The impact of a history of poor mental health on health care costs in the perinatal period

Background: Alteplase (tPA) contraindications for acute ischemic stroke (AIS) were originally derived from the 1995 NINDS trial. Recently, a history of intracranial hemorrhage (ICH) and recent stroke (within 3 months) were removed as contraindications from the drug package insert, which could increase the number of patients eligible for IV thrombolysis. We sought to define the potential impact on outcomes and health care costs in this newly eligible population. Methods: Consecutive patients (March 2014 - April 2015) who presented with AIS to our Comprehensive Stroke Center (CSC) were retrospectively analyzed. Demographics and tPA exclusions were recorded. The annual number of discharges with primary diagnosis of ischemic stroke in the U.S. was estimated from the National Inpatient Sample (2006 - 2011). A previously reported value of $25,000/patient was utilized to calculate lifetime cost savings in patients receiving tPA. Results: During the study period, 776 AIS were admitted to our CSC (median age 64; 55,74, 51% men, 62% white). Seventy-six percent of our patients (n=590) had ≥1 tPA exclusions according to the NINDS trial. Among these patients, 11 excluded had history of ICH, 15 with recent strokes, and 1 both. Following the new package insert, the proportion of patients with ≥1 tPA exclusion fell to 73% (n=563). Given the 432,000 ischemic stroke discharges annually, a 3% increase in patients eligible for tPA could translate to treatment of 12,960 more patients annually and a lifetime cost savings of $324,000,000. Furthermore, we estimate that 1,685 of these newly eligible patients will experience a favorable functional outcome based on the results of the NINDS trial (13% shift analysis for mRS 0-1). Conclusions: Our results suggest that the new tPA package insert has the potential to increase national tPA treatment rates, decrease U.S. health care costs, and improve functional outcomes in eligible AIS patients. National guidelines need to be updated to reflect these changes.

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Analysis of ‘Revolving Door' Patients in Opioid Dependent Patients: the Impact of Treatment Discontinuation on Relapse Rates and Health Care Costs in us Public Health Insurance Claims

Value in Health ◽

10.1016/j.jval.2014.08.1250 ◽

2014 ◽

Vol 17 (7) ◽

pp. A456

Author(s):

E. Clay ◽

V. Zah ◽

E. Kharitonova ◽

J. Ruby ◽

S. Aballéa ◽

...

Keyword(s):

Public Health ◽

Health Care ◽

Health Insurance ◽

Health Care Costs ◽

Revolving Door ◽

Public Health Insurance ◽

Health Insurance Claims ◽

The Impact ◽

Care Costs ◽

Relapse Rates

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Direct access physiotherapy for patients with musculoskeletal disorders: a systematic review

European Journal of Public Health ◽

10.1093/eurpub/ckz186.335 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

A Demont ◽

A Bourmaud ◽

A Kechichian ◽

F Desmeules

Keyword(s):

Systematic Review ◽

Health Care ◽

Adverse Events ◽

Usual Care ◽

Musculoskeletal Disorders ◽

Health Care Costs ◽

Family Physician ◽

Direct Access ◽

The Impact ◽

Care Costs

Abstract Background Although the benefits of physiotherapy is well supported in the literature, the impact of having direct access to physiotherapy is not well established. Update of the current available evidence is warranted. The aim of this systematic review was to update the current evidence regarding the impact of direct access physiotherapy compared to usual care for patients with musculoskeletal disorders. Methods Systematic searches were conducted in 5 bibliographic databases up until May 2018. Two independent raters reviewed studies and used the Quality Assessment Tool for Quantitative Studies to conduct the methodological quality assessment and a data extraction regarding patient outcomes, adverse events, health care utilization and processes, patient satisfaction and health care costs. Results Sixteen studies of weak to moderate quality were included. Five studies found no significant differences in pain reduction between usual family physician led care and direct access physiotherapy. However, three studies reported better clinical outcomes in patients with direct access in terms of function and quality of life. Five studies did not observe any adverse events with direct access physiotherapy. Three studies showed shorter waiting time and four studies reported fewer number of physiotherapy visits with direct access. Three studies showed that patients with direct access were less likely to have medication and imaging tests prescribed compared to usual care. Five studies reported higher levels of satisfaction for direct access. In terms of health care costs, four studies demonstrated that costs were lower with direct access and one study reported similar costs between both types of care. Conclusions Emerging evidence, although of weak to moderate quality, suggest that direct access physiotherapy provides equal or better outcomes than family physician led care models for musculoskeletal disorders patients. More methodologically strong studies are needed. Key messages This review supports the efficacy, safety and cost-effectiveness of direct access PT, while increasing access to care with a more efficient use of resources. There is a need for more methodologically strong studies to evaluate the efficiency of direct access models of care of physiotherapy for patients with MSKD.

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PSK6 THE IMPACT OF PSORIASIS ON HEALTH CARE COSTS AND WORK LOSS

Value in Health ◽

10.1016/s1098-3015(10)68843-2 ◽

2007 ◽

Vol 10 (3) ◽

pp. A100-A101

Author(s):

MS Duh ◽

JF Fowler ◽

L Rovba ◽

S Buteau ◽

L Pinheiro ◽

...

Keyword(s):

Health Care ◽

Health Care Costs ◽

Work Loss ◽

The Impact ◽

Care Costs

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The Impact of Weight Reduction Surgery on Health-Care Costs in Morbidly Obese Patients

Obesity Surgery ◽

10.1381/0960892041719662 ◽

2004 ◽

Vol 14 (7) ◽

pp. 939-947 ◽

Cited By ~ 140

Author(s):

John S. Sampalis ◽

Moishe Liberman ◽

Stephane Auger ◽

Nicolas V. Christou

Keyword(s):

Health Care ◽

Health Care Costs ◽

Weight Reduction ◽

Morbidly Obese ◽

Obese Patients ◽

The Impact ◽

Care Costs

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Direct Health Care Costs of Treating Seasonal Affective Disorder: A Comparison of Light Therapy and Fluoxetine

Depression Research and Treatment ◽

10.1155/2012/628434 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Amy Cheung ◽

Carolyn Dewa ◽

Erin E. Michalak ◽

Gina Browne ◽

Anthony Levitt ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Affective Disorder ◽

Health Care Costs ◽

Seasonal Affective Disorder ◽

Light Therapy ◽

Major Depressive Episodes ◽

Depressive Episodes ◽

Care Costs

Objective.To compare the direct mental health care costs between individuals with Seasonal Affective Disorder randomized to either fluoxetine or light therapy.Methods.Data from the CANSAD study was used. CANSAD was an 8-week multicentre double-blind study that randomized participants to receive either light therapy plus placebo capsules or placebo light therapy plus fluoxetine. Participants were aged 18–65 who met criteria for major depressive episodes with a seasonal (winter) pattern. Mental health care service use was collected for each subject for 4 weeks prior to the start of treatment and for 4 weeks prior to the end of treatment. All direct mental health care services costs were analysed, including inpatient and outpatient services, investigations, and medications.Results.The difference in mental health costs was significantly higher after treatment for the light therapy group compared to the medication group—a difference of $111.25 (z=−3.77,P=0.000). However, when the amortized cost of the light box was taken into the account, the groups were switched with the fluoxetine group incurring greater direct care costs—a difference of $75.41 (z=−2.635,P=0.008).Conclusion.The results suggest that individuals treated with medication had significantly less mental health care cost after-treatment compared to those treated with light therapy.

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