Assessing direct healthcare costs when restricted to self-reported data: a scoping review

Background In the absence of electronic health records, analysis of direct healthcare costs often relies on resource utilisation data collected from patient-reported surveys. This scoping review explored the availability, use and methodological details of self-reported healthcare service utilisation and cost data to assess healthcare costs in Ireland. Methods Population health surveys were identified from Irish data repositories and details were collated in an inventory to inform the literature search. Irish cost studies published in peer-reviewed and grey sources from 2009 to 2019 were included if they used self-reported data on healthcare utilisation or cost. Two independent researchers extracted studies’ details and the PRISMA-ScR guidelines were used for reporting. Results In total, 27 surveys were identified containing varying details of healthcare utilisation/cost, health status, demographic characteristics and health-related risk and behaviour. Of those surveys, 21 were general population surveys and six were study-specific ad-hoc surveys. Furthermore, 14 cost studies were identified which used retrospective self-reported data on healthcare utilisation or cost from ten of the identified surveys. Nine of these cost studies used ad-hoc surveys and five used data from pre-existing population surveys. Compared to population surveys, ad-hoc surveys contained more detailed information on resource use, albeit with smaller sample sizes. Recall periods ranged from 1 week for frequently used services to 1 year for rarer service use, or longer for once-off costs. A range of perspectives (societal, healthcare and public sector) and costing approaches (bottom-up costing and a mix of top-down and bottom-up) were used. The majority of studies (n = 11) determined unit prices using multiple sources, including national healthcare tariffs, literature and expert views. Moreover, most studies (n = 13) reported limitations concerning data availability, risk of bias and generalisability. Various sampling, data collection and analysis strategies were employed to minimise these. Conclusion Population surveys can aid cost assessments in jurisdictions that lack electronic health records, unique patient identifiers and data interoperability. To increase utilisation, researchers wanting to conduct cost analyses need to be aware of and have access to existing data sources. Future population surveys should be designed to address reported limitations and capture comprehensive health-related, demographic and resource use data.

Cost analysis of chronic obstructive pulmonary disease (COPD): a systematic review

Background Chronic Obstructive Pulmonary Disease (COPD) is a treatable disease with a high prevalence, and high morbidity associated with significant socioeconomic costs. Objective To carry out a systematic review of the literature to analyze the main cost studies associated with COPD, in order to determine the main factors that influence the costs of the disease. Methods Searches were conducted in PubMed, SCOPUS and Web of Science databases for cost studies on COPD published in English, between the years 2015 and 2020. The search terms were “COPD” OR “pulmonary disease, chronic obstructive”, “cost*” OR “cost of illness”, “economic impact” AND “burden of disease”. The inclusion criteria included the identification of reported cost of the disease, economic burden, medical care expenses or use resources for COPD, the methodology used, data sources, and variables studied. Results 18 publications were analyzed: 17 included direct health costs, 6 included direct non-medical costs, 12 analyzed indirect costs and two reported intangible costs. Most of the studies reported data for developed and European countries, with direct costs being the most studied. Trends were observed in multiple studies of direct and healthcare costs for European countries measured by patient and year, where the higher costs were associated with more severe COPD and a frequent history of exacerbations. The highest costs reported corresponded to hospitalizations and the associated pharmacological treatment. The importance of the loss of productivity and premature retirement within the profile of the COPD patient was also highlighted as the main generator of indirect costs of the disease. Conclusion COPD generates substantial costs for the health system, mainly related to moderate to severe stages and the exacerbations and complications entailed. It is important to strengthen health systems with monitoring, evaluation and health education models that allow these patients to remain stable to avoid decompensation and subsequent hospitalizations.

The Excess Costs of Dementia: A Systematic Review and Meta-Analysis

Background: Dementia is one of the costliest diseases for health care systems with growing importance for policy makers. Objective: The aim of this study is to systematically review the current literature of excess cost studies for dementia and to analyze excess costs in a meta-analysis. Methods: A systematic literature search was conducted in PubMed, EconLit, NHS-EED, and Cochrane Library. 22 studies were included and assigned to one of three subgroups according to the time period that they analyzed during disease progression: the time of diagnosis, the time between diagnosis and death, and the time prior to death. Excess costs were analyzed using the ratio of means (ROM) and meta-analysis was performed by pooling ROMs in a random effects model. Results: Total costs were significantly higher for demented persons compared to non-demented persons at the time of diagnosis (ROM: 2.08 [1.71, 2.54], p < 0.00001, I 2 = 98%) and in the time period between diagnosis and death (ROM: 2.19 [1.97, 2.44], p < 0.00001, I 2 = 100%). The ROM was highest for professional home care (ROM: 4.96 [2.62, 9.40], p < 0.0001, I 2 = 88%) and for nursing facilities (ROM: 4.02 [2.53, 6.40], p < 0.00001, I 2 = 100%) for the time period between diagnosis and death. Conclusion: This meta-analysis is the first to assess excess costs of dementia by the ROM method on a global scale. We conclude that our findings demonstrate that costs of dementia constitute a substantial economic burden.

Economic Burden of Stroke Disease: A Systematic Review

Globally, one of the main causes of non-communicable disease as a cause of death every year is stroke. The objective of this study was to analyze the burden in consequence of stroke. This research used a systematic review method. Furthermore, a search for articles was carried out in June–July 2020. Four databases were used to search articles from 2015 to 2020. Eligible studies were identified, analyzed, and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The inclusion criteria were prospective cost studies, retrospective cost studies, database analysis, mathematical models, surveys, and COI studies that assess burden of stroke in primary and referral healthcare (hospital-based). The results showed that from four databases, 9270 articles were obtained, and 13 articles were qualified. A total of 9270 articles had the identified search keywords, but only 13 articles met the set criteria for inclusion. The criteria for inclusion were stroke patients, the economic burden of stroke disease based on cost of illness method, which is approximately equal to USD 1809.51–325,108.84 (direct costs 86.2%, and indirect costs 13.8%). Those that used the health expenditure method did not present the total cost; instead, only either direct or indirect cost of health expenditure were reported. For most hospital admissions due to stroke, LOS (length of stay) was the dominant cost. The high economic burden to manage stroke justifies the promotion and preventive efforts by the policymakers and motivates the practice of healthy lifestyles by the people.

A MODEL TO ASSESS THE MAINTENANCE LEANNESS OF APPAREL INDUSTRY BUILDINGS IN SRI LANKA

Escalating needs of availability in built environments have pursued maintenance to be recognized with the strategic importance notwithstanding the conventional belief of necessary evil. Nevertheless, it absorbs the three-quarters of whole building lifecycle cost. Studies proved that proportion significantly contributed by inefficiencies owing to poor maintenance, lack of reliability focus, poor management commitment, technical and human resources-related issues. Consequently, Sri Lankan buildings opted to adopt numerous strategic management approaches such as Lean, Six-Sigma to acquire the higher status of efficiency and effectiveness in their operations. Simultaneously, adherence to lean concepts was apparent in Sri Lankan manufacturing context, relatively fewer attempts were made on establishing assessment procedures to distinguish the degree of leanness. Hence, research was focused on developing an assessment model to address the leanness levels in maintenance operations. Lean quantification metric “Leanness” in maintenance is defined through identified parameters in literature and those were narrowed down into seven (7) leanness criteria and further expanded into forty-two (42) leanness attributes paving a pathway to the formation of a theoretical assessment model. For the investigation, nine semi-structured interviews were conducted from three identical cases. The derived data were analysed using the manual content analysis technique. Empirical findings revealed satisfactory adherence scoring the thirty-eight (38) attributes accomplishment as the highest and twenty-five (25) as the least. Findings point out significant gaps in lack incorporation of planned maintenance programs with maintenance inventory-related aspects, lack of undertakings on extensive reliability analysis efforts for maintenance activities. The outcomes will mark valuable insights for building practitioners to engage in maintenance operations in a versatile manner to acquire a waste-free, quality, stakeholder-driven maintenance environment.

Do remote dialysis services really cost more? An economic analysis of hospital and dialysis modality costs associated with dialysis services in urban, rural and remote settings

Background Rates of end-stage kidney disease in Australia are highest in the Northern Territory (NT), with the burden of disease heaviest in remote areas. However, the high cost of delivering dialysis services in remote areas has resulted in centralisation, requiring many people to relocate for treatment. Patients argue that treatment closer to home improves health outcomes and reduces downstream healthcare use. Existing dialysis cost studies have not compared total health care costs associated with treatment in different locations. Objective To estimate and compare, from a payer perspective, the observed health service costs (all cause hospital admissions, emergency department presentations and maintenance dialysis) associated with different dialysis models in urban, rural and remote locations. Methods Using cost weights attributed to diagnostic codes in the NT Department of Health’s hospital admission data set (2008–2014), we calculated the mean (SD) total annual health service costs by dialysis model for 995 dialysis patients. Generalized linear modeling with bootstrapping tested the marginal cost differences between different explanatory variables to estimate ‘best casemix’/‘worst casemix’ cost scenarios. Results The mean annual patient hospital expenditure was highest for urban models at $97 928 (SD $21 261) and $43 440 (SD $5 048) and lowest for remote at $19 584 (SD $4 394). When combined with the observed maintenance dialysis costs, expenditure was the highest for urban models at $148 510 (SD $19 774). The incremental cost increase of dialysing in an urban area, compared with a rural area, for a relocated person from a remote area, was $5 648 more and increased further for those from remote and very remote areas to $10 785 and $15 118 respectively. Conclusions This study demonstrates that dialysis treatment in urban areas for relocated people has health and cost implications that maybe greater than the cost of remote service delivery. The study emphasises the importance of considering all health service costs and cost consequences of service delivery models. Key points for decision makers Relocation for dialysis treatment has serious health and economic consequences. Relocated people have low dialysis attendance and high hospital costs in urban areas. While remote dialysis service models are more expensive than urban models, the comparative cost differences are significantly reduced when all health service costs are included. The delivery of equitable and accessible dialysis service models requires a holistic approach that incorporates the needs of the patient; hence dialysis cost studies must consider the full range of cost impacts beyond the dialysis treatments alone.

Protecting local water quality has global benefits

Surface water is among Earth’s most important resources. Yet, benefit–cost studies often report that the costs of water quality protection exceed its benefits. One possible reason for this seeming paradox is that often only a narrow range of local water quality benefits are considered. In particular, the climate damages from water pollution have rarely been quantified. Recent advances in global water science allow the computation of the global methane emission from lakes caused by human nutrient enrichment (eutrophication). Here, we estimate the present value of the global social cost of eutrophication-driven methane emissions from lakes between 2015 and 2050 to be $7.5–$81 trillion (2015 $US), and in a case-study for one well-studied lake (Lake Erie) we find the global value of avoiding eutrophication exceeds local values of either beach use or sport fishing by 10-fold.

245 Equine research programs: Where are they going?

Those in the equine community have a strong desire for knowledge in the quest to provide the best care for their horses. Unfortunately, they often seek out advice through on-line sources and are quick to take anecdotal evidence or testimonials as fact. While those in the scientific community would encourage decisions to be made based upon quality research, often there are insufficient data available to answer questions posed by the industry. One of the reasons for this is limited resources. In the past it was common to have departmental-funded assistantships for graduate students. However, those assistantships have disappeared in many departments and now students are often supported through grants. Likewise, there is additional pressure by administrators for federal funding though “horse research” is often considered less important to such funding agencies as horses are viewed as recreational animals as opposed to being a food-producing animals. Hence, much funded equine research would fall under the category of product-testing. While somewhat limited in scope, such research may provide the opportunity to answer other research questions if projects are appropriately planned. However, such “side-projects” are only useful if adequate subject numbers and controls are in place. Reduced animal availability and increased costs of utilizing horses in research may necessitate using other animal models for horses to answer fundamental questions and, if appropriately designed, may allow projects to be competitive for federal funding. Especially as it pertains to junior faculty, collaborative research utilizing colleagues with specialized skills can be important in terms of promoting competitive and fundamental research proposals. While limited resources may increase the appeal for low-cost studies, there is still a need for well-designed studies that answer questions critical to the horse industry and doing quality research is important to enhance the reputation of equine research.

Approximately self-consistent ensemble density functional theory: toward inclusion of all correlations

Recent theory developments in ensemble density functional theory (EDFT) promise to bring decades of work for ground-states to the practical resolution of excited-states - provided newly-discovered "density-driven correlations" can be dealt with and adequate effective potentials can be found. This Letter introduces simple theories for both; and shows that EDFT using these theories outperforms ΔSCF DFT and time-dependent DFT for low-lying gaps in most of the small atoms and molecules tested, even when all use the same density functional approximations. It thus establishes EDFT as a promising tool for low-cost studies of excited states; and provides a clear route to practical EDFT implementation of arbitrary functional approximations.<br><br>

Approximately self-consistent ensemble density functional theory: toward inclusion of all correlations

Recent theory developments in ensemble density functional theory (EDFT) promise to bring decades of work for ground-states to the practical resolution of excited-states - provided newly-discovered "density-driven correlations" can be dealt with and adequate effective potentials can be found. This Letter introduces simple theories for both; and shows that EDFT using these theories outperforms ΔSCF DFT and time-dependent DFT for low-lying gaps in most of the small atoms and molecules tested, even when all use the same density functional approximations. It thus establishes EDFT as a promising tool for low-cost studies of excited states; and provides a clear route to practical EDFT implementation of arbitrary functional approximations.<br><br>