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Influenza Other Respir Viruses ; 12(2): 232-240, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29125689


BACKGROUND: Consideration of cost determinants is crucial to inform delivery of public vaccination programs. OBJECTIVES: To estimate the average total cost of laboratory-confirmed influenza requiring hospitalization in Canadians prior to, during, and 30 days following discharge. To analyze effects of patient/disease characteristics, treatment, and regional differences in costs. METHODS: Study utilized previously recorded clinical characteristics, resource use, and outcomes of laboratory-confirmed influenza patients admitted to hospitals in the Serious Outcomes Surveillance (SOS), Canadian Immunization Research Network (CIRN), from 2010/11 to 2012/13. Unit costs including hospital overheads were linked to inpatient/outpatient resource utilization before and after admissions. RESULTS: Dataset included 2943 adult admissions to 17 SOS Network hospitals and 24 Toronto Invasive Bacterial Disease Network hospitals. Mean age was 69.5 years. Average hospital stay was 10.8 days (95% CI: 10.3, 11.3), general ward stays were 9.4 days (95% CI: 9.0, 9.8), and ICU stays were 9.8 days (95% CI: 8.6, 11.1) for the 14% of patients admitted to the ICU. Average cost per case was $14 612 CAD (95% CI: $13 852, $15 372) including $133 (95% CI: $116, $150) for medical care prior to admission, $14 031 (95% CI: $13 295, $14 768) during initial hospital stay, $447 (95% CI: $271, $624) post-discharge, including readmission within 30 days. CONCLUSION: The cost of laboratory-confirmed influenza was higher than previous estimates, driven mostly by length of stay and analyzing only laboratory-confirmed influenza cases. The true per-patient cost of influenza-related hospitalization has been underestimated, and prevention programs should be evaluated in this context.

Expert Rev Pharmacoecon Outcomes Res ; 15(1): 181-9, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25284595


BACKGROUND: Uterine fibroids (UF) represent the most common benign uterine tumor in women of reproductive age. Symptoms including heavy, prolonged menstrual bleeding, pelvic pain/pressure, and/or urinary frequency have a substantial impact on women's quality of life and utility values for UF have not been published. METHODS: Health state descriptions associated with UF symptoms and treatment side effects were developed based on patient focus groups; validated using expert clinical input; and pilot tested for understandability. Using a web-based questionnaire, 909 community-dwelling, Canadian women were surveyed to assess their perceived value associated with these states. RESULTS: Utility for uncontrolled bleeding was 0.55 (95% CI: 0.54, 0.57) and the decrement associated with hot flashes was 0.06 (95% CI: -0.07, -0.04). Utility improvement associated with bleeding control was 0.18 (95% CI: 0.17, 0.19) and with smaller fibroid size was 0.03 (95% CI: 0.02, 0.04). CONCLUSION: These values illustrate the high utility associated with control of excessive menstrual bleeding.

Leiomioma/fisiopatologia , Pré-Menopausa , Qualidade de Vida , Neoplasias Uterinas/fisiopatologia , Adulto , Canadá/epidemiologia , Feminino , Grupos Focais , Humanos , Leiomioma/epidemiologia , Leiomioma/terapia , Pessoa de Meia-Idade , Projetos Piloto , Inquéritos e Questionários , Hemorragia Uterina/epidemiologia , Hemorragia Uterina/etiologia , Neoplasias Uterinas/epidemiologia , Neoplasias Uterinas/terapia , Adulto Jovem
Soc Sci Med ; 81: 102-9, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23347496


The objective of this study was to estimate the annual costs and consequences of unpaid caregiving by Canadians from a government perspective. We estimated these costs both at the individual and population levels for caregivers aged 45 and older. We conducted a cost-benefit analysis where we considered the costs of unpaid caregiving to be potential losses in income tax revenues and changes in social assistance payments and the potential benefit of reduced paid care expenditures. Our costing methods were based on multivariate analyses using the 2007 General Social Survey, a cross-sectional survey of 23,404 individuals. We determined the differential probability of employment, wages, and hours worked by caregivers of varying intensity versus non-caregivers. We also used multivariate analysis to determine how receiving different intensities of unpaid care impacted both the probability of receiving paid care and the weekly hours of paid care received. At the lowest intensities of caregiving, there was a net benefit to government from caregiving, at both the individual and population levels. At the population level, the net benefit to government was estimated to be $4.4 billion for caregivers providing less than five hours of weekly care. At the highest intensity of caregiving, there was a net cost to government of $641 million. Our overall findings were robust to a number of changes applied in our sensitivity analysis. We found that the factor with the greatest impact on cost was the probability of labour force participation. As the biggest cost driver appears to be the higher likelihood of intense caregivers dropping out of the labour force, government policies that enable intense caregivers to balance caregiving with employment may help to mitigate these losses.

Cuidadores/economia , Governo Federal , Assistência Domiciliar/economia , Canadá , Cuidadores/estatística & dados numéricos , Análise Custo-Benefício , Estudos Transversais , Emprego/economia , Feminino , Assistência Domiciliar/estatística & dados numéricos , Humanos , Imposto de Renda/economia , Masculino , Pessoa de Meia-Idade , Seguridade Social/economia , Fatores de Tempo
Cult Health Sex ; 13(5): 561-74, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21390947


In addition to facing barriers to health care and experiencing poor health status, immigrants to Canada and Sweden tend to have more negative birth outcomes than the native-born population, including low birth weight and perinatal mortality rates. Explored through interviews with health care professionals, including midwives, nurse practitioners, social workers and obstetrician gynaecologists, this paper evaluates their experiences in providing prenatal care to immigrants in Hamilton, Ontario, Canada. Results reveal the complexity of delivering care to immigrants, particularly with respect to expectations surrounding language, culture and type and professionalism of care. The paper concludes by discussing future research options and implications for the delivery of prenatal care to this population.

Atitude do Pessoal de Saúde , Cultura , Emigrantes e Imigrantes/psicologia , Nível de Saúde , Cuidado Pré-Natal/psicologia , Conscientização , Competência Cultural , Feminino , Acesso aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Linguagem , Ontário , Satisfação do Paciente , Gravidez , Suécia , Saúde da Mulher