PubMed Health⌕ Search

Biomedical subjects

D Torgerson

Publications and source records attributed to D Torgerson.

At least 37 records · Page 2Linked to original sources
PubMed1997

Unequal randomisation can improve the economic efficiency of clinical trials.

OBJECTIVES: In the majority of clinical trials patients are randomised equally between treatment groups. This approach maximises statistical power for a given total sample size. The objectives of this paper were to determine if, when research costs between treatments differ, it is more economically efficient to randomise additional patients to the cheaper treatment, and how the optimum randomisation ratio can be estimated. METHODS: Estimation of the most economically efficient randomisation ratio for four hypothetical clinical trials using cost-effectiveness analysis. RESULTS: When research costs differ between treatments, and there is no constraint on total sample size, it is always more cost-effective to randomise more patients to the cheaper treatment. For example, a cost ratio between the lesser and more expensive treatment of ten, results in a randomisation ratio of 3.2:1. CONCLUSIONS: Unequal randomisation ratios should be more widely used as this will achieve optimum statistical power for the lowest expenditure of research resources.

Budgets↗
PubMed1996

A cost comparison of hysterectomy and hysteroscopic surgery for the treatment of menorrhagia.

OBJECTIVES: To estimate and compare the costs of treating women with menorrhagia by hysterectomy or hysteroscopic surgery, in the form of transcervical resection of the endometrium (TCRE) or endometrial laser ablation (ELA). STUDY DESIGN: Randomised controlled trial set in the gynaecological department of a large British teaching hospital. Under usual circumstances, 204 women who would have undergone hysterectomy for menorrhagia were randomly allocated to either hysterectomy (n = 99) or hysteroscopic surgery in the form of TCRE (n = 52) or ELA (n = 53). National Health Service (NHS) costs and costs to patients per patient occurring up to 1 year following surgery were estimated. Theatre times and length of hospital stay were recorded during the trial. Costs were obtained from the health board finance department and relevant suppliers of technical equipment. One year after treatment patients completed questionnaires on personal costs incurred. RESULTS: The NHS costs of treating women with hysteroscopic surgery were 24% (TCRE) or 20% (ELA) less than treating women by hysterectomy (1001 pounds/1046 pounds vs. 1315 pounds). On average, women undergoing hysteroscopic surgery incurred 71% less costs to themselves than those who underwent hysterectomy (21 pounds vs. 73.40 pounds). CONCLUSIONS: Hysteroscopic endometrial ablation incurs less costs than hysterectomy both to the National Health Service and to women alike, up to 1 year after surgery.

Costs and Cost Analysis↗
PubMed1996

Using economics to prioritize research: a case study of randomized trials for the prevention of hip fractures due to osteoporosis.

OBJECTIVES: To assess the role of economics, in combination with clinical judgement, for setting research priorities, using osteoporosis prevention (and, as a result, hip fracture prevention) as an example. METHODS: Modelling the cost and effectiveness of each of six potential interventions to prevent hip fractures over the 5-year length of a randomized trial (vitamin D injection; thiazide diuretics; hormone replacement therapy; oral calcium and vitamin D; calcium alone; calcitonin). Drug costs were derived from the Monthly Index of Medical Specialties (MIMS); averted fracture costs and estimates of effectiveness were derived from published sources. RESULTS: Vitamin D injection proved to be the most potentially cost-effective treatment with a cost-effectiveness ratio of 584 Pounds. If averted costs are included, this leads to a saving of 9,176,496 Pounds per 100,000 women treated. By contrast, the most expensive therapy was calcitonin (marginal cost-effectiveness ratio of 433,548 Pounds). This suggests that priority should be given to trials assessing the effectiveness of vitamin D injections. CONCLUSIONS: Relatively simple economic modelling exercises can inform research priorities and could help optimize the use of scarce research resources.

Benzothiadiazines↗
PubMed1994

Service uptake. Clock wise.

The costs to certain social groups of time spent using healthcare services need to be addressed if true equity of access is to be achieved, argue David Torgerson and Cam Donaldson.

Cost of Illness↗
PubMed1994

Evaluation of costs.

Explore the source record for details and available documents.

Cost-Benefit Analysis↗