Cost effectiveness

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

Randomised clinical trial, observational study and assessment of cost-effectiveness of the treatment of varicose veins (REACTIV trial).

Abstract: OBJECTIVES To establish the cost-effectiveness of surgery and sclerotherapy for the treatment of varicose veins. DESIGN Randomised controlled trials (RCTs) were carried out for conservative treatment, sclerotherapy and surgery for varicose veins. An economic analysis was carried out alongside the randomised trial. Economic modelling was undertaken based on the primary data collection and a literature review (database searches undertaken in April 2000 and updated in March 2001). SETTING Primary data collection was from a large district general hospital and a teaching hospital both in England over a 2-year period from January 1999. Cost-effectiveness analysis and economic modelling were carried out using an NHS perspective. PARTICIPANTS A total of 1009 patients were recruited. INTERVENTIONS Thirty-four patents were randomised in Group 1 (minor varicose veins with no reflux, randomised between conservative treatment and sclerotherapy), 77 in Group 2 (moderate varicose veins with reflux, randomised between surgery and sclerotherapy) and 246 in Group 3 (severe varicose veins with reflux, randomised between conservative treatment and surgery). The remaining 652 patients formed the observational part of the study. MAIN OUTCOME MEASURES The cost-effectiveness analysis was based on NHS treatment costs for the 2002--3 financial year, and utilities based on the Short Form 6D (SF-6D) preference-based health measure. For the clinical trial, the outcome measures were health-related quality of life (HRQoL) [Short Form with 36 Items (SF-36), EuroQol quality of life questionnaire (EQ-5D), visual analogue scale (VAS) and standard gamble], symptomatic relief, anatomical extent (for which a new classification was developed and validated), patient satisfaction and the incidence of complications. RESULTS Of the RCTs, only the Group 3 trial was large enough to provide clear results. This showed that surgical treatment produced better results than conservative treatment in terms of HRQoL, symptomatic relief, anatomical extent and patient satisfaction. Clinical outcomes of surgery and sclerotherapy showed significant improvement in the extent of varicose veins, symptomatic and HRQoL parameters. Cost-effectiveness analysis based on the Group 3 trial showed that the surgery produced an estimated discounted benefit of 0.054 quality-adjusted life-year (QALY) over a 2-year period, with an additional discounted cost of pound 387.45, giving an incremental cost-effectiveness ratio (ICER) of pound 7175 per QALY. Economic modelling suggested that surgery produced a still greater benefit when considered with a 10-year time horizon, with an ICER of pound 1936 per QALY. Injection sclerotherapy produced an incremental benefit of approximately 0.044 QALY at a cost of pound 155 when compared with conservative treatment, giving an ICER of pound 3500 per QALY. When surgery was compared with sclerotherapy, surgery produced greater benefit with a lower ICER (showing extended dominance). CONCLUSIONS Standard surgical treatment of varicose veins by saphenofemoral ligation, stripping and multiple phlebectomies is a clinically effective and cost-effective treatment for varicose veins, with an ICER well below the threshold normally considered appropriate for the funding of treatments within the NHS. Injection sclerotherapy also appears to be cost-effective, but produces less overall benefit, with a higher ICER than surgery for patients with superficial venous reflux. In minor varicose veins without reflux, sclerotherapy is likely to provide a small average benefit with acceptable cost-effectiveness. Research is needed into methods for accurate and acceptable utility evaluations for conditions with relatively minor effect on HRQoL and also for a validated and standardised method of classification for varicose veins.

A comparison of the effectiveness of camera trapping and live trapping for sampling terrestrial small-mammal communities

Abstract: Context. There is an increasing reliance on the use of camera-trap technologies for surveys of medium to large terrestrial mammals. Camera trapping may, however, also have significant applications for broad-scale surveys of small mammals. Aims. The present study aims to compare results from camera-trapping surveys to those of the more traditional live-trapping techniques. Specifically, it aims to test the effectiveness of the techniques for detecting species, and the cost effectiveness of both approaches. Methods. Surveys were conducted across 36 sites in the Grampians National Park, Victoria, Australia, between April and July 2009. At each site, independent surveys were conducted for small mammals by using a combination of Elliot and cage trapping, then camera trapping. Results for the two different approaches were compared for both their ability to generate small-mammal presence data and their cost effectiveness. Key results. Camera-trapping surveys of 36 sites in the Grampians National Park compared favourably with those of live-trapping surveys. Similar species were detected across the sites, and camera trapping was a considerably more cost effective than live trapping. Conclusions. Camera-trapping surveys of small terrestrial mammals may provide a new and cost-effective technique for surveying terrestrial small mammals. This is particularly the case when presence data are the main requirement of the survey, with no requirement to capture and tag animals. Implications. Given the cost-effective nature of camera trapping, there is potential to use this approach to increase the level of replication and spatial coverage of small-mammal surveys. Improving the replication and spatial coverage of studies has the potential to significantly increase the scope of research questions that can be asked, thus providing the potential to improve wildlife management.

Microcosting quantity data collection methods.

Abstract: Background—Micro-costing studies collect detailed data on resources utilized and the value of those resources. Such studies are useful for estimating the cost of new technologies or new community-based interventions, for producing estimates in studies that include non-market goods, and for studying within-procedure cost variation. Objectives—This objectives of this paper were to (1) describe basic micro-costing methods focusing on quantity data collection; and (2) suggest a research agenda to improve methods in and the interpretation of micro-costing Research Design—Examples in the published literature were used to illustrate steps in the methods of gathering data (primarily quantity data) for a micro-costing study. Results—Quantity data collection methods that were illustrated in the literature include the use of (1) administrative databases at single facilities, (2) insurer administrative data, (3) forms applied across multiple settings, (4) an expert panel, (5) surveys or interviews of one or more types of providers; (6) review of patient charts, (7) direct observation, (8) personal digital assistants, (9) program operation logs, and (10) diary data. Conclusions—Future micro-costing studies are likely to improve if research is done to compare the validity and cost of different data collection methods; if a critical review is conducted of studies done to date; and if the combination of the results of the first two steps described are used to develop guidelines that address common limitations, critical judgment points, and decisions that can reduce limitations and improve the quality of studies.

Reducing the Global Burden of Cardiovascular Disease, Part 2: Prevention and Treatment of Cardiovascular Disease.

Abstract: In this second part of a 2-part series on the global burden of cardiovascular disease, we review the proven, effective approaches to the prevention and treatment of cardiovascular disease. We specifically review the management of acute cardiovascular diseases, including acute coronary syndromes and stroke; the care of cardiovascular disease in the ambulatory setting, including medical strategies for vascular disease, atrial fibrillation, and heart failure; surgical strategies for arterial revascularization, rheumatic and other valvular heart disease, and symptomatic bradyarrhythmia; and approaches to the prevention of cardiovascular disease, including lifestyle factors, blood pressure control, cholesterol-lowering, antithrombotic therapy, and fixed-dose combination therapy. We also discuss cardiovascular disease prevention in diabetes mellitus; digital health interventions; the importance of socioeconomic status and universal health coverage. We review building capacity for conduction cardiovascular intervention through strengthening healthcare systems, priority setting, and the role of cost effectiveness.

Cost-effectiveness of systematic depression treatment for high utilizers of general medical care.

Abstract: Background Expanding access to high-quality depression treatment will depend on the balance of incremental benefits and costs. We examine the incremental cost-effectiveness of an organized depression management program for high utilizers of medical care. Methods Computerized records at 3 health maintenance organizations were used to identify adult patients with outpatient medical visit rates above the 85th percentile for 2 consecutive years. A 2-step screening process identified patients with current depressive disorders, who were not in active treatment. Eligible patients were randomly assigned to continued usual care (n = 189) or to an organized depression management program (n = 218). The program included patient education, antidepressant pharmacotherapy initiated in primary care (when appropriate), systematic telephone monitoring of adherence and outcomes, and psychiatric consultation as needed. Clinical outcomes (assessed using the Hamilton Depression Rating Scale on 4 occasions throughout 12 months) were converted to measures of "depression-free days." Health services utilization and costs were estimated using health plan–standardized claims. Results The intervention program led to an adjusted increase of 47.7 depression-free days throughout 12 months (95% confidence interval [CI], 28.2-67.8 days). Estimated cost increases were $1008 per year (95% CI, $534-$1383) for outpatient health services, $1974 per year for total health services costs (95% CI, $848-$3171), and $2475 for health services plus time-in-treatment costs (95% CI, $880-$4138). Including total health services and time-in-treatment costs, estimated incremental cost per depression-free day was $51.84 (95% CI, $17.37-$108.47). Conclusions Among high utilizers of medical care, systematic identification and treatment of depression produce significant and sustained improvements in clinical outcomes as well as significant increases in health services costs.