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A Ament

Publications and source records attributed to A Ament.

At least 19 recordsLinked to original sources
PubMed2001

Pneumococcal vaccination and pneumonia: even a low level of clinical effectiveness is highly cost-effective.

Most studies of the cost-effectiveness of pneumococcal vaccination show very favorable cost-effectiveness ratios for preventing pneumococcal pneumonia, but they make the controversial assumption that vaccination is equally effective in preventing bacteremic (BPP) and nonbacteremic (NBPP) pneumonia. However, the results of our study showed that, compared with preventing BPP alone, the cost-effectiveness of pneumococcal vaccination increased substantially even when only a small proportion of additional cases of NBPP were prevented.

Cost-Benefit Analysis↗
PubMed2000

[Vaccination of the elderly against pneumococcal disease is cost-efficient. Mass vaccination of all aged 65 and over is recommended].

The pneumococcal vaccine has been shown to be about 70 percent efficacious in preventing invasive pneumococcal disease in elderly persons. In a European multicenter study, pneumococcal vaccination was moderately cost-effective in preventing hospital admission due to invasive pneumococcal disease in persons 65 years of age or above. In Sweden the cost was approximately 300,000 SEK per quality adjusted life years (QALY) gained, but only about 60,000 SEK per QALY in a two-way sensitivity analysis making reasonable assumptions regarding the incidence and mortality of invasive pneumococcal disease in this age group. On the basis of these findings, pneumococcal vaccination should be recommended for all persons 65 years of age or older.

Aged↗
PubMed2000

Cost-effectiveness of pneumococcal vaccination of older people: a study in 5 western European countries.

Pneumococcal vaccination of older persons is thought to be cost-effective in preventing pneumococcal pneumonia, but evidence of clinical protection is uncertain. Because there is better evidence of vaccination effectiveness against invasive pneumococcal disease, we determined the cost-effectiveness of pneumococcal vaccination of persons aged > or =65 years in preventing hospital admission for both invasive pneumococcal disease and pneumococcal pneumonia in 5 western European countries. In the base case analyses, the cost-effectiveness ratios for preventing invasive disease varied from approximately 11,000 to approximately 33,000 European currency units (ecu) per quality-adjusted life year (QALY). Assuming a common incidence (50 cases per 100,000) and mortality rate (20%-40%) for invasive disease, the cost-effectiveness ratios were <12,000 ecu per QALY in all 5 countries. For preventing pneumococcal pneumonia, vaccinating all elderly persons would be highly cost-effective to cost saving. Public health authorities should consider policies for encouraging pneumococcal vaccination for all persons aged > or =65 years.

Aged↗
PubMed1999

Real world designs in economic evaluation. Bridging the gap between clinical research and policy-making.

This paper identifies the information that economic evaluation should provide to adequately inform policy-makers. First, policy-makers need cost-effectiveness information that is both internally and externally valid. The latter aspect is often ignored and refers to the relevance of the results of economic trials to the specific decision-making context of the policy-maker. Second, policy-makers, like purchasers of care, may want assessments of the overall budget and health impacts of adopting an intervention in a disease or treatment area. This requires more of an aggregate analysis than the current approaches to economic evaluation (which are typically individual-orientated). There are 3 main conceptual approaches to economic evaluation: the use of randomised controlled trials (RCTs), observational studies and modelling. The RCT can be considered as the gold standard in economic evaluation because of its high internal validity, but results should be interpreted with caution because of its low external validity. There a number of options to enhance external validity; of these, additional modelling and observational data seem to be the most promising. To address issues at the system level, disease modelling or public health modelling is suggested. A 3-step approach, comprising successive assessment of internal validity, external validity (real world relevance) and net impact at the system level, can enhance the informative value of economic analyses. For example, this approach has been used to assess the informative value to decision-makers of an RCT in benign prostatic hyperplasia. The analysis emphasised the feasibility and importance of additional modelling beyond the results from an RCT-based economic analysis and provided important information of relevance for policy-making. Because of the need to increase the real world relevance of pharmacoeconomic analyses, there is potentially a large role for modelling in economic evaluation; however, in order to enhance its credibility, more attention should be paid to validity aspects.

Cost-Benefit Analysis↗
PubMed1996

Making cost assessments based on RCTs more useful to decision-makers.

The appropriateness of results from economic evaluation for allocation-decisions in health care is a point of major concern for decision-makers. Much attention has been focused on potential biases stemming form the methodological shortcomings of economic evaluation. This article adds to this and concentrates on the 'real world' relevance of results from economic evaluation as an additional step towards making results more useful to decision-makers. Being the accepted standard for economic evaluation, the RCT is used as the reference case; yet, many of the issues raised are also relevant for other research designs. Three classes of biases are examined. The first relates to the limited scope that economic analysts sometimes choose in RCTs. The second class involves the methodological aspects of RCTs and questions the 'real world' relevance of the tools with which economic analysts estimate costs on the basis of RCTs. The third class concerns the representativeness of RCT results, i.e. the generalizability of these results and their usefulness in other treatment contexts. options for limiting the potential confounding influences of these biases are discussed. A check-list is provided which should be applied by decision-makers when using constructing and describing RCTs. This will enhance the relevance of the results of economic evaluation in decision-making and improve the information basis for actual allocation decisions in health care.

Cost-Benefit Analysis↗
PubMed1996

Medical technology assessment and the role of economic evaluation in health care.

The growth in health care expenditure over the last few decades has necessitated the introduction of priority setting and decision making based on the results of critical evaluation. Medical technology assessment (MTA) is a valuable tool to assist policy makers in controlling existing and new medical technologies. Medical technology assessment and the role of economic evaluation as part of MTA are described, and various techniques of economic evaluation are discussed.

Cost-Benefit Analysis↗
PubMed1995

Symptomatic gallbladder stones. Cost-effectiveness of treatment with extracorporeal shock-wave lithotripsy, conventional and laparoscopic cholecystectomy.

In order to strike the most favorable balance between health benefits and costs, three treatment modalities for symptomatic cholelithiasis were compared in a cost-effectiveness study: extracorporeal shock-wave lithotripsy (ESWL), conventional cholecystectomy (CC), and laparoscopic cholecystectomy (LC). Data were analyzed from 55 patients who were treated by ESWL, 45 patients who had CC, and 47 patients who had LC. The study was performed by analysis of patients charts and a written questionnaire. After ESWL 35% of the patients were free of stones, 23% had fragments < or = 5 mm, and 42% had fragments > 5 mm at 1-year follow-up. Persistent complaints were reported by 59% after ESWL, 11% after CC, and 14% after LC (P < 0.001). New complaints arose in 12% after ESWL, 11% after CC, and in 5% after LC (P = NS). Patient appreciation score was highest for LC and lowest for ESWL. Mean hospital stay was 2.4 days for ESWL, 10 days for CC, and 3.5 days for LC. Overall costs of treatment were: $5,066 for ESWL; $5,893 for CC; and $3,117 for LC. This study reveals that laparoscopic cholecystectomy is the most effective treatment of the large majority of patients with symptomatic cholelithiasis. ESWL should only be considered in the case of a solitary, relatively small, completely radiolucent stone.

Adult↗
PubMed1993

Optimal test strategy in the case of two tests and one disease.

Decision-making, especially about test performance, is very complex in nature. Clinical decision analysis can provide tools for doctors which can be used in improving the ordering of laboratory tests. This article describes an approach which is relevant for medical practice and easy to understand, with the goal of obtaining better decisions rather than optimal solutions. The methodology enables a clear understanding of the possibilities and restrictions of test use and needs very little calculation. The cornerstone of the methodology is a graphical representation, by which the benefits of test use are evaluated. Furthermore, a simple algorithm has been developed that can be used to find the optimal solution in the case of two tests. In each step decision rules can be used. In a graphical representation the effect of combining tests can be easily evaluated. If a test combination is chosen one has to decide which sequence is optimal. Finally one has to choose between parallel and series testing. The gain in time of the parallel procedure (and possible gain in effectiveness of treatment) should be compared with the efficiency gain of series testing. The authors conclude that the developed methodology is closer to the intuitive decision-making process than the traditional decision-making techniques and therefore can be used in order to improve the rather intuitive decisions of doctors.

Clinical Laboratory Techniques↗
PubMed1993

Cost of illness studies in health care: a comparison of two cases.

Cost of illness (COI) studies describe the economic burden of disease on society. In this article a standard procedure for a COI study is developed, including the explicit definition of the disease, choice of relevant variables and appraisal of direct and indirect costs. COI studies can be incidence-based or prevalence-based. The adjustment of cost figures for time preferences and the performance of a sensitivity analysis are presented. The standard methodology is applied to diseases in two different areas. The first disease category is dyspepsia, a complaint with a rather somatic background. The second is schizophrenia, a mental syndrome. In performing COI studies in practice, however, researchers are forced to deviate, in many aspects, from the theoretical standards. In this article these choices, and the reasons behind these choices, are explained. Furthermore, we discuss certain problems regarding the reluctance to make a diagnosis regarding certain diseases, the reliability and the validity of the sources used and the absence of certain figures. The value of the information derived from COI studies for policy-making is assessed.

Cost of Illness↗
PubMed1992

Inter-institutional information exchange in healthcare.

In this paper the results of the standardization efforts and an evaluation study concerning electronic data interchange (EDI) performed by the 31 (Inter Institutional Information exchange)-project are described. In an earlier paper the results of a preliminary study were reported. EDI concerns communication between autonomous information systems and therefore needs standardization of the messages to be exchanged. In the 31-project ten different types of standard messages have been defined. The use of these messages for exchanging information between hospitals, GPs and pharmacies is described. It is concluded that relatively large time savings can be obtained when communicating electronically. It is also concluded that the electronic data interchange between hospitals and GPs can be performed without additional costs. The electronic communication of prescriptions between GPs and pharmacies does raise the costs of communication at the moment. The impact of EDI on the functioning of people in the organizations involved varies widely.

Clinical Pharmacy Information Systems↗