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Results for “Cost Effectiveness”

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At least 19 recordsLinked to original sources
PubMed2006

Accident and emergency teleconsultation for primary care--a systematic review of technical feasibility, clinical effectiveness, cost effectiveness and level of local management.

A systematic review of accident and emergency teleconsultation services was carried out. Studies (English language only) conducted worldwide and published between 1996 and 2003 were included. Evidence relating to technical feasibility, clinical effectiveness, cost effectiveness and level of local management was used as the main outcome measure. Thirty-one studies met the selection criteria. Only two studies were randomized controlled studies. All studies provided evidence that that the service was technically feasible. Of the studies, 97% suggested that the service was clinically effective; 48% (15) of the studies gave figures for the level of local management achieved. The range for local management was 35-100% with a mean of 76%. Only 23% of the studies provided evidence to suggest that the service was cost effective. The case for cost-effectiveness is far from proven and this area of research requires immediate attention if potential users are to be convinced of the value of telemedicine.

Cost-Benefit Analysis↗
PubMed1992

Effectiveness, costs, and cost-effectiveness of recruitment strategies for a mammographic screening program to detect breast cancer.

BACKGROUND AND PURPOSE: Since effective and affordable recruitment methods are essential for the widespread implementation of mammographic screening for detection of breast cancer, we studied the effectiveness, the costs, and the cost-effectiveness of various recruitment strategies in the population targeted by a pilot Australian program that offered free mammography screening between 1988 and 1990. METHODS: We evaluated three public recruitment strategies--local newspaper articles, community promotion, and promotion to physicians--and five personal strategies--invitation letters with or without specified appointment times, either alone or with a follow-up letter, or telephone call to nonattenders. The effectiveness of public recruitment strategies was estimated from monthly attendance rates by Poisson regression analysis, while the probability of attendance in response to personal strategies was calculated using logistic regression analysis. Costs were determined by resource usage studies. The cost-effectiveness ratios for personal strategies were determined using decision analysis. RESULTS: The costs in 1988-1989 Australian dollars per woman recruited were $22 for local newspaper articles and $106 for community promotion. No detectable increase in attendance resulted from promotion to physicians. When the cost of reserving an appointment was considered, the most cost-effective personal recruitment strategy was an invitation letter without a specified appointment time, followed by a second letter to nonattenders. This strategy recruited 35.6% of women in the sample targeted and cost $10.52 per attendee. In comparison, the most effective personal recruitment strategy was a letter with a specified appointment time followed by a second letter to nonattenders, which recruited 44.1% of women at an average cost of $19.99 and a marginal cost of $59.71 per additional attendee. CONCLUSIONS: Personal recruitment strategies were more cost-effective than public strategies. The most cost-effective personal strategy was an invitation letter without a specified appointment time, followed by a second letter to nonattenders.

Australia↗
PubMed2006

Lifetime effects, costs, and cost effectiveness of testing for human papillomavirus to manage low grade cytological abnormalities: results of the NHS pilot studies.

OBJECTIVES: To predict the incremental lifetime effects, costs, and cost effectiveness of using human papillomavirus testing to triage women with borderline or mildly dyskaryotic cervical smear results for immediate colposcopy. DESIGN: Modelling study. SETTING: Three centres participating in NHS pilot studies, United Kingdom. Population Women aged 25-64 with borderline or mildly dyskaryotic cervical smear results. INTERVENTIONS: Screening using conventional cytology, liquid based cytology, and four strategies with different age cut-off points and follow up times that used combined liquid based cytology and human papillomavirus testing (adjunctive human papillomavirus testing). RESULTS: The model predicts that compared with using conventional cytology without testing for human papillomavirus, testing for the virus in conjunction with liquid based cytology for women with borderline or mildly dyskaryotic cervical smear results (aged 35 or more) would cost 3735 pounds sterling (5528 euros; 6474 dollars) per life year saved. Extending adjunctive human papillomavirus testing in combination with liquid based cytology to include women aged between 25 and 34 costs an additional 4233 pounds sterling per life year saved. Human papillomavirus testing is likely to reduce lifetime repeat smears by 52%-86% but increase lifetime colposcopies by 64%-138%. CONCLUSIONS: Testing for human papillomavirus to manage all women with borderline or mildly dyskaryotic cervical smear results is likely to be cost effective. The predicted increase in lifetime colposcopies, however, deserves careful consideration.

Adult↗
PubMed2004

Genetic counseling program in familial breast cancer: analysis of its effectiveness, cost and cost-effectiveness ratio.

Women with a family history of breast cancer are at increased risk for developing this neoplasm. Starting surveillance more frequently at a younger age than the general population and the possibility of undergoing genetic testing are options for their medical management. We analyzed the benefits and costs of our clinical program in familial breast cancer (FBC) and carried out a cost-effectiveness analysis of such procedure. The benefits and costs of performing genetic counseling and a screening program in FBC based on 143 high-risk families registered in our database between June 1995 and December 2001 were analyzed. A decision tree was constructed to estimate the survival benefit and cost-effectiveness of the clinical genetic counseling program compared with the strategy of not performing any screening protocol. We estimated that the prevalence of a BRCA mutation in an unaffected relative of our high-risk cohort was 10% and that 53% of the mutations are found in the BRCA1 gene. We assigned a 58.5% lifetime risk of breast cancer for a 30-year-old mutation carrier according to the SEER data. The effectiveness of the screening was obtained from our experience and data for estimating survival were derived from other studies with longer follow-up. We used our local payment data to calculate the costs of the program. A mutation in the BRCA1 or BRCA2 genes was identified in 20% of the probands. Seventy primary breast cancer cases were recorded since the onset of the program. Thirty percent of the tumors were diagnosed through the screening program and 71% of them were lymph node-negative compared to 49% of the tumors diagnosed outside the program (p=0.1). The cost-effectiveness ratio of our FBC genetic counseling and screening program was 4,294 euros per life-year gained. The model was sensitive to the prevalence of mutation carriers, the lifetime risk of breast cancer and the effectiveness of the screening. In our setting and according to our model, this analysis suggests that a program of genetic testing and screening for breast cancer in a high-risk population may be cost-effective. These results need to be confirmed as more effective interventions for cancer prevention and screening are being implemented.

Aged↗
PubMed1981

Are home hemodialysis aides cost-effective? Cost of home hemodialysis aides.

Payment for home hemodialysis aides has been proposed as a means of inducing shifts from center hemodialysis to less-expensive home hemodialysis. By using a simulation model, we computed the cost per life year of end-stage renal disease care when changes in the proportions of patients treated by center for home hemodialysis are brought about by paying for home hemodialysis aides. If all home hemodialysis patients receive payment for aides, total costs will increase unless there are sufficient shifts from center to home hemodialysis to offset the increased costs. The cost-effectiveness of home hemodialysis aides is critically dependent on who receives a paid aide, the salary of the aid, and the number of patients who move from center to home hemodialysis. Poorly formulated regulations may jeopardize the cost-effectiveness of home hemodialysis and increase the total cost of end-stage renal disease care.

Allied Health Personnel↗
PubMed1993

[Economic analysis and public health. Why does one need economic evaluation applied to diabetes? What methods does one choose: cost effectiveness, cost utility, cost benefit? Are such studies useful in terms of public health?].

The application of economic methods to public health is relatively recent and linked to the context of economic crisis: cooperation between medical doctors is to day in process. The main objective of health economics is the optimization of health care by improving resources allocation to take care of the patients. So, in France, the health system budget, 573 billions, represents 8.3% of the GNP; this percentage is one of the highest of Europe. Can such a growing rate decrease or are we going towards rationing of health system resources? In this context, economic analysis applied to diabetes uses mainly evaluation methods: cost-effectiveness, cost-utility, cost-benefit. Evaluation always supposes a comparison between medical alternative actions in terms of costs and results. Economic crisis made easier the acceptance of evaluation studies but their development supposes great scientific caution.

Budgets↗
PubMed2001

Counselling for depression in primary care.

BACKGROUND: There is wide clinician and patient support for counselling in primary care, particularly in the UK. This review examines the effectiveness and cost effectiveness of counselling for psychological and psychosocial problems in the primary care setting. OBJECTIVES: To assess the effects of counselling in primary care by reviewing cost and outcome data for patients with psychological and psychosocial problems considered suitable for counselling. SEARCH STRATEGY: The search strategy included electronic searching of databases (including the CCDAN Register of RCTs and CCTs) along with handsearching of a specialist journal. Published and unpublished sources (clinical trials, books, dissertations, agency reports etc.) were searched, and their reference lists scanned. Contact was made with subject experts and CCDAN members. SELECTION CRITERIA: Randomised and controlled patient preference trials comparing counselling in primary care with usual general practitioner care for patients with psychological and psychosocial problems considered suitable for counselling. Trials completed before the end of April 1998 were included in the review. DATA COLLECTION AND ANALYSIS: Trials were independently assessed by at least two reviewers for appropriateness of inclusion and methdological quality. MAIN RESULTS: Four trials, involving 678 participants, of whom 487 were followed up, were included. Data for psychological symptom levels (four trials) were pooled statistically. Patients receiving counselling had significantly better psychological symptom levels post intervention than patients receiving usual general practitioner care (standardised mean difference -0.30, 95% CI, (-0.49 to - 0.11). The effect remained statistically significant when the results from studies with less rigorous methodology were excluded in a sensitivity analysis. Patients who received counselling tended to be more satisfied with their treatment (three trials). Health service utilisation data were reported in all trials reviewed, but only one trial undertook a cost analysis. No clear cost advantage was associated with either counselling or usual general practice care. REVIEWER'S CONCLUSIONS: Patients who received counselling were more likely to have improved psychological symptom levels than those who did not receive counselling. Levels of satisfaction with counselling were high. There is limited information about the cost effectiveness of counselling, with one study reporting no clear cost advantage with either counselling or general practice care. The four trials included in this review were all pragmatic trials of counselling in primary care in the UK, which reflect the reality of clinical provision in this context. There were methdological weaknesses identified in the studies, which should be taken into account when considering the results. The evidence base will be extended by trials of counselling which are nearing completion.

Controlled Clinical Trials as Topic↗
PubMed1999

The cost, effectiveness and cost effectiveness of removal and retention of asymptomatic, disease free third molars.

PURPOSE OF INVESTIGATION: The study was undertaken to identify the least costly, most effective and most cost-effective management strategy for asymptomatic, disease free mandibular third molars. METHODS AND PATIENTS: A decision tree model of the outcomes of mandibular third molar retention and removal was constructed. Probability data for possible outcomes were obtained from a comprehensive literature review and entered into the decision tree. The cost to the NHS in treating each outcome was calculated. 100 patients attending the oral surgery clinics, University of Wales Dental Hospital rated the effect of each outcome on their own life. The cost and effectiveness data for each outcome were entered into the decision tree and the analyses were conducted by 'folding back' the decision tree based on the probabilities. MAIN FINDINGS: Mandibular third molar retention was less costly (170 Pounds), more effective (69.5 effectiveness units on a 100 point scale) and more cost-effective (2.43 Pounds per unit of effectiveness) than removal (226 Pounds, 63.3 and 3.57 Pounds respectively). These findings were sensitive to changes in the probability of pericoronitis, periodontal disease and caries. PRINCIPAL CONCLUSIONS: Mandibular third molar retention is less costly to the NHS, more effective for the patient and more cost-effective to both parties than removal. However, should the likelihood of developing pericoronitis, periodontal disease and caries increase substantially then removal becomes the more cost-effective strategy.

Cost-Benefit Analysis↗
PubMed2002

A randomized trial to evaluate effectiveness and cost effectiveness of naturopathic cranberry products as prophylaxis against urinary tract infection in women.

PURPOSE: To determine, from a societal perspective, the effectiveness and cost effectiveness of concentrated cranberry tablets, versus cranberry juice, versus placebo used as prophylaxis against lower urinary tract infection (UTI) in adult women. MATERIALS AND METHODS: One hundred fifty sexually active women aged 21 through 72 years were randomized for one year to one of three groups of prophylaxis: placebo juice + placebo tablets versus placebo juice + cranberry tablets, versus cranberry juice + placebo tablets. Tablets were taken twice daily, juice 250 ml three times daily. Outcome measures were: (1) a >50% decrease in symptomatic UTI's per year (symptoms + >or= 100 000 single organisms/ml) and (2) a >50% decrease in annual antibiotic consumption. Cost effectiveness was calculated as dollar cost per urinary tract infection prevented. Stochastic tree decision analytic modeling was used to identify specific clinical scenarios for cost savings. RESULTS: Both cranberry juice and cranberry tablets statistically significantly decreased the number of patients experiencing at least 1 symptomatic UTI/year (to 20% and 18% respectively) compared with placebo (to 32%) (p<0.05). The mean annual cost of prophylaxis was $624 and $1400 for cranberry tablets and juice respectively. Cost savings were greatest when patients experienced >2 symptomatic UTI's per year (assuming 3 days antibiotic coverage) and had >2 days of missed work or required protective undergarments for urgency incontinence. Total antibiotic consumption was less annually in both treatment groups compared with placebo. Cost effectiveness ratios demonstrated cranberry tablets were twice as cost effective as organic juice for prevention. CONCLUSIONS: Cranberry tablets provided the most cost-effective prevention for UTI.

Adult↗
PubMed1996

Cost-effectiveness and cost containment. A physician's primer.

Cost-effectiveness and cost containment are becoming increasingly more important in medicine as health care costs continue to rise and as public attention continues to focus on these costs. This article examines the major issues and terminology of cost-effectiveness and cost containment in the context of primary care. A review of basic terminology and a quick reference glossary are included; relevant literature is reviewed. The goal of this article is to provide a beginning step for physicians to become more knowledgeable and enthusiastic participants in cost-effectiveness and cost-containment efforts.

Cost Control↗
PubMed2003

Cost effectiveness and cost utility of acetylcysteine versus dimethyl sulfoxide for reflex sympathetic dystrophy.

OBJECTIVE: To determine the cost effectiveness and cost utility of acetylcysteine versus dimethyl sulfoxide (DMSO) for patients with reflex sympathetic dystrophy (RSD), from a societal viewpoint. DESIGN: An economic evaluation was conducted alongside a double-dummy, double-blind, randomised, controlled trial. Patients were followed for 1 year. The primary outcome measure was the Impairment-level Sum Score (ISS). Utilities were determined by the EuroQOL instrument (EQ-5D). Both cost-effectiveness and cost-utility analyses were performed. Differences in mean direct, indirect and total costs were estimated. Corresponding 95% confidence intervals were calculated by bootstrapping techniques. RESULTS: Both groups (DMSO, n = 64; acetylcysteine, n = 67) showed relevant improvement; no differences in effects were found. Only the total direct costs were significantly lower in the DMSO group for the period of 0-52 weeks. The incremental cost-effectiveness ratios showed that, in general, DMSO generated fewer costs and more effects compared with acetylcysteine. Post-hoc subgroup analyses on cost effectiveness suggested that patients with warm RSD could be best treated with DMSO and patients with cold RSD with acetylcysteine. These results were based on small subsamples. CONCLUSION: In general, DMSO is the preferred treatment for patients with RSD.

Acetylcysteine↗
PubMed2003

Cost-effectiveness, cost-utility, and cost-benefit studies in rheumatology: a review of the literature, 2001-2002.

Economic analyses of prevention and treatment interventions in rheumatology are potentially powerful tools for evaluating many complex decisions facing clinical and public policy makers. Cost-effectiveness, cost-utility, and cost-benefit analyses allow for the assessment of the trade-offs between expended resources and expected health benefits. This review describes 12 cost-effectiveness analyses done in the past year. Each relates to a different intervention for a variety of rheumatologic conditions including osteoporosis, rheumatoid arthritis, the use of cyclooxygenase-II inhibitors, infected total joint replacements, back pain, and Lyme disease. While cost-effectiveness analyses of the use of the new biologic agents in rheumatoid arthritis have been presented at national meetings, these have yet to be published. Proper use of cost-effectiveness analysis could provide valuable evidence about treatment decisions for clinical and public policy makers in rheumatology.

Cost-Benefit Analysis↗