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1.  A one-year economic evaluation of six alternative strategies for the management of uninvestigated upper gastrointestinal symptoms in Canadian primary care 
BACKGROUND:
The cost-effectiveness of initial strategies in managing Canadian patients with uninvestigated upper gastrointestinal symptoms remains controversial.
OBJECTIVE:
To assess the cost-effectiveness of six management approaches to uninvestigated upper gastrointestinal symptoms in the Canadian setting.
METHODS:
The present study analyzed data from four randomized trials assessing homogeneous and complementary populations of Canadian patients with uninvestigated upper gastrointestinal symptoms with comparable outcomes. Symptom-free months, quality-adjusted life-years (QALYs) and direct costs in Canadian dollars of two management approaches based on the Canadian Dyspepsia Working Group (CanDys) Clinical Management Tool, and four additional strategies (two empirical antisecretory agents, and two prompt endoscopy) were examined and compared. Prevalence data, probabilities, utilities and costs were included in a Markov model, while sensitivity analysis used Monte Carlo simulations. Incremental cost-effectiveness ratios and cost-effectiveness acceptability curves were determined.
RESULTS:
Empirical omeprazole cost $226 per QALY ($49 per symptom-free month) per patient. CanDys omeprazole and endoscopy approaches were more effective than empirical omeprazole, but more costly. Alternatives using H2-receptor antagonists were less effective than those using a proton pump inhibitor. No significant differences were found for most incremental cost-effectiveness ratios. As willingness to pay (WTP) thresholds rose from $226 to $24,000 per QALY, empirical antisecretory approaches were less likely to be the most cost-effective choice, with CanDys omeprazole progressively becoming a more likely option. For WTP values ranging from $24,000 to $70,000 per QALY, the most clinically relevant range, CanDys omeprazole was the most cost-effective strategy (32% to 46% of the time), with prompt endoscopy-proton pump inhibitor favoured at higher WTP values.
CONCLUSIONS:
Although no strategy was the indisputable cost-effective option, CanDys omeprazole may be the strategy of choice over a clinically relevant range of WTP assumptions in the initial management of Canadian patients with uninvestigated dyspepsia.
PMCID: PMC2947002  PMID: 20711528
Antisecretory therapy; Cost-effectiveness; Dyspepsia; Economic modelling; Endoscopy; Helicobacter pylori
2.  The Value of Performance Measurement in Promoting Improvements in Women's Health 
Healthcare Policy  2009;5(2):52-67.
Objectives:
To determine the factors associated with the use and impact of performance data relevant to women's health.
Methods:
We developed a survey on six levels of information use based on Knott and Wildavsky's (1980) policy utilization framework and used this survey to determine Ontario hospital administrators' use of women's health report indicators. We related responses to this survey to six potentially relevant organizational factors, such as women's health as a written hospital priority, a women's health program and hospital budget size, using correlation and multiple-regression analysis.
Results:
Only women's health in a written hospital priority (p=0.01) and hospital budget (p=0.02, log transformed) were significantly associated with the highest level of use when all organizational factors were considered.
Conclusion:
These findings suggest that the use of women's health performance indicators is strongly related to the size of the hospital budget and to organizational commitment to women's health.
PMCID: PMC2805140  PMID: 21037826
3.  Economic benefits of a routine second dose of combined measles, mumps and rubella vaccine in Canada 
OBJECTIVE:
To evaluate the potential economic benefits of a program for a second routine dose of combined measles, mumps and rubella (MMR) vaccine, administered to children in Canada.
DESIGN:
Both published and unpublished data from the United States and Canada were incorporated into a linear model. This information was supplemented with opinions on probability and resource use from interviews with a Canadian panel of physicians and practitioners. The province of Quebec was used as a model for resource use and costs.
MATERIAL AND METHODS:
Data were based on a vaccination program for Canadian children at 18 months, with an estimated annual birth cohort of 400,000. Further data were also collected for the lifetime costs of complications arising from these diseases or from vaccination, for both patients and family caregivers.
OUTCOME MEASURES:
Outcomes were reviewed from the perspectives of a provincial ministry of health (direct medical costs) and of society (all direct and indirect medical and nonmedical costs).
RESULTS:
It was estimated that a second dose of MMR vaccine administered at 18 months of age would prevent 9200 cases of measles, 6120 cases of mumps and 1960 cases of rubella, producing a savings of $6.34 for every dollar spent from the ministry of health perspective, and $3.25 from the societal perspective.
CONCLUSIONS:
A routine second dose immunization with MMR vaccine would result in considerable cost savings in Canada.
PMCID: PMC3250895  PMID: 22346520
Benefit-cost; Economics; Measles; Mumps; Rubella; Second dose vaccine

Results 1-3 (3)