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An incremental economic evaluation of targeted and universal influenza vaccination in pregnant women.

https://arctichealth.org/en/permalink/ahliterature128873
Source
Can J Public Health. 2011 Nov-Dec;102(6):445-50
Publication Type
Article
Author
Chris Skedgel
Joanne M Langley
Noni E MacDonald
Jeff Scott
Shelly McNeil
Author Affiliation
Canadian Center for Vaccinology, IWK Health Centre, Capital District Health Authority and Dalhousie University, Halifax, NS. chris.skedgel@cdha.nshealth.ca
Source
Can J Public Health. 2011 Nov-Dec;102(6):445-50
Language
English
Publication Type
Article
Keywords
Comorbidity
Cost-Benefit Analysis
Female
Humans
Influenza Vaccines - administration & dosage - economics
Influenza, Human - economics - immunology - prevention & control
Models, Economic
Nova Scotia
Pregnancy
Pregnancy Complications, Infectious - economics - immunology - prevention & control
Pregnant Women
Quality-Adjusted Life Years
Abstract
Pregnancy is associated with increased influenza hospitalizations and physician visits (events) in healthy women and those with co-morbidities. Annual influenza immunization is recommended for all pregnant women. Although vaccination is expected to reduce influenza-related events, the economic implications are unclear. We developed an economic model to estimate the cost-effectiveness (CE) of different vaccination strategies in Nova Scotia.
A decision tree characterized the one-year costs and consequences of targeted (pregnant women with co-morbidities only) and universal (all pregnant women) vaccination strategies relative to a no-vaccination strategy. Baseline event probabilities, vaccine effectiveness, costs and quality-of-life weights were derived from individual-level Nova Scotia administrative databases, health system sources and published reports. Sensitivity analyses tested the impact of varying key parameters, including vaccine effectiveness and mode of delivery.
Targeted vaccination was cost-saving relative to no vaccination when delivered by public health clinics (PHC) or routine family practitioner (FP) visit. Cost per quality-adjusted life year gained by universal vaccination relative to targeted strategy was
PubMed ID
22164556 View in PubMed
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[A study of IVF treatment: misleading polemics on cost effectiveness]

https://arctichealth.org/en/permalink/ahliterature64943
Source
Lakartidningen. 1992 Jul 22;89(30-31):2496
Publication Type
Article
Date
Jul-22-1992
Author
B. Jönsson
B. Brorsson
P. Carlsson
G. Karlsson
Source
Lakartidningen. 1992 Jul 22;89(30-31):2496
Date
Jul-22-1992
Language
Swedish
Publication Type
Article
Keywords
Cost-Benefit Analysis
Female
Fertilization in Vitro
Humans
Pregnancy
Sweden
PubMed ID
1507973 View in PubMed
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[Cesarean section--a woman's choice or physician's responsibility?]

https://arctichealth.org/en/permalink/ahliterature64019
Source
Lakartidningen. 1999 Oct 20;96(42):4549-50, 4553
Publication Type
Article
Date
Oct-20-1999
Author
E L Ryding
Author Affiliation
Kvinnokliniken, Nordvästra Skåne.
Source
Lakartidningen. 1999 Oct 20;96(42):4549-50, 4553
Date
Oct-20-1999
Language
Swedish
Publication Type
Article
Keywords
Cesarean Section - economics - statistics & numerical data
Cost-Benefit Analysis
Decision Making
Ethics, Medical
Fear
Female
Humans
Labor, Obstetric - psychology
Patient Advocacy
Physician's Role
Pregnancy
Sweden
PubMed ID
10575862 View in PubMed
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Chlamydia sequelae cost estimates used in current economic evaluations: does one-size-fit-all?

https://arctichealth.org/en/permalink/ahliterature283048
Source
Sex Transm Infect. 2017 Feb;93(1):18-24
Publication Type
Article
Date
Feb-2017
Author
Koh Jun Ong
Kate Soldan
Mark Jit
J Kevin Dunbar
Sarah C Woodhall
Source
Sex Transm Infect. 2017 Feb;93(1):18-24
Date
Feb-2017
Language
English
Publication Type
Article
Keywords
Australia
Canada
Chlamydia Infections - complications - economics - therapy
Cost-Benefit Analysis
Costs and Cost Analysis
Denmark
Epididymitis - economics - etiology
Female
Humans
Infertility, Female - economics - etiology
Ireland
Male
Mass Screening - economics
Netherlands
Pelvic Inflammatory Disease - economics - etiology
Pregnancy
Pregnancy, Ectopic - economics - etiology
Sweden
United Kingdom
Abstract
Current evidence suggests that chlamydia screening programmes can be cost-effective, conditional on assumptions within mathematical models. We explored differences in cost estimates used in published economic evaluations of chlamydia screening from seven countries (four papers each from UK and the Netherlands, two each from Sweden and Australia, and one each from Ireland, Canada and Denmark).
From these studies, we extracted management cost estimates for seven major chlamydia sequelae. In order to compare the influence of different sequelae considered in each paper and their corresponding management costs on the total cost per case of untreated chlamydia, we applied reported unit sequelae management costs considered in each paper to a set of untreated infection to sequela progression probabilities. All costs were adjusted to 2013/2014 Great British Pound (GBP) values.
Sequelae management costs ranged from £171 to £3635 (pelvic inflammatory disease); £953 to £3615 (ectopic pregnancy); £546 to £6752 (tubal factor infertility); £159 to £3341 (chronic pelvic pain); £22 to £1008 (epididymitis); £11 to £1459 (neonatal conjunctivitis) and £433 to £3992 (neonatal pneumonia). Total cost of sequelae per case of untreated chlamydia ranged from £37 to £412.
There was substantial variation in cost per case of chlamydia sequelae used in published chlamydia screening economic evaluations, which likely arose from different assumptions about disease management pathways and the country perspectives taken. In light of this, when interpreting these studies, the reader should be satisfied that the cost estimates used sufficiently reflect the perspective taken and current disease management for their respective context.
PubMed ID
27288417 View in PubMed
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[Chlamydia trachomatis in pregnant women in the county of Vestsjaelland. Prevalence, prevention of perinatal transmission and cost-effectiveness of screening]

https://arctichealth.org/en/permalink/ahliterature34913
Source
Ugeskr Laeger. 1996 Feb 5;158(6):756-8
Publication Type
Article
Date
Feb-5-1996
Author
M. Ottesen
I. Sahl
M M Herbstman
H M Friis
T. Philipsen
Author Affiliation
Gynaekologisk-obstetrisk afdeling, Centralsygehuset i Holbaek.
Source
Ugeskr Laeger. 1996 Feb 5;158(6):756-8
Date
Feb-5-1996
Language
Danish
Publication Type
Article
Keywords
Adult
Chlamydia Infections - epidemiology - prevention & control - transmission
Chlamydia trachomatis - isolation & purification
Conjunctivitis, Inclusion - prevention & control - transmission
Cost-Benefit Analysis
Denmark - epidemiology
English Abstract
Female
Humans
Infant, Newborn
Mass Screening - economics
Pregnancy
Prevalence
Research Support, Non-U.S. Gov't
Abstract
The prevalence of genital Chlamydia trachomatis (CT) in pregnant women and the perinatal transmission after treatment was investigated. An analysis of the cost-effectiveness of introducing a screening program among women at risk of having CT was made. Out of 339 pregnant women 2.9% had cervical CT. CT-positive women were treated with erythromycin. CT-positive women were significantly younger than CT-negative women and the odds ratio (OR) of having CT if nulliparous was 3.35. The CT-prevalence was 6.6% among women younger than 25 years and 1.6% among women 25 years or older (p = 0.0163). OR of having CT if younger than 25 years was 4.3. The young women were significantly younger at sexual début. None of the children of women treated for CT during pregnancy developed neonatal CT-conjunctivitis. The screening of women younger than 25 years was considered to be cost-effective. It is concluded that women younger than 25 years are at risk of having CT. Treatment of CT-positive women with erythromycin during pregnancy seems to be effective in eradicating this microorganism and thus preventing perinatal transmission and neonatal CT-conjunctivitis. It therefore seems rational to screen all pregnant women under the age of 25 years for cervical CT, especially in high risk areas.
PubMed ID
8638313 View in PubMed
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[Clinical aspects of prenatal prevention of rhesus incompatibility]

https://arctichealth.org/en/permalink/ahliterature59685
Source
Beitr Infusionsther. 1992;30:425-30
Publication Type
Article
Date
1992
Author
D H Maas
Author Affiliation
Gynäkologisch-geburtshilfliche Abteilung des Kreiskrankenhauses Schwäbisch Gmünd, Mutlangen, BRD.
Source
Beitr Infusionsther. 1992;30:425-30
Date
1992
Language
German
Publication Type
Article
Keywords
Antibodies, Anti-Idiotypic - administration & dosage
Cost-Benefit Analysis
English Abstract
Erythroblastosis, Fetal - blood - economics - prevention & control
Female
Gestational Age
Humans
Immunoglobulin D - immunology
Infant, Newborn
Pregnancy
Prenatal Care - economics
Rh Isoimmunization - blood - economics - prevention & control
Rh-Hr Blood-Group System - blood
Abstract
The postnatal treatment with anti-D immunoglobulin to prevent rhesus sensitization is successful in about 90% of all rhesus-negative mothers at risk. Failures derive mostly from large fetomaternal hemorrhages during the last months of pregnancy. Studies from Canada, Great Britain and Sweden have shown that the injection of an additional dosage of anti-D during the 28th to 34th week of pregnancy results in a further 90% reduction of the failure rate. Although there is only a limited number of cases of hemolytic diseases in the newborn, the cost-effect ratio of this prophylactic treatment calculated for the Federal Republic of Germany shows not only a medical but also an economic benefit.
PubMed ID
1284752 View in PubMed
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Combined care nursing caters to parents' needs.

https://arctichealth.org/en/permalink/ahliterature237228
Source
Dimens Health Serv. 1986 Apr;63(3):17-8
Publication Type
Article
Date
Apr-1986

Comparison of different strategies in prenatal screening for Down's syndrome: cost effectiveness analysis of computer simulation.

https://arctichealth.org/en/permalink/ahliterature152635
Source
BMJ. 2009;338:b138
Publication Type
Article
Date
2009
Author
Jean Gekas
Geneviève Gagné
Emmanuel Bujold
Daniel Douillard
Jean-Claude Forest
Daniel Reinharz
François Rousseau
Author Affiliation
Centre de recherche du CHUQ, Service de Génétique Médicale, Unité de Diagnostic Prénatal, Faculté de Médecine, Université Laval, Québec city, Québec, Canada. jean.gekas@mail.chuq.qc.ca
Source
BMJ. 2009;338:b138
Date
2009
Language
English
Publication Type
Article
Keywords
Abortion, Induced - utilization
Adult
Age Distribution
Computer simulation
Cost-Benefit Analysis
Decision Support Techniques
Down Syndrome - diagnosis - economics
Female
Health Services Misuse - economics - statistics & numerical data
Humans
Maternal Age
Middle Aged
Pregnancy
Pregnancy outcome
Pregnancy Trimester, First
Pregnancy Trimester, Second
Prenatal Diagnosis - economics - methods
Quebec
Statistics as Topic
Young Adult
Abstract
To assess and compare the cost effectiveness of three different strategies for prenatal screening for Down's syndrome (integrated test, sequential screening, and contingent screenings) and to determine the most useful cut-off values for risk.
Computer simulations to study integrated, sequential, and contingent screening strategies with various cut-offs leading to 19 potential screening algorithms.
The computer simulation was populated with data from the Serum Urine and Ultrasound Screening Study (SURUSS), real unit costs for healthcare interventions, and a population of 110 948 pregnancies from the province of Québec for the year 2001.
Cost effectiveness ratios, incremental cost effectiveness ratios, and screening options' outcomes.
The contingent screening strategy dominated all other screening options: it had the best cost effectiveness ratio ($C26,833 per case of Down's syndrome) with fewer procedure related euploid miscarriages and unnecessary terminations (respectively, 6 and 16 per 100,000 pregnancies). It also outperformed serum screening at the second trimester. In terms of the incremental cost effectiveness ratio, contingent screening was still dominant: compared with screening based on maternal age alone, the savings were $C30,963 per additional birth with Down's syndrome averted. Contingent screening was the only screening strategy that offered early reassurance to the majority of women (77.81%) in first trimester and minimised costs by limiting retesting during the second trimester (21.05%). For the contingent and sequential screening strategies, the choice of cut-off value for risk in the first trimester test significantly affected the cost effectiveness ratios (respectively, from $C26,833 to $C37,260 and from $C35,215 to $C45,314 per case of Down's syndrome), the number of procedure related euploid miscarriages (from 6 to 46 and from 6 to 45 per 100,000 pregnancies), and the number of unnecessary terminations (from 16 to 26 and from 16 to 25 per 100,000 pregnancies).
Contingent screening, with a first trimester cut-off value for high risk of 1 in 9, is the preferred option for prenatal screening of women for pregnancies affected by Down's syndrome.
Notes
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Comment In: BMJ. 2009;338:b14019218324
PubMed ID
19218323 View in PubMed
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[Cost benefit analysis and ethics of prenatal diagnosis]

https://arctichealth.org/en/permalink/ahliterature65278
Source
Ugeskr Laeger. 1989 Oct 30;151(44):2868-71
Publication Type
Article
Date
Oct-30-1989
Author
M A Mooney
S. Nørby
Source
Ugeskr Laeger. 1989 Oct 30;151(44):2868-71
Date
Oct-30-1989
Language
Danish
Publication Type
Article
Keywords
Cost-Benefit Analysis
DNA - analysis
Denmark
English Abstract
Ethics, Medical
Female
Humans
Pregnancy
Prenatal Diagnosis - economics
Research Support, Non-U.S. Gov't
Abstract
Cost-benefit analysis is a necessary part of the decision-making process concerning the introduction of DNA-analysis in antenatal diagnosis (and diagnosis of carrier status) of hereditary diseases. The problems involved which are of increasing significance given the rapid development in mapping of the human genome, are reviewed on the basis of the autosomal dominant polycystic kidney disease. Many problems exist, particularly of an ethical nature, when attempts are made to employ cost-benefit analysis in this field. This article describes some of these and suggests some solutions. The discussion is concentrated on the need to decide what should be done as regards the genetic diagnosis, why this should be done and how decisions should be made to do so. These questions are too important to be decided by only the medical profession. Many others, not only in the health sector, are involved both economically and ethically. The numerous new methods of analysis make it necessary to decide who is to assess the costs and benefits when the Danish health service allocares resources to this and to many other fields.
PubMed ID
2511655 View in PubMed
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Cost-benefit analysis of a prenatal preventive programme against congenital syphilis.

https://arctichealth.org/en/permalink/ahliterature245817
Source
NIPH Ann. 1980 May;3(1):57-66
Publication Type
Article
Date
May-1980
Author
B. Stray-Pedersen
Source
NIPH Ann. 1980 May;3(1):57-66
Date
May-1980
Language
English
Publication Type
Article
Keywords
Cost-Benefit Analysis
Female
Humans
Infant, Newborn
Maternal-Fetal Exchange
Norway
Pregnancy
Preventive Health Services - economics
Syphilis Serodiagnosis - economics
Syphilis, Congenital - economics - prevention & control
Abstract
Serologic screening of pregnant women to prevent congenital syphilis has been obligatory in Norway since 1948. Today the incidence of unrecognized, untreated maternal syphilis is approximately 0.2 per 1000 pregnancies. A cost-benefit model is applied to the current prenatal screening programme in Norway. Although may of the benefit parameters are given only an approximate value, or are not valued at all, it was found that the benefit-cost ratio was nearly 2 (1.9), indicating that the economic benefits or savings to the society represent twice the cost of the preventive programme.
PubMed ID
6779243 View in PubMed
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95 records – page 1 of 10.