Economic evaluation of strategies for the control and management of influenza in Europe

We compared the cost-effectiveness of different strategies for the control and management of influenza for the elderly populations in three European countries (England and Wales, France, Germany). A "no intervention" scenario was compared with six control strategies: opportunistic vaccination (passive recruitment), comprehensive vaccination programmes (active recruitment), 4 weeks chemoprophylaxis course using neuraminidase inhibitors (NIs), 4 weeks chemoprophylaxis course using ion-channel inhibitors (ICIs), early treatment with NIs, and early treatment with ICIs. Vaccination strategies were the most cost-effective. Chemoprophylaxis strategies were highly expensive even under assumptions of optimal timing. Early treatment strategies with antivirals substantially increased demand for GP services and were more expensive than prevention through vaccination.     

Economic evaluation and rationale for human health risk management decisions

The priority task of human health maintenance and improvement is risk management using the new economic concepts based on the assessment of potential and real human risks from exposure to poor environmental factors and on the estimation of cost-benefit and cost-effectiveness ratios. The application of economic tools to manage a human risk makes it possible to assess various measures both as a whole and their individual priority areas, to rank different scenarios in terms of their effectiveness, to estimate costs per unit of risk reduction and benefit increase (damage decrease).     

Collaborative study for the calibration of a new Italian HCV RNA reference preparation against the international standard

We organised a collaborative study to calibrate a new Italian reference preparation for HCV RNA, the ISS 0102 reagent, to be used for plasma pools testing. This preparation will replace the previous one, the ISS 0498 reagent, as we are running short of it. The ISS 0102 reagent was obtained by appropriately diluting an HCV RNA-positive donation. Every participant in the collaborative study received four coded panels, each consisting of 5 semi-logarithmic dilutions of the international standard, 5 semi-logarithmic dilutions of the ISS 0102, and 2 samples of a negative plasma pool. Based on the results provided by the 22 participating laboratories, an HCV RNA concentration of 4500 IU/ml was assigned to the reference material. This preparation is available free of charge to any laboratory upon request.     

Quality management standards for facility services in the Italian health care sector

PURPOSE: Health care, one of the most dynamic sectors in Italy, is studied with a particular focus on outsourcing non-core activities such as facility management (FM) services. The project's goals are to define national standards to balance and control facility service evolution, and to drive FM services towards organisational excellence. The authors, in cooperation with a pool of facility service providers and hospitals managers, studied cleaning services--one of the most critical areas. DESIGN/METHODOLOGY/APPROACH: This article describes the research steps and findings following definition and publication of the Italian standard and its application to an international benchmarking process. The method chosen for developing the Italian standard was to merge technical, strategic and organisational aspects with the goal of standardising the contracting system, giving service providers the chance to improve efficiency and quality, while helping healthcare organisations gain from a better, more reliable and less expensive service. FINDINGS: The Italian standard not only improved services but also provided adequate control systems for outsourcing organisations. In this win-win context, it is hoped to continually drive FM services towards organisational excellence. RESEARCH LIMITATIONS/IMPLICATIONS: This study is specific to the Italian national healthcare system. However, the strategic dynamics described are common to many other contexts. PRACTICAL IMPLICATIONS: A systematic method for improving hospital FM services is presented. ORIGINALITY/VALUE: The authors believe that lessons learned from their Italian case study can be used to better understand and drive similar services in other countries or in other FM service outsourcing sectors.     

Economic evaluation of an intensified disease management system for patients with type 2 diabetes.

We evaluated the effect of a disease management (DM) program on adherence with recommended laboratory tests, health outcomes, and health care expenditures for patients with type 2 diabetes. The study was a natural experiment in a primary care setting in which the intervention was available to 1 group and then compared to the experience of a matched control group. Univariate analysis and difference in differences analysis were used to test for any significant differences between the 2 groups following a 12-month intervention period. A payer perspective was used to estimate the health care cost consequences based on hospital and physician utilization weighted by Medicare prices. The results were nonsignificant at the .10 level, except for compliance with recommended tests, which showed significant results in the univariate analysis. The intervention increased compliance with testing for HbA1c, microalbuminuria, and lipids, and decreased HbA1c value and the percent of patients with HbA1c >or=9.5%. The point estimates showed small reductions in health care cost; only reductions in costs for office visits were significant at the .10 level. We concluded that while there were signs of improvement in adherence to testing, the low effectiveness may be attributed to existing diabetes management activities in this primary care setting, high compliance rates for testing at the beginning of the study, and a steep learning curve for this complex, information-technology-based DM system. The study raises questions about the incremental gains from complex systems approaches to DM and illustrates a rigorous method to assess DM programs under "real-world" conditions, with control for possible selection bias.     

HCV抗原ABS-ELISA检测方法的建立及初步评价

目的 建立新的HCV抗原生物素-亲和素-酶联免疫检测方法(ABS-ELISA).方法 将生物素-亲和素系统与酶联免疫技术相结合,建立用于丙型肝炎病毒抗原检测的方法,分析检测方法的灵敏度、特异度、稳定性及精确度等主要技术指标,并对应用效果进行评价.结果 建立的检测方法,对40余种肠道病毒样品均无交叉反应,在第二代HCV-RNA国家标准品的10份阴性标准品中,未检出HCV-Ag阳性样品,在10份HCV-RNA阳性标准品中,检出6份HCV-Ag阳性的样品,表现出良好的特异性;检测试剂CV平均值为6.28％,精密性好;在90份HCV抗体阳性样品中检测出HCV-RNA样品67份(74.44％),检出HCV游离抗原阳性样品30份(33.33％)、HCV总抗原阳性样品68份(75.56％),HCV游离抗原与HCV-RNA两个指标检出率差异有统计学意义(x2=22.443,P＜0.01),但HCV总抗原与HCV-RNA检测结果之间差异无统计学意义(x2=0.037,P＞0.05);以HCV-RNA检测试剂为金标准,所建立的ABS-HCV抗原检测试剂总抗原检测结果的一致性、灵敏度、特异度、阳性预测值及阴性预测值分别为98.03％、80.60％、98.93％、79.41％、99.00％.结论 新建立的HCV抗原ABS-ELISA检测方法特异性好,其灵敏度与荧光定量PCR相近.     

Economic evaluation of varicella vaccination in Italian children and adolescents according to different intervention strategies: the burden of uncomplicated hospitalised cases

An economic evaluation of universal varicella vaccination in Italy was performed to assess the potential clinical and economic effects of three different strategies versus no vaccination. By means of the EVITA model, vaccination with two doses in toddlers only (1-1.5 years), adolescents only (13 years) and toddlers with adolescents catch-up programmes were simulated. All universal varicella vaccination strategies including toddlers (with or without an adolescent catch-up programme) turned out to be highly effective in reducing the burden of disease due to varicella. In addition, they lead to significant net savings from the societal perspective but to higher costs compared to return of investment from National Health Service perspective. The huge economic burden of hospitalised uncomplicated varicella cases registered in Italy can partially explain these highly beneficial findings for the societal perspective. Overall, our analysis confirmed the favourable clinical and economic impact of routine varicella vaccination with two doses of vaccine in Italy.     

Economic evaluation of pharmacotherapies for smoking cessation

INTRODUCTION: Public policies for smoking cessation are mainly based on advice from the primary care physician and group therapy. Several pharmacological treatments to reduce tobacco addiction are currently available. One of these treatments, bupropion, has remarkable efficacy (30% over 1 year) compared with nicotine replacement therapies (chewing gum 8%, patches 17% over 1 year). The objective of this study was to assess the efficiency of three smoking cessation strategies based on pharmacotherapies in Spain. MATERIAL AND METHODS: The current situation of methods for smoking cessation in Spain includes a mixture of primary care physician advice, group therapy and willpower, combined with the use of drugs in a small proportion of individuals. This situation was compared with three scenarios in which the use of the available pharmacotherapies was increased (by up to 10%) for 1 year. A cost-effectiveness evaluation was used to calculate the cost per death prevented and per year of life saved in each scenario. The analysis used a time horizon of 20 years and was based on an adaptation of the HECOS model, sponsored by WHO-Euro, which enables comparison of distinct pharmacotherapy interventions. Epidemiological data were based on the National Health Survey (1997) and the National Institute of Statistics (1999). RESULTS: The cost-effectiveness ratio of bupropion at 5 years was 70,939 euros per death prevented and was 37,305 euros per year of life saved. When the time horizon was increased to 20 years, these figures became net savings of 28,166 and 3,265 euros, respectively. The cost-effectiveness ratios for both nicotine gums and patches were higher than that for bupropion: 171,834 euros per death prevented at 5 years and 90,362 euros per year of life saved for patches and 513,004 euros per death prevented and 269,772 euros per year of life saved at 5 years. Furthermore, bupropion treatment for 1 year would prevent a greater number of deaths than the alternative strategies (approximately 3,000 deaths in a time horizon of 20 years) due to the decrease in the number of smokers. CONCLUSIONS: The cost of some tobacco cessation methods, such as primary care physician advice and group therapy, is low but their efficacy is also low. New drug treatments increase costs and also achieve higher efficacy rates. When assessing interventions and their costs economic evaluation shows that in the long run greater use of bupropion generates net savings in tobacco-related health costs.     

Economic evaluation of screening for open-angle glaucoma

OBJECTIVES: The aim of this study was to assess the cost-effectiveness of screening for open-angle glaucoma (OAG) in the United Kingdom, given that OAG is an important cause of blindness worldwide. METHODS: A Markov model was developed to estimate lifetime costs and benefits of a cohort of patients facing, alternatively, screening or current opportunistic case finding strategies. Strategies, varying in how screening would be organized (e.g., invitation for assessment by a glaucoma-trained optometrist [GO] or for simple test assessment by a technician) were developed, and allowed for the progression of OAG and treatment effects. Data inputs were obtained from systematic reviews. Deterministic and probabilistic sensitivity analyses were performed. RESULTS: Screening was more likely to be cost-effective as prevalence increased, for 40 year olds compared with 60 or 75 year olds, when the re-screening interval was greater (10 years), and for the technician strategy compared with the GO strategy. For each age cohort and at prevalence levels of < or =1 percent, the likelihood that either screening strategy would be more cost-effective than current practice was small. For those 40 years of age, "technician screening" compared with current practice has an incremental cost-effectiveness ratio (ICER) that society might be willing to pay when prevalence is 6 percent to 10 percent and at over 10 percent for 60 year olds. In the United Kingdom, the age specific prevalence of OAG is much lower. Screening by GO, at any age or prevalence level, was not associated with an ICER < pound 30,000. CONCLUSIONS: Population screening for OAG is unlikely to be cost-effective but could be for specific subgroups at higher risk.     

Economic evaluation of the cochlear implant

OBJECTIVE: To examine the economic efficiency of current cochlear implant technology under Australian conditions in profoundly deaf adults, partially deafened adults, and children. METHODS: Cost-utility study, with weights based on judgments from persons experienced with the technology, and cost data from Australian sources. RESULTS: Quality-of-life improvements due to functional consequences of hearing improvement were greater than those due to amelioration of hearing disability. Costs in Australian dollars per QALY (15-year assessment) ranged from $5,070-$11,100 for children, $11,790-$38,150 for profoundly deaf adults, and $14,410-$41,000 for partially deaf adults. CONCLUSIONS: Results suggest cochlear implantation is acceptable value for money when compared with other health programs to which resources are committed in Australia.     

早期血液灌流在急性有机磷农药中毒患者治疗中的经济学评价

目的 从经济学方面对急性有机磷农药中毒治疗中的早期血液灌流技术进行评价.方法 40例急性有机磷农药中毒患者根据是否行早期血液灌流分为早期灌流组（20例）和对照组（20例）.观察两组患者在基础情况、治疗和预后情况以及治疗费用方面的差别.结果 两组在性别构成、年龄、初始胆碱酯酶（ChE）水平、中毒程度方面比较差异无统计学意义（P＞0.05）.两组患者在病程中均接受了至少1次血液灌流治疗.早期灌流组和对照组开始血液灌流时间分别为（1.6±0.9）h和（6.4±3.6）h,两组比较差异有统计学意义（P＜0.05）.早期灌流组ChE恢复正常时间和住院时间短于对照组[（8.5±2.1）d比（10.0±1.8）d、（10.5±4.2）比（12.3±5.4）d],差异有统计学意义（P＜0.05）.早期灌流组再次血液灌流5例,机械通气4例,对照组分别为8、5例,早期灌流组无院内死亡及28 d死亡,对照组院内死亡1例,28 d死亡1例.早期灌流组总住院费用、每天治疗费用、监护费用及药品费用均低于对照组[（17 231.75±5 411.45）元比（21 394.52±6 049.81）元、（1 412.25±169.33）元比（1 579.41±307.19）元、（4 309.22±1 490.12）元比（5 581.71±1 681.00）元、（8 223.41±1 426.10）元比（9 790.02±1 909.24）元],差异有统计学意义（P＜0.05）.结论 对于急性有机磷农药中毒患者,在病程早期实施血液灌流对其预后有益,缩短了血ChE恢复正常时间和住院时间,且降低了总住院费用.     

Validation of the Italian version of the EUROPEP instrument for patient evaluation of general practice care

Objective: To describe the validity and reliability of the Italian version of the EUROPEP instrument for patient evaluation of general practice care. Methods: A survey was performed among patients who visited a general practice (n=983), using the 23-item EUROPEP questionnaire. The scores are aggregated in two dimensions: “clinical behaviour” and “organization of care”. The cultural adaptation of the questionnaire into Italian has been performed by using the formal translation procedures applied in other European countries. Data were analysed with respect to item response rate, item–scale correlation, internal consistency reliability and construct validity of the instrument. Results: The item response rate was good for 17 items, acceptable for four items and problematic for one item. The item–scale correlation largely exceeded a value of 0.40 for all items in both scales. The internal consistency of the aggregated scores was also very good, the reliability coefficients being 0.95 for “clinical behaviour” and 0.90 for “organization of care”. As expected, older age and better health status were associated with more positive evaluation of care.

Conclusion: Our study confirms that, even in its Italian version, the EUROPEP is a valid and easy-to-use instrument for gathering information on patients’ experience with and evaluation of general practice care.     

Economic evaluation for first-line anti-hypertensive medicines: applications for the Philippines

Background

Medicines to control hypertension, a leading cause of morbidity and mortality, are a major component of health expenditures in the Philippines. This study aims to review economic studies for first line anti-hypertensive medical treatment without co-morbidities; and discuss practical, informational and policy implications on the use of economic evaluation in the Philippines.

Methods

A systematic literature review was performed using the following databases: MEDLINE, EMBASE, BIOSIS, PubMed, The Cochrane Library, Health Economics Evaluations Database (HEED) and the Centre for Reviews and Dissemination – NHS NICE. Six existing economic analytical frameworks were reviewed and one framework for critical appraisal was developed.

Results

Out of 1336 searched articles, 12 fulfilled the inclusion criteria. The studies were summarized according to their background characteristics (year, journal, intervention and comparators, objective/study question, target audience, economic study type, study population, setting and country and source of funding/conflict of interest) and technical characteristics (perspective, time horizon, methodology/modeling, search strategy for parameters, costs, effectiveness measures, discounting, assumptions and biases, results, cost-effectiveness ratio, endpoints, sensitivity analysis, generalizability, strengths and limitations, conclusions, implications and feasibility and recommendations). The studies represented different countries, perspectives and stakeholders.

Conclusions

Diuretics were the most cost-effective drug class for first-line treatment of hypertension without co-morbidities. Although the Philippine Health Insurance Corporation may apply the recommendations given in previous studies (i.e. to subsidize diuretics, ACE inhibitors and calcium channel blockers), it is uncertain how much public funding is justified. There is an information gap on clinical data (transition probabilities, relative risks and risk reduction) and utility values on hypertension and related diseases from middle- and low- income countries. Considering the national relevance of the disease, a study on the costs of hypertension in the Philippines including in-patient, out-patient, out-of-pocket, local government and national government expenditure must be made. Economic evaluation may be incorporated in health technology assessment, planning, proposal development, research, prioritization and evaluation of health programmes. The approaches will vary depending on the policy questions. The information gap calls for building strong economic evaluative capacity in growing economies.

     

论医疗器械库房的经济效益管理

结合医院实际对医疗器械库房实行科学化的经济效益管理，在取得较好效果的基础上，对医院所有医疗器械的使用进行经济效益跟踪分析，加大监管力度，形成了一个适用于医院医疗器械库房的管理模式。     

Economic evaluation of laparoscopic surgery for colorectal cancer

OBJECTIVES: The aim of this study was to assess the cost-effectiveness of laparoscopic surgery compared with open surgery for the treatment of colorectal cancer. METHODS: A Markov model was developed to model cost-effectiveness over 25 years. Data on the clinical effectiveness of laparoscopic and open surgery for colorectal cancer were obtained from a systematic review of the literature. Data on costs came from a systematic review of economic evaluations and from published sources. The outcomes of the model were presented as the incremental cost per life-year gained and using cost-effectiveness acceptability curves to illustrate the likelihood that a treatment was cost-effective at various threshold values for society's willingness to pay for an additional life-year. RESULTS: Laparoscopic surgery was on average pounds 300 more costly and slightly less effective than open surgery and had a 30 percent chance of being cost-effective if society is willing to pay pounds 30,000 for a life-year. One interpretation of the available data suggests equal survival and disease-free survival. Making this assumption, laparoscopic surgery had a greater chance of being considered cost-effective. Presenting the results as incremental cost per quality-adjusted life-year (QALY) made no difference to the results, as utility data were poor. Evidence suggests short-term benefits after laparoscopic repair. This benefit would have to be at least 0.01 of a QALY for laparoscopic surgery to be considered cost-effective. CONCLUSIONS: Laparoscopic surgery is likely to be associated with short-term quality of life benefits, similar long-term outcomes, and an additional pounds 300 per patient. A judgment is required as to whether the short-term benefits are worth this extra cost.