Cost effectiveness

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

Competitive Coupon Targeting

Abstract: With the advent of panel data on household purchase behavior, and the development of statistical procedures to utilize this data, firms can now target coupons to selected households with considerable accuracy and cost effectiveness. In this article, we develop an analytical framework to examine the effect of such targeting on firm profits, prices, and coupon face values. We also derive comparative statics on firms' optimal mix of offensive and defensive couponing, the number of coupons distributed, redemption rates, face values, and incremental sales per redemption. Among our findings: when rival firms can target their coupon promotions at brand switchers, the outcome will be a prisoner's dilemma in which the net effect of targeting is simply the cost of distribution plus the discount given to redeemers.

A randomised controlled trial and cost-effectiveness study of systematic screening (targeted and total population screening) versus routine practice for the detection of atrial fibrillation in people aged 65 and over. The SAFE study.

Abstract: Background Atrial fibrillation (AF) is a major risk factor for stroke. This risk can be reduced through treatment with antithrombotic therapy, with a risk reduction of up to 68% observed with warfarin therapy. Guidelines for treatment of AF recommend ages 65 years and over as an indication for treatment with antithrombotic therapy in the presence of AF. This raises the question of whether screening for AF would be a useful policy, and if so what would be the best method for screening. There are no good data on the prevalence of AF in the UK. One small UK study (four practices, n = 3001) demonstrated that systematic nurse-led screening detected more cases than opportunistic case finding; however, most of those cases detected were already diagnosed. Two further single practice-based studies investigated the role of practice nurses in the screening process and whole population screening, but were too small to be meaningful. Objectives To evaluate the incremental cost-effectiveness of targeted, population and opportunistic screening with prompts compared with routine clinical practice. To evaluate the relative cost-effectiveness of different methods of recording and interpreting the ECG within a screening programme. To identify the prevalence and incidence of AF in patients aged 65 years and over. Methods This multicentred randomised controlled trial involved patients aged 65 years and over from 50 primary care centres across the West Midlands. These purposefully selected general practices were randomly allocated to 25 intervention practices and 25 control practices. GPs and practice nurses in the intervention practices received education on the importance of AF detection and ECG interpretation. Patients in the intervention practices were randomly allocated to systematic (n = 5000) or opportunistic screening (n = 5000). Prospective identification of pre-existing risk factors for AF within the screened population enabled comparison between targeted screening of people at higher risk of AF and total population screening. AF detection rates in systematically screened and opportunistically screened populations in the intervention practices were compared with AF detection rate in 5000 patients in the control practices. The screening period was 12 months. Results The total number of patients included in each arm was: control 4936, opportunistic screening 4933 and systematic screening 4933. Baseline prevalence of AF was 7.2%, with a higher prevalence in males (7.8%) and patients aged 75 years and over (10.3%). The control population demonstrated higher baseline prevalence (7.9%) than either the systematic (6.9%) or opportunistic (6.9%) intervention population. In the control population 47 new cases were detected (incidence 1.04% per year). In the opportunistic arm 243 patients without a baseline diagnosis of AF were found to have an irregular pulse, with 177 having an ECG, yielding 31 new cases (incidence 0.69% per year). A further 44 cases were detected outside the screening programme (overall incidence 1.64% per year). In the systematic arm 2357 patients had an ECG yielding 52 new cases (incidence 1.1% per year). Of these, 31 were detected by targeted screening and a further 21 by total population screening. A further 22 cases were detected outside the screening programme (overall incidence 1.62% per year). In terms of ECG interpretation, computerised decision support software (CDSS) gave a sensitivity of 87.3%, a specificity of 99.1% and a positive predictive value (PPV) of 89.5% compared with the gold standard (cardiologist reporting). GPs and practice nurses performed less well. The only difference in performance between intervention populations and controls was that practice nurses from the control arm performed less well than intervention practice nurses on interpretation of limb-lead (PPV 38.8% versus 20.8%) and single-lead (PPV 37.7% versus 24.0%) ECGs. The within-trial economic evaluation results showed the lowest incremental cost to be for the opportunistic arm, with an incremental cost-effectiveness ratio of £337 for each additional case detected compared to the control arm. Opportunistic screening dominated both more intensive screening strategies. Model-based analyses showed small differences in cost and quality-adjusted life-years for different methods and intensities of screening, but annual opportunistic screening resulted in the lowest number of ischaemic strokes and greatest proportion of cases of AF diagnosed. Probabilistic sensitivity results indicated that there was a probability of approximately 60% that screening from the age of 65 was cost-effective in both men and women. Conclusions The prevalence of AF in this population was found to be 7.2%. The incidence ranged from 1.04 to 1.64% per annum. Within the trial, in terms of a screening programme, the only strategy that improved on routine practice was opportunistic screening, at a cost of £337 per additional case detected. Model-based analyses indicated that there was a probability of approximately 60% of annual opportunistic screening being cost effective. Use of CDSS may be considered for analysis of ECGs for detection of AF.

Potential health and economic impact of adding a human papillomavirus vaccine to screening programs.

Abstract: ContextRecently published results suggest that effective vaccines against cervical cancer—associated human papillomavirus (HPV) may become available within the next decade.ObjectiveTo examine the potential health and economic effects of an HPV vaccine in a setting of existing screening.Design, Setting, and PopulationA Markov model was used to estimate the lifetime (age 12-85 years) costs and life expectancy of a hypothetical cohort of women screened for cervical cancer in the United States. Three strategies were compared: (1) vaccination only; (2) conventional cytological screening only; and (3) vaccination followed by screening. Two of the strategies incorporated a vaccine targeted against a defined proportion of high-risk (oncogenic) HPV types. Screening intervals of 1, 2, 3, and 5 years and starting ages for screening of 18, 22, 24, 26, and 30 years were chosen for 2 of the strategies (conventional cytological screening only and vaccination followed by screening).Main Outcome MeasuresIncremental cost per life-year gained.ResultsVaccination only or adding vaccination to screening conducted every 3 and 5 years was not cost-effective. However, at more frequent screening intervals, strategies combining vaccination and screening were preferred. Vaccination plus biennial screening delayed until age 24 years had the most attractive cost-effectiveness ratio ($44 889) compared with screening only beginning at age 18 years and conducted every 3 years. However, the strategy of vaccination with annual screening beginning at age 18 years had the largest overall reduction in cancer incidence and mortality at a cost of $236 250 per life-year gained compared with vaccination and annual screening beginning at age 22 years. The cost-effectiveness of vaccination plus delayed screening was highly sensitive to age of vaccination, duration of vaccine efficacy, and cost of vaccination.ConclusionsVaccination for HPV in combination with screening can be a cost-effective health intervention, but it depends on maintaining effectiveness during the ages of peak oncogenic HPV incidence. Identifying the optimal age for vaccination should be a top research priority.

Blue Water Crime: Deterrence, Legitimacy, and Compliance in Fisheries

Abstract: This study adds to the limited body of empirical evidence on the effect that legitimacy and deterrence have on compliance behavior. The theoretical models of compliance behavior tested include the basic deterrence model, which focuses on the certainty and severity of sanctions as key determinants of compliance, and models which integrate economic theory with theories from social psychology to account for legitimacy, deterrence, and other motivations expected to influence indiv duals' decisions whether to comply. Probit and Tobit econometric estimators are used to examine the compliance behavior of 318 Peninsular Malaysian fishermen who face a regulation banning them from fishing in a zone along the coast. The results of the empirical analysis provide additional evidence on the relationship of deterrence and legitimacy to compliance. The findings are also used to draw implications for compliance policy for regulated fisheries. According to normative compliance theory, people tend to obey laws made and implemented by authorities perceived to be legitimate. A key determinant of perceived legitimacy, according to the procedural justice literature, is the fairness built into the procedures used to develop and implement laws and regulations.l Paternoster et al. (1997) note that while there are numerous theoretical perspectives suggesting that legitimacy is an important determinant of compliance, the empirical evidence making that connection is meager.2 Our study adds to this limited body of empirical evidence. The subjects of our study are fishermen. Fishermen are excellent subjects for the study of compliance. They are subject to numerous regulations that constrain their opportunities to earn income, and temptations and opportunities for offending repeatedly occur.3 Passion, inadvertence, and accident rarely cause a fishery violation; most are the result of deliberate choice. The behavior of fishermen offers good evidence on which to test the role deterrence, legitimacy, and other factors play in explaining compliance. Studying the compliance behavior of such regulated economic agents as fishermen is important for other reasons. Achieving compliance in regulated industries is both costly and difficult. Expenditures on enforcement commonly constitute the largest cost element in governmental regulatory programs. The viability of environmental protection and resource management programs is often threatened by low rates of compliance and high enforcement costs. This raises questions whether there are ways to improve the cost effectiveness of traditional enforcement and whether there are ways to secure compliance without heavy reliance on costly enforcement. Central to improving the cost effectiveness of enforcement and compliance programs is understanding the compliance behavior of the economic agents subject to regulations. To this end, we present tests of alternative models of compliance behavior. The models tested include the basic deterrence model, which focuses on the certainty and severity of sanctions as key determinants of compliance, and models which integrate economic theory with theories from social psychology to account for both intrinsic and extrinsic motivations influencing individuals' decisions whether to comply.4 The tests are conducted on data from interviews with fishermen in Peninsular Malaysia (selfreports of violations). Becker (1968) was the first to develop a formal theoretical framework for explaining criminal activity. Following Smith (1966 [1759], 1985 [1776]) and Bentham (1967 [1789]), Becker assumes that criminals behave basically like other individuals in that they attempt to maximize utility subject to a budget constraint. In Becker's model, an individual commits a crime if the expected utility from committing the crime exceeds the utility from engaging in legitimate activity.5 The basic deterrence framework used in these studies assumes that the threat of sanctions is the only policy mechanism available to improve compliance with regulations. …