摘要:

AbstractAn earlier version of the following paper was presented at the Bicentennial Conference of the Plymouth Medical Society, April 15th, 1994.Mary Warnock is a member of the House of Lords and a distinguished philosopher who, until her retirement, was Mistress of Girton College Cambridge. She chaired the Committee of Inquiry into Human Fertilization and Embryology from 1982 to 1984, as a result of which The Warnock Report, entitled ‘A Question of Life’, was published in 1

ISSN:1057-9230    

DOI:10.1002/hec.4730030502

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

年代:1994

数据来源: WILEY

ISSN:1057-9230    

DOI:10.1002/hec.4730030503

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

年代:1994

数据来源: WILEY

ISSN:1057-9230    

DOI:10.1002/hec.4730030504

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

年代:1994

数据来源: WILEY

摘要:

AbstractA general approach is discussed to assess the uncertainty surrounding the cost effectiveness ratio (C/E‐ratio) estimated on the basis of data from a randomised clinical trial. The approach includes the calculation of a 95% probability ellipse and introduces the concept of a so called C/E‐acceptability curve. This last curve defines for each predefined C/E‐ratio the probability that the C/E‐ratio found in the study is acceptable. The approach is illustrated by estimates of costs per life saved and costs per patient discharged alive on the basis of data from a phase II trial addressing the value of anakinra in treating sepsis s

ISSN:1057-9230    

DOI:10.1002/hec.4730030505

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

年代:1994

数据来源: WILEY

摘要:

AbstractSuspected acute appendicitis is a common reason for surgery. Unfortunately, diagnosis is not always simple and, in recent years, considerable attention has been devoted to developing better diagnostic techniques. Peritoneal cytology is one such technique. It is simple, minimally invasive, and has been established as clinically effective. This paper reports on an economic evaluation of peritoneal cytology, carried out at Wellington Hospital, New Zealand.The analysis is based on two trials totalling 192 patients. The perspective taken initially is that of a hospital financial manager, seeking to minimise costs. In the first trial, there was a marginal increase in overall cost per person presenting with suspected acute appendicitis, from using the test. In the second, there was a reduction. In both trials there were significant health benefits—unnecessary operations were avoided, and necessary operations done more quickly. Also, the practice developed, in the second trial, of sending patients home immediately following a negative test result. This further increased savings.We then discuss the results from a broader perspective. We conclude that the additional personal benefits—less time convalescing, and lower mortality, on average—ensure that the benefits outweigh the costs of the

ISSN:1057-9230    

DOI:10.1002/hec.4730030506

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

年代:1994

数据来源: WILEY

摘要:

AbstractThis paper suggests an approach to deal with an estimation problem which is often encountered in analyzing the longitudinal cost data gathered in a clinical trial. The source of that estimation problem is twofold: 1) a considerable number of missing data due to treatment‐related withdrawal of severely affected patients with high health care costs in only one the treatment groups and 2) a heavily skewed cost distribution due to rare high‐cost events. The approach is illustrated using data from a trial comparing 3 different drug regimes.In order to calculate costs per patient‐year in case of selectively missing data we extrapolated the costs of patients with incomplete follow‐up. Due to the skewness and the associated large variance in costs per patient‐year, these costs cannot be analyzed using common parametric statistical methods relying on underlying normal distributions. A logarithmic transformation was performed to approximate a normal distribution, reduce the impact of extreme values and create similar size variances in the treatment groups. An ordinary least squares regression analysis of transformed data then standardized for differences in patient characteristics between the groups. For the retransformation, the so‐called smearing estimate was used. This ‘transformation‐standardization‐retransformation’ approach enabled us to provide more consistent and efficient estimates of cost differences that were shown to be statistically significant and jud

ISSN:1057-9230    

DOI:10.1002/hec.4730030507

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

年代:1994

数据来源: WILEY

ISSN:1057-9230    

DOI:10.1002/hec.4730030509

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

年代:1994

数据来源: WILEY

ISSN:1057-9230    

DOI:10.1002/hec.4730030510

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

年代:1994

数据来源: WILEY

ISSN:1057-9230    

DOI:10.1002/hec.4730030511

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

年代:1994

数据来源: WILEY

ISSN:1057-9230    

DOI:10.1002/hec.4730030501

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

年代:1994

数据来源: WILEY