Paula M. Bracy

University of Toledo, Toledo, Ohio, United States

Are you Paula M. Bracy?

Claim your profile

Publications (5)14.15 Total impact

  • Andre Konski · Paula Bracy · Steven Weiss · Perry Grigsby
    [Show abstract] [Hide abstract]
    ABSTRACT: To perform a cost-utility analysis utilizing a cooperative group protocol and constrasting the results with the published quality adjusted survival. A cost-utility analysis was performed on Radiation Therapy Oncology Group (RTOG) protocol 83-02. The quality-adjusted survival has been published previously. Pretreatment tests and chemotherapy costs are not considered, as these were similar across all treatment arms. Payor costs are calculated from Federal Register data for Medicare Region IV. Global charges are used to calculate the professional and technical charges. Costs are measured in relative value units (RVUs) and are tabulated assuming equal treatment complexity for all treatment arms. The number of RVUs calculated for each arm were 48 Gy--166.65; 54.4 Gy--182.17; 64.8 Gy--232.53; 72.0 Gy--272.19; 76.8 Gy--287.11; and 81.6 Gy--302.63. The RVU/QALY for the <50-year-old group were 48 Gy--119.03; 54.4 Gy--100.65; 64.8 Gy--104.78; 72.0 Gy--90.73; 76.8 Gy--193.99; and 81.6 Gy--165.37. The RVU/QALY for the >50-year-old group were 48 Gy--198.39; 54.4 Gy--276.85; 64.8 Gy--426.57; 72.0 Gy--423.71; 76.8 Gy--703.70; and 81.6 Gy--519.10. Sensitivity analysis of one treatment plan, simulation, and set of blocks for the 48 Gy and 54.4 Gy arms decreased the RVU/QALY to 105.34 and 90.05, respectively. Our analyses shows the experimental arm with the lowest RVU/QALY is also the arm with the longest quality-adjusted survival. This arm had the most efficient use of resources in this protocol. Prospective collection of all pertinent cost data is required for comparison of one treatment against another. All cooperative group protocols should have prospective quality of life and economic endpoints to allow for comparison of the most cost efficient treatment method.
    No preview · Article · Oct 1997 · International Journal of Radiation OncologyBiologyPhysics
  • C. R. Winegarden · Paula Bracy

    No preview · Article · Jul 1997 · Southern Economic Journal
  • [Show abstract] [Hide abstract]
    ABSTRACT: This study compares the payors' cost of treatment for surgical Stage I endometrial carcinoma with results of published clinical studies to determine which treatment most efficiently uses available resources. Six options for treatment of surgical Stage I endometrial carcinoma were selected for comparison. The treatment options were observation only, low-dose-rate brachytherapy (LDRB) (nonremote afterloading), LDRB and external beam radiation (EBRT), EBRT only, high-dose-rate brachytherapy (HDRB) only (three applications), and EBRT and HDRB (three applications). The literature was reviewed to obtain disease-free survival (DFS) rates corresponding to the treatment options chosen in surgical Stages IA, IB, and IC. Metaanalysis and sensitivity testing were performed on the collected clinical data. A typical midsized city in Medicare region IV was used as our representative payor cost basis. Thirteen retrospective articles contained sufficient clinical information for analysis. Comparison of DFS between the observation, LDRB, and EBRT treatment groups was made for Stage IA; LDRB and EBRT for Stage IB; and LDRB, EBRT, LDRB +/- EBRT, LDRB + EBRT, and HDRB + EBRT for Stage IC. Meta-analysis failed to reveal statistically significant DFS between the respective treatment options within Stages IA, IB, or IC. The RVUs for each treatment option were LDRB, 21.7; EBRT, 117.1; EBRT + LDRB, 130.7; HDRB, 155.5; and EBRT + HDRB, 264.4. The DRG payment for LDRB is $2714.92. The calculated payor's cost for each treatment option was: LDRB, $3466.62; EBRT, $4053.03; EBRT + LDRB, $7238.55; HDRB, $5381.19; and EBRT + HDRB, $9153.14. Our analysis reveals no statistically significant differences in DFS among the treatment options considered within each surgical stage. Observation appears to result in acceptable DFS with minimal cost in Stage IA. Low-dose-rate brachytherapy was the most cost-effective treatment in Stage IB, with no statistically significant difference in DFS between LDRB and EBRT. Although LDRB had inferior DFS compared to other treatment options in surgical Stage IC, this difference failed to reach statistical significance. Our analysis implies, excluding observation, that LDRB may be a more cost-efficient treatment than the other treatment options considered. Further studies stratifying for surgical stage and grade are needed to determine the optimal cost-effective treatment for this common malignancy.
    No preview · Article · Feb 1997 · International Journal of Radiation OncologyBiologyPhysics
  • A. Konski · S. Weiss · P. Bracy

    No preview · Article · Dec 1996 · Radiotherapy and Oncology
  • C R Winegarden · Paula M. Bracy
    [Show abstract] [Hide abstract]
    ABSTRACT: The present paper tries to measure the effects of paid maternity-leave on three demographic variables: infant mortality, labor-force participation of women in the prime childbearing ages, and fertility rates. A simultaneous-equations model is constructed, using the individual fixed-effects method and a data set comprising 17 OECD countries and four time periods. The structural estimates provide substantial evidence in support of predictions that lengthening the allowed duration of paid leave reduces infant mortality, while increasing both the labor-force participation of young women and the general fertility rate. However, the reduced-form analysis casts doubt on the long-run fertility effect. Maternal-leave policies in industrial countries are surveyed Section III deals with the data and estimation methods. -from Authors
    No preview · Article · May 1995 · Southern Economic Journal