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Objective: To describe the economic impact of age-related macular degeneration (AMD) and to assess its medical and non-medical costs.Design and Settings: An observational study was carried out in 105 patients in two French centres in a sample of 105 French patients. All consecutive patients, consulting during a 3-week period, were included provided they were 60 years of age or older and they presented an exudative form of AMD with a distant visual acuity in the best eye < or = 20/40. Data collected included clinical items, treatment modalities, medical follow-up, transport costs, impact of AMD on living conditions and welfare payments related to visual impairment. Costs were presented in 2000 values.Perspective: General payer perspective (Social Security, private health insurance and patient).Results: Mean age was 79.3 years and ranged from 62.8-95 years. Average length of disease evolution was 3.5 years. During a 3-month period, patients had a mean of 2.6 visits to the ophthalmologist. Thirty percent of the patients used vascular medications and 72.4% had been previously treated by laser photocoagulation. Only 10% had benefited from visual rehabilitation. Annual AMD cost per patient was 3660.29 euros (EUR) [95% CI: 2881.92-4438.62]. Half of these annual costs were medical costs. Other major cost components were home help costs EUR904.91 [95% CI: 478.88-1330.94] and transport costs for care EUR542.73 [95% CI: 146.31-939.14]. Non-medical costs were significantly higher for patients with more severe disease.Conclusions: The economic argument that costs are higher in patients with the lowest visual acuity emphasises the necessity of early detection and treatment of patients with AMD. [ABSTRACT FROM AUTHOR]

Objective: To assess and compare the incremental costs of the 15-day treatment of osteoarthritis (OA) with nimesulide vs that with diclofenac in France, Italy and Spain. Design: A cost-minimisation analysis was performed through a decision tree, assuming the National Health System perspective. A meta-analysis was performed to assess the incidence of gastrointestinal adverse events (GIAEs) in patients with OA treated with nimesulide or diclofenac. Results: Three studies were included in the meta-analysis, which included a sample size of 484 patients in total. The incidence of GIAEs is higher in patients treated with diclofenac than in those treated with nimesulide. Nimesulide is cost-saving in all three countries: treatment costs are reduced by Euro dollars (EUR) 1.5 per case in France, EUR2 in Italy and EUR3.6 in Spain. Final results are not sensitive to variation of incidence rates of gastric and intestinal events and to changes in the resource consumption: nimesulide always remains cost-saving. Conclusions: This is the first economic analysis carried out in three different countries on original epidemiological data comparing nimesulide and diclofenac directly. Projecting our results to the estimated OA prevalence in the entire population of the three countries, the expected savings to the NHS would vary from a minimum of EUR17 500 000 in France to a maximum of EUR30 000 000 in Spain. It can be stated that these findings can provide support for clinicians and policy-makers for the adoption of this cost-saving treatment strategy in patients with OA. [ABSTRACT FROM AUTHOR]

The availability of the Diagnosis Related Group (DRG) system for determining hospital costs in some European countries has encouraged its use in pharmacoeconomic evaluations. The DRG system was developed in the US to provide data for prospective payments for hospitals. However, the financing of hospitals in some European countries is still based on the so-called 'global budget' approach. Therefore, results of pharmacoeconomic studies involving hospitals financed by the 'global-budget' approach in which DRG costs have been used require careful consideration. The main points to consider are: (i) that most of the cost components constituting the DRGs are in fact charges fixed by the government. This cost-charge ratio varies significantly across different DRGs, altering economic consequences when cost-shifting between DRGs; (ii) that there is rarely a perfect concordance between attributable cost (as proposed by the DRGs) and the definition of variable cost (as defined in economic evaluations); (iii) from the Sickness Fund's point of view, the way DRGs could be interpreted is rather unclear: financing or bench-marking?; and (iv) the perspective of DRG cost is a mixed patient-hospital perspective which is neither the societal nor the health insurance perspective generally used in pharmacoeconomic evaluations. In conclusion, the use of DRG costs is a major improvement for pharmacoeconomic evaluation. However, many hypotheses still need to be made in these studies, depending on the economic perspective of the study. Therefore, the results of pharmacoeconomic studies should be considered and discussed in line with the national financing system of the hospitals involved. [ABSTRACT FROM AUTHOR]

Objective: To assess the relationship between severity and progression of illness in Parkinson's disease and the use of healthcare resources. Design and setting: This was a prospective cost-of-illness study conducted in France based on clinical observation over a 6-month period of patients with Parkinson's disease treated in the hospital or community setting. Regression analyses were performed to construct the model that offered the best explanation for health expenditures using clinical and sociodemographic indicators. Patients and participants: All patients included in the study had well-defined idiopathic Parkinson's disease, were aged >35 years, were receiving treatment with levodopa or other antiparkinsonian agents, and were capable of completing questionnaires, alone or with the help of a household member. The final study population consisted of 294 patients, of whom 54 were enrolled by general practitioners and 240 by neurologists. Interventions: Investigators completed a clinical questionnaire at the beginning and end of the 6-month observation period. Patients completed a questionnaire on their daily living conditions at the beginning and end of the study, and also completed monthly reports of healthcare use and loss of productivity. Patients with motor fluctuations also filled in fluctuation diaries on 4 consecutive days at the beginning and end of the 6-month period. Resource data collected included hospital stays, ancillary care, drug therapy, medical visits and transportation. Social costs were evaluated in nonmonetary terms, with the exception of costs of adapting the home environment. Transfer payments were analysed using reports from patients. Main outcome measures and results: Hospital stays were the most expensive component of care (39% of costs), followed by ancillary care (30%) and drug therapy (22%). The mean medical cost was 308 euros (EUR) [$US357] for patients followed by a general practitioner and EUR2580 ($US2993) for patients followed by a neurologist. Costs also varied with age and motor fluctuations. Medical costs were strongly correlated with most clinical indicators and the cost generally progressed in line with the severity of the disease. The strongest correlation was between clinical indicators and ancillary care costs. Conclusions: These results confirm the importance of the social burden of Parkinson's disease. The regression results could be used to evaluate the benefit of novel treatments that reduce the intensity of motor fluctuations. [ABSTRACT FROM AUTHOR]