The Experts below are selected from a list of 309 Experts worldwide ranked by ideXlab platform
Kevin C. Chung - One of the best experts on this subject based on the ideXlab platform.
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a cost Utility Analysis of nonsurgical management total wrist arthroplasty and total wrist arthrodesis in rheumatoid arthritis
Journal of Hand Surgery (European Volume), 2010Co-Authors: Christi M. Cavaliere, Kevin C. ChungAbstract:Purpose Management of end-stage rheumatoid wrist disease remains controversial. Total wrist arthrodesis provides reliable pain relief and stability and is the most commonly applied management strategy. Total wrist arthroplasty is a motion-preserving alternative that is gaining popularity. The purpose of this study was to perform a cost-Utility Analysis comparing nonsurgical management, total wrist arthroplasty, and total wrist arthrodesis for the rheumatoid wrist. Methods A time trade-off Utility survey was developed to investigate patient and physician preferences for the potential outcomes of total wrist arthroplasty and total wrist arthrodesis. The study sample consisted of rheumatoid patients (N = 49) recruited as part of an ongoing prospective study and a national random sample of hand surgeons and rheumatologists (N = 109). A decision tree was created using Utility values derived from the survey, and the expected quality-adjusted life-years (QALYs) for each procedure were determined. Using the societal perspective, costs were based on the Medicare fee schedules for the Current Procedural Terminology codes associated with total wrist arthroplasty and total wrist arthrodesis and their potential complications. Costs per QALY were calculated and compared. Results Patients and physicians both showed a preference for surgical management over nonsurgical management. Application of cost data indicated that the incremental cost per additional QALY gained for total wrist arthroplasty over nonsurgical management was $2,281 and the incremental cost per QALY gained with total wrist arthroplasty over total wrist arthrodesis was $2,328, which is substantially less than the national standard of $50,000/QALY deemed acceptable for adoption. Conclusions In the absence of rigorous outcome data, cost-Utility Analysis is a useful tool to guide treatment decisions. Total wrist arthroplasty and total wrist arthrodesis are both extremely cost-effective procedures. This study incorporated patient and physician utilities to demonstrate that total wrist arthroplasty has only a small incremental cost over the traditional total wrist arthrodesis procedure. Based on this economic model, total wrist arthroplasty may be worthy of further consideration, and cost should not be considered prohibitive. Type of study/level of evidence Decision Analysis II.
Christi M. Cavaliere - One of the best experts on this subject based on the ideXlab platform.
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a cost Utility Analysis of nonsurgical management total wrist arthroplasty and total wrist arthrodesis in rheumatoid arthritis
Journal of Hand Surgery (European Volume), 2010Co-Authors: Christi M. Cavaliere, Kevin C. ChungAbstract:Purpose Management of end-stage rheumatoid wrist disease remains controversial. Total wrist arthrodesis provides reliable pain relief and stability and is the most commonly applied management strategy. Total wrist arthroplasty is a motion-preserving alternative that is gaining popularity. The purpose of this study was to perform a cost-Utility Analysis comparing nonsurgical management, total wrist arthroplasty, and total wrist arthrodesis for the rheumatoid wrist. Methods A time trade-off Utility survey was developed to investigate patient and physician preferences for the potential outcomes of total wrist arthroplasty and total wrist arthrodesis. The study sample consisted of rheumatoid patients (N = 49) recruited as part of an ongoing prospective study and a national random sample of hand surgeons and rheumatologists (N = 109). A decision tree was created using Utility values derived from the survey, and the expected quality-adjusted life-years (QALYs) for each procedure were determined. Using the societal perspective, costs were based on the Medicare fee schedules for the Current Procedural Terminology codes associated with total wrist arthroplasty and total wrist arthrodesis and their potential complications. Costs per QALY were calculated and compared. Results Patients and physicians both showed a preference for surgical management over nonsurgical management. Application of cost data indicated that the incremental cost per additional QALY gained for total wrist arthroplasty over nonsurgical management was $2,281 and the incremental cost per QALY gained with total wrist arthroplasty over total wrist arthrodesis was $2,328, which is substantially less than the national standard of $50,000/QALY deemed acceptable for adoption. Conclusions In the absence of rigorous outcome data, cost-Utility Analysis is a useful tool to guide treatment decisions. Total wrist arthroplasty and total wrist arthrodesis are both extremely cost-effective procedures. This study incorporated patient and physician utilities to demonstrate that total wrist arthroplasty has only a small incremental cost over the traditional total wrist arthrodesis procedure. Based on this economic model, total wrist arthroplasty may be worthy of further consideration, and cost should not be considered prohibitive. Type of study/level of evidence Decision Analysis II.
L P Voruganti - One of the best experts on this subject based on the ideXlab platform.
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Cost-Utility Analysis in schizophrenia.
The Journal of clinical psychiatry, 1999Co-Authors: A G Awad, L P VorugantiAbstract:Estimation of quality of life is important to the study of the pharmacoeconomics of schizophrenia. The subject has gained popularity among policymakers, clinicians, and patients and their families, since the advent of new antipsychotic medications that are more expensive than older drugs yet have been shown to cause fewer side effects. Quantifying quality of life has been difficult, since studies often inconsistently define the concept or use rating scales that are inappropriate for the patient population. Utility Analysis is a procedure that calculates subjects' preferences regarding living with various health states, given such options as trading more years of life at a lowered health state for dying sooner but having a strong health state during the last years of life. The feasibility of performing Utility Analysis among patients with schizophrenia was recently examined in a study carried out by the authors. This article reflects initial observations from that study of Utility Analysis and includes a discussion of problems still facing the study of quality of life and Utility Analysis.
Jeff Richardson - One of the best experts on this subject based on the ideXlab platform.
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cost Utility Analysis what should be measured
Social Science & Medicine, 1994Co-Authors: Jeff RichardsonAbstract:The paper re-examines the issue of the appropriate unit for measuring output in cost Utility Analysis and the technique that will measure it. There are two main themes. The first is that Utility, as it is often conceived and quantified, is not an appropriate basis for measurement. Consequently, a question arises concerning the selection of an appropriate unit of measurement. The second theme is that there is a need to establish criteria for the evaluation of measurement units. Four criteria are proposed which follow from commonly accepted social objectives and from the requirements of a measurement unit. It is concluded that, as judged by these criteria, the measurement units produced by the time trade-off and person trade-off (equivalence) techniques are more satisfactory than the units produced by the rating scale, magnitude estimation or the standard gamble.
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A cost Utility Analysis of mammography screening in Australia
Social Science & Medicine, 1992Co-Authors: Jane Hall, Karen Gerard, Glenn Salkeld, Jeff RichardsonAbstract:Cost Utility Analysis is the preferred method of Analysis when quality of life instead is an important outcome of the project being appraised. However, there are several methodological issues to be resolved in implementing cost Utility Analysis, including whether to use generalised measures or direct disease specific outcome assessment, the choice of measurement technique, and the combination of different health states. Screening for breast cancer meets this criterion as mammographic screening has been shown to reduce mortality; and it is said that earlier treatment frequently results in less radical surgery so that women are offered the additional benefit of improved quality of life. Australia, like many other countries, has been debating whether to introduce a national mammographic screening programme. This paper presents the results of a cost Utility Analysis of breast cancer screening using an approach to measuring outcome, Healthy Year Equivalents, developed within this study to resolve these problems. Descriptions of breast cancer quality of life were developed from surveys of women with breast cancer, health professionals and the published literature. The time trade off technique was then used to derive values for breast cancer treatment outcomes in a survey of women in Sydney, Australia. Respondents included women with breast cancer and women who had not had breast cancer. Testing of (i) the effect of prognosis on the value attached to a health scenario; and (ii) whether the value attached to a health scenario remains constant over time has been reported. The estimate of the net costs of screening are reported. The costs of breast cancer screening include the screening programme itself, the further investigations and the subsequent treatment of breast cancer cases. Breast cancer is treated in the absence of screening, many commentators claim earlier treatment is costly but there is little evidence. Therefore we have investigated current patterns of breast cancer treatment, current use of investigations for women presenting with symptoms and current use of covert mammography screening. The results are extrapolated to obtain estimates of the costs and outcomes presented as cost per healthy year equivalent. This Analysis produces important information for the Australian policy debate over mammography. It also contributes to the development of cost Utility Analysis and the approach developed here can be applied more generally.
Jose Luis Pinto - One of the best experts on this subject based on the ideXlab platform.
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A proposal to solve the comparability problem in cost-Utility Analysis
Journal of Health Economics, 2002Co-Authors: Han Bleichrodt, Carmen Herrero, Jose Luis PintoAbstract:In cost-Utility Analysis it is assumed that health state valuations are directly comparable across individuals. Instead, health state valuations may be relative and related to people’s expectations and abilities. Then health state valuations are not fully comparable across people and, consequently, cost Utility Analysis cannot be applied in full. The present paper analyzes this comparability problem and proposes a method to solve it.
