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2.
PLoS One ; 15(4): e0232041, 2020.
Article in English | MEDLINE | ID: mdl-32324781

ABSTRACT

Most U.S. states that have regulated and taxed cannabis have imposed some form of mandatory safety testing requirements. In California, the country's largest and oldest legal cannabis market, mandatory testing was first enforced by state regulators in July 2018, and additional mandatory tests were introduced at the end of 2018. All cannabis must be tested and labeled as certified by a state-licensed cannabis testing laboratory before it can be legally marketed in California. Every batch that is sold by licensed retailers must be tested for more than 100 contaminants, including 66 pesticides with tolerance levels lower than the levels allowable for any other agricultural product in California. This paper estimates the costs of compliance with mandatory cannabis testing laws and regulations, using California's testing regime as a case study. We use state government data, data collected from testing laboratories, and data collected from lab equipment suppliers to run a set of Monte Carlo simulations and estimate the cost per pound of compliance with California's new cannabis testing regulations. We find that cost per pound is highly sensitive to average batch size and testing failure rates. We present results under a variety of different assumptions about batch size and failure rates. We also find that under realistic assumptions, the loss of cannabis that must be destroyed if a batch fails testing accounts for a larger share of total testing costs than does the cost of the lab tests. Using our best estimates of average batch size (8 pounds) and failure rate (4%) in the 2019 California market, we estimate testing cost at $136 per pound of dried cannabis flower, or about 10 percent of the reported average wholesale price of legal cannabis in the state. Our findings explain effects of the testing standards on the cost of supplying legal licensed cannabis, in California, other U.S. states, and foreign jurisdictions with similar testing regimes.


Subject(s)
Cannabis/chemistry , Legislation, Drug/economics , Mandatory Testing/legislation & jurisprudence , Marijuana Smoking/legislation & jurisprudence , California , Commerce/economics , Guideline Adherence , Humans , Mandatory Testing/economics , Monte Carlo Method
3.
Eur J Health Econ ; 17(2): 203-15, 2016 Mar.
Article in English | MEDLINE | ID: mdl-25773049

ABSTRACT

We use the 1997-2008 Medical Expenditure Panel Survey (MEPS) and variation in the timing of state mandates for coverage of colorectal, cervical, and prostate cancer screenings to investigate the behavioral and financial effects of mandates on privately insured adults. We find that state mandates did not result in increased rates of cancer screening. However, coverage of preventive care, whether mandated or not, moves the cost of care from the consumer's out-of-pocket expense to the premium, resulting in a cross-subsidy of users of the service by non-users. While some cross-subsidies are intentional, others may be unintentional. We find that users of cancer screening have higher levels of income and education, while non-users tend to be racial minorities, lack a usual source of care, and live in communities with fewer physicians per capita. These results suggest that coverage of preventive care may transfer resources from more advantaged individuals to less advantaged individuals.


Subject(s)
Early Detection of Cancer/economics , Mandatory Testing/economics , State Government , Adult , Aged , Colonoscopy/economics , Colonoscopy/statistics & numerical data , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/economics , Early Detection of Cancer/statistics & numerical data , Female , Health Care Costs/statistics & numerical data , Humans , Insurance, Health/economics , Insurance, Health/legislation & jurisprudence , Male , Mandatory Testing/statistics & numerical data , Middle Aged , Papanicolaou Test/economics , Papanicolaou Test/statistics & numerical data , Prostate-Specific Antigen/blood , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/economics , United States , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/economics
4.
Infection ; 41(2): 479-83, 2013 Apr.
Article in English | MEDLINE | ID: mdl-23225209

ABSTRACT

PURPOSE: Before elective operations, particularly orthopaedic surgery, national guidelines in Germany recommend testing for human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) to reduce the risk of transmission of the virus through a needlestick or cutting injury. Such testing is expensive. The number of new and unknown diagnoses of viral infections that can be detected by routine screening has not yet been evaluated. METHODS: The aim of our department of orthopaedic surgery is to screen every adult patient listed for an operation for HBV, HCV and HIV. We retrospectively analysed the number of operations in this single centre from 2001 to 2010, correlated this number with the total number of screens and calculated the number of newly diagnosed infections. An additional cost:benefit ratio was calculated. RESULTS: A total of 20,869 operations were performed by the department between 2001 and 2010. After exclusion of all interventions in children and all patients who had multiple operations, 15,482 patients remained. Test results were found for 10,011 of these patients during this period (screening rate 65 %). Of those screened, in only four cases (0.4 ‰) was a previously unknown infection detected. CONCLUSIONS: Two-thirds of the patients included in our study actually underwent screening; this rate was lower than expected. The incidence of newly detected infections was low, putting the benefit of a routine preoperative screening for HBV, HCV and HIV into question. From an economic point of view the low detection rate is a strong argument in favour of omitting routine preoperative screening. Screening only those patients with risk factors may be as safe as screening every patient and would help reduce costs.


Subject(s)
Elective Surgical Procedures/statistics & numerical data , HIV Infections/diagnosis , Hepatitis B/diagnosis , Hepatitis C/diagnosis , Mandatory Testing/statistics & numerical data , Orthopedic Procedures/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Cost-Benefit Analysis , Germany , HIV/isolation & purification , Hepacivirus/isolation & purification , Hepatitis B virus/isolation & purification , Humans , Mandatory Testing/economics , Middle Aged , Retrospective Studies , Risk Factors , Young Adult
5.
Annu Rev Genomics Hum Genet ; 13: 381-93, 2012.
Article in English | MEDLINE | ID: mdl-22559326

ABSTRACT

Continued technological advances have made the prospect of routine whole-genome sequencing (WGS) imminent. To date, much of the discussion about WGS has focused on its application and use in clinical medicine. Relatively little attention has been paid to the potential integration of WGS into newborn screening programs. Given the structure and scope of these programs, it is possible that the early applications of WGS will occur in state-run newborn screening programs. Assessment of the pressing ethical issues currently facing the newborn screening community will provide insight into the challenges that lie ahead in the genomics era.


Subject(s)
Genetic Testing/ethics , Neonatal Screening/ethics , Dried Blood Spot Testing , Genetic Counseling , Genetic Testing/economics , Genomics , Health Knowledge, Attitudes, Practice , Health Policy , Humans , Infant, Newborn , Mandatory Testing/economics , Mandatory Testing/ethics , Neonatal Screening/economics , State Government , United States
8.
Sports Med ; 41(12): 989-1002, 2011 Dec 01.
Article in English | MEDLINE | ID: mdl-22060174

ABSTRACT

European and North American cardiologists have long debated the need for mandatory ECG screening of athletes in order to prevent sudden cardiac death. European investigators have recently adduced new evidence, which they believe supports the need for such screening. They note a decrease of sudden cardiac deaths among Italian athletes following the introduction of mandatory screening in that country, clearer definitions of resting ECG abnormalities in athletes, new and more encouraging calculations of cost/benefit ratios and direct comparisons of clinical examination alone against clinical examination plus ECG screening. Nevertheless, it seems that critical criteria for the success of any screening procedure (a substantial prevalence of the problem, coupled with an adequate test sensitivity and specificity) have yet to be satisfied. Very few athletes are liable to sudden cardiac death, only a few of those who are vulnerable will be identified by ECG screening, and even if all potential cases could be detected, restriction of their physical activity would be unlikely to have a major influence on their prognosis. At the same time, a requirement of mandatory testing would discourage engagement in physical activity, and would impose substantial direct costs on the community. Moreover, the large number of false positive test results could have important and undesirable consequences for both indirect medical costs and the overall health of competitors. ECG screening might become more effective if it could be focused on a smaller sub-group of vulnerable athletes, or if the problem of false positive tests could be addressed through an increase of test specificity. However, on the basis of current information, it would seem better to direct efforts in preventive medicine to more common causes of premature death in the young adult.


Subject(s)
Athletes , Death, Sudden, Cardiac/prevention & control , Electrocardiography/ethics , Mandatory Testing/ethics , Mass Screening/ethics , Death, Sudden, Cardiac/epidemiology , Electrocardiography/economics , False Positive Reactions , Female , Humans , Male , Mandatory Testing/economics , Mass Screening/economics , Prevalence , Prognosis
10.
Clin J Sport Med ; 21(1): 13-7, 2011 Jan.
Article in English | MEDLINE | ID: mdl-21200165

ABSTRACT

The risk of sudden cardiac death may be increased up to 2.8 times in competitive athletes compared with nonathletes. The majority of sudden cardiac death cases are caused by an underlying abnormality that potentially may be identified on cardiovascular screening, depending on the specific abnormality and the content of the cardiovascular screening applied. Indeed, today, cardiac screening is universally recommended by the cardiac societies [European Society of Cardiology (ESC) and American Heart Association (AHA)] and required by the sporting bodies [Fédération Internationale de Football Association (FIFA) and Union of European Football Associations (UEFA)]. Pre-participation examination is by consensus understood to include personal history and physical examination; controversy exists regarding the usefulness and appropriateness of screening using resting 12-lead electrocardiogram (ECG), with an apparent transatlantic difference. The ESC recommends screening consisting of personal history, physical examination, and 12-lead resting ECG, whereas recommendations from the AHA includes only personal history and physical examination. There is firm scientific ground to state that the sensitivity of screening with ECG is vastly superior to, and the cost-effectiveness significantly better than, screening without ECG. Cardiac screening of elite athletes with personal history, physical examination, and ECG is cost-effective also in comparison with other well-accepted procedures of modern health care, such as dialysis and implantable cardiac defibrillators. Newly published recommendations for the interpretation of the ECG in athletes (ESC) and future studies on ECGs in athletes of different ethnicity, gender, and age may further increase the specificity of ECG in cardiac screening, refining the screening procedure and lowering the costs for additional follow-up testing. Cardiac screening without ECG is not cost-effective and may be only marginally better than no screening at all and at a considerable higher cost. The difficulties in feasibility and liability issues for recommending ECGs in some countries need to be acknowledged but must be dealt with within those countries/systems. On ethical grounds, the reasons (logistical, legal, economic) for not screening individual athletes should be clearly stated. Alas, the current evidence, as presented here, suggests that the ECG should be mandatory in pre-participation screening of athletes.


Subject(s)
Athletes , Death, Sudden, Cardiac/prevention & control , Electrocardiography/methods , Evidence-Based Medicine , Mandatory Testing/methods , Physical Examination/methods , Cardiovascular Diseases/diagnosis , Electrocardiography/economics , Feasibility Studies , Humans , Mandatory Testing/economics , Medical History Taking , Physical Examination/economics , Sensitivity and Specificity , Sports Medicine
11.
Rev. panam. salud pública ; 24(4): 256-264, oct. 2008. ilus, tab
Article in Spanish | LILACS | ID: lil-500455

ABSTRACT

OBJETIVO: Comparar mediante un modelo de análisis de decisiones tres estrategias de tamizaje de la infección por el VIH en mujeres embarazadas según su relación costo-efectividad y proponer la más apropiada para el sistema de salud colombiano. MÉTODOS: Estudio económico basado en el análisis mediante árboles de decisión según tres estrategias de tamizaje de la infección por el VIH en mujeres embarazadas: la voluntaria, la universal y la opcional. Se consideró a todas las mujeres colombianas embarazadas sin diagnóstico de infección por el VIH que se presentaban para el parto. Se emplearon los costos médicos directos desde la realización de la prueba hasta un año después del parto, según el Sistema General de Seguridad Social en Salud. Se compararon las razones costo-efectividad y el ahorro de cada estrategia analizada. RESULTADOS: Por cada 10 000 mujeres, la estrategia universal permitió detectar 5 casos más que la estrategia voluntaria y 7 casos más que la opcional. La estrategia universal generó costos aproximados de US$ 17,00 por cada recién nacido positivo, es decir, menos de la mitad que lo calculado para la estrategia voluntaria (US$ 38,00) y menor que para la opcional (US$ 24,00). Según el análisis bifactorial, la estrategia de tamizaje universal fue menos costosa que la voluntaria y más efectiva que las otras dos estrategias, independientemente de la prevalencia, la tasa de positivos falsos del sistema de diagnóstico empleado y la tasa de aceptación materna para realizarse la prueba de tamizaje. CONCLUSIONES: La estrategia de tamizaje voluntaria, que se utiliza actualmente en Colombia, es más costosa que la universal a mediano y largo plazos y tiene menor efectividad y capacidad de prevención. Se recomienda a las autoridades nacionales de salud realizar el tamizaje de la infección por el VIH a todas las embarazadas colombianas con pruebas de tercera generación.


OBJECTIVES: To apply decision analysis to compare the cost-effectiveness of three strategies for HIV screening of pregnant women and to recommend the one most appropriate for the health care system of Colombia. METHODS: An economic study applying decision analysis to three types of HIV screening of expectant women: voluntary, universal, and optional. All the women in Colombia with unknown HIV status who were admitted for child birth were included. The study included all the direct medical costs incurred from the time of testing through the first year following delivery, according to the General System for Healthcare Social Security. Cost-effectiveness ratio and the savings of each of the strategies were compared. RESULTS: For every 10 000 women, the universal strategy detected five cases more than the voluntary strategy and seven cases more than the optional. The universal strategy carried a cost of approximately US$ 17 for each HIV-positive newborn; that is, less than half of that of the voluntary strategy (US$ 38) and less than the optional (US$ 24). According to the bifactorial analysis, the universal screening strategy was less costly than the voluntary and more effective than both of the others, regardless of prevalence, the false-positive rate of each method, and the rate of maternal compliance with screening. CONCLUSIONS: The screening strategy currently in use in Colombia is more costly (in both the medium- and long-term), less effective, and less capable of prevention, than the universal screening strategy. The recommendation to the national health authorities of Colombia is to begin screening all pregnant women for HIV infection using third-generation testing.


Subject(s)
Adult , Female , Humans , Infant, Newborn , Male , Pregnancy , AIDS Serodiagnosis/methods , HIV Infections/prevention & control , Infectious Disease Transmission, Vertical/prevention & control , Mandatory Testing , Mass Screening/methods , Patient Acceptance of Health Care , Pregnancy Complications, Infectious/diagnosis , Prenatal Care/methods , Voluntary Programs , AIDS Serodiagnosis/economics , Blotting, Western/economics , Colombia/epidemiology , Costs and Cost Analysis , Decision Trees , Enzyme-Linked Immunosorbent Assay/economics , False Positive Reactions , HIV Infections/congenital , HIV Infections/drug therapy , HIV Infections/economics , HIV Infections/epidemiology , HIV Infections/transmission , Infectious Disease Transmission, Vertical/economics , Mandatory Testing/economics , Mass Screening/economics , Polymerase Chain Reaction/economics , Pregnancy Complications, Infectious/economics , Pregnancy Complications, Infectious/epidemiology , Prenatal Care/economics , Voluntary Programs/economics
12.
HIV Med ; 9 Suppl 2: 1-5, 2008 Jul.
Article in English | MEDLINE | ID: mdl-18557862

ABSTRACT

The articles in this supplement were developed from a recent pan-European conference entitled 'HIV in Europe 2007: Working together for optimal testing and earlier care', which took place on 26-27 November in Brussels, Belgium. The conference, organized by a multidisciplinary group of experts representing advocacy, clinical and policy areas of the HIV field, was convened in an effort to gain a common understanding on the role of HIV testing and counselling in optimizing diagnosis and the need for earlier care. Key topics discussed at the conference and described in the following articles include: current barriers to HIV testing across Europe, trends in the epidemiology of HIV in the region, problems associated with undiagnosed infection and the psychosocial barriers impacting on testing. The supplement also provides a summary of the World Health Organization's recommendations for HIV testing in Europe and an outline of an indicator disease-guided approach to HIV testing proposed by a committee of experts from the European AIDS Clinical Society (EACS). We hope that consideration of the issues discussed in this supplement will help to shift the HIV field closer towards our ultimate goal: provision of optimal HIV testing and earlier care across the whole of the European region.


Subject(s)
AIDS Serodiagnosis/standards , HIV Infections/diagnosis , HIV-1 , AIDS Serodiagnosis/trends , Europe/epidemiology , Female , HIV Infections/economics , HIV Infections/epidemiology , Humans , Male , Mandatory Testing/economics , World Health Organization
13.
Rev Panam Salud Publica ; 24(4): 256-64, 2008 Oct.
Article in Spanish | MEDLINE | ID: mdl-19133174

ABSTRACT

OBJECTIVES: To apply decision analysis to compare the cost-effectiveness of three strategies for HIV screening of pregnant women and to recommend the one most appropriate for the health care system of Colombia. METHODS: An economic study applying decision analysis to three types of HIV screening of expectant women: voluntary, universal, and optional. All the women in Colombia with unknown HIV status who were admitted for child birth were included. The study included all the direct medical costs incurred from the time of testing through the first year following delivery, according to the General System for Healthcare Social Security. Cost-effectiveness ratio and the savings of each of the strategies were compared. RESULTS: For every 10,000 women, the universal strategy detected five cases more than the voluntary strategy and seven cases more than the optional. The universal strategy carried a cost of approximately US$ 17 for each HIV-positive newborn; that is, less than half of that of the voluntary strategy (US$ 38) and less than the optional (US$ 24). According to the bifactorial analysis, the universal screening strategy was less costly than the voluntary and more effective than both of the others, regardless of prevalence, the false-positive rate of each method, and the rate of maternal compliance with screening. CONCLUSIONS: The screening strategy currently in use in Colombia is more costly (in both the medium- and long-term), less effective, and less capable of prevention, than the universal screening strategy. The recommendation to the national health authorities of Colombia is to begin screening all pregnant women for HIV infection using third-generation testing.


Subject(s)
AIDS Serodiagnosis/methods , HIV Infections/prevention & control , Infectious Disease Transmission, Vertical/prevention & control , Mandatory Testing , Mass Screening/methods , Patient Acceptance of Health Care , Pregnancy Complications, Infectious/diagnosis , Prenatal Care/methods , Voluntary Programs , AIDS Serodiagnosis/economics , Adult , Blotting, Western/economics , Colombia/epidemiology , Costs and Cost Analysis , Decision Trees , Enzyme-Linked Immunosorbent Assay/economics , False Positive Reactions , Female , HIV Infections/congenital , HIV Infections/drug therapy , HIV Infections/economics , HIV Infections/epidemiology , HIV Infections/transmission , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical/economics , Male , Mandatory Testing/economics , Mass Screening/economics , Polymerase Chain Reaction/economics , Pregnancy , Pregnancy Complications, Infectious/economics , Pregnancy Complications, Infectious/epidemiology , Prenatal Care/economics , Voluntary Programs/economics
14.
Policy Polit Nurs Pract ; 8(3): 201-9, 2007 Aug.
Article in English | MEDLINE | ID: mdl-18178927

ABSTRACT

In 2005, a federal advisory committee recommended that the number of disorders in state newborn screening programs be expanded from 9 to 29. In view of this recommendation, state leaders will need to make cogent decisions regarding the expanse of their state newborn screening programs. They must consider several factors, including the costs and outcomes of the screening program. The expense of the initial screening test can be misleading because it does not include the cost of the entire program (testing, tracking, notifying, retesting, confirmatory testing, and follow-up). Also, outcomes such as false positive findings can be costly to newborn screening programs, result in additional testing for infants, and lead to parental concern and worry. This article examines some of the policy issues related to newborn screening and specifically focuses on three disorders recommended for newborn screening, cystic fibrosis (CF), medium-chain acyl CoA dehydrogenase Deficiency (MCADD), and beta-ketothiolase (BKT).


Subject(s)
Acetyl-CoA C-Acyltransferase/deficiency , Acyl-CoA Dehydrogenase/deficiency , Cystic Fibrosis/diagnosis , Health Policy , Metabolism, Inborn Errors/diagnosis , Neonatal Screening/organization & administration , Cost-Benefit Analysis , Cystic Fibrosis/epidemiology , Cystic Fibrosis/genetics , Early Diagnosis , Evidence-Based Medicine , False Positive Reactions , Genetic Testing/organization & administration , Health Planning Guidelines , Health Policy/economics , Health Policy/legislation & jurisprudence , Health Services Needs and Demand , Humans , Infant, Newborn , Mandatory Testing/economics , Mandatory Testing/legislation & jurisprudence , Metabolism, Inborn Errors/epidemiology , Metabolism, Inborn Errors/genetics , Neonatal Screening/adverse effects , Outcome Assessment, Health Care , Parental Consent/legislation & jurisprudence , Policy Making , Public Health Practice/economics , Public Health Practice/legislation & jurisprudence , Sensitivity and Specificity , State Health Plans/organization & administration , United States/epidemiology
16.
BMC Public Health ; 4: 4, 2004 Feb 23.
Article in English | MEDLINE | ID: mdl-15053833

ABSTRACT

BACKGROUND: To determine the frequency of Medicaid mandated blood lead level (BLL) screening compliance rates by clinical site. METHODS: Retrospective chart review for evidence of BLLs. Data analyses were conducted using frequencies, percentages & chi-square. RESULTS: The overall incidence of documented BLLs was 78.9% with one clinic demonstrating 100% BLLs while the others had 72%. Screening rates differed significantly by clinical site (X2 = 18.460, df = 3, p < 0.001). CONCLUSION: Although universal blood lead screening is mandated, there were missed opportunities to obtain BLLs in 21.1% of the records reviewed. Only one clinic had 100% documentation of BLLs when children on Medicaid were seen between the ages of 12-18 months.


Subject(s)
Child Health Services/statistics & numerical data , Lead/blood , Mandatory Testing/legislation & jurisprudence , Mass Screening/statistics & numerical data , Medicaid/legislation & jurisprudence , State Health Plans/legislation & jurisprudence , Child , Child Health Services/economics , Child Health Services/legislation & jurisprudence , Child, Preschool , Ethnicity , Female , Guideline Adherence , Health Care Surveys , Humans , Infant , Male , Mandatory Testing/economics , Mandatory Testing/statistics & numerical data , Mass Screening/economics , Mass Screening/legislation & jurisprudence , Nebraska , United States
20.
Obstet Gynecol ; 91(2): 174-81, 1998 Feb.
Article in English | MEDLINE | ID: mdl-9469271

ABSTRACT

OBJECTIVE: To determine the cost-effectiveness of mandatory screening for human immunodeficiency virus (HIV) in pregnancy compared with that of voluntary screening under varying assumptions about patient behavior. METHODS: Using a health care system perspective, a decision-analysis model was constructed to estimate the outcomes and costs of the two strategies. Average and incremental cost-effectiveness ratios were calculated for each strategy. Sensitivity analyses were performed to test the effects of different values on the results of the simulation. In particular, we examined the potential effects of changes in patient behavior resulting from mandatory screening on our estimates of cost-effectiveness. RESULTS: At a prevalence of 170 per 100,000, average costs per case prevented were $255,158 and $367,998 for mandatory and voluntary screening, respectively. The incremental cost-effectiveness of mandatory compared with voluntary screening was $29,478. These values decreased as prevalence of HIV increased, or as the estimated lifetime cost of pediatric HIV infection increased: above an estimated cost for pediatric HIV of $129,250, mandatory screening was less expensive and more effective than voluntary screening. Assumptions about patient behavior affected these results: a 40% reduction in zidovudine acceptance in women identified only through mandatory screening increased the incremental cost-effectiveness to $112,434. The impact of behavior increased as the prevalence of HIV increased. CONCLUSION: Mandatory screening will prevent more cases of pediatric AIDS, but at a somewhat higher cost than voluntary screening under baseline assumptions. The cost-effectiveness of mandatory screening will be influenced by patient behavior, especially acceptance of zidovudine treatment among women who would have refused voluntary screening.


Subject(s)
AIDS Serodiagnosis/economics , Mandatory Testing/economics , Pregnancy Complications, Infectious/economics , AIDS Serodiagnosis/legislation & jurisprudence , Anti-HIV Agents/economics , Anti-HIV Agents/therapeutic use , Cost-Benefit Analysis , Costs and Cost Analysis , Female , HIV Infections/diagnosis , HIV Infections/economics , HIV Infections/prevention & control , Health Behavior , Health Care Costs , Humans , Infectious Disease Transmission, Vertical/prevention & control , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Zidovudine/economics , Zidovudine/therapeutic use
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