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Cost-effective Intervention (cost-effective + intervention)
Selected AbstractsCost-effectiveness of HIV nonoccupational post-exposure prophylaxis in AustraliaHIV MEDICINE, Issue 4 2009D Guinot Objective The aim of the study was to determine the cost-effectiveness of HIV nonoccupational post-exposure prophylaxis (NPEP) in Australia. Methods A retrospective cost analysis of a population-based observational cohort of 1601 participants eligible for NPEP in Australia between 1998 and 2004 was carried out. We modelled NPEP treatment costs and combined them with effectiveness outcomes to calculate the cost per seroconversion avoided. We estimated the cost-utility of the programme, and sensitivity and threshold analysis was performed on key variables. Results The average NPEP cost per patient was A$1616, of which A$848 (52%) was for drugs, A$331 (21%) for consultations, A$225 (14%) for pathology and A$212 (13%) for other costs. The cost per seroconversion avoided in the cohort was A$1 647 476 in our base case analysis, and A$512 410 when transmission rates were set at their maximal values. The cost per quality-adjusted life-year (QALY) was between A$40 673 and A$176 772, depending on the risks of HIV transmission assumed. Conclusions In our base case, NPEP was not a cost-effective intervention compared with the widely accepted Australian threshold of A$50 000 per QALY. It was only cost-effective after receptive unprotected anal intercourse exposure to an HIV-positive source. Although NPEP was a relatively well-targeted intervention in Australia, its cost-effectiveness could be improved by further targeting high-risk exposures. [source] Music and its effect on anxiety in short waiting periods: a critical appraisalJOURNAL OF CLINICAL NURSING, Issue 2 2005Marie Cooke PhD Aims and objectives., This paper undertakes a critical appraisal of the methodological issues associated with studies that have investigated the extent to which music decreased the anxiety experienced by patients in short-term waiting periods such as day surgery. Background., Investigations and surgery undertaken on a day basis have significantly increased in number over the last decade. Music has been evaluated as an appropriate nursing intervention in relation to pain, discomfort and anxiety in a number of clinical settings but its usefulness for decreasing anxiety in short-term waiting periods such as day surgery is only beginning to be understood. Conclusion., A number of methodological limitations are identified by this critical review, particularly in relation to the design of research studies. Recommendations to strengthen research in this area are suggested and include (i) describing methods clearly and with detail to allow assessment of the validity and rigour of study results; (ii) using permuted block randomization; (iii) recruiting from a variety of surgical procedures and cultural groups; and (iv) standardizing the health care provided during waiting period. Relevance to clinical practice., Music as a simple and cost-effective intervention to reduce the anxiety experienced in limited time periods will have enormous impact on clinical practice where patients wait and undergo invasive investigations, procedures or surgery. However, the evidence of its utility in these unique environments is only beginning to emerge and this critical review provides a basis for considerations for future research. [source] Hearing aid fitting in adults: results of a cost-effectiveness studyCLINICAL OTOLARYNGOLOGY, Issue 4 2000L.J.C. Anteunis For The Sihi Study Group Objective. Despite its high prevalence (, 20% in adults) and the adverse impact on daily life, hearing impairment is a neglected problem. Despite the fact that <,25% of the hearing-impaired seek help and acquire hearing aids in the Netherlands, hearing aid provision and rules for reimbursment are questioned. This is the reason for a cost-effectiveness study. Materials and methods. Self-reported hearing disability and its impact on quality of life was studied in 60 first-time-users, followed prospectively for 16 weeks after hearing aid fitting. They reported significant benefits in hearing ability, experienced an increased number and quality of social contacts and improved self-assessed personal health. Integrating the positive and negative effects of the intervention in a gain in quality of life, a utility value was obtained. Multiplying this utility value by the number of years the effect is expected to last, yielded Quality Adjusted Life Years. Results. In an economic evaluation, based on a model of tracing and referral and costs per QALY, hearing aid fitting in hearing-impaired adults was compared to the effectiveness of other health care interventions and, as a result, placed near the top of a QALY league table. Conclusions. Hearing aid fitting is a very cost-effective intervention. [source] Surgical strategies for faecal incontinence , a decision analysis between dynamic graciloplasty, artificial bowel sphincter and end stomaCOLORECTAL DISEASE, Issue 6 2008E. K. Tan Abstract Background Artificial bowel sphincter (ABS) and dynamic graciloplasty (DG) are surgical treatments for faecal incontinence (FI). FI may affect quality of life (QOL) so severely that patients are often willing to consider a permanent end stoma (ES). It is unclear which is the more cost-effective strategy. Method Probability estimates for patients with FI were obtained from published data (ABS, n = 319; DG, n = 301), supplemented by expert opinion. The primary outcome was quality-adjusted life years (QALYs) gained from each strategy. Factors considered were the risk of failure of the primary and redo operation and the consequent risk of permanent stoma. Results were assessed as incremental cost-effectiveness ratio (ICER). Results Over the 5-year time horizon, ES gave a QALY gain of 3.45 for £16 280, giving an ICER of £4719/QALY. ABS produced a gain of 4.38 QALYs for £23 569, giving an ICER of £5387/QALY. DG produced a gain of 4.00 QALYs for £25 035, giving an ICER of £6257/QALY. With the willingness-to-pay threshold set at £30 000/QALY, ES was the most cost-effective intervention. The ABS was most cost-effective after 10 years. Conclusion All three procedures were found to be cost-effective. The ES was most cost-effective over 5 years, while the ABS was most cost-effective in excess of 10. DG maybe considered as an alternative in specialist centres. [source] Management of HIV and AIDS in the African contextORAL DISEASES, Issue 2002R Wood The initial response to the African HIV epidemic was to concentrate on the prevention of new infections. There is now an urgent need to address the health care requirements of large numbers of already infected individuals. The spectrum of disease in the African setting is dominated by tuberculosis, bacterial and protozoan infections. In much of Africa, health services are overwhelmed by the care of terminally ill AIDS patients. In the absence of specific HIV therapy, health care resources are being increasingly utilised, but with little survival benefit for the individual. Resources available for treating patients vary considerably between the richer and poorer countries of the continent. Primary prevention of opportunistic infections and maternal child transmission are at present affordable and cost-effective interventions. Whilst antiretroviral therapies may presently be unaffordable in much of Africa, they represent a modality that can have a major effect on HIV survival. The challenge is to improve the health and longevity of HIV-infected individuals with the rational use of the limited health resources available in Africa today. [source] Livestock-handling injuries in agriculture: An analysis of Colorado workers' compensation data,AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 5 2009David I. Douphrate PhD Abstract Background Previous studies have reported that livestock-handling injuries are among the most severe of agricultural injuries. This study identifies the costs, characteristics, and contributing factors associated with livestock-handling injuries among Colorado dairy farmers, cattle/livestock raisers, and cattle dealers. Methods A 10-year (1997,2006) history of Colorado's workers' compensation claims data was used for analysis. Descriptive analyses of livestock-handling injury claims were performed. Claim cost analysis was also conducted. The agent,host,environment epidemiological model was used to analyze injury event descriptions. Results A total of 1,114 livestock-handling claims were analyzed. Claims associated with milking parlor tasks represented nearly 50% of injuries among dairy workers. Claims associated with riding horseback, sorting/penning cattle, and livestock-handling equipment represented high proportions of livestock-handling injuries among cattle/livestock raisers and cattle dealers. Claims associated with livestock-handling represented the highest percentage of high-cost and high-severity injuries in all three sectors. Conclusions Livestock-handling injuries are a significant problem, more costly, and result in more time off work than other causes of agricultural injuries. There is a strong and compelling need to develop cost-effective interventions to reduce the number of livestock-handling injuries in agriculture. Am. J. Ind. Med. 52:391,407, 2009. © 2009 Wiley-Liss, Inc. [source] Electron Beam Computed Tomographic Scanning in Preventive MedicinePREVENTIVE CARDIOLOGY, Issue 2 2002David G. King BSc Undetected coronary atherosclerosis is present in the majority of patients suffering myocardial infarction or sudden death. Electron beam computed tomography affords noninvasive scanning of the heart to detect and measure coronary calcification. These data permit dramatically improved assessment of both short term and future risk for cardiac and other events. Knowledge of this risk gives the physician an opportunity for timely and cost-effective interventions. [source] Reducing alcohol related harm experienced by Indigenous Australians: identifying opportunities for Indigenous primary health care servicesAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2010Anthony Shakeshaft Abstract Objective: Identify key issues and opportunities relating to the dissemination of cost-effective interventions for alcohol in Indigenous-specific settings. Methods: Update previous reviews of the Indigenous alcohol literature, particularly in relation to intervention and dissemination studies aimed at identifying and integrating into routine clinical care those strategies that are most cost-effective in reducing alcohol-related harm. Results: The harmful use of alcohol has been identified as a major public health issue, which has a disproportionately high negative impact on Indigenous Australians. While the disproportionately high burden of harm borne by Indigenous Australian communities is well documented in descriptive studies, attempts to redress this imbalance through well controlled intervention and dissemination studies appear to have been inadequate to date. There is compelling evidence from the non-Indigenous community that brief intervention is an effective treatment for harmful alcohol use, compared to the relatively lower levels of evidence for primary and tertiary level interventions. The effectiveness of brief intervention for alcohol in Indigenous Australian communities should, therefore, be examined. Conclusions and Implications: An opportunity exists to implement brief intervention into Indigenous primary health care settings, as an evidence-based strategy using established resources. There is the possibility that such Indigenous-specific health services research will lead the dissemination field in demonstrating how the implementation process can be successfully tailored to specific and defined clinical settings. [source] | ||||||||||