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At least 577 records · Page 32Linked to original sources
PubMed2002

Dysphagia: a cost analysis of the diagnostic approach.

OBJECTIVES: The initial diagnostic approach for dysphagia is controversial. The choices include barium swallow (BaS) versus esophagogastroduodenoscopy (EGD). The aim of this study was to determine the clinical cost of establishing a diagnosis and treating dysphagia based on initial diagnostic approach (BaS vs EGD). METHODS: Clinical outcome of patients with undiagnosed dysphagia evaluated by either internists in a primary care clinic (n = 100) or gastroenterologists (n = 120) were determined based on the initial diagnostic test: BaS versus EGD. Final diagnoses in each group were determined based on any testing performed subsequent to the initial studies. Total cost in achieving the final diagnosis for each group were determined based on 2002 Medicare reimbursement cost. RESULTS: BaS (66% and 62%) and EGD (34% and 38%) were ordered in equal prevalence by gastroenterologists and internists, respectively. Final diagnoses included: benign obstruction (37% and 36%), gastroesophageal reflux disease (GERD) (18% and 44%), achalasia (17% and 1%), nonspecific esophageal motility disorder (NSEMD) (17% and 11%), neoplasm (7% and 6%), and infectious esophagitis (4% and 2%) in subspecialty and primary care clinics, respectively. Motility disorders (NSEMD and achalasia) was diagnosed more often by gastroenterologists (40 of 120, 34%) than by internists (12 of 100, 12%) (p < 0.001). GERD was the predominant diagnosis made by internists (44 of 100, 44%) compared to gastroenterologists (22 of 120, 18%) (p < 0.001). Although the cost of diagnosing benign obstruction was less for BaS ($73 +/- 13) than EGD ($370 +/- 5, p < 0.001), subsequent therapy with dilation increased the cost for barium testing first (BaS $602 +/- 22 vs EGD $515 +/- 5, p < 0.02). Cost of diagnosis or treatment of esophageal dysmotility (achalasia/NSEMD) was significantly (p < 0.001) less using BaS as the initial test. CONCLUSIONS: 1) BaS is less costly than EGD for diagnoses and treatment involving abnormal motility. 2) Initial EGD with therapeutic intent is less costly for patients with history suggesting benign obstruction. 3) Primary care physicians identified GERD and benign obstructions as the cause of dysphagia more often in their patient group than the gastroenterologists, making EGD a reasonable initial test in this setting instead of currently practiced BaS.

Aged↗
PubMed2004

Determinants of direct costs in Dutch rheumatoid arthritis patients.

OBJECTIVES: To estimate annual direct costs in four distinct disease duration groups (0 to < or =2, 2 to < or =6, 6 to < or =10, and >10 years) of patients with rheumatoid arthritis (RA), to determine predictors of high costs and to describe characteristics of patients with high and with low costs. METHODS: A questionnaire assessing RA related care and resource utilisation rates and costs was completed by 615 RA patients. Predictive variables for incurred costs, as observed during the first year after disease onset, were determined in a subgroup of patients (n = 347). RESULTS: Mean (median) annual direct costs for the four groups with increasing disease duration were respectively: 5235 (2923) Euros, 3930 (1968) Euros, 4664 (1952)Euros, and 8243 (3778) Euros, (p < 0.05). During the first 2 years of the disease total direct costs comprised mainly of consultations with healthcare workers (28%). After 10 years, devices and adaptations were the main contributors (40%) to total costs. Positive rheumatoid factor results at the time of diagnosis and deterioration of functional disability in the first year of disease were predictors of high costs later on in the course of the disease. CONCLUSION: Annual direct costs among patients with a disease duration of less than 2 years tend to be lower among patients with a disease duration of between 2 and 10 years than among patients with a disease duration of more than 10 years. In addition, the proportional distribution of different cost categories to total costs increases with with increasing disease duration.

Adult↗
PubMed2006

Poor control increases the economic cost of asthma. A multicentre population-based study.

BACKGROUND/AIMS: Up to now, few cost-of-illness (COI) studies have estimated the cost of adult asthma at an individual level on general population samples. We sought to evaluate the cost of current asthma from the societal perspective in young Italian adults and the determinants of cost variation. METHODS: In 2000, a COI study was carried out in the frame of the Italian Study on Asthma in Young Adults on 527 current asthmatics (20-44 years) screened out of 15,591 subjects from the general population in seven centres. Detailed information about direct medical expenditures (DMEs) and indirect costs due to asthma was collected at an individual level over the past 12 months. RESULTS: The mean annual cost per patient was EUR 741 (95% CI: 599-884). DMEs represented 42.8% of the total cost, whereas the remaining 57.2% was indirect costs. The largest component of DMEs was medication costs (47.3%; 23.0% was due to hospitalization). The mean annual cost per patient ranged from EUR 379 (95% CI: 216-541)for well-controlled asthmatics to EUR 1,341 (95% CI: 978-1,706) for poorly controlled cases that accounted for 46.2% of the total cost. Poor control, coexisting chronic cough and phlegm, and low socio-economic status were significantly associated with high DMEs and indirect costs. CONCLUSIONS: In Italy, asthma-related costs were substantial even in unselected patients and were largely driven by indirect costs. Since about half of the total cost was due to a limited proportion of poorly controlled asthmatics, interventions aimed at these high-cost patients could reduce the economic burden of the disease.

Adolescent↗
PubMed1995

Direct cost of depression: analysis of treatment costs of paroxetine versus Imipramine in Canada.

OBJECTIVE: To assess the potential economic impact of new and more expensive antidepressants on the overall cost of treatment using cost-effectiveness analysis. METHOD: For this analysis, a computerized decision tree of clinical practice was developed to model the 12-month treatment of moderate to severe depression in Canada. To complete the model, data were obtained from physician panels, the Ontario Ministry of Health, and clinical comparative trials of paroxetine, a selective serotonin reuptake inhibitor, and imipramine, a tricyclic antidepressant. RESULTS: The overall cost of treatment when paroxetine 30 mg per day was used first-line was found to be lower than when generic imipramine was used as the initial therapy ($1697 versus $1793). The higher drug cost of paroxetine ($1.69 per day) versus imipramine ($0.05 per day) was offset by a higher rate of treatment failures with the tricyclic necessitating an alternate therapy, additional physician visits and/or hospitalization. Sensitivity analysis of key variables determined that drug price and relapse rates after discontinuation were relatively insensitive predictors of the overall cost of care. More important was the continuation rate while on different therapies. CONCLUSION: Paroxetine demonstrated a cost-benefit relative to imipramine when the continuation rate was > or = 47%. Clinical trials of paroxetine have reported continuation rates of 41% to 65%, suggesting that paroxetine is a cost-effective alternative to imipramine in the 1-year management of patients with moderate to severe depression.

Adolescent↗
PubMed1999

Direct costs of hip fractures in patients over 60 years of age in Belgium.

OBJECTIVE: Osteoporosis-related costs are now considered a major burden for health authorities in most developed countries. An accurate and exhaustive evaluation of these costs would be a major contribution to health economic studies evaluating the efficiency of screening and prevention strategies. Osteoporosis is the most frequent underlying cause of femoral neck fractures in the elderly; these fractures weigh heavily on healthcare budgets. However, in Belgium, very few data on the financial burden of hip fractures are available and no updated estimates have been made. The goal of this paper is to estimate the direct medical expenditures associated with hip fractures in Belgium in 1996. DESIGN AND SETTING: This 1-year population-based cross-sectional study is conducted from the social security perspective. The target population in this study are men and women aged 60 years and over. PATIENTS AND PARTICIPANTS: We selected patients who had been hospitalised for a hip fracture during the year 1996 who were also affiliated with a registered social security organisation (covering 25% of the Belgian population). The sample constituted 2374 patients. INTERVENTIONS: For each of these patients, we collected an exhaustive and detailed list of healthcare resource use as well as nursing home admissions following the hip fracture event. Cost items investigated in the analysis were inpatient hospital costs and outpatient costs. Mean annual costs per case recorded in the sample were then extrapolated to the whole country on the basis of an exhaustive list of diagnoses having lead to all countrywide hospitalisations (1,700,000 hospital stays/year). MAIN OUTCOME MEASURES AND RESULTS: The mean hospital inpatient costs for hip fracture were evaluated at 332,148 Belgian francs (BeF) [$US8977] per case and BeF4,367,746,200 ($US118,047,194) for the whole country (10 million inhabitants). Patients with a hip fracture experienced an annual BeF27,825 ($US752) extra outpatient cost during the year following this fracture event, after correcting for costs related to additional comorbidity already present before the hip fracture. Finally, after a proximal femoral neck fracture, the rate of nursing home admission was higher, both for men and women at any age compared with age- and gender-matched population. CONCLUSIONS: With a total cost (acute hospital and outpatient costs) of BeF4,667,894,950 ($US126,159,323) per year in Belgium, proximal femoral neck fracture should be considered a major health economic problem and appropriate measures to prevent this disease should be rapidly undertaken.

Aged↗
PubMed2003

The cost of diabetes in Latin America and the Caribbean.

OBJECTIVE: To measure the economic burden associated with diabetes mellitus in Latin America and the Caribbean. METHODS: Prevalence estimates of diabetes for the year 2000 were used to calculated direct and indirect costs of diabetes mellitus. Direct costs included costs due to drugs, hospitalizations, consultations and management of complications. The human capital approach was used to calculate indirect costs and included calculations of forgone earnings due to premature mortality and disability attributed to diabetes mellitus. Mortality and disability attributed to causes other than diabetes were subtracted from estimates to consider only the excess burden due to diabetes. A 3% discount rate was used to convert future earnings to current value. FINDINGS: The annual number of deaths in 2000 caused by diabetes mellitus was estimated at 339,035. This represented a loss of 757,096 discounted years of productive life among persons younger than 65 years (> billion US dollars). Permanent disability caused a loss of 12,699,087 years and over 50 billion US dollars, and temporary disability caused a loss of 136,701 years in the working population and over 763 million US dollars. Costs associated with insulin and oral medications were 4720 million US dollars, hospitalizations 1012 million US dollars, consultations 2508 million US dollars and care for complications 2,480 million US dollars. The total annual cost associated with diabetes was estimated as 65,216 million US dollars (direct 10,721 US dollars; indirect 54,496 US dollars). CONCLUSION: Despite limitations of the data, diabetes imposes a high economic burden to individuals and society in all countries and to Latin American and the Caribbean as whole.

Adult↗
PubMed2003

[Costs, costs and more costs: which one should we use?].

A cost is not an intrinsic feature of a product in the same way as temperature is for water and air. It is a calculation based on theory and convention. Costs may be characterised by their object (an hospital admission, a hospitalization day, a diagnostic related group, a treatment phase), their contents (costs directly attributable to the patient, controllable costs, including not only departmental operating costs but also costs resulting from the department's activity, full costs including administrative and infrastructure overhead costs), the point of reference from where the costs are considered (from the point of view of the family, the health professionals suppliers, the buyers, the health care system, or society) and the time when the costs were calculated. The cost framework which must be considered in any economic evaluation must relate to the budgetary concerns of the party whose involvement is sought in a health care project. There is no all encompassing study in this field; an evaluation performed for one type of contributor must only consider this party's point of view.

Cost of Illness↗
PubMedDate not supplied

[Cost of illness: an inextricable maze or an aid in decision making? The case of schizophrenia].

The cost of schizophrenia has been a major point of interest abroad. In the United States, two authors evaluated the direct cost of the illness. According to Gunderson and Mosher (13), it reaches US $25,625 million. In the United Kingdom, the estimations are of 390 million pounds (7) and 1,178 million pounds (16). In Australia, a direct cost calculation based on incidence leads to US $24,621 million (1), which is 6 times as much as the cost of infarction. At last, the only French study (Rouillon et al., 1997) gives a result of FF 17,911 millions. The indirect cost estimations vary from 71% (29) to 83% (13) of the total cost. The difference between the 6 publications are suprizing (especially when they concern the same country) and are probably link to the difference of methodology. This point tempers largely the interest of these studies as a tool in order to hierarchise Public Health priorities. Moreover, the elaboration of structures equivalencies between the different countries is an ambitious enterprise and make difficult comparisons of the studies. Finally, the lack of transparency of some of them limits their credibility.

Cost Control↗
PubMedDate not supplied

Prevalence, correlates, and costs of patients with poor adjustment to mixed cancers.

Approximately 2% to 3% of the Canadian society has experienced cancer. Literature indicates that there is poor adjustment to chronic illness. Individuals with poor adjustment to chronic illness have been found to disproportionately use more health services. The purpose of this study was to determine the prevalence, correlates, and costs associated with poor adjustment to mixed cancer. A consecutive sample (n = 171) of breast, lung, and prostate cancer patients at the Nova Scotia Regional Cancer Center were surveyed. Twenty-eight percent of the cancer group showed fair to poor adjustment to illness using the Psychological Adjustment to Illness Self-report Scale Psychological Adjustment to Illness Self-Report Scale raw score. Poor adjustment was moderately correlated with depression (r = 0.50, P < .0001) and evasive coping (r = 0.38, P < .0001) and unrelated to demographic variables. Depression explained 25% of the variance in poor adjustment to illness in regression analysis. Cancer patients with fair to poor adjustment to illness had statistically significantly higher annual healthcare expenditures (P < .002) than those with good adjustment to illness. Expenditure findings agree with previous literature on chronic illnesses. The prevalence of fair to poor adjustment in this cancer population using the Psychological Adjustment to Illness Self-Report Scale measure is similar to that reported for chronic illness to date, suggesting that only those with better adjustment consented to this study.

Adaptation, Psychological↗
PubMed1997

Diagnostic imaging in 2001 - a health economics perspective.

Factors contributing to the growth and diffusion of new imaging technologies are discussed. The benefits derived from implementing and using new technologies are carefully evaluated against the associated costs to both patients and service providers. The need to invest in early scientific assessment of a new imaging technology in order to prevent wasted acquisition and utilisation later on is highlighted. Such assessment might involve evaluating the ability of the technology to improve diagnosis, positively impact on treatment plans and, above all, improve health.

Cost-Benefit Analysis↗
PubMed2006

Cost-utility analysis of cochlear implants in Korea using different measures of utility.

CONCLUSIONS: All cost-utility ratios obtained using the various measures of utility except quality well-being (QWB) were below 25,000 dollars per quality-adjusted life year (QALY). Therefore, treatment of post-lingual deaf adults with cochlear implants improves the quality of life at a reasonable direct cost and appears to produce net savings for Korean society. OBJECTIVES: To determine the quality of life and the cost consequences of cochlear implants for deaf adults. PATIENTS AND METHODS: We performed a cost-utility analysis using data from 11 post-lingual deaf adults who had received cochlear implants between 1990 and 2002 in Seoul, Korea. The average age of the participants was 49.6 years. The main outcome was the direct cost per QALY calculated using the visual analog scale (VAS), health utility index (HUI), EuroQol (EQ-5D) measure and QWB measure. Costs and utility were discounted 3% annually. RESULTS: Recipients used implants for an average of 5.6 years. The mean VAS, HUI, EQ-5D, and QWB score increased by 0.33 (from 0.27 before implantation to 0.60 at survey), 0.36 (0.29 to 0.65), 0.26 (0.52 to 0.78), and 0.16 (0.45 to 0.61), respectively. The discounted direct cost was 22,320 dollars, which yielded a cost-utility ratio of 19,223 dollars per QALY using VAS, 17,387 dollars per QALY using HUI, 24,604 dollars per QALY using EQ-5D, and 40,474 dollars per QALY using QWB.

Adult↗
PubMed1979

Charging for hospital pharmaceutical services: combined product-service per diem fees.

The development of a per diem hospital pharmacy charge is reviewed after five years of use. The itemized pharmacy charges for every tenth patient (total of 250 patients) admitted to the hospital during a three-month period were studied to determine the average daily charges for drugs and pharmaceutical services. Six categories of rates were designated, based on the type of hospital service. A comparison of the actual charges and the projected per diem rate indicated that the per diem rate would produce the same revenue as the itemized charging method. A procedure for periodically monitoring the per diem rate was also established. The per diem pharmacy charges range from $3.50 (for patients admitted to the psychiatric service) to $12 (surgical patients). Intravenous solutions, i.v. admixtures, normal human serum albumin, drugs administered in the intensive care and cardiac care units, and drug with an acquistion cost of more than $10 are not included in the per diem charging system. The per diem system enabled the hospital to reduce administrative and accounting costs while continuing to provide quality pharmaceutical services.

Colorado↗