Showing papers on "Cost effectiveness published in 1980"
TL;DR: The use of computers to assist in the learning situation in a simulation, game, tutorial, or drill and practice mode is reviewed on an international basis with centers of activity identified in the United States, Canada, the United Kingdom, and Japan.
Abstract: The use of computers to assist in the learning situation in a simulation, game, tutorial, or drill and practice mode is reviewed on an international basis with centers of activity identified in the United States, Canada, the United Kingdom, and Japan. The use of the computer as an adjunct to support learning is compared to its use in a substitution mode. Evaluative studies of CAI are reviewed and costs are examined. The critical issues of CAI are enumerated and analyzed as they pertain to computer hardware, CAI languages, and courseware development and use. The future of CAI is briefly sketched from the viewpoints of individuals prominent in the field. Finally, conclusions are drawn and recommendations are offered to help ensure the most educationally cost-effective use of CAI in learning situations.
354 citations
TL;DR: A program of selective primary health care is compared with other approaches and suggested as the most cost-effective form of medical intervention in the least developed countries.
239 citations
TL;DR: A review of literature concerning patient dropouts and broken appointments was undertaken in an effort to identify correlates of the behavior, assess proposed interventions and identify issues for the content and methodology of future research.
Abstract: Patient dropouts create inefficiencies for medical providers, threaten the validity of clinical research and may themselves suffer unnecessary morbidity. A review of literature concerning patient dropouts and broken appointments was undertaken in an effort to identify correlates of the behavior, assess proposed interventions and identify issues for the content and methodology of future research. While the bulk of existing reports deal with psychiatric and pediatric populations, studies of general adult clinics report missed appointments rates of 15 to 33 per cent and often emphasize demographic features of the patient. Other factors, such as patient beliefs, sociobehavioral characteristics, aspects of the disease and its therapy, patient-provider interactions and organizational features of the providing facility are less well studied, but probably more important. Organizational features exert a strong influence and are particularly amenable to modification. Patient surveys suggest that forgetting and administrative oversights are common problems, and the success of mailed appointment reminders supports this notion. Such surveys have often suggested successful intervention strategies. Future investigations should emphasize more consistent methodology, improved analysis techniques, identification of better predictors and development of a conceptual model for this patient behavior. These efforts may suggest new intervention methods, which should be evaluated for cost effectiveness and the feasibility of individualized application.
212 citations
TL;DR: Treatment appears to be relatively cost effective in menopausal women with prior hysterectomy or osteoporosis but does not appear to be cost effective as a prophylactiv measure in asymptomatic women with intact uteri.
Abstract: The cost effectiveness of estrogen use in postmenopausal women was analyzed with use of data from the medical and epidemiologic literature. Risks of endometrial cancer, uterine bleeding, and gallbladder disease were weighed against benefits associated with relief of menopausal symptoms and with prevention of osteoporosis and consequent fractures. Net effects on life expectancy are probably small in either direction, although they are likely to be positive in women with existing osteoporosis or prior hysterectomy. Treatment appears to be relatively cost effective in menopausal women with prior hysterectomy or osteoporosis but does not appear to be cost effective as a prophylactic measure in asymptomatic women with intact uteri. For women with menopausal symptoms and intact uteri, the decision to prescribe estrogens for the individual patient and the cost effectiveness of estrogen use at the societal level depend critically on the subjective values assigned to symptomatic relief. (N Engl J Med. 198...
178 citations
TL;DR: Efficacy and dollar cost together determine cost effectiveness, which provides a practical guide to selection of the prophylactic approach appropriate to an individual patient.
Abstract: The rapidly expanding literature regarding prevention of venous thromboembolism is confusing and contradictory, but, when analysed in the aggregate, the collective experience permits a judgment about the relative efficacy of different prophylactic regimens in specific patient populations, who vary in the risk factors predisposing them to thromboembolism. The dollar cost of the several approaches to prevention and their consequences should also be a matter of concern. Efficacy and dollar cost together determine cost effectiveness, which provides a practical guide to selection of the prophylactic approach appropriate to an individual patient.
177 citations
TL;DR: In this paper, the authors used cost-effectiveness analysis to examine the medical-care costs of vaccination against pneumococcal pneumonia in relation to its effects on health and found that vaccination could add a year of healthy life among all age groups for about $4,800 in net medical care costs.
Abstract: We used cost-effectiveness analysis to examine the medical-care costs of vaccination against pneumococcal pneumonia in relation to its effects on health. Vaccination could add a year of healthy life among all age groups for about $4,800 in net medical-care costs. Cost-effectiveness ratios vary according to the age of the person vaccinated--from $1,000 per year of healthy life for an adult 65 years old or older to $77,000 per year of healthy life for a child between the ages of two and four. These ratios may change substantially with variations in such factors as the cost of vaccination, the duration of immunity, the efficacy and composition of the vaccine, and the percentage of pneumonia that is pneumococcal. This analysis has particular relevance for the Medicare program, since present legislation excludes coverage of most immunizations and other preventive services. Provision of pneumococcal vaccine to the elderly and inclusion of the vaccine as a Medicare benefit merit serious consideration.
157 citations
TL;DR: The policies of assigning at every moment the task with shortest (longest) expected processing time among those not yet completed to the fastest processor available, 2nd shortest to the 2nd fastest etc., are examined, and shown to minimize expected values of various cost functions.
Abstract: : We consider preemptive scheduling of N tasks on m processors; processors have different speeds, tasks require amounts of work which are exponentially distributed, with different parameters. The policies of assigning at every moment the task with shortest (longest) expected processing time among those not yet completed to the fastest processor available, 2nd shortest (longest) to the 2nd fastest etc., are examined, and shown to minimize expected values of various cost functions. As special cases we obtain policies which minimize expected flowtime, expected makespan and expected lifetime of a series system with m component locations and N spares. (Author)
145 citations
TL;DR: It is found that shifts from center dialysis to either home dialysis or cadaver donor transplantation would save $7000 to $8000 per life year, or $284 million per year for the existing end-stage renal disease population, if legislative changes fail to produce real shifts fromCenter hemodialysis, costs will increase.
Abstract: We examined the survival time and costs of therapy for patients with end-stage renal disease. A computer simulation model of the current system was constructed to estimate the cost-effecti...
137 citations
TL;DR: Replacement of the standard enzymes with CK-MB provides a faster and safer diagnosis of AMI and reduces hospitalization time considerably for patients without AMI.
Abstract: The predictive value of a diagnostic test estimates the likelihood for presence or absence of disease in a patient with a positive or negative test result (PVpos or PVneg). We evaluated the predictive values of serum activities of the heart-specific creatine kinase isoenzyme MB (CK-MB), aspartate aminotransferase, lactate dehydrogenase, CK, and ECG in 401 consecutively admitted patients suspected of acute myocardial infarction (AMI). The study showed that CK-MB (PVpos = 0.98, PVneg = 1.00) was better than the other enzymes (single as well as serial) and ECG, evaluated both separately and in combinations. In all cases of AMI CK-MB was positive within 17 hours from admission. Replacement of the standard enzymes with CK-MB provides a faster and safer diagnosis of AMI and reduces hospitalization time considerably for patients without AMI.
100 citations
TL;DR: In patients with normal findings from neurological examination, no clinically important abnormalities were detected by CT, skull roentgenogram, angiography, or nuclide brain scan and neurodiagnostic evaluation was clinically unrewarding.
Abstract: One hundred sixty-one highly selected patients with headache were studied to assess the impact of computerized tomography (CT) on diagnostic evaluation and to determine cost-effectiveness of neurodiagnostic evaluation of headache. Fewer nuclide brain scans were performed after availability of CT, but diagnostic charges stayed about the same. A careful history and physical and neurological examinations were adequate screens to detect intracranial mass lesions or systemic disease associated with headache. In patients with normal findings from neurological examination, no clinically important abnormalities were detected by CT, skull roentgenogram, angiography, or nuclide brain scan. The cost of finding a case of brain tumor was estimated to be at least $1,265 for patients with abnormalities on neurological examination and $11,901 for patients with normal findings on neurological examination. Neurodiagnostic evaluation of headache patients with normal findings from neurological examination is expensive and was clinically unrewarding in this series.
88 citations
TL;DR: The finding that the attitudes of the Family Practice residents improved from the first year through the third year of residency is the first medical specialty group to demonstrate such a trend.
Abstract: For the Family Practitioner, elderly patients are a highly significant group. In the past, some health professionals have expressed negative attitudes toward the elderly. Thus a need exists to study specific factors that may influence a Family Practice resident's willingness to treat older patients. A Likert-type questionnaire was developed that utilized the Thurstone-Likert discrimination technique. Five categories were chosen for study: general attitudes, cost effectiveness, time and energy, therapeutic potential, and educational preparation. Responses of 150 Family Practice residents were then analyzed. The attitudes of the residents were significantly positive in all categories except Educational Preparation. Noteworthy was the finding that the attitudes improved from the first year through the third year of residency. This is the first medical specialty group to demonstrate such a trend. Certain negative attitudes observed in the Educational Preparation category re-emphasize the need for training programs to improve professional geriatric instruction.
TL;DR: Trace metal variability was evaluated in two populations of Mytilus californianus through the analysis of individual specimens, indicating that variability may need to be evaluated for each population (site) studied.
TL;DR: In hypoparathyroid patients with vitamin D intoxication and patients with malabsorption and/or post-gastrectomy states had significantly subnormal values for both 25-hydroxyvitamin D and 24,25-dihydroxyv vitamin D in serum, and there was a significantly negative correlation between each of these biochemical values and the severity of osteomalacia.
Abstract: We describe a simplified assay for 24,25-and 1.25-dihydroxyvitamin D in human serum. It involves two preparative steps, and normal chick intestine is used in preparing cytosol-binding protein. Our results for 24,25-dihydroxyvitamin D include a reference interval of 2.9--16 nmol/L (1.2--6.7 microgram/L), a mean of 6.7 nmol/L (2.8 microgram/L), an intra-assay CV of 11%, and an interassay CV of 22%. For 1,25-dihydroxyvitamin D, these data were 29--168 pmol/L (12--70 ng/L), 86 pmol/L (36 ng/L), 12%, and 22%, respectively. In hypoparathyroid patients with vitamin D intoxication, mean concentrations of 25-hydroxyvitamin D and 24,25-dihydroxyvitamin D in serum were significantly above normal; the 1,25-dihydroxyvitamin D concentrations were significantly below normal. Patients with malabsorption and/or post-gastrectomy states had significantly subnormal values for both 25-hydroxyvitamin D and 24,25-dihydroxyvitamin D in serum, and there was a significantly negative correlation between each of these biochemical values and the severity of osteomalacia. We also discuss cost effectiveness of assaying vitamin D metabolites in human serum.
TL;DR: In this article, the authors developed a simple model which would be used to predict runoff losses of pesticides from agricultural lands, which would then enable them to determine the possible effects of best management practices on the volume of pesticides transported via runoff from application sites to surface waters.
Abstract: PESTICIDE use in agriculture has undoubtedly bene-fited crop production efficiency. Its convenience and cost effectiveness have greatly simplified the task of pest control for the farmer, and at the same time have confer-red on consumers the benefit of relatively inexpensive agricultural goods. However, chemical control of agricultural pests has also created numerous ecological problems, problems which are in part caused by the tendency of applied pesticides to migrate away from target fields via runoff and erosion to surrounding sur-face waters. Modeling of pesticide loss in runoff water has been at-tempted by Crawford and Donigian, 1973; Frere et al., 1975; Donigian et al., 1976, 1977; Adams and Kurisu, 1976; McElroy et al., 1976. All but the latter group have developed continuous simulation models that are capable of modeling losses of pesticides that are in-termediate and strongly adsorbed to soil. McElroy et al, 1976, have developed a simple loading formula that only applies to strongly adsorbed pesticides. No one, to our knowledge, has developed a simple procedure for model-ing intermediately adsorbed pesticide loss in the runoff water. The objective of our research was to develop a simple model which would be used to predict runoff losses of pesticides from agricultural lands. Once developed, this model would then enable us to determine the possible ef-fects of best management practices on the volume of pesticides transported via runoff from application sites to surface waters.
TL;DR: In this article, the authors presented a multiple assessment exploration of cost effectiveness in behavioral family therapy, and the results indicated that the group condition performed as well as the individual therapy condition with no differences between conditions.
01 Jul 1980
TL;DR: Flow control algorithms consisting of two parts: quasi- static flow control and dynamic flow control are considered, which has the function of admitting or rejecting individual units of traffic into the network so as to enforce the maximum allocated rates and to prevent congestion by smoothing out the fluctuations in buffer occupancy.
Abstract: : We consider flow control algorithms consisting of two parts: quasi- static flow control and dynamic flow control. The quasi-static part uses short term average information on network utilization to allocate maximum data rates and to determine routes for each user. The rates are allocated to achieve an optimal trade-off between assigned priority cost functions for each user and the cost of congestion in the network. This optimization can be done by a distributed algorithm and is essentially no more complicated than optimizing routing alone. The dynamic flow control has the function of admitting or rejecting individual units of traffic into the network so as to enforce the maximum allocated rates and to prevent congestion by smoothing out the fluctuations in buffer occupancy. (Author)
TL;DR: In this article, the authors compare the cost-effectiveness of the two principal strategies for accomplishing a reduction in force; namely, layoff and attrition, in the State of New York.
Abstract: A recent symposium appearing in Public Administration Review, which explored organizational decline and cutback management, addressed an issue that seems to have grown in importance since the early 1970s.1 Despite the proliferation of organizational cutbacks, however, relatively little is yet known about their dynamics and administration.3 The authors' experience with the State of New York, which underwent a series of organizational retrenchments during this era, suggested that public administrators had come to rely on layoffs as a standard operating procedure for accomplishing reductions in force, or worse, had come to equate the concepts of reduction in force and layoff and, as a consequence, did not even consider alternatives.4 The purpose of this paper is to compare the cost-effectiveness of the two principal strategies for accomplishing a reduction in force; namely, layoff and attrition. The data presented were gathered as part of a research program which provided policy guidance to a state-level, labormanagement committee' mandated to explore and institutionalize alternatives for accomplishing future work force reductions, and to develop action programs to restore more than 10,000 employees laid off in the early 1970s to suitable jobs.
TL;DR: The limitations of the actual operating environment, both past and present, have greatly influenced Load Management strategies as discussed by the authors, and important lessons concerning cost effectiveness have been learned and must be applied to future undertakings.
Abstract: Detroit Edison has accumulated 10 years' operating experience with a large-scale radio controlled electric water heater Load Management system. The limitations of the actual operating environment, both past and present, have greatly influenced Load Management strategies. Important lessons concerning cost effectiveness have been learned and must be applied to future. undertakings.
TL;DR: Current technique using same-day multiple-view aerosol scans after a preliminary perfusion scan, makes use of the most logical diagnostic scheme in the vast majority of patients with chest complaints, since a normal perfusions scan often eliminates the need for a ventilation scan.
01 Jul 1980
TL;DR: Based on the systolic array approach, new designs of special-purpose devices for filtering, correlation, convolution, and discrete Fourier transform are proposed and discussed and it is argued that because of high degrees of simplicity, regularity and concurrency inherent to these designs, their VLSI implementation will be cost effective.
Abstract: : Based on the systolic array approach, new designs of special-purpose devices for filtering, correlation, convolution, and discrete Fourier transform are proposed and discussed. It is argued that because of high degrees of simplicity, regularity and concurrency inherent to these designs, their VLSI implementation will be cost effective. (Author)
TL;DR: The TISS alone could not distinguish survivors from nonsurvivors in this patient population, and the major factor determining the outcome of the illness was the age of the patient.
Abstract: Fifty-eight consecutive patients admitted to the ICU requiring ventilatory support for respiratory failure were studied. The Therapeutic Intervention Scoring System (TISS) was used daily as an objective measure of the severity of critical illness in each patient. Patients who survived (27 of 58) 8-10 months after admission to the ICU were interviewed in their homes to assess the outcome of their illness. Most survivors were functioning at or above their premorbid level with respect to their activities of self care and community living. Survivors had minimal recall of the pain and anguish of their ICU experience. The financial cost of care was estimated. Of the total ICU cost, 40% was expended on the 27 survivors. The TISS alone could not distinguish survivors from nonsurvivors in this patient population. The major factor determining the outcome of the illness was the age of the patient. More information on the outcome of critical illness in elderly patients is needed.
TL;DR: Leukocyte transfusion is an extremely expensive technologic procedure in preventing death from infection during intensive chemotherapy for acute leukemia.
Abstract: We analyzed the cost effectiveness of leukocyte transfusion in preventing death from infection during intensive chemotherapy for acute leukemia. Effectiveness was estimated with an odds-ratio analysis based on published results of controlled studies of therapeutic and prophylactic leukocyte transfusion. Cost estimates were based on blood-bank charges throughout the country. Calculations of effectiveness suggest that leukocyte transfusion might prevent 50 to 75 per cent of early deaths from infection. Therapeutic transfusion would add approximately 10.9 per cent to the hospital bill of the average leukemic patient and cost $17.7 million annually nationwide. Prophylactic transfusion would add 35.2 per cent to the hospital bill and cost $57.8 million annually. Mean cost-effectiveness ratios were $14,982 per life-year for therapeutic transfusion and $35,020 to $50,029 per life-year for prophylactic transfusion. The cost per additional life-year achieved with prophylactic rather than therapeutic leukocyte tran...
Journal Article•
TL;DR: Although cost-benefit analyses tend to underestimate the benefits of immunization, there is evidence of very high rates of return on investments in this area and this benefit would become even more evident if the benefits derived from a rural infant's immunization were weighted higher than those associated with immunization of urban infants.
Abstract: Cost-benefit analysis can provide strong evidence of the viability of immunization programs. This form of analysis involves the identification valuation and summation of the costs and benefits in each year of the program. The main components of immunization program costs are the wages of the immunizing and supervisory staff transport costs and the cost of the vaccine. Major benefits include savings in treatment costs following reduced incidence of disease reductions in mortality and morbidity avoidance of suffering to children and their families and spillover benefits. Although cost-benefit analyses tend to underestimate the benefits of immunization there is evidence of very high rates of return on investments in this area. This benefit would become even more evident if the benefits derived from a rural infants immunization were weighted higher than those associated with immunization of urban infants. Moreover this approach would bring the welfare function in cost-benefit analysis more in line with the aims of policy makers to address inequity in access to health care. Also needing to be addressed are the inadequacies of the human capital approach of life valuation especially in rural areas of developing countries.
01 Jun 1980
Abstract: Maps were made of the Upper Colorado River Basin showing locations of coal deposits, oil and gas, oil shale, uranium, and tar sand, in relationship to cities and towns in the area. Superimposed on these are locations of wells showing four ranges of water quality; 1000 to 3000 mg/l, 3000 to 10,000 mg/l, 10,000 to 35,000 mg/l, and over 35,000 mg/l. Information was assembled relative to future energy-related projects in the upper basin, and estimates were made of their anticipated water needs. Using computer models, various options were tested for using saline water for coal-fired power plant cooling. Both cooling towers and brine evaporation ponds were included. Information is presented of several proven water treatment technologies, and comparisons are made of their cost effectiveness when placed in various combinations in the power plant makeup and blowdown water systems. A relative value scale was developed which compares graphically the relative values of waters of different salinities based on three different water treatment options and predetermined upper limits of cooling tower circulating salinities. Coal from several different mines was slurried in waters of different salinities. Samples were analyzed in the laboratory to determine which constituents had been leached from or absorbed bymore » the coal, and what possible deleterious effects this might have on the burning properties of the coal, or on the water for culinary use or irrigation.« less
TL;DR: Much research is needed to provide the basis for examining the variety of proposed alternatives to nursing homes to allow us to compare costs and benefits in some reasonable fashion.
Abstract: cost implications have spurred strong interest in seeking alternatives to nursing homes. The rationale for such alternatives is a mixture of prevention, displacement, and deinstitutionalization; none may result. The alternative services may prove to be additive rather than substitutive. Much research is needed to provide the basis for examining the variety of proposed alternatives to allow us to compare costs and benefits in some reasonable fashion.
TL;DR: Approaches to improved planning of drug use, including the setting of expenditure norms based on recommended prescribing routines, are detailed, and it is concluded that the resultant savings could allow a sizable extension of the coverage given to rural populations by the primary health care system.
Abstract: Pharmaceutical expenditure in Ghana accounts for about 1/3 of the total recurrent costs of the Ministry of Health but in isolation this figure is a misleading indicator of economic importance. In this primary care sector up to 75-80% of the running cost of a health center may be accounted for by pharmaceuticals and because the Ghanaian currency is heavily overvalued even these proportions understate the true value of resources used on imported drugs. An apparent lack of central control drugs of expenditure led to a study of the existing allocation procedures and prescribing practices. The results suggest largescale wastage through overprescribing often in response to patients preferences for more costly medication. Approaches to improved planning of drug use including the setting of expenditure norms based on recommended prescribing routines are detailed and it is concluded that the resultant savings could allow a sizable extension of the coverage given to rural populations by the primary health care system. (authors)
TL;DR: Cost-benefit and cost-effectiveness analyses (CBA and CEA) indicated that the preventive program was highly uneconomic compared to traditional dental care (3.73/1) but when comparing the cost per completely treated child and year in the trial clinic continuing to use the preventive measures described, the cost seemed to be lower.
Abstract: Cost-benefit and cost-effectiveness analyses (CBA and CEA) have been done on a preventive program. The program included professional toothcleaning, dietary and oral hygiene instruction, topical fluoride application and sealing of pits and fissures in 9--12-year-old children over 2 years. All measures were delivered by a specially trained dental nurse. In spite of a marked reduction in caries activity both CBA and CEA indicated that the preventive program was highly uneconomic compared to traditional dental care (3.73/1). However, when comparing the cost per completely treated child and year in the trial clinic continuing to use the preventive measures described, with that in dental clinics with no special preventive programs the cost seemed to be lower in the trial clinic now markedly interested in prophylaxis.
TL;DR: A quantitative model is offered to describe the relationship between global scale ratings and multidimensional facets influencing the global ratings, since the major use of a global scale is as an integrating construct.
TL;DR: The underlying theory for robust data structures is presented, and it is used to discuss the synthesis and cost effectiveness of robust Data Structures.
Abstract: A companion paper, "Redundancy in Data Structures: Improving Software Fault Tolerance," provides an infonnal introduction to robust data structures. Here, we present the underlying theory for them, and use it to discuss the synthesis and cost effectiveness of robust data structures.
Journal Article•
TL;DR: Derivation of the cost/benefit ratio showed that the decreased rehospitalization rate of the surgically treated group and the apparent better "quality of life" almost offset the increased initial hospital costs for this group.