Cost of Treating Skin Problems in Patients with Diabetes Who Use Insulin Pumps and/or Glucose Sensors.

Background: The use of insulin pump and glucose sensor is advantageous, but unfortunately many experience skin problems. To reduce or overcome skin problems, patients use additional products or change their sets preterm. Therefore, the aim was to investigate costs related to skin problems. Materials and Methods: Two hundred sixty-three patients from four different hospitals in Denmark participated in a cross-sectional survey about skin problems related to insulin pump and/or glucose sensor use. Additional costs aside technology and diabetes treatment were calculated based on adhesives, patches, lotion, and preterm shifts of infusion or sensor sets due to skin problems. Descriptive statistics and linear regression were used. Results: The total costs for all these expenses were 11493.9 U.S. dollars (USD) in 145 pediatric patients and 4843 USD in 118 adult patients. The costs were higher in patients with, than without, skin problems and for skin problems due to the glucose sensor compared with insulin pump. Pediatric patients with eczema and/or wound due to the glucose sensor did cost 154.3 USD more, than patients without these skin problems (P < 0.01). We found a clear dose/response relationship between costs and severity of skin problems, especially in pediatric patients. Conclusions: Our data show that skin problems due to use of insulin pump and/or glucose sensor have significant costs on the Danish welfare system. This leaves an economic incentive for developing more skin-sensitive adhesive for the infusion set and sensors, at least for a certain subgroup of patients.

Study protocol: cost-effectiveness of multidisciplinary nutritional support for undernutrition in older adults in nursing home and home-care: cluster randomized controlled trial.

BACKGROUND: Older adults in nursing home and home-care are a particularly high-risk population for weight loss or poor nutrition. One negative consequence of undernutrition is increased health care costs. Several potentially modifiable nutritional risk factors increase the likelihood of weight loss or poor nutrition. Hence a structured and multidisciplinary approach, focusing on the nutritional risk factors and involving e.g. dieticians, occupational therapists, and physiotherapist, may be necessary to achieve benefits. Up till now a few studies have been done evaluating the cost-effectiveness of nutritional support among undernourished older adults and none of these have used such a multidisciplinary approach. METHODS: An 11 week cluster randomized trial to assess the cost-effectiveness of multidisciplinary nutritional support for undernutrition in older adults in nursing home and home-care, identified by screening with the Eating validation Scheme. Before start of the study there will be performed a train-the-trainer intervention involving educated nutrition coordinators.In addition to the nutrition coordinator, the participants assigned to the intervention group strategy will receive multidisciplinary nutrition support. Focus will be on treatment of the potentially modifiable nutritional risk factors identified by screening, by involving physiotherapist, registered dietician, and occupational therapist, as relevant and independent of the municipality's ordinary assessment and referral system.The primary outcome parameter will be change in quality of life (by means of Euroquol-5D-3L). Secondary outcomes will be: physical performance (chair stand), nutritional status (weight, Body Mass Index and hand-grip strength), oral care, fall incidents, hospital admissions, rehabilitation stay, moving to nursing homes (for participants from home-care), use of social services and mortality.An economic evaluation will be conducted to evaluate the cost-effectiveness of the multidisciplinary support.Furthermore, interviews with nursing home and home-care management, nursing staff and nutrition coordinators in both the control and intervention groups, participants in the intervention group and the involved multidisciplinary team will be performed. CONCLUSION: In this study we will evaluate in a randomized controlled trial whether multidisciplinary nutritional support is cost-effective, in undernourished older adults in home-care and nursing home and contribute to important research. TRIAL REGISTRATION: ClinicalTrials.gov 2013 NCT01873456.

Cost-effectiveness of varenicline for smoking cessation.

Smoking cessation therapies are among the most cost-effective preventive healthcare measures. Varenicline is a relatively new drug developed especially for this purpose, and it has been shown to achieve better quit rates than nicotine replacement therapies and the non-nicotine-based drug, bupropion, which has been in use for some years. The cost-effectiveness of varenicline depends on the cost of the therapy and the cost-savings achieved through reduced morbidity and mortality; several investigations, based on the situation in different countries, indicate that varenicline either finances itself fully through the cost-savings achieved or offers additional life-years at a lower price than that paid elsewhere in the healthcare sector.

A cost-effectiveness analysis of fistula treatment in the abdominal region using a new integrated fistula and wound management system.

OBJECTIVE: To evaluate wear time and costs of a new fistula and wound management system (FWMS) compared to standard fistula treatments. METHODS: Data were collected from 22 patients with an abdominal fistula recruited from 5 sites in the United States. This economic evaluation was based on a cost-effectiveness analysis with wear time, material costs, and labor costs taken into account. RESULTS: A longer wear time for each pouch as well as simpler handling by nurses amounted to an average lower cost of $83 per day of treatment with the FWMS. A large variation was observed in the collected data. However, the sensitivity analysis showed that 77% of patients achieved a cost reduction when changing to the FWMS. CONCLUSION: The FWMS was less costly than traditional methods for managing abdominal fistula, probably due to longer wear time and less time spent on each pouching session.

[Cost effectiveness in the Danish health care of ezetemibe co-administration compared to simvastatin]. / Omkostningseffektivitet i det danske sundhedsvaesen ved ezetimibe-koadministration med simvastatin.

INTRODUCTION: The purpose of this analysis is to evaluate the cost effectiveness of ezetemibe coadministration compared to a shift to higher doses of simvastatin or to a more potent statin. MATERIALS AND METHODS: The calculations are based on a Markov model in which a patient who does not attain the desired cholesterol outcome with simvastatin treatment is treated either with ezetemibe coadministration, or with increased simvastatin doses, or with a more potent statin. Calculations are conducted for a total of 72 different patient types followed over the remainder of their lives. RESULTS: Ezetemibe coadministration evaluated over the entire lifetime will be somewhat more expensive than simvastatin titration but must, however, be seen in relation to improved survival and increased quality of life. For the typical patient, treatment will be associated with costs of between DKK 50,000 and 100,000 per gained year of life, which cannot be deemed too expensive in relation to other interventions provided by the Health Authorities. For some patient types who receive treatment with a potent statin (atorvastatin), savings will also be possible here as well as an increase in life expectancy and quality of life. CONCLUSION: The results of the study indicate that ezetemibe coadministration is cost effective. The results are sustainable even with quite significant changes of the estimates used and taking into account uncertainties in the material and methods.

[Economic feasibility study and reimbursement rules--illustrated by a concrete example]. / Økonomiske konsekvensberegninger og tilskudsregler--belyst ved et eksempel.

INTRODUCTION: In deciding whether a pharmaceutical drug should be granted reimbursement, economic considerations play a considerable role. However, the fact that the very decision on reimbursement - whether individual, conditional or general--influences the cost-effectiveness of the drug considered as a medical intervention is often overlooked. MATERIAL AND METHODS: In the computation of cost-effectiveness not only purely medical effects should be taken into consideration but also the risk that a patient in need of treatment is not treated--possibly as a consequence of the procedure involved in applying for individual reimbursement--as well as the risk of wasting resources on treatment that is not medically justified. The method is illustrated by a concrete example based on the data from treatment of coronary heart disease patients with statins in the period 1994-1998 where reimbursement was given on an individual basis and after 1998 when conditional reimbursement was introduced. RESULTS: The individually-based regime turns out to have been very cost-ineffective, given that it prevented medically appropriate treatment of a large number of patients. A simple calculation along the principles outlined here would have shown this resource-loss. DISCUSSION: Including the reimbursement regime in the assessment of cost-effectiveness seems to be a useful tool for preventing the loss of patients who could have been treated at a lower cost with the medical intervention considered than with other interventions currently used in the health care sector.

A cost-effectiveness analysis of immunotherapy with SQ allergen extract for patients with seasonal allergic rhinoconjunctivitis in selected European countries.

BACKGROUND: Seasonal allergic rhinoconjunctivitis can, for some people, reduce quality of life and the ability to cope with everyday tasks. SCOPE: In this paper we investigate the cost-effectiveness of immunization therapy with Alutard SQ (ASQ) and compare the cost-effectiveness in countries where the therapy has been in use in order to assess the impact of national therapeutic practices on the results of health economic assessments. Data are obtained from a clinical trial carried out in 2001-2002. To evaluate the cost-effectiveness of immunization we have added data on resource use in Austria, Denmark, Finland, Germany, The Netherlands, and Sweden. FINDINGS: The computations result in cost-effectiveness ratios for allergen immunization between 10,000 euros and 20,000 euros per QALY even without provision for indirect costs, and achieving dominance in most countries where indirect costs have also been taken into account. The country comparisons show that the direct cost of administrating the up-dosing and maintenance differs considerably between countries, and that the cost of medical staff is substantial, constituting in most cases more than half of the direct costs of the immunization therapy. CONCLUSION: The study shows that immunotherapy with SQ allergen extract is cost-effective in a wide range of national environments, and that cost-effectiveness differences by country are largely a result of different practices in the up-dosing phase.

[Methods for cost-effectiveness evaluation of intensive care]. / Metoder til sundhedsøkonomisk evaluering af intensiv terapi.

Intensive care costs are a challenge to the health care system. Because of a political strategy aiming at competition as well as the documentation of treatment quality, cost-effectiveness evaluations are important in order to clarify the association between quality and the costs of treating critically-ill patients. The context of cost-effect analyses is important. Most studies apply the hospital's perspective based on surrogate markers such as organ failure and length of stay as a replacement for health status evaluation in the context of society. The treatment of critically-ill patients aims at improved health. Cost-effectiveness analyses should therefore include quality variables in that the healthcare system is an integral and inseparable part of society.

[Diagnosis Related Groups in intensive care units--cost model for critically ill patients]. / Diagnoserelaterede grupper på intensivafdelinger--afregningsmodel for kritisk syge patienter.

The actual contribution of intensive care to total hospital costs in Denmark has yet not been completely identified. In order to adapt the DRG system to better reflect the actual costs of the intensive care units (ICUs) the original primarily diagnosis-based DRG system was modified in order to be based on ICU-related procedure codes. A new DRG system for ICU patients was developed and implemented in 2004. The ICU DRG-system consists of four groups reflecting progressive deterioration in organ failure. As a result there has since been a qualitative improvement in the documentation of the activities in the ICUs. The information categorized according to the new ICU DRG-groups allows for better differentiation of patients, and might lead to an increasing understanding of the quality of healthcare provision in the ICU by the use of comparisons in a database. A meaningful cost comparison between intensive care units can only be made by combining activity with quality of delivered care.

[Cost-effectiveness of treatment of high blood pressure with losartan in Denmark]. / Omkostningseffektivitet ved hypertensionsbehandling med losartan i Danmark.

INTRODUCTION: The purpose of this analysis was to evaluate the cost-effectiveness of losartan compared with atenolol for the treatment of hypertension, both from the point of view of society and from that of the health care sector, based on data from the LIFE study. MATERIALS AND METHODS: The computations are based on a simple decision tree model, where the probability of stroke was obtained from the LIFE study, a double-blind, randomised clinical study of 9,193 patients with hypertensive left ventricle hypertrophy. RESULTS: The treatment of hypertension with losartan rather than atenolol entails a cost of DKK 19,668 per gained quality-adjusted life year (QALY), when only the cost of the health care sector is taken into account, and DKK 72,564 if all costs to society are included. CONCLUSION: The analysis shows that treatment with losartan is cost-effective even when the uncertainty in both data and economic evaluations is taken into account.

On the aggregation of health status measures.

In the present paper, we address the problem of finding conditions under which aggregation of individual health status measurements (e.g. QALYs) is meaningful in the sense that there is a universal unit of measurement for health. The problem is studied in a model where different aspects of health take the form of Lancasterian characteristics to be produced by the individuals using commodities obtained in the market. For a meaningful unit of measurement to exist, marginal rates of substitution between different aspects of health should not differ among individuals, and for this to happen in an equilibrium of the economy considered, certain assumptions of separability (of technology and/or preferences) must be satisfied. This means that universal measures of health will be meaningful only if there are not too many spillovers in achieving different aspects of health.

Cost-effectiveness with multiple outcomes.

In a large number of situations, activities in health care have to be measured in terms of outcome and cost. However, the cases where outcome is fully captured by a single measure are rather few, so that one uses some index for outcome, computed by weighing together several outcome measures using subjective and somewhat arbitrary weights. In the paper we propose an approach to cost-effectiveness analysis where such artificial aggregation is avoided. This is achieved by assigning to each activity the weights which are the most favourable in a comparison with the other options available, so that activities which have a poor score in this method are guaranteed to be inferior. The method corresponds to applying Data envelopment analysis, known from the theory of productivity, to the context of health economic evaluations. The method is applied to an analysis of the cost-effectiveness of alternative health plans using data from the Medical Outcome Study (JAMA 1996; 276: 1039-1047), where outcome is measured as improvement in mental and physical health.

Alternative health insurance schemes: a welfare comparison.

In this paper, we present a simple model of health insurance with asymmetric information, where we compare two alternative ways of organizing the insurance market. Either as a competitive insurance market, where some risks remain uninsured, or as a compulsory scheme, where however, the level of reimbursement of loss is to be determined by majority decision. In a simple welfare comparison, the compulsory scheme may in certain environments yield a solution which is inferior to that obtained in the market. We further consider the situation where the compulsory scheme may be supplemented by voluntary competitive insurance; this situation turns out to be at least as good as either of the alternatives.