Health economic analysis

Based on this methodology, we can expect the following from a health economic analysis of an intervention ... 

Compared with the standard health economic methodology applied in COI studies for other diseases (e.g. Keith and Shackleton 2006 Welte et al. 2000 Leidl et al. 1999 Henke et al. 1997 Xie et al. 1996), the quality of health economic analysis of HIV/AIDS is not always satisfactory as far as costs are concerned (Levy et al. 2006). Sometimes it is not clear whether researchers included both inpatient and outpatient medications in their analyses. Equally important, many of the early studies used costs and charges interchangeably data using charges may not accurately reflect true costs. Drummond and Davis (1988) also argued that there have been incorrect estimates of the survival times and costs in aU these early studies, since there were no explicit adjustments made for disease severity. 

Various health economic analysis strategies are available to assist in exploring the value of allergy and asthma preventions. Of the various strategies, cost-effectiveness analysis is becoming the leading method. 

Scanlon E, Karlsmark T, Leaper DJ, Carter K, Poulsen PB, Hart-Hansen K and Hahn TW, Cost-effective faster wound heahng with a sustained silver-releasing foam dressing in delayed healing leg ulcers - a health-economic analysis . International Wound Journal, 2 (2), 2005, pp 150-160. 

The team should also undertake a comparative economic analysis of the P2 options and the existing situation. Where it cannot quantify benefits or changes (e.g., reduction in future liability, worker health and safety costs, etc.), it should make some form of qualitative assessment. 

This chapter adds the socio-economic dimension to the medical or technical perspectives of the proceeding contributions of this book. As its health economic terminology and approach might be unfamiliar to some readers, we start with a section on methodology. In particular, we present an overview of the concept of Cost-of-Illness (COI) and of relevant health economic evaluation techniques. In Sect. 2, we present the basic findings of a meta-analysis of the socio-economic costs of HIV/AIDS and of the socio-economic impact of antiviral intervention. The major findings are reflected in Sect. 3. The chapter closes with a speculation on long-term socio-economic costs of antiviral intervention. 

Three evaluative modes are discussed here cost-benefit analysis, cost-effectiveness analysis (and its recently distinguished variant cost-consequences analysis) and cost-utility analysis. Books by Drummond et al (1997) and Gold et al (1996)—the two most respected and widely cited texts on health economics evaluations—give excellent accounts of these modes of economic evaluation, and interested readers are referred to them for more advanced discussions. 

Readmission rates at 2 yr clozapine 13% risperidone 34% No significant differences in health-care resource expenditure No economic analysis... 

Shah and Jenkins (2000) in a review of mental health economic studies from around the world identified 40 cost-of-illness studies, of which five covered all disorders, one neuroses, two panic disorders and one anxiety. All were from developed countries. There were numerous cost-effectiveness studies but none involving the anxiety disorders specifically. One study in the UK examined the cost-benefit analysis of a controlled trial of nurse therapy for neurosis in primary care (Ginsberg et al, 1984). 

Andrea Manca is Research Fellow at the Centre for Health Economics, University of York. His research interests lie in the investigation of methodological and theoretical issues related to two broad areas the application of modelling techniques to support the decisionmaking process in health care, and the use of analytical methods in the conduction of economic analysis of health care interventions. Andrea s applied work focuses on a number of different technologies in several clinical areas, including mental health. 

A useful example of sustainable design comes from BASF, and their development of the eco-efficiency tool. This tool seeks to integrate the combined aspects of each of the three pillars in an attempt to quantify the most sustainable products and illustrates some of the concerns associated with evaluating sustainable products. For example, the economic analysis includes a total cost of ownership that goes beyond the purchase price of a product to incorporate the cost of operation, the cost of environmental health and safety, and the cost of labour. Thus, even though a product may have a lower purchase price, it may be more expensive to use and thus costlier over the total life cycle of the product. 

Pauly, M.V. and S.D. Ramsey (1999), Would you like suspenders to go with that belt An analysis of optimal combinations of cost sharing and managed care , Journal of Health Economics, 18, 443-58. 

Ontario Ministry of Health. Ontario guideUnes for economic analysis of pharmaceutical products. 1994 http //www.gov.on.ca/health/english/pub/ drugs / drugpro / economic.html... 

Griffin JP, Griffin TD, The economic imphca-tions of Therapeutic conservatism. In George Teeling Smith ed., Innovative Competition in Medicine A Shumpetarian analysis of the Pharmaceutical industry and the NHS, London Office of Health Economics Whitehall, 1991 85-96. 

Willan, A. R., E. M. Pinto, B. J. O Brien, et al. 2005. Country Specific Cost Comparisons from Multinational Clinical Trials Using Empirical Bayesian Shrinkage Estimation The Canadian ASSENT-3 Economic Analysis. Health Economics 14( l) 327-338. 

Chee-Ruey Hsieh is a Research Fellow in the Institute of Economics at Academia Sinica, Taipei, Taiwan. He received his Ph.D. in economics from Vanderbilt University in 1990. Dr. Hsieh has a long-standing interest in health economics and health policy. He is the co editor of The Economic Analysis of Substance Use and Abuse and The Economics of Health Care in Asia-Pacific Countries. 

The third axis in Fig. 1 is that of the perspective of an economic analysis of medical care. Costs and benefits can be calculated with respect to society s, the patient s, the payer s, and the provider s points of view. A study s perspective determines how costs and benefits are measured, and the economist s strict definition of costs (the consumption of a resource that could otherwise be used for another purpose) may no longer be appropriate when perspectives different from that of society as a whole are used. For example, a hospital s cost of providing a service may be less than its charge. From the hospital s perspective, then, the charge could be an overstatement of the resources consumed for some services. However, if the patient has to pay the full charge, it is an accurate reflection of the cost of the service to the patient. Alternatively, if the hospital decreases its costs by discharging patients early, the hospital s costs may decrease, but patients costs may increase because of the need for increased outpatient expenses that are not covered by their health insurance plan. 

Nevertheless, conducting economic analysis from other perspectives, in addition to the societal perspective, is important. This is because the costs of medical care may not be borne solely by the same parties who stand to benefit from it. Economic analysis of medical care often raises vexing ethical problems related to equity, distribution of resources, and responsibility for the health of society s members. Economic analysis from multiple perspectives shed light on the equity issues associated with new interventions. 

Drummond MF, Davies L. Economic analysis alongside chnical trials revisiting the methodological issues. Int J Technol Assess Health Care 1991 7 561-73. 

Willan AR, Pinto EM, O Brien BJ, Kaul P, Goeree R, Lynd L et al. Country-specific cost comparisons from multinational clinical trials using empirical Bayesian shrinkage estimation the Canadian ASSENT 3 economic analysis. Health Econ 2005 14 327-38. 

Therefore, an economic analysis must measure the quality of life of the patient to ensure that the value of the drug incorporates the patient s perspective. Quality of life is a concept that usually incorporates the physical, mental and social well-being of the patient. Initial doubts concerning the ability of schizophrenic patients to provide reliable and valid reports of their own quality of life led to the use of proxies for patient interviews. Caregivers and clinicians were consulted most often. However, recent research has shown that the use of proxies can produce very different results to those derived directly from the patient s responses. In addition, research now indicates that schizophrenic patients are able to provide stable, reliable and valid self-reports of their psychological well-being, health status and subjective evaluation of drug therapies (Awad et al., 1995). 

Chapter 9, Psychopharmacology and Health Economics, authored by Dr Ed Snyder, explains the principles of pharmacoeconomics and its applications in psychopharmacology. Readers will find a clear statement of the methodology employed in this still developing field which is of immense importance to day. Major decisions which affect the availability of psychotropic drugs and clinical decisions by individual practitioners are often based on poorly informed concepts of cost-benefit analysis. This chapter will greatly increase the sophistication of many readers on this topic. 

Member States or the Commission (via the Agency) can propose that the manufacture or use of specific substances is restricted, provided that a risk assessment has shown that the substances pose an unacceptable risk to human health or the environment. The risk assessment and the proposed restrictions must be considered within a set time period by a committee within the European Chemicals Agency (Article 67). The proposed restrictions are subject to a socio-economic analysis, considered by another committee within the Agency, and the opinion of both committees forwarded to the Commission. 

Under European chemicals legislation, proposals to restrict the production or use of chemicals, or to authorize the use of a chemical subject to the authorization procedures of REACH, are subject to a socio-economic analysis. The socio-economic analysis should include the following consideration of the commercial impacts on manufacturers, importers and downstream users the impacts on consumers the social impacts, such as effects on job security and employment the availability, suitability, technical and economic feasibility of alternative substances and/or technologies implications for trade, competition and economic development and the benefits for human health and the environment and the economic and social benefits of restrictions or refusal of authorizations (Regulation (EC) 1907/2006, Annex XVI). 

Article 56). Articles containing an Annex XIV substance may be imported to the EU without authorisation.16 Authorisation is to be granted by the Commission on a case-by-case basis for a specified period and under conditions subject to review, if the risks to health and the environment arising from the listed intrinsic properties of a substance are adequately controlled (Article 60, as defined in Annex I). However, the adequate control route is closed for a SVHC that has the properties PBT or vPvB or that is a CMR for which a threshold cannot be determined (Article 60). For such substances, or when control is not adequate, authorisation requires that socioeconomic benefits outweigh risks and that there are no substitutes available (Article 64). These aspects must be considered by a Committee for Risk Assessment and a Committee for Socioeconomic Analysis before the Commission can take a decision on an application, which must include a socio-economic analysis according to Annex XVI. 

In general, the scope and detail of a risk assessment determines the appropriateness of a given risk management measure (Section 2.3). Additional scientific study such as lifecycle assessment (LCA) can inform managers of the appropriateness of one regulatory measure compared with another in terms of the overall effects on health and the environment (Section 2.3). A socio-economic analysis of the effects of a regulatory measure can be carried out. Ultimately, the tolerability of a risk, which depends on perceived risks and benefits of a given risky chemical or activity, also influences the appropriateness of a risk reduction measure. 

To protect occupational and consumer health from DCM, Germany set technical standards on DCM sales. National measures would not have been practical for regulating the trade and marketing of DCM in the EU. Action to restrict the marketing of dangerous substances to protect human health or the environment must comply with Article 95 of the EC Treaty relating to the internal market. Objecting to immediate adoption of EU standards to ensure adequate risk reduction, the UK - a major producer of DCM - declared that it was necessary to conduct full risk assessments of alternative substances, as well as a detailed socio-economic analysis of... 

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