Background: In October 2000, 41 people were infected during an outbreak of adenoviral keratoconjunctivitis. Such nosocomial outbreaks are frequently reported in long-term care institutions, even though simple measures...
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Background: In October 2000, 41 people were infected during an outbreak of adenoviral keratoconjunctivitis. Such nosocomial outbreaks are frequently reported in long-term care institutions, even though simple measures to prevent or limit such occurrences are well documented. This study describes the significant direct costs incurred as a result of this nosocomial outbreak that involved patients and staff. Methods: The costs measured in this study were grouped into the following 4 categories: medical, investigative, preventive, and lost productivity. Information about costs incurred by the hospital was gathered from a number of sources. Results: The outbreak cost the hospital US $29,527 ($1085 for medical costs, $8210 for investigative costs, $3048 for preventive measures, and $17,184 for lost productivity). Conclusion: This study demonstrates the substantial expense incurred by 1 hospital as a result of an outbreak of a preventable disease. The measures necessary to prevent such a costly outbreak are simple and, therefore, cost-effective.
作者：
Wong, JBDavis, GLPauker, SGTufts Univ
New England Med Ctr Sch Med Dept MedDiv Clin Decis MakingTupper Res Inst Boston MA 02111 USA Univ Florida
Coll Med Sect Hepatobiliary Dis Gainesville FL USA
PURPOSE: Many patients with chronic hepatitis C who are treated with interferon suffer a relapse after an initial response. About half of these patients have a sustained virological response to retreatment with the co...
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PURPOSE: Many patients with chronic hepatitis C who are treated with interferon suffer a relapse after an initial response. About half of these patients have a sustained virological response to retreatment with the combination of ribavirin and interferon alfa-2b. The aim of this study was to estimate the cost effectiveness of retreatment with combination therapy versus interferon alone for patients who have previously relapsed after interferon. SUBJECTS AND METHODS: Data from a randomized trial among 345 relapsed patients that compared combination therapy with interferon alone were used to project lifelong clinical and economic outcomes. Natural history and economic estimates (discounted at 3% per year) were based upon published literature, expert panel estimates, and cost and reimbursement data. RESULTS: Compared with retreatment with interferon alone, combination therapy should prolong life expectancy by about 2 discounted quality-adjusted life years (3 life years, undiscounted) while increasing costs modestly. The results were robust, maintaining an advantage to combination therapy in sensitivity analysis for all subgroups and with reasonable variations in ail model parameters. CONCLUSION: For patients with chronic hepatitis C who relapse after an initial response to interferon alone, retreatment with the combination of ribavirin and interferon alfa-ab should prolong life and be cost effective. Am J Med. 2000;108: 366-373. (C) 2000 by Excerpta Medica, Inc.
Hepatitis C virus (HCV) infection has emerged as a major health care problem in the US veteran population. The growing awareness of its importance is reflected in the recent mandate by the Department of Veterans Affai...
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Hepatitis C virus (HCV) infection has emerged as a major health care problem in the US veteran population. The growing awareness of its importance is reflected in the recent mandate by the Department of Veterans Affairs to perform HCV testing on all veterans at risk for the disease (1) and to manage patients according to the Center for Disease Control and Prevention guidelines (2). Interferon/ribavirin combination therapy is available to VA patients, and Congress has earmarked $230 million for HCV diagnosis and treatment for the year 2000 VA budget. Gastroenterologists practicing in the VA system have noticed a drastic increase in HCV-related morbidity over the past years. However, the full impact of the disease is unknown. This is due to the lack of epidemiological data that would allow one to estimate the number of affected patients and to calculate the HCV-related expenditures. The study by Ramsey Cheung in this issue of the American Journal of Gastroenterology (3) provides a first systematic and detailed report on HCV antibody seroprevalence, risk factors, genotypes, and age distribution of infected patients. The data were obtained in a retrospective analysis of the Palo Alto VA Healthcare system. Over a period of 6 yr, (1992-1998), approximately one-fifth of the approximately 40,000 veterans living in this predominantly suburban area were tested for HCV antibodies by a second generation ELISA assay. The test was positive in 2985 subjects, corresponding to a point prevalence of 35%. The overwhelming majority of these patients were found to be viremic, as confirmed by PCR analysis. As pointed out by the authors, the high rate of seropositivity is likely to be affected by selection and referral bias, as patients were tested based on the presence of HCV risk factors or abnormal liver tests. To obtain a more representative seroprevalence rate, the author measured HCV antibodies in 126 consecutive patients involved in blood-borne exposure accidents and obtained a pre
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