Optimization of Antibacterial Therapy to Minimize Costs, Medication Errors, and Adverse Outcomes
Robert C. Owens, Paul G. Ambrose, Charles H. Nightingale in Antibiotic Optimization, 2004
Cost-benefit analysis is another type of pharmacoeconomic assessment that can be used to compare competing therapeutic strategies. In cost-benefit analysis, both the numerator (i.e., the benefit) and the denominator (i.e., the cost) are expressed in dollars. The advantage of this form of analysis is that it allows for comparisons of totally different treatment modalities. For example, the cost of infectious complications associated with the use of antibacterial-impregnated catheters could be compared to the cost of treating such complications with systemic antibacterial agents once infection occurs. In this example, the hypothesized benefit might be reduced cost of infectious complications associated with the catheters. If the benefit was clearly in favor of the catheters, the use of the catheters might be justified even if the relative costs associated with product acquisition (the denominator) were the same with both approaches. The major limitation of cost-benefit analysis is that it requires conversion of all benefits into a dollar figure, which may be very difficult with certain study end points (e.g., cost of death). Therefore, cost-benefit analysis tends to be used more for programmatic analyses than for therapeutic comparisons.
Rationalism, bureaucracy, and the organization of the health services
Graham Scambler in Sociological Theory and Medical Sociology, 1987
‘Only do those things where benefit exceeds cost; do not do those things where costs exceed benefits’ (Mooney 1986: 16). Cost/benefit analysis has its problems. Not all costs can be calculated; while the cost of an elderly person in a hospital bed can be assessed, it is more difficult to see the costs to that patient’s relatives (particularly the female ones) if that elderly person is nursed at home. As for benefits, like better care, comfort, and quality of life, these involve social, political, and moral judgements and few so far have been robustly confident enough to make these. In the first section of this chapter subjective assessments of health were discussed; measures of health status, however, need not contain a subjective component. Rather they may contain an objectively judged ‘subjective’ component. The assessment of quality of life is not a neutral technical tool, but it can appear so. This process of valorization carries potential for zweck-rationality. Weber himself remarked: ‘I do not believe questions of universal importance can be dealt with like questions of economics, or become the object of special disciplines like political economy’.
Evidence-Based Treatment
Barbara A. Wilson, Jill Winegardner, Caroline M. van Heugten, Tamara Ownsworth in Neuropsychological Rehabilitation, 2017
Economic evaluation can be defined as the comparative analysis of alternative courses of action in terms of costs on the one hand (resource use) and consequences on the other hand (outcomes, effects) (Adamiak, 2006). The aim of economic evaluation studies is to describe, measure and value all relevant alternative costs and consequences (e.g. intervention X versus comparator Y) (Shemilt et al., 2011). Different types of economic evaluation exist, such as cost-benefit analysis, cost-effectiveness analysis and cost-utility analysis. In partial economic evaluations (e.g. cost-analyses and cost-description studies), less evidence on the description, measurement or valuation of health-care interventions and technologies is provided in comparison to full economic evaluations. To give a relevant example of the difference between partial and full economic evaluations, we recently published a full economic evaluation of an augmented cognitive behavioural therapy intervention in comparison to computerised cognitive training for post-stroke depressive symptoms (Van Eeden et al., 2015). In this study both costs and effects were taken into account from a societal perspective. A few years ago we published a cost-analysis of a residential community reintegration programme for severe brain injury patients where only the costs of the programme but not the effects were taken into account (van Heugten et al., 2011).
Development of clinical practice guidelines for allied health and nursing assessment and management of Duchenne muscular dystrophy
Published in Disability and Rehabilitation, 2022
Z. E. Davidson, P. Bray, K. Rose, M. J. Rodrigues, L. Corben, K. N. North, M. M. Ryan, J. Burns
The CPG development process highlighted key areas where more allied health research is needed. The primary area identified was musculoskeletal management, especially in the area of stretching. Outside of serial casting, we did not retrieve any evidence in this area; and this was the area for which the second Delphi survey was required to obtain consensus. Other key areas where there was limited evidence to guide practice included: management of upper limb function (splinting); weight management, dysphagia assessment and management, pressure care, psychosocial, learning and behaviour assessment and management, and pathways for transition care. In the included management papers, it was evident that broader health outcomes such as quality of life, participation, pain, and disease progression were not formally assessed using validated patient reported outcome measures. These health outcomes are needed so that we can understand if allied health and nursing interventions improve daily life from patients’ perspectives. Finally, due to a lack of clear consensus in treatment approach and frequency prior to this work, cost–benefit studies are not yet available for allied health in DMD. Cost–benefit analysis would strongly support an evidence to decision framework to be applied in future guidelines [24].
Consequences of a large-scale nuclear accident and guidelines for evacuation: a cost-effectiveness analysis
Published in International Journal of Radiation Biology, 2020
Moshe Yanovskiy, Ori Nissim Levi, Yair Y. Shaki, Yehoshua Socol
In this work, we have developed a recommendation for quantitatively justified guidelines for evacuation, considering its human and economic cost. To the best of our knowledge such quantitative justification has not been performed as yet. The present guidelines published by IAEA—International Atomic Energy Agency (IAEA 2015)—are probably based on averting radiation risk only. In past, IAEA (1985) considered cost-benefit analysis as an important tool in decision making. However, the present guidelines do not mention cost-benefit or cost-effectiveness analysis. We would like to stress therefore that the difference between the past (IAEA 1985) and the present (IAEA 2015) recommendations are likely a matter of the change in policy rather than of accumulated scientific evidence. An extensive quantitative assessment of the cost-effectiveness of relocation measures following nuclear power plant accidents has been published (Waddington et al. 2017). However, this assessment is purely retrospective (Chernobyl and Fukushima) and the authors do not provide recommendations for establishing an action level for evacuation in future emergencies. This assessment (Waddington et al. 2017) is addressed in more detail in the Discussion section. Very recently, an important analysis of Church and Brooks (2020) has been published. The latter, however, also lacks quantitative recommendations.
Process Evaluation of Home-based Bimanual Training in Children with Unilateral Cerebral Palsy (The COAD-study): A Mixed Methods Study
Published in Developmental Neurorehabilitation, 2022
LWME Beckers, RJEM Smeets, MAC de Mooij, B Piškur, JJW van der Burg, EAA Rameckers, PBM Aarts, COAD Author Group, YJM Janssen-Potten
A natural progression of this study is to confirm the appropriateness of the proposed modifications, by investigating either an amended version of the current program or a new program using a user-centered design in which the recommendations are incorporated. In particular, the consequences of a reduced duration to eight weeks on the motor performance improvements should be examined. Given the importance of the video-recordings in the coaching process, a well-operating data sharing system is imperative. The arQive system seems promising. However, as this was implemented later on in the study, the credibility of this finding is limited. More studies need to be done to establish whether arQive does indeed suffice, or to assess the feasibility of alternatives. A better understanding of interacting variables in implicit and explicit motor learning is an essential next step in defining their eligibility for particular children, parents, and phases of learning. Ideally, a model will be developed to predict the optimal proportion of implicit and explicit motor learning techniques for each individual family and situation. A cost-benefit analysis for the various program components is also a relevant topic for future research. Lastly, following the suggestion of parents and therapists, further work is recommended to explore and test the optimal design of a hybrid model, integrating home-based and center-based training.
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