PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Direct Service Costs”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 397 records · Page 22Linked to original sources
PubMed1986

Costs of illness: United States, 1980.

The total costs of illness and injury in the U.S. civilian noninstitutionalized population in 1980 amounted to $381.7 billion. The direct costs of illness and injury--resource expenditures for the diagnosis, treatment, and management of medical and dental conditions--were $153.9 billion, or 40.3 percent of total costs. Indirect costs--economic losses from morbidity and mortality--were $227.9 billion, or 59.7 percent of total costs. Of indirect costs, $104.9 billion resulted from productivity losses because of morbidity, and $123.0 billion represent the present value of lost productivity from premature mortality based on a net effective discount rate of 4 percent. These estimates, based on data from the 1980. National Medical Care Utilization and Expenditure Survey (NMCUES), differ from other estimates of the costs of illness and injury in 1980 (Gibson and Waldo, 1982; Rice, Hodgson, and Kopstein, 1985). The differences, which can be resolved, are attributable to two major factors: (1) NMCUES includes only the civilian noninstitutionalized population, but the other estimates include the institutionalized population and the military; and (2) NMCUES indirect cost estimates for the population unable to work include persons who were retired for health reasons in 1979 and 1980, disabled homemakers, and other persons who were disabled for the entire year 1980 but were not retired for health reasons in 1979, but the Rice et al. estimates do not include the last two categories in the population unable to work. The principal NMCUES findings on the total costs of illness in the civilian noninstitutionalized population reinforce the importance of considering distributional effects. Persons 65 years of age and over represent one-tenth of this population yet account for more than one-fourth of direct costs and more than their share of total costs, even though the institutionalized elderly are excluded. More than two-thirds of total costs for this age category are accounted for by direct costs. Direct costs also account for more than two-thirds of total costs for people under 17 years of age. However, this youngest age category, which constitutes over one-fourth of the civilian noninstitutionalized population, generates only 12.3 percent of direct costs. In contrast, indirect costs account for well more than 60 percent of total costs for the working-age population (17-64 years of age). Within the working-age population, per capita direct costs are highest among persons who are not full participants in the work force, many of whom are not working full time or at all because of injury or ill health.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1999

The cost-effectiveness of magnetic resonance imaging for patients with internal derangement of the knee.

Magnetic resonance imaging (MRI) has excellent specificity and sensitivity for the diagnosis of internal derangement of the knee (IDK). The use of MRI to screen patients with suspected IDK could avoid unnecessary arthroscopies with a reduction in costs. The purpose of this study was to evaluate the use of arthroscopy among patients with IDK, and to estimate the potential cost-effectiveness of MRI in these patients to avoid unnecessary arthroscopies. The study was based on a retrospective cohort of all patients attending three orthopedic clinics between April and September 1993 with a new diagnosis of IDK. Charts were reviewed in 1994 to allow for a follow-up of more than 6 months. An economic evaluation was performed based on cost-effectiveness ratios (per averted arthroscopy), including direct and indirect costs. There were 241 patients with a new diagnosis of IDK (67% males, mean age 35 +/- 12 years), and 110 (46%) underwent arthroscopy. The remaining patients received conservative therapy and were not scheduled for arthroscopy within the period of observation. Using a priori established criteria, 10% of the arthroscopies could be considered diagnostic only (e.g., normal knee) and 27% were of doubtful efficacy from a therapeutic perspective (e.g., debridement alone). Many of these arthroscopies could have been avoided by performing a prior MRI. Using these findings, we conducted decision tree analyses of the use of MRI among patients requiring arthroscopy of the knee. A sensitivity analysis was performed to evaluate the various model assumptions. In general, MRI appeared to be a cost-effective diagnostic procedure for patients with IDK requiring arthroscopy of the knee, and there were cost savings associated with it in some of the models tested.

Adult↗
PubMed1999

An overview of cancer economics. Based on a presentation by C. Daniel Mullins, PhD.

The National Cancer Institute (NCI) has estimated that the aggregate outlay for cancer, including research and direct medical costs, was about $104 billion in 1996. Treatment expenditures for the 3 leading types of cancer--breast, lung, and prostate--total $16 billion a year, with breast cancer alone accounting for $6 billion. Early detection is key to reducing the cost of breast cancer because the costs per patient are higher for those who die than for those who survive and the cost effectiveness of detection and treatment are inseparable. Likewise, screening can be cost effective but only if options exist for treatment. Lack of access to care for financial and other reasons continues to be a major impediment to early detection.

Breast Neoplasms↗
PubMed1999

[Medico-socio-economic aspects of mental health: impact of anxiety disorders].

Budgetary control policies implemented in order to cope with the increase in health costs in industrialised countries, all along with the inbalance of the national health insurance accounts, give rise to the problem of preserving the quality of care and quality of life of the patients. This is particularly true for the treatment of psychiatric diseases, and especially anxiety. Early optimal treatment, of adequate duration, of the anxiety disorders might be the most economic attitude in the management of this pathology. On the other hand, the impact of the treatment of anxiety on the quality of life of the patient has a direct effect on costs if one considers the supplement to medical consumption and the social deficit induced by therapeutic failure in particular anxiety disorders. It remains that the evaluation of the health economics of anxiety is difficult, because of the complexity of the parameters involved.

Anxiety Disorders↗
PubMedDate not supplied

[Cost effectiveness of vaccination against pneumococcal bacteremia in the elderly: the results in Belgium].

BACKGROUND: Several studies have shown that pneumococcal vaccination of older persons would be cost-effective in preventing pneumococcal pneumonia, but evidence of clinical protection for this condition is uncertain. Given much better evidence of vaccination effectiveness against invasive disease, studies showing that vaccination is cost-effective in preventing invasive disease alone could provide strong support for public policies to vaccinate older persons. METHODS: We examined the cost-effectiveness of preventing invasive pneumococcal infection by vaccination with the 23-valent pneumococcal polysaccharide vaccine of persons > or = 65 years in age in Belgium. The direct medical costs expressed per quality adjusted life year (QALYs) of a cohort of vaccinated persons was compared with the costs per QALY in a cohort of persons who are not vaccinated. RESULTS: Preventing invasive pneumococcal infections by vaccinating elderly persons clearly benefits people's health. By vaccinating 10,000 persons over 65 years of age, approximately eight QALYs can be gained compared with no vaccination. Achieving these health benefits however requires additional costs,: 30,000 ECU per QALY gained. The cost-effectiveness ratio is slightly better (i.e. 25,000 ECU per QALY) for the age group 65-75 years, and slightly worse (i.e. 35,000 ECU per QALY) for the age group 75-84 years. It increases sharply to 77,000 ECU per QALY for the persons over 85 years of age. An extensive one-dimensional sensitivity analysis did not greatly affect these results. If vaccination is also clinically effective in preventing pneumococcal pneumonia, vaccinating all elderly persons is cost saving. CONCLUSION: Using empirical epidemiological data, pneumococcal vaccination to prevent invasive pneumococcal disease is acceptably to moderately cost-effective in Belgium. On the basis of our findings, we believe public health authorities should consider policies for encouraging pneumococcal vaccination for all persons > or = 65 years in age.

Age Factors↗
PubMed2001

Development of a matrix of cost domains in economic evaluation of rheumatoid arthritis.

The aim of our study was to comprehensively review and critically appraise the cost domains used in economic evaluations of the rheumatic diseases and to use this information to propose standardization of cost domains. The literature search identified 210 abstracts, 32 of which included original cost data. The listed cost categories were grouped into 3 major areas: (direct) health care costs, other (direct) disease related costs, and productivity costs (indirect costs). The number of individual cost categories was reduced by considering the following criteria: (1) inclusion of all relevant cost domains; (2) avoidance of double counting; (3) summarizing of related categories under one representative heading; (4) feasibility of level of aggregation. After adjustment for synonymous labeling, 38 cost categories remained. The subsequent development of a classification scheme of cost categories led to a set of 19 separate cost domains including 7 outpatient, 3 inpatient, 6 other disease related, and 3 productivity cost domains. This literature review indicates that cost assessment in economic evaluations in rheumatoid arthritis lacks standardization. A preliminary scheme to categorize cost assessment in rheumatic conditions is presented. The adoption of standards for economic evaluation would greatly facilitate national and international comparisons.

Arthritis, Rheumatoid↗
PubMed2000

Direct impact of non-fatal occupational injuries.

OBJECTIVE: The objectives of this study were to describe the pattern of certain direct impacts of non-fatal injuries among workers insured by the General Organization of Social Insurance, admitted to hospitals in Al-Khobar City, and to determine factors influencing these direct impacts. METHODS: This cohort study consisted of 65, 915 insured male workers in various industries, followed to determine those who were admitted to 2 private hospitals selected randomly in Al-Khobar City. A data-collection sheet was used to collect the necessary data from patients and their medical records on admission to the hospital. RESULTS: The majority of admissions (78%) were for periods of less than a week. Absence from work was longer than 3 weeks in 35.5% and shorter than 1 week in 25% of admissions. The majority of the cases (65%) visited clinics from 2 to 7 times. Direct medical cost per admission was less than SR2,000 in 64% of the cases in one of the hospitals (one United States dollar = 3.75 Saudi Riyals). Multiple linear regression analysis for period of absence from work, length of hospitalization, and number of clinic visits showed these direct impact variables to be inter-related. Injury outside the work place (road traffic accidents), and the hospital which the injured worker was referred to, were the other main risk factors determining the direct impact of the injury. Multiple linear regression for direct medical cost was positively associated and predicted by the younger age of the worker. CONCLUSIONS: The direct impact of occupational injuries in this study, though less than the same reported from Western countries, were responsible for significant medical charges, human suffering and loss of productivity. Efforts made by different industries to prevent occupational injuries should be encouraged and continued, and the General Organization of Social Insurance may monitor their success by conducting similar studies.

Absenteeism↗
PubMed2001

Irritable bowel syndrome: toward a cost-effective management approach.

OBJECTIVE: To examine the economic implications of current irritable bowel syndrome (IBS) management practices and formulate recommendations based on these implications. METHODS: Relevant English-language research publications in which the direct and indirect costs of IBS were examined, identified using a search of records contained in Medline. RESULTS: Review of the identified publications indicates that in Western nations, IBS management is associated with high direct costs (particularly for diagnostic testing, office visits, pharmacotherapy, and emergency department visits). Indirect costs, associated with lost wages and decreased productivity, account for the largest proportion of the IBS economic burden. Moreover, rapid projected growth in IBS disease-related costs indicates a need for more focused attention toward improved treatment of IBS. More cost-effective management might be achieved by diagnosing and instituting nonpharmacologic and pharmacologic management earlier in the disease process. Under such an approach, patients are classified based on symptoms and a therapeutic trial is begun. More extensive, expensive diagnostic testing is reserved for patients refractory to treatment or for whom serious disease must be ruled out. CONCLUSION: IBS is a condition with high direct and indirect costs. Management strategies should be evaluated both on their clinical efficacy and on their cost effectiveness. As new, IBS-specific pharmacotherapies become available, the ability to diagnose and manage the condition in a cost-effective manner can be improved.

Colonic Diseases, Functional↗
PubMed2002

Current clinical characteristics and economic impact of subacute stent thrombosis.

Subacute stent thrombosis (SAT), while uncommon, continues to produce serious clinical consequences, including major myocardial infarction (MI) in 60 70% of cases, and short-term mortality rates of 20% or higher. A number of procedural and patient factors have been shown to predict the occurrence of SAT, including longer stent length, smaller minimum luminal diameter, persistent dissection, multivessel intervention, and possibly acute coronary syndrome (ACS) presentation. Despite substantial knowledge about the clinical and technical aspects of SAT, the economic impact of these events has not been previously reported. Methods. We retrospectively reviewed 26 cases of SAT that occurred at our institution from 1998-2000. Baseline clinical and procedural data, as well as clinical outcomes for the initial hospital admissions required to treat SAT, were obtained by record review. Direct health care costs for these admissions were calculated based on hospital billing data and measured resource utilization for catheterization laboratory procedures. Results. Most cases of SAT occurred in high-risk circumstances, including ACSs, multi-stent interventions, and treatment of 3.0 mm or smaller vessels. Most patients suffered significant MIs and were treated with repeat percutaneous coronary intervention. The median time to SAT was 3.5 days, with 58% of events occurring on an outpatient basis. Median total hospital costs were $11,100 per patient, with more than half of the costs generated by the catheterization laboratory and pharmacy. Conclusions. Despite its low overall frequency, the clinical and economic costs of SAT are substantial. Specific strategies at preventing its occurrence are warranted, particularly in high-risk situations.

Aged↗
PubMed2002

Cardiovascular disease costs associated with uncontrolled hypertension.

This research evaluated the effect of inadequate blood pressure (BP) control on selected cardiovascular (CV) disease outcomes and costs for American patients with hypertension. The results of a hypertension outcomes trial, which provided incidence rates for CV disease morbidity and mortality at distinct systolic/diastolic BP ranges, were integrated with U.S. hypertension statistics from the Third National Health and Nutrition Examination Survey and cost estimates for stroke, congestive heart failure, and myocardial infarction. A model was developed to estimate the number of cases and costs of myocardial infarction, stroke, and congestive heart failure for patients achieving BP control versus those not achieving control. For the U.S. population with hypertension, inadequate BP control was estimated to result in 39,702 CV events, 8,374 CV disease deaths, and $964 million in direct medical expenditures. Within the medicated population with CV disease, the incremental costs of failure to attain BP goals reached approximately $467 million. These results reflect the importance of adequate BP control--in particular, systolic BP control--in reducing cardiovascular morbidity, mortality, and overall health care expenditures among patients with hypertension.

Blood Pressure↗
PubMed2003

[The economic impact of hand injury].

Basing on 170 cases treated at the II Surgery Department of the Medical Faculty of Kraków University, the authors have tried to assess the direct and indirect costs of treatment of hand injuries. The rates negotiated between the Małopolska NHS Provides and the University Hospital were analyzed in order to assess direct treatment costs of hand injuries. Indirect cost assessment was based on analysis of insurance costs sustained by insurance providers. The analysis showed that over 96% of total treatment costs are indirect expenses related to compensation, work absence and disability pensions. The costs could probably be extensively reduced if hand injuries were referred directly to specialized surgery units.

Adolescent↗
PubMed2004

[Cost-effectiveness of epilepsy surgery in a cohort of patients with medically intractable partial epilepsy--preliminary results].

OBJECTIVE: Patients with medically intractable epilepsy are potential candidates for surgery if the epileptogenic tissue is localized and resectable. Surgical therapy can eliminate seizures but is very expensive. We followed a prospective adult cohort of intractable epileptic patients in order to perform a cost-effectiveness analysis. POPULATION AND METHODS: Adult patients with a suspected partial medically intractable and operable epilepsy were eligible for evaluation, explorations and/or surgery. Clinical and economical data were collected at the inclusion and every 6 months over at least two years. Two patient groups were analyzed: some underwent a surgery, others did not. Clinical data were compared between both groups. As the data collection was not yet complete, we compared the surgery to a continuation of the preoperative medical management in a cost-effectiveness analysis. Direct medical and nonmedical costs were evaluated according to a societal perspective. The effectiveness was defined as one year without seizure. We assessed the incremental cost-effectiveness ratio (ICER) for the first two years after the surgery. We also modeled long-term costs and effectiveness and extrapolated the results over the patients' lifetime with a Markov model. We computed the ICER and performed a sensitivity analysis. Indirect costs were measured in physical units and intangible costs were assessed with quality-of-life measures (QOLIE-31, SEALS). Data were compared before and after surgery. RESULTS: Among the 286 patients included, 119 did not enter in the analysis: 7 were not eligible, 44 not operable, 31 did not present a follow-up, 37 still underwent exams. Finally, 89 underwent a surgical treatment, and 78 were medically treated. Disease was more severe in surgical patients than in medical patients: seizures frequency, depressive disorders and cognitive impairment were greater. One year after the surgery, 83% patients were seizure free. During the year before inclusion and the year after surgery, direct costs were mainly due to hospitalization. During the second year after surgery, the cost of antiepileptic drugs predominated. One additional year without seizure costs 23 531 euro one year after surgery and 9533 euro two years after surgery. In a long-term perspective, the surgery became cost-effective between 7 and 8 years after the surgery. CONCLUSION: Surgical therapy is a cost-effective treatment in a middle-term even without indirect costs consideration.

Adolescent↗