Cost-effectiveness analysis relies on preference-weighted health outcome measures as they form the basis for quality adjusted life years. Studies of preference-weighted outcomes for children ...following traumatic brain injury are lacking.
This study seeks to describe the preference-weighted health outcomes of children following a traumatic brain injury at 3- and 6-months following pediatric intensive care unit (ICU) discharge.
Children aged 5-17 who required ICU admission and endotracheal intubation or mechanical ventilation.
The Quality of Well-being (QWB) score was used to describe preference-weighted outcomes. Clinical measures from the intensive care unit stay were used to estimate risk of mortality. Risk of mortality, Glasgow coma scores, patient length of stay in the intensive care unit, and parent-reported items from the Child Health Questionnaire (CHQ) were used to test construct validity.
Subject data were obtained from nine pediatric intensive care units with consent procedures approved by representative institutional review boards. Medical records containing clinical information from the ICU stay were abstracted by the study coordinating center. Caregivers of children were contacted by telephone for follow-up interviews at 3- and 6-months following ICU discharge. All interviews were conducted by telephone with the primary caregiver of the injured child. Preference score statistics are presented overall and in relation to characteristics of the patient and their ICU admission.
A response rate of 59% was achieved for the 3-month interviews (N = 56) and 67% for the 6-month interviews (N = 65) for caregivers of children aged 5 years and above that consented to participate. Overall, QWB scores averaged 0.508 (95% CI: 0.454-0.562) at the 3-month interview and 0.582 (95% CI: 0.526-0.639) at the 6-month interview. For both interview periods, scores ranged from 0.093 to 1.0 on a 0-1 value scale, where 0 represents death and 1 represents perfect health. Specific acute and chronic health problems from the QWB scale were present more often in patients with higher injury severity. Mortality risk, ICU length of stay, Glasgow Coma Scales, and parental reported summary scores from the CHQ all correlated correctly with the QWB scores.
The findings support the use of the QWB score with parental report to measure preference-weighted health outcomes of children following a traumatic brain injury. Information from the study can be used in economic evaluations of interventions to prevent or treat traumatic brain injuries in children.
Purpose. To assess feasibility, complications, local tumor recurrences, overall survival (OS) and estimates of cost-effectiveness for multi-site cryoablation (MCA) of oligo-metastatic colorectal ...cancer (mCRC) in a prospective study. Materials and Methods. 111 CT and/or US-guided percutaneous MCA procedures were performed on 151 tumors in 59 oligo mCRC patients. Mean patient age was 63 years (range 21–92 years), consisting of 29 males and 30 females. Tumor location was grouped according to common metastatic sites. Median OS was determined using the Kaplan-Meier. Estimates of MCA costs per LYG were compared to historical values for systemic therapies. Results. A mean 1.9 MCAs per patient were performed with a median clinical follow-up of 12 months. Major complication and local recurrence rates were 8% (9/111) and 12% (18/151), respectively. Median overall-survival (OS) was 23.6 months with an estimated 3-year survival rate of ~30%. Cryoablation remained cost effective with or without the presence of systemic therapies, with an adjunctive cost-effectiveness ratio (ACER) of $39,661–$85,580 per LYG. Conclusions. Multi-site cryoablation had very low complication and local recurrence rates, and was able to provide local control even for diverse soft tissue locations. Even as an adjunct to systemic therapies, MCA appeared cost-effective, with apparent increased survival.
Cost‐effectiveness calculations of prostate cancer early detection havenot been possible due to the lack of any data demonstrating reduction inmortality from any test or procedure. Prior analyses ...focused only on costassessments without consideration of any possible benefits. We used currentdata from three consecutive years of the American Cancer Society‐National Prostate Cancer Detection Project to assess different economic perspectivesof test performance, marginal costs, and benefit‐cost analysis. Themarginal cost, or cost per cancer, of digital rectal examination (DRE)markedly increased by the third year relative to several proposedprostate‐specific antigen (PSA) scenarios. Sensitivity analysis for averagecost showed that at 4 ng/ml, pricing PSA below $30 would be the most potentfactor in potentially lowering costs. Analysis of receiver operatorcharacteristic curves suggested that optimal performance for PSA may be at3 ng/ml when combined with DRE or between 2 to 3 ng/ml when used alone. Benefit‐cost calculations demonstrated that DRE when performed by highlyskilled examiners had the lowest cost. However, DRE became one of the mostcostly detection scenarios when a minor decrease in performance wasassumed. Sensitivity analysis demonstrated that the three most determinantparameters of net benefit, in decreasing order, are: specificity, benefitsfrom earlier therapy, and prevalence. If a slightly more specific PSA assayis developed, the higher prevalence of clinically detectable prostatecancer could also make screening less costly than breast cancer screening. Under the assumptions of these analyses, the combination of PSA and DREappears to represent an ethical and economical detection choice forindividual patients in consultation with their physicians. Additionalresearch is needed to quantify the significance of differences betweendifferent screening strategies.
Several authors have attributed the heteroskedasticity observed in repeat sales house price equations to the length of time between sales. Recently, Goodman and Thibodeau (1995) developed a ...theoretical model that relates heteroskedasticity in hedonic house price equations to dwelling age. Using data for nearly 2,000 repeat sales in Dallas, Texas, this research examines whether repeat sales heteroskedasticity is related to dwelling age, to the length of time between sales, or to both. An iterative generalized least squares procedure that explicitly models the residual variance is used to obtain robust parameter estimates and to increase the efficiency of the usual repeat sales price indices.
This study investigates whether alcoholism treatment costs are offset by reductions in other medical treatment costs by comparing people treated for alcoholism with a matched comparison group. The ...alcoholism treatment group is defined by diagnoses of alcohol dependence, abuse, or psychoses from health insurance claims filed between January 1980 and June 1987. A comparison sample was matched on age, gender, and insurance coverage. In this primarily methodological study, expected costs for nonalcoholism treatments were calculated from standardized regressions. Offset effects were measured from the insurer’s perspective through differences in expected total nonalcoholism treatment costs in the periods preceding and following alcoholism treatment. Members of the alcoholism treatment group were more likely than the comparison group to be hospitalized and to need other (nonalcoholism) medical treatment, thus incurring higher total costs. Offset effects emerged for patients with alcohol abuse and without mental psychosis comorbidities.
This study addresses intertemporal housing demand in the presence of transactions costs. The consumer solves a problem similar to a government′s calculation of the socially optimal level of a public ...good. Instead of the government′s optimizing across individuals, the consumer optimizes over time periods, subject to the constraint that housing consumption remains constant. The resulting immobility cost provides a latent variable that can be modeled and compared to moving costs in the move-stay decision. Housing demand, number of moves, and lengths of stay all emerge endogenously. Comparative statics results are derived, and simulation analysis shows the dynamic properties.
This paper examines the incidence and extent of racial discrimination in various dimensions of owner‐occupied housing search. Audit data for sales units (1980‐90) from the Fair Housing Center of ...metropolitan Detroit is used in an ordered probit framework. Agents' own prejudices and the prejudices of their customers are shown to be significant in explaining discrimination. Results also indicate that white home seekers are steered toward more white and affluent neighborhoods.
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