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BMC Health Services Research Feb 2013An economic evaluation of interventions for older people requires accurate assessment of costing and consideration of both acute and long-term services. Accurate... (Review)
Review
BACKGROUND
An economic evaluation of interventions for older people requires accurate assessment of costing and consideration of both acute and long-term services. Accurate information on the unit cost of allied health and community services is not readily available in Australia however. This systematic review therefore aims to synthesise information available in the literature on the unit costs of allied health and community services that may be utilised by an older person living in Australia.
METHOD
A comprehensive search of Medline, Embase, CINAHL, Google Scholar and Google was undertaken. Specialised economic databases were also reviewed. In addition Australian Government Department websites were inspected. The search identified the cost of specified allied health services including: physiotherapy, occupational therapy, dietetics, podiatry, counselling and home nursing. The range of community services included: personal care, meals on wheels, transport costs and domestic services. Where the information was not available, direct contact with service providers was made.
RESULTS
The number of eligible studies included in the qualitative synthesis was fourty-nine. Calculated hourly rates for Australian allied health services were adjusted to be in equivalent currency and were as follows as follows: physiotherapy $157.75, occupational therapy $150.77, dietetics $163.11, psychological services $165.77, community nursing $105.76 and podiatry $129.72.
CONCLUSIONS
Utilisation of the Medicare Benefits Scheduled fee as a broad indicator of the costs of services, may lead to underestimation of the real costs of services and therefore to inaccuracies in economic evaluation.
Topics: Aged; Allied Health Personnel; Australia; Community Health Services; Costs and Cost Analysis; Health Services for the Aged; Humans; Internationality
PubMed: 23421756
DOI: 10.1186/1472-6963-13-69 -
The Journal of the American Academy of... Jul 2019Musculoskeletal conditions disproportionately affect the lives of aging adults. We aimed to examine the literature using Medicare claims data in the United States for...
INTRODUCTION
Musculoskeletal conditions disproportionately affect the lives of aging adults. We aimed to examine the literature using Medicare claims data in the United States for musculoskeletal surgical procedures.
METHODS
Following the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, we searched the PubMed and Medline databases for peer-reviewed articles published between 1990 and 2015. We included the studies that (1) reported primary Medicare claims data use, (2) involved musculoskeletal surgery, and (3) were original peer-reviewed studies. We abstracted the types of surgical procedure and aims, and evaluated outcomes, and strengths and weaknesses of each included article. We assessed the quality of included articles with Newcastle Ottawa Assessment Scale.
RESULTS
The literature search returned 3,233 articles, of which 119 met our inclusion criteria. These studies focused on different outcomes: epidemiology and treatment variation (26), cost of care (15), hospital-level analyses (30), health outcomes (31), the validity and accuracy of Medicare claims data (4), disparities in health care (10), and policy evaluation (3).
DISCUSSION
Medicare claims data provide a unique way for researchers to study a nationally representative patient population longitudinally. A significant limitation of using claims data has been a lack of granularity on defining severity of a condition.
LEVEL OF EVIDENCE
Therapeutic level III.
Topics: Aged; Health Services Research; Humans; Medicare; Musculoskeletal Diseases; Orthopedic Procedures; Outcome Assessment, Health Care; Postoperative Complications; United States
PubMed: 31232800
DOI: 10.5435/JAAOS-D-17-00297 -
Cost Effectiveness and Resource... 2019External beam radiotherapy is the recommended but expensive treatment option for localized prostate cancer. Prostate cancer is the most common cancer in men worldwide. A... (Review)
Review
BACKGROUND
External beam radiotherapy is the recommended but expensive treatment option for localized prostate cancer. Prostate cancer is the most common cancer in men worldwide. A cost-effectiveness study is needed given the excessive cost of radiotherapy treatment and the high prevalence of prostate cancer. The aim of this systematic review was to assess and identify studies that examined model based economic evaluation of external beam radiation therapy for the treatment of localized prostate cancer.
METHODS
A systematic review of the published literature was conducted through MEDLINE, NHS EED (NHS Economic Evaluation Database), and Cochrane databases with a specific search strategy. The literatures were searched according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. At first 1046 citations were identified. The extracted files were imported into the Rayyan systematic review site for inclusion or exclusion based on the defined criteria. Studies included in this review were articles published between 2003 and 2017, and that conducted full-economic evaluations of the modality of external beam radiotherapy for the treatment of localized prostate cancer.
RESULTS
There were 12 studies that satisfied the inclusion and exclusion criteria. Seven studies compared intensity modulated radiation therapy (IMRT) with three-dimensional conformal radiation therapy (3D-CRT), two compared IMRT with stereotactic body radiation therapy (SBRT) another two-paper assessed IMRT with proton beam therapy (PBT). One paper compared the three external-beam radio therapy options of IMRT, SBRT and PBT. Most of the studies were originated from the US and analyzed the cost data from the payer's perspective. Most studies were supported that IMRT was cost effective when it compared with 3D-CRT. Compared with IMRT, SBRT was found to be cost-effective.
CONCLUSIONS
There are limited number of studies exist on the cost effectiveness of radiation therapy options for the treatment of localize prostate cancer across Europe. Most studies are originated from the US Medicare payer Perspective. Further research is need that investigate the cost effectiveness of these radiation therapy options from the societal perspective in Europe.
PubMed: 31139024
DOI: 10.1186/s12962-019-0178-3 -
Population Health Management Feb 2024Out-of-pocket (OOP) health care expenditures in the United States have increased significantly in the past 5 decades. Most research on OOP costs focuses on expenditures... (Review)
Review
Out-of-pocket (OOP) health care expenditures in the United States have increased significantly in the past 5 decades. Most research on OOP costs focuses on expenditures related to insurance and cost-sharing payments or on costs related to specific conditions or settings, and does not capture the full picture of the financial burden on patients and unpaid caregivers. The aim for this systematic literature review was to identify and categorize the multitude of OOP costs to patients and unpaid caregivers, aid in the development of a more comprehensive catalog of OOP costs, and highlight potential gaps in the literature. The authors found that OOP costs are multifarious and underestimated. Across 817 included articles, the authors identified 31 subcategories of OOP costs related to direct medical (eg, insurance premiums), direct nonmedical (eg, transportation), and indirect spending (eg, absenteeism). In addition, 42% of articles studied an expenditure that the authors did not label as "OOP." A holistic and comprehensive catalog of OOP costs can inform future research, interventions, and policies related to financial barriers to health care in the United States to ensure the full range of costs for patients and unpaid caregivers are acknowledged and addressed.
Topics: Humans; United States; Caregivers; Health Expenditures; Delivery of Health Care; Cost Sharing
PubMed: 38099925
DOI: 10.1089/pop.2023.0238 -
BMC Geriatrics May 2016Systems for identifying potentially inappropriate medications in older adults are not immediately transferrable to advanced dementia, where the management goal is... (Review)
Review
BACKGROUND
Systems for identifying potentially inappropriate medications in older adults are not immediately transferrable to advanced dementia, where the management goal is palliation. The aim of the systematic review was to identify and synthesise published systems and make recommendations for identifying potentially inappropriate prescribing in advanced dementia.
METHODS
Studies were included if published in a peer-reviewed English language journal and concerned with identifying the appropriateness or otherwise of medications in advanced dementia or dementia and palliative care. The quality of each study was rated using the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist. Synthesis was narrative due to heterogeneity among designs and measures. Medline (OVID), CINAHL, the Cochrane Database of Systematic Reviews (2005 - August 2014) and AMED were searched in October 2014. Reference lists of relevant reviews and included articles were searched manually.
RESULTS
Eight studies were included, all of which were scored a high quality using the STROBE checklist. Five studies used the same system developed by the Palliative Excellence in Alzheimer Care Efforts (PEACE) Program. One study used number of medications as an index, and two studies surveyed health professionals' opinions on appropriateness of specific medications in different clinical scenarios.
CONCLUSIONS
Future research is needed to develop and validate systems with clinical utility for improving safety and quality of prescribing in advanced dementia. Systems should account for individual clinical context and distinguish between deprescribing and initiation of medications.
Topics: Aged; Checklist; Dementia; Drug Prescriptions; Humans; Inappropriate Prescribing; Medication Therapy Management; Potentially Inappropriate Medication List; Quality Improvement
PubMed: 27245843
DOI: 10.1186/s12877-016-0289-z -
International Journal of Geriatric... Dec 2018Medicines play a key role in the lives of people with dementia, primarily to manage symptoms. Managing medicines is complex for people with dementia and their family...
OBJECTIVES
Medicines play a key role in the lives of people with dementia, primarily to manage symptoms. Managing medicines is complex for people with dementia and their family carers and can result in multiple problems leading to harm. We conducted a systematic review to identify and model medication issues experienced and coping strategies used by people with dementia and/or family carers.
METHODS
Eleven general databases and four systematic review databases were searched. Studies were quality assessed using an established framework and thematically analysed.
RESULTS
Twenty-one articles were included in this study, and four domains affecting medication use were identified: cognitive, medication, social and cultural, and knowledge/educational and communication. People with dementia reported medication issues in all four domains, but few coping strategies were developed. Family carers reported issues and coping strategies related to the medication and knowledge/educational and communication domains. Common issues with regards to knowledge and communication about medicines remain unresolved. The "voices" of people with dementia appeared largely missing from the literature so were in-depth understanding of how, whether, and in which circumstances coping strategies work in managing medicines.
CONCLUSIONS
Medicines management is a complex set of activities and although current coping strategies exists, these were primarily used by family carers or the person with dementia-carer dyad. Health and social care practitioners and researchers should seek to understand in-depth the "mechanisms of action" of existing coping strategies and actively involve people with dementia as co-producers of knowledge to underpin any further work on medicines management.
Topics: Adaptation, Psychological; Caregivers; Communication; Dementia; Health Knowledge, Attitudes, Practice; Humans; Medication Therapy Management
PubMed: 30270451
DOI: 10.1002/gps.4985 -
Journal of Cardiovascular and Thoracic... 2015To assess the efficacy of written information versus non written information intervention in reducing hospital readmission cost, if prescribed or presented to the... (Review)
Review
OBJECTIVE
To assess the efficacy of written information versus non written information intervention in reducing hospital readmission cost, if prescribed or presented to the patients with HF.
METHODS
The study was a systematic review and meta-analysis. We searched Medline (Ovid) and Cochrane library during the past 20 years from 1993 to 2013. We also conducted a manual search through Google Scholar and a direct search in the group of related journals in Black Well and Science Direct trough their websites. Two reviewers appraised the identified studies, and meta-analysis was done to estimate the mean saving cost of patient readmission. All the included studies must have been done by randomization to be eligible for study.
RESULT
We assessed the full-texts 3 out of 65 studies with 754 patients and average age of 74.33. The mean of estimated saving readmission cost in intervention group versus control group was US $2751 (95% CI: 2708 - 2794) and the mean of total saving cost in intervention group versus control group was US $2047 (base year 2010) with (95% CI: 2004 - 2089). No publication bias was found by testing the heterogeneity of studies.
CONCLUSION
One of the effective factors in minimizing the healthcare cost and preventing from hospital re-admission is providing the patients with information prescription in a written format. It is suggested that hospital management, Medicare organizations, policy makers and individual physicians consider the prescription of appropriate medical information as the indispensable part of patient's care process.
PubMed: 25859308
DOI: 10.15171/jcvtr.2015.01 -
Cancer Aug 2018Rising US health care costs have led to the creation of alternative payment and care-delivery models designed to maximize outcomes and/or minimize costs through changes...
Rising US health care costs have led to the creation of alternative payment and care-delivery models designed to maximize outcomes and/or minimize costs through changes in reimbursement and care delivery. The impact of these interventions in cancer care is unclear. This review was undertaken to describe the landscape of new alternative payment and care-delivery models in cancer care. In this systematic review, 22 alternative payment and/or care-delivery models in cancer care were identified. These included 6 bundled payments, 4 accountable care organizations, 9 patient-centered medical homes, and 3 other interventions. Only 12 interventions reported outcomes; the majority (n = 7; 58%) improved value, 4 had no impact, and 1 reduced value, but only initially. Heterogeneity of outcomes precluded a meta-analysis. Despite the growth in alternative payment and delivery models in cancer, there is limited evidence to evaluate their efficacy. Cancer 2018. © 2018 American Cancer Society.
Topics: Health Care Costs; Health Care Reform; Health Expenditures; Humans; Medical Oncology; Medicare; Neoplasms; Patient Protection and Affordable Care Act; Quality of Health Care; Reimbursement Mechanisms; United States
PubMed: 30141837
DOI: 10.1002/cncr.31367 -
JAMA Network Open Feb 2024Publicly available, US Census-based composite measures of socioeconomic disadvantage are increasingly being used in a wide range of clinical outcomes and health services...
IMPORTANCE
Publicly available, US Census-based composite measures of socioeconomic disadvantage are increasingly being used in a wide range of clinical outcomes and health services research. Area Deprivation Index (ADI) and Social Vulnerability Index (SVI) are 2 of the most commonly used measures. There is also early interest in incorporating area-level measures to create more equitable alternative payment models.
OBJECTIVE
To review the evidence on the association of ADI and SVI with health care spending, including claims-based spending and patient-reported barriers to care due to cost.
EVIDENCE REVIEW
A systematic search for English-language articles and abstracts was performed in the PubMed, Web of Science, Embase, and Cochrane databases (from inception to March 1, 2023). Peer-reviewed articles and abstracts using a cross-sectional, case-control, or cohort study design and based in the US were identified. Data analysis was performed in March 2023.
FINDINGS
This review included 24 articles and abstracts that used a cross-sectional, case-control, or cohort study design. In 20 of 24 studies (83%), ADI and SVI were associated with increased health care spending. No association was observed in the 4 remaining studies, mostly with smaller sample sizes from single centers. In adjusted models, the increase in spending associated with higher ADI or SVI residence was $574 to $1811 for index surgical hospitalizations, $3003 to $24 075 for 30- and 90-day episodes of care, and $3519 for total annual spending for Medicare beneficiaries. In the studies that explored mechanisms, postoperative complications, readmission risk, and poor primary care access emerged as health care system-related drivers of increased spending.
CONCLUSIONS AND RELEVANCE
The findings of this systematic review suggest that both ADI and SVI can play important roles in efforts to understand drivers of health care spending and in the design of payment and care delivery programs that capture aspects of social risk. At the health care system level, higher health care spending and poor care access associated with ADI or SVI may represent opportunities to codesign interventions with patients from high ADI or SVI areas to improve access to high-value health care and health promotion more broadly.
Topics: United States; Humans; Aged; Cohort Studies; Cross-Sectional Studies; Health Expenditures; Medicare; Socioeconomic Disparities in Health
PubMed: 38358740
DOI: 10.1001/jamanetworkopen.2023.56121