Marie Kruse

Lifetime costs of cerebral palsy

This study quantified the lifetime costs of cerebral palsy (CP) in a register‐based setting. It was the first study outside the US to assess the lifetime costs of CP. The lifetime costs attributable to CP were divided into three categories: health care costs, productivity costs, and social costs. The population analysed was retrieved from the Danish Cerebral Palsy Register, which covers the eastern part of the country and has registered about half of the Danish population of individuals with CP since 1950. For this study we analysed 2367 individuals with CP, who were born in 1930 to 2000 and were alive in 2000. The prevalence of CP in eastern Denmark was approximately 1.7 per 1000. Information on productivity and the use of health care was retrieved from registers. The lifetime cost of CP was about €860 000 for men and about €800 000 for women. The largest component was social care costs, particularly during childhood. A sensitivity analysis found that alterations in social care costs had a small effect, whereas lowering the discount rate from 5 to 3 per cent markedly increased total lifetime costs. Discounting decreases the value of costs in the future compared with the present. The high social care costs and productivity costs associated with CP point to a potential gain from labour market interventions that benefit individuals with CP.

Violence against women and consequent health problems: a register-based study:

Aims: This study set out to examine whether women victimized by domestic violence in a given year subsequently have more health problems measured by amount of hospital contacts due to disease than non-victimized women. Methods: A case control study was carried out, based on data in the Danish National Patient Register, which covers all hospital contacts, identified by the unique citizen number. Three age groups were included: 15—19, 20—29, and 30—49 years. Cases were women with any hospital contact as a result of intentional injuries, defined as domestic violence, in 1995, and controls were women with all other reasons for hospital contact in 1995. The Nordic Classification of External Causes of Injuries classified reason for contact, place of occurrence, and mechanism of injury. Domestic violence was defined as intentional injury by blunt force and occurring in a residential area. The rate of subsequent hospital contacts because of any disease, induced abortions, gynaecological diseases, and mental illness among cases and controls in 1996—98 was compared. Results: 1,815 women victimized by domestic violence and 388,366 controls were identified. In the entire period, the victims of violence presented significantly more health problems than the controls, as measured by hospital contacts due to any disease. The rate of contacts due to induced abortions, gynaecological diseases, and mental illness was significantly higher among the victims in all three age groups in the first year following the identified violence. In the entire period, victims of violence aged 20—49 presented a significantly higher rate of contacts due to mental illness, and victims aged 20—29 years a higher rate of induced abortions. Conclusions: Registration practice of all hospital contacts in Denmark facilitates nationally representative analyses of associations between violence and health problems. The observed differences among women victimized by domestic violence and controls point to violence against women as a major public health problem. Proper registration of hospital contacts due to intentional injury may both guarantee adequate follow-up of the individual victim, and serve as a useful tool in the monitoring of general violence prevention.

Meta-analysis of negative-pressure wound therapy for closed surgical incisions

Postoperative wound complications are common following surgical procedures. Negative‐pressure wound therapy (NPWT) is well recognized for the management of open wounds and has been applied recently to closed surgical incisions. The evidence base to support this intervention is limited. The aim of this study was to assess whether NPWT reduces postoperative wound complications when applied to closed surgical incisions.

Future costs in cost-effectiveness analysis: an empirical assessment

AimThe aim of this study was to assess the impact on the cost-effectiveness ratio of including measures of production and consumption following a health care or health promotion intervention that improves survival.Data and methodsWe defined the net incremental consumption, or future costs, as the change in consumption minus change in production, while differentiating between health care and non-health care consumption. Based on 2005 register-based data for the entire Danish population, we estimated the average value of annual production and consumption for 1-year age groups. We computed the net consumption in the remaining expected lifetime and the net consumption per life year gained for different age groups.ResultsAge has a profound effect on the magnitude of net consumption. When including net incremental consumption in the cost-effectiveness ratio of a health care or health promotion intervention, the relative cost-effectiveness changed up to €21,000 across age groups. The largest difference in the cost-effectiveness ratio was observed among the 30-year-olds where costs were reduced significantly due to significant future net contributions to society.ConclusionThis paper contains cost figures for use in cost-effectiveness analyses, when the societal perspective is adopted and future consumption and production effects are taken into account. The net consumption varies considerably with age. Inclusion of net incremental consumption in the cost-effectiveness analysis will markedly affect the relative cost-effectiveness of interventions targeted at different age groups. Omitting future cost from cost-effectiveness analysis may bias the ranking of health care interventions and favour interventions aimed at older age groups. We used Danish data for this assessment, and our results will therefore not represent true figures for other countries. We do, however, believe that the overall impact of including net production value in CEA will be similar in other countries that have similar transfers of income from the younger age groups to older age groups as well as publicly financed social and health care services.

Risk factors for violence exposure and attributable healthcare costs: Results from the Danish national health interview surveys

Aims: To describe the characteristics of men and women exposed to physical violence, to identify risk factors for violence exposure and to quantify the attributable healthcare costs of violence. Methods: The Danish national health interview surveys of 2000 and 2005 included data on exposure to defined forms of physical violence over the last 12 months. Respondents who reported exposure to violence during the past year were compared with a reference group of non-exposed respondents, and data were merged with the National Health Registers. We identified risk factors for violence by logistic regression models and used OLS regression for quantification of attributable healthcare costs of violence, including somatic and psychiatric admissions, outpatient contacts, prescriptions and primary health services; and analyzed intimate partner violence separately. Results: Young age, being divorced and drinking more than the recommended amount of alcohol per week were risk factors for violence both for men and women. Total annual healthcare costs, adjusted for age and deliveries, were 787 euros higher on average for women exposed to violence than for non-exposed women, mainly related to psychiatric treatment. For women, no significant cost differences existed between victims of partner violence and non-victims. The total healthcare costs were not higher for exposed men than for non-exposed men, but male victims of partner violence incurred significantly higher costs. Conclusions: Primarily due to costs of psychiatric treatment, male and female victims of violence had higher total healthcare costs than non-exposed people. Whether mental health problems increase the risk of violence exposure or violence is a particular risk factor for health problems cannot be assessed by cross-sectional data alone.

Short and long-term labour market consequences of coronary heart disease: a register-based follow-up study

Objective The aim of this study was to analyse to what extent individuals with coronary heart disease (CHD) leave the labour market earlier than individuals without CHD and to discuss the implications for rehabilitation. Data and methods Individuals with CHD were identified from the Danish National Cohort study and were followed from the year of their first hospital admission for CHD and onwards for up to 23 years. Individuals with CHD were individually matched with individuals without CHD. We analysed their short-term labour market participation and compared the long-term withdrawal risk for the two groups through Cox regression. Results In the year after the first CHD-related admission, 79% of individuals with CHD maintained their labour force participation compared with 93% of individuals without CHD. Individuals with CHD had a hazard ratio of 1.32 for withdrawal compared with their matched counterparts. This means that the individuals with CHD were on the labour market, on average, for 0.8 years less than the individuals without CHD. Stratified analyses showed that, in particular, individuals with CHD aged below 60 years and individuals employed as manual labour may benefit from cardiac rehabilitation, which aims to maintain labour market participation. Conclusion Individuals with CHD have a significantly increased risk of withdrawing from the labour market. Especially younger individuals and those employed as manual labour seem to have greater problems in maintaining labour market participation. This suggests that greater focus in cardiac rehabilitation on returning these individuals to the labour market might be worthwhile.

Costs and Quality at the Hospital Level in the Nordic Countries

This article develops and analyzes patient register-based measures of quality for the major Nordic countries. Previous studies show that Finnish hospitals have significantly higher average productivity than hospitals in Sweden, Denmark, and Norway and also a substantial variation within each country. This paper examines whether quality differences can form part of the explanation and attempts to uncover quality-cost trade-offs. Data on costs and discharges in each diagnosis-related group for 160 acute hospitals in 2008-2009 were collected. Patient register-based measures of quality such as readmissions, mortality (in hospital or outside), and patient safety indices were developed and case-mix adjusted. Productivity is estimated using bootstrapped data envelopment analysis. Results indicate that case-mix adjustment is important, and there are significant differences in the case-mix adjusted performance measures as well as in productivity both at the national and hospital levels. For most quality indicators, the performance measures reveal room for improvement. There is a weak but statistical significant trade-off between productivity and inpatient readmissions within 30 days but a tendency that hospitals with high 30-day mortality also have higher costs. Hence, no clear cost-quality trade-off pattern was discovered. Patient registers can be used and developed to improve future quality and cost comparisons.

Costs and Quality at the Hospital Level in the Nordic Countries.

This article develops and analyzes patient register-based measures of quality for the major Nordic countries. Previous studies show that Finnish hospitals have significantly higher average productivity than hospitals in Sweden, Denmark, and Norway and also a substantial variation within each country. This paper examines whether quality differences can form part of the explanation and attempts to uncover quality-cost trade-offs. Data on costs and discharges in each diagnosis-related group for 160 acute hospitals in 2008-2009 were collected. Patient register-based measures of quality such as readmissions, mortality (in hospital or outside), and patient safety indices were developed and case-mix adjusted. Productivity is estimated using bootstrapped data envelopment analysis. Results indicate that case-mix adjustment is important, and there are significant differences in the case-mix adjusted performance measures as well as in productivity both at the national and hospital levels. For most quality indicators, the performance measures reveal room for improvement. There is a weak but statistical significant trade-off between productivity and inpatient readmissions within 30 days but a tendency that hospitals with high 30-day mortality also have higher costs. Hence, no clear cost-quality trade-off pattern was discovered. Patient registers can be used and developed to improve future quality and cost comparisons.

Physical violence and health-related quality of life: Danish cross-sectional analyses.

BackgroundThe aim of this study was to evaluate the association between experienced physical violence and health-related quality of life (HRQoL) by comparing self-reported health status for individuals with and without experience of physical violence. Our hypothesis was that individuals exposed to violence would experience worse HRQoL than non-exposed individuals. We tested whether men and women and different age groups experience similar reductions in HRQoL, and the extent to which such differences might be associated with social circumstances and lifestyle conditions. Finally, we explored the HRQoL consequences of exposure to violence in a longer time perspective.MethodsWe used data from self-completed questionnaires in two Danish nationally representative, cross-sectional health interview surveys. Exposure to violence was indicated through specific survey questions (Straus’ conflict tactics scale) enquiring about different types of violence during the last 12 months. Health status of respondents was elicited by the EQ-5D and SF-36 questionnaires. The health status profiles were converted to health score indexes using the Danish algorithm for EQ-5D and the revised Brazier algorithm for SF-6D. Differences in score indexes between the exposed and non-exposed individuals were explored separately for men and women using ordinary least square regression with four age categories as explanatory variables.ResultsIn the 2000 and 2005 surveys, respectively, 4.9% and 5.7% of respondents indicated that they had been exposed to physical violence within the last 12 months. Exposure to violence was more prevalent in the younger age groups and more prevalent for men than women. Respondents exposed to violence had lower score indexes on both the EQ-5D and the SF-6D compared with the non-exposed. Respondents who reported exposure to violence in both 2000 and 2005 reported lower HRQoL than individuals who only reported exposure in one of the surveys.ConclusionsThe results of this study provide evidence for an association between exposure to physical violence and reduction in health-related quality of life.

The Health Care Costs of Violence Against Women

The aim of this study is to analyze the health care costs of violence against women. For the study, we used a register-based approach where we identified victims of violence and assessed their actual health care costs at individual level in a bottom-up analysis. Furthermore, we identified a reference population. We computed the attributable costs, that is, the excess health care costs for victims compared to an identified reference population of nonvictims. Only costs within the health care sector were included, that is, somatic and psychiatric hospital costs, costs within the primary health care sector and costs of prescription pharmaceuticals. We estimated the attributable health care costs of violence against women in Denmark, using a generalized linear model where health care costs were modeled as a function of age, childbirth, and exposure to violence. In addition we tested whether socioeconomic status, multiple episodes of violence, and psychiatric contacts had any impact on health care costs. We found that the health care costs were about €1,800 higher for victims of violence than for nonvictims per year, driven mostly by higher psychiatric costs and multiple episodes of violence.