Cost-utility analysis from a societal perspective

In this paper, we outline how to use cost-utility analysis from a societal perspective and the arguments that could be made for using data such as a model for economic evaluation of health care. We show that to include all the costs in the analysis, a price per quality-adjusted life years (QALY) gained rather than a given budget should be used as the decision rule. Using cost-utility analysis this way is based on a willingness to pay per QALY gained that is constant and the same for everyone. To use a fixed price per QALY gained is consistent with societal utility maximization if aggregated QALYs are a measure of societal utility and if the mix of financing sources is the same for all health care programmes. If, furthermore, the price per QALY gained is set at the optimal level, cost-utility analysis will lead to a maximization of societal utility. To get more information on the willingness to pay per QALY gained so as to provide cost-utility analysis with a useful decision rule should be a research priority.     

Videoconferenced continuing medical education in Nova Scotia

Videoconferencing has been used for continuing medical education (CME) in Nova Scotia since a pilot project to four communities in 1995. The Nova Scotia Telehealth Network was developed after the pilot project. Using the network, the videoconferenced CME programme expanded over the next few years until in, 2000-1, 66 programmes were broadcast to 38 sites. During the expansion of the programme, we improved video quality and developed efficient methods of: scheduling and planning the content of the videoconferences; training faculty presenters in videoconferencing techniques; and evaluation. We consider this programme represents a success. However, several aspects could be improved. Faculty members still need encouragement to make visual aids legible by videoconference and to provide handouts. Also, there has been little upgrading of equipment over the past four years and some reduction in the reliability of connections.     

Suicidal behaviours among adolescents in northern Nova Scotia

OBJECTIVES: To estimate the 12-month prevalence of suicidal behaviours by gender and to investigate the gender-specific factors associated with suicidal behaviours and to describe health service utilization by suicidal adolescents. METHODS: This was a cross-sectional study. The baseline data of the Adolescent Health Study conducted in northern Nova Scotia were used. RESULTS: Female students were more likely to report suicidal behaviours than male students (p < 0.005). There was no gender difference in injurious suicide attempts. Depression was the strongest risk factor for suicidal behaviours in the two genders (p < 0.005). Female students who reported drug use and living in a non-intact family were at higher risk of suicide attempts. Low self-esteem was positively associated with suicidal ideation and suicide planning among male students. Suicidal girls were more likely to seek professional help for emotional disturbance than boys. Family doctors were the most frequently contacted professional by suicidal adolescents. CONCLUSIONS: Some factors associated with suicidal behaviours among adolescents may be gender specific. Suicidal behaviours have been considered a depressive symptom. Most suicidal students, however, had not contacted a health professional for an emotional problem in this population. This presents challenges for prevention of suicidal behaviours among adolescents.     

An empirical analysis of a telehealth system in terms of cost-sharing

We interviewed 348 users of a home telemonitoring system and asked questions about their willingness to pay (WTP). Assuming that the functional form of demand was logistic, the best estimate of the WTP was yen 4519 per user per month. We also analysed how the benefits of the system (expressed in terms of WTP) were attributed to four factors: stabilizing illness; enhancement of health consciousness; less anxiety in day-to-day life; and a decrease in medical expenditures. All except the last were significant. According to the resulting model, individual users should bear yen 2763 in costs, while society should reimburse yen 349. Surprisingly, the value of yen 2763 obtained here is very close to the amount ( yen 2500) actually charged by Kamaishi City.     

Changes in maternal characteristics in Nova Scotia, Canada from 1988 to 2001

BACKGROUND: Maternal characteristics such as age, parity, smoking status, pre-pregnancy weight and pregnancy weight gain have changed in many industrialized countries in recent years. Many of these changes have not been adequately described at a population level. The purpose of this study was to describe recent trends in selected maternal characteristics in Nova Scotia. METHODS: Data from a population-based perinatal database were used to examine changes in maternal age, parity, smoking, pre-pregnancy weight, delivery weight and pregnancy weight gain among all deliveries between 1988 and 2001. RESULTS: The proportion of deliveries to women > or = 35 years increased by 84% over the study period from 7.0% in 1988-1991 to 12.9% in 1998-2000, while deliveries to women > or = 40 years increased by more than 100%. The number of nulliparous women > or = 35 years also increased significantly. The overall prevalence of smoking decreased from 32.7% in 1988-1991 to 25.1% in 1998-2001, however the prevalence of smoking among women <20 years did not change over the study period and was almost 50%. The proportion of women with a pre-pregnancy weight of > or = 90 kilograms (kg) increased by 165% from 4.1% in 1988-1991 to 10.7% in 1998-2001. The proportion of women with pregnancy weight gain of < 7 kg and > or =18 kg increased by 37% and 13%, respectively. CONCLUSION: Dramatic changes have occurred in several important maternal characteristics and there is evidence of ongoing change. Continuation of these trends is likely to impact on future obstetric practice and perinatal health.     

从费用上分析腹腔镜下阑尾切除术的可行性

比较腹腔镜下阑尾切除术与开腹阑尾切除术的总医疗费用,结果显示,腹腔镜下阑尾切除术费用高于开腹阑尾切除术,但在总体费用方面无显著性差异。     

Community-based cultural predictors of Pap smear screening in Nova Scotia

BACKGROUND: Pap smear screening is effective in reducing the incidence of cervical cancer. However, some subgroups of women are less likely to be screened than others. Since Canadian provincial health databases do not contain data fields identifying ethnicity or language, analyses employing these variables are typically not available. This paper overcomes this problem by using community- rather than person-based measures. Associations with having had a recent Pap smear are reported by community income, language, ethnic group, and urban/rural status, as well as the woman's age. METHODS: The provincial Health Card Number and Cytology Registries were linked to ascertain the screening status of women in mainland Nova Scotia and Cape Breton. Postal codes were linked to census enumeration areas and then to Statistics Canada census data to create community-based cultural measures for each woman. RESULTS: Women in mainland Nova Scotia were more likely to have had a recent Pap smear (Odds Ratio (OR)=1.36; 95% Confidence Interval (CI):1.33-1.39). Women living in low income (OR=1.19; CI:1.15-1.22), Aboriginal (OR=1.60; CI:1.46-1.76), mixed Black (OR=1.25; CI:1.19-1.30) and rural (OR=1.09; CI:1.07-1.11) communities and who were older were less likely to have had a recent Pap smear. DISCUSSION: These findings were not unexpected. In the United States and elsewhere, associations between Pap screening status and women with low income, rural residence, Aboriginal and Black heritage have been reported using person-based methods. Our findings demonstrate a method of providing measures of ethnicity and language that should be considered for use in Canadian studies of service utilization, disease status, and well-being.