Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research
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It is normally stated that an economic evaluation should take the societal perspective and that this implies the incorporation of all costs and effects, regardless of where these occur. Nevertheless, this broad perspective may be in conflict with the narrower perspective of the health-care decision-makers we are usually trying to aid. In this article, it is argued that not all costs have to be considered equally important for health-care decision-making and that there is a discrepancy between the economically preferred societal perspective and the aim of aiding health-care decision-makers. ⋯ We suggest that it may be useful to adopt a two-perspective approach as a standard, presenting one cost-effectiveness ratio following a strict health-care perspective and one following the common societal perspective. The health-care perspective may assist the health-care policymaker better in achieving health-care goals, while the societal perspective indicates whether the local rationality of the narrow health-care perspective is also in line with societal optimality. More research on actual decisions should provide more insight into the relative weights attached to different types of costs.
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Comparative Study
Comparing the EQ-5D and the SF-6D descriptive systems to assess their ceiling effects in the US general population.
The EuroQol (EQ-5D) and SF-6D (derived from the SF-12) were compared to assess any ceiling effect in the EQ-5D and the SF-6D descriptive systems. In addition, the Physical Component Summary (PCS-12), the Mental Component Summary (MCS-12) and the EuroQol Visual Analog Scale (EQ-VAS) were compared on their discriminative ability to detect differences among individuals with different morbidities and sociodemographic characteristics. ⋯ Unlike the EQ-5D descriptive system, the SF-6D descriptive system derived from the SF-12 does not seem to have a ceiling effect. Nevertheless, the SF-6D does not discriminate between individuals with different morbidities who report full health on the EQ-5D, as does the PCS-12 and the EQ-VAS.
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Managing meningococcal disease in the United States: Hospital case characteristics and costs by age.
Meningococcal disease occurs worldwide. Approximately 1400 to 2800 cases are reported in the United States annually. The goal of this analysis was to examine hospitalized cases of meningitis and meningococcemia to identify case characteristics, resource use, and inpatient care costs. ⋯ The presence of meningococcemia results in a greater death rate, longer length of stay, and increased care costs. Meningococcal disease has substantial economic, as well as profound clinical consequences for patients of all ages.
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To explore the cost-effectiveness of fluticasone propionate (FP) for the treatment of chronic obstructive pulmonary disease (COPD), we estimated costs and quality-adjusted life-years (QALYs) over 3 years, based on an economic appraisal of a previously reported clinical trial (Inhaled Steroids in Obstructive Lung Disease in Europe [ISOLDE]). ⋯ Previous analyses of the ISOLDE study showed significant improvement on disease-specific health status measures and a trend toward a survival advantage for treatment with FP. This analysis shows that joint considerations of quality of life and survival result in a substantial increase in QALYs favoring treatment with FP. Based on these data, the inhaled corticosteroid FP appears cost-effective for the treatment of COPD. Confirmation or refutation of this result may be achieved once the Towards a Revolution in COPD Health (TORCH) study reports, a large randomized controlled trial powered to detect mortality changes associated with the use of FP alone, or in combination with salmeterol, which is also collecting resource use and utility data suitable for estimating cost-effectiveness.
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Comparative Study
Health resource utilization and medical care cost of acute care elderly unit patients.
In this study we compared the readmissions, medical care cost, and health resource utilization (HRU) of acute care elderly (ACE) unit patients and usual medical care patients. ⋯ Our results confirm the hypotheses that ACE unit patients have lower medical care cost, shorter LOS, and fewer readmissions. Thus, ACE unit may be a beneficial model for improved inpatient care of elderly.