The importance of the economic aspects of Type I (insulin-dependent) diabetes management is increasing due to the rising health care costs, limited health care resources, increasing incidence and prevalence, and the potential to reduce incidence and progression of diabetes-related complications with optimal management [1±3]. Most clinical trials focus on short-to medium-term outcomes requiring the development of methods for forecasting long-term outcomes based on known short-term data. Additionally, improved diabetes management ofteninvolvesrelatively highamounts of short-term expenditure to avoid long-term complications, with the overall effect on total long-term costs being difficult to quantify empirically [4±6]. Diabetologia (2000)

There has been an exponential growth in the literature on economic evaluation in health care. As the range and quality of analytical work has improved, economic studies are becoming more influential with health care decision makers. The development of standards for economic evaluation methods would help maintain the scientific quality of studies, facilitate the comparison of economic evaluation results for different health care interventions, and assist in the interpretation of results from setting to setting. However, standardization might unnecessarily stifle methodological developments. This paper reviews the arguments for and against standardization, assesses attempts to date, outlines the main areas of agreement and disagreement on methods for economic evaluation, and makes recommendations for further work.

A computer model was developed with decision analysis software to explore the long-term clinical and economic outcomes of alcohol abstinence maintenance with either standard counselling therapy or standard therapy plus 48 weeks of adjuvant acamprosate in detoxified alcoholic patients. Important complications of alcoholism were modelled using Markov processes, and included relapse (return to drinking), alcohol-related hepatic disease, acute and chronic pancreatitis, acute and chronic gastritis, oropharyngeal carcinoma, oesophageal carcinoma, alcoholic cardiomyopathy, alcohol-related peripheral neuropathy, alcoholic psychosis, accidental death, and suicide. Probabilities of developing complications were dependent on whether the patients within the cohort remained abstinent or had relapsed. Relapse rates, probabilities, and costs for acamprosate therapy and treatment of complications were taken from published literature. The analysis was performed from the German health insurance perspective. Life expectancy and total lifetime costs (costs of initial abstinence maintenance therapy plus costs of complications) were calculated for a typical male cohort with average age of 41 years, 80% with fatty liver, 15% with cirrhosis, 22% with chronic pancreatitis, and 1% with alcoholic cardiomyopathy at baseline. Life expectancy with and without acamprosate therapy was 15.90 and 14.70 years respectively, and discounted (5% per annum) average total lifetime costs per patient were DEM 46 448 and DEM 49 549 respectively. We conclude that, despite the acquisition costs of DEM 2177, adjuvant acamprosate therapy was both clinically and economically attractive under conservative assumptions.

Since the early 1990s, regional networks have received a lot of academic and political attention as vehicles for knowledge-based economic development. However, this powerful rhetoric has been accompanied by surprisingly little concrete analysis. Economic geography is only recently waking up to the potential of network analysis for interorganisational linkages within and between regions. We discuss network analysis as a strategic information tool for regional knowledge management and apply it to the metropolitan region of Hannover-Braunschweig-Göttingen-Wolfsburg in the northern German state of Lower Saxony. Producing network diagrams and parameters of network size, density, centrality, cohesion and connectivity from a large sample of actors and linkages, our survey shows striking differences between different fields of competence that highlight the potential of network analysis as a powerful tool and a necessary basis for decision-making to propel metropolitan regions into the knowledge economy. We outline both case-specific and generic implications for the practice of regional knowledge management. However, a few methodological shortcomings still call for further research to be conducted. Copyright (c) 2009 by the Royal Dutch Geographical Society KNAG.

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