scholarly journals Strategic options for antenatal screening for syphilis in the United Kingdom: a cost effectiveness analysis

2000 ◽  
Vol 7 (1) ◽  
pp. 7-13 ◽  
Author(s):  
N. Connor ◽  
J. Roberts ◽  
A. Nicoll
Keyword(s):  
United Kingdom ◽  
Cost Effectiveness ◽  
Pregnant Women ◽  
Screening Programme ◽  
Number Needed To Treat ◽  
Antenatal Screening ◽  
The United Kingdom ◽  
Increased Risk ◽  
Strategic Options ◽  
The Cost

Objective Antenatal screening for syphilis is well established in the United Kingdom. The prevalence of syphilis is now very low, prompting the question as to whether this screening programme is still necessary. This paper aims at identifying possible screening strategy options for the programme and comparing their effectiveness and cost effectiveness. Methods The cost of the screening programme in the United Kingdom was estimated. This was based on the cost of screening tests, treatment, and follow up of infected women and their infants. This information was obtained from laboratories, antenatal clinics, and genitourinary medicine clinics. Epidemiological data from a survey of women treated for syphilis in pregnancy were analysed to identify groups at increased risk of syphilis. Strategic options for the screening programme were then identified. The effectiveness, number needed to treat, and cost effectiveness of these options were compared. Results Antenatal screening in the United Kingdom detected at least 40 pregnant women who need treatment for syphilis every year. This means that 18 602 women are screened for every woman detected who needs treatment for syphilis. The marginal annual cost of this screening programme in the United Kingdom is £672 366. This is equivalent to 90p per woman screened, or £16 670 to detect one woman who needs treatment for syphilis. The screening programme could be targeted geographically at pregnant women in the Thames regions. This option has the potential to save £482 185. Other strategic options are to target pregnant women in non-white ethnic groups, or those born outside the United Kingdom. These targeted options would each detect between 70% and 77% of women needing treatment for syphilis. These options could potentially save £592 938 and £562 691 respectively. Conclusions Targeting or stopping the screening programme would save relatively little money. Although selectively screening groups by country of birth or by ethnic group could detect at least 70% of cases, this would be politically and practically difficult. Targeting by region would also be effective, but would pose similar ethical and medicolegal problems. These facts and the changing international epidemiology of syphilis lead us to recommend that the current universal antenatal screening for syphilis should continue.

scholarly journals Variations in cost calculations in spine surgery cost-effectiveness research

2014 ◽  
Vol 36 (6) ◽  
pp. E1 ◽  
Author(s):  
Matthew D. Alvin ◽  
Jacob A. Miller ◽  
Daniel Lubelski ◽  
Benjamin P. Rosenbaum ◽  
Kalil G. Abdullah ◽  
...  
Keyword(s):  
United Kingdom ◽  
Cost Effectiveness ◽  
Spine Surgery ◽  
Indirect Costs ◽  
Cost Calculation ◽  
Effectiveness Research ◽  
Reimbursement System ◽  
The United Kingdom ◽  
The Cost ◽  
Effectiveness Studies

Object Cost-effectiveness research in spine surgery has been a prominent focus over the last decade. However, there has yet to be a standardized method developed for calculation of costs in such studies. This lack of a standardized costing methodology may lead to conflicting conclusions on the cost-effectiveness of an intervention for a specific diagnosis. The primary objective of this study was to systematically review all cost-effectiveness studies published on spine surgery and compare and contrast various costing methodologies used. Methods The authors performed a systematic review of the cost-effectiveness literature related to spine surgery. All cost-effectiveness analyses pertaining to spine surgery were identified using the cost-effectiveness analysis registry database of the Tufts Medical Center Institute for Clinical Research and Health Policy, and the MEDLINE database. Each article was reviewed to determine the study subject, methodology, and results. Data were collected from each study, including costs, interventions, cost calculation method, perspective of cost calculation, and definitions of direct and indirect costs if available. Results Thirty-seven cost-effectiveness studies on spine surgery were included in the present study. Twenty-seven (73%) of the studies involved the lumbar spine and the remaining 10 (27%) involved the cervical spine. Of the 37 studies, 13 (35%) used Medicare reimbursements, 12 (32%) used a case-costing database, 3 (8%) used cost-to-charge ratios (CCRs), 2 (5%) used a combination of Medicare reimbursements and CCRs, 3 (8%) used the United Kingdom National Health Service reimbursement system, 2 (5%) used a Dutch reimbursement system, 1 (3%) used the United Kingdom Department of Health data, and 1 (3%) used the Tricare Military Reimbursement system. Nineteen (51%) studies completed their cost analysis from the societal perspective, 11 (30%) from the hospital perspective, and 7 (19%) from the payer perspective. Of those studies with a societal perspective, 14 (38%) reported actual indirect costs. Conclusions Changes in cost have a direct impact on the value equation for concluding whether an intervention is cost-effective. It is essential to develop a standardized, accurate means of calculating costs. Comparability and transparency are essential, such that studies can be compared properly and policy makers can be appropriately informed when making decisions for our health care system based on the results of these studies.

scholarly journals Risk and Prevention of Meningococcal Disease among Education Workers: A Review

2004 ◽  
Vol 15 (2) ◽  
pp. 89-93 ◽  
Author(s):  
Philippe De Wals ◽  
Pierre Deshaies ◽  
Gaston De Serres ◽  
Bernard Duval ◽  
Lise Goulet ◽  
...  
Keyword(s):  
United Kingdom ◽  
Pregnant Women ◽  
Meningococcal Disease ◽  
Disease Risk ◽  
The United States ◽  
Population Based ◽  
Work Place ◽  
Societal Benefit ◽  
The United Kingdom ◽  
The Cost

The aims of the present study were to review the risk of invasive meningococcal disease (IMD) among education workers, particularly pregnant women, and to evaluate preventive measures, in a context of endemicity, outbreak or epidemic as observed in the province of Quebec. The literature was reviewed and persons in charge of IMD surveillance in France, Quebec, the United Kingdom and the United States were interviewed. Surveys of asymptomatic carriage ofNeisseria meningitidisshow that transmission among students is higher than transmission between students and teachers. IMD incidence among education workers was analyzed in Cheshire (United Kingdom) in the period from 1997 to 1999, and the results indicated a risk six times higher than that in the general population. Overestimation of the magnitude of the risk is possible because the analysis focused on a cluster. None of the population-based studies of IMD mentioned a risk of secondary cases among education workers. Six IMD cases in education workers were identified in five clusters in schools in the United Kingdom, but not in the other countries. There is no epidemiological study on IMD risk among pregnant women, and this factor was not mentioned in any published review of IMD. Immunization of education workers at the beginning of their employment, using serogroup C glycoconjugate vaccine or a combined A, C, W-135, and Y conjugate vaccine (still under development), could reduce IMD risk, but the cost effectiveness of this measure should be evaluated. The societal benefit of excluding pregnant women from the work place during an outbreak seems to be very low, even if disease risk could be decreased for this specific group. When chemoprophylaxis is indicated for the control of an outbreak in an educational setting, treatment should be offered both to students and teachers in the group at risk.

scholarly journals Evaluation of the cost-effectiveness of rifaximin-α for the management of patients with hepatic encephalopathy in the United Kingdom

2018 ◽  
Vol 34 (11) ◽  
pp. 2001-2008 ◽  
Author(s):  
Ellen Berni ◽  
Daniel Murphy ◽  
James Whitehouse ◽  
Pete Conway ◽  
Paola Di Maggio ◽  
...  
Keyword(s):  
United Kingdom ◽  
Cost Effectiveness ◽  
Hepatic Encephalopathy ◽  
The United Kingdom ◽  
The Cost

Expanded Function Orthodontic Auxiliaries; a Proposal for their Introduction in the UK

1988 ◽  
Vol 15 (4) ◽  
pp. 281-286 ◽  
Author(s):  
K. D. O'Brien ◽  
W. C. Shaw
Keyword(s):  
United States ◽  
United Kingdom ◽  
Cost Effectiveness ◽  
Orthodontic Treatment ◽  
The United States ◽  
The United Kingdom ◽  
Treatment Provision ◽  
The Uk ◽  
The Cost

The role of dental and orthodontic auxiliaries in Europe and the United States is reviewed, and the advantages of their employment in the United Kingdom are discussed in terms of increasing the cost-effectiveness of orthodontic treatment provision. A three-stage programme for the evaluation of Orthodontic Auxiliaries in the UK is proposed.

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