Carvedilol reduces the costs of medical care in severe heart failure: An economic analysis of the COPERNICUS study applied to the United Kingdom

Background: The aim of this study was to determine the effects of carvedilol on the costs related to the treatment of severe chronic heart failure (CHF). Methods: Costs for the treatment for heart failure within the National Health Service (NHS) in the United Kingdom (UK) were applied to resource utilisation data prospectively collected in all patients randomized into the Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) Study. Unit-specific, per them (hospital bed day) costs were used to calculate expenditures due to hospitalizations. We also included costs of carvedilol treatment, general practitioner surgery/office visits, hospital out-patient clinic visits and nursing home care based on estimates derived from validated patterns of clinical practice in the UK. Results: The estimated cost of carvedilol therapy and related ambulatory care for the 1156 patients assigned to active treatment was 530,771 pound (44.89 pound per patient/month of follow-up). However, patients assigned to carvedilol were hospitalised less often and accumulated fewer and less expensive days of admission. Consequently, the total estimated cost of hospital care was 3.49 pound million in the carvedilol group compared with 4.24 pound million for the 1133 patients in the placebo arm. The cost of post-discharge care was also less in the carvedilol than in the placebo group (479,200 pound vs. 548,300) pound. Overall, the cost per patient treated in the carvedilol group was 3948 pound compared to 4279 pound in the placebo group. This equated to a cost of 385.98 pound vs. 434.18 pound, respectively, per patient/month of follow-up: an 11.1% reduction in health care costs in favour of carvedilol. Conclusions: These findings suggest that not only can carvedilol treatment increase survival and reduce hospital admissions in patients with severe CHF but that it can also cut costs in the process.

The economic costs of road traffic crashes: Australia, states and territories

In this paper, we obtain detailed data on road traffic crash (RTC) casualties, by severity, for each of the eight state and territory jurisdictions for Australia and use these to estimate and compare the economic impact of RTCs across these regions. We show that the annual cost of RTCs in Australia, in 2003, was approximately $17b, which is approximately 2.3% of the Gross Domestic Product (GDP). Importantly, though, there is remarkable intra-national variation in the incident rates of RTCs in Australia and costs range from approximately 0.62 to 3.63% of Gross State Product (GSP). The paper makes two fundamental contributions: (i) it provides a detailed breakdown of estimated RTC casualties, by state and territory regions in Australia, and (ii) it presents the first sub-national breakdown of RTC costs for Australia. We trust that these contributions will assist policy-makers to understand sub-national variations in the road toll better and will encourage further research on the causes of the marked differences between RTC outcomes across the states and territories of Australia. (c) 2006 Elsevier Ltd. All rights reserved.

Costs of learning: the dynamics of mixed-prey exploitation by silver perch, Bidyanus bidyanus (Mitchell, 1838)

Although generalist predators have been reported to forage less efficiently than specialists, there is little information on the extent to which learning can improve the efficiency of mixed-prey foraging. Repeated exposure of silver perch to mixed prey (pelagic Artemia and benthic Chironomus larvae) led to substantial fluctuations in reward rate over relatively long (20-day) timescales. When perch that were familiar with a single prey type were offered two prey types simultaneously, the rate at which they captured both familiar and unfamiliar prey dropped progressively over succeeding trials. This result was not predicted by simple learning paradigms, but could be explained in terms of an interaction between learning and attention. Between-trial patterns in overall intake were complex and differed between the two prey types, but were unaffected by previous prey specialization. However, patterns of prey priority (i.e. the prey type that was preferred at the start of a trial) did vary with previous prey training. All groups of fish converged on the most profitable prey type (chironomids), but this process took 15-20 trials. In contrast, fish offered a single prey type reached asymptotic intake rates within five trials and retained high capture abilities for at least 5 weeks. Learning and memory allow fish to maximize foraging efficiency on patches of a single prey type. However, when foragers are faced with mixed prey populations, cognitive constraints associated with divided attention may impair efficiency, and this impairment can be exacerbated by experience. (c) 2005 The Association for the Study of Animal Behaviour. Published by Elsevier Ltd. All rights reserved.

Should future health-care costs be discounted? The case of diabetes in Australia [Editorial]

No Abstract

Costs of surgical site infections that appear after hospital discharge

Data were collected from surgical patients in the hospital and on 4 occasions postdischarge. The incidence of postdischarge surgical site infection was 8.46%. Strong evidence showed that these infections caused minor additional costs, which contradicts existing literature. We discuss why previous studies might have overstated costs.

Accounting for management costs in sensitivity analyses of matrix population models

Traditional sensitivity and elasticity analyses of matrix population models have been used to p inform management decisions, but they ignore the economic costs of manipulating vital rates. For exam le, the growth rate of a population is often most sensitive to changes in adult survival rate, but this does not mean that increasing that rate is the best option for managing the population because it may be much more expensive than other options. To explore how managers should optimize their manipulation of vital rates, we incorporated the cost of changing those rates into matrix population models. We derived analytic expressions for locations in parameter space where managers should shift between management of fecundity and survival, for the balance between fecundity and survival management at those boundaries, and for the allocation of management resources to sustain that optimal balance. For simple matrices, the optimal budget allocation can often be expressed as simple functions of vital rates and the relative costs of changing them. We applied our method to management of the Helmeted Honeyeater (Lichenostomus melanops cassidix; an endangered Australian bird) and the koala (Phascolarctos cinereus) as examples. Our method showed that cost-efficient management of the Helmeted Honeyeater should focus on increasing fecundity via nest protection, whereas optimal koala management should focus on manipulating both fecundity and survival simultaneously, These findings are contrary to the cost-negligent recommendations of elasticity analysis, which would suggest focusing on managing survival in both cases. A further investigation of Helmeted Honeyeater management options, based on an individual-based model incorporating density dependence, spatial structure, and environmental stochasticity, confirmed that fecundity management was the most cost-effective strategy. Our results demonstrate that decisions that ignore economic factors will reduce management efficiency.

The continuing use of complementary and alternative medicine in South Australia: costs and beliefs in 2004

Objective: To survey the use, cost, beliefs and quality of life of users of complementary and alternative medicine (CAM). Design: A representative population survey conducted in 2004 with longitudinal comparison to similar 1993 and 2000 surveys. Participants: 3015 South Australian respondents over the age of 15 years (71.7% participation). Results: In 2004, CAMs were used by 52.2% of the population. Greatest use was in women aged 25-34 years, with higher income and education levels. CAM therapists had been visited by 26.5% of the population. In those with children, 29.9% administered CAMs to them and 17.5% of the children had visited CAM therapists. The total extrapolated cost in Australia of CAMs and CAM therapists in 2004 was AUD$1.8 billion, which was a decrease from AUD$2.3 billion in 2000. CAMs were used mostly to maintain general health. The users of CAM had lower quality-of-life scores than non-users. Among CAM users, 49.7% used conventional medicines on the same day and 57.2% did not report the use of CAMs to their doctor. About half of the respondents assumed that CAMs were independently tested by a government agency; of these, 74.8% believed they were tested for quality and safety, 21.8% for what they claimed, and 17.9% for efficacy. Conclusions: Australians continue to use high levels of CAMs and CAM therapists. The public is often unaware that CAMs are not tested by the Therapeutic Goods Administration for efficacy or safety.

National culture, infrastructure, and costs: Factors that lead to the use of wireless technologies

This research-in-progress paper utilizes the Technology Acceptance Model (TAM) to assess the effects of National Culture, Infrastructure, and Access Costs on the adoption of Wireless Technologies in Australia. The cultural dimensions emanating from the GLOBE project were chosen because of their broad coverage and contemporary nature. Australia is unique in that it has one of the lowest population densities in the world. The provision of wireless technologies is challenging in such an environment, and I believe the model developed in this research will have applicability in other similarly populated countries.

Costs and decisions in population management: Koalas on Kangaroo Island

Many populations have a negative impact on their habitat, or upon other species in the environment, if their numbers become too large. For this reason they are often managed using some form of control. The objective is to keep numbers at a sustainable level, while ensuring survival of the population.+Here we present models that allow population management programs to be assessed. Two common control regimes will be considered: reduction and suppression. Under the suppression regime the previous population is maintained close to a particular threshold through near continuous control, while under the reduction regime, control begins once the previous population reaches a certain threshold and continues until it falls below a lower pre-defined level. We discuss how to best choose the control parameters, and we provide tools that allow population managers to select reduction levels and control rates. Additional tools will be provided to assess the effect of different control regimes, in terms of population persistence and cost.In particular we consider the effects of each regime on the probability of extinction and the expected time to extinction, and compare the control methods in terms of the expected total cost of each regime over the life of the population. The usefulness of our results will be illustrated with reference to the control of a koala population inhabiting Kangaroo Island, Australia.