The aim of the article is to present the medium-term results of surgical treatment of Schatzker's IV, V, and VI tibial plateau fractures, in a retrospective study of 22 patients at a level-1 trauma center. Twenty-two of 34 patients with Schatzker's IV–VI fractures completed follow-up at a mean of 56 months (range: 7–103 months). Patients' mean age was 47.6 years (range: 18–76 years). Open reduction and internal fixation were performed in 16 patients, while external fixators were used in the remaining six patents. Patients were assessed radiologically for the presence of arthritis using the Kellgren–Lawrence scale. Functional outcomes were measured using the Lysholm's knee score, knee injury, and osteoarthritis outcome score (KOOS). Quality of life was also assessed postoperatively using the EuroQol-5D (EQ-5D) form and EQ-VAS (visual analogue scale) score. There were no postoperative infections and no fracture went on to nonunion. Absence of arthritic change was noted in only 6.3% of cases. The average KOOS score was 80 and the average Lysholm's score was 84.91. Regarding the postoperative quality of life, mobility was impaired in 45.5%, self-care in 27.3%, and usual activities in 36.3% of patients. Pain or discomfort was reported in 77.2% and anxiety or depression in 40.9% of cases. The mean VAS score was 77.8. Eighty percent of patients had returned to their previous activities at the time of last follow-up. Although complex tibial plateau fractures are associated with a high rate of complications and can have a severe impact on the injured knee, most patients had quite satisfactory results during their medium-term clinical evaluation, in our study. It is a Level IV case series study.
ObjectivesRespiratory infectious disease outbreaks pose a threat for loss of life, economic instability and social disruption. We conducted a systematic review of published econometric analyses to assess the direct and indirect costs of infectious respiratory disease outbreaks that occurred between 2003 and 2019.SettingRespiratory infectious disease outbreaks or public health preparedness measures or interventions responding to respiratory outbreaks in OECD countries (excluding South Korea and Japan) so as to assess studies relevant to the European context. The cost-effectiveness of interventions was assessed through a dominance ranking matrix approach. All cost data were adjusted to the 2017 Euro, with interventions compared with the null. We included data from 17 econometric studies.Primary and secondary outcome measuresDirect and indirect costs for disease and preparedness and/or response or cost-benefit and cost-utility were measured.ResultsOverall, the economic burden of infectious respiratory disease outbreaks was found to be significant to healthcare systems and society. Indirect costs were greater than direct costs mainly due to losses of productivity. With regard to non-pharmaceutical strategies, prehospitalisation screening and the use of protective masks were identified as both an effective strategy and cost-saving. Community contact reduction was effective but had ambiguous results for cost saving. School closure was an effective measure, but not cost-saving in the long term. Targeted antiviral prophylaxis was the most cost-saving and effective pharmaceutical intervention.ConclusionsOur cost analysis results provide evidence to policymakers on the cost-effectiveness of pharmaceutical and non-pharmaceutical intervention strategies which may be applied to mitigate or respond to infectious respiratory disease outbreaks.
Purpose: To estimate the net cost effect associated with the real-world practice of repeated use of designated single-use medical devices (SUDs) versus their proper single use in cataract surgery in Greece. Design: A cost-benefit analysis model was constructed in the form of a decision tree. Methods: A digital expert panel was assembled in order to estimate the probabilities of intraoperative and postoperative complications associated with single and repeated use of SUDs. Unit costs for the management of each complication were obtained from the official Greek bulletins. A Monte Carlo-type sensitivity analysis was performed to assess the robustness of the results. Results: Based on the probabilities of complications attained from the expert panel, repeated use of SUDs is associated with a higher chance of complications compared to single use, which results in higher cost of complication management. Under the healthcare sector perspective, the total expected cost per cataract surgery is 1,403.98€ (1,244.20€ the initial cost of cataract surgery plus 159.78€ the cost of adverse events) in the case of single use, while for repeated use the total cost is 1,486.29€ (1,146.86€ + 339.43€, respectively) and, thus, repeated use of SUDs in cataract surgery results in 82.31€ higher expected cost per patient compared to their single use. Moreover, the societal perspective analysis indicated even higher additional costs in the case of SUD reuse (108.24€). Conclusion: Repeated use of SUDs in cataract surgery is not appropriate, it jeopardizes patient safety and carries a legal liability for the reuser. The present study, which is the first to attach a monetary value to the common yet questionable practice of SUD reuse, shows that it is not cost beneficial. Therefore, it is expected that the results will have implications in policy formulations to improve the delivery of cataract healthcare.
Objective To classify, analyze, and compare published guidelines for economic evaluation within health technology assessment (HTA) in European countries and highlight differences and similarities. Methods We performed a literature review to identify published guidance for the conduct and assessment of economic evaluation studies that are undertaken within the context of HTA processes in European countries. Organizations and working groups were identified via the ISPOR, INAHTA, and EUnetHTA databases. Following the identification of official documents, we performed a qualitative content analysis to highlight discrepancies or common practices under the following categories: comparator, perspective on costs/benefits, time horizon, economic evaluation method, instrument used for utility measurement, outcome measure, source for efficacy, modeling, sensitivity analysis, discounting, and incremental cost-effectiveness ratio. Results A total of nineteen guidance documents were identified (in English) providing data for the analysis in nineteen countries. The comparative content analysis identified common practices in most countries regarding the approaches to the choice of comparator, source of data, the preferred economic evaluation method, the option for a lifetime analytical horizon, discounting, and the choice of key outcome measure—for which, most countries recommend the use of the EQ-5D instrument. Differences were mainly found in the choice of perspective, dealing with uncertainty and sensitivity analysis, the use of end points, and the required use of modeling. Conclusions The use of economic evaluation constitutes one of the key pillars of the HTA process in Europe. Although a methodological convergence has occurred during the last few years, notable differences still remain.
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