The Outcome of Health Anxiety in Primary Care. A Two-Year Follow-up Study on Health Care Costs and Self-Rated Health

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.

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Costing Methodology and Key Drivers of Health Care Costs Within Economic Analyses in Musculoskeletal Community and Primary Care Services: A Systematic Review of the Literature

Journal of Primary Care & Community Health ◽

10.1177/2150132719899763 ◽

2020 ◽

Vol 11 ◽

pp. 215013271989976

Author(s):

Roanna Burgess ◽

James Hall ◽

Annette Bishop ◽

Martyn Lewis ◽

Jonathan Hill

Keyword(s):

Primary Care ◽

Health Care ◽

Health Care Costs ◽

Community Settings ◽

Outpatient Visits ◽

Key Drivers ◽

Gp Visits ◽

Economic Analyses ◽

Care Costs

Background: Identifying variation in musculoskeletal service costs requires the use of specific standardized metrics. There has been a large focus on costing, efficiency, and standardized metrics within the acute musculoskeletal setting, but far less attention in primary care and community settings. Objectives: To ( a) assess the quality of costing methods used within musculoskeletal economic analyses based primarily in primary and community settings and ( b) identify which cost variables are the key drivers of musculoskeletal health care costs within these settings. Methods: Medline, AMED, EMBASE, CINAHL, HMIC, BNI, and HBE electronic databases were searched for eligible studies. Two reviewers independently extracted data and assessed quality of costing methods using an established checklist. Results: Twenty-two studies met the review inclusion criteria. The majority of studies demonstrated moderate- to high-quality costing methods. Costing issues included studies failing to fully justify the economic perspective, and not distinguishing between short- and long-run costs. Highest unit costs were hospital admissions, outpatient visits, and imaging. Highest mean utilization were the following: general practitioner (GP) visits, outpatient visits, and physiotherapy visits. Highest mean costs per patient were GP visits, outpatient visits, and physiotherapy visits. Conclusion: This review identified a number of key resource use variables that are driving musculoskeletal health care costs in the community/primary care setting. High utilization of these resources (rather than high unit cost) appears to be the predominant factor increasing mean health care costs. There is, however, need for greater detail with capturing these key cost drivers, to further improve the accuracy of costing information.

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Health care costs of depression in primary care patients in The Netherlands

Family Practice ◽

10.1093/fampra/cmq033 ◽

2010 ◽

Vol 27 (5) ◽

pp. 542-548 ◽

Cited By ~ 10

Author(s):

J. E. Bosmans ◽

M. C. de Bruijne ◽

M. R. de Boer ◽

H. van Hout ◽

P. van Steenwijk ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

The Netherlands ◽

Health Care Costs ◽

Primary Care Patients ◽

Care Costs

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602 - Follow-Up Ileocolonoscopy is Underused in Crohn's Disease Patients after Ileocecal Resection Despite Higher Total and Inpatient Health Care Costs Compared to Controls without Resection

Gastroenterology ◽

10.1016/s0016-5085(18)30855-2 ◽

2018 ◽

Vol 154 (6) ◽

pp. S-128

Author(s):

Thomas Greuter ◽

Stephan R. Vavricka ◽

Beat Bruengger ◽

Eva Blozik ◽

Jennifer Celeiro ◽

...

Keyword(s):

Health Care ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Health Care Costs ◽

Ileocecal Resection ◽

Care Costs

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Factors contributing to post-stroke health care utilization and costs. Secondary results from the Life After Stroke (LAST) study, a pragmatic randomized controlled trial

10.21203/rs.2.17944/v2 ◽

2020 ◽

Author(s):

Øystein Døhl ◽

Vidar Halsteinli ◽

Torun Askim ◽

Mari Gunnes ◽

Hege Ihle Hansen ◽

...

Keyword(s):

Health Care ◽

Health Care Costs ◽

Gait Speed ◽

Standard Care ◽

Controlled Trial ◽

Health Care Use ◽

Post Stroke ◽

Randomized Controlled ◽

Care Costs

Abstract Background The result from the Life After Stroke (LAST) study showed that an 18-month follow up program as part of the primary health care, did not improve maintenance of motor function for stroke survivors. In this study we evaluated whether the follow-up program could lead to a reduction in the use of health care compared to standard care. Furthermore, we analyse to what extent differences in health care costs for stroke patients could be explained by individual need factors (such as physical disability, cognitive impairment, age, gender and marital status), and we tested whether a generic health related quality of life (HRQoL) is able to predict the utilisation of health care services for patients post-stroke as well as more disease specific indexes. Methods The Last study was a multicentre, pragmatic, single-blinded, randomized controlled trial. Adults (age ≥18 years) with first-ever or recurrent stroke, community dwelling, with modified Rankin Scale <5. The study included 380 persons recruited 10 to 16 weeks post-stroke, randomly assigned to individualized coaching for 18 months (n=186) or standard care (n=194). Individual need was measured by the Motor assessment scale (MAS), Barthel Index, Hospital Anxiety and Depression Scale (HADS), modified Rankin Scale (mRS) and Gait speed. HRQoL was measured by EQ-5D-5L. Health care costs were estimated for each person based on individual information of health care use. Multivariate regression analysis was used to analyse cost differences between the groups and the relationship between individual costs and determinants of health care utilisation. Results There were higher total costs in the intervention group. MAS, Gait speed, HADS and mRS were significant identifiers of costs post-stroke, as was EQ-5D-5L. Conclusion Long term, regular individualized coaching did not reduce health care costs compared to standard care. We found that MAS, Gait speed, HADS and mRS were significant predictors for future health care use. The generic EQ-5D-5L performed equally well as the more detailed battery of outcome measures, suggesting that HRQoL measures may be a simple and efficient way of identifying patients in need of health care after stroke and targeting groups for interventions. Clinical Trial Registration : https://www.clinicaltrials.gov NCT01467206.

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