摘要:

Increased worldwide cost consciousness with regard to healthcare spending has resulted in a greater reliance of health systems on pharmacoeconomics as a tool for obtaining optimal value, attaining better outcomes, and controlling spending. In such capacities, pharmacoeconomics is often used as a basis for pricing, purchasing, and reimbursement decisions. Current barriers to the use of pharmacoeconomic data are related to the international coexistence of various evolutionary states of the theory and implementation of pharmacoeconomics, the fragmentation of healthcare budgets, and the diversity of healthcare systems and clinical settings. One result of these barriers is the decision makers' need for more rigorous, more directly relevant pharmacoeconomic data that are presented in an interactive, customizable manner. Other stakeholders in the healthcare market have been noticeably affected by decision makers' use of pharmacoeconomics and the more stringent data demands. Physicians have experienced decreased autonomy, patients have experienced delayed drug access and possibly compromised care, and manufacturers have endured greater financial burden and risk. This paper identifies ways in which manufacturers can maximize the effectiveness of their pharmacoeconomic activities to efficiently meet decision-maker needs, overcome some of the current barriers to the use of pharmacoeconomics, and minimize deleterious effects on major healthcare stakeholders.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

Over the past 50 years the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has relied primarily on an assessment of standards compliance to make judgments about the capability of a healthcare organization to provide good quality care. Over the last decade, the focus has shifted from paying exclusive attention to capabilities and routine processes of care, to an assessment of the actual results of care by monitoring and measuring clinical outcomes. This transition requires exploration and understanding of the complex inter-relationships between healthcare standards and performance measures.Adding performance measurement to a standards-based assessment means that the JCAHO can implement a more continuous accreditation process. Continuous accreditation allows an organization to regularly evaluate and improve its processes to maintain performance that constantly meets or exceeds expectations. Establishing a valid, complementary relationship between healthcare standards and performance measures is a complex and challenging undertaking, and fertile ground for extensive research. Success will result in a more complete, thorough and continuous assessment of the care provided by healthcare organizations.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

Highly active antiretroviral therapy (HAART) has dramatically altered the natural history of HIV disease. Studies demonstrate that ≥95% adherence is necessary to garner the full benefits of HAART. However, appropriate adherence to treatment is difficult and challenging. This paper provides an overview of potential clinical and economic outcomes associated with poor adherence to HAART. Since there are no studies exploring the costs associated with poor adherence to HAART, we discuss potential direct and indirect costs accrued with more frequent treatment failures, selection of resistant strains, increased hospitalizations and a faster progression to AIDS associated with poor adherence to HAART. Additionally, we review studies of interventions and strategies to improve adherence to HAART. Although, single-focus interventions have enhanced the chances of achieving viral suppression by 10 to 23%, the literature has demonstrated that for long-term treatments, programs employing diverse interventions that continue over time are more effective. Under constrained healthcare budgets, government, healthcare managers and policy makers require accurate and timely information concerning the cost effectiveness of adherence intervention programs. We discuss considerations in determining the cost effectiveness of an adherence intervention program.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

Disease-state management is gaining in use for the management of chronically ill individuals including those with diabetes mellitus, congestive heart failure, asthma, and some forms of cancer. Recently, disease management (DM) has been applied to patients with chronic kidney disease (CKD), a growing population of patients with high annual costs. CKD is ideally suited to DM since the definition of the condition is unambiguous and current care is highly fragmented. There are currently over 240 000 patients receiving dialysis for end-stage renal disease (ESRD), with projected numbers of nearly 600 000 by 2010, and nearly 9 million individuals with CKD not yet on dialysis. The total cost of care for patients with ESRD alone exceeded $US17 billion in 2000. Over 40% of costs for patients with ESRD result from hospitalizations, many of which can be avoided. In addition, much of the clinical morbidity and cost relates to associated comorbidities rather than ESRDper se, with little management presently provided for these conditions in the dialysis facility setting.DM for CKD uses field-based nurse care managers who can risk-assess patients and provide coordination of care so that the renal issues as well as comorbidities are identified and appropriately managed. Although few results from such efforts have been published, those that have, from RMS Disease Mnagement Inc., show remarkable improvements in a variety of clinical outcomes including mortality and hospitalization.Challenges to expanding DM for CKD include up-front funding to provide the needed DM, the availability of robust information systems to manage and analyze clinical and financial data, and the interest and participation of nephrologists, primary care providers and dialysis facilities, as well as other key providers to ensure that the DM approach is effective. With continuing increases in the number of patients with CKD in managed health plans, DM for this population will be even more important in the future to optimize clinical outcomes while constraining the costs of care.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

Although the significant majority of employers offer health promotion programs, for most companies the size and impact of existing programs is minor. Recent research has yielded substantial data in support of worksite health promotion activities, from both medical and economic perspectives. Yet despite this compelling information, corporations have been slow to incorporate more substantial health promotion activities.Employers must come to see that an investment in employee health promotion programs is an investment in their workforce, likely their greatest asset. The impact of health promotion programs needs to be viewed not simply in the context of a business operations cost. In the face of rapidly escalating healthcare costs, successful health promotion programs have the potential to reduce those expenditures as well as enhance employee performance, resulting in improved business productivity.To be effective, worksite health promotion programs must be implemented in a systematic manner. To gain senior management support, education regarding the principles of health and productivity is critical. Program selection and implementation must be carefully planned, reflecting the health promotion interests, needs, culture and resources of the organization. Objective, easily measurable parameters of program quality and outcome must be identified prior to program implementation, in order to assess program effectiveness, from both employee health and business productivity perspectives. Collaborative data review through regular reporting can identify program strengths and weaknesses, leading to corrective modifications.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

This article describes the rationale for health promotion and disease management (DM) activities in the workplace. It also reviews the trends that are driving DM in the workplace, such as increased healthcare costs and reduced length of stay in the hospital setting. Specific discussion of DM in the workplace includes principles of effective program design and evaluation. Some key issues of effective design involve:using a behavioral model for the design framework that addresses the maintenance phase of behavior;including educational topics beyond the disease-specific issues;providing materials in a variety of formats;stratifying the program by risk level;using multiple distribution channels;having the information reinforce the clinical guidelines;ensuring repeated contacts with the participants; andmaking the program low-cost, easy to administrate and portable.The critical theme in the evaluation of DM programs is to include both process and impact assessments. The uses of experimental and quasi-experimental designs are discussed as tools to determine program impact. The design is also important in order to eliminate alternative explanations for program findings.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

Parent training can be an effective strategy for assisting children and their families to cope with attention-deficit/hyperactivity disorder (ADHD), particularly when it is used as part of a multimodal approach in combination with stimulant medication. The benefits of parent training include: cost effectiveness, particularly when applied in group formats; structured format, enabling the treatment to be applied in a relatively standardized manner across settings and providers; and its generally high degree of acceptability to families. Challenges to implementing parent training programs include: problems with adherence to treatment that may be related to parenting stress; inaccessibility of services; cultural differences between clinicians and families; and the limited financial resources of some families. This article reviews the literature on the effectiveness of parent training as a treatment for ADHD and presents potential benefits as well as barriers to effective interventions. For each barrier, proposed solutions are recommended. Two examples of comprehensive parent training programs used in the treatment of ADHD are provided.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

ObjectiveTo develop and implement a quality assessment instrument to evaluate cost estimates in economic evaluation studies.Design and settingThe assessment instrument was devised through a consensus process. The instrument was developed in the process of estimating a national set of provincial standard costs for healthcare services in Canada.ParticipantsAll healthcare providers for a variety of services including public health, inpatient acute care, ambulatory care, physicians, pharmaceuticals, blood and ambulance services, and workers' lost productivity.Main outcome measuresAn assessment form which evaluated estimates for the full cost of resources; the appropriate inclusion of resources and resource prices; the degree of detail in the unit of measurement; basis of evidence; and the sample of providers from which cost estimates were generated.ResultsWhen applied to existing cost estimates, a wide variation in quality was observed between service categories and provinces. Inpatient hospital, physician services, and drugs had high quality estimates; public health, nursing home, and home care had lower quality estimates.ConclusionsThis quality assessment instrument can be used to target deficiencies in cost estimates and to identify administrative units which are leaders in the field, and hence which can serve as role models for further development of these data.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

A number of first-line chemotherapy options for patients with advanced non-small cell lung cancer (NSCLC) are advocated in treatment guidelines and/or by various clinical investigators. Platinum-based chemotherapy has clearly demonstrated efficacy in patients with advanced NSCLC and is generally recommended as first-line therapy, although there is increasing interest in the use of non-platinum chemotherapy regimens. Among the platinum-based combinations currently used in clinical practice are regimens such as cisplatin or carboplatin combined with paclitaxel, vinorelbine, gemcitabine, docetaxel or irinotecan. The particular combinations employed may vary between institutions and geographic regions.Several pharmacoeconomic analyses have been conducted on paclitaxel in NSCLC and most have focused on its use in combination with cisplatin. In terms of clinical efficacy, paclitaxel-cisplatin combinations achieved significantly higher response rates than teniposide plus cisplatin or etoposide plus cisplatin (previously thought to be among the more effective regimens available) in two large randomized trials. One of these studies showed a survival advantage for paclitaxel plus cisplatin [with or without a granulocyte colony-stimulating factor (G-CSF)] compared with etoposide plus cisplatin.A Canadian cost-effectiveness analysis incorporated data from one of the large randomized comparative trials and showed that the incremental cost per life-year saved for outpatient administration of paclitaxel plus cisplatin versus etoposide plus cisplatin was $US22 181 (30 619 Canadian dollars; $Can) [1997 costs]. A European analysis incorporated data from the other large randomized study and showed slightly higher costs per responder for paclitaxel plus cisplatin than for teniposide plus cisplatin in The Netherlands ($US30 769vs$US29 592) and Spain ($US19 923vs$US19 724) but lower costs per responder in Belgium ($US22 852vs$US25 000) and France ($US28 080vs$US34 747) [1995/96 costs].In other cost-effectiveness analyses, paclitaxel plus cisplatin was associated with a cost per life-year saved relative to best supportive care of approximately $US10 000 in a US study (year of costing not reported) or $US11 200 in a Canadian analysis ($Can15 400; 1995 costs). Results were less favorable when combining paclitaxel with carboplatin instead of cisplatin and particularly when G-CSF was added to paclitaxel plus cisplatin. The Canadian study incorporated the concept of extended dominance in a threshold analysis and ranked paclitaxel plus cisplatin first among several comparator regimens (including vinorelbine plus cisplatin) when the threshold level was $Can75 000 ($US54 526) per life-year saved or per quality-adjusted life-year gained (1995 values).ConclusionCurrent treatment guidelines for advanced NSCLC recognize paclitaxel-platinum combinations as one of the first-line chemotherapy treatment options. In two large head-to-head comparative clinical trials, paclitaxel plus cisplatin was associated with significantly greater response rates than cisplatin in combination with either teniposide or etoposide, and a survival advantage was shown for paclitaxel plus cisplatin (with or without G-CSF) over etoposide plus cisplatin. There are limitations to the currently available pharmacoeconomic data and further economic analyses of paclitaxel-carboplatin regimens are warranted, as this combination is widely used in NSCLC and appears to have some clinical advantages over paclitaxel plus cisplatin in terms of ease of administration and effects on platelets. Nevertheless, results of various cost-effectiveness studies support the use of paclitaxel-platinum combinations, particularly paclitaxel plus cisplatin, as a first-line chemotherapy treatment option in patients with advanced NSCLC.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS