The prevalence of TRD among patients diagnosed with depression varied from 13% (Denmark) to 55% (United Kingdom). Sixteen studies indicated a positive association between TRD and inpatient and outpatient visits. Annual health care costs for patients with TRD were much higher than for patients with other forms of depression. Average annual per person costs varied across studies from USD 3,075 (Brazil) to USD 24,543 (United States). Overall, patients with TRD incur significant annual healthcare expenditure. There was limited evidence on incidence (n=3), mortality (n=1) and indirect costs (n=4) of TRD. Additionally, the study results are limited by inconsistencies in definitions of TRD across studies. Conclusions: The burden imposed by TRD on patients, payers, and society is considerable. However, due to limited availability of evidence, further studies are required to fully assess the overall burden of this disease.
Objectives: Cardiovascular (CV) events are a leading cause of premature mortality and extended morbidity in Canada. While the direct costs of the burden of cardiovascular disease (CVD) are well-studied, the indirect costs due to lost productivity, caregiver burden, disability, and mortality are not as well understood. In order to characterize these costs, we conducted a literature review of the indirect costs of CVD in Canada. MethOds: A targeted literature review of the Ovid MEDLINE, Wiley's Cochrane Library, HEED, and Web of Science databases over the years 2000-2015 was conducted using MeSH terms and other keywords. Studies published in English, presenting indirect costs associated with CVD or CVD-related conditions in Canada were included. Costs were inflated to $2015 CDN dollars. Results: Out of 122 records identified by the literature search, 104 citations were excluded based on abstract screening. Full-text review of the remaining 18 studies resulted in the exclusion of 11 studies, while 7 studies were included for analysis. These 7 studies provided indirect costs associated with stroke (n= 3), myocardial infarction (n= 2), heart failure (n= 2), angina (n= 2) and coronary artery disease (n= 1). Most studies were prospective studies (n= 5) and estimated indirect costs in terms of productivity losses using the human capital method. Indirect costs ranged from $3 (heart failure) to $22,270 (stroke) per patient. cOnclusiOns: There are very few studies that have evaluated the indirect cost of CVD in Canada. In addition, the magnitude of the cost estimates varied widely between studies based on the patient population, availability of data, and calculation method selected.
Objectives: Colorado has the lowest rate of measles vaccination in the entire country, partially due to the ease of obtaining non-medical exemptions. Our primary objective was to determine the magnitude and cost of a measles outbreak in Denver at current vaccination coverage levels. We then simulated the effect of changing the Colorado non-medical exemption complexity to medium or difficult. MethOds: An agent based transmission model simulated the transmission of the measles virus in Denver following the introduction of a measles case. We modeled public health response, including contact tracing and quarantine of cases. Model outputs included the number of secondary cases, hospitalizations and deaths. Four vaccination scenarios were modeled: Colorado vaccination rate, national vaccination rate, Colorado vaccination rate under medium exemption regulations, and Colorado vaccination rate under difficult exemption regulations. Results: At the Colorado vaccination rate, seven secondary cases followed the introduction of an index case, two of which required hospitalization. This outbreak ranged in cost from $111,048-$338,304, which is equivalent to the purchase of 5,580-17,000 measles vaccines. This could increase 2-dose vaccination coverage in Denver by 1.3%. If Colorado increased their difficulty in obtaining non-medical exemptions, the number of secondary cases reduced by 86%, alleviating costs related to public health interventions and the negative consequences of a measles outbreak. At the national vaccination level, no other individuals became infected due to herd immunity. cOnclusiOns: Herd immunity is not established at the Colorado vaccination rate and thus an outbreak is likely following the introduction of an index case. There is an inverse relationship between non-medical exemption complexity and exemption rate. Increasing vaccination coverage by as little as 3.1% (from easy to medium complexity) would reduce the likelihood and magnitude of an outbreak. Adding a required education component or a written statement of objection would be a prudent public health nudge toward measles herd immunity.
synchronization impact on total healthcare cost, three medication adherence improvements from 3 independent studies with different program settings were applied in the model. This model can be customized by entering alternative population sizes, medication synchronization eligible rates, enrollment rates, and cost saving projection year. The primary outcome measure reported net healthcare cost savings per member per year. Results: In a group of 100,000 commercial and Medicaid beneficiaries, if 2.5% enrolled in a medication synchronization program and they improved medication adherence an average of 6.8%, the net healthcare cost savings per member per year is $11.60. If they achieved an 8.4% medication adherence improvement, the net healthcare cost savings per member per year is $14.55; if they achieved a 15.6% medication adherence improvement, the net healthcare cost savings per member per year increases to $27.84. Conclusions: Economic modeling demonstrated that medication synchronization programs can result in substantial healthcare cost savings by improving medication adherence. Proper planning with cost models can help policy makers understand the value of medication synchronization and develop strategies to implement and improve its impact. Legislation, especially state-level, is needed to facilitate programs that help patients synchronize their medications.
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