Stage-specific direct health care costs in patients with cutaneous malignant melanoma.

BACKGROUND: Clinical stage at diagnosis is a strong prognostic factor for death in cutaneous malignant melanoma (CMM), with worse prognosis at higher stages. However, few studies have investigated how direct health care cost per patient varies with clinical stage. OBJECTIVE: The aim of this study was to determine the stage-specific direct health care costs for CMM patients compared to the health care costs in the general population in the County of Östergötland, Sweden. METHODS: Cutaneous malignant melanoma patients in the County of Östergötland diagnosed 2005-2012 were identified from the Swedish cancer registry. Information on clinical stage was collected from the Swedish Melanoma Register (SMR) and cost data from the Cost per Patient database (CPP) for 1075 CMM patients in Östergötland. CPP contains costs associated with all health care contacts per patient including inpatient, outpatient and primary care. The CMM-related costs were defined as the difference in mean health care costs between CMM patients and general population. RESULTS: The first year after CMM diagnosis, the average health care costs for CMM patients were 2.8 times higher than in the general population. The health care cost ratio varied from 2.0 (stage I) to 10.1 (stage IV) and the CMM-related costs per patient-year varied from €2 670 (stage I) to €29 291 (stage IV). The mean health care costs decreased over time but remained significantly higher than in the general population for all clinical stages. During the first year after diagnosis, patients in clinical stage III-IV (7% of CMM patients) accounted for 27% of the total CMM-related health care costs. CONCLUSIONS: The direct health care costs for CMM patients were significantly higher than in the general population independent of clinical stage. CMM patients diagnosed in clinical stage III-IV were associated with particularly high costs and the health care system may save resources by finding CMM patients in earlier stages.

Hospitalization in adolescence affects the likelihood of giving birth: a Swedish population-based register study.

AIM: To examine the effect of hospitalization during adolescence on the likelihood of giving birth. METHODS: 142 998 women born in 1973-75 were followed with the help of the Swedish Medical Birth Register (MBR) and the Swedish Total Population Register (TPR) up until the end of 2000 with respect to their likelihood of giving birth. All analyses were adjusted for parental socio-economic characteristics and factors related to the studied women's own birth. RESULTS: The likelihood of giving birth between 20 and 27 years of age was positively affected by hospitalization at least once during adolescence according to the Swedish Hospital Discharge Register (HDR); adjusted hazard ratio (HR) = 1.32, 95% confidence interval: 1.29-1.35. Women hospitalized due to genitourinary diseases, respiratory diseases, abdominal problems and abuse of alcohol and drugs were more likely to have given birth during the study period, while hospitalizations according to cerebral palsy and congenital malformations tended to decrease childbearing. Women hospitalized due to psychiatric diseases had an increase likelihood of given birth at 20-24 years but a reduced thereafter. CONCLUSION: A majority of the causes of hospitalization during adolescence increased the likelihood of giving birth between ages 20 to 27.

Age-specific direct healthcare costs attributable to diabetes in a Swedish population: a register-based analysis.

AIMS: The aim of this population-based study was to explore the age-specific additional direct healthcare cost for patients with diabetes compared with the non-diabetic population. METHODS: In 1999-2005, patients with diabetes in the Swedish county of Ostergötland (n = 20,876) were identified from an administrative database. Cost data on the healthcare expenditure in primary healthcare, out-patient hospital care and in-patient care for the entire county population (n = approximately 415,000) in 2005 were extracted from a cost per patient (CPP) database, which includes information on all utilized healthcare resources in the county. Data on drug sales were obtained from the Swedish Prescribed Drug Register. RESULTS: The cost per person was 1.8 times higher in patients with diabetes than in the non-diabetic population, 7.7 times higher in children and 1.3 times higher in subjects aged > 75 years. The additional cost per person for diabetes was euro 1971; euro 3930 and euro 1367, respectively, for children and subjects aged > 75 years. The proportion of total additional diabetes costs attributable to in-patient care increased with age from 25 to 50%; in-patient care was the most expensive component at all ages except in children, for whom visiting a specialist was most expensive. The diabetes-related segment of the total healthcare cost was 6.6%, increasing from 2.0% in children to 10.3% in the age group 65-74 years, declining to 6.2% in the oldest age group. CONCLUSIONS: The direct medical cost of diabetes varies considerably by age. Knowledge about the influence of age on healthcare costs to society will be important in future planning of diabetes management.

Trend of psychological distress in a Swedish population from 1989 to 1995.

The economic recession which began in Sweden in 1991 was followed by a large increase in the unemployment rate, especially in the younger labour force. The main purpose of the present study was to examine whether this recession has resulted in an increase in psychological distress in the population. Self-reported symptoms of anxiety, anguish, depression and sleeplessness have been analysed in repeated cross-sectional surveys conducted every other year from 1989 to 1995 in the County of Ostergötland. The study was confined to the 20-39 years age group and includes 3122 male and 3440 female respondents. The analysis was restricted to symptoms reported as occurring often or constantly. There was a significant increase in the 12-month prevalence of psychological distress among both men and women. At the beginning of the period 5% of the men in the 20-29 years age group reported frequent symptoms of psychological distress. By 1995 this had increased to 10%. The largest increase in prevalence, however, was found in men in the 30-39 years age group and women in the 20-29 years group Interestingly, when the non-employed groups were excluded from the analysis, the increasing trends of reported distress remained statistically significant with the exception of women aged 30-39 years.

Effects of an assessment of needs for medical and social services on long-term mortality: a randomized controlled study.

BACKGROUND: The aim of this study was to investigate the long-term effects of one general health screening on mortality. METHOD: After stratification and randomization of a population of 450,000 inhabitants, two groups were formed, an intervention group of 3064 people and a control group of 29,122 people. From the National Cause of Death Register, data were collected as regards death and causes of deaths for 1970-1990. RESULTS: Multivariate analysis was used to correct for known confounders. We then found no differences between the groups regarding deaths from all causes, cardiovascular diseases, cancer or accidents and poisoning. CONCLUSIONS: One general health screening seems to have little, if any value in preventing fatal diseases.

Impact of pregnancy on gender differences in sickness absence.

UNLABELLED: Women in general have a higher sickness absence than men, and sickness absence is particularly high among pregnant women. STUDY OBJECTIVES: To study the level of male sickness absence as compared to female, including and excluding pregnant women. DESIGN: Studies of incidence and length of sickness absence exceeding 7 days using population-based sick-leave records. SETTING: The community of Linköping, Sweden, 117,000 inhabitants. PARTICIPANTS: Subjects included in the analysis were all men and women aged 16-44 who in 1985 or 1986 had at least one sick-leave spell exceeding 7 days. RESULTS: Pregnant women had a very high sickness absence. When pregnant women were excluded, the female sick-leave rate decreased from 0.18 (95% C.I. 0.17-0.18) to 0.15 (95% C.I. 0.15-0.16) for all women. The corresponding male sick-leave rate was 0.12 (95% c.i. 0.12-0.13). Gender differences in length of sickness absence decreased to the same extent. The results were similar when restricting the analysis to employed persons. The decrease varied a little with occupational group and was largest in the age-group 25-34. CONCLUSIONS: When pregnant women were excluded the excess female sick-leave rate was halved, but still remained 25% higher than the male. The impact of excluding pregnant women was highest in the age group 25-34, where the fertility-rate was highest. Although only 5% of all women aged 16-44 were pregnant, they had a large impact on gender differences in sickness absence.

Methods for the assessment of the stability of tablet disintegrants.

To allow assessment of the long-term stability of tablet disintegrants, two mechanisms for their functionality (i.e., water uptake and swelling force generation) were monitored. Three disintegrants, alginic acid, sodium starch glycolate, and crospovidone, were used to establish the methodology. The water uptake and swelling force methodologies developed were reproducible, thus allowing for the evaluation of the effect of time, temperature, and humidity on these properties of disintegrants. The data obtained suggest that the process of water uptake and swelling force generation was essentially a two-step process. Initially, water entered the pore space in the powder bed; there was a definitive lag time before a swelling force was generated. In the stability evaluation of alginic acid and sodium starch glycolate, samples were stored for 1-year. Above 30 degrees C and 75% relative humidity, the swelling force performance of alginic acid was markedly affected. Changes seen with sodium starch glycolate were much less marked.