Methods for the economic evaluation of health

care programmes Fourth Edition Drummond download

https://textbookfull.com/product/methods-for-the-economic-
evaluation-of-health-care-programmes-fourth-edition-drummond/

Download more ebook instantly today - get yours now at textbookfull.com

We believe these products will be a great fit for you. Click
the link to download now, or visit textbookfull.com
to discover even more!

Statistical Tools for Program Evaluation : Methods and

Applications to Economic Policy, Public Health, and
Education 1st Edition Jean-Michel Josselin

https://textbookfull.com/product/statistical-tools-for-program-
evaluation-methods-and-applications-to-economic-policy-public-
health-and-education-1st-edition-jean-michel-josselin/

Qualitative research in health care Fourth Edition Mays

https://textbookfull.com/product/qualitative-research-in-health-
care-fourth-edition-mays/

Health care ethics critical issues for the 21st century

Fourth Edition Elizabeth Furlong (Editor)

https://textbookfull.com/product/health-care-ethics-critical-
issues-for-the-21st-century-fourth-edition-elizabeth-furlong-
editor/

Introduction to health care Fourth Edition. Edition

Dakota Mitchell

https://textbookfull.com/product/introduction-to-health-care-
fourth-edition-edition-dakota-mitchell/
Priced Out The Economic and Ethical Costs of American
Health Care Uwe Reinhardt

https://textbookfull.com/product/priced-out-the-economic-and-
ethical-costs-of-american-health-care-uwe-reinhardt/

Boys' Bodies: Sport, Health and Physical Activity

Murray Drummond

https://textbookfull.com/product/boys-bodies-sport-health-and-
physical-activity-murray-drummond/

Economic Evaluation of Sustainable Development Vinod

Thomas

https://textbookfull.com/product/economic-evaluation-of-
sustainable-development-vinod-thomas/

An Integrative Paradigm for Mental Health Care Ideas

and Methods Shaping the Future James H. Lake

https://textbookfull.com/product/an-integrative-paradigm-for-
mental-health-care-ideas-and-methods-shaping-the-future-james-h-
lake/

The Patient as Agent of Health and Health Care:

Autonomy in Patient-Centered Care for Chronic
Conditions 1st Edition Sullivan

https://textbookfull.com/product/the-patient-as-agent-of-health-
and-health-care-autonomy-in-patient-centered-care-for-chronic-
conditions-1st-edition-sullivan/
Methods for the Economic
Evaluation of Health Care
Programmes
Methods for
the Economic
Evaluation of Health
Care Programmes
FOURTH EDITION

Michael F. Drummond
Professor, Centre for Health Economics,
University of York, UK

Mark J. Sculpher
Professor, Centre for Health Economics,
University of York, UK

Karl Claxton
Professor, Department of Economics and Related Studies and
Centre for Health Economics, University of York, UK

Greg L. Stoddart
Professor Emeritus, McMaster University, Hamilton, Canada

George W. Torrance
Professor Emeritus, McMaster University, Hamilton, Canada

1
1
Great Clarendon Street, Oxford, ox2 6dp,
United Kingdom
Oxford University Press is a department of the University of Oxford.
It furthers the University’s objective of excellence in research, scholarship,
and education by publishing worldwide. Oxford is a registered trade mark of
Oxford University Press in the UK and in certain other countries
© Oxford University Press 2015
The moral rights of the authors have been asserted
First edition published in 1987
Second edition published in 1997
Third edition published in 2005
Fourth edition published in 2015
Impression: 1
All rights reserved. No part of this publication may be reproduced, stored in
a retrieval system, or transmitted, in any form or by any means, without the
prior permission in writing of Oxford University Press, or as expressly permitted
by law, by licence or under terms agreed with the appropriate reprographics
rights organization. Enquiries concerning reproduction outside the scope of the
above should be sent to the Rights Department, Oxford University Press, at the
address above
You must not circulate this work in any other form
and you must impose this same condition on any acquirer
Published in the United States of America by Oxford University Press
198 Madison Avenue, New York, NY 10016, United States of America
British Library Cataloguing in Publication Data
Data available
Library of Congress Control Number: 2015938217
ISBN 978–0–19–966587–7 (hbk.)
ISBN 978–0–19–966588–4 (pbk.)
Printed and bound by
CPI Group (UK) Ltd, Croydon, CR0 4YY
Oxford University Press makes no representation, express or implied, that the
drug dosages in this book are correct. Readers must therefore always check
the product information and clinical procedures with the most up-to-date
published product information and data sheets provided by the manufacturers
and the most recent codes of conduct and safety regulations. The authors and
the publishers do not accept responsibility or legal liability for any errors in the
text or for the misuse or misapplication of material in this work. Except where
otherwise stated, drug dosages and recommendations are for the non-pregnant
adult who is not breast-feeding
Links to third party websites are provided by Oxford in good faith and
for information only. Oxford disclaims any responsibility for the materials
contained in any third party website referenced in this work.
In memory of our friend and colleague, Bernie O’Brien
 Preface to the fourth edition

The first question in anyone’s mind reading the fourth edition of any book will be ‘What
has changed from previous editions?’ The most obvious change, in keeping with the
tradition we have maintained since the outset, is the addition of a new coauthor, Karl
Claxton. Like all those before him, Karl has questioned aspects of the work and pro-
voked changes which otherwise may not have been made.
The other change, of course, is that the field itself has moved on in the 10 years since
the last edition. The new edition reflects these changes. Chapters 5 and 6, on measuring
and valuing effects, reflect the growth in the literature on the measurement of health
gain and other benefits of health care. In addition, we include two new chapters (10 and
11) discussing the methods of evidence synthesis and characterizing uncertainty, given
their growing importance in economic evaluation.
However, considering the 28-year period since the original publication of the book,
the most fundamental change relates to the role of economic evaluation in health care
decision-making. Back in 1987 our emphasis was on explaining the methods used in
economic evaluations so that readers could critically appraise them and potentially
embark on their own studies. As the role of economic evaluation in decision-making
expanded we added a chapter on ‘Presentation and use of economic evaluation results’,
discussing the use of cost-effectiveness thresholds and the transferability of data from
one setting to another. However, in discussing the content of the fourth edition, we
realised that this was no longer sufficient because, owing to the international growth in
the use of economic evaluation, it has become apparent that the use of particular meth-
ods is best discussed in the context of the decision problem being faced.
Therefore, in this edition we have added two new chapters (2 and 4) which emphasize
that, in health care decision-making, it is important to be clear on what we are trying to
maximize (for example, health or welfare), the constraints that we face, and the import-
ance of opportunity cost. This enables us to give additional insights on the role of the
various analytic approaches, given the decision-making context. In essence, the choice
of methods and the use of study results are now integrated throughout the book, rather
than being discussed in separate chapters.
We hope that readers feel that the new edition represents an improvement on previ-
ous editions and that it leads to further advances in both methods and decision-making
processes in the future.
Michael F. Drummond Mark J. Sculpher
Karl Claxton George W. Torrance
Greg L. Stoddart
York, UK and Hamilton, Canada
 Acknowledgements

We would like to thank a number of people who have helped us in important ways
in developing the 4th edition of this book. The following individuals provided com-
ments and suggestions on draft chapters which greatly improved the book: Bernard
van den Berg, John Brazier, Tony Culyer, Catherine Claudius Cole, Richard Grieve,
Jonathan Karnon, Andrew Lloyd, Andrea Manca, Gavin Roberts, Marta Soares and
Beth Woods. Needless to say, none of the above are responsible for the final views
­expressed. Rita Faria and Sebastian Hinde helped develop the critical appraisal exer-
cises for Chapter 3. Gill Forder, Frances Sharp, and Gillian Robinson provided a range
of assistance in formatting and checking materials. We are grateful to all.
 Contents

List of abbreviations xii

1 Introduction to economic evaluation 1

1.1 Some basics 1
1.2 Why is economic evaluation important? 2
1.3 The features of economic evaluation 3
1.4 Do all economic evaluations use the same techniques? 5
1.5 Use of economic evaluation in health care decision-making 11
1.6 How to use this book 13
2 Making decisions in health care 19
2.1 Some basics 19
2.2 Informing health care choices 19
2.3 Requirements for economic evaluation 22
2.4 What is the purpose of health care interventions? 27
2.5 Concluding remarks 37
3 Critical assessment of economic evaluation 41
3.1 Some basics 41
3.2 Elements of a sound economic evaluation 41
3.3 Reporting guidelines for economic evaluation 61
3.4 Limitations of economic evaluation techniques 63
3.5 Conclusions 64
3.6 Critical appraisal of published articles 65
4 Principles of economic evaluation 77
4.1 Alternatives, costs, and benefits: some basics 77
4.2 Making decisions about health care 79
4.3 The cost-effectiveness threshold 83
4.4 Making decisions with multiple alternatives 98
4.5 Some methodological implications 106
4.6 Concluding remarks 116
5 Measuring and valuing effects: health gain 123
5.1 Some basics 123
5.2 Using health effects in economic evaluation 124
5.3 Measuring preferences for health states 133
x CONTENTS

5.4 Methods for measuring preferences 136

5.5 Multi-attribute health status classification systems with preference
scores 144
5.6 Mapping between non-preference-based measures of health and
generic preference-based measures 162
5.7 Whose values should be used to value health states? 164
5.8 Criticisms of QALYs 166
5.9 Further reading 170
6 Measuring and valuing effects: consumption benefits of health
care 181
6.1 Some basics 181
6.2 Assigning money values to the outcomes of health care
programmes 182
6.3 What might we mean by willingness to pay (WTP)? 187
6.4 Pragmatic measurement issues in willingness to pay (WTP) 194
6.5 Exercise: designing a willingness-to-pay (WTP) survey for a new
treatment for ovarian cancer 197
6.6 Other stated preference approaches: discrete choice experiments
(DCEs) 199
6.7 Valuation of health effects for health policy decisions 206
6.8 Further reading 211
7 Cost analysis 219
7.1 Some basics 219
7.2 Allowance for differential timing of costs (discounting and the
annuitization of capital expenditures) 241
7.3 Productivity changes 245
7.4 Exercise: costing alternative radiotherapy treatments 250
7.5 Concluding remarks 255
Annex 7.1 Tutorial on methods of measuring and valuing capital costs 258
Annex 7.2 Discount tables 262
8 Using clinical studies as vehicles for economic evaluation 267
8.1 Introduction to vehicles for economic evaluation 267
8.2 Alternative vehicles for economic evaluation 267
8.3 Analytical issues with individual patient data 288
8.4 Conclusions 305
8.5 Exercise 306
9 Economic evaluation using decision-analytic modelling 311
9.1 Some basics 311
9.2 The role of decision-analytic models for economic evaluation 312
9.3 Key elements of decision-analytic modelling 323
 CONTENTS xi

9.4 Stages in the development of a decision-analytic model 325

9.5 Critical appraisal of decision-analytic models 338
9.6 Conclusions 339
9.7 Exercise: developing a decision-analytic model 339
  Annex 9.1 Checklist for assessing quality in decision-analytic models 345
10 Identifying, synthesizing, and analysing evidence for economic
evaluation 353
10.1 Introduction to evidence in economic evaluation 353
10.2 Defining relevant evidence 353
10.3 Identifying and reviewing evidence 354
10.4 Synthesizing evidence 359
10.5 Estimating other parameters for economic evaluation 370
10.6 Conclusions 384
10.7 Exercise 384
11 Characterizing, reporting, and interpreting uncertainty 389
11.1 Some basics 389
11.2 Characterizing uncertainty 392
11.3 Is current evidence sufficient? 409
11.4 Implications for approval and research decisions 417
11.5 Uncertainty, heterogeneity, and individualized care 421
11.6 Concluding remarks 422
12 How to take matters further 427
12.1 Taking matters further 427
12.2 Further reading and key sources of literature 427
12.3 Planning and undertaking an economic evaluation 427
12.4 Expanding your network in economic evaluation 428
12.5 Looking to the future 429

Author index 431

Subject index 437
 List of abbreviations

AAA abdominal aortic aneurysm EDSS expanded disability status scale

AD Alzheimer’s disease ENBS expected net benefit of sample
AQoL Assessment of Quality of Life EORTC European Organisation for
(measure) Research and Treatment of
ARM age-related maculopathy Cancer
BSC best supportive care EVPI expected value of perfect
information
CABG coronary artery bypass grafting
EVSI expected value of sample
CCA cost consequences analysis; or
information
complete case analysis
GBD global burden of disease
CCyR complete cytogenetic response
GDP gross domestic product
CDR clinical dementia rating
GLM general linear models
CEA cost-effectiveness analysis
GORD gastro-oesophageal reflux
CEAC cost-effectiveness acceptability
disease
curve
HAQ health assessment questionnaire
CEAF cost-effectiveness acceptability
frontier HEED health economic evaluations
database
CER comparative effectiveness
research HMO health maintenance organization
CHEERS Consolidated Health HRQoL health-related quality of life
Economic Evaluation Reporting HTA Health Technology Assessment
Standards HTAi Health Technology Assessment
CI confidence interval International
CLT central limit theorem HUI health utilities index
CMA cost-minimization analysis HYE healthy-year equivalents
CRF case report forms ICD International Classification of
CRT cardiac resynchronization Diseases
therapy ICER incremental cost-effectiveness
CT computed tomography (scan) ratio
CUA cost­–utility analysis ISM individual sampling models
CV compensating variation ISPOR International Society for
Pharmacoeconomics and
DALY disability-adjusted life-year
Outcomes Research
DCE discrete choice experiment
IVF in vitro fertilization
DES discrete event simulation; or
MACE major adverse cardiac events
drug-eluting stent
MAR missing at random
DIRUM Database of Instruments for
Resource Use Measurement MCAR missing completely at random
DRG diagnosis-related group MCDA multi-criteria decision analysis
DVT deep vein thrombosis MEPS Medical Expenditure Panel
Survey
EC expected costs
 LIST OF ABBREVIATIONS xiii

MI multiple imputation PSA probabilistic sensitivity analysis

MI myocardial infarction PTO person trade-off
MMR major molecular response QALY quality-adjusted life-year
MNAR missing not at random QoL quality of life
NB net benefit RCT randomized controlled trial
NHB net health benefit SAVE saved young life equivalents
NHMS National Health Measurement SD standard deviation
Study SD strong dominance
NHS National Health Service (UK) SMDM Society of Medical Decision
NICE National Institute for Health and Making
Care Excellence (UK) SUIT stress urinary incontinence
NIHR National Institute for Health treatment
Research (UK) TAU treatment as usual
NMB net monetary benefit TTO time trade-off
NPV net present value UKPDS UK prospective diabetes study
OLS ordinary least squares VAS visual analogue scale
PBAC Pharmaceutical Benefits VPF value of a prevented fatality
Advisory Committee
WHO World Health Organization
PBC programme budget categories
WTA willingness to accept
PBS Pharmaceutical Benefits
WTP willingness to pay
Schedule
YHL years of healthy life
PRO patient-reported outcome
 Chapter 1

Introduction to economic
evaluation

1.1 Some basics

Those who plan, provide, receive, or pay for health services face an incessant barrage of
questions such as the following.
◆ Should clinicians check the blood pressure of each adult who walks into their
offices?
◆ Should planners launch a scoliosis screening programme in secondary schools?
◆ Should individuals be encouraged to request annual check-ups?
◆ Should local health departments free scarce nursing personnel from well-baby
clinics so that they can carry out home visits on lapsed hypertensives?
◆ Should hospital administrators purchase each and every piece of new diagnostic
equipment?
◆ Should a new, expensive drug be listed on the formulary?
These are examples of general, recurring questions about who should do what to whom,
with what health care resources, and with what relation to other health services.
The answers to these questions are most strongly influenced by our estimates of the
relative merit or value of the alternative courses of action they pose. This book focuses
on the evaluation of alternative policies, services, or interventions which are intended
to improve health. Since the effects of choosing one course of action over another will
not only have effects on health, but also on health care resources as well as other effects
outside health care, informing health care decisions requires consideration of costs and
benefits. For this reason this type of evaluation is most commonly referred to as eco-
nomic evaluation. The purpose of economic evaluation, however, is to inform deci-
sions, so the key inputs to any economic evaluation are evidence about the effects of
alternative courses of action. Much of this evidence will draw on the results of clinical
evaluations (e.g. randomized clinical trials). The evidence from clinical studies needs
to be sought in a systematic way, interpreted appropriately (including an assessment of
its relevance and potential for bias) and then, when appropriate, synthesized to provide
estimates of key parameters (see Chapter 10). Therefore, economic and clinical evalu-
ations are not alternative approaches to achieve the same end but complements. Eco-
nomic evaluation provides a framework to make best use of clinical evidence through
an organized consideration of the effects of all the available alternatives on health,
health care costs, and other effects that are regarded as valuable.
2 INTRODUCTION TO ECONOMIC EVALUATION

For these reasons an understanding of the core principles of clinical epidemiology

and the criteria for assessing the relevance and potential for bias in clinical evidence of
the effect of an intervention is very important and has been described elsewhere (Guy-
att et al. 2008; Stevens et al. 2001). These guides and other introductory texts in clinical
epidemiology provide suitable background, so we do not review them here. However,
later chapters of the book draw on, and develop, these core principles.

1.2 Why is economic evaluation important?

To put it simply, resources—people, time, facilities, equipment, and knowledge—are
scarce. Choices must and will be made concerning their deployment, and methods
such as ‘what we did last time’, ‘gut feelings’, and even ‘educated guesses’ are rarely better
than organized consideration of the factors involved in a decision to commit resources
to one use instead of another. This is true for at least four reasons.
1. Without systematic analysis, it is difficult to identify clearly the relevant alternatives.
For example, in deciding to introduce a new programme (rehabilitation in a special
centre for chronic lung disease), all too often little or no effort is made to describe
existing activities (episodic care by family physicians in their offices) as an alter-
native ‘programme’ to which the new proposal must be compared. Furthermore,
if the objective is, indeed, to reduce morbidity due to chronic lung disease then
preventive programmes (e.g. cessation of cigarette smoking) may represent a more
efficient avenue and should be added to the set of programmes being considered
in the evaluation. Of course, in practice the range of alternative programmes com-
pared may be restricted to those that are the responsibility of a particular decision-
maker (e.g. a given decision-maker may be responsible for cancer treatment, but
not for cancer prevention). Also, if a new programme is compared to ‘existing care’,
it is important to consider whether existing care is itself cost-effective. This may
not be the case, for example, if there is an alternative, lower-cost, programme that
is just as effective. Although it may not possible to consider all conceivable alterna-
tives in a given study, an important contribution of economic evaluation is to min-
imize the chances of an important alternative being excluded from consideration,
or a new programme being compared to a baseline which is not cost-effective.
2. The perspective (or viewpoint), assumed in an analysis is important. A programme
that looks unattractive from one perspective may look significantly better when
other perspectives are considered. Analytic perspectives may include any or all of
the following: the individual patient, the specific institution, the target group for
specific services, the Ministry of Health budget, the government’s overall budget
position (Ministry of Health plus other ministries), and the wider economy or the
aggregation of all perspectives (sometimes called the ‘societal’ perspective).
3. Without some attempt at quantification, informal assessment of orders of magnitude
can be misleading. For example, when the American Cancer Society endorsed a
protocol of six sequential stool tests for cancer of the large bowel, most analysts
would have predicted that the extra cost per case detected would increase mark-
edly with each test. But would they have guessed that it would reach $47 million for
 INTRODUCTION TO ECONOMIC EVALUATION 3

the sixth test, as Neuhauser and Lewicki (1975) demonstrated? Admittedly, while
this is an extreme example, it illustrates that without measurement and comparison
of outputs and inputs we have little upon which to base any judgement about value
for money. In fact, the real cost of any programme is not the number of dollars ap-
pearing on the programme budget, but rather the value of the benefits achievable
in some other programme that has been forgone by committing the resources in
question to the first programme. It is this ‘opportunity cost’ that economic evalu-
ation seeks to estimate and to compare with programme benefits.
4. Systematic approaches increase the explicitness and accountability in decision-­
making. Economic evaluation offers an organized consideration of the range of
possible alternative courses of action and the evidence of their likely effects. It also
requires that the scientific judgements needed to interpret evidence are made ex-
plicitly so they can be scrutinized and the impact of alternative, but plausible, views
examined. Possibly more importantly, it can provide a clear distinction between the
questions of fact and the unavoidable questions of social value. Indeed, the main
contribution of economic evaluation may not be in changing the decisions that are
ultimately made but how they are made. By making the scientific and social value
judgements explicit it offers the opportunity for proper accountability for the social
choices made on behalf of others. (These issues are discussed further in Chapter 2.)

1.3 The features of economic evaluation

Economic evaluation seeks to inform the range of very different but unavoidable deci-
sions in health care. Whatever the context or specific decision, a common question is
posed: are we satisfied that the additional health care resources (required to make the
procedure, service, or programme available to those who could benefit from it) should
be spent in this way rather than some other ways? The other ways these resources could
be used might include providing health care for other patients with different condi-
tions, reducing the tax burden of collectively funded health care, or reducing the costs
of social or private insurance premiums.
Economic evaluation, regardless of the activities (including health services) to which
it is applied, has two features. First, it deals with both the inputs and outputs, which can
be described as the costs and consequences, of alternative courses of action. Few of us
would be prepared to pay a specific price for a package whose contents were unknown.
Conversely, few of us would accept a package, even if its contents were known and
desired, until we knew the specific price being asked. In both cases, it is the linkage of
costs (what must be given up) and consequences (the overall benefits expected to be
received) that allows us to reach our decision.
Second, economic evaluation concerns itself with choices. Resources are limited, and
our consequent inability to produce all desired outputs (including efficacious therap-
ies), necessitates that choices must, and will, be made in all areas of human activity.
These choices are made on the basis of many criteria, sometimes explicit but often im-
plicit, especially when decisions are made on our own behalf using our own resources.
Economic evaluation seeks to identify and to make explicit the criteria (social values)
that are applied when decisions are made on others’ behalf; when the consequences
4 INTRODUCTION TO ECONOMIC EVALUATION

accrue to some, but some or all of the costs will be borne by others. It can also provide
useful information to patients and their clinicians when making choices about their
own health care, since they are not necessarily best placed to identify and to synthesize
all relevant evidence and undertake the computation required fully to assess all the ef-
fects of the alternative courses of action available, and especially so at the point of care.
These two characteristics of economic evaluation lead us to define economic evalu-
ation as the comparative analysis of alternative courses of action in terms of both their
costs and consequences. Therefore, the basic tasks of any economic evaluation are to
identify, measure, value, and compare the costs and consequences of the alternatives
being considered. These tasks characterize all economic evaluations, including those
concerned with health services (see Box 1.1).

Box 1.1 Economic evaluation always involves

a comparative analysis of alternative courses of action
Figure 1.1 illustrates that an economic evaluation is usually formulated in terms of
a choice between competing alternatives. Here we consider a choice between two
alternatives, A and B. The comparator to Programme A, the programme of inter-
est, does not have to be an active treatment. It could be doing nothing. Even when
two active treatments are being compared, it may still be important to consider the
baseline of doing nothing, or a low-cost option. This is because the comparator
(Programme B) may itself be inefficient. (As mentioned earlier, it is important that
the evaluation considers all relevant alternatives.)
The precise nature of the costs and consequences to be considered, and how they
might be measured and valued, will be discussed in later chapters of the book. How-
ever, the general rule when assessing programmes A and B is that the difference in
costs is compared with the difference in consequences, in an incremental analysis.

PROGRAMME CONSEQUENCESA
COSTSA
A

CHOICE

COMPARATOR CONSEQUENCESB
COSTSB
B

Fig. 1.1 Economic evaluation always involves a comparative analysis of alternative

courses of action.
 INTRODUCTION TO ECONOMIC EVALUATION 5

However, not all of the studies measuring costs constitute economic evaluations. The
large literature on cost of illness, or burden of illness, falls into this category. These stud-
ies describe the cost of disease to society, but are not full economic evaluations because
alternatives are not compared (Drummond 1992). Some studies do compare alterna-
tives but just consider costs. An example of such a study is that by Lowson et al. (1981)
on the comparative costs of three methods of providing long-term oxygen therapy in
the home: oxygen cylinders, liquid oxygen, and the oxygen concentrator (a machine
that extracts oxygen from air). Such studies are called cost analyses. The authors argued
that a cost analysis was sufficient as the relative effectiveness of the three methods was
not a contentious issue. However, a full economic evaluation would explicitly consider
the relative consequences of the alternatives and compare them with the relative costs.

1.4 Do all economic evaluations use the same techniques?

The identification of various types of costs and their subsequent measurement in mon-
etary units is similar across most economic evaluations; however, the nature of the
consequences stemming from the alternatives being examined may differ considerably.
Let us consider three examples to illustrate how the nature of consequences affects their
measurement, valuation, and comparison to costs.

1.4.1 Example 1: cost-effectiveness analysis

Suppose that our interest is the prolongation of life after renal failure and that we are
comparing the costs and consequences of hospital dialysis with kidney transplanta-
tion. In this case the outcome of interest—life-years gained—is common to both pro-
grammes; however, the programmes may have differential success in achieving this
outcome, as well as differential costs. Consequently we would not automatically lean
towards the least-cost programme unless, of course, it also resulted in a greater pro-
longation of life. In comparing these alternatives we would normally calculate this pro-
longation and estimate incremental cost per unit of effect (that is, the extra cost per
life-year gained of the more effective and more costly option). Such analyses, in which
costs are related to a single, common effect that may differ in magnitude between the
alternative programmes, are usually referred to as cost-effectiveness analyses (CEAs).
Note that the results of such comparisons may be stated either in terms of incremental
cost per unit of effect, as in this example, or in terms of effects per unit of cost (life-years
gained per dollar spent).
It is sometimes argued that if the two or more alternatives under consideration
achieve the given outcome to the same extent, a cost-minimization analysis (CMA) can
be performed. However, it is not appropriate to view CMA as a form of full economic
evaluation (see Box 1.2).
There are many examples of CEA in the early literature on economic evaluation. Lud-
brook (1981) provided an estimate of the cost-effectiveness of treatment options for
chronic renal failure. In addition, a number of studies compare the cost-­effectiveness of
actions that do not produce health effects directly, but that achieve other clinical object-
ives that can be clearly linked to improvements in patient outcome. For example, Hull
et al. (1981) compared diagnostic strategies for deep vein thrombosis in terms of the
6 INTRODUCTION TO ECONOMIC EVALUATION

Box 1.2 The death of cost-minimization analysis?

Economic evaluations are sometimes referred to in the literature as cost-­minimization
analyses (CMAs). Typically this is used to describe the situation where the conse-
quences of two or more treatments or programmes are broadly equivalent, so the
difference between them reduces to a comparison of costs.
It can be seen from Figure 1.2 that there are nine possible outcomes when one
therapy is being compared with another. In two of the cases (boxes 4 and 6) it might
be argued that the choice between the treatment and control depends on cost be-
cause the effectiveness of the two therapies is the same.
However, Briggs and O’Brien (2001) point out that, because of the uncertainty
around the estimates of costs and effects, the results of a given study rarely fit neatly
into one of the nine squares shown in the diagram. Also, because of this uncertainty,
CMA is not a unique study design that can be determined in advance.
The only possible application of CMA is in situations where a prior view has been
taken, based on previous research or professional opinion, that the two options are
equivalent in terms of effectiveness. However, here one might question the basis
on which this view has been formed. It is likely only to be justifiable in situations
where the two therapies embody a near-identical technology (e.g. drugs of the same
pharmacological class).

Incremental effectiveness of treatment compared to control

Key:
More Same Less Strong dominance for decision
1 = accept treatment
More 7 4 2 2 = reject treatment
Incremental cost of Weak dominance for decision
treatment compared Same 3 9 5 3 = accept treatment
4 = reject treatment
to control
5 = reject treatment
Less 1 6 8 6 = accept treatment
Non-dominance;
no obvious decisions
7 = Is added effect worth added
cost to adopt treatment?
8 = Is reduced effect acceptable
given reduced cost to adopt
treatment?
9 = Neutral on cost and effects.
Other reasons to adopt treatment?
Fig. 1.2 The death of cost-minimization analysis?

cost per case detected. Similarly, Logan et al. (1981) compared work-site and regular
(physician office) care for hypertensive patients in terms of the cost per mmHg drop in
diastolic blood pressure obtained. Sculpher and Buxton (1993) compared treatments
for asthma in terms of the cost per episode-free day.
The more recent literature contains a lower proportion of CEAs, probably because
of influential sets of methods guidelines, such as those produced by the Washington
 INTRODUCTION TO ECONOMIC EVALUATION 7

Panel (Gold et al. 1996), or the official requirements for the conduct of economic evalu-
ations in some jurisdictions, such as the United Kingdom (NICE 2013). Many of these
guidelines recommend the use of cost–utility analysis, with quality-adjusted life-years
(QALYs) as the measure of benefit (see Section 1.4.2).
Of the CEAs that are published, many are conducted alongside a single clinical study and
use the chosen clinical endpoint as the measure of benefit in the economic study. Examples
of this approach are the study by Haines et al. (2013) on the cost-effectiveness of patient
education for the prevention of falls in hospital (which used ‘number of falls prevented’ and
‘reduction in the number of patients who fell’ as the denominator of the cost-effectiveness
ratio) and the study by Price et al. (2013) on the cost-effectiveness of alternative asthma
treatments (which used ‘number of patients who experienced severe exacerbations’ and
‘number of patients with risk domain asthma control’ as the measures of benefit).
Other frequent examples of cost-effectiveness studies are those of prevention or
diagnostic interventions. These tend to focus on the specific impact of the interven-
tion as opposed to the broader health of the patient. Examples of this approach are the
study by Rabalais et al. (2012) of the CEA of positive emission tomography (PET)-CT
for patients who had oropharyngeal cancer of the neck (which used ‘patients free from
disease in the neck after one year’ as the benefit measure) and the study by Pukallus
et al. (2013) on the cost-effectiveness of a telephone-delivered education programme
to prevent early childhood caries (which used ‘reduced number of caries’ as the bene-
fit measure). Another feature of many of these studies is that they do not necessarily
calculate cost-effectiveness ratios, rather they present differences in cost (between the
alternative programmes) alongside the other outcomes.
Finally, some CEAs are conducted in jurisdictions where QALYs are not recom-
mended as the measure of benefit in economic studies. An example is the study by
Dorenkamp et al. (2013) on the cost-effectiveness of paclitaxel-coated balloon angio-
plasty in patients with drug-eluting stent restenosis, conducted from the perspective of
the German Statutory Insurance. This used ‘life-years gained’ as the denominator in the
incremental cost-effectiveness ratio.
Cost-effectiveness analysis is of most use in situations where a decision-maker, op-
erating with a given budget, is considering a limited range of options within a given
field. For example, a person with the responsibility for managing a hypertension treat-
ment programme may consider blood pressure reduction to be a relevant outcome; a
person managing a cancer screening programme may be interested in cases detected.
However, even in these situations, these outcomes may be insufficient. For example, the
benefits from detecting a cancer will depend on the type of cancer and the stage of its
development. Similarly, the benefits from reducing blood pressure by a given amount
will depend on the patient’s pretreatment level.
However, the biggest limitation of these analyses is that, because of the specific meas-
ures of effect used in evaluating a given treatment or programme, it is difficult to assess
the opportunity cost (i.e. benefits forgone) in other programmes covered by the same
budget. In order to make an informed decision, the decision-maker needs to compare the
benefits gained from introducing the new intervention with those lost from any existing
programmes that will be displaced. This requires the use of a generic measure of benefit
that is relevant to all the interventions for which the decision-maker is responsible.
8 INTRODUCTION TO ECONOMIC EVALUATION

1.4.2 Example 2: cost–utility analysis

Another term you might encounter in the economic evaluation literature is cost–utility
analysis (CUA) (NICE 2013). These studies are essentially a variant of cost-effectiveness
and are often referred to as such. The only difference is that they use, for the conse-
quences, a generic measure of health gain. As we will argue later, this offers the poten-
tial to compare programmes in different areas of health care, such as treatments for
heart disease and cancer, and to assess the opportunity cost (on the budget) of adopting
programmes. In this literature the term ‘utility’ is used in a general sense to refer to the
preferences individuals or society may have for any particular set of health outcomes
(e.g. for a given health state, or a profile of states through time). Later, in Chapter 5, we
shall be more specific about terminology, because utility has specific connotations in
economics. The various methods to elicit health state preferences to construct meas-
ures of health-related quality of life might be better thought of as measures of outcome
that attempt to capture effects on different aspects of health.
The notion that the value of an outcome, effect, or level of health status is different
from the outcome, effect, or level of health status itself can be illustrated by the follow-
ing example. Suppose that twins, identical in all respects except occupation (one being
a signpainter and the other a translator), each broke their right arm. While they would
be equally disabled (or conversely, equally healthy), if we asked them to rank ‘having a
broken arm’ on a scale of 0 (dead) to 1 (perfect health) their rankings might differ con-
siderably because of the significance each one attaches to arm movement, in this case
due to occupation. Consequently, we would expect that their assessments of the value
of treatment (i.e. the degree to which treatment of the fractures improved the quality of
their lives) would also differ.
The estimation of preferences for health states is viewed as a particularly useful tech-
nique because it allows for health-related quality-of-life adjustments to a given set of
treatment outcomes, while simultaneously providing a generic outcome measure for
comparison of costs and outcomes in different programmes. The generic outcome, usu-
ally expressed as QALYs, is arrived at in each case by adjusting the length of time affected
through the health outcome by the preference weight (on a scale of 0 to 1) of the resulting
level of health status (see Box 1.3). Other generic outcome measures, such as the healthy
years equivalent (HYE) (Mehrez and Gafni 1989), the disability-adjusted life-year (DALY)
(Tan-Torres Edejer et al. 2003), and the saved-young-life equivalent (Nord 1995), have
been proposed as alternatives to the QALY. These are discussed further in Chapter 5.
The results of CUAs are typically expressed in terms of the cost per healthy year
gained, or cost per QALY gained, by undertaking one programme instead of another.
Examples of CUAs include the study by Boyle et al. (1983) on neonatal intensive care
for very-low-birth-weight infants, that by Oldridge et al. (1993) on a formal post-
myocardial infarction rehabilitation programme, and that by Torrance et al. (2001)
on the incorporation of a viscosupplementation product into the treatment of knee
osteoarthritis.
Cost–utility analyses now represent the most widely published form of economic
evaluation. Recent examples include the study by Stranges et al. (2013) of two alternative
drug regimens for treating Clostridium difficile infection in the United States, the study by
 INTRODUCTION TO ECONOMIC EVALUATION 9

Box 1.3 QALYs gained from an intervention

In the conventional approach to QALYs the quality-adjustment weight for each
health state is multiplied by the time in the state (which may be discounted, as dis-
cussed in Chapter 4) and then summed to calculate the number of QALYs. The
advantage of the QALY as a measure of health output is that it can simultaneously
capture gains from reduced morbidity (quality gains) and reduced mortality (quan-
tity gains), and integrate these into a single measure. A simple example is displayed
in Figure 1.3, in which outcomes are assumed to occur with certainty. Without the
health intervention an individual’s health-related quality of life would deteriorate
according to the lower curve and the individual would die at time Death 1. With
the health intervention the individual would deteriorate more slowly, live longer,
and die at time Death 2. The area between the two curves is the number of QALYs
gained by the intervention. For instruction purposes the area can be divided into
two parts, A and B, as shown. Then part A is the amount of QALY gained due to
quality improvements (i.e. the quality gain during time that the person would have
otherwise been alive anyhow), and part B is the amount of QALY gained due to
quantity improvements (i.e. the amount of life extension, but adjusted by the quality
of that life extension).

Perfect
health 1.0 2. With
programme
HEALTH-RELATED

A
QUALITY OF LIFE

QU
ALI
TY- B
AD
(Weights)

JUS
1. Without TED
LIFE
programme -YE
AR
S

Dead 0.0
Death 1 Death 2
Intervention
DURATION (Years)
Fig. 1.3 QALYs gained from an intervention.
Reproduced from Gold, M.R. et al. (ed.), Cost-effectiveness in health and medicine, Figure 4.2,
p. 92, Oxford University Press, New York, USA, Copyright © 1996, with permission of Oxford
University Press, USA. Source: data from Torrance, G.W., Designing and conducting cost–­utility
analyses, pp. 1105–11, in B. Spilker (ed.), Quality of life and pharmacoeconomics in clinical
­trials, 2nd edition, Lippincott-Raven, Philadelphia, USA, Copyright © 1996.
10 INTRODUCTION TO ECONOMIC EVALUATION

Pennington et al. (2013) comparing three types of prosthesis for total hip replacement in
adults with osteoarthritis, and the study by McConnachie et al. (2014) on the long-term
impact on costs and QALYs of statin treatment in men aged 45–64 years with hypercho-
lesterolaemia. A good source of published cost–utility studies is the CEA Registry, main-
tained by the New England Medical Center (<https://research.tufts-nemc.org/cear4>).
In addition, economic evaluations of all types are summarized on the Health Economic
Evaluations Database (HEED), published by Wiley (<http://onlinelibrary.wiley.com/
book/10.1002/9780470510933>). This can also be accessed via the Cochrane Library.

1.4.3 Example 3: cost–benefit analysis

Both CEAs and CUAs are techniques that relate to constrained maximization; that is,
where a decision-maker is considering how best to allocate an existing budget. In this
situation a decision to expand one programme, to increase the number of cancers de-
tected or to increase the QALYs gained, has an opportunity cost in terms of benefits
forgone in other programmes covered by the budget. However, is there a form of eco-
nomic evaluation that can address whether it is worthwhile expanding the budget?
One approach would be to broaden the concept of value and to express the con-
sequences of an intervention in monetary terms in order to facilitate comparison to
programme costs. This, of course, requires us to translate effects such as disability days
avoided, life-years gained, medical complications avoided, or QALYs gained, into a
monetary value that can be interpreted alongside costs. This type of analysis is called
cost–benefit analysis (CBA) and has a long track record in areas of economic analysis
outside health such as transport and environment. The results of such analyses might
be stated either in the form of a ratio of costs to benefits, or as a simple sum (possibly
negative) representing the net benefit (loss) of one programme over another.
With CBA, monetary valuation of the different effects of interventions is undertaken
using prices that are revealed in markets. Where functioning markets do not exist, in-
dividuals can express their hypothetical willingness to pay for (or accept compensation
to avoid) different outcomes. The literature contains a number of studies that assess
individuals’ willingness to pay for health benefits. For example, Johanneson and Jönsson
(1991) give estimates for willingness-to-pay for antihypertensive therapy, Neumann
and Johanneson (1994) give them for in vitro fertilization, and O’Brien et al. (1995)
give them for a new antidepressant. A comprehensive CBA of health care interven-
tions would use this approach to value the health benefits. Although there are many
examples of studies using willingness-to-pay methods, very few CBAs incorporating
these estimates have so far been published. See O’Byrne et al. (1996) for an example of
such a study in the field of asthma and a pilot study by Haefeli et al. (2008), exploring
the use of willingness-to-pay estimates in a CBA of spinal surgery.
The measurement characteristics of the various forms of economic evaluation are
summarized in Table 1.1. However, it is important to note that the more fundamental
differences between the various techniques relate not to their measurement character-
istics, but to the value judgements implied in following each approach and their appro-
priateness for addressing particular resource allocation problems. This is explored in
more depth in Chapter 2. Each approach to economic evaluation embodies a series of
normative judgements and it is important to appreciate these when conducting a study.
 INTRODUCTION TO ECONOMIC EVALUATION 11

Table 1.1 Measurement of costs and consequences in economic evaluation

Type of study Measurement / Identification of Measurement/

valuation of costs consequences valuation of
in both alternatives consequences
Cost analysis Monetary units None None
Cost-effectiveness Monetary units Single effect of Natural units (e.g. life-
analysis interest, common to years gained, disability
both alternatives, but days saved, points
achieved to different of blood pressure
degrees reduction, etc.)
Cost–utility Monetary units Single or multiple Healthy years
analysis effects, not necessarily (typically measured
common to both as quality-adjusted
alternatives life-years)
Cost–benefit Monetary units Single or multiple Monetary units
analysis effects, not necessarily
common to both
alternatives

1.5 Use of economic evaluation in health care

decision-making
Over the past 20 years, two factors have led to an increased prominence of economic
evaluation within health care decision-making. First, increasing pressures on health
care budgets have led to a shift in focus from merely assessing clinical effective-
ness, to one on assessing both clinical effectiveness and cost-effectiveness. Secondly,
­decision-making processes have emerged in several jurisdictions that enable the results
of economic evaluations to be used as an integral part of funding, reimbursement, or
coverage, decisions.
Although economic evaluation can be applied to all health technologies, including
drugs, devices, procedures, and systems of organization of health care, in the main the
formal requirement for assessment of cost-effectiveness has been applied to pharma-
ceuticals. In 1991 the Commonwealth of Australia announced that, from January 1993,
economic analyses would be required in submissions to the Pharmaceutical Benefits
Advisory Committee, the body that advises the minister on the listing of drugs on the
national formulary of publicly subsidized drugs, the Pharmaceutical Benefits Schedule
(PBS). A new set of submission guidelines, including economic analyses, was produced
(Department of Health, Commonwealth of Australia 1992) and submissions were in-
vited initially on a voluntary basis.
Since that time this policy has become fairly widespread, with approximately half
the countries in the European Union, plus Canada and New Zealand, requesting eco-
nomic analyses of pharmaceuticals, and sometimes other health technologies, to vary-
ing degrees. In the last 5 years several payers in the United States and countries in Latin
America and Asia have also expressed an interest in receiving economic data. However,
Another Random Scribd Document
with Unrelated Content
This book was produced in EPUB format by the Internet Archive.

The book pages were scanned and converted to EPUB format

automatically. This process relies on optical character recognition,
and is somewhat susceptible to errors. The book may not offer the
correct reading sequence, and there may be weird characters, non-
words, and incorrect guesses at structure. Some page numbers and
headers or footers may remain from the scanned page. The process
which identifies images might have found stray marks on the page
which are not actually images from the book. The hidden page
numbering which may be available to your ereader corresponds to
the numbered pages in the print edition, but is not an exact match;
page numbers will increment at the same rate as the corresponding
print edition, but we may have started numbering before the print
book's visible page numbers. The Internet Archive is working to
improve the scanning process and resulting books, but in the
meantime, we hope that this book will be useful to you.

The Internet Archive was founded in 1996 to build an Internet

library and to promote universal access to all knowledge. The
Archive's purposes include offering permanent access for
researchers, historians, scholars, people with disabilities, and the
general public to historical collections that exist in digital format. The
Internet Archive includes texts, audio, moving images, and software
as well as archived web pages, and provides specialized services for
information access for the blind and other persons with disabilities.

Created with hocr-to-epub (v.1.0.0)

The text on this page is estimated to be only 0.62%
accurate

.-rl^-^:,^ ^*l*#*f^ m^. W^M jPwlPJ «TJF '-r- ^ f*-

-«*#*-« ■#■ ■«■ 1*. *:■ t ■*' ■» :, ^fftjl^ilf^ 5?»^ .«^■.«-
:.#.:»■.,> «■:,.*^:»*.p 'i':-.p fe- !:■*'.: »::..; ■"»■■»■■
 ^ INDI-X LIBIU PSALMOUU.M. 292 l'as. l>.\ns QLI.NIA.
Pfalnius ecnlcsimus scptimus . . 2li Psalmus centesimus octavus 218
Psalmus centesimus nonus 220 Psalmus centesimus decimus 223
Psalmus centesimus undecimus .... 22 5 Psalmus centesimus
duodecimus ... 22o Psalmus centesimus decimus tertius ... 226
Psalmus centesimus decimus quartus. . . 227 Psalmus centesimus
decimus quintus. . . 228 Psalmus centesinms decimus sextus . . .
230 Psalmus cenlesimus decimus septimus . . 232 Psalmus
centesimus decimus octavus. . . 232 Psalmus centesimus decimus
nonus . . . 235 Psalmus centesimus vigesimus 2i9 Psalmus
centesimus vigesimus primus . . 2.!)0 Psalmus centesimus vigesimus
secundus. - 2.dI Psalmus centesimus vigesimus tertius . . 252
Psalmus centesimus vigesimus quartus . . 252 Psalmus centesimus
vigesimus quintus - . 253 Psalmus centesimus vigesiraus sextus . .
254 Psalmus centesimus vigesimus septimus. . 2,^5 Psalmus
centesimus vigesiraus octavus . . 250 Psalmus centesimus vigesimus
nonus. . . 257 Psalmus centesimus trigesiraus 258 Psalmus
centesimus trigesimus primus . . 259 Psalmus centesimus
trigesimussecundus. . 2G0 Psalmus centesimus trigesiraus tertius . .
2G2 Psalmus centesimus trigesimus quartus . . 2G2 Psalmus
centesimus trigesiraus quinlus . . 2G3 Psalmus centesimus trigesimus
sextus . . 2G5 Psalraus centesimus trigesimus septimus. . 2G7
Psalmus centesiraus trigesimus octavus . . 2G8 Psalraus centesimus
trigesimus nonus. . .270 Psalmus centesimus quadragesimus . . .
272 Psalmus centesimus quadragesimus primus. 274
Psalmuscentesimusquadragesimussecundus 275 Psalmus centesimus
quadragesimus tertius . 27G
Psalmuscentesimusquadragesimusquartus. 278 Psalmus centesimus
quadragesimus quintus. 280 Psalmus centesiraus quadragesimus
sextus . 282 Psalmuscentesimusquadragesimusseptiraus 283
Psalraus centesimus quadragesinms octavus. 285 Psalmus
centesimus quadragesimus nonus . 28G Psalraus centesimus
quinquagesimus . . . 287 Errata 290 Psalmus scxagesimus quartus
Psalmus sexagesimus quintus Psalraus sexagesimus sextus. Psalmus
sexagesimus septiraus Psalmus sexagesimus octavus Psalraus
sexagesimus nonus. Psalmus septuagesimus . . Psalmus
septuagesiraus primus Psalmus septuagesiraus secundus PARS
TERTIA Psalmus septuagesimus tertius. Psalmus septuagesimus
qnarlus Psalmus septuagesiraus quintus Psalmus septuagesiraus
sextus . Psalmus septuagesiraus septimus Psalmus septuagesimus
octavus. Psalraus septuagesimus nonus . Psalraus octogesimus ....
Psalmus octogesimus primus. . Psalraus octogesimus secundus.
Psalraus octogesimus tertius. . Psalmus octogeiimus quartus .
Psalmus octogesimus quintus . Psalmus octogesiraus sextus. .
Psalmus octogesiraus septiraus. Psalmus octogesimus octavus .
Psalmus octogesiraus nonus. . PARS QUARTA Psalmus nonagesimus.
. . . Psalmus nonagesimus primus . Psalmus nonagesimus secundus
Psalmus nonagesimus tertius . Psalmus nonagesimus quartus .
Psalmus nonagesimus quintus . Psalmus nonagesimus sextus .
Psalmus nonagesimus septimus. Psalmus nonagesimus octavus .
Psalmus nonagesimus nonus. . Psalmus centesimus .... Psalmus
centesimus primus . . Psalmus centesiraus secundus . Psalraus
centesimus tertius . . Psalmus centesimus quartus . Psalmus
centesimus quintus. . Psalmus centesimus scxtus . , 123 125 127
12« 132 I3G 137 139 148 150 152 169 IGO 1G2 1G4 IG5 1C7 169
170 173 175 180 182 184 185 13f; 188 190 191 i;i3 I9i 195 I9(; 197
200 202 205 209
 INDEX LIBIU rSALMORUM, Psalmus Irigcsinius secundu;
I*salmus trigesimus tertius . 1'saimus trigesimus quartus. Psalmus
trigesimus quintus. Psalmus trigesimus sextus . Psalmus trigesimus
scptimus Psalmus trigesimus octavus . Psalmus trigesimus nonus .
I*salmus quadragesimus . . I'salmus quadragesimus primus. PARS
SECUNDA Psalmus quadrage.simus secundus l'salmus
quadragesimus tertius. Psalmus quadragesimus quartus Psalmus
quadragesimus quintus Psalmus quadragesimus sextus. Psalmus
quadragesimus septimus Psalmus quadragesimus octavus P.-almus
quadragesimus nonus. P.^almus quinquagesimus. . . Psalmus
quinquagcsimus prlmus P.salmus quinquagesimus secundus Psalmus
quinquagesimus tertius Psalmus quinquagesimus quartus Psalmus
quinquagesimus quintus P.salmus quinquagesimus sextus Psalmus
quinquagesimus septimus Psalmus quinquagesimus octavus Psalmus
quinquagesimus nonus Psalmus sexagesimus .... Psalmus
sexagesimus primus . Psalmus scxagcsimus sccundus. 1'salmus
scxagcsimu.'? tcrtiu.< . Pag. 58 69 02 Ci C7 C9 73 76 85 80 88 91
92 9^ 95 98 101 103 10 i lOG 107 109 111 112 114 IIG 118 119 U'0
Pnctatio. Pag. VU XX PAUS PRLMA. Psalmus primus j Psalmus
secundus ^ Psalmus tertius ^ Psalmus quartus ^ Psalmus quintus g
Psalmus scxtus g Psalmus septimus q Psalmus octavus u Psalmus
nonus j3 Psalmus decimus 15 Psalmus undecimus 17 Psalmus
duodecimus 19 tertius 20 Psalmus deeimus Psalmus deciraus
quartus Psalmus decimus quintus Psalmus decimus sextus . Psalmus
decimus septimus Psalraus decimus octavus Psalmus decimus nonus
. Psalmus vigesimus . . . Psalmus vigesimus primus Psalmus
vigeslmus secundu Psalmus vigesimus tertius Psalmus vigcsimus
quartus 41 Psalmus vigesimus quintus 44 Psalmus vigesimus sextus
47 Psalraus vigesimus scptimus 43 Psalmus vigesimus octavus 51
Psalraus vigcslmus nonus 52 P.salraus trigesimus ' 53 Psalmu.s
trigcsimus primus ..,,.. 65
The text on this page is estimated to be only 14.97%
accurate

ERHAIA. 290 r;.K. Lin. pro lcgc Pag. lin. pio lcge 159 17
b,:..! i^jl^\ 67 19 i..y)> iJi 160 tx ^j=^ 69 17 Ibid. (j .v>r^"^^^
Ibid. 18 ^hj^ li, ^i 161 [\ j\V ,\y 71 l\ jyj'. J.^^>. 16^1 \ J^y c^^
72 8 \ " ^^^ 168 17 ^') ^j 11 3 ■ j'^'^ J, 181 11 Lk • vL 85 \ti ;^'
^lisW 185 /i .,y^^ 95 7 '^\ '^\ 186 6 ^b'^L^ ^b-bL^i. 96 1 j^L,
jUuOL. 187 19 j' ?. 99 8 ui L*£ 192 2U ninnoriiE ob niemoriani 100 5
^»^Li j^l-LJvel^^.^Lj 193 h ^Jli', cic. i^j iJ c^jLi' 112 7 ^b:.i31_5
^yJl JLxJi3^^3J^ ..^ji £b'^j 119 13 niateriae inaeeri* 199 1 (J^
^^.2.^ 133 10 cr^ u"^ •20Z, 16 cri..-) c^V 139 1 JO.JJJI joliiSI 207
1 Ijr-'' ijL-,' UO 22 ;.u '^L. 237 11 Jv-'. j';-'^ U2 6 >. ^^. 2^0 7 .;-'
;>' 1Z|3 13 J" Jl" lbi(l.llell2 .j.lj3.^LJi ..i^.,^jl;> m 6 ^;l^ aL2Zi4 6
cessarc faciain ccssare fecisti Ikl 21 (^ c^' 255 10 ^>^ Jri. 1Z»9 15
j^ df 275 1 i^ \.S" 152 10 v3l^ J. 276 3 :^^ '^ 15/^ 5 ^. ^. 281 5
iifX. issL 155 7 ^'^^■^ c-J-t-^ 285 17 ,ur /^vv 156 3 -!;? iA_^'j.J
The text on this page is estimated to be only 15.40%
accurate

CRRATA t^raviora iiiilii iiiler rclocciuluni obscivata bcncvoliis

lcclor sic corrisat Pag. Ibicl. U2 hk 65 Ibid. hl Ibid. 55 57 Ibid. 60
Ibid. Lin. ih M 19 6 19 11 15 16 pio lege J^^^ JI:^^ VCl 3^:,:^^j
A...w.dH 6.^.:^ VCl i~^wsr' i3. h J.~i.LdJ Jl>'^ vci J^J^ 15 ^^^^1
Jr -U '±^\ 0 >'^ >L61 6 i-^lcL i>„i.Ld.VeU--^'.::^ 62 1 6 Cl 1 9 i.J^'
'w^ Cju.l:k~ vcl J^'^^ 63 65 r Pag. 11 \h 16 Ibid. 17 18 Liii. 5 16 7
22 h 1 19 10 et 11 Ibid. 20 22 15 Ibid. 1h 6 lcge ^T U vel ^LJI .: I
^LJl ^^,sK::j cT-:'^.^vel ^ j,(-^ 25 8 _ Ibid. 9 jL 38 13 ^]^. llml 5
.,/.^Ld>. ^.y^Li. VcK y-~ww:k II vcl i....i^Ld.
The text on this page is estimated to be only 27.36%
accurate

PSALMUS CENTESIMUS QUINQUAGESIMUS. 288 3.

Lauclate eum clangore tuba^ ; ^J^ »^j>!*! j^uJI wya J^ Sali,!-! p
laudate eum pulsando fidiculam ct ' /. ^7. ^^uT ^' citharam. -f '- ^
^,^- ;> ^. Laudate eum pulsando doffuni »ja.J->=l JlL.M_j ^3Ji
.,_^^. JcLLj.^! & et tympanum, laudate eum [chordis _ .c^^.-r/
;.c'Ar" c. (/ et organo]. ^ S^' >' -^ ^ ^ -^ ^- '-^ 5. Laudate eum
cymbah's auditio- 5j=wi.^! 2 U;J! ^y,o ^ Jsj^i- LLj^l 0 nis ; laudate
eum cymbalis vocifera: ' ilU^! ^J.^ wv.o tioms. ' • ■ ,C^ : -^ 6.
Omnis anima laudet Dominum. Laudate /Eternum ! ^lj^! !^.L1^!
^})! JSUi i:Z.I3! J i PERSOLUTUS EST, JUVANTE DEO, o'-*^ ''-^-''
^J^'^, r* — ^' Lir.ER PSALMORUM. '■) ' Duo vocabula ^i^_^ p^
desiderantur in codice nis., caque Yapheticae versioni supplevi juxta
sensum quem vocibus hebraicis :25iyi DiID communiter
uibuuntlnterpretes arabici. Vocabuh niv;, quod Gen. IV, 21, habetur,
versionem, post relatum hebraici textusversum, omisitquoque auctor
nosler, quanquam in ejusdem versus commentario, ahquatenus iliud
iiiterpretari videtur; loquens enim de Jubal, cujusmentio ibi facta est,
eum ait primum fuisse qui instrumenta musica invcnit : ^«3! ci^^V
LiJ! ,w> Jj!. inde merito dubitari polest utrum veram istius vocis
significaiionem attigerit. Haud splendidiorem huic loco affert lucem
R. Saadias, qui in sua Psalmorum versione nomen di^D interpretatus
est pcr \^j^\ .^^wA^^!, hoc est varia (jaudii genera, et vocem
ajv^, qute Gen. IV, 21, habetur, arabice vertit perjLiJiJ! citkaravi,
xidin Job. XXI, 12, etXXX, 31, sicut mihi apertum est ex ejus
commentario ms. quod prae oculis habeo. Veriim, juxta communem
aliorum interpretum sententiam, per vocabulum i:i"iy innuitur
inslrumenlum quod inflatur, fistulam puta siinplicem, aut organon,
sive tibiam duplicem aut mnltiplicem cx pluribus listulis compositam,
et opponitur instrumentis quorum fides pulsantur, ut lyrae, cithara?,
fidicute, etc. , quaeque hebraice Di^a generalim vocantur. — ^
pLn.»J! --y-s cymbalis aiiditionis, hoc est, ut exponitur in
commentario, cymbalis quorum sonus e longinquo auditur. — ^ iJ.sr-
i ^y^ cymbalis vociferationis, hoc est, quorum pulsatio,
acclamationibus fulelium juncla, publicarum precum finem indicat. -3
=]yiS ]T^2 -jnn ,1211 nayy Diais» ^inSi Isaia; XL, 29.
The text on this page is estimated to be only 17.93%
accurate

^§rj.^lisx);y^^^rj.i;j:i jis V 2S7 PSALMUS CENTESIMUS

QUINQUAGESIMUS. 3. Laudabunt nomen ejus pul- jliJ^^^^jj j^|
^^j ^^S ;^^;^j^^ psando tympanum; doffo et cithara " ' ' ' ' ,: . ^
, . celebrabunt eum. " ■- •• 6. Quia Deus delectabitur populo
'^j^^\^\'j^'^„ i^li ^^^ jo\\ i3Ji jLi f suo; ornabithumiies salute. '
,'\-;^ ,^^ •, 5. Personabunt pii in gloriS, Ifptos ; ^^Xr^ A^ , i " 'a;'
, I-s-^Lj V ^j^ ' , i ^^ri) o clamores tollent in cubilibus suis. 6.
Elationes Potentis in cutture ,i LL'. L/y^-^ ,i ^Lj}\ ^'1[sjL\ i eorum,
et gladius anceps in manu " ' ^ , cx . eorum. ■ f.^::^™- ^"^-^ 7.
Ad faciendum vindictam in genlibus, increpationes in nationibus. 8.
Ad alligandum reges eorum JL^ ' Libl^U '• J!^i!^lj *Oj.L' J>~J^ a
vinculis, etmagnates eorum compe- ' ' ' ^^r" dibus ferreis. ' • ' 9. Ad
faciendum in illis judicium s^C! ji) '^ 'i^^. by:V lICI L-,' Jkij =i
scriptum ; honori hoc est omnibus " ' •^v^Mr ' "■'^ piis ejus.
Laudate numen ffiternum ! " vJ ^-^' * ^>. — ^ ^^-^-J. Do/fcsl
tympanum arnbicum, forma quadrata, crepilaculis aeneis ornatum,
quod Hispanis (uliife dicitur, nobis vcro lambouv de basque. — ' ^\\.
— ' J1^U\V, vincula quibus ligatur speciatim cervix. PS. CENTESIMUS
QUINQUAGESIMUS. ^!.--^^ 3 j ..^^ ] ^ yjj) 1. Laudate /Eternum.
Laudate Po- LLjii ^.j.i;j \
The text on this page is estimated to be only 24.36%
accurate

PSALMUS CENTESIMUS QUA DR AGESIM US NONUS. 286

9. Montes et omnes colles, arbores fructiferae et omnes cedri. 10.
Bestiae et universcT pecudes, reptile et volatile pennatum. 11. Reges
terr» et omnes gentes, principes et omnes judices terrae. 12.
Juvenes atque virgines. senes cum junioribus. 13. Laudant nomen
Domini mundorum, quia inviolabiie est nomen ejus solum;
majestasejus super terram et coelum. :f;L \j^ 'Z ^X^'] ^ ^J. J^\y
;i" ^^ ir ^^ Ij\ '^y^'^*i\ *~. I 1 a:a. ^-*J \ J J^^\J jjj'^] ^^ iV^s
sS.Lj i^l,\ iU. Et esaltavit cornu (vertitur J>J '^.^^j^ iJJ:J 'JlI JJ^
lj^,3 li^j \f quoque dignitalem) populo suo, laudem omnibus piis suis
, filiis Israel , populo propinqui sui. Laudate numen /Eternum ! I
JJ:'^^. d^^ Jr' th •, ^Vy^J ^^^. filii Sion la^^tabuntur de rese
suo. k9^
The text on this page is estimated to be only 16.62%
accurate

-285 PSALMUS CEiNTESIMUS QU ADRAGESIMUS OCTAVUS.

judicia ejus noii cognoverunt. Lau- : ~Sj^^ ^j ^-^ ^^' ' b ^' ' date
iEternum ! ' ,A-^* — - (^ _ ' u,, _ ' ^r _ ^ ^;- _ f , . \j , _ : iju.
CEMESniUS QUADRAGESIMUS h^^-^^ J iJJ^^J^^^J (J^}^^jyj^^
OCTAVUS 1. Laudate .Eternum! Laudate .-JJ\ '^.^ \ '^ ijL'S^\
i:S^J% J^ '^ iAS^\ \ ejus; laudate eum, omnes exercitus _ , ,ejus.
^ '-— • 3. Laudate eum, sol et luna ; lau- J^ IJ ^^iJi j-^h iT^ '•.•!
^_?=^^'' " date eum, omnes stellae lucis. -*^' c^' ' (3 ^.^ -'-^ ' li.
Laudateeum,coDlicoeli,etaqua ^jj! jLJI^^ ^UlJl ^il'^^ U sJ^iJ»! f
quas super coelo est. -, _ --- ., 5. Laudant nomen Dei, quia ipse _^^
cJJ! Is wU A.\i! U»! Ojl,sV c est qui mandavit, et creata sunt. _ c / ,
vp'. 6. Et statuit ea in perpetuum et in . \^^j J^ C^' aj^J^DJ ' ^-
'^% 1 ffiternum ; praBceptum posuit, neque ^ ' ' . ' pra^terit. 7.
Laudate Deum de terra, draco- l^' 'w.jL-J!
The text on this page is estimated to be only 19.47%
accurate

. PSALMUS CENTESIMUS OUADll AGESIMUS SEPTIMUS.

284 8. (jLii operit cadum nubibus, qui Jf;-^^ Vr:^*'' v^I-^""'1-j A^\
^^^^^^1 '^ parat leiTffi pluviam, qui germinare '' r . ^ {• 'fT -
'"\T\^\' lacit montes herba. •• - "^ -^' \ J 9. Dat pecudi escam
suam, pullis ij^..^^'^ v^'^^ -^L^^ L'^UkL i'.rir^lj 1 ^LxjJ! ^ corvi
qui invocant. ' ' . , ,c, 10. Non fortitudinem equi concu- J,L1j "il
^^j,^,^-'. c/t^^' '^j^^ ijrr' !♦ piscit ; non cruribus viri delectatur. ' .
o, ,^ ,^ 11. Delectatur Deus timentibus se, ; ^jui ^}^,]^^ i^kfiL ^
'"S" js\j \\ iis qui exspectant gratiam ejus. '' ' ,. 12. Celebra,
Jerusalem,Dominum ^^-^-^^ (^r::-f^'^' ■^)^ ^,^^ji '-^' ^^4-"
IT mundorum; laudaDeumtuum,Sion. ' , ^. , ,, : , JjJi ^o lerram ad
celeritatem, et cucurrit sermo ejus. 16. Qui dat nivem instar lana.',
JL U_.o ^j^Ji Ji^ L^-'J ^iJ;ii ^ pruinam instar cineris dispergit. '
>-.,.— 17. Projicit glaciem suam sicut '1^? 2<.>>j ^ils ^l^yi J.L ^J-
LL ^^.llJi [v frusta panis ; coram frigore ejus ' , ,,, quis consistet? ' '
"— • 18. Emittit jussum suum et lique- ' J^i 't>M.\ -^^i'. " '^H^-i V'
J-*"'^^^' i'^ facit ea;flare facit ventum suum; ' ' ' '^'^u fiuit aqua.
19. Qui annunclat verbum suum i_.«i£!^l^ i_.-^^.lj ^.ajiJ ijLJ-k
'^..Ir^ ^^ Jacob, prfficepta sua et judicia sua ' ''—,
The text on this page is estimated to be only 17.23%
accurate

283 PSAI.MUS CEiNTESIMUS QU ADRx\ GESIM US

SEPTIMUS. 9. Deus custodit peregrinos; or- lv^*j iL.Uj"^lJ 1^~JI
^Lj /iJ! JiiLk '^\ _jl^ Lj' ^^11 ^s-jJl J,^ '^l c-Ul>' !• Deus tuus,
Sion, per generalionem =i''"Tt ' "-T i ' M et generationem . Laudate
/Eternum ! ^J ^ V > -^ t ;' %:,;. - ^.iL», j=.. - ' ^vr. _ '■ L>b. - ^
..^.i. PS. CENTESIMUS QUADRAGESIMUS j./.Jij j»x,j^lj ,j.,)L*».M
j^^^o-H SEPTIMUS. 1. Laudate /Eternum , quoniam '^ls lis"^!
^■:r^' -^ 'w'-3 3j^' uLi-^^^ \ bonumestcelebrareDeumnostrum; '. '
^ ^T ■•'. 't ' •» : ic».J-^Ji ij iiJ J-jJJ quoniam jucundum; congrua est
ei ^ ; laudatio. 2. yEdificat Deus Jerusalem ; dis- -. L^i J)J\jZ\ ^jj!>
'SLj[^ytSl\ t^li [ persos Israel congregat. 3. Qui sanat confractos
corde, et :\^l^y)^ s^J^j^^-^iS^ ^jJSJ ^ii.lM p obligat dolores
eorum. ^ ' ' ^ h. Qui numerat computationcm : ^^^ ^^,^1 * L4^-|
The text on this page is estimated to be only 19.30%
accurate

PSALMUS CENTESIMUS gUADHAGESlMUS SEXTUS. ?

msgM&*f^f^^:S!Mtsm^ = tPS. CEINTESIMUS QUADRAGESIMUS
SEXTUS. 1. Laudale /Eternum ! Lauda , wm ^C^ '"^- ^^"''' 3j^^
L=5.j.^' ^ anima mea , Dominum mundorum. ^ - ,'-,7" L^'". 2.
Laudabo Deum quamdiii su- cf'^'.^ -t^"' ' ^-:' '-■'' 1-4'^ 3-H^ vj;
13 ■ :„L' c h. Cujusspiritus, in fine temporis Ti^l^L ^= i-LJ^ L\L^'
JLcv .cvi ^jj) f ejus , exit h corpore ejus ; revertitur interram
suam.Illo die periit astutia - ■ S-"' - ^ " ^- C;--" cogitationum ejus
ingeniosarum. ; iiiLlJ 5. Beatus ille cui auxilio est Deus 'i^\\
6:;^!^%^ ^i J^.yij '-i^^ ^^' ^j,ji= c Jacob, cujus spes in Deo, Deo
suo ! ' =-^7". : i^i' ^\ , ^ 6. Qui creavit coelum et terram et L^
y.^.^ ys>)\ ^ ^^\ ^ ^L,slJ! ^^-^ 1 mare, et omnia quee in iis
sunt; qui servat fidem in £Bternum. jAi 11 iJUSl1]i3L'li ^'J.J 7. Qui
agit judicium oppressis, L>''^i' ,iii^J) ^^.lJkL^) S1L\ J^Li v qui dat
escam esurientibus. Deus . '~'..'\T"\\'''^.\T 1' 1» \ .. ,.. : ,..^J^1
S^.^ ^\ pL^-lJ solvit compeditos. ^•■' - ,ii! j-^»^' ^-rr^ i-''^-^ '^"'
^ Deus eriffit incurvatos; Deus dili";it probos. • ^^^:^^'^:^^
The text on this page is estimated to be only 19.94%
accurate

2SI PSALMUS CENTESIMUS QUADR A GESIMUS QUINTUS.

10. Celebrant te, Domine, omnia ^j^^^^j jJJL^! J5' C.^ b' 2 j'Ci.;
^. opera tua, et pii tui benedicunt til3i. - ' 9 11. Gloriam regni tui
dicunt, et . ' p£:-, ^;:^_y,)k J^d^U^^ \\ potentiam tuam loquuntur.
" ' ^' ' "" '" "" 12. Ut notam faciant filiis homi- i^^ j'i^'j i:,1j;.v^ 'Sf
/J ^jx-^ \\ num potentias ejus et gloriam splon- ' '' " ^' ' ^ -' ^ . ^
doris regni ejus. ' ^^;j-'^-' 13. Kegnum tuum regnum om- JilLL^
lr.:0! ^ ^^SS.^ ji.Ct |^ nium sfficulorum,et imperium tuum per
omnem generalionem etgenera- * V"'^^ t"^ ^ '— ' tionem. IZi.
Suflfulciensc.s/Deusomnesqui ^3 ^C^'/^ ^*:^*^^' y&:' ^-^' -'^^-
^ \\ labant, et erigens omnes qni incur- . '■..\x vantur. c^- . 15.
Oculi omnium in te sperant, «-'-fi=*'' Ji^olj ^ J^lj" JJ^ jSJi '• 'wlL
'^o ct tudas escam illorum temporesuo. ' ^ 18. Propinquus Deus
omnibus qui invocant eum, et omnibus qui invocant eum cum fide.
19. Beneplacitum timentium se facit, et vociferationem eorum audit
et auxilium praebet eis. 20. Custodit Deus omnes qui diligunt eum,
et eradlcat omnes improbos. uL^Lj ilxi[jS'. i..^!i^.rii^i J^jy \^ 2 *
,14 pLi^l j J*i-/ •^-r^'-=^ '^; \\ ■•,^j J^ :ui^::. ., ^v ^» 21.
Hymnum Domini mundorum J,L.v;;% J^L^' ^rJ^-JfjL; iL^^.^ \\
loquetur os meum, et benedicet om- - '\i -^, ,- \^ .cJ , -' nis mortalis
nomen ejus sanctum in • f^-^^^ ^ ^/'. , ^T""^' ^^ ^j^^ J^
scmpitcrnum et in perpetuum. 3(i
The text on this page is estimated to be only 18.51%
accurate

PSALMUS CENTESLMUS QUADR AGESIMUS QUINTUS. 280

fmm^^m:!^^^^^^^^^^ K ^^iji^^^i^^':;^ }\ rS. f.ENTESIMUS
OUADRAGESIMUS QUIMTUS. Hymnus David. : SJS^ 'iAl'^ 1.
Exaltabo te, Deus meus rex, ct ^Uwi JjLj^j ^CJ' ,s-^' j SJjI^ \
henedicam nomen tuuni in sempi- cx.r"/ 'tV, ternum et in
perpetuum. / ^ , - , 2. Quotidie benedicam te, et lau- jj!^1' ^Ull
Lx>\'^ Ji^o! f-jj ^ J T dabo nomen tuum in sempilernum ^ > ^_ et
in perpetuum. > -^ 3. Magnus Deus super opera sua ^-^^ ^'^
LJ^^-^'^ J'Jii! Ji 'iJ^' iJii p et laudandus valde, et nullus est ma- ^_
. gnitudini e]us finis. •• ^, ,, h. Generatio generationi piVTdicat
^'^j^y^^j ^^^\ 'lUj J^A J_^ f opera tua, et potentias tuas confi-
^' * , ^ , tcntur ' c)->.'f:'. 5. Splendorem gloria; majestatis z)-^^^^
J^^j jjj^-f ^--^ ^"^ *^ tua? et verba mirabilium tuorum di- ' ' ^ f=
vulgabo. ■ ^ 6. Etvirtutemterribiliumfactorum : L^^ ^M^j r))y-'' *
c^^^-^^J^ '^j^j "i tuorum dicent, et magnitudinem tuam
enarrabo. , , , , , 7. Memoriam magnitudinis boni : ^j>^„ ^^M---^
jj*rf. ^f:?^ jr, y^ ^ tuiebullient, et justitiam tuam magnificabunt. ^ ,
^^^ -^ 8. Clemens et misericors est Deus ^^zj ^j^^ ^y^^^\ ^j
^\ ^^j^^^jij a Dominus mundorum, moram conce- ' ■ c '/-^-r dens
etmagnae grali£e. ^ -o ^ ^ 9. Benignus Deus erga omnes, et : ^l^
J^ ^'- L-l^Jj jDJJ^iii' jl^^ ^ miserationes ejus super omnes
crealuras ejus.
The text on this page is estimated to be only 3.24%
accurate

Jk liuoram a^ lucutum tjst m«tiituoiam. «stitextijnt twrum

ihnLtwnt mtjoii. D«imintf> cunticum aurum cirntaiwi tiiji; lyn\ ' • :a
duntlobu te. W. «iui ias uuxilium regibus; qui •" • ^ •. servu tiio* u.
^iiiu IL ip« 'pe ine $ manu tflianmi pc. , .... ;LLurtmi os lucutam est
meuilacium. et «feiteni eQram iesteri meuitadi. c^t^i p^:-? ;;w^?
^:x"Ui.:^:OT V V - Vi"^ 1:1 Jos. rauram dlii sicut pianta»,
«irescentiis in puerilia sua: quoram tilLae ^cataaguii altarisv pktx
la^cut fbrms picturaram palatiL ~ .1. miunm; aves lentes. m
myriades .XX.-.. .■ - ■■- lustris. !i Wm , ' mma^ : onila cufus D*". \'.
:t »t !i — »*^*^-». — ^* -:^_^'.
The text on this page is estimated to be only 7.60%
accurate

'MZmZ W'm gr^mAGfislMLHb I^IJSTI^ ■V .**'. ^^

iiatfhore •»i«r 0 ^^ "^■;¥": i-d^: Ji^ »S5 ^-Ju ^ i:r ^,,;^ £r^ i
f^^ 2. Detis gratia mea et an mea, et *^ jLiiJ. jLa?. -^'^' J-^ JJ' *
palum rueum soi) me. 3- Domine, quidestTalorbo«Hnis, -ii- j^'^!—
*^ yo-£? '• -2. 3*^ w^ i^ T et a;pjOTi5ti eam? et qniJ est Talor . ' .
^-^-^ ^ .- ,,., -^ ^ , ^f, -. * > qus, et cogitasti de eo ? " - ^^ 'O-*-
i. Homo palveri similis est ; dies :^--^ J-^ J^-- ^=-^^ **r^' *4^^
%— T^^^ fejas velat umbra praeteriens. 'j. Domine, inclina caelum
tuum, J-i-- *o^ ,J^~I sjJ^U- JCl* wj l> C et descende ;
appropinqua montes, ' ' ' ' ^ ^ , , > et fumigabunt. ' c^"^^^ 6.
Ful;^ura fulgur, etdispergeeos: : ^^ILl jJLl_^ \^^^} Ij-t^Oj !it^
^>j^ 1 emitte sagitta.s tuas, et conlurba eos. 7. E.ilende manus
tuas ex alto; aperi mihi, et libera me ex aquis mullis , e manu
filiorum poregrini.
The text on this page is estimated to be only 14.07%
accurate

279 PSALMUS CENTESLMUS QUA DRAGESIMUS QUARTUS.

8. Quorumoslocutumestmenda- ^j^^ ^^^'-^.j ^'j^-^ IKj" ' U J c-
^^ ^ cium,etdexteraeorumdexteramen- ' ' ■ \< dacii. * ' 9. Domine,
canticum noTum can- sjr^ ^_;»j oD ^j^ ^^i.-^ ^--rp' v^j ^. ^
tabo tibi; Ivra decachorda glorifi- ' ',', ^ ~ 'J ,;.4 cabo te. , ^ ' ^^
10. Qui das auxilium regibus ; qui f^y-^ ' 3^1 j.3 ^"'-i" jj JJJ ijy/»
,^*^' r aperuisti David, servo tuo, a gladio ' . g - ' .^' ^ maligno
/26e/Y;ns eum. '^, -' ^" ^11. Aperimibi et eripe me ^manu "--^^^
^'^J f-f. cj,r' ^,^\^J S -J^l W filiorum peregrini, quorum os locu- / ,
^ ,. ,, • ^T" ' l>-- ^ u':'-t^' -^ ""'>:' ;^^.r '^^ crescentes in
pueritia sua; quorum ',';, " .-:/' - \ Ar^ '\". \^ ■.''■■w - , , „^^ -, \h.
Magnates nostri portati ; nulla ^^j'-^ ;j-~j '^j'^ ^jr'^^ ""^ jA'^ Ljj-
=-^ \f est ruptura neque femina exiens, i'-r" ; nullusque clamor in
plateis nostris. ^ ^' ' , 15. Beatus populus cui talis des- ^^J^ '--^
J^; ,3^-^^ .._,-ouJ! ^^oi ^o criplio propria fd ! Beatus populus ' ^
^^, ^f^^jf^oJjf^i 13 cujus Deus Deus esH "■ ^' : "^" ^ .. Lx •• •
^ •• \ *■" ^ JJ «J. _ ' iJ^,. — '» ^.O, — ^' .A.Jo. — ^2 L" ^. _ 13
IJ^ 3,1_ _ 14 _^j'j. ..^ .. y . -• •• . e-'-' •-' -/ ^" ••
Welcome to our website – the ideal destination for book lovers and
knowledge seekers. With a mission to inspire endlessly, we offer a
vast collection of books, ranging from classic literary works to
specialized publications, self-development books, and children's
literature. Each book is a new journey of discovery, expanding
knowledge and enriching the soul of the reade

Our website is not just a platform for buying books, but a bridge
connecting readers to the timeless values of culture and wisdom. With
an elegant, user-friendly interface and an intelligent search system,
we are committed to providing a quick and convenient shopping
experience. Additionally, our special promotions and home delivery
services ensure that you save time and fully enjoy the joy of reading.

Let us accompany you on the journey of exploring knowledge and

personal growth!

textbookfull.com