PubMed · 16344693
New intravenous pumps help increase safety measures and improve cost-effectiveness.
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Barbara Jacobs. 2005. Pump away high-risk infusion errors.. https://doi.org/10.1097/00006247-200512000-00010
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The National Institute for Clinical Excellence has recently changed its guidelines on discounting costs and effects in economic evaluations. In common with most other regulatory bodies it now requires that health effects should be discounted at the same rate as costs. We show that the guideline leads to sub-optimal decisions because it fails to account for the changing value of health. NICE (and other regulatory bodies) should either use differential discounting or stipulate how the changing value of health should otherwise be dealt with. We also show how binding health service budget constraints should be incorporated in evaluations.
An important subject of debate in cost-utility analysis of health care programmes is whether to include costs of unrelated medical care in life years gained. The inclusion of such costs is likely to be of consequence in the case of primary prevention. This paper presents different strategies regarding the inclusion not only of the costs, but also of the health effects of unrelated medical care in economic evaluations. Four different cost-utility ratios are presented and related to the criterion of internal consistency. In addition, the possibility to relate the ratios to a well-posed decision problem is analysed. An example computes the different ratios for smoking cessation interventions in different age groups. Including health care costs of unrelated medical care in life years gained increases cost utility ratios, but excluding unrelated medical costs favours smoking cessation interventions targeted at older smokers over those at younger smokers. We conclude that for primary prevention only a cost utility ratio that includes both the costs and effects of unrelated medical care meets the criterion of internal consistency and is related to a meaningful decision problem. Therefore, this type of cost-utility ratio should be preferred even if the data requirements may be substantial.
Cost-efficient sample designs for collection of ground data and accurate mapping of variables are required to monitor natural resources and environmental and ecological systems. In this study, a sample design and mapping method was developed by integrating stratification, model updating, and cokriging with Landsat Thematic Mapper (TM) imagery. This method is based on the spatial autocorrelation of variables and the spatial cross-correlation among them. It can lead to sample designs with variable grid spacing, where sampling distances between plots vary depending on spatial variability of the variables from location to location. This has potential cost-efficiencies in terms of sample design and mapping. This method is also applicable for mapping in the case in which no ground data can be collected in some parts of a study area because of the high cost. The method was validated in a case study in which a ground and vegetation cover factor was sampled and mapped for monitoring soil erosion. The results showed that when the sample obtained with three strata using the developed method was used for sampling and mapping the cover factor, the sampling cost was greatly decreased, although the error of the map was slightly increased compared to that without stratification; that is, the sample cost-efficiency quantified by the product of cost and error was greatly increased. The increase of cost-efficiency was more obvious when the cover factor values of the plots within the no-significant-change stratum were updated by a model developed using the previous observations instead of remeasuring them in the field.