Caregiver Costs Research Articles

Residual economic burden of Streptococcus pneumoniae- and nontypeable Haemophilus influenzae- associated disease following vaccination with PCV-7: A multicountry analysis

This paper estimates the annual direct medical and caregiver costs of Streptococcus pneumoniae ( Sp) and nontypeable Haemophilus influenzae (NT Hi)-associated diseases in children younger than 10 years in Canada, Germany, Mexico, and Norway after vaccination with the 7-valent pneumococcal conjugate vaccine (PCV-7). Per-episode direct medical costs for treating Sp- and NT Hi-associated diseases were summarised from the literature for three countries, and a Delphi panel was used to estimate resource use and the per-episode costs for Mexico. Per-episode or annual costs were inflated to 2008 local currency and converted to 2008 United States (US) dollars using purchasing power parities. The analysis was for 1 year; therefore, costs were not discounted. Sp- and NT Hi-associated diseases resulted in current annual national costs of $179–$260 million ($5.43–$7.89 per capita) in Canada, $290–$435 million ($3.53–$5.29 per capita) in Germany, $277–$432 million ($2.59–$4.05 per capita) in Mexico, and $20–$28 million ($4.35–$6.17 per capita) in Norway. Although acute otitis media (AOM) was associated with the lowest per-case costs, it accounted for between 45% and 88% of the national direct medical costs and between 67% and 96% of caregiver costs for Sp- and NT Hi-associated diseases. Sp- and NT Hi-associated diseases continue to result in substantial direct medical and caregiver costs despite current PCV-7 vaccination programs.

The Caregiving Journey for Family Members of Relatives With Cancer

Family caregivers need adequate support from healthcare professionals to complete the demands associated with caregiving with minimal impact on their own health and well-being. An optimal balance of provision of care between family and support services has not been achieved; therefore, this literature review investigates how family caregivers endure and cope with the challenges of caring for an adult relative with cancer. This review considered the characteristics of caregivers and their functioning, the external and internal supports that help them cope, the ongoing challenges as they journey along the caregiving trajectory, the personal costs of caregiving, and how caregivers cope with supporting their family members through to the end of their journeys. The literature provides an abundance of research on the numerous challenges encountered by families living with cancer; however, little research has been conducted on the coping strategies used by family caregivers at specific stages along the illness trajectory that either optimize or hinder personal recovery. Even less information is available on interventions nurses can introduce to ease the caregiving burden. Improving nurses' understanding of the stressors and unmet needs associated with caregiving is fundamental to the development of effective family-focused clinical interventions.

Valuing health technologies at nice: recommendations for improved incorporation of treatment value in HTA

Pricing, reimbursements and coverage decisions for medical innovations and services are complex. In many countries, valuing medical technologies is the responsibility of national health-care systems that strive for distributive efficiency under fiscal constraints on medical spending. In the UK, the National Institute for Health and Clinical Excellence (NICE) is charged with the difficult task of assessing new and existing medical technologies, and making recommendations that guide NHS coverage decisions. These are responsibilities that NICE carries out rigorously and with the objective of achieving efficiency in the allocation of NHS resources. Nevertheless, the current process of health technology appraisal (HTA) has been criticized for failure to systematically incorporate important sources of value from new innovations. In maintaining NICE’s current approach to HTA, the UK risks suboptimal patient outcomes and social welfare relative to what could be achieved if limited NHS resources were targeted toward those technologies with greatest social value. Perhaps recognizing these limitations, NICE commissioned Professor Sir Ian Kennedy in January, 2009, to carry out a study of valuing innovation aimed at addressing the approach that should be adopted by NICE to ensure that innovation is properly taken into account when establishing the value of new health technologies; whether particular forms of value be considered more important than others; how should innovation in health technologies be defined and understanding the relationship between innovation and value. As part of this process, we were asked to present our views on what such new approaches may be and how they could be implemented in practice within the NICE regulatory framework. This work was presented to the Kennedy Commission on May 19, 2009. We discuss these approaches below, and expand on ways in which important value dimensions can be integrated within the current framework. While framed in response to the Kennedy study, these views are broadly applicable to other health-care systems charged with valuing innovation and achieving distributive efficiency.

A systematic review of Canadian and American cost-of-illness studies in dementia

Estimates of the annual cost of dementia range into the billions of dollars. The objective of this study was to conduct a systematic review of published cost-of-illness (COI) studies in Canada and the United States, as well as to synthesize the conclusions of these studies into a set of common themes about the cost of dementia. Medline, CINAHL, EconLit, AMED, and the Cochrane Library were searched from inception to October 2009 for English-language COI studies. Other types of economic studies (cost-benefit, cost-effectiveness, and cost-utility analyses) were excluded from the review. Articles retrieved in the literature search were screened for inclusion using two levels of screening: (1) title and abstract and (2) full text. Data were extracted from articles that passed both levels of screening. Extracted data included information on study author(s), design, study participants, cost data, and sponsorship. Content analysis was used to synthesize the major conclusions of the extracted COI studies into a set of common themes about dementia cost. Nine hundred fifty-one articles were retrieved in the literature search and data were extracted from 46 articles. All except three articles reported American data. Most articles pertained to AD. Cost estimates varied considerably across articles. Sources of variation were differences in study populations and heterogeneity of COI methodologies (e.g., types of included costs, methods of calculating indirect costs). Despite cost variability, the extracted studies contained several common themes about the cost of dementia. Themes included general observations about dementia cost, cost drivers in dementia, caregiver cost, items that may lower dementia cost, social service cost, Medicare and Medicaid cost, and cost comparisons with other diseases. The content of each of the common themes could serve as the basis for policy-oriented research. However, authors of COI articles tended to focus on reporting the cost of dementia as an end in itself. Given methodological heterogeneity, there was no way to ascertain which (if any) of the articles actually reported the true cost of dementia.

Caregiver time and cost of informal care for Alzheimer's disease: A clinic-based observational study in Beijing, China

Caregiver time and cost of informal care for Alzheimer's disease: A clinic-based observational study in Beijing, China

Caregiver Time and Cost of Home Care for Alzheimer’s Disease: A Clinic-based Observational Study in Beijing, China

This cross-sectional study was conducted to estimate the caregiver time and calculate the cost of informal care for AD, and to explore the potential predictors of caregiver time. Seventy-one community-dwelling AD patient-caregiver dyads completed the assessment and questionnaire. AD patients were assessed with Mini-mental status examination (MMSE), activities of daily living (ADL), and Neuropsychiatric Inventory (NPI). Caregiver time was recorded using the Resource Utilization in Dementia (RUD). According to the MMSE score, subjects were classified as mild (n = 18), moderate (n = 43), and severe (n = 10) groups. The PADL care time was significantly different among three groups, with highest in severe group (172.5 ± 208.0 h/month), and least in mild group (24.9 ± 70.5 h/month) (F = 5.215, df = 2, P = 0.008). The supervision time was higher in severe group compared to mild group (F = 3.330, df = 2, P = 0.042), while there were no differences between mild and moderate groups, and between moderate and severe groups. There was no difference in IADL caregiver time among three groups. The estimated annual cost of PADL care ranged from 903 USD (mild) to 6,259 USD (severe), IADL care from 4042USD to 7645USD, and supervision from 871 USD to 6,172 USD. Stepwise logistic regression analysis showed that MMSE score was significant predictor of PADL care time. For every one unit increase in MMSE, the odds of PADL care time decrease by a factor of 0.791 (χ2 = 13.628, P = 0.000). Spouse caregivers significantly predict greater IADL care time (OR = 4.469, 95%CI = 1.248–15.999, P = 0.021), and male caregiver was a protector for IADL care time (OR = 0.157, 95%CI = 0.040–0.609, P = 0.007). The ADL score was a significant predictor of supervision time. For every one unit increase in ADL, the odds of supervision time increase by a factor of 1.132 (95%CI = 1.055–1.215, P = 0.001). Higher educational level of the patient predicted decrease in supervision time (OR = 0.888, 95%CI = 0.794–0.994, P = 0.038). Caregiver time and cost of home care for AD was substantial in China. Care time of PADL increased with the progression of cognitive decline. The IADL care time was strongly influenced by the biographical characteristics of caregivers. Supervision was mostly predicted by the functional status of the patient.

Cost minimization analysis of different growth hormone pen devices based on time-and-motion simulations

BackgroundNumerous pen devices are available to administer recombinant Human Growth Hormone (rhGH), and both patients and health plans have varying issues to consider when selecting a particular product and device for daily use. Therefore, the present study utilized multi-dimensional product analysis to assess potential time involvement, required weekly administration steps, and utilization costs relative to daily rhGH administration.MethodsStudy objectives were to conduct 1) Time-and-Motion (TM) simulations in a randomized block design that allowed time and steps comparisons related to rhGH preparation, administration and storage, and 2) a Cost Minimization Analysis (CMA) relative to opportunity and supply costs. Nurses naïve to rhGH administration and devices were recruited to evaluate four rhGH pen devices (2 in liquid form, 2 requiring reconstitution) via TM simulations. Five videotaped and timed trials for each product were evaluated based on: 1) Learning (initial use instructions), 2) Preparation (arrange device for use), 3) Administration (actual simulation manikin injection), and 4) Storage (maintain product viability between doses), in addition to assessment of steps required for weekly use. The CMA applied micro-costing techniques related to opportunity costs for caregivers (categorized as wages), non-drug medical supplies, and drug product costs.ResultsNorditropin® NordiFlex and Norditropin® NordiPen (NNF and NNP, Novo Nordisk, Inc., Bagsværd, Denmark) took less weekly Total Time (p < 0.05) to use than either of the comparator products, Genotropin® Pen (GTP, Pfizer, Inc, New York, New York) or HumatroPen® (HTP, Eli Lilly and Company, Indianapolis, Indiana). Time savings were directly related to differences in new package Preparation times (NNF (1.35 minutes), NNP (2.48 minutes) GTP (4.11 minutes), HTP (8.64 minutes), p < 0.05)). Administration and Storage times were not statistically different. NNF (15.8 minutes) and NNP (16.2 minutes) also took less time to Learn than HTP (24.0 minutes) and GTP (26.0 minutes), p < 0.05). The number of weekly required administration steps was also least with NNF and NNP. Opportunity cost savings were greater in devices that were easier to prepare for use; GTP represented an 11.8% drug product savings over NNF, NNP and HTP at time of study. Overall supply costs represented <1% of drug costs for all devices.ConclusionsTime-and-motion simulation data used to support a micro-cost analysis demonstrated that the pen device with the greater time demand has highest net costs.

The D&amp;T Report

The D&amp;T Report

Cost and Cost-Effectiveness of Treating Smear-Positive Tuberculosis by Health Extension Workers in Ethiopia: An Ancillary Cost-Effectiveness Analysis of Community Randomized Trial

by HEWs in the health posts and general health workers at health facility were compared along a community-randomized trial. Costs were analysed from societal perspective in 2007 in US $ using standard methods. We prospectively enrolled smear positive patients, and calculated cost-effectiveness as the cost per patient successfully treated. The total cost for each successfully treated smear-positive patient was higher in health facility ($158.9) compared with community ($61.7). Community-based treatment reduced the total, patient and caregiver cost by 61.2%, 68.1% and 79.8%, respectively. Involving HEWs added a total cost of $8.80 (14.3% of total cost) on health service per patient treated in the community.Conclusions/SignificanceCommunity-based treatment by HEWs costs only 39% of what treatment by general health workers costs for similar outcomes. Involving HEWs in TB treatment is a cost effective treatment alternative to the health service, to the patients and the family. There is an economic and public health reason to consider involving HEWs in TB treatment in Ethiopia. However, community-based treatment requires initial investment to start its implementation, training and supervision.Trial RegistrationClinicalTrials.gov NCT00803322

PC-FACS

PC-FACS

How valuable are environmental health interventions? Evaluation of water and sanitation programmes in India.

To evaluate and quantify the economic benefits attributable to improvements in water supply and sanitation in rural India. We combined propensity-score "pre-matching" and rich pre-post panel data on 9500 households in 242 villages located in four geographically different districts to estimate the economic benefits of a large-scale community demand-driven water supply programme in Maharashtra, India. We calculated coping costs and cost of illness by adding across several elements of coping and illness and then estimated causal impacts using a difference-in-difference strategy on the pre-matched sample. The pre-post design allowed us to use a difference-in-difference estimator to measure "treatment effect" by comparing treatment and control villages during both periods. We compared average household costs with respect to out-of-pocket medical expenses, patients' lost income, caregiving costs, time spent on collecting water, time spent on sanitation, and water treatment costs due to filtration, boiling, chemical use and storage. Three years after programme initiation, the number of households using piped water and private pit latrines had increased by 10% on average, but no changes in hygiene-related behaviour had occurred. The behavioural changes observed suggest that the average household in a programme community could save as much as 7 United States dollars per month (or 5% of monthly household cash expenditures) in coping costs, but would not reduce illness costs. Poorer, socially marginalized households benefited more, in alignment with programme objectives. Given the renewed interest in water, sanitation and hygiene outcomes, evaluating the economic benefits of environmental interventions by means of causal research is important for understanding the true value of such interventions.

Kinship Care and “Child-Only” Welfare Grants: Low Participation Despite Potential Benefits

Several U.S. social policies identify kinship care as the preferred out-of-home placement. However, financial assistance to defray the cost of kinship caregiving is limited. One option is the child-only welfare grant. This study investigates kinship households' eligibility for, utilization of, and educational benefits associated with these grants. Most kinship households are eligible for these grants, which in 2003 provided a median monthly benefit of $227. However, analysis of National Longitudinal Study of Adolescent Health data indicates that few eligible kinship households receive the grants. Regression analysis indicates that an increase in this amount of monthly household income during adolescence is associated with a 7% greater likelihood of kinship youth graduating from high school.

Socioeconomic Costs of Food-Borne Disease Using the Cost-of-Illness Model: Applying the QALY Method

This study estimated the annual socioeconomic costs of food-borne disease in 2008 from a societal perspective and using a cost-of-illness method. Our model employed a comprehensive set of diagnostic disease codes to define food-borne diseases with using the Korea National Health Insurance (KNHI) reimbursement data. This study classified the food borne illness as three types of symptoms according to the severity of the illness: mild, moderate, severe. In addition to the traditional method of assessing the cost-of-illness, the study included measures to account for the lost quality of life. We estimated the cost of the lost quality of life using quality-adjusted life years and a visual analog scale. The direct cost included medical and medication costs, and the non-medical costs included transportation costs, caregiver's cost and administration costs. The lost productivity costs included lost workdays due to illness and lost earnings due to premature death. The study found the estimated annual socioeconomic costs of food-borne disease in 2008 were 954.9 billion won (735.3 billion won-996.9 billion won). The medical cost was 73.4 - 76.8% of the cost, the lost productivity cost was 22.6% and the cost of the lost quality of life was 26.0%. Most of the cost-of-illness studies are known to have underestimated the actual socioeconomic costs of the subjects, and these studies excluded many important social costs, such as the value of pain, suffering and functional disability. The study addressed the uncertainty related to estimating the socioeconomic costs of food-borne disease as well as the updated cost estimates. Our estimates could contribute to develop and evaluate policies for food-borne disease.

PW01-257 - Direct costs of suicide attempts in Basel, Switzerland

BackgroundSuicide is one of the major health problems today. The few available health economic studies have focussed on suicides. However suicide attempts, which are much more frequent, have been disregarded.MethodsWe made use of available data of the WHO-Euro-Multicentre study. During the year 2003, N=201 persons committing a suicide attempt in Basel could be accessed for health economic investigations. Due to the care structure in our region we started with the direct costs of inpatient treatment at the university (psychiatric) hospitals, which provide a wide majority of care for the people of the area, especially in emergency cases like suicide. Outpatient treatment was only calculated, if it was performed by these hospitals. This analysis included the overhead of the hospitals (staff etc.) was well as the costs provides for special services, consultation and liaison services, transports and emergency actions.ResultsWe assume that the direct costs make up only part of the total costs. For example the loss of working ability, health costs for family members, caregivers and friends affected are not included in our analyses. Against our assumption, we could not find major differences regarding the underling diagnoses. However, elderly suicide attempts were more costly. There were also gender differences. Further details will be discussed.ConclusionThe data show, that suicide attempts are expensive. Health care planers should take these data into account when discussing and deciding investments in suicide preventions.

Societal cost of rheumatoid arthritis patients in the US

Objective:To estimate comprehensive cost of rheumatoid arthritis (RA) patients to society and individual stakeholders, including patients/employees, employers, family members/caregivers, and government.Research design and methods:Administrative claims databases covering privately insured and Medicare and Medicaid beneficiaries in the US were used to compute the excess payer and beneficiary-paid costs per patient with RA compared with matched controls. Similarly, per-person excess costs for caregivers and uninsured patients with RA were estimated. Costs were estimated for other burdens, including costs of work-loss to employers, adaptations to home and work environments, lost on-the-job productivity, informal and hired care/household help, and job turnover costs. Intangible costs associated with quality-of-life deterioration were estimated based on legal system jury awards, whereas costs for premature mortality were based on lifetime earnings data. Per-capita cost estimates were weighted by the relevant population to estimate societal costs. Because data were incomplete, several assumptions were required; these assumptions could lead to an over- or under-estimation of cost burdens.Results:Annual excess health care costs of RA patients were $8.4 billion, and costs of other RA consequences were $10.9 billion. These costs translate to a total annual cost of $19.3 billion. From a stakeholder perspective, 33% of the total cost was allocated to employers, 28% to patients, 20% to the government, and 19% to caregivers. Adding intangible costs of quality-of-life deterioration ($10.3 billion) and premature mortality ($9.6 billion), total annual societal costs of RA (direct, indirect, and intangible) increased to $39.2 billion.Conclusions:Societal costs of RA in the US are $19.3 billion and $39.2 billion (in 2005 dollars) without and with intangible costs, respectively. This study was one of the first to attempt to quantify the comprehensive burdens of RA. Despite several assumptions made in areas in which few data exist, the findings generate useful insights into the full burden of RA.

The Cost of Care for People With Impaired Vision in Australia

To prospectively collect data on the providers, types, and costs of care for people with impaired vision in Australia. Adults with impaired vision, visual acuity worse than 20/40, were recruited from clinics, vision rehabilitation agencies, and support groups. Participants completed daily diaries for 12 months, entering information on the amount of time they used caregivers and providers and types of care. Demographic information was obtained from questionnaires. The cost of care was calculated using mean hourly wage rates. The mean age of the 114 participants was 66.5 years (standard deviation [SD], 19.7) with 64% of participants female; 105 of 114 participants relied on a caregiver at least once during the 12 months. The mean amount of yearly caregiver time used was 152.2 hours (SD, 193; median, 81.3; range, 1-851 hours). The median time represents 4.6% of a working week. There were no significant associations of age, sex, type, or place of residence with the amount of care received (P > or = .1). As most of the caregivers were family members who assisted with transport, written communications, and personal affairs, the "opportunity costs" were calculated. The median annual opportunity cost was A$915 (US $710) (range, $A0-$9653 [US $0-$7491]). This study prospectively obtained data for the cost of caregivers for people with impaired vision. The degree of vision impairment was not associated with the amount of care used but showed a threshold effect: when vision is impaired to the extent that people cannot legally hold a driver's license, reliance on caregivers appears to be independent of the severity of loss of vision.

Risk Factors Associated With Injury Attributable to Falling Among Elderly Population With History of Stroke

Stroke survivors are at high risk for falling. Identifying physical, clinical, and social factors that predispose stroke patients to falls may reduce further disability and life-threatening complications, and improve overall quality of life. We used 5 biennial waves (1998-2006) from the Health and Retirement Study to assess risk factors associated with falling accidents and fall-related injuries among stroke survivors. We abstracted demographic data, living status, self-evaluated general health, and comorbid conditions. We analyzed the rate ratio (RR) of falling and the OR of injury within 2 follow-up years using a multivariate random effects model. We identified 1174 stroke survivors (mean age+/-SD, 74.4+/-7.2 years; 53% female). The 2-year risks of falling, subsequent injury, and broken hip attributable to fall were 46%, 15%, and 2.1% among the subjects, respectively. Factors associated with an increased frequency of falling were living with spouse as compared to living alone (RR, 1.4), poor general health (RR, 1.1), time from first stroke (RR, 1.2), psychiatric problems (RR, 1.7), urinary incontinence (RR, 1.4), pain (RR, 1.4), motor impairment (RR, 1.2), and past frequency of > or = 3 falls (RR, 1.3). Risk factors associated with fall-related injury were female gender (OR, 1.5), poor general health (OR, 1.2), past injury from fall (OR, 3.2), past frequency of > or = 3 falls (OR, 3.1), psychiatric problems (OR, 1.4), urinary incontinence (OR, 1.4), impaired hearing (OR, 1.6), pain (OR, 1.8), motor impairment (OR, 1.3), and presence of multiple strokes (OR, 3.2). This study demonstrates the high prevalence of falls and fall-related injuries in stroke survivors, and identifies factors that increase the risk. Modifying these factors may prevent falls, which could lead to improved quality of life and less caregiver burden and cost in this population.

Perspectives and expectations for telemedicine opportunities from families of nursing home residents and caregivers in nursing homes

Background This study assessed current perspectives and expectations for telemedicine by nursing home caregivers and families of nursing home patients in Taipei, Taiwan. Methods A total of 116 interviews were conducted with family members ( n = 37) and caregivers ( n = 79) using an original, four-part questionnaire devised to assess the expectations and concerns related to prospective telemedicine opportunities, including consumer attitude, knowledge of and interest in medicine, concerns and worries about telemedicine, and anticipated benefits of telemedicine. Results Statistical significance between the two groups was observed in sex, age, and educational level (all p < 0.001). Most respondents had heard about telemedicine before participation and showed some interest in telemedicine implementation. More than 70.0% of subjects in both groups had perceptions of telemonitoring of patients, notifications of health abnormalities, teleconferencing between physicians and family members, obtaining test/exam results and face-to-face consultation through telenetworks. Both groups hoped for information and education through telemedicine. More caregivers were concerned about increased costs ( p = 0.020), poor hardware quality ( p < 0.001), poor security, confidentiality, and reliability ( p = 0.036), inconvenience to patients ( p = 0.006), associated moral and ethical issues ( p = 0.006), and uncertainty about responsibility ( p = 0.022). The two groups did not differ in expectations concerning benefits of telemedicine. More than 60% of family members or caregivers expected improved efficiency and quality of hospital and nursing home health care, greater rapport between nursing homes and either staff or patients, reduced overall medical costs of caregiving, and reduced staff/caregiver working hours. The acceptable cost was anything up to $15.30 USD per month. Conclusions Nursing home caregivers and families of nursing home patients are highly interested in telemedicine; however, they are only willing to pay a slightly higher cost of nursing care for this service. The challenge for the future in this industry is to balance peoples’ demands and telemedicine's associated costs. Results of this study suggest that caregivers and families of nursing home residents favour telemedicine implementation to provide enhanced care coordination in nursing homes when economic circumstances are favourable.

Economic cost of tobacco use in India, 2004

Objective:To estimate the tobacco-attributable costs of diseases separately for smoked and smokeless tobacco use in India.Methods:The prevalence-based attributable-risk approach was used to estimate the economic cost of tobacco using healthcare...

Impact of visual impairment on service and device use by individuals with diabetic retinopathy

Purpose. This study was performed to assess the use of devices and caregiving among individuals with diabetic retinopathy and to evaluate the impact of visual acuity on use.Methods. Data were collected using a questionnaire that included items on demographic and clinical characteristics and on the use of services, assistive devices, and caregiving. The study was approved by an institutional review board. Two ophthalmologists identified and invited patients with diabetic retinopathy and provided best corrected visual acuity (BCVA). Patients provided informed consent. De-identified data were analysed in SAS®.Results. Of the 806 respondents, 55% were women; mean age was 65 years. Respondents were classified into five categories based on BCVA. Few respondents used services such as transportation and counseling, but there was wide use of assistive devices. More than 20% of respondents used a cane, a hand-held magnifier, and/or special glasses. The mean number of devices used increased significantly as BCVA deteriorated, as did hours of caregiving. Annual costs for services, devices, and caregiving increased as BCVA deteriorated.Conclusions. There are substantial differences in the use and costs of assistive devices and caregiving among individuals with diabetic retinopathy with varying BCVA.