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Active surveillance for localized prostate cancer: an analysis of patient contacts and utilization of healthcare resources.

https://arctichealth.org/en/permalink/ahliterature271603
Source
Scand J Urol. 2015 Feb;49(1):43-50
Publication Type
Article
Date
Feb-2015
Author
Frederik B Thomsen
Kasper D Berg
M Andreas Røder
Peter Iversen
Klaus Brasso
Source
Scand J Urol. 2015 Feb;49(1):43-50
Date
Feb-2015
Language
English
Publication Type
Article
Keywords
Aged
Ambulatory Care - economics - utilization
Biopsy, Large-Core Needle - adverse effects - economics - statistics & numerical data
Cohort Studies
Denmark
Disease Management
Disease Progression
Health Resources - economics - utilization
Hospitalization - economics - statistics & numerical data
Humans
Kallikreins - blood
Male
Middle Aged
Prospective Studies
Prostate-Specific Antigen - blood
Prostatic Neoplasms - blood - pathology - therapy
Transurethral Resection of Prostate
Watchful Waiting - economics - statistics & numerical data
Abstract
Evidence supports active surveillance (AS) as a means to reduce overtreatment of low-risk prostate cancer (PCa). The consequences of close and long-standing follow-up with regard to outpatient visits, tests and repeated biopsies are widely unknown. This study investigated the trajectory and costs of AS in patients with localized PCa.
In total, 317 PCa patients were followed in a prospective, single-arm AS cohort. The primary outcomes were number of patient contacts, prostate-specific antigen (PSA) tests, biopsies, hospital admissions due to biopsy complications and patients eventually undergoing curative treatment. The secondary outcome was cost.
The 5 year cumulative incidence of discontinued AS in a competing-risk model was 40%. During the first 5 years of AS patients underwent a median of two biopsy sets, and patients were seen in an outpatient clinic including PSA testing three to four times annually. In total, 38 of the 406 biopsy sessions led to hospital admission and 87 of the 317 patients required treatment for bladder outlet obstruction (BOO). With a median of 3.7 years' follow-up, the total cost of AS was euro (€) 1,240,286. Assuming all patients had otherwise undergone primary radical prostatectomy, the cost difference favoured AS with a net benefit of €662,661 (35% reduction).
AS entails a close clinical follow-up with a considerable risk of rebiopsy complication, treatment of BOO and subsequent delayed definitive therapy. This risk should be weighed against a potential economic benefit and reduction in the risk of overtreatment compared to immediate radical treatment.
PubMed ID
25363612 View in PubMed
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Source
Can J Cardiol. 2008 Jul;24 Suppl B:6B-8B
Publication Type
Article
Date
Jul-2008
Author
Serge Lepage
Author Affiliation
Cardiology Division, Faculty of Medicine, University of Sherbrooke, Sherbrooke, Quebec. serge.lepage@USherbrooke.ca
Source
Can J Cardiol. 2008 Jul;24 Suppl B:6B-8B
Date
Jul-2008
Language
English
Publication Type
Article
Keywords
Acute Disease
Age Distribution
Aged
Aged, 80 and over
Canada - epidemiology
Cardiotonic Agents - therapeutic use
Diuretics - therapeutic use
Drug Therapy, Combination
Female
Heart Failure - diagnosis - drug therapy - epidemiology
Hospital Costs
Hospitalization - economics - statistics & numerical data
Humans
Incidence
Male
Natriuretic Peptide, Brain - therapeutic use
Patient Readmission - economics - statistics & numerical data
Risk assessment
Severity of Illness Index
Sex Distribution
Survival Analysis
Abstract
Acute decompensated heart failure is the most common cause of hospitalization for patients older than 65 years of age. Although treatment of this condition has improved over the past two decades, the specific approach to patients in the acute setting has not evolved in the same way. A patient facing acute decompensation is experiencing a serious medical condition that is associated with a poor prognosis. In addition, acute decompensated heart failure results in significant costs to the health care system. Significant morbidity and mortality are associated with patients who are readmitted within a year of the first hospitalization. Because of this important problem, further research on improving the prognosis for this condition is warranted. The present article will focus on the risk factors associated with acute decompensation and the importance of this condition, both on prognosis and economics.
Notes
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Cites: Can J Cardiol. 2004 May 1;20(6):599-60715152289
Cites: Arch Intern Med. 2005 Nov 28;165(21):2486-9216314545
Cites: Can J Cardiol. 2005 Dec;21(14):1301-616341301
Cites: N Engl J Med. 2006 Jul 20;355(3):260-916855266
Cites: Can J Cardiol. 2003 Mar 31;19(4):436-812704492
Cites: Circulation. 2007 Jun 19;115(24):3103-1017548729
Cites: Arch Intern Med. 2001 Oct 22;161(19):2337-4211606149
Cites: Eur Heart J. 2003 Mar;24(5):442-6312633546
Cites: Int J Cardiol. 2003 Mar;88(1):33-4112659982
Cites: Can J Cardiol. 2003 Mar 31;19(4):430-512704491
Cites: Can J Cardiol. 2007 Jan;23(1):21-4517245481
PubMed ID
18629381 View in PubMed
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The aging Canadian population and hospitalizations for acute myocardial infarction: projection to 2020.

https://arctichealth.org/en/permalink/ahliterature125549
Source
BMC Cardiovasc Disord. 2012;12:25
Publication Type
Article
Date
2012
Author
Nigel S B Rawson
Rong Chu
Afisi S Ismaila
Jorge Alfonso Ross Terres
Author Affiliation
Medical Affairs, GlaxoSmithKline Inc, 7333 Mississauga Road, Mississauga L5N 6L4, ON, Canada.
Source
BMC Cardiovasc Disord. 2012;12:25
Date
2012
Language
English
Publication Type
Article
Keywords
Aged
Canada - epidemiology
Cardiac Catheterization - economics - statistics & numerical data - trends
Coronary Artery Bypass - economics - statistics & numerical data - trends
Female
Forecasting
Hospitalization - economics - statistics & numerical data - trends
Humans
Length of Stay - economics - statistics & numerical data - trends
Male
Middle Aged
Myocardial Infarction - economics - epidemiology - surgery
Myocardial Revascularization - economics - statistics & numerical data - trends
Population Dynamics
Abstract
The risk of experiencing an acute myocardial infarction (AMI) increases with age and Canada's population is aging. The objective of this analysis was to examine trends in the AMI hospitalization rate in Canada between 2002 and 2009 and to estimate the potential increase in the number of AMI hospitalizations over the next decade.
Aggregated data on annual AMI hospitalizations were obtained from the Canadian Institute for Health Information for all provinces and territories, except Quebec, for 2002/03 and 2009/10. Using these data in a Poisson regression model to control for age, gender and year, the rate of AMI hospitalizations was extrapolated between 2010 and 2020. The extrapolated rate and Statistics Canada population projections were used to estimate the number of AMI hospitalizations in 2020.
The rates of AMI hospitalizations by gender and age group showed a decrease between 2002 and 2009 in patients aged = 65 years and relatively stable rates in those aged
Notes
Cites: Lancet. 2000 Jul 22;356(9226):279-8411071182
Cites: J Am Coll Cardiol. 2011 May 10;57(19):1859-6621545941
Cites: Can J Cardiol. 2003 May;19(6):655-6312772015
Cites: Can J Cardiol. 2003 Jul;19(8):893-90112876609
Cites: Can J Cardiol. 2003 Aug;19(9):997-100412915926
Cites: Can J Cardiol. 2003 Sep;19(10):1123-3114532937
Cites: Can J Cardiol. 2004 May 1;20(6):599-60715152289
Cites: Stroke. 2004 Jul;35(7):1756-6215143293
Cites: Stat Med. 1995 Dec 30;14(24):2627-438619104
Cites: BMC Public Health. 2007;7:17417650341
Cites: CMAJ. 2009 Jun 23;180(13):E118-2519546444
Cites: CMAJ. 2009 Aug 4;181(3-4):E55-6619620271
Cites: Can J Cardiol. 2009 Oct;25(10):585-819812804
Cites: Am Heart J. 2010 Jan;159(1):117.e1-620102876
Cites: CMAJ. 2010 May 18;182(8):E301-1020403888
Cites: Circulation. 2010 Jun 22;121(24):2635-4420529997
Cites: J Am Coll Cardiol. 2010 Jul 20;56(4):254-6320633817
Cites: Am Heart J. 2002 Aug;144(2):290-612177647
PubMed ID
22471314 View in PubMed
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Alcohol-attributable morbidity and resulting health care costs in Canada in 2002: recommendations for policy and prevention.

https://arctichealth.org/en/permalink/ahliterature166214
Source
J Stud Alcohol Drugs. 2007 Jan;68(1):36-47
Publication Type
Article
Date
Jan-2007
Author
Benjamin Taylor
Jürgen Rehm
Jayadeep Patra
Svetlana Popova
Dolly Baliunas
Author Affiliation
Centre for Addiction and Mental Health, Toronto, Ontario, M5S 2S1, Canada.
Source
J Stud Alcohol Drugs. 2007 Jan;68(1):36-47
Date
Jan-2007
Language
English
Publication Type
Article
Keywords
Acute Disease
Adult
Alcohol-Related Disorders - economics - mortality - therapy
Alcoholism - economics - epidemiology - rehabilitation
Canada
Catchment Area (Health)
Chronic Disease
Female
Health Care Costs
Health Policy
Health status
Hospitalization - economics - statistics & numerical data
Hospitals, Psychiatric - economics - statistics & numerical data
Humans
Male
Mental Health Services - economics
Prevalence
Abstract
Alcohol is one of the most important risk factors for burden of disease, particularly in high-income countries such as Canada. The purpose of this article was to estimate the number of hospitalizations, hospital days, and the resulting costs attributable to alcohol for Canada in 2002.
Exposure distribution was taken from the Canadian Addiction Survey and corrected for per capita consumption from production and sales. For chronic disease, risk relations were taken from the published literature and combined with exposure to calculate age- and gender-specific alcohol-attributable fractions. For injury, alcohol-attributable fractions were taken directly from available statistics. Data on the most responsible diagnosis, length of stay for hospitalizations, and costs were obtained from the national Canadian databases.
For Canada in 2002, there were 195,970 alcohol-related diagnoses among acute care hospitalizations, 2,058 alcohol-attributable psychiatric hospitalizations, and 183,589 alcohol-attributable admissions to specialized treatment centers. These accounted for 1,246,945 hospital days in acute care facilities, 54,114 hospital days in psychiatric hospitals, and 3,018,688 hospital days in specialized treatment centers (inpatient and outpatient). The main causes of alcohol-attributable morbidity were neuropsychiatric conditions, cardiovascular disease, and unintentional injuries. In total, Can. $2.29 billion were spent on alcohol-related health care.
Alcohol poses a heavy burden of disease as well as a financial strain on Canadian society. However, there are evidence-based effective and cost-effective policy and legislative interventions as well as measures to better enforce these laws.
PubMed ID
17149516 View in PubMed
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[Alternatives to acute admissions to a city hospital. Is it possible to reduce the number of acute admissions?]

https://arctichealth.org/en/permalink/ahliterature73162
Source
Ugeskr Laeger. 1994 Jul 18;156(29):4233-6
Publication Type
Article
Date
Jul-18-1994
Author
F H Andersen
I L Pedersen
M O Nielsen
D P Ehlers
N. Fredensborg
S N Holmegaard
S C Sanders
Author Affiliation
Organkirurgisk afdeling, Sundby Hospital, København.
Source
Ugeskr Laeger. 1994 Jul 18;156(29):4233-6
Date
Jul-18-1994
Language
Danish
Publication Type
Article
Keywords
Adult
Aged
Ambulatory Care - standards
Denmark
Emergency Service, Hospital - economics - statistics & numerical data
English Abstract
Female
Health Services Accessibility
Hospitals, Municipal - economics - statistics & numerical data
Humans
Male
Middle Aged
Patient Admission - statistics & numerical data
Questionnaires
Research Support, Non-U.S. Gov't
Abstract
The purpose of the study was to evaluate the number of inappropriate admissions to a smaller city hospital and find possible alternatives. Physicians and surgeons from three units (abdominal surgery, internal medicine and orthopaedic surgery) together with general practitioners, doctors on homecall duty and health personnel from the region contributed to the study. In all 421 consecutive patients were included during a three-week period. The patients' median age was 60.5 years. It was found that at least 13.6% of all patients seemed to have been admitted for an inappropriate reason. According to the admitting doctor 3.4% of the patients were not ill at all. The investigation implies that one out of seven acute admissions could be replaced by alternatives such as immediate care in residential homes, more flexible contact to the outpatient's clinic, better access to geriatric evaluation and improved laboratory service. We conclude that acute admission to hospital can be replaced by other alternatives, thereby achieving greater efficiency and better economics.
PubMed ID
8066921 View in PubMed
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An economic evaluation of hospital-based hemodialysis and home-based peritoneal dialysis for pediatric patients.

https://arctichealth.org/en/permalink/ahliterature212286
Source
Am J Kidney Dis. 1996 Apr;27(4):557-65
Publication Type
Article
Date
Apr-1996
Author
P C Coyte
L G Young
B L Tipper
V M Mitchell
P R Stoffman
J. Willumsen
D F Geary
Author Affiliation
Department of Health Administration, University of Toronto, Ontario, Canada.
Source
Am J Kidney Dis. 1996 Apr;27(4):557-65
Date
Apr-1996
Language
English
Publication Type
Article
Keywords
Canada
Child
Child, Preschool
Costs and Cost Analysis
Direct Service Costs
Hemodialysis Units, Hospital - economics - statistics & numerical data
Hospital Costs
Humans
Peritoneal Dialysis, Continuous Ambulatory - adverse effects - economics - methods - statistics & numerical data
Renal Dialysis - adverse effects - economics - methods - statistics & numerical data
Sensitivity and specificity
Abstract
The purpose of this study was to assess the relative health system cost of pediatric ambulatory hospital-based hemodialysis and home-based peritoneal dialysis, including both continuous ambulatory peritoneal dialysis and continuous cycling peritoneal dialysis when either treatment is equally appropriate. A cost analysis was performed from the viewpoint of the "study hospital" and service providers (physicians) using treatment protocols, based on current clinical practice, which incorporate procedures to establish dialysis access sites, ongoing dialysis maintenance, and possible complications. Cost estimates used information from the period between April 1, 1993, to March 31, 1994, including fully allocated inpatient and outpatient costs. A sensitivity analysis was conducted to analyze the effect of complications on treatment costs. Total annual costs (in 1994 Canadian dollars, $1.00 CDN approximately $0.75. US) of a typical and uncomplicated continuous ambulatory peritoneal dialysis, continuous cycling peritoneal dialysis, and hemodialysis patient were $47,569, $48,658, and $76,023, respectively. Differences in cost between peritoneal dialysis and hemodialysis patients were due to hemodialysis maintenance costs, which were attributed to larger physician fees (25.8 percent), greater direct treatment costs incurred by the study hospital (14.2 percent), and higher overhead costs (60.0 percent). The expected total cost of hemodialysis complicated by an arteriovenous fistula clot and central venous line blockages, or peritoneal dialysis complicated by hernia repair and peritonitis was $78,568 and $50,438 for hemodialysis and peritoneal dialysis, respectively. For the range of complication probabilities considered, expected total costs were always lower with peritoneal dialysis than with hemodialysis. The cost analysis demonstrates that peritoneal dialysis is less costly than hemodialysis for pediatric patients. Such analyses are but one component of the treatment decision, and as such, should not be viewed as the sole means to yield a treatment decision, but rather as a device for systematically evaluating the alternative treatment options.
PubMed ID
8678067 View in PubMed
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[Appropriate use of laboratory tests--medical aspects].

https://arctichealth.org/en/permalink/ahliterature157890
Source
Tidsskr Nor Laegeforen. 2008 Apr 3;128(7):810-3
Publication Type
Article
Date
Apr-3-2008
Author
Anne-Lise Bjørke Monsen
Roar Gjelsvik
Oddvar Kaarbøe
Hanne Husom Haukland
Sverre Sandberg
Author Affiliation
Laboratorium for klinisk biokjemi, Haukeland Universitetssjukehus, 5021 Bergen. almo@helse-bergen.no
Source
Tidsskr Nor Laegeforen. 2008 Apr 3;128(7):810-3
Date
Apr-3-2008
Language
Norwegian
Publication Type
Article
Keywords
Clinical Chemistry Tests - economics - statistics & numerical data - utilization
Cost-Benefit Analysis
Humans
Laboratories, Hospital - economics - statistics & numerical data - utilization
Norway
Questionnaires
Unnecessary Procedures - economics - statistics & numerical data - utilization
Utilization Review
Abstract
There has been a large increase in the use and costs of laboratory tests during recent years. Several reports have indicated excessive and inappropriate use. The purpose of this study was to assess the use of public laboratory services within clinical chemistry in two Norwegian health regions.
Production statistics for 2004 were obtained through a questionnaire sent to all public clinical chemistry hospital laboratories in northern and western Norway. Additional detailed production statistics were obtained from Haukeland University Hospital for 2002-04.
We observed differences in the absolute frequency of requested tests and a marked variation in relative ratios (ratio between related tests) between the laboratories in northern and western Norway. Data from Haukeland University Hospital showed a mean increase of 12% (range: -24-54%) in the number of ordered tests between 2002-04.
There are no known differences in morbidity between the northern and western health regions that can explain the observed variations in the use of laboratory tests. Our observations indicate a need for a thorough investigation of current utilisation of laboratory tests. Initiatives should be taken on a national basis to improve appropriate use.
PubMed ID
18389026 View in PubMed
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Assessing the burden of hospitalized and community-care heart failure in Canada.

https://arctichealth.org/en/permalink/ahliterature104912
Source
Can J Cardiol. 2014 Mar;30(3):352-8
Publication Type
Article
Date
Mar-2014
Author
Claudia Blais
Sulan Dai
Chris Waters
Cynthia Robitaille
Mark Smith
Lawrence W Svenson
Kim Reimer
Jill Casey
Rolf Puchtinger
Helen Johansen
Yana Gurevich
Lisa M Lix
Hude Quan
Karen Tu
Author Affiliation
Institut national de santé publique du Québec, Québec City, Québec, Canada; Faculté de pharmacie, Université Laval, Québec City, Québec, Canada.
Source
Can J Cardiol. 2014 Mar;30(3):352-8
Date
Mar-2014
Language
English
Publication Type
Article
Keywords
Aged
Canada - epidemiology
Community Networks - statistics & numerical data
Cost of Illness
Feasibility Studies
Female
Heart Failure - economics - epidemiology
Hospitalization - economics - statistics & numerical data
Humans
Inpatients
Male
Middle Aged
Prevalence
Survival Rate - trends
Abstract
The surveillance of heart failure (HF) is currently conducted using either survey or hospital data, which have many limitations. Because Canada is collecting medical information in administrative health data, the present study seeks to propose methods for the national surveillance of HF using linked population-based data.
Linked administrative data from 5 Canadian provinces were analyzed to estimate prevalence, incidence, and mortality rates for persons with HF between 1996/1997 and 2008/2009 using 2 case definitions: (1) 1 hospitalization with an HF diagnosis in any field (H_Any) and (2) 1 hospitalization in any field or at least 2 physician claims within a 1-year period (H_Any_2P). One hospitalization with an HF diagnosis code in the most responsible diagnosis field (H_MR) was also compared. Rates were calculated for individuals aged = 40 years.
In 2008/2009, combining the 5 provinces (approximately 82% of Canada's total population), both age-standardized HF prevalence and incidence were underestimated by 39% and 33%, respectively, with H_Any when compared with H_Any_2P. Mortality was higher in patients with H_MR compared with H_Any. The degree of underestimation varied by province and by age, with older age groups presenting the largest differences. Prevalence estimates were stable over the years, especially for the H_Any_2P case definition.
The prevalence and incidence of HF using inpatient data alone likely underestimates the population rates by at least 33%. The addition of physician claims data is likely to provide a more inclusive estimate of the burden of HF in Canada.
PubMed ID
24565257 View in PubMed
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The association between influenza immunization coverage rates and hospitalization for community-acquired pneumonia in Alberta.

https://arctichealth.org/en/permalink/ahliterature183137
Source
Can J Public Health. 2003 Sep-Oct;94(5):341-5
Publication Type
Article
Author
Yan Jin
Keumhee C Carriere
Gerry Predy
David H Johnson
Thomas J Marrie
Author Affiliation
Information Analysis, Alberta Health and Wellness.
Source
Can J Public Health. 2003 Sep-Oct;94(5):341-5
Language
English
Publication Type
Article
Keywords
Aged
Alberta - epidemiology
Community-Acquired Infections - economics - epidemiology - mortality
Cost of Illness
Health Care Costs - statistics & numerical data
Hospitalization - economics - statistics & numerical data
Humans
Immunization Programs - economics - utilization
Influenza A virus - pathogenicity
Influenza Vaccines - administration & dosage - economics
Insurance Coverage - statistics & numerical data
Linear Models
Pneumonia - economics - epidemiology - mortality
Abstract
We compared regional coverage rates of influenza vaccination (composition in 1999/00 was A/Sydney-like A/Beijing-like B/Yamanashi-like and in 2000/01 was A/Moscow A/New Caledonia B/Beijing) to the rates, cost, and mortality for community-acquired pneumonia.
We used the Pearson's correlation coefficient to establish linear associations between variables derived from Alberta administrative data during the period April 1, 1999 to March 31, 2001.
The influenza vaccination coverage rate for the 17 health regions varied between 30% to 80% (mean 70%) in Alberta seniors (n=298,473). The annual hospitalization and ambulatory community-acquired pneumonia attack rates were 2% and 6.5% per year respectively. There were strongly negative correlations between vaccination coverage rates and pneumonia rates requiring hospitalization (r1999=-0.59 and r2000=-0.79 with both p
PubMed ID
14577740 View in PubMed
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150 records – page 1 of 15.