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Burden of parkinsonism: a population-based study.

https://arctichealth.org/en/permalink/ahliterature186373
Source
Mov Disord. 2003 Mar;18(3):313-9
Publication Type
Article
Date
Mar-2003
Author
Mark Guttman
Pamela M Slaughter
Marc-Erick Theriault
Donald P DeBoer
C David Naylor
Author Affiliation
Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. mguttman@idirect.com
Source
Mov Disord. 2003 Mar;18(3):313-9
Date
Mar-2003
Language
English
Publication Type
Article
Keywords
Adult
Aged
Canada - epidemiology
Cohort Studies
Costs and Cost Analysis
Female
Health Services Research
Hospitalization - economics - statistics & numerical data
Humans
Male
Middle Aged
Office Visits - economics - statistics & numerical data
Parkinson Disease - economics - epidemiology - therapy
Parkinsonian Disorders - economics - epidemiology - therapy
Prevalence
Abstract
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.
PubMed ID
12621635 View in PubMed
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Source
J Altern Complement Med. 2010 Jun;16(6):621-6
Publication Type
Article
Date
Jun-2010
Author
Joel Alcantara
Jeanne Ohm
Derek Kunz
Author Affiliation
International Chiropractic Pediatric Association, Media, PA 19063, USA. dr_jalcantara@yahoo.com
Source
J Altern Complement Med. 2010 Jun;16(6):621-6
Date
Jun-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Canada
Child
Chiropractic - economics - statistics & numerical data
Cross-Sectional Studies
Europe
Female
Humans
Income - statistics & numerical data
Male
Manipulation, Spinal - statistics & numerical data
Office Visits - economics - statistics & numerical data
Osteopathic Physicians
Pediatrics - methods
Physician's Practice Patterns - economics - statistics & numerical data
Preventive Medicine
Referral and Consultation - statistics & numerical data
Reimbursement Mechanisms - statistics & numerical data
United States
Abstract
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 (
Notes
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PubMed ID
20569028 View in PubMed
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Copayments and physicians visits: A panel data study of Swedish regions 2003-2012.

https://arctichealth.org/en/permalink/ahliterature285757
Source
Health Policy. 2016 Sep;120(9):1095-9
Publication Type
Article
Date
Sep-2016
Author
Niklas Jakobsson
Mikael Svensson
Source
Health Policy. 2016 Sep;120(9):1095-9
Date
Sep-2016
Language
English
Publication Type
Article
Keywords
Aged
Cost Sharing - economics
Health Services Accessibility - economics
Humans
Office Visits - economics - utilization
Physicians
Primary Health Care
Sweden
Abstract
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.
PubMed ID
27477892 View in PubMed
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Cost comparison of psoriasis treatments.

https://arctichealth.org/en/permalink/ahliterature147324
Source
J Cutan Med Surg. 2009 Nov-Dec;13(6):303-7
Publication Type
Article
Author
Dalia Mikhael
Kelly Babcock
Jean-Pierre DesGroseilliers
Author Affiliation
Division of Dermatology, University of Ottawa, Ottawa, ON, Canada. dalia_mikhael@yahoo.com
Source
J Cutan Med Surg. 2009 Nov-Dec;13(6):303-7
Language
English
Publication Type
Article
Keywords
Clinical Laboratory Techniques - economics
Costs and Cost Analysis
Dermatologic Agents - economics
Female
Humans
Immunosuppressive Agents - economics
Male
Office Visits - economics
Ontario
Phototherapy - economics
Psoriasis - economics - therapy
Severity of Illness Index
Abstract
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.
PubMed ID
19919807 View in PubMed
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Cost-effectiveness of dronedarone in atrial fibrillation: results for Canada, Italy, Sweden, and Switzerland.

https://arctichealth.org/en/permalink/ahliterature122813
Source
Clin Ther. 2012 Aug;34(8):1788-802
Publication Type
Article
Date
Aug-2012
Author
Örjan Åkerborg
Jonas Nilsson
Stephanie Bascle
Peter Lindgren
Matthew Reynolds
Author Affiliation
OptumInsight, Stockholm, Sweden. orjan.akerborg@optum.com
Source
Clin Ther. 2012 Aug;34(8):1788-802
Date
Aug-2012
Language
English
Publication Type
Article
Keywords
Aged
Amiodarone - adverse effects - analogs & derivatives - economics - therapeutic use
Anti-Arrhythmia Agents - adverse effects - economics - therapeutic use
Atrial Fibrillation - complications - diagnosis - drug therapy - economics - mortality
Canada
Computer simulation
Cost Savings
Cost-Benefit Analysis
Diagnostic Tests, Routine - economics
Drug Costs
Europe
Female
Hospital Costs
Hospitalization - economics
Humans
Male
Models, Economic
Office Visits - economics
Quality-Adjusted Life Years
Stroke - economics - etiology - prevention & control
Survival Analysis
Time Factors
Treatment Outcome
Abstract
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.
PubMed ID
22770643 View in PubMed
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Cost identification of Nordic FLIRI, Nordic FLOX, XELIRI and XELOX in first-line treatment of advanced colorectal cancer in Sweden -- a clinical practice model approach.

https://arctichealth.org/en/permalink/ahliterature121110
Source
Acta Oncol. 2012 Sep;51(7):840-8
Publication Type
Article
Date
Sep-2012
Author
Karin Pettersson
Göran Carlsson
Christoffer Holmberg
Sofia Kälvemark Sporrong
Author Affiliation
Department of Pharmacy, Uppsala University, Uppsala, Sweden.
Source
Acta Oncol. 2012 Sep;51(7):840-8
Date
Sep-2012
Language
English
Publication Type
Article
Keywords
Administration, Oral
Adult
Aged
Antineoplastic Combined Chemotherapy Protocols - administration & dosage - economics - therapeutic use
Camptothecin - administration & dosage - analogs & derivatives - economics
Colorectal Neoplasms - drug therapy - economics - pathology
Cost-Benefit Analysis
Deoxycytidine - administration & dosage - analogs & derivatives - economics
Drug Costs
Female
Fluorouracil - administration & dosage - analogs & derivatives - economics
Hospitalization - economics
Humans
Infusions, Intravenous
Injections, Intravenous
Leucovorin - administration & dosage - economics
Male
Middle Aged
Neoplasm Staging
Office Visits - economics
Organoplatinum Compounds - administration & dosage - economics
Palliative Care - economics - methods
Physician's Practice Patterns - economics - trends
Randomized Controlled Trials as Topic
Retrospective Studies
Scandinavia
Sweden
Abstract
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.
PubMed ID
22937953 View in PubMed
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Cost of gestational diabetes-related antenatal visits in health care based on the Finnish Medical Birth Register.

https://arctichealth.org/en/permalink/ahliterature137349
Source
Prim Care Diabetes. 2011 Jul;5(2):139-41
Publication Type
Article
Date
Jul-2011
Author
Päivi Kolu
Jani Raitanen
Riitta Luoto
Author Affiliation
UKK Institute for Health Promotion, Tampere, Finland. paivi.kolu@uta.fi
Source
Prim Care Diabetes. 2011 Jul;5(2):139-41
Date
Jul-2011
Language
English
Publication Type
Article
Keywords
Adult
Diabetes, Gestational - diagnosis - economics - therapy
Female
Finland
Glucose Tolerance Test - economics
Health Care Costs
Hospitals, University - economics
Humans
Maternal Health Services - economics
Models, Economic
Office Visits - economics
Pregnancy
Primary Health Care - economics
Registries
Abstract
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.
PubMed ID
21292576 View in PubMed
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The cost of long term therapy for gastro-oesophageal reflux disease: a randomised trial comparing omeprazole and open antireflux surgery.

https://arctichealth.org/en/permalink/ahliterature71861
Source
Gut. 2001 Oct;49(4):488-94
Publication Type
Article
Date
Oct-2001
Author
H E Myrvold
L. Lundell
P. Miettinen
S A Pedersen
B. Liedman
J. Hatlebakk
R. Julkunen
K. Levander
M. Lamm
C. Mattson
J. Carlsson
N O Ståhlhammar
Author Affiliation
Trondheim University Hospital, Norway. helge.myrvold@medisin.ntnu.no
Source
Gut. 2001 Oct;49(4):488-94
Date
Oct-2001
Language
English
Publication Type
Article
Keywords
Aged
Anti-Ulcer Agents - economics - therapeutic use
Comparative Study
Confidence Intervals
Cost of Illness
Female
Fundoplication - economics
Gastroesophageal Reflux - economics - therapy
Health Care Costs
Humans
Length of Stay - economics - statistics & numerical data
Male
Middle Aged
Office Visits - economics - statistics & numerical data
Omeprazole - economics - therapeutic use
Reoperation - economics - statistics & numerical data
Research Support, Non-U.S. Gov't
Sick Leave - economics - statistics & numerical data
Abstract
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.
Notes
Comment In: Gut. 2001 Oct;49(4):462-311559638
PubMed ID
11559644 View in PubMed
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The costs and effects of two different lipid intervention programmes in primary health care.

https://arctichealth.org/en/permalink/ahliterature48411
Source
J Intern Med. 1995 Jan;237(1):13-7
Publication Type
Article
Date
Jan-1995
Author
Y. Tomson
M. Johannesson
H. Aberg
Author Affiliation
Department of Clinical Neuroscience and Family Medicine, Karolinska Institute, Stockholm, Sweden.
Source
J Intern Med. 1995 Jan;237(1):13-7
Date
Jan-1995
Language
English
Publication Type
Article
Keywords
Adult
Analysis of Variance
Chi-Square Distribution
Cholesterol - blood
Comparative Study
Cost-Benefit Analysis
Dietetics - economics
Family Practice - economics
Female
Humans
Hypercholesterolemia - blood - economics - therapy
Male
Middle Aged
Office Visits - economics
Primary Health Care - economics
Referral and Consultation - economics
Sweden
Treatment Outcome
Abstract
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.
Notes
Comment In: J Intern Med. 1995 Jan;237(1):1-37830021
PubMed ID
7830025 View in PubMed
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