Low-molecular-weight heparin preparations are as safe and effective as unfractionated heparin for the treatment of acute deep venous thrombosis. These preparations have been shown to be costeffective for thromboprophylaxis after hip replacement surgery compared with low-dose warfarin or unfractionated heparin (6). We hypothesized that despite their current higher price, low-molecular-weight heparins might also be cost-effective relative to unfractionated heparin for treating established deep venous thrombosis. If therapy with low-molecular-weight heparin resulted in fewer bleeding complications or more effectively prevented thromboembolic recurrences, the costs associated with these events would be reduced.
We developed a decision model to compare the costs and health effects of low-molecular-weight heparins and unfractionated heparin for the treatment of acute deep venous thrombosis. In our base-case analysis, we assumed that all treatment occurred in an inpatient hospital setting. To fully quantify the potential economic impact of low-molecular-weight heparin treatment, we performed a secondary analysis that allowed for the possibility of outpatient treatment with this drug.
Also a 1998 research report: Medical Advisory Panel, TEC Program, Blue Cross Blue Shield Association
This paper explores the significance of policy-induced technological change for the design of carbon-abatement policies. We derive analytical expressions characterizing optimal CO2 abatement and carbon tax profiles under different specifications for the channels through which technological progress occurs. We consider both R&D-based and learning-by-doing-based knowledge accumulation, and examine each specification under both a cost-effectiveness and a benefit-cost policy criterion. We show analytically that the presence of induced technological change (ITC) implies a lower time profile of optimal carbon taxes. The impact of ITC on the optimal abatement path varies. When knowledge is gained through R&D investments, the presence of ITC justifies shifting some abatement from the present to the future. However, when knowledge is generated through learning-by-doing, the impact on the timing of abatement is analytically ambiguous. Illustrative numerical simulations indicate that the impact of ITC upon overall costs and optimal carbon taxes can be quite large in a cost-effectiveness setting but typically is much smaller under a benefit-cost policy criterion. The impact of ITC on the timing of abatement is very weak, and the effect (applicable in the benefit-cost case) on total abatement over time is generally small as well, especially when knowledge is accumulated via R&D.
For this report, the Technology Evaluation Center, an AHCPR Evidence-based Practice Center of the Blue Cross and Blue Shield Association, conducted a systematic review of the evidence from randomized controlled trials on the relative effectiveness of alternative strategies for androgen suppression as treatment of advanced prostate cancer.
Prostate cancer is a disease of older men, and is second only to lung cancer in cancer mortality for men. For 1998, it was estimated that 184,500 new cases of prostate cancer would be diagnosed, and 39,200 men would die of prostate cancer that year.
In 1994, the total Medicare expenditure for treatment of prostate cancer was $1,411,687,900. Of the total, $477,851,000 was for androgen suppression therapy using luteinizing hormone-releasing hormone (LHRH) agonists. The prevalence of prostate cancer, and the expenditures for its treatment, are likely to increase with the aging of the population and the trend to earlier detection of the disease.
Three key issues are addressed in the report:
Two supplementary analyses were also conducted for each key question: