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At least 19 recordsLinked to original sources
PubMed1995

Preferences for outcomes in economic evaluation: an economic approach to addressing economic problems.

In this paper we critically appraise the appropriateness and validity from an economic perspective of alternative preference-based approaches to measuring outcomes in economic evaluations of health care interventions. We describe the properties of an outcome measure for economic evaluation to make it compatible with the principles of economics when applied to the problem of resource allocation. We also describe the difference and similarities between the psychometric and the economic approaches for the measurement of outcome. Using these properties we critically appraise the use of QALY and HYE methods of measuring individual and social preferences for health outcome. We argue that the most advanced measure currently available that meets these required properties is the HYE. Because the HYE, unlike the QALY, has its foundations in utility theory under uncertainty, it neither assumes particular formulations of the individual utility function, nor is it incompatible with the principles of economics. As such it represents a further stage in the continuing development of methods for economic evaluation of health care programmes.

Evaluation Studies as Topic↗
PubMed1998

The contention within health economics: a micro-economic foundation using a macro-economic analysis.

Health economists claim to use market economics combined with the micro-economic concepts of opportunity cost and the margin to advise on priority setting. However, they are advising on setting priorities through a macro-economic analysis using the costs of the supplier, thus prioritising the producer and not the consumer as the dynamic of economic activity. For health economists any contention within priority setting is due to lack of data not their confusion over fundamental concepts.

Costs and Cost Analysis↗
PubMed1998

Evaluating the BMJ guidelines for economic submissions: prospective audit of economic submissions to BMJ and The Lancet.

CONTEXT: Editorial management of articles on health economics may benefit from guidelines for peer review and revision. OBJECTIVE: To assess whether publication (in August 1996) of the BMJ guidelines on peer review of economics submissions made any difference to editorial and peer review processes, quality of submitted manuscripts, and quality of published manuscripts. DESIGN AND SETTING: Before-after study conducted in the editorial offices of BMJ and The Lancet of the effect of the BMJ guidelines on review and revision of economics submissions, defined as those making explicit comments about resource allocation and/or costs of interventions. MAIN OUTCOME MEASURES: Editorial fate and changes in the quality of submissions. RESULTS: A total of 2982 manuscripts were submitted to the 2 journals during the before periods, 105 (3.5%) of which were economics submissions. Of these, 27 (24.3%) were full economics evaluations, and 78 (75.7%) were other economics submissions. Overall acceptance rate was 11.6% (12/105). During the after period 2077 manuscripts were submitted to the 2 journals, 87 (4.2%) of which were economics submissions. Eighteen (20.7%) were full economics evaluations, and 69 (79.3%) were other economics submissions. Overall acceptance rate was 6.9% (6/87). Although a number of manuscripts could not be traced to determine whether they were economics submissions, there appeared to be little difference between the 2 journals in numbers or editorial fate of the manuscripts. There was no change in the quality of submitted manuscripts, but BMJ editors found the guidelines and checklists useful and sent fewer economics submissions for external peer review in the after phase. CONCLUSIONS: Publication of the guidelines helped the BMJ editors improve the efficiency of the editorial process but had no impact on the quality of economics evaluations submitted or published.

Economics↗
PubMed2002

Sex- and age- specific relations between economic development, economic inequality and homicide rates in people aged 0-24 years: a cross-sectional analysis.

OBJECTIVE: To test whether relations between economic development, economic inequality, and child and youth homicide rates are sex- and age-specific, and whether a country's wealth modifies the impact of economic inequality on homicide rates. METHODS: Outcome variables were homicide rates around 1994 in males and females in the age ranges 0-4, 5-9, 10-14, 15-19 and 20-24 years from 61 countries. Predictor variables were per capita gross domestic product (GDP), GINI coefficient, percentage change in per capita gross national product (GNP) and female economic activity as a percentage of male economic activity. Relations were analysed by ordinary least squares regression. FINDINGS: All predictors explained significant variances in homicide rates in those aged 15-24. Associations were stronger for males than females and weak for children aged 0-9. Models that included female economic inequality and percentage change in GNP increased the effect in children aged 0-9 and the explained variance in females aged 20-24. For children aged 0-4, country clustering by income increased the explained variance for both sexes. For males aged 15-24, the association with economic inequality was strong in countries with low incomes and weak in those with high incomes. CONCLUSION: Relations between economic factors and child and youth homicide rates varied with age and sex. Interventions to target economic factors would have the strongest impact on rates of homicide in young adults and late adolescent males. In societies with high economic inequality, redistributing wealth without increasing per capita GDP would reduce homicide rates less than redistributions linked with overall economic development.

Adolescent↗
PubMed2003

Economic weights for feed intake in the growing pig derived from a growth model and an economic model.

Economic weights are obtained for feed intake using a growth model and an economic model. The underlying concept of the growth model is the linear plateau model. Parameters of this model are the marginal ratio (MR) of extra fat and extra protein deposition with increasing feed intake (FI) and the maximum protein deposition (Pd(max)). The optimum feed intake (FI0) is defined as the minimum feed intake that meets energy requirements for Pd(max). The effect of varying FI and MR on performance traits was determined. An increase in FI results in a larger increase in growth rate with lower MR. For a given MR, feed conversion ratio is lowest when FI equals FI0. Lean meat percentage (LMP) is largest for a low MR in combination with a low FI. The decrease in LMP with higher FI islargest when FI exceeds FI0. Economic weights for FI, MR and Pd(max) depend on FI in relation to FI0. Economic weights for FI are positive when FI is less than FI0 and negative when FI is larger than FI0. The MR has only then a negative economic weight, when FI is below FI0. Economic weights of FI and MR have a larger magnitude with lower MR and lower Fl. In contrast, economic weights for growth rate and FI derived from the economic model only change in magnitude and not in sign with different levels of these traits. The economic model always puts a negative economic weight on FI since it expresses profit due to a decrease in FI with constant growth rate and LMP. This holds the risk of continuous decrease in FI in pig breeding programs. In contrast, the use of growth models for genetic improvement allows direct selection for an optimum feed intake which maximizes feed efficiency in combination with maximum lean meat growth. It is concluded that recording procedures have to be adapted to collect the data necessary to implement growth models in practical pig breeding applications.

Adipose Tissue↗
PubMed1994

Using cost-effectiveness analysis for formulary decision making: from theory into practice.

The growth of expenditures on healthcare and pharmaceutical products is a concern to third-party payers because of the absence of market discipline (price signals that consumers face). Cost-effectiveness analysis is a method that allows third-party payers to systematically make judgements about the 'value for money' of these products. It moves beyond simple unit price comparisons of alternate interventions/products to consider the full stream of relevant cost and benefits. As formulary committees begin to adopt the systematic use of cost-effectiveness analyses to inform the debate, the exercise will move from an academic to a more practical application. This transition will require several important changes including defining the purpose of cost-effectiveness analysis, measurement of outcomes and data, format of reports, and contractual arrangements between the pharmaceutical industry and analysts. As more 'real world' experience is gained in the practical application of cost-effectiveness analysis, the quality of data will improve as will its value as an aid to decision making.

Cost-Benefit Analysis↗
PubMed2003

OMERACT 6 Economics Working Group report: a proposal for a reference case for economic evaluation in rheumatoid arthritis.

Standardization of methods for economic evaluation is essential for defining the methodological research agenda that will advance the discipline. Standardization also greatly facilitates the interpretation and comparison of the results of economic analyses. For these reasons, several jurisdictions now require economic evaluation, conducted according to standardized methodological guidelines, as a key ingredient in decision making for reimbursement of health treatments and technologies. The application of these general guidelines, however, can be difficult in the absence of disease-specific information. In the case of rheumatoid arthritis (RA), the recent emergence of innovative, highly effective, but also expensive treatments has created an immediate need to more fully understand the economic implications of RA treatments. With this background, the OMERACT Economics Working Group set out in 1994 to develop an RA-specific reference case for economic evaluation. This report summarizes the OMERACT process leading to specific recommendations on the 12 key elements of a proposed "reference case" for economic evaluation in RA. These elements include: study horizon, duration of therapy, extrapolation beyond trial duration, modeling beyond therapy, synthesis of comparisons where head-to-head trials do not exist, clinical outcome measures, mortality, valuation of health states, resource utilization, discontinuation of therapy, therapeutic sequence, and population risk stratification. Through these efforts, the OMERACT Economics Working Group aims to expedite and enhance the conduct and dissemination of methodological research in economic analyses in the rheumatic diseases.

Arthritis, Rheumatoid↗
PubMed2003

Economic transition and environmental sustainability: effects of economic restructuring on air pollution in the Russian Federation.

Economic liberalization in former socialist countries may have various implications for their environmental sustainability. Positive effects of this process are potentially associated with improved efficiency, investments into cleaner technologies, responsiveness to environmentally aware markets, and ending subsidies to heavy industries. On the other hand, market liberalization may result in weaker environmental controls, economic instabilities distracting attention from environmental issues, and increasing orientation towards profit-making leading to more intensive exploitation of natural resources. In addition, trade liberalization may result in shifts towards more pollution and resource-intensive industries. This article seeks to quantify effects of economic restructuring in Russia on air pollution from productive economic sectors in the 1990s. Air pollution in Russia had significantly declined in 1991-1999, however, this decline was largely due to economic decline, as the overall pollution intensity of the economy had decreased only slightly. The factors that affected the pollution intensity are: (1) a decrease in the combined share of industrial and transport activities in the economy and (2) changing pollution intensities of the industrial and transport sectors. The pollution intensity of the Russian industry had remained relatively stable during the 1990s. This was the result of the two opposite and mutually canceling trends: (a) increasing shares of pollution-intensive branches such as metal smelting and oil production vs. less pollution intensive manufacturing and (b) decline in pollution intensities within the industrial branches. The article proposes a methodology by which the contribution of both factors to the overall pollution intensity of the industrial sector can be quantified. The pollution intensity of the Russian transport sector appears to have declined in the first half of the 1990s and increased in the second half. The most recent trend can be explained by a rising proportion of private motorcars used for transportation of people and goods instead of traditional rail and other public transport. The findings of the paper demonstrate that shifts towards more pollution-, resource- and energy-intensive industries as a result of economic liberalization emerges as a significant negative factor of the process of economic transition threatening sustainability of emerging market economies. A research agenda to further investigate these impacts is proposed.

Air Pollutants↗
PubMedDate not supplied

Economic development and environmental protection: an ecological economics perspective.

This paper argues on both theoretical and empirical grounds that, beyond a certain point, there is an unavoidable conflict between economic development (generally taken to mean 'material economic growth') and environmental protection. Think for a moment of natural forests, grasslands, marine estuaries, salt marshes, and coral reefs; and of arable soils, aquifers, mineral deposits, petroleum, and coal. These are all forms of 'natural capital' that represent highly-ordered self-producing ecosystems or rich accumulations of energy/matter with high use potential (low entropy). Now contemplate despoiled landscapes, eroding farmlands, depleted fisheries, anthropogenic greenhouse gases, acid rain, poisonous mine tailings and toxic synthetic compounds. These all represent disordered systems or degraded forms of energy and matter with little use potential (high entropy). The main thing connecting these two states is human economic activity. Ecological economics interprets the environment-economy relationship in terms of the second law of thermodynamics. The second law sees economic activity as a dissipative process. From this perspective, the production of economic goods and services invariably requires the consumption of available energy and matter. To grow and develop, the economy necessarily 'feeds' on sources of high-quality energy/matter first produced by nature. This tends to disorder and homogenize the ecosphere, The ascendance of humankind has consistently been accompanied by an accelerating rate of ecological degradation, particularly biodiversity loss, the simplification of natural systems and pollution. In short, contemporary political rhetoric to the contrary, the prevailing growth-oriented global development paradigm is fundamentally incompatible with long-term ecological and social sustainability. Unsustainability is not a technical nor economic problem as usually conceived, but rather a state of systemic incompatibility between a economy that is a fully-contained, growing, dependent sub-system of a non-growing ecosphere. Potential solutions fly in the face of contemporary development trends and cultural values.

Conservation of Natural Resources↗
PubMed2003

Assessing socio-economic factors in relation to stigmatization, impairment status, and selection for socio-economic rehabilitation: a 1-year cohort of new leprosy cases in north Bangladesh.

The current leprosy elimination strategy focuses almost exclusively on delivery of leprosy diagnostic services and multi-drug treatment (MDT). However, the specific problems of people newly diagnosed with leprosy or cured with MDT primarily relate to impairment of nerve function and social and economic consequences of the diagnosis of leprosy. This study was carried out to investigate the relation between socio-economic factors and the development of nerve impairments and stigma. In addition the relation between socio-economic factors and selection for socio-economic assistance was studied. The study population was a cohort of 2364 newly diagnosed people with leprosy in rural Bangladesh in 1996, including 42.5% women, with an overall mean age of 31.4 years. Three hundred and sixty people (15.2%) had WHO grade 1 or 2 disability identified at diagnosis, and 50 (2.1%) had stigma identified on interview at home visit conducted within one month of diagnosis. One hundred and eighty-eight people (8%) were selected for specific assistance for rehabilitation, primarily interest-free loans for income generating activities or vocational training. Factors independently associated with WHO grade 1 or 2 disability at diagnosis were multibacillary (MB) classification, adult status, and manual occupations. Smear positivity, female sex, and the presence of dependents were associated with an increase in the experience of stigma. The presence of nerve impairments and stigma, as well as several indices of poverty were clearly associated with selection for inclusion in an integrated program for socio-economic assistance. An increased focus by leprosy services on the socio-economic factors associated with poorer physical and social outcomes is recommended. Where adequate finances and trained staff are available, efforts could be made to identify those at higher risk of poor outcomes, and to provide or to mobilize appropriately targeted socio-economic interventions.

Adolescent↗
PubMed2001

Paradigms and research programmes: is it time to move from health care economics to health economics?

As an applied subdiscipline of economics, health economics has flourished, defining itself as the study of how scarce health care resources may be used to meet our needs. This evolutionary pathway has led to health economists adopting a very 'medical' model of health, in which the predominant production function for health is health care. This paper sets out policy challenges to health economics which have arisen in light of growing recognition by governments of the socioeconomic determinants of health and their stated commitment to tackle inequalities in health. It reviews Thomas Kuhn's theory of paradigm shift and Imre Lakatos' theory of scientific research programmes in the natural sciences, favouring the latter as an explanation of the evolution of the subdiscipline of health economics. The paper brings together four recently published visions of the future of health economics-visions that are almost exclusively focused on the production, organization and distribution of health care. In contrast to these visions, in Lakatosian terms, this paper challenges the subdiscipline's core 'positive heuristic', i.e. the set of imperatives which determines how the research programme should unfold, how it may be defended, its scope and boundaries. This paper argues that health economics will need to evolve to embrace a more socioeconomic model of health and, to this end, offers for debate an expansion of Williams' diagrammatic representation of the subdiscipline. It concludes by asking whether the magnitude and the magnetism of health care policy issues will continue to prove too strong to allow health economists, should they wish, to steer their research and educational programmes more directly towards 'health' rather than 'health care' as the relevant social want.

Delivery of Health Care↗
PubMed2002

[Agreement between guidelines for pharmaco-economic research and never-before-published health-economics evaluations].

OBJECTIVE: To investigate whether the health-economics research published in Dutch journals is in agreement with the guidelines for pharmaco-economic research as published in 1999 by the Dutch 'College voor zorgverzekeringen' [Healthcare Insurance Board]. DESIGN: Descriptive. METHOD: A literature search was performed for health-economic evaluations published during 1990-1999 in Dutch journals such as Nederlands Tijdschrift voor Geneeskunde (NTvG), Pharmaceutisch Weekblad and Tijdschrift voor Gezondheidswetenschappen. The resulting 19 studies, primarily published in the NTvG, were compared with the pharmaco-economic guidelines, summarised in 9 criteria. RESULTS: The social perspective was taken in 5 studies (26%), non-related medical costs were excluded in 19 (100%), relevant subgroup analyses were performed in 16 (84%), effectiveness was explicitly differentiated from efficacy in 15 (79%), incremental analysis was performed in 18 (95%), an adequate period of analysis was chosen in 16 (84%), costs, benefits and health gains were discounted in 13 (68%), sensitivity analysis was included in the investigation in 10 (53%), and estimated cost prices were used in 9 (47%). CONCLUSION: The methodology in recently published Dutch health-economics research was partly in agreement with the later official guidelines for pharmaco-economic studies in the Netherlands.

Bibliometrics↗
PubMed1994

Current status of economic appraisal of health technology in the European Community: report of the network. The EC Network on the Methodology of Economic Appraisal of Health Technology.

The use of economic evaluation to assess the costs and consequences of health care technologies has steadily increased in recent years. However, little is known about the influence economic studies have on health care decision makers or policy at local and national level. This paper reports the results of a survey of economic evaluations in EC countries to identify the impact of the results on decision and policy making in health care. Health service researchers in 10 EC countries were identified and asked to participate in the survey. The researchers were asked to locate economic evaluations in their country and complete a standardised questionnaire for each study. The criteria for inclusion in the survey were first, the studies should have been started or reported since 1987, second, the evaluations should include a comparison of the cost and consequences of the technologies assessed and finally, the appraisals should include a comparison of alternative health care technologies or programmes. A total of 66 studies which met the survey criteria were reported. Of these, 27% were thought to have influenced health care decision makers or policy. The results suggested that method of dissemination, source of funding and purpose of the study may be important determinants of whether an economic evaluation will be used in health care policy or decision making. The results of the survey suggest that economic evaluation currently has a relatively low impact on health care policy or decision making.(ABSTRACT TRUNCATED AT 250 WORDS)

Cost-Benefit Analysis↗
PubMed2000

The U.K. NHS economic evaluation database. Economic issues in evaluations of health technology.

OBJECTIVE: The U.K. NHS Economic Evaluation Database (EED) project is commissioned to identify papers on economic evaluations of health technologies and to disseminate their findings to NHS decision makers by means of structured abstracts that are available through a public database and the Cochrane Library. This paper discusses current issues relating to the economic aspects of producing NHS EED abstracts. METHODS: A review of NHS EED was undertaken between 1994 and 1999 to determine the methodologies adopted and issues that influence the usefulness of economic evaluations. Methods adopted to improve the quality of NHS EED abstracts are also reported. RESULTS: Eighty-five percent of NHS EED abstracts are cost-effectiveness analyses (CEAs), 9.3% are cost-utility analyses (CUAs), and only 1.4% are cost-benefit analyses (CBAs). Of the total abstracts, 65.9% are based on single studies, 19.5% on reviews, 3.9% on estimates of effectiveness, and 10.7% on combinations of these sources. Models are utilized in 16.7% of CEAs, 60.2% of CUAs, and 20% of CBAs. Analyses of CBA studies reveal a degree of misuse of well-established definitions. NHS EED internal control mechanisms are reported that provide a means of ensuring that abstracts are based on sound academic principles. CONCLUSIONS: Most economic evaluations are conducted by means of CEA, followed by CUA, while CBA accounts for an extreme minority of cases. Single studies form the principal source of effectiveness data, although models are widely used, principally in CUA. The structure of NHS EED abstracts provides decision makers with the principal results and an interpretation of the relative strengths and weaknesses of economic evaluations.

Abstracting and Indexing↗
PubMed1983

Genetic-economic evaluation of traits in a broiler enterprise: the relative genetic-economic values.

Selection for growth rate and food utilisation (assuming annual genetic gains of 3 and 1.5% respectively) have about the same economic value and account for 94.3% of the annual potential economic savings in the production costs of an integrated broiler enterprise. Selection for more hatching eggs (annual genetic gain of 1.7 eggs) accounts for only 4.2% and selection for fertility, hatchability and reduced mortality have a value of less than 1% each. The introduction of the dwarf gene (dw) has a questionable economic value. Even if growth rate and fertility are not reduced by using dwarf females, the economic importance will equal no more than two generations of selection for growth rate. As egg production increases, the relative economic value of growth rate and food utilisation will increase, while the advantage of using dwarf females will decrease. Both body weight and body fat content (which are correlated with food utilisation) are moderately heritable and if body fat can be measured reliably in live birds, this may aid breeding for economic advantage.

Adipose Tissue↗
PubMed2002

[Macro-economic calculation of spending versus micro-economic follow-up of costs of breast cancer].

BACKGROUND: In the healthcare field, the ability to make economic forecasts requires knowledge of the costs of caring for major diseases. In the case of a semi-chronic condition like cancer, this cost covers all the episodes of care associated with a patient. An evaluation of a macro-economic method of calculating costs for treating non-metastatic cancer, covering all hospital episodes, is proposed. This method is based entirely on the use of annual hospital activity databases, linked to data concerning the incidence of cancer. It allows us to obtain the global cost of care for a neoplasm of a particular site, without the need to reconstruct the whole care pathway of the patients. METHODS: The model was assessed by comparing it's own results, in the particular case of breast cancer to those issuing from a micro-economic follow-up of 115 patients. Data for macro-economic calculation are extracted from the national French hospital database for the year 1999 and from cancer incidence data. The prospective study was done in 1995, in a comprehensive cancer centre. RESULTS: Macro-economic calculation leads to a cost of 14,555 Euro, for primary breast cancer. Prospective follow-up showed a cost of 14,350 Euro (data corrected, 1999 value). With a difference of 1%, there was a clear cohesion of the two results, while a higher level of divergence was noticed (from 1 to 15%) in the comparison between therapeutic techniques. Accuracy and reliability of results were evaluated. CONCLUSION: This method may be extended to all types of neoplasms. This method cannot be used instead of follow-up studies, for cost-efficacy or cost-severity analysis, but may be interesting beyond economic forecasts, in the field of payment per pathology.

Breast Neoplasms↗
PubMedDate not supplied

A comparison of economic modelling and clinical trials in the economic evaluation of cholesterol-modifying pharmacotherapy.

There are various ways in which data for economic evaluations may be obtained, including via clinical trials and via economic modelling. There are numerous advantages and disadvantages associated with each method, although it is generally assumed that economic models lack the accuracy required for the calculation of meaningful cost-effectiveness data. In order to assess the predictive accuracy of economic modeling in the context of cholesterol-modifying pharmacotherapy it is possible to compare predicted coronary heart disease (CHD) incidence estimates obtained using CHD risk equations derived from the Framingham Heart Study (FHS) with actual CHD incidence rates achieved in a major clinical trial, the West of Scotland Coronary Prevention Study (WOSCOPS). FHS-derived CHD risk equations substantially underestimate the actual risks of nonfatal myocardial infarction obtained by WOSCOPS. However, in predicting risks of death from CHD, FHS-derived CHD risk equations estimate extremely accurately the incidence obtained by WOSCOPS. For example, from WOSCOPS the risk of an individual fulfilling the trial entry criteria incurring nonfatal myocardial infarction or CHD death in 4.9 years is 0.079 for placebo group and 0.055 for the intervention group. Therefore, the relative risk for the intervention group relative to placebo group is 0.696, implying a risk reduction of 30%. Comparable risks predicted using FHS-derived CHD risk equations are 0.116 for the placebo group and 0.088 for the intervention group. Consequent relative risks and risk reductions for the intervention relative to placebo are 0.757 and 24%, respectively. Using both model and trial estimates of CHD incidence in an economic evaluation of cholesterol-modifying pharmacotherapy, incremental costs per life year gained are 41,707 Pounds using WOSCOPS data and 36,480 Pounds using FHS-derived CHD risk equations.

Anticholesteremic Agents↗