Biomedical subjects

W L England

Publications and source records attributed to W L England.

7 recordsLinked to original sources

PubMed1990

Cost and volume trends in health care facility construction.

In 1987, the Health Care Financing Administration proposed adding capital cost reimbursement to the prospective payment system. A data base was developed from which an index was calculated to adjust for geographic variation in construction cost. Findings from the data base, along with a description of trends in health care facility construction from 1970 through 1986, are presented. Spending (in constant 1986 dollars) and volume of health care facility construction declined from 1970 to 1986. Construction cost per square foot increased until 1983, followed by a decline to pre-1980 levels after the 1983 implementation of the prospective payment system.

Abstracting and Indexing↗

PubMed1986

Setting health maintenance organization capitation rates for Medicaid in Wisconsin.

In late fall 1984, more than 110,000 Wisconsin Aid to Families with Dependent Children (AFDC) Medicaid recipients were enrolled in health maintenance organizations (HMO's). Capitation rates were set by competitive bidding, subject to a rate ceiling. Planners considered whether to adjust the rates to account for demographic changes in the AFDC population between the time that data for the rate ceilings were collected and when the rates went into effect. They also considered whether to pay a single rate or to adjust rates for the age and sex of each HMO's actual enrollees. This article is a report of the analysis that led to a decision to pay a single, countywide rate that was not demographically adjusted.

Actuarial Analysis↗

PubMed1981

Immunization to prevent insulin-dependent diabetes mellitus? The economics of genetic screening and vaccination for diabetes.

There is increasing evidence that some cases of insulin-dependent diabetes mellitus are virally induced, and vaccination against this disease may become possible. We have prospectively examined the costs and benefits that would occur if a diabetes vaccine were developed, using a decision tree to model the alternative vaccination policies, including histocompatibility leukocyte antigen (HLA) screening. We found many cost and likelihood data in the literature, and when data on the potential vaccine had to be hypothesized, we used sensitivity analysis to check our estimates. We conclude that vaccinating all children at age 3 would be preferable to HLA screening and vaccinating only persons with a genetic predisposition to developing diabetes. A 50% effective vaccine would cut the diabetes incidence rate by 29% and save the U.S. population $30 million annually in direct costs of diabetes care. If indirect costs are considered these savings could amount to $4.2 billion over 60 years, discounted to present value at 5%, while preventing over 200,000 cases of insulin-dependent diabetes.

Adolescent↗

PubMedDate not supplied

Cost effectiveness in the detection of renal artery stenosis.

Cost effectivenesses of four tests for diagnosing renal artery stenosis were examined. Sensitivity, specificity, cost per patient, and cost per stenosis found for a variety of diagnostic strategies using these tests were retrospectively evaluated using clinical data from 605 hypertensive patients. Cost effectiveness of a given strategy was found to depend on the sequence in which the tests were performed, but to be relatively independent of the exact cost of the tests. Auscultation for a systolic/diastolic abdominal bruit was the most cost-effective test for beginning a diagnostic strategy and showed a 99.6% specificity for stenosis. When the patient has a systolic bruit only or no bruit, plasma renin activity measurement should guide the clinician's choice of whether to test further with intravenous pyelography or renal arteriography. Diagnosis of renal artery stenosis using these tests is estimated to cost between $2,300 and $6,200 per stenosis found, depending on the prevalence of renal artery stenosis.

Adult↗

PubMedDate not supplied

Surgery or angioplasty for cost-effective renal revascularization?

The authors retrospectively compared the cost-effectiveness of percutaneous transluminal angioplasty with that of renal artery bypass surgery for treating renal artery stenosis, using the experiences of 52 patients treated for renovascular hypertension between 1977 and 1983. The expected results of treatment for angioplasty and surgery were taken from published literature and from experience. Based on the analysis, angioplasty is recommended for treating patients with fibromuscular disease, and patients less than 50 years old, while surgery is the preferred treatment for older patients and those with atherosclerotic disease. These strategies not only minimize the cost per life-year gained from treatment, but also maximize the life expectancy of treated patients. The results are quite robust for the discount rate used in the cost calculations, for variations in the expected rate of stenosis recurrence, and for variations in the treatment outcome probabilities.

Age Factors↗

PubMedDate not supplied

An exponential model used for optimal threshold selection on ROC curves.

A two-parameter exponential equation for modeling a receiver operating characteristic (ROC) curve is presented, where the area under the curve is a simple function of one of the parameters. The model makes no distributional assumptions about the underlying normal and abnormal patient populations or about the shape of the resulting ROC curves. In a computer simulation of 75 ROC curves, the model provides a fit equivalent to the maximum likelihood estimate method commonly used for ROC curve fitting. Similar results are obtained using the model to fit ROC curve data from the literature. The model's equation calculates the true-positive ratio as a function of the false-positive ratio, and has a first derivative that is useful for finding the optimal decision threshold for a diagnostic testing procedure. In particular, the model is useful in a computer program for finding jointly optimal thresholds for multiple sequential tests.

Computer Simulation↗

PubMedDate not supplied

Strategies for screening for colorectal carcinoma.

Four tests commonly used in screening strategies to detect colorectal cancer were examined from a cost-effectiveness perspective. Thirteen combinations of the tests were evaluated. Evaluating a positive fecal occult blood test with a double-contrast barium enema study, followed, if necessary, by colonoscopy, is the most cost-effective strategy for individuals at average risk. An alternative screening strategy for higher-risk individuals or for populations in which the frequency of adenomatous polyps is higher is to follow a positive fecal occult blood test directly with colonoscopy. Sensitivity analysis demonstrated that the superior cost-effectiveness of these two strategies compared with the other 11 modeled strategies is almost independent for reasonable alterations in test cost and for the sensitivities and specificities of the procedures. The major contributing factor to the diagnostic cost is the frequency of adenomatous polyps. The major contributing factor to the marginal cost per year of extended life is the frequency of cancer.

Barium Sulfate↗