A two-part model to estimate inpatient, outpatient, prescribing and care home costs associated with atrial fibrillation in Scotland

Objective:This study aimed to estimate global inpatient, outpatient, prescribing and care home costs for patients with atrial fibrillation using population-based, individual-level linked data. Design:A two-part model was employed to estimate the probability of resource utilisation and costs conditional on positive utilisation using individual-level linked data. Settings:Scotland, 5 years following first hospitalisation for AF between 1997 and 2015. Participants: Patients hospitalised with a known diagnosis of AF or atrial flutter. Primary and secondary outcome measures: Inpatient, outpatient, prescribing and care home costs. Results: The mean annual cost for a patient with AF was estimated at £3785 (95% CI £3767 to £3804). Inpatient admissions and outpatient visits accounted for 79% and 8% of total costs, respectively; prescriptions and care home stay accounted for 7% and 6% of total costs. Inpatient cost was the main driver across all age groups. While inpatient cost contributions (~80%) were constant between 0 and 84 years, they decreased for patients over 85 years. This is offset by increasing care home cost contributions. Mean annual costs associated with AF increased significantly with increasing number of comorbidities. Conclusion: This study used a contemporary and representative cohort, and a comprehensive approach to estimate global costs associated with AF, taking into account resource utilisation beyond hospital care. While overall costs, considerably affected by comorbidity, did not increase with increasing age, care home costs increased proportionally with age. Inpatient admission was the main contributor to the overall financial burden of AF, highlighting the need for improved mechanisms of early diagnosis to prevent hospitalisations

Understanding Pathways into Care-homes using Data (UnPiCD study): a two-part model to estimate inpatient and care-home costs using national linked health and social care data

Background: Pathways into care-homes have been under-researched. Individuals who move-in to a care-home from hospital are clinically distinct from those moving-in from the community. However, it remains unclear whether the source of care-home admission has any implications in term of costs. Our aim was to quantify hospital and care-home costs for individuals newly moving-in to care homes to compare those moving-in from hospital to those moving-in from the community. Methods: Using routinely-collected national social care and health data we constructed a cohort including people moving into care-homes from hospital and community settings between 01/04/2013-31/03/2015 based on records from the Scottish Care-Home Census (SCHC). Individual-level data were obtained from Scottish Morbidity Records (SMR01/04/50) and death records from National Records of Scotland (NRS). Unit costs were identified from NHS Scotland costs data and care-home costs from the SCHC. We used a two-part model to estimate costs conditional on having incurred positive costs. Additional analyses estimated differences in costs for the one-year period preceding and following care-home admission. Results: We included 14,877 individuals moving-in to a care-home, 8,472 (57%) from hospital, and 6,405 (43%) from the community. Individuals moving-in to care-homes from the community incurred higher costs at £27,117 (95% CI £ 26,641 to £ 27,594) than those moving-in from hospital with £24,426 (95% CI £ 24,037 to £ 24,814). Hospital costs incurred during the year preceding care-home admission were substantially higher (£8,323 (95% CI£8,168 to £8,477) compared to those incurred after moving-in to care-home (£1,670 (95% CI£1,591 to £1,750). Conclusion: Individuals moving-in from hospital and community have different needs, and this is reflected in the difference in costs incurred. The reduction in hospital costs in the year after moving-in to a care-home indicates the positive contribution of care-home residency in supporting those with complex needs. These data provide an important contribution to inform capacity planning on care provision for adults with complex needs and the costs of care provision

Microbiological characteristics of compost produced from dairy and wine by-products

Wine and dairy chains rapresent of the agri-foof leading sectors in Sicily. Composting residues from these two chains would contribute to increase the environmental sustainability of the production with additional advantages represented by the reduction the costs recover soil fertility. This work represents the first attempt to combine the green of the vine cultivation as well as wine and dairy by-products. Raw materials provided potential bioactivators identified as Bacillus subtilis, Bacillus velezensis and Kocuria rhizophila which showed cellulolytic activity. The strain were inocultated in the mass to be composted in order to accelerate the process. Four compost trials were performed: (i) absence of boactivators and mainteinace of umidity with deproteinized whey; (ii) presence of bioactivators and mainteinace of umidity with deproteinized whey; (iii) absence of boactivators and mainteinance of umidity with water; (iv) presence of bioactivators and mainteinace of umidity with water. The experiment lasted 105 days, during which environmental parameters, such as temperature and umidity were monitored. Growth dynamics of the principal functional groups of mesophilic and thermophilic microorganisms were followed. The composting process was monitored during the entire period through the detection of physical-chemical (pH, humidity, TOC, humic acid + fulvic acid, TN, Org-N, C/N, S, Cd, Cr, Hg, Ni, Pb, Cu, Zn) and microbiological parameters (Salmonella spp., Escherichia coli). The characteristics of all composts fulfilled the requirements of the Italian legislation for ther use to amendt soil. Furthemore, germination tests demonstrated the absence of phytotoxicity against Lepidium sativum L.

Evaluating the effect of inequalities in oral anti-coagulant prescribing on outcomes in people with atrial fibrillation

Background Whilst anti-coagulation is typically recommended for thromboprophylaxis in atrial fibrillation (AF), it is often never prescribed, or prematurely discontinued. The aim of this study was to evaluate the effect of inequalities in anti-coagulant prescribing by assessing stroke/systemic embolism (SSE) and bleeding risk in people with AF who continue anticoagulation compared with those who stop transiently, permanently, or never start. Methods This retrospective cohort study utilised linked Scottish healthcare data to identify adults diagnosed with AF between January 2010 and April 2016, with a CHA2DS2-VASC score of ≥2. They were sub-categorised based on anti-coagulant exposure: never started, continuous, discontinuous, and cessation. Inverse probability of treatment weighting-adjusted Cox regression and competing-risks regression were utilised to compare SSE and bleeding risks between cohorts during five year follow-up. Results Of an overall cohort of 47,427 people, 26,277 (55.41%) were never anti-coagulated, 7,934 (16.72%) received continuous anti-coagulation, 9,107 (19.2%) temporarily discontinued and 4,109 (8.66%) permanently discontinued. Lower socio-economic status, elevated frailty score, and age ≥75 were associated with a reduced likelihood of initiation and continuation of anti-coagulation. SSE risk was significantly greater in those with discontinuous anti-coagulation, compared to continuous (SHR: 2.65; 2.39-2.94). In the context of a major bleeding event, there was no significant difference in bleeding risk between the cessation and continuous cohorts (SHR 0.94; 0.42-2.14). Conclusion Our data suggest significant inequalities in anti-coagulation prescribing, with substantial opportunity to improve initiation and continuation. Decision-making should be patient-centered and must recognise that discontinuation or cessation is associated with considerable thromboembolic risk not offset by mitigated bleeding risk