1. SOCIOECONOMIC COSTS OF RHEUMATIC DISEASES Implications for Technology Assessment
- Author
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Magnus Husberg and Dick Jonsson
- Subjects
Sweden ,Gerontology ,medicine.medical_specialty ,Technology Assessment, Biomedical ,Rehabilitation ,business.industry ,Total cost ,Cost-Benefit Analysis ,Health Policy ,medicine.medical_treatment ,Public health ,Quality-adjusted life year ,Indirect costs ,Quality of life (healthcare) ,Cost of Illness ,Socioeconomic Factors ,Rheumatic Diseases ,Health care ,medicine ,Humans ,business ,health care economics and organizations ,Health policy - Abstract
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.
- Published
- 2000