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1.
Acta Med Indones ; 52(3): 196-198, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33020330

RESUMO

Since the detection of the first confirmed case of coronavirus disease 2019 (COVID-19) in early March 2020, 248,852 cases have been detected in Indonesia by 21 September 2020. At least 100 doctors have died from COVID-19 nationwide. Full large-scale social restriction was a temporary measure, followed by an early transition to the new normal era during the never-ending first wave in the country. Workers in industrial, retail, transport, and tourism fields suffered a significant decrease in work. Many countries are, however, in dilemma of protecting the health of the citizens and prioritising economy. Health should be prioritised because it is an important aspect of our lives for our economy. Poor health is estimated to reduce global gross domestic product (GDP) by 15% annually through premature deaths and potential loss of productivity of the working-age citizens. Pandemics also depress economy through decrease in both supply and demand. Data from flu pandemic a century ago suggested the importance of aggressiveness and speed of intervention. Taiwan's early action led to beneficial effects on SARS-CoV-2 infection rate and economy recovery. The target of enhancement of containment measures, provision of personal protective equipments, and testing and isolation facilities should be achieved earlier and be more than the projected demand.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Assistência à Saúde/organização & administração , Custos de Cuidados de Saúde , Pandemias , Pneumonia Viral/epidemiologia , Infecções por Coronavirus/economia , Humanos , Indonésia/epidemiologia , Pandemias/economia , Pneumonia Viral/economia
2.
Artigo em Inglês | MEDLINE | ID: mdl-33066327

RESUMO

OBJECTIVES: Assess the survival of hospitalized coronavirus disease 2019 (COVID-19) patients across age groups, sex, use of mechanical ventilators (MVs), nationality, and intensive care unit (ICU) admission in the Kingdom of Saudi Arabia. METHODS: Data were retrieved from the Saudi Ministry of Health (MoH) between 1 March and 29 May 2020. Kaplan-Meier (KM) analyses and multiple Cox proportional-hazards regression were conducted to assess the survival of hospitalized COVID-19 patients from hospital admission to discharge (censored) or death. Micro-costing was used to estimate the direct medical costs associated with hospitalization per patient. RESULTS: The number of included patients with complete status (discharge or death) was 1422. The overall 14-day survival was 0.699 (95%CI: 0.652-0.741). Older adults (>70 years) (HR = 5.00, 95%CI = 2.83-8.91), patients on MVs (5.39, 3.83-7.64), non-Saudi patients (1.37, 1.01-1.89), and ICU admission (2.09, 1.49-2.93) were associated with a high risk of mortality. The mean cost per patient (in SAR) for those admitted to the general Medical Ward (GMW) and ICU was 42,704.49 ± 29,811.25 and 79,418.30 ± 55,647.69, respectively. CONCLUSION: The high hospitalization costs for COVID-19 patients represents is a significant public health challenge. Efficient allocation of healthcare resources cannot be emphasized enough.


Assuntos
Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/terapia , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/economia , Pneumonia Viral/mortalidade , Pneumonia Viral/terapia , Idoso , Infecções por Coronavirus/economia , Feminino , Humanos , Masculino , Pandemias/economia , Pneumonia Viral/economia , Arábia Saudita/epidemiologia , Análise de Sobrevida
3.
JNMA J Nepal Med Assoc ; 58(229): 677-680, 2020 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-33068090

RESUMO

INTRODUCTION: There is a global crisis which has been led by COVID-19. The patients undergoingdental procedures and dental professionals are at higher risk of contracting this disease owing toaerosols generated and a lot of face to face contact during the procedures. The aim of this study was to know the perceptions of dental students of COMS-TH regarding future of dentistry in Nepal amidCOVID-19 pandemic. METHODS: The present cross-sectional descriptive study was conducted at COMS-TH, Bharatpur by sending an online e-survey questionnaire to 146 dental students out of which 99 responded. The e-survey questionnaire consisted of three parts which consisted of questions about demographics, knowledge about COVID-19 and their perceptions about future of dentistry. RESULTS: The results of the study depicted that most of the students thought dentistry is good and noble profession and will recommend it to young medical aspirants. Most of them wanted to pursue post graduation courses in future giving preference to Oral and Maxillofacial Surgery. CONCLUSIONS: The study concluded that most of the dental students were satisfied with dentistry as their profession and wanted National Dental Association to fix the minimum charges of each dental procedure. Also there is a need to start more post graduation courses in existing institutions providing dental education as most of the students want to pursue it in future.


Assuntos
Atitude do Pessoal de Saúde , Infecções por Coronavirus , Odontologia/tendências , Economia em Odontologia/tendências , Pandemias , Pneumonia Viral , Estudantes de Odontologia , Betacoronavirus , Escolha da Profissão , Feminino , Previsões , Custos de Cuidados de Saúde/tendências , Humanos , Controle de Infecções Dentárias , Masculino , Nepal , Padrões de Prática Odontológica/tendências , Cirurgia Bucal , Inquéritos e Questionários
4.
Drug Discov Ther ; 14(4): 153-160, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32908070

RESUMO

The COVID-19 infection has been a matter of urgency to tackle around the world today, there exist 200 countries around the world and 54 countries in Africa that the COVID-19 infection cases have been confirmed. This situation prompted us to look into the challenges African laboratories are facing in the diagnosis of novel COVID-19 infection. A limited supply of essential laboratory equipment and test kits are some of the challenges faced in combatting the novel virus in Africa. Also, there is inadequate skilled personnel, which might pose a significant danger in case there is a surge in COVID-19 infection cases. The choice of diagnostic method in Africa is limited as there are only two available diagnostic methods being used out of the six methods used globally, thereby reducing the opportunity of supplementary diagnosis, which will further lead to inappropriate diagnosis and affect the accuracy of diagnostic reports. Furthermore, challenges like inadequate power supply, the method used in sample collection, storage and transportation of specimens are also significant as they also pose their respective implication. From the observations, there is an urgent need for more investment into the laboratories for proper, timely, and accurate diagnosis of COVID-19.


Assuntos
Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Acesso aos Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/organização & administração , Pneumonia Viral/diagnóstico , Virologia/organização & administração , Betacoronavirus/patogenicidade , Orçamentos , Técnicas de Laboratório Clínico/economia , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Custos de Cuidados de Saúde , Acesso aos Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/economia , Humanos , Nigéria/epidemiologia , Pandemias/economia , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Carga Viral , Virologia/economia , Fluxo de Trabalho
5.
Nihon Koshu Eisei Zasshi ; 67(8): 501-508, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32879236

RESUMO

Objectives Medical expenses for diabetes differ between Japan's 47 prefectures. The medical care expenditure regulation plan aims to reduce regional differences in outpatient medical costs through prevention of severe diabetes, promotion of specific health checkups and specific health guidance, promotion of generic drugs, and proper use of medicines. To achieve this goal, we need to conduct an in-depth analysis of inter-prefecture differences in diabetes care expenses. This study analyzed regional differences in prescription fees for dipeptidyl peptidase-4 (DPP-4) inhibitors and the use of generic sulfonylureas (SUs), glinides, biguanides, α-glucosidase inhibitors (α-GIs), and thiazoline derivatives, using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB). Furthermore, we analyzed regional differences in consultancy fees for dialysis prevention.Methods We analyzed the 2nd NDB Open Data Japan website of the Ministry of Health, Labor, and Welfare. Pearson's correlation coefficient (r) was used to evaluate the relationship between the medical costs of diabetes and each factor. The correlation coefficient was analyzed with Student's t-test, and a P-value<0.05 was considered statistically significant.Results Regarding oral hypoglycemic drugs, prefectures with a large number of DPP-4 inhibitors tended to have higher medical costs of diabetes (r=0.40, P=0.0048). Furthermore, such expenses tended to be low in prefectures where the use of generic SU drugs was high (r=-0.43, P=0.0023).Conclusions In conclusion, the results revealed regional differences in the use of DPP-4 inhibitors and generic SU drugs, which may contribute to the regional differences in medical expenses for diabetes. This study suggests that NDB open data are useful for policy making to reduce regional differences in outpatient medical costs of diabetes.


Assuntos
Serviços de Saúde Comunitária/economia , Efeitos Psicossociais da Doença , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/economia , Inibidores Enzimáticos/administração & dosagem , Inibidores Enzimáticos/economia , Custos de Cuidados de Saúde , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/economia , Compostos de Sulfonilureia/administração & dosagem , Compostos de Sulfonilureia/economia , Análise de Dados , Diabetes Mellitus/prevenção & controle , Dipeptidil Peptidase 4 , Humanos , Japão , Honorários por Prescrição de Medicamentos , Encaminhamento e Consulta/economia
7.
Value Health ; 23(9): 1210-1217, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32940239

RESUMO

OBJECTIVES: Significant literature exists on the effects of medication adherence on reducing healthcare costs, but less is known about the effect of medication adherence among Medicare low-income subsidy (LIS) recipients. This study examined the effects of medication adherence on healthcare costs among LIS recipients with diabetes, hypertension, and/or heart failure. METHODS: This retrospective study analyzed Medicare claims data (2012-2013) linked to the Area Health Resources Files. Using measures developed by the Pharmacy Quality Alliance, adherence to 11 medication classes was studied among patients with 7 possible combinations of the diseases mentioned. Adherence was measured in 8 categories of proportion of days covered (PDC): ≥95%, 90% to <95%, 85% to <90%, 80% to <85%, 75% to <80%, 50% to <75%, 25% to <50%, and <25%. Annual Medicare costs were compared across adherence categories. A generalized linear model was used to control for patient/community characteristics. RESULTS: Among patients with only one disease, such as diabetes, patients with the lowest adherence (PDC < 25%) had $3152/year higher Medicare costs than patients with the highest adherence (PDC ≥ 95%; $11 101 vs $7949; P < .05). The adjusted costs among patients with PDC < 25% was $1893 higher than patients with PDC ≥ 95% ($9919 vs $8026; P < .05). Among patients with multiple chronic conditions, patients' adherence to medications for fewer diseases had higher costs. CONCLUSIONS: Greater medication adherence is associated with lower Medicare costs in the Medicare LIS population. Future policy affecting the LIS program should encourage better medication adherence among patients with chronic diseases.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Custos de Cuidados de Saúde/estatística & dados numéricos , Insuficiência Cardíaca/epidemiologia , Hipertensão/epidemiologia , Medicare/estatística & dados numéricos , Adesão à Medicação/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Diabetes Mellitus Tipo 2/tratamento farmacológico , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Hipertensão/tratamento farmacológico , Medicare/economia , Estudos Retrospectivos , Estados Unidos
8.
BMC Public Health ; 20(1): 1464, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993588

RESUMO

BACKGROUND: The winter pressure often experienced by NHS hospitals in England is considerably contributed to by severe cases of seasonal influenza resulting in hospitalisation. The prevention planning and commissioning of the influenza vaccination programme in the UK does not always involve those who control the hospital budget. The objective of this study was to describe the direct medical costs of secondary care influenza-related hospital admissions across different age groups in England during two consecutive influenza seasons. METHODS: The number of hospital admissions, length of stay, and associated costs were quantified as well as determining the primary costs of influenza-related hospitalisations. Data were extracted from the Hospital Episode Statistics (HES) database between September 2017 to March 2018 and September 2018 to March 2019 in order to incorporate the annual influenza seasons. The use of international classification of disease (ICD)-10 codes were used to identify relevant influenza hospitalisations. Healthcare Resource Group (HRG) codes were used to determine the costs of influenza-related hospitalisations. RESULTS: During the 2017/18 and 2018/19 seasons there were 46,215 and 39,670 influenza-related hospital admissions respectively. This resulted in a hospital cost of £128,153,810 and £99,565,310 across both seasons. Results showed that those in the 65+ year group were associated with the highest hospitalisation costs and proportion of in-hospital deaths. In both influenza seasons, the HRG code WJ06 (Sepsis without Interventions) was found to be associated with the longest average length of stay and cost per admission, whereas PD14 (Paediatric Lower Respiratory Tract Disorders without Acute Bronchiolitis) had the shortest length of stay. CONCLUSION: This study has shown that influenza-related hospital admissions had a considerable impact on the secondary healthcare system during the 2017/18 and 2018/19 influenza seasons, before taking into account its impact on primary health care.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/economia , Influenza Humana/economia , Vacinação/economia , Adulto , Inglaterra , Feminino , Recursos em Saúde , Hospitalização/estatística & dados numéricos , Humanos , Classificação Internacional de Doenças , Masculino , Pessoa de Meia-Idade , Estações do Ano , Vacinação/estatística & dados numéricos
9.
Lancet Glob Health ; 8(11): e1372-e1379, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32918872

RESUMO

BACKGROUND: Since WHO declared the COVID-19 pandemic a Public Health Emergency of International Concern, more than 20 million cases have been reported, as of Aug 24, 2020. This study aimed to identify what the additional health-care costs of a strategic preparedness and response plan (SPRP) would be if current transmission levels are maintained in a status quo scenario, or under scenarios where transmission is increased or decreased by 50%. METHODS: The number of COVID-19 cases was projected for 73 low-income and middle-income countries for each of the three scenarios for both 4-week and 12-week timeframes, starting from June 26, 2020. An input-based approach was used to estimate the additional health-care costs associated with human resources, commodities, and capital inputs that would be accrued in implementing the SPRP. FINDINGS: The total cost estimate for the COVID-19 response in the status quo scenario was US$52·45 billion over 4 weeks, at $8·60 per capita. For the decreased or increased transmission scenarios, the totals were $33·08 billion and $61·92 billion, respectively. Costs would triple under the status quo and increased transmission scenarios at 12 weeks. The costs of the decreased transmission scenario over 12 weeks was equivalent to the cost of the status quo scenario at 4 weeks. By percentage of the overall cost, case management (54%), maintaining essential services (21%), rapid response and case investigation (14%), and infection prevention and control (9%) were the main cost drivers. INTERPRETATION: The sizeable costs of a COVID-19 response in the health sector will escalate, particularly if transmission increases. Instituting early and comprehensive measures to limit the further spread of the virus will conserve resources and sustain the response. FUNDING: WHO, and UK Foreign Commonwealth and Development Office.


Assuntos
Infecções por Coronavirus/prevenção & controle , Países em Desenvolvimento , Custos de Cuidados de Saúde , Necessidades e Demandas de Serviços de Saúde/economia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Previsões , Humanos , Modelos Teóricos , Pandemias/economia , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia
10.
Z Gastroenterol ; 58(9): 855-867, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32947631

RESUMO

BACKGROUND: The economic effects of spontaneous bacterial peritonitis (SBP), nosocomial infections (nosInf) and acute-on-chronic liver failure (ACLF) have so far been poorly studied. We analyzed the impact of these complications on treatment revenues in hospitalized patients with decompensated cirrhosis. METHODS: 371 consecutive patients with decompensated liver cirrhosis, who received a paracentesis between 2012 and 2016, were included retrospectively. DRG (diagnosis-related group), "ZE/NUB" (additional charges/new examination/treatment methods), medication costs, length of hospital stay as well as different kinds of specific treatments (e. g., dialysis) were considered. Exclusion criteria included any kind of malignancy, a history of organ transplantation and/or missing accounting data. RESULTS: Total treatment costs (DRG + ZE/NUB) were higher in those with nosInf (€â€Š10,653 vs. €â€Š5,611, p < 0.0001) driven by a longer hospital stay (23 d vs. 12 d, p < 0.0001). Of note, revenues per day were not different (€â€Š473 vs. €â€Š488, p = 0.98) despite a far more complicated treatment with a more frequent need for dialysis (p < 0.0001) and high-complex care (p = 0.0002). Similarly, SBP was associated with higher total revenues (€â€Š10,307 vs. €â€Š6,659, p < 0.0001). However, the far higher effort for the care of SBP patients resulted in lower daily revenues compared to patients without SBP (€â€Š443 vs. €â€Š499, p = 0.18). ACLF increased treatment revenues to €â€Š10,593 vs. €6,369 without ACLF (p < 0.0001). While treatment of ACLF was more complicated, revenue per day was not different to no-ACLF patients (€â€Š483 vs. €â€Š480, p = 0.29). CONCLUSION: SBP, nosInf and/or ACLF lead to a significant increase in the effort, revenue and duration in the treatment of patients with cirrhosis. The lower daily revenue, despite a much more complex therapy, might indicate that these complications are not yet sufficiently considered in the German DRG system.


Assuntos
Insuficiência Hepática Crônica Agudizada/economia , Infecções Bacterianas/economia , Infecção Hospitalar/economia , Grupos Diagnósticos Relacionados/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Peritonite/economia , Insuficiência Hepática Crônica Agudizada/terapia , Infecções Bacterianas/terapia , Infecção Hospitalar/complicações , Infecção Hospitalar/terapia , Grupos Diagnósticos Relacionados/estatística & dados numéricos , Alemanha/epidemiologia , Humanos , Tempo de Internação , Cirrose Hepática/complicações , Peritonite/tratamento farmacológico , Estudos Retrospectivos
11.
PLoS One ; 15(8): e0237865, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32866187

RESUMO

BACKGROUND: Illness-related costs experienced by tuberculosis patients produce a severe economic impact on households, especially poor families. Few studies have investigated the full costs, including direct and indirect costs, at the patient and household levels in south-east China. METHODS: A case follow-up study was conducted in the Bao'an district of Shenzhen City, China. Eligible new and previously treated individuals with pulmonary tuberculosis (TB) during January 1st 2013 to June 30th 2013 were enrolled. Medical and non-medical costs as well as income loss were calculated in diagnosis and treatment periods, respectively. Factors associated with costs due to TB diagnosis, treatment and TB care (diagnosis + treatment) were explored respectively with a linear regression model. RESULTS: Of the total 514 TB patients enrolled, 95% were from the migrant population, and 65% were males, with a mean age of 32.25 (±10.11). The median costs due to TB diagnosis and TB treatment were 79 United States dollar (USD), 748USD (6.2897 China Yuan (CNY) = 1USD, 2013) per patient, respectively. The median costs due to TB care (diagnosis and treatment) per patient was 1218USD, corresponding to 26% of patients' annual income pre-illness. Those who visited more times to health facilities, hospitalized, received higher education, or occupied in national civil servant/services/retired staff might expense more before diagnosis. Costs due to TB treatment was significantly higher among migrant patients, sputum smear positive patients, and widowed/divorced population. Factors associated with less total costs were native patients, fewer times of visiting to health-care facilities and those with no hospitalization history due to TB. CONCLUSIONS: Although a free TB control policy is in force, patients with TB are still facing a heavy economic burden. More available interventions to reduce the financial burden on tuberculosis patients are urgently needed.


Assuntos
Efeitos Psicossociais da Doença , Tuberculose/diagnóstico , Tuberculose/economia , Adulto , China/epidemiologia , Fatores de Confusão Epidemiológicos , Feminino , Custos de Cuidados de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Tuberculose/epidemiologia , Tuberculose/terapia , Adulto Jovem
12.
Lancet Glob Health ; 8(10): e1282-e1294, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32971051

RESUMO

BACKGROUND: Worldwide, smoking tobacco causes 7 million deaths annually, and this toll is expected to increase, especially in low-income and middle-income countries. In Latin America, smoking is a leading risk factor for death and disability, contributes to poverty, and imposes an economic burden on health systems. Despite being one of the most effective measures to reduce smoking, tobacco taxation is underused and cigarettes are more affordable in Latin America than in other regions. Our aim was to estimate the tobacco-attributable burden on mortality, disease incidence, quality of life lost, and medical costs in 12 Latin American countries, and the expected health and economic effects of increasing tobacco taxes. METHODS: In this modelling study, we developed a Markov probabilistic microsimulation economic model of the natural history, medical costs, and quality-of-life losses associated with the most common tobacco-related diseases in 12 countries in Latin America. Data inputs were obtained through a literature review, vital statistics, and hospital databases from each country: Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, Honduras, Mexico, Paraguay, Peru, and Uruguay. The main outcomes of the model are life-years, quality-adjusted life-years, disease events, hospitalisations, disease incidence, disease cost, and healthy years of life lost. We estimated direct medical costs for each tobacco-related disease included in the model using a common costing methodology for each country. The disease burden was estimated as the difference in disease events, deaths, and associated costs between the results predicted by the model for current smoking prevalence and a hypothetical cohort of people in each country who had never smoked. The model estimates the health and financial effects of a price increase of cigarettes through taxes, in terms of disease and health-care costs averted, and increased tax revenues. FINDINGS: In the 12 Latin American countries analysed, we estimated that smoking is responsible for approximately 345 000 (12%) of the total 2 860 921 adult deaths, 2·21 million disease events, 8·77 million healthy years of life lost, and $26·9 billion in direct medical costs annually. Health-care costs attributable to smoking were estimated to represent 6·9% of the health budgets of these countries, equivalent to 0·6% of their gross domestic product. Tax revenues from cigarette sales cover 36·0% of the estimated health expenditures caused by smoking. We estimated that a 50% increase in cigarette price through taxation would avert more than 300 000 deaths, 1·3 million disease events, gain 9 million healthy life-years, and save $26·7 billion in health-care costs in the next 10 years, with a total economic benefit of $43·7 billion. INTERPRETATION: Smoking represents a substantial health and economic burden in these 12 countries of Latin America. Tobacco tax increases could successfully avert deaths and disability, reduce health-care spending, and increase tax revenues, resulting in large net economic benefits. FUNDING: International Development Research Centre (IDRC), Canada.


Assuntos
Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde/estatística & dados numéricos , Fumar/economia , Fumar/epidemiologia , Impostos/economia , Produtos do Tabaco/economia , Humanos , América Latina/epidemiologia , Cadeias de Markov , Modelos Econômicos , Impostos/estatística & dados numéricos , Produtos do Tabaco/estatística & dados numéricos
13.
Gesundheitswesen ; 82(S 03): S196-S206, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32984943

RESUMO

In this article, we present the Austrian data on physical activity, the societal costs and outcomes of physical inactivity, and the areas of influence to promote physical activity. Based on an analysis of the status quo and its consequences, suggestions on relevant measures to counter physical inactivity are made. While the proportion of Austrians that do not fulfill the current recommendations on physical activity is high, the Austrian population is physically more active than many populations of other countries. In Austria, major differences in physical activity are associated with demographic, socio-economic, and geographic factors. The economic burden related to physical inactivity is considerable, with regard to both societal costs and outcomes. This includes major health and social care costs, productivity losses (estimated at around 248 million Euro in 2017 in Austria), and life years lost due to premature death. Evidence-based areas of influence to increase physical activity include kindergartens and schools, the workplace, communities, cities, long-term care facilities, and nature.


Assuntos
Comportamentos Relacionados com a Saúde , Custos de Cuidados de Saúde , Promoção da Saúde , Comportamento Sedentário , Áustria , Exercício Físico , Alemanha , Humanos
14.
Plast Reconstr Surg ; 146(2): 177e-186e, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740586

RESUMO

BACKGROUND: Evidence-based practices in medicine are linked with a higher quality of care and lower health care cost. For trigger finger, identifying patient factors associated with nonadherence to evidence-based practices will aid physicians in treatment decisions. The objectives were to (1) determine patient factors associated with treatment nonadherence, (2) examine the success rates of steroid injections, and (3) evaluate the economic consequences of nonadherence to treatment recommendations. METHODS: The authors used data from the Clinformatics DataMart database from 2010 to 2017 to conduct a population-based analysis of patients with single-digit trigger finger. The authors calculated rates of steroid injection success and examined associations between injection success and patient factors using chi-square tests. In addition, the authors analyzed differences in the cost to the insurer, the cost to the patient, and total cost. RESULTS: A total of 29,722 patients were included in this analysis. Injection success rates were similar for diabetic (72 percent) and nondiabetic patients (73 percent), women (73 percent), and men (73 percent). Nonetheless, diabetics (OR, 1.4; 95 percent CI, 1.4 to 1.5; p < 0.001) and women (OR, 1.2; 95 percent CI, 1.1 to 1.2; p < 0.001) were significantly more likely to receive nonadherent treatment. In total, $23 million (U.S. dollars) were spent on nonadherent trigger finger care. CONCLUSIONS: Diabetics and women have increased odds of having surgery without a prior steroid injection, despite similar success rates of steroid injections compared to nondiabetics and men. Because performing surgical release before any steroid injections may represent a higher cost treatment option, providers should provide steroid injections before surgery for all patients regardless of diabetes status or sex to minimize overtreatment. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Assuntos
Diabetes Mellitus/epidemiologia , Glucocorticoides/administração & dosagem , Procedimentos Ortopédicos/economia , Cooperação do Paciente/estatística & dados numéricos , Dedo em Gatilho/terapia , Idoso , Custos e Análise de Custo/estatística & dados numéricos , Medicina Baseada em Evidências/economia , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/estatística & dados numéricos , Feminino , Seguimentos , Glucocorticoides/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Injeções Intralesionais/economia , Injeções Intralesionais/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/estatística & dados numéricos , Fatores de Risco , Fatores Sexuais , Resultado do Tratamento , Dedo em Gatilho/economia
16.
Internist (Berl) ; 61(9): 903-911, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32734335

RESUMO

In an international comparison, Germany is in the top group for health care. Not only since the economic burdens of the corona pandemic, however, has there been agreement of the necessity of exploiting the considerable efficiency and effectiveness reserves that also exist in this area. Particularly in the interface area between outpatient and inpatient care, increasingly divergent development paths are beeing discusssed. Despite scientific findings to the contrary, integrative cooperative structures threaten to fall behind.


Assuntos
Prestação Integrada de Cuidados de Saúde , Assistência à Saúde , Alemanha , Custos de Cuidados de Saúde , Hospitalização , Humanos
17.
PLoS One ; 15(8): e0237509, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32810157

RESUMO

Limited data are available regarding treatment patterns, healthcare resource utilization (HCRU), treatment costs and clinical outcomes for patients with diffuse large B-cell lymphoma (DLBCL) in Japan. This retrospective database study analyzed the Medical Data Vision database for DLBCL patients who received treatment during the identification period from October 1 2008 to December 31 2017. Among 6,965 eligible DLBCL patients, 5,541 patients (79.6%) received first-line (1L) rituximab (R)-based therapy, and then were gradually switched to chemotherapy without R in subsequent lines of therapy. In each treatment regimen, 1L treatment cost was the highest among all lines of therapy. The major cost drivers i.e. total direct medical costs until death or censoring across all regimens and lines of therapy were from the 1L regimen and inpatient costs. During the follow-up period, DLBCL patients who received a 1L R-CHOP regimen achieved the highest survival rate and longest time-to-next-treatment, with a relatively low mean treatment cost due to lower inpatient healthcare resource utilization and fewer lines of therapy compared to other 1L regimens. Our retrospective analysis of clinical practices in Japanese DLBCL patients demonstrated that 1L treatment and inpatient costs were major cost contributors and that the use of 1L R-CHOP was associated with better clinical outcomes at a relatively low mean treatment cost.


Assuntos
Custos de Cuidados de Saúde , Linfoma Difuso de Grandes Células B , Padrões de Prática Médica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/economia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Criança , Pré-Escolar , Análise Custo-Benefício , Ciclofosfamida/economia , Ciclofosfamida/uso terapêutico , Bases de Dados Factuais , Doxorrubicina/economia , Doxorrubicina/uso terapêutico , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Formulário de Reclamação de Seguro/estatística & dados numéricos , Japão/epidemiologia , Linfoma Difuso de Grandes Células B/economia , Linfoma Difuso de Grandes Células B/mortalidade , Linfoma Difuso de Grandes Células B/terapia , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/economia , Terapia Neoadjuvante/estatística & dados numéricos , Padrões de Prática Médica/economia , Padrões de Prática Médica/estatística & dados numéricos , Prednisona/economia , Prednisona/uso terapêutico , Estudos Retrospectivos , Rituximab/administração & dosagem , Rituximab/economia , Rituximab/uso terapêutico , Análise de Sobrevida , Vincristina/economia , Vincristina/uso terapêutico , Adulto Jovem
18.
PLoS One ; 15(8): e0237002, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32780774

RESUMO

BACKGROUND: Increased maternal health care (MHC) service utilisation in Bangladesh over the past decades has contributed to improvements in maternal health outcomes nationally, yet there is little understanding of Indigenous women's experiences of accessing MHC services in Bangladesh. METHODS: Face-to-face semi-structured qualitative interviews with 21 Indigenous women (aged 15-49 years) within 36 months of delivery from three ethnic groups (Chakma, Marma and Tripura) were conducted between September 2017 and February 2018 in Khagrachhari district. Purposive sampling was used to recruit women representative of the population distribution in terms of age, ethnic community and service use experience. All interviews were conducted in Bangla language and audio-recorded with consent. Interviews were transcribed directly into English before being coded. Data were analysed thematically using a qualitative descriptive approach aided by NVivo12 software. RESULTS: Of the 21 women interviewed, 14 had accessed at least one MHC service during their last pregnancy or childbirth and were categorised as the User group. The remaining seven participants were categorised as 'Non-users' as they had not access antenatal care, facility delivery or postnatal care services. Women reported that they wanted culturally relevant, respectful, home-based and affordable care, and generally perceived formal MHC services as being only for complications and emergencies. Barriers to accessing MHC services included low levels of understanding about the importance of MHC services, concerns about service costs, limited transport and fears of intrusive practices. Experiences within health services that deterred women from accessing future MHC services included demands for unofficial payments and abusive treatment by public facility staff. CONCLUSION: Improving access to MHC services for the CHT Indigenous women requires improved understandings of cultural values, priorities and concerns. Multifaceted reform is needed at individual, community and health systems levels to offer culturally appropriate health education and flexible service delivery options.


Assuntos
Acesso aos Serviços de Saúde , Serviços de Saúde do Indígena , Povos Indígenas , Serviços de Saúde Materna , Adolescente , Adulto , Bangladesh , Estudos Transversais , Medo , Feminino , Custos de Cuidados de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Serviços de Saúde do Indígena/economia , Humanos , Povos Indígenas/psicologia , Recém-Nascido , Serviços de Saúde Materna/economia , Gravidez , Pesquisa Qualitativa , Inquéritos e Questionários , Transportes , Confiança , Adulto Jovem
19.
J Headache Pain ; 21(1): 99, 2020 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-32787820

RESUMO

BACKGROUND: Migraine is a common and incapacitating condition, with severe impact on the quality of life (QoL) of the afflicted and their families, and negative economic consequences through decreased workforce participation, reduced functional ability and elevated healthcare costs. This study aimed to describe the economic consequences of migraine in Sweden using cost of illness survey data and, based on this data, assess the cost-effectiveness of onabotulinumtoxinA (Botox) for the treatment of chronic migraine in Sweden and Norway. METHODS: A survey study was conducted in Swedish migraine patients, with questions on patient characteristics, headache frequency and severity, effect on daily activities and work, QoL, health resource utilization, and medication use. Resulting costs were estimated as annual averages over subgroups of average monthly headache days. Some results were used to inform a Markov cost-effectiveness chronic migraine model. The model was adapted to Sweden and Norway using local data. The analysis perspective was semi-societal. Results' robustness was tested using one-way, structural, and probabilistic sensitivity analyses. RESULTS: Results from the cost of illness analysis (n = 454) indicated a clear correlation between decreased QoL and increased costs with increasing monthly headache days. Total annual costs ranged from EUR 6221 in patients with 0-4 headache days per month, to EUR 57,832 in patients with 25-31. Indirect costs made up the majority of costs, ranging from 82% of total costs in the 0-4 headache days group, to 91% in 25-31 headache days. The cost-effectiveness analyses indicated that in Sweden, Botox was associated with 0.223 additional QALYs at an additional cost of EUR 4126 compared to placebo, resulting in an incremental cost-effectiveness ratio (ICER) of EUR 18,506. In Norway, Botox was associated with 0.216 additional QALYs at an additional cost of EUR 4301 compared to placebo, resulting in an ICER of EUR 19,954. CONCLUSIONS: In people with migraine, an increase in monthly headache days is clearly related to lower QoL and higher costs, indicating considerable potential costs-savings in reducing the number of headache days. The main cost driver for migraine is indirect costs. Botox reduces headache days and is a cost-effective treatment for chronic migraine in Sweden and Norway.


Assuntos
Toxinas Botulínicas Tipo A/economia , Toxinas Botulínicas Tipo A/uso terapêutico , Transtornos de Enxaqueca/tratamento farmacológico , Transtornos de Enxaqueca/economia , Adulto , Análise Custo-Benefício , Feminino , Cefaleia/tratamento farmacológico , Custos de Cuidados de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Inquéritos e Questionários , Suécia , Resultado do Tratamento
20.
Cochrane Database Syst Rev ; 8: CD012927, 2020 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-32813281

RESUMO

BACKGROUND: The widespread use of mobile technologies can potentially expand the use of telemedicine approaches to facilitate communication between healthcare providers, this might increase access to specialist advice and improve patient health outcomes. OBJECTIVES: To assess the effects of mobile technologies versus usual care for supporting communication and consultations between healthcare providers on healthcare providers' performance, acceptability and satisfaction, healthcare use, patient health outcomes, acceptability and satisfaction, costs, and technical difficulties. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase and three other databases from 1 January 2000 to 22 July 2019. We searched clinical trials registries, checked references of relevant systematic reviews and included studies, and contacted topic experts. SELECTION CRITERIA: Randomised trials comparing mobile technologies to support healthcare provider to healthcare provider communication and consultations compared with usual care. DATA COLLECTION AND ANALYSIS: We followed standard methodological procedures expected by Cochrane and EPOC. We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS: We included 19 trials (5766 participants when reported), most were conducted in high-income countries. The most frequently used mobile technology was a mobile phone, often accompanied by training if it was used to transfer digital images. Trials recruited participants with different conditions, and interventions varied in delivery, components, and frequency of contact. We judged most trials to have high risk of performance bias, and approximately half had a high risk of detection, attrition, and reporting biases. Two studies reported data on technical problems, reporting few difficulties. Mobile technologies used by primary care providers to consult with hospital specialists We assessed the certainty of evidence for this group of trials as moderate to low. Mobile technologies: - probably make little or no difference to primary care providers following guidelines for people with chronic kidney disease (CKD; 1 trial, 47 general practices, 3004 participants); - probably reduce the time between presentation and management of individuals with skin conditions, people with symptoms requiring an ultrasound, or being referred for an appointment with a specialist after attending primary care (4 trials, 656 participants); - may reduce referrals and clinic visits among people with some skin conditions, and increase the likelihood of receiving retinopathy screening among people with diabetes, or an ultrasound in those referred with symptoms (9 trials, 4810 participants when reported); - probably make little or no difference to patient-reported quality of life and health-related quality of life (2 trials, 622 participants) or to clinician-assessed clinical recovery (2 trials, 769 participants) among individuals with skin conditions; - may make little or no difference to healthcare provider (2 trials, 378 participants) or participant acceptability and satisfaction (4 trials, 972 participants) when primary care providers consult with dermatologists; - may make little or no difference for total or expected costs per participant for adults with some skin conditions or CKD (6 trials, 5423 participants). Mobile technologies used by emergency physicians to consult with hospital specialists about people attending the emergency department We assessed the certainty of evidence for this group of trials as moderate. Mobile technologies: - probably slightly reduce the consultation time between emergency physicians and hospital specialists (median difference -12 minutes, 95% CI -19 to -7; 1 trial, 345 participants); - probably reduce participants' length of stay in the emergency department by a few minutes (median difference -30 minutes, 95% CI -37 to -25; 1 trial, 345 participants). We did not identify trials that reported on providers' adherence, participants' health status and well-being, healthcare provider and participant acceptability and satisfaction, or costs. Mobile technologies used by community health workers or home-care workers to consult with clinic staff We assessed the certainty of evidence for this group of trials as moderate to low. Mobile technologies: - probably make little or no difference in the number of outpatient clinic and community nurse consultations for participants with diabetes or older individuals treated with home enteral nutrition (2 trials, 370 participants) or hospitalisation of older individuals treated with home enteral nutrition (1 trial, 188 participants); - may lead to little or no difference in mortality among people living with HIV (RR 0.82, 95% CI 0.55 to 1.22) or diabetes (RR 0.94, 95% CI 0.28 to 3.12) (2 trials, 1152 participants); - may make little or no difference to participants' disease activity or health-related quality of life in participants with rheumatoid arthritis (1 trial, 85 participants); - probably make little or no difference for participant acceptability and satisfaction for participants with diabetes and participants with rheumatoid arthritis (2 trials, 178 participants). We did not identify any trials that reported on providers' adherence, time between presentation and management, healthcare provider acceptability and satisfaction, or costs. AUTHORS' CONCLUSIONS: Our confidence in the effect estimates is limited. Interventions including a mobile technology component to support healthcare provider to healthcare provider communication and management of care may reduce the time between presentation and management of the health condition when primary care providers or emergency physicians use them to consult with specialists, and may increase the likelihood of receiving a clinical examination among participants with diabetes and those who required an ultrasound. They may decrease the number of people attending primary care who are referred to secondary or tertiary care in some conditions, such as some skin conditions and CKD. There was little evidence of effects on participants' health status and well-being, satisfaction, or costs.


Assuntos
Pessoal de Saúde , Telemedicina/estatística & dados numéricos , Tempo para o Tratamento , Adulto , Viés , Telefone Celular/estatística & dados numéricos , Agentes Comunitários de Saúde/estatística & dados numéricos , Segurança Computacional , Dermatologistas , Retinopatia Diabética/diagnóstico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Custos de Cuidados de Saúde , Pessoal de Saúde/psicologia , Pessoal de Saúde/estatística & dados numéricos , Nível de Saúde , Humanos , Satisfação do Paciente , Satisfação Pessoal , Atenção Primária à Saúde/estatística & dados numéricos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Encaminhamento e Consulta/estatística & dados numéricos , Insuficiência Renal Crônica/terapia , Dermatopatias/terapia , Telemedicina/economia , Fatores de Tempo , Ultrassonografia
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