55 research outputs found
Long-term economic outcomes
Objectives: This study aimed to provide a long-term cost comparison of
patients using additional homeopathic treatment (homeopathy group) with
patients using usual care (control group) over an observation period of 33
months. Methods: Health claims data from a large statutory health insurance
company were analysed from both the societal perspective (primary outcome) and
from the statutory health insurance perspective (secondary outcome). To
compare costs between patient groups, homeopathy and control patients were
matched in a 1:1 ratio using propensity scores. Predictor variables for the
propensity scores included health care costs and both medical and demographic
variables. Health care costs were analysed using an analysis of covariance,
adjusted for baseline costs, between groups both across diagnoses and for
specific diagnoses over a period of 33 months. Specific diagnoses included
depression, migraine, allergic rhinitis, asthma, atopic dermatitis, and
headache. Results: Data from 21,939 patients in the homeopathy group (67.4%
females) and 21,861 patients in the control group (67.2% females) were
analysed. Health care costs over the 33 months were 12,414 EUR [95% CI
12,022–12,805] in the homeopathy group and 10,428 EUR [95% CI 10,036–10,820]
in the control group (p<0.0001). The largest cost differences were attributed
to productivity losses (homeopathy: EUR 6,289 [6,118–6,460]; control: EUR
5,498 [5,326–5,670], p<0.0001) and outpatient costs (homeopathy: EUR 1,794
[1,770–1,818]; control: EUR 1,438 [1,414–1,462], p<0.0001). Although the costs
of the two groups converged over time, cost differences remained over the full
33 months. For all diagnoses, homeopathy patients generated higher costs than
control patients. Conclusion: The analysis showed that even when following-up
over 33 months, there were still cost differences between groups, with higher
costs in the homeopathy group
A Retrospective Cost-Analysis Based on 44500 Insured Persons
Objectives The aim of this study was to compare the health care costs for
patients using additional homeopathic treatment (homeopathy group) with the
costs for those receiving usual care (control group). Methods Cost data
provided by a large German statutory health insurance company were
retrospectively analysed from the societal perspective (primary outcome) and
from the statutory health insurance perspective. Patients in both groups were
matched using a propensity score matching procedure based on socio-demographic
variables as well as costs, number of hospital stays and sick leave days in
the previous 12 months. Total cumulative costs over 18 months were compared
between the groups with an analysis of covariance (adjusted for baseline
costs) across diagnoses and for six specific diagnoses (depression, migraine,
allergic rhinitis, asthma, atopic dermatitis, and headache). Results Data from
44,550 patients (67.3% females) were available for analysis. From the societal
perspective, total costs after 18 months were higher in the homeopathy group
(adj. mean: EUR 7,207.72 [95% CI 7,001.14–7,414.29]) than in the control group
(EUR 5,857.56 [5,650.98–6,064.13]; p<0.0001) with the largest differences
between groups for productivity loss (homeopathy EUR 3,698.00
[3,586.48–3,809.53] vs. control EUR 3,092.84 [2,981.31–3,204.37]) and
outpatient care costs (homeopathy EUR 1,088.25 [1,073.90–1,102.59] vs. control
EUR 867.87 [853.52–882.21]). Group differences decreased over time. For all
diagnoses, costs were higher in the homeopathy group than in the control
group, although this difference was not always statistically significant.
Conclusion Compared with usual care, additional homeopathic treatment was
associated with significantly higher costs. These analyses did not confirm
previously observed cost savings resulting from the use of homeopathy in the
health care system
Frequency and clinical relevance of potential cytochrome P450 drug interactions in a psychiatric patient population – an analysis based on German insurance claims data
Background Numerous drugs used in the treatment of psychiatric disorders are
substrates of cytochrome P450 enzymes and are potential candidates for drug-
drug interactions (DDIs). Methods Claims data of a German statutory health
insurance company from severely mentally ill patients who registered in an
integrated care contract from August 2004 to December 2009 were analysed. We
measured time periods of concomitant prescription of drugs that have been
reported to interact via cytochrome P450, with a focus on drugs acting as
strong inhibitors. Such drug-drug exposure (DDE) is an incontrovertible
precursor of DDIs. We assessed whether potential DDIs were considered
clinically relevant based on the prescribing information of the respective
drugs. Results Among all 1221 patients, 186 patients (15.2 %; Clopper-Pearson
95 % confidence interval (CI): 13.3–17.4 %) had at least one DDE prescription,
and 58 patients (4.8 %; 95 % CI 3.6–6.1) had at least one DDE prescription
involving a strong cytochrome P450 inhibitor. In 59 patients, (4.8 %; 95 % CI:
3.7–6.2 %) five or more DDEs were identified, and five or more DDEs with a
strong inhibitor were identified in 18 patients (1.5 %; 95 % CI: 0.9–2.3). The
rates of DDEs were 0.27 (Garwood 95%CI: 0.25–0.28) per person-year and 0.07
(95 % CI: 0.07–0.08) for strong-inhibitor DDEs. Four of the ten most frequent
DDEs were identified as clinically relevant, and seven of the eight most
frequent DDEs involving a strong inhibitor were clinically relevant.
Conclusions The number of patients with DDEs was not alarmingly high in our
sample. Nevertheless, prescription information showed that some prescribed
drug combinations could result in serious adverse consequences that are known
to weaken or strengthen the effect of the drugs and should therefore be
avoided
Cost evaluation of an innovative outreach clinic across social insurance codes in rural Northern Germany - A routine data analysis
A community outreach clinic was established in 2013 in a rural part of Germany to counsel and better integrate patients with mental health disorders or clients with psychosocial problems into the healthcare and complementary social assistance system. In a pilot study, we aimed to evaluate the costs of the integration assistance system after the outreach clinic was opened, the number of visits and the trend in the costs of the social assistance system of the federal state. Anonymised secondary cost data were used to evaluate the costs associated with the integration assistance receivers before (2010–2012) and after the establishment of the outreach clinic (2013–2015). Total costs were descriptively compared between the intervention group (consultation in the outreach clinic), the non-referral group, and a propensity score-matched control group for the years 2013–2015. To monitor the counselling activity, we used anonymised data on visits to the outreach clinic between 2013 and 2015. Data from 50 clients in the outreach clinic and 678 non-referral clients were analysed. The total costs of the integration assistance for the years 2013–2015 amounted to EUR 21,516 (95% CI 14,513–28,518) and EUR 28,464 (25,789–31,140) respectively. Propensity score matching of the controls resulted in equalised total costs for the years 2013 through 2015 for clients (n = 50, EUR 21,516 (14,513–28,518)) and controls (n = 250, EUR 21,725 (18,214–25,234)). The total number of integration assistance receivers in the district was lower than the average for the federal state. The number of consultations at the outpatient clinic steadily increased from 146 in 2013 to 1,090 in 2015. Counselling in the outreach clinic might help reduce the placement of clients into integration assistance, including supported housing, and slow the expected cost trend. However, counselling failed to lower total costs in the integration assistance service, possibly due to the selection of more severe cases
Nomenclature for renal replacement therapy and blood purification techniques in critically ill patients: practical applications
This article reports the conclusions of the second part of a consensus expert conference on the nomenclature of renal replacement therapy (RRT) techniques currently utilized to manage acute kidney injury and other organ dysfunction syndromes in critically ill patients. A multidisciplinary approach was taken to achieve harmonization of definitions, components, techniques, and operations of the extracorporeal therapies. The article describes the RRT techniques in detail with the relevant technology, procedures, and phases of treatment and key aspects of volume management/fluid balance in critically ill patients. In addition, the article describes recent developments in other extracorporeal therapies, including therapeutic plasma exchange, multiple organ support therapy, liver support, lung support, and blood purification in sepsis. This is a consensus report on nomenclature harmonization in extracorporeal blood purification therapies, such as hemofiltration, plasma exchange, multiple organ support therapies, and blood purification in sepsis
Common, low-frequency, rare, and ultra-rare coding variants contribute to COVID-19 severity
The combined impact of common and rare exonic variants in COVID-19 host genetics is currently insufficiently understood. Here, common and rare variants from whole-exome sequencing data of about 4000 SARS-CoV-2-positive individuals were used to define an interpretable machine-learning model for predicting COVID-19 severity. First, variants were converted into separate sets of Boolean features, depending on the absence or the presence of variants in each gene. An ensemble of LASSO logistic regression models was used to identify the most informative Boolean features with respect to the genetic bases of severity. The Boolean features selected by these logistic models were combined into an Integrated PolyGenic Score that offers a synthetic and interpretable index for describing the contribution of host genetics in COVID-19 severity, as demonstrated through testing in several independent cohorts. Selected features belong to ultra-rare, rare, low-frequency, and common variants, including those in linkage disequilibrium with known GWAS loci. Noteworthily, around one quarter of the selected genes are sex-specific. Pathway analysis of the selected genes associated with COVID-19 severity reflected the multi-organ nature of the disease. The proposed model might provide useful information for developing diagnostics and therapeutics, while also being able to guide bedside disease management. © 2021, The Author(s)
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Clinical Characteristics and Outcomes of Drug-Induced Acute Kidney Injury Cases
Introduction
Drug-induced acute kidney injury (DI-AKI) is a frequent adverse event. The identification of DI-AKI is challenged by competing etiologies, clinical heterogeneity among patients, and a lack of accurate diagnostic tools. Our research aims to describe the clinical characteristics and predictive variables of DI-AKI.
Methods
We analyzed data from the DIRECT study (NCT02159209), an international, multi-center, observational cohort study of enriched clinically adjudicated DI-AKI cases. Cases met the primary inclusion criteria if the patient was exposed to at least one nephrotoxic drug for a minimum of 24 hours prior to acute kidney injury (AKI) onset. Cases were clinically adjudicated and inter-rater reliability (IRR) was measured using Krippendorff's alpha. Variables associated with DI-AKI were identified using L1 regularized multivariable logistic regression. Model performance was assessed using the area under the receiver operating characteristic curve (ROC AUC).
Results
314 AKI cases met the eligibility criteria for this analysis, and 271 (86%) cases were adjudicated as DI-AKI. The majority of the AKI cases were recruited from the United States (68%). The most frequent causal nephrotoxic drugs were vancomycin (48.7%), non-steroidal anti-inflammatory drugs (18.2%), and piperacillin/tazobactam (17.8%). The IRR for DI-AKI adjudication was 0.309. The multivariable model identified age, vascular capacity, hyperglycemia, infections, pyuria, serum creatinine trends, and contrast media as significant predictors of DI-AKI with good performance, ROC AUC 0.86.
Conclusions
The identification of DI-AKI is challenging even with comprehensive adjudication by experienced nephrologists. Our analysis identified key clinical characteristics and outcomes of DI-AKI compared to other AKI etiologies
The psychological science accelerator’s COVID-19 rapid-response dataset
In response to the COVID-19 pandemic, the Psychological Science Accelerator coordinated three large-scale psychological studies to examine the effects of loss-gain framing, cognitive reappraisals, and autonomy framing manipulations on behavioral intentions and affective measures. The data collected (April to October 2020) included specific measures for each experimental study, a general questionnaire examining health prevention behaviors and COVID-19 experience, geographical and cultural context characterization, and demographic information for each participant. Each participant started the study with the same general questions and then was randomized to complete either one longer experiment or two shorter experiments. Data were provided by 73,223 participants with varying completion rates. Participants completed the survey from 111 geopolitical regions in 44 unique languages/dialects. The anonymized dataset described here is provided in both raw and processed formats to facilitate re-use and further analyses. The dataset offers secondary analytic opportunities to explore coping, framing, and self-determination across a diverse, global sample obtained at the onset of the COVID-19 pandemic, which can be merged with other time-sampled or geographic data
In COVID-19 Health Messaging, Loss Framing Increases Anxiety with Little-to-No Concomitant Benefits: Experimental Evidence from 84 Countries
The COVID-19 pandemic (and its aftermath) highlights a critical need to communicate health information effectively to the global public. Given that subtle differences in information framing can have meaningful effects on behavior, behavioral science research highlights a pressing question: Is it more effective to frame COVID-19 health messages in terms of potential losses (e.g., "If you do not practice these steps, you can endanger yourself and others") or potential gains (e.g., "If you practice these steps, you can protect yourself and others")? Collecting data in 48 languages from 15,929 participants in 84 countries, we experimentally tested the effects of message framing on COVID-19-related judgments, intentions, and feelings. Loss- (vs. gain-) framed messages increased self-reported anxiety among participants cross-nationally with little-to-no impact on policy attitudes, behavioral intentions, or information seeking relevant to pandemic risks. These results were consistent across 84 countries, three variations of the message framing wording, and 560 data processing and analytic choices. Thus, results provide an empirical answer to a global communication question and highlight the emotional toll of loss-framed messages. Critically, this work demonstrates the importance of considering unintended affective consequences when evaluating nudge-style interventions
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