Showing papers on "Cost effectiveness published in 1986"
TL;DR: Monitoring schizophrenic patients undergoing rehabilitation for symptomatology and use of suggested operational criteria for defining clinical states such as relapse would improve outcome studies on rehabilitation interventions.
Abstract: Although precise laboratory methods for measuring psychopathology are not available, interviewer-rated instruments developed to assess symptomatology can be used to monitor schizophrenic patients undergoing rehabilitation. By regularly assessing patients, rehabilitation staff can improve the effectiveness of their interventions. Patients can be screened for high levels of symptomatology which might preclude assignment to rehabilitation programs with high levels of social stimulation. Monitoring the prodromal symptoms of relapse can sometimes prevent florid relapses and sustain a rehabilitative trajectory. Standardized instruments for measuring positive symptoms (e.g., hallucinations, delusions, and conceptual disorganization) and negative symptoms (e.g., affective blunting, amotivation, and asociality) are available. Monitoring target symptoms may be particularly cost effective in the rehabilitation milieu. Use of suggested operational criteria for defining clinical states such as relapse would improve outcome studies on rehabilitation interventions.
601 citations
295 citations
TL;DR: TJR is more cost-effective for patients with the most to gain and less effective for those with better preoperative health status, and more effective for patients who initially had the poorest health.
Abstract: Although total joint replacement (TJR) is a major advance in the treatment of patients with osteoarthritis, its cost-effectiveness has been questioned. We report the results of a study of the costs and benefits of TJR in consecutive osteoarthritis patients, 6 months after the surgery. Health status was measured by the Index of Well-Being. Costs of services for arthritis were determined by interview and billing records. Six months after TJR, significant improvements were seen in global health and in functional status. The average cost of care for the 6 months prior to TJR was $933. The average cost during the 6 months beginning with the TJR was $22,730 per patient--due almost entirely to costs of surgery. In general, the surgery did not change work status, probably because the mean age of the patients was 66.4 years. There were large effectiveness/cost differentials (the larger the effectiveness/cost differential, the higher the degree of cost-effectiveness [CE]). At 6 months, for all patients, the CE was associated with initial health status. The highest CE was observed in 10 patients who initially had the poorest health. TJR is more cost-effective for patients with the most to gain and less effective for those with better preoperative health status.
220 citations
TL;DR: The relationship between decentralization and the effectiveness of strategic business units (SBUs) within multibusiness organizations is examined in this paper, where three strategic continua are considered: Gupta and Govindarajan's (1984) build-harvest, Porter's (1980) differentiation low cost, and Miles and Snow's (1978) prospector-defender.
Abstract: The relationship between decentralization and the effectiveness of strategic business units (SBUs) within multibusiness organizations is examined. Three strategic continua are considered—Gupta and Govindarajan's (1984) build-harvest, Porter's (1980) differentiation-low cost, and Miles and Snow's (1978) prospector-defender; in each case it is proposed that the degree of decentralization of decision-making authority delegated to the general manager of the SBU should be closely aligned with the SBU's strategy to optimize the effectiveness of the SBU.
186 citations
TL;DR: Government and industry have applied the blunter instruments of prospective payment systems and reductions in the number of people with health insurance and the comprehensiveness of coverage to achieve cost containment.
Abstract: Cost containment has dominated recent debate on health policy. Most analysts agree that skyrocketing costs necessitate constraints on the amount of medical care delivered, but the best way to effect such rationing remains controversial.1 , 2 Clinical epidemiologists and economists have used cost-effectiveness analysis and other tools to dissect the necessary from the superfluous in medical practice.3 , 4 Government and industry have applied the blunter instruments of prospective payment systems and reductions in the number of people with health insurance and the comprehensiveness of coverage.5 6 7 While attention has been riveted on reducing the volume of services, the cost effectiveness of many nonclinical health . . .
181 citations
TL;DR: The findings indicate that nicotine gum is a cost-effective adjunct to physician's advice against cigarette smoking in a primary care setting, and compares favorably with other widely accepted medical practices.
Abstract: A nicotine chewing gum has recently become available for use as an aid in giving up cigarette smoking. Although its efficacy has been demonstrated in clinic-based smoking cessation programs, its value in a primary care setting is uncertain. We examined the cost-effectiveness of nicotine gum as an adjunct to physician's advice and counseling against smoking during routine office visits. Our findings indicate that the cost per year of life saved with this intervention ranges from $4113 to $6465 for men and from $6880 to $9473 for women, depending on age. This compares favorably with other widely accepted medical practices, eg, treatment of hypertension or hyperlipidemia. Our study, therefore, suggests that nicotine gum is a cost-effective adjunct to physician's advice against cigarette smoking in a primary care setting. (JAMA1986;256:1315-1318)
180 citations
TL;DR: Current levels of vaccination appear too low considering the potential health benefits and cost-effectiveness, and the low estimates of 10% of pneumonia as pneumococcal and a 3-year duration of immunity now appear more likely.
Abstract: We updated a 1978 cost-effectiveness analysis of vaccination against pneumococcal pneumonia in light of the introduction in 1983 of a 23-valent vaccine, recent medical literature, and different relative prices of medical services. Although other base-case assumptions have remained reasonable, the low estimates of 10% of pneumonia as pneumococcal and a 3-year duration of immunity now appear more likely. Vaccination of a person age 65 or older could gain a year of healthy life for about $6000 in 1983 dollars. Medicare has covered pneumococcal vaccination since 1981. With the revised assumptions, net Medicare expenditures ranged from about $5.50 to $10.50 per vaccination, or from $4400 to $8300 per year of healthy life gained. Vaccination of an elderly person would almost break even, if duration of immunity were 8 years and would be cost saving if the vaccine were administered under a public program. Current levels of vaccination appear too low considering the potential health benefits and cost-effectiveness.
132 citations
TL;DR: In this paper, the authors synthesize empirical research on the effects of scale (enrollment size) on average cost per student in higher education using a meta-analytic approach.
Abstract: Abstract: This study synthesizes empirical research on the effects of scale (enrollment size) on average cost per student in higher education using a meta-analytic approach. Results are reported separately for two-year colleges, four-year colleges, and universities, and for expenditures in several areas including instruction and administration. The institution is the primary unit of analysis. Scale effects are most noticeable at low enrollment levels and for administrative functions.
123 citations
TL;DR: A cost-effectiveness analysis of the three alternative regimens of isoniazid preventive therapy indicates that a regimen of 24 weeks' duration is more cost-effective than either the 12- or 52-week regimen.
Abstract: Daily administration of isoniazid for one year to persons infected withMycobacterium tuberculosisis effective in considerably reducing the risk of disease From a practical viewpoint, this approach to prevention is less than ideal because it results in considerable costs as health care providers monitor for possible hepatotoxic effects and because it is difficult to maintain compliance for 12 months The efficacy and toxicity of isoniazid preventive therapy regimens of 12, 24, and 52 weeks' duration were recently assessed in a study conducted in Eastern Europe We used data from this study to conduct a cost-effectiveness analysis of the three alternative regimens The results indicate that over a wide range of assumptions, a regimen of 24 weeks' duration is more cost-effective than either the 12- or 52-week regimen Using base case estimates, the cost per case prevented for the 24-week regimen was $7,112, compared with $16,024 for the 52-week regimen Among a cohort of 1,000 persons treated, each additional case prevented by the 52-week regimen would cost $80,807 Thus, a shorter course of isoniazid preventive therapy is relatively cost-effective compared with current policy (JAMA1986;255:1579-1583)
119 citations
TL;DR: In this paper, the authors investigated how the increased use of computers affects clerical and managerial employment and found that the net effect of computers in 1972-78 was to depress the employment of clerks and managers substantially, but that the pattern over time supported the bureaucratic reorganization hypothesis.
Abstract: This paper investigates how the increased use of computers affects clerical and managerial employment. The author hypothesizes that the much-discussed displacement effect—computers taking over for clerks—is offset at least in part by complementary effects. For example, computers may increase clerical and managerial employment by lowering unit cost, thus expanding production, and by inducing structural reorganization of the firm. Analyzing new data from a national survey of computer installations by industry, the author finds that the net effect of computers in 1972–78 was to depress the employment of clerks and managers substantially, but that the pattern over time—a larger displacement effect in the first few years, followed by increased clerical and managerial employment—supports the bureaucratic reorganization hypothesis.
118 citations
TL;DR: In this article, the authors describe several advantages and disadvantages of the construction industry for innovation, including project organization, necessity and challenge, engineering and construction integration, low capital investment, capability and experience of key personnel, process emphasis, and variation in methods.
Abstract: Construction presents important opportunities for innovation. Current competitive conditions and owner demands for cost effectiveness provide strong incentives. Examining mechanisms for innovation rather than barriers to technical progress is one means to stimulate advance. This paper describes several advantages and disadvantages which the construction industry presents for innovation. The advantages include project organization, necessity and challenge, engineering and construction integration, low capital investment, capability and experience of key personnel, process emphasis, and variation in methods. Major disadvantages for construction include investment reluctance, competitive conditions, institutional framework, seasonal and economic cyclicity, and the role of suppliers. Based on these conditions, a set of hypotheses is developed (project demands, individual initiative, construction input to design, and transfer from other industries) concerning possible mechanisms for innovation in construction....
TL;DR: The results suggest the usefulness of a cost-benefit approach in understanding consumer information-seeking for nutrition; they emphasize the importance of examining consumers' use of a variety of information sources and support recent suggestions for segmentation of the audience for nutrition information.
Abstract: Much consumer research on nutrition information-seeking has focused on prepurchase label reading. This study examines the search for nutrition information from a broader group of sources, because prepurchase label reading appears to be only a small part of consumers' total search. The use of different information sources was analyzed using 2 cost benefit model for search. Benefits are related to the importance of nutrition to the consumer, and to obtaining better food value. Although the model fits better for some sources than for others, support was obtained for the model. The results suggest the usefulness of a cost-benefit approach in understanding consumer information-seeking for nutrition; they emphasize the importance of examining consumers' use of a variety of information sources and support recent suggestions for segmentation of the audience for nutrition information. Policy makers may be able to encourage search for nutrition information by emphasizing the enduring importance of nutrition to consumers.
TL;DR: The main valid objection to an experiment is neither methodological nor ethical, it is the experiment's cost in relation to that of nonexperimental methods of analysis as discussed by the authors, and the offsetting gain from experimentation is the inherent reliability of experimental estimates of treatment effects.
Abstract: The critical element that distinguishes classical experiments from all other modes of analysis is the random assignment of treatment to enrollees in a study. This paper examines the major methodological advantages of random assignment for the purpose of estimating the effectiveness of current manpower policy. It also reviews the claimed methodological and ethical objections to experiments. The main valid objection to an experiment is neither methodological nor ethical, it is the experiment's cost in relation to that of nonexperimental methods of analysis. The authors argue that the offsetting gain from experimentation is the inherent reliability of experimental estimates of treatment effects. The paper offers a simple framework for deciding whether the improved reliability of treatment-effect estimates is worth the added cost of experimentation. It concludes with an assessment of the actual value of experiments for evaluating current manpower policies.
TL;DR: Those interventions for which the evidence for high effectiveness and feasibility is strong are concentrated on, including promotion of breastfeeding weaning education measles immunization improving water supply and sanitation promotion of hygiene and when the new vaccines are available rotavirus and possibly cholera immunization.
Abstract: Oral rehydration therapy (ORT) has become the cornerstone of most programs of diarrhea control and is highly effective in preventing death from dehydration caused by acute watery episodes of diarrhea. The effectiveness of ORT in reducing mortality from chronic or dysenteric diarrheas is believed to be low and in addition ORT can be expected to have little or no impact on diarrhea morbidity rates. In view of this ORT should be complemented by other interventions designed to avert mortality not averted by ORT and to reduce morbidity rates. The Diarrheal Diseases Control Program of WHO has initiated a systematic study of the effectiveness and cost of interventions that are potentially useful in diarrhea control. This paper summarizes the findings of this study concentrating on those interventions for which the evidence for high effectiveness and feasibility is strong. These are: promotion of breastfeeding weaning education measles immunization improving water supply and sanitation promotion of hygiene and when the new vaccines are available rotavirus and possibly cholera immunization. Estimates are presented of the cost-effectiveness of these interventions in reducing diarrhea morbidity and mortality rates among children under 5 years of age. (authors)
TL;DR: It is concluded that percutaneous gastrostomies are relatively safe, cost-effective, and should be given first consideration for long-term enteral therapy in appropriate patients.
Abstract: The results of the first 55 consecutive percutaneous endoscopic gastrostomies (PEGs) that were performed over an 18-month period in a tertiary care center are presented. We followed these cases prospectively to assess the morbidity, mortality, staff acceptance, short- and long-term complications, and cost effectiveness of the technique. Fifty-one (93%) were successful with no mortality. Long-term morbidity included 6/ 55 (11%) tube extrusions; 5/55 (9%) cellulitis around the catheter site; 5/55 (9%) aspiration pneumonias; and 2/55 (3.6%) clogged tubes requiring replacement. Morbidity was considered minor and easily dealt with in all but five instances (9%) where more prolonged treatment was required. A review of the literature including other techniques used for percutaneous gastrostomy is also presented. It is concluded that percutaneous gastrostomies are relatively safe, cost-effective, and should be given first consideration for long-term enteral therapy in appropriate patients. (Journal of Parenteral ...
TL;DR: Most chemicals to which the authors are exposed are not properly tested for carcinogenicity, and in vitro testing provides a way of screening with sufficient accuracy to remedy this situation.
Abstract: Most chemicals to which we are exposed are not properly tested for carcinogenicity. The latest methods of in vitro testing provide a way of screening with sufficient accuracy to remedy this situation.
TL;DR: Oral rehydration is a safe and cost-effective means of treating dehydrated children in an outpatient setting in the United States and the use of a holding room for observation in the emergency room can markedly decrease health care costs and unnecessary hospitalizations.
Abstract: • Twenty-nine dehydrated, well-nourished infants, who were 3 to 24 months of age and had acute gastroenteritis, were enrolled in a prospective randomized study that compared the safety, efficacy, and costs of oral vs intravenous rehydration. The study was designed to assess the use of a holding room in the emergency room for the outpatient rehydration of dehydrated infants. The oral solution that was used contained 60 mEq/L of sodium, 20 mEq/L of potassium, 50 mEq/L of chloride, 30 mEq/L of citrate, 20 g/L of glucose, and 5 g/L of fructose. Thirteen of 15 patients were successfully rehydrated orally as outpatients; two patients, who were subsequently discovered to have urinary tract infections, required hospitalization due to persistent vomiting. Orally rehydrated outpatients spent a mean of 10.7 hours in the holding room, as compared with intravenously rehydrated inpatients, who were hospitalized for a mean of 103.2 hours. Outpatient oral rehydration therapy was significantly less costly than inpatient intravenous therapy ($272.78 vs $2,299.50). Our results indicate that oral rehydration is a safe and cost-effective means of treating dehydrated children in an outpatient setting in the United States. The use of a holding room for observation in the emergency room can markedly decrease health care costs and unnecessary hospitalizations. (AJDC1986;140:211-215)
TL;DR: Since FNA biopsy is cost effective even when followed by an excisional or frozen section biopsy for confirmation, it would be safe and reasonable to expand its use to smaller hospitals where the personnel may be initially less experienced with the technique.
Abstract: Although fine needle aspiration (FNA) biopsy of the breast has been shown to be a safe and accurate technique, many surgeons question whether it is reliable enough to replace excisional biopsy. If FNA biopsy is followed by excisional biopsy for confirmation, it would seem that the cost of diagnostic work-up would be increased. In this study, however, the authors show that the major economic benefit of FNA biopsy is not that it replaces excisional biopsy, but that it allows the surgeon to triage which patients should have a 1-stage inpatient procedure with frozen section and which patients should have an excisional biopsy as an outpatient under local anesthesia. Over the past 2 years, the average cost at the East Carolina University School of Medicine of excisional outpatient biopsy (negative) was +702 +/- 348; inpatient biopsy (negative) was +1410 +/- 262; inpatient 1-stage procedure (positive) was +4135 +/- 361; and outpatient biopsy (positive) followed by inpatient procedure was +4822 +/- 586. The authors' last 100 FNA biopsies were read as 23 positive, three suspicious, 65 negative, and nine insufficient. There were no false-positives and four false-negatives, for a sensitivity of 87%, specificity of 100%, and accuracy of 96%. Using the above figures, it is possible to calculate the cost per case if all 100 cases had been biopsied by the 1-stage inpatient technique (+2227), by the 2-stage outpatient method (+1938), or guided by the FNA biopsy where positive and suspicious readings are followed by an inpatient 1-stage procedure and negative and insufficient readings followed by an outpatient 2-stage procedure (+1759). Since the FNA biopsy costs +75, it resulted in a savings per case of +393 over routine inpatient biopsy and +104 per case over routine outpatient biopsy. Computer analysis revealed that the FNA biopsy would still be economically favorable if the sensitivity of the test fell as low as 37%, the specificity as low as 80%, or if the percentage of cases of cancer in the population biopsied fell as low as 13%. Since FNA biopsy is cost effective even when followed by an excisional or frozen section biopsy for confirmation, it would be safe and reasonable to expand its use to smaller hospitals where the personnel may be initially less experienced with the technique.
TL;DR: In this article, the authors extend the existing literature on educational cost functions in the following ways: it employs flexible cost functions to comply with prior theoretical expectations about price homogeneity without the imposition of overly restrictive assumptions regarding the technological structure; it examines possible complementarities in the provision of different levels of schooling by treating schools as multiproduct firms; and it uses disaggregated school-level data for two developing countries.
TL;DR: There were 288 fewer than expected fatal strokes and myocardial infarctions during the first 5 years of the North Karelia Hypertension Program; 134 of these are attributable to the hypertension program.
Abstract: The North Karelia Hypertension Program was initiated in 1972 as part of the North Karelia Project. This article examines the costs and effects of the first 5 years of the project. There were 288 fewer than expected fatal strokes and myocardial infarctions during the period; 134 of these are attributable to the hypertension program. The costs of the hypertension program totalled $5.16 million. Drugs consumed 86% of this cost. Using the zero discount rate as an outside boundary, the program is expected to increase old age pension costs by $2.5 million for the 5 years but will decrease earnings losses by $7 million for the same period. With earnings excluded, the cost per quality-adjusted life-year gained is $3,612 at zero discount and $5,830 at 10% discount. Hypertension care is more cost-effective than many of the treatments applied after the appearance of coronary heart disease symptoms but would be much more cost-effective if hypertension could be treated as effectively without medications or if the costs of medications could be reduced.
TL;DR: Empiric treatment of all patients attending the clinic was the most cost-effective strategy, followed by empirical treatment of high-risk women and culture-based treatment of low- risk women, and therapy based on diagnostic test results in women at low risk.
Abstract: We have evaluated the cost-effectiveness of using cell culture to test for chlamydial infections in 9979 patients at a clinic for sexually transmitted diseases. From results of cultures, we have established prevalence data and, using decision-theory analysis, have calculated costs and probabilities of various outcomes. According to their histories and presenting signs and symptoms, patients were classified as at high or low risk for chlamydial infections. Empiric treatment of all patients attending the clinic was the most cost-effective strategy, followed by empiric treatment of high-risk women and culture-based treatment of low-risk women. Obtaining cultures for men at high and low risk was not cost-effective. If universal treatment is not provided, the most cost-effective strategy appears to be empiric therapy in patients at high risk for chlamydial infections and therapy based on diagnostic test results in women at low risk.
TL;DR: In the five intervening years, the number of economic evaluation studies has grown to several hundred; some of the methodologic challenges have been met, and progress has been made on others; but new challenges have arisen out of the pragmatic efforts of those involved in cost-effectiveness evaluation.
Abstract: cost-benefit studies, and cited numerous methodologic problems and obstacles to implementation. In the five intervening years, the number of economic evaluation studies has grown to several hundred; some of the methodologic challenges have been met, and progress has been made on others; but new challenges have arisen out of the pragmatic efforts of those involved in cost-effectiveness evaluation. Meanwhile, changes in the financial and economic environment in which health care is delivered have created new
TL;DR: Both gauze and MVP dressings proved effective for the treatment of grade III ulcers, and the MVP improved the healing rate and was more cost effective for grade II ulcers.
TL;DR: The analysis reveals that treating 80% of patients through ambulatory R and E regimes would have reduced total health expenditures for tuberculosis care by two thirds compared to inpatient regimes based on TH, and the number of people complying and cured would have doubled.
Book•
01 Feb 1986
TL;DR: Managing Hospital Infection Control for Cost-Effectiveness should be required reading for every board chairperson, hospital administrator, hospital epidemiologist , infection control practitioner, infection control committee member, risk manager, and quality assurance coordinator, and the approach advocated, "Surveillance by Objectives," should certainly be the method of choice to initiate or refocus any infection surveillance and control program.
Abstract: Change your habit to hang or waste the time to only chat with your friends. It is done by your everyday, don't you feel bored? Now, we will show you the new habit that, actually it's a very old habit to do that can make your life more qualified. When feeling bored of always chatting with your friends all free time, you can find the book enPDF managing hospital infection control for cost effectiveness and then read it.
TL;DR: It is shown that the generalized ordering policy minimizing the cost rate or maximizing the cost effectiveness is either one of the two typical ordering policies: (1) the original unit is replaced as soon as the ordered spare is delivered, or (2) the delivered spare is put into inventory until the originalunit fails.
Journal Article•
TL;DR: With chronic institutionalized psychiatric patients, an intensive social learning program resulted in greater increases in adaptive functioning, reductions in bizarre behavior, less prescribed medication, and over 98 percent of patients being successfully discharged into the community.
Abstract: With chronic institutionalized psychiatric patients, an intensive social learning program resulted in greater increases in adaptive functioning, reductions in bizarre behavior, less prescribed medication, and over 98 percent of patients being successfully discharged into the community. The social-learning program was more cost-effective than custodial hospital care, and nonprofessional staff were able to apply the treatment with a high degree of competence. Especially effective elements of the social-learning program included integrated procedures emphasizing the acquisition of patient skills and the reduction of bizarre, inappropriate behavior; a token economy structure; and consistent pacing and generalization training. More recent research in the area has sought to identify the remediative aspects of social-learning programs, to specify patient variables that are related to improvement in a token economy, and to offer patients more specialized interventions (e.g., social skills training) in conjunction with a standard token economy. With the demonstrated and operationalized efficacy of social-learning procedures, the rehabilitation of chronic psychiatric patients has become more feasible.