Parkinson's disease (PD) is associated with a significant burden of illness and cost to society, which has been difficult to quantify. Our objective was to use linked administrative databases from the population of Ontario, Canada, to assess the prevalence of parkinsonism, physician- and drug-related costs, and hospital utilization for parkinsonian patients compared with age/sex matched controls. An inception cohort of parkinsonian cases from 1993/1994 was age and sex matched (1:2) to controls and followed for 6 years. Patients were identified by the diagnostic code for PD, the use of specific PD drugs, or a combination. The parkinsonian case cohort (15,304) was matched to (30,608) controls that did not have parkinsonism. The age-adjusted prevalence rates were 3.63 for men and for 3.24 women per 1,000 (increased by 5.4% for men and 9.8% for women). Physician costs were 1.4 times more, there were 1.44 times more hospital admissions, admissions were on average 1.19 times longer, and drug costs were 3.0 times more for parkinsonian cases. We conclude that the substantially higher physician and drug costs as well as hospitalization rates compared with controls clearly suggest that parkinsonism is associated with large direct costs to society.
The objective of this study was to characterize the practice of pediatric chiropractic.
The study design was a cross-sectional descriptive survey.
The settings were private practices throughout the United States, Canada, and Europe.
The participants were 548 chiropractors, the majority of whom are practicing in the United States, Canada, and Europe.
Practitioner demographics (i.e., gender, years in practice, and chiropractic alma mater), practice characteristics (i.e., patient visits per week, practice income reimbursement), and chiropractic technique were surveyed. The practitioners were also asked to indicate common indicators for pediatric presentation, their practice activities (i.e., use of herbal remedies, exercise and rehabilitation, prayer healing, etc.), and referral patterns.
A majority of the responders were female with an average practice experience of 8 years. They attended an average of 133 patient visits per week, with 21% devoted to the care of children (
Cites: J Pain Palliat Care Pharmacother. 2008;22(2):153-719062353
This paper analyzes how primary care physician visits are affected by the level of copayment in Sweden.
We use data between the years 2003-2012 from 21 Swedish health care regions that have the mandate to set their own level of copayment. The copayment per visit varies between €10 and €20 for these years and regions.
Our strategy to identify the causal effect and deal with unobserved endogeneity of price changes on physician visits is based on a panel data model using fixed effects to control for region and time and regional-variation in time trends.
We cannot reject that the copayment has no statistical or economic effect of significance, and we estimate the "zero effect" with very high precision.
In a setting with sub-national regions with autonomy to set co-payments the results points to that the copayment is not an important predictor for the number of health care visits. The result is in line with some previous studies on European data where the range of copayments used tends to be relatively low.
Knowledge of the cost of various psoriasis therapeutic options is essential to the prescribing clinician.
To compare the cost of various psoriasis treatments over a 10-year period in the province of Ontario, Canada.
We used a hypothetical patient with plaque-type psoriasis of moderate severity with a Psoriasis Area and Severity Index of 10, body surface area of 20%, and no joint involvement. The costs to treat this hypothetical patient with different therapeutic regimens were compared in this study.
In a 60 kg patient, alefacept was the most costly form of therapy, based on two 12-week treatments per year, followed by infliximab 5 mg/kg. In a 90 kg patient, infliximab 5 mg/kg was the most costly, followed by alefacept. The least costly treatment was ultraviolet B phototherapy.
With the knowledge of these data, informed prescribing by the dermatologist may reduce the financial burden to the patient, the provincial health care system, and insurance companies.
Dronedarone is a therapy for the treatment of patients with paroxysmal and persistent atrial fibrillation or atrial flutter. According to results in the ATHENA trial, dronedarone on top of standard of care (SOC) decreases the risk of cardiovascular hospitalizations or death by 24% compared with SOC alone.
A patient-level health economic model was developed to evaluate the cost-effectiveness of dronedarone on top of SOC versus SOC alone.
The risk of experiencing stroke, congestive heart failure, acute coronary syndromes, treatment discontinuation, and death was modeled by separate health states, whereas adverse events were included as 1-time cost and utility decrements. State transition probabilities were primarily deduced from the patient-level data from ATHENA using survival analysis. Four sets of analyses were performed to reflect costs and treatment effects in Canada, Italy, Sweden, and Switzerland. Cost-effectiveness analysis was also conducted in a newly defined patient population identified by the European Medicines Agency (EMA) to avoid the use of dronedarone in permanent AF patients resembling those in the PALLAS study.
The predicted survival time was, for the Canadian cohort, extended from 10.11 to 10.24 years when dronedarone was added to SOC. Similar results were found for the other countries, resulting in incremental cost-effectiveness ratios (ICERs) of €5828, €5873, €14,970, and €8554 per QALYs for Canada, Italy, Sweden, and, Switzerland, respectively. These results are all well below current established cost-effectiveness thresholds. In the EMA-restricted population, all patients were predicted to live longer, and the ICER increased but remained within established thresholds, with an average cost per QALY gained of €15,900.
Dronedarone on top of SOC appears to be a cost-effective treatment for atrial fibrillation compared with SOC alone. Despite the differences in the local settings considered, the results were consistent among all the countries included in the study. ClinicalTrials.gov identifier: NCT00174785.
The role of health-related economy is crucial due to the finite healthcare resources. Intravenous (i.v.) regimes Nordic FLOX and Nordic FLIRI, and the partly oral alternatives XELIRI and XELOX are four commonly used chemotherapies in the first-line treatment of advanced colorectal cancer (CRC) in the Scandinavian countries, all with different costs.
To describe and compare costs associated with four commonly used treatments for advanced CRC in clinical routine practice. An additional aim was to evaluate the theoretical cost impact of adverse effects associated with the therapies.
The retrospective study was carried out using observations and a clinical quality database of CRC patients treated with Nordic FLOX, Nordic FLIRI, XELIRI and XELOX as first line at an oncology clinic in Gothenburg, Sweden. The treatments are used in parallel in clinical practice. All patients treated from 2003 to 2009 were included. The clinical outcome of the therapies was equivalent; mean treatment time was 5.9-7.7 months. A clinical economic evaluation model was designed. All direct costs associated with the baseline treatment, administration of chemotherapy and drug costs were collected and evaluated.
The maximum cost for the four treatments was estimated to be 72 000-75 000 SEK per patient for six months, of this approximately 8000 SEK was linked to treatment of toxicity. During six months the i.v. treatments could include 17 more outpatient visits per patient compared to the oral alternatives. During treatment at the clinic around 20% of the patients were hospitalised (XELOX excluded, because of few included patients).
The results indicate that the four regimens are similar in terms of treatment costs. Different costs affect the total cost. The oral alternative makes it possible to treat additional patients with the same labour force resources. Treatment of adverse effects contributes to extensive resource use at the hospital.
The aim was to evaluate frequency and costs of antenatal health care visits related to risk of gestational diabetes (GDM) using Birth Register. Costs among all GDM risk groups were 10-41% larger than non-risk groups. Primary health care is needed to reduce special health care costs related to GDM.
BACKGROUND AND AIM: To comprehensively assess the relative merits of medical and surgical therapy for gastro-oesophageal reflux disease (GORD), health economic aspects have to be incorporated. We have studied the direct and indirect costs of medical and surgical therapy within the framework of a prospective randomised multicentre trial. METHODS: After initial treatment of reflux oesophagitis with omeprazole to control symptoms and to heal oesophagitis, 154 patients were randomised to continue treatment with omeprazole (20 or 40 mg daily) and 144 patients to have an open antireflux operation (ARS). In case of GORD relapse, patients allocated to omeprazole were offered ARS and those initially operated on had either a reoperation or were treated with omeprazole. The costs were assessed over five years from randomisation. RESULTS: Differences in cumulative direct medical costs per patient between the two therapeutic strategies diminished with time. However, five year direct medical costs per patient when given omeprazole were still significantly lower than for those having ARS in Denmark, Norway, and Sweden (differences were DKK 8703 (US$1475), NOK 32 992 (US$ 5155), and SEK 13 036 (US$ 1946), respectively). However, in Finland the reverse was true (the difference in favour of ARS amounted to FMK 7354 (US$ 1599)). When indirect costs (loss of production due to GORD related sick leave) were also included, the cost of surgical treatment increased substantially and exceeded the cost of medical treatment in all countries. CONCLUSIONS: The total costs of medical therapy for chronic GORD were lower than those of open ARS when prospectively assessed over a five year period, although significant differences in cost estimates were revealed between countries.
OBJECTIVE. To compare the costs and effects of two different intervention strategies for the nonpharmacological treatment of hypercholesterolaemia. DESIGN. Randomized, controlled trial. Subjects were randomly allocated to one of two intervention models and followed up for 1 year. SETTING. Vårby Health Centre, a primary care practice located in a suburb of Stockholm. SUBJECTS. Subjects with a total serum cholesterol in the range 7.0-7.8 mmol L-1 and no signs of ischaemic heart disease or diabetes mellitus, randomized to a low-intensity (n = 35) or medium-intensity (n = 41) intervention. INTERVENTION. Two strategies were used, one labelled medium-intensity strategy which followed national current guidelines for nonpharmacological treatment of hypercholesterolaemia, the other was a low-intensity strategy. MAIN OUTCOME MEASURES. Total serum cholesterol and intervention costs. RESULTS. Both intervention strategies resulted in small (mean 3.5%) decreases in total cholesterol with no significant difference between the groups. The cost per subject in the low-intensity group was SEK 753 and in the medium-intensity group SEK 3614. CONCLUSIONS. Because the effect of the two intervention programmes did not differ, the low-intensity programme is to be preferred from a cost-effectiveness point of view. If only one-third of the population in Stockholm county with cholesterol levels > or = 6.5 mmol L-1 are discovered by the primary health care system, and follow the treatment advice, the net savings in the low-intensity model compared to the current guidelines here presented as the moderate-intensity model, would be SEK 93 million.