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Afschin Gandjour

Publications and source records attributed to Afschin Gandjour.

At least 19 recordsLinked to original sources
PubMed2006

Cost-effectiveness of referrals to high-volume hospitals: an analysis based on a probabilistic Markov model for hip fracture surgeries.

Previous studies suggest that German hospitals that perform a high volume of hip fracture surgeries have a lower mortality rate and shorter length of stay than low-volume hospitals. The goal of this paper was to determine the long-term cost-effectiveness (over 20 years) of referring hip fracture surgeries to high-volume hospitals, based on data from previous studies. From a societal perspective, the cost-effectiveness ratio was 15,530 Euro per QALY (quality-adjusted life year) (95% confidence interval 9,864-33,048 Euro), while total annual costs to the statutory health insurance amounted up to 19.6 million Euro. The referral of hip fracture surgeries to high-volume hospitals is thus likely to be cost-effective in Germany.

Aged↗
PubMed2005

[When is it worth reducing overuse of health care services? The example of prescribing expensive antihypertensives].

BACKGROUND AND PURPOSE: Reducing overuse of health care services saves costs only if implementation costs are lower than savings from avoided health care services. Predicting the expected net benefit helps policymakers to make a choice among the various overuse problems and components of implementation programs in health care. The goal of this paper is to demonstrate how to calculate the net benefit of reducing overuse. In an application example feedback or outreach visits to primary care physicians in Germany reduce the prescription of expensive antihypertensives with questionable benefit. METHODS: In a mathematical model secondary data were used to portray the relationship between the net benefit from reducing overuse and the degree of overuse. RESULTS: Assuming that currently 30% of treated hypertensive patients could switch to thiazides and combinations with other drugs, an overuse reduction through feedback or outreach visits to primary care physicians is efficient. CONCLUSION: If the degree of overuse is large, an overuse reduction can be efficient. The explicit consideration of the size of an overuse problem may contribute to a more efficient use of health care resources.

Adolescent↗
PubMed2005

European comparison of costs and quality in the treatment of acute back pain.

STUDY DESIGN: Retrospective multicenter observational study. OBJECTIVES: To compare the outpatient quality and costs of treating acute back pain in England, Germany, the Netherlands, and Switzerland. SUMMARY OF BACKGROUND DATA: No study has yet attempted to compare the quality, costs, and resource utilization of acute back pain treatment in Europe. METHODS: A total of 130 randomly selected physician practices assessed services for 1 hypothetical average patient during the first 4 weeks of treatment (cost evaluation) and 127 practices reported retrospective data on 1 real patient (quality evaluation) in 2001. Reimbursement fees served as unit costs for Germany and Switzerland. Average reimbursement fees were used to measure resource utilization in all countries. Quality of care was assessed in terms of the following unnecessary treatments and diagnoses: bed rest for more than 2 days; exercise therapy; scheduling of a radiograph or other imaging tests; and referral to another provider. Responses were weighted with the level of scientific evidence for overuse. RESULTS: Weighted-average overuse ranged from 18% in the Netherlands to 31% in Germany. In England, Germany, and Switzerland, at least a third of the resources used to treat back pain were wasted. CONCLUSIONS: There was considerable waste in treating acute back pain. The Netherlands had highest quality and lowest resource utilization in providing treatment for acute back pain.

Acute Disease↗
PubMed2005

Does prevention save costs? Considering deferral of the expensive last year of life.

Published cost-effectiveness analyses may overstate the cost-effectiveness ratio of preventive care if they do not explicitly model the costs of the last year of life, which is postponed by prevention. To determine the degree of overestimation, the authors built a statistical model using Medicare expenditure data on survivors and decedents. The model shows that the cost-effectiveness ratio of prevention may decrease by up to US$ 11,000 per quality-adjusted life year saved when expenditure data on the last year life are used. The model is able to explain more than half of the median cost increase of published cost-effectiveness analyses on clinical preventive services.

Aged↗
PubMed2005

Technology assessment in dentistry: a comparison of the longevity and cost-effectiveness of inlays.

OBJECTIVES: An example of technology assessment in dental care by evaluating the (cost-)effectiveness of types of three-surface inlays (gold, laboratory-fabricated ceramic, and chairside CAD/CAM ceramic) is provided. METHODS: MEDLINE, EMBASE, and the Cochrane Library were searched for studies published between 1966 and June 2003 that reported annual survival probabilities and annual observations. The longevity of different types of inlays was measured by the number of failure-free years. Annual survival rates from different studies were pooled by weighing the rates of each study by the inverse of the variance of the effect estimate. A cost-effectiveness analysis from the perspective of German private health insurers was performed using billing charges. RESULTS: Three, five, and two case series on laboratory-fabricated ceramic, chairside CAD/CAM ceramic, and gold inlays, respectively, were included. Over a 9-year observation period, the number of undiscounted failure-free years was 8.62 (95 percent confidence interval, 8.40-8.85), 8.65 (8.58-8.73), and 8.76 (8.72-8.80) for laboratory-fabricated ceramic, chairside CAD/CAM ceramic, and gold inlays, respectively. Laboratory-fabricated ceramic inlays were the most expensive. CONCLUSIONS: While laboratory-fabricated ceramic, chairside CAD/CAM ceramic, and gold inlays had a strikingly similar failure-free survival rate, laboratory-fabricated ceramic inlays had the highest costs and, thus, were less cost-effective than chairside CAD/CAM ceramic and gold inlays.

Cost-Benefit Analysis↗
PubMed2005

Impact of demographic changes on healthcare expenditures and funding in the EU.

While there are many international comparisons on the impact of demographic changes on future healthcare expenditures, there are few such comparisons with regard to the impact of demographic changes on future healthcare funding. The purpose of this article is to analyse the impact of demographic changes on healthcare expenditures and funding in 14 selected EU Member States. This article shows that in most countries, healthcare costs per worker are predicted to increase at a faster rate than per capita costs, because workers comprise a decreasing proportion of the total population. On the other hand, the impact of aging on healthcare payments per worker is about the same as healthcare costs per capita because citizens have to make out-of-pocket payments for healthcare. Roughly one-quarter of the predicted income growth of the work-force will be used for aging-related healthcare payments.

Demography↗
PubMed2004

[At what time is a reduction of medical under- or overtreatment sensible? Treatment of acute depression as an example].

OBJECTIVE: 1) To portray the mathematical relationship between the size of an underuse or overuse problem caused by non-compliance of health professionals and the cost-effectiveness of a quality improvement program; 2) to demonstrate the applicability of the models to a real-world problem (underuse and overuse in the treatment of major depression) and to stress the importance of the costs of a quality improvement program using this example. METHODS: Mathematical formulation of the relationship between the costs of a quality improvement program and the degree of underuse and overuse. RESULTS: The example of reducing underuse in the treatment of major depression shows that an intervention with a favorable cost-effectiveness ratio may be economically unattractive if a quality improvement program incurs high costs secondary to a small quality deficit. The application example also shows that reducing treatment overuse is inefficient if overuse is small and hence the costs of a quality improvement program are higher than the costs of overuse. CONCLUSIONS: The explicit consideration of the size of an underuse or overuse problem in the cost-effectiveness ratio of a quality improvement program may contribute to a more efficient use of health care resources.

Amitriptyline↗
PubMed2004

Costs and quality in the treatment of acute depression in primary care: a comparison between England, Germany and Switzerland.

No study has yet compared the costs and quality of depression treatment between European countries. The present study aimed to compare the costs and quality of treatment for the first manifestation of an acute major depression in England, Germany and Switzerland. Seventy-four randomly selected physician practices assessed their services for one hypothetical average patient (cost evaluation) and 73 practices reported retrospective data on one real patient (quality evaluation) for the year 2001. Reimbursement fees served as unit costs for Germany and Switzerland. Average reimbursement fees were used to measure resource utilization in all countries. Resource utilization was lowest in Switzerland. The percentage of patients receiving evidence-based treatment for major depression was insignificantly higher in Switzerland and England compared to Germany (56%, 52% and 35%, respectively; P>0.30). Switzerland was both the most effective and the most efficient country (in terms of resource utilization) in providing outpatient treatment for depression.

Acute Disease↗
PubMed2004

Direct costs of care in germany for children and adolescents with diabetes mellitus in the early course after onset.

BACKGROUND AND OBJECTIVE: Prospective population-based cost-of-illness study to evaluate diabetes mellitus (DM)-related direct costs in German pediatric DM care in the early course after onset (perspective: statutory health insurers). PATIENTS AND METHODS: 573 patients with DM <15 years of age were followed for up to 2 years after onset. DM-related hospitalization and ambulatory care, insulin and self-testing regimen were ascertained. Costs per patient-year were estimated (2000 prices). Using multivariate regression, associations between costs and families' socioeconomic status was evaluated. RESULTS: Mean total costs per patient-year were 7,069 euro (interquartile range 5,414-8,127). Onset hospitalization accounted for the majority of costs (4,908 euro, 3,728-6,213). Within post-onset costs, most were attributable to blood glucose self measurement and hospitalization (36% and 32%). Costs were significantly higher in children from families with lower compared to highest educated parents and in children from non-German families (p <0.01). CONCLUSIONS: Among the direct medical costs of childhood DM in the early course after onset, the greatest economic burden was due to hospitalization, in particular at onset. Blood glucose self measurement accounted for the majority of the post-onset costs. Costs were associated with the socio-economic status. It is recommended to evaluate the cost-effectiveness of outpatient programs targeting children from families with lower social status.

Adolescent↗
PubMed2004

Cost-effectiveness analysis of different screening procedures for type 2 diabetes: the KORA Survey 2000.

OBJECTIVE: To compare the cost-effectiveness of different type 2 diabetes screening strategies using population-based data (KORA Survey; Augsburg, Germany; subjects aged 55-74 years), including participation data. RESEARCH DESIGN AND METHODS: The decision analytic model, which had a time horizon of 1 year, used the following screening strategies: fasting glucose testing, the oral glucose tolerance test (OGTT) following fasting glucose testing in impaired fasting glucose (IFG) (fasting glucose + OGTT), OGTT only, and OGTT if HbA(1c) was >5.6% (HbA(1c) + OGTT), all with or without first-step preselection (p). The main outcome measures were costs (in Euros), true-positive type 2 diabetic cases, incremental cost-effectiveness ratios (ICERs), third-party payers, and societal perspectives. RESULTS: After dominated strategies were excluded, the OGTT and HbA(1c) + OGTT from the perspective of the statutory health insurance remained, as did fasting glucose + OGTT and HbA(1c) + OGTT from the societal perspective. OGTTs (4.90 per patient) yielded the lowest costs from the perspective of the statutory health insurance and fasting glucose + OGTT (10.85) from the societal perspective. HbA(1c) + OGTT was the most expensive (21.44 and 31.77) but also the most effective (54% detected cases). ICERs, compared with the next less effective strategies, were 771 from the statutory health insurance and 831 from the societal perspective. In the Monte Carlo analysis, dominance relations remained unchanged in 100 and 68% (statutory health insurance and societal perspective, respectively) of simulated populations. CONCLUSIONS: The most effective screening strategy was HbA(1c) combined with OGTT because of high participation. However, costs were lower when screening with fasting glucose tests combined with OGTT or OGTT alone. The decision regarding which is the most favorable strategy depends on whether the goal is to identify a high number of cases or to incur lower costs at reasonable effectiveness.

Aged↗