The societal costs of intracerebral hemorrhage in Spain

This study estimates the lifetime societal costs associated with incident intracerebral hemorrhage (ICH) in Spain. An epidemiological model of ICH incidence, survival and morbidity was developed using retrospective data from 28 hospitals in Andalusia and published data identified in a systematic literature review. Data on resource utilization and costs were obtained from five hospitals in the Canary Islands, whereas cost of outpatient care, informal care and lost productivity were obtained from standardized questionnaires completed by survivors of ICH. The lifetime societal costs of incident ICH in Spain is estimated at €46 193 per patient. Direct medical costs accounted for 32.7% of lifetime costs, whilst 67.3% were related to indirect costs. One-third of direct medical costs over the first year were attributable to follow-up care, including rehabilitation. Indirect costs were dominated by costs of informal care (71.2%). The aggregated lifetime societal costs for the estimated 12 534 Spanish patients with a first-ever ICH in 2004 was €579 million. ICH implies substantial costs to society primarily due to formal and informal follow-up care and support needed after hospital discharge. Interventions that offer survival benefits without improving patients' functional status are likely to further increase the societal costs of ICH.     

Cost of Epilepsy in the United States: A Model Based on Incidence and Prognosis

Summary: A model of the clinical course of epilepsy from onset until remission or death has been developed for six prognostic groups, including survival, use and cost of medical care, and time lost from work and housekeeping. The model has been used to generate preliminary estimates of the lifetime cost of epilepsy for a cohort of persons diagnosed in 1990 in the United States. The distribution of incident cases among prognostic groups is derived from epidemiologic studies of prognosis in epilepsy. Direct cost is estimated by multiplying nationally representative unit costs by the expected type and frequency of medical care use. The latter were derived by an expert panel, based on inferences from existing literature and on their own clinical experiences. Indirect cost is estimated based on lost earnings associated with projections of restricted activity days, excess unemployment, and excess mortality. Total lifetime cost in 1990 dollars of all persons with epilepsy onset in 1990 was estimated at $3.0 billion, with indirect cost accounting for 62% of the total. Cost per patient ranged from $4,272 for persons with remission after initial diagnosis and treatment to $138,602 for persons with intractable and frequent seizures. Antiepileptic drug (AED) treatment is the most costly category of service. Different assumptions about the amount and type of drug administration cause major changes in overall cost estimates.     

Uptake and Costs of Care for Epilepsy: Findings from a U.K. Regional Study

Summary: Purpose: Epilepsy is a common neurological condition, with significant resource implications for the health services, but few studies to date have examined the uptake and costs of care for this condition. As part of a large prevalence study of epilepsy conducted in one U.K. Health Region, we investigated both direct and indirect costs of epilepsy care and measured and valued the direct costs.
Methods: Data about service use were obtained from primary physician records and patient questionnaires. Unit costs for each item of resource use were generated from several sources.
Results: The greatest direct health care cost is that of hospital-based care. Pharmaceutical services also represent a significant element of the cost of epilepsy, the financial costs of prescribing newly developed antiepileptic drugs (AEDs) being large relative to those of the older drugs; therefore, the benefits derived from their use must be carefully assessed. The importance of good seizure control is amply illustrated by the findings about the differential costs associated with epilepsy of varying severity. The direct costs of caring for people with poorly controlled epilepsy are significant, with more than half the total cost of epilepsy care accounted for by patients with frequent seizures even though this group represented only a quarter of all patients in the present study.
Conclusions: Our data emphasize the importance of optimizing seizure control as a means of reducing the costs of epilepsy, not only to the person with the condition, but also to society.     

Direct and indirect costs of refractory epilepsy in a tertiary epilepsy center in Germany

PURPOSE: There are only few studies on the costs of epilepsy in Germany. Therefore, we performed a pilot study to estimate the direct and indirect costs of refractory epilepsy in a German epilepsy center. METHODS: A "prevalence-based," cross-sectional convenience sample of adults with active epilepsy attending the outpatient clinic of our tertiary epilepsy center was evaluated. Seizure-free patients and patients presenting with their first seizure were excluded. Direct and indirect costs were prospectively recorded over a three-month period using questionnaires and a patient diary. Cost driving factors were identified. RESULTS: One hundred one patients were included (40.7+/-15.2 years; disease duration: 18.1+/-15.3 years; 6 patients had focal epilepsy with simple partial seizures only, 28 with complex partial seizures, 43 with secondarily generalized tonic-clonic seizures; 20 had idiopathic generalized epilepsy with generalized tonic-clonic seizures). The total costs of epilepsy per patient were in average euro 2610+/-4200 over the three-month period. Direct cost contributed 39% to the total costs. Costs of anticonvulsant medication were the main contributor to the direct costs while indirect costs were caused mainly by losses due to early retirement. Cost driving factors included higher seizure frequency, longer disease duration, ictal falls, and situationally inappropriate complex behavior during or after the seizure. CONCLUSIONS: Indirect costs were higher than direct costs in adult patients with active epilepsy attending a German epilepsy center. Medication contributed the most to the direct costs and early retirement was the main factor for the indirect costs. The costs of poorly controlled epilepsy in this German study were above average of the European costs of epilepsy.     

Length of stay and antipsychotic treatment costs of patients with acute psychosis admitted to hospital in Spain.

Abstract. Objective: The aim of this study was to describe the length of stay, cost of drug treatment, diagnostic tests and other therapeutic measures in acute psychotic patients admitted to acute in-patient psychiatric units and to analyse the factors associated with these. Methods: A retrospective review was made of medical records of 200 patients admitted for acute psychosis in eight Spanish hospitals. Information was collected concerning the length of stay, cost of drug treatment and diagnostic tests; bivariate and multivariate analysis was made of factors associated with length of stay and cost of antipsychotic drug treatment. Results: The average admission cost ranged between 2,830.29 and 3,624.95 euros, with a wide variability among hospitals. Of this cost, 94.3% corresponded to fixed costs, 3.4% to diagnostic tests and 2.4% to drug treatment (84.2% of this latter cost corresponded to antipsychotic drugs). Age younger than 25 years and a diagnosis of schizophrenia were associated with longer hospital stays; longer length of stay, the presence of aggressiveness/agitation, a diagnosis of schizophrenia, age younger than 25 years and the use of atypical antipsychotics were associated with higher costs in antipsychotic drug treatment. Conclusions: The hospital admission cost of an acute psychotic episode is mostly dependent on the structural costs derived from in-patient treatment. The differences in costs seem to be related to the different length of stay schemes used by the various hospitals rather than to the clinical characteristics of patients or the drugs used.* The Psychosp Group includes: Ana Alvarez Díaz, Sonia Cruz Pardo (Hospital General de Guadalajara), Milagros Anaya Turrientes, Leonor Sanz Vila, Marta Soler (Hospital Ramón y Cajal de Madrid), Alicia Díez del Pino, Sonia González Ponsjoan, Antonia M^a Mejías Corbacho (Hospital Insular de Las Palmas), María Forés Mayán, Juan Rojo, Mónica Suárez (Hospital Conxo de Santiago),Gregorio Gómez, Salvador Peiró (Fundación Instituto de Investigación en Servicios de Salud, Valencia), Iris Guadarrama, Javier Rejas (Pfizer Spain, Madrid), Isabel Martín Herranz, Juan C. Yañez Rubal (Hospital Juan Canalejo de La Coruña), Montserrat Navarro (Hospital de Santa María, Lleida), Amaya Navarte, José Luis Vila Jato (Hospital General de Santiago), Ramón Pla Poblador, Susana Redondo Capafons (Hospital Mutua de Tarrasa), Josep Rivas, Francesc Sorio (Hospital Clinic i Provincial, Barcelona).     

The societal costs and quality of life of patients suffering from bipolar disorder in the Netherlands

OBJECTIVE: To assess the societal costs and quality of life of patients suffering from bipolar disorder in the Netherlands. METHOD: Forty persons with a lifetime diagnosis of bipolar disorder (SCID/DSM-IV) and representative for the Dutch general population were interviewed to collect data on direct (use of medical resources) and indirect (productivity losses because of absence from work and reduced efficiency at work) costs of illness. Respondents' quality of life was also assessed. Prevalence (5.2%) of bipolar disorder was used to estimate total costs. RESULTS: Total costs of bipolar disorder were estimated at US 1.83 billion dollars (total direct costs = US 454 million dollars; total indirect costs = US 1.37 billion dollars). Participants' quality-of-life scores were lower than those of the general population. CONCLUSION: The societal costs form patients suffering of bipolar disorder in the Netherlands were high, especially the indirect costs because of absence from work. The quality of life of bipolar patients was lower than the general population.     

Medical and productivity costs of anxiety disorders: case control study

This retrospective case-control study examines the medical and productivity costs associated with a diagnosis of anxiety. The study used a data set from a large employer database that collected medical, pharmaceutical, absenteeism, short-term disability, and worker compensation records during 2000 from 6 major employers. Patients diagnosed with anxiety disorders (n= 1917) were matched at a 1:1 ratio to patients not diagnosed with anxiety disorders (n= 1917) based on age, sex, metropolitan statistical area, and type of insurance coverage. Paired-difference t tests, McNemer's test, and analyses of covariance were used to compare the anxiety population with the control group. Employees diagnosed with anxiety disorders were significantly more likely to have additional diagnoses, use more services, require hospitalization, or visit the emergency room compared with the control group. Furthermore, after controlling for differences in comorbidities, employees diagnosed with anxiety disorders had significantly higher medical costs [$1555; 95% confidence interval (CI) $1066-2043], productivity costs ($1366; 95% CI $708-2023), and total costs ($2920; 95% CI $2035-3805) compared with the control group. Results indicate that anxiety disorders are associated with significant medical and productivity costs.     

Refining the Costs Analyses of the Fort Bragg Evaluation: The Impact of Cost Offset and Cost Shifting

A key aim of the evaluation of the Fort Bragg Demonstration was to determine whether delivering services through a continuum of care lowered expenditures on mental health services. The evaluation clearly showed that expenditures were actually higher in the Demonstration. Critics of the evaluation claimed that the evaluation's perspective on costs was too narrow—in particular, that the Demonstration produced cost shifting and cost offset that were not captured by the evaluation. New data allow us to include a broader array of costs: mental health services received outside the catchment areas, general medical services for the children themselves, and mental health services used by family members. Results showed that reductions in other costs do partially offset higher expenditures on mental health services for children at the Fort Bragg Demonstration. However, even when broader costs are included, total family expenditures are still substantially higher at the Demonstration.     

The influence of race on SLP utilisation and costs among persons with aphasia

Background: Recent evidence suggests racial disparities exist in post-stroke conditions such as aphasia, yet the underlying cause of such disparities is unclear. Disparities in rehabilitation service utilisation have been previously proposed as a contributor to racial disparities in post-stroke outcomes.

Aim: To examine racial differences in speech–language pathology (SLP) service utilisation and costs among persons with aphasia being treated in acute care hospitals in North Carolina.

Methods & Procedures: The North Carolina Healthcare Cost and Utilization Project data from 2011 to 2012 were analysed to examine SLP service utilisation and costs for stroke patients with aphasia. Analyses included length of stay (LOS) and charges/costs of SLP services. Generalised linear models were constructed to determine the impact of demographic characteristics, stroke severity, residence, and hospital fixed effects (variability of hospital management practices) on SLP utilisation and costs.

Outcomes & Results: Approximately 5% more Blacks with aphasia were seen for SLP services than Whites with aphasia. LOSs were 2.1 days longer in acute care at 17% greater cost. Generalised linear models showed that Blacks with aphasia were seen for approximately 0.416 more visits than Whites after controlling for demographic characteristics, stroke/illness severity and residence and 0.25 more visits after controlling for hospital fixed effects. The slight increase in visits occurred at a cost of $57 when controlling for demographic characteristics, $63 when controlling for stroke/illness severity, $50 when controlling for residence, and $23 when controlling for hospital fixed effects.

Conclusions: Blacks with aphasia utilise more SLP services during longer LOSs and with greater costs when compared to Whites with aphasia.     

Cost of Parkinson’s disease among Filipino patients seen at a public tertiary hospital in Metro Manila

BackgroundCost of illness (COI) studies are used to estimate the economic burden of a particular disease. The chronicity of Parkinson's disease (PD) and its lack of treatment make its projected economic burden to grow substantially over the next few decades.MethodsTo evaluate the cost of having PD, a COI study was done in a public tertiary hospital in Metro Manila, Philippines. PD patients who were consecutively seen at out patient clinic for a period of six months were included in this study and were interviewed using a ready-made financial burden questionnaire. To identify the possible factors that may affect the cost, European Quality of Life 5 Dimensions (EQ5D), Montreal Cognitive Assessment-Philippines (MoCA-P), Hospital Anxiety and Depression Scale-Pilipino (HADS-P), Unified Parkinson's Disease Rating Scale (UPDRS) motor and activities of daily living (ADL) scores, Schwab and England ADL and Hoehn and Yahr scoring were also administered.ResultsThirty three consecutive PD patients (mean age: 58.4 yrs, men: 52%) were identified. The annual total cost of PD per capita was Php 308,796 (USD 6175) with direct cost accounting for 23% and indirect cost 77%. The main cost components for direct medical, direct non-medical and indirect cost were pharmacotherapy (97%), home care (42.6%) and productivity loss (100%) respectively. The factors observed to have high cost of PD included being male, married, employed, the presence of wearing off phenomenon, low MOCA-P and HADS-P, low Schwab and England ADL and increasing Hoehn and Yahr stage.ConclusionThis study showed that PD is a costly neurodegenerative disease that may pose a significant economic burden on patients, health care system and society.     

The Nottingham study of neurotic disorder: predictors of 12 year costs

OBJECTIVE: To examine the relationship between clinical, demographic and socio-economic characteristics and the long-term costs of a cohort of neurotic patients. METHOD: Analysis of the costs of a cohort of 210 people entered in the Nottingham study of neurotic disorders, a randomized controlled evaluation of five treatments for neurotic disorders. Service use data were collected at 5 and 12 years after study entry. Multiple regression analyses were conducted. RESULTS: The total cost per patient over the 12-year follow-up period was calculated to be $11,940 (SD $15,520) ( pound7450, SD pound9690). Higher costs were significantly associated with the presence of general neurotic syndrome, an initial diagnosis of dysthymia and a recurrent episode of illness. CONCLUSION: The total costs of care for a range of neurotic disorders are broadly comparable with other estimates of costs reported in the literature for similar populations. Those responsible for higher costs in the longer-term have comorbid anxiety, depressive and personality disorders.     

Assessing Administrative Costs of Mental Health and Substance Abuse Services

Increasing competition in the market for mental health and substance abuse MHSA services and the potential to realize significant administrative savings have created an imperative to monitor, evaluate, and control spending on administrative functions. This paper develops a generic model that evaluates spending on administrative personnel by a group of providers. The precision of the model is demonstrated by examining a set of data assembled from five MHSA service providers. The model examines a differential cost construction derived from inter-facility comparisons of administrative expenses. After controlling for the scale of operations, the results enable MHSA programs to control the efficiency of administrative personnel and related rates of compensation. The results indicate that the efficiency of using the administrative complement and the scale of operations represent the lion's share of the total differential cost. The analysis also indicates that a modest improvement in the use of administrative personnel results in substantial cost savings, an increase in the net cash flow derived from operations, an improvement in the fiscal performance of the provider, and a decline in opportunity costs that assume the form of foregone direct patient care.     

Measuring the costs of crime using the willingness-to-pay method

Background

Criminal justice policy decisions are increasingly being influenced by the ratio of the monetary benefits to the monetary costs. While policies based on evidence and analysed via cost-benefit studies are a welcome development, cost-benefit calculations are only as robust as the data upon which they are based. For England and Wales up to the present, cost-of-crime estimates used in cost-benefit analyses have been calculated by the Home Office using a multi-method approach. However, the intangible costs of crime have not been estimated adequately in England and Wales.

Aim

The main aim was to quantify the intangible costs of crime using the willingness-to-pay (WTP) method. Also, stated preferences for different crime reduction methods were investigated.

Method

This study utilises samples from the City of Cambridge (n = 534) and from Criminal Justice Practitioners (n = 124), to assess their WTP to prevent a range of crimes from happening in their neighbourhood, and their preferred crime reduction techniques. A Contingent Valuation Survey (CVS) was used.

Results

Overall, both samples gave a higher WTP for low volume, high harm crimes than for high volume, low harm crimes. Both samples supported funding youth programmes in preference to other forms of crime reduction initiatives.

Conclusion

It is proposed that a CVS should be included in the next Crime Survey for England and Wales, in order to collect relevant WTP data on crime at the national level.

     

Comparing patterns and costs of schizophrenia care in five European countries: the EPSILON study. European Psychiatric Services: Inputs Linked to Outcome Domains and Needs

OBJECTIVE: To compare service utilization and cost profiles of people with schizophrenia living in Europe in order to understand differences in treatment and care costs. METHOD: Cross-sectional samples were taken of people with schizophrenia in five European locations. Sociodemographic, clinical and service use data were collected via interviewer-administered questionnaires. Site-specific unit costs were obtained, transformed subsequently into a single currency (UK pound). Multiple regression analyses were conducted. RESULTS: There were widespread and considerable differences between sites in service utilization patterns and associated costs. Higher needs, greater symptom severity and longer psychiatric history are associated with higher costs: quality of life and service satisfaction are not. Few differences were found between sites in patterns of association with cost. CONCLUSION: Comparative analyses of the use and cost of mental health services can highlight existing variations helpfully in service provision and uptake. Methodological consistency is required if meaningful conclusions are to be drawn from such comparative data.     

Health care costs of therapy-refractory schizophrenic patients treated with clozapine: a study in a community psychiatric service in Italy

This study evaluates the utilization of clozapine in the treatment of therapy-refractory schizophrenia in terms both of patterns of care and of health care costs in a community psychiatric service in Italy. Data covering the year prior to commencing clozapine and the year following the initiation of the therapy were collected. Clinical outcome was assessed by means of the Clinical Global Impression (CGI) and Global Assessment of Functioning (GAF) scales. Cost analysis followed a two-step procedure: (i) to record all health care services provided to patients and (ii) to assign a monetary value to each service. Three of the 15 patients enrolled in the study dropped out before the end of the 12-month period of therapy. Considering the 12 patients on clozapine treatment for at least 1 year, clinical improvements are associated with a substantial modification of the pattern of care. While patients in the pre-clozapine period were mainly managed in hospital settings, patients on clozapine were prevalently placed in the community and participated in intensive rehabilitative programmes. The higher costs of drug therapy and community services in the post-clozapine period were more than offset by the lower costs of acute hospital care.     

The costs of domus care

In this article we examine the costs and certain characteristics of domus care in two facilities. The domuses are registered mental health nursing homes and the charge made to residents covers many of the service needs of residents. All residents are dependent on social security benefits. The two facilities are highly staffed and each client receives between 17 and 25 hours per week of individual, one-to-one support. The research uses the Client Service Receipt Interview to gather data which allow measures of costs for all domus residents to be built up. Use of services based outside the domuses was rare, nevertheless a wide variety of professionals visited the domuses. The main service gaps and deficiencies related to day support services and the inputs of GPs. Accommodation (including in-house services) dominated the aggregate total costs of care (96%). Average total community care cost was £951 per week for current domus A residents and £909 for domus B residents. Although the new service was more costly than the hospitals from which residents came, the results from the outcomes study suggest that domus residents are experiencing a better quality of life than in hospital.