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Direct costs of ankylosing spondylitis and its determinants:: an analysis among three European countries

ANNALS OF THE RHEUMATIC DISEASES 2003年第8期62卷 732-740页

作者： Boonen, A van der Heijde, D Landewé, R Guillemin, F Rutten-van Mölken, M Dougados, M Mielants, H de Vlam, K van der Tempel, H Boesen, S Spoorenberg, A Schouten, H van der Linden, S Univ Hosp Dept Internal Med Div Rheumatol NL-6202 AZ Maastricht Netherlands Univ Hosp Dept Clin Epidemiol & Eval Nancy France Erasmus Univ Inst Med Technol Assessment Rotterdam Netherlands Univ Paris 05 Dept Rheumatol Hop Cochin Paris France Ghent Univ Hosp Dept Rheumatol B-9000 Ghent Belgium Maasland Ziekenhuis Sittard Sittard Netherlands Univ Maastricht Fac Hlth Sci Maastricht Netherlands Univ Maastricht Dept Methodol & Stat Maastricht Netherlands

Objective: To assess direct costs associated with ankylosing spondylitis (AS). To determine which variables, including country, predict costs. Methods: 216 patients with AS from the Netherlands, France, and Belgium participated in a two year observational study and filled in bimonthly economic questionnaires. Disease related healthcare resource use was measured and direct costs were calculated from a societal perspective (true cost estimates) and from a financial perspective (country-specific tariffs). Predictors of costs were assessed using Cox's regression analysis. Results: 209 patients provided sufficient data for cost analysis. Mean annual societal direct costs for each patient were E2640, of which 82% were direct healthcare costs. In univariate analysis costs were higher in the Netherlands than in Belgium, but this difference disappeared after adjusting for baseline differences in patients' characteristics among countries. Longer disease duration, lower education, worse physical function, and higher disease activity were predictors of costs. Mean annual direct costs from a financial perspective were E2122, E1402, and E941 per patient in the Netherlands, France, and Belgium, respectively. For each country, costs from a financial perspective were significantly lower than costs from a societal perspective. Conclusion: Direct costs for AS are substantial in three European countries but not significantly different after adjusting for baseline characteristics among countries. Worse physical function and higher disease activity are important determinants of costs, suggesting better disease control might reduce the costs of AS. The difference in costs from a societal and financial perspective emphasises the importance of an economic analysis.

关键词：抗风湿药/经济学比利时患病代价直接服务费用/统计学和数值数据药费支出随访研究法国卫生经费支出/统计学和数值数据卫生服务/统计学和数值数据荷兰前瞻性研究疾病严重程度指数脊柱炎强直性/经济学脊柱炎强直性/治疗统计学(主题) 青少年成年人老年人女(雌)性人类男(雄)性中年人

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COMPARING THE COST-EFFECTIVENESS OF DRUG REGIMENS IN THE TREATMENT OF DUODENAL-ULCERS

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JOURNAL OF HEALTH ECONOMICS 1990年第1期9卷 85-101页

作者： SINTONEN, H ALANDER, V HELSINKI SCH ECON SF-00100 HELSINKI FINLAND

This paper compares cost-effectiveness of drug regimens based on omeprazole, ranitidine and sucralfate in the treatment of duodenal ulcers. Measures used were expected total costs and expected healthy days in a six month period after starting treatment. Both measures were calculated by decision tree analysis using healing and relapse probabilities estimated by logit regressions from results of earlier RCTs. Omeprazole and sucralfate regimens tied in the direct C/E comparison and were clearly superior to ranitidine regimens. Yet problems with patient compliance and faster relief from pain/symptoms with omeprazole may contribute to breaking the tie to omeprazole's advantage.

关键词：费用效益分析/统计学和数值数据决策树直接服务费用/统计学和数值数据药物评价/经济学十二指肠溃疡/药物疗法十二指肠溃疡/经济学芬兰 Logistic模型奥美拉唑/治疗应用概率雷尼替丁/治疗应用硫糖铝/治疗应用人类

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A model for calculating costs of hospital wards: an Italian experience.

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Journal of management in medicine 1999年第2-3期13卷 71-82页

作者： Garattini, L. Giuliani, G. Pagano, E. Centre for Health Economics CESAV Mario Negri Institute for Pharmacological Research BG Ranica Italy

Until recently Italian hospitals had no cost accounting or activity data collection systems, being formally required only to do financial book-keeping. The cost analysis method presented here might be used to set up detailed and complete hospital cost accounting, which would permit a better understanding of patterns of resource distribution among departments, better opportunities for cost saving and cost control for hospital managers and health authorities. The study first identified a framework within which to assess the annual cost related to a hospital ward, then calculated the mean bed day cost for each speciality. Cost data were collected over one year in 1996 from manually compiled records, at one local hospital in Northern Italy. Costs were estimated following a step-down allocation method. Wards requiring a major amount of resources per day of stay are intensive cardio-coronary unit (US$650.689), and ophthalmology (US$483.322). The less expensive ward is general medicine (US$148.645). The cost analysis method presented in this study might be used to set a detailed and complete hospital cost database, which is a necessary tool for hospital managers to realise cost control and cost recovery.

关键词：会计学/方法辅助服务医院/经济学病床利用率/经济学费用分配/方法直接服务费用/统计学和数值数据财务管理医院/方法医院费用/统计学和数值数据医院科室/经济学医院专科病房/经济学意大利模型经济计量学门诊部医院/经济学病房/经济学专业医学/经济学

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Impact of patient characteristics, complications, and facility volume on the costs and time of cardiac catheterization and coronary angioplasty in 70 catheterization laboratories

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American Journal of Cardiology 2000年第6期86卷 595-601页

作者： Cohen, David J. Becker, Edmund R. Culler, Steven D. Ellis, Stephen Green, Luann M. Schnitzler, Robert N. Simon, April W. Weintraub, William S. Beth Israel Deaconess Med. Ctr. H. Boston MA United States Dept. of Hlth. Policy and Management Rollins Sch. Pub. Hlth. Emory Univ. Atlanta GA United States The Cleveland Clinic Foundation Cleveland OH United States Dept. Hlthcare. Strategies Programs Boston Scientific Corporation Natick MA United States Southwest Texas Methodist Hospital San Antonio TX United States BSM Consulting Group Tucker GA United States Emory Ctr. for Outcomes Res. (ECOR) Emory University Hospital Atlanta GA United States

Although over 1 million procedures are performed in cardiac catheterization laboratories (CCLs) annually, little comparative data exist on costs or resource use in these settings. In this study, data from 70 CCLs were used to profile CCL times and total direct costs for 2 high-volume procedures: left heart catheterization (LHC) and percutaneous transluminal coronary angioplasty (PTCA) with or without stent placement. In total, 70,677 consecutive patient examinations for a 12-month period from January 1, 1998 to December 31, 1998 were analyzed. For LHC mean total direct costs averaged $306, whereas for PTCA catheterization laboratory costs averaged $3,172. The average total times for these procedures were 63 and 108 minutes, respectively. Seventy-two percent of the PTCA patients underwent coronary stenting with an associated incremental cost of $1,244. By multivariate linear regression, baseline patient characteristics such as age, gender, and clinical factors had little impact on total time and total costs. The major determinants of CCL time and cost were procedural factors (e.g., number and type of interventions) and in-lab complications, including profound hypotension, abrupt vessel closure, and emergency bypass surgery. Using facility procedure volume as a proxy for potential economies of scale, we found no relation between CCL volume and total direct CCL costs. There did appear to be a significant inverse relation between facility volume and total procedural time with CCLs that performed the highest volumes of LHC and PTCA procedures saving an average of 5 to 9 minutes per procedure. These findings may be useful in defining specific time and cost benchmarks for these commonly performed procedures and serve to underscore the critical role of reducing complications in both quality improvement and cost-saving efforts. (C) 2000 by Excerpta Medica, Inc.

关键词：心脏病医疗设施/经济学心脏病医疗设施/统计学和数值数据费用节省/经济学直接服务费用/统计学和数值数据直接服务费用/发展趋势心脏导管插入术/经济学心脏导管插入术/统计学和数值数据回顾性研究女(雌)性人类男(雄)性

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Fiscal outcomes of the closing of central state hospital: An analysis of the costs to state government

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JOURNAL OF BEHAVIORAL HEALTH SERVICES & RESEARCH 1999年第3期26卷 262-275页

作者： Wright, ER Indiana Univ Purdue Univ Dept Sociol Indianapolis IN 46202 USA Indiana Consortium Mental Hlth Serv Res Bloomington IN USA

This study reports estimates of the preclosure and postclosure costs of mental health services for patients directly affected by the closing of Central State Hospital. The data come from state budget documents and from the billing records of the community mental health centers sewing the discharged clients. On average, it cost Indiana approximately $68,347 (in 1995 dollars) to provide 12 months of state hospital care for this client cohort in fiscal year 1993. rn contrast, during the first year following the closure, the average per patient cost to the state was $55,417. When clients were sewed exclusively in community care settings, the average annual per patient cost was $40, 618 The analyses suggest that the closing reduced the costs of caring for this cohort of patients by approximately 18.9%. A significant portion of the cost savings to the state mental health budget was achieved by shifting some of the direct patient care costs to Medicaid/Medicare.

关键词：患病代价费用效益分析成本及成本分析医院外治疗/经济学直接服务费用/统计学和数值数据直接服务费用/发展趋势卫生设施关闭/经济学医院精神病/经济学医院州立/经济学印第安纳最小二乘法分析纵向研究精神障碍/经济学精神卫生服务/经济学多元分析州政府人类

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The cost of health conditions in a health maintenance organization

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MEDICAL CARE RESEARCH AND REVIEW 2000年第1期57卷 92-109页

作者： Ray, GT Collin, F Lieu, T Fireman, B Colby, CJ Quesenberry, CP Van Den Eeden, SK Selby, JV Kaiser Permanente Med Care Program Div Res Oakland CA 94611 USA

In this retrospective cohort analysis of all adults who were members of Kaiser Permanente, Northern California, between July 1995 and June 1996 (N = 2,076,303), the authors estimated the prevalence, average annual costs per person, and percentage of total direct medical expenditures attributable to each of 25 chronic and acute conditions. Ordinary least squares regression was used to adjust for age, gender, and comorbidities. The costs attributable to the 25 conditions accounted for 78 percent of the health maintenance organization's total direct medical expense for this age-group. Injury accounted for a higher proportion (11.5 percent) of expenditures than any other single condition. Three cardiovascular conditions-ischemic heart disease, hypertension, and congestive heart failure-together accounted for 17 percent of direct medical expense and separately accounted for 6.8 percent, 5.7 percent, and 4.0 percent, respectively. Renal failure ($22,636), colorectal cancer ($10,506), pneumonia ($9,499), and lung cancer ($8,612) were the most expensive conditions per person per year.

关键词：急性病/经济学年龄分布加利福尼亚慢性病/经济学共病现象诊断相关患者组/经济学直接服务费用/统计学和数值数据健康维护组织/经济学健康维护组织/利用卫生服务研究最小二乘法分析模型经济计量学回顾性研究敏感性与特异性性别分布成年人老年人女(雌)性人类男(雄)性中年人

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METHODS OF DETERMINING THE COST OF HEALTH-CARE IN THE DEPARTMENT OF VETERANS AFFAIRS MEDICAL-CENTERS AND OTHER NON-PRICED SETTINGS

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EVALUATION & THE HEALTH PROFESSIONS 1991年第3期14卷 282-303页

作者： CHAPKO, MK EHRETH, JL HEDRICK, S UNIV WASHINGTON SEATTLEWA 98195 USA

Cost is increasingly important in the evaluation of health care. Though charges are often used as a proxy for cos4 some health care systems such as the Veterans Administration do little or no billing. This article describes, presents examples of and evaluates four options for determining the cost of care within the Department of Veterans Affairs: measuring input costs, the Departmen t's cost accounting system, the reimbursement system, and use of charges from a surrogate health care facility. Each approach is evaluated for accuracy, ability to compare the costs of different treatments, and effort required to estimate cost.

关键词：会计学/方法费用分配/方法直接服务费用/统计学和数值数据费用和收费/统计学和数值数据卫生保健费用/统计学和数值数据医院退伍军人/经济学偿还途径美国美国退伍军人事务部

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Estimating the cost impact of three dual diagnosis treatment programs

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EVALUATION REVIEW 1996年第2期20卷 160-180页

作者： Jerrell, JM Hu, TW UNIV S CAROLINA SCH MEDCOLUMBIASC 29208 UNIV CALIF BERKELEY SCH PUBL HLTHBERKELEYCA 94720

Specialized intervention programs for people with concurrent severe mental illness and substance abuse reduce the total costs of care. Compared to baseline, cost savings of over 40% were achieved by 18 months primarily due to significant reductions in the use of acute and subacute mental health services and despite an increase in outpatient mental health services. There also was an observable impact on cost reductions in medical and criminal justice services without an increase in family costs over the same time period.

关键词：嗜酒者互戒协会病例管理认知疗法费用节省费用效益分析直接服务费用/统计学和数值数据精神障碍/并发症精神障碍/治疗精神卫生服务/组织和管理方案评价社会支持物质相关性障碍/并发症物质相关性障碍/治疗青少年成年人女(雌)性人类男(雄)性

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A comparison of effectiveness and cost between two models of care for individuals with schizophrenia living in Taiwan

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ARCHIVES OF PSYCHIATRIC NURSING 2001年第6期15卷 272-278页

作者： Lin, ECL Yin, TJC Kuo, BIT Chang, WY Tsai, SL Hung Kuang Inst Technol Hung Kuang Taiwan Taipei Vet Gen Hosp Taipei Taiwan Taipei Med Univ Taipei Taiwan

Schizophrenia is a chronic disease that places tremendous costs and burden on patients, families, and communities. The purpose of this study was to compare the cost and effectiveness of a hospital-based home care model and a traditional community care model for schizophrenia in Taiwan using six principles of cost-effectiveness analysis. Based on the health care provider's analytic perspective, four effectiveness indicators and four service costs were, identified and measured, and the ratio of average cost value to effectiveness score for each patient was calculated. According to that ratio, the hospital-based home care model was more cost-effective. The results suggest that the hospital-based outreach home care model is a cost-effective way to care for patients and their family in the community. Copyright (C) 2001 by W.B. Saunders Company.

关键词：社区精神卫生服务/经济学社区精神卫生服务/标准社区和机构的关系费用效益分析直接服务费用/统计学和数值数据卫生保健费用/统计学和数值数据卫生服务研究家庭医疗保健服务基于医院的/经济学家庭医疗保健服务基于医院的/标准住院/经济学住院/统计学和数值数据模型组织管理方案评价质量指标卫生保健精神分裂症/治疗敏感性与特异性台湾治疗结果成年人女(雌)性人类男(雄)性中年人

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