Outpatient Treatment Costs Research Articles

Economic burden of inpatient and outpatient antibiotic treatment for methicillin-resistant Staphylococcus aureus complicated skin and soft-tissue infections: a comparison of linezolid, vancomycin, and daptomycin

BackgroundPrevious economic analyses evaluating treatment of methicillin-resistant Staphylococcus aureus (MRSA) complicated skin and soft-tissue infections (cSSTI) failed to include all direct treatment costs such as outpatient parenteral antibiotic therapy (OPAT). Our objective was to develop an economic model from a US payer perspective that includes all direct inpatient and outpatient costs incurred by patients with MRSA cSSTI receiving linezolid, vancomycin, or daptomycin.MethodsA 4-week decision model was developed for this economic analysis. Published literature and database analyses with validation by experts provided clinical, resource use, and cost inputs on data such as efficacy rate, length of stay, adverse events, and OPAT services. Base-case analysis assumed equal efficacy and equal length of stay for treatments. We conducted several sensitivity analyses where assumptions on resource use or efficacy were varied. Costs were reported in year-end 2011 US dollars.ResultsTotal treatment costs in the base-case were lower for linezolid ($10,571) than vancomycin ($11,096), and daptomycin ($13,612). Inpatient treatment costs were $740 more, but outpatient costs, $1,266 less with linezolid than vancomycin therapy due to a switch to oral linezolid when the patient was discharged. Compared with daptomycin, both inpatient and outpatient treatment costs were lower with linezolid by $87 and $2,954 respectively. In sensitivity analyses, linezolid had lower costs compared with vancomycin and daptomycin when using differential length of stay data from a clinical trial, and using success rates from a meta-analysis. In a scenario without peripherally inserted central catheter line costs, linezolid became slightly more expensive than vancomycin (by $285), but remained less costly than daptomycin (by $2,316).ConclusionOutpatient costs of managing MRSA cSSTI may be reduced by 30%–50% with oral linezolid compared with vancomycin or daptomycin. Results from this analysis support potential economic benefit and cost savings of using linezolid versus traditional OPAT when total inpatient and outpatient medical costs are evaluated.

Mo1376 Depression and the Cost of Outpatient Treatment of Crohn's Disease in an US Academic Medical Center

Background: There are over 700,000 Americans affected by Crohn's disease (CD). A number of previous studies have looked at the cost of treating CD but they have focused primarily on inpatient costs. This study examines the cost of CD treatment in an outpatient setting and the economic burden of the comorbidity of depression among CD patients at a US academic medical center. Method: This is a retrospective study examining hospital cost data of all new patients with CD based on ICD-9 coding seen in an academic medical center's Inflammatory Bowel Disease Center from November 2010-November 2011. Chart review confirmed that billing was only for CDrelated issues. Cost data represent the actual cost to the institution of providing the service and was obtained from the institution's cost accounting database. The presence of depression was measured with the Patient Health Questionnaire-9 (PHQ-9), a self-report instrument used as part of the regular clinical practice in the Inflammatory Bowel Disease (IBD) Center. Multiple regression analysis was used to examine the relationship between patient's PHQ-9 score and cost, adjusting for age, race, and gender, as well as an interaction between gender and severity of depression. Results: 650 patients (377 female [58%]) were included in the study. The average age of the patients is 39.7 years [(malesM.39.4 (SD. 15.85) femalesM39.9,( SD. 15.85)]. The average PHQ9 score is 6.80. Females had a higher average PHQ-9 score of 7.80 (SD. 6.40 ) vs. males-

1062 SOCIOECONOMIC TRENDS AND UTILIZATION IN THE EMERGENCY DEPARTMENT TREATMENT OF URINARY TRACT INFECTIONS

INTRODUCTION AND OBJECTIVES: The cost of outpatient clinic treatment of urinary tract infections (UTI) has been estimated at $300, per episode, including office visit and laboratory fees. In this study we examined the populations most likely to be treated and released (TR on Medicaid (24.4 vs. 13.0%) or Private insurance (32.6 vs. 17.6%) p 0.001 and was more likely in the lowest income quartile (33.5 vs. 28.7%, p 0.001). Median ED charges for the T&R population were $1,072 per ED visit (IQR: 593 to 2,306.5). In comparison to UTI treatment charges in an outpatient setting, this represents a $772 (IQR: 293 to 2,006.5) average increase in the cost of treatment, per episode. The total differential cost nationwide was 1.6 billion dollars in 2006, increasing to 1.8 billion dollars in 2009. CONCLUSIONS: The number of patients treated and released for a UTI from US emergency rooms increased from 2.0 million in 2006 to 2.3 million in 2009. Improved guidelines and greater access to primary care physicians for these patients could result in annual cost savings of nearly 2 billion dollars.

A comparative analysis of outpatient costs in HIV treatment programs

To analyze the costs of human immunodeficiency virus (HIV) outpatient treatment for individuals with different CD4 cell counts in the Brazilian public health system, and to compare to costs in other national health systems. A retrospective survey was conducted in five public outpatient clinics of the Brazilian national HIV program in the city of São Paulo. Data on healthcare services provided for a period of one year of HIV outpatient treatment were gathered from randomly selected medical records. Prices of inputs used were obtained through market research and public sector databases. Information on costs of HIV outpatient treatment in other national health systems were gathered from the literature. Annual costs of HIV outpatient treatment from each country were converted into 2010 U.S. dollars. Annual cost of HIV outpatient treatment for the Brazilian national public program was US$ 2,572.92 in 2006 in São Paulo, ranging from US$ 1,726.19 for patients with CD4 cell count > 500 to US$ 3,693.28 for patients with 51 < CD4 cell count < 200. Antiretrovirals (ARVs) represented approximately 62.0% of annual HIV outpatient costs. Comparing among different health systems during the same period, HIV outpatient treatment presented higher costs in countries where HIV treatment is provided by the private sector. The main cost drivers of HIV outpatient treatment in different health systems were: ARVs, other medications, health professional services, and diagnostic exams. Nevertheless, the magnitude of cost drivers varied among HIV outpatient treatment programs due to health system efficiency. The data presented may be a valuable tool for public policy evaluation of HIV treatment programs worldwide.

Incidence and Cost of Depression After Occupational Injury

We examined if injured workers were more likely than noninjured workers to be treated for depression after an occupational injury and estimated the cost paid by group medical insurance. Nearly 367,900 injured and noninjured workers were drawn from the 2005 Thomson Reuters MarketScan data. Descriptive, logistic, and two-part model regression analyses were used. The odds of injured workers being treated for depression within the study period were 45% higher than those of noninjured workers (95% confidence interval, 1.17-1.78). The unconditional average cost of outpatient depression treatment was 63% higher for injured workers than for noninjured workers. Injured workers were more likely than noninjured workers to suffer from depression during the study period. Consequently, additional costs are incurred for treating injured workers' depression; these costs were not covered by the workers' compensation system.

Impact of Health Insurance on Health Care Treatment and Cost in Vietnam: A Health Capability Approach to Financial Protection

We applied an alternative conceptual framework for analyzing health insurance and financial protection grounded in the health capability paradigm. Through an original survey of 706 households in Dai Dong, Vietnam, we examined the impact of Vietnamese health insurance schemes on inpatient and outpatient health care access, costs, and health outcomes using bivariate and multivariable regression analyses. Insured respondents had lower outpatient and inpatient treatment costs and longer hospital stays but fewer days of missed work or school than the uninsured. Insurance reform reduced household vulnerability to high health care costs through direct reduction of medical costs and indirect reduction of income lost to illness. However, from a normative perspective, out-of-pocket costs are still too high, and accessibility issues persist; a comprehensive insurance package and additional health system reforms are needed.

Hospital versus home treatment of deep vein thrombosis in a tertiary care hospital in Saudi Arabia: Are we ready?

Aim/BackgroundTreatment of DVT with LMWHs has been shown recently to be as effective as UFH with suggested lower costs. This study was conducted to determine and compare the cost of in-patient hospital treatment versus outpatient hospital treatment of patients with DVT. MethodAll adult patients with acute proximal DVT referred to the Emergency Department of King Khalid University Hospital, Riyadh, Saudi Arabia between August 2009 and August 2010 were invited to the study. An economic analysis was performed to compare the cost impact of outpatients versus hospital treatment. ResultsSixty-one patients were included in the study, 31 were followed in the outpatient setting and 30 as the control group (inpatients). There were no significant differences in the outcome between the outpatient and inpatient group; three patients (9.7%) in the outpatient group and four patients (13.3%) in the inpatient group had recurrent DVT. Mean nursing cost was $55 for the outpatient group and $215 for the inpatient group, mean laboratory monitoring cost was $638 for outpatient group and $1511 for the inpatient group. Hospital stay and doctor’s fees amounted to a mean of $1000 for outpatient treatment and $2387 for inpatient treatment, p<0.0001. The mean outpatient cost was significantly lower than the inpatient cost ($1750 vs. $4338, p<0.0001). ConclusionOutpatient treatment of patients with DVT using LMWHs is cost-effective with no significant differences in the outcome of patients. OPD treatment of DVT is feasible in Saudi Arabia provided there is enough logistic support from thrombosis clinics and those involved in DVT care.

Evaluation of health-care utilization among adult patients with epilepsy in Germany

This study evaluated the resource use of patients with epilepsy in the German district of Marburg-Biedenkopf. A cross-sectional cohort of consecutive adults with epilepsy, irrespective of seizure severity, duration of illness and epilepsy syndrome, was investigated in all health-care sectors. Costs of inpatient and outpatient treatment were derived from billing data of participating hospitals and office-based physicians. Data on socioeconomic status, course of epilepsy and further direct and indirect costs were recorded using patient questionnaires.We enrolled 366 patients from the district of Marburg-Biedenkopf and calculated annual epilepsy-specific costs of €7738 per patient. Direct costs contributed 31.1% (€2406) and indirect costs 68.9% (€5332) of the total costs. Direct medical costs were mainly due to hospitalization (33.2% of total direct costs) and anticonvulsants (26.7%). Costs of admissions were due to status epilepticus (24.4%), video-EEG monitoring (14.8%), newly diagnosed patients (14.4%) and seizure-related injuries (8.8%). Indirect costs were mainly due to early retirement (38.0%), unemployment (35.9%) and days off due to seizures (26.2%). The mean costs of epilepsy found in our study were lower than those found in studies conducted at European epilepsy centers due to the inclusion of patients in all health-care sectors.

Costs and quality of life for psoriatic patients at different degrees of severity in southern Sweden – a cross-sectional study

Knowledge of the societal costs of psoriasis is limited. This study estimated the cost of care, psoriasis area and severity index (PASI), and quality of life in a defined patient population in Sweden. A prevalence-based prospective recruitment of patients visiting two Swedish dermatology clinics between September and December 2009 was performed, collecting resource utilization for health care contacts, treatment, travelling, and productivity loss during 1 month. 164 patients were included. Mean total cost per patient-month was 994€. Main cost drivers were outpatient visits and light therapy (49%), biological drugs (20%) and productivity loss (22%). Total cost for topical treatment only (TT; 34%) was 369€, light therapy (LT; 24%) 1,274€, traditional systemic treatment (TST; 26%) 1,085€ and biological systemic treatment (BST; 16%) 1,709€ per patient-month. Main cost drivers were: outpatient visits (56%) in TT as well as for LT (78%), productivity loss (40%) in TST, and biological drugs (71%) among BST patients. There was no clear relationship between clinical (PASI) or subjective (DLQI) severity estimations and costs. The one-month cost-of-illness amounted to almost 1,000€/month, with great variations. Despite 1,190€ difference in drug cost for TST vs BST, total cost per month differed by 623€ because of offsets from improved productivity. A trend towards lower severity and reductions in outpatient and topical treatment costs was seen.

PMS25 Evaluation of Direct Costs for the Treatment of Active Juvenile Rheumatoid Arthritis Using Biologics

Evaluate direct costs for the treatment of patient with active juvenile rheumatoid arthritis (JRA) in the inefficiency of conventional therapy. Direct costs applied to patient, health care and society in process of medical care provision were evaluated. In the study direct costs included cost of biologics for the treatment of active JRA, therapy cost of the most common side effects caused by biologics use, cost of inpatient care and cost of out-patient diagnostic and treatment of JRA patients. Therapy cost with Etanercept and Abatacept was evaluated on the first stage including spending on one patient treatment with active JRA with body weight 15 till 65 kg. during one year after three months of inefficient conventional therapy. Biologics doses and dosing regimen were defined on the basis of application sheet. Calculated annual therapy cost for Etanercept varied from 11,752 EUR to 23,503 EUR depending on body weight and for Abatacept from 8,879 EUR to 26,638 EUR respectively. During cost analysis authors considered only very often (>1/10) and often (>1/100, < 1/10) occurred side effects. Thus, cost of side effects treatment caused by Etanercept use resulted in 44 EUR and for Abatacept – 69 EUR. Next stage of cost analysis was evaluation of therapy cost for patients with JRA according standard of inpatient treatment è standard of out-patient treatment. Cost of 30 days of inpatient care and 14 months of out-patient care was considered during cost analysis for the treatment of patients with JRA. Cost of inpatient and out-patient care for patient with JRA excluding biologics cost amounted to 33585 EUR. Finally total direct costs for the treatment of patient with JRA during one year with body weight from 15 till 65 kilogram varied from 45,380 EUR to 57,132 EUR for Etanercept and from 42,534 EUR to 60,292 EUR for Abatacept respectively.

The economic cost to households of childhood malaria in Papua New Guinea: a focus on intra-country variation

We compare direct and indirect household costs associated with malaria treatment for children<3 years in two provinces of Papua New Guinea. In particular, we explore the role of uncertainty around mean household costs and whether assuming a normal distribution for household costs limits the accuracy of any direct cost comparisons. Exit surveys were undertaken at inpatient and outpatient health facilities. In order to handle uncertainty and facilitate comparisons, parametric and non-parametric bootstrap methods were used to estimate direct and indirect costs at the individual data level. The inpatient and outpatient incremental costs from Madang and Maprik health facilities were compared and significant differences between provinces were identified. Differences were noted between provinces for both inpatient and outpatient household costs. Total arithmetic mean costs for an outpatient malaria episode were US$7.54 in Madang and US$9.20 in Maprik. Total mean inpatient malaria episode costs were US$25.20 in Madang and US$14.08 in Maprik. As cost distributions were not normal, non-parametric bootstrap techniques were used for cost comparisons. Total household costs per outpatient episode of malaria were lower, although not significantly, in Maprik than in Madang (incremental cost of US$ -1.67; 95% CI -4.16, 0.31), while total household costs per inpatient episode were significantly higher in Madang than in Maprik (difference of US$11.16; 95% CI 5.47, 25.33). A difference was noted between provinces in the proportion of indirect costs in total household costs for an outpatient visit: 76% in Madang vs 94% in Maprik. The proportion for indirect costs associated with inpatient visits varied less: 63% in Madang vs 68% in Maprik. Intra-country differences need to be considered in estimating household costs for both outpatient and inpatient malaria treatment. Our findings suggest that it is important to recognize the impact of both direct and indirect costs on individuals' capacity to afford treatment. Certain indirect costs are difficult to measure accurately, particularly respondents' interpretations of their productive versus non-productive time. Despite this, exploring intra-country cost variation can provide important information to health policy makers.

Climate Change and Vector-borne Diseases: An Economic Impact Analysis of Malaria in Africa

A semi-parametric econometric model is used to study the relationship between malaria cases and climatic factors in 25 African countries. Results show that a marginal change in temperature and precipitation levels would lead to a significant change in the number of malaria cases for most countries by the end of the century. Consistent with the existing biophysical malaria model results, the projected effects of climate change are mixed. Our model projects that some countries will see an increase in malaria cases but others will see a decrease. We estimate projected malaria inpatient and outpatient treatment costs as a proportion of annual 2000 health expenditures per 1,000 people. We found that even under minimal climate change scenario, some countries may see their inpatient treatment cost of malaria increase more than 20%.

Análisis comparativo de costos directos y funcionamiento global en personas afectadas por trastorno bipolar I y II, en tratamiento ambulatorio

ObjectiveTo evaluate the direct costs, the functional level and the employment rate reported for a random sample of people with Bipolar Disorders (BD) I and II that are cared for as outpatients. MethodsThe direct costs of outpatient treatment for 165 patients diagnosed with types I and II bipolar disorders were compared and analyzed (the monthly cost of pharmacological treatments, the number of consultations per month, the number of hospitalizations and the days spent in hospital). Global functioning was estimated and their employment was recorded. Results51,5% (N=85) of the patients had been diagnosed with type I BD and 48.5% (N=80) with BD type II. 40,6% of the patients were unemployed; the GAF score was 73 ± 12,59. Monthly costs of pharmacological treatment were $480 ± $350,4 per patient, with no difference between the type of BD. A larger percentage of type I BD patients had been hospitalized and received anti-psychotic drugs, whereas a greater percentage of BD II patients received anti-depressants and went to a psychologist. DiscussionPatients diagnosed with BDI and BD II must face pharmacological treatments that imply an average cost equal to one quarter of the minimum income in our country, independent of the type of bipolar disorder they suffer. Both groups of patients presented a high level of unemployment and relatively low global functioning scores.

Cost-effectiveness of pharmacological and psychosocial interventions for schizophrenia.

BackgroundInformation on cost-effectiveness of interventions to treat schizophrenia can assist health policy decision making, particularly given the lack of health resources in developing countries like Thailand. This study aims to determine the optimal treatment package, including drug and non-drug interventions, for schizophrenia in Thailand.MethodsA Markov model was used to evaluate the cost-effectiveness of typical antipsychotics, generic risperidone, olanzapine, clozapine and family interventions. Health outcomes were measured in disability adjusted life years. We evaluated intervention benefit by estimating a change in disease severity, taking into account potential side effects. Intervention costs included outpatient treatment costs, hospitalization costs as well as time and travel costs of patients and families. Uncertainty was evaluated using Monte Carlo simulation. A sensitivity analysis of the expected range cost of generic risperidone was undertaken.ResultsGeneric risperidone is more cost-effective than typicals if it can be produced for less than 10 baht per 2 mg tablet. Risperidone was the cheapest treatment with higher drug costs offset by lower hospital costs in comparison to typicals. The most cost-effective combination of treatments was a combination of risperidone (dominant intervention). Adding family intervention has an incremental cost-effectiveness ratio of 1,900 baht/DALY with a 100% probability of a result less than a threshold for very cost-effective interventions of one times GDP or 110,000 baht per DALY. Treating the most severe one third of patients with clozapine instead of risperidone had an incremental cost-effectiveness ratio of 320,000 baht/DALY with just over 50% probability of a result below three times GDP per capita.ConclusionsThere are good economic arguments to recommend generic risperidone as first line treatment in combination with family intervention. As the uncertainty interval indicates the addition of clozapine may be dominated and there are serious side effects, treating severe patients with clozapine is advisable only for patients who do not respond to risperidone and only in the presence of a stricter side effect monitoring system than currently exists.

Hospital Health Care Cost of Diarrheal Disease in Northern Ghana

Diarrhea caused by rotaviruses is one of the most frequent causes of hospitalization among pediatric patients in rural communities of developing countries in sub-Saharan Africa and Southeast Asia, and it is a major cause of death in these communities. The complexity of diarrhea and the increasing cost of treatment puts additional burden on the health sector. To demonstrate the economic burden of diarrhea to policy makers, this study was conducted to estimate the treatment cost of diarrhea in children <5 years old in Ghana using the World Health Organization protocol for cost data collection and estimation. The study was undertaken in Navrongo War Memorial Hospital in northern Ghana. Cost estimates were made for 3 treatment scenarios observed: (1) treatment by rehydration, (2) treatment by rehydration and antibiotics, and (3) treatment of diarrhea and other diseases. The average outpatient treatment costs for the 3 treatment scenarios were US$3.86, $4.10, and $4.35 respectively, and the average treatment costs for hospitalization (inpatient care) were $65.14, $97.40, and $133.86 respectively. The annual national treatment costs, based on the 3 treatment scenarios, ranged from $907,116 to $1,851,280 for outpatients clinic visits and from $701,833 to $4,581,213 for hospitalizations. The average length of stay for the inpatients ranged from 2.3 to 4.9 days. The study did not cover patient costs (ie, household costs).

Cost‐effectiveness of extended buprenorphine–naloxone treatment for opioid‐dependent youth: data from a randomized trial

The objective is to estimate cost, net social cost and cost-effectiveness in a clinical trial of extended buprenorphine-naloxone (BUP) treatment versus brief detoxification treatment in opioid-dependent youth. Economic evaluation of a clinical trial conducted at six community out-patient treatment programs from July 2003 to December 2006, who were randomized to 12 weeks of BUP or a 14-day taper (DETOX). BUP patients were prescribed up to 24 mg per day for 9 weeks and then tapered to zero at the end of week 12. DETOX patients were prescribed up to 14 mg per day and then tapered to zero on day 14. All were offered twice-weekly drug counseling. 152 patients aged 15-21 years. Data were collected prospectively during the 12-week treatment and at follow-up interviews at months 6, 9 and 12. The 12-week out-patient study treatment cost was $1514 (P < 0.001) higher for BUP relative to DETOX. One-year total direct medical cost was only $83 higher for BUP (P = 0.97). The cost-effectiveness ratio of BUP relative to DETOX was $1376 in terms of 1-year direct medical cost per quality-adjusted life year (QALY) and $25,049 in terms of out-patient treatment program cost per QALY. The acceptability curve suggests that the cost-effectiveness ratio of BUP relative to DETOX has an 86% chance of being accepted as cost-effective for a threshold of $100,000 per QALY. Extended BUP treatment relative to brief detoxification is cost effective in the US health-care system for the outpatient treatment of opioid-dependent youth.

Opioid-Sparing Effect of Intravenous Outpatient Ketamine Infusions Appears Short-Lived in Chronic-Pain Patients with High Opioid Requirements

Background and Objectives: Ketamine is opioid-sparing. It attenuates the onset of opioid tolerance, and suppresses opioid-induced hyperalgesia. This study evaluated whether or not repeated outpatient infusions of intravenous ketamine reduced the amount of pain and the amount of opioid requirements for patients suffering with chronic, noncancerous pain. Study Design: Retrospective study Setting: Outpatient pain clinic Methods: We reviewed the records of 18 patients taking high doses of opioids chronically and nonetheless reporting poorly controlled pain. A comparison control group of 18 similar patients with high opioid requirements who were not given ketamine were selected from our clinic population. Intervention: Intravenous ketamine infusions Measurement: VAS pain scores and opioid use Results: Morphometric and demographic characteristics, baseline opioid use, and pain scores were similar in the ketamine and comparison groups. Five patients given ketamine experienced no benefit and discontinued treatment after 1-2 infusions. One patient developed a supraventricular arrhythmia which immediately resolved upon cessation of the infusion. And another, despite pain relief, felt overly-anxious and opted out. Eleven patients thus completed 3-6 weekly ketamine infusions. At 6 months, 5 patients maintained less than 50% of their baseline opioid use, while the remaining patients returned to the baseline opioid use or increased their requirements. There was no significant difference in pain scores at 6 months in patients who received ketamine infusions and control group patients. Limitations: Retrospective nature of the study Conclusions: Outpatient intravenous ketamine infusions did not improve long-term pain scores in patients with high opioid requirements and only a few were able to substantially reduce opioid use. Considering infusion risks and cost of such outpatient treatment, ketamine infusions do not appear to be a feasible option for improving pain relief and decreasing opioid use in high-opioid requirement patients. Key words: Ketamine; anesthesia; chronic pain; opioids; continuous infusion; opioid requirements

Health burden and costs of obesity and overweight in Germany

This study aimed to estimate the health burden and the direct as well as indirect costs of morbidity and mortality attributable to obesity and overweight in Germany for the year 2002. We used the concept of attributable fractions based on German prevalence data and relative risks from US studies as well as routine statistics. We estimated obesity- and overweight-attributable deaths, years of potential life lost (YPLL) and quality-adjusted life years lost (QALY) for various diseases associated with obesity and overweight. Direct costs were estimated for inpatient and outpatient treatment, rehabilitation and non-medical costs. Indirect costs were estimated for sickness absence, early retirement and mortality using the human capital approach. We estimated 36,653 obesity- and overweight-attributable deaths with 428,093 consecutive YPLL and 367,772 QALYs lost. Obesity caused 4,854 million EUR in direct costs corresponding to 2.1% of the overall German health expenditures in 2002 and 5,019 million EUR in indirect costs. Forty-three percent of direct costs resulted from endocrinological diseases like diabetes and obesity itself, followed by cardiovascular diseases (38%), neoplasms (14%) and digestive diseases (6%). Sixty percent of indirect costs resulted from unpaid work, and 67% of overall indirect costs were due to mortality. Obesity and overweight are connected to considerable morbidity and mortality as well as societal costs. Improvement and further development of effective strategies for preventing and dealing with obesity and overweight are necessary.

Cost implications of specific and non‐specific treatment for young persons at ultra high risk of developing a first episode of psychosis

Costs associated with mental health treatment for young persons at 'ultra' high risk (UHR) of developing a psychotic disorder have not previously been reported. This paper reports cost implications of providing psychological and pharmacological intervention for individuals at UHR for psychosis compared with minimal psychological treatment. Mental health service costs associated with a randomized controlled trial of two treatments (Specific Preventive Intervention: SPI and Needs-Based Intervention: NBI) for UHR young persons were estimated and compared at three time points: treatment phase, short-term follow up and medium-term follow up. Although the SPI group incurred significantly higher treatment costs than the NBI group over the treatment phase, they incurred significantly lower outpatient treatment costs over the longer term. This study indicates that specific interventions designed to treat young persons who are identified as being at UHR of psychosis might be associated with some cost savings compared with non-specific interventions.

Economic Burden of High Risk Acute Lymphoblastic Leukemia (ALL) in Adults and Children

Background: Acute lymphoblastic leukemia is a hematological malignancy, characterized by overproduction of immature white blood cells in the bone marrow. Highrisk forms of ALL are typically characterized by poor treatment response, short remission duration, poor survival with conventional chemotherapy and incur high disease-related costs. The most common form of high-risk acute lymphoblastic leukemia in adults is Philadelphia chromosome positive (Ph+) ALL.Objectives: This study investigated the treatment costs of high-risk ALL from a Canadian perspective.Methods: Costs for the induction phase of ALL treatment (inpatient costs and length of stay in hospital) were obtained from the Ontario Case Costing Initiative (OCCI) acute inpatient databases. Drug costs for outpatient treatment were obtained from the Ontario Drug Benefit Program and the medical literature. Since no published Canadian guidelines were available treatment pathways and costs for consolidation and maintenance phases of chemotherapy, broken down by age and risk level of disease, were based on the medical literature and expert opinion.Results: The average total cost of inpatient ALL treatement (induction phase) was $31,694 for both adults and children. The cost for consolidation therapy was $29,244 and $12,753 in adults and children, respectively. The maintenance therapy cost was $7,288 and $3,452 in adults and children, respectively. The high-risk therapy following relapse was $17,100 and $12,000 in adults and children, respectively. The total treatment cost for ALL is estimated at $85,326 in adults and $59,899 in children.Conclusions: In canada, high-risk ALL exacts a substantial economic burden as a result of rapid disease progression and decreased survival duration. Imatinib (Gleevec®) in Ph+ALL has produced superior results in terms of clinical response, disease-free survival, and overall survival with a good safety and tolerability profile. More comprehensive research is recommended to investigate the economic and humanistic benefits of imatinib as compared to the current therapies in the treatment of Ph+ ALL.