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PubMed2004

Direct costs of schizophrenia and related disorders in Italian community mental health services: a multicenter, prospective 1-year followup study.

The behavior that accompanies schizophrenia and related disorders interferes with professional and social activities. As a result, schizophrenia is one of the most costly psychiatric illnesses. Direct medical costs associated with schizophrenia were estimated from the Italian National Health Service perspective. This was a multicenter observational 1-year study conducted in 14 Italian community mental health centers (CMHCs). Eligible patients were those with a diagnosis of schizophrenia or schizoaffective or schizophreniform disorder who had been followed by the CMHCs for at least 2 years at study entry. Exactly 643 patients were enrolled in the study. The mean direct cost per year was 6,964 (27,025 for schizophrenia and 6,587 for patients with related psychotic disorders) (1998 exchange rate U.S.$1 = 1.121). The present study provides further estimates of the cost of schizophrenia treatment in Italian mental health services and highlights the variability in the single cost components across clinically defined subgroups of patients.

Adult↗
PubMed1998

Uptake and costs of care for epilepsy: findings from a U.K. regional study.

PURPOSE: Epilepsy is a common neurological condition, with significant resource implications for the health services, but few studies to date have examined the uptake and costs of care for this condition. As part of a large prevalence study of epilepsy conducted in one U.K. Health Region, we investigated both direct and indirect costs of epilepsy care and measured and valued the direct costs. METHODS: Data about service use were obtained from primary physician records and patient questionnaires. Unit costs for each item of resource use were generated from several sources. RESULTS: The greatest direct health care cost is that of hospital-based care. Pharmaceutical services also represent a significant element of the cost of epilepsy, the financial costs of prescribing newly developed antiepileptic drugs (AEDs) being large relative to those of the older drugs; therefore, the benefits derived from their use must be carefully assessed. The importance of good seizure control is amply illustrated by the findings about the differential costs associated with epilepsy of varying severity. The direct costs of caring for people with poorly controlled epilepsy are significant, with more than half the total cost of epilepsy care accounted for by patients with frequent seizures even though this group represented only a quarter of all patients in the present study. CONCLUSIONS: Our data emphasize the importance of optimizing seizure control as a means of reducing the costs of epilepsy, not only to the person with the condition, but also to society.

Adolescent↗
PubMed1998

Multivariate analysis of outcome of mental health care using graphical chain models. The South-Verona Outcome Project 1.

BACKGROUND: Short-term outcome of mental health care was assessed in a multidimensional perspective using graphical chain models, a new multivariate method that analyses the relationship between variables conditionally, i.e. taking into account the effect of antecedent and intervening variables. METHODS: GAF, BPRS, DAS (at baseline and after 6 months), LQL and VSSS (at follow-up only) were administered to 194 patients attending the South-Verona community-based mental health service. Direct costs in the interval were also calculated. Graphical chain models were used to analyse: (1) the associations between predictors (psychopathology, disability, functioning, assessed at baseline); (2) the effects of predictors on costs; and (3) the effect of predictors and costs on outcomes (psychopathology, disability, functioning, quality of life and service satisfaction) as well as their correlation. RESULTS: Psychopathology, disability and functioning scores at baseline predicted the corresponding scores at 6-month follow-up, with greater improvement in the more severely ill. Higher psychopathology and poorer functioning at baseline predicted higher costs and, in turn, costs predicted poorer functioning at follow-up. Outcome indicators polarized in two groups: psychopathology, disability and functioning, which were highly correlated; and the dyad service satisfaction and quality of life. Service satisfaction was highly related to quality of life and was predicted by low disability and high dysfunctioning. No predictors for quality of life were found. CONCLUSIONS: Graphical chain models were demonstrated to be a useful methodology to analyse process and outcome data. The results of the present study help in formulating specific hypotheses for future studies on outcome.

Adult↗
PubMed1990

Case-mix classification for emergency departments.

This study developed a patient classification system for hospital emergency departments. Conducted at three Los Angeles area community hospitals, data collection included coding and abstracting medical records information, patient billing information detailing each patient's utilization of hospital services, and patient-specific provider time measuring each provider's time spent in direct patient care activities. A 20,000 patient sample was derived containing clinical and resource use variables, including physician, emergency department, and ancillary service direct costs. Patient visits were classified into 216 homogeneous groups, or patient clusters, using four types of variables: diagnoses, disposition, age, and physician procedures. The Emergency Department Groups (EDGs) appear to represent a clinically coherent system for classifying emergency department visits; moreover, the groups were found to explain 63% of the overall variance in resource use (total direct cost) suggesting that the EDGs may offer a useful tool for hospital cost control and reimbursement reform.

Accounts Payable and Receivable↗
PubMedDate not supplied

[Direct cost of care for acute asthmatic crisis at a pediatric emergency service].

BACKGROUND: The acute asthma crisis in emergency services of second level hospitals represents one of the highest levels of intake, generating a high number of hospitalizations. OBJECTIVE: To determine, in emergency service medical attention, the frequency and direct cost related generated by the hospitalization of pediatric patients with acute asthma crisis in second level attention of Social Security Service (Instituto Mexicano del Seguro Social, IMSS). MATERIALS AND METHOD: In 2000, a cohort study was done on pediatric patients with acute asthma crisis in a second level hospital. RESULTS: In the cohort of 2,277 patients, the response to treatment was adequate in 94% (2,141) of the cases, the consultation predominated in September (13.6%) and October (12%). The average patient was 3 years old and the patients were predominantly male (63.4%). The direct cost generated from attending these patients totaled to 342,989.80 USD, the monthly cost average was of 28,582.48 USD. DISCUSSION: The use of health services is an indirect indicator of morbidity, also referred to as the increase of hospitalization and rehospitalization in children between 0 and 4 years old. The knowledge of leading factors, the education on long term control, and the handling of initial rescue in asthmatic patients are modifiable factors that can help reduce the costs generated by the hospitalization of acute cases of this disease.

Acute Disease↗
PubMedDate not supplied

[Direct cost of medical treatment to the asthmatic patient in the pediatric emergency service of a medical care tier-two hospital].

BACKGROUND: Asthma is one of the most common breathing pathologies in the pediatric population that causes many consults to the emergency service, generating a high cost for the services of health. OBJECTIVE: To determine the direct cost of the treatment in the pediatric patients with acute crisis of asthma in the emergency service from 1998 to 2001 in a hospital of second level of medical attention of the health sector. MATERIAL AND METHOD: A retrospective cohort study was done in the emergency service of pediatrics patients with ages from 12 months to 18 years 11 months, who visited the service during the period of study. To calculate the total cost that these patients generated, the unitary price of medications, nebulize, oxygen, consults and hospitalization in the emergency service were determine. RESULTS: A total of 106,813 consultations was provided from 1998 to 2001 in emergency service, 26,387 were hospitalized and of these, 9,328, with diagnosis of asthma, required handling with inhalotherapy. The total direct cost in the period of study was of $17,620,517.83, nebulize: $213,292.60, oxygen: $788,287.57, steroids: $253,619.70, aminophylline: $152,589.00, medical attention: $3,232,360.38, hospitalization in the emergency service: $12,980,468.58. CONCLUSIONS: The results indicate that the biggest costs were generated by the oxygen consume and the hospitalizations. Asthma generates an important demand in emergency services, thus it is necessary to improve alternatives in the control and education of patients, in order to reduce the number of events, severity of the crises and to improve the quality of the patients' life and their families.

Adolescent↗
PubMed1991

Cost-effectiveness of alternative approaches in treating severely mentally ill in California.

Given the rising costs of health care and the decrease in public expenditures on mental health care, policy-makers and program managers must identify cost-effective approaches for treating severely mentally ill patients. During the last year, there have been two major cost-effectiveness studies implemented in California. One initiated by Santa Clara County and funded by the National Institute of Mental Health compares the cost-effectiveness of two existing community-based treatment and case-management approaches. The other study, which compares the cost-effectiveness of capitation funding of services for the severely mentally ill, was initiated by the State of California and is currently being implemented in two counties. This article describes the cost-effectiveness evaluations of these two programs and provides preliminary results of the case-management program.

California↗
PubMed2006

A cost analysis of monoplace hyperbaric oxygen therapy with and without recirculation.

OBJECTIVE: Hyperbaric oxygen therapy is covered by the NHS under Specialist Services Definition Set 28. The indications and availability of the therapy have been influenced by educational failures, perceived costs and, compared with drug studies, the small number of controlled trials. This study aimed to inform this debate by calculating the direct costs to the health service of hyperbaric oxygen therapy for inpatients using a single, one-person chamber. METHOD: The costs included in this cost analysis were: hyperbaric chambers, staff, oxygen, property and cleaning, miscellaneous and general overheads. All costs are for 2004. RESULTS: Lower and upper costs were calculated. Start-up costs range from pounds 64,800 to pounds 110,000 depending on the hardware selected. Annual costs, including 10-year amortisation of capital costs, range from pounds 40,069 to pounds 57,618 and per-treatment costs range from pounds 30 to pounds 41. Oxygen recirculation becomes cost effective after four to six years. CONCLUSION: Hyperbaric oxygen therapy is an inexpensive treatment that should be routinely available for conditions where evidence indicates that tissue hypoxia is a significant component of the injury or disease.

Capital Expenditures↗
PubMed1999

The cost of suicide mortality in New Brunswick, 1996.

Suicide is a major public health problem in Canada. Suicide deaths affect society by consuming both human lives and economic resources. The present study estimates the economic impact of suicide deaths that occurred in New Brunswick in 1996, using the human capital approach. For the 94 suicide deaths reported, direct costs for health care services, autopsies, funerals and police investigations were $535,158.32. Indirect costs, which estimate the value of lost productivity due to premature death, had the largest economic value, of $79,353,354.56. The mean total cost estimate per suicide death in 1996 was $849,877.80. Although the most significant impact of a suicide death remains the loss of a human life, these results indicate that the economic cost of this public health tragedy in New Brunswick is also great. To our knowledge, this report provides the first complete cost-of-suicide analysis performed in a Canadian province.

Adolescent↗
PubMed2000

The cost to providers of participating in an immunization registry.

INTRODUCTION: The medical and public health communities advocate immunization registries as one tool to achieve national immunization goals. Although substantial resources have been expended to establish registries across the nation, minimal research has been conducted to evaluate provider participation costs. METHODS: The objective of this study was to identify the direct costs to participate in an immunization registry. To estimate labor and equipment costs, we conducted interviews and direct observation at four sites that were participating in one of two immunization registries. We calculated mean data-entry times from direct observation of clinic personnel. RESULTS: The annual cost of participating in a registry varied extremely, ranging from $6083 to $24,246, with the annual cost per patient ranging from $0.65 to $7. 74. Annual per-patient costs were lowest in the site that used an automated data-entry interface. Of the sites requiring a separate data-entry step, costs were lowest for the site participating in the registry that provided more intensive training and had a higher proportion of the target population entered into the registry. CONCLUSIONS: Ease of registry interface, data-entry times, and target population coverage affect provider participation costs. Designing the registry to accept electronic transfers of records and to avoid duplicative data-entry tasks may decrease provider costs.

Ambulatory Care Facilities↗
PubMed2003

The cost of positron emission tomography in six United States Veterans Affairs hospitals and two academic medical centers.

OBJECTIVE: Positron emission tomography (PET) is a high-cost imaging tool primarily used in oncology, cardiology, and neuropsychiatry. Accurate estimates of the cost of PET are needed to assess its cost effectiveness and determine the appropriate role for this modality in clinical applications. We performed a survey-based cost analysis of PET with FDG by estimating direct, indirect, and capital costs from eight PET centers. A breakdown of the operational budget of PET centers and FDG-compounding facilities is presented along with the costs per scan. Differences in costs between sites that purchase FDG and those that manufacture FDG are also examined. MATERIALS AND METHODS: We sent surveys to managers of eight Veterans Affairs and two non-Veterans Affairs PET scanning and FDG-compounding facilities. The survey included questions about service volume and the direct costs of equipment, personnel, space, supplies, and repairs needed for FDG compounding and PET scanning and interpretation. We estimated the indirect costs associated with FDG compounding, PET scanning, and PET interpretation. RESULTS: Of the eight sites that responded to our survey, three sites manufacture FDG on-site, three sites purchase FDG, and two sites do both. The total mean cost per scan using manufactured FDG is 1885 US dollars, and it is 1898 US dollars using purchased FDG. CONCLUSION: PET is expensive. The cost is similar when FDG is manufactured or purchased. Because both PET and cyclotron facilities have high fixed costs, increasing the number of scans obtained and the number of FDG doses manufactured may lead to a decrease in unit costs.

Academic Medical Centers↗
PubMed1986

Cost-outcome analysis and service planning in a CMHC.

The outcome of outpatient treatment of 497 children and 396 adults at a large community mental health and mental retardation center was associated with cost of services and with clients' number of sessions, length of stay, and density of treatment. The cost of one hour of outpatient services averaged $53.15 for adults and $52.32 for children. Treatment outcome was not directly related to cost of treatment, but clients who regressed used more resources than did clients whose conditions remained the same. Adults who improved were in therapy for a shorter period than were adults who became worse, but they were treated more times per month. The cost-outcome analysis methodology described here can be useful in forecasting the effects of budget reductions on case mix and treatment outcome, in developing effective service models for various funding levels, and in identifying optimal caseloads.

Adolescent↗
PubMedDate not supplied

Cost-consequence models for varicella-zoster virus infections.

Three cost-consequence models were developed for treatment of infections due to varicella-zoster virus (VZV) with acyclovir in immunocompetent patients--adult- and childhood-onset chickenpox, and herpes zoster (shingles) in adults. For chickenpox, separate models allow examination of differences in severity and impact of the disease for children and adults, as well as in the management of civilians and adults in military service. Each model includes direct medical costs, indirect costs and health-related productivity loss, symptom and quality of life impact, and model assumptions and conclusions. Alternatives of treatment and no treatment are addressed. Quality of life impact is conceptualized in terms of a quality-adjusted life-days decrement due to VZV symptoms of importance to the patient, such as pain, rash, and itching. As experience and data become available, alternative agents such as valacyclovir and famciclovir for the treatment of patients with herpes zoster should be included in the modeling process.

Acyclovir↗
PubMed1991

Cardiac rehabilitation--a cost analysis.

This economic evaluation is based on a 5-year follow-up study comparing a comprehensive cardiac rehabilitation programme with standard care after myocardial infarction (MI). The intervention group consisted of 147 non-selected MI patients aged less than 65 years, who were participating in a rehabilitation programme consisting of follow-up at a post-MI clinic, health education and physical training in out-patient groups. The control group consisted of a non-selected MI-population aged less than 65 years (n = 158), who were receiving standard care. The rehabilitation programme did not increase the health-care costs of post-MI care, as the increase in cost due to participation in the programme was balanced by a decrease in readmissions for cardiovascular diseases. On average, the rehabilitated patient returned to work more frequently, resulting in decreased costs due to loss of production. The mean patient total cost of a 5-year MI follow-up was SEK 73,500 lower in the rehabilitated group. The outstanding winner of the rehabilitation programme was the Swedish National Health Insurance System (NHIS). It must be concluded that the comprehensive cardiac rehabilitation programme is a major strategy that leads to both lowered costs and positive health effects. The cardiac rehabilitation programme is therefore highly cost-effective.

Cardiology Service, Hospital↗
PubMed2000

On dental trauma in children and adolescents. Incidence, risk, treatment, time and costs.

BACKGROUND: Dental trauma occur in childhood and adolescence with consequences in time and costs for both patient and family. The scientific knowledge of these matters is scarce. For some individuals, dental trauma will result in long, time-consuming and costly treatments in childhood which will continue into adulthood. AIM: The thesis aimed to increase the knowledge of incidence, risk, treatment, time and costs spent on dental traumas to primary and permanent teeth in children and adolescents. MATERIAL AND METHOD: The material for the studies emanated from the county of Västmanland, Sweden, and the municipality of Copenhagen, Denmark, and from a Swedish nation-wide material (Folksam). The material was collected from accident reports, dental files, dental trauma forms, questionnaires and telephone interviews. Descriptive, prospective and analytical methods were used. A classification of uncomplicated and complicated dental traumas was presented. RESULTS: The incidence of dental trauma to boys was higher, compared to girls, in the county of Västmanland in almost all age groups. For both sexes, the first years in life and the first years in school were the most accident prone periods with incidence twice as high as the average incidence for all children and adolescents in the county. Every third trauma was complicated with injuries to the pulp or periodontal ligaments. Every second patient with a dental trauma to permanent teeth suffered from multiple dental trauma episodes (MDTE) during a period of 12 years. In almost every second patient with MDTE, at least one of the affected teeth had sustained repeated trauma episodes. The risk of sustaining MDTE increased when the first trauma episode occurred in the age interval of 6-10, compared to 11-18 year olds. During a 12-year period, treatment times for complicated traumas were 2.0 and 2.7 times higher for primary and permanent teeth, respectively, compared to corresponding values for uncomplicated traumas. On average, direct time (treatment time) represented 11% and 16% of the total time, while the direct costs (health care service, transport, loss of personal property and medicine) represented 60% and 72% of the total costs of traumas to primary and permanent teeth, respectively, during a 2-year period for cases of a nation-wide material. CONCLUSION: Dental traumas are frequent and some individuals are injured several times. Besides treatment time, efforts from the family are substantial in time and costs. Parameters such as degree of severity, access to treatment and place of injury are of major importance to both patient and family and should be considered when calculating time and costs of dental trauma in children and adolescents.

Accidents↗