| 1. |
- Ghatnekar, Ola, et al.
(författare)
-
Medical Resource Utilization and Cost of HIV-Related Care in the Highly Active Antiretroviral Therapy Era at a University Clinic in Sweden.
- 2010
-
Ingår i: PharmacoEconomics. - : Springer Science and Business Media LLC. - 1179-2027 .- 1170-7690. ; 28:S1, s. 49-57
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction: Little is known regarding healthcare costs for HIV/AIDS patients in the era of highly active antiretroviral therapy (HAART) and subgroups of patients according to the severity and progression of HIV infection in Sweden. The objective of this study is therefore to describe the direct medical resource use and cost of healthcare for HIV patients at a university clinic in Sweden. Methods: A patient registry database for HIV treatment at the Department of Infectious Diseases, Sahlgrenska University Hospital, between 2000 and 2005 provided information on patient characteristics, antiretroviral drugs and dosages, tests and diagnostic procedures, outpatient visits and inpatient stays. The review used publicly available unit costs with a county council perspective, expressed in 2006 Euros. Results: Two hundred and eighty-five patients with a mean age of 38 years in 2000 (64% men) were followed for 1368 patient-years. They had a mean (median) of 6.3 (0) inpatient days, 4.1 (3.7) physician visits, 4.2 (3.8) nurse visits, 2.6 (0.7) counsellor visits and 11.5 (7.7) tests and diagnostic procedures per patient-year. Only 12 deaths were recorded during the study period, and the proportion of treated patients with successful treatment (HIV-RNA <50copies/mL) increased from 74% to 92% during the period. The mean cost per patient-month amounted to &U20AC;1069. The main cost driver was HIV drugs (51%), followed by inpatient stays (including hospitalizations for opportunistic infections; 22%), outpatient physician, nurse or therapist visits (19%) and diagnostics and tests (7%). All non-drug costs increased with a decreasing CD4 cell count. Conclusions: Overall, approximately half of the direct costs of HIV treatment were not related to antiretroviral treatment. The non-antiretroviral costs were inversely correlated with HIV-induced immune deficiency.
|
|
| 2. |
- Hjortsberg, Catharina, et al.
(författare)
-
Are Treatment Satisfaction, Quality of Life, and Self-assessed Disease Severity Relevant Parameters for Patient Registries? Experiences from Finnish and Swedish Patients with Psoriasis.
- 2011
-
Ingår i: Acta Dermato-Venereologica. - : Medical Journals Sweden AB. - 1651-2057 .- 0001-5555. ; 91, s. 409-414
-
Tidskriftsartikel (refereegranskat)abstract
- Patient registries often lack indicators of the disease as experienced by patients, e.g. treatment satisfaction and self-assessed disease severity. There is scarce information about the relationship between these assessments and currently existing instruments used in treatment evaluation. Our objective was to explore the importance of these indicators among patients with psoriasis in Finland and Sweden, in relation to treatment patterns and current measures of health-related quality of life. Data were collected from a patient survey and a retrospective chart review for 273 patients over 12 months. To assess psoriasis treatment completely, it is necessary to consider the impact of the disease on the patient in terms of treatment satisfaction, disease severity and health-related quality of life. The individual disease burden on patients should play a central role in formulating treatment goals. Clinician- and patient-based perspectives of the overall impact of psoriasis can assist clinical decision-making and evaluations of treatments.
|
|
| 3. |
- Hjortsberg, Catharina, et al.
(författare)
-
Cost of access to health services in Zambia.
- 2002
-
Ingår i: Health Policy and Planning. - : Oxford University Press (OUP). - 0268-1080 .- 1460-2237. ; 17:1, s. 7-71
-
Tidskriftsartikel (refereegranskat)abstract
- Equity is an important policy objective in the health care field. The importance of equity in health care provision can be argued from various points of view. As a result governments in all countries attempt to provide health care systems that enable equal access for everyone. Zambia is no exception. In the health care reforms the objective of the national health strategy is to provide Zambians with equity of access to health care. We focus on access defined as the costs (both monetary and time) an individual incurs when visiting a health care facility. Using a survey of 900 households, this article explores equality of access to health care among Zambians. Four areas are compared: urban high cost, urban low cost, townships and rural areas. The results of the analysis indicate that there are inequalities among residential areas, especially between rural and urban areas. In particular these differences exist because of differing distances to the nearest health facility. Large distances make it very costly for rural dwellers to seek medical care, especially during the high season for farming. The analysis suggests that obtaining equality of access to health care poses a challenge for the Zambian Government.
|
|
| 4. |
- Hjortsberg, Catharina, et al.
(författare)
-
Costs for patients with psychotic illness : differences depending upon state of remission
- 2011
-
Ingår i: The Journal of Mental Health Policy and Economics. - Milano. - 1091-4358. ; 14:2, s. 87-93
-
Tidskriftsartikel (refereegranskat)abstract
- Psychotic illnesses have a substantial economic burden on patients, family members, friends, and society in general, still there have been limited attempts to estimate the costs associated with this condition. Moreover, nothing is known about the differences in costs between patients depending on disease severity, i.e. state of remission.AIM:Estimate the direct and indirect costs for a defined patient population with psychotic illness in Sweden, and demonstrate differences in direct costs depending on disease severity (state of remission).MATERIALS AND METHODS:The cost analyses are based on data from the Clinical Long-term Investigation of Psychosis in Sweden (CLIPS), which is an ongoing, single-centre, epidemiological study. Resource use and disease severity were captured for the patients during one year, 2007. Total costs per patients are estimated and cost differences between patients, depending on state of remission, are considered.RESULTS:199 patients with a mean age of 51 (63% men) were followed for 12 months. They had a mean of 6.4 inpatient-days, 1.4 physician visits, 18.6 nurse visits, 1.2 counsellor visits and 6.3 visits to other staff including tests and diagnostic procedures per patient- year. The mean total cost (direct and indirect) amounted to 62,500 per patient and year. Patients in steady state of remission had lower direct costs compared to other patients. Moreover, the size of the various cost items differed between patients' depending on state of remission. Patients in steady remission had almost no inpatient costs.DISCUSSION:For a comprehensive assessment of treatment of psychotic illnesses it is necessary to provide evidence of the costs related to disease severity. We find that patients suffering from psychotic illness have varying costs depending on their disease severity, and this study indicates that if patients can be kept in remission direct costs will decrease. We can also confirm that reallocation has taken place the last 15 years, between different cost items, from in-patient care at hospitals to out-patient care and assistance at home.LIMITATIONS:Information about informal care was collected from patients and not from informal carers themselves.IMPLICATIONS FOR HEALTH CARE PROVISION AND USE:Costs have been reallocated from in-patient care to costs for assistance at home, which is a reflection of the change in care of patients with mental problems that has taken place during the last 15 years. Patients in steady remission have lower costs compared to patients in steady non-remission or patients switching between the two states. A better surveillance of the disorder would lead to lower direct, as well as indirect, costs.
|
|
| 5. |
- Hjortsberg, Catharina
(författare)
-
Health care utilisation in a developing country -the case of Zambia
- 2004
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis is to contribute to our understanding of health care utilisation and its determinants in developing countries, especially in sub-Saharan Africa. This is done by explicitly focusing on health care expenditures and its determinants as well as the choice to seek health care to cure the illness. Firstly, the focus is on a household’s expenditures for health care. The aim of this paper is to explore the determinants of health care utilisation of Zambian households and in particular whether other factors than just health status influence utilisation in developing countries. The results point out a significant difference between households in rural and urban areas as well as between poor and non-poor households regarding the magnitude of health care expenditures. In general, results show that the households are influenced by economic status, illness and access variables such as distance and owning a vehicle. Secondly, a sick individual’s choice of health care and expenditures related to it are analysed. In this paper the aim is on the one hand to determine what factors influence sick individuals’ propensity to seek health care at a health facility or to use self-medication (or do nothing), and on the other hand to determine the factors that influence the magnitude of the expenditures they incur for health care. We find that the individuals’ utilisation is influenced by economic status, education, insurance, type of illness and access variables such as distance and owning a vehicle.Thirdly, only children are focused on in analysing the determinants of those being taken to professional health care when sick, and then, given that health care is provided, estimating determinants of the level of expenditures incurred. The results show that children’s utilisation of professional health care is influenced by the household’s economic status, mother’s education, age, household ownership of motor transportation, child being an orphan (mother dead), distance to health care and living in a rural area. Then, in the last paper, Zambian households’ access to health care facilities are analysed. The results of the analysis indicate that there are inequalities among socio-economic groups, especially between rural and urban areas. In particular these differences exist because of differing distances to the nearest health facility.With these papers on Zambia and their different angles, a comprehensive picture of health care utilisation and factors influencing it in a sub-Saharan context is given. Interestingly, we can conclude that health care utilisation among individuals in developing countries is greatly influenced by the same factors as have been shown to influence individuals in developed countries.
|
|
| 6. |
- Hjortsberg, Catharina, et al.
(författare)
-
The Value of Informal Caregiver Time for Psychotic Illness
- 2010
-
Ingår i: Journal of Mental Health Policy and Economics. - 1099-176X. ; 13:3, s. 127-133
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Psychotic illness can have a substantial economic burden not only on the patient and society in general, but also on family members providing informal care (i.e. those not subject to a market wage). While informal caregiving confers benefits for the patient and society, time spent providing informal care is diverted from other activities such as work or leisure. Relatives and caregivers experience burden both on a practical and an emotional level. Informal caregiving has often gone unrecognised in public policy discussions about the financing and costs of health care. Aim: The aim of this paper is to provide suggestions for valuing caregiver time for psychotic illness. Materials and Methods Literature on the costs of informal care and the cost of leisure time, is used to discuss possibilities for estimating the value of informal care. Results: The monetary value of informal care depends on income levels both for those who give up paid work and for those who forego leisure time. Estimates are thus context dependent and might be difficult to generalise. Discussion: Informal care is a substantial part of total patient care, especially for chronic illness. The support of family caregivers for patients with mental illnesses often has an important impact on the general well-being of the patient. Because it is typically unpaid, informal care has been seen as a low cost, even costless, substitute for formal care. Placing a value on the hours of care provided by informal caregivers for patients suffering from mental illnesses is necessary if one wants to provide an accurate picture of the costs associated with the diseases. Time spent on informal care has a value and methods of estimating costs of informal care are available. Implications for Health Care Provision and Use: Cost studies should take account of the cost of informal care, as ignoring informal care means that it is viewed as a costless substitute for formal care. While informal care is unpaid, it is not free in an economic sense since time spent providing care cannot be directed to other activities such as paid work or leisure. From a societal perspective, not accounting for informal care may lead to a poor allocation of resources and a disregard of the effect of informal care on the health and well-being of caregivers. Cost of informal care constitutes a sizeable proportion of total costs and should not be neglected.
|
|
| 7. |
- Hjortsberg, Catharina
(författare)
-
Why do the sick not utilise health care? The case of Zambia
- 2003
-
Ingår i: Health Economics. - : Wiley. - 1099-1050 .- 1057-9230. ; 12:9, s. 755-770
-
Tidskriftsartikel (refereegranskat)abstract
- When ill the individual faces the options of seeking health care, using self-medication or doing nothing. In an economic perspective, an individual's propensity to utilise health care is determined by the costs of utilisation and the perceived benefits of health care. The propensity to utilise health care may hence be expected to vary between individuals. In this paper we attempt on the one hand to determine what factors influence sick individuals' propensity to seek health care at a health facility or use self-medication (or do nothing), and on the other hand attempt to determine the factors that influence the magnitude of their expenditures for health care, in particular what other factors than just health status influence utilisation. For the empirical analysis, data, covering 9700 individuals, from the 1998 Living Conditions Monitoring Survey (LCMS) is used. We use a Multinomial Logit selection model to estimate the equation, which allows us to analyse health-care utilisation through two separate processes, the decision to seek care and the magnitude of expenditures incurred. In general, we find that the individuals are influenced by income, insurance, type of illness and access variables such as distance and owning a vehicle. Copyright (C) 2003 John Wiley Sons, Ltd.
|
|
