A reappraisal of hepatitis B virus vaccination strategies using cost-effectiveness analysis
Vaccinating infants and 10-year-old children against hepatitis B virus (HBV) may be the most cost-effective method for controlling the spread of hepatitis B. Hepatitis B is a blood-borne infection that can lead to liver cancer in some individuals. A study evaluated the cost-effectiveness of three strategies to prevent the transmission of hepatitis B in newborns, 10-year-old children, high-risk adults and the general adult population. The most cost-effective strategy for preventing the transmission of hepatitis B would begin with screening all pregnant women for HBV. The newborns of women infected with HBV would be given HBV immunoglobulin and the HBV vaccine. Infants whose mothers are not infected would also be vaccinated against HBV. Children would be vaccinated at the age of 10 and again at the age of 20.
Publication Name: Annals of Internal Medicine
How do financial incentives affect physicians' clinical decisions and the financial performance of health maintenance organizations?
The use of financial incentives by health maintenance organizations may change the attitude of physicians towards individual patients. This hypothesis was tested by evaluating data from a survey of HMOs regarding the presence offinancial incentives and the rate of hospitalization, visits for outpatient services and the achievement of break-even status. The use of salaries resulted in a lower number of hospitalizations than the use of fee-for-service payment plans. HMOs that were larger, older, had physicians who treated more HMO patients, and placed physicians at personal financial risk for the cost of outpatient tests were more likely to break even.
Publication Name: The New England Journal of Medicine
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