Skip to main content
Erschienen in: Applied Health Economics and Health Policy 4/2013

01.08.2013 | Original Research Article

Explaining the Health Costs Associated with Managing Intracranial Aneurysms in Italy

verfasst von: Stefano Calciolari, Aleksandra Torbica, Rosanna Tarricone

Erschienen in: Applied Health Economics and Health Policy | Ausgabe 4/2013

Einloggen, um Zugang zu erhalten

Abstract

Background

The clinical management of intracranial aneurysms is debated in many countries because of the associated disability risk and costs. Therefore, estimating the costs and explaining their variability will provide important information for decision makers.

Objective

We aimed to evaluate the acute and post-acute health costs of intracranial aneurysm management and to explain the variability in these costs in the Italian National Health System.

Methods

An observational study was conducted on 145 patients who were affected by a (single) ruptured or an unruptured intracranial aneurysm. They were consecutively admitted to 14 Italian hospitals between October 2005 and March 2007. The data collected during the initial hospitalization and three follow-up visits were used to assess the 1-year health costs and the patients’ health status after discharge. Two multivariate regression models were used to explain the variability in the acute and post-acute costs.

Results

The average total cost per patient was €30,813 (evaluation year: 2012). The first model explained the acute costs fairly well and showed that the severity of illness, the admission unit (i.e., intensive care unit vs. another unit of the hospital), and mortality were associated with large, significant (p < 0.05) coefficients. The second model outperformed the first one in explaining the post-acute costs and showed that health status assessed 30 days after discharge was a significant (p < 0.05) predictor of costs.

Conclusion

Policies aimed at containing health costs should focus on interventions that help to reduce disability, which is a key predictor of long-term costs.
Anhänge
Nur mit Berechtigung zugänglich
Fußnoten
1
ICU versus another unit in the hospital.
 
2
The mRS is a disease-specific scale that is widely used with stroke patients to define clinically discrete disability categories. This outcome measure does not include the ‘death’ status.
 
3
The model explains about 48 % of the variability by including the health status assessed 12 months after discharge, though this time period would make the model’s estimates strictly retrospective.
 
4
We refer to discharge records of the Ministry of Health (http://​www.​salute.​gov.​it).
 
Literatur
2.
Zurück zum Zitat Leal J, Luengo-Fernández R, Gray A, Petersen S, Rayner M. Economic burden of cardiovascular diseases in the enlarged European Union. Eur Heart J. 2006;27(13):1610–9.PubMedCrossRef Leal J, Luengo-Fernández R, Gray A, Petersen S, Rayner M. Economic burden of cardiovascular diseases in the enlarged European Union. Eur Heart J. 2006;27(13):1610–9.PubMedCrossRef
3.
Zurück zum Zitat Laloux P. Cost of acute stroke: a review. Acta Neurol Belg. 2003;103(2):71–7.PubMed Laloux P. Cost of acute stroke: a review. Acta Neurol Belg. 2003;103(2):71–7.PubMed
4.
Zurück zum Zitat Payne KA, Huybrechts KF, Caro JJ, Craig Green TJ, Klittich WS. Long term cost-of-illness in stroke: an international review. Pharmacoeconomics. 2002;20(12):813–25.PubMedCrossRef Payne KA, Huybrechts KF, Caro JJ, Craig Green TJ, Klittich WS. Long term cost-of-illness in stroke: an international review. Pharmacoeconomics. 2002;20(12):813–25.PubMedCrossRef
5.
Zurück zum Zitat Evers SM, Struijs JN, Ament AJ, van Genugten ML, Jager JH, van den Bos GA. International comparison of stroke cost studies. Stroke. 2004;35(5):1209–15.PubMedCrossRef Evers SM, Struijs JN, Ament AJ, van Genugten ML, Jager JH, van den Bos GA. International comparison of stroke cost studies. Stroke. 2004;35(5):1209–15.PubMedCrossRef
6.
Zurück zum Zitat Dawson J, Lees JS, Chang TP, Walters MR, Ali M, Davis SM, et al. Association between disability measures and healthcare costs after initial treatment for acute stroke. Stroke. 2007;38(6):1893–8.PubMedCrossRef Dawson J, Lees JS, Chang TP, Walters MR, Ali M, Davis SM, et al. Association between disability measures and healthcare costs after initial treatment for acute stroke. Stroke. 2007;38(6):1893–8.PubMedCrossRef
7.
Zurück zum Zitat Spieler JF, Lanoe JL, Amarenco P. Costs of stroke care according to handicap levels and stroke subtypes. Cerebrovasc Dis. 2004;17(2–3):134–42.PubMedCrossRef Spieler JF, Lanoe JL, Amarenco P. Costs of stroke care according to handicap levels and stroke subtypes. Cerebrovasc Dis. 2004;17(2–3):134–42.PubMedCrossRef
8.
Zurück zum Zitat Spratt N, Wang Y, Levi C, Ng K, Evans M, Fisher J. A prospective study of predictors of prolonged hospital stay and disability after stroke. J Clin Neurosci. 2003;10(6):665–9.PubMedCrossRef Spratt N, Wang Y, Levi C, Ng K, Evans M, Fisher J. A prospective study of predictors of prolonged hospital stay and disability after stroke. J Clin Neurosci. 2003;10(6):665–9.PubMedCrossRef
9.
Zurück zum Zitat Christensen MC, Morris S. Association between disability measures and short-term health care costs following intracerebral hemorrhage. Neurocrit Care. 2008;9(3):313–8.PubMedCrossRef Christensen MC, Morris S. Association between disability measures and short-term health care costs following intracerebral hemorrhage. Neurocrit Care. 2008;9(3):313–8.PubMedCrossRef
10.
Zurück zum Zitat Rinkel GJE, Djibuti M, Algra A, Van Gijn J. Prevalence and risk of rupture of intracranial aneurysms: a systematic review. Stroke. 1998;29:251–6.PubMedCrossRef Rinkel GJE, Djibuti M, Algra A, Van Gijn J. Prevalence and risk of rupture of intracranial aneurysms: a systematic review. Stroke. 1998;29:251–6.PubMedCrossRef
11.
Zurück zum Zitat Higashida RT, Lahue BJ, Torbey MT, Hopkins LN, Leip E, Hanley DF. Treatment of unruptured intracranial aneurysms: a nationwide assessment of effectiveness. Am J Neuroradiol. 2007;28:146–51.PubMed Higashida RT, Lahue BJ, Torbey MT, Hopkins LN, Leip E, Hanley DF. Treatment of unruptured intracranial aneurysms: a nationwide assessment of effectiveness. Am J Neuroradiol. 2007;28:146–51.PubMed
12.
Zurück zum Zitat Dodel R, Winter Y, Ringel F, Spottke A, Gharevi N, Müller I, et al. Cost of illness in subarachnoid hemorrhage: a German longitudinal study. Stroke. 2010;41(12):2918–23.PubMedCrossRef Dodel R, Winter Y, Ringel F, Spottke A, Gharevi N, Müller I, et al. Cost of illness in subarachnoid hemorrhage: a German longitudinal study. Stroke. 2010;41(12):2918–23.PubMedCrossRef
13.
Zurück zum Zitat Raja PV, Huang J, Germanwala AV, Gailloud P, Murphy KP, Tamargo RJ. Microsurgical clipping and endovascular coiling of intracranial aneurysms: a critical review of the literature. Neurosurgery 2008;62(6):1187–202; discussion 202–3. Raja PV, Huang J, Germanwala AV, Gailloud P, Murphy KP, Tamargo RJ. Microsurgical clipping and endovascular coiling of intracranial aneurysms: a critical review of the literature. Neurosurgery 2008;62(6):1187–202; discussion 202–3.
14.
Zurück zum Zitat Birkmeyer J, Siewers A, Finlayson E, Stukel T, Lucas F, Batista I, et al. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346(15):1128–37.PubMedCrossRef Birkmeyer J, Siewers A, Finlayson E, Stukel T, Lucas F, Batista I, et al. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346(15):1128–37.PubMedCrossRef
15.
Zurück zum Zitat Tarricone R. Cost-of-illness analysis: what room in health economics. Health Policy. 2006;77(1):51–63.PubMedCrossRef Tarricone R. Cost-of-illness analysis: what room in health economics. Health Policy. 2006;77(1):51–63.PubMedCrossRef
16.
Zurück zum Zitat Roos YBWEM, Dijkgraaf MGW, Albrecht KW, Beenen LFM, Groen RJM, De Haan RJ, et al. Direct costs of modern treatment of aneurysmal subarachnoid haemorrhage in the first year after diagnosis. Stroke. 2002;33:1595–9.PubMedCrossRef Roos YBWEM, Dijkgraaf MGW, Albrecht KW, Beenen LFM, Groen RJM, De Haan RJ, et al. Direct costs of modern treatment of aneurysmal subarachnoid haemorrhage in the first year after diagnosis. Stroke. 2002;33:1595–9.PubMedCrossRef
17.
Zurück zum Zitat Caro JJ, Huybrechts KF, Kelley HE. Predicting treatment costs after acute ischemic stroke on the basis of patient characteristics at presentation and early dysfunction. Stroke. 2001;32:100–6.PubMedCrossRef Caro JJ, Huybrechts KF, Kelley HE. Predicting treatment costs after acute ischemic stroke on the basis of patient characteristics at presentation and early dysfunction. Stroke. 2001;32:100–6.PubMedCrossRef
18.
Zurück zum Zitat Marques de Sa J. Applied statistics using SPSS, STATISTICA and MATLAB. Berlin: Springer; 2003. Marques de Sa J. Applied statistics using SPSS, STATISTICA and MATLAB. Berlin: Springer; 2003.
19.
Zurück zum Zitat Fox J. Applied regression analysis, linear models and related methods. Thousand Oaks: Sage; 1997. Fox J. Applied regression analysis, linear models and related methods. Thousand Oaks: Sage; 1997.
20.
Zurück zum Zitat Zivot E, Wang J. Modelling financial time series with S-PLUS. Boston: Birkhauser; 2006. Zivot E, Wang J. Modelling financial time series with S-PLUS. Boston: Birkhauser; 2006.
21.
Zurück zum Zitat Baum C. An introduction to modern econometrics using Stata. College Station: Stata Press; 2006. Baum C. An introduction to modern econometrics using Stata. College Station: Stata Press; 2006.
22.
Zurück zum Zitat White H. A heteroskedasticity-consistent covariance matrix estimator and a direct test for heteroskedasticity. Econometrica. 1980;48(4):817–38.CrossRef White H. A heteroskedasticity-consistent covariance matrix estimator and a direct test for heteroskedasticity. Econometrica. 1980;48(4):817–38.CrossRef
23.
Zurück zum Zitat Manning WG, Basu A, Mullahy J. Generalized modeling approaches to risk adjustment of skewed outcomes data. J Health Econ. 2005;24(3):465–88.PubMedCrossRef Manning WG, Basu A, Mullahy J. Generalized modeling approaches to risk adjustment of skewed outcomes data. J Health Econ. 2005;24(3):465–88.PubMedCrossRef
24.
Zurück zum Zitat Manning WG, Mullahy J. Estimating log models: to transform or not to transform. J Health Econ. 2001;20(4):461–94.PubMedCrossRef Manning WG, Mullahy J. Estimating log models: to transform or not to transform. J Health Econ. 2001;20(4):461–94.PubMedCrossRef
25.
Zurück zum Zitat Buccoliero L, Calciolari S, Marsilio M. A methodological and operative framework for the evaluation of an e-health project. Int J Health Plan Manag. 2008;23(1):3–20.CrossRef Buccoliero L, Calciolari S, Marsilio M. A methodological and operative framework for the evaluation of an e-health project. Int J Health Plan Manag. 2008;23(1):3–20.CrossRef
26.
Zurück zum Zitat Drummond M, Griffin A, Tarricone R. Economic evaluation for devices and drugs—same or different? Value Health. 2009;12(4):402–4.PubMedCrossRef Drummond M, Griffin A, Tarricone R. Economic evaluation for devices and drugs—same or different? Value Health. 2009;12(4):402–4.PubMedCrossRef
27.
Zurück zum Zitat Fattore G, Torbica A. Economic evaluation in health care: the point of view of informed physicians. Value Health. 2006;9(3):157–67.PubMedCrossRef Fattore G, Torbica A. Economic evaluation in health care: the point of view of informed physicians. Value Health. 2006;9(3):157–67.PubMedCrossRef
28.
Zurück zum Zitat Sorenson C, Tarricone R, Siebert M, Drummond M. Applying health economics for policy decision making: do devices differ from drugs? Europace. 2011;13(Suppl 2):1154–8.CrossRef Sorenson C, Tarricone R, Siebert M, Drummond M. Applying health economics for policy decision making: do devices differ from drugs? Europace. 2011;13(Suppl 2):1154–8.CrossRef
29.
Zurück zum Zitat Anand SS, Yusuf S. Stemming the global tsunami of cardiovascular disease. Lancet. 2011;377(9765):529–32.PubMedCrossRef Anand SS, Yusuf S. Stemming the global tsunami of cardiovascular disease. Lancet. 2011;377(9765):529–32.PubMedCrossRef
30.
Zurück zum Zitat Ciani O, Tarricone R, Torbica A. Diffusion and use of health technology assessment in policy making: What lessons for decentralised healthcare systems? Health Policy. 2012;108(2-3):194-202. Ciani O, Tarricone R, Torbica A. Diffusion and use of health technology assessment in policy making: What lessons for decentralised healthcare systems? Health Policy. 2012;108(2-3):194-202.
Metadaten
Titel
Explaining the Health Costs Associated with Managing Intracranial Aneurysms in Italy
verfasst von
Stefano Calciolari
Aleksandra Torbica
Rosanna Tarricone
Publikationsdatum
01.08.2013
Verlag
Springer International Publishing
Erschienen in
Applied Health Economics and Health Policy / Ausgabe 4/2013
Print ISSN: 1175-5652
Elektronische ISSN: 1179-1896
DOI
https://doi.org/10.1007/s40258-013-0041-1

Weitere Artikel der Ausgabe 4/2013

Applied Health Economics and Health Policy 4/2013 Zur Ausgabe