We analyse the link between diet diversity, (which is a proxy of diet quality) and health outcomes measured by body-mass index (BMI) in a representative sample of Kosovar adults using household expenditure micro-data. Building on a household model of health production we devise a two-stage empirical strategy to estimate the determinants of diet diversity and its effect on BMI. Economic factors and demographic characteristics play an important role in the choice of balanced diets. Results from the BMI analysis support the hypothesis that diet diversity is associated with optimal BMI. One standard deviation increase in diet diversity leads to 2.3% increase in BMI of the underweight individuals and to 1.5% reduction in BMI of the obese individuals. The findings have important implications for food security policies aiming at enhancing the public health in Kosovo.
- Klíčová slova
- BMI, Diet diversity, Diet quality, Food security, Health, Kosovo,
- MeSH
- dieta * MeSH
- dospělí MeSH
- ekonometrické modely MeSH
- hubenost epidemiologie MeSH
- index tělesné hmotnosti * MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- obezita epidemiologie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- socioekonomické faktory * MeSH
- zdravotní stav MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Kosovo epidemiologie MeSH
AIMS: This study assessed the cost-effectiveness of the subcutaneous RANKL inhibitor, denosumab, vs the intravenous bisphosphonate, zoledronic acid, for the prevention of skeletal-related events (SREs) in patients with prostate cancer, breast cancer, and other solid tumors (OST) in the Czech Republic. MATERIALS AND METHODS: A lifetime Markov model was developed to compare the effects of denosumab and zoledronic acid on costs (including drug costs and administration, patient management, SREs, and adverse events), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios from a national payer perspective. Different discount rates, time horizons, SRE rates, distributions, and nature (asymptomatic vs all SREs), and the inclusion of treatment discontinuation were considered in scenario analyses. The robustness of the model was tested using deterministic and probabilistic sensitivity analyses. RESULTS: Across tumor types, denosumab was associated with fewer SREs, improved QALYs, and higher total costs over a lifetime. The incremental cost per QALY gained for denosumab vs zoledronic acid was 382,673 CZK for prostate cancer, 408,450 CZK for breast cancer, and 608,133 CZK for OST. Incremental costs per SRE avoided for the same tumor type were 54,007 CZK, 51,765 CZK, and 94,426 CZK, respectively. In scenario analyses, the results remained similar to baseline, when different discount rates and time horizons were considered. At a non-official willingness-to-pay threshold of 1.2 million CZK, the probabilities of denosumab being cost-effective vs zoledronic acid were 0.64, 0.67, and 0.49 for prostate cancer, breast cancer, and OST, respectively. LIMITATIONS: The SRE rates used were obtained from clinical trials; studies suggest rates may be higher in clinical practice. Additional evidence on real-world SRE rates could further improve the accuracy of the modeling. CONCLUSIONS: Compared with zoledronic acid, denosumab provides a cost-effective treatment option for the prevention of SREs in patients with prostate cancer, breast cancer, and OST in the Czech Republic.
- Klíčová slova
- Bone, Breast cancer, Cost-effectiveness, Czech Republic, Oncology, Prostate cancer,
- MeSH
- analýza nákladů a výnosů MeSH
- bisfosfonáty aplikace a dávkování ekonomika MeSH
- denosumab aplikace a dávkování ekonomika MeSH
- dvojitá slepá metoda MeSH
- ekonometrické modely MeSH
- imidazoly aplikace a dávkování ekonomika MeSH
- inhibitory kostní resorpce aplikace a dávkování ekonomika MeSH
- kvalita života MeSH
- kvalitativně upravené roky života MeSH
- kyselina zoledronová MeSH
- lidé MeSH
- Markovovy řetězce MeSH
- nádory prostaty komplikace MeSH
- nádory prsu komplikace MeSH
- nádory komplikace MeSH
- nemoci kostí etiologie prevence a kontrola MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky, fáze III MeSH
- randomizované kontrolované studie MeSH
- Geografické názvy
- Česká republika MeSH
- Názvy látek
- bisfosfonáty MeSH
- denosumab MeSH
- imidazoly MeSH
- inhibitory kostní resorpce MeSH
- kyselina zoledronová MeSH
BACKGROUND: We analyzed the cost-effectiveness of treating incident chronic myeloid leukemia in chronic phase (CML-CP) with generic imatinib when it becomes available in United States in 2016. In the year following generic entry, imatinib's price is expected to drop 70% to 90%. We hypothesized that initiating treatment with generic imatinib in these patients and then switching to the other tyrosine-kinase inhibitors (TKIs), dasatinib or nilotinib, because of intolerance or lack of effectiveness ("imatinib-first") would be cost-effective compared with the current standard of care: "physicians' choice" of initiating treatment with any one of the three TKIs. METHODS: We constructed Markov models to compare the five-year cost-effectiveness of imatinib-first vs physician's choice from a US commercial payer perspective, assuming 3% annual discounting ($US 2013). The models' clinical endpoint was five-year overall survival taken from a systematic review of clinical trial results. Per-person spending on incident CML-CP treatment overall care components was estimated using Truven's MarketScan claims data. The main outcome of the models was cost per quality-adjusted life-year (QALY). We interpreted outcomes based on a willingness-to-pay threshold of $100 000/QALY. A panel of European LeukemiaNet experts oversaw the study's conduct. RESULTS: Both strategies met the threshold. Imatinib-first ($277 401, 3.87 QALYs) offered patients a 0.10 decrement in QALYs at a savings of $88 343 over five years to payers compared with physician's choice ($365 744, 3.97 QALYs). The imatinib-first incremental cost-effectiveness ratio was approximately $883 730/QALY. The results were robust to multiple sensitivity analyses. CONCLUSION: When imatinib loses patent protection and its price declines, its use will be the cost-effective initial treatment strategy for CML-CP.
- MeSH
- analýza nákladů a výnosů MeSH
- analýza přežití MeSH
- chronická myeloidní leukemie farmakoterapie ekonomika mortalita MeSH
- dospělí MeSH
- ekonometrické modely MeSH
- generika * ekonomika terapeutické užití MeSH
- imatinib mesylát ekonomika terapeutické užití MeSH
- inhibitory proteinkinas ekonomika terapeutické užití MeSH
- kvalitativně upravené roky života MeSH
- lékařská praxe - způsoby provádění * normy trendy MeSH
- lidé středního věku MeSH
- lidé MeSH
- Markovovy řetězce MeSH
- protinádorové látky ekonomika terapeutické užití MeSH
- senioři MeSH
- tyrosinkinasy antagonisté a inhibitory MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Research Support, N.I.H., Extramural MeSH
- srovnávací studie MeSH
- Geografické názvy
- Spojené státy americké epidemiologie MeSH
- Názvy látek
- generika * MeSH
- imatinib mesylát MeSH
- inhibitory proteinkinas MeSH
- protinádorové látky MeSH
- tyrosinkinasy MeSH
Objective Patients with bone metastases or lesions secondary to solid tumors or multiple myeloma often experience bone complications (skeletal-related events [SREs]-radiation to bone, pathologic fracture, surgery to bone, and spinal cord compression); however, recent data that can be used to assess the value of treatments to prevent SREs across European countries are limited. This study aimed to provide estimates of health resource utilization (HRU) and cost associated with all SRE types in Europe. HRU data were reported previously; cost data are reported herein. Methods Eligible patients from 49 centers across Austria (n = 57), the Czech Republic (n = 59), Finland (n = 60), Greece (n = 59), Portugal (n = 59), and Sweden (n = 62) had bone metastases or lesions secondary to breast, lung, or prostate cancer, or multiple myeloma, and ≥1 index SRE (a SRE preceded by a SRE-free period of ≥ 6.5 months). SRE-related costs were estimated from a payer perspective using health resource utilization data from patient charts (before and after the index SRE diagnosis). Country-specific unit costs were from 2010 and local currencies were converted to 2010 euros. Results The mean costs across countries were €7043, €5242, €11,101, and €11,509 per radiation to bone, pathologic fracture, surgery to bone, and spinal cord compression event, respectively. Purchasing power parity (PPP)-adjusted mean cost ratios were similar in most countries, with the exception of radiation to bone. Limitations The overall burden of SREs may have been under-estimated owing to home visits and evaluations outside the hospital setting not being reported here. Conclusions All SREs were associated with substantial costs. Variation in SRE-associated costs between countries was most likely driven by differences in treatment practices and unit costs.
- Klíčová slova
- Bone metastases, Cost, Europe, Skeletal-related events, Supportive care,
- MeSH
- ekonometrické modely MeSH
- fraktury spontánní ekonomika etiologie MeSH
- komprese míchy ekonomika etiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory kostí komplikace ekonomika sekundární MeSH
- senioři MeSH
- výdaje na zdravotnictví statistika a číselné údaje MeSH
- zdravotnické služby ekonomika statistika a číselné údaje MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Evropa MeSH
Using inpatient discharge records from the Italian region of Piedmont, we estimate the impact of an increase in malpractice pressure brought about by experience-rated liability insurance on obstetric practices. Our identification strategy exploits the exogenous location of public hospitals in court districts with and without schedules for noneconomic damages. We perform difference-in-differences analysis on the entire sample and on a subsample which only considers the nearest hospitals in the neighborhood of court district boundaries. We find that the increase in medical malpractice pressure is associated with a decrease in the probability of performing a C-section from 2.3 to 3.7 percentage points (7-11.6%) with no consequences for medical complications or neonatal outcomes. The impact can be explained by a reduction in the discretion of obstetric decision-making rather than by patient cream skimming.
- Klíčová slova
- C-sections JEL K13, I13, K32, experience rating, medical liability insurance, scheduled damages,
- MeSH
- císařský řez statistika a číselné údaje MeSH
- dospělí MeSH
- ekonometrické modely MeSH
- lékařská praxe - způsoby provádění ekonomika statistika a číselné údaje MeSH
- lidé MeSH
- pojištění zákonné odpovědnosti ekonomika statistika a číselné údaje MeSH
- porodnictví ekonomika normy statistika a číselné údaje MeSH
- těhotenství MeSH
- výsledek těhotenství ekonomika epidemiologie MeSH
- zanedbání povinné péče ekonomika statistika a číselné údaje MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Itálie epidemiologie MeSH
OBJECTIVE: To prove that higher cigarette taxes eventually decrease smoking and do also increase state incomes from tobacco taxes by using Hungarian figures. METHOD: Collection and analysis of available data on tobacco use, levels of excise and value added taxes on tobacco products and state incomes originating from the tobacco sector. CONCLUSIONS: In Hungary, regular tobacco tax increases resulted in decreased cigarette consumption and its lower prevalence figures in some population groups. State incomes have increased in spite of regular cigarette tax raises. Therefore, there is on conflict of interest between the health and finance portfolios in supporting further tobacco tax increases. Hungary should use regular, above the inflation tobacco tax raises as means for improving population health. Tobacco control advocates should prevent tobacco companies' attempts aimed at deterring decision makers from supporting such tax policies.
- MeSH
- daně zákonodárství a právo MeSH
- ekonometrické modely MeSH
- lidé MeSH
- prevalence MeSH
- příjem MeSH
- tabák MeSH
- věkové faktory MeSH
- zdravotní stav * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Maďarsko epidemiologie MeSH
Using western economic models evaluating cost/benefit in perinatal care, the author analyzed on examples of undesirable perinatal outcomes the health benefit as a result of extension of screening and therapeutic procedures in the Czech Republic in 1990-1996 as well as the efficacy, effectivity and efficiency of these procedures. The results of analyses provided evidence that extension of the above procedures led to a decline of undesirable outcomes, different for each of the five investigated types, but at the same time a considerable increase of costs was recorded which exceed resources available at present for health services in the Czech Republic. Further development of perinatal care which will have to overcome this discrepancy without jeopardizing the present high standard of perinatal care will have to consider a compromise which will achieve a balance between present professional knowledge and possibilities, the moral aspect, demands of society and available funds.
- MeSH
- analýza nákladů a výnosů MeSH
- ekonometrické modely MeSH
- lidé MeSH
- novorozenec MeSH
- perinatální péče ekonomika MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
The mutual cost-benefit relationship of any activity is the main principle of the market mechanism where both these variables are expressed in monetary terms. According to western economists this system cannot be applied, or if so only partly, in the sphere of health services because health benefit can be only in exceptional instances expressed in monetary terms. This is why they recommended for evaluation of health care, incl. perinatal care, other economic models where the health benefit is evaluated by saved lives or improvement of the health status. With this aspect in mind the author described five recommended models for the evaluation of alternative procedures and for evaluation of programmes in perinatology. Each of them is supplemented by examples from clinical practice. Most frequently different views are held on the effectivity of costly screening programmes for early detection of threatened foetuses and intensive care of these neonates, i.e. procedures which are the main cause of rising costs of perinatal care. The author discusses reasons for controversial views on contemporary economic problems in perinatology.
- MeSH
- ekonometrické modely MeSH
- finanční revize * MeSH
- jednotky intenzivní péče o novorozence ekonomika MeSH
- lidé MeSH
- lůžková kapacita nemocnice MeSH
- marketing zdravotnických služeb MeSH
- nemocnice - náklady statistika a číselné údaje MeSH
- novorozenec nedonošený * MeSH
- novorozenec MeSH
- platba za výkon MeSH
- případové studie organizací MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
We designed a simulation model for the assessment of the financial risks involved when a new diagnostic test is introduced in the laboratory. The model is based on a neural network consisting of ten neurons and assumes that input entities can have assigned appropriate uncertainty. Simulations are done on a 1-day interval basis. Risk analysis completes the model and the financial effects are evaluated for a selected time period. The basic output of the simulation consists of total expenses and income during the simulation time, net present value of the project at the end of simulation, total number of control samples during simulation, total number of patients evaluated and total number of used kits.
- MeSH
- ekonometrické modely * MeSH
- imunohistochemie ekonomika MeSH
- klinická chemie ekonomika metody MeSH
- lidé MeSH
- náklady na zdravotní péči MeSH
- neuronové sítě * MeSH
- počítačová simulace MeSH
- reagenční diagnostické soupravy ekonomika statistika a číselné údaje MeSH
- rizikové faktory MeSH
- technologie lékařská ekonomika metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- reagenční diagnostické soupravy MeSH
