Diagnosing Crohn\u27s Disease: An economic analysis comparing wireless capsule endoscopy with traditional diagnostic procedures

The purpose of this study was to review economic considerations related to establishing a diagnosis of Crohn\u27s disease, and to compare the costs of a diagnostic algorithm incorporating wireless capsule endoscopy (WCE) with the current algorithm for diagnosing Crohn\u27s disease suspected in the small bowel. Published literature, clinical trial data on WCE in comparison to other diagnostic tools, and input from clinical experts were used as data sources for (1) identifying contributors to the costs of diagnosing Crohn\u27s disease; (2) exploring where WCE should be placed within the diagnostic algorithm for Crohn\u27s; and (3) constructing decision tree models with sensitivity analyses to explore costs (from a payor perspective) of diagnosing Crohn\u27s disease using WCE compared to other diagnostic methods. Literature review confirms that Crohn\u27s disease is a significant and growing public health concern from clinical, humanistic and economic perspectives, and results in a long-term burden for patients, their families, providers, insurers, and employers. Common diagnostic procedures include radiologic studies such as small bowel follow through (SBFT), enteroclysis, CT scans, ultrasounds, and MRIs, as well as serologic testing, and various forms of endoscopy. Diagnostic costs for Crohn\u27s disease can be considerable, especially given the cycle of repeat testing due to the low diagnostic yield of certain procedures and the inability of current diagnostic procedures to image the entire small bowel. WCE has a higher average diagnostic yield than comparative procedures due to imaging clarity and the ability to visualize the entire small bowel. Literature review found the average diagnostic yield of SBFT and colonoscopy for work-up of Crohn\u27s disease to be 53.87%, whereas WCE had a diagnostic yield of 69.59%. A simple decision tree model comparing two arms--colonoscopy and SBFT, or WCE--estimates that WCE produces a cost savings of 291dollars for each case presenting for diagnostic work-up for Crohn\u27s. Sensitivity analysis varying diagnostic yields of colonoscopy and SBFT vs. WCE demonstrates that WCE is still less costly than SBFT and colonoscopy even at their highest reported yields, as long as the diagnostic yield of WCE is 64.10% or better. Employing WCE as a first-line diagnostic procedure appears to be less costly, from a payor perspective, than current common procedures for diagnosing suspected Crohn\u27s disease in the small bowel. Although not addressed in this model, earlier diagnosis with WCE (due to higher diagnostic yield) also could lead to earlier management, improved quality of life and workplace productivity for people with Crohn\u27s disease

Correlations Between Clinical Trial Outcomes Based on Symptoms, Functional Impairments, and Quality of Life in Children and Adolescents With ADHD

OBJECTIVE: To assess relationships between treatment-associated changes in measures of ADHD symptoms, functional impairments, and health-related quality of life in children and adolescents with ADHD. METHOD: Pearson correlation coefficients were calculated post hoc for changes from baseline to endpoint in outcomes of one randomized, placebo- and active-controlled trial of lisdexamfetamine (osmotic-release methylphenidate reference) and one of guanfacine extended-release (atomoxetine reference). RESULTS: Changes in ADHD Rating Scale IV (ADHD-RS-IV) total score generally correlated moderately with changes in Child Health and Illness Profile-Child Edition: Parent Report Form (CHIP-CE:PRF) Achievement and Risk Avoidance ( r ≈ .4), but weakly with Resilience, Satisfaction, and Comfort ( r ≈ .2); and moderately with Weiss Functional Impairment Rating Scale-Parent (WFIRS-P) total score ( r ≈ .5). CHIP-CE: PRF Achievement and Risk Avoidance correlated moderately to strongly with WFIRS-P total score ( r ≈ .6). CONCLUSION: The ADHD-RS-IV, CHIP-CE:PRF, and WFIRS-P capture distinct but interconnected aspects of treatment response in individuals with ADHD

Impact of Mental Health Comorbidities on Health Care Utilization and Expenditure in a Large US Managed Care Adult Population with ADHD

AbstractObjectiveTo estimate the health resource use (HRU) and expenditure of adult patients with attention deficit/hyperactivity disorder (ADHD) subsequently diagnosed with one or more mental health (MH) comorbidities.MethodsUsing Kaiser Permanente Southern California electronic medical records (January 1, 2006, to December 31, 2009), we identified adults with at least one ADHD diagnosis and at least two subsequent prescriptions fills for ADHD medication. The date of first MH comorbidity diagnosis after the index ADHD diagnosis was defined as the index transition date. Continuous eligibility 12 months before and after the index transition date was required. For patients with multiple transitions (≥2), the post-transition period reflected the 12 months after the second transition. HRU for all-cause inpatient, outpatient, emergency department, behavioral therapy, overall prescription fill counts, and ADHD-specific prescription fill counts and mean patient expenditure (2010 US $) were estimated. Generalized estimating equations were used to evaluate differences in HRU and expenditure between the pre- and post-transition periods, respectively.ResultsOf the 3809 patients with ADHD identified, 989 (26$1822 ± $306 and$4432 ± $301 (both P < 0.0001) in the single and multiple transition cohorts, respectively.ConclusionsTwenty-six percent of patients with ADHD transitioned to MH comorbid diagnoses. Increased HRU and expenditure were associated with MH transitions. Identifying of patients with ADHD at risk for MH comorbidities may help to improve their outcomes

Modell für die Strömung von Mikroplastikpartikeln im inhomogenen und laminaren Geschwindigkeitsfeld

Iz perspektive održivog razvoja, nerazgradivost te konstantni porast broja čestica mikroplastike u akvatičnim recipijentima zahtijeva urgentan razvoj mjera zaštite od nepovoljnih ekoloških posljedica što između ostalog iziskuje razumijevanje geneze mikroplastike te mehanike gibanja ovakve vrste onečišćenja u biosferi. Iz navedenoga slijedi i motivacija za istraživačkim aktivnostima koje su u ovom radu dokumentirane, a odnose se na prikaz odabrane teorijske osnove za modeliranje gibanja čestica mikroplastike te na relativno jednostavni numerički algoritam razvijen u svrhe modeliranja pronosa čestica mikroplastike u nehomogenom polju brzine tekućine u ravninskom i laminarnom toku. Lagrangeov opis gibanja čestica mikroplastike je neophodan radi nemogućnosti definiranja predmetnog REV-a te kontinuiranog polja koncentracije. Kako analize od praktičnog značaja uvjetuju relativno veliki broj čestica mikroplastike, neophodno je numerički algoritam formirati kroz kompromisno rješenje u okviru kojeg se nastoji minimizirati proračunsko vrijeme te maksimizirati utjecaj svih dominantnih fizikalnih procesa. Predloženi model se tako temelji na sustavu od dvije obične i nelinearne diferencijalne jednadžbe. Kako bi se pritom uvela mogućnost modeliranja čestica različitih oblika, faktor otpora oblika cd je modeliran poopćenim četvero-parametarskim Clift-Gauvinovim modelom u kojem su parametri definirani faktorom sferičnosti čestice mikroplastike odnosno mjerom odstupanja oblika čestice od kugle. Predloženi pristup modeliranja se može inkorporirati u neki od raspoloživih programskih rješenja (npr.OpenFOAM), a na kraju rada je prikazan numerički primjer dobiven implementacijom algoritma u programskom jeziku Python te je iznijet i osvrt na naredne eksperimentalne aktivnosti.From the sustainable development perspective,non-degradability and a constant microplastic particle increase in aquatic recipients require urgent development of protection measures against unfavourable environmental consequences. In order to do that, we firstly need an understanding of the microplastics genesis and the mechanics of its movement in the biosphere. This requiresresearch activities documented in this paper. They are related to the presentation of a selected theoretical basis for modelling the movement of microplastic particles, and a relatively simple numerical algorithm developed for modelling the transport of microplastic particles in inhomogeneous field of fluid velocity in planar and laminar flow.The Lagrange’s description ofthe movement of microplastic articles is necessary because it is impossible to define the subject REV and the continuous concentration field. Analyses of practical importance require a relatively large number of microplastic particles, so it is necessary to develop a numeric algorithm through a compromise solution that attempts to minimise the computational time and maximise the impact of all dominant physical processes. Therefore, the proposed model is based on a system of two ordinary, nonlinear differential equations. In order to introduce the possibility of modelling particles of different shapes, the resistance factor of cdshape is modelled by a generalised four-parameter Clift and Gauvin model, where the parameters are defined by the spherical factor of a microplastic particle or the measure of a particle shape deviation from the sphere. The proposed modelling approach can be incorporated into some available software solutions (e.g. OPENFOAM). The end of the paper contains the presentation of a numerical example obtained by implementing the algorithm in the Python programming language anda review of the next experimental activities.Im Rahmender nachhaltigen Entwicklungist es wegen der Nichtabbaubarkeit und ständiger Erhöhung der Anzahl von Mikroplastikpartikeln in Gewässern erforderlich, Schutzmaßnahmen gegen ungünstige Umweltauswirkungen dirngend zu entwickeln. Das impliziert, dass die Entstehung der Mikroplastik und die Bewegungsmechanik dieser Schadstoffe in der Biosphäre schon gut verstanden sind. Das war auch die Motivation für die hier beschriebenen Untersuchungen, die auch eine Darstellung der theoretischen Grundlage für das Modellieren der Mikroplastikpartikelbewegung einbeziehen sowie einen relativ einfachen numerischen Algorithmus, der zum Zwecke der Modellierung des Transportes von Mikroplastikpartikeln im inhomogenen Flüssigkeitsgeschwindigkeitsfeld in ebener und laminarer Strömung entwickelt worden ist. Die lagrangesche Darstellung der Bewegung von Mikroplastikpartikeln ist unentbehrlich, weil das gegenständliche repräsentative Elementarvolumen (REV) und das kontinuierliche Konzentrationsfeld nicht definiert werden können. Da praxisrelevante Analysen eine relative große Anzahl von Mikroplastikpartikeln benötigen, ist es notwendig, den numerischen Algorithmus als eine Kompromisslösung zu gestalten, im Rahmen derer die Berechnungszeit minimiert und der Einfluss aller dominanten physikalischen Prozesse maximiert wird. Das vorgeschlagene Modell basiert auf einem System von zwei gewöhnlichen und nichtlinearen Differenzengleichungen. Um dabei auch die Modellierung von Partikeln unterschiedlicher Form zu ermöglichen, wurde der Formwiderstandsfaktor cdanhand des verallgemeinerten Vier-Parameter-Modells von Clift und Gauvin modelliert, in dem die Parameter durch die Sphärizität des Mikroplastikpartikels bzw. Maß für die Abweichung der Partikelform von der Kugel definiert werden. Der vorgeschlagene Ansatz zur Modellierung kann in frei erhältliche Simulationspakete (z.B. OpenFOAM) übernommen werden. Am Ende der Arbeit wird ein numerisches Beispiel der Umsetzung des Algorithmus in die Programmiersprache Python dargestellt, und zukünftige Untersuchungsaktivitäten werden erwähnt

Economic impact of childhood/adolescent ADHD in a European setting:the Netherlands as a reference case

Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent psychiatric disorder in children/adolescents. This study reviews available European-based studies of ADHD-related costs and applies the findings to the Netherlands to estimate annual national costs for children/adolescents from a societal perspective. A systematic literature search was conducted for primary studies in Europe, published January 1, 1990 through April 23, 2013. Per-person cost estimates were converted to 2012 Euros and used to estimate annual national ADHD-related costs based on the Dutch 2011 census, ADHD prevalence rates, family composition, and employment rates. Seven studies met the inclusion criteria. The average total ADHD-related costs ranged from a,not sign9,860 to a,not sign14,483 per patient and annual national costs were between a,not sign1,041 and a,not sign1,529 million (M). The largest cost category was education (a,not sign648 M), representing 62 and 42 % of the low- and high-value overall national estimates, respectively. By comparison, ADHD patient healthcare costs ranged between a,not sign84 M (8 %) and a,not sign377 M (25 %), and social services costs were a,not sign4.3 M (0.3-0.4 %). While the majority of the costs were incurred by ADHD patients themselves, a,not sign161 M (11-15 %) was healthcare costs to family members that were attributable to having an ADHD child/adolescent. In addition, productivity losses of family members were a,not sign143-a,not sign339 M (14-22 %). Despite uncertainties because of the small number of studies identified and the wide range in the national cost estimates, our results suggest that ADHD imposes a significant economic burden on multiple public sectors in Europe. The limited number of European-based studies examining the economic burden of ADHD highlights the need for more research in this area

The inpatient burden of abdominal and gynecological adhesiolysis in the US

<p>Abstract</p> <p>Background</p> <p>Adhesions are fibrous bands of scar tissue, often a result of surgery, that form between internal organs and tissues, joining them together abnormally. Postoperative adhesions frequently occur following abdominal surgery, and are associated with a large economic burden. This study examines the inpatient burden of adhesiolysis in the United States (i.e., number and rate of events, cost, length of stay [LOS]).</p> <p>Methods</p> <p>Hospital discharge data for patients with primary and secondary adhesiolysis were analyzed using the 2005 Healthcare Cost and Utilization Project's Nationwide Inpatient Sample. Procedures were aggregated by body system.</p> <p>Results</p> <p>We identified 351,777 adhesiolysis-related hospitalizations: 23.2% for primary and 76.8% for secondary adhesiolysis. The average LOS was 7.8 days for primary adhesiolysis. We found that 967,332 days of care were attributed to adhesiolysis-related procedures, with inpatient expenditures totaling $2.3 billion ($1.4 billion for primary adhesiolysis; $926 million for secondary adhesiolysis). Hospitalizations for adhesiolysis increased steadily by age and were higher for women. Of secondary adhesiolysis procedures, 46.3$220 million in attributable costs.</p> <p>Conclusions</p> <p>Adhesiolysis remain an important surgical problem in the United States. Hospitalization for this condition leads to high direct surgical costs, which should be of interest to providers and payers.</p

Functional outcomes from a head-to-head, randomized, double-blind trial of lisdexamfetamine dimesylate and atomoxetine in children and adolescents with attention-deficit/hyperactivity disorder and an inadequate response to methylphenidate

Attention-deficit/hyperactivity disorder (ADHD) is associated with functional impairments in multiple domains of patients' lives. A secondary objective of this randomized, active-controlled, head-to-head, double-blind, dose-optimized clinical trial was to compare the effects of lisdexamfetamine dimesylate (LDX) and atomoxetine (ATX) on functional impairment in children and adolescents with ADHD. Patients aged 6-17 years with an ADHD Rating Scale IV total score ≥ 28 and an inadequate response to methylphenidate treatment (judged by investigators) were randomized (1:1) to once-daily LDX or ATX for 9 weeks. Parents/guardians completed the Weiss Functional Impairment Rating Scale-Parent Report (WFIRS-P) at baseline and at week 9 or early termination. p values were nominal and not corrected for multiple comparisons. Of 267 randomized patients, 200 completed the study (LDX 99, ATX 101). At baseline, mean WFIRS-P total score in the LDX group was 0.95 [standard deviation (SD) 0.474; 95% confidence interval (CI) 0.87, 1.03] and in the ATX group was 0.91 (0.513; 0.82, 1.00). Scores in all WFIRS-P domains improved from baseline to endpoint in both groups, with least-squares mean changes in total score of -0.35 (95% CI -0.42, -0.29) for LDX and -0.27 (-0.33, -0.20) for ATX. The difference between LDX and ATX was statistically significant (p < 0.05) for the Learning and School (effect size of LDX vs ATX, 0.43) and Social Activities (0.34) domains and for total score (0.27). Both treatments reduced functional impairment in children and adolescents with ADHD; LDX was statistically significantly more effective than ATX in two of six domains and in total score