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Shiozawa A, Mancuso S, Young C, Friderici J, Tran S, Trenz HM. Comparison of Healthcare Costs for Women with Treated Versus Untreated Vasomotor Symptoms Due to Menopause. Adv Ther 2024; 41:1885-1895. [PMID: 38467985 PMCID: PMC11052820 DOI: 10.1007/s12325-024-02821-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/08/2024] [Indexed: 03/13/2024]
Abstract
INTRODUCTION The study objective was to estimate all-cause healthcare resource utilization (HCRU) and medical and pharmacy costs for women with treated versus untreated vasomotor symptoms (VMS) due to menopause. METHODS A retrospective study was conducted using US claims data from Optum Research Database (study period: January 1, 2012-February 29, 2020). Women aged 40-63 years with a VMS diagnosis claim and ≥ 12 and ≥ 18 months of continuous enrollment during baseline and follow-up periods, respectively, were included. Women treated for VMS were propensity score matched 1:1 to untreated controls with VMS. Standardized differences (SDIFF) ≥ 10% were considered meaningful. A generalized linear model (gamma distribution, log link, robust standard errors) estimated the total cost of care ratio. Subgroup analyses of on- and off-label treatment costs were conducted. RESULTS Of 117,582 women diagnosed with VMS, 20.5% initiated VMS treatment and 79.5% had no treatment. Treated women (n = 24,057) were matched to untreated VMS controls. There were no differences in HCRU at follow-up (SDIFF < 10%). Pharmacy ($487 vs $320, SDIFF 28.4%) and total ($1803 vs $1536, SDIFF 12.6%) costs were higher in the treated cohort. Total costs were 7% higher in the treated cohort (total cost ratio 1.07, 95% CI 1.05-1.10, P < 0.001). The on-label treatment pharmacy costs ($546 versus $315, SDIFF 38.6%) were higher in the treated cohort. Off-label treatment had higher medical costs ($1393 versus $1201, SDIFF 10.4%). CONCLUSIONS Most women with VMS due to menopause were not treated within 6 months following diagnosis. While both on- and off-label treatment increased the total cost of care compared with untreated controls, those increases were modest in magnitude and should not impede treatment for women who report symptom improvement as a result of treatment.
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Affiliation(s)
- Aki Shiozawa
- Medical Affairs US, Astellas Pharma, Inc., 1 Astellas Way, Northbrook, IL, 60062, USA.
| | - Shayna Mancuso
- Medical Affairs US, Astellas Pharma, Inc., 1 Astellas Way, Northbrook, IL, 60062, USA
| | - Christopher Young
- Medical Affairs US, Astellas Pharma, Inc., 1 Astellas Way, Northbrook, IL, 60062, USA
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Kingston R, Vella V, Pouwels KB, Schmidt JE, Abdelatif El-Abasiri RA, Reyna-Villasmil E, Hassoun-Kheir N, Harbarth S, Rodríguez-Baño J, Tacconelli E, Arieti F, Gladstone BP, de Kraker MEA, Naylor NR, Robotham JV. Excess resource use and cost of drug-resistant infections for six key pathogens in Europe: a systematic review and Bayesian meta-analysis. Clin Microbiol Infect 2024; 30 Suppl 1:S26-S36. [PMID: 38128781 DOI: 10.1016/j.cmi.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/05/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Quantifying the resource use and cost of antimicrobial resistance establishes the magnitude of the problem and drives action. OBJECTIVES Assessment of resource use and cost associated with infections with six key drug-resistant pathogens in Europe. METHODS A systematic review and Bayesian meta-analysis. DATA SOURCES MEDLINE (Ovid), Embase (Ovid), Econlit databases, and grey literature for the period 1 January 1990, to 21 June 2022. STUDY ELIGIBILITY CRITERIA Resource use and cost outcomes (including excess length of stay, overall costs, and other excess in or outpatient costs) were compared between patients with defined antibiotic-resistant infections caused by carbapenem-resistant (CR) Pseudomonas aeruginosa and Acinetobacter baumannii, CR or third-generation cephalosporin Escherichia coli (3GCREC) and Klebsiella pneumoniae, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant Enterococcus faecium, and patients with drug-susceptible or no infection. PARTICIPANTS All patients diagnosed with drug-resistant bloodstream infections (BSIs). INTERVENTIONS NA. ASSESSMENT OF RISK OF BIAS An adapted version of the Joanna Briggs Institute assessment tool, incorporating case-control, cohort, and economic assessment frameworks. METHODS OF DATA SYNTHESIS Hierarchical Bayesian meta-analyses were used to assess pathogen-specific resource use estimates. RESULTS Of 5969 screened publications, 37 were included in the review. Data were sparse and heterogeneous. Most studies estimated the attributable burden by, comparing resistant and susceptible pathogens (32/37). Four studies analysed the excess cost of hospitalization attributable to 3GCREC BSIs, ranging from -€ 2465.50 to € 6402.81. Eight studies presented adjusted excess length of hospital stay estimates for methicillin-resistant S. aureus and 3GCREC BSIs (4 each) allowing for Bayesian hierarchical analysis, estimating means of 1.26 (95% credible interval [CrI], -0.72 to 4.17) and 1.78 (95% CrI, -0.02 to 3.38) days, respectively. CONCLUSIONS Evidence on most cost and resource use outcomes and across most pathogen-resistance combinations was severely lacking. Given the importance of this evidence for rational policymaking, further research is urgently needed.
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Affiliation(s)
- Rhys Kingston
- Field Service Data Science Team, UK Health Security Agency, London, UK
| | | | - Koen B Pouwels
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK
| | | | | | - Eduardo Reyna-Villasmil
- Infectious Diseases and Microbiology Division, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen Macarena, Department of Medicine, University of Sevilla/CSIC, Sevilla, Spain
| | - Nasreen Hassoun-Kheir
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, WHO Collaborating Center, Geneva, Switzerland
| | - Stephan Harbarth
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, WHO Collaborating Center, Geneva, Switzerland
| | - Jesús Rodríguez-Baño
- Infectious Diseases and Microbiology Division, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen Macarena, Department of Medicine, University of Sevilla/CSIC, Sevilla, Spain
| | - Evelina Tacconelli
- Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Fabiana Arieti
- Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Beryl Primrose Gladstone
- Department of Internal Medicine, DZIF-Clinical Research Unit, Infectious Diseases, University Hospital Tübingen, Tübingen, Germany
| | - Marlieke E A de Kraker
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, WHO Collaborating Center, Geneva, Switzerland
| | - Nichola R Naylor
- HCAI, Fungal, AMR, AMU, & Sepsis Division, UK Health Security Agency, London, UK
| | - Julie V Robotham
- HCAI, Fungal, AMR, AMU, & Sepsis Division, UK Health Security Agency, London, UK.
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Kauppala A, Heikkilä P, Palmu S. An analysis of the diagnoses and costs of pediatric emergency care visits: a single center study. BMC Health Serv Res 2024; 24:251. [PMID: 38414020 PMCID: PMC10900614 DOI: 10.1186/s12913-024-10746-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/18/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Children's emergency care visits are common, although the costs and reasons for visits vary. This register-based study examines the costs of pediatric emergency care and the diagnoses related to visits made to the Pediatric Emergency Unit at Tampere University Hospital (Tays), Tampere, Finland. METHODS This retrospective study described pediatric emergency care visits made between September 2018 and December 2019 to a single center in Tampere, Finland. The data were gathered from medical files and from cost-per-patient software and analyzed in groups by age, season, level of treatment in the ED (primary or secondary), and hospitalization, as well as by diagnosis groups. RESULTS During the study period, 11,454 visits were made. The total costs were over €3,380,000 ($2,837,758), with a median cost per visit was €260 ($217.90). Higher costs were associated with hospitalization and treatment in secondary care. The most common diagnoses were respiratory tract infections, counseling, other infections, GI symptoms, and other reasons. CONCLUSION Seriously ill children incur the highest costs per visit in pediatric emergency care. Respiratory tract infections are common reasons for emergency care visits, and the reasons why children come to emergency care in Finland are similar to those in other countries.
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Affiliation(s)
- Annika Kauppala
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland
| | - Paula Heikkilä
- Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland
- Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Elämänaukio 2, 33520, Tampere, Finland
| | - Sauli Palmu
- Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland.
- Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Elämänaukio 2, 33520, Tampere, Finland.
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Sing AK, Guderjan L, Lemke K, Wiemers M, Schmitt T, Wendt M. Different ecological demands shape differences in population structure and behaviour among the two generations of the small pearl-bordered fritillary. PeerJ 2024; 12:e16965. [PMID: 38426142 PMCID: PMC10903349 DOI: 10.7717/peerj.16965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/26/2024] [Indexed: 03/02/2024] Open
Abstract
The population structure and behaviour of univoltine butterfly species have been studied intensively. However, much less is known about bivoltine species. In particular, in-depth studies of the differences in population structure, behaviour, and ecology between these two generations are largely lacking. Therefore, we here present a mark-release-recapture study of two successive generations of the fritillary butterfly Boloria selene performed in eastern Brandenburg (Germany). We revealed intersexual and intergenerational differences regarding behaviour, dispersal, population characteristics, and protandry. The observed population densities were higher in the second generation. The flight activity of females decreased in the second generation, but remained unchanged in males. This was further supported by the rate of wing decay. The first generation displayed a linear correlation between wing decay and passed time in both sexes, whereas the linear correlation was lost in second-generation females. The proportion of resting individuals in both sexes increased in the second generation, as well as the number of nectaring females. The choice of plant genera used for nectaring seems to be more specialised in the first and more opportunistic in the second generation. The average flight distances were generally higher for females than for males and overall higher in the first generation. Predictions of long-distance movements based on the inverse power function were also generally higher in females than in males but lower in the first generation. Additionally, we found protandry only in the first but not in the second generation, which might correlate with the different developmental pathways of the two generations. These remarkable differences between both generations might reflect an adaptation to the different ecological demands during the flight season and the different tasks they have, i.e., growth in the spring season; dispersal and colonisation of new habitats during the summer season.
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Affiliation(s)
- Ann-Kathrin Sing
- Senckenberg German Entomological Institute, Müncheberg, Germany
- Institute of Earth and Environmental Sciences, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Laura Guderjan
- Senckenberg German Entomological Institute, Müncheberg, Germany
- Institute of Geoecology, Technische Universität Braunschweig, Braunschweig, Germany
| | - Klara Lemke
- Senckenberg German Entomological Institute, Müncheberg, Germany
- Faculty of Natural and Environmental Sciences, Zittau/Görlitz University of Applied Sciences, Zittau/Görlitz, Germany
| | - Martin Wiemers
- Senckenberg German Entomological Institute, Müncheberg, Germany
| | - Thomas Schmitt
- Senckenberg German Entomological Institute, Müncheberg, Germany
- Institute of Biochemistry and Biology, University of Potsdam, Potsdam, Germany
| | - Martin Wendt
- Senckenberg German Entomological Institute, Müncheberg, Germany
- Leibniz Centre for Agricultural Landscape Research, Müncheberg, Germany
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O'Guinn ML, Martino AM, Ourshalimian S, Holliday-Carroll MC, Chaudhari PP, Spurrier R. Association Between Hospital Arrival Time and Avoidable Transfer in Pediatric Trauma. J Pediatr Surg 2024; 59:310-315. [PMID: 37973422 DOI: 10.1016/j.jpedsurg.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/13/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Avoidable transfers (AT) in pediatric trauma can increase strain on healthcare resources and families. We sought to identify characteristics of patients and their injuries that are associated with AT. METHODS A multicenter retrospective cross-sectional study of the regional Trauma Registry was conducted from 1/1/10-12/31/21 of children <18 years-old who experienced an interfacility transfer. AT was defined as receiving hospital length of stay (LOS) < 48 hrs without procedure or intervention performed. Patient demographics, mechanism of injury, and arrival time were analyzed with descriptive statistics. A multivariable logistic regression was performed to analyze demographic and clinical factors associated with AT. RESULTS We included 5438 trauma transfers, of which 2187 (40.2%) were AT. Patients experiencing AT had a median [IQR] age of 5 years [1-12] and most were male (67%) and Hispanic/Latino (46.3%). The odds of experiencing AT decreased as age increased and were less likely in females and Non-Hispanic Black children. Injuries from falls (ground level (OR = 2.48; 95%CI = 1.89-3.28) and >10 ft (OR = 3.20; 95%CI = 2.35-4.39)), sports/recreational activities (OR = 2.36; 95%CI = 1.78-3.16), MVCs (OR = 1.44; 95%CI = 1.05-1.98), and firearms (OR = 1.74; 95%CI = 1.15-2.62) were associated with an increased odds of AT. Time of arrival at the receiving facility in early hours (00:00-07:59) (OR = 1.48; 95%CI = 1.24-1.76) and evening hours (17:00-23:59) (OR = 1.75; 95%CI = 1.47-2.07) were associated with an increased odds of AT. CONCLUSION Younger patients, injuries from falls, sports/recreational activities, MVCs, and firearms as well as arrival time outside of standard work hours are more likely to result in AT. Knowing these results, we can begin working with our referral centers to improve communication and strengthen institutional transfer criteria for pediatric trauma patients. Further investigation will then be needed to determine if the changes implemented have influenced care and lowered rates of avoidable transfer. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- MaKayla L O'Guinn
- Children's Hospital Los Angeles, Division of Pediatric Surgery, 4650 W Sunset Blvd, Los Angeles, CA 90027, USA
| | - Alice M Martino
- Children's Hospital Los Angeles, Division of Pediatric Surgery, 4650 W Sunset Blvd, Los Angeles, CA 90027, USA
| | - Shadassa Ourshalimian
- Children's Hospital Los Angeles, Division of Pediatric Surgery, 4650 W Sunset Blvd, Los Angeles, CA 90027, USA
| | - Mary C Holliday-Carroll
- Children's Hospital Los Angeles, Division of Pediatric Surgery, 4650 W Sunset Blvd, Los Angeles, CA 90027, USA
| | - Pradip P Chaudhari
- Children's Hospital Los Angeles, Division of Emergency Medicine &Transport Medicine, 4650 W Sunset Blvd, Los Angeles, CA 90027, USA; Keck School of Medicine of University of Southern California, Department of Pediatrics, 1975 Zonal Ave, Los Angeles, CA 90033, USA
| | - Ryan Spurrier
- Children's Hospital Los Angeles, Division of Pediatric Surgery, 4650 W Sunset Blvd, Los Angeles, CA 90027, USA; Keck School of Medicine of University of Southern California, Department of Surgery, 1975 Zonal Ave, Los Angeles, CA 90033, USA.
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Wiesli TX, Przepiorka W. Does Living in a Protected Area Reduce Resource Use and Promote Life Satisfaction? Survey Results from and Around Three Regional Nature Parks in Switzerland. Soc Indic Res 2023; 169:341-364. [PMID: 37649831 PMCID: PMC10462571 DOI: 10.1007/s11205-023-03164-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 09/01/2023]
Abstract
Regional nature parks in Switzerland are, for the most part, protected areas that aim to promote sustainable development and residents' well-being. In recent years, research on regional nature parks and comparable protected areas has focused on questions regarding local populations' acceptance of such areas, their governance, and their economic effects. However, we know surprisingly little about the impact of protected areas on environmental resource use and life satisfaction, two essential ingredients of sustainable regional development. In this study, we survey people living in and around three regional nature parks in Switzerland on their resource use and life satisfaction (gross sample n = 3358). We propose a novel measurement of resource use based on vignettes describing different lifestyles, which we validate against the carbon footprint obtained for a subsample of our respondents. With these indicators, using multiple regression analyses, we test several hypotheses derived from the literature on the relationship between resource use and life satisfaction in and around protected areas. Contrary to our expectations, we do not find differences in resource use or life satisfaction, or the relationship between resource use and life satisfaction, across park and non-park regions. We discuss potential explanations for our findings and their implications for nature park authorities and future study designs. Supplementary Information The online version contains supplementary material available at 10.1007/s11205-023-03164-z.
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Affiliation(s)
- Thea Xenia Wiesli
- Centre for Development and Environment, University of Bern, Bern, Switzerland
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Wiethoff I, Evers SMAA, Michels M, Hiligsmann M. An introduction to health technology assessment and health economic evaluation: an online self-learning course. Neth Heart J 2023; 31:219-225. [PMID: 37171709 DOI: 10.1007/s12471-023-01777-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 05/13/2023] Open
Abstract
Cardiovascular diseases impose an enormous burden on patients and society. New health technologies promise to lower this burden; however, novel treatments often come at a high cost. In the Netherlands, health technology assessment (HTA) is increasingly being used to inform policy bodies about the optimal distribution of scarce healthcare resources and to guide decision-making about financing and reimbursement. In particular, economic evaluations, as one pillar of HTA, are frequently used to compare the costs and effects of different interventions. This paper aims to define HTA and its relevance to healthcare policy as well as providing a comprehensive overview of the methodology of economic evaluations targeting health professionals and researchers with limited prior knowledge of this subject. Accordingly, different types of economic evaluations are introduced, together with their respective costs and outcomes. Further, the results of economic evaluations are explained, along with techniques for performing them and methods for coping with uncertainty. In addition to this paper-based learning format, each chapter is complemented by a video lecture with further information and practical examples, helping to better understand and analyse health economic studies.
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Affiliation(s)
- Isabell Wiethoff
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
| | - Silvia M A A Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Centre for Economic Evaluation and Machine Learning, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Michelle Michels
- Department of Cardiology, Thoraxcenter, Erasmus MC Rotterdam, Rotterdam, The Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Deng H, Zhang Y, Kaczan D, Qiao Y, Wang X, Chen B, Wang Y. How has China's industrial eco-efficiency been improved? Evidence from multi-scale countrywide study. Environ Sci Pollut Res Int 2023; 30:69379-69392. [PMID: 37133664 DOI: 10.1007/s11356-023-27300-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 04/25/2023] [Indexed: 05/04/2023]
Abstract
The process of industrialization often causes resource depletion and environmental pollution. To shed light on China's resource use and pollution trends in the context of the country's rapid industrial growth, this study analyzes the eco-efficiency of China's industry from 2000 to 2015. We quantify industrial eco-efficiency (IEE) for China and its provinces using data envelopment analysis (DEA) and analyze potential influencing factors at national and regional levels using Tobit regression. IEE in China and in most provinces shows a clear upward trend with some fluctuations, with national scores increasing from 0.394 to 0.704. There is strong regional disparity, with average IEE scores in eastern provinces (0.840) higher than those in central provinces (0.625), which are in turn higher than those in the northeast (0.537) and west (0.438). We next consider potential drivers. Economic development and foreign direct investment (FDI) are positively associated with IEE but appear to show diminishing returns. Environmental enforcement and market for technology are also positively associated with IEE, as expected. The impact of economic development, industrial sector structure, and investment in research and development (R&D) are modified by the stage of industrialization in each region. Targeted measures that can adjust industry structure, enhance environmental enforcement, attract FDI, and increase R&D investment may help further improve IEE in China.
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Affiliation(s)
- Huijing Deng
- Fudan Tyndall Center, Department of Environmental Science & Engineering, Fudan University, Shanghai, 200438, China
| | - Yizhe Zhang
- Fudan Tyndall Center, Department of Environmental Science & Engineering, Fudan University, Shanghai, 200438, China
| | - David Kaczan
- Environment, Natural Resources, and the Blue Economy Global Practice, The World Bank, 1818 H St, Washington D.C, 20433, USA
| | - Yuanbo Qiao
- Institute for County Studies, Shandong University, Qingdao, 266200, China
| | - Xu Wang
- China Center for Information Industry Development Institute, Courtyard 27, Wanshou Road, Haidian District, Beijing, 100036, China
| | - Bin Chen
- Fudan Tyndall Center, Department of Environmental Science & Engineering, Fudan University, Shanghai, 200438, China
| | - Yutao Wang
- Fudan Tyndall Center, Department of Environmental Science & Engineering, Fudan University, Shanghai, 200438, China.
- Institute of Eco-Chongming (IEC), No.3663 Northern Zhongshan Road, Shanghai, 200065, China.
- IRDR International Center of Excellence on Risk Interconnectivity and Governance on Weather, Shanghai, 200438, China.
- Shanghai Institute for Energy and Carbon Neutrality Strategy, Fudan University, Shanghai, 200438, China.
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Dorr E, Hawes JK, Goldstein B, Fargue-Lelièvre A, Fox-Kämper R, Specht K, Fedeńczak K, Caputo S, Cohen N, Poniży L, Schoen V, Górecki T, Newell JP, Jean-Soro L, Grard B. Food production and resource use of urban farms and gardens: a five-country study. Agron Sustain Dev 2023; 43:18. [PMID: 36748098 PMCID: PMC9891751 DOI: 10.1007/s13593-022-00859-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 06/18/2023]
Abstract
UNLABELLED There is a lack of data on resources used and food produced at urban farms. This hampers attempts to quantify the environmental impacts of urban agriculture or craft policies for sustainable food production in cities. To address this gap, we used a citizen science approach to collect data from 72 urban agriculture sites, representing three types of spaces (urban farms, collective gardens, individual gardens), in five countries (France, Germany, Poland, United Kingdom, and United States). We answered three key questions about urban agriculture with this unprecedented dataset: (1) What are its land, water, nutrient, and energy demands? (2) How productive is it relative to conventional agriculture and across types of farms? and (3) What are its contributions to local biodiversity? We found that participant farms used dozens of inputs, most of which were organic (e.g., manure for fertilizers). Farms required on average 71.6 L of irrigation water, 5.5 L of compost, and 0.53 m2 of land per kilogram of harvested food. Irrigation was lower in individual gardens and higher in sites using drip irrigation. While extremely variable, yields at well-managed urban farms can exceed those of conventional counterparts. Although farm type did not predict yield, our cluster analysis demonstrated that individually managed leisure gardens had lower yields than other farms and gardens. Farms in our sample contributed significantly to local biodiversity, with an average of 20 different crops per farm not including ornamental plants. Aside from clarifying important trends in resource use at urban farms using a robust and open dataset, this study also raises numerous questions about how crop selection and growing practices influence the environmental impacts of growing food in cities. We conclude with a research agenda to tackle these and other pressing questions on resource use at urban farms. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s13593-022-00859-4.
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Affiliation(s)
- Erica Dorr
- University Paris-Saclay, INRAE-AgroParisTech, UMR SAD-APT, Palaiseau, France
| | - Jason K. Hawes
- School for Environment and Sustainability, University of Michigan, Ann Arbor, MI USA
| | - Benjamin Goldstein
- Department of Bioresource Engineering, McGill University, Ste-Anne-de-Bellevue, Quebec Canada
| | | | - Runrid Fox-Kämper
- ILS Research Institute for Regional and Urban Development, Dortmund, Germany
| | - Kathrin Specht
- ILS Research Institute for Regional and Urban Development, Dortmund, Germany
| | - Konstancja Fedeńczak
- Faculty of Human Geography and Planning, Department of Integrated Geography, Adam Mickiewicz University, Poznań, Poland
| | - Silvio Caputo
- School of Architecture and Planning, University of Kent, Canterbury, UK
| | - Nevin Cohen
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY USA
| | - Lidia Poniży
- Faculty of Human Geography and Planning, Department of Integrated Geography, Adam Mickiewicz University, Poznań, Poland
| | - Victoria Schoen
- Centre for Agroecology, Water, and Resilience (CAWR), Coventry University, Coventry, UK
| | - Tomasz Górecki
- Faculty of Mathematics and Computer Science, Adam Mickiewicz University, Poznań, Poland
| | - Joshua P. Newell
- School for Environment and Sustainability, University of Michigan, Ann Arbor, MI USA
| | - Liliane Jean-Soro
- University Gustave Eiffel, GERS-LEE, F-44344 Bouguenais, France
- IRSTV-FR CNRS 2488, Ecole Centrale de Nantes, Nantes, France
| | - Baptiste Grard
- University Paris-Saclay, INRAE-AgroParisTech, UMR ECOSYS, Palaiseau, France
- ISARA, Agroecology and Environment Research Unit, Lyon, France
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Artime E, Serra E, Mert C, Díaz-Cerezo S, Huete T, Hernández-Subirá I, Lledo-Bryant L, Sicras-Mainar A. Real-World Treatment Patterns, Resource Use and Costs in Adult Patients With Atopic Dermatitis Receiving Systemic Treatment: Derma-Atopic Study in Spain. Actas Dermosifiliogr 2023; 114:9-18. [PMID: 36030827 DOI: 10.1016/j.ad.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 07/27/2022] [Accepted: 08/08/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Moderate-severe atopic dermatitis (AD) has a significant impact on patients' lives, with many requiring systemic treatment to manage symptoms (e.g., pruritus). Several drugs are used off-label to treat AD. This study describes sociodemographic/clinical characteristics, treatment patterns, health resource use (HRU) and costs in adults with AD who initiated systemic treatment or phototherapy in routine practice. METHODS This retrospective observational study of electronic medical records in the BIG-PAC database identified adults with prior diagnosis of AD (ICD-9: 691.8 or 692.9) starting oral corticosteroids, immunosuppressants, biologics or phototherapy between 01/01/2012 and 31/12/2016. Patients were followed for 3 years from treatment initiation, up to 31/12/2019. Data on patient characteristics, treatment patterns, HRU and costs were analyzed descriptively. RESULTS Patients (N=1995) had a mean age of 60 years, 64% were female, with a mean time of 23 years since diagnosis (84% were ≥18 years at AD onset). Main comorbidities were anxiety (38%), arterial hypertension (36%) and dyslipidemia (35%). Most patients used oral corticosteroids as first systemic (84%; median duration 29 days) and immunosuppressants in 13% of patients (median duration 117 days, 5% cyclosporine and 4% methotrexate). Half of patients required a second line systemic and 12% a third line. The use of immunosuppressants and biologics increased with treatment lines. About 13% of patients received systemic treatments continuously over the 3-year follow-up. The average 3-year per patient cost was 3835 euros, with an average annual cost of 1278 euros. CONCLUSIONS Results suggest a high comorbidity and economic burden in this real-world adult population with AD, and the need for systemic treatments indicated for use in AD.
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Affiliation(s)
- E Artime
- Medical Department, Lilly, Madrid, Spain.
| | - E Serra
- Dermatology Service, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - C Mert
- HaaPacs GmbH, Schriesheim, Germany
| | | | - T Huete
- Medical Department, Lilly, Madrid, Spain
| | | | - L Lledo-Bryant
- Health Economics and Outcomes Research, Barcelona, Spain
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11
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Prada SI, Pulgarín-Rodríguez E, Hincapié-Zapata L, Pizarro AB. A comparison of resource use of insured and uninsured venezuelan migrants: evidence from the hospital setting. J Immigr Minor Health 2023; 25:123-128. [PMID: 35594001 PMCID: PMC9121081 DOI: 10.1007/s10903-022-01369-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 02/24/2022] [Accepted: 05/04/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND There is no characterization of resource use in the hospital setting for immigrants in Colombia, we aimed to describe the resource use by Venezuelan immigrants, comparing those enrolled in the national health insurance system with those with and without the ability to pay. METHODS Retrospective review in the billing data system of our Hospital from 2011 to 2020. We collected information for 6,837 hospital episodes associated with 1,022 Venezuelan patients, hospital's billing information for all services rendered was extracted. RESULTS The mean cost per patient event were 4,595 USD for those without the ability to pay, costing 2.37 times more than a legal resident insured. Care in the ICU, inpatient days, surgery, and OB-GYN department consume most resources provided to vulnerable migrants. DISCUSSION Enrolment in the national health insurance may allow better access to health services by vulnerable Venezuelan migrants and thus reduce resource use for the health system.
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Affiliation(s)
- Sergio I. Prada
- Centro de Investigación e Innovación, Fundación Valle del Lili, Cra. 98 # 18-49., 760026 Cali, Colombia
| | | | | | - Ana Beatriz Pizarro
- Centro de Investigación e Innovación, Fundación Valle del Lili, Cra. 98 # 18-49., 760026 Cali, Colombia
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Artime E, Serra E, Mert C, Díaz-Cerezo S, Huete T, Hernández-Subirá I, Lledo-Bryant L, Sicras-Mainar A. Real-World Treatment Patterns, Resource Use and Costs in Adult Patients With Atopic Dermatitis Receiving Systemic Treatment: Derma-Atopic Study in Spain. Actas Dermosifiliogr 2023; 114:T9-T18. [PMID: 36368579 DOI: 10.1016/j.ad.2022.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 08/08/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Moderate-severe atopic dermatitis (AD) has a significant impact on patients' lives, with many requiring systemic treatment to manage symptoms (e.g., pruritus). Several drugs are used off-label to treat AD. This study describes sociodemographic/clinical characteristics, treatment patterns, health resource use (HRU) and costs in adults with AD who initiated systemic treatment or phototherapy in routine practice. METHODS This retrospective observational study of electronic medical records in the BIG-PAC database identified adults with prior diagnosis of AD (ICD-9: 691.8 or 692.9) starting oral corticosteroids, immunosuppressants, biologics or phototherapy between 01/01/2012 and 31/12/2016. Patients were followed for 3 years from treatment initiation, up to 31/12/2019. Data on patient characteristics, treatment patterns, HRU and costs were analyzed descriptively. RESULTS Patients (N = 1995) had a mean age of 60 years, 64% were female, with a mean time of 23 years since diagnosis (84% were ≥18 years at AD onset). Main comorbidities were anxiety (38%), arterial hypertension (36%) and dyslipidemia (35%). Most patients used oral corticosteroids as first systemic (84%; median duration 29 days) and immunosuppressants in 13% of patients (median duration 117 days, 5% cyclosporine and 4% methotrexate). Half of patients required a second line systemic and 12% a third line. The use of immunosuppressants and biologics increased with treatment lines. About 13% of patients received systemic treatments continuously over the 3-year follow-up. The average 3-year per patient cost was 3835 euros, with an average annual cost of 1278 euros. CONCLUSIONS Results suggest a high comorbidity and economic burden in this real-world adult population with AD, and the need for systemic treatments indicated for use in AD.
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Affiliation(s)
- E Artime
- Departamento Médico, Lilly, Madrid, España.
| | - E Serra
- Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - C Mert
- SpaincHaaPacs GmbH, Schriesheim, Alemania
| | | | - T Huete
- Departamento Médico, Lilly, Madrid, España
| | | | - L Lledo-Bryant
- Health Economics and Outcomes Research, Atrys Health, Barcelona, España
| | - A Sicras-Mainar
- Health Economics and Outcomes Research, Atrys Health, Madrid, España
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Simon J, Wienand D, Park AL, Wippel C, Mayer S, Heilig D, Laszewska A, Stelzer I, Goodwin GM, McDaid D. Excess resource use and costs of physical comorbidities in individuals with mental health disorders: A systematic literature review and meta-analysis. Eur Neuropsychopharmacol 2023; 66:14-27. [PMID: 36345094 DOI: 10.1016/j.euroneuro.2022.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/28/2022] [Accepted: 10/01/2022] [Indexed: 11/06/2022]
Abstract
Individuals with mental health disorders (MHDs) have worse physical health than the general population, utilise healthcare resources more frequently and intensively, incurring higher costs. We provide a first comprehensive overview and quantitative synthesis of literature on the magnitude of excess resource use and costs for those with MHDs and comorbid physical health conditions (PHCs). This systematic review (PROSPERO CRD42017075319) searched studies comparing resource use or costs of individuals with MHDs and comorbid PHCs versus individuals without comorbid conditions published between 2007 and 2021. We conducted narrative and quantitative syntheses, using random-effects meta-analyses to explore ranges of excess resource use and costs across care segments, comparing to MHD only, PHC only, or general population controls (GPC). Of 20,075 records, 228 and 100 were eligible for narrative and quantitative syntheses, respectively. Most studies were from the US, covered depression or schizophrenia, reporting endocrine/metabolic or circulatory comorbidities. Frequently investigated healthcare segments were inpatient, outpatient, emergency care and medications. Evidence on lost productivity, long-term and informal care was rare. Substantial differences exist between MHDs, with depressive disorder tending towards lower average excess resource use and cost estimates, while excess resource use ranges between +6% to +320% and excess costs between +14% to +614%. PHCs are major drivers of resource use and costs for individuals with MHDs, affecting care segments differently. Significant physical health gains and cost savings are potentially achievable through prevention, earlier identification, management and treatment, using more integrated care approaches. Current international evidence, however, is heterogeneous with limited geographical representativeness and comparability.
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Affiliation(s)
- Judit Simon
- Department of Health Economics, Center of Public Health, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute Applied Diagnostics, Vienna, Austria; Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom.
| | - Dennis Wienand
- Department of Health Economics, Center of Public Health, Medical University of Vienna, Vienna, Austria
| | - A-La Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Christoph Wippel
- Department of Health Economics, Center of Public Health, Medical University of Vienna, Vienna, Austria
| | - Susanne Mayer
- Department of Health Economics, Center of Public Health, Medical University of Vienna, Vienna, Austria
| | - Daniel Heilig
- Department of Health Economics, Center of Public Health, Medical University of Vienna, Vienna, Austria
| | - Agata Laszewska
- Department of Health Economics, Center of Public Health, Medical University of Vienna, Vienna, Austria
| | - Ines Stelzer
- Ludwig Boltzmann Institute Applied Diagnostics, Vienna, Austria
| | - Guy M Goodwin
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
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Ikonne U, Brodie A, Bay C, Campbell A. Frequency of Student Resource Use and Academic Performance in Preclerkship Education: A Survey Study. Med Sci Educ 2022; 32:1465-1479. [PMID: 36407815 PMCID: PMC9648453 DOI: 10.1007/s40670-022-01674-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 06/16/2023]
Abstract
Medical students have unprecedented access to a large variety of learning resources, but patterns of resource use, differences in use across education cohorts, and the relationship between resource use and academic performance are unclear. Therefore, the purpose of the current study was to evaluate student resource use and its relationship to academic performance during preclerkship years. First-year and second-year medical students completed a 10-question electronic survey that assessed likelihood of using outside resources recommended by others, reasons for using outside resources, frequency of use of resources, and use of outside resources for specific disciplines. Outcomes were compared between the 2 cohorts of students. First-year students were more likely to use instructor-produced resources and self-generated study resources, and second-year students were more likely to use board review resources. Although differences were found between cohorts for frequency of use of certain resources, correlations between resource use and academic performance were modest. Overall, our results indicated that student use of study resources changed between the first and second years of medical school. These results suggest opportunities for medical educators to guide students in the selection and effective use of outside resources as they mature as self-regulated learners. Further, since students seem to extensively use external resources for learning, institutions should consider calibrating their curriculum and teaching methods to this learning style and providing high-quality, accessible resource materials for all students to reduce the potential impact of socioeconomic factors on student performance.
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Affiliation(s)
- Uzoma Ikonne
- Department of Physiological Sciences, Eastern Virginia Medical School, 700 W. Olney Rd, Norfolk, VA USA
- Fine Family Academy of Medical Educators, Eastern Virginia Medical School, P.O. Box 1980, Norfolk, VA USA
| | - Adrienne Brodie
- A.T. Still Memorial Library, A.T. Still University, 5850 E. Still Circle, Mesa, AZ USA
| | - Curt Bay
- Department of Interdisciplinary Health Sciences, Arizona School of Health Sciences, A.T. Still University, 5850 E. Still Circle, Mesa, AZ USA
| | - Anna Campbell
- Department of Anatomy, School of Osteopathic Medicine in Arizona, A.T. Still University, 5850 E. Still Circle, Mesa, AZ USA
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Seidel D, Lefering R. NPWT resource use compared with standard moist wound care in diabetic foot wounds: DiaFu randomized clinical trial results. J Foot Ankle Res 2022; 15:72. [PMID: 36180953 PMCID: PMC9524075 DOI: 10.1186/s13047-022-00569-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 08/24/2022] [Indexed: 11/21/2022] Open
Abstract
Background Diabetic foot ulcers not only have a negative impact on patient mortality, morbidity and quality of life, but also require high resource utilization to achieve complete wound healing. The aim of this evaluation was to compare resource utilization of negative pressure wound therapy (NPWT) and standard moist wound care (SMWC) for diabetic foot wounds after amputation, surgical debridement or wound cleansing. Methods The multicenter clinical DiaFu study enrolled 368 adults with diabetic foot ulcers between December 23, 2011 and October 21, 2014. Patients were randomly assigned to NPWT and SMWC. Evaluation of direct resource use comprised inpatient and outpatient treatment time, and personnel and material for wound treatment within 16 weeks. This resource use analysis was primarily based on the per protocol population (NPWT 44; SMWC 110). Results Treatment duration was 16 days shorter with NPWT (mean (SD) 82.8 (31.6), SMWC 98.8 (24.6); U test, p = 0.001) with 14.9 days shorter outpatient treatment (mean (SD) NPWT 68.3 (31.1), SMWC 83.2 (29.7)). The number of dressing changes per study participant was lower with NPWT (mean (SD) 35.1 (18.6), SMWC (42.9 (21.4); U test, p = 0.067). Time per dressing change was significantly lower with SMWC (mean (SD) 19.7 (12.8), NPWT (16.5 (8.2) minutes; U test, p < < 0.0001). Time for surgical debridements per study participant was 23.3 minutes shorter with NPWT (mean (SD) 20.5 (20.5), SMWC (43.8 (46.7); U test, p = 0.395). Conclusions Resource use was lower for NPWT, which may be an efficient treatment alternative to SMWC for diabetic foot wounds, to be demonstrated in subsequent cost analyses. Trial registration clinicaltrials.govNCT01480362 on November 28, 2011 Supplementary Information The online version contains supplementary material available at 10.1186/s13047-022-00569-w.
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Affiliation(s)
- Dörthe Seidel
- Institut für Forschung in der Operativen Medizin (IFOM), University of Witten/Herdecke, Ostmerheimerstraße 200 Haus 38, 51109, Köln, Germany.
| | - Rolf Lefering
- Institut für Forschung in der Operativen Medizin (IFOM), University of Witten/Herdecke, Ostmerheimerstraße 200 Haus 38, 51109, Köln, Germany
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Chaudhary D, Bhat B, Shields GE, Davies LM, Green J, Verghis T, Roy R, Kumar D, Kakra M, Vajaratkar V, Lall G, Pandey S, Johri S, Shakeel S, Patel V, Juneja M, Gulati S, Divan G. Development of a cost of illness inventory questionnaire for children with autism spectrum disorder in South Asia. BMC Health Serv Res 2022; 22:1137. [PMID: 36076224 PMCID: PMC9461098 DOI: 10.1186/s12913-022-08508-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 08/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The economic burden of autism is substantial and includes a range of costs, including healthcare, education, productivity losses, informal care and respite care, among others. In India, approximately, 2 million children aged 2-9 years have autism. Given the likely substantial burden of illness and the need to identify effective and cost-effective interventions, this research aimed to produce a comprehensive cost of illness inventory (COII) suitable for children with autism in South Asia (India) to support future research. METHODS A structured and iterative design process was followed to create the COII, including literature reviews, interviews with caregivers, pilot testing and translation. Across the development of the COII, thirty-two families were involved in the design and piloting of the tool. The COII was forward translated (from English to Hindi) and back translated. Each stage of the process of development of the COII resulted in the further refinement of the tool. RESULTS Domains covered in the final COII include education, childcare, relocation, healthcare contacts (outpatient, inpatient, medical emergencies, investigations and medication), religious retreats and rituals, specialist equipment, workshops and training, special diet, support and care, certification, occupational adjustments and government rebates/schemes. Administration and completion of the COII determined it to be feasible to complete in 35 minutes by qualified and trained researchers. The final COII is hosted by REDCap Cloud and is a bilingual instrument (Hindi and English). CONCLUSIONS The COII was developed using experiences gathered from an iterative process in a metropolitan area within the context of one low- and middle-income country (LMIC) setting, India. Compared to COII tools used for children with autism in high-income country settings, additional domains were required, such as complimentary medication (e.g. religious retreats and homeopathy). The COII will allow future research to quantify the cost of illness of autism in India from a broad perspective and will support relevant economic evaluations. Understanding the process of developing the questionnaire will help researchers working in LMICs needing to adapt the current COII or developing similar questionnaires.
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Affiliation(s)
- Divya Chaudhary
- Sangath, House No 451 (168), Bhatkar Waddo, Socorro, Porvorim, Bardez, Goa, 403501, India
| | - Bhargav Bhat
- Sangath, House No 451 (168), Bhatkar Waddo, Socorro, Porvorim, Bardez, Goa, 403501, India
| | | | | | | | - Tara Verghis
- Sangath, House No 451 (168), Bhatkar Waddo, Socorro, Porvorim, Bardez, Goa, 403501, India
| | - Reetabrata Roy
- Sangath, House No 451 (168), Bhatkar Waddo, Socorro, Porvorim, Bardez, Goa, 403501, India
| | - Divya Kumar
- Sangath, House No 451 (168), Bhatkar Waddo, Socorro, Porvorim, Bardez, Goa, 403501, India
| | - Minal Kakra
- Sangath, House No 451 (168), Bhatkar Waddo, Socorro, Porvorim, Bardez, Goa, 403501, India
| | | | - Gitanjali Lall
- Sangath, House No 451 (168), Bhatkar Waddo, Socorro, Porvorim, Bardez, Goa, 403501, India
| | - Sonakshi Pandey
- Sangath, House No 451 (168), Bhatkar Waddo, Socorro, Porvorim, Bardez, Goa, 403501, India
| | - Sanchita Johri
- Sangath, House No 451 (168), Bhatkar Waddo, Socorro, Porvorim, Bardez, Goa, 403501, India
| | - Saani Shakeel
- Sangath, House No 451 (168), Bhatkar Waddo, Socorro, Porvorim, Bardez, Goa, 403501, India
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
| | - Monica Juneja
- Maulana Azad Medical College and Assoc. Lok Nayak Hospital (MAMC), New Delhi, India
| | | | - Gauri Divan
- Sangath, House No 451 (168), Bhatkar Waddo, Socorro, Porvorim, Bardez, Goa, 403501, India.
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Peres IT, Hamacher S, Oliveira FLC, Bozza FA, Salluh JIF. Data-driven methodology to predict the ICU length of stay: A multicentre study of 99,492 admissions in 109 Brazilian units. Anaesth Crit Care Pain Med 2022; 41:101142. [PMID: 35988701 DOI: 10.1016/j.accpm.2022.101142] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 06/25/2022] [Accepted: 06/25/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE The length of stay (LoS) is one of the most used metrics for resource use in Intensive Care Units (ICU). We propose a structured data-driven methodology to predict the ICU length of stay and the risk of prolonged stay, and its application in a large multicenter Brazilian ICU database. METHODS Demographic data, comorbidities, complications, laboratory data, and primary and secondary diagnosis were prospectively collected and retrospectively analysed by a data-driven methodology, which includes eight different machine learning models and a stacking model. The study setting included 109 mixed-type ICUs from 38 Brazilian hospitals and the external validation was performed by 93 medical-surgical ICUs of 55 hospitals in Brazil. RESULTS A cohort of 99,492 adult ICU admissions were included from the 01st of January to the 31st of December 2019. The stacking model combining Random Forests and Linear Regression presented the best results to predict ICU length of stay (RMSE = 3.82; MAE = 2.52; R² = 0.36). The prediction model for the risk of long stay were accurate to early identify prolonged stay patients (Brier Score = 0.04, AUC = 0.87, PPV = 0.83, NPV = 0.95). CONCLUSION The data-driven methodology to predict ICU length of stay and the risk of long-stay proved accurate in a large multicentre cohort of general ICU patients. The proposed models are helpful to predict the individual length of stay and to early identify patients with high risk of prolonged stay.
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Affiliation(s)
- Igor Tona Peres
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Silvio Hamacher
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Fernando Augusto Bozza
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil; IDOR, D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil
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Sicras-Mainar A, Sicras-Navarro A, Palacios B, Sequera M, Blanco J, Hormigo A, Manito N, Alcázar-Arroyo R, Botana-Lopez MA. Epidemiology and resource use in Spanish type 2 diabetes patients without previous cardiorenal disease: CaReMe Spain study summary. ENDOCRINOL DIAB NUTR 2022; 69:509-519. [PMID: 36084988 DOI: 10.1016/j.endien.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/10/2021] [Indexed: 06/15/2023]
Abstract
AIMS To determine the first manifestation of cardiovascular or kidney disease (CVKD) and associated resource use in type 2 diabetes mellitus (T2DM) patients during seven years of follow-up. METHODS Observational-retrospective secondary data study using medical records of patients aged ≥18 years with T2DM and without prior CVKD between 2013 and 2019. The index date was 01/01/2013 (fixed date). The manifestation of CVKD was defined by the first diagnosis of heart-failure (HF), chronic-kidney disease (CKD), myocardial-infarction (MI), stroke or peripheral-artery disease (PAD). The main variables were baseline characteristics, manifestation of CVKD, mortality, resource use and costs. Descriptive analyses and Cox model were applied to the data. RESULTS 26,542 patients were selected (mean age: 66.6 years, women: 47.8%, mean duration of T2DM: 17.1 years). 18.7% (N=4974) developed a first CVKD manifestation during the seven years [distribution: HF (22.4%), CKD (36.6%), MI (14.5%), stroke (15.3%) and PAD (11.3%)]. Overall mortality was 8.3% (N=2214). The mortality risk of the group that developed HF or CKD as the first manifestation compared to the CVKD-free cohort was higher [HR: 2.5 (95% CI: 1.8-3.4) and 1.8 (95% CI: 1.4-2.3)], respectively. The cumulative costs per patient of HF (€50,942.80) and CKD (€48,979.20) were higher than MI (€47,343.20) and stroke (€47,070.30) and similar to PAD (€51,240.00) vs. €13,098.90 in patients who did not develop CVKD, p<0.001. CONCLUSIONS In T2DM patients, HF and CKD were the first most common manifestations and had higher mortality and re-hospitalisation rates. HF and CKD were associated with the highest resource use and costs for the Spanish National-Health-System.
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Affiliation(s)
| | | | | | | | | | - Antonio Hormigo
- Dirección Médica, Centro de Salud de San Andrés-Torca, Málaga, Spain
| | - Nicolas Manito
- Bellvitge Hospital, Hospitalet de Llobregat, Barcelona, Spain
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Baker HK, Bruggeman CEF, Shurin JB. Population niche width is driven by within-individual niche expansion and individual specialization in introduced brook trout in mountain lakes. Oecologia 2022; 200:1-10. [PMID: 35661919 PMCID: PMC9547792 DOI: 10.1007/s00442-022-05201-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/21/2022] [Indexed: 11/02/2022]
Abstract
The width of a population's resource-use niche is determined by individual diet breadth ("within-individual component") and the degree of niche partitioning between individuals ("between-individual component"). The balance between these two factors affects ecological stability and evolutionary trajectories, and may shift as ecological opportunity permits broader population niches. Lakes in California's Sierra Nevada Mountains vary in resource diversity for introduced brook trout (Salvelinus fontinalis) due to elevation, lake morphometry, and watershed features. We compared the relative contributions of within- and between-individual niche components to two measures of the dietary niches of thirteen populations of brook trout: prey taxonomic composition and prey size distribution. For both taxonomic and size diversity of fish diets, population niche width was positively related to both the within- and between-individual components. For taxonomic diversity, the two components increased in parallel, while for size diversity, the between-individual component became more important relative to the within-individual component in populations with the greatest niche widths. Our results support the Niche Variation Hypothesis that populations with broader niches are more heterogeneous among individuals and show that individual niche width and individual specialization can operate in parallel to expand the population niche.
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Affiliation(s)
- H K Baker
- Department of Ecology, Behavior, and Evolution, University of California San Diego, La Jolla, CA, 92093, USA.
| | - C E F Bruggeman
- Department of Ecology, Behavior, and Evolution, University of California San Diego, La Jolla, CA, 92093, USA
| | - J B Shurin
- Department of Ecology, Behavior, and Evolution, University of California San Diego, La Jolla, CA, 92093, USA
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Yong AYP, Lim SSL. Coexistence of Juvenile with Adult Ocypode gaudichaudii at Culebra Beach, Panama: A Temporal-spatial Partitioning Compromise. Zool Stud 2022; 60:e8. [PMID: 35774260 PMCID: PMC9168729 DOI: 10.6620/zs.2022.61-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 01/28/2022] [Indexed: 06/15/2023]
Abstract
The temporal-spatial resource use patterns of juvenile and adult Ocypode gaudichaudii were studied by comparing the zonation patterns and activity budgets of the two life stages at Culebra Beach, Panama. Burrow distribution of the crabs during the day and at night was studied over six months. Diurnal activity budgets of 46 crabs (22 juveniles and 24 adults) were determined by observing seven predominant behaviors upon emergence from their respective burrows when the burrow zone is uncovered after the tide recedes. The behaviors comprise three foraging-related activities (i.e., deposit-feeding, scavenging, and probing for food), the maintenance of burrow, walking, staying within the burrow, and resting at the burrow entrance. Juvenile crabs occupied a higher intertidal zone than the adults and had a higher emergence rate at night. This temporal-spatial habitat partitioning could possibly reduce intraspecific competition between the two life stages, thereby enabling their coexistence in the habitat as well as increasing the survival rate of the juveniles, potentially raising the carrying capacity of the population at Culebra Beach. All 46 crabs-regardless of life stage-spent the highest mean proportion of time on foraging-related activities. Out of the three feeding-related behaviors, adults spent most time on deposit-feeding while juveniles spent most time probing. Only juveniles scavenged. In both life stages, a similar proportion of time was spent maintaining the burrow and staying within the burrow.
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Affiliation(s)
- Adeline Y P Yong
- Ecology Lab, Natural Sciences and Science Education, NIE, Nanyang Technological University, 1 Nanyang Walk, Singapore 637616, Republic of Singapore. E-mail: ; (Lim); (Yong)
| | - Shirley S L Lim
- Ecology Lab, Natural Sciences and Science Education, NIE, Nanyang Technological University, 1 Nanyang Walk, Singapore 637616, Republic of Singapore. E-mail: ; (Lim); (Yong)
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Thomas SM, Reindorp Y, Christophe BR, Connolly ES. Systematic Review of Resource Use and Costs in the Hospital Management of Intracerebral Hemorrhage. World Neurosurg 2022; 164:41-63. [PMID: 35489599 DOI: 10.1016/j.wneu.2022.04.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND While clinical guidelines provide a framework for hospital management of spontaneous intracerebral hemorrhage (ICH), variation in the resource use and costs of these services exists. We sought to perform a systematic literature review to assess the evidence on hospital resource use and costs associated with management of adult patients with ICH, as well as identify factors that impact variation in such hospital resource use and costs, regarding clinical characteristics and delivery of services. METHODS A systematic literature review was performed using PubMed, Cochrane Central Register of Controlled Trials, and Ovid MEDLINE(R) 1946 to present. Articles were assessed against inclusion and exclusion criteria. Study design, ICH sample size, population, setting, objective, hospital characteristics, hospital resource use and cost data, and main study findings were abstracted. RESULTS In total, 43 studies met the inclusion criteria. Pertinent clinical characteristics that increased hospital resource use included presence of comorbidities and baseline ICH severity. Aspects of service delivery that greatly impacted hospital resource consumption included intensive care unit length of stay and performance of surgical procedures and intensive care procedures. CONCLUSIONS Hospital resource use and costs for patients with ICH were high and differed widely across studies. Making concrete conclusions on hospital resources and costs for ICH care was constrained, given methodologic and patient variation in the studies. Future research should evaluate the long-term cost-effectiveness of ICH treatment interventions and use specific economic evaluation guidelines and common data elements to mitigate study variation.
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Affiliation(s)
- Steven Mulackal Thomas
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, New York, USA.
| | - Yarin Reindorp
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Brandon R Christophe
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Edward Sander Connolly
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, New York, USA
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22
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Weber S, Scott JG, Chatterton ML. Healthcare costs and resource use associated with negative symptoms of schizophrenia: A systematic literature review. Schizophr Res 2022; 241:251-259. [PMID: 35180664 DOI: 10.1016/j.schres.2022.01.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 01/09/2022] [Accepted: 01/22/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To identify and describe the available literature quantifying the economic burden associated with the negative symptoms of schizophrenia. METHODS A search of five electronic databases (Medline, PsycINFO, EconLit, CINAHL, EMBASE) and hand searches of bibliographies was conducted to identify all relevant articles written in English and published from date of database inception to January 2021. Search strategies included terms for schizophrenia, negative symptoms, direct and indirect costs and health-care resource utilisation. Quality assessment of included articles was undertaken using a standardised checklist for the evaluation of cost of illness studies. Annual costs were converted to 2022 Australian dollars (A$). RESULTS Four hundred and thirty-six abstracts were identified for inclusion. Following screening, six unique studies utilizing data from 6293 participants with an average age of 40 were identified to inform the review. Study quality was high for four studies. All studies concluded there was a positive relationship between negative symptoms and costs or resource utilisation. Four studies providing cost data show an increase in direct costs per annum associated with negative symptoms (range A$ 4046 to 171,564). The wide range in costs was attributable to between study differences in patient characteristics and cohorts, included costs, and country of study. CONCLUSION Health care costs and resource utilisation are associated with negative symptoms in people with schizophrenia. Heterogeneity prevented calculation of an overall dollar value per point increase in negative symptoms. Future research is warranted to further quantify the relationship between negative symptoms and costs, including health sector and societal.
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Affiliation(s)
- Sharon Weber
- Deakin University, Faculty of Health, Institute for Health Transformation, Geelong, Australia
| | - James G Scott
- Mental Health Program, QIMR Medical Research Institute, Brisbane, Australia; Metro North Mental Health Service, Herston, Brisbane, Australia
| | - Mary Lou Chatterton
- Deakin University, Faculty of Health, Institute for Health Transformation, Geelong, Australia.
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Smith RL, Takkellapati S, Riegerix RC. Recycling of Plastics in the United States: Plastic Material Flows and Polyethylene Terephthalate (PET) Recycling Processes. ACS Sustain Chem Eng 2022; 10:2084-2096. [PMID: 35425669 PMCID: PMC9004285 DOI: 10.1021/acssuschemeng.1c06845] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
As efforts are made toward establishing a circular economy that engages in activities that maintain resources at their highest values for as long as possible, an important aspect is understanding the systems which allow recycling to occur. In this article a common plastic, polyethylene terephthalate, i.e., PET or plastic #1, has been studied because it is recycled at relatively high rates in the U.S. as compared to other plastics. A material flow analysis is described for PET resin showing materials collected, reclaimed for flake, and converted into items with recycled content. Imports/exports, reclaimer residue, and disposal with mismanaged waste are all shown for U.S. flows of PET. Barriers to recycling PET exist in the collecting, sorting, reclaiming, and converting steps, and this article describes them, offers some solutions, and suggests some research that chemists and engineers could focus on to improve the systems. This effort also models sorting at material recovery facilities (MRF) and reclaimers, with detailed descriptions of the material streams involved, to characterize the resource use and emissions from these operations that are key processes in the recycling system. Example results include greenhouse gas intensities of 8.58 kg CO2 equiv per ton of MRF feed and 103.7 kg CO2 equiv per ton of reclaimer PET bale feed. The results can be used in system analyses for various scenarios and as inputs in economic input-output and life cycle assessments.
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Affiliation(s)
- Raymond L Smith
- U.S. Environmental Protection Agency, Office of Research and Development, Center for Environmental Solutions and Emergency Response, Cincinnati, Ohio 45268, United States
| | - Sudhakar Takkellapati
- U.S. Environmental Protection Agency, Office of Research and Development, Center for Environmental Solutions and Emergency Response, Cincinnati, Ohio 45268, United States
| | - Rachelle C Riegerix
- U.S. Environmental Protection Agency, Office of Land and Emergency Management, Office of Resource Conservation and Recovery, Washington, District of Columbia 20004, United States
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Ribera A, Vela E, García-Altés A, Clèries M, Abilleira S. Trends in healthcare resource use and expenditure before and after ischaemic stroke. A population-based study. Neurologia 2022; 37:21-30. [PMID: 30902459 DOI: 10.1016/j.nrl.2018.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/13/2018] [Accepted: 11/17/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Despite improved survival rates, stroke represents an increasing healthcare and socioeconomic burden. We describe the main characteristics of patients with ischaemic stroke and resource use and associated expenditure one year before and 3 years after stroke, using a population-based dataset. METHODS The information technology systems of the Catalan Health Service were used to identify patients with ischaemic strokes occurring between January 2012 and December 2016. For each patient, information from one year before the stroke and up to 3 years thereafter was linked across databases. We describe annual and monthly resource use and healthcare expenditure per patient. RESULTS We identified 36,044 patients with ischaemic stroke (mean age, 74.7±13.3 years). The survival rate at 3 years was 63%. Average expenditure per patient was €3,230 the year before stroke, €11,060 for year one after stroke, €4,104 for year 2, and €3,878 for year 3. The greatest determinants of cost in year one were hospitalisation (including initial hospitalisation), representing 45% of the difference in expenditure compared to the previous year, and convalescence and rehabilitation services, representing 33% of this difference. After year one, the increase in expenditure was mainly determined by additional hospital admissions and drug treatment. CONCLUSION After ischaemic stroke, healthcare expenditure increases primarily because of initial hospitalisation. After year one, the expenditure decreases but remains above baseline values. Information from population-based datasets is useful for improving the planning of stroke services.
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Affiliation(s)
- A Ribera
- Unidad de Epidemiología Cardiovascular, Hospital Universitario Vall d'Hebron, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Pla Director de la Malaltia Vascular Cerebral, Departament de Salut, Generalitat de Catalunya.
| | - E Vela
- Unitat d'Informació i Coneixement, Servei Català de la Salut, Barcelona, España
| | - A García-Altés
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Agència per la Qualitat i l'Avaluació Sanitària de Catalunya, Departament de Salut, Barcelona, España; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, España
| | - M Clèries
- Unitat d'Informació i Coneixement, Servei Català de la Salut, Barcelona, España
| | - S Abilleira
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Pla Director de la Malaltia Vascular Cerebral, Departament de Salut, Generalitat de Catalunya; Agència per la Qualitat i l'Avaluació Sanitària de Catalunya, Departament de Salut, Barcelona, España
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Davis R, Abebe A, Boyd C, McNevin A. Exploring the relationship between production intensity and land use: A meta-analytic approach with shrimp aquaculture. J Environ Manage 2021; 300:113719. [PMID: 34521002 DOI: 10.1016/j.jenvman.2021.113719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 06/13/2023]
Abstract
Shrimp are one of the fastest growing commodities in aquaculture and have a considerable land footprint. Here, we explored the impact of utilizing different production methods (extensive vs intensive) for expanding shrimp production on the cumulative land footprint of shrimp aquaculture. A meta-analytic approach was utilized to simultaneously estimate model coefficients to explore three relationships: production intensity and total land burden, production intensity and the proportion of land at the farm, and production intensity and the farmland burden. A literature review was conducted and a total of 7 datasets, 22 subsets, and 973 individual farms were included in this study. The global models were as follows: model 1 → ln (total land burden) = 0.1165-0.3863 * ln (production intensity), model 2 → proportion of direct (farm) land use:total land use = 0.7592-0.1737 * ln (production intensity), model 3 → ln (direct land use) = 0.1991-0.9674 * ln (production intensity). Production expansion was modeled under different scenarios. The most land intensive projections involved using only extensive systems to increase production when compared to a business-as-usual scenario. The least land intensive scenario involved utilizing intensive systems. A scenario where farmland was not expanded used 17% less land and 28% less land to produce 7.5 and 10 million tons of shrimp, respectively, when compared to business-as-usual scenarios. These estimates are limited by uncertainty in shrimp feed composition but demonstrate the effect of production intensity on the overall land footprint of shrimp production.
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Affiliation(s)
- Robert Davis
- Auburn University, School of Fisheries, Aquaculture, and Aquatic Sciences, USA.
| | - Ash Abebe
- Auburn University, Department of Mathematics and Statistics, USA
| | - Claude Boyd
- Auburn University, School of Fisheries, Aquaculture, and Aquatic Sciences, USA
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Valero A, Molina J, Nuevo J, Simon S, Capel M, Sicras-Mainar A, Sicras-Navarro A, Plaza V. Economic consequences of the overuse of short-acting beta-adrenergic agonists (SABA) in the treatment of asthma in Spain. J Investig Allergol Clin Immunol 2021; 33:109-118. [PMID: 34825651 DOI: 10.18176/jiaci.0767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND To determine the relationship between short-acting beta-adrenergic agonist (SABA) overuse and healthcare resource use and costs in asthma patients in routine clinical practice. MATERIAL AND METHODS A longitudinal retrospective study in Spanish primary and specialized care using the BIG-PAC® Medical Records Database was conducted. Asthma patients ≥12 years of age who attended ≥ 2 consultations during 2017 and had 1-year follow-up data available were included. Main outcomes were demographics, comorbidities, medication, clinical and healthcare resource use and costs. The relationship between SABA overuseand healthcare costs, and between asthma severity and healthcare costs was determined. RESULTS This SABA use IN Asthma (SABINA) study included 39,555 patients, mean (standard deviation, SD) age 49.8 (20.7) years; 64.2% were female. Charlson comorbidity index was 0.7 (1.0). SABA overuse (≥ 3 canisters/year) was 28.7% (95% CI: 27.7-29.7), with an overall mean number of 3.3 (3.6) canisters/year. Overall, 5.1% of patients were prescribed ≥12 canisters/year. SABA overuse was correlated with healthcare costs (ρ = 0.621; p < 0.001).The adjusted mean annual cost/patient, according to the Global Initiative for Asthma (GINA 2019) classification of asthma severity, was €2,231, €2,345, €2,735, €3,473, and €4,243,for GINA steps 1-5, respectively (p < 0.001). Regardless of asthma severity, SABA overuse yielded a significant increase in healthcare costs per patient and year (€5,702 vs. €1,917, p < 0.001) compared with recommended use (< 2 canisters/year). CONCLUSIONS SABA overuse yields greater costs for the Spanish National Health System. Costs increased according to asthma severity.
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Affiliation(s)
- A Valero
- Sección de Alergología, Servicio de Neumología y Alergia, Hospital Clínic de Barcelona, Spain, Universitat de Barcelona, IDIBAPS, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - J Molina
- CS Francia, Dirección Asistencial Oeste, Fuenlabrada, Madrid, Spain
| | - J Nuevo
- Department of Medical Evidence and Health Economics, AstraZeneca, Madrid, Spain
| | - S Simon
- Department of Medical Evidence and Health Economics, AstraZeneca, Madrid, Spain
| | - M Capel
- Department of Medical Evidence and Health Economics, AstraZeneca, Madrid, Spain
| | - A Sicras-Mainar
- Health Economics and Outcomes Research, Real Life Data, Badalona, Barcelona, Spain
| | - A Sicras-Navarro
- Health Economics and Outcomes Research, Real Life Data, Badalona, Barcelona, Spain
| | - V Plaza
- Servei de Pneumologia i Al•lèrgia, Hospital de la Santa Creu i Sant Pau, Institut d´Investigació Biomèdica Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
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Nejati M, Razavi M, Harirchi I, Zanganeh M, Salari G, Tabatabaee SM. Resource Use and Costs Associated to the Initial Phase of Treatment for Patients with Colorectal Cancer Receiving Post-Surgery Chemotherapy: A Cost Analysis from a Healthcare Perspective. Iran J Public Health 2021; 50:1887-1896. [PMID: 34722385 PMCID: PMC8542811 DOI: 10.18502/ijph.v50i9.7062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/22/2020] [Indexed: 12/09/2022]
Abstract
Background: To estimate the resource use and costs associated to the initial phase of treatment for colorectal cancer in Iran. Methods: A retrospective study was conducted using routinely collected data within Electronic Health Records System (SEPAS), a national database representing public hospitals in Iran between March 20, 2016 and March 19, 2017. Primary end points included healthcare resource use, direct medical and non-medical costs of care in the 12-month study period. Results: The study population included 657 patients with colorectal cancer who underwent surgery and the follow-up chemotherapy. We estimated a total direct cost of $21,407 per patient. The results indicated that direct medical costs were primarily driven by inpatient hospital care, followed by surgery, chemotherapy, and diagnostic services. Conclusion: The initial 12-month of treatment for colorectal cancer, including surgery and the follow-up chemotherapy, is resource intensive. The total direct costs associated to the disease are remarkable, with Inpatient hospital services being the main contributor followed by surgery and chemotherapy.
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Affiliation(s)
- Mina Nejati
- The Cancer Institute at Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Moaven Razavi
- The Schneider Institutes for Health Policy at the Heller School of Brandeis University, Waltham, MA, USA
| | - Iraj Harirchi
- The Cancer Institute at Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Marzieh Zanganeh
- Deputy of Medical Affairs, Ministry of Health and Medical Education, Tehran, Iran
| | - Gholamreza Salari
- Iran Small Businesses and Industrial Parks Organization, Qazvin, Iran
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Kale HP, Qureshi ZP, Shah R, Khandker R, Botteman M, Meng W, Benca R. Changes in Healthcare Resource Use and Costs in Commercially Insured Insomnia Patients Initiating Suvorexant. Adv Ther 2021; 38:5221-5237. [PMID: 34463922 PMCID: PMC8478735 DOI: 10.1007/s12325-021-01891-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/06/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Insomnia diagnosis has been associated with a significant clinical and economic burden on patients and healthcare systems. This study examined changes in healthcare resource use (HCRU) and costs in insomnia patients before and after initiation of suvorexant treatment. METHODS This retrospective cohort study analyzed Optum Clinformatics Data Mart claims data (Jan 2010-Dec 2018). Patients with ≥ 2 insomnia diagnosis claims and ≥ 1 prescription for suvorexant were included. Prevalent and incident insomnia patients were analyzed separately. The change in the trends of HCRU and costs were examined for 12 months before and 12 months after suvorexant initiation. An interrupted time series (ITS) analysis was conducted to assess the level and slope changes. Subgroups of patients with mental health comorbidities were examined. RESULTS The study included 18,919 and 5939 patients in the prevalent and incident insomnia cohorts, respectively. For the prevalent cohort, mean (SD) age was 64.5 (14.1) years, 65% were female, 74% had Medicare Advantage coverage, and 61% had a Charlson comorbidity index score ≥ 1. Characteristics for the incident cohort were similar. The ITS results suggested that the trend for monthly total healthcare cost (THC) was increasing before suvorexant initiation (US$52.51 in the prevalent cohort, $74.93 in incident insomnia cohort), but, after suvorexant initiation, the monthly total cost showed a decreasing trend in both cohorts. The decrease in slope for THC after suvorexant initiation were $72.66 and $112.07 per month in the prevalent and incident cohorts, respectively. The monthly trends in HCRU rates also decreased. The subgroup analysis showed that decreases were 1.5-3 times greater for patients with mental health comorbidities. CONCLUSIONS In this real-world study, suvorexant initiation was associated with immediate and continued decreases in HCRU and costs in insomnia patients. Further research is needed to understand the effect of suvorexant initiation on direct medical costs as well as costs associated with lost productivity in other real-world settings.
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Affiliation(s)
| | - Zaina P Qureshi
- Merck & Co., Inc, 2000 Galloping Hill Rd, Kenilworth, NJ, USA.
| | - Ruchit Shah
- OPEN Health Evidence & Access, Bethesda, MD, USA
| | - Rezaul Khandker
- Merck & Co., Inc, 2000 Galloping Hill Rd, Kenilworth, NJ, USA
| | | | - Weilin Meng
- Merck & Co., Inc, 2000 Galloping Hill Rd, Kenilworth, NJ, USA
| | - Ruth Benca
- University of California, Irvine, Irvine, CA, USA
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Ribera A, Vela E, García-Altés A, Clèries M, Abilleira S. Trends in healthcare resource use and expenditure before and after ischaemic stroke. A population-based study. Neurologia (Engl Ed) 2021; 37:21-30. [PMID: 34538775 DOI: 10.1016/j.nrleng.2018.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/17/2018] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Despite improved survival rates, stroke represents an increasing healthcare and socioeconomic burden. We describe the main characteristics of patients with ischaemic stroke and resource use and associated expenditure one year before and 3 years after stroke, using a population-based dataset. METHODS The information technology systems of the Catalan Health Service were used to identify patients with ischaemic strokes occurring between January 2012 and December 2016. For each patient, information from one year before the stroke and up to 3 years thereafter was linked across databases. We describe annual and monthly resource use and healthcare expenditure per patient. RESULTS We identified 36 044 patients with ischaemic stroke (mean age, 74.7 ± 13.3 years). The survival rate at 3 years was 63%. Average expenditure per patient was €3230 the year before stroke, €11 060 for year 1 after stroke, €4104 for year 2, and €3878 for year 3. The greatest determinants of cost in year 1 were hospitalisation (including initial hospitalisation), representing 45% of the difference in expenditure compared to the previous year, and convalescence and rehabilitation services, representing 33% of this difference. After year one, the increase in expenditure was mainly determined by additional hospital admissions and drug treatment. CONCLUSION After ischaemic stroke, healthcare expenditure increases primarily because of initial hospitalisation. After year one, the expenditure decreases but remains above baseline values. Information from population-based datasets is useful for improving the planning of stroke services.
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Affiliation(s)
- A Ribera
- Unidad de Epidemiología Cardiovascular, Hospital Universitario Vall d'Hebron, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Pla Director de la Malaltia Vascular Cerebral, Departament de Salut, Generalitat de Catalunya, Spain.
| | - E Vela
- Unitat d'Informació i Coneixement, Servei Català de la Salut, Barcelona, Spain
| | - A García-Altés
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Agència per la Qualitat i l'Avaluació Sanitària de Catalunya, Departament de Salut, Barcelona, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - M Clèries
- Unitat d'Informació i Coneixement, Servei Català de la Salut, Barcelona, Spain
| | - S Abilleira
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Pla Director de la Malaltia Vascular Cerebral, Departament de Salut, Generalitat de Catalunya, Spain; Agència per la Qualitat i l'Avaluació Sanitària de Catalunya, Departament de Salut, Barcelona, Spain
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Priest GV, Camarota F, Powell S, Vasconcelos HL, Marquis RJ. Ecosystem engineering in the arboreal realm: heterogeneity of wood-boring beetle cavities and their use by cavity-nesting ants. Oecologia 2021; 196:427-39. [PMID: 33970331 DOI: 10.1007/s00442-021-04934-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
Wood-boring beetle larvae act as ecosystem engineers by creating stem cavities that are used secondarily as nests by many arboreal ant species. Understanding the heterogeneity and distribution of available cavities and their use by ants is therefore key to understanding arboreal ant community assembly and diversity. Our goals were to quantify the abundance and diversity of beetle-produced cavity resources in a tropical canopy, reveal how ants use these resources, and determine which characteristics of the cavity resource contribute to ant use. We dissected branches from six common tree species in the Brazilian Cerrado savanna, measuring cavity characteristics and identifying the occupants. We sampled 2310 individual cavities, 576 of which were used as nests by 25 arboreal ant species. We found significant differences among tree species in the proportion of stem length bored by beetles, the number of cavities per stem length, average entrance-hole size, and the distribution of cavity volumes. The likelihood that a cavity was occupied was greater for cavities with larger entrance-hole sizes and larger volumes. In particular, there was a strong positive correlation between mean head diameters of ant species and the mean entrance-hole diameter of the cavities occupied by those ant species. Wood-boring beetles contribute to the structuring of the Cerrado ant community by differentially attacking the available tree species. In so doing, the beetles provide a wide range of entrance-hole sizes which ant species partition based on their body size, and large volume cavities that ants appear to prefer.
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Sporchia F, Kebreab E, Caro D. Assessing the multiple resource use associated with pig feed consumption in the European Union. Sci Total Environ 2021; 759:144306. [PMID: 33340862 DOI: 10.1016/j.scitotenv.2020.144306] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/10/2020] [Accepted: 11/30/2020] [Indexed: 06/12/2023]
Abstract
Feed consumption is responsible for the largest shares of resource use required for producing pork. In the European Union (EU), a meat consumption decrease is expected in combination with a growth of meat production driven by foreign demand. This paper presents a multiple environmental assessment of the resource use linked to EU pig feed by performing a material flow analysis of each single feed item constituting the EU pig diet. The global relevance and the trade-driven interlinkages are disclosed by considering the country-specific resource efficiencies of 254 territories. Our analysis reveals that in 2017 a total resource use of 14.5 Mha of land, 51.9 Gm3 of green water, 3.9 Gm3 of blue water, 1.23 Mtonnes of nitrogen, 0.35 Mtonnes of phosphorous, and 0.34 Mtonnes of potassium was required to satisfy the EU demand of pig feed. Wheat-based products accounted for the largest share of land use (32%), green water (35%), nitrogen and phosphorous from fertilizer use (44% and 28%, respectively). Also soybean accounted for a significant share of land use (15%), green water (20%) and phosphorous from fertilizer use (25%). Moreover, soybean-related feed items contributed the most to the potassium use (24%). While the domestic production of cereals satisfied the demand, protein-based ingredients such as soybean were largely imported, mainly from South America, outsourcing the related environmental burden. Moreover, most of the feed from extra-EU countries resulted with higher resource use intensities than EU implying a potential resource saving if feed was domestically produced. Results obtained are discussed in relation to the many constraints that limit the possibility of increasing the EU feed production and promising alternative solutions. In particular, while some solutions seem promising in terms of savings, the current EU regulation needs to be redesigned to allow their implementation and the achievement of ambitious EU targets.
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Affiliation(s)
- Fabio Sporchia
- Department of Environmental Science, Aarhus University, Frederikborgsvej 399, DK-4000 Roskilde, Denmark
| | - Ermias Kebreab
- Department of Animal Science, University of California, Davis, 1103 Environmental Horticulture Bldg. One Shields Avenue, Davis, CA 95616, USA
| | - Dario Caro
- Department of Environmental Science, Aarhus University, Frederikborgsvej 399, DK-4000 Roskilde, Denmark.
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Gulea C, Zakeri R, Quint JK. Model-based comorbidity clusters in patients with heart failure: association with clinical outcomes and healthcare utilization. BMC Med 2021; 19:9. [PMID: 33455580 PMCID: PMC7812726 DOI: 10.1186/s12916-020-01881-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/07/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Comorbidities affect outcomes in heart failure (HF), but are not reflected in current HF classification. The aim of this study is to characterize HF groups that account for higher-order interactions between comorbidities and to investigate the association between comorbidity groups and outcomes. METHODS Latent class analysis (LCA) was performed on 12 comorbidities from patients with HF identified from administrative claims data in the USA (OptumLabs Data Warehouse®) between 2008 and 2018. Associations with admission to hospital and mortality were assessed with Cox regression. Negative binomial regression was used to examine rates of healthcare use. RESULTS In a population of 318,384 individuals, we identified five comorbidity clusters, named according to their dominant features: low-burden, metabolic-vascular, anemic, ischemic, and metabolic. Compared to the low-burden group (minimal comorbidities), patients in the metabolic-vascular group (exhibiting a pattern of diabetes, obesity, and vascular disease) had the worst prognosis for admission (HR 2.21, 95% CI 2.17-2.25) and death (HR 1.87, 95% CI 1.74-2.01), followed by the ischemic, anemic, and metabolic groups. The anemic group experienced an intermediate risk of admission (HR 1.49, 95% CI 1.44-1.54) and death (HR 1.46, 95% CI 1.30-1.64). Healthcare use also varied: the anemic group had the highest rate of outpatient visits, compared to the low-burden group (IRR 2.11, 95% CI 2.06-2.16); the metabolic-vascular and ischemic groups had the highest rate of admissions (IRR 2.11, 95% CI 2.08-2.15, and 2.11, 95% CI 2.07-2.15) and healthcare costs. CONCLUSIONS These data demonstrate the feasibility of using LCA to classify HF based on comorbidities alone and should encourage investigation of multidimensional approaches in comorbidity management to reduce admission and mortality risk among patients with HF.
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Affiliation(s)
- Claudia Gulea
- Department of Population Health, National Heart and Lung Institute, Imperial College London, London, UK.
- NIHR Imperial Biomedical Research Centre, London, UK.
| | - Rosita Zakeri
- British Heart Foundation Centre for Research Excellence, King's College London, London, UK
- Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Jennifer K Quint
- Department of Population Health, National Heart and Lung Institute, Imperial College London, London, UK
- NIHR Imperial Biomedical Research Centre, London, UK
- Royal Brompton & Harefield NHS Foundation Trust, London, UK
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Wortel SA, de Keizer NF, Abu-Hanna A, Dongelmans DA, Bakhshi-Raiez F. Number of intensivists per bed is associated with efficiency of Dutch intensive care units. J Crit Care 2020; 62:223-229. [PMID: 33434863 DOI: 10.1016/j.jcrc.2020.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/06/2020] [Accepted: 12/12/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To measure efficiency in Intensive Care Units (ICUs) and to determine which organizational factors are associated with ICU efficiency, taking confounding factors into account. MATERIALS AND METHODS We used data of all consecutive admissions to Dutch ICUs between January 1, 2016 and January 1, 2019 and recorded ICU organizational factors. We calculated efficiency for each ICU by averaging the Standardized Mortality Ratio (SMR) and Standardized Resource Use (SRU) and examined the relationship between various organizational factors and ICU efficiency. We thereby compared the results of linear regression models before and after covariate adjustment using propensity scores. RESULTS We included 164,399 admissions from 83 ICUs. ICU efficiency ranged from 0.51-1.42 (average 0.99, 0.15 SD). The unadjusted model as well as the propensity score adjusted model showed a significant association between the ratio of employed intensivists per ICU bed and ICU efficiency. Other organizational factors had no statistically significant association with ICU efficiency after adjustment. CONCLUSIONS We found marked variability in efficiency in Dutch ICUs. After applying covariate adjustment using propensity scores, we identified one organizational factor, ratio intensivists per bed, having an association with ICU efficiency.
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Affiliation(s)
- Safira A Wortel
- Department of Medical Informatics, Amsterdam UMC, Location AMC, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; National Intensive Care Evaluation (NICE) Foundation, Department of Medical Informatics, Amsterdam UMC, Amsterdam, the Netherlands.
| | - Nicolette F de Keizer
- Department of Medical Informatics, Amsterdam UMC, Location AMC, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; National Intensive Care Evaluation (NICE) Foundation, Department of Medical Informatics, Amsterdam UMC, Amsterdam, the Netherlands
| | - Ameen Abu-Hanna
- Department of Medical Informatics, Amsterdam UMC, Location AMC, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Dave A Dongelmans
- National Intensive Care Evaluation (NICE) Foundation, Department of Medical Informatics, Amsterdam UMC, Amsterdam, the Netherlands; Department of Intensive Care, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | - Ferishta Bakhshi-Raiez
- Department of Medical Informatics, Amsterdam UMC, Location AMC, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; National Intensive Care Evaluation (NICE) Foundation, Department of Medical Informatics, Amsterdam UMC, Amsterdam, the Netherlands
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Elwell R, Rich A. Use of upper-limb compression garments in the management of lipoedema. Br J Community Nurs 2020; 25:S26-S27. [PMID: 33030376 DOI: 10.12968/bjcn.2020.25.sup10.s26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Compression hosiery is commonly used for the management of lymphoedema as well as lipoedema, but it is more commonly indicated for the lower limbs than for the upper limbs. The effects of compression hosiery on upper-limb lipoedema are poorly understood and researched. It is known that compression hosiery works in conjunction with activity or movement when standing or walking, which produces anti-inflammatory and oxygenating effects in the tissues. This effect is naturally difficult to realise in the upper limbs. Lymphoedema practitioners who treat those with lipoedema should bear in mind that compression treatment might not produce the same effects in upper-limb lipoedema as it does in lower-limb lipoedema. In these times of an overstretched health service, pragmatic resource use is essential.
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Affiliation(s)
- Rebecca Elwell
- Macmillan Lymphoedema Advanced Nurse Practitioner and Team Leader, University Hospitals of North Midlands NHS Trust; British Lymphology Society Trustee
| | - Anna Rich
- Clinical Nurse Specialist/Team Leader Lymphoedema, Lymphoedema Clinic, University Hospitals of Derby and Burton NHS Foundation Trust
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Morgan CL, Varga S, Tsong W, Jenkins-Jones S, Holden S. Healthcare utilization and associated costs following initiation of perampanel in patients with epilepsy. Epilepsy Behav 2020; 110:107137. [PMID: 32474360 DOI: 10.1016/j.yebeh.2020.107137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/21/2020] [Accepted: 04/24/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE We compared health service utilization and costs for patients with epilepsy before and after initiation of perampanel and compared with matched controls. METHOD Patients were selected from the Clinical Practice Research Datalink (CPRD). Patients initiating perampanel were matched to controls initiating an alternate add-on therapy for the same underlying epilepsy subtype. First prescription defined index date. Primary and secondary care contacts and associated costs were aggregated in the 12 months before and after index date. Secondary care contacts were available for a subset (~60%) of patients. RESULTS Three hundred and forty-three patients treated with perampanel were identified. One hundred and eighty-three (53.4%) were male, mean age was 39.1 (sd: 16.0). Mean epilepsy duration was 21.1 (standard deviation (sd): 13.3) years. Two hundred and eighty-seven (83.7%) were matched to controls. Inpatient admissions with a primary diagnosis of epilepsy (0.5 versus 0.2 per patient-year (ppy), p = 0.002) and neurology specific outpatient appointments (3.2 versus 2.9 ppy, p = 0.041) were significantly reduced following initiation with perampanel. Total costs attributable to epilepsy (£1889 to 1477 ppy) and overall secondary costs (£2593 to £2102) were also significantly reduced. There was no significant difference in primary care, outpatient, or general inpatient admissions. Compared with controls, there was a significant reduction in primary epilepsy admissions (incidence rate ratio (IRR): 0.423; 95% Confidence intervals (CI): 0.198-0.835) but a significant increase in outpatient appointments (1.306; 95% CI: 1.154-1.478) and accident and emergency contacts (1.603; 95% CI: 1.081-2.390) for patients treated with perampanel. CONCLUSION Treatment with perampanel is associated with reduced epilepsy-related inpatient admissions and accident and emergency contacts.
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Affiliation(s)
| | | | - Wan Tsong
- Formerly Eisai Inc., Woodcliff Lake, NJ, USA
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Ydstebø AE, Benth JŠ, Bergh S, Selbæk G, Vossius C. Informal and formal care among persons with dementia immediately before nursing home admission. BMC Geriatr 2020; 20:296. [PMID: 32811440 PMCID: PMC7436969 DOI: 10.1186/s12877-020-01703-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 08/12/2020] [Indexed: 11/14/2022] Open
Abstract
Background Dementia is a care intensive disease, especially in the later stages, implying in many cases a substantial carer burden. This study assesses the use of formal and informal care resources among persons with dementia during the last month before nursing home admission. It also describes main providers of informal care and assesses the extent of informal care rendered by the extended social network. Methods In this cross-sectional study, we collected data about persons with dementia that were newly admitted to a nursing home in Norway. Information about the amount of formal and informal care during the last 4 weeks preceding nursing home admission was collected from the primary caregivers. Clinical data were collected by examining the patients, while sociodemographic data was collected from the patients’ files. Results A total of 395 persons with dementia were included. The amount of informal care provided by the family caregiver was 141.9 h per month SD = 227.4. Co-resident patients received five times more informal care than non-co-residents. Informal care from the extended social network was provided to 212 patients (53.7%) with a mean of 5.6 (SD = 11.2) hours per month and represented 3.8% of the total informal care rendered to the patients. Formal care was provided to 52.7% of the patients with a mean of 18.0 (SD = 50.1) hours per month. Co-residency was significantly associated with more informal care, and the associations varied with respect to age, relation to the caregiver, and the caregiver’s working situation. Good/excellent general health was associated with less formal care. Conclusion Persons with dementia on the verge of admission to a nursing home are mainly supported by the family caregiver, and the use of informal care is particularly high among co-residents. In order to delay nursing home admission, future research should explore the unrealized care potential in extended social networks, as well as the potential for increasing the number of recipients of formal care services.
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Affiliation(s)
- Arnt Egil Ydstebø
- Centre for Age-related Medicine, Stavanger University Hospital, Stavanger, Norway. .,Centre for Development of Institutional and Home Care Services Rogaland, Stavanger, Norway. .,Research centre for Age-related Functional decline and Disease, Innlandet Hospital Trust, Postboks 68, N-2312, Ottestad, Norway.
| | - Jurate Šaltytė Benth
- Research centre for Age-related Functional decline and Disease, Innlandet Hospital Trust, Postboks 68, N-2312, Ottestad, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Akershus, Norway
| | - Sverre Bergh
- Research centre for Age-related Functional decline and Disease, Innlandet Hospital Trust, Postboks 68, N-2312, Ottestad, Norway.,Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Geir Selbæk
- Research centre for Age-related Functional decline and Disease, Innlandet Hospital Trust, Postboks 68, N-2312, Ottestad, Norway.,Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Corinna Vossius
- Centre for Age-related Medicine, Stavanger University Hospital, Stavanger, Norway.,Centre for Development of Institutional and Home Care Services Rogaland, Stavanger, Norway
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Lambert-Obry V, Lafrance JP, Savoie M, Henri S, Lachaine J. Review of real-world evidence studies in type 2 diabetes mellitus: Lack of good practices. Int J Technol Assess Health Care 2020; 36:1-8. [PMID: 32638670 DOI: 10.1017/s0266462320000392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Unlike randomized controlled trials, lack of methodological rigor is a concern about real-world evidence (RWE) studies. The objective of this study was to characterize methodological practices of studies collecting pharmacoeconomic data in a real-world setting for the management of type 2 diabetes mellitus (T2DM). METHODS A systematic literature review was performed using the PICO framework: population consisted of T2DM patients, interventions and comparators were any intervention for T2DM care or absence of intervention, and outcomes were resource utilization, productivity loss or utility. Only RWE studies were included, defined as studies that were not clinical trials and that collected de novo data (no retrospective analysis). RESULTS The literature search identified 1,158 potentially relevant studies, among which sixty were included in the literature review. Many studies showed a lack of transparency by not mentioning the source for outcome and exposure measurement, source for patient selection, number of study sites, recruitment duration, sample size calculation, sampling method, missing data, approbation by an ethics committee, obtaining patient's consent, conflicts of interest, and funding. A significant proportion of studies had poor quality scores and was at high risk of bias. CONCLUSIONS RWE from T2DM studies lacks transparency and credibility. There is a need for good procedural practices that can increase confidence in RWE studies. Standardized methodologies specifically adapted for RWE studies collecting pharmacoeconomic data for the management of T2DM could help future reimbursement decision making in this major public health problem.
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Affiliation(s)
- Véronique Lambert-Obry
- The Faculty of Pharmacy, Université de Montréal, 2940, Chemin de Polytechnique, Montréal, QuébecH3T 1J4, Canada
| | - Jean-Philippe Lafrance
- The Faculty of Medicine, Université de Montréal, 2900, Boulevard Édouard-Montpetit, Montréal, QuébecH3T 1J4, Canada
| | - Michelle Savoie
- The Faculty of Pharmacy, Université de Montréal, 2940, Chemin de Polytechnique, Montréal, QuébecH3T 1J4, Canada
| | - Sandrine Henri
- The Faculty of Pharmacy, Université de Montréal, 2940, Chemin de Polytechnique, Montréal, QuébecH3T 1J4, Canada
| | - Jean Lachaine
- The Faculty of Pharmacy, Université de Montréal, 2940, Chemin de Polytechnique, Montréal, QuébecH3T 1J4, Canada
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Abstract
Patient involvement in their own treatment can enable those with wounds in the community to play an active role in the management of their condition by, for example, completing dressing changes between health professional visits. The original primary study was undertaken to assess the clinical effectiveness of Zetuvit Plus Silicone Border (ZPSB) on exudate management. This retrospective sub-group analysis is aimed to demonstrate the effectiveness of a superabsorbent polymer (SAP) dressing (ZPSB) in enabling patients or their carers to undertake unsupervised dressing changes on their own. ZPSB was found to be clinically effective in this subgroup of patients, while also having additional features that enabled the patient to self-care. Overall, ZPSB enabled the patient to be part of their treatment plan and play an active role in the care of their wounds, thereby promoting self-care. This had a positive effect on nursing time saving and patient satisfaction.
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Affiliation(s)
- Simon Barrett
- Tissue Viability Nurse Specialist, Humber NHS Foundation Trust
| | - Donna Welch
- Diabetes Healthcare Professional, Humber NHS Foundation Trust
| | - Mark G Rippon
- Visiting Clinical Research Fellow, Huddersfield University; Medical Marketing Consultant, Daneriver Consultancy, Holmes Chapel, Cheshire
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Franken M, Kanters T, Coenen J, de Jong P, Jager A, Groot CU. Hospital-based or home-based administration of oncology drugs? A micro-costing study comparing healthcare and societal costs of hospital-based and home-based subcutaneous administration of trastuzumab. Breast 2020; 52:71-7. [PMID: 32447129 DOI: 10.1016/j.breast.2020.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 04/26/2020] [Accepted: 05/01/2020] [Indexed: 12/24/2022] Open
Abstract
Objective To investigate resource use and time investments of healthcare professionals, patients and their family and to compare healthcare and societal costs of one single hospital-based and one single home-based subcutaneous administration of trastuzumab in The Netherlands. Method We conducted a bottom-up micro-costing study. Patients diagnosed with HER2+ early or metastatic breast cancer were recruited in four Dutch hospitals. For healthcare costs, data were collected on drug use, consumables, use of healthcare facilities, time of healthcare professionals, and travelling distance of the nurse. For societal costs, data were collected on patient and family costs (including travelling expenses and time of informal caregivers) and productivity losses of paid and unpaid work. Results Societal costs of one single administration of SC trastuzumab were €1753 within the home-based and €1724 within the hospital-based setting. Drug costs of trastuzumab were identical in both settings (€1651). Healthcare costs were higher for home-based administration (€91 versus €47) mainly because of more time of healthcare professionals (110 versus 38 minutes). Costs for patient and family were, however, lower for home-based administration due to travelling expenses (€7 versus €0) and time of informal caregivers (€14 versus €4). Costs for productivity losses were similar for both settings. Conclusions Home-based subcutaneous administration of trastuzumab is more time consuming for healthcare professionals and therefore more costly than hospital-based administration. The total budget impact can be large considering that a large number of patients receive a large number of cycles of oncology treatments. If home-based administration is the way forward, novel approaches are crucial for ensuring efficiency of home-based care. Home-based administration of SC trastuzumab almost triples the time of healthcare professionals. Healthcare costs are almost twice as much for home-based than for hospital-based administration. Patient and family costs are almost five times lower for home-based than for hospital-based administration.
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Fujiki S, Ishizaki T, Nakayama T. Clinical pictures, treatments, and resource use of norovirus gastroenteritis in long-term care facilities: a survey with a chart review in Japan. BMC Geriatr 2020; 20:148. [PMID: 32316927 PMCID: PMC7171776 DOI: 10.1186/s12877-020-01549-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 04/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Outbreaks of norovirus infection can have detrimental impacts on long-term care facilities. This study investigated the incidence, clinical picture, treatment and resource use of norovirus gastroenteritis in long-term care facilities. METHODS Nineteen facilities in Osaka and Kyoto, Japan participated in questionnaire surveys conducted between 2009 and 2011 regarding the incidence of norovirus gastroenteritis. From clinical charts, the characteristics, symptoms, and treatment of infected residents were analyzed. Total drug cost per infected resident was calculated by multiplying the unit price for each drug by the daily dose and the number of days administered and summing the costs for each drug (USD 1 = JPY 100). RESULTS Over the 3-year period, 8 outbreaks of norovirus gastroenteritis occurred in 6 facilities. The mean clinical course of 107 infected residents in five facilities that granted permission to examine patients' medical records was 4 days, with all but one resident presenting with vomiting and/or diarrhea, and 84 (79%) also presenting with associated symptoms. Of 107 infected residents, 72 (67%) were isolated. The proportion of infected residents isolated varied from 50 to 100% depending on the facility. Of the infected residents, 81 (76%) received some type of medication, the most common being infusion (67 patients, 63%) and antibiotics (30 patients, 28%). The median total cost of all drugs administered was USD 4.4, and the median drug cost per infected resident per day was USD 2.0. Total drug cost over the entire treatment period was the highest for antibiotics, at USD 8.6. CONCLUSION Clinical course was similar to those of norovirus cases examined at other long-term care facilities. The majority of infected residents received some type of medication. Although the economic burden was not large, not a few infected residents were given antibiotics, which are ineffective for norovirus.
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Affiliation(s)
- Saori Fujiki
- Department of Health Informatics, Kyoto University School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
| | - Tatsuro Ishizaki
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
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Stephens S, Chatterjee A, Coles V, Crawford R. The costs of treating vaginal and vulval cancer in England (2009-2015). BMC Public Health 2020; 20:453. [PMID: 32252711 PMCID: PMC7137284 DOI: 10.1186/s12889-020-08545-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 03/18/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV) infection is a pre-requisite for cervical cancer, which represents the third most common cancer among women worldwide. A causal relationship also exists between HPV and cancer in other areas of the female reproductive system including the vagina and vulva. Whilst the incidence of vaginal cancer in the UK has remained relatively stable over the past 25 years, vulval cancer rates are increasing. A body of literature exists on the epidemiology and aetiology of vaginal and vulval cancer, but little is known about the economic burden. The objective of this study was to quantify the costs of treating these cancers on the National Health Service (NHS) in England. METHODS Inpatient and outpatient episodes were derived from Hospital Episode Statistics (HES). Health Resource Group (HRG) tariffs and National Reference Costs were used to estimate the cost of treating pre-cancerous and invasive vaginal and vulval lesions in England. RESULTS The study showed that for the 5 years from 2009/2010 to 2014/2015 the total cost associated with pre-cancerous and invasive vaginal and vulval lesions was over £14 million per year on average (95% of which was attributed to inpatient costs). Vulval cancer accounted for the largest proportion; an estimated 60% of the total cost (£8.82 million). On average 4316 patients per year in England were admitted to hospital and 912 patients attended outpatient settings for pre-cancerous and invasive disease of the vagina and vulva. CONCLUSION The results indicate that vaginal and vulval cancer cost the English health care system over £14 million per year. Given the causal role of HPV in a proportion of these cancers, preventative measures such as the national HPV immunisation programme have the potential to reduce the economic burden. To ensure optimal use of NHS resources, it is important that future economic evaluations of such preventative measures consider the full burden of HPV related disease.
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Affiliation(s)
| | | | | | - Robin Crawford
- Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Nicholas RS, Heaven ML, Middleton RM, Chevli M, Pulikottil-Jacob R, Jones KH, Ford DV. Personal and societal costs of multiple sclerosis in the UK: A population-based MS Registry study. Mult Scler J Exp Transl Clin 2020; 6:2055217320901727. [PMID: 32030197 PMCID: PMC6977221 DOI: 10.1177/2055217320901727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/23/2019] [Accepted: 12/29/2019] [Indexed: 11/16/2022] Open
Abstract
Objectives To investigate through survey and data linkage, healthcare resource use and
costs (except drugs), including who bears the cost, of multiple sclerosis in
the United Kingdom by disease severity and type. Methods The United Kingdom Multiple Sclerosis Register deployed a cost of illness
survey, completed by people with multiple sclerosis and linked this with
data within the United Kingdom Multiple Sclerosis Register and from their
hospital records. Resource consumption was categorised as being medical or
non-medical and costed by National Health Service and social services
estimates for 2018. Results We calculated £509,003 in non-medical costs over a year and £435,488 in
medical costs generated over 3 months. People with multiple sclerosis
reported self-funding 75% of non-medical costs with non-medical
interventions having long-term potential benefits. Costs increased with
disability as measured by patient-reported Expanded Disability Status Score
and Multiple Sclerosis Impact Scale, with Multiple Sclerosis Impact Scale
physical being a more powerful predictor of costs than the patient-reported
Expanded Disability Status Score. Two distinct groups were identified:
medical and non-medical interventions (n = 138); and
medical interventions only (n = 399). The medical and
non-medical group reported increased disease severity and reduced employment
but incurred 80% more medical costs per person than the medical-only
group. Conclusions The importance of disability in driving costs is illustrated with balance
between medical and non-medical costs consistent with the United Kingdom
health environment. People with multiple sclerosis and their families fund a
considerable proportion of non-medical costs but non-medical interventions
with longer term impact could affect future medical costs.
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Affiliation(s)
| | | | | | | | | | | | - David V Ford
- Swansea University Medical School, United Kingdom
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Vandepitte S, Van Wilder L, Putman K, Van Den Noortgate N, Verhaeghe S, Trybou J, Annemans L. Factors associated with costs of care in community-dwelling persons with dementia from a third party payer and societal perspective: a cross-sectional study. BMC Geriatr 2020; 20:18. [PMID: 31948386 PMCID: PMC6966839 DOI: 10.1186/s12877-020-1414-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/03/2020] [Indexed: 12/15/2022] Open
Abstract
Background Besides the importance of estimating the global economic impact of care for persons with dementia, there is an emerging need to identify the key factors associated with this cost. The aim of this study was to analyze associations between the cost of care in community-dwelling persons with dementia and caregiver characteristics from both the healthcare third party payer perspective and the societal perspective. Methods Several characteristics based on the cross-sectional data of 355 dyads of informal caregivers and persons with dementia living in Belgium were identified to include in a log-gamma generalized linear model and were used in a multiple linear regression model with bootstrapping to test robustness. Results The mean monthly cost of care for a community-dwelling person with dementia was estimated at € 2339 (95% CI € 2133 – € 2545) per person from a societal perspective and at € 968 (95% CI € 825 – € 1111) per person from a third party payer viewpoint. Informal care accounted for the majority of the monthly costs from the societal perspective. Community based healthcare resource use represented the largest cost from the third party perspective. According to the regression analyses, a higher level of functional dependency of the person with dementia and a higher educational level of the caregiver were associated with a higher monthly cost from both a third party payer perspective and a societal perspective. In addition, being retired and a higher quality of life in the caregivers were associated with a lower monthly cost of care from the societal perspective. Conclusions Several characteristics of the caregiver and the person with dementia were associated with the monthly costs of care from a third party payer and a societal perspective. Despite the lack of clear causal relationships, the results of this study can assist policy makers in planning and financing future dementia care. Trial registration Clinicaltrials.gov NCT02630446, December 15, 2015.
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Affiliation(s)
- S Vandepitte
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - L Van Wilder
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - K Putman
- Faculty of Medicine and Pharmacy, Department of Medical Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - N Van Den Noortgate
- Department of Internal medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - S Verhaeghe
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - J Trybou
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - L Annemans
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Jones DA, Mistry P, Dalby M, Fulton-Lieuw T, Kong AH, Dunn J, Mehanna HM, Gray AM. Concurrent cisplatin or cetuximab with radiotherapy for HPV-positive oropharyngeal cancer: Medical resource use, costs, and quality-adjusted survival from the De-ESCALaTE HPV trial. Eur J Cancer 2020; 124:178-185. [PMID: 31794928 PMCID: PMC6947474 DOI: 10.1016/j.ejca.2019.10.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/08/2019] [Accepted: 10/28/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The De-ESCALaTE HPV trial confirmed the dominance of cisplatin over cetuximab for tumour control in patients with human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC). Here, we present the analysis of health-related quality of life (HRQoL), resource use, and health care costs in the trial, as well as complete 2-year survival and recurrence. MATERIALS AND METHODS Resource use and HRQoL data were collected at intervals from the baseline to 24 months post treatment (PT). Health care costs were estimated using UK-based unit costs. Missing data were imputed. Differences in mean EQ-5D-5L utility index and adjusted cumulative quality-adjusted life years (QALYs) were compared using the Wilcoxon signed-rank test and linear regression, respectively. Mean resource usage and costs were compared through two-sample t-tests. RESULTS 334 patients were randomised to cisplatin (n = 166) or cetuximab (n = 168). Two-year overall survival (97·5% vs 90·0%, HR: 3.268 [95% CI 1·451 to 7·359], p = 0·0251) and recurrence rates (6·4% vs 16·0%, HR: 2·67 [1·38 to 5·15]; p = 0·0024) favoured cisplatin. No significant differences in EQ-5D-5L utility scores were detected at any time point. At 24 months PT, mean difference was 0·107 QALYs in favour of cisplatin (95% CI: 0·186 to 0·029, p = 0·007) driven by the mortality difference. Health care costs were similar across all categories except the procurement cost and delivery of the systemic agent, with cetuximab significantly more expensive than cisplatin (£7779 [P < 0.001]). Consequently, total costs at 24 months PT averaged £13517 (SE: £345) per patient for cisplatin and £21064 (SE: £400) for cetuximab (mean difference £7547 [95% CI: £6512 to £8582]). CONCLUSIONS Cisplatin chemoradiotherapy provided more QALYs and was less costly than cetuximab bioradiotherapy, remaining standard of care for nonsurgical treatment of HPV-positive OPSCC.
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Affiliation(s)
- David A Jones
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Pankaj Mistry
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Matthew Dalby
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Tessa Fulton-Lieuw
- Institute of Head and Neck Studies and Education, Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Anthony H Kong
- Institute of Head and Neck Studies and Education, Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Janet Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Hisham M Mehanna
- Institute of Head and Neck Studies and Education, Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Alastair M Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
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Koch M, Butt T, Guo W, Li X, Chen Y, Tan D, Liu GG. Characteristics and health burden of the undiagnosed population at risk of chronic obstructive pulmonary disease in China. BMC Public Health 2019; 19:1727. [PMID: 31870442 PMCID: PMC6929419 DOI: 10.1186/s12889-019-8071-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 12/11/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in China. However, identifying patients has proved challenging, resulting in widespread under-diagnosis of the condition. We examined the prevalence of COPD diagnosis and COPD risk among adults in urban mainland China, the factors associated with having a COPD diagnosis or COPD risk, and the healthcare resource use and health outcomes of these groups compared with controls. METHODS Respondents to the 2017 National Health and Wellness Survey in China (n = 19,994) were classified into three groups: 'COPD Diagnosed', 'COPD Risk (undiagnosed)', and Control (unaffected), based on their self-reported diagnosis and Lung Function Questionnaire (LFQ) score. The groups were characterised by sociodemographic, health-related quality of life (HRQoL), productivity impairment, and healthcare resource use. Pairwise comparisons (t tests and chi-squared tests) and multivariable regression analyses were used to investigate factors associated with being at risk of, or diagnosed with, COPD. RESULTS 3320 (16.6%) respondents had a suspected risk of COPD but did not report receiving a diagnosis. This was projected to 105.3 million people, or 16.9% of adult urban Chinese. Of these respondents with an identified risk, only 554 (16.7%) were aware of COPD by name. Relative to those without COPD, those with a risk of COPD (undiagnosed) had significantly greater healthcare resource use, lower productivity and lower HRQoL not only compared to those without COPD, but also compared to people with a COPD diagnosis. Factors associated with increased odds of being at risk of COPD were older age, smoking, alcohol consumption, overweight BMI, occasional exercise, higher comorbidities, asthma diagnosis, being female, lower education, not being employed, and living in a high pollution province (p < 0.05). CONCLUSIONS There is a substantial group of individuals, undiagnosed, but living with a risk of COPD, who have impaired HRQoL, lower productivity and elevated healthcare resource use patterns. Case-detection tools such as the LFQ may prove a quick and cost-effective approach for identifying these at-risk individuals for further definitive testing and appropriate treatment in China.
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Affiliation(s)
- Marco Koch
- Independent Research Consultant, Cologne, Germany
| | - Thomas Butt
- UCL Institute of Ophthalmology, University College London, London, UK. .,National School of Development, Peking University, Beijing, China.
| | - Wudong Guo
- China National Health Development Research Center, National Health Commission, Beijing, China
| | - Xue Li
- China National Health Development Research Center, National Health Commission, Beijing, China
| | | | | | - Gordon G Liu
- National School of Development, Peking University, Beijing, China
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Nevens H, Harrison J, Vrijens F, Verleye L, Stocquart N, Marynen E, Hulstaert F. Budgeting of non-commercial clinical trials: development of a budget tool by a public funding agency. Trials 2019; 20:714. [PMID: 31829233 PMCID: PMC6907219 DOI: 10.1186/s13063-019-3900-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 11/08/2019] [Indexed: 11/21/2022] Open
Abstract
Background Investigator-led multicentre randomised trials are essential to generate evidence on the optimal use of medical interventions. These non-commercial trials are often hampered by underfunding, which may lead to difficulties in gathering a team with the necessary expertise, a delayed trial start, slow recruitment and even early trial discontinuation. As a new public funder of pragmatic clinical trials, the KCE Trials programme was committed to correctly pay all trial activities in order to assure timely delivery of high-quality trial results. As no appropriate trial budget tool was readily publicly available that took into account the costs for the sponsor as well as the costs for participating sites, we developed a tool to make the budgeting of a clinical trial efficient, transparent and fair across applicants. Methods All trial-related activities of the sponsor and sites were categorised, and cost drivers were identified. All elements were included in a spreadsheet tool allowing the sponsor team to calculate in detail the various activities of a clinical trial and to appreciate the budget impact of specific cost drivers, e.g. a delay in recruitment. Hourly fees by role were adapted from published data. Fixed amounts per activity were developed when appropriate. Results This publicly available tool has already been used for 17 trials funded since the start of the KCE Trials programme in 2016, and it continues to be used and improved. This budget tool is used together with additional risk-reducing measures such as a multistep selection process with advance payments, a recruitment feasibility check by sponsor and funder, a close monitoring of study progress and a milestone-based payment schedule with the last payment made when the manuscript is submitted. Conclusions The budget tool helps the KCE Trials programme to answer relevant research questions in a timely way, within budget and with high quality, a necessary condition to achieve impact of this programme for patients, clinical practice and healthcare payers.
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Affiliation(s)
- Hilde Nevens
- Belgian Healthcare Knowledge Centre - KCE, Kruidtuinlaan 55, 1000, Brussel, Belgium.
| | - Jillian Harrison
- Belgian Healthcare Knowledge Centre - KCE, Kruidtuinlaan 55, 1000, Brussel, Belgium
| | - France Vrijens
- Belgian Healthcare Knowledge Centre - KCE, Kruidtuinlaan 55, 1000, Brussel, Belgium
| | - Leen Verleye
- Belgian Healthcare Knowledge Centre - KCE, Kruidtuinlaan 55, 1000, Brussel, Belgium
| | - Nelle Stocquart
- Belgian Healthcare Knowledge Centre - KCE, Kruidtuinlaan 55, 1000, Brussel, Belgium
| | - Elisabeth Marynen
- Belgian Healthcare Knowledge Centre - KCE, Kruidtuinlaan 55, 1000, Brussel, Belgium
| | - Frank Hulstaert
- Belgian Healthcare Knowledge Centre - KCE, Kruidtuinlaan 55, 1000, Brussel, Belgium
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Ruedenauer FA, Spaethe J, van der Kooi CJ, Leonhardt SD. Pollinator or pedigree: which factors determine the evolution of pollen nutrients? Oecologia 2019; 191:349-358. [PMID: 31463783 DOI: 10.1007/s00442-019-04494-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 08/20/2019] [Indexed: 12/25/2022]
Abstract
A prime example of plant-animal interactions is the interaction between plants and pollinators, which typically receive nectar and/or pollen as reward for their pollination service. While nectar provides mostly carbohydrates, pollen represents the main source of protein and lipids for many pollinators. However, the main function of pollen is to carry nutrients for pollen tube growth and thus fertilization. It is unclear whether pollinator attraction exerts a sufficiently strong selective pressure to alter the nutritional profile of pollen, e.g., through increasing its crude protein content or protein-to-lipid ratio, which both strongly affect bee foraging. Pollen nutritional quality may also be merely determined by phylogenetic relatedness, with pollen of closely related plants showing similar nutritional profiles due to shared biosynthetic pathways or floral morphologies. Here, we present a meta-analysis of studies on pollen nutrients to test whether differences in pollen nutrient contents and ratios correlated with plant insect pollinator dependence and/or phylogenetic relatedness. We hypothesized that if pollen nutritional content was affected by pollinator attraction, it should be different (e.g., higher) in highly pollinator-dependent plants, independent of phylogenetic relatedness. We found that crude protein and the protein-to-lipid ratio in pollen strongly correlated with phylogeny. Moreover, pollen protein content was higher in plants depending mostly or exclusively on insect pollination. Pollen nutritional quality thus correlated with both phylogenetic relatedness and pollinator dependency, indicating that, besides producing pollen with sufficient nutrients for reproduction, the nutrient profile of zoophilous plants may have been shaped by their pollinators' nutritional needs.
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Affiliation(s)
- Fabian A Ruedenauer
- Department of Animal Ecology and Tropical Biology, Biozentrum, University of Würzburg, Am Hubland, 97074, Würzburg, Germany
| | - Johannes Spaethe
- Department of Behavioral Physiology and Sociobiology, Biozentrum, University of Würzburg, Am Hubland, 97074, Würzburg, Germany
| | - Casper J van der Kooi
- Groningen Institute for Evolutionary Life Sciences, University of Groningen, Nijenborgh 7, 9747 AG, Groningen, The Netherlands
| | - Sara D Leonhardt
- Department of Animal Ecology and Tropical Biology, Biozentrum, University of Würzburg, Am Hubland, 97074, Würzburg, Germany.
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Tiberg I, Hansson H, Hallström I, Carlsson A. Implementation of discharge recommendations in type 1 diabetes depends on specialist nurse follow-up. Acta Paediatr 2019; 108:1515-1520. [PMID: 30565294 DOI: 10.1111/apa.14704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 12/13/2018] [Accepted: 12/14/2018] [Indexed: 11/28/2022]
Abstract
AIM This paper presents an implementation study following previous research including a randomised controlled trial (RCT) of hospital-based home care (HBHC), referring to specialist care in a home-based setting. The aim was to evaluate whether the effects sustained when rolled out into wider practice. METHODS In 2013-2014, 42 children newly diagnosed type 1 diabetes were included in the study at a university hospital in Sweden and followed for two years. Measurements of child safety, effects of services, resource use and service quality were included. Descriptive statistics were used to present the results and then discussed in relation to the same intervention of HBHC previously evaluated in an RCT. RESULTS Shorter in-hospital stay was partially implemented but increased support after discharge by the diabetes nurse was not. The results indicated that the implemented HBHC was equally effective in terms of child outcomes two years from diagnosis but less effective in terms of parents' outcome. The results furthermore indicated that the quality of services decreased. CONCLUSION The suggested overall conclusion was that the implemented HBHC services were safe but had become less effective, at least in relation to the HBHC provided under controlled circumstances.
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Affiliation(s)
- I Tiberg
- Department of Health Sciences; Lund University; Lund Sweden
| | - H Hansson
- Pediatrics and Adolescent Medicine; The Juliane Marie Centre; The University Hospital; Copenhagen Rigshospitalet; Copenhagen Denmark
| | - I Hallström
- Department of Health Sciences; Lund University; Lund Sweden
| | - A Carlsson
- Department of Paediatrics; Skåne University Hospital in Lund; Lund Sweden
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Abstract
The attempts to balance between the actual and preferred states of activation or relaxation has been studied from a recovery and a restoration perspective. There are many noticeable parallels between restoration and recovery. Both traditions depart from understanding the need for the individual to regain finite resources that has been used to meet and handle external demands. There is some disagreement of the phenomena, and the terminology may differ as well as the implied meaning of the underlying concepts. Both traditions although consider resource use on one hand, and the processes to return to a state where these resources are replenished, on the other hand. To integrate the recovery and restoration traditions a tentative model is proposed, recognizing that both traditions departs from an interactive process perspective, where the need to replenish resources are consciously perceived.
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Affiliation(s)
- Leif W Rydstedt
- Inland Norway University of Applied Sciences, Department of Psychology, Norway
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Pašukonis A, Loretto MC, Rojas B. How far do tadpoles travel in the rainforest? Parent-assisted dispersal in poison frogs. Evol Ecol 2019; 33:613-623. [PMID: 31404198 PMCID: PMC6647546 DOI: 10.1007/s10682-019-09994-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 06/05/2019] [Indexed: 11/06/2022]
Abstract
Parents can influence offspring dispersal through breeding site selection, competition, or by directly moving their offspring during parental care. Many animals move their young, but the potential role of this behavior in dispersal has rarely been investigated. Neotropical poison frogs (Dendrobatidae) are well known for shuttling their tadpoles from land to water, but the associated movements have rarely been quantified and the potential function of tadpole transport in dispersal has not been addressed. We used miniature radio-transmitters to track the movements of two poison frog species during tadpole transport, and surveyed pool availability in the study area. We found that parental males move farther than expected by the distance to the nearest pool and spread their offspring across multiple pools. We argue that these movement patterns cannot be fully explained by pool quality and availability, and suggest that adaptive benefits related to offspring dispersal also shape the spatial behavior of parental frogs.
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Affiliation(s)
- Andrius Pašukonis
- Department of Biology, Stanford University, 371 Serra Mall, Stanford, CA 94305 USA
- Department of Cognitive Biology, University of Vienna, Althanstrasse 14, 1090 Vienna, Austria
| | | | - Bibiana Rojas
- Department of Biological and Environmental Sciences, University of Jyväskylä, PO Box 35, 40014 Jyväskylä, Finland
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