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Agency for Healthcare Research Quality

Cynthia Palmer

Authors: Luce BR, Zangwill KM, Palmer CS, et al.
Title: Cost-effectiveness analysis of an intranasal influenza vaccine for the prevention of influenza in healthy children.
Publication: Pediatrics 108(2):e24.
Date: 2001
Abstract: This study determined the potential cost-effectiveness of intranasal influenza vaccine among young, healthy children. The analysis included prospectively collected 2-year clinical trial data supplemented with data from the literature. Results indicated that routine use of intranasal influenza vaccine among healthy children may be cost-effective and cost-effectiveness may be maximized by using group-based vaccination approaches.
Topics: Children, Cost, Medical Decisionmaking, Prevention.

Authors: Revicki DA, Kobayashi M, Palmer CS, et al.
Title: Burden of schizophrenia in Japan: Impact on patients, families and society.
Publication: Schizophrenia Frontier 2(41)41-49.
Date: 2001
Abstract: Schizophrenia places a significant financial burden on Japanese society and the health care system. Patients with the disorder suffer stigma, impaired functioning, disability, and decreased quality of life and family members caring for relatives with schizophrenia suffer a financial burden, and psychological distress and caregiver burden. The newer atypical antipsychotics not yet commonly available in Japan may help improve patient functioning and quality of life, enabling fuller benefits from psychosocial programs, and reintegrating patients as productive members of the community. There are opportunities to benefit patients, their families, and society through improved treatment and provision of community-based services for schizophrenia.
Topic: Cost, Mental Health.

Authors: Palmer CS, Schmier J, Snyder E, Scott B.
Title: Patient preferences and utilities for "off-time" outcomes in the treatment of Parkinson's disease.
Publication: Quality of Life Research 9(7):819-27.
Date: 2000
Abstract: The purpose of this study was to derive patient preferences and utilities for outcomes associated with treatment of motor fluctuations, or 'off-time', for patients with Parkinson's disease (PD). Visual analog scale and standard gamble approaches were used with 60 patients to determine patient preferences and utilities for 10 health state descriptions. Health state descriptions were categorized according to two factors: disease severity, and proportion of the day with 'off-time'. The results of this study indicated patients with PD would likely seek treatment that would minimize the amount of 'off-time' experienced per day, and that patients were relatively risk averse.
Topic: Chronic Conditions.

Authors: Palmer CS, Niparko JK, Wyatt JR, et al.
Title: A prospective study: cost-utility of the multichannel cochlear implant.
Publication: Archives of Otolaryngology 125(11):1221-28.
Date: 1999
Abstract: Cochlear implants can benefit individuals with advanced hearing loss insufficiently aided by hearing aids. This study determined the cost per QALY gained with implantation of a multichannel cochlear implant. Health utility and cost data were prospectively collected over 12 months in adults with severe to profound hearing loss. Results indicated a very favorable cost/QALY for those who received an implant compared with those who did not.
Topics: Chronic Conditions, Cost, Medical Decisionmaking.

Authors: Shikiar R, Halpern MT, McGann M, Palmer CS, Seidlin M.
Title: The relation of patient satisfaction with treatment of otitis externa to clinical outcomes: Development of an instrument.
Publication: Clinical Therapeutics 21(6):1091-104.
Date: 1999
Abstract: This survey was undertaken to develop a short, comprehensive measure of patient satisfaction with pharmacologic treatment for otitis externa and to assess the relationships between satisfaction, disease symptoms, and medication side effects. Our results demonstrate that patient satisfaction with otic medication can be assessed across various aspects of satisfaction and that it is correlated with reported disease symptoms and medication side effects. This type of multifaceted assessment may help physicians select between medications with different side-effect profiles and administration schedules.
Topic: Organizational Research.

Authors: Halpern MT, Palmer CS, Seidlin M.
Title: Treatment patterns for otitis externa.
Publication: Journal of the American Board of Family Practitioners 12(1):1-7.
Date: 1999
Abstract: Data were analyzed from the 1993 National Ambulatory Medical Care Survey (NAMCS) and the 1993 National Hospital Ambulatory Medical Care Survey (NHAMCS) for adults and children treated for otitis externa. Data analyses included the reasons for physician visits, concomitant diagnoses, types of physicians seen, sources of payment, medical procedures administered, drugs prescribed, and patient disposition following a physician visit. Study results suggested that treatment patterns differ substantially for adults and children, as well as by physician specialty. Appropriate treatment of localized otitis externa with topical antibiotics should eliminate the need for systemic medications. Addition of systemic medications can unnecessarily increase treatment costs and the likelihood of side effects, and could reduce the likelihood of patient compliance.
Topic: Medical Decisionmaking.

Authors: Palmer CS, Kleinman L, Taylor LA, Revicki DA.
Title: Pharmacoeconomics of antidepressant drug overdose.
Publication: CNS Drugs 10(3):223-31.
Date: 1998
Abstract: Patients with severe depression are often at risk of suicide, and many antidepressant medications are used, either alone or in combination with other substances, to attempt suicide. Drug overdoses involving antidepressants are known to result in significant medical costs to the healthcare system. The medical costs associated with an antidepressant drug overdose depend on the class and toxicity of the antidepressant and possible co-ingestants. Studies indicate that overdoses involving single Selective Serotonin Reuptake Inhibitors (SSRIs) have significantly lower medical costs compared with overdoses involving single TCAs.
Topic: Cost, Mental Health.

Authors: Palmer CS, Miller B, Halpern MT, Geiter L.
Title: A model of the cost-effectiveness of directly observed therapy for treatment of tuberculosis.
Publication: Journal of Public Health Management and Practice 4(3):1-13.
Date: 1998
Abstract: A hypothetical cohort of 25,000 TB patients and their contacts were followed in a 10-year decision model; rates of treatment default, infectiousness following partial treatment, relapse, hospitalization, and development of drug-resistant TB were considered. The incremental cost per additional case cured was $24,064 when all patients started treatment on directly observed therapy (DOT) compared with patient responsible therapy, indicating that outpatient DOT provides a cost-effective method of improving health outcomes for TB patients and their contacts while controlling direct costs.
Topic: Cost, Public Policy.

Authors: Palmer CS, Revicki DA, Genduso LA, Hamilton SH.
Title: A cost-effectiveness clinical decision analysis model for schizophrenia.
Publication: Am J Managed Care 4(3)345-55.
Date: 1998
Abstract: A decision analytic Markov model was used to determine the cost-effectiveness of treatments and outcomes that patients treated for schizophrenia may experience over a 5-year period. Model parameter estimates were based on clinical trial data, published medical literature, and, when needed, clinician judgment. Direct medical costs were incorporated into the model, and outcomes were expressed by using three effectiveness indicators: the Brief Psychiatric Rating Scale, quality-adjusted life years, and lack of relapse.
Topic: Cost, Mental Health.

Authors: Leidy NK, Palmer CS, Murray M, et al.
Title: Health-related quality of life assessment in euthymic and depressed patients with bipolar disorder: Psychometric performance of four self-report measures.
Publications: Journal of Affective Disorders 48:207-14.
Date: 1998
Abstract: The purpose of this study was to evaluate the psychometric properties of selected health-related quality of life (HRQL) self-report measures in 62 euthymic and depressed patients diagnosed with bipolar disorder. Patients completed the Quality of Life in Depression Scale, Mental Health Index-17, Cognitive Function Scale, and Medical Outcomes Study Short Form-36 at baseline and 8 weeks following treatment. Hamilton and Young Rating Scales were used to assess clinical status and validate the HRQL measures. Although the small sample size limits generalizability, euthymic and depressed outpatients with bipolar disorder appear to contribute reliable self reports on selected aspects of their quality of life.
Topic: Mental Health.

Authors: Palmer CS, Revicki DA, Halpern MT, Hatziandreu EJ.
Title: The cost of suicide and suicide attempts in the United States.
Publication: Clinical Neuropharmacology 18(Suppl 3):S25-S33.
Date: 1995
Abstract: Suicide is ranked eighth as a cause of death in the United States and is the third leading cause of death in the 15- to 24-year age group. Schizophrenia, along with depression, is an important risk factor for suicide and attempted suicide. The incidence of suicide in 1994 was estimated, along with the 1994 projected costs of suicide and suicide attempts. Suicide attempts incur greater direct costs during hospitalization and a percentage of patients will suffer permanent disability requiring long-term care and loss of earnings; total costs averaged over $33,000 (U.S.) per attempt. Major cost savings may be achieved by targeting the prevention of suicide.
Topic: Cost, Mental Health.

Authors: Brown RE, Miller B, Taylor WR, Palmer CS, et al.
Title: Health care expenditures for tuberculosis in the United States.
Publication: Arch Intern Med 155:1595-1600.
Date: 1995
Abstract: This retrospective cost of illness study estimated 1991 direct expenditures for TB-related outpatient and inpatient diagnosis and treatment, screening, preventive therapy, contact investigations, surveillance, and outbreak investigations. The direct medical expenditures for TB in 1991 were estimated at $703.1 million. Treatment accounted for more than 86% of all TB-related expenditures; inpatient treatment accounted for 60% of the total. Prevention activities made up only 14% of all costs. Direct medical expenditures may be underestimated because of limitations in the database on hospital expenditures and health department cost-accounting systems and because of the lack of a national database on screening activities.
Topic: Cost, Public Policy.

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