Are Treatment Satisfaction, Quality of Life, and Self-assessed Disease Severity Relevant Parameters for Patient Registries? Experiences from Finnish and Swedish Patients with Psoriasis

Peer reviewe

Treatment Patterns, Treatment Satisfaction, Severity of Disease Problems, and Quality of Life in Patients with Psoriasis in Three Nordic Countries

Peer reviewe

The Diabetic Foot. Costs, health economic aspects, prevention and quality of life.

The overall aims were to investigate the economic consequences of foot complications in diabetic patients, to measure the influence of diabetic foot complications on health-related quality of life (HRQL), and to analyse the cost-effectiveness of interventions to prevent foot ulcers and lower extremity amputations (LEA). The economic consequences of foot ulcers and LEA are large both in a short and a longer perspective. Seventy-six percent of the total short term costs for LEA occurred after amputations had been performed and before complete healing had been achieved. The major long-term costs for the 3 years following healing were related to increased home care and social service, especially for patients who had undergone LEA. The most important determinants of the cost of an ulcer with deep foot infection were wound healing duration and repeated surgery. Costs of inpatient care and topical treatment represent a substantial part of the total costs for both primary healing and healing with minor or major amputation. The frequency of dressing changes and velocity of healing together with costs of material, staff and transportation are important factors for the total topical treatment costs. The Swedish Inpatient Registry is valid regarding completeness of registered discharges for patients who have been treated for foot ulcers, but the database is less valid with reference to reported diagnoses. Cost analyses of diabetic foot complications will be seriously underestimated when based exclusively on primary diagnosis from the database. Patients with current foot ulcers value their HRQL significantly lower than primary healed patients. HRQL is reduced in patients who have undergone major amputations. An intensified prevention strategy including patient education, foot care and footwear is cost-effective or cost saving if the risk for foot ulcers and lower extremity amputations could be reduced by 25%. The strategy would be cost-effective or cost saving in all patients with diabetes, except in those without specific risk factors for development of these complications

Health-economic consequences of diabetic foot lesions.

Abstract in UndeterminedDiabetic foot complications result in huge costs for both society and the individual patients. Few reports on the health-economic consequences of diabetic foot infections have been published. In studies considering a wide societal perspective, costs of antibiotics were relatively low, whereas total costs for topical treatment were high relative to the total costs of foot infections. Total direct costs for healing of infected ulcers not requiring amputation are similar to$17,500 (in 1998 US dollars), whereas the costs for lower-extremity amputations aresimilar to$30,000-$33,500 depending on the level of amputation. Prevention of foot ulcers and amputations by various methods, including patient education, proper footwear, and foot care, in patients at risk is cost effective or even cost saving. Awareness of the potential influence of reimbursement systems on prevention, management, and outcomes of diabetic foot lesions has increased. Despite methodological obstacles, modeling studies are needed in future health-economic evaluations to determine the cost effectiveness of various strategies

Annual costs of treatment for venous leg ulcers in Sweden and the United Kingdom

The aim of this study was to estimate costs of treating venous leg ulcers in Sweden and the United Kingdom during 1 year and to quantify costs in different health states, The costs of treating four different types of venous leg ulcers were estimated for 52 weeks by a stochastic health economic model, which simulated resource use data obtained from prospectively collected patient data, expert panels in the two countries, and published scientific. literature, The average cost of treating an ulcer varied between E 1332 and E2585 in Sweden and from E814 to E1994 in the United Kingdom. Cost of treating large ulcers (greater than or equal to10 cm(2)) of long duration (greater than or equal to6 months) was highest in both countries. Frequency of dressing changes and duration of time for each dressing change were higher in Sweden than in the United Kingdom, resulting in higher total cost per patient in Sweden. An important factor for the total costs was time to heal. Other important variables influencing treatment costs were frequency and duration of dressing changes, Actions to reduce time used for dressing changes and the total time to healing are thus very important in reducing costs spent on treatment of venous leg ulcers in both countries

Under what conditions is feedback microwave thermotherapy (ProstaLund Feedback Treatment) cost-effective in comparison with alpha-blockade in the treatment of benign prostatic hyperplasia and lower urinary tract symptoms?

Objective. Lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) are a common condition in men, and their incidence increases with age. The objective of this study was to evaluate the potential cost-utility of microwave thermotherapy, specifically the ProstaLund Feedback Treatment (PLFT), versus alpha-blockade in Swedish patients with LUTS due to BPH. Material and methods. A health-economic simulation model, based on long-term disease progression and costs, was developed to analyse the cost-utility of PLFT in comparison with alpha-blockade over a 3-year period based on data from published literature, treatment programmes and official price lists. Outcome measures used in the analysis were quality of life, survival and reduction in International Prostate Symptom Score. Sensitivity analyses were performed for a number of essential variables. The perspective of the study is the healthcare sector. All costs are expressed as 2003 prices. Results. Three years after an intervention with PLFT or initiation of drug treatment the cost-utility of PLFT was estimated at approximate to euro6600-9500 per quality-adjusted life-year gained. The cost-utility was further improved over a longer time period, and PLFT appears to be cost-saving after 5 years. One important finding from the model simulation was that PLFT also seems to be favourable in patients with less pronounced symptoms. This result may be further validated when additional results from controlled clinical trials become available. Conclusions. The present model simulation indicates that treatment with PLFT seems to be cost-effective compared with drug therapy with alpha-blockade. The result shows that the time-frame of the analysis has a great impact on the cost-effectiveness ratio

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

Background: 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. Methods: 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. Results: 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. Conclusion: 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