When deciding the right forms of treatment for various medical conditions it has been usual to consider medical knowledge, norms and experience. Increasingly, economic factors and principles are being introduced by the management, in the form of health economics and pharmaco-economic analyses, enforced as budgetary cuts and demands for rationalisation and measures to increase efficiency. Economic evaluations require construction of models for analyses. We have used DRG-information, National Health reimbursements and pharmacological retail prices to make a cost-efficiency analysis of treatments of menorrhagia. The analysis showed better cost-efficiency for certain pharmacological treatments than for surgery.
Telecom-Bretagne, Ecole Supérieure des Télécommunications de Bretagne, (LUSSI)/MARSOUIN/CREM, Département LUSSI, Logiques des Usages, Sciences Sociales et Sciences de l'Information, GET/ENST-Bretagne, Technopôle de Brest Iroise, CS 83818, 29238, Brest Cedex 3, France. firstname.lastname@example.org
This paper proposes a thorough framework for the economic evaluation of telemedicine networks. A standard cost analysis methodology was used as the initial base, similar to the evaluation method currently being applied to telemedicine, and to which we suggest adding subsequent stages that enhance the scope and sophistication of the analytical methodology. We completed the methodology with a longitudinal and stakeholder analysis, followed by the calculation of a break-even threshold, a calculation of the economic outcome based on net present value (NPV), an estimate of the social gain through external effects, and an assessment of the probability of social benefits. In order to illustrate the advantages, constraints and limitations of the proposed framework, we tested it in a paediatric cardiology tele-expertise network. The results demonstrate that the project threshold was not reached after the 4 years of the study. Also, the calculation of the project's NPV remained negative. However, the additional analytical steps of the proposed framework allowed us to highlight alternatives that can make this service economically viable. These included: use over an extended period of time, extending the network to other telemedicine specialties, or including it in the services offered by other community hospitals. In sum, the results presented here demonstrate the usefulness of an economic evaluation framework as a way of offering decision makers the tools they need to make comprehensive evaluations of telemedicine networks.
Several strategies have been proposed to deal with response uncertainty in contingent valuation. One approach, often applied to address issues of hypothetical bias, recodes and/or reweights responses according to stated levels of certainty but so far few analyses compare alternative recoding and reweighting strategies. We explore the choice among alternative strategies that exploit a numerical certainty scale obtained from a follow-up to the payment question in a valuation survey about a whale conservation program. Two novel variations of previously followed approaches perform best on our dataset in terms of the efficiency of estimates. The first one uses an exponential transformation of the numerical certainty scale as a weight in the willingness to pay regression. The other one is based on constructing a continuous willingness to pay variable with the highly certain "yes" and "no" original responses to the payment question as extreme values and with mid-point values that correspond to the original "don't know" responses. We find, though, that the effect of using different treatment strategies on mean willingness to pay is rarely statistically significant and we fail to detect a consistent effect on the efficiency of the estimation regardless of the strategy applied.
To assess the difference in costs of home-based versus clinic-based physiotherapy (PT) for patients with rheumatoid arthritis (RA) from a societal perspective.
A cost analysis was performed using statistical and financial information provided by The Arthritis Society, Ontario Division, from April 1, 1997 to March 30, 1998. Cost estimates included treatment costs and costs borne by patients. A sensitivity analysis was conducted to examine the effect of altering the valuation of treatment time and patient employment status.
Total costs per case were $210.87 for the home setting, and $183.87 for the clinic setting when patients were employed. Sensitivity analysis did not change the trend of the results. The estimated start-up costs for an arthritis clinic were between $302.90 and $652.40. From the perspective of the health care system, these costs would be recovered after serving 4 to 8 RA patients at a clinic.
The findings suggest that ambulatory PT care is less costly than home-based services for people with RA based on The Arthritis Society model. Further studies should be conducted to examine the effectiveness and the possible adverse consequences of alternative settings for service delivery.
Two cost calculation models were used. The "top down" model calculated an average cost of all investigations; this proved suitable for the calculation of the costs of autopsies and electron microscopical specimens. The "bottom up" model calculated the cost of an individual investigation, depending on the resources used in handling each particular specimen; it was necessary to adopt this model for specimens sent for microscopy. Information about the type of specimen and technical details were registered in a computer system. Production was registered in points and the costs were distributed between the clinical departments. The study showed that the cost of the histological specimens varied considerably depending on the material received from the clinical departments. A model using points for technical details in a department of cyto- and histopathology is suitable for calculating production and cost.
Comment In: Ugeskr Laeger. 1997 Jun 9;159(24):3798-99214058
The Swedish producer responsibility ordinance mandates producers to collect and recycle packaging materials. This paper investigates the main determinants of collection rates of household plastic packaging waste in Swedish municipalities. This is done by the use of a regression analysis based on cross-sectional data for 252 Swedish municipalities. The results suggest that local policies, geographic/demographic variables, socio-economic factors and environmental preferences all help explain inter-municipality collection rates. For instance, the collection rate appears to be positively affected by increases in the unemployment rate, the share of private houses, and the presence of immigrants (unless newly arrived) in the municipality. The impacts of distance to recycling industry, urbanization rate and population density on collection outcomes turn out, though, to be both statistically and economically insignificant. A reasonable explanation for this is that the monetary compensation from the material companies to the collection entrepreneurs vary depending on region and is typically higher in high-cost regions. This implies that the plastic packaging collection in Sweden may be cost ineffective. Finally, the analysis also shows that municipalities that employ weight-based waste management fees generally experience higher collection rates than those municipalities in which flat and/or volume-based fees are used.
"The structural change model of the demographic transition developed by Easterlin and others is explored empirically by applying the Brown, Durbin and Evans test of structural change to annual data from the transitions of Sweden, Norway, England and Wales, and Finland. The evidence strongly supports the structural change model over traditional models (based on gradual changes in explanatory variables), indicating a supply response of fertility to declining illness and death during the early stages of transition, and a demand response to the death of children during the latter stages, when families are likely to have achieved desired size."
Breakthrough cancer pain (BTCP) represents a considerable economic burden. A decision-analysis model was developed to evaluate the cost-effectiveness of intranasal fentanyl spray (INFS) compared with oral transmucosal fentanyl citrate (OTFC) and fentanyl buccal tablet (FBT) for the treatment of BTCP.
The model was parameterized for Sweden to estimate the costs and benefits associated with treatments. Expected reductions in pain intensity (PI; measured on a numeric rating scale ranging from 0 to 10) per BTCP episodes were translated into resource use and quality-adjusted life years (QALYs). Relative analgesic efficacy of interventions was derived from a mixed treatment comparison of six randomized controlled trials. The relationship between PI and utility was obtained from a time-trade off study in the general population. Resource use and unit cost data were obtained from the literature and validated by Swedish clinical experts. The base case scenario assumed three BTCP episodes/day, a background PI of 2, and a time horizon of 180 days. Prices of INFS and OTFC were assumed to be equal with FBT ~14% less. Uncertainty in the source data was incorporated by probabilistic sensitivity analyses and different scenario analyses.
With INFS, 55% of BTCP (95% uncertainty interval [UI]: 46-68%) was avoided, which is greater than expected with OTFC (29%; UI 22-38%) or FBT (31%; UI 25-39%). INFS was dominating OTFC (resulting in 0.046 QALY gain and saving 174 Euros with a time horizon of 180 days) and cost-effective versus FBT (incremental cost-effectiveness ratio 12203 Euros/QALY). Despite uncertainty in the source data, there is a >99% probability that INFS is the most cost-effective intervention.
Given inherent limitations of modelling studies, the greater efficacy of INFS translates to cost and QALY advantages over competing interventions in the treatment for BTCP in Sweden.
To construct a decision analytical model to compare the costs and clinical consequences of treating patients with celecoxib or various nonsteroidal anti-inflammatory drug (NSAID)/gastrointestinal (GI) co-therapy regimens for the management of osteoarthritis and rheumatoid arthritis. The model quantified the number of patients expected to experience any GI complication commonly associated with NSAID therapy.
Resource use for the treatment of each GI complication in the model was estimated after consulting Canadian experts. Standard unit costs from Ontario were applied to resources to calculate the cost of each complication.
The model revealed that the NSAID-alone regimen was associated with the lowest cost [$262 Canadian dollars ($Can) per patient per 6 months] followed by the celecoxib regimen ($Can273), diclofenac/misoprostol ($Can365), NSAID + histamine H2 receptor antagonist ($Can413), NSAID + misoprostol ($Can421), and NSAID + proton pump inhibitor ($Can731). A break-even analysis showed that up to 80% of the study cohort could be treated with celecoxib instead of the NSAID-alone regimen without increasing the health system's overall budget. Celecoxib was associated with the fewest GI-related deaths, hospitalised events; symptomatic ulcers, and cases of anaemia. The celecoxib regimen was also associated with the fewest cases of upper GI distress. Sensitivity analyses revealed that the model was most sensitive to the distribution of GI risk in the population and to the ingredient costs of the treatment alternatives.
This model indicates that the use of celecoxib could lead to the avoidance of a significant number of NSAID-attributable GI adverse events, and the incremental cost of using celecoxib for arthritis patients > or = 65 years of age in place of current treatment alternatives would not impose an excessive incremental impact on a Canadian provincial healthcare budget.