Cost effectiveness

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

Resolving Human-Wildlife Conflicts: The Science of Wildlife Damage Management

Abstract: Philosophy Definitions Philosophies of Wildlife Management What Positive Values Are Provided by Wildlife? What Is Wildlife Damage Management? Why Worry About Human-Wildlife Conflicts? Contributions of Wildlife Damage Management to the Larger Field of Wildlife Management Alternative Definitions for Wildlife Damage Management What Is In a Name? What Are the Necessary Ingredients for Damage by Wildlife? The Role of Government in Wildlife Management The Role of Government Wildlife Biologists History Prehistoric Wildlife Management Wildlife Damage Management in the Ancient World Wildlife Damage Management in Medieval Europe Wildlife Management in Colonial America from 1620 to 1776 Wildlife Management in the U.S. from 1776 to 1880 Why the Closing of the Frontier and the Industrial Revolution Sparked a New Philosophy of Wildlife Management Consequences of the World Wars and the Great Depression on Wildlife Management Wildlife Management in Modern America Wildlife Management in the 21st Century: What Now? Threats to Human Safety Why Do Animals Attack People? How Often Are Humans Injured or Killed by Wildlife? Snakebites Bear Attacks Shark Attacks Alligator Attacks Attacks by Wolves and Coyotes Cougar Attacks Attacks by Large Herbivores Why Has There Been a Recent Increase in Wildlife Attacks on Humans in North America? What Can Be Done to Reduce the Frequency of Wildlife Attacks on Humans? Human Injuries and Fatalities from Ungulate-Automobile Collisions Human Injuries and Fatalities from Bird-Aircraft Collisions Zoonoses Bacterial Diseases Viral Diseases Fungal Disease Economics Economic Analysis of Wildlife Values What Are the Sources of Economic Data about the Positive Values of Wildlife? Why Is It Important to Have Accurate Economic Data about Losses from Wildlife Damage? Measuring Wildlife Damage by Making a Direct Assessment of Losses Assessing the Extent of Wildlife Damage by Surveying People Lost Opportunity Costs Economic Assessment of Wildlife Damage in the U.S. and Worldwide Do High Levels of Wildlife Damage Mean that Wildlife Populations Are Too High? Wildlife Damage to Agricultural Production in Other Parts of the World Environmental Damage and Exotic Species What Is An Exotic Species? Impacts of Exotic Species on the Native Biota Hawaii Galapagos Islands Guam Australia North America Resolving Environmental Problems Caused by Exotic Animals Can We Predict when an Exotic Species Will Cause Environmental Damage? Which Sites Are Vulnerable to Exotic Species? Developing an Integrated Program to Stop the Spread of Exotics Lethal Control Intrinsic Growth Rates of Wildlife Populations What Effect Does Lethal Control have on a Wildlife Population's Birth and Mortality Rates? What Effect Does Lethal Control have on a Wildlife Population's Immigration Rate? Is There a Correlation between Wildlife Population Levels and Wildlife Damage? How Do Values Provided by Wildlife Change as Their Populations Increase? Should Lethal Techniques Be Directed at specific Individuals, Specific Subpopulations, or the Entire Population? Are Lethal Methods Legal? Are Lethal Methods Effective at Reducing Wildlife Damage? Should Lethal Methods Be Used Ahead of Time to Prevent Wildlife Damage or Only After Damage has Begun? Are Lethal Techniques Cost Effective? Do Lethal Techniques Pose a Risk to Nontarget Species? Are Lethal Techniques Humane and Socially Acceptable? Common Methods Used in Lethal Control Fertility Control Normal Reproductive Function Mechanical and Surgical Techniques to Reduce Fertility Reducing Fertility by Disrupting Endocrine Regulation Immunocontraception Administering Fertility Drugs to Animals Controlling the Release of an Antifertility Drug to the Body When Should We Use Contraception In Wildlife? Uses of Contraception in Wildlife Oiling, Addling, or Puncturing Eggs Efforts in Australia to Resolfe Human-Wildlife Conflicts Using Immunocontraceptives What are the Drawbacks to Wildlife Contraception? Public Perceptions of Wildlife Fertility Control Laws Governing the Use of Fertility Control to Manage Wildlife Wildlife Translocation Examples of the Use of Translocation to Resolve Wildlife Conflicts Do Translocated Animals Return to the Site where They Were Captured? Do New Animals Replace the Translocated Ones so that the Problem Persists? Do Translocated Animals Create the Same Problem Elsewhere? What Happens to Translocated Animals? What are the Consequences of Translocation on Resident Wildlife Populations? Is Translocation Cost-Effective? What are Governmental Policies Concerning the Translocation of Nuisance Animals? When Is Translocation Warranted? Fear-Provoking Stimuli Visula Stimuli Auditory Stimuli Olfactory Stimuli Chemical Stimuli The Problem of Habituation Can Habituation to Fear-Provoking Stimuli Be Delayed? Using Live Predators as Fear-Provoking Stimuli Using Guard Dogs as Fear-Provoking Stimuli Hazing or Harassment Chemical Repellants How Plants Use Chemicals to Defend Themselves from Herbivores Biological Basis of Food Preferences Types of Repellants Conditioned Food Aversions Based on Deception Similarities between Batesian Mimicry and DBFA Factors Influencing Repellant Effectiveness to Reduce Wildlife Damage Laws Governing the Use of Vertebrate Repellants Diversion Optimal Foraging Theory Large Group Formation as an Antipredator Behavior - A Natural Form of Diversion Examples of Diversion to Resolve Human-Wildlife Conflicts Creating a Food Diversion through Habitat Modification Response of Wildlife to Supplemental Food Response of Wildlife Diversion Cost Effectiveness What Type of Food or Crop Should Be Used in Diversion? Where Should a Feeder Station or Diversion Crop be Located? Can Wildlife Damage and the Effectiveness of Diversion Be Predicted? Which are Better, Diversionary Crops or Feeder Stations? Can Diversion Be Used with Other Techniques? Exclusion Factors Influencing the Cost Effectiveness of Fencing to Reduce Wildlife Damage Fences to Exclude Deer Using Fences to Reduce Predation on Livestock Using Exclusion to Reduce Predation on Nesting Birds Using Barriers to Protect Individual trees from Herbivores Exclusionary Devices to Prevent Beaver from Rebuilding Dams Using a Trap-Barrier System to Reduce Rat Damage in Rice Fields Using Exclusion to Solve Bird Damage Excluding Wildlife from Buildings Habitat Manipulation Reducing Human-Wildlife Conflicts by Modifying the Resource Reducing Human-Wildlife Conflicts by Modifying the Habitat around the Resource Reducing Human-Wildlife Conflicts at the Landscape Level Human Dimensions Societal Responses to Wildlife Damage Differences in Attitudes toward Wildlife Stakeholder Perceptions of Wildlife Damage Impact of Wildlife Damage on a Person's Attitudes toward Wildlife The Concept of Cultural Carrying Capacity Why is the Management of Human-Wildlife Conflicts So Controversial? Making Policy Decisions Regarding Wildlife Damage Management Forming Partnerships between Wildlife Agencies and People Suffering from Wildlife Damage Resolving Human-Wildlife Conflicts through the Human Dimension Are People's Perceptions about Wildlife Damage Accurate? Developing an Integrated Approach Reducing Blackbird Damage to Sunflowers Reducing Bird Predation at Fish Farms Protecting Ground-Nesting Birds from Mammalian Predators Appendix Latin Names for Species Mentioned in the Text All chapters include a Summary section and Literature Cited.

Randomised controlled trial comparing cost effectiveness of general practitioners and nurse practitioners in primary care

Abstract: Objective: To compare the cost effectiveness of general practitioners and nurse practitioners as first point of contact in primary care. Design: Multicentre randomised controlled trial of patients requesting an appointment the same day. Setting: 20 general practices in England and Wales. Participants: 1716 patients were eligible for randomisation, of whom 1316 agreed to randomisation and 1303 subsequently attended the clinic. Data were available for analysis on 1292 patients (651 general practitioner consultations and 641 nurse practitioner consultations). Main outcome measures: Consultation process (length of consultation, examinations, prescriptions, referrals), patient satisfaction, health status, return clinic visits over two weeks, and costs. Results: Nurse practitioner consultations were significantly longer than those of the general practitioners (11.57 v 7.28 min; adjusted difference 4.20, 95% confidence interval 2.98 to 5.41), and nurses carried out more tests (8.7% v 5.6% of patients; odds ratio 1.66, 95% confidence interval 1.04 to 2.66) and asked patients to return more often (37.2% v 24.8%; 1.93, 1.36 to 2.73). There was no significant difference in patterns of prescribing or health status outcome for the two groups. Patients were more satisfied with nurse practitioner consultations (mean score 4.40 v 4.24 for general practitioners; adjusted difference 0.18, 0.092 to 0.257). This difference remained after consultation length was controlled for. There was no significant difference in health service costs (nurse practitioner £18.11 v general practitioner £20.70; adjusted difference £2.33, −£1.62 to £6.28). Conclusions: The clinical care and health service costs of nurse practitioners and general practitioners were similar. If nurse practitioners were able to maintain the benefits while reducing their return consultation rate or shortening consultation times, they could be more cost effective than general practitioners.

The Economic Burden of Insomnia: Direct and Indirect Costs for Individuals with Insomnia Syndrome, Insomnia Symptoms, and Good Sleepers

Abstract: INSOMNIA IS A PREVALENT PUBLIC HEALTH PROBLEM, WITH BETWEEN 6% AND 10% OF THE POPULATION MEETING DIAGNOSTIC CRITERIA FOR INSOMNIA syndrome1–3 and about a third of the population experiencing insomnia symptoms at any given moment.2 Despite its high prevalence, there is little information on the economic burden of insomnia. Information on the costs of illnesses, an indicator of their burden to society, is increasingly driving policy decisions about the funding and development of health care and research programs and priorities. Insurance companies are also concerned with the costs of illnesses and the impact that interventions may have in reducing symptoms and health care system utilization. Economic evaluations of the cost of illnesses or the cost effectiveness of treatments consider 2 broad categories of costs. These include direct costs associated with the consumption of resources (e.g., consultations, products, and testing), and indirect costs associated with the loss of resources (e.g., absenteeism, reduced productivity).4 While studies show a relationship between insomnia severity and the use of health-care service and product utilization,5–9 quantification of the associated costs is scarce. Similarly, some studies have reported a relationship between insomnia, increased absenteeism, and decreased productivity,10–13 yet the economic burden of this has been less frequently measured. The National Commission on Sleep Disorders Research estimated the direct costs of insomnia in the United States at $13.9 billion for the year 1995,14 whereas Leger et al.15 estimated the total cost of insomnia in France at about 10 million francs (or $2 billion US). The indirect costs associated with insomnia have received less attention in the literature, primarily because these costs are more difficult to estimate and quantify, there is no single database from which to draw, and measurement of these variables is more subject to interpretation and memory bias. Stoller16 attempted to quantify work-related deficits by combining data obtained in a study of workplace performance in Navy servicemen17 with her own insomnia prevalence estimate of 33% and a performance decrement estimate of 4%. The monetary value of absenteeism and lost productivity was estimated at $41.1 billion annually (1995 US$). A per person estimate was attempted by Chilcott and Shapiro,5 who suggest a decrease in work productivity due to insomnia of 10%. This amounts to $3,000 per insomnia sufferer per year. Stoller16 also looked at a number of other indirect costs, including insomnia-related accidents, alcoholism, and depression, estimating their costs at between $77.05 and $92.13 billion. Although these estimates have been criticized because they are based on liberal prevalence rates and relied on some questionable assumptions,9 they are still frequently used to describe the indirect economic consequences of insomnia. A French study18 concluded that insomnia is associated with increased absenteeism and reduced productivity, with associated costs about twice as high for insomnia patients as for good sleepers. The methods of costing did not allow, however, for an analysis of the proportional contribution of insomnia. There was also a methodological problem associated with double-counting costs that may have inflated cost estimates. Using existing data banks, Hillman et al.19 estimated the financial costs of all sleep disorders combined (e.g., insomnia, sleep apnea, periodic limb movements) for Australia at about $1,524 million, or 0.8% of the Australian gross domestic product. While an innovative approach was used to estimate fractions of other health impacts attributable to sleep disorders, this study did not permit the identification of costs associated with individual sleep disorders. A recent study by Ozminkowski et al.20 used medical claims data for health-care services, and absenteeism and short-term disability records to assess costs of insomnia occurring in adults in the US. After matching adult (aged 18–64) subsamples on variables determined by propensity score analysis, indirect costs combined were $1,253 higher in individuals with insomnia as compared to those without insomnia. The matching procedure and use of objective data lend strength to this study. However, costs related to reduced productivity, transportation, use of alcohol, and use of over-the-counter products were excluded from the analysis, suggesting that the results may underestimate the real cost of insomnia. Despite recent progress in documenting the economic burden of insomnia, some methodological weaknesses limit the current state of knowledge on this topic. The use of large administrative databases precludes analysis of potential confounding variables such as the reasons for consultations, use of OTC products, actual consumption of prescribed medications and, for some medications, the target ailment for which it was prescribed. When workplace records are used to obtain absenteeism data, reasons for absences are rarely provided and productivity data are not available. Similarly, the use of official accident records precludes identification of the contributing role of insomnia to these events. Studies typically use 2 groups—individuals with and without insomnia; the inclusion of an intermediate category would allow analysis of a linear relationship between costs and insomnia severity. The purpose of this study was to estimate, from the societal perspective, direct and indirect costs of insomnia. Costs were compared across three groups of participants classified as being good sleepers, having insomnia symptoms or having insomnia syndrome. The proportional contribution of insomnia to overall consultation costs and three indirect dependent cost variables, absenteeism, productivity and accidents, was also calculated.

State of the science on psychosocial interventions for ethnic minorities.

Abstract: According to a recent report of the Surgeon General (U.S. Department of Health and Human Services 1999), a range of treatments exist for most mental disorders, and the efficacy of those treatments is well documented. However, a supplement to that report (U.S. Department of Health and Human Services 2001) notes that minorities are largely missing from the efficacy studies that make up the evidence base for treatments. Because of this omission, questions arise as to whether it is appropriate to advocate for providing evidence-based care for minority populations. Do efficacious treatments generalize to minority populations? Should we adapt care for each cultural group? Does poverty affect outcomes of care? If we were better able to encourage ethnic minorities to enter care, would outcomes be similar to those found for majority patients? New data have become available regarding the impact of mental health interventions on ethnic minorities. Although data are not available to answer each question posed above, we examine what is known about outcomes of mental health treatments for ethnic minorities and begin to answer these important questions about providing care to our growing and diverse ethnic minority populations. Outcomes of mental health care are obtained through two types of research, efficacy and effectiveness studies. Efficacy studies, or randomized, controlled trials, are useful in identifying the outcomes that are likely to be associated with precisely defined care provided by experts. These studies identify the impact of interventions on outcomes, such as decreases in psychiatric symptoms and remission of syndromes. The goal of efficacy studies is to determine whether or not an intervention works for a specific syndrome. Thus, the populations studied need to meet criteria for that syndrome and be relatively free of comorbid disorders. Furthermore, highly trained, specialized clinicians provide the care under carefully specified conditions. To date, these studies have predominantly been conducted in nonminority populations; well-controlled efficacy studies examining outcomes of mental health care for minorities are rarely available. In fact, in an analysis conducted for the report of the Surgeon General entitled “Mental Health: Culture, Race and Ethnicity” (U.S. Department of Health and Human Services 2001), it was found that of 9266 participants involved in the efficacy studies forming the major treatment guidelines for bipolar disorder, schizophrenia, depression, and attention deficit/hyperactivity disorder (ADHD), only 561 Black, 99 Latino, 11 Asian American/Pacific Islanders, and zero American Indians/Alaskan Natives were included. Few of these studies had the power necessary to examine the impact of care on specific minorities. In this chapter, we examine available data from treatment outcome studies with minorities. Effectiveness studies are also important when thinking about outcomes of psychosocial interventions because these studies help evaluate outcomes of care given in real-world settings. Once an intervention is found to be efficacious, effectiveness studies then determine how they work within more diverse (both in terms of diagnosis and comorbidities) populations and when given by less-specialized clinicians. Clinicians in effectiveness studies are more likely to be generalists working in clinical settings. Outcomes often include factors such as whether or not care is sought, length of care, and adequacy of interventions. In addition, because of generally larger sample sizes, some of these trials are able to examine outcomes associated with not only symptom reduction, but also with functioning, quality of life, and cost effectiveness of care. Newer studies tend to include more diverse samples and a few have specifically included a minority sample. Again, we examine data available for minorities and compare outcomes with nonminority samples.