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R L Ernst

Publications and source records attributed to R L Ernst.

13 recordsLinked to original sources
PubMed1999

Cost-effectiveness analysis of alternative factor VIII products in treatment of haemophilia A.

Manufactured factor VIII (FVIII) concentrates of varying purity are available for managing patients with haemophilia A. This study is a cost-effectiveness analysis of ultra-high purity and recombinant (UHP/R) FVIII products relative to intermediate and very-high purity (IP/VHP) preparations. Because the societal (including research and development) costs of FVIII products are unknown and product prices vary with market conditions, we conducted the analysis with treatment cost as a variable quantity. We estimated the largest price premium that could be paid for a UHP/R concentrate relative to an IP/VHP concentrate such that the UHP/R product is the more cost-effective preparation. In the analysis haemophilic patients were assumed to be seropositive for human immunodeficiency virus, seropositive for hepatitis C (HCV), or at risk for seroconversion of hepatitis A (HAV) or hepatitis B (HBV). The results showed that the maximum cost-effective UHP/R price premium is essentially zero if the patient is only at risk of HAV or HBV infection, positive but small for the base-case HCV+ patient, and positive and large for the base-case HIV+ patient having a short life expectancy. Thus UHP/R preparations are not uniformly more cost-effective than IP/VHP products across the spectrum of haemophilic patients' health problems, and the relative cost-effectiveness of the two classes of prepared FVIII products is sensitive to product prices. The methodology employed here can be used in other circumstances where multiple treatments exist for illnesses for which there are significant multiple comorbidities or health risks.

Cost-Benefit Analysis↗
PubMed1997

Cognitive function and the costs of Alzheimer disease. An exploratory study.

OBJECTIVE: To estimate the dollar savings in costs attainable from drug or other treatments for Alzheimer disease (AD) that stabilize or reverse patients' cognitive decline. METHODS: Medical and other disease-related utilization data were collected from the caregivers of 64 patients diagnosed as having probable AD. The quantities of utilization were priced at national levels to generate measures of illness costs. Costs per patient were then estimated as regression functions of scores on the Mini-Mental State Examination (MMSE), which was used as an index of patient cognitive function. Potential savings in illness costs were estimated by comparing predicted costs at various baseline and intervention-level values of the patient's MMSE score. RESULTS: The potential savings in illness costs attainable from treatment are small for mildly and very severely demented patients with AD. However, for moderately to severely demented home-dwelling patients having, say, an MMSE score of 7 at baseline, prevention of a 2-point decline in the score would save about $3700 annually, and a 2-point increase in an MMSE score rather than a 2-point decline would save about $7100. CONCLUSION: Large savings in the costs of caring for moderately to severely demented home-dwelling patients with AD may be achievable from disease interventions that have minor effects on patients' cognitive status.

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PubMed1997

Economic research on Alzheimer disease: a review of the literature.

The present review discusses the economic research to date on Alzheimer disease (AD). It focuses on estimates of the costs of AD and on economic evaluations of interventions in the disease. Empirical and conceptual issues concerning the interpretation of costs and the uses of evaluative methodologies also are discussed. We conclude that estimates of the national costs of AD are open to a large margin of uncertainty. We conclude further that significant opportunities exist for new cost-effectiveness or cost-benefit analyses of AD treatments, patient care options, and counselling, respite, or similar programs for AD caregivers.

Alzheimer Disease↗
PubMed1994

The US economic and social costs of Alzheimer's disease revisited.

UNLABELLED: OBJECTIVEs. An earlier paper estimated the per-case and national incidence costs of Alzheimer's disease for 1983. This paper updates the estimates of costs per case to 1991 and presents new national prevalence estimates of the economic and social costs of the disease. METHODS: All data for the cost estimates were taken from published sources or provided by other researchers. RESULTS: At midrange values of the estimated cost and epidemiological parameters, the discounted (at 4%) direct and total costs of Alzheimer's disease were $47,581 and $173,932 per case, respectively. The estimated 1991 national direct and total prevalence costs were $20.6 billion and $67.3 billion, respectively. Assuming conservatively that the prevalence of the disease remains constant, the estimated discounted present values of the direct and total costs of all current and future generations of Alzheimer's patients are $536 billion and $1.75 trillion, respectively. CONCLUSIONS: The $536 billion and $1.75 trillion figures are minimum estimates of the long-term dollar losses to the US economy in 1991 caused by Alzheimer's disease.

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PubMed1987

The economic costs of Alzheimer's disease.

This paper estimates the economic costs of Alzheimer's Disease to individuals and to society, based on review of published Alzheimer's Disease-related research. The analysis is derived from epidemiological projections and cost information for the United States population in 1983. Estimated costs include both direct medical care and social support costs, as well as indirect costs, such as support services provided by family or volunteers, and the value of lost economic productivity in Alzheimer's Disease patients. Mid-range estimates of net annual expected costs for an Alzheimer's Disease patient, excluding the value of lost productivity, are $18,517 in the first year and $17,643 in subsequent years, with direct medical and social services comprising about half of these costs. Under base case assumptions, the total cost of disease per patient in 1983, was $48,544 to $493,277, depending upon patient's age at disease onset. The estimated present value of total net costs to society for all persons first diagnosed with Alzheimer's Disease in 1983 was $27.9-31.2 billion. Development of a public or private insurance market for the economic burdens of Alzheimer's Disease would fill some of the gaps in the current US system of financing long-term chronic disease care.

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PubMed1986

The influence of repeated carotid plaque hemorrhages on the production of cerebrovascular symptoms.

Single carotid intraplaque hemorrhage has been related to the occurrence of cerebrovascular ischemic symptoms. We were unable to reproduce these findings; therefore, our patient population was reinvestigated to ascertain the importance of repeated plaque hemorrhages and their possible relationship to the production of neurologic symptoms. Eighty-five consecutive patients underwent 95 carotid endarterectomies. Plaques were separated into three groups: those from patients with lateralizing symptoms, nonlateralizing symptoms, and no symptoms. All the plaques were inspected microscopically for evidence of hemorrhage, specifically, repeated hemorrhages. Repeated hemorrhages were found in 29 of 44 plaques (66%) in the lateralizing symptom group, 6 of 19 (32%) in the nonlateralizing symptom group, and 12 of 32 (37%) in the no symptom group. We conclude that repeated rather than single intraplaque hemorrhage is the critical factor related to the production of specific cerebrovascular ischemic symptoms.

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PubMed1981

Blue Shield plan physician participation.

Many Blue Shield Plans offer participation agreements to physicians that are structurally similar to the participation provisions of Medicaid programs. This paper examines physicians' participation decisions in two such Blue Shield Plans where the participation agreements were on an all-or-nothing basis. The major results show that increases in the Plans' reasonable fees or fee schedules significantly raise the probability of participation, and that physicians with characteristics associated with "low quality" are significantly more likely to participate than are physicians with characteristics associated with "high quality." In this sense the results highlight the tradeoff that must be faced in administering governmental health insurance policy. On the one hand, restricting reasonable and scheduled fees is the principal current tool for containing expenditures on physicians' services. Yet these restrictions tend to depress physicians' willingness to participate in government programs, thereby reducing access to high quality care by the populations those programs were designed to serve.

Blue Cross Blue Shield Insurance Plans↗
PubMedDate not supplied

The effect of antiplatelet therapy on the incidence of carotid plaque hemorrhage.

Hemorrhage into the carotid atheroma has recently been gaining attention with respect to the pathophysiology of cerebrovascular disease. Many patients are currently receiving platelet agents for various vascular diseases. Some researchers have postulated that antiplatelet therapy may be detrimental by possibly inducing intraplaque hemorrhage or by increasing preexisting hemorrhage. This retrospective study was undertaken to determine if the use of antiplatelet therapy increases the incidence of carotid plaque hemorrhage. Ninety-five consecutive carotid endarterectomies were performed and the atheromas examined microscopically for intraplaque hemorrhage. The atheromas were divided into two groups; those from patients receiving preoperative antiplatelet therapy and those who were not. Forty-five atheromas were removed from patients receiving preoperative antiplatelet therapy; 39 (87%) of these demonstrated intraplaque hemorrhage. Of the 50 atheromas which were removed from patients not receiving preoperative therapy, 45 (90%) showed intraplaque hemorrhage. We conclude that antiplatelet therapy does not increase the incidence of carotid plaque hemorrhage.

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