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Cost effectiveness
About: Cost effectiveness is a research topic. Over the lifetime, 69775 publications have been published within this topic receiving 1531477 citations.
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TL;DR: Cranberry tablets provided the most cost-effective prevention for UTI and cost effectiveness ratios demonstrated cranberry tablets were twice as cost effective as organic juice for prevention.
Abstract: Purpose To determine, from a societal perspective, the effectiveness and cost effectiveness of concentrated cranberry tablets, versus cranberry juice, versus placebo used as prophylaxis against lower urinary tract infection (UTI) in adult women. Materials and methods One hundred fifty sexually active women aged 21 through 72 years were randomized for one year to one of three groups of prophylaxis: placebo juice + placebo tablets versus placebo juice + cranberry tablets, versus cranberry juice + placebo tablets. Tablets were taken twice daily, juice 250 ml three times daily. Outcome measures were: (1) a >50% decrease in symptomatic UTI's per year (symptoms + >or= 100 000 single organisms/ml) and (2) a >50% decrease in annual antibiotic consumption. Cost effectiveness was calculated as dollar cost per urinary tract infection prevented. Stochastic tree decision analytic modeling was used to identify specific clinical scenarios for cost savings. Results Both cranberry juice and cranberry tablets statistically significantly decreased the number of patients experiencing at least 1 symptomatic UTI/year (to 20% and 18% respectively) compared with placebo (to 32%) (p 2 symptomatic UTI's per year (assuming 3 days antibiotic coverage) and had >2 days of missed work or required protective undergarments for urgency incontinence. Total antibiotic consumption was less annually in both treatment groups compared with placebo. Cost effectiveness ratios demonstrated cranberry tablets were twice as cost effective as organic juice for prevention. Conclusions Cranberry tablets provided the most cost-effective prevention for UTI.
312 citations
TL;DR: For adults with diabetes, systematic depression treatment significantly increases time free of depression and appears to have significant economic benefits from the health plan perspective.
Abstract: Context Depression co-occurring with diabetes mellitus is associated with higher health services costs, suggesting that more effective depression treatment might reduce use of other medical services. Objective To evaluate the incremental cost and cost-effectiveness of a systematic depression treatment program among outpatients with diabetes. Design Randomized controlled trial comparing systematic depression treatment program with care as usual. Setting Primary care clinics of group-model prepaid health plan. Patients A 2-stage screening process identified 329 adults with diabetes and current depressive disorder. Intervention Specialized nurses delivered a 12-month, stepped-care depression treatment program beginning with either problem-solving treatment psychotherapy or a structured antidepressant pharmacotherapy program. Subsequent treatment (combining psychotherapy and medication, adjustments to medication, and specialty referral) was adjusted according to clinical response. Main Outcome Measures Depressive symptoms were assessed by blinded telephone assessments at 3, 6, 12, and 24 months. Health service costs were assessed using health plan accounting records. Results Over 24 months, patients assigned to the intervention accumulated a mean of 61 additional days free of depression (95% confidence interval [CI], 11 to 82 days) and had outpatient health services costs that averaged $314 less (95% CI, $1007 less to $379 more) compared with patients continuing in usual care. When an additional day free of depression is valued at $10, the net economic benefit of the intervention is $952 per patient treated (95% CI, $244 to $1660). Conclusions For adults with diabetes, systematic depression treatment significantly increases time free of depression and appears to have significant economic benefits from the health plan perspective. Depression screening and systematic depression treatment should become routine components of diabetes care.
312 citations
TL;DR: Although the rate of smoking cessation among the benefit users with full coverage was lower than the rates among users with plans requiring copayments, the effect on the overall prevalence of smoking was greater with full Coverage than with the cost-sharing plans.
Abstract: Background Lack of information about the effect of insurance coverage on the demand for and use of smoking-cessation services has prevented widescale adoption of coverage for such services. Methods In a longitudinal, natural experiment, we compared the use and cost effectiveness of three forms of coverage with those of a standard form of coverage for smoking-cessation services that included a behavioral program and nicotine-replacement therapy. The study involved seven employers and a total of 90,005 adult enrollees. The standard plan offered 50 percent coverage of the behavioral program and full coverage of nicotine-replacement therapy. The other plans offered 50 percent coverage of both the behavioral program and nicotine-replacement therapy (reduced coverage), full coverage of the behavioral program and 50 percent coverage of nicotine-replacement therapy (flipped coverage), or full coverage of both the behavioral program and nicotine-replacement therapy. Results Estimated annual rates of use of smoking...
311 citations
TL;DR: A meta-analysis of randomised, short term clinical trials found that selective serotonin reuptake inhibitors are better tolerated than tricyclic antidepressants as measured by total numbers of drop outs and that the overall difference is comparatively small.
Abstract: Objective: To assess treatment discontinuation rates with selective serotonin reuptake inhibitors compared with tricyclic antidepressants. Design: Meta-analysis of 62 randomised controlled trials. Subjects: 6029 patients with major unipolar depression. Main outcome measures: Pooled risk ratios for drop out rates with respect to all cases of discontinuation and those due to side effects and treatment failure. Results: The total discontinuation rate was 10% lower with selective serotonin reuptake inhibitors than with tricyclic antidepressants (risk ratio 0.90; 95% confidence interval 0.84 to 0.97) and the drop out rate due to side effects was 25% lower (risk ratio 0.75; 0.66 to 0.84). There was no significant difference between drug classes in the drop out rates for treatment failure. The risk ratios for drop out did not differ significantly between individual selective serotonin reuptake inhibitors. Conclusions: Selective serotonin reuptake inhibitors are better tolerated than tricyclic antidepressants as measured by total numbers of drop outs. The definite advantage to selective serotonin reuptake inhibitors is explained by fewer drop outs due to side effects. The overall difference, however, is comparatively small and may not be clinically relevant. Analyses of cost effectiveness should not overestimate the advantage to selective serotonin reuptake inhibitors. Key messages Key messages In a meta-analysis of randomised, short term clinical trials selective serotonin reuptake inhibitors were associated with 10% fewer overall drop outs than tricyclic antidepressants (nine drop outs for every 10 with tricyclic agents) This difference was accounted for by a lower rate of drop out related to side effects of selective serotonin reuptake inhibitors (25% reduction; three drop outs for every four with tricyclic agents) This comparatively small difference in drop out rate is of uncertain importance clinically and when cost effectiveness is considered Further studies of the tolerability of selective serotonin reuptake inhibitors compared with that of tricyclic antidepressants are required over a longer period in the setting of clinical practice rather than clinical trials
309 citations
TL;DR: In this article, the authors describe the best practices of firms who have integrated environmentalism into their business planning and operations in ways that translate to bottom line benefits, and the experiences of these firms carry a clear and urgent message that companies that continue to approach environmental problems with band-aid solutions and quick fixes will ultimately find themselves at a competitive disadvantage.
Abstract: Contemporary environmentalism in leading companies has become an integral part of organizational strategy. Such a proactive, advantage-driven approach involves change at every level. This article describes the best practices of firms who have integrated environmentalism into their business planning and operations in ways that translate to bottom line benefits. The experiences of these firms carry a clear and urgent message— companies that continue to approach environmental problems with band-aid solutions and quick fixes will ultimately find themselves at a competitive disadvantage.
309 citations