Ja O'Brien

POT3 COST OF HOSPITALIZATIONS FOR ACUTE INJURIES RESULTING FROM MOTORCYCLE ACCIDENTS PRE-AND POST-REPEAL OF THE UNIVERSAL HELMET LAW IN FLORIDA

POS14 HOME AUTOMATED TELEMANAGEMENT IN POST-HIP FRACTURE REHABILITATION Finkelstein J, Joshi A, Rozmarin E, Baumgarten M University of Maryland, Baltimore, MD, USA OBJECTIVES: The objective of the study is to assess the feasibility and acceptance of computer-mediated home-based rehabilitation of hip fracture patients. METHODS: A structured exercise program was developed by a physical therapist (PT) and incorporated into a website where the PT could prescribe, monitor, and modify an individualized exercise plan. The patients were given a laptop computer that was operated by a limited number of keys. The computer guided the patients through their exercise programs and sent daily exercise logs to a central server which analyzed patient performance and alerted the PT if certain clinical condition were met. Overall, ten patients were enrolled in the study who were monitored for 30 days. RESULTS: The average age of the subjects was 76 ± 9 years in whom number of days since hip fracture was 159 ± 143. There was a significant improvement from the beginning to the end of the study in exercise self-efficacy (6 ± 3 vs. 9 ± 1; p = 0.01), Lower Extremity Functional Scale (55 ± 16 vs. 63 ± 13; p = 0.03), and quality of life scale (SF-36) including physical functioning (38 ± 27 vs. 71 ± 31; p = 0.009), physical problems limitations (6 ± 10 vs. 17 ± 12; p = 0.05), social functioning (54 ± 31 vs. 85 ± 28; p = 0.01) and health transition (47 ± 40 vs. 22 ± 18; p = 0.05). Using Yale Physical Activity Survey we found improvement in physical intensity measured as total hours/week (24 ± 14 vs. 31 ± 14; p = 0.04). Based on the Client Satisfaction Questionnaire (CSQ-8), patient satisfaction with their medical care also improved (27 ± 4 vs. 31 ± 0.46; p = 0.04). Adherence to the exercises was above 89%. CONCLUSION: Computer-mediated home-based rehabilitation program could be beneficial for postacute hip fracture recovery.

PHP30 USE OF EMERGENCY DEPARTMENTS BY HOMELESS PERSONS FOR NON-EMERGENCY CARE DURING ONEYEAR: RESOURCE USE AND COST

reports of incremental results, sensitivity analysis, and mention of caveats. Outright budget impact models were not evaluated. RESULTS: Of 35 dossiers submitted during 2003, 27 (77%) included economic models. Of these, model type was justified in 8 (29%); time horizon stated in 22 (82%); discount rate stated in 5 (19%); relevance of productivity changes discussed in 1 (4%) but reported in none; resource quantities reported separately in 3 (11%); relevant alternatives compared in 11 (41%); incremental results reported in 5 (19%); some form of sensitivity analysis in 15 (56%); caveats to conclusions mentioned in 4 (15%).Models of me-too drugs were significantly less likely to report comparisons against relevant alternatives (OR = 0.08, p = 0.011) or incremental results (OR = 0.07, p = 0.03). No other significant differences were found. CONCLUSIONS: Most dossiers submitted to one health plan in 2003 under the AMCP Format contained economic models. Models had low levels of compliance with broadly accepted recommendations. Models of me-too drugs may be particularly prone to bias.

PHP7 MANAGING ACUTE INJURIES RESULTING FROM MOTORCYCLE ACCIDENTS: EMERGENCY DEPARTMENT AND INPATIENT HOSPITAL RESOURCE USE AND COSTS

in Finland since 1980 and also slightly from 1990, but real prices have constantly decreased. Depending from the adjustment index used, the real prices of all drugs have decreased 35–67% since 1980, or 16–40% since 1990. For reimbursed drugs the development was similar; in Basic Refund category real prices have decreased 24–46% since 1990, and even 45–72% since 1980. Since the effectiveness of drugs has not decreased during the time period studied, we suggest that the cost-effectiveness of drug treatment has clearly increased in Finland.

PHP10 EMERGENCY DEPARTMENT VISITS FOR INJURIES RESULTING FROM BICYCLE ACCIDENTS: TIME, TYPE AND COST OF INJURY

security and several private insurance agencies. The regulatory and functional differences between those agencies make drug reimbursement regulations complicated for the health care professionals and patients. Turkish Society of Clinical Pharmacology organized a three-day meeting with all stakeholders (parliamentarians, academicians, Ministry of Health, Ministry of Finance, State Planning Organization, international and local drug industry representatives and social security institutions, medical and pharmacist associations) for discussion of the present reimbursement system and its future. METHODS: Discussion was performed in six steps. First, representatives of the stakeholders presented their own policies and problems. Second, a brainstorm was performed. All the ideas were recorded as a consensus text in the third step. The next day, participants were divided into four groups to evaluate the text at a round table discussion. Finally, collecting all the suggestions, the consensus text was rewritten and distributed to the representatives after the meeting to ask for their approval. RESULTS: All stake holders, except multinational drug companies, were agreeing to use national pharmacoeconomic data for reimbursement issues. Other main outcomes of this consensus meeting accepted by all the representatives were as follows: All health care professionals should get enough education to establish the rational use of drugs. An autarchic “National Drug Institution” should be built. CONCLUSIONS: A “Reimbursement Commission” should be built with the participation of all representatives and should work for the standardization of reference drug prices. State funded social insurance systems should be kept under one valid insurance system. OTC drug definition and the OTC drug list should be defined clearly, and preventive therapy such as vaccination should be reimbursed in full.

PMH41 SUICIDE ATTEMPTS BY THE ELDERLY: HOSPITAL RESOURCE USE AND COSTS

included drug cost and the reduced compliance of medication by methylphenidate users (61%) versus AMP/DEX users (86%) and the AMP/DEX response rate. CONCLUSIONS: Generic Adderall is the dominant strategy over generic Ritalin given that compliance and side effect rates are consistently higher for generic Adderall. However, it is difficult to make strong generalizations about cost-effectiveness between therapies given the overlapping efficacy rates and similar side effect profiles of competing treatments as reported in the literature. Clinicians should find it appropriate to initiate stimulants in the short term regardless of the specific agent available.