Outcomes evaluation approaches

Creating algorithms for programs to choose the best evaluation approaches and outcome indicators based on their size, goals, and activities. 

In other substance use disorders, the use of 12-step interventions is also popular, and participation in 12-step groups is correlated with better outcomes in cocaine abusers (e.g., McKay et al. 1994). However, a smdy of 128 cocaine abusers found that cognitive-behavioral therapy was more efficacious than 12-step facilitation in engendering cocaine abstinence (Maude-Griffm et al. 1998). Thus, the relative efficacy of 12-step approaches for drug use disorders requires further investigation. No known studies have systematically evaluated the efficacy of 12-step treatments in opioid-dependent patients, either alone or in conjunction with pharmacotherapies. 

Algorithms placing value on commercial outcomes can be dangerous due to the enormous uncertainties. Past evaluations based on this method are necessarily incorrect. Now the approach is that if we benefit patients, money will follow. 

The most commonly discussed and most useful modes of economic evaluation are cost-benefit and cost-effectiveness analyses. These and other approaches share some common elements, in particular their conceptualization and measurement of costs, but differ in two main respects they measure outcomes differently, and consequently they address slightly different policy or practice questions. 

The main modes of economic evaluation have a common aim in their approach to cost measurement, which—if a societal perspective is adopted (the most appropriate in mental health contexts see below)—is to range widely across all direct and indirect costs (Table 1.1). Every resource impact and every opportunity cost are to be included. The types of evaluation differ with respect to their measurement of outcomes. In seeking to turn these economic evaluative principles into empirical studies a number of practical decisions must be taken. A fuller account of the following discussion is provided by, for example, Drummond et al (1997) and Gold et al (1996). 

Outcome measurement is not discussed further in this chapter, hut it should he emphasized that some distinctive contributions could be made by economics. These include the development of summary unidimensional measures (discussed in the cost-utility section earlier), and benefit valuation in monetary terms (with its attendant difficulties, even though valuation methods are breaking new ground). However, acceptable (and potentially insightful) economic evaluations can be conducted without resorting to utility or benefit measurement. Cost-effectiveness and cost-consequences approaches have a lot to offer, building on outcome measures which will be more familiar to non-economist researchers in the field. It is for this reason that cost-effectiveness and cost-consequences analyses, linked to drug trials, are the most likely to be used over the next few years. 

Table 12.1 summarizes five major types of pharmacoeconomic evaluations cost-consequence, cost-benefit, cost-effectiveness, cost-minimization, and cost-utility (Drummond et al., 1997 Kielhorn and Graf von der Schulenburg, 2000). In a cost-consequence analysis, a comprehensive list of relevant costs and outcomes (consequences) of alternative therapeutic approaches are presented in tabular form. Costs and outcomes are typically organized according to their relationship to cost (direct and indirect), quality of life, patient preferences, and clinical outcomes (see taxonomy below). No attempt is made to combine the costs and outcomes into an economic ratio, and the interpretation of the analysis is left in large part to the reader. 

Following rapid field testing, samples of the potentially contaminated air/water/ soil will be collected for potential lab analysis. The decision to send samples to a lab for analysis should be based on the outcome of the threat evaluation. If the threat is determined to be credible, then samples should be immediately delivered to the lab for analysis. The analytical approach for samples collected from the site should be developed with input from the supporting lab(s), based on information from the site characterization and threat evaluation. 

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