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A 1-year community-based health economic study of ciprofloxacin vs usual antibiotic treatment in acute exacerbations of chronic bronchitis: the Canadian Ciprofloxacin Health Economic Study Group.

https://arctichealth.org/en/permalink/ahliterature206818
Source
Chest. 1998 Jan;113(1):131-41
Publication Type
Article
Date
Jan-1998
Author
R. Grossman
J. Mukherjee
D. Vaughan
C. Eastwood
R. Cook
J. LaForge
N. Lampron
Author Affiliation
Department of Respiratory Medicine, Mount Sinai Hospital, Toronto, ON.
Source
Chest. 1998 Jan;113(1):131-41
Date
Jan-1998
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Anti-Infective Agents - adverse effects - economics - therapeutic use
Bronchitis - drug therapy - economics
Canada
Chronic Disease
Ciprofloxacin - adverse effects - economics - therapeutic use
Cost-Benefit Analysis
Female
Follow-Up Studies
Health Care Costs
Hospitalization - economics
Humans
Male
Middle Aged
Predictive value of tests
Quality-Adjusted Life Years
Recurrence
Treatment Outcome
Abstract
To evaluate the costs, consequences, effectiveness, and safety of ciprofloxacin vs standard antibiotic care in patients with an initial acute exacerbation of chronic bronchitis (AECB) as well as recurrent AECBs over a 1-year period.
Randomized, multicenter, parallel-group, open-label study.
Outpatient general practice.
A total of 240 patients, 18 years or older with chronic bronchitis, with a history of frequent exacerbations (three or more in the past year) presenting with a type 1 or 2 AECB (two or more of increased dyspnea, increased sputum volume, or sputum purulence).
The assessment included AECB symptoms, antibiotics prescribed, concomitant medications, adverse events, hospitalizations, emergency department visits, outpatient resources such as diagnostic tests, procedures, and patient and caregiver out-of-pocket expenses. Patients completed the Nottingham Health Profile, St. George's Respiratory Questionnaire, and the Health Utilities Index. The parameters were recorded with each AECB and at regular quarterly intervals for 1 year. These variables were compared between the ciprofloxacin-treated group and the usual-care-treated group.
Patients receiving ciprofloxacin experienced a median of two AECBs per patient compared to a median of three AECBs per patient receiving usual care. The mean annualized total number of AECB-symptom days was 42.9+/-2.8 in the ciprofloxacin arm compared to 45.6+/-3.0 days in the usual-care arm (p=0.50). The overall duration of the average AECB was 15.2+/-0.6 days for the ciprofloxacin arm compared to 16.3+/-0.6 days for the usual-care arm. Treatment with ciprofloxacin tended to accelerate the resolution of all AECBs compared to usual care (relative risk=1.20; 95% confidence interval [CI], 0.91 to 1.58; p=0.19). Treatment assignment did not affect the interexacerbation period but a history of severe bronchitis, prolonged chronic bronchitis, and an increased number of AECBs in the past year were associated with shorter exacerbations-free periods. There was a slight, but not statistically significant, improvement in all quality of life measures with ciprofloxacin over usual care. The only factors predictive of hospitalization were duration of chronic bronchitis (odds ratio=4.6; 95% CI, 1.6, 13.0) and severity of chronic bronchitis (odds ratio=4.3; 95% CI, 0.8, 24.6). The incremental cost difference of $578 Canadian in favor of usual care was not significant (95% CI, -$778, $1,932). The cost for the ciprofloxacin arm over the usual care arm was $18,588 Canadian per quality-adjusted life year gained. When the simple base case analysis was expanded to examine the effect of risk stratification, the presence of moderate or severe bronchitis and at least four AECBs in the previous year changed the economic and clinical analysis to one favorable to ciprofloxacin with the ciprofloxacin-treated group having a better clinical outcome at lower cost ("win-win" scenario).
Treatment with ciprofloxacin tended to accelerate the resolution of all AECBs compared to usual care; however, the difference was not statistically significant. Further, usual care was found to be more reflective of best available care rather than usual first-line agents such as amoxicillin, tetracycline, or trimethoprim-sulfamethoxazole as originally expected. Despite the similar antimicrobial activities and broad-spectrum coverage of both ciprofloxacin and usual care, the trends in clinical outcomes and all quality of life measurements favor ciprofloxacin. In patients suffering from an AECB with a history of moderate to severe chronic bronchitis and at least four AECBs in the previous year, ciprofloxacin treatment offered substantial clinical and economic benefits. In these patients, ciprofloxacin may be the preferred first antimicrobial choice.
PubMed ID
9440580 View in PubMed
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Adjuvant cyclophosphamide, methotrexate, fluorouracil (CMF) in breast cancer--is it cost-effective?

https://arctichealth.org/en/permalink/ahliterature20056
Source
Acta Oncol. 2000;39(1):33-9
Publication Type
Article
Date
2000
Author
J. Norum
Author Affiliation
Department of Oncology, University Hospital of Tromsø, Norway. jannorum@fagmed.uit.no
Source
Acta Oncol. 2000;39(1):33-9
Date
2000
Language
English
Publication Type
Article
Keywords
Antineoplastic Combined Chemotherapy Protocols - economics - therapeutic use
Breast Neoplasms - drug therapy - economics
Chemotherapy, Adjuvant - economics
Cisplatin - administration & dosage - economics
Cost-Benefit Analysis
Female
Fluorouracil - administration & dosage - economics
Humans
Methotrexate - administration & dosage - economics
Middle Aged
Norway
Prognosis
Quality-Adjusted Life Years
Research Support, Non-U.S. Gov't
Abstract
Adjuvant chemotherapy (ACT) may expose patients to morbidity, with little gain in outcome. Treatment with CMF (cyclophosphamide, methotrexate, fluorouracil) has been the standard ACT in several countries for decades. In this model, efficacy, tolerability and quality of life data from the English-language literature were incorporated with Norwegian standard ACT practice and cost data in a cost-effectiveness/cost-utility approach. The CMF efficacy was calculated as 2.45 years saved per patient treated. The quality of life was assumed diminished by 0.33 (0-1 scale) for 6 months and the life years gained were valued Q = 0.86. An 85% dose intensity was employed, one British pound ( 1) was calculated as 12 NOK and a 5% discount rate was used. The total cost of adjuvant CMF, including amounts spent on drugs, administration, travelling and production loss, was calculated to 2365- 6253, depending on the method chosen. Money spent on drugs alone constituted 13-34%. The cost per life year saved was measured as 2170- 5737. A cost-utility approach revealed a cost per quality-adjusted life year (QALY) of 2973- 7860. Adjuvant CMF in breast cancer is cost-effective in Norway.
PubMed ID
10752651 View in PubMed
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Advanced cutaneous malignant melanoma: a systematic review of economic and quality-of-life studies.

https://arctichealth.org/en/permalink/ahliterature157950
Source
Value Health. 2008 Mar-Apr;11(2):259-71
Publication Type
Article
Author
Richard P Cashin
Philip Lui
Márcio Machado
Michiel E H Hemels
Patricia K Corey-Lisle
Thomas R Einarson
Author Affiliation
Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
Source
Value Health. 2008 Mar-Apr;11(2):259-71
Language
English
Publication Type
Article
Keywords
Antineoplastic Agents - economics - therapeutic use
Canada
Cost-Benefit Analysis
Humans
Mass Screening - economics
Melanoma - diagnosis - drug therapy - economics - secondary
Neoplasm Metastasis
Palliative Care
Quality of Life
Quality-Adjusted Life Years
Randomized Controlled Trials as Topic - economics
Skin Neoplasms - diagnosis - drug therapy - economics - pathology
United States
Abstract
Metastatic melanoma (MM), a major concern for health-care providers, is increasing. We systematically reviewed published articles describing the impact of interventions (drugs and screening) on quality of life (QoL) in patients with MM, and articles that measured QoL in MM.
We searched secondary databases including MEDLINE, Embase, CINAHL, Cochrane, and DARE from inception to 2006 using MESH terms "melanoma" and "metastases." Economic articles were subject to established quality assessment procedures.
We found 13 QoL and five economic studies (three cost-effectiveness, two cost-utility; average quality = 83% +/- 7%). No strong evidence was found in this review for cost-effectiveness of interferons in Canada (incremental cost-effectiveness ratio [ICER] = $55,090/quality-adjusted life-year) or temozolomide in the United States (ICER = $36,990/Life-year gained based on nonsignificant efficacy differences). Melanoma screening was not cost-effective in the United States ($150,000-931,000/life-saved) or Germany (no survival benefit). From the 13 QoL studies,eight measured baseline QoL; six studied the same population, generating similar results using different approaches/outcomes. Tools used included GLQ-8, QLQ-C30, QLQ-36, QWB-SA, and SF-36. Baseline scores QoL scores ranged from 0.60 to 0.69. Another five studies (N = 959 patients) were randomized trials analyzing QoL in patients treated with dacarbazine alone, dacarbazine +/- interferon, dacarbazine + fotemustine, interleukin +/- histamine, and temozolomide. Little difference was found in QoL scores between drugs or between baseline and end point.
Cost-effectiveness has not been widely demonstrated for treatment of MM. Only two studies with unimpressive results exist for treatments. Screening was not cost-effective in the United States or Germany. Generally, no significant improvements in QoL were found for any alternative for treating MM. A need exists for effective treatments that improve duration and QoL.
PubMed ID
18380638 View in PubMed
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Aflibercept vs. Ranibizumab: cost-effectiveness of treatment for wet age-related macular degeneration in Sweden.

https://arctichealth.org/en/permalink/ahliterature279115
Source
Acta Ophthalmol. 2016 Aug;94(5):441-8
Publication Type
Article
Date
Aug-2016
Author
Hemangi R Panchmatia
Karen M Clements
Erin Hulbert
Marianne Eriksson
Kim Wittrup-Jensen
Jonas Nilsson
Milton C Weinstein
Source
Acta Ophthalmol. 2016 Aug;94(5):441-8
Date
Aug-2016
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Angiogenesis Inhibitors - administration & dosage - economics
Cost-Benefit Analysis
Female
Health Care Costs
Humans
Intravitreal Injections
Male
Markov Chains
Middle Aged
Models, Statistical
Quality-Adjusted Life Years
Randomized Controlled Trials as Topic
Ranibizumab - administration & dosage - economics
Receptors, Vascular Endothelial Growth Factor - administration & dosage
Recombinant Fusion Proteins - administration & dosage - economics
Sweden
Vascular Endothelial Growth Factor A - antagonists & inhibitors
Visual Acuity - drug effects
Wet Macular Degeneration - drug therapy - economics
Abstract
Monthly dosing with ranibizumab (RBZ) is needed to achieve maximal visual gains in patients with neovascular ('wet') age-related macular degeneration (wAMD). In Sweden, dosing is performed as needed (RBZ PRN), resulting in suboptimal efficacy. Intravitreal aflibercept (IVT-AFL) every 2 months after three initial monthly doses was clinically equivalent to RBZ monthly dosing (RBZ q4) in wAMD clinical trials. We assessed the cost-effectiveness of IVT-AFL versus RBZ q4 and RBZ PRN in Sweden.
A Markov model compared IVT-AFL to RBZ q4 or RBZ PRN over 2 years. Health states were based on visual acuity in better-seeing eye; a proportion discontinued treatment monthly or upon visual acuity
PubMed ID
27061020 View in PubMed
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Alcohol-attributed disease burden and alcohol policies in the BRICS-countries during the years 1990-2013.

https://arctichealth.org/en/permalink/ahliterature290723
Source
J Glob Health. 2017 Jun; 7(1):010404
Publication Type
Comparative Study
Journal Article
Date
Jun-2017
Author
Rynaz Rabiee
Emilie Agardh
Matthew M Coates
Peter Allebeck
Anna-Karin Danielsson
Author Affiliation
Karolinska Institutet, Department of Public Health Sciences, Stockholm, Sweden.
Source
J Glob Health. 2017 Jun; 7(1):010404
Date
Jun-2017
Language
English
Publication Type
Comparative Study
Journal Article
Keywords
Alcohol Drinking - blood - trends
Alcohol-Related Disorders - epidemiology - mortality
Brazil
China
Cost of Illness
Disabled Persons
Evidence-Based Practice
Female
Humans
India
Male
Public Policy
Quality-Adjusted Life Years
Risk assessment
Risk factors
Russia
South Africa
Abstract
We aimed to assess alcohol consumption and alcohol-attributed disease burden by DALYs (disability adjusted life years) in the BRICS countries (Brazil, Russia, India, China and South Africa) between 1990 and 2013, and explore to what extent these countries have implemented evidence-based alcohol policies during the same time period.
A comparative risk assessment approach and literature review, within a setting of the BRICS countries. Participants were the total populations (males and females combined) of each country. Levels of alcohol consumption, age-standardized alcohol-attributable DALYs per 100?000 and alcohol policy documents were measured.
The alcohol-attributed disease burden mirrors level of consumption in Brazil, Russia and India, to some extent in China, but not in South Africa. Between the years 1990-2013 DALYs per 100 000 decreased in Brazil (from 2124 to 1902), China (from 1719 to 1250) and South Africa (from 2926 to 2662). An increase was observed in Russia (from 4015 to 4719) and India (from 1574 to 1722). Policies were implemented in all of the BRICS countries and the most common were tax increases, drink-driving measures and restrictions on advertisement.
There was an overall decrease in alcohol-related DALYs in Brazil, China and South Africa, while an overall increase was observed in Russia and India. Most notably is the change in DALYs in Russia, where a distinct increase from 1990-2005 was followed by a steady decrease from 2005-2013. Even if assessment of causality cannot be done, policy changes were generally followed by changes in alcohol-attributed disease burden. This highlights the importance of more detailed research on this topic.
Notes
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PubMed ID
28400952 View in PubMed
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[Alcohol, drugs and tobacco smoking causes much of the burden of disease--Trends in Sweden 1990-2010 mapped based DALY method].

https://arctichealth.org/en/permalink/ahliterature267576
Source
Lakartidningen. 2015;112
Publication Type
Article
Date
2015
Author
Emilie Agardh
Ulrika Boman
Peter Allebeck
Source
Lakartidningen. 2015;112
Date
2015
Language
Swedish
Publication Type
Article
Keywords
Alcohol Drinking - adverse effects - epidemiology
Cost of Illness
Female
Humans
Male
Quality-Adjusted Life Years
Risk factors
Smoking - adverse effects - epidemiology
Substance-Related Disorders - complications - epidemiology
Sweden - epidemiology
Abstract
Various attempts have been made to measure the burden of alcohol, drugs and tobacco smoking on population health, and mortality is an often used measure. As part of the governmental strategy to prevent use of alcohol, drugs, doping and tobacco (ANDT) in Sweden, we assessed disease burden measured by DALY (Disability Adjusted Life Years), attributed to alcohol, drugs and tobacco over time, as an overall indicator of problem level. DALY was developed within the Global Burden of Disease study (GBD), and combines life lost to premature death (YLL) and years lived with disability (YLD) in one measure. In 2010 tobacco contributed to 7.7% of the total disease burden in Sweden, followed by alcohol (3.4%) and drugs (1.3%). The disease burden caused by tobacco has decreased substantially since 1990, while small changes are observed for alcohol and drugs. Much of the disease burden specially related to drugs and alcohol was related to YLD, which can be captured with the DALY measure.
PubMed ID
25584599 View in PubMed
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Allocating funds for cardiovascular disease prevention in light of the NCEP ATP III guidelines.

https://arctichealth.org/en/permalink/ahliterature184450
Source
Am J Manag Care. 2003 Jul;9(7):477-89
Publication Type
Article
Date
Jul-2003
Author
Jaime Caro
Krista F Huybrechts
Wendy S Klittich
Joseph D Jackson
Alistair McGuire
Author Affiliation
Caro Research Institute, 336 Baker Avenue, Concord, MA 01742, USA. jcaro@caroresearch.com
Source
Am J Manag Care. 2003 Jul;9(7):477-89
Date
Jul-2003
Language
English
Publication Type
Article
Keywords
Adult
Anticholesteremic Agents - economics - therapeutic use
Canada
Cardiovascular Diseases - drug therapy - economics - prevention & control
Cost Savings
Cost of Illness
Female
Health Care Rationing
Health Expenditures
Health Policy
Health Services Research
Health Status Indicators
Humans
Male
Practice Guidelines as Topic
Pravastatin - economics - therapeutic use
Preventive Health Services - economics
Quality-Adjusted Life Years
Risk factors
Abstract
Controversy persists about the most efficient allocation of healthcare funds for cardiovascular disease prevention. Previous economic analyses have generally focused on primary or secondary prevention as discrete categories.
To address the information required by decision-makers to distribute budgets optimally across an entire population at risk in view of recommendations promulgated by the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III).
The Continuum of Risk Evaluation (CORE) model is an individual patient simulation of the occurrence of cardiovascular disease allowing for analyses over a broad range of risk. All events are tallied, costs are applied, and survival is modified accordingly. Disaggregated presentation of the results allows decision-makers to evaluate the budgetary implications and cost effectiveness of different strategies according to the risk at which treatment is initiated. This process is illustrated for the United States using information from the 1988-1994 National Health and Nutrition Examination Survey and pravastatin trials.
Secondary prevention with pravastatin costs dollar 2900 per life-year gained for men and dollar 1100 per life-year gained for women. Lowering the treatment threshold to incorporate primary prevention yields cost-effectiveness ratios that remain below dollar 25 000 per undiscounted life-year gained until a 10-year cardiovascular disease risk of 14.4%. Cost savings are possible for very high-risk patients.
The economic impact of an integrated approach to prevention of cardiovascular disease has not been thoroughly explored. CORE permits realistic analysis of policy decisions involving the entire continuum of risk rather than isolated consideration of specific disease stages, and thus provides a unique tool for assessing the full implications of treatment guidelines such as those of the NCEP ATP III.
PubMed ID
12866627 View in PubMed
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Analysis of cost effectiveness of screening Danish men aged 65 for abdominal aortic aneurysm.

https://arctichealth.org/en/permalink/ahliterature88585
Source
BMJ. 2009;338:b2243
Publication Type
Article
Date
2009
Author
Ehlers Lars
Overvad Kim
Sørensen Jan
Christensen Søren
Bech Merete
Kjølby Mette
Author Affiliation
Institute of Public Health, Aarhus University, Vennelyst Boulevard 6, 8000 Aarhus C, Denmark. le@folkesundhed.au.dk
Source
BMJ. 2009;338:b2243
Date
2009
Language
English
Publication Type
Article
Keywords
Aged
Aortic Aneurysm, Abdominal - economics - prevention & control - ultrasonography
Aortic Rupture - economics - prevention & control - ultrasonography
Cost-Benefit Analysis
Denmark
Humans
Male
Markov Chains
Mass Screening - economics
Quality of Life
Quality-Adjusted Life Years
Abstract
OBJECTIVE: To assess the cost effectiveness of screening men aged 65 for abdominal aortic aneurysm. DESIGN: Cost effectiveness analysis based on a probabilistic, enhanced economic decision analytical model from screening to death. POPULATION AND SETTING: Hypothetical population of men aged 65 invited (or not invited) for ultrasound screening in the Danish healthcare system. DATA SOURCES: Published results from randomised trials and observational epidemiological studies retrieved from electronic bibliographic databases, and supplementary data obtained from the Danish Vascular Registry. DATA SYNTHESIS: A hybrid decision tree and Markov model was developed to simulate the short term and long term effects of screening for abdominal aortic aneurysm compared with no systematic screening on clinical and cost effectiveness outcomes. Probabilistic sensitivity analyses using Monte Carlo simulation were carried out. Results were presented in a cost effectiveness acceptability curve, an expected value of perfect information curve, and a curve showing the expected (net) number of avoided deaths from abdominal aortic aneurysm over time after the introduction of screening. The model was validated by calibrating base case health outcomes and expected activity levels against evidence from the recent Cochrane review of screening for abdominal aortic aneurysm. RESULTS: The estimated costs per quality adjusted life year (QALY) gained discounted at 3% per year over a lifetime for costs and QALYs was pound43 485 (euro54,852; $71,160). At a willingness to pay threshold of pound30,000 the probability of screening for abdominal aortic aneurysm being cost effective was less than 30%. One way sensitivity analyses showed the incremental cost effectiveness ratio varying from pound32,640 to pound66,001 per QALY. CONCLUSION: Screening for abdominal aortic aneurysm does not seem to be cost effective. Further research is needed on long term quality of life outcomes and costs.
Notes
Comment In: BMJ. 2009;338:b218519553266
Comment In: BMJ. 2009;339:b304419638382
PubMed ID
19553267 View in PubMed
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Anastrozole is cost-effective vs tamoxifen as initial adjuvant therapy in early breast cancer: Canadian perspectives on the ATAC completed-treatment analysis.

https://arctichealth.org/en/permalink/ahliterature169906
Source
Support Care Cancer. 2006 Sep;14(9):917-27
Publication Type
Article
Date
Sep-2006
Author
A. Rocchi
S. Verma
Author Affiliation
Axia Research, Hamilton, Canada. angela@axiaresearch.com
Source
Support Care Cancer. 2006 Sep;14(9):917-27
Date
Sep-2006
Language
English
Publication Type
Article
Keywords
Analysis of Variance
Antineoplastic Agents, Hormonal - administration & dosage - economics
Antineoplastic Combined Chemotherapy Protocols - economics - therapeutic use
Aromatase Inhibitors - administration & dosage - economics
Breast Neoplasms - drug therapy - economics - mortality
Canada
Chemotherapy, Adjuvant
Cost-Benefit Analysis
Disease-Free Survival
Female
Humans
Neoplasm Recurrence, Local - prevention & control
Nitriles - administration & dosage - economics
Quality-Adjusted Life Years
Randomized Controlled Trials as Topic
Risk Reduction Behavior
Sensitivity and specificity
Survival Rate
Tamoxifen - administration & dosage - economics
Time Factors
Treatment Outcome
Triazoles - administration & dosage - economics
Abstract
To conduct an economic analysis comparing tamoxifen and anastrozole (Arimidex) in the adjuvant treatment of hormone receptor-positive (HR+), post-menopausal early breast cancer patients.
An economic model examined typical patients (64 years of age, HR+, 64% node negative) from the Arimidex, tamoxifen alone, or in combination (ATAC) trial over a lifetime horizon. Rates of events were derived from ATAC trial results. Post-trial event rates were drawn from the literature for tamoxifen; event rates for anastrozole were modified by the relative risks observed in the ATAC trial. Resource utilization was drawn from Statistics Canada's Population Health Model for breast cancer, supplemented by an expert panel. A public health care system perspective, 2004 Canadian prices and a 5% discount rate were employed.
Anastrozole-taking patients incurred additional hormonal treatment costs compared to tamoxifen-taking patients (incremental lifetime cost, 6,974 Canadian dollars per patient), partially offset by reduced downstream recurrences of breast cancer (1,143 Canadian dollars lifetime savings per patient) for a net incremental cost of 5,796 Canadian dollars per patient on anastrozole. The anastrozole-treated patients were projected to experience a 5.6% absolute risk reduction of first breast cancer recurrence and a 2.8% absolute risk reduction in breast cancer death. This corresponded to 30,000 Canadian dollars per life year gained and 28,000 Canadian dollars per quality-adjusted life year gained (95% confidence interval, 17,428 to 54,605 Canadian dollars). The results were affected by the duration and extent of anastrozole benefit under sensitivity analysis but remained cost-effective.
Compared to tamoxifen, anastrozole therapy is effective and cost-effective as initial adjuvant therapy in post-menopausal, HR+ early breast cancer patients.
PubMed ID
16596419 View in PubMed
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An economic evaluation of early versus delayed operative treatment in patients with closed tibial shaft fractures.

https://arctichealth.org/en/permalink/ahliterature189289
Source
Arch Orthop Trauma Surg. 2002 Jul;122(6):315-23
Publication Type
Article
Date
Jul-2002
Author
Sheila Sprague
Mohit Bhandari
Author Affiliation
Department of Clinical Epidemiology and Biostatistics, McMaster University, Health Sciences Centre, Room 2C12, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada.
Source
Arch Orthop Trauma Surg. 2002 Jul;122(6):315-23
Date
Jul-2002
Language
English
Publication Type
Article
Keywords
Ambulatory Care - economics
Canada
Costs and Cost Analysis
Fractures, Closed - economics - surgery
Fractures, Ununited - economics
Hospital Costs
Humans
Length of Stay - economics
Outcome Assessment (Health Care) - economics
Postoperative Complications - economics
Quality-Adjusted Life Years
Retrospective Studies
Statistics as Topic
Tibial Fractures - economics - surgery
Time Factors
Abstract
There are few reports examining the effect of surgical delay on outcomes following operative treatment of lower extremity fractures. Delays in the surgery for closed tibial shaft fractures have been reported to increase the overall complication rate, postoperative hospital stays and crude costs to the health care system. Our purpose was to estimate the cost-effectiveness and cost-utility associated with the adoption of a programme of early operative treatment of all closed tibial shaft fractures. We performed cost analyses based upon data obtained from an observational study. A cohort of patients with closed tibial shaft fractures was identified at a university-affiliated level I trauma centre. Patients were divided into an early surgical group (within 12 h) and delayed surgical group (longer than 12 h). Study outcomes included time to fracture union (weeks), direct inpatient and outpatient costs associated with each intervention, loss of productivity costs, and utilities (patient health perception) as determined from content experts. Sixteen patients were operated on within 12 h of injury and 19 patients were treated later than 12 h after their fracture. These groups were similar for all baseline variables. The average time to fracture union was 28.2 weeks (SD 9.4) and 44.2 weeks (SD 7.4) for the early surgical group and the delayed surgical group, respectively ( p
PubMed ID
12136294 View in PubMed
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580 records – page 1 of 58.