Cost-benefit analysis of a plateletapheresis program

We determined costs and benefits of a community donor plateletapheresis program (CDPP) designed to provide HLA-matched platelet transfusions for patients who were refractory to random-donor platelets (RDPs). Costs of establishing and maintaining the CDPP were $127,520 for the first year (1982). Benefits were expressed as cost savings attributed to the CDPP. After the program began, the use of RDP in the community was 17,458 units less than projected. Estimates of net cost savings during the first year ranged from $177,570 to $272,253 (1982 dollars; cost-to-benefit ratios were 1:1.39 to 1:2.14.) In a matched cohort study of marrow transplant patients, CDPP platelet transfusions were as effective as those from family donors while total platelet and red cell use was unchanged. In patients with acute leukemia treated with chemotherapy, significant reduction in both platelet and red cell use was seen after institution of CDPP support. We conclude that the CDPP is a cost-effective approach to platelet support.     

Cost-benefit analysis of Level II fieldwork in occupational therapy

This cost-benefit study of Level II (professional-level) fieldwork included 180 student-supervisor pairs from 12 occupational therapy educational programs. Costs and benefits were measured in time (valued at market rates) spent by students in patient treatment and by supervisors in fieldwork-related duties. Various factors were also evaluated to determine their relationship to overall cost or benefit. Results indicated a mean benefit of $4,700 for 12-week placements. Costs generated in the first few weeks of placement were generally recovered by the 6th week, with benefits gradually increasing, then declining slightly through the end of the fieldwork. Greater economic benefits resulted from physical dysfunction and psychiatric placements than from pediatric placements, and with second and third student experiences as compared with first experiences.     

农村合作医疗高血压免费服药的成本-效益分析

目的 评价上海市嘉定区外冈镇农村合作医疗2003～2010年对高血压患者提供免费服药后,分析其在提高患者管理率、高血压控制率,降低脑卒中发病率,减少医疗费用的可行性.方法 上海市嘉定区外冈镇对参加合作医疗的农村高血压患者4 009例,免费提供6种基本抗高血压药物,并与未进行高血压免费服药的上海市松江区高血压患者的脑卒中发病率进行对照,统计脑卒中发病人数,计算投入的服药成本及效益间的关系.结果 2003～2010年免费服药需要投入167.7万元,干预后脑卒中发病减少285例,节省医疗费688.8万元,本项目的效益成本比688.8÷167.7=4.11,即投入1元免费服药金额,可减少医疗费用4.11元.结论 高血压基本药物免费治疗是一项成本-效益良好的二级预防策略.     

Cost-benefit considerations in managing oxygenation failure

The evaluation of new therapy poses a formidable challenge in intensive care medicine. When therapy evaluation cannot be double-blinded, as in the evaluation of extracorporeal support, the problem becomes more difficult. The result of the extracorporeal clinical trial, like that of the ECMO trial in the 1970s, is a potent reminder of the importance of concurrent controls in such evaluations. We should view with caution ethical objections to controlled trials of therapies that are not supported by credible data. A stronger ethical argument may frequently be mounted in favor of a randomized, controlled clinical trial. This is particularly pertinent in the high-technology ICU environment in which information overload is intense. The establishment of ICU human laboratories should enable the medical community to make much needed progress and help us identify the useful elements in our therapeutic armamentarium.     

手卫生成本效益与成本效果分析

目的：了解手卫生的成本效益和成本效果。方法：比较用水和肥皂洗手与使用速干手消毒剂的成本,分析某ICU手卫生与插管相关感染的关系及产生的经济效益。结果：使用速干手消毒剂与用肥皂洗手相比,每百次洗手可节约成本10.5元。该院ICU2008年速干手消毒剂的使用量（79L）较2007年（39L）有明显增加,同时2008年插管相关性感染率较2007年明显下降,并节约医疗费用60万元。结论：手卫生可降低医院感染发生率,减少医院损失,具有很好的成本效益和成本效果。     

全环境保护预防恶性血液病患儿医院感染的成本效益分析

目的研究全环境保护预防恶性血液病患儿医院感染的成本效益,为全环境保护在临床推广应用提供理论参考。方法采用队列研究方法,将2004年10月至2005年8月入住南方医科大学附属南方医院行化疗的恶性血液病患儿100例,分为观察组和对照组,每组50例。观察组患儿接受全环境保护,对照组患儿住普通病室接受常规护理。追踪观察两组患儿的住院天数、医院感染次数及部位、住院医疗费用、直接非医疗费用和间接费用等。运用卫生经济学中计量经济分析方法,分析患儿疾病经济负担以及实施全环境保护的效益成本比。结果观察组患儿感染率、感染的严重程度以及住院天数均显著低于对照组的患儿。观察组的医院感染率为20%,对照组为66%(χ2=21.58,P=0.000);观察组的呼吸道、口腔黏膜、消化道感染以及败血症的发生率均低于对照组(χ2=50.79,P=0.000)。观察组的住院日(24.8±23.8)d比对照组的住院日(40.1±30.6)d缩短15.3d(t=2.164,P=0.033)。实施全环境保护预防医院感染,减少了患者的疾病经济负担,可获得1.55的效益成本比。结论对恶性血液病患儿实施全环境保护,不仅可以产生良好的临床效果,而且还可以节约费用,获得良好的社会效果。     

2001-2015年新疆克拉玛依市肺结核病防治成本效益分析

目的 分析2001-2015年克拉玛依市开展结核病防治措施的成本效益。方法 收集2001-2015年克拉玛依市、区两级结核病防治监测季报表、年报表及规划评估自评表,按照《全国结核病防治规划终期评估方案》,对克拉玛依市结核病防治成本效用及效益成本进行分析。结果 2001-2015年全市各级政府和国际组织投入结核病防治经费591.54万元,发现活动性肺结核患者2 340例,涂阳患者治愈1 127例,涂阴患者成功治疗1 088例,成功治疗活动性肺结核患者2 215例,累计避免因结核病死亡587例,避免感染健康人群9 852名,避免新发肺结核患者986例,节约医疗费用75.11万元,挽回的社会经济损失达142 776.58万元,成本效用比为414.84,效益成本比为241.49。即每挽回1个伤残调整生命年（DALY）损失所需要投入的金额为414.84元,每投入1元结核病防治经费可产生241.49元的社会经济效益。结论 2001-2015年克拉玛依市通过实施新疆维吾尔自治区《结核病防治规划（2001-2010）年》及《结核病防治规划（2011-2015年）》各项措施,实现了高发现率、高治愈率,取得显著的社会效益和经济效益。     

Cost-benefit analysis of capecitabine versus 5-fluorouracil/leucovorin in the treatment of colorectal cancer in the Netherlands

BACKGROUND: Capecitabine is an oral prodrug of 5-fluorouracil and has been studied for the treatment of colorectal cancer. In 2 Phase III trials, capecitabine was at least as effective as 5-fluorouracil plus leucovorin and had a more favorable toxicity profile. OBJECTIVE: A cost-benefit analysis was used to assess the pharmacoeconomic profile of capecitabine compared with 5-fluorouracil/leucovorin, given according to the Mayo regimen, for colorectal cancer patients treated in the Netherlands. METHODS: The medical files of patients treated for colorectal cancer at a single center from 1999 to 2002 were examined to determine the numbers of outpatient visits for 5-fluorouracil/leucovorin administration, health care use and medication to manage adverse effects, and travel distance to and from the hospital. The costs of capecitabine treatment were simulated by assuming that the same patients were treated with capecitabine instead of 5-fluorouracil/leucovorin. Toxicity data for capecitabine were derived from 2 Phase III studies that compared capecitabine and 5-fluorouracil/leucovorin. RESULTS: The files of 65 patients were reviewed. Thirty-two patients received adjuvant treatment and 33 patients were treated palliatively for metastatic disease. The mean total costs of palliative treatment were Euro 4004 with capecitabine and Euro 5614 with 5-fluorouracil/leucovorin. These results were robust in sensitivity analyses. The cost savings were primarily related to the number of outpatient visits for capecitabine versus the number of day-care treatment days for 5-fluorouracil/leucovorin, despite the higher acquisition costs of capecitabine. CONCLUSIONS: Based on this analysis, treatment of colorectal cancer with oral capecitabine is cost saving in the Netherlands compared with 5-fluorouracil plus leucovorin administered according to the Mayo regimen. Baseline savings were estimated at Euro 1610 for palliative treatment and Euro 934 for adjuvant treatment.     

Costs and benefits of a leaf beetle Integrated Pest Management (IPM) program II. Cost-benefit analysis

Forest health and biosecurity programs rarely capture sufficient data to enable thorough cost-benefit analyses to be done. One notable exception has been Forestry Tasmania’s research project to develop and use an Integrated Pest Management (IPM) program for the leaf beetle Paropsisterna bimaculata. For this project we were able to estimate all major costs and benefits in monetary terms for the period 1975–2034, to allow analysis of a ‘control’ and a ‘no control’ option across a full rotation.

Overall, the 1975–2034 leaf beetle IPM project provided a net positive return at a 5% discount rate. However, the case study was atypical because research commenced nearly three decades before the IPM program was used operationally in the expanding eucalypt plantation estate. For this reason, the year 1990, when research on the precursor of the operational IPM program commenced, was chosen as the default base year for commencing cash-flow analyses. The present value (in AU$ as at 2015) of the total expenditure between 1990 and 2034 on research to develop the leaf beetle IPM program and on its operational use was $5.4 million, of which nearly 60% was expended on research. The research costs included costs to develop the operational IPM program using conventional insecticides and costs involved in unsuccessful attempts to develop an IPM program using more environmentally friendly control options. When research expenditure was restricted to that needed for developing an IPM program using conventional insecticides, the internal rate of return from the project exceeded 7.5%. Additional timber yields from using the IPM program translated to additional revenues, which resulted in positive cash flows after 2011. The benefit:cost ratio resulting from the operational use of the IPM program (treating research expenditure as sunk costs) was 7.5.

The long interval between commencing research, and applying the IPM program operationally once the plantation estate had become established, is not typical of the circumstances relating to future pest threats. Nonetheless, the findings from our study are still relevant to projects involving future pests that may cause similar damage. Another finding of the study was that research needed for future projects to develop an operational pest management program will provide greater benefit if done centrally and the resultant program adopted broadly by as many affected plantation owners as possible.