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A cost-effectiveness analysis of the routine use of isoniazid prophylaxis in patients with a positive Mantoux skin test.

https://arctichealth.org/en/permalink/ahliterature228336
Source
Am Rev Respir Dis. 1990 Oct;142(4):848-53
Publication Type
Article
Date
Oct-1990
Author
J M Fitzgerald
A. Gafni
Author Affiliation
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Source
Am Rev Respir Dis. 1990 Oct;142(4):848-53
Date
Oct-1990
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Canada
Child
Cost-Benefit Analysis
Humans
Isoniazid - adverse effects - therapeutic use
Middle Aged
Tuberculin Test
Tuberculosis, Pulmonary - diagnosis - economics - prevention & control
Abstract
The role of isoniazid prophylaxis in low-risk patients with positive Mantoux skin tests has recently been questioned. In general, recent research has focused on the risk/benefit ratio. We, therefore, decided to extend these data and apply a cost-effectiveness analysis of the routine use of isoniazid prophylaxis from a societal perspective. Costs per case prevented were calculated for a 20-, 50-, and 70-yr-old low-risk patient who had a positive Mantoux test with base, high, and low costings. Rates were also calculated based on the use of direct costs alone and direct and indirect costs combined. Costs varied from Canadian $8,586.00 in a 20-yr-old patient to $40,102.00 in a 70-yr-old patient per case prevented based on direct costs with costs ranging from $3,236.00 to $11,320.00 with both direct and indirect costs included. These costs could be considered reasonable from a societal perspective but do not address the issue of any increased life expectancy resulting from chemoprophylaxis.
PubMed ID
2121080 View in PubMed
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Could a policy of provision of hip protectors to elderly nursing home residents result in cost savings in acute hip fracture care? The case of Ontario, Canada.

https://arctichealth.org/en/permalink/ahliterature165651
Source
Osteoporos Int. 2007 Jun;18(6):819-27
Publication Type
Article
Date
Jun-2007
Author
A M Sawka
A. Gafni
P. Boulos
K. Beattie
A. Papaioannou
A. Cranney
D A Hanley
J D Adachi
A. Cheung
E A Papadimitropoulos
L. Thabane
Author Affiliation
Division of Endocrinology and Department of Medicine, University Health Network and University of Toronto, Toronto, ON, Canada.
Source
Osteoporos Int. 2007 Jun;18(6):819-27
Date
Jun-2007
Language
English
Publication Type
Article
Keywords
Aged
Cost Savings - statistics & numerical data
Cost-Benefit Analysis
Health Care Costs - statistics & numerical data
Hip Fractures - economics - epidemiology - prevention & control
Homes for the Aged
Humans
Nursing Homes
Ontario - epidemiology
Protective Devices - economics
Randomized Controlled Trials as Topic
Abstract
Hip fractures are an important problem in nursing homes. Hip protectors are external devices that decrease the risk of hip fracture in elderly nursing home residents. We estimated the overall healthcare cost savings from a hypothetical strategy of provision of hip protectors to elderly nursing home residents in Ontario, Canada. In a recent meta-analysis, we determined that a strategy of provision of hip protectors decreases the risk of hip fracture in nursing home residents.
Our objective was to determine whether the provision of hip protectors to all Ontario nursing home residents aged > or =65 years could result in cost savings, stemming from reductions in initial hospitalizations for hip fracture.
We conducted a cost analysis from a Ministry of Health perspective (one year cycle length). The efficacy of the intervention was estimated from a meta-analysis of randomized controlled trials.
A strategy of provision of hip protectors to all 60,775 elderly Ontario nursing home residents could result in an overall mean cost savings of 6.0 million Canadian dollars in one year (95% credibility interval, -26.4 million, 39.7 million), with a probability of cost savings of 0.63 (assuming no additional labor costs). In sensitivity analyses, decreasing hip protector price increased cost savings, whereas additional labor expenditures for application for hip protectors decreased cost savings.
In conclusion, if hip protectors can be provided to elderly Ontario nursing home residents without additional labor expenditures, there is a reasonable probability that such a strategy may result in healthcare cost savings.
PubMed ID
17221294 View in PubMed
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Economic and policy implications of adopting paclitaxel as first-line therapy for advanced ovarian cancer: an Ontario perspective.

https://arctichealth.org/en/permalink/ahliterature209418
Source
J Clin Oncol. 1997 Feb;15(2):632-9
Publication Type
Article
Date
Feb-1997
Author
L M Elit
A. Gafni
M N Levine
Author Affiliation
Department of Obstetrics and Gynaecology, University of Western Ontario, London, Canada. lelit@lhsc.on.ca
Source
J Clin Oncol. 1997 Feb;15(2):632-9
Date
Feb-1997
Language
English
Publication Type
Article
Keywords
Antineoplastic Agents, Phytogenic - economics - therapeutic use
Cost-Benefit Analysis
Female
Humans
Ontario
Ovarian Neoplasms - drug therapy - economics
Paclitaxel - economics - therapeutic use
Practice Guidelines as Topic
Sensitivity and specificity
Abstract
To determine the potential economic and policy implications that result from incorporating paclitaxel into first-line therapy for stage 3 and 4 ovarian cancer patients in the province of Ontario, Canada.
A cost-effectiveness analysis was conducted to compare cisplatin/cyclophosphamide (CC), a standard therapy, with cisplatin/paclitaxel (CT). Based on survival curves from a clinical trial, mean costs and survival were calculated. Sensitivity analyses were conducted based on altering the duration of paclitaxel infusion, discount rates, and efficacy of paclitaxel.
The mean survival duration is prolonged from 2.06 years with the standard therapy to 2.44 years with the paclitaxel combination. The paclitaxel therapy is more expensive, with a mean cost of $17,469 (Canadian) per patient treated with CT compared with $5,228 per patient with CC. The incremental cost-effectiveness ratio is $32,213 per year gained. Sensitivity analyses show that the conclusions remain unchanged. The use of CT as first-line treatment for advanced ovarian cancer patients in Ontario requires an additional $9 million per year over and above the present costs to treat this patient population.
Although paclitaxel-based therapy prolongs survival, it comes at an increased cost. It may not be possible to fund paclitaxel treatment using resources presently allocated to first-line chemotherapy for advanced ovarian cancer. The policy implications for absorbing the cost of paclitaxel in the context of a publicly funded health care system are discussed.
PubMed ID
9053487 View in PubMed
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Economic evaluations of community-based care: lessons from twelve studies in Ontario.

https://arctichealth.org/en/permalink/ahliterature200135
Source
J Eval Clin Pract. 1999 Nov;5(4):367-85
Publication Type
Article
Date
Nov-1999
Author
G. Browne
J. Roberts
A. Gafni
C. Byrne
R. Weir
B. Majumdar
S. Watt
Author Affiliation
System-Linked Research Unit on Health & Social Service Utilization, McMaster University, Hamilton, Ontario, Canada.
Source
J Eval Clin Pract. 1999 Nov;5(4):367-85
Date
Nov-1999
Language
English
Publication Type
Article
Keywords
Cohort Studies
Community Health Services - economics
Cost-Benefit Analysis
Evaluation Studies as Topic
Health Services Research
Humans
Ontario
Randomized Controlled Trials as Topic
Abstract
A series of 12 studies (five historic cohort and seven randomized trials) examined clients in community settings in Southern Ontario suffering from a variety of chronic physical and mental health conditions. These studies are appraised using a framework for evaluating possible outcomes of economic evaluation. In the 12 studies, sample composition and size varied. Each study was designed to quantify the well-being outcomes and expenditures associated with different community-based approaches to care provided in the context of a system of national health insurance. As a collective, these studies represent increasing methodological rigour. Multiple-perspective client well-being outcome measures were used. In two studies, caregiver burden also was analysed. A common approach to quantification and evaluation of expenditures for service consumption was used in all 12 studies. The nature of community-based health services (health vs. disease care orientation) was found to have direct and measurable impact on total expenditures for health service utilization and client well-being outcomes. In most cases, a recurring pattern of equal or better client outcomes, yet lower expenditures for use of community based health services, was associated with well-integrated health oriented services. Integrated services aimed at factors which determine health are superior when compared to individual, fragmented, disease oriented, and focused approaches to care. The main lessons from the 12 studies are that it is as or more effective and as or less expensive to offer complete, proactive, community health services to persons living with chronic circumstance than to provide focused, on-demand, piecemeal services. Complete services would have a psychosocial and mental health focus included with the physical care approach. Furthermore, people with coexisting risk factors (age, living arrangements, mental distress and problem-solving ability) are the ones who most benefit at lower expense from health oriented, proactive interventions.
PubMed ID
10579701 View in PubMed
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Economics, health and health economics: HYEs (healthy-years equivalent) versus QALYs (quality-adjusted live-year)

https://arctichealth.org/en/permalink/ahliterature220314
Source
J Health Econ. 1993 Oct;12(3):325-39
Publication Type
Article
Date
Oct-1993
Author
A. Gafni
S. Birch
A. Mehrez
Author Affiliation
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
Source
J Health Econ. 1993 Oct;12(3):325-39
Date
Oct-1993
Language
English
Publication Type
Article
Keywords
Canada
Choice Behavior
Consumer Satisfaction - economics
Cost-Benefit Analysis - methods
Economics, Medical
Humans
Models, Econometric
Outcome Assessment (Health Care) - economics
Quality of Life
Time Factors
Value of Life
Abstract
This paper responds to Culyer and Wagstaff's (CW) and Buckingham's (B) arguments. We refute their claim about the equivalence of HYEs and QALYs; they fail to distinguish between choice under uncertainty and under certainty. CW assume that all individuals have a specific form of utility function, which yields their conclusion of equivalence. B's arguments confuse the measurement technique and the utility theory from which it stems; his argument about the normative superiority of the QALY construct is inconsistent with economic thinking. The HYE, by being compatible with the principles of economics, is superior to the QALY for economic evaluations of health care interventions.
Notes
Comment In: J Health Econ. 1995 Aug;14(3):397-810145142
Comment In: J Health Econ. 1995 May;14(1):39-4510143488
Comment In: J Health Econ. 1995 May;14(1):1-710143484
Comment In: J Health Econ. 1995 May;14(1):9-1610143492
PubMed ID
10129840 View in PubMed
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Effectiveness and efficiency of selective vs universal screening for chlamydial infection in sexually active young women.

https://arctichealth.org/en/permalink/ahliterature223126
Source
Arch Intern Med. 1992 Sep;152(9):1837-44
Publication Type
Article
Date
Sep-1992
Author
J W Sellors
L. Pickard
A. Gafni
C H Goldsmith
D. Jang
J B Mahony
M A Chernesky
Author Affiliation
Hamilton-Wentworth Department of Public Health Services, Ontario, Canada.
Source
Arch Intern Med. 1992 Sep;152(9):1837-44
Date
Sep-1992
Language
English
Publication Type
Article
Keywords
Adult
Chlamydia Infections - epidemiology - prevention & control
Chlamydia trachomatis
Cost-Benefit Analysis
Costs and Cost Analysis
Female
Humans
Mass Screening - economics - methods
Ontario - epidemiology
Prevalence
Regression Analysis
Sensitivity and specificity
Uterine Cervicitis - epidemiology - microbiology - prevention & control
Abstract
Since chlamydial cervicitis is not associated with specific complaints, screening asymptomatic women is an important initiative to prevent pelvic inflammatory disease and its sequelae. Compared with universal screening, selective screening is less costly but less effective so the cost savings vs the consequences of missing infected women need to be weighed carefully.
In two family planning clinics, 1002 women were surveyed for chlamydial infection (prevalence, 7%) and its predictors to determine whether universal or selective screening is the most efficient strategy. Two rules for the selection of patients were determined by logistic regression modeling and their relative efficiencies were compared by incremental cost-effectiveness and sensitivity analysis. The validity of the screening rules was tested in 191 students attending a university health clinic.
If those with cervical friability, suspicious discharge, urinary frequency, or intermenstrual bleeding had been tested, 55.3% of all women would have been screened and 83.3% of all cases would have been detected. If those reporting a new sex partner in the preceding year had also been tested, 75.4% would have been screened, identifying 93.3% of all cases. The predictive power and practicality of the selection rules were validated in the university health clinic sample. Sensitivity analyses showed selective screening using cervical enzyme immunoassay with blocking confirmation was efficient if the prevalence of chlamydial infection was 16% or less, 11% or less, or 5% or less depending on whether base analyses, overestimated costs, or worst performance scenarios, respectively, were used.
Selective screening based on four or five predictors and confirmed cervical enzyme immunoassay is an effective and efficient strategy in low prevalence settings.
PubMed ID
1520050 View in PubMed
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Preoperative HIV testing: is it less expensive than universal precautions?

https://arctichealth.org/en/permalink/ahliterature219966
Source
J Clin Epidemiol. 1993 Nov;46(11):1219-27
Publication Type
Article
Date
Nov-1993
Author
V A Lawrence
A. Gafni
K. Kroenke
Author Affiliation
Department of Medicine, University of Texas Health Science Center at San Antonio 78284-7879.
Source
J Clin Epidemiol. 1993 Nov;46(11):1219-27
Date
Nov-1993
Language
English
Publication Type
Article
Keywords
Blotting, Western - economics
Canada
Cost-Benefit Analysis
Counseling - economics
Enzyme-Linked Immunosorbent Assay - economics
HIV Infections - epidemiology - prevention & control - transmission
HIV Seropositivity - diagnosis
Humans
Mass Screening - economics
Occupational Diseases - prevention & control
Personnel, Hospital
Preoperative Care - economics
Prevalence
Sensitivity and specificity
Surgical Procedures, Elective
United States
Universal Precautions - economics
Abstract
Universal precautions are officially recommended to prevent HIV transmission in health care settings but for elective surgery some advocate routine preoperative HIV testing. These strategies have not been tested in clinical trials but universal precautions are very expensive and not cost-effective. Thus, for elective surgery, routine testing might save resources by permitting selective use of additional barrier precautions. We performed an economic evaluation to compare both strategies, using a simple approach to determine if routine testing (RT) is less expensive than universal precautions (UP). Conservatively assuming equal effectiveness in preventing HIV transmission, we compared a minimized estimate for the average cost of RT with a maximized estimate for the average cost of UP per elective operation. The minimized estimate for RT (US$57) was greater than the maximized estimate for UP (US$36) per procedure. Results were stable or strengthened by sensitivity analysis. Routine HIV testing is not a valid economic alternative to UP for elective surgery. The simple methodology used in this study can be a preliminary strategy to review other strategies for preventing HIV transmission. This method is particularly useful when data are inadequate for a formal economic evaluation to determine the utility of collecting the detailed information necessary for a full comparison.
Notes
Comment In: J Clin Epidemiol. 1993 Nov;46(11):1229-318229098
PubMed ID
8229097 View in PubMed
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Subcutaneous low-molecular-weight heparin vs warfarin for prophylaxis of deep vein thrombosis after hip or knee implantation. An economic perspective.

https://arctichealth.org/en/permalink/ahliterature209302
Source
Arch Intern Med. 1997 Feb 10;157(3):298-303
Publication Type
Article
Date
Feb-10-1997
Author
R D Hull
G E Raskob
G F Pineo
W. Feldstein
D. Rosenbloom
A. Gafni
D. Green
J. Feinglass
A A Trowbridge
C G Elliott
Author Affiliation
Faculty of Medicine, University of Calgary, Alberta.
Source
Arch Intern Med. 1997 Feb 10;157(3):298-303
Date
Feb-10-1997
Language
English
Publication Type
Article
Keywords
Adult
Aged
Anticoagulants - economics - therapeutic use
Canada
Cost-Benefit Analysis
Double-Blind Method
Female
Heparin, Low-Molecular-Weight - economics - therapeutic use
Hip Prosthesis - adverse effects
Humans
Injections, Subcutaneous
Knee Prosthesis - adverse effects
Male
Middle Aged
Thrombosis - economics - etiology - prevention & control
United States
Warfarin - economics - therapeutic use
Abstract
Postoperative venous thrombosis and pulmonary embolism present a major clinical threat to patients undergoing total hip or knee arthroplasty. We performed an economic evaluation of warfarin sodium and subcutaneous low-molecular-weight heparin sodium prophylaxis comparing cost and effectiveness.
A consecutive series of 1436 patients who underwent hip or knee arthroplasty comparing these 2 regimens in a randomized trial with objective documentation of outcomes provided the opportunity to perform economic evaluations for Canada and the United States.
Deep vein thrombosis was documented in 231 (37.4%) of 617 patients given warfarin and in 185 (31.4%) of 590 patients given low-molecular-weight heparin (P = .03). In Canada, warfarin and low-molecular-weight heparin (tinzaparin sodium) incurred costs per 100 patients of $11,598 and $9,197, respectively, providing a cost savings of $2,401 for the low-molecular-weight heparin group. The drug cost of low-molecular-weight heparin (tinzaparin) was $6 per day and for warfarin was $0.32 per day. Sensitivity analysis showed that low-molecular-weight heparin is more costly if drug costs are increased by 1.5-fold (ie, the cost of tinzaparin is increased from $6 per day to $8.82 per day or more). In the United States, the analysis was also not definitive; low-molecular-weight heparin was more costly than warfarin at drug costs of $15 and $2.01 per day, respectively.
Our findings indicate that the decision to use low-molecular-weight heparin or warfarin prophylaxis in patients undergoing major joint replacement surgery is a finely tuned trade-off. Prophylaxis with low-molecular-weight heparin is equally or more effective than the more complex prophylaxis with warfarin. Major bleeding is uncommon but less frequent with warfarin use. The most significant parameters that influence the comparative cost-effectiveness are the cost of the drug, the cost of international normalized ratio monitoring, and the costs associated with major bleeding. The analysis also demonstrates that the results are health care system dependent (Canada vs US). In Canada, low-molecular-weight heparin (tinzaparin) is less costly because it avoids the need for international normalized ratio monitoring. In the United States, the drug cost for low-molecular-weight heparin will likely be the principal determinant of relative cost-effectiveness.
Notes
Comment In: ACP J Club. 1997 Jul-Aug;127(1):24
PubMed ID
9040296 View in PubMed
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Treatment of proximal vein thrombosis with subcutaneous low-molecular-weight heparin vs intravenous heparin. An economic perspective.

https://arctichealth.org/en/permalink/ahliterature209303
Source
Arch Intern Med. 1997 Feb 10;157(3):289-94
Publication Type
Article
Date
Feb-10-1997
Author
R D Hull
G E Raskob
D. Rosenbloom
G F Pineo
R G Lerner
A. Gafni
A A Trowbridge
C G Elliott
D. Green
J. Feinglass
Author Affiliation
Clinical Trials Unit, University of Calgary, Alberta.
Source
Arch Intern Med. 1997 Feb 10;157(3):289-94
Date
Feb-10-1997
Language
English
Publication Type
Article
Keywords
Anticoagulants - administration & dosage - economics
Bias (epidemiology)
Canada
Cost-Benefit Analysis
Drug Administration Schedule
Heparin - administration & dosage - economics
Heparin, Low-Molecular-Weight - administration & dosage - economics
Humans
Infusions, Intravenous
Injections, Subcutaneous
Sensitivity and specificity
Thromboembolism - etiology - prevention & control
Thrombosis - complications - drug therapy - pathology
United States
Abstract
Subcutaneous low-molecular-weight heparin is at least as effective and safe as classic intravenous heparin therapy for the treatment of proximal vein thrombosis. Anticoagulant monitoring is not required with low-molecular-weight heparin.
To perform an economic evaluation of these therapeutic approaches by comparing cost and effectiveness.
A randomized trial in 432 patients with proximal vein thrombosis that compared intravenous heparin and low-molecular-weight heparin with objective documentation of clinical outcomes provided the opportunity to perform an analysis of cost-effectiveness to rank these alternative therapies in terms of both their cost and effectiveness. The economic viewpoint of this analysis was that of a third-party payer (ie, a ministry of health in Canada or an insurance company in the United States).
In the intravenous heparin-treated group, the cost incurred for 100 patients was $414,655 (Canadian dollars) or $375,836 (US dollars), with a frequency of objectively documented venous thromboembolism of 6.9%. In the low-molecular-weight heparin-treated group, the cost incurred for 100 patients was $399,403 (Canadian dollars) or $335,687 (US dollars), with a frequency of objectively documented venous thromboembolism of 2.8%, thus providing a cost saving of $15,252 (Canadian dollars) or $40,149 (US dollars). Multiple sensitivity analyses were performed, and these procedures did not alter the findings of the study.
The findings indicate that low-molecular-weight heparin therapy is at least as effective and safe but less costly than intravenous heparin treatment. The potential for outpatient therapy in up to 37% of patients who are receiving low-molecular-weight heparin would substantially augment the cost saving.
Notes
Comment In: Arch Intern Med. 2000 Mar 27;160(6):869-7010737288
Comment In: ACP J Club. 1997 Jul-Aug;127(1):23
PubMed ID
9040295 View in PubMed
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9 records – page 1 of 1.