Cost effectiveness

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

Methods of Measuring Patient Satisfaction in Health Care Organizations

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.

Interventions for increasing fruit and vegetable consumption in children aged five years and under

Abstract: Background Insufficient consumption of fruits and vegetables in childhood increases the risk of future chronic diseases, including cardiovascular disease. Objectives To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE, Embase Classic and Embase to identify eligible trials on 30 September 2016. We searched CINAHL and PsycINFO in July 2016, Proquest Dissertations and Theses in November 2016 and three clinical trial registers in November 2016 and June 2017. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included studies to identify further potentially relevant trials. Selection criteria We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. Data collection and analysis Two review authors independently extracted data and assessed the risks of bias of included studies; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures.We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. Main results We included 50 trials with 137 trial arms and 10,267 participants. Thirty trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Eleven trials examined the impact of parent nutrition education in increasing child fruit and vegetable intake. Eight studies examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. One study examined the effect of a nutrition intervention delivered to children in increasing child fruit and vegetable intake. Thirteen of the 50 included trials were judged as free from high risks of bias across all domains; performance, detection and attrition bias were the most common domains judged at high risk of bias of remaining studies. Meta-analysis of trials examining child-feeding practices versus no intervention revealed a positive effect on child vegetable consumption (SMD 0.38, 95% CI 0.15 to 0.61; n = 1509; 11 studies; very low-quality evidence), equivalent to a mean difference of 4.03 grams of vegetables. There were no short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.11, 95% CI -0.05 to 0.28; n = 3023; 10 studies; very low-quality evidence) or multicomponent interventions versus no intervention (SMD 0.28, 95% CI -0.06 to 0.63; n = 1861; 4 studies; very low-quality evidence). Insufficient data were available to assess long-term effectiveness, cost effectiveness and unintended adverse consequences of interventions.Studies reported receiving governmental or charitable funds, except for two studies reporting industry funding. Authors' conclusions Despite identifying 50 eligible trials of various intervention approaches, the evidence for how to increase fruit and vegetable consumption of children remains sparse. There was very low-quality evidence child-feeding practice interventions are effective in increasing vegetable consumption of children aged five years and younger, however the effect size was very small and long-term follow-up is required. There was very low-quality evidence that parent nutrition education and multicomponent interventions are not effective in increasing fruit and vegetable consumption of children aged five years and younger. All findings should be considered with caution, given most included trials could not be combined in meta-analyses. Given the very low-quality evidence, future research will very likely change estimates and conclusions. Such research should adopt more rigorous methods to advance the field. This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.

Care of patients with a low probability of acute myocardial infarction. Cost effectiveness of alternatives to coronary-care-unit admission.

Abstract: We conducted a cost-effectiveness analysis to examine the clinical and economic consequences of alternatives to admission to a coronary-care unit for patients who have a relatively low probability of acute myocardial infarction. Despite the fact that all our assumptions were slanted to favor the current standard policy of admission to a coronary-care unit, our analysis shows that admission to an intermediate-care unit providing resuscitative facilities and prophylactic lidocaine is highly cost effective. For patients with about a 5 per cent probability of infarction, admission to a coronary-care unit would cost $2.04 million per life saved and $139,000 per year of life saved, as compared with intermediate care. For the expected number of such patients annually in the United States, the cost would be $297 million to save 145 lives. At probabilities of infarction up to about 20 per cent, the incremental cost to save a year of life by choosing a coronary-care unit over an intermediate-care unit would be higher than the estimated cost of saving a year of life by treating a 40-year-old man with mild hypertension. Our results suggest that many patients who have a low risk of acute myocardial infarction would be appropriate candidates for admission to an intermediate-care unit.

Lipid modification and cardiovascular risk assessment for the primary and secondary prevention of cardiovascular disease: summary of updated NICE guidance.

Abstract: Cardiovascular disease (CVD) is the leading cause of death in England and Wales, accounting for almost a third of deaths. An update of existing National Institute for Health and Care Excellence (NICE) guidance (published in 2008)1 was necessary in light of new evidence on the efficacy and safety of statin therapy,2 on the effects of combining statins with non-statin drugs,3 4 5 and on novel risk assessment tools for predicting risk of CVD.6 Since the previous guideline, more statins have become available as generic drugs, and this has changed the cost effectiveness of statin treatment. The scope of the update included risk assessment for CVD and the use of lipid modification in people with type 1 diabetes, type 2 diabetes, and chronic kidney disease. This article summarises the most recent recommendations from NICE on lipid modification: cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease.7 NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the guideline development group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets. ### Assessing the risk of CVD #### Full formal risk assessment

Natural history of autoimmune thyroiditis.

Abstract: One hundred and sixty-three asymptomatic people with thyroid antibodies or raised serum thyrotrophin (TSH) concentrations, or both, and 209 age-matched and sex-matched controls without either marker of thyroid disorder were followed up for four years to determine the natural history of autoimmune thyroiditis. Mildly raised TSH concentrations alone and the presence of thyroid antibodies alone did not significantly increase the risk of developing overt hypothyroidism during the four years compared with the controls. Overt hypothyroidism developed at the rate of 5% a year in women who initially had both raised TSH concentrations and thyroid antibodies. Prophylactic treatment with thyroxine may be justified in women found to have both markers of impending thyroid failure. The cost effectiveness of screening the adult population remains to be evaluated.