The Direct Economic Burden of Gout in an Elderly Canadian Population.

OBJECTIVE: To estimate the direct healthcare cost and resource use from the public payer perspective between patients with incident gout and matched gout-free patients in Ontario. METHODS: Patients with incident gout aged ≥ 66 with uninterrupted Ontario Health Insurance Plan (OHIP) coverage in the 1-year baseline period were included in the study. Patients with gout were indexed at first gout diagnosis or prescription over the study period April 1, 2008, to March 31, 2014. Gout-free patients with no gout diagnosis within history were matched (up to 5:1) to each patient with gout. Linked medical records were analyzed until end of study, death, or OHIP ineligibility. Bang and Tsiatis adjusted healthcare costs and resource use were compared using bootstrap p-values and 95% CI. RESULTS: A total of 29,894 patients with gout and 148,231 gout-free patients were included in the study. Patients were 56% male, had a median Adjusted Clinical Group healthcare resource use band of moderate morbidity, and had a median age of 75-79 years. Baseline comorbidities were similar between groups except for renal disease. Analyzing 5-year total healthcare costs, patients with gout ($44,297) incurred a significantly higher average healthcare cost compared to gout-free patients ($33,965), for an incremental cost of $10,332 (95% CI $9617-$11,039; p < 0.01). Similar trends were observed in all individual healthcare component cost and use metrics. CONCLUSION: Following onset of gout, patients in Ontario incur significantly greater healthcare costs and resource use compared to matched gout-free patients. Alternative gout management strategies should be investigated to reduce the incremental burden of gout borne by the Ontario healthcare system.

Knowledge of zoonoses among those affiliated with the ontario Swine industry: a questionnaire administered to selected producers, allied personnel, and veterinarians.

Zoonoses are diseases caused by infectious agents that are transmitted from animals to humans. Some zoonoses have been associated with the pig and pork industry. To ensure the safety of pigs and pork and to improve public health it is essential to understand the level of knowledge of those affiliated with the swine industry. The purpose of our study was to assess the knowledge of and attitude toward zoonotic and other microbial hazards among targeted groups of stakeholders associated with the Ontario swine industry. A postal questionnaire was sent to 409 individuals representing producers, veterinarians, and allied industry personnel. The questionnaire included seven dichotomous and Likert-scale type questions on microbial hazards, addressing topics on familiarity, concern, presence, antimicrobial resistance, and knowledge transfer. The overall response rate was 53% (218/409). More respondents were concerned about the zoonotic potential of Salmonella spp. (53-94%) and swine influenza virus (64-75%) than other hazards. The group of veterinarians were more familiar (>89%) with all microbial hazards than other occupation groups. Additionally, antimicrobial resistance was reported as a problem by more (60%) veterinarians than producers (20%). Educational efforts should focus on preferred methods of knowledge transfer (e.g., producer meetings, magazine) to update swine industry personnel about zoonoses in an attempt to improve food safety and public health.