Showing papers on "Cost effectiveness published in 1994"
Book•
01 Nov 1994
TL;DR: Williamson as discussed by the authors combines institutional economics with aspects of contract law and organization theory to identify and explicate the key differences that distinguish three generic forms of economic organization-market, hybrid, and hierarchy.
Abstract: Oliver E. Williamson University of California, Berkeley This paper combines institutional economics with aspects of contract law and organization theory to identify and explicate the key differences that distinguish three generic forms of economic organization-market, hybrid, and hierarchy. The analysis shows that the three generic forms are distinguished by different coordinating and control mechanisms and by different abilities to adapt to disturbances. Also, each generic form is supported and defined by a distinctive type of contract law. The costeffective choice of organization form is shown to vary systematically with the attributes of transactions. The paper unifies two hitherto disjunct areas of institutional economics-the institutional environment and the institutions of governance-by treating the institutional environment as a locus of parameters, changes in which parameters bring about shifts in the comparative costs of governance. Changes in property rights, contract law, reputation effects, and uncertainty are investigated.'
6,602 citations
TL;DR: The authors discuss the impact of media and attributes of media on learning, motivation and efficiency gains from instruction and respond to Robert Kozma's criticism of my earlier discussion of media effects on instruction.
Abstract: The purpose of this discussion is to explain and sharpen different points of view about the impact of media and attributes of media on learning, motivation and efficiency gains from instruction. This paper is an attempt to summarize my arguments about the research and theory in this area and to respond to Robert Kozma's criticism of my earlier discussion of these issues. I will first briefly summarize my arguments about media effects; next I will attempt to characterize the many reactions to the controversial claim that media do not influence learning or motivation. Finally, I will respond to the specific criticisms advanced by Robert Kozma this issue.
1,779 citations
TL;DR: For elderly citizens living in the community, vaccination against influenza is associated with reductions in the rate of hospitalization and in deaths from influenza and its complications, as compared with the rates in unvaccinated elderly persons, and vaccination produces direct dollar savings.
Abstract: Background Despite recommendations for annual vaccination against influenza, more than half of elderly Americans do not receive this vaccine. In a serial cohort study, we assessed the efficacy and cost effectiveness of influenza vaccine administered to older persons living in the community. Methods Using administrative data bases, we studied men and women over 64 years of age who were enrolled in a large health maintenance organization in the Minneapolis-St. Paul area. We examined the rate of vaccination and the occurrence of influenza and its complications in each of three seasons: 1990-1991, 1991-1992, and 1992-1993. Outcomes were adjusted for age, sex, diagnoses indicating a high risk, use of medications, and previous use of health care services. Results Each cohort included more than 25,000 persons 65 years of age or older. Immunization rates ranged from 45 percent to 58 percent. Although the vaccine recipients had more coexisting illnesses at base line than those who did not receive the vaccine, duri...
968 citations
TL;DR: A general approach is discussed to assess the uncertainty surrounding the cost effectiveness ratio (C/E-ratio) estimated on the basis of data from a randomised clinical trial, which includes the calculation of a 95% probability ellipse and introduces the concept of a so called C/ E-acceptability curve.
Abstract: A general approach is discussed to assess the uncertainty surrounding the cost effectiveness ratio (C/E-ratio) estimated on the basis of data from a randomised clinical trial. The approach includes the calculation of a 95% probability ellipse and introduces the concept of a so called C/E-acceptability curve. This last curve defines for each predefined C/E-ratio the probability that the C/E-ratio found in the study is acceptable. The approach is illustrated by estimates of costs per life saved and costs per patient discharged alive on the basis of data from a phase II trial addressing the value of anakinra in treating sepsis syndrome.
957 citations
TL;DR: The feasibility and desirability of constructing statistical tests of economic hypotheses and estimation of cost-effectiveness ratios with associated 95% confidence intervals are explored and how relevant variances can be estimated are shown.
Abstract: Application of techniques such as cost-effectiveness analysis (CEA) is growing rapidly in health care. There are two general approaches to analysis: deterministic models based upon assumptions and secondary analysis of retrospective data, and prospective stochastic analyses in which the design of a
421 citations
TL;DR: A routine varicella vaccination program for healthy children would result in net savings from the societal perspective, which includes work-loss costs as well as medical costs, and would also be relatively cost-effective from the health care payer's perspective.
Abstract: Objective. —To evaluate the economic consequences of a routine varicella vaccination program that targets healthy children. Methods. —Decision analysis was used to compare the costs, outcomes, and cost-effectiveness of a routine vaccination program with no intervention. Clinical outcomes were based on a mathematical model of vaccine efficacy that relied on published and unpublished data and on expert opinion. Medical utilization rates and costs were collected from multiple sources, including the Kaiser Permanente Medical Care Program and the California Hospital Discharge Database. Results. —A routine varicella vaccination program for healthy children would prevent 94% of all potential cases of chickenpox, provided the vaccination coverage rate is 97% at school entry. It would cost approximately $162 million annually if one dose of vaccine per child were recommended at a cost of $35 per dose. From the societal perspective, which includes work-loss costs as well as medical costs, the program would save more than $5 for every dollar invested in vaccination. However, from the health care payer's perspective (medical costs only), the program would cost approximately $2 per chickenpox case prevented, or $2500 per life-year saved. The medical cost of disease prevention was sensitive to the vaccination coverage rate and vaccine price but was relatively insensitive to assumptions about vaccine efficacy within plausible ranges. An additional program for catch-up vaccination of 12-year-olds would have high incremental costs if the vaccination coverage rate of children of preschool age were 97%, but would result in net savings at a coverage rate of 50%. Conclusions. —A routine varicella vaccination program for healthy children would result in net savings from the societal perspective, which includes work-loss costs as well as medical costs. Compared with other prevention programs, it would also be relatively cost-effective from the health care payer's perspective. (JAMA. 1994;271:375-381)
379 citations
TL;DR: In this paper, the authors tested links between vertical integration, cost structure, and performance at the line-of-business level of analysis, and found that vertical integration results in economies ev...
Abstract: This study tested links between vertical integration, cost structure, and performance at the line-of-business level of analysis. Major findings were (1) Vertical integration results in economies ev...
350 citations
TL;DR: Assessment of the net financial costs to health maintenance organizations of operational vaccine delivery programs is promoted to encourage managers of organized medical care programs and health insurance companies to advocate improved vaccine delivery.
Abstract: Objective: To estimate the cost-effectiveness and net medical care costs of programs for annual influenza vaccinations for the elderly in a health maintenance organization (HMO). Design: Population...
339 citations
TL;DR: The current knowledge base regarding portable recording in the assessment of OSA is reviewed, including technical considerations, validation studies, potential advantages and disadvantages, issues of safety, current clinical usage and areas most in need of further study.
Abstract: The objective assessment of patients with a presumptive diagnosis of obstructive sleep apnea (OSA) has primarily used attended polysomnographic study. Recent technologic advances and issues of availability, convenience and cost have led to a rapid increase in the use of portable recording devices. However, limited scientific information has been published regarding the evaluation of the efficacy, accuracy, validity, utility, cost effectiveness and limitations of this portable equipment. Attaining a clear assessment of the role of portable devices is complicated by the multiplicity of recording systems and the variability of clinical settings in which they have been analyzed. This paper reviews the current knowledge base regarding portable recording in the assessment of OSA, including technical considerations, validation studies, potential advantages and disadvantages, issues of safety, current clinical usage and areas most in need of further study.
332 citations
Book•
01 Sep 1994
TL;DR: In this article, the authors conclude that economic considerations have been entirely absent from the development of educational policies and that economic reality is sorely needed in discussions of new policies, and they advocate a more systematic approach of experimentation, evaluation, and change.
Abstract: Educational reform is a big business in the United States. Parents, educators, and policymakers generally agree that something must be done to improve schools, but the consensus ends there. The myriad of reform documents and policy discussions that have appeared over the past decade have not helped to pinpoint exactly what should be done. This book is the culmination of extensive discussions among a panel of economists led by Eric Hanushek. They conclude that economic considerations have been entirely absent from the development of educational policies and that economic reality is sorely needed in discussions of new policies. The book outlines an improvement plan that emphasises changing incentives in schools and gathering information about effective approaches. Available research and analysis demonstrates that current central decisionmaking has worked poorly. Concentrating on inputs such as pupil-teacher ratios or teacher graduate degrees appears quite inferior to systems that directly reward performance. Nonetheless, since experience with such alternatives is very limited, a program of extensive evaluation appears to be in order. Instead of choosing the "right" approach, this book advocates a more systematic approach of experimentation, evaluation, and change. In addition to Hanushek, the contributors are Charles S. Benson, University of California, Berkeley; Richard B. Freeman, Harvard University; Dean T. Jamison, UCLA: Henry M. Levin, Stanford University; Rebecca A. Maynard, University of Pennsylvania; Richard J. Murnane, Harvard University; Steven G. Rivkin, Amherst College; Richard H. Sabot, Williams College; Lewis C. Solmon, Milken Institute for Job and Capital Formation; Anita A. Summers, University of Pennsylvania; Finis Welch, Texas AM and Barbara L. Wolfe, University of Wisconsin.
323 citations
TL;DR: In this article, the authors describe the best practices of firms who have integrated environmentalism into their business planning and operations in ways that translate to bottom line benefits, and the experiences of these firms carry a clear and urgent message that companies that continue to approach environmental problems with band-aid solutions and quick fixes will ultimately find themselves at a competitive disadvantage.
Abstract: Contemporary environmentalism in leading companies has become an integral part of organizational strategy. Such a proactive, advantage-driven approach involves change at every level. This article describes the best practices of firms who have integrated environmentalism into their business planning and operations in ways that translate to bottom line benefits. The experiences of these firms carry a clear and urgent message— companies that continue to approach environmental problems with band-aid solutions and quick fixes will ultimately find themselves at a competitive disadvantage.
TL;DR: This interval level handicap measurement scale will be useful in assessing both specific therapies and health services, in clinical trials, in analyses of cost effectiveness, and in assessments of quality assurance.
Abstract: OBJECTIVE--To develop a handicap measurement scale in a self completion questionnaire format, with scale weights allowing quantification of handicap at an interval level of measurement. DESIGN--Adaptation of the International Classification of Impairments, Disabilities and handicaps into a practical questionnaire incorporating the dimensions of handicap mobility, occupation, physical independence, social integration, orientation, and economic self sufficiency and scale weights derived from interviews with a general population sample, with the technique of conjoint analysis. SETTING--Two general practices in different areas of London. SUBJECTS--240 adults aged 55-74 years randomly selected from the practices, 101 (42%) of whom agreed to be interviewed, and 79 (78%) of whom completed the exercise. MAIN MEASURES--Rating of severity of handicap associated with 30 hypothetical health scenarios on a visual analogue scale, from which was derived a matrix of scale weights ("part utilities") relating to different levels of disadvantage on each dimension, with a formula for combining them into an overall handicap score. Severity scores measured directly for five scenarios not used to derive the scale weights were compared with those calculated from the formula to validate the model. RESULTS--The part utilities obtained conformed with the expected hierarchy for each dimension, confirming the validity of the method. The measured severities and those calculated from the formula for the five scenarios used to validate the model agreed closely (Pearson's r = 0.98, p = 0.0009; Kendall's tau = 1.00, p = 0.007). CONCLUSIONS--This interval level handicap measurement scale will be useful in assessing both specific therapies and health services, in clinical trials, in analyses of cost effectiveness, and in assessments of quality assurance.
Book•
01 Sep 1994TL;DR: This book discusses Forms of Educational Television, Learning, Mental Effort, and the Perception of Media, as well as Production Methods and Learning, and Perspectives on Video Media.
Abstract: Contents: HF O'Neil,JrForeword Introduction Forms of Educational Television Processing Visual and Verbal Information Dynamic Visual Presentations Computer-Based Interactive Video Video Production Methods and Tradecraft Production Methods and Learning Learning, Mental Effort, and the Perception of Media Symbol Systems and Media Perspectives on Video Media Discussion and Conclusions
TL;DR: The model reveals that medication that appears expensive in terms of cost per day may not be so when patient compliance and the total costs of treatment are taken into account.
Abstract: The purpose of this study was twofold: to measure the overall direct costs of depression for 1990 in the UK, and to develop a model to illustrate issues in the evaluation of the relative cost-effectiveness of the pharmacological treatment of depression. We compared a tricyclic antidepressant, imipramine, with paroxetine, a newer antidepressant. For assessing the cost of illness, we used a top-down approach. We calculated direct but not indirect costs. Cost-effectiveness was evaluated by developing a simulation model based on the theory of clinical decision analysis to compare the costs and outcome of each treatment. From this we estimated the expected cost per patient and the cost per successfully treated patient. The total cost to the nation of depressive illness was estimated to be 222 pounds million. The expected costs per patient were found to be similar for paroxetine and imipramine (430 pounds v. 424 pounds). The costs per successfully treated patient were found to be lower for paroxetine (824 pounds) than for imipramine (1024 pounds). The results were stable when a sensitivity analysis was applied to the variables employed in the model. The most sensitive variable was the cost of treatment failure. Our model thus reveals that medication that appears expensive in terms of cost per day may not be so when patient compliance and the total costs of treatment are taken into account.
TL;DR: Concern about cost now dominates many decisions about the use of drugs and other therapeutic interventions, and published economic analyses that relate the effectiveness of treatments and their associated costs (cost-effectiveness analyses).
Abstract: Concern about cost now dominates many decisions about the use of drugs and other therapeutic interventions. Increasingly, such decisions are being influenced by published economic analyses that relate the effectiveness of treatments and their associated costs (cost-effectiveness analyses). Many of these analyses are supported by grants from the National Institutes of Health (NIH) or other neutral sources. Some, however, are funded by companies that hope these analyses will put their products in a favorable light1. Companies might then even use particularly favorable analyses to justify the prices of new drugs. A cost-effectiveness analysis is usually performed by developing a . . .
TL;DR: Cross-indexing of clinical and economic ICU performance is easy to calculate and has potential as a research and evaluation tool used by physicians, hospital administrators, payers, and others.
Abstract: ObjectivesTo present an approach for assessing intensive care unit (ICU) performance which takes into account both economic and clinical performance while adjusting for severity of illness. To present a graphic display which permits comparisons among a group of hospitals.DesignA multicenter, incepti
TL;DR: The benefits and limitations of structural equation models for multivariate experiments with incomplete data, closely related to models used in classical experimental design, interbattery measurement analysis, longitudinal analyses, and behavioral genetic analyses are presented.
Abstract: This article presents some benefits and limitations of structural equation models for multivariate experiments with incomplete data. Examples from studies of latent variable path models of cognitive performances illustrate analyses with four different kinds of incomplete data: (a) latent variables, (b) omitted variables, (c) randomly missing data, and (d) non- randomly missing data. Power based cost-benefit analyses for experimental design and planning are also presented. These incomplete data approaches are closely related to models used in classical experimental design, interbattery measurement analysis, longitudinal analyses, and behavioral genetic analyses. These structural equation methods for old experimental design problems indicate some new opportunities for future multivariate research.
TL;DR: The data suggest that the coronary observation unit may be a safe and cost-saving alternative to current triage strategies for patients with a low risk of acute myocardial infarction admitted from the emergency department.
TL;DR: Decision analysis was used to calculate the cost-effectiveness of PAD in CABG, expressed as cost per year of life saved, and compare the health benefits of reducing allogeneic transfusions with the potential risks of autologous blood donation by patients with coronary artery disease.
Journal Article•
TL;DR: A minimum package of public health and clinical interventions, which are highly cost-effective and deal with major sources of disease burden, could be provided in low-income countries for about US$ 12 per person per year and in middle-income nations for about $22.
Abstract: A minimum package of public health and clinical interventions, which are highly cost-effective and deal with major sources of disease burden, could be provided in low-income countries for about US$ 12 per person per year, and in middle-income countries for about $22 Properly delivered, this package could eliminate 21% to 38% of the burden of premature mortality and disability in children under 15 years and 10-18% of the burden in adults The cost would exceed what governments now spend on health in the poorest countries but would be easily affordable in middle-income countries Governments should ensure that, at the least, poor populations have access to these services Additional public expenditure should then go either to extending coverage to the non-poor or to expansion beyond the minimum collection of services to an essential national package of health care, including somewhat less cost-effective interventions against a larger number of diseases and conditions
TL;DR: This article summarized seven aspects of the available data from reading recovery in the United States: (a) nature of the reading tasks, (b) characteristics of tutors, (c) student accomplishments as first graders, (d) maintenance of student accomplishments through grade 4, (e) student-teacher ratio, (f) cost-effectiveness, and (g) teacher effectiveness and retention.
Abstract: Reading Recovery, a program in which teachers tutor first graders, has been implemented extensively in the United States over the past decade. This review summarizes seven aspects of the available data from Reading Recovery in the United States: (a) nature of the reading tasks, (b) characteristics of tutees, (c) student accomplishments as first graders, (d) maintenance of student accomplishments through Grade 4, (e) student-teacher ratio, (f) cost-effectiveness, and (g) teacher effectiveness and retention.
TL;DR: It is demonstrated that a randomized controlled clinical trial of 250 patients comparing two types of hip prostheses (cemented versus cementless) with virtually complete follow-up examination is feasible and patients are willing to answer extensive quality-of-life questionnaires that allow complete assessment of the impact of hip arthroplasty on the patient's overall health-related quality of life.
Abstract: The success of a total hip arthroplasty (THA) is dependent on many more parameters than simply the prosthesis used. This study has demonstrated that a randomized controlled clinical trial of 150 patients comparing two types of hip prostheses (cemented versus cementless) with virtually complete follow-up examination is feasible. It also demonstrates that patients are willing to answer extensive quality-of-life questionnaires that allow complete assessment of the impact of hip arthroplasty on the patient's overall health-related quality of life. This studs- has also demonstrated that THA is an extremely effective intervention when one assesses its ability to impact on patients health-related quality of life with no difference between cement versus cementless at two years' follow-up examination
TL;DR: In this article, the authors developed a decision-analytic model to predict quality-adjusted life expectancy and lifetime treatment costs for patients with symptomatic, single-vessel coronary disease treated by either Palmaz-Schatz stenting (PSS) or conventional balloon angioplasty (PTCA).
Abstract: BACKGROUNDCoronary stenting appears to provide more predictable immediate results and lower rates of restenosis than conventional balloon angioplasty for selected lesion types, but its hospital costs are significantly higher. This study was designed to evaluate the potential cost-effectiveness of Palmaz-Schatz coronary stenting relative to conventional balloon angioplasty for the treatment of patients with symptomatic, single-vessel coronary disease.METHODS AND RESULTSWe developed a decision-analytic model to predict quality-adjusted life expectancy and lifetime treatment costs for patients with symptomatic, single-vessel coronary disease treated by either Palmaz-Schatz stenting (PSS) or conventional angioplasty (PTCA). Estimates of the probabilities of overall procedural success (PTCA, 97%; PSS, 98%), abrupt closure requiring emergency bypass surgery (PTCA, 1.0%; PSS, 0.6%), and angiographic restenosis (PTCA, 37%; PSS, 20%) were derived from review of the literature published as of September 1993. Proced...
TL;DR: When used for the same indications as surgical biopsy, NCB substantially reduces the cost of a breast cancer screening program.
Abstract: PURPOSE: To analyze the cost-effectiveness of needle core biopsy (NCB) in a breast cancer screening program. MATERIALS AND METHODS: A computer model was used to compare two hypothetical groups of women: those who undergo annual mammographic screening and those observed without screening. All clinically significant outcomes for each group were included in the model, which reflected the state of a woman's health each year beginning at age 40 years and ending at age 85 years. RESULTS: The marginal cost per year of life saved by screening was reduced a maximum of 23% (from $20,770 to $15,934) with use of NCB instead of surgical biopsy. The cost of NCB had less effect on cost-effectiveness than the number of women who underwent NCB. CONCLUSION: When used for the same indications as surgical biopsy, NCB substantially reduces the cost of a breast cancer screening program.
TL;DR: This study prospectively evaluates the safety and cost‐effectiveness of early discharge of selected low risk children before recovery from neutropenia.
Abstract: Background. Standard treatment for fever during periods of chemotherapy-induced neutropenia includes hospitalization and administration of intravenous antibiotics until the patient is afebrile and no longer neutropenic. This study prospectively evaluates the safety and cost-effectiveness of early discharge of selected low risk children before recovery from neutropenia.
Methods. We studied 74 children with cancer during 131 consecutive admissions for fever during a period of neutropenia. All patients initially were hospitalized and received broad-spectrum antibiotics. Intravenous antibiotic therapy was discontinued, and the patients promptly were discharged even if they had an absolute neutrophil count (ANC) of less than 500 cells/mm3 as long as they were afebrile, appeared clinically well, had negative cultures, exhibited control of local infection, and showed hematologic evidence of bone marrow recovery.
Results. Intravenous antibiotics were discontinued in 82 cases (63%) before recovery of the ANC to more than 500 cells/mm3, and 78 patients were discharged immediately. None of 70 patients discharged while neutropenic but exhibiting a rising ANC at the time of discharge developed recurrent fever and required readmission. Thirty of these children had an improving localized infection when intravenous antibiotics were discontinued and completed a course of oral antibiotics at home. The estimated mean savings in hospital charges due to early discharge was $5058 per patient.
Conclusions. Low risk children with cancer who are hospitalized and treated for fever and neutropenia but appear clinically well may have intravenous antibiotics discontinued and be discharged safely irrespective of the ANC, as long as their granulocyte count is rising. This approach shortens hospital stays and results in considerable cost savings.
TL;DR: Mortality rate of major burns has decreased significantly in this study, while burn severity indices remained constant, and increase in cost of care was substantially lower than that of general hospital care.
TL;DR: The triplex RT-PCR has greater advantages over monoplex RT- PCR for virus detection, namely, the rapid turnaround time and cost effectiveness.
Abstract: A triplex reverse transcriptase PCR (RT-PCR) was developed to simultaneously detect poliovirus, hepatitis A virus (HAV), and rotavirus in sewage and ocean water. Sewage and ocean water samples seeded with the three different viruses were concentrated by ultrafiltration. The unseeded ocean water and sewage samples were concentrated by vortex flow filtration and/or ultrafiltration. Random hexamers and a rotavirus downstream primer were used to initiate reverse transcription. Three different sets of primers specific for poliovirus, HAV, and rotavirus cDNAs were mixed in the PCR mixture to amplify the target DNA. Three distinct amplified DNA products representing poliovirus, HAV, and rotavirus were identified by gel electrophoresis as 394-, 192-, and 278-bp sequences, respectively. Dot blot and Southern analyses were used to confirm the amplified products for each virus present in the environmental samples. Except for poliovirus, the sensitivity of triplex RT-PCR for the detection of rotavirus and HAV was found to be similar to that of monoplex RT-PCR, which uses only one set of primers to amplify a single type of virus. The triplex RT-PCR has greater advantages over monoplex RT-PCR for virus detection, namely, the rapid turnaround time and cost effectiveness.
TL;DR: In selected patients, ML for T1 glottic cancer provides an effective therapeutic modality suited to the cost-conscious environment and provided savings of 2.4 million dollars when compared to the other treatment modalities.
Abstract: Excision of squamous cell carcinoma of the vocal cord using microlaryngoscopy (ML) with or without laser is a cost-effective treatment option in highly selected patients. A retrospective review of 50 cases of invasive and microinvasive squamous cell carcinoma demonstrated a failure rate of 8% (4 patients), all of whom were successfully salvaged by hemilaryngectomy (1 patient) or irradiation (3 patients). Other treatment options for T1 glottic lesions include hemilaryngectomy or radiotherapy, yielding similar cure rates of 95% and 67% to 93%, respectively. Investigation of the potential savings by extrapolating 1992 health care costs into the treatment options for T1 glottic carcinoma resulted in costs of $12,956 per patient for ML, while hemilaryngectomy averaged $35,616 per patient and radiotherapy netted costs of $32,588 per patient. Extrapolating these costs to a theoretic group of 100 patients, ML provided savings of 2.4 million dollars when compared to the other treatment modalities. In selected pati...
TL;DR: The cost-effectiveness of the Mallory Head (Biomet, Warsaw, IN) cemented versus noncemented total hip arthroplasty was determined as part of a randomized trial and there was no difference in costs between the cemented and noncements.
Abstract: The cost-effectiveness of the Mallory Head (Biomet, Warsaw, IN) cemented versus noncemented total hip arthroplasty was determined as part of a randomized trial. Costs were assessed during the first postoperative year. In-hospital resource use was determined using a chart review of 60 randomly selected patients. Costs were determined using a fully allocated costing model. Outpatient resource use was determined using patient diaries, and appropriate costs were allocated for outpatient visits, admissions to hospital, and patient-borne costs. There was no difference in costs between the cemented and noncemented prostheses. The average cost of the initial hospitalization was $9,990 (1988 Canadian dollars), and outpatient costs during the first year were $1,137 (total cost during the first year was $11,127). The cost per quality adjusted life year was $27,139 during the first year and $8,031 during the first 3 years.
Journal Article•
TL;DR: The results of this study would be considered moderate to strong evidence to adopt enoxaparin prophylaxis against DVT after total hip replacement and the estimated incremental cost-effectiveness is $29 120 per life-year gained.
Abstract: OBJECTIVE: To compare the efficacy and cost-effectiveness of enoxaparin, a low-molecular-weight heparin derivative, with that of low-dose warfarin in the prevention of deep-vein thrombosis (DVT) after total hip replacement. DATA SOURCES: English-language articles on enoxaparin and warfarin prophylaxis is patients undergoing total hip replacement published from January 1982 to December 1992. STUDY SELECTION: Four trials of enoxaparin (involving 567 patients) and six trials of warfarin (involving 630) met the following criteria: randomized controlled trial, prophylaxis started no later than 24 hours after surgery and continued for at least 7 days, warfarin dose monitored and adjusted appropriately, enoxaparin dosage 30 mg twice daily, and DVT confirmed by bilateral venography. DATA EXTRACTION: Rates of DVT, cost of prophylaxis, diagnosis and treatment per patient, rate of pulmonary embolism (PE), number of deaths and incremental cost-effectiveness (cost per life-year gained). DATA SYNTHESIS: The pooled rate of DVT was 13.6% with enoxaparin (95% confidence interval [CI] 10.9% to 16.3%) and 20.6% with warfarin (95% CI 17.4% to 23.8%). At a cost of $19.55 per day for enoxaparin the total cost per patient, including prophylaxis and management of DVT, exceeded that per patient receiving warfarin by about $121. For every 10,000 patients treated the use of enoxaparin will prevent 47 cases of DVT, 3 cases of PE and 4 deaths. Thus, the estimated incremental cost-effectiveness of enoxaparin is $29 120 per life-year gained. CONCLUSION: On the basis of current Canadian cost-effectiveness guidelines the results of this study would be considered moderate to strong evidence to adopt enoxaparin prophylaxis against DVT after total hip replacement. However, because of the limited data the estimates are uncertain. Future trials should compare enoxaparin and warfarin and incorporate a prospective economic appraisal.