Cost effectiveness

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

Adding it up: The costs and benefits of investing in sexual and reproductive health 2014.

Abstract: To help decision-makers evaluate the investments needed in developing countries this report provides new estimates for 2014 of the needs for and costs and benefits of sexual and reproductive health interventions in three key areas: Contraceptive services; Maternal newborn and other pregnancy-related care; Selected services related to HIV and other STIs for women of reproductive age. The report shows the immediate and direct benefits of investing in each set of interventions individually and the additional benefits of investing in them all simultaneously as well as the cost implications of the investments. It also summarizes important findings from other studies that have quantified the broad long-term benefits of these investments for individuals and societies. This report focuses in particular on the populations with the greatest needs for services to highlight those who are most vulnerable and dependent on public-sector care and subsidies. Assessing the differences among population subgroups countries and geographic regions can help guide national governments and international agencies in allocating resources and making other program decisions that would help to close existing gaps in services. The report does not examine men’s sexual and reproductive health needs independently from those of women although men’s needs are critical to address in their own right. Rather this report looks at the sexual and reproductive health care that women need and use over the course of their lives and identifies gaps in services that if filled could improve their health as well as that of their partners and children. A large body of research shows that when women and their children survive and thrive their families are on surer financial footing and gains can also be seen in education employment and the economy. (Excerpt)

Out-patient psychotherapy for borderline personality disorder: cost-effectiveness of schema-focused therapy v. transference-focused psychotherapy D. I. van Asselt, Carmen D. Dirksen, Arnoud Arntz, Josephine H. Giesen-Bloo,

Abstract: BACKGROUND Schema-focused therapy (SFT) and transference-focused psychotherapy (TFP) for borderline personality disorder were recently compared in a randomised multicentre trial. AIMS To assess the societal cost-effectiveness of SFT v. TFP in treating borderline personality disorder. METHOD Costs were assessed by interview. Health-related quality of life was measured using EQ-5D. Outcomes were costs per recovered patient (recovery assessed with the Borderline Personality Disorder Severity Index) and costs per quality-adjusted life-year (QALY). RESULTS Mean 4-year bootstrapped costs were euro37 826 for SFT and euro46 795 for TFP (95% uncertainty interval for difference -21 775 to 3546); QALYs were 2.15 for SFT and 2.27 for TFP (95% UI -0.51 to 0.28). The percentages of patients who recovered were 52% and 29% respectively. The SFT intervention was less costly and more effective than TFP (dominant), for recovery; it saved euro90 457 for one QALY loss. CONCLUSIONS Despite the initial slight disadvantage in QALYs, there is a high probability that compared with TFP, SFT is a cost-effective treatment for borderline personality disorder.

Handling uncertainty in economic evaluations of healthcare interventions

Abstract: This is the last of four articles The constant introduction of new health technologies, coupled with limited healthcare resources, has engendered a growing interest in economic evaluation as a way of guiding decision makers towards interventions that are likely to offer maximum health gain. In particular, cost effectiveness analyses—which compare interventions in terms of the extra or incremental cost per unit of health outcome obtained—have become increasingly familiar in many medical and health service journals. Considerable uncertainty exists in regard to valid economic evaluations Firstly, several aspects of the underlying methodological framework are still being debated among health economists. Secondly, there is often considerable uncertainty surrounding the data, the assumptions that may have been used, and how to handle and express this uncertainty. In the absence of data at the patient level sensitivity analysis is commonly used; however, a number of alternative methods of sensitivity analysis exist, with different implications for the interval estimates generated (see box). Finally, there is a substantial amount of subjectivity in presenting and interpreting the results of economic evaluations. The aim of this paper is to give an overview of the handling of uncertainty in economic evaluations of healthcare interventions.3 It examines how analysts have handled uncertainty in economic evaluation, assembled data on the distribution and variance of healthcare costs, and proposed guidelines to improve current practice. It is intended as a contribution towards the development of agreed guidelines for analysts, reviewers, editors, and decision makers.4–7 #### Summary points Economic evaluations are beset by uncertainty concerning methodology and data A review of 492 articles published up to December 1996 found that a fifth did not attempt any analysis to examine uncertainty Only 5% of these studies reported some measure of cost variance Closer adherence to published guidelines would greatly improve the current position Use …

Current industrial practices of assessing permeability and P-glycoprotein interaction.

Abstract: Combination of the in vitro models that are high throughput but less predictive and the in vivo models that are low throughput but more predictive is used effectively to evaluate the intestinal permeability and transport characteristics of a large number of drug candidates during lead selection and lead optimization processes. Parallel artificial membrane permeability assay and Caco-2 cells are the most frequently used in vitro models to assess intestinal permeability. The popularity of these models stems from their potential for high throughput, cost effectiveness, and adequate predictability of absorption potential in humans. However, several caveats associated with these models (eg, poor predictability for transporter-mediated and paracellularly absorbed compounds, significant nonspecific binding to cells/devices leading to poor recovery, variability associated with experimental factors) need to be considered carefully to realize their full potential. P-glycoprotein, among other pharmaceutically relevant transporters, has been well demonstrated to be the major determinant of drug disposition. The review article presents an objective analysis of the permeability and transporter models currently being used in the pharmaceutical industry and could help guide the discovery scientists in implementing these models in an optimal fashion.

Screening and case finding instruments for depression

Abstract: Background Screening or case finding instruments have been advocated as a simple, quick and inexpensive method to improve detection and management of depression in non-specialist settings, such as primary care and the general hospital. However, screening/case finding is just one of a number of strategies that have been advocated to improve the quality of care for depression. The adoption of this seemingly simple and effective strategy should be underpinned by evidence of clinical and cost effectiveness. Objectives To determine the clinical and cost effectiveness of screening and case finding instruments in: (1) improving the recognition of depression; (2) improving the management of depression, and (3) improving the outcome of depression. Search methods The researchers undertook electronic searches of The Cochrane Library (Issue 4, 2004); The Cochrane Depression, Anxiety and Neurosis Group's Register [2004); EMBASE (1980-2004); MEDLINE (1966-2004); CINAHL (to 2004) and PsycLIT (1974-2004). References of all identified studies were searched for further trials, and the researchers contacted authors of trials. Selection criteria Randomised controlled trials of the administration of case finding/screening instruments for depression and the feedback of the results of these instruments to clinicians, compared with no clinician feedback. Trials had to be conducted in non-mental health settings, such as primary care or the general hospital. Studies that used screening strategies in addition to enhanced care, such as case management and structured follow up, were specifically excluded. Data collection and analysis Citations and, where possible, abstracts were independently inspected by researchers, papers ordered, re-inspected and quality assessed. Data were also independently extracted. Data relating to: (1) the recognition of depression; (2) the management of depression and (3) the outcome of depression over time were sought. For dichotomous data the Relative Risk (RR), 95% confidence interval (CI) were calculated on an intention-to-treat basis. For continuous data, weighted and standardised mean difference were calculated. A series of a priori sensitivity analyses relating to the method of administration of questionnaires and population under study were used to examine plausible causes of heterogeneity. Main results Twelve studies (including 5693 patients) met our inclusion criteria. Synthesis of these data gave the following results: (1) the recognition of depression: according to case note entries of depression, screening/case finding instruments had borderline impact on the overall recognition of depression by clinicians (relative risk 1.38; 95% confidence interval 1.04 to 1.83). However, substantial heterogeneity was found for this outcome. Screening and feedback, irrespective of baseline score of depression has no impact on the detection of depression (relative risk 1.00; 95% confidence interval 0.89 to 1.13). In contrast, three small positive studies using a two stage selective procedure, whereby patients were screened and only patients scoring above a certain threshold were entered into the trial, did suggest that this approach might be effective (relative risk 2.66; 95% confidence interval 1.78 to 3.96). Separate pooling according to this variable reduced the overall level of heterogeneity. Publication bias was also found for this outcome. (2) the management of depression: according to case note entries for active interventions and prescription data, a selected subsample of all studies reported this outcome and found that there was there was an overall trend to showing a borderline higher intervention rate amongst those who received feedback of screening/case finding instruments (relative risk 1.35; 95% confidence interval 0.98 to 1.85), although substantial heterogeneity between studies existed for this outcome. This result was dependant upon the presence of one highly positive study. (3) the outcome of depression: few studies reported the impact of case finding/screening instruments on the actual outcome of depression, and no statistical pooling was possible. However, three out of four studies reported no clinical effect (p<0.05) at either six months or twelve months. No studies examined the cost effectiveness of screening/case finding as a strategy. Authors' conclusions There is substantial evidence that routinely administered case finding/screening questionnaires for depression have minimal impact on the detection, management or outcome of depression by clinicians. Practice guidelines and recommendations to adopt this strategy, in isolation, in order to improve the quality of healthcare should be resisted. The longer term benefits and costs of routine screening/case finding for depression have not been evaluated. A two stage procedure for screening/case finding may be effective, but this needs to be evaluated in a large scale cluster randomised trial, with a prospective economic evaluation.