J. Lyle Bootman

Physician prescribing decisions: The effects of situational involvement and task complexity on information acquisition and decision making

This research utilized conjoint analysis and an analysis of information acquisition to examine the effects of situational involvement and task complexity on physicians decision-making process. The predictive accuracy of the linear model in predicting drug choice across situations was also assessed. A contingency model for the selection of decision strategies was used as a framework in the study. A sample of forty-eight physicians was asked to indicate their preferences and choices for hypothetical anti-infective drugs. Situational involvement was manipulated by telling physicians in the experimental group via the written scenario to assume that his/her decision would be reviewed and evaluated by peers and (s)he would be asked to justify drug choice. Task complexity was manipulated by varying the number of drug alternatives in a choice set. Results of the study indicated that physicians shifted from using compensatory to noncompensatory decision-making processes when task complexity increased. The effect of situational involvement on the decision-making process was not supported. However, physicians in the two groups were found to differ in choice outcomes and the attention given to specific drug attribute information. Finally, the linear model was found to be robust in predicting drug choice across contexts.

Time Preference for Health Gains Versus Health Losses

SummaryThe purpost of this research was to determine whether people devalue future heahh gains differently from future health losses. 108 subjects in various states of health were randomised to groups that rated their preference for a hypothetical health gain or loss of variable duration and delay, in the condition ofanhritis. Direction and duration of the hYPOthetical future health change had an interactive effect on time preference (p < 0.00 1). For the health gain, devaluation due to delay was consistent across durations. For the health loss, devaluation depended on duration; the long-duration loss was devalued with delay while the fleeting loss was inflated. These findings cast doubt on the assumptions of positive time preference and constant rate discounting that underlie the classical model of discounting. They provide suppon for a theory of intenemporal choice which posits that vivid, fleeting, future events engender ‘anticipation utility’ which attenuates positive time preference. OUT findings suggest that standard practices fOT discounting future health outcomes in economic evaluations of arthritis and possibly other conditions may need to be re-examined.

The Economics of Multiple Sclerosis: Distribution of Costs and Relationship to Disease Severity

The introduction of expensive disease-modifying agents for the treatment of multiple sclerosis (MS) has created the potential for patients with MS to become higher contributors to healthcare spending. In an attempt to make formulary and reimbursement choices for these agents, decision-makers may look to the literature for guidance. This critical review attempts to decipher a consistent message from the available economic literature regarding the relationship between disease severity and cost in MS. In the 2 studies that have examined MS disease severity, a positive correlation with total (direct and indirect) cost, indirect cost and some, if not all, components of direct cost was reported. In studies taking the societal perspective, the majority of total costs were indirect. This paper documents the high burden of MS on society and serves to guide the decision-maker in interpreting the MS economic literature such that this information can be optimally utilised to make informed resource allocation decisions.

The economics of benign prostatic hyperplasia treatment: a literature review

Benign prostatic hyperplasia (BPH) is one of the most common benign neoplasms in elderly men in the United States; it has been estimated that the annual costs of caring for these men exceed

Evaluating the Cost Impact of Intravenous Antibiotic Dosing Frequencies

4 billion. This condition is rarely life threatening, but often affects the individuals quality of life in varying degrees. There are several treatments for this condition, including surgery, with the most common procedure being transurethral resection of the prostate. Other treatment options include medication (such as finasteride and terazosin), balloon dilation, and watchful waiting. The cost associated with BPH depends on the severity of the disease and the appropriate course of treatment. The objective of this paper is to identify and evaluate the economic research papers that have considered either the economic burden or costs associated with alternative BPH therapy options and to identify key areas for future economic research. This review indicates that the economic studies of BPH are diverse in nature and greater attention needs to be placed on the societal appraisal of competing BPH therapies. Other research areas include the economic analysis of both short- and long-run BPH treatment options, increased cost-utility analysis, and the use of retrospective claims database analysis using regression techniques.

The convergence of new technology with the delivery of health care services

Cost differences between antibiotic dosing frequencies were studied at Robert Wood Johnson University Hospital. Developing a complete cost profile between antibiotic alternatives is difficult because of role separation within the hospital. To present a more complete profile, the study analyzed the incremental costs associated with the hospital pharmacy and nursing staffs regarding various dosing frequencies, including different iv admixture and administration methods. Results showed that administration of an antibiotic dose costs approximately

Cost-effectiveness of two new treatments for onychomycosis: An analysis of two comparative clinical trials

3.35 based on labor and material costs associated with admixture and administration. An average of 4.6 minutes/dose saves nurses up to 23 minutes for each patient who receives an antibiotic dosed once rather than six times daily over a 24-hour period. Costs of administration and admixture should be considered in comparisons of combination therapy with monotherapy when deciding between two therapeutically equivalent alternatives.

Comparative Clinical, Microbiologic, and Economic Audit of the Use of Oral Ciprofloxacin and Parenteral Antimicrobials:

Sometimes the most exciting developments don’t make the big headlines. In early October 2012, at nearly the same time that the first presidential debate shook up the talking heads covering our national election and the tragic outcomes of errors made by one Massachusetts compounding pharmacy were becoming apparent to all, I spotted a story that received much less media attention but that was thrilling to me. The story was about the launch of the country’s fastest genomic supercomputing platform. What made the news so reaffirming to me was not the fact that a new platform existed but that its purpose was to bring “genomic medicine into clinical practice by placing supercomputers in the hands of physicians at the point of care.”

Enalapril to Lisinopril: Economic Impact of a Voluntary Angiotensin-Converting Enzyme-Inhibitor Substitution Program in a Staff-Model Health Maintenance Organization

BACKGROUND Pharmacoeconomic analyses are becoming an increasingly integral component of the overall profile of new drugs. This is particularly true for terbinafine and itraconazole, because both agents have been shown to be clinically effective and relatively safe. OBJECTIVE This study examined the cost-effectiveness of terbinafine and itraconazole in two recent comparative clinical trials of these new agents for onychomycosis of the toenails. METHODS Data as reported in the two clinical trials were used as the basis for an analytic decision-tree model that included cost of drug, medical management of the disease and any adverse reactions, and clinical efficacy data into calculations that estimated the relative cost effectiveness ratio for each drug on the basis of cost per disease-free day. RESULTS The total cost of terbinafine therapy ranged from

Cost-Benefit Analysis A Research Tool for Evaluating Innovative Health Programs

697.55 to