A systematic review of the indirect costs of schizophrenia in Europe.

Background: Schizophrenia is a chronic disease associated with significant and long-lasting effects on health, and it is also a social and financial burden, not only for patients but also for families, other caregivers, and the wider society. It is essential to conduct the assessment of indirect costs, to understand all the effects of the disease on society. Our aim is to gain a better understanding of the indirect costs of schizophrenia in Europe. Methods: We conducted a comprehensive systematic literature review covering EMBASE, Medline, and PsycINFO as well as reviewing Health Technology Assessment databases from different countries. We used a qualitative research synthesis for presenting information, as most of the studies were methodologically diverse, a quantitative analysis would have been impractical. Results: Indirect cost adjusted to inflation ranged vastly between studies included in the review from 119 Euros to 62, 034 Euros annually. The average proportion of indirect costs of total costs was 44%. Studies highlighted important cost drivers as age, gender, and disease severity, explaining the variation in costs between treatment and patient groups. Conclusions: Regardless of the methodological heterogeneity of the reviewed studies, there was an agreement about the significance of indirect costs of schizophrenia on the society. Considering the relatively high prevalence of schizophrenia in Europe, a need for more cost of illness studies especially from Central Eastern and Southern Europe is suggested.

Direct healthcare cost of schizophrenia - European overview.

PURPOSE: To provide an overview on the magnitude of the impact of schizophrenia on the healthcare system in Europe and to gain a better understanding on the most important factors influencing the variation of costs. METHODS: Studies reporting costs and healthcare utilization among patients with schizophrenia were searched in MEDLINE (via Scopus), EMBASE (via Scopus) and Cochrane Database of Systematic Reviews on 19th January 2017. RESULTS: Twenty-three studies, from the 1075 references initially identified, were included in this review. The annual cost per patient ranged from €533 in Ukraine to €13,704 in the Netherlands. Notably drug costs contributed to less than 25% of the direct healthcare cost per patient in every country, which might be explained by similar pharmaceutical prices among countries due to the reference pricing system applied in Europe. Inpatient costs were the largest component of health service costs in the majority of the countries. Despite methodological heterogeneity across studies, four major themes could be identified (age, severity of symptoms, continuation of treatment/persistence, hospitalization) that have substantial impact on the costs of schizophrenia. CONCLUSIONS: Schizophrenia represents a substantial cost for the healthcare system in Europe driven by the high cost per patient. Substantial savings could potentially be achieved by increasing investment in the following areas: (1) reducing the number of hospitalizations e.g. by increasing the efficiency of outpatient care; (2) working out interventions targeted at specific symptoms; (3) improving patient persistence and adherence in antipsychotic therapy.

Cost-effectiveness analysis of intensity-modulated radiation therapy with normal and hypofractionated schemes for the treatment of localised prostate cancer.

The aim of our analysis was to compare the cost-effectiveness of high-dose intensity-modulated radiation therapy (IMRT) and hypofractionated intensity-modulated radiation therapy (HF-IMRT) versus conventional dose three-dimensional radiation therapy (3DCRT) for the treatment of localised prostate cancer. A Markov model was constructed to calculate the incremental quality-adjusted life years and costs. Transition probabilities, adverse events and utilities were derived from relevant systematic reviews. Microcosting in a large university hospital was applied to calculate cost vectors. The expected mean lifetime cost of patients undergoing 3DCRT, IMRT and HF-IMRT were 7,160 euros, 6,831 euros and 6,019 euros respectively. The expected quality-adjusted life years (QALYs) were 5.753 for 3DCRT, 5.956 for IMRT and 5.957 for HF-IMRT. Compared to 3DCRT, both IMRT and HF-IMRT resulted in more health gains at a lower cost. It can be concluded that high-dose IMRT is not only cost-effective compared to the conventional dose 3DCRT but, when used with a hypofractionation scheme, it has great cost-saving potential for the public payer and may improve access to radiation therapy for patients.

Transferability of National Institute for Health and Clinical Excellence recommendations for pharmaceutical therapies in oncology to Central-Eastern European countries.

The health burden of malignancies is greater in Central-Eastern Europe than in Western Europe. Furthermore, these countries have more limited healthcare resources, and therefore transparent decision criteria for innovative cancer therapies, including the assessment of cost-effectiveness, are an absolute necessity. Transferability of good-quality technology assessment reports, especially those prepared by National Institute for Health and Clinical Excellence (NICE) in the UK, could be highly beneficial to prevent duplication of efforts and save resources for local technology assessment. Our objective was to summarise key factors influencing the transferability of NICE recommendations in oncology for policy makers and oncologists in Central-Eastern Europe without personal experience in health technology assessment. In general, NICE recommendations are not transferable without adjustment of the analyses to local data. Even if the recommendation is positive, the conclusion can still be negative in lower-income countries, mainly due to relative price differences and the significance of the local budget impact. Technologies with negative NICE recommendations can still be cost-effective in Central-Eastern Europe due to the worse health status and therefore the greater potential health gain of the targeted population. The appropriateness of reimbursement decisions must be improved in Central-Eastern Europe, but copying NICE recommendations without local adjustment may do more harm than good.

Diabetic foot ulcers and amputations: estimates of health utility for use in cost-effectiveness analyses of new treatments.

OBJECTIVES: Diabetic foot ulcers (DFU), infections and amputations are associated with high costs of care and loss of health. To evaluate new treatments, both the extra costs incurred and the health utility gained need to be examined. However, evaluations of treatments in diabetes are hampered by the lack of utility values for health states such as DFU. We estimated utility values for health states seen amongst DFU patients. METHODS: We identified 13 unique health states based on presence/type of DFU and amputation. Members of the general public (n=107) received a description of each health state. They were then asked to indicate how undesirable each health state was (using the time trade-off method). Each answer was then transformed to create a value representing the "utility" of the health state, the utility value represented on a 0-1 scale. RESULTS: Valid responses could be obtained from 96 persons. Mean values included: 0.84 (diabetes with no DFU or amputation), 0.75 (uninfected DFU, no amputation), 0.68 (no DFU, previous foot amputation), and 0.63 (uninfected DFU, previous amputation of other foot). The impact of an ulcer depended on amputation status. CONCLUSIONS: Our values correspond with previously published results but are more detailed. In addition, since our values were derived from the general public, economic evaluations that incorporate them will use the generally preferred societal perspective. Therefore, these values are appropriate, practical and sensitive weights to calculate QALYs for cost-effectiveness analyses of foot ulcer treatments.

Economic evaluation of kidney transplantation versus hemodialysis in patients with end-stage renal disease in Hungary.

BACKGROUND: Kidney transplantation is generally acknowledged as the more clinically effective and more cost-effective option in managing patients with end-stage renal disease, compared with dialysis. This study looked for confirmatory evidence in a Hungarian population. METHODS: Patients (n = 242) with end-stage renal disease who received cadaveric kidney transplantation during 1994 were followed up for 3 years. They were compared with patients (n = 840) receiving hemodialysis who were on a waiting list for transplantation. Data were collected retrospectively. Treatments were compared for clinical efficacy and for cost-effectiveness. RESULTS: At month 36, the standard mortality hazard function was 3.5 times higher in the group receiving hemodialysis (P < .0001) than in the transplant recipients. Average treatment costs per patient over the 3 years were also significantly higher (P < .0001) in the hemodialysis group than in the group than received transplants. The cost of 1 year gained by transplantation was significantly less (P < .0001) than the cost associated with hemodialysis. CONCLUSIONS: Compared with hemodialysis, kidney transplantation provides greater survival benefits to patients with end-stage renal disease, at less cost.

[Health prospects in the alternative strategies of renal replacement therapies]. / Eletkilátások a vesepótló kezelések alternatív kezelési stratégiáiban.

The authors are publishing the health outcome results of a cost-effectiveness analysis on renal replacement therapies. They analysed the mortality data of the main renal replacement therapies between the 3-year time period of 1994-1997 in a retrospective way. They found that although there is a high initial postoperative mortality risk of the surgical procedure, the kidney transplantation reduces the relative risk of 3-year mortality by 27.7% (p = 0.0601) in comparison with the waiting listed hemodialysis. This means 5.6% absolute risk reduction. As it is proved that transplantation improves quality of life of patients on renal replacement therapy, the loss of a potential donor decreases the expected quality adjusted life years (QALY) benefit of those dialysed patients who are on the waiting list.

[Forecasting the number of patients with end-stage renal disease (Model of the system)]. / Végstádiumú veseelégtelen betegek számának elórejelzése (A rendszer modellje).

The authors are dealing with the renal replacement therapies in Hungary. They are on the opinion that in view fo patient flow renal replacement therapies (such as various methods of dialysis and kidney transplantation) can be considered as one system. With analysing the number of patients in the past years they can establish that end-stage renal disease puts significant burden on the health insurance fund. According to their calculations the number of patients with end-stage renal disease will increase by 14-16% in the next few years if current trends continue. If we want to operate the system efficiently, we can reduce--up to a certain extent--the economic burden of dialysis by increasing the number of kidney transplantations.