Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 5 uppsatser.

Thesis (Ph. D.)--Case Western Reserve University, 2006. / [School of Medicine] Department of Epidemiology and Biostatistics. Includes bibliographical references. Available online via OhioLINK's ETD Center.

The objective of the dissertation is analysis of costs that are connected with acute myocardial infarction in the Znojmo Hospital. It is about the bill of costs of this diagnosis with the use of analysis "Cost of Illness". Cost of Illness is one of many kinds of analysis examining the costs of illnesses. At work, I have tried to capture all relevant costs of this diagnosis, especially the cost of diagnosis, therapy and hospitalization of patients with the diagnosis of acute myocardial infarction.

This thesis is devoted to Alzheimer's disease, which affects millions of people worldwide and the costs of this disease reaching almost $ 400 billion crowns. The first part is devoted to the definition of the disease, symptoms, symptoms and treatment. The second part focuses on the costs associated with this disease. Costs are identified and quantified by Cost of Illness analysis.

This thesis describes management of the patients with Alzheimer's disease. I elucidate the issues of Alzheimer's disease. I identify and quantify costs by Cost of Illness from the patient's perspective. I find the level of awareness of the nursing staff on Alzheimer's disease. In conclusion I evaluate results of research.

Cost-of-illness (COI) analysis was the first economic evaluation methodology used in the health field, and it aims to identify and quantify all of the costs incurred due to a particular illness. While cost-of-illness studies attract much interest from healthcare policy makers and public health advocates, inconsistencies in study methodologies and cost inventories have made cost-of-illness estimates difficult to interpret and compare, limiting their usefulness. The purpose of this thesis was to use a scoping review approach to systematically explore cost inventories in the cost of foodborne illness literature, and to investigate the association between study methodologies, component costs, and foodborne illness-related factors to the estimated cost of non-typhoidal Salmonella spp. illness, using studies identified in the scoping review. The results indicated high variability in terms of the depth and breadth of individual and societal level component costs, along with a wide range of data sources being used in the cost of foodborne illness literature. Additionally, the number of direct component cost categories included in an estimate, particularly long-term care costs, and the inclusion of chronic sequelae costs were significantly associated with the cost of non-typhoidal Salmonella spp. illness. Therefore, these may be important factors to consider when initiating a cost of foodborne illness study and when interpreting or comparing existing cost of foodborne illness estimates. The results of this thesis can be used to address issues that are believed to be limiting cost-of-illness studies as decision making tools, and to better understand factors which may impact a cost of foodborne illness estimate. / Scoping review and linear regression analyses in the area of cost of foodborne illness / Canadian Institutes of Health Research/Public Health Agency of Canada (CIHR/PHAC) Applied Public Health Research Chair (awarded to Dr. Jan M. Sargeant)

Fibromyalgia syndrome (FMS) is a chronic pain condition with significant societal and personal burdens of illness. Chronic opioid therapy in the treatment of chronic nonmalignant pain has increased drastically over the past decade. This is a worrisome trend in general, but specifically, given the pathophysiologic characteristics seen in fibromyalgia syndrome patients, the use of this class of medication deserves special scrutiny. Although the theoretical case against this therapy choice is strong, little empirical evidence exists. In order to supplement this literature, retrospective analysis methods are utilized to examine the association of state-, provider-, and patient level characteristics with the prevalence of chronic opioid use in this disease state. Data gathered through this analysis is then used to develop a propensity index for the identification of an appropriate control group for fibromyalgia patients, a task that has proven difficult in the literature to date. Using propensity stratification and matching techniques analysis of the impact of fibromyalgia, chronic opioid use, and the interaction of these two variables are undertaken. Several key findings and updates to the understanding of chronic opioid use and fibromyalgia syndrome are reported. Wide geographic variation in chronic opioid utilization between states is seen. The role of diagnosing provider type in the rate of chronic opioid prescribing is significant and can be aggregated at various levels. Demographic characteristics, comorbid conditions, and concurrent medication use are all important associates of chronic opioid use in fibromyalgia syndrome. Additionally, chronic opioid use in fibromyalgia patients, independent of propensity to receive that therapy choice is a significant correlate with healthcare costs. A diagnosis of fibromyalgia is a statistically significant source of healthcare costs, though the clinical significance of its impact when compared to a closely matched control group is minimized. Despite the minimization of the role of this diagnosis the impact of the interaction of chronic opioid use with fibromyalgia, despite control for myriad regressors, is significant both statistically and clinically.

The implication of increasing consumption of functional foods, such as pulse-containing products, reveals the potential to reduce the incidence of type 2 diabetes (T2D) and coronary heart disease (CHD) and thereby achieves the cost savings associated with treatment and productivity loss. This research investigates the economic impact of such an important aspect of dietary pulse intake. The objective of the research is to determine the potential annual healthcare savings resulting from pulse flour consumption at Health Canada’s recommended daily rates. This study employs a four-step cost-of-illness approach to estimate such savings: 1) estimation of success rate of the healthy food; 2) determination of lower glycemic index, insulin concentration reduction, and lower cholesterol; 3) assumption of reduction in prevalence of T2D and CHD; 4) calculation of cost savings with regard to reduced occurrence of T2D and CHD. The findings demonstrate that annual cost savings ranging from $ 43.8 to 317.8 million (T2D category) and $ 154.9 to 958.0 million (CHD category) can be achieved for the Canada’s health budgetary framework with the increased consumption of dietary pulses. The estimations of cost savings are contingent on four scenarios: ideal, optimistic, pessimistic, and very pessimistic. People susceptible to higher blood glucose, higher insulin, and higher total cholesterol could benefit considerably by substituting pulse-containing foods for unhealthy foods. The adaptation to a dietary pattern that includes pulses will result in significant expenditure reductions in Canada’s publicly funded health care system, lessening the economic burden of illness in Canada. / October 2016

The total annual incidence of arthritis in this prospective cross-sectional study on adults was 115/100 000. The annual incidence of rheumatoid arthritis (RA) was 24/100 000, 29/100 000 for women, and 18/100 000 for men. For reactive arthritis (ReA) the annual incidence was slightly higher, 28/100 000, and for undifferentiated arthritis 41/100 000. The annual incidence of Lyme disease and sarcoid arthritis was low. The annual incidence of arthritis in this study compares well with findings in earlier reports from both registers and case review studies. Almost 50% of the patients in the series of 71 patients with arthritis of less than 3 months’ duration had a preceding infection. Campylobacter jejuni ReA dominated the enteric ReA group. We found only a few patients with preceding Chl. trachomatis, Chl. pneumoniae, Borrelia burgdorferi or parvovirus B19 infections. The arthritis patients with a preceding infection went into remission more often than the patients without a preceding infection. The disease specificity of anti-CCP antibodies for RA was high, 96%, confirming earlier results. Anti-CCP antibodies differentiated RA from other arthritides. Several patients in the different diagnosis groups had raised serum COMP levels, indicating cartilage involvement very early in the disease, even in mild and self-limiting disease with good prognosis. The economic burden of early joint inflammation was found to be considerable already during the first few months of the arthritis irrespective of diagnosis. Surprisingly, patients with ReA generated almost as high costs as patients with RA during thefirst few months of the disease, even though most of the ReA patients had a relatively mild disease. Sick leave accounted for about 50% of the costs. The distribution of costs in the different patient groups was skewed. The median cost per patient for the group of patients with RA was US$4385, for ReA US$4085, for other types of specified arthritis US$3361, and for undifferentiated arthritis US$1482. This underlines the necessity of quick referral and therapy, not only to decrease the inflammation and prevent functional impairment, but also to decrease the costs of early arthritis.

Rheumatoid arthritis (RA) is a major cause of progressive joint damage and disability, and is associated with decline in quality of life, reduced ability to work and increased health care utilisation. The economic consequences of the disease are substantial for the individuals and their families and for the society as a whole. This thesis describes a 5-year follow up of 320 patients with early RA, enrolled between January 1996 and April 1998 in the Swedish multi-centre inception cohort TIRA (early interventions in rheumatoid arthritis). Health status, function and costs were investigated. Predictors of high costs were calculated, and an algorithm was constructed to predict future need for TNFinhibitor treatment in patients not responding to traditional disease-modifying antirheumatic drugs (DMARDs). Clinical and laboratory data, measures of functional capacity and self-reported assessments were collected regularly. In addition, patients completed biannual/annual questionnaires concerning all health care utilisation and days lost from work due to the disease. Within 3 months, improvements were seen regarding all variables assessing disease activity and functional ability, but 15% of the patients had sustained high or moderate disease activity throughout the study period. The scores of ‘health assessment questionnaire’ (HAQ) were similar for men and women at baseline, but had a less favourable course in women, who also had DMARDs more frequently prescribed. Ambulatory care accounted for 76% of the direct costs during the first year. Women had more ambulatory care visits and higher usage of complementary medicine compared to men. Men ≥65 years had low costs compared to younger men and compared to women of all ages. In multiple logistic regression tests, HAQ, high levels of IgM-class rheumatoid factor (RF), and poor hand function increased the odds of incurring high direct costs. Poor hand function and pain increased the odds of incurring high indirect costs. Indirect costs exceeded direct costs all three years. The average direct costs were €3,704 (US$ 3,297) year 1 and €2,652 (US$ 2,360) year 3. All costs decreased over the years, except those for medication and surgery. The indirect costs were €8,871 (US$ 7,895) year 1 and remained essentially unchanged, similarly for both sexes. More than 50% were on sick leave or early retirement at inclusion. Sick leave decreased but was offset by increase in early retirement. 14 patients (5%) were prescribed TNF-inhibitors at the 3- year follow up, thus increasing drug costs substantially. However, they incurred higher costs even before prescription of anti-TNF therapy. At the 5-year follow-up (2001-2003), 31 patients (12%) were prescribed TNFinhibitors. Baseline values of erythrocyte sedimentation rate, C-reactive protein, anti-CCP antibodies and morning stiffness were significantly higher in this group. These patients were also to a larger extent RF-positive and carriers of the ‘shared epitope’ (SE). Anti-TNF treated patients were significantly younger and more often women. For men, a predictive model was constructed using baseline data including SE+ and IgA-RF >100 U/L and anti-CCP >240 U/L yielding a specificity of 98% and a sensitivity of 71%. For women, disease activity score (DAS28) at the 3-month follow-up proved to be a better predictor, and the final model comprised SE+ and 3-month DAS28>5.2, giving a specificity of 95% and a sensitivity of 59%.