Biomedical subjects

Harri Sintonen

Publications and source records attributed to Harri Sintonen.

At least 19 recordsLinked to original sources

PubMed2007

Decomposition of health inequality by determinants and dimensions.

The study integrates two methodologies so that income-related inequality in general health can be decomposed into contributions from socio-demographic characteristics to each of the dimensions defining general health. It is found that these relative contributions vary substantially across dimensions. For policy purposes such information is valuable as it indicates at which population groups and at which aspects of health efforts to reduce inequalities in health should be targeted.

Adolescent↗

PubMed2006

The effect of hormone therapy on the health-related quality of life in elderly women.

OBJECTIVES: The purpose of this study was to compare the health-related quality of life (HRQoL) of elderly users and non-users of hormone therapy (HT). SUBJECTS AND METHODS: Subjects were participants in an ongoing intervention study, which is aimed at elucidating the effectiveness of an educational program in the prevention of osteoporosis. A random sample (n=4200) of the female population in Southern Finland within the age group of 60-70 years was drawn from the population register and invited to take part in the trial; 2181 (52%) accepted the invitation and were randomized either to the educational program or to a control group. In 2002 all 2181 participants were asked by a postal survey about HRQoL (generic15D), education, profession, climacteric symptoms, use of HT, chronic diseases and medication. Of the 1663 respondents (76% of the participants; 40% of the original cohort) 585 (mean age 67.5 years) were HT users and 1078 (mean age 68.9 years) non-users. RESULTS: After standardizing for age, education, number of continuous medication and ongoing diseases HRQoL of HT users was significantly better on the dimensions of usual activities, vitality and sexual activity. The effect of HT on overall HRQoL on a 0-1 scale was positive, but neither statistically significant nor clinically important. The number of medication and diseases had a statistically significant negative effect, but higher education a positive, but statistically non-significant effect on HRQoL overall. CONCLUSIONS: Among elderly women HT use has a statistically significant positive effect on some dimensions of HRQoL, but not on HRQoL overall. To improve HRQoL is not an indication for elderly postmenopausal women to use HT.

Aged↗

PubMed2006

Cost-utility of routine cataract surgery.

BACKGROUND: If decisions on health care spending are to be as rational and objective as possible, knowledge on cost-effectiveness of routine care is essential. Our aim, therefore, was to evaluate the cost-utility of routine cataract surgery in a real-world setting. METHODS: Prospective assessment of health-related quality of life (HRQoL) of patients undergoing cataract surgery. 219 patients (mean (SD) age 71 (11) years) entering cataract surgery (in 87 only first eye operated, in 73 both eyes operated, in 59 first eye had been operated earlier) filled in the 15D HRQoL questionnaire before and six months after operation. Direct hospital costs were obtained from a clinical patient administration database and cost-utility analysis performed from the perspective of the secondary care provider extrapolating benefits of surgery to the remaining statistical life-expectancy of the patients. RESULTS: Mean (SD) utility score (on a 0-1 scale) increased statistically insignificantly from 0.82 (0.13) to 0.83 (0.14). Of the 15 dimensions of the HRQoL instrument, only seeing improved significantly after operation. Mean utility score improved statistically significantly only in patients reporting significant or major preoperative seeing problems. Of the subgroups, only those whose both eyes were operated during follow-up showed a statistically significant (p < 0.001) improvement. Cost per quality-adjusted life year (QALY) gained was euro5128 for patients whose both eyes were operated and euro8212 for patients with only one eye operated during the 6-month follow-up. In patients whose first eye had been operated earlier mean HRQoL deteriorated after surgery precluding the establishment of the cost per QALY. CONCLUSION: Mean utility gain after routine cataract surgery in a real-world setting was relatively small and confined mostly to patients whose both eyes were operated. The cost of cataract surgery per quality-adjusted life year gained was much higher than previously reported and associated with considerable uncertainty.

Aged↗

PubMed2006

The impact of 29 chronic conditions on health-related quality of life: a general population survey in Finland using 15D and EQ-5D.

BACKGROUND: Health-related quality of life (HRQoL) is an essential outcome of health care, but there is no gold standard of HRQoL measurement. We investigated the impact of major chronic conditions on HRQoL using 15D and EQ-5D in a representative sample of Finns. METHODS: Information on chronic somatic conditions was obtained by interviews. Psychiatric disorders were diagnosed using a structured interview (M-CIDI). Tobit and CLAD regression analysis was used to estimate the impact of conditions on HRQoL at the individual and population level. MAIN RESULTS: Adjusted for other conditions and sociodemographic variables, Parkinson's disease had the largest negative impact on HRQoL at the individual level, followed by anxiety disorders, depressive disorders and arthrosis of the hip and knee. Based on prevalence, arthrosis of the hip or knee, depression, back problems and urinary incontinence caused the greatest loss of HRQoL at the population level. The results obtained with the two HRQoL measures differed markedly for some conditions and the EQ-5D results also varied with the regression method used. CONCLUSIONS: Musculoskeletal disorders are associated with largest losses of HRQoL in the Finnish population, followed by psychiatric conditions. Different HRQoL measures may systematically emphasize different conditions.

Adult↗

PubMed2006

Quality of life in treated patients with acromegaly.

CONTEXT: It is not known to what extent quality of life of patients treated for acromegaly is dependent on levels of GH and IGF-I attained. OBJECTIVE: The objective of this study is to examine the health-related quality of life (HRQoL) and its dependence on treatment outcome and modality in a nationwide survey of acromegalic patients. DESIGN, SETTING, AND PATIENTS: All eligible patients with acromegaly, diagnosed from January 1980 through December 1999 in Finland, were invited to a follow-up study, carried out 11.4 +/- 5.7 (mean +/- sd) yr after initial treatment. HRQoL of the patients, measured by the generic 15D instrument, was compared with that of the general population. Factors related to HRQoL were analyzed by logistic regression. MAIN OUTCOME MEASURE: HRQoL was the main outcome measure. RESULTS: Of 277 eligible patients, 231 (83.4%) participated in the follow-up study. Of them, 51.1% were in remission according to consensus criteria. The patients reported reduced HRQoL in comparison to the age- and gender-standardized general population (P < 0.001). HRQoL was related to nadir GH in oral glucose tolerance test (GHOGTT) in an inverted U-shaped fashion (overall P = 0.021). Patients with GHOGTT nadir values between 0.3-1.0 microg/liter had a better HRQoL than those with lower or higher values. A normal IGF-I (P = 0.038) and not having had radiotherapy (P = 0.004) were also associated with a better HRQoL. CONCLUSIONS: HRQoL is reduced in treated patients with acromegaly. The best HRQoL may be achieved by normalization of IGF-I and by targeting the GHOGTT nadir to levels between 0.3 and 1.0 microg/liter. Radiotherapy is associated with adverse HRQoL.

Acromegaly↗

PubMed2006

Cost-effectiveness of influenza vaccination of healthy children.

Influenza vaccination of children 6-23 months of age is recommended in the United States and Canada because of high rates of influenza-associated hospitalisations, but few other countries have adopted similar policies. Most children with influenza are treated in the primary care setting, and the cost-effectiveness of influenza vaccination of children has not been fully established. We used a decision analysis model to assess the cost-effectiveness of influenza vaccination of children 6 months to 13 years of age in Finland. The analyses were based on comprehensive clinical data on virologically confirmed influenza infections, hospital medical records, and national registers. We estimated the impact of influenza on outpatient and hospitalised children and their families, and performed the analyses from the health care provider and societal perspective. Influenza vaccination resulted in savings in all programs including children <or=13 years of age from both the health care provider and societal perspective. Investing 1.7 million euros in vaccination of children <5 years of age yielded savings of 2.7 million euros in health care costs. From the health care provider perspective, the savings per vaccinated child ranged between 5.7 and 12.6 euros in any program including children up to 13 years of age. The vaccination was cost saving in all age groups even with assumed vaccine efficacy of 60%. The results show that influenza vaccination would be cost saving in all children <or=13 years of age in Finland, which advocates reconsideration of the current influenza vaccine recommendations in all countries.

Adolescent↗

PubMed2006

Health-related quality of life in patients waiting for major joint replacement. A comparison between patients and population controls.

BACKGROUND: Several quality-of-life studies in patients awaiting major joint replacement have focused on the outcomes of surgery. Interest in examining patients on the elective waiting list has increased since the beginning of 2000. We assessed health-related quality of life (HRQoL) in patients waiting for total hip (THR) or knee (TKR) replacement in three Finnish hospitals, and compared patients' HRQoL with that of population controls. METHODS: A total of 133 patients awaiting major joint replacement due to osteoarthritis (OA) of the hip or knee joint were prospectively followed from the time the patient was placed on the waiting list to hospital admission. A sample of controls matched by age, gender, housing and home municipality was drawn from the computerised population register. HRQoL was measured by the generic 15D instrument. Differences between patients and the population controls were tested by the independent samples t-test and between the measurement points by the paired samples t-test. A linear regression model was used to explain the variance in the 15D score at admission. RESULTS: At baseline, 15D scores were significantly different between patients and the population controls. Compared with the population controls, patients were worse off on the dimensions of moving (P < 0.001), sleeping (P < 0.001), sexual activity (P < 0.001), vitality (P < 0.001), usual activities (P < 0.001) and discomfort and symptoms (P < 0.001). Further, psychological factors--depression (P < 0.001) and distress (P = 0.004)--were worse among patients than population controls. The patients showed statistically significantly improved average scores at admission on the dimensions of moving (P = 0.026), sleeping (P = 0.004) and discomfort and symptoms (P = 0.041), but not in the overall 15D score compared with the baseline. In patients, 15D score at baseline (P < 0.001) and body mass index (BMI) (P = 0.020) had an independent effect on patients' 15D score at hospital admission. CONCLUSION: Although patients' HRQoL did not deteriorate while waiting, a consistently worse HRQoL was observed in patients waiting for major joint replacement compared with population controls.

Adult↗

PubMed2006

Use of quality-adjusted life years for the estimation of effectiveness of health care: A systematic literature review.

OBJECTIVES: The objectives of this study were to identify, in a systematic literature review, published studies having used quality-adjusted life years (QALYs) based on actual measurements of patients' health-related quality of life (HRQoL) and to determine which HRQoL instruments have been used to calculate QALYs. Furthermore, the aims were to characterize studies with regard to medical specialty, intervention studied, results obtained, quality, country of origin, QALY gain observed, and interpretation of results regarding cost-effectiveness. METHODS: Systematic searches of the literature were made using the MEDLINE, Embase, CINAHL, SCI, and Cochrane Library electronic databases. Initial screening of identified articles was based on abstracts read independently by two of the authors; full-text articles were again evaluated by two authors, who made the final decision on which articles should be included. RESULTS: The search identified 3,882 articles; 624 were obtained for closer review. Of the reviewed full-text articles, seventy reported QALYs based on actual before-after measurements using a valid HRQoL instrument. The most frequently used instrument was EuroQol HRQoL instrument (EQ-5D, 47.5 percent). Other instruments used were Health Utilities Index (HUI, 8.8 percent), the Rosser-Kind Index (6.3 percent), Quality of Well-Being (QWB, 6.3 percent), Short Form-6D (SF-6D, 5.0 percent), and 15D (2.5 percent). The rest (23.8 percent) used a direct valuation method: Time Trade-Off (10.0 percent), Standard Gamble (5.0 percent), visual analogue scale (5.0 percent), or rating scale (3.8 percent). The most frequently studied medical specialties were orthopedics (15.5 percent), pulmonary diseases (12.7 percent), and cardiology (9.9 percent). Ninety percent of the studies came from four countries: United Kingdom, United States, Canada, the Netherlands. Approximately half of the papers were methodologically high quality randomized trials. Forty-nine percent of the studied interventions were viewed by the authors of the original studies as being cost-effective; only 13 percent of interventions were deemed not to be cost-effective. CONCLUSIONS: Although QALYs gained are considered an important measure of effectiveness of health care, the number of studies in which QALYs are based on actual measurements of patients' HRQoL is still fairly limited.

Cost-Benefit Analysis↗

PubMed2006

Cost-effectiveness of implementing national guidelines in the treatment of acute otitis media in children.

OBJECTIVES: Acute otitis media (AOM) is one of the most common diseases of childhood, representing a major disease burden on the society. New evidence-based guidelines for AOM, focusing on children under 7 years of age, were introduced in Finland in 1999. The aim of this study was to evaluate the cost-effectiveness of implementing those guidelines in Finland. METHODS: A 5-year prospective trial was conducted in thirty community primary healthcare centers in Finland. All AOM patients between 0 and 6 years of age visiting the study health centers for the first time, for this episode of illness, during 1 week in November 1998 (n = 579) and November 2002 (n = 369) were included in this study. The outcome measure was the percentage of symptom-free patients. RESULTS: The mean direct cost of an AOM episode per patient stayed almost the same after implementing the guidelines, euro152 in 1998 and euro150 in 2002. After implementing the guidelines, the percentage of symptom-free patients was 10 percentage points higher than before the guidelines. The treatment after the implementation of the guidelines, thus, was a dominant strategy. CONCLUSIONS: Implementing the guidelines to the treatment of AOM in children was associated with extra health benefits at slightly lower direct costs and, thus, is a dominant strategy. The focus of this study was on the short-term effects of the treatment; including long-term effects in the analysis might affect the results.

Acute Disease↗

PubMed2006

Variation of platelet production and discard rates in 17 blood centers representing 10 European countries from 2000 to 2002.

BACKGROUND: New blood safety regulations raise costs and pressure blood centers to improve their efficiency. Evaluation of platelet (PLT) production and discards between centers of different size and nationality may provide a basis for more efficient PLT inventory management. STUDY DESIGN AND METHODS: Data were gathered retrospectively for 2000 to 2002 from 17 blood centers in 10 European countries. The descriptive analyses comprised evaluation of PLT production methods and volumes. Discard rates were surveyed also for 2003 to 2004. The number of cellular blood components produced per working hour was expressed as an arbitrary labor index. RESULTS: Seven hospital blood banks and 10 centers with other administrative systems participated in the study. Buffy coat (BC) and apheresis PLTs were used by all centers except two preparing all PLTs by apheresis. In 2002, 73 percent of all PLTs were produced by the BC method, and PLTs were utilized from 41 percent of whole-blood donations. One center also produced PLTs by the PLT-rich plasma method. Mean annual production volume of PLTs varied greatly, from 3,345 to 103,643 units, with an increase of 5.6 percent from 2000 to 2002. Three-year mean discard rates varied between 6.7 and 25 percent, and yearly mean discard rates remained at 13 percent in 2000 to 2002 and also in 2003 to 2004. Arbitrary labor index varied from 2.4 to 7.3 between centers. CONCLUSIONS: PLT discard rates were relatively high in the European blood centers. Detailed information on specific causes for high discard rates would help improve the efficiency of PLT management, because blood centers cannot regulate demand. Use of labor resources in component preparation also remains an important target for further research.

Blood Banks↗

PubMed2006

International comparison of the technical efficiency of component preparation.

BACKGROUND: Under economical constraints, blood centers need to identify ways to improve their efficiency. Because there is little evidence regarding the technical efficiency of blood centers, international comparisons may be useful in identifying efficiency discrepancies and can reveal opportunities for enhancing efficiency, such as allocating resources more effectively. STUDY DESIGN AND METHODS: Data were collected for years 2000 through 2002 from 16 blood centers in 10 European countries. Input variables included working hours, whole-blood (WB) collections, premises, and equipment, and the output variables were red blood cells and platelets (PLTs). A nonparametric method, data envelopment analysis (DEA), was used in the analyses of technical efficiency in blood component preparation departments. Efficiency scores were calculated with DEA linear programming techniques and evaluated for site characteristics that possibly affect efficiency, such as the production method of PLTs and the proportion of BCs (buffy coats) from WB and BC PLTs from all PLTs produced. RESULTS: With working hours and equipment as inputs, median technical efficiency was 60 percent (range, 41%-100%). Four departments were efficient (efficiency, > 90%), and 12 were inefficient (range, 41-89). Efficiency remained roughly the same in 13 departments through the 3-year study period and decreased in 3. Efficiency was mainly affected by staffing levels (working hours). Efficiency did not directly relate to production volume, method, or any other site characteristic. CONCLUSIONS: The major cause of inefficiency was excess staffing resulting from a suboptimal combination of manpower and production output levels. Further research is needed to manage factors affecting efficiency, such as the fluctuation of demand in production planning.

Blood Banks↗

PubMed2006

Evaluation of lipid-lowering therapy and cholesterol goal attainment in Finland: the National FINRISK Study.

BACKGROUND: European and US study findings show that patients in primary care and specialty care are not adequately treated for cholesterol reduction. OBJECTIVE: To evaluate lipid-lowering treatment in Finland, estimate the proportions of subjects who are achieving cholesterol goals, and assess the influence of determinants on goal attainment. METHODS: Subgroup analysis of the FINRISK study, a national study of cardiovascular disease risk factors in Finland. Study participants, the subgroup of patients on lipid-lowering therapy from FINRISK, completed a postal self-administered questionnaire on health/health behavioral factors. Serum total cholesterol (TC) and other clinical variables were measured using a standardized protocol. Ten-year coronary risk was computed using Framingham risk equations. The influence of certain factors on goal attainment was determined by logistic regression analysis. The main outcome measure was the proportion of subjects who were receiving lipid-lowering therapy and achieved a TC goal of <5 mmol/L (<194 mg/dL). RESULTS: Among 9581 respondents, 622 subjects were on lipid-lowering therapy. Of these, 68 subjects were excluded because of missing data on TC and/or the type/dose of therapy. Among the 554 subjects included, 210 (38%) were secondary-prevention patients and 51% had 10-year coronary risk >/=20%. Approximately two-thirds of subjects were prescribed simvastatin (42%) or atorvastatin (26%), and about half (51%) were prescribed low-equipotency HMG-CoA reductase inhibitors (statins). There was no difference in equipotent doses of statins prescribed for primary and secondary prevention. About half (54%) of subjects did not attain their cholesterol goal (TC <5.0 mmol/L [194 mg/dL]). Subjects with coronary heart disease (odds ratio [OR] 3.00; 95% CI 2.07, 4.35) and patients prescribed medium-to-high equipotent statins (OR 1.93; 95% CI 1.35, 2.76) were more likely to achieve cholesterol goals, whereas postmenopausal women (OR 0.61; 95% CI 0.42, 0.88) were less likely than men to achieve cholesterol goals. CONCLUSION: Most (92%) patients receiving lipid-lowering therapy in a Finnish population were managed on statin monotherapy and approximately half of the patients did not achieve their recommended cholesterol goals. More effective and safe therapies are needed to enhance cholesterol goal attainment. These treatments might include regimens that act on two or more pharmacologic pathways.

Aged↗

PubMed2006

Cost-utility analysis of routine neurosurgical spinal surgery.

OBJECT: Cost-utility analysis is currently the preferred method with which to compare the cost-effectiveness of various interventions. The authors conducted a study to establish the cost-utility results of routine neurosurgery-based spinal interventions by examining patient-derived values. METHODS: Two hundred seventy patients undergoing surgery for cervical or lumbar radicular pain filled in the 15-dimensional health-related quality of life (HRQOL) questionnaire before and 3 months after surgery. Quality-adjusted life years (QALYs) were calculated using the utility data and the expected remaining life years of the patients. The mean HRQOL score (scale, 0-1) increased after cervical surgery (169 patients, mean age 52 years, 40% women) from 0.81 +/- 0.11 preoperatively, to 0.85 +/- 0.11 at 3 months, and after lumbar surgery (101 patients, mean age 54 years, 59% women) from 0.79 +/- 0.10 preoperatively, to 0.85 +/- 0.12 at 3 months (p < 0.001). Of the 15 dimensions of health, improvement in the following was documented in both groups: sleeping, usual activities, discomfort and symptoms, depression, distress, vitality, and sexual activity (p < 0.05). The cost per QALY gained was Euro 2774 and 1738 for cervical and lumbar operations, respectively. In cases in which surgery was delayed the cost per QALY was doubled. CONCLUSIONS: Spinal surgery led to a statistically significant and clinically important improvement in HRQOL. The cost per QALY gained was reasonable, less than half of that observed, for example, for hip replacement surgery or angioplasty treatment of coronary artery disease; however, a prolonged delay in surgical intervention led to an approximate doubling of the cost per QALY gained by the treatment.

Adult↗

PubMed2005

Sense of coherence and health-related quality of life among patients undergoing coronary artery bypass grafting or angioplasty.

BACKGROUND: Every year, 4 million people die from cardiovascular disease (CAD) in Europe. As many as 800,000 of them die before they reach the age of 65. The ischemic heart disease is also the most common cause of death in Finland. The invasive treatments of the CAD, coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) relieve symptoms and increase patient's health-related quality of life (HRQoL) in most of the cases. In this paper sense of coherence is discussed as related to health-related quality of life among CABG and PTCA patients in a one-year follow-up. SAMPLE: The study sample consisted of consecutive male (N=439) and female (N=176) patients who were treated with the elective CABG or PTCA. The baseline data before the interventions were collected by structured interviews, the follow-up data by mailed self-administered questionnaires six and twelve months afterwards. MEASURES: The sense of coherence was studied by using a 13-item SOC scale. HRQoL was measured by the 15D. It is a generic, multidimensional, standardized, self-administered instrument, which has both a profile and single index score property. The differences in both groups were defined by using T-tests. Follow-up outcomes were analysed by using analyses of variance for repeated measures. RESULTS: Health-related quality of life increased in both groups during the follow-up. There was a correlation between health-related quality of life and sense of coherence in CABG and PTCA patients' group at baseline. The mean score of the 15D was lower in moderate sense of coherence tertile than in strong sense of coherence tertile in both groups. After six and twelve months the similar tendency existed in health-related quality of life and sense of coherence; patients who had poor or moderate sense of coherence had lower health-related quality of life than the patients with strong sense of coherence. CONCLUSIONS: Sense of coherence was more stable among CABG patients than PTCA patients. In PTCA patients' group sense of coherence decreased during the follow-up time. In both patients' group the health-related quality of life increased statistically significant by 6 months. No significant change in health-related quality of life took place in either group from 6 to 12 months.

Activities of Daily Living↗

PubMed2005

Automatic speaking valve in speech rehabilitation for laryngectomized patients.

For speech rehabilitation after total laryngectomy, the Provox FreeHands Heat and Moisture Exchanger (FreeHands HME; Atos Medical AB, Hörby, Sweden) was compared with the Provox Heat and Moisture Exchanger (HME), and the patients' Health-Related Quality of Life (HRQoL) was assessed. A review of the English literature was performed considering automatic speaking valves. The study design was a cohort study. Fourteen laryngectomized male patients who had used the HME successfully before receiving the FreeHands HME entered the study. An ENT specialist and a speech pathologist examined these patients. Data concerning voicing, breathing, skin adhesion, voice and speech quality, and HRQoL were collected by a structured questionnaire. Voice recordings were performed for evaluation of the quality of the voice. A computer-aided search of the MED-LINE database was conducted, supplemented by hand searches of key journals. Twelve patients had used the FreeHands HME on special social occasions and reported three main reasons why FreeHands HME was unsuitable for continuous use: heavier breathing, more difficult speaking, and worse subjective quality of voice. With HME, phonation time tended to be longer and the softest phonation softer ( P =0.034). The loudest phonation was louder with FreeHands HME ( P =0.015). Patients' HRQoL assessed by the 15D profile was similar to that of the age- and sex-matched male Finnish general population (patients 0.877, population 0.884). A review of the literature showed few works dealing with automatic speaking valves. The FreeHands HME is a useful additional device in a selected group of laryngectomized patients. Total laryngectomy did not lower patients' HRQoL notably.

Adult↗

PubMed2005

Health related quality of life after lumbar disc surgery: a prospective study of 145 patients.

PURPOSE: This study compared health related quality of life (HRQOL) among lumber disc surgery patients to general population, and assessed the relationships between HRQOL and other outcome measures 2 and 14 months after surgery. METHODS: The 15D instrument was use to measure HRQOL in 145 lumber disk surgery patients. Subjective outcome was also assessed by the Oswestry index, Short Depression Inventory (SDI) and pain, and objective outcome by trunk muscle strength and mobility of the spine. RESULTS: The mean (SD) 15D score among the patients 2 months after surgery was 0.880 (0.104) compared to 0.941 (0.076) among general population (p = 0.016). The 15D, Oswestry and SDI scores remained unchanged during the follow-up, while the improvements in the spine mobility and trunk muscle strength were significant. Back pain decreased by 68% and leg pain by 74% from preoperative level to 2 months check-up. Leg pain further decreased during the following 12 months, while back pain remained unchanged. HRQOL was associated with age, pain, Oswestry and SDI indices, but not with physical function. CONCLUSION: HRQOL measured by 15D was lower in lumber disc surgery patients compared to general population. 15D was associated with the subjective outcome measures of pain, Oswestry and SDI indices, but not with the objective measures of physical function. Thus, a combination of "disease specific" and "generic" measures is recommended to be used to obtain more accurate information about the overall welfare of individual.

Abdominal Muscles↗

PubMed2005

Measuring cost-effectiveness of secondary health care: feasibility and potential utilization of results.

OBJECTIVES: Whether cost-effectiveness of secondary health care can be measured in a simple, yet commensurate way was studied. METHODS: Approximately 4,900 patients' health-related quality of life scores before and after treatment were measured. Used were a combination of quality of life data with diagnostic and financial indicators routinely collected in the hospital. RESULTS: Seventy percent of patients returned the first questionnaire and the informed written consent to participate. Of these patients, 80 percent also returned the second questionnaire sent out 3 to 12 months after treatment, depending on clinical specialty and diagnostic category. The routine of sending out questionnaires could be automated in such a way that data collection required only a limited amount of extra work. Patients were generally satisfied with the fact that the hospital was interested in their well-being also after treatment. No physician offered the chance to participate refused data collection in the patient group he or she was responsible for. The attitudes of the nursing staff were generally positive toward data collection, although it caused some extra work for some of them. The possibility of relating already routinely collected financial performance indicators with a relevant measure of treatment effectiveness, opened prospects for refined analysis of cost-effectiveness of secondary health care. CONCLUSIONS: Routine collection of health-related quality of life data as an indicator of treatment effectiveness is feasible, requires only a small amount of extra work, and is potentially very useful when combined with existing measures of hospital performance.

Cost-Benefit Analysis↗

PubMed2005

Economic evaluation of pneumococcal conjugate vaccination in Finland.

The aim of this study was to evaluate cost-effectiveness of pneumococcal conjugate vaccine (PCV7) in children <5 y of age. A Markov simulation model was used to compare the cost-effectiveness of 4 doses (assumed 50.5 euros per dose) of PCV7 with no intervention. Only direct effects of the vaccine were taken into account. In Finland, vaccination of a birth cohort of 57,500 healthy infants would potentially prevent annually 60 cases of invasive PD, 1,400 cases of pneumococcal pneumonia, 15,000 episodes of acute otitis media, 3,000 otological surgery procedures and 0.9 deaths in children aged <5 y. Investing 12.0 million euros to vaccinate a birth cohort would save annually 6.3 million euros in medical, and 2.0 million euros in productivity and other, costs. Therefore, investing 1 euros in a vaccination programme would return 0.53 euros in medical costs and 0.70 euros in societal costs. In the base case, vaccination would cost society 139,986 euros per life y gained. To achieve cost savings from a health care provider (societal) perspective, without considering herd effects or replacement phenomenon, the price of PCV7 should be 50% (70%) of the price used in the base case.

Child, Preschool↗