Læknablaðið - 15.08.1995, Blaðsíða 40

Læknablaðið - 15.08.1995, Blaðsíða 40
616 LÆKNABLAÐIÐ 1995; 81 and consequences associated with different forms of health care intervention. Such eval- uations provide frameworks for assisting deci- sion makers to make choices. Ideally, socioec- onomic evaluations should be performed alongside clinical trials. In cost-effectiveness analysis the costs are compared with outcomes measured in natural units, such as per cases treated appropriately, per lives saved, per pain free days, per compli- cations avoided. In cost-utility analysis the costs of different procedures and their out- comes are measured in units that relate to an individual's wellbeing, such as quality adjusted life year (QALY). Cost-benefit analysis is the most comprehensive method of socioeconomic evaluation, and it has been used as an aid to decision making in many different areas of health care policy making. Cost-benefit analy- sis places monetary values on both the inputs, or costs, and outcomes, or benefits, of health care. An important step in the overall socioec- onomic approach is to set the socioeconomic baseline. This includes basic disease data, pat- terns of disease management, and assessment of risks, costs and benefits. Costs are economic inputs required to achieve a certain output. Examples of direct costs are personnel and material expenses. Examples of indirect costs are income losses, loss of working time, and psychological distress. Benefits are the out- comes resulting from the intervention. Exam- ples of direct benefits are reduction of material and personnel costs, and avoidance of future treatment costs. Indirect benefit is for instance improved working or production capacity. So called decision tree analysis can be used in a wide range of socioeconomic analyses. It is a quantitative technique which measures the overall performance of a specific health care intervention, such as a new diagnostic test. In the decision tree model each brand of the tree requires specific input data. The application of PCR-based diagnostic test for C. trachomatis in women (to see whether women can benefit from PCR-based diagnostic testing) requires data of test characteristics, probabilities of clinical outcomes of Chlamydial infection in women, and socioeconomic advantages. The key question is whether finding of asympto- matic infections is cost-effective in a low preva- lence population. Table II. Socioeconomic evaluation of health care interven- tions. Cost-effectiveness analysis Natural units (e.g. lives saved, cases appropriately diagnosed etc.) Cost-utility analysis Quality adjusted life years (QALY) Cost-benefit analysis Monetary values of inputs (costs) and outputs (benefits) Table III. Cost ofa universal screening program*. No. of cases FIM (millions) Screening (Amplicor™ PCR) Antibiotic treatment" 390,000 26.5 1.2 Total 27.7 * Target 65% of total population in the age group of 15-24 ** Estimated prevalence 5% Table IV. Estimated annual cost of sequelae of Chlamydial infections in women in Finland. No. of cases FIM (millions) Acute PID* 2400 27 Subclinical PID** 5800 11 Tubal infertility*** 1300 66 Tubal pregnancy**** 1800 15 Chronic pelvic pain***** 1000 7 Total 129 20% develop acute PID Menometrorrhagia, vaginal discharge, low ab- dominal pain, dysuria 30,000 new couples/year, infertility rate 17%, TFI 25%; Rx IVF 3% of all pregnancies, operative laparoscopy Laparoscopy Magnitude of the cost of short-term and Iong- term consequences of C. trachomatis infections: Table III shows a very preliminary estimate of annual costs of the diagnosis and treatment of Chlamydial infections in Finland. Of the estimated 20,000 sexually transmitted Chlamy- dial infections occurring annually in Finland approximately 60% (12,000) are detected in women. Of all Chlamydia cases, 60% are seen in patients under 25 years, and the loss of fertility is most tragic among these young women. Approximately 20% (2400) of these
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