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1.
Int J Tuberc Lung Dis ; 23(11): 1217-1222, 2019 11 01.
Article in English | MEDLINE | ID: mdl-31718759

ABSTRACT

SETTING: The Groupe Haïtien d'étude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO) Centres, Port-au-Prince, Haiti, facilitate "test and treat" strategies by screening all patients for tuberculosis (TB) at human immunodeficiency virus (HIV) testing.OBJECTIVE: 1) To determine the proportion of patients with chronic cough at HIV testing diagnosed with TB, stratified by HIV test results; and 2) to evaluate the additional diagnostic yield of Xpert® MTB/RIF vs. sputum microscopy.DESIGN: We conducted a retrospective cohort analysis including all adults tested for HIV at GHESKIO from August 2014 to July 2015.RESULTS: Of 29 233 adult patients tested for HIV, 2953 (10%) were diagnosed as HIV-positive. Chronic cough lasting ≥2 weeks was reported by 1116 (38%) HIV-positive patients; 984 (88%) were tested and 265 (27%) were diagnosed with TB. Chronic cough was reported by 5985 (23%) HIV-negative patients; 5654 (94%) were tested and 1179 (21%) were diagnosed with TB. Of all bacteriologically confirmed cases, 27% were smear-negative and Xpert-positive. Among all TB patients, 81% were HIV-negative.CONCLUSIONS: Screening for TB at HIV testing was high-yield, among both HIV-infected and HIV-negative individuals. Testing for both diseases should be conducted among patients who present with chronic cough at HIV testing.


Subject(s)
HIV Infections/diagnosis , Mass Screening/methods , Tuberculosis/diagnosis , Adult , Chronic Disease , Cough/diagnosis , Cough/etiology , Female , HIV Infections/epidemiology , Haiti/epidemiology , Humans , Male , Middle Aged , Mycobacterium tuberculosis/isolation & purification , Retrospective Studies , Sputum/microbiology , Tuberculosis/epidemiology , Young Adult
2.
Int J Tuberc Lung Dis ; 21(11): 1140-1146, 2017 11 01.
Article in English | MEDLINE | ID: mdl-29037294

ABSTRACT

SETTING: Haiti has the highest burden of tuberculosis (TB) in the Americas, with an estimated prevalence of 254 per 100 000 population. The Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes, GHESKIO) conducted active case finding (ACF) for TB at the household level in nine slums in Port-au-Prince. OBJECTIVE: We report on the prevalence of undiagnosed TB detected through GHESKIO's ACF campaign. DESIGN: From 1 August 2014 to 31 July 2015, we conducted a retrospective cohort analysis using GHESKIO's ACF campaign data. All individuals who reported chronic cough (cough 2 weeks) were tested for TB at GHESKIO, and those aged 10 years were included in the analyses. RESULTS: Of 104 097 individuals screened in the community, 5598 (5%) reported chronic cough and satisfied the study inclusion criteria. A total of 1110 (20%) were diagnosed with active TB disease (prevalence of 1066/100 000). Of the 5472 (98%) patients tested for human immunodeficiency virus (HIV), 528 (10%) were HIV-positive; 143 (3%) patients were diagnosed with both diseases. CONCLUSION: Household-level screening for cough with TB and HIV testing for symptomatic patients was a high-yield strategy, leading to the detection of a prevalence of undiagnosed disease exceeding national estimates by more than four-fold for TB, and by five-fold for HIV.


Subject(s)
HIV Infections/diagnosis , Mass Screening/methods , Poverty Areas , Tuberculosis/diagnosis , Adolescent , Adult , Child , Chronic Disease , Cohort Studies , Cough/diagnosis , Cough/etiology , Female , HIV Infections/epidemiology , Haiti/epidemiology , Humans , Male , Prevalence , Retrospective Studies , Tuberculosis/epidemiology , Young Adult
3.
J Health Econ ; 20(2): 271-82, 2001 Mar.
Article in English | MEDLINE | ID: mdl-11252374

ABSTRACT

This research examines the impact of omitted variables on the accuracy of parametric hospital cost function estimations based on Québec hospital level data. We assess the effect of omitted variables resulting from incomplete data on technology and performance measurement and on tests of the cost minimizing behavior of the institution. Our results show that important characteristics of hospital technology, such as returns to scale, are extremely sensitive to omitted variable bias. Similarly, estimates of hospital performance are poor indicators of actual performance when data are incomplete.


Subject(s)
Bias , Health Services Research/methods , Hospital Costs/statistics & numerical data , Hospitalization/economics , Efficiency, Organizational/statistics & numerical data , Health Services Research/statistics & numerical data , Hospitalization/statistics & numerical data , Humans , Models, Statistical , National Health Programs , Quebec , Reproducibility of Results
4.
Tob Control ; 10(1): 33-7, 2001 Mar.
Article in English | MEDLINE | ID: mdl-11226358

ABSTRACT

OBJECTIVE: To examine the actual and anticipated costs of a law regulating workplace smoking and smoking in restaurants, taking into consideration observed and anticipated infrastructure costs, lost productivity, increased absenteeism, and loss of clientele. SETTING AND DESIGN: A survey of 401 Québec restaurants and 600 Québec firms conducted by the Québec Ministry of Health before the enactment of the law was used to derive costs incurred by those who had already complied and anticipated by those that did not. RESULTS: Direct and indirect costs associated with tobacco regulation at work and in restaurants were minimal. Annualised infrastructure costs amounted to less than 0.0002% of firm revenues and 0.15% of restaurant revenues. Anticipated costs were larger and amounted to 0.0004% of firm revenues and 0.41% of restaurant revenues. Impacts on productivity, absenteeism, and restaurant patronage were widely anticipated but not observed in currently compliant establishments. CONCLUSION: Firms and restaurants expected high costs to result from strict tobacco regulation because of infrastructure costs, decreased productivity, and decreased patronage. That none of these were actually observed suggests that policy makers should discount industry claims that smoking regulations impose undue economic hardship.


Subject(s)
Restaurants/economics , Smoking Cessation/economics , Smoking Prevention , Smoking/economics , Workplace , Canada/epidemiology , Health Promotion , Humans , Quebec/epidemiology , Smoking/epidemiology
5.
J Clin Oncol ; 18(14): 2755-61, 2000 Jul.
Article in English | MEDLINE | ID: mdl-10894876

ABSTRACT

PURPOSE: To determine the cost of outpatient RBC transfusion from the provider's perspective at a major urban, academic cancer center. PATIENTS AND METHODS: We retrospectively studied 517 cancer patients with hematologic or solid tumors who received blood during fiscal year 1995 to 1996. A process-flow diagram was developed, and cost and utilization data for 12 months were collected and analyzed. A structured interview process was used to identify all direct and indirect costs from within the inpatient unit, blood bank, and outpatient clinic. Average costs were computed for the entire sample and for specific subgroups. RESULTS: In 1998 dollars, the average cost per RBC unit was $469 for adults and $568 for pediatric cancer patients. Adults and children generally received two and one RBC units per transfusion, respectively. Therefore, the average cost of a two-unit transfusion was $938 for adults. Patients with hematologic tumors required more RBC units (7.1 RBC units per year) at a higher average cost ($512 per RBC unit) than patients with solid tumors (4.7 RBC units per year, $474 per RBC unit). Further variations across tumor types were observed. Overhead, direct material, and direct labor represented 46%, 19%, and 35% of total costs respectively. CONCLUSION: The cost of outpatient RBC transfusions in cancer patients is higher than previously reported, in part because overhead costs and fixed costs might have been underestimated in previous studies. Furthermore, age, tumor type, and geographic variations in the cost of fixed assets and labor have a substantial impact on the cost of blood. The results indicate that the cost-effectiveness of alternatives to transfusions in the management of cancer patients may have been underestimated in the existing literature.


Subject(s)
Ambulatory Care/economics , Blood Transfusion/economics , Neoplasms/economics , Adult , Cancer Care Facilities/economics , Child , Costs and Cost Analysis , Female , Humans , Male , Neoplasms/therapy , Retrospective Studies , United States
6.
Am J Manag Care ; 6(11): 1243-51, 2000 Nov.
Article in English | MEDLINE | ID: mdl-11185849

ABSTRACT

BACKGROUND: Detailed data will be increasingly important in determining the cost of cancer care in the managed care setting. OBJECTIVES: To estimate the full cost of cancer to a major employer in the United States and to determine the nature of the expenditures. STUDY DESIGN: Analysis of medical, pharmaceutical, and disability claims data from 1995 to 1997 for a major employer with more than 100,000 employees. METHODS: The cost of cancer is determined on a per-patient and per-employee basis. Based on a case-control method, cancer patients are matched to individuals with no record of cancer diagnosis or treatment. The incremental cost per employee and the percentage of total healthcare expenditures for cancer are quantified. RESULTS: Approximately $224 per active employee, or 6.5% of the corporation's total healthcare costs, was spent on incremental care for cancer patients in 1997. Medical conditions not directly related to cancer account for approximately half the total excess expenditures for patients with cancer. On average, annual healthcare and disability costs for persons with cancer were approximately 5 times higher than for their counterparts without cancer. CONCLUSIONS: The costs of cancer care are a substantial proportion of healthcare costs for employers. When the full cost of cancer is included in a cost-benefit analysis, expenditures for programs to reduce the risk of cancer in the working population may be justified. Expenditures to reduce the incidence and severity of conditions indirectly associated with cancer may also reduce overall employer healthcare expenses.


Subject(s)
Cost of Illness , Employer Health Costs/statistics & numerical data , Health Benefit Plans, Employee/economics , Neoplasms/economics , Case-Control Studies , Humans , Models, Econometric , United States
7.
Health Econ ; 8(7): 627-39, 1999 Nov.
Article in English | MEDLINE | ID: mdl-10544328

ABSTRACT

This paper revisits the relationship between health care spending and health outcomes. While previous researchers found it difficult to establish such a relationship based on international comparisons, the results based on rather homogenous province-specific Canadian data show that lower health care spending is associated with a statistically significant increase in infant mortality and a decrease in life expectancy in Canada. This relationship is independent of various economic, socio-demographic, nutritional and lifestyle factors, as well as provincial specificity or time trend. It is based on annual data collected from the ten Canadian provinces over 15 years.


Subject(s)
Health Expenditures/statistics & numerical data , Infant Mortality , Life Expectancy , Outcome Assessment, Health Care/economics , Canada/epidemiology , Female , Health Services Accessibility , Humans , Income , Infant, Newborn , Life Style , Male , Models, Econometric , Nutritional Physiological Phenomena
8.
Pharmacoeconomics ; 16(1): 1-8, 1999 Jul.
Article in English | MEDLINE | ID: mdl-10539118

ABSTRACT

Healthcare claims data are a practical complement to data from randomised controlled trials (RCTs) for evaluating health outcomes in non-experimental settings and for generalising results to a broader population. Claims data are a relatively inexpensive way to obtain useful information about patient demographics, as well as healthcare resources used for specific medical conditions and procedures from large numbers of patients over extended periods of time. With claims data, it is possible to identify patients who meet specific medical or sociodemographic criteria, estimate their costs, define episodes of medical care, and measure outcomes more globally than is possible with RCT data. Statistical methods exist to address some of the inherent issues with claims data due to their limited clinical detail. We also identify extensions of claims data to productivity issues, the use of centralised claims data such as in Canada, and the application of new statistical methods to outcomes research literature such as sample selection correction methods.


Subject(s)
Data Interpretation, Statistical , Economics, Pharmaceutical , Insurance Claim Review , Outcome Assessment, Health Care , Canada , United States
9.
Pharmacoeconomics ; 16(5 Pt 1): 425-32, 1999 Nov.
Article in English | MEDLINE | ID: mdl-10662390

ABSTRACT

The use of pharmacoeconomic tools has grown dramatically in the past decade as provision of healthcare throughout the industrialised world has required increased cost consciousness. However, pharmacoeconomic analysis has not yet been fully exploited as a conceptual underpinning for public or private health policy decisions. Pharmacoeconomics is likely to become an increasingly important basis for health policy decisions as a number of significant dynamics evolve in the marketplace, including: (i) consumers acting on their growing access to information and becoming more actively involved in treatment decisions; (ii) payers, providers and patients deepening their interaction and overcoming their traditional (narrow) focus on either costs or benefits alone; and (iii) manufacturers being challenged by other healthcare constituencies as sponsors of cost-based outcomes studies.


Subject(s)
Economics, Pharmaceutical/trends , Health Policy/trends , Cost-Benefit Analysis , Forecasting , Health Policy/economics , Humans
10.
Pharmacoeconomics ; 16(5 Pt 1): 459-72, 1999 Nov.
Article in English | MEDLINE | ID: mdl-10662393

ABSTRACT

OBJECTIVE: To measure the cost effectiveness of a supportive care intervention when the no-treatment option is unrealistic in an analysis of recombinant human erythropoietin (epoetin) treatment for anaemic patients with cancer undergoing chemotherapy. Further, to assess whether quality-adjusted life-years (QALYs) can provide the basis for an appropriate measure of the value of supportive care interventions. DESIGN: A modelling study drawing cost and effectiveness assumptions from a literature review and from 3 US clinical trials involving more than 4500 patients with cancer who were treated with chemotherapy, radiotherapy, epoetin and blood transfusions as needed under standard care for patients with cancer. MAIN OUTCOME MEASURES AND RESULTS: When compared with transfusions, epoetin is cost effective under varying assumptions, whether effectiveness is measured by haemoglobin level or quality of life. Specifically, under a base-case scenario, the effectiveness resulting from $US1 spent on standard care can be achieved with only $US0.81 of epoetin care. Due in part to the health-state dependence of the significance patients attach to incremental changes in their responses on the linear analogue scale, cost per QALY results are ambiguous in this supportive care context. CONCLUSIONS: Under a broad range of plausible assumptions, epoetin can be used cost effectively in the treatment of anaemic patients with cancer. Further, QALYs have limited applicability here because, as a short term supportive treatment, epoetin enhances the quality but not the length of life. Future research would benefit from the establishment of consistent values for quality-of-life changes across patients and health status, and the extension of the QALY framework to supportive care.


Subject(s)
Anemia/drug therapy , Erythropoietin/economics , Erythropoietin/therapeutic use , Neoplasms/therapy , Quality-Adjusted Life Years , Anemia/economics , Anemia/etiology , Combined Modality Therapy , Cost-Benefit Analysis , Humans , Neoplasms/complications , Neoplasms/economics , Pain Measurement , Randomized Controlled Trials as Topic , Recombinant Proteins
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