Showing papers on "Cost effectiveness published in 1982"

Indications for use of hepatitis B vaccine, based on cost-effectiveness analysis.

Abstract: To formulate indications for the use of hepatitis B vaccine, we examined the cost effectiveness of three strategies: vaccinating everyone; screening everyone and vaccinating those without evidence of immunity; and neither vaccinating nor screening, but passively immunizing those with known exposure. Estimates of the hepatitis attack rate, prevalence of immunity, and frequency of known exposure were made for three representative populations: homosexual men, surgical residents, and the general population of the United States. Screening followed by vaccination of homosexual men and vaccination without prior screening of surgical residents would result in savings of medical costs. Neither screening nor vaccination is the lowest-cost strategy for the general population. Vaccination of susceptible persons will save medical costs for populations with annual attack rates above 5 per cent. Vaccination may be considered cost effective (or cost saving when indirect costs are included) for populations with attack rates as low as 1 to 2 per cent.

The selection of channels when seeking information: Cost/benefit vs least-effort

Abstract: Two models of selecting information sources are to be found in the literature. The first, the Cost/Benefit model, proposes that information seekers select information sources on the basis of expected benefits and expected costs of using an information source. Many proponents of this model also feel that expected benefits are the most important consideration for the information seeker. The second model, the Least-Effort model, maintains that information seekers select information sources on the basis of minimizing the effort or cost in obtaining information, while even sacrificing the quality of the information to be obtained. The present study proposes that information seekers place different weights on costs and benefits. In a survey of 968 Forest Service professionals, it was found that perceived costs were twice as important as benefits in choosing information sources.

Cost-effectiveness of primary and secondary prevention of fatal pulmonary embolism in high-risk surgical patients

Abstract: Because death due to pulmonary embolism is relatively rare following general surgery, many question the need for prophylaxis. In addition, there has been reluctance to apply new interventions whose cost-effectiveness has not been adequately evaluated. A cost-effectiveness analysis based on over 1000 high-risk patients undergoing abdominothoracic surgery, with effectiveness measured in terms of numbers of deaths from pulmonary embolism averted, has shown subcutaneous administration of heparin in low doses starting 2 hours before the operation to be the most cost-effective of several active approaches to prophylaxis. It averted seven of the eight deaths expected without active prophylaxis per 1000 such patients and cost half as much as the traditional approach of intervening only when venous thromboembolism becomes clinically apparent. Intravenous administration of dextran, although effective, was expensive, and leg scanning with iodine-125-labelled fibrinogen was extremely expensive. Intermittent pneumatic compression of the legs was inexpensive, but, as with leg scanning, its effectiveness has not been determined in randomized trials.

Economics of polymer blends

Abstract: Economic, technological, and regulatory pressures gradually narrow the chemical variety of polymers: in 1975, the market share of polyethylene was 40 percent, poly(vinyl chloride), 23 percent, polystyrene, 12 percent, and polypropylene, 11 percent, adding up to 86 percent of all thermoplastics (1-3). The same pressures compel the plastics processor to diversify formulations and production methods. He must resort to new materials (e.g., polymer blends, polymer alloys, and composites) and new methods of manufacture. In this work, the economics of blending will be discussed. There are five reasons to employ polymer blends: higher performance at a reasonable price, modification of performance as a market develops, extending the performance of expensive resins, re-use of plastics scrap, generation of a unique material as far as its processabilitv and/or performance are concerned. In Canada, the cost of blending varies from 8 to about 20 ¢/lb, depending primarily on the volume and the kind of material. The cost effectiveness depends on the total technical and economic environment in which the manufacturer operates; it has to be computed for each case separately. In the text, guidelines and examples are provided.

Ground‐Water Network Design for Northwest Kansas, Using the Theory of Regionalized Variables

Abstract: The ground-water observation well network in many parts of Kansas has been developed and expanded through the years without serious attempt to determine the adequacy of the network for any specified purpose or to assess its cost effectiveness. This study was undertaken to examine the existing well network in northwest Kansas and to determine the arrangement that offers the most satisfactory accuracy for the purpose of monitoring it. To achieve this goal, we have employed the theory of regionalized variables to estimate the amount of spatial variability of the water table. The error analysis produced by universal kriging indicates that a significant reduction in the number of wells could be achieved by employing a regular 4-mile (6.4-km) network, without affecting the present level of accuracy. It also indicates that it is not practical to reduce the estimation error in the water-table surface uniformly throughout the region because to do so would increase the cost of monitoring wells drastically. For example, reducing the presently existing error by 50 percent throughout the area would require 16 times more wells than the currently existing well network.

Length of stay of psychiatric patients. A critical review and discussion.

Abstract: In this paper, length of stay for psychiatric inpatients (LOS) is discussed in terms of controlled studies of hospitalization, research on patient factors contributing to LOS, and variation in mean or median LOS between institutions and within units. Although the multiplicity of variables involved precludes ready generalization, it can be said that open-ended hospital stays, above 28 days, have not been demonstrated to improve outcomes. However, the complexity of specific circumstances makes it unrealistic to impose rigid uniform standards within or across units. Medically managed units with a director as the locus of decision making may be in a better position to control LOS. Research into relationships between different treatment milieus and outcomes for specific diagnoses is suggested as a promising avenue for further research into cost effectiveness of hospitalization. Language: en

Cost effectiveness of individual vs. group cognitive behavior therapy for problems of depression and anxiety in an HMO population.

Abstract: Randomly assigned 44 outpatient Ss, enrollees of the George Washington University Health Plan, a Health Maintenance Organization (HMO), to one of three treatment modalities: (1) a cognitive behavior therapy group; (2) a traditional process-oriented interpersonal group; and (3) cognitive behavior therapy in an individual format. All Ss were referred by their physicians to the HMO Mental Health Practice for treatment for anxiety and/or depression. Beck's Depression Inventory, Speilberger's State-Trait Anxiety Inventory and Gay and Galassi's Adult Self-Expression Scale (an assertion measure) were administered pre- and post- treatment to all Ss. A subsample of these Ss also were rated pre- and post-treatment on the Hamilton Rating Scale for Depression by experienced clinicians blind to the treatment groups. All three experimental groups significantly improved on all dependent measures from pre- to post-treatment, and no differential treatment effects were found.

Measures that discriminate among online searchers with different training and experience

Abstract: The major research objectives were to identify the differences among the searchers of users of online bibliographic systems who have different backgrounds of training and experience, and the differences among the searches of persons with and without experience of the Eric database. A quasi‐experimental research design used forty‐two searchers separated into five experience levels who conducted two pre‐selected searches using the Dialog system and the Eric database. The results were measured with variables which related to the search outcome, i.e., cost effectiveness, precision, and recall and to the search process and errors.

Cost-effectiveness appraisal of immunization programmes.

Abstract: This paper describes a cost-effectiveness analysis of the immunization programs in Indonesia the Philippines and Thailand using the program costing guidelines developed for the WHO Expanded Program on Immunization (EPI). The principal organizational features of each program are outlined and total costs and costs/fully immunized infant are assessed at a small sample of health centers in each country. Costs were found to average US $2.86 in Indonesia US $4.97 in the Philippines and US $10.73 in Thailand. At each health center the main element of total immunization costs was fixed so that average costs/fully immunized child fell as coverage levels and activity rates rose. The implications of this preliminary analysis are considered for each country and common managerial issues in EPI in particular and primary health care in general are detailed. Program organization health care input costs and population accessibility are considered as explanations of the observed differences in immunization costs. The feasibility of undertaking routine cost-effectiveness monitoring of immunization and other primary health care programs is considered. (authors) (summary in FRE)

Cost-effectiveness of community-based long-term care: current findings of Georgia's alternative health services project.

Abstract: A study of the cost-effectiveness of community-based, long-term care was conducted with voluntary enrollees eligible for Medicaid reimbursed nursing home care. One year after enrollment, average longevity was greater for the 575 clients in the experiment group, but average Medicaid plus Medicare costs for this group were higher than for the 172 clients in the control group. Among those more at risk of entering a nursing home, costs for persons in the experimental group were somewhat lower than for those in the control group. The results suggest that community-based services targeted to those most at risk of institutionalization may be cost-effective.

Cost Effectiveness of Lead Screening

Abstract: Lead-screening programs may reduce childhood disabilities, but at what cost? Through a review of the literature, we performed a cost-effectiveness analysis in which the costs, savings, and health benefits of two lead-screening strategies — employing either a free erythrocyte protoporphyrin assay or blood lead measurement — were compared with each other and with a strategy of no screening in a population of three-year-old children. When the prevalence of lead poisoning among the children screened is 7 per cent or more, we estimate that free erythrocyte protoporphyrin screening averts morbidity and results In net savings: It is both better and cheaper than no screening. At prevalences below 7 per cent, the net positive costs from screening and early treatment must be weighed against the noneconomic benefits of improved quality of life and considered in relation to other investments that could be made to benefit society. At all prevalence rates, free erythrocyte protoporphyrin screening is more cost...

Urinary Prophylaxis with Trimethoprim and Trimethoprim-Sulfamethoxazole: Efficacy, Influence on the Natural History of Recurrent Bacteriuria, and Cost Control

Abstract: Low-dose trimethoprim (TMP), trimethoprim-sulfamethoxazole (TMP-SMZ), and nitrofurantoin macrocrystals were found to be safe and effective as prophylaxis against recurrent urinary tract infections. Women given placebo had 2.8 infections per patient-year during the six-month study period, while women given TMP, TMP-SMZ, or nitrofurantoin had significantly lower infection rates (0.015 per patient-year). The effect of prophylaxis appeared to be limited to the period when the agents were taken. Only one patient had a TMP-resistant coliform isolated from cultures obtained during prophylaxis and six months afterwards. The sole factor associated with the recurrence of infection after prophylaxis was a history of three or more infections in the year preceding prophylaxis. Thirty-one of the 60 women in the trial were monitored for a mean of 6.1 years before and 3.2 years after they entered the study. Analysis of infection rates indicated that about half these women were experiencing an infection cluster when they entered the study and that the prestudy baseline infection rate correlated with the poststudy rate. Thus, prophylaxis did not appear to exert a long-term effect on the baseline infection rate. Urinary prophylaxis generally appears to become cost-effective when the baseline infection rate exceeds two per patient-year.

Costs of care.

Abstract: This summary of health care costs in Shanghai County China is based on information provided by the Shanghai County Bureau of Health and Information obtained in the special household survey on illness and use of health care services. Some information was obtained from a special sample study of factories carried out by the Shanghai County Bureau of Health. 3 different types of analyses are presented: overall health expenditures by system costs/service in selected facilities and a limited cost-effectiveness analysis of selected programs. Gaps in the data make it difficult to carry out detailed comparisons between the systems. The total identified health expenditures in Shanghai County in 1980 amounted to 9350000 yuan (at the time this paper was written 1 yuan was approximately equivalent to U.S. $0.60). Of this total 3277000 yuan represented direct government appropriations of which 451360 yuan was in support of the government welfare system of care and 1494240 was for salaries of health personnel in county and commune/town hospitals. The remainder was spent in other County Health Bureau activities including Maternal and Child Health Family Planning the Health and Anti-Epidemic Station the vocational medical school and the drug and reagent control unit. Total estimated expenditures for outpatient services were just over 1 million yuan and were 687140 yuan for inpatient services. The average outpatient cost/visit was 2.83 yuan. The average cost/day of hospitalization was 6.86 yuan exclusive of food costs. Dividing total expenditures by the number of persons covered yields an annual per capita expenditure in the cooperative health system (at the brigade level) of 7.99 yuan/person covered of which 7.71 yuan is for curative services and 0.28 yuan is for preventive services. Workers in the 2 brigade operated factories had substantially lower rates of use of the factory clinic than was true for workers at the other factories. Information provided by personnel of the Health and Anti-Epidemic Station allowed limited cost-effectiveness analysis of 2 activities--vaccination programs and filariasis screening. Overall there has been a 93.5% reduction in the incidence of polio since the program began and it can be estimated that the program prevented 859 cases of polio. Analysis of the measles vaccination program indicates a 95.3% reduction in reported incidence and an estimated total of over 100000 cases prevented. The filariasis program initially quite cost-effective has lost its cost-effectiveness to the extent that discontinuation of the program should receive serious consideration.

Clinical use of spacer systems for corticosteroid inhalation therapy: a preliminary analysis.

Abstract: This is a preliminary report on the first half of a study designed to assess the ability of two different spacer devices to improve the results of aerosol steroid treatment in chronic asthmatic patients given budesonide in low and high dosages. The spacers significantly reduced oropharyngeal candidiasis but did not affect dysphonia - possibly because the incidence of the latter was so low throughout the study. The spacers augmented the airway response to budesonide in these patients without materially increasing systemic absorption of the drug (assessed indirectly in terms of the change in blood eosinophil counts). Pretreatment with inhaled terbutaline did not significantly affect the performance of the spacers, either in terms of the airways responses or the amount of budesonide systemically absorbed. When used properly, these spacers can improve the cost effectiveness of aerosol steroid treatment. Since only adults were studied, it is not known whether these findings apply equally well to children with asthma.

How to Improve Schools without Spending More Money.

Abstract: Harder times for schools are by now familiar in many districts across the U.S. We are headed into a period of fiscal stringency and what I would call a fiscal steady state (no growth or decline in per pupil expenditures, after inflation is fac tored out). The fiscal situation will vary across districts, of course, but it is clear that schools as a whole cannot expect to improve as they did in the past: by adding programs or personnel, new categorical ventures, and new functions. How then can schools get better in hard times? Given the broad social functions we ex pect U.S. schools to fulfill, the effort to improve them inevitably heightens fric tion among their constituencies. Consider briefly these objectives we cherish for schools:

Diabetic retinopathy - need and demand for photocoagulation and its cost-effectiveness: evaluation based on services in the United Kingdom.

Abstract: Photocoagulation services in the two Regions, north of the River Thames, treated 6,589 cases of diabetic retinopathy (including an annual incidence of 309 cases) or 20% of the estimated total need for photocoagulation. Sixty-one percent of diabetic retinopathy patients have disease in both eyes. It is cheaper to treat a patient with diabetic retinopathy than to look after a blind person for one year. Hence, adequate training in the identification and early treatment of diabetic retinopathy requiring photocoagulation is urgent.