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Objective. To evaluate direct and indirect costs per quality adjusted life year (QALY) for different initial treatment strategies in very early RA. Methods. The 1-year data of the treatment in the Rotterdam Early Arthritis Cohort trial were used. Patients with a high probability (>70%) according to their likelihood of progressing to persistent arthritis, based on the prediction model of Visser, were randomized into one of following initial treatment strategies: (A) initial triple DMARD therapy (iTDT) with glucocorticoids (GCs) intramuscular (n = 91); (B) iTDT with an oral GC tapering scheme (n = 93); and (C) initial MTX monotherapy (iMM) with GCs similar to B (n = 97). Data on QALYs, measured with the Dutch EuroQol, and direct and indirect cost were used. Direct costs are costs of treatment and medical consumption, whereas indirect costs are costs due to loss of productivity. Results. Average QALYs (S.D.) for A, B and C were, respectively, 0.75 (0.12), 0.75 (0.10) and 0.73 (0.13) for Dutch EuroQol. Highest total costs per QALY (S.D.) were, respectively, €12748 (€ 18767), € 10380 (€15 608) and €17 408 (€21 828) for strategy A, B and C (P = 0.012, B vs C). Direct as well as indirect costs were higher with iMM (strategy C) compared with iTDT (strategy B). Higher direct costs were due to ~40% more biologic usage over time. Higher indirect costs, on the other hand, were caused by more long-term sickness and reduction in contract hours. iTDT was>95% cost-effective across all willingness-to-pay thresholds compared with iMM. Conclusion. iTDT was more cost-effective and had better worker productivity compared with iMM. [ABSTRACT FROM AUTHOR]

Background: Practices regarding hospitalisation of children at diagnosis of type 1 diabetes vary both within countries and internationally, and high-quality evidence of best practice is scarce. The objective of this study was to close some of the gaps in evidence by comparing two alternative regimens for children diagnosed with type 1 diabetes: hospital-based care and hospital-based home care (HBHC), referring to specialist care in a home-based setting. Methods: A randomised controlled trial, including 60 children aged 3–15 years, took place at a university hospital in Sweden. When the children were medically stable, they were randomised to either the traditional, hospital-based care or to HBHC. Results: Two years after diagnosis there were no differences in HbA1c (p = 0.777), in episodes of severe hypoglycaemia (p = 0.167), or in insulin U/kg/24 h (p = 0.269). Over 24 months, there were no statistically significant differences between groups in how parents’ reported the impact of paediatric chronic health condition on family (p = 0.138) or in parents’ self-reported health-related quality of life (p = 0.067). However, there was a statistically significant difference regarding healthcare satisfaction, favouring HBHC (p = 0.002). In total, healthcare costs (direct costs) were significantly lower in the HBHC group but no statistically significant difference between the two groups in estimated lost production (indirect costs) for the family as a whole. Whereas mothers had a significantly lower value of lost production, when their children were treated within the HBHC regime, fathers had a higher, but not a significantly higher value. The results indicate that HBHC might be a cost-effective strategy in a healthcare sector perspective. When using the wider societal perspective, no difference in cost effectiveness or cost utility was found. Conclusions: Overall, there are only a few, well-designed and controlled studies that compare hospital care to different models of home care. The results of this study provide empirical support for the safety and feasibility of HBHC when a child is diagnosed with type 1 diabetes. Our results further indicate that the model of care may have an impact on families’ daily living, not only during the initial period of care but for a longer period of time. [ABSTRACT FROM AUTHOR]

Objectives The main objectives of this study were to calculate total costs of illness and cost-driving disease features among patients with systemic lupus erythematosus (SLE) in Sweden. Methods Five cohorts of well-defined SLE patients, located in different parts of the country were merged. Incident and prevalent cases from 2003 through 2010 were included. The American College of Rheumatology (ACR) classification criteria was used. From the local cohorts, data on demographics, disease activity (SLEDAI 2K), and organ damage (SDI) were collected. Costs for inpatient care, specialist outpatient care and drugs were retrieved from national registries at the National Board of Health and Welfare. Indirect costs were calculated based on sickness leave and disability pensions from the Swedish Social Insurance Agency. Results In total, 1029 SLE patients, 88% females, were included, and approximately 75% were below 65 years at the end of follow-up, and thus in working age. The mean number of annual specialist physician visits varied from six to seven; mean annual inpatient days were 3.1–3.6, and mean annual sick leave was 123–148 days, all per patient. The total annual cost was 208,555 SEK ($33,369 = 22,941€), of which direct cost was 63,672kr ($10,188 = 7004€) and the indirect cost was 144,883 SEK ($23,181 = 15,937€), all per patient. The costs for patients with short disease duration were higher. Higher disease activity as measured by a SLEDAI 2K score > 3 was associated with approximately 50% increase in both indirect and direct costs. Damage in the neuropsychiatric and musculoskeletal domains were also linked to higher direct and indirect costs, while organ damage in the renal and ocular systems increased direct costs. Conclusion Based on this study and an estimate of slightly more than 6000 SLE patients in Sweden, the total annual cost for SLE in the country is estimated at $188 million (=129.5 million €). Both direct (30%) and indirect costs (70%) are substantial. Medication accounts for less than 10% of the total cost. The tax paid national systems for health care and social security in Sweden ensure equal access to health care, sick leave reimbursements, and disability pensions nationwide. Our extrapolated annual costs for SLE in Sweden are therefore the best supported estimations thus far, and they clearly underline the importance of improved management, especially to reduce the indirect costs. [ABSTRACT FROM AUTHOR]

The aim of this paper is to perform an analysis of the occupational health and safety system in the enterprise, identifying factors, which affect the amount of occupational health and safety costs, as well as present proposals to reduce occupational health and safety costs and improve the occupational health and safety system. [ABSTRACT FROM AUTHOR]

Introduction: Costs and the quality of sleep related breathing disorders (SRBD) were assessed in 18 out of 24 sleep laboratories (sl) in Hessen in the second quarter of 2009. Methods: 627 patients with suspected SRBD and their physicians in the sl filled in separate standardized questionnaires concerning socioeconomic and quality aspects. A follow-up investigation was performed after 3-6 months. Direct and indirect costs were calculated on the basis of the respective actual prices. Results: Approximately 1/5th of all patients had a PG prior to being referred to a sl. Based on previous information in BUB step 1, SRBD could be suspected in 75 % of all patients. The indication for PSG was correctly performed on the basis of the PG confirmed apnea-hypopnea indices in 71 % of all patients. All PGs and PSGs fulfilled the 6 hours duration criteria according to BUB guidelines. Out of 75 % of all patients that received positive airway pressure therapy, 50 % received a control investigation within three months. The number of early retirement and permanent disablement were low compared to other sleep disorders, resulting in lower direct and indirect costs. Highest costs were caused by devices. There was a considerable difference about cardiovascular diseases between patients and physicians. Conclusion: Diagnostic and therapeutic actions of the participating sl in Hessen are in line with the BUB guidelines. Cost reduction could be obtained by better clinical diagnostic procedures and avoiding unnecessary repeated PG and PSG procedures by improved evaluation of the clinical information. Low patient awareness for cardiovascular diseases should stimulate optimization of patient training. [ABSTRACT FROM AUTHOR]

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Objectives: This study evaluated the association of body mass index (BMI) with health-related quality of life (HRQoL), health utilities, health care resource utilization, productivity, activity impairment, and the associated costs. Methods: Results were from the 2013 EU5 (France, Germany, Italy, Spain, UK) National Health and Wellness Survey, a nationally representative, online survey of respondents aged ≥18 years. Analyses focused on normal weight (BMI ≥18.5 kg/m2 and BMI ,25 kg/m2), overweight (BMI ≥25 kg/m2 and BMI <30 kg/m2), Obese Class (OC) I (BMI ≥30 kg/m2 and BMI <35 kg/m2), OC II (BMI ≥35 kg/m2 and BMI <40 kg/m2), and OC III (BMI ≥40 kg/m2) respondents. Outcomes included HRQoL (Short Form [SF]-36v2), health utilities (SF-six dimension [6D]), productivity loss (Work Productivity and Activity Impairment questionnaire), and resource utilization (provider visits, emergency room visits, and hospitalizations) in the past 6 months. Direct and indirect costs were estimated from the literature. Generalized linear regression models predicted outcomes as a function of BMI, adjusting for covariates (age, sex, comorbidities). Results: Among 58,364 respondents, 46.9% were normal weight, 34.5% were overweight, 12.5% were OC I, 4.0% were OC II, and 2.1% were OC III. Metabolic comorbidities increased as BMI increased. After adjustments, all three OC respondents exhibited significantly lower HRQoL than normal weight respondents. Health utilities (normal weight: 0.720; overweight: 0.718; OC I: 0.703; OC II: 0.683; OC III: 0.662) declined with an increase in BMI (all P<0.05 vs normal). Among employed respondents (57.7%), overall work impairment increased as BMI increased. Normal (vs all OCs) had lower activity impairment and fewer provider visits, lower indirect costs (normal weight: €7,974; overweight: €7,825; OC I: €8,465; OC II: €9,394; OC III: €10,437), and lower total direct costs (normal weight: €516; overweight: €553; OC I: €583; OC II: €605; OC III: €717), all P<0.05. Conclusion: Increased BMI was associated with worse HRQoL, greater comorbidities, higher direct and indirect costs, and worse health utilities. Weight management may improve patient outcomes. [ABSTRACT FROM AUTHOR]

The individual and societal burdens of living with a chronic disease are a global issue. Diabetes directly increases health care costs to manage the disease and the associated complications and indirectly increases the economic burden through long-term complications that hinder the productivity of humans worldwide. Thus, it is crucial to have accurate information on diabetes-related costs and the geographic and global economic impact when planning interventions and future strategies. Health care systems must work with government agencies to plan national-level pre diabetes and diabetes strategies and policies. Public health services must focus on diabetes screening prevention and remission., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Introduction: Malaria remains a real problem of public health. Its hospital care generates important expenditures for affected households. The present study aimed to estimate direct and indirect costs of severe child malaria in reference hospitals in Kinshasa. Methodology: This prospective study included 1,350 children under 15 years of age suffering from severe malaria. The study was performed between 1 January and 30 November, 2011. Data were collected in nine reference hospitals. The studied parameters were direct pre-hospital costs, direct hospital costs, and indirect costs. Costs were assessed from the household point of view. Results: Median costs associated with the disease ranged from 114 USD in confessional hospitals to 173 USD in state hospitals and 308 USD in private hospitals. Direct pre-hospital median costs ranged between 3 and 11 USD. Direct hospital costs reached 72 USD in confessional hospitals, 139 USD in state hospitals, and 254 USD in private hospitals. Indirect costs ranged from 22 USD in state hospitals to 30 USD in confessional hospitals and 46 USD in private hospitals, regardless of the status of the accompanying parent or guardian. Factors explaining the variability of costs were the neurological form of malaria, indirect recourse to hospital, socioeconomic level, type of prescribing person, child's status upon leaving the hospital, and child's transfusion status. Conclusions: The care of severe child malaria appeared to be expensive in private and state hospitals. A state subsidy of health care and regulation of the private sector would contribute to the reduction of malaria's financial impact. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Agricultural Sciences, Belgrade is the property of University of Belgrade, Faculty of Agriculture and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective The study aims to examine real-world effects of duloxetine treatment for low back pain ( LBP). Methods The study identified employees with ≥1 LBP diagnosis and ≥1 duloxetine prescription within a year after LBP diagnosis from a privately insured claims database (2004-2007). Duloxetine-treated employees were propensity score matched to employees initiating another pharmacological/noninvasive treatment in the same month from LBP diagnosis. Treatment patterns and costs were compared over the 6 months following treatment initiation. Results Relative to controls, duloxetine-treated employees (N = 753) had significantly lower rates of other pharmacological/noninvasive therapies and a similar LBP surgery rate (1.7% vs 2.8%, P = 0.1573). Duloxetine-treated employees, despite higher pharmacy costs, had similar direct (health care) costs ($4,935 vs $5,649, P = 0.2662), and significantly lower indirect (workloss) costs ($1,723 vs $2,198, P = 0.0036). Conclusions Duloxetine treatment in LBP employees was associated with reduced rates of many nonsurgical therapies and lower indirect costs. The findings are limited by the observational study design and unmeasured potential confounders. [ABSTRACT FROM AUTHOR]

Insbesondere bei Behinderungsansprüchen nach der VOB/B gibt es in der Fachliteratur bezüglich der Berücksichtigung der Höhe der Allgemeinen Geschäftskosten (AGK) keine einheitliche Meinungsbildung; der BGH hat hierzu noch keine abschließende Aussage getroffen. Ein wesentlicher Grund hierfür ist, dass komplexe juristische, kostentheoretische und baubetriebswirtschaftliche Anforderungen zu berücksichtigen sind. Auf juristischer Seite sind beispielsweise das Prinzip des Gleichgewichts zwischen Leistung und Vergütung sowie die Anforderungen der VOB bezüglich des Begriffs Mehrkosten und der Grundlagen der Preisermittlung zu nennen. Auf der kostentheoretischen und baubetriebswirtschaftlichen Seite sind unter anderem Kostenzuordnungs- und Kosteneinflussfaktoren im Zusammenhang mit den AGK zu berücksichtigen. Dabei werden bei AGK die Kostenzuordnungsfaktoren in der Auftragskalkulation unternehmensspezifisch festgelegt, die im Ergebnis den für die Baustelle vorgesehenen AGK-Betrag bestimmen. Die Kosteneinflussfaktoren bei der Kalkulation von Mehrvergütungsansprüchen müssen dagegen baubetriebswirtschaftlich geeignet gewählt werden. Ziel des Beitrags ist daher, unter Berücksichtigung der Darstellung von neuen Verfahren zur Ermittlung der Höhe der AGK in der Angebotskalkulation weitere, aus baubetriebswirtschaftlicher Sicht bedeutende Rahmenbedingungen für einen Lösungsansatz und eine ganzheitliche Betrachtung in Bezug auf AGK bei Mehrvergütungsansprüchen darzustellen. Cost impact and cost assignment factors of general costs at claim requests Particularly in claim disputes concerning delay in construction time caused by the client and construction contracts based on the VOB/B there is no consistent opinion concerning the consideration of the appropriate amount of general costs; the Federal Court of Justice (BGH) has not made a final statement on this issue. This is mainly because this issue is quite complex with legal, cost theoretical and construction business management characteristics to be considered. Legal characteristics are e. g. the principle of balance between work performance and compensation, the requirements of the VOB concerning the term 'additional cost' and the consideration of the principles of the pricing methods. From cost theoretical and construction business management point of view, cost assignment and cost impact factors concerning general costs have to be taken into account. On the one hand, cost assignment factors are determined by the contractor in the bid estimate and lead to a defined amount of general costs dedicated to the construction works. On the other hand, cost impact factors, which are used in the calculation of general costs for claim requests, have to follow objective aspects considering construction business management aspects and may differ from cost assignment factors. The main goal of this paper is, under consideration of the new methods of the allocation of general costs in the bid estimate, to enumerate and explain further relevant aspects from the construction business management point of view for a holistic solution of the indirect cost issue of general costs in the context of claims. [ABSTRACT FROM AUTHOR]

Background: Smoking is seen as the most important single risk to health today, and is responsible for a high financial burden on healthcare systems and society. This population-based cross-sectional study compares healthcare utilisation, direct medical costs, and costs of productivity losses for different smoking groups: current smokers, former smokers, and never smokers. Methods: Using a bottom-up approach, data were taken from the German KORA F4 study (2006/2008) on self-reported healthcare utilisation and work absence due to illness for 3,071 adults aged 32-81 years. Unit costs from a societal perspective were applied to utilisation. Utilisation and resulting costs were compared across different smoking groups using generalised linear models to adjust for age, sex, education, alcohol consumption and physical activity. Results: Average annual total costs per survey participant were estimated as €3,844 [95% confidence interval: 3,447-4,233], and differed considerably between smoking groups with never smokers showing €3,237 [2,802-3,735] and former smokers causing €4,398 [3,796-5,058]. There was a positive effect of current and former smoking on the utilisation of healthcare services and on direct and indirect costs. Total annual costs were more than 20% higher (p<0.05) for current smokers and 35% higher (p<0.01) for former smokers compared with never smokers, which corresponds to annual excess costs of €743 and €1,108 per current and former smoker, respectively. Conclusions: Results indicate that excess costs for current and former smokers impose a large burden on society, and that previous top-down cost approaches produced lower estimates for the costs of care for smoking-related diseases. Efforts must be focused on prevention of smoking to achieve sustainable containment on behalf of the public interest. [ABSTRACT FROM AUTHOR]

Understanding the impact of rheumatic heart disease (RHD) has become increasingly important among aging populations around the world, and Korea is no exception. This study was conducted to estimate total annual patient costs associated with RHD in Korea for 2008 using nationally representative data. The subjects were South Korean citizens with RHD (ICD-10 codes I01-I09). The primary information for this study was obtained from claims data compiled by the National Health Insurance Corporation of Korea. Direct medical care costs were estimated using expenses paid by insurers and patients for non-covered care and pharmaceutical costs. Direct non-medical costs were estimated using data on transportation costs for hospital visits and costs for caregivers. Indirect costs included the costs of productivity loss and premature death in RHD patients. The economic burden of RHD in 2008 was estimated at $67.25 million US dollars. The indirect costs amounted to 39.04 % (US $26.26 million) of the total RHD costs. When stratified by age, the costs incurred by the group of patients older than 60 years were US $31.63 million. The prevalence of the disease in the same age group was 791.07 cases per 100,000 people. This study confirms that the prevalence of RHD was highest in patients older than 60 years in 2008. Furthermore, the patterns of disease in South Korea were similar to patterns observed in other high-income countries. These findings indicate that secondary prevention strategies for the early detection of RHD are needed in South Korea. [ABSTRACT FROM AUTHOR]

Background: Although return-to-work (RTW) interventions have been shown to be cost-effective, most previous economic analyses have focused on the insurer's perspective. Employers can also incur costs when supporting the RTW of their employees. Objective: To identify a key set of items for estimating the costs of RTW interventions from the employer's perspective, and to identify and value the costs and consequences of a RTW intervention. Participants: Employers with knowledge of the economic costs of RTW. Methods: A survey of 10 workplaces with RTW programs was conducted. The survey consisted of semi-structured interviews with a human resources or occupational health and safety representative from each enrolled workplace. Results: The interviews were reviewed and from them key items were identified for estimating the costs of RTW interventions from the employer's perspective. Employers identified the following costs: medical, equipment, training and education, wage replacement and productivity, and claims administration when assisting an employee's RTW. Conclusions: Even in a jurisdiction with workers' compensation insurance, employers incur costs associated with RTW programs. It is important to consider these costs, from the perspective of the employer, when studying the cost-effectiveness of RTW interventions or programs. [ABSTRACT FROM AUTHOR]

This paper estimates the healthcare costs and the value of lost productivity from premature deaths for California women with breast cancer in 2001, with an updated estimate for 2008. Multiple secondary data sources were used to estimate the healthcare cost of breast cancer. Mortality costs were estimated as the product of the number of deaths and the expected value of a woman’s future earnings. The total economic cost of breast cancer in California was $1.43 billion in 2001, or $1.91 billion in 2008 dollars. Breast cancer is costly both in terms of healthcare dollars and the value of lost lives. Regular screening and access to treatment for all women will allow the disease to be diagnosed earlier, the prognosis improved, and the economic burden reduced. [ABSTRACT FROM AUTHOR]

Objective: The study objective is to compare the annual total medical and indirect costs of newly treated and untreated employees with multiple sclerosis (MS). Research design and methods: A retrospective database analysis of employer medical, drug, and disability claims database (Ingenix Employer database, 1999–2005; 17 large US companies) was conducted for employees 18–64 years of age with ≥1 MS diagnosis after January 1, 2002. Employees with ≥1 MS disease-modifying drug (DMD) claim comprised the newly treated group; employees with MS but no DMD at any time comprised the untreated, comparison group. Index date was the day after the most recent claim (treated, DMD claim; untreated, MS claim) meeting the following requirements: continuous health coverage for 3 months before (baseline period) and 12 months after the index date (study period) and actively employed during baseline. Main outcome measures: Total medical costs and indirect (work loss) costs over the 1-year study period (2006 $US) were compared for DMD-treated and untreated MS employees, adjusting for baseline characteristics, including comorbidities. Results: During the baseline, MS employees who became treated (n = 258) were younger (40.9 vs. 44.4 years, p < 0.0001) and had a higher proportion of women (72 vs. 62%, p = 0.007) than the untreated group of MS employees who never received DMD treatment (n = 322). The 3-month baseline MS-related medical costs were higher among treated MS employees ($2520 vs. $1012, p < 0.0001). There was a nonsignificant trend toward higher baseline non-MS-related medical costs in untreated versus treated MS employees. Risk-adjusted total annual medical costs ($4393 vs. $6187, p < 0.0001) and indirect costs ($2252 vs. $3053, p < 0.0001) were significantly lower for treated MS employees than for untreated MS employees. Conclusions: Initiation of MS disease-modifying drugs was associated with substantial significant medical and indirect savings for employees with MS. Study findings should be considered in the context of the study limitations (e.g., analytic focus on employees with at least 12-month follow-up; lack of clinical detail on MS severity). [ABSTRACT FROM AUTHOR]

To measure the economic output/input ratios for the various options of prevention of rheumatic fever/rheumatic heart disease (RF/RHD) and check the viability of primary prevention vis-à-vis secondary and tertiary preventions. Cost accounting of the various prevention options was calculated for each variable as available in literature. Actual data as obtainable for the financial year ending March 2006 were computed for the Pondicherry population. Both direct and indirect costs (including community/social costs) were worked out using mostly primary data, and wherever necessary, secondary data. Certain scientific assumptions were used where exact data was not available. Primary prevention is the definite viable economic option (1:1.56) compared to secondary (1: 1.07) and tertiary (1: 0.12) preventions. In fact, the current stress on only secondary and tertiary preventions is found to be economically unviable. It is postulated that primary prevention as a practical policy in tackling RF and RHD can be recommended. [ABSTRACT FROM AUTHOR]

A risk analysis is developed for a test site located in the area north of Lisbon using a scenario of a temporary interruption of the motorway A9 due to a landslide of rotational or translational type. Landslide susceptibility is assessed at the regional scale independently for rotational and translational slides, comparing the landslide distribution with a set of assumed independent landslide predisposing factors. Susceptibility models are validated and classified through the computation of prediction rate curves based on the temporal partition of the landslide data sets. Landslide hazard maps are based on a scenario of future landslide occurrence for the next 27 years. These maps allow the definition of two critical areas on the motorway A9 with regards to landslide susceptibility. Direct costs associated with both critical spots are assessed taking into account the probable affected area of the motorway, and the reconstruction costs. Indirect costs derived from the traffic interruption are evaluated considering the alternatives paths to the motorway, and include costs resulting from: (1) additional fuel consumption; (2) decrease in tollgate income; and (3) loss of productive time. Results show that indirect costs may be 24 to 43 times higher than direct costs, assuming a temporary interruption of the motorway for 6 months. [ABSTRACT FROM AUTHOR]

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OBJECTIVE: To assess asthma-related morbidity, symptom control, and societal cost of asthmatic patients in Hungary. Secondary objective was to assess the relationship between asthma symptom control and costs incurred. METHODS: Three hundred seventy-eight pediatric asthma patients (6–14 years of age) and 711 adult asthma patients (18–55 years of age) in 19 pulmonary clinics were interviewed by their physicians regarding asthma-related drug therapy and recent (past 2 weeks) asthma morbidity (daytime asthma symptoms, nocturnal symptoms, limitation in daily activities resulting from asthma and asthma exacerbation). Physicians estimated patients' level of asthma control based on the Global Initiative of Asthma guidelines. Direct and indirect costs for asthma-related resources were determined based on patient reported 6 months' data except for drug costs that were based on patient reported 2 weeks of data. All cost data were annualized. RESULTS: Patients in the study were mostly prescribed inhaled controller medications for asthma symptom management (76.2% pediatric and 92.3% adult) during the 2 weeks preceding the survey. Asthma-related morbidity was experienced by 15% of pediatric patients and 30% of the adult patients at least once during the 2 weeks preceding the survey. Physician classified 69% of pediatric patients as having good control, 27.5% as having moderate control, and 2.8% as having poor control of their asthma. In the adult population, 50.7% were classified as having good control, 36.6% as having moderate control, and 12.7% as having poor control. The average total annual costs (direct and indirect costs) per patient were 833 EUR (897 USD) for pediatric patients and 632 EUR (681 USD) for adult patients. In both pediatric and adult patients the total costs were highest for patients with poor asthma control. The total cost per patient increased in the ratios of 1 to 1.4 to 2.4 for pediatric patients and 1 to 1.5 to 2.9 for adult patients with good, moderate, and poor control of asthma, respectively. CONCLUSION: Inhaled corticosteroids was the most frequent treatment prescribed for asthma patients in the study. However, patients reported substantial asthma-related morbidity. Children used more resources than adults, despite being classified as having better control. Patients with poor control of asthma symptoms incurred the highest societal cost, improving patient control may reduce cost to society by 40% or more. [ABSTRACT FROM AUTHOR]

This analysis addresses three important conceptual problems in the measurement of direct and indirect costs and benefits: (1) the distribution of impacts between a regional economy and the encompassing state economy; (2) the distinction between indirect impacts and indirect costs (IC), focusing on the dynamic time path unemployed resources follow to find alternative employment; and (3) the distinction among the affected firms' microeconomic categories of fixed and variable costs as they are used to compute regional direct and indirect costs. It uses empirical procedures that reconcile the usual measures of economic impact provided by input/output models with the estimates of economic costs and benefits required for analysis of welfare changes. The paper illustrates the relationships and magnitudes involved in the context of water policy issues facing the Pecos River Basin of New Mexico. [ABSTRACT FROM AUTHOR]

A wide range of studies have been published over the past two decades that involve the intersection of sleep EEG, insomnia, psychiatric illness (especially depressive disorders) and psychopharmacology. Much of value has been discovered, but there have also been false starts and contradictory results. There is in fact strong evidence that insomnia is associated with medical and psychiatric illness and that the sleepiness associated with insomnia is the cause of many accidents. Thus, the direct (visits to doctors, cost of sleeping medication, complications from use of these medications) and indirect (accidents, quality of life) costs of insomnia are enormous and constitute a major public health problem in the industrialized countries. Believing that it is now timely to assess the state of this important research area, a consensus conference was convened on June 26–28, 1998, in Porto Cervo (Italy) to attempt to clarify the important issues and findings on the clinical effect of the different classes of antidepressant drugs on sleep quality in depression. The participants’ consensus on some of the main topics is presented with the hope that this discussion and analysis will contribute to productive research in this important field.Copyright © 2000 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

• Multiple Sclerosis places a huge economic burden on healthcare models and societies. • The estimated total annual cost per patient in Europe is 40,303€. • Costs of drugs were main the cost determinants for less severe cases of MS. • Informal care and production losses were the main cost for the most severe cases of MS. • Eastern European countries face the smallest costs. Multiple sclerosis has both high healthcare and social impacts. The purpose of this article is to analyse the available literature describing the economic burden of multiple sclerosis and to compare costs among studies examining main cost drivers. A literature search on studies published in English on cost-of-illness of multiple sclerosis included in this review using PubMed, the Cochrane Library, SCOPUS and Web of Science includes a retrospective horizon and it describes direct and indirect costs in patients categorized into severity groups. Several papers were obtained from the database search (n =37). Additionally, results from "hand searching" were also included, where a wider horizon was considered. Cost estimates were compared among studies that used a societal perspective on costs, time-period studied, and year of price level used. The estimated total annual cost per patient in Europe is on average 40,300€ (n= 20). In addition, differences by geographic areas and severity groups are also considered. All in all, the higher the severity, the higher the associated costs. This systematic review provides one clear finding: multiple sclerosis places a huge economic burden on healthcare models and societies due to productivity losses and caregiver burden. Moreover, costs of drugs were main cost determinants for less severe cases of multiple sclerosis and informal care and production losses for the most severe cases of multiple sclerosis. [ABSTRACT FROM AUTHOR]