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Cheema ZM, Gomez LC, Johnson N, Laflamme OD, Rabin HR, Steele K, Leong J, Cheng SY, Quon BS, Stephenson AL, Wranik WD, Sadatsafavi M, Stanojevic S. Measuring the burden of cystic fibrosis: A scoping review. J Cyst Fibros 2023:S1569-1993(23)01722-8. [PMID: 38044160 DOI: 10.1016/j.jcf.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/22/2023] [Accepted: 11/24/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Cystic fibrosis (CF) contributes a significant economic burden on individuals, healthcare systems, and society. Understanding the economic impact of CF is crucial for planning resource allocation. METHODS We conducted a scoping review of literature published between 1990 and 2022 that reported the cost of illness, and/or economic burden of CF. Costs were adjusted for inflation and reported as United States dollars. RESULTS A total of 39 studies were included. Direct healthcare costs (e.g., medications, inpatient and outpatient care) were the most frequently reported. Most studies estimated the cost of CF using a prevalence-based (n = 18, 46.2 %), bottom-up approach (n = 23, 59 %). Direct non-healthcare costs and indirect costs were seldom included. The most frequently reported direct cost components were medications (n = 34, 87.2 %), inpatient care (n = 33, 84.6 %), and outpatient care (n = 31, 79.5 %). Twenty-eight percent (n = 11) of studies reported the burden of CF from all three perspectives (healthcare system (payer), individual, and society). Indirect costs of CF were reported in approximately 20 % of studies (n = 8). The reported total cost of CF varied widely, ranging from $451 to $160,000 per person per year (2022 US$). The total cost depended on the number of domains and perspectives included in each study. CONCLUSIONS Most studies only reported costs to the healthcare system (i.e., hospitalizations and healthcare encounters) which likely underestimates the total costs of CF. The wide range of costs reported highlights the importance of standardizing perspectives, domains and costs when estimating the economic burden of CF.
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Affiliation(s)
- Zain M Cheema
- Department of Medicine, McMaster University, Hamilton, Canada; Cystic Fibrosis Canada, Toronto, Canada
| | - Lilian C Gomez
- Department of Community Health, and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Noah Johnson
- Department of Community Health, and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Olivier D Laflamme
- Department of Community Health, and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Harvey R Rabin
- Department of Medicine, Cumming School of Medicine at the University of Calgary, Calgary, Canada
| | | | - Jeanette Leong
- Department of Medicine, Cumming School of Medicine at the University of Calgary, Calgary, Canada
| | | | - Bradley S Quon
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Anne L Stephenson
- Division of Respirology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - W Dominika Wranik
- Department of Community Health, and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada; Department of Public and International Affairs, Faculty of Management, Dalhousie University, Halifax, Canada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Sanja Stanojevic
- Department of Community Health, and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada.
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Wranik WD, Muir A, Hu M. Costs of productivity loss due to occupational cancer in Canada: estimation using claims data from Workers' Compensation Boards. Health Econ Rev 2017; 7:9. [PMID: 28188606 PMCID: PMC5307412 DOI: 10.1186/s13561-017-0145-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 01/20/2017] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Cancer is a leading cause of illness globally, yet our understanding of the financial implications of cancer caused by working conditions and environments is limited. The goal of this study is to estimate the costs of productivity losses due to occupational cancer in Canada, and to evaluate the factors associated with these costs. METHODS Two sources of data are used: (i) Individual level administrative claims data from the Workers Compensation Board of Nova Scotia; and (ii) provincial aggregated cancer claims statistics from the Association of Workers Compensation Boards of Canada. Benefits paid to claimants are based on actuarial estimates of wage-loss, but do not include medical costs that are covered by the Canadian publicly funded healthcare system. Regional claims level data are used to estimate the total and average (per claim) cost of occupational cancer to the insurance system, and to assess which characteristics of the claim/claimant influence costs. Cost estimates from one region are weighted using regional multipliers to adjust for system differences between regions, and extrapolated to estimate national costs of occupational cancer. RESULTS/DISCUSSION We estimate that the total cost of occupational cancer to the Workers' Compensation system in Canada between 1996 and 2013 was $1.2 billion. The average annual cost was $68 million. The cancer being identified as asbestos related were significantly positively associated with costs, whereas the age of the claimant was significantly negatively associated with costs. The industry type/region, injury type or part of body affected by cancer were not significant cost determinants. CONCLUSION Given the severity of the cancer burden, it is important to understand the financial implications of the disease on workers. Our study shows that productivity losses associated with cancer in the workplace are not negligible, particularly for workers exposed to asbestos.
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Affiliation(s)
- W Dominika Wranik
- School of Public Administration, Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada.
| | - Adam Muir
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Min Hu
- Department of Economics, Dalhousie University, Halifax, NS, Canada
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Wranik WD, Haydt SM, Katz A, Levy AR, Korchagina M, Edwards JM, Bower I. Funding and remuneration of interdisciplinary primary care teams in Canada: a conceptual framework and application. BMC Health Serv Res 2017; 17:351. [PMID: 28506224 PMCID: PMC5433058 DOI: 10.1186/s12913-017-2290-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 05/04/2017] [Indexed: 12/03/2022] Open
Abstract
Background Reliance on interdisciplinary teams in the delivery of primary care is on the rise. Funding bodies strive to design financial environments that support collaboration between providers. At present, the design of financial arrangements has been fragmented and not based on evidence. The root of the problem is a lack of systematic evidence demonstrating the superiority of any particular financial arrangement, or a solid understanding of options. In this study we develop a framework for the conceptualization and analysis of financial arrangements in interdisciplinary primary care teams. Methods We use qualitative data from three sources: (i) interviews with 19 primary care decision makers representing 215 clinics in three Canadian provinces, (ii) a research roundtable with 14 primary care decision makers and/or researchers, and (iii) policy documents. Transcripts from interviews and the roundtable were coded thematically and a framework synthesis approach was applied. Results Our conceptual framework differentiates between team level funding and provider level remuneration, and characterizes the interplay and consonance between them. Particularly the notions of hierarchy, segregation, and dependence of provider incomes, and the link between funding and team activities are introduced as new clarifying concepts, and their implications explored. The framework is applied to the analysis of collaboration incentives, which appear strongest when provider incomes are interdependent, funding is linked to the team as a whole, and accountability does not have multiple lines. Emergent implementation issues discussed by respondents include: (i) centrality of budget negotiations; (ii) approaches to patient rostering; (iii) unclear funding sources for space and equipment; and (iv) challenges with community engagement. The creation of patient rosters is perceived as a surprisingly contentious issue, and the challenges of funding for space and equipment remain unresolved. Conclusions The development and application of a conceptual framework is an important step to the systematic study of the best performing financial models in the context of interdisciplinary primary care. The identification of optimal financial arrangements must be contextualized in terms of feasibility and the implementation environment. In general, financial hierarchy, both overt and covert, is considered a barrier to collaboration. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2290-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- W Dominika Wranik
- School of Public Administration, Dalhousie University, Halifax, Canada.
| | - Susan M Haydt
- Faculty of Management, Dalhousie University, Halifax, Canada
| | - Alan Katz
- Department of Community Health Sciences, Department of Family Medicine, University of Manitoba, Winnipeg, Canada
| | - Adrian R Levy
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Maryna Korchagina
- Provider Compensation and Strategic Partnership Branch, Alberta Health, Edmonton, Canada
| | - Jeanette M Edwards
- Primary Health Care and Chronic Disease, Winnipeg Regional Health Authority, Winnipeg, Canada
| | - Ian Bower
- Primary Care, Nova Scotia Department of Health and Wellness, Halifax, Canada
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Wranik WD, Hayden JA, Price S, Parker RM, Haydt SM, Edwards JM, Suter E, Katz A, Gambold LL, Levy AR. How best to structure interdisciplinary primary care teams: the study protocol for a systematic review with narrative framework synthesis. Syst Rev 2016; 5:170. [PMID: 27716357 PMCID: PMC5050675 DOI: 10.1186/s13643-016-0339-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 09/13/2016] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Western publicly funded health care systems increasingly rely on interdisciplinary teams to support primary care delivery and management of chronic conditions. This knowledge synthesis focuses on what is known in the academic and grey literature about optimal structural characteristics of teams. Its goal is to assess which factors contribute to the effective functioning of interdisciplinary primary care teams and improved health system outcomes, with specific focus on (i) team structure contribution to team process, (ii) team process contribution to primary care goals, and (iii) team structure contribution to primary care goals. METHODS AND DESIGN The systematic search of academic literature focuses on four chronic conditions and co-morbidities. Within this scope, qualitative and quantitative studies that assess the effects of team characteristics (funding, governance, organization) on care process and patient outcomes will be searched. Electronic databases (Ovid MEDLINE, Embase, CINAHL, PAIS, Web of Science) will be searched systematically. Online web-based searches will be supported by the Grey Matters Tool. Studies will be included, if they report on interdisciplinary primary care in publicly funded Western health systems, and address the relationships between team structure, process, and/or patient outcomes. Studies will be selected in a three-stage screening process (title/abstract/full text) by two independent reviewers in each stage. Study quality will be assessed using the Mixed Methods Assessment Tool. An a priori framework will be applied to data extraction, and a narrative framework approach is used for the synthesis. DISCUSSION Using an integrated knowledge translation approach, an electronic decision support tool will be developed for decision makers. It will be searchable along two axes of inquiry: (i) what primary care goals are supported by specific team characteristics and (ii) how should teams be structured to support specific primary care goals? The results of this evidence review will contribute directly to the design of interdisciplinary primary care teams. The optimized design will support the goals of primary care, contributing to the improved health of populations. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016041884.
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Affiliation(s)
- W. Dominika Wranik
- School of Public Administration, Faculty of Management, Dalhousie University, Halifax, Canada
| | - Jill A. Hayden
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Sheri Price
- Faculty of Nursing, Dalhousie University, Halifax, Canada
| | | | - Susan M. Haydt
- Faculty of Management, Dalhousie University, Halifax, Canada
| | - Jeanette M. Edwards
- Primary Health Care and Chronic Disease, Winnipeg Regional Health Authority, Winnipeg, Canada
| | - Esther Suter
- Workforce Research and Evaluation, Alberta Health Services, Calgary, Canada
| | - Alan Katz
- Department of Community Health Sciences, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Liesl L. Gambold
- Department of Sociology and Social Anthropology, Faculty of Arts and Social Sciences, Dalhousie University, Halifax, Canada
| | - Adrian R. Levy
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada
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Wranik WD, Gambold L, Hanson N, Levy A. The evolution of the cancer formulary review in Canada: Can centralization improve the use of economic evaluation? Int J Health Plann Manage 2016; 32:e232-e260. [PMID: 27469429 PMCID: PMC5484361 DOI: 10.1002/hpm.2372] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/25/2016] [Accepted: 06/08/2016] [Indexed: 11/11/2022] Open
Abstract
Public reimbursement of drugs is a costly proposition for health care systems. Decisions to add drugs to the public formulary are often guided by review processes and committees. The evolution of the formulary review process in Canada's publicly funded health system is characterized by increased centralization and systematization. In the past, the review of evidence and recommendation was conducted at the regional level, but was replaced with the pan‐Canadian Oncology Drug Review in 2011. We assess the extent to which centralization and systematization of the review process have responded to past challenges, focusing on the use of economic evaluation in the process. Past challenges with economic evaluation experienced by regionalized review committees were identified from literature and qualitative data collected in the province of Nova Scotia. We categorize these using a typology with a macro‐, meso, and micro‐level hierarchy, which provides a useful framework for understanding at which level change is required, and who has the authority to influence change. Using grounded theory methods, we identify approaches used by Nova Scotia past committee members to compensate for perceived shortcomings of the process. These include an undue reliance on other committee members, on the multidisciplinarity of the committee, and on past decisions. Using a policy analysis approach, we argue that centralization and systematization of the review process only partially address the shortcomings of the previous regionalized process. Lessons from Canada can inform policy discussions across all health systems, where similar challenges with the formulary review process have been identified. © 2016 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.
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Affiliation(s)
- W Dominika Wranik
- School of Public Administration, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Liesl Gambold
- Department of Sociology and Social Anthropology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Natasha Hanson
- Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - Adrian Levy
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
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