Cost-minimisation analysis

Cost-minimisation analysis are performed when the clinical outcomes (e.g. efficacy and safety) of the comparator groups are virtually identical and for all practical purposes can be considered to be equal. Because no decision can be made based on differences in the clinical endpoints, decisions are based on the incremental costs of the treatment pathways. Such was the case in a study that assessed the cost-effectiveness of treating proximal deep vein thromboses (DVT) at home with low molecular weight heparin versus standard heparin in hospital therapy. A cost-minimisation approach was chosen for this analysis because the results from a comparative clinical trial confirmed that there were no statistically significant differences in safety or efficacy between the two treatment groups. The study authors concluded that for patients with acute proximal DVTs, treatment at home with low molecular weight heparin was less costly than hospital treatment with standard heparin. ... 

An allied measure is the cost-minimisation analysis which finds the least costly programme among those shown or assumed to be of equal benefit. Economic analysis requires that both quantity and quality of life be measured. The former is easy, the latter is hard. 

The underlying premise of pharmacoeconomic analyses is that fiscal resources are scarce and that there is a need to make decisions based on the relative value of different interventions in creating better health and/or longer life. There are five main analytical techniques used to evaluate the incremental value of products. These are cost-consequence analysis (CCA) cost-effectiveness analysis (CEA) cost-benefit analysis (CBA) cost-minimisation analysis (CMA) and cost-utility analysis (CUA). Although the identification and valuation of the cost component (numerator) of these analyses are similar, it is the identification and valuation of the consequences (denominator) that truly differentiate these analytic techniques. A brief description of each of these techniques follows. 

Wakerly L, Craig A-M, Malek M et al. (1996). Fluconazole versus oral polyenes in the prophylaxis of immunocompromised patients a cost-minimisation analysis. J Hosp Infect, 33, 35—48. 

Cost-efifectiveness analysis (CEA) again measures costs in monetary units but it expresses effectiveness using a biological yet quantifiable unit of effect such as the number of lives saved or life years gained. CEA assesses the incremental costs and incremental effectiveness of one medical intervention relative to another. Unlike CBA, CEA ratios must be compared to an external standard and outcomes common to both alternatives are needed in order to judge relative desirability. A special form of CEA known as cost-minimisation analysis is essentially limited to comparing costs between alternative forms of treatment where the effectiveness of each has been demonstrated or can reasonably be assumed to be the same. 

Industrial analytical laboratories search for methodologies that allow high quality analysis with enhanced sensitivity, short overall analysis times through significant reductions in sample preparation, reduced cost per analysis through fewer man-hours per sample, reduced solvent usage and disposal costs, and minimisation of errors due to analyte loss and contamination during evaporation. The experience and criticism of analysts influence the economical aspects of analysis methods very substantially. 

First, project objectives must be clear through an analysis of the problem(s) appertaining to the product(s). Do not proceed blindly into a strategy which does not suit the situation. The final objective will be to prevent, or at least minimise, product copying, substitution, etc. at a realistic cost. There are only two options ... 

Smith, R., E. A. Petela, 1991-1992, Waste minimisation in process industries. The Chemical Engineer (UK), ibid. 1. The problem, 24-25, Oct. 1991, ibid. 2. Reactors. 17-23, Dec. 1991, ibid 3. Separation and recycle systems, 24-28 Febr. 1992, ibid 4. Process operations, 21-23, April 1992, ibid 5. Utility waste, 32-35, July, 1992 Towler, G. P., R. Mann, A. J. Serriere, C. M. D. Gabaude, 1996, Refinery hydrogen management cost analysis of chemically-integrated facilities, Ind. Eng. Chem. Res., 35 (78), 2378-2388... 

Although most samples are commonly presented as liquids for atomic emission spectroscopy, direct solid sample analysis has the advantage that no major pretreatment or dissolution steps are required [44]. This minimises dilution errors or contamination from reagents and reduces the reagent and manpower cost per sample. In addition, improved detection Hmits may be obtained if microsamples or microanalysis are possible without any further dilution. However, the analyst has to ensure that the solid material sampled is representative of the bulk material. ICP-AES has generally a remarkable tolerance for total dissolved sohds compared to ICP-MS or flame AAS so that, depending on the overall matrix, between 2 and 25 % suspended sohds can be coped with. Therefore, most of the sohd sample introduction devices described below are dedicated for ICP-AES. 

A consideration to bear in mind when using mass spectrometry for DNA analysis, either by SOMA or other methods, is that the presence of Na and K can result in the formation of adduct ions. The presence of adduct ions reduces both sensitivity and resolution and purification steps are therefore required to minimise their occurrence during sample preparation. Another concern of mass spectrometry-based methods is cost. However, once the mass spectrometer has been purchased ( US 100,000 to 300,000), the cost per sample is similar to that for other technologies. 

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