Showing papers on "Cost effectiveness published in 1987"
Journal Article•
248 citations
TL;DR: This review of six large-scale community-based worker programs suggests that they have succeeded in some of their objectives but not in others, and that their potential has not been achieved in large routine programs.
225 citations
TL;DR: The results suggest that pharmacologic therapy may not be cost-effective for all patients with elevated cholesterol levels, especially those over 65 years of age, and may be comparable with other accepted medical practices.
Abstract: Using cholestyramine as a model, we considered the cost-effectiveness of antihyperlipemic therapy in the primary prevention of coronary heart disease among men between 35 and 74 years of age with elevated levels of total plasma cholesterol. Our findings indicate that the cost-effectiveness of treatment varies substantially, ranging from about $36 000 to over $1 million per year of life saved. Cost-effectiveness was highest for younger patients, for those with additional coronary risk factors (eg, smoking or hypertension), and for those whose course of therapy is of less-than-lifelong duration. Conversely, it is lowest for older patients, for those with no additional coronary risk factors, and for those who are treated for a lifetime. Our results suggest that pharmacologic therapy may not be cost-effective for all patients with elevated cholesterol levels, especially those over 65 years of age. For many younger patients, however—those with additional coronary risk factors and more severe elevations in cholesterol levels—the cost-effectiveness of therapy may be comparable with other accepted medical practices. (JAMA1987;258:2381-2387)
175 citations
TL;DR: In this paper, the average scores on state-developed and nationally standardized tests of third-, sixth-, and ninth-graders in New Jersey districts were regressed on indexes of district socioeconomic status (SES), per-student expenditures on education, and the size of enrollments in the districts.
Abstract: In one of the largest studies yet carried out on the subject, the average scores on state-developed and nationally standardized tests of third-, sixth-, and ninth-graders in New Jersey districts were regressed on indexes of district socioeconomic status (SES), per-student expenditures on education, and the size of enrollments in the districts. The numbers of districts entering the analyses, depending on grade level and test, varied from 261 to 507. SES accounted for much of the accountable variance; higher SES districts, of course, achieved more than lower SES districts. When SES was taken into account, higher expenditures were inconsistently and generally insignificantly (probability less than 0. 05) associated with lower test scores; and students m smaller districts generally achieved more than those in larger districts. The inefficiency of expenditures and diseconomies of scale in rinsing achievement are contrary to popular and considerable opinion but corroborate previous research.
149 citations
TL;DR: The self-help program had the lowest total cost, lowest per cent quit rate, lowest time requirement for participants, and was the most cost-effective of the three smoking cessation programs analyzed.
Abstract: This study analyzed the cost-effectiveness and distribution of costs by program stage of three smoking cessation programs: a smoking cessation class; an incentive-based quit smoking contest; and a self-help quit smoking kit. The self-help program had the lowest total cost, lowest per cent quit rate, lowest time requirement for participants, and was the most cost-effective. The most effective program, the smoking cessation class, required the most time from participants, had the highest total cost, and was the least cost-effective. The smoking contest was in-between the other two programs in total costs, per cent quit rate, and cost-effectiveness; it required the same time commitment from participants as the self-help program. These findings are interpreted within the context of community-based intervention in which the argument is made that cost-effectiveness is only one of several factors that should determine the selection of smoking cessation programs.
130 citations
TL;DR: In this article, the prevalence of syphilis seroreactivity in pregnant women in many parts of Africa is at least 10% and it approaches 20% in some areas, and the incidence of gonococcal ophthalmia neonatorum in neonates appears to be between 2% and 4%.
Abstract: Africa in the 1980s appears to be facing problems associated with syphilis and gonorrhoea during pregnancy similar in severity and magnitude to those faced by the western world in the early 1900s. From a review of published reports, the prevalence of syphilis seroreactivity in pregnant women in many parts of Africa is at least 10%. Assuming this level of seroreactivity, we estimate that 5% to 8% of all pregnancies surviving past 12 weeks will have an adverse outcome caused by syphilis, such as spontaneous abortion, perinatal or infant death, or a living infant with syphilis. Our findings on gonorrhoea during pregnancy are almost as startling. The prevalence of gonorrhoea in pregnant women in many parts of Africa is at least 10% and it approaches 20% in some areas. The incidence of gonococcal ophthalmia neonatorum in neonates appears to be between 2% and 4%. We recommend commitment of health resources to initiatives to prevent and control sexually transmitted disease in Africa and additional research into the cost effectiveness of different prevention and control approaches.
125 citations
TL;DR: One important message to remember is that whenever a patient has evidence of a pituitary tumor, a serum T4 and TSH level must be obtained, and the dramatic reduction in pituitsary size and resolution of endocrine dysfunction with thyroid hormone is gratifying.
119 citations
TL;DR: M-mode echocardiography was favored over 12-lead electrocardiography in each analysis of the cost-effectiveness of these two techniques for detecting left ventricular hypertrophy for clinical or research purposes in patients with hypertension.
Abstract: Although echocardiography is more accurate than electrocardiography for detection of left ventricular hypertrophy, it is also more expensive, making it uncertain whether echocardiography is cost-effective for detection of this abnormality in hypertensive patients. Accordingly, the sensitivity of M-mode echocardiographic and electrocardiographic criteria for left ventricular hypertrophy was determined in necropsied patients with anatomic hypertrophy of mild (n = 26), moderate (n = 21) or severe (n = 46) degree, and the prevalence of each degree of hypertrophy was determined in 561 hypertensive adults drawn from clinical and employed population samples. The sensitivity of echocardiographic left ventricular mass index criteria was 57% in necropsied patients with mild hypertrophy and 98% in patients with moderate or severe hypertrophy. All electrocardiographic criteria exhibited lower sensitivity: 15 to 42% for mild, 10 to 38% for moderate, and 30 to 57% for severe hypertrophy. Cost estimates from three sources were $160 for M-mode echocardiography and $48 to $64 for 12-lead electrocardiography. In populations with a 12 to 40% prevalence of hypertrophy, echocardiography was calculated to cost less than electrocardiography per instance of hypertrophy detected ($390-$1013 vs $800-$1829), yielded better separation in predicted incidence of morbid events between hypertensive patients with or without hypertrophy (3.4-4.7 vs 1.5-2.1 per 100 patient-years as opposed to 3.0-4.4 vs 1.9-2.9 per 100 patient-years), and required smaller case and control samples for hypothetical research studies (n = 254-309 vs 397-3478).(ABSTRACT TRUNCATED AT 250 WORDS)
95 citations
Journal Article•
TL;DR: FNA breast biopsy is a diagnostically accurate and economical triage procedure, even when followed by an excisional or frozen-section biopsy for confirmation, and could be expanded to a greater number of medical centers and decrease the potential for false-positive diagnoses.
Abstract: A total of 219 fine needle aspiration (FNA) biopsies of the breast were performed during the period 1983 to 1985 at a tertiary medical center. The series consisted of 215 women (98.2%) and 4 men (1.8%), with an are range of 14 to 90 years (mean of 46.5 years). Histologic confirmation (93 cases) or clinical follow-up for up to two years was obtained. The sensitivity of the FNA procedure was 82.2%, its specificity was 98.8%, and the overall efficiency of the test was 95.4%. The false-negative rate was 4.4%, with no false-positive diagnoses for the primary diagnosis of breast carcinoma. We have found that one of the major advantages of FNA biopsy is that it lowers costs by allowing the surgeon to triage which patients should have an outpatient excisional biopsy under local anesthesia and which patients should have a one-stage inpatient procedure with frozen section confirmation. For this triage role, suspicious diagnoses (3.2%) were included in the positive group and atypical (1.8%) and insufficient diagnoses (6.8%) in the negative group. Taking into account the FNA biopsy cost of $75, the procedure resulted in a savings per case of $262 over the cost that would have occurred if all cases had had routine inpatient biopsy and $154 per case over the cost that would have occurred with routine outpatient biopsy of all cases. Our results indicate that FNA breast biopsy is a diagnostically accurate and economical triage procedure, even when followed by an excisional or frozen-section biopsy for confirmation. The use of FNA biopsy could be expanded to a greater number of medical centers and decrease the potential for false-positive diagnoses by combining FNA biopsy with frozen-section confirmation.
91 citations
Book•
10 Jun 1987
TL;DR: The authors reviewed factors that influence how well knowledge and skills are retained over relatively long periods of nonuse and identified instructional strategies (conditions of learning) which promote long-term retention and do not have an adverse impact on learning.
Abstract: : This report reviews factors that influence how well knowledge and skills are retained over relatively long periods of nonuse. A cognitively oriented interpretation is applied to prior findings and beliefs about the nature of long-term retention. The report identifies instructional strategies (conditions of learning) which promote long-term retention and do not have an adverse impact on learning.
89 citations
TL;DR: The PMS program was studied over three and one half years for its contribution to infection control of MRSA, early identification of nosocomial MRSA outbreaks, use of the highest yield surveillance culture sites, and cost effectiveness.
Abstract: A prospective microbiological surveillance (PMS) program was developed in a comprehensive hospital-wide effort for control of nosocomial methicillin-resistant Staphylococcus aureus (MRSA). This PMS program entailed: 1) active identification of colonized and infected patients; 2) application of a screening microbiologic system for MRSA; 3) isolation of colonized and infected patients; 4) antibiotic decolonization of MRSA; and 5) educational efforts. The PMS program was studied over three and one half years for its contribution to infection control of MRSA, early identification of nosocomial MRSA outbreaks, use of the highest yield surveillance culture sites, and cost effectiveness. Following initiation of the PMS program in December 1982, during an MRSA outbreak, the frequency of new MRSA cases declined from 14 to none by the end of a 3-month pilot study. The frequency of new MRSA cases stabilized at approximately 2 per month until October 1983, when the PMS system allowed prompt detection of a new outbreak of 11 cases. Following isolation and antibiotic decolonization, the frequency of cases again declined to 3 per month. A third outbreak in December 1985 again was promptly detected and controlled. Infection to colonization ratio decreased from a maximum of 1.5 during outbreaks to a minimum of 0.17 after outbreaks. Wounds and tracheostomy sites provided the greatest yield of detection of new cases of MRSA. During one 15-month period, 35 of the 43 new cases were detected initially at wounds and tracheostomy sites. No new MRSA cases were detected by a positive axillary or nares site alone. The estimated quarterly cost of outbreaks and infection paralleled the quarterly frequency of new MRSA cases. The cost of managing MRSA outbreaks and treating MRSA infections versus the cost of implementing the PMS program suggested that the PMS program may be cost effective. This prospective microbiological surveillance program may be applicable to other institutions for hospital-wide infection control of MRSA.
TL;DR: In this article, the authors review the existing literature to assess the strength of the empirical evidence regarding the economics of early intervention and find that a few studies provide credible evidence that early intervention for disadvantaged children can be a sound economic investment.
Abstract: From an economic perspective, early educational intervention is an investment in the lives of young children that may yield both immediate and future returns. Economic analysis can be used to estimate the costs and benefits of investments in early intervention and to produce estimates of the net economic gain to society resulting from early intervention. In the last two decades, at least 20 economic analyses of early intervention have been conducted and their results widely distributed. The “cost-effectiveness” of early intervention has been used with apparent success as an argument for a wide range of early interventions for infants and young children. This paper critically reviews the existing literature to assess the strength of the empirical evidence regarding the economics of early intervention. We find that a few studies provide credible evidence that early intervention for disadvantaged children can be a sound economic investment. Many of the studies that have been conducted were found to be proble...
TL;DR: The efforts of those advocating supported employment have resulted in expansion of the opportunities for people with moderate and severe disabilities in the past several years as discussed by the authors, and the results reported pre-...
Abstract: The efforts of those advocating supported employment have resulted in expansion of the opportunities for people with moderate and severe disabilities in the past several years. Results reported pre...
TL;DR: A decision analysis model was used to compare seven strategies that physicians might choose to examine a positive "screenee" and found the primary colonoscopy strategy is both more effective and less costly than the combination of flexible sigmoidoscopy and barium enema.
TL;DR: In this article, the authors present case studies and a review of the literature on probability sampling, controlled surface collecting, and explicit research designs in the field of archaeological field research, and propose six basic principles as guides to the formulation of future field strategies.
Abstract: Probability sampling, controlled surface collecting, and explicit research designs are standard working procedures for a large portion of the archaeological profession. The need for adopting these approaches and their utility in the field have been persuasively argued in the literature for 20 years. Despite their agreed-upon utility, these approaches are often poorly understood. Field strategies of four projects and their rationales are presented to provide examples of specific approaches that have had positive results. Based on these case studies and a review of the literature, I propose six basic principles as guides to the formulation of future field strategies. The researcher must define interpretive objectives, specify minimal data requirements, understand the problems of data recognition, structure the flow of research and evaluation, choose appropriate tools for each stage of research, and maintain cost effectiveness.
TL;DR: This was the first use of the Self-Reporting Questionnaire and Clinical Interview Schedule in conjunction and may prove to be more cost-effective in primary care and community surveys, and more appropriate for assessing the wide range of minor psychiatric morbidity commonly encountered in such settings.
Abstract: The use in two developing countries of a two-stage psychiatric screening procedure with an emphasis on minor morbidity is described. This was the first use of the Self-Reporting Questionnaire and Clinical Interview Schedule in conjunction. Health auxiliaries with limited training administered the first-stage screening instrument. In comparison with other psychiatric screening techniques used in developing countries, the procedure described may prove to be more cost-effective in primary care and community surveys, and more appropriate for assessing the wide range of minor psychiatric morbidity commonly encountered in such settings.
TL;DR: A benefit-cost analysis of the supported competitive employment program, occurring during the period from 1978 to 1986, is presented and the authors conclude that supported competitiveemployment is a financially profitable venture for both consumers and taxpayers.
TL;DR: The results underline the importance of obtaining better epidemiological baseline data and information on project effectiveness if the potential usefulness of the healthy days of life approach to project evaluation is to be fully realized.
Journal Article•
TL;DR: In this paper, the effectiveness of different common strategies for protecting bridge decks against deterioration caused by deicing salts was evaluated through literature reviews, a nationwide survey of state transportation departments, and visits to protected decks in selected states.
Abstract: This report documents existing knowledge on the effectiveness of different common strategies for protecting bridge decks against deterioration caused by deicing salts. The strategies considered are: (1) increased cover to the top bar; (2) low-slump dense concrete overlay; (3) latex-modified concrete overlay; (4) interlayer membrane/asphalt concrete system; and (5) epoxy-coated bars. Performance information on those strategies was obtained through literature reviews, a nationwide survey of state transportation departments, and visits to protected decks in selected states. That information was expressed in terms of deck durability (scaling, wearing and overlay stripping), effectiveness in preventing reinforcing bar corrosion, and concrete cracking. The information was analyzed for factors affecting the likely service life of a protected bridge, for costs to achieve a 50-year deck life, and for the relative effectiveness of a certain strategy or combination of strategies. For normal levels of salt application, cost-effective protection strategies can be designed that provide 50 years or more of bridge deck service life free of corrosion-induced deterioration. Epoxy-coating both the top and bottom reinforcing mats is the most cost-effective way of assuring a 50-year or more corrosion-free life.
TL;DR: Therapeutic strategies involving intravenous administration of thrombolytic agents were found to be consistently more cost effective than were strategies involving intracoronary administration of THS agents and primary angioplasty.
TL;DR: In this article, a stochastic programming framework is developed to evaluate the economic implications of reliability criteria and multiple effluent controls on nonpoint source pollution, and an integrated watershed simulation model is used to generate probability distributions for agricultural effluents in surface and ground water resulting from agricultural practices.
Abstract: A stochastic programming framework is developed to evaluate the economic implications of reliability criteria and multiple effluent controls on nonpoint source pollution. An integrated watershed simulation model is used to generate probability distributions for agricultural effluents in surface and ground water resulting from agricultural practices. Results from the planning model indicate that reliability and multiple effluent constraints significantly increase the cost of nonpoint controls but the effects vary by control alternative. The analysis indicates that an evaluation of multiple water quality objectives can be an important planning tool for designing nonpoint source controls for innovative programs to promote cost-effective water quality regulation.
Journal Article•
TL;DR: In this paper, the results of a study of the various methods of strengthening highway bridges are presented, and the types of structures most suitable for strengthening are identified and the cost-effectiveness of various methods is presented for these structures.
Abstract: This report details the results of a study of the various methods of strengthening highway bridges. The initial task in this study was a thorough review of pertinent international literature to determine the methods currently being used and to discover innovative ideas being considered. An extensive overview of all methods is presented. The types of structures most suitable for strengthening are identified, and the cost-effectiveness of the various methods is presented for these structures. New materials and innovative techniques are presented. The major effort of the study was developing a strengthening manual for use by practicing engineers. This manual describes the most effective techniques and indicates how they may be used in various types of structures.
Book•
01 Jan 1987
TL;DR: In this paper, five commonly used strategies: increased cover to the top bar, low-slump, dense concrete overlay, latex-modified concrete overlay; interlayer membrane/asphalt concrete system; and epoxy coated bars.
Abstract: Research is reported which was part of the National Cooperative Highway Research Program to provide definitive information on the performance and likely service life of decks for which corrosion protection was part of the original construction. Such decks were found to perform better than unprotected decks, which in some cases have required rehabilitation after only a few years. Performance information was collected from state highway departments in 46 states for the five most commonly used protective strategies: increased cover to the top bar; low-slump, dense concrete overlay; latex-modified concrete overlay; interlayer membrane/asphalt concrete system; and epoxy coated bars. Quantitative information on protected bridges with 5 to 15 years of service was developed through a comprehensive literature review and analysis. In addition, state transportation personnel were interviewed, and selected bridges were examined. Performance was defined as a function of durability of bridge decks, bar corrosion prevention effectiveness of a given strategy, and the degree of concrete cracking. Each of these areas is discussed, as well as the cost effectiveness of the strategies. Comments are made on current protection methods on newly constructed bridge decks.
TL;DR: An individualized and a group administered educational program are being developed to teach the identified critical skills, using the instructional models previously employed in AIR WISE and AIR POWER programs for children with asthma.
Abstract: The purpose of the AIR/Kaiser-Permanente asthma project is to evaluate various approaches to the education of adults with asthma, identifying those types of patients for whom particular approaches are most cost effective. Critical self-management practices for adults with asthma were identified using the critical incident technique. An individualized and a group administered educational program are being developed to teach the identified critical skills, using the instructional models previously employed in AIR WISE and AIR POWER programs for children with asthma. Three hundred patients with moderate to severe asthma from Northern California Kaiser-Permanente Medical Group clinics will participate in a trial of these programs. Patients will be randomly assigned to one of four conditions: One of two educational programs, an information/attention control, or a data-only control condition. Data will be collected on all patients for 15 months; health care utilization data covering a two-year period will be available from medical records. Program effectiveness will be evaluated in terms of pre-post changes in the patients' knowledge, attitudes, self-management practices, medical condition, daily functioning, and utilization of services. Cost effectiveness will be evaluated, paying specific attention to the cost effectiveness of different educational approaches for different types of patients.
TL;DR: Substantial information exists to argue that all forms of employment—supported, transitional, and sheltered—are more productive in terms of earnings and less costly to provide than adult day care.
Abstract: Evidence about the benefits and costs of supported and transitional employment for persons with severe disabilities is presented along with relevant caveats in the absence of controlled studies. Some of the major forms of supported and transitional employment services are compared with adult day care and traditional sheltered workshops, including work activity centers. Despite weaknesses in the data, sufficient information exists to argue that all forms of employment—supported, transitional, and sheltered—are more productive in terms of earnings and less costly to provide than adult day care. The lack of definitive data is seen as a major impediment to the expansion of supported and transitional employment options for people with severe disabilities; hence, stricter accountability is recommended. All service providers, regardless of the vintage of their programs, should be required to show benefits and costs within a uniform framework of measurement.
TL;DR: In this paper, a review of the most appealing suggestions and evaluation of the current status of these methods is presented. And improvements in film characterization and deposition based on Langmuir-Blodgett techniques are also suggested.
TL;DR: Self-help peer-led therapy can yield improved cost effectiveness and clinical outcome in hospital-based alcoholism treatment by comparing two ambulatory alcoholism treatment programs: a control program operated solely by professional staff, and an experimental one based onpeer-led self-help (SH).
Abstract: Self-help peer-led therapy can yield improved cost effectiveness and clinical outcome in hospital-based alcoholism treatment. This was demonstrated by comparing two ambulatory alcoholism treatment programs: a control program operated solely by professional staff, and an experimental one based on peer-led self-help (SH). The SH program was staffed by only half as many primary therapists as the control. Patients in both programs were evaluated over the course of one year. By means of the Patient Status Form, a clinical assessment instrument applied monthly, SH patients were found to score significantly higher on social adjustment, although retention and drinking rates, and utilization of Alcoholics Anonymous and disulfiram were no different from controls. This study is the continuation of an initial comparison in which SH patients were found to have enhanced retention in treatment after discharge from an impatient service.