Medical Decision Making: An International Journal of the Society for Medical Decision Making
BACKGROUND: Although congestive heart failure (CHF) is a primary target for disease management programs, previous studies have generated mixed results regarding the effectiveness and cost savings of disease management when applied to CHF. OBJECTIVE: We estimated the long-term impact of systolic heart failure disease management from the results of an 18-month clinical trial.
Percutaneous pulmonary valve implantation helps in prolonging the lifespan of surgically placed right ventricle-to-pulmonary artery (RV-PA) conduits, and represents a less invasive alternative to repeat open-heart surgery. The clinical indications for treatment match those of surgery. As far as the suitability is concerned, the current ideal substrate is a degenerated RV-PA conduit, because of the presence of a certain degree of calcification that offers a safe anchoring point.
OBJECTIVE: Fluoride was first added to the Australian water supply in 1953, and by 2003, 69% of Australia's population was receiving the minimum recommended dose. Extending coverage of fluoridation to all remaining communities of at least 1000 people is a key strategy of Australia's National Oral Health Plan 2004-2013. We evaluate the cost-effectiveness of this strategy from an Australian health sector perspective. METHODS: Health gains from the prevention of caries in the Australian population are modelled over the average 15-year lifespan of a treatment plant.
Total knee replacement (TKR) achieves an immediate and exceptional restoration in the quality of life that is comparable only to a few other procedures. It has been suggested that the most common cause of revision TKR is error in surgical technique, from malpositioning of the components which results in a poorer post-operative outcome. Based on the theoretical assumption that the use of computer-assisted systems (CAS) in TKRs may improve implant alignment and thus implant longevity, the use of this technology is becoming increasingly popular.
OBJECTIVES: Vitamin and mineral supplementation is a common practice in the United States, yet little is known about the long-term health effects of regular supplement use. METHODS: To examine the relationship between reported use of supplements and mortality, we analyzed data from US adults 25 to 74 years of age who were examined in the First National Health and Nutrition Examination Survey (1971 to 1975), with vital status determined through 1987. RESULTS: At baseline, 22.5% of the cohort reported using supplements regularly and 10.0% reported irregular use.
Inquiry: A Journal of Medical Care Organization, Provision and Financing
This paper applies instrumental variable (IV) techniques and estimates the average benefits of invasive surgical treatments for marginal acute myocardial infarction (AMI) patients by insurance coverage. The study uses data from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases for the state of Washington, for years 1988-1993. We observed differences in average benefits for marginal patients across insurance subpopulations that cannot be explained by differences in measured clinical circumstances.
The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences
OBJECTIVE: States vary greatly in their support for home- and community-based services (HCBS) that are intended to help disabled seniors live in the community. This article examines how states' generosity in providing HCBS affects the risk of nursing home admission among older Americans and how family availability moderates such effects. METHODS: We conducted discrete time survival analysis of first long-term (90 or more days) nursing home admissions that occurred between 1995 and 2002, using Health and Retirement Study panel data from respondents born in 1923 or earlier.
OBJECTIVE: To estimate patients' elasticity of demand, willingness to pay, and consumer surplus for five high-cost specialty medications treating metastatic disease or hematologic malignancies. DATA SOURCE/STUDY SETTING: Claims data from 71 private health plans from 1997 to 2005. STUDY DESIGN: This is a revealed preference analysis of the demand for specialty drugs among cancer patients. We exploit differences in plan generosity to examine how utilization of specialty oncology drugs varies with patient out-of-pocket costs.
If it is not a naÔve expectation for dentists who have been beneficiaries of public generosity to share their good fortune with the public that made it possible, there may be a rational basis for enhancing the role of dental education in improving access to oral health care by promoting-but not requiring-a voluntary service commitment after graduation commensurate with the magnitude of the subsidy received.