One-year Medicare costs associated with delirium in older hospitalized patients with and without Alzheimer's disease dementia and related disorders.

INTRODUCTION: One-year health-care costs associated with delirium in older hospitalized patients with and without Alzheimer's disease and related dementias (ADRD) have not been examined previously. METHODS: Medicare costs were determined prospectively at discharge, and at 30, 90, and 365 days in a cohort (n = 311) of older adults after hospital admission. RESULTS: Seventy-six (24%) patients had ADRD and were more likely to develop delirium (51% vs. 24%, P < 0.001) and die within 1 year (38% vs. 21%, P = 0.002). In ADRD patients with versus without delirium, adjusted mean difference in costs associated with delirium were $34,828; most of the excess costs were incurred between 90 and 365 days (P = 0.03). In non-ADRD patients, delirium was associated with increased costs at all timepoints. Excess costs associated with delirium in ADRD patients increased progressively over 1 year, whereas in non-ADRD patients the increase was consistent across time periods. DISCUSSION: Our findings highlight the complexity of health-care costs for ADRD patients who develop delirium, a potentially preventable source of expenditures. HIGHLIGHTS: Novel examination of health-care costs of delirium in persons with and without Alzheimer's disease and related dementias (ADRD). Increased 1-year costs of $34,828 in ADRD patients with delirium (vs. without). Increased costs for delirium in ADRD occur later during the 365-day study period. For ADRD patients, cost differences between those with and without delirium increased over 1 year. For non-ADRD patients, the parallel cost differences were consistent over time.

Estimating the Burden of Stroke: Two-Year Societal Costs and Generic Health-Related Quality of Life of the Restore4Stroke Cohort.

(1) Background: This study aimed to investigate two-year societal costs and generic health-related quality of life (QoL) using a bottom-up approach for the Restore4Stroke Cohort. (2) Methods: Adult post-stroke patients were recruited from stroke units throughout the Netherlands. The societal costs were calculated for healthcare and non-healthcare costs in the first two years after stroke. The QoL was measured using EQ-5D-3L. The differences between (sub)groups over time were investigated using a non-parametric bootstrapping method. (3) Results: A total of 344 post-stroke patients were included. The total two-year societal costs of a post-stroke were EUR 47,502 (standard deviation (SD = EUR 2628)). The healthcare costs decreased by two thirds in the second year -EUR 14,277 (95% confidence interval -EUR 17,319, -EUR 11,236). In the second year, over 50% of the total societal costs were connected to non-healthcare costs (such as informal care, paid help, and the inability to perform unpaid labor). Sensitivity analyses confirmed the importance of including non-healthcare costs for long-term follow-up. The subgroup analyses showed that patients who did not return home after discharge, and those with moderate to severe stroke symptoms, incurred significantly more costs compared to patients who went directly home and those who reported fewer symptoms. QoL was stable over time except for the stroke patients over 75 years of age, where a significant and clinically meaningful decrease in QoL over time was observed. (4) Conclusions: The non-healthcare costs have a substantial impact on the first- and second-year total societal costs post-stroke. Therefore, to obtain a complete picture of all the relevant costs related to a stroke, a societal perspective with a follow-up of at least two years is highly recommended. Additionally, more research is needed to investigate the decline in QoL found in stroke patients above the age of 75 years.

Use of Netnography to Understand GoFundMe® Crowdfunding Profiles Posted for Individuals and Families of Children with Osteogenesis Imperfecta.

Osteogenesis imperfecta (OI) is a rare genetic disorder associated with low bone density and increased bone fragility. OI can lead to a variety of supportive and medical care needs; yet financial impacts for families and individuals living with OI remain understudied and largely invisible. Efforts by families to recover costs through GoFundMe®, the most important crowdfunding web platform worldwide, offer an unprecedented opportunity to gain insight into OI costs. The purpose of this study was to describe GoFundMe® profiles and determine what factors may contribute to funding goal achievement. A netnographic approach was used to investigate a publicly available dataset from GoFundMe®, with 1206 webpages extracted and 401 included for analysis. Most webpages originated from the United States and were created by family members. Nineteen cost categories were identified. Thirty-seven web profiles met their funding goal. Funding increases or goal achievements created for children were associated with increased social-media exposure (i.e., Facebook). This study helped to describe and showcase the financial impacts of OI and effectiveness of a crowdfunding website to alleviate costs. The results highlight the need for further research to better understand OI costs and provide economic supports for individuals with OI.

Cost of Diagnosing and Treating Cognitive Complaints: One-year Cost-evaluation Study in a Patient Cohort from a Slovenian Memory Clinic.

Introduction: Dementias present a global health challenge and give rise to significant economic costs. This study aims to evaluate the economic impact of one-year outpatient healthcare, nursing home, and formal and informal home help costs for all patients referred to the Centre for Cognitive Impairments at the Department of Neurology, Ljubljana University Medical Centre, Slovenia. Methods: Data was acquired retrospectively from physicians' records and the costs for 2015 were calculated. Total costs were estimated by means of a bottom-up calculation of outpatient visits, diagnostic examinations and anti-dementia medication. In a subgroup of 120 patients with dementia, the Resource Utilization in Dementia questionnaire was used to estimate formal and informal care costs. Results: A total of 720 patients visited the memory clinic in 2015. Diagnosis at first visit was subjective cognitive or mild cognitive impairment (SCI/ MCI) for 322 patients, dementia for 258 patients, and psychiatric or other disorders for 140 patients. The average annual cost per patient was EUR 578. It was highest for patients with dementia (EUR 751), EUR 550 for patients with SCI/MCI, and lowest for patients with psychiatric and other disorders (EUR 324). Monthly informal and social care costs were between EUR 1,037 and EUR 3,369, depending on the methodology used. Conclusion: The cost of diagnosing a cognitive disorder depends on how extensive the diagnosis is. With an estimated prevalence of 34,137 persons with dementia in Slovenia, basic diagnostic investigations incur costs of approximately EUR 7 million. Direct medical costs represent a smaller portion of total dementia costs; this is because annual costs for formal and informal home help are estimated at EUR 265 million and nursing home placements at EUR 105 million.

The economic burden of rotavirus hospitalization among children < 5 years of age in selected hospitals in Bangladesh.

BACKGROUND: Rotavirus is a common cause of severe acute gastroenteritis among young children. Estimation of the economic burden would provide informed decision about investment on prevention strategies (e.g., vaccine and/or behavior change), which has been a potential policy discussion in Bangladesh for several years. METHODS: We estimated the societal costs of children <5 years for hospitalization from rotavirus gastroenteritis (RVGE) and incidences of catastrophic health expenditure. A total of 360 children with stool specimens positive for rotavirus were included in this study from 6 tertiary hospitals (3 public and 3 private). We interviewed the caregiver of the patient and hospital staff to collect cost from patient and health facility perspectives. We estimated the economic cost considering 2015 as the reference year. RESULTS: The total societal per-patient costs to treat RVGE in the public hospital were 126 USD (95% CI: 116-136) and total household costs were 161 USD (95% CI: 145-177) in private facilities. Direct costs constituted 38.1% of total household costs. The out-of-pocket payments for RVGE hospitalization was 23% of monthly income and 76% of households faced catastrophic healthcare expenditures due to this expense. The estimated total annual household treatment cost for the country was 10 million USD. CONCLUSIONS: A substantial economic burden of RVGE in Bangladesh was observed in this study. Any prevention of RVGE through cost-effective vaccination or/and behavioural change would contribute to substantial economic benefits to Bangladesh.

The Economic Burden of Chronic Kidney Disease in Vietnam.

Our objective is to analyze the economic burden of chronic kidney disease (CKD) in Vietnam, particularly in District 2 Hospital at Ho Chi Minh City in 2019. This is a descriptive cross-sectional study. The data source is the medical records of the patients. Encoding the data, analyzing treatment cost, regression modeling, and verification were performed using Stata 15 software. Patients with stage 3 CKD account for the highest proportion of the CKD patient population. CKD comorbidities include hypertension, diabetes, cardiovascular disease, and anemia, which increase the treatment fees of patients. Approximately half of the patients with CKD have diabetes or cardiovascular disease. Treatment costs increase as the condition of the patient worsens (except for stage 1 and 2 CKD). The total expenses of all CKD patients in District 2 Hospital were USD 916 423 988.60. Five main factors that affect the treatment fee of a patient: CKD stage, age, gender, and the presence of diabetes, cardiovascular disease, and anemia. The regression model correctly predicts 96% of cases and can explain 64.15% of the fluctuations in costs. The cost of CKD treatment was higher than Vietnam's per capita GDP in 2019, and the primary factors affecting costs are comorbidities and dialysis.

Cost of Illness in Young Children: A Prospective Birth Cohort Study.

Childhood illness is extremely common and imposes a considerable economic burden on society. We aimed to quantify the overall economic burden of childhood illness in the first three years of life and the impact of environmental risk factors. The study is based on the prospective, clinical mother-child cohort Copenhagen Prospective Studies on Asthma in Childhood (COPSAC2010) of 700 children with embedded randomized trials of fish-oil and vitamin D supplementations during pregnancy. First, descriptive analyses were performed on the total costs of illness, defined as both the direct costs (hospitalizations, outpatient visits, visit to the practitioner) and the indirect costs (lost earnings) collected from the Danish National Health Registries. Thereafter, linear regression analyses on log-transformed costs were used to investigate environmental determinants of the costs of illness. The median standardized total cost of illness at age 0-3 years among the 559 children eligible for analyses was EUR 14,061 (IQR 9751-19,662). The exposures associated with reduced costs were fish-oil supplementation during pregnancy (adjusted geometric mean ratio (GMR) 0.89 (0.80; 0.98), p = 0.02), gestational age in weeks (aGMR = 0.93 (0.91; 0.96), p < 0.0001), and birth weight per 100 g (aGMR 0.98 (0.97; 0.99), p = 0.0003), while cesarean delivery was associated with higher costs (aGMR = 1.30 (1.15; 1.47), p < 0.0001). In conclusion, common childhood illnesses are associated with significant health-related costs, which can potentially be reduced by targeting perinatal risk factors, including maternal diet during pregnancy, cesarean delivery, preterm birth and low birth weight.

Economic Burden of Influenza in Thailand: A Systematic Review.

Thailand has a high incidence and high mortality rates of influenza. This study summarizes the evidence on economic burden or costs of influenza subsequent to the occurrence of influenza illness in the Thai population by specific characteristics such as population demographics, health conditions, healthcare facilities, and/or cost types from published literature. A systematic search was conducted in six electronic databases. All costs were extracted and adjusted to 2018 US dollar value. Out of 581 records, 11 articles (1 with macroeconomic analysis and 10 with microeconomic analyses) were included. Direct medical costs per episode for outpatients and inpatients ranged from US$4.21 to US$212.17 and from US$163.62 to US$4577.83, respectively, across distinct influenza illnesses. The overall burden of influenza was between US$31.1 and US$83.6 million per year and 50-53% of these estimates referred to lost productivity. Costs of screening for an outbreak of influenza at an 8-bed-intensive-care-unit hospital was US$38242.75 per year. Labor-sensitive sectors such as services were the most affected part of the Thai economy. High economic burden tended to occur among children and older adults with co-morbidities and to be related to complications, non-vaccinated status, and severe influenza illness. Strategies involving prevention, limit of transmission, and treatment focusing on aforementioned patients' factors, containment of hospitalization expenses and quarantine process, and assistance on labor-sensitive economy sectors are likely to reduce the economic burden of influenza. However, a research gap exists regarding knowledge about the economic burden of influenza in Thailand.

The increasing economic burden of multiple sclerosis by disability severity in Australia in 2017: Results from updated and detailed data on types of costs.

BACKGROUND: Economic costs of Multiple Sclerosis (MS) in Australia were last estimated in 2010 and are likely to have changed over time, especially given this new era of increased access to higher efficacy disease modifying therapies (DMTs) with a strong focus on earlier MS diagnosis and treatment. OBJECTIVES: To provide a comprehensive contemporary analysis of the updated direct and indirect costs of MS in Australia from a societal perspective and to examine how the cost landscape has changed overtime. METHODS: Costs were estimated from the 2016 Economic Impact Survey (EIS) of the Australian MS longitudinal Study (AMSLS) and were stratified by various (indirect and direct) cost categories/sub-categories and disability severity. Disability was assessed with the patient determined disease steps (PDDS) and mapped against the gold-standard Expanded Disability Status Scale (EDSS), and classified as no disability (EDSS level: 0), mild (EDSS 1-3.5), moderate (EDSS 4-6) and severe (EDSS 6.5-9.5). A generalized linear model (GLM) predicted covariate adjusted costs for each disability severity. All costs are presented in 2017 Australian dollars. RESULTS: 488 (15.5% of the 3,163) AMSLS participants completed the survey. Annual costs per person with MS increased 17% from 2010 to $68,382 in 2017, driven largely by increased direct costs (from $16,306 in 2010 to $30,346 in 2017) (particularly those related to DMTs, hospitalizations, consultations, and medical tests), but offset by decreased costs of lost wages (from $29,030 in 2010 to $21,858 in 2017) as a result of recent positive shifts in the employment landscape for Australians with MS. Costs increased with increasing disability severity: $30,561 (95% confidence intervals [CI]: $25,672-$35,451), $55,815 (95%CI: $47,503-$64,126), $76,915 (95%CI: $68,866-$84,964), and $114,813 (95%CI: $102,252-$127,374) for no, mild, moderate and severe disability, respectively. The differences in costs between the four disability groups remained statistically significant even after adjustment for age, sex, DMT usage status, disease course and areas of remoteness. CONCLUSIONS: MS has an increasing economic burden in Australia. The study provides current economic data on MS in Australia that are important for policy development, priority setting and management of public health.

The economic burden of prostate cancer - a Swedish prevalence-based register study.

BACKGROUND: Incidence and prevalence of prostate cancer in Sweden have increased markedly due to prostate-specific antigen (PSA) testing. Moreover, new diagnostic tests and treatment technologies are expected to further increase the overall costs. Our aims were (i) to estimate the societal costs for existing testing, diagnosis, management and treatment of prostate cancer, and (ii) to provide reference values for future cost-effectiveness analyses of prostate cancer screening and treatment. METHODS: Taking a societal perspective, this study aimed to investigate the annual cost of prostate cancer in Sweden using a prevalence-based cost-of-illness approach. Resource utilisation and related costs within Stockholm Region during 2016 were quantified using data from the Stockholm PSA and Biopsy Register and other health and population registers. Costs included: (i) direct medical costs for health care utilisation at primary care, hospitals, palliative care and prescribed drugs; (ii) informal care; and (iii) indirect costs due to morbidity and premature mortality. The resource utilisation was valued using unit costs for direct medical costs and the human capital method for informal care and indirect costs. Costs for the Stockholm region were extrapolated to Sweden based on cancer prevalence and the average costs by age and resource type. RESULTS: The societal costs due to prostate cancer in Stockholm in 2016 were estimated to be €64 million Euro (€Mn), of which the direct medical costs, informal care and productivity losses represented 62, 28 and 10% of the total costs, respectively. The total annual costs extrapolated to Sweden were calculated to be €281 Mn. The average direct medical cost, average costs for informal care and productivity losses per prevalent case were €1510, €828 and €271, respectively. These estimates were sensitive to assumptions related to the proportion of primary care visits associated with PSA testing and the valuation method for informal care. CONCLUSION: The societal costs due to prostate cancer were substantial and constitute a considerable burden to Swedish society. Data from this study are relevant for future cost-effectiveness evaluations of prostate cancer screening and treatment.

The economic burden of metastatic breast cancer in Spain.

Objectives: The study aimed to estimate the burden of metastatic breast cancer (mBC) in Spain over 5 years. Methods: An incidence-based cost-of-illness model was developed in which a cohort of patients with mBC was followed from the diagnosis of metastatic disease over 5 years or death. Resource use data were collected through a physician survey conducted with 10 clinical experts in Spain. The model distinguished patients according to HER2 and hormonal receptor (HR) status, and followed the patient cohort in monthly cycles. Results: The incident cohort was estimated to be 2,923 patients with mBC, consisting of 1,575 HER2-/HR+, 520 HER2+/HR+, 324 HER2+/HR-, and 503 triple negative patients. The estimated mean survival over the 5-year time period was 2.51 years, on average, with longer survival of 3.36 years for HER2+/HR+, 2.41 years for HER2-/HR+, 2.82 years for HER2+/HR- and shortest mean survival of 1.74 years for triple negative patients. The total costs were €469,92,731 for the overall population, €190,079,787 for the HER2-/HR+, €151,045,260 for the HER2+/HR+, €80,827,171 for the HER2+/HR- and €47,540,512 for the triple negative subgroups over 5 years. Per patient total costs were €160,642 on average, €120,664 for HER2-/HR+, €290,346 for HER2+/HR+, €249,152 for HER2+/HR-and €94,572 for triple negative patients over 5 years. Conclusions: The economic burden of mBC in Spain is significant, but differs by HER2 and HR status. HER2-/HR +patients account for the highest burden due to the prevalence of this category, but HER2+/HR +patients have the highest per patient costs.

Costs of isocyanate-related occupational diseases: A systematic review.

Although isocyanates are increasingly used in manufacturing and workplace exposure to isocyanates is widely recognized as one of the most frequent causes for occupational lung and skin diseases, little is known about the economic burden on the affected individual and the society. This study provides an overview on costs of occupational diseases related to isocyanates. We performed a systematic literature search of studies in the electronic databases of the German Institute of Medical Documentation and Information, and the Canadian Centre for Occupational Health and Safety. We extracted the key characteristics of the studies and performed a study quality assessment. We identified eight studies on the costs of illness, of which five focused on occupational lung diseases and three on occupational skin diseases. Further, eight studies calculated loss of income/compensation payments. Out of the 16 identified articles, only two reported costs directly attributable to isocyanate-induced diseases (asthma). Studies were hardly comparable because they differed substantially in their methodological approaches. Moreover, the quality assessment of the studies revealed substantial limitations. While a wide range of isocyanate-related costs was identified, consequences of isocyanate-related occupational diseases were considerable in terms of societal costs and loss of income. In most studies, indirect costs were the main cost driver. There is a need for high-quality cost of illness studies on isocyanate-induced diseases stratified by degree of severity and sex. Such studies provide valuable information to develop preventive strategies and set priorities for measures to lower the burden of professional health risks.

Ankylosing spondylitis causes high burden to patients and the healthcare system: results from a German claims database analysis.

To compare healthcare resource utilization and costs between ankylosing spondylitis (AS) patients and a matched sample from the general population without AS covered by the German Statutory Health Insurance (SHI) system, a non-interventional retrospectively matched cohort analysis was conducted using anonymized SHI claims data. Data from January 1st, 2011 through December 31st, 2014 were analyzed. Individuals with a coded diagnosis of AS during the enrollment period comprising the full year of 2013 were directly matched (1:5) to individuals without AS diagnosis in the whole study period by age, gender, hospitalizations, and comorbidities. All-cause healthcare resource utilization and direct costs were analyzed for the year 2013. Statistical tests were applied to compare the differences between the two sampled populations. In 2013, 10,208 AS patients were identified and matched to a sample of 51,040 patients without AS from the general population. Healthcare resource utilization was significantly higher in all healthcare sectors (inpatient, outpatient, pharmaceuticals, remedies, devices and aids, and sick leave) in the AS cohort. Mean all-cause healthcare costs per patient were about €2475 higher in the AS cohort compared to the general population. Most important cost drivers were hospitalizations and pharmaceuticals in terms of bDMARDs prescribed in 10% of the patients. Real-world data from this German claims database analysis showed that AS is associated with a substantial incremental economic burden to the healthcare system.

Why Fibular Nailing Can Be an Efficient Treatment Strategy for AO Type 44-B Ankle Fractures in the Elderly.

The reference standard treatment of unstable AO type 44-B ankle fractures is open reduction and internal fixation. However, delayed-staged surgery because of compromised soft tissues results in prolonged hospitalization and increased total healthcare costs in the elderly (age ≥65 years). The aim of the present study was to measure the efficiency of intramedullary fibular nailing (IMFN) in the elderly. A prospective series of 15 elderly patients with an AO type 44-B ankle fracture treated with IMFN were compared with a retrospective cohort of 97 elderly patients treated with plate and screw osteosynthesis (PSOS). Clinical and process-related variables and total healthcare costs, including 5 cost categories, were assessed. Functional outcomes, general health status, and quality of life were measured using the American Orthopaedic Foot and Ankle Society ankle-hindfoot and EuroQol 5-dimension 3-level visual analog scales. Although the preoperative length of stay was significantly shorter for the patients treated with IMFN, the total length of stay and total healthcare costs were not significantly different between the 2 groups. The complication and reintervention rates were similar in both groups, with improved American Orthopaedic Foot and Ankle Society scale scores in the IMFN group. Compared with delayed-staged surgery, early IMFN led to a significant reduction in total healthcare costs. We could not prove significant cost savings for IMFN compared with PSOS for the treatment of AO type 44-B ankle fractures. However, early IMFN was financially beneficial compared with a delayed-staged (IMFN and PSOS) surgery protocol. Because, ultimately, IMFN allows for early percutaneous fixation in most cases, IMFN is a potentially profitable treatment strategy for AO type 44-B ankle fractures in the elderly with good outcomes.

The worldwide costs of dementia 2015 and comparisons with 2010.

INTRODUCTION: In 2010, Alzheimer's Disease International presented estimates of the global cost of illness (COI) of dementia. Since then, new studies have been conducted, and the number of people with dementia has increased. Here, we present an update of the global cost estimates. METHODS: This is a societal, prevalence-based global COI study. RESULTS: The worldwide costs of dementia were estimated at United States (US) $818 billion in 2015, an increase of 35% since 2010; 86% of the costs occur in high-income countries. Costs of informal care and the direct costs of social care still contribute similar proportions of total costs, whereas the costs in the medical sector are much lower. The threshold of US $1 trillion will be crossed by 2018. DISCUSSION: Worldwide costs of dementia are enormous and still inequitably distributed. The increase in costs arises from increases in numbers of people with dementia and in increases in per person costs.

Health care costs of borderline personality disorder and matched controls with major depressive disorder: a comparative study based on anonymized claims data.

BACKGROUND: Borderline personality disorder (BPD) and major depressive disorder (MDD) pose a significant burden to the German health care system in terms of direct and indirect costs. The aim of this study was to determine the incremental costs that arise due to the treatment of patients with BPD, in relation to MDD patients adjusted for gender and age. METHODS: Insured persons who suffered from BPD (F60.3; N = 6599) or MDD (F32, F33; N = 26,396) in the year 2010 were identified from the German Health Risk Institute research database. To estimate the costs resulting from disorder-specific health care service utilization and the mean total costs per patient for the health care system, we analyzed anonymized claims data of individuals with BPD and matched individuals with MDD. RESULTS: The costs resulting from disorder-specific health care service utilization 1 year after index diagnosis amounted to 8508 EUR for BPD and 8281 EUR for MDD per patient utilizing services. With mean total annual costs per patient of 4636 EUR versus 2020 EUR 1 year preceding index diagnosis, 7478 EUR versus 3638 EUR in the year after index diagnosis, and 11,817 EUR versus 6058 EUR 2 years after index diagnosis, BPD patients incurred markedly higher costs. CONCLUSIONS: Since the treatment of BPD causes incremental costs for the German health care system compared to the treatment of MDD, and since both conditions are associated with a high level of suffering, there is a need for establishing adequate and early treatment of these mental disorders.

Costos de atención y rehabilitación de pacientes con lesiones por accidentes de tránsito en el mundo / Treatment and Rehabilitation costs of patients with injuries caused by traffic accidents in the world / Custos de atendimento e reabilitação de pacientes com ferimentos por acidentes de transido no mundo

Objetivo: Conocer los costos directos (CD) e indirectos (CI) de la atención de pacientes con lesiones por accidentes de tránsito (AT) en el mundo. Métodos: Se realizó una revisión sistemática en PubMed, Embase, Centre for Reviews and Dissemination, Journal Storage y Scielo de estudios de costos de atención de víctimas de AT mayores de 16 años, entre 2008 y 2013. La calidad de los estudios se evaluó con criterios extraídos de Drummond y col, y del " Consolidated Health Economic Evaluation Reporting Standards statement (CHEERS)" y otros definidos por los autores. Se evaluaron los CD, los CI. La carga de la enfermedad (CE), se hizo con los Años de Vida Ajustados por Discapacidad (AVAD), y Años de Vida ajustados por Calidad (AVAC). Se analizaron los costos generados por discapacidad/rehabilitación y Trauma craneoencefálico (TEC). Los costos monetarios en dólares americanos (USD) de 2010 ajustados por inflación. Resultados: Se analizaron 14 estudios, seis de buena calidad. Se encontraron estudios con 567.000 pacientes y 10 años de duración, costos directos de 48.082 e indirectos de 29.706 USD por paciente; los costos indirectos superaron los directos. La carga de la enfermedad mostró amplia variabilidad; en un estudio el 60% de los pacientes con TEC grave y 20% moderado quedaron con discapacidad corto plazo y en otro el 4,6% quedó con discapacidad a largo plazo. Conclusiones: Existe gran heterogeneidad en los estudios, no hay consenso para evaluar la calidad de estos estudios. Los costos indirectos de accidentes de tránsito superan los directos. Los costos derivados de discapacidad y rehabilitación son poco evaluados.

Objective: to know the direct (DC) and indirect costs (IC) generated by the treatment of patients with moderate or severe injuries caused by traffic accidents (TA) in the world. Methodology: a systematic review of studies assessing the costs of treating victims of traffic accidents older than 16 between 2008 and 2013 was conducted using the PubMed, Embase, Centre for Reviews and Dissemination, Journal Storage and Scielo databases. The quality of the studies was assessed using criteria from Drummond and col, as well as the "Consolidated Health Economic Evaluation Reporting Standards statement (CHEERS)" and other mechanisms defined by the authors. DCs and ICs were assessed. The burden of disease (BD) was obtained with the disability-adjusted life year (DALY), and the quality-adjusted life-year (QALY). The costs generated by disability /rehabilitation and traumatic brain injury (TBI) were analyzed. The monetary costs were expressed in 2010 US dollars (USD) adjusted for inflation. Results: 14 studies were analyzed, 6 of which had a good quality. We found studies with up to 567.000 patients and a duration of 10 years. Direct costs were up to USD 48.082 and indirect costs up to USD 29.706 per patient; the direct costs were exceeded by the indirect costs. The burden of disease showed high variability. In one study, 60% of the patients with severe TBI and 20% with moderate TBI had short term disability; in another study 4.6% of the patients sustained long-term disability. Conclusions: there is great heterogeneity in the cost studies. There is no consensus for assessing the quality of these studies. The indirect costs incurred in traffic accidents are greater than direct costs. The costs of disability and rehabilitation are poorly assessed.

Objetivo: conhecer os custos diretos (cd) e indiretos (ci) do atendimento de pacientes com ferimentos por acidentes de trânsito (at) no mundo. Metodologia: realizou-se uma revisão sistemática em PubMed, Embase, Centre for Reviews and Dissemination, Journal Storage e Storage de estudos de custos de atendimento de cítimas de at com mais de 16 anos, entre 2 e 2013. A qualidade dos estudos foi avaliada com critérios extraídos de Drummond y col e do "Consolidated Health Economic Evaluation Reporting Standards statement (cheers)" e com outros definidos pelos autores. Avaliaram-se os DC, os CI. A carga da doença (cd) realizou-se com os Anos de Vida Ajustados por Deficiência (avad), e com Anos de Vida ajustados por Qualidade (avaq). Analisaram-se os custos gerados por Deficiência/reabilitação e Traumatismos cranioencefálicos (tce). Os custos monetários em dólares americanos (usd) de 2010 ajustados por inflação. Resultados : analisaram-se 14 estudos, seis de boa qualidade. Encontraram-se estudos com 567.000 pacientes e 10 anos de duração, custos diretos de 48.082 e indiretos de 29.706 usd por paciente. Os custos indiretos foram superiores aos diretos. A carga da doença mostrou gandre variabilidade. Em um estudo, 60% dos pacientes com tce sério e 20% moderado ficaram com deficiência de curto prazo e em outro, 4,6% ficou com Deficiência de longo prazo. Conclusão: existe grande heterogeneidade nos estudos, não há consenso para avaliar a qualidade destes estudos. Os custos indiretos de acidentes de trânsito são superiores os indiretos. Os custos derivados de Deficiência e de reabilitação são pouco avaliados.

The attributable annual health costs of U.S. occupational lead poisoning.

BACKGROUND: U.S. occupational lead standards have not changed for decades, while knowledge about lead's health effects has grown substantially. OBJECTIVE: The objective of this analysis was twofold: to estimate the attributable annual societal costs of health damages associated with occupationally lead-exposed U.S. workers and, more broadly, to develop methods for a fuller valuation of health damages. METHODS: I combined data voluntarily reported to NIOSH on the number of highly exposed workers with published literature on the health effects of lead in adults to estimate the potential health benefits of lowering the U.S. occupational limit. I developed simple algorithms for monetizing more fully both the direct medical and indirect (productivity) damages associated with those high lead exposures. RESULTS: I estimated direct medical costs of $141 million (2014US$) per year for 16 categories of health endpoints, and combined direct and indirect costs of over $392 million (2014US$) per year for the 10,000 or so U.S. workers with high occupational lead exposures. CONCLUSIONS: Reducing allowable occupational lead limits produces annual societal benefits of almost $40,000 per highly exposed worker. Given underreporting of actual exposures and the omission of important health effects, this is likely a severe underestimate.

Social/economic costs and health-related quality of life in patients with juvenile idiopathic arthritis in Europe.

OBJECTIVE: The aim of this study was to determine the economic burden from a societal perspective and the health-related quality of life (HRQOL) of patients with juvenile idiopathic arthritis (JIA) in Europe. METHODS: We conducted a cross-sectional study of patients with JIA from Germany, Italy, Spain, France, the United Kingdom, Bulgaria, and Sweden. Data on demographic characteristics, healthcare resource utilization, informal care, labor productivity losses, and HRQOL were collected from the questionnaires completed by patients or their caregivers. HRQOL was measured with the EuroQol 5-domain (EQ-5D-5L) questionnaire. RESULTS: A total of 162 patients (67 Germany, 34 Sweden, 33 Italy, 23 United Kingdom, 4 France, and 1 Bulgaria) completed the questionnaire. Excluding Bulgarian results, due to small sample size, country-specific annual health care costs ranged from €18,913 to €36,396 (reference year: 2012). Estimated direct healthcare costs ranged from €11,068 to €22,138; direct non-healthcare costs ranged from €7837 to €14,155 and labor productivity losses ranged from €0 to €8715. Costs are also shown to differ between children and adults. The mean EQ-5D index score for JIA patients was estimated at between 0.44 and 0.88, and the mean EQ-5D visual analogue scale score was estimated at between 62 and 79. CONCLUSIONS: JIA patients incur considerable societal costs and experience substantial deterioration in HRQOL in some countries. Compared with previous studies, our results show a remarkable increase in annual healthcare costs for JIA patients. Reasons for the increase are the inclusion of non-professional caregiver costs, a wider use of biologics, and longer hospital stays.

The Humanistic and Economic Burden of Narcolepsy.

STUDY OBJECTIVES: To evaluate the burden of narcolepsy--with respect to psychiatric comorbidities, Health-Related Quality of Life (HRQoL), direct costs for healthcare resource utilization, and indirect costs for reported work loss-through comparison of patients to matched controls. METHODS: This analysis was conducted on data from the 2011, 2012, and 2013 US National Health and Wellness Survey (NHWS; 2011 NHWS n = 75,000, 2012 NHWS n = 71,157, and 2013 NHWS n = 75,000). Patients who reported a narcolepsy diagnosis (n = 437) were matched 1:2 with controls (n = 874) on age, sex, race/ethnicity, marital status, education, household income, body mass index, smoking status, alcohol use, exercise, and physical comorbidity. Chi-square tests and one-way analyses of variance were used to assess whether the narcolepsy and control groups differed on psychiatric comorbidities, HRQoL, labor force participation, work productivity, and healthcare resource utilization. RESULTS: Patients with narcolepsy, in comparison to matched controls, reported substantially (two to four times) greater psychiatric comorbidity, HRQoL impairment, prevalence of long-term disability, absenteeism, and presenteeism, and greater resource use in the past 6 mo as indicated by higher mean number of hospitalizations, emergency department visits, traditional healthcare professional visits, neurologist visits, and psychiatrist visits (each p < 0.05). CONCLUSIONS: These population-based data suggest that a narcolepsy diagnosis is associated with substantial adverse impact on mental health, HRQoL, and key economic burdens that include work impairment, resource use, and both direct and indirect costs. Although this study is cross-sectional, the results highlight the magnitude of the potential opportunity to improve mental health, lower costs, and augment work-related productivity through effective assessment and treatment of narcolepsy.