Abstract

The administration of insulin by a carer or healthcare professional is associated with a risk of needlestick injury. Such injuries create a burden for carers and professionals in terms of anxiety, stress and morbidity as well as the NHS in terms of lost productivity, treatment costs and litigation. This study estimates the economic burden of these injuries to the NHS in the UK based on published estimates of the incidence and cost of needlestick injuries. The findings suggest that such injuries cost the NHS approximately 600,000 pounds sterling per annum. Many of these injuries and their associated costs could be avoided through increased adoption of safety devices. Indeed, evidence suggests that the increased acquisition cost of safety devices could be more than offset by savings resulting from the reduced incidence of needlestick injuries. Trusts are encouraged to implement improved monitoring and surveillance procedures to inform the debate on the appropriate use of safety devices.

Abstract

OBJECTIVES: Prescribed medications represent a high and increasing proportion of UK health care funds. Our aim was to quantify the influence of body mass index (BMI) on prescribing costs, and then the potential savings attached to implementing a weight management intervention.

METHODS: Paper and computer-based medical records were reviewed for all drug prescriptions over an 18-month period for 3400 randomly selected adult patients (18-75 years) stratified by BMI, from 23 primary care practices in seven UK regions. Drug costs from the British National Formulary at the time of the review were used. Multivariate regression analysis was applied to estimate the cost for all drugs and the 'top ten' drugs at each BMI point. This allowed the total and attributable prescribing costs to be estimated at any BMI. Weight loss outcomes achieved in a weight management programme (Counterweight) were used to model potential effects of weight change on drug costs. Anticipated savings were then compared with the cost programme delivery. Analysis was carried out on patients with follow-up data at 12 and 24 months as well as on an intention-to-treat basis. Outcomes from Counterweight were based on the observed lost to follow-up rate of 50%, and the assumption that those patients would continue a generally observed weight gain of 1 kg per year from baseline.

RESULTS: The minimum annual cost of all drug prescriptions at BMI 20 kg/m(2) was pound 50.71 for men and pound 62.59 for women. Costs were greater by pound 5.27 (men) and pound 4.20 (women) for each unit increase in BMI, to a BMI of 25 (men pound 77.04, women pound 78.91), then by pound 7.78 and pound 5.53, respectively, to BMI 30 (men pound 115.93 women pound 111.23), then by pound 8.27 and pound 4.95 to BMI 40 (men pound 198.66, women pound 160.73). The relationship between increasing BMI and costs for the top ten drugs was more pronounced. Minimum costs were at a BMI of 20 (men pound 8.45, women pound 7.80), substantially greater at BMI 30 (men pound 23.98, women pound 16.72) and highest at BMI 40 (men pound 63.59, women pound 27.16). Attributable cost of overweight and obesity accounted for 23% of spending on all drugs with 16% attributable to obesity. The cost of the programme was estimated to be approximately pound 60 per patient entered. Modelling weight reductions achieved by the Counterweight weight management programme would potentially reduce prescribing costs by pound 6.35 (men) and pound 3.75 (women) or around 8% of programme costs at one year, and by pound 12.58 and pound 8.70, respectively, or 18% of programme costs after two years of intervention. Potential savings would be increased to around 22% of the cost of the programme at year one with full patient retention and follow-up.

CONCLUSION: Drug prescriptions rise from a minimum at BMI of 20 kg/m(2) and steeply above BMI 30 kg/m(2). An effective weight management programme in primary care could potentially reduce prescription costs and lead to substantial cost avoidance, such that at least 8% of the programme delivery cost would be recouped from prescribing savings alone in the first year.

Abstract

Vacuum-assisted closure (V.A.C.) Therapy (KCI International, San Antonio, TX) has been widely used in hospital settings. However, use of V.A.C.) Therapy in home health settings outside of the United States of America (USA) is often limited because of financial considerations. This review paper considers the published evidence on V.A.C. Therapy in home health settings from the USA and beyond and explores the potential economic implications of V.A.C. Therapy in home health settings.

Abstract

The aim of this study was to review the feasibility of using vacuum-assisted closure (V.A.C.) Therapy for the management of surgical and traumatic wounds in the home care settings in the Netherlands. De-identified patient data were collected from a health insurance database in the Netherlands. All patients with complete records, including indication, age, duration of therapy and defined treatment goal between January and November 2006 were included. Data from 338 patients were analysed. On average, wounds had been present for 2 months before start of V.A.C. Therapy. Overall, 74% of patients reached the pre-defined therapy goal (77% for dehisced wounds, 68% for abdominal wounds, 73% for traumatic wounds and 91% for sternal wounds) with approximately 1 month of V.A.C. Therapy. There was a negative association between the wound duration prior to V.A.C. Therapy and the treatment success rate (r = -0.162, P = 0.003). Wounds with shorter duration (6 months prior to V.A.C. Therapy. V.A.C. Therapy is a feasible and effective treatment for surgical and traumatic wounds in home care patients with over 70% of patients treated in this sample achieving pre-defined treatment goals. The success rate of V.A.C. Therapy is negatively associated with the duration of the wound before V.A.C. Therapy is commenced.

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Abstract

OBJECTIVE: To estimate the yield from searching a range of bibliographic databases and additional sources to identify test accuracy studies for systematic reviews.

STUDY DEISGN AND SETTING: We examined eight systematic reviews and their database searches: MEDLINE, EMBASE, BIOSIS, Science Citation Index, LILACS, Pascal, and CENTRAL. We used studies included in each systematic review as the "gold standard," against which yield was estimated. For each database, we classified studies in each gold standard set as being (1) included in the database and identified by searches, (2) included and not identified, and (3) not included in the database.

RESULTS: No search identified all studies in any gold standard set. EMBASE, Science Citation Index, and BIOSIS contained studies that were not on MEDLINE. Over 20% of studies in the gold standard sets were not identified by searching MEDLINE. Six studies on LILACS were not on any other database. Eight gold standard studies were not included in any of the databases, and a further 22 were not identified by the electronic search strategies.

CONCLUSIONS: Systematic reviews of test accuracy studies should search a range of databases. Even searches designed to be very sensitive, that do not use study design filters, can fail to identify relevant studies.