ABSTRACT
BACKGROUND: Orbital and intracranial complications of pediatric acute rhinosinusitis (ARS) are uncommon. With a risk of significant morbidity, hospital utilization and the financial burden of these entities are often high. We sought to assess utilization trends for complicated ARS and elucidate which factors influence cost. METHODOLOGY: Analysis of Kids' Inpatient Database (2006, 2009 and 2012). Children were selected based on diagnosis codes for ARS and grouped as: uncomplicated ARS, orbital complications (OC), or intracranial complications (IC). Patients with IC were subdivided into abscess (ICa), meningitis, or sinus thrombosis. Length of stay (LOS), cost and management information were analysed. Data presented as median [IQR]. RESULTS: A weighted total of 20,775 children were included. OC and IC were observed in 10.9% and 2.7% of these patients. LOS was longer for IC compared to OC (9 [8] v 4 [3]days, pâ¯<â¯0.001). Daily cost for IC was greater than OC ($2861 [4044] v $1683 [1187], pâ¯<â¯0.001), likely due to differences in need for surgery (IC 66.3% v OC 37.1%, pâ¯<â¯0.001). Within the ICa group, patients who received both otolaryngologic (ENT) and neurosurgery, compared to neurosurgery alone, had higher total cost ($41,474 [41,976] v $32,299 [18,235], pâ¯<â¯0.001) but similar LOS (12 [10] v 11 [9] days, pâ¯=â¯0.783). CONCLUSIONS: Children with IC required more surgery than their OC counterparts, resulting in a longer LOS and increased cost. Within the ICa group, the addition of ENT surgery to neurosurgery resulted in higher costs, but with a similar LOS. Considering the increased costs, the additional benefit of ENT surgery to those with children with IC should be investigated further.
Subject(s)
Central Nervous System Diseases/economics , Health Care Costs/statistics & numerical data , Length of Stay/statistics & numerical data , Orbital Diseases/economics , Rhinitis/complications , Sinusitis/complications , Acute Disease , Adolescent , Brain Abscess/economics , Brain Abscess/etiology , Brain Abscess/surgery , Central Nervous System Diseases/etiology , Central Nervous System Diseases/surgery , Child , Databases, Factual , Female , Humans , Male , Meningitis/economics , Meningitis/etiology , Meningitis/surgery , Neurosurgical Procedures/economics , Orbital Diseases/etiology , Orbital Diseases/surgery , Otorhinolaryngologic Surgical Procedures/economics , Sinus Thrombosis, Intracranial/economics , Sinus Thrombosis, Intracranial/etiology , Sinus Thrombosis, Intracranial/surgeryABSTRACT
Over the course of a year, more than 20,000 patients in Taiwan require prolonged mechanical ventilation (PMV). Data from the National Health Insurance Research Database for patients between 2005 and 2011 were used to conduct a retrospective analysis on ventilator dependence. The study subjects were PMV patients aged <17 years in Taiwan. A multiple regression model employing general estimating equations was applied to investigate the factors affecting the use of medical resources by children and adolescent PMV patients. A Cox proportional hazard model was incorporated to explore the factors affecting the survival of these patients. Data were collected for a total of 1,019 children and adolescent PMV patients in Taiwan. The results revealed that the average number of outpatient visits per subject was 32.1 times per year, whereas emergency treatments averaged 1.56 times per year per subject and hospitalizations averaged 160.8 days per year per subject. Regarding average annual medical costs, hospitalizations accounted for the largest portion at NT$821,703 per year per subject, followed by outpatient care at NT$123,136 per year per subject and emergency care at NT$3,806 per year per subject. The demographic results indicated that the patients were predominately male (61.24%), with those under 1 year of age accounting for the highest percentage (36.38%). According to the Kaplan-Meier curve, the 1-year and 5-year mortality rates of the patients were approximately 32% and 47%, respectively. The following factors affecting the survival rate were considered: age, the Charlson Comorbidity Index (CCI), diagnosis type necessitating ventilator use, and whether an invasive ventilator was used. This study investigated the use of medical resources and the survival rates of children and adolescent PMV patients. The findings of this study can serve as a reference for the National Health Insurance Administration in promoting its future integrated pilot projects on ventilator dependency.
Subject(s)
Respiration, Artificial , Respiratory Insufficiency/pathology , Adolescent , Central Nervous System Diseases/economics , Central Nervous System Diseases/mortality , Central Nervous System Diseases/pathology , Child , Child, Preschool , Female , Health Care Costs , Hospitalization/economics , Humans , Infant , Infant, Newborn , Kaplan-Meier Estimate , Male , National Health Programs , Proportional Hazards Models , Respiration, Artificial/economics , Respiratory Insufficiency/economics , Respiratory Insufficiency/mortality , Retrospective Studies , TaiwanABSTRACT
INTRODUCTION: The incidence in the central nervous system diseases has increased with a growing elderly population. Unfortunately, conventional treatments used to treat the mentioned diseases are frequently ineffective due to the presence of the blood brain barrier. AIM: To illustrate the blood-brain barrier properties that limit drug transport into the brain and the main strategies employed to treat neurologic disorders. DEVELOPMENT: The blood-brain barrier is mainly composed of a specialized microvascular endothelium and of glial cells. It constitutes a valuable tool to separate the central nervous system from the rest of the body. Nevertheless, it also represents an obstacle to the delivery of therapeutic drugs to the brain. CONCLUSIONS: To be effective, drugs must reach their target in the brain. On one hand, therapeutic agents could be designed to be able to cross the blood brain barrier. On the other hand, drug delivery systems could be employed to facilitate the therapeutic agents' entry into the central nervous system. In vivo models of neurological diseases, in addition to in vitro models of the blood brain barrier, have been widely employed for the evaluation of drugs utilized to treat central nervous system diseases.
TITLE: Afecciones neurologicas y barrera hematoencefalica. Limitaciones y estrategias para la liberacion de farmacos al cerebro.Introduccion. La incidencia de enfermedades del sistema nervioso central (SNC) aumenta a causa del envejecimiento de la sociedad. Desgraciadamente, los tratamientos clasicos para tratarlas no resultan efectivos debido a la presencia de la barrera hematoencefalica. Objetivo. Abordar las propiedades de la barrera hematoencefalica que impiden el transporte de los farmacos al cerebro y las principales estrategias para tratar las afecciones neurologicas. Desarrollo. La barrera hematoencefalica esta compuesta principalmente por un endotelio vascular especializado y las celulas de la glia. Esta constituye una herramienta a disposicion del organismo para aislar al SNC del resto del cuerpo. Sin embargo, tambien supone un impedimento para que muchos farmacos alcancen su diana en el cerebro. Conclusiones. Para poder tratar las afecciones neurologicas, los farmacos deben ser capaces de alcanzar el cerebro. Los agentes terapeuticos pueden diseñarse para que sean capaces de atravesar esta barrera, o bien facilitar su entrada mediante el uso de sistemas de liberacion. Para evaluar la efectividad de los tratamientos dirigidos a enfermedades del SNC, se emplean los modelos animales de enfermedades neurologicas asi como modelos in vitro de barrera hematoencefalica.
Subject(s)
Blood-Brain Barrier , Central Nervous System Agents/pharmacokinetics , Central Nervous System Diseases/drug therapy , Drug Delivery Systems , Adult , Aged , Aged, 80 and over , Astrocytes/physiology , Blood-Brain Barrier/cytology , Blood-Brain Barrier/physiology , Central Nervous System Agents/administration & dosage , Central Nervous System Diseases/economics , Central Nervous System Diseases/epidemiology , Drug Carriers , Endothelial Cells/physiology , Endothelium, Vascular/physiology , Female , Humans , Incidence , Male , Middle Aged , Neurons/physiology , Pericytes/physiology , PrevalenceSubject(s)
AIDS-Related Opportunistic Infections/diagnosis , Acquired Immunodeficiency Syndrome/diagnosis , Central Nervous System Diseases/diagnosis , Health Services Accessibility/statistics & numerical data , Immune Reconstitution Inflammatory Syndrome/diagnosis , Leukoencephalopathy, Progressive Multifocal/diagnosis , Tuberculosis, Pulmonary/diagnosis , AIDS-Related Opportunistic Infections/drug therapy , AIDS-Related Opportunistic Infections/economics , Acquired Immunodeficiency Syndrome/drug therapy , Acquired Immunodeficiency Syndrome/economics , Anti-HIV Agents/administration & dosage , Anti-HIV Agents/economics , Antitubercular Agents/administration & dosage , Antitubercular Agents/economics , Central Nervous System Diseases/drug therapy , Central Nervous System Diseases/economics , Developing Countries , Diagnosis, Differential , Female , Health Resources , Health Services Accessibility/economics , Humans , Immune Reconstitution Inflammatory Syndrome/drug therapy , Immune Reconstitution Inflammatory Syndrome/economics , Leukoencephalopathy, Progressive Multifocal/drug therapy , Leukoencephalopathy, Progressive Multifocal/economics , Male , Poverty , Risk Factors , Tuberculosis, Pulmonary/drug therapy , Tuberculosis, Pulmonary/economics , Viral LoadSubject(s)
Biomedical Research/economics , Biomedical Research/statistics & numerical data , Central Nervous System Diseases/economics , Neurosciences/economics , Neurosciences/statistics & numerical data , Translational Research, Biomedical/trends , Animals , Biomedical Research/trends , Central Nervous System Diseases/epidemiology , Clinical Trials as Topic/economics , Clinical Trials as Topic/trends , Drug Industry/economics , Drug Industry/statistics & numerical data , Drug Industry/trends , Health Care Costs/statistics & numerical data , Humans , Male , Nerve Regeneration/drug effects , Nerve Regeneration/physiology , Neurosciences/organization & administration , Precision Medicine/methods , Precision Medicine/trends , Prevalence , Spinal Cord Injuries/drug therapy , Spinal Cord Injuries/physiopathology , Stroke/prevention & control , Stroke/therapy , Translational Research, Biomedical/organization & administrationABSTRACT
We describe the process of establishing a large database for the investigation of craniotomy infection and the preliminary results of this database. The initial results have been used to generate a cost analysis for craniotomy infection. The craniotomy infections database prospectively registers craniotomy cases taking place in the John Radcliffe Hospital. In order to achieve this, each patient's details are registered at the time of operation and followed up to identify cases of infection. Infection was defined strictly according to Centre for Disease Control criteria and validated by at least two members of clinical staff. The first 10 months of data are presented here which identifies a total of 245 craniotomies and 20 verified craniotomy infections. An overall infection rate of 8% is identified, and the cost incurred by the neurosurgery department as a result of craniotomy infections is estimated at £1 85 660 for the 10-month period studied. This amounts to a cost per case of infection of £9283.
Subject(s)
Central Nervous System Diseases/economics , Craniotomy/economics , Infections/economics , Central Nervous System Diseases/etiology , Central Nervous System Diseases/mortality , Costs and Cost Analysis , Craniotomy/adverse effects , Craniotomy/mortality , Data Collection/economics , Data Collection/methods , Databases, Factual , Female , Follow-Up Studies , Humans , Infections/etiology , Infections/mortality , Length of Stay , Male , Middle Aged , Postoperative Complications/economics , Postoperative Complications/etiology , Prospective Studies , Reoperation/economics , Surgical Wound Infection/economicsSubject(s)
Central Nervous System Diseases/drug therapy , Drug Discovery/legislation & jurisprudence , Neurosciences/methods , Research/legislation & jurisprudence , Central Nervous System Diseases/economics , Central Nervous System Diseases/metabolism , Clinical Trials as Topic , Europe , Humans , Molecular Targeted TherapyABSTRACT
PURPOSE OF REVIEW: Cost-effective neurorehabilitation is essential owing to financial constraints on healthcare resources. Technologies have the potential to contribute but without strong clinical evidence are unlikely to be widely reimbursed. This review presents evidence of new technologies since 2008 and identifies barriers to translation of technologies into clinical practice. RECENT FINDINGS: Technology has not been shown to be superior to intensively matched existing therapies. Research has been undertaken into the development and preliminary clinical testing of novel technologies including robotics, electrical stimulation, constraint-induced movement therapy, assistive orthoses, noninvasive brain stimulation, virtual reality and gaming devices. Translation of the research into clinical practice has been impeded by a lack of robust evidence of clinical effectiveness and usability. Underlying mechanisms associated with recovery are beginning to be explored, which may lead to more targeted interventions. Improvements in function have been demonstrated beyond the normal recovery period, but few trials demonstrate lasting effects. SUMMARY: Technologies, alone or combined, may offer a cost-effective way to deliver intensive neurorehabilitation therapy in clinical and community environments, and have the potential to empower patients to take more responsibility for their rehabilitation and continue with long-term exercise.
Subject(s)
Central Nervous System Diseases/rehabilitation , Clinical Laboratory Techniques/instrumentation , Clinical Laboratory Techniques/trends , Physical Therapy Modalities/instrumentation , Physical Therapy Modalities/trends , Activities of Daily Living , Central Nervous System Diseases/economics , Clinical Laboratory Techniques/economics , Cost-Benefit Analysis/economics , Electric Stimulation Therapy/economics , Electric Stimulation Therapy/instrumentation , Electric Stimulation Therapy/methods , Health Care Costs/trends , Humans , Outcome Assessment, Health Care/economics , Outcome Assessment, Health Care/methods , Physical Therapy Modalities/economics , Reimbursement Mechanisms/economics , Reimbursement Mechanisms/trends , Robotics/economics , Robotics/instrumentation , Robotics/trendsSubject(s)
Central Nervous System Diseases/epidemiology , Central Nervous System Diseases/immunology , Hypersensitivity/epidemiology , Rhinitis/epidemiology , Asthma/epidemiology , Central Nervous System Diseases/economics , Comorbidity , Depression/epidemiology , Depression/immunology , Environmental Exposure/economics , Health Care Costs/statistics & numerical data , Humans , Hypersensitivity/economics , Low Back Pain/epidemiology , Low Back Pain/immunology , Sinusitis/epidemiology , United States/epidemiologyABSTRACT
Bovine pericardium has been widely used for grafts in cardiac surgery and seems to have suitable properties for use as a dural graft. We report on the use of solvent-preserved, gamma-sterilized Tutoplast bovine pericardium for dural grafts in 32 patients undergoing cranial and spinal operations with the objective of clinically assessing this material and technique by a retrospective analysis. All available records were reviewed and information regarding the indication for grafting, complications, and outcome were collected and analyzed for all patients. Indications for grafting included tethered cord myelolysis, closure of lumbosacral myeloceles, Chiari decompression, posterior fossa craniotomy, supratentorial craniotomy, and trauma. Outcomes were excellent in 31 patients; the one poor outcome was unrelated to surgical closure. The dural graft was not intended for outcome in any patient. Bovine pericardium was found to be a flexible and easily suturable, safe and cost-effective material for duraplasty. These results confirm the excellent suitability of Tutoplast bovine pericardium for dural substitution.
Subject(s)
Bioprosthesis , Central Nervous System Diseases/surgery , Dura Mater/surgery , Pericardium/transplantation , Adolescent , Adult , Aged , Aged, 80 and over , Animals , Cattle , Central Nervous System Diseases/economics , Child , Child, Preschool , Female , Humans , Infant , Male , Medical Records , Middle Aged , Retrospective Studies , Tissue Preservation/economics , Treatment OutcomeABSTRACT
Low birthweight is costly to sufferers and to society. Primary prevention gives benefits exceeding costs, but many plans to prevent low birthweight, for example improvement in antenatal care, have failed because the intervention is too late. Preconception care is generally necessary. Poor maternal nutrition and infection are the major causes of low birthweight.
Subject(s)
Central Nervous System Diseases/prevention & control , Fetal Growth Retardation/prevention & control , Infant, Low Birth Weight , Intellectual Disability/prevention & control , Central Nervous System Diseases/economics , Central Nervous System Diseases/embryology , Central Nervous System Diseases/epidemiology , Cost of Illness , Female , Fetal Growth Retardation/complications , Fetal Growth Retardation/physiopathology , Humans , Infant, Low Birth Weight/physiology , Infant, Newborn , Intellectual Disability/economics , Intellectual Disability/embryology , Intellectual Disability/epidemiology , Male , Pregnancy , Prenatal Care , Risk FactorsABSTRACT
OBJECTIVE: To determine the incremental cost-effectiveness of magnetic resonance imaging (MRI) and computed tomography (CT) in young adults presenting with equivocal neurological signs and symptoms. DESIGNS AND METHODS: A decision analysis of long-term survival using accuracy data from a diagnostic technology assessment of MRI and CT in patients with suspected multiple sclerosis, information from the medical literature, and clinical assumptions. MAIN RESULTS: In the baseline analysis, at 30% likelihood of an underlying neurologic disease, MRI use has an incremental cost of $101,670 for each additional quality-adjusted life-year saved compared with $20,290 for CT use. As the probability of disease increases, further MRI use becomes a cost-effective alternative costing $30,000 for each quality-adjusted life-year saved. If a negative MRI result provides reassurance, the incremental costs of immediate MRI use decreases and falls below $25,000 for each quality-adjusted life-year saved no matter the likelihood of disease. CONCLUSIONS: For most individuals with neurological symptoms or signs, CT imaging is cost-effective while MR imaging is not. The cost-effectiveness of MRI use, however, improves as the likelihood of an underlying neurological disease increases. For selected patients who highly value diagnostic information, MRI is a reasonable and cost-effective use of medical resources when even the likelihood of disease is quite low (5%).
Subject(s)
Central Nervous System Diseases/diagnosis , Magnetic Resonance Imaging/economics , Adult , Central Nervous System Diseases/economics , Cost-Benefit Analysis , Decision Support Techniques , Female , Humans , Multiple Sclerosis/diagnosis , Multiple Sclerosis/economics , Quality-Adjusted Life Years , Tomography, X-Ray Computed/economicsABSTRACT
Magnetic resonance imaging offers new and improved diagnostic capabilities in all body parts and organ systems. Examinations can be quicker, safer and less expensive than traditional radiological procedures. The cost/efficiency of magnetic resonance imaging is under active evaluation.
Subject(s)
Magnetic Resonance Imaging/economics , Central Nervous System Diseases/diagnosis , Central Nervous System Diseases/economics , Cost-Benefit Analysis , Humans , Magnetic Resonance Angiography/economics , Musculoskeletal Diseases/diagnosis , Musculoskeletal Diseases/economicsABSTRACT
Because the federal government's diagnosis-related group (DRG) classification system for prospective payment has not been widely applied to hospitalized pediatric patients, we analyzed the effectiveness of one DRG category (central nervous system infections) for a single year at a medium-sized children's hospital to control for patients' severity of illness and for hospital reimbursement. Several independent measures of severity of illness (length of stay, duration of fever, Physiologic Severity Index) showed that patients with bacterial meningitis and those with encephalitis (DRG 20) were more ill than those with aseptic meningitis (DRG 21) (p less than 0.001 for each measure). Cost analysis revealed that the hospital was only partially reimbursed for its charges (shortfall of $95,547) and that patients with Medicaid or no insurance accounted for 22% of discharges but 88% of losses. Reimbursement by DRG would have increased payment for DRG 21 but decreased that for DRG 20. If DRGs were applied to pediatric central nervous system infections and used in a prospective payment system, they would accurately predict disease severity between but not within groups, and significant financial losses for children's hospitals would still occur.