Health care economics production costs

Few studies have prospectively documented the degree of functional impairment before or after specific treatments or have evaluated the pharmacoeconomic differences in treatments for premenstrual and perimenopausal disorders. Data on the economic burden (i.e., health care utilization, related costs, and the loss of productivity) from different menstrual-related disorders are still lacking. Several PMDD studies have reported greater improvement in psychosocial functioning and work capacity with SRls compared with placebo. In all studies, the degree of functional impairment was substantial at baseline and similar to that seen in studies of major depression. The functional improvement correlated with the improvement in premenstrual symptoms and was evident by the second cycle of treatment. 

Healthy People 2010 Objectives from the US. Deparunent of Health and Human Services (DHHS) has made the facts available relevant to occupational injuries and illnesses. Every five seconds a worker is injured. Every ten seconds a worker is temporarily or permanently disabled. Each day, an average of 137 persons die from work-related diseases, and an additional 17 die from workplace injuries on the job. Each year, about 70 youths under 18 years of age die from injuries at work and 70,000 require treatment in a hospital anergency room. In 1996, an estimated 11,000 workers were disabled each day due to work-related injuries. That same year, the National Safety Council estimated that on-the-job injuries cost society 121 billion, including lost wages, lost productivity, administrative expenses, health care, and other costs (National Safety Council Injury Facts, 2010). A study published in Jnly 1997 reports that the 1992 combined U.S. economic burden for occupational illnesses and injuries was an estimated 171 billion (U.S. Department of Conunerce, www.commerce.gov, 2001). 

The production of welfare approach assumes that the final outcomes of a mental health-care intervention will be influenced ( produced ) by the nature of the services provided, the types, levels and mixes of resources employed, the social environment of the care setting and other non-resource factors. This core theme of the production of welfare model is obviously not built up from economic theory as such, but it is a logical corollary of theory and evidence from psychology, psychiatry and certain other disciplines. However, the formalization of the links between intervention characteristics, resource inputs and patient and family outcomes owes much to economic theories of cost and production relations and their... 

Health-care decision-makers may be required not only to make economic choices between conventional and atypical drugs, but also between individual atypical agents. There are few direct comparisons of atypical drugs. This is probably a result of the marketing aims of pharmaceutical manufacturers each has sought to establish the cost-effectiveness of their product compared with conventional... 

Further detailed analyses of the ECA data have been extrapolated to USA national costs (Rice and Miller, 1998). It was calculated that the economic costs of mental disorders in 1990 in the USA totalled US 147.8 billion. Anxiety disorders were the most cosdy, amounting to 46.6 billion, just under a third of the total. Direct costs spent on mental health care totalled 67 billion, of which anxiety disorders accounted for only 11 billion (16.5%). Drug costs were 2191 million, of which anxiety disorders accounted for 1167 million—over half Morbidity costs—the value of goods and services not produced because of mental disorders — amounted to 63.1 billion, with anxiety disorders accounting for 34.2 billion, 54.2% of the total. This reflects the high prevalence of anxiety disorders in the community and the high associated rate of lost productivity. In contrast, patients with affective disorders appeared better able to function (Rice and Miller, 1995). In summary, anxiety disorders are common, disruptive and costly to society drug treatment is a substantial element of treatment costs (11%) compared with, say, schizophrenia (2.2%). 

This situation of escalating costs from improved survival is not new our society has traditionally spent more for incremental (sometimes minor) improvements in care. From an economic perspective, the question becomes how much more and for how long. Every additional dollar spent on health care is another dollar from the Gross Domestic Product (GDP) that cannot be used for other purposes. This opportunity cost of technological improvement will be one of the primary economic and social issues that must be addressed. Pharmacogenomics-based drug therapies will likely provide a test case. Will these new and expensive therapies be rationed if so, on what basis Will our society continue to value improvements in health care above other goods and services such as education, the environment, and Social Security ... 

Pharmacoeconomics is the study of the costs and consequences of pharmaceutical products and services (Bootman et al., 1991). The basic question addressed in a pharmacoeconomic evaluation is not whether to use a particular product or service, but rather when and under what circumstances a particular intervention is efficient. Rather than focusing on just product cost, pharmacoeconomics examines the total economic impact of a pharmaceutical product on the health care system. The value of pharmaceuticals is determined by balancing the health system costs and consequences (outcomes) of its use. 

In an era of escalating health care costs, "inputs" to the production of health care, such as pharmaceuticals, physician visits, laboratory/diagnostic services, and hospital care, are often viewed in isolation from each other as if one sector of the health care economy can be optimized independent of the others. When cost containment is the primary economic objective, a shortterm, risk-averse decision rubric emerges. 

Individuals with sleep disorders have great impairment in the quality of their life [9, 12, 29], Furthermore, another important aspect related to the high prevalence of insomnia is its economic cost for the health care services. This not only includes the direct costs of diagnosis and treatment (including also the over-the-counter drugs, and the cost of the associated alcoholism), but in addition the substantial indirect costs related to absenteeism, diminished productivity, accidents, and other health problems that are secondary to insomnia [30-32],... 

PTSD compares with depression in the level of disability it imposes on patients with the disorder. Individuals fail to realize their potentials for career development, marriage, and education. Decreased productivity leads to a financial loss of more than 3 billion per year. This figure does not include economic loss associated with the failure of patients with PTSD to achieve their educational or career goals. Women in a health care maintenance organization with high scores on the Posttraumatic Stress Disorder Checklist had more than twice the adjusted total annual median cost ( 1,283) of care (i.e., outpatient, specialty care, primary care, pharmacy and mental health care costs) than those with a low score ( 609). Treatment with effective pharmacotherapy can improve the QOL of these patients. Sertraline and fluoxetine improved measures of social and occupational functioning as well as the perception of improved QOL in patients with PTSD. - ... 

Despite the prevalence of sleep disorders, most cases go undiagnosed and untreated. The direct cost of insomnia alone adds an estimated 13.9 billion to the national health care bill each year. The direct and indirect costs of sleep disorders including medications, treatment, absenteeism, decreased productivity, accidents, hospitalizations, and increased morbidity and mortality is estimated to be between 92.5 and 107.5 billion annually. Improvements in recognition and treatment may decrease the economic burden and prevent progression to both medical and psychiatric disorders. ... 

The organizations that actually pay for medicines — governments, insurers and so on—have only recently started to use the power conferred by their expenditure. A consequence is that a drug company has not only to show that its new product is safe and works, but also that it is cost-effective. In Australia, this has been spelled out in legislation. Since 1993, any drug submitted for approval there must be accompanied not only by the results of clinical trials but also by an economic impact analysis. In 1999 the UK set up a National Institute for Clinical Excellence (NICE) to advise the National Health Service on the cost-effectiveness of health care technologies. Other countries ask formally or informally for pharmacoeconomic analysis. Economic impacts can be measured in a variety of ways, for example, cost-effectiveness, cost-utility or fuU cost-benefit studies. 

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