Costs of shoulder pain and resource use in primary health care: a cost-of-illness study in Sweden

<p>Abstract</p> <p>Background</p> <p>Painful shoulders pose a substantial socioeconomic burden. A prospective cost-of-illness study was performed to assess the costs associated with healthcare use and loss of productivity in patients with shoulder pain in primary health care in Sweden.</p> <p>Methods</p> <p>The study was performed in western Sweden, in a region with 24 000 inhabitants. Data were collected during six months from electronic patient records at three primary healthcare centres in two municipalities. All patients between 20 and 64 years of age who presented with shoulder pain to a general practitioner or a physiotherapist were included. Diagnostic codes were used for selection, and the cases were manually controlled. The cost for sick leave was calculated according to the human capital approach. Sensitivity analysis was used to explore uncertainty in various factors used in the model.</p> <p>Results</p> <p>204 (103 women) patients, mean age 48 (SD 11) years, were registered. Half of the cases were closed within six weeks, whereas 32 patients (16%) remained in the system for more than six months. A fifth of the patients were responsible for 91% of the total costs, and for 44% of the healthcare costs. The mean healthcare cost per patient was €326 (SD 389) during six months. Physiotherapy treatments accounted for 60%. The costs for sick leave contributed to 84% of the total costs. The mean annual total cost was €4139 per patient. Estimated costs for secondary care increased the total costs by one third.</p> <p>Conclusions</p> <p>The model applied in this study provides valuable information that can be used in cost evaluations. Costs for secondary care and particularly for sick leave have a major influence on total costs and interventions that can reduce long periods of sick leave are warranted.</p

Multilaboratory Comparison of Pneumococcal Multiplex Immunoassays Used in lmmunosurveillance of Streptococcus pneumoniae across Europe

Surveillance studies are required to estimate the impact of pneumococcal vaccination in both children and the elderly across Europe. The World Health Organization (WHO) recommends use of enzyme immunoassays (EIAs) as standard methods for immune surveillance of pneumococcal antibodies. However, as levels of antibodies to multiple serotypes are monitored in thousands of samples, a need for a less laborious and more flexible method has evolved. Fluorescent-bead-based multiplex immunoassays (MIAs) are suitable for this purpose. An increasing number of public health and diagnostic laboratories use MIAs, although the method is not standardized and no international quality assessment scheme exists. The EU Pneumo Multiplex Assay Consortium was initiated in 2013 to advance harmonization of MIAs and to create an international quality assessment scheme. In a multilaboratory comparison organized by the consortium, agreement among nine laboratories that used their own optimized MIA was assessed on a panel of 15 reference sera for 13 pneumococcal serotypes with the new WHO standard 007sp. Agreement was assessed in terms of assay accuracy, reproducibility, repeatability, precision, and bias. The results indicate that the evaluated MIAs are robust and reproducible for measurement of vaccine-induced antibody responses. However, some serotype-specific variability in the results was observed in comparisons of polysaccharides from different sources and of different conjugation methods, especially for serotype 4. On the basis of the results, the consortium has contributed to the harmonization of MIA protocols to improve reliability of immune surveillance of Streptococcus pneumoniae

Physiotherapy and shoulder pain; Coactive collaboration, supervised exercises in patients on a waiting list for surgery, and cost-of-illness in primary care.

Background: Shoulder pain is a common cause of disability and lost work days. Rotator cuff disease, impingement syndrome or subacromial pain are similar labels used to describe the most common shoulder diagnosis. Similar results after surgery and exercises supervised by physiotherapist are reported in three randomised controlled trials in hospital settings. The content of the supervised exercise programme has not been explored with qualitative scientific methods. The feasibility of the supervised exercise programme in a specialist primary care setting has not been studied. Cost evaluations of different aspects of shoulder treatment are scarce. Aims: The aim of the first study was to explore and define the communication and teaching techniques used by a physiotherapist in the initial part of the supervised exercise programme. The aim of study II was to evaluate the feasibility of this programme in surgical candidates in a local hospital, and the aim of study III was to evaluate the costs and resource allocation for shoulder treatment in primary health care in a small western Swedish county. Methods: Study I is a qualitative explorative study, using observations with video recordings and field notes. A transcription model was developed and qualitative content analysis was applied to analyse the data. Study II is a prospective cohort study including patients with the impingement syndrome referred for surgical evaluation. The patients had physiotherapy using the method of supervised exercises and this treatment approach was also used in study I. Evaluation was un-blinded using a validated clinical outcome measure (the UCLA score). Study III is a cost-of-illness study with a societal perspective. Evaluation of costs and resource use was based on diagnostic codes and electronic patient records. A spreadsheetbased economic model was constructed. The human capital approach was used to calculate costs for sick leave and a supplementary sensitivity analysis estimated uncertainty due to changes in different parameters. Results: The results of study I were presented in three content areas: context, interaction, and professional skills used in a process of motor learning. The term coactive collaboration was defined to describe the process. It was defined as the mutual effort made by physiotherapist and patient to reduce symptoms. This was accomplished in interaction, using verbal and nonverbal communication, including physical contact. In study II, 72 of 97 patients referred for surgery had in average 11 supervised exercise treatments during 8 weeks. Results were classified as excellent or good by 87% of the 72 patients, and they declined surgery. In study III the mean annual total cost for patients with shoulder pain in primary health care was €4139 per patient. Sick leave contributed to 84% of total costs, while physiotherapy treatments accounted for 60% of the healthcare costs or about 10% of total costs. Conclusions: Study I emphasizes the interaction between physiotherapist and patient. This should be further explored in different settings and comparing different treatment approaches in future studies. With the limitation of the design applied in study II, most patients referred for surgery for the impingement syndrome declined surgery after an average of two months of supervised exercises. This may have consequences for sickness absence, health care costs, and for total costs of shoulder pain. In study III physiotherapy accounted for a major part of healthcare costs, but only a minor part of total costs for shoulder pain in primary care

Costs of shoulder pain and resource use in primary health care: a cost-of-illness study in Sweden

Background: Painful shoulders pose a substantial socioeconomic burden. A prospective cost-of-illness study was performed to assess the costs associated with healthcare use and loss of productivity in patients with shoulder pain in primary health care in Sweden. Methods: The study was performed in western Sweden, in a region with 24 000 inhabitants. Data were collected during six months from electronic patient records at three primary healthcare centres in two municipalities. All patients between 20 and 64 years of age who presented with shoulder pain to a general practitioner or a physiotherapist were included. Diagnostic codes were used for selection, and the cases were manually controlled. The cost for sick leave was calculated according to the human capital approach. Sensitivity analysis was used to explore uncertainty in various factors used in the model. Results: 204 (103 women) patients, mean age 48 (SD 11) years, were registered. Half of the cases were closed within six weeks, whereas 32 patients (16%) remained in the system for more than six months. A fifth of the patients were responsible for 91% of the total costs, and for 44% of the healthcare costs. The mean healthcare cost per patient was €326 (SD 389) during six months. Physiotherapy treatments accounted for 60%. The costs for sick leave contributed to 84% of the total costs. The mean annual total cost was €4139 per patient. Estimated costs for secondary care increased the total costs by one third. Conclusions: The model applied in this study provides valuable information that can be used in cost evaluations. Costs for secondary care and particularly for sick leave have a major influence on total costs and interventions that can reduce long periods of sick leave are warrante