Dissecting cost-effectiveness analysis for preventive interventions: a guide for decision makers. (25/1341)

BACKGROUND: Decision makers usually limit their use of economic evaluations of preventive interventions to the cost-effectiveness ratio. OBJECTIVE: To show decision makers how economic evaluations can be used to understand the cost-effectiveness of different options for altering health intervention strategies. OBSERVATIONS: Cost-effectiveness analysis provides insights into many factors that contribute to the overall benefits, hazards, and costs of interventions. This article reviews how epidemiologic and intervention characteristics, costs, natural history, targeting, and current interventions influence the value of prevention strategies. CONCLUSION: Understanding the factors that contribute to the overall costs and effectiveness of interventions should allow decision makers to better adapt interventions to their needs.  (+info)

Child health promotion in developing countries: the case for integration of environmental and social interventions? (26/1341)

In spite of improving epidemiological knowledge in relation to child health, the challenge of promoting the survival and quality of life of infants and children in most parts of the developing world remains an abiding public health problem, for both the countries and the international agencies involved. Current infant and child health programmes largely reflect western style medical care, with emphasis placed on reducing mortality, and the preventive aspects confined mainly to immunisation, improved nutrition, provision of micronutrients, promotion of breast-feeding and birth spacing. In contrast, environmental and social factors which underpin the proliferation of disease agents are receiving minimal attention. This paper presents a critical review of current strategies for promoting child health in developing countries, and examines the environmental, social, and political factors that influence child health. Presenting a specific example of infant and childhood diarrhoea, the authors argue that in order for a real reduction in mortality, and improvements in quality of life to be sustained, attention needs to be focused equally on the environmental and social factors that underlie much of the childhood diseases in the developing world. This will involve the adoption of a broader strategy aimed at reducing childhood diarrhoea, using the hazard analysis critical control point (HACCP) system in combination with other methods.  (+info)

The effect of delivery mechanisms on the uptake of bed net re-impregnation in Kilifi District, Kenya. (27/1341)

The results of recently completed trials in Africa of insecticide-treated bed nets (ITBN) offer new possibilities for malaria control. These experimental trials aimed for high ITBN coverage combined with high re-treatment rates. Whilst necessary to understand protective efficacy, the approaches used to deliver the intervention provide few indications of what coverage of net re-treatment would be under operational conditions. Varied delivery and financing strategies have been proposed for the sustainable delivery of ITBNs and re-treatment programmes. Following the completion of a randomized, controlled trial on the Kenyan coast, a series of suitable delivery strategies were used to continue net re-treatment in the area. The trial adopted a bi-annual, house-to-house re-treatment schedule free of charge using research project staff and resulted in over 95% coverage of nets issued to children. During the year following the trial, sentinel dipping stations were situated throughout the community and household members informed of their position and opening times. This free re-treatment service achieved between 61-67% coverage of nets used by children for three years. In 1997 a social marketing approach, that introduced cost-retrieval, was used to deliver the net re-treatment services. The immediate result of this transition was that significantly fewer of the mothers who had used the previous re-treatment services adopted this revised approach and coverage declined to 7%. The future of new delivery services and their financing are discussed in the context of their likely impact upon previously defined protective efficacy and cost-effectiveness estimates.  (+info)

Health care coverage and use of preventive services among the near elderly in the United States. (28/1341)

OBJECTIVES: It has been proposed that individuals aged 55 to 64 years be allowed to buy into Medicare. This group is more likely than younger adults to have marginal health status, to be separating from the workforce, to face high premiums, and to risk financial hardship from major medical illness. The present study examined prevalence of health insurance coverage by demographic characteristics and examined how lack of insurance may affect use of preventive health services. METHODS: Data were obtained from the Behavioral Risk Factor Surveillance System, an ongoing telephone survey of adults conducted by the 50 states and the District of Columbia. RESULTS: Many near-elderly adults least likely to have health care coverage were Black or Hispanic, had less than a high school education and incomes less than $15,000 per year, and were unemployed or self-employed. Health insurance coverage was associated with increased use of clinical preventive services even when sex, race/ethnicity, marital status, and educational level were controlled. CONCLUSIONS: Many near-elderly individuals without insurance will probably not be able to participate in a Medicare buy-in unless it is subsidized in some way.  (+info)

Access to care for the uninsured: is access to a physician enough? (29/1341)

OBJECTIVES: This study examined a private-sector, statewide program (Kentucky Physicians Care) of care for uninsured indigent persons regarding provision of preventive services. METHODS: A survey was conducted of a stratified random sample of 2509 Kentucky adults (811 with private insurance, 849 Medicaid recipients, 849 Kentucky Physicians Care recipients). RESULTS: The Kentucky Physicians Care group had significantly lower rates of receipt of preventive services. Of the individuals in this group, 52% cited cost as the primary reason for not receiving mammography, and 38% had not filled prescribed medicines in the previous year. CONCLUSIONS: Providing free access to physicians fills important needs but is not sufficient for many uninsured patients to receive necessary preventive services.  (+info)

Strong bones in later life: luxury or necessity? (30/1341)

Osteoporosis is a global problem which will increase in significance as the population of the world both increases and ages. This report looks at how the demographic changes in different countries of the world will be reflected in the incidence and cost of osteoporotic disease. Comparisons are made between the data collected by the European Union's Report on Osteoporosis in the European Community, issued in June 1998, and some of the data available from other parts of the world. The importance of prevention, early detection and appropriate treatment is stressed, as well as the need for national health services to provide reimbursement of the costs of prevention, diagnosis and treatment for high-risk groups.  (+info)

Strong bones in later life: luxury or necessity? The view from Tunisia: need for an inclusive approach.(31/1341)

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The role of resource allocation models in selecting clinical preventive services. (32/1341)

OBJECTIVE: To demonstrate the potential value and current limitations of using resource allocation models for selecting health services. DESIGN: To identify the most efficient mix of preventive services that could be offered by a managed care organization (MCO) for a fixed budget, an optimization model (greatest number of life years saved) and a cost-effectiveness model (rank order of most to least cost effective) were developed. Because of the lack of cost-effectiveness analyses that met the study criteria, only 9 preventive services were selected to demonstrate each model. PATIENTS AND METHODS: The 2 models were applied to a hypothetical managed care population of 100,000 enrollees with age, sex, and risk distribution similar to that of the US population. Data for the input variables were obtained from cost-effectiveness studies of 9 preventive services. Model variables included the target population, percent of enrollees who received the preventive service, the cost of the preventive service, life years saved, and cost-effectiveness ratios. RESULTS: The models demonstrated that efficient allocation of finite resources can be achieved. When budgets are limited, different premises between the 2 models may yield different health consequences. However, as the budgets were increased, results from the 2 models were more closely aligned. CONCLUSIONS: Resource allocation models have the potential for assisting MCOs in selecting a set of preventive services that will maximize population health. Before this potential can be fully realized, additional methodological development and cost-effectiveness studies are needed. The use of resource allocation should be examined for selecting all healthcare services.  (+info)