Cost-of-illness studies (COI) can identify and measure all the costs of a particular disease, including the direct, indirect and intangible dimensions. They are intended to provide estimates about the economic impact of costly disease. Alzheimer disease (AD) is a relevant example to review cost of illness studies because of its costliness.The aim of this study was to review relevant published cost studies of AD to analyze the method used and to identify which dimension had to be improved from a methodological perspective. First, we described the key points of cost study methodology. Secondly, cost studies relating to AD were systematically reviewed, focussing on an analysis of the different methods used. The methodological choices of the studies were analysed using an analytical grid which contains the main methodological items of COI studies. Seventeen articles were retained. Depending on the studies, annual total costs per patient vary from $2,935 to $52, 954. The methods, data sources, and estimated cost categories in each study varied widely. The review showed that cost studies adopted different approaches to estimate costs of AD, reflecting a lack of consensus on the methodology of cost studies. To increase its credibility, closer agreement among researchers on the methodological principles of cost studies would be desirable.

Objectives. Age-related dementia is a progressive degenerative brain syndrome whose prevalence increases with age. Dementias cause a substantial burden on society and on families who provide informal care. This study aims to review the relevant papers to compare informal care time and costs in different dementias. Methods. A bibliographic search was performed on an international medical literature database (MEDLINE). All studies which assessed the social economic burden of different dementias were selected. Informal care time and costs were analyzed in three care settings by disease stages. Results. 21 studies met our criteria. Mean informal care time was 55.73 h per week for Alzheimer disease and 15.8 h per week for Parkinson disease (P = 0.0076), and the associated mean annual informal costs were $17,492 versus $3,284, respectively (P = 0.0393). Conclusion. There is a lack of data about informal care time and costs among other dementias than AD or PD. Globally, AD is the most costly in terms of informal care costs than PD, $17,492 versus $3,284, respectively.

Thyroid dysfunction is the second most common endocrinopathy affecting women of childbearing age. Many studies have recommended that thyroid function screening should be routinely performed in all pregnant women. The aim of the present study was to determine the prevalence of thyroid disorders during pregnancy and to evaluate efficiency of the universal screening strategy versus case-finding strategy for diagnosing thyroid dysfunctions. METHODS: Comprehensive literature search was done in PubMed and EMBASE databases till July 2012 for studies related to prevalence and screening of thyroid dysfunction. For prevalence, the primary estimate was weighed mean pooled prevalence (%) with 95% CI. For screening, the primary estimate was pooled odds ratio (OR) with 95% CI. Heterogeneity was assessed by I 2 statistics. Publication bias was assessed using Begg and Egger test. Sensitivity analysis was also performed. RESULTS: A total of 33 studies (1988-2012) for prevalence and 5 (2007-2011) for screening were found to be pertinent. Because of significant heterogeneity, a random effects model was chosen. Combined analysis of weighed pooled prevalence of 19 studies of Thyroid Auto Immunity found 9.7% (9.5-10), 21 studies of hypothyroidism found 3.7% (2.2-6.1) and 10 studies of hyperthyroidism found 2.2% (1.0-4.5), 7 studies of overt/ clinical hypothyroidism found 2% (0.8-5.1), 13 studies of subclinical hypothyroidism found 3.7% (3-4.7), 6 studies of hypothyroxinemia found 3.4% (1.2-9.8), 4 studies of overt/ clinical hyperthyroidism found 0.6% (0.3-1.4) and 5 studies of subclinical hyperthyroidism found 0.022 (1.6-2.9). For the effectiveness of universal screening pooled OR was found to be 2.87 (1.60-4.94, P-<0.001). CONCLUSIONS: Our analysis supports the hypothesis of higher prevalence of thyroid dysfunction in pregnancy especially, hypothyroidism. The universal screening strategy is found to be more effective as the case-finding strategy fails to detect the majority of pregnant women with thyroid dysfunction.

Objectives. Cost studies can provide useful guidance, so long as they adhere to accepted methodology. Cochlear implants (CIs) are electronic devices introduced surgically into the inner ear. It is a relevant example to review cost study analyses because of its costliness. The aim of this study was to review relevant published cost studies of CI to analyze the method used. Methods. First, we described the key points of cost study methodology. Cost studies relating to CI were systematically reviewed, focussing on an analysis of the different methods used. Results. The methods, data sources, and estimated cost categories in each study varied widely. The paper showed that cost studies adopted significantly different approaches to estimate costs of CI, reflecting a lack of consensus on the methodology of cost studies. Conclusion. To increase its credibility, closer agreement among researchers on the methodological principles of cost studies would be desirable.

Objectives: Few studies have attempted to quantify the costs of operating room (OR) time. The purpose of this study is to quantify the variable cost per OR minute in isolated non-robotic valvular procedures -aortic valve replacement (AVR), mitral valve replacement (MVR), and mitral valve repair (MVRepair). MethOds:The Premier database, one of the most comprehensive hospital databases, was queried from 2007 to 2011 for patients undergoing AVR, MVR, or MVRepair. This database contains complete billing, hospital cost, and coding data from > 600 US facilities. Patients were identified using the following International Classification of Diseases 9 th Revision (ICD-9) procedure codes: AVR 35. 21, 35.22; MVR 35.23, 35.24; and MVRepair 35.12. Patients having coronary artery bypass grafting were excluded. The surgical approaches, right thoracotomy (RT) and any sternal incision, were identified for each patient with expert clinical assistance. Patients with right thoracotomy were then propensity score matched to patients with any sternal incision, adjusting for patient differences. Premier classified variable costs of the OR into three categories; staff for the surgery room, anesthesia, and recovery room. Outliers were identified based on the cost per minute of the procedure. The top and bottom five percent were removed. All costs were adjusted to 2012 dollars using the Medical Care Component of the Consumer Price Index. Results: There were 2,657 valvular procedures -1,604 AVR, 434 MVR, and 619 MVRepair -that met the inclusion criteria. The average cost per OR minute