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1.
Br J Anaesth ; 124(2): 136-145, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31866001

RESUMO

BACKGROUND: The aim of this study was to simulate and compare the healthcare and economic outcomes associated with routine use of intraoperative transoesophageal echocardiography (TOE) in patients undergoing cardiac surgery with those associated with a scenario where TOE is not routinely used. METHODS: The impact of TOE on surgical decision-making was estimated through a systematic literature review. Individual short-term morbidity and mortality estimates were generated by application of the Society of Thoracic Surgeons risk calculator. Long-term event rates, unit costs, and utility weights were sourced from published literature and expert opinion. A discrete-event simulation model was then constructed to simulate both the in-hospital and post-discharge outcomes for patients undergoing cardiac surgery. Robustness of the base case results was examined through deterministic and probabilistic sensitivity analyses. An incremental cost-effectiveness ratio of €30 000 per quality-adjusted life-year gained was assumed to represent acceptable cost-effectiveness. RESULTS: Routine use of intraoperative TOE was associated with lower costs and higher benefits per patient, which indicates that use of TOE is a dominant strategy. The intervention resulted in the avoidance of 299 cardiac complications, 20 strokes, and 11 all-cause deaths per 10 000 patients. Routine intraoperative TOE was associated with an increased occurrence of bleeding owing to more valvular surgery and subsequent long-term anticoagulation. CONCLUSIONS: Routine intraoperative TOE is a cost-effective procedure for patients undergoing cardiac surgery, leading to lower overall costs. It was associated with a decrease in long-term complications including stroke, cardiac complications, and death, although there was a slight increase in extracranial bleeding events.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Análise Custo-Benefício/economia , Ecocardiografia Transesofagiana/economia , Cuidados Intraoperatórios/economia , Cuidados Intraoperatórios/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Simulação por Computador , Análise Custo-Benefício/estatística & dados numéricos , Ecocardiografia Transesofagiana/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
2.
BMC Public Health ; 19(1): 1700, 2019 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-31852536

RESUMO

BACKGROUND: The rate of tobacco use among people with mental illness is nearly twice that of the general population. Psychotropic medications for tobacco cessation are relatively expensive for most Kenyans. Behavioral counseling and group therapy are effective lower cost strategies to promote tobacco cessation, yet have not been studied in Kenya among individuals with concomitant mental illness. METHODS/DESIGN: One hundred tobacco users with mental illness who were part of an outpatient mental health program in Nairobi, Kenya were recruited and allocated into intervention and control groups of the study (50 users in intervention group and 50 users in control group). Participants allocated to the intervention group were invited to participate in 1 of 5 tobacco cessation groups. The intervention group received the 5As (Ask, Advise, Assess, Assist and Arrange) and tobacco cessation group behavioral intervention, which included strategies to manage cravings and withdrawal, stress and anxiety, and coping with depression due to withdrawal; assertiveness training and anger management; reasons to quit, benefits of quitting and different ways of quitting. Individuals allocated to the control group received usual care. The primary outcome was tobacco cessation at 24 weeks, measured through cotinine strips. Secondary outcomes included number of quit attempts and health-related quality of life. DISCUSSION: This study will provide evidence to evaluate the efficacy and safety of a tobacco cessation group behavioral intervention among individuals with mental illness in Kenya, and to inform national and regional practice and policy. TRIAL REGISTRATION: Trial registration number: NCT04013724. Name of registry: ClinicalTrials.gov. URL of registry: https://register.clinicaltrials.gov Date of registration: 9 July 2019 (retrospectively registered). Date of enrolment of the first participant to the trial: 5th September 2017. Protocol version: 2.0.


Assuntos
Terapia Comportamental/métodos , Análise Custo-Benefício/estatística & dados numéricos , Aconselhamento/métodos , Qualidade de Vida/psicologia , Abandono do Hábito de Fumar/métodos , Abandono do Uso de Tabaco/psicologia , Tabagismo/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Comportamental/economia , Aconselhamento/economia , Feminino , Humanos , Quênia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Abandono do Hábito de Fumar/economia , Abandono do Uso de Tabaco/estatística & dados numéricos
3.
PLoS Med ; 16(12): e1003001, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31887169

RESUMO

BACKGROUND: Retained placenta following vaginal delivery is a major cause of postpartum haemorrhage. Currently, the only effective treatments for a retained placenta are the surgical procedures of manual removal of placenta (MROP) and uterine curettage, which are not universally available, particularly in low- and middle-income countries. The objective of the trial was to determine whether sublingual nitroglycerin spray was clinically effective and cost-effective for medical treatment of retained placenta following vaginal delivery. METHODS AND FINDINGS: A randomised, placebo-controlled, double-blind trial was undertaken between October 2014 and July 2017 at 29 delivery units in the UK (Edinburgh, Glasgow, Manchester, Newcastle, Preston, Warrington, Chesterfield, Crewe, Durham, West Middlesex, Aylesbury, Furness, Southampton, Bolton, Sunderland, Oxford, Nottingham [2 units], Burnley, Chertsey, Stockton-on-Tees, Middlesborough, Chester, Darlington, York, Reading, Milton Keynes, Telford, Frimley). In total, 1,107 women with retained placenta following vaginal delivery were recruited. The intervention was self-administered 2 puffs of sublingual nitroglycerin (800 µg; intervention, N = 543) or placebo spray (control, N = 564). The primary clinical outcome was the need for MROP, assessed at 15 minutes following administration of the intervention. Analysis was based on the intention-to-treat principle. The primary safety outcome was measured blood loss between study drug administration and transfer to the postnatal ward or other clinical area. The primary patient-sided outcomes were satisfaction with treatment and side-effect profile, assessed by questionnaires pre-discharge and 6 weeks post-delivery. Secondary clinical outcomes were measured at 5 and 15 minutes after study drug administration and prior to hospital discharge. There was no statistically significant or clinically meaningful difference in need for MROP by 15 minutes (primary clinical outcome, 505 [93.3%] for nitroglycerin versus 518 [92.0%] for placebo, odds ratio [OR] 1.01 [95% CI 0.98-1.04], p = 0.393) or blood loss (<500 ml: nitroglycerin, 238 [44.3%], versus placebo, 249 [44.5%]; 500 ml-1,000 ml: nitroglycerin, 180 [33.5%], versus placebo, 224 [40.0%]; >1,000 ml: nitroglycerin, 119 [22.2%], versus placebo, 87 [15.5%]; ordinal OR 1.14 [95% CI 0.88-1.48], p = 0.314) or satisfaction with treatment (nitroglycerin, 288 [75.4%], versus placebo, 303 [78.1%]; OR 0.87 [95% CI 0.62-1.22], p = 0.411) or health service costs (mean difference [£] 55.3 [95% CI -199.20 to 309.79]). Palpitations following drug administration were reported more often in the nitroglycerin group (36 [9.8%] versus 15 [4.0%], OR 2.60 [95% CI 1.40-4.84], p = 0.003). There were 52 serious adverse events during the trial, with no statistically significant difference in likelihood between groups (nitroglycerin, 27 [5.0%], versus placebo, 26 [4.6%]; OR 1.13 [95% CI 0.54-2.38], p = 0.747). The main limitation of our study was the low return rate for the 6-week postnatal questionnaire. There were, however, no differences in questionnaire return rates between study groups or between women who did and did not have MROP, with the patient-reported use of outpatient and primary care services at 6 weeks accounting for only a small proportion (approximately 5%) of overall health service costs. CONCLUSIONS: In this study, we found that nitroglycerin is neither clinically effective nor cost-effective as a medical treatment for retained placenta, and has increased side effects, suggesting it should not be used. Further research is required to identify an effective medical treatment for retained placenta to reduce the morbidity caused by this condition, particularly in low- and middle-income countries where surgical management is not available. TRIAL REGISTRATION: ISRCTN.com ISRCTN88609453 ClinicalTrials.gov NCT02085213.


Assuntos
Análise Custo-Benefício/estatística & dados numéricos , Parto Obstétrico/economia , Nitroglicerina/uso terapêutico , Placenta Retida/tratamento farmacológico , Administração Sublingual , Adulto , Parto Obstétrico/métodos , Método Duplo-Cego , Feminino , Humanos , Hemorragia Pós-Parto/tratamento farmacológico , Gravidez , Reino Unido
4.
Int J Public Health ; 64(9): 1261-1271, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31650223

RESUMO

OBJECTIVES: Precision medicine (PM) aims to improve patient outcomes by stratifying or individualizing diagnosis and treatment decisions. Previous reviews found inconclusive evidence as to the cost-effectiveness of PM. The purpose of this scoping review was to describe current research findings on the cost-effectiveness of PM and to identify characteristics of cost-effective interventions. METHODS: We searched PubMed with a combination of terms related to PM and economic evaluations and included studies published between 2014 and 2017. RESULTS: A total of 83 articles were included, of which two-thirds were published in Europe and the USA. The majority of studies concluded that the PM intervention was at least cost-effective compared to usual care. However, the willingness-to-pay thresholds varied widely. Key factors influencing cost-effectiveness included the prevalence of the genetic condition in the target population, costs of genetic testing and companion treatment and the probability of complications or mortality. CONCLUSIONS: This review may help inform decisions about reimbursement, research and development of PM interventions.


Assuntos
Análise Custo-Benefício/estatística & dados numéricos , Medicina de Precisão/economia , Medicina de Precisão/estatística & dados numéricos , Humanos
5.
Bone Joint J ; 101-B(8): 995-1001, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31362556

RESUMO

AIMS: The primary aim of this study was to establish the cost-effectiveness of the early fixation of displaced midshaft clavicle fractures. PATIENTS AND METHODS: A cost analysis was conducted within a randomized controlled trial comparing conservative management (n = 92) versus early plate fixation (n = 86) of displaced midshaft clavicular fractures. The incremental cost-effectiveness ratio (ICER) was used to express the cost per quality-adjusted life-year (QALY). The Six-Dimension Short-Form Health Survey (SF-6D) score was used as the preference-based health index to calculate the cost per QALY at 12 months after the injury. RESULTS: The mean 12-month SF-6D was 0.9522 (95% confidence interval (CI) 0.9355 to 0.9689) following conservative management and 0.9607 (95% CI 0.9447 to 0.9767) following fixation, giving an advantage for fixation of 0.0085, which was not statistically significant (p = 0.46). The mean cost per patient was £1322.69 for conservative management and £5405.32 for early fixation. This gave an ICER of £480 309.41 per QALY. For a threshold of £20 000 per QALY, the benefit of fixation would need to be present for 24 years to be cost-effective compared with conservative treatment. Linear regression analysis identified nonunion as the only factor to adversely influence the SF-6D at 12 months (p < 0.001). CONCLUSION: Routine plate fixation of displaced midshaft clavicular fractures is not cost-effective. Nonunion following conservative management has an increased morbidity with comparable expense to early fixation. This may suggest that a targeted approach of fixation in patients who are at higher risk of nonunion would be more cost-effective than the routine fixation of all displaced fractures. Cite this article: Bone Joint J 2019;101-B:995-1001.


Assuntos
Clavícula/lesões , Tratamento Conservador/economia , Análise Custo-Benefício/estatística & dados numéricos , Fixação Interna de Fraturas/economia , Fraturas Ósseas/cirurgia , Custos de Cuidados de Saúde/estatística & dados numéricos , Adulto , Placas Ósseas , Clavícula/cirurgia , Feminino , Seguimentos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/economia , Humanos , Masculino , Estudos Prospectivos , Anos de Vida Ajustados por Qualidade de Vida , Resultado do Tratamento , Reino Unido
6.
Int J Public Health ; 64(9): 1283-1290, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31297557

RESUMO

OBJECTIVES: This study evaluates the impact of the Belgian Poison Centre (BPC) on national healthcare expenses for calls from the public for unintentional poisonings. METHODS: The probability of either calling the BPC, consulting a general practitioner (GP) or consulting an emergency department (ED) was examined in a telephone survey (February-March 2016). Callers were asked what they would have done in case of unavailability of the BPC. The proportion and cost for ED-ambulatory care, ED 24-h observation or hospitalisation were calculated from individual invoices. A cost-benefit analysis was performed. RESULTS: Unintentional cases (n = 485) from 1045 calls to the BPC were included. After having called the BPC, 92.1% did not seek further medical help, 4.2% consulted a GP and 3.7% went to an ED. In the absence of the BPC, 13.8% would not have sought any further help, 49.3% would have consulted a GP and 36.9% would have gone to the hospital. The cost-benefit ratio of the availability of the BPC as versus its absence was estimated at 5.70. CONCLUSIONS: Financial savings can be made if people first call the BPC for unintentional poisonings.


Assuntos
Análise Custo-Benefício/estatística & dados numéricos , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Centros de Controle de Intoxicações/economia , Centros de Controle de Intoxicações/estatística & dados numéricos , Envenenamento/economia , Bélgica , Humanos
7.
Midwifery ; 77: 144-154, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31330402

RESUMO

OBJECTIVES: To compare neonatal and maternal outcomes, and the relative risk of interventions between mothers attended to by midwives, general practitioners, and obstetricians, and to assess the cost-effectiveness of the employee-model of midwifery-led care in Nova Scotia, Canada, when compared with general practitioners. DESIGN, SETTING, AND PARTICIPANTS: The study was a retrospective cohort study involving routinely collected clinical and administrative data from all low-risk births from January 1st, 2013 to December 31st, 2017. There were 24,662 observations. MEASUREMENTS: Descriptive statistics were used to summarise the mother's socio-demographic characteristics. We used a nearest-neighbour matching estimator in assessing differences in outcomes, and generalized linear models in the estimation of the risks of interventions, adjusting for potential confounders. An analytic decision tree served as the vehicle for the cost-effectiveness analysis, assessed using the net monetary benefit approach. All health care resources utilized were measured and valued. Neonatal intensive care admissions avoided was the measure of outcome. We performed probabilistic sensitivity and subgroup analyses. FINDINGS: Mothers attended to by midwives spent less time at the hospital during birth admissions, were less likely to have interventions, instrumental births, and more likely to have exclusive breastfeeding at discharge from birth admission. There were no differences in Apgar scores and neonatal intensive care unit admissions. The employee-model of midwifery-led care was found to be cost-effective. KEY CONCLUSIONS: The midwifery program is both effective and cost-effective for low-risk pregnancies IMPLICATIONS FOR PRACTICE: Increasing the number of midwives will increase access and represents value for money.


Assuntos
Análise Custo-Benefício/normas , Tocologia/métodos , Padrões de Prática em Enfermagem/normas , Qualidade da Assistência à Saúde/normas , Adulto , Estudos de Coortes , Análise Custo-Benefício/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , Tocologia/organização & administração , Tocologia/estatística & dados numéricos , Nova Escócia , Padrões de Prática em Enfermagem/organização & administração , Padrões de Prática em Enfermagem/estatística & dados numéricos , Gravidez , Qualidade da Assistência à Saúde/estatística & dados numéricos , Estudos Retrospectivos
8.
Nutrients ; 11(7)2019 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-31331027

RESUMO

BACKGROUND: Although there is a growing number of early childhood obesity prevention programs, only a few of them are effective in the long run. Even fewer reports exist on lifetime cost-effectiveness of early prevention strategies. This paper aimed to assess the lifetime cost-effectiveness of infant feeding modification aiming at reducing risk of later obesity. METHODS: The simulation model consists of two parts: (a) Model I used data from the European Childhood Obesity Project (CHOP) trial (up to 6 years) and the German Interview and Examination Survey for Children (KiGGS) (6-17 years) to evaluate BMI trajectories of infants receiving either lower protein (LP) or higher protein (HP) content formula; and (b) Model II estimated lifetime cost-effectiveness based on Model I BMI trajectories. Compared to HP formula, LP formula feeding would incur lower costs that are attributable to childhood obesity across all decades of life. RESULTS: Our analysis showed that LP formula would be cost-effective in terms of a positive net monetary benefit (discounted 3%) as an obesity prevention strategy. For the 19% of infants fed with formula in Germany, the LP strategy would result in cost savings of € 2.5 billion. CONCLUSIONS: Our study is one of the first efforts to provide much-needed cost-effectiveness evidence of infant feeding modification, thereby potentially motivating interventionists to reassess their resource allocation.


Assuntos
Análise Custo-Benefício/estatística & dados numéricos , Dieta com Restrição de Proteínas/economia , Fórmulas Infantis/economia , Obesidade Pediátrica/prevenção & controle , Adolescente , Índice de Massa Corporal , Criança , Fenômenos Fisiológicos da Nutrição Infantil/fisiologia , Pré-Escolar , Custos e Análise de Custo , Europa (Continente) , Alemanha , Humanos , Lactente , Recém-Nascido
9.
Artigo em Inglês | MEDLINE | ID: mdl-31349691

RESUMO

The objective of this study was to evaluate the clinical effectiveness and cost-effectiveness of oral-health promotion programs (OHPPs) aiming to improve children's knowledge of favorable oral health behavior to lower decayed/-missing/-filled teeth (DMFT) while reducing the financial cost on health institutions. An electronic search was performed in seven databases. Studies were restricted to human interventions published in English. The search study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, and the risk of bias was assessed based on the Drummonds Checklist. A total of 1072 references were found. Among these, 19 full texts were included. Most studies had a strong quality. The overall pooled impact of OHPPs estimates children suffering from DMFT/S to have 81% lower odds of participating in OHPP (95% CI 61-90%, I2: 98.3%, p = 0). Furthermore, the program was shown to be effective at lowering the cost in 97 out of 100 OHPPs (95% CI 89-99%, I2: 99%, p = 0). Three subgroups analyses (age groups, study countries, studies of the last five years) were performed to evaluate the influence modification on the pooled effect. A comprehensive analysis of the OHPPs confirmed a reduction effect on child DMFT, hence, lowering the financial burden of dental-care treatment on health institutions.


Assuntos
Análise Custo-Benefício/estatística & dados numéricos , Assistência Odontológica/economia , Cárie Dentária/prevenção & controle , Promoção da Saúde/economia , Promoção da Saúde/métodos , Saúde Bucal/economia , Saúde Bucal/educação , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Resultado do Tratamento
10.
BioDrugs ; 33(4): 423-436, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31201616

RESUMO

BACKGROUND: As the economic burden of treating cancer patients has been soaring in European countries, performing a budget impact analysis is becoming one of the requirements for payers' application dossiers. OBJECTIVE: The objective of this study was to estimate the budgetary impact of introducing the biosimilar trastuzumab (CT-P6) from the payer's perspective and to determine the number of additional patients who could be treated with resulting savings in 28 European countries. METHODS: A budget impact model was developed to analyze the financial impact of switching from originator trastuzumab to biosimilar CT-P6 in the treatment of early and metastatic breast cancer and metastatic gastric cancer with a time horizon of 1-5 years. Budgetary savings and the number of patients potentially affected were measured based on epidemiological and sales volume data. The base-case analysis assumed that the price of CT-P6 is 70% of the originator price, the switching rate of originator to CT-P6 in the first year is 20%, and the annual growth in the switching rate for each subsequent year is 5%. RESULTS: For analyses using the base-case scenario following CT-P6 introduction, the total estimated budgetary savings over a 5-year period (depending on the scenario) ranged from €1.13 billion to €2.27 billion based on epidemiological data, or from €0.91 billion to €1.82 billion based on sales volume data. In the first year only, the projected budgetary savings ranged from €58 million to €136 million, and the number of additional patients who could be treated using the savings ranged from 3503 to 7078 by sensitivity analysis. CONCLUSIONS: The conducted budget impact analysis assessing a switch from originator trastuzumab to biosimilar CT-P6 in 28 European countries indicates that budget savings could be between €0.91 billion and €2.27 billion over the next 5 years. These savings could be used to help improve patient access to local biologics in their respective countries while simultaneously strengthening the overall public health landscape across the European Union.


Assuntos
Antineoplásicos Imunológicos/economia , Medicamentos Biossimilares/economia , Neoplasias da Mama/tratamento farmacológico , Substituição de Medicamentos/economia , Neoplasias Gástricas/tratamento farmacológico , Trastuzumab/economia , Antineoplásicos Imunológicos/uso terapêutico , Medicamentos Biossimilares/uso terapêutico , Neoplasias da Mama/economia , Orçamentos/estatística & dados numéricos , Redução de Custos/estatística & dados numéricos , Análise Custo-Benefício/estatística & dados numéricos , Custos de Medicamentos/estatística & dados numéricos , Substituição de Medicamentos/estatística & dados numéricos , Europa (Continente) , Feminino , Humanos , Modelos Econômicos , Neoplasias Gástricas/economia , Trastuzumab/uso terapêutico
11.
Value Health ; 22(6): 684-692, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31198186

RESUMO

BACKGROUND: The popularity of quality-adjusted life years (QALYs) has been resistant to concerns about validity and reliability. Utility-theoretic outcome equivalents are widely used in other areas of applied economics. Equivalence values can be derived for time, money, risk, and other metrics. These equivalence measures preserve all available information about individual preferences and are valid measures of individual welfare changes. OBJECTIVE: The objective of this study was to derive alternative generalized equivalence measures from first principles and illustrate their application in an empirical comparative-effectiveness example. METHODS: We specify a general-equilibrium model incorporating neoclassical utility functions, health production function, severity-duration preferences, and labor-market tradeoff function. The empirical implementation takes advantage of discrete-choice experiment methods that are widely accepted in other areas of applied economics and increasingly in health economics. We illustrate the practical significance of restrictive QALY assumptions using comparative-effectiveness results based on both QALYs and estimates of welfare-theoretic time-equivalent values for anti-tumor necrosis factor and prolonged corticosteroid treatments for Crohn's disease in three distinct preference classes. RESULTS: The QALY difference between the two treatments is 0.2 months, while time-equivalent values range between 0.5 and 1.3 months for aggregate and class-specific differences. Thus, the QALY-based analysis understates welfare-theoretic values by 60%-85%. CONCLUSION: These results suggest that using disease-specific equivalence values offer a meaningful alternative to QALYs to compare global outcomes across treatments. The equivalence values approach is consistent with principles of welfare economics and offers several features not represented in QALYs, including accounting for preference nonlinearities in disease severity and duration, inclusion of preference-relevant nonclinical healthcare factors, representing preferences of clinically-relevant patient subpopulations, and including utility losses related to risk aversion.


Assuntos
Análise Custo-Benefício/normas , Anos de Vida Ajustados por Qualidade de Vida , Análise Custo-Benefício/métodos , Análise Custo-Benefício/estatística & dados numéricos , Humanos , Modelos Econômicos , Reprodutibilidade dos Testes , Fatores de Tempo
12.
BMC Musculoskelet Disord ; 20(1): 186, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31043169

RESUMO

BACKGROUND: A model for triaging patients in primary care to provide immediate contact with the most appropriate profession to treat the condition in question has been developed and implemented in parts of Sweden. Direct triaging of patients with musculoskeletal disorders (MSD) to physiotherapists at primary healthcare centres has been proposed as an alternative to initial assessment by general practitioners (GPs) and has been shown to have many positive effects. The aim of this study was to evaluate the cost-effectiveness from the societal perspective of this new care-pathway through primary care regarding triaging patients with MSD to initial assessment by physiotherapists compared to standard practice with initial GP assessment. METHODS: Nurse-assessed patients with MSD (N = 55) were randomised to initial assessment and treatment with either physiotherapists or GPs and were followed for 1 year regarding health-related quality of life, utilization of healthcare resources and absence from work for MSD. Quality-adjusted life-years (QALYs) were calculated based on EQ5D measured at 5 time-points. Costs for healthcare resources and production loss were compiled. Incremental cost-effectiveness ratios (ICERS) were calculated. Multiple imputation was used to compensate for missing values and bootstrapping to handle uncertainty. A cost-effectiveness plane and a cost-effectiveness acceptability curve were construed to describe the results. RESULTS: The group who were allocated to initial assessment by physiotherapists had slightly larger gains in QALYs at lower total costs. At a willingness-to-pay threshold of 20,000 €, the likelihood that the intervention was cost-effective from a societal perspective including production loss due to MSD was 85% increasing to 93% at higher thresholds. When only healthcare costs were considered, triaging to physiotherapists was still less costly in relation to health improvements than standard praxis. CONCLUSION: From the societal perspective, this small study indicated that triaging directly to physiotherapists in primary care has a high likelihood of being cost-effective. However, further larger randomised trials will be necessary to corroborate these findings. TRIAL REGISTRATION: ClinicalTrials.gov NCT02218749 . Registered August 18, 2014.


Assuntos
Análise Custo-Benefício/estatística & dados numéricos , Doenças Musculoesqueléticas/terapia , Atenção Primária à Saúde/economia , Triagem/economia , Adolescente , Adulto , Idoso , Procedimentos Clínicos/economia , Procedimentos Clínicos/organização & administração , Feminino , Seguimentos , Clínicos Gerais/economia , Clínicos Gerais/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/psicologia , Enfermeiras e Enfermeiros/economia , Enfermeiras e Enfermeiros/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Fisioterapeutas/economia , Fisioterapeutas/estatística & dados numéricos , Atenção Primária à Saúde/organização & administração , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Suécia , Resultado do Tratamento , Triagem/estatística & dados numéricos , Adulto Jovem
13.
J Surg Res ; 241: 285-293, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31048219

RESUMO

BACKGROUND: Palliative care can improve end-of-life care and reduce health care expenditures, but the optimal timing for initiation remains unclear. We sought to characterize the association between timing of palliative care, in-hospital deaths, and health care costs. METHODS: This is a retrospective cohort study including all patients who were diagnosed and died of colorectal cancer between 2004 and 2012 in Manitoba, Canada. The primary exposure was timing of palliative care, defined as no involvement, late involvement (less than 14 d before death), early involvement (14 to 60 d before death), and very early involvement (>60 d before death). The primary outcome was in-hospital deaths and end-of-life health care costs. RESULTS: A total of 1607 patients were included; 315 (20%) received palliative care and 162 (10%) died in hospital. Compared to those who did not receive palliative care, patients with early and very early involvement experienced significantly decreased odds of dying in hospital (OR 0.21 95% CI 0.06-0.69 P = 0.01 and OR 0.11 95% CI 0.01-0.78 P = 0.03, respectively) and significantly lower health care costs. There were no significant differences in in-hospital deaths and health care costs between patients without palliative care and those who received late palliative care. CONCLUSIONS: Early palliative care involvement is associated with decreased odds of dying in hospital and lower health care utilization and costs in patients with colorectal cancer. These findings provide real-world evidence supporting early integration of palliative care, although the optimal timing (early versus very early) remains a matter of debate.


Assuntos
Neoplasias Colorretais/terapia , Prestação Integrada de Cuidados de Saúde/métodos , Cuidados Paliativos/métodos , Assistência Terminal/métodos , Idoso , Idoso de 80 Anos ou mais , Canadá/epidemiologia , Neoplasias Colorretais/economia , Neoplasias Colorretais/mortalidade , Análise Custo-Benefício/estatística & dados numéricos , Prestação Integrada de Cuidados de Saúde/economia , Prestação Integrada de Cuidados de Saúde/estatística & dados numéricos , Medicina Baseada em Evidências/economia , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/estatística & dados numéricos , Feminino , Gastos em Saúde/estatística & dados numéricos , Mortalidade Hospitalar , Humanos , Masculino , Oncologia/economia , Oncologia/métodos , Oncologia/estatística & dados numéricos , Pessoa de Meia-Idade , Cuidados Paliativos/economia , Cuidados Paliativos/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Assistência Terminal/economia , Assistência Terminal/estatística & dados numéricos , Fatores de Tempo
14.
BMC Cancer ; 19(1): 426, 2019 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-31064346

RESUMO

BACKGROUND: Public health efforts to prevent human papillomavirus (HPV)-related cancers include HPV vaccination and cervical cancer screening. We quantified the annual healthcare cost of six HPV-related cancers in order to provide inputs in cost-effectiveness analyses and quantify the potential economic savings from prevention of HPV-related cancers in Norway. METHODS: Using individual patient-level data from three unlinked population-based registries, we estimated the mean healthcare costs 1) annually across all phases of disease, 2) during the first 3 years of care following diagnosis, and 3) for the last 12 months of life for patients diagnosed with an HPV-related cancer. We included episodes of care related to primary care physicians, specialist care (private specialists and hospital-based care and prescriptions), and prescription drugs redeemed at pharmacies outside hospitals between 2012 and 2014. We valued costs (2014 €1.00 = NOK 8.357) based on diagnosis-related groups (DRG), patient copayments, reimbursement fees and pharmacy retail prices. RESULTS: In 2014, the total healthcare cost of HPV-related cancers amounted to €39.8 million, of which specialist care accounted for more than 99% of the total cost. The annual maximum economic burden potentially averted due to HPV vaccination will be lower for vulvar, penile and vaginal cancer (i.e., €984,620, €762,964 and €374,857, respectively) than for cervical, anal and oropharyngeal cancers (i.e., €17.2 million, €6.7 million and €4.6 million, respectively). Over the first three years of treatment following cancer diagnosis, patients diagnosed with oropharyngeal cancer incurred the highest total cost per patient (i.e. €49,774), while penile cancer had the lowest total cost per patient (i.e. €18,350). In general, costs were highest the first year following diagnosis and then declined; however, costs increased rapidly again towards end of life for patients who did not survive. CONCLUSION: HPV-related cancers constitute a considerable economic burden to the Norwegian healthcare system. As the proportion of HPV-vaccinated individuals increase and secondary prevention approaches advance, this study highlights the potential economic burden avoided by preventing these cancers.


Assuntos
Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde/estatística & dados numéricos , Neoplasias/economia , Infecções por Papillomavirus/economia , Vacinas contra Papillomavirus/economia , Adolescente , Adulto , Criança , Análise Custo-Benefício/estatística & dados numéricos , Detecção Precoce de Câncer/economia , Detecção Precoce de Câncer/métodos , Feminino , Humanos , Masculino , Neoplasias/diagnóstico , Neoplasias/terapia , Neoplasias/virologia , Noruega , Papillomaviridae/imunologia , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/terapia , Infecções por Papillomavirus/virologia , Vacinas contra Papillomavirus/administração & dosagem , Vacinação/economia , Adulto Jovem
15.
BMC Psychiatry ; 19(1): 140, 2019 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-31064371

RESUMO

BACKGROUND: Over the past decades research has shown that employment has a positive impact on quality of life, global functioning and recovery in individuals with schizophrenia. However, access to vocational rehabilitation services for this group is limited and unemployment rates remain high. In this study we explore the potential cost-effectiveness of a novel vocational rehabilitation program (The Job Management Program - JUMP) earmarked for individuals with schizophrenia in Norway. METHODS: The JUMP study was a vocational rehabilitation program augmented with either cognitive behaviour therapy or cognitive remediation. In addition to the JUMP protocol, we extracted treatment cost data from comprehensive and mandatory health and welfare registers. The costs over a two-year follow-up period were compared with the costs over the two-year period prior to inclusion in the study. We also compared the cost-effectiveness of JUMP with a treatment as usual group (TAU). RESULTS: We identified significant reductions in inpatient services in the JUMP group, both for those who obtained employment and those who did not. Significant reductions were also found in the TAU group, but adjusted for baseline differences the total cost for JUMP participants were € 10,621 lower than in the TAU group during the follow-up period. CONCLUSION: In addition to supporting individuals with schizophrenia obtain employment, JUMP appears to have reduced the reliance on mental health services, which should be of interest to stakeholders. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01139502 . Retrospectively registered on 6 February 2010.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Remediação Cognitiva/métodos , Análise Custo-Benefício/estatística & dados numéricos , Reabilitação Vocacional/economia , Reabilitação Vocacional/métodos , Esquizofrenia/reabilitação , Adulto , Terapia Cognitivo-Comportamental/economia , Remediação Cognitiva/economia , Análise Custo-Benefício/economia , Emprego/economia , Emprego/psicologia , Emprego/estatística & dados numéricos , Feminino , Humanos , Masculino , Noruega , Estudos Retrospectivos , Esquizofrenia/economia , Resultado do Tratamento
16.
Int J STD AIDS ; 30(7): 696-702, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31046613

RESUMO

The aim of this study was to evaluate the cost derived from the hospitalization of people living with HIV (PLHIV) in Colombia between 2011 and 2015. This is an analysis of the direct cost of PLHIV hospitalization from the perspective of an insurer of the Colombian General Social Security System. The costs were calculated in Colombian pesos and corrected for inflation on the basis of the 2017 Consumer Price Index of the Bank of the Republic of Colombia. It was converted to US dollars at the Market Representative Exchange Rate of the same year. We analyzed 1129 hospitalizations in 612 PLHIV, of which 12% started with a diagnosis of HIV during the same hospitalization, with the majority in the AIDS stage (63%). The median overall cost of hospitalizations was US$1509 (25th and 75th percentiles: US$711-US$3254), being even higher in patients with AIDS and as the CD4 T lymphocyte count decreased. The cost derived from the medical care of PLHIV increases as the clinical control of the disease worsens, and it is a key indicator of the impact of the strategies implemented for the timely identification of the infection and subsequent management of the disease.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções por HIV/tratamento farmacológico , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/economia , Seguradoras , Infecções Oportunistas Relacionadas com a AIDS/economia , Infecções Oportunistas Relacionadas com a AIDS/mortalidade , Adulto , Colômbia/epidemiologia , Efeitos Psicossociais da Doença , Análise Custo-Benefício/estatística & dados numéricos , Custos e Análise de Custo , Feminino , Infecções por HIV/economia , Infecções por HIV/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade
17.
BMC Psychiatry ; 19(1): 131, 2019 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-31039786

RESUMO

BACKGROUND: Syrians represent the largest group among refugees in Germany. Many of them were exposed to sequential traumatizing events including war, escape and post-migration stressors, which significantly increase the risk to develop symptoms of posttraumatic stress and other mental disorders. However, there is a lack of adequate treatment options for traumatized refugees in Germany. Moreover, their access to psychosocial care is often restricted due to legal regulation, language barriers, and unclear cost coverage. We therefore aim to develop a low-threshold supportive self-help app for Syrian refugees with posttraumatic stress symptoms. By conducting a randomized controlled trial, we further aim to evaluate the apps' efficacy, usability, acceptance, and economic health benefit/cost-effectiveness. METHODS: We will develop a modular, interactive self-help app in Arabic, which will be grounded on cognitive-behavioral models for the treatment of posttraumatic stress. Subsequently, screened positive (i.e., Syrian refugees, 18-65 years old, mild to moderate posttraumatic stress symptomatology as quantified by the Posttraumatic Stress Diagnostic Scale for DSM-5/PDS-5) participants (ideally up to n = 234) will be randomly allocated to an intervention (IG) and control group (CG), respectively. Participants in the IG will gain access to the self-help app for one month, while participants in the CG will receive psychoeducational reading material in form of a comprehensive brochure on traumatization and posttraumatic stress. Measurements are scheduled before the intervention (T0), directly after the intervention (T1, one month later) and three months after the intervention (T2). Using linear mixed effect models, we will investigate change in posttraumatic symptomatology. We will also test for changes in secondary outcomes such as depression, anxiety, and quality of life. Moreover, we will inspect the usability and user acceptance of the app. To evaluate the app in terms of its economic health benefit, the incremental cost-effectiveness ratio will be calculated. DISCUSSION: We plan to make the app freely available to the general public after evaluation. Thus, the app can help to add-on to routine care, which currently lacks sufficient and appropriate treatment options for Syrian refugees. TRIAL REGISTRATION: German Clinical Trials Register/Deutsches Register Klinischer Studien (DRKS). Registration ID: DRKS00013782 . Registered: 06th of July 2018.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Aplicativos Móveis , Refugiados/psicologia , Autocuidado/métodos , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Adolescente , Adulto , Idoso , Terapia Cognitivo-Comportamental/economia , Análise Custo-Benefício/estatística & dados numéricos , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Qualidade de Vida/psicologia , Projetos de Pesquisa , Síria/etnologia , Resultado do Tratamento , Adulto Jovem
18.
Prev Chronic Dis ; 16: E54, 2019 05 02.
Artigo em Inglês | MEDLINE | ID: mdl-31050637

RESUMO

INTRODUCTION: We developed a web-based cost assessment tool (CAT) to collect cost data as an improvement from a desktop instrument to perform economic evaluations of the Centers for Disease Control and Prevention's (CDC's) Colorectal Cancer Control Program (CRCCP) grantees. We describe the development of the web-based CAT, evaluate the quality of the data obtained, and discuss lessons learned. METHODS: We developed and refined a web-based CAT to collect 5 years (2009-2014) of cost data from 29 CRCCP grantees. We analyzed funding distribution; costs by budget categories; distribution of costs related to screening promotion, screening provision, and overarching activities; and reporting of screenings for grantees that received funding from non-CDC sources compared with those grantees that did not. RESULTS: CDC provided 85.6% of the resources for the CRCCP, with smaller amounts from in-kind contributions (7.8%), and funding from other sources (6.6%) (eg, state funding). Grantees allocated, on average, 95% of their expenditures to specific program activities and 5% to other activities. Some non-CDC funds were used to provide screening tests to additional people, and these additional screens were captured in the CAT. CONCLUSION: A web-based tool can be successfully used to collect cost data on expenditures associated with CRCCP activities. Areas for future refinement include how to collect and allocate dollars from other sources in addition to CDC dollars.


Assuntos
Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/economia , Análise Custo-Benefício/estatística & dados numéricos , Detecção Precoce de Câncer/economia , Promoção da Saúde/economia , Internet , Programas de Rastreamento/economia , Software , Detecção Precoce de Câncer/estatística & dados numéricos , Promoção da Saúde/estatística & dados numéricos , Humanos , Programas de Rastreamento/estatística & dados numéricos , Estados Unidos
19.
Ann Allergy Asthma Immunol ; 123(2): 166-172, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31009702

RESUMO

OBJECTIVE: To examine costs related to eosinophilic esophagitis (EoE), understand the source of these costs, discuss a possible approach for cost-effective care in EoE, and identify areas for future research in this topic. DATA SOURCES/STUDY SELECTIONS: Narrative review of the literature from 1977 (first description of EoE) to March 2019, focusing on costs and cost-effectiveness analyses in EoE. RESULTS: High costs in EoE can be related to diagnostic delays, requirement for upper endoscopy with biopsy for diagnosis and monitoring of disease activity, expensive medications currently used off-label, increased food costs related to dietary elimination treatment, frequent doctor visits with subspecialists, and complications or disease exacerbations. Provision of cost-effective care in EoE is an understudied area, and a patient-centric approach is key. There are multiple areas in which future research can make an impact. These include determining predictors of treatment response, minimally or noninvasive methods to monitor disease activity, and validation of the use of multidisciplinary care. CONCLUSION: Eosinophilic esophagitis (EoE) is considered to be a rare disease, but the costs of care and burden of disease attributed to EoE are substantial. However, few studies examine either the costs related to EoE or the approach to cost-effective care for the EoE patient. To provide cost-effective care, a patient-centric approach and shared decision-making model are optimal. In addition, a rational strategy for EoE diagnosis and initial treatment, effective maintenance therapy for disease control and ideally to prevent complications, and appropriate long-term monitoring are all required.


Assuntos
Análise Custo-Benefício/estatística & dados numéricos , Esofagite Eosinofílica/tratamento farmacológico , Esofagite Eosinofílica/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Assistência Centrada no Paciente/economia , Esofagite Eosinofílica/diagnóstico , Humanos , Doenças Raras/economia
20.
J Dermatol ; 46(6): 478-481, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30942911

RESUMO

Compared with topical corticosteroids, topical combined active vitamin D3 /corticosteroids and especially biologics are more expensive despite their marked efficacy in the treatment of psoriasis. The aim of the present study is to evaluate total costs as well as costs versus efficacy of various psoriasis treatments under the current Japanese health-care insurance system. A prospective study was performed from the database of a single clinic located in Hokkaido Prefecture. Cost and quality of life of psoriatic patients were evaluated in a prospective manner during a total of 12 months from March 2017 until June 2018. Quality-adjusted life year (QALY) of biologics was the highest among all treatments. Among the topical treatments, the cost versus efficacy of combined active vitamin D3 /corticosteroid was lowest (¥10 557/1 Psoriasis Area and Severity Index). Furthermore, incremental cost-effectiveness ratio (ICER) of combined active vitamin D3 /corticosteroid was ¥1 024 031/QALY when compared with topical corticosteroid treatment alone. The topical combined active vitamin D3 /corticosteroid treatment showed the best cost-efficacy in terms of medical economic burden.


Assuntos
Efeitos Psicossociais da Doença , Análise Custo-Benefício/estatística & dados numéricos , Fármacos Dermatológicos/economia , Psoríase/tratamento farmacológico , Administração Tópica , Adulto , Idoso , Instituições de Assistência Ambulatorial/economia , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Produtos Biológicos/economia , Produtos Biológicos/uso terapêutico , Colecalciferol/economia , Colecalciferol/uso terapêutico , Fármacos Dermatológicos/uso terapêutico , Combinação de Medicamentos , Custos de Medicamentos/estatística & dados numéricos , Feminino , Glucocorticoides/economia , Glucocorticoides/uso terapêutico , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Psoríase/diagnóstico , Psoríase/economia , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto Jovem
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