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Chitando M, Cleary S, Cunnama L. Systematic review of economic evaluations for paediatric pulmonary diseases. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2023; 21:27. [PMID: 37121992 PMCID: PMC10149023 DOI: 10.1186/s12962-023-00423-1] [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: 05/13/2022] [Accepted: 01/24/2023] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND Paediatric pulmonary diseases are the leading causes of mortality amongst children under five globally. Economic evaluations (EEs) seek to guide decision-makers on which health care interventions to adopt to reduce the paediatric pulmonary disease burden. This study aims to systematically review economic evaluations on different aspects of the inpatient management of paediatric pulmonary diseases globally. METHODS We systematically reviewed EEs published between 2010 and 2020, with a subsequent search conducted for 2020-2022. We searched PubMed, Web of Science, MEDLINE, Paediatric Economic Database Evaluation (PEDE) and the Cochrane library. We extracted data items guided by the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. We collected qualitative and quantitative data which we analysed in Microsoft Excel and R software. RESULTS Twenty-two articles met the inclusion criteria. Six of the articles were cost-effectiveness analyses, six cost-utility analyses, two cost-minimisation analyses and eight cost analyses. Twelve articles were from high-income countries (HICs) and ten were from low- and middle-income countries (LMICs). Eight articles focused on asthma, eleven on pneumonia, two on asthma and pneumonia, and one on tuberculosis. CONCLUSION Conducting more EEs for paediatric pulmonary diseases in LMICs could allow for more evidence-based decision-making to improve paediatric health outcomes.
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Affiliation(s)
- Mutsawashe Chitando
- Health Economics Unit and Division, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa.
| | - Susan Cleary
- Health Economics Unit and Division, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa
| | - Lucy Cunnama
- Health Economics Unit and Division, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa
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Do Chest Compresses with Mustard or Ginger Affect Warmth Regulation in Healthy Adults? A Randomized Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:5034572. [PMID: 35899230 PMCID: PMC9313983 DOI: 10.1155/2022/5034572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 05/25/2022] [Accepted: 05/27/2022] [Indexed: 11/17/2022]
Abstract
Background Chest compresses with mustard (MU) or ginger (GI) are a complementary treatment option for respiratory tract infections. However, little is known about their specific thermogenic qualities. This study examines the short-term effects of MU, GI, and chest compresses with warm water only (WA) on measurable and self-perceived body warmth in healthy adults. Methods This was a single-center, randomized controlled trial with cross-over design (WA versus MU versus GI). 18 participants (23.7 ± 3.4 years; 66.7% female) received MU, GI, and WA in a random order on three different days with a mean washout period of 13.9 days. Chest compresses were applied to the thoracic back for a maximum of 20 minutes. The primary outcome measure was skin temperature of the posterior trunk (measured by infrared thermography) immediately following removal of the compresses (t1). Secondary outcome measures included skin temperature of the posterior trunk 10 minutes later (t2) and several parameters of self-perceived warmth at t1 and t2 (assessed with the Herdecke Warmth Perception Questionnaire). Results Skin temperature of the posterior trunk was significantly higher with MU compared to WA and GI at t1 (p < 0.001 for both, primary outcome measure) and t2 (WA versus MU: p=0.04, MU versus GI: p < 0.01). Self-perceived warmth of the posterior trunk was higher with MU and GI compared to WA at t1 (1.40 ≥ d ≥ 1.79) and remained higher with GI at t2 (WA versus GI: d = 0.74). The overall warmth perception increased significantly with GI (d = 0.69), tended to increase with MU (d = 0.54), and did not change with WA (d = 0.36) between t0 and t1. Conclusions Different effects on warmth regulation were observed when ginger and mustard were applied as chest compresses. Both substances induced self-perceived warming of the posterior trunk, but measurable skin temperature increased only with MU. Further research is needed to examine the duration of these thermogenic effects and how chest compresses with ginger or mustard might be incorporated into practice to influence clinical outcomes in respiratory tract infections.
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Fetz K, Längler A, Schwermer M, Carvalho-Hilje C, Vagedes J, Zuzak TJ, Ostermann T. Comparative analysis of resource utilization in integrative anthroposophic and all German pediatric inpatient departments. BMC Health Serv Res 2020; 20:939. [PMID: 33046108 PMCID: PMC7552368 DOI: 10.1186/s12913-020-05782-6] [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: 04/22/2020] [Accepted: 09/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Integrative Medicine (IM) combines conventional and complementary therapies. It aims to address biological, psychological, social, spiritual and environmental aspects of patients' health. During the past 20 years, the use and request of IM in children and adults has grown. Anthroposophic Medicine (AM) is an IM approach frequently used in children in Germany. From both public health and health economic perspectives, it is relevant to investigate whether there are differences in the resource utilization between integrative pediatric departments (IPD) and the entirety of all pediatric departments. METHODS Standard ward documentation data from all German integrative anthroposophic pediatric departments (2005-2016; N = 29,956) is investigated and systematically compared to data of the entirety of all pediatric departments in Germany derived from the Institute for the Hospital Reimbursement System (2005-2016, N = 8,645,173). The analyses focus on: length of stay, Diagnosis Related Groups (DRG), Major Diagnosis Categories (MDC), and effective Case Mix Index (CMI). RESULTS The length of stay in the IPD (M = 5.38 ± 7.31) was significantly shorter than the DRG defined length of stay (M = 5.8 ± 4.71; p < .001; d = - 0.07) and did not exceed or undercut the DRG covered length of stay. Compared to the entirety of all pediatric departments (M = 4.74 ± 6.23) the length of stay was significantly longer in the in the IPD (p <. 001; d = 0.12). The effective CMI in IPD and all pediatric departments were identical (M = 0.76). The frequencies of DRG and MDC differed between IPD and all pediatric departments, with higher frequencies of DRGs and MDCs associated with chronic and severe illnesses in the IPD. CONCLUSIONS Treatment within integrative anthroposophic pediatric departments fits well in terms of the DRG defined conditions concerning length of stay, even though integrative pediatric patients has an increased length of stay of averagely 1 day, which is most likely associated to time consuming, complex integrative treatment approaches and to a certain extend to higher amount of chronic and severe diseases.
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Affiliation(s)
- Katharina Fetz
- Department of Psychology, Chair of Research Methodology and Statistics in Psychology, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany.
| | - Alfred Längler
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Gerhard-Kienle-Weg 4, 58313, Herdecke, Germany.,Professorship for Integrative Pediatrics, Institute for Integrative Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Melanie Schwermer
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Gerhard-Kienle-Weg 4, 58313, Herdecke, Germany
| | - Clara Carvalho-Hilje
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Gerhard-Kienle-Weg 4, 58313, Herdecke, Germany.,Professorship for Integrative Pediatrics, Institute for Integrative Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Jan Vagedes
- ARCIM Academic Research in Complementary and Integrative Medicine, Filderstadt, Germany.,Department of Neonatology, University Hospital Tuebingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - Tycho Jan Zuzak
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Gerhard-Kienle-Weg 4, 58313, Herdecke, Germany.,Department of Pediatric Oncology and Hematology, University Hospital Essen, Hufelandstr.55, 45147, Essen, Germany
| | - Thomas Ostermann
- Department of Psychology, Chair of Research Methodology and Statistics in Psychology, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
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Vagedes J, Martin D, Müller V, Helmert E, Huber BM, Andrasik F, von Schoen-Angerer T. Restrictive antibiotic use in children hospitalized for pneumonia: A retrospective inpatient study. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2020.101068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Fetz K, Ostermann T, Schwermer M, Appelbaum S, Vagedes J, Zuzak TJ, Längler A. Do patients of integrative anthroposophic pediatric inpatient departments differ? Comparative analysis to all pediatric inpatients in Germany considering demographic and clinical characteristics. BMC Public Health 2019; 19:1623. [PMID: 31795983 PMCID: PMC6889203 DOI: 10.1186/s12889-019-7972-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 11/19/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Integrative medicine (IM) is a patient-centered, evidence-based, therapeutic paradigm which combines conventional and complementary approaches. The use of IM in pediatrics has increased in the past two decades and parents' demand for it is growing. An IM whole systems approach is anthroposophic medicine. Considering the growing demand for integrative approaches in children, it is relevant from a public health perspective to find out which kind of children use IM in Germany and whether they differ from the entirety of pediatric inpatients in Germany. Moreover, it would be interesting to known, whether these patients are willing to travel a longer distance to gain integrative treatment. METHODS The present study investigates the standard ward documentation datasets of 29,956 patients of all German integrative anthroposophic pediatric inpatient wards from 2005 to 2016 and compares them systematically to collect data of the entirety of all pediatric inpatient wards in Germany. Apart from patients' age and gender, and the ICD-10 admission diagnoses, the geographical catchment area of the hospitals were analyzed. RESULTS Sociodemographic characteristics of pediatric inpatients in the integrative anthroposophic departments (IAH) did not differ from the entirety of all pediatric inpatients. Regarding clinical characteristics, higher frequencies were found for endocrine, nutritional and metabolic diseases (IAH: 7.24% vs. 2.98%); mental, behavioral, and neurodevelopmental disorders (IAH: 9.83% vs. 3.78%) and nervous diseases (IAH: 8.82% vs. 5.16%) and lower frequencies for general pediatric diseases such as respiratory diseases (IAH: 17.06% vs. 19.83%), digestive diseases (IAH: 3.90% vs. 6.25%), and infectious and parasitic diseases (IAH: 12.88% vs. 14.82%) in comparison to the entirety of all pediatric inpatients in Germany. The IAH showed a broad catchment area, with most patients being from former, Western federal republic of Germany. Large catchment areas (> 100 km) for the IAH are merely covered by severe and chronic diseases. CONCLUSION Pediatric inpatients of IAH do not differ from the entirety of pediatric inpatients in Germany regarding sociodemographic characteristics but show differences regarding clinical characteristics. Parents are willing to travel further distance to get specialized integrative anthroposophic medical care for children with severe and chronic diseases.
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Affiliation(s)
- Katharina Fetz
- Department of Psychology and Psychotherapy, Chair of Research Methodology and Statistics in Psychology, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
| | - Thomas Ostermann
- Department of Psychology and Psychotherapy, Chair of Research Methodology and Statistics in Psychology, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
| | - Melanie Schwermer
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Gerhard-Kienle-Weg 4, 58313 Herdecke, Germany
| | - Sebastian Appelbaum
- Department of Psychology and Psychotherapy, Chair of Research Methodology and Statistics in Psychology, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
| | - Jan Vagedes
- ARCIM Institute Academic Research in Complementary and Integrative Medicine, Filderstadt, Germany
- Department of Neonatology, University Hospital Tuebingen, Calwerstraße 7, 72076 Tübingen, Germany
| | - Tycho Jan Zuzak
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Gerhard-Kienle-Weg 4, 58313 Herdecke, Germany
- Department of Pediatric Oncology and Hematology, University Hospital Essen, Hufelandstr.55, 45147 Essen, Germany
| | - Alfred Längler
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Gerhard-Kienle-Weg 4, 58313 Herdecke, Germany
- Professorship for Integrative Pediatrics, Institute for Integrative Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
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