http://www.resource-allocation.com The latest research articles published by Cost Effectiveness and Resource Allocation 2010-03-17T00:00:00Z This is an RSS newsfeed from BioMed Central It is intended to be used with an RSS reader. For more information about RSS newsfeeds from BioMed Central, visit http://www.biomedcentral.com/info/about/rss/ Background: Regional generalized cost-effectiveness estimates of prevention, screening and treatment interventions for colorectal cancer are presented. Methods: Standardised WHO-CHOICE methodology was used. A colorectal cancer model was employed to provide estimates of screening and treatment effectiveness. Intervention effectiveness was determined via a population state-transition model (PopMod) that simulates the evolution of a sub-regional population accounting for births, deaths and disease epidemiology. Economic costs of procedures and treatment were estimated, including programme overhead and training costs. Results: In regions characterised by high income, low mortality and high existing treatment coverage the addition of screening to the current high treatment levels is very cost-effective, although no particular intervention stands out in cost-effectiveness terms relative to the others.In regions characterised by low income, low mortality with existing treatment coverage around 50%, expanding treatment with or without screening is cost-effective or very cost-effective. Abandoning treatment in favour of screening (no treatment scenario) would not be cost effective.In regions characterised by low income, high mortality and low treatment levels, the most cost-effective intervention is expanding treatment. Conclusions: From a cost-effectiveness standpoint, screening programmes should be expanded in developed regions and treatment programmes should be established for colorectal cancer in regions with low treatment coverage. http://www.resource-allocation.com/content/8/1/2 Gary Ginsberg Stephen Lim Jeremy Lauer Benjamin Johns Cecilia Sepulveda Cost Effectiveness and Resource Allocation 2010, 8:2 2010-03-17T00:00:00Z doi:10.1186/1478-7547-8-2 Cost Effectiveness and Resource Allocation 1478-7547 8 2 2010-03-17T00:00:00Z PDF Background: The identification of safe and effective alternatives to blood transfusion is a public health priority. In sub-Saharan Africa, blood shortage is a cause of mortality and morbidity. Blood transfusion can also transmit viral infections. Giving tranexamic acid (TXA) to bleeding surgical patients has been shown to reduce both the number of blood transfusions and the volume of blood transfused. The objective of this study is to investigate whether routinely administering TXA to bleeding elective surgical patients is cost effective by both averting deaths occurring from the shortage of blood, and by preventing infections from blood transfusions. Methods: A decision tree was constructed to evaluate the cost-effectiveness of providing TXA compared with no TXA in patients with surgical bleeding in four African countries with different human immunodeficiency virus (HIV) prevalence and blood donation rates (Kenya, South Africa, Tanzania and Botswana). The principal outcome measures were cost per life saved and cost per infection averted (HIV, Hepatitis B, Hepatitis C) averted in 2007 International dollars ($). The probability of receiving a blood transfusion with and without TXA and the risk of blood borne viral infection were estimated. The impact of uncertainty in model parameters was explored using one-way deterministic sensitivity analyses. Probabilistic sensitivity analysis was performed using Monte Carlo simulation. Results: The incremental cost per life saved is $87 for Kenya and $93 for Tanzania. In Botswana and South Africa, TXA administration is not life saving but is highly cost saving since fewer units of blood are transfused. Further, in Botswana the administration of TXA averts one case of HIV and four cases of Hepatitis B (HBV) per 1,000 surgical patients. In South Africa, one case of HBV is averted per 1,000 surgical patients. Probabilistic sensitivity analyses confirmed the robustness of the model. Conclusion: An economic argument can be made for giving TXA to bleeding elective surgical patients. In countries where there is a blood shortage, TXA would be a cost effective way to reduce mortality. In countries where there is no blood shortage, TXA would reduce healthcare costs and avert blood borne infections. http://www.resource-allocation.com/content/8/1/1 Carla Guerriero John Cairns Sudha Jayaraman Ian Roberts Pablo Perel Haleema Shakur Cost Effectiveness and Resource Allocation 2010, 8:1 2010-02-17T00:00:00Z doi:10.1186/1478-7547-8-1 Cost Effectiveness and Resource Allocation 1478-7547 8 1 2010-02-17T00:00:00Z XML ObjectiveTo evaluate cost-utility of infliximab and adalimumab for the treatment of moderate-to-severe ulcerative colitis (UC) refractory to conventional therapies in Canada. Methods: A Markov model was constructed to evaluate incremental cost-utility ratios (ICUR) of 5 mg/kg and 10 mg/kg infliximab and adalimumab therapies compared to 'usual care' in treating a hypothetical cohort of patients (aged 40 years and weighing 80 kg) over a five-year time horizon from the perspective of a publicly-funded health care system. Clinical parameters were derived from the Active Ulcerative Colitis Trials 1 and 2. Costs were obtained through provincial drug benefit plans. ICUR was the main outcome measure and both deterministic and probabilistic sensitivity analyses were conducted. Results: Compared to the strategy A ('usual care') in the base case analysis, the ICURs were CA$358,088/QALY for the strategy B ('5 mg/kg infliximab + adalimumab') and CA$575,540/QALY for the strategy C ('5 mg/kg and 10 mg/kg infliximab + adalimumab'). The results were sensitive to: the remission rates maintained in responders to 'usual care' and to 5 mg/kg infliximab, the rate of remission induced by adalimumab in non-responders to 5 mg/kg infliximab, early surgery rate, and utility values. When the willingness to pay (WTP) was less than CA$150,000/QALY, the probability of 'usual care' being the optimal strategy was 1.0. The probability of strategy B being optimal was 0.5 when the WTP approximated CA$400,000/QALY. Conclusions: The ICURs of anti-TNF-α drugs were not satisfactory in treating patients with moderate-to-severe refractory UC. Future research could be aimed at the long-term clinical benefits of these drugs, especially adalimumab for patients intolerant or unresponsive to infliximab treatment. http://www.resource-allocation.com/content/7/1/20 Feng Xie Gord Blackhouse Nazila Assai Kathryn Gaebel Diana Robertson Ron Goeree Cost Effectiveness and Resource Allocation 2009, 7:20 2009-12-11T00:00:00Z doi:10.1186/1478-7547-7-20 Cost Effectiveness and Resource Allocation 1478-7547 7 20 2009-12-11T00:00:00Z XML Background: Targeted outreach, counselling, and treatment of sexually transmitted infections (STIs) are among the most cost-effective interventions aimed at ameliorating the burden of HIV/STIs. Since many new HIV infections occur in people under the age of 25, youth, and especially most at risk adolescents (MARA), need to be able to access HIV/STI services. Starting in 2006, a programme targeting MARA including outreach, confidential and voluntary counselling and testing, and STI diagnosis and treatment was piloted in three cities in Tajikistan. This study uses data from these pilot sites to estimate the costs of a national programme. Methods: Cost data were collected from the three pilot sites. Then, the target population and the number of patients receiving specific types of services are calculated for other areas. The unit costs from the pilot sites are multiplied by usage rates to determine the total costs of a national programme. Scenarios were developed to reflect data uncertainty. The government's ability to finance the programme was estimated using Ministry of Health budget data. Further analyses were done for one of the pilot cities where more detailed data were available. Results: In total, costs were projected for eight programme sites, covering an estimated 8,020 MARA. Operational and variable cost for the programme are projected to be US$ 119,159 (range US$ 104,953 to 151,524) per year. Including annual equivalent cost for capital and start-up items raises this to US$ 137,082 (range: US$ 123,022 to 169,597) per year. The analyses of potential sources of financing for the programme remain inconclusive, but it may take multiple sources of financing to fund the programme. Conclusion: While the cost-effectiveness of similar programmes have been previously assessed using modelled data, more work needs to be done to assess the costs of new programmes in relation to financial resources available. Full costing should consider cost-savings as well as expenditures. If feasible, the impact of the programme should be monitored over time. http://www.resource-allocation.com/content/7/1/19 Nisso Kasymova Benjamin Johns Benusrat Sharipova Cost Effectiveness and Resource Allocation 2009, 7:19 2009-11-03T00:00:00Z doi:10.1186/1478-7547-7-19 Cost Effectiveness and Resource Allocation 1478-7547 7 19 2009-11-03T00:00:00Z XML Background: Telemedicine has been advocated as an effective means to provide health care services over a distance. Systematic information on costs and consequences has been called for to support decision-making in this field. This paper provides a review of the quality, validity and generalisability of economic evaluations in telemedicine. Methods: A systematic literature search in all relevant databases was conducted and forms the basis for addressing these issues. Only articles published in peer-reviewed journals and written in English in the period from 1990 to 2007 were analysed. The literature search identified 33 economic evaluations where both costs (resource use) and outcomes (non-resource consequences) were measured. Results: This review shows that economic evaluations in telemedicine are highly diverse in terms of both the study context and the methods applied. The articles covered several medical specialities ranging from cardiology and dermatology to psychiatry. The studies analysed telemedicine in home care, and in primary and secondary care settings using a variety of different technologies including videoconferencing, still-images and monitoring (store-and-forward telemedicine). Most studies used multiple outcome measures and analysed the effects using disaggregated cost-consequence frameworks. Objectives, study design, and choice of comparators were mostly well reported. The majority of the studies lacked information on perspective and costing method, few used general statistics and sensitivity analysis to assess validity, and even fewer used marginal analysis. Conclusion: As this paper demonstrates, the majority of the economic evaluations reviewed were not in accordance with standard evaluation techniques. Further research is needed to explore the reasons for this and to address how economic evaluation in telemedicine best can take advantage of local constraints and at the same time produce valid and generalisable results. http://www.resource-allocation.com/content/7/1/18 Trine Bergmo Cost Effectiveness and Resource Allocation 2009, 7:18 2009-10-24T00:00:00Z doi:10.1186/1478-7547-7-18 Cost Effectiveness and Resource Allocation 1478-7547 7 18 2009-10-24T00:00:00Z XML Background: Studies have found a positive effect of low/moderate alcohol consumption on wages. This has often been explained by referring to epidemiological research showing that alcohol has protective effects on certain diseases, i.e., the health link is normally justified using selected epidemiological information. Few papers have tested this link between alcohol and health explicitly, including all diseases where alcohol has been shown to have either a protective or a detrimental effect.AimBased on the full epidemiological information, we study the effect of low alcohol consumption on health, in order to determine if it is reasonable to explain the positive effect of low consumption on wages using the epidemiological literature. Methods: We apply a non-econometrical cost-of-illness approach to calculate the medical care cost and episodes attributable to low alcohol consumption. Results: Low alcohol consumption carries a net cost for medical care and there is a net benefit only for the oldest age group (80+). Low alcohol consumption also causes more episodes in medical care then what is saved, although inpatient care for women and older men show savings. Conclusion: Using health as an explanation in the alcohol-wage literature appears invalid when applying the full epidemiological information instead of selected information. http://www.resource-allocation.com/content/7/1/17 Johan Jarl Ulf-G Gerdtham Klara Hradilova Selin Cost Effectiveness and Resource Allocation 2009, 7:17 2009-10-23T00:00:00Z doi:10.1186/1478-7547-7-17 Cost Effectiveness and Resource Allocation 1478-7547 7 17 2009-10-23T00:00:00Z XML Background: Millions of children die every year in developing countries, from preventable diseases such as pneumonia and diarrhoea, owing to low levels of investment in child health. Investment efforts are hampered by a general lack of adequate information that is necessary for priority setting in this sector. This paper measures the health system costs of providing inpatient and outpatient services, and also the costs associated with treating pneumonia and diarrhoea in under-five children at a health centre in Zambia. Methods: Annual economic and financial cost data were collected in 2005-2006. Data were summarized in a Microsoft excel spreadsheet to obtain total department costs and average disease treatment costs. Results: The total annual cost of operating the health centre was US$1,731,661 of which US$1 284 306 and US$447,355 were patient care and overhead departments costs, respectively. The average cost of providing out-patient services was US$3 per visit, while the cost of in-patient treatment was US$18 per bed day. The cost of providing dental services was highest at US$20 per visit, and the cost of VCT services was lowest, with US$1 per visit. The cost per out-patient visit for under-five pneumonia was US$48, while the cost per bed day was US$215. The cost per outpatient visit attributed to under-five diarrhoea was US$26, and the cost per bed day was US$78. Conclusion: In the face of insufficient data, a cost analysis exercise is a difficult but feasible undertaking. The study findings are useful and applicable in similar settings, and can be used in cost effectiveness analyses of health interventions. http://www.resource-allocation.com/content/7/1/16 Lumbwe Chola Bjarne Robberstad Cost Effectiveness and Resource Allocation 2009, 7:16 2009-10-21T00:00:00Z doi:10.1186/1478-7547-7-16 Cost Effectiveness and Resource Allocation 1478-7547 7 16 2009-10-21T00:00:00Z XML Background and AimsOne of the best-known performance planning and evaluation techniques utilising both monetary and non-monetary data is the Balanced Scorecard (BSC). This is a means of rationalising the global activity of a business in the attempt to create value, and to translate the company vision into a set of tactical objectives and measurable strategies. The aim of this study was to implement and evaluate the use of BSC in two departments of the St. Anna University Hospital, Ferrara: the Analysis Laboratory and Digestive Endoscopy operating units (OU).Materials and methodsWith the collaboration of the health workers involved, a precise methodological programme was pursued: Definition of the strategic map from 4 perspectives, according to Kaplan and Norton, Definition of the Key Performance Areas (KPA), or macro-objectives, Identification of the cause-effect relationships between KPAs, Identification of the sub-objectives of each KPA, Definition of the Key Performance Indicators (KPI), Definition of the weight/importance of each objective in the global evaluation. Results: The information gathered permitted the definition of macro- and sub-objectives for each perspective, as well as determining the relevant indicators, standards, weights, frequency of detection and means of acquisition. Strategic maps showing the cause/effect relationships in each OU were created, as were 'evaluation panels', which describe the global performance of each department. For each perspective, the fundamental data were summarised in one table. Evaluation of each perspective yielded a positive result for the majority of the objectives, and the global result (including all 4 perspectives) was found to be satisfactory.Discussion-ConclusionThe Balanced Scorecard was implemented in the abovementioned OUs of St. Anna University Hospital, Ferrara, after the health workers themselves realised the need for change.In our research the employees were pleased to be evaluated, not only for the financial outcomes, but also for the satisfaction of improving internal procedure, relationships with the community and their own growth/learning. BSC is an ideal point of contact between the financial and clinical dimensions of management. However, difficulties in its application were faced, among these, at least in the initial phase, the lack of information systems able to drive it, and the complexity of the research for specific indicators needed to be overcome. The time factor (on average, at least two years are required) and the availability of technological resources were also limiting factors.The rapid diffusion of BSC among the principal international profit and non-profit organisations is testament to its great potential. This project could be seen as a preparatory phase in the strategical analysis of a subsequent business plan. http://www.resource-allocation.com/content/7/1/15 Adriano Verzola Roberto Bentivegna Lucio Trevisani Gianni Carandina Pasquale Gregorio Alberto Mandini Cost Effectiveness and Resource Allocation 2009, 7:15 2009-09-08T00:00:00Z doi:10.1186/1478-7547-7-15 Cost Effectiveness and Resource Allocation 1478-7547 7 15 2009-09-08T00:00:00Z XML The journal Cost-Effectiveness and Resource Allocation (CERA) is now in its seventh year, and is an excellent example of how open access publishing can improve dissemination. Now the journal is through its infancy, it is time to reflect on its orientation and to define the strategy for the years to come. Firstly, the journal will pay particular attention to stimulating and publishing studies originating from low- and middle-income countries. Second, CERA will continue to solicit contributions originating from high-income countries, but with the caveat that such studies should be of interest to the broad international readership of the journal. Third, the journal encourages submissions on methodological work from any setting, that is generalisable between low-, middle-, and high income countries. Fourth, CERA recognizes the development of national health accounts and expenditure tracking as a first step to improved resource allocation, and solicit manuscripts of this nature. Finally, CERA recognizes that cost and cost-effectiveness analysis alone may not provide sufficient information to decision makers to guide their choices on the allocation of resources, and therefore encourages submission of studies that advance the broader field of priority-setting. http://www.resource-allocation.com/content/7/1/14 Rob Baltussen Arnab Acharya Kathryn Antioch Dan Chisholm Richard Grieve Joses Kirigia Tessa Tan Torres Edejer Damien Walker David Evans Cost Effectiveness and Resource Allocation 2009, 7:14 2009-07-23T00:00:00Z doi:10.1186/1478-7547-7-14 Cost Effectiveness and Resource Allocation 1478-7547 7 14 2009-07-23T00:00:00Z XML Background: As the resource implications of expanding anti-retroviral therapy (ART) are likely to be large, there is a need to explore its cost-effectiveness. So far, there is no such information available from Ethiopia.ObjectiveTo assess the cost-effectiveness of ART for routine clinical practice in a district hospital setting in Ethiopia. Methods: We estimated the unit cost of HIV-related care from the 2004/5 fiscal year expenditure of Arba Minch Hospital in southern Ethiopia. We estimated outpatient and inpatient service use from HIV-infected patients who received care and treatment at the hospital between January 2003 and March 2006. We measured the health effect as life years gained (LYG) for patients receiving ART compared with those not receiving such treatment. The study adopted a health care provider perspective and included both direct and overhead costs. We used Markov model to estimate the lifetime costs, health benefits and cost-effectiveness of ART.FindingsART yielded an undiscounted 9.4 years expected survival, and resulted in 7.1 extra LYG compared to patients not receiving ART. The lifetime incremental cost is US$2,215 and the undiscounted incremental cost per LYG is US$314. When discounted at 3%, the additional LYG decreases to 5.5 years and the incremental cost per LYG increases to US$325. Conclusion: The undiscounted and discounted incremental costs per LYG from introducing ART were less than the per capita GDP threshold at the base year. Thus, ART could be regarded as cost-effective in a district hospital setting in Ethiopia. http://www.resource-allocation.com/content/7/1/13 Asfaw Demissie Bikilla Degu Jerene Bjarne Robberstad Bernt Lindtjorn Cost Effectiveness and Resource Allocation 2009, 7:13 2009-07-17T00:00:00Z doi:10.1186/1478-7547-7-13 Cost Effectiveness and Resource Allocation 1478-7547 7 13 2009-07-17T00:00:00Z XML