Biomedical subjects

K Gerard

Publications and source records attributed to K Gerard.

At least 19 recordsLinked to original sources

PubMed1992

A cost utility analysis of mammography screening in Australia.

Cost utility analysis is the preferred method of analysis when quality of life instead is an important outcome of the project being appraised. However, there are several methodological issues to be resolved in implementing cost utility analysis, including whether to use generalised measures or direct disease specific outcome assessment, the choice of measurement technique, and the combination of different health states. Screening for breast cancer meets this criterion as mammographic screening has been shown to reduce mortality; and it is said that earlier treatment frequently results in less radical surgery so that women are offered the additional benefit of improved quality of life. Australia, like many other countries, has been debating whether to introduce a national mammographic screening programme. This paper presents the results of a cost utility analysis of breast cancer screening using an approach to measuring outcome, Healthy Year Equivalents, developed within this study to resolve these problems. Descriptions of breast cancer quality of life were developed from surveys of women with breast cancer, health professionals and the published literature. The time trade off technique was then used to derive values for breast cancer treatment outcomes in a survey of women in Sydney, Australia. Respondents included women with breast cancer and women who had not had breast cancer. Testing of (i) the effect of prognosis on the value attached to a health scenario; and (ii) whether the value attached to a health scenario remains constant over time has been reported. The estimate of the net costs of screening are reported. The costs of breast cancer screening include the screening programme itself, the further investigations and the subsequent treatment of breast cancer cases. Breast cancer is treated in the absence of screening, many commentators claim earlier treatment is costly but there is little evidence. Therefore we have investigated current patterns of breast cancer treatment, current use of investigations for women presenting with symptoms and current use of covert mammography screening. The results are extrapolated to obtain estimates of the costs and outcomes presented as cost per healthy year equivalent. This analysis produces important information for the Australian policy debate over mammography. It also contributes to the development of cost utility analysis and the approach developed here can be applied more generally.

Australia↗

PubMed1990

Counting the costs of mammography screening: first year results from the Sydney study.

Population-based mammography screening is a highly specialized service which aims to improve the early detection of breast cancer. This is achieved through the installation of a dedicated mix of medical technology and professional skills. It is therefore a resource-intensive activity so the benefits foregone by deploying these resources for mammography screening ought to be determined to investigate the relative efficiency of such a commitment. This paper describes the costing methodology used in the evaluation of the Sydney Breast X-ray Programme and presents the health service costs for the first 12 months of operation. In the first year when attendance was under 5000 it cost $118.93 to screen a woman, $13,817 to detect a cancer and $18,720 to detect an impalpable cancer. However, costs are expected to fall in subsequent years as attendance reaches capacity level. The first screening round will detect prevalent cancers; costs will change with subsequent screening rounds as incident cancers are detected. We are cautious in extrapolating the costs of a national programme from these results. However, on the basis of our data and disregarding treatment costs, a national programme which screened 70% of all Australian women over the age of 45 years every two years would add between $60 million and $100 million to the national health bill each year.

Aged↗

PubMed1989

The cost of diabetes.

This paper estimates the cost of diabetes in England and Wales in 1984 to be in excess of 259.5 million pounds. The costing methodology used follows the 'cost of illness' framework. This framework defines three elements for costing: direct, indirect and psychological, although the latter element is left out of the calculation because monetary valuations for this element have never been adequately estimated. Direct costs include resources used to prevent, detect, and treat diabetes. Indirect costs relate to the loss of productive output caused by absenteeism, early retirement, and premature mortality. The estimate which has been obtained is likely to be an underestimate because of the weaknesses and gaps in the data sets. The estimate of the total lost earnings from diabetes varied greatly according to the choice of absentee rate. If there was no significant difference between absenteeism in the diabetic community and the non-diabetic community then the cost of diabetes would be 259.5 million pounds. If on the other hand the diabetic community was prone to three times as much absenteeism as the non-diabetic community then the cost of diabetes would rise to 602.5 million pounds. The costs of diabetes as a subsidiary diagnosis are extremely difficult to identify. They have been estimated in this study to be 86 million pounds but this is thought to be an overestimate. Nevertheless the cost of diabetes is significant and thus the search for more efficient treatment regimens may reduce such costs as well as enhance the quality of life of the patients concerned.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗

PubMed1989

Paying general practitioners: shedding light on the review of health services.

This paper reviews evidence from recent research on the effects of different methods of remunerating general practitioners. Each method is examined in terms of patient use of health services in general, use of services by different groups in society and health outcome. Little is known about the effects of capitation as it currently exists in the UK, salaries or special payments for 'good practice', although evidence from British research is likely to be forthcoming on the last of these. Both health maintenance organizations and charges deter utilization, although little is known about the effect of this reduced demand. Furthermore, these two methods of financing health care appear to discriminate between members of society on lower and higher incomes in terms of both service use and health outcome. Fees for items of service provided tend to lead to unnecessary demands for fee yielding services by patients on the recommendation of their doctors. Although more evidence on different methods of remuneration is required, the importance of what is already known depends on the objectives of health care provision.

Capitation Fee↗

PubMed1988

An appraisal of the cost-effectiveness of alternative day care settings for frail elderly people.

Three alternative day care settings for a defined subgroup of frail elderly people are evaluated using cost-effectiveness analysis. This subgroup of frail elderly people is a significant minority of day-care users who have specific and separately identifiable needs. Their utilization of day care often results in the expensive use of day hospital resources or inappropriate social centre facilities. By using a mixture of published and original data sources this paper argues that specialist day services for frail elderly people can be considered at least as effective as either day hospital or social centre care. However, although it is concluded that the use of a specialist day service is more cost-effective than the day hospital, more analysis of the benefits of care in social centres is required before any judgement can be made about the relative cost-effectiveness between these settings.

Aged↗

PubMed1978

Inability of patients to give valid consent to psychiatric hospitalization.

Explore the source record for details and available documents.

Attitude↗

PubMedDate not supplied

Determining the contribution of residential respite care to the quality of life of children with severe learning difficulties.

This paper investigates factors which may be influential in determining the impact of residential respite services on residents' quality of life. Residents are all aged 19 or under and have severe learning difficulties. The objective of respite care is to ameliorate some of the burdens which carers associate with caring but to do so without adversely affecting those being cared for, while preferably improving residents' quality of life. The usual focus of evaluations of respite care, however, tends to be directed at how well carers' needs are supported. Only when it is possible to determine the impact of respite care on the quality of lives of both carer and cared for will researchers be in a position to complete a full evaluation. Until then a better understanding of all recipients' responses to respite care is needed. This paper, therefore, takes as its focus the often 'forgotten' recipients, the children with severe learning difficulties themselves. The analysis is somewhat preliminary but this is inevitable reflecting as it does the current state of research work in this area.

Adolescent↗

PubMedDate not supplied