Health resource utilization and the economic burden of patients with wet age-related macular degeneration in Thailand

PubMed Central

Dilokthornsakul, Piyameth; Chaiyakunapruk, Nathorn; Ruamviboonsuk, Paisan; Ratanasukon, Mansing; Ausayakhun, Somsanguan; Tungsomeroengwong, Akrapope; Pokawattana, Nattapol; Chanatittarat, Chalakorn

2014-01-01

AIM To determine healthcare resource utilization and the economic burden associated with wet age-related macular degeneration (AMD) in Thailand METHODS This study included patients diagnosed with wet AMD that were 60 years old or older, and had best corrected visual acuity (BCVA) measured at least two times during the follow-up period. We excluded patients having other eye diseases. Two separate sub-studies were conducted. The first sub-study was a retrospective cohort study; electronic medical charts were reviewed to estimate the direct medical costs. The second sub-study was a cross-sectional survey estimating the direct non-medical costs based on face-to-face interviews using a structured questionnaire. For the first sub-study, direct medical costs, including the cost of drugs, laboratory, procedures, and other treatments were obtained. For the second sub-study, direct non-medical costs, e.g. transportation, food, accessories, home renovation, and caregiver costs, were obtained from face-to-face interviews with patients and/or caregivers. RESULTS For the first sub-study, sixty-four medical records were reviewed. The annual average number of medical visits was 11.1±6.0. The average direct medical costs were $3 604±4 530 per year. No statistically-significant differences of the average direct medical costs among the BCVA groups were detected (P=0.98). Drug costs accounted for 77% of total direct medical costs. For direct non-medical costs, 67 patients were included. Forty-eight patients (71.6%) required the accompaniment of a person during the out-patient visit. Seventeen patients (25.4%) required a caregiver at home. The average direct non-medical cost was $2 927±6 560 per year. There were no statistically-significant differences in the average costs among the BCVA groups (P=0.74). Care-giver cost accounted for 87% of direct non-medical costs. CONCLUSION Our study indicates that wet AMD is associated with a substantial economic burden, especially concerning drug and care-giver costs. PMID:24634881

The economic burden of chronic obstructive pulmonary disease from 2004 to 2013.

PubMed

Kim, Jinhyun; Lee, Tae Jin; Kim, Sungjae; Lee, Eunhee

2016-01-01

This study examines the epidemiology and economic impact of chronic obstructive pulmonary disease (COPD) at a nationwide level in South Korea. This retrospective analysis used the societal cost-of-illness framework, consisting of direct medical costs, direct non-medical costs, and indirect costs. In order to analyze the societal costs of patients with COPD, this study used a data mining and a macro-costing method on data from a South Korean national-level health survey and a national health insurance claims database from 2004-2013. The total societal cost of COPD in 2013 was estimated to be $439.9 million for 1,419,914 patients. The direct medical cost for COPD was $214.3 million, which included a hospitalization cost of $96.3 million, an outpatient cost of $76.4 million, and a pharmaceutical cost of $41.6 million. The direct non-medical cost was estimated at $43.5 million. The indirect overall cost associated with the morbidity and mortality of COPD was $182.2 million in 2013. This study showed that COPD has a major effect on healthcare costs, particularly direct medical costs. Thus, appropriate long-term interventions are recommended to lower the economic burden of COPD in South Korea.

A systematic review of the direct economic burden of type 2 diabetes in china.

PubMed

Hu, Huimei; Sawhney, Monika; Shi, Lizheng; Duan, Shengnan; Yu, Yunxian; Wu, Zhihong; Qiu, Guixing; Dong, Hengjin

2015-03-01

Type 2 diabetes is associated with acute and chronic complications and poses a large economic, social, and medical burden on patients and their families as well as society. This study aims to evaluate the direct economic burden of type 2 diabetes in China. systematic review on cost of illness, health care costs, direct service costs, drug costs, and health expenditures in relation to type 2 diabetes was conducted up to 2014 using databases such as Pubmed; EBSCO; Elsevier ScienceDirect, Web of Science; and a series of Chinese databases, including Wanfang Data, China National Knowledge Infrastructure (CNKI), and the China Science and Technology Journal Database. Factors influencing hospitalization and drug fees were also identified. (1) estimation of the direct economic burden including hospitalization and outpatient cost of type 2 diabetes patients in China; (2) evaluation of the factors influencing the direct economic burden. Articles only focusing on the cost-effectiveness analysis of diabetes drugs were excluded. The direct economic burden of type 2 diabetes has increased over time in China, and in 2008, the direct medical cost reached $9.1 billion, Both outpatient and inpatient costs have increased. Income level, type of medical insurance, the level of hospital care, and type and number of complications are primary factors influencing diabetes related hospitalization costs. Compared to urban areas, the direct non-medical cost of type 2 diabetes in rural areas is significantly greater. The direct economic burden of type 2 diabetes poses a significant challenge to China. To address the economic burden associated with type 2 diabetes, measures need to be taken to reduce prevalence rate and severity of diabetes and hospitalization cost.

Estimating direct and indirect costs of premenstrual syndrome.

PubMed

Borenstein, Jeff; Chiou, Chiun-Fang; Dean, Bonnie; Wong, John; Wade, Sally

2005-01-01

To quantify the economic impact of premenstrual syndrome (PMS) on the employer. Data were collected from 374 women aged 18-45 with regular menses. Direct costs were quantified using administrative claims of these patients and the Medicare Fee Schedule. Indirect costs were quantified by both self-reported days of work missed and lost productivity at work. Regression analyses were used to develop a model to project PMS-related direct and indirect costs. A total of 29.6% (n = 111) of the participants were diagnosed with PMS. A PMS diagnosis was associated with an average annual increase of $59 in direct costs (P < 0.026) and $4333 in indirect costs per patient (P < 0.0001) compared with patients without PMS. A PMS diagnosis correlated with a modest increase in direct medical costs and a large increase in indirect costs.

Direct and indirect costs incurred by Australian living kidney donors.

PubMed

Barnieh, Lianne; Kanellis, John; McDonald, Stephen; Arnold, Jennifer; Sontrop, Jessica M; Cuerden, Meaghan; Klarenbach, Scott; Garg, Amit X; Boudville, Neil

2017-12-07

To describe the direct and indirect costs incurred by Australian living kidney donors. We studied 55 living kidney donors from 3 centres in Perth, Australia and 1 centre in Melbourne, Australia (2010-2014); 49 donors provided information on expenses incurred during the donor evaluation period and up to 3 months after donation. We used a micro-costing approach to measure and value the units of resources consumed. Expenses were grouped as direct costs (ground and air travel, accommodation, and prescription medications) and indirect costs (lost wages and lost productivity). We standardized costs to the year 2016 in Australian dollars. The most common direct costs were for ground travel (100%), parking (76%), and post-donation pain medications or antibiotics (73%). The highest direct costs were for air travel (median $1,986 [3 donors]) and ground travel (median $459 [49 donors]). Donors also reported lost wages (median $9,891 [37 donors]). The inability to perform household activities or care for dependants were reported by 32 (65%) and 23 (47%) donors. Total direct costs averaged $1,682 per donor (median $806 among 49 donors). Total indirect costs averaged $7,249 per donor (median $7,273 among 49 donors). Total direct and indirect costs averaged $8,932 per donor (median $7,963 among 49 donors). Many Australian living kidney donors incur substantial costs during the donation process. Our findings inform the continued development of policies and programs designed to minimize costs incurred by living kidney donors. This article is protected by copyright. All rights reserved.

[Financial burden of hepatitis B-related diseases and factors influencing the costs in Shenzhen, China].

PubMed

Liang, Sen; Zhang, Shun-xiang; Ma, Qi-shan; Xiao, He-wei; Lü, Qiu-ying; Xie, Xu; Mei, Shu-jiang; Hu, Dong-sheng; Zhou, Bo-ping; Li, Bing; Chen, Jing-fang; Cui, Fu-qiang; Wang, Fu-zhen; Liang, Xiao-feng

2010-12-01

To investigate the direct, indirect and intangible costs due to hepatitis B-related diseases and to explore main factors associated with the costs in Shenzhen. Cluster sampling for cases collected consecutively during the study period was administrated. Subjects were selected from eligible hepatitis B-related patients. By pre-trained professional investigators, health economics-related information was collected, using a structured questionnaire. Hospitalization expenses were obtained through hospital records after the patients were discharged from hospital. Total economic burden of hepatitis B-related patients would involve direct, indirect and intangible costs. Direct costs were further divided into direct medical costs and direct nonmedical costs. Human Capital Approach was employed to measure the indirect costs both on patients and the caregivers in 1-year time span. Willing to pay method was used to estimate the intangible costs. Multiple linear stepwise regression models were conducted to determine the factors linked to the economic burden. On average, the total annual cost of per patient with hepatitis B-related diseases was 81 590.23 RMB Yuan. Among which, direct, indirect and intangible costs were 30 914.79 Yuan (account for 37.9%), 15 258.01 Yuan (18.7%), 35 417.43 Yuan (43.4%), respectively. The total annual costs per patient for hepatocellular carcinoma, severe hepatitis B, decompensated cirrhosis, compensated cirrhosis, chronic hepatitis B and acute hepatitis B were 194 858.40 Yuan, 144 549.20 Yuan, 120 333.60 Yuan, 79 528.81 Yuan, 66 282.46 Yuan and 39 286.81 Yuan, respectively. The ratio of direct to indirect costs based on the base-case estimation foot add to 2.0:1, increased from hepato-cellular carcinoma (0.7:1) to compensated cirrhosis (3.5:1), followed by acute hepatitis B (3.3:1), severe hepatitis B (2.8:1), decompensate cirrhosis (2.3:1) and chronic hepatitis B (2.2:1). Direct medical costs were more than direct nonmedical. Ratio between the sum total was 16:1. The proportions of total annual cost per patient with hepatitis B-related diseases accounted for annual patient income were 285.3%, and 75.4% for annual household income. Furthermore, proportions of direct costs accounted for annual patient income and annual household income were 108.1% and 28.6%. The total annual indirect cost per person was 8123.38 Yuan for patients of all hepatitis B-related diseases, while 7134.63 Yuan for caregivers. Corresponding work-loss days were 55.74 days for patients and 19.83 days for caregivers. Based on multiple linear stepwise regression analysis, age of patients was a common influencing factor to all kinds of costs. Other factors were as follows: complicated with other diseases, antiviral medication, monthly household income and self-medications. The economic burden of hepatitis B-related diseases was substantial for patients and their families. All costs tended to increase with the severity of disease. The direct costs were larger than the indirect costs. And the direct medical costs were more than the direct ones. Indirect costs based on patients were larger than the ones of caregivers.

19 CFR 10.197 - Direct costs of processing operations performed in a beneficiary country or countries.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 19 Customs Duties 1 2011-04-01 2011-04-01 false Direct costs of processing operations performed in... TO A REDUCED RATE, ETC. Caribbean Basin Initiative § 10.197 Direct costs of processing operations... operations. As used in § 10.195 and § 10.198, the words “direct costs of processing operations” mean those...

A prospective study to determine the costs incurred by families of children newly diagnosed with cancer in Ontario.

PubMed

Tsimicalis, Argerie; Stevens, Bonnie; Ungar, Wendy J; McKeever, Patricia; Greenberg, Mark; Agha, Mohammad; Guerriere, Denise; Barr, Ronald; Naqvi, Ahmed; Moineddin, Rahim

2012-10-01

A diagnosis of cancer in childhood places a considerable economic burden on families, although costs are not well described. The objectives of this study were to identify and determine independent predictors of the direct and time costs incurred by such families. A prospective, cost-of-illness study was conducted in families of children newly diagnosed with cancer. Parents recorded the resources consumed and costs incurred during 1 week per month for three consecutive months beginning the fourth week following diagnosis and listed any additional costs incurred since then. Descriptive and multiple regression analyses were performed to describe families' costs (expressed in 2007 Canadian dollars) and to determine direct and time cost predictors. In total, 28 fathers and 71 mothers participated. The median total direct and time costs in 3 months were $CAD3503 and $CAD23 130, respectively, per family. The largest component of direct costs was travel and of time costs was time allocated previously for unpaid activities. There were no statistically significant predictors of direct costs. Six per cent of the variance for time costs was explained by language spoken at home. Families of children with cancer are confronted with a wide range of direct and time costs, the largest being travel and time allocated previously for unpaid activities. Copyright © 2011 John Wiley & Sons, Ltd.

The use of AlloDerm in postmastectomy alloplastic breast reconstruction: part II. A cost analysis.

PubMed

Jansen, Leigh A; Macadam, Sheina A

2011-06-01

Increasingly, AlloDerm is being used in alloplastic breast reconstruction, and has been the subject of a recent systematic review. The authors' objective was to perform a cost analysis comparing direct-to-implant with AlloDerm reconstruction to two-stage non-AlloDerm reconstruction. Seven clinically important health outcomes and their probabilities for both types of reconstruction were derived from the recent review. A decision analytic model from the Canadian provincial payer's perspective was constructed based on these health states. Direct medical costs were estimated from a university-based hospital, yielding expected costs for direct-to-implant reconstruction with AlloDerm and two-stage non-AlloDerm reconstruction. Sensitivity analyses were conducted. Baseline and expected costs were calculated for direct-to-implant AlloDerm and two-stage non-AlloDerm reconstruction. Direct-to-implant reconstruction with AlloDerm was found to be less expensive in the baseline ($10,240 versus $10,584) and expected cost ($10,734 versus $11,251) using a 6 × 16-cm AlloDerm sheet. With a 6 × 12-cm sheet, expected cost falls to $9673. By increasing direct-to-implant operative time from 2 hours to 2.5 hours, expected cost rises to $11,784. If capsular contracture rate requiring revision is set at 15 percent for both procedures, expected costs are $10,926 and $11,251 for direct-to-implant and two-stage procedures, respectively. If the capsular contracture rate is lowered for either procedure, this has minimal impact on expected cost. Although AlloDerm is expensive, it appears to be cost-effective if used for direct-to-implant breast reconstruction. The methods used here may be extrapolated to different centers incorporating local costs and complication rates. A formal randomized controlled trial, including costs, is recommended.

Estimate of the cost of multiple sclerosis in Spain by literature review.

PubMed

Fernández, Oscar; Calleja-Hernández, Miguel Angel; Meca-Lallana, José; Oreja-Guevara, Celia; Polanco, Ana; Pérez-Alcántara, Ferran

2017-08-01

Multiple Sclerosis (MS) is a progressive disease leading to increasing disability and costs. A literature review was carried out to identify MS costs and to estimate its economic burden in Spain. Areas Covered: The public electronic databases PubMed, ScienceDirect and IBECS were consulted and a manual review of communications presented at related congresses was carried out. A total of 225 references were obtained, of which 43 were finally included in the study. Expert Commentary: Three major cost groups were identified: direct healthcare costs, direct non-healthcare costs and indirect costs. There is a direct relationship between disease progression and increased costs, mainly direct non-healthcare costs (greater need for informal care) and indirect costs (greater loss of productivity). The total cost associated with MS in Spain is €1,395 million per year, and that the mean annual cost per patient is €30,050. Beyond costs, a large impact on the quality of life of patients, with an annual loss of up to 13,000 quality-adjusted life years was also estimated. MS has a large economic impact on Spanish society and a significant impact on the quality of life of patients.

[Estimation of economic costs for the care of patients with nosocomial pneumonia in a regional peruvian hospital, 2009-2011].

PubMed

Dámaso-Mata, Bernardo; Chirinos-Cáceres, Jesús; Menacho-Villafuerte, Luz

2016-06-01

To estimate and compare the economic costs for the care of patients with and without nosocomial pneumonia at Hospital II Huánuco EsSalud during 2009-2011, in Peru. This was a partial economic evaluation of paired cases and controls. A collection sheet was used. nosocomial pneumonia. direct health costs, direct non-health costs, indirect costs, occupation, age, comorbidities, sex, origin, and education level. A bivariate analysis was performed. Forty pairs of cases and controls were identified. These patients were hospitalized for >2 weeks and prescribed more than two antibiotics. The associated direct health costs included those for hospitalization, antibiotics, auxiliary examinations, specialized assessments, and other medications. The direct non-health costs and associated indirect costs included those for transportation, food, housing, foregone payroll revenue, foregone professional fee revenue, extra-institutional expenses, and payment to caregivers during hospitalization and by telephone. The direct health costs for nosocomial pneumonia patients were more than three times and the indirect costs were more than two times higher than those for the controls. Variables with the greatest impact on costs were identified.

Seasonal fecundity and costs to λ are more strongly affected by direct than indirect predation effects across species

USGS Publications Warehouse

LaManna, Joseph A.; Martin, Thomas E.

2017-01-01

Increased perceived predation risk can cause behavioral and physiological responses to reduce direct predation mortality, but these responses can also cause demographic costs through reduced reproductive output. Such indirect costs of predation risk have received increased attention in recent years, but the relative importance of direct vs. indirect predation costs to population growth (λ) across species remains unclear. We measured direct nest predation rates as well as indirect benefits (i.e., reduced predation rates) and costs (i.e., decreased reproductive output) arising from parental responses to perceived offspring predation risk for 10 songbird species breeding along natural gradients in nest predation risk. We show that reductions in seasonal fecundity from behavioral responses to perceived predation risk represent significant demographic costs for six of the 10 species. However, demographic costs from these indirect predation effects on seasonal fecundity comprised only 12% of cumulative predation costs averaged across species. In contrast, costs from direct predation mortality comprised 88% of cumulative predation costs averaged across species. Demographic costs from direct offspring predation were relatively more important for species with higher within-season residual-reproductive value (i.e., multiple-brooded species) than for species with lower residual-reproductive value (i.e., single-brooded species). Costs from indirect predation effects were significant across single- but not multiple-brooded species. Ultimately, demographic costs from behavioral responses to offspring predation risk differed among species as a function of their life-history strategies. Yet direct predation mortality generally wielded a stronger influence than indirect effects on seasonal fecundity and projected λ across species.

The immediate economic impact of maternal deaths on rural Chinese households.

PubMed

Ye, Fang; Wang, Haijun; Huntington, Dale; Zhou, Hong; Li, Yan; You, Fengzhi; Li, Jinhua; Cui, Wenlong; Yao, Meiling; Wang, Yan

2012-01-01

To identify the immediate economic impact of maternal death on rural Chinese households. Results are reported from a study that matched 195 households who had suffered a maternal death to 384 households that experienced a childbirth without maternal death in rural areas of three provinces in China, using quantitative questionnaire to compare differences of direct and indirect costs between two groups. The direct costs of a maternal death were significantly higher than the costs of a childbirth without a maternal death (US$4,119 vs. $370, p<0.001). More than 40% of the direct costs were attributed to funeral expenses. Hospitalization and emergency care expenses were the largest proportion of non-funeral direct costs and were higher in households with maternal death than the comparison group (US$2,248 vs. $305, p<0.001). To cover most of the high direct costs, 44.1% of affected households utilized compensation from hospitals, and the rest affected households (55.9%) utilized borrowing money or taking loans as major source of money to offset direct costs. The median economic burden of the direct (and non-reimbursed) costs of a maternal death was quite high--37.0% of the household's annual income, which was approximately 4 times as high as the threshold for an expense being considered catastrophic. The immediate direct costs of maternal deaths are extremely catastrophic for the rural Chinese households in three provinces studied.

77 FR 45636 - Food Safety Modernization Act Domestic and Foreign Facility Reinspection, Recall, and Importer...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-01

... of a Supported Direct FDA Work Hour for FY 2013 FDA is required to estimate 100 percent of its costs... operating costs. A. Estimating the Full Cost per Direct Work Hour in FY 2011 In general, the starting point for estimating the full cost per direct work hour is to estimate the cost of a full-time-equivalent...

Incremental direct and indirect cost burden attributed to endometriosis surgeries in the United States.

PubMed

Soliman, Ahmed M; Taylor, Hugh S; Bonafede, Machaon; Nelson, James K; Castelli-Haley, Jane

2017-05-01

To compare direct and indirect costs between endometriosis patients who underwent endometriosis-related surgery (surgery cohort) and those who have not received surgery (no-surgery cohort). Retrospective cohort study. Not applicable. Endometriosis patients (aged 18-49 years) with (n = 124,530) or without (n = 37,106) a claim for endometriosis-related surgery were identified from the Truven Health MarketScan Commercial and Health and Productivity Management databases for 2006-2014. Not applicable. Primary outcomes were healthcare utilization during 12-month pre- and post-index periods, annual direct (healthcare) and indirect (absenteeism and short- and long-term disability) costs during the 12-month post-index period (in 2014 US dollars). Indirect costs were assessed for patients with available productivity data. Patients in the surgery cohort had significantly higher healthcare resource utilization during the post-index period and had mean annual total adjusted post-index direct costs approximately three times the costs among patients in the no-surgery cohort ($19,203 [SD $7,133] vs. $6,365 [SD $2,364]; average incremental annual direct cost = $12,838). The mean cost of surgery ($7,268 [SD $7,975]) was the single largest contributor to incremental annual direct cost. Mean estimated annual total indirect costs were $8,843 (surgery cohort) vs. $5,603 (no-surgery cohort); average incremental annual indirect cost = $3,240. Endometriosis patients who underwent surgery, compared with endometriosis patients who did not, incurred significantly higher direct costs due to healthcare utilization and indirect costs due to absenteeism or short-term disability. Regardless of the surgery type, the cost of index surgery contributed substantially to the total healthcare expenditure. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

The economic burden of musculoskeletal disease in Korea: a cross sectional study.

PubMed

Oh, In-Hwan; Yoon, Seok-Jun; Seo, Hye-Young; Kim, Eun-Jung; Kim, Young Ae

2011-07-13

Musculoskeletal diseases are becoming increasingly important due to population aging. However, studies on the economic burden of musculoskeletal disease in Korea are scarce. Therefore, we conducted a population-based study to measure the economic burden of musculoskeletal disease in Korea using nationally representative data. This study used a variety of data sources such as national health insurance statistics, the Korea Health Panel study and cause of death reports generated by the Korea National Statistical Office to estimate the economic burden of musculoskeletal disease. The total cost of musculoskeletal disease was estimated as the sum of direct medical care costs, direct non-medical care costs, and indirect costs. Direct medical care costs are composed of the costs paid by the insurer and patients, over the counter drugs costs, and other costs such as medical equipment costs. Direct non-medical costs are composed of transportation and caregiver costs. Indirect costs are the sum of the costs associated with premature death and the costs due to productivity loss. Age, sex, and disease specific costs were estimated. Among the musculoskeletal diseases, the highest costs are associated with other dorsopathies, followed by disc disorder and arthrosis. The direct medical and direct non-medical costs of all musculoskeletal diseases were $4.18 billion and $338 million in 2008, respectively. Among the indirect costs, those due to productivity loss were $2.28 billion and costs due to premature death were $79 million. The proportions of the total costs incurred by male and female patients were 33.8% and 66.2%, respectively, and the cost due to the female adult aged 20-64 years old was highest. The total economic cost of musculoskeletal disease was $6.89 billion, which represents 0.7% of the Korean gross domestic product. The economic burden of musculoskeletal disease in Korea is substantial. As the Korean population continues to age, the economic burden of musculoskeletal disease will continue to increase. Policy measures aimed at controlling the cost of musculoskeletal disease are therefore required.

Direct and indirect costs of asthma in Canada, 1990.

PubMed Central

Krahn, M D; Berka, C; Langlois, P; Detsky, A S

1996-01-01

OBJECTIVE: To calculate the direct and indirect costs of asthma in Canada. DESIGN: Cost-of-illness study. SETTING: Canada. PATIENTS: All Canadians receiving inpatient or outpatient care for asthma in 1990. OUTCOME MEASURES: Direct costs incurred by inpatient care, emergency services, physician and nursing services, ambulance use, drugs and devices, outpatient diagnostic tests, research and education. Indirect costs from productivity loss due to absence from work, inability to to perform housekeeping activities, need to care for children with asthma who were absent from school, time spent travelling and waiting for medical care, and premature death from asthma. All costs are in 1990 Canadian dollars. RESULTS: Depending on assumptions, the total cost of asthma was estimated to be between $504 million and $648 million. Direct costs were $306 million. The single largest component of direct costs was the cost of drugs ($124 million). The largest component of indirect costs was illness-related disability ($76 million). CONCLUSIONS: Annual costs of treating asthma are comparable to the individual cost of infectious diseases, hematological diseases, congenital defects, perinatal illnesses, home care and ambulance services. Asthma costs may increase in the future, given current morbidity and mortality trends. Further evaluation of the effectiveness and cost-effectiveness of available asthma interventions in addition to aggregate cost data are required to determine whether resource allocation for the treatment of asthma can be improved. PMID:8634960

Direct costs and cost-effectiveness of dual-source computed tomography and invasive coronary angiography in patients with an intermediate pretest likelihood for coronary artery disease.

PubMed

Dorenkamp, Marc; Bonaventura, Klaus; Sohns, Christian; Becker, Christoph R; Leber, Alexander W

2012-03-01

The study aims to determine the direct costs and comparative cost-effectiveness of latest-generation dual-source computed tomography (DSCT) and invasive coronary angiography for diagnosing coronary artery disease (CAD) in patients suspected of having this disease. The study was based on a previously elaborated cohort with an intermediate pretest likelihood for CAD and on complementary clinical data. Cost calculations were based on a detailed analysis of direct costs, and generally accepted accounting principles were applied. Based on Bayes' theorem, a mathematical model was used to compare the cost-effectiveness of both diagnostic approaches. Total costs included direct costs, induced costs and costs of complications. Effectiveness was defined as the ability of a diagnostic test to accurately identify a patient with CAD. Direct costs amounted to €98.60 for DSCT and to €317.75 for invasive coronary angiography. Analysis of model calculations indicated that cost-effectiveness grew hyperbolically with increasing prevalence of CAD. Given the prevalence of CAD in the study cohort (24%), DSCT was found to be more cost-effective than invasive coronary angiography (€970 vs €1354 for one patient correctly diagnosed as having CAD). At a disease prevalence of 49%, DSCT and invasive angiography were equally effective with costs of €633. Above a threshold value of disease prevalence of 55%, proceeding directly to invasive coronary angiography was more cost-effective than DSCT. With proper patient selection and consideration of disease prevalence, DSCT coronary angiography is cost-effective for diagnosing CAD in patients with an intermediate pretest likelihood for it. However, the range of eligible patients may be smaller than previously reported.

Estimating the Economic Burden of Rheumatoid Arthritis in Taiwan Using the National Health Insurance Database.

PubMed

Wang, Bruce C M; Hsu, Ping-Ning; Furnback, Wesley; Ney, John; Yang, Ya-Wen; Fang, Chi-Hui; Tang, Chao-Hsiun

2016-03-01

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by inflammation and destruction of the joints. This research aims to estimate the economic burden of RA in Taiwan. The National Health Insurance Research Database (NHIRD), a claims-based dataset encompassing 99 % of Taiwan's population, was applied. We used a micro-costing approach for direct healthcare costs and indirect social costs by estimating the quantities and prices of cost categories. Direct costs included surgeries, hospitalizations, medical devices and materials, laboratory tests, and drugs. The costs and quantities of the direct economic burden were calculated based on 2011 data of NHIRD. We identified RA patients and a control cohort matched 1:4 on demographic and clinical covariates to calculate the incremental cost related to RA. Indirect costs were evaluated by missed work (absenteeism) and worker productivity (presenteeism). For the indirect burden, we estimated the rate of absenteeism and presenteeism from a patient survey. Costs were presented in US dollars (US$1 = 30 TWD). A total of 41,269 RA patients were included in the database with incremental total direct cost of US$86,413,971 and indirect cost of US$138,492,987. This resulted in an average incremental direct cost of US$2050 per RA patient. Within direct costs, the largest burdens were associated with drugs (US$73,028,944), laboratory tests (US$6,132,395), and hospitalizations (US$3,208,559). For indirect costs, absenteeism costs and presenteeism costs were US$16,059,681 and US$114,291,687, respectively. The economic burden of RA in Taiwan is driven by indirect healthcare costs, most notably presenteeism.

Estimating the Economic Burden of Rheumatoid Arthritis in Taiwan Using the National Health Insurance Database.

PubMed

Wang, Bruce C M; Hsu, Ping-Ning; Furnback, Wesley; Ney, John; Yang, Ya-Wen; Fang, Chi-Hui; Tang, Chao-Hsiun

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by inflammation and destruction of the joints. This research aims to estimate the economic burden of RA in Taiwan. The National Health Insurance Research Database (NHIRD), a claims-based dataset encompassing 99 % of Taiwan's population, was applied. We used a micro-costing approach for direct healthcare costs and indirect social costs by estimating the quantities and prices of cost categories. Direct costs included surgeries, hospitalizations, medical devices and materials, laboratory tests, and drugs. The costs and quantities of the direct economic burden were calculated based on 2011 data of NHIRD. We identified RA patients and a control cohort matched 1:4 on demographic and clinical covariates to calculate the incremental cost related to RA. Indirect costs were evaluated by missed work (absenteeism) and worker productivity (presenteeism). For the indirect burden, we estimated the rate of absenteeism and presenteeism from a patient survey. Costs were presented in US dollars (US$1 = 30 TWD). A total of 41,269 RA patients were included in the database with incremental total direct cost of US$86,413,971 and indirect cost of US$138,492,987. This resulted in an average incremental direct cost of US$2050 per RA patient. Within direct costs, the largest burdens were associated with drugs (US$73,028,944), laboratory tests (US$6,132,395), and hospitalizations (US$3,208,559). For indirect costs, absenteeism costs and presenteeism costs were US$16,059,681 and US$114,291,687, respectively. The economic burden of RA in Taiwan is driven by indirect healthcare costs, most notably presenteeism.

Measuring the direct costs of graduate medical education training in Minnesota.

PubMed

Blewett, L A; Smith, M A; Caldis, T G

2001-05-01

To demonstrate the usefulness of self-reported cost-accounting data from the sponsors of training programs for estimating the direct costs of graduate medical education (GME). The study also assesses the relative contributions of resident, faculty, and administrative costs to primary care, surgery, and the combined programs of radiology, emergency medicine, anesthesiology, and pathology (REAP). The data were the FY97 direct costs of clinical education reported to Minnesota's Department of Health by eight sponsors of 117 accredited medical education programs, representing 394 sites of training (both hospital- and community-based) and 2,084 full-time-equivalent trainees (both residents and fellows). Average costs of clinical training were calculated as residency, faculty, and administrative costs. Preliminary analysis showed average costs by type of training programs, comparing the cost components for surgery, primary care, and REAP. The average direct cost of clinical training in FY97 was $130,843. Faculty costs were 52%, resident costs were 26%, and administrative costs were 20% of the total. Primary care programs' average costs were lower than were those of either surgery or REAP programs, but proportionally they included more administrative costs. As policymakers assess government subsidies for GME, more detailed cost information will be required. Self-reported data are more cost-effective and efficient than are the more detailed and costly time-and-motion studies. This data-collection study also revealed that faculty costs, driven by faculty hours and base salaries, represent a higher proportion of direct costs of GME than studies have shown in the past.

Direct and Indirect Costs of Asthma Management in Greece: An Expert Panel Approach.

PubMed

Souliotis, Kyriakos; Kousoulakou, Hara; Hillas, Georgios; Bakakos, Petros; Toumbis, Michalis; Loukides, Stelios; Vassilakopoulos, Theodoros

2017-01-01

Asthma is a major cause of morbidity and mortality and is associated with significant economic burden worldwide. The objectives of this study were to map current resource use associated with the disease management and to estimate the annual direct and indirect costs per adult patient with asthma. A Delphi panel with seven leading pulmonologists was conducted. A semistructured questionnaire was developed to elicit data on resource use and treatment patterns. Unit costs from official, published sources were subsequently assigned to resource use to estimate direct medical costs. Indirect costs were estimated as number of work loss days. Cost base year was 2015, and the perspective adopted was that of the National Organization of Health Care Services Provision, as well as the societal. Patients with asthma are mainly managed by pulmonologists (71.4%) and secondarily by general practitioners and internists (28.6%). The annual cost of managing exacerbations was estimated at €273.1, while maintenance costs were estimated at €1,100.2 per year. Total costs of managing asthma per patient per year were estimated at €2,281.8, 64.4% of which represented direct medical costs. Of the direct costs, pharmaceutical treatment was the key driver, accounting for 63.9 and 41.2% of direct and total costs, respectively. Direct non-medical costs (patient travel and waiting time) were estimated at €152.3. Indirect costs accounted for 28.9% of total costs. Asthma is a chronic condition, the management of which constrains the already limited Greek health care resources. The increasing prevalence of the disease raises concerns as it could translate per patient costs into a significant burden for the Greek health care system. Thus, the prevention, self-management, and improved quality of care for asthma should find a place in the health policy agenda in Greece.

Costs of injuries due to interpersonal and self-directed violence in Thailand, 2005.

PubMed

Bundhamcharoen, Kanitta; Odton, Patarapan; Mugem, Suwanna; Phulkerd, Sirinya; Dhisayathikom, Kanjana; Brown, David W; Tangcharoensathien, Viroj

2008-06-01

Violence, a serious public health problem in Thailand, remains largely unknown for its economic costs. This study is a national-level economic cost-estimates of injury from interpersonal and self-directed violence for Thailand during 2005 using the World Health Organization-US Centers for Disease Control and Prevention's guidelines. Direct medical costs from self-directed violence totaled 569 million Baht (THB) while the cost of interpersonal violence was THB 1.3 billion. Productivity losses for injuries due to self-directed violence were estimated at THB 12.2 billion and those for interpersonal violence were THB 14.4 billion. The total direct medical cost, thus, accounted for about 4% of Thailand's total health budget while the productivity losses accounted for approximately 0.4% of Thailand s GDP In summary, interpersonal and self-directed violence caused a total loss of 33.8 billion baht for Thailand in 2005. More than 90% of the economic loss was incurred from productivity loss and about four-fifths came from men.

Direct cost comparison of totally endoscopic versus open ear surgery.

PubMed

Patel, N; Mohammadi, A; Jufas, N

2018-02-01

Totally endoscopic ear surgery is a relatively new method for managing chronic ear disease. This study aimed to test the null hypothesis that open and endoscopic approaches have similar direct costs for the management of attic cholesteatoma, from an Australian private hospital setting. A retrospective direct cost comparison of totally endoscopic ear surgery and traditional canal wall up mastoidectomy for the management of attic cholesteatoma in a private tertiary setting was undertaken. Indirect and future costs were excluded. A direct cost comparison of anaesthetic setup and resources, operative setup and resources, and surgical time was performed between the two techniques. Totally endoscopic ear surgery has a mean direct cost reduction of AUD$2978.89 per operation from the hospital perspective, when compared to canal wall up mastoidectomy. Totally endoscopic ear surgery is more cost-effective, from an Australian private hospital perspective, than canal wall up mastoidectomy for attic cholesteatoma.

The economic burden of HIV/AIDS on individuals and households in Nepal: a quantitative study.

PubMed

Poudel, Ak Narayan; Newlands, David; Simkhada, Padam

2017-01-24

There have been only limited studies assessing the economic burden of HIV/AIDS in terms of direct costs, and there has been no published study related to productivity costs in Nepal. Therefore, this study explores in detail the economic burden of HIV/AIDS, including direct costs and productivity costs. This paper focuses on the direct costs of seeking treatment, productivity costs, and related factors affecting direct costs, and productivity costs. This study was a cross-sectional, quantitative study. The primary data were collected through a structured face-to-face survey from 415 people living with HIV/AIDS (PLHIV). The study was conducted in six representative treatment centres of six districts of Nepal. The data analysis regarding the economic burden (direct costs and productivity costs) was performed from the household's perspective. Descriptive statistics have been used, and regression analyses were applied to examine the extent, nature and determinants of the burden of the disease, and its correlations. Average total costs due to HIV/AIDS (the sum of average total direct and average productivity costs before adjustment for coping strategies) were Nepalese Rupees (NRs) 2233 per month (US$ 30.2/month), which was 28.5% of the sample households' average monthly income. The average total direct costs for seeking HIV/AIDS treatment were NRs 1512 (US$ 20.4), and average productivity costs (before adjustment for coping strategies) were NRs 721 (US$ 9.7). The average monthly productivity losses (before adjustment for coping strategies) were 5.05 days per person. The major determinants for the direct costs were household income, occupation, health status of respondents, respondents accompanied or not, and study district. Health status of respondents, ethnicity, sexual orientation and study district were important determinants for productivity costs. The study concluded that HIV/AIDS has caused a significant economic burden for PLHIV and their families in Nepal. The study has a number of policy implications for different stakeholders. Provision of social support and income generating programmes to HIV-affected individuals and their families, and decentralising treatment services in each district seem to be viable solutions to reduce the economic burden of HIV-affected individuals and households.

48 CFR 52.216-15 - Predetermined Indirect Cost Rates.

Code of Federal Regulations, 2010 CFR

2010-10-01

.... (c) Allowability of costs and acceptability of cost allocation methods shall be determined in...) the period for which the rates apply, and (4) the specific items treated as direct costs or any changes in the items previously agreed to be direct costs. The indirect cost rate agreement shall not...

19 CFR 10.178 - Direct costs of processing operations performed in the beneficiary developing country.

Code of Federal Regulations, 2013 CFR

2013-04-01

..., design, engineering, and blueprint costs insofar as they are allocable to the specific merchandise; and... 19 Customs Duties 1 2013-04-01 2013-04-01 false Direct costs of processing operations performed in... TO A REDUCED RATE, ETC. General Provisions Generalized System of Preferences § 10.178 Direct costs of...

19 CFR 10.178 - Direct costs of processing operations performed in the beneficiary developing country.

Code of Federal Regulations, 2014 CFR

2014-04-01

..., design, engineering, and blueprint costs insofar as they are allocable to the specific merchandise; and... 19 Customs Duties 1 2014-04-01 2014-04-01 false Direct costs of processing operations performed in... TO A REDUCED RATE, ETC. General Provisions Generalized System of Preferences § 10.178 Direct costs of...

19 CFR 10.178 - Direct costs of processing operations performed in the beneficiary developing country.

Code of Federal Regulations, 2012 CFR

2012-04-01

..., design, engineering, and blueprint costs insofar as they are allocable to the specific merchandise; and... 19 Customs Duties 1 2012-04-01 2012-04-01 false Direct costs of processing operations performed in... TO A REDUCED RATE, ETC. General Provisions Generalized System of Preferences § 10.178 Direct costs of...

Burden of epilepsy: a prevalence-based cost of illness study of direct, indirect and intangible costs for epilepsy.

PubMed

Gao, Lan; Xia, Li; Pan, Song-Qing; Xiong, Tao; Li, Shu-Chuen

2015-02-01

We aimed to gauge the burden of epilepsy in China from a societal perspective by estimating the direct, indirect and intangible costs. Patients with epilepsy and controls were enrolled from two tertiary hospitals in China. Patients were asked to complete a Cost-of-Illness (COI), Willingness-to-Pay (WTP) questionnaires, two utility elicitation instruments and Mini Mental State Examination (MMSE). Healthy controls only completed WTP questionnaire, and utility instruments. Univariate analyses were performed to investigate the differences in cost on the basis of different variables, while multivariate analysis was undertaken to explore the predictors of cost/cost component. In total, 141 epilepsy patients and 323 healthy controls were recruited. The median total cost, direct cost and indirect cost due to epilepsy were US$949.29, 501.34 and 276.72, respectively. Particularly, cost of anti-epileptic drugs (AEDs) (US$394.53) followed by cost of investigations (US$59.34), cost of inpatient and outpatient care (US$9.62) accounted for the majority of the direct medical costs. While patients' (US$103.77) and caregivers' productivity costs (US$103.77) constituted the major component of indirect cost. The intangible costs in terms of WTP value (US$266.07 vs. 88.22) and utility (EQ-5D, 0.828 vs. 0.923; QWB-SA, 0.657 vs. 0.802) were both substantially higher compared to the healthy subjects. Epilepsy is a cost intensive disease in China. According to the prognostic groups, drug-resistant epilepsy generated the highest total cost whereas patients in seizure remission had the lowest cost. AED is the most costly component of direct medical cost probably due to 83% of patients being treated by new generation of AEDs. Copyright © 2014 Elsevier B.V. All rights reserved.

Lifestyle factors, direct and indirect costs for a Brazilian airline company.

PubMed

Rabacow, Fabiana Maluf; Luiz, Olinda do Carmo; Malik, Ana Maria; Burdorf, Alex

2014-12-01

OBJECTIVE To analyze lifestyle risk factors related to direct healthcare costs and the indirect costs due to sick leave among workers of an airline company in Brazil. METHODS In this longitudinal 12-month study of 2,201 employees of a Brazilian airline company, the costs of sick leave and healthcare were the primary outcomes of interest. Information on the independent variables, such as gender, age, educational level, type of work, stress, and lifestyle-related factors (body mass index, physical activity, and smoking), was collected using a questionnaire on enrolment in the study. Data on sick leave days were available from the company register, and data on healthcare costs were obtained from insurance records. Multivariate linear regression analysis was used to investigate the association between direct and indirect healthcare costs with sociodemographic, work, and lifestyle-related factors. RESULTS Over the 12-month study period, the average direct healthcare expenditure per worker was US$505.00 and the average indirect cost because of sick leave was US$249.00 per worker. Direct costs were more than twice the indirect costs and both were higher in women. Body mass index was a determinant of direct costs and smoking was a determinant of indirect costs. CONCLUSIONS Obesity and smoking among workers in a Brazilian airline company were associated with increased health costs. Therefore, promoting a healthy diet, physical activity, and anti-tobacco campaigns are important targets for health promotion in this study population.

Lifestyle factors, direct and indirect costs for a Brazilian airline company

PubMed Central

Rabacow, Fabiana Maluf; Luiz, Olinda do Carmo; Malik, Ana Maria; Burdorf, Alex

2014-01-01

OBJECTIVE To analyze lifestyle risk factors related to direct healthcare costs and the indirect costs due to sick leave among workers of an airline company in Brazil. METHODS In this longitudinal 12-month study of 2,201 employees of a Brazilian airline company, the costs of sick leave and healthcare were the primary outcomes of interest. Information on the independent variables, such as gender, age, educational level, type of work, stress, and lifestyle-related factors (body mass index, physical activity, and smoking), was collected using a questionnaire on enrolment in the study. Data on sick leave days were available from the company register, and data on healthcare costs were obtained from insurance records. Multivariate linear regression analysis was used to investigate the association between direct and indirect healthcare costs with sociodemographic, work, and lifestyle-related factors. RESULTS Over the 12-month study period, the average direct healthcare expenditure per worker was US$505.00 and the average indirect cost because of sick leave was US$249.00 per worker. Direct costs were more than twice the indirect costs and both were higher in women. Body mass index was a determinant of direct costs and smoking was a determinant of indirect costs. CONCLUSIONS Obesity and smoking among workers in a Brazilian airline company were associated with increased health costs. Therefore, promoting a healthy diet, physical activity, and anti-tobacco campaigns are important targets for health promotion in this study population. PMID:26039398

Novel model of direct and indirect cost-benefit analysis of mechanical embolectomy over IV tPA for large vessel occlusions: a real-world dollar analysis based on improvements in mRS.

PubMed

Mangla, Sundeep; O'Connell, Keara; Kumari, Divya; Shahrzad, Maryam

2016-01-20

Ischemic strokes result in significant healthcare expenditures (direct costs) and loss of quality-adjusted life years (QALYs) (indirect costs). Interventional therapy has demonstrated improved functional outcomes in patients with large vessel occlusions (LVOs), which are likely to reduce the economic burden of strokes. To develop a novel real-world dollar model to assess the direct and indirect cost-benefit of mechanical embolectomy compared with medical treatment with intravenous tissue plasminogen activator (IV tPA) based on shifts in modified Rankin scores (mRS). A cost model was developed including multiple parameters to account for both direct and indirect stroke costs. These were adjusted based upon functional outcome (mRS). The model compared IV tPA with mechanical embolectomy to assess the costs and benefits of both therapies. Direct stroke-related costs included hospitalization, inpatient and outpatient rehabilitation, home care, skilled nursing facilities, and long-term care facility costs. Indirect costs included years of life expectancy lost and lost QALYs. Values for the model cost parameters were derived from numerous resources and functional outcomes were derived from the MR CLEAN study as a reflective sample of LVOs. Direct and indirect costs and benefits for the two treatments were assessed using Microsoft Excel 2013. This cost-benefit model found a cost-benefit of mechanical embolectomy over IV tPA of $163 624.27 per patient and the cost benefit for 50 000 patients on an annual basis is $8 181 213 653.77. If applied widely within the USA, mechanical embolectomy will significantly reduce the direct and indirect financial burden of stroke ($8 billion/50 000 patients). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

A cost analysis of introducing an infectious disease specialist-guided antimicrobial stewardship in an area with relatively low prevalence of antimicrobial resistance.

PubMed

Lanbeck, Peter; Ragnarson Tennvall, Gunnel; Resman, Fredrik

2016-07-27

Antimicrobial stewardship programs have been widely introduced in hospitals as a response to increasing antimicrobial resistance. Although such programs are commonly used, the long-term effects on antimicrobial resistance as well as societal economics are uncertain. We performed a cost analysis of an antimicrobial stewardship program introduced in Malmö, Sweden in 20 weeks 2013 compared with a corresponding control period in 2012. All direct costs and opportunity costs related to the stewardship intervention were calculated for both periods. Costs during the stewardship period were directly compared to costs in the control period and extrapolated to a yearly cost. Two main analyses were performed, one including only comparable direct costs (analysis one) and one including comparable direct and opportunity costs (analysis two). An extra analysis including all comparable direct costs including costs related to length of hospital stay (analysis three) was performed, but deemed as unrepresentative. According to analysis one, the cost per year was SEK 161 990 and in analysis two the cost per year was SEK 5 113. Since the two cohorts were skewed in terms of size and of infection severity as a consequence of the program, and since short-term patient outcomes have been demonstrated to be unchanged by the intervention, the costs pertaining to patient outcomes were not included in the analysis, and we suggest that analysis two provides the most correct cost calculation. In this analysis, the main cost drivers were the physician time and nursing time. A sensitivity analysis of analysis two suggested relatively modest variation under changing assumptions. The total yearly cost of introducing an infectious disease specialist-guided, audit-based antimicrobial stewardship in a department of internal medicine, including direct costs and opportunity costs, was calculated to be as low as SEK 5 113.

Estimating the direct and indirect costs of lung cancer: a prospective analysis in a Greek University Pulmonary Department.

PubMed

Zarogoulidou, Vasiliki; Panagopoulou, Efharis; Papakosta, Despina; Petridis, Dimitris; Porpodis, Konstantinos; Zarogoulidis, Konstantinos; Zarogoulidis, Paul; Arvanitidou, Malamatenia

2015-02-01

Lung cancer (LC) is a disease with high morbidity and mortality while the prevention and treatment constitutes a significant financial burden. This economic burden has an increasing trend, with hospitalization being the highest cost factor in most studies, while the patients' quality of life (QoL) and response to treatment is not proven to be positively affected. To evaluate the direct and indirect cost of managing patients with LC in Greece according to stage and histological type of cancer, total chemotherapy cycles, age, gender, smoking habit, overall survival (OS), treatment outcome (TO) and QoL. One hundred thirteen of 128 consecutive patients met the inclusion criteria and were included in this prospective study. Patient enrolment started in August 2011 and ended in November 2011. The duration of the patient follow up was 32 months after diagnosis until end of registry. Total direct cost included diagnosis and treatment cost. Indirect cost constituted of patient's and family caregivers lost days of productivity. QoL was assessed with EORTC-QLQ-30 and Lung Cancer Symptom Scale (LCSS) questionnaires before treatment and every three months. Total direct cost was €1,853,984 and chemotherapy drugs was the highest cost factor (€1,216,421). Total indirect cost was 28,774 days of which 27,293 were related to patients. Total direct cost was significantly related to the increased number of total chemotherapy cycles, longer OS, histological type of adenocarcinoma, female gender and younger patients. No relation was found between total indirect cost and the above factors. When the association between total direct/indirect cost and QoL was examined no significant results were drawn. The burden of LC on health care systems remains very high and was associated with the increased number of total chemotherapy cycles, longer OS, adenocarcinoma histological type of cancer, female gender and younger patients. Chemotherapy drugs constituted the higher factor of total direct cost. Indirect cost was considerably higher for patients than family caregivers and did not significantly differ in relation to the above factors. No significant conclusion was drawn regarding QoL and total direct/indirect cost.

Socioeconomic impact of osteoarthritis in Hong Kong: utilization of health and social services, and direct and indirect costs.

PubMed

Woo, Jean; Lau, Edith; Lau, Chak Sing; Lee, Polly; Zhang, James; Kwok, Timothy; Chan, Cynthia; Chiu, P; Chan, Kai Ming; Chan, A; Lam, D

2003-08-15

To determine the direct and indirect cost of osteoarthritis (OA) according to disease severity, and to estimate the total cost of the disease in Hong Kong. This study is a retrospective, cross-sectional, nonrandom, cohort design, with subjects stratified according to disease severity based on functional limitation and the presence or absence of joint prosthesis. Subjects were recruited from primary care, geriatric medicine, rheumatology, and orthopedic clinics. There were 219 patients in the mild disease category, 290 patients in the severe category, and 65 patients with joint replacement. A questionnaire gathered information on demographic and socioeconomic characteristics, function limitation, use of health and social services, and effect on occupation and living arrangements over the previous 12 months. Costs were calculated as direct and indirect. Low education and socioeconomic class were associated with more severe disease. OA affected family or close relationships in 44%. The average cost incurred as a result of side effects of medication is similar to the average cost of medication itself. Excluding joint replacement, the direct costs ranged from Hong Kong (HK) dollar $11,690 to $40,180 per person per year and indirect costs, HK $3,300-$6,640. The direct costs are comparable to those reported in Western countries; however, the ratio of direct to indirect costs is much higher than 1, in contrast to the greater indirect versus direct costs reported in whites. The total cost expressed as a percentage of gross national product is also much lower in Hong Kong. The socioeconomic impact of OA in the Hong Kong population is comparable to Western countries, but the economic burden is largely placed on the government, with patients having relatively low out-of-pocket expenditures.

Direct and indirect medical costs incurred by Canadian patients with rheumatoid arthritis: a 12 year study.

PubMed

Clarke, A E; Zowall, H; Levinton, C; Assimakopoulos, H; Sibley, J T; Haga, M; Shiroky, J; Neville, C; Lubeck, D P; Grover, S A; Esdaile, J M

1997-06-01

To perform the first prospective longitudinal study of direct (health services utilized) and indirect costs (diminished productivity represented by income loss) incurred by patients with rheumatoid arthritis (RA) in Saskatoon and Montreal, followed for up to 12 and 4 years, respectively. 1063 patients reported on health status, health services utilization, and diminished productivity every 6 months. Annual direct costs were $3788 (1994 Canadian dollars) in the late 1980s and $4656 in the early 1990s. Given that the average age exceeded 60 years, few participated in labor force activities or considered themselves disabled from the labor force and their indirect costs were substantially less, $2165 in the late 1980s and $1597 in the early 1990s. Institutional stays and medications made up at least 80% of total direct costs. Lengths of stay in acute care facilities remained constant, but the rate of hospitalization increased in the early 1990s, increasing average hospital costs per patient from $1563 in the late 1980s to $2023 in the early 1990s. For nonacute care facilities, rate of admission as well as length of stay increased over time, increasing costs per patient in Saskatoon 5-fold, from $291 to $1605. Those with greater functional disability incurred substantially higher direct and those under 65 years incurred higher indirect costs. Direct costs are higher than indirect costs. The major component is due to institutional stays that, in contrast to other direct cost components, is increased in the older and more disabled. Measures to reduce longterm disability by earlier, more aggressive intervention have the potential to produce considerable cost savings. However, it is unknown which strategies will have the greatest effect on outcome and accordingly, how resources can be optimally allocated.

Costs and cost-effectiveness of different DOT strategies for the treatment of tuberculosis in Pakistan. Directly Observed Treatment.

PubMed

Khan, M A; Walley, J D; Witter, S N; Imran, A; Safdar, N

2002-06-01

An economic study was conducted alongside a clinical trial at three sites in Pakistan to establish the costs and effectiveness of different strategies for implementing directly observed treatment (DOT) for tuberculosis. Patients were randomly allocated to one of three arms: DOTS with direct observation by health workers (at health centres or by community health workers); DOTS with direct observation by family members; and DOTS without direct observation. The clinical trial found no statistically significant difference in cure rate for the different arms. The economic study collected data on the full range of health service costs and patient costs of the different treatment arms. Data were also disaggregated by gender, rural and urban patients, by treatment site and by economic categories, to investigate the costs of the different strategies, their cost-effectiveness and the impact that they might have on patient compliance with treatment. The study found that direct observation by health centre-based health workers was the least cost-effective of the strategies tested (US dollars 310 per case cured). This is an interesting result, as this is the model recommended by the World Health Organization and International Union against Tuberculosis and Lung Disease. Attending health centres daily during the first 2 months generated high patient costs (direct and in terms of time lost), yet cure rates for this group fell below those of the non-observed group (58%, compared with 62%). One factor suggested by this study is that the high costs of attending may be deterring patients, and in particular, economically active patients who have most to lose from the time taken by direct observation. Without stronger evidence of benefits, it is hard to justify the costs to health services and patients that this type of direct observation imposes. The self-administered group came out as most cost-effective (164 dollars per case cured). The community health worker sub-group achieved the highest cure rates (67%), with a cost per case only slightly higher than the self-administered group (172 dollars per case cured). This approach should be investigated further, along with other approaches to improving patient compliance.

28 CFR 100.10 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... cost objectives and can be distributed to them in reasonable proportion to the benefits received... distributed to them in reasonable proportion to the benefits received. Directly assignable cost means any cost... customers. Labor cost means the sum of the payroll cost, payroll taxes, and directly associated benefits...

Direct cost of monitoring conventional hemodialysis conducted by nursing professionals.

PubMed

Lima, Antônio Fernandes Costa

2017-04-01

to analyze the mean direct cost of conventional hemodialysis monitored by nursing professionals in three public teaching and research hospitals in the state of São Paulo, Brazil. this was a quantitative, explorative and descriptive investigation, based on a multiple case study approach. The mean direct cost was calculated by multiplying (clocked) time spent per procedure by the unit cost of direct labor. Values were calculated in Brazilian real (BRL). Hospital C presented the highest mean direct cost (BRL 184.52), 5.23 times greater than the value for Hospital A (BRL 35.29) and 3.91 times greater than Hospital B (BRL 47.22). the costing method used in this study can be reproduced at other dialysis centers to inform strategies aimed at efficient allocation of necessary human resources to successfully monitor conventional hemodialysis.

[Cost accounting for gastrectomy under critical path--the usefulness of direct accounting of personnel expenses and a guide to shortening hospital stay].

PubMed

Nozue, M; Maruyama, T; Imamura, F; Fukue, M

2000-08-01

In this study, cost accounting was made for a surgical case of gastrectomy according to critical path (path) and the economic contribution of the path was determined. In addition, changes in the cost percentage with changes in number of hospital days were simulated. Basically, cost accounting was done by means of cost accounting by departments, which meets the concept of direct cost accounting of administered accounts. Personnel expenses were calculated by means of both direct and indirect calculations. In the direct method, the total hours personnel participated were recorded for calculation. In the indirect method, personnel expenses were calculated from the ratio of the income of the surgical department to that of other departments. Purchase prices for all materials and drugs used were recorded to check buying costs. According to the direct calculating method, the personnel expenses came to approximately 300,000 yen, total cost was approximately 700,000 yen, and the cost percentage was 59%. According to the indirect method, the personnel expenses were approximately 540,000 yen and the total cost was approximately 940,000 yen, the cost percentage being 80%. A simulation study of changes in the cost with changes in hospital days revealed that the cost percentages were assessed to be approximately 53% in 19 hospital days and approximately 45% in 12 hospital days.

The cost of warfarin treatment for stroke prevention in patients with non-valvular atrial fibrillation in Russia from a collective perspective.

PubMed

Briere, J B; Bowrin, K; Wood, R; Roberts, J; Tatarsky, B

2017-06-01

Vitamin K antagonists (VKAs) are used for stroke prevention in patients with non-valvular atrial fibrillation (NVAF), but necessitate regular monitoring of prothrombin time via international normalized ratio (INR) testing. This study explores the economic burden of VKA therapy for Russian patients with NVAF. Cardiologists provided clinical characteristics and healthcare resource use data relating to the patient's first year of treatment. Data were used to quantify direct medical costs (INR testing, consultations, drug costs). The same patients completed a questionnaire providing data on direct non-medical costs (travel/expenses for attendance at VKA appointments) and indirect costs (opportunity cost and reduced work productivity). Mean costs per patient per year are described (US dollars). Cardiologists (n = 50) provided data on 400 patients (mean age = 63, 47% female), and 351 patients (88%) completed the patient questionnaire. Patients had a mean of nine INR tests. Estimated direct medical costs totaled $151.06, and 18.5% of direct medical costs were attributable to drug costs. Estimated annual direct non-medical costs were $22.89 per patient, and indirect costs were $275.59 per patient. Included patients had been treated for 12-24 months, so are not fully representative of the broader treatment population. Although VKA drugs costs are relatively low, regular INR testing and consultations drive the economic burden for Russian NVAF patients treated with VKA.

The economic burden of musculoskeletal disease in Korea: A cross sectional study

PubMed Central

2011-01-01

Background Musculoskeletal diseases are becoming increasingly important due to population aging. However, studies on the economic burden of musculoskeletal disease in Korea are scarce. Therefore, we conducted a population-based study to measure the economic burden of musculoskeletal disease in Korea using nationally representative data. Methods This study used a variety of data sources such as national health insurance statistics, the Korea Health Panel study and cause of death reports generated by the Korea National Statistical Office to estimate the economic burden of musculoskeletal disease. The total cost of musculoskeletal disease was estimated as the sum of direct medical care costs, direct non-medical care costs, and indirect costs. Direct medical care costs are composed of the costs paid by the insurer and patients, over the counter drugs costs, and other costs such as medical equipment costs. Direct non-medical costs are composed of transportation and caregiver costs. Indirect costs are the sum of the costs associated with premature death and the costs due to productivity loss. Age, sex, and disease specific costs were estimated. Results Among the musculoskeletal diseases, the highest costs are associated with other dorsopathies, followed by disc disorder and arthrosis. The direct medical and direct non-medical costs of all musculoskeletal diseases were $4.18 billion and $338 million in 2008, respectively. Among the indirect costs, those due to productivity loss were $2.28 billion and costs due to premature death were $79 million. The proportions of the total costs incurred by male and female patients were 33.8% and 66.2%, respectively, and the cost due to the female adult aged 20-64 years old was highest. The total economic cost of musculoskeletal disease was $6.89 billion, which represents 0.7% of the Korean gross domestic product. Conclusions The economic burden of musculoskeletal disease in Korea is substantial. As the Korean population continues to age, the economic burden of musculoskeletal disease will continue to increase. Policy measures aimed at controlling the cost of musculoskeletal disease are therefore required. PMID:21749727

The economic burden of advanced gastric cancer in Taiwan.

PubMed

Hong, Jihyung; Tsai, Yiling; Novick, Diego; Hsiao, Frank Chi-Huang; Cheng, Rebecca; Chen, Jen-Shi

2017-09-16

Gastric cancer is one of the leading causes of cancer-related deaths in both sexes worldwide, especially in Eastern Asia. This study aimed to estimate the economic burden of advanced gastric cancer (AGC) in Taiwan. The costs of AGC in 2013 were estimated using resource use data from a chart review study (n = 122 with AGC) and national statistics. Annual per-patient costs, where patients' follow-up periods were adjusted for, were estimated with 82 patients who had complete resource use data. The costs were composed of direct medical costs, direct non-medical costs (healthcare travel and caregiver costs), morbidity costs, and mortality costs. Relevant unit costs were retrieved mainly from literature and national statistics, and applied to the resource use data. A broad definition of morbidity and mortality costs was employed to value the productivity loss in patients with unpaid employment, economically inactive and unemployed as well as the life years after the age of retirement. Their narrow definitions were also used in sensitivity analyses, using age- and/or sex-specific employment rates. Forgone future earnings/productivity loss were discounted at 3%. Annual per-patient costs were projected to estimate the total costs of AGC at the national level with an estimated number of patients with AGC (N = 2611) in Taiwan in 2013. The mean age of the 82 patients was 59.3 (SD: 11.9) years, and 67.1% were male. Per-patient costs were US$26,431 for direct medical costs, US$4669 for direct non-medical costs, US$5758 for morbidity costs, and US$145,990 for mortality costs (per death). These per-patient costs were projected to incur total AGC costs of US$423 million at the national-level. Mortality costs accounted for 77.3% of the total costs, followed by direct medical costs (16.3%), morbidity costs (3.6%), and direct non-medical costs (2.9%). AGC was found to exert a significant economic burden in Taiwan, incurring US$423 million in 2013. This represents about 0.08% of the Taiwanese economy. Mortality costs appeared to be the single greatest contributor to the burden, followed by direct medical costs. Early detection and providing effective treatments will help to reduce its burden on patients, caregivers and society as a whole. A poster of this study was presented at the 2016 American Society of Clinical Oncology (ASCO) Gastrointestinal Cancers Symposium in San Francisco, CA, USA.

The cost of HIV medication adherence support interventions: results of a cross-site evaluation.

PubMed

Schackman, B R; Finkelstein, R; Neukermans, C P; Lewis, L; Eldred, L

2005-11-01

The objective of this study was to determine the direct cost of HIV adherence support programmes participating in a cross-site evaluation in the US. Data on the frequency, type, and setting of adherence encounters; providers' professions; and adherence tools provided were collected for 1,122 patients enrolled in 13 interventions at 9 sites. The site staff estimated the average duration of each type of encounter and national wage rates were used for labour costs. The median (range) adherence encounters/year among interventions was 16.5 (4.3-104.6) per patient; encounters lasted 24.6 (8.9-40.9) minutes. Intervention direct cost was correlated with the average frequency of encounters (r = 0.57), but not with encounter duration or providers' professions. The median direct cost/month was 35 dollars(5 dollars-58 dollars) per patient, and included direct provider costs (66%); incentives (17%); reminders and other tools (8%); and direct administrative time, provider transportation, training, and home delivery (9%). The median direct cost/month from a societal perspective, which includes patient time and travel costs, was 47 dollars(24 dollars-114 dollars) per patient. Adherence interventions with moderate efficacy costing < or =100 dollars/month have been estimated to meet a cost-effectiveness threshold that is generally accepted in the US. Payers should consider enhanced reimbursement for adherence support services.

Cost of illness associated with Niemann-Pick disease type C in the UK.

PubMed

Imrie, Jackie; Galani, Carmen; Gairy, Kerry; Lock, Kevin; Hunsche, Elke

2009-09-01

Niemann-Pick disease type C (NP-C) is a rare and devastating genetic disorder characterised by a range of progressive neurological symptoms, which imposes a burden on patients, family members, the healthcare system and society overall. The objective of this study was to assess direct and indirect costs associated with NP-C in the UK. This was a non-interventional, retrospective, cross-sectional cohort study based on responses from patients and/or their carers/guardians recruited from a UK NP-C database. Resource use and direct medical, direct non-medical and indirect costs were evaluated using data collected via postal survey in October 2007, which included a Medical Resource Use questionnaire. Total annual costs per patient were estimated. In total, 18 Medical Resource Use questionnaires (29% response rate) were received and analysed. The mean total annual cost (SD) of NP-C per patient was 39,168 pounds (50,315 pounds); 46% were direct medical costs, to which home visits and residential care contributed 68% and 15%, respectively. Direct non-medical costs accounted for 24% of the average annual cost per patient, mainly due to specialist education, and indirect costs 30%. If only direct medical costs were considered, the mean annual cost (SD) per patient was reduced to 18,012 pounds (46,536 pounds). The direct annual per-patient cost of NP-C illness in 2007 appears moderate when compared with other rare and severely disabling diseases. However, cost estimates may be conservative, since findings are limited by a small sample size, low survey response rate and potential recall bias. As demonstrated by this study, a substantial proportion of the cost is shifted from the healthcare system to the patient, family and non-medical providers. These findings highlight the need for treatments that can slow or stop disease progression in NP-C.

The economic implications of a multimodal analgesic regimen for patients undergoing major orthopedic surgery: a comparative study of direct costs.

PubMed

Duncan, Christopher M; Hall Long, Kirsten; Warner, David O; Hebl, James R

2009-01-01

Total knee and total hip arthoplasty (THA) are 2 of the most common surgical procedures performed in the United States and represent the greatest single Medicare procedural expenditure. This study was designed to evaluate the economic impact of implementing a multimodal analgesic regimen (Total Joint Regional Anesthesia [TJRA] Clinical Pathway) on the estimated direct medical costs of patients undergoing lower extremity joint replacement surgery. An economic cost comparison was performed on Mayo Clinic patients (n = 100) undergoing traditional total knee or total hip arthroplasty using the TJRA Clinical Pathway. Study patients were matched 1:1 with historical controls undergoing similar procedures using traditional anesthetic (non-TJRA) techniques. Matching criteria included age, sex, surgeon, type of procedure, and American Society of Anesthesiologists (ASA) physical status (PS) classification. Hospital-based direct costs were collected for each patient and analyzed in standardized inflation-adjusted constant dollars using cost-to-charge ratios, wage indexes, and physician services valued using Medicare reimbursement rates. The estimated mean direct hospital costs were compared between groups, and a subgroup analysis was performed based on ASA PS classification. The estimated mean direct hospital costs were significantly reduced among TJRA patients when compared with controls (cost difference, 1999 dollars; 95% confidence interval, 584-3231 dollars; P = 0.0004). A significant reduction in hospital-based (Medicare Part A) costs accounted for the majority of the total cost savings. Use of a comprehensive, multimodal analgesic regimen (TJRA Clinical Pathway) in patients undergoing lower extremity joint replacement surgery provides a significant reduction in the estimated total direct medical costs. The reduction in mean cost is primarily associated with lower hospital-based (Medicare Part A) costs, with the greatest overall cost difference appearing among patients with significant comorbidities (ASA PS III-IV patients).

Direct medical costs associated with atopic diseases among young children in Thailand.

PubMed

Ngamphaiboon, Jarungchit; Kongnakorn, Thitima; Detzel, Patrick; Sirisomboonwong, Krittawan; Wasiak, Radek

2012-01-01

Allergic diseases are the most common childhood illness in Thailand. Their prevalence has been rising over time, with several studies having revealed substantial economic burden. However, no such study had yet been conducted for Thailand. The aim of this study was to estimate direct medical costs associated with atopic diseases among children aged 0-5 years in Thailand. A cost-of-illness model was constructed to estimate the total direct medical costs of atopic diseases comprising atopic dermatitis, chronic rhinitis, asthma (i.e., recurrent wheeze), and cow's milk allergy. The model employed a prevalence-based approach, considering a total number of atopic cases in 2010. Direct medical costs were estimated using a bottom-up analysis with the estimation of the quantity of healthcare resource use and the unit costs. Epidemiological data were obtained from literature and Thai surveys, whereas treatment unit costs were from either a hospital database or Thai standard cost list. Expert opinion informed type, frequency, and quantity of medical resources utilized. Key limitations included lack of data-driven evidences on severity distribution for this particular age group, indirect costs, and medical resource use associated with each condition. Total direct cost was estimated to be THB 27.8 billion (US$899 million). Treatments contributed largest to the total costs (46%), followed by inpatient care (37%), outpatient care (12%), and monitoring and labs (5%). Costs per treated patient were highest in cow's milk allergy (THB 64,383; US$2077), followed by rhinitis (THB 12,669; US$409), asthma (THB 9633; US$312), and atopic dermatitis (THB 5432; US$175). Atopic diseases in young children are associated with substantial burden in direct medical costs to Thailand. These costs can be diminished through nutritional intervention recognized to effectively decrease the incidence of atopic diseases.

28 CFR 100.11 - Allowable costs.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) COST RECOVERY REGULATIONS, COMMUNICATIONS... reimbursement under section 109(e) CALEA are: (1) All reasonable plant costs directly associated with the... undergoes major modifications; (2) Additional reasonable plant costs directly associated with making the...

28 CFR 100.11 - Allowable costs.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) COST RECOVERY REGULATIONS, COMMUNICATIONS... reimbursement under section 109(e) CALEA are: (1) All reasonable plant costs directly associated with the... undergoes major modifications; (2) Additional reasonable plant costs directly associated with making the...

Cost and cost-effectiveness of community based and health facility based directly observed treatment of tuberculosis in Dar es Salaam, Tanzania

PubMed Central

Wandwalo, Eliud; Robberstad, Bjarne; Morkve, Odd

2005-01-01

Background Identifying new approaches to tuberculosis treatment that are effective and put less demand to meagre health resources is important. One such approach is community based direct observed treatment (DOT). The purpose of the study was to determine the cost and cost effectiveness of health facility and community based directly observed treatment of tuberculosis in an urban setting in Tanzania. Methods Two alternative strategies were compared: health facility based directly observed treatment by health personnel and community based directly observed treatment by treatment supervisors. Costs were analysed from the perspective of health services, patients and community in the year 2002 in US $ using standard methods. Treatment outcomes were obtained from a randomised-controlled trial which was conducted alongside the cost study. Smear positive, smear negative and extra-pulmonary TB patients were included. Cost-effectiveness was calculated as the cost per patient successfully treated. Results The total cost of treating a patient with conventional health facility based DOT and community based DOT were $ 145 and $ 94 respectively. Community based DOT reduced cost by 35%. Cost fell by 27% for health services and 72% for patients. When smear positive and smear negative patients were considered separately, community DOT was associated with 45% and 19% reduction of the costs respectively. Patients used about $ 43 to follow their medication to health facility which is equivalent to their monthly income. Indirect costs were as important as direct costs, contributing to about 49% of the total patient's cost. The main reason for reduced cost was fewer number of visits to the TB clinic. Community based DOT was more cost-effective at $ 128 per patient successfully treated compared to $ 203 for a patient successfully treated with health facility based DOT. Conclusion Community based DOT presents an economically attractive option to complement health facility based DOT. This is particularly important in settings where TB clinics are working beyond capacity under limited resources. PMID:16018806

Analysis of Direct Costs of Outpatient Arthroscopic Rotator Cuff Repair.

PubMed

Narvy, Steven J; Ahluwalia, Avtar; Vangsness, C Thomas

2016-01-01

Arthroscopic rotator cuff surgery is one of the most commonly performed orthopedic surgical procedures. We conducted a study to calculate the direct cost of arthroscopic repair of rotator cuff tears confirmed by magnetic resonance imaging. Twenty-eight shoulders in 26 patients (mean age, 54.5 years) underwent primary rotator cuff repair by a single fellowship-trained arthroscopic surgeon in the outpatient surgery center of a major academic medical center. All patients had interscalene blocks placed while in the preoperative holding area. Direct costs of this cycle of care were calculated using the time-driven activity-based costing algorithm. Mean time in operating room was 148 minutes; mean time in recovery was 105 minutes. Calculated surgical cost for this process cycle was $5904.21. Among material costs, suture anchor costs were the main cost driver. Preoperative bloodwork was obtained in 23 cases, adding a mean cost of $111.04. Our findings provide important preliminary information regarding the direct economic costs of rotator cuff surgery and may be useful to hospitals and surgery centers negotiating procedural reimbursement for the increased cost of repairing complex tears.

The cost of care of rheumatoid arthritis and ankylosing spondylitis patients in tertiary care rheumatology units in Turkey.

PubMed

Malhan, Simten; Pay, Salih; Ataman, Sebnem; Dalkilic, Ediz; Dinc, Ayhan; Erken, Eren; Ertenli, Ihsan; Ertugrul, Esin; Gogus, Feride; Hamuryudan, Vedat; Inanc, Murat; Karaarslan, Yasar; Karadag, Omer; Karakoc, Yuksel; Keskin, Goksal; Kisacik, Bunyamin; Kiraz, Sedat; Oksel, Fahrettin; Oksuz, Ergun; Pirildar, Timur; Sari, Ismail; Soy, Mehmet; Senturk, Taskin; Taylan, Ali

2012-01-01

To determine the direct and indirect costs due to rheumatoid arthritis (RA) and ankylosing spondylitis (AS) patients in Turkey. An expert panel was convened to estimate the direct and indirect costs of care of patients with RA and AS in Turkey. The panel was composed of 22 experts chosen from all national tertiary care rheumatology units (n=53). To calculate direct costs, the medical management of RA and AS patients was estimated using 'cost-of-illness' methodology. To measure indirect costs, the number of days of sick leave, the extent of disability, and the levels of early retirement and early death were also evaluated. Lost productivity costs were calculated using the 'human capital approach', based on the minimum wage. The total annual direct costs were 2,917.03 Euros per RA patient and 3,565.9 Euros for each AS patient. The direct costs were thus substantial, but the indirect costs were much higher because of extensive morbidity and mortality rates. The total annual indirect costs were 7,058.99 Euros per RA patient and 6,989.81 for each AS patient. Thus, the total cost for each RA patient was 9,976.01 Euros and that for an AS patient 10,555.72 Euros, in Turkey. From the societal perspective, both RA and AS have become burden in Turkey. The cost of lost productivity is higher than the medical cost. Another important conclusion is that indirect costs constitute 70% and 66% of total costs in patients with RA and AS, respectively.

Instructional Support Costs Related to Faculty Salary Costs. Report No. 79-02.

ERIC Educational Resources Information Center

Hample, Stephen R.

Nonfaculty salary (instructional support) costs for Montana State University (MSU) are examined with specific reference to the adequacy of the 25 percent nonfaculty salary allowance for other costs. Two concepts are examined: nonfaculty salary expenses within the instruction program (direct instructional support costs) and both direct support…

47 CFR 64.901 - Allocation of costs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... cost categories) for which a direct assignment or allocation is available. (iii) When neither direct... 47 Telecommunication 3 2010-10-01 2010-10-01 false Allocation of costs. 64.901 Section 64.901... RULES RELATING TO COMMON CARRIERS Allocation of Costs § 64.901 Allocation of costs. (a) Carriers...

Direct and Indirect Costs of Chronic and Episodic Migraine in the United States: A Web-Based Survey.

PubMed

Messali, Andrew; Sanderson, Joanna C; Blumenfeld, Andrew M; Goadsby, Peter J; Buse, Dawn C; Varon, Sepideh F; Stokes, Michael; Lipton, Richard B

2016-02-01

The objective of this study was to compare the societal direct and indirect costs of chronic and episodic migraine in the United States. Episodic and chronic migraine are distinguished by the frequency of headache-days. Chronic migraine has a greater overall impact on quality of life than does episodic migraine. Individuals with chronic migraine also use more healthcare resources (resulting in higher direct costs) and experience greater decreases in productivity (resulting in higher indirect costs) than those with episodic migraine as shown in the American Migraine Prevalence and Prevention (AMPP) Study. The International Burden of Migraine Study utilized a web-based questionnaire to elicit data on several topics related to the burden of migraine illness, including health resource utilization and productivity losses. Potential survey participants were identified by Synovate Healthcare (Chicago, IL, USA) from a pool of registered panelists from various countries. The panelists were screened online to determine eligibility and to identify individuals with migraine (episodic or chronic), based on reported symptoms. Participants from the United States were divided into episodic and chronic migraine groups, based on reported headache-day per month frequency. Direct and indirect costs were estimated by applying estimated unit costs to reported headache-related productivity losses and resource use. Costs were compared between participants with episodic and chronic migraine. Mean [standard deviation] total annual cost of headache among people with chronic migraine ($8243 [$10,646]) was over three times that of episodic migraine ($2649 [$4634], P < .001). Participants with chronic migraine had significantly greater direct medical costs ($4943 [$6382]) and indirect (lost productivity) costs ($3300 [$6907]) than did participants with episodic migraine (direct, $1705 [$3591]; indirect, $943 [$2084]) (P < .001 for each). Unlike previous findings, direct medical costs constituted the majority of total headache-related costs for both chronic migraine (60.0%, $4943 of $8243) and episodic migraine (64.3%, $1705 of $2649) participants. A large portion of direct medical costs are attributable to pharmaceutical utilization among both chronic migraine (80%, $3925 of 4943) and episodic migraine (70%, $1196 of $1705) participants. The results of this study build on previous results of the AMPP Study, demonstrating that headache-related direct, indirect, and total costs are significantly greater among individuals with chronic migraine than with episodic migraine in the United States. © 2016 American Headache Society.

The total lifetime costs of smoking.

PubMed

Rasmussen, Susanne R; Prescott, Eva; Sørensen, Thorkild I A; Søgaard, Jes

2004-03-01

Net costs of smoking in a lifetime perspective and, hence, the economic interests in antismoking policies have been questioned. It has been proposed that the health-related costs of smoking are balanced by smaller expenditure due to shorter life expectancy. A dynamic (life cycle) method taking differences in life expectancy into account. Main outcome measures were direct and indirect lifetime health costs for ever-smokers and never-smokers, and cost ratios (ever-smokers to never-smokers). The estimations were based on annual disease rates of use of the healthcare services, smoking relative risks, smoking prevalences, and costs. Annual direct and indirect costs of ever-smokers were higher than for never-smokers in all age groups of both genders. The direct and indirect cost ratios were highest at age 45 for women, and at age 35 and 40 for men, respectively. Taking life expectancy differences into account, direct and indirect lifetime health costs for men aged 35, discounted by 5% per year were 66% and 83% higher in ever-smokers than in never-smokers. Corresponding results for women were 74% and 79%, respectively. The results are insensitive to a broad range of relative risk-estimates and discount rates including no discounting. Excess costs of ever-smokers disappear if the inclusion of smoking-related diseases is narrowed to that of previous studies. Smoking imposes costs to society even when taking life expectancy into consideration--both in direct and indirect costs.

An Ownership/Lease Cost Comparison Analysis of Heavy Equipment Motor Vehicles in Air Force Materiel Command

DTIC Science & Technology

1994-09-01

costs are the costs associated with a particular piece of equipment that do not change despite change in variable operating cost ( Horngren and Foster...The Operating and maintenance costs account for direct and indirect costs associated with their respective functions and vary with the utilization of...each vehicle. The operating direct cost includes all on-base and off- base fuel cost . Indirect operations costs account for bench 28 stock items

The cost of dementia in an unequal country: The case of Chile.

PubMed

Hojman, Daniel A; Duarte, Fabian; Ruiz-Tagle, Jaime; Budnich, Marilu; Delgado, Carolina; Slachevsky, Andrea

2017-01-01

We study the economic cost of dementia in Chile, and its variation according to socioeconomic status (SES). We use primary data from a survey of 330 informal primary caregivers who completed both a RUD-Lite and a socio-demographic questionnaire to evaluate the severity of dementia and caregiver's burden. The costs of dementia are broken into three components: direct medical costs (medical care, drugs, tests); direct social costs (social service, daycare); and indirect costs (mostly associated to informal care). The average monthly cost per patient is estimated at US$ 1,463. Direct medical costs account for 20 per cent, direct social costs for 5 per cent and indirect costs for 75 per cent of the total cost. The mean monthly cost is found to be inversely related to SES, a pattern largely driven by indirect costs. The monthly cost for high SES is US$ 1,083 and US$ 1,588 for low SES. A multivariate regression analysis suggests that severity of dementia and caregiver's burden account for between 49 and 70 per cent of the difference in the indirect cost across SES. However, between one-third and one-half of the variation across SES is not due to gradient in severity of dementia. Direct medical costs increase in higher SES, reflecting differences in purchasing power, while indirect costs are inversely related to SES and more than compensate differences in medical costs. Moreover, in lower SES groups, female caregivers, typically family members who are inactive in the labor market, mostly provide informal care. The average annual cost of dementia in Chile (US$ 17,559) is lower in comparison to high-income countries (US$ 39,595) and the proportion of cost related to informal cost is higher (74 per cent compared to 40 per cent). SES is a key determinant in the cost of dementia. In the absence of universal access to treatment, part of the social cost of dementia potentially preserves or increases income and gender inequality.

The cost of dementia in an unequal country: The case of Chile

PubMed Central

Hojman, Daniel A.; Duarte, Fabian; Ruiz-Tagle, Jaime; Budnich, Marilu; Delgado, Carolina; Slachevsky, Andrea

2017-01-01

We study the economic cost of dementia in Chile, and its variation according to socioeconomic status (SES). We use primary data from a survey of 330 informal primary caregivers who completed both a RUD-Lite and a socio-demographic questionnaire to evaluate the severity of dementia and caregiver’s burden. The costs of dementia are broken into three components: direct medical costs (medical care, drugs, tests); direct social costs (social service, daycare); and indirect costs (mostly associated to informal care). The average monthly cost per patient is estimated at US$ 1,463. Direct medical costs account for 20 per cent, direct social costs for 5 per cent and indirect costs for 75 per cent of the total cost. The mean monthly cost is found to be inversely related to SES, a pattern largely driven by indirect costs. The monthly cost for high SES is US$ 1,083 and US$ 1,588 for low SES. A multivariate regression analysis suggests that severity of dementia and caregiver’s burden account for between 49 and 70 per cent of the difference in the indirect cost across SES. However, between one-third and one-half of the variation across SES is not due to gradient in severity of dementia. Direct medical costs increase in higher SES, reflecting differences in purchasing power, while indirect costs are inversely related to SES and more than compensate differences in medical costs. Moreover, in lower SES groups, female caregivers, typically family members who are inactive in the labor market, mostly provide informal care. The average annual cost of dementia in Chile (US$ 17,559) is lower in comparison to high-income countries (US$ 39,595) and the proportion of cost related to informal cost is higher (74 per cent compared to 40 per cent). SES is a key determinant in the cost of dementia. In the absence of universal access to treatment, part of the social cost of dementia potentially preserves or increases income and gender inequality. PMID:28267795

Cost Accounting as a Tool for Increasing Cost Transparency in Selective Hepatic Transarterial Chemoembolization.

PubMed

Ahmed, Osman; Patel, Mikin; Ward, Thomas; Sze, Daniel Y; Telischak, Kristen; Kothary, Nishita; Hofmann, Lawrence V

2015-12-01

To increase cost transparency and uncover potential areas for savings in patients receiving selective transarterial chemoembolization at a tertiary care academic center. The hospital cost accounting system charge master sheet for direct and total costs associated with selective transarterial chemoembolization in fiscal years 2013 and 2014 was queried for each of the four highest volume interventional radiologists at a single institution. There were 517 cases (range, 83-150 per physician) performed; direct costs incurred relating to care before, during, and after the procedure with respect to labor, supply, and equipment fees were calculated. A median of 48 activity codes were charged per selective transarterial chemoembolization from five cost centers, represented by the angiography suite, units for care before and after the procedure, pharmacy, and observation floors. The average direct cost of selective transarterial chemoembolization did not significantly differ among operators at $9,126.94, $8,768.77, $9,027.33, and $8,909.75 (P = .31). Intraprocedural costs accounted for 82.8% of total direct costs and provided the greatest degree in cost variability ($7,268.47-$7,691.27). The differences in intraprocedural expense among providers were not statistically significant (P = .09), even when separated into more specific procedure-related labor and supply costs. Cost accounting systems could effectively be interrogated as a method for calculating direct costs associated with selective transarterial chemoembolization. The greatest source of expenditure and variability in cost among providers was shown to be intraprocedural labor and supplies, although the effect did not appear to be operator dependent. Copyright © 2015 SIR. Published by Elsevier Inc. All rights reserved.

SOCIETAL COSTS ASSOCIATED WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION IN THE UNITED STATES.

PubMed

Brown, Melissa M; Brown, Gary C; Lieske, Heidi B; Tran, Irwin; Turpcu, Adam; Colman, Shoshana

2016-02-01

The purpose of this study was to use a cross-sectional prevalence-based health care economic survey to ascertain the annual, incremental, societal ophthalmic costs associated with neovascular age-related macular degeneration. Consecutive patients (n = 200) with neovascular age-related macular degeneration were studied. A Control Cohort included patients with good (20/20-20/25) vision, while Study Cohort vision levels included Subcohort 1: 20/30 to 20/50, Subcohort 2: 20/60 to 20/100, Subcohort 3: 20/200 to 20/400, and Subcohort 4: 20/800 to no light perception. An interviewer-administered, standardized, written survey assessed 1) direct ophthalmic medical, 2) direct nonophthalmic medical, 3) direct nonmedical, and 4) indirect medical costs accrued due solely to neovascular age-related macular degeneration. The mean annual societal cost for the Control Cohort was $6,116 and for the Study Cohort averaged $39,910 (P < 0.001). Study Subcohort 1 costs averaged $20,339, while Subcohort 4 costs averaged $82,984. Direct ophthalmic medical costs comprised 17.9% of Study Cohort societal ophthalmic costs, versus 74.1% of Control Cohort societal ophthalmic costs (P < 0.001) and 10.4% of 20/800 to no light perception subcohort costs. Direct nonmedical costs, primarily caregiver, comprised 67.1% of Study Cohort societal ophthalmic costs, versus 21.3% ($1,302/$6,116) of Control Cohort costs (P < 0.001) and 74.1% of 20/800 to no light perception subcohort costs. Total societal ophthalmic costs associated with neovascular age-related macular degeneration dramatically increase as vision in the better-seeing eye decreases.

Healthcare Resource Use and Direct Costs in Patients with Ankylosing Spondylitis and Psoriatic Arthritis in a Large US Cohort.

PubMed

Greenberg, Jeffrey D; Palmer, Jacqueline B; Li, Yunfeng; Herrera, Vivian; Tsang, Yuen; Liao, Minlei

2016-01-01

Direct costs of ankylosing spondylitis (AS) and psoriatic arthritis (PsA) have not been well characterized in the United States. This study assessed healthcare resource use and direct cost of AS and PsA, and identified predictors of all-cause medical and pharmacy costs. Adults aged ≥ 18 with a diagnosis of AS and PsA were identified in the MarketScan databases between October 1, 2011, and September 30, 2012. Patients were continuously enrolled with medical and pharmacy benefits for 12 months before and after the index date (first diagnosis). Baseline demographics and comorbidities were identified. Direct costs included hospitalizations, emergency room and office visits, and pharmacy costs. Multivariable regression was used to determine whether baseline covariates were associated with direct costs. Patients with AS were younger and mostly men compared with patients with PsA. Hypertension and hyperlipidemia were the most common comorbidities in both cohorts. A higher percentage of patients with PsA used biologics and nonbiologic disease-modifying drugs (61.1% and 52.4%, respectively) compared with patients with AS (52.5% and 21.8%, respectively). Office visits were the most commonly used resource by patients with AS and PsA (∼11 visits). Annual direct medical costs [all US dollars, mean (SD)] for patients with AS and PsA were $6514 ($32,982) and $5108 ($22,258), respectively. Prescription drug costs were higher for patients with PsA [$14,174 ($15,821)] compared with patients with AS [$11,214 ($14,249)]. Multivariable regression analysis showed higher all-cause direct costs were associated with biologic use, age, and increased comorbidities in patients with AS or PsA (all p < 0.05). Biologic use, age, and comorbidities were major determinants of all-cause direct costs in patients with AS and PsA.

Financial return-on-investment of ophthalmic interventions: a new paradigm.

PubMed

Brown, Melissa M; Brown, Gary C; Lieske, Heidi B; Lieske, P Alexander

2014-05-01

Although the patient value gain (improvement in quality-of-life and/or length-of-life) has been highlighted in Value-based Medicine cost-utility analyses, the financial value gain associated with healthcare interventions has received less emphasis. It is important for professional healthcare providers to realize their interventions often confer a large financial return-on-investment (ROI) to society. The societal costs associated with vitreoretinal and other ophthalmic interventions include: direct ophthalmic medical costs expended (hospital, physician, drug, diagnostic testing and so forth), direct medical costs saved (decreased costs for depression, injury, skilled nursing facility, nursing home and others), direct nonmedical costs saved (decreased costs for caregivers, transportation, residence costs, moving costs, and others), and indirect medical costs saved (improving employment incidence and wages). The financial ROI for direct ophthalmic medical costs expended for ranibizumab therapy for neovascular age-related macular degeneration is 450%, whereas that for cataract surgery is 4500% and for medical open-angle glaucoma therapy is 4000%. Many costs gained add to the Gross Domestic Product and increase the wealth of the nation. Many vitreoretinal and other ophthalmologic interventions confer considerable patient value, but also result in a large financial ROI to society. This financial ROI increases the wealth of the nation.

Direct cost analysis of intensive care unit stay in four European countries: applying a standardized costing methodology.

PubMed

Tan, Siok Swan; Bakker, Jan; Hoogendoorn, Marga E; Kapila, Atul; Martin, Joerg; Pezzi, Angelo; Pittoni, Giovanni; Spronk, Peter E; Welte, Robert; Hakkaart-van Roijen, Leona

2012-01-01

The objective of the present study was to measure and compare the direct costs of intensive care unit (ICU) days at seven ICU departments in Germany, Italy, the Netherlands, and the United Kingdom by means of a standardized costing methodology. A retrospective cost analysis of ICU patients was performed from the hospital's perspective. The standardized costing methodology was developed on the basis of the availability of data at the seven ICU departments. It entailed the application of the bottom-up approach for "hotel and nutrition" and the top-down approach for "diagnostics," "consumables," and "labor." Direct costs per ICU day ranged from €1168 to €2025. Even though the distribution of costs varied by cost component, labor was the most important cost driver at all departments. The costs for "labor" amounted to €1629 at department G but were fairly similar at the other departments (€711 ± 115). Direct costs of ICU days vary widely between the seven departments. Our standardized costing methodology could serve as a valuable instrument to compare actual cost differences, such as those resulting from differences in patient case-mix. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Direct costs of osteoporosis and hip fracture: an analysis for the Mexican healthcare system.

PubMed

Clark, P; Carlos, F; Barrera, C; Guzman, J; Maetzel, A; Lavielle, P; Ramirez, E; Robinson, V; Rodriguez-Cabrera, R; Tamayo, J; Tugwell, P

2008-03-01

This study reports the direct costs related to osteoporosis and hip fractures paid for governmental and private institutions in the Mexican health system and estimates the impact of these entities on Mexico. We conclude that the economic burden due to the direct costs of hip fracture justifies wide-scale prevention programs for osteoporosis (OP). To estimate the total direct costs of OP and hip fractures in the Mexican Health care system, a sample of governmental and private institutions were studied. Information was gathered through direct questionnaires in 275 OP patients and 218 hip fracture cases. Additionally, a chart review was conducted and experts' opinions obtained to get accurate protocol scenarios for diagnoses and treatment of OP with no fracture. Microcosting and activity-based costing techniques were used to yield unit costs. The total direct costs for OP and hip fracture were estimated for 2006 based on the projected annual incidence of hip fractures in Mexico. A total of 22,233 hip fracture cases were estimated for 2006 with a total cost to the healthcare system of US$ 97,058,159 for the acute treatment alone ($4,365.50 per case). We found considerable differences in costs and the way the patients were treated across the different health sectors within the country. Costs of the acute treatment of hip fractures in Mexico are high and are expected to increase with the predicted increment of life expectancy and the number of elderly in our population.

2 CFR Appendix IV to Part 200 - Indirect (F&A) Costs Identification and Assignment, and Rate Determination for Nonprofit...

Code of Federal Regulations, 2014 CFR

2014-01-01

... the direct costs and the indirect costs must exclude capital expenditures and unallowable costs... total direct costs (excluding capital expenditures and other distorting items, such contracts or... buildings, furniture and equipment; care of grounds; maintenance and operation of buildings and other plant...

Cost savings at the end of life. What do the data show?

PubMed

Emanuel, E J

1996-06-26

Medical care at the end of life consumes 10% to 12% of the total health care budget and 27% of the Medicare budget. Many people claim that increased use of hospice and advance directives and lower use of high-technology interventions for terminally ill patients will produce significant cost savings. However, the studies on cost savings from hospice and advance directives are not definitive. The 3 randomized trials show no savings from these interventions, but either they are too small for confidence in their negative results or their intervention and cost accounting are flawed. The nonrandomized trials of hospice and advance directives show a wide range of savings, from 68% to none. Five methodological issues obscure the assessment of these studies: (1) selection bias in those patients who use hospice and advance directives, (2) the different time frames of assessing the costs, (3) the limited types of medical costs evaluated, (4) the variability of reporting the savings, and (5) the lack of generalizability of the findings to other patient populations. A more definitive study that assessed patients' end-of-life care preferences, use of hospice and advance directives, and direct and indirect costs would be desirable. In the absence of such a study, the existing data suggest that hospice and advance directives can save between 25% and 40% of health care costs during the last month of life, with savings decreasing to 10% to 17% over the last 6 months of life and decreasing further to 0% to 10% over the last 12 months of life. These savings are less than most people anticipate. Nevertheless, they do indicate that hospice and advance directives should be encouraged because they certainly do not cost more and they provide a means for patients to exercise their autonomy over end-of-life decisions.

Cost identification of abdominal aortic aneurysm imaging by using time and motion analyses.

PubMed

Rubin, G D; Armerding, M D; Dake, M D; Napel, S

2000-04-01

To compare the costs of performing helical computed tomographic (CT) angiography with three-dimensional rendering versus intraarterial digital subtraction angiography (DSA) for preoperative imaging of abdominal aortic aneurysms (AAAs). A single observer determined the variable direct costs of performing nine intraarterial DSA and 10 CT angiographic examinations in age- and general health-matched patients with AAA by using time and motion analyses. All personnel directly involved in the cases were tracked, and the involvement times were recorded to the nearest minute. All material items used during the procedures were recorded. The cost of labor was determined from personnel reimbursement data, and the cost of materials, from vendor pricing. The variable direct costs of laboratory tests and using the ambulatory treatment unit for postprocedural monitoring, as well as all fixed direct costs, were assessed from hospital accounting records. The total costs were determined for each procedure and compared by using the Student t test and calculating the CIs. The mean total direct cost of intraarterial DSA (+/- SD) was $1,052 +/- 71, and that of CT angiography was $300 +/- 30, which are significantly different (P < 4.1 x 10(-11)). With 95% confidence, intraarterial DSA cost 3.2-3.7 times more than CT angiography for the assessment of AAA. Assuming equal diagnostic utility and procedure-related morbidity, institutions may have substantial cost savings whenever CT angiography can replace intraarterial DSA for imaging AAAs.

Practice expenses in the MFS (Medicare fee schedule): the service-class approach.

PubMed

Latimer, E A; Kane, N M

1995-01-01

The practice expense component of the Medicare fee schedule (MFS), which is currently based on historical charges and rewards physician procedures at the expense of cognitive services, is due to be changed by January 1, 1998. The Physician Payment Review Commission (PPRC) and others have proposed microcosting direct costs and allocating all indirect costs on a common basis, such as physician time or work plus direct costs. Without altering the treatment of direct costs, the service-class approach disaggregates indirect costs into six practice function costs. The practice function costs are then allocated to classes of services using cost-accounting and statistical methods. This approach would make the practice expense component more resource-based than other proposed alternatives.

10 CFR 1009.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... allocable to a particular cost objective (i.e., a specific function, project, process, or organization) if...) Direct materials. (4) Other direct costs. (5) Processing materials and chemicals. (6) Power and other... equipment. (10) Added factor includes general and administrative costs and other support costs that are...

48 CFR 31.603 - Requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., including amusement, diversion, and social activities, and any costs directly associated with such costs...) Costs incurred to influence (directly or indirectly) legislative action on any matter pending before... or an executive agency supplement to the FAR. (5) Costs of any membership in any social, dining, or...

48 CFR 31.603 - Requirements.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., including amusement, diversion, and social activities, and any costs directly associated with such costs...) Costs incurred to influence (directly or indirectly) legislative action on any matter pending before... or an executive agency supplement to the FAR. (5) Costs of any membership in any social, dining, or...

The socioeconomic costs of mental illness in Spain.

PubMed

Oliva-Moreno, Juan; López-Bastida, Julio; Montejo-González, Angel Luis; Osuna-Guerrero, Rubén; Duque-González, Beatriz

2009-10-01

Mental illness affects a large number of people in the world, seriously impairing their quality of life and resulting in high socioeconomic costs for health care systems and society. Our aim is to estimate the socioeconomic impact of mental illness in Spain for the year 2002, including health care resources, informal care and loss of labour productivity. A prevalence-based approach was used to estimate direct medical costs, direct non-medical costs, and loss of labour productivity. The total costs of mental illness have been estimated at 7,019 million euros. Direct medical costs represented 39.6% of the total costs and 7.3% of total public healthcare expenditure in Spain. Informal care costs represented 17.7% of the total costs. Loss of labour productivity accounted for 42.7% of total costs. In conclusion, the costs of mental illness in Spain make a considerable economic impact from a societal perspective.

Direct measurement of health care costs.

PubMed

Smith, Mark W; Barnett, Paul G

2003-09-01

Cost identification is fundamental to many economic analyses of health care. Health care costs are often derived from administrative databases. Unit costs may also be obtained from published studies. When these sources will not suffice (e.g., in evaluating interventions or programs), data may be gathered directly through observation and surveys. This article describes how to use direct measurement to estimate the cost of an intervention. The authors review the elements of cost determination, including study perspective, the range of elements to measure, and short-run versus long-run costs. They then discuss the advantages and drawbacks of alternative direct measurement methods such as time-and-motion studies, activity logs, and surveys of patients and managers. A parsimonious data collection effort is desirable, although study hypotheses and perspective should guide the endeavor. Special reference is made to data sources within the Department of Veterans Affairs (VA) health care system.

Direct and indirect economic costs among private-sector employees with osteoarthritis.

PubMed

Berger, Ariel; Hartrick, Craig; Edelsberg, John; Sadosky, Alesia; Oster, Gerry

2011-11-01

To estimate direct and indirect economic costs among private-sector employees with osteoarthritis (OA). Using a large US employer benefits database, we identified all employees with evidence of OA during calendar year 2007, and compared their costs of health care and work loss to age-and-sex-matched employees without evidence of OA in that year. Private-sector employees with OA (n = 2399) averaged 62.9 days of absenteeism versus 36.7 days among matched comparators (n = 2399) (P < 0.01). Mean total direct costs among these persons were $17,751 and $5057, respectively (P < 0.01); 34% of health care costs among persons with OA arose from medical encounters with listed diagnoses of OA. Mean total indirect costs were two-fold higher among persons with OA ($5002 versus $2120 for those without OA; P < 0.01). Private-sector employees with OA have higher direct and indirect costs than those without this condition.

Costs of bronchoalveolar lavage-directed therapy in the first 5 years of life for children with cystic fibrosis.

PubMed

Moodie, Marj; Lal, Anita; Vidmar, Suzanna; Armstrong, David S; Byrnes, Catherine A; Carlin, John B; Cheney, Joyce; Cooper, Peter J; Grimwood, Keith; Robertson, Colin F; Tiddens, Harm A; Wainwright, Claire E

2014-09-01

To determine whether bronchoalveolar lavage (BAL)-directed therapy for infants and young children with cystic fibrosis (CF), rather than standard therapy, was justified on the grounds of a decrease in average costs and whether the use of BAL reduced treatment costs associated with hospital admissions. Costs were assessed in a randomized controlled trial conducted in Australia and New Zealand on infants diagnosed with CF after newborn screening and assigned to receive either BAL-directed or standard therapy until they reached 5 years of age. A health care funder perspective was adopted. Resource use measurement was based on standardized data collection forms administered for patients across all sites. Unit costs were obtained primarily from government schedules. Mean costs per child during the study period were Australian dollars (AUD)92 860 in BAL-directed therapy group and AUD90 958 in standard therapy group (mean difference AUD1902, 95% CI AUD-27 782 to 31 586, P = .90). Mean hospital costs per child during the study period were AUD57 302 in the BAL-directed therapy group and AUD66 590 in the standard therapy group (mean difference AUD-9288; 95% CI AUD-35 252 to 16 676, P = .48). BAL-directed therapy did not result in either lower mean hospital admission costs or mean costs overall compared with managing patients with CF by a standard protocol based upon clinical features and oropharyngeal culture results alone. Following on our previous findings that BAL-directed treatment offers no clinical advantage over standard therapy at age 5 years, flexible bronchoscopy with BAL cannot be recommended for the routine management of preschool children with CF on the basis of overall cost savings. Copyright © 2014 Elsevier Inc. All rights reserved.

28 CFR 100.13 - Directly assignable costs.

Code of Federal Regulations, 2010 CFR

2010-07-01

... cost may be treated as a directly allocable cost if the accounting treatment is consistently applied within the carrier's accounting system and the application produces substantially the same results as...

Direct Costs of Very Old Persons with Subsyndromal Depression: A 5-Year Prospective Study.

PubMed

Ludvigsson, Mikael; Bernfort, Lars; Marcusson, Jan; Wressle, Ewa; Milberg, Anna

2018-03-15

This study aimed to compare, over a 5-year period, the prospective direct healthcare costs and service utilization of persons with subsyndromal depression (SSD) and non-depressive persons (ND), in a population of very old persons. A second aim was to develop a model that predicts direct healthcare costs in very old persons with SSD. A prospective population-based study was undertaken on 85-year-old persons in Sweden. Depressiveness was screened with the Geriatric Depression Scale at baseline and at 1-year follow-up, and the results were classified into ND, SSD, and syndromal depression. Data on individual healthcare costs and service use from a 5-year period were derived from national database registers. Direct costs were compared between categories using Mann-Whitney U tests, and a prediction model was identified with linear regression. For persons with SSD, the direct healthcare costs per month of survival exceeded those of persons with ND by a ratio 1.45 (€634 versus €436), a difference that was significant even after controlling for somatic multimorbidity. The final regression model consisted of five independent variables predicting direct healthcare costs: male sex, activities of daily living functions, loneliness, presence of SSD, and somatic multimorbidity. SSD among very old persons is associated with increased direct healthcare costs independently of somatic multimorbidity. The associations between SSD, somatic multimorbidity, and healthcare costs in the very old need to be analyzed further in order to better guide allocation of resources in health policy. Copyright © 2018 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Cost of illness and determinants of costs among patients with gout.

PubMed

Spaetgens, Bart; Wijnands, José M A; van Durme, Caroline; van der Linden, Sjef; Boonen, Annelies

2015-02-01

To estimate costs of illness in a cross-sectional cohort of patients with gout attending an outpatient rheumatology clinic, and to evaluate which factors contribute to higher costs. Altogether, 126 patients with gout were clinically assessed. They completed a series of questionnaires. Health resource use was collected using a self-report questionnaire that was cross-checked with the electronic patient file. Productivity loss was assessed by the Work Productivity and Activity Impairment Questionnaire, addressing absenteeism and presenteeism. Resource use and productivity loss were valued by real costs, and annual costs per patient were calculated. Factors contributing to incurring costs above the median were explored using logistic univariable and multivariable regression analysis. Mean (median) annual direct costs of gout were €5647 (€1148) per patient. Total costs increased to €6914 (€1279) or €10,894 (€1840) per patient per year when adding cost for absenteeism or both absenteeism and presenteeism, respectively. Factors independently associated with high direct and high indirect costs were a positive history of cardiovascular disease, functional limitations, and female sex. In addition, pain, gout concerns, and unmet gout treatment needs were associated with high direct costs. The direct and indirect costs-of-illness of gout are primarily associated with cardiovascular disease, functional limitations, and female sex.

15 CFR 296.2 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

...-reward research. Direct costs means costs that can be identified readily with activities carried out in... examples. NIST shall determine the allowability of direct costs in accordance with applicable Federal cost... contemplated activity. High-risk, high-reward research means research that: (1) Has the potential for yielding...

15 CFR 296.2 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-01-01

...-reward research. Direct costs means costs that can be identified readily with activities carried out in... examples. NIST shall determine the allowability of direct costs in accordance with applicable Federal cost... contemplated activity. High-risk, high-reward research means research that: (1) Has the potential for yielding...

15 CFR 296.2 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-01-01

...-reward research. Direct costs means costs that can be identified readily with activities carried out in... examples. NIST shall determine the allowability of direct costs in accordance with applicable Federal cost... contemplated activity. High-risk, high-reward research means research that: (1) Has the potential for yielding...

15 CFR 296.2 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-01-01

...-reward research. Direct costs means costs that can be identified readily with activities carried out in... examples. NIST shall determine the allowability of direct costs in accordance with applicable Federal cost... contemplated activity. High-risk, high-reward research means research that: (1) Has the potential for yielding...

15 CFR 296.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

...-reward research. Direct costs means costs that can be identified readily with activities carried out in... examples. NIST shall determine the allowability of direct costs in accordance with applicable Federal cost... contemplated activity. High-risk, high-reward research means research that: (1) Has the potential for yielding...

Costs and benefits in item-method directed forgetting: differential effects of encoding and retrieval.

PubMed

Lee, Yuh-Shiow

2013-01-01

This study examined how encoding and retrieval factors affected directed forgetting costs and benefits in an item-method procedure. Experiment 1 used a typical item-method procedure and revealed a levels-of-processing effect in overall recall. However, the deep encoding condition showed a smaller directed forgetting effect than the shallow encoding conditions. More importantly, "remember" (R) words were selectively rehearsed as indicated by greater recall from the primacy portion of the list and more apt to be recalled before "forget" (F) words. Experiment 2 showed that a deep encoding operation reduced directed forgetting costs and that directed forgetting benefits occurred only when R words were recalled before F words. These findings supported the hypotheses that encoding manipulation affected directed forgetting costs and that directed forgetting benefits were associated with output order bias. Results were discussed in terms of mechanisms that produce item-method directed forgetting.

Economic burden of acute pesticide poisoning in South Korea.

PubMed

Choi, Yeongchull; Kim, Younhee; Ko, Yousun; Cha, Eun S; Kim, Jaeyoung; Lee, Won J

2012-12-01

To investigate the magnitude and characteristics of the economic burden resulting from acute pesticide poisoning (APP) in South Korea. The total costs of APP from a societal perspective were estimated by summing the direct medical and non-medical costs together with the indirect costs. Direct medical costs for patients assigned a disease code of pesticide poisoning were extracted from the Korean National Health Insurance Reimbursement Data. Direct non-medical costs were estimated using the average transportation and caregiving costs from the Korea Health Panel Survey. Indirect costs, incurred by pre-mature deaths and work loss, were obtained using 2009 Life Tables for Korea and other relevant literature. In 2009, a total of 11,453 patients were treated for APP and 1311 died, corresponding to an incidence of 23.1 per 100,000 population and a mortality rate of 2.6 per 100,000 population in South Korea. The total costs of APP were estimated at approximately US$ 150 million, 0.3% of the costs of total diseases. Costs due to pre-mature mortality accounted for 90.6% of the total costs, whereas the contribution of direct medical costs was relatively small. Costs from APP demonstrate a unique characteristic of a large proportion of the indirect costs originating from pre-mature mortality. This finding suggests policy implications for restrictions on lethal pesticides and safe storage to reduce fatality and cost due to APP. © 2012 Blackwell Publishing Ltd.

Direct and Indirect Costs of Research at Colleges and Universities. Revised Edition.

ERIC Educational Resources Information Center

National Association of College and University Business Officers, Washington, DC. Committee on Governmental Relations.

Information on direct and indirect costs of federally-sponsored research at colleges and universities, the nature of such costs, and the necessity of such costs are presented in this booklet that summarizes relevant federal regulations itemized in Office of Management and Budget Circular A-21, which deals wholly with the costs of research and…

38 CFR 17.260 - Patient care costs to be excluded from direct costs.

Code of Federal Regulations, 2010 CFR

2010-07-01

... VETERANS AFFAIRS MEDICAL Grants for Exchange of Information § 17.260 Patient care costs to be excluded from direct costs. Grant funds for planning or implementing agreements for the exchange of medical information... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Patient care costs to be...

19 CFR 10.197 - Direct costs of processing operations performed in a beneficiary country or countries.

Code of Federal Regulations, 2013 CFR

2013-04-01

... specific merchandise, including fringe benefits, on-the-job training, and the cost of engineering..., engineering, and blueprint costs insofar as they are allocable to the specific merchandise and; (4) Costs of... 19 Customs Duties 1 2013-04-01 2013-04-01 false Direct costs of processing operations performed in...

19 CFR 10.197 - Direct costs of processing operations performed in a beneficiary country or countries.

Code of Federal Regulations, 2014 CFR

2014-04-01

... specific merchandise, including fringe benefits, on-the-job training, and the cost of engineering..., engineering, and blueprint costs insofar as they are allocable to the specific merchandise and; (4) Costs of... 19 Customs Duties 1 2014-04-01 2014-04-01 false Direct costs of processing operations performed in...

Burden of rheumatoid arthritis from a societal perspective: A prevalence-based study on cost of illness for patients with rheumatoid arthritis in China.

PubMed

Hu, Hao; Luan, Luan; Yang, Keqin; Li, Shu-Chuen

2017-02-17

To provide a comprehensive estimation of the economic burden of rheumatoid arthritis (RA) in China, especially for patients from less developed areas, and to explore the cost transferability between regions to assist healthcare decision-making. The study was conducted in south and north China from May 2013 to December 2013. The burden of RA was investigated by interviewing participants with a questionnaire battery containing socio-demographic, cost of illness (COI) and medical treatments. The COI questionnaire captured direct, indirect and intangible costs. Direct costs included hospitalizations, outpatient visits and medications. Indirect costs were estimated using the human capital approach, and intangible costs valued through the willingness-to-pay approach. All cost data were converted to 2013 US dollars by purchasing power parity, and then summarized descriptively and analyzed with mixed models. Questionnaires were administered to 133 RA patients. The average direct costs were $1917.21 ± $2559.06 per patient year, with medications at $1283.89 ± $1898.15 comprising more than 50% of the total. The average indirect costs were $492.88 ± $1739.74 per patient year, while intangible costs were $20396.30 ± $31145.10. There was no significant difference detected between regions. Recent hospitalization was tested as a significant predictor of the direct costs. Age and income were significantly associated with indirect and intangible costs. Besides the substantial burden in terms of direct medical costs and productivity lost, there were notable intangible costs, especially among older patients. This conclusion could be potentially expanded to other provinces in China or even other countries through the adjustments for transferability. © 2017 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.

The costs to the NHS of multiple births after IVF treatment in the UK.

PubMed

Ledger, William L; Anumba, Dilly; Marlow, Neil; Thomas, Christine M; Wilson, Edward C F

2006-01-01

To determine the cost to the NHS resulting from multiple pregnancies arising from IVF treatment in the UK, and to compare those costs with the cost to the NHS due to singleton pregnancies resulting from IVF treatment. A modelling study using data from published literature and cost data from national sources in the public domain, calculating direct costs from the diagnosis of a clinical pregnancy until the end of the first year after birth. Academic Unit of Reproductive and Developmental Medicine. Theoretic core modelling study using data from published literature. The analysis was based on the total annual number of births resulting from an IVF treatment in the UK. Main outcome measures total direct costs to the NHS per IVF singleton, twin or triplet family. Cost of singleton, twin and triplet IVF pregnancies in the UK. Total direct costs to the NHS per IVF twin or triplet family (maternal + infant costs) are substantially higher than per IVF singleton family (singleton: pounds 3313; twin: pounds 9122; and triplet: pounds 32,354). Multiple pregnancies after IVF are associated with 56% of the direct cost of IVF pregnancies, although they represent less than 1/3 of the total annual number of maternities in the UK. Multiple pregnancies after IVF are associated with high direct costs to the NHS. Redirection of money saved by implementation of a mandatory 'two embryo transfer' policy into increased provision of IVF treatment could double the number of NHS-funded IVF treatment cycles at no extra cost. Further savings could be made if a selective 'single embryo transfer' policy were to be adopted.

[Socio-economic costs of road traffic accidents in the Canary Islands, Spain, in 1997].

PubMed

López, J; Serrano, P; Duque, B; Artiles, J

2001-01-01

To evaluate the economic impact in terms of direct and indirect costs road traffic accidents in Canarias Islands (Spain) in 1997. The cost-of-illness method was used. Direct and indirect costs were estimated using prevalence cost, i.e., the costs produced in 1997. Direct costs were divided into health services costs, insurance administration costs and the costs of material damage to the vehicles. Indirect costs were obtained through transformation of physical units into monetary units using the approach of human capital theory. The total cost of road traffic accidents was 39,887.16 million pesetas, equivalent to 24,470 for each inhabitant of the Canary Islands and representing 1.3% of the GNP in this region. The total direct cost was 32,559.67 million pesetas, constituting 82% of the total, which was distributed according to the different concepts analyzed: health service costs: 2,407.40 million pesetas; insurance administration costs, 13,415.89 million pesetas and the costs of material damages to the vehicles: 16,736.38 million pesetas. The total indirect costs was 7,327.49 million pesetas, accounting for 18% of the total costs, which was distributed in premature mortality (6,884.88 million pesetas) and absenteeism from work (442.61 million pesetas). Although this study adopts a conservative approach by omitting costs associated with pain and suffering, permanent disability, and those of at-home care provided by the family, the hight socio-economic cost of road traffic accidents clearly indicates the need for the different administrations of the Canary Islands to collaborate in implementing preventive measures.

Direct Allocation Costing: Informed Management Decisions in a Changing Environment.

ERIC Educational Resources Information Center

Mancini, Cesidio G.; Goeres, Ernest R.

1995-01-01

It is argued that colleges and universities can use direct allocation costing to provide quantitative information needed for decision making. This method of analysis requires institutions to modify traditional ideas of costing, looking to the private sector for examples of accurate costing techniques. (MSE)

The direct and indirect costs of both overweight and obesity: a systematic review

PubMed Central

2014-01-01

Background The rising prevalence of overweight and obesity places a financial burden on health services and on the wider economy. Health service and societal costs of overweight and obesity are typically estimated by top-down approaches which derive population attributable fractions for a range of conditions associated with increased body fat or bottom-up methods based on analyses of cross-sectional or longitudinal datasets. The evidence base of cost of obesity studies is continually expanding, however, the scope of these studies varies widely and a lack of standardised methods limits comparisons nationally and internationally. The objective of this review is to contribute to this knowledge pool by examining direct costs and indirect (lost productivity) costs of both overweight and obesity to provide comparable estimates. This review was undertaken as part of the introductory work for the Irish cost of overweight and obesity study and examines inconsistencies in the methodologies of cost of overweight and obesity studies. Studies which evaluated the direct costs and indirect costs of both overweight and obesity were included. Methods A computerised search of English language studies addressing direct and indirect costs of overweight and obesity in adults between 2001 and 2011 was conducted. Reference lists of reports, articles and earlier reviews were scanned to identify additional studies. Results Five published articles were deemed eligible for inclusion. Despite the limited scope of this review there was considerable heterogeneity in methodological approaches and findings. In the four studies which presented separate estimates for direct and indirect costs of overweight and obesity, the indirect costs were higher, accounting for between 54% and 59% of the estimated total costs. Conclusion A gradient exists between increasing BMI and direct healthcare costs and indirect costs due to reduced productivity and early premature mortality. Determining precise estimates for the increases is mired by the large presence of heterogeneity among the available cost estimation literature. To improve the availability of quality evidence an international consensus on standardised methods for cost of obesity studies is warranted. Analyses of nationally representative cross-sectional datasets augmented by data from primary care are likely to provide the best data for international comparisons. PMID:24739239

Cost effectiveness of a screen-and-treat program for asymptomatic vaginal infections in pregnancy: towards a significant reduction in the costs of prematurity.

PubMed

Kiss, H; Pichler, Eva; Petricevic, L; Husslein, P

2006-08-01

The purpose of this investigation was to determine the cost-saving potential of a simple screen-and-treat program for vaginal infection, which has previously been shown to lead to a reduction of 50% in the rate of preterm births. To determine the potential cost savings, we compared the direct costs of preterm delivery of infants with a birth weight below 1900g with the costs of the screen-and-treat program. We used a cut-off birth weight of 1900g because, in our population, all infants with a birth weight below 1900g were transferred to the neonatal intensive care unit. The direct costs associated with preterm delivery were defined to include the costs of the initial hospitalization of both mother and infant and the costs of outpatient follow-up throughout the first 6 years of life of the former preterm infant. The costs of the screen-and-treat program were defined to include the costs of the screening examination and the resulting costs of antimicrobial treatment and follow-up. All calculations were based on health-economic data obtained in the metropolitan area of Vienna, Austria. The number of preterm infants with a birth weight below 1900g was 12 (0.5%) in the intervention group (N=2058) and 29 (1.3%) in the control group (N=2097). The direct costs per preterm birth were found to amount to EUR (euro) 60262. Overall, the expected total savings in direct costs achieved by the screen-and-treat program and the ensuing 50% reduction in the number preterm births with a birth weight below 1900g amounted to more than euro 11 million. The costs of screening and treatment were found to amount to merely 7% of the direct costs saved as a result of the screen-and-treat program. A simple preterm prevention program, consisting of screening and antimicrobial treatment and follow-up of women with asymptomatic vaginal infection, leads not only to a significant reduction in the rate of preterm births but also to substantial savings in the direct costs associated with prematurity.

The direct and indirect costs of both overweight and obesity: a systematic review.

PubMed

Dee, Anne; Kearns, Karen; O'Neill, Ciaran; Sharp, Linda; Staines, Anthony; O'Dwyer, Victoria; Fitzgerald, Sarah; Perry, Ivan J

2014-04-16

The rising prevalence of overweight and obesity places a financial burden on health services and on the wider economy. Health service and societal costs of overweight and obesity are typically estimated by top-down approaches which derive population attributable fractions for a range of conditions associated with increased body fat or bottom-up methods based on analyses of cross-sectional or longitudinal datasets. The evidence base of cost of obesity studies is continually expanding, however, the scope of these studies varies widely and a lack of standardised methods limits comparisons nationally and internationally. The objective of this review is to contribute to this knowledge pool by examining direct costs and indirect (lost productivity) costs of both overweight and obesity to provide comparable estimates. This review was undertaken as part of the introductory work for the Irish cost of overweight and obesity study and examines inconsistencies in the methodologies of cost of overweight and obesity studies. Studies which evaluated the direct costs and indirect costs of both overweight and obesity were included. A computerised search of English language studies addressing direct and indirect costs of overweight and obesity in adults between 2001 and 2011 was conducted. Reference lists of reports, articles and earlier reviews were scanned to identify additional studies. Five published articles were deemed eligible for inclusion. Despite the limited scope of this review there was considerable heterogeneity in methodological approaches and findings. In the four studies which presented separate estimates for direct and indirect costs of overweight and obesity, the indirect costs were higher, accounting for between 54% and 59% of the estimated total costs. A gradient exists between increasing BMI and direct healthcare costs and indirect costs due to reduced productivity and early premature mortality. Determining precise estimates for the increases is mired by the large presence of heterogeneity among the available cost estimation literature. To improve the availability of quality evidence an international consensus on standardised methods for cost of obesity studies is warranted. Analyses of nationally representative cross-sectional datasets augmented by data from primary care are likely to provide the best data for international comparisons.

The Cost of Morbidities in Very Low Birth Weight Infants

PubMed Central

Johnson, Tricia J.; Patel, Aloka L.; Jegier, Briana; Engstrom, Janet L.; Meier, Paula

2013-01-01

Objective The objective of this study was to determine the association between direct costs for the initial neonatal intensive care unit (NICU) hospitalization and four potentially preventable morbidities in a retrospective cohort of very low birth weight infants (VLBW; <1500g birth weight). Methods The sample included 425 VLBW infants born alive between July 2005 and June 2009 at Rush University Medical Center. Morbidities included brain injury, necrotizing enterocolitis, bronchopulmonary dysplasia, and late onset sepsis. Clinical and economic data were retrieved from the institution’s system-wide data warehouse and cost accounting system. A general linear regression model was fit to determine incremental direct costs associated with each morbidity. Results After controlling for birth weight, gestational age, and socio-demographic characteristics, the presence of brain injury was associated with a $12,048 (p=0.005) increase in direct costs; necrotizing enterocolitis with a $15,440 (p=0.005) increase; bronchopulmonary dysplasia with a $31,565 (p<0.001) increase; and late onset sepsis with a $10,055 (p<0.001) increase in direct costs. The absolute number of morbidities was also associated with significantly higher costs. Conclusions This study provides the first collective estimates of the direct costs during the NICU hospitalization for these four morbidities in VLBW infants. The incremental costs associated with these morbidities were high, and these data can inform future studies evaluating interventions to prevent or reduce these costly morbidities. PMID:22910099

Economic burden of smoking: a systematic review of direct and indirect costs.

PubMed

Rezaei, Satar; Akbari Sari, Ali; Arab, Mohammad; Majdzadeh, Reza; Mohammad Poorasl, Asghar

2016-01-01

Smoking imposes considerably high economic costs both on the healthcare system as well as on a country as a whole. This study was aimed at systematically reviewing the currently published literature on the direct and indirect costs associated with smoking globally. A systematic review was performed on systematically searched articles from PubMed and Scopus databases published during the period 1990 to 2014. A combination of key terms such as "economic burden", "direct cost", "indirect cost", and smoking, tobacco or cigarette" and "productivity lost was used for the search. Original research article published in English with the age of study population greater than 35 years, at least three smoking-related diseases and reported direct or indirect cost of smoking were the inclusion criteria. Fourteen original articles were included in the review. The cost of outpatient care and premature deaths were found to be the most important cost driver of direct and indirect costs respectively. The study showed that smoking-related diseases were responsible for 1.5 - 6.8 % of the national health system expenditures and 0.22-0.88% of GDP of a country. Our review indicated that the costs of smoking are substantial, and smoking have a significant impact on the economy of a country. Policies such as increasing the taxation on a cigarette are required and should be implemented to reduce the economic burden of smoking.

The direct and indirect cost burden of clinically significant and symptomatic uterine fibroids.

PubMed

Lee, David W; Ozminkowski, Ronald J; Carls, Ginger Smith; Wang, Shaohung; Gibson, Teresa B; Stewart, Elizabeth A

2007-05-01

To estimate direct medical costs and indirect (productivity related) for women age 25 to 54 who had clinically significant and symptomatic uterine fibroids (UF). We compared direct medical expenditures among 30,659 women who had clinically significant and symptomatic UF to expenditures among an equal number of matched controls who did not. We also compared indirect costs for a sub-sample of 910 employed women in each group. Regression analyses controlled for demographic and casemix factors. Mean 12-month direct medical costs for women with UF were $11,720 versus $3257 for controls, and mean 12-month indirect costs for women with UF were $11,752 versus $8083 for controls. Differences were statistically significant (P<0.0001). UF is a costly disorder and merits thought as interventions are considered to improve women's health and productivity.

Direct and indirect costs and potential cost savings of laparoscopic adjustable gastric banding among obese patients with diabetes.

PubMed

Finkelstein, Eric A; Allaire, Benjamin T; DiBonaventura, Marco DaCosta; Burgess, Somali M

2011-09-01

To estimate the time to breakeven and 5-year net costs for laparoscopic adjustable gastric banding among obese patients with diabetes taking direct and indirect costs into account. Indirect cost savings were generated by quantifying the cross-sectional relationship between medical expenditures and absenteeism and between medical expenditures and presenteeism (reduced on-the-job productivity) and simulating indirect cost savings based on these multipliers and reductions in direct medical costs available in the literature. Time to breakeven was estimated to be nine quarters with and without the inclusion of indirect costs. After 5 years, net savings increase from $26570 (±$9000) to $34160 (±$10 380) when indirect costs are included. This study presented a novel approach for incorporating indirect costs into cost-benefit analyses. Application to gastric banding revealed that inclusion of indirect costs improves the financial outlook for the procedure. (C)2011The American College of Occupational and Environmental Medicine

[Direct and indirect costs of fractures due to osteoporosis in Austria].

PubMed

Dimai, H-P; Redlich, K; Schneider, H; Siebert, U; Viernstein, H; Mahlich, J

2012-10-01

We examined the financial burden of osteoporosis in Austria. We took both direct and indirect costs into consideration. Direct costs encompass medical costs such as expenses for pharmaceuticals, inpatient and outpatient medical care costs, as well as other medical services (e.g., occupational therapies). Non-medical direct costs include transportation costs and medical devices (e.g., wheel chairs or crutches). Indirect costs refer to costs of productivity losses due to absence of work. Moreover, we included costs for early retirement and opportunity costs of informal care provided by family members. While there exist similar studies for other countries, this is the first comprehensive study for Austria. For our analysis, we combined data of official statistics, expert estimates as well as unique patient surveys that are currently conducted in the course of an international osteoporotic fracture study in Austria. Our estimation of the total annual costs in the year 2008 imposed by osteoporosis in Austria is 707.4 million €. The largest fraction of this amount is incurred by acute hospital treatment. Another significant figure, accounting for 29% of total costs, is the opportunity cost of informal care. The financial burden of osteoporosis in Austria is substantial. Economic evaluations of preventive and therapeutic interventions for the specific context of Austria are needed to inform health policy decision makers. © Georg Thieme Verlag KG Stuttgart · New York.

Tuberculosis and poverty: the contribution of patient costs in sub-Saharan Africa – a systematic review

PubMed Central

2012-01-01

Background Tuberculosis (TB) is known to disproportionately affect the most economically disadvantaged strata of society. Many studies have assessed the association between poverty and TB, but only a few have assessed the direct financial burden TB treatment and care can place on households. Patient costs can be particularly burdensome for TB-affected households in sub-Saharan Africa where poverty levels are high; these costs include the direct costs of medical and non-medical expenditures and the indirect costs of time utilizing healthcare or lost wages. In order to comprehensively assess the existing evidence on the costs that TB patients incur, we undertook a systematic review of the literature. Methods PubMed, EMBASE, Science Citation Index, Social Science Citation Index, EconLit, Dissertation Abstracts, CINAHL, and Sociological Abstracts databases were searched, and 5,114 articles were identified. Articles were included in the final review if they contained a quantitative measure of direct or indirect patient costs for treatment or care for pulmonary TB in sub-Saharan Africa and were published from January 1, 1994 to Dec 31, 2010. Cost data were extracted from each study and converted to 2010 international dollars (I$). Results Thirty articles met all of the inclusion criteria. Twenty-one studies reported both direct and indirect costs; eight studies reported only direct costs; and one study reported only indirect costs. Depending on type of costs, costs varied from less than I$1 to almost I$600 or from a small fraction of mean monthly income for average annual income earners to over 10 times average annual income for income earners in the income-poorest 20% of the population. Out of the eleven types of TB patient costs identified in this review, the costs for hospitalization, medication, transportation, and care in the private sector were largest. Conclusion TB patients and households in sub-Saharan Africa often incurred high costs when utilizing TB treatment and care, both within and outside of Directly Observed Therapy Short-course (DOTS) programs. For many households, TB treatment and care-related costs were considered to be catastrophic because the patient costs incurred commonly amounted to 10% or more of per capita incomes in the countries where the primary studies included in this review were conducted. Our results suggest that policies to decrease direct and indirect TB patient costs are urgently needed to prevent poverty due to TB treatment and care for those affected by the disease. PMID:23150901

Medical Care Costs Associated with Rheumatoid Arthritis in the US: A Systematic Literature Review and Meta-analysis.

PubMed

Hresko, Andrew; Lin, Jay; Solomon, Daniel H

2018-01-05

Rheumatoid arthritis (RA) is a morbid, mortal and costly condition without a cure. Treatments for RA have expanded over the last two decades and direct medical costs may differ by types of treatments. There has not been a systematic literature review since the introduction of new RA treatments, including biologic disease modifying anti-rheumatic drugs (bDMARDs). We conducted a systematic literature review with meta-analysis of direct medical costs associated with RA cared for in the US since the marketing of the first bDMARD. Standard search strategies and sources were used and data were extracted independently by two reviewers. The methods and quality of included studies were assessed. Total direct medical costs as well as RA-specific costs were calculated using random effects meta-analysis. Subgroups of interest included Medicare patients and those using bDMARDs. We found 541 potentially relevant studies and 12 papers met the selection criteria. The quality of studies varied: 1/3 were poor, 1/3 were fair, and 1/3 were good. Total direct medical costs were estimated at $12,509 (95% CI $7,451-21,001) for all RA patients using any treatment regimen and $36,053 (95% CI $32,138-40,445) for bDMARD users. RA-specific costs were $3,723 (95% CI $2,408-5,762) for all RA patients using any treatment regimen and $20,262 (95% CI $17,480-23,487) for bDMARD users. The total and disease-specific direct medical costs of patients with RA is substantial. Among bDMARD users, cost of RA care is over half of all direct medical costs. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Management of End-Stage Ankle Arthritis: Cost-Utility Analysis Using Direct and Indirect Costs.

PubMed

Nwachukwu, Benedict U; McLawhorn, Alexander S; Simon, Matthew S; Hamid, Kamran S; Demetracopoulos, Constantine A; Deland, Jonathan T; Ellis, Scott J

2015-07-15

Total ankle replacement and ankle fusion are costly but clinically effective treatments for ankle arthritis. Prior cost-effectiveness analyses for the management of ankle arthritis have been limited by a lack of consideration of indirect costs and nonoperative management. The purpose of this study was to compare the cost-effectiveness of operative and nonoperative treatments for ankle arthritis with inclusion of direct and indirect costs in the analysis. Markov model analysis was conducted from a health-systems perspective with use of direct costs and from a societal perspective with use of direct and indirect costs. Costs were derived from the 2012 Nationwide Inpatient Sample (NIS) and expressed in 2013 U.S. dollars; effectiveness was expressed in quality-adjusted life years (QALYs). Model transition probabilities were derived from the available literature. The principal outcome measure was the incremental cost-effectiveness ratio (ICER). In the direct-cost analysis for the base case, total ankle replacement was associated with an ICER of $14,500/QALY compared with nonoperative management. When indirect costs were included, total ankle replacement was both more effective and resulted in $5900 and $800 in lifetime cost savings compared with the lifetime costs following nonoperative management and ankle fusion, respectively. At a $100,000/QALY threshold, surgical management of ankle arthritis was preferred for patients younger than ninety-six years and total ankle replacement was increasingly more cost-effective in younger patients. Total ankle replacement, ankle fusion, and nonoperative management were the preferred strategy in 83%, 12%, and 5% of the analyses, respectively; however, our model was sensitive to patient age, the direct costs of total ankle replacement, the failure rate of total ankle replacement, and the probability of arthritis after ankle fusion. Compared with nonoperative treatment for the management of end-stage ankle arthritis, total ankle replacement is preferred over ankle fusion; total ankle replacement is cost-saving when indirect costs are considered and demonstrates increasing cost-effectiveness in younger patients. As indications for and utilization of total ankle replacement increase, continued research is needed to define appropriate subgroups of patients who would likely derive the greatest clinical benefit from that procedure. Economic and decision analysis Level II. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

Direct and indirect cost of myasthenia gravis: A prospective study from a tertiary care teaching hospital in India.

PubMed

Sonkar, Kamlesh Kumar; Bhoi, Sanjeev Kumar; Dubey, Deepanshu; Kalita, Jayantee; Misra, Usha Kant

2017-04-01

Myasthenia gravis (MG) requires lifelong treatment. The cost of management MG is very high in developed countries but there is no information on the cost of management of MG in the developing countries. This study reports the direct and indirect cost and predictors of cost of MG in a tertiary care teaching hospital in India. In a prospective hospital based study, from a tertiary hospital in India 66 consecutive patient during 2014-2015 were included. The age of the patients ranged between 6 and 75years. The severity of MG was assessed by myasthenia gravis foundation association (MGFA) class (MGFA) I-V. The patient data was collected s and their direct cost was calculated from the computerized Hospital information system. The indirect cost was calculated from patient's memory, checking the bills of transportation and wages loss by the patient or the care giver. Total annual cost of MG ranged between INR (4560-532227) with median INR 61390.5 (US$911.64). The median cost of outpatient department (OPD) consultation of 16 patients was INR 20439.9 (US$303.53), of 50 admitted patients was INR 44311.8 (US$658.03) and 21 intensive care unit (ICU) patients was INR 59574.3 (US$ 884.6) and the direct cost of thymectomy was INR 45000 (US$ 668.25). Direct cost was related to indirect cost (r=0.55; p=0.0001). Predictors of patient outcome were severity of MG, ICU admission, and thymectomy. The total median cost for management of myasthenia gravis was INR 61390.5 (4560-532227, US$911.64) per year, and the cost was mainly determined by the severity of MG. Copyright © 2016 Elsevier Ltd. All rights reserved.

A cost minimization analysis of early correction of anterior crossbite-a randomized controlled trial.

PubMed

Wiedel, Anna-Paulina; Norlund, Anders; Petrén, Sofia; Bondemark, Lars

2016-04-01

Economic evaluations provide an important basis for allocation of resources and health services planning. The aim of this study was to evaluate and compare the costs of correcting anterior crossbite with functional shift, using fixed or removable appliances (FA or RA) and to relate the costs to the effects, using cost-minimization analysis. Sixty-two patients with anterior crossbite and functional shift were randomized in blocks of 10. Thirty-one patients were randomized to be treated with brackets and arch wire (FA) and 31 with an acrylic plate (RA). Duration of treatment and number and estimated length of appointments and cancellations were registered. Direct costs (premises, staff salaries, material, and laboratory costs) and indirect costs (the accompanying parents' loss of income while absent from work) were calculated and evaluated with reference to successful outcome alone, to successful and unsuccessful outcomes and to re-treatment when required. Societal costs were defined as the sum of direct and indirect costs. Treatment with FA or RA. There were no significant differences between FA and RA with respect to direct costs for treatment time, but both indirect costs and direct costs for material were significantly lower for FA. The total societal costs were lower for FA than for RA. Costs depend on local factors and should not be directly extrapolated to other locations. The analysis disclosed significant economic benefits for FA over RA. Even when only successful outcomes were assessed, treatment with RA was more expensive. This trial was not registered. The protocol was not published before trial commencement. © The Author 2015. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.

A cost minimization analysis of early correction of anterior crossbite—a randomized controlled trial

PubMed Central

Norlund, Anders; Petrén, Sofia; Bondemark, Lars

2016-01-01

Summary Objective: Economic evaluations provide an important basis for allocation of resources and health services planning. The aim of this study was to evaluate and compare the costs of correcting anterior crossbite with functional shift, using fixed or removable appliances (FA or RA) and to relate the costs to the effects, using cost-minimization analysis. Design, Setting, and Participants: Sixty-two patients with anterior crossbite and functional shift were randomized in blocks of 10. Thirty-one patients were randomized to be treated with brackets and arch wire (FA) and 31 with an acrylic plate (RA). Duration of treatment and number and estimated length of appointments and cancellations were registered. Direct costs (premises, staff salaries, material, and laboratory costs) and indirect costs (the accompanying parents’ loss of income while absent from work) were calculated and evaluated with reference to successful outcome alone, to successful and unsuccessful outcomes and to re-treatment when required. Societal costs were defined as the sum of direct and indirect costs. Interventions: Treatment with FA or RA. Results: There were no significant differences between FA and RA with respect to direct costs for treatment time, but both indirect costs and direct costs for material were significantly lower for FA. The total societal costs were lower for FA than for RA. Limitations: Costs depend on local factors and should not be directly extrapolated to other locations. Conclusion: The analysis disclosed significant economic benefits for FA over RA. Even when only successful outcomes were assessed, treatment with RA was more expensive. Trial registration: This trial was not registered. Protocol: The protocol was not published before trial commencement. PMID:25940585

18 CFR 301.7 - Average System Cost methodology functionalization.

Code of Federal Regulations, 2010 CFR

2010-04-01

... SYSTEM COST METHODOLOGY FOR SALES FROM UTILITIES TO BONNEVILLE POWER ADMINISTRATION UNDER NORTHWEST POWER... functionalization under its Direct Analysis assigns costs, revenues, debits or credits based upon the actual and/or...) Functionalization methods. (1) Direct analysis, if allowed or required by Table 1, assigns costs, revenues, debits...

Understanding the New A-21 Allocation and Documentation Standard.

ERIC Educational Resources Information Center

Sellers, William

1994-01-01

New federal regulations concerning direct cost accounting for college and university research projects are explained. It is concluded that the new standard allows institutions to reduce the signatures required on cost transfers and use reasonable cost allocation methods to simplify distribution of direct costs when research is supported by…

The direct cost of epilepsy in the United States: A systematic review of estimates.

PubMed

Begley, Charles E; Durgin, Tracy L

2015-09-01

To develop estimates of the direct cost of epilepsy in the United States for the general epilepsy population and sub-populations by systematically comparing similarities and differences in types of estimates and estimation methods from recently published studies. Papers published since 1995 were identified by systematic literature search. Information on types of estimates, study designs, data sources, types of epilepsy, and estimation methods was extracted from each study. Annual per person cost estimates from methodologically similar studies were identified, converted to 2013 U.S. dollars, and compared. From 4,104 publications discovered in the literature search, 21 were selected for review. Three were added that were published after the search. Eighteen were identified that reported estimates of average annual direct costs for the general epilepsy population in the United States. For general epilepsy populations (comprising all clinically defined subgroups), total direct healthcare costs per person ranged from $10,192 to $47,862 and epilepsy-specific costs ranged from $1,022 to $19,749. Four recent studies using claims data from large general populations yielded relatively similar epilepsy-specific annual cost estimates ranging from $8,412 to $11,354. Although more difficult to compare, studies examining direct cost differences for epilepsy sub-populations indicated a consistent pattern of markedly higher costs for those with uncontrolled or refractory epilepsy, and for those with comorbidities. This systematic review found that various approaches have been used to estimate the direct costs of epilepsy in the United States. However, recent studies using large claims databases and similar methods allow estimation of the direct cost burden of epilepsy for the general disease population, and show that it is greater for some patient subgroups. Additional research is needed to further understand the broader economic burden of epilepsy and how it varies across subpopulations. Wiley Periodicals, Inc. © 2015 International League Against Epilepsy.

26 CFR 1.925(b)-1T - Temporary regulations; marginal costing rules.

Code of Federal Regulations, 2010 CFR

2010-04-01

... rules—(1) In general. Marginal costing is a method under which only direct production costs of producing... combined taxable income of the FSC and its related supplier under section 925(a)(2). The costs to be taken into account are the related supplier's direct material and labor costs (as defined in § 1.471-11(b)(2...

Treatment costs and indirect costs of cluster headache: A health economics analysis.

PubMed

Gaul, Charly; Finken, Julia; Biermann, Janine; Mostardt, Sarah; Diener, Hans-Christoph; Müller, Oliver; Wasem, Jürgen; Neumann, Anja

2011-12-01

Cluster headache (CH) is the most frequent trigemino-autonomic cephalgia. CH can manifest as episodic (eCH) or chronic cluster headache (cCH) causing significant burden of disease and requiring attack therapy and prophylactic treatment. Treatment costs (direct costs) due to healthcare utilisation, as well as costs caused by disability and reduction in earning capacity (indirect costs), were obtained using a questionnaire in CH patients treated in a tertiary headache centre based at the University Duisburg-Essen over a 6-month period. A total 179 patients (72 cCH, 107 eCH) were included. Mean attack frequency was 3.5 ± 2.5 per day. Mean direct and indirect costs for one person were €5963 in the 6-month period. Direct costs were positively correlated with attack frequency (r = 0.467, p < 0.001). Burden of disease measured with HIT-6 showed a significant correlation with attack frequency (r = 0.467, p < 0.001). Twenty-four (13.4%) of the participants were disabled and not able to work. CH leads to major socioeconomic impact on patients as well as society due to direct healthcare costs and indirect costs caused by loss of working capacity.

Endogenous patient responses and the consistency principle in cost-effectiveness analysis.

PubMed

Liu, Liqun; Rettenmaier, Andrew J; Saving, Thomas R

2012-01-01

In addition to incurring direct treatment costs and generating direct health benefits that improve longevity and/or health-related quality of life, medical interventions often have further or "unrelated" financial and health impacts, raising the issue of what costs and effects should be included in calculating the cost-effectiveness ratio of an intervention. The "consistency principle" in medical cost-effectiveness analysis (CEA) requires that one include both the cost and the utility benefit of a change (in medical expenditures, consumption, or leisure) caused by an intervention or neither of them. By distinguishing between exogenous changes directly brought about by an intervention and endogenous patient responses to the exogenous changes, and within a lifetime utility maximization framework, this article addresses 2 questions related to the consistency principle: 1) how to choose among alternative internally consistent exclusion/inclusion rules, and 2) what to do with survival consumption costs and earnings. It finds that, for an endogenous change, excluding or including both the cost and the utility benefit of the change does not alter cost-effectiveness results. Further, in agreement with the consistency principle, welfare maximization implies that consumption costs and earnings during the extended life directly caused by an intervention should be included in CEA.

Process-based costing.

PubMed

Lee, Robert H; Bott, Marjorie J; Forbes, Sarah; Redford, Linda; Swagerty, Daniel L; Taunton, Roma Lee

2003-01-01

Understanding how quality improvement affects costs is important. Unfortunately, low-cost, reliable ways of measuring direct costs are scarce. This article builds on the principles of process improvement to develop a costing strategy that meets both criteria. Process-based costing has 4 steps: developing a flowchart, estimating resource use, valuing resources, and calculating direct costs. To illustrate the technique, this article uses it to cost the care planning process in 3 long-term care facilities. We conclude that process-based costing is easy to implement; generates reliable, valid data; and allows nursing managers to assess the costs of new or modified processes.

Does pharmacist-supervised intervention through pharmaceutical care program influence direct healthcare cost burden of newly diagnosed diabetics in a tertiary care teaching hospital in Nepal: a non-clinical randomised controlled trial approach.

PubMed

Upadhyay, Dinesh Kumar; Ibrahim, Mohamed Izham Mohamed; Mishra, Pranaya; Alurkar, Vijay M; Ansari, Mukhtar

2016-02-29

Cost is a vital component for people with chronic diseases as treatment is expected to be long or even lifelong in some diseases. Pharmacist contributions in decreasing the healthcare cost burden of chronic patients are not well described due to lack of sufficient evidences worldwide. In developing countries like Nepal, the estimation of direct healthcare cost burden among newly diagnosed diabetics is still a challenge for healthcare professionals, and pharmacist role in patient care is still theoretical and practically non-existent. This study reports the impact of pharmacist-supervised intervention through pharmaceutical care program on direct healthcare costs burden of newly diagnosed diabetics in Nepal through a non-clinical randomised controlled trial approach. An interventional, pre-post non-clinical randomised controlled study was conducted among randomly distributed 162 [control (n = 54), test 1 (n = 54) and test 2 (n = 54) groups] newly diagnosed diabetics by a consecutive sampling method for 18 months. Direct healthcare costs (direct medical and non-medical costs) from patients perspective was estimated by 'bottom up' approach to identify their out-of-pocket expenses (1USD = NPR 73.38) before and after intervention at the baseline, 3, 6, 9 and 12 months follow-ups. Test groups' patients were nourished with pharmaceutical care intervention while control group patients only received care from physician/nurses. Non-parametric tests i.e. Friedman test, Mann-Whitney U test and Wilcoxon signed rank test were used to find the differences in direct healthcare costs among the groups before and after the intervention (p ≤ 0.05). Friedman test identified significant differences in direct healthcare cost of test 1 (p < 0.001) and test 2 (p < 0.001) groups patients. However, Mann-Whitney U test justified significant differences in direct healthcare cost between control group and test 1 group, and test 2 group patients at 6-months (p = 0.009, p = 0.010 respectively), 9-months (p = 0.005, p = 0.001 respectively) and 12-months (p < 0.001, p < 0.001 respectively). Pharmacist supervised intervention through pharmaceutical care program significantly decreased direct healthcare costs of diabetics in test groups compared to control group and hence describes pharmacist's contribution in minimizing direct healthcare cost burden of patients.

Direct, indirect, and intangible costs after severe trauma up to occupational reintegration - an empirical analysis of 113 seriously injured patients.

PubMed

Anders, Benjamin; Ommen, Oliver; Pfaff, Holger; Lüngen, Markus; Lefering, Rolf; Thüm, Sonja; Janssen, Christian

2013-01-01

Although seriously injured patients account for a high medical as well as socioeconomic burden of disease in the German health care system, there are only very few data describing the costs that arise between the days of accident and occupational reintegration. With this study, a comprehensive cost model is developed that describes the direct, indirect and intangible costs of an accident and their relationship with socioeconomic background of the patients. This study included 113 patients who each had at least two injuries and a total Abbreviated Injury Scale (AIS) greater than or equal to five. We calculated the direct, indirect and intangible costs that arose between the day of the accident and occupational reintegration. Direct costs were the treatment costs at hospitals and rehabilitation centers. Indirect costs were calculated using the human capital approach on the basis of the work days lost due to injury, including sickness allowance benefits. Intangible costs were assessed using the Short Form Survey (SF-36) and represented in non-monetary form. Following univariate analysis, a bivariate analysis of the above costs and the patients' sociodemographic and socioeconomic characteristics was performed. At an average Injury Severity Score (ISS) of 19.2, the average direct cost per patient were €35,661. An average of 185.2 work days were lost, resulting in indirect costs of €17,205. The resulting total costs per patient were €50,431. A bivariate analysis showed that the costs for hospital treatment were 58% higher in patients who graduated from lower secondary school [Hauptschule] (ISS 19.5) than in patients with qualification for university admission [Abitur] (ISS 19.4). The direct costs of treating trauma patients at the hospital appear to be lower in patients with a higher level of education than in the comparison group with a lower educational level. Because of missing data, the calculated indirect costs can merely represent a general trend, so that the bivariate analysis can only be seen as a starting point for further studies.

Direct, indirect, and intangible costs after severe trauma up to occupational reintegration – an empirical analysis of 113 seriously injured patients

PubMed Central

Anders, Benjamin; Ommen, Oliver; Pfaff, Holger; Lüngen, Markus; Lefering, Rolf; Thüm, Sonja; Janssen, Christian

2013-01-01

Aim: Although seriously injured patients account for a high medical as well as socioeconomic burden of disease in the German health care system, there are only very few data describing the costs that arise between the days of accident and occupational reintegration. With this study, a comprehensive cost model is developed that describes the direct, indirect and intangible costs of an accident and their relationship with socioeconomic background of the patients. Methods: This study included 113 patients who each had at least two injuries and a total Abbreviated Injury Scale (AIS) greater than or equal to five. We calculated the direct, indirect and intangible costs that arose between the day of the accident and occupational reintegration. Direct costs were the treatment costs at hospitals and rehabilitation centers. Indirect costs were calculated using the human capital approach on the basis of the work days lost due to injury, including sickness allowance benefits. Intangible costs were assessed using the Short Form Survey (SF-36) and represented in non-monetary form. Following univariate analysis, a bivariate analysis of the above costs and the patients’ sociodemographic and socioeconomic characteristics was performed. Results: At an average Injury Severity Score (ISS) of 19.2, the average direct cost per patient were €35,661. An average of 185.2 work days were lost, resulting in indirect costs of €17,205. The resulting total costs per patient were €50,431. A bivariate analysis showed that the costs for hospital treatment were 58% higher in patients who graduated from lower secondary school [Hauptschule] (ISS 19.5) than in patients with qualification for university admission [Abitur] (ISS 19.4). Conclusions: The direct costs of treating trauma patients at the hospital appear to be lower in patients with a higher level of education than in the comparison group with a lower educational level. Because of missing data, the calculated indirect costs can merely represent a general trend, so that the bivariate analysis can only be seen as a starting point for further studies. PMID:23798979

Neurologist adherence to clinical practice guidelines and costs in patients with newly diagnosed and chronic epilepsy in Germany.

PubMed

Strzelczyk, Adam; Bergmann, Arnfin; Biermann, Valeria; Braune, Stefan; Dieterle, Lienhard; Forth, Bernhard; Kortland, Lena-Marie; Lang, Michael; Peckmann, Thomas; Schöffski, Oliver; Sigel, Karl-Otto; Rosenow, Felix

2016-11-01

The aim of this study was to evaluate physician adherence to the German Neurological Society guidelines of 2008 regarding initial monotherapy and to determine the cost-of-illness in epilepsy. This was an observational cohort study using health data routinely collected at 55 outpatient neurology practices throughout Germany (NeuroTransData network). Data on socioeconomic status, course of epilepsy, anticonvulsive treatment, and direct and indirect costs were recorded using practice software-based questionnaires. One thousand five hundred eighty-four patients with epilepsy (785 male (49.6%); mean age: 51.3±18.1years) were enrolled, of whom 507 were newly diagnosed. Initial monotherapy was started according to authorization status in 85.9%, with nonenzyme-inducing drugs in 94.3% of all AEDs. Drugs of first choice by guideline recommendations were used in 66.5%. Total annual direct costs in the first year amounted to €2194 (SD: €4273; range: €55-43,896) per patient, with hospitalization (59% of total direct costs) and anticonvulsants (30%) as the main cost factors. Annual total direct costs decreased by 29% to €1572 in the second year, mainly because of a 59% decrease in hospitalization costs. The use of first choice AEDs did not influence costs. Chronic epilepsy was present in 1077 patients, and total annual direct costs amounted to €1847 per patient, with anticonvulsants (51.0%) and hospitalization (41.0%) as the main cost factors. Potential cost-driving factors in these patients were active epilepsy and focal epilepsy syndrome. This study shows excellent physician adherence to guidelines regarding initial monotherapy in adults with epilepsy. Newly diagnosed patients show higher total direct and hospital costs in the first year upon diagnosis, but these are not influenced by adherence to treatment guidelines. Copyright © 2016 Elsevier Inc. All rights reserved.

Societal burden of cluster headache in the United States: a descriptive economic analysis.

PubMed

Ford, Janet H; Nero, Damion; Kim, Gilwan; Chu, Bong Chul; Fowler, Robert; Ahl, Jonna; Martinez, James M

2018-01-01

To estimate direct and indirect costs in patients with a diagnosis of cluster headache in the US. Adult patients (18-64 years of age) enrolled in the Marketscan Commercial and Medicare Databases with ≥2 non-diagnostic outpatient (≥30 days apart between the two outpatient claims) or ≥1 inpatient diagnoses of cluster headache (ICD-9-CM code 339.00, 339.01, or 339.02) between January 1, 2009 and June 30, 2014, were included in the analyses. Patients had ≥6 months of continuous enrollment with medical and pharmacy coverage before and after the index date (first cluster headache diagnosis). Three outcomes were evaluated: (1) healthcare resource utilization, (2) direct healthcare costs, and (3) indirect costs associated with work days lost due to absenteeism and short-term disability. Direct costs included costs of all-cause and cluster headache-related outpatient, inpatient hospitalization, surgery, and pharmacy claims. Indirect costs were based on an average daily wage, which was estimated from the 2014 US Bureau of Labor Statistics and inflated to 2015 dollars. There were 9,328 patients with cluster headache claims included in the analysis. Cluster headache-related total direct costs (mean [standard deviation]) were $3,132 [$13,396] per patient per year (PPPY), accounting for 17.8% of the all-cause total direct cost. Cluster headache-related inpatient hospitalizations ($1,604) and pharmacy ($809) together ($2,413) contributed over 75% of the cluster headache-related direct healthcare cost. There were three sub-groups of patients with claims associated with indirect costs that included absenteeism, short-term disability, and absenteeism + short-term disability. Indirect costs PPPY were $4,928 [$4,860] for absenteeism, $803 [$2,621] for short-term disability, and $3,374 [$3,198] for absenteeism + disability. Patients with cluster headache have high healthcare costs that are associated with inpatient admissions and pharmacy fulfillments, and high indirect costs associated with absenteeism and short-term disability.

The health economics of ankle and foot sprains and fractures: A systematic review of English-language published papers. Part 2: The direct and indirect costs of injury.

PubMed

Bielska, Iwona A; Wang, Xiang; Lee, Raymond; Johnson, Ana P

2017-07-20

Ankle and foot sprains and fractures are prevalent injuries, which may result in substantial physical and economic consequences for the patient and place a financial burden on the health care system. Therefore, the objectives of this paper are to examine the direct and indirect costs of treating ankle and foot injuries (sprains, dislocations, fractures), as well as to provide an overview of the outcomes of full economic analyses of different treatment strategies. A systematic review was carried out among seven databases to identify English language publications on the health economics of ankle and foot injury treatment published between 1980 and 2014. The direct and indirect costs were abstracted by two independent reviewers. All costs were adjusted for inflation and reported in 2016 US dollars (USD). Among 2047 identified studies, 32 were selected for analysis. The direct costs of ankle sprain management ranged from $292 to $2268 per patient (2016 USD), depending on the injury severity and treatment strategy. The direct costs of managing ankle fractures were higher ($1908-$19,555). Foot fracture treatment had similar direct costs ranging from $998 to $21,801. The economic evaluations were conducted from the societal or payer's perspectives. The costs of treating ankle and foot sprains and fractures varied among the studies, mostly due to differences in injury type and study characteristics, which impacted the ability of directly comparing the financial burden of treatment. Nonetheless, the review showed that the costs experienced by the patient and the health care system increased with injury complexity. Copyright © 2017 Elsevier Ltd. All rights reserved.

The direct health care costs of eating disorders among hospitalized patients: A population-based study.

PubMed

de Oliveira, Claire; Colton, Patricia; Cheng, Joyce; Olmsted, Marion; Kurdyak, Paul

2017-12-01

To estimate the direct health care costs of eating disorders in Ontario, Canada, in 2012, using a prevalence-based cost-of-illness approach. We selected a population-based sample of all patients eligible for public health care insurance over the age of 4 with a hospitalization for an eating disorder at any point since 1988. We estimated total and mean direct net costs per patient in 2012, from the third public payer perspective, by sex, age group, and health service type. In 2012, there were 6,326 patients ever hospitalized for an eating disorder. They had a mean age of 31 at hospitalization, were mostly female (93%), and generally from high-income, urban neighborhoods. Direct total costs were just under $63 million CAD; direct net costs were roughly $48 million CAD. Mean net costs per patient were higher for females than males ($7,743.40 and $6,340.50, respectively), and higher for patients under 20 and patients 65+ ($17,961.50 and $14,953.90, respectively). The main cost drivers were psychiatric hospitalizations and physician visits, although this varied by age group. For younger patients, net costs were mainly because of psychiatric hospitalizations, while for older patients net costs were mainly because of psychiatric and nonpsychiatric hospitalizations, and other care. The cost of eating disorders is substantial and varies by sex and age group. Our findings suggest that, from a health care utilization/cost perspective, the effect of eating disorders is likely to persist over the lifespan. © 2017 Wiley Periodicals, Inc.

Cost and quality trends in direct contracting arrangements.

PubMed

Lyles, Alan; Weiner, Jonathan P; Shore, Andrew D; Christianson, Jon; Solberg, Leif I; Drury, Patricia

2002-01-01

This paper presents the first empirical analysis of a 1997 initiative of the Buyers Health Care Action Group (BHCAG) known as Choice Plus. This initiative entailed direct contracts with provider-controlled delivery systems; annual care system bidding; public reports of consumer satisfaction and quality; uniform benefits; and risk-adjusted payment. After case-mix adjustment, hospital costs decreased, ambulatory care costs rose modestly, and pharmacy costs increased substantially. Process-oriented quality indicators were stable or improved. The BHCAG employer-to-provider direct contracting and consumer choice model appeared to perform reasonably well in containing costs, without measurable adverse effects on quality.

Direct, indirect and intangible costs of acute hand and wrist injuries: A systematic review.

PubMed

Robinson, Luke Steven; Sarkies, Mitchell; Brown, Ted; O'Brien, Lisa

2016-12-01

Injuries sustained to the hand and wrist are common, accounting for 20% of all emergency presentations. The economic burden of these injuries, comprised of direct (medical expenses incurred), indirect (value of lost productivity) and intangible costs, can be extensive and rise sharply with the increase of severity. This paper systematically reviews cost-of-illness studies and health economic evaluations of acute hand and wrist injuries with a particular focus on direct, indirect and intangible costs. It aims to provide economic cost estimates of burden and discuss the cost components used in international literature. A search of cost-of-illness studies and health economic evaluations of acute hand and wrist injuries in various databases was conducted. Data extracted for each included study were: design, population, intervention, and estimates and measurement methodologies of direct, indirect and intangible costs. Reported costs were converted into US-dollars using historical exchange rates and then adjusted into 2015 US-dollars using an inflation calculator RESULTS: The search yielded 764 studies, of which 21 met the inclusion criteria. Twelve studies were cost-of-illness studies, and seven were health economic evaluations. The methodology used to derive direct, indirect and intangible costs differed markedly across all studies. Indirect costs represented a large portion of total cost in both cost-of-illness studies [64.5% (IQR 50.75-88.25)] and health economic evaluations [68% (IQR 49.25-73.5)]. The median total cost per case of all injury types was US$6951 (IQR $3357-$22,274) for cost-of-illness studies and US$8297 (IQR $3858-$33,939) for health economic evaluations. Few studies reported intangible cost data associated with acute hand and wrist injuries. Several studies have attempted to estimate the direct, indirect and intangible costs associated with acute hand and wrist injuries in various countries using heterogeneous methodologies. Estimates of the economic costs of different acute hand and wrist injuries varied greatly depending on the study methodology, however, by any standards, these injuries should be considered a substantial burden on the individual and society. Further research using standardised methodologies could provide guidance to relevant policy makers on how to best distribute limited resources by identifying the major disorders and exposures resulting in the largest burden. Copyright © 2016 Elsevier Ltd. All rights reserved.

Cost-of-illness studies.

PubMed

Oderda, Gary M

2003-01-01

Cost-of-illness studies measure the overall economic impact of a disease on society. Such studies are important in setting public health priorities and for economic evaluation of new treatments. These studies should take the societal perspective and include both direct and indirect costs. Often indirect costs exceed direct costs. Comparison of cost-of-illness studies from different countries is difficult because of differences in population, currency, the way health care is provided, and other social and political factors.

Costs and quality of life in multiple sclerosis patients with spasticity.

PubMed

Svensson, J; Borg, S; Nilsson, P

2014-01-01

The resource use and health-related quality of life (HRQoL) of patients with multiple sclerosis (MS) spasticity are not well known. The purpose of this study was to obtain estimates of resource utilization, costs, and HRQoL, for patients with different levels of MS spasticity in southern Sweden. Cross-sectional data on spasticity severity (using a Numerical Rating Scale, NRS), resource use and HRQoL (using EQ-5D) were collected using a patient questionnaire and chart review. Patients were recruited through a clinic in southern Sweden. The study reviews direct medical, direct non-medical and indirect costs. Total costs were estimated to €114,293 per patient and year. Direct medical costs (€7898) accounted for 7% of total costs. Direct non-medical costs (€68,509) accounted for 60% of total costs. Total costs increased with severity of spasticity: for patients with severe spasticity, the total cost was 2.4 times greater than those for patients with mild spasticity. HRQoL decreased as spasticity increases. The results of this study show that MS spasticity is associated with a substantial burden on society in terms of costs and HRQoL. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Direct medical cost of overweight and obesity in the United States: a quantitative systematic review

PubMed Central

Tsai, Adam Gilden; Williamson, David F.; Glick, Henry A.

2010-01-01

Objectives To estimate per-person and aggregate direct medical costs of overweight and obesity and to examine the effect of study design factors. Methods PubMed (1968–2009), EconLit (1969–2009), and Business Source Premier (1995–2009) were searched for original studies. Results were standardized to compute the incremental cost per overweight person and per obese person, and to compute the national aggregate cost. Results A total of 33 U.S. studies met review criteria. Among the 4 highest quality studies, the 2008 per-person direct medical cost of overweight was $266 and of obesity was $1723. The aggregate national cost of overweight and obesity combined was $113.9 billion. Study design factors that affected cost estimate included: use of national samples versus more selected populations; age groups examined; inclusion of all medical costs versus obesity-related costs only; and BMI cutoffs for defining overweight and obesity. Conclusions Depending on the source of total national health care expenditures used, the direct medical cost of overweight and obesity combined is approximately 5.0% to 10% of U.S. health care spending. Future studies should include nationally representative samples, evaluate adults of all ages, report all medical costs, and use standard BMI cutoffs. PMID:20059703

The importance of ecological costs for the evolution of plant defense against herbivory.

PubMed

van Velzen, Ellen; Etienne, Rampal S

2015-05-07

Plant defense against herbivory comes at a cost, which can be either direct (reducing resources available for growth and reproduction) or indirect (through reducing ecological performance, for example intraspecific competitiveness). While direct costs have been well studied in theoretical models, ecological costs have received almost no attention. In this study we compare models with a direct trade-off (reduced growth rate) to models with an ecological trade-off (reduced competitive ability), using a combination of adaptive dynamics and simulations. In addition, we study the dependence of the level of defense that can evolve on the type of defense (directly by reducing consumption, or indirectly by inducing herbivore mortality (toxicity)), and on the type of herbivore against which the plant is defending itself (generalists or specialists). We find three major results: First, for both direct and ecological costs, defense only evolves if the benefit to the plant is direct (through reducing consumption). Second, the type of cost has a major effect on the evolutionary dynamics: direct costs always lead to a single optimal strategy against herbivores, but ecological costs can lead to branching and the coexistence of non-defending and defending plants; however, coexistence is only possible when defending against generalist herbivores. Finally, we find that fast-growing plants invest less than slow-growing plants when defending against generalist herbivores, as predicted by the Resource Availability Hypothesis, but invest more than slow-growing plants when defending against specialists. Our results clearly show that assumptions about ecological interactions are crucial for understanding the evolution of defense against herbivores. Copyright © 2015 Elsevier Ltd. All rights reserved.

Excess cost burden of diabetes in Southern India: a clinic-based, comparative cost-of-illness study.

PubMed

Sharma, K M; Ranjani, H; Zabetian, A; Datta, M; Deepa, M; Moses, C R Anand; Narayan, K M V; Mohan, V; Ali, M K

2016-01-01

There are few data on excess direct and indirect costs of diabetes in India and limited data on rural costs of diabetes. We aimed to further explore these aspects of diabetes burdens using a clinic-based, comparative cost-of-illness study. Persons with diabetes ( n  = 606) were recruited from government, private, and rural clinics and compared to persons without diabetes matched for age, sex, and socioeconomic status ( n  = 356). We used interviewer-administered questionnaires to estimate direct costs (outpatient, inpatient, medication, laboratory, and procedures) and indirect costs [absence from (absenteeism) or low productivity at (presenteeism) work]. Excess costs were calculated as the difference between costs reported by persons with and without diabetes and compared across settings. Regression analyses were used to separately identify factors associated with total direct and indirect costs. Annual excess direct costs were highest amongst private clinic attendees (INR 19 552, US$425) and lowest amongst government clinic attendees (INR 1204, US$26.17). Private clinic attendees had the lowest excess absenteeism (2.36 work days/year) and highest presenteeism (0.06 work days/year) due to diabetes. Government clinic attendees reported the highest absenteeism (7.48 work days/year) and lowest presenteeism (-0.31 work days/year). Ten additional years of diabetes duration was associated with 11% higher direct costs ( p  < 0.001). Older age ( p  = 0.02) and longer duration of diabetes ( p  < 0.001) were associated with higher total lost work days. Excess health expenditures and lost productivity amongst individuals with diabetes are substantial and different across care settings. Innovative solutions are needed to cope with diabetes and its associated cost burdens in India.

The costs of social anxiety disorder: the role of symptom severity and comorbidities.

PubMed

Stuhldreher, Nina; Leibing, Eric; Leichsenring, Falk; Beutel, Manfred E; Herpertz, Stephan; Hoyer, Juergen; Konnopka, Alexander; Salzer, Simone; Strauss, Bernhard; Wiltink, Joerg; König, Hans-Helmut

2014-08-01

Social anxiety disorder (SAD) is associated with low direct costs compared to other anxiety disorders while indirect costs tend to be high. Mental comorbidities have been identified to increase costs, but the role of symptom severity is still vague. The objective of this study was to determine the costs of SAD, and to explore the impact of symptoms and comorbidities on direct and indirect costs. Baseline data, collected within the SOPHO-NET multi-centre treatment study (N=495), were used. Costs were calculated based on health care utilization and lost productivity. Symptom severity was measured with the Liebowitz-Social-Anxiety-Scale; comorbidities were included as covariates. Total 6-month costs were accrued to €4802; 23% being direct costs. While there was no significant association with SAD symptom severity for direct costs, costs of absenteeism increased with symptom severity in those with costs >0; comorbid affective disorders and eating disorders had an additional effect. Self-rated productivity was lower with more pronounced symptoms even after controlling for comorbidities. As the study was based on a clinical sample total costs were considered, rather than net costs of SAD and no population costs could be calculated. The burden associated with lost productivity was considerable while costs of healthcare utilization were rather low as most patients had not sought for treatment before. Efforts to identify patients with SAD earlier and to provide adequate treatment should be further increased. Mental comorbidities should be addressed as well, since they account for a large part of indirect costs associated with SAD. Copyright © 2014 Elsevier B.V. All rights reserved.

Assessing Tax Form Distribution Costs: A Proposed Method for Computing the Dollar Value of Tax Form Distribution in a Public Library.

ERIC Educational Resources Information Center

Casey, James B.

1998-01-01

Explains how a public library can compute the actual cost of distributing tax forms to the public by listing all direct and indirect costs and demonstrating the formulae and necessary computations. Supplies directions for calculating costs involved for all levels of staff as well as associated public relations efforts, space, and utility costs.…

49 CFR 360.5 - Updating user fees.

Code of Federal Regulations, 2010 CFR

2010-10-01

... updating the cost components comprising the fee. Cost components shall be updated as follows: (1) Direct... determined by the cost study in Regulations Governing Fees For Service, 1 I.C.C. 2d 60 (1984), or subsequent... by total office costs for the office directly associated with user fee activity. Actual updating of...

19 CFR 10.814 - Direct costs of processing operations.

Code of Federal Regulations, 2014 CFR

2014-04-01

... manufacture of the specific good, including fringe benefits, on-the-job training, and the costs of engineering..., design, engineering, and blueprint costs, to the extent that they are allocable to the specific good; (4... 19 Customs Duties 1 2014-04-01 2014-04-01 false Direct costs of processing operations. 10.814...

19 CFR 10.774 - Direct costs of processing operations.

Code of Federal Regulations, 2014 CFR

2014-04-01

... manufacture of the specific good, including fringe benefits, on-the-job training, and the costs of engineering..., design, engineering, and blueprint costs, to the extent that they are allocable to the specific good; (4... 19 Customs Duties 1 2014-04-01 2014-04-01 false Direct costs of processing operations. 10.774...

The economic cost of Alzheimer's disease: Family or public health burden?

PubMed Central

Castro, Diego M.; Dillon, Carol; Machnicki, Gerardo; Allegri, Ricardo F.

2010-01-01

Alzheimer’s disease (AD) patients suffer progressive cognitive, behavioral and functional impairment which result in a heavy burden to patients, families, and the public-health system. AD entails both direct and indirect costs. Indirect costs (such as loss or reduction of income by the patient or family members) are the most important costs in early and community-dwelling AD patients. Direct costs (such as medical treatment or social services) increase when the disorder progresses, and the patient is institutionalized or a formal caregiver is required. Drug therapies represent an increase in direct cost but can reduce some other direct or indirect costs involved. Several studies have projected overall savings to society when using drug therapies and all relevant cost are considered, where results depend on specific patient and care setting characteristics. Dementia should be the focus of analysis when public health policies are being devised. South American countries should strengthen their policy and planning capabilities by gathering more local evidence about the burden of AD and how it can be shaped by treatment options. PMID:29213697

The economic cost of Alzheimer's disease: Family or public health burden?

PubMed

Castro, Diego M; Dillon, Carol; Machnicki, Gerardo; Allegri, Ricardo F

2010-01-01

Alzheimer's disease (AD) patients suffer progressive cognitive, behavioral and functional impairment which result in a heavy burden to patients, families, and the public-health system. AD entails both direct and indirect costs. Indirect costs (such as loss or reduction of income by the patient or family members) are the most important costs in early and community-dwelling AD patients. Direct costs (such as medical treatment or social services) increase when the disorder progresses, and the patient is institutionalized or a formal caregiver is required. Drug therapies represent an increase in direct cost but can reduce some other direct or indirect costs involved. Several studies have projected overall savings to society when using drug therapies and all relevant cost are considered, where results depend on specific patient and care setting characteristics. Dementia should be the focus of analysis when public health policies are being devised. South American countries should strengthen their policy and planning capabilities by gathering more local evidence about the burden of AD and how it can be shaped by treatment options.

The costs of breast cancer in a Mexican public health institution

PubMed Central

Gómez-Rico, Jacobo Alejandro; Altagracia-Martínez, Marina; Kravzov-Jinich, Jaime; Cárdenas-Elizalde, Rosario; Rubio-Poo, Consuelo

2008-01-01

Breast cancer (BC) is the second leading cause of death as a result of neoplasia in Mexico. This study aimed to identify the direct and indirect costs of treating female outpatients diagnosed with BC at a Mexican public hospital. A cross-sectional, observational, analytical study was conducted. A total of 506 medical records were analyzed and 102 were included in the cost analysis. The micro-costing process was used to estimate treatment costs. A 17-item questionnaire was used to obtain information on direct and indirect costs. Of the 102 women with BC included in the study, 92.2% (94) were at Stage II, and only 7.8% at Stage I. Total direct costs over six months for the 82 women who had modified radical mastectomy (MRM) surgury were US$733,821.15. Total direct costs for the 15 patients with conservative surgery (CS) were US$138,190.39. We found that the total economic burden in the study population was much higher for patients with MRM than for patients with CS. PMID:22312199

Cost analysis in support of minimum energy standards for clothes washers and dryers

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1979-02-02

The results of the cost analysis of energy conservation design options for laundry products are presented. The analysis was conducted using two approaches. The first, is directed toward the development of industrial engineering cost estimates of each energy conservation option. This approach results in the estimation of manufacturers costs. The second approach is directed toward determining the market price differential of energy conservation features. The results of this approach are shown. The market cost represents the cost to the consumer. It is the final cost, and therefore includes distribution costs as well as manufacturing costs.

The cost of care of systemic lupus erythematosus (SLE) in the UK: annual direct costs for adult SLE patients with active autoantibody-positive disease.

PubMed

Khamashta, M A; Bruce, I N; Gordon, C; Isenberg, D A; Ateka-Barrutia, O; Gayed, M; Donatti, C; Guillermin, A-L; Foo, J; Perna, A

2014-03-01

The aim of the Systemic LUpus Erythematosus Cost of Care In Europe (LUCIE) study was to evaluate the annual direct medical costs of managing adults with active autoantibody-positive disease on medication for SLE in secondary care. This paper presents the UK analyses only. A cost-of-illness study was conducted from the perspective of the National Health Service. Health resource utilization data were retrieved over a two-year period from four centres in England and unit cost data were taken from published sources. At baseline, 86 patients were included, 38 (44.2%) had severe SLE and 48 (55.8%) had non-severe SLE. The mean (SD) SELENA-SLEDAI score was 7.7 (5.7). The mean (SD) annual direct medical cost of was estimated at £3231 (£2333) per patient and was 2.2 times higher in patients with severe SLE compared with patients with non-severe SLE (p < 0.001). Multivariate model analyses showed that renal disease involvement (p = 0.0016) and severe flares (p = 0.0001) were associated with higher annual direct costs. Improvement of the overall stability of SLE and early intervention to minimize the impact of renal disease may be two approaches to mitigate the long-term direct cost of managing SLE patients in the UK.

A Retrospective Analysis of Direct Medical Cost and Cost of Drug Therapy in Hospitalized Patients at Private Hospital in Western India

PubMed Central

Kumbar, Shivaprasad Kalakappa

2015-01-01

Background Pharmacoeconomics is analytical tool to know cost of hospitalization and its effect on health care system and society. In India, apart from the government health services, private sector also play big role to provide health care services. Objective To study the direct medical cost and cost of drug therapy in hospitalized patients at private hospital. Materials and Methods A retrospective study was conducted at private hospital in a metro city of Western India. Total 400 patients’ billing records were selected randomly for a period from 01/01/2013 to 31/12/2014. Data were collected from medical record of hospital with permission of medical director of hospital. Patients’ demographic profile age, sex, diagnosis and various costs like ICU charge, ventilator charge, diagnostic charge, etc. were noted in previously formed case record form. Data were analysed by Z, x2 and unpaired t-test. Result Patients were divided into less than 45 years and more than 45 year age group. They were divided into medical and surgical patients according to their admission in medical or surgical ward. Mortality, Intensive Care Unit (ICU) admission, patients on ventilator were significantly (p<0.05) higher in medical patients. Direct medical cost, ward bed charge, ICU bed charge, ventilator charge and cost of drug therapy per patient were significantly (p<0.05) higher in medical patients while operation theatre and procedural charge were significantly (p<0.05) higher in surgical patients. Cost of fibrinolytics, anticoagulants, cardiovascular drugs were significantly (p<0.05) higher in medical patients. Cost of antimicrobials, proton pump inhibitors (PPIs), antiemetics, analgesics, were significantly (p<0.05) higher in surgical patients. Conclusion Ward bed charge, ICU bed charge, ventilator charge accounted more than one third cost of direct medical cost in all the patients. Cost of drug therapy was one fourth of direct medical cost. Antimicrobials cost accounted 33% of cost of drug therapy. PMID:26675983

The cost-effectiveness of directly observed highly-active antiretroviral therapy in the third trimester in HIV-infected pregnant women.

PubMed

McCabe, Caitlin J; Goldie, Sue J; Fisman, David N

2010-04-13

In HIV-infected pregnant women, viral suppression prevents mother-to-child HIV transmission. Directly observed highly-active antiretroviral therapy (HAART) enhances virological suppression, and could prevent transmission. Our objective was to project the effectiveness and cost-effectiveness of directly observed administration of antiretroviral drugs in pregnancy. A mathematical model was created to simulate cohorts of one million asymptomatic HIV-infected pregnant women on HAART, with women randomly assigned self-administered or directly observed antiretroviral therapy (DOT), or no HAART, in a series of Monte Carlo simulations. Our primary outcome was the quality-adjusted life expectancy in years (QALY) of infants born to HIV-infected women, with the rates of Caesarean section and HIV-transmission after DOT use as intermediate outcomes. Both self-administered HAART and DOT were associated with decreased costs and increased life-expectancy relative to no HAART. The use of DOT was associated with a relative risk of HIV transmission of 0.39 relative to conventional HAART; was highly cost-effective in the cohort as a whole (cost-utility ratio $14,233 per QALY); and was cost-saving in women whose viral loads on self-administered HAART would have exceeded 1000 copies/ml. Results were stable in wide-ranging sensitivity analyses, with directly observed therapy cost-saving or highly cost-effective in almost all cases. Based on the best available data, programs that optimize adherence to HAART through direct observation in pregnancy have the potential to diminish mother-to-child HIV transmission in a highly cost-effective manner. Targeted use of DOT in pregnant women with high viral loads, who could otherwise receive self-administered HAART would be a cost-saving intervention. These projections should be tested with randomized clinical trials.

[Direct costs of diabetes mellitus in Germany: first estimation of the differences related to educational level].

PubMed

Korber, K; Teuner, C M; Lampert, T; Mielck, A; Leidl, R

2013-12-01

There are many studies on health inequalities, but these are rarely combined with cost-of-illness analyses. If the cost-of-illness were to be calculated for the individual status groups, it would be possible to assess the economic potential of preventive measures aimed specifically at people from low status groups. The objective of this article is to demonstrate for the first time the preventive potential by taking the example of diabetes mellitus (DM) from an economic perspective. Based on a systematic literature review, the average direct costs per patient with DM were assessed. Then, the prevalence of DM among adults with different educational levels was estimated based on the nationwide survey 'German Health Update' (GEDA), conducted by the Robert Koch-Institute in Germany in 2009. Finally, the cost and prevalence data were used to calculate the direct costs for each educational level. The direct costs of DM amount to about 13.1 billion € per year; about 35% of these costs can be attributed to patients with a low educational level. Thus, their share of the total costs is about 67% higher than their share of the total population. If the prevalence in the group with 'low educational level' (14.8%) could be reduced to the prevalence in the group with 'middle educational level' (7.9%), this would save about 2.2 billion (about 16.5%) € of direct costs. The analysis provides a first estimate of the potential savings from an effective status specific prevention programme. However, the direct costs per patient used were only an average for all people with DM, as a breakdown by educational level was not available. Since education can also affect health behaviour and compliance, which are also determinants of cost, the analyses presented here are probably conservative. © Georg Thieme Verlag KG Stuttgart · New York.

Can the Direct Medical Cost of Chronic Disease Be Transferred across Different Countries? Using Cost-of-Illness Studies on Type 2 Diabetes, Epilepsy and Schizophrenia as Examples

PubMed Central

Gao, Lan; Hu, Hao; Zhao, Fei-Li; Li, Shu-Chuen

2016-01-01

Objectives To systematically review cost of illness studies for schizophrenia (SC), epilepsy (EP) and type 2 diabetes mellitus (T2DM) and explore the transferability of direct medical cost across countries. Methods A comprehensive literature search was performed to yield studies that estimated direct medical costs. A generalized linear model (GLM) with gamma distribution and log link was utilized to explore the variation in costs that accounted by the included factors. Both parametric (Random-effects model) and non-parametric (Boot-strapping) meta-analyses were performed to pool the converted raw cost data (expressed as percentage of GDP/capita of the country where the study was conducted). Results In total, 93 articles were included (40 studies were for T2DM, 34 studies for EP and 19 studies for SC). Significant variances were detected inter- and intra-disease classes for the direct medical costs. Multivariate analysis identified that GDP/capita (p<0.05) was a significant factor contributing to the large variance in the cost results. Bootstrapping meta-analysis generated more conservative estimations with slightly wider 95% confidence intervals (CI) than the parametric meta-analysis, yielding a mean (95%CI) of 16.43% (11.32, 21.54) for T2DM, 36.17% (22.34, 50.00) for SC and 10.49% (7.86, 13.41) for EP. Conclusions Converting the raw cost data into percentage of GDP/capita of individual country was demonstrated to be a feasible approach to transfer the direct medical cost across countries. The approach from our study to obtain an estimated direct cost value along with the size of specific disease population from each jurisdiction could be used for a quick check on the economic burden of particular disease for countries without such data. PMID:26814959

Stochastic modelling of direct costs of pancreas disease (PD) in Norwegian farmed Atlantic salmon (Salmo salar L.).

PubMed

Aunsmo, Arnfinn; Valle, Paul Steinar; Sandberg, Marianne; Midtlyng, Paul Johan; Bruheim, Torkjel

2010-02-01

An economic model for estimating the direct costs of disease in industrial aquaculture was developed to include the following areas: biological losses, extraordinary costs, costs of treatment, costs of prevention and insurance pay-out. Direct costs of a pancreas disease (PD) outbreak in Norwegian farmed Atlantic salmon were estimated in the model, using probability distributions for the biological losses and expenditures associated with the disease. The biological effects of PD on mortality, growth, feed conversion and carcass quality and their correlations, together with costs of prevention were established using elicited data from an expert panel, and combined with basal losses in a control model. Extraordinary costs and costs associated with treatment were collected through a questionnaire sent to staff managing disease outbreaks. Norwegian national statistics for 2007 were used for prices and production costs in the model. Direct costs associated with a PD-outbreak in a site stocked with 500,000 smolts (vs. a similar site without the disease) were estimated to NOK (Norwegian kroner) 14.4 million (5% and 95% percentile: 10.5 and 17.8) (NOK=euro0.12 or $0.17 for 2007). Production was reduced to 70% (5% and 95% percentile: 57% and 81%) saleable biomass, and at an increased production cost of NOK 6.0 per kg (5% and 95% percentile: 3.5 and 8.7). Copyright 2009 Elsevier B.V. All rights reserved.

Estimating the costs of induced abortion in Uganda: A model-based analysis

PubMed Central

2011-01-01

Background The demand for induced abortions in Uganda is high despite legal and moral proscriptions. Abortion seekers usually go to illegal, hidden clinics where procedures are performed in unhygienic environments by under-trained practitioners. These abortions, which are usually unsafe, lead to a high rate of severe complications and use of substantial, scarce healthcare resources. This study was performed to estimate the costs associated with induced abortions in Uganda. Methods A decision tree was developed to represent the consequences of induced abortion and estimate the costs of an average case. Data were obtained from a primary chart abstraction study, an on-going prospective study, and the published literature. Societal costs, direct medical costs, direct non-medical costs, indirect (productivity) costs, costs to patients, and costs to the government were estimated. Monte Carlo simulation was used to account for uncertainty. Results The average societal cost per induced abortion (95% credibility range) was $177 ($140-$223). This is equivalent to $64 million in annual national costs. Of this, the average direct medical cost was $65 ($49-86) and the average direct non-medical cost was $19 ($16-$23). The average indirect cost was $92 ($57-$139). Patients incurred $62 ($46-$83) on average while government incurred $14 ($10-$20) on average. Conclusion Induced abortions are associated with substantial costs in Uganda and patients incur the bulk of the healthcare costs. This reinforces the case made by other researchers--that efforts by the government to reduce unsafe abortions by increasing contraceptive coverage or providing safe, legal abortions are critical. PMID:22145859

Estimating the costs of induced abortion in Uganda: a model-based analysis.

PubMed

Babigumira, Joseph B; Stergachis, Andy; Veenstra, David L; Gardner, Jacqueline S; Ngonzi, Joseph; Mukasa-Kivunike, Peter; Garrison, Louis P

2011-12-06

The demand for induced abortions in Uganda is high despite legal and moral proscriptions. Abortion seekers usually go to illegal, hidden clinics where procedures are performed in unhygienic environments by under-trained practitioners. These abortions, which are usually unsafe, lead to a high rate of severe complications and use of substantial, scarce healthcare resources. This study was performed to estimate the costs associated with induced abortions in Uganda. A decision tree was developed to represent the consequences of induced abortion and estimate the costs of an average case. Data were obtained from a primary chart abstraction study, an on-going prospective study, and the published literature. Societal costs, direct medical costs, direct non-medical costs, indirect (productivity) costs, costs to patients, and costs to the government were estimated. Monte Carlo simulation was used to account for uncertainty. The average societal cost per induced abortion (95% credibility range) was $177 ($140-$223). This is equivalent to $64 million in annual national costs. Of this, the average direct medical cost was $65 ($49-86) and the average direct non-medical cost was $19 ($16-$23). The average indirect cost was $92 ($57-$139). Patients incurred $62 ($46-$83) on average while government incurred $14 ($10-$20) on average. Induced abortions are associated with substantial costs in Uganda and patients incur the bulk of the healthcare costs. This reinforces the case made by other researchers--that efforts by the government to reduce unsafe abortions by increasing contraceptive coverage or providing safe, legal abortions are critical.

Analysis of direct medical and nonmedical costs for care of rheumatoid arthritis patients using the large cohort database, IORRA.

PubMed

Tanaka, Eiichi; Hoshi, Daisuke; Igarashi, Ataru; Inoue, Eisuke; Shidara, Kumi; Sugimoto, Naoki; Sato, Eri; Seto, Yohei; Nakajima, Ayako; Momohara, Shigeki; Taniguchi, Atsuo; Tsutani, Kiichiro; Yamanaka, Hisashi

2013-07-01

Our goal was to determine the annual direct medical and nonmedical costs for the care of patients with rheumatoid arthritis (RA) using data from a large cohort database in Japan. Direct medical costs [out of pocket to hospitals and pharmacies and for complementary and alternative medicine (CAM)] and nonmedical costs (caregiving, transportation, self-help devices, house modifications) were determined for RA patients who were participants in the Institute of Rheumatology, Rheumatoid Arthritis (IORRA) studies conducted in October 2007 and April 2008. Correlations between these costs and RA disease activity, disability level, and quality of life (QOL) were assessed. Data were analyzed from 5,204 and 5,265 RA patients in October 2007 and April 2008, respectively. The annual direct medical costs were JPY132,000 [out of pocket to hospital (US$1 = JPY90 in 2007)], JPY84,000 (out of pocket to pharmacy), and JPY146,000 (CAM). Annual direct nonmedical costs were JPY105,000 (caregiving), JPY22,000 (transportation), JPY30,000 (self-help devices), and JPY188,000 (house modifications). Based on the utilization rate for each cost component, the annual medical and nonmedical costs for each RA patient were JPY262,136 and JPY61,441, respectively. Costs increased with increasing RA disease activity and disability level or worsening quality of life (QOL). Based on the IORRA database, patients with RA bear heavy economic burdens that increase as the disease is exacerbated. The results also suggest that the increase in medical and nonmedical costs may be ameliorated by the proactive control of disease activity.

Acute care costs of patients admitted for management of chronic obstructive pulmonary disease exacerbations: contribution of disease severity, infection and chronic heart failure.

PubMed

Hutchinson, A; Brand, C; Irving, L; Roberts, C; Thompson, P; Campbell, D

2010-05-01

In 2003, chronic obstructive pulmonary disease (COPD) accounted for 46% of the burden of chronic respiratory disease in the Australian community. In the 65-74-year-old age group, COPD was the sixth leading cause of disability for men and the seventh for women. To measure the influence of disease severity, COPD phenotype and comorbidities on acute health service utilization and direct acute care costs in patients admitted with COPD. Prospective cohort study of 80 patients admitted to the Royal Melbourne Hospital in 2001-2002 for an exacerbation of COPD. Patients were followed for 12 months and data were collected on acute care utilization. Direct hospital costs were derived using Transition II, an activity-based costing system. Individual patient costs were then modelled to ascertain which patient factors influenced total direct hospital costs. Direct costs were calculated for 225 episodes of care, the median cost per admission was AU$3124 (interquartile range $1393 to $5045). The median direct cost of acute care management per patient per year was AU$7273 (interquartile range $3957 to $14 448). In a multivariate analysis using linear regression modelling, factors predictive of higher annual costs were increasing age (P= 0.041), use of domiciliary oxygen (P= 0.008) and the presence of chronic heart failure (P= 0.006). This model has identified a number of patient factors that predict higher acute care costs and awareness of these can be used for service planning to meet the needs of patients admitted with COPD.

Trends in resource utilization and prescription of anticonvulsants for patients with active epilepsy in Germany.

PubMed

Strzelczyk, Adam; Haag, Anja; Reese, Jens P; Nickolay, Tanja; Oertel, Wolfgang H; Dodel, Richard; Knake, Susanne; Rosenow, Felix; Hamer, Hajo M

2013-06-01

This study evaluated trends in the resource use of patients with active epilepsy over a 5-year period at an outpatient clinic of a German epilepsy center. Two cross-sectional cohorts of consecutive adults with active epilepsy were evaluated over a 3-month period in 2003 and 2008. Data on socioeconomic status, course of epilepsy, as well as direct and indirect costs were recorded using validated patient questionnaires. We enrolled 101 patients in 2003 and 151 patients in 2008. In both cohorts, 76% of the patients suffered from focal epilepsy, and the majority was on antiepileptic drug (AED) polytherapy (mean AED number: 1.7 (2003), 1.8 (2008)). We calculated epilepsy-specific costs of € 2955 in 2003 and € 3532 in 2008 per 3 months per patient. Direct medical costs were mainly due to anticonvulsants in 2003 (59.4% of total direct costs, 34.0% in 2008) and to hospitalization in 2008 (46.9% of total direct costs, 27.7% in 2003). The proportion of enzyme-inducing anticonvulsants and 'old' AEDs decreased between 2003 and 2008. Indirect costs of € 1689 and € 1847 were mainly due to early retirement (48.4%; 46.0% of total indirect costs in 2003; 2008), unemployment (26.1%; 24.2%), and days off due to seizures (25.5%; 29.8%). This study showed a shift in distribution of direct cost components with increased hospital costs as well as a cost-neutral increase in the prescription of 'newer' AEDs. The amount and distribution of indirect cost components remained unchanged. Copyright © 2013 Elsevier Inc. All rights reserved.

A cost-effectiveness comparisons of adult spinal deformity surgery in the United States and Japan.

PubMed

Yagi, Mitsuru; Ames, Christopher P; Keefe, Malla; Hosogane, Naobumi; Smith, Justin S; Shaffrey, Christopher I; Schwab, Frank; Lafage, Virginie; Shay Bess, R; Matsumoto, Morio; Watanabe, Kota

2018-03-01

Information about the cost-effectiveness of surgical procedures for adult spinal deformity (ASD) is critical for providing appropriate treatments for these patients. The purposes of this study were to compare the direct cost and cost-effectiveness of surgery for ASD in the United States (US) and Japan (JP). Retrospective analysis of 76 US and 76 JP patients receiving surgery for ASD with ≥2-year follow-up was identified. Data analysis included preoperative and postoperative demographic, radiographic, health-related quality of life (HRQOL), and direct cost for surgery. An incremental cost-effectiveness ratio (ICER) was determined using cost/quality-adjusted life years (QALY). The cost/QALY was calculated from the 2-year cost and HRQOL data. JP exhibited worse baseline spinopelvic alignment than the US (pelvic incidence and lumbar lordosis: 35.4° vs 22.7°, p < 0.01). The US had more three-column osteotomies (50 vs 16%), and shorter hospital stay (7.9 vs 22.7 days) (p < 0.05). The US demonstrated worse postoperative ODI (41.3 vs. 33.9%) and greater revision surgery rate (40 vs 10%) (p < 0.05). Due to the high initial cost and revision frequency, the US had greater total cost ($92,133 vs. $49,647) and cost/QALY ($511,840 vs. $225,668) at 2-year follow-up (p < 0.05). Retrospective analysis comparing the direct costs and cost-effectiveness of ASD surgery in the US vs JP demonstrated that the total direct costs and cost/QALY were substantially higher in the US than JP. Variations in patient cohort, healthcare costs, revision frequencies, and HRQOL improvement influenced the cost/QALY differential between these countries.

The economic burden of fracture patients with osteoporosis in western China.

PubMed

Qu, B; Ma, Y; Yan, M; Wu, H-H; Fan, L; Liao, D-F; Pan, X-M; Hong, Z

2014-07-01

To study the cost of osteoporotic fracture in China, we performed a prospective study and compared the costs of the disease in referral patients with fractures in three of the most common sites. Our results indicated that the economic burden of osteoporotic fracture to both Chinese patients and the nation is heavy. This paper aims to study the cost of osteoporotic fracture in China and thus to provide essential information about the burden of this disease to individuals and society. This prospective observational data collection study assessed the cost related to hip, vertebral, and wrist fracture 1 year after the fracture based on a patient sample consisting of 938 men and women. Information was collected using patient records, registry sources, and patient interviews. Both direct medical, direct non-medical, and indirect non-medical costs were considered. The annual total costs were highest in hip fracture patients (renminbi, RMB 27,283 or USD 4,330, with confidence interval (RMB 25715, 28851)), followed by patients with vertebral fracture (RMB 21,474 or USD 3,409, with confidence interval (RMB 20082, 22866)) and wrist fracture (RMB 8,828 or USD 1,401, with confidence interval (RMB 7829, 9827)). The direct medical care costs averaged approximately RMB 17,007 per year per patient, of which inpatient costs, drugs, and investigations accounted for the majority of the costs. Nonmedical direct costs were much less compared to direct healthcare costs and averaged approximately RMB 1,846. These results indicate that the economic burden of osteoporotic fracture to both Chinese patients and China was heavy, and the proportion of the costs in China demonstrated many similar features and some significant differences compared to other countries.

Cost-Effectiveness Comparison of Imaging-Guided Prostate Biopsy Techniques: Systematic Transrectal Ultrasound, Direct In-Bore MRI, and Image Fusion.

PubMed

Venderink, Wulphert; Govers, Tim M; de Rooij, Maarten; Fütterer, Jurgen J; Sedelaar, J P Michiel

2017-05-01

Three commonly used prostate biopsy approaches are systematic transrectal ultrasound guided, direct in-bore MRI guided, and image fusion guided. The aim of this study was to calculate which strategy is most cost-effective. A decision tree and Markov model were developed to compare cost-effectiveness. Literature review and expert opinion were used as input. A strategy was deemed cost-effective if the costs of gaining one quality-adjusted life year (incremental cost-effectiveness ratio) did not exceed the willingness-to-pay threshold of €80,000 (≈$85,000 in January 2017). A base case analysis was performed to compare systematic transrectal ultrasound- and image fusion-guided biopsies. Because of a lack of appropriate literature regarding the accuracy of direct in-bore MRI-guided biopsy, a threshold analysis was performed. The incremental cost-effectiveness ratio for fusion-guided biopsy compared with systematic transrectal ultrasound-guided biopsy was €1386 ($1470) per quality-adjusted life year gained, which was below the willingness-to-pay threshold and thus assumed cost-effective. If MRI findings are normal in a patient with clinically significant prostate cancer, the sensitivity of direct in-bore MRI-guided biopsy has to be at least 88.8%. If that is the case, the incremental cost-effectiveness ratio is €80,000 per quality-adjusted life year gained and thus cost-effective. Fusion-guided biopsy seems to be cost-effective compared with systematic transrectal ultrasound-guided biopsy. Future research is needed to determine whether direct in-bore MRI-guided biopsy is the best pathway; in this study a threshold was calculated at which it would be cost-effective.

Cost analysis of surgically treated pressure sores stage III and IV.

PubMed

Filius, A; Damen, T H C; Schuijer-Maaskant, K P; Polinder, S; Hovius, S E R; Walbeehm, E T

2013-11-01

Health-care costs associated with pressure sores are significant and their financial burden is likely to increase even further. The aim of this study was to analyse the direct medical costs of hospital care for surgical treatment of pressure sores stage III and IV. We performed a retrospective chart study of patients who were surgically treated for stage III and IV pressure sores between 2007 and 2010. Volumes of health-care use were obtained for all patients and direct medical costs were subsequently calculated. In addition, we evaluated the effect of location and number of pressure sores on total costs. A total of 52 cases were identified. Average direct medical costs in hospital were €20,957 for the surgical treatment of pressure sores stage III or IV; average direct medical costs for patients with one pressure sore on an extremity (group 1, n = 5) were €30,286, €10,113 for patients with one pressure sore on the trunk (group 2, n = 32) and €40,882 for patients with multiple pressure sores (group 3, n = 15). The additional costs for patients in group 1 and group 3 compared to group 2 were primarily due to longer hospitalisation. The average direct medical costs for surgical treatment of pressure sores stage III and IV were high. Large differences in costs were related to the location and number of pressure sores. Insight into the distribution of these costs allows identification of high-risk patients and enables the development of specific cost-reducing measures. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Large Scale Integrated Circuits for Military Applications.

DTIC Science & Technology

1977-05-01

economic incentive for riarrowing this gap is examined, y (U)^wo"categories of cost are analyzed: the direct life cycle cost of the integrated circuit...dependence of these costs on the physical charac- teristics of the integrated circuits is discussed. (U) The economic and physical characteristics of... economic incentive for narrowing this gap is examined. Two categories of cost are analyzed: the direct life cycle cost of the integrated circuit

Economic burden of influenza-associated hospitalizations and outpatient visits in Bangladesh during 2010

PubMed Central

Bhuiyan, Mejbah U; Luby, Stephen P; Alamgir, Nadia I; Homaira, Nusrat; Mamun, Abdullah A; Khan, Jahangir A M; Abedin, Jaynal; Sturm-Ramirez, Katharine; Gurley, Emily S; Zaman, Rashid U; Alamgir, ASM; Rahman, Mahmudur; Widdowson, Marc-Alain; Azziz-Baumgartner, Eduardo

2014-01-01

Objective Understanding the costs of influenza-associated illness in Bangladesh may help health authorities assess the cost-effectiveness of influenza prevention programs. We estimated the annual economic burden of influenza-associated hospitalizations and outpatient visits in Bangladesh. Design From May through October 2010, investigators identified both outpatients and inpatients at four tertiary hospitals with laboratory-confirmed influenza infection through rRT-PCR. Research assistants visited case-patients' homes within 30 days of hospital visit/discharge and administered a structured questionnaire to capture direct medical costs (physician consultation, hospital bed, medicines and diagnostic tests), direct non-medical costs (food, lodging and travel) and indirect costs (case-patients' and caregivers' lost income). We used WHO-Choice estimates for routine healthcare service costs. We added direct, indirect and healthcare service costs to calculate cost-per-episode. We used median cost-per-episode, published influenza-associated outpatient and hospitalization rates and Bangladesh census data to estimate the annual economic burden of influenza-associated illnesses in 2010. Results We interviewed 132 outpatients and 41 hospitalized patients. The median cost of an influenza-associated outpatient visit was US$4.80 (IQR = 2.93–8.11) and an influenza-associated hospitalization was US$82.20 (IQR = 59.96–121.56). We estimated that influenza-associated outpatient visits resulted in US$108 million (95% CI: 76–147) in direct costs and US$59 million (95% CI: 37–91) in indirect costs; influenza-associated hospitalizations resulted in US$1.4 million (95% CI: 0.4–2.6) in direct costs and US$0.4 million (95% CI: 0.1–0.8) in indirect costs in 2010. Conclusions In Bangladesh, influenza-associated illnesses caused an estimated US$169 million in economic loss in 2010, largely driven by frequent but low-cost outpatient visits. PMID:24750586

Economic burden of influenza-associated hospitalizations and outpatient visits in Bangladesh during 2010.

PubMed

Bhuiyan, Mejbah U; Luby, Stephen P; Alamgir, Nadia I; Homaira, Nusrat; Mamun, Abdullah A; Khan, Jahangir A M; Abedin, Jaynal; Sturm-Ramirez, Katharine; Gurley, Emily S; Zaman, Rashid U; Alamgir, A S M; Rahman, Mahmudur; Widdowson, Marc-Alain; Azziz-Baumgartner, Eduardo

2014-07-01

Understanding the costs of influenza-associated illness in Bangladesh may help health authorities assess the cost-effectiveness of influenza prevention programs. We estimated the annual economic burden of influenza-associated hospitalizations and outpatient visits in Bangladesh. From May through October 2010, investigators identified both outpatients and inpatients at four tertiary hospitals with laboratory-confirmed influenza infection through rRT-PCR. Research assistants visited case-patients' homes within 30 days of hospital visit/discharge and administered a structured questionnaire to capture direct medical costs (physician consultation, hospital bed, medicines and diagnostic tests), direct non-medical costs (food, lodging and travel) and indirect costs (case-patients' and caregivers' lost income). We used WHO-Choice estimates for routine healthcare service costs. We added direct, indirect and healthcare service costs to calculate cost-per-episode. We used median cost-per-episode, published influenza-associated outpatient and hospitalization rates and Bangladesh census data to estimate the annual economic burden of influenza-associated illnesses in 2010. We interviewed 132 outpatients and 41 hospitalized patients. The median cost of an influenza-associated outpatient visit was US$4.80 (IQR = 2.93-8.11) and an influenza-associated hospitalization was US$82.20 (IQR = 59.96-121.56). We estimated that influenza-associated outpatient visits resulted in US$108 million (95% CI: 76-147) in direct costs and US$59 million (95% CI: 37-91) in indirect costs; influenza-associated hospitalizations resulted in US$1.4 million (95% CI: 0.4-2.6) in direct costs and US$0.4 million (95% CI: 0.1-0.8) in indirect costs in 2010. In Bangladesh, influenza-associated illnesses caused an estimated US$169 million in economic loss in 2010, largely driven by frequent but low-cost outpatient visits. © 2014 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.

Single-level anterior cervical discectomy and fusion versus minimally invasive posterior cervical foraminotomy for patients with cervical radiculopathy: a cost analysis.

PubMed

Mansfield, Haley E; Canar, W Jeffrey; Gerard, Carter S; O'Toole, John E

2014-11-01

Patients suffering from cervical radiculopathy in whom a course of nonoperative treatment has failed are often candidates for a single-level anterior cervical discectomy and fusion (ACDF) or posterior cervical foraminotomy (PCF). The objective of this analysis was to identify any significant cost differences between these surgical methods by comparing direct costs to the hospital. Furthermore, patient-specific characteristics were also considered for their effect on component costs. After obtaining approval from the medical center institutional review board, the authors conducted a retrospective cross-sectional comparative cohort study, with a sample of 101 patients diagnosed with cervical radiculopathy and who underwent an initial single-level ACDF or minimally invasive PCF during a 3-year period. Using these data, bivariate analyses were conducted to determine significant differences in direct total procedure and component costs between surgical techniques. Factorial ANOVAs were also conducted to determine any relationship between patient sex and smoking status to the component costs per surgery. The mean total direct cost for an ACDF was $8192, and the mean total direct cost for a PCF was $4320. There were significant differences in the cost components for direct costs and operating room supply costs. It was found that there was no statistically significant difference in component costs with regard to patient sex or smoking status. In the management of single-level cervical radiculopathy, the present analysis has revealed that the average cost of an ACDF is 89% more than a PCF. This increased cost is largely due to the cost of surgical implants. These results do not appear to be dependent on patient sex or smoking status. When combined with results from previous studies highlighting the comparable patient outcomes for either procedure, the authors' findings suggest that from a health care economics standpoint, physicians should consider a minimally invasive PCF in the treatment of cervical radiculopathy.

Cost-benefit analysis of targeted hearing directed early testing for congenital cytomegalovirus infection.

PubMed

Bergevin, Anna; Zick, Cathleen D; McVicar, Stephanie Browning; Park, Albert H

2015-12-01

In this study, we estimate an ex ante cost-benefit analysis of a Utah law directed at improving early cytomegalovirus (CMV) detection. We use a differential cost of treatment analysis for publicly insured CMV-infected infants detected by a statewide hearing-directed CMV screening program. Utah government administrative data and multi-hospital accounting data are used to estimate and compare costs and benefits for the Utah infant population. If antiviral treatment succeeds in mitigating hearing loss for one infant per year, the public savings will offset the public costs incurred by screening and treatment. If antiviral treatment is not successful, the program represents a net cost, but may still have non-monetary benefits such as accelerated achievement of diagnostic milestones. The CMV education and treatment program costs are modest and show potential for significant cost savings. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Cost consideration for aircraft configuration changes, 1

NASA Technical Reports Server (NTRS)

Tumlinson, R. R.

1975-01-01

The costs of improvements in aircraft drag reduction design changes are outlined in the context of production decisions. A drag reduction design with increased airframe weight requires cost increases for direct labor, overhead and direct expenses, plus general and administrative expenses.

45 CFR 402.12 - Use of SLIAG Funds for Costs Incurred Prior to October 1, 1987.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., 1986, that are directly associated with implementation of this part. Such costs may include planning... with the application, and other costs directly resulting from planning for implementation of this part... 45 Public Welfare 2 2010-10-01 2010-10-01 false Use of SLIAG Funds for Costs Incurred Prior to...

The Non-Linear Relationship between BMI and Health Care Costs and the Resulting Cost Fraction Attributable to Obesity.

PubMed

Laxy, Michael; Stark, Renée; Peters, Annette; Hauner, Hans; Holle, Rolf; Teuner, Christina M

2017-08-30

This study aims to analyse the non-linear relationship between Body Mass Index (BMI) and direct health care costs, and to quantify the resulting cost fraction attributable to obesity in Germany. Five cross-sectional surveys of cohort studies in southern Germany were pooled, resulting in data of 6757 individuals (31-96 years old). Self-reported information on health care utilisation was used to estimate direct health care costs for the year 2011. The relationship between measured BMI and annual costs was analysed using generalised additive models, and the cost fraction attributable to obesity was calculated. We found a non-linear association of BMI and health care costs with a continuously increasing slope for increasing BMI without any clear threshold. Under the consideration of the non-linear BMI-cost relationship, a shift in the BMI distribution so that the BMI of each individual is lowered by one point is associated with a 2.1% reduction of mean direct costs in the population. If obesity was eliminated, and the BMI of all obese individuals were lowered to 29.9 kg/m², this would reduce the mean direct costs by 4.0% in the population. Results show a non-linear relationship between BMI and health care costs, with very high costs for a few individuals with high BMI. This indicates that population-based interventions in combination with selective measures for very obese individuals might be the preferred strategy.

The cost of postabortion care and legal abortion in Colombia.

PubMed

Prada, Elena; Maddow-Zimet, Isaac; Juarez, Fatima

2013-09-01

Although Colombia partially liberalized its abortion law in 2006, many abortions continue to occur outside the law and result in complications. Assessing the costs to the health care system of safe, legal abortions and of treating complications of unsafe, illegal abortions has important policy implications. The Post-Abortion Care Costing Methodology was used to produce estimates of direct and indirect costs of postabortion care and direct costs of legal abortions in Colombia. Data on estimated costs were obtained through structured interviews with key informants at a randomly selected sample of facilities that provide abortion-related care, including 25 public and private secondary and tertiary facilities and five primary-level private facilities that provide specialized reproductive health services. The median direct cost of treating a woman with abortion complications ranged from $44 to $141 (in U.S. dollars), representing an annual direct cost to the health system of about $14 million per year. A legal abortion at a secondary or tertiary facility was costly (medians, $213 and $189, respectively), in part because of the use of dilation and curettage, as well as because of administrative barriers. At specialized facilities, where manual vacuum aspiration and medication abortion are used, the median cost of provision was much lower ($45). Provision of postabortion care and legal abortion services at higher-level facilities results in unnecessarily high health care costs. These costs can be reduced significantly by providing services in a timely fashion at primary-level facilities and by using safe, noninvasive and less costly abortion methods.

Annual national direct and indirect cost estimates of the prevention and treatment of cervical cancer in Brazil

PubMed Central

Novaes, Hillegonda Maria Dutilh; Itria, Alexander; Silva, Gulnar Azevedo e; Sartori, Ana Marli Christovam; Rama, Cristina Helena; de Soárez, Patrícia Coelho

2015-01-01

OBJECTIVE: To estimate the annual direct and indirect costs of the prevention and treatment of cervical cancer in Brazil. METHODS: This cost description study used a "gross-costing" methodology and adopted the health system and societal perspectives. The estimates were grouped into sets of procedures performed in phases of cervical cancer care: the screening, diagnosis and treatment of precancerous lesions and the treatment of cervical cancer. The costs were estimated for the public and private health systems, using data from national health information systems, population surveys, and literature reviews. The cost estimates are presented in 2006 USD. RESULTS: From the societal perspective, the estimated total costs of the prevention and treatment of cervical cancer amounted to USD $1,321,683,034, which was categorized as follows: procedures (USD $213,199,490), visits (USD $325,509,842), transportation (USD $106,521,537) and productivity losses (USD $676,452,166). Indirect costs represented 51% of the total costs, followed by direct medical costs (visits and procedures) at 41% and direct non-medical costs (transportation) at 8%. The public system represented 46% of the total costs, and the private system represented 54%. CONCLUSION: Our national cost estimates of cervical cancer prevention and treatment, indicating the economic importance of cervical cancer screening and care, will be useful in monitoring the effect of the HPV vaccine introduction and are of interest in research and health care management. PMID:26017797

26 CFR 301.7433-1 - Civil cause of action for certain unauthorized collection actions.

Code of Federal Regulations, 2010 CFR

2010-04-01

...) The actual, direct economic damages sustained as a proximate result of the reckless or international.... (b) Actual, direct economic damages—(1) Definition. Actual, direct economic damages are actual... and administrative costs are not recoverable as actual, direct economic damages. Litigation costs may...

Direct hospital costs of total laparoscopic hysterectomy compared with fast-track open hysterectomy at a tertiary hospital: a retrospective case-controlled study.

PubMed

Rhou, Yoon J J; Pather, Selvan; Loadsman, John A; Campbell, Neil; Philp, Shannon; Carter, Jonathan

2015-12-01

To assess the direct intraoperative and postoperative costs in women undergoing total laparoscopic hysterectomy and fast-track open hysterectomy. A retrospective review of the direct hospital-related costs in a matched cohort of women undergoing total laparoscopic hysterectomy (TLH) and fast-track open hysterectomy (FTOH) at a tertiary hospital. All costs were calculated, including the cost of advanced high-energy laparoscopic devices. The effect of the learning curve on cost in laparoscopic hysterectomy was also assessed, as was the hospital case-weighted cost, which was compared with the actual cost. Fifty women were included in each arm of the study. TLH had a higher intraoperative cost, but a lower postoperative cost than FTOH (AUD$3877 vs AUD$2776 P < 0.001, AUD$3965 vs AUD$6233 P < 0.001). The total cost of TLH was not different from FTOH (AUD$7842 vs AUD$9009 P = 0.068) and after a learning curve; TLH cost less than FTOH (AUD$6797 vs AUD$8647, P < 0.001). The use of high-energy devices did not impact on the cost benefit of TLH, and hospital case-weight-based funding correlated poorly with actual cost. Despite the use of fast-track recovery protocols, the cost of TLH is no different to FTOH and after a learning curve is cheaper than open hysterectomy. Judicious use of advanced energy devices does not impact on the cost, and hospital case-weight-based funding model in our hospital is inaccurate when compared to directly calculated hospital costs. © 2013 The Authors ANZJOG © 2013 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

The Cost of Unintended Pregnancies in Canada: Estimating Direct Cost, Role of Imperfect Adherence, and the Potential Impact of Increased Use of Long-Acting Reversible Contraceptives.

PubMed

Black, Amanda Y; Guilbert, Edith; Hassan, Fareen; Chatziheofilou, Ismini; Lowin, Julia; Jeddi, Mark; Filonenko, Anna; Trussell, James

2015-12-01

Unintended pregnancies (UPs) are associated with a significant cost burden, but the full cost burden in Canada is not known. The objectives of this study were to quantify the direct cost of UPs in Canada, the proportion of cost attributable to UPs and imperfect contraceptive adherence and the potential cost savings with increased uptake of long-acting reversible contraceptives (LARCs). A cost model was constructed to estimate the annual number and direct costs of UP in women aged 18 to 44 years. Adherence-associated UP rates were estimated using perfect- and typical-use contraceptive failure rates. Change in annual number of UPs and impact on cost burden were projected in three scenarios of increased LARC usage. One-way sensitivity analyses were conducted to assess the impact of key variables on scenarios of increased LARC use. There are more than 180 700 UPs annually in Canada. The associated direct cost was over $320 million. Fifty-eight percent (58%) of UPs occurred in women aged 20 to 29 years at an annual cost of $175 million; 82% of this cost ($143 million) was attributable to contraceptive non-adherence. Increased LARC uptake produced cost savings of over $34 million in all three switching scenarios; the largest savings ($35 million) occurred when 10% of oral contraceptive users switched to LARCs. The minimum duration of LARC usage required before cost savings was realized was 12 months. The cost of UPs in Canada is significant and much of it can be attributed to imperfect contraceptive adherence. Increased LARC uptake may reduce contraceptive non-adherence, thereby reducing rates of UP and generating significant cost savings, particularly in women aged 20 to 29.

[Social costs of the most common inflammatory rheumatic diseases in Mexico from the patient's perspective].

PubMed

Mould-Quevedo, Joaquín; Peláez-Ballestas, Ingris; Vázquez-Mellado, Janitzia; Terán-Estrada, Leobardo; Esquivel-Valerio, Jorge; Ventura-Ríos, Lucio; Aceves-Avila, Francisco J; Bernard-Medina, Ana G; Goycochea-Robles, María V; Hernández-Garduño, Adolfo; Burgos-Vargas, Rubén; Shumski, Clara; Garza-Elizondo, Mario; Ramos-Remus, César; Espinoza-Villalpando, Jesús; Alvarez-Hernández, Everardo; Flores-Alvarado, Diana; Rodríguez-Amado, Jaquelin; Casasola-Vargas, Julio; Skinner-Taylor, Cassandra

2008-01-01

To estimate the social costs of rheumatoid arthritis (RA), ankylosing spondylitis (AS), and gout from the patient's perspective. We carried out a cross-sectional analysis of the cost and resource utilization of 690 RA, AS, and gout patients from 10 medical centers and private facilities in five cities of Mexico. The information was obtained from the baseline of a dynamic cohort. We estimated out-of-pocket expenses, institutional direct costs, and direct medical costs. The mean (SD) annual out-of-pocket expense (USD) was $610.0 ($302.2) for RA, $578.6 ($220.5) for AS, and $245.3 ($124.0) for gout. Figures correspond to 15%, 9.6%, and 2.5% of the family income. They also represented 26.1%, 25.3%, and 24.4% of the total annual cost per RA, AS, and gout patients, respectively. The expected direct institutional patient/year costs were 1,724.2 for RA, $1,710.8 for AS, and $760.7 for gout. The total patient annual costs were $2,334.3 for RA, $2,289.4 for AS, and $1,006.1 for gout. Most out-of-pocket expenses were used to purchase drugs, pay for laboratory tests, imaging studies, and alternative therapies. From the patient's perspective, the cost of RA, AS, and gout represents 25% of direct medical costs. The cost of RA is higher than that for AS and gout.

Economic Costs of Chikungunya Virus in Colombia.

PubMed

Alvis-Zakzuk, Nelson J; Díaz-Jiménez, Diana; Castillo-Rodríguez, Liliana; Castañeda-Orjuela, Carlos; Paternina-Caicedo, Ángel; Pinzón-Redondo, Hernando; Carrasquilla-Sotomayor, María; Alvis-Guzmán, Nelson; De La Hoz-Restrepo, Fernando

2018-04-05

The aim of the present study was to estimate the economic impact of chikungunya virus (CHIKV) infection in Colombia from a societal perspective. We conducted a retrospective, bottom-up cost-of-illness study in clinically confirmed cases during the first chikungunya (CHIK) outbreak in Colombia in 2014. Direct and indirect costs were estimated per patient. Economic costs were calculated by the addition of direct costs (direct medical costs and out-of-pocket heath expenditures) and indirect cost as a result of loss of productivity. A total of 126 patients (67 children and 59 adults) with CHIK were included. The median of the direct medical cost in children was US$257.9 (interquartile range [IQR] 121.7-563.8), and US$66.6 (IQR 26.5-317.3) for adults. The productivity loss median expenditures reached US$81.3 (IQR 72.2-203.2) per adult patient. The median economic cost in adults as a result of CHIK was US$152.9 (IQR 101.0-539.6), of which 53.2% was a result of indirect costs. Out-of-pocket expenditures comprised 3.3% of all economic costs. Our study can help health decision makers to properly assess the burden of disease caused by CHIK in Colombia, an endemic tropical country. We recommend to strength the health information systems and to continue investing in public health measures to prevent CHIK. Copyright © 2018. Published by Elsevier Inc.

42 CFR 405.2468 - Allowable costs.

Code of Federal Regulations, 2011 CFR

2011-10-01

... to the limit on the all-inclusive rate for allowable costs. (3) Allowable graduate medical education.... (f) Graduate medical education. (1) Effective for that portion of cost reporting periods occurring on... receive direct graduate medical education payment for those residents. (2) Direct graduate medical...

19 CFR 10.710 - Value-content requirement.

Code of Federal Regulations, 2011 CFR

2011-04-01

... allocable to the specific goods; (iii) Research, development, design, engineering, and blueprint costs... or value of the materials produced in Jordan, plus the direct costs of processing operations... disposal. (d) Direct costs of processing operations—(1) Items included. For purposes of paragraph (a) of...

Comparison of methods for estimating the cost of human immunodeficiency virus-testing interventions.

PubMed

Shrestha, Ram K; Sansom, Stephanie L; Farnham, Paul G

2012-01-01

The Centers for Disease Control and Prevention (CDC), Division of HIV/AIDS Prevention, spends approximately 50% of its $325 million annual human immunodeficiency virus (HIV) prevention funds for HIV-testing services. An accurate estimate of the costs of HIV testing in various settings is essential for efficient allocation of HIV prevention resources. To assess the costs of HIV-testing interventions using different costing methods. We used the microcosting-direct measurement method to assess the costs of HIV-testing interventions in nonclinical settings, and we compared these results with those from 3 other costing methods: microcosting-staff allocation, where the labor cost was derived from the proportion of each staff person's time allocated to HIV testing interventions; gross costing, where the New York State Medicaid payment for HIV testing was used to estimate program costs, and program budget, where the program cost was assumed to be the total funding provided by Centers for Disease Control and Prevention. Total program cost, cost per person tested, and cost per person notified of new HIV diagnosis. The median costs per person notified of a new HIV diagnosis were $12 475, $15 018, $2697, and $20 144 based on microcosting-direct measurement, microcosting-staff allocation, gross costing, and program budget methods, respectively. Compared with the microcosting-direct measurement method, the cost was 78% lower with gross costing, and 20% and 61% higher using the microcosting-staff allocation and program budget methods, respectively. Our analysis showed that HIV-testing program cost estimates vary widely by costing methods. However, the choice of a particular costing method may depend on the research question being addressed. Although program budget and gross-costing methods may be attractive because of their simplicity, only the microcosting-direct measurement method can identify important determinants of the program costs and provide guidance to improve efficiency.

The direct and indirect costs of long bone fractures in a working age US population.

PubMed

Bonafede, Machaon; Espindle, Derek; Bower, Anthony G

2013-01-01

Information regarding the burden of fractures is limited, especially among working age patients. The objective of this study was to evaluate the direct and indirect costs associated with long bone fractures in a working age population using real-world claims data. This was a claims-based retrospective analysis, comparing adult patients in the 6 months before and 6 months after a long bone fracture between 1/1/2001 and 12/31/2008 using the MarketScan Research Databases. Outcomes included direct medical costs and utilization, as well as work absenteeism and short term disability, which was available for a sub-set of the patients. Observed and adjusted incremental costs (i.e., the difference in costs before and after a fracture) were evaluated and reported in 2008 US$. A total of 208,094 patients with at least one fracture were included in the study. Six, mutually exclusive fracture cohorts were evaluated: tibia shaft (n = 49,839), radius (n = 97,585), hip (n = 11,585), femur (n = 6788), humerus (n = 29,884), and those with multiple long bone fractures (n = 12,413). Average unadjusted direct costs in the 6-months before a long bone fracture ranged from $3291 (radius) to $12,923 (hip). The average incremental direct cost increase in the 6-months following a fracture ranged from $5707 (radius) to $39,041 (multiple fractures). Incremental absenteeism costs ranged from $950 (radius) to $2600 (multiple fractures), while incremental short-term disability costs ranged from $2050 (radius) to $4600 (multiple fractures). The results of this study indicate that long bone fractures are costly, both in terms of direct medical costs and lost productivity. Workplace absences and short-term disability represent a significant component of the burden of long bone fractures. These results may not be generalizable to all patients with fractures in the US, and do not reflect the burden of undiagnosed or sub-clinical fractures.

Best cost-effectiveness and worker productivity with initial triple DMARD therapy compared with methotrexate monotherapy in early rheumatoid arthritis: cost-utility analysis of the tREACH trial.

PubMed

de Jong, Pascal H P; Hazes, Johanna M; Buisman, Leander R; Barendregt, Pieternella J; van Zeben, Derkjen; van der Lubbe, Peter A; Gerards, Andreas H; de Jager, Mike H; de Sonnaville, Peter B J; Grillet, Bernard A; Luime, Jolanda J; Weel, Angelique E A M

2016-12-01

To evaluate direct and indirect costs per quality adjusted life year (QALY) for different initial treatment strategies in very early RA. The 1-year data of the treatment in the Rotterdam Early Arthritis Cohort trial were used. Patients with a high probability (>70%) according to their likelihood of progressing to persistent arthritis, based on the prediction model of Visser, were randomized into one of following initial treatment strategies: (A) initial triple DMARD therapy (iTDT) with glucocorticoids (GCs) intramuscular (n = 91); (B) iTDT with an oral GC tapering scheme (n = 93); and (C) initial MTX monotherapy (iMM) with GCs similar to B (n = 97). Data on QALYs, measured with the Dutch EuroQol, and direct and indirect cost were used. Direct costs are costs of treatment and medical consumption, whereas indirect costs are costs due to loss of productivity. Average QALYs (sd) for A, B and C were, respectively, 0.75 (0.12), 0.75 (0.10) and 0.73 (0.13) for Dutch EuroQol. Highest total costs per QALY (sd) were, respectively, €12748 (€18767), €10 380 (€15 608) and €17 408 (€21 828) for strategy A, B and C (P = 0.012, B vs C). Direct as well as indirect costs were higher with iMM (strategy C) compared with iTDT (strategy B). Higher direct costs were due to ∼40% more biologic usage over time. Higher indirect costs, on the other hand, were caused by more long-term sickness and reduction in contract hours. iTDT was >95% cost-effective across all willingness-to-pay thresholds compared with iMM. iTDT was more cost-effective and had better worker productivity compared with iMM. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Economic Burden of Hepatitis B Virus-Related Diseases: Evidence From Iran

PubMed Central

Keshavarz, Khosro; Kebriaeezadeh, Abbas; Alavian, Seyed Moayed; Akbari Sari, Ali; Abedin Dorkoosh, Farid; Keshvari, Maryam; Malekhosseini, Seyed Ali; Nikeghbalian, Saman; Nikfar, Shekoufeh

2015-01-01

Background: Hepatitis B infection is still the main cause of chronic liver disease in Iran, which is associated with significant economic and social costs. Objectives: This study aimed to estimate the financial burden caused by CHB infection and its complications in Iran. Patients and Methods: Prevalence-based and bottom-up approaches were used to collect the data. Data on direct medical costs were extracted from outpatient medical records in a referral gastroenterology and hepatology research center, inpatient medical records in several major hospitals in Tehran and Shiraz in 2013, and the self-reports of specialists. Data on direct non-medical and indirect costs were collected based on the patients’ self-reports through face-to-face interviews performed in the mentioned centers. To calculate the indirect costs, friction cost approach was used. To calculate the total cost-of-illness in Iran, the total cost per patient at each stage of the disease was estimated and multiplied by the total number of patients. Results: The total annual cost for the activate population of CHB patients and for those receiving treatment at various disease stages were respectively 450 million and 226 million dollars, with 64% and 70% of which allocated to direct costs respectively, and 36% and 30% to indirect costs respectively. The total direct costs alone for each group were respectively 1.17% and 0.6% of the total health expenditure. Furthermore, the cost spent on drugs encompasses the largest proportion of the direct medical cost for all stages of the disease. Conclusions: According to the perspectives of payers, patients, and community, CHB infection can be considered as one of the diseases with a substantial economic burden; the disease, specifically in extreme cases, can be too expensive and costly for patients. Therefore, patients should be protected against more severe stages of the disease through proper treatment and early diagnosis. PMID:25977694

Estimation of the costs of cervical cancer screening, diagnosis and treatment in rural Shanxi Province, China: a micro-costing study

PubMed Central

2012-01-01

Background Cost estimation is a central feature of health economic analyses. The aim of this study was to use a micro-costing approach and a societal perspective to estimate aggregated costs associated with cervical cancer screening, diagnosis and treatment in rural China. Methods We assumed that future screening programs will be organized at a county level (population ~250,000), and related treatments will be performed at county or prefecture hospitals; therefore, this study was conducted in a county and a prefecture hospital in Shanxi during 2008–9. Direct medical costs were estimated by gathering information on quantities and prices of drugs, supplies, equipment and labour. Direct non-medical costs were estimated via structured patient interviews and expert opinion. Results Under the base case assumption of a high-volume screening initiative (11,475 women screened annually per county), the aggregated direct medical costs of visual inspection, self-sampled careHPV (Qiagen USA) screening, clinician-sampled careHPV, colposcopy and biopsy were estimated as US$2.64,$7.49,$7.95,$3.90 and $5.76, respectively. Screening costs were robust to screening volume (<5% variation if 2,000 women screened annually), but costs of colposcopy/biopsy tripled at the lower volume. Direct medical costs of Loop Excision, Cold-Knife Conization and Simple and Radical Hysterectomy varied from $61–544, depending on the procedure and whether conducted at county or prefecture level. Direct non-medical expenditure varied from $0.68–$3.09 for screening/diagnosis and $83–$494 for pre-cancer/cancer treatment. Conclusions Diagnostic costs were comparable to screening costs for high-volume screening but were greatly increased in lower-volume situations, which is a key consideration for the scale-up phase of new programs. The study’s findings will facilitate cost-effectiveness evaluation and budget planning for cervical cancer prevention initiatives in China. PMID:22624619

Cost of illness of cystic fibrosis in Germany: results from a large cystic fibrosis centre.

PubMed

Heimeshoff, Mareike; Hollmeyer, Helge; Schreyögg, Jonas; Tiemann, Oliver; Staab, Doris

2012-09-01

Cystic fibrosis (CF) is the most common life-shortening genetic disorder among Whites worldwide. Because many of these patients experience chronic endobronchial colonization and have to take antibiotics and be treated as inpatients, societal costs of CF may be high. As the disease severity varies considerably among patients, costs may differ between patients. Our objectives were to calculate the average total costs of CF per patient and per year from a societal perspective; to include all direct medical and non-medical costs as well as indirect costs; to identify the main cost drivers; to investigate whether patients with CF can be grouped into homogenous cost groups; and to determine the influence of specific factors on different cost categories. Resource utilization data were collected for 87 patients admitted to an inpatient unit at a CF treatment centre during the first 6 months of 2004 and 125 patients who visited the centre's CF outpatient unit during the entire year. Fifty-four patients were admitted to the hospital and also visited the outpatient unit. Since all patients were exclusively treated at the centre, data could be aggregated. Costs that varied greatly between patients were measured per patient. The remaining costs were summarized as overhead costs and allocated on the basis of days of treatment or contacts per patient. Costs of the outpatient and inpatient units and costs for drugs patients received at the outpatient pharmacy were summarized as direct medical costs. Direct non-medical costs (i.e. travel expenses), as well as indirect costs (i. e. absence from work, productivity losses), were also included in the analysis. Main cost drivers were detected by the analysis of different cost categories. Patients were classified according to a diagnosis-related severity model, and median comparison tests (Wilcoxon-Mann-Whitney tests) were performed to investigate differences between the severity groups. Generalized least squares (GLS) regressions were used to identify variables influencing different cost categories. A sensitivity analysis using Monte Carlo simulation was performed. The mean total cost per patient per year was &U20AC;41 468 (year 2004 values). Direct medical costs accounted for more than 90% of total costs and averaged &U20AC;38 869 (&U20AC;3876 to &U20AC;88 096), whereas direct non-medical costs were minimal. Indirect costs amounted to &U20AC;2491 (6% of total costs). Costs for drugs patients received at the outpatient pharmacy were the main cost driver. Costs rose with the degree of severity. Patients with moderate and severe disease had significantly higher direct costs than the relatively milder group. Regression analysis revealed that direct costs were mainly affected by the diagnosis-related severity level and the expiratory volume; the coefficient indicating the relationship between costs for mild CF patients and other patients rose with the degree of severity. A similar result was obtained for drug costs per patient as the dependent variable. Monte Carlo simulation suggests that there is a 90% probability that annual costs will be lower than &U20AC;37 300. The share of indirect costs as a percentage of total costs for CF was rather low in this study. However, the relevance of indirect costs is likely to increase in the future as the life expectancy of CF patients increases, which is likely to lead to a rising work disability rate and thus increase indirect costs. Moreover we found that infection with Pseudomonas aeruginosa increases costs substantially. Thus, a decrease of the prevalence of P. aeruginosa would lead to substantial savings for society.

Cost-minimization analysis of the direct costs of TPE and IVIg in the treatment of Guillain-Barré syndrome

PubMed Central

2011-01-01

Background Controlled trials have found therapeutic plasma exchange (TPE) and intravenous immunoglobulin (IVIg) infusion therapy to be equally efficacious in treating Guillain-Barré syndrome (GBS). Due to increases in the price of IVIg compared to human serum albumin (HSA), used as a replacement fluid in TPE, we examined direct hospital-level expenditures for TPE and IVIg for meaningful cost-differences between these treatments. Methods Using financial data from our two institutions, hospital cost profiles for IVIg and 5% albumin were established. Reimbursement amounts were obtained from publicly available Medicare data resources to determine payment rates for TPE, non-tunneled central catheter line placement, and drug infusion therapy. A model was developed which allows hospitals to input cost and reimbursement amounts for both IVIg and TPE with HSA that results in real-time valuations of these interventions. Results The direct cost of five IVIg infusion sessions totaling 2.0 grams per kilogram (g/kg) body weight was $10,329.85 compared to a series of five TPE procedures, which had direct costs of $4,638.16. Conclusions In GBS patients, direct costs of IVIg therapy are more than twice that of TPE. Given equivalent efficacy and similar severity and frequencies of adverse events, TPE appears to be a less expensive first-line therapy option for treatment of patients with GBS. PMID:21575219

Primary vs Conversion Total Hip Arthroplasty: A Cost Analysis

PubMed Central

Chin, Garwin; Wright, David J.; Snir, Nimrod; Schwarzkopf, Ran

2018-01-01

Introduction Increasing hip fracture incidence in the United States is leading to higher occurrences of conversion total hip arthroplasty (THA) for failed surgical treatment of the hip. In spite of studies showing higher complication rates in conversion THA, the Centers for Medicare and Medicaid services currently bundles conversion and primary THA under the same diagnosis-related group. We examined the cost of treatment of conversion THA compared with primary THA. Our hypothesis is that conversion THA will have higher cost and resource use than primary THA. Methods Fifty-one consecutive conversion THA patients (Current Procedure Terminology code 27132) and 105 matched primary THA patients (Current Procedure Terminology code 27130) were included in this study. The natural log-transformed costs for conversion and primary THA were compared using regression analysis. Age, gender, body mass index, American Society of Anesthesiologist, Charlson comorbidity score, and smoker status were controlled in the analysis. Conversion THA subgroups formed based on etiology were compared using analysis of variance analysis. Results Conversion and primary THAs were determined to be significantly different (P < .05) and greater in the following costs: hospital operating direct cost (29.2% greater), hospital operating total cost (28.8% greater), direct hospital cost (24.7% greater), and total hospital cost (26.4% greater). Conclusions Based on greater hospital operating direct cost, hospital operating total cost, direct hospital cost, and total hospital cost, conversion THA has significantly greater cost and resource use than primary THA. In order to prevent disincentives for treating these complex surgical patients, reclassification of conversion THA is needed, as they do not fit together with primary THA. PMID:26387923

Costs of Dengue to the Health System and Individuals in Colombia from 2010 to 2012

PubMed Central

Rodriguez, Raul Castro; Galera-Gelvez, Katia; Yescas, Juan Guillermo López; Rueda-Gallardo, Jorge A.

2015-01-01

Dengue fever (DF) is an important health issue in Colombia, but detailed information on economic costs to the healthcare system is lacking. Using information from official databases (2010–2012) and a face-to-face survey of 1,483 households with DF and dengue hemorrhagic fever (DHF) patients, we estimated the average cost per case. In 2010, the mean direct medical costs to the healthcare system per case of ambulatory DF, hospitalized DF, and DHF (in Colombian pesos converted to US dollars using the average exchange rate for 2012) were $52.8, $235.8, and $1,512.2, respectively. The mean direct non-medical costs to patients were greater ($29.7, $46.7, and $62.6, respectively) than the mean household direct medical costs ($13.3, $34.8, and $57.3, respectively). The average direct medical cost to the healthcare system of a case of ambulatory DF in 2010 was 57% of that in 2011. Our results highlight the high economic burden of the disease and could be useful for assigning limited health resources. PMID:25667054

Management of leg and pressure ulcer in hospitalized patients: direct costs are lower than expected.

PubMed

Assadian, Ojan; Oswald, Joseph S; Leisten, Rainer; Hinz, Peter; Daeschlein, Georg; Kramer, Axel

2011-01-01

In Germany, cost calculations on the financial burden of wound treatment are scarce. Studies for attributable costs in hospitalized patients estimate for pressure ulcer additional costs of € 6,135.50 per patient, a calculation based on the assumption that pressure ulcers will lead to prolonged hospitalization averaging 2 months. The scant data available in this field prompted us to conduct a prospective economical study assessing the direct costs of treatment of chronic ulcers in hospitalized patients. The study was designed and conducted as an observational, prospective, multi-centre economical study over a period of 8 months in three community hospitals in Germany. Direct treatment costs for leg ulcer (n=77) and pressure ulcer (n=35) were determined observing 67 patients (average age: 75±12 years). 109 treatments representing 111 in-ward admissions and 62 outpatient visits were observed. During a total of 3,331 hospitalized and 867 outpatient wound therapies, 4,198 wound dressing changes were documented. Costs of material were calculated on a per item base. Direct costs of care and treatment, including materials used, surgical interventions, and personnel costs were determined. An average of € 1,342 per patient (€ 48/d) was spent for treatment of leg ulcer (staff costs € 581, consumables € 458, surgical procedures € 189, and diagnostic procedures € 114). On average, each wound dressing change caused additional costs of € 15. For pressure ulcer, € 991 per patient (€ 52/d) was spent on average (staff costs € 313, consumables € 618, and for surgical procedures € 60). Each wound dressing change resulted in additional costs of € 20 on average. When direct costs of chronic wounds are calculated on a prospective case-by-case basis for a treatment period over 3 months, these costs are lower than estimated to date. While reduction in prevalence of chronic wounds along with optimised patient care will result in substantial cost saving, this saving might be lower than expected. Our results, however, do not serve as basis for making any conclusions on cost-benefit analysis for both, the affected individual, as well as for the society.

The Economic Cost of Environmental Factors Among North Carolina Children Living in Substandard Housing

PubMed Central

Estes, Chris; Lee, Christopher

2009-01-01

Objectives. We quantified the economic cost of selected environmental factors among North Carolina children living in substandard housing. Methods. We gathered data on direct medical care costs for specific childhood medical conditions associated with environmental factors commonly found in substandard housing. Medical claims data for 2006 and 2007 were obtained from BlueCross BlueShield of North Carolina and the North Carolina Department of Health and Human Services. Indirect costs were based in part on nonmedical data obtained from several previous studies. Results. Total (direct and indirect) costs for the conditions assessed exceeded $92 million in 2006 and $108 million in 2007. Neurobehavioral conditions contributed to more than 52% of all costs, followed by lead poisoning (20%) and respiratory conditions (12%). Neurobehavioral conditions were the largest contributor to direct medical costs (44%), followed by respiratory conditions (38%) and accidental burns and falls (10%). Conclusions. Direct and indirect costs associated with environmental factors appear to be increasing at about twice the rate of medical inflation. More aggressive policies and funding are needed to reduce the substantial financial impact of childhood illnesses associated with substandard housing in North Carolina. PMID:19890173

Direct Diabetes-Related Costs in Young Patients with Early-Onset, Long-Lasting Type 1 Diabetes

PubMed Central

Straßburger, Klaus; Flechtner-Mors, Marion; Hungele, Andreas; Beyer, Peter; Placzek, Kerstin; Hermann, Ulrich; Schumacher, Andrea; Freff, Markus; Stahl-Pehe, Anna

2013-01-01

Objective To estimate diabetes-related direct health care costs in pediatric patients with early-onset type 1 diabetes of long duration in Germany. Research Design and Methods Data of a population-based cohort of 1,473 subjects with type 1 diabetes onset at 0–4 years of age within the years 1993–1999 were included (mean age 13.9 (SD 2.2) years, mean diabetes duration 10.9 (SD 1.9) years, as of 31.12.2007). Diabetes-related health care services utilized in 2007 were derived from a nationwide prospective documentation system (DPV). Health care utilization was valued in monetary terms based on inpatient and outpatient medical fees and retail prices (perspective of statutory health insurance). Multiple regression models were applied to assess associations between direct diabetes-related health care costs per patient-year and demographic and clinical predictors. Results Mean direct diabetes-related health care costs per patient-year were €3,745 (inter-quartile range: 1,943–4,881). Costs for glucose self-monitoring were the main cost category (28.5%), followed by costs for continuous subcutaneous insulin infusion (25.0%), diabetes-related hospitalizations (22.1%) and insulin (18.4%). Female gender, pubertal age and poor glycemic control were associated with higher and migration background with lower total costs. Conclusions Main cost categories in patients with on average 11 years of diabetes duration were costs for glucose self-monitoring, insulin pump therapy, hospitalization and insulin. Optimization of glycemic control in particular in pubertal age through intensified care with improved diabetes education and tailored insulin regimen, can contribute to the reduction of direct diabetes-related costs in this patient group. PMID:23967077

Social/economic costs and health-related quality of life in patients with epidermolysis bullosa in Europe.

PubMed

Angelis, Aris; Kanavos, Panos; López-Bastida, Julio; Linertová, Renata; Oliva-Moreno, Juan; Serrano-Aguilar, Pedro; Posada-de-la-Paz, Manuel; Taruscio, Domenica; Schieppati, Arrigo; Iskrov, Georgi; Brodszky, Valentin; von der Schulenburg, Johann Matthias Graf; Chevreul, Karine; Persson, Ulf; Fattore, Giovanni

2016-04-01

The aim of this study was to determine the social/economic costs and health-related quality of life (HRQOL) of patients with epidermolysis bullosa (EB) in eight EU member states. We conducted a cross-sectional study of patients with EB from Bulgaria, France, Germany, Hungary, Italy, Spain, Sweden and the United Kingdom. Data on demographic characteristics, health resource utilisation, informal care, labour productivity losses, and HRQOL were collected from the questionnaires completed by patients or their caregivers. HRQOL was measured with the EuroQol 5-domain (EQ-5D) questionnaire. A total of 204 patients completed the questionnaire. Average annual costs varied from country to country, and ranged from €9509 to €49,233 (reference year 2012). Estimated direct healthcare costs ranged from €419 to €10,688; direct non-healthcare costs ranged from €7449 to €37,451 and labour productivity losses ranged from €0 to €7259. The average annual cost per patient across all countries was estimated at €31,390, out of which €5646 accounted for direct health costs (18.0 %), €23,483 accounted for direct non-healthcare costs (74.8 %), and €2261 accounted for indirect costs (7.2 %). Costs were shown to vary across patients with different disability but also between children and adults. The mean EQ-5D score for adult EB patients was estimated at between 0.49 and 0.71 and the mean EQ-5D visual analogue scale score was estimated at between 62 and 77. In addition to its negative impact on patient HRQOL, our study indicates the substantial social/economic burden of EB in Europe, attributable mostly to high direct non-healthcare costs.

The cost of open heart surgery in Nigeria.

PubMed

Falase, Bode; Sanusi, Michael; Majekodunmi, Adetinuwe; Ajose, Ifeoluwa; Idowu, Ariyo; Oke, David

2013-01-01

Open Heart Surgery (OHS) is not commonly practiced in Nigeria and most patients who require OHS are referred abroad. There has recently been a resurgence of interest in establishing OHS services in Nigeria but the cost is unknown. The aim of this study was to determine the direct cost of OHS procedures in Nigeria. The study was performed prospectively from November to December 2011. Three concurrent operations were selected as being representative of the scope of surgery offered at our institution. These procedures were Atrial Septal Defect (ASD) Repair, Off Pump Coronary Artery Bypass Grafting (OPCAB) and Mitral Valve Replacement (MVR). Cost categories contributing to direct costs of OHS (Investigations, Drugs, Perfusion, Theatre, Intensive Care, Honorarium and Hospital Stay) were tracked to determine the total direct cost for the 3 selected OHS procedures. ASD repair cost $ 6,230 (Drugs $600, Intensive Care $410, Investigations $955, Perfusion $1080, Theatre $1360, Honorarium $925, Hospital Stay $900). OPCAB cost $8,430 (Drugs $740, Intensive Care $625, Investigations $3,020, Perfusion $915, Theatre $1305, Honorarium $925, Hospital Stay $900). MVR with a bioprosthetic valve cost $11,200 (Drugs $1200, Intensive Care $500, Investigations $3040, Perfusion $1100, Theatre $3,535, Honorarium $925, Hospital Stay $900). The direct cost of OHS in Nigeria currently ranges between $6,230 and $11,200. These costs compare favorably with the cost of OHS abroad and can serve as a financial incentive to patients, sponsors and stakeholders to have OHS procedures done in Nigeria.

Perineal tap water burns in the elderly: at what cost?

PubMed

Potter, Michael D E; Maitz, Peter K M; Kennedy, Peter J; Goltsman, David

2017-11-01

Burn injuries are expensive to treat. Burn injuries have been found to be difficult to treat in elderly patients than their younger counterparts. This is likely to result in higher financial burden on the healthcare system; however, no population-specific study has been conducted to ascertain the inpatient treatment costs of elderly patients with hot tap water burns. Six elderly patients (75-92 years) were admitted for tap water burns at Concord Hospital during 2010. All costs incurred during their hospitalization were followed prospectively, and were apportioned into 'direct' and 'indirect' costs. Direct costs encompassed directly measurable costs, such as consumables used on the ward or in theatres, and indirect costs included hospital overheads, such as bed and theatre costs. Three males and three females admitted with burns to the buttocks, legs or feet. Total burn surface area (TBSA) ranged from 9-21% (mean 12.8%). Length of stay ranged from 26-98 days (mean 46 days). One patient died, and four required surgical management or grafting. Total inpatient costs ranged from $69 782.33 to $254 652.70 per patient (mean $122 800.20, standard deviation $67 484.46). TBSA was directly correlated with length of stay (P < 0.01) and total cost (P < 0.01). Hot water burns among the elderly are associated with high treatment costs, which are proportional to the size of the burn. The cost of treating this cohort is higher than previously reported in a general Australian burn cohort. © 2016 Royal Australasian College of Surgeons.

A cost-minimisation study of 1,001 NHS Direct users.

PubMed

Lambert, Rod; Fordham, Richard; Large, Shirley; Gaffney, Brian

2013-08-08

To determine financial and quality of life impact of patients calling the '0845' NHS Direct (NHS Direct) telephone helpline from the perspective of NHS service providers. Cost-minimisation of repeated cohort measures from a National Survey of NHS Direct's telephone service using telephone survey results. 1,001 people contacting NHS Direct's 0845 telephone service in 2009 who agreed to a 4-6 week follow-up. A cost comparison between NHS Direct recommendation and patient-stated first alternative had NHS Direct not been available. Analysis also considers impact on quality of life of NHS Direct recommendations using the Visual Analogue Scale of the EQ-5D. Significant referral pattern differences were observed between NHS Direct recommendation and patient-stated first alternatives (p < 0.001). Per patient cost savings resulted from NHS Direct's recommendation to attend A&E (£36.54); GP Practice (£19.41); Walk-In Centre (£49.85); Pharmacist (£25.80); Dentist (£2.35) and do nothing/treat at home (£19.77), while it was marginally more costly for 999 calls (£3.33). Overall an average per patient saving of £19.55 was found (a 36% saving compared with patient-stated first alternatives). For 5 million NHS Direct telephone calls per year, this represents an annual cost saving of £97,756,013. Significant quality of life differences were observed at baseline and follow-up between those who believed their problem was 'urgent' (p = 0.001) and those who said it was 'non-urgent' (p = 0.045). Whilst both groups improved, self-classified 'urgent' cases made greater health gains than those who said they were 'non-urgent' (urgent by 21.5 points; non-urgent by 16.1 points). The '0845' service of NHS Direct produced substantial cost savings in terms of referrals to the other parts of the NHS when compared with patients' own stated first alternative. Health-related quality of life also improved for users of this service demonstrating that these savings can be produced without perceived harm to patients.

Cost-effectiveness of Recruitment Methods in an Obesity Prevention Trial for Young Children

PubMed Central

Robinson, Jodie L.; Fuerch, Janene H.; Winiewicz, Dana D.; Salvy, Sarah J.; Roemmich, James N.; Epstein, Leonard H.

2007-01-01

Background Recruitment of participants for clinical trials requires considerable effort and cost. There is no research on the cost-effectiveness of recruitment methods for an obesity prevention trial of young children. Methods This study determined the cost-effectiveness of recruiting 70 families with a child aged 4 to 7 (5.9 ± 1.3) years in Western New York from February, 2003 to November, 2004, for a two year randomized obesity prevention trial to reduce television watching in the home. Results Of the 70 randomized families, 65.7% (n = 46) were obtained through direct mailings, 24.3% (n = 17) were acquired through newspaper advertisements, 7.1 % (n = 5) from other sources (e.g. word of mouth), and 2.9% (n = 2) through posters and brochures. Costs of each recruitment method were computed by adding the cost of materials, staff time, and media expenses. Cost-effectiveness (money spent per randomized participant) was US $0 for other sources, US $227.76 for direct mailing, US $546.95 for newspaper ads, and US $3,020.84 for posters and brochures. Conclusion Of the methods with associated costs, direct mailing was the most cost effective in recruiting families with young children, which supports the growing literature of the effectiveness of direct mailing. PMID:17475318

Cost effectiveness of recruitment methods in an obesity prevention trial for young children.

PubMed

Robinson, Jodie L; Fuerch, Janene H; Winiewicz, Dana D; Salvy, Sarah J; Roemmich, James N; Epstein, Leonard H

2007-06-01

Recruitment of participants for clinical trials requires considerable effort and cost. There is no research on the cost effectiveness of recruitment methods for an obesity prevention trial of young children. This study determined the cost effectiveness of recruiting 70 families with a child aged 4 to 7 (5.9+/-1.3) years in Western New York from February 2003 to November 2004, for a 2-year randomized obesity prevention trial to reduce television watching in the home. Of the 70 randomized families, 65.7% (n=46) were obtained through direct mailings, 24.3% (n=17) were acquired through newspaper advertisements, 7.1% (n=5) from other sources (e.g., word of mouth), and 2.9% (n=2) through posters and brochures. Costs of each recruitment method were computed by adding the cost of materials, staff time, and media expenses. Cost effectiveness (money spent per randomized participant) was US $0 for other sources, US $227.76 for direct mailing, US $546.95 for newspaper ads, and US $3,020.84 for posters and brochures. Of the methods with associated costs, direct mailing was the most cost effective in recruiting families with young children, which supports the growing literature of the effectiveness of direct mailing.

AB064. Estimation of direct and indirect costs and quality of life of patients with chronic obstructive pulmonary disease and their burden on Greek Health System

PubMed Central

Zarogoulidou, Vasiliki; Arbanitidou-Bagiona, Maria; Papakosta, Despoina; Zarogoulidis, Paul; Porpodis, Konstantinos; Panagopoulou, Evaggelia; Chaidits, Athanasios Basileio; Kontakiotis, Theodore; Zarogoulidis, Konstantinos

2016-01-01

Background The aim of this study was to make an attempt to estimate the direct and indirect costs of chronic obstructive pulmonary disease since in Greece very few attempts have been done to measure these costs and data available are insufficient. Our research focused on evaluating these direct and indirect costs according to demographic factors, response to treatment, patient survival, quality of life and patient satisfaction from the health care services provided. Methods This study was performed in Pulmonary Department of Aristotle University of Thessaloniki, General Hospital “G. Papanikolaou” and 110 patients with chronic obstructive pulmonary disease were enrolled. The follow-up duration of the patients was two years from the time of diagnosis. First, for study purposes the calculation of direct and indirect costs were performed and their correlations with patients’ demographics (gender, age, profession, place of residence), number of exacerbations, response to treatment and survival. In parallel, every three months from the time of diagnosis patients’ quality of life was recorded, using questionnaires, which was also correlated with the direct and indirect costs of each disease under investigation. The exploration of patient satisfaction from the health services provided was performed once for each patient during the first hospital stay in the Pulmonary Department of Aristotle University of Thessaloniki, General Hospital “G. Papanikolaou”. Results The total mean costs per patient in a one year follow-up was: total mean direct cost: 3.889,08€, total mean indirect cost: 18.01€. In chronic obstructive pulmonary disease (COPD) higher costs were observed in patients over 70 years old, of secondary education and pensioners, while for bronchial asthma higher costs were observed mainly in women. The disease severity, the frequency of exacerbations and the need for hospitalization significantly increased the economic burden of Greek health care system. The increase of the medication and patients’ monitoring cost resulted in improved control of the disease. Patients with COPD showed stable or deteriorating quality of life during the 12 month period of time. At 24 months of follow-up, patients with COPD reported improved quality of life compared to diagnosis. Improved the quality of life was associated with increased direct and indirect costs. The increased costs that were partly the result of frequent examinations, treatments and visits to the doctor, seemed to have negatively affected the emotional state of patients. Improved quality of life in COPD patients was related with reduced direct and indirect costs. Patient satisfaction from the provided health services could not be assessed as there was no homogeneity among the questions of the questionnaire used for the study. Future research should be made for the development of a reliable tool for recording patient satisfaction from the provided health services in hospitals of our country. Conclusions The higher annual burden of COPD patients is probably due to the infectious exacerbations COPD patients experience, which usually leads them to hospitalization. Patients quality of life is influenced from a variety of factors and was correlated with direct or/and indirect hospitalisation and/or monitoring cost.

Pre- and post-diagnosis costs of tuberculosis to patients on Directly Observed Treatment Short course in districts of southwestern Ethiopia: a longitudinal study.

PubMed

Asres, Abyot; Jerene, Degu; Deressa, Wakgari

2018-05-21

Financial burden on tuberculosis (TB) patients results in delayed treatment and poor compliance. We assessed pre- and post-diagnosis costs to TB patients. A longitudinal study among 735 new TB cases was conducted from January 2015 through June 2016 in 10 woredas (districts) of southwestern Ethiopia. Direct out-of-pocket, payments, and lost income (indirect cost) were solicited from patients during the first 2 months and at the end of treatment. Thus, we ascertained direct medical, nonmedical, and indirect costs incurred by patients during pre- and post-diagnosis periods. We categorized costs incurred from onset of illness until TB diagnosis as pre-diagnosis and that incurred after diagnosis through treatment completion as post-diagnosis. Pre- and post-diagnosis costs constitute total cost incurred by the patients. We fitted linear regression model to identify predictors of cost. Between onset of illness and anti-TB treatment course, patients incurred a median (inter-quartile range (IQR)) of US$201.48 (136.7-318.94). Of the total cost, the indirect and direct costs respectively constituted 70.6 and 29.4%. TB patients incurred a median (IQR) of US$97.62 (6.43-184.22) and US$93.75 (56.91-141.54) during the pre- and post-diagnosis periods, respectively. Thus, patients incurred 53.6% of the total cost during the pre-diagnosis period. Direct out-of-pocket expenses during the pre- and post-diagnosis periods respectively amount to median (IQR) of US$21.64 (10.23-48.31) and US$35.02 (0-70.04). Patient delay days (p < 0.001), provider delay days (p < 0.001), number of healthcare facilities visited until TB diagnosis (p < 0.001), and TB diagnosis at private facilities (p = 0.02) independently predicted increased pre-diagnosis cost. Similarly, rural residence (p < 0.001), hospitalization during anti-TB treatment (p < 0.001), patient delay days (p < 0.001), and provider delay days (p < 0.001) predicted increased post-diagnosis costs. TB patients incur substantial cost for care seeking and treatment despite "free service" for TB. Therefore, promoting early care seeking, decentralizing efficient diagnosis, and treatment services within reach of peoples, and introducing reimbursement system for direct costs can help minimize financial burden to the patient.

Cost-of-Illness Analysis of Type 2 Diabetes Mellitus in Iran

PubMed Central

Javanbakht, Mehdi; Baradaran, Hamid R.; Mashayekhi, Atefeh; Haghdoost, Ali Akbar; Khamseh, Mohammad E.; Kharazmi, Erfan; Sadeghi, Aboozar

2011-01-01

Introduction Diabetes is a worldwide high prevalence chronic progressive disease that poses a significant challenge to healthcare systems. The aim of this study is to provide a detailed economic burden of diagnosed type 2 diabetes mellitus (T2DM) and its complications in Iran in 2009 year. Methods This is a prevalence-based cost-of-illness study focusing on quantifying direct health care costs by bottom-up approach. Data on inpatient hospital services, outpatient clinic visits, physician services, drugs, laboratory test, education and non-medical cost were collected from two national registries. The human capital approach was used to calculate indirect costs separately in male and female and also among different age groups. Results The total national cost of diagnosed T2DM in 2009 is estimated at 3.78 billion USA dollars (USD) including 2.04±0.28 billion direct (medical and non-medical) costs and indirect costs of 1.73 million. Average direct and indirect cost per capita was 842.6±102 and 864.8 USD respectively. Complications (48.9%) and drugs (23.8%) were main components of direct cost. The largest components of medical expenditures attributed to diabetes's complications are cardiovascular disease (42.3% of total Complications cost), nephropathy (23%) and ophthalmic complications (14%). Indirect costs include temporarily disability (335.7 million), permanent disability (452.4 million) and reduced productivity due to premature mortality (950.3 million). Conclusions T2DM is a costly disease in the Iran healthcare system and consume more than 8.69% of total health expenditure. In addition to these quantified costs, T2DM imposes high intangible costs on society in terms of reduced quality of life. Identification of effective new strategies for the control of diabetes and its complications is a public health priority. PMID:22066013

Patterns of Cost for Patients Dying in the Intensive Care Unit and Implications for Cost Savings of Palliative Care Interventions

PubMed Central

Benkeser, David; Coe, Norma B.; Engelberg, Ruth A.; Teno, Joan M.; Curtis, J. Randall

2016-01-01

Abstract Background: Terminal intensive care unit (ICU) stays represent an important target to increase value of care. Objective: To characterize patterns of daily costs of ICU care at the end of life and, based on these patterns, examine the role for palliative care interventions in enhancing value. Design: Secondary analysis of an intervention study to improve quality of care for critically ill patients. Setting/Patients: 572 patients who died in the ICU between 2003 and 2005 at a Level-1 trauma center. Methods: Data were linked with hospital financial records. Costs were categorized into direct fixed, direct variable, and indirect costs. Patterns of daily costs were explored using generalized estimating equations stratified by length of stay, cause of death, ICU type, and insurance status. Estimates from the literature of effects of palliative care interventions on ICU utilization were used to simulate potential cost savings under different time horizons and reimbursement models. Main Results: Mean cost for a terminal ICU stay was 39.3K ± 45.1K. Direct fixed costs represented 45% of total hospital costs, direct variable costs 20%, and indirect costs 34%. Day of admission was most expensive (mean 9.6K ± 7.6K); average cost for subsequent days was 4.8K ± 3.4K and stable over time and patient characteristics. Conclusions: Terminal ICU stays display consistent cost patterns across patient characteristics. Savings can be realized with interventions that align care with patient preferences, helping to prevent unwanted ICU utilization at end of life. Cost modeling suggests that implications vary depending on time horizon and reimbursement models. PMID:27813724

Economic evaluation of the societal costs of hepatitis B in South Korea.

PubMed

Yang, B M; Paik, S W; Hahn, O S; Yi, D H; Choi, M S; Payne, S

2001-03-01

Hepatitis B (HBV) infection remains a major public health problem in South Korea, and accounts for considerable morbidity and mortality. At present, very little is known about the cost of HBV to the South Korean health-care system and society. The present study was therefore conducted to estimate the total annual cost of HBV infection in South Korea for a given year (1997). The study was conducted from the South Korean societal perspective, taking into account the direct and indirect costs of HBV vaccination programs (prevention costs), and those related to the treatment of acute and chronic hepatitis, cirrhosis and liver cancer (disease costs). Several assumptions were made in arriving to actual cost estimates. The total societal cost of HBV in 1997 was 1078.3 billion Won ($US 959.7 million), 142.3 billion Won or 13.2% being attributable to prevention costs and 225.4 billion Won or 20.9% being attributable to indirect costs of HBV-related diseases. The total cost (direct plus indirect) associated with HBV-related diseases to the South Korean society was 936.1 billion Won ($US 833.1 million), of which 45.3% was attributable to cirrhosis-related costs. In terms of disease-related direct costs alone (710.5 billion Won or $US 632.3 million), the estimated annual spending per patient was 1.37 million Won ($US 1219). The direct costs of the HBV disease (prevention and disease treatment, amounting to 782.2 billion Won or $US 696.2 million) is equivalent to 3.2% of the national health-care expenditure for 1997. This study confirms that HBV is a significant cost burden to the South Korean society, and in the absence of an effective cure reinforces the importance of continued disease prevention via vaccination.

The cost of chronic pain: an analysis of a regional pain management service in Ireland.

PubMed

Gannon, Brenda; Finn, David P; O'Gorman, David; Ruane, Nancy; McGuire, Brian E

2013-10-01

The objective of the study was to collect data on the direct and indirect economic cost of chronic pain among patients attending a pain management clinic in Ireland. A tertiary pain management clinic serving a mixed urban and rural area in the West of Ireland. Data were collected from 100 patients using the Client Services Receipt Inventory and focused on direct and indirect costs of chronic pain. Patients were questioned about health service utilization, payment methods, and relevant sociodemographics. Unit costs were multiplied by resource use data to obtain full costs. Cost drivers were then estimated. Our study showed a cost per patient of US$24,043 over a 12-month period. Over half of this was attributable to wage replacement costs and lost productivity in those unable to work because of pain. Hospital stays and outpatient hospital services were the main drivers for health care utilization costs, together accounting for 63% of the direct medical costs per study participant attending the pain clinic. The cost of chronic pain among intensive service users is significant, and when extrapolated to a population level, these costs represent a very substantial economic burden. Wiley Periodicals, Inc.

The cost of accessing infant HIV medications and health services in Uganda.

PubMed

Bergmann, Julie N; Wanyenze, Rhoda K; Stockman, Jamila K

2017-11-01

Patient costs are a critical barrier to the elimination of mother to child HIV transmission. Despite the Ugandan government providing free public HIV services, infant antiretroviral (ARV) prophylaxis coverage remains low (25%). To understand costs mothers incur in accessing ARV prophylaxis for their infants, we conducted a mixed methods study to quantify and identify their direct costs. We used cross-sectional survey data and focus group discussions from 49 HIV-positive mothers in Uganda. Means and standard deviations were calculated for the direct costs (e.g., transportation, caretaker, services/medications) involved in accessing infant HIV services. The direct cost of attending HIV clinic visits averaged $3.71 (SD = $3.52). Focus group discussions identified two costs hindering access to infant HIV services: transportation costs and informal service charges. All participants reported significant costs associated with accessing infant HIV services - the equivalent of 2-3 days' income. To address transportation costs, community and home care models should be explored. Additionally, stricter policies and oversight should be implemented to prevent informal HIV service charges.

Economic analysis of threatened species conservation: The case of woodland caribou and oilsands development in Alberta, Canada.

PubMed

Hauer, Grant; Vic Adamowicz, W L; Boutin, Stan

2018-07-15

Tradeoffs between cost and recovery targets for boreal caribou herds, threatened species in Alberta, Canada, are examined using a dynamic cost minimization model. Unlike most approaches used for minimizing costs of achieving threatened species targets, we incorporate opportunity costs of surface (forests) and subsurface resources (energy) as well as direct costs of conservation (habitat restoration and direct predator control), into a forward looking model of species protection. Opportunity costs of conservation over time are minimized with an explicit target date for meeting species recovery targets; defined as the number of self-sustaining caribou herds, which requires that both habitat and population targets are met by a set date. The model was run under various scenarios including three species recovery criteria, two oil and gas price regimes, and targets for the number of herds to recover from 1 to 12. The derived cost curve follows a typical pattern as costs of recovery per herd increase as the number of herds targeted for recovery increases. The results also show that the opportunity costs for direct predator control are small compared to habitat restoration and protection costs. However, direct predator control is essential for meeting caribou population targets and reducing the risk of extirpation while habitat is recovered over time. Copyright © 2018 Elsevier Ltd. All rights reserved.

Direct medical costs of accidental falls for adults with transfemoral amputations.

PubMed

Mundell, Benjamin; Maradit Kremers, Hilal; Visscher, Sue; Hoppe, Kurtis; Kaufman, Kenton

2017-12-01

Active individuals with transfemoral amputations are provided a microprocessor-controlled knee with the belief that the prosthesis reduces their risk of falling. However, these prostheses are expensive and the cost-effectiveness is unknown with regard to falls in the transfemoral amputation population. The direct medical costs of falls in adults with transfemoral amputations need to be determined in order to assess the incremental costs and benefits of microprocessor-controlled prosthetic knees. We describe the direct medical costs of falls in adults with a transfemoral amputation. This is a retrospective, population-based, cohort study of adults who underwent transfemoral amputations between 2000 and 2014. A Bayesian structural time series approach was used to estimate cost differences between fallers and non-fallers. The mean 6-month direct medical costs of falls for six hospitalized adults with transfemoral amputations was US$25,652 (US$10,468, US$38,872). The mean costs for the 10 adults admitted to the emergency department was US$18,091 (US$-7,820, US$57,368). Falls are expensive in adults with transfemoral amputations. The 6-month costs of falls resulting in hospitalization are similar to those reported in the elderly population who are also at an increased risk of falling. Clinical relevance Estimates of fall costs in adults with transfemoral amputations can provide policy makers with additional insight when determining whether or not to cover a prescription for microprocessor-controlled prosthetic knees.

The annual global economic burden of heart failure.

PubMed

Cook, Christopher; Cole, Graham; Asaria, Perviz; Jabbour, Richard; Francis, Darrel P

2014-02-15

Heart failure (HF) imposes both direct costs to healthcare systems and indirect costs to society through morbidity, unpaid care costs, premature mortality and lost productivity. The global economic burden of HF is not known. We estimated the overall cost of heart failure in 2012, in both direct and indirect terms, across the globe. Existing country-specific heart failure costs analyses were expressed as a proportion of gross domestic product and total healthcare spend. Using World Bank data, these proportional values were used to interpolate the economic cost of HF for countries of the world where no published data exists. Countries were categorized according to their level of economic development to investigate global patterns of spending. 197 countries were included in the analysis, covering 98.7% of the world's population. The overall economic cost of HF in 2012 was estimated at $108 billion per annum. Direct costs accounted for ~60% ($65 billion) and indirect costs accounted for ~40% ($43 billion) of the overall spend. Heart failure spending varied widely between high-income and middle and low-income countries. High-income countries spend a greater proportion on direct costs: a pattern reversed for middle and low-income countries. Heart failure imposes a huge economic burden, estimated at $108 billion per annum. With an aging, rapidly expanding and industrializing global population this value will continue to rise. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Modular socket system versus traditionally laminated socket: a cost analysis.

PubMed

Normann, Elna; Olsson, Anna; Brodtkorb, Thor-Henrik

2011-03-01

Using the new modular socket system (MSS) to produce a prosthetic socket directly on the patient has the potential of being easier and quicker to manufacture but also incurring higher costs. The purpose of the study was to compare the costs of manufacturing a transtibial prosthetic socket using either a MSS or a standard laminated socket (PC). Concurrent controlled trial. A total of 20 patients at two orthopaedic facilities were followed with regards to the cost of manufacturing a prosthetic socket using either MSS or PC. Time aspects and material costs were considered in the cost analysis. Other factors studied include delivery time and number of visits. For the cost analysis, only direct costs pertaining to the prosthetic socket were considered. The total cost of MSS was found to be significantly higher (p < 0.01) compared to PC. However, the production and time cost was significantly lower. Delivery time to the patient was 1 day for MSS compared to 17 days for PC. Our study shows that the direct prosthetic cost of treating a patient using MSS is significantly higher than treating a patient using PC. However, the MSS prosthesis can be delivered significantly faster and with fewer visits. Further studies taking the full societal costs of MSS into account should therefore be performed. This study shows that the direct prosthetic cost of treating a patient with Modular Socket System is significantly higher than treating a patient with plastercasting with standard laminated socket. However, the Modular Socket System prosthesis can be delivered significantly faster and with fewer visits.

Retrospective Assessment of Cost Savings From Prevention

PubMed Central

Grosse, Scott D.; Berry, Robert J.; Tilford, J. Mick; Kucik, James E.; Waitzman, Norman J.

2016-01-01

Introduction Although fortification of food with folic acid has been calculated to be cost saving in the U.S., updated estimates are needed. This analysis calculates new estimates from the societal perspective of net cost savings per year associated with mandatory folic acid fortification of enriched cereal grain products in the U.S. that was implemented during 1997–1998. Methods Estimates of annual numbers of live-born spina bifida cases in 1995–1996 relative to 1999–2011 based on birth defects surveillance data were combined during 2015 with published estimates of the present value of lifetime direct costs updated in 2014 U.S. dollars for a live-born infant with spina bifida to estimate avoided direct costs and net cost savings. Results The fortification mandate is estimated to have reduced the annual number of U.S. live-born spina bifida cases by 767, with a lower-bound estimate of 614. The present value of mean direct lifetime cost per infant with spina bifida is estimated to be $791,900, or $577,000 excluding caregiving costs. Using a best estimate of numbers of avoided live-born spina bifida cases, fortification is estimated to reduce the present value of total direct costs for each year's birth cohort by $603 million more than the cost of fortification. A lower-bound estimate of cost savings using conservative assumptions, including the upper-bound estimate of fortification cost, is $299 million. Conclusions The estimates of cost savings are larger than previously reported, even using conservative assumptions. The analysis can also inform assessments of folic acid fortification in other countries. PMID:26790341

Incorporating indirect costs into a cost-benefit analysis of laparoscopic adjustable gastric banding.

PubMed

Finkelstein, Eric A; Allaire, Benjamin T; Dibonaventura, Marco Dacosta; Burgess, Somali M

2012-01-01

The objective of this study was to estimate the time to breakeven and 5-year net costs of laparoscopic adjustable gastric banding (LAGB) taking both direct and indirect costs and cost savings into account. Estimates of direct cost savings from LAGB were available from the literature. Although longitudinal data on indirect cost savings were not available, these estimates were generated by quantifying the relationship between medical expenditures and absenteeism and between medical expenditures and presenteeism (reduced on-the-job productivity) and combining these elasticity estimates with estimates of the direct cost savings to generate total savings. These savings were then combined with the direct and indirect costs of the procedure to quantify net savings. By including indirect costs, the time to breakeven was reduced by half a year, from 16 to 14 quarters. After 5 years, net savings in medical expenditures from a gastric banding procedure were estimated to be $4970 (±$3090). Including absenteeism increased savings to $6180 (±$3550). Savings were further increased to $10,960 (±$5864) when both absenteeism and presenteeism estimates were included. This study presented a novel approach for including absenteeism and presenteeism estimates in cost-benefit analyses. Application of the approach to gastric banding among surgery-eligible obese employees revealed that the inclusion of indirect costs and cost savings improves the business case for the procedure. This approach can easily be extended to other populations and treatments. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

19 CFR 10.206 - Value content requirement.

Code of Federal Regulations, 2011 CFR

2011-04-01

... countries, plus the direct costs of processing operations performed in a beneficiary country or countries...)(1) of this part. Any cost or value of materials or direct costs of processing operations...) combining or packaging operations, or mere dilution with water or mere dilution with another substance that...

The National Survey of Stroke. Economic impact.

PubMed

Adelman, S M

1981-01-01

The estimated economic costs of stroke in 1976 amounted to $7,363,784,000 (based on a 6 percent gross, or 4 percent net, discount rate). Almost half were direct costs, the majority of these were related to inpatient hospital and nursing facility care. Only about six percent of the total were morbidity costs, and the remaining fifty percent consisted of mortality costs, stated in terms of the present value of future earnings. Direct costs include charges by short-term hospitals, extended care facilities, physicians and other medical and allied health personnel, and the costs of aids and appliances. Indirect costs include both morbidity and mortality costs. These costs are distributed as follows. [Formula: see text].

Leisure-time physical activity and direct cost of short-term sickness absence among Finnish municipal employees.

PubMed

Tolonen, Anu; Rahkonen, Ossi; Lahti, Jouni

2017-03-04

We aimed to examine the direct costs of short-term (1-14 days) sickness absence and the effect of employees' physical activity on the costs. The Finnish Helsinki Health Study survey (2007) was used in the analysis (n = 3,935). Physical activity was classified into inactive, moderately active, and vigorously active. Sickness absence (3 years follow-up) and salary data were derived from the employer's registers. On average, an employee was absent 6 days a year due to short-term sickness absence, with a production loss of 2,350 EUR during the 3 years. The vigorously active had less sickness absence than those less active. The direct cost of sickness absence of a vigorously active employee was 404 EUR less than that of an inactive employee. Promoting physical activity among employees may decrease direct cost of short-term sickness absence.

Dental School Accreditation Costs: The Impact of Accreditation on Dental Education at the University of Maryland Dental School, 1981.

ERIC Educational Resources Information Center

Moreland, Ernest F.; Linthicum, Dorothy S.

The Baltimore College of Dental Surgery (University of Maryland) measured direct and indirect costs of the school's 1981 accreditation visit. The four objectives of the cost study were these: (1) to determine the direct (wages and operating expenditures) and indirect (effect on school goals and morale) cost of accreditation to the Dental School;…

Direct and indirect costs for systemic lupus erythematosus in Sweden. A nationwide health economic study based on five defined cohorts.

PubMed

Jönsen, Andreas; Hjalte, Frida; Willim, Minna; Carlsson, Katarina Steen; Sjöwall, Christopher; Svenungsson, Elisabet; Leonard, Dag; Bengtsson, Christine; Rantapää-Dahlqvist, Solbritt; Pettersson, Susanne; Gunnarsson, Iva; Zickert, Agneta; Gustafsson, Johanna T; Rönnblom, Lars; Petersson, Ingemar F; Bengtsson, Anders A; Nived, Ola

2016-06-01

The main objectives of this study were to calculate total costs of illness and cost-driving disease features among patients with systemic lupus erythematosus (SLE) in Sweden. Five cohorts of well-defined SLE patients, located in different parts of the country were merged. Incident and prevalent cases from 2003 through 2010 were included. The American College of Rheumatology (ACR) classification criteria was used. From the local cohorts, data on demographics, disease activity (SLEDAI 2K), and organ damage (SDI) were collected. Costs for inpatient care, specialist outpatient care and drugs were retrieved from national registries at the National Board of Health and Welfare. Indirect costs were calculated based on sickness leave and disability pensions from the Swedish Social Insurance Agency. In total, 1029 SLE patients, 88% females, were included, and approximately 75% were below 65 years at the end of follow-up, and thus in working age. The mean number of annual specialist physician visits varied from six to seven; mean annual inpatient days were 3.1-3.6, and mean annual sick leave was 123-148 days, all per patient. The total annual cost was 208,555 SEK ($33,369 = 22,941€), of which direct cost was 63,672kr ($10,188 = 7004€) and the indirect cost was 144,883 SEK ($23,181 = 15,937€), all per patient. The costs for patients with short disease duration were higher. Higher disease activity as measured by a SLEDAI 2K score > 3 was associated with approximately 50% increase in both indirect and direct costs. Damage in the neuropsychiatric and musculoskeletal domains were also linked to higher direct and indirect costs, while organ damage in the renal and ocular systems increased direct costs. Based on this study and an estimate of slightly more than 6000 SLE patients in Sweden, the total annual cost for SLE in the country is estimated at $188 million (=129.5 million €). Both direct (30%) and indirect costs (70%) are substantial. Medication accounts for less than 10% of the total cost. The tax paid national systems for health care and social security in Sweden ensure equal access to health care, sick leave reimbursements, and disability pensions nationwide. Our extrapolated annual costs for SLE in Sweden are therefore the best supported estimations thus far, and they clearly underline the importance of improved management, especially to reduce the indirect costs. Copyright © 2016 Elsevier Inc. All rights reserved.

A time-driven activity-based costing model to improve health-care resource use in Mirebalais, Haiti.

PubMed

Mandigo, Morgan; O'Neill, Kathleen; Mistry, Bipin; Mundy, Bryan; Millien, Christophe; Nazaire, Yolande; Damuse, Ruth; Pierre, Claire; Mugunga, Jean Claude; Gillies, Rowan; Lucien, Franciscka; Bertrand, Karla; Luo, Eva; Costas, Ainhoa; Greenberg, Sarah L M; Meara, John G; Kaplan, Robert

2015-04-27

In resource-limited settings, efficiency is crucial to maximise resources available for patient care. Time driven activity-based costing (TDABC) estimates costs directly from clinical and administrative processes used in patient care, thereby providing valuable information for process improvements. TDABC is more accurate and simpler than traditional activity-based costing because it assigns resource costs to patients based on the amount of time clinical and staff resources are used in patient encounters. Other costing approaches use somewhat arbitrary allocations that provide little transparency into the actual clinical processes used to treat medical conditions. TDABC has been successfully applied in European and US health-care settings to facilitate process improvements and new reimbursement approaches, but it has not been used in resource-limited settings. We aimed to optimise TDABC for use in a resource-limited setting to provide accurate procedure and service costs, reliably predict financing needs, inform quality improvement initiatives, and maximise efficiency. A multidisciplinary team used TDABC to map clinical processes for obstetric care (vaginal and caesarean deliveries, from triage to post-partum discharge) and breast cancer care (diagnosis, chemotherapy, surgery, and support services, such as pharmacy, radiology, laboratory, and counselling) at Hôpital Universitaire de Mirebalais (HUM) in Haiti. The team estimated the direct costs of personnel, equipment, and facilities used in patient care based on the amount of time each of these resources was used. We calculated inpatient personnel costs by allocating provider costs per staffed bed, and assigned indirect costs (administration, facility maintenance and operations, education, procurement and warehouse, bloodbank, and morgue) to various subgroups of the patient population. This study was approved by the Partners in Health/Zanmi Lasante Research Committee. The direct cost of an uncomplicated vaginal delivery at HUM was US$62 and the direct cost of a caesarean delivery was US$249. The direct costs of breast cancer care (including diagnostics, chemotherapy, and mastectomy) totalled US$1393. A mastectomy, including post-anaesthesia recovery and inpatient stay, totalled US$282 in direct costs. Indirect costs comprised 26-38% of total costs, and salaries were the largest percentage of total costs (51-72%). Accurate costing of health services is vital for financial officers and funders. TDABC showed opportunities at HUM to optimise use of resources and reduce costs-for instance, by streamlining sterilisation procedures and redistributing certain tasks to improve teamwork. TDABC has also improved budget forecasting and informed financing decisions. HUM leadership recognised its value to improve health-care delivery and expand access in low-resource settings. Boston Children's Hospital, Harvard Business School, and Partners in Health. Copyright © 2015 Elsevier Ltd. All rights reserved.

Exploring household economic impacts of childhood diarrheal illnesses in 3 African settings.

PubMed

Rheingans, Richard; Kukla, Matt; Adegbola, Richard A; Saha, Debasish; Omore, Richard; Breiman, Robert F; Sow, Samba O; Onwuchekwa, Uma; Nasrin, Dilruba; Farag, Tamer H; Kotloff, Karen L; Levine, Myron M

2012-12-01

Beyond the morbidity and mortality burden of childhood diarrhea in sub-Saharan African are significant economic costs to affected households. Using survey data from 3 of the 4 sites in sub-Saharan Africa (Gambia, Kenya, Mali) participating in the Global Enteric Multicenter Study (GEMS), we estimated the direct medical, direct nonmedical, and indirect (productivity losses) costs borne by households due to diarrhea in young children. Mean cost per episode was $2.63 in Gambia, $6.24 in Kenya, and $4.11 in Mali. Direct medical costs accounted for less than half of these costs. Mean costs understate the distribution of costs, with 10% of cases exceeding $6.50, $11.05, and $13.84 in Gambia, Kenya, and Mali. In all countries there was a trend toward lower costs among poorer households and in 2 of the countries for diarrheal illness affecting girls. For poor children and girls, this may reflect reduced household investment in care, which may result in increased risks of mortality.

7 CFR 3560.58 - Site requirements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... AGRICULTURE DIRECT MULTI-FAMILY HOUSING LOANS AND GRANTS Direct Loan and Grant Origination § 3560.58 Site... will not be located in areas where there are undesirable influences such as high activity railroad... development costs and standards. The cost of site development must be less than or comparable to the cost of...

48 CFR 3452.216-71 - Negotiated overhead rates-fixed.

Code of Federal Regulations, 2010 CFR

2010-10-01

... acceptability of cost allocation methods shall be determined in accordance with part 31 of the Federal... different period, for which the rates apply, and (4) the specific items treated as direct costs or any changes in the items previously agreed to be direct costs. (e) Pending establishment of fixed overhead...

Cost-effectiveness of quadrivalent influenza vaccine in Hong Kong - A decision analysis.

PubMed

You, Joyce H S; Ming, Wai-Kit; Chan, Paul K S

2015-01-01

Trivalent influenza vaccine (TIV) selects one of the 2 co-circulating influenza B lineages whereas quadrivalent influenza vaccine (QIV) includes both lineages. We examined potential cost-effectiveness of QIV versus TIV from perspectives of healthcare provider and society of Hong Kong. A decision tree was designed to simulate the outcomes of QIV vs. TIV in 6 age groups: 0-4 years, 5-9 years, 10-14 years, 15-64 years, 65-79 y and ≥80 years. Direct cost alone, direct and indirect costs, and quality-adjusted life-years (QALYs) loss due to TIV-unmatched influenza B infection were simulated for each study arm. Outcome measure was incremental cost per QALY (ICER). In base-case analysis, QIV was more effective than TIV in all-age population with additional direct cost per QALY (ICER-direct cost) and additional total cost per QALY (ICER-total cost) of USD 22,603 and USD 12,558, respectively. Age-stratified analysis showed that QIV was cost-effective in age groups 6 months to 9 y and ≥80 years from provider's perspective, and it was cost-effective in all age group except 15-64 y from societal perspective. Percentage of TIV-unmatched influenza B in circulation and additional vaccine cost of QIV were key influential factors. From perspectives of healthcare provider and society, QIV was the preferred option in 52.77% and 66.94% of 10,000 Monte Carlo simulations, respectively. QIV appears to be cost-effective in Hong Kong population, except for age group 15-64 years, from societal perspective. From healthcare provider's perspective, QIV seems to be cost-effective in very young (6 months-9 years) and older (≥80 years) age groups.

Direct healthcare cost of obesity in brazil: an application of the cost-of-illness method from the perspective of the public health system in 2011.

PubMed

de Oliveira, Michele Lessa; Santos, Leonor Maria Pacheco; da Silva, Everton Nunes

2015-01-01

Obesity is a global public health problem and a risk factor for several diseases that financially impact healthcare systems. To estimate the direct costs attributable to obesity (body mass index {BMI} ≥ 30 kg/m2) and morbid obesity (BMI ≥ 40 kg/m2) in adults aged ≥ 20 incurred by the Brazilian public health system in 2011. Public hospitals and outpatient care. A cost-of-illness method was adopted using a top-down approach based on prevalence. The proportion of the cost of each obesity-associated comorbidity was calculated and obesity prevalence was used to calculate attributable risk. Direct healthcare cost data (inpatient care, bariatric surgery, outpatient care, medications and diagnostic procedures) were extracted from the Ministry of Health information systems, available on the web. Direct costs attributable to obesity totaled US$ 269.6 million (1.86% of all expenditures on medium- and high-complexity health care). The cost of morbid obesity accounted for 23.8% (US$ 64.2 million) of all obesity-related costs despite being 18 times less prevalent than obesity. Bariatric surgery costs in Brazil totaled US$ 17.4 million in 2011. The cost of morbid obesity in women was five times higher than it was in men. The cost of morbid obesity was found to be proportionally higher than the cost of obesity. If the current epidemic were not reversed, the prevalence of obesity in Brazil will increase gradually in the coming years, as well as its costs, having serious implications for the financial sustainability of the Brazilian public health system.

Annual costs of chronic obstructive pulmonary disease in Finland during 1996–2006 and a prediction model for 2007–2030

PubMed Central

Herse, Fredrik; Kiljander, Toni; Lehtimäki, Lauri

2015-01-01

Background: Chronic obstructive pulmonary disease (COPD) is a major burden for the health care system, but the exact costs are difficult to estimate and there are insufficient data available on past and future time trends of COPD-related costs. Aims: The aim of the study was to calculate COPD-related costs in Finland during the years 1996–2006 and estimate future costs for the years 2007–2030. Methods: COPD-related direct and indirect costs in the public health care sector of the whole of Finland during the years 1996–2006 were retrieved from national registers. In addition, we made a mathematical prediction model on COPD costs for the years 2007–2030 on the basis of population projection and changes in smoking habits. Results: The total annual COPD-related costs amounted to about 100–110 million Euros in 1996–2006, with no obvious change, but there was a slight decrease in direct costs and an increase in indirect costs during these years. The estimation model predicted a 60% increase up to 166 million Euros in COPD-related annual costs by the year 2030. This is caused almost entirely by an increase in direct health care costs that reflect the predicted ageing of the Finnish population, as older age is a significant factor that increases the need for hospitalisation. Conclusions: The total annual COPD-related costs in Finland have been stable during the years 1996–2006, but if management strategies are not changed a significant increase in direct costs is expected by the year 2030 due to ageing of the population. PMID:25811648

Direct and indirect healthcare costs of rheumatoid arthritis patients in Turkey.

PubMed

Hamuryudan, Vedat; Direskeneli, Haner; Ertenli, Ihsan; Inanc, Murat; Karaaslan, Yasar; Oksel, Fahrettin; Ozbek, Suleyman; Pay, Salih; Terzioglu, Ender; Balkan Tezer, Dilara; Hacibedel, Basak; Akkoc, Nurullah

2016-01-01

To estimate the annual cost of rheumatoid arthritis (RA) in Turkey by obtaining real-world data directly from patients. In this cross-sectional study, RA patients from the rheumatology outpatient clinics of 10 university hospitals were interviewed with a standardised questionnaire on RA-related healthcare care costs. The study included 689 RA patients (565 females) with a mean age of 51.2±13.2 years and mean disease duration of 9.4±7.8 years. The mean scores of the Routine Assessment of Patient Index Data 3 and the Health Assessment Questionnaire-Disability Index (5.08±2.34 and 1.08±0.68, respectively) indicated moderate disease activity and severity for the whole group. One-third of the patients were on biologic agents and 12% had co-morbid conditions. The mean number of annual outpatient visits was 11.7±9.6 per patient. Of the patients, 15% required hospitalisation and 4% underwent surgery. The mean annual direct cost was € 4,954 (median, € 1,805), whereas the mean annual indirect cost was € 2,802 (median, € 608). Pharmacy costs accounted for the highest expenditure (mean, € 2,777; median, € 791), followed by the RA-related consultations and expenses (mean, € 1,600; median, € 696). RA has a substantial economic burden in Turkey, direct costs being higher than indirect costs. Although both direct and indirect costs are lower in Turkey than in Europe with respect to nominal Euro terms, they are higher from the perspectives of purchasing power parity and gross domestic product. Early diagnosis and treatment of RA may positively affect the national economy considering the positive correlation between health care utilisations and increased cost with disease severity.

Direct and indirect costs of nonfatal road traffic injuries in Iran: A population-based study.

PubMed

Karimi, Hasti; Soleyman-Jahi, Saeed; Hafezi-Nejad, Nima; Rahimi-Movaghar, Afarin; Amin-Esmaeili, Masoumeh; Sharifi, Vandad; Hajebi, Ahmad; Saadat, Soheil; Akbari Sari, Ali; Rahimi-Movaghar, Vafa

2017-05-19

The objective of this study was to assess the incidence rate as well as direct and indirect costs of nonfatal road traffic injuries (RTIs) in Iran in 2011. Data from the 2011 national household survey were used. In this survey, data on demographics, history, and costs of injury were obtained in 2 steps: first, direct face-to-face interview and second, telephone calls. We estimated the incidence rate of nonfatal RTIs in this year. The direct costs included medical care as well as nonmedical costs paid by the patient or insurance services. The indirect costs were estimated by considering the cost of absence from work or education. We also used logistic regression analyses to investigate risk factors of nonfatal RTIs. We found 76 nonfatal RTI cases (0.96%) out of 7,886 whole reference study cases. These 76 injured patients had a history of RTI in the preceding 3 months. The annual incidence of RTIs was estimated at 3.84%. The mean age of RTI cases was 28.5 ± 10.6 and 88.16% of them were male. Male gender was a major risk factor (odds ratio [OR] = 9.64, 95% confidence interval [CI], 4.79-19.41) and marriage was a protective factor (OR = 0.44, 95% CI, 0.28-0.70) for RTI. The medians of direct, indirect, and total costs were US$214, US$163, and US$387, respectively. The total cost of nonfatal RTIs in Iran was estimated at 1.29% of the gross domestic product (GDP) in 2011. In Iran, nonfatal RTIs imposed a total cost of almost US$7 billion to the country for one year. Extension and more serious implementation of preventive measurements seem necessary to decrease this notable burden of RTIs.

Direct and indirect cost burden associated with multiple sclerosis relapses: excess costs of persons with MS and their spouse caregivers.

PubMed

Parisé, Hélène; Laliberté, François; Lefebvre, Patrick; Duh, Mei Sheng; Kim, Edward; Agashivala, Neetu; Abouzaid, Safiya; Weinstock-Guttman, Bianca

2013-07-15

MS relapses are unpredictable and can be concerning to patients and their caregivers. To assess the direct and indirect cost burden associated with relapses of different severities in MS patients and with MS relapse frequency on spouse caregivers. Using a U.S. insurance claims and employee disability database (1999-2011), we studied adult MS patients (ICD-9-CM: 340.x) and their spouse caregivers. A previously published algorithm to identify relapses was used to stratify: (1) MS patients into cohorts of no, low/moderate, and high severity relapse based on the most severe relapse within one year of follow-up (if any); (2) caregivers into cohorts of no, less, and more frequent relapses based on the overall frequency of relapses of their spouse. Adjusted cost differences and 95% confidence intervals evaluating the yearly incremental costs at 12 months of follow-up (MS patients) and overall (caregivers) associated with relapses are reported. Among the 9421 MS patients (N: no relapse=7686; low/moderate severity relapse=1220; high severity relapse=515) identified, both relapse cohorts incurred significantly higher annual incremental direct costs than the no relapse cohort (low/moderate severity=$8269 [6565-10,115]; high severity=$24,180 [20,263-28,482]) and indirect costs (low/moderate severity=$1429 [759-2147]; high severity=$2714 [1468-4035]). More frequent relapses versus no relapse also translated into a significantly greater cost burden for caregivers (direct+indirect=$1725 [376-2885]) but less frequent relapses did not. Relapse severity was significantly and increasingly associated with greater direct and indirect costs in MS patients. More frequent relapses also translated into a significant cost burden in spouse caregivers. Copyright © 2013 Elsevier B.V. All rights reserved.

Cost-minimization analysis favors outpatient quick diagnosis unit over hospitalization for the diagnosis of potentially serious diseases.

PubMed

Sanclemente-Ansó, Carmen; Bosch, Xavier; Salazar, Albert; Moreno, Ramón; Capdevila, Cristina; Rosón, Beatriz; Corbella, Xavier

2016-05-01

Quick diagnosis units (QDUs) are a promising alternative to conventional hospitalization for the diagnosis of suspected serious diseases, most commonly cancer and severe anemia. Although QDUs are as effective as hospitalization in reaching a timely diagnosis, a full economic evaluation comparing both approaches has not been reported. To evaluate the costs of QDU vs. conventional hospitalization for the diagnosis of cancer and anemia using a cost-minimization analysis on the proven assumption that health outcomes of both approaches were equivalent. Patients referred to the QDU of Bellvitge University Hospital of Barcelona over 51 months with a final diagnosis of severe anemia (unrelated to malignancy), lymphoma, and lung cancer were compared with patients hospitalized for workup with the same diagnoses. The total cost per patient until diagnosis was analyzed. Direct and non-direct costs of QDU and hospitalization were compared. Time to diagnosis in QDU patients (n=195) and length-of-stay in hospitalized patients (n=237) were equivalent. There were considerable costs savings from hospitalization. Highest savings for the three groups were related to fixed direct costs of hospital stays (66% of total savings). Savings related to fixed non-direct costs of structural and general functioning were 33% of total savings. Savings related to variable direct costs of investigations were 1% of total savings. Overall savings from hospitalization of all patients were €867,719.31. QDUs appear to be a cost-effective resource for avoiding unnecessary hospitalization in patients with anemia and cancer. Internists, hospital executives, and healthcare authorities should consider establishing this model elsewhere. Copyright © 2015. Published by Elsevier B.V.

Anaphylaxis: a payor's perspective on epinephrine autoinjectors.

PubMed

Dunn, Jeffrey D; Sclar, David A

2014-01-01

The scope of expenditures due to anaphylaxis likely is underestimated by health care payors because anaphylaxis is underdiagnosed and, when reported, most costs of anaphylaxis borne by payors relate to direct medical expenses. Direct costs of anaphylaxis have been estimated at $1.2 billion per year, with direct expenditures of $294 million for epinephrine, and indirect costs of $609 million. More accurate diagnostic coding will allow payors to improve their understanding of the full impact of anaphylaxis on health care plans, employers, patients, and their families. Similarly, more accurate diagnosis and treatment of anaphylaxis should have a direct effect on overall cost savings achieved in this disease state. This includes savings in both direct costs, such as emergency department visits, and indirect costs, such as lost productivity of patients and caregivers. Educating medical personnel on treatment guidelines regarding the specific use of appropriate epinephrine autoinjectors will contribute to cost savings. Even though the cost of autoinjectors has been increasing, evidence indicates that the cost of improper response to, and treatment of, anaphylaxis outweighs that increase. At this time, there are several branded epinephrine autoinjectors and one generic equivalent for one of these branded products available on the US market; the branded autoinjectors are not considered equivalents for substitution. Barriers to coverage and access, such as managed care organization tier classification, medication copay, and socioeconomic status of specific patients, need to be examined more closely and addressed. Education in the proper use of epinephrine autoinjectors, including regular checking of medication expiration dates, is critical for proper management of anaphylaxis and minimizing the costs of anaphylactic events. Managed care organizations can play a role in educational initiatives. Copyright © 2014 Elsevier Inc. All rights reserved.

Direct Hospital Cost of Outcome Pathways in Implant-Based Reconstruction with Acellular Dermal Matrices.

PubMed

Qureshi, Ali A; Broderick, Kristen; Funk, Susan; Reaven, Nancy; Tenenbaum, Marissa M; Myckatyn, Terence M

2016-08-01

Current cost data on tissue expansion followed by exchange for permanent implant (TE/I) reconstruction lack a necessary assessment of the experience of a heterogenous breast cancer patient population and their multiple outcome pathways. We extend our previous analysis to that of direct hospital cost as bundling of payments is likely to follow the changing centralization of cancer care at the hospital level. We performed a retrospective analysis (2003-2009) of TE/I reconstructions with or without an acellular dermal matrix (ADM), namely Alloderm RTM. Postreconstructive events were analyzed and organized into outcome pathways as previously described. Aggregated and normalized inpatient and outpatient hospital direct costs and physician reimbursement were generated for each outcome pathway with or without ADM. Three hundred sixty-seven patients were analyzed. The average 2-year hospital direct cost per TE/I breast reconstruction patient was $11,862 in the +ADM and $12,319 in the -ADM groups (P > 0.05). Initial reconstructions were costlier in the +ADM ($6,868) than in the -ADM ($5,615) group, but the average cost of subsequent postreconstructive events within 2 years was significantly lower in +ADM ($5,176) than -ADM ($6,704) patients (P < 0.05). When a complication occurred, but reconstruction was still completed within 2 years, greater costs were incurred in the -ADM than in the +ADM group for most scenarios, leading to a net equalization of cost between study groups. Although direct hospital cost is an important factor for resource and fund allocation, it should not remain the sole factor when deciding to use ADM in TE/I reconstruction.

Cost implications of ACGME's 2011 changes to resident duty hours and the training environment.

PubMed

Nuckols, Teryl K; Escarce, José J

2012-02-01

In July 2011, the Accreditation Council for Graduate Medical Education (ACGME) will implemented stricter duty-hour limits and related changes to the training environment. This may affect preventable adverse event (PAE) rates. To estimate direct costs under various implementation approaches, and examine net costs to teaching hospitals and cost-effectiveness to society across a range of hypothetical changes in PAEs. A decision-analytical model represented direct costs and PAE rates, mortality, and costs. Published literature and publicly available data. Patients admitted to hospitals with ACGME-accredited programs. One year. All teaching hospitals, major teaching hospitals, society. ACGME's 2011 Common Program Requirements. Direct annual costs (all accredited hospitals), net cost (major teaching hospitals), cost per death averted (society). RESULTS OF BASE-ANALYSIS: Nationwide, duty-hour changes would cost $177 million annually if interns maintain current productivity, vs. up to $982 million if they transfer work to a mixture of substitutes; training-environment changes will cost $204 million. If PAEs decline by 7.2-25.8%, net costs to major teaching hospitals will be zero. If PAEs fall by 3%, the cost to society per death averted would be -$523,000 (95%-confidence interval: -$1.82 million to $685,000) to $2.44 million ($271,000 to $6.91 million). If PAEs rise, the policy will be cost-increasing for teaching hospitals and society. The total direct annual cost nationwide would be up to $1.34 billion using nurse practitioners/physician assistants, $1.64 billion using attending physicians, $820 million hiring additional residents, vs. 1.42 billion using mixed substitutes. The effect on PAEs is unknown. Data were limited for some model parameters. Implementation decisions greatly affect the cost. Unless PAEs decline substantially, teaching hospitals will lose money. If PAEs decline modestly, the requirements might be cost-saving or cost-effective to society.

In-hospital cost comparison between percutaneous pulmonary valve implantation and surgery

PubMed Central

Mishra, Vinod; Lewandowska, Milena; Andersen, Jack Gunnar; Andersen, Marit Helen; Lindberg, Harald; Døhlen, Gaute; Fosse, Erik

2017-01-01

Abstract OBJECTIVES: Today, both surgical and percutaneous techniques are available for pulmonary valve implantation in patients with right ventricle outflow tract obstruction or insufficiency. In this controlled, non-randomized study the hospital costs per patient of the two treatment options were identified and compared. METHODS: During the period of June 2011 until October 2014 cost data in 20 patients treated with the percutaneous technique and 14 patients treated with open surgery were consecutively included. Two methods for cost analysis were used, a retrospective average cost estimate (overhead costs) and a direct prospective detailed cost acquisition related to each individual patient (patient-specific costs). RESULTS: The equipment cost, particularly the stents and valve itself was by far the main cost-driving factor in the percutaneous pulmonary valve group, representing 96% of the direct costs, whereas in the open surgery group the main costs derived from the postoperative care and particularly the stay in the intensive care department. The device-related cost in this group represented 13.5% of the direct costs. Length-of-stay-related costs in the percutaneous group were mean $3885 (1618) and mean $17 848 (5060) in the open surgery group. The difference in postoperative stay between the groups was statistically significant (P≤ 0.001). CONCLUSIONS: Given the high postoperative cost in open surgery, the percutaneous procedure could be cost saving even with a device cost of more than five times the cost of the surgical device. PMID:28007875

Costs of epilepsy and cost-driving factors in children, adolescents, and their caregivers in Germany.

PubMed

Riechmann, Janna; Strzelczyk, Adam; Reese, Jens P; Boor, Rainer; Stephani, Ulrich; Langner, Cornelia; Neubauer, Bernd A; Oberman, Bettina; Philippi, Heike; Rochel, Michael; Seeger, Jürgen; Seipelt, Peter; Oertel, Wolfgang H; Dodel, Richard; Rosenow, Felix; Hamer, Hajo M

2015-09-01

To provide first data on the cost of epilepsy and cost-driving factors in children, adolescents, and their caregivers in Germany. A population-based, cross-sectional sample of consecutive children and adolescents with epilepsy was evaluated in the states of Hessen and Schleswig-Holstein (total of 8.796 million inhabitants) in all health care sectors in 2011. Data on socioeconomic status, course of epilepsy, and direct and indirect costs were recorded using patient questionnaires. We collected data from 489 children and adolescents (mean age ± SD 10.4 ± 4.2 years, range 0.5-17.8 years; 264 [54.0%] male) who were treated by neuropediatricians (n = 253; 51.7%), at centers for social pediatrics ("Sozialpaediatrische Zentren," n = 110, 22.5%) and epilepsy centers (n = 126; 25.8%). Total direct costs summed up to €1,619 ± €4,375 per participant and 3-month period. Direct medical costs were due mainly to hospitalization (47.8%, €774 ± €3,595 per 3 months), anticonvulsants (13.2%, €213 ± €363), and ancillary treatment (9.1%, €147 ± €344). The total indirect costs amounted to €1,231 ± €2,830 in mothers and to €83 ± €593 in fathers; 17.4% (n = 85) of mothers and 0.6% (n = 3) of fathers reduced their working hours or quit work because of their child's epilepsy. Independent cost-driving factors were younger age, symptomatic cause, and polytherapy with anticonvulsants. Older age, active epilepsy, symptomatic cause, and polytherapy were independent predictors of higher antiepileptic drug (AED) costs, whereas younger age, longer epilepsy duration, symptomatic cause, disability, and parental depression were independent predictors for higher indirect costs. Treatment of children and adolescents with epilepsy is associated with high direct costs due to frequent inpatient admissions and high indirect costs due to productivity losses in mothers. Direct costs are age-dependent and higher in patients with symptomatic epilepsy and polytherapy. Indirect costs are higher in the presence of a child's disability and parental depression. Wiley Periodicals, Inc. © 2015 International League Against Epilepsy.

Cost of epilepsy: a systematic review.

PubMed

Strzelczyk, Adam; Reese, Jens Peter; Dodel, Richard; Hamer, Hajo M

2008-01-01

The objective of this review was to overview published cost-of-illness (COI) studies of epilepsy and their methodological approaches. Epilepsy imposes a substantial burden on individuals and society as a whole. The mean prevalence of epilepsy is estimated at 0.52% in Europe, 0.68% in the US, and peaks up to 1.5% in developing countries. Estimation of the economic burden of epilepsy is of pivotal relevance to enable a rational distribution of healthcare resources. This is especially so with the introduction of the newer antiepileptic drugs (AEDs), the marketing of vagal-nerve stimulators and the resurgence of new surgical treatment options, which have the potential to considerably increase the costs of treating epilepsy.A systematic literature review was performed to identify studies that evaluated direct and indirect costs of epilepsy. Using a standardized assessment form, information on the study design, methodological framework and data sources were extracted from each publication and systematically reported. We identified 22 studies worldwide on costs of epilepsy. The majority of the studies reflected the costs of epilepsy in Europe (three studies each for the UK and Italy, one study each for Germany, the Netherlands, Switzerland, France and the EU) and the US (four studies), but studies were also available from India (two), Hong Kong, Oman, Burundi, Chile and Mexico. The studies utilized different frameworks to evaluate costs. All used a bottom-up approach; however, only 12 studies (55%) evaluated direct as well as indirect costs. The range for the mean annual direct costs lay between 40 International Dollar purchasing power parities (PPP-$) in rural Burundi and PPP-$4748 (adjusted to 2006 values) in a German epilepsy centre. Recent studies suggest AEDs are becoming the main contributor to direct costs. The mean indirect costs ranged between 12% and 85% of the total annual costs. Epilepsy is a cost-intensive disorder. A reliable comparison of the different COI studies in epilepsy is not easily feasible, as the evaluated studies show substantial methodological differences with respect to their patient selection criteria, diagnostic stratifications and evaluated costs. Therefore, there is an urgent need for studies that evaluate direct and indirect costs in a standardized fashion.

Direct costs associated with a nosocomial outbreak of Salmonella infection: an ounce of prevention is worth a pound of cure.

PubMed

Spearing, N M; Jensen, A; McCall, B J; Neill, A S; McCormack, J G

2000-02-01

Nosocomial outbreaks of Salmonella infections in Australia are an infrequent but significant source of morbidity and mortality. Such an outbreak results in direct, measurable expenses for acute care management, as well as numerous indirect (and less quantifiable) costs to those affected, the hospital, and the wider community. This article describes the significant direct costs incurred as a result of a nosocomial outbreak of Salmonella infection involving patients and staff. Information on costs incurred by the hospital was gathered from a number of sources. The data were grouped into 4 sections (medical costs, investigative costs, lost productivity costs, and miscellaneous) with use of an existing tool for calculating the economic impact of foodborne illness. The outbreak cost the hospital more than AU $120, 000. (US $95,000). This amount is independent of more substantial indirect costs. Salmonella infections are preventable. Measures to aid the prevention of costly outbreaks of nosocomial salmonellosis, although available, require an investment of both time and money. We suggest that dedication of limited resources toward such preventive strategies as education is a practical and cost-effective option for health care facilities.

The economic burden of meningitis to households in Kassena-Nankana district of Northern Ghana.

PubMed

Akweongo, Patricia; Dalaba, Maxwell A; Hayden, Mary H; Awine, Timothy; Nyaaba, Gertrude N; Anaseba, Dominic; Hodgson, Abraham; Forgor, Abdulai A; Pandya, Rajul

2013-01-01

To estimate the direct and indirect costs of meningitis to households in the Kassena-Nankana District of Ghana. A Cost of illness (COI) survey was conducted between 2010 and 2011. The COI was computed from a retrospective review of 80 meningitis cases answers to questions about direct medical costs, direct non-medical costs incurred and productivity losses due to recent meningitis incident. The average direct and indirect costs of treating meningitis in the district was GH¢152.55 (US$101.7) per household. This is equivalent to about two months minimum wage earned by Ghanaians in unskilled paid jobs in 2009. Households lost 29 days of work per meningitis case and thus those in minimum wage paid jobs lost a monthly minimum wage of GH¢76.85 (US$51.23) due to the illness. Patients who were insured spent an average of GH¢38.5 (US$25.67) in direct medical costs whiles the uninsured patients spent as much as GH¢177.9 (US$118.6) per case. Patients with sequelae incurred additional costs of GH¢22.63 (US$15.08) per case. The least poor were more exposed to meningitis than the poorest. Meningitis is a debilitating but preventable disease that affects people living in the Sahel and in poorer conditions. The cost of meningitis treatment may further lead to impoverishment for these households. Widespread mass vaccination will save households' an equivalent of GH¢175.18 (US$117) and impairment due to meningitis.

Air/molten salt direct-contact heat-transfer experiment and economic analysis

NASA Astrophysics Data System (ADS)

Bohn, M. S.

1983-11-01

Direct-contact heat-transfer coefficients have been measured in a pilot-scale packed column heat exchanger for molten salt/air duty. Two types of commercial tower packings were tested: metal Raschig rings and initial Pall rings. Volumetric heat-transfer coefficients were measured and appeared to depend upon air flow but not on salt flow rate. An economic analysis was used to compare the cost-effectiveness of direct-contact heat exchange with finned-tube heat exchanger in this application. Incorporating the measured volumetric heat-transfer coefficients, a direct-contact system appeared to be from two to five times as cost-effective as a finned-tube heat exchanger, depending upon operating temperature. The large cost advantage occurs for higher operating temperatures (2700(0)C), where high rates of heat transfer and flexibility in materials choice give the cost advantage to the direct-contact heat exchanger.

Cost effectiveness analysis of elementary school-located vaccination against influenza--results from a randomized controlled trial.

PubMed

Yoo, Byung-Kwang; Humiston, Sharon G; Szilagyi, Peter G; Schaffer, Stanley J; Long, Christine; Kolasa, Maureen

2013-04-19

School-located vaccination against influenza (SLV-I) has been suggested to help meet the need for annual vaccination of large numbers of school-aged children with seasonal influenza vaccine. However, little is known about the cost and cost-effectiveness of SLV-I. We conducted a cost-analysis and a cost-effectiveness analysis based on a randomized controlled trial (RCT) of an SLV-I program implemented in Monroe County, New York during the 2009-2010 vaccination season. We hypothesized that SLV-I is more cost effective, or less-costly, compared to a conventional, office-located influenza vaccination delivery. First and second SLV-I clinics were offered in 21 intervention elementary schools (n=9027 children) with standard of care (no SLV-I) in 11 control schools (n=4534 children). The direct costs, to purchase and administer vaccines, were estimated from our RCT. The effectiveness measure, receipt of ≥1 dose of influenza vaccine, was 13.2 percentage points higher in SLV-I schools than control schools. The school costs ($9.16/dose in 2009 dollars) plus project costs ($23.00/dose) plus vendor costs excluding vaccine purchase ($19.89/dose) was higher in direct costs ($52.05/dose) than the previously reported mean/median cost [$38.23/$21.44 per dose] for providing influenza vaccination in pediatric practices. However SLV-I averted parent costs to visit medical practices ($35.08 per vaccine). Combining direct and averted costs through Monte Carlo Simulation, SLV-I costs were $19.26/dose in net costs, which is below practice-based influenza vaccination costs. The incremental cost-effectiveness ratio (ICER) was estimated to be $92.50 or $38.59 (also including averted parent costs). When additionally accounting for the costs averted by disease prevention (i.e., both reduced disease transmission to household members and reduced loss of productivity from caring for a sick child), the SLV-I model appears to be cost-saving to society, compared to "no vaccination". Our findings support the expanded implementation of SLV-I, but also the need to focus on efficient delivery to reduce direct costs. Copyright © 2013 Elsevier Ltd. All rights reserved.

Trends in resource utilization and prescription of anticonvulsants for patients with active epilepsy in Germany from 2003 to 2013 - A ten-year overview.

PubMed

Willems, Laurent M; Richter, Saskia; Watermann, Nina; Bauer, Sebastian; Klein, Karl Martin; Reese, Jens-Peter; Schöffski, Oliver; Hamer, Hajo M; Knake, Susanne; Rosenow, Felix; Strzelczyk, Adam

2018-06-01

This study evaluated trends in resource use and prescription patterns in patients with active epilepsy over a 10-year period at the same outpatient clinic of a German epilepsy center. We analyzed a cross-sectional patient sample of consecutive adults with active epilepsy over a 3-month period in 2013 and compared them with equally acquired data from the years 2003 and 2008. Using validated patient questionnaires, data on socioeconomic status, course of epilepsy, as well as direct and indirect costs were recorded. A total of 198 patients (mean age: 39.6±15.0years, 49.5% male) were enrolled and compared with our previous assessments in 2003 (n=101) and 2008 (n=151). In the 2013 cohort, 75.8% of the patients had focal epilepsy, and the majority were taking antiepileptic drugs (AEDs) (39.9% monotherapy, 59.1% polytherapy). We calculated epilepsy-specific costs of €3674 per three months per patient. Direct medical costs were mainly due to anticonvulsants (20.9% of total direct costs) and to hospitalization (20.8% of total direct costs). The proportion of enzyme-inducing anticonvulsants and 'old' AEDs decreased between 2003 and 2013. Indirect costs of €1795 in 2013 were mainly due to early retirement (55.0% of total indirect costs), unemployment (26.5%), and days off due to seizures (18.2%). In contrast to our previous findings from 2003 and 2008, our data show a stagnating cost increase with slightly reduced total costs and balanced direct and indirect costs in patients with active epilepsy. These findings are accompanied by an ongoing cost-neutral increase in the prescription of 'newer' and non-enzyme-inducing AEDs. However, the number and distribution of indirect cost components remained unchanged. Copyright © 2018 Elsevier Inc. All rights reserved.

[Cost analysis of treatment for severe rheumatoid arthritis in a city in southern Brazil].

PubMed

Buendgens, Fabíola Bagatini; Blatt, Carine Raquel; Marasciulo, Antônio Carlos Estima; Leite, Silvana Nair; Farias, Mareni Rocha

2013-11-01

Treatment of rheumatoid arthritis involves the use of medicines, non-pharmaceutical therapies, medical appointments, and complimentary tests, among other procedures. Based on sources of payment, this article presents the direct medical costs related to treatment of rheumatoid arthritis. The cost analysis included 103 patients with severe rheumatoid arthritis treated at the Specialized Division of Pharmaceutical Care in Florianopolis, Santa Catarina State, Brazil. Total annual direct cost was R$ 2,045,596.55 (approximately one million US dollars), or R$ 19,860.16 per patient/year (slightly less than ten thousand US dollars). Total cost breakdown was as follows: 90.8% for medicines, 2.5% for hospitalizations, 2.2% for complimentary tests, 2.1% for medical appointments, and 2.4% for all other costs. The public sector accounted for 73.6% of the total direct medical costs and 79.3% of the cost of medicines. The cost analysis provided a profile of how a group of individuals with a chronic non-communicable disease that requires resources circulates in the public-private mix that characterizes the Brazilian health system.

A cost-benefit analysis of physical activity using bike/pedestrian trails.

PubMed

Wang, Guijing; Macera, Caroline A; Scudder-Soucie, Barbara; Schmid, Tom; Pratt, Michael; Buchner, David

2005-04-01

From a public health perspective, a cost-benefit analysis of using bike/pedestrian trails in Lincoln, Nebraska, to reduce health care costs associated with inactivity was conducted. Data was obtained from the city's 1998 Recreational Trails Census Report and the literature. Per capita annual cost of using the trails was 209.28 U.S. dollars (59.28 U.S. dollars construction and maintenance, 150 U.S. dollars of equipment and travel). Per capita annual direct medical benefit of using the trails was 564.41 U.S. dollars. The cost-benefit ratio was 2.94, which means that every 1 U.S. dollar investment in trails for physical activity led to 2.94 U.S. dollars in direct medical benefit. The sensitivity analyses indicated the ratios ranged from 1.65 to 13.40. Therefore, building trails is cost beneficial from a public health perspective. The most sensitive parameter affecting the cost-benefit ratios were equipment and travel costs; however, even for the highest cost, every 1 U.S. dollar investment in trails resulted in a greater return in direct medical benefit.

Strapdown cost trend study and forecast

NASA Technical Reports Server (NTRS)

Eberlein, A. J.; Savage, P. G.

1975-01-01

The potential cost advantages offered by advanced strapdown inertial technology in future commercial short-haul aircraft are summarized. The initial procurement cost and six year cost-of-ownership, which includes spares and direct maintenance cost were calculated for kinematic and inertial navigation systems such that traditional and strapdown mechanization costs could be compared. Cost results for the inertial navigation systems showed that initial costs and the cost of ownership for traditional triple redundant gimbaled inertial navigators are three times the cost of the equivalent skewed redundant strapdown inertial navigator. The net cost advantage for the strapdown kinematic system is directly attributable to the reduction in sensor count for strapdown. The strapdown kinematic system has the added advantage of providing a fail-operational inertial navigation capability for no additional cost due to the use of inertial grade sensors and attitude reference computers.

Economic burden of asthma in Korea.

PubMed

Lee, Yo-Han; Yoon, Seok-Jun; Kim, Eun-Jung; Kim, Young-Ae; Seo, Hye-Young; Oh, In-Hwan

2011-01-01

Understanding the magnitude of the economic impact of an illness on society is fundamental to planning and implementing relevant policies. South Korea operates a compulsory universal health insurance system providing favorable conditions for evaluating the nationwide economic burden of illnesses. The aim of this study was to estimate the economic costs of asthma imposed on Korean society. The Korean National Health Insurance claims database was used for determining the health care services provided to asthma patients defined as having at least one inpatient or outpatient claim(s) with a primary diagnosis of asthma in 2008. Both direct and indirect costs were included. Direct costs were those associated directly with treatment, medication, and transportation. Indirect costs were assessed in terms of the loss of productivity in asthma patients and their caregivers and consisted of morbidity cost, mortality cost, and caregivers' time cost. The estimated cost for 2,273,290 asthma patients in 2008 was $831 million, with an average per capita cost of $336. Among the cost components, outpatient and medication costs represented the largest cost burden. Although the costs for children accounted for the largest proportion of the total cost, the per capita cost was highest among patients ≥50 years old. The economic burden of asthma in Korea is considerable. Considering that the burden will increase with the rising prevalence, implementation of effective national prevention approaches aimed at the appropriate target populations is imperative.

Fuel-Burning Technology Alternatives for the Army.

DTIC Science & Technology

1985-01-01

control 0.85 2,287,000 Flue gas desulfurization 0.68 3,410,000 Total 12,478,000 *Capital cost estimate...34......... . . Particulate and sulfur dioxide control are needed. A baghouse and flue gas desulfurization (FD) scrubber system must be installed. Each item’s cost in...direct cost) Contingency (20% of 1,253,000 direct and indirect costs) Subtotal 7,518,000 Particulate control 1,342,000 Flue gas desulfurization

Direct medical cost and utility analysis of diabetics outpatient at Karanganyar public hospital

NASA Astrophysics Data System (ADS)

Eristina; Andayani, T. M.; Oetari, R. A.

2017-11-01

Diabetes Mellitus is a high cost disease, especially in long-term complication treatment. Long-term complication treatment cost was a problem for the patient, it can affect patients quality of life stated with utility value. The purpose of this study was to determine the medical cost, utility value and leverage factors of diabetics outpatient. This study was cross sectional design, data collected from retrospective medical record of the financial and pharmacy department to obtain direct medical cost, utility value taken from EQ-5D-5L questionnaire. Data analyzed by Mann-Whitney and Kruskal-Wallis test. Results of this study were IDR 433,728.00 for the direct medical cost and pharmacy as the biggest cost. EQ-5D-5L questionnaire showed the biggest proportion on each dimension were 61% no problem on mobility dimension, 89% no problems on self-care dimension, 54% slight problems on usual activities dimension, 41% moderate problems on pain/discomfort dimension and 48% moderate problems on anxiety/depresion dimension. Build upon Thailand value set, utility value was 0.833. Direct medical cost was IDR 433,728.00 with leverage factors were pattern therapy, blood glucose level and complication. Utility value was 0.833 with leverage factors were patients characteristic, therapy pattern, blood glucose level and complication.

Cost analysis of advanced turbine blade manufacturing processes

NASA Technical Reports Server (NTRS)

Barth, C. F.; Blake, D. E.; Stelson, T. S.

1977-01-01

A rigorous analysis was conducted to estimate relative manufacturing costs for high technology gas turbine blades prepared by three candidate materials process systems. The manufacturing costs for the same turbine blade configuration of directionally solidified eutectic alloy, an oxide dispersion strengthened superalloy, and a fiber reinforced superalloy were compared on a relative basis to the costs of the same blade currently in production utilizing the directional solidification process. An analytical process cost model was developed to quantitatively perform the cost comparisons. The impact of individual process yield factors on costs was also assessed as well as effects of process parameters, raw materials, labor rates and consumable items.

[Costs of chronic obstructive pulmonary disease in patients treated in ambulatory care in Poland].

PubMed

Jahnz-Różyk, Karina; Targowski, Tomasz; From, Sławomir; Faluta, Tomasz; Borowiec, Lukasz

2011-01-01

Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide. A cost-of-illness study aims to determine the total economic impact of a disease or health condition on society through the identification, measurement, and valuation of all direct and indirect costs. Exacerbations are believed to be a major cost driver in COPD. The aim of this study was to examine direct, mean costs of COPD in Poland under usual clinical practice form societal perspective. It was an observational bottom-up-cost-of-illness study, based on a retrospective sample of patients presenting with COPD in pulmonary ambulatory care facilities in Poland. Total medical resources consumption of a sample were collected in 2007/2008 year by physician - lung specialists. Direct costs of COPD were evaluated based on data from different populations of five clinical hospitals and eight out-patient clinics. Resources utilisation and cost data are summarised as mean values per patient per year. 95% confidence intervals were derived using percentile bootstrapping. Total medicals resources consumption of a COPD patient per year was 1007 EURO (EUR 1 = PLN 4.0; year 2008). Among this cost 606 EURO was directly related to COPD follow up, 105 EURO was related to ambulatory exacerbation, and 296 EURO was related to exacerbation treated in hospital. The burden of COPD itself appeared to be considerable magnitude for society in Poland.

Hospitalization of patients with systemic lupus erythematosus is a major cause of direct and indirect healthcare costs.

PubMed

Anandarajah, A P; Luc, M; Ritchlin, C T

2017-06-01

Objectives The objective of this study was to calculate the direct and indirect costs of admission for systemic lupus erythematosus (SLE) patients, identify the population at risk and investigate potential reasons for admission. Methods We conducted a financial analysis of all admissions for SLE to Strong Memorial Hospital between 1 July 2013 and 30 June 2015. Patient and financial records for admissions with a SLE diagnosis for the above period were retrieved. The total cost of admissions was used as a measure of direct costs and the length of stay used to assess indirect costs. Additionally, we analyzed the demographics of the hospitalized population. Results The average, annual cost of confirmed admissions to Strong Memorial Hospital for SLE was US$3.9-6.4 m. The mean annual cost per patient for hospitalization was US$51,808.41. The length of stay for all SLE patients was 1564-2507 days with an average of 8.5 days per admission. The majority of patients admitted were young women from the city of Rochester. Infections were the most common reason for admissions. Conclusion We demonstrated that admissions are a source of high direct and indirect costs to the hospital and a significant financial burden to the patient. Implementing measures to improve the quality of care for SLE patients will help decrease the morbidity and lower the economic costs to hospitals.

Counting Costs under Severe Financial Constraints: A Cost-of-Illness Analysis of Spondyloarthropathies in a Tertiary Hospital in Greece.

PubMed

Tsifetaki, Niki; Migkos, Michail P; Papagoras, Charalampos; Voulgari, Paraskevi V; Athanasakis, Kostas; Drosos, Alexandros A

2015-06-01

To investigate the total annual direct cost of patients with spondyloarthritis (SpA) in Greece. Retrospective study with 156 patients diagnosed and followed up in the rheumatology clinic of the University Hospital of Ioannina. Sixty-four had ankylosing spondylitis (AS) and 92 had psoriatic arthritis (PsA). Health resource use for each patient was elicited through a retrospective chart review that documented the use of monitoring visits, medications, laboratory/diagnostic tests, and inpatient stays for the previous year from the date that the review took place. Costs were calculated from a third-party payer perspective and are reported in 2014 euros. The mean ± SD annual direct cost for the patients with SpA reached €8680 ± 6627. For the patients with PsA and AS, the cost was estimated to be €8097 ± 6802 and €9531 ± 6322, respectively. The major cost was medication, which represented 88.9%, 88.2%, and 89.3% of the mean total direct cost for SpA, AS, and PsA, respectively. The annual amount of the scheduled tests for all patients corresponded to 7.5%, and for those performed on an emergency basis, 1.1%. Further, the cost for scheduled and emergency hospitalization, as well as the cost of scheduled visits to an outpatient clinic, corresponded to 2.5% of the mean total annual direct cost for the patients with SpA. SpA carries substantial financial cost, especially in the era of new treatment options. Adequate access and treatment for patients with SpA remains a necessity, even in times of fiscal constraint. Thus, the recommendations of the international scientific organizations should be considered when administering high-cost drugs such as biological treatments.

Cost-of-illness of cholera to households and health facilities in rural Malawi

PubMed Central

Huang, Xiao Xian; Ngwira, Bagrey; Mwanyungwe, Abel; Mogasale, Vittal; Mengel, Martin A.; Cavailler, Philippe; Gessner, Bradford D.; Le Gargasson, Jean-Bernard

2017-01-01

Cholera remains an important public health problem in many low- and middle-income countries. Vaccination has been recommended as a possible intervention for the prevention and control of cholera. Evidence, especially data on disease burden, cost-of-illness, delivery costs and cost-effectiveness to support a wider use of vaccine is still weak. This study aims at estimating the cost-of-illness of cholera to households and health facilities in Machinga and Zomba Districts, Malawi. A cross-sectional study using retrospectively collected cost data was undertaken in this investigation. One hundred patients were purposefully selected for the assessment of the household cost-of-illness and four cholera treatment centres and one health facility were selected for the assessment conducted in health facilities. Data collected for the assessment in households included direct and indirect costs borne by cholera patients and their families while only direct costs were considered for the assessment conducted in health facilities. Whenever possible, descriptive and regression analysis were used to assess difference in mean costs between groups of patients. The average costs to patients’ households and health facilities for treating an episode of cholera amounted to US$65.6 and US$59.7 in 2016 for households and health facilities, respectively equivalent to international dollars (I$) 249.9 and 227.5 the same year. Costs incurred in treating a cholera episode were proportional to duration of hospital stay. Moreover, 52% of households used coping strategies to compensate for direct and indirect costs imposed by the disease. Both households and health facilities could avert significant treatment expenditures through a broader use of pre-emptive cholera vaccination. These findings have direct policy implications regarding priority investments for the prevention and control of cholera. PMID:28934285

Analysis of economic and social costs of adverse events associated with blood transfusions in Spain.

PubMed

Ribed-Sánchez, Borja; González-Gaya, Cristina; Varea-Díaz, Sara; Corbacho-Fabregat, Carlos; Bule-Farto, Isabel; Pérez de-Oteyza, Jaime

To calculate, for the first time, the direct and social costs of transfusion-related adverse events in order to include them in the National Healthcare System's budget, calculation and studies. In Spain more than 1,500 patients yearly are diagnosed with such adverse events. Blood transfusion-related adverse events recorded yearly in Spanish haemovigilance reports were studied retrospectively (2010-2015). The adverse events were coded according to the classification of Diagnosis-Related Groups. The direct healthcare costs were obtained from public information sources. The productivity loss (social cost) associated with adverse events was calculated using the human capital and hedonic salary methodologies. In 2015, 1,588 patients had adverse events that resulted in direct health care costs (4,568,914€) and social costs due to hospitalization (200,724€). Three adverse reactions resulted in patient death (at a social cost of 1,364,805€). In total, the cost of blood transfusion-related adverse events was 6,134,443€ in Spain. For the period 2010-2015: the trends show a reduction in the total amount of transfusions (2 vs. 1.91M€; -4.4%). The number of adverse events increased (822 vs. 1,588; +93%), as well as their related direct healthcare cost (3.22 vs. 4.57M€; +42%) and the social cost of hospitalization (110 vs 200M€; +83%). Mortality costs decreased (2.65 vs. 1.36M€; -48%). This is the first time that the costs of post-transfusion adverse events have been calculated in Spain. These new figures and trends should be taken into consideration in any cost-effectiveness study or trial of new surgical techniques or sanitary policies that influence blood transfusion activities. Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Costs and trends in pancreatic cancer treatment.

PubMed

O'Neill, Caitriona B; Atoria, Coral L; O'Reilly, Eileen M; LaFemina, Jennifer; Henman, Martin C; Elkin, Elena B

2012-10-15

Pancreatic cancer poses a substantial morbidity and mortality burden in the United States, and predominantly affects older adults. The objective of this study was to estimate the direct medical costs of pancreatic cancer treatment in a population-based cohort of Medicare beneficiaries, and the contribution of different treatment modalities and health care services to the total cost of care and trends in costs over time. In the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database, pancreatic cancer patients were identified who were aged 66 years or older and who were diagnosed from 2000 to 2007. Total direct medical costs were estimated from Medicare payments overall and within categories of care. Costs attributable to pancreatic cancer were estimated by subtracting the costs of medical care in a matched cohort of cancer-free beneficiaries. A total of 15,037 patients were identified, of whom 97% were observed from diagnosis until death. Mean total direct medical costs were $65,500. Mean total costs were greater for patients with resectable locoregional disease ($134,700) than for those with unresectable locoregional or distant disease ($65,300 and $49,000, respectively). Hospitalizations and cancer-directed procedures collectively accounted for the largest fraction of health care costs. The total cost of care appeared to increase slightly over the study period (P = .05). The mean costs attributable to pancreatic cancer were $61,700. Despite poor prognosis and short survival, the economic burden of pancreatic cancer in the elderly is substantial. Demographic trends, greater use of targeted therapies, and possible implementation of screening strategies are likely to impact treatment patterns and costs in the future. Copyright © 2012 American Cancer Society.

Retrospective Assessment of Cost Savings From Prevention: Folic Acid Fortification and Spina Bifida in the U.S.

PubMed

Grosse, Scott D; Berry, Robert J; Mick Tilford, J; Kucik, James E; Waitzman, Norman J

2016-05-01

Although fortification of food with folic acid has been calculated to be cost saving in the U.S., updated estimates are needed. This analysis calculates new estimates from the societal perspective of net cost savings per year associated with mandatory folic acid fortification of enriched cereal grain products in the U.S. that was implemented during 1997-1998. Estimates of annual numbers of live-born spina bifida cases in 1995-1996 relative to 1999-2011 based on birth defects surveillance data were combined during 2015 with published estimates of the present value of lifetime direct costs updated in 2014 U.S. dollars for a live-born infant with spina bifida to estimate avoided direct costs and net cost savings. The fortification mandate is estimated to have reduced the annual number of U.S. live-born spina bifida cases by 767, with a lower-bound estimate of 614. The present value of mean direct lifetime cost per infant with spina bifida is estimated to be $791,900, or $577,000 excluding caregiving costs. Using a best estimate of numbers of avoided live-born spina bifida cases, fortification is estimated to reduce the present value of total direct costs for each year's birth cohort by $603 million more than the cost of fortification. A lower-bound estimate of cost savings using conservative assumptions, including the upper-bound estimate of fortification cost, is $299 million. The estimates of cost savings are larger than previously reported, even using conservative assumptions. The analysis can also inform assessments of folic acid fortification in other countries. Published by Elsevier Inc.

Cost-of-illness of cholera to households and health facilities in rural Malawi.

PubMed

Ilboudo, Patrick G; Huang, Xiao Xian; Ngwira, Bagrey; Mwanyungwe, Abel; Mogasale, Vittal; Mengel, Martin A; Cavailler, Philippe; Gessner, Bradford D; Le Gargasson, Jean-Bernard

2017-01-01

Cholera remains an important public health problem in many low- and middle-income countries. Vaccination has been recommended as a possible intervention for the prevention and control of cholera. Evidence, especially data on disease burden, cost-of-illness, delivery costs and cost-effectiveness to support a wider use of vaccine is still weak. This study aims at estimating the cost-of-illness of cholera to households and health facilities in Machinga and Zomba Districts, Malawi. A cross-sectional study using retrospectively collected cost data was undertaken in this investigation. One hundred patients were purposefully selected for the assessment of the household cost-of-illness and four cholera treatment centres and one health facility were selected for the assessment conducted in health facilities. Data collected for the assessment in households included direct and indirect costs borne by cholera patients and their families while only direct costs were considered for the assessment conducted in health facilities. Whenever possible, descriptive and regression analysis were used to assess difference in mean costs between groups of patients. The average costs to patients' households and health facilities for treating an episode of cholera amounted to US$65.6 and US$59.7 in 2016 for households and health facilities, respectively equivalent to international dollars (I$) 249.9 and 227.5 the same year. Costs incurred in treating a cholera episode were proportional to duration of hospital stay. Moreover, 52% of households used coping strategies to compensate for direct and indirect costs imposed by the disease. Both households and health facilities could avert significant treatment expenditures through a broader use of pre-emptive cholera vaccination. These findings have direct policy implications regarding priority investments for the prevention and control of cholera.

Hospitalization costs associated with diarrhea among children during the period of rotavirus circulation in the Northwest region of Argentina.

PubMed

Giglio, Norberto D; Caruso, Martín; Castellano, Vanesa E; Choque, Liliana; Sandoval, Silvia; Micone, Paula; Gentile, Ángela

2017-12-01

To assess direct medical costs, outof-pocket expenses, and indirect costs in cases of hospitalizations for acute diarrhea among children <5 years of age at Hospital de Niños "Héctor Quintana" in the province of Jujuy during the period of rotavirus circulation in the Northwest region of Argentina. Cross-sectional study on diseaserelated costs. All children <5 years of age, hospitalized with the diagnosis of acute diarrhea and dehydration during the period of rotavirus circulation between May 1st and October 31st of 2013, were included. The assessment of direct medical costs was done by reviewing medical records whereas out-of-pocket expenses and indirect costs were determined using a survey. For the 95% confidence interval of the average cost per patient, a probabilistic bootstrapping analysis of 10 000 simulations by resampling was done. One hundred and five patients were enrolled. Their average age was 18 months (standard deviation: 12); 62 (59%) were boys. The average direct medical cost, out-of-pocket expense, and lost income per case was ARS 3413.6 (2856.35-3970.93) (USD 577.59), ARS 134.92 (85.95-213.57) (USD 22.82), and ARS 301 (223.28-380.02) (USD 50.93), respectively. The total cost per hospitalization event was ARS 3849.52 (3298-4402.25) (USD 651.35). The total cost per hospitalization event was within what is expected for Latin America. Costs are broken down into direct medical costs (significant share), compared to out-of-pocket expenses (3.5%) and indirect costs (7.8%). Sociedad Argentina de Pediatría

Total direct cost, length of hospital stay, institutional discharges and their determinants from rehabilitation settings in stroke patients.

PubMed

Saxena, S K; Ng, T P; Yong, D; Fong, N P; Gerald, K

2006-11-01

Length of hospital stay (LOHS) is the largest determinant of direct cost for stroke care. Institutional discharges (acute care and nursing homes) from rehabilitation settings add to the direct cost. It is important to identify potentially preventable medical and non-medical reasons determining LOHS and institutional discharges to reduce the direct cost of stroke care. The aim of the study was to ascertain the total direct cost, LOHS, frequency of institutional discharges and their determinants from rehabilitation settings. Observational study was conducted on 200 stroke patients in two rehabilitation settings. The patients were examined for various socio-demographic, neurological and clinical variables upon admission to the rehabilitation hospitals. Information on total direct cost and medical complications during hospitalization were also recorded. The outcome variables measured were total direct cost, LOHS and discharges to institutions (acute care and nursing home facility) and their determinants. The mean and median LOHS in our study were 34 days (SD = 18) and 32 days respectively. LOHS and the cost of hospital stay were significantly correlated. The significant variables associated with LOHS on multiple linear regression analysis were: (i) severe functional impairment/functional dependence Barthel Index < or = 50, (ii) medical complications, (iii) first time stroke, (iv) unplanned discharges and (v) discharges to nursing homes. Of the stroke patients 19.5% had institutional discharges (22 to acute care and 17 to nursing homes). On multivariate analysis the significant predictors of discharges to institutions from rehabilitation hospitals were medical complications (OR = 4.37; 95% CI 1.01-12.53) and severe functional impairment/functional dependence. (OR = 5.90, 95% CI 2.32-14.98). Length of hospital stay and discharges to institutions from rehabilitation settings are significantly determined by medical complications. Importance of adhering to clinical pathway/protocol for stroke care is further discussed.

Economic evaluation of genomic test-directed chemotherapy for early-stage lymph node-positive breast cancer.

PubMed

Hall, Peter S; McCabe, Christopher; Stein, Robert C; Cameron, David

2012-01-04

Multi-parameter genomic tests identify patients with early-stage breast cancer who are likely to derive little benefit from adjuvant chemotherapy. These tests can potentially spare patients the morbidity from unnecessary chemotherapy and reduce costs. However, the costs of the test must be balanced against the health benefits and cost savings produced. This economic evaluation compared genomic test-directed chemotherapy using the Oncotype DX 21-gene assay with chemotherapy for all eligible patients with lymph node-positive, estrogen receptor-positive early-stage breast cancer. We performed a cost-utility analysis using a state transition model to calculate expected costs and benefits over the lifetime of a cohort of women with estrogen receptor-positive lymph node-positive breast cancer from a UK perspective. Recurrence rates for Oncotype DX-selected risk groups were derived from parametric survival models fitted to data from the Southwest Oncology Group 8814 trial. The primary outcome was the incremental cost-effectiveness ratio, expressed as the cost (in 2011 GBP) per quality-adjusted life-year (QALY). Confidence in the incremental cost-effectiveness ratio was expressed as a probability of cost-effectiveness and was calculated using Monte Carlo simulation. Model parameters were varied deterministically and probabilistically in sensitivity analysis. Value of information analysis was used to rank priorities for further research. The incremental cost-effectiveness ratio for Oncotype DX-directed chemotherapy using a recurrence score cutoff of 18 was £5529 (US $8852) per QALY. The probability that test-directed chemotherapy is cost-effective was 0.61 at a willingness-to-pay threshold of £30 000 per QALY. Results were sensitive to the recurrence rate, long-term anthracycline-related cardiac toxicity, quality of life, test cost, and the time horizon. The highest priority for further research identified by value of information analysis is the recurrence rate in test-selected subgroups. There is substantial uncertainty regarding the cost-effectiveness of Oncotype DX-directed chemotherapy. It is particularly important that future research studies to inform cost-effectiveness-based decisions collect long-term outcome data.

Economic Burden of Smoking in Iran: A Prevalence-Based Annual Cost Approach

PubMed Central

Rezaei, Satar; Matin, Behzad Karami; Hajizadeh, Mohammad; Bazyar, Mohammad; Sari, Ali Akbari

2017-01-01

Objectives: The burden of smoking on the health system and society is significant. The current study aimed to estimate the annual direct and indirect costs of smoking in Iran for the year 2014. Methods: A prevalence-based disease-specific approach was used to determine costs associated with the three most common smoking-related diseases: lung cancer (LC), chronic obstructive pulmonary disease (COPD) and ischaemic heart disease (IHD). Data on healthcare utilization were obtained from an original survey, hospital records and questionnaires. The number of deaths was extracted from the global burden diseases study (GBD). The human capital approach was applied to estimate the costs of morbidity and mortality due to smoking-related diseases, classified as direct (hospitalization, outpatients and non-medical costs) and indirect (mortality and morbidity). Results: The total economic cost of the three most common smoking-attributable diseases in Iran was US$1.46 billion in 2014, including US$1.05 billion (71.7%) in indirect and US$0.41 billion (28.3%) in direct costs. Direct costs of the three smoking-related diseases accounted for 1.6% of total healthcare expenditures and total costs were about 0.26% of Iran’s gross domestic product (GDP) in 2014. Conclusions: Our study indicated that smoking places a substantial economic burden on Iranian society. Therefore, sustained smoking cessation interventions and tobacco control policies are required to reduce the magnitude and extent of smoking-attributable costs in Iran. PMID:29072438

19 CFR 10.197 - Direct costs of processing operations performed in a beneficiary country or countries.

Code of Federal Regulations, 2010 CFR

2010-04-01

... merchandise: (1) All actual labor costs involved in the growth, production, manufacture or assembly of the... the growth, production, manufacture, or assembly of the merchandise, such as administrative salaries... costs either directly incurred in, or which can be reasonably allocated to, the growth, production...

16 CFR 4.8 - Costs for obtaining Commission records.

Code of Federal Regulations, 2013 CFR

2013-01-01

... section: (1) The term search includes all time spent looking, manually or by automated means, for material... use requesters will be charged for the direct costs to search for, review, and duplicate documents. A... public. (3) Other requesters. Other requesters will be charged for the direct costs to search for and...

16 CFR 4.8 - Costs for obtaining Commission records.

Code of Federal Regulations, 2014 CFR

2014-01-01

... section: (1) The term search includes all time spent looking, manually or by automated means, for material... use requesters will be charged for the direct costs to search for, review, and duplicate documents. A... public. (3) Other requesters. Other requesters will be charged for the direct costs to search for and...

16 CFR 4.8 - Costs for obtaining Commission records.

Code of Federal Regulations, 2012 CFR

2012-01-01

... section: (1) The term search includes all time spent looking, manually or by automated means, for material... use requesters will be charged for the direct costs to search for, review, and duplicate documents. A... public. (3) Other requesters. Other requesters will be charged for the direct costs to search for and...

12 CFR 1070.22 - Fees for processing requests for CFPB records.

Code of Federal Regulations, 2013 CFR

2013-01-01

... CFPB shall charge the requester for the actual direct cost of the search, including computer search time, runs, and the operator's salary. The fee for computer output will be the actual direct cost. For... and the cost of operating the computer to process a request) equals the equivalent dollar amount of...

The economic costs of traffic accidents in Spain.

PubMed

Bastida, Julio López; Aguilar, Pedro Serrano; González, Beatriz Duque

2004-04-01

This study aimed to evaluate the economic impact of traffic accidents in Spain during 1997. The cost-of-illness method was used. Direct costs were divided into health services costs, insurance administration costs, and the costs of the material damages to the vehicles. Indirect costs were obtained through transformation of physical units into monetary units using the approach based on the human capital theory. The total cost of traffic accidents was 6,280.36 million euros, which amounts to 157.59 euros for each inhabitant in Spain and represents 1.35% of the gross national product. The total direct cost was 3,397.00 million euros, representing 54.1% of the total cost. The total indirect cost was 2,883.36 million euros, accounting for 45.9% of the total cost. The high socioeconomic cost of traffic accidents clearly indicates the need for the different administrations in Spain to collaborate in implementing preventive measures.

Medicare rebate for specialist medical practitioners from physiotherapy referrals: analysis of the potential impact on the Australian healthcare system.

PubMed

Byrnes, Joshua M; Comans, Tracy A

2015-02-01

Abstract To identify and examine the likely impact on referrals to specialist medical practitioners, cost to government and patient out-of-pocket costs by providing a rebate under the Medicare Benefits Scheme to patients who attend a specialist medical practitioner upon referral direct from a physiotherapist. A model was constructed to synthesise the costs and benefits of referral with a rebate. Data to inform the model was obtained from administrative sources and from a direct survey of physiotherapists. Given that six referrals per month are made by physiotherapists for a specialist consultation, allowing direct referral to medical specialists and providing patients with a Medicare rebate would result in a likely cost saving to the government ofup to $13 million per year. A range of sensitivity analyses were conducted with all scenarios resulting in some cost savings. The impact of the proposed policy shift to allow direct referral of patients by physiotherapists to specialist medical practitioners and provide patients with a Medicare rebate would be cost saving.

Cost analysis in a clinical microbiology laboratory.

PubMed

Brezmes, M F; Ochoa, C; Eiros, J M

2002-08-01

The use of models for business management and cost control in public hospitals has led to a need for microbiology laboratories to know the real cost of the different products they offer. For this reason, a catalogue of microbiological products was prepared, and the costs (direct and indirect) for each product were analysed, along with estimated profitability. All tests performed in the microbiology laboratory of the "Virgen de la Concha" Hospital in Zamora over a 2-year period (73192 tests) were studied. The microbiological product catalogue was designed using homogeneity criteria with respect to procedures used, workloads and costs. For each product, the direct personnel costs (estimated from workloads following the method of the College of American Pathologists, 1992 version), the indirect personnel costs, the direct and indirect material costs and the portion of costs corresponding to the remaining laboratory costs (capital and structural costs) were calculated. The average product cost was 16.05 euros. The average cost of a urine culture (considered, for purposes of this study, as a relative value unit) reached 13.59 euros, with a significant difference observed between positive and negative cultures (negative urine culture, 10.72 euros; positive culture, 29.65 euros). Significant heterogeneity exists, both in the costs of different products and especially in the cost per positive test. The application of a detailed methodology of cost analysis facilitates the calculation of the real cost of microbiological products. This information provides a basic tool for establishing clinical management strategies.

The Cost-Effectiveness of Ranibizumab for the Treatment of Diabetic Macular Edema.

PubMed

Brown, Gary C; Brown, Melissa M; Turpcu, Adam; Rajput, Yamina

2015-07-01

To assess the incremental, comparative effectiveness (patient value gain) and cost effectiveness (financial value gain) associated with 0.3-mg intravitreal ranibizumab injection therapy versus sham therapy for diabetic macular edema (DME). Value-Based Medicine (Center for Value-Based Medicine, Flourtown, PA) 14-year, cost-utility analysis using patient preferences and 2012 United States real dollars. Published data from the identical Ranibizumab Injection in Subjects with Clinically Significant Macular Edema with Center Involvement Secondary to Diabetes Mellitus (RISE and RIDE) clinical trials. An incremental cost-utility analysis was performed using societal and third-party insurer cost perspectives. Costs and outcomes were discounted with net present value analysis at 3% per annum. The incremental comparative effectiveness was measured in: (1) quality-adjusted life year (QALY) gain and (2) percent patient value (quality-of-life) gain. Cost effectiveness was quantified with the cost-utility ratio (CUR) measured as $/QALY. The 14-year, incremental patient value gain conferred by intravitreal ranibizumab therapy for diabetic maculopathy was 0.9981 QALY, equating to an 11.6% improvement in quality of life. The direct, ophthalmic medical cost for ranibizumab therapy in 1 eye was $30 116, whereas for 2 eyes it was $56 336. The direct, nonophthalmic, medical costs saved from decreased depression, injury, skilled nursing facility admissions, nursing home admissions, and other vision-associated costs totaled $51 758, resulting in an overall direct medical cost of $4578. The net mean societal cost for bilateral ranibizumab therapy was -$30 807. Of this total, decreased caregiver costs accrued a $31 406 savings against the direct medical costs, whereas decreased wage losses accrued a $3978 savings. The third-party insurer CUR for bilateral ranibizumab therapy was $4587/QALY. The societal cost perspective for bilateral therapy was -$30 807/QALY, indicating that ranibizumab therapy dominated sham therapy because it conferred both a positive QALY gain of 0.9981 and a financial value gain (positive financial return on investment) of $30 807 referent to the direct ophthalmic medical costs expended. Intravitreal ranibizumab therapy for the treatment of DME confers considerable patient (human) value gain. It also accrues financial value to patients, public and private insurers, and society. Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Cost-utility of exercise therapy in patients with hip osteoarthritis in primary care.

PubMed

Tan, S S; Teirlinck, C H; Dekker, J; Goossens, L M A; Bohnen, A M; Verhaar, J A N; van Es, P P; Koes, B W; Bierma-Zeinstra, S M A; Luijsterburg, P A J; Koopmanschap, M A

2016-04-01

To determine the cost-effectiveness (CE) of exercise therapy (intervention group) compared to 'general practitioner (GP) care' (control group) in patients with hip osteoarthritis (OA) in primary care. This cost-utility analysis was conducted with 120 GPs in the Netherlands from the societal and healthcare perspective. Data on direct medical costs, productivity costs and quality of life (QoL) was collected using standardised questionnaires which were sent to the patients at baseline and at 6, 13, 26, 39 and 52 weeks follow-up. All costs were based on Euro 2011 cost data. A total of 203 patients were included. The annual direct medical costs per patient were significantly lower for the intervention group (€ 1233) compared to the control group (€ 1331). The average annual societal costs per patient were lower in the intervention group (€ 2634 vs € 3241). Productivity costs were higher than direct medical costs. There was a very small adjusted difference in QoL of 0.006 in favour of the control group (95% CI: -0.04 to +0.02). Our study revealed that exercise therapy is probably cost saving, without the risk of noteworthy negative health effects. NTR1462. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

The social cost of illegal drug consumption in Spain.

PubMed

García-Altés, Anna; Ollé, Josep Ma; Antoñanzas, Fernando; Colom, Joan

2002-09-01

The objective of this study was to estimate the social cost of the consumption of illegal drugs in Spain. We performed a cost-of-illness study, using a prevalence approximation and a societal perspective. The estimation of costs and consequences referred to 1997. As direct costs we included health-care costs, prevention, continuing education, research, administrative costs, non-governmental organizations and crime-related costs. As indirect costs we included lost productivity associated with mortality and the hospitalization of patients. Estimation of intangible costs was not included. The minimum cost of illegal drug consumption in Spain is 88,800 million pesetas (PTA) (467 million dollars). Seventy-seven per cent of the costs correspond to direct costs. Of those, crime-related costs represent 18%, while the largest part corresponds to the health-care costs (50% of direct costs). From the perspective of the health-care system, the minimum cost of illegal drug consumption is 44,000 million PTA (231 million dollars). The cost of illegal drug consumption represents 0.07% of the Spanish GDP. This gross figure compares with 2250 million PTA (12.5 million dollars) invested in prevention programmes during the same year, and with 12,300 million PTA (68.3 million dollars) spent on specific programmes and resources for the drug addict population. Although there are limitations intrinsic in this type of study and the estimations obtained in the present analysis are likely to be an underestimate of the real cost of this condition, we estimate that illegal drug consumption costs the Spanish economy at least 0.2% of GDP.

A pragmatic randomised controlled trial of the effectiveness and cost-effectiveness of 'PhysioDirect' telephone assessment and advice services for physiotherapy.

PubMed

Salisbury, C; Foster, N E; Hopper, C; Bishop, A; Hollinghurst, S; Coast, J; Kaur, S; Pearson, J; Franchini, A; Hall, J; Grove, S; Calnan, M; Busby, J; Montgomery, A A

2013-01-01

As a result of long delays for physiotherapy for musculoskeletal problems, several areas in the UK have introduced PhysioDirect services in which patients telephone a physiotherapist for initial assessment and treatment advice. However, there is no robust evidence about the effectiveness, cost-effectiveness or acceptability to patients of PhysioDirect. To investigate whether or not PhysioDirect is equally as clinically effective as and more cost-effective than usual care for patients with musculoskeletal (MSK) problems in primary care. Pragmatic randomised controlled trial to assess equivalence, incorporating economic evaluation and nested qualitative research. Patients were randomised in 2 : 1 ratio to PhysioDirect or usual care using a remote automated allocation system at the level of the individual, stratifying by physiotherapy site and minimising by sex, age group and site of MSK problem. For the economic analysis, cost consequences included NHS and patient costs, and the cost of lost production. Cost-effectiveness analysis was carried out from the perspective of the NHS. Interviews were conducted with patients, physiotherapists and their managers. Four community physiotherapy services in England. Adults referred by general practitioners or self-referred for physiotherapy for a MSK problem. Patients allocated to PhysioDirect were invited to telephone a senior physiotherapist for initial assessment and advice using a computerised template, followed by face-to-face care when necessary. Patients allocated to usual care were put on to a waiting list for face-to-face care. Primary outcome was the Short Form questionnaire-36 items, version 2 (SF-36v2) Physical Component Score (PCS) at 6 months after randomisation. Secondary outcomes included other measures of health outcome [Measure Yourself Medical Outcomes Profile, European Quality of Life-5 Dimensions (EuroQol health utility measure, EQ-5D), global improvement, response to treatment], wait for treatment, time lost from work and usual activities, patient satisfaction. Data were collected by postal questionnaires at baseline, 6 weeks and 6 months, and from routine records by researchers blind to allocation. A total of 1506 patients were allocated to PhysioDirect and 743 to usual care. Patients allocated to PhysioDirect had a shorter wait for treatment than those allocated to usual care [median 7 days vs 34 days; arm-time ratio 0.32, 95% confidence interval (CI) 0.29 to 0.35] and had fewer non-attended face-to-face appointments [incidence rate ratio 0.55 (95% CI 0.41 to 0.73)]. The primary outcome at 6 months' follow-up was equivalent between PhysioDirect and usual care [mean PCS 43.50 vs 44.18, adjusted difference in means -0.01 (95% CI -0.80 to 0.79)]. The secondary measures of health outcome all demonstrated equivalence at 6 months, with slightly greater improvement in the PhysioDirect arm at 6 weeks' follow-up. Patients were equally satisfied with access to care but slightly less satisfied overall with PhysioDirect compared with usual care. NHS costs (physiotherapy plus other relevant NHS costs) per patient were similar in the two arms [PhysioDirect £ 198.98 vs usual care £ 179.68, difference in means £ 19.30 (95% CI -£ 37.60 to £ 76.19)], while QALYs gained were also similar [difference in means 0.007 (95% CI -0.003 to 0.016)]. Incremental cost per QALY gained was £ 2889. The probability that PhysioDirect was cost-effective at a £ 20,000 willingness-to-pay threshold was 88%. These conclusions about cost-effectiveness were robust to sensitivity analyses. There was no evidence of difference between trial arms in cost to patients or value of lost production. No adverse events were detected. Providing physiotherapy via PhysioDirect is equally clinically effective compared with usual waiting list-based care, provides faster access to treatment, appears to be safe, and is broadly acceptable to patients. PhysioDirect is probably cost-effective compared with usual care.

Doing the math on physician employment.

PubMed

Harris, John M; Simmons, H J; Kierstead, Rudd

2009-12-01

When assessing the costs and benefits of a physician employment strategy, it's important to consider not only the direct costs and benefits of the strategy, but also its indirect benefits, such as increased revenue as a result of eliminating admission-splitting by employed physicians. The indirect risks of physician employment, such as eliminating independent physicians, can be minimized by adjusting timing to match the market's physician employment stage. The strategy will work if the combined direct and indirect benefits are significant enough to outweigh the direct costs.

Study of Advanced Propulsion Systems for Small Transport Aircraft Technology (STAT) Program

NASA Technical Reports Server (NTRS)

Baerst, C. F.; Heldenbrand, R. W.; Rowse, J. H.

1981-01-01

Definitions of takeoff gross weight, performance, and direct operating cost for both a 30 and 50 passenger airplane were established. The results indicate that a potential direct operating cost benefit, resulting from advanced technologies, of approximately 20 percent would be achieved for the 1990 engines. Of the numerous design features that were evaluated, only maintenance-related items contributed to a significant decrease in direct operating cost. Recommendations are made to continue research and technology programs for advanced component and engine development.

Costs of management of patients with coronary artery disease in Poland: the multicenter RECENT study.

PubMed

Jaworski, Rafał; Jankowska, Ewa A; Ponikowski, Piotr; Banasiak, Waldemar

2012-01-01

Treatment of coronary artery disease (CAD) generates the major part of public health expenditure in the developed countries. The aim of the study was to estimate costs associated with the diagnosis and treatment of patients with CAD in Poland. Costs were estimated in a representative sample of 2593 patients with CAD receiving general practitioner (n = 1977) or specialist care (n = 616) in 2005 (the multicenter RECENT study). Data from the National Health Fund, Social Insurance Institution, Central Statistical Office, and current literature were used. The total annual cost of CAD reached €2254.17 per patient, with 48% accounting for direct medical costs (drugs, medical consultations, laboratory tests, diagnostic procedures, invasive treatment, hospitalizations, emergency care) and 52% for indirect costs (related to absence at work and disability). Eighty-one percent of total direct medical costs were covered by the public payer (including 30% of pharmacological treatment costs). Direct medical costs covered by the public payer were higher in men and in patients with more severe angina symptoms (both P <0.05). In the model based on the lowest prevalence of CAD (estimated based on the real population of patients treated in 2005), direct medical costs covered by the public payer reached €617.6 million, i.e., around 7% of the total public health expenditure in Poland in 2005. Modern management of CAD imposes enormous economic burden on the public health system in Poland. There is a need to develop and implement strategies that would optimize health care costs associated with the treatment of CAD.

High direct costs of medical care in patients with Type 1 diabetes attending a referral clinic in a government-funded hospital in Northern India.

PubMed

Katam, Kishore K; Bhatia, Vijayalakshmi; Dabadghao, Preeti; Bhatia, Eesh

2016-01-01

There is little information regarding costs of managing type 1 diabetes mellitus (T1DM) from low- and middle-income countries. We estimated direct costs of T1DM in patients attending a referral diabetes clinic in a governmentfunded hospital in northern India. We prospectively enrolled 88 consecutive T1DM patients (mean [SD] age 15.3 [8] years) with age at onset <18 years presenting to the endocrine clinic of our institution. Data on direct costs were collected for a 12 months-6 months retrospectively followed by 6 months prospectively. Patients belonged predominantly (77%) to the middle socioeconomic strata (SES); 81% had no access to government subsidy or health insurance. The mean direct cost per patient-year of T1DM was `27 915 (inter-quartile range [IQR] `19 852-32 856), which was 18.6% (7.1%-30.1%) of the total family income. A greater proportion of income was spent by families of lower compared to middle SES (32.6% v. 6.6%, p<0.001). The mean out-of-pocket payment for diabetes care ranged from 2% to 100% (mean 87%) of the total costs. The largest expenditure was on home blood glucose monitoring (40%) and insulin (39.5%). On multivariate analysis, total direct cost was associated with annual family income (β=0.223, p=0.033), frequency of home blood glucose monitoring (β=0.249, p=0.016) and use of analogue insulin (β=0.225, p=0.016). Direct costs of T1DM were high; in proportion to their income the costs were greater in the lower SES. The largest expenditure was on home blood glucose monitoring and insulin. Support for insulin and glucose testing strips for T1DM care is urgently required.

Measuring direct and indirect costs of land retirement in an irrigated river basin: A budgeting regional multiplier approach

NASA Astrophysics Data System (ADS)

Hamilton, Joel; Whittlesey, Norman K.; Robison, M. Henry; Willis, David

2002-08-01

This analysis addresses three important conceptual problems in the measurement of direct and indirect costs and benefits: (1) the distribution of impacts between a regional economy and the encompassing state economy; (2) the distinction between indirect impacts and indirect costs (IC), focusing on the dynamic time path unemployed resources follow to find alternative employment; and (3) the distinction among the affected firms' microeconomic categories of fixed and variable costs as they are used to compute regional direct and indirect costs. It uses empirical procedures that reconcile the usual measures of economic impact provided by input/output models with the estimates of economic costs and benefits required for analysis of welfare changes. The paper illustrates the relationships and magnitudes involved in the context of water policy issues facing the Pecos River Basin of New Mexico.

Health care resource utilization and direct medical costs for patients with schizophrenia initiating treatment with atypical versus typical antipsychotics in Tianjin, China.

PubMed

He, Xiaoning; Wu, Jing; Jiang, Yawen; Liu, Li; Ye, Wenyu; Xue, Haibo; Montgomery, William

2015-04-09

It is uncertain whether the extra acquisition costs of atypical antipsychotics over typical antipsychotics are offset by their other reduced resource use especially in hospital services in China. This study compared the psychiatric-related health care resource utilization and direct medical costs for patients with schizophrenia initiating atypical or typical antipsychotics in Tianjin, China. Data were obtained from the Tianjin Urban Employee Basic Medical Insurance database (2008-2010). Adult patients with schizophrenia with ≥1 prescription for antipsychotics after ≥90-day washout and 12-month continuous enrollment after first prescription was included. Psychiatric-related resource utilization and direct medical costs of the atypical and typical cohorts were estimated during the 12-month follow-up period. Logistic regressions, ordinary least square (OLS), and generalized linear models (GLM) were employed to estimate differences of resource utilization and costs between the two cohorts. One-to-one propensity score matching was conducted as a sensitivity analysis. 1131 patients initiating either atypical (N = 648) or typical antipsychotics (N = 483) were identified. Compared with the typical cohort, the atypical cohort had a lower likelihood of hospitalization (45.8% vs. 56.7%, P < 0.001; adjusted OR: 0.58, P < 0.001) over the follow-up period. Medication costs for the atypical cohort were higher than the typical cohort ($438 vs. $187, P < 0.001); however, their non-medication medical costs were significantly lower ($1223 vs. $1704, P < 0.001). The total direct medical costs were similar between the atypical and typical cohorts before ($1661 vs. $1892, P = 0.100) and after matching ($1711 vs. 1868, P = 0.341), consistent with the results from OLS and GLM models for matched cohorts. The atypical cohort had similar total direct medical costs compared to the typical cohort. Higher medication costs associated with atypical antipsychotics were offset by a reduction in non-medication medical costs, driven by fewer hospitalizations.

Healthcare costs of people with type 2 diabetes mellitus in the Basque Country (Spain).

PubMed

Nuño-Solinís, Roberto; Alonso-Morán, Edurne; Arteagoitia Axpe, Jose M; Ezkurra Loiola, Patxi; Orueta, Juan F; Gaztambide, Sonia

2016-12-01

The aim of the study was to estimate the direct costs of healthcare provided to patients with type 2 diabetes mellitus (T2DM) in the Basque Country and to compare them with those of the population with chronic diseases. A retrospective, cross-sectional, population-based study. Direct healthcare costs for patients aged over 35 years diagnosed with T2DM in the Basque Country (n=126,894) were calculated, stratified by age, sex and deprivation index, and compared to the costs for the population diagnosed with a chronic disease other than T2DM (n=1,347,043). The annual average healthcare cost of a person with T2DM was €3,432. Cost gradually increased with age to €4,313 in patients aged 80 to 84 years. Cost in males were €161 higher as compared to costs in females (P<.001). In the most socioeconomically disadvantaged areas, cost per patient was €468 (14.9%) greater than in the most privileged areas (P<.001). Moreover, cost was 68.5% higher (P<.001) for patients with T2DM than for patients with other chronic diseases. Total annual direct costs amounted to €435.5 million, or 12.78% of total public health expenditure in the region. Direct mean healthcare costs in the Basque Country for patients with T2DM were higher in males, in the most underprivileged areas, in patients with comorbidities, and in older age groups, and represented €3,432 per person per year. Copyright © 2016 SEEN. Publicado por Elsevier España, S.L.U. All rights reserved.

Manufacturing cost analysis of a parabolic dish concentrator (General Electric design) for solar thermal electric power systems in selected production volumes

NASA Technical Reports Server (NTRS)

1981-01-01

The manufacturing cost of a General Electric 12 meter diameter concentrator was estimated. This parabolic dish concentrator for solar thermal system was costed in annual production volumes of 100 - 1,000 - 5,000 - 10,000 - 50,000 100,000 - 400,000 and 1,000,000 units. Presented for each volume are the costs of direct labor, material, burden, tooling, capital equipment and buildings. Also presented is the direct labor personnel and factory space requirements. All costs are based on early 1981 economics.

Economic Burden for Lung Cancer Survivors in Urban China.

PubMed

Zhang, Xin; Liu, Shuai; Liu, Yang; Du, Jian; Fu, Wenqi; Zhao, Xiaowen; Huang, Weidong; Zhao, Xianming; Liu, Guoxiang; Mao, Zhengzhong; Hu, Teh-Wei

2017-03-15

With the rapid increase in the incidence and mortality of lung cancer, a growing number of lung cancer patients and their families are faced with a tremendous economic burden because of the high cost of treatment in China. This study was conducted to estimate the economic burden and patient responsibility of lung cancer patients and the impact of this burden on family income. This study uses data from a retrospective questionnaire survey conducted in 10 communities in urban China and includes 195 surviving lung cancer patients diagnosed over the previous five years. The calculation of direct economic burden included both direct medical and direct nonmedical costs. Indirect costs were calculated using the human capital approach, which measures the productivity lost for both patients and family caregivers. The price index was applied for the cost calculation. The average economic burden from lung cancer was $43,336 per patient, of which the direct cost per capita was $42,540 (98.16%) and the indirect cost per capita was $795 (1.84%). Of the total direct medical costs, 35.66% was paid by the insurer and 9.84% was not covered by insurance. The economic burden for diagnosed lung cancer patients in the first year following diagnosis was $30,277 per capita, which accounted for 171% of the household annual income, a percentage that fell to 107% after subtracting the compensation from medical insurance. The economic burden for lung cancer patients is substantial in the urban areas of China, and an effective control strategy to lower the cost is urgently needed.

Economic Impact of Revision Surgery for Proximal Junctional Failure After Adult Spinal Deformity Surgery: A Cost Analysis of 57 Operations in a 10-year Experience at a Major Deformity Center.

PubMed

Theologis, Alexander A; Miller, Liane; Callahan, Matt; Lau, Darryl; Zygourakis, Corinna; Scheer, Justin K; Burch, Shane; Pekmezci, Murat; Chou, Dean; Tay, Bobby; Mummaneni, Praveen; Berven, Sigurd; Deviren, Vedat; Ames, Christopher P

2016-08-15

Retrospective cohort analysis. To evaluate the economic impact of revision surgery for proximal junctional failures (PJF) after thoracolumbar fusions for adult spinal deformity (ASD). PJF after fusions for ASD is a major cause of disability. Although clinical sequelae are described, PJF-revision operation costs are incompletely defined. Consecutive adults who underwent thoracolumbar fusions for ASD (August, 2003 to January, 2013) were evaluated. Inclusion criteria include construct from pelvis to L2 or above and minimum 6 months follow-up after the index ASD operation. Direct costs (surgical supplies/implants, room/care, pharmacy, services) were identified from medical billing data and calculated for index ASD operations and subsequent surgeries for PJF. Not included in direct cost data were indirect costs, charges, surgeon fees, or revision operations for indications other than PJF (i.e., pseudarthrosis). Patients were compared based on the construct's upper-instrumented vertebra: upper thoracic (UT: T1-6) versus thoracolumbar junction (TLjxn: T9-L2). Of 501 patients, 382 met inclusion criteria. Fifty-one patients [UT:14; TLjxn: 40 at index; average follow-up 32.6 months (6-92 months)] had revisions for PJF, which summed to $3.2 million total direct cost. Average direct cost of index operations for the cohort ($68,294) was significantly greater than PJF-revisions ($55,547). Compared with TLjxn, UT had a significantly higher average cost for index operations ($79,860 vs. $65,868). However, PJF-revision cases were similar in average cost (UT:$60,103; TLjxn:$53,920; P = 0.09). Costs of PJF amounted to an additional 12.1% of the total index surgical cost in 382 patients. Revision operations for PJF after long thoracolumbar fusions for ASD are associated with an average direct cost of $55,547 per case. Revision costs for PJF are similar based on the index procedure's upper-instrumented vertebra level. At a major tertiary center over a 10-year period, PJF came at a very significant economic expense amounting to $3.2 million for 57 cases. 3.

76 FR 45820 - Food Safety Modernization Act Domestic and Foreign Facility Reinspections, Recall, and Importer...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-01

... of sick leave 80 10 days of training 80 2 hours of meetings per week 80 Net Supported Direct FDA Work... implementing these user fees in FY 2013. II. Estimating the Average Cost of a Supported Direct FDA Work Hour... Direct Work Hour in FY 2010 In general, the starting point for estimating the full cost per direct work...

Cost of treatment for breast cancer in central Vietnam

PubMed Central

Hoang Lan, Nguyen; Laohasiriwong, Wongsa; Stewart, John Frederick; Tung, Nguyen Dinh; Coyte, Peter C.

2013-01-01

Background In recent years, cases of breast cancer have been on the rise in Vietnam. To date, there has been no study on the financial burden of the disease. This study estimates the direct medical cost of a 5-year treatment course for women with primary breast cancer in central Vietnam. Methods Retrospective patient-level data from medical records at the Hue Central Hospital between 2001 and 2006 were analyzed. Cost analysis was conducted from the health care payers’ perspective. Various direct medical cost categories were computed for a 5-year treatment course for patients with breast cancer. Costs, in US dollars, discounted at a 3% rate, were converted to 2010 after adjusting for inflation. For each cost category, the mean, standard deviation, median, and cost range were estimated. Median regression was used to investigate the relationship between costs and the stage, age at diagnosis, and the health insurance coverage of the patients. Results The total direct medical cost for a 5-year treatment course for breast cancer in central Vietnam was estimated at $975 per patient (range: $11.7–$3,955). The initial treatment cost, particularly the cost of chemotherapy, was found to account for the greatest proportion of total costs (64.9%). Among the patient characteristics studied, stage at diagnosis was significantly associated with total treatment costs. Patients at later stages of breast cancer did not differ significantly in their total costs from those at earlier stages however, but their survival time was much shorter. The absence of health insurance was the main factor limiting service uptake. Conclusion From the health care payers’ perspective, the Government subsidization of public hospital charges lowered the direct medical costs of a 5-year treatment course for primary breast cancer in central Vietnam. However, the long treatment course was significantly influenced by out-of-pocket payments for patients without health insurance. PMID:23394855

The direct and indirect costs associated with endometriosis: a systematic literature review.

PubMed

Soliman, Ahmed M; Yang, Hongbo; Du, Ella Xiaoyan; Kelley, Caroline; Winkel, Craig

2016-04-01

What is the economic burden of endometriosis? The identified studies indicate that there is a significant economic burden associated with endometriosis, as observed by both direct and indirect costs. Two previous systematic literature reviews suggested that there were considerable direct costs associated with endometriosis and there was a general lack of measurement of indirect costs. We performed a systematic literature review. MEDLINE and EMBASE databases from 2000 to 2013 were searched. The literature search was limited to human studies of patients with endometriosis. Papers in languages other than English were excluded. Studies reporting direct or indirect costs among patients with endometriosis were considered for inclusion. Direct costs included inpatient, outpatient, surgery, drug and other healthcare service cost. Indirect costs were related to absenteeism and presenteeism (lost productivity at work). After evaluating the 1396 articles in the search results, 12 primary studies that reported direct or indirect costs associated with endometriosis were identified and included in the data extraction. Three of the studies were conducted in the USA, one study each was conducted in Austria, Belgium, Brazil, Canada, Finland, Germany and Italy, and two studies included data from 10 countries. Significant variability was observed in the reviewed studies in methodology, including data source, cost components considered and study perspective. Estimates of total direct costs ranged from $1109 per patient per year in Canada to $12 118 per patient per year in the USA. Indirect costs of endometriosis ranged from $3314 per patient per year in Austria to $15 737 per patient per year in the USA. The studies identified in the systematic literature review varied greatly by study methodology as well as by country owing to different healthcare systems and costs of healthcare services, which contributed to large variations in the direct and indirect cost estimates. A majority of the studies we found were published after the periods covered in the prior systematic literature reviews, which provided substantial contributions to an understanding of the economic burden of endometriosis, especially in the area of indirect costs. The long-term burden of endometriosis following diagnosis is still under-studied, which is a concern given the chronic nature of the disease and the substantial recurrence of endometriosis symptoms. This study was funded by AbbVie, which also develops the oral GnRH antagonist elagolix (in collaboration with Neurocrine Biosciences) for the management of endometriosis and uterine fibroids. A.M.S. is an employee of AbbVie and currently owns AbbVie stocks. H.Y., E.X.D. and C.K. are employees of Analysis Group, Inc., which has received consultancy fees from AbbVie. C.W. is a Clinical Professor at the Department Obstetrics and Gynecology at Georgetown University in Washington, DC, USA and has served in a consulting role to AbbVie for this project. © The Author 2016. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Costs optimization in anaesthesia.

PubMed

Martelli, Alessandra

2015-04-27

The aim of this study is to analyze the direct cost of different anaesthetic techniques used within the Author's hospital setting and compare with costs reported in the literature. Mean cost of drugs and devices used in our local Department of Anaesthesia was considered in the present study. All drugs were supplied by the in-house Pharmacy Service of Parma's General Hospital. All calculation have been made using an hypothetical ASA1 patient weighting 70 kg. The quality of consumption and cost of inhalation anaesthesia with sevoflurane or desflurane at different fresh gas flow were analyzed, and the cost of total venous anaesthesia (TIVA) using propofol and remifentanil with balanced anaesthesia were also analyzed. In addition, direct costs of general, spinal and sciatic-femoral nerve block anaesthesia used for common plastic surgery procedures were assessed. The results of our study show that the cost of inhalational anaesthesia decreases using fresh gas flow below 1L, and the use of desflurane is more expensive. In our Hospital, the cost of TIVA is more or less equivalent to the costs of balanced anaesthesia with sevoflurane in surgical procedure lasting more than five hours. The direct cost was lower for the spinal anaesthesia compared with general anaesthesia and sciatic- femoral nerve block for some surgical procedures. (www.actabiomedica.it).

Contracts and management services site support program plan WBS 6.10.14

DOE Office of Scientific and Technical Information (OSTI.GOV)

Knoll, J.M. Jr.

1994-09-01

Contracts and Management Services is recognized as the central focal point for programs having company or sitewide application in pursuit of the Hanford Missions`s financial and operational objectives. Contracts and Management Services actively pursues cost savings and operational efficiencies through: Management Standards by ensuring all employees have an accessible, integrated system of clear, complete, accurate, timely, and useful management control policies and procedures; Contract Reform by restructuring the contract, organization, and cost accounting systems to refocus Hanford contract activities on output products; Systems and Operations Evaluation by directing the Cost Reduction program, Great Ideas, and Span of Management activities; Programmore » Administration by enforcing conditions of Accountability (whether DEAR-based or FAR-based) for WHC, BCSR, ICF KH, and BHI; Contract Performance activities; chairing the WHC Cost Reduction Review Board; and analyzing companywide Performance Measures; Data Standards and Administration by establishing and directing the company data management program; giving direction to the major RL programs and mission areas for implementation of cost-effective and efficient data management practices; directing all operations, application, and interfaces contained within the Hanford PeopleCore System; directing accomplishment and delivery of TPA data management milestones; and directing the sitewide data management processes for Data Standards and the Data Directory.« less

The direct and indirect costs of managing chronic obstructive pulmonary disease in Greece.

PubMed

Souliotis, Kyriakos; Kousoulakou, Hara; Hillas, Georgios; Tzanakis, Nikos; Toumbis, Michalis; Vassilakopoulos, Theodoros

2017-01-01

COPD is associated with significant economic burden. The objective of this study was to explore the direct and indirect costs associated with COPD and identify the key cost drivers of disease management in Greece. A Delphi panel of Greek pulmonologists was conducted, which aimed at eliciting local COPD treatment patterns and resource use. Resource use was translated into costs using official health insurance tariffs and Diagnosis-Related Groups (DRGs). In addition, absenteeism and caregiver's costs were recorded in order to quantify indirect COPD costs. The total costs of managing COPD per patient per year were estimated at €4,730, with direct (medical and nonmedical) and indirect costs accounting for 62.5% and 37.5%, respectively. COPD exacerbations were responsible for 32% of total costs (€1,512). Key exacerbation-related cost drivers were hospitalization (€830) and intensive care unit (ICU) admission costs (€454), jointly accounting for 85% of total exacerbation costs. Annual maintenance phase costs were estimated at €835, with pharmaceutical treatment accounting for 77% (€639.9). Patient time costs were estimated at €146 per year. The average number of sick days per year was estimated at 16.9, resulting in productivity losses of €968. Caregiver's costs were estimated at €806 per year. The management of COPD in Greece is associated with intensive resource use and significant economic burden. Exacerbations and productivity losses are the key cost drivers. Cost containment policies should focus on prioritizing treatments that increase patient compliance as these can lead to reduction of exacerbations, longer maintenance phases, and thus lower costs.

34 CFR 300.202 - Use of amounts.

Code of Federal Regulations, 2011 CFR

2011-07-01

... this part; (2) Must be used only to pay the excess costs of providing special education and related... B of the Act to pay for all of the costs directly attributable to the education of a child with a... prevent an LEA from using Part B funds to pay for all of the costs directly attributable to the education...

34 CFR 300.202 - Use of amounts.

Code of Federal Regulations, 2010 CFR

2010-07-01

... this part; (2) Must be used only to pay the excess costs of providing special education and related... B of the Act to pay for all of the costs directly attributable to the education of a child with a... prevent an LEA from using Part B funds to pay for all of the costs directly attributable to the education...

The Economics of Direct versus Indirect Cost Recovery in Sponsored Research. AIR Annual 1984 Forum Paper.

ERIC Educational Resources Information Center

Kutina, Kenneth L.; And Others

The effect of reduced reimbursements by the federal government for indirect research costs was analyzed for the typical academic medical center. The effects of simply cutting indirect cost reimbursement were contrasted with the impact of securing compensating levels of increased direct project support. To determine if the consequences differed as…

26 CFR 1.263(a)-2T - Amounts paid to acquire or produce tangible property (temporary).

Code of Federal Regulations, 2012 CFR

2012-04-01

..., see section 263A requiring taxpayers to capitalize the direct and indirect costs of producing property... direct and allocable indirect costs (including otherwise deductible costs) to be capitalized to property... company to move storage tanks from Y's plant to X's plant. Under paragraph (f)(2)(ii)(A) of this section...

26 CFR 1.263(a)-2T - Amounts paid to acquire or produce tangible property (temporary).

Code of Federal Regulations, 2013 CFR

2013-04-01

..., see section 263A requiring taxpayers to capitalize the direct and indirect costs of producing property... direct and allocable indirect costs (including otherwise deductible costs) to be capitalized to property... company to move storage tanks from Y's plant to X's plant. Under paragraph (f)(2)(ii)(A) of this section...

Low-cost directionally-solidified turbine blades, volume 1

NASA Technical Reports Server (NTRS)

Sink, L. W.; Hoppin, G. S., III; Fujii, M.

1979-01-01

A low cost process of manufacturing high stress rupture strength directionally-solidified high pressure turbine blades was successfully developed for the TFE731-3 Turbofan Engine. The basic processing parameters were established using MAR-M 247 and employing the exothermic directional-solidification process in trial castings of turbine blades. Nickel-based alloys were evaluated as directionally-solidified cast blades. A new turbine blade, disk, and associated components were then designed using previously determined material properties. Engine tests were run and the results were analyzed and compared to the originally established goals. The results showed that the stress rupture strength of exothermically heated, directionally-solidified MAR-M 247 turbine blades exceeded program objectives and that the performance and cost reduction goals were achieved.

The economic burden of incisional ventral hernia repair: a multicentric cost analysis.

PubMed

Gillion, J-F; Sanders, D; Miserez, M; Muysoms, F

2016-12-01

A systematic review of literature led us to take note that little was known about the costs of incisional ventral hernia repair (IVHR). Therefore we wanted to assess the actual costs of IVHR. The total costs are the sum of direct (hospital costs) and indirect (sick leave) costs. The direct costs were retrieved from a multi-centric cost analysis done among a large panel of 51 French public hospitals, involving 3239 IVHR. One hundred and thirty-two unitary expenditure items were thoroughly evaluated by the accountants of a specialized public agency (ATIH) dedicated to investigate the costs of the French Health Care system. The indirect costs (costs of the post-operative inability to work and loss of profit due to the disruption in the ongoing work) were estimated from the data the Hernia Club registry, involving 790 patients, and over a large panel of different Collective Agreements. The mean total cost for an IVHR in France in 2011 was estimated to be 6451€, ranging from 4731€ for unemployed patients to 10,107€ for employed patients whose indirect costs (5376€) were slightly higher than the direct costs. Reducing the incidence of incisional hernia after abdominal surgery with 5 % for instance by implementation of the European Hernia Society Guidelines on closure of abdominal wall incisions, or maybe even by use of prophylactic mesh augmentation in high risk patients could result in a national cost savings of 4 million Euros.

Cost of Behavioral Interventions Utilizing Electronic Drug Monitoring for Antiretroviral Therapy Adherence

PubMed Central

Rasu, Rafia S.; Malewski, David F.; Banderas, Julie W.; Thomson, Domonique Malomo; Goggin, Kathy

2013-01-01

Objective To provide data on the actual costs associated with behavioral ART adherence interventions and electronic drug monitoring used in a clinical trial to inform their implementation in future studies and real-world practice. Methods Direct and time costs were calculated from a multi-site three-arm randomized controlled ART adherence trial. HIV positive participants (n = 204) were randomized to standard care (SC), enhanced counseling (EC), or EC and modified directly observed therapy (mDOT) interventions. Electronic drug monitoring (EDM) was used. Costs were calculated for various components of the 24-week adherence intervention. This economic evaluation was conducted from the perspective of an agency that may wish to implement these strategies. Sensitivity analyses were conducted to examine costs and savings associated with different scenarios. Results Total direct costs were $126,068 ($618/patient). Initial time costs were $53,590 ($262/patient). Base cost of labor was $0.36/minute. EC costs for 134 patients were $18,427 ($137/patient) and mDOT for 64 patients cost $18,638 ($291/patient). Total per patient costs were: SC=$880, EC=$1,018, EC/mDOT=$1,309. Removing driving costs evidenced the most variable impact on savings between the three study arms. The tornado diagram (sensitivity analysis) showed a graphical representation of how each sensitivity assumption reduced costs compared to each other and the resulting comparative costs for each group. Conclusion This novel economic analysis provides valuable cost information to guide treatment implementation and research design decisions. PMID:23337364

Costs and quality of life of patients with ankylosing spondylitis in Hong Kong.

PubMed

Zhu, T Y; Tam, L-S; Lee, V W-Y; Hwang, W W; Li, T K; Lee, K K; Li, E K

2008-09-01

To assess the annual direct, indirect and total societal costs, quality of life (QoL) of AS in a Chinese population in Hong Kong and determine the cost determinants. A retrospective, non-randomized, cross-sectional study was performed in a cohort of 145 patients with AS in Hong Kong. Participants completed questionnaires on sociodemographics, work status and out-of-pocket expenses. Health resources consumption was recorded by chart review. Functional impairment and disease activity were measured using the Bath Ankylosing Spondylitis Functional Index (BASFI) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), respectively. Patients' QoL was assessed using the Short Form-36 (SF-36). The mean age of the patients was 40 yrs with mean disease duration of 10 yrs. The mean BASDAI score was 4.7 and BASFI score was 3.3. Annual total costs averaged USD 9120. Direct costs accounted for 38% of the total costs while indirect costs accounted for 62%. Costs of technical examinations represented the largest proportion of total cost. Patients with AS reported significantly impaired QoL. Functional impairment became the major cost driver of direct costs and total costs. There is a substantial societal cost related to the treatment of AS in Hong Kong. Functional impairment is the most important cost driver. Treatments that reduce functional impairment may be effective to decrease the costs of AS and improve the patient's QoL, and ease the pressure on the healthcare system.

An introduction to clinical microeconomic analysis: purposes and analytic methods.

PubMed

Weintraub, W S; Mauldin, P D; Becker, E R

1994-06-01

The recent concern with health care economics has fostered the development of a new discipline that is generally called clinical microeconomics. This is a discipline in which microeconomic methods are used to study the economics of specific medical therapies. It is possible to perform stand alone cost analyses, but more profound insight into the medical decision making process may be accomplished by combining cost studies with measures of outcome. This is most often accomplished with cost-effectiveness or cost-utility studies. In cost-effectiveness studies there is one measure of outcome, often death. In cost-utility studies there are multiple measures of outcome, which must be grouped together to give an overall picture of outcome or utility. There are theoretical limitations to the determination of utility that must be accepted to perform this type of analysis. A summary statement of outcome is quality adjusted life years (QALYs), which is utility time socially discounted survival. Discounting is used because people value a year of future life less than a year of present life. Costs are made up of in-hospital direct, professional, follow-up direct, and follow-up indirect costs. Direct costs are for medical services. Indirect costs reflect opportunity costs such as lost time at work. Cost estimates are often based on marginal costs, or the cost for one additional procedure of the same type. Finally an overall statistic may be generated as cost per unit increase in effectiveness, such as dollars per QALY.(ABSTRACT TRUNCATED AT 250 WORDS)

Healthcare Costs for Chronic Hepatitis C in South Korea from 2009 to 2013: An Analysis of the National Health Insurance Claims' Data.

PubMed

Ki, Moran; Choi, Hwa Young; Kim, Kyung-Ah; Jang, Eun Sun; Jeong, Sook-Hyang

2017-11-15

The introduction of direct-acting antivirals (DAA) in 2013 revolutionized hepatitis C virus (HCV) treatment, offering a cure rate >90%. However, this therapy is expensive, and estimations of the number of chronic HCV-infected (CHC) patients and their treatment costs pre-2013 are therefore essential for creating policies and expanding drug access. Herein, we aimed to investigate the number of HCV-related liver disease patients, their healthcare utilization, their annual direct medical costs, and the interferon-based antiviral treatment rates and costs from 2009 to 2013 in South Korea. The National Health Insurance database was reviewed, and patients diagnosed with CHC from 2009 to 2013 were extracted. Data regarding detailed healthcare utilization, prescribed drugs, and direct medical costs were obtained. For annual direct healthcare cost calculations, a prevalence-based approach was used. Overall, 181,768 CHC patients were identified. In 2013, the annual per-patient costs for chronic hepatitis, liver cirrhosis, hepatocellular carcinoma, and the first year post-liver transplant were 895, 1,873, 6,945, and 67,359 United States dollars, respectively. Interferon-based antiviral therapeutics were prescribed to 25,223 patients (13.9%). Healthcare costs have increased remarkably with increasing liver disease severity. Thus, efforts to stop disease progression are needed. Moreover, the low rate of interferon-based therapy indicates an unmet need for DAA.

Utility and direct costs: ankylosing spondylitis compared with rheumatoid arthritis.

PubMed

Verstappen, S M M; Jacobs, J W G; van der Heijde, D M; van der Linden, Sj; Verhoef, C M; Bijlsma, J W J; Boonen, A

2007-06-01

To compare utility and disease-specific direct costs between patients with ankylosing spondylitis (AS) and patients with rheumatoid arthritis (RA) in the Netherlands. Patients with AS and those with RA completed questions on disease characteristics, the EuroQol-5D (EQ-5D) to assess utility, and questionnaire resource utilisation. Resource utilisation was assessed prospectively in AS, but retrospectively in RA. True cost estimates (2003) were used to calculate the costs. Differences in disease characteristics between AS and RA were described, and determinants of EQ-5D utility and costs were explored by Cox proportional hazard regressions. 576 patients with RA and 132 with AS completed the questionnaires. EQ-5D utility (0.63 vs 0.7) was lower, and annual direct costs higher in RA (euro5167 vs euro2574). In multivariate Cox proportional hazard regressions, there was no difference in utility between the diagnostic groups, but patients with RA incurred higher direct costs after controlling for age, gender and disease duration. In patients with RA and patients with AS, who are under the care of a rheumatologist, utility is equally reduced, but healthcare costs are higher in RA after controlling for age, gender and disease duration. These data can be helpful to provide insights into the differences and similarities between the healthcare needs of both patient groups and to identify issues for further research and for policy in healthcare organisations.

A cost-minimisation study of 1,001 NHS Direct users

PubMed Central

2013-01-01

Background To determine financial and quality of life impact of patients calling the ‘0845’ NHS Direct (NHS Direct) telephone helpline from the perspective of NHS service providers. Methods Cost-minimisation of repeated cohort measures from a National Survey of NHS Direct’s telephone service using telephone survey results. 1,001 people contacting NHS Direct’s 0845 telephone service in 2009 who agreed to a 4-6 week follow-up. A cost comparison between NHS Direct recommendation and patient-stated first alternative had NHS Direct not been available. Analysis also considers impact on quality of life of NHS Direct recommendations using the Visual Analogue Scale of the EQ-5D. Results Significant referral pattern differences were observed between NHS Direct recommendation and patient-stated first alternatives (p < 0.001). Per patient cost savings resulted from NHS Direct’s recommendation to attend A&E (£36.54); GP Practice (£19.41); Walk-In Centre (£49.85); Pharmacist (£25.80); Dentist (£2.35) and do nothing/treat at home (£19.77), while it was marginally more costly for 999 calls (£3.33). Overall an average per patient saving of £19.55 was found (a 36% saving compared with patient-stated first alternatives). For 5 million NHS Direct telephone calls per year, this represents an annual cost saving of £97,756,013. Significant quality of life differences were observed at baseline and follow-up between those who believed their problem was ‘urgent’ (p = 0.001) and those who said it was ‘non-urgent’ (p = 0.045). Whilst both groups improved, self-classified ‘urgent’ cases made greater health gains than those who said they were ‘non-urgent’ (urgent by 21.5 points; non-urgent by 16.1 points). Conclusions The ‘0845’ service of NHS Direct produced substantial cost savings in terms of referrals to the other parts of the NHS when compared with patients’ own stated first alternative. Health-related quality of life also improved for users of this service demonstrating that these savings can be produced without perceived harm to patients. PMID:23927451

Determination of VA health care costs.

PubMed

Barnett, Paul G

2003-09-01

In the absence of billing data, alternative methods are used to estimate the cost of hospital stays, outpatient visits, and treatment innovations in the U.S. Department of Veterans Affairs (VA). The choice of method represents a trade-off between accuracy and research cost. The direct measurement method gathers information on staff activities, supplies, equipment, space, and workload. Since it is expensive, direct measurement should be reserved for finding short-run costs, evaluating provider efficiency, or determining the cost of treatments that are innovative or unique to VA. The pseudo-bill method combines utilization data with a non-VA reimbursement schedule. The cost regression method estimates the cost of VA hospital stays by applying the relationship between cost and characteristics of non-VA hospitalizations. The Health Economics Resource Center uses pseudo-bill and cost regression methods to create an encounter-level database of VA costs. Researchers are also beginning to use the VA activity-based cost allocation system.

Prospective multi-center study for quantification of chemotherapies and CTX-related direct medication costs avoided by use of biomarkers uPA and PAI-1 in primary breast cancer.

PubMed

Jacobs, Volker R; Augustin, Doris; Wischnik, Arthur; Kiechle, Marion; Höss, Cornelia; Steinkohl, Oliver; Rack, Brigitte; Kapitza, Thomas; Krase, Peter

2013-08-01

Biomarkers uPA/PAI-1 as recommended by ASCO and AGO are used in primary breast cancer to avoid unnecessary CTX in medium risk-recurrence patients. This study verified how many CTX cycles and CTX-related direct medication costs can be avoided by uPA/PAI-1 testing. A prospective, non-interventional, multi-center study was performed among six Certified Breast Centers to analyze application of uPA/PAI-1 and consecutive decision-making. CTX avoided were identified and direct costs for CTX, CTX-related concomitant medication and febrile neutropenia (FN) prophylaxis with G-CSF calculated. In n = 93 breast cancers n = 35 CTX (37.6%) with 210 CTX cycles were avoided according to uPA/PAI-1 test result. uPA/PAI-1 testing saved direct medication costs for CTX of 177,453 €, CTX-related concomitant medication of 27,482 € and FN prophylaxis of 20,599 €, overall 225,534 €. At test costs at 287.50 € uPA/PAI-1 testing resulted in additional costs of 26,737.50 €. uPA/PAI-1 has proven to be cost-effective at a return-on-investment ratio of 8.4:1. Indirect cost savings further increase this ROI. These results support decision-making for cost-effective diagnostics and therapy in breast cancer. Copyright © 2013 Elsevier Ltd. All rights reserved.

Cost-effective technology advancement directions for electric propulsion transportation systems in earth-orbital missions

NASA Technical Reports Server (NTRS)

Regetz, J. D., Jr.; Terwilliger, C. H.

1979-01-01

The directions that electric propulsion technology should take to meet the primary propulsion requirements for earth-orbital missions in the most cost effective manner are determined. The mission set requirements, state of the art electric propulsion technology and the baseline system characterized by it, adequacy of the baseline system to meet the mission set requirements, cost optimum electric propulsion system characteristics for the mission set, and sensitivities of mission costs and design points to system level electric propulsion parameters are discussed. The impact on overall costs than specific masses or costs of propulsion and power systems is evaluated.

Economic burden of moderate to severe plaque psoriasis in Canada.

PubMed

Levy, Adrian R; Davie, Alison M; Brazier, Nicole C; Jivraj, Farah; Albrecht, Lorne E; Gratton, David; Lynde, Charles W

2012-12-01

Psoriasis is a chronic debilitating disease affecting approximately one million Canadians. The objective of this study is to estimate the economic burden in $CDN (2008) of moderate to severe plaque psoriasis among Canadian adults. Using a cross-sectional design, direct resource use, costs, lost productivity, and quality of life were obtained for 90 subjects diagnosed with psoriasis in three dermatology clinics in British Columbia, Ontario, and Québec. An Excel-based economic model was developed to project the annual cost of psoriasis, from the societal perspective. The estimated mean annual cost of psoriasis was $7999/subject (95% CI: $3563-$12,434) with direct costs accounting for 57%. Mean lost productivity costs, which accounted for 43% of the mean annual costs of psoriasis, were $3442/subject (95% CI: $1293-$5590). Projecting the mean costs per patient to the afflicted population yields an estimated total annual cost of $1.7 billion (95% CI: $0.8-$2.6 billion) attributable to moderate to severe psoriasis in Canada. Understanding the interplay between direct costs, lost productivity, and quality of life is critical for accurately identifying and evaluating effective treatments for this disease. © 2012 The International Society of Dermatology.

The evaluation of cost-of-illness due to use of cost-of-illness-based chemicals.

PubMed

Hong, Jiyeon; Lee, Yongjin; Lee, Geonwoo; Lee, Hanseul; Yang, Jiyeon

2015-01-01

This study is conducted to estimate the cost paid by the public suffering from disease possibly caused by chemical and to examine the effect on public health. Cost-benefit analysis is an important factor in analysis and decision-making and is an important policy decision tool in many countries. Cost-of-illness (COI), a kind of scale-based analysis method, estimates the potential value lost as a result of illness as a monetary unit and calculates the cost in terms of direct, indirect and psychological costs. This study estimates direct medical costs, transportation fees for hospitalization and outpatient treatment, and nursing fees through a number of patients suffering from disease caused by chemicals in order to analyze COI, taking into account the cost of productivity loss as an indirect cost. The total yearly cost of the diseases studied in 2012 is calculated as 77 million Korean won (KRW) per person. The direct and indirect costs being 52 million KRW and 23 million KRW, respectively. Within the total cost of illness, mental and behavioral disability costs amounted to 16 million KRW, relevant blood immunological parameters costs were 7.4 million KRW, and disease of the nervous system costs were 6.7 million KRW. This study reports on a survey conducted by experts regarding diseases possibly caused by chemicals and estimates the cost for the general public. The results can be used to formulate a basic report for a social-economic evaluation of the permitted use of chemicals and limits of usage.

Direct and indirect costs of tuberculosis among immigrant patients in the Netherlands.

PubMed

Kik, Sandra V; Olthof, Sandra P J; de Vries, Jonie T N; Menzies, Dick; Kincler, Naomi; van Loenhout-Rooyakkers, Joke; Burdo, Conny; Verver, Suzanne

2009-08-05

In low tuberculosis (TB) incidence countries TB affects mostly immigrants in the productive age group. Little empirical information is available about direct and indirect TB-related costs that patients face in these high-income countries. We assessed the direct and indirect costs of immigrants with TB in the Netherlands. A cross-sectional survey at 14 municipal health services and 2 specialized TB hospitals was conducted. Interviews were administered to first or second generation immigrants, 18 years or older, with pulmonary or extrapulmonary TB, who were on treatment for 1-6 months. Out of pocket expenditures and time loss, related to TB, was assessed for different phases of the current TB illness. In total 60 patients were interviewed. Average direct costs spent by households with a TB patient amounted euro353. Most costs were spent when being hospitalized. Time loss (mean 81 days) was mainly due to hospitalization (19 days) and additional work days lost (60 days), and corresponded with a cost estimation of euro2603. Even in a country with a good health insurance system that covers medication and consultation costs, patients do have substantial extra expenditures. Furthermore, our patients lost on average 2.7 months of productive days. TB patients are economically vulnerable.

The Psychological Cost of Making Control Responses in the Nonstereotype Direction.

PubMed

Chan, Alan H S; Hoffmann, Errol R

2016-12-01

The aim of this study was to develop a scale for the "psychological cost" of making control responses in the nonstereotype direction. Wickens, Keller, and Small suggested values for the psychological cost arising from having control/display relationships that were not in the common stereotype directions. We provide values of such costs specifically for these situations. Working from data of Chan and Hoffmann for 168 combinations of display location, control type, and display movement direction, we define values for the cost and compare these with the suggested values of Wickens et al.'s Frame of Reference Transformation Tool (FORT) model. We found marked differences between the values of the FORT model and the data of our experiments. The differences arise largely from the effects of the Worringham and Beringer visual field principle not being adequately considered in the previous research. A better indication of the psychological cost for use of incorrect control/display stereotypes is given. It is noted that these costs are applicable only to the factor of stereotype strength and not other factors considered in the FORT model. Effects of having controls and displays that are not arranged to operate with population expectancies can be readily determined from the data in this paper. © 2016, Human Factors and Ergonomics Society.

[Assessing the economic impact of cancer in Chile: a direct and indirect cost measurement based on 2009 registries].

PubMed

Cid, Camilo; Herrera, Cristian; Rodríguez, Rodrigo; Bastías, Gabriel; Jiménez, Jorge

2016-08-02

This paper aims to determine the economic impact that cancer represents to Chile, exploring the share of costs for the most important cancers and the differences between the public and private sector. We used the cost of illness methodology, through the assessment of the direct and indirect costs associated with cancer treatment. Data was obtained from 2009 registries of the Chilean Ministry of Health and the Superintendence of Health. Indirect costs were calculated by days of job absenteeism and potential years of life lost. Over US$ 2.1 billion were spent on cancer in 2009, which represents almost 1% of Chile’s Gross Domestic Product. The direct per capita cost was US$ 47. Indirect costs were 1.92 times more than direct costs. The three types of cancer that embody the highest share of costs were gastric cancer (17.6%), breast cancer (7%) and prostate cancer (4.2%) in the public sector, and breast cancer (14%), lung cancer (7.5%) and prostate cancer (4.1%) in the private sector. On average men spent 30.33% more than women. There are few studies of this kind in Chile and the region. The country can be classified as having a cancer economic impact below the average of those in European Union countries. We expect that this information can be used to develop access policies and resource allocation decision making, and as a first step into further cancer-costing studies in Chile and the Latin American and Caribbean region.

The economic impact of chronic prostatitis.

PubMed

Calhoun, Elizabeth A; McNaughton Collins, Mary; Pontari, Michel A; O'Leary, Michael; Leiby, Benjamin E; Landis, J Richard; Kusek, John W; Litwin, Mark S

2004-06-14

Little information exists on the economic impact of chronic prostatitis. The objective of this study was to determine the direct and indirect costs associated with chronic prostatitis. Outcomes were assessed using a questionnaire designed to capture health care resource utilization. Resource estimates were converted into unit costs with direct medical cost estimates based on hospital cost-accounting data and indirect costs based on modified labor force, employment, and earnings data from the US Census Bureau. The total direct costs for the 3 months prior to entry into the cohort, excluding hospitalization, were $126 915 for the 167 study participants for an average of $954 per person among the 133 consumers. Of the men, 26% reported work loss valued at an average of $551. The average total costs (direct and indirect) for the 3 months was $1099 per person for those 137 men who had resource consumption with an expected annual total cost per person of $4397. For those study participants with any incurred costs, tests for association revealed that the National Institutes of Health Chronic Prostatitis Symptom Index (P<.001) and each of the 3 subcategories of pain (P =.003), urinary function (P =.03), and quality-of-life (P =.002) were significantly associated with resource use, although the quality-of-life subscale score from the National Institutes of Health Chronic Prostatitis Symptom Index was the only predictor of resource consumption. Chronic prostatitis is associated with substantial costs and lower quality-of-life scores, which predicted resource consumption. The economic impact of chronic prostatitis warrants increased medical attention and resources to identify and test effective treatment strategies.

The costs of traumatic brain injury due to motorcycle accidents in Hanoi, Vietnam

PubMed Central

Hoang, Hanh TM; Pham, Tran L; Vo, Thuy TN; Nguyen, Phuong K; Doran, Christopher M; Hill, Peter S

2008-01-01

Background Road traffic accidents are the leading cause of fatal and non-fatal injuries in Vietnam. The purpose of this study is to estimate the costs, in the first year post-injury, of non-fatal traumatic brain injury (TBI) in motorcycle users not wearing helmets in Hanoi, Vietnam. The costs are calculated from the perspective of the injured patients and their families, and include quantification of direct, indirect and intangible costs, using years lost due to disability as a proxy. Methods The study was a retrospective cross-sectional study. Data on treatment and rehabilitation costs, employment and support were obtained from patients and their families using a structured questionnaire and The European Quality of Life instrument (EQ6D). Results Thirty-five patients and their families were interviewed. On average, patients with severe, moderate and minor TBI incurred direct costs at USD 2,365, USD 1,390 and USD 849, with time lost for normal activities averaging 54 weeks, 26 weeks and 17 weeks and years lived with disability (YLD) of 0.46, 0.25 and 0.15 year, respectively. Conclusion All three component costs of TBI were high; the direct cost accounted for the largest proportion, with costs rising with the severity of TBI. The results suggest that the burden of TBI can be catastrophic for families because of high direct costs, significant time off work for patients and caregivers, and impact on health-related quality of life. Further research is warranted to explore the actual social and economic benefits of mandatory helmet use. PMID:18718026

A low-cost transportable ground station for capture and processing of direct broadcast EOS satellite data

NASA Technical Reports Server (NTRS)

Davis, Don; Bennett, Toby; Short, Nicholas M., Jr.

1994-01-01

The Earth Observing System (EOS), part of a cohesive national effort to study global change, will deploy a constellation of remote sensing spacecraft over a 15 year period. Science data from the EOS spacecraft will be processed and made available to a large community of earth scientists via NASA institutional facilities. A number of these spacecraft are also providing an additional interface to broadcast data directly to users. Direct broadcast of real-time science data from overhead spacecraft has valuable applications including validation of field measurements, planning science campaigns, and science and engineering education. The success and usefulness of EOS direct broadcast depends largely on the end-user cost of receiving the data. To extend this capability to the largest possible user base, the cost of receiving ground stations must be as low as possible. To achieve this goal, NASA Goddard Space Flight Center is developing a prototype low-cost transportable ground station for EOS direct broadcast data based on Very Large Scale Integration (VLSI) components and pipelined, multiprocessing architectures. The targeted reproduction cost of this system is less than $200K. This paper describes a prototype ground station and its constituent components.

Direct access compared with referred physical therapy episodes of care: a systematic review.

PubMed

Ojha, Heidi A; Snyder, Rachel S; Davenport, Todd E

2014-01-01

Evidence suggests that physical therapy through direct access may help decrease costs and improve patient outcomes compared with physical therapy by physician referral. The purpose of this study was to conduct a systematic review of the literature on patients with musculoskeletal injuries and compare health care costs and patient outcomes in episodes of physical therapy by direct access compared with referred physical therapy. Ovid MEDLINE, CINAHL (EBSCO), Web of Science, and PEDro were searched using terms related to physical therapy and direct access. Included articles were hand searched for additional references. Included studies compared data from physical therapy by direct access with physical therapy by physician referral, studying cost, outcomes, or harm. The studies were appraised using the Centre for Evidence-Based Medicine (CEBM) levels of evidence criteria and assigned a methodological score. Of the 1,501 articles that were screened, 8 articles at levels 3 to 4 on the CEBM scale were included. There were statistically significant and clinically meaningful findings across studies that satisfaction and outcomes were superior, and numbers of physical therapy visits, imaging ordered, medications prescribed, and additional non-physical therapy appointments were less in cohorts receiving physical therapy by direct access compared with referred episodes of care. There was no evidence for harm. There is evidence across level 3 and 4 studies (grade B to C CEBM level of recommendation) that physical therapy by direct access compared with referred episodes of care is associated with improved patient outcomes and decreased costs. Primary limitations were lack of group randomization, potential for selection bias, and limited generalizability. Physical therapy by way of direct access may contain health care costs and promote high-quality health care. Third-party payers should consider paying for physical therapy by direct access to decrease health care costs and incentivize optimal patient outcomes.

A comparative direct cost analysis of pediatric urologic robot-assisted laparoscopic surgery versus open surgery: could robot-assisted surgery be less expensive?

PubMed

Rowe, Courtney K; Pierce, Michael W; Tecci, Katherine C; Houck, Constance S; Mandell, James; Retik, Alan B; Nguyen, Hiep T

2012-07-01

Cost in healthcare is an increasing and justifiable concern that impacts decisions about the introduction of new devices such as the da Vinci(®) surgical robot. Because equipment expenses represent only a portion of overall medical costs, we set out to make more specific cost comparisons between open and robot-assisted laparoscopic surgery. We performed a retrospective, observational, matched cohort study of 146 pediatric patients undergoing either open or robot-assisted laparoscopic urologic surgery from October 2004 to September 2009 at a single institution. Patients were matched based on surgery type, age, and fiscal year. Direct internal costs from the institution were used to compare the two surgery types across several procedures. Robot-assisted surgery direct costs were 11.9% (P=0.03) lower than open surgery. This cost difference was primarily because of the difference in hospital length of stay between patients undergoing open vs robot-assisted surgery (3.8 vs 1.6 days, P<0.001). Maintenance fees and equipment expenses were the primary contributors to robotic surgery costs, while open surgery costs were affected most by room and board expenses. When estimates of the indirect costs of robot purchase and maintenance were included, open surgery had a lower total cost. There were no differences in follow-up times or complication rates. Direct costs for robot-assisted surgery were significantly lower than equivalent open surgery. Factors reducing robot-assisted surgery costs included: A consistent and trained robotic surgery team, an extensive history of performing urologic robotic surgery, selection of patients for robotic surgery who otherwise would have had longer hospital stays after open surgery, and selection of procedures without a laparoscopic alternative. The high indirect costs of robot purchase and maintenance remain major factors, but could be overcome by high surgical volume and reduced prices as competitors enter the market.

The comparative effectiveness and cost-effectiveness of ranibizumab for neovascular macular degeneration revisited.

PubMed

Brown, Gary C; Brown, Melissa M; Lieske, Heidi B; Turpcu, Adam; Rajput, Yamina

2017-01-01

To compare a near decade of follow-up, newer control cohort data, use of both the societal and third party insurer cost perspectives, and integration of unilateral/bilateral therapy on the comparative effectiveness and cost-effectiveness of intravitreal ranibizumab therapy for neovascular, age-related macular degeneration (AMD). Value-Based Medicine ® , 12-year, combined-eye model, cost-utility analysis employing MARINA and HORIZON clinical trial data. Preference-based comparative effectiveness outcomes were quantified in (1) QALY (quality-adjusted life-year) gain, and (2) percent improvement in quality-of-life, while cost-effectiveness outcomes were quantified in (3) the cost-utility ratio (CUR) and financial return-on-investment (ROI) to society. Using MARINA and HORIZON trial data and a meta-analysis control cohort after 24 months, ranibizumab therapy conferred a combined-eye patient value (quality-of-life) gain of 16.3%, versus 10.4% found in 2006. The two-year direct ophthalmic medical cost for ranibizumab therapy was $46,450, a 33.8% real dollar decrease from 2006. The societal cost perspective CUR was -$242,920/QALY, indicating a $282,517 financial return-on-investment (ROI), or 12.3%/year to society for direct ophthalmic medical costs expended. The 3rd party insurer CUR ranged from $21,199/QALY utilizing all direct, medical costs, to $69,591/QALY using direct ophthalmic medical costs. Ranibizumab therapy for neovascular AMD in 2015, considering treatment of both eyes, conferred greater patient value gain (comparative effectiveness) and improved cost-effectiveness than in 2006, as well as a large monetary return-on-investment to the Gross Domestic Product and nation's wealth. The model herein integrates important novel features for neovascular age-related macular degeneration, vitreoretinal cost effectiveness analyses, including: (1) treatment of both eyes, (2) a long-term, untreated control cohort, and (3) the use of societal costs.

Direct cost of pars plana vitrectomy for the treatment of macular hole, epiretinal membrane and vitreomacular traction: a bottom-up approach.

PubMed

Nicod, Elena; Jackson, Timothy L; Grimaccia, Federico; Angelis, Aris; Costen, Marc; Haynes, Richard; Hughes, Edward; Pringle, Edward; Zambarakji, Hadi; Kanavos, Panos

2016-11-01

The direct cost to the National Health Service (NHS) in England of pars plana vitrectomy (PPV) is unknown since a bottom-up costing exercise has not been undertaken. Healthcare resource group (HRG) costing relies on a top-down approach. We aimed to quantify the direct cost of intermediate complexity PPV. Five NHS vitreoretinal units prospectively recorded all consumables, equipment and staff salaries during PPV undertaken for vitreomacular traction, epiretinal membrane and macular hole. Out-of-surgery costs between admission and discharge were estimated using a representative accounting method. The average patient time in theatre for 57 PPVs was 72 min. The average in-surgery cost for staff was £297, consumables £619, and equipment £82 (total £997). The average out-of-surgery costs were £260, including nursing and medical staff, other consumables, eye drops and hospitalisation. The total cost was therefore £1634, including 30 % overheads. This cost estimate was an under-estimate because it did not include out-of-theatre consumables or equipment. The average reimbursed HRG tariff was £1701. The cost of undertaking PPV of intermediate complexity is likely to be higher than the reimbursed tariff, except for hospitals with high throughput, where amortisation costs benefit from economies of scale. Although this research was set in England, the methodology may provide a useful template for other countries.

Construction engineering inspection direct cost survey.

DOT National Transportation Integrated Search

2014-07-01

The objective of the study was to provide a rationale to Georgia Department of Transportation : (GDOT) for Direct Costs in terms of salary and wages charged by qualified independent : contractors performing Construction Engineering Inspection (CEI) s...

Variation in costs of cone beam CT examinations among healthcare systems.

PubMed

Christell, H; Birch, S; Hedesiu, M; Horner, K; Ivanauskaité, D; Nackaerts, O; Rohlin, M; Lindh, C

2012-10-01

To analyse the costs of cone beam CT (CBCT) in different healthcare systems for patients with different clinical conditions. Costs were calculated for CBCT performed in Cluj (Romania), Leuven (Belgium), Malmö (Sweden) and Vilnius (Lithuania) on patients with (i) a maxillary canine with eruption disturbance, (ii) an area with tooth loss prior to implant treatment or (iii) a lower wisdom tooth planned for removal. The costs were calculated using an approach based on the identification, measurement and valuation of all resources used in the delivery of the service that combined direct costs (capital equipment, accommodation, labour) with indirect costs (patients' and accompanying persons' time, "out of pocket" costs for examination fee and visits). The estimates for direct and indirect costs varied among the healthcare systems, being highest in Malmö and lowest in Leuven. Variation in direct costs was mainly owing to different capital costs for the CBCT equipment arising from differences in purchase prices (range €148 000-227 000). Variation in indirect costs were mainly owing to examination fees (range €0-102.02). Cost analysis provides an important input for economic evaluations of diagnostic methods in different healthcare systems and for planning of service delivery. Additionally, it enables decision-makers to separate variations in costs between systems into those due to external influences and those due to policy decisions. A cost evaluation of a dental radiographic method cannot be generalized from one healthcare system to another, but must take into account these specific circumstances.

Estimation of health-care costs for work-related injuries in the Mexican Institute of Social Security.

PubMed

Carlos-Rivera, Fernando; Aguilar-Madrid, Guadalupe; Gómez-Montenegro, Pablo Anaya; Juárez-Pérez, Cuauhtémoc A; Sánchez-Román, Francisco Raúl; Durcudoy Montandon, Jaqueline E A; Borja-Aburto, Víctor Hugo

2009-03-01

Data on the economic consequences of occupational injuries is scarce in developing countries which prevents the recognition of their economic and social consequences. This study assess the direct heath care costs of work-related accidents in the Mexican Institute of Social Security, the largest health care institution in Latin America, which covered 12,735,856 workers and their families in 2005. We estimated the cost of treatment for 295,594 officially reported occupational injuries nation wide. A group of medical experts devised treatment algorithms to quantify resource utilization for occupational injuries to which unit costs were applied. Total costs were estimated as the product of the cost per illness and the severity weighted incidence of occupational accidents. Occupational injury rate was 2.9 per 100 workers. Average medical care cost per case was $2,059 USD. The total cost of the health care of officially recognized injured workers was $753,420,222 USD. If injury rate is corrected for underreporting, the cost for formal injured workers is 791,216,460. If the same costs are applied for informal workers, approximately half of the working population in Mexico, the cost of healthcare for occupational injuries is about 1% of the gross domestic product. Health care costs of occupational accidents are similar to the economic direct expenditures to compensate death and disability in the social security system in Mexico. However, indirect costs might be as important as direct costs.

Cost of opioid-treated chronic low back pain: Findings from a pilot randomized controlled trial of mindfulness meditation-based intervention.

PubMed

Zgierska, Aleksandra E; Ircink, James; Burzinski, Cindy A; Mundt, Marlon P

Opioid-treated chronic low back pain (CLBP) is debilitating, costly, and often refractory to existing treatments. This secondary analysis aims to pilot-test the hypothesis that mindfulness meditation (MM) can reduce economic burden related to opioid-treated CLBP. Twenty-six-week unblinded pilot randomized controlled trial, comparing MM, adjunctive to usual-care, to usual care alone. Outpatient. Thirty-five adults with opioid-treated CLBP (≥30 morphine-equivalent mg/day) for 3 + months enrolled; none withdrew. Eight weekly therapist-led MM sessions and at-home practice. Costs related to self-reported healthcare utilization, medication use (direct costs), lost productivity (indirect costs), and total costs (direct + indirect costs) were calculated for 6-month pre-enrollment and postenrollment periods and compared within and between the groups. Participants (21 MM; 14 control) were 20 percent men, age 51.8 ± 9.7 years, with severe disability, opioid dose of 148.3 ± 129.2 morphine-equivalent mg/d, and individual annual income of $18,291 ± $19,345. At baseline, total costs were estimated at $15,497 ± 13,677 (direct: $10,635 ± 9,897; indirect: $4,862 ± 7,298) per participant. Although MM group participants, compared to controls, reduced their pain severity ratings and pain sensitivity to heat stimuli (p < 0.05), no statistically significant within-group changes or between-group differences in direct and indirect costs were noted. Adults with opioid-treated CLBP experience a high burden of disability despite the high costs of treatment. Although this pilot study did not show a statistically significant impact of MM on costs related to opioid-treated CLBP, MM can improve clinical outcomes and should be assessed in a larger trial with long-term follow-up.

The economic burden of schizophrenia in Malaysia.

PubMed

Teoh, Siew Li; Chong, Huey Yi; Abdul Aziz, Salina; Chemi, Norliza; Othman, Abdul Razak; Md Zaki, Nurzuriana; Vanichkulpitak, Possatorn; Chaiyakunapruk, Nathorn

2017-01-01

Schizophrenia (SCZ) is a highly debilitating disease despite its low prevalence. The economic burden associated with SCZ is substantial and mainly attributed to productivity loss. To improve the understanding of economic burden of SCZ in the low- and middle-income country regions, we aimed to determine the economic burden of SCZ in Malaysia. A retrospective study was conducted using a prevalence-based approach from a societal perspective in Malaysia with a 1 year period from 2013. We used micro-costing technique with bottom-up method and included direct medical cost, direct non-medical cost, and indirect cost. The main data source was medical chart review which was conducted in Hospital Kuala Lumpur (HKL). The medical charts were identified electronically by matching the unique patient's identification number registered under the National Mental Health Schizophrenia Registry and the list of patients in HKL in 2013. Other data sources were government documents, literatures, and local websites. To ensure robustness of result, probabilistic sensitivity analysis was conducted. The total estimated number of treated SCZ cases in Malaysia in 2015 was 15,104 with the total economic burden of USD 100 million (M) which was equivalent to 0.04% of the national gross domestic product. On average, the mean cost per patient was USD 6,594. Of the total economic burden of SCZ, 72% was attributed to indirect cost, costing at USD 72M, followed by direct medical cost (26%), costing at USD 26M, and direct non-medical cost (2%), costing at USD 1.7M. This study highlights the magnitude of economic burden of SCZ and informs the policy-makers that there is an inadequate support for SCZ patients. More resources should be allocated to improve the condition of SCZ patients and to reduce the economic burden.

The economic burden of schizophrenia in Malaysia

PubMed Central

Teoh, Siew Li; Chong, Huey Yi; Abdul Aziz, Salina; Chemi, Norliza; Othman, Abdul Razak; Md Zaki, Nurzuriana; Vanichkulpitak, Possatorn; Chaiyakunapruk, Nathorn

2017-01-01

Introduction Schizophrenia (SCZ) is a highly debilitating disease despite its low prevalence. The economic burden associated with SCZ is substantial and mainly attributed to productivity loss. To improve the understanding of economic burden of SCZ in the low- and middle-income country regions, we aimed to determine the economic burden of SCZ in Malaysia. Methods A retrospective study was conducted using a prevalence-based approach from a societal perspective in Malaysia with a 1 year period from 2013. We used micro-costing technique with bottom-up method and included direct medical cost, direct non-medical cost, and indirect cost. The main data source was medical chart review which was conducted in Hospital Kuala Lumpur (HKL). The medical charts were identified electronically by matching the unique patient’s identification number registered under the National Mental Health Schizophrenia Registry and the list of patients in HKL in 2013. Other data sources were government documents, literatures, and local websites. To ensure robustness of result, probabilistic sensitivity analysis was conducted. Results The total estimated number of treated SCZ cases in Malaysia in 2015 was 15,104 with the total economic burden of USD 100 million (M) which was equivalent to 0.04% of the national gross domestic product. On average, the mean cost per patient was USD 6,594. Of the total economic burden of SCZ, 72% was attributed to indirect cost, costing at USD 72M, followed by direct medical cost (26%), costing at USD 26M, and direct non-medical cost (2%), costing at USD 1.7M. Conclusion This study highlights the magnitude of economic burden of SCZ and informs the policy-makers that there is an inadequate support for SCZ patients. More resources should be allocated to improve the condition of SCZ patients and to reduce the economic burden. PMID:28814869

Cost-effectiveness analysis of two treatment strategies for chronic hepatitis C before and after access to direct-acting antivirals in Spain.

PubMed

Turnes, Juan; Domínguez-Hernández, Raquel; Casado, Miguel Ángel

To evaluate the cost-effectiveness of a strategy based on direct-acting antivirals (DAAs) following the marketing of simeprevir and sofosbuvir (post-DAA) versus a pre-direct-acting antiviral strategy (pre-DAA) in patients with chronic hepatitis C, from the perspective of the Spanish National Health System. A decision tree combined with a Markov model was used to estimate the direct health costs (€, 2016) and health outcomes (quality-adjusted life years, QALYs) throughout the patient's life, with an annual discount rate of 3%. The sustained virological response, percentage of patients treated or not treated in each strategy, clinical characteristics of the patients, annual likelihood of transition, costs of treating and managing the disease, and utilities were obtained from the literature. The cost-effectiveness analysis was expressed as an incremental cost-effectiveness ratio (incremental cost per QALY gained). A deterministic sensitivity analysis and a probabilistic sensitivity analysis were performed. The post-DAA strategy showed higher health costs per patient (€30,944 vs. €23,707) than the pre-DAA strategy. However, it was associated with an increase of QALYs gained (15.79 vs. 12.83), showing an incremental cost-effectiveness ratio of €2,439 per QALY. The deterministic sensitivity analysis and the probabilistic sensitivity analysis showed the robustness of the results, with the post-DAA strategy being cost-effective in 99% of cases compared to the pre-DAA strategy. Compared to the pre-DAA strategy, the post-DAA strategy is efficient for the treatment of chronic hepatitis C in Spain, resulting in a much lower cost per QALY than the efficiency threshold used in Spain (€30,000 per QALY). Copyright © 2017 Elsevier España, S.L.U., AEEH y AEG. All rights reserved.

Evaluating Direct Costs of Gastric Cancer Treatment in Iran - Case Study in Kerman City in 2015.

PubMed

Izadi, Azar; Sirizi, Mohammad Jaffari; Esmaeelpour, Safa; Barouni, Mohsen

2016-01-01

Gastrointestinal cancers are common malignancies associated with high mortality rates. Health- care systems are always faced with high costs of treatment of gastrointestinal cancers including stomach cancer. Identification and prioritization of these costs can help determine economic burden and then improve of health planning by policy-makers. This study was performed in 2015 in Kerman City aimed at estimating the direct hospital costs for patients with gastric cancer. In this cross-sectional study, the medical records of 160 patients with stomach cancer admitted from 2011 to 2014 to Shafa Hospital were examined, the current stage of the disease and the patients' health status were identified, and the direct costs related to the type of treatment in the public and private sectors were calculated. SPSS-19 was used for statistical analysis of the data. Of the patients studied, 103 (65%) were men and 57 (35%) were women. The mean age of patients was 65 years. Distribution into four stages of the disease was 5%, 20%, 30%, and 45%, respectively. Direct costs in four stages of the disease were calculated as 2191.07, 2642.93, 2877, and 2674.07 USD (63,045,879, 76,047,934, 82,783,019, and 76,943,800 IRR), respectively. The highest percentage of costs was related to surgery in Stage I and to medication in Stages II, III, and IV. According to the results of direct costs of treatment for stomach cancer in Kerman, the mean total cost of treating a patient in the public sector was estimated at 74,705,158 IRR, of which averages of 60,141,384 IRR and 14,563,774 IRR were the shares of insurance and patients, respectively. The high prevalence and diagnosis of disease in old age and at advanced stages of disease impose great costs on the patients and the health system. Early diagnosis through screening and selecting an appropriate treatment method might largely ameliorate the economic burden of the disease.

A systematic review of the social and economic burden of influenza in low- and middle-income countries.

PubMed

de Francisco Shapovalova, Natasha; Donadel, Morgane; Jit, Mark; Hutubessy, Raymond

2015-11-27

The economic burden of seasonal influenza outbreaks as well as influenza pandemics in lower- and middle-income countries (LMIC) has yet to be specifically systematically reviewed. The aim of this systematic review is to assess the evidence of influenza economic burden assessment methods in LMIC and to quantify the economic consequences of influenza disease in these countries, including broader opportunity costs in terms of impaired social progress and economic development. We conducted an all language literature search across 5 key databases using an extensive list of key words for the time period 1950-2013. We included studies which explored direct costs (medical and non-medical), indirect costs (productivity losses), and broader economic impact in LMIC associated with different influenza outcomes such as confirmed seasonal influenza infection, influenza-like illnesses, and pandemic influenza. We included 62 full-text studies in English, Spanish, Russian, Chinese languages, mostly from the countries of Latin American and the Caribbean and East Asia and Pacific with pertinent cost data found in 39 papers. Estimates for direct and indirect costs were the highest in Latin American and the Caribbean. Compared to high-income economies, direct costs in LMIC were lower and productivity losses higher. Evidence on broader impact of influenza included impact on the wider national economy, security dimension, medical insurance policy, legal frameworks, distributional impact, and investment flows. The economic burden of influenza in LMIC encompasses multiple dimensions such as direct costs to the health service and households, indirect costs due to productivity losses as well as broader detriments to the wider economy. Evidence from sub-Saharan Africa and in pregnant women remains very limited. Heterogeneity of methods used to estimate cost components makes data synthesis challenging. There is a strong need for standardizing research, data collection and evaluation methods for both direct and indirect cost components. Copyright © 2015 Elsevier Ltd. All rights reserved.

Comparing NASA and ESA Cost Estimating Methods for Human Missions to Mars

NASA Technical Reports Server (NTRS)

Hunt, Charles D.; vanPelt, Michel O.

2004-01-01

To compare working methodologies between the cost engineering functions in NASA Marshall Space Flight Center (MSFC) and ESA European Space Research and Technology Centre (ESTEC), as well as to set-up cost engineering capabilities for future manned Mars projects and other studies which involve similar subsystem technologies in MSFC and ESTEC, a demonstration cost estimate exercise was organized. This exercise was a direct way of enhancing not only cooperation between agencies but also both agencies commitment to credible cost analyses. Cost engineers in MSFC and ESTEC independently prepared life-cycle cost estimates for a reference human Mars project and subsequently compared the results and estimate methods in detail. As a non-sensitive, public domain reference case for human Mars projects, the Mars Direct concept was chosen. In this paper the results of the exercise are shown; the differences and similarities in estimate methodologies, philosophies, and databases between MSFC and ESTEC, as well as the estimate results for the Mars Direct concept. The most significant differences are explained and possible estimate improvements identified. In addition, the Mars Direct plan and the extensive cost breakdown structure jointly set-up by MSFC and ESTEC for this concept are presented. It was found that NASA applied estimate models mainly based on historic Apollo and Space Shuttle cost data, taking into account the changes in technology since then. ESA used models mostly based on European satellite and launcher cost data, taking into account the higher equipment and testing standards for human space flight. Most of NASA's and ESA s estimates for the Mars Direct case are comparable, but there are some important, consistent differences in the estimates for: 1) Large Structures and Thermal Control subsystems; 2) System Level Management, Engineering, Product Assurance and Assembly, Integration and Test/Verification activities; 3) Mission Control; 4) Space Agency Program Level activities.

Enhanced Recovery after Colorectal Surgery: Can We Afford Not to Use It?

PubMed

Jung, Andrew D; Dhar, Vikrom K; Hoehn, Richard S; Atkinson, Sarah J; Johnson, Bobby L; Rice, Teresa; Snyder, Jonathan R; Rafferty, Janice F; Edwards, Michael J; Paquette, Ian M

2018-04-01

Enhanced recovery pathways (ERPs) aim to reduce length of stay without adversely affecting short-term outcomes. High pharmaceutical costs associated with ERP regimens, however, remain a significant barrier to widespread implementation. We hypothesized that ERP would reduce hospital costs after elective colorectal resections, despite the use of more expensive pharmaceutical agents. An ERP was implemented in January 2016 at our institution. We collected data on consecutive colorectal resections for 1 year before adoption of ERP (traditional, n = 160) and compared them with consecutive resections after universal adoption of ERP (n = 146). Short-term surgical outcomes, total direct costs, and direct hospital pharmacy costs were compared between patients who received the ERP and those who did not. After implementation of the ERP, median length of stay decreased from 5.0 to 3.0 days (p < 0.01). There were no differences in 30-day complications (8.1% vs 8.9%) or hospital readmission (11.9% vs 11.0%). The ERP patients required significantly less narcotics during their index hospitalization (211.7 vs 720.2 morphine equivalence units; p < 0.01) and tolerated a regular diet 1 day sooner (p < 0.01). Despite a higher daily pharmacy cost ($477 per day vs $318 per day in the traditional cohort), the total direct pharmacy cost for the hospitalization was reduced in ERP patients ($1,534 vs $1,859; p = 0.016). Total direct cost was also lower in ERP patients ($9,791 vs $11,508; p = 0.004). Implementation of an ERP for patients undergoing elective colorectal resection substantially reduced length of stay, total hospital cost, and direct pharmacy cost without increasing complications or readmission rates. Enhanced recovery pathway after colorectal resection has both clinical and financial benefits. Widespread implementation has the potential for a dramatic impact on healthcare costs. Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Expert panel on practice patterns in the management of cow's milk protein allergy and associated economic burden of disease on health service in Turkey.

PubMed

Sekerel, Bulent Enis; Seyhun, Oznur

2017-09-01

To evaluate practice patterns in the management of cow's milk protein allergy (CMPA) and associated economic burden of disease on health service in Turkey. This study was based on experts' views on the practice patterns in management of CMPA manifesting with either proctocolitis or eczema symptoms and, thereby, aimed to estimate economic burden of CMPA. Practice patterns were determined via patient flow charts developed by experts using the modified Delphi method for CMPA presented with proctocolitis and eczema. Per patient total 2-year direct medical costs were calculated, including cost items of physician visits, laboratory tests, and treatment. According to the consensus opinion of experts, 2-year total direct medical cost from a payer perspective and societal perspective was calculated to be $US2,116.05 and $US2,435.84, respectively, in an infant with CMPA presenting with proctocolitis symptoms, and $US4,001.65 and $US4,828.90, respectively, in an infant with CMPA presenting with eczema symptoms. Clinical nutrition was the primary cost driver that accounted for 89-92% of 2-year total direct medical costs, while the highest total direct medical cost estimated from a payer perspective and societal perspective was noted for the management of an exclusively formula-fed infant presenting either with proctocolitis ($US3,743.85 and $US4,025.63, respectively) or eczema ($US6,854.10 and $US7,917.30, respectively). The first line use of amino acid based formula (AAF) was associated with total direct cost increment $US1,848.08 and $US3,444.52 in the case of proctocolitis and eczema, respectively. Certain limitations to this study should be considered. First, being focused only on direct costs, the lack of data on indirect costs or intangible costs of illness seems to be a major limitation of the present study, which likely results in a downward bias in the estimates of the economic cost of CMPA. Second, given the limited number of studies concerning epidemiology and practice patterns in CMPA in Turkey, use of expert clinical opinion of the panel members rather than real-life data on practice patterns that were used to identify direct medical costs might raise a concern with the validity and reliability of the data. Also, while this was a three-step study with six experts included in the first stage (developing local guidelines for diagnosis, treatment, and follow-up of infants with CMPA in Turkey) and 410 pediatricians included in the second stage (a cross-sectional questionnaire-survey to determine pediatricians' awareness and practice of CMPA in infants and children), only four members were included in the present Delphi panel, which allows a limited discussion. Third, lack of sensitivity analyses and exclusion of indirect costs and costs related to alterations in quality of life, behavior of infants, and general well-being of infants and their parents from the cost-analysis seems to be another limitation that may have caused under-estimation of relative cost-effectiveness of the formulae. Fourth, calculation of costs per local guidelines rather than real-life practice patterns is another limitation that, otherwise, would extend the knowledge achieved in the current study. Notwithstanding these limitations, the present expert panel provided practice patterns in the management of CMPA and an estimate of the associated costs, depending on the symptom profile at initial admission for the first time in Turkey. In conclusion, in providing the first health economic data on CMPA in Turkey, the findings revealed that CMPA imposes a substantial burden on the Turkish healthcare system from both a payer perspective and societal perspective, and indicated clinical nutrition as a primary cost driver. Management of infants presenting with eczema, exclusively formula-fed infants, and first line use of AAF were associated with higher estimates for 2-year direct medical costs.

Using average cost methods to estimate encounter-level costs for medical-surgical stays in the VA.

PubMed

Wagner, Todd H; Chen, Shuo; Barnett, Paul G

2003-09-01

The U.S. Department of Veterans Affairs (VA) maintains discharge abstracts, but these do not include cost information. This article describes the methods the authors used to estimate the costs of VA medical-surgical hospitalizations in fiscal years 1998 to 2000. They estimated a cost regression with 1996 Medicare data restricted to veterans receiving VA care in an earlier year. The regression accounted for approximately 74 percent of the variance in cost-adjusted charges, and it proved to be robust to outliers and the year of input data. The beta coefficients from the cost regression were used to impute costs of VA medical-surgical hospital discharges. The estimated aggregate costs were reconciled with VA budget allocations. In addition to the direct medical costs, their cost estimates include indirect costs and physician services; both of these were allocated in proportion to direct costs. They discuss the method's limitations and application in other health care systems.

The social cost of rheumatoid arthritis in Italy: the results of an estimation exercise.

PubMed

Turchetti, G; Bellelli, S; Mosca, M

2014-03-14

The objective of this study is to estimate the mean annual social cost per adult person and the total social cost of rheumatoid arthritis (RA) in Italy. A literature review was performed by searching primary economic studies on adults in order to collect cost data of RA in Italy in the last decade. The review results were merged with data of institutional sources for estimating - following the methodological steps of the cost of illness analysis - the social cost of RA in Italy. The mean annual social cost of RA was € 13,595 per adult patient in Italy. Affecting 259,795 persons, RA determines a social cost of € 3.5 billions in Italy. Non-medical direct cost and indirect cost represent the main cost items (48% and 31%) of the total social cost of RA in Italy. Based on these results, it appears evident that the assessment of the economic burden of RA solely based on direct medical costs evaluation gives a limited view of the phenomenon.

Economic costs of depression in China.

PubMed

Hu, Teh-wei; He, Yanling; Zhang, Mingyuan; Chen, Ningshan

2007-02-01

A recent survey in China indicated the 12-month prevalence rate of depressive disorders was 2.5% in Beijing and 1.7% in Shanghai. These disorders may result in disability, premature death, and severe suffering of those affected and their families. This study estimates the economic consequences of depressive disorders in China. Depressive disorders can have both direct and indirect costs. To obtain direct costs, the research team interviewed 505 patients with depressive disorders and their caregivers in eight clinics/hospitals in five cities in China. Depression-related suicide rates were obtained from published literature. The human capital approach was used to estimate indirect costs. Epidemiological data were taken from available literature. The total estimated cost of depression in China is 51,370 million Renminbi (RMB) (or US $6,264 million) at 2002 prices. Direct costs were 8,090 million RMB (or US$ 986 million), about 16% of the total cost of depression. Indirect costs were 43,280 million RMB (or US$ 5,278 million), about 84% of the total cost of depression. Depression is a very costly disorder in China. The application of an effective treatment--reducing the length of depressive episodes (or preventing episodes) and reducing suicide rates--will lead to a significant reduction in the total burden resulting from depressive disorders. Government policymakers should seriously consider further investments in mental health services.

48 CFR 9904.403-60 - Illustrations.

Code of Federal Regulations, 2013 CFR

2013-10-01

... personnel, labor hours, payroll, number of hires. 2. Manufacturing policies, (quality control, industrial engineering, production, scheduling, tooling, inspection and testing, etc 2. Manufacturing cost input, manufacturing direct labor. 3. Engineering policies 3. Total engineering costs, engineering direct labor, number...

48 CFR 9904.403-60 - Illustrations.

Code of Federal Regulations, 2014 CFR

2014-10-01

... personnel, labor hours, payroll, number of hires. 2. Manufacturing policies, (quality control, industrial engineering, production, scheduling, tooling, inspection and testing, etc 2. Manufacturing cost input, manufacturing direct labor. 3. Engineering policies 3. Total engineering costs, engineering direct labor, number...

48 CFR 9904.403-60 - Illustrations.

Code of Federal Regulations, 2012 CFR

2012-10-01

... personnel, labor hours, payroll, number of hires. 2. Manufacturing policies, (quality control, industrial engineering, production, scheduling, tooling, inspection and testing, etc 2. Manufacturing cost input, manufacturing direct labor. 3. Engineering policies 3. Total engineering costs, engineering direct labor, number...

Direct Verification of School Meal Applications with Medicaid Data: A Pilot Evaluation of Feasibility, Effectiveness and Costs

ERIC Educational Resources Information Center

Logan, Christopher W.; Cole, Nancy; Kamara, Sheku G.

2010-01-01

Purpose/Objectives: The Direct Verification Pilot tested the feasibility, effectiveness, and costs of using Medicaid and State Children's Health Insurance Program (SCHIP) data to verify applications for free and reduced-price (FRP) school meals instead of obtaining documentation from parents and guardians. Methods: The Direct Verification Pilot…

Early rheumatoid arthritis 6 years after diagnosis is still associated with high direct costs and increasing loss of productivity: the Swedish TIRA project.

PubMed

Hallert, E; Husberg, M; Kalkan, A; Skogh, T; Bernfort, L

2014-01-01

To calculate total costs over 6 years after diagnosis of early rheumatoid arthritis (RA). In the longitudinal prospective multicentre TIRA study, 239 patients from seven units, diagnosed in 1996-98, reported regularly on health-care utilization and the number of days lost from work. Costs were obtained from official databases and calculated using unit costs (Swedish kronor, SEK) from 2001. Indirect costs were calculated using the human capital approach (HCA). Costs were inflation adjusted to Euro June 2012, using the Swedish Consumer Price Index and the exchange rate of June 2012. Statistical analyses were based on linear mixed models (LMMs) for changes over time. The mean total cost per patient was EUR 14,768 in year 1, increasing to EUR 18,438 in year 6. Outpatient visits and hospitalization decreased but costs for surgery increased from EUR 92/patient in year 1 to EUR 444/patient in year 6. Drug costs increased from EUR 429/patient to EUR 2214/patient, mainly because of the introduction of biologics. In year 1, drugs made up for 10% of direct costs, and increased to 49% in year 6. Sick leave decreased during the first years but disability pensions increased, resulting in unchanged indirect costs. Over the following years, disability pensions increased further and indirect costs increased from EUR 10,284 in year 1 to EUR 13,874 in year 6. LMM analyses showed that indirect costs were unchanged whereas direct costs, after an initial fall, increased over the following years, leading to increasing total costs. In the 6 years after diagnosis of early RA, drug costs were partially offset by decreasing outpatient visits but indirect costs remained unchanged and total costs increased.

[Cost-effectiveness analysis and diet quality index applied to the WHO Global Strategy].

PubMed

Machado, Flávia Mori Sarti; Simões, Arlete Naresse

2008-02-01

To test the use of cost-effectiveness analysis as a decision making tool in the production of meals for the inclusion of the recommendations published in the World Health Organization's Global Strategy. Five alternative options for breakfast menu were assessed previously to their adoption in a food service at a university in the state of Sao Paulo, Southeastern Brazil, in 2006. Costs of the different options were based on market prices of food items (direct cost). Health benefits were estimated based on adaptation of the Diet Quality Index (DQI). Cost-effectiveness ratios were estimated by dividing benefits by costs and incremental cost-effectiveness ratios were estimated as cost differential per unit of additional benefit. The meal choice was based on health benefit units associated to direct production cost as well as incremental effectiveness per unit of differential cost. The analysis showed the most simple option with the addition of a fruit (DQI = 64 / cost = R$ 1.58) as the best alternative. Higher effectiveness was seen in the options with a fruit portion (DQI1=64 / DQI3=58 / DQI5=72) compared to the others (DQI2=48 / DQI4=58). The estimate of cost-effectiveness ratio allowed to identifying the best breakfast option based on cost-effectiveness analysis and Diet Quality Index. These instruments allow easy application easiness and objective evaluation which are key to the process of inclusion of public or private institutions under the Global Strategy directives.

Real-World Evaluation of Direct and Indirect Economic Burden Among Endometriosis Patients in the United States.

PubMed

Soliman, Ahmed M; Surrey, Eric; Bonafede, Machaon; Nelson, James K; Castelli-Haley, Jane

2018-03-01

The prevalence of endometriosis and the need for treatment in the USA has led to the need to explore the contemporary cost burden associated with the disease. This retrospective cohort study compared direct and indirect healthcare costs in patients with endometriosis to a control group without endometriosis. Women aged 18-49 years with endometriosis (date of initial diagnosis = index date) were identified in the Truven Health MarketScan ® Commercial database between 2010 and 2014 and female control patients without endometriosis were matched by age and index year. The following outcomes were compared: healthcare resource utilization (HRU) during the 12-month pre- and post-index periods (including inpatient admissions, pharmacy claims, emergency room visits, physician office visits, and obstetrics/gynecology visits), annual direct (medical and pharmacy) and indirect (absenteeism, short-term disability, and long-term disability) healthcare costs during the 12-month post-index period (in 2014 US$). Multivariate analyses were conducted to estimate annual total direct and indirect costs, controlling for demographics, pre-index clinical characteristics, and pre-index healthcare costs. Overall, 113,506 endometriosis patients and 927,599 controls were included. Endometriosis patients had significantly higher HRU during both the pre- and post-index periods compared to controls (p < 0.0001, all categories of HRU). Approximately two-thirds of endometriosis patients underwent an endometriosis-related surgical procedure (including laparotomy, laparoscopy, hysterectomy, oophorectomy, and other excision/ablation procedures) in the first 12 months post-index. Mean annual total adjusted direct costs per endometriosis patient during the 12-month post-index period was over three times higher than that for a non-endometriosis control [$16,573 (standard deviation (SD) = $21,336) vs. $4733 (SD = $14,833); p < 0.005]. On average, incremental direct and indirect 12-month costs per endometriosis patient were $10,002 and $2132 compared to their matched controls (p < 0.005). Endometriosis patients incurred significantly higher direct and indirect healthcare costs than non-endometriosis patients. AbbVie Inc.

The social cost of illicit drugs use in Spain.

PubMed

Rivera, Berta; Casal, Bruno; Currais, Luis

2017-06-01

Illegal drugs consumption not only has a notable impact on the population's health, but also leads to major socio-economic costs. A significant characteristic of drug consumers is that the majority are of working age. The main aim of this study is to estimate the economic impact of drug consumption in Spain from a social perspective. A cost-of-illness methodology is carried out and a distinction is made between health-related and non-health related direct costs, as well as indirect costs. Among the direct health care costs included are hospitalisations, primary and emergency care, support programmes and HIV outpatient care. Expenditure on prevention, law enforcement and research was included as direct costs falling outside of health care. Productivity losses due to premature deaths attributed to substance abuse and patient hospitalisation formed part of indirect costs. For 2012, the total social cost related to drug consumption in Spain was somewhere between 1,436 and 1,651 million euros. The minimum cost of this consumption represented 0.14% of Spain's GDP for that year. The present cost estimations provide a measure of the social burden that illegal drug consumption represents for the community. When it comes to allocating resources, the obtained results quantify the potential economic returns that could be achieved from effective policies and programmes aimed at reducing the consumption of illegal drugs. Copyright © 2017 Elsevier B.V. All rights reserved.

Example of cost calculations for an operating room and a post-anaesthesia care unit.

PubMed

Raft, J; Millet, F; Meistelman, C

2015-08-01

The aim of this study was to evaluate the cost of an operating room using data from our hospital. Using an accounting-based method helped us. Over the year 2012, the sum of direct and indirect expenses with cost sharing expenses allowed us to calculate the cost of the operating room (OR) and of the post-anaesthesia care unit (PACU). The cost of the OR and PACU was €10.8 per minute of time offered. Two thirds of the direct expenses were allocated to surgery and one third to anaesthesia. Indirect expenses were 25% of the direct expenses. The cost of medications and single use medical devises was €111.45 per anaesthesia. The total cost of anaesthesia (taking into account wages and indirect expenses) was €753.14 per anaesthesia as compared to the total cost of the anaesthesia. The part of medications and single use devices for anaesthesia was 14.8% of the total cost. Despite the difficulties facing cost evaluation, this model of calculation, assisted by the cost accounting controller, helped us to have a concrete financial vision. It also shows that a global reflexion is necessary during financial decision-making. Copyright © 2015 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

44 CFR 204.43 - Ineligible costs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Ineligible costs. 204.43... Ineligible costs. Costs not directly associated with the incident period are ineligible. Ineligible costs include the following: (a) Costs incurred in the mitigation, management, and control of undeclared fires...

The effect of severity of depressive disorder on economic burden in a university hospital in Singapore.

PubMed

Ho, Roger C M; Mak, Kwok-Kei; Chua, Anna N C; Ho, Cyrus S H; Mak, Anselm

2013-08-01

Depressive disorder is treatable but costly, thus influencing quality of life of people. Determine direct and indirect costs incurred by depressive disorder in Singapore. A 1-year prospective naturalistic study was conducted in a university mood disorder center between 2007 and 2008. Patients with primary International Classification of Disease-10 diagnosis of depressive disorder were recruited. Disease costs between mild, moderate and severe depression, and cost predictors were analyzed and determined. Forty nine patients completed the study. Mean annual total costs per patient were US$7638. Indirect costs (81%) dominated the total costs. Approximately 50% of indirect costs were associated with loss of productivity and unemployment. Higher education level, higher mean Hamilton Rating Scale for Depression score and number of suicide attempts were independent variables associated with increased direct costs while mean Hamilton Rating Scale for Depression scale score was an independent variable for indirect costs. Medical cost saving strategies should focus on indirect costs.

Economic Cost and Burden of Dengue in the Philippines

PubMed Central

Edillo, Frances E.; Halasa, Yara A.; Largo, Francisco M.; Erasmo, Jonathan Neil V.; Amoin, Naomi B.; Alera, Maria Theresa P.; Yoon, In-Kyu; Alcantara, Arturo C.; Shepard, Donald S.

2015-01-01

Dengue, the world's most important mosquito-borne viral disease, is endemic in the Philippines. During 2008–2012, the country's Department of Health reported an annual average of 117,065 dengue cases, placing the country fourth in dengue burden in southeast Asia. This study estimates the country's annual number of dengue episodes and their economic cost. Our comparison of cases between active and passive surveillance in Punta Princesa, Cebu City yielded an expansion factor of 7.2, close to the predicted value (7.0) based on the country's health system. We estimated an annual average of 842,867 clinically diagnosed dengue cases, with direct medical costs (in 2012 US dollars) of $345 million ($3.26 per capita). This is 54% higher than an earlier estimate without Philippines-specific costs. Ambulatory settings treated 35% of cases (representing 10% of direct costs), whereas inpatient hospitals served 65% of cases (representing 90% of direct costs). The economic burden of dengue in the Philippines is substantial. PMID:25510723

Recruiting Community-Based Dementia Patients and Caregivers in a Nonpharmacologic Randomized Trial: What Works and How Much Does It Cost?

PubMed

Morrison, Karen; Winter, Laraine; Gitlin, Laura N

2016-07-01

The aim of this study was to evaluate the yield and cost of three recruitment strategies-direct mail, newspaper advertisements, and community outreach-for identifying and enrolling dementia caregivers into a randomized trial testing a nonpharmacologic approach to enhancing quality of life of patients and caregivers (dyads). Enrollment occurred between 2006 and 2008. The number of recruitment inquiries, number and race of enrollees, and costs for each recruitment strategy were recorded. Of 284 inquiries, 237 (83%) dyads enrolled. Total cost for recruitment across methodologies was US$154 per dyad. Direct mailings resulted in the most enrollees (n = 135, 57%) and was the least costly method (US$63 per dyad) compared with newspaper ads (US$224 per dyad) and community outreach (US$350 per dyad). Although enrollees were predominately White, mailings yielded the highest number of non-Whites (n = 37). Direct mailings was the most effective and least costly method for enrolling dyads in a nonpharmacologic dementia trial. © The Author(s) 2014.

Analysis of direct costs of decompressive craniectomy in victims of traumatic brain injury.

PubMed

Badke, Guilherme Lellis; Araujo, João Luiz Vitorino; Miura, Flávio Key; Guirado, Vinicius Monteiro de Paula; Saade, Nelson; Paiva, Aline Lariessy Campos; Avelar, Tiago Marques; Pedrozo, Charles Alfred Grander; Veiga, José Carlos Esteves

2018-04-01

Decompressive craniectomy is a procedure required in some cases of traumatic brain injury (TBI). This manuscript evaluates the direct costs and outcomes of decompressive craniectomy for TBI in a developing country and describes the epidemiological profile. A retrospective study was performed using a five-year neurosurgical database, taking a sample of patients with TBI who underwent decompressive craniectomy. Several variables were considered and a formula was developed for calculating the total cost. Most patients had multiple brain lesions and the majority (69.0%) developed an infectious complication. The general mortality index was 68.8%. The total cost was R$ 2,116,960.22 (US$ 661,550.06) and the mean patient cost was R$ 66,155.00 (US$ 20,673.44). Decompressive craniectomy for TBI is an expensive procedure that is also associated with high morbidity and mortality. This was the first study performed in a developing country that aimed to evaluate the direct costs. Prevention measures should be a priority.

Economic cost and burden of dengue in the Philippines.

PubMed

Edillo, Frances E; Halasa, Yara A; Largo, Francisco M; Erasmo, Jonathan Neil V; Amoin, Naomi B; Alera, Maria Theresa P; Yoon, In-Kyu; Alcantara, Arturo C; Shepard, Donald S

2015-02-01

Dengue, the world's most important mosquito-borne viral disease, is endemic in the Philippines. During 2008-2012, the country's Department of Health reported an annual average of 117,065 dengue cases, placing the country fourth in dengue burden in southeast Asia. This study estimates the country's annual number of dengue episodes and their economic cost. Our comparison of cases between active and passive surveillance in Punta Princesa, Cebu City yielded an expansion factor of 7.2, close to the predicted value (7.0) based on the country's health system. We estimated an annual average of 842,867 clinically diagnosed dengue cases, with direct medical costs (in 2012 US dollars) of $345 million ($3.26 per capita). This is 54% higher than an earlier estimate without Philippines-specific costs. Ambulatory settings treated 35% of cases (representing 10% of direct costs), whereas inpatient hospitals served 65% of cases (representing 90% of direct costs). The economic burden of dengue in the Philippines is substantial. © The American Society of Tropical Medicine and Hygiene.

Costs and Effects of Abdominal versus Laparoscopic Hysterectomy: Systematic Review of Controlled Trials

PubMed Central

Bijen, Claudia B. M.; Vermeulen, Karin M.; Mourits, Marian J. E.; de Bock, Geertruida H.

2009-01-01

Objective Comparative evaluation of costs and effects of laparoscopic hysterectomy (LH) and abdominal hysterectomy (AH). Data sources Controlled trials from Cochrane Central register of controlled trials, Medline, Embase and prospective trial registers. Selection of studies Twelve (randomized) controlled studies including the search terms costs, laparoscopy, laparotomy and hysterectomy were identified. Methods The type of cost analysis, perspective of cost analyses and separate cost components were assessed. The direct and indirect costs were extracted from the original studies. For the cost estimation, hospital stay and procedure costs were selected as most important cost drivers. As main outcome the major complication rate was taken. Findings Analysis was performed on 2226 patients, of which 1013 (45.5%) in the LH group and 1213 (54.5%) in the AH group. Five studies scored ≥10 points (out of 19) for methodological quality. The reported total direct costs in the LH group ($63,997) were 6.1% higher than the AH group ($60,114). The reported total indirect costs of the LH group ($1,609) were half of the total indirect in the AH group ($3,139). The estimated mean major complication rate in the LH group (14.3%) was lower than in the AH group (15.9%). The estimated total costs in the LH group were $3,884 versus $3,312 in the AH group. The incremental costs for reducing one patient with major complication(s) in the LH group compared to the AH group was $35,750. Conclusions The shorter hospital stay in the LH group compensates for the increased procedure costs, with less morbidity. LH points in the direction of cost effectiveness, however further research is warranted with a broader costs perspective including long term effects as societal benefit, quality of life and survival. PMID:19806210

Cost analysis of in vitro fertilization.

PubMed

Stern, Z; Laufer, N; Levy, R; Ben-Shushan, D; Mor-Yosef, S

1995-08-01

In vitro fertilization (IVF) has become a routine tool in the arsenal of infertility treatments. Assisted reproductive techniques are expensive, as reflected by the current "take home baby" rate of about 15% per cycle, implying the need for repeated attempts until success is achieved. Israel, today is facing a major change in its health care system, including the necessity to define a national package of health care benefits. The issue of infertility and whether its treatment should be part of the "health basket" is in dispute. Therefore an exact cost analysis of IVF is important. Since the cost of an IVF cycle varies dramatically between countries, we sought an exact breakdown of the different components of the costs involved in an IVF cycle and in achieving an IVF child in Israel. The key question is not how much we spend on IVF cycles but what is the cost of a successful outcome, i.e., a healthy child. This study intends to answer this question, and to give the policy makers, at various levels of the health care system, a crucial tool for their decision-making process. The cost analysis includes direct and indirect costs. The direct costs are divided into fixed costs (labor, equipment, maintenance, depreciation, and overhead) and variable costs (laboratory tests, chemicals, disposable supplies, medications, and loss of working days by the couples). The indirect costs are the costs of premature IVF babies, hospitalization of the IVF pregnant women in a high risk unit, and the cost of complications of the procedure. According to our economic analysis, an IVF cycle in Israel costs $2,560, of which fixed costs are about 50%. The cost of a "take home baby" is $19,267, including direct and indirect costs.

Occupational Injuries and Illnesses and Associated Costs in Thailand

PubMed Central

Thepaksorn, Phayong; Pongpanich, Sathirakorn

2014-01-01

Background The purpose of this study was to enumerate the annual morbidity and mortality incidence and estimate the direct and indirect costs associated with occupational injuries and illnesses in Bangkok in 2008. In this study, data on workmen compensation claims and costs from the Thai Workmen Compensation Fund, Social Security Office of Ministry of Labor, were aggregated and analyzed. Methods To assess costs, this study focuses on direct costs associated with the payment of workmen compensation claims for medical care and health services. Results A total of 52,074 nonfatal cases of occupational injury were reported, with an overall incidence rate of 16.9 per 1,000. The incidence rate for male workers was four times higher than that for female workers. Out of a total direct cost of $13.87 million, $9.88 million were for medical services and related expenses and $3.98 million for compensable reimbursement. The estimated amount of noncompensated lost earnings was an additional $2.66 million. Conclusion Occupational injuries and illnesses contributed to the total cost; it has been estimated that workers' compensation covers less than one-half to one-tenth of this cost. PMID:25180136

Costs and consequences of direct-to-consumer advertising for clopidogrel in Medicaid.

PubMed

Law, Michael R; Soumerai, Stephen B; Adams, Alyce S; Majumdar, Sumit R

2009-11-23

Direct-to-consumer advertising (DTCA) is assumed to be a major driver of rising pharmaceutical costs. Yet, research on how it affects costs is limited. Therefore, we studied clopidogrel, a commonly used and heavily marketed antiplatelet agent, which was first sold in 1998 and first direct-to-consumer advertised in 2001. We examined pharmacy data from 27 Medicaid programs from 1999 through 2005. We used interrupted time series analysis to analyze changes in the number of units dispensed, cost per unit dispensed, and total pharmacy expenditures after DTCA initiation. In 1999 and 2000, there was no DTCA for clopidogrel; from 2001 through 2005, DTCA spending exceeded $350 million. Direct-to-consumer advertising did not change the preexisting trend in the number of clopidogrel units dispensed per 1000 enrollees (P = .10). However, there was a sudden and sustained increase in cost per unit of $0.40 after DTCA initiation (95% confidence interval, $0.31-$0.49; P < .001), leading to an additional $40.58 of pharmacy costs per 1000 enrollees per quarter thereafter (95% confidence interval, $22.61-$58.56; P < .001). Overall, this change resulted in an additional $207 million in total pharmacy expenditures. Direct-to-consumer advertising was not associated with an increase in clopidogrel use over and above preexisting trends. However, Medicaid pharmacy expenditures increased substantially after the initiation of DTCA because of a concomitant increase in the cost per unit. If drug price increases after DTCA initiation are common, there are important implications for payers and for policy makers in the United States and elsewhere.

Impact of increasing adherence to disease-modifying therapies on healthcare resource utilization and direct medical and indirect work loss costs for patients with multiple sclerosis.

PubMed

Yermakov, Sander; Davis, Matthew; Calnan, Michaela; Fay, Monica; Cox-Buckley, Brieana; Sarda, Sujata; Duh, Mei Sheng; Iyer, Ravi

2015-01-01

To estimate the effect of adherence to disease-modifying therapies (DMTs) among patients with multiple sclerosis (MS) on healthcare resource utilization (HRU) and costs, and model the impact of a 10 percentage point increase in adherence on these outcomes. Employed patients, 18-64 years old, with ≥2 MS diagnoses and ≥1 DMT claim during January 1, 2002 to September 30, 2012 were identified from a large commercially-insured US claims database. Adherence was measured as proportion of days covered (PDC) during follow-up. Multivariate regression analyses were conducted to estimate the effect of adherence on HRU related to urgent care (i.e., inpatient or emergency room visit), days of work loss, direct medical cost, and indirect work loss costs. Model coefficients were used to evaluate the impact of a 10 percentage point increase in adherence on the outcomes. A total of 1510 patients were included (mean age = 43.4 years, 64% female). Patients with higher adherence had lower HRU, fewer days of work loss, and lower direct and indirect costs. A 10 percentage point increase in adherence significantly decreased the likelihood of an inpatient or emergency room visit by 9-19%, days of work loss by 3-8%, and direct and indirect costs by 3-5%, depending on the follow-up period (all p < 0.01). Increasing DMT adherence was found to significantly decrease urgent-care HRU, days of work loss, and direct and indirect costs among patients with MS.

75 FR 60417 - Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-30

...-related groups (DRGs). The CHAMPUS DRG-based payment system, except for children's hospitals (whose capital and direct medical education costs are incorporated in the children's hospital differential), who... direct medical education costs. Respondents are institutional providers. Affected Public: Business or...

Direct health care costs associated with obesity in Chinese population in 2011.

PubMed

Shi, Jingcheng; Wang, Yao; Cheng, Wenwei; Shao, Hui; Shi, Lizheng

2017-03-01

Overweight and obesity are established major risk factors for type 2 diabetes, and major public health concerns in China. This study aims to assess the economic burden associated with overweight and obesity in the Chinese population ages 45 and older. The Chinese Health and Retirement Longitudinal Study (CHARLS) in 2011 included 13,323 respondents of ages 45 and older living in 450 rural and urban communities across China. Demographic information, height, weight, direct health care costs for outpatient visits, hospitalization, and medications for self-care were extracted from the CHARLS database. Health Care costs were calculated in 2011 Chinese currency. The body mass index (BMI) was used to categorize underweight, normal weight, overweight, and obese populations. Descriptive analyses and a two-part regression model were performed to investigate the association of BMI with health care costs. To account for non-normality of the cost data, we applied a non-parametric bootstrap approach using the percentile method to estimate the 95% confidence intervals (95% CIs). Overweight and obese groups had significantly higher total direct health care costs (RMB 2246.4, RMB 2050.7, respectively) as compared with the normal-weight group (RMB 1886.0). When controlling for demographic characteristics, overweight and obese adults were 15.0% and 35.9% more likely to incur total health care costs, and obese individuals had 14.2% higher total health care costs compared with the normal-weight group. Compared with the normal-weight counterparts, the annual total direct health care costs were significantly higher among obese adults in China. Copyright © 2016 Elsevier Inc. All rights reserved.

Techniques to Aid DoD Writers in Developing User-Oriented Directives

DTIC Science & Technology

1990-09-01

received from sales of the recovered materials, expenses incurred in this program, the number and costs of projects for environmental improvement and...components for managing acquisition programs. a. Program direction and guidance for ACAT I programs, to include all matters relating to cost , schedule...documented needs and unfunded ownership costs requirements * Operational deficiencies identified must first be Proposed exit criteria tnat must be

Key Aspects of the Federal Direct Loan Program's Cost Estimates: Department of Education. Report to Congressional Requesters.

ERIC Educational Resources Information Center

Calbom, Linda M.; Ashby, Cornelia M.

Because of concerns about the Department of Education's reliance on estimates to project costs of the William D. Ford Federal Direct Loan Program (FDLP) and a lack of historical information on which to base those estimates, Congress asked the General Accounting Office (GAO) to review how the department develops its cost estimates for the program,…

Rationale and design of the health economics evaluation registry for remote follow-up: TARIFF.

PubMed

Ricci, Renato P; D'Onofrio, Antonio; Padeletti, Luigi; Sagone, Antonio; Vicentini, Alfredo; Vincenti, Antonio; Morichelli, Loredana; Cavallaro, Ciro; Ricciardi, Giuseppe; Lombardi, Leonida; Fusco, Antonio; Rovaris, Giovanni; Silvestri, Paolo; Guidotto, Tiziana; Pollastrelli, Annalisa; Santini, Massimo

2012-11-01

The aims of the study are to develop a cost-minimization analysis from the hospital perspective and a cost-effectiveness analysis from the third payer standpoint, based on direct estimates of costs and QOL associated with remote follow-ups, using Merlin@home and Merlin.net, compared with standard ambulatory follow-ups, in the management of ICD and CRT-D recipients. Remote monitoring systems can replace ambulatory follow-ups, sparing human and economic resources, and increasing patient safety. TARIFF is a prospective, controlled, observational study aimed at measuring the direct and indirect costs and quality of life (QOL) of all participants by a 1-year economic evaluation. A detailed set of hospitalized and ambulatory healthcare costs and losses of productivity that could be directly influenced by the different means of follow-ups will be collected. The study consists of two phases, each including 100 patients, to measure the economic resources consumed during the first phase, associated with standard ambulatory follow-ups, vs. the second phase, associated with remote follow-ups. Remote monitoring systems enable caregivers to better ensure patient safety and the healthcare to limit costs. TARIFF will allow defining the economic value of remote ICD follow-ups for Italian hospitals, third payers, and patients. The TARIFF study, based on a cost-minimization analysis, directly comparing remote follow-up with standard ambulatory visits, will validate the cost effectiveness of the Merlin.net technology, and define a proper reimbursement schedule applicable for the Italian healthcare system. NCT01075516.

The costs and consequences of assisted reproductive technology: an economic perspective.

PubMed

Connolly, Mark P; Hoorens, Stijn; Chambers, Georgina M

2010-01-01

Despite the growing use of assisted reproductive technologies (ART) worldwide, there is only a limited understanding of the economics of ART to inform policy about effective, safe and equitable financing of ART treatment. A review was undertaken of key studies regarding the costs and consequences of ART treatment, specifically examining the direct and indirect costs of treatment, economic drivers of utilization and clinical practice and broader economic consequences of ART-conceived children. The direct costs of ART treatment vary substantially between countries, with the USA standing out as the most expensive. The direct costs generally reflect the costliness of the underlying healthcare system. If unsubsidized, direct costs represent a significant economic burden to patients. The level of affordability of ART treatment is an important driver of utilization, treatment choices, embryo transfer practices and ultimately multiple birth rates. The costs associated with caring for multiple-birth ART infants and their mothers are substantial, reflecting the underlying morbidity associated with such pregnancies. Investment analysis of ART treatment and ART-conceived children indicates that appropriate funding of ART services appears to represent sound fiscal policy. The complex interaction between the cost of ART treatment and how treatments are subsidized in different healthcare settings and for different patient groups has far-reaching consequences for ART utilization, clinical practice and infant outcomes. A greater understanding of the economics of ART is needed to inform policy decisions and to ensure the best possible outcomes from ART treatment.

Nursing home case-mix reimbursement in Mississippi and South Dakota.

PubMed

Arling, Greg; Daneman, Barry

2002-04-01

To evaluate the effects of nursing home case-mix reimbursement on facility case mix and costs in Mississippi and South Dakota. Secondary data from resident assessments and Medicaid cost reports from 154 Mississippi and 107 South Dakota nursing facilities in 1992 and 1994, before and after implementation of new case-mix reimbursement systems. The study relied on a two-wave panel design to examine case mix (resident acuity) and direct care costs in 1-year periods before and after implementation of a nursing home case-mix reimbursement system. Cross-lagged regression models were used to assess change in case mix and costs between periods while taking into account facility characteristics. Facility-level measures were constructed from Medicaid cost reports and Minimum Data Set-Plus assessment records supplied by each state. Resident case mix was based on the RUG-III classification system. Facility case-mix scores and direct care costs increased significantly between periods in both states. Changes in facility costs and case mix were significantly related in a positive direction. Medicare utilization and the rate of hospitalizations from the nursing facility also increased significantly between periods, particularly in Mississippi. The case-mix reimbursement systems appeared to achieve their intended goals: improved access for heavy-care residents and increased direct care expenditures in facilities with higher acuity residents. However, increases in Medicare utilization may have influenced facility case mix or costs, and some facilities may have been unprepared to care for higher acuity residents, as indicated by increased rates of hospitalization.

Patterns of resource utilization and cost for postmenopausal women with hormone-receptor-positive, human epidermal growth factor receptor-2-negative advanced breast cancer in Europe.

PubMed

Jerusalem, Guy; Neven, Patrick; Marinsek, Nina; Zhang, Jie; Degun, Ravi; Benelli, Giancarlo; Saletan, Stephen; Ricci, Jean-François; Andre, Fabrice

2015-10-24

Healthcare resource utilization in breast cancer varies by disease characteristics and treatment choices. However, lack of clarity in guidelines can result in varied interpretation and heterogeneous treatment management and costs. In Europe, the extent of this variability is unclear. Therefore, evaluation of chemotherapy use and costs versus hormone therapy across Europe is needed. This retrospective chart review (N = 355) examined primarily direct costs for chemotherapy versus hormone therapy in postmenopausal women with hormone-receptor-positive (HR+), human epidermal growth factor receptor-2-negative (HER2-) advanced breast cancer across 5 European countries (France, Germany, The Netherlands, Belgium, and Sweden). Total direct costs across the first 3 treatment lines were approximately €10,000 to €14,000 lower for an additional line of hormone therapy-based treatment versus switching to chemotherapy-based treatment. Direct cost difference between chemotherapy-based and hormone therapy-based regimens was approximately €1900 to €2500 per month. Chemotherapy-based regimens were associated with increased resource utilization (managing side effects; concomitant targeted therapy use; and increased frequencies of hospitalizations, provider visits, and monitoring tests). The proportion of patients taking sick leave doubled after switching from hormone therapy to chemotherapy. These results suggest chemotherapy is associated with increased direct costs and potentially with increased indirect costs (lower productivity of working patients) versus hormone therapy in HR+, HER2- advanced breast cancer.

The direct and indirect cost of diabetes in Italy: a prevalence probabilistic approach.

PubMed

Marcellusi, A; Viti, R; Mecozzi, A; Mennini, F S

2016-03-01

Diabetes mellitus is a chronic degenerative disease associated with a high risk of chronic complications and comorbidities. However, very few data are available on the associated cost. The objective of this study is to identify the available information on the epidemiology of the disease and estimate the average annual cost incurred by the National Health Service and Society for the Treatment of Diabetes in Italy. A probabilistic prevalence cost of illness model was developed to calculate an aggregate measure of the economic burden associated with the disease, in terms of direct medical costs (drugs, hospitalizations, monitoring and adverse events) and indirect costs (absenteeism and early retirement). A systematic review of the literature was conducted to determine both the epidemiological and economic data. Furthermore, a one-way and probabilistic sensitivity analysis with 5,000 Monte Carlo simulations was performed to test the robustness of the results and define a 95% CI. The model estimated a prevalence of 2.6 million patients under drug therapies in Italy. The total economic burden of diabetic patients in Italy amounted to €20.3 billion/year (95% CI €18.61 to €22.29 billion), 54% of which are associated with indirect costs (95% CI €10.10 to €11.62 billion) and 46% with direct costs only (95% CI €8.11 to €11.06 billion). This is the first study conducted in Italy aimed at estimating the direct and indirect cost of diabetes with a probabilistic prevalence approach. As might be expected, the lack of information means that the real burden of diabetes is partly underestimated, especially with regard to indirect costs. However, this is a useful approach for policy makers to understand the economic implications of diabetes treatment in Italy.

Economic evaluation of childhood epilepsy in a resource-challenged setting: A preliminary survey.

PubMed

Ibrahim, Aliyu; Umar, Umar Isa; Usman, Umar Musa; Owolabi, Lukman Femi

2017-11-01

Considerable disease variability exists between patients with epilepsy, and the societal costs for epilepsy care are overall high, because of high frequency in the general population especially in children from developing countries. A cross-sectional study where children with established diagnosis of epilepsy were interviewed using a semi-structured questionnaire. Prevalence-based costs were stratified by patients' sociodemographic characteristics and socioeconomic scores (SES). The 'bottom-up' and 'human capital' approaches were used to generate estimates on the direct and indirect (productivity losses) costs of epilepsy, respectively. All estimates of the financial burden of epilepsy were analyzed from the 'societal perspective' using IBM SPSS statistics software, version 20.0. The study had 103 enrollees with most in the age group of 0-5years (45.6%). Majority (61.3%) belong to the low socioeconomic class (Ogunlesi SES class IV and V) and reside (80.6%) in an urban setting. The total direct and indirect costs per month were ₦2,149,965.00 ($8497.88) and ₦363,187.80 ($1435.52), respectively. The cost of care per patient per annum was ₦292,794.50 ($1157.29), and the total cost for all the patients per year was ₦30,157,833.60 ($119,200.92). Investigative procedures are the principal cost drivers (₦15,861.17 or $18.15) comprising approximately 58.7% of the total direct costs per patient. Cost of investigations contributed immensely to the total direct cost of care in our study. With the present economic situation in the country, out-of-pocket payments may contribute significantly to catastrophic expenditures and worsening of secondary treatment gap in children with epilepsy. Copyright © 2017 Elsevier Inc. All rights reserved.

The cost of asthma in Kuwait.

PubMed

Khadadah, Mousa

2013-01-01

To evaluate the direct costs of treating asthma in Kuwait. Population figures were obtained from the 2005 census and projected to 2008. Treatment profiles were obtained from the Asthma Insights and Reality for the Gulf and Near East (AIRGNE) study. Asthma prevalence and unit cost estimates were based on results from a Delphi technique. These estimates were applied to the total Kuwaiti population aged 5 years and over to obtain the number of people diagnosed with asthma. The estimates from the Delphi exercise and the AIRGNE results were used to determine the number of asthma patients managed in government facilities. Direct drug costs were provided by the Ministry of Health. Treatment costs (Kuwaiti dinars, KD) were also calculated using the Delphi exercise and the AIRGNE data. The prevalence of asthma was estimated to be 15% of adults and 18% of children (93,923 adults; 70,158 children). Of these, 84,530 (90%) adults and 58,932 (84.0%) children were estimated to be using government healthcare facilities. Inpatient visits accounted for the largest portion of total direct costs (43%), followed by emergency room visits (29%), outpatient visits (21%) and medications (7%). The annual cost of treatment, excluding medications, was KD 29,946,776 (USD 107,076,063) for adults and KD 24,295,439 (USD 86,869,450) for children. Including medications, the total annual direct cost of asthma treatment was estimated to be over KD 58 million (USD 207 million). Asthma costs Kuwait a huge sum of money, though the estimates were conservative because only Kuwaiti nationals were included. Given the high medical expenditures associated with emergency room and inpatient visits, relative to lower medication costs, efforts should be focused on improving asthma control rather than reducing expenditure on procurement of medication. Copyright © 2012 S. Karger AG, Basel.

2 CFR 200.473 - Transportation costs.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 2 Grants and Agreements 1 2014-01-01 2014-01-01 false Transportation costs. 200.473 Section 200... Transportation costs. Costs incurred for freight, express, cartage, postage, and other transportation services... identified with the items involved, they may be charged directly as transportation costs or added to the cost...

Estimating Power Outage Cost based on a Survey for Industrial Customers

NASA Astrophysics Data System (ADS)

Yoshida, Yoshikuni; Matsuhashi, Ryuji

A survey was conducted on power outage cost for industrial customers. 5139 factories, which are designated energy management factories in Japan, answered their power consumption and the loss of production value due to the power outage in an hour in summer weekday. The median of unit cost of power outage of whole sectors is estimated as 672 yen/kWh. The sector of services for amusement and hobbies and the sector of manufacture of information and communication electronics equipment relatively have higher unit cost of power outage. Direct damage cost from power outage in whole sectors reaches 77 billion yen. Then utilizing input-output analysis, we estimated indirect damage cost that is caused by the repercussion of production halt. Indirect damage cost in whole sectors reaches 91 billion yen. The sector of wholesale and retail trade has the largest direct damage cost. The sector of manufacture of transportation equipment has the largest indirect damage cost.

Case mix, quality, and cost relationships in Colorado nursing homes.

PubMed

Schlenker, R E; Shaughessy, P W

1984-01-01

The analyses reported in this article assessed the cost, case mix, and quality interrelationships among Colorado nursing homes. A unique set of patient-level data was collected specifically to measure case mix and quality. Case mix was found to be strongly associated with cost, accounting for up to 45 percent of the variation in cost per patient day. The relationship between quality and cost was weaker; quality variables accounted for only about 10 percent of the cost per day variation. Case mix was also associated with several facility characteristics found to be significant in other cost studies, suggesting that such facility characteristics serve as partial proxy measures for case mix. The cost-case mix relationships appear to be strong enough to justify incorporating case mix directly in nursing home reimbursement systems. In contrast, the weaker cost-quality association implies that it may not (yet) be appropriate to incorporate quality directly in reimbursement.

Cost Analysis of Spinal Versus General Anesthesia for Lumbar Diskectomy and Laminectomy Spine Surgery.

PubMed

Agarwal, Prateek; Pierce, John; Welch, William C

2016-05-01

Lumbar spine surgery can be performed using various anesthetic modalities, most notably general or spinal anesthesia. Because data comparing the cost of these anesthetic modalities in spine surgery are scarce, this study asks whether spinal anesthesia is less costly than general anesthesia. A total of 542 patients who underwent elective lumbar diskectomy or laminectomy spine surgery between 2007 and 2011 were retrospectively identified, with 364 having received spinal anesthesia and 178 having received general anesthesia. Mean direct operating cost, indirect cost (general support staff, insurance, taxes, floor space, facility, and administrative costs), and total cost were compared among patients who received general and spinal anesthesia. Linear multiple regression analysis was used to identify the effect of anesthesia type on cost and determine the factors underlying this effect, while controlling for patient and procedure characteristics. When controlling for patient and procedure characteristics, use of spinal anesthesia was associated with a 41.1% lower direct operating cost (-$3629 ± $343, P < 0.001), 36.6% lower indirect cost (-$1603 ± $168, P < 0.001), and 39.6% lower total cost (-$5232 ± $482, P < 0.001) compared with general anesthesia. Shorter hospital stay, shorter duration of anesthesia, shorter duration of operation, and lower estimated blood loss contributed to lower costs for spinal anesthesia, but other factors beyond these were also responsible for lower direct operating and total costs. When comparing the benefits of spinal and general anesthesia, spinal anesthesia is less costly when used in patients undergoing lumbar diskectomy and laminectomy spine surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

A Review on Cost-Effectiveness and Cost-Utility of Psychosocial Care in Cancer Patients

PubMed Central

Jansen, Femke; van Zwieten, Valesca; Coupé, Veerle M. H.; Leemans, C. René; Verdonck-de Leeuw, Irma M.

2016-01-01

Several psychosocial care interventions have been found effective in improving psychosocial outcomes in cancer patients. At present, there is increasingly being asked for information on the value for money of this type of intervention. This review therefore evaluates current evidence from studies investigating cost-effectiveness or cost-utility of psychosocial care in cancer patients. A systematic search was conducted in PubMed and Web of Science yielding 539 unique records, of which 11 studies were included in the study. Studies were mainly performed in breast cancer populations or mixed cancer populations. Studied interventions included collaborative care (four studies), group interventions (four studies), individual psychological support (two studies), and individual psycho-education (one study). Seven studies assessed the cost-utility of psychosocial care (based on quality-adjusted-life-years) while three studies investigated its cost-effectiveness (based on profile of mood states [mood], Revised Impact of Events Scale [distress], 12-Item Health Survey [mental health], or Fear of Progression Questionnaire [fear of cancer progression]). One study did both. Costs included were intervention costs (three studies), intervention and direct medical costs (five studies), or intervention, direct medical, and direct nonmedical costs (three studies). In general, results indicated that psychosocial care is likely to be cost-effective at different, potentially acceptable, willingness-to-pay thresholds. Further research should be performed to provide more clear information as to which psychosocial care interventions are most cost-effective and for whom. In addition, more research should be performed encompassing potential important cost drivers from a societal perspective, such as productivity losses or informal care costs, in the analyses. PMID:27981151

Variation in costs of cone beam CT examinations among healthcare systems

PubMed Central

Christell, H; Birch, S; Hedesiu, M; Horner, K; Ivanauskaité, D; Nackaerts, O; Rohlin, M; Lindh, C

2012-01-01

Objectives To analyse the costs of cone beam CT (CBCT) in different healthcare systems for patients with different clinical conditions. Methods Costs were calculated for CBCT performed in Cluj (Romania), Leuven (Belgium), Malmö (Sweden) and Vilnius (Lithuania) on patients with (i) a maxillary canine with eruption disturbance, (ii) an area with tooth loss prior to implant treatment or (iii) a lower wisdom tooth planned for removal. The costs were calculated using an approach based on the identification, measurement and valuation of all resources used in the delivery of the service that combined direct costs (capital equipment, accommodation, labour) with indirect costs (patients' and accompanying persons' time, “out of pocket” costs for examination fee and visits). Results The estimates for direct and indirect costs varied among the healthcare systems, being highest in Malmö and lowest in Leuven. Variation in direct costs was mainly owing to different capital costs for the CBCT equipment arising from differences in purchase prices (range €148 000–227 000). Variation in indirect costs were mainly owing to examination fees (range €0–102.02). Conclusions Cost analysis provides an important input for economic evaluations of diagnostic methods in different healthcare systems and for planning of service delivery. Additionally, it enables decision-makers to separate variations in costs between systems into those due to external influences and those due to policy decisions. A cost evaluation of a dental radiographic method cannot be generalized from one healthcare system to another, but must take into account these specific circumstances. PMID:22499131

Cost analysis of a coal-fired power plant using the NPV method

NASA Astrophysics Data System (ADS)

Kumar, Ravinder; Sharma, Avdhesh Kr.; Tewari, P. C.

2015-12-01

The present study investigates the impact of various factors affecting coal-fired power plant economics of 210 MW subcritical unit situated in north India for electricity generation. In this paper, the cost data of various units of thermal power plant in terms of power output capacity have been fitted using power law with the help of the data collected from a literature search. To have a realistic estimate of primary components or equipment, it is necessary to include the latest cost of these components. The cost analysis of the plant was carried out on the basis of total capital investment, operating cost and revenue. The total capital investment includes the total direct plant cost and total indirect plant cost. Total direct plant cost involves the cost of equipment (i.e. boiler, steam turbine, condenser, generator and auxiliary equipment including condensate extraction pump, feed water pump, etc.) and other costs associated with piping, electrical, civil works, direct installation cost, auxiliary services, instrumentation and controls, and site preparation. The total indirect plant cost includes the cost of engineering and set-up. The net present value method was adopted for the present study. The work presented in this paper is an endeavour to study the influence of some of the important parameters on the lifetime costs of a coal-fired power plant. For this purpose, parametric study with and without escalation rates for a period of 35 years plant life was evaluated. The results predicted that plant life, interest rate and the escalation rate were observed to be very sensitive on plant economics in comparison to other factors under study.

The Economic and Social Burden of Traumatic Injuries: Evidence from a Trauma Hospital in Port-au-Prince, Haiti.

PubMed

Zuraik, Christopher; Sampalis, John; Brierre, Alexa

2018-06-01

The cost of traumatic injury is unknown in Haiti. This study aims to examine the burden of traumatic injury of patients treated and evaluated at a trauma hospital in the capital city of Port-au-Prince. A retrospective cross-sectional chart review study was conducted at the Hospital Bernard Mevs Project Medishare for all patients evaluated for traumatic injury from December 2015 to January 2016, as described elsewhere (Zuraik and Sampalis in World J Surg, https://doi.org/10.1007/s00268-017-4088-2 , 2017). Direct medical costs were obtained from patient hospital bills. Indirect and intangible costs were calculated using the human capital approach. A total of 410 patients were evaluated for traumatic injury during the study period. Total costs for all patients were $501,706 with a mean cost of $1224. Indirect costs represented 63% of all costs, direct medical costs 19%, and intangible costs 18%. Surgical costs accounted for the majority of direct medical costs (29%). Patients involved in road traffic accidents accounted for the largest number of injuries (41%) and the largest percentage of total costs (51%). Patients with gunshot wounds had the highest total mean costs ($1566). Mean costs by injury severity ranged from $62 for minor injuries, $1269 for serious injuries, to $13,675 for critical injuries. Injuries lead to a significant economic burden for individuals treated at a semi-private trauma hospital in the capital city of Port-au-Prince, Haiti. Programs aimed at reducing injuries, particularly road traffic accidents, would likely reduce the economic burden to the nation.

Financial burden for tuberculosis patients in low- and middle-income countries: a systematic review

PubMed Central

Tanimura, Tadayuki; Jaramillo, Ernesto; Weil, Diana; Raviglione, Mario; Lönnroth, Knut

2014-01-01

In order to inform the development of appropriate strategies to improve financial risk protection, we conducted a systematic literature review of the financial burden of tuberculosis (TB) faced by patients and affected families. The mean total costs ranged from $55 to $8198, with an unweighted average of $847. On average, 20% (range 0–62%) of the total cost was due to direct medical costs, 20% (0–84%) to direct non-medical costs, and 60% (16–94%) to income loss. Half of the total cost was incurred before TB treatment. On average, the total cost was equivalent to 58% (range 5–306%) of reported annual individual and 39% (4–148%) of reported household income. Cost as percentage of income was particularly high among poor people and those with multidrug-resistant TB. Commonly reported coping mechanisms included taking a loan and selling household items. The total cost of TB for patients can be catastrophic. Income loss often constitutes the largest financial risk for patients. Apart from ensuring that healthcare services are fairly financed and delivered in a way that minimises direct and indirect costs, there is a need to ensure that TB patients and affected families receive appropriate income replacement and other social protection interventions. PMID:24525439

Can value-based insurance impose societal costs?

PubMed

Koenig, Lane; Dall, Timothy M; Ruiz, David; Saavoss, Josh; Tongue, John

2014-09-01

Among policy alternatives considered to reduce health care costs and improve outcomes, value-based insurance design (VBID) has emerged as a promising option. Most applications of VBID, however, have not used higher cost sharing to discourage specific services. In April 2011, the state of Oregon introduced a policy for public employees that required additional cost sharing for high-cost procedures such as total knee arthroplasty (TKA). Our objectives were to estimate the societal impact of higher co-pays for TKA using Oregon as a case study and building on recent work demonstrating the effects of knee osteoarthritis and surgical treatment on employment and disability outcomes. We used a Markov model to estimate the societal impact in terms of quality of life, direct costs, and indirect costs of higher co-pays for TKA using Oregon as a case study. We found that TKA for a working population can generate societal benefits that offset the direct medical costs of the procedure. Delay in receiving surgical care, because of higher co-payment or other reasons, reduced the societal savings from TKA. We conclude that payers moving toward value-based cost sharing should consider consequences beyond direct medical expenses. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Financial burden for tuberculosis patients in low- and middle-income countries: a systematic review.

PubMed

Tanimura, Tadayuki; Jaramillo, Ernesto; Weil, Diana; Raviglione, Mario; Lönnroth, Knut

2014-06-01

In order to inform the development of appropriate strategies to improve financial risk protection, we conducted a systematic literature review of the financial burden of tuberculosis (TB) faced by patients and affected families. The mean total costs ranged from $55 to $8198, with an unweighted average of $847. On average, 20% (range 0-62%) of the total cost was due to direct medical costs, 20% (0-84%) to direct non-medical costs, and 60% (16-94%) to income loss. Half of the total cost was incurred before TB treatment. On average, the total cost was equivalent to 58% (range 5-306%) of reported annual individual and 39% (4-148%) of reported household income. Cost as percentage of income was particularly high among poor people and those with multidrug-resistant TB. Commonly reported coping mechanisms included taking a loan and selling household items. The total cost of TB for patients can be catastrophic. Income loss often constitutes the largest financial risk for patients. Apart from ensuring that healthcare services are fairly financed and delivered in a way that minimises direct and indirect costs, there is a need to ensure that TB patients and affected families receive appropriate income replacement and other social protection interventions. ©ERS 2014.

Comparative Analysis of Direct Hospital Care Costs between Aseptic and Two-Stage Septic Knee Revision

PubMed Central

Kasch, Richard; Merk, Sebastian; Assmann, Grit; Lahm, Andreas; Napp, Matthias; Merk, Harry; Flessa, Steffen

2017-01-01

Background The most common intermediate and long-term complications of total knee arthroplasty (TKA) include aseptic and septic failure of prosthetic joints. These complications cause suffering, and their management is expensive. In the future the number of revision TKA will increase, which involves a greater financial burden. Little concrete data about direct costs for aseptic and two-stage septic knee revisions with an in depth-analysis of septic explantation and implantation is available. Questions/Purposes A retrospective consecutive analysis of the major partial costs involved in revision TKA for aseptic and septic failure was undertaken to compare 1) demographic and clinical characteristics, and 2) variable direct costs (from a hospital department’s perspective) between patients who underwent single-stage aseptic and two-stage septic revision of TKA in a hospital providing maximum care. We separately analyze the explantation and implantation procedures in septic revision cases and identify the major cost drivers of knee revision operations. Methods A total of 106 consecutive patients (71 aseptic and 35 septic) was included. All direct costs of diagnosis, surgery, and treatment from the hospital department’s perspective were calculated as real purchase prices. Personnel involvement was calculated in units of minutes. Results Aseptic versus septic revisions differed significantly in terms of length of hospital stay (15.2 vs. 39.9 days), number of reported secondary diagnoses (6.3 vs. 9.8) and incision-suture time (108.3 min vs. 193.2 min). The management of septic revision TKA was significantly more expensive than that of aseptic failure ($12,223.79 vs. $6,749.43) (p <.001). On the level of the separate hospitalizations the mean direct costs of explantation stage ($4,540.46) were lower than aseptic revision TKA ($6,749.43) which were again lower than those of the septic implantation stage ($7,683.33). All mean costs of stays were not comparable as they differ significantly (p <.001). Major cost drivers were the cost of the implant and general staff. The septic implantation part was on average $3,142.87 more expensive than septic explantations (p <.001). Conclusions Our study for the first time provides a detailed analysis of the major direct case costs of aseptic and septic revision TKA from the hospital-department’s perspective which is the basis for long-term orientated decision making. In the future, our cost analysis has to be interpreted in relation to reimbursement estimates. This is important to check whether revision TKA lead to a financial loss for the operating department. PMID:28107366

Cost and utilization outcomes of patients receiving hospital-based palliative care consultation.

PubMed

Penrod, Joan D; Deb, Partha; Luhrs, Carol; Dellenbaugh, Cornelia; Zhu, Carolyn W; Hochman, Tsivia; Maciejewski, Matthew L; Granieri, Evelyn; Morrison, R Sean

2006-08-01

To compare per diem total direct, ancillary (laboratory and radiology) and pharmacy costs of palliative care (PC) compared to usual care (UC) patients during a terminal hospitalization; to examine the association between PC and ICU admission. Retrospective, observational cost analysis using a VA (payer) perspective. Two urban VA medical centers. Demographic and health characteristics of 314 veterans admitted during two years were obtained from VA administrative data. Hospital costs came from the VA cost accounting system. Generalized linear models (GLM) were estimated for total direct, ancillary and pharmacy costs. Predictors included patient age, principal diagnosis, comorbidity, whether patient stay was medical or surgical, site and whether the patient was seen by the palliative care consultation team. A probit regression was used to analyze probability of ICU admission. Propensity score matching was used to improve balance in observed covariates. PC patients were 42 percentage points (95% CI, -56% [corrected] to -31%) less likely to be admitted to ICU. Total direct costs per day were $239 (95% CI, -387 to -122) lower and ancillary costs were $98 (95% CI, -133 to -57) lower than costs for UC patients. There was no difference in pharmacy costs. The results were similar using propensity score matching. PC was associated with significantly lower likelihood of ICU use and lower inpatient costs compared to UC. Our findings coupled with those indicating better patient and family outcomes with PC suggest both a cost and quality incentive for hospitals to develop PC programs.

The economic cost of road traffic crashes in an urban setting

PubMed Central

García‐Altés, A; Pérez, K

2007-01-01

The objective of this article is to assess the total economic costs of road traffic crashes in Barcelona, a metropolitan city located in Southern Europe. A cost‐of‐illness study was conducted using a prevalence approximation, a societal and healthcare system perspective, and a 1‐year time horizon. Results were measured in terms of Euros in 2003. Total costs of road traffic crashes in Barcelona in 2003 were €367 million. Direct costs equalled €329 million (89.8% of total costs), including property damage costs, insurance administration costs and hospital costs. Police, emergency costs and transportation costs had a minimum effect on total direct costs. Indirect costs were €37 million, including lost productivity due to hospitalization and mortality. The results of the sensitivity analysis showed the upper limit of total economic cost of road traffic crashes in Barcelona to be €782 million. This is the first study to estimate the costs of road traffic crashes for a city in a developed country. The importance of the problem calls for further interventions to reduce road traffic crashes. PMID:17296693

Economic Burden of Herpes Zoster and Post-Herpetic Neuralgia in Adults 60 Years of Age or Older: Results from a Prospective, Physician Practice-Based Cohort Study in Kushiro, Japan.

PubMed

Nakamura, Hiroyuki; Mizukami, Akiko; Adachi, Koichi; Matthews, Sean; Holl, Katsiaryna; Asano, Kazuhiro; Watanabe, Akihiro; Adachi, Riri; Kiuchi, Mariko; Kobayashi, Keiju; Sato, Keiko; Matsuki, Taizo; Kaise, Toshihiko; Curran, Desmond

2017-12-01

Herpes zoster has a high incidence rate among people aged ≥ 60 years and can lead to serious complications such as post-herpetic neuralgia. There are currently no data on the economic burden of herpes zoster and post-herpetic neuralgia in Japan, and the objective of this study was to address this gap. A total of 412 patients aged ≥ 60 years diagnosed with herpes zoster were recruited. Demographic, clinical, and healthcare resource utilization data on patients with herpes zoster or post-herpetic neuralgia collected via case report forms were used to estimate direct medical cost. Data obtained from a questionnaire survey among patients with herpes zoster/post-herpetic neuralgia were used to estimate transportation cost and productivity loss. The mean number of outpatient visits was 5.7. Prescription medications were the main cost driver accounting for 60% of the direct medical cost. The mean direct medical and total herpes zoster-related costs per patient were ¥43,925 and ¥57,112, respectively, and were higher in patients with post-herpetic neuralgia than in those with herpes zoster without complications. Direct medical cost represented 77%, productivity loss 19%, and transportation cost 4% of the total. This is the first study of the economic burden of herpes zoster and post-herpetic neuralgia in Japan and it demonstrated substantial direct medical cost as a result of the multiple outpatient visits and prescription medications required. These findings provide baseline data for possible future economic evaluations of new herpes zoster/post-herpetic neuralgia interventions. This cost analysis is part of a prospective, physician practice-based cohort study conducted between June 2013 and February 2015 in Kushiro, Japan (Clinicaltrials.gov identifier NCT01873365, registered on 6 June, 2013).

Annual Direct Medical Costs of Diabetic Foot Disease in Brazil: A Cost of Illness Study.

PubMed

Toscano, Cristiana M; Sugita, Tatiana H; Rosa, Michelle Q M; Pedrosa, Hermelinda C; Rosa, Roger Dos S; Bahia, Luciana R

2018-01-08

The aim of this study was to estimate the annual costs for the treatment of diabetic foot disease (DFD) in Brazil. We conducted a cost-of-illness study of DFD in 2014, while considering the Brazilian Public Healthcare System (SUS) perspective. Direct medical costs of outpatient management and inpatient care were considered. For outpatient costs, a panel of experts was convened from which utilization of healthcare services for the management of DFD was obtained. When considering the range of syndromes included in the DFD spectrum, we developed four well-defined hypothetical DFD cases: (1) peripheral neuropathy without ulcer, (2) non-infected foot ulcer, (3) infected foot ulcer, and (4) clinical management of amputated patients. Quantities of each healthcare service was then multiplied by their respective unit costs obtained from national price listings. We then developed a decision analytic tree to estimate nationwide costs of DFD in Brazil, while taking into the account the estimated cost per case and considering epidemiologic parameters obtained from a national survey, secondary data, and the literature. For inpatient care, ICD10 codes related to DFD were identified and costs of hospitalizations due to osteomyelitis, amputations, and other selected DFD related conditions were obtained from a nationwide hospitalization database. Direct medical costs of DFD in Brazil was estimated considering the 2014 purchasing power parity (PPP) (1 Int$ = 1.748 BRL). We estimated that the annual direct medical costs of DFD in 2014 was Int$ 361 million, which denotes 0.31% of public health expenses for this period. Of the total, Int$ 27.7 million (13%) was for inpatient, and Int$ 333.5 million (87%) for outpatient care. Despite using different methodologies to estimate outpatient and inpatient costs related to DFD, this is the first study to assess the overall economic burden of DFD in Brazil, while considering all of its syndromes and both outpatients and inpatients. Although we have various reasons to believe that the hospital costs are underestimated, the estimated DFD burden is significant. As such, public health preventive strategies to reduce DFD related morbidity and mortality and costs are of utmost importance.

Cost-effectiveness of lenalidomide plus dexamethasone vs. bortezomib plus melphalan and prednisone in transplant-ineligible U.S. patients with newly-diagnosed multiple myeloma.

PubMed

Usmani, S Z; Cavenagh, J D; Belch, A R; Hulin, C; Basu, S; White, D; Nooka, A; Ervin-Haynes, A; Yiu, W; Nagarwala, Y; Berger, A; Pelligra, C G; Guo, S; Binder, G; Gibson, C J; Facon, T

2016-01-01

To conduct a cost-effectiveness assessment of lenalidomide plus dexamethasone (Rd) vs bortezomib plus melphalan and prednisone (VMP) as initial treatment for transplant-ineligible patients with newly-diagnosed multiple myeloma (MM), from a U.S. payer perspective. A partitioned survival model was developed to estimate expected life-years (LYs), quality-adjusted LYs (QALYs), direct costs and incremental costs per QALY and LY gained associated with use of Rd vs VMP over a patient's lifetime. Information on the efficacy and safety of Rd and VMP was based on data from multinational phase III clinical trials and a network meta-analysis. Pre-progression direct costs included the costs of Rd and VMP, treatment of adverse events (including prophylaxis) and routine care and monitoring associated with MM. Post-progression direct costs included costs of subsequent treatment(s) and routine care and monitoring for progressive disease, all obtained from published literature and estimated from a U.S. payer perspective. Utilities were obtained from the aforementioned trials. Costs and outcomes were discounted at 3% annually. Relative to VMP, use of Rd was expected to result in an additional 2.22 LYs and 1.47 QALYs (discounted). Patients initiated with Rd were expected to incur an additional $78,977 in mean lifetime direct costs (discounted) vs those initiated with VMP. The incremental costs per QALY and per LY gained with Rd vs VMP were $53,826 and $35,552, respectively. In sensitivity analyses, results were found to be most sensitive to differences in survival associated with Rd vs VMP, the cost of lenalidomide and the discount rate applied to effectiveness outcomes. Rd was expected to result in greater LYs and QALYs compared with VMP, with similar overall costs per LY for each regimen. Results of this analysis indicated that Rd may be a cost-effective alternative to VMP as initial treatment for transplant-ineligible patients with MM, with an incremental cost-effectiveness ratio well within the levels for recent advancements in oncology.

Resource use and costs of type 2 diabetes patients receiving managed or protocolized primary care: a controlled clinical trial.

PubMed

van der Heijden, Amber A W A; de Bruijne, Martine C; Feenstra, Talitha L; Dekker, Jacqueline M; Baan, Caroline A; Bosmans, Judith E; Bot, Sandra D M; Donker, Gé A; Nijpels, Giel

2014-06-25

The increasing prevalence of diabetes is associated with increased health care use and costs. Innovations to improve the quality of care, manage the increasing demand for health care and control the growth of health care costs are needed. The aim of this study is to evaluate the care process and costs of managed, protocolized and usual care for type 2 diabetes patients from a societal perspective. In two distinct regions of the Netherlands, both managed and protocolized diabetes care were implemented. Managed care was characterized by centralized organization, coordination, responsibility and centralized annual assessment. Protocolized care had a partly centralized organizational structure. Usual care was characterized by a decentralized organizational structure. Using a quasi-experimental control group pretest-posttest design, the care process (guideline adherence) and costs were compared between managed (n = 253), protocolized (n = 197), and usual care (n = 333). We made a distinction between direct health care costs, direct non-health care costs and indirect costs. Multivariate regression models were used to estimate differences in costs adjusted for confounding factors. Because of the skewed distribution of the costs, bootstrapping methods (5000 replications) with a bias-corrected and accelerated approach were used to estimate 95% confidence intervals (CI) around the differences in costs. Compared to usual and protocolized care, in managed care more patients were treated according to diabetes guidelines. Secondary health care use was higher in patients under usual care compared to managed and protocolized care. Compared to usual care, direct costs were significantly lower in managed care (€-1.181 (95% CI: -2.597 to -334)) while indirect costs were higher (€ 758 (95% CI: -353 to 2.701), although not significant. Direct, indirect and total costs were lower in protocolized care compared to usual care (though not significantly). Compared to usual care, managed care was significantly associated with better process in terms of diabetes care, fewer secondary care consultations and lower health care costs. The same trends were seen for protocolized care, however they were not statistically significant. Current Controlled trials: ISRCTN66124817.

Resource use and costs of type 2 diabetes patients receiving managed or protocolized primary care: a controlled clinical trial

PubMed Central

2014-01-01

Background The increasing prevalence of diabetes is associated with increased health care use and costs. Innovations to improve the quality of care, manage the increasing demand for health care and control the growth of health care costs are needed. The aim of this study is to evaluate the care process and costs of managed, protocolized and usual care for type 2 diabetes patients from a societal perspective. Methods In two distinct regions of the Netherlands, both managed and protocolized diabetes care were implemented. Managed care was characterized by centralized organization, coordination, responsibility and centralized annual assessment. Protocolized care had a partly centralized organizational structure. Usual care was characterized by a decentralized organizational structure. Using a quasi-experimental control group pretest-posttest design, the care process (guideline adherence) and costs were compared between managed (n = 253), protocolized (n = 197), and usual care (n = 333). We made a distinction between direct health care costs, direct non-health care costs and indirect costs. Multivariate regression models were used to estimate differences in costs adjusted for confounding factors. Because of the skewed distribution of the costs, bootstrapping methods (5000 replications) with a bias-corrected and accelerated approach were used to estimate 95% confidence intervals (CI) around the differences in costs. Results Compared to usual and protocolized care, in managed care more patients were treated according to diabetes guidelines. Secondary health care use was higher in patients under usual care compared to managed and protocolized care. Compared to usual care, direct costs were significantly lower in managed care (€-1.181 (95% CI: -2.597 to -334)) while indirect costs were higher (€758 (95% CI: -353 to 2.701), although not significant. Direct, indirect and total costs were lower in protocolized care compared to usual care (though not significantly). Conclusions Compared to usual care, managed care was significantly associated with better process in terms of diabetes care, fewer secondary care consultations and lower health care costs. The same trends were seen for protocolized care, however they were not statistically significant. Trial registration Current Controlled trials: ISRCTN66124817. PMID:24966055

The Estimated Annual Cost of Uterine Leiomyomata in the United States

PubMed Central

CARDOZO, Eden R.; CLARK, Andrew D.; BANKS, Nicole K.; HENNE, Melinda B.; STEGMANN, Barbara J.; SEGARS, James H.

2011-01-01

Objective To estimate the total annual societal cost of uterine fibroids in the United States, based on direct and indirect costs, including associated obstetric complications. Study Design A systematic review of the literature was conducted to estimate the number of women seeking treatment for symptomatic fibroids annually, the costs of medical and surgical treatment, work lost and obstetric complications attributable to fibroids. Total annual costs were converted to 2010 U.S. dollars. A sensitivity analysis was performed. Results The estimated annual direct costs (surgery, hospital admissions, outpatient visits, medications) were $4.1 to $9.4 billion. Estimated lost work costs ranged from $1.55 to $17.2 billion annually. Obstetric outcomes attributed to fibroids resulted in a cost of $238 million to $7.76 billion annually. Uterine fibroids were estimated to cost the US $5.9 to $34.4 billion annually. Conclusions Obstetric complications associated with fibroids contributed significantly to their economic burden. Lost work costs may account for the largest proportion of societal costs due to fibroids. PMID:22244472

Barriers to and Facilitators of Compliance with Clinic-Based Cervical Cancer Screening: Population-Based Cohort Study of Women Aged 23-60 Years

PubMed Central

Östensson, Ellinor; Alder, Susanna; Elfström, K. Miriam; Sundström, Karin; Zethraeus, Niklas; Arbyn, Marc; Andersson, Sonia

2015-01-01

Objective This study aims to identify possible barriers to and facilitators of cervical cancer screening by (a) estimating time and travel costs and other direct non-medical costs incurred in attending clinic-based cervical cancer screening, (b) investigating screening compliance and reasons for noncompliance, (c) determining women’s knowledge of human papillomavirus (HPV), its relationship to cervical cancer, and HPV and cervical cancer prevention, and (d) investigating correlates of HPV knowledge and screening compliance. Materials and Methods 1510 women attending the clinic-based cervical cancer screening program in Stockholm, Sweden were included. Data on sociodemographic characteristics, time and travel costs and other direct non-medical costs incurred in attending (e.g., indirect cost of time needed for the screening visit, transportation costs, child care costs, etc.), mode(s) of travel, time, distance, companion’s attendance, HPV knowledge, and screening compliance were obtained via self-administered questionnaire. Results Few respondents had low socioeconomic status. Mean total time and travel costs and direct non-medical cost per attendance, including companion (if any) were €55.6. Over half (53%) of the respondents took time off work to attend screening (mean time 147 minutes). A large portion (44%) of the respondents were noncompliant (i.e., did not attend screening within 1 year of the initial invitation), 51% of whom stated difficulties in taking time off work. 64% of all respondents knew that HPV vaccination was available; only 34% knew it was important to continue to attend screening following vaccination. Age, education, and income were the most important correlates of HPV knowledge and compliance; and additional factors associated with compliance were time off work, accompanying companion and HPV knowledge. Conclusion Time and travel costs and other direct non-medical costs for clinic-based screening can be considerable, may affect the cost-effectiveness of a screening program, and may constitute barriers to screening while HPV knowledge may facilitate compliance with screening. PMID:26011051

The NLstart2run study: Economic burden of running-related injuries in novice runners participating in a novice running program.

PubMed

Hespanhol Junior, Luiz C; Huisstede, Bionka M A; Smits, Dirk-Wouter; Kluitenberg, Bas; van der Worp, Henk; van Middelkoop, Marienke; Hartgens, Fred; Verhagen, Evert

2016-10-01

To investigate the economic burden of running-related injuries (RRI) occurred during the 6-week 'Start-to-Run' program of the Dutch Athletics Federation in 2013. Prospective cohort study. This was a monetary cost analysis using the data prospectively gathered alongside the RRI registration in the NLstart2run study. RRI data were collected weekly. Cost diaries were applied two and six weeks after the RRI registration to collect data regarding healthcare utilisation (direct costs) and absenteeism from paid and unpaid work (indirect costs). RRI was defined as running-related pain that hampered running ability for three consecutive training sessions. From the 1696 participants included in the analysis, 185 reported a total of 272 RRIs. A total of 26.1% of the cost data (71 RRIs reported by 50 participants) were missing. Therefore, a multiple imputation procedure was performed. The economic burden (direct plus indirect costs) of RRIs was estimated at €83.22 (95% CI €50.42-€116.02) per RRI, and €13.35 (95% CI €7.07-€19.63) per participant. The direct cost per RRI was €56.93 (95% CI €42.05-€71.81) and the indirect cost per RRI was €26.29 (95% CI €0.00-€54.79). The indirect cost was higher for sudden onset RRIs than for gradual onset RRIs, with a mean difference of €33.92 (95% CI €17.96-€49.87). Direct costs of RRIs were 2-fold higher than the indirect costs, and sudden onset RRIs presented higher costs than gradual onset RRIs. The results of this study are important to provide information to public health agencies and policymakers about the economic burden of RRIs in novice runners. Copyright © 2015 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Cost-effectiveness of health research study participant recruitment strategies: a systematic review.

PubMed

Huynh, Lynn; Johns, Benjamin; Liu, Su-Hsun; Vedula, S Swaroop; Li, Tianjing; Puhan, Milo A

2014-10-01

A large fraction of the cost of conducting clinical trials is allocated to recruitment of participants. A synthesis of findings from studies that evaluate the cost and effectiveness of different recruitment strategies will inform investigators in designing cost-efficient clinical trials. To systematically identify, assess, and synthesize evidence from published comparisons of the cost and yield of strategies for recruitment of participants to health research studies. We included randomized studies in which two or more strategies for recruitment of participants had been compared. We focused our economic evaluation on studies that randomized participants to different recruitment strategies. We identified 10 randomized studies that compared recruitment strategies, including monetary incentives (cash or prize), direct contact (letters or telephone call), and medical referral strategies. Only two of the 10 studies compared strategies for recruiting participants to clinical trials. We found that allocating additional resources to recruit participants using monetary incentives or direct contact yielded between 4% and 23% additional participants compared to using neither strategy. For medical referral, recruitment of prostate cancer patients by nurses was cost-saving compared to recruitment by consultant urologists. For all underlying study designs, monetary incentives cost more than direct contact with potential participants, with a median incremental cost per recruitment ratio of Int$72 (Int$-International dollar, a theoretical unit of currency) for monetary incentive strategy compared to Int$28 for direct contact strategy. Only monetary incentives and source of referral were evaluated for recruiting participants into clinical trials. We did not review studies that presented non-monetary cost or lost opportunity cost. We did not adjust for the number of study recruitment sites or the study duration in our economic evaluation analysis. Systematic and explicit reporting of cost and effectiveness of recruitment strategies from randomized comparisons is required to aid investigators to select cost-efficient strategies for recruiting participants to health research studies including clinical trials. © The Author(s) 2014.

The Instructional Cost Index. A Simplified Approach to Interinstitutional Cost Comparison.

ERIC Educational Resources Information Center

Beatty, George, Jr.; And Others

The paper describes a simple, yet effective method of computing a comparative index of instructional costs. The Instructional Cost Index identifies direct cost differentials among instructional programs. Cost differentials are described in terms of differences among numerical values of variables that reflect fundamental academic and resource…

Direct medical costs for partial refractory epilepsy in Mexico.

PubMed

García-Contreras, Fernando; Constantino-Casas, Patricia; Castro-Ríos, Angélica; Nevárez-Sida, Armando; Estrada Correa, Gloria del Carmen; Carlos Rivera, Fernando; Guzmán-Caniupan, Jorge; Torres-Arreola, Laura del Pilar; Contreras-Hernández, Iris; Mould-Quevedo, Joaquin; Garduño-Espinosa, Juan

2006-04-01

The aim was to determine the direct medical costs in patients with partial refractory epilepsy at the Mexican Institute of Social Security (IMSS) in Mexico. We carried out a multicenter, retrospective-cohort partial-economic evaluation study of partial refractory epilepsy (PRE) diagnosed patients and analyzed patient files from four secondary- and tertiary-level hospitals. PRE patients >12 years of age with two or more antiepileptic drugs and follow-up for at least 1 year were included. The perspective was institutional (IMSS). Only direct healthcare costs were considered, and the timeline was 1 year. Cost techniques were microcosting, average per-service cost, and per-day cost, all costs expressed in U.S. dollars (USD, 2004). We reviewed 813 files of PRE patients: 133 had a correct diagnosis, and only 72 met study inclusion criteria. Fifty eight percent were females, 64% were <35 years of age, 47% were students, in 73% maximum academic level achieved was high school, and 53% were single. Fifty one percent of cases experienced simple partial seizures and 94% had more than one monthly seizure. Annual healthcare cost of the 72 patients was 190,486 USD, ambulatory healthcare contributing 76% and hospital healthcare with 24%. Annual mean healthcare cost per PRE patient was 2,646 USD; time of disease evolution and severity of the patient's illness did not affect costs significantly.

Final Report: Mass Production Cost Estimation of Direct H2 PEM Fuel Cell Systems for Transportation Applications (2012-2016)

DOE Office of Scientific and Technical Information (OSTI.GOV)

James, Brian David; Huya-Kouadio, Jennie Moton; Houchins, Cassidy

This report summarizes project activities for Strategic Analysis, Inc. (SA) Contract Number DE-EE0005236 to the U.S. Department of Energy titled “Transportation Fuel Cell System Cost Assessment”. The project defined and projected the mass production costs of direct hydrogen Proton Exchange Membrane fuel cell power systems for light-duty vehicles (automobiles) and 40-foot transit buses. In each year of the five-year contract, the fuel cell power system designs and cost projections were updated to reflect technology advances. System schematics, design assumptions, manufacturing assumptions, and cost results are presented.

Costs of hospitalization with respiratory syncytial virus illness among children aged <5 years and the financial impact on households in Bangladesh, 2010.

PubMed

Bhuiyan, Mejbah Uddin; Luby, Stephen P; Alamgir, Nadia Ishrat; Homaira, Nusrat; Sturm-Ramirez, Katharine; Gurley, Emily S; Abedin, Jaynal; Zaman, Rashid Uz; Alamgir, Asm; Rahman, Mahmudur; Ortega-Sanchez, Ismael R; Azziz-Baumgartner, Eduardo

2017-06-01

Respiratory syncytial virus (RSV) is the leading cause of acute respiratory illness in young children and results in significant economic burden. There is no vaccine to prevent RSV illness but a number of vaccines are in development. We conducted this study to estimate the costs of severe RSV illness requiring hospitalization among children <5 years and associated financial impact on households in Bangladesh. Data of this study could be useful for RSV vaccine development and also the value of various preventive strategies, including use of an RSV vaccine in children if one becomes available. From May through October 2010, children aged <5 years with laboratory-confirmed RSV were identified from a sentinel influenza program database at four tertiary hospitals. Research assistants visited case-patients' homes after hospital discharge and administered a structured questionnaire to record direct medical costs (physician consultation fee, costs for hospital bed, medicines and diagnostic tests); non-medical costs (costs for food, lodging and transportation); indirect costs (caregivers' productivity loss), and coping strategies used by families to pay for treatment. We used WHO-Choice estimates for routine health care service costs. We added direct, indirect and health care service costs to calculate cost-per-episode of severe RSV illness. We used Monte Carlo simulation to estimate annual economic burden for severe RSV illness. We interviewed caregivers of 39 persons hospitalized for RSV illness. The median direct cost for hospitalization was US$ 62 (interquartile range [IQR] = 43-101), indirect cost was US$ 19 (IQR = 11-29) and total cost was US$ 94 (IQR = 67-127). The median out-of-pocket cost was 24% of monthly household income of affected families (US$ 143), and >50% families borrowed money to meet treatment cost. We estimated that the median direct cost of RSV-associated hospitalization in children aged <5 years in Bangladesh was US$ 10 million (IQR: US$ 7-16 million), the median indirect cost was US$ 3.0 million (IQR: 2-5 million) in 2010. RSV-associated hospitalization among children aged <5 years represents a substantial economic burden in Bangladesh. Affected families frequently incurred considerable out of pocket and indirect costs for treatment that resulted in financial hardship.

48 CFR 9904.401-61 - Interpretation.

Code of Federal Regulations, 2010 CFR

2010-10-01

...-61 Section 9904.401-61 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE... ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.401-61 Interpretation. (a) 9904.401, Cost Accounting... accounting practices used in accumulating and reporting costs.” (b) In estimating the cost of direct material...

Variable Cost to Procure

DTIC Science & Technology

1981-03-12

Procurement Work Directive ( PWV ) Procurement Army, CostL to Procure Cost Differential Secondary (PAS) Cost to Buy Economic Order Quantity Procurement...and Assignment of Buyer h. Solicitation Fffort . ) (1) Procurement Planning ( ) ( ) (?) PWV Review and Small Business Coordination ( (3) Determination

The societal burden of blindness secondary to retinopathy of prematurity in Lima, Peru.

PubMed

Dave, Hreem B; Gordillo, Luz; Yang, Zhou; Zhang, Monica S; Hubbard, G Baker; Olsen, Timothy W

2012-10-01

To determine the cost-effectiveness of laser treatment for retinopathy of prematurity (ROP) in Lima, Peru. A cost-of-illness study (in US dollars) to determine the direct cost of treatment, the indirect lifetime cost of blindness, and the quality-adjusted life years. The direct cost of ROP-related treatment was determined by reviewing data retrospectively from a social security sector hospital. The indirect cost was determined using national economic data of Peru published by the Central Information Agency (CIA), including the per capita gross domestic product, the sex-adjusted income distribution, and years spent in the work force. Indirect costs per child that were avoided by treatment were calculated using the known natural history of ROP vs evidence-based treatment. For ROP-related neonatal blindness in Peru, we estimate the total indirect cost saving at $197,753 per child and the direct cost of laser treatment at $2496 per child. The societal lifetime cost saving per child is estimated at $195,257. The mean annual income per educated adult in Peru is $8000 and treating 1 child is equivalent to employing 24 educated Peruvians per year. The generational cost savings for society is approximately $516 million, or the equivalent of 64,500 educated Peruvian work years. The societal burden of blindness far exceeds the costs of treatment per child. Proper screening and treatment of ROP prevents blindness and leads to substantial cost savings for society. Public health policy in Peru and other middle-income countries should consider financial impact when allocating healthcare resources. Copyright © 2012 Elsevier Inc. All rights reserved.

Comparing Methods for Estimating Direct Costs of Adverse Drug Events.

PubMed

Gyllensten, Hanna; Jönsson, Anna K; Hakkarainen, Katja M; Svensson, Staffan; Hägg, Staffan; Rehnberg, Clas

2017-12-01

To estimate how direct health care costs resulting from adverse drug events (ADEs) and cost distribution are affected by methodological decisions regarding identification of ADEs, assigning relevant resource use to ADEs, and estimating costs for the assigned resources. ADEs were identified from medical records and diagnostic codes for a random sample of 4970 Swedish adults during a 3-month study period in 2008 and were assessed for causality. Results were compared for five cost evaluation methods, including different methods for identifying ADEs, assigning resource use to ADEs, and for estimating costs for the assigned resources (resource use method, proportion of registered cost method, unit cost method, diagnostic code method, and main diagnosis method). Different levels of causality for ADEs and ADEs' contribution to health care resource use were considered. Using the five methods, the maximum estimated overall direct health care costs resulting from ADEs ranged from Sk10,000 (Sk = Swedish krona; ~€1,500 in 2016 values) using the diagnostic code method to more than Sk3,000,000 (~€414,000) using the unit cost method in our study population. The most conservative definitions for ADEs' contribution to health care resource use and the causality of ADEs resulted in average costs per patient ranging from Sk0 using the diagnostic code method to Sk4066 (~€500) using the unit cost method. The estimated costs resulting from ADEs varied considerably depending on the methodological choices. The results indicate that costs for ADEs need to be identified through medical record review and by using detailed unit cost data. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Quantifying the direct public health care cost of systemic sclerosis

PubMed Central

Morrisroe, Kathleen; Stevens, Wendy; Sahhar, Joanne; Ngian, Gene-Siew; Rabusa, Candice; Ferdowsi, Nava; Hill, Catherine; Proudman, Susanna; Nikpour, Mandana

2017-01-01

Abstract To quantify the direct healthcare cost of systemic sclerosis (SSc) and identify its determinants. Healthcare use was captured through data linkage, wherein clinical and medication data for SSc patients from the state of Victoria enrolled in the Australian Scleroderma Cohort Study were linked with the Victorian hospital admissions and emergency presentations data sets, and the Medicare Benefits Schedule which contains all government subsidized ambulatory care services, for the period 2011-2015. Medication cost was determined from the Pharmaceutical Benefits Scheme. Costs were extrapolated to all Australian SSc patients based on SSc prevalence of 21.1 per 100,000 and an Australian population of 24,304,682 in 2015. Determinants of healthcare cost were estimated using logistic regression. Total healthcare utilization cost to the Australian government extrapolated to all Australian SSc patients from 2011 to 2015 was Australian Dollar (AUD)$297,663,404.77, which is an average annual cost of AUD$59,532,680.95 (US Dollar [USD]$43,816,040.08) and annual cost per patient of AUD$11,607.07 (USD$8,542.80). Hospital costs, including inpatient hospitalization and emergency department presentations, accounted for the majority of these costs (44.4% of total), followed by medication cost (31.2%) and ambulatory care cost (24.4%). Pulmonary arterial hypertension (PAH) and gastrointestinal (GIT) involvement were the major determinants of healthcare cost (OR 2.3 and 1.8, P = .01 for hospitalizations; OR 2.8 and 2.0, P = .01 for ambulatory care; OR 7.8 and 1.6, P < .001 and P = .03 for medication cost, respectively). SSc is associated with substantial healthcare utilization and direct economic burden. The most costly aspects of SSc are PAH and GIT involvement. PMID:29310332

Quantifying the direct public health care cost of systemic sclerosis: A comprehensive data linkage study.

PubMed

Morrisroe, Kathleen; Stevens, Wendy; Sahhar, Joanne; Ngian, Gene-Siew; Rabusa, Candice; Ferdowsi, Nava; Hill, Catherine; Proudman, Susanna; Nikpour, Mandana

2017-12-01

To quantify the direct healthcare cost of systemic sclerosis (SSc) and identify its determinants. Healthcare use was captured through data linkage, wherein clinical and medication data for SSc patients from the state of Victoria enrolled in the Australian Scleroderma Cohort Study were linked with the Victorian hospital admissions and emergency presentations data sets, and the Medicare Benefits Schedule which contains all government subsidized ambulatory care services, for the period 2011-2015. Medication cost was determined from the Pharmaceutical Benefits Scheme. Costs were extrapolated to all Australian SSc patients based on SSc prevalence of 21.1 per 100,000 and an Australian population of 24,304,682 in 2015. Determinants of healthcare cost were estimated using logistic regression. Total healthcare utilization cost to the Australian government extrapolated to all Australian SSc patients from 2011 to 2015 was Australian Dollar (AUD)$297,663,404.77, which is an average annual cost of AUD$59,532,680.95 (US Dollar [USD]$43,816,040.08) and annual cost per patient of AUD$11,607.07 (USD$8,542.80). Hospital costs, including inpatient hospitalization and emergency department presentations, accounted for the majority of these costs (44.4% of total), followed by medication cost (31.2%) and ambulatory care cost (24.4%). Pulmonary arterial hypertension (PAH) and gastrointestinal (GIT) involvement were the major determinants of healthcare cost (OR 2.3 and 1.8, P = .01 for hospitalizations; OR 2.8 and 2.0, P = .01 for ambulatory care; OR 7.8 and 1.6, P < .001 and P = .03 for medication cost, respectively). SSc is associated with substantial healthcare utilization and direct economic burden. The most costly aspects of SSc are PAH and GIT involvement.

PubMed Central

Turchetti, G.; Bellelli, S.; Palla, I.; Forli, F.

2011-01-01

SUMMARY The aim of the study consists in a systematic review concerning the economic evaluation of cochlear implant (CI) in children by searching the main international clinical and economic electronic databases. All primary studies published in English from January 2000 to May 2010 were included. The types of studies selected concerned partial economic evaluation, including direct and indirect costs of cochlear implantation; complete economic evaluation, including minimization of costs, cost-effectiveness analysis (CEA), cost-utility analysis (CUA) and cost-benefit analysis (CBA) performed through observational and experimental studies. A total of 68 articles were obtained from the database research. Of these, 54 did not meet the inclusion criteria and were eliminated. After reading the abstracts of the 14 articles selected, 11 were considered eligible. The articles were then read in full text. Furthermore, 5 articles identified by bibliography research were added manually. After reading 16 of the selected articles, 9 were included in the review. With regard to the studies included, countries examined, objectives, study design, methodology, prospect of analysis adopted, temporal horizon, the cost categories analyzed strongly differ from one study to another. Cost analysis, cost-effectiveness analysis and an analysis of educational costs associated with cochlear implants were performed. Regarding the cost analysis, only two articles reported both direct cost and indirect costs. The direct cost ranged between € 39,507 and € 68,235 (2011 values). The studies related to cost-effectiveness analysis were not easily comparable: one study reported a cost per QALY ranging between $ 5197 and $ 9209; another referred a cost of $ 2154 for QALY if benefits were not discounted, and $ 16,546 if discounted. Educational costs are significant, and increase with the level of hearing loss and type of school attended. This systematic review shows that the healthcare costs are high, but savings in terms of indirect and quality of life costs are also significant. Cochlear implantation in a paediatric age is cost-effective. The exiguity and heterogeneity of studies did not allow detailed comparative analysis of the studies included in the review. PMID:22287822

Low cost passive solar adobe house

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1981-12-21

A brief description, photographs, and cost breakdown of a hybrid direct-gain passive solar adobe house constructed in the City of El Paso, Texas. The 3-panel active solar domestic hot water system acts as a back-up to the direct gain passive system.

The Costs of Frontloading.

ERIC Educational Resources Information Center

Brinkman, Paul T.; Jones, Dennis P.

The costs of directing additional instructional resources to lower-division instruction is assessed. "Frontloading," or directing additional resources toward lower-division students, was recommended by a national study group because first- and second-year students are frequently taught by junior instructors in large classes in which they…

Understanding Costs of Care in the Operating Room.

PubMed

Childers, Christopher P; Maggard-Gibbons, Melinda

2018-04-18

Increasing value requires improving quality or decreasing costs. In surgery, estimates for the cost of 1 minute of operating room (OR) time vary widely. No benchmark exists for the cost of OR time, nor has there been a comprehensive assessment of what contributes to OR cost. To calculate the cost of 1 minute of OR time, assess cost by setting and facility characteristics, and ascertain the proportion of costs that are direct and indirect. This cross-sectional and longitudinal analysis examined annual financial disclosure documents from all comparable short-term general and specialty care hospitals in California from fiscal year (FY) 2005 to FY2014 (N = 3044; FY2014, n = 302). The analysis focused on 2 revenue centers: (1) surgery and recovery and (2) ambulatory surgery. Mean cost of 1 minute of OR time, stratified by setting (inpatient vs ambulatory), teaching status, and hospital ownership. The proportion of cost attributable to indirect and direct expenses was identified; direct expenses were further divided into salary, benefits, supplies, and other direct expenses. In FY2014, a total of 175 of 302 facilities (57.9%) were not for profit, 78 (25.8%) were for profit, and 49 (16.2%) were government owned. Thirty facilities (9.9%) were teaching hospitals. The mean (SD) cost for 1 minute of OR time across California hospitals was $37.45 ($16.04) in the inpatient setting and $36.14 ($19.53) in the ambulatory setting (P = .65). There were no differences in mean expenditures when stratifying by ownership or teaching status except that teaching hospitals had lower mean (SD) expenditures than nonteaching hospitals in the inpatient setting ($29.88 [$9.06] vs $38.29 [$16.43]; P = .006). Direct expenses accounted for 54.6% of total expenses ($20.40 of $37.37) in the inpatient setting and 59.1% of total expenses ($20.90 of $35.39) in the ambulatory setting. Wages and benefits accounted for approximately two-thirds of direct expenses (inpatient, $14.00 of $20.40; ambulatory, $14.35 of $20.90), with nonbillable supplies accounting for less than 10% of total expenses (inpatient, $2.55 of $37.37; ambulatory, $3.33 of $35.39). From FY2005 to FY2014, expenses in the OR have increased faster than the consumer price index and medical consumer price index. Teaching hospitals had slower growth in costs than nonteaching hospitals. Over time, the proportion of expenses dedicated to indirect costs has increased, while the proportion attributable to salary and supplies has decreased. The mean cost of OR time is $36 to $37 per minute, using financial data from California's short-term general and specialty hospitals in FY2014. These statewide data provide a generalizable benchmark for the value of OR time. Furthermore, understanding the composition of costs will allow those interested in value improvement to identify high-yield targets.

Cost of Hospitalization for Foodborne Diarrhea: A Case Study from Vietnam.

PubMed

Hoang, Van Minh; Tran, Tuan Anh; Ha, Anh Duc; Nguyen, Viet Hung

2015-11-01

Vietnam is undergoing a rapid social and economic developments resulting in speedy urbanization, changes in methods for animal production, food marketing systems, and food consumption habits. These changes will have major impacts on human exposures to food poisoning. The present case study aimed to estimate hospitalization costs of foodborne diarrhea cases in selected health facilities in Vietnam. This is a facility-based cost-of-illness study conducted in seven health facilities in Northern Vietnam. All suspect cases of foodborne diarrhea, as diagnosed by doctors, who admitted to the studied health facilities during June-August, 2013 were selected. Costs associated with hospitalization for foodborne diseases were estimated from societal perspective using retrospective approach. We included direct and indirect costs of hospitalization of foodborne diarrhea cases. During the study period, 87 foodborne diarrhea cases were included. On average, the costs per treatment episode and per hospitalization day for foodborne diarrhea case were US$ 106.9 and US$ 33.6 respectively. Indirect cost (costs of times to patient, their relatives due to the patient's illness) made up the largest share (51.3%). Direct medical costs accounted for 33.8%; direct non-medical costs (patient and their relatives) represented 14.9%. Cost levels and compositions varied by level of health facilities. More attentions should be paid on prevention, control of foodborne diarrhea cases in Vietnam. Ensuring safety of food depends on efforts of everyone involved in food chain continuum, from production, processing, and transport to consumption.

Predicting Costs of Eastern National Forest Wildernesses.

ERIC Educational Resources Information Center

Guldin, Richard W.

1981-01-01

A method for estimating the total direct social costs for proposed wilderness areas is presented. A cost framework is constructed and equations are developed for cost components. To illustrate the study's method, social costs are estimated for a proposed wilderness area in New England. (Author/JN)

Assessing the burden of medical impoverishment by cause: a systematic breakdown by disease in Ethiopia.

PubMed

Verguet, Stéphane; Memirie, Solomon Tessema; Norheim, Ole Frithjof

2016-10-21

Out-of-pocket (OOP) medical expenses often lead to catastrophic expenditure and impoverishment in low- and middle-income countries. Yet, there has been no systematic examination of which specific diseases and conditions (e.g., tuberculosis, cardiovascular disease) drive medical impoverishment, defined as OOP direct medical costs pushing households into poverty. We used a cost and epidemiological model to propose an assessment of the burden of medical impoverishment in Ethiopia, i.e., the number of households crossing a poverty line due to excessive OOP direct medical expenses. We utilized disease-specific mortality estimates from the Global Burden of Disease study, epidemiological and cost inputs from surveys, and secondary data from the literature to produce a count of poverty cases due to OOP direct medical costs per specific condition. In Ethiopia, in 2013, and among 20 leading causes of mortality, we estimated the burden of impoverishment due to OOP direct medical costs to be of about 350,000 poverty cases. The top three causes of medical impoverishment were diarrhea, lower respiratory infections, and road injury, accounting for 75 % of all poverty cases. We present a preliminary attempt for the estimation of the burden of medical impoverishment by cause for high mortality conditions. In Ethiopia, medical impoverishment was notably associated with illness occurrence and health services utilization. Although currently used estimates are sensitive to health services utilization, a systematic breakdown of impoverishment due to OOP direct medical costs by cause can provide important information for the promotion of financial risk protection and equity, and subsequent design of health policies toward universal health coverage, reduction of direct OOP payments, and poverty alleviation.

Costs of hospitalization with respiratory syncytial virus illness among children aged <5 years and the financial impact on households in Bangladesh, 2010

PubMed Central

Bhuiyan, Mejbah Uddin; Luby, Stephen P; Alamgir, Nadia Ishrat; Homaira, Nusrat; Sturm–Ramirez, Katharine; Gurley, Emily S.; Abedin, Jaynal; Zaman, Rashid Uz; Alamgir, ASM; Rahman, Mahmudur; Ortega–Sanchez, Ismael R.; Azziz–Baumgartner, Eduardo

2017-01-01

Background Respiratory syncytial virus (RSV) is the leading cause of acute respiratory illness in young children and results in significant economic burden. There is no vaccine to prevent RSV illness but a number of vaccines are in development. We conducted this study to estimate the costs of severe RSV illness requiring hospitalization among children <5 years and associated financial impact on households in Bangladesh. Data of this study could be useful for RSV vaccine development and also the value of various preventive strategies, including use of an RSV vaccine in children if one becomes available. Methods From May through October 2010, children aged <5 years with laboratory–confirmed RSV were identified from a sentinel influenza program database at four tertiary hospitals. Research assistants visited case–patients’ homes after hospital discharge and administered a structured questionnaire to record direct medical costs (physician consultation fee, costs for hospital bed, medicines and diagnostic tests); non–medical costs (costs for food, lodging and transportation); indirect costs (caregivers’ productivity loss), and coping strategies used by families to pay for treatment. We used WHO–Choice estimates for routine health care service costs. We added direct, indirect and health care service costs to calculate cost–per–episode of severe RSV illness. We used Monte Carlo simulation to estimate annual economic burden for severe RSV illness. Findings We interviewed caregivers of 39 persons hospitalized for RSV illness. The median direct cost for hospitalization was US$ 62 (interquartile range [IQR] = 43–101), indirect cost was US$ 19 (IQR = 11–29) and total cost was US$ 94 (IQR = 67–127). The median out–of–pocket cost was 24% of monthly household income of affected families (US$ 143), and >50% families borrowed money to meet treatment cost. We estimated that the median direct cost of RSV–associated hospitalization in children aged <5 years in Bangladesh was US$ 10 million (IQR: US$ 7–16 million), the median indirect cost was US$ 3.0 million (IQR: 2–5 million) in 2010. Conclusion RSV–associated hospitalization among children aged <5 years represents a substantial economic burden in Bangladesh. Affected families frequently incurred considerable out of pocket and indirect costs for treatment that resulted in financial hardship. PMID:28702175

Relative costs of specialist services in a family practice population

PubMed Central

Norton, Peter G.; Nelson, Wendy; Rudner, Howard L.; Dunn, Earl V.

1985-01-01

The frequency and cost of referrals to specialists in March 1984 for 8980 rostered patients attending a family practice clinic located in a teaching hospital were analysed. The patients made 1891 visits to specialists. In all age groups and for all specialties female patients were more likely to be seen. The total direct provider costs were higher for female patients than for male patients. However, costs per patient seen were higher for male patients, except for psychiatry and medicine. Visits to surgeons had the highest total cost, while visits to psychiatrists had the highest cost per patient seen. Of the direct provider costs 61% was for specialist services. The family physician, in the “gatekeeper” role, has an opportunity to control some of the costs of the health care system by ensuring that the best and most efficient use is made of the referral network. PMID:4042059

Effects of worksite health interventions involving reduced work hours and physical exercise on sickness absence costs.

PubMed

von Thiele Schwarz, Ulrica; Hasson, Henna

2012-05-01

To investigate the effects of physical exercise during work hours (PE) and reduced work hours (RWH) on direct and indirect costs associated with sickness absence (SA). Sickness absence and related costs at six workplaces, matched and randomized to three conditions (PE, RWH, and referents), were retrieved from company records and/or estimated using salary conversion methods or value-added equations on the basis of interview data. Although SA days decreased in all conditions (PE, 11.4%; RWH, 4.9%; referents, 15.9%), costs were reduced in the PE (22.2%) and RWH (4.9%) conditions but not among referents (10.2% increase). Worksite health interventions may generate savings in SA costs. Costs may not be linear to changes in SA days. Combing the friction method with indirect cost estimates on the basis of value-added productivity may help illuminate both direct and indirect SA costs.

Reduction of Direct Health Costs Associated with Pertussis Vaccination with Acellular Vaccines in Children Aged 0-9 Years with Pertussis in Catalonia (Spain).

PubMed

Plans-Rubió, Pedro; Navas, Encarna; Godoy, Pere; Carmona, Gloria; Domínguez, Angela; Jané, Mireia; Muñoz-Almagro, Carmen; Brotons, Pedro

2018-05-14

The aim of this study was to assess direct health costs in children with pertussis aged 0-9 years who were vaccinated, partially vaccinated, and unvaccinated during childhood, and to assess the association between pertussis costs and pertussis vaccination in Catalonia (Spain) in 2012-2013. Direct healthcare costs included pertussis treatment, pertussis detection, and preventive chemotherapy of contacts. Pertussis patients were considered vaccinated when they had received 4-5 doses, and unvaccinated or partially vaccinated when they had received 0-3 doses of vaccine. The Chi square test and the odds ratios were used to compare percentages and the t test was used to compare mean pertussis costs in different groups, considering a p < 0.05 as statistically significant. The correlation between pertussis costs and study variables was assessed using the Spearman's ρ, with a p < 0.05 as statistically significant. Multiple linear regression analysis (IBM-SPSS program) was used to quantify the association of pertussis vaccination and other study variables with pertussis costs. Vaccinated children with pertussis aged 0-9 years had significantly lower odds ratios of hospitalizations (OR 0.02, p < 0.001), laboratory confirmation (OR 0.21, p < 0.001), and severe disease (OR 0.02, p < 0.001) than unvaccinated or partially vaccinated children with pertussis of the same age. Mean direct healthcare costs were significantly lower (p < 0.001) in vaccinated patients (€190.6) than in unvaccinated patients (€3550.8), partially vaccinated patients (€1116.9), and unvaccinated/partially vaccinated patients (€2330). Multivariable linear regression analysis showed that pertussis vaccination with 4-5 doses was associated with a non-significant reduction of pertussis costs of €107.9 per case after taking into account the effect of other study variables, and €200 per case after taking into account pertussis severity. Direct healthcare costs were lower in children with pertussis aged 0-9 years vaccinated with 4-5 doses of acellular vaccines than in unvaccinated or partially vaccinated children with pertussis of the same age.

Continuing to Confront COPD International Patient Survey: Economic Impact of COPD in 12 Countries.

PubMed

Foo, Jason; Landis, Sarah H; Maskell, Joe; Oh, Yeon-Mok; van der Molen, Thys; Han, MeiLan K; Mannino, David M; Ichinose, Masakazu; Punekar, Yogesh

2016-01-01

The Continuing to Confront COPD International Patient Survey estimated the prevalence and burden of COPD across 12 countries. Using data from this survey we evaluated the economic impact of COPD. This cross-sectional, population-based survey questioned 4,343 subjects aged 40 years and older, fulfilling a case definition of COPD based on self-reported physician diagnosis or symptomatology. Direct cost measures were based on exacerbations of COPD (treated and those requiring emergency department visits and/or hospitalisation), contacts with healthcare professionals, and COPD medications. Indirect costs were calculated from work loss values using the Work Productivity and Activity Impairment scale. Combined direct and indirect costs estimated the total societal costs per patient. The annual direct costs of COPD ranged from $504 (South Korea) to $9,981 (USA), with inpatient hospitalisations (5 countries) and home oxygen therapy (3 countries) being the key drivers of direct costs. The proportion of patients completely prevented from working due to their COPD ranged from 6% (Italy) to 52% (USA and UK) with 8 countries reporting this to be ≥20%. Total societal costs per patient varied widely from $1,721 (Russia) to $30,826 (USA) but a consistent pattern across countries showed greater costs among those with increased burden of COPD (symptoms, health status and more severe disease) and a greater number of comorbidities. The economic burden of COPD is considerable across countries, and requires targeted resources to optimise COPD management encompassing the control of symptoms, prevention of exacerbations and effective treatment of comorbidities. Strategies to allow COPD patients to remain in work are important for addressing the substantial wider societal costs.

Direct cost comparison of minimally invasive punch technique versus traditional approaches for percutaneous bone anchored hearing devices.

PubMed

Sardiwalla, Yaeesh; Jufas, Nicholas; Morris, David P

2017-06-12

Minimally Invasive Ponto Surgery (MIPS) was recently described as a new technique to facilitate the placement of percutaneous bone anchored hearing devices. The procedure has resulted in a simplification of the surgical steps and a dramatic reduction in surgical time while maintaining excellent patient outcomes. Given these developments, our group sought to move the procedure from the main operating suite where they have traditionally been performed. This study aims to test the null hypothesis that MIPS and open approaches have the same direct costs for the implantation of percutaneous bone anchored hearing devices in a Canadian public hospital setting. A retrospective direct cost comparison of MIPS and open approaches for the implantation of bone conduction implants was conducted. Indirect and future costs were not included in the fiscal analysis. A simple cost comparison of the two approaches was made considering time, staff and equipment needs. All 12 operations were performed on adult patients from 2013 to 2016 by the same surgeon at a single hospital site. MIPS has a total mean reduction in cost of CAD$456.83 per operation from the hospital perspective when compared to open approaches. The average duration of the MIPS operation was 7 min, which is on average 61 min shorter compared with open approaches. The MIPS technique was more cost effective than traditional open approaches. This primarily reflects a direct consequence of a reduction in surgical time, with further contributions from reduced staffing and equipment costs. This simple, quick intervention proved to be feasible when performed outside the main operating room. A blister pack of required equipment could prove convenient and further reduce costs.

[Direct health care costs in patients with type 2 diabetes mellitus six months after starting insulin treatment in Spain: the INSTIGATE study].

PubMed

Costi, María; Smith, Helen; Reviriego, Jesús; Castell, Conxa; Goday, Alberto; Dilla, Tatiana

2011-01-01

The INSTIGATE study was designed to assess direct health care costs incurred by patients with type 2 diabetes mellitus (T2DM) who start insulin therapy in Spain. It was a multicenter, observational, non-interventional, prospective study. Direct costs per patient in standard clinical practice were assessed for 6 months before and after the start of insulin therapy from the perspective of the Spanish health care system perspective. A total of 188 patients (42.6% women) with a mean age of 65.3 years, a mean body mass index of 29.7 kg/m(2), and a mean disease duration of 10.7 years were assessed. Before insulin therapy was started, mean (standard deviation) values of various clinical parameters were: hemoglobin A(1c) (%), 9.22 (1.58); fasting plasma glucose (mmol/L), 12.03 (3.62); and total cholesterol (mmol/L), 4.90 (1.1). These values decreased after insulin therapy was started. Mean total direct health care costs per patient 6 months before and after insulin start were €639 and €1,110, respectively. Mean total costs 6 months after insulin was started included costs of hospitalization (30.5%, €339), insulin (16.2%, €180), primary care (14.3%, €159), blood glucose monitoring (13.8%, €153), specialized care (13.3%, €148), oral antidiabetics (7.8%, €87), and other diabetes-related treatments (3.9%, €43). The clinical outcomes of T2DM patients improved after insulin therapy was started. This improvement was associated to increases in resource utilization and direct health care costs in the first 6 months of insulin therapy. Copyright © 2010 SEEN. Published by Elsevier Espana. All rights reserved.

Comparison of two public sector tertiary care hospitals' management in reducing direct medical cost burden on breast carcinoma patients in Lahore, Pakistan.

PubMed

Hameed Khaliq, Imran; Zahid Mahmood, Hafiz; Akhter, Naveed; Danish Sarfraz, Muhammad; Asim, Khadija; Masood Gondal, Khalid

2018-01-01

Breast cancer is one of the major causes of death incurring highest morbidity and mortality amongst women of Pakistan. The purpose of this study was to assess and compare the role of two public sector tertiary care hospitals' management in reducing out of pocket (OOP) expenses on direct medical costs borne by breast carcinoma patients' household from diagnosis through treatment. Moreover, the study intended to explore the reasons of opting private diagnostic facilities by the said patients during the services taken from the foresaid tertiary care centers. A purposive sample of 164 primary breast carcinoma patients was recruited for data collection of this cross-sectional study. Face to face interviews and semistructured questionnaires were adopted as method of data gathering tools. Major cost components of direct medical costs were used to compare the financial strain on the patients' households of both targeted hospitals. In addition, information was collected regarding the reasons of opting private diagnostic centers for investigations. Frequency, percentages, median and inter quartile range (IQR) were calculated for the data. Non-parametric variables were compared using the Mann-Whitney U test. It was observed that overall direct medical cost borne by the breast carcinoma patients' households in Jinnah hospital (median US$1153.93 / Rs. 118,589) was significantly higher than Mayo hospital (median US$427.93 /Rs. 43,978), p<0.001; r=0.623. Moreover, spending on almost all of the components of direct medical cost were found smaller in case of Mayo hospital's patients as compared to Jinnah hospital. This study indicates that OOP direct medical cost burden was found considerably less in Mayo hospital as compared to Jinnah hospital. The OOP expenditures on chemotherapy were overwhelmingly high. However, high spending on privately opted investigations procedures was the common issue of the patients under treatment in both hospitals.

Financial implications of ventral hernia repair: a hospital cost analysis.

PubMed

Reynolds, Drew; Davenport, Daniel L; Korosec, Ryan L; Roth, J Scott

2013-01-01

Complicated ventral hernias are often referred to tertiary care centers. Hospital costs associated with these repairs include direct costs (mesh materials, supplies, and nonsurgeon labor costs) and indirect costs (facility fees, equipment depreciation, and unallocated labor). Operative supplies represent a significant component of direct costs, especially in an era of proprietary synthetic meshes and biologic grafts. We aim to evaluate the cost-effectiveness of complex abdominal wall hernia repair at a tertiary care referral facility. Cost data on all consecutive open ventral hernia repairs (CPT codes 49560, 49561, 49565, and 49566) performed between 1 July 2008 and 31 May 2011 were analyzed. Cases were analyzed based upon hospital status (inpatient vs. outpatient) and whether the hernia repair was a primary or secondary procedure. We examined median net revenue, direct costs, contribution margin, indirect costs, and net profit/loss. Among primary hernia repairs, cost data were further analyzed based upon mesh utilization (no mesh, synthetic, or biologic). Four-hundred and fifteen patients underwent ventral hernia repair (353 inpatients and 62 outpatients); 173 inpatients underwent ventral hernia repair as the primary procedure; 180 inpatients underwent hernia repair as a secondary procedure. Median net revenue ($17,310 vs. 10,360, p < 0.001) and net losses (3,430 vs. 1,700, p < 0.025) were significantly greater for those who underwent hernia repair as a secondary procedure. Among inpatients undergoing ventral hernia repair as the primary procedure, 46 were repaired without mesh; 79 were repaired with synthetic mesh and 48 with biologic mesh. Median direct costs for cases performed without mesh were $5,432; median direct costs for those using synthetic and biologic mesh were $7,590 and 16,970, respectively (p < .01). Median net losses for repairs without mesh were $500. Median net profit of $60 was observed for synthetic mesh-based repairs. The median contribution margin for cases utilizing biologic mesh was -$4,560, and the median net financial loss was $8,370. Outpatient ventral hernia repairs, with and without synthetic mesh, resulted in median net losses of $1,560 and 230, respectively. Ventral hernia repair is associated with overall financial losses. Inpatient synthetic mesh repairs are essentially budget neutral. Outpatient and inpatient repairs without mesh result in net financial losses. Inpatient biologic mesh repairs result in a negative contribution margin and striking net financial losses. Cost-effective strategies for managing ventral hernias in a tertiary care environment need to be developed in light of the financial implications of this patient population.

Economic cost analysis of malaria case management at the household level during the malaria elimination phase in The People's Republic of China.

PubMed

Xia, Shang; Ma, Jin-Xiang; Wang, Duo-Quan; Li, Shi-Zhu; Rollinson, David; Zhou, Shui-Sen; Zhou, Xiao-Nong

2016-06-03

In China, malaria has been posing a significant economic burden on households. To evaluate malaria economic burden in terms of both direct and indirect costs has its meaning in improving the effectiveness of malaria elimination program in China. A number of study sites (eight counties in five provinces) were selected from the malaria endemic area in China, representing the different levels of malaria incidence, risk classification, economic development. A number of households with malaria cases (n = 923) were surveyed during the May to December in 2012 to collect information on malaria economic burden. Descriptive statistics were used to characterize the basic profiles of selected malaria cases in terms of their gender, age group, occupation and malaria type. The malaria economic costs were evaluated by direct and indirect costs. Comparisons were carried out by using the chi-square test (or Z-test) and the Mann-Whitney U test among malaria cases with reference to local/imported malaria patients, hospitalized/out patients, and treatment hospitals. The average cost of malaria per case was 1 691.23 CNY (direct cost was 735.41 CNY and indirect cost was 955.82 CNY), which accounted for 11.1 % of a household's total income. The average costs per case for local and imported malaria were 1 087.58 CNY and 4271.93 CNY, respectively. The average cost of a malaria patient being diagnosed and treated in a hospital at the county level or above (3 975.43 CNY) was 4.23 times higher than that of malaria patient being diagnosed and treated at a village or township hospital (938.80 CNY). This study found that malaria has been posing a significant economic burden on households in terms of direct and indirect costs. There is a need to improve the effectiveness of interventions in order to reduce the impact costs of malaria, especially of imported infections, in order to eliminate the disease in China.

Examining the production costs of antiretroviral drugs.

PubMed

Pinheiro, Eloan; Vasan, Ashwin; Kim, Jim Yong; Lee, Evan; Guimier, Jean Marc; Perriens, Joseph

2006-08-22

To present direct manufacturing costs and price calculations of individual antiretroviral drugs, enabling those responsible for their procurement to have a better understanding of the cost structure of their production, and to indicate the prices at which these antiretroviral drugs could be offered in developing country markets. Direct manufacturing costs and factory prices for selected first and second-line antiretroviral drugs were calculated based on cost structure data from a state-owned company in Brazil. Prices for the active pharmaceutical ingredients (API) were taken from a recent survey by the World Health Organization (WHO). The calculated prices for antiretroviral drugs are compared with quoted prices offered by privately-owned, for-profit manufacturers. The API represents the largest component of direct manufacturing costs (55-99%), while other inputs, such as salaries, equipment costs, and scale of production, have a minimal impact. The calculated prices for most of the antiretroviral drugs studied fall within the lower quartile of the range of quoted prices in developing country markets. The exceptions are those drugs, primarily for second-line therapy, for which the API is either under patent, in short supply, or in limited use in developing countries (e.g. abacavir, lopinavir/ritonavir, nelfinavir, saquinavir). The availability of data on the cost of antiretroviral drug production and calculation of factory prices under a sustainable business model provide benchmarks that bulk purchasers of antiretroviral drugs could use to negotiate lower prices. While truly significant price decreases for antiretroviral drugs will depend largely on the future evolution of API prices, the present study demonstrates that for several antiretroviral drugs price reduction is currently possible. Whether or not these reductions materialize will depend on the magnitude of indirect cost and profit added by each supplier over the direct production costs. The ability to achieve price reductions in line with production costs will have critical implications for sustainable treatment for HIV/AIDS in the developing world.

Cost of Opioid-Treated Chronic Low Back Pain: Findings from a Pilot Randomized Controlled Trial of Mindfulness Meditation-Based Intervention

PubMed Central

Ircink, James; Burzinski, Cindy A.; Mundt, Marlon P.

2018-01-01

Objective Opioid-treated chronic low back pain (CLBP) is debilitating, costly and often refractory to existing treatments. This secondary analysis aims to pilot-test the hypothesis that mindfulness meditation (MM) can reduce economic burden related to opioid-treated CLBP. Design 26-week unblinded pilot randomized controlled trial, comparing MM, adjunctive to usual-care, to usual care alone. Setting Outpatient Participants Thirty-five adults with opioid-treated CLBP (≥ 30 morphine-equivalent mg/day) for 3+ months enrolled; none withdrew. Intervention 8 weekly therapist-led MM sessions and at-home practice. Outcome Measures Costs related to self-reported healthcare utilization, medication use (direct costs), lost productivity (indirect costs), and total costs (direct+indirect costs) were calculated for 6-month pre- and post-enrollment periods and compared within and between the groups. Results Participants (21 MM; 14 control) were 20% men, age 51.8 ± 9.7 years, with severe disability, opioid dose of 148.3 ± 129.2 morphine-equivalent mg/day, and individual annual income of $18,291 ± $19,345. At baseline, total costs were estimated at $15,497 ± 13,677 (direct: $10,635 ± 9,897; indirect: $4,862 ± 7,298) per participant. Although MM group participants, compared to controls, reduced their pain severity ratings and pain sensitivity to heat-stimuli (p<0.05), no statistically significant within-group changes or between-group differences in direct and indirect costs were noted. Conclusions Adults with opioid-treated CLBP experience a high burden of disability despite the high costs of treatment. Although this pilot study did not show a statistically significant impact of MM on costs related to opioid-treated CLBP, MM can improve clinical outcomes and should be assessed in a larger trial with long-term follow-up. PMID:28829518

The economic burden of the care and treatment for people with Alzheimer's disease: the outlook for the Czech Republic.

PubMed

Marešová, Petra; Zahálková, Veronika

2016-12-01

The aim of this paper is to specify the cost of treatment and care for people with Alzheimer's disease (AD) in the Czech Republic and also with a view to the future. Data availability is evaluated as well as the quality of cost comparison with other developed countries. Data for the Czech Republic will include data from the health insurance company regarding medicines and treatment, as well as a selected home caring for people with dementia and, ultimately, the Social Security Administration. The basic methods include an analysis of data from publicly available sources, direct interviews with the representatives of nursing homes caring for people with dementia and the representative of the Social Security Administration of the Czech Republic. Items will be specified within the category of direct costs. For the study, the indirect costs related to the loss of patient as well as caring person productivity are not considered. Costs for treatment and care are based from the data on 4162 patients, the costs of a bed from data on 391 beds in homes for the elderly. The average annual cost per patient with AD in the Czech Republic was calculated and came to the amount of 12,783 EUR. These items include outpatient care, inpatient care in a medical facility, inpatient care in homes and medications. In terms of share of these items on the direct costs, the largest item are services provided by special homes which contributes to the direct costs by 94 %, medications create 1 % and treatment (both outpatient and inpatient) 5 %. In the case of home care the total costs are lower at 4698 EUR. The Czech Republic as well as other developed countries are faced with the problem of unified accounting cost of people suffering from Alzheimer's disease. This then causes the calculation of the economic burden to be very difficult and indicative values.

10 CFR 611.102 - Eligible project costs.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Accounting Principles and these costs may be considered by DOE in determining the Borrower's contribution to... 10 Energy 4 2010-01-01 2010-01-01 false Eligible project costs. 611.102 Section 611.102 Energy... PROGRAM Direct Loan Program § 611.102 Eligible project costs. (a) Eligible costs are: (1) Those costs that...

10 CFR 611.102 - Eligible project costs.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 4 2014-01-01 2014-01-01 false Eligible project costs. 611.102 Section 611.102 Energy... PROGRAM Direct Loan Program § 611.102 Eligible project costs. (a) Eligible costs are: (1) Those costs that.... (b) In determining the overall total cost of an Eligible Project, DOE and the applicant may include...

10 CFR 611.102 - Eligible project costs.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 4 2012-01-01 2012-01-01 false Eligible project costs. 611.102 Section 611.102 Energy... PROGRAM Direct Loan Program § 611.102 Eligible project costs. (a) Eligible costs are: (1) Those costs that.... (b) In determining the overall total cost of an Eligible Project, DOE and the applicant may include...

10 CFR 611.102 - Eligible project costs.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 4 2013-01-01 2013-01-01 false Eligible project costs. 611.102 Section 611.102 Energy... PROGRAM Direct Loan Program § 611.102 Eligible project costs. (a) Eligible costs are: (1) Those costs that.... (b) In determining the overall total cost of an Eligible Project, DOE and the applicant may include...

10 CFR 611.102 - Eligible project costs.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 4 2011-01-01 2011-01-01 false Eligible project costs. 611.102 Section 611.102 Energy... PROGRAM Direct Loan Program § 611.102 Eligible project costs. (a) Eligible costs are: (1) Those costs that.... (b) In determining the overall total cost of an Eligible Project, DOE and the applicant may include...

Direct health costs of environmental tobacco smoke exposure and indirect health benefits due to smoking ban introduction.

PubMed

Hauri, Dimitri D; Lieb, Christoph M; Rajkumar, Sarah; Kooijman, Cornelis; Sommer, Heini L; Röösli, Martin

2011-06-01

Introducing comprehensive smoke-free policies to public places is expected to reduce health costs. This includes prevented health damages by avoiding environmental tobacco smoke (ETS) exposure as well as indirect health benefits from reduced tobacco consumption. The aim of this study was to estimate direct health costs of ETS exposure in public places and indirect health benefits from reduced tobacco consumption. We calculated attributable hospital days and years of life lost (YLL), based on the observed passive smoking and disease rates in Switzerland. The exposure-response associations of all relevant health outcomes were derived by meta-analysis from prospective cohort studies in order to calculate the direct health costs. To assess the indirect health benefits, a meta-analysis of smoking ban studies on hospital admissions for acute myocardial infarction was conducted. ETS exposure in public places in Switzerland causes 32,000 preventable hospital days (95% CI: 10,000-61,000), 3000 YLL (95% CI: 1000-5000), corresponding to health costs of 330 Mio CHF. The number of hospital days for ischaemic heart disease attributable to passive smoking is much larger if derived from smoking ban studies (41,000) than from prospective cohort studies (3200), resulting in additional health costs of 89 Mio CHF, which are attributed to the indirect health benefits of a smoking ban introduction. The example of smoking ban studies on ischaemic heart disease hospitalization rates suggests that total health costs that can be prevented with smoking bans are considerably larger than the costs arising from the direct health impact of ETS exposure in public places.

The economic consequences of irritable bowel syndrome: a US employer perspective.

PubMed

Leong, Stephanie A; Barghout, Victoria; Birnbaum, Howard G; Thibeault, Crystal E; Ben-Hamadi, Rym; Frech, Feride; Ofman, Joshua J

2003-04-28

The objective of this study was to measure the direct costs of treating irritable bowel syndrome (IBS) and the indirect costs in the workplace. This was accomplished through retrospective analysis of administrative claims data from a national Fortune 100 manufacturer, which includes all medical, pharmaceutical, and disability claims for the company's employees, spouses/dependents, and retirees. Patients with IBS were identified as individuals, aged 18 to 64 years, who received a primary code for IBS or a secondary code for IBS and a primary code for constipation or abdominal pain between January 1, 1996, and December 31, 1998. Of these patients with IBS, 93.7% were matched based on age, sex, employment status, and ZIP code to a control population of beneficiaries. Direct and indirect costs for patients with IBS were compared with those of matched controls. The average total cost (direct plus indirect) per patient with IBS was 4527 dollars in 1998 compared with 3276 dollars for a control beneficiary (P<.001). The average physician visit costs were 524 dollars and 345 dollars for patients with IBS and controls, respectively (P<.001). The average outpatient care costs to the employer were 1258 dollars and 742 dollars for patients with IBS and controls, respectively (P<.001). Medically related work absenteeism cost the employer 901 dollars on average per employee treated for IBS compared with 528 dollars on average per employee without IBS (P<.001). Irritable bowel syndrome is a significant financial burden on the employer that arises from an increase in direct and indirect costs compared with the control group.

Appropriate VTE prophylaxis is associated with lower direct medical costs.

PubMed

Amin, Alpesh; Hussein, Mohamed; Battleman, David; Lin, Jay; Stemkowski, Stephen; Merli, Geno J

2010-11-01

To calculate and compare the direct medical costs of guideline-recommended prophylaxis with prophylaxis that does not fully adhere with guideline recommendations in a large, real-world population. Discharge records were retrieved from the US Premier Perspective™ database (January 2003-December 2003) for patients aged≥40 years with a primary diagnosis of cancer, chronic heart failure, lung disease, or severe infectious disease who received some form of thromboprophylaxis. Univariate analysis and multivariate regression modeling were performed to compare direct medical costs between discharges who received appropriate prophylaxis (correct type, dose, and duration based on sixth edition American College of Chest Physicians [ACCP] recommendations) and partial prophylaxis (not in full accordance with ACCP recommendations). Market segmentation analysis was used to compare costs stratified by hospital and patient characteristics. Of the 683 005 discharges included, 148,171 (21.7%) received appropriate prophylaxis and 534,834 (78.3%) received partial prophylaxis. The total direct unadjusted costs were $15,439 in the appropriate prophylaxis group and $17,763 in the partial prophylaxis group. After adjustment, mean adjusted total costs per discharge were lower for those receiving appropriate prophylaxis ($11,713; 95% confidence interval [CI], $11,675-$11,753) compared with partial prophylaxis ($13,369; 95% CI, $13,332-$13 406; P<0.01). Appropriate prophylaxis appeared to be associated with numerically lower unadjusted costs than partial prophylaxis, regardless of hospital size, rural/urban location, teaching status, and patient age and gender. This large, real-world analysis suggests that appropriate prophylaxis, in adherence with ACCP guidelines, is potentially cost-saving compared with partial prophylaxis in at-risk medical patients.

The economics of employing a counsellor in general practice: analysis of data from a randomised controlled trial.

PubMed Central

Friedli, K; King, M B; Lloyd, M

2000-01-01

BACKGROUND: Counselling is currently adopted in many general practices, despite limited evidence of clinical and cost effectiveness. AIM: To compare direct and indirect costs of counsellors and general practitioners (GPs) in providing care to people with emotional problems. METHOD: We carried out a prospective, randomized controlled trial of non-directive counselling and routine general practice care in 14 general practices in north London. Counsellors adhered to a Rogerian model of counselling. The counselling sessions ranged from one to 12 sessions over 12 weeks. As reported elsewhere, there were no differences in clinical outcomes between the two groups. Therefore, we conducted a cost minimisation analysis. We present only the economic outcomes in this paper. Main outcome measures were cost data (service utilisation, travel, and work absence) at baseline, three months, and nine months. RESULTS: One hundred and thirty-six patients with emotional problems, mainly depression, took part. Seventy patients were randomised to the counsellors and 66 to the GPs. The average direct and indirect costs for the counsellor was 162.09 Pounds more per patient after three months compared with costs for the GP group; however, over the following six months the counsellor group was 87.00 Pounds less per patient than the GP group. Over the total nine-month period, the counsellor group remained more expensive per patient. CONCLUSIONS: Referral to counselling is no more clinically effective or expensive than GP care over a nine-month period in terms of direct plus indirect costs. However, further research is needed to establish indirect costs of introducing a counsellor into general practice. PMID:10897510

Social cost of heavy drinking and alcohol dependence in high-income countries.

PubMed

Mohapatra, Satya; Patra, Jayadeep; Popova, Svetlana; Duhig, Amy; Rehm, Jürgen

2010-06-01

A comprehensive review of cost drivers associated with alcohol abuse, heavy drinking, and alcohol dependence for high-income countries was conducted. The data from 14 identified cost studies were tabulated according to the potential direct and indirect cost drivers. The costs associated with alcohol abuse, alcohol dependence, and heavy drinking were calculated. The weighted average of the total societal cost due to alcohol abuse as percent gross domestic product (GDP)--purchasing power parity (PPP)--was 1.58%. The cost due to heavy drinking and/or alcohol dependence as percent GDP (PPP) was estimated to be 0.96%. On average, the alcohol-attributable indirect cost due to loss of productivity is more than the alcohol-attributable direct cost. Most of the countries seem to incur 1% or more of their GDP (PPP) as alcohol-attributable costs, which is a high toll for a single factor and an enormous burden on public health. The majority of alcohol-attributable costs incurred as a consequence of heavy drinking and/or alcohol dependence. Effective prevention and treatment measures should be implemented to reduce these costs.

Modeling the predictive value of pain intensity on costs and resources utilization in patients with peripheral neuropathic pain.

PubMed

Pérez, Concepción; Navarro, Ana; Saldaña, María T; Wilson, Koo; Rejas, Javier

2015-03-01

The aim of the present analysis was to model the association and predictive value of pain intensity on cost and resource utilization in patients with chronic peripheral neuropathic pain (PNP) treated in routine clinical practice settings in Spain. We performed a secondary economic analysis based on data from a multicenter, observational, and prospective cost-of-illness study in patients with chronic PNP that is refractory to prior treatment. Pain intensity was measured using the Short-Form McGill Pain Questionnaire. Univariate and multivariate linear regression models were fitted to identify independent predictors of cost and health care/non-health care resource utilization. A total of 1703 patients were included in the current analysis. Pain intensity was an independent predictor of total costs ([total costs]=35.6 [pain intensity]+214.5; coefficient of determination [R(2)]=0.19, P<0.001), direct costs ([direct costs]=10.8 [pain intensity]+257.7; R=0.06, P<0.001), and indirect costs ([indirect costs]=24.8 [pain intensity]-43.4; R(2)=0.20, P<0.001) related to chronic PNP in the univariate analysis. Pain intensity remains significantly associated with total costs, direct costs, and indirect costs after adjustment by other covariates in the multivariate analysis (P<0.001). None of the other variables considered in the multivariate analysis were predictors of resource utilization. Pain intensity predicts the health care and non-health care resource utilization, and costs related to chronic PNP. Management of patients with drugs associated with a higher reduction of pain intensity may have a greater impact on the economic burden of that condition.

Costs of dengue prevention and incremental cost of dengue outbreak control in Guantanamo, Cuba.

PubMed

Baly, Alberto; Toledo, Maria E; Rodriguez, Karina; Benitez, Juan R; Rodriguez, Maritza; Boelaert, Marleen; Vanlerberghe, Veerle; Van der Stuyft, Patrick

2012-01-01

To assess the economic cost of routine Aedes aegypti control in an at-risk environment without dengue endemicity and the incremental costs incurred during a sporadic outbreak. The study was conducted in 2006 in the city of Guantanamo, Cuba. We took a societal perspective to calculate costs in months without dengue transmission (January-July) and during an outbreak (August-December). Data sources were bookkeeping records, direct observations and interviews. The total economic cost per inhabitant (p.i.) per month. (p.m.) increased from 2.76 USD in months without dengue transmission to 6.05 USD during an outbreak. In months without transmission, the routine Aedes control programme cost 1.67 USD p.i. p.m. Incremental costs during the outbreak were mainly incurred by the population and the primary/secondary level of the healthcare system, hardly by the vector control programme (1.64, 1.44 and 0.21 UDS increment p.i. p.m., respectively). The total cost for managing a hospitalized suspected dengue case was 296.60 USD (62.0% direct medical, 9.0% direct non-medical and 29.0% indirect costs). In both periods, the main cost drivers for the Aedes control programme, the healthcare system and the community were the value of personnel and volunteer time or productivity losses. Intensive efforts to keep A. aegypti infestation low entail important economic costs for society. When a dengue outbreak does occur eventually, costs increase sharply. In-depth studies should assess which mix of activities and actors could maximize the effectiveness and cost-effectiveness of routine Aedes control and dengue prevention. © 2011 Blackwell Publishing Ltd.

Direct and indirect costs for adverse drug events identified in medical records across care levels, and their distribution among payers.

PubMed

Natanaelsson, Jennie; Hakkarainen, Katja M; Hägg, Staffan; Andersson Sundell, Karolina; Petzold, Max; Rehnberg, Clas; Jönsson, Anna K; Gyllensten, Hanna

2017-11-01

Adverse drug events (ADEs) cause considerable costs in hospitals. However, little is known about costs caused by ADEs outside hospitals, effects on productivity, and how the costs are distributed among payers. To describe the direct and indirect costs caused by ADEs, and their distribution among payers. Furthermore, to describe the distribution of patient out-of-pocket costs and lost productivity caused by ADEs according to socio-economic characteristics. In a random sample of 5025 adults in a Swedish county, prevalence-based costs for ADEs were calculated. Two different methods were used: 1) based on resource use judged to be caused by ADEs, and 2) as costs attributable to ADEs by comparing costs among individuals with ADEs to costs among matched controls. Payers of costs caused by ADEs were identified in medical records among those with ADEs (n = 596), and costs caused to individual patients were described by socio-economic characteristics. Costs for resource use caused by ADEs were €505 per patient with ADEs (95% confidence interval €345-665), of which 38% were indirect costs. Compared to matched controls, the costs attributable to ADEs were €1631, of which €410 were indirect costs. The local health authorities paid 58% of the costs caused by ADEs. Women had higher productivity loss than men (€426 vs. €109, p = 0.018). Out-of-pocket costs displaced a larger proportion of the disposable income among low-income earners than higher income earners (0.7% vs. 0.2%-0.3%). We used two methods to identify costs for ADEs, both identifying indirect costs as an important component of the overall costs for ADEs. Although the largest payers of costs caused by ADEs were the local health authorities responsible for direct costs, employers and patients costs for lost productivity contributed substantially. Our results indicate inequalities in costs caused by ADEs, by sex and income. Copyright © 2016 Elsevier Inc. All rights reserved.

28 CFR 802.10 - Fee schedule.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Guidelines. They reflect direct costs for search, review (in the case of commercial requesters), and... term direct costs means those expenditures the agency actually makes in searching for, review (in the... searching for, reviewing, and duplicating the records sought. Commercial use requesters are not entitled to...

28 CFR 802.10 - Fee schedule.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Guidelines. They reflect direct costs for search, review (in the case of commercial requesters), and... term direct costs means those expenditures the agency actually makes in searching for, review (in the... searching for, reviewing, and duplicating the records sought. Commercial use requesters are not entitled to...

28 CFR 802.10 - Fee schedule.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Guidelines. They reflect direct costs for search, review (in the case of commercial requesters), and... term direct costs means those expenditures the agency actually makes in searching for, review (in the... searching for, reviewing, and duplicating the records sought. Commercial use requesters are not entitled to...

28 CFR 802.10 - Fee schedule.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Guidelines. They reflect direct costs for search, review (in the case of commercial requesters), and... term direct costs means those expenditures the agency actually makes in searching for, review (in the... searching for, reviewing, and duplicating the records sought. Commercial use requesters are not entitled to...

28 CFR 802.10 - Fee schedule.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Guidelines. They reflect direct costs for search, review (in the case of commercial requesters), and... term direct costs means those expenditures the agency actually makes in searching for, review (in the... searching for, reviewing, and duplicating the records sought. Commercial use requesters are not entitled to...

Evaluation of the economic burden of Herpes Zoster (HZ) infection

PubMed Central

Panatto, Donatella; Bragazzi, Nicola Luigi; Rizzitelli, Emanuela; Bonanni, Paolo; Boccalini, Sara; Icardi, Giancarlo; Gasparini, Roberto; Amicizia, Daniela

2014-01-01

The main objective of this systematic review was to evaluate the economic burden of Herpes Zoster (HZ) infection. The review was conducted in accordance with the standards of the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” guidelines. The following databases were accessed: ISI/Web of Knowledge (WoS), MEDLINE/PubMed, Scopus, ProQuest, the Cochrane Library and EconLit. Specific literature on health economics was also manually inspected. Thirty-three studies were included. The quality of the studies assessed in accordance with the Consolidated Health Economic Evaluation Reporting Standards checklist was good. All studies evaluated direct costs, apart from one which dealt only with indirect costs. Indirect costs were evaluated by 12 studies. The economic burden of HZ has increased over time. HZ management and drug prescriptions generate the highest direct costs. While increasing age, co-morbidities and drug treatment were found to predict higher direct costs, being employed was correlated with higher indirect costs, and thus with the onset age of the disease. Despite some differences among the selected studies, particularly with regard to indirect costs, all concur that HZ is a widespread disease which has a heavy social and economic burden. PMID:25483704

Direct and indirect cost of managing alzheimer’s disease and related dementias in the United States

PubMed Central

Deb, Arijita; Thornton, James Douglas; Sambamoorthi, Usha; Innes, Kim

2017-01-01

Introduction Care of individuals with Alzheimer’s Disease and Related Dementias (ADRD) poses special challenges. As the disease progresses, individuals with ADRD require increasing levels of medical care, caregiver support, and long-term care which can lead to substantial economic burden. Areas covered In this expert review, we synthesized findings from studies of costs of ADRD in the United States that were published between January 2006 and February 2017, highlighted major sources of variation in costs, identified knowledge gaps and briefly outlined directions for future research and implications for policy and program planning. Expert commentary A consistent finding of all studies comparing individuals with and without ADRD is that the average medical, non-medical, and indirect costs of individuals with ADRD are higher than those without ADRD, despite the differences in the methods of identifying ADRD, duration of the study, payer type and settings of study population. The economic burden of ADRD may be underestimated because many components such as direct non-medical costs for home safety modifications and adult day care services and indirect costs due to the adverse impact of ADRD on caregivers’ health and productivity are not included in cost estimates. PMID:28351177

The cost of insulin-dependent diabetes mellitus (IDDM) in England and Wales.

PubMed

Gray, A; Fenn, P; McGuire, A

1995-12-01

This study estimates the direct health and social care costs of insulin-dependent diabetes mellitus (IDDM) in England and Wales in 1992 to be 96 million pounds, or 1021 pounds per person in a population with IDDM estimated at 94,000 individuals. These costs include insulin maintenance, hospitalization, GP and out-patient consultations, renal replacement therapy, and payments to informal carers. Expenditure is concentrated on younger age groups, with one-third of the total expended on those aged 0-24. Around one-half of the total costs can be directly attributed to IDDM, with the remainder associated with a range of complications of the disease. The single largest area of service expenditure is renal replacement therapy. The cost estimates are most sensitive to incidence rates of IDDM, numbers on dialysis and average duration of dialysis. A further 113 million pounds may be lost each year due to premature deaths resulting in lost productive contributions to the economy. The direct and indirect costs of IDDM are therefore significant. The cost of illness framework presented here should facilitate the economic evaluation of new and existing treatment regimens, which may improve value for money by reducing costs and/or increasing the quality or quantity of life for people with IDDM.

Study 2.6 operations analysis mission characterization

NASA Technical Reports Server (NTRS)

Wolfe, R. R.

1973-01-01

An analysis of the current operations concepts of NASA and DoD is presented to determine if alternatives exist which may improve the utilization of resources. The final product is intended to show how sensitive these ground rules and design approaches are relative to the total cost of doing business. The results are comparative in nature, and assess one concept against another as opposed to establishing an absolute cost value for program requirements. An assessment of the mission characteristics is explained to clarify the intent, scope, and direction of this effort to improve the understanding of what is to be accomplished. The characterization of missions is oriented toward grouping missions which may offer potential economic benefits by reducing overall program costs. Program costs include design, development, testing, and engineering, recurring unit costs for logistic vehicles, payload costs. and direct operating costs.

The Economic Costs of Type 2 Diabetes: A Global Systematic Review.

PubMed

Seuring, Till; Archangelidi, Olga; Suhrcke, Marc

2015-08-01

There has been a widely documented and recognized increase in diabetes prevalence, not only in high-income countries (HICs) but also in low- and middle-income countries (LMICs), over recent decades. The economic burden associated with diabetes, especially in LMICs, is less clear. We provide a systematic review of the global evidence on the costs of type 2 diabetes. Our review seeks to update and considerably expand the previous major review of the costs of diabetes by capturing the evidence on overall, direct and indirect costs of type 2 diabetes worldwide that has been published since 2001. In addition, we include a body of economic evidence that has hitherto been distinct from the cost-of-illness (COI) work, i.e. studies on the labour market impact of diabetes. We searched PubMed, EMBASE, EconLit and IBSS (without language restrictions) for studies assessing the economic burden of type 2 diabetes published from January 2001 to October 2014. Costs reported in the included studies were converted to international dollars ($) adjusted for 2011 values. Alongside the narrative synthesis and methodological review of the studies, we conduct an exploratory linear regression analysis, examining the factors behind the considerable heterogeneity in existing cost estimates between and within countries. We identified 86 COI and 23 labour market studies. COI studies varied considerably both in methods and in cost estimates, with most studies not using a control group, though the use of either regression analysis or matching has increased. Direct costs were generally found to be higher than indirect costs. Direct costs ranged from $242 for a study on out-of-pocket expenditures in Mexico to $11,917 for a study on the cost of diabetes in the USA, while indirect costs ranged from $45 for Pakistan to $16,914 for the Bahamas. In LMICs-in stark contrast to HICs-a substantial part of the cost burden was attributed to patients via out-of-pocket treatment costs. Our regression analysis revealed that direct diabetes costs are closely and positively associated with a country's gross domestic product (GDP) per capita, and that the USA stood out as having particularly high costs, even after controlling for GDP per capita. Studies on the labour market impact of diabetes were almost exclusively confined to HICs and found strong adverse effects, particularly for male employment chances. Many of these studies also took into account the possible endogeneity of diabetes, which was not the case for COI studies. The reviewed studies indicate a large economic burden of diabetes, most directly affecting patients in LMICs. The magnitude of the cost estimates differs considerably between and within countries, calling for the contextualization of the study results. Scope remains large for adding to the evidence base on labour market effects of diabetes in LMICs. Further, there is a need for future COI studies to incorporate more advanced statistical methods in their analysis to account for possible biases in the estimated costs.

Collective Bargaining at Kent State University: Negotiating Team and Costs

ERIC Educational Resources Information Center

Charron, William J., Jr.; Plumley, Virginia

1978-01-01

Financial costs incurred by management at Kent State University in preparing and in negotiating its contract are discussed, including the cost of the administrative personnel responsible for negotiating and the assessment of other direct and indirect costs to management. Implementation costs are not included. (LBH)

30 CFR 1220.013 - Unallowable costs.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Mineral Resources OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR Natural... OIL AND GAS LEASES § 1220.013 Unallowable costs. The following costs shall not be charged as direct or... inventory; (e) Research and development costs; (f) The following legal expenses: (1) The costs of litigation...

Direct and indirect costs among employees with diabetic retinopathy in the United States.

PubMed

Lee, Lauren J; Yu, Andrew P; Cahill, Kevin E; Oglesby, Alan K; Tang, Jackson; Qiu, Ying; Birnbaum, Howard G

2008-05-01

To examine, from the employer perspective, the direct (healthcare) and indirect (workloss) costs of employees with diabetic retinopathy (DR) compared to control non-DR employees with diabetes, and within DR subgroups. Compared annual costs using claims data from 17 large companies (1999-2004). 'DR employees' (n = 2098) had >or= 1 DR (International Classification of Disease, 9th Revision [ICD-9]) diagnosis; DR subgroups included employees with diabetic macular edema (DME), proliferative DR (PDR), and employees receiving photocoagulation or vitrectomy procedures. Descriptive and multivariate tests were performed. DR employee annual direct costs were $18,218 (indirect = $3548) compared to $11,898 (indirect = $2374) for controls (Delta = $2032 (adjusted); p < 0.0001). Costs differences were larger across DR employee subgroups: DME/non-DME ($28,606/$16,363); PDR/non-PDR ($30,135/$13,445; p < 0.0001); DR with/without photocoagulation ($34,539/$16,041; p < 0.0001); and DR with/without vitrectomy ($63,933/$17,239; p < 0.0001). This study examined the incremental costs of treating DR employees, which may be higher than the incremental costs of DR itself. Some measures of diabetes severity (e.g., duration of diabetes) were not available in the claims data, and were therefore not included in the multivariate models. The cost of photocoagulation and vitrectomy procedures pertain to individuals who underwent these procedures, and not the cost of the procedures themselves. DR employees had significantly higher costs than controls, and larger differences existed within DR subgroups. Indirect costs accounted for about 20% of total cost.

[Macroeconomic costs of eye diseases].

PubMed

Hirneiß, C; Kampik, A; Neubauer, A S

2014-05-01

Eye diseases that are relevant regarding their macroeconomic costs and their impact on society include cataract, diabetic retinopathy, age-related maculopathy, glaucoma and refractive errors. The aim of this article is to provide a comprehensive overview of direct and indirect costs for major eye disease categories for Germany, based on existing literature and data sources. A semi-structured literature search was performed in the databases Medline and Embase and in the search machine Google for relevant original papers and reviews on costs of eye diseases with relevance for or transferability to Germany (last research date October 2013). In addition, manual searching was performed in important national databases and information sources, such as the Federal Office of Statistics and scientific societies. The direct costs for these diseases add up to approximately 2.6 billion Euros yearly for the Federal Republic of Germany, including out of the pocket payments from patients but excluding optical aids (e.g. glasses). In addition to those direct costs there are also indirect costs which are caused e.g. by loss of employment or productivity or by a reduction in health-related quality of life. These indirect costs can only be roughly estimated. Including the indirect costs for the eye diseases investigated, a total yearly macroeconomic cost ranging between 4 and 12 billion Euros is estimated for Germany. The costs for the eye diseases cataract, diabetic retinopathy, age-related maculopathy, glaucoma and refractive errors have a macroeconomic relevant dimension. Based on the predicted demographic changes with an ageing society an increase of the prevalence and thus also an increase of costs for eye diseases is expected in the future.

International comparison of cost effectiveness of medical management strategies for nephrolithiasis.

PubMed

Lotan, Yair; Cadeddu, Jeffrey A; Pearle, Margaret S

2005-06-01

Although medical therapy is known to reduce the risk of kidney stone recurrence, the cost effectiveness of medical prophylaxis is controversial. We evaluated medical treatment strategies including dietary measures (conservative), empiric medical therapy (empiric) or directed medical therapy (directed) based on comprehensive metabolic evaluation (CME) for patients with recurrent kidney stones, and compared the costs of these strategies using cost data from ten different countries. We previously established rates of stone formation in recurrent stone-formers, risk reduction of medical therapy, sensitivity of CME and rates of spontaneous stone passage from a comprehensive literature search (Lotan et al. 2004 J Urol 172: 2275). The costs of medication, surgical therapy, emergency room visits and CME for ten different countries were obtained from a published report of an international cost survey (Chandhoke 2002 J Urol 168: 937) as well as from our own county hospital in the US. Medication costs in the US were obtained from two national pharmacy chains. A decision tree model was created to compare the costs of different treatment strategies assuming cost accrual for metabolic evaluation, medical therapy and surgery or emergency room visits. For medical therapy, we assumed the distribution of medication use described in the published report, consisting of potassium citrate (60%), thiazide (30%) and allopurinol (10%). A nearly 20-fold difference in the costs of shock-wave lithotripsy, ureteroscopy and medication was found among different countries. From the model (US dollars/patient/year), conservative therapy alone was the most cost effective approach followed by empiric and directed medical therapy in all countries except in the UK. In the UK, the cost of drug therapy (estimated at dollar 29/patient/year) resulted in empiric therapy being the most cost effective strategy for recurrent stone formers. The low likelihood of surgical intervention, as well as the low relative cost of surgery to medication, contributed to the higher cost of empiric and directed medical therapy strategies. Of note, despite the higher cost, drug treatment strategies were associated with significantly lower stone recurrence rates. We found that drug treatment strategies are more costly than conservative treatment but produce good control of stone formation. In all but one country (UK), dietary therapy was the most cost effective approach due to the relatively low cost of surgery compared with medication. The differential resource allocation to different components of a healthcare system (i.e. subsidized medication versus surgical treatment) in different countries determines the cost effectiveness of various treatment strategies.

The economic burden of human papillomavirus-related precancers and cancers in Sweden

PubMed Central

Silfverschiöld, Maria; Greiff, Lennart; Asciutto, Christine; Wennerberg, Johan; Lydryp, Marie-Louise; Håkansson, Ulf; Sparén, Pär; Borgfeldt, Christer

2017-01-01

Background High-risk (HR) human papillomavirus (HPV) infection is an established cause of malignant disease. We used a societal perspective to estimate the cost of HR HPV-related cervical, vulvar, vaginal, anal, and penile precancer and cancer, and oropharyngeal cancer in Sweden in 2006, 1 year before HPV vaccination became available in the country. Materials and methods This prevalence-based cost-of-illness study used diagnosis-specific data from national registries to determine the number of HR HPV-related precancers and cancers. The HR HPV-attributable fractions of these diseases were derived from a literature review and applied to the total burden to estimate HR HPV-attributable costs. Direct costs were based on health care utilization and indirect costs on loss of productivity due to morbidity (i.e., sick leave and early retirement) and premature mortality. Results The total annual cost of all HR HPV-attributable precancers and cancers was €94 million (€10.3/inhabitant). Direct costs accounted for €31.3 million (€3.4/inhabitant) of the total annual cost, and inpatient care amounted to €20.7 million of direct costs. Indirect costs made up €62.6 million (€6.9/inhabitant) of the total annual cost, and premature mortality amounted to €36 million of indirect costs. Cervical precancer and cancer was most costly (total annual cost €58.4 million). Among cancers affecting both genders, anal precancer and cancer, and oropharyngeal cancer were the most costly (€11.2 million and €11.9 million, respectively). For oropharyngeal cancer, males had the highest health care utilization and represented 71% of the total annual cost. Penile precancer and cancer was least costly (€2.6 million). Conclusion The economic burden of HR HPV-related precancers and cancers is substantial. The disease-related management and treatment costs we report are relevant as a point of reference for future economic evaluations investigating the overall benefits of HPV vaccination in females and males in Sweden. PMID:28651012

Cost of illness for outpatients attending public and private hospitals in Bangladesh.

PubMed

Pavel, Md Sadik; Chakrabarty, Sayan; Gow, Jeff

2016-10-10

A central aim of Universal Health Coverage (UHC) is protection for all against the cost of illness. In a low income country like Bangladesh the cost burden of health care in tertiary facilities is likely to be significant for most citizens. This cost of an episode of illness is a relatively unexplored policy issue in Bangladesh. The objective of this study was to estimate an outpatient's total cost of illness as result of treatment in private and public hospitals in Sylhet, Bangladesh. The study used face to face interviews at three hospitals (one public and two private) to elicit cost data from presenting outpatients. Other socio-economic and demographic data was also collected. A sample of 252 outpatients were randomly selected and interviewed. The total cost of outpatients comprises direct medical costs, non-medical costs and the indirect costs of patients and caregivers. Indirect costs comprise travel and waiting times and income losses associated with treatment. The costs of illness are significant for many of Bangladesh citizens. The direct costs are relatively minor compared to the large indirect cost burden that illness places on households. These indirect costs are mainly the result of time off work and foregone wages. Private hospital patients have higher average direct costs than public hospital patients. However, average indirect costs are higher for public hospital patients than private hospital patients by a factor of almost two. Total costs of outpatients are higher in public hospitals compared to private hospitals regardless of patient's income, gender, age or illness. Overall, public hospital patients, who tend to be the poorest, bear a larger economic burden of illness and treatment than relatively wealthier private hospital patients. The large economic impacts of illness need a public policy response which at a minimum should include a national health insurance scheme as a matter of urgency.

[Direct cost of primary care of mild traumatic brain injury in adults by GRD in third level of care].

PubMed

Barragán-Hervella, Rodolfo; Montiel-Jarquín, Álvaro; Limón-Serrano, Iván; Escobedo-Sosa, Víctor; Loría-Castellanos, Jorge

To describe the direct cost of primary health care for patients with mild traumatic head injury in a third level medical facility. Cross-sectional study in 219 patients with mild traumatic brain injury (GRD 090 S06.0 ICD-10 including uncomplicated concussion without complication and increased comorbidity). A medical unit of tertiary care in the State of Puebla, Mexico. Direct costs were taken from ACDO.AS3.HCT.280115 / 7.P.DF Agreement and its annexes in Mexican pesos, the variables analyzed were age, gender, shift attention, laboratory, radiographic and tomographic studies, length of stay, specialist consultations, emergency care, medicines, and treatment materials. Descriptive statistics on SPSS program IBM v22. 53.4% male, 46.6% female; average age 31.9 years; morning shift attention 58.4%, evening 23.3%, and nightly 18.3%. The cost: $ 1,755 laboratory, plain radiographs $ 202,794, tomographic studies $ 26,720, consultation with neurosurgeon $ 279,174, emergency care $ 501,510; curing material: single steri drape $8,326.38, Micropore $1,307.43, infusion equipment $790.59, venipuncture needle $7,408.77; drugs: diclofenac $946.08, Ketorolac $724.89, 1000 ml. intravenous solution $1,561.47, total cost $ 1,032,293.72, average/patient: 4,713.66 Mexican pesos. The direct cost of primary health care of patients with mild traumatic head injury is high; sticking to the correct handling decreases the cost of attention.

Economic Costs Attributable to Smoking in China: Update and an 8-year Comparison, 2000–2008

PubMed Central

Yang, Lian; Sung, Hai-Yen; Mao, Zhengzhong; Hu, Teh-wei; Rao, Keqin

2013-01-01

Objective To estimate the health-related economic costs attributable to smoking in China for persons aged 35 and older in 2003 and in 2008 and to compare these costs with the respective results from 2000. Methods A prevalence-based, disease-specific approach was used to estimate smoking-attributable direct and indirect economic costs. The primary data source was the 2003 and 2008 China National Health Services Survey, which contains individual participant’s smoking status, healthcare utilization, and expenditures. Results The total economic cost of smoking in China amounted to $17.1 billion in 2003 and $28.9 billion in 2008 (both measured in 2008 constant US dollars). Direct smoking-attributable healthcare costs in 2003 and 2008 were $4.2 billion and $6.2 billion, respectively. Indirect economic costs in 2003 and 2008 were $12.9 billion and $22.7 billion, respectively. Compared to 2000, the direct costs of smoking rose by 72% in 2003 and 154% in 2008, while the indirect costs of smoking rose by 170% in 2003 and 376% in 2008. Conclusion The economic burden of cigarette smoking has increased substantially in China during the past decade and is expected to continue to increase as the national economy and the price of healthcare services grow. Stronger intervention measures against smoking should be taken without delay to reduce the health and financial losses caused by smoking. PMID:21339491

Posthospital Discharge Medical Care Costs and Family Burden Associated with Osteoporotic Fracture Patients in China from 2011 to 2013

PubMed Central

Burge, Russel; Yang, Yicheng; Du, Fen; Lu, Tie; Huang, Qiang; Ye, Wenyu; Xu, Weihua

2015-01-01

Objectives. This study collected and evaluated data on the costs of outpatient medical care and family burden associated with osteoporosis-related fracture rehabilitation following hospital discharge in China. Materials and Methods. Data were collected using a patient questionnaire from osteoporosis-related fracture patients (N = 123) who aged 50 years and older who were discharged between January 2011 and January 2013 from 3 large hospitals in China. The survey captured posthospital discharge direct medical costs, indirect medical costs, lost work time for caregivers, and patient ambulatory status. Results. Hip fracture was the most frequent fracture site (62.6%), followed by vertebral fracture (34.2%). The mean direct medical care costs per patient totaled 3,910¥, while mean indirect medical costs totaled 743¥. Lost work time for unpaid family caregivers was 16.4 days, resulting in an average lost income of 3,233¥. The average posthospital direct medical cost, indirect medical cost, and caregiver lost income associated with a fracture patient totaled 7,886¥. Patients' ambulatory status was negatively impacted following fracture. Conclusions. Significant time and cost of care are placed on patients and caregivers during rehabilitation after discharge for osteoporotic fracture. It is important to evaluate the role and responsibility for creating the growing and inequitable burden placed on patients and caregivers following osteoporotic fracture. PMID:26221563

Economic Impact of Atopic Dermatitis in Korean Patients

PubMed Central

Kim, Chulmin; Park, Kui Young; Ahn, Seohee; Kim, Dong Ha; Li, Kapsok; Kim, Do Won; Kim, Moon-Beom; Jo, Sun-Jin; Yim, Hyeon Woo

2015-01-01

Background Atopic dermatitis is a global public health concern owing to its increasing prevalence and socioeconomic burden. However, few studies have assessed the economic impact of atopic dermatitis in Korea. Objective We conducted a cost analysis of atopic dermatitis and evaluated its economic impacts on individual annual disease burden, quality of life, and changes in medical expenses with respect to changes in health related-quality of life. Methods The cost analysis of atopic dermatitis was performed by reviewing the home accounting records of 32 patients. The economic impact of the disease was evaluated by analyzing questionnaires. To handle uncertainties, we compared the results with the data released by the Health Insurance Review & Assessment Board on medical costs claimed by healthcare facilities. Results The direct cost of atopic dermatitis per patient during the 3-month study period was 541,280 Korean won (KRW), and expenditures on other atopic dermatitis-related products were 120,313 KRW. The extrapolated annual direct cost (including expenditures on other atopic dermatitis-related products) per patient was 2,646,372 KRW. The estimated annual indirect cost was 1,507,068 KRW. Thus, the annual cost of illness of atopic dermatitis (i.e., direct+indirect costs) was estimated to be 4,153,440 KRW. Conclusion The annual total social cost of atopic dermatitis on a national level is estimated to be 5.8 trillion KRW. PMID:26082587

A comparison of the direct medical costs for individuals with or without basal or squamous cell skin cancer: A study from Australia.

PubMed

Rowell, David; Gordon, Louisa G; Olsen, Catherine M; Whiteman, David C

2016-01-01

The composition of the medical costs incurred by people treated for basal cell and squamous cell carcinomas (hereafter keratinocyte cancers) is not adequately understood. We sought to compare the medical costs of individuals with or without keratinocyte cancers. We used national health insurance data to analyze the direct medical costs of 2000 cases and 2000 controls nested within the QSkin prospective cohort study (n = 43,794) conducted in Australia. We reconstructed the medical history of patients using medical and pharmaceutical item codes and then compared the health service costs of individuals treated for keratinocyte cancers with those not treated for keratinocyte cancers. Individuals treated for keratinocyte cancers consumed on average AUD$1320 per annum more in medical services than those without keratinocyte cancers. Only 23.2% of costs were attributed to the explicit treatment of keratinocyte cancers. The principal drivers of the residual costs were medical attendances, surgical procedures on the skin, and histopathology services. We found significant positive associations between history of treatment for keratinocyte cancers with treatments for other health conditions, including melanoma, cardiovascular disease, lipidemia, osteoporosis, rheumatoid arthritis, colorectal cancer, prostate cancer, and tuberculosis. Individuals treated for keratinocyte cancers have substantially higher medical costs overall than individuals without keratinocyte cancers. The direct costs of skin cancer excision account for only one-fifth of this difference.

Parkinson Symptoms and Health Related Quality of Life as Predictors of Costs: A Longitudinal Observational Study with Linear Mixed Model Analysis

PubMed Central

Martinez-Martín, Pablo; Rodriguez-Blazquez, Carmen; Paz, Silvia; Forjaz, Maria João; Frades-Payo, Belén; Cubo, Esther; de Pedro-Cuesta, Jesús; Lizán, Luis

2015-01-01

Objective To estimate the magnitude in which Parkinson’s disease (PD) symptoms and health- related quality of life (HRQoL) determined PD costs over a 4-year period. Materials and Methods Data collected during 3-month, each year, for 4 years, from the ELEP study, included sociodemographic, clinical and use of resources information. Costs were calculated yearly, as mean 3-month costs/patient and updated to Spanish €, 2012. Mixed linear models were performed to analyze total, direct and indirect costs based on symptoms and HRQoL. Results One-hundred and seventy four patients were included. Mean (SD) age: 63 (11) years, mean (SD) disease duration: 8 (6) years. Ninety-three percent were HY I, II or III (mild or moderate disease). Forty-nine percent remained in the same stage during the study period. Clinical evaluation and HRQoL scales showed relatively slight changes over time, demonstrating a stable group overall. Mean (SD) PD total costs augmented 92.5%, from €2,082.17 (€2,889.86) in year 1 to €4,008.6 (€7,757.35) in year 4. Total, direct and indirect cost incremented 45.96%, 35.63%, and 69.69% for mild disease, respectively, whereas increased 166.52% for total, 55.68% for direct and 347.85% for indirect cost in patients with moderate PD. For severe patients, cost remained almost the same throughout the study. For each additional point in the SCOPA-Motor scale total costs increased €75.72 (p = 0.0174); for each additional point on SCOPA-Motor and the SCOPA-COG, direct costs incremented €49.21 (p = 0.0094) and €44.81 (p = 0.0404), respectively; and for each extra point on the pain scale, indirect costs increased €16.31 (p = 0.0228). Conclusions PD is an expensive disease in Spain. Disease progression and severity as well as motor and cognitive dysfunctions are major drivers of costs increments. Therapeutic measures aimed at controlling progression and symptoms could help contain disease expenses. PMID:26698860

Parkinson Symptoms and Health Related Quality of Life as Predictors of Costs: A Longitudinal Observational Study with Linear Mixed Model Analysis.

PubMed

Martinez-Martín, Pablo; Rodriguez-Blazquez, Carmen; Paz, Silvia; Forjaz, Maria João; Frades-Payo, Belén; Cubo, Esther; de Pedro-Cuesta, Jesús; Lizán, Luis

2015-01-01

To estimate the magnitude in which Parkinson's disease (PD) symptoms and health- related quality of life (HRQoL) determined PD costs over a 4-year period. Data collected during 3-month, each year, for 4 years, from the ELEP study, included sociodemographic, clinical and use of resources information. Costs were calculated yearly, as mean 3-month costs/patient and updated to Spanish €, 2012. Mixed linear models were performed to analyze total, direct and indirect costs based on symptoms and HRQoL. One-hundred and seventy four patients were included. Mean (SD) age: 63 (11) years, mean (SD) disease duration: 8 (6) years. Ninety-three percent were HY I, II or III (mild or moderate disease). Forty-nine percent remained in the same stage during the study period. Clinical evaluation and HRQoL scales showed relatively slight changes over time, demonstrating a stable group overall. Mean (SD) PD total costs augmented 92.5%, from € 2,082.17 (€ 2,889.86) in year 1 to € 4,008.6 (€ 7,757.35) in year 4. Total, direct and indirect cost incremented 45.96%, 35.63%, and 69.69% for mild disease, respectively, whereas increased 166.52% for total, 55.68% for direct and 347.85% for indirect cost in patients with moderate PD. For severe patients, cost remained almost the same throughout the study. For each additional point in the SCOPA-Motor scale total costs increased € 75.72 (p = 0.0174); for each additional point on SCOPA-Motor and the SCOPA-COG, direct costs incremented € 49.21 (p = 0.0094) and € 44.81 (p = 0.0404), respectively; and for each extra point on the pain scale, indirect costs increased € 16.31 (p = 0.0228). PD is an expensive disease in Spain. Disease progression and severity as well as motor and cognitive dysfunctions are major drivers of costs increments. Therapeutic measures aimed at controlling progression and symptoms could help contain disease expenses.

Cost Allocation Plans for Municipalities for Internal Management and Grant Programs.

DTIC Science & Technology

1981-03-01

21 3. Indirect Cost --------------------------------- 23 4. S ummary--------------------------------------- 25 D. RESPONSIBILITY ACCOUNTING ...depart- ments or operating units. Z-7:6747 In Cost Accounting - A Managerial Emphasis by Charles T. Horngren the word direct refers to the practicable...INDIRECT COST POOL -- COST ALLOCATION BASE -- COST FINDING In Cost Accounting : A Managerial Emphasis, Charles T. Horngren states: There are

How much is the cost of multiple sclerosis--systematic literature review.

PubMed

Kolasa, Katarzyna

2013-01-01

In Poland, a data on MS costs is lacking. The systematic review of cost of illness studies was conducted to estimate the average annual cost of MS patient and its breakdown. The PubMed database was searched for relevant literature. Following search criteria were used: "multiple sclerosis", "costs", "cost of illness" and "disease burden". Articles written in English including total costs published 2002-2012 were included. In total 17 studies were classified. The costs were re-calculated into USD Purchasing Power Parity (PPP). The available approach from the literature was used for the cost breakdown presentation. The average patient was 47 years old with EDSS equals 4 and 13 years from the date of diagnosis. The average annual cost was 41 133 US$ PPP. The direct costs did not exceed 70% of total costs in any study. The pharmaceutical expenses were one of the most important contributors to the direct costs. Only 40% of patients were active on the labor market what translated into the loss of productivity and consequently an increase in total costs. The preformed systematic review revealed that multiple sclerosis imposes a huge economic burden on the healthcare system and society. It happens due to productivity loss and caregiver burden.

Age- and gender-specific epidemiology, treatment patterns, and economic burden of osteoporosis and associated fracture in Taiwan between 2009 and 2013.

PubMed

Wang, Chen-Yu; Fu, Shau-Huai; Yang, Rong-Sen; Shen, Li-Jiuan; Wu, Fe-Lin Lin; Hsiao, Fei-Yuan

2017-10-25

This nationwide study investigated the epidemiology, treatment patterns, and economic burden of osteoporosis and associated fracture in Taiwan. The treatment of osteoporosis is alarmingly suboptimal, considering the significantly increased economic burden of major osteoporotic fracture. Osteoporosis men received lesser anti-osteoporosis drugs but had higher incremental costs attributable to osteoporotic fractures. This nationwide study investigated the epidemiology, treatment patterns, and economic burden of osteoporosis and associated fracture between 2009 and 2013 in Taiwan. We used the National Health Insurance Research Database as our data source. The prevalence of diagnosed osteoporosis and major osteoporotic fractures was calculated annually from 2009 to 2013, stratified by age and gender. Osteoporosis patients who received any prescription of anti-osteoporosis drugs during each fiscal year were defined as osteoporosis patients under treatment. Healthcare utilization and associated direct medical costs were used to quantify the economic burden of osteoporosis. For patients who encountered major osteoporotic fracture, the incremental changes of direct medical costs attributable to fracture using a pre- and post-quasi-experimental design were estimated. Furthermore, we compared the annual direct medical costs of patients who encountered major osteoporotic fracture with those diagnosed osteoporosis only and with the general population. The prevalence of diagnosed osteoporosis increased with age, with the highest rate among those aged 80 and older. Overall, less than one-third of women and only 10% of men received anti-osteoporosis drugs among osteoporosis patients. The annual direct medical costs for osteoporosis patients increased steadily from 2009 to 2013. The total medical costs and incremental change of direct medical costs were higher in men than those in women. We found the treatment of osteoporosis to be alarmingly suboptimal, considering the significantly increased economic burden of major osteoporotic fracture also identified in this study. Osteoporosis men received lesser anti-osteoporosis drugs but had higher incremental costs attributable to major osteoporotic fractures.

The Impact of Patient Profiles and Procedures on Hospitalization Costs through Length of Stay in Community-Acquired Pneumonia Patients Based on a Japanese Administrative Database

PubMed Central

Uematsu, Hironori; Kunisawa, Susumu; Yamashita, Kazuto; Imanaka, Yuichi

2015-01-01

Background Community-acquired pneumonia is a common cause of patient hospitalization, and its burden on health care systems is increasing in aging societies. In this study, we aimed to investigate the factors that affect hospitalization costs in community-acquired pneumonia patients while considering the intermediate influence of patient length of stay. Methods Using a multi-institutional administrative claims database, we analyzed 30,041 patients hospitalized for community-acquired pneumonia who had been discharged between April 1, 2012 and September 30, 2013 from 289 acute care hospitals in Japan. Possible factors associated with hospitalization costs were investigated using structural equation modeling with length of stay as an intermediate variable. We calculated the direct, indirect (through length of stay), and total effects of the candidate factors on hospitalization costs in the model. Lastly, we calculated the ratio of indirect effects to direct effects for each factor. Results The structural equation model showed that higher disease severities (using A-DROP, Barthel Index, and Charlson Comorbidity Index scores), use of mechanical ventilation, and tube feeding were associated with higher hospitalization costs, regardless of the intermediate influence of length of stay. The severity factors were also associated with longer length of stay durations. The ratio of indirect effects to direct effects on total hospitalization costs showed that the former was greater than the latter in the factors, except in the use of mechanical ventilation. Conclusions Our structural equation modeling analysis indicated that patient profiles and procedures impacted on hospitalization costs both directly and indirectly. Furthermore, the profiles were generally shown to have greater indirect effects (through length of stay) on hospitalization costs than direct effects. These findings may be useful in supporting the more appropriate distribution of health care resources. PMID:25923785

13 CFR 107.50 - Definition of terms.

Code of Federal Regulations, 2011 CFR

2011-01-01

... satisfactory to SBA. Control means the possession, direct or indirect, of the power to direct or cause the... definition. Corporate Licensee. See definition of Licensee in this section. Cost of Money has the meaning set... accordance with Licensee's valuation policies, exceeds the cost basis thereof. Unrealized Depreciation means...

Direct benefits of choosing a high-fitness mate can offset the indirect costs associated with intralocus sexual conflict.

PubMed

Pischedda, Alison; Chippindale, Adam K

2017-06-01

Intralocus sexual conflict generates a cost to mate choice: high-fitness partners transmit genetic variation that confers lower fitness to offspring of the opposite sex. Our earlier work in the fruit fly, Drosophila melanogaster, revealed that these indirect genetic costs were sufficient to reverse potential "good genes" benefits of sexual selection. However, mate choice can also confer direct fitness benefits by inducing larger numbers of progeny. Here, we consider whether direct benefits through enhanced fertility could offset the costs associated with intralocus sexual conflict in D. melanogaster. Using hemiclonal analysis, we found that females mated to high-fitness males produced 11% more offspring compared to those mated to low-fitness males, and high-fitness females produced 34% more offspring than low-fitness females. These direct benefits more than offset the reduction in offspring fitness caused by intralocus sexual conflict, creating a net fitness benefit for each sex to pairing with a high-fitness partner. Our findings highlight the need to consider both direct and indirect effects when investigating the fitness impacts of mate choice. Direct fitness benefits may shelter sexually antagonistic alleles from selection, suggesting a novel mechanism for the maintenance of fitness variation. © 2017 The Author(s). Evolution © 2017 The Society for the Study of Evolution.

Cost Accounting: Production and Equipment Services.

ERIC Educational Resources Information Center

Schmid, William T.

Cost accounting for audiovisual productions should include direct costs, and, in some cases, the media administrator may have to calculate a per-hour surcharge for general operating overhead as well. Such procedures enable the administrator to determine cost effectiveness, to control cost overruns, and to generate more staff efficiency. Cost…

44 CFR 80.9 - Eligible and ineligible costs.

Code of Federal Regulations, 2011 CFR

2011-10-01

... ACQUISITION AND RELOCATION FOR OPEN SPACE Requirements Prior to Award § 80.9 Eligible and ineligible costs. (a... eligible entity, compensation for the land is not an allowable cost, but compensation for development... costs for activities directly related to the development of the project proposal. These costs can only...

Comparative cost analysis of outpatient and inpatient rehabilitation for musculoskeletal diseases in Germany.

PubMed

Zeidler, J; Mittendorf, T; Vahldiek, G; Zeidler, H; Merkesdal, S

2008-10-01

To examine the costs of inpatient and outpatient rehabilitation for musculoskeletal disorders from the perspective of a major statutory health insurance fund in Germany. A nation-wide database from a major health insurance fund in Germany was used to evaluate all rehabilitation cases in 2005. In addition, to all direct cost domains of the rehabilitation itself, costs incurred in the preceding and the following year for hospital treatment, drugs and physical therapy were analysed. A cost-cost analysis in different institutional settings was chosen for the cost comparison of inpatient and outpatient rehabilitation. To minimize the influence of possible confounders, a statistical control system was implemented. After a preceding hospital stay, inpatient and outpatient rehabilitation results in mean costs of euro2047 and euro1111, respectively. If the rehabilitation was not preceded by a directly related hospital treatment, mean costs for inpatient (outpatient) rehabilitation were euro2067 (euro1310). No systematic differences could be found between inpatient and outpatient rehabilitation evaluating costs for hospital treatment, drugs or physical therapy in the year preceding and the year directly following the rehabilitation. Assuming comparable medical outcomes, outpatient rehabilitation seems to be a superior alternative compared with inpatient rehabilitation from an economic perspective. Hence, from the perspective of the statutory health insurance, fostering a higher market share of outpatient rehabilitation may add to a better allocation of overall health care resources. For this, regional differences in rehabilitation infrastructure have to be taken into account.

Pattern of healthcare resource utilization and direct costs associated with manic episodes in Spain

PubMed Central

2010-01-01

Background Although some studies indicate that bipolar disorder causes high health care resources consumption, no study is available addressing a cost estimation of bipolar disorder in Spain. The aim of this observational study was to evaluate healthcare resource utilization and the associated direct cost in patients with manic episodes in the Spanish setting. Methods Retrospective descriptive study was carried out in a consecutive sample of patients with a DSM-IV diagnosis of bipolar type I disorder with or without psychotic symptoms, aged 18 years or older, and who were having an active manic episode at the time of inclusion. Information regarding the current manic episode was collected retrospectively from the medical record and patient interview. Results Seven hundred and eighty-four evaluable patients, recruited by 182 psychiatrists, were included in the study. The direct cost associated with healthcare resource utilization during the manic episode was high, with a mean cost of nearly €4,500 per patient, of which approximately 55% corresponded to the cost of hospitalization, 30% to the cost of psychopharmacological treatment and 10% to the cost of specialized care. Conclusions Our results show the high cost of management of the patient with a manic episode, which is mainly due to hospitalizations. In this regard, any intervention on the management of the manic patient that could reduce the need for hospitalization would have a significant impact on the costs of the disease. PMID:20426814

Ablative heat shield design for space shuttle

NASA Technical Reports Server (NTRS)

Seiferth, R. W.

1973-01-01

Ablator heat shield configuration optimization studies were conducted for the orbiter. Ablator and reusable surface insulation (RSI) trajectories for design studies were shaped to take advantage of the low conductance of ceramic RSI and high temperature capability of ablators. Comparative weights were established for the RSI system and for direct bond and mechanically attached ablator systems. Ablator system costs were determined for fabrication, installation and refurbishment. Cost penalties were assigned for payload weight penalties, if any. The direct bond ablator is lowest in weight and cost. A mechanically attached ablator using a magnesium subpanel is highly competitive for both weight and cost.

Tuberculosis care strategies and their economic consequences for patients: the missing link to end tuberculosis.

PubMed

Getahun, Belete; Wubie, Moges; Dejenu, Getiye; Manyazewal, Tsegahun

2016-11-01

While investment in the development of Tuberculosis (TB) treatment strategies is essential, it cannot be assumed that the strategies are affordable for TB patients living in countries with high economic constraints. This study aimed to determine the economic consequences of directly observed therapy for TB patients. A cross-sectional cost-of-illness analysis was conducted between September to November 2015 among 576 randomly selected adult TB patients who were on directly observed treatment in 27 public health facilities in Addis Ababa, Ethiopia. Data were collected using interviewer-administered questionnaire adapted from the Tool to Estimate Patients' Costs. Mean and median costs, reduction of productivity, and household expenditure of TB patients were calculated and ways of coping costs captured. Eta (η), Odds ratio and p values were used to measure association between variables. Of the total 576 TB patients enrolled, 43 % were smear-positive pulmonary TB (PTB), 17 % smear-negative PTB, 37 % Extra-PTB and 3 % multi-drug resistant TB cases. Direct (Out-of-Pocket) mean and median costs of TB illness to patients were $123.0 (SD = 58.8) and $125.78 (R = 338.12), respectively, and indirect (loss income) mean and median costs were $54.26 (SD = 43.5) and $44.61 (R = 215.6), respectively. Mean and median total cost of TB illness to patient were $177.3 (SD = 78.7) and $177.1 (R = 461.8), respectively. The total cost had significant association with patient's household income, residence, need for additional food, and primary income (P <0.05). Direct costs were catastrophic for 63 % of TB patients, regardless of significant difference between gender (P = 0.92) and type of TB cases (P = 0.37). TB patients mean productivity and income reduced by 37 and 10 %, respectively, compared with pre-treatment level, while mean household expenditure increased by 33 % and working hours reduced by 78 % due to TB illness. Income quartile categories were directly correlated with catastrophic costs (η = 0.684). Despite the availability of free-of-charge anti-TB drugs, TB patients were suffering from out-of-pocket payments with catastrophic consequences, which in turn were hampering the efforts to end TB. TB patients in resource-limited countries deserve integrated patient-centered care with comprehensive health insurance coverage, financial incentives, and nutrition support to reduce catastrophic costs and retain them in care. Such countries should induce home-based directly observed therapy programs to reduce costs due to attending health facilities, intensify home treatment of critically-ill patients with impaired mobility, and reduce the spread of TB due to patients traveling to seek care.

Establishing Common Cost Measures to Evaluate the Economic Value of Patient Navigation Programs

PubMed Central

Whitley, Elizabeth; Valverde, Patricia; Wells, Kristen; Williams, Loretta; Teschner, Taylor; Shih, Ya-Chen Tina

2011-01-01

Background Patient navigation is an intervention aimed at reducing barriers to healthcare for underserved populations as a means to reduce cancer health disparities. Despite the proliferation of patient navigation programs across the United States, information related to the economic impact and sustainability of these programs is lacking. Method Following a review of the relevant literature, the Health Services Research (HSR) cost workgroup of the American Cancer Society National Patient Navigator Leadership Summit met to examine cost data relevant to assessing the economic impact of patient navigation and to propose common cost metrics. Results Recognizing that resources available for data collection, management and analysis vary, five categories of core and optional cost measures were identified related to patient navigator programs, including, program costs, human capital costs, direct medical costs, direct non-medical costs and indirect costs. Conclusion(s) Information demonstrating economic as well as clinical value is necessary to make decisions about sustainability of patient navigation programs. Adoption of these common cost metrics are recommended to promote understanding of the economic impact of patient navigation and comparability across diverse patient navigation programs. PMID:21780096

48 CFR 9904.420-60 - Illustrations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... typing its overhead cost pool. In submitting a proposal, the engineering department assigns several... established accounting practice does not charge the cost of typing directly to final cost objectives, the...

The Annual Economic Burden of Syphilis: An Estimation of Direct, Productivity, and Intangible Costs for Syphilis in Guangdong Initiative for Comprehensive Control of Syphilis Sites.

PubMed

Zou, Yaming; Liao, Yu; Liu, Fengying; Chen, Lei; Shen, Hongcheng; Huang, Shujie; Zheng, Heping; Yang, Bin; Hao, Yuantao

2017-11-01

Syphilis has continuously posed a great challenge to China. However, very little data existed regarding the cost of syphilis. Taking Guangdong Initiative for Comprehensive Control of Syphilis area as the research site, we aimed to comprehensively measure the annual economic burden of syphilis from a societal perspective. Newly diagnosed and follow-up outpatient cases were investigated by questionnaire. Reported tertiary syphilis cases and medical institutions cost were both collected. The direct economic burden was measured by the bottom-up approach, the productivity cost by the human capital method, and the intangible burden by the contingency valuation method. Three hundred five valid early syphilis cases and 13 valid tertiary syphilis cases were collected in the investigation to estimate the personal average cost. The total economic burden of syphilis was US $729,096.85 in Guangdong Initiative for Comprehensive Control of Syphilis sites in the year of 2014, with medical institutions cost accounting for 73.23% of the total. Household average direct cost of early syphilis was US $23.74. Average hospitalization cost of tertiary syphilis was US $2,749.93. Of the cost to medical institutions, screening and testing comprised the largest proportion (26%), followed by intervention and case management (22%) and operational cost (21%). Household average productivity cost of early syphilis was US $61.19. Household intangible cost of syphilis was US $15,810.54. Syphilis caused a substantial economic burden on patients, their families, and society in Guangdong. Household productivity and intangible costs both shared positive relationships with local economic levels. Strengthening the prevention and effective treatment of early syphilis could greatly help to lower the economic burden of syphilis.

Trends in Costs of Thyroid Disease Treatment in Denmark during 1995-2015.

PubMed

Møllehave, Line Tang; Linneberg, Allan; Skaaby, Tea; Knudsen, Nils; Ehlers, Lars; Jørgensen, Torben; Thuesen, Betina Heinsbæk

2018-03-01

Iodine fortification (IF) may contribute to changes in costs of thyroid disease treatment through changes in disease patterns. From a health economic perspective, assessment of the development in costs of thyroid disease treatment in the population is pertinent. To assess the trends in annual medicine and hospital costs of thyroid disease treatment during 1995-2015 in Denmark, i.e., before and after the introduction of mandatory IF in 2000. Information on treatments for thyroid disease (antithyroid medication, thyroid hormone therapy, thyroid surgery, and radioiodine treatment) was obtained from nationwide registers. Costs were valued at 2015 prices using sales prices for medicines and the Danish Diagnosis-Related Group (DRG) and Danish Ambulatory Grouping System (DAGS) tariffs of surgeries/radioiodine treatments. Results were adjusted for changes in population size and age and sex distribution. The total direct medicine and hospital costs of thyroid disease treatment increased from EUR ∼190,000 per 100,000 persons in 1995 to EUR ∼270,000 per 100,000 persons in 2015. This was mainly due to linearly increased costs of thyroid hormone therapy and increased costs of thyroid surgery since 2008. Costs of antithyroid medication increased slightly and transiently after IF, while costs of radioiodine treatment remained constant. Costs of thyroid hormone therapy and thyroid surgery did not follow the development in the prevalence of hypothyroidism and structural thyroid diseases observed in concurrent studies. The costs of total direct medicine and hospital costs for thyroid disease treatment in Denmark increased from 1995 to 2015. This is possibly due to several factors, e.g., changes in treatment practices, and the direct effect of IF alone remains to be estimated.

Addressing cost barriers to medications: a survey of patients requesting financial assistance.

PubMed

Grande, David; Lowenstein, Margaret; Tardif, Madeleine; Cannuscio, Carolyn

2014-12-01

Given that many patients with chronic diseases face cost-related barriers to care, we evaluated patients' views on which providers (both physicians and nonphysicians) to involve and which methods to use to screen for those barriers. We also examined patients' preferences for how physicians consider cost-efficacy trade-offs in decisions. A national survey of 1400 randomly sampled adults with a chronic disease seeking financial assistance (842 respondents). Participants rated their comfort with various providers and tools for identifying cost barriers. Then they rated a randomly assigned clinical vignette that described how a clinical decision was made in the context of a cost-efficacy tradeoff. Vignettes depicted 3 decision types: cost-conscious physician, cost-indifferent physician, or patient-directed. Comfort was rated from 1 to 10-ratings above 7 indicated high comfort. More respondents reported high comfort with physicians screening for cost barriers (81.1%) than with pharmacists (74.8%; P=.002), nurses (69.4%; P<.001), professional counselors (68.3%; P<.001), and trained volunteers (50.5%; P<.001). Regarding screening for cost barriers using administrative records, more respondents reported higher comfort with doctors' offices (58.8%) than with insurance companies (53.3%; P=.03), but similar levels of comfort compared to pharmacies (62.1%; P=.17). Participants favored "patient-directed" decisions with physician input (odds ratio, 4.64; 95% CI, 3.14-6.84; P<.001) compared with "cost-conscious" decisions in which physicians unilaterally decided how to manage cost-efficacy tradeoffs. Patients were open to a range of cost-barrier screening approaches, but most favor direct conversations with their doctor and shared decision making in decisions involving cost-efficacy trade-offs.

Assessment of Viral Genotype Impact to the Cost-Effectiveness and Overall Costs of Care for Peg-Interferon-2α + Ribavirine Treated Chronic Hepatitis C Patients

PubMed Central

Jakovljevic, Mihajlo; Mijailovic, Zeljko; Popovska Jovicic, Biljana; Canovic, Predrag; Gajovic, Olgica; Jovanovic, Mirjana; Petrovic, Dejan; Milovanovic, Olivera; Djordjevic, Natasa

2013-01-01

Background Pegylated interferon alfa plus ribavirin protocol is currently considered the most efficient hepatitis C treatment. However, no evidence of costs comparison among common viral genotypes has been published. Objectives We aimed to assess core drivers of hepatitis C medical care costs and compare cost effectiveness of this treatment among patients infected by hepatitis C virus with genotypes 1 or 4 (group I), and 2 or 3 (group II). Patients and Materials Prospective bottom-up cost-effectiveness analysis from societal perspective was conducted at Infectious Diseases Clinic, University Clinic Kragujevac, Serbia, from 2007 to 2010. There were 81 participants with hepatitis C infection, treated with peg alpha-2a interferon plus ribavirin for 48 or 24 weeks. Economic data acquired were direct inpatient medical costs, outpatient drug acquisition costs, and indirect costs calculated through human capital approach. Results Total costs were significantly higher (P = 0.035) in group I (mean ± SD: 12,751.54 ± 5,588.06) compared to group II (mean ± SD: 10,580.57 ± 3,973.02). In addition, both direct (P = 0.039) and indirect (P < 0.001) costs separately were significantly higher in group I compared to group II. Separate comparison within direct costs revealed higher total cost of medical care (P = 0.024) in first compared to second genotype group, while the similar tendency was observed for total drug acquisition (P = 0.072). Conclusion HCV genotypes 1 and 4 cause more severe clinical course require more care and thus incur higher expenses compared to HCV 2 and 3 genotypes. Policy makers should consider willingness to pay threshold differentially depending upon HCV viral genotype detected. PMID:24032044

Estimate of the direct and indirect annual cost of bacterial conjunctivitis in the United States

PubMed Central

2009-01-01

Background The aim of this study was to estimate both the direct and indirect annual costs of treating bacterial conjunctivitis (BC) in the United States. This was a cost of illness study performed from a U.S. healthcare payer perspective. Methods A comprehensive review of the medical literature was supplemented by data on the annual incidence of BC which was obtained from an analysis of the National Ambulatory Medical Care Survey (NAMCS) database for the year 2005. Cost estimates for medical visits and laboratory or diagnostic tests were derived from published Medicare CPT fee codes. The cost of prescription drugs was obtained from standard reference sources. Indirect costs were calculated as those due to lost productivity. Due to the acute nature of BC, no cost discounting was performed. All costs are expressed in 2007 U.S. dollars. Results The number of BC cases in the U.S. for 2005 was estimated at approximately 4 million yielding an estimated annual incidence rate of 135 per 10,000. Base-case analysis estimated the total direct and indirect cost of treating patients with BC in the United States at $ 589 million. One- way sensitivity analysis, assuming either a 20% variation in the annual incidence of BC or treatment costs, generated a cost range of $ 469 million to $ 705 million. Two-way sensitivity analysis, assuming a 20% variation in both the annual incidence of BC and treatment costs occurring simultaneously, resulted in an estimated cost range of $ 377 million to $ 857 million. Conclusion The economic burden posed by BC is significant. The findings may prove useful to decision makers regarding the allocation of healthcare resources necessary to address the economic burden of BC in the United States. PMID:19939250

The Chikungunya Epidemic on La Réunion Island in 2005–2006: A Cost-of-Illness Study

PubMed Central

Soumahoro, Man-Koumba; Boelle, Pierre-Yves; Gaüzere, Bernard-Alex; Atsou, Kokuvi; Pelat, Camille; Lambert, Bruno; La Ruche, Guy; Gastellu-Etchegorry, Marc; Renault, Philippe; Sarazin, Marianne; Yazdanpanah, Yazdan; Flahault, Antoine; Malvy, Denis; Hanslik, Thomas

2011-01-01

Background This study was conducted to assess the impact of chikungunya on health costs during the epidemic that occurred on La Réunion in 2005–2006. Methodology/Principal Findings From data collected from health agencies, the additional costs incurred by chikungunya in terms of consultations, drug consumption and absence from work were determined by a comparison with the expected costs outside the epidemic period. The cost of hospitalization was estimated from data provided by the national hospitalization database for short-term care by considering all hospital stays in which the ICD-10 code A92.0 appeared. A cost-of-illness study was conducted from the perspective of the third-party payer. Direct medical costs per outpatient and inpatient case were evaluated. The costs were estimated in Euros at 2006 values. Additional reimbursements for consultations with general practitioners and drugs were estimated as €12.4 million (range: €7.7 million–€17.1 million) and €5 million (€1.9 million–€8.1 million), respectively, while the cost of hospitalization for chikungunya was estimated to be €8.5 million (€5.8 million–€8.7 million). Productivity costs were estimated as €17.4 million (€6 million–€28.9 million). The medical cost of the chikungunya epidemic was estimated as €43.9 million, 60% due to direct medical costs and 40% to indirect costs (€26.5 million and €17.4 million, respectively). The direct medical cost was assessed as €90 for each outpatient and €2,000 for each inpatient. Conclusions/Significance The medical management of chikungunya during the epidemic on La Réunion Island was associated with an important economic burden. The estimated cost of the reported disease can be used to evaluate the cost/efficacy and cost/benefit ratios for prevention and control programmes of emerging arboviruses. PMID:21695162

Influenza-related healthcare visits, hospital admissions, and direct medical costs for all children aged 2 to 17 years in a defined Swedish region, monitored for 7 years.

PubMed

Rahmqvist, Mikael; Gjessing, Kristian; Faresjö, Tomas

2016-08-01

The seasonal variation of influenza and influenza-like illness (ILI) is well known. However, studies assessing the factual direct costs of ILI for an entire population are rare. In this register study, we analyzed the seasonal variation of ILI-related healthcare visits and hospital admissions for children aged 2 to 17 years, and the resultant parental absence from work, for the period 2005 to 2012. The study population comprised an open cohort of about 78,000 children per year from a defined region. ILI was defined as ICD-10 codes: J00-J06; J09-J15, J20; H65-H67. Overall, the odds of visiting a primary care center for an ILI was 1.64-times higher during the peak influenza season, compared to the preinfluenza season. The corresponding OR among children aged 2 to 4 years was 1.96. On average, an estimated 20% of all healthcare visits for children aged 2 to 17 years, and 10% of the total healthcare costs, were attributable to seasonal ILI. In primary care, the costs per week and 10,000 person years for ILI varied - by season - from &OV0556;3500 to &OV0556;7400. The total ILI cost per year, including all physical healthcare forms, was &OV0556;400,400 per 10,000 children aged 2 to 17 years. The costs for prescribed and purchased drugs related to ILI symptoms constituted 52% of all medicine costs, and added 5.8% to the direct healthcare costs.The use of temporary parental employment benefits for caring of ill child followed the seasonal pattern of ILI (r = 0.91, P < 0.001). Parental absence from work was estimated to generate indirect costs, through loss of productivity of 5.2 to 6.2 times the direct costs. Direct healthcare costs increased significantly during the influenza season for children aged 2 to 17 years, both in primary and hospital outpatient care, but not in hospital inpatient care. Primary care manages the majority of visits for influenza and ILI. Children 2 to 4 years have a larger portion of their total healthcare encounters related to ILI compared with older children. There is a clear correlation between ILI visits across the years and parental absence from work.

The Effect of Activity-Based Costing on Logistics Management

DTIC Science & Technology

1993-01-01

Row, 1980. 49. Drury , Colin , "Activity-Based Costing ," Management Accounting CIMA, Vol. 67, No. 8 (September 1989), pp. 60-66. 50. Dugdale, David...99 Cost Accounting Applications Within Logistics ..................................... 116 Activity-Based Costing Applications Within the...Comparison of Direct Product Profitability (DPP) and Activity-Based Costing (ABC) ....... 91 5. Comparison of Traditional Cost Accounting with Activity

Military Personnel Procurement Resources Report

DTIC Science & Technology

1991-05-28

directed at enlistment in the Military Service. Include cost of advertising agency contract spent on marketing research (to include cost of advertising...programs. Include cost of advertising agency contract spent on marketing research (to include cost of advertising agency subcontractors). 7. Printed...Include cost of advertising agency contract spent on marketing research (to include cost of advertising agency sub- contractors). 7. Printed

Educating Foreign Students in the U.S.A.: A Cost Benefit Analysis.

ERIC Educational Resources Information Center

Mehrabi, Shah M.

The economic costs and benefits of educating foreign students in U.S. public and private colleges are estimated. U.S. costs of educating foreign students consist primarily of: (1) direct educational costs, (2) cost of the foreign students who receive their maintenance allowance from U.S. sources, (3) travel costs of those foreign students whose…

Information System for Societal Cost and Benefit Analysis of Vocational and Manpower Programs. Final Report.

ERIC Educational Resources Information Center

Arora, Mehar

The study was directed toward developing a manual for establishing societal benefits and costs of vocational and manpower programs in Wisconsin. After first outlining the background of benefit-cost analysis, problems in establishing cost functions in education are presented along with some important cost concepts and uses of cost information in…

Reduction in Costs after Treating Comorbid Panic Disorder with Agoraphobia and Generalized Anxiety Disorder.

PubMed

Ikic, Vedrana; Belanger, Claude; Bouchard, Stephane; Gosselin, Patrick; Langlois, Frederic; Labrecque, Joane; Dugas, Michel J; Marchand, Andre

2017-03-01

Panic disorder with agoraphobia (PDA) and generalized anxiety disorder (GAD) are impairing and costly disorders that are often misdiagnosed and left untreated despite multiple consultations. These disorders frequently co-occur, but little is known about the costs associated with their comorbidity and the impact of cognitive-behavioral therapy (CBT) on cost reduction. The first objective of this study was to assess the mental health-related costs associated with the specific concomitance of PDA and GAD. The second aim was to determine whether there is a reduction in direct and indirect mental health-related costs following conventional CBT for the primary disorder only (PDA or GAD) or combined CBT adapted to the comorbidity (PDA and GAD). A total of 123 participants with a double diagnosis of PDA and GAD participated in this study. Direct and indirect mental health-related costs were assessed and calculated from a societal perspective at the pre-test, the post-test, and the three-month, six-month and one-year follow-ups. At the pre-test, PDA-GAD comorbidity was found to generate a mean total cost of CADUSD 2,000.48 (SD = USD 2,069.62) per participant over a three-month period. The indirect costs were much higher than the direct costs. Both treatment modalities led to significant and similar decreases in all cost categories from the pre-test to the post-test. This reduction was maintained until the one-year follow-up. Methodological choices may have underestimated cost evaluations. Nonetheless, this study supports the cost offset effects of both conventional CBT for primary PDA or GAD and combined CBT for PDA-GAD comorbidity. Treatment of comorbid and costly disorders with evidence-based treatments such as CBT may lead to considerable economic benefits for society. Considering the limited resources of healthcare systems, it is important to make choices that will lead to better accessibility of quality services. The application of CBT for PDA, GAD or both disorders and training mental health professionals in this therapeutic approach should be encouraged. Additionally, it would be favorable for insurance plans to reimburse employees for expenses associated with psychological treatment for anxiety disorders. In addition to symptom reduction, it would be of great pertinence to explore which factors can contribute to reducing direct and indirect mental health-related costs.

48 CFR 552.243-71 - Equitable Adjustments.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) Markups. (3) Change to the time for completion specified in the contract. (e) Direct costs. The Contractor... contract regarding the Contractor's project schedule. (h) Markups. For each firm whose direct costs are... applicable, a bond rate and insurance rate. Markups shall be determined and applied as follows: (1) Overhead...

5 CFR 294.109 - Fees.

Code of Federal Regulations, 2013 CFR

2013-01-01

... direct costs associated with any response it has prepared. (5) If fees for document search are authorized... searching for documents and other direct costs of a search, even if a search fails to locate records or if records located are determined to be exempt from disclosure. Searches should be conducted in the most...

5 CFR 294.109 - Fees.

Code of Federal Regulations, 2011 CFR

2011-01-01

... direct costs associated with any response it has prepared. (5) If fees for document search are authorized... searching for documents and other direct costs of a search, even if a search fails to locate records or if records located are determined to be exempt from disclosure. Searches should be conducted in the most...

5 CFR 294.109 - Fees.

Code of Federal Regulations, 2012 CFR

2012-01-01

... direct costs associated with any response it has prepared. (5) If fees for document search are authorized... searching for documents and other direct costs of a search, even if a search fails to locate records or if records located are determined to be exempt from disclosure. Searches should be conducted in the most...

5 CFR 294.109 - Fees.

Code of Federal Regulations, 2014 CFR

2014-01-01

... direct costs associated with any response it has prepared. (5) If fees for document search are authorized... searching for documents and other direct costs of a search, even if a search fails to locate records or if records located are determined to be exempt from disclosure. Searches should be conducted in the most...

Report on the Audit of Foreign Direct Selling Costs

DTIC Science & Technology

1990-09-18

This is our final report on the Audit of Foreign Direct Selling Costs. The Contract Management Directorate made the audit from October 1989 to...The objective of the audit was to assess whether DoD regulations provided the appropriate incentives to stimulate exports by the. U.S. Defense

7 CFR 3560.303 - Housing project budgets.

Code of Federal Regulations, 2010 CFR

2010-01-01

... personnel costs of permanent and part-time staff assigned directly to the project site. This includes... incentive or annual bonuses; (I) Direct costs of travel to off-site locations by on-site staff for property... computers are also included (if approved by the Agency). (J) Real estate taxes (personal tangible property...

47 CFR 52.33 - Recovery of carrier-specific costs directly related to providing long-term number portability.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Recovery of carrier-specific costs directly related to providing long-term number portability. (a... related to providing long-term number portability. 52.33 Section 52.33 Telecommunication FEDERAL... long-term number portability by establishing in tariffs filed with the Federal Communications...

47 CFR 52.33 - Recovery of carrier-specific costs directly related to providing long-term number portability.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Recovery of carrier-specific costs directly related to providing long-term number portability. (a... related to providing long-term number portability. 52.33 Section 52.33 Telecommunication FEDERAL... long-term number portability by establishing in tariffs filed with the Federal Communications...

47 CFR 52.33 - Recovery of carrier-specific costs directly related to providing long-term number portability.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Recovery of carrier-specific costs directly related to providing long-term number portability. (a... related to providing long-term number portability. 52.33 Section 52.33 Telecommunication FEDERAL... long-term number portability by establishing in tariffs filed with the Federal Communications...

47 CFR 52.33 - Recovery of carrier-specific costs directly related to providing long-term number portability.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Recovery of carrier-specific costs directly related to providing long-term number portability. (a... related to providing long-term number portability. 52.33 Section 52.33 Telecommunication FEDERAL... long-term number portability by establishing in tariffs filed with the Federal Communications...

30 CFR 1220.011 - Schedule of allowable direct and allocable joint costs and credits.

Code of Federal Regulations, 2014 CFR

2014-07-01

... engineering design problems related to equipment or facilities required for NPSL operations. (4) The cost of any contract service related to research and development is specifically excluded, as are contract services calling for feasibility studies not directly related to specific engineering design problems or...

19 CFR 10.877 - Direct costs of processing operations.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 19 Customs Duties 1 2014-04-01 2014-04-01 false Direct costs of processing operations. 10.877 Section 10.877 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF THE TREASURY ARTICLES CONDITIONALLY FREE, SUBJECT TO A REDUCED RATE, ETC. United States-Oman...

19 CFR 10.877 - Direct costs of processing operations.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 19 Customs Duties 1 2012-04-01 2012-04-01 false Direct costs of processing operations. 10.877 Section 10.877 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF THE TREASURY ARTICLES CONDITIONALLY FREE, SUBJECT TO A REDUCED RATE, ETC. United States-Oman...