The costs of limited health literacy: a systematic review

Objectives: To summarize evidence about (1) the costs of limited health literacy (HL) and (2) the cost-effectiveness of interventions to improve limited HL. Methods: We performed a systematic review searching electronic databases and additional information resources. We included observational studies and interventional studies with HL-outcomes. We included populations at high risk for low HL and patients with (1) diabetes mellitus or (2) hyperlipidemia. Results: We retrieved 2,340 papers and included 10 studies for analysis. The prevalence of limited HL is considerable (range 34-59%). On the health system level, the additional costs of limited HL range from 3 to 5% of the total health care cost per year. On the patient level, the additional expenditures per year per person with limited HL compared to persons with adequate HL range from US $143 to 7,798. Data on the cost-effectiveness of interventions to improve limited HL are scarce. Conclusion: The costs of limited HL may be substantial, but few studies were retrieved and the results are heterogeneou

The costs of limited health literacy : a systematic review

Objectives: To summarize evidence about the costs of limited health literacy (HL) and the cost-effectiveness of interventions to improve limited HL. Methods: We performed a systematic review searching electronic databases and additional information resources. We included observational studies and interventional studies with HL-outcomes. We included populations at high risk for low HL and patients with diabetes mellitus or hyperlipidemia. Results: We retrieved 2,340 papers and included 10 studies for analysis. The prevalence of limited HL is considerable (range 34-59%). On the health system level, the additional costs of limited HL range from 3 to 5% of the total health care cost per year. On the patient level, the additional expenditures per year per person with limited HL compared to persons with adequate HL range from US $143 to 7,798. Data on the cost-effectiveness of interventions to improve limited HL are scarce. Conclusion:The costs of limited HL may be substantial, but few studies were retrieved and the results are heterogeneous

Development of coverage with evidence development for medical technologies in Switzerland from 1996 to 2012

Objectives: The aim of this study was to assess incidence, time frame, and outcome of “Coverage with Evidence Development” (CED) decisions in the Swiss Basic Health Insurance scheme. Methods: Analysis of all controversial medical technologies submitted to review by the Swiss Federal Office of Public Health (FOPH) from 1996 to 2012 with focus on decisions with constraints. Description of types of technology, type of initial decision, duration of evaluation period, final decision, and search for potential factors associated with changes over time. Results: Forty-five (37.5 percent) of 120 controversial health technologies were classified as “yes, in evaluation, reimbursed” for a certain period of time and thirty-five (29.2 percent) as “no, in evaluation, not reimbursed” by the Federal Department of Home Affairs from 1996 to 2012. The rate of CED decisions ranged between zero and nine per year and was influenced by type of technology and calendar year. Forty-four of forty-five decisions were subject to further restrictions, to a “center or a specialist” (76 percent), “indications” (49 percent), “registry” (31 percent), or “other” (49 percent). The time to a final decision ranged from 1.5 to 11 years (median, 6 years). No factors associated with initial decision and final outcome could be identified. Conclusions: CED as a reality in Switzerland might have enabled patients to obtain access to promising technologies early in their life cycle. CED might have acted as a trigger to a successful implementation of a comprehensive national registry. The lack of qualitative data stresses the urgent need for evaluation of the HTA decisions and their impact on patient outcome and costs

Effects of micronutrient fortified milk and cereal food for infants and children : a systematic review

Background: Micronutrient deficiency is a common public health problem in developing countries, especially for infants and children in the first two years of life. As this is an important time window for child development, micronutrient fortified complementary feeding after 6 months of age, for example with milk or cereals products, in combination with continued breastfeeding, is recommended. The overall effect of this approach is unclear. Methods: We performed a Systematic Review and Meta-analysis to assess the impact of micronutrient fortified milk and cereal food on the health of infants and little children (aged 6 months to 5 years) compared to non-fortified food. We reviewed randomized controlled trials using electronic databases (MEDLINE and Cochrane library searches through FEB 2011), reference list screening and hand searches. Three reviewers assessed 1153 studies for eligibility and extracted data. One reviewer assessed risk of bias using predefined forms. Results: We included 18 trials in our analysis (n = 5’468 children; range of mean hemoglobin values: 9.0 to 12.6 g/dl). Iron plus multi micronutrient fortification is more effective than single iron fortification for hematologic outcomes. Compared to non-fortified food, iron multi micronutrient fortification increases hemoglobin levels by 0.87 g/dl (95%-CI: 0.57 to 1.16; 8 studies) and reduces risk of anemia by 57% (relative risk 0.43; 95%-CI 0.26 to 0.71; absolute risk reduction 22%; number needed to treat 5 [95%-CI: 4 to 6]; 6 Studies). Compared to non-fortified food, fortification increases serum levels of vitamin A but not of zinc. Information about functional health outcomes (e.g. weight gain) and morbidity was scarce and evidence is inconclusive. Risk of bias is unclear due to underreporting, but high quality studies lead to similar results in a sensitivity analysis. Conclusions: Multi micronutrient fortified milk and cereal products can be an effective option to reduce anemia of children up to three years of age in developing countries. On the basis of our data the evidence for functional health outcomes is still inconclusive

Impact evaluation of Swiss Medical Board reports on routine care in Switzerland : a case study of PSA screening and treatment for rupture of anterior cruciate ligament

Questions under Study: Evidence-based recommendations play an important role in medical decision-making, but barriers to adherence are common. In Switzerland, the Swiss Medical Board (SMB) publishes evidence reports that conclude with recommendations. We assessed the impact of two SMB reports on service provision (2009: Recommendation of conservative treatment as first option for rupture of the anterior cruciate ligament of the knee; 2011: Recommendation against PSA screening for prostate cancer). Methods: We performed an observational study and assessed quantitative data over time via interrupted times series analyses. The primary outcome was the quarterly number of performed prostate-specific antigen (PSA) tests and the annual rates of surgical ACL repair in patients with ACL rupture. Data were adjusted for time trends and relevant confounders. Results: We analysed PSA tests in 662,874 outpatients from 2005-2013 and treatment data in 101,737 patients with knee injury from 1990-2011. For the number of PSA tests, the secular trend before the intervention showed a continuous but diminishing increase over time. A statistically significant reduction in tests was estimated immediately after the intervention, but a later return to the trend before the intervention cannot be ruled out. The rate of surgical ACL repair had already declined after the late 1990s to about 55% in 2009. No relevant additional change emerged in this secular trend after the intervention. Conclusions: Despite some evidence of a possible change, we did not find a sustained and significant impact of SMB recommendations in our case study. Further monitoring is needed to confirm or refute these findings

Quality of life data from EQ-5D for evidence-based health service practice in dialysis care

Hemodialysis (HD) and peritoneal dialysis (PD) are therapeutic options for patients with end-stage-renal-disease (ESRD), if transplantation is not available. Mortality rates for HD and PD are similar, while PD is generally the less costly alternative. Percentage of HD and PD shows considerable variability between high income countries (for PD from 5-7% in Germany and Switzerland up to 19- 24% in the UK and Scandinavia). Patient reported outcomes, such as quality of life (QOL), can provide complementary evidence for planning of patient oriented dialysis services. Profile instruments (e.g. SF36, KDQOL) show no consistent QOL differences between HD and PD. However, single index preference-based QOL measures (such as EQ5D), may add new information and are useful for later health economic evaluations. We aimed to collect current evidence for QOL of ESRD patients as measured with EQ-5D

Digital Health : die Zukunft des Schweizer Gesundheitswesens

Digital Health ist in aller Munde. Egal ob nun von eHealth, mHealth, Big Data, Gesundheit 4.0 oder eben Digital Health gesprochen wird, die Chancen und Gefahren der digitalen Möglichkeiten beschäftigen die meisten Akteure unseres Gesundheitssystems. Aber wofür stehen eigentlich die zahlreichen neuen Begriffe? Wird Digital Health wirklich das Gesundheitswesen revolutionieren oder handelt es sich nur um einen weiteren Hype, der schon bald wieder vergessen sein wird? Der vorliegende Report schafft ein einheitliches Verständnis, beschreibt den aktuellen Stand aus der Managementperspektive und geht auf zukünftige Entwicklungen ein