Showing papers on "Cost effectiveness published in 1989"

The long-term effectiveness and clinical significance of three cost-effective training programs for families with conduct-problem children.

Abstract: We evaluated the long-term effectiveness of three cost-effective parent training programs for conduct-problem children. One year posttreatment, 93.1% of families (94 mothers and 60 fathers) were assessed on the basis of teacher and parent reports and home observations. Results indicated that all the significant improvement reported immediately posttreatment were maintained one year later. Moreover, approximately two thirds of the entire sample showed "clinically significant" improvements. There were very few differences between the three treatment conditions except for the "consumer satisfaction" measure indicating that the treatment combining group discussion and video-tape modeling was superior to treatments without both components.

Health transition in middle-income countries: new challenges for health care

Abstract: The health transition occurring in middle-income countries such as Mexico is characterized by competition for scarce health resources between people with "leftover" ills such as infectious diseases and malnutrition and emerging threats such as chronic diseases mental illness and AIDS. This epidemiologic transition can not be expected to occur in the same way as it did in the industrialized countries. Their model was a series of 3 eras: pestilence and famine with high mortality no population growth and life expectancy of 20-40; receding pandemias and falling mortality with population growth; degenerative and man-made diseases with life expectancy over 50. In middle-income countries however the 3 eras are not necessarily sequential but may be protracted with reverses for some diseases. The co-existence of pre- and post-transitional diseases leads to polarization of different populations in the country. Data from Mexican mortality statistics indeed show decreased overall mortality from malaria childhood diarrhea and whooping cough but increased mortality from heart disease cancer diabetes and motor vehicle accidents. Data from Mexico City reveal falling postneonatal deaths due to diarrhea and respiratory infections but rising neonatal deaths (1st month of age) due to low birth weight and prematurity. Another aspect of the epidemiologic transition model is that the decline in mortality from infectious diseases in industrialized countries was due to lower incidence. In Mexico the incidence of infections remains high but mortality is lower because of antibiotics vaccines and vector control all reversible measures. Examples are diarrhea treated by ORT malaria considered "refractory" dengue fever considered "re-emerging" and AIDS considered "emerging." Resources to handle this continuing mixture of old and emerging diseases will be stressed to the limit with the coincident population growth due to momentum of the young population already born. 6 principles are presented to make primary health services equitable: population-based service delivery quality assurance community participation anticipatory care operation integrated with other social services and innovative models of health care.

The Cost-effectiveness of Counseling Smokers to Quit

Abstract: Cigarette smoking is the most important preventable cause of death in the United States. Surveys of patients, however, suggest that many physicians do not routinely counsel smokers to quit. Because physicians may not consider counseling against smoking to be as worthwhile as other medical practices, we examined its cost-effectiveness. We based our estimates of the effectiveness of physician counseling on published reports of randomized trials and our estimates of its cost on average charges for physician office visits. Our results indicate that the cost-effectiveness of brief advice during routine office visits ranges from $705 to $988 per year of life saved for men and from $1204 to $2058 for women. Follow-up visits about smoking appear to be similarly cost-effective. Physician counseling against smoking, therefore, is at least as cost-effective as several other preventive medical practices and should be a routine part of health care for patients who smoke. (JAMA1989;261:75-79)

A Longitudinal-Process Model of Drop-Out from Distance Education

Abstract: A model of drop-out from distance education is proposed. The longitudinal model is developed from Tinto's model. It includes components for background characteristics, goal commitment, academic and social integration, and a cost/benefit analysis. Issues inherent in testing the model are discussed.

An assessment of active versus passive methods for obtaining parental consent.

Abstract: This study provides new information on how passive and active consent methods work in practice. Based on results from two junior high schools, we found that (1) almost all parents received consent packages sent by regular first-class mail, but getting them to pay attention to the materials often required additional communication methods, (2) nonresponse to passive consent typically reflected conscious parental approval, (3) nonresponse to active consent generally signified latent consent, not a deliberate refusal, and (4) vigorous retrieval methods substantially raised active consent response rates, but at a high cost in time and money. These findings suggest that passive consent can provide a viable alternative to active consent when supplemented by appropriate backup and privacy safeguard measures.

Cost effectiveness of bone marrow transplantation in acute nonlymphocytic leukemia.

Abstract: To compare the cost effectiveness of bone marrow transplantation and conventional chemotherapy, we evaluated the resources used in the care of adult patients with acute nonlymphocytic leukemia who were enrolled in a prospective trial and received induction chemotherapy at a single university hospital. Nineteen patients were subsequently treated with chemotherapy and 17 with transplantation. Cost accounting began with induction chemotherapy and extended over a five-year period. Costs were estimated by means of a resource-based, multivariate prediction model. The transplantation and chemotherapy groups had virtually equivalent use of resources (hospital days, laboratory tests, blood products, and radiologic and operative procedures) over five years, except for a 10-fold increase in the use of the intensive care unit for the patients who underwent transplantation (P less than 0.001). The total costs over five years were estimated at $193,000 per patient for transplantation and $136,000 per patient for chemotherapy (P = 0.02). At five years, the costs per year of life saved ("life-year") were nearly equal ($62,500 per life-year for transplantation vs. $64,000 per life-year for chemotherapy) because of the better rate of disease-free survival in patients who underwent bone marrow transplantation. We conclude that the cost effectiveness of bone marrow transplantation to treat acute nonlymphocytic leukemia compares favorably with that of chemotherapy and could be further enhanced if intensive care resources were used more selectively.

The health benefits of prevention: A simulation approach

Abstract: In 1986 the Health 2000 Report, a long term health policy document, was presented to the Dutch parliament. This document is part of shift in interest in public health towards health rather than health services planning. There are two interesting features in this shift. The one is the tendency to measure the effectiveness of a policy, and intervention or a technology in terms of health, the outcome rather than the input, output or process. The other is the acceptance that political choices need to be made, since however large the budget for health is, it will always be limited. One of the choices to make will be whether or not to invest in preventive interventions. Preventive interventions can be defined as deliberate changes in the prevalence of risk factors in a population. To be able to weigh the costs and the benefits of such preventive interventions, an estimate will have to be made of their effect on the health of the population. Furthermore changes in risk factor prevalence may also occur autonomously. An estimate of the changes in the health status of the population as a result of these shifts in risk factor prevalence, will be important for the planning of health services and for the setting of realistic targets, as proposed by WHO. Prevent is a tool that will estimate the health effects of changes in risk factor prevalence in a population, as a result of trends or interventions. Its results can either be used directly in health policy making to formulate targets or quantify different scenario's on changes in risk factor prevalence in the future, or its results can be used as input for formal decision making processes such as for instance cost effectiveness studies. In epidemiology an analysis of the distribution of disease incidence and risk factor prevalence in different populations is used to confirm the hypothesis of a causal relationship between risk factor and disease. The strength of the relationship is often expressed as the ratio of incidence between exposed and non exposed, the Incidence Density Ratio (IDR). The importance of a risk factor for the incidence of a certain disease in a population is usually expressed as the Etiologic Fraction (EF), the proportion of the total incidence of the disease that can be attributed to the prevalence of that risk factor in the population. The EF is sometimes used as an indication of the proportion of incidence that could be prevented by the total elimination of that risk factor in the population.(ABSTRACT TRUNCATED AT 400 WORDS)

Global Control of Hepatitis B Through Vaccination: Role of Hepatitis B Vaccine in the Expanded Programme on Immunization

Abstract: Hepatitis B is a disease that affects people throughout the world, and over 200 million are persistent carriers of the hepatitis B virus (HBV). The chronic sequelae of this infection include chronic active hepatitis, cirrhosis, and primary hepatocellular carcinoma. The development of safe and highly effective hepatitis B vaccines now provides the means by which HBV infection, including the HBV chronic carrier state, can be prevented and the related mortality significantly reduced. The cost of these vaccines has significantly decreased and will soon approach levels at which the cost-effectiveness (cost per death prevented) of hepatitis B vaccine will be similar to that of other childhood vaccines. Integration of hepatitis B vaccine into the Expanded Programme on Immunization for mass vaccination of infants in areas where HBV infection is endemic and morbidity is high would be the most effective means of providing the coverage necessary for effective control and prevention.

Microwave-assisted grinding

Abstract: The US Bureau of Mines has conducted studies on the use of rapid microwave heating to stress-fracture ore samples. Iron ores containing hematite, magnetite, and goethite were subjected to microwave energy in batch operations at 3 kW and heated to average maximum temperatures between 840 and 940 degrees C. Scanning electron microscope (SEM) photomicrographs verified fracturing along grain boundaries and throughout the gangue matrix. Standard bond grindability tests showed that microwave heating reduced the work index of iron ores by 10 to 24%. When a continuous feed belt in a microwave applicator was used, samples heated more uniformly and quickly than in batch operations. In a microwave chamber designed to simulate a continuous throughput operation at 3 kW, the grindability of a taconite ore was improved by 13% at a bulk temperature of 197 degrees C. Because stress cracking occurred at a lower temperature, less energy was consumed, thereby improving the cost effectiveness of microwave-assisted grinding. To further improve the economics of microwave fracturing, preliminary tests were conducted to increase heating rates by using higher microwave powers. To appraise the economic feasibility of microwave-assisted grinding, the beneficial effects in the grinding circuit and in the extractive operation were considered. >

Traffic conflict techniques for safety and operations. observers manual

Abstract: This manual provides basic background information and step-by-step procedures for conducting traffic conflict surveys at signalized and unsignalized intersections. The manual was prepared as a training aid and reference source for persons who are assigned the responsibility of conducting traffic conflict observations at intersections. Based on previous research and experiences, the survey techniques described in this manual provide a standard, cost-effective method for accurately observing and recording traffic conflicts. The manual contains definitions with illustrations and examples of conflict types, and instructions for conducting the field activities, including time schedules, forms, and other details. The results of traffic conflict observations are used to diagnose safety and operational problems and to evaluate the effectiveness of treatments. Observer training techniques, as well as procedures for analyzing and interpreting the results of conflict surveys, are presented in the engineer's guide (FHWA-IP-88-026).

Illness associated with child day care: a study of incidence and cost.

Abstract: We studied 843 children under 36 months of age enrolled in a prepaid health plan from September 1985 through March 1986, to identify characteristics of day care which might be risk factors for infection and to describe the resulting economic costs. Children cared for in their own home had a mean of 2.03 infections diagnosed during the study period. Adjusted rates of excess infection (95 per cent CI) for children cared for in other settings were: -.09 (-.73, .54) in relatives' homes; .10 (-.51, .71) in day care homes; .79 (.13, 1.45) in day care centers; .60 (-.24, 1.46) in mother's day out programs; and .66 (-.01, 1.34) in multiple settings. Children in day care centers were 4.5 times more likely to be hospitalized than those in other settings (95 per cent CI = 1.55, 13.00), primarily due to an increased rate of tympanostomy tube placement (relative risk 3.79, 95 per cent CI = 1.04, 13.36). The strongest predictor of illness risk was the number of other children in the room. The mean monthly cost of medical care was $32.94 for children in the highest risk settings compared with $19.78 for those in other settings. Illness in a child in our study accounted for 40 per cent of parental absenteeism from work; the mean number of days lost per month was 0.52 for parents of children in day care centers compared with 0.37 for those of children in other forms of full time care outside the home.

Reducing the incidence of infection after caesarean section: implications of prophylaxis with antibiotics for hospital resources.

Abstract: OBJECTIVES--To estimate the cost effectiveness of giving prophylactic antibiotics routinely to reduce the incidence of wound infection after caesarean section. DESIGN--Estimation of cost effectiveness was based, firstly, on a retrospective overview of 58 controlled trials and, secondly, on evidence about costs derived from data and observations of practice. SETTING--Trials included in the overview were from obstetric units in several different countries, including the United Kingdom. The costing study was based on data referring to the John Radcliffe Maternity Hospital, Oxford. SUBJECTS--A total of 7777 women were included in the 58 controlled trials comparing the effects of giving routine prophylactic antibiotics at caesarean section with either treatment with a placebo or no treatment. Cost estimates were based on data on 486 women who had caesarean sections between January and September 1987. MAIN OUTCOME MEASURE--Cost effectiveness of prophylaxis with antibiotics. RESULTS--The odds of wound infection are likely to be reduced by between about 50 and 70% by giving antibiotics routinely at caesarean section. Forty one (8.4%) women who had caesarean section were coded by the Oxford obstetric data system as having developed wound infection. The additional average cost of hospital postnatal care for women with wound infection (compared with women who had had caesarean section and no wound infection) was estimated to be 716 pounds; introducing routine prophylaxis with antibiotics would reduce average costs of postnatal care by between 1300 pounds and 3900/100 pounds caesarean sections (at 1988 prices), depending on the cost of the antibiotic used and its effectiveness. CONCLUSIONS--The results suggest that giving antibiotics routinely at caesarean section will not only reduce rates of infection after caesarean section but also reduce costs.

Investment in Education

Abstract: The purpose of this paper is to present new measures of the benefits from education. These measures are based on the incremental effect on human wealth of participation in formal schooling. We define human wealth as the sum of lifetime labor incomes for all individuals in the U.S. population. These incomes include the value of time spent working and the value of nonmarket labor activities, which are defined to include parenting and the enjoyment of leisure. Our estimates of lifetime labor incomes are drawn from an extensive data base on income from work. We have enlarged this data base to incorporate the value of nonmarket activities. We compare our estimates of investment in education and human wealth with estimates based on the expenditures of educational institutions. We find that these expenditures are very much smaller than the benefits of education.

The cost‐effectiveness of breast cancer screening

Abstract: The costs and effects of different invitation schedules of breast cancer screening are compared. The effect estimates are based on trials from the USA, Sweden and the Netherlands. The cost estimates use registration data, file studies and organization charts. The calculations were performed with the MISCAN computer simulation package, which is developed especially for the evaluation of mass screening programmes. Screening women of 50–70 years at 2-yearly intervals is a relatively cost-effective schedule. In a real population, it will reduce breast cancer mortality by 12%. Screening of women under 50 is probably far less cost-effective. Screening induces a considerable shift towards breast-conserving therapy. Although a 12% mortality reduction may seem low, in absolute numbers this represents more than the total mortality from, e.g., cervical cancer. Moreover, cost per death prevented or per life-year saved is much lower than for most other medical interventions for which cost-effectiveness ratios are known, screening for cervical cancer included.

Field performance of fabrics and fibers to retard reflective cracking

Abstract: The purpose of this project was to determine whether any, or various, uses of geotechnical fabrics and fibers will significantly retard reflective cracking in an asphaltic concrete overlay. Four paving fabrics, one fiberized-asphalt membrane, and one fiber-reinforced asphaltic concrete were the treatment alternatives being evaluated. All treatments were compared with each other and with untreated control sections to determine relative performance. Considerations in making these comparisons were construction and maintenance costs, ease of placement, and the ability to prevent or retard reflective cracking. Performance data are presented for surveys conducted at 8 months, 26 months, and 44 months after construction. All treatments retarded cracks over the evaluation period, although the amount and rate of reduction varied. One paving fabric and fiber-reinforced asphalt concrete had the highest crack reduction ratios after the 44-month evaluation. On the basis of all factors considered in the evaluation--cost, ease of construction, and performance relative to distress treated--the fiber-reinforced concrete provided superior performance relative to the treatment alternatives. However, on the basis of the extent of cracking evident after the 44-month survey, and considering current and proposed crack sealing costs in addition to the documented construction costs, none of the treatments used on this project was found to be cost-effective or recommended for use.

The value of information: approaches in economics, accounting, management science

Abstract: This article reviews and analyzes research performed by economists, accounting researchers and management scientists in the field of economics of information. The main emphasis is on approaches taken to describe and measure the value of information. Economists define information as a phenomenon to reduce uncertainty and it is usually studied in terms of exchange values. Information markets and products, as well as information as a public good, are described. The approaches to the value of information favored by economists are (1) statistical decision theory approach, (2) equilibrium theory approach, (3) multidimensional value approach, and (4) cognitive approach. These approaches are discussed and concluded with cost-benefit and value considerations of information. Some empirical studies are also presented. It is concluded that economic approaches based on ‘information theory’ have not achieved significant practical results in a general sense, but ‘classical’ economic approaches can and should be used in describing information products (and services) in terms of exchange values, as has been the case with other goods. But the cognitive approach, with analysis of the tasks performed, should be used simultaneously for describing the value-in-use of information. © 1989 John Wiley & Sons, Inc.

Remote test access system for isdn testing

Abstract: Conformance with established standards and interoperability between products in an integrated services digital network (ISDN) system defined by a layered hierarchy of interrelated protocols is ascertained by remotely testing the protocols between a tester in a local testing centre and a system under test located at a geographically removed site. The protocols tested relate to the first three layers of the system which are concerned mainly with the establishment, holding and release of a telecommunications path. Cost effectiveness in product testing is achieved by accessing both the tester and the system under test and communicating test procedures between the local and remote sites over a packet switching network to support testing at the remote site. Communications over a virtual circuit in the network are established between a pair of remote ISDN test access interfaces, one located at each site. A communications path from a test access interface and its corresponding local tester or system under test is provided by an ISDN interface. Under software control by a computer at each site, the test access interfaces function individually to split the corresponding ISDN interface so that the network may be inserted therebetween to link the tester with the system under test.

Automated system to prioritize repair of plant equipment

Abstract: The system of the present invention uses the importance of a piece of malfunctioning equipment, the severity and the confidence level in a diagnosis to determine repair priority of the equipment by obtaining the product (46) of the confidence level (CF), importance (IMP) and severity (SEV). The these variables are determined by expert system rules. The severity is the reciprocal (88) of the time to failure. The importance (44) is the cost to repair the maximum damage when the malfunction continues. A malfunction can affect several pieces of equipment in combination, the severity and importance associated with each piece is combined (70) with the confidence and used to determine the repair priority. When the diagnosis of a malfunction is by malfunctioning sensors, the expected equipment life (40) and the availability (86) of sensors that provide a partial backup are considered in prioritizing sensor as well as equipment repair. When a primary piece of equipment is backed up (100), the effect of both pieces of equipment failing (106) is considered in prioritizing the repair. The system ranks the repair of all possible malfunctions on a common scale. The system gives a complete repair priority picture and allows the cost effectiveness to be maximized.

Financing the Education of At-Risk Students.

Abstract: Students who are considered to be at risk of educational failure because of their social and economic origins represent about one third of all elementary and secondary enrollments. This article explores the financial requirements for bringing these students into the educational mainstream so that they are academically able. First, it provides an elaboration on the rising demography of at-risk students and the deleterious consequences to the economy and society of failing to meet their educational needs. Second, it summarizes the evidence on the payoffs to educational investments in at-risk students and finds that benefits are well in excess of costs. Third, it evaluates criteria for determining the financial requirements for addressing educational needs of at-risk students and suggests that additional spending of about $21 billion a year (about 10% of present elementary and secondary expenditures) may be appropriate. Finally, it reviews the roles of federal, state, and local governments and the private se...

Epidemiology and spectrum of Vibrio infections in a Chesapeake Bay community.

Abstract: The clinical and epidemiologic features of vibrio infections occurring over 15 y in a hospital adjacent to the Chesapeake Bay were examined. Microbiologic techniques included the use of thiosulfate citrate bile salts sucrose (TCBS) medium on all stool specimens. Among 40 vibrio isolates from 32 patients, eight species were identified: V. parahaemolyticus (16), V. vulnificus (10), non-O1 V. cholerae (7), V. mimicus (3), V. hollisae (1), V. fluvialis (1), V. alginolyticus (1), and an unnamed halophilic vibrio. Sources included stool (13), wound (11), sputum (3), ear (3), bone (1), and gallbladder (1). While illnesses were diverse, they were relatively mild and self-limited with no mortality. The mild clinical spectrum and especially lack of mortality are in sharp contrast to the findings of previous reports. Even with the proximity to the bay and use of optimal isolation techniques, the demonstrated incidence of vibrio infections was low (1.6/100,000/y). The routine use of TCBS medium, which has been advocated for high-risk areas, was not cost-effective.

Benefits and Costs of Dropout Prevention in a High School Program Combining Academic and Vocational Education: Third-Year Results from Replications of the California Peninsula Academies:

Abstract: This paper reports 1987–88 results from an evaluation of 11 academy programs in California high schools. Academies are schools within schools, combining academic and vocational courses in a program...

Women's time: a factor in the use of child survival technologies?

Abstract: What are the actual time costs to women and whether time costs are important determinant in mothers participation in the GOBI technologies are analyzed. GOBI is an acronym for growth monitoring oral rehydration therapy (ORT) breast feeding and immunization the primary health care elements of the child health revolution. These activities are managed by mothers. Third world women average an 18-hour work day taking care of agricultural and household production child care and cash income generation with little time left for personal or leisure activities. Very little data are available on the actual hours spent on child care or the specific GOBI activities. Women in the third world spend 2-4 hours per day on breast feeding. For them whether bottle feeding takes more or less time is not an issue rather the fact that someone else can feed the baby a bottle is perceived as time-saving. Time costs for women for immunization and growth monitoring are probably much higher than program costs considering transportation time and time lost from other work. Time costs for ORT have not been estimated: they would entail constant attendance over several days for each episode to prepare boiled solution spoon feed ORS gradually perhaps 40 days a year for 2 children each having 6 diarrhea episodes. Time savings in illness and death prevented is also unknown although women may spend appreciable time on care of ill family members and funerals. Recommendations for research are made such as the suggestion that determining whether time costs are a significant barrier to the success of the child survival program. It is also suggested that programs emphasize the immediate advantages to women of these technologies; bring the services to mothers; and consider ORT an interim time-costly way to manage diarrhea.

Evidence from project star about class size and student achievement

Abstract: When considering the adoption of any change or new program a policymaker has three major questions to answer. First, how effective will the change be? Second, how much will it cost? And third, what are the problems of implementation, including the support or opposition of the clients and staff (teachers) who implement it? When looking at the issue of

Mechanics of Overflow Erosion on Embankments. I: Research Activities

Abstract: Part I of a two-part report presents model and prototype research studies which have been conducted in the United States and Great Britain to evaluate how embankments for dams, levees, roadways, etc. perform when subjected to overtopping flows from probable maximum flood (PMF) or near-PMF events. With improvements in the collection of flood records and the development of estimated storm events a significant increase in predicted PMF has been realized in some areas of the United States and other countries. These studies provide the engineer with an understanding of the mechanics of overflow erosion through subjecting scale model and prototype embankments to overtopping flow events. The effectiveness of various protection systems in preventing overflow erosion is evaluated. These systems range from grass-lined embankments and spillways to more sophisticated protection using geotextiles, gabions, riprap, cellular concrete blocks and soil cement. Such research efforts provide for the development of cost-effective measures that allow embankments to pass these extreme flood events without breaching.

Cost-effectiveness of antibiotic prophylaxis for dental procedures in patients with artificial joints.

Abstract: We performed a cost-effectiveness analysis to evaluate whether patients with artificial joints should take penicillin, erythromycin, or no antibiotics before dental procedures. We modeled the risk of anaphylaxis from penicillin, the risks and consequences of an artificial joint infection, and the actual variable costs of hospitalization and antibiotics. Penicillin prophylaxis is slightly less expensive than erythromycin prophylaxis but is both more expensive and less effective than no prophylaxis. Erythromycin prophylaxis, the most effective, is the most expensive strategy. The marginal cost effectiveness of erythromycin prophylaxis compared to no prophylaxis is $12,900 per quality-adjusted year of life saved. Sensitivity analysis demonstrates that the risk of developing a joint infection is the key parameter in the analysis. Based on our estimated risk of developing a joint infection, the cost-effectiveness of antibiotic prophylaxis with erythromycin compares favorably with other medical interventions. T...