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Utility Analysis (utility + analysis)
Kinds of Utility Analysis Selected AbstractsA Cost Utility Analysis of Interdisciplinary Early Intervention Versus Treatment as Usual For High-Risk Acute Low Back Pain PatientsPAIN PRACTICE, Issue 5 2010Mark D. Rogerson PhD Abstract Chronic pain is a costly and debilitating condition that has proven difficult to treat, solely with medical interventions, due to the complex interplay of biological, psychological, and social factors in its onset and persistence. Many studies have demonstrated the effectiveness of interdisciplinary treatment that includes psychosocial interventions for low back pain. Nevertheless, these interventions continue to be under-utilized due to concerns of cost and applicability. The present study utilized a cost utility analysis to evaluate effectiveness and associated costs of interdisciplinary early intervention for individuals with acute low back pain that was identified as high-risk for becoming chronic. Treatment effectiveness was evaluated using a standard pain measure and quality-adjusted life years, and associated medical and employment costs were gathered for 1 year. Results indicated that subjects improved significantly from pretreatment to 1-year follow-up, and that the early intervention group reported fewer health-care visits and missed workdays than the treatment as usual group. The majority of 1,000 bootstrapped samples demonstrated the dominance of the early intervention program as being both more effective and less costly from a societal perspective. The early intervention treatment was the preferred option in over 85% of samples within an established range of acceptable costs. These results are encouraging evidence for the cost-effectiveness of interdisciplinary intervention and the benefits of targeted early treatment. [source] Diabetic retinopathy screening: a systematic review of the economic evidenceDIABETIC MEDICINE, Issue 3 2010S. Jones Diabet. Med. 27, 249,256 (2010) Abstract This paper systematically reviews the published literature on the economic evidence of diabetic retinopathy screening. Twenty-nine electronic databases were searched for studies published between 1998 and 2008. Internet searches were carried out and reference lists of key studies were hand searched for relevant articles. The key search terms used were ,diabetic retinopathy', ,screening', ,economic' and ,cost'. The search identified 416 papers of which 21 fulfilled the inclusion criteria, comprising nine cost-effectiveness studies, one cost analysis, one cost-minimization analysis, four cost,utility analyses and six reviews. Eleven of the included studies used economic modelling techniques and/or computer simulation to assess screening strategies. To date, the economic evaluation literature on diabetic retinopathy screening has focused on four key questions: the overall cost-effectiveness of ophthalmic care; the cost-effectiveness of systematic vs. opportunistic screening; how screening should be organized and delivered; and how often people should be screened. Systematic screening for diabetic retinopathy is cost-effective in terms of sight years preserved compared with no screening. Digital photography with telemedicine links has the potential to deliver cost-effective, accessible screening to rural, remote and hard-to-reach populations. Variation in compliance rates, age of onset of diabetes, glycaemic control and screening sensitivities influence the cost-effectiveness of screening programmes and are important sources of uncertainty in relation to the issue of optimal screening intervals. There is controversy in relation to the economic evidence on optimal screening intervals. Further research is needed to address the issue of optimal screening interval, the opportunities for targeted screening to reflect relative risk and the effect of different screening intervals on attendance or compliance by patients. [source] Should the consumption of survivors be included as a cost in cost,utility analysis?HEALTH ECONOMICS, Issue 5 2004John A. Nyman Abstract Survivor costs are those costs associated with a treatment because it extends the patient's life. A controversy exists regarding whether survivor consumption costs should be included in cost,utility analyses. The present paper uses this controversy to motivate a general reexamination of what costs to include in cost,utility analyses. Rather than the ad hoc inclusion rules currently used , a causal relationship between the intervention and the costs, and a proscription on double counting , this paper suggests three inclusion principles based on standard welfare economics. Thus, costs should be (1) included if they represent resources that directly produce the utility that is being measured in the denominator of the cost,utility ratio, (2) excluded if they represent resources that produce utility that is not being measured in the denominator, even though the costs are causally associated with the intervention, and (3) included if they represent resources consumed that are causally related to the intervention, but that have no counterveiling utility gains. These principles suggest important changes in how we account for recuperation time and unrelated medical care. They also suggest that survival consumption costs and earnings be excluded from existing cost,utility analyses. Copyright © 2003 John Wiley & Sons, Ltd. [source] The effects of alternative reports of human resource development results on managerial supportHUMAN RESOURCE DEVELOPMENT QUARTERLY, Issue 2 2003Brent W. Mattson Managerial responses to human resource development (HRD) results evaluation reports were experimentally investigated as a function of (1) how evaluation information was presented and (2) reported HRD program impact levels. Managers (n = 233) read a business scenario in which they were asked to make a decision about whether to implement a development program. They were then exposed to one of nine experimental treatment conditions (evaluation report type × reported program impact level). The report types included utility analysis, critical outcome technique, and anecdotal evaluation reports. Results were varied at three impact levels (low, average, and high). Findings of the study showed that managers perceived utility analysis and critical outcome technique reports as almost equally useful in decision making; however, the anecdotal evaluation report was found to be significantly less useful than either of the other two report types. There was no effect of the reported program impact level on the perceived usefulness of the evaluation reports for decision making. Furthermore, there was no interaction between report type and impact level on the perceived usefulness of the reports for decision making. These findings show that managers prefer information about the financial results of HRD interventions to anecdotal information, regardless of the reported level of impact. [source] A Cost Utility Analysis of Interdisciplinary Early Intervention Versus Treatment as Usual For High-Risk Acute Low Back Pain PatientsPAIN PRACTICE, Issue 5 2010Mark D. Rogerson PhD Abstract Chronic pain is a costly and debilitating condition that has proven difficult to treat, solely with medical interventions, due to the complex interplay of biological, psychological, and social factors in its onset and persistence. Many studies have demonstrated the effectiveness of interdisciplinary treatment that includes psychosocial interventions for low back pain. Nevertheless, these interventions continue to be under-utilized due to concerns of cost and applicability. The present study utilized a cost utility analysis to evaluate effectiveness and associated costs of interdisciplinary early intervention for individuals with acute low back pain that was identified as high-risk for becoming chronic. Treatment effectiveness was evaluated using a standard pain measure and quality-adjusted life years, and associated medical and employment costs were gathered for 1 year. Results indicated that subjects improved significantly from pretreatment to 1-year follow-up, and that the early intervention group reported fewer health-care visits and missed workdays than the treatment as usual group. The majority of 1,000 bootstrapped samples demonstrated the dominance of the early intervention program as being both more effective and less costly from a societal perspective. The early intervention treatment was the preferred option in over 85% of samples within an established range of acceptable costs. These results are encouraging evidence for the cost-effectiveness of interdisciplinary intervention and the benefits of targeted early treatment. [source] Women's choice between sentinel lymph node biopsy and axillary clearanceANZ JOURNAL OF SURGERY, Issue 2 2002Steven Gan Purpose: To determine whether women would choose sentinel lymph node biopsy (SLNB) or axillary clearance (AC) for breast cancer treatment when they are given a single choice based on clear information about morbidity and mortality. Methods: The expected 5-year survival rate of women with breast cancer after either SLNB or AC was calculated using a utility analysis of established literature. The difference in survival was one in 1000. This and other detailed information on SLNB and AC was presented in a questionnaire, which provided subjects with a scenario and a choice between SLNB and AC. After a pilot study of 40 subjects, the questionnaire was mailed to 400 women (who had no mammographic abnormality) attending Breast Screen and handed to 100 women (who were over 40 years of age and had breast symptoms but not cancer) attending the rooms of two surgical specialists. Results: One hundred and twenty one of the 243 respondents to the mailed questionnaires (49.8%) chose SLNB and 35% of the 100 consulting room subjects chose SLNB rather than AC. Conclusions: Women faced with the possibility of having breast cancer seem to be very conservative in their choice of treatment, many choosing the increased morbidity of AC rather than the very small (one in 1000) increased risk of death at 5 years from SLNB. This raises questions about proposals to offer SLNB as standard treatment and demands that women are fully informed about any increased risk of death when making their choice between SLNB and AC. Abbreviations: AC, axillary clearance; SLNB, sentinel lymph node biopsy. [source] Cost utility analysis of physical activity counselling in general practiceAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 1 2006Kim Dalziel Objective:To evaluate the economic performance of the ,Green Prescription' physical activity counselling program in general practice. Methods:Cost utility analysis using a Markov model was used to estimate the cost utility of the Green Prescription program over full life expectancy. Program effectiveness was based on published trial data (878 inactive patients presenting to NZ general practice). Costs were based on detailed costing information and were discounted at 5% per anum. The main outcome measure is cost per quality adjusted life year (QALY) gained. Extensive one-way sensitivity analyses were performed along with probabilistic (stochastic) analysis. Results:Incremental, modelled cost utility of the Green Prescription program compared with ,usual care' was NZ2,053 per QALY gained over full life expectancy (range NZ827 to NZ37,516 per QALY). Based on the probabilistic sensitivity analysis, 90% of ICERs fell below NZ7,500 per QALY. Conclusions:Based on a plausible and conservative set of assumptions, if decision makers are willing to pay at least NZ2,000 per QALY gained the Green Prescription program is likely to represent better value for money than ,usual care'. Implications:The Green Prescription program performs well, representing a good buy relative to other published cost effectiveness estimates. Policy makers should consider encouraging general practitioners to prescribe physical activity advice in the primary care setting, in association with support from exercise specialists. [source] Authors' reply: Prospective randomized trial using cost,utility analysis of early versus delayed laparoscopic cholecystectomy for acute gallbladder disease (Br J Surg 2009; 96: 1031,1040)BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 12 2009D. A. L. Macafee No abstract is available for this article. [source] Growth hormone (GH) replacement in hypopituitary adults with GH deficiency evaluated by a utility-weighted quality of life index: a precursor to cost,utility analysisCLINICAL ENDOCRINOLOGY, Issue 1 2008Maria Ko, towska-Häggström Summary Objectives To examine quality of life (QoL) measured by a utility-weighted index in GH-deficient adults on GH replacement and analyse the impact of demographic and clinical characteristics on changes in utilities during treatment. Design Utilities for items in the QoL-Assessment of Growth Hormone Deficiency in Adults (QoL-AGHDAutility) were estimated based on data obtained from the general population in England and Wales (E&W). These estimates were used to calculate QoL changes in GH-treated patients and compare these with normative population values. Patients A total of 894 KIMS patients (53% women) from E&W were followed for 1 to 6 years. Measurements QoL-AGHDAutility at baseline and at the last reported visit, total QoL-AGHDAutility gain and QoL-AGHDAutility gain per year of follow-up. Results QoL-AGHDAutility in patients before GH treatment differed from the expected population values [0·67 (SD 0·174) vs. 0·85 (SD 0·038), P < 0·0001], constituting a mean deficit of ,0·19 (SD 0·168). There was a difference in the mean QoL-AGHDAutility deficit for men [,0·16 (SD 0·170)] and women [,0·21 (SD 0·162)] (P < 0·001). The main improvement occurred during the first year of treatment [reduction of a deficit to ,0·07 (SD 0·163) (P < 0·001) in the total cohort]; however, patients' utilities remained lower than those recorded for the general population during subsequent follow-up (P < 0·001). Despite an observed impact of age, primary aetiology, disease onset and comorbidities on QoL-AGHDAutility, all patients showed a similar beneficial response to treatment. Conclusions QoL-AGHDAutility efficiently monitors treatment effects in patients with GHD. The study confirmed the QoL-AGHDAutility deficit before treatment and a similar QoL-AGHDAutility gain observed after commencement of GH replacement in all patients. [source] | ||||||||||