Although AIDS is often thought of as a "big-city" disease, it is also becoming a serious health care issue for doctors and other health care workers in "small-city" Canada. Kingston, Ont., is one of those small cities, and of the facilities trying to come to grips with a disease about which much remains to be learned. In this article, Drs. Peter Ford and David Robertson outline their hospital's estimate of the cost, in manpower and money, of dealing with the AIDS crisis. The final estimate: roughly $700,000. Although most of the cost will involve one-time capital spending, they point out that there will likely be ongoing labour-related costs because of the special programs and increased manpower needed to deal with AIDS patients. Clearly, AIDS is no longer a big-city disease.
To assess the costs associated with the performance of outpatient total laparoscopic hysterectomy.
This was a retrospective cohort study involving 224 consecutive patients undergoing total laparoscopic hysterectomy (TLH) by a single surgeon in the Regina General Hospital. Outcomes included costs associated with the initial procedure as well as those associated with any intraoperative or postoperative complications.
The mean age of the patients was 42.7 years. The mean uterine weight was 205 grams (range 69-1163 g), the mean operating time was 79 minutes, and the mean blood loss was 89 cc. The mean postoperative stay in the day surgery unit (DSU) was 354 minutes. Ten patients required admission from the DSU, and nine patients were admitted more than 24 hours after surgery. The total number of admission days was 24, which cost 21,900 US dollars. The total cost of all disposables was 127,373 US dollars and the cost associated with the stays in day surgery was 89,600 US dollars. The total cost for the 224 TLH procedures was 238,573 US dollars, and the average cost per TLH was 1065 US dollars.
Outpatient TLH can be completed safely and with costs that are lower than those incurred by patients having short-stay vaginal hysterectomy in our institution. Outpatient TLH offers the opportunity to save health care costs and a procedure with excellent results.
Of 220 residents living in the residential unit of a multi-level geriatric center, 95 required a total of 131 transfers to other facilities over a one-year period. Fifty-three of these patients were transferred to the associated chronic-care hospital for short-term acute medical investigation or treatment. The average length of stay of 17 days was similar to that of patients of comparable age with comparable medical conditions admitted to an affiliated acute general hospital from the community. In addition to continuity of medical care and the social and psychologic advantages of remaining within the geriatric center, this transfer potential resulted in substantial financial savings. The cost of hospitalization in the general hospital would have been more than twice that of the geriatric unit.
The societal economic burden of herpes zoster in Sweden is not well described today. This study is a top-down analysis of Swedish registers with the objective to describe the burden of herpes zoster and post-herpetic neuralgia in Sweden during 2011.
Data for inpatient care; outpatient primary and specialized cares; the prescriptions of drugs, sick leave and the number or diagnostic tests were collected from Swedish national databases. The incidence of the disease was estimated based on the number of prescriptions of antiviral drugs.
The incidence of herpes zoster was estimated to 315 and 577 cases per 100,000 people for patients at all ages and >?= 50 years, respectively. Almost 30,000 patients at all ages were diagnosed with herpes zoster and the societal cost to treat these patients, including the cost to treat those patients who later developed post-herpetic neuralgia, added up to nearly 227 MSEK (31.6 M€) which corresponds to 7,600 SEK (€870) per patient. The main contributors to the total cost for the treatment of HZ patients were primary care (43 %); sick leave (28 %); hospitalization (10 %) and specialist care (7 %). Medication was a relatively small contributor with 8.5 MSEK (4 %; 1.0 M€) to the overall costs for patients at all ages. The corresponding total cost including only patients 50 years and older was 168 MSEK (19.2 M€) or 8,200 SEK (€939) per patient.
The current study demonstrates that the burden of herpes zoster is significant in Sweden. The society, the health care payers and the patients potentially have a lot to gain by introducing a vaccination program to patients 50 years and older and as a consequence reduce the economic and clinical burden of herpes zoster and post-herpetic neuralgia.
The paper is concerned with part of the results of an analysis of expenditures for the treatment of schizophrenic patients. The task of the present fragment was to delineate ways of optimizing the functioning of the psychiatric assistance services. Research methods including clinico-economic, statistic, mathematic and epidemiological approaches are described in detail. Based on an examination of the representative group of schizophrenic patients (n-386) of one of the psychoneurological dispensaries of Moscow, it has been established that the main "direct" (793.8 rubels per patient/year on the average) and "indirect" (3520.94 rubels per patient/year on the average) expenditures are connected with expensive inpatient treatment and disability allowance payments. It is suggested that redistribution of investments with a purpose of eliminating economic unbalance between different psychiatric services (hospital and ambulatory) will contribute to optimizing their functioning and enable the efficacy of their work to be enhanced.
Intravenous methylprednisolone (IVMP) is the treatment of choice for multiple sclerosis (MS) patients undergoing acute exacerbation of disease symptoms and yet its cost has not been accurately determined. Determination of this cost in different settings is also pertinent to consideration of cost-saving alternatives to in-patient treatment.
Cost analysis from the point of view of the health care system of IVMP treatment of MS patients receiving treatment in association with a selected Toronto teaching hospital in fiscal year 1994/95 was carried out. Costs of any concurrent treatments were excluded.
Total cost for 92 patients, based on a 4 dose regime, was estimated to be $78,527. The the cost per patient was $1,1181.84 for in-patients (IP), $714.64 for out-patients of the MS Clinic (OP) and $774.21 for patients whose treatment was initiated in the Clinic, but completed in the home (HC). Sensitivity analyses indicated: 1) IP treatment was in all cases more expensive than that of OP or HC; 2) the cost savings of OP vs. HC was sensitive to assumptions made regarding Clinic overhead, Clinic nursing costs and Home Care Program overhead.
Alternatives to in-patient care must be considered carefully. In this study, both out-patient and in-home treatment were cost-saving alternatives to in-patient treatment, but large differences in the cost of hospital out-patient vs. in-home care could not be demonstrated.
BACKGROUND: The study's objective was to compare the cost of vaginal wall repair under local anesthesia, undertaken in either an inpatient or an outpatient regimen. The perspective used was that of a department of gynecology over the short and medium term. METHODS: The analysis was based on 2 consecutive cohorts of inpatients and outpatients treated in a Danish university hospital. Data on resource use were collected from clinical records and via a patient telephone survey. Salary and drug costs were estimated from national sources. Costs for consumables, complications and overnight stays were estimated from local data. The analysis compared the costs of inpatient and outpatient surgery relating to staff time, anesthesia, operation, recovery, overnight stays and complications. Multiple regression was employed to adjust for confounding variables. RESULTS: The average cost was estimated to be 10,400 DKK per inpatient and 6,100 DKK per outpatient (2004 price level: 1 euro = 7.50 DKK). Costs relating to overnight stays and staff costs during operation were the largest contributors to the cost difference. Total cost was significantly associated with type of regimen (in- or outpatient), type of operation and complications. After adjustment for confounding variables, the cost difference was estimated at 3,700 DKK (95% bootstrap confidence interval: 2,500-5,000 DKK). The risk of complication was similar for the 2 regimens. CONCLUSION: Vaginal wall repair under local anesthesia, undertaken in an outpatient regimen, appears to be less costly than in an inpatient regimen.