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The 2-year costs and effects of a public health nursing case management intervention on mood-disordered single parents on social assistance.

https://arctichealth.org/en/permalink/ahliterature191135
Source
J Eval Clin Pract. 2002 Feb;8(1):45-59
Publication Type
Article
Date
Feb-2002
Author
Maureen Markle-Reid
Gina Browne
Jacqueline Roberts
Amiram Gafni
Carolyn Byrne
Author Affiliation
System-Linked Research Unit on Health and Social Service Utilization, School of Nursing, McMaster University, Room 3N46, 1200 Main Street West, Hamilton, Ontario, L8N 3Z5, Canada. mreid@mcmaster.ca
Source
J Eval Clin Pract. 2002 Feb;8(1):45-59
Date
Feb-2002
Language
English
Publication Type
Article
Keywords
Adaptation, Psychological
Adult
Case Management - economics
Child
Cost-Benefit Analysis
Depressive Disorder - economics - nursing - rehabilitation
Employment
Female
Health Care Costs
Health Services - utilization
Health Services Accessibility
Humans
Male
Ontario
Public Assistance
Public Health Nursing - economics
Single Parent - psychology
Social Adjustment
Abstract
This randomized controlled trial was designed to evaluate the 2-year costs and effects of a proactive, public health nursing case management approach compared with a self-directed approach for 129 single parents (98% were mothers) on social assistance in a Canadian setting. A total of 43% of these parents had a major depressive disorder and 38% had two or three other health conditions at baseline.
Study participants were recruited over a 12 month period and randomized into two groups: one receiving proactive public health nursing and one which did not.
At 2 years, 69 single parents with 123 children receiving proactive public health nursing (compared with 60 parents with 91 children who did not receive public health nursing services) showed a slightly greater reduction in dysthymia and slightly higher social adjustment. There was no difference between the public health and control groups in total per parent annual cost of health and support services. However, costs were averted due to a 12% difference in non-use of social assistance in the previous 12 months for parents in the public health nursing group. This translates into an annual cost saving of 240,000 dollars (Canadian) of costs averted within 1 year for every 100 parents.
In the context of a system of national health and social insurance, this study supports the fact that it is no more costly to proactively service this population of parents on social assistance.
PubMed ID
11882101 View in PubMed
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The cost-effectiveness of the use of clopidogrel in acute coronary syndromes in five countries based upon the CURE study.

https://arctichealth.org/en/permalink/ahliterature53241
Source
Eur J Cardiovasc Prev Rehabil. 2004 Dec;11(6):460-5
Publication Type
Article
Date
Dec-2004
Author
Andre Lamy
Bengt Jönsson
William S Weintraub
Feng Zhao
Susan Chrolavicius
Ameet Bakhai
Steven Culler
Amiram Gafni
Peter Lindgren
Elizabeth Mahoney
Salim Yusuf
Author Affiliation
Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada. lamya@mcmaster.ca
Source
Eur J Cardiovasc Prev Rehabil. 2004 Dec;11(6):460-5
Date
Dec-2004
Language
English
Publication Type
Article
Keywords
Angina, Unstable - drug therapy
Canada
Cost-Benefit Analysis
Europe
Health Care Costs
Hospitalization - economics
Humans
Myocardial Infarction - drug therapy
Platelet Aggregation Inhibitors - economics - therapeutic use
Randomized Controlled Trials
Ticlopidine - analogs & derivatives - economics - therapeutic use
United States
Abstract
BACKGROUND: The CURE study demonstrated that clopidogrel prevents a range of ischaemic cardiovascular events in patients with Acute Coronary Syndromes (unstable angina or non-ST-segment elevation MI). DESIGN: We undertook an economic analysis of the use of clopidogrel in the UK, USA, Sweden, France and Canada based on the CURE study. METHODS: The costs of hospitalization, study drug and other medications were calculated, based on resource utilization for all patients in CURE. Unit costs were obtained for all resource items for each country, and are reported in local currencies in 2001 prices. RESULTS: While hospitalization costs were lower in the clopidogrel group, when the acquisition cost of clopidogrel for 9 months is included, the average cost per patient is higher in the clopidogrel group than the placebo group in all countries [difference in costs (with 95% CI) 208 pounds sterling (119, 297), 451 US dollars (58, 845), SKr 2571 (728, 4412), 325 euros (85, 565), 161 Canadian dollars (-185, 506)]. The absolute reduction in the number of total primary events was 2.0%, resulting in an incremental cost-effectiveness ratio (ICER) of 10,366 pounds sterling in the UK, 22,484 US dollars in the USA, SKr 127,951 in Sweden, 16,186 euros in France, and 7973 Canadian dollars in Canada per primary event avoided with clopidogrel. CONCLUSIONS: Clopidogrel in CURE reduced hospitalization costs but the acquisition cost of clopidogrel creates an overall increase in direct health care costs over 9 months. Nevertheless, the cost-effectiveness is in a range comparable to other therapies currently utilized for acute coronary syndromes.
PubMed ID
15580055 View in PubMed
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Cost implications of the use of ramipril in high-risk patients based on the Heart Outcomes Prevention Evaluation (HOPE) study.

https://arctichealth.org/en/permalink/ahliterature186549
Source
Circulation. 2003 Feb 25;107(7):960-5
Publication Type
Article
Date
Feb-25-2003
Author
Andre Lamy
Salim Yusuf
Janice Pogue
Amiram Gafni
Author Affiliation
CADENCE Research Group, McMaster University, Hamilton, Ontario, Canada. lamya@mcmaster.ca
Source
Circulation. 2003 Feb 25;107(7):960-5
Date
Feb-25-2003
Language
English
Publication Type
Article
Keywords
Angiotensin-Converting Enzyme Inhibitors - economics - therapeutic use
Canada
Cost-Benefit Analysis
Drug Costs - statistics & numerical data
Health Care Costs - statistics & numerical data
Heart Diseases - economics - mortality - prevention & control
Hospitalization
Humans
Multicenter Studies as Topic
Myocardial Infarction - prevention & control
Placebos - economics
Ramipril - economics - therapeutic use
Randomized Controlled Trials as Topic
Risk
Sensitivity and specificity
Stroke - prevention & control
Treatment Outcome
United States
Abstract
The HOPE study has demonstrated that ramipril is beneficial (ie, prevents cardiovascular death, myocardial infarction, and stroke) for a broad range of patients without evidence of left ventricular dysfunction or heart failure who are at high risk for cardiovascular event. In this study, we report the cost implications, in both the United States and Canada, of the use of ramipril after the HOPE study.
A third-party perspective was chosen (Medicare for the United States and Ministry of Health for Canada). We calculated the costs of the management strategies of ramipril and placebo. An annual discount rate of 3% was used over the 4.5 years of follow-up. Sensitivity analyses were performed. Costs are reported in United States dollars and in Canadian dollars, respectively. The total costs per patient (including acquisition costs of ramipril) were not different between the groups in both countries (United States, $13 520 versus $13 631; Canada, $8702 versus $8588). From the distribution of cases in the bootstrap analysis, we found that 90% of cases fall either into a cost-neutral or cost-saving situation (64% in United States and 27% in Canada) or into a cost-effectiveness situation with an incremental cost-effectiveness ratio
PubMed ID
12600907 View in PubMed
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The cost of clopidogrel use in atrial fibrillation in the ACTIVE-A trial.

https://arctichealth.org/en/permalink/ahliterature130634
Source
Can J Cardiol. 2012 Jan-Feb;28(1):95-101
Publication Type
Article
Author
Andre Lamy
Wesley Tong
Peggy Gao
Susan Chrolavicius
Amiram Gafni
Salim Yusuf
Stuart J Connolly
Author Affiliation
CADENCE Research Group, Hamilton Health Sciences, Hamilton, Ontario, Canada. lamya@mcmaster.ca
Source
Can J Cardiol. 2012 Jan-Feb;28(1):95-101
Language
English
Publication Type
Article
Keywords
Atrial Fibrillation - drug therapy - economics
Canada
Cost-Benefit Analysis
Drug Costs - statistics & numerical data
Follow-Up Studies
Health Care Costs
Humans
Platelet Aggregation Inhibitors - economics - therapeutic use
Ticlopidine - analogs & derivatives - economics - therapeutic use
Abstract
The Atrial Fibrillation Clopidogrel Trial With Irbesartan for Prevention of Vascular Events-Aspirin (ACTIVE-A) demonstrated that in patients with atrial fibrillation unsuitable for vitamin K antagonist (VKA) therapy, a combination of clopidogrel and aspirin reduced stroke risk by 28% but increased major hemorrhage risk by 57%. This analysis examined cost implications of adding clopidogrel to aspirin (C+A) for ACTIVE-A patients.
Health care use was extracted for each patient. We considered only direct costs and included only hospitalization events. We used Canadian unit costs for the health care resources consumed and Canadian list price of brand clopidogrel. Costs, in 2008 Canadian dollars, were discounted at 3% per year.
C+A reduced costs of health care use components except for the study medication. Stroke prevention resulted in important cost savings that offset the cost of clopidogrel. Total costs per patient for C+A were $14,132 (95% confidence interval [CI], $13,445-$14,842), compared with $13,756 (95% CI, $13,032-$14,544) for aspirin alone, resulting in incremental cost of $376 (95% CI, -$645 to $1397) for C+A, confirmed through bootstrap simulation. Estimates were sensitive to the price of clopidogrel, varying from cost savings to a significant increase.
C+A in patients unsuitable for VKA therapy is cost neutral (following our predefined conditions) as cost of clopidogrel is offset by prevention of costly strokes. These findings support the use of C+A in ACTIVE-A patients for whom VKA therapy is unsuitable.
PubMed ID
21983111 View in PubMed
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The cost of laparoscopic myotomy versus pneumatic dilatation for esophageal achalasia.

https://arctichealth.org/en/permalink/ahliterature163759
Source
Surg Endosc. 2007 Jul;21(7):1198-206
Publication Type
Article
Date
Jul-2007
Author
Paul J Karanicolas
Shona E Smith
Richard I Inculet
Richard A Malthaner
Richard P Reynolds
Ron Goeree
Amiram Gafni
Author Affiliation
Department of Surgery, The University of Western Ontario, London, Canada. pjkarani@uwo.ca
Source
Surg Endosc. 2007 Jul;21(7):1198-206
Date
Jul-2007
Language
English
Publication Type
Article
Keywords
Analysis of Variance
Canada
Catheterization - economics
Cost-Benefit Analysis
Esophageal Achalasia - economics - therapy
Esophagoscopy - economics
Female
Health Care Costs
Humans
Laparoscopy - economics
Male
Models, Economic
Probability
Sensitivity and specificity
Abstract
The two main treatment options for esophageal achalasia are laparoscopic distal esophageal myotomy (LM) and pneumatic dilatation (PD). Our objective was to compare the costs of these management strategies.
We constructed a decision analytic model consisting of two treatment strategies for patients diagnosed with achalasia. Probabilities of events were systematically derived from a literature review, supplemented by expert opinion when necessary. Costs were estimated from the perspective of a third-party payer and society, including both direct and indirect costs. Future costs were discounted at a rate of 5.5% over a time horizon of 5 and 10 years. Uncertainty in the probability estimates was incorporated using probabilistic sensitivity analyses. We tested uncertainty in the model by modifying key assumptions and repeating the analysis.
From the societal perspective, the expected cost per patient was $10,789 (LM) compared with $5,315 (PD) five years following diagnosis, and $11,804 (LM) compared with $7,717 (PD) after 10 years. The 95% confidence interval of the incremental cost per patient treated with LM was ($5,280, $5,668) after five years, and ($3,863, $4,311) after 10 years. The incremental cost of LM was similar from the third-party payer perspective and in the secondary model analyzed.
Initial LM is a more costly management strategy under all clinically plausible scenarios tested in this model. Further research is needed to determine patients' preferences for the two treatment modalities, and society's willingness to bear the incremental cost of LM for those who choose it.
PubMed ID
17479318 View in PubMed
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Determining optimal population rates of cardiac catheterization: a phantom alternative?

https://arctichealth.org/en/permalink/ahliterature174017
Source
CMAJ. 2005 Jul 5;173(1):49-52
Publication Type
Article
Date
Jul-5-2005
Author
Madhu K Natarajan
Amiram Gafni
Salim Yusuf
Author Affiliation
Population Health Research Institute and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont. natarajm@ccc.mcmaster.ca
Source
CMAJ. 2005 Jul 5;173(1):49-52
Date
Jul-5-2005
Language
English
Publication Type
Article
Keywords
Canada
Cardiac Catheterization - utilization
Confounding Factors (Epidemiology)
Coronary Artery Disease - therapy
Cost-Benefit Analysis
Decision Making
Health Policy
Humans
Physician's Practice Patterns - statistics & numerical data
Practice Guidelines as Topic
Risk assessment
Notes
Cites: CMAJ. 2005 Jul 5;173(1):35-915997042
Cites: BMJ. 2005 Feb 26;330(7489):44115665006
Cites: JAMA. 2000 Aug 16;284(7):835-4210938172
Cites: Am J Kidney Dis. 2001 Jan;37(1):64-7211136169
Cites: Eur Heart J. 2002 Aug;23(15):1177-8912127920
Cites: Heart. 2002 Nov;88(5):460-612381632
Cites: Heart. 2002 Dec;88(6):627-3312433896
Cites: CMAJ. 2002 Nov 26;167(11):1233-4012451076
Cites: CMAJ. 2003 Apr 1;168(7):849-5112668543
Cites: Health Policy. 2003 May;64(2):207-1912694956
Cites: Health Aff (Millwood). 2004 May-Jun;23(3):100-215160807
Cites: CMAJ. 1992 Mar 15;146(6):921-51544079
Cites: Ann Intern Med. 1997 Jan 1;126(1):13-98992918
Cites: Eur Heart J. 1998 Apr;19(4):529-309597394
Cites: Lancet. 1998 Aug 15;352(9127):507-149716054
Comment On: CMAJ. 2005 Jul 5;173(1):35-915997042
PubMed ID
15997044 View in PubMed
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Economic evaluation of the MEDENOX trial: a Canadian perspective. Medical Patients with Enoxaparin.

https://arctichealth.org/en/permalink/ahliterature189749
Source
Can Respir J. 2002 May-Jun;9(3):169-77
Publication Type
Article
Author
André Lamy
Xiaoyin Wang
Rosanne Kent
Kelly M Smith
Amiram Gafni
Author Affiliation
CADENCE Research Group and Faculty of Health Sciences, McMaster University, Hamilton, Ontario. lamyand@hhsc.ca
Source
Can Respir J. 2002 May-Jun;9(3):169-77
Language
English
Publication Type
Article
Keywords
Adult
Aged
Canada
Cost Savings
Cost-Benefit Analysis
Decision Trees
Double-Blind Method
Enoxaparin - administration & dosage - economics
Humans
Middle Aged
Placebos - administration & dosage
Venous Thrombosis - economics - prevention & control
Abstract
To perform an economic evaluation of the Prophylaxis in Medical Patients with Enoxaparin (MEDENOX) trial from a Canadian perspective.
Using a decision tree model, cost effectiveness analysis was carried out to compare the costs and consequences of thromboprophylaxis using enoxaparin 40 mg with placebo in tertiary and community settings. From a third party payer's perspective, the model calculated the expected rate of symptomatic venous thromboembolism (VTE), and the total expected cost of prophylaxis and VTE management, including inpatient and outpatient treatment, professional fees and long term therapy. Data were derived directly from the MEDENOX trial. Costs are direct medical costs in year 2000 Canadian dollars.
In a tertiary setting in which the estimated inpatient to outpatient deep vein thrombosis treatment ratio was 10%:90%, the total expected cost per patient was 64 dollars in the enoxaparin group and 62 dollars in the placebo group. The expected symptomatic VTE rates were 0.8% and 3.1% in the enoxaparin and placebo groups, respectively. The incremental cost effectiveness of enoxaparin 40 mg versus placebo was 87 dollars/VTE avoided. In a community hospital setting (with a 50%:50% inpatient to outpatient deep vein thrombosis treatment ratio), the total expected cost per patient was 68 dollars in the enoxaparin group compared with 72 dollars in the placebo group, indicating that prophylaxis with enoxaparin 40 mg was cost saving. The model was sensitive to the inpatient to outpatient ratio. However, within each setting, the results were not sensitive to changes in key variables.
For patients hospitalized for acute respiratory failure, congestive heart failure or acute infectious disease and who are at moderate risk of developing VTE, thromboprophylaxis with enoxaparin 40 mg daily is a cost effective strategy in both tertiary and community settings.
PubMed ID
12068338 View in PubMed
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Health-related quality of life and cost-effectiveness components of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial: rationale and design.

https://arctichealth.org/en/permalink/ahliterature162560
Source
Am J Cardiol. 2007 Jun 18;99(12A):90i-102i
Publication Type
Article
Date
Jun-18-2007
Author
Mark D Sullivan
Roger T Anderson
David Aron
Hal H Atkinson
Arnaud Bastien
G John Chen
Patricia Feeney
Amiram Gafni
Wenke Hwang
Lois A Katz
K M Narayan
Chuke Nwachuku
Patrick J O'Connor
Ping Zhang
Author Affiliation
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington 98195-6560, USA. sullimar@u.washington.edu
Source
Am J Cardiol. 2007 Jun 18;99(12A):90i-102i
Date
Jun-18-2007
Language
English
Publication Type
Article
Keywords
Canada
Coronary Artery Disease - blood - economics - prevention & control - psychology
Cost-Benefit Analysis
Diabetes Mellitus, Type 2
Diabetic Angiopathies - blood - economics - prevention & control - psychology
Humans
Quality of Life
Quality-Adjusted Life Years
Questionnaires
Randomized Controlled Trials as Topic
Research Design
United States
Abstract
Diabetes mellitus affects not only life expectancy but also quality of life. The Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial's health-related quality of life (HRQOL) and cost-effectiveness components will enable the assessment of the relative importance of the various outcomes from the point of view of patients, provide an understanding of the balance between the burdens and benefits of the intervention strategies, and offer valuable insights into adherence. The HRQOL measures used include the Diabetes Symptoms Distress Checklist; the 36-Item Short Form Health Survey, Version 2 (SF-36) (RAND Corporation, Santa Monica, CA); the Patient Health Questionnaire (PHQ) depression measure (Pfizer Inc, New York, NY); the World Health Organization (WHO) Diabetes Treatment Satisfaction Questionnaire (DTSQ); and the EuroQol Feeling Thermometer (EuroQol Group, Rotterdam, Netherlands). The cost-effectiveness analysis (CEA) in ACCORD will provide information about the relative economic efficiency of the different interventions being compared in the trial. Effectiveness will be measured in terms of cardiovascular event-free years gained and quality-adjusted life-years gained (using the Health Utilities Index Mark 3 [HUI-3] [Health Utilities Inc., Dundas, Ontario, Canada] to measure health-state utility). Costs will be direct medical costs assessed from the perspective of a single-payer health system collected by means of patient and clinic cost forms and hospital discharge summaries. The primary HRQOL and CEA hypotheses mirror those in the main ACCORD trial, addressing the effects of the 3 main ACCORD interventions considered separately. There are also secondary (pairwise reference case) comparisons that do not assume independence of treatment effects on HRQOL. CEA will be done on a subsample of 4,311 ACCORD participants and HRQOL on a subsample of 2,053 nested within the CEA subsample. Most assessments will occur through questionnaires at baseline and at 12, 36, and 48 months.
PubMed ID
17599429 View in PubMed
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Recreation for children on social assistance, 4-17 years old, pays for itself the same year.

https://arctichealth.org/en/permalink/ahliterature167950
Source
J Public Health (Oxf). 2006 Sep;28(3):203-8
Publication Type
Article
Date
Sep-2006
Author
Marilyn Ott
Gina Browne
Carolyn Byrne
Jacqueline Roberts
Amiram Gafni
Amanda H Bateman
Author Affiliation
School of Nursing, McMaster University, 1200 Main Street West, HSC-2J21, Hamilton, Ontario, Canada L8N 3Z5. ottm@mcmaster.ca
Source
J Public Health (Oxf). 2006 Sep;28(3):203-8
Date
Sep-2006
Language
English
Publication Type
Article
Keywords
Adolescent
Child
Child Health Services - utilization
Child, Preschool
Cost-Benefit Analysis
Follow-Up Studies
Health Expenditures - statistics & numerical data
Humans
Mental Disorders - therapy
Ontario
Parents
Public Assistance - economics
Recreation - economics
Abstract
A randomized control trial completed in the Hamilton-Wentworth and Halton regions of Ontario, Canada, was created to assess the effects and expense of age-appropriate provider-initiated and subsidized versus self-directed and self-financed methods of recreation. Upon completion, this study proved that the annual per-person expenditure for the subsidized, quality recreation paid for itself by children's lower use of healthcare and social services. The children within the subsidized recreation group had lower use of physician, physiotherapy, probation, children's aid society, social work, psychologist and services in comparison with those in the non-subsidized group. The subsidized group also proved to be beneficial for the parents as well. The use of health and social services, by the parents in the subsidized group, was also decreased in comparison with those of the self-financed group. This group also proved to have improvement of the global socioeconomic status, with a 10% greater exit from the social assistance program within 1 year.
PubMed ID
16902074 View in PubMed
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Robotic radiosurgery for the treatment of 1-3 brain metastases: a pragmatic application of cost-benefit analysis using willingness-to-pay.

https://arctichealth.org/en/permalink/ahliterature113270
Source
Technol Cancer Res Treat. 2013 Dec;12(6):517-23
Publication Type
Article
Date
Dec-2013
Author
Jeffrey Noah Greenspoon
Anthony Whitton
Timothy Whelan
Waseem Sharieff
James Wright
Jonathan Sussman
Amiram Gafni
Author Affiliation
Department of Oncology, Juravinski Cancer Centre Division of Radiation Oncology, McMaster University, Ontario, Canada. jeffrey.greenspoon@jcc.hhsc.ca.
Source
Technol Cancer Res Treat. 2013 Dec;12(6):517-23
Date
Dec-2013
Language
English
Publication Type
Article
Keywords
Brain Neoplasms - secondary - surgery
Cost-Benefit Analysis
Humans
Insurance, Health, Reimbursement
Ontario
Radiosurgery - economics
Robotics - economics
Surgery, Computer-Assisted - economics
Abstract
With the emergence of radiosurgery as a new radiotherapeutic technique, health care decision makers are required to incorporate community need, cost and patient preferences when allocating radiosurgery resources. Conventional patient utility measures would not reflect short term preferences and would therefore not inform decision makers when allocating radiosurgery treatment units. The goal of this article is to demonstrate the feasibility of cost-benefit analysis to elicit the yearly net monetary benefit of robotic radiosurgery. To calculate the yearly incremental cost of robotic radiosurgery as compared to fixed gantry radiosurgery we used direct local cost data. We assumed a standard 10 year replacement and 5% amortization rate. Decision boards summarizing the clinical scenario of brain metastases and the difference between robotic and fixed gantry radiosurgery in terms of immobilization, comfort and treatment time were then presented to a sample of 18 participants. Participants who preferred robotic radiosurgery were randomly assigned to either a low ($1) or high ($5) starting point taxation based willingness-to-pay algorithm. The yearly incremental cost of providing robotic radiosurgery was $99,177 CAD. The mean community yearly willingness-to-pay for robotic radiosurgery was $2,300,000 CAD, p = 0.03. The calculated yearly net societal benefit for robotic radiosurgery was $2,200,823 CAD. Among participants who preferred robotic radiosurgery there was no evidence of starting point bias, p = 0.8. We have shown through this pilot study that it is feasible to perform cost-benefit analysis to evaluate new technologies in Radiation Oncology. Cost-benefit analysis offers an analytic method to evaluate local preferences and provide accountability when allocating limited healthcare resources.
PubMed ID
23745785 View in PubMed
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14 records – page 1 of 2.