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Venter M, Grotle M, Øiestad BE, Aanesen F, Tingulstad A, Rysstad T, Ferraro MC, McAuley JH, Cashin AG. Treatment Effect Modifiers for Return-to-Work in Patients With Musculoskeletal Disorders. THE JOURNAL OF PAIN 2024; 25:104556. [PMID: 38710259 DOI: 10.1016/j.jpain.2024.104556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/14/2024] [Accepted: 04/28/2024] [Indexed: 05/08/2024]
Abstract
Investigating how individual characteristics modify treatment effects can improve understanding, interpretation, and translation of trial findings. The purpose of this secondary analysis was to identify treatment effect modifiers of the MI-NAV trial, a 3 arm, parallel randomized controlled trial which compared motivational interviewing and stratified vocational advice intervention in addition to usual case management (UC), to UC alone. This study included (n = 514) participants with musculoskeletal disorders on sick leave for at least 50% of their contracted work hours for at least 7 consecutive weeks with the Norwegian Labour and Welfare Administration. Sickness absence days was the primary outcome, measured from baseline assessment date until the 6-month follow-up. Potential treatment effect modifiers, identified a priori and informed by expert consultation and literature, were evaluated using linear regression models and statistical interaction tests. For motivational interviewing versus UC, age (mean difference [MD] -.7, 95% confidence interval [CI] -1.5 to .2; P = .13) and self-perceived health status (MD -.3, 95% CI -.7 to .1; P = .19) were identified as potential effect modifiers (P ≤ .2). For stratified vocational advice intervention versus UC, analgesic medication use (MD -26.2, 95% CI -45.7 to -6.7; P = .009) was identified as a treatment effect modifier (P ≤ .05). These findings may assist in more targeted treatment adaptation and translation as well as the planning of future clinical trials. PERSPECTIVE: This secondary analysis of the MI-NAV trial found that analgesic medication use, age, and self-perceived health may modify the effect of 2 vocational interventions on reducing sickness absence in people with musculoskeletal disorders.
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Affiliation(s)
- Martjie Venter
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia.
| | - Margreth Grotle
- Centre for Intelligent Musculoskeletal Health, Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway; Research and Communication Unit for MSK Health (FORMI), Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Britt Elin Øiestad
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Fiona Aanesen
- National Institute of Occupational Health, Oslo, Norway
| | - Alexander Tingulstad
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Tarjei Rysstad
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Michael C Ferraro
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia; School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia; School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Aidan G Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia; School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
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Kinge JM, de Linde A, Dieleman JL, Vollset SE, Knudsen AK, Aas E. Production losses from morbidity and mortality by disease, age and sex in Norway. Scand J Public Health 2024; 52:779-783. [PMID: 37501582 PMCID: PMC11308283 DOI: 10.1177/14034948231188237] [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] [Received: 04/02/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/29/2023]
Abstract
AIM The inclusion of production losses in health care priority setting is extensively debated. However, few studies allow for a comparison of these losses across relevant clinical and demographic categories. Our objective was to provide comprehensive estimates of Norwegian production losses from morbidity and mortality by age, sex and disease category. METHODS National registries, tax records, labour force surveys, household and population statistics and data from the Global Burden of Disease were combined to estimate production losses for 12 disease categories, 38 age and sex groups and four causes of production loss. The production losses were estimated via lost wages in accordance with a human capital approach for 2019. RESULTS The main causes of production losses in 2019 were mental and substance use disorders, totalling NOK121.6bn (32.7% of total production losses). This was followed by musculoskeletal disorders, neurological disorders, injuries, and neoplasms, which accounted for 25.2%, 7.4%, 7.4% and 6.5% of total production losses, respectively. Production losses due to sick leave, disability insurance and work assessment allowance were higher for females than for males, whereas production losses due to premature mortality were higher for males. The latter was related to neoplasms, cardiovascular disease and injuries. Across age categories, non-fatal conditions with a high prevalence among working populations caused the largest production losses. CONCLUSIONS The inclusion of production losses in health care priority debates in Norway could result in an emphasis on chronic diseases that occur among younger populations at the expense of fatal diseases among older age groups.
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Affiliation(s)
- Jonas Minet Kinge
- Department of Health Management and Health Economics, University of Oslo, Norway
- Centre for Disease Burden, Norwegian Institute of Public Health, Norway
| | - Astrid de Linde
- Department of Health Management and Health Economics, University of Oslo, Norway
| | | | | | | | - Eline Aas
- Department of Health Management and Health Economics, University of Oslo, Norway
- Division of Health Services, Norwegian Institute of Public Health, Norway
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Tyrdal MK, Perrier F, Røe C, Natvig B, Wahl AK, Veierød MB, Robinson HS. Musculoskeletal disorders in Norway: trends in health care utilization and patient pathways: a nationwide register study. Scand J Prim Health Care 2024:1-11. [PMID: 39034654 DOI: 10.1080/02813432.2024.2368848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 06/11/2024] [Indexed: 07/23/2024] Open
Abstract
OBJECTIVE Describe trends in health care utilization, demographic characteristics and patient pathways among patients with musculoskeletal disorders (MSD) in Norway. DESIGN Register-based cohort study. SETTINGS Data were obtained from two Norwegian National registries; the Norwegian Control and Payment of Health Reimbursements Database (KUHR) and the Norwegian Patient Registry (NPR). SUBJECTS Patients with MSD according to ICPC-2 and ICD-10 during 2014-2017. MAIN OUTCOME MEASURES Patient pathways from the first contact and the following two years, described in a Sankey Diagram for all MSD patients and three common diagnoses: spine pain, osteoarthritis (OA) and fibromyalgia (FM). RESULT About 26% of the Norwegian population consulted PHC annually while 7% were treated in SHC. Mean age was 47 and 53 years in PHC and SHC, respectively. The proportion of women increased by age. Spine pain was the most common diagnosis; 33% and 22% in PHC and SHC, respectively. Over 90% visited a GP first, 50% of them were treated by PT and/or in SHC during follow-up. Patients visiting the PT first were less likely to be treated in SHC. OA patients were most likely to be treated by more than one health care professional (>70%). CONCLUSION One third of the Norwegian population consulted health care services due to MSD annually between 2014-2017. GP was the most consulted health care professional. Among MSD patients with long-term use of health care services, 50% were treated by a PT and/or in SHC in addition to a GP.
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Affiliation(s)
- Mari Kristine Tyrdal
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Flavie Perrier
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Bård Natvig
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Astrid Klopstad Wahl
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Marit B Veierød
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Hilde Stendal Robinson
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway
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Marcuzzi A, Mork PJ, Aasdahl L, Skarpsno E, Moe K, Nilsen TIL. Incidence of sick leave and disability pension in adults with musculoskeletal pain and co-occurring long-term conditions: data from the Norwegian HUNT study and national registries. BMC Musculoskelet Disord 2024; 25:273. [PMID: 38589843 PMCID: PMC11003184 DOI: 10.1186/s12891-024-07405-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 04/01/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Musculoskeletal pain is one of the leading causes of work productivity loss. Long-term conditions (LTCs) commonly occur alongside musculoskeletal pain. However, the incidence of sick leave and disability pension according to LTC status in people with musculoskeletal pain has not been previously described. METHODS Working-age participants (20-65 years) with persistent musculoskeletal pain who participated in the HUNT3 Study (1995-97) were included. Twenty-five LTCs were classified into 8 LTC groups according to the International Classification of Diseases version 11. Data on sickness and disability benefits were obtained from the National Insurance Database and linked to the HUNT3 data using participants' personal identification number. Age-adjusted incidence rates (IRs) (per 10,000 person-years) and hazard ratios (HRs) of sick leave during 5-year follow-up and disability pension during ~ 25-year follow-up were estimated with 95% confidence intervals (CIs) and presented according to LTC status. RESULTS Overall, 11,080 participants with musculoskeletal pain were included. Of those, 32% reported one LTC and 45% reported ≥ 2 LTCs. During the follow up period, 1,312 participants (12%) received disability pension due to musculoskeletal conditions. The IR of sick leave and disability pension due to musculoskeletal conditions increased with number of LTCs. Specifically, the IR of sick leave was 720 (95% CI 672 to 768) in participants without any LTCs and 968 (95% CI 927 to 1,009) if they had ≥ 2 LTCs. The IRs of disability pension were 87 (95% CI 75 to 98) and 167 (95% CI 154 to 179) among those with no LTCs and ≥ 2 LTCs, respectively. The incidence of sick leave and disability pension due to musculoskeletal conditions was largely similar across LTCs, although the incidence of disability pension was somewhat higher among people with sleep disorders (IR: 223, 95% CI 194 to 252). CONCLUSIONS Among people with persistent musculoskeletal pain, the incidence of prematurely leaving the work force due to musculoskeletal conditions was twice as high for those with multiple LTCs compared to those without any LTCs. This was largely irrespective of the type of LTC, indicating that the number of LTCs are an important feature when evaluating work participation among people with musculoskeletal pain.
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Affiliation(s)
- Anna Marcuzzi
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
- Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim, Norway.
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Paul Jarle Mork
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Lene Aasdahl
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Unicare Helsefort Rehabilitation Center, Rissa, Norway
| | - Eivind Skarpsno
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Karoline Moe
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Tom Ivar Lund Nilsen
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Tingulstad A, Maas ET, Rysstad T, Øiestad BE, Aanesen F, Pripp AH, Van Tulder MW, Grotle M. Six-month cost-effectiveness of adding motivational interviewing or a stratified vocational advice intervention to usual case management for workers with musculoskeletal disorders: the MI-NAV economic evaluation. J Occup Med Toxicol 2023; 18:25. [PMID: 37964240 PMCID: PMC10644648 DOI: 10.1186/s12995-023-00394-2] [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: 09/13/2023] [Accepted: 11/08/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVES This study evaluates the six-month cost-effectiveness and cost-benefits of motivational interviewing (MI) or a stratified vocational advice intervention (SVAI) added to usual case management (UC) for workers on sick leave due to musculoskeletal disorders. METHODS This study was conducted alongside a three-arm RCT including 514 employed workers on sick leave for at least 50% for ≥ 7 weeks. All participants received UC. The UC + MI group received two MI sessions, and the UC + SVAI group received 1-4 SVAI sessions. Sickness absence days, quality-adjusted life-years (QALYs), and societal costs were measured between baseline and six months. RESULTS Adding MI to UC, resulted in incremental cost-reduction of -2580EUR (95%CI -5687;612), and a reduction in QALYs of -0.001 (95%CI -0.02;0.01). Secondly, adding MI to UC resulted in an incremental cost-reduction of -538EUR (95%CI -1358;352), and reduction of 5.08 (95%CI -3.3;13.5) sickness-absence days. Financial return estimates were positive, but not statistically significant. Adding SVAI to UC, resulted in an incremental cost-reduction of -2899 EUR (95% CI -5840;18), and a reduction in QALYs of 0.002 (95% CI -0.02;0.01). Secondly, adding SVAI to UC resulted in an statistically significant incremental cost-reduction of -695 EUR (95% CI -1459;-3), and a reduction of 7.9 (95% CI -0.04;15.9) sickness absence days. Financial return estimates were positive and statistically significant. The probabilities of cost-effectiveness for QALYs were high for adding MI or SVAI (ceiling ratio 0.90). CONCLUSIONS In comparison to UC only, adding MI to UC tends to be cost-effective. Adding SVAI to UC is cost-effective for workers on sick leave due to musculoskeletal disorders. TRIAL REGISTRATION ClinicalTrials.gov (identifier: NCT03871712).
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Affiliation(s)
- Alexander Tingulstad
- Department of Rehabilitation and Health Technology, Centre for Intelligent Musculoskeletal Health, Oslo Metropolitan University, St.Olavs Plass, P.O. Box 4, Oslo, 0130, Norway.
| | - Esther T Maas
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and the Amsterdam Movement Sciences Research Institute, de Boelelaan 1085, Amsterdam, 1081 HV, The Netherlands
| | - Tarjei Rysstad
- Department of Rehabilitation and Health Technology, Centre for Intelligent Musculoskeletal Health, Oslo Metropolitan University, St.Olavs Plass, P.O. Box 4, Oslo, 0130, Norway
| | - Britt Elin Øiestad
- Department of Rehabilitation and Health Technology, Centre for Intelligent Musculoskeletal Health, Oslo Metropolitan University, St.Olavs Plass, P.O. Box 4, Oslo, 0130, Norway
| | - Fiona Aanesen
- National Institute of Occupational Health, Majorstuen, P.O. Box 5330, Oslo, 0304, Norway
| | - Are Hugo Pripp
- Department of Rehabilitation and Health Technology, Centre for Intelligent Musculoskeletal Health, Oslo Metropolitan University, St.Olavs Plass, P.O. Box 4, Oslo, 0130, Norway
| | - Maurits W Van Tulder
- Faculty Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Van Der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands
| | - Margreth Grotle
- Department of Rehabilitation and Health Technology, Centre for Intelligent Musculoskeletal Health, Oslo Metropolitan University, St.Olavs Plass, P.O. Box 4, Oslo, 0130, Norway
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Ullevål, Building 37B, P.O. Box 4956, Oslo, Nydalen, 0424, Norway
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Ki Y, McAleavey AA, Moger TA, Moltu C. Cost structure in specialist mental healthcare: what are the main drivers of the most expensive episodes? Int J Ment Health Syst 2023; 17:37. [PMID: 37946305 PMCID: PMC10633930 DOI: 10.1186/s13033-023-00606-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 10/06/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Mental disorders are one of the costliest conditions to treat in Norway, and research into the costs of specialist mental healthcare are needed. The purpose of this article is to present a cost structure and to investigate the variables that have the greatest impact on high-cost episodes. METHODS Patient-level cost data and clinic information during 2018-2021 were analyzed (N = 180,220). Cost structure was examined using two accounting approaches. A generalized linear model was used to explain major cost drivers of the 1%, 5%, and 10% most expensive episodes, adjusting for patients' demographic characteristics [gender, age], clinical factors [length of stay (LOS), admission type, care type, diagnosis], and administrative information [number of planned consultations, first hospital visits, interval between two hospital episode]. RESULTS One percent of episodes utilized 57% of total resources. Labor costs accounted for 87% of total costs. The more expensive an episode was, the greater the ratio of the inpatient (ward) cost was. Among the top-10%, 5%, and 1% most expensive groups, ward costs accounted for, respectively, 89%, 93%, and 99% of the total cost, whereas the overall average was 67%. Longer LOS, ambulatory services, surgical interventions, organic disorders, and schizophrenia were identified as the major cost drivers of the total cost, in general. In particular, LOS, ambulatory services, and schizophrenia were the factors that increased costs in expensive subgroups. The "first hospital visit" and "a very short hospital re-visit" were associated with a cost increase, whereas "the number of planned consultations" was associated with a cost decrease. CONCLUSIONS The specialist mental healthcare division has a unique cost structure. Given that resources are utilized intensively at the early stage of care, improving the initial flow of hospital care can contribute to efficient resource utilization. Our study found empirical evidence that planned outpatient consultations may be associated with a reduced health care burden in the long-term.
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Affiliation(s)
- Yeujin Ki
- Department of Research and Innovation, Helse Førde, Førde, Norway.
| | - Andrew Athan McAleavey
- Department of Research and Innovation, Helse Førde, Førde, Norway
- Department of Health and Caring Sciences, Western Norway University of Applied Science, Bergen, Norway
| | - Tron Anders Moger
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
- Section of Medical Statistics, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Christian Moltu
- Department of Psychiatry, Helse Førde, Førde, Norway
- Department of Health and Caring Sciences, Western Norway University of Applied Science, Bergen, Norway
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Bjøntegaard MM, Molin M, Kolby M, Torheim LE. Purchase of ultra-processed foods in Norway: a repeated cross-sectional analysis of food sales in 2013 and 2019. Public Health Nutr 2023; 26:1743-1753. [PMID: 37339927 PMCID: PMC10478042 DOI: 10.1017/s1368980023001192] [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] [Received: 08/23/2022] [Revised: 05/04/2023] [Accepted: 06/14/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVE A dietary pattern dominated by ultra-processed foods has been associated with non-communicable diseases in several studies. A previous study from 2013 found a high share of ultra-processed foods in Norwegian food sales. This study aimed to investigate the current share of ultra-processed foods in Norway and the development in expenditure on ultra-processed foods from 2013. DESIGN A repeated cross-sectional analysis of scanner data from the Consumer Price Index from September 2013 and 2019 and an investigation of the processing degree according to the NOVA classification system. SETTING Food sales in Norway. PARTICIPANTS Norwegian grocery stores (n 180, for both time periods). RESULTS The share of expenditure in 2019 was highest for ultra-processed foods (46·5 %) and minimally or unprocessed foods (36·3 %), followed by processed foods (8·5 %) and processed culinary ingredients (1·3 %). An increasing degree of processing was found for several of the food groups between 2013 and 2019; however, most effect sizes were weak. In 2019, soft drinks became the most frequently purchased food item, surpassing milk and cheese, with the highest expenditure in Norwegian grocery stores. Increases in expenditure on ultra-processed foods were mainly due to increased expenditures on soft drinks, sweets and potato products. CONCLUSIONS A high share of expenditure on ultra-processed food was found in Norway, which may imply a high consumption of these foods. The change in expenditure of NOVA groups between 2013 and 2019 was small. Carbonated and non-carbonated soft drinks were the most frequently purchased products in Norwegian grocery stores and contributed to most of the expenditures.
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Affiliation(s)
- Marie Michaelsen Bjøntegaard
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, P.O. Box 4 St. Olavs Plass, N-0130 Oslo, Norway
- Department of Nutrition, Faculty of Medicine, University of Oslo, Sognsvannsveien 9, 0372 Oslo, Norway
| | - Marianne Molin
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, P.O. Box 4 St. Olavs Plass, N-0130 Oslo, Norway
- Department of Health Sciences, Oslo New University College, NO-0456 Oslo, Norway
| | - Marit Kolby
- Department of Health Sciences, Oslo New University College, NO-0456 Oslo, Norway
| | - Liv Elin Torheim
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, P.O. Box 4 St. Olavs Plass, N-0130 Oslo, Norway
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Kinge JM, Dieleman JL, Karlstad Ø, Knudsen AK, Klitkou ST, Hay SI, Vos T, Murray CJL, Vollset SE. Disease-specific health spending by age, sex, and type of care in Norway: a national health registry study. BMC Med 2023; 21:201. [PMID: 37277874 PMCID: PMC10243068 DOI: 10.1186/s12916-023-02896-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/09/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Norway is a high-income nation with universal tax-financed health care and among the highest per person health spending in the world. This study estimates Norwegian health expenditures by health condition, age, and sex, and compares it with disability-adjusted life-years (DALYs). METHODS Government budgets, reimbursement databases, patient registries, and prescription databases were combined to estimate spending for 144 health conditions, 38 age and sex groups, and eight types of care (GPs; physiotherapists & chiropractors; specialized outpatient; day patient; inpatient; prescription drugs; home-based care; and nursing homes) totaling 174,157,766 encounters. Diagnoses were in accordance with the Global Burden of Disease study (GBD). The spending estimates were adjusted, by redistributing excess spending associated with each comorbidity. Disease-specific DALYs were gathered from GBD 2019. RESULTS The top five aggregate causes of Norwegian health spending in 2019 were mental and substance use disorders (20.7%), neurological disorders (15.4%), cardiovascular diseases (10.1%), diabetes, kidney, and urinary diseases (9.0%), and neoplasms (7.2%). Spending increased sharply with age. Among 144 health conditions, dementias had the highest health spending, with 10.2% of total spending, and 78% of this spending was incurred at nursing homes. The second largest was falls estimated at 4.6% of total spending. Spending in those aged 15-49 was dominated by mental and substance use disorders, with 46.0% of total spending. Accounting for longevity, spending per female was greater than spending per male, particularly for musculoskeletal disorders, dementias, and falls. Spending correlated well with DALYs (Correlation r = 0.77, 95% CI 0.67-0.87), and the correlation of spending with non-fatal disease burden (r = 0.83, 0.76-0.90) was more pronounced than with mortality (r = 0.58, 0.43-0.72). CONCLUSIONS Health spending was high for long-term disabilities in older age groups. Research and development into more effective interventions for the disabling high-cost diseases is urgently needed.
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Affiliation(s)
- Jonas Minet Kinge
- Norwegian Institute of Public Health, Postboks 222-Skøyen, 0213, Oslo, Norway.
- Department of Health Management and Health Economics, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Joseph L Dieleman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Øystein Karlstad
- Norwegian Institute of Public Health, Postboks 222-Skøyen, 0213, Oslo, Norway
| | - Ann Kristin Knudsen
- Norwegian Institute of Public Health, Postboks 222-Skøyen, 0213, Oslo, Norway
| | | | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Stein Emil Vollset
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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Christiansen SG, Kravdal Ø. Number of children and disability pension due to mental and musculoskeletal disorders: A longitudinal register-based study in Norway. POPULATION STUDIES 2023:1-12. [PMID: 37191160 DOI: 10.1080/00324728.2023.2195847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Earlier research has documented a relationship between parity and all-cause mortality, as well as parity and cause-specific mortality (e.g. cancer and cardiovascular disease mortality). Less is known about the relationship between parity and two very common (but less deadly) types of disorder: mental and musculoskeletal. We examine the association between parity and risk of disability pensioning from all causes and due to mental or musculoskeletal disorders, using Norwegian register data. In addition to controlling for adult socio-demographic characteristics, we control for unobserved confounding from family background by estimating sibling fixed-effects models. We find a higher risk of disability pensioning among the childless and those with one child than for parents with two children, both for all causes combined and for mental disorders. Childless men and fathers with one child also experience excess risk of being pensioned due to musculoskeletal disorders. For mental disorders, we find a positive association with high parity, particularly for men.
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Summers JA, Wilson N, Blakely T, Sigglekow F. Disease-Related Loss to Government Funding: Longitudinal Analysis of Individual-Level Health and Tax Data for an Entire Country. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:170-175. [PMID: 36127245 DOI: 10.1016/j.jval.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES The objective of this longitudinal analysis was to estimate funding loss in terms of tax revenue to the New Zealand (NZ) government from disease and injury among working age adults. METHODS Linked national health and tax data sets of the usually resident population between 2006 and 2016 were used to model 40 disease states simultaneously in a fixed-effects regression analysis to estimate population-level tax loss from disease and injury. To estimate tax revenue loss to the NZ government, we modeled a counterfactual scenario where all disease/injury was cause deleted. RESULTS The estimated tax paid by all 25- to 64-year-olds in the eligible NZ population was $15 773 million (m) per annum (US dollar 2021), or $16 446 m for a counterfactual as though no one had any disease disease-related income loss (a 4.3% or $672.9 m increase in tax revenue per annum). The disease that-if it had no impact on income-generated the greatest impact was mental illness, contributing 34.7% ($233.3 m) of all disease-related tax loss, followed by cardiovascular (14.7%, $99.0 m) and endocrine (10.2%, $68.8 m). Tax revenue gains after deleting all disease/injury increased up to 65 years of age, with the largest contributor occurring among 60- to 64-year-olds ($131.7 m). Varied results were also observed among different ethnicities and differing levels of deprivation. CONCLUSIONS This study finds considerable variation by disease on worker productivity and therefore tax revenue in this high-income country. These findings strengthen the economic and government case for prevention, particularly the prevention of mental health conditions and cardiovascular disease.
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Affiliation(s)
- Jennifer A Summers
- BODE(3) Programme, University of Otago, Wellington, Wellington, New Zealand.
| | - Nick Wilson
- BODE(3) Programme, University of Otago, Wellington, Wellington, New Zealand
| | - Tony Blakely
- Population Interventions, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Finn Sigglekow
- BODE(3) Programme, University of Otago, Wellington, Wellington, New Zealand
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Jagrič T, Brown C, Fister D, Darlington O, Ashton K, Dyakova M, Bellis MA, Jagrič V. Toward an economy of wellbeing: The economic impact of the Welsh healthcare sector. Front Public Health 2022; 10:953752. [PMID: 36388279 PMCID: PMC9643708 DOI: 10.3389/fpubh.2022.953752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 10/05/2022] [Indexed: 01/24/2023] Open
Abstract
Population health and wellbeing is both a result, as well as a driver, of economic development and prosperity on global, European, national and sub-national (local) levels. Wales, one of the four United Kingdom (UK) nations, has shown a long-term commitment to sustainable development and achieving prosperity for all, providing a good example of both national and sub-national level, which can be useful for other European countries and regions. In this paper, the economic importance of the healthcare sector to the Welsh economy is explored. We use a large number of data sources for the UK and Welsh economy to derive an economic model for 2017. We estimate output, income, employment, value-added, and import multipliers of the healthcare sector. Results suggest that the healthcare sector has an above average contribution in four explored economic aspects of the Welsh economy (output, income, employment, value-added), according to its impact on the surrounding economic ecosystem. Also, it is below average regarding leaking through imports. The multipliers' values offer empirical evidence when deciding on alternative policy actions. Such actions can be used as a stimulus for encouraging regional development and post-COVID economic recovery. Our study refers to the Welsh healthcare sector's economic impact as a whole. Therefore, we suggest investigating the economic impact of individual healthcare providers in the future.
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Affiliation(s)
- Timotej Jagrič
- Institute of Finance and Artificial Intelligence, Faculty of Economics and Business, University of Maribor, Maribor, Slovenia
| | - Christine Brown
- European Office for Investment and Health and Development, World Health Organization, Venice, Italy
| | - Dušan Fister
- Institute of Finance and Artificial Intelligence, Faculty of Economics and Business, University of Maribor, Maribor, Slovenia
| | - Oliver Darlington
- Public Health Wales, WHO Collaborating Centre on Investment for Health and Well-being, Capital Quarter 2, Cardiff, United Kingdom
| | - Kathryn Ashton
- Public Health Wales, WHO Collaborating Centre on Investment for Health and Well-being, Capital Quarter 2, Cardiff, United Kingdom
| | - Mariana Dyakova
- Public Health Wales, WHO Collaborating Centre on Investment for Health and Well-being, Capital Quarter 2, Cardiff, United Kingdom
| | - Mark A. Bellis
- Public Health Wales, WHO Collaborating Centre on Investment for Health and Well-being, Capital Quarter 2, Cardiff, United Kingdom
| | - Vita Jagrič
- Institute of Finance and Artificial Intelligence, Faculty of Economics and Business, University of Maribor, Maribor, Slovenia,*Correspondence: Vita Jagrič
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Irgens P, Myhrvold BL, Kongsted A, Natvig B, Vøllestad NK, Robinson HS. Exploring visual pain trajectories in neck pain patients, using clinical course, SMS-based patterns, and patient characteristics: a cohort study. Chiropr Man Therap 2022; 30:37. [PMID: 36076234 PMCID: PMC9454174 DOI: 10.1186/s12998-022-00443-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background The dynamic nature of neck pain has so far been identified through longitudinal studies with frequent measures, a method which is time-consuming and impractical. Pictures illustrating different courses of pain may be an alternative solution, usable in both clinical work and research, but it is unknown how well they capture the clinical course. The aim of this study was to explore and describe self-reported visual trajectories in terms of details of patients’ prospectively reported clinical course, their SMS-based pattern classification of neck pain, and patient’s characteristics. Methods Prospective cohort study including 888 neck pain patients from chiropractic practice, responding to weekly SMS-questions about pain intensity for 1 year from 2015 to 2017. Patients were classified into one of three clinical course patterns using definitions based on previously published descriptors. At 1-year follow-up, patients selected a visual trajectory that best represented their retrospective 1-year course of pain: single episode, episodic, mild ongoing, fluctuating and severe ongoing. Results The visual trajectories generally resembled the 1-year clinical course characteristics on group level, but there were large individual variations. Patients selecting Episodic and Mild ongoing visual trajectories were similar on most parameters. The visual trajectories generally resembled more the clinical course of the last quarter. Discussion The visual trajectories reflected the descriptors of the clinical course of pain captured by weekly SMS measures on a group level and formed groups of patients that differed on symptoms and characteristics. However, there were large variations in symptoms and characteristics within, as well as overlap between, each visual trajectory. In particular, patients with mild pain seemed predisposed to recall bias. Although the visual trajectories and SMS-based classifications appear related, visual trajectories likely capture more elements of the pain experience than just the course of pain. Therefore, they cannot be seen as a proxy for SMS-tracking of pain over 1 year. Supplementary Information The online version contains supplementary material available at 10.1186/s12998-022-00443-3.
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Affiliation(s)
- Pernille Irgens
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Blindern, P.O. Box 1089, 0317, Oslo, Norway.
| | - Birgitte Lawaetz Myhrvold
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Blindern, P.O. Box 1089, 0317, Oslo, Norway
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Chiropractic Knowledge Hub, Odense M, Denmark
| | - Bård Natvig
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Nina Køpke Vøllestad
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Blindern, P.O. Box 1089, 0317, Oslo, Norway
| | - Hilde Stendal Robinson
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Blindern, P.O. Box 1089, 0317, Oslo, Norway
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Rachas A, Gastaldi-Ménager C, Denis P, Barthélémy P, Constantinou P, Drouin J, Lastier D, Lesuffleur T, Mette C, Nicolas M, Pestel L, Rivière S, Tajahmady A, Gissot C, Fagot-Campagna A. The Economic Burden of Disease in France From the National Health Insurance Perspective: The Healthcare Expenditures and Conditions Mapping Used to Prepare the French Social Security Funding Act and the Public Health Act. Med Care 2022; 60:655-664. [PMID: 35880776 PMCID: PMC9365254 DOI: 10.1097/mlr.0000000000001745] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Identifying the most frequently treated and the costliest health conditions is essential for prioritizing actions to improve the resilience of health systems. OBJECTIVES Healthcare Expenditures and Conditions Mapping describes the annual economic burden of 58 health conditions to prepare the French Social Security Funding Act and the Public Health Act. DESIGN Annual cross-sectional study (2015-2019) based on the French national health database. SUBJECTS National health insurance beneficiaries (97% of the French residents). MEASURES All individual health care expenditures reimbursed by the national health insurance were attributed to 58 health conditions (treated diseases, chronic treatments, and episodes of care) identified by using algorithms based on available medical information (diagnosis coded during hospital stays, long-term diseases, and specific drugs). RESULTS In 2019, €167.0 billion were reimbursed to 66.3 million people (52% women, median age: 42 y). The most prevalent treated diseases were diabetes (6.0%), chronic respiratory diseases (5.5%), and coronary diseases (3.2%). Coronary diseases accounted for 4.6% of expenditures, neurotic and mood disorders 3.7%, psychotic disorders 2.8%, and breast cancer 2.1%. Between 2015 and 2019, the expenditures increased primarily for diabetes (+€906 million) and neurotic and mood disorders (+€861 million) due to the growing number of patients. "Active lung cancer" (+€797 million) represented the highest relative increase (+54%) due to expenditures for the expensive drugs and medical devices delivered at hospital. CONCLUSIONS These results have provided policy-makers, evaluators, and public health specialists with key insights into identifying health priorities and a better understanding of trends in health care expenditures in France.
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Affiliation(s)
- Antoine Rachas
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Christelle Gastaldi-Ménager
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Pierre Denis
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Pauline Barthélémy
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Panayotis Constantinou
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Jérôme Drouin
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Dimitri Lastier
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Thomas Lesuffleur
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Corinne Mette
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Muriel Nicolas
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Laurence Pestel
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Sébastien Rivière
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Ayden Tajahmady
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Claude Gissot
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Anne Fagot-Campagna
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
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Aanesen F, Øiestad BE, Grotle M, Løchting I, Solli R, Sowden G, Wynne-Jones G, Storheim K, Eik H. Implementing a Stratified Vocational Advice Intervention for People on Sick Leave with Musculoskeletal Disorders: A Multimethod Process Evaluation. JOURNAL OF OCCUPATIONAL REHABILITATION 2022; 32:306-318. [PMID: 34606049 PMCID: PMC8489360 DOI: 10.1007/s10926-021-10007-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 06/13/2023]
Abstract
Purpose To perform a process evaluation of a stratified vocational advice intervention (SVAI), delivered by physiotherapists in primary care, for people on sick leave with musculoskeletal disorders participating in a randomised controlled trial. The research questions concerned how the SVAI was delivered, the content of the SVAI and the physiotherapists' experiences from delivering the SVAI. Methods We used qualitative and quantitative data from 148 intervention logs documenting the follow-up provided to each participant, recordings of 18 intervention sessions and minutes from 20 meetings with the physiotherapists. The log data were analysed with descriptive statistics. A qualitative content analysis was performed of the recordings, and we identified facilitators and barriers for implementation from the minutes. Results Of 170 participants randomised to the SVAI 152 (89%) received the intervention and 148 logs were completed. According to the logs, 131 participants received the correct number of sessions (all by telephone) and 146 action plans were developed. The physiotherapists did not attend any workplace meetings but contacted stakeholders in 37 cases. The main themes from the recorded sessions were: 'symptom burden', 'managing symptoms', 'relations with the workplace' and 'fear of not being able to manage work'. The physiotherapists felt they were able to build rapport with most participants. However, case management was hindered by the restricted number of sessions permitted according to the protocol. Conclusion Overall, the SVAI was delivered in accordance with the protocol and is therefore likely to be implementable in primary care if it is effective in reducing sick leave.
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Affiliation(s)
- Fiona Aanesen
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway.
| | | | - Margreth Grotle
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
| | - Ida Løchting
- Research and Communication Unit for MSK Health (FORMI), Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Rune Solli
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
| | - Gail Sowden
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Keele, UK
- Connect Health, Newcastle upon Tyne, UK
| | - Gwenllian Wynne-Jones
- School of Medicine, and School of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Keele University, Keele, UK
| | - Kjersti Storheim
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
- Research and Communication Unit for MSK Health (FORMI), Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Hedda Eik
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
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15
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Stucki M, Nemitz J, Trottmann M, Wieser S. Decomposition of outpatient health care spending by disease - a novel approach using insurance claims data. BMC Health Serv Res 2021; 21:1264. [PMID: 34809613 PMCID: PMC8609863 DOI: 10.1186/s12913-021-07262-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 11/03/2021] [Indexed: 11/22/2022] Open
Abstract
Background Decomposing health care spending by disease, type of care, age, and sex can lead to a better understanding of the drivers of health care spending. But the lack of diagnostic coding in outpatient care often precludes a decomposition by disease. Yet, health insurance claims data hold a variety of diagnostic clues that may be used to identify diseases. Methods In this study, we decompose total outpatient care spending in Switzerland by age, sex, service type, and 42 exhaustive and mutually exclusive diseases according to the Global Burden of Disease classification. Using data of a large health insurance provider, we identify diseases based on diagnostic clues. These clues include type of medication, inpatient treatment, physician specialization, and disease specific outpatient treatments and examinations. We determine disease-specific spending by direct (clues-based) and indirect (regression-based) spending assignment. Results Our results suggest a high precision of disease identification for many diseases. Overall, 81% of outpatient spending can be assigned to diseases, mostly based on indirect assignment using regression. Outpatient spending is highest for musculoskeletal disorders (19.2%), followed by mental and substance use disorders (12.0%), sense organ diseases (8.7%) and cardiovascular diseases (8.6%). Neoplasms account for 7.3% of outpatient spending. Conclusions Our study shows the potential of health insurance claims data in identifying diseases when no diagnostic coding is available. These disease-specific spending estimates may inform Swiss health policies in cost containment and priority setting. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07262-x.
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Affiliation(s)
- Michael Stucki
- ZHAW Zurich University of Applied Sciences, Winterthur Institute of Health Economics, Gertrudstrasse 15, 8401, Winterthur, Switzerland. .,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
| | - Janina Nemitz
- ZHAW Zurich University of Applied Sciences, Winterthur Institute of Health Economics, Gertrudstrasse 15, 8401, Winterthur, Switzerland.,Helsana Insurance Group, Zürich, Switzerland
| | | | - Simon Wieser
- ZHAW Zurich University of Applied Sciences, Winterthur Institute of Health Economics, Gertrudstrasse 15, 8401, Winterthur, Switzerland
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16
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Blakely T, Sigglekow F, Irfan M, Mizdrak A, Dieleman J, Bablani L, Clarke P, Wilson N. Disease-related income and economic productivity loss in New Zealand: A longitudinal analysis of linked individual-level data. PLoS Med 2021; 18:e1003848. [PMID: 34847146 PMCID: PMC8631646 DOI: 10.1371/journal.pmed.1003848] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/13/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Reducing disease can maintain personal individual income and improve societal economic productivity. However, estimates of income loss for multiple diseases simultaneously with thorough adjustment for confounding are lacking, to our knowledge. We estimate individual-level income loss for 40 conditions simultaneously by phase of diagnosis, and the total income loss at the population level (a function of how common the disease is and the individual-level income loss if one has the disease). METHODS AND FINDINGS We used linked health tax data for New Zealand as a high-income country case study, from 2006 to 2007 to 2015 to 2016 for 25- to 64-year-olds (22.5 million person-years). Fixed effects regression was used to estimate within-individual income loss by disease, and cause-deletion methods to estimate economic productivity loss at the population level. Income loss in the year of diagnosis was highest for dementia for both men (US$8,882; 95% CI $6,709 to $11,056) and women ($7,103; $5,499 to $8,707). Mental illness also had high income losses in the year of diagnosis (average of about $5,300 per year for males and $4,100 per year for females, for 4 subcategories of: depression and anxiety; alcohol related; schizophrenia; and other). Similar patterns were evident for prevalent years of diagnosis. For the last year of life, cancers tended to have the highest income losses, (e.g., colorectal cancer males: $17,786, 95% CI $15,555 to $20,018; females: $14,192, $12,357 to $16,026). The combined annual income loss from all diseases among 25- to 64-year-olds was US$2.72 billion or 4.3% of total income. Diseases contributing more than 4% of total disease-related income loss were mental illness (30.0%), cardiovascular disease (15.6%), musculoskeletal (13.7%), endocrine (8.9%), gastrointestinal (7.4%), neurological (6.5%), and cancer (4.5%). The limitations of this study include residual biases that may overestimate the effect of disease on income loss, such as unmeasured time-varying confounding (e.g., divorce leading to both depression and income loss) and reverse causation (e.g., income loss leading to depression). Conversely, there may also be offsetting underestimation biases, such as income loss in the prodromal phase before diagnosis that is misclassified to "healthy" person time. CONCLUSIONS In this longitudinal study, we found that income loss varies considerably by disease. Nevertheless, mental illness, cardiovascular, and musculoskeletal diseases stand out as likely major causes of economic productivity loss, suggesting that they should be prioritised in prevention programmes.
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Affiliation(s)
- Tony Blakely
- Population Interventions Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Finn Sigglekow
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Muhammad Irfan
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Anja Mizdrak
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Joseph Dieleman
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, Washington State, United States of America
| | - Laxman Bablani
- Population Interventions Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Philip Clarke
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Nick Wilson
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand
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The School as an Arena for Co-Creating Participation, Equity, and Well-Being-A Photovoice Study from Norway. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168252. [PMID: 34444000 PMCID: PMC8392032 DOI: 10.3390/ijerph18168252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 11/26/2022]
Abstract
Schools may play an essential role as an arena for co-creating community activities that enhance well-being, equity, and citizenship. Still, there is limited knowledge about physical and non-physical factors that contribute to well-being within such approaches. The aim of this study was to identify important factors for well-being as perceived by pupils, school employees, and parents in a community school in Norway. The participatory method photovoice was used, and seven pupils, six employees, and four parents participated by taking photos used as the basis for six focus group discussions. Transcripts of the discussions were analyzed using Systematic Text Condensation. The analysis showed that the participants experienced that the school’s built and natural environment, the activities happening there, and the human resources and organization at the school facilitated perceptions of safety, inclusion, and cohesion, which in turn contributed to well-being. Furthermore, the results showed that co-creating schools as a community arena could be an innovative way of ensuring participation, equity, and well-being in the community. Such an approach might be especially important in deprived areas or in multi-ethnic communities. An important prerequisite to succeed is the openness of the school’s staff to engage in co-creation with other stakeholders in the community.
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Bugge C, Saether EM, Kristiansen IS. Men receive more end-of-life cancer hospital treatment than women: fact or fiction? Acta Oncol 2021; 60:984-991. [PMID: 33979241 DOI: 10.1080/0284186x.2021.1917000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND An important goal of health care systems is equitable access to health care. Previous research, however, indicates that men receive more cancer care and health care resources than women. The aim of this study was to investigate whether there is a gender difference in terms of end-of-life cancer treatment in hospitals in Norway. MATERIAL AND METHODS We used nationwide patient-level data from the Norwegian Patient Registry (2013-2017, n = 64,694), and aggregated data from the Norwegian Cause of Death Registry (2013-2018, n = 66,534). We described direct medical costs and utilization of cancer treatment in hospitals (in-patient stays and out-patient clinics) and specialized palliative home care teams by the means of the following variables: gender, type of cancer, age, region of residence, place of death, and use of pharmaceutical anti-cancer treatment last month before death. Generalized linear models with a gamma distribution and log-link function were fitted to identify determinants of direct medical costs in hospital's last year of life. RESULTS Women aged 0-69 years had an average direct medical cost in hospitals of €26,117 during the last year of life, compared to €29,540 for men, while they were respectively €19,889 and €22,405 for those aged 70 years or older. These gender differences were confirmed in regression models with gender as the only covariate. Adjusted additionally for the type of cancer, the difference was 11%, while including age as a covariate reduced the difference to 6%. When the place of death was also included, the difference was down to 4%. DISCUSSION The gender difference in hospital costs last year of life can largely be explained by age at death and the proportion dying in hospitals. When adjusting for confounding factors, the differences in end-of-life costs in hospitals are minimal.
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Affiliation(s)
- Christoffer Bugge
- Department of Health Management and Health Economics, University of Oslo, Norway
- Oslo Economics, Oslo, Norway
| | | | - Ivar Sønbø Kristiansen
- Department of Health Management and Health Economics, University of Oslo, Norway
- Oslo Economics, Oslo, Norway
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19
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Bugge C, Brustugun OT, Sæther EM, Kristiansen IS. Phase- and gender-specific, lifetime, and future costs of cancer: A retrospective population-based registry study. Medicine (Baltimore) 2021; 100:e26523. [PMID: 34190187 PMCID: PMC8257845 DOI: 10.1097/md.0000000000026523] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 06/04/2021] [Indexed: 01/04/2023] Open
Abstract
Valid estimates of cancer treatment costs are import for priority setting, but few studies have examined costs of multiple cancers in the same setting.We performed a retrospective population-based registry study to evaluate phase-specific (initial, continuing, and terminal phase) direct medical costs and lifetime costs for 13 cancers and all cancers combined in Norway. Mean monthly cancer attributable costs were estimated using nationwide activity data from all Norwegian hospitals. Mean lifetime costs were estimated by combining phase-specific monthly costs and survival times from the national cancer registry. Scenarios for future costs were developed from the lifetime costs and the expected number of new cancer cases toward 2034 estimated by NORDCAN.For all cancers combined, mean discounted per patient direct medical costs were Euros (EUR) 21,808 in the initial 12 months, EUR 4347 in the subsequent continuing phase, and EUR 12,085 in the terminal phase (last 12 months). Lifetime costs were higher for cancers with a 5-year relative survival between 50% and 70% (myeloma: EUR 89,686, mouth/pharynx: EUR 66,619, and non-Hodgkin lymphoma: EUR 65,528). The scenario analyses indicate that future cancer costs are highly dependent on future cancer incidence, changes in death risk, and cancer-specific unit costs.Gender- and cancer-specific estimates of treatment costs are important for assessing equity of care and to better understand resource consumption associated with different cancers.Cancers with an intermediate prognosis (50%-70% 5-year relative survival) are associated with higher direct medical costs than those with relatively good or poor prognosis.
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Affiliation(s)
- Christoffer Bugge
- Department of Health Management and Health Economics, University of Oslo
- Oslo Economics, Oslo
| | - Odd Terje Brustugun
- Section of Oncology, Drammen Hospital, Vestre Viken Health Trust, Drammen, Norway
| | | | - Ivar Sønbø Kristiansen
- Department of Health Management and Health Economics, University of Oslo
- Oslo Economics, Oslo
- Institute of Public Health, University of Southern Denmark, Odense, Denmark
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20
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Bugge C, Sæther EM, Brustugun OT, Kristiansen IS. Societal cost of cancer in Norway -Results of taking a broader cost perspective. Health Policy 2021; 125:1100-1107. [PMID: 34088521 DOI: 10.1016/j.healthpol.2021.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 03/13/2021] [Accepted: 05/15/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND The broader cost consequences of diseases may be of interest for a wide range of stakeholders. We aimed to estimate all relevant societal costs of cancer and to provide insight into the relative magnitude of the different cost categories. METHOD We used data from eight different health and work-related registries in Norway. Direct, indirect, and intangible costs (value of lost life years) were estimated over a period of one year with a combination of a top-down and a bottom-up costing approach. RESULTS The indirect costs (EUR 1,997 million per year) are almost as high as direct costs (EUR 2,154 million), and the value of lost life years and quality of life represents the greatest cost related to cancer (EUR 18,200 million). In addition, cancer is associated with other costs which are commonly omitted from cost-of-illness analyses, including informal nursing (EUR 306 million), patient time costs (EUR 85 million), and excess costs of using public funds (EUR 439 million). Breast and cervical cancer had relatively high work absenteeism costs, while pancreatic and lung cancer had relatively high production costs due to premature deaths. DISCUSSION Direct health care costs represent small proportions of the total societal costs of cancer. Costs commonly omitted in cost-of-illness analyses represent a significant cost and should be measured and valued in these analyses.
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Affiliation(s)
- Christoffer Bugge
- Department of Health Management and Health Economics, University of Oslo, Forskningsveien 3A, 0317 Oslo, Norway; Oslo Economics, Kronprinsesse Märthas plass 1, 0160 Oslo, Norway.
| | | | - Odd Terje Brustugun
- Section of Oncology, Drammen Hospital, Vestre Viken Health Trust, Dronninggata 28, 3004 Drammen, Norway
| | - Ivar Sønbø Kristiansen
- Department of Health Management and Health Economics, University of Oslo, Forskningsveien 3A, 0317 Oslo, Norway; Oslo Economics, Kronprinsesse Märthas plass 1, 0160 Oslo, Norway; Institute of Public Health, University of Southern Denmark, Campusvej 55, 5230 Odense, Danmark
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21
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Stucki M. Factors related to the change in Swiss inpatient costs by disease: a 6-factor decomposition. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:195-221. [PMID: 33433763 PMCID: PMC7881977 DOI: 10.1007/s10198-020-01243-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 10/29/2020] [Indexed: 06/12/2023]
Abstract
There is currently little systematic knowledge about the contribution of different factors to the increase in health care spending in high-income countries such as Switzerland. The aim of this paper is to decompose inpatient care costs in the Swiss canton of Zurich by 100 diseases and 42 age/sex groups and to assess the contribution of six factors to the change in aggregate costs between 2013 and 2017. These six factors are population size, age and sex structure, inpatient treated prevalence, utilization in terms of stays per patient, length of stay per case, and costs per treatment day. Using detailed inpatient cost data at the case level, we find that the most important contributor to the change in disease-specific costs was a rise in costs per treatment day. For most conditions, this effect was partly offset by a reduction in the average length of stay. Changes in population size accounted for one third of the total increase, but population structure had only a small positive association with costs. The most expensive cases accounted for the largest part of the increase in costs, but the magnitude of this effect differed across diseases. A better understanding of the factors related to cost changes at the disease level over time is essential for the design of targeted health policies aiming at an affordable health care system.
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Affiliation(s)
- Michael Stucki
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Gertrudstrasse 15, 8401, Winterthur, Switzerland.
- Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002, Lucerne, Switzerland.
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Babashahi S, Hansen P, Sullivan T. Creating a priority list of non-communicable diseases to support health research funding decision-making. Health Policy 2020; 125:221-228. [PMID: 33357963 DOI: 10.1016/j.healthpol.2020.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/22/2020] [Accepted: 12/02/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To develop and pilot a framework based on multi-criteria decision analysis (MCDA) to prioritize non-communicable diseases (NCDs) to support health research funding decision-making. METHODS The framework involves identifying NCDs to be prioritized, specifying prioritization criteria and determining their weights from a survey of stakeholders. The mean weights from the survey are applied to the NCDs' ratings on the criteria to generate a 'total score' for each NCD, by which the NCDs are prioritized. RESULTS Nineteen NCDs and five criteria were included. The criteria, in decreasing order of importance (mean weights in parentheses), are: deaths across the population (27.7 %), loss of quality-of-life across the population (23.0 %), cost to patients and families (18.6 %), cost to the health system (17.2 %), and whether vulnerable groups are disproportionately affected (13.4 %). The priority list of NCDs, stratified into four tiers of importance, is: 'Very critical' priority: coronary heart disease, back and neck pain, diabetes mellitus; 'Critical' priority: dementia and Alzheimer's disease, stroke; 'High' priority: colon and rectum cancer, depressive disorders, chronic obstructive pulmonary disease, chronic kidney disease, breast cancer, prostate cancer, arthritis, lung cancer; and 'Medium' priority: asthma, hearing loss, melanoma skin cancer, addictive disorders, non-melanoma skin cancer, headaches. CONCLUSION The results indicate the framework for prioritizing NCDs for research funding is feasible and effective. The framework could also be used for other health conditions.
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Affiliation(s)
| | - Paul Hansen
- Department of Economics, University of Otago, Dunedin, New Zealand; 1000minds Ltd, Wellington, New Zealand
| | - Trudy Sullivan
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
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23
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Løchting I, Grotle M, Storheim K, Foldal V, Standal MI, Fors EA, Eik H. Complex return to work process - caseworkers' experiences of facilitating return to work for individuals on sick leave due to musculoskeletal disorders. BMC Public Health 2020; 20:1822. [PMID: 33256648 PMCID: PMC7708113 DOI: 10.1186/s12889-020-09804-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 10/30/2020] [Indexed: 12/14/2022] Open
Affiliation(s)
- Ida Løchting
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway.
| | - Margreth Grotle
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway.,Faculty of Health Science, Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
| | - Kjersti Storheim
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway.,Faculty of Health Science, Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
| | - Vegard Foldal
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Martin Inge Standal
- Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Egil Andreas Fors
- General Practice Research Unit, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hedda Eik
- Faculty of Health Science, Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
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24
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Effects of using text message interventions for the management of musculoskeletal pain: a systematic review. Pain 2020; 161:2462-2475. [DOI: 10.1097/j.pain.0000000000001958] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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25
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Åvitsland A, Leibinger E, Haugen T, Lerum Ø, Solberg RB, Kolle E, Dyrstad SM. The association between physical fitness and mental health in Norwegian adolescents. BMC Public Health 2020; 20:776. [PMID: 32448149 PMCID: PMC7247223 DOI: 10.1186/s12889-020-08936-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 05/17/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Studies indicate that health-related components of physical fitness are associated with mental health outcomes. However, research is scarce concerning this relationship in young adolescents in general and non-existent in Norwegian populations specifically. The aim of the study was to examine whether body composition, muscular strength and cardiorespiratory fitness were associated with self-reported mental health in Norwegian adolescents. METHODS Adolescents from four regions of Norway (n = 1486; mean age = 13.9; girls = 50.6%) participated. Self-reported mental health (psychological difficulties) was measured by completing the Strengths and Difficulties Questionnaire. Cardiorespiratory fitness was assessed with an intermittent running test; muscular strength was assessed by measuring handgrip strength, standing broad jump and sit-ups; and body composition was assessed by calculating body mass index from weight and height. Linear mixed effects models were conducted to assess the associations between the health-related components of physical fitness and psychological difficulties. School clusters were included as random effects and all models were controlled for sex, socioeconomic status and birthplace (domestic or foreign). RESULTS Body composition was not associated with psychological difficulties. Muscular strength was independently associated with psychological difficulties, but when all independent variables were entered in the fully adjusted model, only cardiorespiratory fitness was associated with psychological difficulties. CONCLUSIONS There was a small but significant inverse association between cardiorespiratory fitness and levels of psychological difficulties in Norwegian adolescents. The results suggest that muscular strength is not associated with psychological difficulties in adolescents, when controlling for cardiorespiratory fitness. Future research should focus on the prospective association between physical fitness components and mental health outcomes in adolescents. TRIAL REGISTRATION The study is registered in ClinicalTrials.gov ID nr: NCT03817047. Retrospectively registered January 25, 2019.
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Affiliation(s)
- Andreas Åvitsland
- Department of Education and Sport Science, University of Stavanger, 4036, Stavanger, Norway.
| | - Eva Leibinger
- Department of Education and Sport Science, University of Stavanger, 4036, Stavanger, Norway
| | - Tommy Haugen
- Department of Sport Science and Physical Education, University of Agder, 4604, Kristiansand, Norway
| | - Øystein Lerum
- Department of Sport, Food and Natural Sciences, Western Norway University of Applied Sciences, 6851, Sogndal, Norway
| | - Runar B Solberg
- Department of Sports Medicine, Norwegian School of Sports Sciences, 0806, Oslo, Norway
| | - Elin Kolle
- Department of Sports Medicine, Norwegian School of Sports Sciences, 0806, Oslo, Norway
| | - Sindre M Dyrstad
- Department of Education and Sport Science, University of Stavanger, 4036, Stavanger, Norway
- Department of Public Health, University of Stavanger, 4036, Stavanger, Norway
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26
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Lervik LV, Knapstad M, Smith ORF. Process evaluation of Prompt Mental Health Care (PMHC): the Norwegian version of Improving Access to Psychological Therapies. BMC Health Serv Res 2020; 20:437. [PMID: 32430000 PMCID: PMC7236093 DOI: 10.1186/s12913-020-05311-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 05/08/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Prompt Mental Health Care (PMHC) is the Norwegian adaptation of Improving Access to Psychological Therapies (IAPT). Thus far, evaluations of PMHC have mostly focused on the effectiveness, rather than on contextual and implementation processes. Therefore, the objective of this study was to do a process evaluation and examine: 1) To what extent do the services follow guidelines provided by the Norwegian Directorate of Health (NDH), 2) what the therapists experienced as important barriers and facilitators in implementing the service, and 3) client treatment satisfaction and its associations with baseline variables. METHOD The present study uses data from 526 clients who received PMHC treatment in the municipalities of Sandnes and Kristiansand. The therapists completed questionnaires about each client's course of treatment. We conducted semi-structured interviews with the therapists and analysed them using thematic analysis. Data from client questionnaires were used to report descriptive sample statistics including symptom severity and treatment satisfaction. Linear regression was adopted to examine the associations between client treatment satisfaction and baseline characteristics. RESULTS Several aspects of PMHC were implemented in line with the guidelines provided by NDH. Importantly, both services reached out to the intended target group, and could further be characterized as low-threshold with relatively short waiting times (median waiting time between initial contact and treatment start was 27 days, IQR 18-39), no waiting lists, and frequent use of self-referral (33.3%). From the client perspective, results indicated a high degree of treatment satisfaction (Mean = 3.93 (SD = .71, range 1-5)), and this was true across demographic characteristics and symptom severity at baseline (all p > .05). Most notable challenges that came forward were; the low provision of guided self-help (received by only 1.0% of clients), the lack of focus on work participation (low to some degree of focus in 70.8% among sick-listed clients), the collaboration with other services (no collaboration in 85.3% of the clients), and some aspects regarding future development of the service. CONCLUSION Both sites managed to implement key aspects of PMHC in line with the guidelines, but further development of the program is warranted. Discussion of challenges and future recommendations are presented.
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Affiliation(s)
- Linn Vathne Lervik
- Division of Mental and Physical Health, Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaes gate 7, 5015, Bergen, Norway.
| | - Marit Knapstad
- Division of Mental and Physical Health, Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaes gate 7, 5015, Bergen, Norway.,Faculty of Psychology, Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Otto Robert Frans Smith
- Division of Mental and Physical Health, Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaes gate 7, 5015, Bergen, Norway
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Tew M, Clarke P, Thursky K, Dalziel K. Incorporating Future Medical Costs: Impact on Cost-Effectiveness Analysis in Cancer Patients. PHARMACOECONOMICS 2019; 37:931-941. [PMID: 30864067 DOI: 10.1007/s40273-019-00790-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND The inclusion of future medical costs in cost-effectiveness analyses remains a controversial issue. The impact of capturing future medical costs is likely to be particularly important in patients with cancer where costly lifelong medical care is necessary. The lack of clear, definitive pharmacoeconomic guidelines can limit comparability and has implications for decision making. OBJECTIVE The aim of this study was to demonstrate the impact of incorporating future medical costs through an applied example using original data from a clinical study evaluating the cost effectiveness of a sepsis intervention in cancer patients. METHODS A decision analytic model was used to capture quality-adjusted life-years (QALYs) and lifetime costs of cancer patients from an Australian healthcare system perspective over a lifetime horizon. The evaluation considered three scenarios: (1) intervention-related costs (no future medical cost), (2) lifetime cancer costs and (3) all future healthcare costs. Inputs to the model included patient-level data from the clinical study, relative risk of death due to sepsis, cancer mortality and future medical costs sourced from published literature. All costs are expressed in 2017 Australian dollars and discounted at 5%. To further assess the impact of future costs on cancer heterogeneity, variation in survival and lifetime costs between cancer types and the implications for cost-effectiveness analysis were explored. RESULTS The inclusion of future medical costs increased incremental cost-effectiveness ratios (ICERs) resulting in a shift from the intervention being a dominant strategy (cheaper and more effective) to an ICER of $7526/QALY. Across different cancer types, longer life expectancies did not necessarily result in greater lifetime healthcare costs. Incremental costs differed across cancers depending on the respective costs of managing cancer and survivorship, thus resulting in variations in ICERs. CONCLUSIONS There is scope for including costs beyond intervention costs in economic evaluations. The inclusion of future medical costs can result in markedly different cost-effectiveness results, leading to higher ICERs in a cancer population, with possible implications for funding decisions.
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Affiliation(s)
- Michelle Tew
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia.
- National Centre for Infections in Cancer, Peter MacCallum Cancer Institute, Melbourne, Australia.
| | - Philip Clarke
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia
| | - Karin Thursky
- National Centre for Infections in Cancer, Peter MacCallum Cancer Institute, Melbourne, Australia
- National Centre for Antimicrobial Stewardship, Royal Melbourne Hospital, Melbourne, Australia
| | - Kim Dalziel
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia
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Bornhöft L, Thorn J, Svensson M, Nordeman L, Eggertsen R, Larsson MEH. More cost-effective management of patients with musculoskeletal disorders in primary care after direct triaging to physiotherapists for initial assessment compared to initial general practitioner assessment. BMC Musculoskelet Disord 2019; 20:186. [PMID: 31043169 PMCID: PMC6495522 DOI: 10.1186/s12891-019-2553-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 04/03/2019] [Indexed: 01/21/2023] Open
Abstract
Background A model for triaging patients in primary care to provide immediate contact with the most appropriate profession to treat the condition in question has been developed and implemented in parts of Sweden. Direct triaging of patients with musculoskeletal disorders (MSD) to physiotherapists at primary healthcare centres has been proposed as an alternative to initial assessment by general practitioners (GPs) and has been shown to have many positive effects. The aim of this study was to evaluate the cost-effectiveness from the societal perspective of this new care-pathway through primary care regarding triaging patients with MSD to initial assessment by physiotherapists compared to standard practice with initial GP assessment. Methods Nurse-assessed patients with MSD (N = 55) were randomised to initial assessment and treatment with either physiotherapists or GPs and were followed for 1 year regarding health-related quality of life, utilization of healthcare resources and absence from work for MSD. Quality-adjusted life-years (QALYs) were calculated based on EQ5D measured at 5 time-points. Costs for healthcare resources and production loss were compiled. Incremental cost-effectiveness ratios (ICERS) were calculated. Multiple imputation was used to compensate for missing values and bootstrapping to handle uncertainty. A cost-effectiveness plane and a cost-effectiveness acceptability curve were construed to describe the results. Results The group who were allocated to initial assessment by physiotherapists had slightly larger gains in QALYs at lower total costs. At a willingness-to-pay threshold of 20,000 €, the likelihood that the intervention was cost-effective from a societal perspective including production loss due to MSD was 85% increasing to 93% at higher thresholds. When only healthcare costs were considered, triaging to physiotherapists was still less costly in relation to health improvements than standard praxis. Conclusion From the societal perspective, this small study indicated that triaging directly to physiotherapists in primary care has a high likelihood of being cost-effective. However, further larger randomised trials will be necessary to corroborate these findings. Trial registration ClinicalTrials.gov NCT02218749. Registered August 18, 2014.
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Affiliation(s)
- Lena Bornhöft
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Närhälsan Torslanda Rehabilitation Centre, Gothenburg, Sweden.
| | - Jörgen Thorn
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mikael Svensson
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lena Nordeman
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Sweden
| | - Robert Eggertsen
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria E H Larsson
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Sweden
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29
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Blakely T, Kvizhinadze G, Atkinson J, Dieleman J, Clarke P. Health system costs for individual and comorbid noncommunicable diseases: An analysis of publicly funded health events from New Zealand. PLoS Med 2019; 16:e1002716. [PMID: 30620729 PMCID: PMC6324792 DOI: 10.1371/journal.pmed.1002716] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 11/15/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is little systematic assessment of how total health expenditure is distributed across diseases and comorbidities. The objective of this study was to use statistical methods to disaggregate all publicly funded health expenditure by disease and comorbidities in order to answer three research questions: (1) What is health expenditure by disease phase for noncommunicable diseases (NCDs) in New Zealand? (2) Is the cost of having two NCDs more or less than that expected given the independent costs of each NCD? (3) How is total health spending disaggregated by NCDs across age and by sex? METHODS AND FINDINGS We used linked data for all adult New Zealanders for publicly funded events, including hospitalisation, outpatient, pharmaceutical, laboratory testing, and primary care from 1 July 2007 to 30 June 2014. These data include 18.9 million person-years and $26.4 billion in spending (US$ 2016). We used case definition algorithms to identify if a person had any of six NCDs (cancer, cardiovascular disease [CVD], diabetes, musculoskeletal, neurological, and a chronic lung/liver/kidney [LLK] disease). Indicator variables were used to identify the presence of any of the 15 possible comorbidity pairings of these six NCDs. Regression was used to estimate excess annual health expenditure per person. Cause deletion methods were used to estimate total population expenditure by disease. A majority (59%) of health expenditure was attributable to NCDs. Expenditure due to diseases was generally highest in the year of diagnosis and year of death. A person having two diseases simultaneously generally had greater health expenditure than the expected sum of having the diseases separately, for all 15 comorbidity pairs except the CVD-cancer pair. For example, a 60-64-year-old female with none of the six NCDs had $633 per annum expenditure. If she had both CVD and chronic LLK, additional expenditure for CVD separately was $6,443/$839/$9,225 for the first year of diagnosis/prevalent years/last year of life if dying of CVD; additional expenditure for chronic LLK separately was $6,443/$1,291/$9,051; and the additional comorbidity expenditure of having both CVD and LLK was $2,456 (95% confidence interval [CI] $2,238-$2,674). The pattern was similar for males (e.g., additional comorbidity expenditure for a 60-64-year-old male with CVD and chronic LLK was $2,498 [95% CI $2,264-$2,632]). In addition to this, the excess comorbidity costs for a person with two diseases was greater at younger ages, e.g., excess expenditure for 45-49-year-old males with CVD and chronic LLK was 10 times higher than for 75-79-year-old males and six times higher for females. At the population level, 23.8% of total health expenditure was attributable to higher costs of having one of the 15 comorbidity pairs over and above the six NCDs separately; of the remaining expenditure, CVD accounted for 18.7%, followed by musculoskeletal (16.2%), neurological (14.4%), cancer (14.1%), chronic LLK disease (7.4%), and diabetes (5.5%). Major limitations included incomplete linkage to all costed events (although these were largely non-NCD events) and missing private expenditure. CONCLUSIONS The costs of having two NCDs simultaneously is typically superadditive, and more so for younger adults. Neurological and musculoskeletal diseases contributed the largest health system costs, in accord with burden of disease studies finding that they contribute large morbidity. Just as burden of disease methodology has advanced the understanding of disease burden, there is a need to create disease-based costing studies that facilitate the disaggregation of health budgets at a national level.
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Affiliation(s)
- Tony Blakely
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- * E-mail:
| | - Giorgi Kvizhinadze
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand
| | - June Atkinson
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Joseph Dieleman
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Philip Clarke
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Siotos C, Ibrahim Z, Bai J, Payne R, Seal S, Lifchez S, Hyder A. Hand injuries in low- and middle-income countries: systematic review of existing literature and call for greater attention. Public Health 2018; 162:135-146. [DOI: 10.1016/j.puhe.2018.05.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/21/2018] [Accepted: 05/15/2018] [Indexed: 11/16/2022]
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Rodrigues Manica S, Sepriano A, Ramiro S, Pimentel Santos F, Putrik P, Nikiphorou E, Norton S, Molto A, Dougados M, van der Heijde D, Landewé RBM, van den Bosch FE, Boonen A. Work participation in spondyloarthritis across countries: analysis from the ASAS-COMOSPA study. Ann Rheum Dis 2018; 77:1303-1310. [PMID: 29860232 DOI: 10.1136/annrheumdis-2018-213464] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/15/2018] [Accepted: 05/15/2018] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To explore the role of individual and country level socioeconomic (SE) factors on employment, absenteeism and presenteeism in patients with spondyloarthritis (SpA) across 22 countries worldwide. METHODS Patients with a clinical diagnosis of SpA fulfilling the ASAS classification criteria and in working age (≤65 years) from COMOSPA were included. Outcomes of interest were employment status, absenteeism and presenteeism, assessed by the Work Productivity and Activity Impairment Specific General Health questionnaire. Three multivariable models were built (one per outcome) using mixed-effects binomial (for work status) or ordinal regressions (for absenteeism and presenteeism), with country as random effect. The contribution of SE factors at the individual-level (eg, gender, education, marital status) and country-level (healthcare expenditure (HCE) per capita, Human Development Index (HDI) and gross domestic product per capita) SE factors, independent of clinical factors, was assessed. RESULTS In total, 3114 patients with SpA were included of which 1943 (62%) were employed. Physical function and comorbidities were related to all work outcomes in expected directions and disease activity also with absenteeism and presenteeism. Higher education (OR 4.2 (95% CI 3.1 to 5.6)) or living in a country with higher HCE (OR 2.3 (1.5 to 3.6)) or HDI (OR 1.9 (1.2 to 3.3)) was positively associated with being employed. Higher disease activity was associated with higher odds for absenteeism (OR 1.5 (1.3 to 1.7)) and presenteeism (OR 2.1 (1.8 to 2.4)). No significant association between individual-level and country-level SE factors and absenteeism or presenteeism was found. CONCLUSIONS Higher education level and higher country SE welfare are associated with a higher likelihood of keeping patients with SpA employed. Absenteeism and presenteeism are only associated with clinical but not with individual-level or country-level SE factors.
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Affiliation(s)
- Santiago Rodrigues Manica
- Department of Rheumatology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal.,NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Alexandre Sepriano
- NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.,Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sofia Ramiro
- NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.,Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Fernando Pimentel Santos
- Department of Rheumatology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal.,NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | | | - Elena Nikiphorou
- Academic Rheumatology, King's College of London (KCL), London, UK
| | - Sam Norton
- Academic Rheumatology, King's College of London (KCL), London, UK.,Psychology Department, King's College of London (KCL), London, UK
| | - Anna Molto
- Rheumatology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France.,INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Maxime Dougados
- Rheumatology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France.,INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | | | | | - Filip E van den Bosch
- Department of Internal Medicine, VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium.,Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Spending on health and HIV/AIDS: domestic health spending and development assistance in 188 countries, 1995-2015. Lancet 2018; 391:1799-1829. [PMID: 29678342 PMCID: PMC5946845 DOI: 10.1016/s0140-6736(18)30698-6] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 03/10/2018] [Accepted: 03/13/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Comparable estimates of health spending are crucial for the assessment of health systems and to optimally deploy health resources. The methods used to track health spending continue to evolve, but little is known about the distribution of spending across diseases. We developed improved estimates of health spending by source, including development assistance for health, and, for the first time, estimated HIV/AIDS spending on prevention and treatment and by source of funding, for 188 countries. METHODS We collected published data on domestic health spending, from 1995 to 2015, from a diverse set of international agencies. We tracked development assistance for health from 1990 to 2017. We also extracted 5385 datapoints about HIV/AIDS spending, between 2000 and 2015, from online databases, country reports, and proposals submitted to multilateral organisations. We used spatiotemporal Gaussian process regression to generate complete and comparable estimates for health and HIV/AIDS spending. We report most estimates in 2017 purchasing-power parity-adjusted dollars and adjust all estimates for the effect of inflation. FINDINGS Between 1995 and 2015, global health spending per capita grew at an annualised rate of 3·1% (95% uncertainty interval [UI] 3·1 to 3·2), with growth being largest in upper-middle-income countries (5·4% per capita [UI 5·3-5·5]) and lower-middle-income countries (4·2% per capita [4·2-4·3]). In 2015, $9·7 trillion (9·7 trillion to 9·8 trillion) was spent on health worldwide. High-income countries spent $6·5 trillion (6·4 trillion to 6·5 trillion) or 66·3% (66·0 to 66·5) of the total in 2015, whereas low-income countries spent $70·3 billion (69·3 billion to 71·3 billion) or 0·7% (0·7 to 0·7). Between 1990 and 2017, development assistance for health increased by 394·7% ($29·9 billion), with an estimated $37·4 billion of development assistance being disbursed for health in 2017, of which $9·1 billion (24·2%) targeted HIV/AIDS. Between 2000 and 2015, $562·6 billion (531·1 billion to 621·9 billion) was spent on HIV/AIDS worldwide. Governments financed 57·6% (52·0 to 60·8) of that total. Global HIV/AIDS spending peaked at 49·7 billion (46·2-54·7) in 2013, decreasing to $48·9 billion (45·2 billion to 54·2 billion) in 2015. That year, low-income and lower-middle-income countries represented 74·6% of all HIV/AIDS disability-adjusted life-years, but just 36·6% (34·4 to 38·7) of total HIV/AIDS spending. In 2015, $9·3 billion (8·5 billion to 10·4 billion) or 19·0% (17·6 to 20·6) of HIV/AIDS financing was spent on prevention, and $27·3 billion (24·5 billion to 31·1 billion) or 55·8% (53·3 to 57·9) was dedicated to care and treatment. INTERPRETATION From 1995 to 2015, total health spending increased worldwide, with the fastest per capita growth in middle-income countries. While these national disparities are relatively well known, low-income countries spent less per person on health and HIV/AIDS than did high-income and middle-income countries. Furthermore, declines in development assistance for health continue, including for HIV/AIDS. Additional cuts to development assistance could hasten this decline, and risk slowing progress towards global and national goals. FUNDING The Bill & Melinda Gates Foundation.
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The Impact of Diagnostic Code Misclassification on Optimizing the Experimental Design of Genetic Association Studies. JOURNAL OF HEALTHCARE ENGINEERING 2017; 2017:7653071. [PMID: 29181145 PMCID: PMC5664372 DOI: 10.1155/2017/7653071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 09/13/2017] [Indexed: 12/27/2022]
Abstract
Diagnostic codes within electronic health record systems can vary widely in accuracy. It has been noted that the number of instances of a particular diagnostic code monotonically increases with the accuracy of disease phenotype classification. As a growing number of health system databases become linked with genomic data, it is critically important to understand the effect of this misclassification on the power of genetic association studies. Here, I investigate the impact of this diagnostic code misclassification on the power of genetic association studies with the aim to better inform experimental designs using health informatics data. The trade-off between (i) reduced misclassification rates from utilizing additional instances of a diagnostic code per individual and (ii) the resulting smaller sample size is explored, and general rules are presented to improve experimental designs.
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