Cost effectiveness

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

Health transition in middle-income countries: new challenges for health care

Abstract: The health transition occurring in middle-income countries such as Mexico is characterized by competition for scarce health resources between people with "leftover" ills such as infectious diseases and malnutrition and emerging threats such as chronic diseases mental illness and AIDS. This epidemiologic transition can not be expected to occur in the same way as it did in the industrialized countries. Their model was a series of 3 eras: pestilence and famine with high mortality no population growth and life expectancy of 20-40; receding pandemias and falling mortality with population growth; degenerative and man-made diseases with life expectancy over 50. In middle-income countries however the 3 eras are not necessarily sequential but may be protracted with reverses for some diseases. The co-existence of pre- and post-transitional diseases leads to polarization of different populations in the country. Data from Mexican mortality statistics indeed show decreased overall mortality from malaria childhood diarrhea and whooping cough but increased mortality from heart disease cancer diabetes and motor vehicle accidents. Data from Mexico City reveal falling postneonatal deaths due to diarrhea and respiratory infections but rising neonatal deaths (1st month of age) due to low birth weight and prematurity. Another aspect of the epidemiologic transition model is that the decline in mortality from infectious diseases in industrialized countries was due to lower incidence. In Mexico the incidence of infections remains high but mortality is lower because of antibiotics vaccines and vector control all reversible measures. Examples are diarrhea treated by ORT malaria considered "refractory" dengue fever considered "re-emerging" and AIDS considered "emerging." Resources to handle this continuing mixture of old and emerging diseases will be stressed to the limit with the coincident population growth due to momentum of the young population already born. 6 principles are presented to make primary health services equitable: population-based service delivery quality assurance community participation anticipatory care operation integrated with other social services and innovative models of health care.

Metabolic engineering of cyanobacteria for ethanol production

Abstract: Development of renewable energy is rapidly being embraced by our society and industry to achieve the nation's economic growth goals and to help address the world's energy and global warming crises. Currently most of the bioethanol production is from the fermentation of agricultural crops and residues. There is much debate concerning the cost effectiveness and energy efficiency of such biomass based ethanol production processes. Here, we report the creation of a Synechocystis sp. PCC 6803 strain that can photoautotrophically convert CO2 to bioethanol. Transformation was performed using a double homologous recombination system to integrate the pyruvate decarboxylase (pdc) and alcohol dehydrogenase II (adh) genes from obligately ethanol producing Zymomonas mobilis into the Synechocystis PCC 6803 chromosome under the control of the strong, light driven psbAII promoter. PCR based assay and ethanol production assay were used to screen for stable transformants. A computerized photobioreactor system was established for the experimental design and data acquisition for the analysis of the cyanobacterial cell cultures and ethanol production. The system described here shows an average yield of 5.2 mmol OD730 unit−1 litre−1 day−1 with no required antibiotic/selective agent.

Cost effectiveness of an outpatient multidisciplinary pulmonary rehabilitation programme

Abstract: BACKGROUND—Pulmonary rehabilitation programmes improve the health of patients disabled by lung disease but their cost effectiveness is unproved. We undertook a cost/utility analysis in conjunction with a randomised controlled clinical trial of pulmonary rehabilitation versus standard care. METHODS—Two hundred patients, mainly with chronic obstructive pulmonary disease, were randomly assigned to either an 18 visit, 6 week rehabilitation programme or standard medical management. The difference between the mean cost of 12 months of care for patients in the rehabilitation and control groups (incremental cost) and the difference between the two groups in quality adjusted life years (QALYs) gained (incremental utility) were determined. The ratio between incremental cost and utility (incremental cost/utility ratio) was calculated. RESULTS—Each rehabilitation programme for up to 20 patients cost £12 120. The mean incremental cost of adding rehabilitation to standard care was £ -152 (95% CI -881 to 577) per patient, p=NS. The incremental utility of adding rehabilitation was 0.030 (95% CI 0.002 to 0.058) QALYs per patient, p=0.03. The point estimate of the incremental cost/utility ratio was therefore negative. The bootstrapping technique was used to model the distribution of cost/utility estimates possible from the data. A high likelihood of generating QALYs at negative or relatively low cost was indicated. The probability of the cost per QALY generated being below £0 was 0.64. CONCLUSIONS—This outpatient pulmonary rehabilitation programme produces cost per QALY ratios within bounds considered to be cost effective and is likely to result in financial benefits to the health service.

Using effectiveness and cost-effectiveness to make drug coverage decisions: a comparison of Britain, Australia, and Canada.

Abstract: Context National public insurance for drugs is often based on evidence of comparative effectiveness and cost-effectiveness This study describes how that evidence has been used across 3 jurisdictions (Australia, Canada, and Britain) that have been at the forefront of evidence-based coverage internationally Objectives To describe how clinical and cost-effectiveness evidence is used in coverage decisions both within and across jurisdictions and to identify common issues in the process of evidence-based coverage Design, Setting, and Participants Descriptive analysis of retrospective data from the Common Drug Review (CDR) of Canada, National Institute for Health and Clinical Excellence (NICE) in Britain, and Pharmaceutical Benefits Advisory Committee (PBAC) of Australia All publicly available information as of December 31, 2008, was gathered from each committee's Web site (data set begins in January 2004 [CDR], February 2001 [NICE], and July 2005 [PBAC]) Main Outcome Measure Listing recommendations for each drug by disease indication Results NICE recommended 874% (174/199) of submissions for listing compared with a listing rate of 496% (60/121) and 543% (153/282) for the CDR and PBAC, respectively Significant uncertainty around clinical effectiveness, typically resulting from inadequate study design or the use of inappropriate comparators and unvalidated surrogate end points, was identified as a key issue in coverage decisions Recommendations varied considerably across countries, possibly because of differences in the medications reviewed; different agency processes, including the willingness to negotiate on price; and the approach to “me too” drugs The data suggest that the 3 agencies make recommendations that are consistent with evidence on effectiveness and cost-effectiveness but that other factors are often important Conclusions NICE, PBAC, and CDR face common issues with respect to the quality and strength of the experimental evidence in support of a clinically meaningful effect However, comparative effectiveness and cost-effectiveness, along with other relevant factors, can be used by national agencies to support drug decision making The results of the evaluation process in different countries are influenced by the context, agency processes, ability to engage in price negotiation, and perhaps differences in social values