Cost effectiveness

About: Cost effectiveness is a research topic. Over the lifetime, 69775 publications have been published within this topic receiving 1531477 citations.

Estimating confidence intervals for cost‐effectiveness ratios: an example from a randomized trial

Abstract: Cost-effectiveness ratios usually appear as point estimates without confidence intervals, since the numerator and denominator are both stochastic and one cannot estimate the variance of the estimator exactly. The recent literature, however, stresses the importance of presenting confidence intervals for cost-effectiveness ratios in the analysis of health care programmes. This paper compares the use of several methods to obtain confidence intervals for the cost-effectiveness of a randomized intervention to increase the use of Medicaid's Early and Periodic Screening, Diagnosis and Treatment (EPSDT) programme. Comparisons of the intervals show that methods that account for skewness in the distribution of the ratio estimator may be substantially preferable in practice to methods that assume the cost-effectiveness ratio estimator is normally distributed. We show that non-parametric bootstrap methods that are mathematically less complex but computationally more rigorous result in confidence intervals that are similar to the intervals from a parametric method that adjusts for skewness in the distribution of the ratio. The analyses also show that the modest sample sizes needed to detect statistically significant effects in a randomized trial may result in confidence intervals for estimates of cost-effectiveness that are much wider than the boundaries obtained from deterministic sensitivity analyses.

Pit and fissure sealant: review of the literature.

Abstract: For this literature review of pit and fissure sealant, 1,465 references were selected by a search for "sealants" on PubMed. References were limited to dental journals and papers in the English language. The search comprised papers from 1971 to October 2001. Additional papers of historical significance prior to 1971 were added from memory and from reference lists published in early papers. This paper reviewed the literature on pit and fissure sealants under the following subheadings: (1) laboratory studies, (2) clinical technique and tooth preparation, (3) etching time, (4) auxiliary application of pit and fissure sealant, (5) retention and caries prevention, (6) fluoride used with sealants and fluoride-containing sealant, (7) glass ionomer materials as sealants, (8) options in sealant: filled vs unfilled; colored vs clear; autocure vs light-initiated, (9) sealant placed over caries in a therapeutic manner, (10) cost effectiveness of sealant application, (11) underuse of pit and fissure sealant, (12) the estrogenicity issue, (13) use of an intermediate bonding layer to improve retention, (14) new developments and projections, and (15) summary and conclusions. From a careful and thorough review of peer-reviewed publications on pit and fissure sealant, it is clear that sealants are safe, effective and underused (at least underused in the United States). Pit and fissure sealant is best applied to high-risk populations by trained auxiliaries using sealant that incorporates the benefit of an intermediate bonding layer, applied under the rubber dam or with some alternative short-term, but effective, isolation technique, onto an enamel surface that has been cleaned with an air polishing technique and etched with 35% phosphoric acid for 15 seconds. The dental profession awaits with enthusiasm, and some impatience, the incorporation of dentin-bonding technology into the development of a modern, more durable, resin-based sealant.

No Child Left Behind: Costs and Benefits.

Abstract: The promise of providing all children with a high-quality education is a noble one. But after looking at the projected costs for 10 states to fulfill the requirements of NCLB, Mr. Mathis fears that the federal government is asking too much and giving too little. IT IS THE cruelest illusion to promise far more than we will ever deliver. Yet throughout time reformers of all persuasions have offered Utopian visions in exchange for permission to shape the world to their view. With great fanfare about historic turning points and fervent promises to America's children, in January 2002 President Bush signed into law the No Child Left Behind (NCLB) Act, the latest reauthorization of the Elementary and Secondary Education Act (ESEA). The rhetoric was certainly noble, and the law was sold with the guarantee that, at last, we would leave no student behind. The poor would have the same as the rich, and the strong arm of a resolute government would make it so. Public support for equality, periodic testing, highly qualified teachers, and other provisions of the law was strong.1 As shown by the 87-10 Senate vote, the law passed with substantial bipartisan support. President Bush and Secretary of Education Rod Paige have said much about the great investments the federal government has made in education. And in strident tones, the material accompanying the passage of the law says that the public has a right to demand great returns on this investment.2 Alas, the promises are far greater than the reality. When the "historic" federal investments in education are scrutinized, the first- year increases to Title I compensatory funds amount to a mere 0.4% of total education spending. When the much-touted "flexibility" procedures that NCLB gives to local districts are examined, they allow, at best, a local district to shift around about 4.3% of its already-committed money.3 When the so-called adequate yearly progress provisions of the law are examined, independent reviewers, almost without exception, say the plans are unrealistic.4 Submerged beneath emotional appeals and rhetorical demands, hard questions about costs, the adequacy of resources, and the strength of commitments lie hidden. The Nation's Financial Commitment Throughout the last century, critics loudly proclaimed the nation's peril owing to the alleged poor condition of the schools. Yet results from the National Assessment of Educational Progress show that at the end of the century scores in reading and mathematics had leveled off at a 30-year high, dropouts were near all-time lows, and our nation's economic supremacy was unquestioned.5 This is hardly a picture of a "failed" system. But these facts hide the nation's true educational problems. Much has been made of the "merely average" test scores of U.S. students in comparison with those from other countries. To be sure, U.S. scores on international examinations - such as the Third International Mathematics and Science Study (TIMSS) and the Program of International Student Assessment (PISA) - are at international averages in reading, math, and science.6 However, it is just as clear that the U.S. investment in K-12 education is also less than stellar. We spend the same average amount of our gross domestic product on elementary schools as other developed countries, but we fall to the bottom half in our commitment to high schools.7 The greater and more insidious danger, however, is the disparity in achievement within the United States. International test data tell us that we have the greatest inequities between our highest- and lowest- scoring students of any nation.8 In a UNICEF follow-up study, the gap between our average scorers and our low scorers gives the U.S. an abysmal ranking of 21st out of 24 industrialized nations in educational equality.9 While we are getting more productivity than we pay for, the troubling disparities in achievement reflect our disparities in funding. …