Economic Evaluation 1

Einleitung / Introduction

HOMESIDE is a 12-week family carer training program to use music purposefully with people living with dementia at home. There is evidence that music therapy-based interventions are effective in reducing behavioural and psychological symptoms of dementia (BPSD) and increasing the quality of life (QoL) of the dyad (people living with dementia and their family carer). Usually, BPSD are managed with pharmacological interventions and represent a considerable burden for caregivers by the increased time spent in the care and the impact on their health and QoL. The HOMESIDE randomised controlled trial (RCT) will compare the effectiveness and cost-effectiveness of music interventions (MI) plus standard care (SC) compared to reading interventions plus SC and to SC alone. However, this study presents a preliminary examination of the resources used by dyads (co-habiting family caregivers and persons living with dementia) 30 days before the start of the trial.

Methode / Method

This trial is underway with 345 dyads enrolled from Australia, Germany, Norway, Poland and the UK (by 12 November 2021), expecting to finalise their data collection by December 2022. BPSD were measured by the Neuropsychiatric Inventory-Questionnaire (NPI-Q), and data from health resource use and time spent in the care collected using the Resource Use in Dementia (RUD) questionnaire.

Ergebnisse / Results

Family caregivers (mean age 63.9 +- 12.1, 80% female) were mainly spouses or partners (62.8%) and children (22.6%). Care recipients (mean age 76.8 +- 8.7, 54% male, 45.7% diagnosed with dementia 3.7 +- 3.6 years ago) presented an NPI-Q Severity score of 11.7 +- 4.7 at baseline, which can be found in moderate dementia stages. 49% of caregivers are the only caregivers for the person living with dementia, 37% have paid work, and 12% stopped working to care for their loved ones. These informal caregivers support daily activities such as feeding, bathing, and grooming in a mean of 2.2 +- 2.9 hours/day per 20.3 +- 13.4 days the 30 days before the interview. People living with dementia have an increase in health resource use, but also their caregivers: more than a half of the caregivers (51%) and 67.5% of the care recipients had at least one visit to a physician or other health specialist in the last 30 days, and 1.2% and 3.4% had hospitalisations respectively in the period.

Zusammenfassung / Conclusion

The snapshot of our baseline data highlights the significant impact on health and informal costs of caring for a person living with dementia even in their early stages, putting an additional burden on families and the health systems. The complete database will support the analysis of resource use and costs six months after starting the trial, in both active and control arms, across the five countries.

AutorInnen

Tanara Vieira Sousa, The University of Melbourne, Australia

Sven Warnke, Hochschule für angewandte Wissenschaften Würzburg-Schweinfurt, Germany

Anna A. Bukowska,, University of Physical Education, Poland

Helen Odell-Miller, Anglia Ruskin University, United Kingdom

Karette A. Sensaeth, Norwegian Academy of Music, Norway

Jeanette Tamplim, The University of Melbourne, Australia

Thomas Wosch, Hochschule für angewandte Wissenschaften Würzburg-Schweinfurt, Germany

Felicity A. Baker, The University of Melbourne, Australia

Einleitung / Introduction

Socially deprived urban districts are characterized by deficits in medical care, such as a lack of orientation of service offerings to the needs of socially disadvantaged population groups and “misplaced demand” of patients seeking medical care for social problems. These deficits can lead to an increased inadequate use of health care services like emergency care and higher risk for ambulatory care sensitive hospitalizations (ACSCs), resulting in increased healthcare cost. One much-discussed approach to addressing these problems are low-threshold integrated care models that link medical care with social care. Although there are numerous approaches to integrated care models, not all new care approaches can be financed within the framework of standard care against the background of limited health insurance budgets. Decision-makers therefore need robust evaluations to assess new approaches to care in order to decide which models should be made permanent. However, there is a paucity of research evaluating integrated care interventions in socially disadvantaged areas, and the results are characterized by methodological limitations. The aim of the study is to provide a robust evaluation of the impact of an integrated care model in a socially deprived area in Germany by overcoming methodological limitations of existing evaluation studies. In this study we focus on health care utilization outcomes, i.e. number of outpatient physician visits, hospitalizations, ACSCs, emergency admissions and expenditures, i.e. annual outpatient, inpatient and total costs.

Methode / Method

We use administrative data of three German sickness funds for the years 2015-2019. The sample contains data of 556.145 residents of Hamburg, of which 49.365 live in the intervention’s target area. We use Augmented Inverse Probability Weighting (AIPW), a doubly robust method based on estimating both the treatment and the outcome model, to estimate treatment effects. Treatment and outcome model are estimated using the Superlearner, a weighted ensemble of multiple base learners including both parametric and non-parametric approaches.

Ergebnisse / Results

Results of a subset of the data containing 10.000 randomly selected observations show no significant changes in care utilization outcomes. For health care expenditures outcomes, results indicate a significant reduction of inpatient costs (ATT = -268.87, p < 0.1).

Zusammenfassung / Conclusion

Preliminary results show that the model works and important limitations in the existing evaluation methodology could be overcome. The model will now be further extended and applied to the full sample. The results provide important decision support in the evaluation of new forms of care and make an innovative contribution to the further development of the evaluation methodology.

AutorInnen

Vanessa Ress, Hamburg Center for Health Economics (HCHE)

Eva Wild, Hamburg Center for Health Economics (HCHE)

Einleitung / Introduction

Import of medical supplies is common, but limited knowledge about import costs and their structure introduces uncertainty to budget planning, cost management, and cost-effectiveness analysis of health programs. We aimed to estimate the import costs of a tuberculosis (TB) program in Uzbekistan, including the import costs of specific imported items.

Methode / Method

We developed a framework that applies costing and cost accounting to import costs. First, transport costs, customs-related costs, cargo weight, unit weights, and quantities ordered were gathered for a major shipment of medical supplies from the Médecins Sans Frontières (MSF) Procurement Unit in Amsterdam, the Netherlands, to a TB program in Karakalpakstan, Uzbekistan, in 2016. Second, air freight, land freight, and customs clearance cost totals were estimated. Third, total import costs were allocated to different cargos (standard, cool, and frozen), items (e.g., TB drugs), and units (e.g., one tablet) based on imported weight and quantity. Data sources were order invoices, waybills, the local MSF logistics department, and an MSF standard product list.

Ergebnisse / Results

The shipment contained 1.8 million units of 85 medical items of standard, cool, and frozen cargo. The average import cost for the TB program was 9.0% of the shipment value. Import cost varied substantially between cargos (8.9–28% of the cargo value) and items (interquartile range 4.5–35% of the item value). The largest portion of the total import cost was caused by transport (82–99% of the cargo import cost) and allocated based on imported weight. Ten (14%) of the 69 items imported as standard cargo were associated with 85% of the standard cargo import cost. Standard cargo items could be grouped based on contributing to import costs predominantly through unit weight (e.g., fluids), imported quantity (e.g., tablets), or the combination of unit weight and imported quantity (e.g., items in powder form).

Zusammenfassung / Conclusion

The cost of importing medical supplies to a TB program in Karakalpakstan, Uzbekistan, was sizable, variable, and driven by a subset of imported items. The framework used to measure and account import costs can be adapted to other health programs.

AutorInnen

Stefan Kohler, Universität Heidelberg, Heidelberger Institut für Global Health

Norman Sitali, Médecins Sans Frontières, Berlin

Nicolas Paul, Universität Heidelberg, Heidelberger Institut für Global Health