Assessing the economic value of antihypertensive medications.
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OBJECTIVE: To assess the economic value of antihypertensive medications by comparing the likelihood of coronary heart disease and stroke events and subsequent event treatment costs. STUDY DESIGN: Duration of blood pressure reduction was used to profile event risk reduction of three antihypertensive medications. METHODS: We used clinical data to determine the duration of blood pressure reduction achieved with use of two angiotensin converting enzyme inhibitors and one angiotensin II receptor antagonist. We then used trough-to-peak ratios to calculate the reduction in risk of coronary heart disease and stroke events associated with each medication. RESULTS: Across a number of different event treatment cost and population size estimates, the economic value of different medications can be assessed. CONCLUSION: Our method for assessing the economic value of antihypertensive medications can be applied to other drug classes and can be further refined by integrating patient population and other risk-related data. (+info)
Demographics and cost of epilepsy. Based on a presentation by John F. Annegers, PhD.
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Over the past decade, there has been considerable interest in cost-of-illness studies for many diseases, including epilepsy. However, the nature of epilepsy and the wide spectrum of its clinical course make it difficult to assess the overall costs of the disease. Differences in incidence rates by age, gender, etiology, and other demographic variables further complicate the task of assessing costs. The incidence is highest in the first decade of life and in the elderly. A cost-simulation study based on incidence and prognosis sheds light on how costs are estimated. This type of study also serves as a prelude to cost-of-disease studies, cost-benefit studies, and cost-effectiveness studies. Approximately 70% of patients with new-onset epilepsy will achieve remission relatively quickly and at relatively low cost. The picture is far less rosy for patients with intractable seizures; for them, the outcome is fair to poor, and the lifetime costs are high. An empiric version of the cost-stimulation study is now under way. Its objectives are to identify incidence cases of epilepsy in two cohorts, collect longitudinal data on each case, estimate the costs of care over time and across service, measure patterns of resource use over time, and use the resultant direct cost estimates as a national cost model. (+info)
The prevalence and health burden of self-reported diabetes in older Mexican Americans: findings from the Hispanic established populations for epidemiologic studies of the elderly.
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OBJECTIVES: The prevalence and health burden of self-reported adult-onset diabetes mellitus were examined in older Mexican Americans. METHODS: Data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly were used to assess the prevalence of self-reported diabetes and its association with other chronic conditions, disability, sensory impairments, health behaviors, and health service use in 3050 community-dwelling Mexican Americans 65 years and older. RESULTS: The prevalence of self-reported diabetes in this sample was 22%, and there were high rates of obesity, diabetes-related complications, and diabetic medication use. Myocardial infarction, stroke, hypertension, angina, and cancer were significantly more common in diabetics than in nondiabetics, as were high levels of depressive symptoms, low perceived health status, disability, incontinence, vision impairment, and health service use. Many of the rate differences found in this sample of older Mexican Americans were higher than those reported among other groups of older adults. CONCLUSIONS: Our findings indicate that the prevalence and health burden of diabetes are greater in older Mexican Americans than in older non-Hispanic Whites and African Americans, particularly among elderly men. (+info)
Screening for breast cancer: time, travel, and out-of-pocket expenses.
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BACKGROUND: We estimated the personal costs to women found to have a breast problem (either breast cancer or benign breast disease) in terms of time spent, miles traveled, and cash payments made for detection, diagnosis, initial treatment, and follow-up. METHODS: We analyzed data from personal interviews with 465 women from four communities in Florida. These women were randomly selected from those with a recent breast biopsy (within 6-8 months) that indicated either breast cancer (208 women) or benign breast disease (257 women). One community was the site of a multifaceted intervention to promote breast screening, and the other three communities were comparison sites for evaluation of that intervention. All P values are two-sided. RESULTS: In comparison with time spent and travel distance for women with benign breast disease (13 hours away from home and 56 miles traveled), time spent and travel distance were statistically significantly higher (P<.001) for treatment and follow-up of women with breast cancer (89 hours and 369 miles). Personal financial costs for treatment of women with breast cancer were also statistically significantly higher (breast cancer = $604; benign breast disease = $76; P < .001) but were statistically significantly lower for detection and diagnosis (breast cancer = $170; benign breast disease = $310; P < .001). Among women with breast cancer, time spent for treatment was statistically significantly lower (P = .013) when their breast cancer was detected by screening (68.9 hours) than when it was detected because of symptoms (84.2 hours). Personal cash payments for detection, diagnosis, and treatment were statistically significantly lower among women whose breast problems were detected by screening than among women whose breast problems were detected because of symptoms (screening detected = $453; symptom detected = $749; P = .045). CONCLUSION: There are substantial personal costs for women who are found to have a breast problem, whether the costs are associated with problems identified through screening or because of symptoms. (+info)
Beyond disability: measuring the social and personal consequences of osteoarthritis.
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OBJECTIVE: Measuring the impact of osteoarthritis has traditionally focused on the disease (measures of impairment), functional disability and latterly, general health status or quality of life. This paper highlights the importance of measuring the wider personal and social consequences of OA both at a population and an individual patient level. DESIGN: The World Health Organisation definition of handicap is used to describe this wider impact of disease and measures of handicap, both generic and disease-specific are reviewed. The measurement of handicap in OA is illustrated by the use of the Disease Repercussion Profile in a clinical trial of orthopaedic out-patients with OA and low back pain. These data are compared to routine clinical handicap data collected on consecutive patients with rheumatoid arthritis attending a different outpatient clinic. RESULTS: OA patients reported handicap in six areas of their lives: functional and social activities, relationships, socio-economic status, emotional well-being and body image. The prevalence was similar to that reported by RA patients. OA patients reported more severe handicap than RA patients in each of the 6 areas (F ratios 4. 97-55.67) and the differences were statistically significant (P values 0.03-0.0001) for all dimensions except functional and social handicap. The LBP patients scored slightly more severe handicap on all dimensions than the OA patients but these differences did not reach statistical significance. However, they scored significantly more severe handicap than the RA patients (F ratios 8.49-174.72, P< 0.0001). CONCLUSIONS: These data suggest that the psychosocial impact of OA may have been underestimated and highlight the importance of going beyond disability in assessing the impact of OA. Measurement of the wider impact of OA can be achieved using disease-specific and generic measures of handicap. The choice of tool will depend upon the setting (research or clinical practice) and the purpose of measurement. (+info)
The health and cost effects of substituting home care for inpatient acute care: a review of the evidence.
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BACKGROUND: There is much interest in reducing hospital stays by providing some health care services in patients' homes. The authors review the evidence regarding the effects of this acute care at home (acute home care) on the health of patients and caregivers and on the social costs (public and private costs) of managing the patients' health conditions. METHODS: MEDLINE and HEALTHSTAR databases were searched for articles using the key term "home care." Bibliographies of articles read were checked for additional references. Fourteen studies met the selection criteria (publication between 1975 and early 1998, evaluation of an acute home care program for adults, and use of a control group to evaluate the program). Of the 14, only 4 also satisfied 6 internal validity criteria (patients were eligible for home care, comparable patients in home care group and hospital care group, adequate patient sample size, appropriate analytical techniques, appropriate health measures and appropriate costing methods). RESULTS: The 4 studies with internal validity evaluated home care for 5 specific health conditions (hip fracture, hip replacement, chronic obstructive pulmonary disease [COPD], hysterectomy and knee replacement); 2 of the studies also evaluated home care for various medical and surgical conditions combined. Compared with hospital care, home care had no notable effects on patients' or caregivers' health. Social costs were not reported for hip fracture. They were unaffected for hip and knee replacement, and higher for COPD and hysterectomy; in the 2 studies of various conditions combined, social costs were higher in one and lower in the other. Effects on health system costs were mixed, with overall cost savings for hip fracture and higher costs for hip and knee replacement. INTERPRETATION: The limited existing evidence indicates that, compared with hospital care, acute home care produces no notable difference in health outcomes. The effects on social and health system costs appear to vary with condition. More well-designed evaluations are needed to determine the appropriate use of acute home care. (+info)
Prognosis of accidental low back pain at work.
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Accidental low back pain at the workplace was classified into two groups; 177 cases of the organic type and 176 cases of the non-specific type. Concerning the recuperation period, the length of leave, and the amount of compensation for recuperation, medical cost and leave of absence, a comparison was made between two groups. Regarding age, sex, and the type of work, no difference was found between the organic and the non-specific groups. However, the non-specific group showed lower values than the organic one for the duration of recuperation and leave and the amount of compensation for medical cost and leave of absence. Multiple regression analysis showed that the difference in the type of low back pain had more influence on the duration and cost than that in sex and age. The prognosis of non-specific low back pain is better than that of organic one in terms of cost and duration. (+info)
Empiric investigation on direct costs-of-illness and healthcare utilization of Medicaid patients with diabetes mellitus.
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OBJECTIVE: To determine total direct costs-of-illness and to study the influence of different factors affecting these costs. In addition, we examined each type of service (e.g., hospitalization, outpatient care, prescription drugs, physician encounters, and laboratory tests) for diabetic Medicaid patients to provide evidence about the relationship between diabetic patients' healthcare utilization and their related predictors. PATIENTS AND METHODS: A total of 7931 patients with diabetes who were 65 years or younger in the Alabama Medicaid program from 1992 to 1995 were studied. Using a relational database created from Medicaid claims, multiple regression and canonical correlation methods were used to analyze the patients' direct costs-of-illness, including the costs associated with each healthcare service used by each patient. RESULTS: The costs of hospitalization, outpatient care, prescription drugs, and physician encounters were the four largest components of the direct costs-of-illness for diabetic Medicaid patients, comprising 29.9%, 21.3%, 28.2%, and 14.3%, respectively. After controlling for other factors in an empiric model, the direct costs-of-illness for a patient with insulin-dependent diabetes mellitus was $5160 higher than for a patient with noninsulin-dependent diabetes mellitus during the 3-year study. The cost for a patient with renal dysfunction was $59,920 higher than for other diabetic patients. Each increase in the number of different prescribing physicians per patient was associated with a cost increase of $450. Each additional comorbidity increased the cost by $735 per patient. The cost for a male patient was $2140 higher than that for a female patient, and the cost for a white patient was $1330 higher than that for a non-white patient. For a patient who relied on diet to control diabetes, there were $2750 less in costs compared with other patients during the study period. More than 20% of the variability in patients' healthcare utilization costs was explained by the set of predictive factors. CONCLUSIONS: The direct costs-of-illness and healthcare utilization for Medicaid diabetic patients were significantly accounted for by the number of comorbidities, the number of different physicians visited, insulin-dependent diabetes mellitus, and complications (especially renal dysfunction). Patients who relied on dietary therapy and exercise to control their diabetes had lower healthcare costs and utilization than other patients. A significant amount of healthcare costs and utilization might be controlled or reduced if diabetes disease management can successfully be aimed at preventing diabetic complications, controlling comorbidities, and minimizing the number of different physicians visited. (+info)