Health Economic Benefits Research Articles

A pharmacoeconomic evaluation of results from the coronary angioplasty amlodipine restenosis study (CAPARES) in Norway and Canada

Introduction: The objective of this analysis was to evaluate the health economic benefits of using amlodipine in patients undergoing angioplasty procedures in Canada and Norway. Methods: A decision tree model was constructed to find the total expected cost per patient for a 4-month time period following an initial angioplasty. The model used clinical data from the Coronary Angioplasty Amlodipine Restenosis Study (CAPARES), a prospective, randomized, double blind, placebo-controlled trial conducted to investigate the effects of amlodipine on restenosis and clinical events in patients undergoing percutaneous transluminal coronary angioplasty (PTCA). Outcomes of interest to this analysis included MI, repeat PTCA, CABG, and all-cause mortality. Clinical experts from Canada and Norway were enlisted and a modified Delphi study approach was used to quantify healthcare resources consumed for each clinical outcome. Results: The use of amlodipine decreased the rates of MI, PTCA, and CABG by 2.0, 4.7, and 2.7%, respectively. The total expected cost per patient using amlodipine was $6,398.30 (US$4,323) in Canada and kr 59,993.27 (US$6,846) in Norway. The total expected cost per patient not using amlodipine was $6,519.37 (US$4,405) in Canada and kr 64,292.17 (US$7,337) in Norway. The model demonstrated potential cost-savings over a 4-month follow up period resulting from the improved clinical outcomes for patients using amlodipine with PTCA—$121,071 (US$81,844) per 1000 patients in Canada and kr 4,298,899 (US$490,074) per 1000 patients in Norway. Conclusions: The adjunctive use of amlodipine is a cost-effective therapeutic strategy to achieve more favorable clinical outcomes in patients undergoing PTCAs in Canada and Norway.

The influence of complications on rehabilitation of spinal cord injuries: economical minus effects and physical disadvantages caused by urinary tract infection and decubitus ulcer

There are few studies on the many complications that disrupt the rehabilitation of patients with cervical cord injuries and their subsequent health-economic benefits. I particularly focused on the treatment of urinary tract infection and decubitus ulcers because these are very frequently encountered complications in a clinical setting. I examined how these complications affect the progress of rehabilitation and facilitate a patient's return to society. The subjects included ninety-eight cervical cord injury patients with tetraplegia who were discharged from the Rehabilitation Center for Severely Disabled Persons from 1995 to 2000. I retrospectively investigated these ninety-eight subjects regarding ninety-six items from clinical records, among which twenty items were selected because they are considered to be closely associated with outcome, such as age, sex, length of stay, medical expense, urinary tract infection, and decubitus ulcer. Moreover, I examined the influence that urinary tract infection and decubitus ulcer had on other items. The average length of stay and total medical expenses per patient were 1,174.4 +/- 559.9 days and 13,563,128.4 +/- 6,351,078.1 yen, respectively. Urinary tract infection and decubitus ulcer occurred at a rate of 97% in patients with cervical cord injury undergoing chronic stage rehabilitation, and these complications caused a two-fold prolongation of the length of stay and a three-fold increase in medical expenses compared with patients without complications. It is important to fully recognize that these complications produce many expenses as well as those for the medical treatment of cervical cord injury.

A Worksite Influenza Immunization Program

Using a randomized, retrospective case control survey approach, this study compared employees immunized (cases) to a group of non immunized employees (controls) between the months of October and December 1994. In May 1995, a self administered questionnaire was distributed to employees working at the Hanford nuclear reservation located in eastern Washington State. Bivariate analysis included chi-square tests to study the association between influenza vaccine and rates of influenza like illness and related complications, rates of employee absenteeism, rates of physician visits, use of prescribed medication, and rates of hospitalization. To assess the economic benefits associated with vaccination, analysis included estimating the direct and indirect costs associated with immunization and influenza like illnesses, and complications related to influenza like illnesses. Responses to the survey resulted in 789 employees in the vaccinated group and 931 employees in the nonvaccinated group. As compared to vaccinated employees, nonvaccinated employees reported significantly higher rates of episodes of influenza like illness (78 per 100 compared to 59 per 100, p < 0), influenza related complications (8.0 compared to 5.0, p < .01), lost work days (63 per 100 compared to 35 per 100, p < 0), use of prescription medication (18.6 per 100 compared to 8.7 per 100, p < 0), physician visits (18.6 per 100 compared to 8.7 per 100, p < 0), and inpatient hospital. Cost savings were estimated to be $83.84 per person vaccinated. The results of this study suggest this worksite influenza vaccination program produced significant health related and economic benefit to employee participants and their employers.

Supplemental calcium for the prevention of hip fracture: Potential health-economic benefits

We assessed the cost-effectiveness of daily calcium supplementation for the prevention of primary osteoporotic hip fractures. The assessment was based on our meta-analysis of the published relative-risk estimates from 3 double-masked, placebo-controlled, clinical trials and our analysis of raw data from the National Health and Nutrition Examination Survey 1988–1994 on the daily intake of calcium supplements by adults in the United States. These data were then used to estimate the preventable proportion of hip fractures. The 1995 National Hospital Discharge Survey database provided the number and demographic characteristics of patients discharged with a primary diagnosis of hip fracture, as well as their discharge destination. The 1990 itemized costs of hip fractures, as estimated by the US Congress Office of Technology Assessment, were inflated to 1995 dollars using the medical care component of the Consumer Price Index. Using these inflated itemized costs, we then estimated the weighted average expenditures, reflecting both the types of services associated with specific hospitaldischarge destinations and the demographic characteristics of discharged patients. The cost of supplements containing 1200 mg/d of elemental calcium for the mean duration (34 months) of the 3 clinical trials was calculated on the basis of 1998 unit-price and market-share data for 6 representative products. For 1995, the data indicate that 290327 patients aged ≥50 years were discharged from US hospitals with a primary diagnosis of hip fracture, at our estimated direct cost of $5.6 billion. Based on the risk reductions seen in the 3 trials, we estimated that 134,764 hip fractures and $2.6 billion in direct medical costs could have been avoided if individuals aged ≥50 years consumed approximately 1200 mg/d of supplemental calcium. Additional savings could be expected, because this intervention is also associated with significant reductions in the risk for all nonvertebral fractures. Comparing the cost of calcium with the expected medical savings from hip fractures avoided, it is cost-effective to give 34 months of calcium supplementation to women aged ≥75 years in the United States. If, as the published studies suggest, shorter periods of supplementation result in an equivalent reduction in the risk of hip fractures, calcium supplementation becomes cost-effective for all adults aged ≥65 years in the United States. The data support encouraging older adults to increase their intake of dietary calcium and to consider taking a daily calcium supplement. Even small increases in the usage rate of supplementation are predicted to yield significant savings and to reduce the morbidity and mortality associated with hip fracture at an advanced age.

How Can Payback from Health Services Research Be Assessed?

Throughout the world there is a growing recognition that health care should be research-led. This strengthens the requirement for expenditure on health services research to be justified by demonstrating the benefits it produces. However, payback from health research and development is a complex concept and little used term. Five main categories of payback can be identified: knowledge; research benefits; political and administrative benefits; health sector benefits; and broader economic benefits. Various models of research utilization together with previous assessments of payback from research helped in the development of a new conceptual model of how and where payback may occur. The model combines an input-output perspective with an examination of the permeable interfaces between research and its environment. The model characterizes research projects in terms of Inputs, Processes, and Primary Outputs. The last consist of knowledge and research benefits. There are two interfaces between the project and its environment. The first (Project Specification, Selection and Commissioning) is the link with Research Needs Assessment. The second (Dissemination) should lead to Secondary Outputs (which are policy or administrative decisions), and usually Applications (which take the form of behavioural changes), from which Impacts or Final Outcomes result. It is at this final stage that health and wider economic benefits can be measured. A series of case studies were used to assess the feasibility both of applying the model and the payback categorization. The paper draws various conclusions from the case studies and identifies a range of issues for further work.

Costs and benefits of vehicle inspection: a case study of the Maryland region

Vehicle emission inspection programs, as required by the Clean Air Act amendments of 1977, are now in place in over 40 regions of the U.S. Their purpose is to reduce the in-use emissions of vehicles, and hence to improve air quality and provide health and other economic benefits. We examine the full social costs and benefits for a representative emission inspection program, the Maryland program in the Baltimore/Washington corridor. Using data from a survey of drivers, we are able to estimate the full social costs of the program. We also estimate the joint reduction of both carbon monoxide and hydrocarbon (HC) pollution and the resulting benefits. Both cost-effectiveness and cost-benefit analyses are performed. We find the costs to be many times higher than a reasonable measure of the benefits in the Maryland region. Also, the costs are high relative to the cost of reducing pollution from other sources. We simulate some modifications to the Maryland program to determine ways to make it more cost-effective. Extending the inspection to include older vehicles, and increasing the repair limit for the waiver policy would improve the efficiency of the program.