Showing papers on "Cost effectiveness published in 1985"

The Stanford Five-City Project: design and methods.

Abstract: The Stanford Five-City Project is a large experimental field study of community health education for the prevention of cardiovascular disease. It will provide data on fundamental questions in cardiovascular disease epidemiology, communication, health education, behavior change, and community organization, and will also test the ability of a potentially cost-effective program to prevent cardiovascular disease at the community level. This paper describes the purposes, hypotheses, design, and methods of the Five-City Project as a reference for future papers describing results. It is hypothesized that a 20% decrease in cardiovascular disease risk will lead to a significant decline in cardiovascular disease event rates in two treatment communities compared with three reference communities as a result of a six-year intervention program of community-wide health education and organization. Risk factor change will be assessed through four surveys of independent samples and in a repeatedly surveyed cohort. Cardiovascular disease event rates will be assessed through continuous community surveillance of fatal and nonfatal myocardial infarction and stroke.

Cost-effectiveness of interventions to prevent or treat coronary heart disease.

Abstract: Coronary heart disease (CHD) is the leading cause of death and disability in the United States. One in five Americans develop CHD by their sixtieth birthday (60); of these, 11% will die suddenly and another 44% will suffer nonfatal myocardial infarctions (36). Extrapolating from previous estimates of the national cost of CHD (14), we estimate that the annual economic burden of CHD in the US, including both direct and indirect costs, is well in excess of $100 billion. It is not surprising that such an important disease should be the target for a rapidly growing share of our national resources. Use of technologies such as coronary artery bypass surgery, beta-blocking drugs, and percutaneous trans­ luminal coronary angioplasty (PTCA) has been growing rapidly. Other emerg­ ing technologies, such as intracoronary thrombolysis, calcium-channel­ blocking drugs, and heart transplantation, offer new hope to patients with CHD

Cost-Effectiveness of Coronary Artery Bypass Surgery

Abstract: Coronary artery bypass graft surgery (CABG) has become the mainstay of treatment for patients with severe refractory angina and extensive coronary artery disease (CAD). Approximately 170,000 operations were performed in 1983 in the United States at a cost of $ 20,000 to $ 25,000 per operation for a total cost of between 3 and 4 billion dollars. Hence, CABG contributes significantly to total health care costs and requires special scrutiny to determine whether these costs are justified by the added health benefits enjoyed by recipients.

Immunization of US children with Hemophilus influenzae type b polysaccharide vaccine. A cost-effectiveness model of strategy assessment.

Abstract: Hemophilus influenzaetype b (HIB) is the leading cause of bacterial meningitis in the United States. Efforts are under way to develop vaccines immunogenic in children younger than 18 months, but clinical efficacy of a previously developed HIB polysaccharide vaccine has already been established in children aged 18 months or older. We developed a cost-effectiveness model to evaluate immunizing US children with this HIB polysaccharide vaccine pending development of a more immunogenic product. The model permitted comparison of the impact of alternative strategies for use of the vaccine, including universal use at 18 or 24 months of age, use of a second dose after primary immunization, and use in high-risk groups such as day-care-center attendees. Universal vaccination at 18 or 24 months of age resulted in similar estimates of disease prevented, as a consequence of the higher expected efficacy and duration of immunity for the vaccine when given at 24 months. Overall, the implementation of routine childhood immunization against HIB at 18 months of age was the most cost-effective strategy. Universal vaccination at 18 months of age combined with a second dose for day-care—center attendees would substantially increase the number of cases prevented, with a minimal increase in costs. Universal vaccination with a two-dose schedule beginning at 18 months of age could prevent the most disease. (JAMA1985;253:521-529)

Cost-Effectiveness: A Primer

Abstract: Introduction to Cost Analysis Establishing an Analytic Framework The Concept and Measurement of Costs Placing Values on Ingredients Analyzing Costs Benefits, Effects, and Utility The Use of Cost Evaluations

Benefit-Cost Analysis of the Perry Preschool Program and Its Policy Implications

Abstract: Benefit-cost analysis is applied to the Perry Preschool Program and its long-term follow-up in order to examine preschool education as a social investment. Economic values are estimated for program cost, child care provided, later education cost reductions, increased higher education cost, delinquency and crime cost reductions, earnings increases, and welfare cost reductions. The net present value of benefits and costs is positive, indicating that the program was a profitable social investment. Analysis of the distribution of effects revealed that taxpayers obtained most of the economic benefits and that their benefits exceeded costs. Generalizability of the findings and their implications for public policy are examined.

Economic evaluation of routing strategies for hazardous road shipments

Abstract: Potential risks from hazardous materials spills can be reduced by restricting shipments to designated safe routes. Several criteria can be used for designating safe truck routes with widely varying results. Three distinctive routing strategies for the road transportation of hazardous materials are discussed: minimum risk, minimum accident likelihood, and minimum truck operating costs. Each routing strategy is applied to the Toronto road network, on the basis of 1981 truck accident profiles. Recommended safe routes are analyzed for cost-effectiveness for a wide range of environmental conditions. Two important aspects emerge from this cost-effectiveness analysis: (a) the minimum risk routing strategy produces net economic gains in the form of enhanced safety, and (b) significant trade-offs occur between truck operating costs and safety benefits. These trade-offs are of fundamental concern to the implementation of this type of safety enhancement strategy for the transportation of hazardous materials.

Mail Surveys of Reluctant Professionals

Abstract: This article discusses procedures for improving cooperation to mail questionnaires of professional groups. Some of the methods proposed differ from those used with general populations. The procedur...

The Cost and Effectiveness of School-Based Preventive Dental Care

Abstract: The National Preventive Dentistry Demonstration Program assessed the cost and effectiveness of various types and combinations of school-based preventive dental care procedures. The program involved 20,052 first, second, and fifth graders from five fluoridated and five nonfluoridated communities. These children were examined at baseline and assigned to one of six treatment regimens. Four years later, 9,566 members of this group were examined again. Analyses of their dental examination data showed that dental health lessons, brushing and flossing, fluoride tablets and mouthrinsing, and professionally applied topical fluorides were not effective in reducing a substantial amount of dental decay, even when all of these procedures were used together. Occlusal sealants prevented one to two carious surfaces in four years. Children who were especially susceptible to decay did not benefit appreciably more from any of the preventive measures than did children in general. Annual direct per capita costs were $23 for s...

Utility of cognitive-behavioral procedures for social skills training with children: A critical review

Abstract: Thirty-three studies that have used cognitive-behavioral social skills training procedures were critically reviewed. These studies were classified under four broad categories: modeling, coaching, treatment packages, and social problem solving. Seven criteria were used to critically evaluate these studies: subject characteristics, treatment specification, outcome measures, statistical analyses, experimental design, generalization, and cost effectiveness.

State-of-the-art geophysical exploration for geothermal resources

Abstract: At the present stage of development, use of geothermal energy saves about 77 million barrels of oil per year worldwide that would otherwise be required for electrical power generation and direct heat applications. More than a dozen countries are involved in development of geothermal resources. Currently, only the moderate- and high-temperature hydrothermal convective type of geothermal system can be economically used for generating electric power. Lower-temperature resources of several types are being tapped for space heating and industrial processing. Geophysics plays important roles both in exploration for geothermal systems and in delineating, evaluating, and monitoring production from them. The thermal methods, which detect anomalous temperatures directly, and the electrical methods are probably the most useful and widely used in terms of siting drilling targets, but gravity, magnetics, seismic methods, and geophysical well logging all have important application.Advances in geophysical methods are needed to improve cost effectiveness and to enhance solutions of geologic problems. There is no wholly satisfactory electrical system from the standpoint of resolution of subsurface resistivity configuration at the required scale, depth of penetration, portability of equipment, and survey cost. The resolution of microseismic and microearthquake techniques needs improvement, and the reflection seismic technique needs substantial improvement to be cost effective in many hard-rock environments. Well-logging tools need to be developed and calibrated for use in corrosive wells at temperatures exceeding 200 degrees C. Well-log interpretation techniques need to be developed for the hard-rock environment. Borehole geophysical techniques and geotomography are just beginning to be applied and show promise with future development.

The internist as gatekeeper. Preparing the general internist for a new role.

Abstract: To reduce health care costs, some third-party payers have enlisted primary care physicians as gatekeepers to medical care. In gatekeeper systems, primary care physicians must approve all care provided to their patients. This approval is a condition of payment for the service, with the usual exception of true emergencies. The gatekeeper approach, sometimes called the case-manager plan, extends the responsibility of primary care physicians from coordination to control of medical care. However, for the plan to stimulate cost-effective medical care, it must overcome obstacles that threaten its ability to save money and provide high-quality medical care. If internists are to serve as gatekeepers, then medical educators must ensure that the necessary attitudes, skills, and knowledge are taught to students of internal medicine.

Cost-benefit analysis of a thalassemia disease prevention program.

Abstract: We offer an economic perspective on prevention of beta-thalassemia disease by means of genetic screening and prenatal diagnosis in an established program in Quebec province. The program screens 80 per cent of at-risk persons in the high-risk communities, provides diagnosis to 75 per cent of at-risk couples, and prevented two-thirds of new cases in the period of study. We measured the additional costs, in 1981 Canadian dollars, of medical and public health resources, both incurred and avoided, resulting from use of these prevention services. The total direct cost per case prevented in the program is less than the cost for a single year of treatment for an individual with the disease. Sensitivity analysis accommodating demographic assumptions, participation rates, and discounting rates indicates that, even at rates of marriage, endogamy, and participation lower than observed in the current program, treatment costs will still exceed prevention costs when discounting is set at conventional rates of 4 per cent and 8 per cent. Cost effectiveness of the program is confirmed.

Control of chagas' disease vectors

Abstract: Most Latin American countries are making dramatic progress in controlling Chagas disease, through a series of national and international initiatives focusing on elimination of domestic populations of Triatominae, improved screening of blood donors, and clinical support and treatment of persons infected with Trypanosoma cruzi. Some countries, particularly Uruguay, Chile and Brazil, are sufficiently advanced in their programmes to initiate detailed planning of the subsequent phases of Chagas disease control, while others such as Peru, Ecuador, and Mexico, are currently applying only the initial phases of the control campaigns. In this review, we seek to provide a brief history of the campaigns as a basis for discussion of future interventions. Our aim is to relate operational needs to the underlying biological aspects that have made Chagas disease so serious in Latin America but have also revealed the epidemiological vulnerability of this disease. The English version of this paper is available too at: http://www.insp.mx/salud/index.html.

A university-based incentive program to increase safety belt use: Toward cost-effective institutionalization.

Abstract: A cost-effective incentive program to increase safety belt use was implemented by the campus police of a large university. For each of the 3-week intervention periods during three consecutive academic quarters, the 22 campus police officers recorded the license plate numbers of vehicles with drivers wearing a shoulder belt. From these numbers, 10 raffle winners were drawn who received gift certificates donated by community merchants. Faculty and staff increased their belt usage markedly as a result of the "Seatbelt Sweepstakes," whereas students increased their belt use only slightly. A cost-effectiveness analysis indicated that the sweepstakes cost an average of $0.98 per each newly buckled driver. During each sweepstakes intervention, officers' belt usage increased significantly, but diminished to initial baseline levels after the final withdrawal of the program. Surveys of officers' opinions indicated that the police would accept the program demands as a regular task requirement. This result and the fact that program promotion and coordination were eventually taken over by two student organizations suggest that institutionalization of the "Seatbelt Sweepstakes" is feasible.

Finite Element Matrix and Mass Balance Computational Schemes for Transport in Variably Saturated Porous Media

Abstract: An upstream-weighted residual finite element formulation is developed for the numerical simulation of solute transport in variably saturated porous media Included in this formulation is an influence coefficient scheme for element matrix evaluation and a mass balance computation scheme These schemes are not only simple to implement but also cost effective Three examples are provided to verify the numerical techniques and demonstrate the utility of the computer model These examples indicate that mass balance information serves a useful purpose as a screening device for examining the numerical solution They also show certain behavior of the mass balance error as well as numerical difficulties associated with the manner in which the finite element formulation of the transport equation is performed Finally, information on the CPU time and cost required to solve the three example problems is provided to show the cost effectiveness of the present transport model Although the present analysis considers only two dimensions, the schemes described can be extended to three dimensions, where the time and cost savings are more significant

Design of unpaved roads and trafficked areas with geogrids. polymer grid reinforcement: proceedings of a conference sponsored by the science and engineering research council and netlon ltd and held in london 22-23 march 1984

Abstract: An increasing number of unpaved roads and trafficked areas, such as parking lots and drilling pads, are built using geogrids. These unpaved structures are composed of a base layer placed on a subgrade soil and reinforced with one or several layers of geogrids. At the present time, no design method for these structures is available. This paper presents the initial development of a design method for geogrid-reinforced unpaved structures. The paper reviews the mechanisms through which geogrids can improve the performance of an unpaved structure. An analysis of published full-scale unpaved road data is presented. The analytical development of the design method is described, as is the preparation of design charts. The charts give base layer thickness as a function of the subgrade soil undrained shear strength, geogrid tensile stiffness, traffic, and allowable rut depth of the unpaved structure. The use of the charts is illustrated by a design example. It is pointed out that the design method is still undergoing development and that field and/or laboratory verification of the method is required. When fully developed, the method will allow designers to evaluate the cost effectiveness of geogrids as compared with other methods for constructing unpaved roads and trafficked areas. For the covering abstract of the symposium see IRRD 284425. (TRRL)

The efficacy and cost-effectiveness of minimal-therapist-contact, non-drug treatments of chronic migraine and tension headache.

Abstract: SYNOPSIS Two studies, one involving 53 tension headache patients and the other involving 87 vascular (both migraine and combined migraine and tension headaches) headache patients, are presented in which a largely home-based, self-administered non-drug treatment for headache was compared to a comparable clinic-based, therapist-administered treatment regimen. The home-based treatment programs were equal in effectiveness to the clinic-based programs and significantly more cost effective for both types of headache patients.

Worker Attitudes, Worker Behavior, and Productivity in the U.S. Automobile Industry, 1959–1976:

Abstract: This study tests both a standard model of the production process and an augmented model that incorporates a linkage from worker attitudes to total factor productivity and the total unit cost of production. The authors estimate these models with data on the U.S. automobile industry for the years 1959–76, including plant-level data on grievances, quits, and unauthorized strike activity that provide the basis for an index of the effects of worker attitudes. The augmented model, including that index, is significantly more successful than the standard model in explaining variations in productivity and costs. During the years studied, worker attitudes negatively influenced productivity growth and unit costs, resulting from the failure of both management and labor to create a satisfactory work environment.

Efficacy of prenatal nutrition counseling: weight gain, infant birth weight, and cost-effectiveness.

Abstract: A retrospective study on the effect of intensive nutrition counseling on weight gain of pregnant women and birth weight of their infants was conducted at an outpatient clinic by comparing one group of 86 women who attended only a nutrition class with another group of 114 women who attended the class plus multiple counseling sessions on appropriate weight gain and nutrient intake. The women receiving the counseling on an average gained 2.5 kg more weight, had fewer low-birth-weight infants (4% vs. 13%), and had infants weighing 100 gm more at birth. That indicates that intensive nutrition counseling results in a superior outcome of pregnancy. When the cost of intensive neonatal care for six infants was compared with the cost of nutrition counseling, a benefit-to-cost ratio of 1:5 was found.

Cost-effectiveness in the diagnosis and treatment of carcinoma of unknown primary origin

Abstract: Between 2% and 9% of patients with cancer present with metastatic nonsquamous cell carcinoma of unknown primary origin. Traditionally, a series of investigations is undertaken to locate the primary origin of the tumour, although many of these tests are often painful or distressing to patients, unsuccessful in locating the primary site and costly to the health care system. Moreover, even if a tumour is found it usually cannot be treated surgically. However, a small number of cancers of unknown primary origin can be cured, arrested or effectively palliated with systemic treatment. This study compares the costs and outcomes of the current practice of comprehensively searching for the primary tumour with those of an alternative, limited approach that identifies only the primary tumours for which relatively effective systemic therapy exists. Decision trees were constructed for the two diagnostic approaches and their associated therapeutic options. Costs and probabilities were integrated with published data on the survival of patients with each type of cancer. The results indicate that the comprehensive diagnostic strategy may increase 1-year survival rates from 11.0% to 11.5%. On the basis of Ontario cost data it is calculated that the additional costs of a comprehensive search for 1000 patients will range from approximately $2 million to $8 million, depending on the subsequent treatment strategy.

The Cost of Public Schooling in New York State: The Role of Scale and Efficiency in 1978-79.

Abstract: Cost differentials between large and small school districts are decomposed into scale and efficiency effects. The analysis shows that scale economies enjoyed by large districts can come at the expense of the efficient production of educational outcomes. Attention is focused on the possible loss of efficiency associated with efforts to increase size by closing schools and consolidating school districts. Empirical evidence from New York State is presented which shows that lower levels of efficiency exist in large compared to small school districts. Implications for policy are explored.