tobacco control programs on adult cigarette smoking. JOURNAL OF HEALTH ECONOMICS 2012; 31:393-405. [PMID: 22459501 DOI: 10.1016/j.jhealeco.2012.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 02/13/2012] [Accepted: 02/27/2012] [Indexed: 05/31/2023]
Abstract
This study is the second to use national survey data to assess the effect of comprehensive state tobacco control programs on adult cigarette smoking. Data are drawn from the Behavioral Risk Factor Surveillance System (1991-2006) and reveal consistent evidence that these programs have a statistically significant effect to reduce prevalence of cigarette smoking among adults. Simulations indicate that had all states spent the CDC recommended level of funding from 1991 to 2006 then cigarette smoking prevalence would have been 1.40-8.07% lower in 2006, translating to between 635,000 and 3.7 million fewer adult cigarette smokers.
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Affiliation(s)
- Jennifer K Rhoads
- Department of Economics, St. Catherine University, 2004 Randolph Ave., St. Paul, MN 55101, USA.
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Abstract
This review describes methods used in comparative effectiveness research (CER). The aim of CER is to improve decisions that affect medical care at the levels of both policy and the individual. The key elements of CER are (a) head-to-head comparisons of active treatments, (b) study populations typical of day-to-day clinical practice, and (c) a focus on evidence to inform care tailored to the characteristics of individual patients. These requirements will stress the principal methods of CER: observational research, randomized trials, and decision analysis. Observational studies are especially vulnerable because they use data that directly reflect the decisions made in usual practice. CER will challenge researchers and policy makers to think deeply about how to extract more actionable information from the vast enterprise of the daily practice of medicine. Fortunately, the methods are largely applicable to research in the public health system, which should therefore benefit from the intense interest in CER.
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Affiliation(s)
- Harold C Sox
- Department of Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Hanover, New Hampshire 03755, USA.
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Owen L, Morgan A, Fischer A, Ellis S, Hoy A, Kelly MP. The cost-effectiveness of public health interventions. J Public Health (Oxf) 2011; 34:37-45. [PMID: 21933796 DOI: 10.1093/pubmed/fdr075] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The need to make best use of limited resources in the English National Health Service is now greater than ever. This paper contributes to this endeavour by synthesizing data from cost-effectiveness evidence produced to support the development of public health guidance at the National Institute of Health and Clinical Excellence (NICE). No comprehensive list of cost-effectiveness estimates for public health interventions has previously been published in England. METHODS Cost-effectiveness estimates using English cost data were collected and analysed from 21 (of 26) economic analyses underpinning public health guidance published by NICE between 2006 and 2010. RESULTS Two hundred base-case cost-effectiveness estimates were analysed, 15% were cost saving (i.e. the intervention was more effective and cheaper than comparator). Eighty-five per cent were cost-effective at a threshold of £20,000 per quality-adjusted life year and 89% at the higher threshold of £30,000. A further 5.5% were above £30,000 and 5.5% of the interventions were dominated (i.e. the intervention was more costly and less effective than comparator). CONCLUSIONS The majority of public health interventions assessed are highly cost-effective. The next challenge is to provide commissioners with a framework that allows information from economic analyses to be combined with other criteria that supports making better investment decisions at a local level.
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Affiliation(s)
- Lesley Owen
- Centre for Public Health Excellence, National Institute for Health and Clinical Excellence, London WC1V 6NA, UK.
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Spronk S, van Kempen BJH, Boll APM, Jørgensen JJ, Hunink MGM, Kristiansen IS. Cost-effectiveness of screening for abdominal aortic aneurysm in the Netherlands and Norway. Br J Surg 2011; 98:1546-55. [DOI: 10.1002/bjs.7620] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2011] [Indexed: 11/06/2022]
Abstract
Abstract
Background
The aim of this study was to determine the cost-effectiveness of ultrasound screening for abdominal aortic aneurysm (AAA) in men aged 65 years, for both the Netherlands and Norway.
Methods
A Markov model was developed to simulate life expectancy, quality-adjusted life-years, net health benefits, lifetime costs and incremental cost-effectiveness ratios for both screening and no screening for AAA. The best available evidence was retrieved from the literature and combined with primary data from the two countries separately, and analysed from a national perspective. A threshold willingness-to-pay (WTP) of €20 000 and €62 500 was used for data from the Netherlands and Norway respectively.
Results
The additional costs of the screening strategy compared with no screening were €421 (95 per cent confidence interval 33 to 806) per person in the Netherlands, and the additional life-years were 0·097 (−0·180 to 0·365), representing €4340 per life-year. For Norway, the values were €562 (59 to 1078), 0·057 (−0·135 to 0·253) life-years and €9860 per life-year respectively. In Norway the results were sensitive to a decrease in the prevalence of AAA in 65-year-old men to 1 per cent, or lower. Probabilistic sensitivity analyses indicated that AAA screening has a 70 per cent probability of being cost-effective in the Netherlands with a WTP threshold of €20 000, and 70 per cent in Norway with a threshold of €62 500.
Conclusion
Using this model, screening for AAA in 65-year-old men would be highly cost-effective in both the Netherlands and Norway.
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Affiliation(s)
- S Spronk
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands
- Department of Radiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - B J H van Kempen
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands
- Department of Radiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - A P M Boll
- Department of Surgery, Canisius-Wilhelmina Hospital Nijmegen, Nijmegen, The Netherlands
| | - J J Jørgensen
- Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway
| | - M G M Hunink
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands
- Department of Radiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - I S Kristiansen
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
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Sharma M, Ortendahl J, van der Ham E, Sy S, Kim JJ. Cost-effectiveness of human papillomavirus vaccination and cervical cancer screening in Thailand. BJOG 2011; 119:166-76. [DOI: 10.1111/j.1471-0528.2011.02974.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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What Is the Social Cost of Injured People in Traffic Collisions? An Assessment for Catalonia. ACTA ACUST UNITED AC 2011; 70:744-50. [DOI: 10.1097/ta.0b013e3181eaaa5b] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Working poor in Germany: Dimensions of the problem and repercussions for the health-care system. J Public Health Policy 2010; 31:298-311. [PMID: 20805802 DOI: 10.1057/jphp.2010.20] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The 'working poor' may not exceed the poverty threshold despite full-time (or even double) employment. The general relationship between poverty and illness is understood, but little is known about specific health implications of the 'working poor' status. The proportion of 'working poor' is increasing in Germany. Poverty-related health problems occur because of a lower standard of nutrition and housing, financial restraints, bad labour conditions, high-risk behaviours, and lack of access to health services. Impaired health status, in turn, adversely affects incomes and wages, raising concern about a vicious circle. Limited health-care resources demand preventive policies to improve employment status and income. Health and economic policy demand specific research on the health implications of precarious employment. In some areas, swift action is required.
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Schoenbaum M, Butler B, Kataoka S, Norquist G, Springgate B, Sullivan G, Duan N, Kessler RC, Wells K. Promoting mental health recovery after hurricanes Katrina and Rita: what can be done at what cost. ARCHIVES OF GENERAL PSYCHIATRY 2009; 66:906-14. [PMID: 19652130 PMCID: PMC2910784 DOI: 10.1001/archgenpsychiatry.2009.77] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Concerns about mental health recovery persist after the 2005 Gulf storms. We propose a recovery model and estimate costs and outcomes. OBJECTIVE To estimate the costs and outcomes of enhanced mental health response to large-scale disasters using the 2005 Gulf storms as a case study. DESIGN Decision analysis using state-transition Markov models for 6-month periods from 7 to 30 months after disasters. Simulated movements between health states were based on probabilities drawn from the clinical literature and expert input. SETTING A total of 117 counties/parishes across Louisiana, Mississippi, Alabama, and Texas that the Federal Emergency Management Agency designated as eligible for individual relief following hurricanes Katrina and Rita. PARTICIPANTS Hypothetical cohort, based on the size and characteristics of the population affected by the Gulf storms. Intervention Enhanced mental health care consisting of evidence-based screening, assessment, treatment, and care coordination. MAIN OUTCOME MEASURES Morbidity in 6-month episodes of mild/moderate or severe mental health problems through 30 months after the disasters; units of service (eg, office visits, prescriptions, hospital nights); intervention costs; and use of human resources. RESULTS Full implementation would cost $1133 per capita, or more than $12.5 billion for the affected population, and yield 94.8% to 96.1% recovered by 30 months, but exceed available provider capacity. Partial implementation would lower costs and recovery proportionately. CONCLUSIONS Evidence-based mental health response is feasible, but requires targeted resources, increased provider capacity, and advanced planning.
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Schwarcz SK, Hsu LC, Vittinghoff E, Vu A, Bamberger JD, Katz MH. Impact of housing on the survival of persons with AIDS. BMC Public Health 2009; 9:220. [PMID: 19583862 PMCID: PMC2728715 DOI: 10.1186/1471-2458-9-220] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Accepted: 07/07/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Homeless persons with HIV/AIDS have greater morbidity and mortality, more hospitalizations, less use of antiretroviral therapy, and worse medication adherence than HIV-infected persons who are stably housed. We examined the effect of homelessness on the mortality of persons with AIDS and measured the effect of supportive housing on AIDS survival. METHODS The San Francisco AIDS registry was used to identify homeless and housed persons who were diagnosed with AIDS between 1996 and 2006. The registry was computer-matched with a housing database of homeless persons who received housing after their AIDS diagnosis. The Kaplan-Meier product limit method was used to compare survival between persons who were homeless at AIDS diagnosis and those who were housed. Proportional hazards models were used to estimate the independent effects of homelessness and supportive housing on survival after AIDS diagnosis. RESULTS Of the 6,558 AIDS cases, 9.8% were homeless at diagnosis. Sixty-seven percent of the persons who were homeless survived five years compared with 81% of those who were housed (p < 0.0001). Homelessness increased the risk of death (adjusted relative hazard [RH] 1.20; 95% confidence limits [CL] 1.03, 1.41). Homeless persons with AIDS who obtained supportive housing had a lower risk of death than those who did not (adjusted RH 0.20; 95% CL 0.05, 0.81). CONCLUSION Supportive housing ameliorates the negative effect of homelessness on survival with AIDS.
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Spronk S, Bosch JL, Ryjewski C, Rosenblum J, Kaandorp GC, White JV, Hunink MGM. Cost-effectiveness of new cardiac and vascular rehabilitation strategies for patients with coronary artery disease. PLoS One 2008; 3:e3883. [PMID: 19065259 PMCID: PMC2587698 DOI: 10.1371/journal.pone.0003883] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Accepted: 10/29/2008] [Indexed: 12/31/2022] Open
Abstract
Objective Peripheral arterial disease (PAD) often hinders the cardiac rehabilitation program. The aim of this study was evaluating the relative cost-effectiveness of new rehabilitation strategies which include the diagnosis and treatment of PAD in patients with coronary artery disease (CAD) undergoing cardiac rehabilitation. Data Sources Best-available evidence was retrieved from literature and combined with primary data from 231 patients. Methods We developed a Markov decision model to compare the following treatment strategies: 1. cardiac rehabilitation only; 2. ankle-brachial index (ABI) if cardiac rehabilitation fails followed by diagnostic work-up and revascularization for PAD if needed; 3. ABI prior to cardiac rehabilitation followed by diagnostic work-up and revascularization for PAD if needed. Quality-adjusted-life years (QALYs), life-time costs (US $), incremental cost-effectiveness ratios (ICER), and gain in net health benefits (NHB) in QALY equivalents were calculated. A threshold willingness-to-pay of $75 000 was used. Results ABI if cardiac rehabilitation fails was the most favorable strategy with an ICER of $44 251 per QALY gained and an incremental NHB compared to cardiac rehabilitation only of 0.03 QALYs (95% CI: −0.17, 0.29) at a threshold willingness-to-pay of $75 000/QALY. After sensitivity analysis, a combined cardiac and vascular rehabilitation program increased the success rate and would dominate the other two strategies with total lifetime costs of $30 246 a quality-adjusted life expectancy of 3.84 years, and an incremental NHB of 0.06 QALYs (95%CI:−0.24, 0.46) compared to current practice. The results were robust for other different input parameters. Conclusion ABI measurement if cardiac rehabilitation fails followed by a diagnostic work-up and revascularization for PAD if needed are potentially cost-effective compared to cardiac rehabilitation only.
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Affiliation(s)
- Sandra Spronk
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands.
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Andermann A, Blancquaert I, Beauchamp S, Déry V. Revisiting Wilson and Jungner in the genomic age: a review of screening criteria over the past 40 years. Bull World Health Organ 2008; 86:317-9. [PMID: 18438522 DOI: 10.2471/blt.07.050112] [Citation(s) in RCA: 521] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Shih YCT, Halpern MT. Economic evaluations of medical care interventions for cancer patients: how, why, and what does it mean? CA Cancer J Clin 2008; 58:231-44. [PMID: 18596196 DOI: 10.3322/ca.2008.0008] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
While the past decade has seen the development of multiple new interventions to diagnose and treat cancer, as well as to improve the quality of life for cancer patients, many of these interventions have substantial costs. This has resulted in increased scrutiny of the costs of care for cancer, as well as the costs relative to the benefits for cancer treatments. It is important for oncologists and other members of the cancer community to consider and understand how economic evaluations of cancer interventions are performed and to be able to use and critique these evaluations. This review discusses the components, main types, and analytic issues of health economic evaluations using studies of cancer interventions as examples. We also highlight limitations of these economic evaluations and discuss why members of the cancer community should care about economic analyses.
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Affiliation(s)
- Ya-Chen Tina Shih
- Department of Biostatistics, Division of Quantitative Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Kim JJ, Kobus KE, Diaz M, O'Shea M, Van Minh H, Goldie SJ. Exploring the cost-effectiveness of HPV vaccination in Vietnam: insights for evidence-based cervical cancer prevention policy. Vaccine 2008; 26:4015-24. [PMID: 18602731 DOI: 10.1016/j.vaccine.2008.05.038] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2008] [Revised: 05/05/2008] [Accepted: 05/12/2008] [Indexed: 10/22/2022]
Abstract
Using mathematical models of cervical cancer for the northern and southern regions of Vietnam, we assessed the cost-effectiveness of cervical cancer prevention strategies and the tradeoffs between a national and region-based policy in Vietnam. With 70% vaccination and screening coverage, lifetime risk of cancer was reduced by 20.4-76.1% with vaccination of pre-adolescent girls and/or screening of older women. Only when the cost per vaccinated girl was low (i.e., <I$25) was vaccination combined with screening (three times per lifetime or every 5 years) favored in both regions; at high costs per vaccinated girl (i.e., >I$100), screening alone was most cost-effective. When optimal policies differed between regions, implementing a national strategy resulted in health and economic inefficiencies. HPV vaccination appears to be an attractive cervical cancer prevention strategy for Vietnam, provided high coverage can be achieved in young pre-adolescent girls, cost per vaccinated girl is <I$25 (i.e., <$5 per dose), and screening is offered at older ages.
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Affiliation(s)
- Jane J Kim
- Department of Health Policy and Management, Program in Health Decision Science, Harvard School of Public Health, 718 Huntington Avenue, Boston, MA 02115, USA.
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Abstract
OBJECTIVE The purpose of our review is to discuss the current state of lung cancer screening using CT in the context of defined criteria for effective screening. CONCLUSION Although there are hopeful developments in lung cancer screening, a number of unresolved issues must be answered before adopting screening on a large scale. Currently no data exist to suggest that lung cancer screening with CT will result in a decrease in lung cancer mortality.
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Grosse SD, Teutsch SM, Haddix AC. Lessons from cost-effectiveness research for United States public health policy. Annu Rev Public Health 2007; 28:365-91. [PMID: 17222080 DOI: 10.1146/annurev.publhealth.28.021406.144046] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The application of cost-effectiveness analysis to health care has been the subject of previous reviews. We address the use of economic evaluation methods in public health, including case studies of population-level policies, e.g., environmental regulations, injury prevention, tobacco control, folic acid fortification, and blood product safety, and the public health promotion of clinical preventive services, e.g., newborn screening, cancer screening, and childhood immunizations. We review the methods used in cost-effectiveness analysis, the implications for cost-effectiveness findings, and the extent to which economic studies have influenced policy and program decisions. We discuss reasons for the relatively limited impact to date of economic evaluation in public health. Finally, we address the vexing question of how to decide which interventions are cost effective and worthy of funding. Policy makers have funded certain interventions with rather high cost-effectiveness ratios, notably nucleic acid testing for blood product safety. Cost-effectiveness estimates are a decision aid, not a decision rule.
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Affiliation(s)
- Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Coordinating Center for Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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de Bekker-Grob EW, Polder JJ, Mackenbach JP, Meerding WJ. Towards a comprehensive estimate of national spending on prevention. BMC Public Health 2007; 7:252. [PMID: 17883834 PMCID: PMC2071917 DOI: 10.1186/1471-2458-7-252] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Accepted: 09/20/2007] [Indexed: 11/23/2022] Open
Abstract
Background Comprehensive information about national spending on prevention is crucial for health policy development and evaluation. This study provides a comprehensive overview of prevention spending in the Netherlands, including those activities beyond the national health accounts. Methods National spending on health-related primary and secondary preventive activities was examined by funding source with the use of national statistics, government reports, sector reports, and data from individual health associations and corporations, public services, occupational health services, and personal prevention. Costs were broken down by diseases, age groups and gender using population-attributable risks and other key variables. Results Total expenditures on prevention were €12.5 billion or €769 per capita in the Netherlands in 2003, of which 20% was included in the national health accounts. 82% was spent on health protection, 16% on disease prevention, and 2% on health promotion activities. Most of the spending was aimed at the prevention of infectious diseases (34%) and acute physical injuries (29%). Per capita spending on prevention increased steeply by age. Conclusion Total expenditure on health-related prevention is much higher than normally reported due to the inclusion of health protection activities beyond the national health accounts. The allocative efficiency of prevention spending, particularly the high costs of health protection and the low costs of health promotion activities, should be addressed with information on their relative cost effectiveness.
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Wong IOL, Kuntz KM, Cowling BJ, Lam CLK, Leung GM. Cost effectiveness of mammography screening for Chinese women. Cancer 2007; 110:885-95. [PMID: 17607668 DOI: 10.1002/cncr.22848] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although the cost effectiveness of screening mammography in most western developed populations has been accepted, it may not apply to Chinese women, who have a much lower breast cancer incidence. The authors estimated the cost effectiveness of biennial mammography in Hong Kong Chinese women to inform evidence-based screening policies. METHODS For the current study, a state-transition Markov model was developed to simulate mammography screening, breast cancer diagnosis, and treatment in a hypothetical cohort of Chinese women. The benefit of mammography was modeled by assuming a stage shift, in which cancers in screened women were more likely to be diagnosed at an earlier disease stage. The authors compared costs, quality-adjusted life years (QALYs) saved, and life years saved (LYS) for 5 screening strategies. RESULTS Biennial screening resulted in a gain in life expectancy ranging from 4.3 days to 9.4 days compared with no screening at an incremental cost of from US $1,166 to US $2,425 per woman. The least costly, nondominated screening option was screening from ages 40 years to 69 years, with an incremental cost-effectiveness ratio (ICER) of US $61,600 per QALY saved or US $64,400 per LYS compared with no screening. In probabilistic sensitivity analyses, the probability of the ICER being below a threshold of US $50,000 per QALY (LYS) was 15.3% (14.6%). CONCLUSIONS The current results suggested that mammography for Hong Kong Chinese women currently may not be cost effective based on the arbitrary threshold of US $50,000 per QALY. However, clinicians must remain vigilant and periodically should revisit the question of population screening: Disease rates in China have been increasing because of westernization and socioeconomic development.
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Affiliation(s)
- Irene O L Wong
- Department of Community Medicine and School of Public Health, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong SAR, China
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Esperato A, García-Altés A. [Health promotion: a profitable investment? Economic efficiency of preventive interventions in Spain]. GACETA SANITARIA 2007; 21:150-61. [PMID: 17419933 DOI: 10.1157/13101044] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To examine the quantity and quality of economic evaluations analyzing preventive interventions in Spain to September 2005, with the further goal of extracting conclusions for further research and the design of future programs. METHODS We performed a systematic review of the evidence. First, we defined the criteria for including studies in our review. Second, a search was conducted of specialized search engines (Pubmed, NHS EED, DARE, HTA, HRSPROJ, IME, EMBASE) and a manual search was performed of journals and the web sites of Spanish public health organizations. In a third phase, the characteristics relevant to our analysis were extracted from the selected articles. Lastly, the characteristics collected were analyzed through uni- and bivariate analyses. RESULTS Forty-nine articles were found that complied with the inclusion criteria, of which 40 were reviewed. The technique most extensively used was cost-effectiveness analysis (60% of all articles). Twenty-eight evaluations (70%) focused on immunization campaigns. The quality of publications increased overtime, from an average score of 4.21 (1985-1995) to 6.38 (1995-2004), although several methodological areas still require improvement. Lastly, 72.5% of the studies supported the universal use or expansion of the policy analyzed. CONCLUSIONS The Spanish research community should increase efforts to improve the quantity and quality of economic evaluations in preventive health. Three basic strategies are suggested: a) evaluation of the preventive programs currently in place in Spain and dissemination of the results; b) efforts to publish and index articles in international scientific journals; and c) adherence to international economic evaluation guidelines and manuals.
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Affiliation(s)
- Alexo Esperato
- Agència de Salut Pública de Barcelona, Barcelona, España
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van Helvoort-Postulart D, Dirksen CD, Nelemans PJ, Kroon AA, Kessels AGH, de Leeuw PW, Vasbinder GBC, van Engelshoven JMA, Hunink MGM. Renal Artery Stenosis: Cost-effectiveness of Diagnosis and Treatment. Radiology 2007; 244:505-13. [PMID: 17581886 DOI: 10.1148/radiol.2442060713] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To use a decision analytic model to determine the cost-effectiveness of performing diagnostic digital subtraction angiography (DSA), computed tomographic (CT) angiography, or magnetic resonance (MR) angiography or proceeding immediately to tentative percutaneous revascularization in patients suspected of having renovascular hypertension. MATERIALS AND METHODS With use of a Markov-Monte Carlo decision model, cost-effectiveness analysis was performed from a societal perspective. Data were derived from the Renal Artery Diagnostic Imaging Study in Hypertension and from published literature. The base-case analyses were used to evaluate a 50-year-old patient with a diastolic blood pressure higher than 95 mm Hg and one or more clinical clues suggestive of renovascular hypertension. Outcome measures were quality-adjusted life-year (QALY), lifetime costs, and incremental cost-effectiveness. RESULTS For a 50-year-old male patient, immediate tentative revascularization was the least costly (euro54 415) and most effective (12.265 QALYs) strategy. For the other strategies, costs and QALYs, respectively, were euro55 570 and 12.195 for DSA, euro55 191 and 12.163 for CT angiography, and euro56 890 and 12.088 for MR angiography. For a 50-year-old female patient, costs and QALYs, respectively, were euro66 731 and 13.731 for MR angiography, euro63 970 and 13.749 for CT angiography, and euro63 079 and 13.902 for DSA. Immediate tentative revascularization yielded more QALYs (13.937) and was more costly (euro63 329) than DSA. The incremental cost-effectiveness ratio was euro7143 per QALY. As the prior probability increased, use of a more invasive diagnostic imaging strategy became justified. Also, the sensitivities of CT angiography and MR angiography and the costs of DSA influenced the results. CONCLUSION Given currently accepted incremental cost-effectiveness ratios, immediate tentative percutaneous revascularization is a cost-effective strategy for the diagnosis of renal artery stenosis. Management decisions should be conditional on the prior probability.
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Affiliation(s)
- Debby van Helvoort-Postulart
- Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, P Debyelaan 25, 6229 HX Maastricht, the Netherlands.
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Drummond M, Chevat C, Lothgren M. Do we fully understand the economic value of vaccines? Vaccine 2007; 25:5945-57. [PMID: 17629362 DOI: 10.1016/j.vaccine.2007.04.070] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2006] [Revised: 03/13/2007] [Accepted: 04/19/2007] [Indexed: 11/26/2022]
Abstract
Although many vaccination strategies are cost-effective, some of the newer vaccines are more expensive and may raise concerns about value for money. However, standard methods of economic evaluation may not adequately assess the true cost-effectiveness of vaccines, with the consequent under-application of vaccine strategies. Therefore, this paper reviews the evidence on cost-effectiveness of vaccines and vaccination strategies for pneumococcal disease, meningococcal disease, Hepatitis A and influenza. In each case the evidence is considered alongside existing vaccination policies in the major developed countries. The paper also highlights areas where traditional economic evaluations may not adequately reflect the value of vaccines.
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Abstract
The objective of this article is to assess the total economic costs of road traffic crashes in Barcelona, a metropolitan city located in Southern Europe. A cost-of-illness study was conducted using a prevalence approximation, a societal and healthcare system perspective, and a 1-year time horizon. Results were measured in terms of Euros in 2003. Total costs of road traffic crashes in Barcelona in 2003 were euro367 million. Direct costs equalled euro329 million (89.8% of total costs), including property damage costs, insurance administration costs and hospital costs. Police, emergency costs and transportation costs had a minimum effect on total direct costs. Indirect costs were euro37 million, including lost productivity due to hospitalization and mortality. The results of the sensitivity analysis showed the upper limit of total economic cost of road traffic crashes in Barcelona to be euro782 million. This is the first study to estimate the costs of road traffic crashes for a city in a developed country. The importance of the problem calls for further interventions to reduce road traffic crashes.
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Affiliation(s)
- A García-Altés
- Agència de Salut Pública de Barcelona, Barcelona, Spain.
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Hu D, Hook EW, Goldie SJ. The impact of natural history parameters on the cost-effectiveness of Chlamydia trachomatis screening strategies. Sex Transm Dis 2006; 33:428-36. [PMID: 16572038 DOI: 10.1097/01.olq.0000200577.46261.b0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE/GOAL To understand the potential impact of assumptions about the natural history of untreated Chlamydia trachomatis on the cost-effectiveness of screening strategies. STUDY DESIGN Using a previously developed state-transition model, we explored how alternative assumptions about the natural history of disease following infection affect the estimated cost-effectiveness of screening for U.S. women. The analysis was conducted from a modified societal perspective and incorporated a lifetime analytic horizon. RESULTS Different natural history assumptions affect cost-effectiveness outcomes. Assumptions about the combined risk of persistent and repeat infections have the greatest impact on the composition of optimal screening strategies, whereas assumptions about the risk of pelvic inflammatory disease most greatly influenced the magnitude of incremental cost-effectiveness ratios. CONCLUSIONS Priorities for future C trachomatis research should include better estimates of the risk of pelvic inflammatory disease, persistence, and repeat infection. Better delineation of these variables will permit improved evaluation of potential screening activities.
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Affiliation(s)
- Delphine Hu
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts 02138, USA.
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Liu CJ, Chen DS, Chen PJ. Epidemiology of HBV infection in Asian blood donors: Emphasis on occult HBV infection and the role of NAT. J Clin Virol 2006; 36 Suppl 1:S33-44. [PMID: 16831692 DOI: 10.1016/s1386-6532(06)80007-7] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Hepatitis B virus (HBV) infection is endemic in many Asian countries. Among many transmission routes, transfusion is the one that should be prevented. The first major success in enhancing transfusion safety came with the implementation of hepatitis B surface antigen (HBsAg) in the early 1970s. However, the studies quoted in this review demonstrate that transmission by blood components negative for HBsAg can still occur in the acute phase of infection during the seronegative window period, or during chronic stages of infection (i.c. "occult" HBV infection, OHB). OHB is defined as the presence of HBV DNA in blood or liver tissues in patients negative for HBsAg, with or without any HBV antibodies. Because of limitations in current blood screening practices, OHB is an overlooked source of HBV transmission. For policy development on screening for HBV infection in blood donors, it would be useful to assess the relative contribution of the above two sources of transfusion-transmitted HBV infection from HBsAg-negative donations. New screening policy should be evaluated on the basis of available data or newly designed studies. While anti-HBc screening can climinate residual risk of occult HBV transmission by transfusion in low-endemic areas, it would not be practical in most parts of the world where the prevalence of anti-HBc is >10% as too many otherwise healthy donors will be ineligible. On the contrary, studies mentioned in this paper indicate that nucleic acid amplification test (NAT) or new HBsAg tests of enhanced sensitivity would be effective in the screening of blood donors for OHB in highly endemic countries. However, the cost-effectiveness of blood screening tests is a major concern in Asia. We therefore have systemically reviewed the literature on prevalence and infectivity of OHB in Asian countries and the possible role of NAT for identifying blood donors in the pre-HBsAg window phase or in later stages of OHB.
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Affiliation(s)
- Chun-Jen Liu
- Division of Gastroenterology, Department of Internal Medicine, National Taiwan University Hospital, Taipei
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Le Faou AL, Scemama O. Comparaison des systèmes de couverture assurantielle des traitements pharmacologiques d’aide au sevrage tabagique dans cinq pays de l’Organisation de Coopération et de Développement Économiques. Rev Epidemiol Sante Publique 2005; 53:535-48. [PMID: 16434927 DOI: 10.1016/s0398-7620(05)84730-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Reports in the literature demonstrate effectiveness and cost-effectiveness of tobacco treatments including drug and behavioral therapies. The health insurance coverage of smoking cessation treatments could lower financial barriers which limit the access to these services. The purpose of this paper was to compare health insurance coverage for pharmacotherapies for smoking cessation in five countries from the Organisation for Economic Co-operation and Development. METHODS A literature review was performed using Medline, official websites and Google. A grid was used to analyse articles and reports in order to identify: the public or private coverage of smoking cessation pharmacotherapies; the population groups who were covered; the extent and content of the insurance coverage as well as the practical ways to obtain it and the training and certification of the health staff to prescribe these treatments. RESULTS Australia, Quebec, the United States, New Zealand and the United Kingdom provide financial coverage for some of the drugs prescribed to stop smoking. The financial coverage depends on the organization of the health care system: universal coverage in Australia, Quebec, New Zealand, and the United Kingdom and private coverage in the United States except for the Medicaid public program. In the United States as well as in the United Kingdom the first population group to benefit from financial coverage of smoking cessation therapy were socially precarious persons. Prescription schemes are recommended in the present programs and persons who receive the treatment are generally requested to attend follow-up visits. All countries studied encourage training of health professionals in tobacco cessation, but except for Australia and New Zealand there is no mandatory registration of physicians who prescribe smoking cessation drugs. CONCLUSION The financial coverage of smoking cessation pharmacotherapies is often the result of a political decision. Taking into consideration the situation of developed countries, France should first consider the financial coverage of smoking cessation pharmacotherapies for socially precarious persons and populations with tobacco-related diseases. In addition, a population-based study should be conducted in France to measure the efficacy of financial coverage on smoking cessation.
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Affiliation(s)
- A-L Le Faou
- Département de Santé publique, Faculté de Médecine Paris 5, Université René-Descartes, 15, rue de l'Ecole de Médecine, 75270 Paris Cedex 06.
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Rauner MS, Heidenberger K, Pesendorfer EM. Model-Based Evaluation of Diabetic Foot Prevention Strategies in Austria. Health Care Manag Sci 2005; 8:253-65. [PMID: 16379409 DOI: 10.1007/s10729-005-4136-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Diabetes mellitus affects approximately 171 million individuals worldwide. The costs of the adult form of diabetic mellitus account for up to 6% of total health care expenditures in industrialized countries. About 25% of these diabetics develop disabling and most painful foot complications accounting for about 17% of the direct lifetime costs. Diabetic foot prevention programs have been recently introduced in some Austrian federal states to meet the diabetic health targets of the Austrian Health Plan and the St. Vincent Declaration. We developed a new age-group specific Markov model combined with a Monte Carlo simulation model to help policymakers analyze the cost-effectiveness of such programs compared to the status quo in terms of incremental costs per quality-adjusted life years gained (QALY). The Markov model revealed that diabetic foot prevention programs were cost saving when targeted at patients at high risk and mainly cost-effective when targeted at patients with mild symptoms. The Monte Carlo simulation showed that only large scope prevention programs would fulfill the specified reductions in the number of diabetic foot complications as defined in the Austrian Health Plan and the St. Vincent Declaration. Our results clearly indicate the enormous impact of diabetic foot prevention programs.
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Affiliation(s)
- Marion S Rauner
- Department of Innovation and Technology Management, University of Vienna, Faculty of Business, Economics and Statistics, Bruenner Str. 72, A-1210 Vienna, Austria.
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Perlis RH, Ganz DA, Avorn J, Schneeweiss S, Glynn RJ, Smoller JW, Wang PS. Pharmacogenetic testing in the clinical management of schizophrenia: a decision-analytic model. J Clin Psychopharmacol 2005; 25:427-34. [PMID: 16160617 DOI: 10.1097/01.jcp.0000177553.59455.24] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Clinical application of pharmacogenetic testing has been proposed as a means of improving treatment outcomes in psychiatry. The identification of a putative genetic test for better clozapine response in schizophrenia offers an opportunity to evaluate the cost-effectiveness of such testing. The authors performed a cost-effectiveness analysis of a genetic test that may identify individuals with greater likelihood of responding to clozapine treatment. We modeled a target population of schizophrenia patients in an acute psychotic episode, using a lifetime time horizon and societal perspective. Outcome measures included life expectancy, quality-adjusted life expectancy, costs, and incremental cost-effectiveness. Effects of variations in testing parameters were also examined. For a 30-year-old with schizophrenia, applying the pharmacogenetic test and treating those predicted to respond to clozapine with clozapine-first cost US $47,705 per additional quality-adjusted life-year, compared with treating all patients with conventional agents and reserving clozapine for treatment-resistant patients. In 1-way sensitivity analyses, test sensitivity and cost had the greatest impact on the incremental cost-effectiveness. We conclude that pharmacogenetic tests may achieve utility in clinical psychiatry, although their cost-effectiveness depends on several clinical parameters. More consistent reporting of test parameters such as sensitivity and specificity would greatly facilitate assessment of future pharmacogenetic studies.
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Affiliation(s)
- Roy H Perlis
- Pharmacogenomics Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
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Anderson GM, Bronskill SE, Mustard CA, Culyer A, Alter DA, Manuel DG. Both clinical epidemiology and population health perspectives can define the role of health care in reducing health disparities. J Clin Epidemiol 2005; 58:757-62. [PMID: 16018910 DOI: 10.1016/j.jclinepi.2004.10.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2003] [Revised: 10/14/2004] [Accepted: 10/29/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To compare and contrast clinical epidemiology and population health perspectives on the role of health care in reducing socioeconomic disparities in health. STUDY DESIGN AND SETTING A review of concepts outlined in selected articles on population health and clinical epidemiology and a systematic literature search for randomized controlled trials (RCTs) of therapeutic interventions for cardiovascular disease that contained analysis of outcomes by socioeconomic status. RESULTS Population health has a focus on health disparities, particularly disparities related to socioeconomic status, and many of its proponents have a pessimistic view of the degree to which health care can reduce these disparities. Clinical epidemiology has a focus on the production of valid evidence on the impact of health care interventions; however, RCTs rarely report the impact of interventions across socioeconomic strata. Both population health and clinical epidemiology share the view that efficacy, effectiveness, and cost-effectiveness are all important in defining the impact of health care on health disparities. CONCLUSION Principles drawn from both population health and clinical epidemiology could be used to provide a clearer picture of the role that health care interventions can have on socioeconomic disparities in health and to identify implications for policy, research, and clinical practice.
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Affiliation(s)
- Geoffrey M Anderson
- Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, McMurrich Building, 2nd floor, 12 Queen's Park Crescent West, Toronto, Ontario M5S 1A8, Canada.
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Ganz DA, Simmons SF, Schnelle JF. Cost-effectiveness of recommended nurse staffing levels for short-stay skilled nursing facility patients. BMC Health Serv Res 2005; 5:35. [PMID: 15885148 PMCID: PMC1145183 DOI: 10.1186/1472-6963-5-35] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2004] [Accepted: 05/10/2005] [Indexed: 11/10/2022] Open
Abstract
Background Among patients in skilled nursing facilities for post-acute care, increased registered nurse, total licensed staff, and nurse assistant staffing is associated with a decreased rate of hospital transfer for selected diagnoses. However, the cost-effectiveness of increasing staffing to recommended levels is unknown. Methods Using a Markov cohort simulation, we estimated the incremental cost-effectiveness of recommended staffing versus median staffing in patients admitted to skilled nursing facilities for post-acute care. The outcomes of interest were life expectancy, quality-adjusted life expectancy, and incremental cost-effectiveness. Results The incremental cost-effectiveness of recommended staffing versus median staffing was $321,000 per discounted quality-adjusted life year gained. One-way sensitivity analyses demonstrated that the cost-effectiveness ratio was most sensitive to the likelihood of acute hospitalization from the nursing home. The cost-effectiveness ratio was also sensitive to the rapidity with which patients in the recommended staffing scenario recovered health-related quality of life as compared to the median staffing scenario. The cost-effectiveness ratio was not sensitive to other parameters. Conclusion Adopting recommended nurse staffing for short-stay nursing home patients cannot be justified on the basis of decreased hospital transfer rates alone, except in facilities with high baseline hospital transfer rates. Increasing nurse staffing would be justified if health-related quality of life of nursing home patients improved substantially from greater nurse and nurse assistant presence.
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Affiliation(s)
- David A Ganz
- Robert Wood Johnson Clinical Scholars Program, Veterans Affairs Greater Los Angeles Health Care System and University of California, Los Angeles, 911 Broxton Plaza, Los Angeles, CA 90024, USA
| | - Sandra F Simmons
- Borun Center for Gerontological Research, University of California, Los Angeles and Jewish Home for the Aging, 7150 Tampa Avenue, Reseda, CA 91335, USA
| | - John F Schnelle
- Borun Center for Gerontological Research, University of California, Los Angeles and Jewish Home for the Aging, 7150 Tampa Avenue, Reseda, CA 91335, USA
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Cowper PA, Udayakumar K, Sketch MH, Peterson ED. Economic effects of prolonged clopidogrel therapy after percutaneous coronary intervention. J Am Coll Cardiol 2005; 45:369-76. [PMID: 15680714 DOI: 10.1016/j.jacc.2004.10.041] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2004] [Revised: 10/17/2004] [Accepted: 10/18/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVES This study examined the incremental cost-effectiveness of extending clopidogrel therapy from one month to one year after percutaneous coronary intervention (PCI) in an unselected, heterogeneous patient population. BACKGROUND Clinical trials suggest that prolonging clopidogrel therapy for up to one year after PCI reduces downstream cardiac events. However, clopidogrel therapy is costly and may increase bleeding risk. METHODS Using decision analysis, we compared the outcomes and cost of prolonging clopidogrel treatment from one month to one year after PCI with the alternative strategy of discontinuing therapy one month after the procedure. Event rates were based on 3,976 PCI patients who were treated between January 1999 and December 2001 at the Duke Medical Center and received no more than one month of clopidogrel after the procedure. Baseline characteristics and event rates were obtained from Duke clinical information systems. The effect of prolonged clopidogrel therapy on event rates was based on the Clopidogrel for the Reduction of Events During Observation (CREDO) trial per-protocol data. Unit costs and the effect of myocardial infarction (MI) on life expectancy were based on published sources. RESULTS Extending clopidogrel therapy from one month to one year after PCI cost USD 879 per patient and reduced the risk of MI by 2.6%. Assuming MI decreases life expectancy by two years, prolonged therapy would cost USD 15,696 per year of life saved. Economic attractiveness of therapy varied with baseline risk, the effect of prolonged therapy on MI risk, and the price of clopidogrel. CONCLUSIONS Prolonging clopidogrel therapy for one year after PCI is economically attractive, particularly in high-risk patients.
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Affiliation(s)
- Patricia A Cowper
- Outcomes Research and Assessment Group, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
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Abstract
PURPOSE To make preliminary estimates of the effectiveness (in life-years) and cost-effectiveness (in costs per life-year) of whole-body computed tomographic (CT) screening. MATERIALS AND METHODS Costs and effectiveness (in life-years) of onetime whole-body CT screening relative to those of no screening were calculated by using a decision-analytic model. It was assumed that any benefits from screening were due to earlier detection of disease and improvement in survival relative to survival with routine care. Eight conditions were included in the model: ovarian, pancreatic, lung, liver, kidney, and colon cancer; abdominal aortic aneurysm; and coronary artery disease. Costs of the screening examination, follow-up tests, and patient care were estimated. The base-case analysis was performed for a hypothetical cohort of 500 000 self-referred asymptomatic 50-year-old men. For sensitivity analyses, the age and sex of the cohort were varied. Results were expressed in 2001 U.S. dollars per life-year gained. RESULTS Compared with routine care, whole-body CT screening provided minimal gains in life expectancy (0.016 6 years or 6 days) at an average additional cost of 2513 dollars per patient, or an incremental cost-effectiveness ratio of 151 000 dollars per life-year gained. Most patients (90.8%) had at least one positive finding, but only 2.0% had disease; work-up in patients with a false-positive result of screening accounted for 32.3% of total costs (1720 dollars of 5332 dollars). Results were sensitive to the prevalence of disease, the effect of screening on stage of disease at diagnosis, the specificity of screening, and the costs of follow-up for false-positive findings. CONCLUSION Even with assumptions favorable to whole-body CT, implementation of onetime screening would not be cost-effective compared with currently funded medical interventions; follow-up for false-positive findings would add a substantial financial burden to the health care system.
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Affiliation(s)
- Molly T Beinfeld
- Massachusetts General Hospital Institute for Technology Assessment, 101 Merrimac St, 10th Floor, Boston, MA 02114-4724, USA
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Kent R, Viano DC, Crandall J. The field performance of frontal air bags: a review of the literature. TRAFFIC INJURY PREVENTION 2005; 6:1-23. [PMID: 15823870 DOI: 10.1080/15389580590903131] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This article presents a broad review of the literature on frontal air bag field performance, starting with the initial government and industry projections of effectiveness and concluding with the most recent assessments of depowered systems. This review includes as many relevant metrics as practicable, interprets the findings, and provides references so the interested reader can further evaluate the limitations, confounders, and utility of each metric. The evaluations presented here range from the very specific (individual case studies) to the general (statistical analyses of large databases). The metrics used to evaluate air bag performance include fatality reduction or increase; serious, moderate, and minor injury reduction or increase; harm reduction or increase; and cost analyses, including insurance costs and the cost of life years saved for various air bag systems and design philosophies. The review begins with the benefits of air bags. Fatality and injury reductions attributable to the air bag are presented. Next, the negative consequences of air bag deployment are described. Injuries to adults and children and the current trends in air bag injury rates are discussed, as are the few documented instances of inadvertent deployments or non-deployment in severe crashes. In the third section, an attempt is made to quantify the influence of the many confounding factors that affect air bag performance. The negative and positive characteristics of air bags are then put into perspective within the context of societal costs and benefits. Finally, some special topics, including risk homeostasis and the performance of face bags, are discussed.
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Affiliation(s)
- Richard Kent
- Department of Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, Virginia 22902, USA.
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Hay JW, Sterling KL. Cost effectiveness of treating low HDL-cholesterol in the primary prevention of coronary heart disease. PHARMACOECONOMICS 2005; 23:133-141. [PMID: 15748088 DOI: 10.2165/00019053-200523020-00005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND A low serum level of high-density lipoprotein (HDL)-cholesterol is an independent risk factor for coronary heart disease (CHD). Fibrates, particularly gemfibrozil, have been shown to raise HDL-cholesterol levels and reduce the incidence of CHD. The literature on fibrate cost effectiveness is quite limited. OBJECTIVE The objective of this analysis is to determine the cost effectiveness of the fibrates gemfibrozil and fenofibrate in the primary prevention of CHD. The target population includes patients with low levels of HDL-cholesterol, but without pre-existing CHD or other CHD risk factors sufficiently elevated to indicate drug therapy. STUDY DESIGN AND METHODS From a societal perspective, a lifetime incremental cost-effectiveness model was developed to calculate baseline and treatment costs, life-years gained and QALYs gained. Model parameter values were taken from existing literature. In this 'backward induction' model, the expected costs and outcomes for each 5-year time-interval are utilised in subsequent 5-year time period calculations over the patient's entire lifetime. The study population consisted of a hypothetical cohort of males and females in the US aged 45-74 years, with low levels of HDL-cholesterol and no prior history of CHD. The base-case CHD risk factors for this population were obtained from the VA-HIT (Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial) population baseline characteristics, but assuming no prior CHD history. Estimates for the reduction in CHD risk associated with fibrate therapy reduction are also taken from the VA-HIT study. RESULTS Using a societal cost-effectiveness threshold of US$50, 000 per QALY, primary prevention of CHD in patients with low HDL-cholesterol levels using generic gemfibrozil therapy is cost effective for all age and sex categories, in contrast to fenofibrate therapy, which is cost effective for males, but not for females at baseline risks levels. In the base-case scenario, because of their higher CHD lifetime risk, it is more cost effective to treat males than females with either gemfibrozil or fenofibrate. For males and females the cost per QALY decreases with age for most age intervals. Gemfibrozil is more cost effective than fenofibrate for all age-sex categories because of the assumed equal efficacy and the higher fenofibrate drug cost. In the comparison scenario, generic lovastatin was more cost effective than gemfibrozil for men except at age 45 years and women at all ages, and more cost effective than fenofibrate for both men and women. CONCLUSIONS This analysis suggests that fibrate therapy, particularly with generic gemfibrozil, is cost effective in the primary prevention of CHD in individuals with low HDL-cholesterol levels, with or without elevated triglyceride levels. Certain patient subgroups, such as those with elevated triglyceride levels, smokers and those with diabetes mellitus are likely to achieve both CHD risk reduction and overall savings in net expected medical care costs. Comparable cost-effectiveness results are also shown for lovastatin therapy in the target patient population. Gemfibrozil dominates fenofibrate because of the lower cost of therapy (direct and indirect costs). These conclusions are robust to reasonable changes in model parameter values.
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Affiliation(s)
- Joel W Hay
- Department of Pharmaceutical Economics and Policy, University of Southern California, Los Angeles, California 90089, USA.
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Mendeloff J, Ko K, Roberts MS, Byrne M, Dew MA. Procuring Organ Donors as a Health Investment: How Much Should We Be Willing to Spend? Transplantation 2004; 78:1704-10. [PMID: 15614139 DOI: 10.1097/01.tp.0000149787.97288.a2] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND This paper examines the benefits and costs that accrue when a cadaveric organ donor is procured. We estimate the cost per quality-adjusted life year (QALY) for donor procurement. Our objective was not only to see whether organ procurement is a "good" health investment, but also to clarify how much it is worth spending to obtain additional donors. METHODS We calculated the average number of kidney, heart, and liver transplants that a typical cadaveric donor generates. Relying primarily on reviewing the published literature, we estimated for each organ type the average number of QALYs that transplants add and the average medical costs they generate. We multiplied per organ benefits and costs by the number of organs from the typical donor, and summed the results to calculate the cost per QALY from procuring an additional donor. We conducted extensive sensitivity analyses of the assumptions. RESULTS Our central estimate indicates that the typical donor generates about 13 QALYs at an added medical cost of about $214,000, a cost of approximately $16,000 per QALY. Our high estimate is approximately $57,000. CONCLUSIONS The implications of these findings depend upon how we choose to value QALYs. Most analysts agree that a figure of $100,000 is reasonable. At this value, the benefit obtained from one added donor would be $1.3 million (13 x $100,000) while the medical costs would be $214,000. The implication is that we should be willing to spend up to $1,086,000 ($1.3 million - $214,000) to obtain one more donor.
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Affiliation(s)
- John Mendeloff
- Graduate School of Public Health, Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, PA 15260, USA.
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