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In the United States in 2000, 180,400 new cases of prostate carcinoma were expected to occur, with 31,900 men expected to die from this illness. In addition, prostate carcinoma is the cause of over half a million disability-adjusted life-years. This study summarizes the current body of published literature about the economics of prostate carcinoma.The authors used a MEDLINE-based literature review for relevant articles from 1990 to the present.The authors' search returned 216 articles, 56 of which met the criteria of interest. Prostate carcinoma is costly to treat, currently averaging above $20,000 per case. Cost of care is directly related to stage of disease and comorbidity. Substantial geographic variation exists, even within small locales, with regard to care patterns and cost. In-hospital mortality, length of stay, and cost are inversely related to case volume. Care rendered in health maintenance organizations is generally less technologically intensive than in the fee-for-service sector. Out of the 18 cost studies examined, 13 were cost-minimization analyses and five assessed cost-effectiveness. From a cost perspective, laparoscopic pelvic node dissection was favored over an open pelvic procedure; 3D conformal radiation therapy was favored over 2D; and radiation therapy was favored over radical prostatectomy. Cost-effectiveness analyses favored the use of metastron, mitroxantone plus prednisone over prednisone alone, flutamine with either medical or surgical castration, and orchiectomy as the androgen suppression therapy.The literature on the economics of prostate carcinoma is relatively meager. Most cost studies were done on small samples, had short follow-up periods, used charges rather than cost data, and did not include adequate representation of all stages of disease. Additional research is needed.

To assess the cost savings associated with a patient education and high-intensity strength intervention to improve rehabilitation after hip fracture.Economic analysis conducted alongside a randomized controlled trial, using cost-benefit ratios and net present value statistics. Study subjects were aged over 64 years and were followed for 18 months postsurgery. Resource utilization data were gathered by telephone questionnaire. Medicare reimbursement rates and prevailing costs for services not covered by Medicare were used to convert utilization patterns into costs. Intervention costs were obtained from program records.The cost of the intervention was $722 per patient. Over the followup period, median costs were $11,941 and $21,577 for the intervention and control groups, respectively, yielding an average program benefit of $9,636. Cost-benefit ratios exceeded 4.5, and net present value exceeded $150,974.The results indicate that the benefits of the intervention exceeded its costs.

Among 195 people who did not have recommended elective surgery in which a second opinion was required, virtually all indicated they were not going to have the operation and did not want a second opinion. The extent to which this decision adversely affected their health status and well-being and the extent to which alternate treatments were tried are examined. The findings also highlight the discretionary nature of patient and physician decision making.

Using a random sample of 310 Massachusetts community-residing elderly between the ages of 65 and 74, this study investigates the relationship between employment status and quality of life using a modified version of the Spitzer Uniscale QL index. The odds of reporting the highest quality of life rating, after controlling for socioeconomic and health characteristics, was 3.51:1 for those who worked versus those who did not do so.

Authors Warren Betty, M.D., et. al., describe how the Staten Island Medical Group computerized the data entry functions necessary for a workable physician audit and feedback program and how the program has been successful in some settings in bringing about lower utilization levels.

Despite more than a decade of cost containment initiatives, medical care costs continue to rise at levels that concern both policy makers and third-party payers. Various explanations can be offered for this apparent lack of success. A crucial factor in the opinion of the authors, Robert Braham, M.D., and Hirsch Ruchlin, Ph.D., is the way in which cost containment is approached. Braham and Ruchlin describe how their organization successfully tackled this concern.

Costs of care are presented for elderly persons in five community-based settings. These settings include elderly persons living in their own homes or in group housing and who do or do not receive case-managed home care. Expenditures for care ranged from a low of about $1,100 per year to a high of $4,025. The level of expenditure was directly related to risk of institutionalization and was higher for those receiving case-managed home care. As a majority of the elderly use a substantial amount of care even without case management, the potential for community care demonstration programs to yield significant cost savings appears quite limited.

This paper examines certain quality of life outcomes, as well as comparative costs of care, for selected types of persons entering three very distinct types of alternative service programs that address the long-term care needs of vulnerable elderly persons: nursing homes (NH), geriatric day hospitals (GDH), and senior center (SC) programs. For selected outcomes, based on secondary analysis of the data gathered in another study, it was possible to add to the comparison samples of similar types of persons entering small foster-type domiciliary care homes (DC). From pools of persons entering these programs, six separate sets of comparison samples who were similar at baseline were constructed (GDH-SC, NH-SC, NH-GDH, NH-DC, SC-DC, GDH-DC). Only analyses pertaining to institutionalization and costs were conducted for the last three sets of comparison groups. Except for the issue of institutionalization, quality of life impact analysis showed only a few more post-test differences than would be expected by chance (although the few post-test differences that were observed in each case favored less restrictive settings). This more general similarity of outcome is indeed provocative, suggesting that in many ways the applicants adapted similarly to these quite distinct programs. Cost analyses found that nursing home and geriatric day hospital care, the two most restrictive settings, were also the two most expensive interventions.

Programmes for securing second opinions on elective surgery are designed to help patients make a more informed decision once elective surgery has been recommended. The patient is assessed before surgery is performed, which allows alternatives to be considered. The Cornell/New York Hospital second opinion programme is the only one to have accumulated statistics on voluntary and mandatory programmes. Data from the mandatory programme showed that 18.7% of the 6799 patients screened were no confirmed for surgery. Follow-up data at one year showed that 67.5% of the unconfirmed patients had not in fact had surgery. A cost-benefit analysis showed that for every $1.00 spent there was a benefit of $2.63.

In a recently completed study profiling CCRCs, it was concluded that CCRCs are showing an improved financial position. However, financial problems were noted. In many cases, income and equity deficits were reported. Financial ratios indicated additional potential problems. Unless improvements can be made, CCRCs may be facing a future of financial difficulties.

A pilot program based on the substitution of domiciliary care for traditional institutional care was established by the Commonwealth of Pennsylvania to provide community-based care for individuals who could no longer live independently (aging, mentally retarded, mentally ill). To ascertain the cost saving potential of this program, 190 participants and a comparable pool of non-participants were followed for an average 10-month follow-up period. Within each subgroup, participants were disaggregated into two categories: those residing in a community setting at pretest, and those residing in an institutional setting. An analysis of medical care and social support service utilization profiles indicated that program savings exceeded program cost for five of the six study subsamples; the one exception was the mental retardation cohort residing in a community setting at pretest. Net savings were greatest for the three subsamples residing in an institutional setting at pretest. For all the subsamples, over 90 per cent of the program saving stemmed from a lower use of institutional placements.

The need for effective management information systems is now evident. No longer is pertinent and timely information merely something desirable to group practice; it is essential for management control and even survival in today's healthcare environment. Most of the management information systems currently in use are designed for controlling line-item budget categories and not the key professionals whose actions determine the fate of the practice. A physician practice profile system was developed at the Cornell Medical Practice and implemented in July 1982. This tiered reporting system is described in detail, including its ancillary service utilization and quality audit profiles, and the results of the system are presented.