PubMed Health⌕ Search

Biomedical subjects

M C Weinstein

Publications and source records attributed to M C Weinstein.

8 recordsLinked to original sources
PubMed1979

Pertussis vaccine--an analysis of benefits, risks and costs.

Using decision analysis, we estimated the benefits, risks and costs of routine childhood immunization against pertussis. Without an immunization program, we predict that there would be a 71-fold increase in cases and an almost fourfold increase in deaths (2.0 to 7.6) per cohort of one million children. With a vaccination program, we predict 0.1 case of encephalitis associated with pertussis and five cases of post-vaccination encephalitis; without a program, there would be only 2.3 cases of encephalitis associated with pertussis. Community vaccination would reduce by 61 per cent the costs related to pertussis. Our analysis supports continuation of vaccination in routine childhood immunization programs, but suggests the need for more reliable data on complications from the vaccine, further study of the epidemiology of pertussis and development of a less toxic vaccine.

Child↗
PubMed1979

Sample-size estimation: a sensitivity analysis in the context of a clinical trial for treatment of mild hypertension.

The effectiveness of treatment for mild hypertension (diastolic pressures of 85 to 105 mm Hg) has not been conclusively demonstrated. Both the costs of a carefully designed clinical trial and the likelihood that it will produce definitive answers will depend importantly on the sample size. This paper presents sample-size estimates under a variety of assumptions regarding the characteristics of the population to be studied, the degree of blood pressure control to be achieved, and the health benefits to be expected. Under a central set of assumptions, the estimated sample size per group is 22,700 with death as an endpoint and 14,000 with morbid events (CHD and stroke) as endpoints. As individual assumptions are varied one at a time, required sample sizes range from 10,900 to 101,100 and from 6,800 to 63,100 for the respective endpoints. Results are most sensitive to the degree of blood pressure control actually achieved to the expected health benefits from blood pressure control. They are also highly sensitive to the sex composition of the population and to expected dropout rates. The choice of sample size will depend on the decision maker's assessment of the likelihood that each assumption will be fulfilled and on the degree of willingness to risk an inconclusive study result. By making explicit the effect of variation in each assumption, decision making is rendered more susceptible to critical examination by outside reviewers.

Adult↗
PubMed1978

Screening for hypertension: a rational approach.

A strategy for the control of hypertension in communities is presented as a staged program. Stage I consists of the evaluation and improvement of hypertension management in health care facilities. Stage II entails case-finding in health care facilities. Finally, Stage III involves targeted screening in the community. While isolated screening programs have been justly labeled "irrational", such a sequential strategy represents a highly rational approach to the community control of hypertension.

Community Health Services↗
PubMed1977

Foundations of cost-effectiveness analysis for health and medical practices.

Limits on health-care resources mandate that resource-allocation decisions be guided by considerations of cost in relation to expected benefits. In cost-effectiveness analysis, the ratio of net health-care costs to net health benefits provides an index by which priorities may be set. Quality-of-life concerns, including both adverse and beneficial effects of therapy, may be incorporated in the calculation of health benefits as adjustments to life expectancy. The timing of future benefits and costs may be accounted for by the appropriate use of discounting. Current decisions must inevitably be based on imperfect information, but sensitivity analysis can increase the level of confidence in some decisions while suggesting areas where further research may be valuable in guiding others. Analyses should be adaptable to the needs of various health-care decision makers, including planners, administrators and providers.

Cost-Benefit Analysis↗