The Economic Burden of Vertigo: Results From the Hospitalized and Outpatients

Objective: Vertigo and dizziness are the common presenting concerns in emergency departments and outpatient clinics, accounts for approximately 15% to 20% of adults annually. We aimed to evaluate economic burden of vertigo on health-care system and work productivity in association between clinic characteristics of in- or outpatients. Methods: A total number of 2289 patients diagnosed with peripheric (noncentral) vertigo were evaluated retrospectively. The direct medical costs associated with vertigo classified as medication, consumable, imaging, and laboratory. In addition, the indirect costs were associated with lost working days. The overall economic impact of vertigo assessed via total expenditure for diagnosis and treatment. Results: The mean duration of hospitalization was 5.6 ± 4.3 days and working day lost was 9.47 ± 3.90 days. The overall impact on work productivity of disease was 15.35 ± 6.11 days. The overall mean direct cost including all expenditure items associated with vertigo care was $250.25 ± $1479.62 per patient. The overall cost associated with vertigo was found to be statistically increased in the male, aged ≥65 years, widow or divorced, and hospitalized patients. Conclusions: Our findings clearly indicate that a vertigo–dizziness management program based on patients’ risk factors may achieve to reduce hospitalizations and cost of hospital care as well.

Download Full-text

The Economic Burden of Coronavirus Disease 2019 (COVID-19): Evidence from Iran

10.21203/rs.3.rs-60500/v1 ◽

2020 ◽

Author(s):

Mohsen Ghaffari Darab ◽

Khosro Keshavarz ◽

Elnaz Sadeghi ◽

Javad Shahmohamadi ◽

Zahra Kavosi

Keyword(s):

Economic Burden ◽

Indirect Costs ◽

Premature Death ◽

University Hospital ◽

Fars Province ◽

Income Loss ◽

Cross Sectional ◽

Accounting Information Systems ◽

Economic Production ◽

The Mean

Abstract This study aimed to estimate both direct medical and indirect costs of treating the Coronavirus disease 2019 (COVID-19) from a societal perspective in the patients at a referral hospital in Fars province as well as the economic burden of COVID-19 in Iran in 2020.Methods:This is a partial economic evaluation and a cross-sectional cost-description study conducted descriptively-analytically and based on the data of the COVID-19 patients referred to a referral university hospital in Fars province between March and July 2020. The data were collected by examining the patients' records and accounting information systems. The subjects included all the inpatients with COVID-19 (477 individuals) who admitted to the medical centre during the four months. Bottom-up costing, incidence-based and income-based human capital approaches were used as the main methodological features of this study.Results: The mean direct medical costs were estimated 28,240,025,968 Rials ($ 1,791,172) in total and 59,203,409 Rials ($ 3,755) per person, a significant part of which (41 %) was that of intensive and general care beds (11,596,217,487 Rials equal to $ 735,510. (The second to which were the costs of medicines and medical consumables (28 %). The mean indirect costs including income loss due to premature death, economic production loss due to hospitalization and job absenteeism during recovery course were estimated 129,870,974 Rials ($ 11634) per person. Furthermore, the economic burden of the disease in the country for inpatient cases with the definitive diagnosis was 22,688,925,933,095 Rial equal to $ 1,439,083,784.Conclusion: The results of this study showed that the severe status of the disease would bring about the extremely high cost of illness in this case. It is estimated that the high prevalence rate of COVID-19 has been imposing a heavy economic burden on the country and health system directly that may result in rationing or painful cost-control approaches.

Download Full-text

Rethinking the economic costs of hospitalization for malaria: accounting for the comorbidities of malaria patients in western Kenya

Malaria Journal ◽

10.1186/s12936-021-03958-x ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Caroline Watts ◽

Harrysone Atieli ◽

Jason Alacapa ◽

Ming-Chieh Lee ◽

Guofa Zhou ◽

...

Keyword(s):

Health System ◽

Economic Burden ◽

Indirect Costs ◽

Malaria Diagnosis ◽

Medical Costs ◽

Malaria Episode ◽

Economic Costs ◽

Western Kenya ◽

The Mean ◽

Household Costs

Abstract Background Malaria causes significant mortality and morbidity in sub-Saharan Africa, especially among children under five years of age and places a huge economic burden on individuals and health systems. While this burden has been assessed previously, few studies have explored how malaria comorbidities affect inpatient costs. This study in a malaria endemic area in Western Kenya, assessed the total treatment costs per malaria episode including comorbidities in children and adults. Methods Total economic costs of malaria hospitalizations were calculated from a health system and societal perspective. Patient-level data were collected from patients admitted with a malaria diagnosis to a county-level hospital between June 2016 and May 2017. All treatment documented in medical records were included as health system costs. Patient and household costs included direct medical and non-medical expenses, and indirect costs due to productivity losses. Results Of the 746 patients admitted with a malaria diagnosis, 64% were female and 36% were male. The mean age was 14 years (median 7 years). The mean length of stay was three days. The mean health system cost per patient was Kenyan Shilling (KSh) 4288 (USD 42.0) (95% confidence interval (CI) 95% CI KSh 4046–4531). The total household cost per patient was KSh 1676 (USD 16.4) (95% CI KSh 1488–1864) and consisted of: KSh 161 (USD1.6) medical costs; KSh 728 (USD 7.1) non-medical costs; and KSh 787 (USD 7.7) indirect costs. The total societal cost (health system and household costs) per patient was KSh 5964 (USD 58.4) (95% CI KSh 5534–6394). Almost a quarter of patients (24%) had a reported comorbidity. The most common malaria comorbidities were chest infections, diarrhoea, and anaemia. The inclusion of comorbidities compared to patients with-out comorbidities led to a 46% increase in societal costs (health system costs increased by 43% and patient and household costs increased by 54%). Conclusions The economic burden of malaria is increased by comorbidities which are associated with longer hospital stays and higher medical costs to patients and the health system. Understanding the full economic burden of malaria is critical if future malaria control interventions are to protect access to care, especially by the poor.

Download Full-text

Indirect costs attributed to headache: A nation-wide survey of an active working population

Cephalalgia ◽

10.1177/03331024211043795 ◽

2021 ◽

pp. 033310242110437

Author(s):

Raquel Gil-Gouveia ◽

Raquel Miranda

Keyword(s):

Economic Burden ◽

Migraine Headache ◽

Productivity Loss ◽

Work Productivity ◽

Indirect Costs ◽

Headache Disorder ◽

Point Prevalence ◽

Work Loss ◽

Convenience Sample ◽

Nation Wide Survey

Background The economic burden of headache in European countries is substantial, mostly related to indirect work-productivity loss costs, yet data for Portugal is scarce. Methods An anonymous web-based survey of headache was distributed to a convenience sample of Portuguese companies’ workforces, to assess last-year headache and “yesterday”-point prevalence. Preexisting headaches were classified into migraine and non-migraine headache and work impact (absenteeism and presenteeism) was evaluated in relation to point prevalence. If no significant selection biases were detected, projected work-loss costs for the whole country were to be calculated. Results Eleven (17%) of 65 invited companies participated, around 15,000 active workers were exposed to the survey and 3624 (24.3%) responded, 73% females, 84.3% with previous (“last-year”) headaches, 53% with migraine. Due to participation and gender bias, national cost-projections were not calculated. Workday point-prevalence was 21% (migraine) and 9% (non-migraine headache), resulting in 14 employees with migraine losing, on average, 4 h and 32 min of work time. Presenteeism occurred in 29% of migraine and 15% of NMH employees. Yearly cost of each employee with a headache disorder was €664.88. Discussion Headache has a significant economic burden, as measured by work loss costs, in Portugal. Company-based interventions should aim to support employees’ access to headache diagnosis and treatment, including non-pharmacological coping strategies, in order to reduce headache related economic costs.

Download Full-text

Methodological considerations in the assessment of direct and indirect costs of back pain: A systematic scoping review

PLoS ONE ◽

10.1371/journal.pone.0251406 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0251406

Author(s):

Dawit T. Zemedikun ◽

Jesse Kigozi ◽

Gwenllian Wynne-Jones ◽

Alessandra Guariglia ◽

Tracy Roberts

Keyword(s):

Back Pain ◽

Economic Burden ◽

Methodological Approach ◽

Work Productivity ◽

Indirect Costs ◽

Case Definition ◽

Cost Estimates ◽

Direct And Indirect Costs ◽

Per Capita ◽

Reported Data

Background Back pain is a common and costly health problem worldwide. There is yet a lack of consistent methodologies to estimate the economic burden of back pain to society. Objective To systematically evaluate the methodologies used in the published cost of illness (COI) literature for estimating the direct and indirect costs attributed to back pain, and to present a summary of the estimated cost burden. Methods Six electronic databases were searched to identify COI studies of back pain published in English up to February 2021. A total of 1,588 abstracts were screened, and 55 full-text studies were subsequently reviewed. After applying the inclusion criteria, 45 studies pertaining to the direct and indirect costs of back pain were analysed. Results The studies reported data on 15 industrialised countries. The national cost estimates of back pain in 2015 USD ranged from $259 million ($29.1 per capita) in Sweden to $71.6 billion ($868.4 per capita) in Germany. There was high heterogeneity among the studies in terms of the methodologies used for analysis and the resulting costs reported. Most of the studies assessed costs from a societal perspective (n = 29). The magnitude and accuracy of the reported costs were influenced by the case definition of back pain, the source of data used, the cost components included and the analysis method. Among the studies that provided both direct and indirect cost estimates (n = 15), indirect costs resulting from lost or reduced work productivity far outweighed the direct costs. Conclusion Back pain imposes substantial economic burden on society. This review demonstrated that existing published COI studies of back pain used heterogeneous approaches reflecting a lack of consensus on methodology. A standardised methodological approach is required to increase credibility of the findings of COI studies and improve comparison of estimates across studies.

Download Full-text

Clinical characteristics of COVID-19 patients admitted at the Korle-Bu Teaching Hospital, Accra, Ghana

Ghana Medical Journal ◽

10.4314/gmj.v54i4s.6 ◽

2020 ◽

Vol 54 (4s) ◽

pp. 33-38

Author(s):

Patrick Adjei ◽

Jane Afriyie-Mensah ◽

Vincent J. Ganu ◽

Peter Puplampu ◽

Bismark Opoku-Asare ◽

...

Keyword(s):

Diabetes Mellitus ◽

Teaching Hospital ◽

Chart Review ◽

Data Extraction ◽

Treatment Center ◽

Presenting Symptoms ◽

Duration Of Hospitalization ◽

The Common ◽

The Mean ◽

Prompt Attention

Design: Study design was a retrospective single-center review of hospital data.Setting: The study was conducted at the COVID-19 Treatment Center of the Department of Medicine and Therapeutics of the Korle-Bu Teaching hospital in Accra, Ghana.Participants and study tools: A total of fifty patients with laboratory (rRT-PCR) confirmed COVID-19 infection were involved in the study. A chart review of the medical records of the patients was conducted and the data obtained was documented using a data extraction form.Results: The median age was 53 years and most (36% (18/50)) of the patients were at least 60 years of age. Eighty percent (40/50) of the patients were symptomatic, with cough and difficulty in breathing being the commonest presenting symptoms. The mean duration of hospitalization was 12.3 ± 7.3 days. Hypertension and Diabetes Mellitus were the commonest co-morbidities occurring in 52% (26/50) and 42% (21/50) of patients respectively. Fifty percent of patients developed COVID-19 pneumonia as a complication. The mortality rate was 12% (6/50).Conclusion: In this study, SARS-CoV2 infection affected older adults with hypertension and diabetes mellitus being the common comorbidities. Patients with these comorbid conditions should be counselled by their clinicians to strictly observe the COVID-19 prevention protocols to reduce their risk of acquiring the infection. There is a need to pay critical and prompt attention to the management of patients with COVID-19 pneumonia particularly among people with diabetes to improve outcomes.

Download Full-text

Rethinking the Economic Costs of Hospitalisation for Malaria: Accounting for the Comorbidities of Malaria Patients in Western Kenya

10.21203/rs.3.rs-561893/v1 ◽

2021 ◽

Author(s):

Caroline Watts ◽

Harrysone Atieli ◽

Jason Alacapa ◽

Ming-Chieh Lee ◽

Guofa Zhou ◽

...

Keyword(s):

Health System ◽

Economic Burden ◽

Indirect Costs ◽

Malaria Diagnosis ◽

Medical Costs ◽

Malaria Episode ◽

Economic Costs ◽

Western Kenya ◽

The Mean ◽

Household Costs

Abstract BackgroundMalaria causes significant mortality and morbidity in sub-Saharan Africa, especially among children under five years of age and places a huge economic burden on individuals and health systems. While this burden has been assessed previously, few studies have explored how malaria comorbidities affect inpatient costs. This study in a malaria endemic area in Western Kenya, assessed the total treatment costs per malaria episode including comorbidities in children and adults.MethodsTotal economic costs of malaria hospitalisations were calculated from a health system and societal perspective. Patient-level data were collected from patients admitted with a malaria diagnosis to a county-level hospital between June 2016 and May 2017. All treatment documented in medical records were included as health system costs. Patient and household costs included direct medical and non-medical expenses, and indirect costs due to productivity losses.ResultsOf the 746 patients admitted with a malaria diagnosis, 64% were female and 36 % were male. The mean age was 14 years (median 7 years). The mean length of stay was three days. The mean health system cost per patient was Kenyan Shilling (KSh) 4,288 (USD 42.0) (95% confidence interval (CI) 95%CI KSh 4,046-4,531). The total household cost per patient was KSh 1,676 (USD 16.4) (95%CI KSh 1,488-1,864) and consisted of: KSh 161 (USD1.6) medical costs; KSh 728 (USD 7.1) non-medical costs; and KSh 787 (USD 7.7) indirect costs. The total societal cost (health system and household costs) per patient was KSh 5,964 (USD 58.4) (95%CI KSh 5,534- 6,394). Almost a quarter of patients (24%) had a reported comorbidity. The most common malaria comorbidities were chest infections, diarrhoea, and anaemia. The inclusion of comorbidities compared to patients with-out comorbidities led to a 46% increase in societal costs (i.e. health system costs increased by 43% and patient and household costs increased by 54%). ConclusionsThe economic burden of malaria is increased by comorbidities which are associated with longer hospital stays and higher medical costs to patients and the health system. Understanding the full economic burden of malaria is critical if future malaria control interventions are to protect access to care, especially by the poor.

Download Full-text

Clinical, humanistic, and economic burden of severe hemophilia B in the United States: Results from the CHESS US and CHESS US+ population surveys

Orphanet Journal of Rare Diseases ◽

10.1186/s13023-021-01774-9 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Tom Burke ◽

Sohaib Asghar ◽

Jamie O’Hara ◽

Eileen K. Sawyer ◽

Nanxin Li

Keyword(s):

United States ◽

Economic Burden ◽

Indirect Costs ◽

The United States ◽

Factor Ix ◽

Hemophilia B ◽

Patient Records ◽

Severe Hemophilia ◽

The Us ◽

The Mean

Abstract Background Hemophilia B is a rare congenital bleeding disorder that has a significant negative impact on patients’ functionality and health-related quality of life. The standard of care for severe hemophilia B in the United States is prophylactic factor IX replacement therapy, which incurs substantial costs for this lifelong condition. Accurate estimates of the burden of hemophilia B are important for population health management and policy decisions, but have only recently accounted for current management strategies. The ‘Cost of Severe Hemophilia across the US: a Socioeconomic Survey’ (CHESS US) is a cross-sectional database of medical record abstractions and physician-reported information, completed by hematologists and care providers. CHESS US+ is a complementary database of completed questionnaires from patients with hemophilia. Together, CHESS US and CHESS US+ provide contemporary, comprehensive information on the burden of severe hemophilia from the provider and patient perspectives. We used the CHESS US and CHESS US+ data to analyze the clinical, humanistic, and economic burden of hemophilia B for patients treated with factor IX prophylaxis between 2017 and 2019 in the US. Results We conducted analysis to assess clinical burden and direct medical costs from 44 patient records in CHESS US, and of direct non-medical costs, indirect costs, and humanistic burden (using the EQ-5D-5L) from 57 patients in CHESS US+. The mean annual bleed rate was 1.73 (standard deviation, 1.39); approximately 9% of patients experienced a bleed-related hospitalization during the 12-month study period. Nearly all patients (85%) reported chronic pain, and the mean EQ-5D-5L utility value was 0.76 (0.24). The mean annual direct medical cost was $614,886, driven by factor IX treatment (mean annual cost, $611,971). Subgroup analyses showed mean annual costs of $397,491 and $788,491 for standard and extended half-life factor IX treatment, respectively. The mean annual non-medical direct costs and indirect costs of hemophilia B were $2,371 and $6,931. Conclusions This analysis of patient records and patient-reported outcomes from CHESS US and CHESS US+ provides updated information on the considerable clinical, humanistic, and economic burden of hemophilia B in the US. Substantial unmet needs remain to improve patient care with sustainable population health strategies.

Download Full-text

The Economic Burden of Coronavirus Disease 2019 (COVID-19): Evidence from Iran

10.21203/rs.3.rs-80962/v1 ◽

2020 ◽

Author(s):

Mohsen Ghaffari Darab ◽

Khosro Keshavarz ◽

Elnaz Sadeghi ◽

Javad Shahmohamadi ◽

Zahra Kavosi

Keyword(s):

Economic Burden ◽

Indirect Costs ◽

Premature Death ◽

University Hospital ◽

Fars Province ◽

Income Loss ◽

Cross Sectional ◽

Accounting Information Systems ◽

Economic Production ◽

The Mean

Abstract This study aimed to estimate both direct medical and indirect costs of treating the Coronavirus disease 2019 (COVID-19) from a societal perspective in the patients at a referral hospital in Fars province as well as the economic burden of COVID-19 in Iran in 2020.Methods:This study is a partial economic evaluation and a cross-sectional cost-description study conducted descriptively-analytically and based on the data of the COVID-19 patients referred to a referral university hospital in Fars province between March and July 2020. The data were collected by examining the patients' records and accounting information systems. The subjects included all the inpatients with COVID-19 (477 individuals) who admitted to the medical centre during the four months. Bottom-up costing, incidence-based and income-based human capital approaches were used as the main methodological features of this study.Results: The mean direct medical costs were estimated 28,240,025,968 Rials ($ 1,791,172) in total and 59,203,409 Rials ($ 3,755) per person, a significant part of which (41 %) was that of intensive and general care beds (11,596,217,487 Rials equal to $ 735,510. (The second to which were the costs of medicines and medical consumables (28 %). The mean indirect costs, including income loss due to premature death, economic production loss due to hospitalization and job absenteeism during recovery course were estimated 129,870,974 Rials ($ 11634) per person. Furthermore, the economic burden of the disease in the country for inpatient cases with the definitive diagnosis was 22,688,925,933,095 Rial equal to $ 1,439,083,784.Conclusion: The results of this study showed that the severe status of the disease would bring about the extremely high cost of illness in this case. It is estimated that the high prevalence rate of COVID-19 has been imposing a heavy economic burden on the country and health system directly that may result in rationing or painful cost-control approaches.

Download Full-text

Comparison of Heffner Criteria and Light Criteria in Differentiating Exudative and Transudative Pleural Effusion

Nepal Medical College Journal ◽

10.3126/nmcj.v22i3.32638 ◽

2020 ◽

Vol 22 (3) ◽

pp. 141-145

Author(s):

Krishna Chandra Devkota ◽

S Hamal ◽

PP Panta

Keyword(s):

Pleural Effusion ◽

Cross Sectional Study ◽

Pleural Space ◽

Sectional Study ◽

Inclusion Criteria ◽

Cross Sectional ◽

Medical College ◽

The Common ◽

The Mean ◽

Exudative Pleural Effusion

Pleural effusion is present when there is >15ml of fluid is accumulated in the pleural space. It can be divided into two types; exudative and transudative pleural effusion. Tuberculosis and parapneumonic effusion are the common cause of exudative pleural effusion whereas heart failure accounts for most of the cases of transudative pleural effusion. This study was a hospital based cross sectional study performed at Nepal Medical College during the period of January 2016-December 2016. A total of 50 patients who fulfilled the inclusion criteria were enrolled. Pleural effusion was confirmed by clinical examination and radiology. After confirmation of pleural effusion, pleural fluid was aspirated and was analysed for protein, LDH, cholesterol. The Heffner criteria was compared with Light criteria to classify exudative or transudative pleural effusion. Among 50 patients, 30 were male and 20 were female. The mean age of patient was 45.4±21.85 years. The sensitivity and specificity of using Light criteria to detect the two type of pleural effusion was 100% and 90.9%, whereas using Heffner criteria was 94.87%, 100% respectively(P<0.01). There are variety of causes for development of pleural effusion and no one criteria is definite to differentiate between exudative or transudative effusion. In this study Light criteria was more sensitive whereas Heffner criteria was more specific to classify exudative pleural effusion. Hence a combination of criteria might be useful in case where there is difficulty to identify the cause of pleural effusion.

Download Full-text

Of Reformed Versifying

10.1093/oso/9780198704102.003.0005 ◽

2018 ◽

Author(s):

Neil Rhodes

Keyword(s):

Sixteenth Century ◽

Faerie Queene ◽

Classical Literature ◽

Native Form ◽

Christian Doctrine ◽

English Verse ◽

The Common ◽

The Mean ◽

The Faerie Queene ◽

Stylistic Ideal

This chapter examines how the development of English poetry in the second half of the sixteenth century is characterized by the search for an appropriate style. In this context, ‘reformed versifying’ may be understood as a reconciliation of high and low in which the common is reconfigured as a stylistic ideal of the mean. That development can be traced in debates about prosody where an alternative sense of ‘reformed versifying’ as adapting classical metres to English verse is rejected in favour of native form. At the same time Sidney recuperates poetry by reforming it as an agent of virtue. Reformation and Renaissance finally come together in Spenser, who realizes Erasmus’ aim of harmonizing the values of classical literature with Christian doctrine, and reconciles the foreign and the ‘homewrought’. The Faerie Queene of 1590 represents the triumph of the mean in both style and, through its celebration of marriage, in substance.

Download Full-text