Browsing by Subject "Public Affairs, Public Policy and Public Administration"
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Item A Cost Analysis of Tuberculosis and its Prevention in Tarrant County, Texas(2007-05-01) Miller, Thaddeus L.; Scott McNabb; Peter Hilsenrath; Jotam PasipanodyaMiller, Thaddeus L. A Cost Analysis of Tuberculosis and its Prevention in Tarrant County, Texas. Doctor of Public Health (Health Management and Policy), May 2007, 232 pp., 29 tables, 2 illustrations, bibliography, 274 titles. Tuberculosis cost has been incompletely described as the cost arising from acute illness and treatment. The societal cost of tuberculosis arises from infection, suspicion of infection, acute and preventive responses, the sequalae of illness (including acute morbidity, drug induced hepatitis, mortality, and disability), and the compounding effects of transmission. This societal cost in unknown however the variable portion of this cost is equivalent to the savings made possible by averting tuberculosis, This study measured the societal cost of tuberculosis in Tarrant County, Texas, for the year 2002. Societal costs were estimated as the sum of known or estimated expenditures and health losses related to tuberculosis and discounted at 3%. Current and future costs will accrue to an estimated net $33.9 2002 USD million for the year 2002 in Tarrant County, Texas. An average of 1.4 QALYs net of 3% social discount were lost per incident case. The greatest burdens of tuberculosis, when analyzed by either cost or health quality, can be averted only by case prevention. Forty-three and 44% of societal cost was generate by secondary transmission and chronic impairment associated with pulmonary tuberculosis. Neither factor is routinely considered in discussions of tuberculosis cost. Acute treatment, hospitalization and direct medical care account for only 2.4% of societal cost. Any intervention that prevents one tuberculosis case will prevent at least a net $295,182 (2002 USD) and individual health quality losses averaging 1.4 net QALYs.Item An Economic Analysis of Texas' Measles Vaccination Program: 1990-1996(2000-08-01) MacDonald, Tammy O.; Claudia S. CogginIn order to get the most benefit out of limited resources, public health departments must examine the costs and benefits of their activities to determine the most cost-effective method to allocate these scarce resources. The use of economic analysis can inform and help clarify upon which decisions are to be made. (CDC, 1996). The resources used to produce most goods and services in society are efficiently allocated through markets. However, markets can fail to efficiently provide goods and services that largely benefit individuals other than the consumer. The types of goods and services that public health departments provide often fall into that category. Cost-benefit analysis is one type of economic decision-making tool used when market forces are not in control Cost-benefit analysis (CBA) places a dollar value on the costs and benefits of each outcome so they can be compared. This type of economic analysis can then be taken one step further. An incremental or marginal analysis can determine changes in the relative costs and benefits’ resulting from increase or decreases in the amount of resources used in a program. Such an analysis should be part of the decision making process, so that scarce resources can be used efficiently. This paper examines not only the costs and benefits of the measles immunization program in Texas but also, the expansion of the program in the 1990’s. The most significant changes in Texas’ immunization program took place in 1994 as a result of the measles outbreak of 1989-1990. The years 1992, 1993, 1994 and 1996 were chosen for this analysis because of the difference in immunization rates, incidence rates and the level of State funding. This time period represents the most dramatic changes to these three areas. Since the measles vaccination was put into use in 1963, the number of measles cases in the United States has decreased dramatically. An average of 450 measles-associated deaths was reported each year between 1953 and 1963. (TDH, unpublished). Widespread use of the vaccine has led to a 95% reduction in measles compared with the pre-vaccine era. (TDH, unpublished). However, during 1989-1990, the number of measles cases and deaths rose sharply. During 1989, more than 18,000 cases and 41 deaths were reported. The largest number of reported cases since 1978 and the largest number of deaths in two decades in the U.S. (National Vaccine Advisory Committee, 1991). The major cause of the epidemic of 1989 and 1990 was a low vaccination rate among preschool children. (TDH, unpublished). The Centers for Disease Control and Prevention (CDC) estimates national measles vaccine coverage for 2-year-olds in 1985 was 61%, compared with 82% in 1991 and 1992. (CDC, 1994). The CDC has set a goal of 90% of 2-year-olds to be immunized against measles, mumps and rubella. Texas reported 11% of all measles cases in the U.S. between 1989 and 1990, although it only accounted for 7% of the total U.S. population (Schulte et al. 1996). This is likely due to the fact that immunization rates were low throughout the state. In 1989, only 66% of the children in Dallas and 58% in Houston were estimated to be immunized against polio, diphtheria, pertussis, tetanus, measles, mumps, and rubella by the age of two. Nationally, immunization rates were estimated to be 70% at the same time (Schulte et al., 1996). This paper will proceed as follows. Two benefit/cost studies will be outlined in the background section. These studies compare the total benefits and costs of current vaccination programs to no vaccination program. Then a history of Texas’ measles vaccination program will be discussed. It will explain how the measles outbreak of 1989-1990 brought about organizational and financial changes to the immunization program within the Texas Department of Health (TDH). In the method section, the disease costs and costs associated with a vaccination program are used to calculate a benefit/cost ratio. The changes in immunization rates and the associated marginal costs and benefits are then compared. The results of the CBA and marginal analysis indicate that the benefit to cost (B/C) ratios range from 17 to 30:1. After reaching an immunization rate of about 81%, marginal benefits become smaller and smaller while the cost of increasing the immunization rate rises. Finally, the results will be discussed and conclusions made as to the efficiency of Texas’ measles vaccination program. There is some evidence that the CDC’s goal to immunize 90% of 2-year-old children for measles may not the most efficient goal for Texas.Item Are the Disaster Preparedness Plans in the Largest Cities in the States Adequate for Disabled & Elderly Populations?(2007-05-01) Hall, Stephanie K.Hall, Stephanie K, Are the Disaster Preparedness Plans in the Largest Cities in the Unites States Adequate for Disabled & Elderly Populations? Master of Public Health (Community Health), May 2007, 36 pp., 10 tables, 1 map, reference, 15 titles. This study seeks to compare urban disaster plans in the 25 largest U.S. cities. The focus of this study involves two populations that are often neglected or dealt with last: elderly and disabled. Therefore, the largest US cities should have a comprehensive disaster preparedness plan that includes evacuation & transportation; sheltering and health services; and legal considerations for both the disabled & elderly populations. The data reported in this study was gathered from each city Office of Emergency Management website. The data was analyzed to determine which cities have disaster preparedness plans that consider the disabled and again populations. Results indicate many cities are not prepared.Item Disability-Adjusted Life Years Lost Due to Adult Pulmonary Tuberculosis in Tarrant County, 2005-2006: An Analysis of the Role of Post Tuberculosis Impairment(2008-05-01) Pasipanodya, Jotam Garaimunashe; Sejong Bae; Kristine Lykens; Peter HilsenrathPasipanodya, Jotam G. Disability-Adjusted Life Years lost due to adult pulmonary tuberculosis in Tarrant County, 2005-2006: An analysis of the role of post tuberculosis impairment. Doctor of Public Health (Health Management and Policy), May 2008. 145 pages, 18 tables, 11 illustrations, 135 references. Pulmonary impairment after tuberculosis treatment (PIAT) is not yet incorporated in assessing burden of tuberculosis. Previous global and national TB burden estimates therefore did not fully reflect the consequences of surviving tuberculosis disease. This study was conducted to assess burden of TB in Tarrant County, Texas, using Disability-Adjusted Life Years (DALY). DALY is a composite measure of premature mortality and disability that equates years of healthy life lost. DALY, stratified by gender and race were calculated for 118 adult TB subjects seen between July 2005 and October 2006. Years of Life Lost (YLL) were calculated from the difference between standard life expectancy and age at death from TB, summed across county population. Years Lived with Disability (YLD) were derived from age and gender-specific disease incidence weight-adjusted for impairment levels; using disability weights obtained from literature. Three percent discount rate per year was used. One hundred and eighteen subjects lost 444.25 DALY during the study period. Years of life lost to premature mortality (YLL) contributed 159.62 (36%) and years of life lived with disability (YLD) contributed majority of total DALY. Pulmonary impairment after tuberculosis (YLD PIAT) contributed 234.6 (53%), while YLD Acute contributed only 50.03 (11 %) of total DALYS. Contrary to previous estimates; disability contributes more than mortality to TB burden in areas with low TB adult and child mortality. PIA T contributes significantly to TB burden, but was previously unrecognized. These findings suggest that the greatest health savings will be achieved through strategies to prevent tuberculosis from developing rather than strategies to shorten treatment once it has developed.Item Is an Enviormental Health Educational Intervention Sufficient to Change Behavior?: Perceptions from an Indigenous Lake Community in Guatemala(2006-12-01) Pezzia, Carla; Terrance Gratton; Sue Lurie; Norman TrieffPezzia, Carla. Is an environmental health educational intervention sufficient to change behavior?: Perceptions from an indigenous lake community in Guatemala. Master of Public Health (Environmental Health), December 2006, 46 pp., 6 tables, 1 illustration, references, 18 titles. Traditional environmental health practices focus on education and exposure prevention, but the division between the biophysico-chemical and social environment keeps them from always being sufficient; human ecology seeks to bridge this division. The second leading cause of mortality in Guatemala is gastrointestinal infections, and San Pedro, Guatemala, provides an opportunity to study these infections utilizing a human ecological approach. Morbidity data were collected from the local health center, observations noted systematically, and both residents and tourists were interviewed regarding their perceptions of the community’s environmental health. Results found that residents who had no contact with tourists stated that, for gastrointestinal infections due to refuse in the streets, education alone would not be sufficient to reduce this problem; most felt some type of government intervention would be necessary. It is recommended that public health specialists enjoy a human ecological approach and refer to the community when designing an appropriate intervention.