Impacto económico del tratamiento a largo plazo de la incontinencia fecal grave / Economic burden of long-term treatment of severe fecal incontinence

Objetivo Conocer el coste económico a largo plazo asociado al tratamiento de la incontinencia fecal grave mediante SNS frente al tratamiento conservador sintomático y la colostomía definitiva. Métodos Estudio descriptivo pormenorizado de los costes del proceso asistencial (intervenciones, consultas, dispositivos, pruebas complementarias, hospitalización, etc.) de 3 alternativas de tratamiento de la incontinencia fecal empleando herramientas de gestión y contabilidad analítica del propio Servicio de Salud con base en datos de actividad clínica. Se estimó, en cada caso, la frecuencia de uso de recursos sanitarios o la cantidad de productos dispensados en farmacias (medicación, pañales, material de ostomía, etc.). Se incluyeron costes derivados de situaciones adversas. Se incluyeron pacientes con incontinencia fecal grave, definida por una puntación superior a 9 en la escala de severidad de Wexner, en los que han fracasado los tratamientos de primera línea. Se emplearon datos de una cohorte consecutiva de 93 pacientes a los que se realizó una SNS entre los años 2002 y 2016; de pacientes intervenidos de colostomía definitiva (n=2); hernia paraestomal (n=3) y estenosis de colostomía (n=1). Resultados El coste medio acumulado en 10 años por paciente en cada alternativa fue: 10.972,9€ para el tratamiento sintomático (62% pañales); 17.351,57€ para la SNS (95,83% intervenciones; 81,6% dispositivos), y 25.858,54€ para la colostomía definitiva (70,4% material de ostomía) Conclusiones El manejo de la incontinencia fecal grave implica un gran impacto en términos económicos. La colostomía es la alternativa que más costes directos genera, seguida de la SNS y el tratamiento sintomático (AU)

Introduction Find out the long-term economic cost associated with the treatment of severe fecal incontinence by SNS versus symptomatic conservative treatment and definitive colostomy. Methods Detailed descriptive study of the costs of the healthcare process (interventions, consultations, devices, complementary tests, hospitalization, etc.) of 3 treatment alternatives for fecal incontinence using analytical accounting tools of the Health Service based on clinical activity data. The frequency of use of health resources or the quantity of products dispensed in pharmacies (medication, diapers, ostomy material, etc.) was estimated in each case. Costs derived from adverse situations were included. Patients with severe fecal incontinence, defined by a score greater than 9 on the Wexner severity scale, in whom first-line treatments had failed, were included. Data from a consecutive cohort of 93 patients who underwent an SNS between 2002 and 2016 were used; patients who underwent definitive colostomy (n=2); parastomal hernia (n=3), and colostomy stenosis (n=1). Results The mean cumulative cost in 10 years per patient in each alternative was: € 10,972.9 symptomatic treatment (62% diapers); € 17,351.57 SNS (95.83% interventions; 81.6% devices); € 25,858.54 definitive colostomy (70.4% ostomy material and accessories). Conclusions Management of severe fecal incontinence implies a great burden in economic terms. The colostomy is the alternative that generates the most direct cost, followed by SNS and symptomatic treatment (AU)

Costes del ictus desde la perspectiva social. Enfoque de incidencia retrospectiva con seguimiento a tres años / Costs deriving from strokes from a social perspective. A retrospective incidence approach with a follow-up at three years

Introducción. El coste del ictus es importante desde el punto de vista social, pues se trata de una enfermedad con gran impacto individual, familiar y social. Los estudios de coste de la enfermedad aportan una descripción total de los aspectos económicos del ictus. La perspectiva más amplia es la social, donde se incluyen todos los costes y consecuencias. La aproximación deseable es la denominada bottom-up. Objetivos. Calcular el coste del ictus desde la perspectiva social en la población de una zona básica de salud (12.000 habitantes) mediante un enfoque de incidencia retrospectiva (seguimiento a tres años) y una aproximación ‘de abajo a arriba’. Calcular la fracción atribuible a la atención primaria, la hospitalaria y la social. Pacientes y métodos. Todos los ictus diagnosticados entre el desde el 1 de enero de 1999 hasta el 31 de diciembre de 2003, pertenecientes a una zona básica de salud de Navarra (n = 91). Recogida de datos: cuestionario ad hoc –cuestionario CACV (costes del accidente cerebrovascular)–, que valora el coste ‘incremental’ provocado por el ictus y sus complicaciones. Resultados. El coste medio se sitúa en 5.759,50 € para el primer año, 3.596,60 € para el segundo y 4.671,30 € para el tercero. El coste en el primer año viene determinado por la atención hospitalaria, que supone el 50% de los costes. A partir del segundo año los costes de la atención ambulatoria adquieren una gran importancia, ya que suponen un 70% del total. Conclusiones. El coste del ictus en los tres primeros años se aproxima a los 5.000 €/año. Se necesitan más estudios de coste de la enfermedad cerebrovascular desde la perspectiva social, que debería incluir, por tanto, el coste del cuidado informal

Introduction. The costs deriving from strokes are important from a social point of view because this is a pathology with a substantial individual, familial and social impact. Cost-of-illness studies provide an overall description of the economic aspects of strokes. The widest perspective is the social one, where all the costs and consequences are included. If possible, it is wise to take a bottom-up approach. Aims. To calculate the costs deriving from strokes from the social perspective in the population of a district health service (12,000 inhabitants) by means of a retrospective incidence approach (follow-up at three years) and a bottom-up procedure. We also intended to calculate the fractions that can be attributed to primary care, hospital care and social care. Patients and methods. Our study included all the cases of stroke diagnosed between 1st January 1999 and 31st December 2003 within a basic health care district in Navarre (n = 91). Data collection: an ad hoc questionnaire –the CACV (cerebrovascular accident cost) questionnaire– which assessed the ‘incremental’ costs due to strokes and their complications. Results. The average cost was found to be 5,759.50 € for the first year, 3,596.60 € for the second and 4,671.30 € for the third. The cost in the first year is marked by the hospital care, which accounts for 50% of the total. From the second year onwards the costs of outpatient care become very important, since they represent 70% of the overall costs. Conclusions. The costs deriving from strokes in the first three years amount to almost 5,000 €/year. More cerebrovascular cost-of-illness studies need to be conducted from the social perspective and should therefore include the costs of informal care

[Costs deriving from strokes from a social perspective. A retrospective incidence approach with a follow-up at three years]. / Costes del ictus desde la perspectiva social. Enfoque de incidencia retrospectiva con seguimiento a tres años.

INTRODUCTION: The costs deriving from strokes are important from a social point of view because this is a pathology with a substantial individual, familial and social impact. Cost-of-illness studies provide an overall description of the economic aspects of strokes. The widest perspective is the social one, where all the costs and consequences are included. If possible, it is wise to take a bottom-up approach. AIMS: To calculate the costs deriving from strokes from the social perspective in the population of a district health service (12,000 inhabitants) by means of a retrospective incidence approach (follow-up at three years) and a bottom-up procedure. We also intended to calculate the fractions that can be attributed to primary care, hospital care and social care. PATIENTS AND METHODS: Our study included all the cases of stroke diagnosed between 1st January 1999 and 31st December 2003 within a basic health care district in Navarre (n = 91). DATA COLLECTION: an ad hoc questionnaire -the CACV (cerebrovascular accident cost) questionnaire- which assessed the 'incremental' costs due to strokes and their complications. RESULTS: The average cost was found to be 5,759.50 euro for the first year, 3,596.60 euro for the second and 4,671.30 euro for the third. The cost in the first year is marked by the hospital care, which accounts for 50% of the total. From the second year onwards the costs of outpatient care become very important, since they represent 70% of the overall costs. CONCLUSIONS: The costs deriving from strokes in the first three years amount to almost 5,000 euro/year. More cerebrovascular cost-of-illness studies need to be conducted from the social perspective and should therefore include the costs of informal care.

Estimation of mental health care cost units for patients with schizophrenia.

INTRODUCTION: The disease-cost study, based on the study of cohorts of patients through their visits to the mental health system, requires knowledge on the cost of each health care unit. However, lack of standardized procedures limits the external validity of the results obtained. When methodological information regarding the procedures applied is available, it makes it possible to compare the internal validity and to understand the suppositions on which the cost estimations have been made. METHODS: Cost-units for the health care received by a cohort of patients diagnosed of schizophrenia were estimated. The study was performed by a community-based team and at several hospital premises belonging to the Andalusia Health Service. A sensitivity analysis was conducted whenever necessary. RESULTS: Both in inpatients and outpatients care, personnel represents the biggest cost, this proportion being higher within the outpatient care. Among the professional categories the care given by the psychiatrists is the most expensive. Time load is similar for the different categories except for the psychiatrist. CONCLUSIONS: Cost unit estimates are lower than that which has been published internationally and within Spain. However, the findings must be carefully considered due to the influence that the different methodological options may have.

Análisis coste-consecuencia de un centro de día psicogeriátrico / Cost-consequence analysis of a psychogeriatric day center

OBJETIVO: Se pretende llevar a cabo una evaluación económica de un centro de día psicogeriátrico (CD), comparándolo con los cuidados comunitarios habituales (CC). MATERIAL Y MÉTODO: Se ha estudiado a 96 pacientes psicogeriátricos: 51 que acudían a CD y 45 que recibían CC. Para la recogida de datos se diseñó un protocolo que incluía variables sociodemográficas, clínicas y de costes, tanto del paciente como del cuidador familiar. Los dos grupos eran homogéneos en cuanto a la edad, el sexo, el deterioro cognitivo y la capacidad funcional al inicio del estudio, y se realizó un seguimiento durante un año. RESULTADOS: No se encontraron diferencias en cuanto al estado de salud del paciente ni a la situación del cuidador, aunque se observó una tendencia no significativa a presentar menos trastornos conductuales entre los pacientes que acudían al CD. Únicamente la satisfacción con los cuidados era significativamente mayor entre los familiares de los pacientes atendidos en estos centros. En cuanto al coste, éste era superior en el CD, con diferencias distributivas en los componentes de los costes en ambos recursos asistenciales. CONCLUSIÓN: El CD supone mayor coste que los CC sin modificar de forma significativa la salud del paciente ni la de su cuidador, con la excepción de una mayor satisfacción con los cuidados. (AU)

[The cost of care of elderly patients with psychogeriatric pathology in the community]. / El coste del paciente anciano con patología psicogeriátrica en la comunidad.

OBJECTIVE: To estimate the cost and cost variability of psychogeriatric care in the community. METHODS: 69 patients and their respective family caregivers were studied, 34 attending a psychogeriatric Day Centre (DC) and 35 receiving the usual Community Care (CC) based mainly on outpatient healthcare. The following costs were recorded: general expenses, medication, transportation, resource utilisation, informal care and indirect costs due to health impairment and loss of work productivity of the caregiver. RESULTS: The mean cost of the care of a psychogeriatric outpatient was of 205,989 Spanish pta per month (1,648 US $), with an additional cost of DC of 85,941 Spanish pta/month (688 US $). In the CC group, 71% of the cost was due to informal care but in the case of DC, the largest cost item corresponded to resource utilisation (42%). Cost increased with age of the patient, cognitive and functional impairment and caregiver burden. CONCLUSIONS: The cost of psychogeriatric patients' care in the community is higher for those who attend a DC, those who are in a more advanced state of their disease and those whose caregivers are overburdened.

El coste del paciente anciano con patología psicogeriátrica en la comunidad / The cost of care of elderly patients with psychogeriatric pathology in the community

Objetivo. Estimar el coste del paciente psicogeriátrico en la comunidad y la variabilidad del mismo. Material y método. Se estudiaron 69 pacientes y sus respectivos cuidadores familiares, 34 que acudían a un Centro de Día psicogeriátrico (CD) y 35 que recibían cuidados comunitarios habituales (CC), basados fundamentalmente en la atención ambulatoria. Se registraron los siguientes costes: gastos generales, medicación, transporte, uso de recursos, cuidados informales y los costes indirectos debidos a la pérdida de salud y de productividad laboral del cuidador informal. Resultados. El coste del paciente psicogeriátrico en régimen ambulatorio ascendía 205.989 ptas al mes (1.648 US $), suponiendo la atención en CD un coste adicional de 85.941 ptas/mes (688 US $). En el grupo CC el 71 por ciento del coste era debido a los cuidados informales y sin embargo en el caso de CD el mayor componente de los costes correspondía al uso de recursos (42 por ciento). El coste aumentaba con la edad del paciente, el deterioro cognitivo y funcional y la sobrecarga del cuidador. Conclusiones. El coste del paciente psicogeriátrico en la comunidad es mayor para aquellos que acuden a un CD, se encuentran en un estadio más avanzado de su enfermedad y sus cuidadores están más sobrecargados. (AU)

Incidence, risk and evolution of ostheoporotic hip fractures in Spanish women using a Markov type model. / Incidencia, riesgo y evolución de las fracturas osteoporóticas de cuello de fémur en las mujeres en España, a partir de un modelo de Markov.

BACKGROUND: To estimate osteoporotic hip fracture incidence rates, by age and gender, and lifetime fracture risk of women of different age groups over 45 in Spain, and to determine the expected number of fractures and fracture-related person-years of functional impairment, as a basis for estimating the social costs of osteoporosis in Spain and the avoided costs of fractures in future cost-effectiveness analyses. MATERIAL AND METHODS: The natural history of disease, recognized from fractures, is described using a Markov model and MonteCarlo simulations. Four cohorts of 10,000 women, each of a different age group, were simulated. Data were obtained from six hospitals of different size and geographical setting, to allow for differences in hospital service structure. Patients included were all new cases of hip fracture who were attended in those hospitals in 1995. Results are extrapolated to the Spanish population based on 1991 census. RESULTS: We can predict in the group of women aged 50 an over in Spain 968,000 osteoporotic hip fractures during their remaining lifetime, with a total amount of 1,013,000 fractures. Some 135,000 will become functionally impaired due to the fractures, accounting for 1,177,000 person-years of functional impairment. CONCLUSIONS: The study provides a prototype for estimating avoided costs of fractures in future cost-effectiveness analyses.

[Cost-benefit analysis of the early detection program for metabolic diseases in the Autonomous Basque Community]. / Análisis coste-beneficio del programa de detección precoz de enfermedades metabólicas en la Comunidad Autónoma Vasca.

The efficiency of an early screening and treatment Programme for two Metabolic disorders, phenylketonuria and congenital hypothyroidism running since November 1982 in the Basque Country, is analysed. The cost-benefit analysis technique is used. The social costs of screening and treatment are compared with the social benefits for the prevention of mental handicap (1984-1985). Benefit-cost ratios and the net present value shows the social efficiency of the programme except when high discount rates have been used for discounting future costs and benefits. That conclusion is consistent with the results of other cost-benefit studies. In terms of cost-effectiveness the cost per child with mental handicap prevented was estimated on 3,300.000 ptas. That could be seen as the lowest social value for the prevention of a child with mental handicap.