Stated time preferences for health: a systematic review and meta analysis of private and social discount rates

The present study aimed to provide better insight on methodological issues related to time preference studies, and to estimate private and social discount rates, using a rigorous systematic review and meta-analysis. We searched PubMed, EMBASE and Proquest databases in June 2013. All studies had estimated private and social time preference rates for health outcomes through stated preference approach, recognized eligible for inclusion. We conducted both fixed and random effect meta-analyses using mean discount rate and standard deviation of the included studies. I-square statistics was used for testing heterogeneity of the studies. Private and social discount rates were estimated separately via Stata11 software. Out of 44 screened full texts, 8 population-based empirical studies were included in qualitative synthesis. Reported time preference rates for own health were from 0.036 to 0.07 and for social health from 0.04 to 0.2. Private and social discount rates were estimated at 0.056 [95% CI: 0.038, 0.074] and 0.066 [95% CI: 0.064, 0.068], respectively. Considering the impact of time preference on healthy behaviors and because of timing issues, individual's time preference as a key determinant of policy making should be taken into account. Direct translation of elicited discount rates to the official discount rates has been remained questionable. Decisions about the proper discount rate for health context, may need a cross-party consensus among health economists and policy makers

Femtosecond laser versus mechanical microkeratome in thin-flap laser in situ keratomileusis [Lasik] for correction of refractive errors an evidence-based effectiveness and cost analysis

To compare the efficacy and cost-effectiveness of Femtosecond laser versus mechanical Microkeratome corneal flap creation in correction of refractive errors. In this review, a comprehensive search of Medline, SCOPUS, Cochrane, TRIP database, supplemented by HTA and economic databases was performed. We searched for randomized controlled trials [RCTs] of Femtosecond laser which included mechanical Microkeratome in other arm. The quality of the retrieved studies was appraised by two independent reviewers and appropriate articles were finalized. A total of 1142 articles were identified, of which, 1059 were excluded after review of the titles and abstracts and 83 articles remained. Systematic reviews and RCTs were evaluated through CASP international worksheet. Eventually, 61 titles were excluded, leaving 22 articles to be reviewed. Safety: There was no individual evidence to cover all safety components about Femtosecond laser, but in summary, this modality seems a safe method for corneal flap creation. Effectiveness: No statistically significant difference was shown in visual acuity and refractive errors. The important secondary end point of this review was diffuse Lamellar keratitis in 17% of the Femtosecond group versus 5% in mechanical Microkeratome. Inflammation was low-grade and improved during the first 3 months of follow-up period with a low dose medication without corneal scarring. The two groups was comparable in all clinical outcomes including Unorrected Visual Acuity [UCVA], Best Special Corrected Visual Acuity [BSCVA], manifest refraction, wave front aberrometry, Schirmer test, and Tear Break up time [TBUT]. Cost Analysis: Results showed that marginal cost incurred due to Femtosecond technology adoption may vary from 27 to 117 _ [resulted from sensitivity analysis]. It is clear that additional cost may be a small proportion of LASIK procedure total cost. Although Femtosecond flap creation is a modern method with a good quality of corneal flap, but, there is no high-quality evidence to show superiority of Femtosecond laser in clinical outcomes. Although the efficacy and cost of the systems is almost equal, traditional method still remains as the standard approach

Holmium laser prostate enucleation [HOLEP] versus trans-urethral resection of prostate [TURP] in treatment of symptomatic prostatic enlargement; a health technology assessment

Our aim was to compare the cost effectiveness of holmium laser prostate enucleation [HOLEP] versus trans-urethral resection of prostate. We searched all available databases for any controlled trials comparing HOLEP and TURP from January 2000 to February 2009. Two independent reviewers studied and appraised the selected evidences. Then, effectiveness and cost effectiveness of HOLEP was evaluated. We identified four randomized controlled trials and one systematic review according to the inclusion criteria. Most of the studies had moderate quality of evidence with limited sample sizes. Overall success rate of HOLEP was comparable with TURP; but, some secondary outcomes such as pick flow rate twelve months after the surgery was better in HOLEP. A comparison between the original costs and those obtained from sensitivity analysis showed that the cost parameters were sensitive to the number of the patients treated. Increasing the number of the patients from 200 to 300 changed the study's results in favor of the new techniques. Since the holmium and thulium laser sets are sensitive to the number of the patients and multipurpose, they potentially can be applied for stone fragmentation. Thus, utilization of these equipments will divide the costs between two groups of the services. In economic terms, these properties lower overhead costs and justify the purchasing of these equipments