Dictionary of Evidence-based Medicine.pdf

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Dictionary of Evidence-based Medicine 79 It is used in many areas of economics such as modelling of economic growth. In the health economics literature, the human capital method is used for estimating the loss in productivity (indirect cost) due to illness. In its simplest form, consider a previously fully healthy individual who succumbs to disease. The illness takes its course and the patient recovers to be fully fit again. The time off work can hence be ascertained and a value placed on that based on market earnings. The modelling clearly needs to be much more complex if disease incapacity is preceded by a period of ill health which reduces productivity or recovery is accompanied by residual morbidity. The human capital approach is now rarely used because it discriminates against people not earning a wage and because it is not rooted in the theoretical foundations of cost benefit analysis where benefits are defined as the willingness to pay for those benefits (Becker GS (1964) Human capital University of Chicago Press, Chicago. Berger MC, Blomquist GC, Kenkel G, Tolley GS (1989) Valuing changes in health risks: a comparison of alternative measures. Southern Economic Journal. 53: 967-84). Human development index The human development index (HDI) is a measure of living standards proposed by the United Nations Development Program in 1990 to account for the contribution of factors other than the gross domestic product (GDP) to human well-being. In addition to GDP at purchasing power parity on a sliding scale, the index includes life expectancy at birth, income, adult literacy and enrolment in primary, secondary and tertiary education. In the 1994 world rankings, Canada took pole position based on HDI, while it was only eighth when ranked on per capita GDP. France took the second and 15th positions on the two corresponding rankings. In contrast, Singapore and Hong Kong had higher per capita GDP than HDI rankings (Economist (1997) 343: 138). Hypothesis testing Often we need to ask questions such as whether, after a given treatment, the weight of those treated has changed relative to those receiving a placebo. To answer such questions objectively, in classic statistics, one starts off with a null hypothesis (H o ). This is a statistical hypothesis that one postulates and against which we would test the observed data. It contains a statement about what one believes about the value of one or more population parameters or about the probabilistic mechanism which has generated the observations. For example, we may wish to compare the effects of a new antihypertensive agent against an established one. To test
80 Dictionary of Evidence-based Medicine for this we postulate that the two drugs are of equal efficacy. This forms our null hypothesis which can be written symbolically as: In a hypothesis test we also have to specify an alternative hypothesis (H a ) which we would accept if our null hypothesis is rejected. The simple alternative for the above example is that the two drugs do not produce similar average effects. This can be written as: In a hypothesis test, we also have to define the significance level of the test. This is the probability at which we would reject the null hypothesis. For example, we may postulate that the effects of the two drugs are normally distributed. Under this assumption, we may say that if the observed difference in mean effects of the two drugs is so extreme (under our null hypothesis of equipotency) that they would only occur with a probability of 0.05 or lower, then we would reject the null hypothesis and accept the alternative hypothesis. This 0.05 value is what we call the significance level of our test (see Li Wan Po A (1998) Statistics for pharmacists. Blackwell Science, Oxford).
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Dictionary of Evidence-based Medici
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Preface This book was conceived at
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A Ability to pay Ability to pay is
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Figure I Audit: Clinical audit cycl
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B Balanced design In an experiment,
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Page 66 and 67: Figure 9 Concept of externality Dic
Page 72 and 73: G Game theory Game theory, first de
Page 86 and 87: I ICD (see International Classifica
Page 94 and 95: K Keynes, John Maynard (1883-1946)
Page 100 and 101: M Macroeconomics Macroeconomics is
Page 112 and 113: N N of I trial An N of 1 trial is a
Page 116 and 117: o OBM (see Opinion-based medicine)
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Figure 25 Measuring quality of life
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S Scarcity Scarcity is often referr
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T TDM (see Therapeutic drug monitor
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u Unique value effect This term is
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Z Z variate A random variable which
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