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Avoidable cost of alcohol abuse in Canada.

https://arctichealth.org/en/permalink/ahliterature138671
Source
Eur Addict Res. 2011;17(2):72-9
Publication Type
Article
Date
2011
Author
Jürgen Rehm
Jayadeep Patra
William H Gnam
Anna Sarnocinska-Hart
Svetlana Popova
Author Affiliation
Centre for Addiction and Mental Health, CAMH, Toronto, Ont., Canada.
Source
Eur Addict Res. 2011;17(2):72-9
Date
2011
Language
English
Publication Type
Article
Keywords
Alcohol Drinking - economics - prevention & control
Alcoholism - economics - mortality
Canada
Cost-Benefit Analysis - methods - statistics & numerical data
Health Care Costs - statistics & numerical data
Health Policy - economics
Humans
Models, Economic
Abstract
To estimate avoidable burden and avoidable costs of alcohol abuse in Canada for the year 2002.
A policy effectiveness approach was used. The impact of six effective and cost-effective alcohol policy interventions aimed to reduce alcohol consumption was modeled. In addition, the effect of privatized alcohol sales that would increase alcohol consumption and alcohol-attributable costs was also modeled. The effects of these interventions were compared with the baseline (aggregate) costs obtained from the second Canadian Study of Social Costs Attributable to Substance Abuse.
It was estimated that by implementing six cost-effective policies from about 900 million to two billion Canadian dollars per year could be saved in Canada. The greatest savings due to the implementation of these interventions would be achieved in the lowering of productivity losses, followed by health care, and criminality. Substantial increases in burden and cost would occur if Canadian provinces were to privatize alcohol sales.
The implementation of proven effective population-based interventions would reduce alcohol-attributable burden and its costs in Canada to a considerable degree.
PubMed ID
21150206 View in PubMed
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Cost-effectiveness analysis of hypertension treatment--a review of methodological issues.

https://arctichealth.org/en/permalink/ahliterature225889
Source
Health Policy. 1991 Sep;19(1):55-77
Publication Type
Article
Date
Sep-1991
Author
M. Johannesson
B. Jönsson
Author Affiliation
Department of Health and Society, Linköping University, Sweden.
Source
Health Policy. 1991 Sep;19(1):55-77
Date
Sep-1991
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antihypertensive Agents - economics
Cost-Benefit Analysis - methods - statistics & numerical data
Female
Humans
Hypertension - drug therapy - economics - epidemiology
Male
Middle Aged
Models, Theoretical
Quality of Life
Sweden - epidemiology
Treatment Outcome
Value of Life
Abstract
There is a lack of methodological conformity in cost-effectiveness analyses of hypertension treatment. They differ with respect to assumptions about the effectiveness of treatment, the outcome measure chosen, the cost-concept, the discounting of effects and the duration of therapy. The aim of this paper is to review these issues and estimate the importance of different assumptions for the cost per life-year gained. To analyse these assumptions a computer simulation model was constructed based on the Framingham logistic risk equations and Swedish cost data. It is shown that the cost per life-year gained is highly sensitive towards many of these assumptions. It is also shown that the average cost-effectiveness ratios calculated in previous studies and the relevant marginal cost-effectiveness ratios can differ by several hundred per cent. The results of cost-effectiveness analyses in the hypertension field have to be interpreted with caution. Due to the lack of standardized methodology, the comparability between studies is limited. There is also a need to complement cost-effectiveness analysis in this area with other approaches, for example based on WTP.
PubMed ID
10117392 View in PubMed
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Cost effectiveness of high-dose intravenous esomeprazole for peptic ulcer bleeding.

https://arctichealth.org/en/permalink/ahliterature145444
Source
Pharmacoeconomics. 2010;28(3):217-30
Publication Type
Article
Date
2010
Author
Alan N Barkun
Viviane Adam
Joseph J Y Sung
Ernst J Kuipers
Joachim Mössner
Dennis Jensen
Robert Stuart
James Y Lau
Emma Nauclér
Jan Kilhamn
Helena Granstedt
Bengt Liljas
Tore Lind
Author Affiliation
Division of Gastroenterology, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada. alan.barkun@muhc.mcgill.ca
Source
Pharmacoeconomics. 2010;28(3):217-30
Date
2010
Language
English
Publication Type
Article
Keywords
Administration, Oral
Anti-Ulcer Agents - administration & dosage - economics
Combined Modality Therapy - economics
Cost-Benefit Analysis - methods - statistics & numerical data
Decision Support Techniques
Esomeprazole - administration & dosage - economics
Health Care Costs - statistics & numerical data
Hemostasis, Endoscopic - economics
Humans
Infusions, Intravenous
Models, Economic
Peptic Ulcer Hemorrhage - drug therapy - economics - prevention & control - therapy
Randomized Controlled Trials as Topic
Spain
Sweden
Treatment Outcome
United States
Abstract
Peptic ulcer bleeding (PUB) is a serious and sometimes fatal condition. The outcome of PUB strongly depends on the risk of rebleeding. A recent multinational placebo-controlled clinical trial (ClinicalTrials.gov identifier: NCT00251979) showed that high-dose intravenous (IV) esomeprazole, when administered after successful endoscopic haemostasis in patients with PUB, is effective in preventing rebleeding. From a policy perspective it is important to assess the cost efficacy of this benefit so as to enable clinicians and payers to make an informed decision regarding the management of PUB. Using a decision-tree model, we compared the cost efficacy of high-dose IV esomeprazole versus an approach of no-IV proton pump inhibitor for prevention of rebleeding in patients with PUB. The model adopted a 30-day time horizon and the perspective of third-party payers in the USA and Europe. The main efficacy variable was the number of averted rebleedings. Healthcare resource utilization costs (physician fees, hospitalizations, surgeries, pharmacotherapies) relevant for the management of PUB were also determined. Data for unit costs (prices) were primarily taken from official governmental sources, and data for other model assumptions were retrieved from the original clinical trial and the literature. After successful endoscopic haemostasis, patients received either high-dose IV esomeprazole (80 mg infusion over 30 min, then 8 mg/hour for 71.5 hours) or no-IV esomeprazole treatment, with both groups receiving oral esomeprazole 40 mg once daily from days 4 to 30. Rebleed rates at 30 days were 7.7% and 13.6%, respectively, for the high-dose IV esomeprazole and no-IV esomeprazole treatment groups (equating to a number needed to treat of 17 in order to prevent one additional patient from rebleeding). In the US setting, the average cost per patient for the high-dose IV esomeprazole strategy was $US14 290 compared with $US14 239 for the no-IV esomeprazole strategy (year 2007 values). For the European setting, Sweden and Spain were used as examples. In the Swedish setting the corresponding respective figures were Swedish kronor (SEK)67 862 ($US9220 at average 2006 interbank exchange rates) and SEK67 807 ($US9212) [year 2006 values]. Incremental cost-effectiveness ratios were $US866 and SEK938 ($US127), respectively, per averted rebleed when using IV esomeprazole. For the Spanish setting, the high-dose IV esomeprazole strategy was dominant (more effective and less costly than the no-IV esomeprazole strategy) [year 2008 values]. All results appeared robust to univariate/threshold sensitivity analysis, with high-dose IV esomeprazole becoming dominant with small variations in assumptions in the US and Swedish settings, while remaining a dominant approach in the Spanish scenario across a broad range of values. Sensitivity variables with prespecified ranges included lengths of stay and per diem assumptions, rebleeding rates and, in some cases, professional fees. In patients with PUB, high-dose IV esomeprazole after successful endoscopic haemostasis appears to improve outcomes at a modest increase in costs relative to a no-IV esomeprazole strategy from the US and Swedish third-party payer perspective. Whereas, in the Spanish setting, the high-dose IV esomeprazole strategy appeared dominant, being more effective and less costly.
Notes
Comment In: Expert Rev Pharmacoecon Outcomes Res. 2010 Aug;10(4):371-420715913
PubMed ID
20151726 View in PubMed
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A Danish cost-effectiveness model of escitalopram in comparison with citalopram and venlafaxine as first-line treatments for major depressive disorder in primary care.

https://arctichealth.org/en/permalink/ahliterature77951
Source
Nord J Psychiatry. 2007;61(2):100-8
Publication Type
Article
Date
2007
Author
Sørensen Jan
Stage Kurt B
Damsbo Niels
Le Lay Agathe
Hemels Michiel E
Author Affiliation
CAST - Centre for Applied Health Services Research and Technology Assessment, University of Southern Denmark. J. B. Winsløws Vej 9B, Odense C, DK-5000, Denmark. jas@cast.sdu.dk
Source
Nord J Psychiatry. 2007;61(2):100-8
Date
2007
Language
English
Publication Type
Article
Keywords
Antidepressive Agents, Second-Generation - economics - therapeutic use
Citalopram - economics - therapeutic use
Cost-Benefit Analysis - methods - statistics & numerical data
Cyclohexanols - economics - therapeutic use
Decision Support Techniques
Denmark
Depressive Disorder, Major - drug therapy - economics
Drug Costs - statistics & numerical data
Humans
Models, Economic
Physician's Practice Patterns - statistics & numerical data
Primary Health Care - economics - methods
Remission Induction - methods
Abstract
The objective of this study was to model the cost-effectiveness of escitalopram in comparison with generic citalopram and venlafaxine in primary care treatment of major depressive disorder (baseline scores 22-40 on the Montgomery-Asberg Depression Rating Scale, MADRS) in Denmark. A three-path decision analytic model with a 6-month horizon was used. All patients started at the primary care path and were referred to outpatient or inpatient secondary care in the case of insufficient response to treatment. Model inputs included drug-specific probabilities derived from systematic literature review, ad-hoc survey and expert opinion. Main outcome measures were remission defined as MADRS
PubMed ID
17454724 View in PubMed
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Economic evaluation of lipid lowering--a feasibility test of the contingent valuation approach.

https://arctichealth.org/en/permalink/ahliterature225219
Source
Health Policy. 1992;20(3):309-20
Publication Type
Article
Date
1992
Author
M. Johannesson
Author Affiliation
Stockholm School of Economics, Sweden.
Source
Health Policy. 1992;20(3):309-20
Date
1992
Language
English
Publication Type
Article
Keywords
Attitude to Health
Cost-Benefit Analysis - methods - statistics & numerical data
Feasibility Studies
Health Services Research - methods
Humans
Hypercholesterolemia - economics - prevention & control - psychology
Lipids
Pilot Projects
Questionnaires
Social Values
Sweden
Value of Life
Abstract
A large number of cost-effectiveness analyses of treatment of high cholesterol levels have been published the last few years. Due to the inherent problems of cost-effectiveness analysis of prevention and the specific problems in the case of lipid lowering, it is important to test alternative approaches. This study reports the results of a pilot study of three benefit measures based on individual preferences. Willingness to pay (WTP), willingness to give up leisure time (WTGT) and maximum acceptable risk (MAR) for lowering cholesterol levels to normal were investigated among persons with hypercholesterolaemia in a postal survey. The respondents were on average prepared to pay about SEK 450 per month, to give up about 7 hours of leisure time per week or to take an immediate mortality risk of about 1.4% to get normal lipid levels. The WTP and WTGT questions seemed to be about equally acceptable, whereas the MAR question performed less well with respect to acceptability. It is concluded that especially WTP deserves further attention, due to its inherent advantages, since it performed at least as well as the other measures.
PubMed ID
10118015 View in PubMed
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Economic evaluation of osteoporosis prevention.

https://arctichealth.org/en/permalink/ahliterature73366
Source
Health Policy. 1993 May;24(2):103-24
Publication Type
Article
Date
May-1993
Author
M. Johannesson
B. Jönsson
Author Affiliation
Centre for Health Economics, Stockholm School of Economics, Sweden.
Source
Health Policy. 1993 May;24(2):103-24
Date
May-1993
Language
English
Publication Type
Article
Keywords
Aged
Cost-Benefit Analysis - methods - statistics & numerical data
Data Collection
Evaluation Studies
Female
Health Care Costs - statistics & numerical data
Health Services Research
Humans
Middle Aged
Models, Econometric
Osteoporosis, Postmenopausal - economics - prevention & control
Preventive Health Services - economics - statistics & numerical data
Quality of Life
Sweden
Value of Life
Abstract
In this paper economic evaluation of osteoporosis prevention is discussed. So far economic evaluation in this area has been limited to cost-effectiveness analysis. Four cost-effectiveness analyses of osteoporosis prevention are reviewed. It is noted that the major problem with these studies is the lack of reliable and valid data to base the cost-effectiveness analyses on, which precludes clear-cut conclusions about the cost-effectiveness of osteoporosis prevention. The studies, however, form a basis for future cost-effectiveness analyses in this field and as new data become available it should be possible to improve the accuracy and precision of the analyses. Due to the methodological problems of cost-effectiveness analysis and the decision-maker approach to economic evaluation, it is also argued that the contingent valuation (CV) method of measuring willingness to pay should be tested in this area. The CV method can be used both to value an actual treatment and the outcome of that treatment and the resulting amount can be compared with the costs (including the costs of externalities) to carry out cost-benefit analysis. It is concluded that a lot of work remains to be done in this area before economic evaluations can give a real contribution to policy, but such work may well be worthwhile due to the importance of this public health problem.
PubMed ID
10126753 View in PubMed
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Health research: measuring the social, health and economic benefits.

https://arctichealth.org/en/permalink/ahliterature153005
Source
CMAJ. 2009 Mar 3;180(5):528-34
Publication Type
Article
Date
Mar-3-2009
Author
Cyril Frank
Edward Nason
Author Affiliation
Department of Surgery, University of Calgary, Calgary, Alberta.
Source
CMAJ. 2009 Mar 3;180(5):528-34
Date
Mar-3-2009
Language
English
Publication Type
Article
Keywords
Benchmarking
Biomedical Research - economics
Canada
Cost-Benefit Analysis - methods - statistics & numerical data
Decision Support Techniques
Health Services Research - economics
Humans
Models, Econometric
Program Evaluation
Notes
Cites: Med J Aust. 2002 Oct 7;177(7):368-7112358580
Cites: Health Policy. 2003 Feb;63(2):133-912543526
Cites: J Health Serv Res Policy. 2003 Jul;8(3):165-7012869343
Cites: J Health Serv Res Policy. 1996 Jan;1(1):35-4310180843
Cites: Int J Technol Assess Health Care. 2008 Summer;24(3):259-6918601793
Cites: Bull World Health Organ. 2004 Oct;82(10):733-915643793
Cites: Rheumatology (Oxford). 2005 Sep;44(9):1145-5616049052
Cites: CMAJ. 2008 Apr 8;178(8):1029-3118390948
Cites: J R Soc Med. 1998;91 Suppl 35:2-69797742
PubMed ID
19164482 View in PubMed
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Potential cost-effectiveness of a preventive hepatitis C vaccine in high risk and average risk populations in Canada.

https://arctichealth.org/en/permalink/ahliterature176296
Source
Vaccine. 2005 Feb 18;23(13):1549-58
Publication Type
Article
Date
Feb-18-2005
Author
Murray D Krahn
Ava John-Baptiste
Qilong Yi
Andrea Doria
Robert S Remis
Paul Ritvo
Samuel Friedman
Author Affiliation
Department of Medicine, University Health Network, Department of Health Policy, Management and Evaluation, University of Toronto, 200 Elizabeth Street, Toronto, Ontario, Canada M5G 1C4. murray.krahn@uhn.on.ca
Source
Vaccine. 2005 Feb 18;23(13):1549-58
Date
Feb-18-2005
Language
English
Publication Type
Article
Keywords
Canada - epidemiology
Child
Cost-Benefit Analysis - methods - statistics & numerical data
Hepatitis C - economics - epidemiology - prevention & control
Humans
Markov Chains
Monte Carlo Method
Risk factors
Substance Abuse, Intravenous - economics - epidemiology - therapy
Viral Hepatitis Vaccines - economics - therapeutic use
Abstract
Hepatitis C virus (HCV) vaccine development remains at an early stage. We explored the economic and health consequences of potential HCV vaccines by comparing universal vaccination with a hepatitis C vaccine to no vaccination in two groups: (1) injecting drug users (IDU); (2) all 12 year olds, using a Markov cohort simulation. Among IDUs, vaccination would avert 248 cases of HCV infection and 89 HCV-related deaths per 1000 individuals, and reduce costs. In average risk cohorts, vaccination did not reduce costs but was reasonably cost effective. These results provide encouragement to vaccine developers that a vaccine that is moderately effective and reasonably priced should not face economic barriers to implementation and will be attractive to third party payers.
PubMed ID
15694507 View in PubMed
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Regression methods for covariate adjustment and subgroup analysis for non-censored cost-effectiveness data.

https://arctichealth.org/en/permalink/ahliterature180241
Source
Health Econ. 2004 May;13(5):461-75
Publication Type
Article
Date
May-2004
Author
Andrew R Willan
Andrew H Briggs
Jeffrey S Hoch
Author Affiliation
Program in Population Health Sciences, Hospital for Sick Children, and Department of Public Health Services, University of Toronto, ON, Canada. willana@mcmaster.ca
Source
Health Econ. 2004 May;13(5):461-75
Date
May-2004
Language
English
Publication Type
Article
Keywords
Adult
Canada
Cost-Benefit Analysis - methods - statistics & numerical data
Humans
Middle Aged
Models, Statistical
Randomized Controlled Trials as Topic - economics - standards - statistics & numerical data
Regression Analysis
Abstract
The current interest in undertaking cost-effectiveness analyses alongside clinical trials has lead to the increasing availability of patient-level data on both the costs and effectiveness of intervention. In a recent paper, we show how cost-effectiveness analysis can be undertaken in a regression framework. In the current paper we develop a direct regression approach to cost-effectiveness analysis by proposing the use of a system of seemingly unrelated regression equations to provide a more general method for prognostic factor adjustment with emphasis on sub-group analysis. This more general method can be used in either an incremental cost-effectiveness or an incremental net-benefit approach, and does not require that the set of independent variables for costs and effectiveness be the same. Furthermore, the method can exhibit efficiency gains over unrelated ordinary least squares regression.
PubMed ID
15127426 View in PubMed
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Results of a model analysis to estimate cost utility and value of information for intravenous immunoglobulin in Canadian adults with chronic immune thrombocytopenic purpura.

https://arctichealth.org/en/permalink/ahliterature150198
Source
Clin Ther. 2009 May;31(5):1082-91; discussion 1066-8
Publication Type
Article
Date
May-2009
Author
Feng Xie
Gord Blackhouse
Nazila Assasi
Kaitryn Campbell
Mitchell Levin
Jim Bowen
Jean-Eric Tarride
David Pi
Ron Goeree
Author Affiliation
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. fengxie@mcmaster.ca
Source
Clin Ther. 2009 May;31(5):1082-91; discussion 1066-8
Date
May-2009
Language
English
Publication Type
Article
Keywords
Administration, Oral
Adult
Aged
Anti-Inflammatory Agents - administration & dosage - economics - therapeutic use
Canada
Chronic Disease
Cost-Benefit Analysis - methods - statistics & numerical data
Decision Support Techniques
Humans
Immunoglobulins, Intravenous - administration & dosage - economics - therapeutic use
Middle Aged
Models, Economic
Prednisone - administration & dosage - economics - therapeutic use
Purpura, Thrombocytopenic - drug therapy - economics
Quality-Adjusted Life Years
Sensitivity and specificity
Treatment Outcome
Abstract
The aim of this work was to estimate the cost-effectiveness of intravenous immunoglobulin (IVIg) compared with oral prednisone as a treatment for Canadian adults with persistent chronic immune thrombocytopenic purpura (ITP).
The lifetime costs and effectiveness of IVIg and prednisone were estimated from the perspective of a publicly funded health care system in Canada, using a Markov model that was developed based on a systematic clinical and economic review and recommendations of clinical experts in Canada. Transition probabilities (ie, point estimates and 95% CIs) were estimated from the studies identified in a systematic literature review using a random-effect meta-analysis; point estimates were weighted-mean values from the meta-analysis. No published studies directly estimate the utility weight for patients with relapsed or refractory ITP; therefore, a value of 0.76 was used, based on the mean of the utilities for thrombocytopenia without major bleeding or hemorrhagic stroke. Costs and incremental cost-effectiveness ratios were reported as year-2007 Can $.
The incremental costs and quality-adjusted life-years (QALYs) of IVIg versus prednisone were Can $8080 and 0.0071, respectively, resulting in an incremental cost-effectiveness ratio of Can $1.13 million/ QALY in the base-case analysis. The probability of IVIg being cost-effective was 0 if the maximum willingness-to-pay (WTP) value for an additional QALY was below Can $40,000. The probability that IVIg would be cost-effective was only 20%, even if the WTP increased to Can $100,000. The expected value of perfect information (EVPI) and expected value of partial perfect information (EVPPI) were 0 if the WTP was less than Can $30,000. If WTP increased to Can $100,000, the EVPI was Can $1700, and the EVPPI was Can $1010 for utility weights of relapse/refractory states, Can $136 for initial response rates of the treatments, and Can $6 for first-year relapse rates for the treatments.
Based on the current available clinical evidence, this model analysis of hypothetical patients suggests that IVIg may not be a cost-effective option for adults with persistent chronic ITP in Canada.
PubMed ID
19539109 View in PubMed
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11 records – page 1 of 2.