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The prevalence of inflammatory bowel disease (IBD) is increasing. The total direct costs of IBD have not been assessed on a population-wide level in the era of biologic therapy. We identified all persons with IBD in Manitoba between 2005 and 2015, with each matched to 10 controls on age, sex, and area of residence. We enumerated all hospitalizations, outpatient visits and prescription medications including biologics, and their associated direct costs. Total and per capita annual IBD-attributable costs and health care utilization (HCU) were determined by taking the difference between the costs/HCU accrued by an IBD case and their controls. Generalized linear modeling was used to evaluate trends in direct costs and Poisson regression for trends in HCU. The number of people with IBD in Manitoba increased from 6,323 to 7,603 between 2005 and 2015. The total per capita annual costs attributable to IBD rose from $3,354 in 2005 to $7,801 in 2015, primarily driven by an increase in per capita annual anti-tumor necrosis factor costs, which rose from $181 in 2005 to $5,270 in 2015. There was a significant decline in inpatient costs for CD ($99 ± 25/yr. P < 0.0001), but not for ulcerative colitis ($8 increase ±$18/yr, P = 0.63). The direct health care costs attributable to IBD have more than doubled over the 10 years between 2005 and 2015, driven mostly by increasing expenditures on biological medications. IBD-attributable hospitalization costs have declined modestly over time for persons with CD, although no change was seen for patients with ulcerative colitis.

In an era of rapidly growing competition logistic customer service is growing increasingly important and is becoming a substantial factor in the success of companies operating in the market. Therefore, it is necessary to improve the components affecting the quality of customer service. Taking appropriate action in this regard, and thus preparing and implementing an appropriate logistic customer service strategy becomes important from the point of view of both the survival and development of enterprises, and to achieve sustainable competitive advantage. The aim of this study is to identify and evaluate determinants influencing consumers′ purchasing decisions in the area of logistics customer service. In addition, the article focuses on the development of solution proposals for enterprises to enable a better match the supply to the needs and preferences of customers. It is worth noting that the effectiveness and efficiency of operations in the field of logistic customer service is highly dependent on proper identification of needs and expectations of existing and potential buyers. Therefore, there is in this respect a need for permanent monitoring of the quality of service and customer expectations.

Early-onset aggressive behavior is known for its negative developmental consequences, and the associated high costs for families, the health care system and wider society. Although the origins of aggressive behavior are to be found in early childhood, the costs incurred by aggressive behavior of young children have not been studied extensively. The present study aimed to investigate whether preschool children with a high level of aggressive behavior already differ in the generated amount of costs and impact on family functioning from children with lower levels of aggressive behavior. A population-based sample of 317 preschool children was divided into four groups with different levels of aggression (moderate, borderline, clinical). Parents filled out questionnaires to assess service use (lifetime and past 3 months) and impact on family functioning. Over the past 3 months as well as over the first 4 years of life, children with a clinical level of aggression were more costly than children with a low level of aggression (mean total costs over the past 3 months: low = €167,05 versus clinical € = 1034,83 and mean lifetime costs: low € = 817,37 versus clinical € = 1433,04), due to higher costs of services used by the child. In addition, families of children with a borderline or clinical level of aggressive behavior reported more impairment in their daily functioning than families of children with lower levels of aggression. The findings demonstrate that a high level of aggressive behavior results in high costs and impaired family functioning in the preschool years already.

ObjectiveTo investigate the cost-effectiveness of early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma (PACG) compared to standard care.DesignCost-effectiveness analysis alongside a multicentre pragmatic two-arm randomised controlled trial. Patients were followed-up for 36 months, and data on health service usage and health state utility were collected and analysed within the trial time horizon. A Markov model was developed to extrapolate the results over a 5-year and 10-year time horizon.Setting22 hospital eye services in the UK.PopulationMales and females aged 50 years or over with newly diagnosed PACG or primary angle closure (PAC).InterventionsLens extraction compared to standard care (ie, laser iridotomy followed by medical therapy and glaucoma surgery).Outcome measuresCosts of primary and secondary healthcare usage (UK NHS perspective), quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER) for lens extraction versus standard care.ResultsThe mean age of participants was 67.5 (8.42), 57.5% were women, 44.6% had both eyes eligible, 1.4% were of Asian ethnicity and 35.4% had PAC. The mean health service costs were higher in patients randomised to lens extraction: £2467 vs £1486. The mean adjusted QALYs were also higher with early lens extraction: 2.602 vs 2.533. The ICER for lens extraction versus standard care was £14 284 per QALY gained at three years. Modelling suggests that the ICER may drop to £7090 per QALY gained by 5 years and that lens extraction may be cost saving by 10 years. Our results are generally robust to changes in the key input parameters and assumptions.ConclusionsWe find that lens extraction has a 67–89% chance of being cost-effective at 3 years and that it may be cost saving by 10 years.Trial registration numberISRCTN44464607; Results.

Background Direct healthcare costs of patients with symptomatic diverticular disease randomized for either laparoscopic or open elective sigmoid resection are compared. Cost-effectiveness analysis of the laparoscopic approach compared with open sigmoid resections is presented. Methods An economic evaluation of the randomized control Sigma trial was conducted, comparing elective laparoscopic sigmoid resection (LSR) to open sigmoid resection (OSR) in patients with symptomatic diverticulitis. Prospective registration of detailed intervention units per patient resulted in actual resource use per individual patient. To avoid distributional assumptions, the nonparametric bootstrap was applied. For the cost-effectiveness analysis, differences in total cost between LSR and OSR were compared with the differences in VAS pain score, SF-36 values for general health, and complication rate. Results The difference in total healthcare costs between the group that received LSR (€ 9969) and the group that received OSR (€ 9366) was not statistically significant. The slight increase in total costs was determined mainly by the significantly higher operation costs of LSR (€ 6663 vs. € 5306). Lower costs for hospitalization (€ 2983 vs. € 3598), blood products (€ 87 vs. € 240), paramedical services (€ 157 vs. € 278), and emergency attendance (€ 72 vs. € 115) in the LSR group partially compensated these increased operation costs. The incremental cost-effectiveness ratios (ICER) indicate that improvements in pain, quality of life, and complication rate could be achieved at limited costs. Conclusion Total healthcare costs of laparoscopic and open elective sigmoid resections for symptomatic diverticular disease are similar. As the clinical outcomes are in favor of the LSR group, candidates for an elective sigmoid resection should preferably be approached laparoscopically.

Objective: To develop a systematic set of German cost data in rheumatoid arthritis (RA) based solely on valid healthcare payer’s cost data sources. Methods: Retrospectively one year cost data of 338 patients with RA were generated and analysed. The cost data were derived from a major statutory health insurance plan (“Allgemeine Ortskrankenkasse Niedersachsen”) and the regional physicians’ association (“Kassenärztliche Vereinigung Niedersachsen”). The recently published matrix of cost domains in RA was applied to structure the analysis. Descriptive statistics were used to analyse the data. Results: The total direct costs for the 338 patients during one year (third quarter 2000 to second quarter 2001) were €3815 per patient-year. RA related direct costs were €2312 per patient-year. Outpatient costs accounted for 73.7%, inpatient costs for 24.0%, and other disease related costs for 2.3% of RA related direct costs. Outpatients cost drivers were RA related drugs (€1019 per patient-year), physician visits (€323 per patient-year), diagnostic and therapeutic procedures and tests (€185 per patient-year), and devices and aids (€168 per patient-year). 98 patients were retired prematurely owing to RA related work disability and incurred costs of €8358 per retired patient-year. 96 patients were gainfully employed and incurred sick leave costs of €2835 per employed patient-year. Conclusion: Micro-costing based on healthcare payer’s data provides a relatively conservative albeit highly accurate estimate of costs in RA. Both RA related and non-RA related costs must be taken into account. In gainfully employed patients and in patients who receive RA related retirement payments productivity costs exceed direct costs.

What transforms a desirable project on a government wish list to an attractive investment opportunity in the eyes of a potential private sector partner? This guide seeks to enhance the chances of developing effective partnerships between the public and the private sectors by addressing one of the main obstacles to the effective delivery of public-private partnership (PPP) projects: having the right information on the right project for the right partners at the right time. Data from the World Bank and the Public-Private Infrastructure Advisory Facility (PPIAF) private participation in infrastructure (PPI) project database indicate that private sector investment in infrastructure in developing economies grew steadily over the past decade. By 2007 the levels had finally surpassed the peak levels seen in 1997, the end of the previous growth spurt. This guide focuses specifically on what should be done, and when, in order to prepare projects to attract the right long-term private partners, procure their involvement, and manage the partnership. This guide is not a detailed project preparation manual; rather, it seeks to provide an overview of the process and what is involved so that greater realism can be applied to this challenging task and adequate resource plans can be developed.

Objectives. To estimate cost and outcomes of the Arthritis Foundation aquatic exercise classes from the societal perspective. Design. Randomized trial of 20-week aquatic classes. Cost per quality-adjusted life year (QALY) gained was estimated using trial data. Sample size was based on 80% power to reject the null hypothesis that the cost/QALY gained would not exceed $50,000. Subjects and Methods. Recruited 249 adults from Washington State aged 55 to 75 with a doctor-confirmed diagnosis of osteoarthritis to participate in aquatic classes. The Quality of Well-Being Scale (QWB) and Current Health Desirability Rating (CHDR) were used for economic evaluation, supplemented by the arthritis-specific Health Assessment Questionnaire (HAQ), Center for Epidemiologic Studies-Depression Scale (CES-D), and Perceived Quality of Life Scale (PQOL) collected at baseline and postclass. Outcome results applied to life expectancy tables were used to estimate QALYs. Use of health care facilities was assessed from diaries/questionnaires and Medicare reimbursement rates used to estimate costs. Nonparametric bootstrap sampling of costs/QALY ratios established the 95% CI around the estimates. Results. Aquatic exercisers reported equal (QWB) or better (CHDR, HAQ, PQOL) health-related quality of life compared with controls. Outcomes improved with regular class attendance. Costs/QALY gained discounted at 3% were $205,186 using the QWB and $32,643 using the CHRD. Conclusion. Aquatic exercise exceeded $50,000 per QALY gained using the community-weighted outcome but fell below this arbitrary budget constraint when using the participant-weighted measure. Confidence intervals around these ratios suggested wide variability of cost effectiveness of aquatic exercise.

Kigali, Rwanda lacks a centralized sewer system, which leaves residents to choose between on-site options; the majority of residents in informal settlements use pit latrines as their primary form of sanitation. When their pits fill, the pits are either sealed, or emptied; emptying is often done by hand and then dumped in the environment, putting the residents and the broader population at risk of infectious disease outbreaks. In this paper, we used revealed and stated preference models to: (1) estimate the demand curve for improved emptying services; and, (2) evaluate household preferences and the willingness to pay (WTP) for different attributes of improved emptying services. We also quantify the costs of improved service delivery at different scales of production. The study included 1167 households from Kigali, Rwanda across 30 geographic clusters. Our results show that, at a price of US $79 per pit, 15% of all the pits would be emptied by improved emptying services, roughly the current rate of manual emptying. Grouping empties by neighborhood and ensuring that each truck services an average of four households per day could reduce the production costs to US$ 44 per empty, ensuring full cost coverage at that price. At a lower price of US $24, we estimate that the sealing of pits might be fully eliminated, with full coverage of improved emptying services for all pits; this would require a relatively small subsidy of US$ 20 per empty. Our results show that households had strong preferences for fecal sludge (FS) treatment, formalized services (which include worker protections), and distant disposal. The results from the study indicate a few key policies and operational strategies that can be used for maximizing the inclusion of low-income households in safely managed sanitation services, while also incorporating household preferences and participation.

The exploding cost of health care in the United States is a source of widespread alarm. Similarly, the upward spiral of college tuition fees is cause for serious concern. In this concise and illuminating book, well-known economist William J. Baumol explores the causes of these seemingly intractable problems and offers a surprisingly simple explanation. Baumol identifies the \"cost disease\" as a major source of rapidly rising costs in service sectors of the economy. Once we understand that disease, he explains, effective responses become apparent.Baumol presents his analysis with characteristic clarity, tracing the fast-rising prices of health care and education in the U.S. and other major industrial nations, then examining the underlying causes of the phenomenon, which have to do with the nature of providing labor-intensive services. The news is good, Baumol reassures, because the nature of the disease is such that society will be able to afford the rising costs.