ISSN:1057-9230    

DOI:10.1002/hec.4730040401

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractDespite growing concern over the use of health utility measures in economic evaluations of health care programmes, economists have been reluctant to use the wealth of knowledge contained within studies using condition specific outcome measures (CSOMs). Problems with the measurement properties of many CSOMs means that the scope for their use in economic appraisal is extremely limited. This paper examines the potential uses of CSOMs in economics, namely: to provide valid descriptive material, to provide scales for comparing the effectiveness of interventions and to ‘validate’ the descriptive accuracy of economic measures of benefit. It is argued that valid descriptive information is essential for economic appraisal, no matter which method of evaluation is used. Generic measures have been criticised for being too narrow and insensitive to the consequences of specific conditions. CSOMs offer a rich source of information to produce quality adjusted life years (QALYs) but two potential methods, one of mapping health states from one scale to a QALY classification (such as Rosser), and the other, developing ‘exchange rates’ between scales are unsatisfactory. A more rigorous approach would necessitate a major research programme of revaluing existing CSOMs using preference based methods.Another interesting avenue of research would be to use the information from CSOMs to construct health scenarios for valuation.Given the current state of development of outcome measures, it seems advisable to use CSOMs alongside economic measures in trials. Such a strategy would help demonstrate the usefulness of economic measures to clinicians and to reconcile the two m

ISSN:1057-9230    

DOI:10.1002/hec.4730040402

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractResearchers working on economic evaluations alongside trials have to balance minimising data collection with maximising the ability to measure differences in costs. Using existing data sources may keep the costs of research down, but these data may not be entirely appropriate to the evaluation question. When evaluating technologies in intensive care it is particularly important to be able to classify patients correctly by their resource requirements especially when those requirements vary considerably from day to day.This paper describes and justifies methods for costing the care provided for babies in (one arm of) an on‐going multi‐ centre trial, the Collaborative ECMO trial.1This trial is evaluating alternative policies of life support for mature (full term) newborn babies with severe respiratory failure. The most reliable cost information on neonatal intensive care is available from a study, conducted independently from the trial, which has used simple cost apportionment on a large sample of units. By drawing on clinical opinion and carrying out a case note exercise we assessed whether this available information was appropriate to estimate ‘baseline’ costs for the control group during their initial ‘acute’ phase of illness. We concluded that the available cost estimates would need to be weighted to reflect the additional costs of drugs and investigations for this group of babies during the acute phase.Multidisciplinary collaboration on trials can help economists and other researchers to balance the requirement for simple cost measurements with more detailed prima

ISSN:1057-9230    

DOI:10.1002/hec.4730040403

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractAfrican trypanosomiasis, or sleeping sickness, is a tropical disease caused by trypanosome parasites transmitted by tsetse flies. The focus of this paper is on the cost‐effectiveness of alternative drug treatments for patients in the late stage of the disease. Melarsoprol has been used for many decades. More recently, eflornithine has been developed. It has fewer side effects and improves the overall cure rate. It is much more expensive than melarsoprol, however.The objective of the present cost‐effectiveness is to identify the costs and benefits that would be involved in switching from melarsoprol to eflornithine in the treatment of late stage sleeping sickness. Benefits are expressed in lives saved as well as in disability adjusted life years (DALYs). The analysis is applied to the case of Uganda. The implications for affordability are also considered, by taking account of how the treatment costs would be shared between the national government, donors and patients.The baseline results indicate that melarsoprol treatment is associated with an incremental cost per life and DALY saved of $209 and $8, respectively. Each additional life saved by switching from melarsoprol alone to a combination of melarsoprol and eflornithine would cost an extra $1,033 per life saved, and an extra $40.9 per DALY gained. Shifting from this second alternative to treatment of all patients with eflornithine leads to an incremental cost per life saved of $4,444 and an incremental cost of $166.8 per DALY gai

ISSN:1057-9230    

DOI:10.1002/hec.4730040404

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractThere is increasing interest in health status measurement and the relative weights that people attach to different states of health and illness. One important issue which has been raised is the effect that the time spent in a health state may have on the way that state is perceived. Previous studies have suggested that the worse a state is, the more intolerable it becomes as it lasts longer. However, for most of these studies, it is impossible to determine how much of what was observed is attributable to the time spent in the state and how much is attributable towhenit was occurring. This paper reports on a pilot study designed to test the feasibility of using the Time Trade‐Off (TTO) method to isolate the effect of pure time preference from the effect of durationper se.Interviews were conducted with 39 members of the general population who were asked to rate 5 health states for durations of one month, one year and ten years. In aggregate, rates of time preference were very close to zero which suggests that the implicit assumption of the TTO method that there is no discounting may be a valid one. However, that more respondents had negative (rather than positive) rates, casts some doubt on the axioms of discounted utility theory. In addition, implied valuations for states lasting for short periods were often counter‐intuitive which questions the feasibility of using the TTO method to measure preferences for temporary health sta

ISSN:1057-9230    

DOI:10.1002/hec.4730040405

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractThis paper describes and analyzes the changing distribution across hospitals in the U.S. of total hip replacement surgery (THR) for the period 1980–1987. THR is one of the most costly single procedures contributing to health care expenses. Also, the use of THR exhibits a particularly high degree of geographic variation. Recent research pointed to shifts in demand as one plausible economic explanation for increasing use of THR. This paper questions whether shifts in supply may have been large enough to explain changes in patient mix and the relationship of patient mix to the number of procedures performed at a particular hospital. In addition, the relationship between total use of THR and the local availability of orthopaedic surgeons as well as the average allowable Medicare fee for standardized physician services is analyzed. These relationships might yield evidence to support a scenario of induced demand beyond the optimum for patients' welfare, or evidence of supply increase within a disequilibrium scenario.This study, using data for all THR patients in a large sample of hospitals, tends to reject the formulation of a market with independent supply and demand shifts where the supply shifts were the dominant forces. Hospitals with a larger number of THRs performed did not see a higher percentage of older, sicker, and lower income patients. It was more likely that demand shifts generated increases in capacity for surgical services. Moreover, there was little evidence for a persistent disequilibrium and only weak evidence for inducement Also, we found little evidence that hospitals responded to financial incentives inherent in the Medicare payment system after 1983 to select among THR candidates in favour of those with below average expected cost We did observe increased concentration over time of THR procedures in facilities with high volume—suggesting plausible demand shifts towards hospitals witha prioriquality and cost advantages or who obtained those advantages with a high volume of patie

ISSN:1057-9230    

DOI:10.1002/hec.4730040406

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractStudies of the demand for health insurance by elderly persons often inadequately address the distinctions between those who receive insurance through a former employer and those who purchase insurance on their own. The failure to distinguish these two modes of supplementing Medicare can lead to an inability to identify the effects of important independent variables. Using data from the Survey of Income and Program Participation this paper examines the demand for employer provided health insurance among retired pensioners using a bivariate probit model with partial observability and compares these results to other models of insurance demand among elderly persons.The results indicate that unobserved factors reducing the probability of being offered employer provided insurance are associated with increased acceptance. A comparison of the employer provided results with results from other models of the demand for privately purchased insurance indicates that different independent variables may determine the probability of having these types of insurance. Previous studies of insurance that have not distinguished between these two types of insurance may not provide reliable estimates of the relationship between independent variables and the probability of insurance coverage.

ISSN:1057-9230    

DOI:10.1002/hec.4730040407

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

ISSN:1057-9230    

DOI:10.1002/hec.4730040408

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

ISSN:1057-9230    

DOI:10.1002/hec.4730040409

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

ISSN:1057-9230    

DOI:10.1002/hec.4730040410

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY