Economic analysis of chronic diseases is required for proper allocation of resources and understanding costeffectiveness studies of new therapies. Studies on health care cost of ulcerative colitis （UC） and Crohn＇s ...Economic analysis of chronic diseases is required for proper allocation of resources and understanding costeffectiveness studies of new therapies. Studies on health care cost of ulcerative colitis （UC） and Crohn＇s disease （CD） are reviewed here. These studies were carried out in various countries with disparate health care systems. In the United States, data were often modeled or retrieved from large insurance schemes. Surgery and in-patient hospitalization accounted for over half the outlay on UC and CD. Fistulous disease in CD and parenteral nutrition were very costly. In Canada, overall charges were lower than in the United States, but there too, surgical costs were relatively high. In European studies, economic data were abstracted directly from patients＇ files. One pan-European study examined the outlay on UC and CD in a community-based prospective inception cohort followed for 10 years. Overall costs in Europe were lower than in the United States. Surgery, hospitalization, year of follow-up, disease phenotype in CD and ASCA-positivity impacted significantly on costs. In all studies, the cost data were right skewed, aminosalicylates were expensive drugs, and biological agents the most expensive; moreover indirect costs were not calculated. Infliximab raised costs considerably in CD, but there were no long-term followup studies, so that the cost-benefit of biological agents remains unknown. In conclusion, costs of managing UC and CD vary by country, surgery, genotype and several other factors. The most important question for further research is whether the biological therapies are cost-effective in the long-term.展开更多
The current ulcerative colitis （UC） treatment algorithm involves a step-up therapeutic strategy, mainly aiming at inducing and maintaining its clinical remission. Although this therapeutic strategy may seem to be co...The current ulcerative colitis （UC） treatment algorithm involves a step-up therapeutic strategy, mainly aiming at inducing and maintaining its clinical remission. Although this therapeutic strategy may seem to be cost-efficient and reduce the risk of side effects, recent trials and case reports have shown that top-down therapy using infliximab induces a rapid clinical response, enhances patient quality of life, promotes mucosal healing, reduces surgeries and indirect cost of treatment for patients with severe UC. Moreover, since long-term treatment with infliximab is safe and well tolerated, early aggressive top-down therapeutic strategy may be a more effective approach, at least in a subgroup of severe extensive UC patients.展开更多
We read with great interest the editorial article by Meshikhes AWN published in issue 25 of World J Gastroenterol 2011.The article described the advantages of emergency laparoscopic appendectomy compared with interval...We read with great interest the editorial article by Meshikhes AWN published in issue 25 of World J Gastroenterol 2011.The article described the advantages of emergency laparoscopic appendectomy compared with interval appendectomy as a new safe treatment modality for the appendiceal mass.The author concluded that the emergency laparoscopic appendectomy was a safe treatment modality for the appendiceal mass,and might prove to be more cost-effective than conservative treatment,with no need for interval appendectomy.However,we would like to highlight certain issues regarding the possibility of percutaneous catheter drainage to successfully treat the appendiceal mass,with no need for appendectomy,too.展开更多
Currently,the growing number of end-stage renal disease patients in developing countries consumes a greater proportion of healthcare budget,and increasing attention is being focused on the cost-effectiveness of the pr...Currently,the growing number of end-stage renal disease patients in developing countries consumes a greater proportion of healthcare budget,and increasing attention is being focused on the cost-effectiveness of the procedure.We aimed to assess the cost-effectiveness of living-related renal transplantation (RTx) as compared with that for hemodialysis (HD) and identify medical factors associated with charges for RTx in northwestern China.This study was a retrospective analysis of 372 patients on regular HD and 122 living-related kidney transplant recipients on regular follow-up for at least 3 years in northwestern China.All data on charges included HD procedure,RTx procedure,the cost for donor operation,immunosuppression,and follow-up medicare.The average annual cost to all patients on HD and kidney recipients during the first 3 years after RTx was $14482/$31027,$13502/$11038,and $13382/$10243,respectively.The three variables were found to be significant in predicting increased costs for RTx:diltiazem administration,acute rejection and infection complications.We concluded that from the second year on,RTx in China was more effective and less costly than dialysis treatment,although recipients without diltiazem administration and with acute rejection or infection proved costlier during the first year after transplantation.展开更多
Three data envelopment analysis (DEA) models were used to analyse the relative efficiencies of four AIDS treatments in AIDS Clinical Trial Group (ACTG) Study 193A(1 309 patients in total, classified into 4 age groups)...Three data envelopment analysis (DEA) models were used to analyse the relative efficiencies of four AIDS treatments in AIDS Clinical Trial Group (ACTG) Study 193A(1 309 patients in total, classified into 4 age groups). Results from the output-oriented BCC model show that Treatment 4 ( 600 mg of zidovudine plus 400 mg of didanosine plus 400 mg of nevirapine) is particularly efficient for age group 14—25, but not efficient for the older age groups; Treatment 1 (600 mg of zidovudine alternating monthly with 400 mg of didanosine)and Treatment 2 (600 mg of zidovudine plus 2.25 mg of zalcitabine) are efficient for the age groups 35—45 and 45— ; age group 25—35 does not have a particularly efficient treatment, but Treatments 1 and 2 are relatively good. The cost efficiency BCC model, which takes the treatment cost into account, gives similar results as the output-oriented model. Results from the indirect output-oriented BCC model, which allows the replacement among medicines, show that the efficiency of Treatment 2 has greatly decreased compared with that of the output-oriented model, and a set of optimal medicine amounts for different age groups is obtained.展开更多
文摘Economic analysis of chronic diseases is required for proper allocation of resources and understanding costeffectiveness studies of new therapies. Studies on health care cost of ulcerative colitis （UC） and Crohn＇s disease （CD） are reviewed here. These studies were carried out in various countries with disparate health care systems. In the United States, data were often modeled or retrieved from large insurance schemes. Surgery and in-patient hospitalization accounted for over half the outlay on UC and CD. Fistulous disease in CD and parenteral nutrition were very costly. In Canada, overall charges were lower than in the United States, but there too, surgical costs were relatively high. In European studies, economic data were abstracted directly from patients＇ files. One pan-European study examined the outlay on UC and CD in a community-based prospective inception cohort followed for 10 years. Overall costs in Europe were lower than in the United States. Surgery, hospitalization, year of follow-up, disease phenotype in CD and ASCA-positivity impacted significantly on costs. In all studies, the cost data were right skewed, aminosalicylates were expensive drugs, and biological agents the most expensive; moreover indirect costs were not calculated. Infliximab raised costs considerably in CD, but there were no long-term followup studies, so that the cost-benefit of biological agents remains unknown. In conclusion, costs of managing UC and CD vary by country, surgery, genotype and several other factors. The most important question for further research is whether the biological therapies are cost-effective in the long-term.
文摘The current ulcerative colitis （UC） treatment algorithm involves a step-up therapeutic strategy, mainly aiming at inducing and maintaining its clinical remission. Although this therapeutic strategy may seem to be cost-efficient and reduce the risk of side effects, recent trials and case reports have shown that top-down therapy using infliximab induces a rapid clinical response, enhances patient quality of life, promotes mucosal healing, reduces surgeries and indirect cost of treatment for patients with severe UC. Moreover, since long-term treatment with infliximab is safe and well tolerated, early aggressive top-down therapeutic strategy may be a more effective approach, at least in a subgroup of severe extensive UC patients.
文摘We read with great interest the editorial article by Meshikhes AWN published in issue 25 of World J Gastroenterol 2011.The article described the advantages of emergency laparoscopic appendectomy compared with interval appendectomy as a new safe treatment modality for the appendiceal mass.The author concluded that the emergency laparoscopic appendectomy was a safe treatment modality for the appendiceal mass,and might prove to be more cost-effective than conservative treatment,with no need for interval appendectomy.However,we would like to highlight certain issues regarding the possibility of percutaneous catheter drainage to successfully treat the appendiceal mass,with no need for appendectomy,too.
基金Supported by the Science Foundation of Shaanxi Province (No. SJ08C201)
文摘Currently,the growing number of end-stage renal disease patients in developing countries consumes a greater proportion of healthcare budget,and increasing attention is being focused on the cost-effectiveness of the procedure.We aimed to assess the cost-effectiveness of living-related renal transplantation (RTx) as compared with that for hemodialysis (HD) and identify medical factors associated with charges for RTx in northwestern China.This study was a retrospective analysis of 372 patients on regular HD and 122 living-related kidney transplant recipients on regular follow-up for at least 3 years in northwestern China.All data on charges included HD procedure,RTx procedure,the cost for donor operation,immunosuppression,and follow-up medicare.The average annual cost to all patients on HD and kidney recipients during the first 3 years after RTx was $14482/$31027,$13502/$11038,and $13382/$10243,respectively.The three variables were found to be significant in predicting increased costs for RTx:diltiazem administration,acute rejection and infection complications.We concluded that from the second year on,RTx in China was more effective and less costly than dialysis treatment,although recipients without diltiazem administration and with acute rejection or infection proved costlier during the first year after transplantation.
基金National Natural Science Foundation of China (No 10571134)
文摘Three data envelopment analysis (DEA) models were used to analyse the relative efficiencies of four AIDS treatments in AIDS Clinical Trial Group (ACTG) Study 193A(1 309 patients in total, classified into 4 age groups). Results from the output-oriented BCC model show that Treatment 4 ( 600 mg of zidovudine plus 400 mg of didanosine plus 400 mg of nevirapine) is particularly efficient for age group 14—25, but not efficient for the older age groups; Treatment 1 (600 mg of zidovudine alternating monthly with 400 mg of didanosine)and Treatment 2 (600 mg of zidovudine plus 2.25 mg of zalcitabine) are efficient for the age groups 35—45 and 45— ; age group 25—35 does not have a particularly efficient treatment, but Treatments 1 and 2 are relatively good. The cost efficiency BCC model, which takes the treatment cost into account, gives similar results as the output-oriented model. Results from the indirect output-oriented BCC model, which allows the replacement among medicines, show that the efficiency of Treatment 2 has greatly decreased compared with that of the output-oriented model, and a set of optimal medicine amounts for different age groups is obtained.
