Cost-effectiveness of a graded exercise therapy program for patients with chronic shoulder complaints

2006 ◽  
Vol 22 (1) ◽  
pp. 76-83 ◽  
Author(s):  
Jacques J. X. R. Geraets ◽  
Mariëlle E. J. B. Goossens ◽  
Camiel P. C. de Bruijn ◽  
Imelda J. M. de Groot ◽  
Albère J. S. Köke ◽  
...  
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
Treatment Period ◽  
Health Care Costs ◽  
Daily Activities ◽  
Graded Exercise Therapy ◽  
Graded Exercise ◽  
Health Related ◽  
Care Costs

Objectives:The present study evaluated the cost-effectiveness of a behavioral graded exercise therapy (GET) program compared with usual care (UC) in terms of the performance of daily activities by patients with chronic shoulder complaints in primary care.Methods:A total of 176 patients were randomly assigned either to GET (n=87) or to UC (n=89). Clinical outcomes (main complaints, shoulder disability [SDQ] and generic health-related quality of life [EQ-5D], and costs [intervention costs, direct health care costs, direct non–health-related costs, and indirect costs]) were assessed during the 12-week treatment period and at 52 weeks of follow-up.Results:Results showed that GET was more effective than UC in restoring daily activities as assessed by the main complaints instrument after the 12-week treatment period (p=.049; mean difference, 7.5; confidence interval [CI], 0.0–15.0). These effects lasted for at least 52 weeks (p=.025; mean difference 9.2; CI, 1.2–17.3). No statistically significant differences were found on the SDQ or EQ5D. GET significantly reduced direct health care costs (p=.000) and direct non–health care costs (p=.029). Nevertheless, total costs during the 1-year follow-up period were significantly higher (p=.001; GET=€530 versus UC=€377) due to the higher costs of the intervention. Incremental cost-effectiveness ratios for the main complaints (0–100), SDQ (0–100), and EQ-5D (−1.0–1.0) were €17, €74, and €5,278 per unit of improvement, respectively.Conclusions:GET proved to be more effective in the short- and long-term and reduces direct health care costs and direct non–health care costs but is associated with higher costs of the intervention itself.

Cost-effectiveness of intensive home treatment enhanced by inpatient treatment elements in child and adolescent psychiatry in Germany: A randomised trial

2015 ◽  
Vol 30 (5) ◽  
pp. 583-589 ◽  
Author(s):  
I. Boege ◽  
N. Corpus ◽  
R. Schepker ◽  
R. Kilian ◽  
J.M. Fegert
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Cost Effectiveness ◽  
Health Care Costs ◽  
Adolescent Psychiatry ◽  
Inpatient Treatment ◽  
Child And Adolescent ◽  
Child And Adolescent Psychiatry ◽  
Care Costs

AbstractBackgroundAdmission rate to child and adolescent mental health inpatient units in Germany is high (54 467 admissions in 2013), resources for providing necessary beds are scarce. Alternative pathways to care are needed. Objective of this study was to assess the cost-effectiveness of inpatient treatment versus Hot-BITs-treatment (Hometreatment brings inpatient-treatment outside), a new supported discharge service offering an early discharge followed by 12 weeks of intensive support.MethodsOf 164 consecutively recruited children and adolescents, living within families and being in need of inpatient mental health care, 100 patients consented to participate and were randomised via a computer-list into intervention (n = 54) and control groups (n = 46). Follow-up data were available for 76 patients. Primary outcome was cost-effectiveness. Effectiveness was gathered by therapist-ratings on the Children's Global Assessment Scale (CGAS) at baseline (T1), treatment completion (T2) and an 8-month-follow-up (T3). Cost of service use (health care costs and non–health care costs) was calculated on an intention-to-treat basis at T2 and T3.ResultsSignificant treatment effects were observed for both groups between T1/T2 and T1/T3 (P < 0.001). The Hot-BITs treatment, however, was associated with significantly lower costs at T2 (difference: −6900.47€, P = 0.013) and T3 (difference: −8584.10€, P = 0.007). Bootstrap cost-effectiveness ratio indicated that Hot-BITs was less costly and tended to be more effective at T2 and T3.ConclusionsHot-BITs may be a feasible cost-effective alternative to long inpatient stays in child and adolescent psychiatry. Further rigorous evaluations of the model are required. (Registration number: ISRCTN02672532, part 1, Current Controlled Trials Ltd, URL: http://www.controlled-trials.com).

scholarly journals Cost-effectiveness of magnetic resonance imaging for diagnosing recurrent ipsilateral deep vein thrombosis

2021 ◽  
Vol 5 (5) ◽  
pp. 1369-1378
Author(s):  
Lisette F. van Dam ◽  
Wilbert B. van den Hout ◽  
Gargi Gautam ◽  
Charlotte E. A. Dronkers ◽  
Waleed Ghanima ◽  
...  
Keyword(s):  
Health Care ◽  
Deep Vein Thrombosis ◽  
Cost Effectiveness ◽  
Health Care Costs ◽  
Cost Effective ◽  
Diagnostic Strategies ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
Care Costs

Abstract The diagnostic workup of recurrent ipsilateral deep vein thrombosis (DVT) using compression ultrasonography (CUS) can be complicated by persistent intravascular abnormalities after a previous DVT. We showed that magnetic resonance direct thrombus imaging (MRDTI) can exclude recurrent ipsilateral DVT. However, it is unknown whether the application of MRDTI in daily clinical practice is cost effective. The aim of this study was to evaluate the cost effectiveness of MRDTI-based diagnosis for suspected recurrent ipsilateral DVT during first year of treatment and follow-up in the Dutch health care setting. Patient-level data of the Theia study (NCT02262052) were analyzed in 10 diagnostic scenarios, including a clinical decision rule and D-dimer test and imaging with CUS and/or MRDTI. The total costs of diagnostic tests and treatment during 1-year follow-up, including costs of false-positive and false-negative diagnoses, were compared and related to the associated mortality. The 1-year health care costs with MRDTI (range, €1219-1296) were generally lower than strategies without MRDTI (range, €1278-1529). This was because of superior specificity, despite higher initial diagnostic costs. Diagnostic strategies including CUS alone and CUS followed by MRDTI in case of an inconclusive CUS were potential optimal cost-effective strategies, with estimated average costs of €1529 and €1263 per patient and predicted mortality of 1 per 737 patients and 1 per 609 patients, respectively. Our model shows that diagnostic strategies with MRDTI for suspected recurrent ipsilateral DVT have generally lower 1-year health care costs than strategies without MRDTI. Therefore, compared with CUS alone, applying MRDTI did not increase health care costs.

scholarly journals Benefits of Home-Based Solutions for Diagnosis and Treatment of Acute Coronary Syndromes on Health Care Costs: A Systematic Review

Sensors ◽  
2020 ◽  
Vol 20 (17) ◽  
pp. 5006
Author(s):  
Pau Redón ◽  
Atif Shahzad ◽  
Talha Iqbal ◽  
William Wijns
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Cost Effectiveness ◽  
Health Care Costs ◽  
Acute Coronary Syndromes ◽  
Clinical Evidence ◽  
Home Based ◽  
Risk Patients ◽  
Coronary Syndromes ◽  
Care Costs

Diagnosing and treating acute coronary syndromes consumes a significant fraction of the healthcare budget worldwide. The pressure on resources is expected to increase with the continuing rise of cardiovascular disease, other chronic diseases and extended life expectancy, while expenditure is constrained. The objective of this review is to assess if home-based solutions for measuring chemical cardiac biomarkers can mitigate or reduce the continued rise in the costs of ACS treatment. A systematic review was performed considering published literature in several relevant public databases (i.e., PUBMED, Cochrane, Embase and Scopus) focusing on current biomarker practices in high-risk patients, their cost-effectiveness and the clinical evidence and feasibility of implementation. Out of 26,000 references screened, 86 met the inclusion criteria after independent full-text review. Current clinical evidence highlights that home-based solutions implemented in primary and secondary prevention reduce health care costs by earlier diagnosis, improved patient outcomes and quality of life, as well as by avoidance of unnecessary use of resources. Economical evidence suggests their potential to reduce health care costs if the incremental cost-effectiveness ratio or the willingness-to-pay does not surpass £20,000/QALY or €50,000 limit per 20,000 patients, respectively. The cost-effectiveness of these solutions increases when applied to high-risk patients.

Use, cost, and digital divide in online public health care: lessons from Denmark

2019 ◽  
Vol 13 (2) ◽  
pp. 197-211 ◽  
Author(s):  
Kim Normann Andersen ◽  
Jeppe Agger Nielsen ◽  
Soonhee Kim
Keyword(s):  
Health Care ◽  
Digital Divide ◽  
Health Care Costs ◽  
Online Communication ◽  
Population Data ◽  
Public Health Care ◽  
Content Type ◽  
Health Related ◽  
Use Of The Internet ◽  
Care Costs

Purpose The purpose of this paper is to enhance the knowledge about the use of online communication between patients and health-care professionals in public health care. The study explores digital divide gaps and the impacts of online communication on the overall costs of health care. Design/methodology/approach This study focuses on online health care in Denmark. The authors rely on population data from 3,500 e-visits (e-mail consultations) between patients and general practitioners (GPs) from 2009 to 2015. Additionally, they include survey data on the use of the internet to search for health-related information. Findings The analysis of the Danish data reveals a rapid uptake in the use of the internet to search for health-related information and a three-fold increase in e-visits from 2009 to 2015. The results show that the digital divide gaps exist also in the online health-care communication. Further, the study findings suggest that enforced supply of online communication between GPs and patients does not alleviate the costs. Rather, the number of visits to GPs has not been decreased significantly and health-care costs showing a marginal increase. Research limitations/implications Further data should be collected and analyzed to explore the impacts of other institutional factors and population cohort on the digital divide and healthcare costs. Also, it is difficult to estimate whether the increased use of online health care in the long run lead to lowering overall health-care costs. While the internal validity of the study is high due to the use of population data, the external validity is lower as the study results are based on the data collected in Denmark only. Practical implications The study offers important input for practice. First, leaders in government might reconsider how they can control the health-care costs when opening online channels for communication between patients and doctors. Second, concerns about digital divide issues remains, but the study suggests that the uptake of e-visits does not widen the socio-economic, gender or age gaps. For health policy concern, this is encouraging news to lead to an increasing push of online communication. Social implications The dynamics of online health-care communication may lead to mixed results and unexpected impacts on overall health-care costs. Originality/value The paper offers new insights in the impacts of mandatory supply of digital services. The Danish push-strategy has led to an enforced supply of e-visits and a rapid growing use of the online health care without widening digital divide but at the risk of potential increasing the overall costs.

scholarly journals Cerebral palsy in Canada, 2011-2031: results of a microsimulation modelling study of epidemiological and cost impacts

2020 ◽  
Vol 40 (2) ◽  
pp. 25-37
Author(s):  
Nana Amankwah ◽  
Maryam Oskoui ◽  
Rochelle Garner ◽  
Christina Bancej ◽  
Douglas G. Manuel ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Cerebral Palsy ◽  
Health Care Costs ◽  
Health Related Quality ◽  
Incidence And Mortality ◽  
Related Quality ◽  
Health Related ◽  
Care Costs

Introduction The objective of our study was to present model-based estimates and projections on current and future health and economic impacts of cerebral palsy in Canada over a 20-year time horizon (2011–2031). Methods We used Statistics Canada’s Population Health Model (POHEM)–Neurological to simulate individuals’ disease states, risk factors and health determinants and to describe and project health outcomes, including disease incidence, prevalence, life expectancy, health-adjusted life expectancy, health-related quality of life and health care costs over the life cycle of Canadians. Cerebral palsy cases were identified from British Columbia’s health administrative data sources. A population-based cohort was then used to generate the incidence and mortality rates, enabling the projection of future incidence and mortality rates. A utility-based measure (Health Utilities Index Mark 3) was also included in the model to reflect various states of functional health to allow projections of health-related quality of life. Finally, we estimated caregiving parameters and health care costs from Canadian national surveys and health administrative data and included them as model parameters to assess the health and economic impact of cerebral palsy. Results Although the overall crude incidence rate of cerebral palsy is projected to remain stable, newly diagnosed cases of cerebral palsy will rise from approximately 1800 in 2011 to nearly 2200 in 2031. In addition, the number of people with the condition is expected to increase from more than 75 000 in 2011 to more than 94 000 in 2031. Direct health care costs in constant 2010 Canadian dollars were about $11 700 for children with cerebral palsy aged 1–4 years versus about $600 for those without the condition. In addition, people with cerebral palsy tend to have longer periods in poorer health-related quality of life. Conclusion Individuals with cerebral palsy will continue to face challenges related to an ongoing need for specialized medical care and a rising need for supportive services. Our study offers important insights into future costs and impacts associated with cerebral palsy and provides valuable information that could be used to develop targeted health programs and strategies for Canadians living with this condition.

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