Economic Evaluations Of Interventions Research Articles

Strategies to contain the emergence of antimicrobial resistance: a systematic review of effectiveness and cost-effectiveness.

To conduct a systematic review of the literature to describe and critically appraise studies reporting on the cost and/or effectiveness of interventions proposed to control the emergence of antimicrobial resistance (AMR). The search for relevant studies encompassed consultation with world experts in AMR, and electronic bibliographic database search of: Medline (1960-2000); ISI (1981-2000); EMBASE (1988-2000); Grey Literature (1999-2000); Database of Reviews of Effectiveness (DARE) and the NHS Health Economic Evaluation Database (HEED) at York University's Centre for Reviews and Dissemination (CRD) (numerous years); OPAC (1975-2000); and the Cochrane Library Online (1990-2000). Only studies that concerned the effectiveness or cost-effectiveness of measures specifically designed to contain the emergence of AMR were reviewed. Standardised data extraction sheets, based on existing checklists for effectiveness and cost-effectiveness, were used to assess the validity of each study using the 'risk of bias criteria' suggested in the Cochrane Handbook. Only studies categorised as being at low or moderate risk of bias were reported fully. The reliability of the data review process was monitored by comparison of several, random, independent assessments by all authors. The mix of study methods (i.e. including studies based on non-randomised controlled trials) meant that formal meta-analysis was not possible, and thus a qualitative review was performed. In total, 43 studies were reviewed, with 21 classed as being at moderate or low risk of bias and therefore reported in the paper. These studies covered policies on: restricting the use of antimicrobials (five studies, suggesting that restriction policies can alter prescriber behaviour, although with limited evidence of subsequent effect on AMR); prescriber education, feedback and use of guidelines (six studies, with no clear conclusion); combination therapies (seven studies, showing the potential to lower drug-specific resistance, although for an indeterminate time period); vaccination (three studies showing cost/effectiveness). Most of these studies were: from the developed world, principally the USA; hospital-based, with few community level interventions; and concerned with effectiveness, not cost-effectiveness. Overall, there is an absence of good evidence concerning what is effective, and especially cost-effective, in reducing the emergence of AMR. However, in addition to more research concerning these forms of intervention, the paper highlights four specific areas for further investigation: validating intermediate or surrogate outcome measures to enable better use to be made of the literature on intermediate measures; development and evaluation of 'macro' strategies; research into specific aspects of AMR in developing countries; and empirical and methodological research concerning the economic evaluation of interventions.

Issues in the Economic Evaluation of Treatments for Menopausal Symptoms

A considerable number of menopausal women are affected by climacteric symptoms and, in the context of scarce health care resources, economic evaluations of interventions to alleviate them provide valuable information to decision makers. Relatively few evaluations of interventions solely aimed at reducing menopausal symptoms have been identified in the literature. This can be explained by the need to incorporate long term risks and benefits of treatments such as hormone replacement therapy as well as the short term effects. Moreover, little empirical work has been done to date on eliciting valuations of health states from women. It appears that many studies based on assumptions have underestimated the impact of menopausal symptoms on women's quality of life and more research is required in this area.

Issues in the economic evaluation of treatments for menopausal symptoms

Issues in the economic evaluation of treatments for menopausal symptoms

Alzheimer's disease: a review of current economic perspectives

Alzheimer's disease (AD) is one of the most widely known of the organic mental disorders described as dementias. It is apparent, in both the USA and the UK, that AD imposes a large economic burden in terms of both formal and informal costs. In the UK, one estimate is that annual costs are about £1,039 million at 1990/91 prices and another, even higher, at £4,684 million. There is an extremely heavy burden on informal caregivers, and on agencies providing social services and residential accommodation.After the onset of AD, the progress of the illness results in declining levels of functioning and increased dependency for patients, factors linked to higher needs for care. Evidence from clinical trials indicates that some drugs may retard the effects of this decline. Economic evaluation of treatments has focused on drug therapies and their ability to alter this progress. One suggestion is that, through delaying the decline and consequent institutionalisation of the patient, effective drug therapy would have economic benefits and reduce health service costs, but this point has not been clearly demonstrated and is open to question.

Economic Evaluation of Acupuncture

Economic evaluation of treatments is essential to make the best use of limited resources. The methodology for this is established and there are four basic analyses: cost-minimisation compares different methods of achieving an overall result, cost-effectiveness measures the outcome of treatment in a natural endpoint, cost-utility attempts to measure the treatment's effect on the overall quality of life, and cost-benefit examines the benefits of treatment in monetary terms. Economic evaluation should ideally be performed alongside randomised controlled trials, preferably placebo-controlled. Other less rigorous designs may be easier to arrange but will generate less conclusive results. In such trials, costs must be measured accurately and as fully as possible. Some examples of economic analysis of acupuncture are discussed.

Economic Evaluation of Treatment of Gastro-Oesophageal Reflux Disease in the United States

Gastro-oesophageal reflux disease (GORD), including endoscopically confirmed reflux oesophagitis of grade II and above [termed severe erosive oesophagitis (SEO)], is a common but difficult to diagnose illness. Symptoms are often not closely correlated with pathological findings. A decision analysis found empirical therapy based on initial treatment with omeprazole to be a dominant strategy for SEO compared with ranitidine or phase I therapy. Phase I therapy, the most common treatment, includes antacids, cessation of smoking, reduction of alcohol consumption, weight loss, dietary changes, and elevating the head of the bed. A subsequent randomised controlled trial found that omeprazole was a more cost-effective strategy than ranitidine plus metoclopramide; clinical outcome was better in the omeprazole-treated group than in the rani-tidine/metoclopramide group, while cost was similar in both groups. However, the changing of treatment strategies (e.g. modifying dosages and regimens), or new surgical interventions, require periodic re-evaluation of the cost-effectiveness of all alternative therapies for GORD.

Economic evaluation of treatments for respiratory disease.

Considerable quantities of health service resources are being devoted to tackling the problems posed by respiratory diseases and this can be expected to continue as the prevalence of such diseases increases. This paper provides an assessment of the most efficient use of these healthcare resources by reviewing the literature on economic evaluation relating to interventions in the field of respiratory medicine. Currently, this literature largely comprises cost-minimisation studies of both management and educational interventions. Asthma educational interventions, whether targeted at adults or children, appear to be effective in improving patient self-management and adherence to medications, and appear to be associated with a lower overall use of healthcare resources. In terms of management interventions the overall picture is rather less clear although there is some support for the greater efficiency of patient administration of beta-adrenergic agonists by metered dose inhalers over therapist-administered up-draft nebulisation. Two features of respiratory disease make evaluation in this field somewhat unusual: there are alternative methods of delivering therapy to patients, which makes patient compliance an important issue, and since most respiratory diseases are chronic conditions the long-term effectiveness of interventions must be assessed. The scarcity of cost-effectiveness and cost-utility studies in this field may, in part, reflect the difficulties of measuring outcomes in respiratory disease.