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Economic considerations in overactive bladder.

Many costs are associated with overactive bladder (OAB). They include direct costs, such as those associated with treatment, diagnosis, routine care, and the consequences of the disease; indirect costs of lost wages and productivity; and intangible costs associated with pain, suffering, and decreased quality of life. Quantification of all these costs is essential for establishing the total economic burden of a disease on society. Currently, the total economic burden of OAB is unknown. However, various studies have determined that the economic burden of urinary incontinence, one of the symptoms of OAB, is substantial. It is also important to establish the economic impact of various interventions for OAB. Cost-minimization, cost-outcome, cost-utility, and cost-benefit models can be used for these analyses. The most difficult aspect of evaluating the economic impact of a treatment is estimating the intangible costs.

Cost Allocation↗

A South African pharmaco-economic analysis of the Acute lnfarction Ramipril Efficacy (AIRE) Study.

OBJECTIVES: Heart failure (HF) is a serious, prevalent health condition in industrialised countries where the incidence has been on the increase. The economic repercussions are costly, and therefore cost-effective medication is important in the overall management of the condition. It has been shown that angiotensin-converting enzyme (ACE) inhibitors are clinically effective in the management of HF. Ramipril has been shown to reduce mortality and the probability of hospitalisation in post-myocardial infarction (MI) patients. Internationally, the use of this drug has proved to be cost-effective. The objective of this study was to investigate the economic implications of using ramipril in South Africa for post-MI patients with HF. METHODOLOGY: An incremental cost-effectiveness analysis was performed comparing the use of ramipril and placebo in post-MI patients with HF who were receiving standard therapy. The economic impacts included drug acquisition costs and savings on hospitalisation; these were evaluated based on the clinical benefits of using ramipril in terms of life-years gained (LYG). The cost-utility of the use of ramipril was determined to provide an incremental cost per quality-adjusted life-year (QALY). Sensitivity analyses were performed on the major economic variables; discounting of future costs and savings was performed at rates of 0%, 5 % and 10 %. RESULTS: The use of ramipril results in an incremental cost/LYG of R16 808 and a total incremental cost per patient per month of R107 over 3.8 years. When the quality of life of the patients is taken into account, the cost-utility analysis shows an incremental cost/QALY of R21 382 for those younger than 65 years of age and R18 029 for those older than 65 years. The pharmaco-economic model was robust and consistent when tested at the extremes of the major variables, including costs, savings and discount rates. CONCLUSION: The results indicate that it is cost-effective to administer ramipril in addition to standard therapy for post-MI patients with HF in South Africa.

Journal Article↗

Food and nutrition security and the economic crisis in Indonesia.

Indonesia has been afflicted by an economic crisis since July 1997. The economic crisis was preceded by a long drought associated with El Nino. The result has been a decline in food production, especially rice. In the eastern part of the country, especially in Irian Jaya, there was food insecurity during the early stages of the economic crisis. When the crisis escalated to become an economic, social and political crisis in 1998, food insecurity spread to other provinces, especially to urban areas in Java. The crisis led to increasingly high inflation. unemployment, poverty, food insecurity and malnutrition. The official figures indicate that poverty in Indonesia increased from 22.5 million (11.3%) in 1996 to 36.5 million (17.9%) in 1998. Food production decreased by 20-30% in some parts of the country. Compared with prices in January 1998, food prices had escalated 1.5- to threefold by August/November 1998 when acute food shortages occurred, especially in urban Java. Coupled with a drop in purchasing power, the higher food prices worsened health, nutritional status and education of children of urban poor and unemployed families. Despite social and political uncertainties, the Indonesian Government has taken prompt action to prevent a worsening of the situation by massive imports of rice, instituting food price subsidies for the poor and launching social safety net programmes to cope with food shortages and malnutrition. The present paper attempts to highlight the impact of the economic crisis on food insecurity and malnutrition in Indonesia.

Adolescent↗

[A matched case-control study on direct economic costs of four kinds of nosocomial infections].

OBJECTIVE: To evaluate the direct economic costs of four major kinds of nosocomial infections such as nosocomial pneumonia, urinary tract infection, deep surgical wound infection and intracranial infection. METHODS: A matched case-control study was conducted among 95 pairs of hospitalized patients to investigate the direct economic costs of nosocomial infections. RESULTS: The average medical cost for patients in the case group was 38 741 RMB Yuan, 20 365 Yuan more than that in the control group patients (P < 0.0001). The largest part of extra costs was found in drug expenses, taking up 62.07%, while other extra costs such as non-drug therapies, blood transmission and laboratory examinations, accounted for 10.32%, 7.40% and 5.72% respectively. Extra economic burden caused by nosocomial infections varied in different degrees with different departments, with the heaviest found in the department of tumourology and hematology at an average extra cost of 34 944 Yuan. The average extra charges in case group caused by nosocomial pneumonia, urinary tract infection, deep surgical wound infection and intracranial infection were 31 940 Yuan, 7 436 Yuan, 17 332 Yuan and 17 349 Yuan respectively. The average length of hospital stay was 50.57 days in case group and 25.22 days in control group, showing a 25.53 extra days (P < 0.0001) of hospitalization due to nosocomial infections. CONCLUSION: Nosocomial infections had significantly added to the economic burden of managing the underlying diseases, led to prolonged hospitalization of the patients and lowered the turnover rate of hospital bed. There is a need to call for better infection control program, which would bring tremendous social and economic profits.

Case-Control Studies↗

Family economic resources in the post-reform era.

Aided by the longest economic expansion in U.S. history and other policy changes designed to make work pay, federal welfare reform legislation has spurred mothers to leave welfare at an unprecedented rate. The majority of mothers who left welfare are working, but most have jobs with low pay and limited benefits. This article discusses the relationship between economic resources and child well-being, and how family economic resources have changed under welfare reform. A survey of the research conducted since reform indicates the following: Families' economic resources clearly matter to child well-being, but the connections are complex and vary by the age of the child. Without the benefit of supports designed to "make work pay," many families working full time at the minimum wage have resources beneath the poverty line, and the poverty line itself falls substantially short of the needs of most working families. Although poverty overall has declined under welfare reform, a significant segment of families are worse off--in part because after leaving welfare, many families do not receive other government supports designed to help them. Most states are still struggling to design more effective systems for delivering supports to help low-income working families move out of poverty. The author cautions that the evolving story of welfare reform will need to be monitored carefully to achieve long-term positive impacts on family economic resources and child well-being.

Child↗

Socio-economic and ethnic influences on infant feeding practices related to oral health.

OBJECTIVE: To assess the role of socio-economic factors in explaining ethnic differences in two infant feeding practices contra-indicated for dental health: adding sugary foods to a feeding bottle and bottle usage for any type of drink after one year. DESIGN: Secondary analysis of dietary and socio-demographic data from the Office of National Statistics (ONS) survey of infant feeding in Asian families. Regression models examining the impact of ethnicity on the two feeding practices were compared with models which also included eight socio-economic variables. SAMPLE: The ONS survey collected data from a representative sample of minority ethnic groups living in the UK. The sample consisted of 764 Indian, 593 Pakistani, and 477 Bangladeshi families and 548 White families by the final stage of the study. RESULTS: Significant socio-economic differences were identified between the different ethnic groups in the sample. The Bangladeshi group were the most disadvantaged and deprived group. Regression analyses showed that inclusion of socio-economic variables added significantly to models based solely on ethnicity for the two selected feeding practices. There was a considerable drop in the odds ratios for ethnicity when socioeconomic variables were included in models for adding sugary foods to the bottle. However, this effect was less evident in models predicting bottle usage at fifteen months. CONCLUSION: While ethnicity may influence infant feeding practices, when socio-economic factors are considered it appears to be a less important determinant for some of these behaviours.

Bangladesh↗

The prevalence and economic importance of bovine fasciolosis in Kenya--an analysis of abattoir data.

A retrospective study covering a period of 10 years (1990-1999) was carried out using post mortem meat inspection records at the Veterinary Department Headquarters at Kabete to determine the prevalence and economic importance of bovine fasciolosis in Kenya. Meat inspection records from abattoirs in 38 districts distributed over seven out of the eight provinces of Kenya were examined. Prevalence of fasciolosis was calculated as the number of cattle found to be infected with Fasciola, expressed as a percentage of the total number of cattle slaughtered. Using the average weight and market price of a bovine liver, the monetary loss occasioned by condemnation of Fasciola infected livers was calculated. A survey was also carried out at Dagoretti slaughterhouse complex in Nairobi to determine the relative occurrence of F. gigantica and F. hepatica in slaughtered cattle. Cattle slaughtered at Dagoretti slaughterhouse originate from all parts of the country. A total of 5,421,188 cattle were slaughtered in the seven provinces of Kenya during the 10-year period and 427,931 (8%) of these cattle were infected with Fasciola. The region with the highest prevalence of fasciolosis was Western Province (16%) followed, in descending order, by Eastem Province (11%), Nyanza Province (9%), Rift Valley Province (8%), Central Province (6%), Nairobi Province (4%) and Coast Province (3.5%). The total economic loss incurred by the country during the 10-year period as a result of condemnation of the infected livers was approximately US$2.6 million. The total annual economic losses during this period ranged from approximately US$0.2-0.3 million. The highest total economic losses for the 10-year period were recorded in Western Province (US$0.8 million) and Central Province (US$0.7 million). A total of 1584 cattle originating from five provinces of Kenya were slaughtered at Dagoretti slaughterhouse over a period of two months of which 147 (9.3%) were infected with liver flukes. All the liver flukes obtained from the infected livers were identified as F. gigantica. It is concluded that fasciolosis is prevalent in cattle in all provinces of Kenya, that it causes great economic losses as a result of condemnation of infected livers, and that F. gigantica is the main species of liver flukes affecting cattle in Kenya. Local climatic factors, cattle trade, rustling and population numbers, and the presence of the snail intermediate hosts are probably the main factors influencing the incidence of the disease in the various regions of the country.

Abattoirs↗

Trends in the economic status of the elderly, 1976-2000.

The economic well-being of elderly Americans (aged 65 or older) improved between 1976 and 2000. Overall, poverty rates fell during this period, median real income rose, and median income relative to the working-age population was relatively stable. Most population subgroups shared in the reduced poverty rates; however, the economic status of elderly Hispanics did not improve. This article attempts to explain those economic trends by identifying changes in five sources of income for the elderly and analyzing the changes in the context of demographic changes in the elderly populations over the past 25 years. As a result of increased longevity, for example, larger proportions of elderly men and women are now 80 or older, and smaller proportions are 65 to 69. Hispanics and Asian Americans make up a larger share of the elderly population and whites a smaller share. The fraction of women who are married has increased, the fraction who are widowed has fallen, and the fraction who are divorced has grown. Such demographic changes can greatly affect the economic status of subgroups as well as the overall elderly population. Of the five sources of income for the elderly, Social Security remains the most prevalent and important. While both the rate of receipt and the share of aggregate income from Social Security benefits stayed relatively steady over the past 25 years, the average real Social Security benefit increased because of rising wages. Income from assets, the second most important source of income for the elderly, fluctuated. Because the elderly are more likely to hold interest-bearing assets such as bonds rather than stocks, their asset income is responsive to changes in nominal interest rates and bond yields. Receipt of pension income increased during this period, although it leveled off during the 1990s. Factors contributing to this pattern include enactment of the Employee Retirement Income Security Act of 1974, which increased protections of pension benefits for spouses, and improved labor market opportunities for blacks and women. In recent years, defined contribution pension plans have become more prevalent than defined benefit plans, but the full effect of this change on pension income may not yet be apparent. After decades of decline, labor force participation rates of older men leveled out in the mid-1980s and then increased. For older women, the trend before the mid-1980s was flat, but since then rates have risen substantially. The increased use of part-time jobs or self-employment to ease the transition into retirement, the economic expansion of the 1990s, and the liberalization of the Social Security earnings test may all have contributed to those trends. Although the percentage of elderly people with earnings has increased only modestly in the past few years, the share of income from earnings has grown substantially--from 16 percent of income in 1984 to 23 percent in 2000. Finally, Supplemental Security Income (SSI) benefits are indexed for inflation but not for growth in real wages. As real incomes of the elderly rose, therefore, fewer elderly persons were eligible to receive SSI or, for those receiving SSI, were eligible for smaller benefits. The proportion of elderly persons receiving public assistance, primarily SSI, declined from 11 percent in 1976 to 5 percent in 2000.

Aged↗

[Economic evaluation of the demand of medical care for mental health in Mexico: schizophrenia and depression, 1996-2000].

Financing protection for both, users and providers of health care services is one of the main objectives of National Program of Health in Mexico, 2001-2006. In fact one of the elements of the present health care reform initiatives is need for the efficient allocation of financial resources, using resource allocation schemes by specific health care demands that combine both the economic, clinical and the epidemiological perspectives. The evaluation of such schemes has been approached in several ways; however, in the case of mental health services, there is dearth of studies that use economic assessment methods. Moreover, such studies are of limited scope, often a response to unmated health needs, disregarding the economic implication for health services production and financing and ensuing medical care market imbalances. This paper presents the results of an evaluative research work aimed to assess the average cost of depression and schizophrenia case management, the financial resources required to meet the health care demands by type of institution, period 1996-2000, in Mexico by type of health care provider. The case management average cost for schizophrenia was $211.00 US, and that for depression was $221.00 US. The demand of services for both conditions in each type of institution showed that the greatest relative demands (96% of the national total for depression and 94% of the national total for schizophrenia) occur in three institutions: IMSS, SSA and ISSSTE. The greatest demand of the health services for the two study condition corresponded to those insured by the IMSS, followed by those uninsured who use the SSA services, and those insured by the ISSSTE. The case management costs for mental conditions are in the middle range between hypertension and diabetes in the upper end, pneumonia and diarrhea in the lower end. The case managment costs of health care demands for the selected tracer conditions differ considerably among institutions for insure populations and those for uninsured populations, with a greater economic impact on-the former. Independent from differences found, these results allow the identification of economic evaluation indicators that could be used to design resource allocation schemes for each of the institutions included in this study.

Depression↗

Socio-economic class distribution of the prognostic variants of lymphoproliferative cancers in Nigerians.

One hundred and twenty Nigerians with various lymphoproliferative cancers were grouped according to socio-economic class and the prognosis of their disease. The best prognostic variant of acute lymphoblastic leukaemia occurred mainly in the highest socio-economic class and the worst variant mostly in the low socio-economic class. Chronic lymphocytic leukaemia, a low grade malignancy, and the high grade Burkitt's type of Non-Hodgkin's lymphoma occurred predominantly in the low class. The relationship between prognosis and socio-economic class was not so remarkable in patients with Hodgkin's disease and multiple myeloma. The precise mechanisms by which socio-economic strata influence development of the different prognostic variants of individual lymphoproliferative cancers are not certain.

Adolescent↗

Environmental, health and economic conditions perceived by 50 rural communities in Bangladesh.

For randomly selected 50 villages in Bangladesh, an interview survey with a structured questionnaire was conducted to reveal their perception on the environmental, health and economic conditions at present and for the past 10-year change. The eight following items were analyzed in this paper: air pollution and water pollution, which represent environmental conditions with close relation to health conditions, soil degradation and deforestation, which represent environmental conditions with close relation to economic conditions, epidemic diseases and malnutrition, which represent health conditions, and poverty and jobless, which represent economic conditions. Among the 50 villages, deforestation was most frequently perceived serious at present and worsened in the past 10 years. Of the remaining seven items, those related to economic conditions were more seriously perceived than those related to health and environmental conditions. As revealed by the cluster analysis for the inter-item relations, epidemic diseases, which formed the same cluster with the environmental items, were recognized less serious whereas malnutrition, which formed the same cluster with the economic items, was recognized more serious. These findings are useful not only for rural development programs but also for mitigation programs toward health and environmental hazards in Bangladesh.

Bangladesh↗

The influence of socio-economic factors on Helicobacter pylori infection rates of students in rural Zambia.

OBJECTIVES: Although prevalence of disease in sub-Saharan Africa is often quite high and attracts much research, relatively little is known about less critical maladies. We examined Helicobacter pylori infected students in rural Zambia. We attempted to determine if any socio-economic or co-occurring diseases were correlated to H. pylori infection. Understanding the context in which H. pylori infections occur may increase our understanding of this organism. DESIGN: We conducted a screening survey with diagnostic tests of primary and secondary school students to determine rates of H. pylori infection. We then correlated these rates to socio-economic factors such as income and tobacco use. We also explored the correlation of H. pylori to HIV and malaria. SETTING: Zimba, Zambia. SUBJECTS: Eighty seven primary and secondary school students. MAIN OUTCOME MEASURE: Correlation of H. pylori to socio-economic factors. RESULTS: H. pylori infection was common (60.9%) and was consistent with rates found in other African countries. We found no significant correlation between H. Pylori and disease and socio-economic variables. CONCLUSION: In the studied population H. pylori infection does not appear to be correlated with the measured socio-economic or disease variables.

Adolescent↗

Economics and decisions to end life: van Acht and Stooker revisited.

Debates about euthanasia have tended to exclude any economic arguments. This might be due to the narrow perspective of the economic arguments presented to date, most of which focus on the health care costs in the last year of life. This paper considers the wider economic aspects in decisions to end life, including potential methodological weaknesses in measuring costs in the last year of life, the costs of euthanasia itself, the value of patient preferences and the value (and problems) of choice. Suggestions are made on how these economic issues might be explored to take the economic arguments forward.

Decision Making↗

Why does economic analysis in health care not get implemented more? Towards a greater understanding of the rules of the game and the costs of decision making.

Despite recent initiatives across a number of countries to institutionalise the use of economic evaluation in the assessment of new technologies, the evidence suggests that, to date, the impact of economic analysis on health sector decision making in practice has been low. This paper proposes that incentive compatibility problems associated with much of the decision making that economics is meant to inform is a major factor in this. The argument involves recognition that economic priority setting tends to create winners and losers and, as a consequence, any change in the status quo will tend to impose direct costs on those decision makers required to implement them. At the same time, such individuals often lack any stake over the benefits of such decisions. In this type of institutional setting, the prospects of achieving the necessary cooperation for implementation are likely to be low, particularly if it is viewed as being part of a 'one-off' initiative. Conventional health economic analysis and agency theory are limited in the extent to which they can address this problem. Such forms of analyses tend to lack an appreciation of broader institutional characteristics, including the prevailing values and norms within a decision making context that are potentially important in promoting cooperation and thus the prospects of implementation.

Decision Making, Organizational↗

Socio-economic Predictors of Life Style. A pilot study.

In epidemiological studies there exists the evidence of relationship between socio-economic status (SES) and health. The suspicious cause of these differences is life-style. The aim of the presented study was to identify the relationship between SES, demographic characteristics and the life-style in an industrial region. A structured questionnaire was distributed to a random sample of some 3,000 aged 25-70 and collected by postal delivery. The SES and demographic factors being analysed were sex, age, education, marital status and economic situation of the family in the relationship with a wide range of information on life style. The data was analysed using the chi-square test and logistic regression. The total number of analysed questionnaires was 634. The lowest response-rate was in the group with the basic education. Significant differences were found by sex in education (less women with university degree) and household income (more women in the lowest income category, men in the highest one). A detail analysis of the aggregated variables (adjusted for all SES variables) found: passivity and contentment were in adverse correlation with the level of education and economic situation; psychical well-being was correlated with family status and economic situation, risk behaviour was correlated with all SES factors except sex and education. Among the analysed factors economical situation of respondents, family and education were the most significant determinants of the differences in life-style.

Adult↗

Economic analyses on the use of positron emission tomography for the work-up of solitary pulmonary nodules and for staging patients with non-small-cell-lung-cancer in Italy.

AIM: Increasing ageing of the population and tumor incidence, along with worldwide rationing of the resources for public health systems, spur the use of economic analyses for the choice of strategies and technologies in the assessment and management of cancer patients. Incidence and clinical managing of tumors vary in different countries even if positron emission tomography (PET) with 2-deoxy-2-[18F]-fluoro-D-glucose (FDG) is becoming a routine clinical method for diagnosis, staging, treatment monitoring and follow-up in a variety of tumors. Available data indicate that PET can be considered a superior alternative or complementary tool to other well-established methods. However, in spite of the above and of the rapidly increasing number of PET centers in Europe, USA and Japan, only a few studies have dealt with some of the economic aspects raised by the clinical use of PET because of differences in values of reimbursements and health costs. The main aim of this study is to propose and discuss an economic model of analysis for PET applications in the field of detection and management of pulmonary tumors. METHODS: In this study 2 assessments were performed by decision tree analysis on the economic impact of the availability of PET on decision-making processes for 2 conditions: solitary pulmonary nodules assessment and non-small-cell lung cancer (NSCLC) staging. In order to define a methodology consistent with the system of reimbursement and the prevalent clinical views of the Italian National Health Service, data on costs, death probability, and life expectancy were gathered from the literature and from the Italian system of reimbursement (ROD-DRGs). RESULTS: The results of the cost minimization analysis demonstrate that the use of PET in the diagnostic path for the workup of patients with SPN reduces the overall diagnostic costs, by approximately 50 Euro per patient, by reducing inappropriate invasive diagnostic investigation and their complications. The results of the cost effectiveness analysis demonstrate that the use of PET in the diagnostic path for the staging of patients with NSCLC reduces the overall diagnostic costs by approximately 108 Euro for added year, by reducing inappropriate surgical interventions and their complications. CONCLUSION: Both analyses are based on standard methods used in the literature, so our conclusions can be compared with results and assessments of similar studies in different countries and health care systems. Also in the Italian case, the use of an economic assessment provides relevant information on the efficacy and effectiveness of PET.

Carcinoma, Non-Small-Cell Lung↗

[Economic efficiency of methadone maintenance and factors affecting it].

UNLABELLED: Methadone maintenance is effective in reducing injection drug use, needle sharing, and the overall mortality associated with opiate abuse. Scientific literature describes that efficiency of methadone maintenance program depends on many factors. Our analysis is based on description of economic research methods and on factors affecting economic efficiency of methadone maintenance. METHODS: Computerized Medline data base was searched by key words: "economic evaluation", "cost-effectiveness", "cost-utility", "methadone", "methadone dosage", "ancillary services", "treatment duration". Review and analysis. RESULTS: Methadone maintenance therapy has higher economic efficiency with 80-100 mg per day methadone dose. Doses lower than 40 mg per day are considered as inefficient. Some methadone programs limit treatment to 90 days or less, but such short treatment episodes are not likely to be cost-effective. Ancillary services are more cost-effective at the beginning of methadone maintenance program, than in the later stages of the program. Economic efficiency is higher when program involves more participants, than when more ancillary services are provided. CONCLUSIONS. Effectiveness of Methadone maintenance program affects methadone dosage policy, treatment duration and ancillary services.

Cohort Studies↗

Is lower socio-economic status a risk factor for Helicobacter pylori infection in pregnant women with hyperemesis gravidarum?

BACKGROUND/AIMS: Lower socio-economic status was demonstrated to be a major risk factor for infection with H. pylori infection in the general population. The aim of the present study was to investigate any possible association between infection with H. pylori and hyperemesis gravidarum and between socio-economic status and H. pylori infection in pregnant women with hyperemesis gravidarum. METHODS: Fifty-six pregnant women with hyperemesis gravidarum and 90 control pregnant women were enrolled in the study. Forty-five (80.4%) subjects in the hyperemesis gravidarum group and 72 (80%) subjects in the control group were assessed as lower socio-economic status by questionnaire. Specific serum immunglobulin G for H. pylori was assayed by fluorescent enzyme immunoassay method for both groups. RESULTS: Serologically positive H. pylori infection was detected in 46 (82.1%) subjects of the hyperemesis gravidarum group and in 58 (64.4%) of the controls (p=0.024). With respect to the patients with lower socio-economic status, 40 (88.9%) of the 45 patients with hyperemesis gravidarum and 49 (68.1%) of the 72 controls were positive for H. pylori (p=0.013). CONCLUSIONS: This study supports the studies suggesting an association between H. pylori and hyperemesis gravidarum. In addition, the lower socio-economic status may also be an important risk factor for infection with H. pylori in pregnant women with hyperemesis gravidarum.

Adult↗