The cost of Type 1 diabetes mellitus in the United Kingdom: a review of cost-of-illness studies

Aims

To identify cost-of-illness studies of Type 1 diabetes mellitus (Type 1 DM) in the United Kingdom (UK) and review this literature to estimate the current cost of Type 1 DM to the UK National Health Service.

Methods

Bibliographic databases and grey literature were searched systematically to identify all published and unpublished reporting of the costs of Type 1 DM in the UK. Studies were excluded if they did not present cost information from the UK or did not disaggregate information by diabetes type. Three grey literature sources and 11 published studies were identified for inclusion in the literature review.

Results

The included studies and reports covered topics including the overall cost of Type 1 DM, costs of individual diabetic complications and costs of specific interventions for Type 1 DM. The most recent published estimate of the cost of Type 1 DM was over 15 years old, and although this estimate has been inflated to current prices the estimate is not adjusted for changes to treatment pathways over this period and is therefore not considered an accurate estimate of current costs of Type 1 DM.

Conclusions

There is no recently published estimate of the cost of Type 1 DM in the UK; therefore, it is recommended that an up-to-date national, comprehensive cost-of-illness study should be conducted. Recommendations for the format of this study are made, including extending the scope to cover recent treatment developments and resource use where diabetes is a subsidiary diagnosis.     

Pharmacoeconomic studies in Italy: a critical review of the literature

To assess the state of pharmacoeconomics in Italy we reviewed all the original studies published by Italian authors in national and international journals from January 1994 to December 2003. We selected 70 articles and broadly assessed 92 economic evaluations (EEs) since some articles contained multiple analyses. We adopted common analysis criteria to allow methodological comparison of the studies. The variables investigated can be grouped into three categories: general methods, costs, and consequences. To further assess the quality of the EEs, we decided to rank them according to criteria of both clinical and economic good practice. Then, to complete our critical evaluation, we analysed whether sponsorship might have somehow affected the results. Our analysis seems to support the widespread scepticism of the Italian NHS decision-makers towards pharmacoeconomic studies, whose results seem to be biased by flawed methods and sponsors’ interference with results.      

The methodological quality of economic evaluations of measles outbreaks: A systematic review of cost-of-illness studies

ObjectivesTo identify the main cost components included in the economic evaluations of measles outbreaks, their items and cost drivers, and evaluate the quality of costing methodology, analyzing the key features that may affect the validity of these studies in countries with different income levels. Methods: We systematically searched multiple databases EMBASE, MEDLINE (via PubMed), Biblioteca Virtual em Saúde do Ministério da Saúde (BVS MS), NHS Economic Evaluation Database (NHS EED) and NHS Health Technology Assessment (NHS HTA) (via The Centre for Reviews and Dissemination Library – CRD), and EconLit, SCOPUS, and Web of Science, selecting cost analysis and cost of illness studies (COI) of measles outbreaks. Two independent reviewers screened articles for relevance and extracted the data. The quality of costing methods was assessed using a guide to critical evaluation of COI studies. We performed a qualitative narrative synthesis. Results: Twenty-two studies were reviewed. Most studies evaluated outbreaks that occurred from 2011 to 2013 and 2017 to 2019. Total costs varied from $40,147 to $39.3 million. Per case cost varied from $168 to $49,439. The main drivers of measles outbreak costs were outbreak response, personnel, and productivity losses. Most studies (20/22) did not report the costing methodology adopted, the degree of disaggregation used in the identification and measurement of resource and costs components and the method for the valuation of resource and cost components. Conclusions: The quality of the costing methodology, its transparency and accuracy are essential to the validity of these studies results and their potential use to allocate public health resources in the most efficient manner and to inform measles outbreak control strategies, with rapid and effective response.     

Infantile gastroenteritis in the community: a cost-of-illness study

Rotavirus infections are the main cause of gastroenteritis in infants and children and it is expected that by the age of 5 years, nearly every child will have experienced at least one episode of rotavirus gastroenteritis. While severe cases are hospitalized, milder disease is either treated at home or by the GP, and as such the true prevalence of rotavirus infection in the community, and the burden of disease, is unknown. This paper reports the results of a cost-of-illness study which was conducted alongside a structured community surveillance study. Forty-eight percent of our sample was found to have rotavirus acute gastroenteritis; and the average total cost of a child presenting with rotavirus gastroenteritis ranged between pound sterling 59 and pound sterling 143 per episode, depending on the perspective. Given the prevalence and severity of the disease, the estimated burden of rotavirus gastroenteritis to society is pound sterling 11.5 million per year.     

Health care contingent valuation studies: a review and classification of the literature

Purpose: The contingent valuation method (CVM) is a survey-based approach for eliciting consumer's monetary valuations for programme benefits for use in cost-benefit analysis (CBA). We used the conceptual framework of O'Brien and Gafni (1996) to classify and critically appraise health care CVM studies. Methods: Search of computerized health care and economic citation databases (e.g. MEDLINE, ECONLIT) and manual search for papers published between 1984–1996 reporting primary data valuing health programme benefits in monetary units by CVM using willingness-to-pay (WTP) or accept (WTA). We classified studies using both empirical (i.e. who was surveyed and how) and conceptual criteria (i.e. which measure of consumer utility was measured and why). Results: 48 CVM studies were retrieved; the majority (42) undertook money valuation in the context of cost benefit analysis (CBA), with the remainder being pricing/demand studies. Among the 42 CBA studies, the consumer utility being measured (i.e. compensating (CV) vs. equivalent variation (EV) was explicitly stated in only three (7%) studies). WTP was measured in 95% of studies and WTA in 5%. By cross-tabulation, 42 (91%) studies were designed as WTP/CV, two (4%) were WTP/EV, two (4%) were WTA/CV and no studies used WTA/EV. Most studies were administered by mail (52%) with 38% being in-person interviews. Value elicitation techniques included open-ended questions (38%), payment cards (19%) discrete choice questions (26%) or bidding games (29%). Some form of construct validation tests, particularly associations between WTP and income, were done in 21 studies (50%). Conclusions: (i) The number of health care CVM studies is growing rapidly and the majority are done in the context of CBA; (ii) there is wide variation among health care CVM studies in terms of the types of questions being posed and the elicitation formats being used; (iii) classification and appraisal of the literature is difficult because reporting of methods and their relationship with the conceptual framework of CBA is poor; (iii) the applicability to health care of the CVM guidelines issued by the National Oceanic and Atmospheric Administration (NOAA) panel for environmental economics is unclear. © 1998 John Wiley & Sons, Ltd.     

Safety of non-medically led primary maternity care models: a critical review of the international literature

The Australian government has announced major reforms with the move to a primary maternity care model. The direction of the reforms remains contentious; with the Australian Medical Association warning that the introduction of non-medically led services will compromise current high standards in maternity services and threaten the safety of mothers and babies. The purpose of this paper is to conduct a critical review of the literature to determine whether there is convincing evidence to support the safety of non-medically led models of primary maternity care. Twenty-two non-randomised international studies were included representing midwifery-led care, birth centre care and home birth. Comparative outcome measurements included: perinatal mortality; perinatal morbidity; rates of medical intervention in labour; and antenatal and intrapartum referral and transfer rates. Findings support those of the three Cochrane reviews, that there is sufficient international evidence to support the conclusion of no difference in outcomes associated with low risk women in midwifery-led, birth centre and home birth models compared with standard hospital or obstetric care. These findings are limited to services involving qualified midwives working within rigorous exclusion, assessment and referral guidelines, limiting the number of urgent intrapartum transfers that come with increased risk of perinatal mortality.     

Interventions to reduce socioeconomic health differences: A review of the international literature

The objective of this study was to review information on evaluatedinterventions to reduce socioeconomic health differences (SEHD)and analyse studies to identify possible conditions for success.The analysed interventions were from published and unpublishedsources. They were evaluated in terms of socioeconomic healthoutcomes. Ninety-eight publications on actual interventionsto reduce SEHD and 31 so-called ‘grey literature’interventions were identified. Many of the interventions describedare reported to be effective. Many of the local experimentalinterventions, however, were not formally evaluated. Structuralmeasures appear to be effective most often, but cannot be takento affect all determinants. Interventions often Involve healtheducation. This, however, only appears to be successful if providinginformation is combined with personal support or structuralmeasures. Many very creative interventions to reduce SEHD havebeen reported. Several appear to be effective, but all addressonly a small aspect of health inequalities. Regrettably thelack of standardized measures and a common methodology hamperour ability to integrate and compare the results. However, allthe studies show that there is room for improvement in our existinghealth policies to reach everyone in our population to the samedegree of effectiveness.     

医疗服务质量和费用关系的国际研究综述

医疗服务质量和费用是卫生保健系统经常面临的两个互相竞争的关键要素。医疗费用的不断上涨是否带来质量的提升是不同卫生保健系统共同关注的问题,解决该问题的核心在于了解医疗服务质量和费用之间的关系。本文通过对国外有关质量和费用关系的理论与实践研究进行综述,基于Donabedian结构—过程—结果三维度质量框架进行归纳分析,尝试对目前该主题的研究进展进行系统梳理和展示。研究结果显示,现有研究的分析单位一般基于地区、服务提供者、病人等水平;不同研究所用到的质量指标差异较大;较多研究关注结果质量和费用的关系,而对于结构质量和过程质量与费用关系的研究尚不足;多数研究基于住院环境下,较少研究关注门诊环境,缺乏二者对比的研究。基于现有证据,尚无法对医疗服务质量和费用的关系得出一致的结论,但不同研究所用到的质量指标、数据与方法或局限性等仍值得未来的研究借鉴,以便于更客观合理的对质量和费用关系进行探讨。     

Online alcohol sales and home delivery: An international policy review and systematic literature review

BackgroundOnline alcohol sales are experiencing rapid growth in many places, accelerated by the COVID-19 pandemic, prompting new laws and regulations. There are no comprehensive and systematic analyses of the laws or their effectiveness.ObjectiveTo summarise international policies governing online alcohol sale and delivery, including changes occurring with COVID-19, and examine available evidence of retailer compliance with such policies.MethodA policy review of 77 jurisdictions in six English-speaking OECD countries: United States, Canada, United Kingdom, Ireland, Australia and New Zealand. We synthesised policies according to ten elements identified as potentially relevant for public health regulation. A systematic literature review of compliance evaluations in Medline, Medline Epub, EMBASE, CINAHL, Web of Science and Google Scholar.Results72 of 77 jurisdictions permitted online alcohol sales and home delivery. Few jurisdictions require age verification at the time of purchase (n = 7), but most require it at delivery (n = 71). Since the COVID-19 pandemic began, most jurisdictions (69%) have either temporarily or permanently relaxed liquor regulations for alcohol home delivery. Three articles examined retailer compliance with age restrictions and found relatively low compliance (0%-46%).ConclusionMany jurisdictions permit the online sale and delivery of alcohol, but regulation of these sales varies widely. In most, regulations do not meet the same standard as bricks-and-mortar establishments and may be insufficient to prevent youth access.     

Bedwetting, behaviour and self-esteem: a review of the literature

AIM: The aim of this review was to examine the empirical evidence on the impact of bedwetting and its treatment on a child's self-esteem and behaviour. INCLUSION CRITERIA: The inclusion criteria for this review were empirical studies conducted on children, aged 5-16 years old, with primary nocturnal enuresis using measures of self-esteem or behaviour. Studies utilizing psychological measurement scales completed by children were the main focus although those that used scales completed by parents were also included. SEARCH STRATEGIES: The electronic databases from 1981 to 1999 were searched, and hand searching of the literature dating back to 1973 was conducted using the reference lists of key papers. RESEARCH FINDINGS: Fifteen empirical studies matched the inclusion criteria. There was only one randomised-controlled trial and the rest of the studies were cohort, case-control or cross-sectional design. Evidence of sample bias predominantly due to the use hospital-based and/or 'volunteer' subjects was found in five studies. A further five studies used birth cohort data, which excludes important variables such as the impact of treatment. Four studies used single parent-reported measures, which may under or over-estimate the problem. No large cohort studies were available which compare the self-esteem of bedwetting children with matched controls. The most interesting line of enquiry is pursued by studies looking at whether self-esteem improves with successful treatment. However, the use of self-selected subject groups does not make the current evidence convincing and more work is required to determine outcomes for all children. There is empirical evidence for increased behavioural problems in bedwetting children. Studies conducted on younger children report less behavioural problems with more reported in studies conducted on older children with complex wetting disorders. This may point towards wetting being the primary problem, but more work is needed, as causation in any direction is difficult to ascertain from the literature.     

BK-virus infections: a literature review

BK-virus is a very common polyomavirus in the global population, similar to the JC-virus responsible for Progressive Multifocal Leukoencephalopathy. BK-virus infections are an important diagnostic and therapeutic challenge in immuno-compromised patients, including: bone marrow transplant pediatric recipients in whom it may cause hemorrhagic cystitis, renal transplant recipients in whom it may cause interstitial nephropathy leading to graft loss, and in HIV infected patients in whom it may cause some types of encephalitis. Indeed, this poorly documented virus is responsible for infections with various clinical profiles, probably under-diagnosed, but could also be involved in the genesis of some cancers, especially cervix and prostate cancer. We reviewed the latest published data on this virus focusing on its possible pro-oncogenic properties. We also listed the diseases in which it is involved, with an emphasis on rare and insufficiently investigated entities. Finally, we studied the new tools available for diagnosis and treatment, and their importance in current practice.     

Shared care: a review of the literature

This review examines broad issues of concern regarding the primary/secondarycare interface. The main purpose was to identify areas of goodpractice which could be adapted for more general use. One ofthe most fundamental aspects identified was communication, whichis discussed in some detail. Also covered are shared prescribingand disease management. The data suggest that the most effectivesystem(s) of shared care has yet to be established. Furtherqualitative and economic evaluations are required, taking intoaccount patient preferences. Although the literature does describecertain practice exemplars, it is clear that inter- and intra-professionalcommunication continues to be a problem. Whilst informationtechnology may provide some of the solutions, it is concludedthat a culture change, which compels health professionals tomake sharing of patient information a much higher priority,is reauired. Keywords. Shared care, seamless care, hospital, general practice, family practice.