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Social and Medical Costs of Dupuytren's Disease
Losenický, Jakub ; Votápková, Jana (advisor) ; Paulus, Michal (referee)
The thesis investigates the relative cost-effectiveness of two treatment methods of Dupuytren's disease (DD) - surgical fasciectomy and injectable collagenase - and assesses the impact of the two health technologies on the budget of the Czech Republic. For this purpose, cost-minimization analysis (CMA) and budget impact analysis (BIA) are employed and, importantly, both social and medical costs are taken into consideration. Concerning the CMA, different patients are modelled with respect to personal characteristics such as occupation, type of work (manual, non-manual) and income. In the BIA, data on DD occurrence in the Czech Republic from the National Register of Hospitalised Patients (NRHOSP) are analysed. We found that collagenase is a cost-minimizing treatment for a big majority of employees and manually working SMEs. On the other hand, collagenase turned out to be more expensive than fasciectomy for most of the non-manual SMEs. All things considered, collagenase appeared to be cheaper for most of the model patients. We also discovered that if all the patients in the dataset were treated with collagenase, the Czech state budget would annually save 1,685,452 CZK. The average annual costs of fasciectomy and collagenase were 41,334,049 CZK and 39,648,597 CZK, respectively. Powered by TCPDF (www.tcpdf.org)
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Comprehensive therapeutic rehabilitation of patients after surgery of Dupuytern's contracture
DYRYNKOVÁ, Pavlína
The topic of this bachelor thesis is concerned on problematic of Dupuytren's contracture. In the theoretical part I describe palmodigital aponeurosis, kinesiology, Dupuytren's disease, its classification, symptomatology, relation with gender, age, nationality, possible association with diseases and further description of treatment options. The aim of the thesis was to compile and propose a therapeutic plan and then to evaluate it in terms of proband's subjective perception and to compare it with the measured results. In the practical part, I made three case reports of probands who underwent Dupuytren's contracture operation. I obtained the data by taking a history and processing the input and output kinesiological analysis, followed by observation and a semi-structured interview. The first two probandes underwent ten therapies in my bachelor thesis and third only four, because he had to end the therapy prematurely for health reasons. In the first two cases, the extension was the most limited, and in the third proband there was the greatest limitation in reduced muscle strength and gait pain. According to the initial kinesiological analysis, I created a short-term plan and focused on the therapy. I used the aspect, palpation, anthropometric examination, goniometry, muscle test, table top test, sensitivity and grip assessment, and I always asked propand about subjective perception of his illness. Outcomes showed overall improvement in both patients. The other patient had no restrictions after the end of therapy. The first patient, despite visible improvements, still suffered from hand stiffness in the morning and increased manual labor and tingle I. - III. finger for the probably starting carpal tunnel syndrome. Achieving goals during therapy can be understood by creating individual rehabilitation plans, evaluating objective tests and subjective perception of probands.
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Social and Medical Costs of Dupuytren's Disease
Losenický, Jakub ; Votápková, Jana (advisor) ; Paulus, Michal (referee)
The thesis investigates the relative cost-effectiveness of two treatment methods of Dupuytren's disease (DD) - surgical fasciectomy and injectable collagenase - and assesses the impact of the two health technologies on the budget of the Czech Republic. For this purpose, cost-minimization analysis (CMA) and budget impact analysis (BIA) are employed and, importantly, both social and medical costs are taken into consideration. Concerning the CMA, different patients are modelled with respect to personal characteristics such as occupation, type of work (manual, non-manual) and income. In the BIA, data on DD occurrence in the Czech Republic from the National Register of Hospitalised Patients (NRHOSP) are analysed. We found that collagenase is a cost-minimizing treatment for a big majority of employees and manually working SMEs. On the other hand, collagenase turned out to be more expensive than fasciectomy for most of the non-manual SMEs. All things considered, collagenase appeared to be cheaper for most of the model patients. We also discovered that if all the patients in the dataset were treated with collagenase, the Czech state budget would annually save 1,685,452 CZK. The average annual costs of fasciectomy and collagenase were 41,334,049 CZK and 39,648,597 CZK, respectively. Powered by TCPDF (www.tcpdf.org)
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