Biomedical subjects

M T Halpern

Publications and source records attributed to M T Halpern.

35 records · Page 2Linked to original sources

PubMed1997

Cost analysis of once-daily ISMN versus twice-daily ISMN or transdermal patch for nitrate prophylaxis.

OBJECTIVE: To compare the costs and outcomes of treating exercise-induced angina with once- or twice-daily isosorbide mononitrate (ISMN) or transdermal patch. METHOD: A decision-analytic model was designed based on published literature showing compliance and increasing symptoms and estimates from physicians on treatment patterns and worsening symptoms. RESULTS: Data show that patients are more compliant with once-daily ISMN (Imdur, Astra Hässle, Mölndal, Sweden) and patch regimens than with twice-daily dose. Based upon the assumption that more compliant patients are better controlled, the model found that fewer medical care resources were consumed by patients treated with the once-daily and the patch regimens. The unit cost of the twice-daily ISMN regimen is 40% of the unit cost of the once-daily. Annual costs of treating an exercise-induced angina patient are 248 pounds for Imdur compared to 250 pounds for the twice-daily ISMN and 299 pounds for the transdermal patch. CONCLUSION: Unit prices alone are not good indicators for estimating medical management costs.

Administration, Cutaneous↗

PubMed1997

Cost-effectiveness of thrombolytic therapy for acute myocardial infarction.

OBJECTIVE: To estimate the cost-effectiveness of thrombolytic therapy versus no thrombolytic therapy for patients following acute myocardial infarction, focusing on the impact of time to treatment on outcome. METHODS: A decision model was developed to assess the benefits, risks, and costs associated with thrombolytic therapy for treatment of acute myocardial infarction compared with standard nonthrombolytic therapy. The model used pooled data from a recent study of nine large randomized, controlled clinical trials and 12-month outcome data from a recently published meta-analysis of thrombolytic therapy trial data. Outcomes were expressed in terms of survival to hospital discharge and survival to 1 year after discharge. The risks of treatment that led to death, morbidity, or added costs were estimated. The model determined excess and marginal costs per death averted to hospital discharge and at 1 year. Results were also estimated in terms of cost per year of life saved. Sensitivity analyses included variations in time to treatment and drug cost. RESULTS: The marginal cost of thrombolytic therapy per death averted at 1 year was $222,344, or $14,438 per year of life saved. For patients treated within 6 hours of acute myocardial infarction, the marginal cost per death averted was $181,536 at 1 year, or $11,788 per year of life saved. CONCLUSIONS: Thrombolytic therapy is significantly more cost-effective than many other cardiovascular interventions and compares favorably with other forms of medical therapy. Results suggest that shortening the time to treatment has a critical impact on the cost-effectiveness of thrombolytic therapy.

Acute Disease↗

PubMed1996

Cost of refractory epilepsy in adults in the USA.

A cost of illness of refractory epilepsy was developed based on estimates supplied by an expert panel of physicians and a review of the current literature. The basic elements of model can be divided into two main components: direct and indirect costs. Direct costs include the medical resource utilization patterns associated with epilepsy care while the indirect costs represent lost productivity associated with the disease. The results of the analysis indicate that an estimated 24,578 incident cases of epilepsy incur a total of $318,582,669; while our prevalence estimates indicate that 335,167 individuals incur a total of $3,905,183,463, in a given year. Direct medical costs account for one-third of the total costs while indirect costs constitute the remaining two-thirds.

Adult↗

PubMed1996

The short-term effects of merger on hospital operations.

OBJECTIVE: The short-term effects of merger on three areas of hospital operations - scale of activity, personnel/staffing practices, and operating efficiency - is examined. DATA SOURCES: Secondary data obtained from the AHA Annual Surveys (1980-1990) were applied to analyze 92 hospital mergers over the period 1982-1989. STUDY DESIGN: The study employed a multiple time-series design involving a six-year longitudinal assessment of change in hospital operating characteristics before and after merger, and a parallel analysis of change in a randomly selected group of nonmerging hospitals. DATA COLLECTION: Pooled, cross-sectional data files were constructed. Comparisons were evaluated using paired and two-sample t-tests. PRINCIPAL FINDINGS: General merger effects occurred primarily in areas related to operating efficiency. Merger resulted in slowing rates of preexisting trends, rather than dramatic improvements in operating practices. CONCLUSIONS: The short-term impact of merger was generally modest but differed by the conditions under which the merger occurred. Specifically, mergers occurring later in the study period and mergers between similarly sized hospitals displayed greater change in operating characteristics than those occurring earlier in the study period and those between hospitals of dissimilar size. Such differences are attributed respectively to increased competitive pressures after PPS and to greater opportunities for consolidation and efficiencies in mergers involving similarly sized hospitals.

American Hospital Association↗

PubMed1993

Patterns of absolute risk of lung cancer mortality in former smokers.

BACKGROUND: It is well known that the relative risk (RR) of lung cancer mortality decreases following smoking cessation compared with the risk in persons who continue to smoke. However, changes in the absolute risk of lung cancer death following smoking cessation are not well documented. Further, few studies have examined the effect of age at smoking cessation on subsequent lung cancer death risk. PURPOSE: The purpose of this study was to examine and compare absolute and relative lung cancer death risks in former smokers as a function of age at cessation. METHODS: Using the American Cancer Society's Cancer Prevention Study II, a prospective cohort study with 6 years of follow-up, we modeled absolute risk of lung cancer mortality in individuals who had never smoked and in current and former smokers. The model was fit with the use of person-years logistic regression analysis. RESULTS: Similar patterns of absolute risk of lung cancer death by age were found for all ages of smoking cessation up to the mid-60s. Lower lung cancer death risk was observed for those quitting earlier in life, and the risk for all former smokers was significantly lower than that for current smokers. For those quitting between ages 30 and 49, lung cancer death risk rose gradually with age at a rate slightly greater than that for those who had never smoked. Lung cancer death risk for former smokers quitting between ages 50 and 64 leveled off near the risk attained at the time of quitting until around age 75, when it rose sharply. At age 75, the RR for former smokers compared with current smokers was approximately 45% for those quitting in their early 60s, approximately 20% for those quitting in their early 50s, and less than 10% for those quitting in their 30s. For those who had never smoked, the RR at age 75 is less than 5%. CONCLUSIONS: In terms of reduced risk of lung cancer mortality, smoking cessation is beneficial at any age, with much greater benefits accruing to those quitting at younger ages. Unlike previous research, which has primarily examined the effects of cessation as a function of years since quitting, our results demonstrate that age at cessation has a major impact on subsequent lung cancer risks. IMPLICATIONS: Smokers of all ages should be encouraged to quit because cessation at any age decreases lung cancer risk relative to that of current smokers.

Adult↗

PubMed1993

Motivations for smoking cessation: a comparison of successful quitters and failures.

To foster successful smoking cessation, public health professionals need to understand better the reasons why smokers quit smoking. Although researchers have studied smokers' characteristics that may predict smoking cessation, few studies have examined the relationships between reasons stated for quitting and successful smoking cessation. We examined six reasons for smoking cessation and their association with successfully quitting among approximately 7,700 current and former smokers who participated in the 1986 Adult Use of Tobacco Survey (AUTS). Using logistic regression analysis, we found that successful cessation was associated with having personal concerns regarding the health effects of smoking and with wanting to set a good example for children. In contrast, concerns about the cost of smoking, the effect of smoking on others, and pressure from friends and family to quit were associated with decreased likelihoods of cessation. Furthermore, the relative importance of a reason (somewhat important vs. very important) also influenced the association of that reason with smoking cessation.

Adolescent↗

PubMed1993

Leadership instability in hospitals: the influence of Board-CEO relations and organizational growth and decline.

This study tested whether leadership instability--a systemic pattern of frequent succession in the top management position of an organization--was associated with sociopolitical structures that define the relationship between the board and chief executive officer (CEO), controlling for temporal patterns of the organizational life-cycle stage. In organizations that are not profit maximizing and subject to considerable uncertainty, such governance properties were hypothesized to affect leadership instability independent of organizational growth or decline. Results of regression analyses demonstrate strong main effects of board-CEO relations, net of the impact of organizational life cycle, on leadership instability.

Chi-Square Distribution↗

PubMed1992

Multihospital system affiliation as a survival strategy for rural hospitals under the prospective payment system.

The introduction of Medicare's Prospective Payment System (PPS) has disproportionately increased financial pressures on rural hospitals and posed challenges to the survival of these institutions. Increasingly, rural hospitals are seeking strategies that can enhance their chances for survival in a turbulent and hostile environment. This study examined the survival effects of one such strategy, multihospital system affiliation. Specifically, we assessed: (1) whether and how different types of system affiliation in the post-PPS era affect the likelihood of rural hospital survival; (2) whether particular structural, environmental and hospital performance characteristics moderate the effects of system affiliation on rural hospital survival; and (3) whether systematic selection by rural hospitals into multihospital systems potentially accounts for observed relationships between system affiliation and survival. Proportional hazards analyses indicate that system affiliation with investor-owned systems significantly reduces survival probabilities of rural hospitals. Affiliation with not-for-profit systems or system affiliation under contract management arrangements does not affect survival probabilities of rural hospitals. These general findings are moderated by the effects of hospital ownership and size at the time of affiliation. Finally, study findings indicated that systematic selection by poor performing rural hospitals into investor-owned systems has occurred in the post-PPS era. No evidence of selection into not-for-profit systems was discovered.

Contract Services↗

PubMed1991

Human nonspecific suppressive lymphokines.

Since the term "lymphokine" first appeared in print over 20 years ago, a tremendous number of these soluble mediators of the immune system have been described. Within the past few years, many human nonspecific suppressive lymphokines have been identified. This review discusses the historical basis of immunologic suppression and suppressor factors. Later reports describing suppressive human lymphokines are then grouped into four categories: primarily stimulatory lymphokines that also mediate certain suppressive activities, suppressive lymphokines produced during altered states of immunity, suppressive lymphokines produced by exogenously stimulated lymphocytes, and suppressive lymphokines produced by unstimulated lymphocytes. Recent work I have been involved in focusing on the human suppressive lymphokine soluble suppressor factor (SSF) is also discussed.

Humans↗

PubMed1991

Modulation of a human immunosuppressive lymphokine by monosaccharides.

Soluble suppressor factor (SSF) is a recently purified human lymphokine produced by peripheral blood lymphocytes (PBL) in serum-free medium as a likely consequence of an autologous mixed lymphocyte reaction. Immunoregulatory actions of SSF include suppression of: polyclonal B cell activation, proliferative responses of normal PBL, and natural killer (NK) and antibody-dependent cellular cytotoxicity. We examined the ability of the monosaccharides fucose (Fuc), galactose (Gal), glucose (Glc), and mannose (Man) to reverse SSF-mediated suppression of NK activity. Fuc and Gal can partially or completely reverse SSF-mediated suppression at four effector:target cell ratios. Man and Glc were unable to significantly reverse SSF-mediated suppression. Fuc or Gal was added to PBL at various times after addition of SSF. SSF-mediated suppression of NK cytotoxicity becomes irreversible with respect to these monosaccharides during the first 24 hr of PBL exposure to SSF. To explore the mechanism behind this block of SSF-mediated suppression. Fuc or Gal (50 mM) was cultured with PBL for 24 hr before addition of SSF, or with SSF for 24 hr before addition to PBL. Our experiments indicate that SSF is directly interacting with these monosaccharides, and may function by recognizing specific sugar moieties on the surface of effector cells.

Chromatography, Affinity↗

PubMedDate not supplied

Effect of smoking characteristics on cognitive dissonance in current and former smokers.

The effect of smoking characteristics on the development of cognitive dissonance in current and former smokers is examined. Smoking characteristics (number of cigarettes per day, number of years smoked, and years since quitting) and health beliefs were obtained from over 9,000 respondents to the 1986 Adult Use of Tobacco Survey. Overall, current smokers exhibited more cognitive dissonance involving smoking-related beliefs than did former smokers. Logistic regression analysis indicated that heavier current smokers (those smoking > or = 20 cigarettes per day) were more likely to exhibit cognitive dissonance over smoking-related health beliefs than were lighter smokers. In contrast, number of cigarettes consumed per day had only minor effects on former smokers' beliefs; former smokers who had smoked for more years (> or = 17), or who had quite recently (within the last 8 years), were more likely to showed greater dissonance than former smokers without these characteristics. The factors underlying these results and their implications for smoking cessation programs are discussed.

Adolescent↗

PubMedDate not supplied

Health and economic outcomes modeling practices: a suggested framework.

In the field of outcomes research, modeling is increasingly being used to assess costs and outcomes associated with healthcare interventions. However, there is little standardization with regard to modeling practices, and the quality and usefulness of economic and health outcomes models may vary. We propose the following set of recommendations for good modeling practices to be used in both the development and review of models. These recommendations are divided into three sections: criteria to be addressed before model development or initial review; criteria used during model development or evaluation; and criteria used following model development. These recommendations also include examples regarding different modeling techniques and practices as well as a checklist (see appendix) to assess model correspondence with the recommendations. We hope that the use of good practice recommendations for modeling will not only improve the development and review of models but also lead to greater acceptance of this methodology.

Journal Article↗

PubMedDate not supplied

Treatment patterns for otitis externa.

BACKGROUND: Although otitis externa is a common and painful infection of the outer ear canal, there is little specific information available regarding current treatment patterns in the United States. We wanted to examine treatment patterns for otitis externa. METHODS: Data were analyzed from the 1993 National Ambulatory Medical Care Survey (NAMCS) and the 1993 National Hospital Ambulatory Medical Care Survey (NHAMCS) for adults and children treated for otitis externa. Data analyses included the reasons for physician visits, concomitant diagnoses, types of physicians seen, sources of payment, medical procedures administered, drugs prescribed, and patient disposition following a physician visit. RESULTS: Study results suggested that treatment patterns differ substantially for adults and children, as well as by physician specialty. Although otitis externa is frequently painful, few cases are classified as severe, and the data indicated that less than 20 percent of patients have concomitant diagnoses treatable by medication. Nevertheless, 40 percent of patients received both topical and systemic medication, and many of the oral antibiotics prescribed are not active against Staphylococcus aureus or Pseudomonas aeruginosa, the most common bacterial pathogens in otitis externa. CONCLUSIONS: Appropriate treatment of localized otitis externa with topical antibiotics should eliminate the need for systemic medications. Addition of systemic medications can unnecessarily increase treatment costs and the likelihood of side effects, and could reduce the likelihood of patient compliance.

Administration, Topical↗

PubMedDate not supplied

Economic evaluations of gastric and pancreatic cancer.

The total cost of cancer care in the US is about $146 billion, of which pancreatic cancer comprises $2.6 billion (1.8% of the total) and gastric cancer comprises $1.8 billion (1.3%). We have reviewed published studies presenting economic analysis of treatment or follow-up for patients with pancreatic or gastric cancer. Relatively few studies report on economic evaluations of pancreatic cancer care. There are also few economic studies for gastric cancer, although we identified three cost-effectiveness analyses. In general, economic analyses in these areas are relatively unsophisticated, relying on charge data or simple multipliers (e.g., average cost per day in the hospital multiplied by days in the hospital), and are often limited to in-hospital costs (particularly studies for pancreatic cancer). A wide range of costs is included in these studies and a variety of methodologies for assigning costs are used, making comparisons between studies difficult. Future health economics research in this area should evaluate the costs and effectiveness of alternative practice patterns for gastric and pancreatic cancer; conduct additional cost-effectiveness analyses of chemotherapeutic interventions; consider quality of life, survival, stage at diagnosis, patient-borne costs, and complications of therapy; and, take advantage of administrative data from large populations.

Cost of Illness↗

PubMedDate not supplied

Health-related quality of life evaluations of gastric and pancreatic cancer.

This review addresses the state of the literature on health-related quality of life (HRQL) assessment among patients with cancers of the pancreas and stomach. We first briefly review the epidemiology of these cancers. We examine the concept of HRQL and the degree to which it has been measured among these patient groups. The impact of gastric and pancreatic cancers on HRQL is described, including the domains which these conditions are most likely to impact. The effect of different treatments on HRQL is considered, including surgical procedures, pharmacological and non-pharmacological therapies, and procedures for symptom palliation. Based on our findings on the limited quantity and quality of the body of literature, we make suggestions for further research in the area. Results suggest three areas in which HRQL can play an important role in the study of gastric and pancreatic cancer. First, future investigations should consider both survival and HRQL in comparing surgical procedures. Second, studies of chemotherapy should include HRQL evaluation, with careful attention to conducting assessments at times appropriate to capture the effects of chemotherapy. Third, studies of the impact of palliative care should include assessments of HRQL.

Humans↗

PubMedDate not supplied

Patient adherence to prescribed potassium supplement therapy.

We have investigated whether patient adherence ratios calculated from prescription refill data for potassium supplement medications differ depending on the type of supplement. By using automated pharmacy claims records from a large managed care organization, an index of adherence to prescribed therapy was calculated for each patient as a ratio of total days of drug supplied to the total number of days between prescription refills. The mean patient adherence to prescribed therapy ratios were compared among different potassium drug regimens. There were 2289 patients eligible for analysis; 65.9% were women, and the mean age was 57.6 years. The mean patient adherence ratio for one brand of extended-release tablet, K-DUR, was 0.81 (a majority of the patients were receiving 20 mEq/day). This was higher than the combined mean patient adherence ratio for all other supplements (0.73); the combined mean ratio for all other extended-release tablets (0.74); the combined mean ratio for all other tablets and capsules (0.74); the combined mean ratio for liquids (0.50); the combined mean ratio for liquids and powders (0.63); and equivalent to the ratio for another extended tablet, Micro-K (0.82). Regression analysis showed that increased patient adherence was seen among patients taking K-DUR tablets as compared with those taking other potassium supplements. Increased adherence among patients taking K-DUR remained statistically significant after controlling for number of prescriptions filled, dose, age, sex, and health plan location. Pharmacy claims data can be used effectively to measure patient adherence with potassium supplement therapy. Future research should relate patient adherence ratios to clinical outcomes.

Adult↗

PubMedDate not supplied

Differences in former smokers' beliefs and health status following smoking cessation.

Many studies have examined changes in former smokers' disease risk after smoking cessation. Little is known, however, about differences in the health beliefs and self-reported health characteristics of former smokers in the years following cessation. We examine these differences in former smokers, using data from the 1990 National Health Interview Survey. Current smokers were less likely than people who had never smoked to perceive both smoking and nonsmoking disease risk factors as dangerous. Recent former smokers held beliefs similar to those of respondents who had never smoked. Former smokers who had quit for five years or more tended to believe in the effects of these risk factors even more than those who had never smoked. For self-perceived health characteristics, current smokers generally indicated worse health than did lifelong non-smokers. Former smokers who had recently quit reported even worse health than current smokers. For certain health indicators, former smokers were more likely to indicate poor health than were current smokers even a decade or more following smoking cessation. These results, based on health beliefs and health characteristics, suggest that former smokers are a diverse group and should not be compared to other smoking-status groups without evaluation of the time interval since smoking cessation.

Adolescent↗