Public Health Care Costs Research Articles

Preterm Birth and Total Health Care Use and Costs in the First 5 Years of Life: A Population-based Study

To investigate the relationship between preterm birth and hospital / out-of-hospital care and costs over the first five years of life. Birth data from a population-based cohort of 631,532 infants born between 2007 and 2013 were linked probabilistically with data on hospitalisations, primary and secondary care, and the use of medicines. We analysed the distribution of healthcare use and public healthcare costs for infants that survived at least five years, comparing the outcomes of extremely preterm (< 28 weeks' gestation), very preterm (28-32 weeks), moderate to late preterm (32-37 weeks), and term infants (at least 37 weeks). A linear regression model was used to investigate the effect of preterm birth on these outcomes, controlling for important confounders including pregnancy and birth complications, neonatal morbidity, survival, and maternal socioeconomic characteristics. Preterm birth has a statistically significant and economically relevant effect on healthcare use and costs in the first five years of life. Compared with a term infant, preterm infants born 32-36 weeks, 28-32 weeks, and < 28 weeks, respectively, had an average: 7.0 (std.err.=0.06), 41.6 (0.18), and 68.7 (0.35) days more hospital days; 3.1 (0.04), 11.0 (0.13) and 13.2 (0.25) more outpatient specialist physician visits; and five-year public healthcare costs which were 1.2 (<0.01), 6.8 (0.01), and 10.9 (0.02) times higher. Preterm infants also had statistically significant higher levels of GP visits and use of medicines. Higher levels of accessible care is needed for preterm infants across healthcare settings, and over a sustained period of time. As our understanding of the impact of preterm birth on long term clinical outcomes continues to improve, clinicians and policymakers should develop an accurate recognition of these needs for appropriate resource allocation towards research priorities and early intervention strategies.

An Overview on Advanced Materials Used in Health Care Applications

Wearable devices possess immense potential that could bring about a revolutionary, nonclinical approach to health monitoring and disease diagnosis. Through ongoing innovation and dedicated focus on materials and fabrication technologies, the development of these healthcare devices is being actively encouraged. The integration of wearable devices capable of collecting diverse physiological data is gradually becoming a part of people's daily lives. Monitoring physiological indicators is crucial for assessing health, enabling early detection of diseases, and reducing the occurrence of more severe health issues. This proactive approach to disease prevention can also contribute to lowering overall public sector healthcare costs. This review emphasizes the importance of fabrication technologies and the properties of materials utilized in wearable healthcare devices

CHILKBP protects against podocyte injury by preserving ZO-1 expression.

Glomerular diseases afflict millions of people and impose an enormous burden on public healthcare costs worldwide. Identification of potential therapeutic targets for preventing glomerular diseases is of considerable clinical importance. CHILKBP is a focal adhesion protein and modulates a wide array of biological functions. However, little is known about the role of CHILKBP in glomerular diseases. To investigate the function of CHILKBP in maintaining the structure and function of podocytes in a physiologic setting, a mouse model (CHILKBP cKO) was generated in which CHILKBP gene was conditionally deleted in podocytes using the Cre-LoxP system. Ablation of CHILKBP in podocytes resulted in massive proteinuria and kidney failure in mice. Histologically, typical podocyte injury including podocyte loss, foot process effacement, and glomerulosclerosis was observed in CHILKBP cKO mice. Mechanistically, we identified ZO-1 as a key junctional protein that interacted with CHILKBP. Loss of CHILKBP in podocytes exhibited a significant reduction of ZO-1 expression, leading to abnormal actin organization, aberrant slit diaphragm protein expression and compromised podocyte filtration capacity. Restoration of CHILKBP or ZO-1 in CHILKBP-deficient podocytes effectively alleviated podocyte injury induced by the loss of CHILKBP in vitro and in vivo. Finally, we showed the glomerular expression of CHILKBP and ZO-1 was decreased in patients with proteinuric kidney diseases. Our findings reveal a novel signaling pathway consisting of CHILKBP and ZO-1 that plays an essential role in maintaining podocyte homeostasis and suggest novel therapeutic approaches to alleviate glomerular diseases.

Cholesterol, Exercise and Diet: A Cross-sectional Survey of Middle-aged Maltese Adults

Researchers have shown that poor lifestyle habits like unhealthy dietary intake, physical inactivity, smoking, and alcohol consumption exert negative effects on the cholesterol levels and risk of adverse health outcomes in most segments of the population. For middle-aged adults, specifically, high cholesterol, or hypercholesterolemia, represents a key risk factor in the onset of non-communicable diseases (NCDs). NCDs are considered to be the leading cause of death in this age cohort and result in substantial public health care costs at both a European and local level. Maltese researchers have meanwhile posited that poor awareness exists in the local population about the harmful effects of unhealthy lifestyle factors on cholesterol levels. Given the generally high obesity rates in Malta and the prevalence of lifestyle-related risk factors, like smoking and physical inactivity in particular, a cross-sectional survey was designed to explore risk factors for hypercholesterolemia in a sample of 37 middle-aged adults having undergone a cholesterol test in the previous 12 months. Multiple regression analysis was carried out to ascertain the effects of exercise, diet, smoking, and alcohol consumption on the total cholesterol ratio (TCR). The findings suggest that exercise constitutes a particularly vital component of any intervention aimed at improving cholesterol levels due to its significant influence on TCR. Furthermore, the effect of exercise on lowered TCR values was not dependent on diet. The findings also do not support the idea that popular unhealthy foods unique to the Maltese context have any significant effects on cholesterol levels while controlling for overall dietary habits.

The cost of inaction on physical inactivity to public health-care systems: a population-attributable fraction analysis

Physical inactivity is an important modifiable risk factor for non-communicable diseases (NCDs) and mental health conditions. We aimed to estimate the public health-care costs associated with these diseases because of physical inactivity, which will help policy makers to prioritise investment in policy actions to promote and enable more people to be more active. We used a population-attributable fraction formula to estimate the direct public health-care costs of NCDs and mental health conditions for 2020-30. The disease outcomes that we included were incident cases of coronary heart disease, stroke, type 2 diabetes, hypertension, cancer (breast, colon, bladder, endometrial, oesophageal, gastric, and renal), dementia, and depression in adults aged at least 18 years. We used the most recent health and economic data evidence available for 194 countries. 499·2 million new cases of preventable major NCDs would occur globally by 2030 if the prevalence of physical inactivity does not change, with direct health-care costs of INT$520 billion. The global cost of inaction on physical inactivity would reach approximately $47·6 billion per year. Although 74% of new cases of NCDs would occur in low-income and middle-countries, high-income countries would bear a larger proportion (63%) of the economic costs. The cost of treatment and management of NCDs varied-although dementia accounted for only 3% of new preventable NCDs, the disease corresponded to 22% of all costs; type 2 diabetes accounted for 2% of new preventable cases but 9% of all costs; and cancers accounted for 1% of new preventable cases but 15% of all costs. This health and economic burden of physical inactivity is avoidable. Further investments in and implementation of known and effective policy interventions will support countries to reach the Sustainable Development Goal of reduction of NCD mortality by 2030. None.

Day surgery in reduction mammaplasty – saving money or increasing complications?

The benefits of reduction mammoplasty procedures have been reported previously. However, to control the rise in public healthcare costs, we need to find ways of conducting these procedures safely and more cost-effectively. Our aim was to examine whether reduction mammaplasty performed in an outpatient setting has comparable surgical complication rates to those performed in an inpatient setting. We also investigated whether any savings gained from day surgery are still present after any possible indirect costs are considered. The study population comprised 276 patients who underwent reduction mammaplasty in a single center between January 2019 and February 2021. Data were collected from patient medical records. The costs associated with the primary procedure and any possible additional expenses were calculated. Basic statistical comparisons were performed for propensity score-matched data. Complication rates, readmissions, number of contacts to the health care system, and need for additional surgical interventions were comparable between outpatients and inpatients. The basic costs for outpatients were 2990 euros per patient and 3923 euros for inpatients. Total costs after possible extra expenses were lower in day surgery as it was markedly more cost-effective than patients treated as inpatients. Reduction mammaplasties can be safely performed in an outpatient setting. Moreover, the emergence of complications is comparable to those performed in an inpatient setting. An outpatient setting produced significant cost savings not only in the immediate costs of primary surgery but also in the costs associated with possible complications and extra contacts to the healthcare system.

What affects the public healthcare costs of breast cancer in New Zealand?

The pressure to the healthcare system for providing ongoing monitoring and treatment for breast cancer survivors is increasing. This study aims to identify the factors that affect the public healthcare costs of stage I-III breast cancer and stage IV cancer in New Zealand. We identified women diagnosed with invasive breast cancer between July 1, 2010 and June 30, 2018 and who received services in a public hospital. Patients were identified from the National Breast Cancer Register and/or New Zealand Cancer Registry and were linked to the national administrative datasets. A two-part model was used to identify the factors that affect the public healthcare costs of stage I-III breast cancer and stage IV cancer. We identified 16,977 stage I-III and 1,093 stage IV breast cancer patients eligible for this study. The costs of stage I-III cancer in the second to fifth year post diagnosis decreased over time, and the costs of stage IV cancer in the first year post diagnosis increased over time. After adjustment for other factors, the costs of stage I-IV cancer decreased with age but increased with cancer stage. HER2+ cancers had the highest costs, followed by triple negative cancers. After adjustment for other factors, Pacific and Asian women had lower costs, and Māori had similar costs compared to others. For stage I-III cancers, women living in nonmajor urban areas had a higher chance of incurring costs in follow-up years, and screen detected patients and patients having any services in a private hospital had a decreased probability of receiving any public healthcare services. Pacific women had higher costs than others, but after adjustment for cancer stage, subtype, and other factors, they had lower costs than others. The early detection and better management of stage I-III breast cancer can lead to better outcome and lower costs in follow-up years.

Explainable Stacking-Based Model for Predicting Hospital Readmission for Diabetic Patients

Artificial intelligence is changing the practice of healthcare. While it is essential to employ such solutions, making them transparent to medical experts is more critical. Most of the previous work presented disease prediction models, but did not explain them. Many healthcare stakeholders do not have a solid foundation in these models. Treating these models as ‘black box’ diminishes confidence in their predictions. The development of explainable artificial intelligence (XAI) methods has enabled us to change the models into a ‘white box’. XAI allows human users to comprehend the results from machine learning algorithms by making them easy to interpret. For instance, the expenditures of healthcare services associated with unplanned readmissions are enormous. This study proposed a stacking-based model to predict 30-day hospital readmission for diabetic patients. We employed Random Under-Sampling to solve the imbalanced class issue, then utilised SelectFromModel for feature selection and constructed a stacking model with base and meta learners. Compared with the different machine learning models, performance analysis showed that our model can better predict readmission than other existing models. This proposed model is also explainable and interpretable. Based on permutation feature importance, the strong predictors were the number of inpatients, the primary diagnosis, discharge to home with home service, and the number of emergencies. The local interpretable model-agnostic explanations method was also employed to demonstrate explainability at the individual level. The findings for the readmission of diabetic patients could be helpful in medical practice and provide valuable recommendations to stakeholders for minimising readmission and reducing public healthcare costs.

Estimation of Tinnitus-Related Socioeconomic Costs in Germany.

Despite the high prevalence of tinnitus in Germany of nearly 12% of the general population, there have been no systematic studies on the socioeconomic costs for German society caused by tinnitus so far. Here we analyzed data from 258 chronic tinnitus patients—namely tinnitus severity and health utility index (HUI)—and correlated them with their tinnitus-related public health care costs, private expenses, and economic loss due to their tinnitus percept as assessed by questionnaires. We found correlations of the HUI with health care costs and calculated the mean socioeconomic costs per tinnitus patient in Germany. According to our most conservative estimate, these sum up to EUR 4798.91 per year. Of that EUR 2206.95 account for the public health care, EUR 290.45 are carried by the patient privately and the remaining EUR 2301.51 account for economical loss due to sick leave. With a prevalence of 5.5% with at least bothersome tinnitus, this sums up to 21.9 billion Euro per year and with 25.82 sick leave days; tinnitus patients miss work more than double the time of the average German employee (10.9 days). The findings fit within the cost ranges of studies from other European countries and the USA and show that the socioeconomic burden of this disease-like symptom is a global problem. In comparison with the costs of other major chronic diseases in Germany—such as chronic obstructive pulmonary diseases (ca. 16 billion Euro) or diabetes mellitus (ca. 42 billion Euro)—the relevance of the ‘symptom’ tinnitus for the German social economy becomes even more obvious.

Public healthcare costs associated with long-term exposure to mixtures of persistent organic pollutants in two areas of Southern Spain: A longitudinal analysis.

BackgroundPolychlorinated biphenyls and organochlorine pesticides are persistent organic pollutants (POPs) that had been banned or restricted in many countries, including Spain. However, their ubiquity still poses environmental and human health threats. ObjectiveTo longitudinally explore public healthcare costs associated with long-term exposure to a mixture of 8 POPs in a cohort of residents of two areas of Granada Province, Southern Spain. MethodsLongitudinal study in a subsample (n = 385) of GraMo adult cohort. Exposure assessment was performed by analyzing adipose tissue POP concentrations at recruitment. Average primary care (APC) and average hospital care (AHC) expenditures of each participant over 14 years were estimated using the data from their medical records. Data analyses were performed by robust MM regression, weighted quantile sum regression (WQS) and G-computation analysis. ResultsIn the adjusted robust MM models for APC, most POPs showed positive beta coefficients, being Hexachlorobenzene (HCB) significantly associated (β: 1.87; 95% Confidence interval (95%CI): 0.17, 3.57). The magnitude of this association increased (β: 3.72; 95%CI: 0.80, 6.64) when the analyses were restricted to semi-rural residents, where β-HCH was also marginally-significantly associated to APC (β: 3.40; 95%CI: −0.10, 6.90). WQS revealed a positive but non-significant mixture association with APC (β: 0.14; 95%CI: −0.06, 0.34), mainly accounted for by β-HCH (54%) and HCB (43%), that was borderline-significant in the semi-rural residents (β: 0.23; 95%CI: −0.01, 0.48). No significant results were observed in G-Computation analyses. ConclusionLong-term exposure to POP mixtures might represent a modifiable factor increasing healthcare costs, thus affecting the efficiency of the healthcare systems. However, and owing the complexity of the potential causal pathways and the limitations of the present study, further research is warranted to fully elucidate ascertain whether interventions to reduce human exposure should be considered in healthcare policies.

Development of the European Healthcare and Social Cost Database (EU HCSCD) for use in economic evaluation of healthcare programs

IntroductionCosts are one of the critical factors for the transferability of the results in health technology assessment and economic evaluation. The objective is to develop a cost database at the European level to facilitate cross-border cost comparisons in different settings and explains the factors that lead to differences in healthcare costs in different countries, taking into account the differences between health systems and other factors.MethodologyThe core of the database is compounded of three main categories (primary resources, composite goods and services, and complex processes and interventions) organized into 13 subcategories. A number of elements providing as detailed information of unit cost as possible were identified in order to mitigate the problem of comparability. Consortium partners validated both the database structure and selected costing items.ResultsTwenty-seven costing items included in the EU HCSCD resulted in 1450 unit costs when taking into account all item subtypes and countries. Cross-country differences in costs are driven by the type of resources included in the costing items (e.g., overhead costs in case of complex processes and interventions) or by the variety of existing brands and/or models and the type of unit value in most of the primary resources.ConclusionThe EU HCSCD is the only public unit healthcare and social cost database at European level that gather data on unit costs and explains differences in costs across countries. Its maintenance and regular data updating will enable establishing specific systems for generating and recording information that will meet many of its current limitations.

Severe marginality in the Como area. Homelessness phenomenon and nursing care.

Homelessness is a growing problem. These people face huge inequalities and frequent hospitalizations, often lacking social support. The condition is one of extreme poverty and affects public health care costs. The risk of mortality and morbidity is high. Together with the synergy between health care institutions and targeted policies, Third Sector Associations are fundamental. The nurse is crucial in responding to the needs of the most fragile individuals by ensuring an integrated approach to care. The Como Services for Serious Marginalization are concerned with taking charge of and satisfying the needs of homeless people through the services provided also in the current pandemic. The main exigencies that emerge are hospitality, active listening and the need for primary services. Both Italian and immigrant populations are represented. The realities involved rely on the figure of the nurse both directly and indirectly. The health inequity faced by the homeless requires special attention. The homelessness needs require an integrated service model with reorganization needed due to the ongoing pandemic. The Nurse can become central to the territorial management of frailty and social vulnerabilities.

Differences in Breast Cancer Costs by Cancer Stage and Biomarker Subtype in New Zealand.

BackgroundBreast cancer requires the greatest expenditure among all cancer types, and the costs vary by cancer stage and biomarker status.ObjectiveThis study aimed to examine the differences in public healthcare costs of breast cancer in New Zealand by stage and subtype.MethodThis study included patients diagnosed with invasive breast cancer between 1 July 2010 and 30 June 2018 and receiving services in public hospitals. These patients were identified from the National Breast Cancer Register and/or New Zealand Cancer Registry. Linking with the Pharmaceutical Collection, National Minimum Dataset, National Non-Admitted Patient Collection, and Mortality Collection, we estimated the median public healthcare costs of breast cancer by cancer stage and biomarker subtype.ResultsWe identified 22,948 eligible patients. The median costs of breast cancer increased with stage of disease, from $NZ26,930 for stage I disease to $NZ50,388 for stage IV disease. The median costs for human epidermal growth factor receptor 2-positive (HER2+) disease were three times those for HER2-negative (HER2−) disease: $NZ106,428 for HER2+ cancers compared with$NZ28,481 for oestrogen receptor-positive (ER+)/HER2− cancers and $NZ31,722 for triple negative disease. Over 55% of the costs for HER2+ breast cancers were targeted therapy costs. For HER2− cancers, surgery incurred the biggest cost, followed by radiotherapy.ConclusionsTreating patients with early-stage breast cancer is less costly than treating those with metastatic disease. The costs vary considerably between the subtypes. Patients with HER2+ cancer incurred three times the costs of those with HER2− cancers. These results provide baseline costing data for clinicians and policy makers when considering new targeted treatments.Supplementary InformationThe online version contains supplementary material available at 10.1007/s41669-022-00327-5.

Effect of an Integrative Mobile Health Intervention in Patients With Hypertension and Diabetes: Crossover Study

BackgroundObesity, hypertension, and type 2 diabetes mellitus (T2DM) are worldwide epidemics that inflict burdens on both public health and health care costs. Self-management plays an important role in the proper management of these 3 chronic diseases, and in this context, mobile health (mHealth) can be a cost-effective self-management tool.ObjectiveThe aim of this pilot study is to evaluate the effects of an integrative mHealth approach for obesity, hypertension, and T2DM on body fat, blood pressure, and blood glucose levels and demonstrate the clinical outcomes. The participants were patients aged 40 to 70 years who were treated for T2DM (hemoglobin A1c [HbA1c] above 6.0%) without insulin or hypertension and obesity, controlled with pharmacotherapy.MethodsThis pilot study was performed using a controlled, randomized, 3-month, 2-period crossover design. A total of 37 participants were recruited from 2 university hospitals in South Korea. Integrative mHealth comprised 4 parts: self-measuring home devices for monitoring blood glucose and blood pressure; 2 smartphone apps, where one gathered lifestyle data, giving them feedback with health information, and the other provided drug information and reminders of the medication schedule; unmanned kiosks for official measurement of blood pressure and body composition; and web-based access to participants’ health information.ResultsData from the 32 participants were analyzed. Their mean HbA1c level was 7.5% (SD 0.8, ranging from 6.1% to 9.4%). Approximately 38% (12/32) of the participants had hypertension. BMIs of all participants except 1 were >23 kg/m2. The input rates of food intake and exercise to the smartphone app were very low (24.9% and 5.3%, respectively). On the contrary, the input rate of medicine intake was high (84.0%). Moreover, there was no significant difference in the input rate of taking medicine irrespective of whether the mHealth period was before or after the conventional treatment period (80.3% and 87.3%, respectively; P=.06). Among the 3 input functions of food intake, exercise, and medicine intake in smartphone apps, the input of medicine intake was a more helpful, easier to use, and better-designed function than the others. There were no significant differences in changes in body weight (−0.519 kg vs 0 kg), BMI (−0.133 kg/m2 vs −0.167 kg/m2), body composition (body fat −0.255% vs 0.172%), blood pressure (systolic −0.226 mm Hg vs −2.839 mm Hg), and HbA1c (−0.269% vs –0.009%) between the integrative mHealth and conventional treatment groups. However, in proportion to the elevation in the input rate of taking medicine, body fat mass (P=.04) and HbA1c (P=.03) were lower in the integrative mHealth group.ConclusionsAlthough smartphone apps can influence body fat and blood glucose levels, they have failed to show clinical improvement. A higher input rate of taking medicine was related to significantly lower body fat mass and HbA1c levels.

What Does Economic Evaluation Mean in the Context of Children at the End of Their Life?

The ‘conventional framework’ of economic evaluation, the comparative public sector healthcare costs and quality adjusted life year (QALY) of two or more interventions, has become synonymous with commissioning decisions in many countries. However, while useful as a framework in guiding value-based decisions, it has limited relevance in areas such as end of life care in children and young people, where the costs fall across multiple stakeholders and QALY gains are not the primary outcome. This paper makes the case that the restricted relevance of the ‘conventional framework’ has contributed to the inconsistent and varied provision of care in this setting, and to the knock-on detrimental impact on children nearing the end of their lives as well as their families. We explore the challenges faced by those seeking to conduct economic evaluations in this setting alongside some potential solutions. We conclude that there is no magic bullet approach that will amalgamate the ‘conventional framework’ with the requirements of a meaningful economic evaluation in this setting. However, this does not imply a lack of need for the summation of the costs and outcomes of care able to inform decision makers, and that methods such as impact inventory analysis may facilitate increased flexibility in economic evaluations.

Implementation of good life with osteoarthritis in denmark (GLA:D®) is feasible in australian tertiary public hospital facilities

Purpose: Clinical guidelines consistently recommend the use of exercise, education and weight management as first-line interventions for knee and hip osteoarthritis. Good Life with osteoArthritis in Denmark (GLA:D®) is a physiotherapist-led, evidence-based approach to delivering exercise and education to people with knee and hip osteoarthritis. GLA:D® has been successfully implemented in Denmark and Canada, as well as in Australia, predominantly in private practice settings. Successful implementation has the potential to reduce public healthcare costs by reducing or delaying total joint replacement surgery.

Reality Check 2: The Cost-Effectiveness of Policy Disallowing Body Checking in Non-Elite 13- to 14-Year-Old Ice Hockey Players.

Sport-related injuries are the leading cause of injury in youth and are costly to the healthcare system. When body checking is disallowed in non-elite levels of Bantam (ages 13–14 years) ice hockey, the injury rate is reduced, but the impact on costs is unknown. This study compared rates of game injuries and costs among non-elite Bantam ice hockey leagues that disallow body checking to those that did not. Methods: An economic evaluation was conducted alongside a prospective cohort study comparing 608 players from leagues where body checking was allowed in games (Calgary/Edmonton 2014–2015, Edmonton 2015–2016) with 396 players from leagues where it was not allowed in games (Vancouver, Kelowna 2014–2015, Calgary in 2015–2016). The effectiveness measure was rate of game injuries per 1000 player-hours. Costs were estimated based on associated healthcare use within the publicly funded healthcare system as well as privately paid healthcare costs. Probabilistic sensitivity analysis was conducted using bootstrapping. Results: Disallowing body checking reduced the rate of injuries by 4.32 per 1000 player-hours (95% CI −6.92, −1.56) and reduced public and total healthcare system costs by $1556 (95% CI −$2478, −$559) and $1577 (95% CI −$2629, −$500) per 1000 player-hours, respectively. These finding were robust in over 99% of iterations in sensitivity analyses in the public healthcare and the total healthcare system perspectives. There was no statistically significant difference in privately paid healthcare costs (−$65 per 1000 player-hours (95% CI −$220, $99)). Interpretation: Disallowing body checking in non-elite 13–14-year-old ice hockey nationally would prevent injuries and reduce public healthcare costs.

Ocular foreign bodies: evolution of professional roles and public costs in Quebec

Purpose&#x0D; In 2003, Quebec optometrists were legally enabled to extract superficial ocular foreign bodies, with part of this service covered by the universal health insurance. This study analyses the evolution of roles for professionals managing this condition (optometrists, ophthalmologists, emergency physicians and family physicians) and the related public healthcare costs.&#x0D; Methods&#x0D; Data from the provincial health insurance were combined to demographic and annual healthcare workforce statistics. Across professions and sociosanitary regions, variations in annual rates of conditions treated were calculated, as well as variations in public healthcare costs. Linear regression slopes of these variations were used as indicators of linear trends.&#x0D; Results&#x0D; Between 2010 and 2016, the proportion of cases managed by optometrists increases from 32% to 44%, following a significant trend (p &lt; 0.007). For family physicians, the proportion of cases managed decreases from 49% to 33%, following a significant trend (p &lt; 0.0001). The increase in optometrists managing cases is visible in almost all sociosanitary regions, reaching +19%. A significant trend was observed for increasing healthcare costs for optometrists (p &lt; 0.008) and ophthalmologists (p &lt; 0.004) and for decreasing healthcare costs for family physicians (p &lt; 0.001). In 2016, optometrists managed 44% of cases, representing 13% of related healthcare costs.&#x0D; Conclusion&#x0D; In Quebec, optometrists are now the professionals managing the largest proportion of superficial ocular foreign bodies, across the province. There is an apparent shift from the proportion of cases managed by family physicians, which have similarly decreased.

An Economic Evaluation of Disallowing Body Checking in 11- to 12-Year-Old Ice Hockey Leagues.

Background:After a national policy change in 2013 disallowing body checking in Pee Wee ice hockey games, the rate of injury was reduced by 50% in Alberta. However, the effect on associated health care costs has not been examined previously.Hypothesis:A national policy removing body checking in Pee Wee (ages 11-12 years) ice hockey games will reduce injury rates, as well as costs.Study Design:Cost-effectiveness analysis alongside cohort study.Level of Evidence:Level 3.Methods:A cost-effectiveness analysis was conducted alongside a cohort study comparing rates of game injuries in Pee Wee hockey games in Alberta in a season when body checking was allowed (2011-2012) with a season when it was disallowed after a national policy change (2013-2014). The effectiveness measure was the rate of game injuries per 1000 player-hours. Costs were estimated based on associated health care use from both the publicly funded health care system and privately paid health care cost perspectives. Probabilistic sensitivity analysis was conducted using bootstrapping.Results:Disallowing body checking significantly reduced the rate of game injuries (−2.21; 95% CI [−3.12, −1.31] injuries per 1000 player-hours). We found no statistically significant difference in public health care system (−$83; 95% CI [−$386, $220]) or private health care costs (−$70; 95% CI [−$198, $57]) per 1000 player-hours. The probability that the policy of disallowing body checking was dominant (with both fewer injuries and lower costs) from the perspective of the public health care system and privately paid health care was 78% and 92%, respectively.Conclusion:Given the significant reduction in injuries, combined with lower public health care system and private costs in the large majority of iterations in the probabilistic sensitivity analysis, our findings support the policy change disallowing body checking in ice hockey in 11- and 12-year-old ice hockey leagues.

Cost-effectiveness analysis of enzalutamide for patients with chemotherapy-naïve metastatic castration-resistant prostate cancer in Japan.

BackgroundWe aimed to evaluate cost-effectiveness of enzalutamide in chemotherapy-naïve metastatic castration-resistant prostate cancer patients in Japan.MethodsA Markov model was developed to capture time spent by patients in various health states: stable, progression and death. Abiraterone acetate and docetaxel were set as active comparators. Clinical outcomes were obtained from the PREVAIL, COU-AA-302 and TAX327 trials. Treatment sequence, concomitant drugs and therapies for adverse events were estimated from responses to a survey by 14 Japanese prostate cancer experts. The analytic perspective was public healthcare payer, with a 10-year time horizon. The incremental cost-effectiveness ratio was estimated from quality-adjusted life-years and Japanese public healthcare costs. Probabilistic sensitivity analysis was performed to assess the robustness of the findings.ResultsAccording to the survey, the most common treatment sequences were (i) enzalutamide → docetaxel → cabazitaxel (enzalutamide-first sequencing), (ii) abiraterone → enzalutamide → docetaxel (abiraterone-first sequencing) and (iii) docetaxel→ enzalutamide → cabazitaxel (docetaxel-first sequencing). In the base-case analysis, enzalutamide-first sequencing saved 1.74 million Japanese Yen versus abiraterone-first sequencing, with a 0.129 quality-adjusted life-year gain (dominant). Enzalutamide-first sequencing had a cost increase of 4.44 million Japanese Yen over docetaxel-first sequencing, with a 0.371 quality-adjusted life-years gain. The incremental cost-effectiveness ratio of enzalutamide-first sequencing versus docetaxel-first sequencing was estimated as 11.94 million Japanese Yen/quality-adjusted life-years. Probabilistic sensitivity analyses demonstrated that, compared with abiraterone-first sequencing, enzalutamide-first sequencing had an 87.4% probability of being dominant.ConclusionsResults modeled herein suggest that the enzalutamide-first sequencing is more cost-effective than the abiraterone-first sequencing, but less cost-effective than docetaxel-first sequencing for chemotherapy-naïve patients with metastatic castration-resistant prostate cancer.