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S Teutsch

Publications and source records attributed to S Teutsch.

8 recordsLinked to original sources
PubMed2000

Cost-utility analyses of clinical preventive services: published ratios, 1976-1997.

BACKGROUND: Cost-effectiveness analyses of clinical preventive services are a potential means to aid public health resource allocation. Cost-utility analysis (CUA) is a specific form of cost-effectiveness analysis where results are expressed in terms of cost per quality-adjusted life year (QALY) gained. To increase the transparency and comparability of CUAs, standardization of methods has been recommended. OBJECTIVES: The purposes of this study were as follows: (1) identify published articles with original CUAs of primary and secondary clinical preventive services, (2) summarize the ratios found in these analyses, (3) identify articles employing comparable methods, and (4) explore analytic methods employed over time. METHODS: As part of a larger study we conducted a comprehensive search of published CUAs in the area of clinical preventive services and systematically collected data on the results of the analyses and analytic methods employed. Cost-effectiveness ratios were standardized and organized into a table. RESULTS: We found 50 CUAs pertaining to clinical preventive services (primary, n=22, 44%; and secondary, n=28, 56%) and 174 cost-effectiveness ratios. These ratios ranged from cost-savings up to $27,000,000/QALY, with a median of $14,000/QALY. Only three (6%) of the CUAs met minimum reference case requirements. There was no apparent improvement of methods over time. CONCLUSIONS: Immunizations and chemoprophylaxis have the most favorable cost-effectiveness ratios, and preventive services are more cost-effective when targeted at high-risk populations. However, there is wide variation in the methods used in these analyses. This study allows us to define where improvements in methodologic rigor need to occur, provides a base-line for future audits, and highlights disease areas in clinical preventive services that have been omitted or underevaluated.

Cost-Benefit Analysis↗
PubMed1998

Trends in infectious disease hospitalizations in the United States, 1980-1994.

BACKGROUND: A recent study concluded that between 1980 and 1992, deaths from infectious diseases increased 58%. This article explores trends in infectious diseases as a cause of hospitalization. METHODS: We analyzed data from the National Hospitalization Discharge Survey for 1980 through 1994 using a previously developed approach to evaluate infectious diseases in data coded according to the International Classification of Diseases, Ninth Revision. RESULTS: Between 1980 and 1994, the rate of hospitalizations in the United States declined approximately 33%; hospitalizations occurred at a rate of 133+/-5 per 1000 US population (35 million+/-1 million discharges) in 1994. The rate of hospitalization for infectious diseases declined less steeply--12% during this interval--resulting in an increased proportion of hospitalizations because of infectious diseases. In 1994, the rate of hospitalizations for infectious diseases was 15.4+/-0.7 per 1000 US population (4.0 million+/-0.2 million discharges). The fatality rate associated with hospitalizations for infectious diseases increased from 1.9%+/-0.1% to 4.0%+/-0.3%, attributable to increased hospitalizations of elderly persons and an increased fatality rate among those younger than 65 years. Among selected categories, hospitalizations for human immunodeficiency virus infections and acquired immunodeficiency syndrome, prosthetic device infections, sepsis, and mycosis increased substantially, and hospitalizations for upper respiratory tract infections, pelvic inflammatory disease, and oral infections declined sharply. Hospitalizations for lower respiratory tract infections constituted 37% of all infectious disease hospitalizations in 1994. CONCLUSIONS: Considering hospitalizations as a dimension of the burden of infectious diseases involves an array of factors: secular trends in hospitalization, changing case management practices, demographic changes, and trends in the variety of infectious diseases themselves. Increases in the proportions of hospitalizations because of infectious diseases during years when hospitalizations for all causes were decreasing reflect an increasing burden of infectious diseases in the United States between 1989 and the mid-1990s.

Communicable Diseases↗
PubMed1997

Canine fucosidosis: a model for retroviral gene transfer into haematopoietic stem cells.

Severe progressive fatal neurological degeneration occurs in fucosidosis, a storage disease. Bone marrow transplantation into affected dogs has shown that haematopoietic stem cells can provide enzyme producing daughter cells to the central nervous system, altering disease course. This makes canine fucosidosis an ideal large animal model for gene therapy. Fucosidosis affected allogeneic or autologous canine marrow was transduced ex vivo by cocultivation, then transplanted into fucosidosis affected dogs conditioned with total lymphoid irradiation. The vectors were Moloney murine leukaemia virus based. Transduction efficiency was increased with multiple cytokines in short term marrow culture. Despite high levels of transduction, proviral sequence was detected 2 months post transplant in only one dog. Early or total graft failure occurred in all transplants. We believe lack of engraftment could be caused by differentiation or change of repopulating ability of marrow cells occurring with multiple cytokine mixes in culture media.

Animals↗
PubMed1989

Are racial differences in the prevalence of diabetes in adults explained by differences in obesity?

To determine whether the higher prevalence of diabetes found among blacks in the United States is explained by racial differences in obesity, we examined the prevalence of diabetes adjusted for adiposity, education, and income in a cohort of US Army veterans from the Vietnam era. Among 12,558 white men and 1677 black men, aged 30 to 47 years, blacks were more likely than whites to have diagnosed diabetes (adjusted prevalence ratio, 1.9; 95% confidence interval, 1.3 to 2.7). Within every age, adiposity, and socioeconomic stratum, blacks had a higher prevalence of diagnosed diabetes than whites. In a subgroup of veterans for whom fasting serum glucose values were measured, blacks were more likely than whites to have fasting hyperglycemia (fasting serum glucose value greater than or equal to 7.8 mmol/L) (adjusted prevalence ratio, 5.7; 95% confidence interval, 2.7 to 12.0). These data provide evidence that the higher prevalence of diabetes found among blacks is not explained by differences in obesity.

Adult↗
PubMed1989

Investigation of a cluster of deaths of adolescents from asthma: evidence implicating inadequate treatment and poor patient adherence with medications.

We investigated a cluster of five deaths of adolescents from asthma in St. Louis during a 3-month period in 1987. Although the cluster represented a statistically significant increase in the number of asthma deaths in this age group over that observed in previous years, no common exposure to environmental, infectious, or therapeutic agents could be identified. The patterns of hospital admissions for asthma and emergency room visits at the two pediatric hospitals in the community did not suggest an increase in the frequency or severity of asthma during this time. Despite the lack of evidence for common exposure, the decedents shared many personal and medical characteristics. All decedents were black patients and were of lower socioeconomic status. All were adolescents and were responsible for regulating their own medication schedules. Lack of appreciation of the severity of their asthma by medical personnel and the patients' families was evident. For example, two patients with severe asthma had not been prescribed inhaled corticosteroids. In addition, the four decedents tested had markedly subtherapeutic or zero serum theophylline levels measured at the time of the fatal episode, even though appropriate amounts of theophylline had been prescribed. Their theophylline levels were substantially lower than levels in patients of the same age observed at the emergency room or hospitalized for asthma during the same time period. Continued efforts to educate adolescent patients, their families, and medical care providers about the treatment of asthma are warranted.

Adolescent↗
PubMed1989

The problem of diabetic renal failure in the United States: an overview.

Native Americans, blacks, and other minorities are at high risk for diabetic renal failure, most of which is caused by non-insulin-dependent diabetes. Many of these patients receive care in publicly supported health programs. Recent evidence of the efficacy of hypertension control in slowing the decline in renal function and our ability to detect those at highest risk for renal deterioration with inexpensive microalbuminuria tests suggest major opportunities for concerted efforts to reduce the incidence of end-stage renal disease. Guidelines for management of high-risk patients are needed to translate effective management strategies into routine clinical practice.

Black or African American↗
PubMed1988

Evaluating outcomes of pregnancy in diabetic women. Epidemiologic considerations and recommended indicators.

Many programs have been applied in various settings to reduce adverse outcomes of pregnancy in women with diabetes. Efforts to standardize criteria and methods for evaluating these programs are relatively recent. Without such standardization, evaluation of the impact of many programs and comparisons among programs have not been possible. We review the suitability of available data sources for monitoring adverse outcomes of pregnancy in women with diabetes in light of epidemiological considerations relevant to selection of indicators of program impact. This article is intended to be a resource to help evaluate in a standardized fashion the impact of programs at a regional, state, or local level. We conclude that primary data (information collected by programs themselves) collected in a standardized manner are necessary for evaluation of programs for diabetes in pregnancy. Secondary data sources alone are of limited value for monitoring outcomes because of underreporting of maternal diabetes, especially in the absence of identified complications. Ultimately, the ability to rigorously assess the impact of efforts to improve outcomes of diabetes in pregnancy may depend on the creation of comprehensive statewide systems to identify women of childbearing age who have diabetes.

Congenital Abnormalities↗