1,721,240 research outputs found

    Implementing improvements to health care services in the US

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    In a previous blog I was critical of the US health care system for not using cost-effectiveness information to plan their services. Today I’m going to talk about the implementation of innovation in health services, something the US does really well compared to Australia

    What do most Americans think of cost-effectiveness research in health care?

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    My impression is that explicit data on the cost-effectiveness of different health care services are not valued highly by US policy makers. An example is a recent decision to approve ipilimumab for the treatment of metastatic melanoma. The extra health benefit over standard treatment is 2.1 months in previously untreated patients and the cost is 120,000for4doses.Thisispoorvalueformoney.Had120,000 for 4 doses. This is poor value for money. Had 120,000 been allocated to an intensive lifestyle modification programme for diabetes risk (Diabet Med. 2004 Nov;21(11):1229-36) then 67 years of life or 800 months could have been returned. A massive increase in health benefits for the same costs

    The cost effectiveness of universal antenatal screening for HIV in New Zealand.

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    OBJECTIVE: To model the incremental costs and benefits of a universal antenatal HIV screening programme in New Zealand (NZ). DESIGN: Cost effectiveness analysis, including only health service costs, using secondary data sources and expert opinion. Uncertainty assessed in multi-way sensitivity analyses. SETTING: The NZ Health Care System. SUBJECTS: Antenatal population of NZ. INTERVENTION: Universal antenatal HIV screening programme. MAIN OUTCOME MEASURES: Incremental cost per true-positive HIV case detected in mothers; incremental cost per HIV case avoided in babies; and incremental cost per discounted life-year gained, for mothers and babies, due to screening. RESULTS: Using base case values the application of universal screening would cost an additional NZ723607(NZ 723 607 (US 307 917) and would lead to the identification of an additional 6.25 true-positive women. After terminations have been excluded, the screening programme would detect five HIV exposed babies. There would be 1.15 avoided cases of HIV infection in babies and a net gain of 41.97 discounted life-years, for mothers and babies combined. The cost per incremental HIV-positive woman detected was NZ115859(NZ 115 859 (US 49 301), HIV infected baby avoided NZ629669(NZ 629 669 (US 267 944) and discounted life-year gained NZ17241(NZ 17 241 (US 7336). CONCLUSION: The discounted cost per life gained in NZ compares favourably to estimates reported in studies of similar interventions in other developed countries and other health care interventions in NZ. The decision of whether to implement universal screening in NZ would be clarified if the prevalence of antenatal HIV infection was known and policy makers identified their willingness to pay for an additional life-year gained

    How costs change with infection prevention efforts

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    Purpose of review: To describe articles since January 2013 that include information on how costs change with infection prevention efforts.\ud \ud Recent findings: Three articles described only the costs imposed by nosocomial infection and so provided limited information about whether or not infection prevention efforts should be changed. One article was found that described the costs of supplying alcohol-based hand run in low-income countries. Eight articles showed the extra costs and cost savings from changing infection prevention programmes and discussed the health benefits. All concluded that the changes are economically worthwhile. There was a systematic review of the costs of methicillin-resistant Staphylococcus aureus control programmes and a methods article for how to make cost estimates for infection prevention programmes.\ud \ud Summary: The balance has shifted away from studies that report the high cost of nosocomial infections toward articles that address the value for money of infection prevention. This is good as simply showing a disease is high cost does not inform decisions to reduce it. More research, done well, on the costs of implementation, cost savings and change to health benefits in this area needs to be done as many gaps exist in our knowledge

    Economics and preventing healthcare acquired infection

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    The evolution of organisms that cause healthcare acquired infections (HAI) puts extra stress on hospitals already struggling with rising costs and demands for greater productivity and cost containment. Infection control can save scarce resources, lives, and possibly a facility’s reputation, but statistics and epidemiology are not always sufficient to make the case for the added expense. Economics and Preventing Healthcare Acquired Infection presents a rigorous analytic framework for dealing with this increasingly serious problem. ----- \ud \ud \ud Engagingly written for the economics non-specialist, and brimming with tables, charts, and case examples, the book lays out the concepts of economic analysis in clear, real-world terms so that infection control professionals or infection preventionists will gain competence in developing analyses of their own, and be confident in the arguments they present to decision-makers. The authors: -----\ud \ud \ud \ud Ground the reader in the basic principles and language of economics. -----\ud \ud \ud Explain the role of health economists in general and in terms of infection prevention and control. -----\ud \ud \ud Introduce the concept of economic appraisal, showing how to frame the problem, evaluate and use data, and account for uncertainty. -----\ud \ud \ud Review methods of estimating and interpreting the costs and health benefits of HAI control programs and prevention methods. -----\ud \ud \ud Walk the reader through a published economic appraisal of an infection reduction program. -----\ud \ud \ud Identify current and emerging applications of economics in infection control. ----\ud \ud \ud Economics and Preventing Healthcare Acquired Infection is a unique resource for practitioners and researchers in infection prevention, control and healthcare economics. It offers valuable alternate perspective for professionals in health services research, healthcare epidemiology, healthcare management, and hospital administration. -----\ud \ud Written for:\ud Professionals and researchers in infection control, health services research, hospital epidemiology, healthcare economics, healthcare management, hospital administration; Association of Professionals in Infection Control (APIC), Society for Healthcare Epidemiologists of America (SHEA)\u

    Going Beyond Counting First Authors in Author Co-citation Analysis

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    The present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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