scispace - formally typeset
Search or ask a question

Showing papers on "Cost effectiveness published in 1997"


Journal ArticleDOI
TL;DR: SSR technology presents the potential advantages of reliability, reproducibility, discrimination, standardization and cost effectiveness over RFLPs, and represents the optimum approach for the identification and pedigree validation of maize genotypes compared to other currently available methods.
Abstract: The utility of 131 simple sequence repeat (SSR) loci to characterize and identify maize inbred lines, validate pedigree, and show associations among inbred lines was evaluated using a set of 58 inbred lines and four hybrids. Thirteen sets of inbred parent-progeny triplet pedigrees together with four hybrids and their parental lines were used to quantify incidences of scoring that departed from expectations based upon simple Mendelian inheritance. Results were compared to those obtained using 80 restriction fragment length polymorphism (RFLP) probes. Over all inbred triplets, 2.2% of SSRs and 3.6% of RFLP loci resulted in profiles that were scored as having segregated in a non-Mendelian fashion. Polymorphic index content (PIC, a measure of discrimination ability) values ranged from 0.06 to 0.91 for SSRs and from 0.10 to 0.84 for RFLPs. Mean values for PIC for SSRs and RFLPs were similar, approximately 0.62. However, PIC values for nine SSRs exceeded the maximum PIC for RFLPs. Di-repeats gave the highest mean PIC scores for SSRs but this class of repeats can result in “stutter” bands that complicate accurate genotyping. Associations among inbreds were similar for SSR and RFLP data, closely approximating expectations from known pedigrees. SSR technology presents the potential advantages of reliability, reproducibility, discrimination, standardization and cost effectiveness over RFLPs. SSR profiles can be readily interpreted in terms of alleles at mapped loci across a broad range of maize germ plasm. Consequently, SSRs represent the optimum approach for the identification and pedigree validation of maize genotypes compared to other currently available methods.

877 citations


Journal ArticleDOI
TL;DR: The authors discuss the evidence on the link between school resources and educational and economic outcomes, and debate whether additional spending can improve the performance of the nation's schools. But they find little evidence that large increases in spending leads to improvements in educational performance.
Abstract: Many believe that American education can only be improved with a sizable infusion of new resources into the nation's schools. Others find little evidence that large increases in spending lead to improvements in educational performance. Do additional school resources actually make any difference?The evidence on this question offers a striking paradox. Many analysts have found that extra school resources play a negligible role in improving student achievement while children are in school. Yet many economists have gathered data showing that students who attend well-endowed schools grow up to enjoy better job market success than children whose education takes place in schools where resources are limited. For example, children who attend schools with a lower pupil-teacher ratio and a better educated teaching staff appear to earn higher wages as adults than children who attend poorer schools. This book, which grew out of a Brookings conference, brings together scholars from a variety of disciplines to discuss the evidence on the link between school resources and educational and economic outcomes. In a lively exchange of views, they debate whether additional spending can improve the performance of the nation's schools. In addition to editor Gary Burtless, the contributors include Eric Hanushek, University of Rochester; James Heckman, University of Chicago; Julian Betts, University of California, San Diego; Richard Murnane, Harvard University; Larry Hedges, University of Chicago; and Christopher Jencks, Northwestern University. Dialogues on Public Policy

624 citations


Journal ArticleDOI
TL;DR: The second in a three-part series as discussed by the authors describes the basis for recommendations constituting the reference case analysis, the set of practices developed to guide CEAs that inform societal resource allocation decisions, and the content of these recommendations.
Abstract: Objective. —To develop consensus-based recommendations for the conduct of cost-effectiveness analysis (CEA). This article, the second in a 3-part series, describes the basis for recommendations constituting the reference case analysis, the set of practices developed to guide CEAs that inform societal resource allocation decisions, and the content of these recommendations. Participants. —The Panel on Cost-Effectiveness in Health and Medicine, a nonfederal panel with expertise in CEA, clinical medicine, ethics, and health outcomes measurement, was convened by the US Public Health Service (PHS). Evidence. —The panel reviewed the theoretical foundations of CEA, current practices, and alternative methods used in analyses. Recommendations were developed on the basis of theory where possible, but tempered by ethical and pragmatic considerations, as well as the needs of users. Consensus Process. —The panel developed recommendations through 21/2 years of discussions. Comments on preliminary drafts prepared by panel working groups were solicited from federal government methodologists, health agency officials, and academic methodologists. Conclusions. —The panel's methodological recommendations address (1) components belonging in the numerator and denominator of a cost-effectiveness (C/E) ratio; (2) measuring resource use in the numerator of a C/E ratio; (3) valuing health consequences in the denominator of a C/E ratio; (4) estimating effectiveness of interventions; (5) incorporating time preference and discounting; and (6) handling uncertainty. Recommendations are subject to the "rule of reason," balancing the burden engendered by a practice with its importance to a study. If researchers follow a standard set of methods in CEA, the quality and comparability of studies, and their ultimate utility, can be much improved.

526 citations


Journal ArticleDOI
03 Dec 1997-JAMA
TL;DR: The more intensive the intervention, the lower the cost per QALY saved, which suggests that greater spending on interventions yields more net benefit.
Abstract: Context. —The Agency for Health Care Policy and Research (AHCPR) published the Smoking Cessation: Clinical Practice Guideline in 1996. Based on the results of meta-analyses and expert opinion, the guideline identifies efficacious interventions for primary care clinicians and smoking cessation specialty providers. Objective. —To determine the cost-effectiveness of clinical recommendations in AHCPR's guideline. Design. —The guideline's 15 recommended smoking cessation interventions were analyzed to determine their relative cost-effectiveness. Then, using decision probabilities, the interventions were combined into a global model of the guideline's overall cost-effectiveness. Patients. —The analysis assumes that primary care clinicians screen all presenting adults for smoking status and advise and motivate all smokers to quit during the course of a routine office visit or hospitalization. Smoking cessation interventions are provided to 75% of US smokers 18 years and older who are assumed to be willing to make a quit attempt during a year's time. Intervention. —Three counseling interventions for primary care clinicians and 2 counseling interventions for smoking cessation specialists were modeled with and without transdermal nicotine and nicotine gum. Main Outcome Measure. —Cost (1995 dollars) per life-year or quality-adjusted life-year (QALY) saved, at a discount of 3%. Results. —The guideline would cost $6.3 billion to implement in its first year. As a result, society could expect to gain 1.7 million new quitters at an average cost of $3779 per quitter, $2587 per life-year saved, and $1915 for every QALY saved. Costs per QALY saved ranged from $1108 to $4542, with more intensive interventions being more cost-effective. Group intensive cessation counseling exhibited the lowest cost per QALY saved, but only 5% of smokers appear willing to undertake this type of intervention. Conclusions. —Compared with other preventive interventions, smoking cessation is extremely cost-effective. The more intensive the intervention, the lower the cost per QALY saved, which suggests that greater spending on interventions yields more net benefit. While all these clinically delivered interventions seem a reasonable societal investment, those involving more intensive counseling and the nicotine patch as adjuvant therapy are particularly meritorious.

467 citations


Journal ArticleDOI
22 Mar 1997-BMJ
TL;DR: The relevance of sleep apnoea to public health has been exaggerated and the effectiveness of continuous positive airways pressure in improving health outcomes has been poorly evaluated.
Abstract: Additional data from this article are available on the www.bmj.com/ Objective: To examine the research evidence for the health consequences of obstructive sleep apnoea and the effectiveness of continuous positive airways pressure. Design: A systematic review of published research, studies being identified by searching Medline (1966-96), Embase (1974-96), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) (1982-95); scanning citations; and consulting experts. Studies in all languages were considered which either investigated the association between obstructive sleep apnoea in adults and key health outcomes or evaluated the effectiveness of treatment of obstructive sleep apnoea with continuous positive airways pressure in adults. Main outcome measures: Mortality, systematic hypertension, cardiac arrhythmias, ischaemic heart disease, left ventricular hypertrophy, pulmonary hypertension, stroke, vehicle accidents, measures of daytime sleepiness, and quality of life. Results: 54 epidemiological studies examined the association between sleep apnoea and health related outcomes. Most were poorly designed and only weak or contradictory evidence was found of an association with cardiac arrhythmias, ischaemic heart disease, cardiac failure, systemic or pulmonary hypertension, and stroke. Evidence of a link with sleepiness and road traffic accidents was stronger but inconclusive. Only one small randomised controlled trial evaluated continuous positive airways pressure. Five non-randomised controlled trials and 38 uncontrolled trials were identified. Small changes in objectively measured daytime sleepiness were consistently found, but improvements in morbidity, mortality, and quality of life indicators were not adequately assessed. Conclusions: The relevance of sleep apnoea to public health has been exaggerated. The effectiveness of continuous positive airways pressure in improving health outcomes has been poorly evaluated. There is enough evidence suggesting benefit in reducing daytime sleepiness in some patients to warrant large randomised placebo controlled trials of continuous positive airways pressure versus an effective weight reduction programme and other interventions. Key messages Obstructive sleep apnoea is claimed to be an important cause of premature death and disability There is increasing pressure to provide sleep services for the treatment of patients with sleep apnoea Epidemiological evidence suggests that sleep apnoea causes daytime sleepiness and possibly vehicle accidents Evidence for a causal association between sleep apnoea and other adverse health outcomes is weak There is a paucity of robust evidence for the clinical and cost effectiveness of continuous positive airways pressure in the treatment of most patients with sleep apnoea

441 citations


Journal ArticleDOI
TL;DR: In patients with coronary heart disease, simvastatin therapy is cost effective among both men and women at the ages and cholesterol levels studied.
Abstract: Background The Scandinavian Simvastatin Survival Study (4S) showed that lowering cholesterol levels with simvastatin reduces mortality and morbidity in patients with angina pectoris or previous acute myocardial infarction. Before the widespread use of cholesterol-lowering drugs in such patients is recommended, its cost effectiveness should be demonstrated. We estimated the cost effectiveness of simvastatin treatment to lower cholesterol levels in relation to the age, sex, and cholesterol level before treatment of patients with coronary heart disease. Methods We estimated the cost per year of life gained with simvastatin therapy. To model the increased life expectancy, hazard functions from 4S were used. The costs studied included those of the intervention and the direct and indirect costs associated with morbidity from coronary causes. We prepared separate estimates for men and women at various ages (from 35 to 70 years) and total cholesterol levels before treatment (213 to 309 mg per deciliter). Results ...

403 citations


Journal ArticleDOI
TL;DR: In this paper, transaction cost and institutional theories are integrated in order to enhance understanding of the process by which entities adopt new organizational designs, by grafting cognitive and institutional constraints into the comparative-efficiency framework favored by transaction cost theorists.
Abstract: Transaction cost and institutional theories are integrated in order to enhance understanding of the process by which entities adopt new organizational designs. By grafting cognitive and institutional constraints into the comparative-efficiency framework favored by transaction cost theorists, theorists using the constrained-efficiency framework demonstrate both how efficiency-seeking organizations may be biased in favor of current designs and those that are legitimated within their institutional contexts. The article closes by overlaying the constrained-efficiency framework onto the discussion about the evolution of the M-form of organization, as well as suggesting empirical and simulation strategies consistent with the logic of the constrained-efficiency framework.

393 citations


Journal ArticleDOI
TL;DR: The nature of the most urgent threats to patient information privacy in perspective is put in perspective, as well as the new threats that almost certainly will arise because of the technologies of digital information.
Abstract: W e are well into the digital information age. Digital communications and information resources affect almost every aspect of our lives— business, finance, education, government, and entertainment. Clinical medicine is highly information intensive, but it is one of the few areas of our society where computer access to information has had only limited success in selected areas such as billing and scheduling, laboratory result reporting, and diagnostic instrument systems (such as radiology and cardiology). The move to widely accepted electronic patient records (EPRs) is accelerating, however, and is inevitable because of many pressures. Among those pressures are the desire to improve health care through timely access to information and decision-support aids; the need for simultaneous access to records by doctors, nurses, and administrators in modern, integrated provider and referral systems; meeting the needs of highly mobile patients; the push toward improved cost effectiveness based on analyses of outcomes and utilization information; the need for better support of clinical research; and the growing use of telemedicine and telecare [5]. We are, of course, motivated by the great benefits to patient care and medicine that can derive from this effort. But almost daily we hear about network computer break-ins—often close to home—arousing vivid fears [4]. By putting our personal medical records online, might we be increasing the risk of exposing highly private and sensitive information to outsiders? In this article we take a systems view of privacy and information security in health care. We will put the nature of the most urgent threats to patient information privacy in perspective, the new threats that almost certainly will arise because of the technologies of digital information,

379 citations


Journal ArticleDOI
22 Oct 1997-JAMA
TL;DR: Pneumococcal vaccination saves costs in the prevention of bacteremia alone and is greatly underused among the elderly population, on both health and economic grounds, and supports recent recommendations of the Advisory Committee on Immunization Practices.
Abstract: Context. —Clinical, epidemiologic, and policy considerations support updating the cost-effectiveness of pneumococcal vaccination for elderly people and targeting the evaluation only to prevention of pneumococcal bacteremia. Objective. —To assess the implications for medical costs and health effects of vaccination against pneumococcal bacteremia in elderly people. Design. —Cost-effectiveness analysis of pneumococcal vaccination compared with no vaccination, from a societal perspective. Setting and Participants. —The elderly population aged 65 years and older in the United States in 3 geographic areas: metropolitan Atlanta, Ga; Franklin County, Ohio; and Monroe County, New York. Main Outcome Measures. —Incremental medical costs and health effects, expressed in quality-adjusted life-years per person vaccinated. Results. —Vaccination was cost saving, ie, it both reduced medical expenses and improved health, for all age groups and geographic areas analyzed in the base case. For people aged 65 years and older, vaccination saved $8.27 and gained 1.21 quality-adjusted days of life per person vaccinated. Vaccination of the 23 million elderly people unvaccinated in 1993 would have gained about 78 000 years of healthy life and saved $194 million. In univariate sensitivity analysis, the results remained cost saving except for doubling vaccination costs, including future medical costs of survivors, and lowering vaccination effectiveness. With assumptions most unfavorable to vaccination, cost per quality-adjusted life-year ranged from $35822 for ages 65 to 74 years to $598487 for ages 85 years and older. In probabilistic sensitivity analysis, probability intervals were more narrow, with less than 5% probability that the ratio for ages 85 years and older would exceed $100000. Conclusions. —Pneumococcal vaccination saves costs in the prevention of bacteremia alone and is greatly underused among the elderly population, on both health and economic grounds. These results support recent recommendations of the Advisory Committee on Immunization Practices and public and private efforts under way to improve vaccination rates.

358 citations


Journal ArticleDOI
TL;DR: A decision analytic model was developed to project the immediate responses to treatment and predict the long-term outcomes on the basis of current natural history data to determine whether treatment of histologically mild chronic hepatitis C with a single 6-month course of interferon-2b would affect life expectancy and lifelong costs.
Abstract: Background: Chronic hepatitis C is a major cause of illness and death in the United States. Interferon-α2b can induce clinical, biochemical, and virologic remission in some patients with chronic he...

341 citations


Journal ArticleDOI
06 Sep 1997-BMJ
TL;DR: Compression systems improve the healing of venous leg ulcers and should be used routinely in uncomplicated venous ulcers, and high compression is more effective than low compression but should only be used in the absence of significant arterial disease.
Abstract: Objective: To estimate the clinical and cost effectiveness of compression systems for treating venous leg ulcers. Methods: Systematic review of research. Search of 19 electronic databases including Medline, CINAHL, and Embase. Relevant journals and conference proceedings were hand searched and experts were consulted. Main outcome measures: Rate of healing and proportion of ulcers healed within a time period. Study selection: Randomised controlled trials, published or unpublished, with no restriction on date or language, that evaluated compression as a treatment for venous leg ulcers. Results: 24 randomised controlled trials were included in the review. The research evidence was quite weak: many trials had inadequate sample size and generally poor methodology. Compression seems to increase healing rates. Various high compression regimens are more effective than low compression. Few trials have compared the effectiveness of different high compression systems. Conclusions: Compression systems improve the healing of venous leg ulcers and should be used routinely in uncomplicated venous ulcers. Insufficient reliable evidence exists to indicate which system is the most effective. More good quality randomised controlled trials in association with economic evaluations are needed, to ascertain the most cost effective system for treating venous leg ulcers. Key messages Compression treatment increases the healing of ulcers compared with no compression High compression is more effective than low compression but should only be used in the absence of significant arterial disease No clear differences in the effectiveness of different types of compression systems (multilayer and short stretch bandages and Unna9s boot) have been shown Intermittent pneumatic compression appears to be a useful adjunct to bandaging Rather than advocate one particular system, the increased use of any correctly applied high compression treatment should be promoted

Journal ArticleDOI
TL;DR: The incremental effectiveness of treating NIDDM with the goal of normoglycemia is estimated to be ∼ $16,000/QALY gained, which is in the range of interventions that are generally considered cost-effective.
Abstract: OBJECTIVE To analyze the health benefits and economics of treating NIDDM with the goal of normoglycemia. RESEARCH DESIGN AND METHODS Incidence-based simulation model of NIDDM was used. Hazard rates for complications were adjusted for glycemia using risk gradients from the Diabetes Control and Complications Trial. Treatment costs were estimated from national survey data and clinical trials. Incremental costs and benefits were expressed in present value dollars (3% discount rate). Life-years were adjusted for quality of life, yielding quality-adjusted life-years (QALYs). RESULTS Comprehensive treatment of NIDDM that maintains an HbA 1c value of 7.2% is predicted to reduce the cumulative incidence of blindness, end-stage renal disease, and lower-extremity amputation by 72, 87, and 67%, respectively. Cardiovascular disease risk increased by 3% (no effect of treating glycemia is assumed). Life expectancy increased 1.39 years. The cost of treating hyperglycemia increased by almost twofold, which is partially offset by reductions in the cost of complications. The estimated incremental cost/QALY gained is $16,002. Treatment is more cost-effective for those with longer glycemic exposure (earlier onset of diabetes), minorities, and those with higher HbA 1c under standard care. CONCLUSIONS The incremental effectiveness of treating NIDDM with the goal of normoglycemia is estimated to be ∼ $16,000/QALY gained, which is in the range of interventions that are generally considered cost-effective.

Journal ArticleDOI
TL;DR: In this paper, the authors examined the comparative of higher education institutions in the UK and proposed concepts of cost and outcome efficiency in order to gain further insights into the universities' operations.
Abstract: In this paper, we examine the comparative of higher education institutions in the UK. The governmental inititatives of the decade within this sector have given emphasis to issues of accountability, value for money and cost control. The reporting of various statistics regarding the universities' activities only fully achieves its potential value if it is used to define comprehensive concepts of performance and goal achievements informed by the institutions' missions. In that spirit, we propose concepts of cost and outcome efficiency in order to gain further insights into the universities' operations. Data envelopment analysis and its recent advances were used to asses the two types of efficiency. The application of the methodology to 45 universities in the UK revealed a subset of six institutions that showed satisfactory performance across alternative efficiency tests.

Journal ArticleDOI
TL;DR: Overall probabilities of miscoverage for the nonparametric bootstrap method and the Fieller theorem method were more accurate than those for the other the methods and confidence intervals for cost-effectiveness ratios were more dependably accurate.
Abstract: SUMMARY We evaluated four methods for computing confidence intervals for cost‐effectiveness ratios developed from randomized controlled trials: the box method, the Taylor series method, the nonparametric bootstrap method and the Fieller theorem method. We performed a Monte Carlo experiment to compare these methods. We investigated the relative performance of each method and assessed whether or not it was affected by differing distributions of costs (normal and log normal) and effects (10% absolute difference in mortality resulting from mortality rates of 25% versus 15% in the two groups as well as from mortality rates of 55% versus 45%) or by differing levels of correlation between the costs and effects (correlations of ‐0.50, ‐0.25, 0.0, 0.25 and 0.50). The principal criterion used to evaluate the performance of the methods was the probability of miscoverage. Symmetrical miscoverage of the intervals was used as a secondary criterion for evaluating the four methods. Overall probabilities of miscoverage for the nonparametric bootstrap method and the Fieller theorem method were more accurate than those for the other the methods. The Taylor series method had confidence intervals that asymmetrically underestimated the upper limit of the interval. Confidence intervals for cost‐effectiveness ratios resulting from the nonparametric bootstrap method and the Fieller theorem method were more dependably accurate than those estimated using the Taylor series or box methods. Routine reporting of these intervals will allow individuals using cost‐effectiveness ratios to make clinical and policy judgments to better identify when an intervention is a good value for its cost. © 1997 by John Wiley & Sons, Ltd.

Journal ArticleDOI
TL;DR: It is demonstrated that rapid diagnosis of respiratory viral infections in children is a cost-effective procedure and significantly reduced hospital stays, antibiotic use, and laboratory utilization.
Abstract: Rapid diagnosis of respiratory viral infections in children resulted in significantly reduced hospital stays, antibiotic use, and laboratory utilization compared with those of a matched group of patients from the previous year who were diagnosed by virus culture. We demonstrate that rapid diagnosis of respiratory infections in children is a cost-effective procedure.

Journal ArticleDOI
TL;DR: In this paper, the authors measure cost efficiency and profit efficiency for property-liability insurers and find strong support for the product-quality hypothesis, implying that independent-agency insurers produce higher-quality outputs and are compensated by higher revenues.
Abstract: Property-liability insurance is distributed through a direct-writer system, where agents represent one insurer, and an independent-agency system, where agents represent several insurers. Independent-agency insurers have higher costs than direct writers. The market-imperfections hypothesis attributes the coexistence of the two types of insurers to impediments to competition, while the product-quality hypothesis holds that independent-agency insurers provide higher-quality services. The authors measure cost efficiency and profit efficiency for property-liability insurers and find strong support for the product-quality hypothesis, implying that independent-agency insurers produce higher-quality outputs and are compensated by higher revenues. Copyright 1997 by University of Chicago Press.

Journal ArticleDOI
TL;DR: The cost-effectiveness of screening in women 50 years of age and older was calculated by comparing the first strategy with the second strategy and the actual delay times before the onset of benefits, and the transition probabilities were both age- and strategy-dependent.
Abstract: Background: Screening mammography is recommended for women 50 to 69 years of age because of its proven efficacy and reasonable cost-effectiveness. Extending screening recommendations to include wom...

Journal ArticleDOI
TL;DR: The first Glossop Lecture as mentioned in this paper explores the borderland between geology and engineering, partly historically and through the attitude and education of the practitioners but mainly by consideration of site investigation practice and the use of the geological model in the characterization of a site for engineering purposes.
Abstract: This First Glossop Lecture explores the borderland between geology and engineering, partly historically and through the attitude and education of the practitioners but mainly by consideration of site investigation practice and the use of the geological model in the characterization of a site for engineering purposes. It starts with a historical overview, including the work of Glossop, to introduce the subject matter. The text is illustrated by tables and line drawings, many of which are block models. All models are annotated so that they largely speak for themselves. Text boxes are included for readers with less geological or geotechnical knowledge. Considered simply, the geology at any one site is a product of its history. The engineering geological environment of the site includes the geological history and the current geomorphological processes and climatic conditions. The development of the geological model for any site therefore requires specific consideration of the regional and local geological and geomorphological history and current ground surface conditions. This concept is examined from the scale of plate tectonics to the smallest geological features and micro climate. Simple models of various terrains, rock associations and surface environments and their effect on the geology and geomorphology are presented as geology for engineers, and these are used together with case histories from Britain and overseas to illustrate the development of a model for any particular site. Conclusions are drawn, based on experience of the use of models in practice. Appendices give details of various engineering geological environments. At each stage of site investigation, the status and capability of the model to anticipate are reviewed. Examples are given of varying approaches to each stage dependent upon the local geology and the project, and estimates are given of the potential improvement in geological knowledge at each stage depending on local circumstances. Geological mapping is an underused but important component in getting the model right. The geologist9s role is to get the geology right. The model is also simply examined from risk and uncertainty viewpoints, geometry of local site geology, small scale features, sampling and also from a cost effectiveness perspective. The power of the model is more in its ability to anticipate conditions than to predict them precisely. Anticipation is turned into reality by the ground investigation. A Geological Enviromnental Matrix (GEM) to help anticipate the geology at any one site is presented and examples given of the matrix tested in operation. The paper concludes with consideration of unforeseen and unforeseeable geological conditions in a contractual situation; and discussion on the education, training, research and experience of geologists and engineers in improving teaching, communication and understanding in the borderland of geology and engineering. On any site, an experienced and appropriate geotechnical team is needed to get both the geological and the companion geotechnical models right, to outline objectives and questions to be answered and to determine activities to achieve these. The current status of development in engineering geology on a parochial and world scene is briefly judged. At present engineering geology is largely seen as a service profession, but the potential for developments in understanding the earth and earth9s processes for the benefit of mankind through engineering is exciting. Engineering geology should not lose its distinct role but communication and interaction with engineering need fostering.

Journal ArticleDOI
TL;DR: The Panel outlines a ‘Reference Case’ set of methodological practices to improve study quality and usability, and permit comparison of pharmaceuticals with other health interventions, to improve quality and comparability of analyses.
Abstract: This article reports the recommendations of the Panel on Cost Effectiveness in Health and Medicine, sponsored by the US Public Health Service, on standardised methods for conducting cost-effectiveness analyses. Although not expressly directed at analyses of pharmaceutical agents, the Panel’s recommendations are relevant to pharmacoeconomic studies. The Panel outlines a ‘Reference Case’ set of methodological practices to improve quality and comparability of analyses. Designed for studies that inform resource-allocation decisions, the Reference Case includes recommendations for study framing and scope, components of the numerator and denominator of cost-effectiveness ratios, discounting, handling uncertainty and reporting. The Reference Case analysis is conducted from the societal perspective, and includes all effects of interventions on resource use and health. Resource use includes ‘time’ resources, such as for caregiving or undergoing an intervention. The quality-adjusted life-year (QALY) is the common measure of health effect across Reference Case studies. Although the Panel does not endorse a measure for obtaining quality-of-life weights, several recommendations address the QALY. The Panel recommends a 3% discount rate for costs and health effects. Pharmacoeconomic studies have burgeoned in recent years. The Reference Case analysis will improve study quality and usability, and permit comparison of pharmaceuticals with other health interventions.

Journal ArticleDOI
TL;DR: Nine different methods of measuring patient satisfaction with service quality are examined, with guidelines for measurement of patient satisfaction and implementation of managerial follow-up recommended.
Abstract: Patient perceptions of the quality of services provided is a key factor (along with cost effectiveness) in determining a health care organization's competitive advantage and survival. This article examines the advantages, disadvantages, and problems associated with nine different methods of measuring patient satisfaction with service quality. The appropriateness of each of these techniques under different organizational conditions is also discussed. The article concludes with guidelines for measurement of patient satisfaction and implementation of managerial follow-up.

Journal ArticleDOI
TL;DR: In this article, the authors examined the benefits and costs of job training partnership act (JTPA) Title II-A programs for economically disadvantaged adults and out-of-school youths.
Abstract: This paper examines the benefits and costs of Job Training Partnership Act (JTPA) Title II-A programs for economically disadvantaged adults and out-of-school youths. It is based on a 21,000-person randomized experiment conducted within ongoing Title II-A programs at 16 local JTPA Service Delivery Areas (SDAs) from around the country. In the paper, we present the background and design of our study, describe the methodology used to estimate program impacts, present estimates of program impacts on earnings and educational attainment, and assess the overall success of the programs studied through a benefit-cost analysis.

Journal ArticleDOI
TL;DR: The PTL, LM, and Combi appear to offer substantial advances over the OA/BVM system and the Combitube was associated with the least problems with ventilation and was the most preferred by a majority of EMAs.

Journal ArticleDOI
TL;DR: Knee arthroplasty surgery compares favorably with other surgical interventions such as coronary artery bypass surgery and extremely favorable with medical treatments such as renal dialysis and should be considered an appropriate investment by society.
Abstract: Few studies quantitate the cost of a quality well being as produced by arthroplasty surgery. The objective was to use the Quality of Well Being Index to calculate the cost per quality of well year in knee arthroplasty surgery. The difference in Quality of Well Being Index scores before and after the intervention was calculated and multiplied by the patient's life expectancy. The procedure cost was divided by this quantity resulting in the cost of a quality well year. One hundred patients underwent a primary knee arthroplasty. There were 30 males (average age, 62 years old) and 70 females (average age, 64 years old). The calculated costs per a quality well year were $30,695 (standard deviation $90,883) at 3 months, $17,804 (standard deviation $25,888) at 6 months, $11,560 (standard deviation $11,874) at 1 year, and $6656 (standard deviation $3567) at 2 years postsurgery. Health economists consider an intervention costing less than $30,000 per quality of well year a bargain to society. Cost effectiveness of knee arthroplasty surgery compares favorably with other surgical interventions such as coronary artery bypass surgery ($5000 per quality of well year) and extremely favorable with medical treatments such as renal dialysis ($50,000.00 for the quality well year). Knee arthroplasty is a cost effective procedure and should be considered an appropriate investment by society.

Journal ArticleDOI
TL;DR: Brief Intervention produced significantly greater improvement than Usual Care on multiple measures of change in dietary behaviour and on serum cholesterol levels at 12-month follow-up, and the costs were modest relative to many commonly used practices.

Journal ArticleDOI
TL;DR: Age and behavioral history are as sensitive in predicting chlamydial infection as criteria that include cervicitis, and cost‐effectiveness of selective screening is strongly influenced by the criteria's sensitivity in predicting infection, which was significantly higher in STD clients.
Abstract: Background and Objectives:Detection of subclinicalChlamydia trachomatisinfection in women is a high but costly public health priority.Goals:To develop and test simple selective screening criteria for chlamydia in women, to assess the contribution of cervicitis to screening criteria, and to evaluate

Journal ArticleDOI
TL;DR: The future of this endeavor is challenged by the needs to show cost effectiveness of the activity; update and validate outcomes instruments used as input into the database; and maintain satisfactory followup rates in a medical economic environment that often discourages patient return visits or local assessment.
Abstract: A computerized database was established for all total joint replacements done at the authors' institution. To date the registry contains information on more than 56,000 arthroplasties of which more than 30,000 involve the hip. The registry was designed to determine the effectiveness of total hip arthroplasty as a function of implant design, surgical technique, and patient selection. Furthermore, by maintaining and updating the patient record, data regarding success or anticipated failure could be communicated to the patient. Finally, this resource would provide reliable information that could be communicated to the orthopedic community. Patients are routinely evaluated at 1, 2, and 5 years postoperatively and at 5-year intervals thereafter by examination or letter or telephone questionnaire. Followup of patients at each interval is approximately 95%. Patients are more likely to respond by questionnaire (rather than be seen in person) if they are older, if a longer time has elapsed since surgery, or if they live a long distance from the clinic. Data are collected by five full time employees including computer and statistical support specifically assigned to the project. The annual joint registry budget is in excess of $400,000. Unfortunately, the future of this endeavor is challenged by the needs to: (1) show cost effectiveness of the activity; (2) update and validate outcomes instruments used as input into the database; and (3) maintain satisfactory followup rates in a medical economic environment that often discourages patient return visits or local assessment.

Journal ArticleDOI
TL;DR: Clinical outcomes and estimated health care costs for 490 seriously ill patients who developed renal failure requiring dialysis were examined and the cost-effectiveness of initiating dialysis and continuing aggressive care in patients who were at low, average, and high risk for dying within 6 months was determined.
Abstract: Background: Renal failure requiring dialysis in the setting of hospitalization for serious illness is a poor prognostic sign, and dialysis and aggressive care are sometimes withheld. Objective: To ...

Journal ArticleDOI
TL;DR: Laroscopic adrenalectomy can be performed safety and with the benefits associated with minimally invasive surgery, and the procedure is cost effective, which suggest that laparoscopic Adrenalectomy should be the preferential surgical technique for benign adrenal disease.
Abstract: Objective The authors review their experience with laparoscopic adrenalectomy in patients with benign adrenal neoplasms. Efficacy, safety, and cost effectiveness of the procedure are examined. Background Laparoscopic adrenalectomy is replacing open adrenalectomy in some medical centers as the standard surgical approach for uncomplicated tumors. However, laparoscopic adrenalectomy often is considered more difficult and more expensive than traditional open surgery. Methods Perioperative and postoperative records as well as hospital charges from the first 19 patients undergoing laparoscopic unilateral adrenalectomies at the authors' medical institutions were examined and compared with 19 patients who underwent open unilateral adrenalectomies. Results None of the 19 patients undergoing unilateral laparoscopic adrenalectomy required conversion to open adrenalectomy. Mean operative times as well as total hospital charges were similar in those patients undergoing ether laparoscopic or open adrenalectomy. However, the morbidity and postoperative length of hospital stay were significantly less in those patients undergoing laparoscopic adrenalectomy. Conclusions Laparoscopic adrenalectomy can be performed safety and with the benefits associated with minimally invasive surgery. In addition, the procedure is cost effective. These factors suggest that laparoscopic adrenalectomy should be the preferential surgical technique for benign adrenal disease.

Journal ArticleDOI
TL;DR: Can electronic publications be operated at much lower costs than print journals, and still provide all the services that scholars require? That is the key question that is still in dispute as mentioned in this paper.
Abstract: Can electronic publications be operated at much lower costs than print journals, and still provide all the services that scholars require? That is the key question that is still in dispute. Available evidence shows that free or at least much less expensive journals are possible on the Net. It is probable that such journals will dominate in the area of basic scholarly publishing. However, the transition is likely to be complicated, since the scholarly publishing business is full of inertia and perverse economic incentives.

Journal ArticleDOI
TL;DR: The cost-effectiveness of treatment with an ICD varies when the device is used in a population that has a lower risk for sudden cardiac death than do survivors of cardiac arrest, and the reduction in total mortality that ICD use would have to confer to reach specified cost-Effectiveness ratios is determined.
Abstract: Background: Implantable cardioverter defibrillators (ICDs) are remarkably effective in terminating ventricular arrhythmias, but they are expensive and the extent to which they extend life is unknow...