Nick Bosanquet

The budgetary impact of 5-HT3 receptor antagonists in the management of chemotherapy-induced emesis

The study examined the budgetary implications of using 5-hydroxytryptamine3 receptor antagonists (5-HT3RA), granisetron or ondansetron, in the management of chemotherapy-induced emesis (CIE). A treatment model was constructed to represent a baseline of efficacy and costs for treating a cohort of patients with conventional antiemetics. Groups of patients who would be expected to receive the most benefit from 5-HT3RA were then identified and the effect upon costs of using these compounds in a consecutively larger proportion of selected patients was calculated. On the basis of illustrative costs from The Cookridge Hospital in the UK, it was concluded that the new antiemetics can be used in acute emesis with substantial clinical benefit for an increase of 3-10% to total treatment costs. However, for delayed emesis these compounds have not yet shown a clinical advantage, and the increase in total costs of 12-34% is not justified.

Immunization in the UK : policy review and future economic options

Vaccination is one of the most effective health promotion activities, but specific targets have been difficult and costly to achieve, and have frequently fallen short of the desired aims, leaving some vulnerable groups unprotected. Policy in the UK has differed for the childhood diseases and in some cases, for example diphtheria and poliomyelitis, has been successful in almost eliminating the disease. In other cases, such as that of pertussis, there has been public opposition, and for other diseases, for example, measles, sufficient numbers of the susceptible population have only recently been reached. Although the World Health Organization target of 90% uptake for the childhood diseases has been reached for all except pertussis, the figures conceal lower uptake rates in some areas, particularly the inner cities. The introduction of target payments to general practitioners appears to have had some effect in increasing uptake rates, particularly in some inner city areas, although the change in immunization schedules may also have had an impact. Target payments fail to take account of the difficulties faced by inner city GPs and, in effect, favour those who need to make least effort, since, in some areas, high uptake rates may already have been achieved before targets were introduced. It is suggested that there is a case for special local development programmes in inner city areas which will provide help with improving record keeping and recall systems for immunization. An alternative policy, which might be more difficult to implement, would be to have targets which could be set at different levels in different areas so that uptake rates could be progressively improved.(ABSTRACT TRUNCATED AT 250 WORDS)

Tax harmonisation and the reduction of European smoking rates

Amidst growing optimism that smoking in Europe can be greatly reduced by the year 2000, this paper simulates the possible impacts of European tax harmonization in the context of rising incomes. A range of price and income elasticities are chosen from econometric studies which use micro information. This is justified by the aggregation problems associated with studies in the smoking literature which use aggregate data. Using micro elasticities, the simulations reported in this paper show that the aims of fiscal harmonization are at variance with the aims of health promotion.

Advertising and the Medical Profession in Britain

The paper summarizes the issues of principle which have been raised over the period 1986–88 relating to advertising by doctors. It examines the effect of deregulation in other professions such as solicitors and shows that the switch to advertising was one part of a wider change to a more commercial organization; the final section looks at the possible effects of advertising on family doctors, private health care and practitioners of holistic medicine. A steady increase in local advertising by GPs is forecast as a result of any greater freedom to advertise.

Models of Palliative Care Service Delivery: What is Most Cost Effective?

Palliative care has been through a difficult development process, but now has the evidence and experience base to make a contribution in the changing health environment. There has now been a great deal of experience with different types of care, and research has shown that patients strongly prefer home-based care. Research on outcomes has inevitably proved difficult, but the evidence on patient perspectives is strong. The aim of ensuring privacy, dignity and control in the last phase of life is a very positive one and is attainable for most patients. Health funders should be keen to drive forward advances in this field.

Have Higher Tax Rates Reduced the European Smoking Rate

The aim of this paper is to set out options for national and EU policy on tobacco taxation. The Council of Ministers has agreed to review the directives on tobacco before 31 December 1994. This change will be crucial in setting a context and giving signals for national decision-making.

Two cheers for the internal market

This paper presents a challenge to health professionals who have opposed the health care reforms. It is argued that there were many deficiencies in the health care system both prior to and after the implementation of the NHS, and that the reforms present at least some prospect of providing a service which meets local needs.

Disease management: from sand table exercise to local achievement

Presents an outline of a local pilot project on disease management in Ollerton, Nottinghamshire, UK. Disease management has been a staff college exercise at a national level: the alliance for health in Ollerton involved a purchaser, an acute trust and a practice. Secondary care expertise was used earlier in the disease process to identify patients and to treat them with a more continuous care programme. Disease management began with gastric illness--in examination, review and treatment for H Pylori eradication; extensions are planned to glaucoma and epilepsy. The project involved co-ordinated investment in building extensions, staff skills and records.