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R Leidl

Publications and source records attributed to R Leidl.

30 records · Page 2Linked to original sources
PubMed1998

Health economic assessment of behavioural rehabilitation in chronic low back pain: a randomised clinical trial.

The aim of this cost-effectiveness study was to compare a combined operant programme plus cognitive/relaxation programme with an operant programme plus attention-control and to compare both programmes with a waiting-list control group and with operant rehabilitation provided, as usual, by the same rehabilitation centre. One hundred and forty eight patients with chronic low back pain were randomly assigned to the different conditions. The economic endpoints were the costs of the programme and other health care utilisation, costs for the patient, and indirect costs associated with production losses due to low back pain. The effects were measured in terms of global assessment of change and utilities, using rating scale and standard gamble methods. The 3-year study determined that adding a cognitive component to an operant treatment did not lead to significant differences in costs and improvement in quality of life when compared with the operant treatment alone. Compared with the common individual rehabilitation therapy it can be concluded that the same effects can be reached at the same or lower costs with a shorter, more intense standardised group programme. The operant treatment alone is more effective than providing no treatment in the waiting-list control group.

Adult↗
PubMed1998

Economic evaluation is essential in healthcare for the elderly. A viewpoint.

The aging population is considered to be one of the major factors driving the cost of healthcare upward in industrialised countries. However, several analyses show that expenditure has increased mainly because of other factors. Expenditure is expected to increase when an aging population is combined with technical progress. In addition, the growing proportion of the population who are elderly means that there is an increasing proportion of people who do not work, creating further problems in the financing of healthcare. These problems make it imperative to provide medical care to the elderly in an efficient way. Economic evaluation studies should render information about the cost-effectiveness of medical treatments as well as the preferences of patients. A MEDLINE-based review of the literature reveals that few studies specifically assess the cost-effectiveness of medical care for the elderly. Since age can influence the costs and effects of patient treatment, study results from younger patient samples may not adequately reflect the results to be expected for elderly patients. A significant information gap concerning the efficiency of care for the elderly thus exists, including information on the efficiency of drug treatment. There is also a need to test and, eventually, specify evaluation methodology (such as the appropriateness of quality of life measurement) for elderly patients. Since the elderly have a shorter life expectancy, they may be at a disadvantage when cost-effectiveness measures are compared across age groups. Depending on the normative position, such comparisons can be accepted from a utilitarian, population-oriented perspective, or rejected from a libertarian, individualistic perspective. The normative position needs to be discussed when making use of evaluation results. Avoiding this discussion can bring about ethically unfavourable consequences.

Aged↗
PubMed1996

Making cost assessments based on RCTs more useful to decision-makers.

The appropriateness of results from economic evaluation for allocation-decisions in health care is a point of major concern for decision-makers. Much attention has been focused on potential biases stemming form the methodological shortcomings of economic evaluation. This article adds to this and concentrates on the 'real world' relevance of results from economic evaluation as an additional step towards making results more useful to decision-makers. Being the accepted standard for economic evaluation, the RCT is used as the reference case; yet, many of the issues raised are also relevant for other research designs. Three classes of biases are examined. The first relates to the limited scope that economic analysts sometimes choose in RCTs. The second class involves the methodological aspects of RCTs and questions the 'real world' relevance of the tools with which economic analysts estimate costs on the basis of RCTs. The third class concerns the representativeness of RCT results, i.e. the generalizability of these results and their usefulness in other treatment contexts. options for limiting the potential confounding influences of these biases are discussed. A check-list is provided which should be applied by decision-makers when using constructing and describing RCTs. This will enhance the relevance of the results of economic evaluation in decision-making and improve the information basis for actual allocation decisions in health care.

Cost-Benefit Analysis↗
PubMed1993

Economic impact of the AIDS epidemic in the European Community: towards multinational scenarios on hospital care and costs.

OBJECTIVE: To underpin multinational public-health HIV/AIDS strategy planning in the European Community (EC) by integrating national studies on HIV/AIDS in scenario analysis. METHOD: Three types of data are used: routine surveillance data, information on disease progression and observational studies on the economic impact. The HIV/AIDS epidemic is simulated using two models (MIDAS and PC-Based AIDS Scenarios). Selected simulations, consistent with surveillance data, are connected to economic impact (hospital-bed needs and annual hospital costs for AIDS patients). Parameter values expressing per person-year economic impacts are derived from a structured review of publications on economic aspects of AIDS. RESULTS: Evaluation of published studies on hospital resource use and costs in EC countries shows that there are significant differences between both countries and studies, even after conversion to similar measures (for example, using purchasing power parities). These differences are partly due to factors such as the composition of the patient population. Differences in methodology may also have influenced the results. Economic impact is analysed for combinations of three factors; survival time after AIDS diagnosis, hospital inpatient days needed per person-year and corresponding hospital costs per person-year. All scenarios indicate 1995 hospital-bed needs above the 1990 level of 5400 beds. Hospital cost projections for 1995 vary (up to US$1050 million). CONCLUSIONS: (1) For economic impact assessment, there are important gaps in epidemiological and economic data, and in the methods for linking these. (2) Standardization of studies on the resource use and costs of HIV/AIDS is necessary to provide a sound basis for multinational scenarios. (3) Preliminary multinational scenarios show that by 1995 hospital-bed needs for AIDS might reach 0.45% of all hospital beds available in the EC, and that hospital cost projections for AIDS in that year will range from 0.15% to 0.30% of EC health-care expenditure.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Health economic issues relevant to countries with aging populations.

This article investigates the health economic impacts of aging populations, using scenario techniques and economic systems analysis. Age-related data on hospital utilization and health care expenditure are linked with demographic models for Germany from 1990 to 2040. Findings indicate that the demographic component may not play a major role in determining long-term trends as compared with other, not yet fully elucidated components of utilization and expenditure, both of which are the result of the interplay between supply and demand in health care, and of interactions with the general economy. This acts as a deterrent against the use of simple extrapolations of current indicators (or their trends), but more adequate theoretical economic models are still lacking.

Adult↗
PubMed1988

Training health services managers: improving health by more health economics?

In times of rising health expenditures and imminent health problems, efficiency is a crucial element for maintaining and improving health care and, finally, health. One major support measure is the effective management of health services. This paper considers possible improvements of health care by training health services managers in health economics. It surveys the current state of health economics training, presents approaches towards the key issues of health economics, discusses the impact of health economics by two examples, and considers management aspects of health economics training.

Curriculum↗
PubMed1983

The hospital financing system of the Federal Republic of Germany.

This paper deals with the present hospital financing system of the Federal Republic of Germany. The structure of the financing system is treated as well as the actual financing process, and, as far as possible, both are also quantitatively described. The first section contains a description of the structure, and is concerned with the major institutions participating in the hospital financing system:--the hospitals are described according to ownership, number of beds, specialization, personnel, regional distribution and utilization;--the health insurance system is illustrated by the two major institutions, i.e. statutory and private health insurance agencies, and its effect on hospital financing is explained;--the regulation of the hospital financing system by the federal political system is discussed;--finally, the major economic functions of the institutions involved are summarized; the interrelations of hospital care and the ambulatory sector are also mentioned. The second section contains a detailed description of the actual financing process, which can be classified according to the sections of financing:--the basic system of the German hospital financing law is introduced;--in the section on investment costs, public grants and their allocation, which are closely related to hospital planning, are discussed;--in the section on operating costs, full cost reimbursement as the basic principle, the structure of costs, the elements and the mechanism of operating cost financing, the actual prices, the financing of private patients' care and special services are described;--a short view of accounting balances, i.e. the differences between costs and financing of hospital services which result in profits or deficits, is given. A few considerations on the evaluation of the financing system conclude the paper.

Costs and Cost Analysis↗
PubMedDate not supplied

The impact of age on cost-effectiveness ratios and its control in decision making.

Throughout Europe and in a number of other industrialized countries, the coming decades have been predicted to feature an increase in the proportion of patients who are elderly. This has led to considerable concern with respect to financing the health care system and has also increased the concerns about the efficiency of health care. Integrating ageing and efficiency issues, this paper examines the effects of age on the cost-effectiveness of medical interventions and its impact on decision making. First, at the clinical level, the relation between age and the cost-effectiveness of medical interventions is analysed. Second, at the population level, a framework is presented which allows researchers and decision makers to assess the impact of these effects on the decision-making process. It is shown that the allocation of health care resources at the macro-level is seriously impaired when age is ignored as a variable in cost-effectiveness analysis. Because clinical trials typically employ 'young' populations, when the data are extrapolated to the whole population the attractiveness of medical interventions in terms of cost-effectiveness may be considerably overestimated. Furthermore, the cost-effectiveness ratio may vary across countries or over time as a result of demographic or epidemiological variation. Economic evaluators should describe the impact of age, which should then be considered by decision makers to control for age effects.

Age Factors↗