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12 records – page 1 of 2.

The allocation of scarce medical resources: some moral and value issues.

https://arctichealth.org/en/permalink/ahliterature247959
Source
J Can Diet Assoc. 1979 Jan;40(1):9-18
Publication Type
Article
Date
Jan-1979

[Concentrate more on trauma research! Injuries have enormous social and economical consequences].

https://arctichealth.org/en/permalink/ahliterature207046
Source
Lakartidningen. 1997 Oct 8;94(41):3603-5
Publication Type
Article
Date
Oct-8-1997

Cost-effectiveness analysis of potential improvements to emergency medical services for victims of out-of-hospital cardiac arrest.

https://arctichealth.org/en/permalink/ahliterature211840
Source
Ann Emerg Med. 1996 Jun;27(6):711-20
Publication Type
Article
Date
Jun-1996
Author
G. Nichol
A. Laupacis
I G Stiell
K. O'Rourke
A. Anis
H. Bolley
A S Detsky
Author Affiliation
Clinical Epidemiology Unit, Loeb Medical Research Institute, Ottawa Civic Hospital, Ontario, Canada.
Source
Ann Emerg Med. 1996 Jun;27(6):711-20
Date
Jun-1996
Language
English
Publication Type
Article
Keywords
Cardiopulmonary Resuscitation - education
Cost-Benefit Analysis
Decision Trees
Electric Countershock - economics
Emergency Medical Services - economics
Heart Arrest - mortality - therapy
Humans
Life Support Care - economics
Ontario
Reaction Time
Abstract
To measure the incremental cost-effectiveness of various improvements to emergency medical services (EMS) systems aimed at increasing survival after out-of-hospital cardiac arrest.
We performed cost-effectiveness analysis based on (1) metaanalysis of effectiveness of the various EMS systems, (2) costing of each component of EMS systems, (3) modeling of the relationship between the proportion of cardiac arrest victims who receive CPR and the proportion of individuals trained, (4) modeling of the relationship between response time interval and the characteristics of the EMS system, (5) measurement of quality of life, and (6) decision analysis to combine the results of the first five components.
The incremental cost-effectiveness ratio for a 48-second improvement in mean response time in a one-tier EMS system yielded by the addition of more EMS providers was $368,000 per quality-adjusted life year (QALY). For improved response time in a two-tier EMS system by the addition of more basic life support (BLS)/BLS-defibrillator (BLS-D) providers to the first tier, the ratio was $53,000 per QALY with pump vehicles or $159,000 per QALY with ambulances. Change from a one-tier EMS to a two-tier EMS system by the addition of initial BLS/BLS-D providers in pump vehicles as the first tier was associated with a cost per QALY of $40,000. Change from one-tier EMS to two-tier EMS by the addition of initial BLS/BLS-D providers in ambulances as the first tier was associated with a cost per QALY of $94,000.
The most attractive options in terms of incremental cost-effectiveness were improved response time in a two-tier EMS system or change from a one-tier to a two-tier EMS system. Future research should be directed toward identification of the costs of instituting the first tier of a two-tier EMS system and identification of cost-effective methods of improving response time.
PubMed ID
8644957 View in PubMed
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Counting the costs of chemotherapy in a National Cancer Institute of Canada randomized trial in nonsmall-cell lung cancer.

https://arctichealth.org/en/permalink/ahliterature228661
Source
J Clin Oncol. 1990 Aug;8(8):1301-9
Publication Type
Article
Date
Aug-1990
Author
L. Jaakkimainen
P J Goodwin
J. Pater
P. Warde
N. Murray
E. Rapp
Author Affiliation
Department of Preventive Medicine and Biostatistics, University of Toronto, Ontario, Canada.
Source
J Clin Oncol. 1990 Aug;8(8):1301-9
Date
Aug-1990
Language
English
Publication Type
Article
Keywords
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Canada
Carcinoma, Non-Small-Cell Lung - drug therapy - economics
Cisplatin - administration & dosage
Cost-Benefit Analysis
Cyclophosphamide - administration & dosage
Doxorubicin - administration & dosage
Government Agencies
Hospitalization - economics
Humans
Life Support Care - economics
Lung Neoplasms - drug therapy - economics
Randomized Controlled Trials as Topic
Retrospective Studies
Vindesine - administration & dosage
Abstract
An economic evaluation was undertaken of a previously reported National Cancer Institute of Canada (NCIC) trial of chemotherapy in advanced nonsmall-cell lung cancer (NSCLC). That trial had demonstrated a survival benefit associated with the use of either vindesine and cisplatin (VP) or cyclosphosphamide, doxorubicin, and cisplatin (CAP) in relation to best supportive care (BSC). The economic technique used in this evaluation was cost-effectiveness analysis (CEA). All costs were determined from the viewpoint of two provincial health care plans. When compared with BSC, the survival benefit of 8 weeks in favor of patients receiving CAP chemotherapy was associated with an economic saving of $949.49 (in 1984 Canadian dollars). This translated into a savings of $6,171.69 per year of life gained. The mean survival benefit of 12.8 weeks that was obtained with VP chemotherapy compared with BSC was associated with an increased cost of $3,637.60 per patient, or $14,777.75 per year of life gained. The economic evaluation demonstrated that the majority of costs on each of the three treatment arms was related to hospitalization and not to the use of chemotherapy agents. These results compare favorably with estimates of cost-effectiveness (CE) of commonly used treatments for other diseases and demonstrate that a policy of supportive care is associated with costs that may exceed those of active treatment. It is concluded that economic factors should not adversely affect decisions regarding the use of chemotherapy in advanced NSCLC.
PubMed ID
2166142 View in PubMed
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The difference between withholding and withdrawing life-sustaining treatment.

https://arctichealth.org/en/permalink/ahliterature206550
Source
Intensive Care Med. 1997 Dec;23(12):1264-7
Publication Type
Article
Date
Dec-1997
Author
G. Melltorp
T. Nilstun
Author Affiliation
Department of Anaesthesiology, University Hospital MAS, Malmö, Sweden.
Source
Intensive Care Med. 1997 Dec;23(12):1264-7
Date
Dec-1997
Language
English
Publication Type
Article
Keywords
Ethics, Medical
Health Personnel - psychology
Humans
Life Support Care - economics - standards
Practice Guidelines as Topic
Questionnaires
Sweden
Treatment Outcome
Abstract
First, to present the position on the distinction between withholding and withdrawing life-sustaining treatment as expressed in guidelines and examine its relation to the attitudes of health care professionals. Second, to examine the possible ethical justification of this distinction.
Critical analysis of guidelines on life-sustaining treatment and questionnaire administered to 148 health care professionals--physicians and nurses at the intensive care unit (ICU), University Hospital MAS, Malmö, Sweden.
In contrast to the guidelines, which emphasize that there is no ethical difference between withholding and withdrawing life-sustaining treatment, not less than 50 per cent of the professionals in the ICU were of the opinion that there is an ethical difference. All attempts to justify this difference with reference to an inherent distinction between withholding and withdrawing seem to be controversial.
We recommend a change in emphasis in professional guidelines. Such guidelines should avoid the controversial issue about the possible inherent ethical difference between withholding and withdrawing life-sustaining treatment. What should be underlined is that the particular situation and the consequences of withholding as well as withdrawing life-sustaining treatment should always be taken into account.
PubMed ID
9470083 View in PubMed
Less detail
Source
Can Fam Physician. 1999 Jan;45:30-1, 33
Publication Type
Article
Date
Jan-1999
Author
T. Mayberry
Source
Can Fam Physician. 1999 Jan;45:30-1, 33
Date
Jan-1999
Language
English
Publication Type
Article
Keywords
Canada
Decision Making, Organizational
Female
Humans
Life Support Care - economics - methods
Obstetric Labor Complications - therapy
Pregnancy
United States
Notes
Cites: Can Fam Physician. 1998 Nov;44:2480-19839066
PubMed ID
10889850 View in PubMed
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The Ontario Prehospital Advanced Life Support (OPALS) Study: rationale and methodology for cardiac arrest patients.

https://arctichealth.org/en/permalink/ahliterature204850
Source
Ann Emerg Med. 1998 Aug;32(2):180-90
Publication Type
Article
Date
Aug-1998
Author
I G Stiell
G A Wells
D W Spaite
M B Lyver
D P Munkley
B J Field
E. Dagnone
J P Maloney
G R Jones
L G Luinstra
B D Jermyn
R. Ward
V J DeMaio
Author Affiliation
Department of Medicine, and Ottawa Hospital Loeb Research Institute, University of Ottawa, Ontario, Canada.
Source
Ann Emerg Med. 1998 Aug;32(2):180-90
Date
Aug-1998
Language
English
Publication Type
Article
Keywords
Cost-Benefit Analysis
Critical Care - economics
Direct Service Costs
Drug Therapy
Electric Countershock
Emergency Medical Services - economics
Evaluation Studies as Topic
Feasibility Studies
Heart Arrest - therapy
Humans
Injections, Intravenous
Intervention Studies
Intubation, Intratracheal
Life Support Care - economics
Logistic Models
Multivariate Analysis
Neurologic Examination
Ontario
Outcome Assessment (Health Care)
Patient Discharge
Quality of Life
Research Design
Retrospective Studies
Survival Rate
Wounds and Injuries - therapy
Abstract
The Ontario Prehospital Advanced Life Support Study represents the largest prehospital study yet conducted, worldwide. This study will involve more than 25,000 cardiac arrest, trauma, and critically ill patients over an 8-year period. The study will evaluate the incremental benefit of rapid defibrillation and prehospital Advanced Cardiac Life Support measures for cardiac arrest survival and the benefit of Advanced Life Support for patients with traumatic injuries and other critically ill prehospital patients. This article describes the OPALS study with regard to the rationale and methodology for cardiac arrest patients.
Notes
Comment In: Ann Emerg Med. 1999 Feb;33(2):2419988665
PubMed ID
9701301 View in PubMed
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Paramedic helicopter emergency service in rural Finland - do benefits justify the cost?

https://arctichealth.org/en/permalink/ahliterature189255
Source
Acta Anaesthesiol Scand. 2002 Aug;46(7):779-84
Publication Type
Article
Date
Aug-2002
Author
J. Kurola
M. Wangel
A. Uusaro
E. Ruokonen
Author Affiliation
Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Finland. jouni.kurola@kuh.fi
Source
Acta Anaesthesiol Scand. 2002 Aug;46(7):779-84
Date
Aug-2002
Language
English
Publication Type
Article
Keywords
Adult
Air Ambulances - economics - statistics & numerical data
Cost-Benefit Analysis
Costs and Cost Analysis
Emergency Medical Technicians - economics
Female
Finland
Heart Diseases - mortality - therapy
Humans
Life Support Care - economics
Male
Middle Aged
Outcome Assessment (Health Care)
Rural Health Services - economics - statistics & numerical data
Survival Rate
Wounds and Injuries - mortality - therapy
Abstract
The benefit of the Helicopter Emergency Medical Service (HEMS) is not well documented. The aim of our study was to investigate the potential health benefits of HEMS, and their relation to cost of the service in a rural area in Finland. We also evaluated whether the patient benefit is due to early Advanced Life Support (ALS) procedures performed on-scene, or due to rapid transport of patients to definitive care.
We reviewed all helicopter missions during 1 year (1999). Based on given prehospital care, we divided these missions into various categories. At the time of discharge, in-hospital records were reviewed for patients who received prehospital ALS care in order to estimate the potential benefit of HEMS.
There were 588 missions. In 40% (n = 233/588), the mission was aborted. ALS care was given on-scene to 206 patients. It was estimated that in this group lives of three patients (1.5%) were saved, and 42 (20%) patients, mostly with cardiovascular disease, otherwise benefited from the service. The majority (84%) of the patients benefited from on-scene ALS procedures only. The cost for beneficial mission was euro 28 444.
A minority of all patients did benefit from HEMS. Benefit was related to early ALS care and the cost per beneficial mission was 28 444.
Notes
Comment In: Acta Anaesthesiol Scand. 2002 Aug;46(7):757-812139527
PubMed ID
12139530 View in PubMed
Less detail

Should we let them die? The moral dilemmas of economic restraints on life-support treatments.

https://arctichealth.org/en/permalink/ahliterature243296
Source
Can Med Assoc J. 1982 Apr 1;126(7):745-6
Publication Type
Article
Date
Apr-1-1982

12 records – page 1 of 2.