Comparative Analysis of the Efficiency of Two Treatment Protocols for Posterior Canal Benign Paroxysmal Positional Vertigo.

BACKGROUND AND OBJECTIVE: Benign paroxysmal positional vertigo (BPPV) is the most common vertigo of labyrinthine origin, its social and healthcare impact is remarkable. It has recently been shown that single session treatment is as safe and effective as weekly treatment, which could have impact on direct and indirect costs related to the disease. The objective of this study is to determine whether single session treatment of unilateral posterior canal BPPV canalolithiasis is more efficient than conventional treatment. MATERIALS AND METHODS: A prospective randomized controlled trial was performed in 53 consecutive patients diagnosed with unilateral posterior canal BPPV canalolithiasis previously untreated: 26 patients were assigned to single session treatment and 27 patients to weekly treatment. Average and total cost of care, consultation time and the impact in terms of temporary disability and loss of productivity for the company due to patients' medical visits were compared. RESULTS: Average and total cost of care and loss of productivity for the company due to patients' medical visits were significantly lower in the single session group. Consultation time was also better in this group when travelling time was considered. CONCLUSIONS: The single session protocol is fast, effective and reduces direct and indirect cost of care related to disease justifying high resolution consultations.

Análisis comparativo de la eficiencia de dos protocolos de tratamiento del vértigo posicional paroxístico benigno del conducto semicircular posterior / Comparative Analysis of the Efficiency of Two Treatment Protocols for Posterior Canal Benign Paroxysmal Positional Vertigo

Antecedentes y objetivo: El vértigo posicional paroxístico benigno (VPPB) es la causa más frecuente de vértigo de origen laberíntico; su impacto social y en términos de cuidados de salud es notable. Recientemente se ha demostrado que es clínicamente posible realizar el tratamiento y su comprobación en la misma sesión, lo cual podría tener repercusión en los costes asistenciales directos e indirectos relacionados con la enfermedad. El objetivo de este trabajo es determinar si el protocolo de tratamiento unisesión del VPPB CP unilateral tipo conductolitiasis es más eficiente que el protocolo de tratamiento convencional. Materiales y métodos: Estudio prospectivo controlado y aleatorizado en 53 pacientes consecutivos diagnosticados de un VPPB CP unilateral tipo conductolitiasis no tratados previamente; 26 pacientes fueron asignados al grupo unisesión y 27 al semanal clásico. Se compararon los costes medio y total de la asistencia, el tiempo de consulta y el impacto en términos de incapacidad temporal y pérdida de productividad para la empresa asociada a la visita médica del paciente. Resultados: Los costes medio y total de la asistencia así como la pérdida de productividad para una empresa asociada a la visita médica de los pacientes laboralmente activos fueron significativamente menores en el protocolo unisesión. También el tiempo de consulta cuando se consideró el tiempo de desplazamiento al centro. Conclusiones: El protocolo de tratamiento unisesión es rápido, efectivo y reduce los costes asistenciales directos e indirectos relacionados con la enfermedad justificando consultas de alta resolución. (AU)

Background and objective: Benign paroxysmal positional vertigo (BPPV) is the most common vertigo of labyrinthine origin, its social and healthcare impact is remarkable. It has recently been shown that single session treatment is as safe and effective as weekly treatment, which could have impact on direct and indirect costs related to the disease. The objective of this study is to determine whether single session treatment of unilateral posterior canal BPPV canalolithiasis is more efficient than conventional treatment. Materials and methods: A prospective randomized controlled trial was performed in 53 consecutive patients diagnosed with unilateral posterior canal BPPV canalolithiasis previously untreated: 26 patients were assigned to single session treatment and 27 patients to weekly treatment. Average and total cost of care, consultation time and the impact in terms of temporary disability and loss of productivity for the company due to patients’ medical visits were compared. Results: Average and total cost of care and loss of productivity for the company due to patients’ medical visits were significantly lower in the single session group. Consultation time was also better in this group when travelling time was considered. Conclusions: The single session protocol is fast, effective and reduces direct and indirect cost of care related to disease justifying high resolution consultations. (AU)

Los costes indirectos de la cefalea tensional. Una revisión sistemática de la literatura / The indirect costs of tension type headache. A systematic literature review

Objetivo: El objetivo de este trabajo fue revisar sistemáticamente la literatura publicada con relación a los costes indirectos estimados asociados al TTH.DiseñoEsta revisión sistemática siguió la declaración de elementos de informes preferidos para revisiones sistemáticas y metaanálisis (PRISMA).Fuentes de datosLa revisión se realizó en dos bases de datos principales, PubMed y EconLit, y fue completada con la búsqueda de literatura gris.Selección de estudiosEl criterio básico para la inclusión de estudios fue que presentaran al menos una medida de costes indirectos específicos del TTH.Extracción de datosSe seleccionaron finalmente 12 estudios para la extracción de la información. De todos los artículos seleccionados se sintetizaron las características del diseño del estudio, los tipos de coste incluidos, así como el instrumento de medida, y los resultados principales.ResultadosLa búsqueda arrojó en total 568 estudios. Se encontró heterogeneidad en los diseños y muestras/poblaciones de los estudios incluidos. Sólo dos estudios estimaron costes directos e indirectos para el TTH. Entre los resultados más destacables, encontramos un impacto moderado estimado de la discapacidad por TTH (entre 0,037 y 0,15 por persona, 0,06-0,09% para la población). Las pérdidas de productividad y eficiencia se observaron y fueron muy heterogéneas. La disposición a pagar por un tratamiento efectivo oscilaría entre $1,32 y $9,20 mensuales. La calidad de vida es baja, entre 28,2 y 28,4 puntos sobre 100, y la calidad de vida relacionada con la salud, parece mejorar significativamente con un tratamiento.ConclusionesA pesar de la elevada heterogeneidad de los resultados, podemos concluir que la cefalea tensional se caracteriza por un impacto moderado en la discapacidad, en la productividad y eficiencia en el trabajo o la escuela, y en la calidad de vida de quien la sufre.

Objective: The objective of this work was to systematically review the published literature in relation to the estimated indirect costs associated with TTH.DesignThis systematic review followed the Preferred Reporting Items Statement for Systematic Reviews and Meta-analyzes (PRISMA).Data sourcesThe review was performed in two main databases, PubMed and EconLit, and was completed with the gray literature search.Study selectionThe basic criterion for the inclusion of studies was that they present at least one measure of indirect costs specific to TTH.Data extraction12 studies were finally selected for information extraction. Of all the selected articles, the characteristics of the study design, the types of costs included, as well as the measurement instrument, and the main results were synthesized.ResultsThe search yielded a total of 568 studies. Heterogeneity was found in the designs and samples/populations of the included studies. Only two studies estimated direct and indirect costs for TTH. Among the most notable results, we find an estimated moderate impact of disability due to TTH (between 0.037 and 0.15 per person, 0.06–0.09% for the population). Productivity and efficiency losses were observed and were very heterogeneous. The willingness to pay for effective treatment would range from $1.32 to $9.20 per month. Quality of life is low, between 28.2 and 28.4 points out of 100, and health-related quality of life seems to improve significantly with treatment.ConclusionsDespite the high heterogeneity of the results, we can conclude that tension headache is characterized by a moderate impact on disability, on productivity and efficiency at work or school, and on the quality of life of those who suffer it.

[The indirect costs of tension type headache. A systematic literature review]. / Los costes indirectos de la cefalea tensional. Una revisión sistemática de la literatura.

OBJECTIVE: The objective of this work was to systematically review the published literature in relation to the estimated indirect costs associated with TTH. DESIGN: This systematic review followed the Preferred Reporting Items Statement for Systematic Reviews and Meta-analyzes (PRISMA). DATA SOURCES: The review was performed in two main databases, PubMed and EconLit, and was completed with the gray literature search. STUDY SELECTION: The basic criterion for the inclusion of studies was that they present at least one measure of indirect costs specific to TTH. DATA EXTRACTION: 12 studies were finally selected for information extraction. Of all the selected articles, the characteristics of the study design, the types of costs included, as well as the measurement instrument, and the main results were synthesized. RESULTS: The search yielded a total of 568 studies. Heterogeneity was found in the designs and samples/populations of the included studies. Only two studies estimated direct and indirect costs for TTH. Among the most notable results, we find an estimated moderate impact of disability due to TTH (between 0.037 and 0.15 per person, 0.06-0.09% for the population). Productivity and efficiency losses were observed and were very heterogeneous. The willingness to pay for effective treatment would range from $1.32 to $9.20 per month. Quality of life is low, between 28.2 and 28.4 points out of 100, and health-related quality of life seems to improve significantly with treatment. CONCLUSIONS: Despite the high heterogeneity of the results, we can conclude that tension headache is characterized by a moderate impact on disability, on productivity and efficiency at work or school, and on the quality of life of those who suffer it.

Comparative analysis of the efficiency of two treatment protocols for posterior canal benign paroxysmal positional vertigo. / Análisis comparativo de la eficiencia de dos protocolos de tratamiento del vértigo posicional paroxístico benigno del conducto semicircular posterior.

BACKGROUND AND OBJECTIVE: Benign paroxysmal positional vertigo (BPPV) is the most common vertigo of labyrinthine origin, its social and healthcare impact is remarkable. It has recently been shown that single session treatment is as safe and effective as weekly treatment, which could have impact on direct and indirect costs related to the disease. The objective of this study is to determine whether single session treatment of unilateral posterior canal BPPV canalolithiasis is more efficient than conventional treatment. MATERIALS AND METHODS: A prospective randomized controlled trial was performed in 53 consecutive patients diagnosed with unilateral posterior canal BPPV canalolithiasis previously untreated: 26 patients were assigned to single session treatment and 27 patients to weekly treatment. Average and total cost of care, consultation time and the impact in terms of temporary disability and loss of productivity for the company due to patients' medical visits were compared. RESULTS: Average and total cost of care and loss of productivity for the company due to patients' medical visits were significantly lower in the single session group. Consultation time was also better in this group when travelling time was considered. CONCLUSIONS: The single session protocol is fast, effective and reduces direct and indirect cost of care related to disease justifying high resolution consultations.

The opportunity costs of caring for people with dementia in Southern Spain.

OBJECTIVE: The aim of this paper is to study the opportunity costs (OC) that are involved in being a caregiver and to compare them with the direct costs assumed by the State and the families. We evaluate direct cost (those that imply a payment-out-of-pocket) and indirect cost (those that imply a dedication in time). We hypothesized that costs increase with the severity of the dementia, with the educational level and active occupational situation of caregiver. They are greater if the caregiver is male, but if the patient and caregiver cohabit they are reduced. METHOD: 778 surveys were analyzed. Data was collected using a questionnaire specifically designed for the purpose, with the collaboration of Alzheimer's Diseases Associations in Andalusia (Spain). For the indirect cost, we used the reveal preferences method. For the comparison between groups an ANOVA and a MANOVA was done. RESULTS: The hypotheses were confirmed. The OC exponentially increases with severity. More than 55% of costs are assumed by families. Occupied people have higher educational level and incomes and contract more external support. Costs are significantly higher for male caregivers. Cohabiting reduces all kinds of costs. CONCLUSIONS: The relationship between educational level and employment situation lead to think that if these variables are greater more people will seek professional support. Cultural reasons still maintain women as main caregivers for all educational levels. The existence of these informal caregivers as the main care providers is a saving for the State, and a brake for the development of professional supply.

[Economic impact of cognitive impairment and dementia]. / Impacto económico del deterioro cognitivo y la demencia.

Increased life expectancy has had a corresponding socioeconomic impact due to the ageing population and, among other issues, has increased the incidence of diseases related to cognitive impairment, such as dementia. These changes particularly affect the most developed countries. Any analysis of economic costs aiming to study patients with health problems related to cognitive impairment or dementia should consider the reality of the distinct phases of these disorders and should be conducted from the perspective of the payer, that is, the publicly-funded healthcare system. Moreover, given the complexity and importance of cognitive impairment, there is a need to consider both direct healthcare costs, such as hospitalization measures, medication for the treatment of these diseases, specialist consultations, transport (eg, ambulances in severe cases), and direct non-healthcare costs (eg, professional care, nonprofessional care). In addition, indirect costs (related to productivity losses such as sick leave) must be considered for these diseases. Lastly, in 2014, the annual total mean cost (direct and indirect costs) in Spain for each patient with cognitive impairment, dementia and Alzheimer disease, was around €30 000. A large part of this economic burden was due especially to indirect costs, which are usually a borne by affected individuals and their families.

Cost of myopic patients with and without myopic choroidal neovascularisation. / Costes en pacientes miopes magnos con y sin neovascularización coroidea miópica.

OBJECTIVE: To study the costs associated with high myopia (HM) with choroidal neovascularisation (mCNV) or without mCNV. METHODS: Observational, retrospective, cross-sectional, and multicentre study (HM and mCNV) conducted on adult patients. Annualised medical direct cost (MDC) from the perspective of the National Health System, the non-medical direct cost (nMDC) from the patient perspective, and productivity losses were calculated. RESULTS: A total of 137 mCNV and 48 HM patients were included (mean age [SD]: 55.1 [2.8] vs. 54.7 [13.8]; P=.2), with 80% women in both groups. The observation time (months) ranged from 17.9 (9.6) right eye (RE) and 20.0 (9.7), left eye (LE) in mCNV and 47.1 (21.5) RE/45.5 (20.7) LE in MM. A higher percentage of emergency room visits was observed in mCNV vs. HM patients (41.7 vs. 25%; P=.06) and retinal specialists (91.2 vs. 77.1%; P=.01). The MDC was higher in mCNV: € 1,985 (95% CI: 1772-2198) vs. € 356 (251-480) HM, P<.001. The nMDC was also higher in mCNV: € 256 (11-524) vs. €19 (11-26) HM, P>.4. The number of affected eyes, the follow-up time, and the mCNV were factors associated with direct costs. The impact on work productivity was higher in mCNV (quite/very concerned): 27.7 vs. 10.4% HM. The mCNV showed a significant association with activity impairment (OR: 3.47, 95% CI: 10.101-1.195). CONCLUSIONS: mCNV involves higher medical costs than HM. In addition, mCNV patients have a greater need of care and assistive devices, and greater impact of the disease in their work productivity.

Productivity loss due to premature mortality caused by blood cancer: a study based on patients undergoing stem cell transplantation.

INTRODUCTION: Stem cell transplantation has been used for many years to treat haematological malignancies that could not be cured by other treatments. Despite this medical breakthrough, mortality rates remain high. Our purpose was to evaluate labour productivity losses associated with premature mortality due to blood cancer in recipients of stem cell transplantations. METHODS: We collected primary data from the clinical histories of blood cancer patients who had undergone stem cell transplantation between 2006 and 2011 in two Spanish hospitals. We carried out a descriptive analysis and calculated the years of potential life lost and years of potential productive life lost. Labour productivity losses due to premature mortality were estimated using the Human Capital method. An alternative approach, the Friction Cost method, was used as part of the sensitivity analysis. RESULTS: Our findings suggest that, in a population of 179 transplanted and deceased patients, males and people who die between the ages of 30 and 49 years generate higher labour productivity losses. The estimated loss amounts to over €31.4 million using the Human Capital method (€480,152 using the Friction Cost method), which means an average of €185,855 per death. The highest labour productivity losses are produced by leukaemia. However, lymphoma generates the highest loss per death. CONCLUSIONS: Further efforts are needed to reduce premature mortality in blood cancer patients undergoing transplantations and reduce economic losses.

Economic impact of heart failure according to the effects of kidney failure.

INTRODUCTION AND OBJECTIVES: To evaluate the use of health care resources and their cost according to the effects of kidney failure in heart failure patients during 2-year follow-up in a population setting. METHODS: Observational retrospective study based on a review of medical records. The study included patients ≥ 45 years treated for heart failure from 2008 to 2010. The patients were divided into 2 groups according to the presence/absence of KF. Main outcome variables were comorbidity, clinical status (functional class, etiology), metabolic syndrome, costs, and new cases of cardiovascular events and kidney failure. The cost model included direct and indirect health care costs. Statistical analysis included multiple regression models. RESULTS: The study recruited 1600 patients (prevalence, 4.0%; mean age 72.4 years; women, 59.7%). Of these patients, 70.1% had hypertension, 47.1% had dyslipidemia, and 36.2% had diabetes mellitus. We analyzed 433 patients (27.1%) with kidney failure and 1167 (72.9%) without kidney failure. Patients with kidney failure were associated with functional class III-IV (54.1% vs 40.8%) and metabolic syndrome (65.3% vs 51.9%, P<.01). The average unit cost was €10,711.40. The corrected cost in the presence of kidney failure was €14,868.20 vs €9,364.50 (P=.001). During follow-up, 11.7% patients developed ischemic heart disease, 18.8% developed kidney failure, and 36.1% developed heart failure exacerbation. CONCLUSIONS: Comorbidity associated with heart failure is high. The presence of kidney failure increases the use of health resources and leads to higher costs within the National Health System.

Cost of temporary work disability due to musculoskeletal diseases in Spain.

OBJECTIVE: To estimate the annual cost of temporary work disability (TWD) caused by musculoskeletal diseases (MSDs) in Spain and its variations between regions (autonomous communities: ACs) and paying institutions. METHOD: Descriptive study of the costs of MSD-related TWD in ACs in 2007. The Spanish National Institute of Social Security (NISS) provided aggregate data. Extrapolations to the rest of the TWD payers (mutual societies and employers) were used. RESULTS: MSDs were the leading cause of TWD in Spain in 2007, causing 908,781 episodes of TWD (18% of the total), 39,342,857 lost working days (23%), and a cost of 1,702 million euros (23%). The annual incidence of TWD episodes per 1,000 employed was 45. The cost per TWD process was 1,873 €, ranging from 1,391 € (La Rioja) to 2,429 € (Basque Country). CONCLUSION: MSDs produce annually in Spain over 39 million days lost by TWD with a cost of over 1,700 million euros. Regions observed wide variations of the TWD cost.

[Coverage and costs of opportunistic screening for cervical cancer in Cantabria (Spain)]. / Cobertura y costes del cribado oportunista de detección precoz del cáncer de cuello uterino en Cantabria.

OBJECTIVE: To analyze cervical cancer screening performed in Cantabria by evaluating the coverage and costs of screening and by calculating the available direct costs of the disease and the indirect costs of cervical cancer mortality. METHODS: Screening for cervical cancer is performed in women aged between 21 and 65. According to the census for 2011 in Cantabria, there were 189.111 women in this age group. We performed a cross sectional, quantitative and qualitative study of the Pap smears performed and analyzed the direct and indirect costs of cervical cancer. RESULTS: Between 2006 and 2011, 51% of women studied had one Pap smear, and 26% had two. In 2011, 31.554 Pap smears were performed in opportunistic screening in Cantabria, and the direct cost was 2,904.760 €. The annual direct cost of cervical cancer (average 2008-2010) was 567.567 €. The annual indirect costs (average 2001-2008) of cervical cancer was 386.122.02 €, in the reference scenario considered. CONCLUSIONS: Only 26% of women in Cantabria attended screening within the intervals recommended in the current opportunistic protocol. The cost data provided in this study may be useful for future economic evaluations.