Topic
Cost effectiveness
About: Cost effectiveness is a research topic. Over the lifetime, 69775 publications have been published within this topic receiving 1531477 citations.
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TL;DR: Naloxone distribution to heroin users is likely to reduce overdose deaths and is cost-effective, even under markedly conservative assumptions.
Abstract: Over the past decade, programs have emerged that provide heroin users with naloxone to treat overdose, but the cost-effectiveness of this approach is unknown. This model estimates that this manner ...
273 citations
TL;DR: Propranolol appears to be the preferred initial option under most of a variety of alternative assumptions for antihypertensive medications in persons aged 35 through 64 years with diastolic blood pressure of 95 mm Hg or greater.
Abstract: To evaluate the comparative efficacy and cost-effectiveness of various antihypertensive medications in persons aged 35 through 64 years with diastolic blood pressure of 95 mm Hg or greater and no known coronary heart disease, we used the Coronary Heart Disease Policy Model, which is a computer simulation of overall mortality as well as the mortality, morbidity, and cost of coronary heart disease in the US population. From the pooled literature, we estimated the antihypertensive and total cholesterol effects of various antihypertensive regimens. For 20 years of simulated therapy from 1990 through 2010, the cost per year of life saved was projected to be $10 900 for propranolol hydrochloride; $16 400 for hydrochlorothiazide; $31 600 for nifedipine; $61 900 for prazosin hydrochloride; and $72 100 for captopril. Doubling the cholesterol effects of the agents under study did not significantly change their effectiveness because, in general, lowering diastolic blood pressure by 1 mm Hg was equivalent to lowering the cholesterol level by 6%. Although any projection requires multiple estimates, each of which may be open to debate, propranolol appears to be the preferred initial option under most of a variety of alternative assumptions. ( JAMA . 1990;263:408-413)
273 citations
TL;DR: Evidence for a strong correlation between therapist input and outcome is found and most studies in the field have not included a formal evaluation of cost–effectiveness, which has implications for the costs of the treatments and possibly their effectiveness.
Abstract: Psychiatric problems such as mood and anxiety disorders are highly prevalent and are associated with high societal costs and individual suffering. Evidence-based psychological treatments obtain good results but are not available to the required extent due to the lack of practitioners with adequate training. One way to solve this problem is to provide minimal-contact self-help treatments, for example, with the assistance of computers. Recently, internet-delivered cognitive-behavioral treatment has been tested in a series of controlled trials. However, the interventions come in many forms with different levels and kinds of therapist input, which have implications for the costs of the treatments and possibly their effectiveness. In this review we found evidence for a strong correlation between therapist input and outcome. While emerging evidence attests to the efficacy of internet-delivered treatment when at least minimal therapist guidance is provided, most studies in the field have not included a formal evaluation of cost-effectiveness. Future research needs are discussed.
272 citations
TL;DR: Four years after stroke, besides physical functioning, neuropsychological sequelae such as depression and cognitive impairment contributed to a reduced HRQoL, and the incidence of incontinence proved to be an important factor for HRZoL.
Abstract: Background and Purpose— As stroke mortality rates decline, individuals are increasingly likely to live with their residual impairments and disabilities. Therefore, the quality of poststroke life is...
272 citations
TL;DR: Treatment with perphenazine was less costly than treatment with second-generation antipsychotics with no significant differences in measures of effectiveness, but the trial was limited by a high dropout rate, and longer-term neurological and metabolic side effects require further study.
Abstract: Background: Second-generation antipsychotics have largely replaced firstgeneration antipsychotics for the treatment of schizophrenia, but a large-scale cost/effectiveness analysis has not been attempted. Method: Patients with schizophrenia (N=1,493) were assigned to treatment with a first-generati on antipsychotic (perphenazine) or one of four secondgeneration drugs (olanzapine, quetiapine, risperidone, or ziprasidone) and followed for up to 18 months. Patients with tardive dyskinesia were prohibited from assignment to perphenazine. Patients could be reassigned at any time to another second-generation drug, including clozapine, but not to perphenazine. The cost analysis included medications plus health services use. Qualityadjusted life year (QALY) ratings were assessed on the basis of Positive and Negative Syndrome Scale (PANSS) subscale scores and side effects. An intention-totreat analysis included all available observations, classified by initial drug assignment, and costs of reassignment of most patients to another second-generation drug. The analysis was repeated considering only treatment on initially assigned medications. Results: Although QALY ratings, PANSS scores, and other quality of life measures indicated modest improvement over 18 months, there were no significant differences between perphenazine and any second-generation medication. Average total monthly health care costs were $300–$600 (20%–30%) lower for perphenazine than for second-generation antipsychotics because of lower drug cost. Differences in costs remained when maximally discounted drug prices were used for all patients and when only observations during treatment with the first medication were included. Conclusions: Treatment with perphenazine was less costly than treatment with second-generation antipsychotics with no significant differences in measures of effectiveness. However, the trial was limited by a high dropout rate, and longer-term neurological and metabolic side effects require further study.
272 citations