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Reimer J, Vogelmann T, Trümper D, Scherbaum N. Opioid use disorder in Germany: healthcare costs of patients in opioid maintenance treatment. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2019; 14:57. [PMID: 31842942 PMCID: PMC6916156 DOI: 10.1186/s13011-019-0247-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 12/11/2019] [Indexed: 01/24/2023]
Abstract
Background Opioid Use Disorder (OUD) is a substance use disorder with a chronic course associated with comorbid mental and somatic disorders, a high burden of psychosocial problems and opioid maintenance treatment (OMT) as a standard treatment. In the US, OUD imposes a significant economic burden on society, with annual societal costs estimated at over 55 billion dollars. Surprisingly, in Europe and especially in Germany, there is currently no detailed information on the healthcare costs of patients with OUD. The goal of the present research is to gather cost information about OUD patients in OMT with a focus on maintenance medication and relapses. Methods We analysed health claims data of four million persons covered by statutory health insurance in Germany, applying a cost-of-illness approach and aimed at examining the direct costs of OMT patients in Germany. Patients with an ICD-10 code F11.2 and at least one claim of an OMT medication were stratified into the treatment groups buprenorphine, methadone or levomethadone, based on the first prescription in each of the follow-up years. Costs were stratified for years with and without relapses. Group comparisons were performed with ANOVA. Results We analysed 3165 patient years, the total annual sickness funds costs were on average 7470 € per year and patient. Comparing costs of levomethadone (8400 €, SD: 11,080 €), methadone (7090 €, SD: 10,900 €) and buprenorphine (6670 €, SD: 7430 €) revealed significant lower costs of buprenorphine compared to levomethadone (p < 0.0001). In years with relapses, costs were higher than in years without relapses (8178 € vs 7409 €; SD: 11,622, resp. 10,378 €). In years with relapses, hospital costs were the major cost driver. Conclusions The present study shows the costs of OUD patients in OMT for the first time with a German dataset. Healthcare costs for patients with an OUD in OMT are associated with more than two times the cost of an average German patients. Preventing relapses might have significant impact on costs. Patients in different OMT were dissimilar which may have affected the cost differences.
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Affiliation(s)
- Jens Reimer
- Center for Interdisciplinary Addiction Research, Dept. of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Center for Psychosocial Medicine, Health North, Hospital Group Bremen, Bremen, Germany
| | | | | | - Norbert Scherbaum
- LVR-Hospital Essen, Department of Addictive Behaviour and Addiction Medicine, Medical Faculty, University of Duisburg-Essen, Essen, Germany
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Jovanovic MR, Miljatovic A, Puskas L, Kapor S, Puskas DL. Does the Strategy of Risk Group Testing for Hepatitis C Hit the Target? Front Pharmacol 2017; 8:437. [PMID: 28713277 PMCID: PMC5492802 DOI: 10.3389/fphar.2017.00437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 06/16/2017] [Indexed: 12/12/2022] Open
Abstract
In the European Union, it is estimated that there are 5.5 million individuals with chronic infection of hepatitis C. Intravenous drug abuse is undoubtedly the key source of the hepatitis C epidemic in Europe and the most efficient mode of transmission of HCV infections (primarily due to short incubation time, but also because the virus is introduced directly into the blood stream with the infected needle). Potentially high-risk and vulnerable populations in Europe (and the world) include immigrants, prisoners, sex workers, men having sex with men, individuals infected with HIV, psychoactive substance users etc. Since there is a lack of direct evidence of clinical benefits of HCV testing, decisions related to testing are made based on indirect evidence. Clinical practice has shown that HCV antibody tests are mostly adequate for identification of HCV infection, but the problem is that this testing strategy does not hit the target. As a result of this health care system strategy, a large number of infected patients remain undetected or they are diagnosed late. There is only a vague link between screening and treatment outcomes since there is a lack of evidence on transmission risks, multiple causes, risk behavior, ways of reaching screening decisions, treatment efficiency, etc. According to results of limited number of studies it can be concluded that there is a need to develop targeted programmes for detection of HCV and other infections, but there also a need to decrease potential harms.
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Affiliation(s)
- Mirjana R. Jovanovic
- Psychiatric Clinic, Clinical Center KragujevacKragujevac, Serbia
- Department for Psychiatry, Faculty of Medical Sciences, University of KragujevacKragujevac, Serbia
| | | | - Laslo Puskas
- Faculty of Medicine, University of BelgradeBelgrade, Serbia
| | - Slobodan Kapor
- Faculty of Medicine, University of BelgradeBelgrade, Serbia
| | - Dijana L. Puskas
- Faculty of Special Rehabilitation and Education, University of BelgradeBelgrade, Serbia
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Janicijevic KM, Kocic SS, Radevic SR, Jovanovic MR, Radovanovic SM. Socioeconomic Factors Associated with Psychoactive Substance Abuse by Adolescents in Serbia. Front Pharmacol 2017; 8:366. [PMID: 28659800 PMCID: PMC5468426 DOI: 10.3389/fphar.2017.00366] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 05/26/2017] [Indexed: 01/18/2023] Open
Affiliation(s)
- Katarina M. Janicijevic
- Department of Social Medicine, Faculty of Medical Sciences, University of KragujevacKragujevac, Serbia
| | - Sanja S. Kocic
- Department of Social Medicine, Faculty of Medical Sciences, University of KragujevacKragujevac, Serbia
| | - Svetlana R. Radevic
- Department of Social Medicine, Faculty of Medical Sciences, University of KragujevacKragujevac, Serbia
| | - Mirjana R. Jovanovic
- Department of Psychiatry, Faculty of Medical Sciences, University of KragujevacKragujevac, Serbia
| | - Snezana M. Radovanovic
- Department of Social Medicine, Faculty of Medical Sciences, University of KragujevacKragujevac, Serbia
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Mihailovic N, Kocic S, Jakovljevic M. Review of Diagnosis-Related Group-Based Financing of Hospital Care. Health Serv Res Manag Epidemiol 2016; 3:2333392816647892. [PMID: 28462278 PMCID: PMC5266471 DOI: 10.1177/2333392816647892] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 03/18/2016] [Accepted: 03/18/2016] [Indexed: 11/17/2022] Open
Abstract
Since the 1990s, diagnosis-related group (DRG)-based payment systems were gradually introduced in many countries. The main design characteristics of a DRG-based payment system are an exhaustive patient case classification system (ie, the system of diagnosis-related groupings) and the payment formula, which is based on the base rate multiplied by a relative cost weight specific for each DRG. Cases within the same DRG code group are expected to undergo similar clinical evolution. Consecutively, they should incur the costs of diagnostics and treatment within a predefined scale. Such predictability was proven in a number of cost-of-illness studies conducted on major prosperity diseases alongside clinical trials on efficiency. This was the case with risky pregnancies, chronic obstructive pulmonary disease, diabetes, depression, alcohol addiction, hepatitis, and cancer. This article presents experience of introduced DRG-based payments in countries of western and eastern Europe, Scandinavia, United States, Canada, and Australia. This article presents the results of few selected reviews and systematic reviews of the following evidence: published reports on health system reforms by World Health Organization, World Bank, Organization for Economic Co-operation and Development, Canadian Institute for Health Information, Canadian Health Services Research Foundation, and Centre for Health Economics University of York. Diverse payment systems have different strengths and weaknesses in relation to the various objectives. The advantages of the DRG payment system are reflected in the increased efficiency and transparency and reduced average length of stay. The disadvantage of DRG is creating financial incentives toward earlier hospital discharges. Occasionally, such polices are not in full accordance with the clinical benefit priorities.
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Affiliation(s)
| | - Sanja Kocic
- Institute for Public Health Kragujevac, Kragujevac, Serbia
- Department of Social Medicine, The Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Mihajlo Jakovljevic
- Health Economics and Pharmacoeconomics, The Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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Jakovljevic M(M, Lazarevic M, Jurisevic M, Jovanovic MR. When cure becomes an illness-abuse of addictive prescription medicines. Front Pharmacol 2015; 6:193. [PMID: 26441650 PMCID: PMC4584929 DOI: 10.3389/fphar.2015.00193] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 08/25/2015] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Marija Lazarevic
- Department of Pharmacy, Faculty of Medical Sciences, University of KragujevacKragujevac, Serbia
| | - Milena Jurisevic
- Department of Pharmacy, Faculty of Medical Sciences, University of KragujevacKragujevac, Serbia
| | - Mirjana R. Jovanovic
- Department of Psychiatry, Faculty of Medical Sciences, University of KragujevacKragujevac, Serbia
- Psychiatry Clinic, University Clinical Center KragujevacKragujevac, Serbia
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Velickovic V, Simovic A, Lazarevic G, Lazarevic M, Jakovljevic M. Improvements in Neonatal and Childhood Medical Care - Perspective from the Balkans. Front Public Health 2015; 3:206. [PMID: 26380251 PMCID: PMC4550749 DOI: 10.3389/fpubh.2015.00206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 08/11/2015] [Indexed: 12/03/2022] Open
Affiliation(s)
- Vesna Velickovic
- Clinic for Pediatrics, University Clinical Centre Kragujevac , Kragujevac , Serbia
| | - Aleksandra Simovic
- Clinic for Pediatrics, University Clinical Centre Kragujevac , Kragujevac , Serbia ; Department of Pediatrics, Faculty of Medical Sciences, University of Kragujevac , Kragujevac , Serbia
| | - Gordana Lazarevic
- Clinic for Pediatrics, University Clinical Centre Kragujevac , Kragujevac , Serbia
| | - Marija Lazarevic
- Faculty of Medical Sciences, University of Kragujevac , Kragujevac , Serbia
| | - Mihajlo Jakovljevic
- Health Economics & Pharmacoeconomics, Faculty of Medical Sciences, University of Kragujevac , Kragujevac , Serbia
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Cupurdija V, Lazic Z, Petrovic M, Mojsilovic S, Cekerevac I, Rancic N, Jakovljevic M. Community-acquired pneumonia: economics of inpatient medical care vis-à-vis clinical severity. J Bras Pneumol 2015; 41:48-57. [PMID: 25750674 PMCID: PMC4350825 DOI: 10.1590/s1806-37132015000100007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 12/05/2014] [Indexed: 12/26/2022] Open
Abstract
Objective: To assess the direct and indirect costs of diagnosing and treating community-acquired pneumonia (CAP), correlating those costs with CAP severity at diagnosis and identifying the major cost drivers. Methods: This was a prospective cost analysis study using bottom-up costing. Clinical severity and mortality risk were assessed with the pneumonia severity index (PSI) and the mental Confusion-Urea-Respiratory rate-Blood pressure-age ≥ 65 years (CURB-65) scale, respectively. The sample comprised 95 inpatients hospitalized for newly diagnosed CAP. The analysis was run from a societal perspective with a time horizon of one year. Results: Expressed as mean ± standard deviation, in Euros, the direct and indirect medical costs per CAP patient were 696 ± 531 and 410 ± 283, respectively, the total per-patient cost therefore being 1,106 ± 657. The combined budget impact of our patient cohort, in Euros, was 105,087 (66,109 and 38,979 in direct and indirect costs, respectively). The major cost drivers, in descending order, were the opportunity cost (lost productivity); diagnosis and treatment of comorbidities; and administration of medications, oxygen, and blood derivatives. The CURB-65 and PSI scores both correlated with the indirect costs of CAP treatment. The PSI score correlated positively with the overall frequency of use of health care services. Neither score showed any clear relationship with the direct costs of CAP treatment. Conclusions: Clinical severity at admission appears to be unrelated to the costs of CAP treatment. This is mostly attributable to unwarranted hospital admission (or unnecessarily long hospital stays) in cases of mild pneumonia, as well as to over-prescription of antibiotics. Authorities should strive to improve adherence to guidelines and promote cost-effective prescribing practices among physicians in southeastern Europe.
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Affiliation(s)
- Vojislav Cupurdija
- University of Kragujevac, Center for Clinical Medicine, Pulmonology Department, Kragujevac, Serbia. Pulmonology Department, University of Kragujevac Center for Clinical Medicine, Kragujevac, Serbia
| | - Zorica Lazic
- University of Kragujevac, Center for Clinical Medicine, Pulmonology Department, Kragujevac, Serbia. Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia; and Head. Pulmonology Department, University of Kragujevac Center for Clinical Medicine, Kragujevac, Serbia
| | - Marina Petrovic
- University of Kragujevac, Center for Clinical Medicine, Pulmonology Department, Kragujevac, Serbia. Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia; and Internist. Pulmonology Department, University of Kragujevac Center for Clinical Medicine, Kragujevac, Serbia
| | - Slavica Mojsilovic
- University of Kragujevac, Center for Clinical Medicine, Pulmonology Department. Pulmonology Department, University of Kragujevac Center for Clinical Medicine, Kragujevac, Serbia
| | - Ivan Cekerevac
- University of Kragujevac, Center for Clinical Medicine, Kragujevac, Serbia. Intensive Care Unit, University of Kragujevac Center for Clinical Medicine, Kragujevac, Serbia
| | - Nemanja Rancic
- University of Defence, Military Medical Academy, Medical Faculty, Belgrade, Serbia. Centre for Clinical Pharmacology, Medical Faculty, Military Medical Academy, University of Defence, Belgrade, Serbia
| | - Mihajlo Jakovljevic
- University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia. Graduate Program in Health Economics and Pharmacoeconomics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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Jakovljevic MB, Jovanovic M, Lesch OM. Accessibility and affordability of alcohol dependency medical care in serbia. Front Psychiatry 2015; 5:192. [PMID: 25628574 PMCID: PMC4290475 DOI: 10.3389/fpsyt.2014.00192] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 12/16/2014] [Indexed: 01/01/2023] Open
Affiliation(s)
- Mihajlo B. Jakovljevic
- Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Mirjana Jovanovic
- Department of Psychiatry, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Otto Michael Lesch
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
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