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Objectives: Patients waking up with stroke symptoms are often excluded from intravenous thrombolysis with alteplase (IV-tpa). The WAKE-UP trial, a European multicenter randomized controlled trial, proved the clinical effectiveness of magnetic resonance imaging-guided IV-tpa for these patients. This analysis aimed to assess the cost-effectiveness of the intervention compared to placebo.Methods: A Markov model was designed to analyze the cost-effectiveness over a 25-year time horizon. The model consisted of an inpatient acute care phase and a rest-of-life phase. Health states were defined by the modified Rankin Scale (mRS). Initial transition probabilities to mRS scores were based on WAKE-UP data and health state utilities on literature search. Costs were based on data from the University Medical Center Hamburg-Eppendorf, literature, and expert opinion. Incremental costs and effects over the patients' lifetime were estimated. The analysis was conducted from a formal German healthcare perspective. Univariate and probabilistic sensitivity analyses were performed.Results: Treatment with IV-tpa resulted in cost savings of €51 009 and 1.30 incremental gains in quality-adjusted life-years at a 5% discount rate. Univariate sensitivity analysis revealed incremental cost-effectiveness ratio being sensitive to the relative risk of favorable outcome on mRS for placebo patients after stroke, the costs of long-term care for patients with mRS 4, and patient age at initial stroke event. In all cases, IV-tpa remained cost-effective. Probabilistic sensitivity analysis proved IV-tpa cost-effective in >95% of the simulations results.Conclusions: Magnetic resonance imaging-guided IV-tpa compared to placebo is cost-effective in patients with ischemic stroke with unknown time of onset. [ABSTRACT FROM AUTHOR]

Background: Collaborative group intervention (CGI) in patients with functional somatic syndromes (FSS) has been shown to improve mental quality of life.Objective: To analyse incremental cost-utility of CGI compared to enhanced medical care in patients with FSS.Methods: An economic evaluation alongside a cluster-randomised controlled trial was performed. 35 general practitioners (GPs) recruited 300 FSS patients. Patients in the CGI arm were offered 10 group sessions within 3months and 2 booster sessions 6 and 12months after baseline. Costs were assessed via questionnaire. Quality adjusted life years (QALYs) were calculated using the SF-6D index, derived from the 36-item short-form health survey (SF-36). We calculated patients' net-monetary-benefit (NMB), estimated the treatment effect via regression, and generated cost-effectiveness acceptability curves.Results: Using intention-to-treat analysis, total costs during the 12-month study period were 5777EUR in the intervention, and 6858EUR in the control group. Controlling for possible confounders, we found a small, but significant positive intervention effect on QALYs (+0.017; p=0.019) and an insignificant cost saving resulting from a cost-increase in the control group (-10.5%; p=0.278). NMB regression showed that the probability of CGI to be cost-effective was 69% for a willingness to pay (WTP) of 0EUR/QALY, increased to 92% for a WTP of 50,000EUR/QALY and reached the level of 95% at a WTP of 70,375EUR/QALY. Subgroup analyses yielded that CGI was only cost-effective in severe somatic symptom severity (PHQ-15≥15).Conclusion: CGI has a high probability to be a cost-effective treatment for FSS, in particular for patients with severe somatic symptom severity. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To analyse the association of direct and indirect costs in patients with medically unexplained symptoms (MUS) with somatic symptom severity (SSS). Methods: A cross-sectional cost analysis for retrospective 6months was conducted in 294 primary care patients with MUS. Health care utilisation and loss of productivity were measured by questionnaires. SSS was measured using the “Patient Health Questionnaire 15” (PHQ-15). Direct and indirect costs and the association of costs with SSS were analysed via multiple linear regression analysis. Results: Patients with MUS had average 6-month direct costs of 1098EUR and indirect costs of 7645EUR. For direct costs, outpatient physician visits were the most expensive single cost category (36%), followed by pharmaceuticals (25%) and hospital stays (19%). Indirect costs were predominantly caused by productivity reduction at work (56%) followed by early retirement (29%) and acute sickness absence (14%). As compared to mild SSS, moderate SSS was not significantly associated with direct, but with indirect costs (+2948EUR; p<.001); severe SSS was associated with increased direct cost (+658EUR; p=.001) and increased indirect costs (+4630EUR; p<.001). Age was positively associated with direct cost (+15EUR for each additional year; p=.015) as well as indirect cost (+104EUR for each additional year; p<.001). Conclusions: MUS are associated with relevant direct and even much higher indirect costs that strongly depend on SSS. [Copyright &y& Elsevier]

Obesity has substantially increased in recent decades and is now one of the major global health problems. The large obesity-related health burden negatively impacts many relevant health outcomes (e.g. quality of life, disability, mortality) and leads to increased healthcare utilization. This excess service use is the main driver behind high healthcare costs of obese individuals. Findings indicate that costs rise curvilinearly with increasing body mass index, especially among the obese. As more individuals of a country's population become obese, a larger share of total annual national healthcare expenditure is spent on obesity and obesity-related health problems. In addition to escalating healthcare costs, obesity goes along with indirect costs through decreases in workforce productivity. The empirical evidence has shown beyond doubt that obesity negatively impacts individuals, healthcare systems, employers, and the economy as a whole. This article provides a brief overview of selected economic consequences associated with excess-weight. [Copyright &y& Elsevier]

Abstract: Background context: Back pain presents a significant cause of health care costs and lost productivity. In most cases, conservative treatment will be sufficient, but in the most severe cases, disc surgery is indicated. Purpose: To analyze the effect of psychiatric comorbidity on health care costs and lost productivity in patients with back pain undergoing disc surgery. Study design: A cross-sectional study design was used. Patient sample: A sample of 305 disc surgery patients (lumbar, 239; cervical, 66). Outcome measures: Patients were interviewed using the German version of the Composite International Diagnostic Interview to assess psychiatric comorbidity and a questionnaire to assess resource utilization and lost productivity for a 3-month period prior disc surgery. Health care resources were monetarily valued by unit costs, whereas productivity was valuated by labor costs. Methods: Cost differences between patients with and without psychiatric comorbidity were analyzed using bootstrap regression techniques. Results: Back pain was associated with mean 3-month direct health care costs ranging from €5,534 (lumbar disc herniation without psychiatric comorbidity) to €8,507 (cervical disc herniation with psychiatric comorbidity), of which between 51% and 79% were caused by disc surgery. Mean indirect costs ranged from €7,589 to €8,492. Psychiatric comorbidity was significantly associated with increased direct costs in lumbar disc herniation (€7,042 vs. €5,534). Regression analysis showed increments of €851 (p=.043) in direct costs and €1,636 (p=.058) in total costs for psychiatric comorbidity, which predominantly resulted from nonpsychiatric health care utilization. Conclusions: Severe back pain is associated with high direct and indirect costs, which are influenced by the presence of psychiatric comorbidity. We found a lack of treatment for psychiatric comorbidity indicated by low mental health care utilization in affected individuals. More attention should be given to psychiatric comorbidity in the treatment of patients undergoing disc surgery. Clinicians should be aware of the high prevalence rates of psychiatric comorbidity in this patient group. They should consider the assessment of psychiatric distress and support of mental health professionals if applicable. [Copyright &y& Elsevier]

Objective: Moderate alcohol consumption is associated with both positive and negative health effects. This study aims to estimate the positive and negative consequences on mortality, years of potential life (YPL), quality-adjusted life-years (QALYs), resource utilization, and societal costs attributable to moderate alcohol consumption in Germany in 2002. Methods: The concept of attributable risks and a prevalence-based approach was used to calculate age- and sex-specific alcohol attributable mortality and resource utilization for a wide range of disorders, and avoided mortality and resource utilization for diabetes mellitus, coronary heart disease, stroke, and cholelithiasis. The literature provided prevalence of moderate alcohol consumption in Germany by age and sex and relative risks. Direct costs were calculated using routine utilization and expenditure statistics. Indirect costs were calculated using the human capital approach. Results: Due to moderate alcohol consumption, 14,457 lives, 205,691 YPL, and 179,964 QALYs were lost, whereas 29,918 lives, 300,382 YPL, and 258,284 QALYs were gained. Up to an age of 55 to 60 (62.5–67.5) years, more lives were lost than gained among men (women), whereas in older age groups more lives were gained than lost. Moderate alcohol consumption caused &U20AC;3049 million of direct and &U20AC;2630 million of indirect costs, whereas &U20AC;2094 million of direct and &U20AC;2604 million of indirect costs were avoided. Conclusion: Despite considerable uncertainty, moderate alcohol consumption seems to result in an overall net effect of gained lives, YPL, and QALYs, realized among the elderly, but overall increased societal costs. Thus, moderate alcohol consumption should still be seen critical, especially among youths. [ABSTRACT FROM AUTHOR]

The health-related quality of life (HrQoL) and the recovery process of persons with mental health conditions can be assessed with the Recovering Quality of Life questionnaires (ReQoL-20 and ReQoL-10). The aim of this study was to assess the psychometric properties of the German version of the ReQoL measures in patients with anxiety, obsessive-compulsive, stress-related, and somatoform disorders and in patients with disorders of adult personality and behavior. This study was based on a sub-sample of patients that were included in a randomized controlled trial evaluating an evidence-based, stepped and coordinated care service model for mental disorders (RECOVER). The internal consistency was assessed using Cronbach's Alpha and the test-retest reliability was assessed by the intra-class correlation coefficient (ICC). Concurrent validity was assessed by Pearson's Correlation Coefficient and the known-group validity was assessed using the Cohen's d. The internal consistency of the ReQoL-20 and ReQoL-10 was excellent and good with Cronbach's alpha of α = 0.91 and α = 0.83 for all items. The test-retest reliability of the ReQoL measures was moderate with ICC of r = 0.72 to 0.74. The concurrent validity of the ReQoL measures with the Global Severity Index was overall high with a correlation coefficient of r = −0.70. In conclusion, for patients with anxiety, obsessive-compulsive, stress-related, somatoform and personality disorders, the German version of the ReQoL measures is valid and reliable for the assessment of HrQoL and the recovery process. • The ReQoL measures have an overall good to excellent internal consistency. • The test-retest reliability of the ReQoL measures was only moderate to good. • The known-group validity of the ReQoL measures was good. • The ReQoL measures were sensitive to treatment response and remission from symptoms. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to calculate disorder-specific excess costs in patients with functional somatic syndromes (FSS).Methods: We compared 6-month direct and indirect costs in a patient group with FSS (n=273) to a control group of the general adult population in Germany without FSS (n=2914). Data on the patient group were collected between 2007 and 2009 in a randomized controlled trial (speciAL). Data on the control group were obtained from a telephone survey, representative for the general German population, conducted in 2014. Covariate balance between the patient group and the control group was achieved using entropy balancing. Excess costs were calculated by estimating generalized linear models and two-part models for direct costs and indirect costs. Further, we estimated excess costs according to the level of somatic symptom severity (SSS).Results: FSS patients differed significantly from the control group regarding 6-month costs of outpatient physicians (+€280) and other outpatient providers (+€74). According to SSS, significantly higher outpatient physician costs were found for mild (+€151), moderate (+€306) and severe (+€376) SSS. We also found significantly higher costs of other outpatient providers in patients with mild, moderate and severe SSS. Regarding costs of rehabilitation and hospital treatments, FSS patients did not differ significantly from the control group for any level of SSS. Indirect costs were significantly higher in patients with severe SSS (+€760).Conclusion: FSS were of major importance in the outpatient sector. Further, we found significantly higher indirect costs in patients with severe SSS. [ABSTRACT FROM AUTHOR]

Abstract: Objective: This study examines longitudinal depression and anxiety rates in disc surgery patients in comparison to the general population, the change and associated determinants of depression and anxiety over time. Methods: The longitudinal observational study refers to 305 consecutive disc surgery patients (age range: 18–55years). Depression and anxiety was assessed with the Hospital Anxiety and Depression Scale. Random effects regression models for unbalanced panel data were used. Results: Depression and anxiety decreases significantly during nine months after surgery. Depression rates vary between 23.6% (T0), 9.6% (T1) and 13.1% (T2). Only at T0 the depression rate differs significantly from the general population. Anxiety rates range between 23.7% (T0), 10.9% (T1) and 11.1% (T2). Compared to the general population anxiety rates are significantly higher at all three assessment points. Risk factors for anxiety or depression at the time of the surgery are psychiatric comorbidity before surgery, higher age, female gender, lower educational level, lower physical health status and higher pain intensity. Regarding depression and anxiety in the course of time significant time interactions were found for the existence of other chronic diseases, higher pain intensity and vocational dissatisfaction. Conclusions: Compared to the general population patients undergoing herniated disc surgery are often affected by depression and anxiety during hospital treatment and also in the course of time. Multimodal diagnostics regarding psychological well-being, pain and physical health status may help to identify this risk group. The assistance by mental health professionals during hospital and rehabilitation treatment may reduce poor postoperative outcome. [Copyright &y& Elsevier]