Care, cost

A new profession, that of infection control practitioner, has been developed to deal with hospital infection problems and at least one practitioner for every 250 hospital beds has been recommended (10). In the mid-1970s, the cost of nosocomial infections was said to be in excess of 1 biUion dollars (11), and has continued to rise with health care costs. 

Scitovsky et al. (1986) calculated the average cost per AIDS-related hospital admission as US 9,024 ranging from US 7,026 to US 23,425. A more comprehensive picture is presented by Scitovsky and Rice (1987), who estimated provider cost of the AIDS epidemic in the United States in 1985, 1986, and 1991, based on prevalence estimates provided by the Center for Disease Control (CDC). They predicted that the core provider costs of AIDS would rise from US 630 million in 1985 to US 1.1 billion in 1986 and to US 8.5 billion in 1991. The authors compared their estimates of the cost of AIDS in the USA with the estimates for end-stage renal disease (US 2.2 billion), traffic accidents (US 5.6 billion), lung cancer (US 2.7 billion), and breast cancer (US 2.2 billion). They concluded that the core provider costs of AIDS were relatively low in comparison with the provider costs of all illness as well as the costs of these other diseases. However, they also assessed the non-care costs (e.g., for research) to rise from US 319 million in 1985 to US 542 million in 1986 and to US 2.3 billion in 1991. 

Schackman et al. (2006) projected HIV medical care costs in the USA in 2004 US. From the time of entering HIV care, the discounted lifetime direct provider cost was calculated as US 385,200, whereas 73% were due to antiretrovirals. For patients with a CD4- - count of less than 200, the discounted lifetime cost was US 354,100. 

Hellinger FJ (1991) Forecasting the medical care costs of the HIV epidemic 1991-1994, Inquiry 28 213-215... 

Scitovsky AA, Rice DP (1987) Estimates of the direct and indirect costs of acquired immunodeficiency syndrome in the United States, 1985, 1986, and 1991. Pubhc Health Rep 102 5-17 Scitovsky AA, Cline M, Lee PR (1986) Medical care costs of patients with AIDS in San Francisco. JAMA 256 3103-3106... 

Scitovsky AA, Cline MW, Abrams DI (1990) Effects of the use of AZT on the medical care costs of persons with AIDS in the first 12 months. J Acquit Immune Defic Syndr 3 904-912 Seage III GR, Landers S, Lamb GA et al (1990) Effects of changing patterns of care and duration of survival on the cost of treating the acquired immunodeficiency syndrome (AIDS). Am J Public Health 80 835-839... 

Direct health-care costs Health-care costs only. 

Percudani M, Fattore G, Galletta J, et al (1999). Health care costs of therapy-refractory schizophrenic patients treated with clozapine a study in a community psychiatric service in Italy. Acta Psyehiatr Scand > 274-80. 

Various forms of psychotherapy are regarded as effective interventions in mild to moderate depression, but studies comparing the economics of psychotherapy and pharmacotherapy are few (Rosenbaum and Hylan, 1999). One study found that the total health-care costs for patients who received psychotherapy were no different from those for patients who received an antidepressant. However, no efficacy measure was used (Edgell and Hylan, 1997). A randomized, prospective study which evaluated the treatment of depression with nortriptyline, interpersonal therapy or treatment as usual, with outcomes expressed in quality-adjusted life years, found that nortriptyline but not interpersonal therapy was a cost-effective alternative to treatment as usual (Lave et al, 1998). 

Hylan TR, Crown WH, Meneades L, et al (1998). SSRI and TCA antidepressant selection and health care costs a multivariate analysis. /... 

Health care costs of primary care patients with recognised depression. Arch Gen Psychiatry 52, 850-6. 

Out-patient treatment is substantially cheaper than in-patient management and is generally as effective (Lowman, 1991). A French study on patients with generalized anxiety disorder estimated costs per patient over 3 months to he US 423 for hospitalization, 335 for out-patient services and 43 for medications (Souetre et al, 1994). Comorbid conditions (mostly alcoholism and depression) doubled these direct health-care costs. Over three-quarters of all patients were taking anxiolytic medication. 

Simon G, Ormel J, VonKorff M, et al (1995). Health care costs associated with depressive and anxiety disorders in primary care. Am J Psychiatry 152, 352—7. 

Further primary and secondary research is required to provide robust estimates of the formal and informal care costs associated with the new dmgs and the value of health improvements to patients and carers. 

National dmg expenditure as a proportion of total health expenditure currently ranges from 7% to 66% worldwide. The proportion is higher in developing countries (24%-66%) than in developed countries (7%-30%). In the former, at the individual and household level, drugs represent a major out-of-pocket health care cost (1). 

Hypertension is strongly associated with type 2 diabetes.6 The added comorbidity of hypertension in diabetes leads to a higher risk of cardiovascular disease (CVD), stroke, renal disease, and diabetic retinopathy leading to greater health care costs.7... 

The obvious goal of therapy for the depressed patient is the resolution of depressive symptoms and a return to euthymia. Once symptoms have resolved, then the purpose of ongoing therapy is to prevent relapse and recurrence of depressive symptoms. One extremely important outcome in the treatment of MDD is the prevention of suicidal attempts. Other essential outcomes include improvement of the patient s quality of life, normalization of functioning in areas such as work and relationships, avoidance or minimization of adverse effects, and reduction of health care costs.15... 

Proper ADHD treatment is a substantial financial burden.27,28 Annual health care costs of patients with ADHD are more than double those of patients without ADHD ( 1343 versus 503, respectively).27 Further, the total cost of ADHD in the United States in 2000 was 31.6 billion.28 The financial burden... 

Osteoporosis is a common and often silent disorder associated with significant morbidity and mortality and reduced quality of life. It is associated with increased risk and rates of bone fracture and is responsible for over 1.5 million fractures in the United States annually, resulting in direct health care costs of over 17 billion.1 As the population ages, these numbers are expected to increase. It is estimated that postmenopausal Caucasian women have a 50% lifetime chance of developing an osteoporosis-related fracture.1 Common sites of fracture include the spine, hip, and wrist, although almost all sites can be affected. Only a fraction of patients with osteoporosis receive optimal treatment. 

O Osteomyelitis is an infection of the bone that is associated with high morbidity and increased health care costs. The inflammatory response associated with acute osteomyelitis can lead to bone necrosis and subsequently chronic infections. Bacterial pathogens, particularly Staphylococcus aureus, are the most common microorganisms implicated in these infections. Diagnosis and treatment are often difficult due to the heterogeneous... 

Discuss the epidemiology and impact of surgical wound infections on patient outcomes and health care costs. 

Discuss the importance of P-lactam allergy screening and how this could impact resistance and health care costs. 

SSIs negatively affect patient outcomes and increase health care costs. Patients who develop SSIs are five times more likely to be readmitted to the hospital and have twice the mortality of patients who do not develop an SSI.1 A patient infected with an SSI is also 60% more likely to be admitted to an intensive care unit.1 Clinical studies have shown that SSIs increase lengths of hospital stay and costs.1,3,4 The type of SSI can also affect outcome. Deep SSIs, involving organs or spaces, result in longer durations of hospital stay and higher costs compared to SSIs that are limited to the incision.5... 

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