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Biomedical subjects

T N Chirikos

Publications and source records attributed to T N Chirikos.

At least 19 recordsLinked to original sources
PubMed2001

Cost consequences of sentinel lymph node biopsy in the treatment of breast cancer. A preliminary analysis.

OBJECTIVES: To assess whether sentinel lymph node biopsy (SLNB), an alternative to axillary lymph node dissection in treating female breast cancer, affords any cost savings. METHODS: We profile cumulative treatment costs of 811 breast cancer patients, 555 of whom received SLNB. Univariate and multivariate statistical tests are used to appraise whether these cost profiles differ between SLNB and other patients. RESULTS: The statistical results are mixed. However, none supports the conjecture that SLNB necessarily lowers the cost of treating the average breast patient. CONCLUSIONS: SLNB may be cost-effective, but longer term costs and outcomes must be estimated before firm conclusions can be reached.

Axilla↗
PubMed2001

Impact of clinical trials on the cost of cancer care.

BACKGROUND: Empirical evidence on the economic impact of cancer clinical trials is in short supply, but it is widely assumed that clinical trials add at least 10% to overall costs. OBJECTIVES: To estimate how much, if at all, trial enrollment increases the use of scarce resources in treating breast, lung, lymphoma, and ovarian cancer patients. RESEARCH DESIGN: A profile of the cumulative charges for all inpatient and outpatient hospital care received by a sample of patients over an observation period beginning at diagnosis and continuing for upwards of 44 months postdiagnosis. Patients are classified by whether they were enrolled on an IRB-sanctioned research protocol and, if so, by the type of protocol. Both univariate and multivariate statistical tests are conducted to appraise whether cumulative charges differ between patients who were enrolled on key types of protocols and those who were not. SUBJECTS: Approximately 1,900 breast, lung, lymphoma, and ovarian cancer patients treated at a single center. MEASURES: Clinical endpoints and demographic, disease, and therapy characteristics of patients that drive treatment costs. RESULTS: Controlling for demographic and disease characteristics, initial therapy, and key endpoints, the net effect of trial participation on cumulative charges for hospital inpatient and outpatient care is never significantly positive at conventional confidence limits. This result is found for each of the four patient groups and three types of protocols encompassed by this analysis. CONCLUSIONS: Support for clinical trials by health care payers does not necessarily risk adding significantly to the cost of cancer care.

Aged↗
PubMed2000

Evaluating the financial impact of clinical trials in oncology: results from a pilot study from the Association of American Cancer Institutes/Northwestern University clinical trials costs and charges project.

PURPOSE: Medical care for clinical trials is often not reimbursed by insurers, primarily because of concern that medical care as part of clinical trials is expensive and not part of standard medical practice. In June 2000, President Clinton ordered Medicare to reimburse for medical care expenses incurred as part of cancer clinical trials, although many private insurers are concerned about the expense of this effort. To inform this policy debate, the costs and charges of care for patients on clinical trials are being evaluated. In this Association of American Cancer Institutes (AACI) Clinical Trials Costs and Charges pilot study, we describe the results and operational considerations of one of the first completed multisite economic analyses of clinical trials. METHODS: Our pilot effort included assessment of total direct medical charges for 6 months of care for 35 case patients who received care on phase II clinical trials and for 35 matched controls (based on age, sex, disease, stage, and treatment period) at five AACI member cancer centers. Charge data were obtained for hospital and ancillary services from automated claims files at individual study institutions. The analyses were based on the perspective of a third-party payer. RESULTS: The mean age of the phase II clinical trial patients was 58.3 years versus 57.3 years for control patients. The study population included persons with cancer of the breast (n = 24), lung (n = 18), colon (n = 16), prostate (n = 4), and lymphoma (n = 8). The ratio of male-to-female patients was 3:4, with greater than 75% of patients having stage III to IV disease. Total mean charges for treatment from the time of study enrollment through 6 months were similar: $57,542 for clinical trial patients and $63,721 for control patients (1998 US$; P =.4) CONCLUSION: Multisite economic analyses of oncology clinical trials are in progress. Strategies that are not likely to overburden data managers and clinicians are possible to devise. However, these studies require careful planning and coordination among cancer center directors, finance department personnel, economists, and health services researchers.

Aged↗
PubMed2000

Measuring hospital efficiency: a comparison of two approaches.

OBJECTIVE: To compare the results of scoring hospital efficiency by means of two new types of frontier models, Data Envelopment Analysis (DEA) and stochastic frontier regression (SFR). STUDY SETTING: Financial records of Florida acute care hospitals in continuous operation over the period 1982-1993. STUDY DESIGN: Comparable DEA and SFR models are specified, and these models are then estimated to obtain the efficiency indexes yielded by each. The empirical results are subsequently examined to ascertain the extent to which they serve the needs of hospital policymakers. DATA COLLECTION: A longitudinal or panel data set is assembled, and a common set of output, input, and cost indicators is constructed to support the estimation of comparable DEA and SFR models. PRINCIPAL FINDINGS: DEA and SFR models yield convergent evidence about hospital efficiency at the industry level, but divergent portraits of the individual characteristics of the most and least efficient facilities. CONCLUSIONS: Hospital policymakers should not be indifferent to the choice of the frontier model used to score efficiency relationships. They may be well advised to wait until additional research clarifies reasons why DEA and SFR models yield divergent results before they introduce these methods into the policy process.

Bed Occupancy↗
PubMed1998

Identifying efficiently and economically operated hospitals: the prospects and pitfalls of applying frontier regression techniques.

This article examines whether policy makers can make immediate use of recently developed frontier regression techniques to identify efficient hospitals primarily for rate setting purposes. This new approach is applied to data on Florida hospitals for the period 1982-1993 to appraise how well it performs in gauging variations in hospital costs and efficiency. This appraisal suggests that frontier methods are quite promising, but that they may not yield sufficiently unambiguous results to serve the short-term needs of hospital regulators interested in scaling reimbursement rates to the efficiency with which hospitals deliver services. Other policy-relevant strengths and weaknesses of frontier techniques are also discussed.

Cross-Sectional Studies↗
PubMed1996

Cost consequences of surveillance, medical management or surgery for benign prostatic hyperplasia.

PURPOSE: The cost consequences of alternative treatment modalities for benign prostatic hyperplasia (BPH) were investigated. The present lifetime costs of watchful waiting, medical management and surgery alone and in various combinations were estimated for a synthetic cohort of men comprised of 5 age groupings. MATERIALS AND METHODS: Synthetic cohort models were constructed to follow men at different ages "analytically" for specific intervals and to calculate the cumulative health care costs associated with alternative BPH treatment regimens during those periods. These models accounted explicitly for survival probabilities, the use of different types of health care services and products, price changes for those services and products, failure rates of some therapies and a discount factor needed to compute the present value of the cost streams. The models were implemented with hospital discharge and other data on BPH incident cases in the state of Florida in approximately 1989. RESULTS: The addition of medical management to the mix of therapies is likely to increase overall health care spending on BPH treatment, perhaps by a considerable amount. The cost-effectiveness of each type of BPH therapy differs by the age of the patient at which it is first initiated. All other parameters being equal, surgery appears to be more cost-effective at younger patient ages, while medical management has a cost advantage at older ages. CONCLUSIONS: The cost implications of alternative BPH therapies are substantial, and warrant more detailed consideration by clinicians and health policy specialists.

Age Factors↗
PubMed1995

Medicare and the Social Security Disability Insurance program.

This DataWatch traces changes over time in the age and health characteristics of persons awarded Social Security Disability Insurance (SSDI) benefits. SSDI beneficiaries are increasingly younger and more likely to be incapacitated by health conditions that at any age lengthen spells of disablement. These changes have had a significant impact on SSDI operations; they also have important implications for financing the Medicare program.

Adult↗
PubMed1992

Quality competition in local hospital markets: some econometric evidence from the period 1982-1988.

This study examines whether American hospitals continued to engage in non-price or quality competition over the recent past as health care markets underwent fundamental structural changes and the economic incentives facing hospital managers were correspondingly altered. It also investigates the degree to which such rivalrous behavior contributes to losses in economic welfare. An econometric model of quality competition is specified that tests, among other things, for the effect of spending by the hospital to enhance the quality of output on annual changes in its share of the local (inpatient) market as well as the effects of competitive conditions in the local market on the annual sum spent on quality enhancement. The model is estimated with panel data on 195 acute care hospitals in the State of Florida for the years 1982-1988. The results suggest that quality competitive behavior continued unabated over this period and that it was stimulated as much by the growth in physician supply and alternative delivery mechanisms as it was by other competing hospitals in the local market. Furthermore, the results show that quality competition yields some inefficiency or waste, but much of it also meets the test of the market.

Economic Competition↗
PubMed1990

Functional disability of elderly patients with long-term coronary heart disease: a sex-stratified analysis.

The survival of elderly women with angina has improved greatly in recent years, but little is known about the functional capacity of these women over the longer duration of their disease. This article analyzes the incidence and determinants of functional disability in a cohort of 1,001 females and males hospitalized with angina or other acute coronary diseases in 1976-77 and followed through 1985. Proportional hazards and logistic models are utilized to examine sex interactions in long-term disability outcomes. Female survivors with angina are shown to be at significantly higher risk for diminished functional capacity when compared to men as well as to women with other heart disease. Thus, the extended survival and higher incidence of angina among elderly women will likely result in an increased societal burden of disablement in the aged population.

Activities of Daily Living↗
PubMed1989

Occupation, impaired health, and the functional capacity of men to continue working.

Whether the functional capacity of older men to remain at work differs by occupational assignment is an important consideration in judging policies designed to advance the age of retirement. A continuous-time Markov model of retirement disability, and death is used to test hypotheses about the influence of physically demanding work and impaired health on the ability to delay retirement. The model is estimated with panel data on a nationally representative sample of older American males. Physical job requirements and health conditions are found to affect the likelihood of retiring in a disabled state. However, cohort projections of the fractions of workers in physically demanding and sedentary job categories retiring nondisabled are very similar. Special policy consideration of workers in physically demanding occupations may therefore be questioned.

Aged↗
PubMed1989

Aggregate economic losses from disability in the United States: a preliminary assay.

Interest in particular demographic subgroups with disabilities--such as working-age adults, the elderly, and young children--obscures seeing the populations as integral elements of a broad policy issue. Calculations based on national surveys indicate that functional disability exacted an estimated total of $177 billion in aggregate economic losses in the United States in 1980. Refinements in collecting information on disability and its consequences are needed to gauge the causes and correlates of chronic activity limitations. Policy makers will otherwise find it difficult to assess the scope that disabilities pose to people, or to monitor the effect of changes in disability policy.

Adolescent↗
PubMed1988

Measuring hospital competition.

This paper appraises the use of the Herfindahl market share index as an exogenous competition variable in empirical studies of the hospital sector. An analysis of cross-sectional Florida data shows that this index itself is significantly influenced by the demand and supply factors commonly included in econometric models of hospital performance. The analysis then illustrates that biased inferences about the effects of market competition on the costs of hospital care may result unless the values of the Herfindahl Index are treated endogenously in hospital cost models.

Costs and Cost Analysis↗
PubMed1988

Work capacity of older men and age-eligibility for Medicare benefits.

Whether the functional capacities of older Americans enable them to remain in the work force longer, is a significant consideration in appraising proposals to advance the normal eligibility age for Medicare benefits. This article analyzes the durations of work capability and work disablement of a representative panel of 5000 white and black men in their sixties and early seventies. The analysis shows that these men and succeeding cohorts of men are expected to function capably for long enough periods to meet the conditions necessary for raising the age of Medicare eligibility.

Black or African American↗
PubMed1987

Competition in health care markets and the development of alternative forms of service delivery.

This paper examines whether alternative forms of health care delivery locate in highly competitive health service markets. The analysis uses cross-sectional Florida data on the penetration of HMOs, ambulatory surgery centers, urgent care centers, hospices and home health programs in local markets characterized by varying levels of competitiveness among hospitals and among physicians. The results show generally that the development of these newer forms of service delivery are not systematically linked to inter-hospital competition but are influenced by physician supply and insurance demand. The potential contribution of such development to cost-containment efforts is thus questioned.

Ambulatory Care Facilities↗
PubMed1987

Survivorship differences in geographical comparisons of cancer mortality: an urban-rural analysis.

Epidemiologists have traditionally used geographical comparisons of cancer site-specific mortality rates to draw aetiological inferences about neoplasms. This approach is based on the unproven assumption that cancer mortality and incidence rates are highly correlated within geographical areas. Since mortality is a function of both incidence and survival rates, geographical differences in cancer survivorship may confound area comparison of cancer mortality rates. To test this possibility, the survival experience of white male cancer patients residing in rural and urban areas is examined using cancer registry data. A multi-variable proportional hazards model is specified to determine the unique effect of geographical residence on survival. Only for cancers of the gastro-intestinal (GI) tract are there statistically significant differences in survivorship by geographical residence. This suggests that for most cancers, survival differences are not likely to play a confounding role in geographical comparisons of cancer mortality rates. However for GI cancers, survival differences should probably be considered in geographical-oriented analyses and their interpretation.

Health↗
PubMed1986

Socioeconomic determinants of continuing functional disablement from chronic disease episodes.

Functional disablement of persons with chronic disease is a complex outcome shaped by a variety of medical and socioeconomic factors, including those influencing the competing risk of death from the disease. The increasingly important task of explaining trends in the functional health status of various populations requires more detailed knowledge about the respective roles of these disability determinants. This paper reports the results of an analysis of the determinants of continuing functional incapacity after an episode of heart disease. A proportional hazards regression model is used to estimate the relative effects of socioeconomic and disease factors on the duration of work disablement and functional incapacitation of 976 surviving and nonsurviving patients hospitalized for presumptive myocardial infarction. The analysis shows that socioeconomic variables play a prominent role in disability outcomes, especially in work resumption. Evidence of aging effects on disability prevalence is also found.

Activities of Daily Living↗