Cost effectiveness

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

Opening Pandora's box: the unpredictability of reassurance by a normal test result.

Abstract: Objectives: To determine the rate of failure of patient reassurance after a normal test result and study the determinants of failure. Design: Replicated single case study with qualitative and quantitative data analysis. Setting: University teaching hospital. Subjects: 40 consecutive patients referred for echocardiography either because of symptoms (10 patients) or because of a heart murmur (30). 39 were shown to have a normal heart. Interventions: Medical consultations and semistructured patient interviews were tape recorded. Structured interviews with consultant cardiologists were recorded in survey form. Main outcome measures: Patient recall of the explanation and residual understanding, doubt, and anxiety about the heart after the test and post-test consultation. Results: All 10 patients presenting with symptoms were left with anxiety about the heart despite a normal test result and reassurance by the consultant. Of 28 patients referred because of a murmur but shown to have no heart abnormality, 20 became anxious after detection of the murmur; 11 had residual anxiety despite the normal test result. Conclusions: Reassurance of the “worried well”—anxious patients with symptoms or patients concerned by a health query resulting from a routine medical examination or from screening—constitutes a large part of medical practice. It seems to be widely assumed that explaining that tests have shown no abnormality is enough to reassure. The results of this study refute this and emphasise the importance of personal and social factors as obstacles to reassurance. Key messages Obstacles to reassurance relate not only to prob- lems of doctor-patient communication but also to the patient9s past experience and social circum- stances Because of the risk of residual anxiety and the epidemiological hazard of a false positive or incon- clusive test result, referral for the test should be avoided if an expert clinical opinion will suffice Clinical skills in recognising anxiety and identifying innocent murmurs should be rein- forced to minimise unnecessary referrals The consequences of possible residual doubt and anxiety must be factored into measurements of cost effectiveness of echocardiography and of other imaging technologies

Time From Human Immunodeficiency Virus Seroconversion to Reaching CD4+ Cell Count Thresholds <200, <350, and <500 Cells/mm3: Assessment of Need Following Changes in Treatment Guidelines

Abstract: Background. Recent updates of human immunodeficiency virus (HIV) treatment guidelines have raised the CD4+ cell count thresholds for antiretroviral therapy initiation from 350 to 500 cells/mm(3) in the United States and from 200 to 350 cells/mm(3) in mid- and low-income countries. Robust data of time from HIV seroconversion to CD4+ cell counts of 200, 350, and 500 cells/mm(3) are lacking but are needed to inform health care planners of the likely impact and cost effectiveness of these and possible future changes in CD4+ cell count initiation threshold. Methods. Using Concerted Action on Seroconversion to AIDS and Death in Europe data from individuals with well-estimated dates of HIV seroconversion, we fitted mixed models on the square root of CD4+ cell counts measured before combined antiretroviral therapy (cART) initiation. Restricting analyses to adults (age >16 years), we predicted time between seroconversion and CD4+ cell count <200, <350, and <500 cells/mm(3) as well as CD4+ cell count distribution and proportions reaching these thresholds at 1, 2, and 5 years after seroconversion. Results. Median (interquartile range [IQR]) follow-up for the 18495 eligible individuals from seroconversion while cART-free was 3.7 years (1.5, 7). Most of the subjects were male (78%), had a median age at seroconversion of 30 years (IQR, 25-37 years), and were infected through sex between men (55%). Estimated median times (95% confidence interval [CI]) from seroconversion to CD4+ cell count <500, <350, and <200 cells/mm(3) were 1.19 (95% CI, 1.12-1.26), 4.19 (95% CI, 4.09-4.28), and 7.93 (95% CI, 7.76-8.09) years, respectively. Almost half of infected individuals would require treatment within 1 year of seroconversion for guidelines recommending its initiation at 500 cells/mm(3), compared with 26% and 9% for guidelines recommending initiation at 350 and 200 cells/mm(3), respectively. Conclusions. These data suggest substantial increases in the number of individuals who require treatment and call for early HIV testing.

The cost-effectiveness of a multifactorial targeted prevention program for falls among community elderly persons.

Abstract: OBJECTIVESFalls and fall injuries are common—potentially preventable—causes of morbidity, functional decline, and increased health-care use among elderly persons The current analyses, performed on data obtained as part of a randomized controlled trial conducted within a health maintenance organizat

Indications for use of hepatitis B vaccine, based on cost-effectiveness analysis.

Abstract: To formulate indications for the use of hepatitis B vaccine, we examined the cost effectiveness of three strategies: vaccinating everyone; screening everyone and vaccinating those without evidence of immunity; and neither vaccinating nor screening, but passively immunizing those with known exposure. Estimates of the hepatitis attack rate, prevalence of immunity, and frequency of known exposure were made for three representative populations: homosexual men, surgical residents, and the general population of the United States. Screening followed by vaccination of homosexual men and vaccination without prior screening of surgical residents would result in savings of medical costs. Neither screening nor vaccination is the lowest-cost strategy for the general population. Vaccination of susceptible persons will save medical costs for populations with annual attack rates above 5 per cent. Vaccination may be considered cost effective (or cost saving when indirect costs are included) for populations with attack rates as low as 1 to 2 per cent.

Therapeutic drug monitoring for antidepressants: Efficacy, safety, and cost effectiveness.

Abstract: Therapeutic drug monitoring (TDM) of tricyclic antidepressants (TCAs) is a cost-effective tool to increase efficacy and safety in patients suffering from major depressive illness. The concentration:antidepressant response relationships of nortriptyline, desipramine, and amitriptyline conform to a curvilinear relationship between concentration:antidepressant response; whereas, imipramine conforms to a linear relationship. Besides improving efficacy, TDM identifies the subset of patients who are at risk to develop excessive plasma TCA levels with potential resultant central nervous system and cardiovascular toxicity. Taking both the efficacy and safety data into account, cost:benefit analyses demonstrate that TDM is cost effective when used once as a standard aspect of care in the TCA treatment of patients with major depressive illness.