ABSTRACT
Antecedentes y objetivo No se dispone de datos españoles sobre el coste asociado al linfoma cutáneo de célulasT (LCCT). Además, la incorporación de nuevos tratamientos hace necesario analizar el coste real de la enfermedad. El estudio MICADOS analizó dos objetivos principales: Por un lado, evaluó el impacto en la calidad de vida en los pacientes con LCCT, y por otro lado, estudió los costes de la enfermedad. En esta publicación se recoge el segundo de los objetivos del estudio. Métodos El coste de la enfermedad se estudió bajo la perspectiva del Sistema Nacional de Salud (SNS) con un horizonte temporal de un año. Participaron 23 dermatólogos y hematólogos de 15 hospitales públicos españoles. Se incluyeron pacientes adultos con LCCT del tipo micosis fungoide (MF) y síndrome de Sézary (SS). Resultados Se incluyeron 141 pacientes, el 57,4% masculinos, con una edad media de 63,6 años (IC95%: 61,4-65,7). Los costes directos anuales medios por pacientes del estudio fueron de 34.214, siendo de 11.952,47 en estadioI, 23.506,21 en estadioII, 38.771,81 en estadioIII y 72.748,84 en estadioIV. El coste anual directo total estimado de todos los pacientes en España con MF/SS resultó en 78.301.171, donde el 81% de los costes fueron atribuibles a pacientes en estadioI, el 7% al estadioII, el 6% al estadioIII y el 6% al estadioIV. Conclusiones Este estudio ofrece una evaluación precisa del coste directo del LCCT en pacientes con MF/SS en España, mostrando costes que varían sustancialmente en función del estadio. Los costes soportados por el paciente y los costes indirectos deberán considerarse en futuras investigaciones (AU)
Background and objective The cost of treating cutaneous T-cell lymphoma (CTCL) in Spain is unknown. With the advent of new treatments, it is more important than ever to gain an accurate picture of the true costs involved. The MICADOS study had 2 primary objectives: 1)to evaluate the impact of CTCL on patient quality of life, and 2)to evaluate the costs associated with the disease. This article reports the results of the cost analysis. Methods We estimated the cost of treating CTCL over a period of 1year from the perspective of the Spanish National Health System. Twenty-three dermatologists and hematologists from 15 public hospitals analyzed data for adult patients with mycosis fungoides (MF) or Sézary syndrome (SS). Results A total of 141 patients (57.4% male) with a mean age of 63.6 years (95%CI: 61.4-65.7 years) were included. The mean direct annual cost of treating CTCL was 34,214 per patient. The corresponding costs by stage were 11,952.47 for stageI disease, 23,506.21 for stageII disease, 38,771.81 for stageIII disease, and 72,748.84 for stageIV disease. The total direct annual cost of treating MF/SS in public hospitals in Spain was estimated at 78,301,171; stageI disease accounted for 81% of all costs, stageII for 7%, and stagesIII andIV for 6% each. Conclusions The MICADOS study offers an accurate picture of the direct cost of treating CTCL in patients with MF/SS in Spain and shows that costs vary significantly according to disease stage. Patient-borne and indirect costs should be analyzed in future studies (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Lymphoma, T-Cell, Cutaneous/economics , Lymphoma, T-Cell, Cutaneous/therapy , Skin Neoplasms/economics , Skin Neoplasms/therapy , Cost of Illness , Health Care Costs , Cross-Sectional Studies , Retrospective Studies , SpainABSTRACT
Background and objective The cost of treating cutaneous T-cell lymphoma (CTCL) in Spain is unknown. With the advent of new treatments, it is more important than ever to gain an accurate picture of the true costs involved. The MICADOS study had 2 primary objectives: 1)to evaluate the impact of CTCL on patient quality of life, and 2)to evaluate the costs associated with the disease. This article reports the results of the cost analysis. Methods We estimated the cost of treating CTCL over a period of 1year from the perspective of the Spanish National Health System. Twenty-three dermatologists and hematologists from 15 public hospitals analyzed data for adult patients with mycosis fungoides (MF) or Sézary syndrome (SS). Results A total of 141 patients (57.4% male) with a mean age of 63.6 years (95%CI: 61.4-65.7 years) were included. The mean direct annual cost of treating CTCL was 34,214 per patient. The corresponding costs by stage were 11,952.47 for stageI disease, 23,506.21 for stageII disease, 38,771.81 for stageIII disease, and 72,748.84 for stageIV disease. The total direct annual cost of treating MF/SS in public hospitals in Spain was estimated at 78,301,171; stageI disease accounted for 81% of all costs, stageII for 7%, and stagesIII andIV for 6% each. Conclusions The MICADOS study offers an accurate picture of the direct cost of treating CTCL in patients with MF/SS in Spain and shows that costs vary significantly according to disease stage. Patient-borne and indirect costs should be analyzed in future studies (AU)
Antecedentes y objetivo No se dispone de datos españoles sobre el coste asociado al linfoma cutáneo de célulasT (LCCT). Además, la incorporación de nuevos tratamientos hace necesario analizar el coste real de la enfermedad. El estudio MICADOS analizó dos objetivos principales: Por un lado, evaluó el impacto en la calidad de vida en los pacientes con LCCT, y por otro lado, estudió los costes de la enfermedad. En esta publicación se recoge el segundo de los objetivos del estudio. Métodos El coste de la enfermedad se estudió bajo la perspectiva del Sistema Nacional de Salud (SNS) con un horizonte temporal de un año. Participaron 23 dermatólogos y hematólogos de 15 hospitales públicos españoles. Se incluyeron pacientes adultos con LCCT del tipo micosis fungoide (MF) y síndrome de Sézary (SS). Resultados Se incluyeron 141 pacientes, el 57,4% masculinos, con una edad media de 63,6 años (IC95%: 61,4-65,7). Los costes directos anuales medios por pacientes del estudio fueron de 34.214, siendo de 11.952,47 en estadioI, 23.506,21 en estadioII, 38.771,81 en estadioIII y 72.748,84 en estadioIV. El coste anual directo total estimado de todos los pacientes en España con MF/SS resultó en 78.301.171, donde el 81% de los costes fueron atribuibles a pacientes en estadioI, el 7% al estadioII, el 6% al estadioIII y el 6% al estadioIV. Conclusiones Este estudio ofrece una evaluación precisa del coste directo del LCCT en pacientes con MF/SS en España, mostrando costes que varían sustancialmente en función del estadio. Los costes soportados por el paciente y los costes indirectos deberán considerarse en futuras investigaciones (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Lymphoma, T-Cell, Cutaneous/economics , Lymphoma, T-Cell, Cutaneous/therapy , Skin Neoplasms/economics , Skin Neoplasms/therapy , Cost of Illness , Health Care Costs , Cross-Sectional Studies , Retrospective Studies , SpainABSTRACT
BACKGROUND AND OBJECTIVE: The cost of treating cutaneous T-cell lymphoma (CTCL) in Spain is unknown. With the advent of new treatments, it is more important than ever to gain an accurate picture of the true costs involved. The MICADOS study had 2 primary objectives: 1)to evaluate the impact of CTCL on patient quality of life, and 2)to evaluate the costs associated with the disease. This article reports the results of the cost analysis. METHODS: We estimated the cost of treating CTCL over a period of 1year from the perspective of the Spanish National Health System. Twenty-three dermatologists and hematologists from 15 public hospitals analyzed data for adult patients with mycosis fungoides (MF) or Sézary syndrome (SS). RESULTS: A total of 141 patients (57.4% male) with a mean age of 63.6 years (95%CI: 61.4-65.7 years) were included. The mean direct annual cost of treating CTCL was 34,214 per patient. The corresponding costs by stage were 11,952.47 for stageI disease, 23,506.21 for stageII disease, 38,771.81 for stageIII disease, and 72,748.84 for stageIV disease. The total direct annual cost of treating MF/SS in public hospitals in Spain was estimated at 78,301,171; stageI disease accounted for 81% of all costs, stageII for 7%, and stagesIII andIV for 6% each. CONCLUSIONS: The MICADOS study offers an accurate picture of the direct cost of treating CTCL in patients with MF/SS in Spain and shows that costs vary significantly according to disease stage. Patient-borne and indirect costs should be analyzed in future studies.
Subject(s)
Lymphoma, T-Cell, Cutaneous , Mycosis Fungoides , Sezary Syndrome , Skin Neoplasms , Adult , Humans , Male , Middle Aged , Female , Quality of Life , Spain/epidemiology , Skin Neoplasms/therapy , Skin Neoplasms/pathology , Lymphoma, T-Cell, Cutaneous/epidemiology , Lymphoma, T-Cell, Cutaneous/therapy , Lymphoma, T-Cell, Cutaneous/pathology , Mycosis Fungoides/therapy , Mycosis Fungoides/pathology , Sezary Syndrome/therapy , Sezary Syndrome/pathologyABSTRACT
BACKGROUND AND OBJECTIVE: The cost of treating cutaneous T-cell lymphoma (CTCL) in Spain is unknown. With the advent of new treatments, it is more important than ever to gain an accurate picture of the true costs involved. The MICADOS study had 2 primary objectives: 1)to evaluate the impact of CTCL on patient quality of life, and 2)to evaluate the costs associated with the disease. This article reports the results of the cost analysis. METHODS: We estimated the cost of treating CTCL over a period of 1year from the perspective of the Spanish National Health System. Twenty-three dermatologists and hematologists from 15 public hospitals analyzed data for adult patients with mycosis fungoides (MF) or Sézary syndrome (SS). RESULTS: A total of 141 patients (57.4% male) with a mean age of 63.6 years (95%CI: 61.4-65.7 years) were included. The mean direct annual cost of treating CTCL was 34,214 per patient. The corresponding costs by stage were 11,952.47 for stageI disease, 23,506.21 for stageII disease, 38,771.81 for stageIII disease, and 72,748.84 for stageIV disease. The total direct annual cost of treating MF/SS in public hospitals in Spain was estimated at 78,301,171; stageI disease accounted for 81% of all costs, stageII for 7%, and stagesIII andIV for 6% each. CONCLUSIONS: The MICADOS study offers an accurate picture of the direct cost of treating CTCL in patients with MF/SS in Spain and shows that costs vary significantly according to disease stage. Patient-borne and indirect costs should be analyzed in future studies.
Subject(s)
Lymphoma, T-Cell, Cutaneous , Mycosis Fungoides , Sezary Syndrome , Skin Neoplasms , Adult , Humans , Male , Middle Aged , Female , Quality of Life , Spain/epidemiology , Skin Neoplasms/therapy , Skin Neoplasms/pathology , Lymphoma, T-Cell, Cutaneous/therapy , Lymphoma, T-Cell, Cutaneous/pathology , Mycosis Fungoides/therapy , Mycosis Fungoides/pathology , Sezary Syndrome/therapy , Sezary Syndrome/pathologyABSTRACT
Introducción: La epilepsia es una enfermedad neurológica muy frecuente que implica una elevada morbimortalidad. La epilepsia farmacorresistente (EFR) supone un desafío terapéutico superior, incluso para expertos en la materia. A pesar de ello, el acceso a recursos avanzados para este tipo de pacientes continúa siendo dificultoso y desigual. El objetivo de este estudio es analizar la desigualdad en una población perteneciente a un hospital de primer nivel. Pacientes y métodos Se llevó a cabo un estudio transversal observacional analítico con pacientes epilépticos que acuden a consultas de neurología del área IX del Servicio Murciano de Salud. Se describen variables demográficas, clínicas, terapéuticas, pronósticas y de equidad, y se analizan diferencias significativas entre distintos subgrupos. Resultados En el estudio se incluyó a 68 pacientes con una media de edad de 42,93 años. El tipo de epilepsia principal fue la focal (64,7%), y los fármacos más usados fueron el levetiracetam (33,8%), el ácido valproico (27,9%) y la lamotrigina (22,1%). La EFR se dio en 18 pacientes (el 26,5% del total) y sólo cuatro se encontraban en seguimiento activo en una unidad de epilepsia, lo que implica que el 71% no accedía a un recurso necesario (advanced therapeutic gap). Conclusiones Este estudio demuestra que la desigualdad en la epilepsia continúa siendo un problema, especialmente en ciertas áreas geográficas, con una falta de acceso a atención avanzada en pacientes que más lo necesitan. La solución puede conseguirse aumentando recursos humanos y materiales que mejoren la atención global del paciente, reforzando así tanto los hospitales de referencia como las unidades de epilepsia. (AU)
INTRODUCTION: Epilepsy is a very common neurological disease with high morbidity and mortality. Drug-resistant epilepsy (DRE) poses a major therapeutic challenge, even for experts in the field. Despite this, access to advanced resources for this type of patient remains difficult and unequal. The aim of this study is to analyse inequality in a population belonging to a first level hospital. PATIENTS AND METHODS An analytical observational cross-sectional study was conducted on epileptic patients attending neurology consultations in Area IX of the Murcian Health Service. Demographic, clinical, therapeutic, prognostic and equity variables are described, and significant differences between different subgroups are analysed. RESULTS The study included 68 patients with a mean age of 42.93 years. Focal epilepsy was the main type (64.7%), and the most commonly used drugs were levetiracetam (33.8%), valproic acid (27.9%) and lamotrigine (22.1%). DRE occurred in 18 patients (26.5% of the total) and only four were under active follow-up in an epilepsy unit, meaning that 71% did not have access to a necessary resource (advanced therapeutic gap). CONCLUSIONS This study demonstrates that epilepsy inequality continues to be a problem, especially in certain geographical areas, with a lack of access to advanced care for patients who need it most. The solution can be achieved by increasing human and material resources to improve overall patient care, thus strengthening both referral hospitals and epilepsy units. (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Epilepsy/drug therapy , Epilepsy/therapy , Drug Resistant Epilepsy/therapy , Health Status Disparities , Cross-Sectional Studies , Laboratory and Fieldwork Analytical Methods , Cost of Illness , Seizures , AnticonvulsantsABSTRACT
Objective: The aim of this study is to determine the financial burden of preeclampsia (PE) from a single institution's perspective and then determine the cost of the illness from the reimbursement institution perspective and finally draw a regression model that predicts the annual cost of a patient. Materials and methods: The research is a descriptive and cross-sectional type of research and a retrospective cost analysis. Patients diagnosed with PE in 2021 were included in the study. For the regression analysis of the study, a dataset with 29 parameters belonging to 65 patients was created. Regression models were built on top of it. Results: In our study, per-patient expenses of PE patients from the perspective of the reimbursement institution were calculated and presented as average costs; severe PE patient with cesarean section 7598.5 Ł ($769.8), severe PE patient with normal vaginal delivery 8487.48 Ł (1050.43 $), mild PE patient with cesarean section 5331.67 Ł ($659.86) and mild PE patient with normal vaginal delivery was calculated as 6220.65 Ł (769.88 $). In the study, different regression formulas were created for the two groups of PE. The created regression model had an R2 score of 91.85%. Conclusion: The actors involved in the management of the disease should determine the cost-effectiveness of the disease by using the financial data of the patients and choose the right approach. Health costs in Turkey differ from the parameters in the European Union economy. Therefore, there are lower health costs. The financial findings of the disease are a guide for health policy makers, health managers and researchers.(AU)
Objetivo: El objetivo de este estudio es determinar la carga financiera de la preeclampsia (PE) desde la perspectiva de una única institución, para luego determinar los costes de la enfermedad desde la perspectiva de la institución de reembolso, y así elaborar un modelo de regresión que prediga el coste anual de un paciente. Materiales y métodos: Se trata de una investigación de tipo descriptivo, transversal y de un análisis retrospectivo de costes. Se incluyeron en el estudio los pacientes diagnosticados de PE en 2021. Para el análisis de regresión del estudio se creó un conjunto de datos con 29 parámetros que pertenecían a 65 pacientes diferentes. Los modelos de regresión se construyeron en base a este. Resultados: En nuestro estudio, los gastos por paciente de las pacientes con PE desde la perspectiva de la institución de reembolso se calcularon y presentaron como costos promedio; paciente con PE grave con cesárea 7598.5 (769.8 $), paciente con PE grave con parto vaginal normal 8487.48 (1050.43 $), paciente con PE leve con cesárea 5331.67 (659.86 $) y paciente con PE leve con parto vaginal normal se calculó como 6220.65 (769.88 $). En el estudio se crearon diferentes fórmulas de regresión para los dos grupos de PE. El modelo de regresión creado tuvo una puntuación R2 de 91,85%. Conclusión: Los agentes implicados en la gestión de la enfermedad tendrán que determinar su rentabilidad utilizando los datos económicos de los pacientes y elegir el enfoque adecuado. Los costes sanitarios en Turquía difieren de los parámetros de la economía de la Unión Europea. Por tanto, los costes sanitarios se reducen. Los hallazgos financieros de la enfermedad servirán de guía para los responsables de las políticas de salud, los gerentes de salud y los investigadores.(AU)
Subject(s)
Humans , Pre-Eclampsia , Insurance, Health, Reimbursement , Regression Analysis , Cost of Illness , Obstetrics and Gynecology Department, Hospital , Gynecology , Research , Epidemiology, Descriptive , Retrospective Studies , Cross-Sectional StudiesABSTRACT
Mundialmente, así como en España, el consumo de drogas ilegales es uno los principales contribuyentes a la carga mundial de morbilidad. Cuantificar los costes que las drogas ilegales imponen a la sociedad es clave para la toma de decisiones. El objetivo de este trabajo es estimar el coste social del consumo de drogas ilegales en Cataluña para un año específico y establecer una metodología para poder replicar dichas estimaciones regularmente y monitorear el impacto de los planes nacionales. Se ha realizado un estudio de coste de la enfermedad. Para la estimación de los costes de mortalidad y morbilidad se ha utilizado el enfoque de la fracción atribuible. Solo se incluyeron los costes del sector público, sanitarios y no sanitarios. El coste del consumo de drogas ilegales en Cataluña en 2011 se estimó en 326,39 millones de (0,16% del PIB catalán en 2011; 0,15% en 2018). El 82% del coste total correspondió a costes directos; de estos, el 30,32% correspondió al sistema penal, 15,99% a hospitalizaciones, 13,48% a la policía, 17,19% a farmacia, 8,34% a tratamiento en centros especializados y 5,74% a comunidades terapéuticas, entre otros. Los costes indirectos representaron el 18% de los costes totales, principalmente pérdidas de productividad debidas a muertes por el consumo de drogas. Este estudio ha sido una oportunidad para recopilar datos de forma sistemática y pensar en los posibles rendimientos económicos que podrían obtenerse de políticas y programas efectivos destinados a reducir el consumo de drogas ilegales.(AU)
Worldwide, as well as in Spain, the use of illegal drugs is among the major contributors to the global burden of disease. Quantifying the costs that illegal drugs impose on society is key in terms of decision-making. The objective of this paper is to estimate the social cost of illicit drug consumption in Catalonia for a specific year, and to establish a methodology to be able to replicate such estimations regularly and monitor properly the impact of national plans. To do that, a cost of illness study was performed. For the estimation of mortality and morbidity costs, we relied on the Attributable Fraction approach. Only public sector costs were included: healthcare and non healthcare costs. The cost of illegal drug consumption in Catalonia in 2011 was estimated at 326.39 million (0.16% of the Catalan GDP in 2011; 0.15% in 2018). Of the total cost, 82% corresponded to direct costs. Among direct costs, 30.32% corresponded to the penal system, 15.99% to hospitalizations, 13.48% to the police force, 17.19% to pharmacy, 8.34% to treatment in specialized centres, and 5.74% to therapeutic communities, among others. Indirect costs represented 18% of total costs, mostly lost income due to drug-related death. This study has been an opportunity to systematically collect data and think about the potential economic returns that could be achieved from effective policies and programs aimed at reducing the consumption of illegal drugs.(AU)
Subject(s)
Humans , Illicit Drugs/economics , Costs and Cost AnalysisABSTRACT
OBJECTIVE: To systematically review guidance documents for the estimation of the social cost of illegal drugs, and to define standards for this estimation. METHOD: A systematic literature search was conducted between April and May 2015 and updated in November 2015. Pubmed, Scopus, and Google Scholar were searched. Studies were included only if they provided indications of analytical methods for calculating the social cost of illegal drugs consumption. RESULTS: A total of 21 papers were selected for a final review. Four main areas of discussion were identified: a) alternative theories for the framework design; b) basic concepts definition; c) theoretical issues in the application of the framework and; d) definition of the cost matrix and its elements. The review exercise enabled the definition of two analytical approaches, which are proposed as references for estimation in the field. CONCLUSIONS: although social cost is a well-established method in the literature, there is a lack of agreement on the most appropriate approaches in the area of estimation of the social cost of illegal drugs consumption. Moreover, the two analytical approaches proposed are aimed at promoting more research focused at sophisticating the methodology in the field.
Subject(s)
Cost of Illness , Guidelines as Topic , Illicit Drugs/economics , Substance-Related Disorders/economics , Costs and Cost Analysis , Crime/economics , Efficiency , Humans , Socioeconomic FactorsABSTRACT
INTRODUCTION: While the introduction of biologics has improved the quality of life of patients with psoriasis and psoriatic arthritis, it may have increased the economic burden of these diseases. OBJECTIVE: To perform a systematic review of studies on the costs associated with managing and treating psoriasis and psoriatic arthritis in 5 European countries: Germany, Spain, France, Italy, and the United Kingdom. METHODS: We undertook a systematic review of the literature (up to May 2015) using the MEDLINE and EMBASE databases. The methodological quality of the studies identified was evaluated using the Consolidated Health Economic Evaluation Reporting Standards checklist. We considered both direct costs (medical and nonmedical) and indirect costs, adjusted for country-specific inflation and converted to international dollars using purchasing power parity exchange rates for 2015 ($US PPP). RESULTS: The search retrieved 775 studies; 68.3% analyzed psoriasis and 31.7% analyzed psoriatic arthritis. The total annual cost per patient ranged from US $2,077 to US $13,132 PPP for psoriasis and from US $10,924 to US $17,050 PPP for psoriatic arthritis. Direct costs were the largest component of total expenditure in both diseases. The severity of these diseases was associated with higher costs. The introduction of biologics led to a 3-fold to 5-fold increase in direct costs, and consequently to an increase in total costs. CONCLUSIONS: We have analyzed the economic burden of psoriasis and psoriatic arthritis and shown that costs increase with the treatment and management of more severe disease and the use of biologics.
Subject(s)
Cost of Illness , Psoriasis/economics , Arthritis, Psoriatic/diagnosis , Arthritis, Psoriatic/economics , Arthritis, Psoriatic/therapy , France , Germany , Humans , Italy , Psoriasis/diagnosis , Psoriasis/therapy , Spain , United KingdomABSTRACT
OBJECTIVE: To analyse the disease burden in patients with diabetic macular oedema (DMO) or with retinal vein occlusion macular oedema (RVOMO) from a societal perspective. METHODS: Observational, cross-sectional, multicentre study conducted on patients >18 years old diagnosed with uni- or bilateral DMO or unilateral RVOMO. Data on the use of health resources from diagnosis was collected, and the impact of disease on work life was assessed. Costs were annualised (euros, January 2014). Differences were contrasted using Chi-squared test (or Fisher Exact test), Mann Whitney-U test or Kruskal-Wallis test (Dunn contrast). RESULTS: A total of 448 patients were included (DMO 255; RVOMO 193). There were significant differences in costs of diagnosis: RVOMO 1856, bilateral DMO 1661, and unilateral DMO 1401 (P<.001) and the aggregate medical costs: RVOMO 4639, bilateral DMO 6275 and unilateral DMO 6269 (P<.001). Cost by permanent time off work was higher in bilateral DMO 11712, than in unilateral DMO 4284, and than in RVOMO 1052 (P<.05). Linear regression analysis showed that variables associated with direct health costs were: Diagnosis (bilateral DMO was associated with higher cost), as well as number of days in hospital, number of visits, time of observation, and number of days of time off work. CONCLUSIONS: Patients with bilateral DMO are associated with a higher direct health cost, as well as a higher indirect cost by impact of the disease on work life.
Subject(s)
Diabetic Retinopathy/economics , Health Care Costs/statistics & numerical data , Health Expenditures/statistics & numerical data , Macular Edema/economics , Retinal Vein Occlusion/economics , Absenteeism , Adult , Aged , Aged, 80 and over , Costs and Cost Analysis , Cross-Sectional Studies , Diabetic Retinopathy/etiology , Diagnostic Techniques, Ophthalmological/economics , Female , Health Resources/economics , Health Resources/statistics & numerical data , Hospitalization/economics , Hospitalization/statistics & numerical data , Humans , Macular Edema/etiology , Male , Middle Aged , Office Visits/economics , Office Visits/statistics & numerical data , Quality of Life , Retinal Vein Occlusion/complications , Spain/epidemiologyABSTRACT
OBJECTIVE: To estimate the average treatment costs of pneumonia and meningitis among children under five years of age in a tertiary hospital in Hanoi, Vietnam from societal, health sector and household perspectives. METHODS: We used a cost-of-illness approach to identify cost categories to be included for different perspectives. A prospective survey was conducted among eligible patients to get detailed personal costing items. RESULTS: From the perspective of the health sector, the mean costs for treating a case of pneumonia and meningitis were USD 180 and USD 300, respectively. From the household's perspective, the average treatment costs were USD 272 for pneumonia and USD 534 for meningitis. When also including indirect costs, the average total treatment costs from the societal perspective were USD 318 for pneumonia and USD 727 for meningitis. CONCLUSION: The study contributed to limited evidence on the high treatment costs of pneumonia and meningitis to the Vietnamese society, which is useful for a cost-effectiveness analysis of Haemophilus influenzae type b vaccine or other relevant disease preventions. It also indicated a need to re-evaluate the health insurance policy for children under 6 years old, so that the unnecessarily high out-of-pocket costs of these diseases are reduced.
Subject(s)
Cost of Illness , Health Care Costs/statistics & numerical data , Hospital Costs/statistics & numerical data , Meningitis/economics , Meningitis/therapy , Pneumonia/economics , Pneumonia/therapy , Child, Preschool , Female , Health Expenditures/statistics & numerical data , Hospitalization/economics , Humans , Infant , Infant, Newborn , Male , Prospective Studies , Tertiary Care Centers/economics , VietnamABSTRACT
OBJECTIVES: To inform policy-making, we measured the risk, causes and consequences of catastrophic expenditures for tuberculosis and investigated potential inequities. METHODS: Between August 2008 and February 2009, a cross-sectional study was conducted among all (245) smear-positive pulmonary tuberculosis patients of six health districts from southern Benin. A standardised survey questionnaire covered the period of time elapsing from onset of tuberculosis symptoms to completion of treatment. Total direct cost exceeding the conventional 10% threshold of annual income was defined as catastrophic and used as principal outcome in a multivariable logistic regression. A sensitivity analysis was performed while varying the thresholds. RESULTS: A pure gradient of direct costs of tuberculosis in relation to income was observed. Incidence (78.1%) and intensity (14.8%) of catastrophic expenditure were high; varying thresholds was insensitive to the intensity. Incurring catastrophic expenditure was independently associated with lower- and middle-income quintiles (adjusted odd ratio (aOR) = 36.2, 95% CI [12.3-106.3] and aOR = 6.4 [2.8-14.6]), adverse pre-diagnosis stage (aOR = 5.4 [2.2-13.3]) and less education (aOR = 4.1[1.9-8.7]). Households incurred important days lost due to TB, indebtedness (37.1%), dissaving (51.0%) and other coping strategies (52.7%). CONCLUSIONS: Catastrophic direct costs and substantial indirect and coping costs may persist under the 'free' tuberculosis diagnosis and treatment strategy, as well as inequities in financial hardship.
Subject(s)
Cost of Illness , Financing, Personal , Health Expenditures , Income , Tuberculosis, Pulmonary/economics , Adult , Aged , Benin , Cross-Sectional Studies , Data Collection , Family Characteristics , Female , Humans , Male , Middle Aged , Odds Ratio , Socioeconomic Factors , Young AdultABSTRACT
Temporary disability is the condition that workers face when, as the result of illness (common or professional) or accident (work-related or not), they are temporarily prevented from performing their work and require health care. The management of temporary disability is a medical act that involves (in addition to a complex clinical assessment) obvious social, occupational and financial connotations and requires continuing medical follow-up from doctors, as well as responses to medical-legal conflicts. The regulatory framework on the subject is extensive in the Spanish setting and highly diverse in the European setting. Beyond the regulatory framework, the repercussions of temporary disability are self-evident at all levels. Although determining temporary disability is a common medical act for practicing physicians, it is not exempt from risks or difficulties arising from the assessment itself and the characteristics of practicing medical care. Established medical-legal conflicts include the processing of health data and the requirements for transferring information related to workers' temporary disability to their company's medical services. The interest and usefulness demonstrated by the data obtained from forensic medicine for public health require the incorporation of these data into general healthcare information, as it could be essential to the surveillance of worker health. The recommendations established by medical societies, as good practice guidelines, are especially useful in this type of conflict.
Subject(s)
Disability Evaluation , Liability, Legal , Return to Work/legislation & jurisprudence , Sick Leave/legislation & jurisprudence , Absenteeism , Confidentiality/legislation & jurisprudence , Cost of Illness , Europe , Forms and Records Control , Humans , Medical Records/legislation & jurisprudence , Occupational Health/legislation & jurisprudence , Practice Guidelines as Topic , Return to Work/ethics , Salaries and Fringe Benefits/legislation & jurisprudence , Sick Leave/statistics & numerical data , SpainABSTRACT
OBJECTIVE: To estimate the economic and health impact of chronic complications (macrovascular and microvascular) of type 2 diabetes mellitus (T2DM) in the autonomous community of Madrid (Spain) (ACM). METHODS: The number of expected complications was obtained from a descriptive, cross-sectional study on a cohort of 3,268 patients with T2DM from the ACM. Cost of complications (, 2012) was assessed both at hospitals and in primary care. The number of medical visits in primary care and drug treatment for complications were collected by a panel of 21 physicians experienced in treatment of T2DM. Population and epidemiological data and healthcare costs were obtained from Spanish sources. Univariate sensitivity analyses were performed. RESULTS: It is estimated that there are 390,944 patients with T2DM in the ACM, and that they experience 172,406 and 212,283 macrovascular and microvascular complications respectively during their lifetimes. Mean cost of T2DM complications per patient is estimated at 4,121.54 (66% due to macrovascular complications). The economic impact of T2DM complications in the ACM would be 1,611 million (1,065 and 545 millions from macrovascular and microvascular complications respectively). The economic impact would range from 1,249 and 2.509 million euro depending on T2DM prevalence. CONCLUSIONS: Complications of T2DM have a great health and economic impact in ACM.
Subject(s)
Cost of Illness , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/economics , Diabetic Angiopathies/economics , Health Impact Assessment , Aged , Cross-Sectional Studies , Female , Humans , Male , SpainABSTRACT
OBJECTIVES: [corrected] Underreporting of work-related cancer in the Basque Country (Spain) is massive. The aim of our study is to estimate the job-related cancer in the Basque Country in 2008 treated by the Basque Public Health System-Osakidetza, as well as the medical costs derived from its treatment in the same year. METHODS: Scientific evidence from industrialised countries is used to estimate the number of processes of cancer attributable to work. Medical costs for specialised care (outpatient and hospital admissions) are derived from the National Health System cost accounts. Costs due to primary health care and pharmaceutical benefits are obtained from Spanish secondary sources. Figures were computed according to disease and sex. RESULTS: We estimate 1,331 work-attributable cancers hospitalizations and 229 work-attributable cancers specialized ambulatory cases. Medical costs borne by public health care system exceed 10 million euros. Specialized care accounts for 64.2% of the total cost. Bronchus and lung cancer represents the largest percentage of total expenditure (27%), followed by the bladder cancer (12.6%), mesothelioma (8.6%), the colon cancer (7.3%), and stomach (6.7%). CONCLUSIONS: The magnitude of cancer attributable to work in the Basque Country is much higher than reflected in the official Registry of Occupational Diseases. Underreporting of work-related cancers hampers prevention and shifts funding of medical costs from social security to the tax-financed public health system.
