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Szarvas Z, Fekete M, Szollosi GJ, Kup K, Horvath R, Shimizu M, Tsuhiya F, Choi HE, Wu HT, Fazekas-Pongor V, Pete KN, Cserjesi R, Bakos R, Gobel O, Gyongyosi K, Pinter R, Kolozsvari D, Kovats Z, Yabluchanskiy A, Owens CD, Ungvari Z, Tarantini S, Horvath G, Muller V, Varga JT. Optimizing cardiopulmonary rehabilitation duration for long COVID patients: an exercise physiology monitoring approach. GeroScience 2024:10.1007/s11357-024-01179-z. [PMID: 38771423 DOI: 10.1007/s11357-024-01179-z] [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: 02/27/2024] [Accepted: 04/25/2024] [Indexed: 05/22/2024] Open
Abstract
The presence of prolonged symptoms after COVID infection worsens the workability and quality of life. 200 adults with long COVID syndrome were enrolled after medical, physical, and mental screening, and were divided into two groups based on their performance. The intervention group (n = 100) received supervised rehabilitation at Department of Pulmonology, Semmelweis University with the registration number 160/2021 between 01/APR/2021-31/DEC/2022, while an age-matched control group (n = 100) received a single check-up. To evaluate the long-term effects of the rehabilitation, the intervention group was involved in a 2- and 3-month follow-up, carrying out cardiopulmonary exercise test. Our study contributes understanding long COVID rehabilitation, emphasizing the potential benefits of structured cardiopulmonary rehabilitation in enhancing patient outcomes and well-being. Significant difference was found between intervention group and control group at baseline visit in pulmonary parameters, as forced vital capacity, forced expiratory volume, forced expiratory volume, transfer factor for carbon monoxide, transfer coefficient for carbon monoxide, and oxygen saturation (all p < 0.05). Our follow-up study proved that a 2-week long, patient-centered pulmonary rehabilitation program has a positive long-term effect on people with symptomatic long COVID syndrome. Our data showed significant improvement between two and three months in maximal oxygen consumption (p < 0.05). Multidisciplinary, individualized approach may be a key element of a successful cardiopulmonary rehabilitation in long COVID conditions, which improves workload, quality of life, respiratory function, and status of patients with long COVID syndrome.
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Affiliation(s)
- Zsofia Szarvas
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Monika Fekete
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Gergo Jozsef Szollosi
- Coordination Center for Research in Social Sciences, Faculty of Economics and Business, University of Debrecen, Debrecen, Hungary
| | - Katica Kup
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Rita Horvath
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Maya Shimizu
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Fuko Tsuhiya
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Ha Eun Choi
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Huang-Tzu Wu
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Vince Fazekas-Pongor
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Kinga Nedda Pete
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Renata Cserjesi
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Regina Bakos
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Orsolya Gobel
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Kata Gyongyosi
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Renata Pinter
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Dora Kolozsvari
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Kovats
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Andriy Yabluchanskiy
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, USA
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Cameron D Owens
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Zoltan Ungvari
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Stefano Tarantini
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, USA
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Gabor Horvath
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Veronika Muller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Janos Tamas Varga
- Department of Pulmonology, Semmelweis University, Budapest, Hungary.
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Nur AM, Aljunid SM, Almari M. The Economic Burden of the COVID-19 Pandemic in State of Kuwait. CLINICOECONOMICS AND OUTCOMES RESEARCH 2024; 16:111-122. [PMID: 38463550 PMCID: PMC10921943 DOI: 10.2147/ceor.s442913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/28/2024] [Indexed: 03/12/2024] Open
Abstract
Purpose The main aim of this study is to estimate the provider's cost, patients' cost (home and institutional quarantine cost) and the total economic burden of COVID-19 for patients with PCR positive in Kuwait. Patients and Methods This cross-sectional and retrospective study identified the cost incurred for treating COVID-19 inpatients admitted to a General Hospital in Kuwait, a designated COVID-19 treatment center by the Kuwait Government during pandemic. A total of 485 COVID-19 patients were randomly selected from May 1st to September 31st, 2021. Data on sociodemographic information, length of stay (LOS), discharge status, and comorbidities were obtained from the patients' medical records. A step-down approach was done to estimate the healthcare provider cost per patient per admission. Patient cost (loss of productivity due to hospitalization, institutional and home quarantine) was calculated using human capital approach. The national economic burden of COVID-19 was estimated using costing data from a general hospital for the entire nation. The data were analyzed using the statistical software package SPSS version 25. Results In all, 485 COVID-19 patients were involved in the research. KD 2216 (USD 7,344) was the average cost per patient per admission. The ICU accounted for 20.6% of the total cost, the physician and nursing staff for 42.1%, and the laboratory services for 10.2%. The estimated annual cost of care for COVID-19 patients in Kuwait was KD 147.4 (USD 488.5) million, or 5.5% of the MOH budget for 2021, given that 9.03% (383,731) of the population had positive COVID-19 PCR results in 2021. The range of the estimated national economic burden, considering both the best and worst-case scenarios, is KD 73.6 (USD 244.2) million to KD 221.0 (USD 732.7) million. Conclusion COVID-19 poses a substantial financial strain on the healthcare system, estimated at 5.9% to 8.8% of the MOH's annual budget and 0.2% to 0.7% of Kuwait's GDP in 2021. To mitigate costs, prioritizing prevention and health education is crucial. Targeted strategies, such as workforce optimization, are needed to address high expenses. Policymakers and administrators should leverage these insights for enhanced efficiency and sustainability in future epidemic responses.
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Affiliation(s)
- Amrizal Muhammad Nur
- Department of Health Policy and Management, College of Public Health, Health Sciences Center, Kuwait University, Shadadiya, Kuwait
| | - Syed Mohamed Aljunid
- Department of Public Health and Community Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Mohammad Almari
- Department of Health Policy and Management, College of Public Health, Health Sciences Center, Kuwait University, Shadadiya, Kuwait
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Assiri AM, Alsubaie FSF, Amer SA, Almuteri NAM, Ojeil R, Dhopte PR, Alsaqa'aby M, Alotaibi AFM. The economic burden of viral severe acute respiratory infections in the Kingdom of Saudi Arabia: A nationwide cost-of-illness study. IJID REGIONS 2024; 10:80-86. [PMID: 38173861 PMCID: PMC10762365 DOI: 10.1016/j.ijregi.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/22/2023] [Accepted: 11/22/2023] [Indexed: 01/05/2024]
Abstract
Objectives The authors conducted a study to estimate the rising disease and economic burden of viral severe acute respiratory infections and their management, including COVID-19, respiratory syncytial virus, and influenza types A and B, in early and delayed diagnosis scenarios in the Kingdom of Saudi Arabia from a national perspective. Methods This cross-sectional study was conducted in May 2022 using a de novo Excel-based universal cost-of-illness calculator model. The study used primary data, such as expert interviews, as well as secondary data from a thorough literature search. Results The total economic burden of viral severe acute respiratory infections in patients with an early diagnosis was lower than those with a delayed diagnosis among patients with complications, both from the payer's (United States dollar [USD] 3846 million vs USD 4726 million) and societal (USD 4048 million vs USD 5020 million, respectively) perspectives. The major cost driver of the total economic burden for both early and delayed diagnosis was disease management costs: 49% (USD 1880 million) and 58% (USD 2730 million), respectively. Conclusions In the Kingdom of Saudi Arabia, the total economic burden for COVID-19, influenza (epidemic phase), and respiratory syncytial virus was higher with a delayed diagnosis vs an early diagnosis, emphasizing the importance of using a broader diagnostic method.
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Affiliation(s)
- Abdullah M. Assiri
- Deputyship for Preventive Health, Ministry of Health, Riyadh, Saudi Arabia
| | | | - Samar A. Amer
- Deputyship for Preventive Health, Ministry of Health, Riyadh, Saudi Arabia
| | | | - Rita Ojeil
- Health Economic and Outcomes Research (HEOR)—Real-World Evidence (RWE) department, IQVIA, Beirut, Lebanon
| | - Pratik Ramesh Dhopte
- Health Economic and Outcomes Research (HEOR)—Real-World Evidence (RWE), IQVIA, India
| | - Mai Alsaqa'aby
- Health Economic and Outcomes Research (HEOR)—Real-World Evidence (RWE), IQVIA Solutions Limited, Riyadh, KSA
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Ida FS, Ferreira HP, Vasconcelos AKM, Furtado IAB, Fontenele CJPM, Pereira AC. Post-COVID-19 syndrome: persistent symptoms, functional impact, quality of life, return to work, and indirect costs - a prospective case study 12 months after COVID-19 infection. CAD SAUDE PUBLICA 2024; 40:e00022623. [PMID: 38381867 PMCID: PMC10877695 DOI: 10.1590/0102-311xpt026623] [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: 02/13/2023] [Revised: 09/13/2023] [Accepted: 10/05/2023] [Indexed: 02/23/2024] Open
Abstract
The persistent symptoms of post-COVID-19 syndrome negatively impact health, quality of life, and productivity. This study aimed to describe the persistent symptoms of post-COVID-19 syndrome (especially neurological ones) and their 12-month post-infection cognitive, emotional, motor, quality of life, and indirect cost repercussions. Patients showing the first symptoms of COVID-19 from January to June 2021 who developed post-COVID-19 syndrome and sought care at the Fortaleza Unit (Ceará, Brazil) of the SARAH Network of Rehabilitation Hospitals were included in this study. Information was obtained at the baseline follow-up and by telephone interview 12 months post-infection. In total, 58 people participated in this study with an average age of 52.8±10.5 years, of which 60% required an ICU. The most frequent symptoms on admission included fatigue (64%), arthralgia (51%), and dyspnea (47%), whereas, after 12 months, fatigue (46%) and memory impairment (39%). The following scales/functional tests showed alterations: PCFS, MoCA, HAD, FSS, SF-36, TLS5x, timed up and go, 6-minute walk, and handgrip. Indirect costs totaled USD 227,821.00, with 11,653 days of absenteeism. Moreover, 32% of patients were unable to return to work. Better TLS5x and higher SF-36 scores in the functional capacity, physical functioning, vitality, and pain dimensions were associated with return to work (p ≤ 0.05). The most frequent persistent symptoms referred to fatigue, arthralgia, dyspnea, anxiety, and depression, which negatively affected cognitive, emotional, and motor function and quality of life. These symptoms lasted for over a year, especially fatigue and memory alteration, the latter of which being the most reported after COVID-19 infections. Results also show a significant difficulty returning to work and indirect costs of USD 4,847.25 per person/year.
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Affiliation(s)
- Fernando Shizuo Ida
- Centro de Neurorreabilitação SARAH Fortaleza, Rede SARAH de Hospitais de Reabilitação, Fortaleza, Brasil
| | - Hebert Pereira Ferreira
- Centro de Neurorreabilitação SARAH Fortaleza, Rede SARAH de Hospitais de Reabilitação, Fortaleza, Brasil
| | | | - Iris Aline Brito Furtado
- Centro de Neurorreabilitação SARAH Fortaleza, Rede SARAH de Hospitais de Reabilitação, Fortaleza, Brasil
| | | | - Antonio Carlos Pereira
- Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas, Piracicaba, Brasil
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Faramarzi A, Norouzi S, Dehdarirad H, Aghlmand S, Yusefzadeh H, Javan-Noughabi J. The global economic burden of COVID-19 disease: a comprehensive systematic review and meta-analysis. Syst Rev 2024; 13:68. [PMID: 38365735 PMCID: PMC10870589 DOI: 10.1186/s13643-024-02476-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 01/31/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has caused a considerable threat to the economics of patients, health systems, and society. OBJECTIVES This meta-analysis aims to quantitatively assess the global economic burden of COVID-19. METHODS A comprehensive search was performed in the PubMed, Scopus, and Web of Science databases to identify studies examining the economic impact of COVID-19. The selected studies were classified into two categories based on the cost-of-illness (COI) study approach: top-down and bottom-up studies. The results of top-down COI studies were presented by calculating the average costs as a percentage of gross domestic product (GDP) and health expenditures. Conversely, the findings of bottom-up studies were analyzed through meta-analysis using the standardized mean difference. RESULTS The implemented search strategy yielded 3271 records, of which 27 studies met the inclusion criteria, consisting of 7 top-down and 20 bottom-up studies. The included studies were conducted in various countries, including the USA (5), China (5), Spain (2), Brazil (2), South Korea (2), India (2), and one study each in Italy, South Africa, the Philippines, Greece, Iran, Kenya, Nigeria, and the Kingdom of Saudi Arabia. The results of the top-down studies indicated that indirect costs represent 10.53% of GDP, while the total estimated cost accounts for 85.91% of healthcare expenditures and 9.13% of GDP. In contrast, the bottom-up studies revealed that the average direct medical costs ranged from US $1264 to US $79,315. The meta-analysis demonstrated that the medical costs for COVID-19 patients in the intensive care unit (ICU) were approximately twice as high as those for patients in general wards, with a range from 0.05 to 3.48 times higher. CONCLUSIONS Our study indicates that the COVID-19 pandemic has imposed a significant economic burden worldwide, with varying degrees of impact across countries. The findings of our study, along with those of other research, underscore the vital role of economic consequences in the post-COVID-19 era for communities and families. Therefore, policymakers and health administrators should prioritize economic programs and accord them heightened attention.
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Affiliation(s)
- Ahmad Faramarzi
- Department of Health Economics and Management, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran.
| | - Soheila Norouzi
- Department of Health Economics and Management, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran
| | - Hossein Dehdarirad
- Department of Medical Library and Information Science, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Siamak Aghlmand
- Department of Health Economics and Management, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran
| | - Hasan Yusefzadeh
- Department of Health Economics and Management, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran
| | - Javad Javan-Noughabi
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Nakhaee M, Khandehroo M, Esmaeili R. Cost of illness studies in COVID-19: a scoping review. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:3. [PMID: 38238797 PMCID: PMC10797972 DOI: 10.1186/s12962-024-00514-7] [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: 01/14/2023] [Accepted: 01/10/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Human communities suffered a vast socioeconomic burden in dealing with the pandemic of coronavirus disease 2019 (COVID-19) globally. Real-word data about these burdens can inform governments about evidence-based resource allocation and prioritization. The aim of this scoping review was to map the cost-of-illness (CoI) studies associated with COVID-19. METHODS This scoping review was conducted from January 2019 to December 2021. We searched cost-of-illness papers published in English within Web of Sciences, PubMed, Google Scholar, Scopus, Science Direct and ProQuest. For each eligible study, extracted data included country, publication year, study period, study design, epidemiological approach, costing method, cost type, cost identification, sensitivity analysis, estimated unit cost and national burden. All of the analyses were applied in Excel software. RESULTS 2352 records were found after the search strategy application, finally 28 articles met the inclusion criteria and were included in the review. Most of the studies were done in the United States, Turkey, and China. The prevalence-based approach was the most common in the studies, and most of studies also used Hospital Information System data (HIS). There were noticeable differences in the costing methods and the cost identification. The average cost of hospitalization per patient per day ranged from 101$ in Turkey to 2,364$ in the United States. Among the studies, 82.1% estimated particularly direct medical costs, 3.6% only indirect costs, and 14.3% both direct and indirect costs. CONCLUSION The economic burden of COVID-19 varies from country to country. The majority of CoI studies estimated direct medical costs associated with COVID-19 and there is a paucity of evidence for direct non-medical, indirect, and intangible costs, which we recommend for future studies. To create homogeneity in CoI studies, we suggest researchers follow a conceptual framework and critical appraisal checklist of cost-of-illness (CoI) studies.
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Affiliation(s)
- Majid Nakhaee
- Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Masoud Khandehroo
- Department of Community Medicine, School of Medicine, Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Reza Esmaeili
- Department of Public Health, School of Health, Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Imam Khomeini Avenue, Gonabad, Khorasan, 9691793718, Iran.
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Lanyo TN, Adjei CA, Ani-Amponsah M. Informational and Practical Needs of Expectant Mothers with Chronic Hepatitis B in Ghana. SAGE Open Nurs 2024; 10:23779608241255183. [PMID: 38828400 PMCID: PMC11141223 DOI: 10.1177/23779608241255183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 03/24/2024] [Accepted: 04/28/2024] [Indexed: 06/05/2024] Open
Abstract
Hepatitis B virus infection is a global public health problem with disproportionately high endemicity in Africa and Ghana. The current national prevalence of hepatitis B among pregnant women in Ghana stands at 7.44%, highlighting the considerable threat of chronic hepatitis B on pregnant women and their general well-being. The study explored the informational and practical needs of pregnant women with chronic hepatitis B in Ghana. Fourteen pregnant women were selected purposefully using the exploratory descriptive qualitative design. Data were analyzed using thematic analysis. The findings showed that pregnant women with chronic hepatitis B lacked knowledge about the infection and were in great need of hepatitis B-related information. The study also revealed significant financial implications for treating the infection, necessitating policy reforms and stakeholder actions. To achieve effective coping, better health-seeking, and health-promoting behaviors for better health outcomes, it is crucial to provide targeted care that comprehensively covers the specific needs of pregnant women with chronic hepatitis B. It is also essential to consider including hepatitis B management in the National Health Insurance package to improve care quality.
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Affiliation(s)
- Theresa Norpeli Lanyo
- Department of Women and Children, University of Ghana Medical Centre, Accra, Greater Accra, Ghana
| | - Charles Ampong Adjei
- Department of Public Health Nursing, University of Ghana, School of Nursing and Midwifery, Legon, Greater Accra, Ghana
| | - Mary Ani-Amponsah
- Department of Maternal and Child Health, University of Ghana, School of Nursing and Midwifery, Legon, Greater Accra, Ghana
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Nur AM, Aljunid SM, Almari M. Cost of in-patient management of COVID-19 patients in a general hospital in Kuwait. BMC Health Serv Res 2023; 23:1314. [PMID: 38017444 PMCID: PMC10685622 DOI: 10.1186/s12913-023-10287-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 11/06/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Among the GCC countries affected by COVID-19 infections, Kuwait has been significantly impacted, with 658,520 cases and 2,563 deaths reported by the WHO on September 30, 2022. However, the impact of the COVID-19 epidemic on Kuwait's economy, especially in the healthcare sector, remains unknown. OBJECTIVE This study aims to determine the total cost of managing COVID-19 in-patients in Kuwait. METHOD A cross-sectional design was employed for this study. A total of 485 COVID-19 patients admitted to a general hospital responsible for COVID-19 cases management were randomly selected for this study from May 1st to September 31st, 2021. Data on sociodemographic information, length of stay (LOS), discharge status, and comorbidities were obtained from the patients' medical records. The data on costs in this study cover administration, utility, pharmacy, radiology, laboratory, nursing, and ICU costs. The unit cost per admission was calculated using a step-down costing method with three levels of cost centers. The unit cost was then multiplied by the individual patient's length of stay to determine the cost of care per patient per admission. FINDINGS The mean cost of COVID-19 in-patient care per admission was KD 2,216 (SD = 2,018), which is equivalent to USD 7,344 (SD = 6,688), with an average length of stay of 9.4 (SD = 8.5) days per admission. The total treatment costs for COVID-19 in-patients (n = 485) were estimated to be KD 1,074,644 (USD 3,561,585), with physician and nursing care costs constituting the largest share at 42.1%, amounting to KD 452,154 (USD 1,498,529). The second and third-largest costs were intensive care (20.6%) at KD 221,439 (USD 733,893) and laboratory costs (10.2%) at KD 109,264 (USD 362,123). The average cost for severe COVID-19 patients was KD 4,626 (USD 15,332), which is almost three times higher than non-severe patients of KD 1,544 (USD 5,117). CONCLUSION Managing COVID-19 cases comes with substantial costs. This cost information can assist hospital managers and policymakers in designing more efficient interventions, especially for managing high-risk groups.
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Affiliation(s)
- Amrizal Muhammad Nur
- Department of Health Policy and Management, College of Public Health, Kuwait University, Shadadiya, Kuwait.
| | - Syed Mohamed Aljunid
- Department of Health Policy and Management, College of Public Health, Kuwait University, Shadadiya, Kuwait
- Department of Public Health and Community Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Mohammad Almari
- Department of Health Policy and Management, College of Public Health, Kuwait University, Shadadiya, Kuwait
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Bhattacharya P, John D, Mukherjee N, Ms N, Menon J, Banerjee A. Estimation of non-health gross domestic product (NHGDP) loss due to COVID-19 deaths in West Bengal, India. BMJ Open 2023; 13:e072559. [PMID: 37907289 PMCID: PMC10619121 DOI: 10.1136/bmjopen-2023-072559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 09/13/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVES The state of West Bengal witnessed a significant surge of COVID-19 in all three waves. However, there is a gap in understanding the economic loss associated with COVID-19. This study estimates future non-health gross domestic product (NHGDP) losses associated with COVID-19 deaths in West Bengal, India. SETTING Various open domains were used to gather data on COVID-19 deaths in West Bengal and the aforementioned estimates. PRIMARY AND SECONDARY OUTCOME MEASURES The NHGDP losses were evaluated using the cost-of-illness approach. Future NHGDP losses were discounted at 3%. Excess death estimates by the WHO and Global Burden of Disease (GBD) were used. Sensitivity analysis was carried out by varying discount rates and average age of death (AAD). RESULTS 21 532 deaths in West Bengal from 17 March 2020 to 31 December 2022 decreased the future NHGDP by $0.92 billion. Nearly 90% of loss was due to deaths occurring in the age group of 30 years and above. Majority of the NHGDP loss was borne by the 46-60 years age group. NHGDP loss/death was $55,171; however, the average loss/death declined with rise in age. Based on the GBD and WHO excess death estimates, the NHGDP loss increased to $9.38 billion and $9.42 billion, respectively. When the lower age interval is considered as AAD, the NHGDP loss increased to $1.3 billion. At 5% and 10% discount rates, the losses reduced to $0.767 billion and $0.549 billion, respectively. CONCLUSIONS Results from the study suggest that COVID-19 contributed to a major economic loss in West Bengal. The mortality and morbidity caused by COVID-19, the substantial economic costs at individual and population levels in West Bengal, and probably across India and other countries, is another economic argument for better infection control strategies across the globe to minimise the impact of COVID-19.
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Affiliation(s)
- Paramita Bhattacharya
- Centre for Public Health Research, Manbhum Ananda Ashram Nityananda Trust, Kolkata, West Bengal, India
| | - Denny John
- Faculty of Life and Allied Health Sciences, MS Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
| | - Nirmalaya Mukherjee
- Centre for Public Health Research, Manbhum Ananda Ashram Nityananda Trust, Kolkata, West Bengal, India
| | - Narassima Ms
- Great Lakes Institute of Management, Manamai Village, Tamilnadu, India
| | - Jaideep Menon
- Department of Cardiology, Amrita Institute of Medical Sciences & Research Centre, Kochi, Kerala, India
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, UK
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De Vito A, Moi G, Saderi L, Puci MV, Colpani A, Firino L, Puggioni A, Uzzau S, Babudieri S, Sotgiu G, Madeddu G. Vaccination and Antiviral Treatment Reduce the Time to Negative SARS-CoV-2 Swab: A Real-Life Study. Viruses 2023; 15:2180. [PMID: 38005858 PMCID: PMC10675806 DOI: 10.3390/v15112180] [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: 09/29/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023] Open
Abstract
Clinical trials demonstrated the role of vaccines and antiviral treatments against SARS-CoV-2 in reducing the likelihood of disease progression and death. However, there are limited data available regarding the time to negativity of people who received these treatments. Further, several comorbidities and risk factors might affect the impact of vaccines and antiviral treatments. To this end, we aimed to evaluate and disentangle the impact of anti-SARS-CoV-2 treatments and that of underlying clinical factors associated with a shortened length of SARS-CoV-2 infection. Hence, we recorded the timeframe of positive nasopharyngeal swab in people infected while being hospitalized for reasons other than SARS-CoV-2 infection. All patients who died or were discharged with a positive swab were excluded from the study. A total of 175 patients were included in this study. Clinical conditions encompass malignancies, immunological disorders, cardiovascular, metabolic, neurodegenerative, and chronic kidney disease. Most of the participants (91.4%) were vaccinated before admission to the hospital, and 65.1% received antiviral treatment within three days after the symptom's onset. Unvaccinated patients had a longer median time to negativity than people who received at least two doses of vaccine (18 vs. 10 days). Concerning the clinical conditions of all patients, multivariate analysis highlighted a lower probability of 14-day conversion of antigenic test positivity in patients with hematological malignancy, including those vaccinated and those exposed to antiviral therapies. In conclusion, our data showed that prompt administration of antiviral treatments accelerates the clearance of SARS-CoV-2. Further, in the elderly patients under study, previous vaccination and antiviral treatment synergize to reduce time to negativity. This translates into a shorter hospitalization time and a lower risk of transmission through patients and connected healthcare workers in a hospital ward setting, with considerable improvement in cost-effective care management.
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Affiliation(s)
- Andrea De Vito
- Unit of Infectious Disease, Department of Medicine, Surgery, and Pharmacy, University of Sassari, 07100 Sassari, Italy; (G.M.); (A.C.); (S.B.); (G.M.)
| | - Giulia Moi
- Unit of Infectious Disease, Department of Medicine, Surgery, and Pharmacy, University of Sassari, 07100 Sassari, Italy; (G.M.); (A.C.); (S.B.); (G.M.)
| | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (L.S.); (M.V.P.); (G.S.)
| | - Mariangela V. Puci
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (L.S.); (M.V.P.); (G.S.)
| | - Agnese Colpani
- Unit of Infectious Disease, Department of Medicine, Surgery, and Pharmacy, University of Sassari, 07100 Sassari, Italy; (G.M.); (A.C.); (S.B.); (G.M.)
| | - Laura Firino
- Division of Microbiology and Virology, Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (L.F.); (A.P.); (S.U.)
| | - Anna Puggioni
- Division of Microbiology and Virology, Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (L.F.); (A.P.); (S.U.)
| | - Sergio Uzzau
- Division of Microbiology and Virology, Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (L.F.); (A.P.); (S.U.)
| | - Sergio Babudieri
- Unit of Infectious Disease, Department of Medicine, Surgery, and Pharmacy, University of Sassari, 07100 Sassari, Italy; (G.M.); (A.C.); (S.B.); (G.M.)
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (L.S.); (M.V.P.); (G.S.)
| | - Giordano Madeddu
- Unit of Infectious Disease, Department of Medicine, Surgery, and Pharmacy, University of Sassari, 07100 Sassari, Italy; (G.M.); (A.C.); (S.B.); (G.M.)
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Vatandoost V, Tabatabaee SS, Okhovati M, Barooni M. Explaining the challenges of resources management and its underlying factors in COVID-19 era in Iran: a qualitative study. BMC Public Health 2023; 23:2118. [PMID: 37891547 PMCID: PMC10612242 DOI: 10.1186/s12889-023-17045-0] [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: 07/29/2023] [Accepted: 10/22/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Identifying factors affecting health costs can contribute to formulating the best policies for controlling and managing health costs. To this end, the present study aimed to analyze resource wastage and identify the factors underlying it in COVID-19 management in Iran's health sector. METHOD This qualitative content analysis study was conducted in Iran's health sector. The participants were 23 senior, middle, and operational managers in the health sector. The data were collected through semistructured interviews with the managers. The participants were selected using purposive, quota, and snowball sampling techniques. The interviews continued until the data were saturated. The collected data were analyzed using MAXQDA software (version 10). RESULTS Following the data analysis, the factors affecting the wastage of health resources were divided into 4 themes and 13 main themes. Vaccines, diagnostic kits, medicines, and human resources were the main factors underlying resource wastage. The identified main themes were open and unused vials, nonuse of distributed vaccines and their expiration, excess supply and decreased demand for vaccines, expiration of diagnostic and laboratory kits and their quantitative and qualitative defects, and the large number of tests. Inefficiency and the expiration of COVID-19 drugs, poor drug supply and consumption chain management, inaccuracy in inventory control and expiration dates, disorganization and inconsistency in the distribution of healthcare staff, low productivity of the staff, and failure to match the staff's skills with assigned tasks in selected centers were identified as the most important causes of resource wastage. CONCLUSION Given the limited health funds and the increased healthcare costs, effective preparation and planning and making reasonable decisions for unexpected events can minimize unnecessary costs and resource wastage, which requires some revisions in attitudes toward COVID-19 management in the healthcare sector.
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Affiliation(s)
- Vahid Vatandoost
- Department of Health Management, Policy and Economics, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Seyed Saeed Tabatabaee
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Health Economics and Management Sciences, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Okhovati
- Department of Library and Medical Information, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohsen Barooni
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
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Keyvanlo Z, Javan-Noughabi J, Heidari Jamebozorgi M, Kargar M, Samadipour E. Productivity Loss of Temporary Work Absenteeism Due to COVID-19 and Its Determinant Factors in Northeastern Iran. J Occup Environ Med 2023; 65:832-835. [PMID: 37340668 DOI: 10.1097/jom.0000000000002912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
OBJECTIVE This study aimed to estimate the lost productivity cost of temporary work absenteeism due to COVID-19. METHODS This study conducted on all hospitalized patients with COVID-19 in northeastern Iran between February 2020 and March 2022 (10,406 cases). Data were collected from the Hospital Information System. Indirect costs were estimated using the human capital approach. Data were analyzed with the STATA version 17. RESULTS The total indirect cost of work absenteeism due to COVID-19 was estimated at $513,688. There was a statistically significant relationship between the mean lost productivity cost and COVID-19 peak, sex, insurance type, age, and hospitalization. CONCLUSIONS Because the absenteeism costs of COVID-19 had increased in the second peak, which coincided with the summer holidays, the country's crisis management headquarters should pay more attention to formulating and implementing appropriate preventive programs in future epidemics.
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Affiliation(s)
- Zahra Keyvanlo
- From the Healthcare Management (Z.K.); Sabzevar University of Medical Sciences, Sabzevar, Iran (Z.K.); Mashhad University of Medical Sciences, Mashhad, Iran (Z.K.); Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran (J.J.-N.); Department of Health Economics and Management Sciences, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran (J.J.-N.); Department of Public Health, Sirjan School of Medical Sciences, Sirjan, Iran (M.H.J.); School of Abarkouh Paramedicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran (M.K.); and Non-Communicable Diseases Research Center, School of Paramedical, Sabzevar University of Medical Sciences, Sabzevar, Iran (E.S.)
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13
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Blázquez-Fernández C, Lanza-León P, Sanchez-Ruiz L, Cantarero-Prieto D. Economic costs related to coronavirus disease 2019 pandemic: A systematic literature review. Sci Prog 2023; 106:368504231201548. [PMID: 37876179 PMCID: PMC10601401 DOI: 10.1177/00368504231201548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
Due to the COVID-19 pandemic, the pressure on healthcare systems has been tremendous and it is having a huge economic impact. The objective of this paper is to carry out a systematic literature review of the publications that have analysed the costs derived from COVID-19 from the patient's perspective. Not only is this study aimed at measuring the impact of COVID-19 in economic terms, but also in qualitative terms, analysing, for instance, the types of costs (direct and indirect) and their variations depending on the geographical area under study. Searches were conducted in PubMed, Cochrane Library, Web of Science and Scopus. The time frame for the analysis was from the start of the pandemic until 9th December 2021. A total of 322 papers were found. The number of articles assessed for eligibility was 32, and after applying the exclusion criteria, 13 papers were included in the qualitative synthesis. Most of the studies analysed only direct costs (69.23%) and were focused on Asia (61.54%), where the larger indirect costs, as well as the greater total costs, were found. However, the higher costs per patient and year were shown for the United States. This investigation showed the importance of COVID-19 in national, regional and local budgets. More studies are to be developed in Europe due to both the existing differences in the health care systems and financing by country and the difference in the incidence of COVID-19 by country and wave.
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Affiliation(s)
- Carla Blázquez-Fernández
- Departamento de Economía, Facultad de Ciencias Económicas y Empresariales, Universidad de Cantabria, Santander, España
- Health Economics Research Group-Valdecilla Health Research Institute (IDIVAL), Santander, Spain
| | - Paloma Lanza-León
- Departamento de Economía, Facultad de Ciencias Económicas y Empresariales, Universidad de Cantabria, Santander, España
- Health Economics Research Group-Valdecilla Health Research Institute (IDIVAL), Santander, Spain
| | - Lidia Sanchez-Ruiz
- Health Economics Research Group-Valdecilla Health Research Institute (IDIVAL), Santander, Spain
- Departamento de Administración de Empresas, Facultad de Ciencias Económicas y Empresariales, Universidad de Cantabria, Santander, España
- Santander Financial Institute – SANFI, Santander, Spain
| | - David Cantarero-Prieto
- Departamento de Economía, Facultad de Ciencias Económicas y Empresariales, Universidad de Cantabria, Santander, España
- Health Economics Research Group-Valdecilla Health Research Institute (IDIVAL), Santander, Spain
- Santander Financial Institute – SANFI, Santander, Spain
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14
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Gholipour K, Behpaie S, Iezadi S, Ghiasi A, Tabrizi JS. Costs of inpatient care and out-of-pocket payments for COVID-19 patients: A systematic review. PLoS One 2023; 18:e0283651. [PMID: 37729207 PMCID: PMC10511135 DOI: 10.1371/journal.pone.0283651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/13/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE To identify the costs of hospital care for patients with COVID-19 and the amount of out-of-pocket payments. METHODS We conducted a systematic review using Scopus and WEB OF SCIENCE and PubMed databases in April 5, 2022 and then updated in January 15, 2023. English articles with no publication year restrictions were included with study designs of cost-of-illness (COI) studies, cost analyses, and observational reports (cross-sectional studies and prospective and retrospective cohorts) that calculated the patient-level cost of care for COVID-19. Costs are reported in USD with purchasing power parity (PPP) conversion in 2020. The PROSPERO registration number is CRD42022334337. RESULTS The results showed that the highest total cost of hospitalization in intensive care per patient was 100789 USD, which was reported in Germany, and the lowest cost was 5436.77 USD, which was reported in Romania. In the present study, in the special care department, the highest percentage of total expenses is related to treatment expenses (42.23 percent), while in the inpatient department, the highest percentage of total expenses is related to the costs of hospital beds/day of routine services (39.07 percent). The highest percentage of out-of-pocket payments was 30.65 percent, reported in China, and the lowest percentage of out-of-pocket payments was 1.12 percent, reported in Iran. The highest indirect cost per hospitalization was 16049 USD, reported in USA, and the lowest was 449.07 USD, reported in India. CONCLUSION The results show that the COVID-19 disease imposed a high cost of hospitalization, mainly the cost of hospital beds/day of routine services. Studies have used different methods for calculating the costs, and this has negatively impacted the comparability costs across studies. Therefore, it would be beneficial for researchers to use a similar cost calculation model to increase the compatibility of different studies. Systematic review registration: PROSPERO CRD42022334337.
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Affiliation(s)
- Kamal Gholipour
- Tabriz Health Services Management Research Center, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sama Behpaie
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shabnam Iezadi
- Research Center for Emergency and Disaster Resilience, Red Crescent Society of the Islamic Republic of Iran, Tehran, Iran
| | - Akbar Ghiasi
- HEB School of Business & Administration, University of the Incarnate Word, San Antonio, Texas, United States of America
| | - Jafar Sadegh Tabrizi
- Tabriz Health Services Management Research Center, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
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Sobczyk K, Holecki T, Rogalska A. The impacts of the COVID-19 pandemic on indirect costs of mental illness and behavioral disorders in Poland. Front Public Health 2023; 11:1207389. [PMID: 37790719 PMCID: PMC10544582 DOI: 10.3389/fpubh.2023.1207389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/30/2023] [Indexed: 10/05/2023] Open
Abstract
Introduction In various research, the estimation of the disease's economic burden has been taken into consideration. But given the fact that different settings will have distinguished consequences, determining the economic burden of COVID-19 in the studied environment is of great importance. As a result, this study aimed to show the change in indirect costs of mental health problems due to the COVID-19 pandemic in Poland. Methods and Results Indirect costs related to mental health problems were analyzed from the perspective of the Social Insurance Institution in Poland. In 2021, they amounted to about 285.8 billion PLN (Polish currency) [61.1 billion EUR (European currency)], up 6% from the previous year. A large increase in spending on disability benefits was observed for 2019-2021 (+14.7%). Disease groups generating the highest expenditures in the structure of total expenditures on incapacity benefits in 2021 in Poland were mental health problems (16.7% of total expenditures). Expenditures on disability benefits related to mental health problems incurred by Social Security in 2021 amounted to about 7.42 billion PLN [1.6 billion EUR] and were 19.4% higher than in 2019 (before the pandemic). In the 2012-2019 period, there was a significant decrease in expenses related to inpatient rehabilitation (41.3%), while in 2020-2021, these expenses decreased several times as the epidemiological situation related to the COVID pandemic reduced access to such services. Discussion This is the first study on the economic burden of COVID-19 indirect costs in Poland. Calculating the economic impact is crucial, particularly when there is a large disease outbreak and countries are severely constrained by financial resources. Doing so could aid in the development of effective social security policies. As shown in this study, the indirect costs of absenteeism expenses due to mental health problems increased significantly during the COVID-19 pandemic. It is necessary to take all possible measures, both in the field of primary and secondary prevention, to prevent disability and exclusion from the labor market of people affected by mental health problems, which is justified by epidemiological data and financial data on the expenses incurred by Social Security for social insurance benefits.
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Affiliation(s)
- Karolina Sobczyk
- Department of Economics and Health Care Management, Faculty of Public Health in Bytom, Medical University of Silesia in Katowice, Katowice, Poland
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Kaso AW, Mohammed E, Agero G, Churiso G, Kaso T, Ewune HA, Hailu A. Assessment of hospitalisation costs and their determinants among Covid-19 patients in South Central Ethiopia. BMC Health Serv Res 2023; 23:948. [PMID: 37667355 PMCID: PMC10478187 DOI: 10.1186/s12913-023-09988-2] [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: 03/28/2023] [Accepted: 08/30/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (Covid-19) pandemic is a global public health problem. The Covid-19 pandemic has had a substantial impact on the economy of developing countries, including Ethiopia.This study aimed to determine the hospitalisation costs of Covid-19 and the factors associated with the high cost of hospitalisation in South Central Ethiopia. METHODS A retrospective cost analysis of Covid-19 patients hospitalised between July 2020 and July 2021 at Bokoji Hospital Covid-19 Treatment Centre was conducted using both the micro-costing and top-down approaches from the health system perspective. This analysis used cost data obtained from administrative reports, the financial reports of the treatment centre, procurement invoices and the Covid-19 standard treatment guidelines. The Student's t-test, Mann-Whitney U test or Kruskal-Wallis test was employed to test the difference between sociodemographic and clinical factors when appropriate.To identify the determinants of cost drivers in the study population, a generalised linear model with gamma distribution and log link with a stepwise algorithm were used. RESULTS A total of 692 Covid-19 patients were included in the costing analysis. In this study, the mean cost of Covid-19-infected patients with no symptoms was US$1,073.86, with mild symptoms US$1,100.74, with moderate symptoms US$1,394.74 and in severe-critically ill condition US$1,708.05.The overall mean cost was US$1,382.50(95% CI: 1,360.60-1,404.40) per treated episode.The highest mean cost was observed for personnel, accounting for 64.0% of the overall cost. Older age, pre-existing diseases, advanced disease severity at admission, admission to the intensive care unit, prolonged stay on treatment and intranasal oxygen support were strongly associated with higher costs. CONCLUSIONS This study found that the clinical management of Covid-19 patients incurred significant expenses to the health system. Factors such as older age, disease severity, presence of comorbidities, use of inhalation oxygen therapy and prolonged hospital stay were associated with higher hospitalisation costs.Therefore, the government should give priority to the elderly and those with comorbidities in the provision of vaccination to reduce the financial burden on health facilities and health systems in terms of resource utilisation.
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Affiliation(s)
- Abdene Weya Kaso
- Department of Public Health, College of Health Science, Arsi University, Assela, Ethiopia.
| | - Esmael Mohammed
- Bokoji Primary Hospital, Oromia Health Bureau, Bokoji, Ethiopia
| | - Gebi Agero
- Department of Public Health, College of Health Science, Arsi University, Assela, Ethiopia
| | - Gemechu Churiso
- Department of Medical Laboratory, College of Medicine and Health Science, Dilla University, Dila, Ethiopia
| | - Taha Kaso
- Department of Surgery, College of Health Science, Arsi University, Assela, Ethiopia
| | - Helen Ali Ewune
- Department of Public Health, College of Medicine and Health Science, Dilla University, Dila, Ethiopia
| | - Alemayehu Hailu
- Faculty of Health and Social Science, Section for Global Health and Rehabilitation, Western Norway University of Applied Sciences, Bergen, Norway
- Bergen Centre for Ethics and Priority Setting, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Rocha JLL, Riediger I, Gasparetto J, Tuon FF. COVID-19 in real world: Survival and medical costs of hospitalized patients in Brazil´s first wave. Braz J Infect Dis 2023; 27:102778. [PMID: 37209711 PMCID: PMC10183623 DOI: 10.1016/j.bjid.2023.102778] [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: 01/09/2023] [Revised: 04/01/2023] [Accepted: 05/04/2023] [Indexed: 05/22/2023] Open
Abstract
OBJECTIVE To evaluate survival and direct medical costs of patients admitted in private hospitals with COVID-19 during the first wave. METHODS A retrospective, observational study analyzing survival and the economic data retrieved on hospitalized patients with COVID-19. Data from March 2020 to December 2020. The direct cost of hospitalization was estimated using the microcosting method with each individual hospitalization. RESULTS 342 cases were evaluated. Median age of 61.0 (95% CI 57.0‒65.0). 194 (56.7%) were men. The mortality rate was higher in the female sex (p = 0.0037), ICU (p < 0.001), mechanical ventilation (p<0.001) and elderly groups. 143 (41.8%) patients were admitted to the ICU (95% CI 36.6%-47.1%), of which 60 (41.9%) required MV (95% CI 34.0%-50.0%). Global LOS presented median of 6.7 days (95% CI 6.0-7.2). Mean costs were US$ 7,060,00 (95% CI 5,300.94-8,819,00) for each patient. Mean cost for patients discharged alive and patients deceased was US$ 5,475.53 (95% CI 3,692.91-7,258.14) and US$ 12,955.19 (95% CI 8,106.61-17,803.76), respectively (p < 0.001). CONCLUSIONS Patients admitted with COVID-19 in these private hospitals point to great economic impact, mainly in the elderly and high-risk patients. It is key to better understand such costs in order to be prepared to make wise decisions during the current and future global health emergencies.
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Affiliation(s)
- Jaime Luís Lopes Rocha
- Pontifícia Universidade Católica do Paraná, Faculdade de Medicina, Laboratório de Doenças Infecciosas Emergentes, Curitiba, PR, Brazil
| | - Irina Riediger
- Laboratório Central do Estado do Paraná, São José dos Pinhais, PR, Brazil
| | - Juliano Gasparetto
- Pontifícia Universidade Católica do Paraná, Faculdade de Medicina, Laboratório de Doenças Infecciosas Emergentes, Curitiba, PR, Brazil
| | - Felipe Francisco Tuon
- Pontifícia Universidade Católica do Paraná, Faculdade de Medicina, Laboratório de Doenças Infecciosas Emergentes, Curitiba, PR, Brazil.
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Tatsis F, Dragioti E, Gouva M, Koulouras V. Economic Burden of ICU-Hospitalized COVID-19 Patients: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e41802. [PMID: 37575747 PMCID: PMC10422680 DOI: 10.7759/cureus.41802] [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] [Accepted: 07/13/2023] [Indexed: 08/15/2023] Open
Abstract
The impact of the coronavirus disease 2019 (COVID-19) pandemic on the global economy is far-reaching and difficult to assess accurately. We aimed to systematically determine the magnitude of the costs and the economic burden of intensive care for hospitalized COVID-19 patients since the onset of the pandemic by means of a systematic review. We conducted a PRISMA 2020-compliant (protocol: PROSPERO CRD42022348741) systematic review by searching PubMed, EMBASE, and Web of Science for relevant literature. We included studies that presented costs based on a primary partial economic evaluation. Using the Consolidated Health Economic Evaluation Reporting Standards checklist and the population, intervention, control, and outcome criteria, we established the risk of bias in studies at the individual level. Daily cost per ICU admission and total cost per ICU patient of the original studies extracted. A random effect model was adopted for meta-analysis whenever possible. Of the 1,635 unique records identified, 14 studies related to ICU-hospitalized costs due to COVID-19 were eligible for inclusion. Included studies represented 93,721 hospitalized COVID-19 patients. Regarding total direct medical costs, the lowest cost per patient at ICU was observed in Turkey ($2,984.78 ± 2,395.93), while the highest was in Portugal ($51,358.52 ± 30,150.38). The Republic of Korea reported the highest length of stay of 29.4 days (±17.80), and the lowest is observed in India for nine days (±5.98). Our findings emphasize COVID-19's significance on health-economic outcomes. Limited research exists on the economic burden of COVID-19 in the ICU. Further studies on cost estimates can enhance data clarity, enabling informed analysis of healthcare costs and aiding efficient patient care organization by care providers and policymakers.
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Affiliation(s)
- Fotios Tatsis
- Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, GRC
| | - Elena Dragioti
- Research Laboratory Psychology of Patients, Families & Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, GRC
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, SWE
| | - Mary Gouva
- Research Laboratory Psychology of Patients, Families & Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, GRC
| | - Vasilios Koulouras
- Department of Intensive Care Unit, University Hospital of Ioannina, Ioannina, GRC
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Beshah SA, Zeru A, Tadele W, Defar A, Getachew T, Fekadu Assebe L. A cost-effectiveness analysis of COVID-19 critical care interventions in Addis Ababa, Ethiopia: a modeling study. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2023; 21:40. [PMID: 37365623 DOI: 10.1186/s12962-023-00446-8] [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: 02/02/2023] [Accepted: 06/05/2023] [Indexed: 06/28/2023] Open
Abstract
OBJECTIVE To estimate and compare the cost-effectiveness of COVID-19 critical care intervention approaches: noninvasive (oxygen without intubation) and invasive (intubation) management in Ethiopia. METHODS A Markov model is used to compare the costs and outcomes for non-invasive and invasive COVID-19 clinical interventions using both primary and secondary data sources. Healthcare provider costs (recurrent and capital cost) and patient-side costs (direct and indirect) were estimated and reported in United States Dollars (US$), 2021. The outcome measure used in this analysis was DALYs averted. Both the average cost-effectiveness ratio (ACER) and incremental cost-effectiveness ratio (ICER) were reported. One-way and probabilistic sensitivity analyses were applied to assess the robustness of the findings. The analysis is conducted using Tree Age pro health care software 2022. RESULT The average cost per patient per episode for mild/moderate, severe, noninvasive, and invasive critical management was $951, $3449, $5514, and $6500, respectively. According to the average cost-effective ratio (ACER), non-invasive management resulted in $1991 per DALY averted, while invasive management resulted in $3998 per DALY averted. Similarly, the incremental cost-effective ratio (ICER) of invasive compared to noninvasive management was $ 4948 per DALY averted. CONCLUSION Clinical management of critical COVID-19 cases in Ethiopia is associated with a significant financial burden. Invasive intervention is unlikely to be a cost-effective COVID-19 intervention in Ethiopia compared to noninvasive critical case management using a willingness to pay threshold of three times GDP per capita.
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Affiliation(s)
- Senait Alemayehu Beshah
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
| | - Arega Zeru
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Wogayehu Tadele
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Atkure Defar
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Theodros Getachew
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Lelisa Fekadu Assebe
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
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20
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Gheinali Z, Moshiri E, Ebrahimi Tavani M, Haghi M, Gharibi F. Catastrophic health expenditures in hospitalized patients with delta variant of COVID-19: A cross-sectional study. Health Promot Perspect 2023; 13:68-76. [PMID: 37309437 PMCID: PMC10257567 DOI: 10.34172/hpp.2023.09] [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: 08/21/2022] [Accepted: 02/05/2023] [Indexed: 06/14/2023] Open
Abstract
Background: Financial protection of populations against healthcare costs is one of the fundamental responsibilities of governments. This study aimed to investigate the incidence of catastrophic health expenditures (CHE) and it's affecting factors in hospitalized patients with delta variant of COVID-19. Methods: In this cross-sectional study, we included 400 hospitalized COVID-19 patients at Kosar Hospital of Semnan in 2022, using a researcher-made checklist. Based on qualitative nature of the variables, chi-square test was used to investigate the statistical associations between the demographic/background characteristics and the incidence of CHE. Results: On average, COVID-19 imposed 1833.43 USD direct medical costs per one hospitalized patient. The ratio of direct-medical costs to household's non-food expenses was 2.35, and 61% (CI:±4.78%) of the patients were subject to CHE. Besides, residence place, basic insurance type, benefitting from supplementary insurance, suffering from underlying diseases, hospitalization in ICU, falling into a coma, facing pulmonary failure, and performing hemoperfusion had significant associations with CHE (P<0.05). Conclusion: The incidence of CHE in hospitalized COVID-19 patients was undesirable, which may be due to geographical, economical, and occupational inequalities apart from the factors related to the severity of the disease. So, health policymakers should pay attention to the provision of proper financial risk protection policies to make the health insurance system more efficient and appropriate.
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Affiliation(s)
- Zahra Gheinali
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Esmaeil Moshiri
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Masoumeh Ebrahimi Tavani
- Quality Improvement, Monitoring and Evaluation Department, Center of Health Network Management, Deputy of Public Health, Ministry of Health & Medical Education, Tehran, Iran
| | - Mehdi Haghi
- Social Determinants of Health Research Center, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Farid Gharibi
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
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21
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Lotfi F, Khodabandeh F, Jafari A, Rezaee M, Rahimi H, Shiravani Z, Keshavarz K. Economic burden of cervical cancer and premalignant lesions associated with human papilloma virus: a societal perspective. Expert Rev Pharmacoecon Outcomes Res 2023; 23:439-447. [PMID: 36876411 DOI: 10.1080/14737167.2023.2186400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Cervical cancer is one of the most common cancers in women, the cause of which is mostly human papilloma virus (HPV). The aim of this study was to determine the economic burden of cervical cancer and premalignant lesions associated with HPV infection from a societal perspective. METHODS The study is a partial economic evaluation (cost of illness), which was conducted cross-sectionally in the referral university clinic in Fars province in 2021. The prevalence-based and bottom-up approaches used to calculate the costs, the indirect costs were calculated by human capital approach. RESULTS The mean cost of premalignant lesions associated with HPV infection was USD 2,853 per patient, which 68.57% was direct medical costs. In addition, the mean cost of cervical cancer was USD 39,327 per patient, the largest share of which (57.9%) was related to indirect costs. The mean annual cost of cervical cancer patients in the country was estimated at USD 40,884,609 as well. CONCLUSION Cervical cancer and premalignant lesions associated with HPV infection imposed a significant economic burden on the health system and patients. The results of the present study can help health policymakers with efficient and equitable prioritization and allocation of resources.
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Affiliation(s)
- Farhad Lotfi
- National Center for Health Insurance Research, Tehran, Iran.,Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Khodabandeh
- Student Research Committee, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdosaleh Jafari
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Rezaee
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamed Rahimi
- School of Medicine, Dezful University of Medical Sciences, Dezful, Iran
| | - Zahra Shiravani
- Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Khosro Keshavarz
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.,Emergency Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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22
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Moslehi S, Dehdashti A, Pourmohammdi B, Fatemi F. Main social vulnerability indicators in the COVID-19 pandemic in Iran. Front Public Health 2023; 11:1080137. [PMID: 37050958 PMCID: PMC10083335 DOI: 10.3389/fpubh.2023.1080137] [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: 10/25/2022] [Accepted: 03/02/2023] [Indexed: 03/28/2023] Open
Abstract
Background Social factors play the main role in the vulnerability of exposed countries to disasters. The COVID-19 pandemic as a disaster is not an exception to this fact. This study aimed to determine the main social vulnerability indicators in the COVID-19 pandemic in Iran. Methods This study was conducted during the period of 2021-2022 in three phases, including a systematic review, a virtual panel expert, and the Analytical Hierarchy Process. First, the draft of social vulnerability indicators in COVID-19 was extracted through a systematic review. Then, the extracted indicators were finalized and prioritized by the expert panel and the AHP, respectively. Results Initially, the literature review found five domains and 38 indicators of social vulnerability in COVID-19. The outcome of the expert panel increased the related domains to six but decreased the indicators to 31. The three prioritized social vulnerability indicators that were determined by the AHP were population density, accessibility to healthcare facilities, and relevant services and vulnerable groups. Conclusion Measuring social vulnerability with the identified indicators is valuable for addressing high COVID-19 incidence among socially vulnerable hotspot areas. Regarding the result of this study, further research should be conducted to validate the identified indicators.
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Affiliation(s)
- Shandiz Moslehi
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
- Department of Health in Disasters and Emergencies, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Dehdashti
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
- Research Center of Health Sciences and Technologies, Faculty of Health, Semnan University of Medical Sciences, Semnan, Iran
| | - Behrad Pourmohammdi
- Department of Parasitology, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Farin Fatemi
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
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23
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Alshahrani A. The expected economic burden on the healthcare system because of quarantining patients with monkeypox virus. Saudi Med J 2023; 44:231-236. [PMID: 36940962 PMCID: PMC10043895 DOI: 10.15537/smj.2023.44.3.20220515] [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] [Indexed: 03/23/2023] Open
Abstract
Quarantine is a common public health intervention that is often used to curb pandemics of infectious diseases. Quarantine is the intentional separation of people who are either suspected or confirmed to be infected with a contagious virus from the uninfected population. The goal of this study was to determine the expected economic cost for healthcare systems due to quarantine in the case of the monkeypox virus. A systematic literature review of studies on similar virus outbreaks was performed. The findings affirm that quarantine effectively mitigates the spread of a virus outbreak, but it has high direct and indirect costs that can only be justifiable for a dangerous virus with high mortality. The monkeypox virus presents moderate risk, unlike high-risk diseases for which quarantine is mandatory. The study recommends the introduction of mass vaccination programs and public awareness and sensitization forums to inform the population about the best behavioral practices to curb the spread of monkeypox virus.
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Affiliation(s)
- Ali Alshahrani
- From the Department of Clinical Pharmacy, College of Pharmacy, Tiaf University, Taif, Kingdom of Saudi Arabia.
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24
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Sousa FFD, Vieira BB, Reis ADC. Cost Analysis of Hospitalization for COVID-19 in a Brazilian Public Teaching Hospital. Value Health Reg Issues 2023; 34:48-54. [PMID: 36469989 PMCID: PMC9718517 DOI: 10.1016/j.vhri.2022.10.006] [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: 03/22/2022] [Revised: 09/13/2022] [Accepted: 10/14/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVES This study aimed to measure the hospitalization costs for suspect or confirmation cases of COVID-19 and aggregate knowledge in the costing process for future research on related topics. METHODS A cost calculation model was applied using absorption costing technique. Cost was allocated into 2 main groups: hospitalization and personnel. The cost analysis considers the hospital perspective. This is a retrospective study whose data were collected between April and September 2020, equivalent to the first wave of the disease in Brazil. This research uses data from Hospital Information System, Brazilian Unified Health System (SUS) Cost Calculation and Management System, and SUS Hospital Information System. RESULTS The average total cost per hospitalization was US$11 260 (R$63 504) for patients suspect or confirmed by COVID-19, and considering only detectable cases, the value was US$17 178 (R$96 886). The profile of hospitalized patients was male (51%), with a mean age of 59 years, white ethnicity (64%), and average length of stay of 9 days. CONCLUSIONS The amount approved by SUS for remuneration of hospitalizations by COVID-19 proved to be insufficient to cover the calculated costs. The results of this study collaborate to measure the expenditure of hospital institutions with COVID-19 hospitalizations, contribute as a parameter for health managers to identify whether the values attributed to hospitalization by COVID-19 by the SUS are adequate to cover all costs involved, and provide lessons learned on costs to the public health system in the event of new pandemics.
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Affiliation(s)
| | - Bruno Barbosa Vieira
- Juiz de Fora Federal University Hospital (HU-UFJF/Ebserh), Juiz de Fora, Minas Gerais, Brazil; Postgraduate Programme in Production Engineering and Systems (PPPRO), Federal Centre for Engineering Studies and Technological Education - CEFET/RJ, Rio de Janeiro, Brazil
| | - Augusto da Cunha Reis
- Postgraduate Programme in Production Engineering and Systems (PPPRO), Federal Centre for Engineering Studies and Technological Education - CEFET/RJ, Rio de Janeiro, Brazil
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25
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Cardoso RB, Marcolino MAZ, Marcolino MS, Fortis CF, Moreira LB, Coutinho AP, Clausell NO, Nabi J, Kaplan RS, Etges APBDS, Polanczyk CA. Comparison of COVID-19 hospitalization costs across care pathways: a patient-level time-driven activity-based costing analysis in a Brazilian hospital. BMC Health Serv Res 2023; 23:198. [PMID: 36829122 PMCID: PMC9955521 DOI: 10.1186/s12913-023-09049-8] [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: 05/06/2022] [Accepted: 01/09/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic raised awareness of the need to better understand where and how patient-level costs are incurred in health care organizations, as health managers and other decision-makers need to plan and quickly adapt to the increasing demand for health care services to meet patients' care needs. Time-driven activity-based costing offers a better understanding of the drivers of cost throughout the care pathway, providing information that can guide decisions on process improvement and resource optimization. This study aims to estimate COVID-19 patient-level hospital costs and to evaluate cost variability considering the in-hospital care pathways of COVID-19 management and the patient clinical classification. METHODS This is a prospective cohort study that applied time-driven activity-based costing (TDABC) in a Brazilian reference center for COVID-19. Patients hospitalized during the first wave of the disease were selected for their data to be analyzed to estimate in-hospital costs. The cost information was calculated at the patient level and stratified by hospital care pathway and Ordinal Scale for Clinical Improvement (OSCI) category. Multivariable analyses were applied to identify predictors of cost variability in the care pathways that were evaluated. RESULTS A total of 208 patients were included in the study. Patients followed five different care pathways, of which Emergency + Ward was the most followed (n = 118, 57%). Pathways which included the intensive care unit presented a statistically significant influence on costs per patient (p < 0.001) when compared to Emergency + Ward. The median cost per patient was I$2879 (IQR 1215; 8140) and mean cost per patient was I$6818 (SD 9043). The most expensive care pathway was the ICU only, registering a median cost per patient of I$13,519 (IQR 5637; 23,373) and mean cost per patient of I$17,709 (SD 16,020). All care pathways that included the ICU unit registered a higher cost per patient. CONCLUSIONS This is one of the first microcosting study for COVID-19 that applied the TDABC methodology and demonstrated how patient-level costs vary as a function of the care pathways followed by patients. These findings can be used to develop value reimbursement strategies that will inform sustainable health policies in middle-income countries such as Brazil.
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Affiliation(s)
- Ricardo Bertoglio Cardoso
- grid.8532.c0000 0001 2200 7498National Institute of Science and Technology for Health Technology Assessment (IATS) (project: 465518/2014-1), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil ,grid.8532.c0000 0001 2200 7498Graduate Program in Epidemiology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Miriam Allein Zago Marcolino
- grid.8532.c0000 0001 2200 7498National Institute of Science and Technology for Health Technology Assessment (IATS) (project: 465518/2014-1), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil ,grid.8532.c0000 0001 2200 7498Graduate Program in Epidemiology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Milena Soriano Marcolino
- grid.8430.f0000 0001 2181 4888Internal Medicine Division, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Camila Felix Fortis
- grid.8532.c0000 0001 2200 7498National Institute of Science and Technology for Health Technology Assessment (IATS) (project: 465518/2014-1), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Leila Beltrami Moreira
- grid.8532.c0000 0001 2200 7498School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil ,grid.414449.80000 0001 0125 3761Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Ana Paula Coutinho
- grid.414449.80000 0001 0125 3761Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Nadine Oliveira Clausell
- grid.8532.c0000 0001 2200 7498School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil ,grid.414449.80000 0001 0125 3761Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Junaid Nabi
- grid.38142.3c000000041936754XHarvard Business School, Boston, MA USA
| | - Robert S. Kaplan
- grid.38142.3c000000041936754XHarvard Business School, Boston, MA USA
| | - Ana Paula Beck da Silva Etges
- grid.8532.c0000 0001 2200 7498National Institute of Science and Technology for Health Technology Assessment (IATS) (project: 465518/2014-1), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil ,grid.8532.c0000 0001 2200 7498Graduate Program in Epidemiology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil ,grid.412519.a0000 0001 2166 9094School of Technology, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Carisi Anne Polanczyk
- National Institute of Science and Technology for Health Technology Assessment (IATS) (project: 465518/2014-1), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. .,Graduate Program in Epidemiology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. .,School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. .,Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
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26
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Yuan S, Li T, Chu C, Wang X, Liu L. Treatment cost assessment for COVID-19 inpatients in Shenzhen, China 2020-2021: facts and suggestions. Front Public Health 2023; 11:1066694. [PMID: 37213645 PMCID: PMC10192705 DOI: 10.3389/fpubh.2023.1066694] [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: 10/11/2022] [Accepted: 04/17/2023] [Indexed: 05/23/2023] Open
Abstract
Background Knowledge regarding the treatment cost of coronavirus disease 2019 (COVID-19) in the real world is vital for disease burden forecasts and health resources planning. However, it is greatly hindered by obtaining reliable cost data from actual patients. To address this knowledge gap, this study aims to estimate the treatment cost and specific cost components for COVID-19 inpatients in Shenzhen city, China in 2020-2021. Methods It is a 2 years' cross-sectional study. The de-identified discharge claims were collected from the hospital information system (HIS) of COVID-19 designated hospital in Shenzhen, China. One thousand three hundred ninety-eight inpatients with a discharge diagnosis for COVID-19 from January 10, 2020 (the first COVID-19 case admitted in the hospital in Shenzhen) to December 31, 2021. A comparison was made of treatment cost and cost components of COVID-19 inpatients among seven COVID-19 clinical classifications (asymptomatic, mild, moderate, severe, critical, convalescent and re-positive cases) and three admission stages (divided by the implementation of different treatment guidelines). The multi-variable linear regression models were used to conduct the analysis. Results The treatment cost for included COVID-19 inpatients was USD 3,328.8. The number of convalescent cases accounted for the largest proportion of all COVID-19 inpatients (42.7%). The severe and critical cases incurred more than 40% of treatment cost on western medicine, while the other five COVID-19 clinical classifications spent the largest proportion (32%-51%) on lab testing. Compared with asymptomatic cases, significant increases of treatment cost were observed in mild cases (by 30.0%), moderate cases (by 49.2%), severe cases (by 228.7%) and critical cases (by 680.7%), while reductions were shown in re-positive cases (by 43.1%) and convalescent cases (by 38.6%). The decreasing trend of treatment cost was observed during the latter two stages by 7.6 and 17.9%, respectively. Conclusions Our findings identified the difference of inpatient treatment cost across seven COVID-19 clinical classifications and the changes at three admission stages. It is highly suggestive to inform the financial burden experienced by the health insurance fund and the Government, to emphasize the rational use of lab tests and western medicine in the COVID-19 treatment guideline, and to design suitable treatment and control policy for convalescent cases.
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Affiliation(s)
- Shasha Yuan
- Institute of Medical Information & Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ting Li
- National Clinical Research Centre for Infectious Diseases, The Third People's Hospital of Shenzhen, Shenzhen, China
- Centre for Environment and Population Health, School of Medicine and Dentistry, Griffith University, Brisbane, QLD, Australia
| | - Cordia Chu
- Centre for Environment and Population Health, School of Medicine and Dentistry, Griffith University, Brisbane, QLD, Australia
| | - Xiaowan Wang
- Institute of Medical Information & Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- *Correspondence: Xiaowan Wang
| | - Lei Liu
- National Clinical Research Centre for Infectious Diseases, The Third People's Hospital of Shenzhen, Shenzhen, China
- Lei Liu
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27
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Altawalbeh SM, Alshogran OY, Al-Sawalha NA, Al-Saleem MM. Clinical Outcomes and Direct Medical Expenditures Associated With Intensive Care Unit Admission for Inpatients With COVID-19 in Jordan: A Retrospective Cohort Study. Value Health Reg Issues 2023; 33:76-82. [PMID: 36270104 PMCID: PMC9578045 DOI: 10.1016/j.vhri.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 08/25/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES This study aimed to describe clinical outcomes and medical expenditures associated with COVID-19 admissions. In addition, this study aimed to investigate the impact of patients' characteristics and baseline comorbidities on intensive care unit (ICU) admission, mortality, and medical expenditures for hospitalized patients with COVID-19. METHODS This retrospective cohort study included all hospitalized patients with confirmed COVID-19 in Prince Hamza Hospital and King Abdullah University Hospital, during the period from March 2020 to June 2021. Medical records and pharmacy data were followed and reviewed throughout their admissions. The ICU admission, inpatient mortality, hospital length of stay, and inpatient charges were described. Predictors of ICU admission and inpatient charges were evaluated. RESULTS A total of 7694 COVID-19 hospital admissions were included. Approximately 1189 patients (15.5%) were admitted to ICU and 21.4% died in the hospital. The fatality rate among those admitted to ICU was 82.6% compared with 10.2% for non-ICU admitted patients. The average admission charge and charge per admission day were 1598.2 and 200.2 Jordanian dinar, respectively, and both charges were higher in ICU admitted patients than non-ICU admitted patients. Being older in age, smoker or ex-smoker, and having chronic diseases were all significantly associated with a higher likelihood of ICU admission and mortality among admitted patients. CONCLUSIONS ICU admission in patients with COVID-19 is associated with poor clinical outcomes and substantial medical expenditures and is more likely among older adults, smokers, and those with chronic diseases.
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Affiliation(s)
- Shoroq M. Altawalbeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan,Correspondence: Shoroq M. Altawalbeh, PharmD, PhD, Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan
| | - Osama Y. Alshogran
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Nour A. Al-Sawalha
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
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28
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Rahimi H, Goudarzi R, Markazi-Moghaddam N, Nezami-Asl A, Zargar Balaye Jame S. Cost-benefit analysis of Intensive Care Unit with Activity-Based Costing approach in the era COVID-19 pandemic: A case study from Iran. PLoS One 2023; 18:e0285792. [PMID: 37192194 DOI: 10.1371/journal.pone.0285792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/29/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Providing intensive care to acute patients is a vital part of health systems. However, the high cost of Intensive Care Units (ICU) has limited their development, especially in low-income countries. Due to the increasing need for intensive care and limited resources, ICU cost management is important. This study aimed to analyze the cost-benefit of ICU during COVID-19 in Tehran, Iran. METHODS This cross-sectional study is an economic evaluation of health interventions. The study was conducted in the COVID-19 dedicated ICU, from the provider's point of view and within one-year horizon. Costs were calculated using a top-down approach and the Activity-Based Costing technique. Benefits were extracted from the hospital's HIS system. Benefit Cost ratio (BCR) and Net Present Value (NPV) indexes were used for cost-benefit analysis (CBA). A sensitivity analysis was performed to evaluate the dependence of the CBA results on the uncertainties in the cost data. Analysis was performed with Excel and STATA software. RESULTS The studied ICU had 43 personnel, 14 active beds, a 77% bed occupancy rate, and 3959 occupied bed days. The total costs were $2,372,125.46 USD, of which 70.3% were direct costs. The highest direct cost was related to human resources. The total net income was $1,213,314.13 USD. NPV and BCR were obtained as $-1,158,811.32 USD and 0.511 respectively. CONCLUSION Despite operating with a relatively high capacity, ICU has had high losses during the COVID-19. Proper management and re-planning in the structure of human resources is recommended due to its importance in the hospital economy, provision of resources based on needs assessment, improvement of drugs management, reduction of insurance deductions in order to reduce costs and improve ICU productivity.
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Affiliation(s)
- Hamed Rahimi
- Department of Health Management and Economics, Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Reza Goudarzi
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Nader Markazi-Moghaddam
- Department of Health Management and Economics, Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Amir Nezami-Asl
- Faculty of Aerospace and Subaquatic Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Sanaz Zargar Balaye Jame
- Department of Health Management and Economics, Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran
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29
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Rajabi M, Rezaee M, Omranikhoo H, Khosravi A, Keshmiri S, Ghaedi H, Pourreza A. Cost of Illness of COVID-19 and Its Consequences on Health and Economic System. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2022; 59:469580221144398. [PMID: 36572983 PMCID: PMC9805926 DOI: 10.1177/00469580221144398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The outbreak of COVID-19 has had destructive influences on social and economic systems as well as many aspects of human life. In this study, we aimed to estimate the economic effects of COVID-19 at the individual and societal levels during a fiscal year. This cost of illness analysis was used to estimate the economic burden of COVID-19 in Iran. Data of the COVID-19 patients referred to the hospitals affiliated to Bushehr University of Medical Sciences in 2021 were collected through the Hospital Information System (HIS). The study methodology was based upon the human capital approach and bottom-up technique. The COVID-19 pandemic has resulted in 9711 confirmed hospital cases and 717 deaths in Bushehr province during the study period. The direct and indirect costs were estimated to be $1446.06 and $3081.44 per patient. The economic burden for the province and country was estimated to be $43.97 and $2680.88 million. The results showed that the economic burden of this disease particularly premature death costs is remarkably high. Therefore, in order to increase the resiliency of the health system and the stability in service delivery, preventive-oriented strategies have to be more seriously considered by policymakers.
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Affiliation(s)
- Marziyeh Rajabi
- Department of Public Health, School of
Health, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Mehdi Rezaee
- Student Research Committee, Health
Human Resources Research Center, School of Health Management and Information
Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Habib Omranikhoo
- Department of Public Health, School of
Health, Bushehr University of Medical Sciences, Bushehr, Iran,Habib Omranikhoo, Department of Public
Health, School of Health, Bushehr University of Medical Sciences, Medical
University Campus, Sabzabad Street, Bushehr 7518759577, Iran.
| | - Abdolrasool Khosravi
- Department of Medical Library and
Information Science, Faculty of Paramedicine, Bushehr University of Medical
Sciences, Bushehr, Iran
| | - Saeed Keshmiri
- Faculty of Medicine, Bushehr University
of Medical Sciences, Bushehr, Iran
| | - Hossien Ghaedi
- Department of Environmental Health
Engineering, Faculty of Health, Bushehr University of Medical Sciences, Bushehr,
Iran
| | - Abolghasem Pourreza
- Department of Health Promotion and
Education, School of Public Health, Community Based Participatory Research Center,
Iranian Institute for reduction of High- Risk Behaviors, Tehran University of
Medical Sciences, Tehran, Iran
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Lopez-Villegas A, Bautista-Mesa RJ, Acosta-Robles P, Hidalgo-Serrano D, Aguirre-Ortega FJ, Castellano-Ortega MA, Mollo MM, Leal-Costa C, Peiro S. Analysis of Healthcare Costs Incurred in Regional Hospitals in Andalusia (Spain) during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16132. [PMID: 36498203 PMCID: PMC9735610 DOI: 10.3390/ijerph192316132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/15/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
(1) Background: The global health crisis caused by the coronavirus disease (COVID-19) pandemic has led to extreme overloading of different public healthcare systems worldwide. The Spanish Public Healthcare System is one of them. This study aimed to conduct a comparative cost analysis to assess the impact of the COVID-19 pandemic on small- and medium-sized regional hospitals in Andalusia (Spain). (2) Methods: This comparative, multicentre, observational, and retrospective study was designed to perform a comparative cost analysis between the Alto Guadalquivir Health Agency (AGHA) and Poniente University Hospital (PUH), both of which belong to the Spanish Public Health System (PHS). The data included in this study corresponds to the total costs by area and year incurred by the 61,335 patients from both healthcare institutions (AGHA = 36,110; PUH = 25,225) in the areas of hospital emergency service (HES), hospitalisation, and intensive care unit (ICU), during the 24 months of the study period (from 1 January 2019 to 31 December 2020). (3) Results: The analysis results showed a significant increase in costs incurred in 2020 for HES relative to those incurred in 2019 for both AGHA (+14%; p < 0.003) and PUH (+36%; p = 0.002). Additionally, costs incurred for ICU increased significantly in 2020 relative to those incurred in 2019 for both AGHA (+30%; p = 0.003) and PUH (+46%; p = 0.002). Hospitalisation costs for AGHA also increased significantly (+9%; p < 0.012) in 2020 versus those obtained in 2019; however, no significant differences were found for PUH (+6%; p = 1) in the same period analysed. However, the number of patients treated in the areas of HES, hospitalisation, and ICU was significantly reduced throughout 2020 compared to 2019. (4) Conclusions: Our findings show that the costs incurred during 2020 in the regional hospitals of Andalusia (Spain) increased significantly in most of the parameters analysed relative to those incurred in the year before the pandemic (i.e., 2019).
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Affiliation(s)
- Antonio Lopez-Villegas
- Laboratory for Research, Education and Planning in Critical and Intensive Care Medicine, CTS-609 Research Group, Poniente University Hospital, 04700 El Ejido, Spain
| | | | | | - David Hidalgo-Serrano
- Economic Directorate and General Services, Poniente University Hospital, 04700 El Ejido, Spain
| | | | | | - Maria Marta Mollo
- Management Control Unit, Alto Guadalquivir Health Agency, 23740 Andujar, Spain
| | - Cesar Leal-Costa
- Nursing Department, University of Murcia, El Palmar, 30120 Murcia, Spain
| | - Salvador Peiro
- Health Services Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 46020 Valencia, Spain
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31
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Lanyo TN, Ani-Amponsah M, Adjei CA. Challenges and ways of coping of parturient women with chronic hepatitis B in Ghana during COVID-19 pandemic: a qualitative inquiry. BMJ Open 2022; 12:e062557. [PMID: 36283752 PMCID: PMC9606735 DOI: 10.1136/bmjopen-2022-062557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To explore the psychosocial concerns and ways of coping of pregnant women with chronic hepatitis B infection in Ghana. SETTING Participants were selected from public health facilities in the Tema Metropolis. DESIGN Exploratory descriptive qualitative design was employed. PARTICIPANTS Fourteen pregnant women were purposively selected to participate in face-to-face interviews. The data were analysed using the content analysis procedure. RESULTS The participants' psychosocial concerns and coping strategies were diverse. A significant number of the participants were concerned about the impact their hepatitis B seropositivity would have on their relationships, finances, and general well-being. Specifically, they feared that their social network, especially their spouses, would perceive them as having led a promiscuous lifestyle in the past to acquire hepatitis B infection. Also, fear of transmitting the infection to their infants and the effects of the infection on their infants later in life were identified as major concerns by nearly all participants. The participants further reported feelings of distress and diminished self-esteem. These psychosocial afflictions reported were attributed to lack of pre-test counselling during the antenatal care period. However, the participants coped using different strategies, including avoidance/denial, spirituality, and alternative treatment use. CONCLUSION To achieve optimal psychological and social well-being of pregnant women with chronic hepatitis B, it is important that their unique challenges are considered in their care and treatment cascade. Explicitly, protocols for supportive care addressing the specific needs of pregnant women with chronic hepatitis B should be implemented in the study setting.
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Affiliation(s)
| | - Mary Ani-Amponsah
- Department of Maternal and Child Health, University of Ghana School of Nursing, Accra, Ghana
| | - Charles Ampong Adjei
- Department of Public Health Nursing, University of Ghana School of Nursing, Accra, Ghana
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Behboodikhah H, Shorafa E, Karimzadeh I, Moghadami M, Shahmohammadi J, Bayati M, Keshavarz K, Negahdaripour M. Evaluation of the Costs and Outcomes of COVID-19 Therapeutic Regimens in Hospitalized Patients in Shiraz. IRANIAN JOURNAL OF SCIENCE AND TECHNOLOGY. TRANSACTION A, SCIENCE 2022; 46:1339-1347. [PMID: 36128189 PMCID: PMC9477173 DOI: 10.1007/s40995-022-01351-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/20/2022] [Indexed: 06/15/2023]
Abstract
COVID-19 patients in critical conditions are hospitalized and treated with various protocols including antiviral drugs, which have been updated repeatedly. This study was aimed to analyze the demographics, costs, and outcomes of drug regimens in COVID-19 patients hospitalized in "Ali Asghar" hospital, affiliated with Shiraz University of Medical Sciences, from March 2019 to December 2020 as a retrospective study, approved by the ethics committee of Shiraz University of Medical Sciences (IR.SUMS.REC.1399.1003) on Dec. 28, 2020. Using hospital information system (HIS) data, 2174 patients receiving favipiravir, remdesivir, interferon-β, and Kaletra® were analyzed. Descriptive, univariate, and regression analyses were used. The costs and consequences of different drug regimens were significantly different (P value < 0.05); the highest and lowest costs belonged to remdesivir and Kaletra®, respectively. The highest and lowest mean length of stay and mortality were related to remdesivir and favipiravir, respectively. Mortality did not differ significantly with various regimens. Length of stay was significantly shorter with favipiravir and Kaletra® than interferon-β. Remdesivir had significantly the highest cost. Age presented a significantly positive relationship with mortality and length of stay. Besides, ICU admission significantly increased mortality, length of stay, and costs. Underlying diseases and low blood oxygen saturation contributed to mortality. COVID-19 correlation with age and underlying diseases is accordant with the published data. Given the highest costs and broad usage of remdesivir, besides controversies regarding its outcomes and side effects, a stricter evaluation of remdesivir benefits seems essential. Totally, COVID-19 therapeutic protocols should be selected carefully to optimize costs and outcomes.
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Affiliation(s)
- Hooman Behboodikhah
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, P.O. Box 71345-1583, Shiraz, Iran
| | - Eslam Shorafa
- Division of Intensive Care Unit, Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Iman Karimzadeh
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Moghadami
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Javad Shahmohammadi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Bayati
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Khosro Keshavarz
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Emergency Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Manica Negahdaripour
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, P.O. Box 71345-1583, Shiraz, Iran
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Kim JE, Choi H, Choi Y, Lee CH. The economic impact of COVID-19 interventions: A mathematical modeling approach. Front Public Health 2022; 10:993745. [PMID: 36172208 PMCID: PMC9512395 DOI: 10.3389/fpubh.2022.993745] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/23/2022] [Indexed: 01/26/2023] Open
Abstract
Prior to vaccination or drug treatment, non-pharmaceutical interventions were almost the only way to control the coronavirus disease 2019 (COVID-19) epidemic. After vaccines were developed, effective vaccination strategies became important. The prolonged COVID-19 pandemic has caused enormous economic losses worldwide. As such, it is necessary to estimate the economic effects of control policies, including non-pharmaceutical interventions and vaccination strategies. We estimated the costs associated with COVID-19 according to different vaccination rollout speeds and social distancing levels and investigated effective control strategies for cost minimization. Age-structured mathematical models were developed and used to study disease transmission epidemiology. Using these models, we estimated the actual costs due to COVID-19, considering costs associated with medical care, lost wages, death, vaccination, and gross domestic product (GDP) losses due to social distancing. The lower the social distancing (SD) level, the more important the vaccination rollout speed. SD level 1 was cost-effective under fast rollout speeds, but SD level 2 was more effective for slow rollout speeds. If the vaccine rollout rate is fast enough, even implementing SD level 1 will be cost effective and can control the number of critically ill patients and deaths. If social distancing is maintained at level 2 at the beginning and then relaxed when sufficient vaccinations have been administered, economic costs can be reduced while maintaining the number of patients with severe symptoms below the intensive care unit (ICU) capacity. Korea has wellequipped medical facilities and infrastructure for rapid vaccination, and the public's desire for vaccination is high. In this case, the speed of vaccine supply is an important factor in controlling the COVID-19 epidemic. If the speed of vaccination is fast, it is possible to maintain a low level of social distancing without a significant increase in the number of deaths and hospitalized patients with severe symptoms, and the corresponding costs can be reduced.
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Affiliation(s)
- Jung Eun Kim
- Department of Mathematical Sciences, Ulsan National Institute of Science and Technology, Ulsan, South Korea
| | - Heejin Choi
- Department of Mathematical Sciences, Ulsan National Institute of Science and Technology, Ulsan, South Korea
| | - Yongin Choi
- Busan Center for Medical Mathematics, National Institute of Mathematical Sciences, Daejeon, South Korea
| | - Chang Hyeong Lee
- Department of Mathematical Sciences, Ulsan National Institute of Science and Technology, Ulsan, South Korea,*Correspondence: Chang Hyeong Lee
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Apostol-Nicodemus L, Tabios IKB, Limpoco AGO, Domingo GDP, Tantengco OAG. Psychosocial Distress among Family Members of COVID-19 Patients Admitted to Hospital and Isolation Facilities in the Philippines: A Prospective Cohort Study. J Clin Med 2022; 11:jcm11175236. [PMID: 36079167 PMCID: PMC9457412 DOI: 10.3390/jcm11175236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/30/2022] [Accepted: 09/02/2022] [Indexed: 11/16/2022] Open
Abstract
This study determined the psychosocial impact of COVID-19 on families of adult COVID-19 patients in isolation facilities in Metro Manila, Philippines. This prospective cohort study was conducted in COVID-19 healthcare facilities. Data collection was undertaken 2 weeks and 8 weeks after discharge. Logistic regression was performed to determine the socioeconomic and clinical factors influencing anxiety, depression, and family function. Based on HADS-P, 43.2% of the participants had anxiety symptoms, and 16.2% had depression symptoms 2 weeks after the discharge of their relative with COVID-19 infection. The prevalence of anxiety and depression significantly decreased to 24.3% and 5.4%, respectively, 8 weeks after discharge. The percentage of participants with a perceived moderate family dysfunction was 9.5% in the 2nd week and 6.8% in the 8th week post discharge. Participants with perceived severe family dysfunction increased from none to 4.1%. The most inadequate family resources for the participants were economic, medical, and educational resources. Patient anxiety (p = 0.010) and perceived inadequate family resources (p = 0.032) were associated with anxiety symptoms among family members. Patient anxiety (p = 0.013) and low educational attainment (p = 0.002) were associated with anxiety symptoms among family members 8 weeks after discharge. On the other hand, patient depression (p = 0.013) was a factor related to depressive symptoms among family members 2 weeks after discharge. This study provided an in-depth understanding of the mental health status of family members caring for relatives with COVID-19 infection. This can be used to guide healthcare professionals caring for COVID-19 patients and their family members.
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Affiliation(s)
- Leilanie Apostol-Nicodemus
- Department of Family and Community Medicine, University of the Philippines—Philippine General Hospital, Taft Avenue, Manila 1000, Philippines
- Correspondence: (L.A.-N.); (I.K.B.T.)
| | - Ian Kim B. Tabios
- Institute of Biology, College of Science, University of the Philippines Diliman, Quezon City 1101, Philippines
- College of Medicine, University of the Philippines Manila, Manila 1000, Philippines
- Correspondence: (L.A.-N.); (I.K.B.T.)
| | - Anna Guia O. Limpoco
- Department of Family and Community Medicine, University of the Philippines—Philippine General Hospital, Taft Avenue, Manila 1000, Philippines
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Khandehroo M, Dorri M, Paykani T, Khajavi A, Joshani-Kheibari M, Esmaeili R. Direct Inpatient Cost and Payments of COVID-19 in Iran: Quantile Regression Analysis. Med J Islam Repub Iran 2022; 36:101. [PMID: 36447539 PMCID: PMC9700402 DOI: 10.47176/mjiri.36.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Indexed: 11/03/2023] Open
Abstract
Background: COVID-19 pandemic imposes a substantial medical and socioeconomic burden on health systems. The study aimed to estimate the direct inpatient costs of COVID-19 in Iran. Methods: This is a Cost of Illness (COI) study with the bottom-up method. Provider perspective and prevalence approach were applied for cost identification. Data included inpatient charges and clinical characteristics of all COVID-19 cases (2015 patients) admitted to a teaching hospital during a financial year (March 2020 to February 2021). We extracted data from Hospital Information System (HIS) and applied the quantile regression to estimate determinant factors of COVID-19 inpatient cost using STATA software. Results: 1026 (50.92%) of admitted COVID-19 patients were female, and 42.3% were older than 65 years. More than 82% of discharged COVID-19 patients in this study recovered. 189 (9.38%) patients admitted to ICUs. Length of Stay (LOS) for about 70% of admitted COVID-19 cases was 7 days or less. The Total Inpatient Charges (TIC) was 155,372,056,826 Rials (5,041,836 PPP USD). The median charge was 42,410,477 Rials, and Average Inpatient Charges (AIC) was 77,107,720±110,051,702 (2,461 PPP USD) per person. Drugs and supplies accounted for 37% of total inpatient charges. Basic insurance companies would pay more than 79% of total claims and the share of Out-of-Pocket Payments (OOP) was 7%. ICUs admission and LOS of more than 3 days are associated with higher costs across all percentiles of the cost distribution (p<0.001). Conclusion: This study call attention to the substantial economic burden based on real-world data. According to the broad socio-economic impacts of COVID-19 and also multiple components of COI study designs, conducting meta-analysis approaches is needed to combine results from independent studies.
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Affiliation(s)
- Masoud Khandehroo
- Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Mehdi Dorri
- Clinical Research Development Unit, Bohlool Hospital, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Toktam Paykani
- Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Abdoljavad Khajavi
- Department of Community Medicine, School of Medicine, Social Determinants of Health Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | | | - Reza Esmaeili
- Department of Public Health, School of Health, Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
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Kwon CY, Yeh CH. Use of Information and Communication Technologies to Enhance Self-Acupressure: a Literature Review. J Acupunct Meridian Stud 2022; 15:214-226. [DOI: 10.51507/j.jams.2022.15.4.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/15/2021] [Accepted: 03/15/2022] [Indexed: 11/03/2022] Open
Affiliation(s)
- Chan-Young Kwon
- Department of Oriental Neuropsychiatry, Dong-Eui University College of Korean Medicine, Busan, Korea
| | - Chao Hsing Yeh
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, USA
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Koumpias AM, Schwartzman D, Fleming O. Long-haul COVID: healthcare utilization and medical expenditures 6 months post-diagnosis. BMC Health Serv Res 2022; 22:1010. [PMID: 35941617 PMCID: PMC9358916 DOI: 10.1186/s12913-022-08387-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 07/28/2022] [Indexed: 11/17/2022] Open
Abstract
Background Despite extensive evidence that COVID-19 symptoms may persist for up to a year, their long-term implications for healthcare utilization and costs 6 months post-diagnosis remain relatively unexplored. We examine patient-level association of COVID-19 diagnosis association of COVID-19 diagnosis with average monthly healthcare utilization and medical expenditures for up to 6 months, explore heterogeneity across age groups and determine for how many months post-diagnosis healthcare utilization and costs of COVID-19 patients persist above pre-diagnosis levels. Methods This population-based retrospective cohort study followed COVID-19 patients’ healthcare utilization and costs from January 2019 through March 2021 using claims data provided by the COVID-19 Research Database. The patient population includes 250,514 individuals infected with COVID-19 during March-September 2020 and whose last recorded claim was not hospitalization with severe symptoms. We measure the monthly number and costs of total visits and by telemedicine, preventive, urgent care, emergency, immunization, cardiology, inpatient or surgical services and established patient or new patient visits. Results The mean (SD) total number of monthly visits and costs pre-diagnosis were .4783 (4.0839) and 128.06 (1182.78) dollars compared with 1.2078 (8.4962) visits and 351.67 (2473.63) dollars post-diagnosis. COVID-19 diagnosis associated with .7269 (95% CI, 0.7088 to 0.7449 visits; P < .001) more total healthcare visits and an additional $223.60 (95% CI, 218.34 to 228.85; P < .001) in monthly costs. Excess monthly utilization and costs for individuals 17 years old and under subside after 5 months to .070 visits and $2.77, persist at substantial levels for all other groups and most pronounced among individuals age 45–64 (.207 visits and $73.43) and 65 years or older (.133 visits and $60.49). Conclusions This study found that COVID-19 diagnosis was associated with increased healthcare utilization and costs over a six-month post-diagnosis period. These findings imply a prolonged burden to the US healthcare system from medical encounters of COVID-19 patients and increased spending. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08387-3.
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Affiliation(s)
- Antonios M Koumpias
- Department of Social Sciences, University of Michigan-Dearborn, Dearborn, USA
| | - David Schwartzman
- Olin College of Business, Washington University in St. Louis, St. Louis, USA
| | - Owen Fleming
- Department of Economics, Wayne State University, 656 W. Kirby St FAB 2140, Detroit, USA.
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Tsui TCO, Zeitouny S, Bremner KE, Cheung DC, Mulder C, Croxford R, Del Giudice L, Lapointe-Shaw L, Mendlowitz A, Wong WWL, Perlis N, Sander B, Teckle P, Tomlinson G, Walker JD, Malikov K, McGrail KM, Peacock S, Kulkarni GS, Pataky RE, Krahn MD. Initial health care costs for COVID-19 in British Columbia and Ontario, Canada: an interprovincial population-based cohort study. CMAJ Open 2022; 10:E818-E830. [PMID: 36126976 PMCID: PMC9497846 DOI: 10.9778/cmajo.20210328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND COVID-19 imposed substantial health and economic burdens. Comprehensive population-based estimates of health care costs for COVID-19 are essential for planning and policy evaluation. We estimated publicly funded health care costs in 2 Canadian provinces during the pandemic's first wave. METHODS In this historical cohort study, we linked patients with their first positive SARS-CoV-2 test result by June 30, 2020, in 2 Canadian provinces (British Columbia and Ontario) to health care administrative databases and matched to negative or untested controls. We stratified patients by highest level of initial care: community, long-term care, hospital (without admission to the intensive care unit [ICU]) and ICU. Mean publicly funded health care costs for patients and controls, mean net (attributable to COVID-19) costs and total costs were estimated from 30 days before to 120 days after the index date, or to July 31, 2020, in 30-day periods for patients still being followed by the start of each period. RESULTS We identified 2465 matched people with a positive test result for SARS-CoV-2 in BC and 28 893 in Ontario. Mean age was 53.4 (standard deviation [SD] 21.8) years (BC) and 53.7 (SD 22.7) years (Ontario); 55.7% (BC) and 56.1% (Ontario) were female. Net costs in the first 30 days after the index date were $22 010 (95% confidence interval [CI] 19 512 to 24 509) and $15 750 (95% CI 15 354 to 16 147) for patients admitted to hospital, and $65 828 (95% CI 58 535 to 73 122) and $56 088 (95% CI 53 721 to 58 455) for ICU patients in BC and Ontario, respectively. In the community and long-term care settings, net costs were near 0. Total costs for all people, from 30 days before to 30 days after the index date, were $22 128 330 (BC) and $175 778 210 (Ontario). INTERPRETATION During the first wave, we found that mean costs attributable to COVID-19 were highest for patients with ICU admission and higher in BC than Ontario. Reducing the number of people who acquire COVID-19 and severity of illness are required to mitigate the economic impact of COVID-19.
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Affiliation(s)
- Teresa C O Tsui
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Seraphine Zeitouny
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Karen E Bremner
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Douglas C Cheung
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Carol Mulder
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Ruth Croxford
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Lisa Del Giudice
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Lauren Lapointe-Shaw
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Andrew Mendlowitz
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - William W L Wong
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Nathan Perlis
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Beate Sander
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Paulos Teckle
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - George Tomlinson
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Jennifer D Walker
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Kamil Malikov
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Kimberlyn M McGrail
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Stuart Peacock
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Girish S Kulkarni
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Reka E Pataky
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Murray D Krahn
- Toronto Health Economics and Technology Assessment (THETA) Collaborative (Bremner, Cheung, Krahn, Mendlowitz, Sander, Tsui); Toronto General Hospital Research Institute (Lapointe-Shaw); General Internal Medicine (Lapointe-Shaw), Toronto General Hospital; Biostatistics Research Unit (Tomlinson), University Health Network; Hospital for Sick Children (Tsui); Chiefs of Ontario (Mulder); Ontario Ministry of Health and Ontario Ministry of Long-Term Care (Malikov); ICES Central (Croxford, Lapointe-Shaw, Wong, Sander, Walker, Kulkarni, Krahn); Sunnybrook Health Sciences Centre (Del Giudice); Canadian Centre for Applied Research in Cancer Control (Tsui); Divisions of Urology (Cheung, Kulkarni, Perlis) and Surgical Oncology (Cheung, Kulkarni), Department of Surgery, and Department of Family and Community Medicine (Del Giudice), Temerty Faculty of Medicine, and Institute of Health Policy Management and Evaluation (Mendlowitz), University of Toronto; Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Zeitouny, Teckle, Peacock, Pataky), BC Cancer Agency; Centre for Health Services and Policy Research (Zeitouny), School of Population and Public Health (McGrail, Pataky), University of British Columbia; University Canada West (Teckle), Vancouver, BC; Queens University (Mulder), Kingston, Ont.; School of Pharmacy, University of Waterloo (Wong), Kitchener, Ont.; Department of Health Research Methods, Evidence, and Impact (Walker), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
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Thomas R, Jacob QM, Raj Eliza S, Mini M, Jose J, A S. Financial Burden and Catastrophic Health Expenditure Associated with COVID-19 Hospitalizations in Kerala, South India. CLINICOECONOMICS AND OUTCOMES RESEARCH 2022; 14:439-446. [PMID: 35813122 PMCID: PMC9270006 DOI: 10.2147/ceor.s365999] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/23/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Catastrophic health expenditure during COVID-19 hospitalization has altered the economic picture of households, especially in low resource settings with high rates of COVID-19 infection. This study aimed to estimate the out of pocket (OOP) expenditure and the proportion of households that incurred catastrophic health expenditure due to COVID-19 hospitalization in Kerala, South India. Materials and Methods A cross-sectional study was conducted among a representative sample of 155 COVID-19 hospitalized patients in Kottayam district over four months, using a pretested interview schedule. The direct medical and non-medical costs incurred by the study participants during hospitalization and the total monthly household expenditure were obtained from the respective COVID-19 affected households. Catastrophic health expenditure was defined as direct medical expenditure exceeding 40% of the household’s capacity to pay. Results From the study, median and mean OOP expenditure was obtained as USD 93.57 and USD 502.60 respectively. The study revealed that 49.7% of households had catastrophic health expenditure, with 32.9% having incurred distress financing. Multivariate analysis revealed being below poverty line, hospitalization in private healthcare facility, and presence of co-morbid conditions as significant determinants of catastrophic health expenditure. Conclusion High levels of catastrophic health expenditure and distress financing revealed by the study have unveiled major unaddressed challenges in the road to universal health coverage.
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Affiliation(s)
- Ronnie Thomas
- Department of Community Medicine, Government Medical College Kottayam, Kottayam, Kerala, India
- Correspondence: Ronnie Thomas, Department of Community Medicine, Government Medical College Kottayam, Kottayam, Kerala, India, Tel +91 9947014747, Email
| | - Quincy Mariam Jacob
- Department of Community Medicine, Government Medical College Kottayam, Kottayam, Kerala, India
| | - Sharon Raj Eliza
- Department of Community Medicine, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala, India
| | - Malathi Mini
- Department of Community Medicine, Government Medical College Kottayam, Kottayam, Kerala, India
| | - Jobinse Jose
- Department of Community Medicine, Kasturba Medical College, Mangalore, India
| | - Sobha A
- Department of Community Medicine, Government Medical College Kottayam, Kottayam, Kerala, India
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Richard D, Phillip S, Hosseinali A, Gracie DZ, Hai L, January W, Holtgrewe M, Charlotte T, Melina M, Xiaomin W, Zehra K, Jacopo S, Jan-Moritz D, Ralf-Harto H, Bernd H, Anja B, Sandra S, Dilduz T, Norbert S, Martin W, Stefan H, Carsten S, Wolfgang P, Leif E S, Dieter B, Florian K, Toumy G, Ulf L, Jan B, Khai L, Rubelt F, Bettina H. Highly multiplexed immune repertoire sequencing links multiple lymphocyte classes with severity of response to COVID-19. EClinicalMedicine 2022; 48:101438. [PMID: 35600330 PMCID: PMC9106482 DOI: 10.1016/j.eclinm.2022.101438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 04/15/2022] [Accepted: 04/19/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Disease progression of subjects with coronavirus disease 2019 (COVID-19) varies dramatically. Understanding the various types of immune response to SARS-CoV-2 is critical for better clinical management of coronavirus outbreaks and to potentially improve future therapies. Disease dynamics can be characterized by deciphering the adaptive immune response. METHODS In this cross-sectional study we analyzed 117 peripheral blood immune repertoires from healthy controls and subjects with mild to severe COVID-19 disease to elucidate the interplay between B and T cells. We used an immune repertoire Primer Extension Target Enrichment method (immunoPETE) to sequence simultaneously human leukocyte antigen (HLA) restricted T cell receptor beta chain (TRB) and unrestricted T cell receptor delta chain (TRD) and immunoglobulin heavy chain (IgH) immune receptor repertoires. The distribution was analyzed of TRB, TRD and IgH clones between healthy and COVID-19 infected subjects. Using McFadden's Adjusted R2 variables were examined for a predictive model. The aim of this study is to analyze the influence of the adaptive immune repertoire on the severity of the disease (value on the World Health Organization Clinical Progression Scale) in COVID-19. FINDINGS Combining clinical metadata with clonotypes of three immune receptor heavy chains (TRB, TRD, and IgH), we found significant associations between COVID-19 disease severity groups and immune receptor sequences of B and T cell compartments. Logistic regression showed an increase in shared IgH clonal types and decrease of TRD in subjects with severe COVID-19. The probability of finding shared clones of TRD clonal types was highest in healthy subjects (controls). Some specific TRB clones seems to be present in severe COVID-19 (Figure S7b). The most informative models (McFadden´s Adjusted R2=0.141) linked disease severity with immune repertoire measures across all three cell types, as well as receptor-specific cell counts, highlighting the importance of multiple lymphocyte classes in disease progression. INTERPRETATION Adaptive immune receptor peripheral blood repertoire measures are associated with COVID-19 disease severity. FUNDING The study was funded with grants from the Berlin Institute of Health (BIH).
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Affiliation(s)
| | - Suwalski Phillip
- Department of Cardiology, Charité Universitätsmedizin Berlin, Berlin, DE 10117, Germany
| | | | | | - Lin Hai
- Roche Sequencing Solutions Pleasanton, CA 94588, United States
| | - Weiner January
- Core Unit Bioinformatics Berlin, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, DE 10178, Germany
| | - Manuel Holtgrewe
- Core Unit Bioinformatics Berlin, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, DE 10178, Germany
| | - Thibeault Charlotte
- Department of Infectious Diseases and Respiratory Medicine, Charité Universitätsmedizin Berlin, DE 12203, Germany
| | - Müller Melina
- Department of Cardiology, Charité Universitätsmedizin Berlin, Berlin, DE 10117, Germany
| | - Wang Xiaomin
- Department of Cardiology, Charité Universitätsmedizin Berlin, Berlin, DE 10117, Germany
| | - Karadeniz Zehra
- Department of Cardiology, Charité Universitätsmedizin Berlin, Berlin, DE 10117, Germany
| | - Saccomanno Jacopo
- Department of Infectious Diseases and Respiratory Medicine, Charité Universitätsmedizin Berlin, DE 12203, Germany
| | - Doehn Jan-Moritz
- Department of Infectious Diseases and Respiratory Medicine, Charité Universitätsmedizin Berlin, DE 12203, Germany
| | - Hübner Ralf-Harto
- Department of Infectious Diseases and Respiratory Medicine, Charité Universitätsmedizin Berlin, DE 12203, Germany
| | | | - Blüher Anja
- Signature Diagnostics GmbH, DE 14473, Germany
| | | | - Telman Dilduz
- Roche Sequencing Solutions Pleasanton, CA 94588, United States
| | - Suttorp Norbert
- Department of Infectious Diseases and Respiratory Medicine, Charité Universitätsmedizin Berlin, DE 12203, Germany
| | - Witzenrath Martin
- Department of Infectious Diseases and Respiratory Medicine, Charité Universitätsmedizin Berlin, DE 12203, Germany
| | - Hippenstiel Stefan
- Department of Infectious Diseases and Respiratory Medicine, Charité Universitätsmedizin Berlin, DE 12203, Germany
| | - Skurk Carsten
- Department of Cardiology, Charité Universitätsmedizin Berlin, Berlin, DE 10117, Germany
| | - Poller Wolfgang
- Department of Cardiology, Charité Universitätsmedizin Berlin, Berlin, DE 10117, Germany
| | - Sander Leif E
- Department of Infectious Diseases and Respiratory Medicine, Charité Universitätsmedizin Berlin, DE 12203, Germany
| | - Beule Dieter
- Core Unit Bioinformatics Berlin, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, DE 10178, Germany
| | - Kurth Florian
- Department of Infectious Diseases and Respiratory Medicine, Charité Universitätsmedizin Berlin, DE 12203, Germany
| | | | - Landmesser Ulf
- Department of Cardiology, Charité Universitätsmedizin Berlin, Berlin, DE 10117, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Germany
| | - Berka Jan
- Roche Sequencing Solutions Pleasanton, CA 94588, United States
| | - Luong Khai
- Roche Sequencing Solutions Pleasanton, CA 94588, United States
| | | | - Florian Rubelt
- Roche Sequencing Solutions Pleasanton, CA 94588, United States
| | - Heidecker Bettina
- Department of Cardiology, Charité Universitätsmedizin Berlin, Berlin, DE 10117, Germany
- Corresponding authors.
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Liang Y, Zou L, Lin H, Li B, Zhao J, Wang H, Sun J, Chen J, Mo Y, Yang X, Deng X, Tang S. Detection of Major SARS-CoV-2 Variants of Concern in Clinical Samples via CRISPR-Cas12a-Mediated Mutation-Specific Assay. ACS Synth Biol 2022; 11:1811-1823. [PMID: 35481381 DOI: 10.1021/acssynbio.1c00643] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objectives: Emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants pose a great threat and burden to global public health. Here, we evaluated a clustered regularly interspaced short palindromic repeat-associated enzyme 12a (CRISPR-Cas12a)-based method for detecting major SARS-CoV-2 variants of concern (VOCs) in SARS-CoV-2 positive clinical samples. Methods: Allele-specific CRISPR RNAs (crRNAs) targeting the signature mutations in the spike protein of SARS-CoV-2 are designed. A total of 59 SARS-CoV-2 positive oropharyngeal swab specimens were used to evaluate the performance of the CRISPR-Cas12a-mediated assay to identify major SARS-CoV-2 VOCs. Results: Compared with Sanger sequencing, the eight allele-specific crRNAs analyzed can specifically identify the corresponding mutations with a positive predictive value of 83.3-100% and a negative predictive value of 85.7-100%. Our CRISPR-Cas12a-mediated assay distinguished wild-type and four major VOCs (Alpha, Beta, Delta, and Omicron) of SARS-CoV-2 with a sensitivity of 93.8-100.0% and a specificity of 100.0%. The two methods showed a concordance of 98.3% (58/59) with a κ value of 0.956-1.000, while seven (11.9%) samples were found to be positive for extra mutations by the CRISPR-based assay. Furthermore, neither virus titers nor the sequences adjacent to the signature mutations were associated with the variation of fluorescence intensity detected or the false-positive reaction observed when testing clinical samples. In addition, there was no cross-reaction observed when detecting 33 SARS-CoV-2 negative clinical samples infected with common respiratory pathogens. Conclusions: The CRISPR-Cas12a-based genotyping assay is highly sensitive and specific when detecting both the SARS-CoV-2 wild-type strain and major VOCs. It is a simple and rapid assay that can monitor and track the circulating SARS-CoV-2 variants and the dynamics of the coronavirus disease 2019 (COVID-19) pandemic and can be easily implemented in resource-limited settings.
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Affiliation(s)
- Yuanhao Liang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China
| | - Lirong Zou
- Institute of Pathogenic Microbiology, Guangdong Provincial Center for Disease Control and Prevention, Guangdong Workstation for Emerging Infectious Disease Control and Prevention, Chinese Academy of Medical Sciences, Guangzhou 511430, China
| | - Hongqing Lin
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China
| | - Baisheng Li
- Institute of Pathogenic Microbiology, Guangdong Provincial Center for Disease Control and Prevention, Guangdong Workstation for Emerging Infectious Disease Control and Prevention, Chinese Academy of Medical Sciences, Guangzhou 511430, China
| | - Jianhui Zhao
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China
| | - Haiying Wang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China
| | - Jiufeng Sun
- Institute of Pathogenic Microbiology, Guangdong Provincial Center for Disease Control and Prevention, Guangdong Workstation for Emerging Infectious Disease Control and Prevention, Chinese Academy of Medical Sciences, Guangzhou 511430, China
| | - Jingdiao Chen
- Institute of Pathogenic Microbiology, Guangdong Provincial Center for Disease Control and Prevention, Guangdong Workstation for Emerging Infectious Disease Control and Prevention, Chinese Academy of Medical Sciences, Guangzhou 511430, China
| | - Yanling Mo
- Institute of Pathogenic Microbiology, Guangdong Provincial Center for Disease Control and Prevention, Guangdong Workstation for Emerging Infectious Disease Control and Prevention, Chinese Academy of Medical Sciences, Guangzhou 511430, China
| | - Xingfen Yang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China
| | - Xiaoling Deng
- Institute of Pathogenic Microbiology, Guangdong Provincial Center for Disease Control and Prevention, Guangdong Workstation for Emerging Infectious Disease Control and Prevention, Chinese Academy of Medical Sciences, Guangzhou 511430, China
| | - Shixing Tang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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Richards F, Kodjamanova P, Chen X, Li N, Atanasov P, Bennetts L, Patterson BJ, Yektashenas B, Mesa-Frias M, Tronczynski K, Buyukkaramikli N, El Khoury AC. Economic Burden of COVID-19: A Systematic Review. Clinicoecon Outcomes Res 2022; 14:293-307. [PMID: 35509962 PMCID: PMC9060810 DOI: 10.2147/ceor.s338225] [Citation(s) in RCA: 78] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/23/2022] [Indexed: 12/26/2022]
Abstract
Objective To review and qualitatively synthesize the evidence related to the economic burden of COVID-19, including healthcare resource utilization and costs. Methods A systematic review of studies that assessed the economic burden [eg, direct costs, productivity, macroeconomic impact due to non-pharmaceutical interventions (NPIs) and equity] of COVID-19 was conducted by searches in EMBASE, MEDLINE, MEDLINE-IN-PROCESS, and The Cochrane Library, as well as manual searches of unpublished research for the period between January 2020 to February 2021. Single reviewer data extraction was confirmed independently by a second reviewer. Results The screening process resulted in a total of 27 studies: 25 individual publications, and 2 systematic literature reviews, of narrower scopes, that fulfilled the inclusion criteria. The patients diagnosed with more severe COVID-19 were associated with higher costs. The main drivers for higher costs were consistent across countries and included ICU admission, in-hospital resource use such as mechanical ventilation, which lead to increase costs of $2082.65 ± 345.04 to $2990.76 ± 545.98. The most frequently reported indirect costs were due to productivity losses. On average, older COVID-19 patients incurred higher costs when compared to younger age groups. An estimation of a 20% COVID-19 infection rate based on a Monte Carlo simulation in the United States led to a total direct medical cost of $163.4 billion over the course of the pandemic. Conclusion The COVID-19 pandemic has generated a considerable economic burden on patients and the general population. Preventative measures such as NPIs only have partial success in lowering the economic costs of the pandemic. Implementing additional preventative measures such as large-scale vaccination is vital in reducing direct and indirect medical costs, decreased productivity, and GDP losses.
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Affiliation(s)
| | | | - Xue Chen
- HEMA Amaris, Shanghai, People's Republic of China
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The effect of COVID-19 on public hospital revenues in Iran: An interrupted time-series analysis. PLoS One 2022; 17:e0266343. [PMID: 35358279 PMCID: PMC8970352 DOI: 10.1371/journal.pone.0266343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/19/2022] [Indexed: 12/03/2022] Open
Abstract
Background The “Coronavirus Disease 2019” (COVID-19) pandemic has become a major challenge for all healthcare systems worldwide, and besides generating a high toll of deaths, it has caused economic losses. Hospitals have played a key role in providing services to patients and the volume of hospital activities has been refocused on COVID-19 patients. Other activities have been limited/repurposed or even suspended and hospitals have been operating with reduced capacity. With the decrease in non-COVID-19 activities, their financial system and sustainability have been threatened, with hospitals facing shortage of financial resources. The aim of this study was to investigate the effects of COVID-19 on the revenues of public hospitals in Lorestan province in western Iran, as a case study. Method In this quasi-experimental study, we conducted the interrupted time series analysis to evaluate COVID-19 induced changes in monthly revenues of 18 public hospitals, from April 2018 to August 2021, in Lorestan, Iran. In doing so, public hospitals report their earnings to the University of Medical Sciences monthly; then, we collected this data through the finance office. Results Due to COVID-19, the revenues of public hospitals experienced an average monthly decrease of $172,636 thousand (P-value = 0.01232). For about 13 months, the trend of declining hospital revenues continued. However, after February 2021, a relatively stable increase could be observed, with patient admission and elective surgeries restrictions being lifted. The average monthly income of hospitals increased by $83,574 thousand. Conclusion COVID-19 has reduced the revenues of public hospitals, which have faced many problems due to the high costs they have incurred. During the crisis, lack of adequate fundings can damage healthcare service delivery, and policymakers should allocate resources to prevent potential shocks.
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Rocha-Filho CR, Martins JWL, Lucchetta RC, Ramalho GS, Trevisani GFM, da Rocha AP, Pinto ACPN, Reis FSDA, Ferla LJ, Mastroianni PDC, Correa L, Saconato H, Trevisani VFM. Hospitalization costs of coronaviruses diseases in upper-middle-income countries: A systematic review. PLoS One 2022; 17:e0265003. [PMID: 35275935 PMCID: PMC8916657 DOI: 10.1371/journal.pone.0265003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 02/18/2022] [Indexed: 12/22/2022] Open
Abstract
Background COVID-19, SARS and MERS are diseases that present an important health burden worldwide. This situation demands resource allocation to the healthcare system, affecting especially middle- and low-income countries. Thus, identifying the main cost drivers is relevant to optimize patient care and resource allocation. Objective To systematically identify and summarize the current status of knowledge on direct medical hospitalization costs of SARS, MERS, or COVID-19 in Upper-Middle-Income Countries. Methods We conducted a systematic review across seven key databases (PubMed, EMBASE, BVS Portal, CINAHL, CRD library, MedRxiv and Research Square) from database inception to February 2021. Costs extracted were converted into 2021 International Dollars using the Purchasing Power Parity-adjusted. The assessment of quality was based on the protocol by the BMJ and CHEERS. PROSPERO 2020: CRD42020225757. Results No eligible study about SARS or MERS was recovered. For COVID-19, five studies presented cost analysis performed in Brazil, China, Iran, and Turkey. Regarding total direct medical costs, the lowest cost per patient at ward was observed in Turkey ($900.08), while the highest in Brazil ($5,093.38). At ICU, the lowest was in Turkey ($2,984.78), while the highest was in China ($52,432.87). Service care was the most expressive (58% to 88%) cost driver of COVID-19 patients at ward. At ICU, there was no consensus between service care (54% to 87%) and treatment (72% to 81%) as key burdens of total cost. Conclusion Our findings elucidate the importance of COVID-19 on health-economic outcomes. The marked heterogeneity among studies leaded to substantially different results and made challenging the comparison of data to estimate pooled results for single countries or regions. Further studies concerning cost estimates from standardized analysis may provide clearer data for a more substantial analysis. This may help care providers and policy makers to organize care for patients in the most efficient way.
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Affiliation(s)
- César Ramos Rocha-Filho
- Evidence-Based Health Program, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Johnny Wallef Leite Martins
- Pharmaceutical Sciences Program, School of Pharmaceutical Sciences, Universidade Estadual de São Paulo, Araraquara, SP, Brazil
| | - Rosa Camila Lucchetta
- Department of Drugs and Medicines, School of Pharmaceutical Sciences, Universidade Estadual de São Paulo, Araraquara, SP, Brazil
- Department of Sustainability and Social Responsibility, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil
| | - Gabriel Sodré Ramalho
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Aline Pereira da Rocha
- Evidence-Based Health Program, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Ana Carolina Pereira Nunes Pinto
- Evidence-Based Health Program, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Department of Biological and Health Sciences, Universidade Federal do Amapá, Macapá, AP, Brazil
| | | | - Laura Jantsch Ferla
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Patrícia de Carvalho Mastroianni
- Pharmaceutical Sciences Program, School of Pharmaceutical Sciences, Universidade Estadual de São Paulo, Araraquara, SP, Brazil
- Department of Drugs and Medicines, School of Pharmaceutical Sciences, Universidade Estadual de São Paulo, Araraquara, SP, Brazil
| | - Luci Correa
- Discipline of Infectiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Humberto Saconato
- Discipline of Emergency and Evidence-Based Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- * E-mail:
| | - Virgínia Fernandes Moça Trevisani
- Evidence-Based Health Program, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Faculdade de Medicina, Universidade de Santo Amaro, São Paulo, SP, Brazil
- Discipline of Emergency and Evidence-Based Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Esteves E, Mendes AK, Barros M, Figueiredo C, Andrade J, Capelo J, Novais A, Rebelo C, Soares R, Nunes A, Ferreira A, Lemos J, Duarte AS, Silva RM, Inácio Bernardino L, Correia MJ, Esteves AC, Rosa N. Population wide testing pooling strategy for SARS-CoV-2 detection using saliva. PLoS One 2022; 17:e0263033. [PMID: 35089942 PMCID: PMC8797214 DOI: 10.1371/journal.pone.0263033] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/10/2022] [Indexed: 12/24/2022] Open
Abstract
SARS-CoV-2 pandemic has forced frequent testing of populations. It is necessary to identify the most cost-effective strategies for the detection of COVID-19 outbreaks. Nasopharyngeal samples have been used for SARS-CoV-2 detection but require a healthcare professional to collect the sample and cause discomfort and pain to the individual. Saliva has been suggested as an appropriate fluid for the diagnosis of COVID-19. We have investigated the possibility of using pools of saliva samples to detect SARS-CoV-2 in symptomatic and asymptomatic patients. Two hundred and seventy-nine saliva samples were analyzed through RT-PCR of Envelope, Nucleocapsid and Open Reading Frame 1ab genes. Reproducibility assays showed an almost perfect agreement as well as high sensitivity (96.6%), specificity (96.8%), positive predicted value (96.6%), and negative predicted value (96.8%). The average Cycle Threshold of the genes detected was 29.7. No significant differences (p > 0.05) were detected when comparing the cycle threshold average of two consecutive reactions on the same positive saliva samples. Saliva samples have a higher median viral load (32.6) than in nasopharyngeal samples (28.9), although no significant differences were detected (p > 0.05). Saliva-pool samples allowed effective SARS-CoV-2 screening, with a higher sensibility (96.9%) on 10-sample pools than in 20-sample pools (87.5%). Regardless of pools size specificity was high (99.9%) and an almost perfect agreement was observed. Our strategy was successfully applied in population wide testing of more than 2000 individuals, showing that it is possible to use pooled saliva as diagnostic fluid for SARS-CoV-2 infection.
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Affiliation(s)
- Eduardo Esteves
- Universidade Católica Portuguesa, Faculty of Dental Medicine (FMD), Center for Interdisciplinary Research in Health (CIIS), Viseu, Portugal
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - Ana Karina Mendes
- Universidade Católica Portuguesa, Faculty of Dental Medicine (FMD), Center for Interdisciplinary Research in Health (CIIS), Viseu, Portugal
| | - Marlene Barros
- Universidade Católica Portuguesa, Faculty of Dental Medicine (FMD), Center for Interdisciplinary Research in Health (CIIS), Viseu, Portugal
| | | | | | - Joana Capelo
- Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | | | - Carla Rebelo
- Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Rita Soares
- Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Ana Nunes
- Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | | | - Joana Lemos
- Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Ana Sofia Duarte
- Universidade Católica Portuguesa, Faculty of Dental Medicine (FMD), Center for Interdisciplinary Research in Health (CIIS), Viseu, Portugal
| | - Raquel M. Silva
- Universidade Católica Portuguesa, Faculty of Dental Medicine (FMD), Center for Interdisciplinary Research in Health (CIIS), Viseu, Portugal
| | | | - Maria José Correia
- Universidade Católica Portuguesa, Faculty of Dental Medicine (FMD), Center for Interdisciplinary Research in Health (CIIS), Viseu, Portugal
| | | | - Nuno Rosa
- Universidade Católica Portuguesa, Faculty of Dental Medicine (FMD), Center for Interdisciplinary Research in Health (CIIS), Viseu, Portugal
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Byambadorj A, Amarsanaa S, Enebish O, Mandakh U, Batsaikhan O, Purevsuren U, Gantumur K, Yundendorj G, Davaakhuu N. Spending Assessment and Economic Burden of COVID-19 in Mongolia, January- September, 2020. Asia Pac J Public Health 2022; 34:456-458. [PMID: 35086346 DOI: 10.1177/10105395221074551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | - Undram Mandakh
- Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | | | | | | | - Gantugs Yundendorj
- Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
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Determinants of COVID-19-Related Length of Hospital Stays and Long COVID in Ghana: A Cross-Sectional Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19010527. [PMID: 35010786 PMCID: PMC8744866 DOI: 10.3390/ijerph19010527] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 12/30/2021] [Accepted: 01/02/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES There is paucity of data on determinants of length of COVID-19 admissions and long COVID, an emerging long-term sequel of COVID-19, in Ghana. Therefore, this study identified these determinants and discussed their policy implications. METHOD Data of 2334 patients seen at the main COVID-19 treatment centre in Ghana were analysed in this study. Their characteristics, such as age, education level and comorbidities, were examined as explanatory variables. The dependent variables were length of COVID-19 hospitalisations and long COVID. Negative binomial and binary logistic regressions were fitted to investigate the determinants. RESULT The regression analyses showed that, on average, COVID-19 patients with hypertension and diabetes mellitus spent almost 2 days longer in hospital (p = 0.00, 95% CI = 1.42-2.33) and had 4 times the odds of long COVID (95% CI = 1.61-10.85, p = 0.003) compared to those with no comorbidities. In addition, the odds of long COVID decreased with increasing patient's education level (primary OR = 0.73, p = 0.02; secondary/vocational OR = 0.26, p = 0.02; tertiary education OR = 0.23, p = 0.12). CONCLUSION The presence of hypertension and diabetes mellitus determined both length of hospitalisation and long COVID among patients with COVID-19 in Ghana. COVID-19 prevention and management policies should therefore consider these factors.
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Shanbhag V, Arjun NR, Chaudhuri S, Pandey AK. Utility of Age-adjusted Charlson Comorbidity Index as a Predictor of Need for Invasive Mechanical Ventilation, Length of Hospital Stay, and Survival in COVID-19 Patients. Indian J Crit Care Med 2021; 25:987-991. [PMID: 34963715 PMCID: PMC8664016 DOI: 10.5005/jp-journals-10071-23946] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background Multiple parameters may be used to prognosticate coronavirus disease-2019 (COVID-19) patients, which are often expensive laboratory or radiological investigations. We evaluated the utility of age-adjusted Charlson comorbidity index (CCI) as a predictor of outcome in COVID-19 patients treated with remdesivir. Materials and methods This was a single-center, retrospective study on 126 COVID-19 patients treated with remdesivir. The age-adjusted CCI, length of hospital stay (LOS), need for invasive mechanical ventilation (IMV), and survival were recorded. Results The mean and standard deviation (SD) of age-adjusted CCI were 3.37 and 2.186, respectively. Eighty-six patients (70.5%) had age-adjusted CCI ≤4, and 36 (29.5%) had age-adjusted CCI >4. Among patients with age-adjusted CCI ≤4, 20 (23.3%) required IMV, whereas in those with age-adjusted CCI >4, 19 (52.8%) required IMV (p <0.05, Pearson's chi-square test). In those with age-adjusted CCI ≤4, the mortality was 18.6%, whereas it was 41.7% in patients with age-adjusted CCI >4 (p <0.05, Pearson's chi-square test). The receiver operating curve (ROC) of age-adjusted CCI for predicting the mortality had an area under the curve (AUC) of 0.709, p = 0.001, and sensitivity 68%, specificity 62%, and 95% confidence interval (CI) [0.608, 0.810], for a cutoff score >4. The ROC for age-adjusted CCI for predicting the need for IMV had an AUC of 0.696, p = 0.001, and sensitivity 67%, specificity 63%, and 95% CI [0.594, 0.797], for a cutoff score >4. ROC for age-adjusted CCI as a predictor of prolonged LOS (≥14 days) was insignificant. Conclusion In COVID-19 patients, the age-adjusted CCI is an independent predictor of the need for IMV (score >4) and mortality (score >4) but is not useful to predict LOS (CTRI/2020/11/029266). How to cite this article Shanbhag V, Arjun NR, Chaudhuri S, Pandey AK. Utility of Age-adjusted Charlson Comorbidity Index as a Predictor of Need for Invasive Mechanical Ventilation, Length of Hospital Stay, and Survival in COVID-19 Patients. Indian J Crit Care Med 2021;25(9):987-991.
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Affiliation(s)
- Vishal Shanbhag
- Department of Critical Care Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - N R Arjun
- Department of Critical Care Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Souvik Chaudhuri
- Department of Critical Care Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Akhilesh K Pandey
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Thant PW, Htet KT, Win WY, Htwe YM, Htoo TS. Cost estimates of COVID-19 clinical management in Myanmar. BMC Health Serv Res 2021; 21:1365. [PMID: 34961536 PMCID: PMC8710920 DOI: 10.1186/s12913-021-07394-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 12/08/2021] [Indexed: 11/28/2022] Open
Abstract
Objective This study aims to estimate the cost of clinical management of COVID-19 infected patients based on their severity by exploring the resources used in health care provision in Myanmar. Methods A multicenter retrospective cost analysis of COVID-19 patients was performed using the micro-costing approach from the perspective of the health system. It covered two cost components, namely direct and indirect cost of treating a patient. Input data and their quantities were obtained from COVID-19 Standard Treatment Guidelines of Ministry of Health and Sports, and administrative and financial records of resource utilization of three designated health facilities in Yangon Region. Valuation of these resources was based on the price list from the Procurement Section of the Ministry. Results This study estimated the unit cost of clinical management of COVID-19 infected patients with no symptom to be 953,552 MMK(717 USD), with mild-moderate symptoms to be 1,155,222 MMK(869 USD) and with severe-critically ill conditions to be 5,705,052 MMK(4290 USD). Average cost for a patient par day was 86,687 MMK(65 USD) for asymptomatic patients, 105,020 MMK(79 USD) for mild-moderate patients and 283,252 MMK(214 USD) for severe-critically ill patients. Since the first case detected till December 31, 2020, COVID-19 clinical management cost was accounted for 139 Billion MMK (104 Million USD) for total 124,630 confirmed cases. Conclusions COVID-19 pandemic has caused health systems to incur the significant health care expenses. Timely implementation of the sustainable, affordable and efficient policy for COVID-19 responses is of utmost important for every nation especially in the face of a pandemic. This study provides the fundamental inputs for strategic planning, for future economic evaluations of different policy interventions, and policy recommendations for health systems to remain resilient during and after the COVID-19 pandemic in Myanmar.
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Affiliation(s)
- Phyu Win Thant
- National Health Plan Implementation Monitoring Unit, Minister's Office, Ministry of Health and Sports, Nay Pyi Taw, Myanmar.
| | - Khin Thu Htet
- National Health Plan Implementation Monitoring Unit, Minister's Office, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Wit Ye Win
- National Health Plan Implementation Monitoring Unit, Minister's Office, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Ye Min Htwe
- National Health Plan Implementation Monitoring Unit, Minister's Office, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Thant Sin Htoo
- National Health Plan Implementation Monitoring Unit, Minister's Office, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
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50
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Reddy KN, Shah J, Iyer S, Chowdhury M, Yerrapalem N, Pasalkar N, Jedge PP. Direct Medical Cost Analysis of Indian COVID-19 Patients Requiring Critical Care Admission. Indian J Crit Care Med 2021; 25:1120-1125. [PMID: 34916743 PMCID: PMC8645812 DOI: 10.5005/jp-journals-10071-23991] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Introduction Intensive care unit (ICU) admission is required for approximately 25% of patients affected with coronavirus disease-19 (COVID-19) and imposes a high economic burden on patients in resource-limited settings. Method We conducted a retrospective direct medical care cost analysis of COVID-19 patients requiring ICU admission after obtaining the Institutional Ethics Committee approval. Data were obtained from the records of patients admitted to the COVID-19 ICU of a tertiary care trust teaching hospital from June 2020 to December 2020. Direct costs were analyzed and correlated with various demographic variables and clinical outcomes. Results A total of 176 patients were included (males-76%). The median direct medical cost for a median stay of 13 days was INR 202248.5 ($ 2742.91). Hospital drugs and disposables accounted for 20% of the total cost followed by bed charges (19%), equipment charges (17%), biosafety protective gear (15.5%), pathological and radiological tests (15%), clinical management (7.6%), and biomedical waste management (1.6%). Government schemes accounted for 79% of medical claims followed by directly paying patients (12.5%) and private insurance (8.5%). The cost was significantly higher in patients with diabetes mellitus and sepsis and in those requiring mechanical ventilation (MV) (p <0.05). Shorter lead time to hospital admission and lesser length of hospital stay were associated with significant lower direct cost. Conclusion Direct medical care cost is substantial for COVID-19 patients requiring ICU admission. This cost is significantly associated with increased ICU and hospital stay, longer lead time to admission, diabetes mellitus, sepsis, and those who need high-flow nasal cannula (HFNC), noninvasive ventilation (NIV), and MV. How to cite this article Reddy KN, Shah J, Iyer S, Chowdhury M, Yerrapalem N, Pasalkar N, et al. Direct Medical Cost Analysis of Indian COVID-19 Patients Requiring Critical Care Admission. Indian J Crit Care Med 2021;25(10):1120-1125.
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Affiliation(s)
- Kamini N Reddy
- Department of Critical Care Medicine, Bharati Vidyapeeth (Deemed to be University), Medical College, Pune, Maharashtra, India
| | - Jignesh Shah
- Department of Critical Care Medicine, Bharati Vidyapeeth (Deemed to be University), Medical College, Pune, Maharashtra, India
| | - Shivakumar Iyer
- Department of Critical Care Medicine, Bharati Vidyapeeth (Deemed to be University), Medical College, Pune, Maharashtra, India
| | - Monidipa Chowdhury
- Department of Clinical Pharmacy, Bharati Vidyapeeth (Deemed to be University), Medical College, Pune, Maharashtra, India
| | - Naveen Yerrapalem
- Department of Clinical Pharmacy, Bharati Vidyapeeth (Deemed to be University), Medical College, Pune, Maharashtra, India
| | - Neeraja Pasalkar
- Department of Clinical Pharmacy, Bharati Vidyapeeth (Deemed to be University), Medical College, Pune, Maharashtra, India
| | - Prashant P Jedge
- Department of Critical Care Medicine, Bharati Vidyapeeth (Deemed to be University), Medical College, Pune, Maharashtra, India
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