BackgroundDespite the considerable health impact of coeliac disease (CD), reliable estimates of the impact of diagnosis on health care use and costs are lacking.AimsTo quantify the volume, type and costs, in a United Kingdom primary care setting, of healthcare resources used by individuals diagnosed with CD up to ten years before and after diagnosis, and to estimate medical costs associated with CD.MethodsA cohort of 3,646 CD cases and a parallel cohort of 32,973 matched controls, extracted from the General Practice Research Database (GPRD) over the period 1987–2005 were used i) to evaluate the impact of diagnosis on the average resource use and costs of cases; ii) to assess direct healthcare costs due to CD by comparing average resource use and costs incurred by cases vs. controls.ResultsAverage annual healthcare costs per patient increased by £310 (95% CI £299, £320) after diagnosis. CD cases experienced higher healthcare costs than controls both before diagnosis (mean difference £91; 95% CI: £86, £97) and after diagnosis (mean difference £354; 95% CI: £347, £361). These differences were driven mainly by higher test and referral costs before diagnosis, and by increased prescription costs after diagnosis.ConclusionsThis study shows significant additional primary care costs associated with coeliac disease. It provides novel evidence that will assist researchers evaluating interventions in this area, and will challenge policymakers, clinicians, researchers and the public to develop strategies that maximise the health benefits of the resources associated with this disease.
Health system assessment (HSA) tools are often built around static health system building blocks, which lead to largely descriptive narrative and lack of linkages to health system outcomes. The development of a common framework that would also focus on performance outcomes is long overdue. We analysed the key HSA frameworks and tools based on them, with the purpose of identifying a common approach that would allow to link health system components to specific outcomes. The presentation will focus on using the health system functions as the basis of conducting the performance assessment. In a second step, the presentation will elaborate on the intermediate and final health system goals as part of the HSPA framework. It will explain their links to the four functions and thus, discuss their relevance for performance assessment.
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