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Amarni MSA, Fetati H, Djoudad K, Bendifallah B, Zerdoumi F, Toumi H. Pharmaco-economic evaluation of kidney transplantation at the University Hospital Establishment of Oran: cost analysis and implications. Nephrol Ther 2024; 20:1-10. [PMID: 38567524 DOI: 10.1684/ndt.2024.72] [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: 04/04/2024]
Abstract
Introduction In Algeria, the number of patients treated by dialysis is estimated at 23,798 in 2019. Kidney transplantation is the best therapeutic option for patients suffering from end stage kidney Disease (ESKD). However, this procedure is costly and requires complex management. The aim of this study is to assess the costs associated with kidney transplantation at the University Hospital Establishment of Oran, Algeria (UHEO). Materials and methods A retrospective, descriptive, monocentric study was carried out on 31 patients who underwent kidney transplantation at the UHEO. Estimated costs included drugs, consumables, imaging and laboratory tests for pre-transplant examinations, immediate post-transplant hospitalization, post-transplant follow-up and management of any complications. Results The average cost of graft preparation was 485,438.31 Algerian Dinar (DZD). Immediate post-transplant hospitalization represented an average cost of 375,484.70 DZD. The first year post-transplantation was the most costly with an average cost of 1,305,197.40 DZD mainly attributed to treatment, hospitalization, clinical and paraclinical examinations. Conclusion This study estimated the cost of kidney transplantation at the UHEO and revealed that the cost of the first year is the most important due to many factors. It also showed that costs tend to decrease with the age of the transplant and the clinical stability of the recipient.
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Affiliation(s)
- Mohamed Sadeg Amine Amarni
- Établissement hospitalier universitaire, service de pharmacovigilance, BP N° 4166 Ibn Rochd Oran, Algérie
| | - Habiba Fetati
- Établissement hospitalier universitaire, service de pharmacovigilance, BP N° 4166 Ibn Rochd Oran, Algérie
| | - Kada Djoudad
- Établissement hospitalier universitaire, service de néphrologie et de transplantation rénale, BP N° 4166 Ibn Rochd Oran, Algérie
| | - Brahim Bendifallah
- Établissement hospitalier universitaire, service de néphrologie et de transplantation rénale, BP N° 4166 Ibn Rochd Oran, Algérie
| | - Faiza Zerdoumi
- Établissement hospitalier universitaire, service de néphrologie et de transplantation rénale, BP N° 4166 Ibn Rochd Oran, Algérie
| | - Houari Toumi
- Établissement hospitalier universitaire, service de pharmacovigilance, BP N° 4166 Ibn Rochd Oran, Algérie
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Odensten C, Gunnarsson U, Johansson J, Näsvall P. Impact of parastomal hernia on colostomy costs at 1 year: Secondary analysis of a randomized clinical trial (STOMAMESH). Scand J Surg 2024; 113:33-39. [PMID: 37563916 DOI: 10.1177/14574969231188021] [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: 08/12/2023]
Abstract
BACKGROUND AND AIMS Parastomal hernia (PSH) is a common complication after the creation of a colostomy, with a prevalence of approximately 50%. Despite the high frequency, little is known how PSH affects the cost of colostomy care.The hypothesis in this study was that PSH increases the cost of colostomy care compared with not having a PSH. METHODS Two groups with (N = 61) and without (n = 147) PSH were compared regarding costs of stoma appliances and visits. The population from a large randomized trial comparing construction of colostomy with or without prophylactic mesh (STOMAMESH) was used and cross-matched with health economic data from the National Pharmaceutical Register, 1 year after initial surgery. RESULTS Patients with and without a PSH were similar in basic demographic data. No difference in cost of stoma appliances (with PSH 2668.3 EUR versus no PSH 2724.5 EUR, p = 0.938) or number of visits to a stoma therapist (p = 0.987) was seen, regardless of the presence or not of a PSH. CONCLUSIONS PSH appears not to affect costs due to colostomy appliances or the need to visit a stoma therapist, in the first year. The lesson to be learnt is that PSHs are not a driver for costs. Other factors may be determinants of the cost of a colostomy, including manufacturers' price and persuasion, means of procurement, and presence of guidelines.
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Affiliation(s)
- Christoffer Odensten
- Division of Surgery Sunderby Hospital Luleå 97180 Sweden Sunderby Research Unit Department of Surgical and Perioperative Sciences Medical Faculty Umeå University Umeå Sweden
| | - Ulf Gunnarsson
- Department of Surgical and Perioperative Sciences, Medical Faculty, Umeå University, Umeå, Sweden
| | - Jeaneth Johansson
- Department of Business Administration and Industrial Engineering, Luleå University of Technology, Luleå, Sweden
| | - Pia Näsvall
- Sunderby Research Unit, Department of Surgical and Perioperative Sciences, Medical Faculty, Umeå University, Umeå, Sweden
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Lunardi M, Mamas MA, Mauri J, Molina CM, Rodriguez-Leor O, Eggington S, Pietzsch JB, Papo NL, Walleser-Autiero S, Baumbach A, Maisano F, Ribichini FL, Mylotte D, Barbato E, Piek JJ, Wijns W, Naber CK. Predicted clinical and economic burden associated with reduction in access to acute coronary interventional care during the COVID-19 lockdown in two European countries. Eur Heart J Qual Care Clin Outcomes 2024; 10:25-35. [PMID: 37286294 DOI: 10.1093/ehjqcco/qcad025] [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] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/13/2023] [Accepted: 05/11/2023] [Indexed: 06/09/2023]
Abstract
AIMS As a consequence of untimely or missed revascularization of ST-elevation myocardial infarction (STEMI) patients during the COVID-19 pandemic, many patients died at home or survived with serious sequelae, resulting in potential long-term worse prognosis and related health-economic implications.This analysis sought to predict long-term health outcomes [survival and quality-adjusted life-years (QALYs)] and cost of reduced treatment of STEMIs occurring during the first COVID-19 lockdown. METHODS AND RESULTS Using a Markov decision-analytic model, we incorporated probability of hospitalization, timeliness of PCI, and projected long-term survival and cost (including societal costs) of mortality and morbidity, for STEMI occurring during the first UK and Spanish lockdowns, comparing them with expected pre-lockdown outcomes for an equivalent patient group.STEMI patients during the first UK lockdown were predicted to lose an average of 1.55 life-years and 1.17 QALYs compared with patients presenting with a STEMI pre-pandemic. Based on an annual STEMI incidence of 49 332 cases, the total additional lifetime costs calculated at the population level were £36.6 million (€41.3 million), mainly driven by costs of work absenteeism. Similarly in Spain, STEMI patients during the lockdown were expected to survive 2.03 years less than pre-pandemic patients, with a corresponding reduction in projected QALYs (-1.63). At the population level, reduced PCI access would lead to additional costs of €88.6 million. CONCLUSION The effect of a 1-month lockdown on STEMI treatment led to a reduction in survival and QALYs compared to the pre-pandemic era. Moreover, in working-age patients, untimely revascularization led to adverse prognosis, affecting societal productivity and therefore considerably increasing societal costs.
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Affiliation(s)
- Mattia Lunardi
- The Lambe Institute for Translational Medicine, Smart Sensors Laboratory and Curam, University of Galway, Ireland
- Division of Cardiology, University Hospital of Verona, Verona, Italy
| | - Mamas A Mamas
- Keele Cardiovascular Research, Keele University, Stoke on Trent, UK
| | - Josepa Mauri
- Gerència de Processos Integrats de Salut. Àrea Assistencial. Servei Català de la Salut. Generalitat de Catalunya, Barcelona, Spain
- Institut del Cor, Hospital Universiari Germans Trias i Pujol, Badalona, Spain
| | - Carmen Medina Molina
- Registry of Myocardial Infarction, Catalan Health Service, Catalunyia, Barcelona, Spain
| | | | - Simon Eggington
- Health Economics, Policy and Reimbursement, Medtronic International Trading Sarl, Tolochenaz, Switzerland
| | | | - Natalie L Papo
- Health Economics, Policy and Reimbursement, Medtronic International Trading Sarl, Tolochenaz, Switzerland
| | - Silke Walleser-Autiero
- Health Economics, Policy and Reimbursement, Medtronic International Trading Sarl, Tolochenaz, Switzerland
| | - Andreas Baumbach
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London and Barts Heart Centre, London, UK
| | - Francesco Maisano
- Valve Center OSR, Cardiac Surgery IRCCS San Raffaele Hospital, Vita Salute University UniSR, Milano, Italy
| | | | - Darren Mylotte
- Galway University Hospital, SAOLTA Healthcare Group and University of Galway, Galway, Ireland
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Via di Grottarossa, Roma, Italy
| | - Jan J Piek
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam UMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, Meibergdreef, Amsterdam, the Netherlands
| | - William Wijns
- The Lambe Institute for Translational Medicine, Smart Sensors Laboratory and Curam, University of Galway, Ireland
| | - Christoph K Naber
- Department of Internal Medicine I, Cardiology and Intensive Care, Klinikum Wilhelmshaven, Wilhelmshaven, Germany
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Johanson S, Gregersen Oestergaard L, Bejerholm U, Nygren C, van Tulder M, Zingmark M. Cost-effectiveness of occupational therapy return-to-work interventions for people with mental health disorders: A systematic review. Scand J Occup Ther 2023; 30:1339-1356. [PMID: 37119175 DOI: 10.1080/11038128.2023.2200576] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 04/03/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND Return-to-work (RTW) resources for persons with mental health disorders are limited and costs are typically shared by several stakeholders in society. Occupational therapists (OT) provide RTW interventions for this target group, however, increased knowledge of health, and employment effects, as well as costs are needed to better inform decision makers in their prioritisations. AIMS/OBJECTIVES To identify and summarise evidence of cost-effectiveness of RTW interventions for persons with mental health disorders which OTs provide. MATERIALS AND METHODS A systematic search was applied and resulted in 358 articles. After screening, nine articles met inclusion criteria and were reviewed. Quality assessment was conducted using the economic evaluation tool by Joanna Briggs Institute. RESULTS Supported employment, Individual Placement and Support was cost-effective in several contexts while three studies showed larger effects and higher costs. An OT intervention added to treatment for major depression was indicated to be cost-beneficial and an advanced supported employment was cost-saving. The methodological quality varied considerably between studies. CONCLUSIONS AND SIGNIFICANCE The results of the included studies are promising, however, to further strengthen the economic perspective in OT RTW interventions, the need for conducting more and methodologically robust economic evaluations is crucial in future studies.
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Affiliation(s)
- Suzanne Johanson
- Department of Health Sciences, Lund University, Lund, Sweden
- Department of Health Sciences/Centre for Evidence Based Psychosocial Interventions (CEPI), Lund University, Lund, Sweden
| | - Lisa Gregersen Oestergaard
- DEFACTUM Central Denmark Region, Aarhus, Denmark
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Ulrika Bejerholm
- Department of Health Sciences, Lund University, Lund, Sweden
- Department of Health Sciences/Centre for Evidence Based Psychosocial Interventions (CEPI), Lund University, Lund, Sweden
| | - Carita Nygren
- Swedish Association of Occupational Therapists, Nacka, Sweden
| | - Maurits van Tulder
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences Research Institute, Vrije University, Amsterdam, The Netherlands
| | - Magnus Zingmark
- Department of Health Sciences, Lund University, Lund, Sweden
- Municipality of Östersund, Health and Social Care Administration, Östersund, Sweden
- Epidemiology and Public Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Schnitzer M, Houge Mackenzie S, Kopp M. Editorial: Planetary health challenges and physical activity. Front Public Health 2023; 11:1240097. [PMID: 37521994 PMCID: PMC10374302 DOI: 10.3389/fpubh.2023.1240097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/04/2023] [Indexed: 08/01/2023] Open
Affiliation(s)
- Martin Schnitzer
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | | | - Martin Kopp
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
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Messiha D, Petrikhovich O, Lortz J, Mahabadi AA, Hering R, Schulz M, Rassaf T, Rammos C. Income-Related Peripheral Artery Disease Treatment: A Nation-Wide Analysis from 2009-2018. J Cardiovasc Dev Dis 2022; 9:392. [PMID: 36421927 PMCID: PMC9697322 DOI: 10.3390/jcdd9110392] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 10/23/2022] [Revised: 11/09/2022] [Accepted: 11/12/2022] [Indexed: 08/24/2023] Open
Abstract
Economic status has a measurable and significant effect on cardiovascular health. Socioeconomic- and income-related disparities worsen cardiovascular risk factors. Peripheral artery disease (PAD) remains a major risk factor for morbidity and mortality. Not all patients benefit equally from recent advances in outpatient healthcare. The implementation of guideline recommendations regarding treatment is inadequate. Income-related disparities for PAD treatment are unknown. We aimed to analyse income-stratified PAD prevalence, outpatient treatment and pharmacotherapy. Associations of statutory health insurance physicians at the regional level, income-stratified PAD prevalence and differences in outpatient care and pharmacotherapy were analysed in 70.1 million statutorily insured patients/year between 2009 and 2018. Analysis was based on claims data (§295 of the social code (SGB V)) and drug-prescription data (§300 SGB V). The diagnosis of PAD was defined by ICD I70.2-9. Regional income data were derived from the German Census Bureau. PAD prevalence was higher in low-income than in high-income areas. Low-income patients more often presented to angiology outpatient care and more frequently received guideline recommended pharmacotherapy. High-income patients more often presented to outpatient vascular surgery. This was true for statins, antiplatelets, intermittent claudication and critical limb ischemia alike. These data indicate that PAD and income are associated. Regional income is related to insufficiencies in guideline-recommended treatment and contact to vascular specialists. Our results aim to encourage medical professionals to implement PAD guideline recommendations, especially in high-income areas. Further studies on associations between spatial-level income and healthcare in PAD are needed.
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Affiliation(s)
- Daniel Messiha
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Centre, University of Duisburg-Essen, 45147 Essen, Germany
| | - Olga Petrikhovich
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Centre, University of Duisburg-Essen, 45147 Essen, Germany
| | - Julia Lortz
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Centre, University of Duisburg-Essen, 45147 Essen, Germany
| | - Amir Abbas Mahabadi
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Centre, University of Duisburg-Essen, 45147 Essen, Germany
| | - Ramona Hering
- Department of Data Science and Healthcare Analyses, Central Research Institute for Ambulatory Healthcare in Germany (Zi), 10587 Berlin, Germany
| | - Mandy Schulz
- Department of Data Science and Healthcare Analyses, Central Research Institute for Ambulatory Healthcare in Germany (Zi), 10587 Berlin, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Centre, University of Duisburg-Essen, 45147 Essen, Germany
| | - Christos Rammos
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Centre, University of Duisburg-Essen, 45147 Essen, Germany
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Enodien B, Moser D, Kessler F, Taha-Mehlitz S, Frey DM, Taha A. Cost and Quality Comparison of Hernia Surgery in Stationary, Day-Patient and Outpatient Care. Int J Environ Res Public Health 2022; 19:12410. [PMID: 36231718 PMCID: PMC9566150 DOI: 10.3390/ijerph191912410] [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] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Medical progress is increasingly enabling more and more stationary treatment to be provided in the outpatient sector. This development should be welcomed, as healthcare costs have been rising for years. The design of efficient processes and a needs-based infrastructure enable further savings. According to international recommendations (EHS/IEHS), outpatient treatment of unilateral inguinal hernias is recommended. METHOD Data from patients in GZO Hospital Wetzikon/Zurich between 2019 and 2021 for unilateral inguinal hernia repair was included in this study (n = 234). Any over- or under-coverage correlated with one of the three treatment groups: stationary, partially stationary and patients treated in outpatients clinic. Complications and 30-day readmissions were also monitored. RESULTS Final revenue for all patients is -95.36 CHF. For stationary treatments, the mean shifts down to -575.01 CHF, for partially stationary treatments the mean shifts up to -24.73 CHF, and for patients in outpatient clinic final revenue is 793.12 CHF. This result is also consistent with the operation times, which are lowest in the outpatient clinic with a mean of 36 min, significantly longer in the partially stationary setting with 58 min, and longest in the stationary setting with 76 min. The same applies to the anesthesia times and the relevant care times by the nurses as the most important cost factors in addition to the supply and allocation costs. CONCLUSIONS We show that cost-effective elective unilateral inguinal hernia care in the outpatient clinic with profit (mean 793.12 CHF) is possible. Stationary unilateral hernia care (mean -575.01 CHF) is loss-making. Crucial factors for cost efficiency are optimized processes in the operating room (anesthesia, surgical technique and quality, operating time), as well as optimized care processes with minimal preoperative services and care times for the patient. However, at the same time, these optimizations pose a challenge to surgical and anesthesiology training and structures with high levels of preoperative and Postoperative services and pay-as-you-go costs. The complication rate is 0.91% lower than in a comparable study. The readmission within 30 days post-operation results with a positive deviation of -3.53% (stationary) and with a negative deviation of +2.29% (outpatient clinic) compared to a comparative study.
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Affiliation(s)
- Bassey Enodien
- Department of Surgery, GZO Hospital Wetzikon/Zurich, 8620 Wetzikon, Switzerland
| | - Dominik Moser
- Operations Management, GZO Hospital Wetzikon/Zurich, 8620 Wetzikon, Switzerland
- Department of Health Care Management, Technical University of Berlin, 10623 Berlin, Germany
- Department of Economics and Technology, Swiss Distance University of Applied Sciences (FFHS), 8005 Zurich, Switzerland
- School of Medicine, University of St. Gallen, 9000 St. Gallen, Switzerland
| | - Florian Kessler
- Department of Anesthesiology, GZO Hospital Wetzikon/Zurich, 8620 Wetzikon, Switzerland
| | - Stephanie Taha-Mehlitz
- Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, 4058 Basel, Switzerland
| | - Daniel M. Frey
- Department of Surgery, GZO Hospital Wetzikon/Zurich, 8620 Wetzikon, Switzerland
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
| | - Anas Taha
- Department of Surgery, GZO Hospital Wetzikon/Zurich, 8620 Wetzikon, Switzerland
- Department of Biomedical Engineering, Faculty of Medicine, University of Basel, 4123 Allschwil, Switzerland
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Han TS, Murray P, Robin J, Wilkinson P, Fluck D, Fry CH. Evaluation of the association of length of stay in hospital and outcomes. Int J Qual Health Care 2022; 34:mzab160. [PMID: 34918090 PMCID: PMC9070811 DOI: 10.1093/intqhc/mzab160] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 07/31/2021] [Revised: 10/21/2021] [Accepted: 12/16/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND There exist wide variations in healthcare quality within the National Health Service (NHS). A shorter hospital length of stay (LOS) has been implicated as premature discharge, that may in turn lead to adverse consequences. We tested the hypothesis that a short LOS might be associated with increased risk of readmissions within 28 days of hospital discharge and also post-discharge mortality. METHODS We conducted a single-centred study of 32 270 (46.1% men) consecutive alive-discharge episodes (mean age = 64.0 years, standard deviation = 20.5, range = 18-107 years), collected between 01/04/2017 and 31/03/2019. Associations of LOS tertiles (middle tertile as a reference) with readmissions and mortality were assessed using observed/expected ratios, and logistic and Cox regressions to estimate odds (OR) and hazard ratios (HR) (adjusted for age, sex, patients' severity of underlying health status and index admissions), with 95% confidence intervals (CIs). RESULTS The observed numbers of readmissions within 28 days of hospital discharge or post-discharge mortality were lower than expected (observed: expected ratio < 1) in patients in the bottom tertile (<1.2 days) and middle tertile (1.2-4.3 days) of LOS, whilst higher than expected (observed: expected ratio > 1) in patients in the top tertile (>4.3 days), amongst all ages. Patients in the top tertile of LOS had increased risks for one readmission: OR = 2.32 (95% CI = 1.86-2.88) or ≥2 readmissions: OR = 6.17 (95% CI = 5.11-7.45), death within 30 days: OR = 2.87 (95% CI = 2.34-3.51), and within six months of discharge: OR = 2.52 (95% CI = 2.23-2.85), and death over a two-year period: HR = 2.25 (95% CI = 2.05-2.47). The LOS explained 7.4% and 15.9% of the total variance (r2) in one readmission and ≥2 readmissions, and 9.1% and 10.0% of the total variance in mortality with 30 days and within six months of hospital discharge, respectively. Within the bottom, middle and top tertiles of the initial LOS, the median duration from hospital discharge to death progressively shortened from 136, 126 to 80 days, whilst LOS during readmission lengthened from 0.4, 0.9 to 2.8 days, respectively. CONCLUSION Short LOS in hospital was associated with favourable post-discharge outcomes such as early readmission and mortality, and with a delay in time interval from discharge to death and shorter LOS in hospital during readmission. These findings indicate that timely discharge from our hospital meets the aims of the NHS-generated national improvement programme, Getting It Right First Time.
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Affiliation(s)
- Thang S Han
- Department of Endocrinology, Ashford and St Peter’s Hospitals NHS Foundation Trust, Guildford Road, Chertsey, Surrey KT16 0PZ, UK
- Institute of Cardiovascular Research, Royal Holloway, University of London, Egham Hill, Egham, Surrey TW20 0EX, UK
| | - Paul Murray
- Department of Respiratory Medicine, Ashford and St Peter’s Hospitals NHS Foundation Trust, Guildford Road, Chertsey, Surrey KT16 0PZ, UK
| | - Jonathan Robin
- Acute Medical Unit, Ashford and St Peter’s Hospitals NHS Foundation Trust, Guildford Road, Chertsey, Surrey KT16 0PZ, UK
| | - Peter Wilkinson
- Department of Cardiology, Ashford and St Peter’s Hospitals NHS Foundation Trust, Guildford Road, Chertsey, Surrey KT16 0PZ, UK
| | - David Fluck
- Department of Cardiology, Ashford and St Peter’s Hospitals NHS Foundation Trust, Guildford Road, Chertsey, Surrey KT16 0PZ, UK
| | - Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Biomedical Sciences Building, University Walk, Bristol BS8 1TD, UK
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Cattoi B, Alpern I, Katz JS, Keepnews D, Solanto MV. The Adverse Health Outcomes, Economic Burden, and Public Health Implications of Unmanaged Attention Deficit Hyperactivity Disorder (ADHD): A Call to Action Resulting from CHADD Summit, Washington, DC, October 17, 2019. J Atten Disord 2022; 26:807-808. [PMID: 34585995 DOI: 10.1177/10870547211036754] [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] [Indexed: 11/15/2022]
Abstract
Recent research has increasingly documented the adverse effects of ADHD on physical health in addition to its well-known effects on emotional health. Responding to this concern, CHADD organized a summit meeting of health care providers, governmental and other health-related organizations, and health care payers. A White Paper generated from the meeting reviewed the adverse health outcomes, economic burden and public health implications of unmanaged ADHD. Here we summarize the resulting Calls to Action to the various stakeholder groups including: increased awareness and education of providers; development of professional guidelines for diagnosis and treatment; insurance coverage of the relevant services; support of research targeting the role of ADHD in the etiology and treatment of physical illness; and public education campaigns.
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Karlsson K, Derks J, Wennström JL, Petzold M, Berglundh T. Health economic aspects of implant-supported restorative therapy. Clin Oral Implants Res 2021; 33:221-230. [PMID: 34888933 DOI: 10.1111/clr.13885] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 07/05/2021] [Revised: 09/10/2021] [Accepted: 11/25/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND It is poorly understood how much additional dental care patients consume subsequent to implant therapy. The aim of the present study is to evaluate costs associated with implant-supported restorative therapy during the long-term follow-up. MATERIAL AND METHODS Costs associated with preventive measures and complication-related procedures over a mean follow-up period of 8.2 years were assessed in patient files of 514 Swedish subjects provided with implant-supported restorative therapy. The restorative therapy and each of the subsequent interventions were assigned a specific cost. Accumulated costs were calculated in three categories: (i) total cost including initial restorative therapy and complication-related interventions, (ii) cost of preventive measures alone, and (iii) cost of complication-related procedures alone. Potential differences by background variables were analyzed using growth curve models. RESULTS In the whole sample, costs during follow-up ranged from 878 € (95% CI 743; 1,014) for patients with single-tooth restoration(s) to 1,210 € (95% CI 1,091; 1,329) for subjects with full-jaw restoration(s). The majority of costs during follow-up originated from preventive measures (741 € 95% CI 716; 766). Among individuals receiving ≥1 intervention dealing with a complication (n = 253), complication-related costs amounted to 557 € (95% CI 480; 634). For patients with full-jaw restorations, the corresponding amount was 769 € (95% CI 622; 916). Procedures related to peri-implantitis and technical complications resulted in costs similar to each other. Implant loss generated greater costs than any other type of complication. CONCLUSIONS Costs related to implant-supported restorative therapy during follow-up were associated with the extent of initial therapy. The higher costs during follow-up noted in patients provided with full-jaw restorations were explained by complication-associated procedures. Implant loss was the most costly type of complication.
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Affiliation(s)
- Karolina Karlsson
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jan Derks
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jan L Wennström
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Max Petzold
- School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Tord Berglundh
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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11
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Abstract
OBJECTIVE The objective was to examine the association between primary care consultations and a Care Need Index (CNI) used to compensate Swedish primary care practices for the extra workload associated with patients with low socioeconomic status. DESIGN Observational study combining graphical analysis with linear regressions of cross-sectional administrative practice-level data. SETTING Three Swedish regions, Västra Götaland, Skåne and Östergötland (3.5 million residents). Outcomes were measured in February 2018 and the CNI was computed based on data for 31 December 2017. SUBJECTS The unit of analysis was the primary care practice (n = 390). MAIN OUTCOME MEASURES i) Number of GP visits per registered patient; ii) Number of nurse visits per registered patient; iii) Number of morbidity-weighted GP visits per registered patient; iv) Number of morbidity-weighted nurse visits per registered patient. RESULTS The linear associations between the CNI and GP visits per patient were positive and statistically significant (p<0.01) for both the unweighted and weighted measure in two regions, but the associations were mainly due to 10 practices with very high CNI values. The results for nurse visits varied across regions. CONCLUSIONS For most levels of the CNI, there was no association with the number of consultations provided. This result may indicate insufficient compensation, weak incentives to spend the money, decisions to spend the money on other things than consultations, or stronger competition for patients among low-CNI practices. The result of this observational study should not be taken as evidence against the possibility that the CNI adjustment of capitation may have affected the socioeconomic equity in GP and nurse visits.Key PointsSwedish primary care practices receive extra compensation for socioeconomically deprived patients but it is unknown how this affects service provision.Practice-level data from three regions years 2017-2018 indicate weak or no relation between the socioeconomic burden and the number of physical consultations per patient.Results are similar when adjusting for patients' morbidity levels, suggesting that the weak gradient was not explained by longer consultations.The exception is that a small number of practices with very high burdens provide more consultations per patient.The results may reflect insufficient compensation, lack of incentives, or funds being spent on other things than consultations.
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Affiliation(s)
- Anders Anell
- Department of Business Administration, Lund University, Lund, Sweden
| | | | - Lina Maria Ellegård
- Department of Economics, Lund University and Faculty of Business, Kristianstad University, Kristianstad, Sweden
- CONTACT Lina Maria Ellegård Department of Economics, Lund University, 7080, S-220 07, Lund, Sweden
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12
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Hastrup LH, Jennum P, Ibsen R, Kjellberg J, Simonsen E. Costs of schizotypal disorder: A matched-controlled nationwide register-based study of patients and spouses. Acta Psychiatr Scand 2021; 144:60-71. [PMID: 33650099 DOI: 10.1111/acps.13292] [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: 11/05/2020] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Information on societal cost of patients with schizotypal disorder is limited. The aim was to investigate the societal costs of schizotypal disorder before and after initial diagnosis including both patients and their spouses. METHODS A register-based cohort study of 762 patients with incident schizotypal disorder (ICD-10; F21) including their spouses and 3048 matched controls, during 2002 to 2016. Total healthcare costs, home care costs, and costs of lost productivity of patients and spouses were included in the analysis. RESULTS Total costs amounted €47,215 per year for patients with schizotypal disorder, which was fifteen times higher than the matched controls. Of these, 41% were healthcare and home care costs and 59% were costs of lost productivity. Healthcare costs and costs of lost productivity were increased during five years before initial diagnosis of schizotypal disorder. Total costs of spouses to patients were €21,384 compared with € 2519 among spouses of controls. 75% of the total costs of spouses to patients were related to lost productivity. The total costs were higher than the costs of borderline personality disorder, but on the same level as the costs of schizophrenia identified in earlier comparable studies. CONCLUSIONS The total societal costs of patients with schizotypal disorder drawn from national registers differed substantially from the controls representing the general population. As evidence-based recommendations for diagnoses and treatment of patients with schizotypal disorder do not exist, future research should focus on developing effective treatment for this group of patients to reduce cost of illness.
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Affiliation(s)
| | - Poul Jennum
- Faculty of Health Sciences, Danish Center for Sleep Medicine, Neurophysiology Clinic, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | | | - Jakob Kjellberg
- VIVE - The Danish Center for Social Science Research, Copenhagen, Denmark
| | - Erik Simonsen
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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13
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Darbà J, Ascanio M, Syk J, Alving K. Economic Evaluation of the Use of FeNO for the Diagnosis and Management of Asthma Patients in Primary Care in Sweden. Clinicoecon Outcomes Res 2021; 13:289-297. [PMID: 33935507 PMCID: PMC8079249 DOI: 10.2147/ceor.s306389] [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: 02/15/2021] [Accepted: 03/25/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To determine the economic impact of the fraction of exhaled nitric oxide (FeNO) in asthma diagnosis and management in primary care in Sweden. METHODS An economic model has been developed to determine the economic impact of the fraction of exhaled nitric oxide (FeNO) in asthma diagnosis and management in primary care in Sweden. The model includes the use and cost of commonly used tests, the associated outcomes and diagnostic accuracy. We compared FeNO with spirometry and reversibility testing, methacholine challenge test, allergy testing, and blood eosinophil count. One-way sensitivity analyses were performed to confirm the robustness of results. RESULTS Adding FeNO measurement in asthma diagnosis resulted in cost savings of SEK 672 per patient by the fourth year. The use of FeNO testing in asthma management proved to be a dominant strategy when compared with each other test except methacholine challenge test. Sensitivity analyses confirmed the robustness of the results. CONCLUSION Introducing FeNO testing in clinical practice for the diagnosis and management of asthma in primary care in Sweden is less costly than standard methods while providing similar health benefits.
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Affiliation(s)
- Josep Darbà
- Department of Economics, Universitat de Barcelona, Barcelona, Spain
| | | | - Jörgen Syk
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Academic Primary Health Care Centre, Stockholm, Sweden
| | - Kjell Alving
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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14
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Vanholder R, Annemans L, Bello AK, Bikbov B, Gallego D, Gansevoort RT, Lameire N, Luyckx VA, Noruisiene E, Oostrom T, Wanner C, Wieringa F. Fighting the unbearable lightness of neglecting kidney health: the decade of the kidney. Clin Kidney J 2021; 14:1719-1730. [PMID: 34221379 PMCID: PMC8243275 DOI: 10.1093/ckj/sfab070] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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: 03/10/2021] [Accepted: 03/16/2021] [Indexed: 01/08/2023] Open
Abstract
A brief comprehensive overview is provided of the elements constituting the burden of kidney disease [chronic kidney disease (CKD) and acute kidney injury]. This publication can be used for advocacy, emphasizing the importance and urgency of reducing this heavy and rapidly growing burden. Kidney diseases contribute to significant physical limitations, loss of quality of life, emotional and cognitive disorders, social isolation and premature death. CKD affects close to 100 million Europeans, with 300 million being at risk, and is projected to become the fifth cause of worldwide death by 2040. Kidney disease also imposes financial burdens, given the costs of accessing healthcare and inability to work. The extrapolated annual cost of all CKD is at least as high as that for cancer or diabetes. In addition, dialysis treatment of kidney diseases imposes environmental burdens by necessitating high energy and water consumption and producing plastic waste. Acute kidney injury is associated with further increases in global morbidity, mortality and economic burden. Yet investment in research for treatment of kidney disease lags behind that of other diseases. This publication is a call for European investment in research for kidney health. The innovations generated should mirror the successful European Union actions against cancer over the last 30 years. It is also a plea to nephrology professionals, patients and their families, caregivers and kidney health advocacy organizations to draw, during the Decade of the Kidney (2020–30), the attention of authorities to realize changes in understanding, research and treatment of kidney disease.
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Affiliation(s)
- Raymond Vanholder
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium.,European Kidney Health Alliance, Brussels, Belgium
| | - Lieven Annemans
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Department of Public Health, Interuniversity Center for Health Economics Research (I-CHER), Free University of Brussels, Brussels, Belgium
| | - Aminu K Bello
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Boris Bikbov
- Istituto di Richerche Farmcologiche Mario Negri RICCS, Milan, Italy
| | - Daniel Gallego
- European Kidney Patient Federation (EKPF), Dublin, Ireland.,Spanish Kidney Patient Federation (ALCER), Madrid, Spain
| | - Ron T Gansevoort
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Norbert Lameire
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | - Valerie A Luyckx
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.,Renal Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Edita Noruisiene
- European Dialysis and Transplant Nurses Association-European Renal Care Association (EDTNA/ERCA), Nidwalden, Switzerland
| | - Tom Oostrom
- Dutch Kidney Foundation, Bussum, the Netherlands
| | - Christoph Wanner
- Department of Internal Medicine I, Nephrology Section, Würzburg University, Würzburg University Hospital, Würzburg, Germany
| | - Fokko Wieringa
- IMEC Eindhoven, Eindhoven, the Netherlands.,Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
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Šprem Goldštajn M, Mikuš M, Ćorić M, Orešković S, Dumančić S, Noventa M, Buzzaccarini G, Andrisani A, Laganà AS. The pharmacoeconomic impact of follitropin alpha biosimilars in IVF therapy in Europe: a report of the literature. Expert Rev Pharmacoecon Outcomes Res 2021; 21:553-558. [PMID: 33784935 DOI: 10.1080/14737167.2021.1910026] [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] [Indexed: 10/21/2022]
Abstract
Introduction: To study the impact of biosimilars in assisted reproductive treatments, we performed a review of the literature. Biosimilars are a bioequivalent chemical drug referred to the original. Their production is strongly requested in order to reduce drug cost and reduce health economic impact on national health system. In assisted reproductive treatments different gonadotropin biosimilars are being produced.Areas covered: For this reason, we performed a review of the literature on follitropin alfa Gonal-F biosimilar, Ovaleap and Bemfola, to assess their cost efficacy in national health system. Cost effective (CE) analysis and incremental cost-effectiveness ratio (ICER) were used as parameters for biosimilar impact evaluation in the national health system economy. In particular, they had only slight impact on cost reduction of recombinant follitropin alfa products in Europe.Expert opinion: considering cost-effective analysis, Gonal-F remains the first choice for national health systems. However, well-designed powered methods are strongly needed to assess biosimilars cost-effectiveness.
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Affiliation(s)
- Marina Šprem Goldštajn
- Department of Obstetrics and Gynecology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Mislav Mikuš
- Department of Obstetrics and Gynecology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Mario Ćorić
- Department of Obstetrics and Gynecology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Slavko Orešković
- Department of Obstetrics and Gynecology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Stipe Dumančić
- Department of Obstetrics and Gynecology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Marco Noventa
- Department of Women and Children's Health, University of Padua, Padua, Italy
| | | | | | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
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16
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Fu L, Xu K, Liu F, Liang L, Wang Z. Regional Disparity and Patients Mobility: Benefits and Spillover Effects of the Spatial Network Structure of the Health Services in China. Int J Environ Res Public Health 2021; 18:1096. [PMID: 33530638 PMCID: PMC7908610 DOI: 10.3390/ijerph18031096] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/18/2021] [Accepted: 01/22/2021] [Indexed: 12/02/2022]
Abstract
BACKGROUND The distribution of medical resources in China is seriously imbalanced due to imbalanced economic development in the country; unbalanced distribution of medical resources makes patients try to seek better health services. Against this backdrop, this study aims to analyze the spatial network characteristics and spatial effects of China's health economy, and then find evidence that affects patient mobility. METHODS Data for this study were drawn from the China Health Statistical Yearbooks and China Statistical Books. The gravitational value of China's health spatial network was calculated to establish a network of gravitational relationships. The social network analysis method was used for centrality analysis and spillover effect analysis. RESULTS A gravity correlation matrix was constructed among provinces by calculating the gravitational value, indicating the spatial relationships of different provinces in the health economic network. Economically developed provinces, such as Shanghai and Jiangsu, are at the center of the health economic network (centrality degree = 93.333). These provinces also play a strong intermediary role in the network and have connections with other provinces. In the CONCOR analysis, 31 provinces are divided into four blocks. The spillover effect of the blocks indicates provinces with medical resource centers have beneficial effects, while provinces with insufficient resources have obvious spillover effects. CONCLUSION There is a significant gap in the geographical distribution of medical resources, and the health economic spatial network structure needs to be improved. Most medical resources are concentrated in economically developed provinces, and these provinces' positions in the health economic spatial network are becoming more centralized. By contrast, economically underdeveloped regions are at the edge of the network, causing patients to move to provinces with medical resource centers. There are health risks of the increasing pressure to seek medical treatment in developed provinces with abundant medical resources.
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Affiliation(s)
- Liping Fu
- College of Management and Economics, Center for Social Science Survey and Data Tianjin University, Tianjin 300072, China; (L.F.); (L.L.); (Z.W.)
| | - Kaibo Xu
- College of Management and Economics, Center for Social Science Survey and Data Tianjin University, Tianjin 300072, China; (L.F.); (L.L.); (Z.W.)
- Politics and Public Administration College, Qinghai Nationalities University, Xining 810007, China
| | - Feng Liu
- School of Public Finance and Administration, Tianjin University of Finance & Economics, Tianjin 300222, China;
| | - Lu Liang
- College of Management and Economics, Center for Social Science Survey and Data Tianjin University, Tianjin 300072, China; (L.F.); (L.L.); (Z.W.)
| | - Zhengmin Wang
- College of Management and Economics, Center for Social Science Survey and Data Tianjin University, Tianjin 300072, China; (L.F.); (L.L.); (Z.W.)
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17
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Viste E, Vinje CA, Lid TG, Skeie S, Evjen-Olsen Ø, Nordström T, Thorsen O, Gilje B, Janssen EAM, Kjosavik SR. Effects of replacing PSA with Stockholm3 for diagnosis of clinically significant prostate cancer in a healthcare system - the Stavanger experience. Scand J Prim Health Care 2020; 38:315-322. [PMID: 32772613 PMCID: PMC7470071 DOI: 10.1080/02813432.2020.1802139] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To describe early experience of replacing PSA with Stockholm3 for detection of prostate cancer in primary care. DESIGN AND METHODS Longitudinal observations, comparing outcome measures before and after the implementation of Stockholm3. SETTING Stavanger region in Norway with about 370,000 inhabitants, 304 general practitioners (GPs) in 97 primary care clinics, and one hospital. INTERVENTION GPs were instructed to use Stockholm3 instead of PSA as standard procedure for diagnosis of prostate cancer. MAIN OUTCOME MEASURES Proportion of GP clinics that had ordered a Stockholm3 test. Number of men referred to needle biopsy. Distribution of clinically significant prostate cancer (csPC) (Gleason Score ≥7) and clinically non-significant prostate cancer (cnsPC) (Gleason Score 6), in needle biopsies. Estimation of direct healthcare costs. RESULTS Stockholm3 was rapidly implemented as 91% (88/97) of the clinics started to use the test within 14 weeks. After including 4784 tested men, the percentage who would have been referred for prostate needle biopsy was 29.0% (1387/4784) if based on PSA level ≥3ng/ml, and 20.8% (995/4784) if based on Stockholm3 Risk Score (p < 0.000001). The proportion of positive biopsies with csPC increased from 42% (98/233) before to 65% (185/285) after the implementation. Correspondingly, the proportion of cnsPC decreased from 58% (135/233) before to 35% (100/285) after the implementation (p < 0.0017). Direct healthcare costs were estimated to be reduced by 23-28% per tested man. CONCLUSION Replacing PSA with Stockholm3 for early detection of prostate cancer in primary care is feasible. Implementation of Stockholm3 resulted in reduced number of referrals for needle-biopsy and a higher proportion of clinically significant prostate cancer findings in performed biopsies. Direct healthcare costs decreased. KEY POINTS A change from PSA to Stockholm3 for the diagnosis of prostate cancer in primary care in the Stavanger region in Norway is described and assessed. •Implementation of a new blood-based test for prostate cancer detection in primary care was feasible. A majority of GP clinics started to use the test within three months. •Implementation of the Stockholm3 test was followed by: -a 28% reduction in number of men referred for urological prostate cancer work-up -an increase in the proportion of clinically significant cancer in performed prostate biopsies from 42 to 65% -an estimated reduction in direct health care costs between 23 and 28%.
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Affiliation(s)
- Eirik Viste
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- The General Practice and Care Coordination Research Group, Stavanger University Hospital, Stavanger, Norway
| | - Cathrine Alvaer Vinje
- Department of Urology, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Torgeir Gilje Lid
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- The General Practice and Care Coordination Research Group, Stavanger University Hospital, Stavanger, Norway
| | - Svein Skeie
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Research, Stavanger University Hospital, Stavanger, Norway
- CONTACT Svein R. Kjosavik The General Practice and Care Coordination Research Group, Stavanger University Hospital, P.O. Box 8100, Stavanger, 4068, Norway
| | - Øystein Evjen-Olsen
- Organization and Development Unit SUS 2023, Stavanger University Hospital, Stavanger, Norway
| | - Tobias Nordström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Olav Thorsen
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- The General Practice and Care Coordination Research Group, Stavanger University Hospital, Stavanger, Norway
| | - Bjørnar Gilje
- Department of Oncology, Stavanger University Hospital, Stavanger, Norway
| | - Emiel A. M. Janssen
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway
- Faculty of Science and Technology, University of Stavanger, Stavanger, Norway
| | - Svein R. Kjosavik
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- The General Practice and Care Coordination Research Group, Stavanger University Hospital, Stavanger, Norway
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Xing Y, Wang D, Sheng K, Xiao X, Wei H, Liu L, Zhou W, Tong X. Dynamic change of Mycoplasma pneumoniae pneumonia in hospitalized children in a general hospital: a 3-year retrospective analysis. Transl Pediatr 2020; 9:522-531. [PMID: 32953550 PMCID: PMC7475305 DOI: 10.21037/tp-20-149] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The epidemiology and economic burden of hospitalized community-acquired pneumonia (CAP) children due to MP is still poorly understood. This study aimed to investigate the dynamic changes of Mycoplasma pneumoniae pneumonia (MPP) in children in a general hospital. METHODS A total of 2011 CAP children aged 1-16 years hospitalized at Peking University Third Hospital from 2017 to 2019 were enrolled by cross-sectional study for the retrospective analysis of the clinical data mainly including seasonal distribution of MPP, hospital stay, severity, complications, use of flexible bronchoscopy, and hospitalization costs. The dynamic changes of CAP and MPP children within 3 consecutive years and the differences between the MPP group and non-MPP groups were compared. RESULTS The proportion of CAP children among hospitalized children was 32.4%, 38.5%, and 39.5% in 2017, 2018, and 2019, respectively, showing an upward trend (P<0.05).The prevalence rate of MPP was highest in the third quarter (30.2%) and the fourth quarter (39.2%) and lowest in the second quarter (13.2%) (χ2=51.8, P<0.05). Compared with the non-MPP group, the MPP group had significantly higher incidence of severe pneumonia (19.4% vs. 12.0%, χ2=20.99), incidence of complications (16.1% vs. 6.5%, χ2=48.24), proportion of patients undergoing flexible bronchoscopy (38.4% vs. 9.0%, χ2=252.79), and hospitalization costs (all P<0.05), along with significantly longer hospital stay (6 vs. 4 days, z=-11.131). A dynamic comparison of the clinical characteristics of MPP in 3 years showed that the number of children with MPP increased significantly in preschoolers in 2018 (37.3%) and in school-aged or older children in 2019 (53%) (P<0.05). MPP peaks occurred in August 2018 and November 2019. The total hospitalization costs, examination fees, and non-medication treatment costs increased significantly (the z values were 35.24, 46.79, and 9.64, respectively; P<0.05) year by year among MPP children; there was no significant difference in the medication cost over these 3 years (z=4.81, P>0.05). CONCLUSIONS The proportions of severe pneumonia, complications, and use of flexible bronchoscopy as well as the hospitalization days and costs are higher in MPP children. General hospitals should develop integrated clinical quality control programs for MPP children, so as to optimize the allocation of medical resources.
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Affiliation(s)
- Yan Xing
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Dan Wang
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Kai Sheng
- Department of Emergency, Beijing Children's Hospital, Beijing, China
| | - Xiumei Xiao
- Department of Laboratory Medicine, Peking University Third Hospital, Beijing, China
| | - Hongling Wei
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Ling Liu
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Wei Zhou
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Xiaomei Tong
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
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Hastrup LH, Jennum P, Ibsen R, Kjellberg J, Simonsen E. Societal costs of Borderline Personality Disorders: a matched-controlled nationwide study of patients and spouses. Acta Psychiatr Scand 2019; 140:458-467. [PMID: 31483859 DOI: 10.1111/acps.13094] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [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] [Accepted: 08/22/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Information on societal cost of patients with Borderline Personality Disorder (BPD) and spouses is limited. The aim was to investigate factual societal costs before and after initial BPD diagnosis. METHOD A register-based cohort study of 2756 patients with incident BPD (ICD F60.3) with spouses and 11 024 matched controls, during 2002-2016. RESULTS Total direct healthcare costs and lost productivity costs amounted €40 441 for patients with BPD, which was more than 16 times higher than the matched controls. Somatic and psychiatric health care costs and costs of lost productivity were increased during 5 years before initial diagnosis of BPD. Before and after initial diagnosis, health care costs and lost productivity were increased among spouses of patients with BPD. CONCLUSION Patients with BPD differed substantially from the general population with respect to all included costs. The study documented a significant burden on their spouses. Besides the early onset of BPD, which implies that patients are affected before they finish school and enter labor market, the neurocognitive impairment and fundamental symptoms of BPD, e.g. unstable, intense relationships, impulsivity, and lack of stable sense of self together with psychiatric and somatic comorbidity are part of explanation of the excess costs of BPD.
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Affiliation(s)
- L H Hastrup
- Psychiatric Research Unit, Psychiatry in Region Zealand, Slagelse, Denmark
| | - P Jennum
- Faculty of Health Sciences, Danish Center for Sleep Medicine, Neurophysiology Clinic, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - J Kjellberg
- VIVE - The Danish Center for Social Science Research, Copenhagen, Denmark
| | - E Simonsen
- Psychiatric Research Unit, Psychiatry in Region Zealand, Slagelse, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Abstract
OBJECTIVE This research aimed to examine the impact of attention deficit disorder (ADD)/ADHD in children on parental labor force participation across different child age groups. METHOD This study utilized a longitudinal, quantitative analyses approach. All data were collected from Wave 6 of the Growing Up in Australia: The Longitudinal Study of Australian Children (LSAC) survey. RESULTS After adjusting for various confounders, mothers whose children were 10/11 years old and had been diagnosed with ADD/ADHD were significantly more likely to be out of the labor force compared with those mothers whose child had not been diagnosed with ADD/ADHD. The impact was more pronounced for single mothers. No significant influence on paternal labor force participation was found. CONCLUSION In assessing the cost-effectiveness of interventions for ADD/ADHD, policy makers and researchers must consider the long-term social and economic effects of ADD/ADHD on maternal workforce participation when considering costs and outcomes.
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Affiliation(s)
| | - Faith Allele
- 1 James Cook University, Townsville, Queensland, Australia
| | - Hayley Roberts
- 1 James Cook University, Townsville, Queensland, Australia
| | - William Guinea
- 1 James Cook University, Townsville, Queensland, Australia
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Wallentin L, Lindahl B. Uppsala Clinical Research Center-development of a platform to promote national and international clinical science. Ups J Med Sci 2019; 124:1-5. [PMID: 30513248 PMCID: PMC6450489 DOI: 10.1080/03009734.2018.1540506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 10/22/2018] [Accepted: 10/22/2018] [Indexed: 10/27/2022] Open
Abstract
Uppsala Clinical Research Center (UCR) is a non-profit organization that provides service for clinical research aiming for development and improvement of health care in Sweden and worldwide. UCR was started in 2001 with the ambition to shift the focus of clinical research from new medications or devices launched by the industry to problem-based research on issues identified in clinical reality, for example through the national quality registries. In order to accomplish these goals, UCR has established services in: 1) clinical trials of new and old methods in health care; 2) quality development of the health care system supported by internet-based national quality registries; 3) biostatistics, epidemiology, and data management; 4) biobanking of biological materials (Uppsala Biobank); 5) high-throughput biochemical analyses (UCR laboratory); and 6) academic leadership by the members of the UCR research faculty. The UCR clinical trials group provides services for investigator-driven projects in all areas of health care, for global mega-trials on new pharmaceutical treatments and devices, for biobanking including biomarker and genetics analyses, and for clinical events adjudication in national as well as global mega-trials. During the last few years, UCR has been a pioneer in establishing the registry-based randomized clinical trial (R-RCT), which today is an international model on how to perform cost-effective pragmatic randomized trials in the real-world environment. In 2002, UCR started the first national competence center for national quality registries, which pioneered the development of the current internet-based technologies for registering, reporting, and supporting continuous systematic improvement of health care. UCR is currently harboring around 20 national quality registries in all areas of health care. Today, UCR is the leading European center for registry-based quality development and evaluation of new medical treatments in cardiovascular care and has started to support other European countries in implementing the UCR registry platform in order to improve quality of care in the European Union.
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Affiliation(s)
- Lars Wallentin
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Bertil Lindahl
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
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Timpka T, Nyce JM, Amer-Wåhlin I. Value-Based Reimbursement in Collectively Financed Healthcare Requires Monitoring of Socioeconomic Patient Data to Maintain Equality in Service Provision. J Gen Intern Med 2018; 33:2240-2243. [PMID: 30206793 PMCID: PMC6258603 DOI: 10.1007/s11606-018-4661-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 07/25/2018] [Accepted: 07/26/2018] [Indexed: 10/28/2022]
Abstract
Value-based purchasing is increasingly discussed in association with efforts to develop modern healthcare systems. These models are the most recent example of models derived from health economics research intended to reform collectively financed healthcare. Previous examples have ranged from creation of pseudo-markets to opening these markets for competition between publicly and privately owned enterprises. Most value-based purchasing models tend to ignore that health service provision in collectively financed settings is based on an insurance with political, social obligations attached that challenge the notion of free market and individualist premises which these models rest on. Central social issues related to healthcare in any modern complex society, such as inequality in service provision, can all too easily "disappear" in value-based reform efforts. Based on an analysis of Swedish policy development, we contend that management information systems need to be extended to allow routine monitoring of socioeconomic data when models such as value-based purchasing are introduced in collectively financed health services. The experiences from Sweden are important for health policy in Europe and other regions with collectively financed healthcare plans.
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Affiliation(s)
- Toomas Timpka
- Centre for Health Service Development, Region Östergötland, Linköping, Sweden.
- Department of Medical and Health Sciences, Linköpings Universitet, SE-581 83, Linköping, Sweden.
| | - James M Nyce
- Department of Anthropology, Ball State University, Muncie, IN, USA
- Medical Management Center (LIME), Department of Women and Child Health, Karolinska Institute, Stockholm, Sweden
| | - Isis Amer-Wåhlin
- Department of Medical and Health Sciences, Linköpings Universitet, SE-581 83, Linköping, Sweden
- Medical Management Center (LIME), Department of Women and Child Health, Karolinska Institute, Stockholm, Sweden
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Rudberg AS, Berge E, Gustavsson A, Näsman P, Lundström E. Long-term health-related quality of life, survival and costs by different levels of functional outcome six months after stroke. Eur Stroke J 2018; 3:157-164. [PMID: 31008347 PMCID: PMC6460413 DOI: 10.1177/2396987317753444] [Citation(s) in RCA: 6] [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] [Received: 11/15/2017] [Accepted: 12/16/2017] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Information about the impact of functional outcome after stroke is currently missing on health-related quality of life, survival and costs. This information would be valuable for health economic evaluations and for allocation of resources in stroke health care. PATIENTS AND METHODS Data on 297 Swedish patients included in the Third International Stroke Trial were analysed including functional outcome at six months (measured by Oxford Handicap Scale), health-related quality of life up to 18 months (EQ-5D-3L) and survival up to 36 months. We used record linkage to collect data on costs up to 36 months, using national patient registers. RESULTS Patients with a better functional outcome level at six months had a significantly better health-related quality of life at 18 months (p < 0.05), better long-term survival (p < 0.05) and lower costs (p < 0.001), for all time points up to 36 months. The difference in costs was mainly due to differences in days spent in hospital (p < 0.005). DISCUSSION This study showed an association between functional outcome at six months and health-related quality of life up to 18 months, and costs up to 36 months. CONCLUSION Functional outcome six months after stroke is an important determinant of health-related quality of life, survival and costs over 36 months. Effective interventions aimed at reducing short-term disability levels are therefore also expected to reduce the overall burden of stroke.
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Affiliation(s)
- Ann-Sofie Rudberg
- Department of Clinical Neuroscience,
Division of Neurology, Karolinska Institutet, Stockholm, Sweden
| | - Eivind Berge
- Department of Internal Medicine and Cardiology, Oslo University
Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Tromsø, Tromsø,
Norway
| | - Anders Gustavsson
- Quantify Research, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society,
Karolinska Institutet, Stockholm, Sweden
| | - Per Näsman
- Center for Safety Research, KTH Royal Institute of Technology,
Stockholm, Sweden
| | - Erik Lundström
- Department of Clinical Neuroscience,
Division of Neurology, Karolinska Institutet, Stockholm, Sweden
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Hajj JJ, Laudanski K. Home Hemodialysis (HHD) Treatment as Effective yet Underutilized Treatment Modality in the United States. Healthcare (Basel) 2017; 5:E90. [PMID: 29182543 DOI: 10.3390/healthcare5040090] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 10/13/2017] [Revised: 11/09/2017] [Accepted: 11/17/2017] [Indexed: 11/17/2022] Open
Abstract
End-stage renal disease (ESRD) is a major health burden and its incidence has been increasing yearly reaching 120,000 cases in 2014. Home hemodialysis (HHD) is a treatment modality option that has been shown to contribute to numerous clinical benefits but is largely underutilized due to many contributing factors. The purpose of this review paper is to analyze the advantages and disadvantages of HHD and the reasons for its low utilization with a special focus on its socioeconomic impact as compared to facility hemodialysis. Key factors contributing to HHD underutilization are related to the reimbursement system of the facility and nephrologists as well as the underutilization of the pre-dialysis educational benefit. Based on this comprehensive review of the literature, we propose several suggestions which may contribute to the expansion of HHD treatment modality.
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Abstract
OBJECTIVE Approximately 20-30% of all colorectal cancer (CRC) cases may have a familial contribution. The family history of CRC can be prominent (e.g., hereditary colorectal cancer (HCRC)) or more moderate (e.g., familial colorectal cancer (FCRC)). For family members at risk, colonoscopic surveillance is a well-established method to prevent both HCRC and FCRC, although the evidence for the exact procedures of the surveillance is limited. Surveillance can come at a high price if individuals are frequently examined, as this may result in unnecessary colonoscopies in relation to actual risk for CRC. This study analyses the cost-effectiveness of a surveillance programme implemented in the Northern Sweden Health Care Region. METHODS The study includes 259 individuals prospectively recorded in the colonoscopic surveillance programme registry at the Cancer Prevention Clinic, Umeå University Hospital. We performed a cost-utility analysis with a contrafactual design: we compared observed costs and loss of quality-adjusted life years (QALYs) due to CRC with the surveillance programme to an expected outcome without surveillance. The main measure was the incremental cost-effectiveness ratio (ICER) between surveillance and non-surveillance. Scenario analysis was used to explore uncertainty. RESULTS The ICER between surveillance and non-surveillance in the base model was 3596€/QALY. The ICER varied from -4620€ in the best-case scenario to 33,779€ in the worst-case scenario. CONCLUSION Colonoscopic surveillance is a very cost-effective method to prevent HCRC and FCRC compared to current thresholds for cost-effectiveness and other cancer preventive interventions.
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Affiliation(s)
- Olle Sjöström
- a Department of Radiation Sciences, Oncology , Umeå University , Umeå , Sweden
| | - Lars Lindholm
- b Department of Public Health and Clinical Medicine, Epidemiology and Global Health , Umeå University , Umeå , Sweden
| | - Beatrice Melin
- a Department of Radiation Sciences, Oncology , Umeå University , Umeå , Sweden
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Ansari D, Sambergs F, Johansson L, Andersson R. Can protein science solve the unmet needs in pancreatic cancer diagnosis and therapy? Expert Rev Proteomics 2017; 14:469-471. [PMID: 28388239 DOI: 10.1080/14789450.2017.1314787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Daniel Ansari
- a Department of Surgery, Clinical Sciences Lund , Lund University, Skåne University Hospital , Lund , Sweden
| | - Fredrik Sambergs
- a Department of Surgery, Clinical Sciences Lund , Lund University, Skåne University Hospital , Lund , Sweden
| | - Love Johansson
- a Department of Surgery, Clinical Sciences Lund , Lund University, Skåne University Hospital , Lund , Sweden
| | - Roland Andersson
- a Department of Surgery, Clinical Sciences Lund , Lund University, Skåne University Hospital , Lund , Sweden
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Abstract
For several years, there has been a distinct political will for the development of home care. However, this shift to ambulatory care, a source of financial savings for the health system and comfort for the patient, requires sociological debate. Notable issues for discussion are the social inequalities caused by this evolution and the role of the family in the care.
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Affiliation(s)
- Frédéric Pierru
- CNRS-CERAPS, Université Lille 21, Place Déliot, BP 629, 59024 Lille Cedex.
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Tranaeus U, Heintz E, Johnson U, Forssblad M, Werner S. Injuries in Swedish floorball: a cost analysis. Scand J Med Sci Sports 2016; 27:508-513. [PMID: 27038298 DOI: 10.1111/sms.12675] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2016] [Indexed: 11/28/2022]
Abstract
The epidemiology of sport injuries is well documented. However, the costs are rarely discussed. Previous studies have presented such costs in specific sports or localization. No study has investigated the costs related to injuries in elite floorball. Thus, the aim of this study was to estimate cost of injuries in Swedish elite floorball players. During 1 year, 346 floorball players were prospectively followed. All time-loss injures were recorded. The injured players were asked to complete a questionnaire regarding their costs tied to the injury. Mean costs were calculated by multiplying the total resource use with the collected unit costs and dividing these total costs with the number of injuries as well as players. The results showed that the average cost per injury increased with the level of severity and ranged from 332 to 2358 Euros. The mild and moderate overuse injuries were costlier than the corresponding traumatic injuries. However, the severe traumatic injuries were associated with higher costs than overuse injuries. Knee injuries were the costliest. Our results indicate that there are costs to be saved, if floorball injuries can be avoided. They should be of interest to decision makers deciding whether to invest in preventive interventions.
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Affiliation(s)
- U Tranaeus
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - E Heintz
- Swedish Council on Health Technology Assessment, Stockholm, Sweden.,Center for Medical Technology Assessment, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - U Johnson
- Center of Research on Welfare, Health and Sport, Halmstad University, Halmstad, Sweden
| | - M Forssblad
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - S Werner
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Sundin J, Rangel I, Kumawat AK, Hultgren-Hörnquist E, Brummer RJ. Aberrant mucosal lymphocyte number and subsets in the colon of post-infectious irritable bowel syndrome patients. Scand J Gastroenterol 2014; 49:1068-75. [PMID: 24919810 DOI: 10.3109/00365521.2014.926982] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is characterized by chronic abdominal symptoms such as pain, discomfort, and altered bowel habits. A subset of IBS patients, denoted as post-infectious IBS (PI-IBS) patients, develop symptoms after an enteric infection. Distinct abnormalities in the gut mucosa, including mucosal inflammation, have been proposed to contribute to or be the cause of PI-IBS. This study investigated lymphocyte subsets in PI-IBS patients compared to healthy controls. MATERIALS AND METHODS Ten PI-IBS patients and nine healthy controls participated. All PI-IBS patients met the Rome III diagnostic criteria for IBS and reported sustained symptoms at least 1 year after an episode of acute gastroenteritis. Intraepithelial lymphocytes and lamina propria lymphocytes (LPLs), isolated from mucosal tissue samples, were stained and analyzed for a comprehensive set of cell markers using flow cytometry. RESULTS The number of LPLs in PI-IBS was significantly increased compared to those in healthy controls (p < 0.05). PI-IBS patients showed significantly increased proportions of CD45RO(+) CD4(+) activated/memory T cells (p < 0.05) and double-positive CD4(+) CD8(+) cells (p < 0.05), respectively, in the lamina propria. The number of CD19(+) LPLs was decreased in PI-IBS patients compared to healthy controls (p < 0.001). CONCLUSION This study presents new evidence that PI-IBS is associated with a sustained aberrant mucosal immune response and support future studies of anti-inflammatory or immune-modulating treatments in these patients.
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Affiliation(s)
- Johanna Sundin
- School of Health and Medical Sciences, Örebro University , Örebro , Sweden
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van der Heijden AAWA, de Bruijne MC, Feenstra TL, Dekker JM, Baan CA, Bosmans JE, Bot SDM, Donker GA, Nijpels G. Resource use and costs of type 2 diabetes patients receiving managed or protocolized primary care: a controlled clinical trial. BMC Health Serv Res 2014; 14:280. [PMID: 24966055 PMCID: PMC4099139 DOI: 10.1186/1472-6963-14-280] [Citation(s) in RCA: 13] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 06/09/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The increasing prevalence of diabetes is associated with increased health care use and costs. Innovations to improve the quality of care, manage the increasing demand for health care and control the growth of health care costs are needed. The aim of this study is to evaluate the care process and costs of managed, protocolized and usual care for type 2 diabetes patients from a societal perspective. METHODS In two distinct regions of the Netherlands, both managed and protocolized diabetes care were implemented. Managed care was characterized by centralized organization, coordination, responsibility and centralized annual assessment. Protocolized care had a partly centralized organizational structure. Usual care was characterized by a decentralized organizational structure. Using a quasi-experimental control group pretest-posttest design, the care process (guideline adherence) and costs were compared between managed (n = 253), protocolized (n = 197), and usual care (n = 333). We made a distinction between direct health care costs, direct non-health care costs and indirect costs. Multivariate regression models were used to estimate differences in costs adjusted for confounding factors. Because of the skewed distribution of the costs, bootstrapping methods (5000 replications) with a bias-corrected and accelerated approach were used to estimate 95% confidence intervals (CI) around the differences in costs. RESULTS Compared to usual and protocolized care, in managed care more patients were treated according to diabetes guidelines. Secondary health care use was higher in patients under usual care compared to managed and protocolized care. Compared to usual care, direct costs were significantly lower in managed care (€-1.181 (95% CI: -2.597 to -334)) while indirect costs were higher (€ 758 (95% CI: -353 to 2.701), although not significant. Direct, indirect and total costs were lower in protocolized care compared to usual care (though not significantly). CONCLUSIONS Compared to usual care, managed care was significantly associated with better process in terms of diabetes care, fewer secondary care consultations and lower health care costs. The same trends were seen for protocolized care, however they were not statistically significant. TRIAL REGISTRATION Current Controlled trials: ISRCTN66124817.
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Affiliation(s)
- Amber AWA van der Heijden
- Department of General Practice, The EMGO Institute for Health and Care Research, VU University Medical Center, van der Boechorststraat 7, 1081BT Amsterdam, The Netherlands
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Martine C de Bruijne
- Department of General Practice, The EMGO Institute for Health and Care Research, VU University Medical Center, van der Boechorststraat 7, 1081BT Amsterdam, The Netherlands
- Department of Public and Occupational Health, The EMGO Institute for Health and Care Research, VU University Medical Center, van der Boechorststraat 7, 1081BT Amsterdam, The Netherlands
| | - Talitha L Feenstra
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Jacqueline M Dekker
- Department of General Practice, The EMGO Institute for Health and Care Research, VU University Medical Center, van der Boechorststraat 7, 1081BT Amsterdam, The Netherlands
| | - Caroline A Baan
- Department of General Practice, The EMGO Institute for Health and Care Research, VU University Medical Center, van der Boechorststraat 7, 1081BT Amsterdam, The Netherlands
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Judith E Bosmans
- Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Sandra DM Bot
- Department of General Practice, The EMGO Institute for Health and Care Research, VU University Medical Center, van der Boechorststraat 7, 1081BT Amsterdam, The Netherlands
| | - Gé A Donker
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Giel Nijpels
- Department of General Practice, The EMGO Institute for Health and Care Research, VU University Medical Center, van der Boechorststraat 7, 1081BT Amsterdam, The Netherlands
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Wimo A, Religa D, Spångberg K, Edlund AK, Winblad B, Eriksdotter M. Costs of diagnosing dementia: results from SveDem, the Swedish Dementia Registry. Int J Geriatr Psychiatry 2013; 28:1039-44. [PMID: 23440702 DOI: 10.1002/gps.3925] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [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: 06/25/2012] [Accepted: 12/04/2012] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Diagnostic of different dementia disorders is an important part of dementia care. So far, there is limited knowledge about how dementia is diagnosed in clinical routine, and there are few reports on the costs of the dementia work-up leading to a diagnosis. Here, we examine the costs of diagnostic dementia work-up in Sweden. METHODS The analyses were made on the data from the Swedish Dementia Registry (SveDem) and included 11,561 dementia patients diagnosed during 2007-2010, mainly not only in specialist care (SC) (n = 53) but also some primary care centres (PC). We have studied differences in the use of investigations for dementia diagnostics such as cognitive tests, blood and cerebrospinal fluid analyses, radiological examinations and assessments of functions. Unit costs for each diagnostic investigation were combined with the use of these investigations for all cases in the database. Results are presented versus gender and stratified for age. RESULTS The number of diagnostic tests performed was 2.8 in PC and 4.6 in SC. The average costs (€1 = SEK9 and US$1 = SEK7 in 2010) were SEK6777 in PC and SEK11,682 in SC. Age was the strongest cost predictor while there were no gender differences. There were also regional differences, ranging from SEK8231 to SEK14,734 in SC. CONCLUSIONS The SveDem database offers valuable information on the diagnostic procedures for dementia in daily clinical practice. The differences between PC and SC in diagnostic costs reflect national guidelines. The age effect needs to be studied more.
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Affiliation(s)
- Anders Wimo
- KI-Alzheimer Disease Research Center (KI-ADRC), Department of Neurobiology, Caring Sciences and Society, Karolinska Institute Stockholm, Stockholm, Sweden; The Primary Health Care of Hudiksvall-Nordanstig, Bergsjö, Sweden
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Abstract
Umbilical cord blood (CB) has become, since its first successful use more than two decades ago, an increasingly important source of blood stem cells. In this light, an overview of current usage of CB in the field of unrelated hematopoietic blood stem cell transplantation (HSCT) is given. The three main sources of hematopoietic stem cells: bone marrow (BM), peripheral blood stem cells (PBSC), and cord blood (CB) are compared as regards their current quantitative usage in HSCT. A cost analysis of the named three hematopoietic blood stem cell (HSC) sources, taking into account various factors, is undertaken. The health economical comparison shows significant differences between CB on the one side, and BM and PBSC on the other. The consequences for the public health side and propositions for a possible health care policy, especially regarding future resource allocation towards the different choices for HSCT products, are discussed. An outlook on the possible future usage of BM, PBSC, and CB and its implications on health systems, donor registries, and CB banks is given.
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Hofmann U, Szedlak M, Rittgen W, Jung EG, Schadendorf D. Primary staging and follow-up in melanoma patients--monocenter evaluation of methods, costs and patient survival. Br J Cancer 2002; 87:151-7. [PMID: 12107834 PMCID: PMC2376106 DOI: 10.1038/sj.bjc.6600428] [Citation(s) in RCA: 131] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2001] [Revised: 04/12/2002] [Accepted: 05/09/2002] [Indexed: 12/02/2022] Open
Abstract
In a German cohort of 661 melanoma patients the performance, costs and survival benefits of staging methods (history and physical examination; chest X-ray; ultrasonography of the abdomen; high resolution sonography of the peripheral lymph nodes) were assessed at initial staging and during follow-up of stage I/II+III disease. At initial staging, 74% (23 out of 31) of synchronous metastases were first detected by physical examination followed by sonography of the lymph nodes revealing 16% (5 out of 31). Other imaging methods were less efficient (Chest X-ray: one out of 31; sonography of abdomen: two out of 31). Nearly 24% of all 127 first recurrences and 18% of 73 second recurrences developed in patients not participating in the follow-up programme. In follow-up patients detection of first or second recurrence were attributed to history and physical examination on a routine visit in 47 and 52% recurrences, respectively, and to routine imaging procedures in 21 and 17% of cases, respectively. Lymph node sonography was the most successful technical staging procedure indicating 13% of first relapses, but comprised 24% of total costs of follow-up in stage I/II. Routine imaging comprised nearly 50% of total costs for follow-up in stage I/II and in stage III. The mode of detecting a relapse ('patient vs. doctor-diagnosed' or 'symptomatic vs asymptomatic') did not significantly influence patients overall survival. Taken together, imaging procedures for routine follow-up in stage I/II and stage III melanoma patients were inefficient and not cost-efficient.
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Affiliation(s)
- U Hofmann
- Skin Cancer Unit (German Cancer Research Centre), University Hospital Mannheim, Theodor Kutzer Ufer 1, Mannheim 68167, Germany
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