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1.
Orthopade ; 49(1): 32-38, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31089777

RESUMO

Further developments in disease diagnosis and treatment are of immense relevance for advancements in medical care of the population. A detailed cost-benefit analysis of direct and indirect costs is usually unavailable. In the current article, these aspects are investigated using prospectively collected randomized data over two years. Specifically, the surgical treatment of a herniated lumbar disc is addressed, and whether a newly introduced technique (e.g., annular closure device) can lead to a better quality of care and increased patient satisfaction when performed during the standard operation, while also being economically viable.


Assuntos
Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral , Vértebras Lombares , Análise Custo-Benefício , Economia Médica , Humanos , Região Lombossacral
3.
Expert Rev Pharmacoecon Outcomes Res ; 19(6): 663-676, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31859542

RESUMO

Introduction: Health anxiety, also known as 'hypochondriasis', is a common, distressing and costly condition that responds to cognitive behavior therapy (CBT) but evidence pertaining to response and remission rates, treatment in routine care, therapist-guided Internet-delivered CBT (ICBT) and health economics has not been systematically reviewed.Areas covered: In this systematic review and meta-analysis we searched PubMed, PsycINFO, and OATD (17/06/2019) for randomized controlled trials (RCTs) comparing CBT to non-CBT controls for health anxiety. Based on 19 RCTs, the pooled between-group effect on health anxiety was moderate to large (g = 0.79; 95% CI: 0.57-1.01; adjusted for publication bias: g = 0.62), with small to moderate effects on secondary symptoms and effects largely sustained 12-18 months after treatment. Moderators were control condition and recruitment path, but not treatment setting. The pooled CBT response rate was 66%, and the remission rate 48%. ICBT had effects comparable to face-to-face CBT. CBT for health anxiety is probably cost-effective, but with limited effect on the quality of life.Expert opinion: CBT is a highly efficacious and probably cost-effective treatment for health anxiety. We recommend that ICBT is implemented more widely, and that health economic outcomes and ways of increasing response and remission rates are explored further.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Hipocondríase/terapia , Terapia Cognitivo-Comportamental/economia , Análise Custo-Benefício , Economia Médica , Humanos , Hipocondríase/economia , Internet , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
4.
Artigo em Russo | MEDLINE | ID: mdl-31765533

RESUMO

The assessment was applied to degree of impact of medical social factors on morbidity of total population according appealability in the Republic of Bashkortostan, considering their spatial temporal distribution. The database of the Federal Information Fund for Social and Hygienic Monitoring (Automated Information System "Social and Hygienic Monitoring") of the Department of Rospotrebnadzor and data of official statistical forms of the Territorial Board of the Federal State Statistics Service in the Republic of Bashkortostan were used as source material for the study. The data was applied in case of presence of combination of observations on 54 municipalities and 8 urban okrugs in the dynamics for 2000-2015. The panel regression analysis of was applied as research tool. The results of modeling can be considered in developing target programs of reducing morbidity in particular municipality of the region.


Assuntos
Economia Médica , Bashkiria , Morbidade
6.
Expert Rev Pharmacoecon Outcomes Res ; 19(5): 517-528, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31401898

RESUMO

Background: Health-care systems in Asian countries are diverse. The economic evaluation provides information on how to make efficient use of the resources available to obtain the maximum benefits. In Asia, diseases such as cardiovascular diseases (CVDs), diabetes mellitus (DM), tuberculosis (TB) and epilepsy generate a heavy economic burden. The objective of this article is to provide a review of the economic burden of health to patients in Asian countries. Areas covered: All data were collected from already published research article and review papers. The databases searched were Science Direct, PubMed, MEDLINE and Google scholar. We found a total of 4456 articles on health economics. After reviewing the title, only 876 relevant articles were considered. Only 92 (n = 92) articles were considered on the basis of inclusion and exclusion criteria. Expert opinion: Available data give evidence that diseases are linked to the low socio-economic status of the Asian population. The cost per capita is high in Asian countries due to insufficient health-care facilities. The cost per capita in Asian countries ranges from $23 (Pakistan) to $1775 (Taiwan). The per capita cost of Malaysia, China, Singapore, and Thailand is $27 $83, $75, and $27, respectively.


Assuntos
Efeitos Psicossociais da Doença , Assistência à Saúde/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Ásia , Análise Custo-Benefício , Economia Médica , Humanos , Fatores Socioeconômicos
7.
Neurology ; 93(6): 273-276, 2019 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-31383802

RESUMO

Medical education is the understanding of how medical knowledge is taught and practiced and encompasses not just medical students, but resident trainees, colleagues, and the community. While there is a growing emphasis in medicine on "clinician-educators," neurology training has only slowly developed formal opportunities in medical education. Here we highlight the current opportunities in residency and beyond, and explore options for further medical education infrastructure within neurology.


Assuntos
Economia Médica/tendências , Neurologia/educação , Currículo , Educação Médica , Educação de Pós-Graduação em Medicina , Internato e Residência
8.
Health Res Policy Syst ; 17(1): 72, 2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31337398

RESUMO

BACKGROUND: Technology adoption in hospitals is usually based on cost-effectiveness analysis, feasibility and potential success. Different countries have embraced a range of principles to accomplish an effective comprehensive process of health technology assessment (HTA). The aim of the study was to analyse the viewpoints and relative weight of technology-oriented hospital staff members toward the clinical, social, technological and economic aspects of HTA. METHODS: Using a structured questionnaire, a survey was conducted among different professionals in an 850-bed hospital. RESULTS: We revealed a range of viewpoints among hospital staff members according to their personal characteristics and professional standpoints. The clinical aspects of HTA were considered 'highly important' (HI) by most participants, especially the 'lifesaving' parameter. Similarly, the 'lack of effective alternative technology' was ranked HI by a high percentage of participants, independent of their profession. Economic aspects were ranked HI only by half of the participants, while social and technological aspects were ranked HI only by a relatively low percentage. Nurses added 'improving quality of life', 'increasing teamwork efficiency' and 'improving medical standards'. Allied health professionals focused on 'lack of effective alternative technologies' as a main argument for adoption of HTA, alongside increasing efficiency, budget savings and contribution to hospital reputation. Engineers emphasised the requirement of significant investment in infrastructure and increasing efficiency. Administrators ranked patient experience as HI. Interestingly, the high ranking of social aspects correlated with older responders, while junior staff ranked safety significantly higher. CONCLUSIONS: A multi-perspective multidisciplinary approach would be beneficial for policy-makers at hospitals and even on a national scale in Israel.


Assuntos
Atitude do Pessoal de Saúde , Recursos Humanos em Hospital/psicologia , Avaliação da Tecnologia Biomédica/organização & administração , Orçamentos , Análise Custo-Benefício , Economia Médica/organização & administração , Eficiência Organizacional , Humanos , Equipe de Assistência ao Paciente/organização & administração , Preferência do Paciente , Segurança do Paciente , Estudos Prospectivos , Qualidade de Vida , Fatores Sexuais , Meio Social
9.
Cad. Ibero Am. Direito Sanit. (Impr.) ; 8(2): 44-63, abr.-jun.2019. ilus, mapas, graf
Artigo em Português | LILACS | ID: biblio-1015751

RESUMO

Objective: to analyze the results of the health audit in the area of orthoses, prostheses and special materials (OPM), multiple and sequential surgeries (CMS), performed by the State Health Department of Rio Grande do Sul, Brazil (SES/RS). Methodology: Descriptive quantitative study, based on secondary data from SES/RS, in the area of OPM and CMS, referring to the period of post-payment audit practice, from March 2013 to January 2017, using the case study approach. Results: 1,004 completed observations were analyzed for the period; the number of administrative processes requiring a return of financial resources did not have a tendency in the analyzed historical series, a result influenced by the presence of administrative processes that were not conclusive, especially from 2014, on the execution of the audit or even the judicialisation of the subject audited institutions. As for the financial value requested for the return of the analyzed processes, it was higher in 2014, decreasing in 2015 and decreasing considerably in the years 2016 and 2017. Considering the 30 health regions of the state of Rio Grande do Sul, Brasil, three hospitals were highlighted, the first with 43 administrative processes requesting the return of financial resources; the second with 30; and the third with 28. Conclusion: health actions in this area can be qualified through special attention to the regions of health and hospital institutions that repeat more and have large financial volume glossed. (AU).


Objetivo: analisar os resultados da auditoria em saúde na área de órteses, próteses e materiais especiais (OPM) e cirurgias múltiplas e sequenciais (CMS), realizada pela Secretaria Estadual de Saúde do Rio Grande do Sul (SES/RS). Metodologia: estudo quantitativo descritivo, baseado em dados secundários da SES/RS, na área de OPM e CMS, referente ao período da prática de auditoria de pós-pagamento, de março de 2013 a janeiro de 2017, utilizando a abordagem estudo de caso. Resultados: foram analisadas 1.004 observações concluídas para o período; o número de processos administrativos com solicitação de devolução de recursos financeiros não teve uma tendência na série histórica analisada, resultado influenciado pela presença de processos administrativos não conclusos, em especial a partir de 2014, relativos à execução da auditoria ou até mesmo a judicialização do assunto pelas instituições auditadas. Quanto ao valor financeiro solicitado para devolução dos processos analisados, foi maior em 2014, decrescendo em 2015 e diminuiu consideravelmente nos anos 2016 e 2017. Considerando as 30 regiões de saúde do estado do Rio Grande do Sul, três instituições hospitalares tiveram destaque, a primeira com 43 processos administrativos com solicitação de devolução de recursos financeiros; a segunda com 30; e a terceira com 28. Conclusão: as ações em saúde, nessa área, podem ser qualificadas por meio de atenção especial para as regiões de saúde e instituições hospitalares que mais reincidem e tem grandes volumes financeiros glosados. (AU).


Objetivo: analizar los resultados de la auditoría de salud en el área de ortesis, prótesis y materiales especiales (OPM), cirugías múltiples y secuenciales (CMS), realizadas por el Departamento de Salud del Estado de Rio Grande do Sul, Brasil (SES / RS). Metodología: estudio cuantitativo descriptivo, basado en datos secundarios de SES / RS, en el área de OPM y CMS, en referencia al período de la práctica de auditoría posterior al pago, desde marzo de 2013 hasta enero de 2017, utilizando el enfoque de estudio de caso. Resultados: se analizaron 1,004 observaciones completas para el período; el número de procesos administrativos que requirieron un retorno de los recursos financieros no tuvo una tendencia en las series históricas analizadas, un resultado influenciado por la presencia de procesos administrativos que no fueron concluyentes, especialmente a partir de 2014, en la ejecución de la auditoría o incluso la judicialización del sujeto Instituciones auditadas. En cuanto al valor financiero solicitado para el retorno de los procesos analizados, fue mayor en 2014, disminuyó en 2015 y disminuyó considerablemente en los años 2016 y 2017. Considerando las 30 regiones de salud del estado de Rio Grande do Sul, Brasil, se destacaron tres hospitales, el primero con 43 procesos administrativos solicitando la devolución de recursos financieros; el segundo con 30; y el tercero con 28. Conclusión: las acciones de salud en esta área se pueden calificar a través de una atención especial a las regiones de salud y las instituciones hospitalarias que repiten más y tienen grandes volúmenes financieros. (AU).


Assuntos
Economia Médica , Auditoria Médica
10.
PLoS One ; 14(4): e0214222, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31013271

RESUMO

BACKGROUND: Procalcitonin is a biomarker that supports clinical decision-making on when to initiate and discontinue antibiotic therapy. Several cost (-effectiveness) analyses have been conducted on Procalcitonin-guided antibiotic stewardship, but none mainly based on US originated data. OBJECTIVE: To compare effectiveness and costs of a Procalcitonin-algorithm versus standard care to guide antibiotic prescription for patients hospitalized with a diagnosis of suspected sepsis or lower respiratory tract infection in the US. METHODS: A previously published health economic decision model was used to compare the costs and effects of Procalcitonin-guided care. The analysis considered the societal and hospital perspective with a time horizon covering the length of hospital stay. The main outcomes were total costs per patient, including treatment costs and productivity losses, the number of patients with antibiotic resistance or C.difficile infections, and costs per antibiotic day avoided. RESULTS: Procalcitonin -guided care for hospitalized patients with suspected sepsis and lower respiratory tract infection is associated with a reduction in antibiotic days, a shorter length of stay on the regular ward and the intensive care unit, shorter duration of mechanical ventilation, and fewer patients at risk for antibiotic resistant or C.difficile infection. Total costs in the Procalcitonin-group compared to standard care were reduced by 26.0% in sepsis and 17.7% in lower respiratory tract infection (total incremental costs of -$11,311 per patient and -$2,867 per patient respectively). CONCLUSIONS: Using a Procalcitonin-algorithm to guide antibiotic use in sepsis and hospitalised lower respiratory tract infection patients is expected to generate cost-savings to the hospital and lower rates of antibiotic resistance and C.difficile infections.


Assuntos
Gestão de Antimicrobianos/economia , Calcitonina/metabolismo , Custos e Análise de Custo , Economia Médica , Hospitalização/economia , Modelos Econômicos , Infecções Respiratórias/tratamento farmacológico , Sepse/tratamento farmacológico , Humanos , Infecções Respiratórias/economia , Sepse/economia , Resultado do Tratamento , Estados Unidos
11.
J Med Libr Assoc ; 107(2): 163-171, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31019384

RESUMO

Objective: Entrepreneurship and innovative product design in health care requires expertise in finding and evaluating diverse types of information from a multitude of sources to accomplish a number of tasks, such as securing regulatory approval, developing a reimbursement strategy, and navigating intellectual property. The authors sought to determine whether an intensive, specialized information literacy training program that introduced undergraduate biomedical engineering students to these concepts would improve the quality of the students' design projects. We also sought to test whether information literacy training that included active learning exercises would offer increased benefits over training delivered via lectures and if this specialized information literacy training would increase the extent of students' information use. Methods: A three-arm cohort study was conducted with a control group and two experimental groups. Mixed methods assessment, including a rubric and citation analysis, was used to evaluate program outcomes by examining authentic artifacts of student learning. Results: Student design teams that received information literacy training on topics related to medical entrepreneurship and health care economics showed significantly improved performance on aspects of project performance relevant to health care economics over student design teams that did not receive this training. There were no significant differences between teams that engaged in active learning exercises and those that only received training via lectures. Also, there were no significant differences in citation patterns between student teams that did or did not receive specialized information literacy training. Conclusions: Information literacy training can be used as a method for introducing undergraduate health sciences students to the health care economics aspects of the medical entrepreneurship life cycle, including the US Food and Drug Administration regulatory environment, intellectual property, and medical billing and reimbursement structures.


Assuntos
Engenharia Biomédica/educação , Economia Médica , Contrato de Risco , Competência em Informação , Humanos , Comportamento de Busca de Informação , Avaliação de Programas e Projetos de Saúde , Ensino
12.
Value Health ; 22(3): 377-382, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30832977

RESUMO

OBJECTIVE: It is useful for reviewers of economic evaluations to assess quality in a manner that is consistent and comprehensive. Checklists can allow this, but there are concerns about their reliability and how they are used in practice. We aimed to describe how checklists have been used in systematic reviews of health economic evaluations. METHODS: Meta-review with snowball sampling. We compiled a list of checklists for health economic evaluations and searched for the checklists' use in systematic reviews from January 2010 to February 2018. We extracted data regarding checklists used, stated checklist function, subject area, number of reviewers, and issues expressed about checklists. RESULTS: We found 346 systematic reviews since 2010 that used checklists to assess economic evaluations. The most common checklist in use was developed in 1996 by Drummond and Jefferson, and the most common stated use of a checklist was quality assessment. Checklists and their use varied within subject areas; 223 reviews had more than one reviewer who used the checklist. CONCLUSIONS: Use of checklists is inconsistent. Eighteen individual checklists have been used since 2010, many of which have been used in ways different from those originally intended, often without justification. Different systematic reviews in the same subject areas would benefit from using one checklist exclusively, using checklists as intended, and having 2 reviewers complete the checklist. This would increase the likelihood that results are transparent and comparable over time.


Assuntos
Lista de Checagem/tendências , Análise Custo-Benefício/tendências , Economia Médica/tendências , Lista de Checagem/normas , Análise Custo-Benefício/normas , Economia Médica/normas , Humanos
13.
Value Health ; 22(2): 220-224, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30711067

RESUMO

OBJECTIVE: This paper constitutes the first attempt to draw lessons from the recent uptake of health economic evaluation of innovative drugs in the French regulatory framework. STUDY DESIGN: Taking the example of new direct-acting antivirals against hepatitis C virus, the paper asks whether and how the cost-effectiveness (CE) opinions issued by the French National Health Authority improve the information available to support the pricing decisions. METHODS: The analysis compares the assessment of these drugs based on three different sources: CE opinions, clinical opinions, and the published cost-utility analyses (CUA) available in the literature and identified through a systematic review. RESULTS: The results show that CE opinions bring to the fore three issues prone to impact the incremental cost utility ratio and those were not available to the decision maker through clinical opinions or published CUA: the stage of treatment initiation, the modeling of the disease progression, and the uncertainty around the efficacy rates. CONCLUSIONS: France has introduced the criterion of the cost per QALY gained in the pricing and regulation of innovative pharmaceuticals since 2013. Our analysis shows that the use of CUA does enhance the information available to the decision makers on the value of the treatments.


Assuntos
Antivirais/economia , Análise Custo-Benefício/métodos , Hepatite C/economia , Terapias em Estudo/economia , Antivirais/farmacologia , Antivirais/uso terapêutico , Economia Médica , França/epidemiologia , Hepatite C/tratamento farmacológico , Hepatite C/epidemiologia , Humanos , Imidazóis/economia , Imidazóis/uso terapêutico , Sofosbuvir/economia , Sofosbuvir/uso terapêutico , Terapias em Estudo/métodos
14.
Int J Technol Assess Health Care ; 35(1): 45-49, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30744730

RESUMO

OBJECTIVES: Cardiac surgery has seen substantial scientific progress over recent decades. Health economic evaluations have become important tools for decision makers to prioritize scarce health resources. The present study aimed to identify and critically appraise the reporting quality of health economic evaluations conducted in the field of cardiac surgery. METHODS: A literature search was performed to identify health economic evaluations in cardiac surgery. The consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement was used to assess the quality of reporting of studies. RESULTS: A total 4,705 articles published between 1981 and 2016 were identified; sixty-nine studies fulfilled the inclusion criteria. There was a trend toward a greater number of publications and reporting quality over time. Six (8.7 percent) studies were conducted between 1981 and 1990, nine (13 percent) between 1991 and 2000, twenty-four (34.8 percent) between 2001 and 2010, and thirty (43.5 percent) after 2011. The mean CHEERS score of all articles was 16.7/24; for those published between 1980 and 1990 the mean (SD) score was 10.2 (±1.4), for those published between 1991 and 2000 it was 11.2 (±2.4), between 2001 and 2010 it was 15.3 (±4.8), and after 2011 it was 19.9 (±2.9). The quality of reporting was still insufficient for several studies after 2000, especially concerning items "characterizing heterogeneity," "assumptions," and "choice of model." CONCLUSIONS: The present study suggests that, even if the quantity and the quality of health economics evaluation in cardiac surgery has increased, there remains a need for improvement in several reporting criteria to ensure greater transparency.


Assuntos
Procedimentos Cirúrgicos Cardíacos/economia , Economia Médica/organização & administração , Publicações Periódicas como Assunto/normas , Bibliometria , Análise Custo-Benefício , Economia Médica/normas , Humanos , Projetos de Pesquisa
16.
Res Synth Methods ; 10(2): 195-206, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30761762

RESUMO

INTRODUCTION: The number of systematic reviews of health economic evaluations (SR-HEs) is increasing. We aimed at providing a detailed overview of the characteristics and applied methods in recently published SR-HEs. METHODS: We searched MEDLINE (03/2017) for SR-HEs published since 2015 using validated search filters. We included studies that performed a systematic review of full economic evaluations and searched at least one electronic database. We extracted data in a standardized, beforehand piloted form that was deduced from the items of the PRISMA and CHEERS checklists. Data were extracted by one reviewer, and a 10% random sample was verified by a second. We prepared descriptive statistical measures to describe the SR-HEs. RESULTS: We included 202 SR-HEs. We identified similarities especially in the methods for information retrieval. Study selection, data extraction, and assessment of quality and transferability were frequently not reported or performed without taking measures to reduce errors (eg, independent study selection). A wide range of different tools was applied for critical appraisal. Moreover, the reporting of included economic evaluations and the synthesis of their results showed strong variations. CONCLUSIONS: Overall, we identified few common features in the applied methods for SR-HEs. The information retrieval processes are largely standardized, but many studies did not use validated search filters. For the other systematic review steps, the methodological approaches varied. In particular, important challenges seem to be the methodological quality and transferability assessment as well as presentation and (quantitative) synthesis of results. Efforts are needed for increasing standardization, quality of applied methods, and reporting of SR-HEs.


Assuntos
Economia Médica/tendências , Pesquisa sobre Serviços de Saúde/tendências , Revisão Sistemática como Assunto , Análise Custo-Benefício , Coleta de Dados , Custos de Cuidados de Saúde , Humanos , MEDLINE , Publicações , Projetos de Pesquisa
17.
Am J Emerg Med ; 37(4): 722-725, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30611579

RESUMO

OBJECTIVE: Characterize the frequency and magnitude of all categories of publicly reported financial payments made to emergency physicians (EPs) in the United States (U.S.) in 2017. METHODS: This cross-sectional study of the 2017 Centers for Medicare and Medicaid Services Open Payments Database was exempt from Institutional Review Board Review. We calculated descriptive statistics of the frequency, type, and amount (medians) of general, research, and ownerships transactions made to EPs from industry, described regional differences of median payments to EPs, and characterized the drugs or devices most commonly associated with transactions. RESULTS: In 2017, among 40,899 practicing U.S. EPs, 14,447 (35.4%) received 51,870 general payments from industry totaling $12,870,832. The median per-physician payment was $18.30 (interquartile range [IQR], $13.63-$60.90). The most frequent transaction was food and beverage (89.6%), though most payments by dollar amount were related to speaker and consulting fees (74.5%). Antithrombotics were the most frequently drug or device associated with transactions. Only 35 (0.08%) and 20 (0.05%) EPs had research and ownership relationships with industry, respectively. A significant difference was observed in median payments per physician across all U.S. Census regions (p < 0.01) except when comparing Northeast and West (p = 1.00). CONCLUSIONS: Over one-third of U.S. EPs had general payments from industry in 2017, while <1% of EPs had either research and ownership payments during this time period. Consistent with previous research, most payments to EPs are of low monetary value. Antithrombotics remain the most frequent drug associated with payments to EPs.


Assuntos
Revelação/legislação & jurisprudência , Medicina de Emergência/economia , Indústrias/economia , Médicos/economia , Conflito de Interesses , Indústria Farmacêutica/economia , Economia Médica , Doações , Humanos , Medicina , Patient Protection and Affordable Care Act , Mecanismo de Reembolso , Estados Unidos
18.
19.
J Eval Clin Pract ; 25(2): 244-250, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30259596

RESUMO

RATIONALE, AIMS AND OBJECTIVES: There is considerable uncertainty around the cost-effectiveness of interventions for preventing secondary falls in older people presenting to emergency departments (ED). The objective was to complete an economic evaluation of a brief educational ED intervention aimed at preventing falls in older people post discharge. METHODS: A net cost analysis was completed from the health system perspective, using data from a controlled clinical trial, where an education intervention was compared to standard care. Patients aged 65 and older presenting to the ED with any diagnosis were enrolled. The costs, using Australian dollars (A$) at 2015 values, included resources required for the intervention and any health care cost incurred in the 6-month follow-up period (time horizon). Cost data were sourced through institutional billing records and liaison with the patient and their general practitioner. Mean costs and differences were analysed through nonparametric bootstrapping. RESULTS: The total costs in the control group (n = 201) were A$1 576 496 compared to A$1 292 130 in the intervention group (n = 211). The mean net cost per patient was A$7749 and A$6187 (P = 0.68) respectively resulting in a mean difference of A$1580 per patient in the intervention group (95% CI: A$-2806 to A$6150). Patients who presented to the ED with a fall diagnosis were reviewed through subgroup analysis. Total costs for patients who presented with a fall in the control group (n = 69) were A$708 995 compared to A$512 874 in the intervention group (n = 97). The mean net cost per patient was A$10 326 and A$5343 respectively (P = 0.33) with an overall saving of A$4624 per patient in the intervention group (95% CI: A$-2868 to A$15 426). CONCLUSIONS: A brief intervention had no net cost benefit across the whole study population, but is more cost effective in older people presenting to the ED with a fall.


Assuntos
Acidentes por Quedas/prevenção & controle , Serviço Hospitalar de Emergência , Promoção da Saúde/economia , Promoção da Saúde/métodos , Alta do Paciente , Idoso , Idoso de 80 Anos ou mais , Austrália , Análise Custo-Benefício , Economia Médica , Medicina Baseada em Evidências , Feminino , Humanos , Masculino
20.
Expert Rev Pharmacoecon Outcomes Res ; 19(2): 181-187, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30426801

RESUMO

INTRODUCTION: Metamodels, also known as meta-models, surrogate models, or emulators, are used in several fields of research to negate runtime issues with analyzing computational demanding simulation models. This study introduces metamodeling and presents results of a review on metamodeling applications in health economics. AREAS COVERED: A scoping review was performed to identify studies that applied metamodeling methods in a health economic context. After search and selection, 13 publications were found to employ metamodeling methods in health economics. Metamodels were used to perform value of information analysis (n = 5, 38%), deterministic sensitivity analysis (n = 4, 31%), model calibration (n = 1, 8%), probabilistic sensitivity analysis (n = 1), or optimization (n = 1, 8%). One study was found to extrapolate a simulation model to other countries (n = 1, 8%). Applied metamodeling techniques varied considerably between studies, with linear regression being most frequently applied (n = 7, 54%). EXPERT COMMENTARY: Although it has great potential to enable computational demanding analyses of health economic models, metamodeling in health economics is still in its infancy, as illustrated by the limited number of applications and the relatively simple metamodeling methods applied. Comprehensive guidance specific to health economics is needed to provide modelers with the information and tools needed to utilize the full potential of metamodels.


Assuntos
Assistência à Saúde/economia , Economia Médica , Modelos Econômicos , Simulação por Computador , Tomada de Decisões , Humanos , Modelos Lineares
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