RESUMEN
BACKGROUND: To evaluate the cost-effectiveness of growth hormone (GH) treatment (Genotropin®) compared with no GH treatment in adults with GH deficiency in a Swedish societal setting. METHODS: A Markov-type cost-utility simulation model was constructed and used to simulate, for men and women, morbidity and mortality for GH-treated and -untreated individuals over a 20-year period. The calculations were performed using current available prices concerning morbidity-related healthcare costs and costs for Genotropin®. All costs and treatment effects were discounted at 3%. Costs were expressed in Euro (1 = 9.03 SEK). GH-treated Swedish patients (n = 434) were identified from the KIMS database (Pfizer International Metabolic Database) and untreated patients (n = 2135) from the Swedish Cancer Registry and the Hospital Discharge Registry. RESULTS: The results are reported as incremental cost per quality-adjusted life year (QALY) gained, including both direct and indirect costs for GH-treated versus untreated patients. The weighted sum of all subgroup incremental cost per QALY was 15,975 and 20,241 for men and women, respectively. Including indirect cost resulted in lower cost per QALY gained: 11,173 and 10,753 for men and women, respectively. Key drivers of the results were improvement in quality of life, increased survival, and intervention cost. CONCLUSIONS: The incremental cost per QALY gained is moderate when compared with informal thresholds applied in Sweden. The simulations suggest that GH-treatment is cost-effective for both men and women at the 55,371 (SEK 500,000 - the informal Swedish cost-effectiveness threshold) per QALY threshold.
RESUMEN
PURPOSE: To review the negative effects of attention-deficit/hyperactivity disorder (ADHD) in adolescence and adulthood on work productivity and occupational health. METHODS: A review of the MEDLINE database was carried out to identify direct and indirect effects of ADHD on work, employment and occupational health. RESULTS: ADHD is associated with higher levels of unemployment versus controls. Adults with ADHD who are employed experience workplace impairment and reduced productivity, as well as behavioural issues such as irritability and low frustration tolerance. Adults with ADHD are also at increased risk of accidents, trauma and workplace injuries, particularly traffic accidents. Indirect effects of ADHD on occupational health include reduced educational achievement and increased rates of substance abuse and criminality. Overall, ADHD in adults has a substantial economic impact as a result of absenteeism and lost productivity. Psychoeducation, combined with stimulant medications if necessary, is recommended as first-line treatment for adults with ADHD. Limited data available suggest that stimulant treatment can improve work productivity and efficacy, and reduce the risks associated with driving, although further studies are necessary. CONCLUSIONS: ADHD can affect the ability to gain and maintain employment and to work safely and productively. As ADHD is a treatable condition, patients, employers and physicians have a role to play in ensuring optimal occupational health.
Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/complicaciones , Trastorno por Déficit de Atención con Hiperactividad/psicología , Eficiencia , Salud Laboral , Traumatismos Ocupacionales/etiología , Accidentes de Tránsito , Adolescente , Adulto , Trastorno por Déficit de Atención con Hiperactividad/tratamiento farmacológico , Crimen , Escolaridad , Humanos , Genio Irritable , Trastornos Relacionados con Sustancias/complicaciones , DesempleoRESUMEN
Examines the relationships between different aspects involved in asthma treatment. Analyses each aspect's impact on overall patient satisfaction with asthma treatment. Also studies how outcome variables such as compliance with physician's recommendations, health-related quality of life and resource use are affected by the degree of patient satisfaction. The results refer to asthma patients as a group but not necessarily to each patient as an individual. The statistical technique applied for this analysis is partial least squares. Tests the suggested generic model on 599 respondents from a questionnaire survey. The structure of the suggested model is well supported by the data.