Showing papers on "Cost effectiveness published in 1995"
Book•
01 Jan 1995TL;DR: Data from parent reports are used to describe the typical course and the extent of variability in major features of communicative development between 8 and 30 months of age, and unusually detailed information is offered on the course of development of individual lexical, gestural, and grammatical items and features.
Abstract: Data from parent reports on 1,803 children--derived from a normative study of the MacArthur Communicative Development Inventories (CDIs)--are used to describe the typical course and the extent of variability in major features of communicative development between 8 and 30 months of age. The two instruments, one designed for 8-16-month-old infants, the other for 16-30-month-old toddlers, are both reliable and valid, confirming the value of parent reports that are based on contemporary behavior and a recognition format. Growth trends are described for children scoring at the 10th-, 25th-, 50th-, 75th-, and 90th-percentile levels on receptive and expressive vocabulary, actions and gestures, and a number of aspects of morphology and syntax. Extensive variability exists in the rate of lexical, gestural, and grammatical development. The wide variability across children in the time of onset and course of acquisition of these skills challenges the meaningfulness of the concept of the modal child. At the same time, moderate to high intercorrelations are found among the different skills both concurrently and predictively (across a 6-month period). Sex differences consistently favor females; however, these are very small, typically accounting for 1%-2% of the variance. The effects of SES and birth order are even smaller within this age range. The inventories offer objective criteria for defining typicality and exceptionality, and their cost effectiveness facilitates the aggregation of large data sets needed to address many issues of contemporary theoretical interest. The present data also offer unusually detailed information on the course of development of individual lexical, gestural, and grammatical items and features. Adaptations of the CDIs to other languages have opened new possibilities for cross-linguistic explorations of sequence, rate, and variability of communicative development.
2,467 citations
TL;DR: The 587 interventions identified ranged from those that save more resources than they cost, to those costing more than 10 billion dollars per year of life saved, with the median intervention costing $42,000 per life-year saved.
Abstract: We gathered information on the cost-effectiveness of life-saving interventions in the United States from publicly available economic analyses. "Life-saving interventions" were defined as any behavioral and/or technological strategy that reduces the probability of premature death among a specified target population. We defined cost-effectiveness as the net resource costs of an intervention per year of life saved. To improve the comparability of cost-effectiveness ratios arrived at with diverse methods, we established fixed definitional goals and revised published estimates, when necessary and feasible, to meet these goals. The 587 interventions identified ranged from those that save more resources than they cost, to those costing more than 10 billion dollars per year of life saved. Overall, the median intervention costs $42,000 per life-year saved. The median medical intervention cost $19,000/life-year; injury reduction $48,000/life-year; and toxin control $2,800,000/life-year. Cost/life-year ratios and bibliographic references for more than 500 life-saving interventions are provided.
1,276 citations
585 citations
TL;DR: The cost effectiveness of treatment with accelerated t-PA rather than streptokinase compares favorably with that of other therapies whose added medical benefit for dollars spent is judged by society to be worthwhile.
Abstract: Background Patients with acute myocardial infarction who were treated with accelerated tissue plasminogen activator (t-PA) (given over a period of 11/2 hours rather than the conventional 3 hours, and with two thirds of the dose given in the first 30 minutes) had a 30-day mortality that was 15 percent lower than that of patients treated with streptokinase in the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO) study. This was equivalent to an absolute decrease of 1 percent in 30-day mortality. We sought to assess whether the use of t-PA, as compared with streptokinase, is cost effective. Methods Our primary, or base-case, analysis of cost effectiveness used data from the GUSTO study and life expectancy projected on the basis of the records of survivors of myocardial infarction in the Duke Cardiovascular Disease Database. In the primary analysis, we assumed that there were no additional treatment costs due to the use of t-PA after the first year and...
531 citations
TL;DR: Given the improved safety of allogeneic transfusions today, the increased protection afforded by donating autologous blood is limited and may not justify the increased cost.
Abstract: Background Since the recognition that human immunodeficiency virus is transmissible by blood transfusion there has been increasing public and professional support for autologous blood donations before elective surgery. Autologous blood donation is, however, a more expensive process than the donation of allogeneic blood by community volunteers. Furthermore, there have been recent improvements in the safety of the volunteer blood supply. Methods We used a decision-analysis model to assess the cost effectiveness of donating autologous blood for four surgical procedures. Cost data were collected from the observation of transfusion practice at the University of California, Los Angeles, in 1992. Estimates of the risks of transfusion-associated diseases and the costs of treating them came from the medical literature. Cost effectiveness was expressed in dollars per quality-adjusted year of life saved. We performed sensitivity analyses of the variables in our model and examined the effect of strategies suggested t...
483 citations
TL;DR: Immigrant families, those using English as a second language, and parents of children with severe behaviour problems were significantly more likely to enroll in Community/Groups than Clinic/Individual PT, and a cost analysis showed that, with groups of 18 families, Community/ Group programs are more than six times as cost effective as Clinic/ individual programs.
Abstract: A significant percentage of children with disruptive behavior disorders do not receive mental health assistance. Utilization is lowest among groups whose children are at greatest risk. To increase the availability, accessibility, and cost efficacy of parent training programs, this prospective randomized trial compared a large group community-based parent training program to a clinic-based individual parent training (PT) programs. All families of junior kindergartners in the Hamilton public and separate school boards were sent a checklist regarding problems at home. Those returning questionnaires above the 90th percentile were block randomly assigned to: (1) a 12-week clinic-based individual parent training (Clinic/Individual), (2) a 12-week community-based large group parent training (Community/Group), or (3) a waiting list control condition. Immigrant families, those using English as a second language, and parents of children with severe behaviour problems were significantly more likely to enroll in Community/Groups than Clinic/Individual PT. Parents in Community/Groups reported greater improvements in behaviour problems at home and better maintenance of these gains at 6-month follow-up. A cost analysis showed that, with groups of 18 families, Community/Groups are more than six times as cost effective as Clinic/Individual programs.
451 citations
Journal Article•
TL;DR: In this article, a model is presented in which contestants compete to find the innovation of highest value to the tournament sponsor, and the winner receives a prespecified prize, which has a unique subgame-perfect equilibrium.
Abstract: Contracting for research is often infeasible because research inputs are unobservable and research outcomes cannot be verified by a court. Sponsoring a research tournament can resolve these problems. A model is presented in which contestants compete to find the innovation of highest value to the tournament sponsor. The winner receives a prespecified prize. The tournament game has a unique subgame-perfect equilibrium. Free entry is not optimal because equilibrium effort by each researcher decreases in the number of contestants. An optimally designed research tournament balances the probability of overshooting the first-best quality level against the probability of falling short. Copyright 1995 by American Economic Association.
401 citations
TL;DR: In this article, the authors developed an analytical framework to examine the effect of such targeting on firm profits, prices, and coupon face values, and derived comparative statics on firms' optimal mix of offensive and defensive couponing, the number of coupons distributed, redemption rates, face values and incremental sales per redemption.
Abstract: With the advent of panel data on household purchase behavior, and the development of statistical procedures to utilize this data, firms can now target coupons to selected households with considerable accuracy and cost effectiveness. In this article, we develop an analytical framework to examine the effect of such targeting on firm profits, prices, and coupon face values. We also derive comparative statics on firms' optimal mix of offensive and defensive couponing, the number of coupons distributed, redemption rates, face values, and incremental sales per redemption. Among our findings: when rival firms can target their coupon promotions at brand switchers, the outcome will be a prisoner's dilemma in which the net effect of targeting is simply the cost of distribution plus the discount given to redeemers.
375 citations
TL;DR: The results show that total costs vary by stage at diagnosis and age, but the patterns of variation differ for each cancer.
Abstract: PURPOSE This study was conducted to evaluate the effect of stage at diagnosis, age, and level of comorbidity (presence of other illness) on the costs of treating three types of cancer among members of a health maintenance organization. METHODS Among 388,000 members enrolled anytime during 1990 and 1991 in Group Health Cooperative (GHC) of Puget Sound (Washington State), we estimated the total and net direct costs of medical care for colon, prostate, and breast cancers, including both incident (290, 554, and 645 patients, respectively) and prevalent (1046, 1295, and 2299 patients, respectively) cases. We summarized costs for initial, continuing, and terminal phases of care. Net costs were the difference between the costs of the care of each case subject and the average costs of the care for all enrollees without the cancer of interest who were of the same sex and in the same 5-year age group. Differences in estimated total and net costs by stage at diagnosis, age, and comorbidity were separately evaluated using multivariate regression modeling. All P values were two-sided. Comorbidity was based on a score calculated from 1988 pharmacy data. RESULTS Total costs of initial care increased with stage at diagnosis for colon (P = .0013) and breast (P < .0001) cancer cases, but not for prostate cancer cases. Total initial costs decreased with age for prostate (P = .0225) and breast (P = .0002) cancers but did not change with degree of comorbidity for any of the three cancers. Total continuing medical care costs increased with stage at diagnosis for colon (P < .0001) and breast (P < .0001) cancer cases but not for prostate cancer cases. Total terminal care costs were similar by stage for all three cancers. Net initial costs differed with stage for all three cancers (P < .05). Net continuing care costs increased with stage (P < .0001) and decreased with age (P < .001) for colon and breast cancers but not for prostate cancer. Net continuing care costs decreased with comorbidity for all three cancers (P = .004, P = .011, and P < .0001 for colon, prostate, and breast cancers, respectively). Among regional stage cancers, continuing care costs decreased with age for colon (P < .0017) and breast (P = .033) cancers but not for prostate cancers. CONCLUSIONS The results show that total costs vary by stage at diagnosis and age, but the patterns of variation differ for each cancer. Costs of cancer are not simply additive to costs of other conditions. IMPLICATIONS More needs to be done to explore the reasons and implications of age-related cost differences. Cost-effectiveness analyses of cancer control interventions that shift cancer stage distributions may need to consider both the age and comorbidity of the target populations.
354 citations
TL;DR: In 65-year-old patients with NVAF but no other risk factors for stroke, prescribing warfarin instead of aspirin would affect quality-adjusted survival minimally but increase costs significantly.
Abstract: Objective. —To examine the cost-effectiveness of prescribing warfarin sodium in patients who have nonvalvular atrial fibrillation (NVAF) with or without additional stroke risk factors (a prior stroke or transient ischemic attack, diabetes, hypertension, or heart disease). Design. —Decision and cost-effectiveness analyses. The probabilities for stroke, hemorrhage, and death were obtained from published randomized controlled trials. The quality-of-life estimates were obtained by interviewing 74 patients with atrial fibrillation. Costs were estimated from literature review, phone survey, and Medicare reimbursement. Patients. —In the base case, the patients were 65 years of age and good candidates for warfarin therapy. Interventions. —Treatment with warfarin, aspirin, or no therapy in the decision analytic model. Main Outcome Measures. —Quality-adjusted survival and marginal cost-effectiveness of warfarin as compared with aspirin or no therapy. Results. —For patients with NVAF and additional risk factors for stroke, warfarin therapy led to a greater quality-adjusted survival and to cost savings. For patients with NVAF and one additional risk factor, warfarin therapy cost $8000 per quality-adjusted life-year saved. For 65-year-old patients with NVAF alone, warfarin cost about $370000 per quality-adjusted life-year saved, as compared with aspirin therapy. However, for 75-year-old patients with NVAF alone, prescribing warfarin cost $110000 per quality-adjusted life-year saved. For patients who were not prescribed warfarin, aspirin was preferred to no therapy on the basis of both quality-adjusted survival and cost in all patients, regardless of the number of risk factors present. Conclusions. —Treatment with warfarin is cost-effective in patients with NVAF and one or more additional risk factors for stroke. In 65-year-old patients with NVAF but no other risk factors for stroke, prescribing warfarin instead of aspirin would affect quality-adjusted survival minimally but increase costs significantly. (JAMA. 1995;274:1839-1845)
324 citations
TL;DR: FOBT alone is the most cost-effective of the programs, but the cost is sensitive to several key variables, including compliance, which is an important determinant of effectiveness of all of the screening programs.
TL;DR: A meta-analysis of randomised, short term clinical trials found that selective serotonin reuptake inhibitors are better tolerated than tricyclic antidepressants as measured by total numbers of drop outs and that the overall difference is comparatively small.
Abstract: Objective: To assess treatment discontinuation rates with selective serotonin reuptake inhibitors compared with tricyclic antidepressants. Design: Meta-analysis of 62 randomised controlled trials. Subjects: 6029 patients with major unipolar depression. Main outcome measures: Pooled risk ratios for drop out rates with respect to all cases of discontinuation and those due to side effects and treatment failure. Results: The total discontinuation rate was 10% lower with selective serotonin reuptake inhibitors than with tricyclic antidepressants (risk ratio 0.90; 95% confidence interval 0.84 to 0.97) and the drop out rate due to side effects was 25% lower (risk ratio 0.75; 0.66 to 0.84). There was no significant difference between drug classes in the drop out rates for treatment failure. The risk ratios for drop out did not differ significantly between individual selective serotonin reuptake inhibitors. Conclusions: Selective serotonin reuptake inhibitors are better tolerated than tricyclic antidepressants as measured by total numbers of drop outs. The definite advantage to selective serotonin reuptake inhibitors is explained by fewer drop outs due to side effects. The overall difference, however, is comparatively small and may not be clinically relevant. Analyses of cost effectiveness should not overestimate the advantage to selective serotonin reuptake inhibitors. Key messages Key messages In a meta-analysis of randomised, short term clinical trials selective serotonin reuptake inhibitors were associated with 10% fewer overall drop outs than tricyclic antidepressants (nine drop outs for every 10 with tricyclic agents) This difference was accounted for by a lower rate of drop out related to side effects of selective serotonin reuptake inhibitors (25% reduction; three drop outs for every four with tricyclic agents) This comparatively small difference in drop out rate is of uncertain importance clinically and when cost effectiveness is considered Further studies of the tolerability of selective serotonin reuptake inhibitors compared with that of tricyclic antidepressants are required over a longer period in the setting of clinical practice rather than clinical trials
TL;DR: In this article, les AA examine si les benefices attribuables a Recouvrer la lecture demeurent apres interruption de l'intervention, and si ce programme conduit a d'autres effets dans le cadre scolaire.
Abstract: Recouvrer la lecture est une intervention educative aupres d'enfants a risque. Pour juger de l'efficacite de ce programme, les AA. evaluent s'il conduit a l'apprentissage et comparent les taux d'apprentissage realises par des lecteurs moyens et faibles. L'analyse examine si les benefices attribuables a Recouvrer la lecture demeurent apres interruption de l'intervention, et si ce programme conduit a d'autres effets dans le cadre scolaire. Les AA. examinent egalement les couts et benefices du programme
TL;DR: All 15 contraceptives were more effective and less costly than no method and up-front acquisition costs are inaccurate predictors of the total economic costs of competing contraceptive methods.
Abstract: OBJECTIVES. The purpose of the study was to determine the clinical and economic impact of alternative contraceptive methods. METHODS. Direct medical costs (method use, side effects, and unintended pregnancies) associated with 15 contraceptive methods were modeled from the perspectives of a private payer and a publicly funded program. Cost data were drawn from a national claims database and MediCal. The main outcome measures included 1-year and 5-year costs and number of pregnancies avoided compared with use of no contraceptive method. RESULTS. All 15 contraceptives were more effective and less costly than no method. Over 5 years, the copper-T IUD, vasectomy, the contraceptive implant, and the injectable contraceptive were the most cost-effective, saving $14,122, $13,899, $13,813, and $13,373, respectively, and preventing approximately the same number of pregnancies (4.2) per person. Because of their high failure rates, barrier methods, spermicides, withdrawal, and periodic abstinence were costly but still...
TL;DR: In patients without systemic toxicity, a 10-week course of culture-guided oral antibiotic therapy following surgical débridement may be as effective as and less costly than other approaches.
Abstract: Objective. —To examine the cost-effectiveness of approaches to the diagnosis and treatment of patients with type II (non—insulin-dependent) diabetes mellitus (NIDDM) who have foot infections and suspected osteomyelitis. Design. —Decision and cost-effectiveness analyses were performed using a Markov model. We examined the prevalence of osteomyelitis, the major complications and efficacies of long-term antibiotic therapy and surgery, and the performance characteristics of four diagnostic tests (roentgenography, technetium Tc 99m bone scanning, indium In 111—labeled white blood cell scanning, and magnetic resonance imaging). Data were drawn from the English-language literature using MEDLINE searches and bibliographies from selected articles. Setting. —Primary care. Patients. —Patients with NIDDM who had foot infections and suspected osteomyelitis but no signs of systemic toxicity. Interventions. —Following hospitalization for surgical debridement and intravenous antibiotic therapy: (1) treatment for presumed soft-tissue infection, (2) culture-guided empiric treatment for presumed osteomyelitis, (3) 71 combinations of diagnostic tests preceding antibiotic therapy for osteomyelitis, (4) 71 combinations of tests preceding amputation, and (5) immediate amputation. Main Outcome Measures. —Quality-adjusted life expectancy, average costs. Results. —Culture-guided empiric treatment for osteomyelitis with 10 weeks of oral antibiotic therapy has similar effectiveness to testing followed by a long course of antibiotic therapy if any test result is positive. However, empiric treatment is the least expensive strategy. Conclusions. —Noninvasive testing adds significant expense to the treatment of patients with NIDDM in whom pedal osteomyelitis is suspected, and such testing may result in little improvement in health outcomes. In patients without systemic toxicity, a 10-week course of culture-guided oral antibiotic therapy following surgical debridement may be as effective as and less costly than other approaches. (JAMA. 1995;273:712-720)
TL;DR: In this article, data collected from the FINCA group credit programme in Costa Rica were used to study the viability and cost effectiveness of group credit as a means to transmit information on borrower creditworthiness.
Abstract: Information asymmetries plague credit markets in developing countries, leading to selective rationing and market segmentation with adverse income distributional consequences for small borrowers. Data collected from the FINCA group credit programme in Costa Rica were used to study the viability and cost effectiveness of group credit as a means to transmit information on borrower creditworthiness. Groups that screened members and used local information had lower delinquency rates than those that did not. However, less than half the groups had positive rates of economic return, suggesting that group lending may improve information flow but is a cost‐sensitive institutional design.
TL;DR: This study projected the expected clinical and economic outcomes of patients with chronic hepatitis B and estimated the cost-effectiveness of interferon therapy and calculated the quality-adjusted life expectancy for each cohort by using a Markov computer simulation.
Abstract: Objective: To estimate the cost-effectiveness of interferon-α2B for the treatment of patients with chronic hepatitis B infection who are positive for hepatitis B e antigen (HBeAg). Design: Meta-ana...
TL;DR: It is essential to consider the clinical history (pCAD) when selecting the clinical algorithm to make a diagnosis with the lowest cost per effect or cost per utility unit when estimating total costs of diagnostic tests for CAD.
Abstract: Background To compare cost-effectiveness and utility of four clinical algorithms to diagnose obstructive coronary atherosclerotic heart disease (CAD), we compared exercise ECG (ExECG), stress single photon emission computed tomography (SPECT), positron emission tomography (PET), and coronary angiography Methods and Results Published data and a straightforward mathematical model based on Bayes’ theorem were used to compare strategies Effectiveness was defined as the number of patients with diagnosed CAD, and utility was defined as the clinical outcome, ie, the number of quality-adjusted life years (QALY) extended by therapy after the diagnosis of CAD Our model used published values for costs, accuracy, and complication rates of tests Analysis of the model indicates the following results (1) The direct cost (fee) for each test differs considerably from total cost per ΔQALY (2) As pretest likelihood of CAD (pCAD) in the population increases, there is a linear increase in cost per patient tested but a h
TL;DR: The results of discriminant analysis reveal that of the seven predictor variables, five are important to differentiate adopters from non-adopters and are consistent with findings in innovation adoption literature as well as case studies of many firms' experience on CASE implementation.
Abstract: This study examines the impact of various organizational and technology characteristics on the adoption of computer aided software engineering (CASE) technology. Based on research in innovation adoption and IS implementation, the study develops a research model comprised of seven factors that are important for the successful adoption of CASE technology. The data for the study were collected through a field survey of IS managers in the midwest area and 90 responses were received. The results of discriminant analysis reveal that of the seven predictor variables, five are important to differentiate adopters from non-adopters. They are the existence of a product champion, strong top management support, lower IS expertise, perception that CASE technology has greater relative advantage over other alternatives, and a conviction of the cost effectiveness of the technology. The results are consistent with findings in innovation adoption literature as well as case studies of many firms' experience on CASE implementation.
TL;DR: In this paper, the authors examined the departmental production and cost structures of a homogeneous sample of American public research universities in order to estimate their degrees of economies of scale and scope.
TL;DR: Because of the greater complication rate and higher theatre costs forlaparoscopic repair and the patient outcome preferences expressed, the results of larger trials of clinical and cost effectiveness using recurrence as the primary outcome measure should be known before laparoscopic herniorrhaphy is widely adopted.
Abstract: Objective: To establish the safety, short term outcome, and theatre costs of transabdominal laparoscopic repair of inguinal hernia performed as day surgery. Design: Randomised controlled trial. The control operation was the two layer modified Maloney darn. Setting: Teaching hospital and district general hospital. Subjects: 125 men randomised to laparoscopic or open repair of inguinal hernia. Outcome measures: Morbidity, postoperative pain and use of analgesics, quality of life, and theatre costs. Outcome was assessed by questionnaires administered to patients daily for 10 days and at six weeks postoperatively and by outpatient review at six weeks. Return to normal activity was assessed by questionnaire at three months. Results: One vascular complication (2%) occurred in the group that had open repair. Seven complications (12%) including vessel injury and early recurrence arose in the group that had laparoscopic repair (difference in complication rate 10% (95% confidence interval 4% to 18%; P=0.02). Pain scores and quality of life assessed by the short form 36 showed a significant benefit to the group that had laparoscopic repair in the early postoperative period. Return to normal activity was not significantly different between the two groups. Total theatre costs were higher in the group that had laparoscopic repair (mean cost for laparoscopic repair pounds sterling850 (pounds sterling622 to pounds sterling1078); mean cost for open repair pounds sterling268 (pounds sterling245 to pounds sterling292)). Conclusions: Because of the greater complication rate and higher theatre costs forlaparoscopic repair and the patient outcome preferences expressed, the results of larger trials of clinical and cost effectiveness using recurrence as the primary outcome measure should be known before laparoscopic herniorrhaphy is widely adopted.
TL;DR: In this article, the authors compared the results of surgical resection and Stereotactic radiosurgery (SR) as reported in the medical literature between 1974 and 1994, and found that SR had a lower uncomplicated procedure cost, a lower average complication cost per case, and a lower total cost per procedure.
Abstract: SOLITARY METASTATIC BRAIN tumors are the most common intracranial neoplasms encountered by neurosurgeons. Surgical resection of brain metastasis with whole brain radiotherapy (WBR) significantly increases survival in comparison with WBR alone. Stereotactic radiosurgery (SR) seems to provide results that are similar to those of surgical resection. To analyze the economic efficiency of these different treatments, we compared the results of surgical resection and SR as reported in the medical literature between 1974 and 1994. We included studies in which : 1) at least 75% of patients received WBR ; 2) study dates were in the computed tomography era (after 1975) ; 3) operative morbidity, mortality, and median survival were reported ; 4) study dates were not included in a more recent update or review ; 5) tumor histologies were reported ; and 6) the cobalt-60 gamma unit was used for SR. Three surgical resection studies and one SR study met all entry requirements. The WBR baseline was developed from two prospective, randomized trials and used for incremental cost effectiveness analysis. We developed a model of typical resource usage for uncomplicated procedures, reported complications, and subsequent craniotomies (for recurrent tumor or radiation necrosis) for both treatment options. Costs were estimated from the societal viewpoint using the 1992 Medicare Provider Analysis and Review database with average cost :charge ratios for surgery and WBR. A survey of capital and operating costs from five sites was used for radiosurgery. Our analysis revealed that radiosurgery had a lower uncomplicated procedure cost ($20,209 versus $27,587), a lower average complication cost per case ($2,534 versus $2,874), and a lower total cost per procedure ($22,743 versus $30,461), was more cost effective ($24,811 versus $32,149 per life year), and had a better incremental cost effectiveness ($40,648 versus $52,384 per life year) than surgical resection. A sensitivity analysis revealed that large changes in key assumptions would be required to change the analysis outcome. Equalization of the incremental cost effectiveness of the two treatments would require one of the following : 1) a 38.7% reduction in SR annual case volume, 2) a 34.7% increase in SR procedure cost, 3) a 18.8% reduction in surgical resection procedure cost, 4) a 240.5% increase in SR morbidity cost, 5) a 12.7% reduction in SR median survival, 6) a 16.8% increase in surgical resection median survival. Elimination of all surgical resection morbidity cost would still result in superior incremental cost effectiveness for SR. These results indicate the need for prospective clinical trials that examine both the clinical efficacy and the cost effectiveness of surgical resection and SR in the management of solitary metastatic brain tumors.
TL;DR: In this article, a meta-analysis of the effects of marital and family therapy (MFT) across 163 randomized trials is presented, concluding that MFT demonstrates moderate, statistically significant, and often clinically significant effects.
Abstract: This article reviews the major findings from a multiproject meta-analysis of the effects of marital and family therapy (MFT). Across 163 randomized trials, MFT demonstrates moderate, statistically significant, and often clinically significant effects. No orientation is yet demonstrably superior to any other, nor is MFT superior to individual therapy. Cost effectiveness information is scant in these 163 studies, but supportive. Randomized experiments yield very different answers from nonrandomized experimental studies of the effects of MFT, calling into question whether we should mix the two in reviews. We have also found several new differences in the ways that marital therapy (MT) and family therapy (FT) studies are conducted, making them harder to compare. Finally, important questions still exist about whether any psychotherapy, including MFT, yet has sufficient information about how well research generalizes to everyday clinical practice.
01 Jan 1995
TL;DR: The authors describe the design of such a "real world" randomized trial comparing newer antidepressants with older alternatives and use available data on the cost-effectiveness of new antidepressant drugs to illustrate the limitations of these methods.
TL;DR: The results suggest that for the preoperative detection of a 70% to 99% carotid stenosis, the combination of DS and MRA, supplemented by CA for disparate results, is associated with the lowest long-term morbidity and mortality and has a favorable cost-effectiveness ratio.
Abstract: Objective. —To assess the cost-effectiveness of four diagnostic strategies for the preoperative evaluation of symptomatic patients who are potential candidates for carotid endarterectomy (ie, 70% to 99% stenosis): (1) duplex sonography (DS), (2) magnetic resonance angiography (MRA), (3) contrast angiography (CA), and (4) the combination of DS and MRA supplemented by CA for disparate results. Methods. —Cost-effectiveness analysis based largely on published clinical trial data. Sensitivities and specificities of noninvasive tests were estimated from 81 patients undergoing prospective evaluation with DS, MRA, and CA. Outcome Measure. —Incremental cost per quality-adjusted year of life gained. Results. —For a hypothetical cohort of symptomatic patients undergoing evaluation for carotid endarterectomy, the combination of tests resulted in the greatest quality-adjusted life expectancy of the four options considered. After incorporating the costs of testing, surgery, and stroke, we found that neither the MRA nor the CA strategy was cost-effective. The combination of tests was more effective but more costly than DS, resulting in an additional cost of $22 400 per quality-adjusted year of life gained. For centers that do not have adequate MRA, CA resulted in an additional cost of $99 200 per quality-adjusted year of life saved compared with DS. Conclusions. —Our results suggest that for the preoperative detection of a 70% to 99% carotid stenosis, the combination of DS and MRA, supplemented by CA for disparate results, is associated with the lowest long-term morbidity and mortality and has a favorable cost-effectiveness ratio. The combination of tests, or DS alone when MRA is not available, could potentially replace the current practice of using CA alone in the preoperative evaluation of patients with symptomatic carotid stenosis. (JAMA. 1995;274:888-893)
TL;DR: The results of this study suggest that palliative chemotherapy is cost-effective in patients with advanced gastric and colorectal cancer.
TL;DR: MR imaging shows good sensitivity and specificity for diagnosing osteomyelitis in diabetic feet, and it is competitively priced compared with other imaging modalities, making MR imaging clinically useful and cost-effective.
Abstract: PURPOSE: To evaluate sensitivity, specificity, clinical utility, and cost-effectiveness of magnetic resonance (MR) imaging in the diagnosis of osteomyelitis of the foot in diabetics. MATERIALS AND METHODS: MR studies of 62 feet (diabetics [n = 27], nondiabetics [n = 35]) in 59 patients were prospectively evaluated to detect the presence and extent of osteomyelitis. Biopsy (n = 41 feet) and clinical follow-up (n = 62 feet) were used to establish the diagnosis, select treatment, and determine outcome; sensitivity and specificity of MR imaging were calculated. A cost analysis was performed. RESULTS: Sensitivity and specificity of MR imaging in the diagnosis of osteomyelitis were 82% and 80%, respectively, in diabetics and 89% and 94%, respectively, in nondiabetics. There was no recurrent infection at the surgical margin in 13 feet in which the area of limited resection had been delineated at MR imaging. CONCLUSION: MR imaging shows good sensitivity and specificity for diagnosing osteomyelitis in diabetic fee...