Cost of care

Consequently, there is no golden standard of calculating indirect Costs-of-Illness. The estimates based on different methodologies might differ significantly, and so will the total Costs-of-Illness of HIV/AIDS. It is possible to analyze the quality of studies whether all components (such as indirect costs of caring relatives etc.) have been included. Whether the methodology applied is best cannot always be determined. 

Yazdanpanah et al. (2002) calculated the resource use and cost for different stages of HIV infection in France based on a clinical database of HIV-infected patients between 1994 and 1998. The total costs attributable to bed-day and day-care inpatient care included the mean cost of each inpatient day times the length of stay, as well as total number of laboratory tests, dosage and quantity of medications, and total number of procedures. The total cost attributable to outpatient care included the mean physician and nurse fees per visit, as well as total number of laboratory tests and total number of procedures. In the absence of an AIDS-deflning event, the average total cost of care ranged from US 797 per person-month in the highest CD4 stratum to US 1,261 per person-month in the lowest CD4 stratum. 

Holtgrave and Pinkerton (1997) also estimated the lifetime costs after the diffusion of new combination therapies. Having discounted the costs of care, their lifetime estimates ranged from US 71,143 to US 424,763. The ranges reflect different levels of access to care. 

Caekelbergh K et al (2007) Cost of care for HIV/AIDS in Belgium according to disease stage. Poster presented at the 11th European AIDS Conference/EACS, 24-27 October 2007, Code P19,5/01... 

The costs of care for people with cognitive disability in the UK have been estimated at between UK 14 926 and 47 232 per person (updated to 1997/8 costs), depending on the severity of disability and the setting of care (Kavanagh et al, 1993 Kavanagh and Knapp, 1999). Reports of the total costs of care for people with dementia in the UK range from 1 billion to 6 billion per year (Gray and Fenn, 1993 Bosanquet et al, 1998 Manca and Davies, 1999). These... 

Holmes J, Pugner K, Phillips R, Dempsey G, Cayron H (1998). Managing Alzheimer s disease rhe cost of care per parienr. Br J Health Care Manage 332-7. 

Economic impact of Alzheimer s disease in the United Kingdom. Cost of care and disease severity for non-institutionalised patients with Alzheimer s disease. Br J Psychiatry 174, 51—5. 

Angus DC, Linde-Zwirble WT, Lidicker J, et al. Epidemiology of severe sepsis in the United States Analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001 29 1303-1310. 

The indemnity fee-for-service model protects the patient from catastrophic medical expenses but has its own set of potential problems. There is little incentive for either the provider or the patient to control costs. The patient pays less than the full cost of care, creating an incentive to use more care. The provider is paid on a fee-for-service basis and thus can generate more income by providing more services. The health care... 

Schizophrenia is a severe, chronic disabling mental disorder. Schizophrenia affects approximately 1% of the population worldwide. Symptomatic onset occurs in late adolescence and early adulthood in males and somewhat later in females, who tend to be somewhat less severely affected. It is estimated to be the seventh most costly medical illness to society in terms of cost of care and loss of productivity, because less than 30% of affected individuals... 

The direct medical costs of care usually are associated with monetary transactions and represent costs that are incurred during the provision of care. Examples of direct medical costs include payments for purchasing a pharmaceutical product, payments for physicians fees, salaries of allied health professionals, or purchases of diagnostic tests. Because the charge for medical care may not accurately reflect the resources consumed, accounting or statistical techniques may be needed to determine direct costs. 

First, the protocol may induce the detection of extra cases - cases that would have gone undetected if no protocol were used in the usual care of patients. These cases may be detected earlier than they would have been in usual care. In the prophylaxis example above, repeated testing of all patients is likely to increase the number of deep vein thromboses that are detected, especially if, in usual care, patients are only tested when they develop clinical signs of deep vein thromboses. This extra or early detection may also reduce the average costs for each case detected, because subclinical cases or those detected early may be less costly to treat than clinically detected cases. However, because these two potential biases - more cases, each of which may cost less -work in opposite directions, the total costs of care for patients in the trial may or may not exceed those that would occur in usual care. 

Fourth, due to ethical obligations that arise when patients are enrolled in trials, outcomes detected in trials may be treated more aggressively than they would be in usual care. In trials, it is likely that physicians will treat all detected treatable clinical outcomes. In usual care, physicians may treat only those outcomes that in their judgment are clinically relevant. This potential bias would tend to increase the costs of care observed in the trial compared to usual care. 

There is little or no evidence that thiazides should be avoided in patients with hyperlipidemia (353), although some physicians continue to make this recommendation. Serum lipids should be checked within 3-6 months of starting thiazides to detect the very few patients who have an increase in total cholesterol or LDL cholesterol. This should not add to the cost of care, since serum chemistry need only be obtained once or twice a year and is no reason to avoid the use of these drugs as initial monotherapy. 

The Health Plan Employer Data and Information Set (HED IS) is a health care report card created by NCQA. HEDIS standardizes health plan performance data and disseminates this information so that plans can be compared (O Malley, 1997). This allows health care purchasers and consumers to make informed choices (O Malley, 1997). HEDIS s performance domains include effectiveness of care, access and availability of care, health plan stability, use of services, cost of care, informed health care choices, satisfaction with the experience of care, and health plan descriptive information. 

The third step is to establish a framework to evaluate the question. When establishing the framework, pharmacists need to know some basic facts about the programs and diseases they are studying. Pharmacists undertaking these projects first should prioritize their objectives by determining what interventions and outcomes most need to be evaluated. For example, Cynthia Marshall may wish to determine the effect of her monitoring program on cost of care (an economic outcome), blood pressure (a clinical outcome), and quality of life (a humanistic outcome). 

After identifying a research question, study objectives, and variables to evaluate, researchers also need to think about other variables that may affect the results of the study. For example, Cynthia Marshall may wish to evaluate the impact of her monitoring service on the cost of caring for these patients from the perspective of the HMO. Her results may show that patients who used her service had much lower costs of care compared... 

Does this mean that the service did not have a positive effect Actually, it means that the results are unclear. The severity of heart failure and number of disease states may have clouded the results of the study. For example, the service may not have saved the HMO any money, but the fact that those who used the service (less severely ill patients) generally had lower costs of care than those who did not use the service (more severely ill patients) may have made it look that way. Any variable that also may have an impact on the results of study but is not one of the primary variables being evaluated is known as a confounding variable. 

Alois Alzheimer first described Alzheimer s disease in Germany in 1907. There are approximately 3-4 million people in the United States with Alzheimer s disease, about 10% of all those over 70 years of age. The health care cost of treatment is more than 80 billion per year, and the cost of caring for one patient with Alzheimer s disease is more than 50,000 per year when the disease is advanced. Alzheimer s disease is one of the most common reasons that a person is placed in a nursing home. Several genetic factors have been tied to Alzheimer s disease and other dementias, but very often there seems to be no family history, and the cause of Alzheimer s disease is unknown at this time. 

A stand-alone outpatient drug benefit manager might only worry about the drug cost for the nonhospitalized portion of the therapy. The overall health system may be at financial risk for all elements of outpatient and inpatient care. Because each element of the system may be responsible for a different component of the total cost of care, the cost-impact of a given drug product selection may be different for each element. The societal perspective" often represents yet another view of drug costs in that it incorporates nonhealthcare costs and the value of lost days of work and disability. Formulary inclusion is not routinely based on that level of evaluation, but public policy may be influenced by that information. 

Russell A, Haraoui B, Keystone E, Klinkhoff A. Current and emerging therapies for rheumatoid arthritis, with a focus on infliximab clinical impact on joint damage and cost of care in Canada. Clin Ther 2001 23(ll) 1824-38. 

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