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Effectiveness Analysis (effectiveness + analysis)
Selected AbstractsSixty-four,slice Computed Tomography of the Coronary Arteries: Cost,Effectiveness Analysis of Patients Presenting to the Emergency Department with Low-risk Chest PainACADEMIC EMERGENCY MEDICINE, Issue 7 2008Rahul K. Khare MD Abstract Objectives:, The aim was to use a computer model to estimate the cost,effectiveness of 64-slice multidetector computed tomography (MDCT) of the coronary arteries in the emergency department (ED) compared to an observation unit (OU) stay plus stress electrocardiogram (ECG) or stress echocardiography for the evaluation of low-risk chest pain patients presenting to the ED. Methods:, A decision analytic model was developed to compare health outcomes and costs that result from three different risk stratification strategies for low-risk chest pain patients in the ED: stress ECG testing after OU care, stress echocardiography after OU care, and MDCT with no OU care. Three patient populations were modeled with the prevalence of symptomatic coronary artery disease (CAD) being very low risk, 2%; low risk, 6% (base case); and moderate risk, 10%. Outcomes were measured as quality-adjusted life years (QALYs). Incremental cost,effectiveness ratios (ICERs), the ratio of change in costs of one test over another to the change in QALY, were calculated for comparisons between each strategy. Sensitivity analyses were conducted to test the robustness of the results to assumptions regarding the characteristics of the risk stratification strategies, costs, utility weights, and likelihood of events. Results:, In the base case, the mean (±standard deviation [SD]) costs and QALYs for each risk stratification strategy were MDCT arm $2,684 (±$1,773 to $4,418) and 24.69 (±24.54 to 24.76) QALYs, stress echocardiography arm $3,265 (±$2,383 to $4,836) and 24.63 (±24.28 to 24.74) QALYs, and stress ECG arm $3,461 (±$2,533 to $4,996) and 24.59 (±24.21 to 24.75) QALYs. The MDCT dominated (less costly and more effective) both OU plus stress echocardiography and OU plus stress ECG. This resulted in an ICER where the MDCT arm dominated the stress echocardiography arm (95% confidence interval [CI] = dominant to $29,738) and where MDCT dominated the ECG arm (95% CI = dominant to $7,332). The MDCT risk stratification arm also dominated stress echocardiography and stress ECG in the 2 and 10% prevalence scenarios, which demonstrated the same ICER trends as the 6% prevalence CAD base case. The thresholds where the MDCT arm remained a cost-saving strategy compared to the other risk stratification strategies were cost of MDCT, <$2,097; cost of OU care, >$1,092; prevalence of CAD, <70%; MDCT specificity, >65%; and a MDCT indeterminate rate, <30%. Conclusions:, In this computer-based model analysis, the MDCT risk stratification strategy is less costly and more effective than both OU-based stress echocardiography and stress ECG risk stratification strategies in chest pain patients presenting to the ED with low to moderate prevalence of CAD. [source] Methods for incorporating covariate adjustment, subgroup analysis and between-centre differences into cost-effectiveness evaluationsHEALTH ECONOMICS, Issue 12 2005Richard M. Nixon Abstract Background: Overall assessments of cost,effectiveness are now commonplace in informing medical policy decision making. It is often important, however, also to investigate how cost,effectiveness varies between patient subgroups. Yet such analyses are rarely undertaken, because appropriate methods have not been sufficiently developed. Methods: We propose a coherent set of Bayesian methods to extend cost,effectiveness analyses to adjust for baseline covariates, to investigate differences between subgroups, and to allow for differences between centres in a multicentre study using a hierarchical model. These methods consider costs and effects jointly, and allow for the typically skewed distribution of cost data. The results are presented as inferences on the cost,effectiveness plane, and as cost,effectiveness acceptability curves. Results: In applying these methods to a randomised trial of case management of psychotic patients, we show that overall cost,effectiveness can be affected by ignoring the skewness of cost data, but that it may be difficult to gain substantial precision by adjusting for baseline covariates. While analyses of overall cost,effectiveness can mask important subgroup differences, crude differences between centres may provide an unrealistic indication of the true differences between them. Conclusions: The methods developed allow a flexible choice for the distributions used for cost data, and have a wide range of applicability , to both randomised trials and observational studies. Experience needs to be gained in applying these methods in practice, and using their results in decision making. Copyright © 2005 John Wiley & Sons, Ltd. [source] Evaluating Medical Effectiveness for the California Health Benefits Review ProgramHEALTH SERVICES RESEARCH, Issue 3p2 2006Harold S. Luft An important aspect of the mandate assessments requested by the California legislature is a review of the scientific and medical literature on the medical effectiveness of the proposed health insurance benefit mandate. Although such a review bears many similarities to effectiveness reviews that might be undertaken for publication as research studies, several important differences arise from the requirements of the California legislation. Our reviews are intended to assist the legislators in deciding whether to support a specific mandate to modify health insurance benefits in a particular way. Thus, our assessments focus on how the scientific literature bears on the proposed mandate, which may involve a complicated chain of potential effects leading from altered coverage to ultimate impact on health. Evidence may be available for only some of the links in the chain. Furthermore, not all the evidence may be directly applicable to the diverse population of California or the subpopulation affected by the mandate. The mandate reviews, including the medical effectiveness analyses, may be used in a potentially contentious decision making setting. The legislative calendar requires that they need to be timely, yet they must be as valid, credible, and based on the best information available as possible. The focus on applicability also implies the need for informed, technical decisions concerning the relevance of the articles for the report, and these decisions need to be made as transparent as possible. These goals and constraints yield an approach that differs somewhat from an investigator-initiated review of the literature. [source] ARSENIC IN THE SHALLOW GROUND WATERS OF CONTERMINOUS UNITED STATES: ASSESSMENT, HEALTH RISKS, AND COSTS FOR MCL COMPLIANCE,JOURNAL OF THE AMERICAN WATER RESOURCES ASSOCIATION, Issue 2 2006Navin Kumar C. Twarakavi ABSTRACT: A methodology consisting of ordinal logistic regression (OLR) is used to predict the probability of occurrence of arsenic concentrations in different threshold limits in shallow ground waters of the conterminous United States (CONUS) subject to a set of influencing variables. The analysis considered a number of maximum contaminant level (MCL) options as threshold values to estimate the probabilities of occurrence of arsenic in ranges defined by a given MCL of 3, 5, 10, 20, and 50 ,g/l and a detection limit of 1 ,g/l. The fit between the observed and predicted probability of occurrence was around 83 percent for all MCL options. The estimated probabilities were used to estimate the median background concentration of arsenic in the CONUS. The shallow ground water of the western United States is more vulnerable than the eastern United States. Arizona, Utah, Nevada, and California in particular are hotspots for arsenic contamination. The risk assessment showed that counties in southern California, Arizona, Florida, and Washington and a few others scattered throughout the CONUS face a high risk from arsenic exposure through untreated ground water consumption. A simple cost effectiveness analysis was performed to understand the household costs for MCL compliance in using arsenic contaminated ground water. The results showed that the current MCL of 10 ,g/l is a good compromise based on existing treatment technologies. [source] A cost effectiveness analysis of omitting radiography in diagnosis of acute bronchiolitis,PEDIATRIC PULMONOLOGY, Issue 2 2009Jean Hai Ein Yong MASc Abstract Objective To carry out a cost-effectiveness analysis of omitting chest radiography in the diagnosis of infant bronchiolitis. Hypothesis Omitting chest radiographs in the diagnosis of typical bronchiolitis was expected to reduce costs without adversely affecting the detection rate of alternate diseases. Study Design An economic evaluation was conducted using clinical and health resources. Emergency department (ED) physicians provided diagnoses pre- and post-radiography as well as a management plan. The primary outcome was the diagnostic accuracy (false-negative rate) of alternate diagnoses with and without X-ray. The incremental costs of omitting radiography in comparison to routine radiography per patient were assessed from a health system perspective. Patient Selection We studied 265 infants, 2,23 months old, presenting at the ED with typical bronchiolitis. Patients with pre-existing conditions or radiographs were omitted from the study. Methodology Expected costs to the health care system of including and excluding chest radiographs were compared, including costs associated with misdiagnosis. Results All alternate diagnoses (two cases) were missed by ED physicians pre- and post-radiography, resulting in a 100% false negative rate. The specificity in detecting alternate diseases was 96.6% pre-radiography and 88.6% post-radiography. Of the 17 cases of coexistent pneumonia, 88% were missed pre-radiography and 59% post-radiography, with respective false positive rates of 10.5% and 16.1%. Omission of routine chest radiograph saved CDN $59 per patient, primarily due to savings in radiography and hospitalization costs. The economic benefit persisted after the inpatient length of stay, ED overhead and radiograph costs were varied. Conclusion For infants with typical bronchiolitis, omitting radiography is cost saving without compromising diagnostic accuracy of alternate diagnoses and of associated pneumonia. Pediatr Pulmonol. 2009; 44:122,127. © 2009 Wiley-Liss, Inc. [source] Using medical records to supplement a claims-based comparative effectiveness analysis of antidepressants,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 8 2010Thomas W. Croghan Abstract Purpose Because health insurance claims lack clinical information, comparative effectiveness research studies that rely on these data may be challenging to interpret and may result in biased inference. We conducted an exploratory study to determine if medical information contained in patient charts could offer clinical details that would assist in interpreting the results of a claims-based comparative effectiveness study of selective serotonin reuptake inhibitors (SSRIs). Methods Retrospective review of 457 charts of patients initiating SSRI treatment. Descriptive data elements included patient diagnosis, symptoms of depressive and anxiety disorders, provider's assessment, and medication treatment and side effects. Results Most subjects were excluded from the study because their charts were not accessible (58.7%), they did not have a follow-up visit (55.6%), providers could not be contacted (58.0%), or providers refused participation in the study (36.5%). Among those included in the study, most patients were noted to have depression, but most charts lacked information on the majority of depression symptoms at baseline and follow-up. Few concomitant symptoms, side effects, and other important clinical and treatment characteristics were recorded. Conclusions Inability to obtain charts due to plan or provider refusal, lack of available information in charts at key times in the course of illness, and missing data elements posed considerable challenges and prevented firm conclusions beyond those drawn from the parent, claims-based study. Copyright © 2010 John Wiley & Sons, Ltd. [source] Demonstrating the clinical and cost effectiveness of adhesion reduction strategiesCOLORECTAL DISEASE, Issue 5 2002M. S. Wilson Abstract Objective To examine the feasibility of conducting Randomized Controlled Trials (RCT) in lower abdominal surgery to demonstrate a reduction in adhesion-related admissions following use of an adhesion reduction product, and to model the cost effectiveness of such products. Methods The number of patients in each limb of a RCT comparing an adhesion reduction product to a control has been estimated based on 25% and 50% reductions in adhesion-related readmissions one year after surgery, for P = 0.05 at a power of 80% and P = 0.01 at a power of 90%. A cost effectiveness model based on the Surgical and Clinical Adhesions Research Group (SCAR) database has been developed which calculates the percentage reduction in readmissions required of an adhesion reduction product to return the cost of investment. It also estimates the cumulative costs of adhesion-related readmissions for lower abdominal surgery and the cost savings associated with an adhesion reduction policy using a low or high cost product. Results 7.2% of patients undergoing lower abdominal surgery will readmit due to adhesions in the first year after surgery. To demonstrate a 25% reduction in readmissions one year after surgery, it is calculated that a RCT would require between 5686 (P = 0.05, power = 80%) and 7766 (P = 0.01, power = 90%) lower abdominal surgery patients followed-up for one year. A cost effectiveness analysis demonstrates that routine use of adhesion reduction products costing £50 per patient will payback the cost of such investment if they reduce adhesion-related readmissions by 16% after 3 years. A product costing £200 will need to offer a 64.1% reduction in readmissions after 3 years. For the estimated 158 000 lower abdominal surgery operations conducted in the UK each year, the cumulative costs of adhesion-related readmissions over 10 years are estimated at £569 Million. Conclusion Demonstrating the clinical effectiveness of adhesion reduction products in the RCT setting is unlikely to be feasible due to the large number of patients required. Products costing £200 or more are unlikely to payback their direct costs. [source] | ||||||||||