Direct patient treatment costs in the Allergology Service of a University Hospital

Health resources are limited and consequently real cost generators must be identified to optimize resources. In the present article, we describe the structure of the Allergy Unit of the University Hospital Virgen de la Arrixaca in Murcia (Spain), the health area in which allergic patients are attended, and the final healthcare products generated. Based on the 2004-2005 budget, variable costing was used to calculate the costs of the healthcare products generated (first visits, subsequent visits, and diverse laboratory tests) by two of the three homogeneous functional groups (HFG), i.e., HFG of the ambulatory service and HFG of complementary tests. The following conclusions can be drawn: 1) the current system of variable costing provides information, which should be useful to health professionals; 2) the real cost generators in the microcosm of daily clinical practice should be identified to allow resource reallocation; 3) the costing system used enables modifications to be made that allow decision making on optimal use of the budget; 4) clinical management and complementary tests should go hand in hand with a view to optimizing resources.     

Determinants of treatment costs of unstable angina pectoris]

BACKGROUND AND AIM: Unstable angina, a common serious clinical entity, is associated with a high rate of complications. The aim of our study was to evaluate treatment costs of patients with uncomplicated and complicated follow-up in order to evaluate the economic consequences of new therapeutic strategies, like the introduction of GPIIb/IIIa blockers at our hospital. METHODOLOGY: All 103 patients who were admitted to the medical intensivecare unit of Johann Wolfgang Goethe-University Hospital, Frankfurt am Main between March 2, 1992 and October 31, 1997 for unstable angina of Braunwald class III B were enrolled in the study. Clinical events were the occurrence of refractory ischemia, nontransmural or transmural myocardial infarction or cardiac death. The following were documented: duration of treatment in the ICU and in the general ward, cardiac catheterizations, balloon angioplasties (PTCA), and bypass operations. Treatment costs were calculated on the basis of daily rates, flat rates, and special fees. RESULTS: Following successful primary treatment, a clinical event occurred in 48 of the 103 patients, recurrent refractory ischemia in 34 patients, nontransmural infarction in eight patients, transmural infarction in three patients, and death in four patients. Patients with events were significantly less likely to have had a history of PTCA (38% vs 60%, p < 0.05) and were significantly less likely to be undergoing long-term treatment with aspirin (63% vs 80%, p < 0.05). Other sociodemographic data as well as the initial treatment strategies were comparable. The occurrence of a complication significantly prolonged the duration of treatment in the ICU from 2.6 days (95%-CI [2.1; 3.0]) to 3.6 days (95%-CI [3.1; 4.1]) and the total duration of treatment from 7.0 days (95%-CI [5.7; 8.4]) to 12.8 days (95%-CI [9.6; 16.1]). The total treatment costs rose accordingly from DM 14,360 (95%-CI [12,360; 16,360]) to DM 26,690 (95%-CI [23,150; 30,240]). CONCLUSION: The data show that ischemic complications following successful primary treatment of unstable angina constitute a common problem. Such complications are associated with significantly more intensive treatment and significantly longer hospitalization times, resulting in a near doubling of treatment costs.     

Direct medical costs of polymyalgia rheumatica

OBJECTIVE: To describe the patterns of care and direct medical costs of polymyalgia rheumatica (PMR) to test the hypothesis that the direct medical costs incurred by patients with PMR are higher than costs incurred by age- and sex-matched population-based controls from the same community. METHODS: The study population comprised 193 Olmsted County, Minnesota residents who were first diagnosed with PMR between January 1, 1987 and December 31, 1999. Inclusion criteria were as follows: age > or = 50 years; bilateral aching and morning stiffness (lasting > or = 30 minutes) persisting for at least 1 month and involving the neck, shoulders, or hip girdle regions; and an erythrocyte sedimentation rate (ESR) > or = 40 mm/hour. In patients who fulfilled the first 2 criteria, but had a normal ESR, a rapid response to low-dose corticosteroids served as the third criterion. A total of 695 age- and sex-matched subjects without PMR served as control subjects. Billing data from the Olmsted County Healthcare Expenditure and Utilization Database (OCHEUD) were used to provide estimates of nationally representative unit costs in the year 2002 inflation-adjusted dollars. All subjects were followed using the OCHEUD records until December 31, 2002 to assess the total direct medical costs. Generalized quantile regression modeling was used to estimate the effect of PMR on direct medical costs, after adjusting for age, sex, Charlson comorbidity score, number of hospital days, and number of radiographs. RESULTS: During the first year following diagnosis, subjects with PMR used a substantially higher number of outpatient services and laboratory tests compared with controls, but during the subsequent 4 years, there were no differences between the 2 groups. In age- and sex-adjusted analysis, PMR was associated with a significant incremental cost of 2,233 dollars at the 10th percentile of costs and 27,712 dollars at the 90th percentile of costs. However, further adjustments for comorbidities, number of hospital days, radiographs, and imaging eliminated the incremental cost difference between the subjects with PMR and control subjects. PMR subjects were significantly more likely to have a history of myocardial infarction (odds ratio [OR] 1.78, 95% confidence interval [95% CI] 1.13, 2.82), peripheral vascular diseases (OR 2.21, 95% CI 1.37, 3.60), and cerebrovascular diseases (OR 1.60, 95% CI 1.08, 2.39) compared with the controls. CONCLUSION: Incremental direct medical costs associated with the management of PMR can be substantial, especially early in the disease course. These incremental costs appear to originate mainly from comorbid cardiovascular conditions that were shown to be more prevalent among subjects with PMR.     

HIV/AIDS Outreach in Southern New Mexico

Abstract

This paper describes the outreach component of the New Mexico Border Health Initiative (NMBHI), one of five Special Projects of National Significance funded in 2000 along the United States/Mexico border by the Health Resources and Services Administration. The initial intent of the NMBHI was to utilize the traditional promotormodel of natural helpers within the informal support systems in the communities in which they physically live for the purpose of increasing utilization of HIV/AIDS prevention services. What evolved instead was more closely aligned with traditional street outreach, whereby peers were utilized to engage and inform potential clients about HIV prevention, provide HIV testing and link HIV-affected persons to medical services. Programmatic elements, implications for practice, and recommendations for program coordinators are presented in the paper.     

Direct medical costs of syncope-related hospitalizations in the United States

Little is known about the costs of syncope-related admissions in the United States. A nationally representative sample of hospital discharges and reported charges was analyzed, and costs were estimated using Medicare cost-to-charge ratios. A conservative estimate of total annual costs for syncope-related hospitalizations was $2.4 billion (95% confidence interval [CI] $2.2 to $2.6 billion), with a mean cost of $5,400 (95% CI $5,100 to $5,600) per hospitalization. Efforts to safely decrease syncope-related admissions may result in substantial costs savings.     

AIDS and social strata in Mexico: the importance of bisexuality

The prevalence of AIDS in Mexico and the frequency of sexually transmitted risks was analyzed in relation to the socioeconomic strata of the patients. The study was based on the obligatory notifications of AIDS received by the Ministry of Health between 1982 and september of 1988. The findings show that AIDS is accumulating more rapidly among the low socioeconomic strata, where the bisexual and heterosexual risk factors are also more frequent. These findings are explained in the context of the sexual mores and living conditions of the low social strata of the country. The study leads to the recommendation of diversified preventive activities that meet the peculiarities of the various social strata in Mexico.     

Direct healthcare costs and predictors of costs in patients with primary Sjogren's syndrome

OBJECTIVES: To analyse the healthcare usage, direct healthcare costs and predictors of cost in primary Sj?gren's syndrome (PSS) in the UK and to compare the findings with the data from healthy control groups and rheumatoid arthritis (RA) patients. METHODS: A total of 129 patients with PSS (American-European criteria), 91 with RA and 92 controls, were included in the study. All groups were age-matched females and all completed questionnaires on health status (SF-36) and healthcare utilization (economic component of the Stanford Health Assessment Questionnaire). Annual direct healthcare costs were calculated (and expressed in 2004 UK pound sterling) and predictors of costs for each patient group were determined by regression analyses. Age, health status, disease duration and anti-Ro/La antibody positivity were used as potential predictor variables. RESULTS: Mean age was similar in the PSS (59.2 yrs, S.D. 11.6), RA (60.3 yrs, S.D. 10.5) and control groups (57.7 yrs, S.D. 12.5). The mean disease duration was 5.4 yrs (S.D. 4.8) in the PSS group and 13.4 yrs (S.D. 11.4) in the RA group. The mean annual total direct cost per patient [95% confidence interval (CI)] was 2188 pounds sterling (1831 and 2546 pounds sterling) in the PSS group, 2693 pounds sterling(2069 and 3428 pounds sterling) in the RA group and 949 pounds sterling (741 and 1156 pounds sterling) in the control group. The costs in the PSS group were greater than for the RA and control groups for visits to all healthcare professionals (total) as well as visits to the dentist, dental hospital and ophthalmologist. The costs in the PSS and RA groups were higher than in controls for diagnostic tests and visits to hospital and the accident and emergency (A&E) department. The PSS group also incurred higher costs than controls, but lower costs than the RA group, for visits to a rheumatologist, urine and blood tests, assistive devices and drug therapy. Regression analysis identified the SF-36 physical function subscale as the best predictor of costs in PSS patients as well as controls and the mental health subscale in RA patients. CONCLUSION: This is the first study to evaluate direct healthcare costs in patients with PSS. PSS has a significant impact on the healthcare system, similar to that of RA, by more than doubling costs compared with control patients.     

Seroepidemiology of cysticercosis in Mexico]

The seroprevalence of cysticercosis indicate that there is a high risk of contact with Taenia solium in Mexico, including both genders and all regions, socioeconomic group, and ages. There are some statistically significant differences in risk of contact, affecting principally the center and southeast of the country, rural areas, handicapped persons, children, old people and women. However, these differences are small. This study emphasizes the fact that the risks of infection by Taenia solium are important in all groups, and therefore, the programs for the control of this disease should be focused at the entire population and emphasize strategies for social development.     

Seroepidemiology of toxoplasmosis in Mexico]

This article presents to the results of the National Seroepidemiology Survey with regard to the prevalence of toxoplasmosis in Mexico. Some theoretical aspects of the disease are discussed, and the prevalences found in earlier reports are presented. The study measured 29,279 blood samples from persons in all 32 states of Mexico, for both sexes, all ages, and socio-economic groups. The samples were processed by indirect immunofluorescence for antibody titers of 1:16 and 1:128. Positivity levels were stratified by age, sex, socioeconomic level, place of residence, education level, number of persons in the family, state, and with or without rights to care in the social security medical institutions. The results pointed to greater prevalences in the costal areas, in lower socioeconomic levels, and a high incidence in women of reproductive age. Also included are a discussion of socio-economic aspects and the potential role of the domestic cat.     

Direct and indirect costs of osteoarthritis of the knee

BACKGROUND: Rheumatic diseases have an economic impact of 1-2.5% of GDP in industrialized countries and osteoarthritis is the most common joint disorder. Osteoarthritis of the knee is especially common and is a major cause of disability requiring extensive utilization of health care resources. OBJECTIVE: To estimate the burden of osteoarthritis of the knee in Italy, we studied retrospectively a cohort of 254 patients over a period of 12 months in 2000-2001. METHODS: Twenty-nine rheumatology institutes took part in the study. A bottom-up approach was used, analytically measuring pro capita consumption. We considered medical (hospitalization, diagnosis, and therapies) and non-medical costs (transport, temporary caregivers, and auxiliary devices) as direct costs. We calculated losses of productivity borne by patients and caregivers, and informal care provided by caregivers as indirect costs. RESULTS: Direct costs came to Euros 934 per patient per year: Euros 233 were spent on hospitalization, Euros 209 on diagnostic procedures (56% on visits and 44% on instrumental and laboratory tests), Euros 146 on therapy (58% on physiotherapy and 42% on drugs), and Euros 346 on non-medical costs (73% on salaries to temporary caregivers, 14% on transport, and 13% on auxiliary devices). It is interesting to point out that at least 37% of costs were charged directly to patients. Indirect costs were almost 30% higher and came to Euros 1236 per patient per year: 31% was due to loss of productivity of patients, 60% due to informal care provided by primary caregivers, and 9% by other caregivers. CONCLUSIONS: This study confirms that the direct and indirect costs attributable to osteoarthritis of the knee are substantial.     

Seroepidemiology of measles in Mexico]

Measles is an illness of universal distribution and great social impact. According to the WHO, the annual deaths due to this disease amount to more than a million children in the world. The objectives of this paper are to estimate the seroprevalence of titer of antibodies to measles in the population of 12 to 59 months of age in Mexico and identify the determinants of the immunity state. From the National Seroepidemiology Survey, 5,232 blood samples of children between 12 and 59 months of age, were analyzed, their blood samples were considered positive when the antibody titers were greater or equal to 1:4, tested by hemagglutination inhibition using sensitized erythrocytes. The National seroprevalence was 76.2 per cent. By age group, an increment in positive level was observed age increased. The seroprevalence was 56 per cent in children of 12 to 24 month and 82 per cent for children 48 to 59 month of age. The history of vaccination was obtained verbally; 62.5 per cent of seropositive didn't have vaccination history and 82.5 per cent were of those vaccinated were positive. By place of residence, at rural level (populations less than 2,500 inhabitants) 74 per cent positives, compared to 79 per cent in children of urban areas. All risk factor were significant, based on a univariate analysis, being the one with greatest risk those with negative vaccine history and children of one year of age. The efficiency of the vaccine estimation was of 63.6 per cent. Risk factors related to the vinculation of immunity protection to measles or seropositives were age, and verbal history of vaccination.     

Seroepidemiology of brucellosis in Mexico]

Brucellosis is an important and widely distributed zoonosis in Mexican cattle which also affects an unknown proportion of the human population. This report presents the brucellosis antibody levels registered in the National Seroepidemiology Survey (NAS) in sera obtained from 66,982 healthy persons from one to 98 years of age and determined by the test of plaque microagglutination. Seroprevalences by states ranged from 0.24 per cent in Morelos to 13.5 per cent in the state of Mexico. The national mean was estimated to be 3.42 per cent. The analysis showed no statistical differences for brucellosis antibody levels by urban and rural residence and by density of family sleeping areas (three or more persons vs. one or two persons per bedroom). Adults between 20 and 39 years of age had greater seropositivity and children from one to nine years had the least. Women were most affected and had 48 per cent more seropositivity than men. According to the information obtained in the study, brucellosis in Mexico has the following characteristics: it is related to gender but not to occupation; affects persons in all age groups, social strata and is independent of size of the community of residence. Historically, brucellosis has been an endemic disease in Mexico. Recently an increasing incidence has been reported, and this is possibly due to a better national notification system.