Biomedical subjects

G Thomas Ray

Publications and source records attributed to G Thomas Ray.

10 recordsLinked to original sources

PubMed2004

Preferences and willingness to pay for health states prevented by pneumococcal conjugate vaccine.

OBJECTIVE: To measure parents' and other adults' values for preventing disease associated with pneumococcal infection and to evaluate how including these values changes the economic appraisal of pneumococcal conjugate vaccine. METHODS: Data on preferences and willingness to pay to reduce risk of illness were collected for 6 illnesses that are preventable by pneumococcal conjugate vaccine (simple otitis media, complex otitis media, moderate pneumonia, severe pneumonia, bacteremia, and meningitis) and 1 vaccine-related adverse event (fever and fussiness after vaccine). Interviews were conducted with 2 groups of respondents: 1) parents of children who had experienced 1 or more of the outcomes described in the survey (n = 101) and 2) a US community sample (n = 109). The 30-minute telephone interview used modified time trade-off questions and willingness-to-pay questions. Values from the interview were incorporated in an existing decision-analytic model that simulated the cost-effectiveness and cost-benefit of pneumococcal conjugate vaccine in a hypothetical cohort of newborns. RESULTS: Among parents, the median amount of time that respondents said that they would be willing to trade to avoid diseases ranged from 0 days for otitis media to 1 year for severe pneumonia and 2 years for meningitis. Among the US community sample, the median amounts of time traded were higher, ranging from 7 days for otitis media to 3 years for meningitis. Median willingness-to-pay amounts varied from 100 dollars to prevent 1 episode of otitis media and 500 dollars to reduce the risk of meningitis from 21 in 100 000 to 6 in 100 000 and were similar between parents and community members. Incorporating time trade-off amounts into the existing economic model for pneumococcal conjugate vaccine resulted in cost-effectiveness ratios <10 000 dollars per quality-adjusted life year at a vaccine cost of 58 dollars per dose. CONCLUSIONS: Both parents and community members assign relatively high values to preventing meningitis, pneumonia, and complex otitis media. When the value of preventing pneumococcal diseases is incorporated into economic analyses, pneumococcal conjugate vaccine has a cost-effectiveness ratio in the range of other widely used health interventions.

Adult↗

PubMed2003

Short-term alcohol and drug treatment outcomes predict long-term outcome.

INTRODUCTION: Although addiction is recognized as a chronic, relapsing condition, few treatment studies, and none in a commercially insured managed care population, have measured long-term outcomes. We examined the relationship of 6-month treatment outcomes to abstinence 5 years post-treatment, and whether the predictors of abstinence at 5 years were different for those who were, and were not, abstinent at 6 months. METHODS: The sample (N=784) is from an outpatient (day hospital and traditional outpatient) managed care chemical dependency program. Subjects were interviewed at baseline, 6 months, and 5 years. Logistic regression analysis was used to assess which individual, treatment and extra-treatment characteristics predicted alcohol and drug abstinence at 5 years. RESULTS: Abstinence at 6 months was an important predictor of abstinence at 5 years. Among those abstinent at 6 months, predictors of abstinence at 5 years were older age, being female, 12-step meeting attendance, and recovery-oriented social networks. Among those not abstinent at 6 months, being alcohol dependent rather than drug dependent, 12-step meeting attendance, treatment readmission, and recovery-oriented social networks predicted abstinence at 5 years. CONCLUSION: Our findings demonstrate a clear association between short-term and long-term treatment success. In addition, these results strongly support the importance of recovery-oriented social networks for those with good short-term outcomes, and the beneficial impact of readmission for those not initially successful in treatment.

Adolescent↗

PubMed2003

Early discontinuation of treatment for osteoporosis.

PURPOSE: To identify factors associated with early treatment discontinuation of three agents commonly prescribed for women with low bone density. METHODS: A telephone survey was conducted in 2000 to 2001 in a random sample of women aged 45 years or older who had bone density T-scores -1.0 or lower and who had initiated treatment with hormone replacement therapy, raloxifene, oral endronate. Logistic regression was used to estimate adjusted odds ratios for early treatment discontinuation. RESULTS: Among 956 women who were interviewed an average of 7 months after treatment initiation, 334 were taking hormone therapy, and 88 (26%) had discontinued; 256 were taking raloxifene, and 48 (19%) had discontinued (P = 0.03 vs. hormone therapy); and 366 were taking alendronate, and 70(19%) had discontinued (P = 0.02 vs. hormone therapy). Women with bothersome side effects (somewhat bothered: odds ratio [OR] = 4.0; 95% confidence interval [CI]: 2.5 to 6.5; very or extremely bothered: OR = 25; 95% CI: 16 to 39) or who thought that their bone density test results did not show osteoporosis (OR = 1.6; 95% CI: 1.0 to 2.5) were more likely to discontinue therapy, as compared with women reporting regular exercise (OR = 0.7; 95% CI: 0.4 to 1.0) or a willingness to take prescribed medications (OR = 0.6; 95% CI: 0.4 to 0.9). After adjustment for side effects and patient characteristics, the odds of early treatment discontinuation did not differ significantly among treatments. CONCLUSION: Improved adherence to osteoporosis treatment requires that treatment side effects be minimized and women be educated regarding their bone density test results.

Alendronate↗

PubMed2003

Services integration and cost-effectiveness.

Alcohol treatment services are increasingly combined with other health and social services to address the needs of multiple-problem clients. Hence, it has been of growing policy interest to find the most effective and the most cost-effective ways of linking these services. This symposium presents some recent studies in this area. The small but growing body of studies in this area has great potential to inform public policy debates.

Alcoholism↗

PubMed2003

Comparing the medical expenses of adults with Medicaid and commercial insurance in a health maintenance organization.

The objective of this study was to compare the health care costs of adults with Medicaid aged 19 to 65 years (n = 29,680) and adults in the same age range with commercial insurance (n = 29,680) who were members of the same health maintenance organization between 1996 and 1998. After adjusting for age and sex, income-eligible Medicaid-insured adults were $35 (29 percent) per month more expensive than commercially insured adults. The medically needy/indigent (excluding "spend-down") were $61 (51 percent) per month more expensive than commercially insured adults, and the blind or disabled were $289 (240 percent) per month more expensive. When the analysis adjusted for health status as well as age and sex, however, income-eligible Medicaid adults were $12 (p = 0.01) per month less costly than commercially insured adults. The costs of Medicaid-insured adults were substantially higher than those of commercially insured adults; these differences were likely due to higher rates of pregnancy and to worse health status among the Medicaid cohort.

Adult↗

PubMed2002

Transient pseudohypoaldosteronism with hyponatremia-hyperkalemia in infant urinary tract infection.

PURPOSE: We describe an uncircumcised male infant and a female neonate treated for infant urinary tract infection who had multiple hormonal and electrolyte abnormalities consistent with the diagnosis of transient pseudohypoaldosteronism. MATERIALS AND METHODS: We retrospectively reviewed these 2 cases. RESULTS: In each case successful treatment of infant urinary tract infection was accompanied by the resolution of all hormonal and electrolyte abnormalities, including hyperaldosteronemia, hyperreninemia, hyponatremia and hyperkalemia. CONCLUSIONS: Because of future renal scarring, decreased renal function and possible hypertension, appropriate hormonal studies should be performed in infants with infant urinary tract infection who also have hyponatremia and hyperkalemia.

Circumcision, Male↗

PubMed2002

Observed costs and health care use of children in a randomized controlled trial of pneumococcal conjugate vaccine.

BACKGROUND: Pneumococcal conjugate vaccine for infants has recently been found to be effective for prevention of meningitis, bacteremia, pneumonia and otitis media, but it is more costly than previously introduced vaccines. AIM: We sought to determine the savings in medical costs through 36 months of life attributable to the use of the vaccine in healthy infants in a large randomized trial. METHODS: We analyzed the actual medical costs of 36 471 children involved in a randomized trial of heptavalent pneumococcal conjugate vaccine conducted in the Northern California Kaiser Permanente Medical Care Program. The costs of the vaccine and vaccine administration were excluded. RESULTS: Compared with the control group, the vaccinated group experienced a 2% reduction in clinic related costs [$48; 95% confidence interval (CI), $10 to $83] and a nearly significant 14% reduction in outpatient hospitalization costs ($32; CI -$1 to $66). The savings in total medical costs were 1.2%, but this difference was not significant ($41; CI -$204 to $270). Inpatient hospital costs were highly variable and were responsible for the lack of precision in the difference in total cost. In a post hoc analysis that excluded hospital costs not believed to be potentially pneumococcal related, savings in medical costs were $78 and significant (CI $5 to $158). CONCLUSIONS: The pneumococcal conjugate vaccine reduced ambulatory care costs in children in the first 36 months of life, but without a larger trial, the magnitude of the savings in total medical costs is uncertain. These results indicate, however, that any medical cost savings that are associated with the vaccine are unlikely to be high enough to offset the cost of the vaccine at its current price.

Bacteremia↗

PubMed2002

Pneumococcal conjugate vaccine: economic issues of the introduction of a new childhood vaccine.

In February 2000, a pneumococcal conjugate vaccine was licensed for use in the USA. This vaccine has been shown to be effective in reducing pneumococcal disease, and has been recommended for universal use in infants. However, pneumococcal conjugate vaccine is by far the most expensive child vaccine series routinely administered in the USA, alone accounting for over 40% of the total purchase price of vaccines for the recommended childhood schedule. This article reviews the existing efficacy and economic studies of pneumococcal conjugate vaccine and discusses the process by which routine use of pneumococcal conjugate vaccine was introduced and the role economic analysis played in that process. Some of the scientific and funding issues relating to its use in both the industrialized and developing world are also discussed.

Animals↗

PubMedDate not supplied

Limb fractures in elderly men as indicators of subsequent fracture risk.

BACKGROUND: Whether limb fracture in elderly men predicts future fracture is unknown. METHODS: Electronic health records were examined to determine fracture incidence among men 60 years or older who were members of a large health maintenance organization, experienced no fracture in the past 2 years, and experienced an ankle, hip, humerus, or wrist fracture between July 1, 1997, and August 31, 2001. Proportional hazards models were used to compare risk of new fracture (ankle, hip, humerus, or wrist) between groups. Recurrent fractures of the same type were excluded from analysis. RESULTS: During the follow-up period (mean duration, 2.4 years), 0.5% of the control subjects without fractures experienced a subsequent ankle fracture; 0.6%, a hip fracture; 0.2%, a humerus fracture; and 0.4%, a wrist fracture. A limb fracture was about 4 times more likely to occur in persons who experienced a previous humerus fracture (relative risk, 3.9; 95% confidence interval, 2.5-6.0), about 3 times more likely to occur in persons who experienced a previous hip fracture (relative risk, 2.8; 95% confidence interval, 1.7-4.5), and about 2 times more likely to occur in persons who experienced a previous wrist fracture (relative risk, 2.2; 95% confidence interval, 1.4-3.5) than in controls. In contrast, persons who experienced a previous ankle fracture had no greater risk of subsequent fracture than nonfracture controls (relative risk, 1.0; 95% confidence interval, 0.5-1.9). CONCLUSIONS: Among men 60 years or older, a recent hip, humerus, or wrist fracture is a statistically and clinically significant predictor of future limb fracture risk. An increased risk of future fracture is greatest after a humerus fracture and is lowest after a wrist fracture; however, among elderly men, a previous ankle fracture is not an indicator of future fracture risk.

Aged↗

PubMedDate not supplied

Pediatricians' views on financial barriers and values for pneumococcal vaccine for children.

OBJECTIVES: To 1) describe barriers to pneumococcal conjugate vaccine adoption and 2) estimate the value of the vaccine based on pediatricians' responses to willingness-to-pay questions. METHODS: In June 2000, we mailed a random sample of pediatricians in Massachusetts a questionnaire about barriers to adoption of the vaccine and willingness to pay for the vaccine and associated outcomes. Respondents were assigned at random to 1 of 2 survey versions: the Personal Perspective version, for which they imagined spending their own money for their own child, or the Public Perspective version, for which they imagined spending the government's money for the average child. RESULTS: Of the 546 pediatricians who responded (estimated completion rate, 80%), only 9% were using the vaccine routinely at the time of the survey. Most said that if the state did not provide the vaccine, financial barriers including inadequate insurance reimbursement would limit their use of the vaccine either a great deal (61%) or a moderate amount (25%). Pediatricians who were asked how much they would pay for the vaccine for their own child (personal perspective) gave a mean of $56 per dose, whereas those who were asked how much the government should pay on behalf of an average child (public perspective) gave a mean of $36 per dose. Alternatively, when we used a decision analysis model and incorporated pediatricians' values for preventing pneumococcal infections to estimate the vaccine's value, the value per dose was $38 from the personal perspective and $34 from the public perspective. CONCLUSIONS: Pediatricians in Massachusetts identified significant financial barriers to the adoption of pneumococcal conjugate vaccine related to insurance arrangements. Based on willingness-to-pay questions, the value of the vaccine is lower than the current list price. The methods used to estimate the value of a vaccine, including the perspective used to frame questions, may substantially influence the results.

Attitude of Health Personnel↗