Establishing the Cost-Effectiveness of New Pharmaceuticals under Conditions of Uncertainty—When Is There Sufficient Evidence?

Decisions about which health-care interventions represent adequate value to collectively funded health-care systems are as widespread as they are unavoidable. In the case of new pharmaceuticals, many countries now require formal cost-effectiveness analysis to inform this decision-making process. This requires evidence on parameters associated with health-related utilities, treatment effects, resource use, and costs, for which data from available regulatory trials are invariably absent or highly uncertain. This uncertainty results from a number of factors including the predominance of intermediate end points in the clinical evidence-base and the limited period of follow-up of patients in clinical studies. Despite these imperfections in the evidence base, decisions about whether new pharmaceuticals are sufficiently cost-effective for reimbursement cannot be side-stepped. Data limitations do, however, require the use of rigorous analytical methods to support decision making. Probabilistic decision models and value of information analysis offer a means of structuring decision problems, synthesizing all available data, characterizing the uncertainty in the decision, quantifying the cost of uncertainty, and establishing the expected value of perfect information. This analytical framework is important because it addresses two fundamental questions about new pharmaceuticals. First, is the product expected to be cost-effective on the basis of existing evidence? Second, is additional research concerning the product itself cost-effective? In addressing these questions, the analytical framework can establish when sufficient evidence exists to sustain a claim for a new pharmaceutical to be cost-effective.     

Development of a new Adolescent Patient-Provider Interaction Scale (APPIS) for youth at risk for STDs/HIV

PurposeAlthough an adult model of patient-provider mutual exchange of information has been proposed, there is no guiding model for adolescents or measurement methodology. Our purpose was to develop a new scale of patient-provider interaction for adolescents accessing reproductive health care and at risk for sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV), and assess the reliability and validity of the scale.MethodsThe Adolescent Patient-Provider Interaction Scale (APPIS) was developed from the Roter and Hall theory of doctor-patient relationships, previously validated adolescent satisfaction and communication scales, and focus group and individual elicitation interviews. To assess construct validity, the new nine-item APPIS was compared with the satisfaction scale used by the Young Adult Health Care Survey (YAHCS), and Kahn’s Provider Communication Scale. Pearson correlation coefficients were used to examine convergence across scales, and factor analysis of the APPIS was performed.ResultsThe study recruited 192 African American girls aged 17.9 ± 1.7 years (range 15–21 years) from three sites: a county STD clinic (n = 51), urban adolescent clinic (n = 99), and a family planning clinic (n = 42). Most participants (85%) rated their overall health care highly (≥ 7 on a 10-point scale); 49% felt that both the provider and patient were “in charge” of the visit, and 88% “strongly agreed” or “agreed” that there was an equal “exchange of information” during the visit. The APPIS showed good internal consistency (Cronbach alpha = .75), and moderate convergence with the six-item YAHCS scale (r = .57, p < .001) and seven-item Kahn scale (r = .48, p < .001). Three factors emerged from exploratory factor analyses, supporting our conceptualization of patient-provider interaction as being multi-dimensional.ConclusionsA new theory-based scale of adolescent patient-provider interaction compares favorably with previous scales of health care satisfaction and communication. The new APPIS may be useful for evaluating approaches to improve health care outcomes for adolescents at-risk for STDs and HIV.     

县级医院医疗仪器管理对策

医疗仪器在疾病诊断和医疗中的作用越来越大,完善的管理不仅可提高仪器的使用寿命和安全性,关系到医院的经济效益和社会效益,更关系到患者的利益.文章结合实际,提出县级医院医疗仪器管理对策.     

中国部分地区妇幼卫生信息系统的现状分析

本文通过研究卫生 项目地区报表资料和现场调查 ,对项目地区妇幼卫生信息系统的建设及运作情况进行了分析 ,并对报表数据质量进行了评价。分析显示 :卫 项目推动了贫困地区信息系统建设 ,项目地区已建立起系统的妇幼卫生信息管理体系 ,但分析也反映出项目地区妇幼卫生常规报表的数据质量仍存在一定问题。分析结果提示 ,应进一步加强妇幼卫生信息系统建设 ,提高妇幼卫生统计信息专业队伍的业务水平。     

人力资源管理信息系统的设计与分析

人力资源管理是企业管理的重要基础工作,提高人力资源管理工作的科学性、有效性和效率,是当前人力资源管理工作的客观要求。结合企业人力资源管理的现状,本文讨论了人力资源管理信息系统的设计与开发。本系统能够完成企业员工信息的存储、备份、恢复、添加、删除、查询以及各类相关报表的打印。     

浅谈网络卫生信息管理的几个问题

网络的出现和发展为信息的传播创造了十分便利的条件,卫生信息也因此进入了传播速度和信息量巨增的网络时代。但是,政府作为管理机构不仅要重视网络设备的建设,更重要的是要重视如何很好地运用网络设备来传播信息。卫生信息有着自身的独特性,它所包含的卫生新闻不完全等同于新闻学中定义的新闻,因为医学科普信息也是卫生信息,而且是内容广泛的群众迫切需要的卫生信息。如此大量的借助网络设备传播的卫生信息,需要有专人或者是一个有组织的群体来承担采编工作,政府部门不能陷入这些具体的事务中,而束缚了自己的管理职能。