Economic Analysis As Part Of The Clinical Decision

With limited social and human resources and restrictions of the health insurance cost considerations have become increasingly important in clinical decisions. Limited resources should not be wasted, allocation depends on a thorough knowledge about the various care costs. Returns What elements included in them is often determined from the viewpoint of analysis. Different aspects often lead to different conclusions about the costs and consequences should be considered. Service Provider (z. B. practicing physicians, institutions) usually consider only the cost within the organization (eg. As personnel, supplies, operating costs). Payers (eg. As insurance) only consider the costs that must be refunded. Patients consider their own expenses (eg. As cost of insurance, co-payments, transportation, parking) and the loss of income (for themselves and their family). From a societal perspective, all of these costs added up with the cost of lost productivity and the cost of treating other diseases (iatrogenic and naturally occurring), which can develop in patients by treating or recovering. For years after cure of lymphoma are, for might. As in a young man develop leukemia or coronary heart disease. The cost analysis of a screening program must also include the costs of prosecution of false-positive results, which in a screening test for a disease with low prevalence often the cost of evaluation and treatment of patients who are in fact the disease exceed. Marginal cost marginal cost is the cost for the use (or withholding) of an additional service unit. These costs are often among the most important factors for the decision of a single doctor and differ from the costs, which are generally scheduled for this service. For example, a hospital may have found that the making of a chest x-ray will cost $ 50. A clinical protocol that better identifies patients who need a chest x-ray, though could lead to less X-rays per day (without a change in the results), but it would not lead to real savings for the hospital, because the personnel and operating costs remained unchanged only the cost of materials (X-ray films) would disappear. The marginal cost of chest X-rays would be the cost of X-ray films, and since these will be replaced more and more by digital techniques, even these fall away. It should be noted that the marginal cost varies with the amount. Adding or retaining a large number of X-rays would eventually have a change in personnel and a reduction in X-ray machines result, which would again lead to other marginal costs. In addition, the marginal cost of the various cost carriers are different; the withholding of a chest x-ray would save the payers a lot, a lot of which are far higher than the marginal cost of the hospital. Result The benefits of medical care is measured by the results. Results are for. B. Patients Based Process Based Disease Based Patient-oriented results can be simplified to three points: dying patients disability complaints related results are indisputable key. Improvements in the process (eg. As reducing the time to antibiotics or surgery) or with the symptoms (eg. As shrinkage in tumor size, improved O2 saturation), reduce nichtdie mortality, prevent disability or discomfort or improve, can hardly designed for the benefit of patients. So lidocaine was administered prior years routinely in patients with MI, as it was known that it may reduce the incidence of ventricular fibrillation and thus improve the course of disease for example. The Lidocainbehandlung was continued over many years before studies showed that it did not reduce mortality and thus does not improve the crane evenness progression. Then the Lidocainbehandlung at MI has been set. A change in the mortality rates is the most effective method to evaluate an impact on mortality. For more complex analysis of death and disability are often used in combination as a quality-dependent age (life year, QALY) evaluated. The treatment, which results in that there is an additional age at 100% of the normal functioning is rated 1 QALY, the treatment that leads to an additional year of life with only 75% of the normal functioning is evaluated with 0.75 QALY , QALY is more difficult to apply for complaints, but some believe that it can be estimated by the time trade-off: A person estimates how many years would be acceptable with complaints against a shorter period with perfect health straight. For example, if a person nine years with good health for a period of 10 years, prefers with chronic pain (but would prefer having pain a period of 8 years without pain 10 years), then each year of life is pain with 9:10 = 0.9 QALY evaluated. All these QALY estimates are somewhat problematic, because people are very different in terms of risk tolerance and acceptance of different results. The number needed to treat a value that is needed to treat (NNT) and the injury is another way to quantify the result of the patient; NNT is the reciprocal of the absolute change in a dichotomous outcome (death, disability). So if a drug causes a 3% drop in mortality, need 1: 0.03 = 33.3 patients are treated to prevent a single death. The number that is necessary for an injury is similar. Therefore, as to a drug that causes leukopenia in 8% of patients that 1: 0.08 or 12.5 patients must be treated to harm a person. Shows another method of 12.5 treated individuals, one person is harmed. The adequacy of the NNT is clearer if the mortality rate is compared with weak harmful effects of treatment. It is less clear if the reduction at a certain morbidity is compared to a serious adverse effect. From the perspective of the physician but it can be a very useful tool to explain to the patient the benefit-risk ratio of the treatment. Cost-benefit analysis A simple analysis of the economic consequences of the results (cost-benefit analysis) is based on assumptions about the perceived monetary value of a longer life expectancy and better health. Such assumptions are often questionable and complex. Although such analyzes can determine whether a particular strategy saves costs or net expenditure of available resources increases, it does not indicate whether these issues are worthwhile. In cost-benefit analyzes, the medical costs and health effects are studied separately. Both effect sizes can be strongly influenced by perspective and duration of the analysis as well as underlying assumptions. (: Cost-benefit comparison of management strategies A and B see table) by comparing the costs and health outcomes of two treatment strategies, one of nine possible relationships results. Are the health effects of both treatments equivalent (middle column), the choice should be based on the costs, and the costs are equally high (middle row), the election on treatment success (outcome) should contain. If a treatment strategy has better success and cost-effective (upper right and lower left), the decision is clear. Difficult the decision is only when treatment is more expensive, but also leads to better results (top left and bottom right). In such cases, the ratio of marginal costs should be analyzed for the benefit. Cost-benefit comparison of management strategies A and B cost health result A> B, A = B A B To Calculate: Marginal cost-benefit ratio *. B is less expensive: Choose B. B dominates A: Choose B. A = B A has a better result: Select A. It makes no difference. B has a better result: Choose B. A

Health Life Media Team

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