Healthcare costs and loss of productivity in patients with trapeziometacarpal osteoarthritis.

The objective of this study was to analyse healthcare and productivity costs in patients with trapeziometacarpal osteoarthritis. We included 161 patients who received surgery or steroid injection and calculated their healthcare costs in Euro (€) over 1 year. Patients filled out the Work Productivity and Activity Impairment Questionnaire to assess loss of productivity at baseline, and after 3, and 12 months. In the surgical group, loss of productivity among employed patients first increased and then decreased (50%, 64%, and 25% at 0, 3, and 12 months). Productivity was more stable over time in the injection group (52%, 38%, and 48%). In the surgical group, estimated total annual healthcare and productivity costs were €5770 and €5548, respectively. In the injection group, healthcare and productivity costs were €348 and €3503. These findings highlight the need for assessing productivity costs to get a comprehensive view of the costs associated with a treatment.Level of Evidence III.

Monitoring and surveillance for rare health-related events: a review from the veterinary perspective.

Disease monitoring and surveillance systems (MOSSs) have become one of the major components of veterinary activity. Such systems are used to assess the existing levels of prevalence, the effectiveness of control programmes and, after disease eradication, to document the continued absence of disease from a given region or zone. With decreasing disease or infection prevalence, traditional approaches become less reliable and increasingly costly. The objective of this work was to summarize and discuss methodological issues related to veterinary (animal health) MOSSs. There are considerable inconsistencies in the use of the terms 'monitoring' and 'surveillance'. Passive as well as active MOSS have their disadvantages when used for rare health-related events such as emerging and re-emerging diseases. There is a need for evaluation and improvement of these approaches. Integrated systems that call for the use of several parallel surveillance activities seem to be the favoured approach, and analytical methods to combine MOSS data from various sources into a population prevalence, or probability of disease freedom, are under development. The health and safety of the animal and human generations depends on our continuous ability to detect, monitor and control newly emerging or re-emerging livestock diseases and zoonoses rapidly. Uniform surveillance definitions, sound scientifically based approaches that use the resources and data available, and a pool of researchers and veterinary public health officials with sufficient training in epidemiology, are critically important to handle this challenging task.

A quantitative assessment of the validity of animal-health surveys using stochastic modelling.

This paper presents a stochastic simulation model to evaluate the efficacy of regional or national surveys aimed at identifying infection in populations of animals. The process of evaluation involves specification or calculation of cluster-level test sensitivity and specificity, which are derived from two probability distributions of the number of individual-level positive tests expected from non-infected and infected clusters, respectively. Probability distributions for the number of positive clusters expected in a situation of freedom from infection and under various levels of cluster prevalence are specified and used to determine survey properties (the survey being considered a diagnostic system), and ROC curves are drawn. Likelihood ratios allow investigators to state the extent to which a survey result is more likely to be observed if the region or country is infected at a given prevalence than if it is free from infection. The result of a survey carried out to investigate the presence of porcine reproductive and respiratory syndrome (PRRS) in Switzerland is used to illustrate this approach. The model can be adapted to a wide range of survey designs.

[Evaluation of a monitoring system for assessing animal health in dairy cattle]. / Evaluation eines Monitoringsystems zur Erfassung der Tiergesundheit beim Milchvieh.

A monitoring system to assess animal health in dairy farms was developed and applied on 44 farms in an epidemiological study. The objective of the study was to evaluate the applicability of the system for long term monitoring of health data. For this purpose, the quality of the collected data and the acceptance of the system by farmers and veterinarians were investigated. Farmers recorded all health events using a form. Collected data was entered into a central database on a monthly basis. The recording of health data was easy to do and did not take a lot of time. Most of the farmers (89%) used less than 20 minutes per week for the recording. This time need was independent of the herd size. 66% of the farmers found it useful to record health data, especially for improving their overview on health of each single cow. Treatments were reported in 81% of the cases, inseminations and calving in 80% of the cases. All events were reported correctly and precise.

[Frequency and cost of health problems in Swiss dairy cows and their calves (1993-1994)]. / Häufigkeit und Kosten von Gesundheitsproblemen bei Schweizer Milchkühen und deren Kälbern (1993-1994).

Between July 1993 and July 1994 morbidity and management information related to dairy cows and their calves up to the age of 8 weeks were recorded in 113 randomly selected dairy herds. Also recorded were any costs incurred through disease and prevention. Blood and faeces were analysed with respect to selected pathogens. The health problems most frequently diagnosed in cows were reproductive and udder diseases. Calves suffered most often from diarrhea, omphalitis and pneumonia. The directly disease-related costs per cow-year on average amounted to CHF 139.44 and CHF 4.18 per calf. For prevention, farmers spent on average CHF 10.18 per cow-year. Results from the laboratory analyses indicate that in 68.1% of the farms antibodies against Leptospira hardjo and in 61.9% against Coxiella burnetii were detected. In 8.0% of the farms antibodies against Mycobacterium paratuberculosis were found. Antibodies against BVD virus was present in 99.4% of the farms. Cows from 63.7% farms were infected with gastrointestinal strongylids. Veterinary assistance was required on average 1.96 times per cow-year. In almost all reproductive and puerperal disease cases a veterinarian was consulted while lameness in the majority of cases was treated by the owner. The veterinary profession was hardly ever involved in disease prevention.