Measuring economic consequences of preterm birth - Methodological recommendations for the evaluation of personal burden on children and their caregivers.

This study aims to identify the impact of a preterm birth on financial and emotional burden from the families' perspective. Additionally, a comprehensive schedule of recommendations for a sufficient evaluation of all aspects of burden is developed. Based on the results of a literature search relevant categories and sub-domains for a questionnaire covering multiple aspects of associated financial and emotional burden are identified and converted into a recommendation scheme. Results of the literature search illustrate the large extend of burden of prematurity on parents. This results in substantial out-of-pocket expenditures (OOPE) and emotional distress to the parents besides the medical problems and further financial costs to the health insurance system. According to the results on infants' state of health, OOPE and emotional distress are significantly increased with decreasing gestational age. OOPE for transportation often amounts to the main parental cost dimension. Moreover there is some evidence for a high magnitude of reduced income and missed work days. The family perspective has to be taken into account when calculating the overall costs of preterm births from a societal point of view. However, in recent years economic evaluations were performed rather inhomogeneously in this field. For future studies a) direct medical costs, b) direct non-medical costs, c) indirect costs as well as d) intangible costs (in terms of emotional distress and reduced quality of life for caregivers and children) are the main categories that should be evaluated measuring personal burden of preterm birth on families adequately. A detailed list of specific sub-domains is given. Additionally, the recommendations are not restricted to application in infants born preterm and/or at low birth weight.

[Methodological standards for cost-of-illness studies using breast cancer, prostate cancer and colon cancer as an example]. / Methodische Standards von Krankheitskostenstudien am Beispiel von Brust-, Prostata- und Darmkrebs.

Malignant neoplasia in mammary gland, prostate and colon appear at the top end of the cancer incidence and mortality statistics in Germany. In this context cost-of-illness studies are a suitable tool for quantifying disease-specific health economic consequences of disease. Their primary aim is to illustrate the economic burden of a specific disease and its implications for society and for the national economy. The present review summarizes the methods and results of cost-of-illness studies regarding the three cancer diseases mentioned. Despite some limitations and remarkable differences in respect of methodological aspects, it is possible to point out that numerous studies lead to similar results. For all three kinds of cancer, there is sufficient evidence to suggest that mainly initial and terminal states of disease are important, due to the major resource utilization caused by the claim of initial and palliative therapies. Inpatient costs--caused by the high rate of hospitalisation--account for 50% to 98% of the direct costs. As regards the societal perspective, a comparison of the three diseases considered demonstrates that especially the costs associated with breast cancer present a big challenge to the health care systems, which is primarily due to the high incidence rate in women under 65 years of age and the correspondingly high indirect costs resulting from invalidity, invalidity pensions or premature death. Future tasks to work on include analyzing the different patterns of health service utilisation and identifying the cost effects of different influencing factors. Transparency of costs, as a basis for cost-effectiveness analyses, could help to make interventions more precise.

Determinants of willingness to pay for a new therapy in a sample of menopausal-aged women.

Menopause is a natural physiological event that usually begins in women between the ages of 48 and 55 years. In many cases, this event is associated with unpleasant somatic-vegetative, urogenital or psychological symptoms. To test the health and social demographic factors (especially household income level) that influence willingness to pay (WTP) for a new hormone-free treatment in women of menopausal age. 1365 women between the ages of 45 and 73 years were surveyed about their health and WTP for the new treatment. WTP was evaluated with a closed-ended binary questionnaire (four groups with different levels of co-payment between euro15 and euro60), using the contingent valuation method. The average WTP was calculated according to the area under the demand function. Factors contributing to payment readiness were examined by means of binary logistic regression. WTP was significantly affected by women's opinion of the new medication, the level of co-payment required, net household income, whether currently in treatment for menopausal symptoms, and Menopause Rating Scale (MRS) values. Compared with other factors, the level of co-payment was predicted to have a negative impact on WTP. Income level is an important factor in WTP and correlates highly with several other health-related variables (WHO-5 index, MRS value, receipt of other menopause medicines and existing co-morbidity). The average co-payment that our group of women was willing to pay was between euro17 and euro35 per month, or euro24 to euro42 for women who were currently receiving treatment for symptoms of menopause. While interpreting the results, it should be considered that the hypothetical therapy was assumed to be a new non-reimbursable alternative to conventional therapy offered under the existing statutory framework for health insurance in Germany. Despite some methodological limitations, these results are useful for examining the factors affecting WTP and incremental utilities for future medicine dealing with menopause.