Lifetime Cost Of Care Research Articles

Lifetime cost of surgical treatment for canine hip osteoarthritis is less than conservative management in dogs under eight years of age.

To determine the lifetime cost of 3 treatments for canine hip osteoarthritis: (1) conservative management, (2) femoral head and neck excision (FHNE), or (3) total hip replacement. We hypothesized that FHNE would be the least expensive treatment at all ages. Cost estimates from 11 private and academic referral centers from 8 randomly chosen cities across the US. Costs of surgeries were collected from practices in 8 US cities. The literature was used to determine expected postoperative costs. For conservative management, costs of pain medications and diet were obtained by use of online pharmacies. A 4.5% inflation adjustment was used for costs in subsequent years. For a dog aged 1 to 7 years, FHNE had the lowest lifetime cost. Total hip replacement had the second lowest cost until age 4, after which conservative management was lower. For dogs > 8 years, conservative management was the most cost-effective. For dogs presenting with clinical signs at or under 1 year of age, the perceived benefits of total hip replacement may not be financially prohibitive if lifetime cost of care is considered. Femoral head and neck excision was also less expensive than long-term conservative management. This can help veterinarians inform owners on costs of treatments over the lifetime of their pet. This type of analysis is limited to financial costs alone and does not account for differences in outcomes, as these are not well established. It should be expanded in the future as better data on outcomes and impacts of care become available.

Economic Analysis of a Ketoanalogue-Supplemented Very Low-Protein Diet in Patients With Chronic Kidney Disease in Taiwan and Thailand

A vegetarian very low-protein diet (VLPD) supplemented with ketoanalogues of essential amino acids Ketoanalogue-supplemented very low-protein diet (sVLPD) delays dialysis initiation in patients with chronic kidney disease (CKD). In this cost-effectiveness analysis, we compare an sVLPD with a conventional low-protein diet (LPD) in patients with CKD stage 4-5 using data from Taiwan and Thailand. A Markov model simulated health outcomes and care costs in patients receiving an sVLPD (0.3-0.4g/kg-day, vegetarian diet) supplemented with ketoanalogues (1 tablet/5 kg-day) or an LPD (0.6g/kg-day, mixed proteins). Health state transition probability and resource cost inputs were based on published literature and local sources, respectively. An sVLPD increased survival and quality-adjusted life years (QALYs) at a lower cost than an LPD. Total cost of care in Taiwan was 2,262,592.30 New Taiwan dollars (NTD) (68,059.35 EUR) with an LPD and 1,096,938.20 NTD (32,996.18 EUR) with an sVLPD (difference -1,165,654.10 NTD; -35,063.17 EUR). Total cost of care in Thailand was 500,731.09 Thai baht (THB) (14,584.12 EUR) with an LPD and 421,019.22 THB (12,262.46 EUR) with an sVLPD (difference -79,711.86 THB; -2,321.66 EUR). A ketoanalogue-supplemented vegetarian sVLPD increased QALYs and lowered lifetime care costs versus an LPD in patients with predialysis CKD in Taiwan and Thailand. These data, together with the new KDOQI Guidelines for nutrition in CKD, support dietary intervention using ketoanalogue-supplemented vegetarian sVLPDs to prevent CKD progression and postpone dialysis as a cost-effective approach, with beneficial effects for patients and health care providers.

Lifetime Costs for Treated Follicular Lymphoma Patients in the US

The objective of this study was to estimate the lifetime costs of patients receiving treatment for follicular lymphoma (FL) in the United States. A Markov model was programmed in hēRo3 with a 6-month cycle length, 35-year time horizon (lifetime projection), and health states for line of treatment, response, receipt of maintenance therapy among responders, transformation to diffuse large B-cell lymphoma (DLBCL), development of second primary malignancy (SPM), and death. The model was used to estimate the expected lifetime costs of FL (in 2019 USD), including costs of drug acquisition and administration, transplant procedures, radiotherapy, adverse events, follow-up, DLBCL, SPM, end-of-life care, and indirect costs. Model inputs were based on published sources. In the US, patients with FL receiving treatment have a life expectancy of approximately 14.5 years from initiation of treatment and expected lifetime direct and indirect costs of US$515,884. Costs of drugs for induction therapy represent the largest expenditure (US$233,174), followed by maintenance therapy costs (US$88,971) and terminal care costs (US$57,065). Despite the relatively advanced age of these patients, indirect costs (due to patient morbidity and mortality and caregiver lost work time) represent a substantial share of total costs (US$40,280). Treated FL patients spend approximately 6.9 years in the health states associated with first-line therapy. Approximately 66 and 46% continue to second- and third-line therapies, respectively. The mean (95% credible interval) of expected lifetime costs based on the probabilistic sensitivity analyses was US$559,202 (421,997-762,553). In the US, the expected lifetime costs of care for FL patients who receive treatment is high. The results highlight the potential economic benefits that might be achieved by treatments for FL that prevent or delay disease progression.

Development of a Mathematical Model to Estimate the Cost-Effectiveness of HRSA's Ryan White HIV/AIDS Program.

The Health Resources and Services Administration's Ryan White HIV/AIDS Program provides services to more than half of all people diagnosed with HIV in the United States. We present and validate a mathematical model that can be used to estimate the long-term public health and cost impact of the federal program. We developed a stochastic, agent-based model that reflects the current HIV epidemic in the United States. The model simulates everyone's progression along the HIV care continuum, using 2 network-based mechanisms for HIV transmission: injection drug use and sexual contact. To test the validity of the model, we calculated HIV incidence, mortality, life expectancy, and lifetime care costs and compared the results with external benchmarks. The estimated HIV incidence rate for men who have sex with men (502 per 100,000 person years), mortality rate of all people diagnosed with HIV (1663 per 100,000 person years), average life expectancy for individuals with low CD4 counts not on antiretroviral therapy (1.52-3.78 years), and lifetime costs ($362,385) all met our validity criterion of within 15% of external benchmarks. The model represents a complex HIV care delivery system rather than a single intervention, which required developing solutions to several challenges, such as calculating need for and receipt of multiple services and estimating their impact on care retention and viral suppression. Our strategies to address these methodological challenges produced a valid model for assessing the cost-effectiveness of the Ryan White HIV/AIDS Program.

Sports Monitoring with Moving Aerial Cameras Maybe Cost Efficient For Injury Prevention

Objectives: An Australian access economics report (2009) estimated the lifetime cost of care is 5.0 million for a person whom suffers paraplegia and 9.5 million for quadriplegia, and costs/year are approximately $90,000. Hilton )2018( on drones at sporting venues discusses their potential to revolutionize injury surveillance monitoring via expert exposure gained for recording, investigation, tracking and monitoring of sporting injuries. Hilton (2018) reviewed rugby union and league Australian spinal cord injury datasets, finding more incident cases in the union then league [1]. Methods/Analysis: Wikipedia reports 20 professional rugby union and 26 rugby league playing fields in Australia. The Australian Institute of Health and Welfare document; Australian sports injury hospitalizations 2011–12 report just under 800 head and neck injuries requiring hospitalization related to rugby-related sports “35 neck fractures and 348 head fractures”. Brisbane’s leading drone aerial photography service “Droneworxs” according to previous enquiries by the author charge $650/hour to monitor a sporting event. A crude drone implementation cost estimate, hypothetically is to utilize this device across 46 professional clubs X 52 weeks one hour/week = $1,554,800. A basic hypothetical mathematical cost benefit comparison was performed. Findings: Droneworxs cost divided by healthcare costs/case/year ($90,000) = 17 so if these injuries are prevented then cost equivalence is reached figurately speaking, then cost benefits accrue. Novelty /Improvement: Drones are not overly expensive compared to spinal cord injury costs. The occasional presence of aerial cameras at sporting venues may also deter repeated foul play, in the same way that webcam cameras deter potential thieves.

HIV care cost in England: a cross-sectional analysis of antiretroviral treatment and the impact of generic introduction.

Reliable and timely HIV care cost estimates are important for policy option appraisals of HIV treatment and prevention strategies. As HIV clinical management and outcomes have changed, we aimed to update profiles of antiretroviral (ARV) usage pattern, patent/market exclusivity details and management costs in adults (≥18years old) accessing HIV specialist care in England. The data reported quarterly to the HIV and AIDS Reporting System in England was used to identify ARV usage pattern, and were combined with British National Formulary (BNF) prices, non-ARV care costs and patent/market exclusivity information to generate average survival-adjusted lifetime care costs. The cumulative budget impact from 2018 to the year in which all current ARVs were expected to lose market exclusivity was calculated for a hypothetical 85000 (± 5000) person cohort, which provided an illustration of potential financial savings afforded by bioequivalent generic switches. Price scenarios explored BNF70 (September 2015) prices and generics at 10/20/30/50% of proprietary prices. The analyses took National Health Service (NHS) England's perspective (as the payer), and results are presented in 2016/2017 British pounds. By 2033, most currently available ARVs would lose market exclusivity; that is, generics could be available. Average per person lifetime HIV cost was ~£200000 (3.5% annual discount) or ~£400000 (undiscounted), reducing to ~£70000 (3.5% annual discount; ~£120000 undiscounted) with the use of generics (assuming that generics cost 10% of proprietary prices). The cumulative budget to cover 85000 (± 5000) persons for 16years (2018-2033) was £10.5 (± 0.6) billion, reducing to £3.6 (± 0.2) billion with the use of generics. HIV management costs are high but financial efficiency could be improved by optimizing generic use for treatment and prevention to mitigate the high cost of lifelong HIV treatment. Earlier implementation of generics as they become available offers the potential to maximize the scale of the financial savings.

Cost-Effectiveness Analysis of Early vs Late Diagnosis of HIV-Infected Patients in South Carolina.

It is anticipated that early diagnosis, linkage to care, initiation of antiretroviral therapy (ART), and retention in care would lead to reduced opportunistic infections, reduction in human immunodeficiency virus-related morbidity and mortality and reduced rates of HIV transmission. This would be expected to lead to a reduction in the lifetime cost of care (LCC). This study analyzed existing data to determine to what extent early-versus-late HIV diagnosis affects LCC. The South Carolina Department of Health and Environmental Control electronic HIV/acquired immunodeficiency syndrome reporting system data were used for this study. The first CD4 and viral load reported to the Enhanced HIV/AIDS Reporting System of the Centers for Disease Control and Prevention are considered the initial CD4 and viral load. Late HIV diagnosis was based on a CD4 count ≤200 at diagnosis. A previously validated simulation model developed by the John Snow Institute for the South Carolina Department of Health and Environmental Control was used to determine the discounted LCC. Comparisons were made between late and early HIV diagnosis. From 2013 through 2015, 2138 individuals were diagnosed as having HIV in South Carolina; 180 individuals were excluded from further analysis because an initial CD4 count was missing. Final analysis was based on 1958 individuals. Late HIV diagnosis occurred in 509 individuals (26%). When stratified based on CD4 count at diagnosis, the discounted LCC per person in those with an initial CD4 count ≤200 was $262,374 and in those with an initial CD4 count >500 was $416,766. Those with lower CD4 counts at diagnosis had more lost quality-adjusted life-years (QALYs; 7.95 QALYs lost per person with an initial CD4 count ≤200 compared with 4.45 QALYs lost per person with an initial CD4 count >500), more lifetime HIV transmissions (1.4 per person with an initial CD4 count ≤200 compared with 0.72 per person with an initial CD4 count >500), and lower additional life expectancy (30.73 additional years with an initial CD4 count ≤200 compared with 38.08 additional years with an initial CD4 count >500). Although individuals with lower CD4 counts at diagnosis had a lower discounted LCC, they had more lost QALYs, more lifetime HIV transmissions, and lower additional life expectancy.

The cost-effectiveness and budgetary impact of a dolutegravir-based regimen as first-line treatment of HIV infection in India.

IntroductionDolutegravir (DTG)‐based antiretroviral therapy (ART) is recommended for first‐line HIV treatment in the US and Europe. Efavirenz (EFV)‐based regimens remain the standard of care (SOC) in India. We examined the clinical and economic impact of DTG‐based first‐line ART in the setting of India's recent guidelines change to treating all patients with HIV infection regardless of CD4 count.MethodsWe used a microsimulation of HIV disease, the Cost‐Effectiveness of Preventing AIDS Complications (CEPAC)‐International model, to project outcomes in ART‐naive patients under two strategies: (1) SOC: EFV/tenofovir disoproxil fumarate (TDF)/lamivudine (3TC); and (2) DTG: DTG + TDF/3TC. Regimen‐specific inputs, including virologic suppression at 48 weeks (SOC: 82% vs. DTG: 90%) and annual costs ($98 vs. $102), were informed by clinical trial data and other sources and varied widely in sensitivity analysis. We compared incremental cost‐effectiveness ratios (ICERs), measured in $/year of life saved (YLS), to India's per capita gross domestic product ($1600 in 2015). We compared the budget impact and HIV transmission effects of the two strategies for the estimated 444,000 and 916,000 patients likely to initiate ART in India over the next 2 and 5 years.ResultsCompared to SOC,DTG improved 5‐year survival from 76.7% to 83.0%, increased life expectancy from 22.0 to 24.8 years (14.0 to 15.5 years, discounted), averted 13,000 transmitted HIV infections over 5 years, increased discounted lifetime care costs from $3040 to $3240, and resulted in a lifetime ICER of $130/YLS, less than 10% of India's per capita GDP in 2015. DTG maintained an ICER below 50% of India's per capita GDP as long as the annual three‐drug regimen cost was ≤$180/year. Over a 2‐ or 5‐year horizon, total undiscounted outlays for HIV‐related care were virtually the same for both strategies.ConclusionsA generic DTG‐based regimen is likely to be cost‐effective and should be recommended for initial therapy of HIV infection in India.

Planning the home and facility-based care dynamics using the multiple decrement approach: The case study for Slovenia

Physical environment, especially urban facilities that are age-friendly are of particular importance for those growing older. Investments in facilities and changes in the environment can lower the disability threshold and travelling costs for caregivers and other suppliers. It influences the needs for care in each category of dependency, measured by care dependency scale. The good planning of a Home Health Care Structure requires a resolution of several complex challenges, dependent on dynamics of the rapid ageing of the European population. Therefore the spatial interaction model developed individually for each group of functional capacity can improve the forecast of overall dynamics of the structure according to age cohorts of older persons in care, and optimise investments in home care systems and other facilities in the framework of regional and urban spatial planning. The method for calculation of expected future structure of cohorts and human resources required for the care of older adults which are dependent on the help of others is given. As a novelty, the actuarial present value of lifetime care costs is a subject of criterion function at a given life expectancy. Here the disability thresholds are determined in a given environment, and the needed capacities are forecasted using the asymmetric Lowry-like gravity model associated with the multi-state transition approach. The numerical example shows how we can plan the dynamics of needed investments in facilities and human resources based on the forecasted structure of care dependency categories if some new financial mechanisms for seniors are available and the tax system is friendly to older cohorts.

Dementia increases lifetime costs of care in USA

Dementia increases lifetime costs of care in USA

VP103 Health Technology Assessment Of Genetic Tests For Cystic Fibrosis Carrier Screening In Italy

INTRODUCTION:Cystic Fibrosis (CF) is a genetic disorder caused by mutations in CFTR gene. In Italy, reported prevalence is approximately .70 per 10,000 inhabitants (1). The practice and recommendations for Cystic Fibrosis carrier screening are very heterogeneous in Europe. A proposal of a carrier genetic test in the general population raises many questions. Health Technology Assessment (HTA) could offer a sound methodological basis for this evaluation. The aim of this work was to summarize the available evidence, using the HTA approach, on the genetic tests for Cystic Fibrosis carrier screening.METHODS:A systematic literature search was used to find the best available international and national evidence on genetics test for CF carrier screening. In this report, we specifically addressed the health problem of disease, description and technical characteristics of tests – its analytic and clinical validity, and clinical utility. Economic evaluation of different scenarios was synthesized from the literature. Ethical, organizational, and social aspects of CF and genetic screening were also considered.RESULTS:Several screening strategies have been evaluated in the literature and screening options can be characterized by different timing, model and place of screening (2). The reported cost of a screening test ranged from EUR25 to EUR212 (3). Estimated life time cost of care for CF patients ranged from EUR291,048 to EUR1,105,452. Ethical analysis emphasized that the use of these tests is an advantage in terms of the acquisition of knowledge and of responsible management of choices, but at the same time raises many ethical questions. Social considerations reported among patients and their families an overall positive attitude toward population CF carrier screening.CONCLUSIONS:The advances in the molecular genetics technology have made CF carrier testing reliable and affordable. The multidisciplinary approach of this HTA provided an evidence-based evaluation of genetic tests and offers a firm scientific background for the decision-makers to consider the implementation of a screening for Cystic Fibrosis carriers into the Italian health care system.

An Analysis of Young Driver Crash Types and the Associated Lifetime Care Cost in Victoria, Australia

Objective: The elevated crash involvement rate of young drivers is well documented. Given the higher crash risk of young drivers and the need for innovative policy and programs, it remains important to fully understand the type of crashes young drivers are involved in, and knowledge of the lifetime care cost of crashes can support effective policy development. The aim of this article is to document the number and type of young driver crashes, as well as the associated lifetime care cost over a 9-year period (2005–2013) in Victoria, Australia.Methods: In Victoria, Australia, the Transport Accident Commission (TAC) has legislated responsibility for road safety and the care of persons injured in road crashes, irrespective of fault. TAC claims data for the period 2005–2013 were used to document the number and type of young driver crashes. Lifetime care costs (past and future payment liabilities) were calculated by Taylor Fry actuarial consultancy. License and population data were used to define the crash involvement rate of young drivers.Results: Over the 9-year period, 16,817 claims were lodged to the TAC by drivers 18–25 years of age following a crash. There were 646 fewer drivers aged 18–25 killed and injured in 2013, compared to 2005, representing an unadjusted change of −28.7% (−29.8% males; −28.4% females). The total lifetime care cost of young drivers killed and injured in Victoria for the period 2005–2013 was estimated to be AU$634 million (US$493 million). Differences between males and females, single- and multivehicle crashes, and fatalities and injuries were found to be statistically significant. Run-off-road crashes and crashes from opposing direction were overrepresented in the lifetime care costs for young driver claimants. Twenty-eight injured drivers were classified as high-severity claims. These 28 claimants require additional long-term care, which was estimated to be AU$219 million; of these 28, 24 were male (85.7%). The long-term care costs for these 28 drivers (0.16%) accounts for 34.5% of the total lifetime care cost of all 18- to 25-year-old injured drivers.Conclusions: By using no-fault lifetime care costs that account for medical and like expenses, rehabilitation, and social reintegration costs, a more accurate understanding of the cost of young driver crashes can be determined. Application of these costs to specific crash types highlights new priorities and opportunities for developing programs to reduce young driver crashes.

A longitudinal cohort study of the relationship between Thimerosal-containing hepatitis B vaccination and specific delays in development in the United States: Assessment of attributable risk and lifetime care costs

Epidemiological evidence suggests a link between mercury (Hg) exposure from Thimerosal-containing vaccines and specific delays in development. A hypothesis-testing longitudinal cohort study (n=49,835) using medical records in the Vaccine Safety Datalink (VSD) was undertaken to evaluate the relationship between exposure to Hg from Thimerosal-containing hepatitis B vaccines (T-HBVs) administered at specific intervals in the first 6months of life and specific delays in development [International Classification of Disease, 9th revision (ICD-9): 315.xx] among children born between 1991 and 1994 and continuously enrolled from birth for at least 5.81years. Infants receiving increased Hg doses from T-HBVs administered within the first month, the first 2months, and the first 6months of life were significantly more likely to be diagnosed with specific delays in development than infants receiving no Hg doses from T-HBVs. During the decade in which T-HBVs were routinely recommended and administered to US infants (1991–2001), an estimated 0.5–1million additional US children were diagnosed with specific delays in development as a consequence of 25μg or 37.5μg organic Hg from T-HBVs administered within the first 6months of life. The resulting lifetime costs to the United States may exceed $1 trillion.

Updates of Lifetime Costs of Care and Quality-of-Life Estimates for HIV-Infected Persons in the United States

Lifetime costs of care and quality-of-life estimates for HIV-infected persons depend on the disease stage at which these persons are diagnosed, enter care, and start antiretroviral therapy. Updated estimates were used to analyze the effects of late versus early diagnosis/entry on US lifetime care costs, quality-of-life estimates, and HIV transmissions. The Progression and Transmission of HIV/AIDS model was used to estimate discounted (3%) lifetime treatment costs ($US 2011) and quality-of-life variables from time of infection for cohorts of 10,000 HIV-infected index patients in 4 categories of CD4 count at diagnosis: (I) ≤200 cells/μL, (II) 201-350 cells/μL, (III) 351-500 cells/μL, and (IV) 501-900 cells/μL. It is assumed that index patient diagnoses were uniformly distributed across the CD4 count range in each category and that patients entered care at the time of diagnosis, remained in care, and were eligible to initiate antiretroviral therapy at a CD4 count of 500 cells/μL. Lifetime transmissions of the index patients were also estimated. Discounted average lifetime costs varied from $253,000 for category I index patients to $402,000 for category IV patients. Discounted quality-adjusted life years lost decreased from 7.95 to 4.45 across these categories, additional years of life expectancy increased from 30.8 to 38.1, and lifetime transmissions decreased from 1.40 to 0.72. Early diagnosis and treatment of HIV infection increases lifetime costs but improves length and quality of life and reduces the number of new infections transmitted by nearly 50%.

Abstract TP326: Incremental Cost of an Individualized Telephone Intervention for Stroke Caregivers

Background/Purpose: Informal care represents a substantial part of total lifetime care costs for stroke patients; yet, the literature has focused on the costs of tertiary care for stroke patients. The purpose of this study was to estimate the cost of a nurse-led individualized Telephone Assessment and Skill-building Kit (TASK) intervention compared to one in which a nurse actively listened, and paraphrased the ASA pamphlet on caregiving. Methods: A sample of stroke caregivers were randomly assigned to one of two phone interventions: the individualized TASK intervention or information, Support and Referral (ISR). This analysis uses the first 50 caregivers assigned to each of the two interventions. Following a template designed in the pilot study, we included the costs of training and supervising nurse interveners, intervention (preparation, delivery and wrap-up), materials for caregivers and caregiver time (for phone calls and material review). Results: Average cost for the intervention was $173 for the TASK group and $110 for the ISR group; materials for caregivers and caregiver time costs were $116 for TASK and $42 for ISR. Training and supervising nurse interveners cost $144 per care giver in the TASK group and $75 for the ISR group. We estimate that, for 9 calls to caregivers, the TASK intervention cost was $433 per caregiver while the ISR cost $227 per caregiver_$48 and $25 on a per call basis, respectively. Conclusions: For 50 caregivers, the incremental cost per caregiver for TASK relative to ISR was $206, of which, $69 was for training and supervising nurse interveners. Average costs (ie, costs per caregiver) associated with training and supervising, can be expected to decrease as the number of caregivers served increases, unless there is high attrition among nurse interveners. Consequently we expect that the incremental cost per caregiver will decrease as more caregivers are served. The estimated costs can be used in a future cost-effectiveness analysis, and also provide insight into the extent to which average costs can be reduced.

The Lifetime Economic Burden of Keratoconus: A Decision Analysis Using a Markov Model

To estimate the expected incremental lifetime cost of treatment of keratoconus compared to the expected cost of the treatment of myopia. Cost estimate from the patient's perspective using a Markov decision model. We modeled a hypothetical cohort of people with clinically significant incident keratoconus as defined by the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study. We included costs of clinic visits, fitting fees, contact lenses, surgical procedures, and complications. Survival curves of corneal transplants and associated complications were modeled using data from the 2007 Australian Graft Registry. Medical treatment regimens after surgery were defined by expert opinion. The expected value of the lifetime cost of the treatment of keratoconus over myopia was $25 168 with a standard deviation of $16 247 and a median of $17 596. The factors that most influenced the lifetime cost were the probability of initial corneal transplant and a subsequent regraft. The cost of routine care had relatively little influence on the lifetime cost of care. The expected lifetime cost of treatment of keratoconus represents a significant cost to patients and payors. While the cost of routine care for keratoconus is not trivial, the primary factor influencing changes in the cost of care for keratoconus is the probability of corneal transplant. Combined with the significantly impaired vision-related quality of life and the relatively young onset of disease, the economic burden of the treatment of keratoconus represents a significant public health concern.

Informing policy for the Australian context – Costs, outcomes and cost savings of prenatal carrier screening for cystic fibrosis

To examine the costs, outcomes and cost savings of three models of prenatal cystic fibrosis (CF) carrier screening compared to no screening from a public health sector perspective. A decision tree was generated to estimate costs and outcomes for each screening model for a hypothetical cohort of 38 000 pregnancies. Sensitivity analysis assessed the impact of model parameter variation. Under baseline assumptions, the initial annual cost to provide a prenatal CF carrier-screening programme is Au$5.32 million, Au$3.35 million and $2.93 million for one-step, two-step simultaneous and two-step sequential screening respectively. Annual costs are significantly lower for an established programme. No screening model provides a net saving over a lifetime horizon; however, the results were sensitive to variation in lifetime cost of care, screening test costs and number of pregnancies per carrier couple. Under some scenarios, prenatal CF carrier screening is cost saving to the health system; however, this is not conclusive and depends on several factors. Cost remains a potential barrier due to the substantial level of funding required in the short term. Feasibility and psychosocial, ethical and legal implications of screening need to be considered. Additionally, consultation is required with the Australian community on the acceptability and/or desire for prenatal CF carrier screening.

The Cost of Pediatric Stroke Acute Care in the United States

The cost of pediatric stroke care has received little attention, but the available data suggest it is expensive. To determine the cost of acute stroke, we analyzed a US national database. Method- We used the Kids' Inpatient Database (KID2003) to determine the hospital-based costs of acute stroke in children ages 3 months to 20 years. Discharges were selected if the first diagnostic position contained an International Classification of Diseases, 9th Revision code pertaining to ischemic or hemorrhagic stroke. We examined the relationship between cost and stroke type by adjusting for variables that predict the cost of adult stroke. There were 2224 pediatric cases, after statistical weighting, discharged with a diagnosis of hemorrhagic or ischemic stroke in KID2003. The estimated cost of acute pediatric stroke in the United States was $42 million in 2003. For the entire cohort, the mean cost of acute hospital care was $20 927 per discharge. The mean cost for ischemic stroke was $15 003, for intracerebral hemorrhage $24 117, and for subarachnoid hemorrhage $31 653. Stroke diagnosis, length of stay, hospital ownership, rural/urban teaching status, US geographical region, and discharge disposition were significantly associated with cost. Cost remained significantly associated with stroke diagnosis after adjusting for other predictors in the final multivariable regression model. Pediatric stroke is expensive, and the lifetime cost of care is likely greater for a child than an adult. The cost to the family and the larger society underscore the importance of pediatric stroke treatment and prevention.

The Association of High-Magnitude Cerebral Passivity and Intraventricular Hemorrhage in Premature Infants

The Association of High-Magnitude Cerebral Passivity and Intraventricular Hemorrhage in Premature Infants

Sidebar: Long-term care is an important consideration in financial planning for later life

Sidebar: Long-term care is an important consideration in financial planning for later life