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PubMed1993

A Canadian study of the total medical costs for patients with systemic lupus erythematosus and the predictors of costs.

OBJECTIVE: We conducted a cost identification analysis on 164 consecutive patients with systemic lupus erythematosus (SLE) who entered the Montreal General Hospital Lupus Registry between January 1977 and January 1990, compared their costs to the population of Quebec, and determined the predictors of cost. METHODS: In January 1990 and 1991, participants completed questionnaires on health services utilization and on employment history over the preceding 6 months, as well as on functional, psychological, and social well-being. The societal burden of SLE was determined in terms of direct costs (all resources consumed in patient care) and indirect costs (wages lost due to lack of work force participation because of morbidity). RESULTS: The mean total annual cost for 1989, as assessed in January 1990 and expressed in 1990 Canadian dollars, was $13,094. Although only 44% of the patients were fully employed, indirect costs were responsible for 54% of this total ($7,071). Ambulatory costs, primarily diagnostic procedures, medications, and visits to health care professionals, comprised 55% of direct costs ($3,331). The results of the 1990 cost determination were similar. On average, hospitalizations among SLE patients were 4 times more frequent than among the general population of Quebec (matched for age and sex), and the number of ambulatory visits to physicians was double that for the average resident of Quebec. Higher 1989 values of creatinine and a poorer level of physical functioning were the best predictors of higher 1990 direct costs (R2 = 0.29). A poorer SLE well-being score, a combination of education and employment status, and a weaker level of social support were the best predictors of higher indirect costs (R2 = 0.29). CONCLUSION: The direct and indirect costs for patients with SLE are substantial, and their respective predictors are distinct. Direct costs arise from organic complications which induce functional disability. Predictors of indirect costs are potentially amenable to psychological or social interventions and may be more easily modified than the determinants of direct costs, thereby improving patient outcome while simultaneously reducing disease costs.

Adolescent↗
PubMed1997

Costing the library services. Cairns Library: a case study.

In the present climate libraries have to adopt a business approach to funding submissions; detailed management information must be produced in support of expenditure and to ensure that the services are cost-effective. In addition to the grant from its parent body (the Faculty of Clinical Medicine, University of Oxford), the Cairns Library obtains funding from five other bodies, including National Health Service Hospital Trusts. The Cairns Library has introduced an ongoing costing exercise covering the different services. The costs are divided into three categories: salary costs, other direct costs and indirect costs. Staff time has been identified from detailed time-sheets kept by each member of staff; the time recorded is assigned to the individual services. The direct costs and the indirect costs have been identified and allocated/apportioned similarly. The services are divided into five packages: core, current awareness, document delivery, enquiries and user education. The costs for each package have been apportioned to the funding bodies on the basis of the number of registered users from each body.

Cost Allocation↗
PubMed2003

Direct medical costs and their predictors in patients with rheumatoid arthritis: a three-year study of 7,527 patients.

OBJECTIVE: To estimate total direct medical costs in persons with rheumatoid arthritis (RA) and to characterize predictors of these costs. METHODS: Patients (n = 7,527) participating in a longitudinal study of outcome in RA completed 25,050 semiannual questionnaires from January 1999 through December 2001. From these we determined direct medical care costs converted to 2001 US dollars using the consumer price index. We used generalized estimating equations to examine potential predictors of the costs. Monte Carlo simulations and sensitivity analyses were performed to evaluate the varying prevalence and cost of biologic therapy. RESULTS: The mean total annual direct medical care cost in 2001 for a patient with RA was 9,519 US dollars. Drug costs were 6,324 US dollars (66% of the total), while hospitalization costs were only 1,573 US dollars (17%). Approximately 25% of patients received biologic therapy. The mean total annual direct cost for patients receiving biologic agents was 19,016 US dollars per year, while the cost for those not receiving biologic therapy was 6,164 US dollars. RA patients who were in the worst quartile of functional status, as measured by the Health Assessment Questionnaire, experienced direct medical costs for the subsequent year that were 5,022 US dollars more than the costs incurred by those in the best quartile. Physical status as determined by the Short Form 36 physical component scale had a similar large effect on RA costs, as did comorbidity. Medical insurance type played a more limited role. However, those without insurance had substantially lower service utilization and costs, and health maintenance organization patients had lower drug costs and total medical costs. Increased years of education, increased income, and majority ethnic status were all associated with increased drug costs but not hospitalization costs. Costs in all categories decreased after age 65 years. CONCLUSION: Estimates of direct medical costs for patients with RA are substantially higher than cost estimates before the biologic therapy era, and costs are now driven predominantly by the cost of drugs, primarily biologic agents. RA patients with poor function continue to incur substantially higher costs, as do those with comorbid conditions, and sociodemographic characteristics also play an important role in determination of costs.

Activities of Daily Living↗
PubMed2004

Direct health care costs of 4 common skin ulcers in New Mexico Medicaid fee-for-service patients.

OBJECTIVE: To determine health care costs associated with pressure ulcers, ulcers of the lower limbs, other chronic ulcers, and venous leg ulcers from the New Mexico Medicaid fee-for-service program perspective. DESIGN: Retrospective analysis of claims database MAIN OUTCOME MEASURES: Physician visit, hospital, and prescription costs were determined for New Mexico Medicaid patients with a primary and/or secondary diagnosis of 1 of 4 identified categories of skin ulcers from January 1, 1994, through December 31, 1998. Costs were determined in terms of mean and median annual cost per patient and total costs per year. Zero dollar claims were included within the cost calculations. All costs are expressed in 2000-dollar values. MAIN RESULTS: Mean annual physician visit costs per patient ranged from $71 (standard deviation [SD] = $60) for venous leg ulcers in 1998 to $520 (SD = $1228) for pressure ulcers in 1996. Mean annual hospital costs per patient ranged from $266 (SD = $348) for other chronic ulcers in 1998 to $15,760 (SD = $30,706) for pressure ulcers in 1998. Mean annual prescription costs per patient ranged from $145 (SD = $282) for other chronic ulcers in 1998 to $654 (SD = $1488) for pressure ulcers in 1994. CONCLUSION: The New Mexico Medicaid fee-for-service system incurred a total cost of approximately $11.6 million (in 2000 dollars) from 1994 through 1998 for the treatment of the 4 categories of skin ulcers studied. The data showed that the majority of wounds were coded as pressure ulcers, which had the highest associated costs.

Chronic Disease↗
PubMed2004

Direct cost of medical management of epilepsy among adults in Italy: a prospective cost-of-illness study (EPICOS).

PURPOSE: To investigate the costs of epilepsy from a nationwide survey comparing adult patients included in different prognostic categories. METHODS: A 12-month prospective observational study was conducted in 15 epilepsy centers from Northern, Central, and Southern Italy. The study population included a random sample of individuals aged 18 years and older with newly diagnosed (ND) epilepsy, seizure remission (R), occasional seizures (OS), active non-drug-resistant (NDR) seizures, drug-resistant (DR) seizures, or surgical candidates (SC). Estimates of the direct costs of care of epilepsy were based on the use of diagnostic examinations, laboratory tests, specialist consultations, hospital admissions, day-hospital days, and drugs, taking the Italian National Health Service perspective. RESULTS: The sample included 631 patients (ND 62, R 158, OS 155, NDR 114, DR 128, and SC 14). The SC group had the highest total cost per patient (3,619 euros) followed by DR (2,190 euros), ND (976 euros), NDR (894 euros), OS (830 euros), and R (561 euros). For each epilepsy group, the main components of the total cost were drugs and hospital admissions. Drug costs increased from the R group to the DR group. The new antiepileptic drugs (AEDs) were the largest part of the cost of treatment. CONCLUSIONS: The costs of epilepsy in referral patients vary significantly according to the time course of the disease and the response to treatment. Hospital admissions and drugs are the major sources of expenditure.

Adolescent↗
PubMed1998

Comparative cost analysis of myringotomy with insertion of ventilation tubes in Ontario and British Columbia.

OBJECTIVE: The purpose of this study was to conduct a comparative cost analysis of myringotomy with insertion of ventilation tube (MVT) for children performed at two regional paediatric centres: The Hospital for Sick Children, and the British Columbia Children's Hospital. DESIGN: Comparative cost analysis. SETTING: The Hospital for Sick Children (HSC), Toronto, and the British Columbia Children's Hospital (BCCH), Vancouver. METHODS: The cost analysis was performed from a health system perspective using a treatment protocol developed through a review of the literature and input from staff from each of the study hospitals. MVT cost estimates were derived, including direct treatment costs and overhead costs. RESULTS: Total costs per MVT case (in 1994 Canadian dollars: Cdn$ 1.00 approximately US$ 0.75) varied from $390.81 at BCCH to $455.63 at HSC. Regional variations in physician costs accounted for almost 70% of the difference in MVT case costs. The distribution of nonphysician MVT case costs were similar in each study hospital, with direct (nonphysician) surgical costs, preoperative assessment and recovery room costs, and administration accounting for 30%, 26%, and 44% of total nonphysician costs, respectively. CONCLUSIONS: This study identified the magnitude and determinants of regional variations in the cost of MVT surgery. Such cost estimates serve as an important (but not the sole) ingredient in service cost-effectiveness deliberations and in the formulation of evidence-based care when health care resources are scarce.

British Columbia↗
PubMed2001

Cost analysis of dialysis modalities in Italy.

This study analyses management and costs of dialysis in the Italian National Health Service (NHS). Information on efficacy and health-related quality of life (HRQOL) based on the existing literature also is presented. The clinical differences between the dialysis modalities seem to be related to their appropriateness to specific patient groups. Efficacy rates are similar and the only differences are in complications and HRQOL. Traditional haemodialysis (THD) can be done by Italian patients in dialysis centres or in hospital. Highflux haemodialysis (HFHD) is generally only done in hospital. Peritoneal dialysis (PD) is usually done at home. The cost analysis was performed on a sample of Italian dialysis centres and hospitals, according to the full cost method. As expected, HFHD was more expensive than THD and PD, but no marked differences emerged among the different HFHD modalities. THD modalities in dialysis centres were less costly than in hospitals. Automated PD (APD) was much more expensive (almost twice) than continuous ambulatory PD (CAPD), the cheapest method in absolute terms. This study confirms that dialysis is costly and that it is very difficult to assess the cost-effectiveness of the different approaches. Although this study has limits, it should provide sufficient analytical information to local healthcare managers for more rational allocation of financial resources to dialysis services.

Ambulatory Care Facilities↗
PubMed2002

Exploring the costs of a limited public sector antiretroviral treatment programme in South Africa.

BACKGROUND: The role of antiretroviral treatment for adults in the pubic sector in South Africa is debated with little consideration of programme choices that could impact on the cost-effectiveness of the intervention. This study seeks to explore the impact of these programme choices at an individual level, as well as explore the total cost of a rationed national public sector antiretroviral treatment programme. METHODS: Eight scenarios were modelled of limited national treatment programmes over the next 5 years, reflecting different programme design choices. The individual cost-effectiveness of these scenarios were compared. The total costs of the most cost-effective scenario were calculated, and the potential for savings in other areas of health care utilisation was explored. RESULTS: The direct programme costs per life-year saved varied between scenarios from R5,923 to R11,829. All the costs of the most cost-effective scenario could potentially be offset depending on assumptions of health care access and utilisation. The total programme costs for the most cost-effective scenario in 2007 with 107,000 people on treatment are around R409 million. CONCLUSION: Specific policy choices could almost double the number of people who could benefit from an investment in a limited national antiretroviral treatment programme. Such a programme is affordable within current resource constraints. The consideration of antiretroviral treatment calls for a unique public health approach to the rationing of health services in the public sector.

Adult↗
PubMed2003

Socioeconomic impact of osteoarthritis in Hong Kong: utilization of health and social services, and direct and indirect costs.

OBJECTIVE: To determine the direct and indirect cost of osteoarthritis (OA) according to disease severity, and to estimate the total cost of the disease in Hong Kong. METHODS: This study is a retrospective, cross-sectional, nonrandom, cohort design, with subjects stratified according to disease severity based on functional limitation and the presence or absence of joint prosthesis. Subjects were recruited from primary care, geriatric medicine, rheumatology, and orthopedic clinics. There were 219 patients in the mild disease category, 290 patients in the severe category, and 65 patients with joint replacement. A questionnaire gathered information on demographic and socioeconomic characteristics, function limitation, use of health and social services, and effect on occupation and living arrangements over the previous 12 months. Costs were calculated as direct and indirect. RESULTS: Low education and socioeconomic class were associated with more severe disease. OA affected family or close relationships in 44%. The average cost incurred as a result of side effects of medication is similar to the average cost of medication itself. Excluding joint replacement, the direct costs ranged from Hong Kong (HK) dollar $11,690 to $40,180 per person per year and indirect costs, HK $3,300-$6,640. The direct costs are comparable to those reported in Western countries; however, the ratio of direct to indirect costs is much higher than 1, in contrast to the greater indirect versus direct costs reported in whites. The total cost expressed as a percentage of gross national product is also much lower in Hong Kong. CONCLUSIONS: The socioeconomic impact of OA in the Hong Kong population is comparable to Western countries, but the economic burden is largely placed on the government, with patients having relatively low out-of-pocket expenditures.

Costs and Cost Analysis↗
PubMed2001

The cost effectiveness of combination antiretroviral therapy for HIV disease.

BACKGROUND: Combination antiretroviral therapy with a combination of three or more drugs has become the standard of care for patients with human immunodeficiency virus (HIV) infection in the United States. We estimated the clinical benefits and cost effectiveness of three-drug antiretroviral regimens. METHODS: We developed a mathematical simulation model of HIV disease, using the CD4 cell count and HIV RNA level as predictors of the progression of disease. Outcome measures included life expectancy, life expectancy adjusted for the quality of life, lifetime direct medical costs, and cost effectiveness in dollars per quality-adjusted year of life gained. Clinical data were derived from major clinical trials, including the AIDS Clinical Trials Group 320 Study. Data on costs were based on the national AIDS Cost and Services Utilization Survey, with drug costs obtained from the Red Book. RESULTS: For patients similar to those in the AIDS Clinical Trials Group 320 Study (mean CD4 cell count, 87 per cubic millimeter), life expectancy adjusted for the quality of life increased from 1.53 to 2.91 years, and per-person lifetime costs increased from $45,460 to $77,300 with three-drug therapy as compared with no therapy. The incremental cost per quality-adjusted year of life gained, as compared with no therapy, was $23,000. On the basis of additional data from other major studies, the cost-effectiveness ratio for three-drug therapy ranged from $13,000 to $23,000 per quality-adjusted year of life gained. The initial CD4 cell count and drug costs were the most important determinants of costs, clinical benefits, and cost effectiveness. CONCLUSIONS: Treatment of HIV infection with a combination of three antiretroviral drugs is a cost-effective use of resources.

AIDS-Related Opportunistic Infections↗
PubMed2003

Cost of managing an episode of relapse in multiple sclerosis in the United States.

BACKGROUND: The purpose of this study was to determine the direct medical US cost of managing multiple sclerosis relapses. METHODS: Direct data analysis and cost modeling were employed to derive typical resource use profiles and costs in 2002 US dollars, from the perspective of a third-party payer responsible for comprehensive health-care. The location and scope of health care services provided over a 90-day period were used to define three levels of relapse management. Hospitalization and resulting subsequent care was defined as high intensity management. A medium level of intervention was defined as either use of the emergency room, an observational unit, or administration of acute treatments, such as intravenous methylprednisolone in an outpatient or home setting. The lowest intensity of care comprised physician office visits and symptom-related medications. Data were obtained from many sources including all payer inpatient, ambulatory and emergency room databases from several states, fee schedules, government reports, and literature. All charges were adjusted using cost-to-charge ratios. RESULTS: Average cost per person for high management level was 12,870 dollars, based on analysis of 4,634 hospital cases (mean age 48 years, 73% female). Hospital care comprised 71% of that cost. At discharge, 36% required inpatient sub-acute care, rehabilitation or home care. The typical cost per moderate episode was 1,847 dollars and mild episode 243 dollars. CONCLUSIONS: Management strategies leading to a reduction in the frequency and severity of a relapse, less reliance on inpatient care, or increased access to steroid infusions in the home, would have a substantial impact on the economic consequences of managing relapses.

Adult↗
PubMedDate not supplied

Cost and utilization impacts of oral antihistamines in the California Medi-Cal program.

OBJECTIVES: Newer oral allergic rhinitis (AR) medications, the second-generation antihistamines (SGAs) have gained widespread acceptance because of their efficacy and reduced side effects relative to first-generation antihistamines (FGAs). There are no empirical studies comparing the costs of treatment of SGAs relative to FGAs. METHODS: We analyzed data from a 20% beneficiary sample (approximately 120,000 continuously enrolled beneficiaries per year) for the Medi-Cal Fee-for-Service program during 1999 to 2000. AR medications available under Medi-Cal included three SGA medications (loratadine, fexofenadine, and cetirizine) and over 200 FGA products containing either diphenhydramine or chlorpheniramine or both. Because multiple medications were evaluated, a sample selection model was estimated using a two-stage multinomial logistic--variance components regression framework. RESULTS: SGA medications have significantly lower total direct health-care treatment costs per patient than FGA medications with costs ranging from US 347 dollars to US 448 dollars less (P < 0.001), despite higher AR medication costs. Total drug expenditures were also not significantly different for patients using SGA or FGA medications despite SGA prescriptions averaging US 47 dollars higher than FGAs. Emergency department visits, inpatient admissions and physician office visits were also significantly lower for patients using SGA medications. CONCLUSIONS: Significant cost and utilization reductions were associated with all of the SGA medications relative to FGA drugs, despite their higher acquisition costs. If facing higher copayments for prescription AR drugs, many patients, particularly lower income patients, may choose cheaper over-the-counter (OTC) FGAs rather than SGAs. Our analysis finds this might lead to increased overall health-care treatment costs, unless Medicaid and health insurance plans subsidize OTC AR medications.

Administration, Oral↗
PubMed1998

Service-level agreements at the Huddersfield NHS Trust.

Service-level agreements (SLAs) have been claimed to be an excellent vehicle for organisational improvement where there is a substantial degree of departmental autonomy. Such a situation is likely to exist in NHS trust hospitals because of the differentiated nature of the work performed by each department, with varying degrees of specialisation and professionalism, access to patients, use of technology and differing cost bases but also an interdependence of the direct services to the support services. It is proposed that SLAs can be used to promote improved integration between departments, quality assurance and provide a framework for cost transfer charging. The article describes and analyses SLAs from an overview of the idea to the particular implementation to date at the Huddersfield NHS Trust. SLAs have been negotiated between the Directorate of Clinical Support and its customers, and these are supported by computerised measurement and reporting tools.

Ancillary Services, Hospital↗
PubMed1994

[The use of services, the effect of compensation and the costs of a panic disorder].

BACKGROUND: The use of general health care services by psychiatric patients has decreased drastically following correct diagnosis. This phenomenon, called offset effect, allows the use of inefficient health care services to be evaluated and contributes to the estimation of the relative impact of the disorder in addition to the estimation of the benefits of the training campaigns and/or the implementation of services. The aim of this study was to evaluate the offset effect and the costs of the panic disorder (PD) in a natural environment. METHODS: The clinical data and the use of health care services over 12 months prior to diagnosis and 12 months following diagnosis were collected. Clinical evaluation of 61 patients with PD included a standard interview (SCID-UP), scales of general functioning, improvement, severity of the symptoms and the level of disability. The number of work days missed was also reported. RESULTS: The sociodemographic features, clinical evolution and the rate of response to treatment were comparable to those referred in other studies performed in a natural medium. The direct costs of treatment of AP were 1,795,000 pesetas (1,547,000-1,889,000) higher during the year following the first psychiatric consultation, mainly due to the costs of the visits to the psychiatrist and the medication. On the contrary, the indirect costs were 5,435,000 pesetas less during this period. CONCLUSIONS: In this study on the treatment of patients with the panic disorder a strong offset effect (94%) was found being much greater than that described for general psychiatric disorders. Adequate psychiatric treatment induces in the next 12 months an increase in the cost due psychiatric consultation and medication, however reduces the total costs when absenteeism is taken into account.

Adolescent↗
PubMed1998

Health economics and cost implications of anxiety and other mental disorders in the United States.

BACKGROUND: Mental disorders impose a multi-billion dollar burden on the economy each year; translating the burden into economic terms is important to facilitate formulating policies about the use of resources. METHODS: For direct costs, data were obtained from national household interview and provider surveys; for morbidity costs, a timing model was used that measures the lifetime effect on current income of individuals with mental disorders, taking into account the timing of onset and the duration of these disorders, based on regression analysis of Epidemiologic Catchment Area study data. RESULTS: The total economic costs of mental disorders amounted to US$147.8 billion in 1990. Anxiety disorders are the most costly, amounting to $46.6 billion, or 31.5% of the total; schizophrenic disorders accounted for $32.5 billion, affective disorders for $30.4 billion, and other mental disorders for $38.4 billion. CONCLUSIONS: Mental illnesses, especially anxiety disorders, are costly to society. Although anxiety disorders have a higher prevalence than affective disorders and schizophrenia, use of medical care services is lowest for anxiety disorders. Anxiety disorders appear to be under-recognised and untreated even though treatment interventions have been shown to be effective and can be delivered in a cost-efficient manner.

Anxiety Disorders↗
PubMed2005

Cost-effective faster wound healing with a sustained silver-releasing foam dressing in delayed healing leg ulcers--a health-economic analysis.

The aim of this analysis was to examine the cost-effectiveness of Contreet Foam (A) in comparison with three other commonly used venous leg ulcer treatment protocols: Aquacel Ag (B), Actisorb Silver (C) and Iodoflex (D). A health-economic analysis reflecting the UK treatment practice and cost structure was performed. The analysis was set up to assess the cost of relative wound area reduction over a 4-week treatment period. The model was validated by a UK expert panel consisting of four wound care specialists. To assure that the 4-week model had a realistic link to cost-effectiveness of complete wound healing, a Markov analysis was also performed. Sensitivity analyses were carried out to ensure validity. Protocol A and C proved to be the most effective treatments. The mean relative reduction in wound area after 4 weeks of treatment was 50.2% (protocol A), 23.9% (protocol B), 44.6% (protocol C) and 36.0% (protocol D). Cost-effectiveness ratios showed that protocol A proved to be the most cost-effective treatment, and protocol B the least. The cost per percentage reduction in wound area was 9.50 UK pounds for protocol A, compared to 16.50-17.60 UK pounds for the other treatment options. The cost-effectiveness of complete healing (Markov analysis) and sensitivity analyses confirmed these results. Using Contreet Foam instead of the other dressing alternatives may imply savings of 2.2-4.4 million UK pounds per year to the National Health Service.

Amoxicillin↗
PubMed1996

Estimating the cost impact of three dual diagnosis treatment programs.

Specialized intervention programs for people with concurrent severe mental illness and substance abuse reduce the total costs of care. Compared to baseline, cost savings of over 40% were achieved by 18 months, primarily due to significant reductions in the use of acute and subacute mental health services and despite an increase in outpatient mental health services. There also was an observable impact on cost reductions in medical and criminal justice services without an increase in family costs over the same time period.

Adolescent↗