Estimating treatment cost functions for progressive diseases: a multiproduct approach with an application to breast cancer.

Using the theory of multiproduct cost functions, a treatment cost function is derived for diseases which progress through a number of stages. The output classes are conceived as the stages at detection of the disease, with the unit of output within each class being the treated case. The derivation clarifies the assumptions underlying various specific functional forms for the treatment cost function. An empirical application to the treatment of breast cancer is provided, producing evidence on an important issue in the economics of screening programs, viz. whether detection of breast cancer at an earlier stage results in treatment cost savings.

The costs of treating breast cancer in Australia and the implications for breast cancer screening.

The aim of the study was to determine if there is a relationship between the stage of breast cancer at the time of detection and the costs of treatment and to assess whether any such relationship would have an influence on the cost of a mammographic screening programme. A retrospective analysis of the stage at presentation for primary breast cancer and the treatment costs over the duration of treatment was made. Multiple regression analysis was employed, with treatment cost as the dependent variable and categorical variables to represent stage at detection. A total of 301 women whose treatment for breast cancer commenced at the Royal Brisbane Hospital participated in the study. A statistically significant relationship was found between the stage of disease at the time of detection and subsequent treatment costs; more advanced stages of disease incurred higher treatment costs. This relationship was robust even after taking into account the age of patients, their discharge status, and differences between patients in the duration of treatment. When the effect of earlier detection on treatment cost was assessed in relation to a breast screening programme, cost savings were estimated to be in the range of 8-36% of total screening costs. There are treatment cost savings to be gained from breast cancer screening as a result of the detection of earlier stages of disease. These treatment cost savings should be offset against the cost of a mammographic screening programme.

Application of control chart statistics to blood pressure measurement variability in the primary care setting.

This study was undertaken as an interdisciplinary effort in response to a frequently frustrating clinical problem of interpreting variable blood pressure measurements under uncertain conditions of quality control. The method is an application of the Shewhart Control Chart analysis to blood pressure measurement in adults in an academic nursing center. The natural variability found in a series of blood pressure readings is measured and described after a pilot study to eliminate examiner, equipment, and time interval variability. Results revealed that there was a significant drop from the first systolic reading to subsequent readings. A three standard deviation limit will be met if the range between the second and third systolic reading does not exceed 13 and the range between the second and third diastolic readings does not exceed 11. Thus for recognition and management of measurement variability, three blood pressure measurements 1 minute apart should be taken as a routine, and the average of the second and third reading recorded. The positive impact on clients, providers, and interdisciplinary research colleagues in changing measurement technique to achieve greater quality in clinical practice is discussed. Limitations and recommendations are presented.

Public hospital activity, expenditure and staffing levels for indigenous and nonindigenous settlements in remote Queensland.

Aborigines and Torres Strait Islanders who live in discrete communities have poor health. Their life expectancy is relatively low and the underlying rates of morbidity, mortality and hospitalisation are much higher than the Australian average. For Aborigines and Torres Strait Islanders in the remote communities, the mortality rate is some three times higher than that of the total population. By comparing remote Aboriginal and Torres Strait Islander communities with similarly remote nonindigenous settlements, the paper shows that there was greater hospital activity per person in remote Aboriginal and Torres Strait Islander communities. Paradoxically, whereas there was greater hospital activity in discrete indigenous communities, there was lower expenditure per person on hospital services. The paper finds also that there were fewer medical and nursing staff per person in remote Aboriginal and Torres Strait communities.