This paper reports the results of a 'cost-of-illness' study of the socio-economic costs of back pain in the UK. It estimates the direct health care cost of back pain in 1998 to be pound1632 million. Approximately 35% of this cost relates to services provided in the private sector and thus is most likely paid for directly by patients and their families. With respect to the distribution of cost across different providers, 37% relates to care provided by physiotherapists and allied specialists, 31% is incurred in the hospital sector, 14% relates to primary care, 7% to medication, 6% to community care and 5% to radiology and imaging used for investigation purposes. However, the direct cost of back pain is insignificant compared to the cost of informal care and the production losses related to it, which total pound10668 million. Overall, back pain is one of the most costly conditions for which an economic analysis has been carried out in the UK and this is in line with findings in other countries. Further research is needed to establish the cost-effectiveness of alternative back pain treatments, so as to minimise cost and maximise the health benefit from the resources used in this area.
AimsCohorts of millions of people's health records, whole genome sequencing, imaging, sensor, societal and publicly available data present a rapidly expanding digital trace of health. We aimed to critically review, for the first time, the challenges and potential of big data across early and late stages of translational cardiovascular disease research.Methods and resultsWe sought exemplars based on literature reviews and expertise across the BigData@Heart Consortium. We identified formidable challenges including: data quality, knowing what data exist, the legal and ethical framework for their use, data sharing, building and maintaining public trust, developing standards for defining disease, developing tools for scalable, replicable science and equipping the clinical and scientific work force with new inter-disciplinary skills. Opportunities claimed for big health record data include: richer profiles of health and disease from birth to death and from the molecular to the societal scale; accelerated understanding of disease causation and progression, discovery of new mechanisms and treatment-relevant disease sub-phenotypes, understanding health and diseases in whole populations and whole health systems and returning actionable feedback loops to improve (and potentially disrupt) existing models of research and care, with greater efficiency. In early translational research we identified exemplars including: discovery of fundamental biological processes e.g. linking exome sequences to lifelong electronic health records (EHR) (e.g. human knockout experiments); drug development: genomic approaches to drug target validation; precision medicine: e.g. DNA integrated into hospital EHR for pre-emptive pharmacogenomics. In late translational research we identified exemplars including: learning health systems with outcome trials integrated into clinical care; citizen driven health with 24/7 multi-parameter patient monitoring to improve outcomes and population-based linkages of multiple EHR sources for higher resolution clinical epidemiology and public health.ConclusionHigh volumes of inherently diverse (‘big’) EHR data are beginning to disrupt the nature of cardiovascular research and care. Such big data have the potential to improve our understanding of disease causation and classification relevant for early translation and to contribute actionable analytics to improve health and healthcare.
Objective: To estimate the economic burden of coronary heart disease in the UK using both direct and indirect costs. Design and setting: A prevalence based approach was used to assess coronary heart disease related costs from the societal perspective. Patients: All UK residents in 1999 with coronary heart disease (ICD 9 codes 410-414 and ICD10 codes I20-I25). Main outcome measures: Direct health care costs were estimated from spending on prevention, accident and emergency care, hospital care, rehabilitation, and drug treatment. Direct non-health service costs were estimated from data on informal care. "Friction period" adjusted productivity costs were estimated using the human capital approach from lost earnings attributable to coronary heart disease related mortality and morbidity. The friction period is the period of employees' absence from work before the employer replaces them with other workers. Failure to adjust for this factor would overstate production loss. Results: Coronary heart disease cost £1.73 billion to the UK health care system in 1999: £2.42 billion in informal care and £2.91 billion in friction period adjusted productivity loss; 24.1% of production losses were attributable to mortality and 75.9% to morbidity. The total annual cost of all coronary heart disease related burdens was £7.06 billion, the highest of all diseases in the UK for which comparable analyses have been done. Conclusions: Coronary heart disease is a leading public health problem in the UK in terms of the economic burden from disease. Cost estimates would be substantially understated if informal care/productivity costs were excluded. C oronary heart disease, defined in this study as International classification of diseases ICD 9 codes 410-414 and ICD10 codes I20-I25 (ischaemic heart diseases), is the leading single cause of death in the UK and one of the most important causes of years of life lost before the age of 65. . At the age of 40, lifetime risk for developing coronary heart disease in the West is 50% in men and 33% in women. 3 In economics, a cost or burden of illness study estimates the resources consumed in disease prevention, detection, and treatment. This type of study provides a potentially useful decision making aid for setting priorities in health care research, and has been conducted for many diseases in the UK.4-18 Previous attempts to estimate the economic impact of coronary heart disease in the UK have focused only on cost items attributed to the health care system, the so called direct health care costs. [19][20][21][22] However, there are also substantial direct non-health service costs from the care of coronary heart disease patients provided by family members and friends, the so called "informal care" costs. The economy also suffers from productivity loss, because a high percentage of patients with coronary heart disease and the people who care for them would otherwise be in paid employment. The burden of productivity loss falls on employers as lost working days and on the government as incapacity benefi...
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