Cost comparison of four revascularisation procedures for the treatment of multivessel coronary artery disease

Objective: An economic evaluation was performed, using modelling techniques, to compare 1-year total costs of four revascularisation procedures in patients with multivessel disease: on-pump coronary artery bypass grafting (CABG); off-pump CABG; percutaneous coronary intervention (PCI) with bare-metal stents (BMS); and PCI with drug-eluting stents (DES).

Methods: Clinical data were derived from four randomised clinical trials comparing CABG versus PCI, as well as from literature reviews. Resource use and unit cost estimates were modelled to reflect current Canadian practice.

Results: This study demonstrated that 1 year after the initial revascularisation, PCI with BMS is the least costly procedure, followed by off-pump CABG, PCI with DES and on-pump CABG. DES became the most costly procedure if 3.5 or more DES were used or if staged PCI was performed.     

An application of the SF-6D to create heath values in Portuguese working age adults

Objectives: This study describes the health-related quality of life (HRQOL) of the Portuguese working age population and investigates sociodemographic differences.

Methods: Subjects randomly selected from the working age population (n=2,459) were assessed using the SF-36v2 and converted into the preference-based SF-6D.

Results: The mean SF-6D utility value was 0.70 (range 0.63–0.73). The mean utility value was lower for the lower educational level than for the highest. Women, people living in rural areas and older adults reported lower levels of utility values. Non-parametric tests showed that health utility values were significantly related to employment; unskilled manual workers reported utility values lower than non-manual workers. For different diseases, mean utility values ranged from 0.58 (sexual diseases) to 0.66 (hepatic conditions). Cluster analysis was adopted to classify individuals into three groups according to their answers to the SF-6D dimensions. Multinomial logit regression was used to detect sociodemographic characteristics affecting the probability of following each cluster pattern. This study yielded normative data by age and gender for the SF-6D.

Conclusions: The authors conclude that SF-6D is an effective tool for measuring HRQOL in the community so that different population groups can be compared. The preference-based measure used seems to discriminate adequately across sociodemographic differences. These results allow a better understanding of the impact of sociodemographic variables on the burden of illness perception.

A previous version of this paper was presented at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 8th Annual European Congress held at Florence, Italy in November 2005.     

Injuries in different socio-economic groups in Finland

Introduction. Suicides are a hidden and unrecognized epidemic in the Indian region, affecting predominantly younger age groups. Information on causative risk factors and mechanisms is not available in the country, which is crucial for designing intervention programmes.

Objectives. To identify and quantify risk factors for completed suicides in the city of Bangalore.

Methods. A case–control study was conducted with the families of 269 completed suicides and 269 living controls within the broader population of the city using psychological autopsy methods.

Results. The study has shown that several factors in the areas of family, marriage, education, occupation, general health, mental health and absence of protective factors contribute significantly for suicides. The cumulative and repetitive interaction of several factors in a complex manner results in suicides. The significant factors were presence of previous suicidal attempt in self (odds ratio (OR) = 42.62), interpersonal conflicts and marital disharmony with spouse (OR = 27.98), alcoholism in self (OR = 23.38), presence of a mental illness (OR = 11.07), sudden economic bankruptcy (OR = 7.1), domestic violence (OR = 6.82) and unemployment (OR = 6.15). Individuals completing suicides did not have a positive outlook towards life, problem-solving approaches and coping skills.

Conclusion. The observed findings are at variance with suicidal causation in the West in some areas operating in a different sociocultural and economic environment. The intervention strategies should include prioritized macro and micro level efforts aimed at individual, family and society.     

Organizational Issues in Sales Force Decisions

No abstract available for this article.     

Understanding Biophilia Leisure as Facilitating Well-Being and the Environment: An Examination of Participants’ Attitudes Toward Horticultural Activity

Biophilia is humans’ inherited psychological tendency to be attracted to other forms of life and the natural environment. The main purpose of this study was to identify the attributes of horticultural activity as a form of biophilia leisure, which is based on humans’ biophilic tendency to affiliate with life and nature. Confirmatory factor analysis was used to examine the multidimensional structure of horticultural attitudes in understanding biophilia leisure. The results identified a second-order factor structure with four dimensions of horticultural attitudes: leisure belief, increasing positive mood, improving social relationships, and improving the environment. This result suggests a persuasive framework for biophilia leisure, which is beneficial not only for human well-being, but also for preserving the natural environment.     

Economic evaluation in health: saving money or improving care?

Summary

Economic evaluation, most commonly in the form of cost-effectiveness analysis, has now become an established tool of overall health financing policy. However, health policy makers choose to use or ignore the accumulated body of economic evidence for a variety of reasons. This policy review takes a step back and looks objectively at the appropriate role and use of cost-effectiveness analysis within the broader context of health system financing, and also discusses a series of technical limitations (and potential solutions) that impact on the generation of a genuinely comparable economic evidence base in health at the population level. While the explicit purpose of economic evaluation is to address the health financing objective of efficiency, the authors conclude that its application can be usefully extended to other health system goals, including financial protection (specification of core public healthcare packages for universal insurance) and equity in financing (assessment of intervention costs and effects by stakeholder or socioeconomic group). In order to contribute to these broader objectives, a sectoral or population-based approach to cost-effectiveness analysis is needed.     

Perceived Impacts of Government Regulations on Technology Transfers

ABSTRACT

This paper examines the effects of government regulation on the technology transfer process. Technology transfer is an important component of an economic development effort in communities, states, and nations. Understanding the process used to transfer technology is needed to promote policies that develop an effective infrastructure to encourage technology transfer. This paper uses qualitative and quantitative methodologies to examine managerial perceptions of the effects of government policies on the technology transfer process. The impacts of tax policies, environmental regulations, health and safety regulations, labor regulations, international trade regulations, and the differences in regulations between countries are studied. Items used to measure the success of technology transfer are proposed.     

The Social Value Theory of Orthodoxy: A Review and Critique

From an institutionalist perspective, we identify five sources of policy conflict. Each may explain why policies intended to obtain particular goals for an institutionalized practice may have unintended consequences. We illustrate by analyzing attempts at introducing market-oriented reform in health care provision.     

慢性病健康管理与社区卫生服务发展的思考

慢性病健康管理与社区卫生服务互相促进、互相补充，共同服务于慢性病防治工作。应通过制度创新，转变筹资模式，创新支付机制，推行协议管理等措施发展社区卫生服务，做好慢性病健康管理工作。