Treatment patterns and health care resource utilization in a 1-year observational cohort study of outpatients with schizophrenia at risk of nonadherence treated with long-acting injectable antipsychotics

Purpose: To describe (1) the clinical profiles and the patterns of use of long-acting injectable (LAI) antipsychotics in patients with schizophrenia at risk of nonadherence with oral antipsychotics, and in those who started treatment with LAI antipsychotics, (2) health care resource utilization and associated costs. Patients and methods: A total of 597 outpatients with schizophrenia at risk of nonadherence, according to the psychiatrist's clinical judgment, were recruited at 59 centers in a noninterventional prospective observational study of 1-year follow-up when their treatment was modified. In a post hoc analysis, the profiles of patients starting LAI or continuing with oral antipsychotics were described, and descriptive analyses of treatments, health resource utilization, and direct costs were performed in those who started an LAI antipsychotic. Results: Therapy modifications involved the antipsychotic medications in 84.8% of patients, mostly because of insufficient efficacy of prior regimen. Ninety-two (15.4%) patients started an LAI antipsychotic at recruitment. Of these, only 13 (14.1%) were prescribed with first-generation antipsychotics. During 1 year, 16.3% of patients who started and 14.9% of patients who did not start an LAI antipsychotic at recruitment relapsed, contrasting with the 20.9% who had been hospitalized only within the prior 6 months. After 1 year, 74.3% of patients who started an LAI antipsychotic continued concomitant treatment with oral antipsychotics. The mean (median) total direct health care cost per patient per month during the study year among the patients starting any LAI antipsychotic at baseline was 1,407 ( 897.7). Medication costs (including oral and LAI antipsychotics and concomitant medication) represented almost 44%, whereas nonmedication costs accounted for more than 55% of the mean total direct health care costs. Conclusion: LAI antipsychotics were infrequently prescribed in spite of a psychiatrist-perceived risk of nonadherence to oral antipsychotics. Mean medication costs were lower than nonmedication costs.

Mating does not influence reproductive investment, in a viviparous lizard.

Mating is crucial for females that reproduce exclusively sexually and should influence their investment into reproduction. Although reproductive adjustments in response to mate quality have been tested in a wide range of species, the effect of exposure to males and mating per se has seldom been studied. Compensatory mechanisms against the absence of mating may evolve more frequently in viviparous females, which pay higher direct costs of reproduction, due to gestation, than oviparous females. To test the existence of such mechanisms in a viviparous species, we experimentally manipulated the mating opportunity of viviparous female lizard, Lacerta (Zootoca) vivipara. We assessed the effect of mating on ovulation, postpartum body condition and parturition date, as well as on changes in locomotor performances and body temperatures during the breeding cycle. Female lizards ovulated spontaneously and mating had no influence on litter size, locomotor impairment or on selected body temperature. However, offspring production induced a more pronounced locomotor impairment and physical burden than the production of undeveloped eggs. Postpartum body condition and parturition dates were not different among females. This result suggests that gestation length is not determined by an embryonic signal. In the common lizard, viviparity is not associated with facultative ovulation and a control of litter size after ovulation, in response to the absence of mating.

The economic burden of alcohol dependence in europe.

AIMS: To determine the economic burden pertaining to alcohol dependence in Europe. METHODS: Database searching was combined with grey literature searching to identify costs and resource use in Europe relating to alcohol dependence as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) or the World Health Organisation's International Classification of Diseases (ICD-10). Searches combined MeSH headings for both economic terms and terms pertaining to alcohol dependence. Relevant outcomes included direct healthcare costs and indirect societal costs. Main resource use outcomes included hospitalization and drug costs. RESULTS: Compared with the number of studies of the burden of alcohol use disorders in general, relatively few focussed specifically on alcohol dependence. Twenty-two studies of variable quality were eligible for inclusion. The direct costs of alcohol dependence in Europe were substantial, the treatment costs for a single alcohol-dependent patient lying within the range euro1591-euro7702 per hospitalization and the annual total direct costs accounting for 0.04-0.31% of an individual country's gross domestic product (GDP). These costs were driven primarily by hospitalization; in contrast, the annual drug costs for alcohol dependence were low. The indirect costs were more substantial than the direct costs, accounting for up to 0.64% of GDP per country annually. Alcohol dependence may be more costly in terms of health costs per patient than alcohol abuse. CONCLUSIONS: This review confirms that alcohol dependence represents a significant burden for European healthcare systems and society. Difficulties in comparing across cost-of-illness studies in this disease area, however, prevent specific estimation of the economic burden.

Minimally invasive fixation versus conservative treatment of undisplaced scaphoid fractures: a cost-effectiveness study.

This study compares the direct and indirect costs of conservative and minimally invasive treatment for undisplaced scaphoid fractures. Costs data concerning groups of non-operated and operated patients were analysed. Direct costs were higher in operated patients. Although highly variable, indirect costs were significantly smaller in operated patients and the total costs were higher in non-operated patients. In conclusion, operative treatment of scaphoid fractures is initially more expensive than conservative treatment but markedly decreases the work compensation costs.

Treatment patterns and health care resource utilization in a 1-year observational cohort study of outpatients with schizophrenia at risk of nonadherence treated with long-acting injectable antipsychotics

Purpose: To describe (1) the clinical profiles and the patterns of use of long-acting injectable (LAI) antipsychotics in patients with schizophrenia at risk of nonadherence with oral antipsychotics, and in those who started treatment with LAI antipsychotics, (2) health care resource utilization and associated costs. Patients and methods: A total of 597 outpatients with schizophrenia at risk of nonadherence, according to the psychiatrist's clinical judgment, were recruited at 59 centers in a noninterventional prospective observational study of 1-year follow-up when their treatment was modified. In a post hoc analysis, the profiles of patients starting LAI or continuing with oral antipsychotics were described, and descriptive analyses of treatments, health resource utilization, and direct costs were performed in those who started an LAI antipsychotic. Results: Therapy modifications involved the antipsychotic medications in 84.8% of patients, mostly because of insufficient efficacy of prior regimen. Ninety-two (15.4%) patients started an LAI antipsychotic at recruitment. Of these, only 13 (14.1%) were prescribed with first-generation antipsychotics. During 1 year, 16.3% of patients who started and 14.9% of patients who did not start an LAI antipsychotic at recruitment relapsed, contrasting with the 20.9% who had been hospitalized only within the prior 6 months. After 1 year, 74.3% of patients who started an LAI antipsychotic continued concomitant treatment with oral antipsychotics. The mean (median) total direct health care cost per patient per month during the study year among the patients starting any LAI antipsychotic at baseline was 1,407 ( 897.7). Medication costs (including oral and LAI antipsychotics and concomitant medication) represented almost 44%, whereas nonmedication costs accounted for more than 55% of the mean total direct health care costs. Conclusion: LAI antipsychotics were infrequently prescribed in spite of a psychiatrist-perceived risk of nonadherence to oral antipsychotics. Mean medication costs were lower than nonmedication costs.

Toimintojen kuormitusten mallintaminen ja toimintolaskennan käyttöönottomahdollisuudet kokoonpanokonepajassa

Työn tavoitteena oli kehittää yrityksen liiketoimintaprosessikuvausta, mallintaa eräiden siinä esitettyjen toimintoryhmien ja yksittäisten toimintojen kuormitukset sekä tutkia toimintolaskennan käyttöönottomahdollisuuksia yrityksessä. Työssä on tuotu esille kapasiteettiin ja resursseihin liittyviä käsitteitä, kuten kapasiteettipäätösten ajoitus, resurssitarvesuunnittelu ja resurssien kohdistaminen. Työssä on myös tarkasteltu perinteisen kustannuslaskennan ja toimintolaskennan välisiä eroja. Aiempaa tutkimustietoa on käytetty asetettujen tavoitteiden saavuttamiseen. Liiketoimintaprosessikuvausta on muokattu vastaamaan paremmin yrityksen nykyistä rakennetta. Toimintojen kuormitukset on mallinnettu liiketoimintaprosessikuvauksesta ja kyselyistä saadun tiedon perusteella. Toimintolaskennan käyttöönottomahdollisuuksien arviointiperusteena on käytetty toimintolaskennan laskennallista toteutettavuutta yrityksessä. Työn ensimmäinen tulos on yksinkertaisempi ja monikäyttöisempi liiketoimintaprosessikuvaus, jota voidaan käyttää henkilöstöhallinnossa ja yrityksen toiminnan kehittämiseen. Toinen tulos on kuormitusmalli, jota voidaan käyttää muun muassa tulevaisuuden kapasiteettitarpeen arvioimiseen. Työnkolmas tulos on analyysi toimintolaskennan käyttöönottomahdollisuuksista ja työnumeroperusteisen kustannusten kohdistamisen periaatteet.

Kunnossapidosta aiheutuvien epäsuorien kustannusten, laatuvaikutusten ja tuotannon toteutumattomien tuottojen liiketaloudellinen vaikutus

Työn tavoitteena on selvittää välillisten kunnossapitokustannusten rakennetta, selkeyttää kunnossapitokonseptin myyntiä ja luoda benchmarking- työkalu kunnossapitoliiketoiminnan jatkuvaan kehittämiseen. Kunnossapidon palvelukonseptin tarjoamiseen liittyen tutkimuksessa kartoitetaan kunnossapidon asiakkaan näkemyksiä kunnossapidon vaikutuksista asiakkaan edustamassa organisaatiossa, jolloin voidaan saada työkaluja kunnossapitotuotteiden ja kunnossapitokonseptien edelleen kehittämiseksi paremmin asiakkaan tarpeita tyydyttävään suuntaan ja näin nostaa asiakkaan ostaman palvelun laatua ja saada tuotetuksi lisäarvoa asiakkaalle. Tutkimuksen perusteella voidaan todeta kunnossapidon vaikutuksen yrityksen talouteen ja menestykseen olevan huomattava. Kun tarkastellaan kunnossapitoa vain välittömien kustannusten osalta, ei yrityksen toimintoja voida optimoida tehokkaimman mahdollisen toiminnan mahdollistavalla tavalla. Kunnossapito voidaan siis kehittää aidosti lisäarvoa tuottavaksi palveluksi, kun saadaan epäsuoria kustannuksia asteittain vähennetyksi.

Profitability Analysis of Service Contracts of Devices

The objective of this study has been to make a profitability analysis of service contracts for a company in Finland. The purpose has been to see how profitable the contracts are and if there possibly were some things to change or develop in the contracts. Allocation rules of cost accounting, service costs both profitability and management of services have been considered in the theory part. All the service contracts that have been valid at least three last accounting periods have been included in the study. All direct costs relating to the contracts have been collected and indirect costs have been assigned to the contracts. Profitability of the contracts has been calculated over three years. Results have been analyzed according to the key figures the company is controlling. Some suggestions for developments have been given at the end of the study. The study has shown differences between the contracts. Part of them has turned out to be like the profitability aims of the company and part less profitable. The study has shown that many factors have an effect on the profitability of the service contracts.

Lifetime and intergenerational fitness consequences of harmful male interactions for female lizards.

Male mating behaviors harmful to females have been described in a wide range of species. However, the direct and indirect fitness consequences of harmful male behaviors have been rarely quantified for females and their offspring, especially for long-lived organisms under natural conditions. Here, lifetime and intergenerational consequences of harmful male interactions were investigated in female common lizards (Lacerta vivipara) using field experiments. We exposed females to male harm by changing the population sex ratio from a normal female-biased to an experimental male-biased sex ratio during the first experimental year. Thereafter, females and their first generation of offspring were monitored during two additional years in a common garden with a female-biased sex ratio. We found strong immediate fitness costs and lower lifetime reproductive success in females subjected to increased male exposure. The immediate fitness costs were partly mitigated by direct compensatory responses after exposure to male excess, but not by indirect benefits through offspring growth, offspring survival, or mating success of offspring. These results support recent empirical findings showing that the direct costs of mating are not outweighed by indirect benefits.

Konekohtaiset kunnossapidon kustannukset ohutlevy-yrityksessä

Diplomityön tavoitteena on laskea kohdeyrityksen tehtaan koneiden kunnossapidosta aiheutuvat kustannukset. Koneiden kunnossapidon kustannusten laskemisen lisäksi työn aikana laaditaan kunnossapidon kustannusten kuukausittainen raportti sekä tehdään kunnossapitoa helpottava ohjelma. Kunnossapidon kustannukset jaotellaan kahteen osaan, jotka ovat välittömät ja välilliset kustannukset. Työn teoriaosassa käydään läpi kustannuslaskentaa, kunnossapidon teoriaa sekä kapasiteetin riittävyyttä. Empiriaosassa esitellään kohdeyritys ja kunnossapidon nykytila. Tämän jälkeen käydään läpi koneiden kunnossapidon kustannusten laskentamalli ja kunnossapitojärjestelmä. Esittelyjen jälkeen analysoidaan työn tuloksia ja ehdotetaan muutamia kehitysvaihtoehtoja. Diplomityön tuloksista on huomattavissa, että kohdeyrityksen tehtaan koneiden kunnossapidon kustannukset ovat pääasiassa välittömiä kustannuksia. Koneiden kunnossapidon kustannusten selvittäminen toi esille kustannusten vaikutuksen eri tuotteisiin, niiden omakustannusarvoihin ja katteisiin. Joidenkin tuotteiden katteet muuttuivat jopa negatiivisiksi. Vaikka kunnossapidon konekohtaiset kustannukset saadaan pysymään samana, kehittämällä tuotantoa voidaan vähentää merkittävästi tuotekohtaisia kunnossapidon kustannuksia.

Comparing service contract prices of outsourcing partner

The main objective of this Master’s thesis is to find out which one of the two pricing models is the most cost-effective. In this thesis there are two companies that have made an outsourcing contract, in which they have a possibility to choose between two different pricing models. The first model is so called FTE (Full Time Employee) -based. The total cost will be based on the amount of outsourced person-workyears. The second pricing model is the transaction-based, in which the price will be formed according to the amount of transactions. Changing the pricing model from FTE-based to the transaction-based will also incur other costs. It is very important that these other costs are also taken into consideration, so that it is possible to determine the total costs of the pricing models. These other costs are direct costs, indirect costs and performance related costs of outsourcing. Activity based-costing (ABC) was used in order to find out the trues indirect costs of the outsourced processes. Performance related costs are related to quality, so Pareto-analysis was used to analyse the costs. Based on all of that, a framework for service related cost analysis was developed. Quality costs were almost impossible to quantify, so quality had to be taken into consideration in a qualitative way. Furthermore, considering only the indirect and direct costs in a quantitative way and quality costs in a qualitative way, it was possible to find a conditional solution for the research question.

Palvelutasopoikkeamariskin kustannusvaikutusten määrittäminen tietoliikennepalveluiden tuotannossa

Tutkimuksen päämääränä oli selvittää laadullisin menetelmin millaisia kustannusvaikutuksia laajavaikutteiset palvelutasopoikkeamat, eli erilaiset viat tai häiriöt tietoliikennepalveluissa aiheuttavat kohdeyrityksen tietoliikennepalveluiden tuotannossa. Tutkimus muistutti lähtökohdiltaan paljolti riskianalyysia, sillä sen tavoitteina oli tunnistaa merkittävimmät palvelutasopoikkeamien aiheuttajat, arvioida palvelutasopoikkeaman kustannusvaikutuksia ja pohtia millaisin toimin ja kustannuksin palvelutasopoikkeamia voitaisiin ehkäistä. Tutkimusongelmaa lähestyttiin jakamalla palvelutasopoikkeaman kustannusvaikutukset viankorjauksesta aiheutuviin välittömiin ja asiakasvaikutusten kautta mahdollisesti syntyviin välillisiin kustannuksiin. Välillisiä kustannuksia aiheuttaviksi ilmiöiksi tunnistettiin palvelukatkon aiheuttama liikennetulomenetys, nykyisten tai potentiaalisten asiakkaiden menettäminen ja nykyisten asiakkaiden alentunut ostohalukkuus. Yhteenvetona tutkimuksessa tehtyihin havaintoihin perustuen välilliset kustannukset eivät osoittautuneet niin merkittäviksi kuin tutkimuksen aloitusvaiheessa oletettiin, mutta lisätutkimus aiheesta voi olla perusteltua.

Economic Burden of Psoriasis

Psoriasis may cause a substantial economic burden to patients, health service providers, third parties, and the society as a whole. However, all of these costs may not be adequately considered when assessing the treatment costs for psoriasis. Psoriasis may negatively affect work productivity as psoriasis has a relatively high incidence in working age people that lead to possible costs because of lost productivity. The aims of this thesis were to estimate the economic burden of psoriasis particularly from patients’ and health service providers’ perspectives and to estimate the background factors (e.g., severity of psoriasis) that may have led to high costs. Another aim was to estimate the total medication costs and to estimate psoriasis’ proportion of health-related productivity losses. The patient sample was based on patients with psoriasis who visited the Department of Dermatology in Turku University Hospital during a one-year study period. These patients were sent a questionnaire. From the patients who gave consent, medication information, clinical information, and number of visits to Turku University Hospital were collected. This data was linked to the information from the questionnaire. Overall psoriasis was estimated to cause a substantial economic burden for the patient, health service provider, health insurance system, employer, and the society as a whole. The direct costs represented only a small proportion of the overall financial burden of psoriasis, whereas indirect costs were significant. The estimated annual costs for patients and employers were almost twice the costs to health service providers or the Social Insurance Institution of Finland. In conclusion, the cost contribution of patients and employers should be considered when assessing the costs of different treatments, in addition to commonly studied direct costs of medications and costs to health service providers. Methods used to assess these costs should be well justified and be described clearly to allow comparisons between studies and to evaluate the quality of the results.

La collaboration médecin-pharmacien en soins de première ligne pour la gestion des dyslipidémies : un essai clinique contrôlé et randomisé en grappe (étude TEAM)

L’hypothèse de cette thèse est qu’une pratique collaborative médecins de famille-pharmaciens communautaires (PCMP) où le pharmacien fournit des soins pharmaceutiques avancés avec ajustement posologique d’une statine permettrait aux patients avec une dyslipidémie une réduction plus importante de leur LDL et augmenterait le nombre de patients atteignant leurs cibles lipidiques. Dans une étude clinique contrôlée et randomisée en grappe visant à évaluer une PCMP pour des patients ayant une dyslipidémie (l’étude TEAM), une journée de formation basée sur un protocole de traitement et des outils cliniques a été offerte aux pharmaciens PCMP pour les préparer à fournir des soins pharmaceutiques avancés. Les connaissances des pharmaciens sur les dyslipidémies étaient faibles avant la formation mais se sont améliorées après (moyenne de 45,8% à 88,2%; p < 0,0001). Après la formation, les pharmaciens avaient un haut niveau d’habiletés cliniques théoriques et pratiques. Bref, une journée de formation basée sur un protocole de traitement et des outils cliniques était nécessaire et adéquate pour préparer les pharmaciens à fournir des soins pharmaceutiques avancés à des patients ayant une dyslipidémie dans le contexte d’une étude clinique. Dans l’étude TEAM, 15 grappes de médecins et de pharmaciens (PCMP : 8; soins habituels (SH) : 7) ont suivi pendant un an, 225 patients (PCMP : 108; SH : 117) à risque modéré ou élevé de maladie coronarienne qui débutaient ou étaient déjà traités par une monothérapie avec une statine mais qui n’avaient pas atteint les cibles lipidiques. Au départ, par rapport aux patients SH, les patients PCMP avaient un niveau de LDL plus élevé (3,5 mmol/L vs 3,2 mmol/L) et recevaient moins de statine à puissance élevée (11,1 % vs 39,7 %). Après 12 mois, la différence moyenne du changement de LDL entre les groupes était égale à -0,2 mmol/L (IC95%: -0,3 à -0,1) et -0,04 (IC95%: -0,3 à 0,2), sans ajustement et avec ajustement, respectivement. Le risque relatif d’atteindre les cibles lipidiques était 1,10 (IC95%: 0,95 à 1,26) et 1,16 (1,01 à 1,32), sans ajustement et avec ajustement, respectivement. Les patients PCMP ont eu plus de visites avec un professionnel de la santé et d’analyses de laboratoire et étaient plus enclins à rapporter des changements de style de vie. La PCMP a amélioré l’adhésion aux lignes directrices en augmentant la proportion de patients aux cibles lipidiques. Les données intérimaires de l’étude TEAM (PCMP : 100 patients; SH : 67 patients) ont permis d’évaluer les coûts directs annuels du suivi du pharmacien du groupe PCMP (formation, visites, laboratoire), du médecin (visites, laboratoire) et du traitement hypolipémiant. Le suivi du pharmacien a coûté 404,07$/patient, incluant 320,67$ pour former les pharmaciens. Le coût global incrémental était 421,01$/patient. Une pratique collaborative pour des patients ayant une dyslipidémie engendre un coût raisonnable.

Durée de lʼexposition avec symptômes, séquelles et coûts de lʼasthme professionnel en relation avec le statut psychologique et socioéconomique

Le facteur le plus important de pronostic de l'asthme professionnel (AP) est la durée des symptômes avant le retrait de lʼexposition à lʼagent causant lʼAP. La qualité de vie réduite, la détresse psychologique et les maladies psychiatriques sont des conditions souvent associées à l'AP. Notre objectif était d'identifier les facteurs, incluant le statut socioéconomique, qui ont une influence sur lʼintervalle de temps nécessaire pour présenter une requête à une agence médicolégale à la suite de lʼapparition de symptômes dʼasthme et de confirmer qu'un tel délai est associé à un moins bon pronostic respiratoire et à des coûts directs plus élevés. En outre, nous avons examiné la relation entre les variables cliniques et socio-économiques dʼune part et leur influence sur les facteurs psychologiques et économiques dʼautre part chez des travailleurs atteints d'AP. Ensuite, nous avons voulu évaluer si les individus souffrant de détresse psychologique (DP) et de morbidité psychiatrique pourraient être identifiés en utilisant un instrument mesurant la qualité de vie (QV). Lʼétude a été effectuée auprès dʼindividus ayant déposé des demandes d'indemnisation pourʼAP auprès du Commission de la sécurité et de la santé du travail du Québec (CSST). Les données ont été recueillies au moment de la réévaluation, soit environ deux ans et demi après le diagnostic. Outre la collecte des marqueurs cliniques de l'asthme, les individus ont été soumis à une évaluation générale de leur histoire sociodémographique et médicale, à une brève entrevue psychiatrique (évaluation des soins primaires des troubles mentaux, PRIME-MD) et à un ensemble de questionnaires, incluant le Questionnaire sur la qualité de vie - AQLQ(S), le Questionnaire respiratoire de St. George (SGRQ) et le Psychiatric Symptom Index (PSI).Soixante personnes ont été incluses dans l'étude. Etre plus âgé, avoir un revenu supérieur à 30 000$ CA etêtre atteint dʼAP dû à un allergène de haut poids moléculaire ont une association positive avec le nombre dʼannées dʼexposition avec symptômes avant le retrait. Au cours de la période de suivi, le nombre dʼannées dʼexposition avec symptômes était plus grand chez les individus ayant une hyperréactivité bronchique persistante. Par ailleurs, la présence de symptômes au poste de travail pendant moins d'un an est associée à une réduction des coûts directs. Les paramètres de QV et de DP avaient des corrélations modérées avec les marqueurs cliniques de lʼAP. Les plus fortes associations avec ces variables ont pu être observées dans les cas de la sévérité de l'asthme, des statuts dʼemploi et matrimonial, du revenu et de la durée de la période de travail avec l'employeur. Un seuil de 5,1 au niveau de la sous-échelle de la fonction émotionnelle de lʼAQLQ(S) sʼest avéré avoir la meilleure valeur discriminante pour distinguer les individus avec ou sans détresse psychiatrique cliniquement significative selon le PSI. Nous avons été en mesure d'identifier les variables socio-économiques associées à un intervalle plus long dʼexposition professionnelle en présence de symptômes dʼasthme. De même, une plus longue période d'exposition a été associée à un moins bon pronostic de la maladie et à des coûts de compensation plus élevés. Ces résultats s'avèrent utiles pour la surveillance de lʼAP qui pourrait cibler ces sous-groupes d'individus. La QV et la PS sont fréquemment réduites chez les individus atteints d'AP qui perçoivent une compensation. Elles sont associées à des marqueurs cliniques de lʼasthme et à des facteurs socio-économiques. En outre, nos résultats suggèrent que le questionnaire de lʼAQLQ(S) peut être utilisé pour identifier les individus avec un niveau de détresse psychologique potentiellement significatif.