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Biomedical subjects

C M Kozma

Publications and source records attributed to C M Kozma.

At least 73 records · Page 4Linked to original sources
PubMed1996

Effect of organization-level variables on differential employee participation in 10 federal worksite health promotion programs.

Guided by a conceptual model, the authors used both qualitative data (e.g., individual interviews, focus groups) and quantitative data from an employee survey (N = 3,388) in 10 federal agencies to investigate whether organization context and implementation process affected participation in worksite health promotion and disease prevention (HPDP) activities among demographic subgroups. Overall, employees on average participated in fewer than two agency-supported health-related activities per year (17% in fitness, 40% in health risk assessment activities). Employees participated more where coworkers endorsed such programs. Minority employees and employees in lower level positions were more likely to participate in fitness activities when organizations had a more comprehensive program structure, engaged in more marketing strategies, gave time off to employees to participate, or had on-site facilities. Management support for the program was related to participation by employees who were male, white, and had upper level positions. The data supported the proposed model; also confirmed was two predicted relationships between model constructs, which provided a better understanding of differential participation by employee groups.

Accidents, Occupational↗
PubMed1996

Economic outcomes for the treatment of allergic rhinitis.

The purpose of this article is to review the literature related to economic outcomes associated with treating allergic rhinitis. A literature review was conducted using 'Medline' and the in-house database of the publishers of this journal for articles published between January 1991 and January 1996. Only 3 cost-outcome analyses that compared alternative treatments for allergic rhinitis were found. Given the limited number of full economic evaluations, much of this article focuses on issues related to direct and indirect costs and outcome measures that should be considered when performing an economic evaluation of allergic rhinitis. We conclude that more comprehensive analyses using a wide array of costs and outcomes are needed. At present, it is not possible to draw general conclusions regarding the economic value of alternative treatments for allergic rhinitis.

Cost-Benefit Analysis↗
PubMed1996

Comparing dihydroergotamine mesylate and sumatriptan in the management of acute migraine. A retrospective cost-efficacy analysis.

The annual cost of managing migraine totals billions of US dollars. This retrospective economic analysis of a clinical trial comparing subcutaneous dihydroergotamine mesylate (DHE) with subcutaneous sumatriptan in the treatment of acute migraine is appropriate because, although each product has been shown to be efficacious, the acquisition cost of sumatriptan is over 3 times that of DHE. Total costs in each treatment group were calculated and applied independently to 11 clinical trial efficacy measures. Three of the efficacy measures showed no statistically significant difference between treatment arms, leading to a decision to use the less expensive DHE. In 4 of the efficacy measures. DHE was the obvious choice because it is more efficacious and less expensive. For the final 4 efficacy measures, where sumatriptan is more efficacious and more expensive, incremental cost-efficacy ratios were calculated to determine the additional expenditure required to achieve outcomes associated with quick relief. Depending on the efficacy variable chosen and the assumptions used in the model, the incremental cost-efficacy ratios ranged from $US4000 to $US6700 per year (1993 dollars) for each additional patient who is successfully treated with sumatriptan compared with DHE. Therefore, in a population of 100 migraineurs, an additional 13 to 22 patients would achieve these short term benefits of sumatriptan, although it would cost an additional $US88 395 annually, given the assumptions made. Because each product has unique advantages, we conclude that the more cost-efficacious product is dependent on the outcome of interest and the amount that the patient or provider is willing to pay to achieve that outcome.

Adolescent↗
PubMed1994

Multivariate analysis of health status scores: chronic airway disorders and the MOS SF-36.

Multivariate analysis of variance (MANOVA) with follow-up canonical discriminant analysis may be used to interpret differences in health-related quality of life measured by the Medical Outcome Study Short Form 36 (MOS SF-36). Due to the moderate correlations between the 8 health dimensions of the SF-36, MANOVA is theoretically a more appropriate method than traditional univariate approaches for detecting group differences on the SF-36. Additionally, canonical discriminant analysis presents a novel approach to understanding the relationship between health dimensions of the SF-36 and model-independent variables. Results from the MANOVA and canonical discriminant analysis provide evidence of the sensitivity of the SF-36 in cross-sectional, self-reported data. Significant differences in health status (alpha less than or equal to 0.05) were found for the variables of age, and primary physician visits, and between levels of disease severity, type of breathing problem, whether patients had seen a specialist or not, use of emergency room, the comorbid states of depression and arthritis, and income. No significant differences in health status were reported between males and females or racial groups.

Chronic Disease↗
PubMed1994

Obtaining pharmacoeconomic data in health care organizations.

The article illustrates the process and techniques of obtaining or collecting pharmacoeconomic data in various health care organizations, focusing on hospitals, physicians' offices, and pharmacies as the research settings. The role that pharmacoeconomic data have in the decision-making process as well as the perspective of the decision maker are also discussed. The three primary components needed to conduct a complete pharmacoeconomic analysis (clinical outcomes, humanistic outcomes, and economic outcomes) are described in relation to the health care organization. The strengths, weaknesses, advantages, and disadvantages of such data are discussed. Various databases that are accessible within each organization are also outlined.

Data Collection↗
PubMed1993

Economic impact of cost-containment strategies in third party programmes in the US. Part II.

This is the second article in a 2-part series that examines the economic impact of several different strategies used to control costs in third party programmes. This article investigates 5 different methods: (a) formularies; (b) capitation; (c) drug utilisation review; (d) prior approval; and (e) drug product selection. The published literature indicates that use of formularies decreases drug expenditures, but these savings may be offset by expenditures in other areas of healthcare programmes. Capitation, though less well studied than other strategies, may show some effectiveness in reducing costs by increasing generic dispensing and promoting switching from prescription drug to over-the-counter. Drug utilisation review, as a systematic programme of claims data review, has been shown to yield positive economic return in a variety of areas, including both impersonal and face-to-face educational interventions with healthcare practitioners. Prior approval and drug product selection both result in savings when examined in isolation from other aspects of healthcare. Cost-shifting, administrative costs and costs incurred because of possible decreased access to care have yet to be fully accounted for.

Capitation Fee↗
PubMed1990

Expanding Medicaid drug formulary coverage. Effects on utilization of related services.

Effects on utilization and expenditures occurring concurrently with an expansion of coverage in the South Carolina Medicaid drug formulary were investigated. Data were collected for prescriptions, physician office visits, and outpatient and inpatient hospital visits. Data were evaluated for a cohort of 12,139 individuals who had at least one prescription claim and were continuously eligible for benefits during the two-year study. A repeated measures design was employed to control the differences between subjects. A multivariate analysis of variance was used to detect overall differences in utilization and expenditures. A priori comparisons of means were performed to detect changes in levels and rates of expenditures and utilization for each service. Increases were observed in the number of prescriptions, physician visits, and outpatient visits per person while the number of inpatient hospital admissions declined. Similarly, expenditures increased for all service areas except the inpatient hospital service. The proportion of variance explained by the formulary change was small in all service areas, but would be of practical significance because of the large number of Medicaid recipients affected. From a theoretical perspective, an association of a reduction in inpatient hospital use and expenditures following the elimination of drug formulary restrictions is particularly noteworthy. These findings support the thesis that medical care services should not be viewed in isolation but rather as a system of interrelated activities. Interventions in one portion of the system are mirrored by changes in utilization of other components. Frequently, private and public medical care programs are managed with organizationally distinct benefit budgets, which are controlled independently. In view of the results of this study, this organizational approach may lead to a suboptimal allocation of resources.

Adult↗
PubMedDate not supplied

A comparison of costs and efficacy of intranasal fluticasone propionate and terfenadine tablets for seasonal allergic rhinitis.

This paper compares cost-efficacy ratios for intranasal fluticasone propionate and terfenadine tablets within a sample of patients with seasonal allergic rhinitis symptoms due to mountain cedar allergy. Efficacy was assessed using secondary data analysis of patient ratings of symptoms and their overall assessment of response to treatment within a previously conducted clinical trial. Costs include direct costs of the drugs used for therapy. Patients with documented mountain cedar allergy who were 12 years of age or older (N = 232) had been randomized to either receive intranasal fluticasone propionate, terfenadine, or placebo. The cost-efficacy ratios for intranasal fluticasone propionate 200 micrograms once daily were more favorable than the ratios for terfenadine 60 mg twice daily. This relationship remained throughout the sensitivity analysis. Because intranasal fluticasone propionate is only available in a fixed package size, the number of efficacy-adjusted days of terfenadine therapy that could be purchased to reach break-even costs for a 30-day supply of fluticasone was calculated. Cost efficacy-adjusted days ranged from 11 to 18 days. If cost-efficacy adjustments are not conducted, the upper end of the range increases from 18 to 22 days, since 22 days of terfenadine could be purchased for the price of a 30-day supply of intranasal fluticasone propionate. Depending on which of the efficacy measures the reader believes, if patients use terfenadine for longer than 11 to 22 days, fluticasone propionate is the more cost-efficacious choice. Because most allergies are seasonal and allergy seasons typically last longer than 11 to 22 days, it is likely that fluticasone propionate will frequently be the more cost-efficacious choice in the patient population represented in this study.

Adult↗