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At least 37 records · Page 2Linked to original sources
PubMed2006

Crash costs in the United States by crash geometry.

MAIN OBJECTIVES: This study was conducted to estimate the costs per crash for three police-coded crash severity groupings within 16 selected crash geometry types and within two speed limit categories ( or=50 mph). METHODS: We merged previously developed costs per victim by abbreviated injury scale (AIS) score into U.S. crash data files that scored injuries in both the AIS and police-coded severity scales to estimate injury costs, then aggregated the estimates into costs per crash by maximum injury severity. RESULTS: The most costly crashes were non-intersection fatal/disabling injury crashes on a road with a speed limit of 50 miles per hour or higher where multiple vehicles crashed head-on or a single vehicle struck a human (over 1.69 US dollars and 1.16 million US dollars per crash, respectively). The annual cost of police-reported run-off-road collisions, which include both rollovers and object impacts, represented 34% of total costs. CONCLUSIONS: This paper provides cost estimates useful for evaluating roadway countermeasures and for designing vehicles to minimize crash harm. It gives unit costs of crashes by type in the coding system used by the police. The costs are in an appropriate form for economic analysis of countermeasures addressing locally defined problems identified by analyzing police crash reports.

Abbreviated Injury Scale↗
PubMed2004

[Kangaroo mother care: bibliographical review on the current attitudes, their interests and their limits].

Initiated in 1978 by a Colombian team, then largely adapted in industrialized countries as well as in poor developed countries, the kangaroo mother care (KMC) are known to ensure for low birth weight newborn, a thermoregulation, a good physiological stability and a better relational comfort with their parents. The goal of this work is to make a bibliographical review on current concepts, interests and limits of this method. We re-examined impact of the KMC on the basal metabolism, thermoregulation, growth and evolution of these children. They are helpful in the developing countries but medical safety should not be forgotten. In these countries where there's high frequentation of the services, they are able to regulate body temperature and metabolic adaptation of the newborn. In developed countries, KMC contribute to decrease anxiety of parents and improve the relations with their child. However, it is difficult to recommend their use in current practice. Rigorous randomised studies are necessary to argue their establishment in full safety, to know the neuropsychological development and the real somatic growth on the long term of the children and to known their true economic cost.

Attitude↗
PubMed2003

The price of innovation: new estimates of drug development costs.

The research and development costs of 68 randomly selected new drugs were obtained from a survey of 10 pharmaceutical firms. These data were used to estimate the average pre-tax cost of new drug development. The costs of compounds abandoned during testing were linked to the costs of compounds that obtained marketing approval. The estimated average out-of-pocket cost per new drug is 403 million US dollars (2000 dollars). Capitalizing out-of-pocket costs to the point of marketing approval at a real discount rate of 11% yields a total pre-approval cost estimate of 802 million US dollars (2000 dollars). When compared to the results of an earlier study with a similar methodology, total capitalized costs were shown to have increased at an annual rate of 7.4% above general price inflation.

Capital Expenditures↗
PubMed2000

Comparison of methods for teaching clinical skills in assessing and managing drug-seeking patients.

AIMS: New medical graduates lack clinical skills in assessing and managing patients seeking drugs of dependence. This study compares the effectiveness of three different clinical skills training methods, with similar content, which were developed to teach these skills to senior medical students. METHODS: A preliminary survey indicated that common problems seen by primary care practitioners included both new and previously known patients seeking either benzodiazepines or opiates. The common content of the teaching was determined from this survey. A didactic small group tutorial (DT), a video-based tutorial (VBT) using professional actors, and a computer-aided instruction package using digitized video (CAI) were developed with this common content, and trialled with undergraduate medical students over 2 years in a parallel-group design. Outcome was assessed by student feedback, performance on a case-based written examination and by a structured evaluation of interviews with simulated patients requesting drugs. Comparison was also made between methods on the basis of knowledge tests. RESULTS: No difference was seen in written examination and simulated patient outcomes between the three groups. However, the VBT was thought by the students to be preferable to other methods. The estimated development costs of CAI were higher, but total costs over a 6-year period were lower than for the DT and VBT. The results suggest that clinical skills can be taught equally effectively through several different methods. Collaboration between institutions in the development of widely applicable CAI tools should be an efficient and economical mode of teaching with a wide range of applications.

Clinical Competence↗
PubMed1996

Do market components account for higher US prescription prices?

BACKGROUND: Although only 7-8% of US healthcare expenditures are spent on prescription drug products, the pharmaceutical industry's profitability and high cost of prescriptions to consumers make prescription drugs a visible target for reform. When compared with other products, it appears as if unfair pricing tactics are used. The pharmaceutical industry cites costs of research and development and a short patent life as justifiable grounds for high prices, but the reason why US drug prices appear to be so high has yet to be answered. OBJECTIVE: To examine identified components of the pharmaceutical industry that allow US prescription drugs to appear to be highly priced and to review the apparent factors that affect pricing policies for pharmaceuticals. DATA SOURCES: The literature was reviewed to identify current research regarding the pharmaceutical market. Sources included MEDLINE, Econolit, Business Periodical Index, International Pharmaceutical Abstracts, the Wall Street Journal, New York Times, and the F-D-C Pink Sheet. SUMMARY: Key factors account for the fact that US prescription drug prices are higher and that price discrimination occurs in the pharmaceutical industry within the US and among other countries. These factors include the unique market structure of the pharmaceutical industry, asymmetry of information, research and development costs, numerous channels of distribution and the differences among them, and government laws and regulations of prescription drugs. Pricing policies of pharmaceutical companies are based on manufacturing, promotion, and distribution costs; drug characteristics; and economic goals of the parent company.

Drug Costs↗
PubMed2002

Look beyond budgets to the broader benefits.

The success of researchers in developing innovative and effective medicines has produced a healthier and older population, as well as an observable shift in expenditure towards pharmaceuticals. In contrast to drug expenditures, patented drug prices have actually shown an average annual decrease of 0.5% since 1988. While we agree cost-effectiveness evaluation is a useful input into the decision-making process of drug benefit managers, it is but one consideration, and it is imperative that governments look beyond drug budgets to the broader benefits of innovative drug therapy to Canadians, both economically and clinically. The lead paper makes a number of suggestions regarding clinical trials that would lead to an increased demand on the developers of innovative medicines, all of which would raise the development costs of drugs while reducing the spectrum of available agents. This commentary argues that focusing greater attention on ensuring the appropriate use of medicines, with less concentration on restricting Canadians' access to effective drugs available in other countries, will yield the greatest benefits to the health of our population. Patient health management is a strategy that deserves a closer look to achieve this goal.

Budgets↗
PubMed1995

Research and development costs for new drugs by therapeutic category. A study of the US pharmaceutical industry.

The clinical period (i.e. clinical trial and long term animal testing) development costs of a random sample of new chemical entities (NCEs) were examined for differences in average cost. All of the NCEs studied were first tested in humans between 1970 and 1982, and were classified for the purposes of the study by therapeutic class. The costs of unsuccessful projects were included with those of projects that resulted in US marketing approval. Including income forgone from expending funds before returns are earned ('time costs'), the capitalised (i.e. out-of-pocket plus time) clinical period costs per approved NCE were $US70, $US98, $US103 and $US163 million (1993 dollars) for anti-infective, cardiovascular, neuropharmacological and nonsteroidal anti-inflammatory drugs, respectively. Combining the data for all therapeutic categories, the mean clinical period cost per approved NCE was $US93 million. Omitting costs associated with unsuccessful projects, the mean capitalised clinical period costs for approved NCEs ranged from $US7.1 million (for topical steroids) to $US66.7 million (for cardiovascular agents) [1993 dollars]. The estimates of total clinical period costs per approved NCE depend on average out-of-pocket clinical phase costs, attrition rates across phases (i.e. the rates at which compounds drop out of active testing), the probability of marketing approval, and development and regulatory review times. Phase attrition and approval rates are the most important sources of variability in total clinical period costs between therapeutic categories. Development cost estimates by therapeutic category did not correlate strongly with US sales in the fifth year of marketing. Cardiovascular NCEs had much higher than average sales revenues, but clinical development costs for these drugs were only slightly above average. Conversely, nonsteroidal anti-inflammatory drugs attained average sales revenues, but had much higher than average development costs.

Clinical Trials as Topic↗
PubMed1999

Pharmacoeconomic considerations in treating patients with acute leukaemia.

Whereas individual cost-effectiveness analyses of new agents for acute leukaemia should be performed in target populations, any meaningful pharmacoeconomic evaluation of treatment options for this condition should include the many types of costs and outcomes in unselected, representative groups of patients. Both direct costs (e.g. costs for medication and hospitalisation) and indirect costs (e.g. lost productivity costs and reduced quality of life) are important parameters to assess, as are the costs of chronic adverse effects, research and development costs for new agents, and costs of procedure-related deaths. Complete remission, cure and survival are the 'success' response criteria for acute leukaemia treatments, in addition to prolonged life with acceptable quality of life for patients with incurable acute leukaemia. Death is 'failure', caused either by resistant disease (relapse and progressive disease) inspite of optimal chemotherapy or, sometimes, by insufficient treatment. All of these parameters should be taken into account when a pharmacoeconomic evaluation is performed (either for administrative or scientific purposes) in order to ensure a comprehensive and reliable background for the evaluation in question. Treatment of acute leukaemia is expensive with a total cost of about $US3000 per patient per day during the induction. Although 80% of children with acute leukaemia are cured, only less than 50% of adults are cured. Thus, a great cost is associated with death during treatment and only optimal medical treatment with full-scale combination chemotherapy and full supportive treatment can keep the number of deaths to a minimum.

Acute Disease↗
PubMed2002

Use of randomised controlled trials for producing cost-effectiveness evidence: potential impact of design choices on sample size and study duration.

BACKGROUND: A number of approaches to conducting economic evaluations could be adopted. However, some decision makers have a preference for wholly stochastic cost-effectiveness analyses, particularly if the sampled data are derived from randomised controlled trials (RCTs). Formal requirements for cost-effectiveness evidence have heightened concerns in the pharmaceutical industry that development costs and times might be increased if formal requirements increase the number, duration or costs of RCTs. Whether this proves to be the case or not will depend upon the timing, nature and extent of the cost-effectiveness evidence required. OBJECTIVE: To illustrate how different requirements for wholly stochastic cost-effectiveness evidence could have a significant impact on two of the major determinants of new drug development costs and times, namely RCT sample size and study duration. DESIGN: Using data collected prospectively in a clinical evaluation, sample sizes were calculated for a number of hypothetical cost-effectiveness study design scenarios. The results were compared with a baseline clinical trial design. RESULTS: The sample sizes required for the cost-effectiveness study scenarios were mostly larger than those for the baseline clinical trial design. Circumstances can be such that a wholly stochastic cost-effectiveness analysis might not be a practical proposition even though its clinical counterpart is. In such situations, alternative research methodologies would be required. For wholly stochastic cost-effectiveness analyses, the importance of prior specification of the different components of study design is emphasised. However, it is doubtful whether all the information necessary for doing this will typically be available when product registration trials are being designed. CONCLUSIONS: Formal requirements for wholly stochastic cost-effectiveness evidence based on the standard frequentist paradigm have the potential to increase the size, duration and number of RCTs significantly and hence the costs and timelines associated with new product development. Moreover, it is possible to envisage situations where such an approach would be impossible to adopt. Clearly, further research is required into the issue of how to appraise the economic consequences of alternative economic evaluation research strategies.

Cost-Benefit Analysis↗
PubMed2000

Age of calf at weaning of spring-calving beef cows and the effect on cow and calf performance and production economics.

Over a 5-yr period, spring-calving cows were used in a carry-over design experiment to evaluate effects of calf age at weaning on cow and calf performance and production economics. Weaning management groups were early (n = 60, calf age 150 d, EW), traditional (n = 60, calf age 210 d, NW), and late (n = 60, calf age 270 d, LW). Cow body condition score (BCS) and weights at the last weaning date were different (P < .05) for EW (5.8, 583 kg), NW (5.5, 560 kg), and LW (5.2, 541 kg) management groups. Pregnancy rates among groups were similar. Days on feed for groups differed (P = .001) and was 247 for EW, 204 for NW, and 164 d for LW steers. Average daily gain in the feedlot differed (P = .01) among groups and averaged 1.5 kg for LW, 1.4 kg for NW, and 1.3 kg for EW steers. Dry matter intake while steers were in the feedlot was greater (P = .001) for LW than for NW and EW calves. Hot carcass weight was greater (P = .01) for EW (328 kg) and NW (332 kg) calves than for LW (321 kg) steers, and fat depth was greater (P = .05) for EW and NW steers than for LW steers. When carcass data for the NW and LW steers were adjusted to the fat depth of EW steers, carcass characteristics among groups were similar. Net income per steer at slaughter for the feedlot phase was greater (P < .001) for the EW ($75.36) and NW ($62.16) steers than for the LW ($10.09) steers. Again, when carcass data for the NW and LW steers were adjusted to the same fat depth of the EW steers, net income differences among groups were reduced. Replacement heifers were developed in a drylot and costs were higher (P < .001) for the EW than for NW and LW heifers. Annual cow costs were greater (P < .10) for the LW ($443.45) than for the EW ($410.09) and NW ($421.35) groups. Break-even for each system on a steer financial basis was not different between the NW and LW groups, and both the NW and LW groups had lower (P = .08) break-evens than the EW group. Age of the calf at weaning affects cow weight and BCS. Net income in each system is influenced by cow costs, month of the year that steer calves are purchased into the feedlot and finished steers are sold, month of the year cull cows are marketed, and replacement heifer development costs.

Aging↗
PubMed1987

Economic evaluation of alternative crossbreeding systems involving four breeds of swine. I. The simulation model.

A static, deterministic computer model, programmed in Microsoft Basic for IBM PC and Apple Macintosh computers, was developed to calculate production efficiency (cost per kg of product) for nine alternative types of crossbreeding system involving four breeds of swine. The model simulates efficiencies for four purebred and 60 alternative two-, three- and four-breed rotation, rotaterminal, backcross and static cross systems. Crossbreeding systems were defined as including all purebred, crossbred and commercial matings necessary to maintain a total of 10,000 farrowings. Driving variables for the model are mean conception rate at first service and for an 8-wk breeding season, litter size born, preweaning survival rate, postweaning average daily gain, feed-to-gain ratio and carcass backfat. Predictions are computed using breed direct genetic and maternal effects for the four breeds, plus individual, maternal and paternal specific heterosis values, input by the user. Inputs required to calculate the number of females farrowing in each sub-system include the proportion of males and females replaced each breeding cycle in purebred and crossbred populations, the proportion of male and female offspring in seedstock herds that become breeding animals, and the number of females per boar. Inputs required to calculate the efficiency of terminal production (cost-to-product ratio) for each sub-system include breeding herd feed intake, gilt development costs, feed costs and labor and overhead costs. Crossbreeding system efficiency is calculated as the weighted average of sub-system cost-to-product ratio values, weighting by the number of females farrowing in each sub-system.

Animal Husbandry↗
PubMedDate not supplied

Estimating the economic impact of secondhand smoke on the health of a community.

PURPOSE: This study provides a model to estimate the health-related costs of secondhand smoke exposure at a community level. MODEL DEVELOPMENT: Costs of secondhand smoke-related mortality and morbidity were estimated using national attributable risk values for diseases that are causally related to secondhand smoke exposure for adults and children. Estimated costs included ambulatory care costs, hospital inpatient costs, and loss of life costs based on vital statistics, hospital discharge data, and census data. APPLICATION OF THE MODEL: The model was used to estimate health-related costs estimates of secondhand smoke exposure for Marion County, Indiana. Attributable risk values were applied to the number of deaths and hospital discharges to determine the number of individuals impacted by secondhand smoke exposure. RESULTS: The overall cost of health care and premature loss of life attributed to secondhand smoke for the study county was estimated to be $53.9 million in 2000-$10.5 million in health care costs and $20.3 million in loss of life for children compared with $6.2 million in health care costs and $16.9 million in loss of life for adults. This amounted to $62.68 per capita. CONCLUSIONS: This method may be replicated in other counties to provide data needed to educate the public and community leaders about the health effects and costs of secondhand smoke exposure.

Adolescent↗
PubMed1979

Specialty groups give cost containment support, advice.

A number of medical and health care specialty organizations have either given direct support to the Voluntary Effort or have sanctioned cost containment as a principle. Some have drawn upon their professional expertise and developed cost containment recommendations for their constituencies. A sampling of these recommendations is included.

Anesthesiology↗
PubMed2003

Searching for scalable processes: addressing the challenges in times of increasing complexity.

The position of the pharmaceutical industry at the beginning of the 21st Century and its role in process research and development are important considerations. Based on recent figures and statistics, it is evident that new and maybe unorthodox ways of operating need to be envisaged to counteract the explosive rise in research and development costs (> US $800 million per successful launch in 2002) and the worryingly high level of attrition (approximately 90%), which, in addition to long handling times for authority approval, lead to a continued decline in the number of drugs entering the market. In addition to pointing out these harsh realities, it is essential to remember that the time taken to bring a new product forward is crucial. In this context, a front-loading model has been developed and applied in AstraZeneca's process research and development. The enormous implications of chirality in the pharmacological arena have been fully acknowledged for many years, and sales figures of chiral molecules corroborate the importance of this feature. The methodologies that are available to address the design and scale-up of production methods are also reviewed against a backdrop of recent in-house cases.

Drug Approval↗
PubMed2004

Comprehensive and human capital crash costs by maximum police-reported injury severity within selected crash types.

This paper presents estimates for both the economic and comprehensive costs per crash for three police-coded severity groupings within 16 selected crash types and within two speed limit categories ( or=50 mph). The economic costs are hard dollar costs. The comprehensive costs include economic costs and quality of life losses. We merged previously developed costs per victim keyed on the Abbreviated Injury Scale (AIS) into US crash data files that scored injuries in both the AIS and police-coded severity scales to produce per crash estimates. The most costly crashes were non-intersection fatal/disabling injury crashes on a road with a speed limit of 50 miles per hour or higher where multiple vehicles crashed head-on or a single vehicle struck a human (over 1.69 and $1.16 million per crash, respectively). The annual cost of police-reported run-off-road collisions, which include both rollovers and object impacts, represented 34% of total costs.

Abbreviated Injury Scale↗
PubMed1991

Cost-effectiveness of environmental management for vector control in resource development projects.

Vector control methods are traditionally divided in chemical, biological and environmental management approaches, and this distinction also reflected in certain financial and economic aspects. This is particularly true for environmental modification, usually engineering or other structural works. It is highly capital intensive, as opposed to chemical and biological control which require recurrent expenditures, and discount rates are therefore a prominent consideration in deciding for one or the other approach. Environmental manipulation requires recurrent action, but can often be carried out with the community participation, which raises the issue of opportunity costs. The incorporation of environmental management in resource projects is generally impeded by economic considerations. The Internal Rate of Return continues to be a crucial criterion for funding agencies and development banks to support new projects; at the same time Governments of debt-riden countries in the Third World will do their best to avoid additional loans on such frills as environmental and health safeguards. Two approaches can be recommended to nevertheless ensure the incorporation of environmental management measures in resource projects in an affordable way. First, there are several examples of cases where environmental management measures either have a dual benefit (increasing both agricultural production and reducing vector-borne disease transmission) or can be implemented at zero costs. Second, the additional costs involved in structural modifications can be separated from the project development costs considered in the calculations of the Internal Rate of Return, and financial support can be sought from bilateral technical cooperation agencies particularly interested in environmental and health issues. There is a dearth of information in the cost-effectiveness of alternative vector control strategies in the developing country context. The process of integrating vector control in the general health services will make it even more difficult to gain a clear insight in the matter.

Animals↗