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Jülicher P, Makarova N, Ojeda F, Giusepi I, Peters A, Thorand B, Cesana G, Jørgensen T, Linneberg A, Salomaa V, Iacoviello L, Costanzo S, Söderberg S, Kee F, Giampaoli S, Palmieri L, Donfrancesco C, Zeller T, Kuulasmaa K, Tuovinen T, Lamrock F, Conrads-Frank A, Brambilla P, Blankenberg S, Siebert U. Cost-effectiveness of applying high-sensitivity troponin I to a score for cardiovascular risk prediction in asymptomatic population. PLoS One 2024; 19:e0307468. [PMID: 39028718 PMCID: PMC11259308 DOI: 10.1371/journal.pone.0307468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 07/05/2024] [Indexed: 07/21/2024] Open
Abstract
INTRODUCTION Risk stratification scores such as the European Systematic COronary Risk Evaluation (SCORE) are used to guide individuals on cardiovascular disease (CVD) prevention. Adding high-sensitivity troponin I (hsTnI) to such risk scores has the potential to improve accuracy of CVD prediction. We investigated how applying hsTnI in addition to SCORE may impact management, outcome, and cost-effectiveness. METHODS Characteristics of 72,190 apparently healthy individuals from the Biomarker for Cardiovascular Risk Assessment in Europe (BiomarCaRE) project were included into a discrete-event simulation comparing two strategies for assessing CVD risk. The standard strategy reflecting current practice employed SCORE (SCORE); the alternative strategy involved adding hsTnI information for further stratifying SCORE risk categories (S-SCORE). Individuals were followed over ten years from baseline examination to CVD event, death or end of follow-up. The model tracked the occurrence of events and calculated direct costs of screening, prevention, and treatment from a European health system perspective. Cost-effectiveness was expressed as incremental cost-effectiveness ratio (ICER) in € per quality-adjusted life year (QALYs) gained during 10 years of follow-up. Outputs were validated against observed rates, and results were tested in deterministic and probabilistic sensitivity analyses. RESULTS S-SCORE yielded a change in management for 10.0% of individuals, and a reduction in CVD events (4.85% vs. 5.38%, p<0.001) and mortality (6.80% vs. 7.04%, p<0.001). S-SCORE led to 23 (95%CI: 20-26) additional event-free years and 7 (95%CI: 5-9) additional QALYs per 1,000 subjects screened, and resulted in a relative risk reduction for CVD of 9.9% (95%CI: 7.3-13.5%) with a number needed to screen to prevent one event of 183 (95%CI: 172 to 203). S-SCORE increased costs per subject by 187€ (95%CI: 177 € to 196 €), leading to an ICER of 27,440€/QALY gained. Sensitivity analysis was performed with eligibility for treatment being the most sensitive. CONCLUSION Adding a person's hsTnI value to SCORE can impact clinical decision making and eventually improves QALYs and is cost-effective compared to CVD prevention strategies using SCORE alone. Stratifying SCORE risk classes for hsTnI would likely offer cost-effective alternatives, particularly when targeting higher risk groups.
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Affiliation(s)
- Paul Jülicher
- Medical Affairs, Core Diagnostics, Abbott, Abbott Park, IL, United States of America
| | - Nataliya Makarova
- Midwifery Science—Health Care Research and Prevention, Institute for Health Service Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Francisco Ojeda
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Isabella Giusepi
- Medical Affairs, Core Diagnostics, Abbott, Abbott Park, IL, United States of America
| | - Annette Peters
- Institute of Epidemiology, German Research Center for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, München, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology—IBE, Faculty of Medicine, Ludwig-Maximilians-Universität in Munich, Munich, Germany
| | - Barbara Thorand
- Institute of Epidemiology, German Research Center for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology—IBE, Faculty of Medicine, Ludwig-Maximilians-Universität in Munich, Munich, Germany
| | - Giancarlo Cesana
- Centro Studi Sanità Pubblica, Università Milano Bicocca, Milan, Italy
| | - Torben Jørgensen
- Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
- Center for Clinical Research and Prevention, Copenhagen University Hospital–Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Allan Linneberg
- Center for Clinical Research and Prevention, Copenhagen University Hospital–Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Veikko Salomaa
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
- Department of Medicine and Surgery, LUM University “Giuseppe Degennaro”, Casamassima, Italy
| | - Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Frank Kee
- Centre for Public Health, Queen’s University of Belfast, Belfast, Northern Ireland
| | - Simona Giampaoli
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Luigi Palmieri
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Chiara Donfrancesco
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Tanja Zeller
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Kari Kuulasmaa
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tarja Tuovinen
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Felicity Lamrock
- Mathematical Science Research Centre, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Annette Conrads-Frank
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT TIROL—University for Health Sciences and Technology, Hall in Tirol, Austria
| | - Paolo Brambilla
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Stefan Blankenberg
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT TIROL—University for Health Sciences and Technology, Hall in Tirol, Austria
- Center for Health Decision Science, Depts. of Epidemiology and Health Policy & Management, Harvard Chan School of Public Health, Boston, MA, United States of America
- Program on Cardiovascular Research, Institute for Technology Assessment and Dept. of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
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Liu Y, Wang G, Qin TG, Kobayashi S, Karako T, Song P. Comparison of diagnosis-related groups (DRG)-based hospital payment system design and implementation strategies in different countries: The case of ischemic stroke. Biosci Trends 2024; 18:1-10. [PMID: 38403739 DOI: 10.5582/bst.2023.01027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Diagnosis-related groups (DRG) based hospital payment systems are gradually becoming the main mechanism for reimbursement of acute inpatient care. We reviewed the existing literature to ascertain the global use of DRG-based hospital payment systems, compared the similarities and differences of original DRG versions in ten countries, and used ischemic stroke as an example to ascertain the design and implementation strategies for various DRG systems. The current challenges with and direction for the development of DRG-based hospital payment systems are also analyzed. We found that the DRG systems vary greatly in countries in terms of their purpose, grouping, coding, and payment mechanisms although based on the same classification concept and that they have tended to develop differently in countries with different income classifications. In high-income countries, DRG-based hospital payment systems have gradually begun to weaken as a mainstream payment method, while in middle-income countries DRG-based hospital payment systems have attracted increasing attention and increased use. The example of ischemic stroke provides suggestions for mutual promotion of DRG-based hospital payment systems and disease management. How to determine the level of DRG payment incentives and improve system flexibility, balance payment goals and disease management goals, and integrate development with other payment methods are areas for future research on DRG-based hospital payment systems.
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Affiliation(s)
- Yuan Liu
- Statistics Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Gang Wang
- Statistics Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tian-Ge Qin
- Anqing Medical College, Anqing, Anhui, China
| | - Susumu Kobayashi
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takashi Karako
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
- National College of Nursing, Japan, Tokyo, Japan
| | - Peipei Song
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
- National College of Nursing, Japan, Tokyo, Japan
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Wilhelm NJ, Haddadin S, Lang JJ, Micheler C, Hinterwimmer F, Reiners A, Burgkart R, Glowalla C. Development of an Exoskeleton Platform of the Finger for Objective Patient Monitoring in Rehabilitation. SENSORS (BASEL, SWITZERLAND) 2022; 22:4804. [PMID: 35808299 PMCID: PMC9269489 DOI: 10.3390/s22134804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 11/17/2022]
Abstract
This paper presents the application of an adaptive exoskeleton for finger rehabilitation. The system consists of a force-controlled exoskeleton of the finger and wireless coupling to a mobile application for the rehabilitation of complex regional pain syndrome (CRPS) patients. The exoskeleton has sensors for motion detection and force control as well as a wireless communication module. The proposed mobile application allows to interactively control the exoskeleton, store collected patient-specific data, and motivate the patient for therapy by means of gamification. The exoskeleton was applied to three CRPS patients over a period of six weeks. We present the design of the exoskeleton, the mobile application with its game content, and the results of the performed preliminary patient study. The exoskeleton system showed good applicability; recorded data can be used for objective therapy evaluation.
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Affiliation(s)
- Nikolas Jakob Wilhelm
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, School of Medicine, 80333 Munich, Germany; (J.J.L.); (C.M.); (F.H.); (R.B.); (C.G.)
- Munich Institute of Robotics and Machine Intelligence, Department of Electrical and Computer Engineering, Technical University of Munich, 80333 Munich, Germany;
| | - Sami Haddadin
- Munich Institute of Robotics and Machine Intelligence, Department of Electrical and Computer Engineering, Technical University of Munich, 80333 Munich, Germany;
| | - Jan Josef Lang
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, School of Medicine, 80333 Munich, Germany; (J.J.L.); (C.M.); (F.H.); (R.B.); (C.G.)
| | - Carina Micheler
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, School of Medicine, 80333 Munich, Germany; (J.J.L.); (C.M.); (F.H.); (R.B.); (C.G.)
| | - Florian Hinterwimmer
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, School of Medicine, 80333 Munich, Germany; (J.J.L.); (C.M.); (F.H.); (R.B.); (C.G.)
| | - Anselm Reiners
- Klinik für Frührehabilitation und Physikalische Medizin, Zentrum für Orthopädie, Unfallchirurgie und Sportmedizin, München Klinik Bogenhausen, 81925 Munich, Germany;
| | - Rainer Burgkart
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, School of Medicine, 80333 Munich, Germany; (J.J.L.); (C.M.); (F.H.); (R.B.); (C.G.)
| | - Claudio Glowalla
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, School of Medicine, 80333 Munich, Germany; (J.J.L.); (C.M.); (F.H.); (R.B.); (C.G.)
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, 82418 Murnau, Germany
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Wahler S, Birkemeyer R, Alexopoulos D, Siudak Z, Müller A, von der Schulenburg JM. Cost-effectiveness of a photopethysmographic procedure for screening for atrial fibrillation in 6 European countries. HEALTH ECONOMICS REVIEW 2022; 12:17. [PMID: 35218421 PMCID: PMC8882287 DOI: 10.1186/s13561-022-00362-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/10/2022] [Indexed: 05/12/2023]
Abstract
BACKGROUND Strokes cause an estimated annual health care burden of 170 billion euros across Europe. Atrial fibrillation is one of the major risk factors for stroke and increases the individual risk 4.2-fold. But prevention with anticoagulants may reduce this risk by 70%. Screening methods are employed to detect previously undetected atrial fibrillation. Screening studies in various European countries show a high degree of undetected atrial fibrillation. This study aims to assess the cost-effectiveness of systematic screening with a smartphone application, named Preventicus Heartbeats. It is a hands-on screening tool for use on smartphone to diagnose AF with high sensitivity and specificity. METHODS A previously published model for calculating screening cost-effectiveness was extended to 6 European countries covering a wide range in terms of treatment costs and epidemiologic parameters. RESULTS The use of screening lowers the cost per case in countries with comparatively high levels of health care costs (Switzerland: -€75; UK: -€7). Moderate higher costs per case were observed in 4 countries (Greece: €6; Netherlands: €15). Low levels of health care costs result in less or no potential for further cost reduction (Poland: €20; Serbia: €33). In all countries considered, the model showed an increase in effectiveness measures both in the number of strokes avoided and the quality adjusted life years. The number of strokes avoided per 1000 participants ranged from 2.52 (Switzerland) to 4.44 (Poland). Quality-adjusted life-years per case gained from screening ranged from 0.0105 (Switzerland) to 0.0187 (Poland). The screening procedure dominated in two countries (Switzerland, UK). For the remaining countries, the incremental cost effectiveness ratio ranged from €489/QALY (Greece) to €2548/QALY (Serbia). CONCLUSION The model results showed a strong dependence of the results on the country-specific costs for stroke treatment. The use of the investigated screening method is close to cost-neutral or cost-reducing in the Western European countries and Greece. In countries with low price levels, higher cost increases due to AF screening are to be expected. Lower costs of anticoagulation, which are expected due to the upcoming patent expiry of direct anticoagulants, have a positive effect on the cost result.
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Affiliation(s)
- Steffen Wahler
- St. Bernward GmbH, Friedrich-Kirsten-Straße 40, D-22391, Hamburg, Germany.
| | | | - Dimitrios Alexopoulos
- Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Tetrapoleos 18, GR-115 27, Athens, Greece
| | - Zbigniew Siudak
- Department of Internal Medicine and Cardiology, Jan Kochanowski University, Stefana Żeromskiego 5, PL-25-369, Kielce, Poland
| | - Alfred Müller
- Analytic Services GmbH, Jahnstr. 34c, D-80469, Munich, Germany
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Dickmann T, Wilhelm NJ, Glowalla C, Haddadin S, van der Smagt P, Burgkart R. An Adaptive Mechatronic Exoskeleton for Force-Controlled Finger Rehabilitation. Front Robot AI 2021; 8:716451. [PMID: 34660703 PMCID: PMC8514640 DOI: 10.3389/frobt.2021.716451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/13/2021] [Indexed: 11/13/2022] Open
Abstract
This paper presents a novel mechatronic exoskeleton architecture for finger rehabilitation. The system consists of an underactuated kinematic structure that enables the exoskeleton to act as an adaptive finger stimulator. The exoskeleton has sensors for motion detection and control. The proposed architecture offers three main advantages. First, the exoskeleton enables accurate quantification of subject-specific finger dynamics. The configuration of the exoskeleton can be fully reconstructed using measurements from three angular position sensors placed on the kinematic structure. In addition, the actuation force acting on the exoskeleton is recorded. Thus, the range of motion (ROM) and the force and torque trajectories of each finger joint can be determined. Second, the adaptive kinematic structure allows the patient to perform various functional tasks. The force control of the exoskeleton acts like a safeguard and limits the maximum possible joint torques during finger movement. Last, the system is compact, lightweight and does not require extensive peripherals. Due to its safety features, it is easy to use in the home. Applicability was tested in three healthy subjects.
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Affiliation(s)
- Thomas Dickmann
- Orthopaedic Research, Clinic for Orthopaedics and Sport Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Nikolas J Wilhelm
- Orthopaedic Research, Clinic for Orthopaedics and Sport Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Chair of Robotics and System Intelligence, Munich School of Robotics and Machine Intelligence, Technical University of Munich, Munich, Germany
| | - Claudio Glowalla
- Orthopaedic Research, Clinic for Orthopaedics and Sport Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sami Haddadin
- Chair of Robotics and System Intelligence, Munich School of Robotics and Machine Intelligence, Technical University of Munich, Munich, Germany
| | - Patrick van der Smagt
- Machine Learning Research Lab, Volkswagen Group, Munich, Germany.,Graduate School of Systemic Neurosciences, Ludwig-Maximilians-University Munich, Munich, Germany.,Department of Artificial Intelligence, Faculty of Informatics, Eötvös Lórand University, Budapest, Hungary
| | - Rainer Burgkart
- Orthopaedic Research, Clinic for Orthopaedics and Sport Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
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Zaprutko T, Florczak-Wyspiańska J, Kopciuch D, Paczkowska A, Ratajczak P, Dorszewska J, Nowakowska E, Kus K. Costs of Stroke and Incidence of First Diagnosis of Atrial Fibrillation at Time of Stroke. Neurology Ward Hospital Poznań, Poland 2018. Healthcare (Basel) 2021; 9:healthcare9080999. [PMID: 34442136 PMCID: PMC8394020 DOI: 10.3390/healthcare9080999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/29/2021] [Accepted: 08/03/2021] [Indexed: 11/16/2022] Open
Abstract
Stroke is a major cause of morbidity in industrialized countries, representing 8% of total deaths across Europe in 2017. It is also a very costly disorder, frequently caused by atrial fibrillation. We aimed to calculate the cost of stroke hospitalization in 2018 in Poznań (Poland). We also intended to present patients with the first AF diagnosis at the time of stroke. The study was conducted from January 2019 to July 2020. Data were obtained from hospital records and from the hospital accounting department. Out of 164 patients included in the study, 41 had AF and in 18 cases AF was first diagnosed at the time of stroke. The cost of hospitalization in Poznań was EUR 139,257.21 (x¯= EUR 849.13). Among those with concomitant AF, the general cost of inpatient care was EUR 33,859.18 (x¯= EUR 825.83). Considering those who had AF first diagnosed during hospitalization the cost was EUR 16,248.97 (x¯= EUR 906.24). Stroke is associated with high costs of inpatient care, which turned out to be higher among those with AF first diagnosed at the time of stroke. The number of patients who used oral anticoagulants at the time of admission was relatively low. The most frequently used NOAC was dabigatran.
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Affiliation(s)
- Tomasz Zaprutko
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 7 Rokietnicka St, 60-806 Poznan, Poland; (D.K.); (A.P.); (P.R.); (K.K.)
- Correspondence: ; Tel./Fax: +48-61-845-26-84
| | - Jolanta Florczak-Wyspiańska
- Department of Neurology, Poznan University of Medical Sciences, 49 Przybyszewskiego St, 60-355 Poznan, Poland; (J.F.-W.); (J.D.)
| | - Dorota Kopciuch
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 7 Rokietnicka St, 60-806 Poznan, Poland; (D.K.); (A.P.); (P.R.); (K.K.)
| | - Anna Paczkowska
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 7 Rokietnicka St, 60-806 Poznan, Poland; (D.K.); (A.P.); (P.R.); (K.K.)
| | - Piotr Ratajczak
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 7 Rokietnicka St, 60-806 Poznan, Poland; (D.K.); (A.P.); (P.R.); (K.K.)
| | - Jolanta Dorszewska
- Department of Neurology, Poznan University of Medical Sciences, 49 Przybyszewskiego St, 60-355 Poznan, Poland; (J.F.-W.); (J.D.)
| | - Elżbieta Nowakowska
- Department of Toxicology and Pharmacology, University of Zielona Góra, 28 Zyty St, 65-046 Zielona Góra, Poland;
| | - Krzysztof Kus
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 7 Rokietnicka St, 60-806 Poznan, Poland; (D.K.); (A.P.); (P.R.); (K.K.)
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Lorenzovici L, Székely A, Csanádi M, Gaál P. Cost Assessment of Inpatient Care Episodes of Stroke in Romania. Front Public Health 2020; 8:605919. [PMID: 33344405 PMCID: PMC7746609 DOI: 10.3389/fpubh.2020.605919] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/11/2020] [Indexed: 11/27/2022] Open
Abstract
Introduction: Stroke is the second leading cause of death worldwide and Romania is no exception. There is a high economic burden associated with the treatment of stroke patients, which puts pressure on the healthcare budget. This study aims to measure the inpatient treatment costs of stroke patients in Romania. Methods: Our retrospective analysis follows stroke patients in six Romanian hospitals at different progressivity level from different regions. Patients are identified from the official hospital databases, reported for reimbursement purposes. Mean inpatient costs incurred with the treatment of these stroke patient episodes are calculated using the gross costing method. The cost data are derived from the management control system of the study hospitals. Results: 3,155 patient episodes of stroke were identified in the study hospitals. The average cost per stroke inpatient care episode sums up to EUR 995.57 (95% CI: EUR 963.74-EUR 1 027.39) in 2017, while the overall yearly healthcare burden adds up to EUR 140 million, representing 2.18% of the total national health insurance budget and a cost of EUR 7.15 per capita. Conclusion: The hospital cost of stroke inpatient care episode in Romania is high and it represents a sizable part of the healthcare budget, but it is among the lowest in Europe, which can mainly be explained by the level of economic development of the country. As both the number of patients and the cost of acute care are expected to increase in the future, the economic burden of stroke is also expected to increase.
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Affiliation(s)
- László Lorenzovici
- Syreon Research Romania, Tirgu Mures, Romania
- G. E. Palade University of Medicine, Pharmacy, Science and Technology, Tirgu Mures, Romania
| | | | | | - Péter Gaál
- Health Services Management Training Centre, Faculty of Health and Public Administration, Semmelweis University, Budapest, Hungary
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Puumalainen A, Elonheimo O, Brommels M. Costs structure of the inpatient ischemic stroke treatment using an exact costing method. Heliyon 2020; 6:e04264. [PMID: 32613126 PMCID: PMC7322047 DOI: 10.1016/j.heliyon.2020.e04264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 11/19/2019] [Accepted: 06/17/2020] [Indexed: 11/18/2022] Open
Abstract
Objectives Most stroke care expenses are inhospital costs. Given the previously reported inaccuracy of conventional costing, the purpose of this study was to provide an accurate analysis of inpatient costs of stroke care in an acute care hospital. Materials and methods We used activity-based costing (ABC) for calculating the costs of ischemic stroke patients. We collected the activity data at the Helsinki University Central Hospital. Persons involved in patient care logged their activities on survey forms for one week. The costs of activities were calculated based on information about salaries, material prices, and other costs obtained from hospital accounting data. We calculated costs per inpatient days and episodes, analyzed cost structure, made a distinction in cost for stroke subtypes according to the Oxford and TOAST classification schemes, and compared cost per inpatient episode with the diagnoses-related group (DRG) -price of the hospital. Results The sample comprised 196 inpatient days of 41 patients. By using the ABC, the mean and median costs of an inpatient day were 346 € and 268 €, and of an inpatient episode 3322 € and 2573 €, respectively. Average costs differed considerably by stroke subtype. The first inpatient day was the most expensive. Working time costs comprised 63% of the average inpatient day cost, with nursing constituting the largest proportion. The mean cost of an inpatient episode was 21% lower with ABC than with DRG pricing. Conclusion We demonstrate that there are differences in cost estimates depending on the methods used. ABC revealed differences among patients having the same diagnosis. The cost of an episode was lower than the DRG price of the hospital. Choosing an optimal costing method is essential for both reimbursements of hospitals and health policy decision-making.
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Affiliation(s)
- Anne Puumalainen
- Department of Public Health, University of Helsinki, Kajavankatu 2C 79, 04230, Kerava, Finland
- Corresponding author.
| | - Outi Elonheimo
- Network of Academic Health Centres and Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - Mats Brommels
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
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Vaseva V, Voynov L, Donchev T, Popov R, Mutafchiyski V, Aleksiev L, Kostadinov K, Petrov N. Outcomes analysis of hospital management model in restricted budget conditions. BIOTECHNOL BIOTEC EQ 2016. [DOI: 10.1080/13102818.2015.1134276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Bystrov V, Staszewska-Bystrova A, Rutkowski D, Hermanowski T. Effects of DRG-based hospital payment in Poland on treatment of patients with stroke. Health Policy 2015; 119:1119-25. [DOI: 10.1016/j.healthpol.2015.04.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 04/24/2015] [Accepted: 04/28/2015] [Indexed: 10/23/2022]
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Kontsevaya A, Kalinina A, Oganov R. Economic Burden of Cardiovascular Diseases in the Russian Federation. Value Health Reg Issues 2013; 2:199-204. [PMID: 29702865 DOI: 10.1016/j.vhri.2013.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES In the Russian Federation, cardiovascular disease (CVD) is the primary cause of death and premature death; however, to date, there have been no systematic cost-of-illness studies to assess the economic impact of CVD. METHODS The economic burden of CVD was estimated from statistic data on morbidity, mortality, and health care resource use. Health care costs were estimated on the basis of expenditure on primary, outpatient, emergency, and inpatient care, as well as medications. Non-health care costs included economic losses due to morbidity and premature death in the working age. RESULTS CVD was estimated to cost Russia RUR 836.1 billion (€24,517.8 million) in 2006 and RUR 1076 billion (€24,400.4 million) in 2009. Of the total costs of CVD, 14.5% in 2006 and 21.3% in 2009 were due to health care, with 85.5% and 78.7%, respectively, due to non-health care costs. CONCLUSIONS CVD is a leading public health problem. We first assessed the economic burden of CVD in Russia. Our results can be used for planning investments in prevention programs and measures for improving care for patients with CVD. Regular monitoring of the economic burden of CVD in the future at the federal, regional, and municipal levels will allow assessment of the dynamics of economic burden, as well as the effectiveness of investments in the economy in primary and secondary prevention. Because data are relatively unavailable, there are important limitations to this study, which highlight the need for more accurate CVD-specific information.
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Affiliation(s)
- Anna Kontsevaya
- Department of Primary Prevention in Healthcare, National Research Center for Preventive Medicine, Moscow, Russia.
| | - Anna Kalinina
- Department of Primary Prevention in Healthcare, National Research Center for Preventive Medicine, Moscow, Russia
| | - Rafael Oganov
- Department of Primary Prevention in Healthcare, National Research Center for Preventive Medicine, Moscow, Russia
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Bouvy JC, Fransen PSS, Baeten SA, Koopmanschap MA, Niessen LW, Dippel DWJ. Cost-effectiveness of two endovascular treatment strategies vs intravenous thrombolysis. Acta Neurol Scand 2013; 127:351-9. [PMID: 23278859 DOI: 10.1111/ane.12065] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the cost-effectiveness of endovascular treatment against intravenous thrombolysis (IVT) when varying assumptions concerning its effectiveness. METHODS We developed a health economic model including a hypothetical population consisting of patients with ischemic stroke, admitted within 4.5 h from onset, without contraindications for IVT or intra-arterial treatment (IAT). A decision tree and life table were used to assess 6-month and lifetime costs (in Euros) and effects in quality-adjusted life years treatment with IVT alone, IAT alone, and IVT followed by IAT if the patient did not respond to treatment. Several analyses were performed to explore the impact of considerable uncertainty concerning the clinical effectiveness of endovascular treatment. RESULTS Probabilistic sensitivity analysis demonstrated a 54% probability of positive incremental lifetime effectiveness of IVT-IAT vs IVT alone. Sensitivity analyses showed significant variation in outcomes and cost-effectiveness of the included treatment strategies at different model assumptions. CONCLUSIONS Acceptable cost-effectiveness of IVT-IAT compared to IVT will only be possible if recanalization rates are sufficiently high (>50%), treatment costs of IVT-IAT do not increase, and complication rates remain similar to those reported in the few randomized studies published to date. Large randomized studies are needed to reduce the uncertainty concerning the effects of endovascular treatment.
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Affiliation(s)
| | - P. S. S. Fransen
- Department of Neurology; Erasmus MC Rotterdam; Rotterdam; The Netherlands
| | - S. A. Baeten
- Department of Health Policy and Management (iBMG); Institute for Medical Technology Assessment; Erasmus MC Rotterdam; Rotterdam; The Netherlands
| | - M. A. Koopmanschap
- Department of Health Policy and Management (iBMG); Institute for Medical Technology Assessment; Erasmus MC Rotterdam; Rotterdam; The Netherlands
| | | | - D. W. J. Dippel
- Department of Neurology; Erasmus MC Rotterdam; Rotterdam; The Netherlands
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de Mendivil AO, Alcalá-Galiano A, Ochoa M, Salvador E, Millán JM. Brainstem Stroke: Anatomy, Clinical and Radiological Findings. Semin Ultrasound CT MR 2013; 34:131-41. [DOI: 10.1053/j.sult.2013.01.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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15
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Peltola M, Quentin W. Diagnosis-related groups for stroke in Europe: patient classification and hospital reimbursement in 11 countries. Cerebrovasc Dis 2013; 35:113-23. [PMID: 23406838 DOI: 10.1159/000346092] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 11/22/2012] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Diagnosis-related groups (DRGs) are increasingly being used for various purposes in many countries. However, there are no studies comparing different DRG systems in the care of stroke. As part of the EuroDRG project, researchers from 11 countries (i.e. Austria, England, Estonia, Finland, France, Germany, Ireland, the Netherlands, Poland, Sweden and Spain) compared how their DRG systems deal with stroke patients. The study aims to assist clinicians and national authorities to optimize their DRG systems. METHODS National or regional databases were used to identify hospital cases with a diagnosis of stroke. DRG classification algorithms and indicators of resource consumption were compared for those DRGs that individually represent at least 1% of stroke cases. In addition, standardized case vignettes were defined, and quasi prices according to national DRG-based hospital payment systems were ascertained. RESULTS European DRG systems vary widely: they classify stroke patients according to different sets of variables (between 1 and 7 classification variables) into diverging numbers of DRGs (between 1 and 10 DRGs). In 6 of the countries more than half of the patients are concentrated within a single DRG. The countries' systems also vary with respect to the evaluation of different kinds of stroke patients. The most complex DRG is considered 3.8 times more resource intensive than an index case in Finland. By contrast, in England, the DRG system does not account for complex cases. Comparisons of quasi prices for the case vignettes show that hypothetical payments for the index case amount to only EUR 907 in Poland but to EUR 7,881 in Ireland. CONCLUSIONS Large variations in the classification of stroke patients raise concerns whether all systems rely on the most appropriate classification variables and whether the DRGs adequately reflect differences in the complexity of treating different groups of patients. Learning from other DRG systems may help in improving the national systems. Clinicians and national DRG authorities should consider how other countries' DRG systems classify stroke patients in order to optimize their DRG system and to ensure fair and appropriate reimbursement. In future, quantitative research is needed to verify whether the most important determinants of cost are considered in different patient classification systems, and whether differences between systems reflect country-specific differences in treatment patterns and, most importantly, what influence they have on patient outcomes.
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Affiliation(s)
- Mikko Peltola
- Centre for Health and Social Economics, National Institute for Health and Welfare, Helsinki, Finland.
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Pirson M, Schenker L, Martins D, Dung D, Chalé JJ, Leclercq P. What can we learn from international comparisons of costs by DRG? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2013; 14:67-73. [PMID: 22237779 DOI: 10.1007/s10198-011-0373-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 12/13/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVES The objective of this study was to compare costs data by diagnosis related group (DRG) between Belgium and Switzerland. Our hypotheses were that differences between countries can probably be explained by methodological differences in cost calculations, by differences in medical practices and by differences in cost structures within the two countries. METHODS Classifications of DRG used in the two countries differ (AP-DRGs version 1.7 in Switzerland and APR-DRGs version 15.0 in Belgium). The first step of this study was to transform Belgian summaries into Swiss AP-DRGs. Belgian and Swiss data were calculated with a clinical costing methodology (full costing). Belgian and Swiss costs were converted into US$ PPP (purchasing power parity) in order to neutralize differences in purchasing power between countries. RESULTS The results of this study showed higher costs in Switzerland despite standardization of cost data according to PPP. The difference is not explained by the case-mix index because this was similar for inliers between the two countries. The length of stay (LOS) was also quite similar for inliers between the two countries. The case-mix index was, however, higher for high outliers in Belgium, as reflected in a higher LOS for these patients. Higher costs in Switzerland are thus probably explained mainly by the higher number of agency staff by service in this country or because of differences in medical practices. CONCLUSIONS It is possible to make international comparisons but only if there is standardization of the case-mix between countries and only if comparable accountancy methodologies are used. Harmonization of DRGs groups, nomenclature and accountancy is thus required.
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Affiliation(s)
- M Pirson
- Unité Economie et Gestion des Institutions de Soins, Département d'économie de la santé, Ecole de Santé Publique, Université Libre de Bruxelles, 808, Route de Lennik, CP592, 1070 Bruxelles, Belgium.
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Inokuchi T, Ikegami N, Gupta V, Rao S, Anderson GF. Comparison of price, volume and composition of services provided to inpatients for two procedures between a US and a Japanese academic hospital. Health (London) 2013. [DOI: 10.4236/health.2013.54093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Fattore G, Torbica A, Susi A, Giovanni A, Benelli G, Gozzo M, Toso V. The social and economic burden of stroke survivors in Italy: a prospective, incidence-based, multi-centre cost of illness study. BMC Neurol 2012; 12:137. [PMID: 23150894 PMCID: PMC3536660 DOI: 10.1186/1471-2377-12-137] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2011] [Accepted: 10/15/2012] [Indexed: 12/31/2022] Open
Abstract
Background The aim of this study was to estimate the one-year societal costs due to a stroke event in Italy and to investigate variables associated with costs in different phases following hospital admission. Methods The patients were enrolled in 44 hospitals across the country and data on socio-demographic, clinical variables and resource consumption were prospectively surveyed for 411 stroke survivors at admission, discharge and 3, 6 and 12 months post the event. We adopted a micro-costing procedure to identify cost generating components and the attribution of appropriate unit costs for three cost categories: direct healthcare, direct non-healthcare (including informal care costs) and productivity losses. The relation between costs of stroke management and socio-demographic and clinical characteristics as well as disability levels was evaluated in a series of bivariate analyses using non parametric tests (Mann Whitney and Kruskal-Wallis). Multiple linear regression analyses were performed to determine predictors of costs incurred by stroke patients during the acute phase and follow-up of 1 year. Results On average, one-year healthcare and societal costs amounted to €11,747 and € 19,953 per stroke survivor, respectively. The major cost component of societal costs was informal care accounting for € 6,656 (33.4% of total), followed by the initial hospitalisation, (€ 5,573; 27.9% of total), rehabilitation during follow up (€ 4,112; 20.6 %), readmissions (€ 439) and specialist and general practioner visits (€ 326). Mean drug costs per patient over the follow-up period was about € 50 per month. Costs associated to the provision of paid and informal care followed different pattern and were persistent over time (ranging from € 639 to € 597 per month in the first and the second part of the year, respectively). Clinical variables (presence of diabetes mellitus and hemorrhagic stroke) were significant predictors of total healthcare costs while functional outcomes (Barthel Index and Modified Ranking Scale scores) were significantly associated with both healthcare and societal costs at one year. Conclusions The significant role of informal care in stroke management and different distribution of costs over time suggest that appropriate planning should look at both incident and prevalent stroke cases to forecast health infrastructure needs and more importantly, to assure that stroke patients have adequate “social” support.
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Affiliation(s)
- Giovanni Fattore
- Centre for Research on Health and Social Care Management (CERGAS) and SDA Bocconi, Università Bocconi, Milan, Italy.
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Busse R. Do diagnosis-related groups explain variations in hospital costs and length of stay? Analyses from the EuroDRG project for 10 episodes of care across 10 European countries. HEALTH ECONOMICS 2012; 21 Suppl 2:1-5. [PMID: 22815107 DOI: 10.1002/hec.2861] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Peltola M. Patient classification and hospital costs of care for stroke in 10 European countries. HEALTH ECONOMICS 2012; 21 Suppl 2:129-140. [PMID: 22815118 DOI: 10.1002/hec.2841] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Stroke is a major cause of death and disability around the world, and the care of stroke patients ties up a great amount of resources in healthcare systems. Stroke severity and the given care may vary substantially between patients, and there is remarkable variation in both the costs and length of stay (LoS) of stroke patients. Using patient level data from 10 European countries on costs and LoS, we explored the ability of the diagnosis-related group (DRG) systems to explain variance in the costs and length of stay of stroke patients. In addition, we evaluated whether the existing DRGs for stroke patients would benefit from additional patient-related and treatment-related factors that are commonly found in the administrative databases across countries. Cost analyses were run using OLS fixed effects models, and LoS analyses with negative binomial models. The descriptive statistics showed that the stroke patients differ remarkably across countries. Large variations in the classification of stroke patients raise concerns about whether all systems rely on the most appropriate classification variables. In all the countries, the DRG classifications' performance could be improved with the introduction of the patient characteristics analysed here.
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Affiliation(s)
- Mikko Peltola
- Centre for Health and Social Economics CHESS, National Institute for Health and Welfare, Helsinki, Finland.
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Kaló Z, Landa K, Doležal T, Vokó Z. Transferability of National Institute for Health and Clinical Excellence recommendations for pharmaceutical therapies in oncology to Central-Eastern European countries. Eur J Cancer Care (Engl) 2012; 21:442-9. [PMID: 22510226 DOI: 10.1111/j.1365-2354.2012.01351.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The health burden of malignancies is greater in Central-Eastern Europe than in Western Europe. Furthermore, these countries have more limited healthcare resources, and therefore transparent decision criteria for innovative cancer therapies, including the assessment of cost-effectiveness, are an absolute necessity. Transferability of good-quality technology assessment reports, especially those prepared by National Institute for Health and Clinical Excellence (NICE) in the UK, could be highly beneficial to prevent duplication of efforts and save resources for local technology assessment. Our objective was to summarise key factors influencing the transferability of NICE recommendations in oncology for policy makers and oncologists in Central-Eastern Europe without personal experience in health technology assessment. In general, NICE recommendations are not transferable without adjustment of the analyses to local data. Even if the recommendation is positive, the conclusion can still be negative in lower-income countries, mainly due to relative price differences and the significance of the local budget impact. Technologies with negative NICE recommendations can still be cost-effective in Central-Eastern Europe due to the worse health status and therefore the greater potential health gain of the targeted population. The appropriateness of reimbursement decisions must be improved in Central-Eastern Europe, but copying NICE recommendations without local adjustment may do more harm than good.
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Affiliation(s)
- Z Kaló
- Health Economics Research Centre, Faculty of Social Sciences, Eötvös Loránd University, Budapest, Hungary.
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Oppong R, Coast J, Hood K, Nuttall J, Smith RD, Butler CC. Resource use and costs of treating acute cough/lower respiratory tract infections in 13 European countries: results and challenges. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2011; 12:319-329. [PMID: 20364288 DOI: 10.1007/s10198-010-0239-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Accepted: 03/15/2010] [Indexed: 05/29/2023]
Abstract
The objectives of this study were to estimate the resource use and cost of treating acute cough/lower respiratory tract infection (acute cough/LRTI) in 13 European countries, to explore reasons for differences in cost and to document the challenges that researchers face when collecting information on cost alongside multinational studies. Data on resource use and cost were collected alongside an observational study in 14 primary care networks across 13 European countries and a mean cost was generated for each network. The results show that the mean cost (standard deviation) of treating acute cough/LRTI in Europe ranged from euro23.88 (34.67) in Balatonfüred (Hungary) to euro116.47 (34.29) in Jonkoping (Sweden). The observed differences in costs were statistically significant (P < 0.01). Major cost drivers include general practitioner visits and drug costs in all networks, whilst differences in health systems and regional factors could account for differences in cost between networks. The major barrier to conducting multinational cost studies are barriers associated with identifying cost information.
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Affiliation(s)
- Raymond Oppong
- Health Economics Unit, School of Health and Population Sciences, University of Birmingham, Public Health Building, Birmingham, B15 2TT, UK.
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From the stroke unit to the stroke competence center: corresponding beneficial clinical and financial effects. J Neurol 2011; 258:1929-32. [DOI: 10.1007/s00415-011-6032-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Revised: 01/18/2011] [Accepted: 03/24/2011] [Indexed: 10/18/2022]
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Yekhlef F, Decup D, Niclot P, Servan J, Descombes S, Richecoeur J, Ollivier A. [Medico-economic assessment of the Pontoise Hospital stroke unit]. Rev Neurol (Paris) 2010; 166:901-8. [PMID: 20478608 DOI: 10.1016/j.neurol.2010.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2009] [Revised: 01/16/2010] [Accepted: 03/04/2010] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Annually, approximately 120,000 people in France have a stroke. Various controlled studies have pointed out the benefits of treatment in a stroke unit (SU). The objective of this study was to evaluate, from a medical point of view, the economic impact of the Pontoise Hospital SU. PATIENTS AND METHODS Based on the national cost study (NCS [étude nationale des coûts: ENC]) we analyzed data of five diagnosis related groups (DRG) which have a principle diagnosis in relation with stroke. This work was limited to strokes and transient ischemic events in adults and excluded sub-arachnoid hemorrhage. Medical and economic parameters were collected over the period from January to October 2006 and compared with those of the same period in 2005, that is to say before the opening of the SU. RESULTS Three hundred and twenty-three hospital stays occurred between January 1st and October 31st, 2006 and 216 during the same time period before the opening of the SU, an increase of approximately 50% of all stroke-related admissions in our hospital. The number of stays carried out in the neurology unit increased by 29%. There was no significant difference between the two periods regarding age (median 69 versus 70 years) and sex- ratio. Average length of stay (ALS) was the same (9 days). There were no significant differences concerning the death rate (5.6% versus 6.2%) and that of discharge to home (44.6% versus 44.4%). The cost by stay in 2006 was 3534 euros [median; min 664-max 57,542] versus 3541 euros in 2005 [681-35,149] (p=0.57). Analysis by DRG highlighted an increase in the cost for serious strokes, cerebral infarctions and hemorrhages. For transitory ischemic events, the cost and the ALS decreased. CONCLUSION After the opening of the SU, there was an increase in the activity without an increase in the total cost. This could be related in part to the limited means allocated to the stroke unit at its opening (in particular medical staff). The NCS can be used to evaluate the activity of a stroke unit. This work could be completed on a larger number of units or in several units of different size.
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Affiliation(s)
- F Yekhlef
- Service de neurologie, centre hospitalier René-Dubos, 6, avenue de l'Ile-de-France, 95300 Pontoise, France.
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The impact of acute myocardial infarction and stroke on health care costs in patients with type 2 diabetes in Sweden. ACTA ACUST UNITED AC 2010; 16:576-82. [PMID: 19491686 DOI: 10.1097/hjr.0b013e32832d193b] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Estimates of the economic impact of cardiovascular events in patients with type 2 diabetes are scarce. The aim of this study was to determine the health care costs associated with acute myocardial infarction (AMI) and stroke in patients with type 2 diabetes in Sweden. DESIGN Population-based open cohort study of 9941 patients with type 2 diabetes retrospectively identified in primary care records at 26 centres in Uppsala County. METHODS Episodes of AMI and stroke suffered by study patients were tracked in the Swedish National Inpatient Register. Annual per patient costs of health care were computed for the years 2000-2004 using register data covering inpatient care, outpatient hospital care, primary care and drugs. Panel data regression was applied to determine the impact of suffering a first or repeat AMI or stroke on health care costs during the year of the event and in subsequent years. RESULTS Total health care costs of patients suffering a first AMI/stroke increased by 4.1/6.5 during the year of the event [95% confidence interval (CI): 3.1-5.4/4.9-8.5] and by 1.1/1.4 during subsequent years (95% CI: 1.0-1.3/1.2-1.6), controlling for age, sex, the event of amputation and presence of renal failure, heart failure and diabetic eye disease. Total health care costs of patients suffering a first or repeat AMI/stroke increased by 4.1/6.4 during the year of an event (95% CI: 3.2-5.2/5.0-8.1) but were not significantly higher during subsequent years. CONCLUSION Estimates of the costs related to major cardiovascular complications of type 2 diabetes are critical input to economic evaluations.
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Tan SS, van Ineveld BM, Redekop WK, Hakkaart-van Roijen L. Comparing methodologies for the allocation of overhead and capital costs to hospital services. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2009; 12:530-535. [PMID: 19138307 DOI: 10.1111/j.1524-4733.2008.00475.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Typically, little consideration is given to the allocation of indirect costs (overheads and capital) to hospital services, compared to the allocation of direct costs. Weighted service allocation is believed to provide the most accurate indirect cost estimation, but the method is time consuming. OBJECTIVE To determine whether hourly rate, inpatient day, and marginal mark-up allocation are reliable alternatives for weighted service allocation. METHODS The cost approaches were compared independently for appendectomy, hip replacement, cataract, and stroke in representative general hospitals in The Netherlands for 2005. RESULTS Hourly rate allocation and inpatient day allocation produce estimates that are not significantly different from weighted service allocation. CONCLUSIONS Hourly rate allocation may be a strong alternative to weighted service allocation for hospital services with a relatively short inpatient stay. The use of inpatient day allocation would likely most closely reflect the indirect cost estimates obtained by the weighted service method.
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Affiliation(s)
- Siok Swan Tan
- Institute for Medical Technology Assessment, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
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Busse R, Schreyögg J, Smith PC. Variability in healthcare treatment costs amongst nine EU countries - results from the HealthBASKET project. HEALTH ECONOMICS 2008; 17:S1-S8. [PMID: 18186039 DOI: 10.1002/hec.1330] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Schreyögg J, Tiemann O, Stargardt T, Busse R. Cross-country comparisons of costs: the use of episode-specific transitive purchasing power parities with standardised cost categories. HEALTH ECONOMICS 2008; 17:S95-103. [PMID: 18186031 DOI: 10.1002/hec.1327] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
International comparisons of healthcare costs are growing in importance for a number of different applications. The use of common approaches to converting costs such as GDP purchasing power parities (PPPs) often does not reflect price differences in healthcare in an appropriate manner. This means that new approaches need to be explored. The objective of this paper is to demonstrate the feasibility of using episode-specific PPPs (ESPPPs) to facilitate cross-country comparisons of healthcare costs and to compare this approach with other common approaches to conversion. Costs for five care episodes from hospitals in eight European countries were obtained from the EU HealthBASKET project. ESPPPs were created by using Fisher-type PPPs in combination with the Eltetö-Köves-Szulc method at the episode level. Differences in ESPPPs among the five care episodes were discussed and compared with other common conversion approaches. We found that ESPPPs-reflected prices and resource use more accurately than conventional conversion approaches such as GDP PPPs and medical care PPPs. This was particularly evident for labour-intensive care episodes in which other conversion approaches revealed problems in the way that labour input had not been considered appropriately. The results demonstrate that ESPPPs are preferable to other common conversion approaches when international healthcare cost comparisons are performed.
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Affiliation(s)
- Jonas Schreyögg
- Department of Health Care Management, Berlin University of Technology, Berlin, Germany.
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