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Treatment Costs (treatment + cost)
Selected AbstractsClomiphene Citrate and Testosterone Gel Replacement Therapy for Male Hypogonadism: Efficacy and Treatment CostTHE JOURNAL OF SEXUAL MEDICINE, Issue 1pt1 2010Frederick Taylor MD ABSTRACT Introduction., The efficacy of oral clomiphene citrate (CC) in the treatment of male hypogonadism and male infertility (MI) with low serum testosterone and normal gonadotropin levels has been reported. Aim., The aim of this article is to evaluate CC and testosterone gel replacement therapy (TGRT) with regard to biochemical and clinical efficacy and cost. Main Outcome Measures., The main outcome measures were change in serum testosterone with CC and TGRT therapy, and change in the androgen deficiency in aging male (ADAM) questionnaire scores with CC therapy. Methods., Men receiving CC or TGRT with either Androgel® 1% or Testim® 1% for hypogonadism (defined as testosterone < 300 ng/mL) or MI were included. Serum values were collected 1,2 months after treatment initiation and semi-annually thereafter. Retrospective data collection was performed via chart review. Subjective follow up of patients receiving CC was performed via telephone interview using the ADAM questionnaire. Results., A hundred and four men (65 CC and 39 TGRT) were identified who began CC (50 mg every other day) or TGRT (5 g). Average age (years) was 42(CC) vs. 57 (TGRT). Average follow up was 23 months (CC, range 8,40 months) vs. 46 months (TGRT, range 6,149 months). Average posttreatment testosterone was 573 ng/dL in the CC group and 553 ng/dL in the TGRT group (P value < 0.001). The monthly cost of Testim® 1% (5 gm daily) is $270, Androgel® 1% (5 gm daily) is $265, and CC (50 mg every other day) is $83. Among CC patients, the average pretreatment ADAM score was 4.9 vs. 2.1 at follow up (P < 0.05). Average pretreatment ADAM sexual function domain score was 0.76 vs. 0.23 at follow up (P < 0.05). There were no adverse events reported. Conclusion., CC represents a treatment option for men with hypogonadism, demonstrating biochemical and clinical efficacy with few side effects and lower cost as compared with TGRT. Taylor F, and Levine L. Clomiphene citrate and testosterone gel replacement therapy for male hypogonadism: Efficacy and treatment cost. J Sex Med 2010;7:269,276. [source] Employer burden of mild, moderate, and severe major depressive disorder: mental health services utilization and costs, and work performance,DEPRESSION AND ANXIETY, Issue 1 2010Howard G. Birnbaum Ph.D. Abstract Background: Treatment utilization/costs and work performance for persons with major depressive disorder (MDD) by severity of illness is not well documented. Methods: Using National Comorbidity Survey-Replication (2001,2002) data, US workforce respondents (n=4,465) were classified by clinical severity (not clinically depressed, mild, moderate, severe) using a standard self-rating scale [Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR)]. Outcomes included 12-month prevalence of medical services/medications use/costs and workplace performance. Treatment costs (employer's perspective) were estimated by weighing utilization measures by unit costs obtained for similar services used by MDD patients in claims data. Descriptive analysis across three severity groups generated ,2 results. Results: Using a sample of 539 US workforce respondents with MDD, 13.8% were classified mild, 38.5% moderate, and 47.7% severe cases. Mental health services usage, including antidepressants, increased significantly with severity, with average treatment costs substantially higher for severe than for mild cases both regarding mental health services ($697 vs. $388, ,2=4.4, P=.019) and antidepressants ($256 vs. $88, ,2=9.0, P=.001). Prevalence rates of unemployment/disability increased significantly (,2=11.7, P=.003) with MDD severity (15.7, 23.3, and 31.3% for mild, moderate, and severe cases). Severely and moderately depressed workers missed more work than nondepressed workers; the monthly salary-equivalent lost performance of $199 (severely depressed) and $188 (moderately depressed) was significantly higher than for nondepressed workers (,2=10.3, P<.001). Projected to the US workforce, monthly depression-related worker productivity losses had human capital costs of nearly $2 billion. Conclusions: MDD severity is significantly associated with increased treatment usage/costs, treatment adequacy, unemployment, and disability and with reduced work performance. Depression and Anxiety, 2010. © 2009 Wiley-Liss, Inc. [source] Hydrophobic pervaporation for environmental applications: Process optimization and integrationENVIRONMENTAL PROGRESS & SUSTAINABLE ENERGY, Issue 4 2002Frank Lipnizki The focus of this paper is on the design of pervaporation units for wastewater treatment taking into account technical, economic, and environmental aspects. Two different sized industrial wastewater streams of water-chloroform, and of water-methyl-isobutylketone (MIBK) are considered. Based on a wastewater stream of 1,500 kg/d, a semi-batch process combining pervaporation with a decanter recycle loop is developed. Using this process, it is possible to recover over 99% of the organic components at concentrations of more than 98 wt. %. The treatment costs are between 0.11 to 0.16 $/kg wastewater. For the treatment of a wastewater stream of 1,000 kg/h, pervaporation combined with a decanter and recycling loop, as well as integrated in a hybrid process with adsorption, is considered. For MIBK, pervaporation with a decanter is the most attractive option taking economic and environmental aspects into account, while, for chloroform, the hybrid process is the better option. Treatment costs in all cases are about 0.03 $/kg wastewater. The recovery rate of the organic compounds is over 99% at concentrations over 98 wt. %. The authors concluded that pervaporation as a stand-alone unit, or integrated into hybrid processes, offers significant advantages over conventional alternatives. [source] Health economics of treating haemophilia A with inhibitorsHAEMOPHILIA, Issue 2005C. KNIGHT Summary., Haemophilia is a rare, inherited blood disorder in which blood clotting is impaired such that patients suffer from excessive internal and external bleeding. At present there is no cure for haemophilia A and patients require expensive, life-long treatment involving clotting factor replacement therapy. Treatment costs are perceived to be higher for patients who have developed inhibitory antibodies to factor VIII, the standard therapy for haemophilia A. However, initial cost analyses suggest that clotting factor therapy with alternative haemostatic agents, such as recombinant activated factor VII or activated prothrombin complex concentrate, is no more expensive for the majority of haemophilia A patients with inhibitors than for those without inhibitors. With the availability of effective alternative haemostatic agents, orthopaedic surgery for haemophilia A patients with inhibitors is now a clinical option, and initial cost analyses suggest this may be a cost-effective treatment strategy for patients with inhibitors whose quality of life (QoL) is severely impaired by joint arthropathy. In an era of finite healthcare resourcing it is important to determine whether new treatments justify higher unit costs compared with standard therapies and whether such higher costs are justified from an individual perspective in terms of improved QoL, and from a societal perspective in terms of improved productivity and reduced overall healthcare costs. This paper examines current data on the health economics of treating haemophilia A patients with inhibitors, focusing on the overall costs of clotting factor replacement therapy and the cost consequences of joint replacement. [source] A prospective study of patients absconding from a general hospital psychiatry unit in a developing countryJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 6 2008N. KHISTY Characteristics of patients absconding from an open psychiatry ward in a developing country may be different from both those in developed countries and a mental hospital setting. The aim of this paper is to study the incidence and characteristics of patients absconding from an open psychiatric ward in a general hospital-based psychiatric unit in India. We studied patients consecutively admitted to an open psychiatric ward over a 2-month period. We compared those who absconded with those who did not. Out of 231 patients admitted, 33 absconded. Among those who absconded, 15 had bipolar disorder, 11 had schizophrenia and five had substance-related disorders. Nine had indicated their intention to do so at admission. Ten patients had absconded by the second day. The treatment cost was the likely influencing factor for seven patients who absconded after deemed fit for discharge on clinical grounds. Only 10 patients were readmitted to the hospital within 2 weeks of absconding. The risk of absconding is highest in the early days following. Absconding patients did not differ significantly from others in many socio-demographic and clinical features. Treatment costs are an important consideration in India. [source] Frequency of Seborrheic Keratosis Biopsies in the United States: A Benchmark of Skin Lesion Care Quality and Cost EffectivenessDERMATOLOGIC SURGERY, Issue 8 2003Maria I. Duque MD Background. Most seborrheic keratoses may be readily clinically differentiated from skin cancer, but occasional lesions resemble atypical melanocytic neoplasms. Objective. To evaluate the frequency, cost, and intensity of procedures performed that result in the removal and histopathologic evaluation of seborrheic keratoses. Methods. Episodes of surgical removal of lesions that were identified as seborrheic keratoses by histologic identification were determined using Medicare Current Beneficiary Survey data from 1998 to 1999. These episodes were defined by a histopathology procedure code that is associated with a diagnosis code for seborrheic keratosis. We then identified what procedure(s) generated the histopathology specimen. Biopsy and shave procedures were considered "low intensity," whereas excision and repair procedures were considered "high intensity." Results. Dermatologists managed 85% of all episodes of seborrheic keratoses. Dermatologists managed 89% of seborrheic keratosis episodes using low-intensity procedures compared with 51% by other specialties. For nondermatologists, 46% of the treatment cost ($9 million) to Medicare was generated from high-intensity management compared with 15% by dermatologists ($6 million). Conclusion. There is a significant difference in the management of suspicious pigmented lesions between dermatologists and other specialists. This affects both the cost and quality of care. [source] Cost-effectiveness of extended buprenorphine,naloxone treatment for opioid-dependent youth: data from a randomized trialADDICTION, Issue 9 2010Daniel Polsky ABSTRACT Aims The objective is to estimate cost, net social cost and cost-effectiveness in a clinical trial of extended buprenorphine,naloxone (BUP) treatment versus brief detoxification treatment in opioid-dependent youth. Design Economic evaluation of a clinical trial conducted at six community out-patient treatment programs from July 2003 to December 2006, who were randomized to 12 weeks of BUP or a 14-day taper (DETOX). BUP patients were prescribed up to 24 mg per day for 9 weeks and then tapered to zero at the end of week 12. DETOX patients were prescribed up to 14 mg per day and then tapered to zero on day 14. All were offered twice-weekly drug counseling. Participants 152 patients aged 15,21 years. Measurements Data were collected prospectively during the 12-week treatment and at follow-up interviews at months 6, 9 and 12. Findings The 12-week out-patient study treatment cost was $1514 (P < 0.001) higher for BUP relative to DETOX. One-year total direct medical cost was only $83 higher for BUP (P = 0.97). The cost-effectiveness ratio of BUP relative to DETOX was $1376 in terms of 1-year direct medical cost per quality-adjusted life year (QALY) and $25 049 in terms of out-patient treatment program cost per QALY. The acceptability curve suggests that the cost-effectiveness ratio of BUP relative to DETOX has an 86% chance of being accepted as cost-effective for a threshold of $100 000 per QALY. Conclusions Extended BUP treatment relative to brief detoxification is cost effective in the US health-care system for the outpatient treatment of opioid-dependent youth. [source] An environmental evaluation of household garbage processorsELECTRONICS & COMMUNICATIONS IN JAPAN, Issue 7 2010Kazuhito Haruki Abstract The amount of garbage emitted from households and industries has been constantly increasing in recent years, and its treatment cost has been a financial burden to municipal governments in Japan. Many municipal governments recommend that their citizens purchase household garbage processors in order to reduce the volume of garbage transferred to and incinerated at their facilities. Actually, 1535 municipal governments subsidize their citizens' purchase of electrical garbage processors and/or compost containers. These subsidies should be assessed from various points of view, such as the costs and benefits to municipal governments and citizens, and also global or local environmental loads. An environmental planning department of a city office sent questionnaires to its residents to investigate the utilization of the subsidized devices. An environmental organization of citizens supported the department with design of the questionnaire form and analysis of the collected questionnaire data. In this paper, the processes of designing the form and analyzing the data are explained, and then an evaluation of the subsidy is presented. The conclusions are as follows: Electrical garbage processors would be beneficial for dealing with local environmental problems such as lack of a final landfill site. However, the processors will increase CO2 emissions unless their electrical consumption efficiency can be improved. © 2010 Wiley Periodicals, Inc. Electron Comm Jpn, 93(7): 42,52, 2010; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/ecj.10285 [source] Improved methods for carbon adsorption studies for water and wastewater treatmentENVIRONMENTAL PROGRESS & SUSTAINABLE ENERGY, Issue 2 2006Wei-chi Ying Abstract An improved method was developed to rank activated carbon in removing organic water pollutants. The simple and standardized evaluation method uses a set of four adsorptive capacity indicators: phenol, iodine, methylene blue, and tannic acid numbers; those four indicator compounds were selected because they cover the molecular size range of most organic water pollutants. An improved microcolumn rapid breakthrough (MCRB) test method was developed from the existing HPMC (high-pressure minicolumn) and RSSCT (rapid small-scale column test) methods by simplifying the experimental procedure and using readily available low-cost pump, sampler, piping, and fittings. This method can be practiced in an ordinary environmental laboratory to select the best carbon, to verify the treatment effectiveness, and to estimate the adsorption treatment cost based on the observed capacity utilization rate for carbon in the adsorber without the problems often encountered with using small and mini traditional columns. The benefits of the four-parameter carbon selection method and the MCRB method were demonstrated by adsorption isotherm and breakthrough data for several indicator compounds and organic water pollutants. These improved methods will enable efficient carbon adsorption studies necessary for more applications of carbon adsorption technology in water and wastewater treatment. © 2006 American Institute of Chemical Engineers Environ Prog, 2006 [source] Predictors of entering 24-h care for people with Alzheimer's disease: results from the LASER-AD studyINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 11 2009Stephanie Habermann Abstract Objectives Many studies have investigated predictors of people with dementia entering 24-h care but this is the first to consider a comprehensive range of carer and care recipient (CR) characteristics derived from a systematic review, in a longitudinal cohort study followed up for several years. Methods We interviewed 224 people with Alzheimer's disease (AD) and their carers, recruited to be representative in terms of their severity, sex and living situation as part of the LASER-AD study; and determined whether they entered 24-h care in the subsequent 4.5,years. We tested a comprehensive range of characteristics derived from a systematic review, and used Cox proportional hazard regression to determine whether they independently predicted entering 24-h care. Results The main independent predictors of shorter time to enter 24-h care were the patient being: more cognitively or functionally impaired (hazard ratio (HR),=,1.09; 95% CI,=,1.06,1.12) and (HR,=,1.04 95% CI,=,1.03,1.05), having a paid versus a family carer (HR,=,2.22; 95% CI,=,1.39,3.57), the carer being less educated (HR,=,1.43; 95% CI,=,1.12,1.83) and spending less hours caring (HR,=,1.01; 95% CI,=,1.00,1.01). Conclusion As having a family carer who spent more time caring (taking into account illness severity) delayed entry to 24-h care, future research should investigate how to enable carers to provide this. Other interventions to improve patients' impairment may not only have benefits for patients' health but also allow them to remain longer at home. This financial benefit could more than offset the treatment cost. Copyright © 2009 John Wiley & Sons, Ltd. [source] Evaluation of the impact of restructuring wound management practices in a community care provider in Niagara, CanadaINTERNATIONAL WOUND JOURNAL, Issue 2 2008Theresa Hurd Abstract The burden of chronic wounds is substantial, and this burden is set to increase as the population ages. The challenge for community health services is significant. Wound care is labour intensive, and demand for services is set to increase at a time when the availability of nursing resources is likely to be severely limited. In March 2005, the Niagara community health care provider implemented a radical reorganisation of wound management practices designed to ensure that available resources, particularly nurse time, were being used in the most efficient way. An evaluation of the impact of the reorganisation has shown improvements in clinical practice and better patient outcomes. The use of traditional wound care products reduced from 75% in 2005 to 20% in 2007 in line with best practice recommendations, and frequency of daily dressing changes reduced from 48% in 2005 to 15% in 2007. In a comparison of patients treated in 2005 and 2006, average time to healing was 51·5 weeks in 2005 compared with 20·9 weeks in 2006. Total treatment cost was lower in 2006 by $10 700 (75%) per patient. Overall, improvements in wound management practice led to a net saving of $3·8 million in the Niagara wound care budget. [source] Removal of heavy metals and cyanide from gold mine wastewaterJOURNAL OF CHEMICAL TECHNOLOGY & BIOTECHNOLOGY, Issue 5 2010Mike A. Acheampong Abstract This paper reviews the technology and biotechnology to remove heavy metals (such as copper, arsenic, lead and zinc) and cyanide from contaminated wastewater. The paper places special emphasis on gold mine wastewater and the use of low cost materials as sorbent. Various biological as well as physicochemical treatment processes are discussed and compared on the basis of costs, energy requirement, removal efficiency, limitations and advantages. Sorption using natural plant materials, industrial and agricultural waste has been demonstrated to have the potential to replace conventional methods for the removal of heavy metals because of its cost effectiveness, efficiency and the local availability of these materials as biosorbent. The parameters affecting sorption, such as initial ion concentration, pH, sorbent dosage, particle size and temperature, are discussed. The overall treatment cost of metal and cyanide contaminated wastewater depends on the process employed and the local conditions. In general, technical applicability, cost-effectiveness and plant simplicity are the key factors in selecting the most suitable treatment method. Copyright © 2010 Society of Chemical Industry [source] A property-based optimization of direct recycle networks and wastewater treatment processesAICHE JOURNAL, Issue 9 2009José María Ponce-Ortega Abstract This article presents a mathematical programming approach to optimize direct recycle-reuse networks together with wastewater treatment processes in order to satisfy a given set of environmental regulations. A disjunctive programming formulation is developed to optimize the recycle/reuse of process streams to units and the performance of wastewater treatment units. In addition to composition-based constraints, the formulation also incorporates in-plant property constraints as well as properties impacting the environment toxicity, ThOD, pH, color, and odor. The MINLP model is used to minimize the total annual cost of the system, which includes the cost for the fresh sources, the piping cost for the process integration and the waste stream treatment cost. An example problem is used to show the application of the proposed model. The results show that the simultaneous optimization of a recycle network and waste treatment process yields significant savings with respect to a commonly-used sequential optimization strategy. © 2009 American Institute of Chemical Engineers AIChE J, 2009 [source] The comparison of outcome and cost of three protocols for childhood non-high risk acute lymphoblastic leukemia in ChinaPEDIATRIC BLOOD & CANCER, Issue 2 2008Xue-Qun Luo MD Abstract Objective To compare the outcome and treatment cost of three protocols for childhood non-high risk acute lymphoblastic leukemia (ALL), and evaluate the feasibility of less intensive treatment protocol for low income families. Methods Two hundred forty-three children were newly diagnosed ALL in a university hospital from May 1999 to August 2006. Three protocols were offered to the patients: China-98 protocol, or modified ALLIC BFM2002 protocol, or an in-house Reduced Intensity Protocol (or also known as Economic Protocol). Results Among 243 patients, 19 abandoned treatment, 3 transferred to other hospitals, 48 were high-risk and were treated with the high risk protocol, and 4 had mature B-ALL. A total of 169 cases were enrolled on non-high risk protocols: 46 treated on China-98 protocol, 73 on modified ALLIC BFM2002 and 50 from low income families on Economic Protocol. The event-free survival (EFS) at 4 years was 80.4% (95%CI, 68.8,92.2%), 83.5% (95%CI, 73.5,93.5%), and 72.8% (95%CI, 59.3,86.3%) for China-98 protocol, modified ALLIC BFM2002, and Economic Protocol respectively. The hospitalization costs (range and median) were significantly different between protocols: US$ 8,700,25,500 (12,500), US$ 6,900,16,400 (9,900), US$ 3,100,6,800 (4,300) for China-98 protocol, modified ALLIC BFM2002, and Economic Protocol respectively. Conclusion This report from China has systematically reviewed the outcome and costs of protocols for ALL having different dose intensity. The reduced intensity protocol appears to achieve reasonable EFS (72.8% at 4 years) for non-high risk ALL at a much lower cost. This is especially important for low income families in developing countries. Pediatr Blood Cancer 2008;51:204,209. © 2008 Wiley-Liss, Inc. [source] The development of artemisinin resistance in malaria: reasons and solutionsPHYTOTHERAPY RESEARCH, Issue 7 2010Cosima Chrubasik Abstract Despite world-wide efforts in fighting malaria, this mosquito-borne infectious disease is a huge burden for the population, especially in tropical and subtropical areas. The WHO recommends artemisinin-based combination therapy for the treatment of uncomplicated Plasmodium falciparum malaria. However, artemisinin resistance cannot now be ignored. Factors affecting the development of artemisinin resistance include uncontrolled use of artemisinin-based combination therapy (ACT), mobile populations and migrants, artemisinin monotherapy, the use of subtherapeutic levels of artesiminin, substandard and counterfeit drugs, high treatment cost, and co-use of artemisinin derivates as prophylactic agents. Promising herbal alternatives are already in the pipeline, but the only long-term solution for eradicating malaria would be the development of a successful vaccination. Copyright © 2010 John Wiley & Sons, Ltd. [source] Clomiphene Citrate and Testosterone Gel Replacement Therapy for Male Hypogonadism: Efficacy and Treatment CostTHE JOURNAL OF SEXUAL MEDICINE, Issue 1pt1 2010Frederick Taylor MD ABSTRACT Introduction., The efficacy of oral clomiphene citrate (CC) in the treatment of male hypogonadism and male infertility (MI) with low serum testosterone and normal gonadotropin levels has been reported. Aim., The aim of this article is to evaluate CC and testosterone gel replacement therapy (TGRT) with regard to biochemical and clinical efficacy and cost. Main Outcome Measures., The main outcome measures were change in serum testosterone with CC and TGRT therapy, and change in the androgen deficiency in aging male (ADAM) questionnaire scores with CC therapy. Methods., Men receiving CC or TGRT with either Androgel® 1% or Testim® 1% for hypogonadism (defined as testosterone < 300 ng/mL) or MI were included. Serum values were collected 1,2 months after treatment initiation and semi-annually thereafter. Retrospective data collection was performed via chart review. Subjective follow up of patients receiving CC was performed via telephone interview using the ADAM questionnaire. Results., A hundred and four men (65 CC and 39 TGRT) were identified who began CC (50 mg every other day) or TGRT (5 g). Average age (years) was 42(CC) vs. 57 (TGRT). Average follow up was 23 months (CC, range 8,40 months) vs. 46 months (TGRT, range 6,149 months). Average posttreatment testosterone was 573 ng/dL in the CC group and 553 ng/dL in the TGRT group (P value < 0.001). The monthly cost of Testim® 1% (5 gm daily) is $270, Androgel® 1% (5 gm daily) is $265, and CC (50 mg every other day) is $83. Among CC patients, the average pretreatment ADAM score was 4.9 vs. 2.1 at follow up (P < 0.05). Average pretreatment ADAM sexual function domain score was 0.76 vs. 0.23 at follow up (P < 0.05). There were no adverse events reported. Conclusion., CC represents a treatment option for men with hypogonadism, demonstrating biochemical and clinical efficacy with few side effects and lower cost as compared with TGRT. Taylor F, and Levine L. Clomiphene citrate and testosterone gel replacement therapy for male hypogonadism: Efficacy and treatment cost. J Sex Med 2010;7:269,276. [source] Cancer treatment cost in the United States,,CANCER, Issue 14 2010Has the burden shifted over time? Abstract BACKGROUND: There has not been a comprehensive analysis of how aggregate cancer costs have changed over time. The authors present 1) updated estimates of the prevalence and total cost of cancer for select payers and how these have changed over the past 2 decades; and 2) for each payer, the distribution of payments by type of service over time to assess whether there have been shifts in cancer treatment settings. METHODS: Pooled data from the 2001 through 2005 Medical Expenditure Panel Survey and the 1987 National Medical Care Expenditure Survey were used for the analysis. The authors used an econometric approach to estimate cancer-attributable medical expenditures by payer and type of service. RESULTS: In 1987, the total medical cost of cancer (in 2007 US dollars) was $24.7 billion. Private payers financed the largest share of the total (42%), followed by Medicare (33%), out of pocket (17%), other public (7%), and Medicaid (1%). Between 1987 and the 2001 to 2005 period, the total medical cost of cancer increased to $48.1 billion. In 2001 to 2005, the shares of cancer costs were: private insurance (50%), Medicare (34%), out of pocket (8%), other public (5%), and Medicaid (3%). The share of total cancer costs that resulted from inpatient admissions fell from 64.4% in 1987 to 27.5% in 2001 to 2005. CONCLUSIONS: The authors identified 3 trends in the total costs of cancer: 1) the medical costs of cancer have nearly doubled; 2) cancer costs have shifted away from the inpatient setting; and 3) the share of these costs paid for by private insurance and Medicaid have increased. Cancer 2010. Published 2010 by American Cancer Society. [source] Immediate Provisional for Single-Tooth Implant Replacement with Brånemark System: Preliminary ReportCLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 2 2001Edward Hui MDS, FDSRCS, FRCDC Abstract: Background: The success of osseointegrated implants ad modum Brånemark for single-tooth restorations is documented. Future developments should aim at improving the benefits to patients by decreasing treatment time, minimizing surgical stages, and maximizing esthetic outcomes. Using knowledge from studies of immediate implant placement, one-stage, immediate loading protocols, the authors developed the immediate provisional. Purpose: The purpose of this study was to develop a protocol to provide an immediate solution for restoring a single missing tooth in the esthetic zone. The protocol should be simple, predictable, cost effective, and allow the use of other techniques to improve esthetic outcome. Materials and Method: This prospective clinical study included 24 patients treated from August 1999 to October 2000. Single-tooth implant replacement was done according to immediate provisional protocol. Thirteen of the 24 patients had immediate implant placement after tooth extraction. All implants were placed in the esthetic zone. During surgery, emphasis was placed on obtaining primary stability by achieving bicortical anchorage and maximum insertion torque of at least 40 Ncm. CeraOne (Nobel Biocare) abutments were used, and provisional crowns were fabricated immediately before wound closure. The occlusion was protected by adjacent teeth. Results: Within the follow-up period of between 1 month and 15 months, all fixtures in the 24 patients were stable. Crestal bone loss greater than one thread-width was not detected. The esthetic result was considered satisfactory by all patients. Conclusions: The implant placement and restoration protocol used in this study showed promising initial results for both the immediate implant and healed extraction site groups. The desirable goals of patient satisfaction, excellent esthetic outcomes, and no increase in treatment cost were achieved in this protocol. Further studies to elucidate the potential of the immediate provisional protocol are justified. [source] Epidemiology and natural course of social fears and social phobia,ACTA PSYCHIATRICA SCANDINAVICA, Issue 2003H.-U. Wittchen Objective: To summarize epidemiological studies providing data on prevalence, incidence, comorbidity, natural course, risk factors and consequences of social phobia (SP). Method: Data from cross-sectional studies and prospective longitudinal studies in particular are considered. Results: These studies portray SP as a frequent mental disorder, which begins typically in early adolescence, and is highly comorbid with other anxiety disorders, as well as secondary depression and substance abuse disorders. Several possible risk factors have already been identified for the onset and unfavorable course of SP; some of them have been tested in prospective longitudinal studies. SP is a chronic disorder when compared with other mental disorders and when subclinical symptomatic levels are considered. Impairment caused by SP is considerable and increases over a patient's life span. The negative impact of SP is not only reflected in subjective well-being and reduced quality of life but also in social role functioning, and it impacts negatively on career progression. Conclusion: Prospective longitudinal studies in representative samples drawn from the general population provide information that allows the overall direct and indirect costs of the disorder (treatment costs, disability, social welfare) to be determined, and enables an improvement in long-term care strategies as well as preventive efforts to be established. [source] Mortality among opiate users: opioid maintenance therapy, age and causes of deathADDICTION, Issue 8 2009Thomas Clausen ABSTRACT Aims This study investigates how age of opioid users is related to causes of death prior to, during and after opioid maintenance treatment (OMT), and estimates risks of death from various causes in relation to age. Design, setting and participants Data on all opiate dependents in Norway (1997,2003) who applied for and were accepted for OMT (n = 3789) were cross-linked with the Norwegian death register. The total observation time was 10 934 person-years. Findings A total of 213 deaths was recorded. Of these, 73% were subject to autopsy, and causes of death were known for 208 cases: the overall death rate was 1.9%. Deaths were due to drug overdose (54%), somatic (32%) and traumatic causes (14%). Overdose deaths among all age groups were reduced during OMT but age had a differential effect upon risk when out of treatment. Younger opioid users were at greater risk of overdose before entering treatment; older users were at greater risk after leaving treatment. Older OMT patients were at higher risk of both somatic and traumatic deaths, and deaths during OMT were most likely to be due to somatic causes. Conclusions The high rates of overdose prior to and after treatment emphasize the need to provide rapid access to OMT, to retain patients in treatment and to re-enrol patients. The high prevalence among older patients of deaths due to somatic causes has implications for screening, treatment and referral, and may also lead to increased treatment costs. [source] Comparison of costs and utilization among buprenorphine and methadone patientsADDICTION, Issue 6 2009Paul G. Barnett ABSTRACT Aims Buprenorphine is an effective alternative to methadone for treatment of opioid dependence, but economic concerns represent a barrier to implementation. The economic impacts of buprenorphine adoption by the US Veterans Health Administration (VHA) were examined. Design Prescriptions of buprenorphine, methadone treatment visits, health-care utilization and cost, and diagnostic data were obtained for 2005. Findings VHA dispensed buprenorphine to 606 patients and methadone to 8191 other patients during the study year. An analysis that controlled for age and diagnosis found that the mean cost of care for the 6 months after treatment initiation was $11 597 for buprenorphine and $14 921 for methadone (P < 0.001). Cost was not significantly different in subsequent months. The first 6 months of buprenorphine treatment included an average of 66 ambulatory care visits, significantly fewer than the 137 visits in methadone treatment (P < 0.001). In subsequent months, buprenorphine patients had 8.4 visits, significantly fewer than the 21.0 visits of methadone patients (P < 0.001). Compared to new methadone episodes, new buprenorphine episodes had 0.634 times the risk of ending [95% confidence interval 0.547,0.736]. Implementation of buprenorphine treatment was not associated with an influx of new opioid-dependent patients. Conclusion Despite the higher cost of medication, buprenorphine treatment was no more expensive than methadone treatment. VHA methadone treatment costs were higher than reported by other providers. Although new buprenorphine treatment episodes lasted longer than new methadone episodes, buprenorphine is recommended for more adherent patients. [source] Optimization of a single-effect evaporation system to effectively utilize thermal energyENVIRONMENTAL PROGRESS & SUSTAINABLE ENERGY, Issue 2 2009Raafat Alnaizy Abstract Wastewater treatment facilities at Emirates Gold in Dubai seek to improve the steam economy of the existing single-effect with recirculation and vapor-compression evaporation process. Maximizing steam economy is important as it impacts treatment costs. There are two main approaches for improving steam economy in evaporators. One is to use a multiple-effect evaporator; the other is to use a mechanical vapor recompression. Multiple-effect evaporators were rejected because of higher capital and power cost. One of the suggestions that were made towards improving the steam economy was to recover heat from the steam condensate. A modified process flow diagram was proposed and investigated. The modified process was simulated using SuperPro Designer and Hysys with complete material and energy balance computation. The modified process increased the total water evaporation capacity and gained 40% better steam economy of the process. Another advantage was an increase in the amount of water reused, which is both economical and environmentally friendly. © 2008 American Institute of Chemical Engineers Environ Prog, 2009 [source] Prophylactic versus on-demand treatment strategies for severe haemophilia: a comparison of costs and long-term outcomeHAEMOPHILIA, Issue 6 2002K. Fischer Summary., A multicentre study was performed to compare clotting factor use and outcome between on-demand and prophylactic treatment strategies for patients with severe haemophilia. Data on treatment and outcome of 49 Dutch patients with severe haemophilia, born 1970,80, primarily treated with prophylaxis, were compared with those of 106 French patients, who were primarily treated on demand. Dutch patients received intermediate dose prophylaxis, for a median duration of 12.7 years. Patients primarily treated with prophylaxis had fewer joint bleeds per year (median 2.8 vs. 11.5), a higher proportion of patients without joint bleeds (29% vs. 9%), lower clinical scores (median 2.0 vs. 8.0), and less arthropathy as measured by the Pettersson score (median 7 points vs. 16 points). Mean annual clotting factor use was equal at 1488 ± 783 IU kg,1 year,1 (mean ± standard deviation) for patients primarily treated with prophylaxis and 1612 ± 1442 IU kg,1 year,1 for patients primarily treated on demand. These findings suggest that, compared with a primarily on-demand treatment strategy, a primarily prophylactic treatment strategy leads to better outcome at equal treatment costs in young adults with severe haemophilia. [source] The analysis of efficiency among a small number of organisations: How inferences can be improved by exploiting patient-level dataHEALTH ECONOMICS, Issue 6 2008Kim Rose Olsen Abstract Those responsible for monitoring and managing the performance of health-care organisations face the common problem that the relationship between observed performance and effort is difficult to establish. A solution is to compare the performance of multiple organisations, but this requires a sufficient number of comparators. Faced with a small sample, it may be possible to exploit other information sources. Multilevel regression models are applied to analyse the performance of six Danish vascular departments in 2004 using a patient-level data set. We find that treatment costs are higher for smokers, older patients, patients with cerebrovascular and pulmonal diseases and for those subject to acute hospitalisation and with longer lengths of stay. Costs are lower for patients who are having follow-up surgery and for patients who receive some form of home care, suggesting that there may be some substitution of care input between vascular departments and other care providers. We estimate the relative efficiency of each department. The construction of confidence intervals allows the six departments to be sorted into two groups containing the least and most efficient departments. Conclusions about relative efficiency are robust to model specification, choice of estimator and hold at the 95% confidence level. Copyright © 2007 John Wiley & Sons, Ltd. [source] Modality options for renal replacement therapy: The integrated care concept revisitedHEMODIALYSIS INTERNATIONAL, Issue 2 2006Gihad NESRALLAH Abstract As the End-stage renal disease population continues to grow, innovative strategies that optimize patient outcomes while capitalizing on the relative strengths of the existing modalities must be sought. Renal transplantation remains the preferred form of renal replacement therapy, but given the limited supply of donor organs, dialytic therapies will continue to constitute a large part of the modality mix. Matching patients to the most suitable modalities requires that a number of factors be considered. These include the patient's autonomy, medical and social factors, system-related issues, patient outcomes, and finances. While peritoneal dialysis and hemodialysis (HD) have traditionally been viewed as competing modalities, we propose that they, along with home and frequent HD regimens, may be used in a complementary manner, which is based on current evidence, and may provide optimal outcomes while containing treatment costs. In this review, we attempt to synthesize the current literature describing the various issues that affect modality selection, and offer an approach to achieving a balance between these many competing factors. [source] Cost-effectiveness of HIV nonoccupational post-exposure prophylaxis in AustraliaHIV MEDICINE, Issue 4 2009D Guinot Objective The aim of the study was to determine the cost-effectiveness of HIV nonoccupational post-exposure prophylaxis (NPEP) in Australia. Methods A retrospective cost analysis of a population-based observational cohort of 1601 participants eligible for NPEP in Australia between 1998 and 2004 was carried out. We modelled NPEP treatment costs and combined them with effectiveness outcomes to calculate the cost per seroconversion avoided. We estimated the cost-utility of the programme, and sensitivity and threshold analysis was performed on key variables. Results The average NPEP cost per patient was A$1616, of which A$848 (52%) was for drugs, A$331 (21%) for consultations, A$225 (14%) for pathology and A$212 (13%) for other costs. The cost per seroconversion avoided in the cohort was A$1 647 476 in our base case analysis, and A$512 410 when transmission rates were set at their maximal values. The cost per quality-adjusted life-year (QALY) was between A$40 673 and A$176 772, depending on the risks of HIV transmission assumed. Conclusions In our base case, NPEP was not a cost-effective intervention compared with the widely accepted Australian threshold of A$50 000 per QALY. It was only cost-effective after receptive unprotected anal intercourse exposure to an HIV-positive source. Although NPEP was a relatively well-targeted intervention in Australia, its cost-effectiveness could be improved by further targeting high-risk exposures. [source] The economic consequences of noncompliance in cardiovascular disease and related conditions: a literature reviewINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 2 2008N. Muszbek Summary Objectives:, To review studies on the cost consequences of compliance and/or persistence in cardiovascular disease (CVD) and related conditions (hypertension, dyslipidaemia, diabetes and heart failure) published since 1995, and to evaluate the effects of noncompliance on healthcare expenditure and the cost-effectiveness of pharmaceutical interventions. Methods:, English language papers published between January 1995 and February 2007 that examined compliance/persistence with medication for CVD or related conditions, provided an economic evaluation of pharmacological interventions or cost analysis, and quantified the cost consequences of noncompliance, were identified through database searches. The cost consequences of noncompliance were compared across studies descriptively. Results:, Of the 23 studies identified, 10 focused on hypertension, seven on diabetes, one on dyslipidaemia, one on coronary heart disease, one on heart failure and three covered multiple diseases. In studies assessing drug costs only, increased compliance/persistence led to increased drug costs. However, increased compliance/persistence increased the effectiveness of treatment, leading to a decrease in medical events and non-drug costs. This offset the higher drug costs, leading to savings in overall treatment costs. In studies evaluating the effect of compliance/persistence on the cost-effectiveness of pharmacological interventions, increased compliance/persistence appeared to reduce cost-effectiveness ratios, but the extent of this effect was not quantified. Conclusions:, Noncompliance with cardiovascular and antidiabetic medication is a significant problem. Increased compliance/persistence leads to increased drug costs, but these are offset by reduced non-drug costs, leading to overall cost savings. The effect of noncompliance on the cost-effectiveness of pharmacological interventions is inconclusive and further research is needed to resolve the issue. [source] Update on treatment guidelines for acute bacterial sinusitisINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 2 2005J. M. Klossek Summary Acute bacterial sinusitis (ABS) is a common complication of viral upper respiratory tract infections and represents a considerable social burden both in terms of diminished quality of life for the patient and the economic implications of decreased productivity and treatment costs. Several national health authorities have developed guidelines for the management of ABS, which aim to promote rational selection of anti-bacterial therapy to optimise clinical outcomes while minimising the potential for selection of anti-bacterial resistance as a result of inappropriate anti-bacterial usage. This article provides an overview of current guidelines, with particular focus on the clinical significance of variations in treatment recommendations and new treatment options, such as the ketolide telithromycin, which was recently added to a number of national treatment guidelines. [source] Therapeutic and economic implications of traumatic dental injuries in Denmark: an estimate based on 7549 patients treated at a major trauma centreINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 4 2001Mette Kit Borum Aim. To analyse the type and extent of injuries presented by patients seeking treatment for traumatic dental injuries at a major trauma centre. Furthermore, to analyse acute and subsequent treatment demands and treatment costs. Methods. A therapeutic and economic analysis was performed of 7549 patients treated for traumatic dental injuries in a major trauma centre located at the University Hospital in Copenhagen, Denmark. Cases were divided into uncomplicated (concussion, subluxation, enamel and enamel-dentine fractures) and complicated cases (crown fractures with exposed pulps and crown-root fractures, luxation injuries with displacement of the tooth and bone fractures). Results. Primary tooth injuries were found in 2874 patients, involving 5443 teeth, among which 62·8% had complicated injuries. Permanent tooth injuries were found in 4525 patients, involving 10673 teeth, among which 40·4% had complicated injuries. The cost of treatment (including acute trauma service, follow-up and subsequent restoration) was estimated to be 0·6,1 mill USD a year for the patients treated in this trauma centre. If this figure is transferred to the estimated trauma population in Denmark, a yearly cost of traumatic dental injuries appears to range from 2 to 5 mill USD per 1 mill inhabitants per year according to the treatment scenario. Conclusion. Thus, treatment of traumatic dental injuries comprises an expensive part of the health services in Denmark. [source] Costs and Insurance Coverage Associated with Permanent Mechanical Cardiac Assist/Replacement Devices in the United StatesJOURNAL OF CARDIAC SURGERY, Issue 4 2001Roger W. Evans Ph.D. Each year over 50,000 persons in the United States could potentially benefit from some form of permanent cardiac replacement or assistance. Approximately 7000 of these persons get on the waiting list for a transplant, and 2300 are transplanted. About 2000 patints are reportedly exposed to a mechanical cardiac assist device, most often as a bridge to transplant. The majority of persons who might benefit from cardiac replacement are never referred for treatment and, thus, the number of deaths on the waiting list is a misleading indicator of access to transplantation and overall patient mortality. The total economic burden associated with coronary artery disease and congestive heart failure now exceeds $140 billion each year, with approximately $700 million directly spent on heart transplant procedures alone. If a viable total artificial heart is devised to replace a failed heart, or a ventriular assist system to permanently assist a failing heart, direct aggregate expenditures alone are likely to be somewhere between $5.4 and $24.0 billion annually. Based on individual patient care costs, as well as aggregate national expenditures, insurers will be reluctant to pay for the permanent use of such devices, even though cost is reportedly not a consideration in coverage decisions. Today, medical benefits and added value are concepts that will shape the coverage determination process, as will increasingly liberal policies regarding payment for treatment costs in relationship to clinical trials. Nonetheless, resource allocation and rationing decisions loom large as strange "characters at play" on an international economic "stage," while being "directed" by worldwide health care needs. [source] | ||||||||||||||||||||||||||||||||||