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Sejersen T, Graham S, Ekström AB, Kroksmark AK, Kwiatkowska M, Ganz ML, Justo N, Gertow K, Simpson A. Healthcare resource utilisation and direct medical cost for individuals with 5q spinal muscular atrophy in Sweden. Eur J Health Econ 2024:10.1007/s10198-024-01678-y. [PMID: 38642267 DOI: 10.1007/s10198-024-01678-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 01/25/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Spinal muscular atrophy (SMA) is a rare, progressive, neuromuscular disorder. Recent advances in treatment require an updated assessment of burden to inform reimbursement decisions. OBJECTIVES To quantify healthcare resource utilisation (HCRU) and cost of care for patients with SMA. METHODS Cohort study of patients with SMA identified in the Swedish National Patient Registry (2007-2018), matched to a reference cohort grouped into four SMA types (1, 2, 3, unspecified adult onset [UAO]). HCRU included inpatient admissions, outpatient visits, procedures, and dispensed medications. Direct medical costs were estimated by multiplying HCRU by respective unit costs. Average annual HCRU and medical costs were modelled for SMA versus reference cohorts to estimate differences attributable to the disease (i.e., average treatment effect estimand). The trajectory of direct costs over time were assessed using synthetic cohorts. RESULTS We identified 290 SMA patients. Annualised HCRU was higher in SMA patients compared with reference cohorts. Highest risk ratios were observed for inpatient overnight stays for type 1 (risk ratio [RR]: 29.2; 95% confidence interval [CI]: 16.0, 53.5) and type 2 (RR: 23.3; 95% CI: 16.4,33.1). Mean annual direct medical costs per patient for each year since first diagnosis were greatest for type 1 (€114,185 and SMA-attributable: €113,380), type 2 (€61,876 and SMA-attributable: €61,237), type 3 (€45,518 and SMA-attributable: €44,556), and UAO (€4046 and SMA-attributable: €2098). Costs were greatest in the 2-3 years after the first diagnosis for all types. DISCUSSION AND CONCLUSION The economic burden attributable to SMA is significant. Further research is needed to understand the burden in other European countries and the impact of new treatments.
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Affiliation(s)
- Thomas Sejersen
- Department of Child Neurology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
- Center for Neuromusculoskeletal Restorative Medicine, Hong Kong Science Park, Shatin, New Territories, Hong Kong
| | | | - Anne-Berit Ekström
- Pediatric Rehabilitation Center, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Pediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna-Karin Kroksmark
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | | | - Nahila Justo
- Evidera-PPD, Stockholm, Sweden
- NVS Department, Karolinska Institute, Stockholm, Sweden
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Prasartpornsirichoke J, Pityaratstian N, Poolvoralaks C, Sirinimnualkul N, Ormtavesub T, Hiranwattana N, Phonsit S, Rungnirundorn T. The prevalence and economic burden of treatment-resistant depression in Thailand. BMC Public Health 2023; 23:1541. [PMID: 37573321 PMCID: PMC10422729 DOI: 10.1186/s12889-023-16477-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 08/08/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND The objectives of this study were to investigate the proportion of treatment-resistant depression (TRD) among patients with diagnosed major depressive disorder (MDD) and undergoing antidepressant treatment, to estimate the economic cost of MDD, TRD, and non-treatment-resistant depression (non-TRD), and to examine the differences between TRD and non-TRD MDD in a Thai public tertiary hospital. METHODS This was a combined study between retrospective review of medical records and a cross-sectional survey. The sample size was 500 dyads of antidepressant-treated MDD patients and their unpaid caregivers. MDD patients' medical records, the concept of healthcare resource utilization, the Work Productivity and Activity Impairment Questionnaire: depression and mood & mental state versions (WPAI: D, MM), the Class Impairment Questionnaire (CIQ), and the Family Experiences Interview Schedule (FEIS) were applied as the tools of the study. Pearson Chi's square, Fisher's Exact test, and independent T-test were employed for statistical analysis. RESULTS The proportion of TRD was 19.6% among antidepressant-treated MDD patients in a Thai tertiary public hospital. The results of the study indicated that several factors showed a statistically significant association with TRD criteria. These factors included younger age of MDD patients, a younger age of onset of MDD, lower body mass index (BMI), a history of suicide attempts and self-harm, as well as frequent smoking behavior. The annualized economic cost of TRD was 276,059.97 baht per person ($7,668.33), which was significantly higher than that of cost of non-TRD (173,487.04 baht or $4,819.08). The aggregated economic costs of MDD were 96.8 million baht annually ($2.69 M) if calculated from 500 MDD patients and unpaid caregivers. This contributed to the economic cost of TRD 27.05 million baht (98 respondents) and the economic cost of non-TRD 69.74 million baht (402 respondents). CONCLUSIONS The economic burden associated with TRD was significantly higher compared to non-TRD among antidepressant-treated MDD patients. Specifically, both direct medical costs and indirect costs were notably elevated in the TRD group.
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Affiliation(s)
- Jirada Prasartpornsirichoke
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand.
| | - Nuttorn Pityaratstian
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand
- Department of Psychiatry, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | - Naphat Sirinimnualkul
- Department of Psychiatry, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | | | | | - Sasitorn Phonsit
- Department of Psychology, Faculty of Social Sciences, Kasetsart University, Bangkok, Thailand
| | - Teerayuth Rungnirundorn
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand
- Department of Psychiatry, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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Ong JCM, Than H, Tripathi S, Gkitzia C, Wang X. A cost-effectiveness analysis of ruxolitinib versus best alternative therapy for patients with steroid-refractory chronic graft-versus-host disease aged > 12 years in Singapore. Cost Eff Resour Alloc 2023; 21:34. [PMID: 37259074 DOI: 10.1186/s12962-023-00444-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/18/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Approximately 30-70% of patients who have undergone allogeneic (allo) hematopoietic stem cell transplantation (HSCT) eventually experience chronic graft-versus-host disease (cGVHD). Patients who develop steroid-refractory (SR)-cGVHD are the most severely impacted due to significant disease and financial burden. There remains an unmet need for safe, efficacious, and accessible treatments for these patients. The objective of this study was to determine the cost effectiveness of ruxolitinib for treatment of SR-cGvHD from the Singapore healthcare system perspective. METHODS Based on data from the REACH3 randomized open-label trial, a semi-Markov model was developed to evaluate cost-effectiveness of ruxolitinib compared with investigators' choice of best alternative therapy (BAT) for treatment of patients > 12 years of age with SR-cGVHD in Singapore over a 40-year time horizon. The model only considered direct medical-care costs related to the treatment of SR-cGVHD and reported them in Singapore Dollars (SGD). Half-cycle correction was applied to all costs and outcomes, which were discounted at 3%. Probabilistic sensitivity analysis (PSA), one-way sensitivity analysis (OWSA), and scenario analysis were conducted to explore the drivers of uncertainty in the model. RESULTS In the deterministic base case, more life years (LY; 10.28 vs. 9.42) and quality-adjusted life years (QALYs; 7.31 vs. 6.51) were gained with ruxolitinib than BAT at higher costs (SGD 303,214 vs. SGD 302,673) leading to an incremental cost-effectiveness ratio (ICER) of SGD 677/QALY. At a willingness-to-pay threshold of SGD 75,000/QALY gained, PSA found that ruxolitinib had a 78.52% probability of being cost-effective. Findings were sensitive to variations in non-responder utilities in the BAT arm and duration of BAT treatment in the OWSA, or comparison to either methotrexate (MTX) or mycophenolic acid as a single comparator in the scenario analysis. ICERs remained lower than SGD 75,000/QALY in all other tested variations and scenarios. CONCLUSION Ruxolitinib is likely to be cost-effective from Singapore healthcare system's perspective for patients with SR-cGVHD, which is promising in the management of patients with unmet clinical needs.
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Affiliation(s)
| | - Hein Than
- Department of Haematology, Singapore General Hospital, Singapore, Singapore
| | | | | | - Xiaojun Wang
- Novartis Singapore Pte. Ltd., Mapletree Business City, Singapore, Singapore.
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Harrington L, Aris E, Bhavsar A, Jamet N, Akpo EIH, Simeone JC, Ramond A, Lambrelli D, Oppenheimer J, Sergerie Y, Mukherjee P, Meszaros K. Burden of Pertussis in Adults Aged 50 Years and Older: A Retrospective Database Study in England. Infect Dis Ther 2023; 12:1103-1118. [PMID: 36966230 PMCID: PMC10147870 DOI: 10.1007/s40121-023-00774-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/07/2023] [Indexed: 03/27/2023] Open
Abstract
INTRODUCTION Pertussis, a highly infectious respiratory disease caused by Bordetella pertussis, affects people of all ages. Older adults are particularly susceptible to its severe outcomes and complications. METHODS In this retrospective cohort study, the incidence rate of pertussis among individuals aged ≥ 50 years was assessed during 2009-2018 using Clinical Practice Research Datalink and Hospital Episode Statistics databases, United Kingdom. Health care resource utilisation (HCRU) and direct medical costs (DMCs) were compared between patients with a pertussis diagnosis and propensity score-matched controls (matched on demographic and clinical variables). RESULTS Among 5,222,860 individuals, 1638 had a pertussis diagnosis (incidence rate: 5.8 per 100,000 person-years; 95% confidence interval 5.5-6.0). Baseline (- 18 to - 6 months) HCRU and DMC were similar among 1480 pertussis patients and 1480 matched controls. However, there were increases in HCRU in the pertussis vs. matched cohort around the pertussis diagnosis (from months - 6 to - 1 to 5-11). The most notable increases (pertussis vs. controls) were in the rates of general practitioner (GP)/nurse visits (4.7-fold), clinical assessments (4.1-fold), and accident and emergency visits (3.0-fold) during the month before diagnosis and GP/nurse visits during the 2 months after diagnosis (2.5-fold) (all p < 0.001). DMCs were significantly higher in the pertussis cohort (p < 0.001). Total excess DMC in the pertussis cohort during months - 1 to + 11 was £318 per patient. CONCLUSION A pertussis diagnosis among adults aged ≥ 50 years resulted in significant increases in HCRU and DMC across several months around diagnosis. These results highlight the need for increased awareness of pertussis infection among adults aged ≥ 50 years and suggest that pertussis booster doses among this population should be considered.
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Tene L, Bergroth T, Eisenberg A, David SSB, Chodick G. Risk factors, health outcomes, healthcare services utilization, and direct medical costs of patients with long COVID. Int J Infect Dis 2023; 128:3-10. [PMID: 36529373 DOI: 10.1016/j.ijid.2022.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/10/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Data on the economic burden of long COVID are scarce. We aimed to examine the prevalence and medical costs of treating long COVID. METHODS We conducted this historical cohort study using data from patients with COVID-19 among members of a large health provider in Israel. Cases were defined according to physician diagnosis (definite long COVID) or suggestive symptoms given ≥ 4 weeks from infection (probable cases). Healthcare resource utilization and direct healthcare costs (HCCs) in the period before infection and afterward were compared across study groups. RESULTS Between March 2020, and March 2021, a total of 180,759 COVID-19 patients (mean [SD] age = 32.9 years [19.0 years]; 89,665 [49.6%] females) were identified. Overall, 14,088 (7.8%) individuals developed long COVID (mean [SD] age = 40.0 years [19.0 years]; 52.4% females). Among them, 1477(10.5%) were definite long COVID and 12,611(89.5%) were defined as probable long COVID. Long COVID was associated with age (adjusted odds ratio [AOR] = 1.058 per year, 95% CI: 1.053-1.063), female sex (AOR = 1.138; 95% CI: 1.098-1.180), smoking (AOR = 1.532; 95% CI: 1.358-1.727), and symptomatic acute phase (AOR = 1.178; 95% CI: 1.133-1.224), primarily muscle pain and cough. Hypertension was an important risk factor for long COVID among younger adults. Compared with patients with non-long COVID, definite and probable cases were associated with AORs of 2.47 (2.22-2.75) and 1.76 (1.68-1.84) for post-COVID hospitalization, respectively. Although among patients with non-long COVID HCCs decreased from $1400 during 4 months before the infection to $1021 and among patients with long COVID, HCCs increased from $2435 to $2810. CONCLUSION Long COVID is associated with a substantial increase in the utilization of healthcare services and direct medical costs. Our findings underline the need for timely planning and allocating resources for patient-centered care for patients with long COVID as well as for its secondary prevention in high-risk patients.
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Keshavarz K, Hedayati A, Rezaei M, Goudarzi Z, Moghimi E, Rezaee M, Lotfi F. Economic burden of major depressive disorder: a case study in Southern Iran. BMC Psychiatry 2022; 22:577. [PMID: 36042423 PMCID: PMC9426032 DOI: 10.1186/s12888-022-04220-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression disorders are a leading cause of disability in the world which imposes a significant economic burden on patients and societies The present study aimed to determine the economic burden of Major Depressive Disorder (MDD) on the patients referred to the reference psychiatric single-specialty hospitals in southern Iran in 2020. METHODS This cross-sectional research is a partial economic evaluation and a cost-of-illness study conducted in southern Iran in 2020. A total of 563 patients were enrolled through the census method, and a researcher-made data collection form was used to gather the required information. The prevalence-based and the bottom-up approaches were also used to collect the cost information and calculate the costs, respectively. The data on direct medical, direct non-medical, and indirect costs were obtained using the information in the patients' medical records and insurance bills as well as their self-reports or those of their companions. To calculate the indirect costs, the human capital approach was used as well. RESULTS The results showed that the annual cost of MDD was $ 2717.41 Purchasing Power Parity (PPP) (USD 2026.13) per patient in 2020. Direct medical costs accounted for the largest share of the costs (73.68%), of which hoteling and regular beds expenses were the highest (57.70% of the total direct medical costs). The shares of direct non-medical and indirect costs were 7.52 and 18.80%, respectively, and the economic burden of the disease in the country was estimated at $7,120,456,596 PPP (USD 5,309,088,699). CONCLUSION In general, due to the high prevalence of MDD and the chronicity of the disease, the costs of its treatment can impose a heavy economic burden on the society, healthcare system, insurance system, and the patients themselves. Therefore, it is suggested that health policymakers and managers should take appropriate measures to increase the basic and supplemental insurance coverage of these patients. In addition, in order to reduce the costs, proper and equitable distribution of psychiatrists and psychiatric beds, expansion of home care services, and use of Internet-based technologies and the cyberspace to follow up the treatment of these patients are recommended.
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Affiliation(s)
- Khosro Keshavarz
- grid.412571.40000 0000 8819 4698Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran ,grid.412571.40000 0000 8819 4698Emergency Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arvin Hedayati
- grid.412571.40000 0000 8819 4698Department of Psychiatry, School of Medicine, Research Center for Psychiatry and Behavior Science, Ebnesina Hospital, Hafez Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mojtaba Rezaei
- grid.412571.40000 0000 8819 4698Student Research Committee, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Goudarzi
- grid.412571.40000 0000 8819 4698Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ebrahim Moghimi
- grid.412571.40000 0000 8819 4698Department of Psychiatry, School of Medicine Research Center for Psychiatry and Behavior Science Ebnesina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Rezaee
- grid.412105.30000 0001 2092 9755Department of Health Management, Policy and Economics, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Farhad Lotfi
- 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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Darbà J, Marsà A. Burden of ischemic heart disease in Spain: incidence, hospital mortality and costs of hospital care. Expert Rev Pharmacoecon Outcomes Res 2022; 22:1147-1152. [PMID: 36001004 DOI: 10.1080/14737167.2022.2108794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Ischemic heart disease (IHD) is the leading global cause of death and is assumed to entail a significant social and economic burden globally. This study aimed to evaluate incidence and mortality trends of IHD in Spain and to estimate direct medical costs. METHODS Admission files corresponding to patients with IHD registered between 2011 and 2019 were obtained from a Spanish hospital discharge database and analyzed in a retrospective study. RESULTS Admission data corresponding to 814,740 patients with IHD was analyzed. The majority of patients were males, and about half of the hospitalizations were due to an acute myocardial infarction. Incidence decreased significantly in most age groups over time, while hospital mortality rate remained stable (4.4%). Additionally, mortality rate was significantly higher among females (6.6%). Median admission cost was €5175; the higher costs per admission were found in patients with an acute myocardial infarction and in admissions with an ICU stay. The annual cost of hospital care was €693.8 million. CONCLUSIONS Despite the decreasing trends described in the general population, hospital mortality rate was constant among hospitalized patients during the study period. The higher hospital mortality rate described among females should be considered in further studies and protocol revisions.
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Affiliation(s)
- Josep Darbà
- Department of Economics, Universitat de Barcelona, Barcelona, Spain
| | - Alicia Marsà
- Department of Health Economics, BCN Health Economics & Outcomes Research S.L, Barcelona, Spain
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Diallo M, Fall D, Mballo I, Niang CI, Charfi ME. [ Direct medical costs of breast cancer treatment at the Joliot Curie Institute of the Aristide Le Dantec Hospital in Dakar, Senegal]. Pan Afr Med J 2022; 42:266. [PMID: 36338564 PMCID: PMC9617494 DOI: 10.11604/pamj.2022.42.266.32967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 06/04/2022] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION in 2020, the incidence of breast cancer was 2261419 cases worldwide, 1186598 cases in Africa and 817 cases in Senegal. However, direct medical costs of cancer treatment are not known in Senegal. For a better resource allocation, it is important to estimate costs. The purpose of this study is to analyze direct medical costs of breast cancer treatment at the Joliot Curie Institute in Dakar. METHODS we conducted a retrospective study of patients diagnosed with breast cancer between January and December 2017 at the Joliot Curie Institute. A questionnaire survey and semi-structured interviews were conducted among patients and their relatives to reconstruct direct medical costs. RESULTS average direct medical costs of breast cancer treatment at the Joliot Curie Institute were $33 713.45 with a minimum of $1 495.15 and a maximum of $10 662.97 over an average period of 31 months. These costs include chemotherapy (29%); diagnosis (15%) and surgery (15%). Costs of radiotherapy and prescription medicines accounted for 13% for each procedure. Medical costs were related to educational level (p=0.05) and stage of disease (p=0.03). CONCLUSION direct medical costs of breast cancer treatment are very high in Senegal. Direct medical costs of maximum treatment is $10 662.97 and of minimum treatment is $495.15, reflecting an average cost of $3 713.45.
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Affiliation(s)
- Mory Diallo
- Institut Joliot Curie, Hôpital Aristide Le Dantec, Dakar, Sénégal,Corresponding author: Mory Diallo, Institut Joliot Curie, Hôpital Aristide Le Dantec, Dakar, Sénégal.
| | - Dieynaba Fall
- Institut Joliot Curie, Hôpital Aristide Le Dantec, Dakar, Sénégal
| | - Ibrahima Mballo
- Institut Joliot Curie, Hôpital Aristide Le Dantec, Dakar, Sénégal
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Rezaee M, Keshavarz K, Izadi S, Jafari A, Ravangard R. Economic burden of multiple sclerosis: a cross-sectional study in Iran. Health Econ Rev 2022; 12:2. [PMID: 34981265 PMCID: PMC8725304 DOI: 10.1186/s13561-021-00350-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 12/10/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Multiple Sclerosis (MS) is a chronic debilitating disease that imposes a heavy socioeconomic burden on societies. This study aimed to determine the economic burden of MS on patients using the first (CinnoVex and ReciGen) and second (Fingolimod and Natalizumab) drug therapy lines. METHODS This cost of illness study was an economic evaluation carried out as cross-sectional research in 2019 in southern Iran. A total of 259 patients were enrolled in two lines of drug therapy (178 patients in the first line and 81 ones in the second). The prevalence-based approach and the bottom-up approach were used to collect cost information and to calculate the costs from the societal perspective, respectively. The human capital approach was applied to calculate indirect costs. To collect the required data a researcher-made data collection form was utilized. The data were obtained using the information available in the patients' medical records and insurance invoices as well as their self-reports or that of their companions. RESULTS The results showed that the annual costs of MS in the first and second lines of drug therapy per patient were $ 1919 and $ 4082 purchasing power parity (PPP), respectively, and in total, $ 2721 PPP in 2019. The highest mean costs in both lines were those of direct medical costs, of which purchasing the main medicines in both lines accounted for the highest. CONCLUSION Considering the findings of this study and in order to reduce the burden of the disease, the following suggestions are presented: providing necessary facilities for the production of MS drugs in the country; proper and equitable distribution of neurologists; expanding the provision of home care services; and using the technologies related to the Internet, including WhatsApp, to follow up the MS patients' treatment.
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Affiliation(s)
- Mehdi Rezaee
- Student Research Committee, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Health Management, Policy and Economics, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Khosro Keshavarz
- Department of Health Services Management, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Almas Building, Alley 29, Qasrodasht Avenue, 71336-54361 Shiraz, Iran
| | - Sadegh Izadi
- Clinical Neurology Research Center, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdosaleh Jafari
- Department of Health Services Management, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Almas Building, Alley 29, Qasrodasht Avenue, 71336-54361 Shiraz, Iran
| | - Ramin Ravangard
- Department of Health Services Management, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Almas Building, Alley 29, Qasrodasht Avenue, 71336-54361 Shiraz, Iran
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Nejati M, Razavi M, Harirchi I, Zanganeh M, Salari G, Tabatabaee SM. Resource Use and Costs Associated to the Initial Phase of Treatment for Patients with Colorectal Cancer Receiving Post-Surgery Chemotherapy: A Cost Analysis from a Healthcare Perspective. Iran J Public Health 2021; 50:1887-1896. [PMID: 34722385 PMCID: PMC8542811 DOI: 10.18502/ijph.v50i9.7062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/22/2020] [Indexed: 12/09/2022]
Abstract
Background: To estimate the resource use and costs associated to the initial phase of treatment for colorectal cancer in Iran. Methods: A retrospective study was conducted using routinely collected data within Electronic Health Records System (SEPAS), a national database representing public hospitals in Iran between March 20, 2016 and March 19, 2017. Primary end points included healthcare resource use, direct medical and non-medical costs of care in the 12-month study period. Results: The study population included 657 patients with colorectal cancer who underwent surgery and the follow-up chemotherapy. We estimated a total direct cost of $21,407 per patient. The results indicated that direct medical costs were primarily driven by inpatient hospital care, followed by surgery, chemotherapy, and diagnostic services. Conclusion: The initial 12-month of treatment for colorectal cancer, including surgery and the follow-up chemotherapy, is resource intensive. The total direct costs associated to the disease are remarkable, with Inpatient hospital services being the main contributor followed by surgery and chemotherapy.
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Affiliation(s)
- Mina Nejati
- The Cancer Institute at Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Moaven Razavi
- The Schneider Institutes for Health Policy at the Heller School of Brandeis University, Waltham, MA, USA
| | - Iraj Harirchi
- The Cancer Institute at Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Marzieh Zanganeh
- Deputy of Medical Affairs, Ministry of Health and Medical Education, Tehran, Iran
| | - Gholamreza Salari
- Iran Small Businesses and Industrial Parks Organization, Qazvin, Iran
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Rein DB, Wittenborn JS, Zhang P, Sublett F, Lamuda PA, Lundeen EA, Saaddine J. The Economic Burden of Vision Loss and Blindness in the United States. Ophthalmology 2021; 129:369-378. [PMID: 34560128 DOI: 10.1016/j.ophtha.2021.09.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 08/17/2021] [Accepted: 09/15/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To estimate the economic burden of vision loss (VL) in the United States and by state. DESIGN Analysis of secondary data sources (American Community Survey [ACS], American Time Use Survey, Bureau of Labor Statistics, Medical Expenditure Panel Survey [MEPS], National and State Health Expenditure Accounts, and National Health Interview Survey [NHIS]) using attributable fraction, regression, and other methods to estimate the incremental direct and indirect 2017 costs of VL. PARTICIPANTS People with a yes response to a question asking if they are blind or have serious difficulty seeing even when wearing glasses in the ACS, MEPS, or NHIS. MAIN OUTCOME MEASURES We estimated the direct costs of medical, nursing home (NH), and supportive services and the indirect costs of absenteeism, lost household production, reduced labor force participation, and informal care by age group, sex, and state in aggregate and per person with VL. RESULTS We estimated an economic burden of VL of $134.2 billion: $98.7 billion in direct costs and $35.5 billion in indirect costs. The largest burden components were NH ($41.8 billion), other medical care services ($30.9 billion), and reduced labor force participation ($16.2 billion), all of which accounted for 66% of the total. Those with VL incurred $16 838 per year in incremental burden. Informal care was the largest burden component for people 0 to 18 years of age, reduced labor force participation was the largest burden component for people 19 to 64 years of age, and NH costs were the largest burden component for people 65 years of age or older. New York, Connecticut, Massachusetts, Rhode Island, and Vermont experienced the highest costs per person with VL. Sensitivity analyses indicate total burden may range between $76 and $218 billion depending on the assumptions used in the model. CONCLUSIONS Self-reported VL imposes a substantial economic burden on the United States. Burden accrues in different ways at different ages, leading to state differences in the composition of per-person costs based on the age composition of the population with VL. Information on state variation can help local decision makers target resources better to address the burden of VL.
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Affiliation(s)
- David B Rein
- NORC at the University of Chicago, Chicago, Illinois.
| | | | - Ping Zhang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Farah Sublett
- NORC at the University of Chicago, Chicago, Illinois
| | | | - Elizabeth A Lundeen
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jinan Saaddine
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
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Yang S, Chen G, Li Y, Li G, Liang Y, Zhou F, Zhou S, Yang Y, Jia W, Gao Y, Chen Y. The trend of direct medical costs and associated factors in patients with chronic hepatitis B in Guangzhou, China: an eight-year retrospective cohort study. BMC Med Inform Decis Mak 2021; 21:71. [PMID: 34330262 PMCID: PMC8323196 DOI: 10.1186/s12911-021-01429-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/09/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Although the expenses of liver cirrhosis are covered by a critical illness fund under the current health insurance program in China, the medical costs associated with hepatitis B virus (HBV) related diseases is not well addressed. In order to provide evidence to address the problem, we investigated the trend of direct medical costs and associated factors in patients with chronic HBV infection. METHODS A retrospective cohort study of 65,175 outpatients and 12,649 inpatients was conducted using a hospital information system database for the period from 2008 to 2015. Generalized estimating equations (GEE) were applied to explore associations between annual direct medical costs and corresponding factors, meanwhile quantile regression models were used to evaluate the effect of treatment modes on different quantiles of annual direct medical costs stratified by medical insurances. RESULTS The direct medical costs increased with time, but the proportion of antiviral costs decreased with CHB progression. Antiviral costs accounted 54.61% of total direct medical costs for outpatients, but only 6.17% for inpatients. Non-antiviral medicine costs (46.06%) and lab tests costs (23.63%) accounted for the majority of the cost for inpatients. The direct medical costs were positively associated with CHB progression and hospitalization days in inpatients. The direct medical costs were the highest in outpatients with medical insurance and in inpatients with free medical service, and treatment modes had different effects on the direct medical costs in patients with and without medical insurance. CONCLUSIONS CHB patients had a heavy economic burden in Guangzhou, China, which increased over time, which were influenced by payment mode and treatment mode.
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Affiliation(s)
- Shuo Yang
- Department of Epidemiology and Medical Statistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Ge Chen
- Department of Epidemiology and Medical Statistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Yueping Li
- Guangzhou Eighth People's Hospital, Guangzhou, Guangdong, China
| | - Guanhai Li
- Department of Epidemiology and Medical Statistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Yingfang Liang
- Guangzhou Eighth People's Hospital, Guangzhou, Guangdong, China
| | - Feng Zhou
- Department of Epidemiology and Medical Statistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Shudong Zhou
- Department of Epidemiology and Medical Statistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Yi Yang
- Department of Epidemiology and Medical Statistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Weidong Jia
- Guangzhou Eighth People's Hospital, Guangzhou, Guangdong, China.
| | - Yanhui Gao
- Department of Epidemiology and Medical Statistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong, China. .,Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China.
| | - Yue Chen
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Guevara-Sanginés E, Pérez-Rojas D, Nevárez-Sida A, Aceves MA, Barrón-Tapia MT, Abaroa-Cantú FJ, Ancona-Castro C, García-Salazar MR, Hernández-Rodríguez JM, García-Contreras F, Estrada-Aguilar L. [The annual cost of medical care for patients with moderate to severe atopic dermatitis in Mexico. A multicenter study]. ACTA ACUST UNITED AC 2021; 67:9-18. [PMID: 32447863 DOI: 10.29262/ram.v67i1.700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND In Mexico, the economic burden of medical care for patients with atopic dermatitis is unknown. OBJECTIVE To determine the annual direct medical costs of the treatment for patients with moderate to severe atopic dermatitis who receive medical attention at "Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado" (Institute for Social Security and Social Services for State Workers, better known as ISSSTE), as well as the main variables associated with it. METHODS A multicenter, retrospective cohort study. Clinical records of patients with moderate to severe atopic dermatitis were reviewed and a multivariate analysis was designed by using a generalized linear model. RESULTS 65 patients were included; 41 of them (63.07 %) had moderate atopic dermatitis, and 24 (36.92 %) had severe AD; 39 (60 %) of them were female patients. In groups with severe atopic dermatitis, statistically significant differences were observed in matters of the duration of the evolution of the disease, comorbidities, intense pruritus, and depression. The average annual cost of medical care for patients with moderate atopic dermatitis was 1527 ± 623 USD, and for patients with severe atopic dermatitis the cost was 9487 ± 8990 USD. Significant differences were observed in dermatology consultations, referrals, laboratory and diagnostic studies, and the number of drugs prescribed by physicians. With the multivariate analysis, it was identified that the highest cost was presented by severe patients (p = 0.0001) who were younger and had comorbidities, along with diagnosis of depression. CONCLUSIONS The severity of atopic dermatitis, the age average, the presence of comorbidities, and the diagnosis of depression are the variables with the highest association and impact on the direct cost of medical care.
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Affiliation(s)
- Esther Guevara-Sanginés
- Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Hospital Regional Lic. Adolfo López Mateos, Servicio de Dermatología, Ciudad de México, México.
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Schain F, Batyrbekova N, Liwing J, Baculea S, Webb T, Remberger M, Mattsson J. Real-world study of direct medical and indirect costs and time spent in healthcare in patients with chronic graft versus host disease. Eur J Health Econ 2021; 22:169-180. [PMID: 33275188 PMCID: PMC7822787 DOI: 10.1007/s10198-020-01249-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 11/17/2020] [Indexed: 06/12/2023]
Abstract
Chronic graft versus host disease (cGVHD) is a debilitating and costly complication following haemopoietic stem cell transplantation (HSCT). This study describes the economic burden associated with cGVHD. Direct costs associated with specialised healthcare utilisation (inpatient admissions and outpatient visits), as well as indirect costs associated with sickness absence-associated productivity loss were estimated in patients who underwent allogeneic HSCT in Sweden between 2006 and 2015, linking population-based health and economic registers. To capture the period of chronic GVHD, patients were included who survived > 182 days post-HSCT (start of follow-up), and cGVHD was classified based on patient treatment records to correct for any diagnosis underreporting. Patients were classified as 'non-cGVHD' if they received no immunosuppressive treatment, 'mild cGVHD' if they received only systemic corticosteroid treatment or immunosuppressive treatment, or 'moderate-severe cGVHD' if they received extracorporeal photopheresis (ECP) only, corticosteroid treatment and immunosuppressive treatment, or systemic corticosteroid treatment and ECP treatments. Patients with moderate-severe cGVHD spent more time in healthcare, had higher healthcare resource costs and higher sickness absence-related productivity loss compared to patients with non- or mild cGVHD. The cumulative total costs during the first 3 years of follow-up were EUR 14,887,599, EUR 20,544,056, and EUR 47,811,835 for non-, mild, and moderate-severe groups, respectively. The long-term costs incurred with cGVHD following HSCT continue to be very high and significantly impacted by cGVHD severity. This study adds real-world health resource and economic insight relevant for policy-makers and healthcare providers when considering the clinical challenge of balancing immunosuppression to reduce cGVHD.
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Affiliation(s)
- Frida Schain
- Janssen Global Services, Stockholm, Sweden.
- Department of Medicine, Division of Hematology, Karolinska Institutet, Solna, Sweden.
- Schain Research, Bromma, Sweden.
| | - Nurgul Batyrbekova
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Scandinavian Development Services, Stockholm, Sweden
| | - Johan Liwing
- Janssen Global Services, Stockholm, Sweden
- Department of Medicine, Division of Hematology, Karolinska Institutet, Huddinge, Sweden
| | | | | | - Mats Remberger
- KFUE, Uppsala University Hospital and Institution of Medical Science, Uppsala University, Uppsala, Sweden
| | - Jonas Mattsson
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
- Gloria and Seymour Epstein Chair in Cell Therapy and Transplantation, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
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15
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Rezapour A, Nargesi S, Mezginejad F, Rashki Kemmak A, Bagherzadeh R. The Economic Burden of Cancer in Iran during 1995-2019: A Systematic Review. Iran J Public Health 2021; 50:35-45. [PMID: 34178762 PMCID: PMC8213609 DOI: 10.18502/ijph.v50i1.5070] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Cancer is the third cause of death following cardiovascular disease and accidents, in Iran. The purpose of this study was to systematically review the economic burden of cancer studies in Iran. Methods This systematic review examined the types of direct medical and non-medical costs and indirect costs in cancer patients and includes studies in English and Persian that were reviewed in Scopus, Web of science, SID, Iranmedex, Magiran and databases of Medline, etc., from 1995-2019. Results Twenty-one articles were included. Most studies have examined the direct costs of all types of cancers. The articles reviewed different types of cancer, such as prostate cancer (n=2), colorectal cancer (n=2), breast cancer (n=4), gastric cancer (n=2), oral and pharyngeal cancer (n=1), lung cancer (n=3), and blood cancer (n=4). The great number of studies were related to the gastrointestinal, breast and blood cancers. The gastrointestinal (gastric and colorectal) and breast cancer had the major economic burden than others. Conclusion It is necessary that special attention to patients, supportive measures to reduce the share of costs, and more budget allocation for prevention, screening and early detection being at priorities in the health system planning.
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Affiliation(s)
- Aziz Rezapour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Shahin Nargesi
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Fateme Mezginejad
- Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Asma Rashki Kemmak
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Rafat Bagherzadeh
- Department of Foreign Languages, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Shi JH, Luo L, Chen XL, Pan YP, Zhang Z, Fang H, Chen Y, Chen WD, Cao Q. Real-world cost-effectiveness associated with infliximab maintenance therapy for moderate to severe Crohn’s disease in China. World J Gastroenterol 2020; 26:6455-6474. [PMID: 33244205 PMCID: PMC7656205 DOI: 10.3748/wjg.v26.i41.6455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/05/2020] [Accepted: 09/17/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Infliximab was the first approved biologic treatment for moderate to severe Crohn’s disease (MS-CD) in China. However, the cost-effectiveness of infliximab maintenance therapy (IMT) for MS-CD relative to conventional maintenance therapy remained unclarified.
AIM To assess the cost-effectiveness of IMT for MS-CD in Chinese patients from the perspective of Chinese public insurance payer.
METHODS A cohort of MS-CD patients managed in a Chinese tertiary care hospital was created to compare IMT with conventional maintenance therapy (CMT) for clinical outcomes and direct medical costs over a 1-year observation time using conventional regression analyses. A decision-analytic model with the generated evidence was constructed to assess the cost-effectiveness of IMT relative to CMT using reimbursed medical costs.
RESULTS Based on the included 389 patients, IMT was associated with significantly higher disease remission chance [odds ratio: 4.060, P = 0.003], lower risk of developing new complications (odds ratio: 0.527, P = 0.010), higher utility value for quality of life (coefficient 0.822, P = 0.008), and lower total hospital costs related to disease management (coefficient -0.378, P = 0.008) than CMT. Base-case cost-effectiveness analysis estimated that IMT could cost Chinese health insurance payers ¥55260 to gain one quality-adjusted life year (QALY). The cost-effectiveness of IMT was mainly driven by the estimate of quality of life, treatment efficacy of maintenance therapy, mortality risk associated with active disease, and unit price of infliximab. The probability that IMT was cost-effective at a willingness-to-pay threshold of three times gross domestic product [2018 Chinese gross domestic product per capita (GDPPC)] was 86.4%.
CONCLUSION IMT significantly improved real-world health outcomes and cost the Chinese public health insurance payers less than one GDPPC to gain one QALY in Chinese MS-CD patients.
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Affiliation(s)
- Ji-Hao Shi
- Department of Gastroenterology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Liang Luo
- Department of Gastroenterology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Xiao-Li Chen
- Department of Gastroenterology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Yi-Peng Pan
- Department of Gastroenterology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Zhou Zhang
- Department of Gastroenterology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Hao Fang
- Department of Gastroenterology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Ying Chen
- Department of Project, Changsha Normin Health Technology Ltd, Changsha 410013, Hunan Province, China
| | - Wen-Dong Chen
- Department of HEOR, Normin Health Consulting Ltd, Toronto L5R 0E9, Ontario, Canada
| | - Qian Cao
- Department of Gastroenterology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
- Inflammatory Bowel Disease Center, Sir Run Run Shaw Hospital, Hangzhou 310016, Zhejiang Province, China
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Wu T, Yang F, Chan WWL, Lam CLK, Wong CKH. Healthcare utilization and direct medical cost in the years during and after cancer diagnosis in patients with type 2 diabetes mellitus. J Diabetes Investig 2020; 11:1661-1672. [PMID: 32471010 PMCID: PMC7610124 DOI: 10.1111/jdi.13308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/11/2020] [Accepted: 05/22/2020] [Indexed: 12/11/2022] Open
Abstract
AIMS/INTRODUCTION There is uncertainty about the direct medical costs of type 2 diabetes patients with cancers. MATERIALS AND METHODS A population-based retrospective cohort of 99,915 type 2 diabetes patients from the Hong Kong Hospital Authority between 2006 and 2017 was assembled. A total of 16,869 patients who had an initial cancer diagnosis after type 2 diabetes diagnosis were matched with 83,046 patients without cancer (controls) using a matching ratio of up to one-to-five propensity score-matching method. Patients were divided into four categories according to life expectancy. Healthcare service utilization and direct medical costs during the index year, subsequent years and mortality year were compared between patients with and without cancer in each category. RESULTS Medical costs of cancer patients in the index year ranged from $US27,533 for patients who died in <1 year to $US11,303 for those survived >3 years. Cancer patients had significantly greater expenditures than controls in the index year (all P < 0.001) and subsequent years ($US4,569 vs $US4,155, P < 0.001). Cancer patients also had greater costs in the year of death, and the difference was significant for patients who survived >3 years after the index year ($US32,558 vs $US28,260). For patients in both groups, patients who survived >3 years had significantly lower costs than those who died in <1 year. Costs incurred in the mortality year were greater than those in the index year and subsequent years. Hospitalization accounted for >90% of the medical costs for both groups in the mortality year. CONCLUSIONS Type 2 diabetes patients with cancers incurred greater medical costs in the diagnosis, ensuing and mortality years than type 2 diabetes patients without cancers.
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Affiliation(s)
- Tingting Wu
- Department of Family Medicine and Primary CareThe University of Hong KongHong Kong
| | - Fan Yang
- Centre for Health EconomicsThe University of YorkYorkUK
| | | | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary CareThe University of Hong KongHong Kong
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary CareThe University of Hong KongHong Kong
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Muttamba W, Tumwebaze R, Mugenyi L, Batte C, Sekibira R, Nkolo A, Katamba A, Kasasa S, Majwala RK, Turyahabwe S, Mugabe F, Mugagga K, Lochoro P, Dejene S, Birabwa E, Marra C, Baena IG, Kirenga B. Households experiencing catastrophic costs due to tuberculosis in Uganda: magnitude and cost drivers. BMC Public Health 2020; 20:1409. [PMID: 32938411 PMCID: PMC7493412 DOI: 10.1186/s12889-020-09524-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 09/09/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) patients in Uganda incur large costs related to the illness, and while seeking and receiving health care. Such costs create access and adherence barriers which affect health outcomes and increase transmission of disease. The study ascertained the proportion of Ugandan TB affected households incurring catastrophic costs and the main cost drivers. METHODS A cross-sectional survey with retrospective data collection and projections was conducted in 2017. A total of 1178 drug resistant (DR) TB (44) and drug sensitive (DS) TB patients (1134), 2 weeks into intensive or continuation phase of treatment were consecutively enrolled across 67 randomly selected TB treatment facilities. RESULTS Of the 1178 respondents, 62.7% were male, 44.7% were aged 15-34 years and 55.5% were HIV positive. For each TB episode, patients on average incurred costs of USD 396 for a DS-TB episode and USD 3722 for a Multi drug resistant tuberculosis (MDR TB) episode. Up to 48.5% of households borrowed, used savings or sold assets to defray these costs. More than half (53.1%) of TB affected households experienced TB-related costs above 20% of their annual household expenditure, with the main cost drivers being non-medical expenditure such as travel, nutritional supplements and food. CONCLUSION Despite free health care in public health facilities, over half of Ugandan TB affected households experience catastrophic costs. Roll out of social protection interventions like TB assistance programs, insurance schemes, and enforcement of legislation related to social protection through multi-sectoral action plans with central NTP involvement would palliate these costs.
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Affiliation(s)
- Winters Muttamba
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Racheal Tumwebaze
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Levicatus Mugenyi
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Charles Batte
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rogers Sekibira
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Abel Nkolo
- University Research Co, LLC (URC) & Center for Human Services (CHS), Kampala, Uganda
| | - Achilles Katamba
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Simon Kasasa
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Robert Kaos Majwala
- University Research Co, LLC (URC) & Center for Human Services (CHS), Kampala, Uganda
- National Tuberculosis and Leprosy Program, Ministry of Health, Kampala, Uganda
| | - Stavia Turyahabwe
- National Tuberculosis and Leprosy Program, Ministry of Health, Kampala, Uganda
| | - Frank Mugabe
- National Tuberculosis and Leprosy Program, Ministry of Health, Kampala, Uganda
| | | | | | | | | | - Claudio Marra
- National Tuberculosis and Leprosy Program, Ministry of Health, Kampala, Uganda
| | | | - Bruce Kirenga
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
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Yoo JS, Choe EY, Kim YM, Kim SH, Won YJ. Predictive costs in medical care for Koreans with metabolic syndrome from 2009 to 2013 based on the National Health Insurance claims dataset. Korean J Intern Med 2020; 35:936-945. [PMID: 31422650 PMCID: PMC7373977 DOI: 10.3904/kjim.2016.343] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 08/16/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND/AIMS Although metabolic syndrome has been associated with increasing medical costs worldwide, there have been no studies using a nationwide and longitudinal South Korean dataset. We investigated trends in subsidized medical costs among Korean adults with metabolic syndrome. METHODS This study was based on the National Sample Cohort database of South Korea. We used data of national health checkups in 2009 as well as data of subsidized prescription drugs and the Korean Classification of Disease diagnosis codes from claims in 2007 to 2008 to identify underlying diseases. We calculated the direct medical costs, which were subsidized by the Korean National Health Insurance, among 204,768 individuals older than 20 years from 2009 to 2013. RESULTS The proportion of subjects with metabolic syndrome was 27.2%. Direct medical costs for 5 years differed by a magnitude of 2.16 between subjects with and without metabolic syndrome. The costs increased by approximately 41.8% in the metabolic syndrome group in 5 years. Direct medical costs increased with every additional risk factor, even if a subject had less than three risk factors of metabolic syndrome. Metabolic syndrome per se and all of its components, except low serum high-density lipoprotein cholesterol level, resulted in a significant increase in medical costs. CONCLUSION The medical costs of subjects with metabolic syndrome were higher than that of those without metabolic syndrome and it increased with the number of risk factors. Further research using cumulative data of more than 10 years, including unsubsidized and indirect costs, is needed in the future.
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Affiliation(s)
- Jeong Seon Yoo
- Department of Internal Medicine, Seobuk Hospital, Seoul Metropolitan Government, Seoul, Korea
- Graduate School, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Yeong Choe
- Graduate School, Yonsei University College of Medicine, Seoul, Korea
| | - Yoo Mee Kim
- Department of Internal Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Se Hwa Kim
- Department of Internal Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Young Jun Won
- Department of Internal Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
- Correspondence to Young Jun Won, M.D. Department of Internal Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, 25 Simgok-ro 100beon-gil, Seogu, Incheon 22711, Korea Tel: +82-32-290-3963 Fax: +82-32-290-3879 E-mail:
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Seong JM, Kim JJ, Kim HJ, Sohn HS. Comparison of heart failure risk and medical costs between patients with type 2 diabetes mellitus treated with dapagliflozin and dipeptidyl peptidase-4 inhibitors: a nationwide population-based cohort study. Cardiovasc Diabetol 2020; 19:95. [PMID: 32571319 PMCID: PMC7310428 DOI: 10.1186/s12933-020-01060-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/08/2020] [Indexed: 12/14/2022] Open
Abstract
Background Dapagliflozin is one of the novel glucose-lowering agents, which has recently been reported to reduce the risk of hospitalization for heart failure (hHF). The present study aimed to compare the differences between the risk of hHF after using dapagliflozin and dipeptidyl peptidase-4 inhibitors (DPP-4i) as second-line drugs for the treatment of type 2 diabetes mellitus using the latest nationwide population data in Korea. Additionally, we aimed to examine the impact of clinical outcomes on direct medical costs in the two groups. Methods The present population-based, retrospective cohort study was conducted using the nationwide claims data between September 01, 2014 and June 30, 2018. New users of dapagliflozin and DPP-4i were identified from the database and the differences in patients’ characteristics between the two groups were analyzed using propensity score-weighted analysis. Cox proportional hazards regression analysis was used to estimate the risk of hHF. A simple model was used for the estimation of direct medical costs for 3 years. Results In total, 23,147 patients in the dapagliflozin group and 237,187 patients in the DPP-4i group were selected for the analysis. The incidence rates of hHF were 3.86 and 6.79 per 1000 person-years in the dapagliflozin and DPP-4i groups, respectively. In the entire study population, the hazard ratio for hHF in the dapagliflozin group compared to the DPP-4i group was 0.58 (95% confidence interval 0.46–0.74), with 0.55 (95% confidence interval 0.41–0.74) among patients with underlying cardiovascular disease and 0.66 (95% confidence interval 0.46–0.95) among patients without underlying cardiovascular disease. The direct medical costs were $57,787 lower in the dapagliflozin group than in the DPP-4i group for 3 years. Conclusions This study showed that dapagliflozin lowers the risk for hHF and subsequently reduces direct medical costs compared to DPP-4i. The protective effect against hHF was more evident among patients with underlying cardiovascular disease.
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Affiliation(s)
- Jong-Mi Seong
- Research Institute for Pharmaceutical Sciences, Ewha Womans University, Seoul, 03760, Republic of Korea
| | - Jong Joo Kim
- Pharmaceutical Information Research Institute, CHA University, Seongnam, 13488, Republic of Korea
| | - Hae Jin Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, 206, World cup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea.
| | - Hyun Soon Sohn
- College of Pharmacy, CHA University, 335 Pangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13488, Republic of Korea.
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Li X, Xu Z, Ji L, Guo L, Liu J, Feng K, Xu Y, Zhu D, Jia W, Ran X, Chen L, Zhao S, Shi B, Zhu J, Shan Z, Zhou Z, Zeng L, Weng J. Direct medical costs for patients with type 2 diabetes in 16 tertiary hospitals in urban China: A multicenter prospective cohort study. J Diabetes Investig 2019; 10:539-551. [PMID: 30079578 PMCID: PMC6400170 DOI: 10.1111/jdi.12905] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 07/25/2018] [Accepted: 08/01/2018] [Indexed: 02/05/2023] Open
Abstract
AIMS/INTRODUCTION To investigate the direct medical costs for patients with type 2 diabetes in China and to examine the influencing factors. MATERIALS AND METHODS In the present multicenter study, 1,070 patients with type 2 diabetes from 16 tertiary hospitals in 14 major cities of China were enrolled. Patient data and direct medical costs were collected during a follow-up period of 6 months at intervals of 1 month. The log-transformed direct medical costs were fitted by a generalized estimation equation to indicator variables for demographics, metabolic control, treatments, complications and comorbidities. RESULTS Data of 871 participants were included in the analysis. The mean annual total direct medical costs and outpatient medical costs were $1,990.20 and $1,687.20 respectively. The average costs per inpatient per admission were $2,127.10. The share of out-of-pocket for total medical costs, outpatient costs and cost per inpatient per admission were 45.4, 46.3 and 26.0% respectively. Independent determinants of total medical costs were diabetes duration, dyslipidemia and diabetic complications, such as neuropathy and nephropathy, as well as diabetes treatment, such as the use of glucagon-like peptide-1 receptor agonists. Costs showed prominent variation across centers. CONCLUSIONS Diabetes is imposing a growing economic burden in patients with type 2 diabetes in China. Diabetes-related complications and comorbidities have a great impact on the medical costs. As different health policies, economic development and regional health inequalities also have an important influence on the direct medical cost, healthcare reform needs to optimize resource allocation in health service delivery systems, and provide more equitable and affordable healthcare.
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Affiliation(s)
- Xiang Li
- Diabetes CenterDepartment of EndocrinologyThe 306th Hospital of PLABeijingChina
| | - Zhangrong Xu
- Diabetes CenterDepartment of EndocrinologyThe 306th Hospital of PLABeijingChina
| | - Linong Ji
- Department of Endocrine and MetabolismPeking University People's HospitalBeijingChina
| | - Lixin Guo
- Department of EndocrinologyBeijing HospitalBeijingChina
| | - Jing Liu
- Department of EndocrinologyGansu Provincial HospitalLanzhouChina
| | - Kun Feng
- Department of EndocrinologyHeilongjiang Provincial HospitalHarbinChina
| | - Yushan Xu
- Department of EndocrinologyFirst Affiliated Hospital of Kumming Medical UniversityKunmingChina
| | - Dalong Zhu
- Department of EndocrinologyNanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
| | - Weiping Jia
- Department of EndocrinologyShanghai Jiao Tong UniversityAffiliated Sixth People's HospitalShanghaiChina
| | - XinWu Ran
- Department of Endocrinology and MetabolismWest China HospitalSichuan UniversityChengduChina
| | - Limin Chen
- Key Laboratory of Hormones and Development (Ministry of Health)Tianjin Key Laboratory of Metabolic Diseases HospitalTianjin Medical UniversityTianjinChina
| | - Shi Zhao
- Department of EndocrinologyThe Central Hospital of Wuhan Tongji Medical CollegeHuazhong University of Science & TechnologyWuhanChina
| | - Bingying Shi
- Department of EndocrinologyThe First Affiliated Hospital of Xi'anJiao Tong UniversityXi'anChina
| | - Jun Zhu
- Department of EndocrinologyFirst Affiliated Hospital of Xinjiang Medical UniversityUrumqiChina
| | - Zhongyan Shan
- The First Affiliated Hospital of China Medical UniversityShenyangChina
| | - Zhiguang Zhou
- Department of Endocrinology and MetabolismThe Second Xiangya Hospital of Central South UniversityChangshaChina
| | - Longyi Zeng
- Department of Endocrinology and MetabolismThe Third Affiliated Hospital Sun Yat‐Sen UniversityGuangzhouChina
| | - Jianping Weng
- Department of Endocrinology and MetabolismThe Third Affiliated Hospital Sun Yat‐Sen UniversityGuangzhouChina
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Zhang H, Sun Y, Zhang D, Zhang C, Chen G. Direct medical costs for patients with schizophrenia: a 4-year cohort study from health insurance claims data in Guangzhou city, Southern China. Int J Ment Health Syst 2018; 12:72. [PMID: 30479658 PMCID: PMC6251138 DOI: 10.1186/s13033-018-0251-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/19/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Schizophrenia is one of the leading public health issues in psychiatry and imposes a heavy financial burden on the healthcare systems. This study aims to report the direct medical costs and the associated factors for patients with schizophrenia in Guangzhou city, Southern China. METHODS This was a retrospective 4-year cohort study. Data were obtained from urban health insurance claims databases of Guangzhou city, which contains patients' sociodemographic characteristics, direct medical costs of inpatient and outpatient care. The study cohort (including all the reimbursement claims submitted for schizophrenia inpatient care during November 2010 and October 2014) was identified using the International Classification of Diseases Tenth version (F20). Their outpatient care information was merged from outpatient claims database. Descriptive analysis and the multivariate regression analysis based on Generalized Estimating Equations model were conducted. RESULTS A total of 2971 patients were identified in the baseline. The cohort had a mean age of 50.3 years old, 60.6% were male, and 67.0% received medical treatment in the tertiary hospitals. The average annual length of stay was 254.7 days. The average annual total direct medical costs per patient was 41,972.4 Chinese Yuan (CNY) ($6852.5). The inpatient costs remained as the key component of total medical costs. The Urban Employee Basic Medical Insurance enrollees with schizophrenia had higher average costs for hospitalization (CNY42,375.1) than the Urban Resident Basic Medical Insurance enrollees (CNY40,917.3), and had higher reimbursement rate (85.8% and 61.5%). The non-medication treatment costs accounted for the biggest proportion of inpatient costs for both schemes (55.8% and 64.7%). Regression analysis suggested that insurance type, age, hospital levels, and length of stay were significantly associated with inpatient costs of schizophrenia. CONCLUSIONS The direct annual medical costs of schizophrenia were high and varied by types of insurance in urban China. The findings of this study provide vital information to understand the burden of schizophrenia in China. Results of this study can help decision-makers assess the financial impact of schizophrenia.
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Affiliation(s)
- Hui Zhang
- School of Public Health, Sun Yat-sen University, No. 74, Zhongshan 2nd Road, Guangzhou, China
| | - Yuming Sun
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109 USA
| | - Donglan Zhang
- Department of Health Policy and Management, College of Public Health, University of Georgia, 100 Foster Road, Wright Hall 205D, Athens, GA 30602 USA
| | - Chao Zhang
- Business School, Sun Yat-sen University, No. 135, Xingang Xi Road, Guangzhou, China
| | - Gang Chen
- College of Medicine and Public Health, Flinders University, Adelaide, SA 5041 Australia
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Goring SM, Wilson JB, Risebrough NR, Gallagher J, Carroll S, Heap KJ, Obradovic M, Loebinger MR, Diel R. The cost of Mycobacterium avium complex lung disease in Canada, France, Germany, and the United Kingdom: a nationally representative observational study. BMC Health Serv Res 2018; 18:700. [PMID: 30200944 PMCID: PMC6131733 DOI: 10.1186/s12913-018-3489-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 08/22/2018] [Indexed: 12/02/2022] Open
Abstract
Background Management of nontuberculous mycobacterial lung disease (NTMLD) consists of a long-term multi-drug antibiotic regimen, yet many patients do not achieve culture conversion. We estimated the NTMLD-related direct medical costs in Canada, France, Germany, and the United Kingdom (UK) among refractory patients who were infected with Mycobacterium avium complex (MAC), without concomitant cystic fibrosis, tuberculosis, or HIV. Methods We conducted a retrospective observational physician survey of nationally representative samples. The survey captured anonymized information about patients’ treatment histories for NTMLD-related health care resource utilization over a 24-month period. We summarized NTMLD-related resource use and estimated the total economic burden, from each country’s health care payer perspective. Results In total, 59 physicians provided data on 157 patients. The average person time observed during the 24-month period was 1.7 years (SD: 0.4); 17% of patients died by the end of the study period. The major components of NTMLD-related direct medical costs among refractory patients were hospitalizations (varying from 29% of total annual costs in the UK to 69% in France), outpatient visits (8% in Canada to 51% in the UK), and outpatient testing such as post-diagnostic sputum testing, bronchial wash/lavage, spirometry, biopsies, imaging, and electrocardiograms (5% in France to 35% in Canada). In this patient cohort, the average direct medical costs per person-year, in local currencies, were approximately $16,200 (Canada), €11,600 (Germany), €17,900 (France) and £9,700 (UK). Conclusions Based on this study’s findings, we conclude that managing patients with refractory NTMLD caused by MAC is associated with a substantial economic burden. Electronic supplementary material The online version of this article (10.1186/s12913-018-3489-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | - J Gallagher
- Clarity Pharma Research LLC, Spartanburg, USA
| | - S Carroll
- Clarity Pharma Research LLC, Spartanburg, USA
| | - K J Heap
- Clarity Pharma Research LLC, Spartanburg, USA
| | | | - M R Loebinger
- Host Defence Unit, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK
| | - R Diel
- Institute for Epidemiology, University Medical Hospital Schleswig-Holstein (Member of the German Center for Lung Research [ARCN]), Kiel, Germany
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Li J, Liu Q, Chen Y, Gao S, Zhang J, Yang Y, Chen W. Treatment patterns, complications, and direct medical costs associated with ankylosing spondylitis in Chinese urban patients: a retrospective claims dataset analysis. J Med Econ 2017; 20:91-97. [PMID: 27552493 DOI: 10.1080/13696998.2016.1227829] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
AIM To describe treatment pattern, complications, and direct medical costs associated with ankylosing spondylitis (AS) in Chinese urban patients. METHODS The 2013 China Health Insurance Research Association (CHIRA) urban insurance claims database was used to identify patients with AS. The identified patients were stratified by AS treatments for the comparisons of well established AS-related complications and direct medical costs. Conventional regression analyses adjusted the collected patient baseline characteristics to confirm the impact of treatments on complications and direct medical costs. RESULTS Of the identified 1299 patients with AS, 18.0% received non-steroidal anti-inflammatory drugs (NSAID), 11.2% received immunosuppressant, 48.2% received NSAID plus immunosuppressant, 4.6% received biologic agents, and 17.9% received medications without indication for AS. Biologic group was associated with the lowest proportion of AS-related complications (8.3%) that was confirmed by multiple logistic regression analysis (odds ratio = 0.200, p = .017). The biologic group was also associated with highest direct medical costs (median: RMB = 14,539) that were confirmed by the multiple generalized linear model (coefficient = 1.644, p < .001). CONCLUSIONS Biologics were not commonly used for AS in Chinese patients likely due to their high cost. Future studies are needed to confirm the potential long-term clinical benefits associated biologic treatment for AS.
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Affiliation(s)
- Jinghu Li
- a China Health Insurance Research Association , Beijing , PR China
| | - Qingjing Liu
- b Beijing North Medical & Health Economics Research Center , Beijing , PR China
| | - Yi Chen
- c Normin Health Changsha Representative Office , Changsha , PR China
| | - Shuangqing Gao
- b Beijing North Medical & Health Economics Research Center , Beijing , PR China
| | - Jie Zhang
- a China Health Insurance Research Association , Beijing , PR China
| | | | - Wendong Chen
- c Normin Health Changsha Representative Office , Changsha , PR China
- e Normin Health , Toronto , Canada
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Abstract
AIMS To quantify the excess cost of diabetes in Norway in 2011. METHODS A national cross-sectional cost-of-illness analysis of direct and indirect diabetes-related healthcare costs, based on pseudonymised data from six public national registers, international studies, and clinical expertise. Direct medical costs are estimated from primary and secondary health care registers and the national prescription database. Indirect costs include social and productivity costs. RESULTS The total excess cost of diabetes in Norway in 2011 was €516 million. Direct costs amounted to €408 million and indirect costs amounted to €108 million. Scenario analysis proposes an upper boundary of total cost at €575 million, direct costs at €428 million and indirect costs at €161 million. Expenditure on blood glucose lowering agents was €71 million and expenditure on blood glucose monitoring strips was €55 million. Blood glucose lowering agents-, lipid lowering agents, and antihypertensives represented 28% of the direct costs. Loss of productivity (€0.9 million) scored highest among the indirect costs. CONCLUSIONS The cost implications of diabetes in Norway in 2011 were high and comparable to previous studies in Scandinavia. Prevention of complications contributed to a higher cost than treating diabetes-related complications. The more than five-fold higher expenditure in other countries might be due to differences in budget priorities, efficacy of healthcare, indirect healthcare cost applications, or research methodology.
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Affiliation(s)
- M Sørensen
- Dept. of Minority Health and Rehabilitation, Division of Primary Healthcare, Norwegian Directorate of Health, Oslo, Norway.
| | - F Arneberg
- Division of Financing and Health Economics, Norwegian Directorate of Health, Oslo, Norway
| | - T M Line
- Division of Financing and Health Economics, Norwegian Directorate of Health, Oslo, Norway
| | - T J Berg
- Dept. of Minority Health and Rehabilitation, Division of Primary Healthcare, Norwegian Directorate of Health, Oslo, Norway; Dept. of Endocrinology, Oslo University Hospital, Aker, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Norway
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Vouk K, Benter U, Amonkar MM, Marocco A, Stapelkamp C, Pfersch S, Benjamin L. Cost and economic burden of adverse events associated with metastatic melanoma treatments in five countries. J Med Econ 2016; 19:900-12. [PMID: 27123564 DOI: 10.1080/13696998.2016.1184155] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To estimate per-event cost and economic burden associated with managing the most common and/or severe metastatic melanoma (MM) treatment-related adverse events (AEs) in Australia, France, Germany, Italy, and the UK. METHODS AEs associated with chemotherapy (dacarbazine, paclitaxel, fotemustine), immunotherapy (ipilimumab), and targeted therapy (vemurafenib) were identified by literature review. Medical resource use data associated with managing AEs were collected through two blinded Delphi panel cycles in each of the five countries. Published costs were used to estimate per-event costs and combined with AEs incidence, treatment usage, and MM prevalence to estimate the economic burden for each country. RESULTS The costliest AEs were grade 3/4 events due to immunotherapy (Australia/France: colitis; UK: diarrhea) and chemotherapy (Germany/Italy: neutropenia/leukopenia). Treatment of AEs specific to chemotherapy (Australia/Germany/Italy/France: neutropenia/leukopenia) and targeted therapy (UK: squamous cell carcinoma) contributed heavily to country-specific economic burden. LIMITATIONS Economic burden was estimated assuming that each patient experienced an AE only once. In addition, the context of settings was heterogeneous and the number of Delphi panel experts was limited. CONCLUSIONS Management costs for MM treatment-associated AEs can be substantial. Results could be incorporated in economic models that support reimbursement dossiers. With the availability of newer treatments, establishment of a baseline measure of the economic burden of AEs will be crucial for assessing their impact on patients and regional healthcare systems.
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Affiliation(s)
| | | | | | | | | | - Sylvie Pfersch
- e Novartis Pharma S.A.S. , Rueil-Malmaison Cedex , France
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Huo X, Chen LL, Hong L, Xiang LH, Tang FY, Chen SH, Gao Q, Chen C, Dai QG, Sun CW, Xu K, Dai WJ, Qi X, Li CC, Yu HY, Zhou Y, Huang HD, Pan XY, Xu CS, Zhou MH, Bao CJ. Economic burden and its associated factors of hospitalized patients infected with A (H7N9) virus: a retrospective study in Eastern China, 2013-2014. Infect Dis Poverty 2016; 5:79. [PMID: 27580946 PMCID: PMC5007809 DOI: 10.1186/s40249-016-0170-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 07/11/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND H7N9 continues to cause human infections and remains a pandemic concern. Understanding the economic impacts of this novel disease is important for making decisions on health resource allocation, including infectious disease prevention and control investment. However, there are limited data on such impacts. METHODS Hospitalized laboratory-confirmed H7N9 patients or their families in Jiangsu Province of China were interviewed. Patients' direct medical costs of hospitalization were derived from their hospital bills. A generalized linear model was employed to estimate the mean direct medical costs of patients with different characteristics. RESULTS The mean direct cost of hospitalization for H7N9 was estimated to be ¥ 71 060 (95 % CI, 48 180-104 820), i.e., US$ 10 996 (95 % CI, 7 455-16 220), and was ¥12 060 (US$ 1 861), ¥136 120 (US$ 21 001) and ¥218 610 (US$ 33 728) for those who had mild or severe symptoms or who died, respectively. The principal components of the total fees differed among patients with different disease severity, although medication fees were always the largest contributors. Disease severity, proportion of reimbursement and family member monthly average income were identified as the key factors that contributed to a patient's direct medical cost of hospitalization. CONCLUSIONS The direct medical costs of hospitalized patients with H7N9 are significant, and far surpass the annual per capita income of Jiangsu Province, China. The influencing factors identified should be taken into account when developing related health insurance policies and making health resource allocation. TRIAL REGISTRATION Not applicable. This is a survey study with no health care intervention implemented on human participants.
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Affiliation(s)
- Xiang Huo
- Department of Acute Infectious Disease, Jiangsu Provincial Center for Disease Control and Prevention, 172 Jiang-su Rd, Nanjing, 210009, China
| | - Li-Ling Chen
- Suzhou Center for Disease Prevention and Control, Suzhou, China
| | - Lei Hong
- Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
| | - Lun-Hui Xiang
- Baoshan District Center for Disease Control and Prevention, Shanghai, China
| | - Fen-Yang Tang
- Department of Acute Infectious Disease, Jiangsu Provincial Center for Disease Control and Prevention, 172 Jiang-su Rd, Nanjing, 210009, China
| | - Shan-Hui Chen
- Wuxi Center for Disease Control and Prevention, Wuxi, China
| | - Qiang Gao
- Huaian Center for Disease Control and Prevention, Huaian, China
| | - Cong Chen
- Changzhou Center for Disease Control and Prevention, Changzhou, China
| | - Qi-Gang Dai
- Department of Acute Infectious Disease, Jiangsu Provincial Center for Disease Control and Prevention, 172 Jiang-su Rd, Nanjing, 210009, China
| | - Chuan-Wu Sun
- Xuzhou Center for Disease Control and Prevention, Xuzhou, China
| | - Ke Xu
- Department of Acute Infectious Disease, Jiangsu Provincial Center for Disease Control and Prevention, 172 Jiang-su Rd, Nanjing, 210009, China
| | - Wen-Jun Dai
- Taizhou Center for Disease Control and Prevention, Taizhou, China
| | - Xian Qi
- Department of Acute Infectious Disease, Jiangsu Provincial Center for Disease Control and Prevention, 172 Jiang-su Rd, Nanjing, 210009, China
| | - Chang-Cheng Li
- Yancheng Center for Disease Control and Prevention, Yancheng, China
| | - Hui-Yan Yu
- Department of Acute Infectious Disease, Jiangsu Provincial Center for Disease Control and Prevention, 172 Jiang-su Rd, Nanjing, 210009, China
| | - Yin Zhou
- Zhenjiang Center for Disease Prevention and Control, Zhenjiang, China
| | - Hao-Di Huang
- Department of Acute Infectious Disease, Jiangsu Provincial Center for Disease Control and Prevention, 172 Jiang-su Rd, Nanjing, 210009, China
| | - Xing-Yang Pan
- Yangzhou Center for Disease Control and Prevention, Yangzhou, China
| | - Chang-Sha Xu
- Suqian Municipal Center for Disease Control and Prevention, Suqian, China
| | - Ming-Hao Zhou
- Department of Acute Infectious Disease, Jiangsu Provincial Center for Disease Control and Prevention, 172 Jiang-su Rd, Nanjing, 210009, China
| | - Chang-Jun Bao
- Department of Acute Infectious Disease, Jiangsu Provincial Center for Disease Control and Prevention, 172 Jiang-su Rd, Nanjing, 210009, China.
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Wagner RG, Bertram MY, Gómez-Olivé FX, Tollman SM, Lindholm L, Newton CR, Hofman KJ. Health care utilization and outpatient, out-of-pocket costs for active convulsive epilepsy in rural northeastern South Africa: a cross-sectional Survey. BMC Health Serv Res 2016; 16:208. [PMID: 27353295 DOI: 10.1186/s12913-016-1460-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 06/13/2016] [Indexed: 11/21/2022] Open
Abstract
Background Epilepsy is a common neurological disorder, with over 80 % of cases found in low- and middle-income countries (LMICs). Studies from high-income countries find a significant economic burden associated with epilepsy, yet few studies from LMICs, where out-of-pocket costs for general healthcare can be substantial, have assessed out-of-pocket costs and health care utilization for outpatient epilepsy care. Methods Within an established health and socio-demographic surveillance system in rural South Africa, a questionnaire to assess self-reported health care utilization and time spent traveling to and waiting to be seen at health facilities was administered to 250 individuals, previously diagnosed with active convulsive epilepsy. Epilepsy patients’ out-of-pocket, medical and non-medical costs and frequency of outpatient care visits during the previous 12-months were determined. Results Within the last year, 132 (53 %) individuals reported consulting at a clinic, 162 (65 %) at a hospital and 34 (14 %) with traditional healers for epilepsy care. Sixty-seven percent of individuals reported previously consulting with both biomedical caregivers and traditional healers. Direct outpatient, median costs per visit varied significantly (p < 0.001) between hospital (2010 International dollar ($) 9.08; IQR: $6.41-$12.83) and clinic consultations ($1.74; IQR: $0-$5.58). Traditional healer fees per visit were found to cost $52.36 (IQR: $34.90-$87.26) per visit. Average annual outpatient, clinic and hospital out-of-pocket costs totaled $58.41. Traveling to and from and waiting to be seen by the caregiver at the hospital took significantly longer than at the clinic. Conclusions Rural South Africans with epilepsy consult with both biomedical caregivers and traditional healers for both epilepsy and non-epilepsy care. Traditional healers were the most expensive mode of care, though utilized less often. While higher out-of-pocket costs were incurred at hospital visits, more people with ACE visited hospitals than clinics for epilepsy care. Promoting increased use and effective care at clinics and reducing travel and waiting times could substantially reduce the out-of-pocket costs of outpatient epilepsy care. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1460-0) contains supplementary material, which is available to authorized users.
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Chang CY, Tang CH, Chen KC, Huang KC, Huang KC. The mortality and direct medical costs of osteoporotic fractures among postmenopausal women in Taiwan. Osteoporos Int 2016; 27:665-76. [PMID: 26243356 DOI: 10.1007/s00198-015-3238-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 07/06/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED This study estimated the fracture-related mortality and direct medical costs among postmenopausal women in Taiwan by fracture types and age groups by utilizing a nationwide population-based database. Results demonstrated that hip fractures constituted the most severe and expensive complication of osteoporosis across fracture sites. INTRODUCTION The aims of the study were to evaluate the risk of death and direct medical costs associated with osteoporotic fractures by fracture types and age groups among postmenopausal women in Taiwan. METHODS This nationwide, population-based study was based on data from the National Health Insurance Research Database in Taiwan. Female patients aged 50 years and older in the fracture case cohort were matched in 1:1 ratio with randomly selected subjects in the reference control cohort by age, income-related insurance amount, urbanization level, and the Charlson comorbidity index. There were two main outcome measures of the study: age-differentiated mortality and direct medical costs in the first and subsequent years after osteoporotic fracture events among postmenopausal women. The bootstrap method by resampling with replacement was conducted to generate descriptive statistics of mortality and direct medical costs of the case and control cohorts. Student's t tests were then performed to compare mortality and costs between the two cohorts. RESULTS A total of 155,466 postmenopausal women in the database met the inclusion criteria for the fracture case cohort, including 22,791 hip fractures, 72,292 vertebral fractures, 15,621 upper end humerus (closed) fractures, 36,774 wrist fractures, and 7,988 multiple fractures. Analytical results demonstrated that patients experiencing osteoporotic fractures were at considerable excess risk of death and incurred substantially higher treatment costs, notably for hip fractures. Furthermore, results also revealed that the risk of mortality increased with advancing age across the spectrum of fracture sites. CONCLUSIONS The present study confirmed an excess mortality and higher direct medical costs associated with osteoporotic fractures. Moreover, hip fractures constituted the most severe and expensive complication of osteoporosis among fracture types.
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Affiliation(s)
- C-Y Chang
- Division of Orthopedic Surgery, Hsinchu Cathay General Hospital, Hsinchu, Taiwan
| | - C-H Tang
- School of Health Care Administration, Taipei Medical University, No. 250, Wu-Hsing Street, Taipei, Taiwan
| | - K-C Chen
- School of Health Care Administration, Taipei Medical University, No. 250, Wu-Hsing Street, Taipei, Taiwan
| | - K-C Huang
- School of Health Care Administration, Taipei Medical University, No. 250, Wu-Hsing Street, Taipei, Taiwan
| | - K-C Huang
- School of Health Care Administration, Taipei Medical University, No. 250, Wu-Hsing Street, Taipei, Taiwan.
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Darbà J, Kaskens L, Lacey L. Relationship between global severity of patients with Alzheimer's disease and costs of care in Spain; results from the co-dependence study in Spain. Eur J Health Econ 2015; 16:895-905. [PMID: 25348897 DOI: 10.1007/s10198-014-0642-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 10/10/2014] [Indexed: 05/18/2023]
Abstract
OBJECTIVE The objectives of this analysis were to examine how patients' global severity with Alzheimer's disease (AD) relates to costs of care and explore the incremental effects of global severity measured by the clinical dementia rating (CDR) scale on these costs for patients in Spain. METHODS The Codep-EA study is an 18-multicenter, cross-sectional, observational study among patients (343) with AD according to the CDR score and their caregivers in Spain. The data obtained included (in addition to clinical measures) also socio-demographic data concerning the patient and its caregiver. Cost analyses were based on resource use for medical care, social care, caregiver productivity losses, and informal caregiver time reported in the resource utilization in dementia (RUD). Lite instrument and a complementary questionnaire. Multivariate regression analysis was used to model the effects of global severity and other socio-demographic and clinical variables on cost of care. RESULTS The mean (standard deviation) costs per patient over 6 months for direct medical, social care, indirect and informal care costs, were estimated at €1,028.1 (1,655.0), €843.8 (2,684.8), €464.2 (1,639.0) and €33,232.2 (30,898.9), respectively. Dementia severity, as having a CDR score 0.5, 2, or 3 with CDR score 1 being the reference group were all independently and significantly associated with informal care costs. Whereas having a CDR score of 2 was also significantly related with social care costs, a CDR score of 3 was associated with most cost components including direct medical, social care, and total costs, all compared to the reference group. CONCLUSIONS The costs of care for patients with AD in Spain are substantial, with informal care accounting for the greatest part. Dementia severity, measured by CDR score, showed that with increasing severity of the disease, direct medical, social care, informal care and total costs augmented.
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Affiliation(s)
- J Darbà
- Department of Economics, Universitat de Barcelona, Diagonal 690, 08034, Barcelona, Spain.
| | - L Kaskens
- BCN Health Economics & Outcomes Research SL, Barcelona, Spain
| | - L Lacey
- Janssen Alzheimer Immunotherapy Research and Development, LLC and Pfizer Inc, Dublin, Ireland
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Sun P, Liu Z, Krueger D, Kohrman M. Direct medical costs for patients with tuberous sclerosis complex and surgical resection of subependymal giant cell astrocytoma: a US national cohort study. J Med Econ 2015; 18:349-56. [PMID: 25525770 DOI: 10.3111/13696998.2014.1001513] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To estimate direct medical costs for patients with tuberous sclerosis complex (TSC) and surgical resection of subependymal giant-cell astrocytoma (SEGA). METHODS This retrospective cohort study selected patients who had SEGA surgery and TSC claims between 2000-2011 from three large US nationwide claims databases. Selected patients were age 35 or less and had continuous health insurance in the year before and the year after their first SEGA surgery claim. The study examined the patients' demographic and clinical characteristics and estimated inpatient, outpatient, medication, and total medical costs paid by insurance companies for the pre-surgery year, post-surgery year, and other study periods, respectively. Repeated measures analysis and bootstrapping technique were used to assess the impact of the surgery on the direct medical costs. RESULTS Select patients (n = 47) had a mean baseline age of 11.6 years and 66% were male. Many had seizures (91.0%), hydrocephalus (59.6%), vision disorders (38.3%), stroke and hemiparesis (36.2%), and shunt (34.0%) in the pre-surgery year. The mean direct medical costs were $8543 (inpatient: $3770; outpatient: $3473; medication: $1300) for the pre-surgery year, and $85,397 (inpatient: $71,562; outpatient: $11,497; medication: $2338) for the post-surgery year. With the exclusion of the costs during the surgery month, the inpatient, outpatient, medication, and total costs in the post-surgery year were 1.6-4.3 times as much as the costs in the pre-surgery year (inpatient: 4.3:1; outpatient: 2.5:1; medication: 1.6:1; total: 3.1:1, p < 0.05). Repeated measures analysis with bootstrapping confirmed a link between the surgery and increases in direct medical costs (p < 0.05). CONCLUSIONS SEGA surgery had a substantial impact on direct medical costs. TSC patients with the surgery experienced significant post-surgery increases in their inpatient, outpatient, and medication costs. Additional research should be conducted to examine the surgery's cost-impact in a longer duration, or to compare the cost-effectiveness of the surgery vs other treatments.
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Affiliation(s)
- Peter Sun
- Kailo Research Group , Indianapolis, IN , USA
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Wong C, Luk IW, Ip M, You JH. Prevention of gram-positive infections in peritoneal dialysis patients in Hong Kong: a cost-effectiveness analysis. Am J Infect Control 2014; 42:412-6. [PMID: 24679568 DOI: 10.1016/j.ajic.2013.12.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 12/09/2013] [Accepted: 12/09/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Gram-positive bacteria are the major causative pathogens of peritonitis and exit site infection in patients undergoing peritoneal dialysis (PD). We investigated the cost-effectiveness of regular application of mupirocin at the exit site in PD recipients from the perspective of health care providers in Hong Kong. METHODS A decision tree was designed to simulate outcomes of incident PD patients with and without regular application of mupirocin over a 1-year period. Outcome measures included total direct medical costs, quality-adjusted life-years (QALYs) gained, and gram-positive infection-related mortality rate. Model inputs were derived from the literature. Sensitivity analyses evaluated the impact of uncertainty in all model variables. RESULTS In a base case analysis, the mupirocin group had a higher expected QALY value (0.6496 vs 0.6456), a lower infection-related mortality rate (0.18% vs 1.64%), and a lower total cost per patient (US $258 vs $1661) compared with the control group. The rate of gram-positive peritonitis without mupirocin and the risk of gram-positive peritonitis with mupirocin were influential factors. In 10,000 Monte Carlo simulations, the mupirocin group had significantly lower associated costs, higher QALYs, and a lower mortality rate 99.9% of the time. CONCLUSIONS Topical mupirocin appears to be a cost-effective preventive measure against gram-positive infection in incident patients undergoing PD. The cost-effectiveness of mupirocin is affected by the level of infection risk reduction and subject to resistance against mupirocin.
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Cortés-Sanabria L, Paredes-Ceseña CA, Herrera-Llamas RM, Cruz-Bueno Y, Soto-Molina H, Pazarín L, Cortés M, Martínez-Ramírez HR. Comparison of cost-utility between automated peritoneal dialysis and continuous ambulatory peritoneal dialysis. Arch Med Res 2013; 44:655-61. [PMID: 24211750 DOI: 10.1016/j.arcmed.2013.10.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 10/22/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS The use of automated peritoneal dialysis (APD) is increasing compared to continuous ambulatory peritoneal dialysis (CAPD). Surprisingly, little data about health benefits and cost of APD exist, and virtually no information comparing the cost-utility between CAPD and APD is available. We undertook this study to evaluate and compare the health-related quality of life (HRQOL) and cost-utility indexes in patients on CAPD vs. APD METHODS This was a prospective cohort of patients initiating dialysis (2008-2009). Two questionnaires were self-administered: European Research Questionnaire Quality of Life (EQ-5D) and Kidney Disease Quality of Life (short form, KDQOL-SF, Rand, Santa Monica, CA). Direct medical costs (DMC) were determined from the health provider perspective including the following medical resource utilization: outpatient clinic/emergency care, dialysis procedures, medications, laboratory tests, hospitalization, and surgery. Cost-utility indexes were calculated dividing total mean cost by indicators of the HRQOL. RESULTS One hundred twenty-three patients were evaluated: 77 on CAPD and 46 on APD. Results of the EQ-5D and KDQOL-SF questionnaires were significantly better in APD compared to the CAPD group. Main costs in both APD and CAPD were attributed to hospitalization and dialysis procedures followed by medication and surgery. Outpatient clinic visits and laboratory tests were significantly more costly in CAPD than in APD, whereas dialysis procedures were more expensive in the latter. Cost-utility indexes were significantly better in APD compared to CAPD. CONCLUSIONS A significant cost-utility advantage of APD vs. CAPD was observed. The annual DMC per-patient were not different between groups but the HRQOL was better in the APD compared to the CAPD group.
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Affiliation(s)
- Laura Cortés-Sanabria
- Medical Research Unit in Kidney Diseases, Specialties Hospital, CMNO, Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Mexico.
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Osiri M, Sattayasomboon Y. Prevalence and out-patient medical costs of comorbid conditions in patients with rheumatoid arthritis. Joint Bone Spine 2013; 80:608-12. [PMID: 23827409 DOI: 10.1016/j.jbspin.2013.01.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 01/24/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the prevalence, types, and out-patient direct medical costs of comorbid conditions in patients with RA in Thailand. METHODS Information of the patients with RA treated by rheumatologists with at least one disease modifying antirheumatic drugs (DMARDs), including demographic data, RA-related medication types and treatment costs, comorbidity-related medication types and treatment costs, and total direct medical costs, was captured from King Chulalongkorn Memorial Hospital databases. RESULTS The data from 684 patients with RA were included for analysis. The majority of the patients were prescribed combined DMARDs, while only 2.5% received biologics. Comorbid conditions were reported in 434 patients (63.5%). The most common comorbid condition was hypertension (51.2%). Advanced age and presence of healthcare coverage was associated with comorbid conditions. The average annual cost of non-RA-related treatments in patients with comorbid diseases was 15 times the cost in those without comorbidities (1546 vs. 104 USD; P < 0.001) while the total direct medical cost in patients with comorbid conditions was twice that in patients without comorbid diseases (4118 vs. 2045 USD; P < 0.001). Parameters that influenced total direct medical costs were RA medications costs, comorbidity, healthcare coverage, patient's age, and types of DMARDs. CONCLUSIONS Comorbid conditions were common in this study. However, the major cost component incurred in RA patients was the costs of RA medications and services, while the out-patient costs of comorbid conditions accounted for approximately 38% of the total costs.
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Affiliation(s)
- Manathip Osiri
- Division of Rheumatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, 1873, Rama IV Road, Pathumwan, 10330 Bangkok, Thailand.
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Kalantari H, Davari M, Akbari M, Hejazi SM, Kalantari M, Zakerin S, Shahshahan Z. The estimation of direct medical costs of treating patients with chronic hepatitis B and C in iran. Int J Prev Med 2012; 3:191-6. [PMID: 22448312 PMCID: PMC3309633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 12/21/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The objective of this study is to estimate the average diagnosis and treatment costs of chronic hepatitis B and C, with respect to different therapeutic strategies in Iran. METHODS This is a descriptive, analytical, and cross-sectional study carried out on patients with hepatitis B and C, who were referred to the Liver Disease Research Center for Prevention and Treatment of Hepatitis, Isfahan University of Medical Sciences, in 2011. We have estimated the direct medical costs including doctors' fees, cost of para-clinical tests, medical treatments, and liver biopsy, in different treatment strategies. FINDINGS The results of this study showed that the total cost of diagnostic services for hepatitis B virus (HBV) and hepatitis C virus (HCV) patients, with state medical tariffs, was US$ 1499.07 and US$ 2084.89, respectively. The patients' profiles showed that there were currently seven therapeutic strategies available to treat HBV patients. The total cost of treatment strategies varied significantly from US$ 73 to US$ 8256. There were also four main strategies for HCV patients, each of these could be applied in two periods of time. The total cost of these treatment strategies showed a high discrepancy from US$ 242 to US$ 8256. CONCLUSION The results confirmed that the total direct medical cost for an HBV patient in Iran exceeded US$ 5.5 Milliard in 2011. The results implied that the market price of direct medical cost of HBV and HCV patients in Iran is much higher than the estimated state costs. These costs would likely be saved or reduced by effective disease management and early prevention.
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Affiliation(s)
- Hamid Kalantari
- Department of Gastroenterology, Isfahan Liver Disease Research Center, Isfahan, Iran
| | - Majid Davari
- Health Management and Economics Research Center, Isfahan, Iran
| | - Mojtaba Akbari
- Department of Epidemiologist, School of Medicine, Isfahan, Iran
| | - Seyed Mehdi Hejazi
- Department of Academic Member of Medical Informatics, School of Health Management and Information Sciences, Isfahan, Iran
| | - Maryam Kalantari
- Architect, Young Researchers Club, Khorasgan Branch, Islamic Azad University, Isfahan, Iran
| | - Shahram Zakerin
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Shahshahan
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran,Correspondence to: Asso. Prof. Zahra Shahshahan, Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
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