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PubMedDate not supplied

The economic cost of senile dementia in the United States, 1985.

Senile dementia is a progressive and irreversible decline of mental functions. The symptoms are mental confusion, memory loss, disorientation, cognitive decline, and inappropriate social behavior. It is one of the most common, costly, and distressful diseases among the elderly in the United States. Information on the economic costs of senile dementia is essential for determining research priorities and the allocation of resources to support aging and medical research. Economic consequences, such as direct medical and nonmedical expenditures by patients' families and the amount of time by third parties in caring for patients with senile dementia, are substantial. However, little systematic accounting to estimate these consequences has been undertaken. This paper attempts to estimate various costs associated with the care of senile dementia, based on available secondary data. We have used the direct cost and indirect cost approach and avoided double counting to identify the additional economic costs due to senile dementia. The total, direct national cost of senile dementia is $13.26 billion, which includes $6.36 billion of medical care costs, $2.56 billion of nursing home care costs, and $4.34 billion of social agency service costs. The indirect cost for community home care alone is $31.46 billion, more than twice the total direct costs. The costs of premature death and loss of productivity due to senile dementia are about $43.17 billion. Although most of the indirect costs were imputed from the value of housekeeping or productivity loss, the magnitude of indirect costs reflects the serious consequences and burden on society's resources of this disease.

Aged↗
PubMed1995

Estimating the hospital-wide cost differentials warranted for teaching hospitals. An alternative to regression approaches.

Under Medicare's Prospective Payment System, teaching hospitals receive additional reimbursements, vis-à-vis nonteaching hospitals, for both "direct" teaching expenses and for "indirect" expenses. They totaled $3.1 billion in fiscal year 1989. The authors propose and illustrate a non-regression-based, nonparametric method for viewing the total hospital-wide reimbursement differential warranted for teaching hospitals, a method utilizing a peer grouping of like hospitals to estimate two different "best practices" cost frontiers. The hospital's efficiently delivered cost to meet all of the hospital's actual service outputs, including its teaching mission, and delivered level of quality of care, is compared to the corresponding cost when only the teaching mission is excluded. The difference in these costs for a particular hospital can be used to estimate a suggested lump sum Medicare reimbursement add-on, in recognition of the hospital's teaching mission. The approach is illustrated using a subset of the Health Care Financing Administration's 1988 hospital data set, with comparisons of actual and suggested reimbursements provided.

Cost Allocation↗
PubMed1983

Measuring hospital output: a review of the service mix and case mix approaches.

This paper presents a survey of the literature on the definition and measurement of hospital output concentrating on those studies that have used either 'service-mix' or 'case-mix' as their basic output measure. The service-mix approach is described as a supply side analysis in which the nature of a hospital's output is determined by the character and range of its facilities and services. In contrast, the case-mix approach is essentially a demand side analysis which regards each hospital's case load as being determined by the needs and demands of the population served, with facilities and services the dependent variables. It is also argued that hospital output measurement has rarely been tackled directly. Typically such work has been secondary to the principle research objectives which have related to the study of hospital cost structure and economies of scale. The units developed have been, for the most part, partial measures which satisfy the requirements of their particular investigators but which, until recently, have had little potential for wider application. The call for more effective cost control in health care through reimbursement systems and review procedures, particularly in the United States, has led to an upsurge of interest in hospital output measurement and to a consequent improvement in techniques.

Australia↗
PubMed2005

Factors influencing clinicians' decisions to prescribe medication to prevent coronary heart disease.

BACKGROUND AND OBJECTIVE: There are variations between individual clinicians as to the thresholds at which preventive treatment for coronary heart disease (CHD) should commence. Patients' decisions may be influenced by clinicians' recommendations. Free text comments added by respondents to closed questionnaires may identify areas which are of real concern to them about the topic being studied. The study aimed to identify issues voluntarily raised by clinicians surrounding the decision to prescribe preventive treatment for CHD. METHODS: An analysis was undertaken of the free text comments made by cardiologists, general practitioners and practice nurses who responded to a closed question postal questionnaire in which they were asked to identify at which level of pretreatment risk they would offer treatment. RESULTS AND DISCUSSION: A similar percentage of respondents in each professional group provided free text comments. Clinicians' concerns centred on five main themes around prescribing decisions: the risks and benefits of treatment, the patient's role in treatment decisions, patient characteristics, costs to patients, and costs to the health services. Different issues may be of more concern to some professional groups than others. CONCLUSION: In addition to the use of risk assessment tools and guidelines, clinicians' actual prescribing behaviour may be influenced by more subjective factors. Patients at similar risk may receive different advice depending on the individual clinician they consult.

Attitude of Health Personnel↗
PubMed1992

The economic burden of mental illness.

Mental illness imposes a substantial burden on individuals and society. Using data from national surveys and a newly developed methodology for calculating costs, the authors estimate that in 1985 the total economic costs of mental illness were $103.7 billion. Of this total, direct treatment and support costs were $42.5 billion, or 11.5 percent of total personal health care spending for all illnesses. Morbidity costs--the value of reduced or lost productivity--amounted to $47.4 billion. Mortality costs--the lost value of productivity due to premature death resulting from mental illness--were estimated to be $9.3 billion, or 5.1 percent of total productivity losses for all deaths. Other related costs, including the cost of caregiver services, amounted to $4.5 billion.

Activities of Daily Living↗
PubMedDate not supplied

Developing radiology procedure cost standards.

Containing costs is at the forefront of healthcare management, particularly as managed care replaces fee-for-service care. The first step in costs is to gain an understanding of the "building blocks" or components of procedure costs. The department of radiology at Duke University Medical Center and Health System, in conjunction with the department of management engineering, developed labor and supply standards to predict direct procedure costs throughout the radiology department, where 285,000 procedures are performed annually. This team concept resulted in a consistent approach to building procedure standards that predict direct costs across all sections. Step by step instructions are given for the following standards. Variable labor standards represent the average amount of staff time required for each procedure. Variable supply standards represent the average amount of consumable supply resources required per procedure. Fixed labor time standards predict the amount of fixed time resources necessary to operate the department of radiology at Duke University hospital. Cost per procedure uses the standards developed in the other sections. These basic steps will help readers determine their own direct costs per procedure for most radiology procedures (excluding capital and indirect costs). When these standards and costs are identified, the next step is to identify the areas to reduce such costs without affecting the quality of patient care.

Cost Allocation↗
PubMed1999

Costs of coronary heart disease and stroke: the case of Sweden.

OBJECTIVES: To estimate the annual costs in Sweden of coronary heart disease (CHD) and stroke, and the potential cost savings if these clinical 'events' are avoided. The analysis is undertaken from a societal perspective, including both direct and indirect costs. Costs are calculated for five clinical conditions: (i) acute myocardial infarction (AMI), (ii) angina pectoris (AP), (iii) unstable angina (UA), (iv) congestive heart failure (CHF), and (v) stroke. DESIGN: A retrospective study including patients admitted to the Department of Medicine at Södertälje Hospital during the period January 1993 to March 1995 with CHD or a stroke. Each patient was followed for 1 year after admission to the hospital. To estimate potential cost savings, the patient was used as his or her own control. The potential savings in direct costs if CHD or a stroke is avoided were estimated as the difference between costs for 1 year after and 1 year before the event. The indirect costs were calculated as the difference between the values of market production of goods and services the year before the event and the year after. SETTING: The Department of Medicine at Södertälje Hospital, Södertälje, Sweden. SUBJECTS: The patients included in the study were patients at the Department of Medicine at Södertälje Hospital in Sweden. The inclusion criterion was that the patients should have been admitted for the first time for CHD or stroke during the year 1994. To obtain 25 patients for each clinical category we first had to expand the inclusion period to cover January 1993 to March 1995. Secondly, we also had to include 36 patients with an earlier established uncomplicated CHD or stroke. Despite this, no more than 22 patients with UA were found. INTERVENTIONS: Patients were followed in medical practice. MAIN OUTCOME MEASURES: Costs, direct and indirect costs, and potential savings. RESULTS: The mean direct costs during the year after a clinical event range between Swedish kronor (SEK) 41 000 for CHF and SEK 96 000 for stroke, whereas the mean potential savings in direct costs range from SEK 36 000 for CHF to SEK 91 000 for UA. The potential mean savings in indirect costs range between SEK 24 000 for CHF and SEK 102 000 for AMI. The direct costs for first-time patients are lower than those for patients with an earlier established CHD or stroke. No systematic differences have been found in potential direct cost savings and indirect costs between the two patient groups. CONCLUSIONS: CHD and stroke are associated with high costs during the year after admission to the Department of Medicine. There are also large potential cost savings from the prevention of CHD and stroke. However, further studies, including more patients and costs arising in the municipality, are needed to establish more precise and complete estimates of the costs related to CHD and stroke.

Aged↗
PubMed1990

Costs and benefits of early detection of prostatic cancer.

During recent years prostatic cancer has emerged as an increasing health problem in many countries. However, there is reason to believe it can be cured if detected at an early stage while still confined to the prostate. An effective screening programme could thus alter the natural history of the disease and reduce the overall mortality. But the benefit of such a programme is still under debate. A pilot programme using rectal-digital examination to investigate organisational, social and economical aspects was carried out. This information was then used to estimate the consequences of routine prostatic screening in the Swedish health service with aid of a decision analysis model. The study shows that prostatic cancer screening by rectal-digital examination can be organized as an integral part of primary health care, with high acceptance by the public. The total economic burden of screening on the health care sector will be high. The total expected health care cost in Sweden for all diagnosed prostatic cancers during the next 2 years, without screening, was estimated to be 53 million USD (in 1989 prices). 1048 patients were expected to be offered some potentially curative therapy. With rectal-digital examination the total cost during the next 2 years would be 131 million USD and 6522 patients would be given treatment. Alternatively, with transurethral ultrasound examination, the total cost would be 174 million USD and 10275 patients would receive potentially curative therapy. The ultimate health benefits of potentially curative treatment remain uncertain. Until we have scientific evidence of the cost-effectiveness of this method the model presented for analysing the consequences of different strategies could well prove helpful in policymaking for this complex problem.

Adult↗
PubMed2005

Cost effectiveness of concurrent chemoradiation in comparison with radiation alone in locally advanced cervical cancer.

INTRODUCTION: Concurrent chemoradiation has been advocated to be more effective than radiation alone in the treatment of cervical cancer. However, it certainly has more side effects. Hence, it is worthwhile to investigate the cost-effectiveness (CE) of concurrent chemoradiation in comparison with radiation alone in locally advanced cervical cancer. MATERIAL AND METHOD: The treatment of cervical cancer was modeled using the decision tree where the treatment option would be either concurrent chemoradiation or radiation alone. Patients receiving each treatment had different risks of tumor recurrence. Costs in this analysis were separated into four major categories: costs for treatment of cervical cancer, costs for treatment of major side effects, costs for follow up cancer patients, and costs for diagnosis including supportive care of recurrent cervical cancer Charges were used for the costs of chemotherapy, radiotherapy, drugs, and accessories. Unit cost was used for the costs of laboratory investigations, in-patient and out-patient services. Costs incurred after the first year were discounted at an annual rate of 5%. The benefit was measured as months of life survived. The present study evaluated the patients to 5 years after complete treatment. RESULTS: The CE ratio in the concurrent chemoradiation group was 2,855 and 1,835 Baht/month survived if the chemotherapy was given as in-patient and out-patient respectively. The CE ratio in the radiation group equaled 2,366 Baht/month survived. For the sensitivity analysis, in the situation that chemoradiation was not much better than radiation alone in terms that the recurrent rate from chemoradiation group was not more than 20% lower than the radiation group, radiation therapy alone would be more cost effective even if chemotherapy was given as an out-patient basis. CONCLUSION: Radiation alone was more cost effective than chemoradiation in the treatment of cervical cancer. Nevertheless, if chemotherapy was administered on an out-patient basis, chemoradiation will be more cost effective only if the recurrent rate from the chemoradiation group was more than 20% lower than the radiation group.

Ambulatory Care↗
PubMed1984

Adult day care services in New York State: a comparison with other long-term care providers.

In response to the need for the creation of adult health-oriented day care programs, New York State in 1969 enacted the first state legislation and regulations to govern the operation of such programs. This report categorizes existing New York State nonoccupant programs into four types on the basis of the ratio of total ancillary costs to total direct costs and then compares and assesses their costs. Costs and characteristics of registrants in the four nonoccupant models are also described and contrasted. The report then compares the patient characteristics and costs of nonoccupant programs with those of the most similar long-term care providers in the state, namely, certified home health agencies and health-related facilities.

Activities of Daily Living↗
PubMed1998

Crisis: what crisis?

There is a large economic cost associated with low back pain. In 1994 its cost to the United Kingdom (UK) was estimated by the UK Clinical Standards Advisory Group report to be nearly pound sterling 6,000 million (ECU 8,350 million) annually. This principally consists of the indirect costs of lost production and disability payments rather than direct health service costs. A re-examination of the assumptions in the report shows that these costs appear to overestimate the economic cost of back pain by an unquantified, but possibly large, amount. This may restrict the benefit of introducing more effective treatments for back pain.

Cost-Benefit Analysis↗
PubMed1990

Comparing the cost-effectiveness of drug regimens in the treatment of duodenal ulcers.

This paper compares cost-effectiveness of drug regimens based on omeprazole, ranitidine and sucralfate in the treatment of duodenal ulcers. Measures used were expected total costs and expected healthy days in a six month period after starting treatment. Both measures were calculated by decision tree analysis using healing and relapse probabilities estimated by logit regressions from results of earlier RCTs. Omeprazole and sucralfate regimens tied in the direct C/E comparison and were clearly superior to ranitidine regimens. Yet problems with patient compliance and faster relief from pain/symptoms with omeprazole may contribute to breaking the tie to omeprazole's advantage.

Clinical Trials as Topic↗
PubMed1993

Cost of illness studies in health care: a comparison of two cases.

Cost of illness (COI) studies describe the economic burden of disease on society. In this article a standard procedure for a COI study is developed, including the explicit definition of the disease, choice of relevant variables and appraisal of direct and indirect costs. COI studies can be incidence-based or prevalence-based. The adjustment of cost figures for time preferences and the performance of a sensitivity analysis are presented. The standard methodology is applied to diseases in two different areas. The first disease category is dyspepsia, a complaint with a rather somatic background. The second is schizophrenia, a mental syndrome. In performing COI studies in practice, however, researchers are forced to deviate, in many aspects, from the theoretical standards. In this article these choices, and the reasons behind these choices, are explained. Furthermore, we discuss certain problems regarding the reluctance to make a diagnosis regarding certain diseases, the reliability and the validity of the sources used and the absence of certain figures. The value of the information derived from COI studies for policy-making is assessed.

Cost of Illness↗
PubMed1991

Evaluation of the costs and benefits of reducing hospital infection.

The techniques of economic evaluation have now been widely applied in health care. These techniques assess the value for money from interventions by comparing their costs and consequences. Since measures to reduce hospital infection normally result in costs they should, in principle, be subjected to economic evaluation. This paper outlines the essential elements of economic evaluation and distinguishes between different forms of analysis. It also discusses a number of evaluations of infection control measures undertaken to date. The recurring methodological weaknesses in current studies are identified and improvements suggested. Finally, the practical relevance of such studies in the current cost-conscious health care environment is discussed.

Communicable Disease Control↗
PubMed2004

Cost-effectiveness of using electron beam computed tomography to identify patients at risk for clinical coronary artery disease.

BACKGROUND: The use of electron beam computed tomography (EBCT) to screen for coronary artery calcification (CAC) has been widely promulgated, although the cost effectiveness of this practice is unknown. METHODS: We constructed a decision tree to determine the marginal cost per additional patient who was "at risk" (>10% 10-year risk of coronary heart disease) identified with the addition of EBCT to the Framingham Risk Index (FRI) in a screening population with no cardiac symptoms. We also determined the marginal cost per quality adjusted life year (QALY) saved, assuming a 30% improvement in life expectancy associated with primary prevention. A consecutive screening cohort of 39- to 45-year-old men and women was used for demographic and risk factor data. Estimates of the relevant input costs were made on the basis of published literature when available. RESULTS: Compared with using FRI alone, the strategy of incorporating EBCT detects patients who are "at risk" at a cost of 9789 dollars/additional case and a marginal cost of 86,752 dollars/QALY. The marginal cost per QALY is highly sensitive to the gain in life expectancy from early intervention (10,000-1,700,000 dollars/QALY for a relative risk reduction in mortality of 50% or 25%, respectively), the utility of being "at risk" (18,000 dollars/QALY to dominated for a utility of 1.0-<0.98, similar to other asymptomatic chronic illnesses), and the added prognostic value of EBCT (60,000 dollars/QALY to dominated in a wide range). CONCLUSION: The use of EBCT to improve cardiovascular risk prediction in a population with no cardiac symptoms who are at low absolute risk is expensive, even using favorable assumptions. If the utility of being "at risk" is comparable with other asymptomatic disease states, EBCT may in aggregate have a detrimental effect on the quality of life of screening populations.

Bayes Theorem↗