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Neri M, Mewes JC, de Almeida FA, Stoychev S, Minarovic N, Charos A, Shea KM, Steuten LMG. Impact of including productivity costs in economic analyses of vaccines for C. difficile infections and infant respiratory syncytial virus, in a UK setting. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:34. [PMID: 38689331 PMCID: PMC11059668 DOI: 10.1186/s12962-024-00533-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/21/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVES It has been estimated that vaccines can accrue a relatively large part of their value from patient and carer productivity. Yet, productivity value is not commonly or consistently considered in health economic evaluations of vaccines in several high-income countries. To contribute to a better understanding of the potential impact of including productivity value on the expected cost-effectiveness of vaccination, we illustrate the extent to which the incremental costs would change with and without productivity value incorporated. METHODS For two vaccines currently under development, one against Cloistridioides difficile (C. difficile) infection and one against respiratory syncytial disease (RSV), we estimated their incremental costs with and without productivity value included and compared the results. RESULTS In this analysis, reflecting a UK context, a C. difficile vaccination programme would prevent £12.3 in productivity costs for every person vaccinated. An RSV vaccination programme would prevent £49 in productivity costs for every vaccinated person. CONCLUSIONS Considering productivity costs in future cost-effectiveness analyses of vaccines for C. difficile and RSV will contribute to better-informed reimbursement decisions from a societal perspective.
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Tran PB, Kazibwe J, Nikolaidis GF, Linnosmaa I, Rijken M, van Olmen J. Costs of multimorbidity: a systematic review and meta-analyses. BMC Med 2022; 20:234. [PMID: 35850686 PMCID: PMC9295506 DOI: 10.1186/s12916-022-02427-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 06/06/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Multimorbidity is a rising global phenomenon, placing strains on countries' population health and finances. This systematic review provides insight into the costs of multimorbidity through addressing the following primary and secondary research questions: What evidence exists on the costs of multimorbidity? How do costs of specific disease combinations vary across countries? How do multimorbidity costs vary across disease combinations? What "cost ingredients" are most commonly included in these multimorbidity studies? METHODS We conducted a systematic review (PROSPERO: CRD42020204871) of studies published from January 2010 to January 2022, which reported on costs associated with combinations of at least two specified conditions. Systematic string-based searches were conducted in MEDLINE, The Cochrane Library, SCOPUS, Global Health, Web of Science, and Business Source Complete. We explored the association between costs of multimorbidity and country Gross Domestic Product (GDP) per capita using a linear mixed model with random intercept. Annual mean direct medical costs per capita were pooled in fixed-effects meta-analyses for each of the frequently reported dyads. Costs are reported in 2021 International Dollars (I$). RESULTS Fifty-nine studies were included in the review, the majority of which were from high-income countries, particularly the United States. (1) Reported annual costs of multimorbidity per person ranged from I$800 to I$150,000, depending on disease combination, country, cost ingredients, and other study characteristics. (2) Our results further demonstrated that increased country GDP per capita was associated with higher costs of multimorbidity. (3) Meta-analyses of 15 studies showed that on average, dyads which featured Hypertension were among the least expensive to manage, with the most expensive dyads being Respiratory and Mental Health condition (I$36,840), Diabetes and Heart/vascular condition (I$37,090), and Cancer and Mental Health condition in the first year after cancer diagnosis (I$85,820). (4) Most studies reported only direct medical costs, such as costs of hospitalization, outpatient care, emergency care, and drugs. CONCLUSIONS Multimorbidity imposes a large economic burden on both the health system and society, most notably for patients with cancer and mental health condition in the first year after cancer diagnosis. Whether the cost of a disease combination is more or less than the additive costs of the component diseases needs to be further explored. Multimorbidity costing studies typically consider only a limited number of disease combinations, and few have been conducted in low- and middle-income countries and Europe. Rigorous and standardized methods of data collection and costing for multimorbidity should be developed to provide more comprehensive and comparable evidence for the costs of multimorbidity.
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Affiliation(s)
- Phuong Bich Tran
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
| | - Joseph Kazibwe
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden.,Department of Global Health, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Ismo Linnosmaa
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Mieke Rijken
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland.,Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Josefien van Olmen
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Schick-Makaroff K, Karimi-Dehkordi M, Cuthbertson L, Dixon D, Cohen SR, Hilliard N, Sawatzky R. Using Patient- and Family-Reported Outcome and Experience Measures Across Transitions of Care for Frail Older Adults Living at Home: A Meta-Narrative Synthesis. THE GERONTOLOGIST 2021; 61:e23-e38. [PMID: 31942997 DOI: 10.1093/geront/gnz162] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Our aim was to create a "storyline" that provides empirical explanation of stakeholders' perspectives underlying the use of patient- and family-reported outcome and experience measures to inform continuity across transitions in care for frail older adults and their family caregivers living at home. RESEARCH DESIGN AND METHODS We conducted a meta-narrative synthesis to explore stakeholder perspectives pertaining to use of patient-reported outcome and experience measures (PROMs and PREMs) across micro (patients, family caregivers, and healthcare providers), meso (organizational managers/executives/programs), and macro (decision-/policy-makers) levels in healthcare. Systematic searches identified 9,942 citations of which 40 were included based on full-text screening. RESULTS PROMs and PREMS (54 PROMs; 4 PREMs; 1 with PROM and PREM elements; 6 unspecified PROMs) were rarely used to inform continuity across transitions of care and were typically used independently, rarely together (n = 3). Two overarching traditions motivated stakeholders' use. The first significant motivation by diverse stakeholders to use PROMs and PREMs was the desire to restore/support independence and care at home, predominantly at a micro-level. The second motivation to using PROMs and PREMs was to evaluate health services, including cost-effectiveness of programs and hospital discharge (planning); this focus was rarely at a macro-level and more often split between micro- and meso-levels of healthcare. DISCUSSION AND IMPLICATIONS The motivations underlying stakeholders' use of these tools were distinct, yet synergistic between the goals of person/family-centered care and healthcare system-level goals aimed at efficient use of health services. There is a missed opportunity here for PROMs and PREMs to be used together to inform continuity across transitions of care.
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Affiliation(s)
| | - Mehri Karimi-Dehkordi
- Department of Medicine and Community Health Sciences, University of Calgary, Vancouver
| | - Lena Cuthbertson
- Office of Patient-Centered Measurement, British Columbia, Ministry of Health, Vancouver
| | - Duncan Dixon
- Norma Marion Alloway Library, Trinity Western University, Langley
| | - S Robin Cohen
- Department of Oncology and Medicine, McGill University, Montréal.,Lady Davis Institute, Palliative Care Research, Montréal
| | | | - Richard Sawatzky
- School of Nursing, Trinity Western University, Langley.,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, Canada.,Sahlgrenska Academy, University of Gothenburg, Sweden
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Nwadiugwu MC. Multi-Morbidity in the Older Person: An Examination of Polypharmacy and Socioeconomic Status. Front Public Health 2021; 8:582234. [PMID: 33537273 PMCID: PMC7848189 DOI: 10.3389/fpubh.2020.582234] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 11/18/2020] [Indexed: 12/30/2022] Open
Abstract
There has been increased focus on clinically managing multi-morbidity in the older population, but it can be challenging to find appropriate paradigm that addresses the socio-economic burden and risk for polypharmacy. The Commission on Social Determinants of Health (CSDH) has examined the need for institutional change and the parallel need to address the social causes of poor health. This study explored three potential interventions namely, meaningful information from electronic health records (EHR), social prescribing, and redistributive welfare policies from a person-centered perspective using the CARE (connecting, assessing, responding, and empowering) approach. Economic instruments that immediately redistribute state welfare and reduce income disparity such as direct taxation and conditional cash transfers could be adopted to enable older people with long-term conditions have access to healthcare services. Decreased socioeconomic inequality and unorthodox prescriptive interventions that reduce polypharmacy could mitigate barriers to effectively manage the complexities of multi-morbidity.
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Affiliation(s)
- Martin C Nwadiugwu
- Faculty of Health and Sports University of Stirling, Stirling, United Kingdom.,Department of Biomedical Informatics, University of Nebraska, Omaha, NE, United States
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Swoboda NL, Dahlke S, Hunter KF. Nurses' perceptions of their role in functional focused care in hospitalised older people: An integrated review. Int J Older People Nurs 2020; 15:e12337. [PMID: 32790240 DOI: 10.1111/opn.12337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 07/01/2020] [Accepted: 07/20/2020] [Indexed: 12/01/2022]
Abstract
AIM The aim of this integrative review was to identify nurses' perspectives of their role in influencing the functional status of hospitalised older people. METHODS An integrative review using Whittemore and Knafls' method was conducted using EBSCOhost CINAHL, Ovid MEDLINE(R), EBSCOhost, Social Gerontology, Cochrane Database of Systematic Reviews and ProQuest Dissertations & Theses data bases. Only studies with nurses' perspectives, or beliefs about their role in function-focused care were included. Content analysis was used to develop the themes nurses' role in function-focused care and barriers to functional care. RESULTS The review found 12 relevant articles. Nurses believed that they were responsible for function-focused care, yet functional care tasks were often missed. Organisational contexts created many barriers to providing function-focused care for patients. Nurses felt powerless to address these overarching problems in their organisations. CONCLUSION Nurses understand the importance of functional care yet often fail to carry out functional care interventions. Lack of organisational support creates a workplace that is short on staff, time and equipment and does not prioritise functional care needs. Nurse leaders and healthcare organisations need to reprioritise function-focused care for the good of patients, families and healthcare budgets.
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Affiliation(s)
| | - Sherry Dahlke
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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Penders YW, Rietjens J, Albers G, Croezen S, Van den Block L. Differences in out-of-pocket costs of healthcare in the last year of life of older people in 13 European countries. Palliat Med 2017; 31:42-52. [PMID: 27129681 DOI: 10.1177/0269216316647206] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Research on the costs of healthcare provision has so far focused on insurer costs rather than out-of-pocket costs. Out-of-pocket costs may be important to patients making medical decisions. AIM To investigate the self-reported out-of-pocket costs associated with healthcare in the last year of life of older adults in Europe. DESIGN A post-death survey, part of the Survey of Health, Ageing, and Retirement in Europe, completed by proxy respondents in four waves from 2005 to 2012. SETTING/PARTICIPANTS Proxy respondents for 2501 deceased adults of 55 years or over. Data from 13 European countries and four waves from 2005 to 2012 were used. RESULTS The proportion of people with out-of-pocket costs ranged from 21% to 96% in different European Union countries. Out-of-pocket costs ranged from 2% to 25% of median household income. Secondary and institutional care was most often the largest contributor to out-of-pocket costs, with care received in a care home being the most expensive type of care in 11 of 13 countries. Multilevel analyses showed that limitations in more than two activities of daily living (coefficient = 6.47, 95% confidence interval = 1.81-11.14) and a total hospitalization time of 3-6 months (coefficient = 14.66; 95% confidence interval = 0.97-28.35) or more than 6 months (coefficient = 31.01; 95% confidence interval = 11.98-50.15) were associated with higher out-of-pocket costs. In total, 24% of the variance on a country level remained unexplained. CONCLUSION Variation in out-of-pocket costs for healthcare in the last year of life between European countries indicates that countries face different challenges in making healthcare in the last year of life affordable for all.
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Affiliation(s)
- Yolanda Wh Penders
- 1 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Judith Rietjens
- 1 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.,2 Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Gwenda Albers
- 1 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Simone Croezen
- 2 Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.,3 The Netherlands Institute for Social Research (SCP), The Hague, The Netherlands
| | - Lieve Van den Block
- 1 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
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Fox MT, Butler JI. Nurses' perspectives on how operational leaders influence function-focused care for hospitalised older people. J Nurs Manag 2016; 24:1119-1129. [PMID: 27633608 DOI: 10.1111/jonm.12421] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2016] [Indexed: 01/03/2023]
Abstract
AIMS To explore nurses' perspectives on how leaders influence function-focused care, defined as care that preserves and restores older people's functional abilities. BACKGROUND Hospitalised older people are at risk of functional decline. Although leaders have the potential to influence function-focused care, few studies have explored nurses' perspectives on how leaders influence function-focused care. METHODS Thirteen focus groups were held with 57 acute care nurses. Semi-structured questions prompted discussion on nurses' perspectives, needs and strategies to meet their needs. Data were thematically analysed. RESULTS Three themes were identified: (1) the emphasis in hospitals is on moving older people quickly through the system, not supporting their functioning; (2) leaders are generally seen as too disconnected from practice to design system efficiency initiatives that support older people's functioning and nurses' provisioning of function-focused care; and (3) leadership strategies to better support nurses in providing function-focused care to older people in the context of system efficiency. CONCLUSIONS Leaders should connect with practice to devise age-sensitive efficiency initiatives that support function-focused care. Nurses need support from leaders in four areas to provide function-focused care to older people in the current hospital context. IMPLICATIONS The findings provide direction on how leaders can facilitate function-focused care in the current health-care environment emphasising system efficiency.
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Affiliation(s)
- Mary T Fox
- School of Nursing, York University, Toronto, Ontario, Canada.
| | - Jeffrey I Butler
- York University Centre for Aging Research and Education, Toronto, Ontario, Canada
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Picco L, Achilla E, Abdin E, Chong SA, Vaingankar JA, McCrone P, Chua HC, Heng D, Magadi H, Ng LL, Prince M, Subramaniam M. Economic burden of multimorbidity among older adults: impact on healthcare and societal costs. BMC Health Serv Res 2016; 16:173. [PMID: 27160080 PMCID: PMC4862090 DOI: 10.1186/s12913-016-1421-7] [Citation(s) in RCA: 139] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 04/30/2016] [Indexed: 12/21/2022] Open
Abstract
Background Multimorbidity is not uncommon and the associated impact it places on healthcare utilisation and societal costs is of increased concern. The aim of the current study was to estimate the economic burden of multimorbidity among older adults in Singapore by investigating its association with the healthcare and societal resource use and cost. Methods The Well-being of the Singapore Elderly (WiSE) study was a single phase, cross sectional survey among a nationally representative sample of Singapore residents (N = 2565) aged 60 years and above. Multimorbidity was defined in this study as having two or more chronic conditions, from a list of 10 conditions. Care was classified into healthcare which included direct medical care, intermediate and long-term care, indirect care, and social care, provided by paid caregivers and family members or friends. Costs were calculated from the societal perspective, including healthcare and social care costs, by multiplying each service unit with the relevant unit cost. Generalized linear models were used to investigate the relationship between total annual costs and various socio-demographic factors. Results The prevalence of multimorbidity was 51.5 %. Multimorbid respondents utilised more healthcare and social care resources than those with one or no chronic conditions. The total societal cost of multimorbidity equated to SGD$15,148 per person, annually, while for those with one or no chronic conditions the total annual societal costs per person were SGD$5,610 and SGD$2,806, respectively. Each additional chronic condition was associated with increased healthcare (SGD$2,265) and social care costs (SGD$3,177). Older age (i.e. 75–84 years old, and especially over 85 years), Indian ethnicity and being retired were significantly associated with higher total costs from the societal perspective, while older age (75 years and above) and ‘Other’ ethnicity were significantly associated with higher total healthcare costs. Conclusion Multimorbidity was associated with substantially higher healthcare utilisation and social care costs among older adults in Singapore. With the prevalence of multimorbidity increasing, especially as the population ages, we need healthcare systems that are evolving to address the emerging challenges associated with multimorbidity and the respective healthcare and societal costs.
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Affiliation(s)
- Louisa Picco
- Research Division, Institute of Mental Health, Singapore, Singapore.
| | | | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Paul McCrone
- King's Health Economics, King's College London, London, UK
| | | | | | - Harish Magadi
- Department of Geriatric Psychiatry, Institute of Mental Health, Singapore, Singapore
| | - Li Ling Ng
- Changi General Hospital, Singapore, Singapore
| | - Martin Prince
- Institute of Psychiatry, King's College London, London, UK
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