Economics of medically unexplained symptoms: a systematic review of the literature

Objective: To review cost-of-illness studies (COI) and economic evaluations (EE) conducted for medically unexplained symptoms and to analyze their methods and results. Methods: We searched the databases PubMed, PsycINFO and National Health Service Economic Evaluations Database of the University of York. Cost data were inflated to 2006 using country-specific gross domestic product inflators and converted to 2006 USD purchasing power parities. Results: We identified 5 COI and 8 EE, of which 6 were cost-minimization analyses and 2 were cost-effectiveness analyses. All studies used patient level data collected between 1980 and 2004 and were predominantly conducted in the USA (n = 10). COI found annual excess health care costs of somatizing patients between 432 and 5,353 USD in 2006 values. Indirect costs were estimated by only one EE and added up to about 18,000 USD per year. In EE, educational interventions for physicians as well as cognitive-behavioral therapy approaches for patients were evaluated. For both types of interventions, effectiveness was either shown within EE or by previous studies. Most EE found (often insignificant) cost reductions resulting from the interventions, but only two studies explicitly combined changes in costs with data on effectiveness to cost-effectiveness ratios (ratio of additional costs to additional effects). Conclusions: Medically unexplained symptoms cause relevant annual excess costs in health care that are comparable to mental health problems like depression or anxiety disorders and which may be reduced by interventions targeting physicians as well as patients. More extensive research on indirect costs and cost-effectiveness is needed.     

Income-, education- and gender-related inequalities in out-of-pocket health-care payments for 65+ patients - a systematic review

Background  

In all OECD countries, there is a trend to increasing patients' copayments in order to balance rising overall health-care costs. This systematic review focuses on inequalities concerning the amount of out-of-pocket payments (OOPP) associated with income, education or gender in the Elderly aged 65+.     

Direct costs associated with depression in old age in Germany

BACKGROUND: Depression in old age is common. Only few studies, exclusively conducted in the USA, have examined the impact of depression on direct costs in the elderly (60+). This study aims to determine the effect of depression on direct costs of the advanced elderly in Germany from a societal perspective. METHODS: 451 primary care patients aged 75+ were investigated face-to-face regarding depressive symptoms (Geriatric Depression Scale), chronic medical illness (Chronic Disease Score) and resource utilisation and costs (cost diary). Resource utilisation was monetarily valued using 2004/2005 prices. RESULTS: Mean annual direct costs of the depressed (euro5241) exceeded mean costs of non-depressed individuals (euro3648) by one third (p<.01). Significant differences were found for pharmaceutical costs, costs for medical supply and dentures, and for home care. Only few costs were caused by depression treatment. Depression has a significant impact on direct costs after controlling for age, gender, education, chronic medical illness and cognitive functions. A one-point increase in the GDS-Score was associated with a euro336 increase in the annual direct costs. LIMITATIONS: Reported costs can be considered as rather conservative estimates. There were no nursing home residents and no patients with dementia disorders in the sample. Furthermore, recall bias cannot be ruled out completely. CONCLUSION: Depression in old age is associated with a significant increase of direct costs, even after adjustment for chronic medical illness. Future demographic changes in Germany will lead to an increase in the burden of old age depression. Therefore health policy should promote the development and use of cost-effective treatment strategies.     

Conspiracy mentality among informal caregivers as a risk factor for caregiver burden,mental health,perceived loneliness and social isolation during the COVID-19 pandemic: findings of a representative online study from Germany

Quality of Life Research - This study aims to analyze if and how conspiracy mentality is associated with mental health, burden and perceived social isolation and loneliness of informal caregivers...     

Costs of inflammatory bowel disease in Germany

INTRODUCTION: Inflammatory bowel disease (IBD) is a chronic condition that afflicts young adults in their economically productive years. The goal of this study was to determine the costs of IBD in Germany from a societal perspective, using cost diaries. METHODS: Members of the German Crohn's Disease and Ulcerative Colitis Association who had IBD were recruited by post, and those who agreed to participate documented their IBD-associated costs prospectively in a diary over 4 weeks. They documented their use of healthcare facilities, medications, sick leave and out-of-pocket expenditures, as well as general demographic information, the status and history of their IBD, and long-term disability. Item costs were calculated according to national sources. Cost data were calculated using non-parametric bootstrapping and presented as mean costs (year 2004) over 4 weeks. RESULTS: The cost diaries were returned by 483 subjects (Crohn's disease: n = 241, ulcerative colitis: n = 242) with a mean age of 42 years and an average disease duration of 13 years (SD +/- 8.09). The cost diaries were regarded as 'easy to complete' by 89% of participants. The mean 4-week costs per subject were 1,425 Euros(95% CI 1201, 1689) for Crohn's disease and 1,015 Euros(95% CI 832, 1258) for ulcerative colitis. Of the total costs for Crohn's disease, 64% were due to indirect costs such as early retirement or sick leave and 32% were due to direct medical costs. In contrast, of the total costs for ulcerative colitis, 41% were due to direct medical costs and 54% to indirect costs. CONCLUSIONS: This is the first comprehensive cost study for Crohn's disease and ulcerative colitis in Germany. The most important economic factors that influenced the cost profiles of both diseases were the long-term productivity losses due to an ongoing inability to work and the cost of medications. Results indicate significant cost differences between Crohn's disease and ulcerative colitis. This data provides initial cost estimates that can be analysed further with respect to cost determinants and disease-specific costs in the future.     

Self-efficacy moderates the relationship between health comparisons and social exclusion: results of the German ageing survey

Background

Little is known about the consequences of health comparisons. Negative health comparisons might, for example, result in emotions such as anger or frustration. These negative emotions might intensify feelings of social exclusion. Thus, the objective of the current study was to investigate whether health comparisons are associated with social exclusion. Moreover, it was examined whether the relation between health comparisons and social exclusion is moderated by self-efficacy.

Methods

We analyzed cross-sectional data of N?=?7838 individuals from the German Ageing Survey. The German Ageing Survey is a representative sample of community-residing individuals aged 40 and over. An established social exclusion scale was used. The degree of self-efficacy was measured according to Schwarzer and Jerusalem. Health comparisons were measured with the question “How would you rate your health compared with other people your age” (Much better; somewhat better; the same; somewhat worse, much worse).

Results

Multiple linear regressions revealed that negative health comparisons were associated with feelings of social exclusion in men, but not women. Furthermore, positive health comparisons were weakly associated with decreased feelings of social exclusion in men. The association between negative as well as positive health comparisons and social exclusion in men was significantly moderated by self-efficacy.

Conclusions

The findings of the present study suggests that negative health comparisons are associated with feelings of social exclusion in men. In conclusion, comparison effects are not symmetric and predominantly upwards among men in the second half of life. Strengthening self-efficacy might be fruitful for attenuating this relationship.

     

Understanding Mortality of Femoral Fractures Following Low-Impact Trauma in Persons With and Without Care Need

Objectives

Persons with osteoporotic fracture history are subject to an increased risk for subsequent fractures and mortality. The aim of this retrospective study was to investigate the impact of a previous osteoporotic low-impact (fragility) index fracture (eg, forearm, lower leg) on mortality of a subsequent femoral fracture.