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Disability, rehabilitation and health economic assessment
Linköping University, The Tema Institute, Technology and Social Change. Linköping University, Faculty of Arts and Sciences.
2001 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Disability caused by long-term illnesses and diseases involves welfare losses through human suffering and huge societal costs. Rehabilitation of disabled individuals is a complex and growing field where health economic assessment studies could play a role in health policy and medical decision-making.

Aims: The overall aim was the application of a multidisdplinary framework of health economic assessment of rehabilitation technologies for disabled individuals. A specific aim was to examine the costs for some disabilitygroups, and another aim was to examine the cost-effectiveness of certain rehabilitation technologies for disabled individuals.

Methods: Six empirical studies were used. Cost analyses were applied to disabilities caused by long-term illnesses (Paper I), rheumatic· diseases (Paper II), and severe schiwphrenia (Paper III). A cost-effectivenessanalysis was performed on the rehabilitation of disabled patients with severe schizophrenia {Paper IV). Costutilily analyses were carried out on the rehabilitation of disabled patients with long-term illnesses (Paper V)and schizophrenia (Paper VI).

Results: The socioeconomic costs for the studied disability groups was SEK 1.9 billion for severe schizophrenia, SEK 25.6 billion for long term illness and SEK 62 billion for rheumatic diseases. The proportions of indirect productivity costs were considerable, 67-92% of total costs, and the social insurance expenditures were also high. Rehabilitation technologies based on co-operation between resource providers for disabled patients with schizophrenia improved health status by 26%, health-related quality of life by 27% and quality adjusted life years (QALY's). The costs for health care decreased significantly by 51% and sociely by 28%. Early rehabilitation of disabled patients with severe schizophrenia improved health status, social functioning and increased the health care costs. Rehabilitation of disabled patients with long-term illnesses did not improve health statu..~, quality of life and QALY's in the short run. The costs decreased for health care and the indirect costs increased. In optimizing the cost-effectiveness of rehabilitation technologies, disabled individuals must be precisely defined into homogeneous groups that match well-defined rehabilitation technologies. The costs for all resource providers in rehabilitation must be included in the cost concept in order to avoid underestimation of the socioeconomic costs. A financial analysis of transfer payments was valuable from a decision-maker perspective. The EuroQol-instrumem was sensitive in detecting significant changesin health status and health related qualily of life. One of the shortcomings in the study design i,s due to the lack of resources for health economic assessment studies. Long-term, randomized, controlled studies arc needed.

Conclusions: The application of the framework for health economic assessment to the rehabilitation of disabled individuals showed that the costs for disabilities in society were high, as was the proportion of indirectcosts. Co-operation among resource providers involved in rehabilitation can increase quality of life and save money for health care and society.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet , 2001. , 62 p.
Series
Linköping Studies in Arts and Science, ISSN 0282-9800 ; 239
Keyword [en]
Disability, Rehabilitation, Cost-effectiveness, Cost-Utility, Quality of Life
Keyword [sv]
Rehabilitering, Kostnadseffektivitet, Hälsoekonomi, Sjukvårdsekonomi, Livskvalitet
National Category
Social Sciences Interdisciplinary
Identifiers
URN: urn:nbn:se:liu:diva-35036Local ID: 24711ISBN: 91-7373-110-2 (print)OAI: oai:DiVA.org:liu-35036DiVA: diva2:255884
Public defence
2001-09-12, Berzeliussalen, Hälsouniversitetet, Linköping, 13:00 (Swedish)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2014-08-28Bibliographically approved
List of papers
1. The Cost of the Swedish Handicap Service System: Implications for Technology Assessment
Open this publication in new window or tab >>The Cost of the Swedish Handicap Service System: Implications for Technology Assessment
1995 (English)In: International Journal of Technology Assessment in Health Care, ISSN 0266-4623, E-ISSN 1471-6348, Vol. 11, no 2, 269-275 p.Article in journal (Refereed) Published
Abstract [en]

The total cost of the Swedish handicap system is estimated at US $ 10.7 billion for 1989. The cost is distributed across different authorities with separate legal and financial responsibility. The concept of technology must be extended to include consideration of both the resources spent and benefits gained in the public sector and the magnitude and distribution of transfer payments from social insurance to fulfill its function in handicap policy decision making.

National Category
Social Sciences Interdisciplinary
Identifiers
urn:nbn:se:liu:diva-79054 (URN)10.1017/S0266462300006887 (DOI)7790170 (PubMedID)
Available from: 2012-06-28 Created: 2012-06-28 Last updated: 2017-12-07Bibliographically approved
2. Socioeconomic costs of rheumatic diseases - Implications for technology assessment
Open this publication in new window or tab >>Socioeconomic costs of rheumatic diseases - Implications for technology assessment
2000 (English)In: International Journal of Technology Assessment in Health Care, ISSN 0266-4623, E-ISSN 1471-6348, Vol. 16, no 4, 1193-1200 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: To study the socioeconomic impact of rheumatic illness in Sweden and to discuss the consequences for technology assessment studies.

Methods: A cost-of-illness study based on data from official statistics and treatment studies.

Results: The total socioeconomic cost was 52 billion Swedish kronor (SEK) in 1994. The imbalance between direct (10% of total) and indirect costs (90effectiveness of the healthcare sector, the need for new treatment methods, appropriate information systems, and technology assessment studies as well as the institutional arrangements for rehabilitation and basic medical research.

Conclusions: A discussion of solutions for financial cooperation between county councils and regional social insurance offices should be considered. The new biotechnological pharmaceuticals will increase the cost for drugs in health care about 20 times, but the total socioeconomic cost for society may remain at the same level due to a decrease of inpatient costs and indirect costs for loss of production as well as a decrease of transfer payments from social insurance. It is unavoidable that the new pharmaceuticals require priority discussions and active resource allocation in health care and in other sectors of society.

Keyword
rheumatic diseases, socioeconomic, cost of illness, quality of life, rehabilitation
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-49490 (URN)11155838 (PubMedID)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-12Bibliographically approved
3. The socioeconomic cost of treatment of therapy-refractory schizophrenic patients in Sweden
Open this publication in new window or tab >>The socioeconomic cost of treatment of therapy-refractory schizophrenic patients in Sweden
1994 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 48, no 5, 311-313 p.Article in journal (Refereed) Published
Abstract [en]

The aim of the study is to examine the socioeconomic costs of treatment of therapy-refractory schizophrenic patients. The patients usually have a great need for health care and remain in institutions for long periods of time. The method is retrospective, and the data refer to patients who received treatment at the Department of Psychiatry, University Hospital in Linköping, Sweden in 1990. The total annual health care cost for treatment of therapy-refractory schizophrenia is estimated to be SEK 4.8 million (USD 1 = SEK 7.7). Inpatient care amounts to 93% of the total cost, and the cost of outpatient care to 6%. The cost of drugs and laboratory services corresponds to 1 % of the total cost. The high cost of inpatient care and the low cost of outpatient care may indicate that a redistribution of resources from inpatient to outpatient care is necessary. A generalization of the results indicates that the total annual cost of treating all therapy-refractory schizophrenic patients in Sweden is approximately SEK 1.9 billion. The result highlights the need for discussions concerning alternative treatment methods but also focuses on the importance of using health economic evaluations within psychiatry.

National Category
Social Sciences Interdisciplinary
Identifiers
urn:nbn:se:liu:diva-79060 (URN)10.3109/08039489409081366 (DOI)
Available from: 2012-06-28 Created: 2012-06-28 Last updated: 2017-12-07Bibliographically approved
4. Cost-effectiveness of clozapine treatment in therapy-refractory schizophrenia
Open this publication in new window or tab >>Cost-effectiveness of clozapine treatment in therapy-refractory schizophrenia
1995 (English)In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 92, no 3, 199-201 p.Article in journal (Refereed) Published
Abstract [en]

The costs and effects of clozapine treatment of refractory schizophrenic patients have been discussed recently. This study shows that 18 months of clozapine treatment results in an improvement of symptoms and social functioning in approximately 70% of treatment-refractory schizophrenic patients, compared with treatment with conventional neuroleptics during a similar period of time. Treatment with clozapine reduces the cost of inpatient care but places increased demands on active rehabilitation resources in outpatient care. This leads to increased total costs in a short-term perspective, but clozapine treatment is cost-saving for annual maintenance therapy. These costs must be weighed against the positive effects on psychotic symptoms and social functioning.

Keyword
schizophrenia, clozapine, cost-effectiveness
National Category
Social Sciences Interdisciplinary
Identifiers
urn:nbn:se:liu:diva-79065 (URN)10.1111/j.1600-0447.1995.tb09568.x (DOI)
Available from: 2012-06-28 Created: 2012-06-28 Last updated: 2017-12-07Bibliographically approved
5. Socio-Economic Analysis of Rehabilitation in Primary Health Care
Open this publication in new window or tab >>Socio-Economic Analysis of Rehabilitation in Primary Health Care
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Aims: The aim was to compare a new strategy for rehabilitation based on coordinated teamwork with traditional health care activities for patients with longterm illnesses in primary health care with respect to costs and health related quality of life.

Methods and data: This was a 3-month, prospective, controlled study in primary health care where a trial group of health care centers with rehabilitation teams (n=665) was compared with a control group of health care centers working with traditional health care activities without co-ordinated teams (n=665). The data collection was carried out for 12 months during the years 1993 and 1994 in 6 geographically defined areas. All individuals in the regions were consecutively included after being on sick leave for more than 30 days. The patients were followed upduring a period of three months using postal questionnaires. The analytical method was cost-utility analysis.

Results: The team based rehabilitation strategy did not improve health related quality of life (p=0.46) compared with traditional rehabilitation. The total costs for health care was 9% lower (p=0.51) and the indirect costs for loss of production was 8% higher (p=0.02) for the trial group. Social insurance expenditures were 9% higher for the trial group (p=0.14).

Discussion: It was not possible to form any reliable conclusions from this short term study about whether rehabilitation teams reduced health status and health related quality of life, as the differences were small but also negative. The perspective of analysis is important, from a health care perspective the teams were cost saving but from a broader socioeconomic perspective the teams lead to increased costs for society. The inclusion of indirect costs in cost-effectiveness analyses andcost-utility analyses requires further exploration. The time period was probably too short for capturing long-term effects.

Conclusions: Rehabilitation teams in primary health care do not improve health related quality of life within a short-term perspective, reduce costs for health care but increase indirect costs and social insurance expenditures compared with traditional health care activities. In order to improve quality of life for those with longterm illnesses and decrease society's costs for rehabilitation, rehabilitation strategiesfor people with different illnesses may be developed into more specialized strategies for specific patient groups, defined into homogenous treatment groups that matchwell-defined rehabilitation. For further research long-term studies are needed.

Keyword
Long-term illness, Rehabilitation, Socioeconomic, Cost-utility, Quality of life
National Category
Social Sciences Interdisciplinary
Identifiers
urn:nbn:se:liu:diva-79116 (URN)
Available from: 2012-06-29 Created: 2012-06-29 Last updated: 2012-06-29Bibliographically approved
6. Cost-Utility Analysis of Rehabilitation of Patients with Schizophrenia
Open this publication in new window or tab >>Cost-Utility Analysis of Rehabilitation of Patients with Schizophrenia
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: The socioeconomic cost for schizophrenia is high and there is a growing interest to consider the economic consequences of introducing new rehabilitation methods in health care and other sectors of society. In order to facilitate health policy making and medical decision-making in health care from a health economic perspective, broad socioeconomic evaluations of different rehabilitation methods for patients with schizophrenia are necessary.

Aims of the study: To compare two rehabilitation strategies for patients with schizophrenia in Sweden. The new method of rehabilitation was based on interagency co-operation and teamwork involving the county council, local authorities, labor market policy agencies and the social insurance office. The alternative treatment method was traditional rehabilitation activities. The rehabilitation methods were compared with respect to differences in socioeconomic costs, transfer payments and quality of life.

Methods: It was a pre/post intervention cohort study in Sweden conducted in 1998. Data were gathered prospectively by postal questionnaires from 52 consecutively included, unemployed schizophrenic patients during a period of 6 months before and 6 months after a rehabilitation intervention. The patients had been ill for five years on average. The mean age was 29 years and the proportion of women was 56%. Data on costs, transfer payments and quality of life (EuroQol) were registered.The analytical method used was cost-utility analysis.

Results: The new rehabilitation program improved health status by 26% (p=0.007) and health related quality of life by 27% (p=0.0002), which corresponded with a change in quality adjusted life years. The total socioeconomic costs decreased, by 28% (p=0.018), SEK 19 000 per patient. The healthcare costs decreased by 51% (p=0.005) and the costs for the labor market policy agencies decreased by 90% (p=0.004). There were no significant changes in costs for the local authorities and the social insurance oflice at the 5% level. There were no changes in transfer pay- .ments at the 5% level, SEK 49 000/patient.

Discussion: The co-operative strategy in the rehabilitation of patients with schizophrenia was cost-effective for health care and society. The cohort design allowed for some uncertainty over time. However, the patients' health status had been constant for a long period before the intervention, so the impact is minimized. In order to study long-term changes in social insurance expenditures and indirect costs, the time period for the studies must be longer.

Conclusion: Interagency co-operation in rehabilitation saved money for health care and society and improved health status, health related quality of life and quality adjusted life years. It is necessary to discuss the principles for shared financial responsibility as well as incentives for monitoring resource allocations in the field of rehabilitation. Additional studies, preferably long-term, randomized, controlled trials, are needed. In the search for predictors of cost-effective rehabilitation technologies,studies of the impact of motivation on costs and quality of life are useful.

Keyword
Mental illness, Schizophrenia, Rehabilitation, Cost-Utility, Quality of Life
National Category
Social Sciences Interdisciplinary
Identifiers
urn:nbn:se:liu:diva-79118 (URN)
Available from: 2012-06-29 Created: 2012-06-29 Last updated: 2012-06-29Bibliographically approved

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