RESUMEN
Biological drugs are expensive, but can reduce symptoms and increase quality of life for patients with psoriasis. The aim of this study was to examine quality of life, disease severity and treatment satisfaction in Danish, Finnish and Swedish patients with psoriasis. Based on 12 months' data from patient surveys and chart reviews, 3 treatment groups were identified: topical, systemic and/or biological <12 months, and biological for 12 months. Regression analyses were performed to investigate influence on treatment satisfaction, disease problems and quality of life. Patients treated with biological drugs for 12 months showed the highest treatment satisfaction and the lowest Dermatology Life Quality Index score. A number of patients with topical treatment reported low quality of life, severe or very severe disease problems, and low treatment satisfaction. Some patients with psoriasis may be under-treated and might benefit from a more aggressive treatment strategy. It is important, however, that resource utilization is optimized and patients are not treated with more advanced agents than necessary.
Asunto(s)
Productos Biológicos/administración & dosificación , Fármacos Dermatológicos/administración & dosificación , Satisfacción del Paciente , Pautas de la Práctica en Medicina/tendencias , Psoriasis/tratamiento farmacológico , Calidad de Vida , Administración Tópica , Adulto , Anciano , Productos Biológicos/efectos adversos , Dinamarca/epidemiología , Fármacos Dermatológicos/efectos adversos , Femenino , Finlandia/epidemiología , Encuestas de Atención de la Salud , Humanos , Masculino , Persona de Mediana Edad , Psoriasis/diagnóstico , Psoriasis/epidemiología , Psoriasis/psicología , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Suecia/epidemiología , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Psychotic illnesses have a substantial economic burden on patients, family members, friends, and society in general, still there have been limited attempts to estimate the costs associated with this condition. Moreover, nothing is known about the differences in costs between patients depending on disease severity, i.e. state of remission. AIM: Estimate the direct and indirect costs for a defined patient population with psychotic illness in Sweden, and demonstrate differences in direct costs depending on disease severity (state of remission). MATERIALS AND METHODS: The cost analyses are based on data from the Clinical Long-term Investigation of Psychosis in Sweden (CLIPS), which is an ongoing, single-centre, epidemiological study. Resource use and disease severity were captured for the patients during one year, 2007. Total costs per patients are estimated and cost differences between patients, depending on state of remission, are considered. RESULTS: 199 patients with a mean age of 51 (63% men) were followed for 12 months. They had a mean of 6.4 inpatient-days, 1.4 physician visits, 18.6 nurse visits, 1.2 counsellor visits and 6.3 visits to other staff including tests and diagnostic procedures per patient- year. The mean total cost (direct and indirect) amounted to 62,500 per patient and year. Patients in steady state of remission had lower direct costs compared to other patients. Moreover, the size of the various cost items differed between patients' depending on state of remission. Patients in steady remission had almost no inpatient costs. DISCUSSION: For a comprehensive assessment of treatment of psychotic illnesses it is necessary to provide evidence of the costs related to disease severity. We find that patients suffering from psychotic illness have varying costs depending on their disease severity, and this study indicates that if patients can be kept in remission direct costs will decrease. We can also confirm that reallocation has taken place the last 15 years, between different cost items, from in-patient care at hospitals to out-patient care and assistance at home. LIMITATIONS: Information about informal care was collected from patients and not from informal carers themselves. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: Costs have been reallocated from in-patient care to costs for assistance at home, which is a reflection of the change in care of patients with mental problems that has taken place during the last 15 years. Patients in steady remission have lower costs compared to patients in steady non-remission or patients switching between the two states. A better surveillance of the disorder would lead to lower direct, as well as indirect, costs.
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Servicios de Salud/estadística & datos numéricos , Trastornos Psicóticos/economía , Adulto , Anciano , Costos y Análisis de Costo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos Económicos , Índice de Severidad de la Enfermedad , SueciaRESUMEN
Patient registries often lack indicators of the disease as experienced by patients, e.g. treatment satisfaction and self-assessed disease severity. There is scarce information about the relationship between these assessments and currently existing instruments used in treatment evaluation. Our objective was to explore the importance of these indicators among patients with psoriasis in Finland and Sweden, in relation to treatment patterns and current measures of health-related quality of life. Data were collected from a patient survey and a retrospective chart review for 273 patients over 12 months. To assess psoriasis treatment completely, it is necessary to consider the impact of the disease on the patient in terms of treatment satisfaction, disease severity and health-related quality of life. The individual disease burden on patients should play a central role in formulating treatment goals. Clinician- and patient-based perspectives of the overall impact of psoriasis can assist clinical decision-making and evaluations of treatments.
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Autoevaluación Diagnóstica , Satisfacción del Paciente , Psoriasis/terapia , Calidad de Vida , Encuestas y Cuestionarios , Adulto , Anciano , Costo de Enfermedad , Femenino , Finlandia , Humanos , Masculino , Persona de Mediana Edad , Psoriasis/diagnóstico , Psoriasis/psicología , Sistema de Registros , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Suecia , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
INTRODUCTION: Little is known regarding healthcare costs for HIV/AIDS patients in the era of highly active antiretroviral therapy (HAART) and subgroups of patients according to the severity and progression of HIV infection in Sweden. The objective of this study is therefore to describe the direct medical resource use and cost of healthcare for HIV patients at a university clinic in Sweden. METHODS: A patient registry database for HIV treatment at the Department of Infectious Diseases, Sahlgrenska University Hospital, between 2000 and 2005 provided information on patient characteristics, antiretroviral drugs and dosages, tests and diagnostic procedures, outpatient visits and inpatient stays. The review used publicly available unit costs with a county council perspective, expressed in 2006 Euros. RESULTS: Two hundred and eighty-five patients with a mean age of 38 years in 2000 (64% men) were followed for 1368 patient-years. They had a mean (median) of 6.3 (0) inpatient days, 4.1 (3.7) physician visits, 4.2 (3.8) nurse visits, 2.6 (0.7) counsellor visits and 11.5 (7.7) tests and diagnostic procedures per patient-year. Only 12 deaths were recorded during the study period, and the proportion of treated patients with successful treatment (HIV-RNA < 50 copies/mL) increased from 74% to 92% during the period. The mean cost per patient-month amounted to 1069. The main cost driver was HIV drugs (51%), followed by inpatient stays (including hospitalizations for opportunistic infections; 22%), outpatient physician, nurse or therapist visits (19%) and diagnostics and tests (7%). All non-drug costs increased with a decreasing CD4 cell count. CONCLUSIONS: Overall, approximately half of the direct costs of HIV treatment were not related to antiretroviral treatment. The non-antiretroviral costs were inversely correlated with HIV-induced immune deficiency.
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Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/economía , Terapia Antirretroviral Altamente Activa/economía , Costos de la Atención en Salud , Recursos en Salud/economía , Recursos en Salud/estadística & datos numéricos , Adolescente , Adulto , Anciano , Atención Ambulatoria/economía , Fármacos Anti-VIH/economía , Fármacos Anti-VIH/uso terapéutico , Progresión de la Enfermedad , Costos de los Medicamentos , Femenino , VIH , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/economía , Accesibilidad a los Servicios de Salud/economía , Hospitalización/economía , Humanos , Masculino , Persona de Mediana Edad , Suecia , Universidades/economía , Adulto JovenRESUMEN
BACKGROUND: Psychotic illness can have a substantial economic burden not only on the patient and society in general, but also on family members providing informal care (i.e. those not subject to a market wage). While informal caregiving confers benefits for the patient and society, time spent providing informal care is diverted from other activities such as work or leisure. Relatives and caregivers experience burden both on a practical and an emotional level. Informal caregiving has often gone unrecognised in public policy discussions about the financing and costs of health care. AIM: The aim of this paper is to provide suggestions for valuing caregiver time for psychotic illness. Materials and Methods Literature on the costs of informal care and the cost of leisure time, is used to discuss possibilities for estimating the value of informal care. RESULTS: The monetary value of informal care depends on income levels both for those who give up paid work and for those who forego leisure time. Estimates are thus context dependent and might be difficult to generalise. DISCUSSION: Informal care is a substantial part of total patient care, especially for chronic illness. The support of family caregivers for patients with mental illnesses often has an important impact on the general well-being of the patient. Because it is typically unpaid, informal care has been seen as a low cost, even costless, substitute for formal care. Placing a value on the hours of care provided by informal caregivers for patients suffering from mental illnesses is necessary if one wants to provide an accurate picture of the costs associated with the diseases. Time spent on informal care has a value and methods of estimating costs of informal care are available. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: Cost studies should take account of the cost of informal care, as ignoring informal care means that it is viewed as a costless substitute for formal care. While informal care is unpaid, it is not free in an economic sense since time spent providing care cannot be directed to other activities such as paid work or leisure. From a societal perspective, not accounting for informal care may lead to a poor allocation of resources and a disregard of the effect of informal care on the health and well-being of caregivers. Cost of informal care constitutes a sizeable proportion of total costs and should not be neglected.
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Cuidadores/economía , Costo de Enfermedad , Trastornos Psicóticos/economía , Humanos , Trastornos Psicóticos/enfermería , Literatura de Revisión como AsuntoRESUMEN
CONTEXT: Treatment with strong opioids is connected with frequent and problematic side effects. One of the most common side effects is opioid-induced constipation (OIC). The discomfort of OIC can limit the effectiveness of pain therapy. Because constipation typically persists for as long as opioid therapy is administered, its effects on the quality of life (QoL) of patients need to be taken seriously. Data and published studies on the cost implications of OIC are, however, scarce. OBJECTIVES: To estimate the direct and indirect costs of OIC in a defined patient population during treatment with strong opioids. METHODS: The study is based on patient data from a Swedish noninterventional study, UPPSIKT. The cost analysis is based on 197 patients treated with strong opioids over a six-month period. Direct and indirect costs in this article are calculated per patient-month, and the cost for OIC is estimated as the difference in mean costs between months with and without constipation. RESULTS: The total costs per patient-month for patients with severe constipation are significantly higher than those for patients with mild, moderate, or no constipation. Patients with severe constipation have the highest total costs, Euro (EUR) 1525 per patient-month, whereas patients with mild, moderate, and no problems cost EUR 1196, EUR 1088, and EUR 1034, respectively. CONCLUSION: Opioid use is costly to society, and the costs vary with OIC severity. OIC is discomforting, affects the QoL of patients, and can limit an effective pain therapy.
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Analgésicos Opioides/economía , Estreñimiento/economía , Dolor/economía , Adulto , Anciano , Anciano de 80 o más Años , Analgésicos Opioides/efectos adversos , Análisis de Varianza , Estreñimiento/inducido químicamente , Femenino , Costos de la Atención en Salud , Humanos , Masculino , Persona de Mediana Edad , Dolor/tratamiento farmacológico , Satisfacción del Paciente , Calidad de Vida , Índice de Severidad de la Enfermedad , SueciaRESUMEN
When ill the individual faces the options of seeking health care, using self-medication or doing nothing. In an economic perspective, an individual's propensity to utilise health care is determined by the costs of utilisation and the perceived benefits of health care. The propensity to utilise health care may hence be expected to vary between individuals. In this paper we attempt on the one hand to determine what factors influence sick individuals' propensity to seek health care at a health facility or use self-medication (or do nothing), and on the other hand attempt to determine the factors that influence the magnitude of their expenditures for health care, in particular what other factors than just health status influence utilisation. For the empirical analysis, data, covering 9700 individuals, from the 1998 Living Conditions Monitoring Survey (LCMS) is used. We use a Multinomial Logit selection model to estimate the equation, which allows us to analyse health-care utilisation through two separate processes, the decision to seek care and the magnitude of expenditures incurred. In general, we find that the individuals are influenced by income, insurance, type of illness and access variables such as distance and owning a vehicle.
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Gastos en Salud/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Servicios de Salud Rural/estadística & datos numéricos , Automedicación/estadística & datos numéricos , Rol del Enfermo , Servicios Urbanos de Salud/estadística & datos numéricos , Costo de Enfermedad , Femenino , Humanos , Masculino , Modelos Econométricos , Pobreza , Servicios de Salud Rural/economía , Automedicación/economía , Servicios Urbanos de Salud/economía , ZambiaRESUMEN
The Health Systems in Transition (HiT) series provide detailed descriptions of health systems in the countries of the WHO European Region as well as some additional OECD countries. An individual health system review (HiT) examines the specific approach to the organization, financing and delivery of health services in a particular country and the role of the main actors in the health system. It describes the institutional framework, process, content, and implementation of health and health care policies. HiTs also look at reforms in progress or under development and make an assessment of the health system based on stated objectives and outcomes with respect to various dimensions (health status, equity, quality, efficiency, accountability).