Search

We examine the cost-effectiveness of treating epilepsy with anti-epileptic medicines in autistic children, looking at impacts on healthcare providers (in England, Ireland, Italy and Spain) and children's families (in Ireland). We find carbamazepine to be the most cost-effective drug to try first in children with newly diagnosed focal seizures. For England and Spain, oxcarbazepine is the most cost-effective treatment when taken as additional treatment for those children whose response to monotherapy is suboptimal. In Ireland and Italy, gabapentin is the most cost-effective option. Our additional scenario analysis presents the aggregate cost to families with autistic children who are being treated for epilepsy: this cost is considerably higher than healthcare provider expenditure.

The increase in the aged population led to a global rise in the demand for elderly healthcare services, such as long-term care facilities (LTCFs), nursing homes, residential homes. Unfortunately, the spread of multidrug-resistant organisms (MDROs) in these structures represent an urgent public health threat requiring immediate action. The aim of this review is to provide a practice guide for the prevention of infections in European LTCFs. A team of experts identify specific problems and proposed practical solutions for the management of colonized and infected patients residing in LTCFs. The heterogeneity of LTCF represents one of the main problems for the implementation of standardized surveillance and infection control programs. Crucial steps involved in the spread of infections among LTCF residents are represented by patient's accommodation, MDRO screening on admission, management of patients with rectal colonization by MDROs, management of patients at high risk of MDRO infections, MDRO transmission by staff and implementation of antimicrobial stewardship. Efforts to implement specific actions in each of these fields are required to reduce the infections in this setting. [ABSTRACT FROM AUTHOR]

Background: Parkinson's disease (PD) is a chronic progressive neurological disorder with a high psychosocial and economic burden. As part of the European Brain Council (EBC)‐led Value of Treatment project, this study aimed to capture the economic benefit of timely, adequate, and adherence to PD treatment. Methods: The EBC Value of Treatment Initiative combined different stakeholders to identify unmet needs in the patients' journey according to Rotterdam methodology. The economic evaluation focused on three major topics identified as major gaps: start of treatment; best treatment for advanced disease; and adherence to treatment. Two separate healthcare systems (Germany and the UK) were chosen. Cost‐effectiveness was determined by using decision‐analytical modelling approaches. Effectiveness was expressed as quality‐adjusted life‐years (QALYs) gained and incremental cost‐effectiveness ratio (ICER). Results: Treatment intervention in PD was found to be cost‐effective regardless of the initial health state of the patient receiving the treatment. Cost savings were between ‐€1000 and −€5400 with 0.10 QALY gain and ‐€1800 and ‐€7600 with 0.10 QALY gain for Germany and the UK, respectively. Treatment remains cost‐effective within the National Institute for Health and Care Excellence thresholds. Availability of adequate treatment to more patients was also found to be cost‐effective, with an ICER of €15,000–€32,600 across country settings. Achieving the target adherence to treatment would generate cost‐savings of €239,000–€576,000 (Germany) and €917,000–€2,980.000 (UK) for every 1,000 patients treated adequately. Conclusions: The analyses confirmed that timely, adequate, and adherence to PD treatment will not only improve care of the patients but is also cost‐effective across healthcare systems. Further studies with a distinct identification of gaps in care are necessary to develop better and affordable care. [ABSTRACT FROM AUTHOR]

Restless legs syndrome (RLS) is one of the most common neurological disorders. It describes an irresistible urge to move the legs, mostly manifested in the evening and at night, which can lead to severe sleep disturbance. As part of the European Brain Council (EBC)‐led Value‐of‐Treatment project, this study aimed at capturing the socioeconomic impact of RLS related to the inadequate diagnosis and treatment across different European healthcare settings. The economic burden of RLS was estimated using the published EBC framework of analysis in three separate European Union healthcare systems (France, Germany, and Italy). The RLS care pathway was mapped to identify the unmet needs of patients. Based on specific patient stories, the economic impact of correctly diagnosing RLS and changing between inadequate and target treatment was calculated using appropriate scenario analysis. RLS proved to be a significant personal and social burden, when epidemiological data, high prevalence of RLS, and its need for treatment are combined. By looking at the savings emerging from the provision of optimal care management (timely and correct diagnosis, evidence‐based therapy, avoidance of therapy‐related complications such as augmentation), the authors foresee substantial economic savings with the achievement of adequate diagnosis and treatment of RLS. Education about RLS is urgently needed for all subspecialties involved in RLS patient care as well as the general public. Equally important, the search for new causal treatment strategies should be intensified to reduce suffering and substantial societal cost. [ABSTRACT FROM AUTHOR]

Background and purpose: Idiopathic normal‐pressure hydrocephalus (iNPH) is a progressive, severe brain disorder, which mainly affects people above the age of 65 years. iNPH is characterized by the accumulation of excess cerebrospinal fluid in the brain's ventricles. In most cases, iNPH patients can be effectively treated with shunt surgery, which involves placing a tube into the brain to drain the excess fluid. As part of the European Brain Council‐led Value of Treatment project, this study aimed to investigate the cost‐effectiveness of delivering timely and adequate iNPH treatment in Germany. Methods: The study identified treatment gaps that prevent iNPH patients from receiving adequate and timely treatment. The cost‐effectiveness of delivering shunt surgery to iNPH‐prevalent patients aged ≥65 years in Germany was calculated using decision‐analytical modelling. The model compared two alternatives, current care (shunt surgery in 25% of iNPH cases) and target care (shunt surgery in 90% of iNPH cases), and looked at healthcare costs (diagnosis, shunt intervention and follow‐up care) from the public health insurance perspective, as well as effectiveness outcomes in terms of lives saved and quality‐adjusted life‐years (QALYs) gained. Results: Delivering timely and adequate iNPH treatment proved to be cost‐effective. Cost per life saved varied between €27 921 at 5 years and €246 726 at 15 years. Cost‐per‐QALY estimates varied between €10 202 at 5 years and €35 128 at 15 years. Conclusions: Idiopathic normal‐pressure hydrocephalus is a treatable but often not‐treated disease, resulting in unnecessary and avoidable disease burden for the healthcare system. Actions required to close this treatment gap are straightforward and their implementation has been modelled with successful outcomes. [ABSTRACT FROM AUTHOR]