Societal Cost Of Caring Research Articles

Cost-Effectiveness of a Homeless Care Transition Program: Durham Homeless Care Transitions.

BACKGROUND Transitional care and medical respite programs provide assistance to people experiencing homelessness as they move from acute care into community settings. These programs can address issues that may fall outside the reach of traditional medical care yet have a profound impact on the health of vulnerable populations. This article focuses on the cost-effectiveness of the Durham Homeless Care Transitions (DHCT) program.METHOD This intervention study of the DHCT program uses a comparison group of people experiencing homelessness who were referred but did not participate. Encounter-level data, aggregated by quarterly segments of charges and reimbursements, were abstracted for all persons referred. Descriptive statistics were computed and models of charges and reimbursements were created using ordinary least squares (OLS) regression to compare utilization for 12 months pre- and post-referral.RESULTS Patients referred to the DHCT program (N = 485) were primarily non-Hispanic Black (62.5%), male (68.4%), uninsured (35.5%), and had an average of 5.3 chronic conditions and an average age of 50.0 years (SD = 11.3). There was variability among charges and reimbursement based on health care visit type but a negative association between treatment and charges, indicating that being part of the DHCT program led to lower charges post-referral.LIMITATIONS The study is limited by lack of access to line-item details of charges, reimbursement, and payer mix.CONCLUSION There is evidence of benefit to patients from transitional care and medical respite programs that does not substantially increase the overall societal cost of care; however, health systems commonly require evidence of cost savings and benefit as a return on investment.

The opportunity cost (OC) of low adherence with screening (scr) recommendations for colorectal cancer (CRC).

1553Background: Scr rates are <60% below the Healthy People 2020 target of 70.5%, leaving 20 million people unscreened. Prior cost effectiveness analyses (CEAs) have shown that although Scr is more costly compared to No Scr, the incremental cost effectiveness ratios (ICERs) for Scr are favorable. However, these CEAs did not include the costs of drugs such as oxaliplatin and bevacizumab. More effective treatments and longer overall survival with advanced CRC result in higher average societal costs of care. Methods: A Markov model was built to represent the CRC incidence and its natural history in the US general population. Individual level simulation was used to compare the benefits of CRC Scr from a societal perspective. Costs and effects were discounted (Dis) at 3%. 12 Scr strategies (ST) were compared to No Scr. Dis Life Years (LY), incidence reduction (IR), CRC mortality reduction (CMR), and Dis costs were measured. ICERs were calculated. Results: Among the STs studied, only stool DNA Scr cost more tha...

Pharma Pricing & Market Access Europe 2016--Health Network Communications' Tenth Annual Conference (February 23-25, 2016--London, UK).

Tighter national budgets and escalating drug prices continue to present challenges for pharmaceutical market access strategies and societal cost of care. As pharmaceutical companies and medical governmental advisory organizations enter tougher negotiations, hospital trusts and other dispensary firms face barriers to receiving the best medical treatment, and as a result patient access is limited. The 2016 HealthNetwork Communications' Pharma Pricing & Market Access Europe meeting brought together pharmaceutical, medical governmental advisory and stakeholders and market access/pricing consultants, to encourage discussions and negotiations into how to improve the drug pricing system and consequential market access strategies while achieving the respective reimbursement and affordability objectives.

The burden of inhibitors in haemophilia patients.

The burden of disease in haemophilia patients has wide ranging implications for the family and to society. There is evidence that having a current inhibitor increases the risk of morbidity and mortality. Morbidity is increased by the inability to treat adequately and its consequent disabilities, which then equates to a poor quality of life compared with non-inhibitor patients. The societal cost of care, or `burden of inhibitors', increases with the ongoing presence of an inhibitor. Therefore, it is clear that successful eradication of inhibitors by immune tolerance induction (ITI) is the single most important milestone one can achieve in an inhibitor patient. The type of factor VIII (FVIII) product used in ITI regimens varies worldwide. Despite ongoing debate, there is in vitro and retrospective clinical evidence to support the use of plasma-derived VWF-containing FVIII concentrates in ITI regimens in order to achieve early and high inhibitor eradication success rates.

Commentary: The Impact of Neuroimmune Alterations in Autism Spectrum Disorder.

The dramatic increasing prevalence of autism spectrum disorders (ASDs) (1), together with the influence on the quality of life and the lifetime societal cost of caring, has called for newest research on both the development of these diseases and the therapeutic options. Nowadays, it is well recognized that multifactorial and polygenic features (complex combination of genetic, epigenetic, and environmental interactions) characterize ASDs (2). Prenatal immune alterations and early inflammatory processes could be the autism etiological events. The authors Gottfried et al. (3) in this hypothesis-and-theory article discuss the recent findings in autism discovery. Starting from a brief historical way on autism development, the main topic of the article is to focus on the state-of-the-art of the novel findings in autism studies. The authors rightly highlight the newest challenging frontier of autism research: the neuroimmune axis alterations. These alterations are first evident in the cells early responsible for immune responses, as they are the precursors for macrophages, dendritic, and microglial cells: monocytes or peripheral blood mononuclear cells (PBMCs). These cells show strong dysfunctions in ASD children and are committed to a pro-inflammatory state, which in turn result in long-term immune alterations (4). In ASDs, altered PBMCs are responsible for elevated pro-inflammatory cytokine production. The up-regulation of inflammatory cytokines is also reflected in brain centers of autistic patients (5): the consequences are the induction of blood–brain barrier (the immunological interface between peripheral immune system and central nervous system) disruption. Changes in BBB permeability directly influence neural plasticity, connectivity and function, triggering impairments in social interaction, communication, and behavior (3). Immunological abnormalities also influence the gastrointestinal system and the microglial innate immune cells of the central nervous system (6). The authors also discuss the role of autoimmunity in the pathogenesis of autism. Familial or virus/bacteria-infected autoimmunity could be a risk factor for autism. Even if the exact cellular and molecular pathways responsible for the induction of neuroimmune alterations are still to be further clarify, a complex interaction among epigenetic and environmental risk factors (7) could trigger the neuroimmune abnormalities, such as abnormal neuron and glia responses. Taken together, these autism-associated neuroimmune changes could help in identifying novel therapeutic target for a better future management of ASDs.

The searching for autism biomarkers: a commentary on: a new methodology of viewing extra-axial fluid and cortical abnormalities in children with autism via transcranial ultrasonography.

Autism spectrum disorders (ASDs) are now recognized as urgent public health concerns with dramatically increased frequencies seen across Western countries for more than 2 decades (Baio, 2014). ASDs significantly impact on the quality of life for both patients and their families (Siniscalco et al., 2013). It has been estimated that the total lifetime societal cost of caring for one individual with ASDs is about $3.2 million US dollars (Siniscalco, 2013). The diagnosis of ASDs is based on the evaluation of social communication skills and behavior; currently there is no specific biomarker rendering a diagnosis potentially subjective. Recent changes with the DSM-5 diagnostic criteria illustrate the challenges clinicians face due to the lack of quantifiable diagnostic markers. The search for biomarkers is a priority in autism research and care (Siniscalco et al., 2012). The authors Bradstreet et al. (2014) used a novel imaging approach to detect abnormalities in the central nervous system of autistic subjects. The authors used a transcranial ultrasonography (TUS) imaging technique, that allowed the detection of abnormalities in extra-axial fluid production and cortical structures. Alternative brain imaging technologies such as MRI are generally expensive and invasive, especially for children with ASDs who need sedation to undergo such investigation. TUS resolution is potentially capable of observing structures as small as 0.1 mm and can detect a cortical abnormality up to a depth of several cm in order of magnitude. Using this approach the authors were able to identify a cortical dysplasia and increased extra-axial fluid presence in brains of autistic patients. These brain abnormalities correlated with autism severity. In addition, this study raised the possibility that the detected cortical abnormalities may be associated with impaired neurotransmissions which could underlie some of the cognitive abnormalities seen in ASDs. This very interesting technique is simple, reproducible, safe, and effective. It is non-invasive and presents the advantage of being inexpensive. It further has the potentials to enable real-time analysis of sub-arachnoidal and cortical brain regions. Functional imaging studies conducted in autism have shown consistently abnormalities of hypo-perfusion in the temporal lobe areas which may correlate with the degree of impairment. Unfortunately most ASD subjects do not have access to such analysis, due to limited access and cost. Clinicians are in need of fast, non-invasive, accurate and safe means to evaluate any potential structural brain abnormality, especially if such abnormalities correlate with mental and neurological dysfunctions. 2D TUS might offer such fast analysis of the upper brain anatomy. Whether this can assist with regard to diagnosis remains to be shown with larger scale investigations and comparison with age matched individuals suffering from other developmental abnormalities.

Total Societal Cost of Care: Analysis of Partial Breast With APBI or IORT Versus Conventional Versus Accelerated External Beam Regimens for Breast Conservation

Total Societal Cost of Care: Analysis of Partial Breast With APBI or IORT Versus Conventional Versus Accelerated External Beam Regimens for Breast Conservation

P4‐363: The medical food Souvenaid preserves functional brain network organisation in patients with mild Alzheimer's disease

clinical evaluation was complex; but for our purpose we have used MMSE, grouping the patients into stages: mild (MMSE score 21-26), mild to moderate (MMSE score 15-20), moderate (MMSE score 10-14) and severe (MMSE score Below 10).For evaluating their socioeconomic and clinical status the Centre’s standard questionnaire was used; care costs were included (for medications, use of professional services, use of community support services by caregivers and lay carers.Caregiver burden was also determined by specific scales, using the human capital method. Descriptive statistics and regression models were used.Assessment of costs was made considering existing costs at 1st of January, 2010 as applicable to a discounting rate of 6%. Results: A total of 64 claims were reviewed. The average total cost of AD per patient per a 12-month period was ,V6072. The proportion of cost attributable to caregivers was the main component of burden 61% in AD.The annual societal cost of care per patient increased with severity of Alzheimer’s disease. The cost per patient was estimated to be 5.378V 8V for mild disease, 6.259V for mild to moderate disease, 6.343V for moderate disease and 6.407V for severe disease. Poorer functional status was associated with higher total and care giving costs. For subjects living in the community, unpaid caregiver time was the greatest components of cost and increased with disease severity. Conclusions: Health care costs for AD are substantial. The societal cost of care of Alzheimer’s disease increases with increasing disease severity. Informal cost is responsible for the largest cost component

Outcomes of rehabilitation services for nursing home residents

Murray PK, Singer M, Dawson NV, Thomas CL, Cebul RD. Outcomes of rehabilitation services for nursing home residents. Arch Phys Med Rehabil 2003;84:1129–36. Objective: To examine survival and community discharge outcomes related to rehabilitation services among patients admitted to nursing homes before the implementation of the Balanced Budget Amendment of 1997. Design: Retrospective cohort. Setting: A total of 945 Medicaid-certified nursing homes in Ohio. Participants: A total of 11,150 patients admitted for the first time to a nursing home from 1994 to 1996. Interventions: Not applicable. Main Outcome Measures: Community discharge and survival rates among patients who did or did not receive rehabilitation services, using multivariable techniques to adjust for patients’ propensity to receive rehabilitation and for other potential confounders. In secondary analyses, we also examined dose-response effects and analyzed the effects of rehabilitation when patients were divided into 5 diagnostic groups (stroke, hip fracture, congestive heart failure, chronic lung disease, other). Results: Rehabilitation was provided to 58% of the patients and was associated with higher community discharge rates (relative risk=1.48; 95% confidence interval [CI], 1.40–1.57) and a lower hazard of death (hazard ratio=.81; 95% CI, .75–.88). Dose-response effects were observed for both outcomes ( P<.001) among patients receiving rehabilitation. Rehabilitation was associated with improved community discharge rates in each of the 5 diagnostic groups. Conclusions: New reimbursement policies that discourage the provision of rehabilitation services may have adverse effects on patients, their families, and societal costs of care.