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Gu Y, Liu M, Wang A, He D, Sun H, Cui X, Tian W, Zhang Y, Jin C, Wang H. Analysis of Factors Influencing Hospitalization Expenses of Patients with Gastric Cancer in Shanghai, 2014-2021: Based on Grey Relational Analysis and Structural Equation Modeling. Value Health Reg Issues 2024; 44:101029. [PMID: 39094426 DOI: 10.1016/j.vhri.2024.101029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 05/06/2024] [Accepted: 06/20/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVES This study analyzed the basic condition and the influencing factors of hospitalization costs of patients with gastric cancer in Shanghai from 2014 to 2021, so as to provide a scientific reference for promoting the reform of the medical and healthcare system. METHODS The study data were obtained from the electronic medical record system of Shanghai Hospital. The grey relational analysis was applied to analyze the correlation strength of various expenses with hospitalization costs. The structural equation modeling was constructed to analyze the influences of factors on the hospitalization expenses, as well as the relationship between each factor. RESULTS A total of 23 335 study subjects were included. The results of grey relational analysis showed that the total cost of drugs had the strongest correlation with hospitalization expenses, followed by material expenses and surgery cost, whereas those of others were lower. The results of the structural equation modeling showed that age had the greatest influence on hospitalization expenses with a path coefficient of 0.618. Other influencing factors included surgery history, length of stay, hospital level, gender, and medical insurance. CONCLUSIONS The total cost of drugs had the strongest correlation with hospitalization expenses. Factors such as gender, age, and hospital level all affect the hospitalization expenses. In the future, it is necessary to take further measures to control the cost of drugs and constantly optimize the structure of hospitalization costs. Meanwhile, the reform of the medical and healthcare system should be deepened to reasonably regulate the medical behaviors and reduce the financial burden of patients.
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Affiliation(s)
- Yichun Gu
- Shanghai Health Development Research Center, Shanghai, China
| | - Mengying Liu
- School of Pharmacy, Anhui Xinhua University, Hefei, Anhui, China
| | - Anqi Wang
- School of Public Health, Shandong Second Medical University, Weifang, Shandong, China
| | - Da He
- Shanghai Health Development Research Center, Shanghai, China
| | - Hui Sun
- Shanghai Health Development Research Center, Shanghai, China
| | - Xin Cui
- Shanghai Health Statistics Center, Shanghai, China
| | - Wenqi Tian
- Shanghai Health Statistics Center, Shanghai, China
| | - Yulin Zhang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Chunlin Jin
- Shanghai Health Development Research Center, Shanghai, China.
| | - Haiyin Wang
- Shanghai Health Development Research Center, Shanghai, China.
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Huang HL, Chang TS, Canseco LM, Wu F, Lu SN. Role of reimbursement and Physicians' awareness in the survival of sorafenib-eligible advanced hepatocellular carcinoma patients. Kaohsiung J Med Sci 2024; 40:589-598. [PMID: 38695728 DOI: 10.1002/kjm2.12838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/03/2024] [Accepted: 04/08/2024] [Indexed: 06/06/2024] Open
Abstract
In 2008, sorafenib became the first approved systemic therapeutic agent for advanced HCC. Although its pharmacological efficacy has been established, reimbursement for such a new, high-cost drug, as well as physicians' awareness and prescription practice, likewise contribute to its clinical effectiveness. We therefore conducted a retrospective study using 38 sorafenib-eligible, advanced HCC patients when sorafenib was approved but not yet reimbursed as a control and 216 patients during the reimbursed era. Study group showed longer survival at 8.2 months versus the control's 4.9 months (p = 0.0063 hazard ratio: 0.612 [0.431 ~ 0.868], p = 0.0059). Among the 42 (19.4%) patients who survived more than 2 years, 50% had tumor rupture, and all 32 patients with portal vein tumor thrombus and/or extrahepatic metastasis received sorafenib (p = 0.003). Furthermore, during their first 2 years of HCC management, sorafenib had been given in 29.1% of the treatment courses among survivors between 2 and 5 years while it was prescribed in 55.8% among the more than 5 years survivor group (p < 0.001). In conclusion, survival of sorafenib-eligible HCC patients significantly improved after reimbursement. Patients who underwent longer sorafenib treatment had a survival advantage, except for those with tumor rupture. Reimbursement and awareness of prescriptions for a newly introduced medication therefore improve clinical effectiveness.
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Affiliation(s)
- Hui-Ling Huang
- Department of Nursing, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Management Information Systems, National Chung Cheng University Chiayi, Chiayi, Taiwan
| | - Te-Sheng Chang
- Department of Hepatology and Gastroenterology, Division of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Lariza Marie Canseco
- Section of Gastroenterology, Department of Internal Medicine, De Los Santos Medical Center, Quezon City, Philippines
| | - Fan Wu
- Department of Management Information Systems, National Chung Cheng University Chiayi, Chiayi, Taiwan
| | - Sheng-Nan Lu
- Department of Hepatology and Gastroenterology, Division of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Hepato-Gastroenterology, Division of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Jung W, Shin DW, Jung KW, Kim D, Park J, Nari F, Suh M. The Impact of Neighborhood Deprivation on the Survival Rates of Patients with Cancer in Korea. Healthcare (Basel) 2023; 11:3171. [PMID: 38132061 PMCID: PMC10742845 DOI: 10.3390/healthcare11243171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023] Open
Abstract
The objective of this study is to investigate the correlation between the neighborhood deprivation index and survival rates of cancer patients in Korea. In this study, 5-year age-standardized survival rates of patients with cancer were determined using the National Cancer Cohort from 2014 to 2018 in Korea. The primary cancer sites were the stomach, colorectum, liver, lung, breast, cervix, prostate, and thyroid. Disparities were measured, and their impact on the overall survival rates was assessed using the Korean version of the Neighborhood Deprivation Index. Pearson's correlation coefficient was calculated to determine the strength of the correlation. The study cohort comprised 726,665 patients with cancer, of whom 50.7% were male. The predominant primary cancer sites were the stomach (n = 138,462), colorectum (n = 125,156), and thyroid gland (n = 120,886). Urban residents showed better survival outcomes than those situated in rural areas. The most deprived quartile had the lowest survival rate, while the least deprived quartile had the highest (p < 0.001). Most cancer types revealed significant correlations between neighborhood deprivation and 5-year age-standardized overall survival, with lung cancer showing the most substantial negative correlation (r = -0.510), followed by prostate cancer (r = -0.438). However, thyroid cancer showed only a marginal correlation (p = 0.069). The results of this study suggested that neighborhood deprivation is closely linked to disparities in overall survival across various types of cancer. A substantial negative correlation between the neighborhood deprivation index and all-cause mortality for lung and prostate cancer, as compared to breast and cervical cancers covered by the National Cancer Screening Program, may reinforce the need to address healthcare access and improve the early detection of cancer in socioeconomically deprived neighborhoods.
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Affiliation(s)
- Wonyoung Jung
- Department of Family Medicine/Obesity and Metabolic Health Center, Kangdong Sacred Heart Hospital, Hallym University, Seoul 05355, Republic of Korea;
| | - Dong Wook Shin
- Department of Family Medicine and Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul 06355, Republic of Korea
| | - Kyu-Won Jung
- Korea Central Cancer Registry, National Cancer Center, Goyang 10408, Republic of Korea;
- National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea; (J.P.)
| | - Dongjin Kim
- Center for Health Policy Research, Korea Institute for Health and Social Affairs, Sejong 30147, Republic of Korea;
| | - Juwon Park
- National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea; (J.P.)
| | - Fatima Nari
- National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea; (J.P.)
| | - Mina Suh
- National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea; (J.P.)
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Shang L, Lin Y, Fang W, Liu Y, Bao Y, Li X, Zhang Y. How National Health Insurance Coverage Policy Affected the Use of Trastuzumab and Rituximab in China: A Bicentric Retrospective Study. Risk Manag Healthc Policy 2023; 16:1739-1753. [PMID: 37692767 PMCID: PMC10488736 DOI: 10.2147/rmhp.s420899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/01/2023] [Indexed: 09/12/2023] Open
Abstract
Background Cancer is a significant health concern and is China's leading cause of mortality. Targeted therapies, such as trastuzumab and rituximab, have enhanced clinical treatment efficacy. However, their high costs burden patients and healthcare systems considerably. Patient demographic factors further influence the utilization of these expensive drugs. On September 1, 2017, China implemented the National Health Insurance Coverage (NHIC) policy, necessitating additional real-world evidence to assess its impact on patients. Methods Data on human epidermal growth factor receptor 2-positive breast cancer and CD20-positive non-Hodgkin B-cell lymphoma patients were gathered in Jiangsu Cancer Hospital and Fujian Cancer Hospital from September 2015 to August 2019, including demographic and clinical information. All eligible patients were divided into two groups. Univariate analysis and multivariable logistic regression were used to investigate the differences between subgroups. An interrupted time-series regression was used to examine the change in trastuzumab and rituximab utilization percentages. Results Before and after the NHIC policy, utilization of trastuzumab increased from 61.13% to 75.10%, and the increase was statistically significant. Rituximab therapy increased statistically significantly from 64.79% to 74.88%. The key factor influencing trastuzumab and rituximab use was the NHIC policy. With policy implementation, medical insurance status, occupations, and cancer disease stage affected trastuzumab and rituximab use. Conclusion The NHIC policy is essential to the utilization of trastuzumab and rituximab, and the patient's income level and repayment abilities continue to impact the use of innovative anti-cancer drugs. Appropriate steps, such as reducing the urban-rural gap and broadening medical insurance coverage, would enable more people to access novel anti-cancer drugs.
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Affiliation(s)
- Linlin Shang
- Department of Clinical Pharmacy, School of Pharmacy, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Yingtao Lin
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Wenqing Fang
- Department of Medical Ethics Supervision, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Yanyan Liu
- Department of Health Policy, School of Health Policy and Management, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Yuwen Bao
- Department of Health Policy, School of Health Policy and Management, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Xin Li
- Department of Clinical Pharmacy, School of Pharmacy, Nanjing Medical University, Nanjing, People’s Republic of China
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, People’s Republic of China
- Department of Health Policy, School of Health Policy and Management, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Yuanyuan Zhang
- Department of Pharmacy, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
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Kim SH, Choe YH, Choi J, Park JY, Yi E. Factors Associated With Quality of Life Among Posttreatment Cancer Survivors in Korea: A Meta-analysis. Cancer Nurs 2023:00002820-990000000-00162. [PMID: 37523733 DOI: 10.1097/ncc.0000000000001273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
BACKGROUND Identification of factors associated with quality of life (QOL) among cancer survivors is crucial for identifying potential targets for intervention. OBJECTIVES We aimed to provide evidence of factors associated with the QOL among posttreatment cancer survivors in Korea. METHODS We performed a systematic literature search from January 2000 to September 2022 using PubMed, EMBASE, CINAHL, PsycINFO, and Korean databases (RISS, SCIENCEON). We evaluated study quality using the Joanna Briggs Institute Quality Appraisal Checklists for Analytical Cross-sectional Studies and performed statistical analysis using the R 3.0 software (R Foundation for Statistical Computing, Vienna, Austria) package. We analyzed the pooled effect sizes of potential QOL correlates by the random-effects model. RESULTS This meta-analysis included 31 studies with 8934 participants. The pooled estimates were significantly large for economic status (r = -0.53); significantly medium for fatigue (r = -0.39), anxiety (r = -0.29), depression (r = -0.42), self-efficacy (r = 0.37), and social support (r = 0.30); and significantly small for education level (r = -0.18), job status (r = -0.09), cancer stage (r = -0.20), and time since diagnosis (r = -0.26). CONCLUSIONS Low education level, having no job, low economic status, advanced cancer stage, short disease period, fatigue, anxiety, and depression were significantly associated with worse QOL, whereas self-efficacy and social support were significantly associated with better QOL. IMPLICATIONS FOR PRACTICE The findings have potential implications for identifying "at-risk survivors" of deteriorated QOL and for suggesting powerful strategies (eg, enhancing self-efficacy or social support) for improving QOL.
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Affiliation(s)
- Soo Hyun Kim
- Author Affiliations: Department of Nursing, Inha University, Incheon, South Korea
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Jang Y, Kim T, Kim BHS, Kim JH, Seong H, Kim YJ, Park B. Economic Burden of Cancer for the First Five Years after Cancer Diagnosis in Patients with Human Immunodeficiency Virus in Korea. J Cancer Prev 2023; 28:53-63. [PMID: 37434797 PMCID: PMC10331032 DOI: 10.15430/jcp.2023.28.2.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/14/2023] [Accepted: 06/14/2023] [Indexed: 07/13/2023] Open
Abstract
This study aimed to estimate the medical cost of cancer in the first five years of diagnosis and in the final six months before death in people who developed cancer after human immunodeficiency virus (HIV) infection in Korea. The study utilized the Korea National Health Insurance Service-National Health Information Database (NHIS-NHID). Among 16,671 patients diagnosed with HIV infection from 2004 to 2020 in Korea, we identified 757 patients newly diagnosed with cancer after HIV diagnosis. The medical costs for 60 months after diagnosis and the last six months before death were calculated from 2006 to 2020. The mean annual medical cost due to cancer in HIV-infected people with cancer was higher for acquired immunodeficiency syndrome (AIDS)-defining cancers (48,242 USD) than for non-AIDS-defining cancers (24,338 USD), particularly non-Hodgkin's lymphoma (53,007 USD), for the first year of cancer diagnosis. Approximately 25% of the cost for the first year was disbursed during the first month of cancer diagnosis. From the second year, the mean annual medical cost due to cancer was significantly reduced. The total medical cost was higher for non-AIDS-defining cancers, reflecting their higher incidence rates despite lower mean medical costs. The mean monthly total medical cost per HIV-infected person who died after cancer diagnosis increased closer to the time of death. The estimated burden of medical costs in patients with HIV in the present study may be an important index for defining healthcare policies in HIV patients in whom the cancer-related burden is expected to increase.
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Affiliation(s)
- Yoonyoung Jang
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
- Program in Regional Information, Department of Agricultural Economics and Rural Development, Seoul National University, Seoul, Korea
| | - Taehwa Kim
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
- Department of Psychology, Sungkyunkwan University, Seoul, Korea
| | - Brian H. S. Kim
- Program in Regional Information, Department of Agricultural Economics and Rural Development, Seoul National University, Seoul, Korea
- Program in Agricultural and Forest Meteorology, Research Institute of Agriculture and Life Sciences, Seoul National University, Seoul, Korea
| | - Jung Ho Kim
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Seong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Youn Jeong Kim
- Division of Infectious Disease, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Boyoung Park
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
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Kim Y, Chae J, Shin S, Jo G, Shin J, Kim B, Kim DS, Lee JY. Trends in National Pharmaceutical Expenditure in Korea during 2011 - 2020. Infect Chemother 2023; 55:237-246. [PMID: 37407241 DOI: 10.3947/ic.2023.0028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/08/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND This study aimed to identify the trends in pharmaceutical expenditure (PE), share of PE in health expenditure (HE), and trends in expenditure by pharmacological groups (ATC level 1 classification) in Korea for a 10-year period (2011 - 2020) and compare the data with those of other Organisation for Economic Co-operation and Development (OECD) countries. Using the findings, we determined the current status of pharmaceutical expenditure (PE) management in Korea and derived the implications for establishing future macroscopic policies on PE. MATERIALS AND METHODS We analyzed the OECD Health Statistics and the Korean national health insurance claims database from January 2011 through December 2020. The outcome measures were HE, PE, and pharmaceutical sales data for ATC level 1 medicines from OECD Health Statistics data during 2011 - 2020. As OECD collects limited ATC level 1 data, we used the HIRA health insurance claims data for PEs of ATC level-1 classification, including D, L, P, and S. RESULTS PE in Korea increased by 38.5% from 19.9 billion USD in 2011 to 27.6 billion USD in 2020, whereas the share of PE in HE decreased by 6.3%p from 26.4% in 2011 to 20.1% in 2020. In 2020, Korea ranked third in PE per capita (760.9 USD PPP) and had the highest share of PE (20.1%) among the 19 OECD countries studied. By ATC level 1 class, the highest PE was A (alimentary tract and metabolism) at 4.3 billion USD, and L (antineoplastic and immunomodulating agents) had the highest increase at 13.4%; in contrast, J (anti-infectives for systemic use) had the lowest increase in annual average PE at -0.2% in 2020 relative to 2011. Among the 17 OECD countries, Korea had the highest and the third-highest expenditures for ATC codes A and J, respectively. CONCLUSION PE in Korea has continued to increase between 2011 and 2020, indicating the need for macroscopic management of PE. Our results on PE by ATC code may help health authorities in establishing future policies on PE.
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Affiliation(s)
- Yujeong Kim
- Health Insurance Review and Assessment (HIRA) Research Institute, Wonju, Korea
| | - Jungmi Chae
- Health Insurance Review and Assessment (HIRA) Research Institute, Wonju, Korea
| | - Seohee Shin
- Health Insurance Review and Assessment (HIRA) Research Institute, Wonju, Korea
| | - Gayoung Jo
- Health Insurance Review and Assessment (HIRA) Research Institute, Wonju, Korea
| | - Jihye Shin
- Health Insurance Review and Assessment (HIRA) Research Institute, Wonju, Korea
| | - Byungsoo Kim
- Drug Utilization Review (DUR) Operation Division, DUR Department, Health Insurance Review and Assessment Service (HIRA), Wonju, Korea
| | - Dong-Sook Kim
- Health Insurance Review and Assessment (HIRA) Research Institute, Wonju, Korea
- Department of Health Administration, College of Nursing and Health, Kongju National University, Gongju, Korea.
| | - Jin Yong Lee
- Health Insurance Review and Assessment (HIRA) Research Institute, Wonju, Korea
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea.
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Dong S, Fu W, Yu Z, Li J. Can decreased cost-sharing reduce the vulnerability of sick families to poverty? An analysis of the multi-level social health insurance scheme in China. Health Policy Plan 2023; 38:74-82. [PMID: 36124929 DOI: 10.1093/heapol/czac081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/12/2022] [Accepted: 09/18/2022] [Indexed: 01/11/2023] Open
Abstract
In recent years, China has been increasing social health insurance benefits to alleviate poverty due to illness. In 2015, China introduced the Critical Illness Insurance for patients with high out-of-pocket expenses as supplementary to the social health insurance, which categorized patients with different medical expenses into different cost-sharing policies. We conducted a survey on households with high-cost patients in rural Shandong in 2019 and employed the instrumental variables estimation approach to determine how different cost-sharing measures affect households' poverty vulnerability. We found that cost-sharing reduction significantly decreases the vulnerability of sick families to poverty. Moreover, we found that the positive effect is attributed to a reduction in health burden and household livelihood capital shocks. The vulnerability to poverty is still exceptionally high owing to the heavy health burden in rural China and other developing countries. The results of our study provide insights into poverty alleviation by improving social health insurance in developing economies.
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Affiliation(s)
- Shiju Dong
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 Wenhuaxi Road, Jinan 250012, China.,NHC Key Lab of Health Economics and Policy Research, Shandong University, No. 44 Wenhuaxi Road, Jinan 250012, China
| | - Wenhao Fu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 Wenhuaxi Road, Jinan 250012, China.,NHC Key Lab of Health Economics and Policy Research, Shandong University, No. 44 Wenhuaxi Road, Jinan 250012, China
| | - Zexuan Yu
- Department of Biostatistics, Brown University School of Public Health, Providence, RI 02912, USA
| | - Jiajia Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 Wenhuaxi Road, Jinan 250012, China.,NHC Key Lab of Health Economics and Policy Research, Shandong University, No. 44 Wenhuaxi Road, Jinan 250012, China
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Cho HJ, Chae J, Yoon S, Kim D. Factors related to polypharmacy and hyper-polypharmacy for the elderly: A nationwide cohort study using National Health Insurance data in South Korea. Clin Transl Sci 2022; 16:193-205. [PMID: 36401587 PMCID: PMC9926077 DOI: 10.1111/cts.13438] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/27/2022] [Accepted: 09/27/2022] [Indexed: 11/21/2022] Open
Abstract
Polypharmacy may cause adverse health outcomes in the elderly. This study examined the prevalence of continuous polypharmacy and hyper-polypharmacy, factors associated with polypharmacy, and the most frequently prescribed medications among older adults in South Korea. This was a retrospective observational study using National Health Insurance claims data. In total, 7,358,953 Korean elderly patients aged 65 years and older were included. Continuous polypharmacy and hyper-polypharmacy were defined as the use of ≥5 and ≥10 medications, respectively, for both ≥90 days and ≥180 days within 1 year. A multivariate logistic regression analysis was conducted with adjustment for general characteristics (sex, age, insurance type), comorbidities (12 diseases, number of comorbidities, and Elixhauser Comorbidity Index [ECI] classification), and healthcare service utilization. Among 7.36 million elderly patients, 47.8% and 36.9% had polypharmacy for ≥90 and ≥180 days, and 11.9% and 7.1% of patients exhibited hyper-polypharmacy for ≥90 and ≥180 days, respectively. Male sex, older age, insurance, comorbidities (cardio-cerebrovascular disease, diabetes mellitus, depressive disorder, dementia, an ECI score of ≥3), and healthcare service utilization were associated with an increased probability of polypharmacy. The therapeutic class with the most prescriptions was drugs for acid-related disorders (ATC A02). The number of outpatient visit days more strongly influenced polypharmacy than hospitalizations and ED visits. This study provides health policymakers with important evidence about the critical need to reduce polypharmacy among older adults.
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Affiliation(s)
- Ho Jin Cho
- Department of ResearchHealth Insurance Review and Assessment ServiceWonjuSouth Korea
| | - Jungmi Chae
- Department of ResearchHealth Insurance Review and Assessment ServiceWonjuSouth Korea
| | - Sang‐Heon Yoon
- Department of ResearchHealth Insurance Review and Assessment ServiceWonjuSouth Korea
| | - Dong‐Sook Kim
- Department of ResearchHealth Insurance Review and Assessment ServiceWonjuSouth Korea
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Hsu YH, Huang MY, Huang CJ, Kao HH, Huang YJ. Comparison of survival outcomes after CyberKnife® radiotherapy in Taiwan using preapproved insurance-based reimbursement versus out-of-pocket expenditure. Medicine (Baltimore) 2022; 101:e29736. [PMID: 35984132 PMCID: PMC9388004 DOI: 10.1097/md.0000000000029736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND With technological advances, radiotherapy has progressed from simple irradiation to robotic arm-based stereotactic radiosurgery systems (SRS, in this case, CyberKnife®). This equipment is high-priced and might be cost-effective or not. The National Health Insurance (NHI) in Taiwan has a premedical claims review process for approving CyberKnife® treatment; however, patients might have to pay for the procedure themselves if the NHI rejects the practice. Under the high treatment cost and such an insurance system, a sketch of patients treated by these high-cost machines and whether the prereview of insurance for reimbursement is reasonable without hindering the patient's right to undergo treatment should be investigated. In this study, the patients of CyberKnife® radiotherapy in our institute were investigated as an example for this purpose. METHODS Patients who underwent CyberKnife® radiotherapy in our department were investigated retrospectively. Their demographic characteristics, disease patterns, and treatment sites were analyzed. Survivals were compared according to clinical features, and treatment expenses were reimbursed after prereview or out-of-pocket. RESULTS From October 19, 2014, to January 30, 2018, there were 331 patients included in this study, 205 (55.3%) of whom underwent CyberKnife® radiotherapy at their own expense, while 166 (44.7%) had their expenses approved for reimbursement after prereview by NHI. Most patients were treated for metastatic tumors (37.5%), and the brain was the most frequent treatment site (46.1%). The 1-year overall survival was 67.1%, and the 2-year overall survival was 56.3% after CyberKinfe® radiotherapy. The best survival rate (96.8% at 1 year) was for patients with brain tumors. In patient's characteristics, A better Eastern Cooperative Oncology Group (ECOG) performance status, treatment for primary tumors, and outpatient treatment were independent factors for superior survival after CyberKnife® radiotherapy. The survivals for patients whose treatment expenses were approved for reimbursement after prereview by NHI were also better than out-of-pocket. CONCLUSIONS Besides the patients' characteristics, the treatment expense could be approved or rejected for reimbursement by the NHI prereview was an independent factor for survival in CyberKnife® radiotherapy. Prereview to reimburse expensive treatment is not an unreasonable requirement.
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Affiliation(s)
- Ya-Hui Hsu
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Mei-Yueh Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chin-Ju Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hui-Hua Kao
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Jie Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Radiation Oncology, Xiamen Chang Gung Hospital, Xiamen, Fujian, China
- *Correspondence: Yu-Jie Huang, Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, 129 Tai-Pei RD, Naiosong, Kaoishiung 833, Taiwan (e-mail: )
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