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Nakhaee M, Khandehroo M, Esmaeili R. Cost of illness studies in COVID-19: a scoping review. Cost Eff Resour Alloc 2024; 22:3. [PMID: 38238797 PMCID: PMC10797972 DOI: 10.1186/s12962-024-00514-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 01/10/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Human communities suffered a vast socioeconomic burden in dealing with the pandemic of coronavirus disease 2019 (COVID-19) globally. Real-word data about these burdens can inform governments about evidence-based resource allocation and prioritization. The aim of this scoping review was to map the cost-of-illness (CoI) studies associated with COVID-19. METHODS This scoping review was conducted from January 2019 to December 2021. We searched cost-of-illness papers published in English within Web of Sciences, PubMed, Google Scholar, Scopus, Science Direct and ProQuest. For each eligible study, extracted data included country, publication year, study period, study design, epidemiological approach, costing method, cost type, cost identification, sensitivity analysis, estimated unit cost and national burden. All of the analyses were applied in Excel software. RESULTS 2352 records were found after the search strategy application, finally 28 articles met the inclusion criteria and were included in the review. Most of the studies were done in the United States, Turkey, and China. The prevalence-based approach was the most common in the studies, and most of studies also used Hospital Information System data (HIS). There were noticeable differences in the costing methods and the cost identification. The average cost of hospitalization per patient per day ranged from 101$ in Turkey to 2,364$ in the United States. Among the studies, 82.1% estimated particularly direct medical costs, 3.6% only indirect costs, and 14.3% both direct and indirect costs. CONCLUSION The economic burden of COVID-19 varies from country to country. The majority of CoI studies estimated direct medical costs associated with COVID-19 and there is a paucity of evidence for direct non-medical, indirect, and intangible costs, which we recommend for future studies. To create homogeneity in CoI studies, we suggest researchers follow a conceptual framework and critical appraisal checklist of cost-of-illness (CoI) studies.
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Affiliation(s)
- Majid Nakhaee
- Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Masoud Khandehroo
- Department of Community Medicine, School of Medicine, Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Reza Esmaeili
- Department of Public Health, School of Health, Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Imam Khomeini Avenue, Gonabad, Khorasan, 9691793718, Iran.
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陈 楚, 陈 婷, 潘 杰. [Effect of Health Poverty Alleviation Project on the Economic Burden of Disease Among Poor Households: Empirical Evidence from Sichuan Province]. Sichuan Da Xue Xue Bao Yi Xue Ban 2023; 54:393-399. [PMID: 36949704 PMCID: PMC10409157 DOI: 10.12182/20230360105] [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] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Indexed: 03/24/2023]
Abstract
Objective To evaluate the effect of Health Poverty Alleviation Project on the economic burden of disease among poor families and to provide references for further improvement of the Health Poverty Alleviation Project. Methods The difference-in-differences with propensity score matching method was used to analyze 48 counties in Sichuan Province. Propensity score matching was first carried out with data from the Sichuan Provincial Information System for Medical Care for Low-Income Population and the New Rural Cooperative Medical Insurance data to identify the non-poor population closest to the poor population. Then, difference-in-difference method was used to determine the effect of the Health Poverty Alleviation Project. Results Health Poverty Alleviation Project reduced the total annual out-of-pocket (OOP) payments by 13.1% on average, the outpatient OOP payments by an average 2.4%, inpatient OOP payments by an average 19.5%, and the probability of incurring catastrophic health care expenditures by an average of 3.9% for low-income households. In addition, the program had a more significant effect in poverty-stricken counties than it did in non-poverty-stricken counties. Despite the significant effectiveness of the project, 12.1% of the low-income families still incurred catastrophic health expenditures after the program was implemented. Conclusion Health Poverty Alleviation Project reduces the economic burden of disease for poor households, and it has a better effect on reducing the economic burden of poor households in poverty-stricken counties. However, a certain number of households still incurred catastrophic health expenditures. When consolidating and expanding the effects of Health Poverty Alleviation Project and monitoring medical expenses for poverty prevention, policymakers should focus on the households with catastrophic medical expenditures to prevent them from sinking back into poverty.
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Affiliation(s)
- 楚 陈
- 福建医科大学卫生管理学院 (福州 350000)School of Health Management, Fujian Medical University, Fuzhou 350000, China
- 四川大学华西公共卫生学院/四川大学华西第四医院 HEOA研究团队 (成都 610041)Healthcare Evaluation and Organizational Analysis Group, West China School of Public Health and West China Fourth Hospital, Chengdu 610041, China
| | - 婷 陈
- 福建医科大学卫生管理学院 (福州 350000)School of Health Management, Fujian Medical University, Fuzhou 350000, China
- 四川大学华西公共卫生学院/四川大学华西第四医院 HEOA研究团队 (成都 610041)Healthcare Evaluation and Organizational Analysis Group, West China School of Public Health and West China Fourth Hospital, Chengdu 610041, China
| | - 杰 潘
- 福建医科大学卫生管理学院 (福州 350000)School of Health Management, Fujian Medical University, Fuzhou 350000, China
- 四川大学华西公共卫生学院/四川大学华西第四医院 HEOA研究团队 (成都 610041)Healthcare Evaluation and Organizational Analysis Group, West China School of Public Health and West China Fourth Hospital, Chengdu 610041, China
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de Soarez PC, Martins Rozman L, Siraisi Fonseca T, Rodrigo Borsari P, Percio J, Guzmán Barrera LS, Christovam Sartori AM. The methodological quality of economic evaluations of measles outbreaks: A systematic review of cost-of-illness studies. Vaccine 2023; 41:1319-1332. [PMID: 36707337 DOI: 10.1016/j.vaccine.2023.01.015] [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: 07/25/2022] [Revised: 12/29/2022] [Accepted: 01/02/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To identify the main cost components included in the economic evaluations of measles outbreaks, their items and cost drivers, and evaluate the quality of costing methodology, analyzing the key features that may affect the validity of these studies in countries with different income levels. METHODS We systematically searched multiple databases EMBASE, MEDLINE (via PubMed), Biblioteca Virtual em Saúde do Ministério da Saúde (BVS MS), NHS Economic Evaluation Database (NHS EED) and NHS Health Technology Assessment (NHS HTA) (via The Centre for Reviews and Dissemination Library - CRD), and EconLit, SCOPUS, and Web of Science, selecting cost analysis and cost of illness studies (COI) of measles outbreaks. Two independent reviewers screened articles for relevance and extracted the data. The quality of costing methods was assessed using a guide to critical evaluation of COI studies. We performed a qualitative narrative synthesis. RESULTS Twenty-two studies were reviewed. Most studies evaluated outbreaks that occurred from 2011 to 2013 and 2017 to 2019. Total costs varied from $40,147 to $39.3 million. Per case cost varied from $168 to $49,439. The main drivers of measles outbreak costs were outbreak response, personnel, and productivity losses. Most studies (20/22) did not report the costing methodology adopted, the degree of disaggregation used in the identification and measurement of resource and costs components and the method for the valuation of resource and cost components. CONCLUSIONS The quality of the costing methodology, its transparency and accuracy are essential to the validity of these studies results and their potential use to allocate public health resources in the most efficient manner and to inform measles outbreak control strategies, with rapid and effective response.
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Affiliation(s)
- Patricia Coelho de Soarez
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | - Luciana Martins Rozman
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Taiane Siraisi Fonseca
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | - Pietro Rodrigo Borsari
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | | | - Lely Stella Guzmán Barrera
- Initiative of Immunization - Panamerican Health Organization/World Health Organization (PAHO/WHO), Brasilia, DF, Brazil.
| | - Ana Marli Christovam Sartori
- Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
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Safari Z, Fouladi-Fard R, Vahedian M, Mahmoudian MH, Rahbar A, Fiore M. Health impact assessment and evaluation of economic costs attributed to PM 2.5 air pollution using BenMAP-CE. Int J Biometeorol 2022; 66:1891-1902. [PMID: 35852660 PMCID: PMC9295116 DOI: 10.1007/s00484-022-02330-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 07/02/2022] [Accepted: 07/06/2022] [Indexed: 06/01/2023]
Abstract
Air pollution is considered the most prominent public health. Economically, air pollution imposes additional costs on governments. This study aimed to quantify health effects and associated economic values of reducing PM2.5 air pollution using BenMAP-CE in Qom in 2019. The air quality data were acquired from Qom Province Environmental Protection Agency, and the population data were collected from Qom Province Management and Planning Organization website. The number of deaths due to Stroke, Chronic Obstructive Pulmonary Disease, Lung Cancer, and Ischemic Heart Disease attributable to PM2.5 were estimated using BenMAP-CE based on two control scenarios, 2.4 and 10 μg/m3, known as scenarios I and II, respectively. The associated economic effect of premature deaths was assessed by value of a statistical life (VSL) approach. The annual average of PM2.5 concentration was found to be 16.32 μg/m3 (SD: 9.93). A total of 4694.5 and 2475.94 premature deaths in scenarios I and II were found to be attributable to PM2.5 in overall, respectively. The total associated cost was calculated to be 855.91 and 451.40 million USD in scenarios I and II, respectively. The total years of life lost due to PM2.5 exposure in 2019 was 158,657.06 and 78,351.51 in scenarios I and II, respectively. The results of both health and economic assessment indicate the importance of solving the air pollution problem in Qom, as well as other big cities in Iran. The elimination of limitations, such as insufficient local data, should be regarded in future studies.
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Affiliation(s)
- Zahra Safari
- Research Center for Environmental Pollutants, Department of Environmental Health Engineering, Faculty of Health, Qom University of Medical Sciences, Qom, 3715614566 Iran
- Student Research Committee, Qom University of Medical Sciences, Qom, 3715614566 Iran
| | - Reza Fouladi-Fard
- Research Center for Environmental Pollutants, Department of Environmental Health Engineering, Faculty of Health, Qom University of Medical Sciences, Qom, 3715614566 Iran
| | - Mostafa Vahedian
- Research Center for Environmental Pollutants, Department of Environmental Health Engineering, Faculty of Health, Qom University of Medical Sciences, Qom, 3715614566 Iran
| | - Mohammad Hassan Mahmoudian
- Research Center for Environmental Pollutants, Department of Environmental Health Engineering, Faculty of Health, Qom University of Medical Sciences, Qom, 3715614566 Iran
| | - Ahmad Rahbar
- Department of Public Health, School of Health, Qom University of Medical Sciences, Qom, 3715614566 Iran
| | - Maria Fiore
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 87-95123 Catania, Italy
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Tissot M, Valnet-Rabier MB, Stalder T, Limat S, Davani S, Nerich V. Epidemiology and economic burden of "serious" adverse drug reactions: Real-world evidence research based on pharmacovigilance data. Therapie 2022; 77:291-300. [PMID: 35012757 DOI: 10.1016/j.therap.2021.12.007] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/21/2021] [Accepted: 12/10/2021] [Indexed: 12/23/2022]
Abstract
AIM OF THE STUDY Serious adverse drug reactions account for 3.6% of French hospital admissions. Of these, 48.5% are, at least potentially, preventable. The first aim of post-marketing pharmacovigilance is to detect adverse drug reactions as a safety signal to improve patients' safety. Thus, this study describes the epidemiology of "serious" adverse drug reactions reported between 2015 and 2018 to a regional pharmacovigilance centre and assesses their economic burden. METHODS All "serious" adverse drug reactions reported to a regional pharmacovigilance centre during the four-year study period were collected and cost associated. Only congenital anomalies related to "serious" adverse drug reactions were excluded. RESULTS All 2585 "serious" adverse drug reactions reported are related to 1242 "serious" individual case safety reports. Among 58.1% of them, patients required hospital admission or a visit to the emergency room with a median cost estimated to €3725 per "serious" individual case safety report. The most "serious" adverse drug reactions reported involved gastrointestinal disorders. Fifteen percent of the imputed drugs had a narrow therapeutic index and the most frequently drug was fluindione. Finally, high relationships with an economic burden were observed for ages over or equal to 65, and imputed drugs from "Blood and Blood-Forming Organs" and "Anti-infectives for systemic use" therapeutic groups. CONCLUSION This study provides news data on epidemiology and cost of "serious" adverse drug reactions completing the existing literature. On a regional scale, pharmacovigilance real world data could be interesting for pharmacist clinicians in common practice to improve the good use of drugs.
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Affiliation(s)
- Marion Tissot
- Department of Pharmacy, University Hospital of Besançon, 25030 Besançon, France
| | | | - Thomas Stalder
- Department of Pharmacy, University Hospital of Besançon, 25030 Besançon, France
| | - Samuel Limat
- Department of Pharmacy, University Hospital of Besançon, 25030 Besançon, France; Inserm, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, 25000 Besançon, France
| | - Siamak Davani
- Pharmacology and Toxicology Laboratory, University Hospital of Besançon, 25030 Besançon, France
| | - Virginie Nerich
- Department of Pharmacy, University Hospital of Besançon, 25030 Besançon, France; Inserm, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, 25000 Besançon, France.
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Schnitzler L, Jackson LJ, Paulus ATG, Roberts TE, Evers SMAA. Intersectoral costs of sexually transmitted infections (STIs) and HIV: a systematic review of cost-of-illness (COI) studies. BMC Health Serv Res 2021; 21:1179. [PMID: 34715866 PMCID: PMC8555721 DOI: 10.1186/s12913-021-07147-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 10/08/2021] [Indexed: 11/26/2022] Open
Abstract
Background Sexually transmitted infections (STIs) and HIV can generate costs both within and outside the health sector (i.e. intersectoral costs). This systematic review aims (i) to explore the intersectoral costs associated with STIs and HIV considered in cost-of-illness (COI) studies, (ii) to categorise and analyse these costs according to cost sectors, and (iii) to illustrate the impact of intersectoral costs on the total cost burden. Methods Medline (PubMed), EMBASE (Ovid), Web of Science, CINAHL, PsycINFO, EconLit and NHS EED were searched between 2009 and 2019. Key search terms included terms for cost-of-illness, cost analysis and all terms for STIs including specific infections. Studies were included that assessed intersectoral costs. A standardised data extraction form was adopted. A cost component table was established based on pre-defined sector-specific classification schemes. Cost results for intersectoral costs were recorded. The quality of studies was assessed using a modified version of the CHEC-list. Results 75 COI studies were considered for title/abstract screening. Only six studies were available in full-text and eligible for data extraction and narrative synthesis. Intersectoral costs were captured in the following sectors: Patient & family, Informal care and Productivity (Paid Labour). Patient & family costs were addressed in four studies, including patient out-of-pocket payments/co-payments and travel costs. Informal care costs including unpaid (home) care support by family/friends and other caregiver costs were considered in three studies. All six studies estimated productivity costs for paid labour including costs in terms of absenteeism, disability, cease-to-work, presenteeism and premature death. Intersectoral costs largely contributed to the total economic cost burden of STIs and HIV. The quality assessment revealed methodological differences. Conclusions It is evident that intersectoral costs associated with STIs and HIV are substantial. If relevant intersectoral costs are not included in cost analyses the total cost burden of STIs and HIV to society is severely underestimated. Therefore, intersectoral costs need to be addressed in order to ensure the total economic burden of STIs and HIV on society is assessed, and communicated to policy/decision-makers. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07147-z.
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Affiliation(s)
- Lena Schnitzler
- Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. .,Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands.
| | - Louise J Jackson
- Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Aggie T G Paulus
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands.,School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - Tracy E Roberts
- Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Silvia M A A Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands.,Trimbos Institute, Centre for Economic Evaluations, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
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Khadka A, Verguet S. The economic value of changing mortality risk in low- and middle-income countries: a systematic breakdown by cause of death. BMC Med 2021; 19:156. [PMID: 34266420 PMCID: PMC8282406 DOI: 10.1186/s12916-021-02029-x] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 06/09/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND We develop a framework for quantifying monetary values associated with changes in disease-specific mortality risk in low- and middle-income countries to help quantify trade-offs involved in investing in mortality reduction due to one disease versus another. METHODS We monetized the changes in mortality risk for communicable and non-communicable diseases (CD and NCD, respectively) between 2017 and 2030 for low-income, lower-middle-income, and upper-middle-income countries (LICs, LMICs, and UMICs, respectively). We modeled three mortality trajectories ("base-case", "high-performance", and "low-performance") using Global Burden of Disease study forecasts and estimated disease-specific mortality risk changes relative to the base-case. We assigned monetary values to changes in mortality risk using value of a statistical life (VSL) methods and conducted multiple sensitivity analyses. RESULTS In terms of NCDs, the absolute monetary value associated with changing mortality risk was highest for cardiovascular diseases in older age groups. For example, being on the low-performance trajectory relative to the base-case in 2030 was valued at $9100 (95% uncertainty range $6800; $11,400), $28,300 ($24,200; $32,400), and $30,300 ($27,200; $33,300) for females aged 70-74 years in LICs, LMICs, and UMICs, respectively. Changing the mortality rate from the base-case to the high-performance trajectory was associated with high monetary value for CDs as well, especially among younger age groups. Estimates were sensitive to assumptions made in calculating VSL. CONCLUSIONS Our framework provides a priority setting paradigm to best allocate investments toward the health sector and enables intersectoral comparisons of returns on investments from health interventions.
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Affiliation(s)
- Aayush Khadka
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, 02115, USA.
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, 02115, USA
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Huey RW, George GC, Phillips P, White R, Fu S, Janku F, Karp DD, Naing A, Piha-Paul S, Subbiah V, Tsimberidou AM, Pant S, Yap TA, Rodon J, Meric-Bernstam F, Shih YCT, Hong DS. Patient-Reported Out-of-Pocket Costs and Financial Toxicity During Early-Phase Oncology Clinical Trials. Oncologist 2021; 26:588-596. [PMID: 33783054 DOI: 10.1002/onco.13767] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [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: 11/19/2020] [Accepted: 03/18/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Clinical trials are an important therapeutic option for patients with cancer. Although financial burden in cancer treatment is well documented, the financial burden associated with clinical trials is not well understood. PATIENTS AND METHODS We conducted a survey regarding economic burden and financial toxicity in patients with cancer enrolled in phase I clinical trials for >1 month. Financial toxicity score was assessed using the Comprehensive Score for Financial Toxicity survey. Patients also reported monthly out-of-pocket (OOP) costs. RESULTS Two hundred and thirteen patients completed the survey (72% non-Hispanic White; 45% with annual income ≤$60,000; 50% lived >300 miles from the clinic; 37% required air travel). Forty-eight percent of patients had monthly OOP costs of at least $1,000. Fifty-five percent and 64% of patients reported unanticipated medical and nonmedical expenses, respectively. Worse financial toxicity was associated with yearly household income <$60,000 (odds ratio [OR]: 2.7; p = .008), having unanticipated medical costs (OR: 3.2; p = .024), and living >100 miles away from the clinical trial hospital (OR: 2.3; p = .043). Non-White or Hispanic patients (OR: 2.5; p = .011) and patients who were unemployed or not working outside the home (OR: 2.5; p = .016) were more likely to report high unanticipated medical costs. CONCLUSION Among patients with cancer participating in clinical trials, economic burden is high, and most of patients' OOP costs were nonmedical costs. Financial toxicity is disproportionally higher in patients with lower income and those who travel farther, and unexpected medical costs were more common among non-White or Hispanic patients. OOP costs can be substantial and are often unexpected for patients. IMPLICATIONS FOR PRACTICE The financial burden of cancer treatment is well documented, but there are limited data regarding the financial burden associated with cancer clinical trials. This study surveyed 213 patients enrolled in early-phase clinical trials. Monthly out-of-pocket costs were at least $1000 for nearly half of patients. Worse financial toxicity was associated with income <$60,000 and living farther away from the hospital. Racial/ethnic minorities had higher rates of unanticipated medical costs. These data help to quantify the high financial burden for patients and may reveal a cause of disparities in clinical trial enrollment for underrepresented populations.
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Affiliation(s)
- Ryan W Huey
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Goldy C George
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Penny Phillips
- Clinical Center for Targeted Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Revenda White
- Clinical Center for Targeted Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Siqing Fu
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Filip Janku
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Daniel D Karp
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Aung Naing
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sarina Piha-Paul
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vivek Subbiah
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Apostolia M Tsimberidou
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shubham Pant
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Timothy A Yap
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jordi Rodon
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Funda Meric-Bernstam
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ya-Chen Tina Shih
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David S Hong
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Joo H, Maskery BA, Berro AD, Rotz LD, Lee YK, Brown CM. Economic Impact of the 2015 MERS Outbreak on the Republic of Korea's Tourism-Related Industries. Health Secur 2019; 17:100-108. [PMID: 30969152 DOI: 10.1089/hs.2018.0115] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [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: 11/12/2022] Open
Abstract
The 2015 Middle East respiratory syndrome (MERS) outbreak in the Republic of Korea (ROK) is an example of an infectious disease outbreak initiated by international travelers to a high-income country. This study was conducted to determine the economic impact of the MERS outbreak on the tourism and travel-related service sectors, including accommodation, food and beverage, and transportation, in the ROK. We projected monthly numbers of noncitizen arrivals and indices of services for 3 travel-related service sectors during and after the MERS outbreak (June 2015 to June 2016) using seasonal autoregressive integrated moving average models. Tourism losses were estimated by multiplying the monthly differences between projected and actual numbers of noncitizen arrivals by average tourism expenditure per capita. Estimated tourism losses were allocated to travel-related service sectors to understand the distribution of losses across service sectors. The MERS outbreak was correlated with a reduction of 2.1 million noncitizen visitors corresponding with US$2.6 billion in tourism loss for the ROK. Estimated losses in the accommodation, food and beverage service, and transportation sectors associated with the decrease of noncitizen visitors were US$542 million, US$359 million, and US$106 million, respectively. The losses were demonstrated by lower than expected indices of services for the accommodation and food and beverage service sectors in June and July 2015 and for the transportation sector in June 2015. The results support previous findings that public health emergencies due to traveler-associated outbreaks of infectious diseases can cause significant losses to the broader economies of affected countries.
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Affiliation(s)
- Heesoo Joo
- Heesoo Joo, PhD, is an Economist, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brian A Maskery
- Brian A. Maskery, PhD, is an Economist, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andre D Berro
- Andre D. Berro, MPH, is a Public Health Advisor, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lisa D Rotz
- Lisa D. Rotz, MD, is a Medical Epidemiologist, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yeon-Kyeng Lee
- Yeon-Kyeng Lee, PhD, is Division Director, Korea Centers for Disease Control and Prevention, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Clive M Brown
- Clive M. Brown, MD, is Branch Chief, Quarantine and Border Health Services, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
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Ackerman IN, Bohensky MA, Zomer E, Tacey M, Gorelik A, Brand CA, de Steiger R. The projected burden of primary total knee and hip replacement for osteoarthritis in Australia to the year 2030. BMC Musculoskelet Disord 2019; 20:90. [PMID: 30797228 DOI: 10.1186/s12891-019-2411-9] [Citation(s) in RCA: 211] [Impact Index Per Article: 42.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 01/08/2019] [Indexed: 12/21/2022] Open
Abstract
Background Comprehensive national joint replacement registries with well-validated data offer unique opportunities for examining the potential future burden of hip and knee osteoarthritis (OA) at a population level. This study aimed to forecast the burden of primary total knee (TKR) and hip replacements (THR) performed for OA in Australia to the year 2030, and to model the impact of contrasting obesity scenarios on TKR burden. Methods De-identified TKR and THR data for 2003–2013 were obtained from the Australian Orthopaedic Association National Joint Replacement Registry. Population projections and obesity trends were obtained from the Australian Bureau of Statistics, with public and private hospital costs sourced from the National Hospital Cost Data Collection. Procedure rates were projected according to two scenarios: (1) constant rate of surgery from 2013 onwards; and (2) continued growth in surgery rates based on 2003–2013 growth. Sensitivity analyses were used to estimate future TKR burden if: (1) obesity rates continued to increase linearly; or (2) 1–5% of the overweight or obese population attained a normal body mass index. Results Based on recent growth, the incidence of TKR and THR for OA is estimated to rise by 276% and 208%, respectively, by 2030. The total cost to the healthcare system would be $AUD5.32 billion, of which $AUD3.54 billion relates to the private sector. Projected growth in obesity rates would result in 24,707 additional TKRs totalling $AUD521 million. A population-level reduction in obesity could result in up to 8062 fewer procedures and cost savings of up to $AUD170 million. Conclusions If surgery trends for OA continue, Australia faces an unsustainable joint replacement burden by 2030, with significant healthcare budget and health workforce implications. Strategies to reduce national obesity could produce important TKR savings. Electronic supplementary material The online version of this article (10.1186/s12891-019-2411-9) contains supplementary material, which is available to authorized users.
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Delgado-Ortega L, González-Domínguez A, Borrás JM, Oliva-Moreno J, González-Haba E, Menjón S, Pérez P, Vicente D, Cordero L, Jiménez M, Simón S, Hidalgo-Vega Á, Moya-Alarcón C. The economic burden of disease of epithelial ovarian cancer in Spain: the OvarCost study. Eur J Health Econ 2019; 20:135-147. [PMID: 29922900 PMCID: PMC6394604 DOI: 10.1007/s10198-018-0986-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 06/06/2018] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To assess the economic burden of epithelial ovarian cancer (EOC) in incident patients and the burden by disease stage in Spain. METHODS We developed a Markov model from a social perspective simulating the natural history of EOC and its four stages, with a 10-year time horizon, 3-week cycles, 3% discount rate, and 2016 euros. Healthcare resource utilization and costs were estimated by disease stage. Direct healthcare costs (DHC) included early screening, genetic counselling, medical visits, diagnostic tests, surgery, chemotherapy, hospitalizations, emergency services, and palliative care. Direct non-healthcare costs (DNHC) included formal and informal care. Indirect costs (IC) included labour productivity losses due to temporary and permanent leaves, and premature death. Epidemiology data and resource use were taken from the literature and validated for Spain by the OvarCost group using a Delphi method. RESULTS The total burden of EOC over 10 years was 3102 mill euros: 15.1% in stage I, 3.9% in stage II, 41.0% in stage III, and 40.2% in stage IV. Annual average cost/patient was €24,111 and it was €8,641; €14,184; €33,858, and €42,547 in stages I-IV, respectively. Of total costs, 71.2% were due to DHC, 24.7% to DNHC, and 4.1% to IC. CONCLUSIONS EOC imposes a significant economic burden on the national healthcare system and society in Spain. Investment in better early diagnosis techniques might increase survival and patients' quality of life. This would likely reduce costs derived from late stages, consequently leading to a substantial reduction of the economic burden associated with EOC.
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Affiliation(s)
- Laura Delgado-Ortega
- AstraZeneca Farmacéutica Spain, Serrano Galvache, 56, Building Álamo, Madrid Spain
| | | | - Josep María Borrás
- Clinical Sciences Department, University of Barcelona, L’Hospital de Llobregat, Barcelona Spain
| | | | | | - Salomón Menjón
- Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Pedro Pérez
- Hospital Clínico Universitario, Madrid, Spain
| | - David Vicente
- Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Luis Cordero
- AstraZeneca Farmacéutica Spain, Serrano Galvache, 56, Building Álamo, Madrid Spain
| | | | - Susana Simón
- AstraZeneca Farmacéutica Spain, Serrano Galvache, 56, Building Álamo, Madrid Spain
| | | | - Carlota Moya-Alarcón
- AstraZeneca Farmacéutica Spain, Serrano Galvache, 56, Building Álamo, Madrid Spain
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12
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MOHAMMADZADEH M, DERAFSHI H, GHARI T. The Estimation of Economic Burden of Hepatitis C Virus Infection in Iran. Iran J Public Health 2018; 47:1575-1582. [PMID: 30524989 PMCID: PMC6277710] [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] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 08/12/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND One of the major causes of liver-related mortality and morbidity is Hepatitis C Virus (HCV) infection. It is also one of the reasons behinds of chronic liver disease and related complications such as cirrhosis and hepatocellular carcinoma. This autoimmune liver disease imposes a high economic burden on individuals and the society. This study aimed to estimate burden of HCV in Iran. METHODS Overall, 200 patients with HCV infection, referred to hospitals in three cities of Tehran, Karaj and Tabriz, Iran during year 2015, were randomly enrolled. To estimate the total burden of hepatitis, direct and indirect costs, costs of DALYs and social welfare were calculated. RESULTS Economic burden of HCV infection was obtained 26242.8 purchasing power parity (PPP$). Intangible costs of HCV was calculated 207421.6 PPP$. CONCLUSION Total direct costs of HCV for each patient are more than household consumption expenditure. Therefore, it is a reasonable policy to control and increase insurance coverage of HCV patients in order to decrease their costs.
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Affiliation(s)
- Mehdi MOHAMMADZADEH
- Dept. of Pharmacoeconomy and Administrative Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Pharmacoeconomy & Medical-Pharma Management Research Center, Tehran, Iran
| | - Hamid DERAFSHI
- Dept. of Ophthalmology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
- Dept. of Ophthalmology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Tayebeh GHARI
- Pharmacoeconomy & Medical-Pharma Management Research Center, Tehran, Iran
- Dept. of Pharmaceutics, School of Pharmacy, Alborz University of Medical Sciences, Karaj, Iran
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13
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Eljamel S, Griffiths A, Evans J, Banerjee I, Hussain K, Thompson R. The burden of congenital hyperinsulinism in the United Kingdom: a cost of illness study. Orphanet J Rare Dis 2018; 13:123. [PMID: 30029695 DOI: 10.1186/s13023-018-0867-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 07/03/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Congenital hyperinsulinism (CHI) is a rare, genetic disease which causes persistent hypoglycaemia, typically in new-borns. Patients with the diffuse disease variant often require near-total surgical removal of the pancreas, causing insulin-dependent diabetes mellitus (IDDM). The CHI economic burden is currently unknown. This study aimed to estimate the annual cost of illness (COI) of CHI patients in the UK from a service provider perspective (National Health Service, NHS and Personal Social Services), and to explore cost distribution within the patient population. METHODS The model was based on standard practice of two CHI centres of excellence. Model inputs were informed by a pragmatic literature review, NHS Reference Costs (2015-2016) and the British National Formulary (2017). Only direct costs to the NHS and Personal Social Services were considered. A prevalence-based approach was used and annual costs incurred at all ages were calculated. A deterministic sensitivity analysis (DSA; run at 10%) identified major cost drivers. RESULTS The COI of CHI patients to the NHS was £3,408,398.59 annually and average cost per patient was £2124.95. Cost distribution was skewed among CHI patients, with 5.9% of patients (95 patients in their first year of life) contributing to 61.8% (£2,105,491.07) of total costs. DSA results identified lack of response to first-line therapy and IDDM development post surgery (and associated healthcare costs) as major cost drivers. CONCLUSIONS Despite its rare disease status, estimated annual costs of CHI to the NHS were substantial. Development and management of post-surgical IDDM as a major cost driver highlights the need for effective treatments to mitigate such consequences and costs.
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Konomura K, Nagai H, Akazawa M. Economic burden of community-acquired pneumonia among elderly patients: a Japanese perspective. Pneumonia (Nathan) 2017; 9:19. [PMID: 29226070 PMCID: PMC5715537 DOI: 10.1186/s41479-017-0042-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 08/01/2017] [Accepted: 11/09/2017] [Indexed: 01/01/2023] Open
Abstract
Background This study aimed to estimate the economic burden of community-acquired pneumonia (CAP) among elderly patients in Japan. In addition, the study evaluated the relationship between total treatment cost and CAP risk factors. Methods An administrative database was searched for elderly patients (≥ 65 years old) who had pneumonia (ICD-10 code: J12–J18) and an antibiotic prescription between 1 June 2014 and 31 May 2015. The all-cause total healthcare costs of outpatient and inpatient CAP episodes were calculated. Results This study evaluated data from 29,619 patients with CAP who experienced 14,450 outpatient CAP episodes and/or 20,314 inpatient CAP episodes. The mean ages were 77.5 ± 8.0 years and 81.5 ± 8.2 years among the outpatient and inpatient groups, respectively. The median treatment costs were US$346 (interquartile range: $195–551) per outpatient episode and US$4851 (interquartile range: $3313–7669) per inpatient episode. More severe cases had increased treatment costs at the treating hospitals. Male sex, diabetes, chronic obstructive pulmonary disease, and liver dysfunction were associated with increased total treatment costs, while dementia, dialysis, and rheumatism were associated with high costs of treating a CAP episode. Conclusions The economic burden of CAP might be decreased by reducing the number of hospitalizations for mild CAP and the incidence of severe CAP. Therefore, preventative care (e.g. oral hygiene or pneumococcus vaccination) is recommended for patients with related risk factors, such as male sex, older age, diabetes, chronic obstructive pulmonary disease, liver dysfunction, rheumatism, dementia, or dialysis. Electronic supplementary material The online version of this article (10.1186/s41479-017-0042-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Keiko Konomura
- Public Health and Epidemiology, Meiji Pharmaceutical University, 2-522-1, Noshio, Kiyose, Tokyo, 204-8588 Japan
| | - Hideaki Nagai
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose-shi, Tokyo, 204-8585 Japan
| | - Manabu Akazawa
- Public Health and Epidemiology, Meiji Pharmaceutical University, 2-522-1, Noshio, Kiyose, Tokyo, 204-8588 Japan
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15
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Dumas A, Allodji R, Fresneau B, Valteau-Couanet D, El-Fayech C, Pacquement H, Laprie A, Nguyen TD, Bondiau PY, Diallo I, Guibout C, Rubino C, Haddy N, Oberlin O, Vassal G, de Vathaire F. The right to be forgotten: a change in access to insurance and loans after childhood cancer? J Cancer Surviv 2017; 11:431-437. [PMID: 28130711 DOI: 10.1007/s11764-017-0600-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 10/28/2016] [Accepted: 01/17/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Access to insurance for a loan or a mortgage is an important issue for childhood cancer survivors. The aim of this study was to describe difficulties experienced by adult survivors. METHODS A total of 1920 survivors treated before the age of 18 in five French cancer centers responded to a questionnaire in 2010. Survivors who had tried to obtain a loan were asked if they had experienced difficulties, which were defined as experiencing rejection, higher premiums, or exclusions. The questionnaire investigated health problems related to the circulatory, respiratory, digestive, urinary, endocrine, hormonal, and nervous systems. Second tumors, diabetes mellitus, cardiac disease, and stroke were ascertained from a physician's report or medical records. Multivariable analyses were conducted to identify the characteristics of survivors reporting difficulties. RESULTS Difficulties were experienced by 10.4% of those who had tried to obtain a small loan (n = 787) and by 30.1% of those who had tried to obtain a home loan (n = 909). Disclosure of childhood cancer to the insurer and amputation surgery were negatively associated with insurance accessibility, even when controlling for age, gender, education, health-related unemployment, familial situation, and severe or life-threatening conditions such as cardiovascular diseases, second cancers, or diabetes. CONCLUSION This study showed that the financial burden of cancer can extend decades after diagnosis. IMPLICATIONS FOR CANCER SURVIVORS Thanks to a 2016 law, French cancer survivors no longer have to disclose their cancer to insurers after a fixed number of years. This law will probably lessen the socioeconomic burden of cancer.
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Affiliation(s)
- Agnès Dumas
- Centre for Research in Epidemiology and Population Health (CESP), Cancer and Radiation team, INSERM U1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, 94807, Villejuif, France. .,Department of Clinical Research, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France.
| | - Rodrigue Allodji
- Centre for Research in Epidemiology and Population Health (CESP), Cancer and Radiation team, INSERM U1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, 94807, Villejuif, France.,Department of Clinical Research, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France
| | - Brice Fresneau
- Centre for Research in Epidemiology and Population Health (CESP), Cancer and Radiation team, INSERM U1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, 94807, Villejuif, France.,Department of Clinical Research, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France.,Department of Paediatric and Adolescent Oncology, Gustave Roussy, 94805, Villejuif, France
| | | | - Chiraz El-Fayech
- Department of Paediatric and Adolescent Oncology, Gustave Roussy, 94805, Villejuif, France
| | - Hélène Pacquement
- Department of Paediatric Oncology, Institut Curie, 75005, Paris, France
| | - Anne Laprie
- Department of Radiation Oncology, Centre Claudius Regaud, 31059, Toulouse, France
| | - Tan Dat Nguyen
- Radiotherapy Department, Centre Jean Godinot, 51100, Reims, France
| | - Pierre-Yves Bondiau
- Department of Radiation Oncology, Centre Antoine Lacassagne, 06100, Nice, France
| | - Ibrahima Diallo
- Centre for Research in Epidemiology and Population Health (CESP), Cancer and Radiation team, INSERM U1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, 94807, Villejuif, France.,Department of Clinical Research, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France
| | - Catherine Guibout
- Centre for Research in Epidemiology and Population Health (CESP), Cancer and Radiation team, INSERM U1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, 94807, Villejuif, France.,Department of Clinical Research, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France
| | - Carole Rubino
- Centre for Research in Epidemiology and Population Health (CESP), Cancer and Radiation team, INSERM U1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, 94807, Villejuif, France.,Department of Clinical Research, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France
| | - Nadia Haddy
- Centre for Research in Epidemiology and Population Health (CESP), Cancer and Radiation team, INSERM U1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, 94807, Villejuif, France.,Department of Clinical Research, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France
| | - Odile Oberlin
- Department of Paediatric and Adolescent Oncology, Gustave Roussy, 94805, Villejuif, France
| | - Gilles Vassal
- Department of Clinical Research, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France
| | - Florent de Vathaire
- Centre for Research in Epidemiology and Population Health (CESP), Cancer and Radiation team, INSERM U1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, 94807, Villejuif, France.,Department of Clinical Research, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France
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Cuschieri S, Vassallo J, Calleja N, Pace N, Abela J, Ali BA, Abdullah F, Zahra E, Mamo J. The diabesity health economic crisis-the size of the crisis in a European island state following a cross-sectional study. ACTA ACUST UNITED AC 2016; 74:52. [PMID: 27999669 PMCID: PMC5151145 DOI: 10.1186/s13690-016-0164-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 11/09/2016] [Indexed: 11/26/2022]
Abstract
Background Diabetes type 2 and obesity are well-established global epidemics and contributors to clinical, social and economic health burdens. The prevalence rates of these diseases are still on the rise among countries resulting in a corresponding public health burden. The Mediterranean island of Malta, known for it’s high diabetes and obesity rates, provides a good fundamental basis to portray the economical health burden of these diseases. Method A recent randomised stratified representative cross-sectional survey conducted in Malta tackling diabetes, obesity and other determinants, was used to work out the population prevalence of these diseases. The cost burden of diabetes and obesity, based on published data, was incorporated to the established population prevalence rates, in order to estimate the Maltese economical burden. Projections to the year 2050 by a bottom-up prevalence based design were performed. Results One eight of the Maltese adults (25 to 64 years) suffered from diabetes out of which approximately 10,000 adults were unaware of the disease. Alarmingly, more than a third of the Maltese population suffer from obesity. The approximate health care costs (direct and indirect) for the diabetic adult population was of €29,159,217 (€21,994,676 - €38,919,121) annually, amounting to 3.64% (2.75–4.875%) of the total health expenditure in Malta. The obesity cost burden was of €23,732,781 (€21,514,972-€26,049,204) annually contributing for 2.97% (2.69–3.26%) of the total health expenditure. The projected prevalence and costs for 2050 exhibited an estimated cost burden increase of €33,751,487 (€25,458,606–€45,048,473) for the diabetes mellitus population and €46,532,294 (€42,183,889–€51,074,049) for the obese population. These projected cost burdens are expected to increase exponentially the total health care expenditure in Malta by 2050. Conclusion Having an understanding of the prevalence and the economic cost burden of diabetes and obesity within a country, along with projections of the expected burden will enable policy and public health officials to clearly visualize this growing problem. It also helps in establishing effective preventive strategies and screening programs targeting these epidemics.
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Affiliation(s)
- Sarah Cuschieri
- Department of Anatomy, Faculty of Medicine and Surgery, Biomedical Building, University of Malta, Msida, MSD 2080 Malta
| | - Josanne Vassallo
- Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Neville Calleja
- Department of Public Health, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Nikolai Pace
- Department of Anatomy, Faculty of Medicine and Surgery, Biomedical Building, University of Malta, Msida, MSD 2080 Malta
| | - Janice Abela
- Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Bader A Ali
- Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | | | | | - Julian Mamo
- Department of Public Health, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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Ekwaru JP, Ohinmaa A, Loehr S, Setayeshgar S, Thanh NX, Veugelers PJ. The economic burden of inadequate consumption of vegetables and fruit in Canada. Public Health Nutr 2017; 20:515-23. [PMID: 27819197 DOI: 10.1017/S1368980016002846] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objective Public health decision makers not only consider health benefits but also economic implications when articulating and issuing lifestyle recommendations. Whereas various estimates exist for the economic burden of physical inactivity, excess body weight and smoking, estimates of the economic burden associated with our diet are rare. In the present study, we estimated the economic burden attributable to the inadequate consumption of vegetables and fruit in Canada. Design We accessed the Canadian Community Health Survey to assess the inadequacy in the consumption of vegetables and fruit and published meta-analyses to assemble risk estimates for chronic diseases. Based on these inadequacy and risk estimates, we calculated the population-attributable fraction and avoidable direct and indirect costs to society. Direct costs include those for hospital care, physician services and drugs in 2015. Results About 80 % of women and 89 % of men consume inadequate amounts of vegetables and fruit. We estimated this to result in an economic burden of $CAN 3·3 billion per year, of which 30·5 % is direct health-care costs and 69·5 % is indirect costs due to productivity losses. A modest 1 percentage point annual reduction in the prevalence of inadequate vegetables and fruit consumption over the next 20 years would avoid approximately $CAN 10·8 billion, and an increase of one serving of vegetables and fruit per day would avoid approximately $CAN 9·2 billion. Conclusions Further investments in the promotion of vegetables and fruit will prevent chronic disease and substantially reduce direct and indirect health-care costs.
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Guandalini S, Tundia N, Thakkar R, Macaulay D, Essenmacher K, Fuldeore M. Direct Costs in Patients with Celiac Disease in the USA: A Retrospective Claims Analysis. Dig Dis Sci 2016; 61:2823-30. [PMID: 27417565 DOI: 10.1007/s10620-016-4219-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 05/27/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Celiac disease (CeD) is an autoimmune disease triggered by gluten ingestion. AIM We assessed total direct costs burden associated with CeD in patients with CeD versus patients without CeD using administrative claims data. METHODS Patients with CeD (cases) with ≥1 occurrences of CeD diagnosis were selected at a randomly chosen date (index date) from the OptumHealth Reporting and Insights database from 01/01/1998 through 03/31/2013. Cases were continuously enrolled throughout baseline (1 year before index date) and study (1 year after index date) periods. Cases were categorized as full remission and partial remission and matched 1:1 based on age, sex, region, index date, company, and employment status. Total all-cause and CeD-related costs were calculated. RESULTS A total of 12,187 cases were matched with an equal number of controls. Mean total all-cause costs were $12,217 in cases versus $4935 in controls (P < 0.0001). In full remission (N = 10,181 [83.5 %]) and partial remission (N = 2006 [16.5 %]) cases, mean total all-cause direct costs (cases versus controls) were $11,038 versus $4962 and $18,206 versus $4796, respectively. All-cause medical costs ($9839 for all cases, $8723 for full remission cases, $15,499 for partial remission cases) accounted for the majority of all-cause total costs and included outpatient costs ($6675; $6456; and $7785, respectively) and hospitalizations ($2776; $1963; and $6906, respectively). CeD-related medical costs were 13 and 27 % of all-cause medical costs for all cases and partial remission cases, respectively. CONCLUSIONS Patients with CeD and partial remission of CeD incurred significantly higher (2.5 and 3.8 times) total all-cause costs compared with matched controls.
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Konikoff T, Avraham T, Ophir E, Bornstein J. Hyperemesis gravidarum in northern Israel: a retrospective epidemiological study. Isr J Health Policy Res 2016; 5:39. [PMID: 27733901 PMCID: PMC5045651 DOI: 10.1186/s13584-016-0100-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 08/12/2016] [Indexed: 12/27/2022] Open
Abstract
Background Hyperemesis gravidarum (HG) is characterized by severe intractable nausea and vomiting in pregnancy leading to electrolyte imbalance, ketonuria, and weight loss. The cause is unknown. This study sought to investigate the prevalence and characteristics of HG in the Western Galilee in two ethnic populations and to estimate its economic burden. Methods Data on ethnicity, age, gestational age, number of pregnancies, and length of hospitalization were collected from the medical files of all women with HG admitted to the Galilee Medical Center in 2010–2013. Findings were compared between Arabs and Jews. Prevalence was assessed relative to total number of births. Economic burden was assessed by cost of hospitalization and work days lost. Results The cohort included 184 women, 124 Arabic (67.4 %) and 60 Jewish (32.6 %). There were 13,630 births at the medical center during the study period, for a calculated prevalence of HG of 1.2 %. There was no difference in the relative proportions of Arabs and Jews between the cohort and the total women giving birth at our center. Mean patient age was 27.2 years, gestational age 9.3 weeks, parity 2.35. Mean age was significantly higher in the Jewish group. There were no significant between-group differences in the other clinical parameters. Mean number of hospitalization days was 2.24 days, and of additional rest days prescribed, 4.62. The calculated annual cost of HG was 452,943.42 NIS (120,144.14 USD), crudely extrapolated to a nationwide cost of 15–20 million NIS (5,300,000 USD). Conclusion The prevalence and characteristics of HG are similar in the Arabic and Jewish populations of northern Israel. Mean gestational age at admission for HG was lower in our study than earlier ones, probably owing to the universal health care provided by law in Israel. HG prevalence was twice that reported previously in southern Israel but still within the range observed in other world regions. The socioeconomic differences between Arabs and Jews in the Galilee are smaller than elsewhere in Israel, suggesting a multifactorial etiology of HG. HG poses a major economic burden which should be considered when planning health policies. Further studies of this issue are warranted.
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Affiliation(s)
- Tom Konikoff
- Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel ; Department of Internal Medicine D, Rabin Medical Center Beilinson Hospital, Petach Tikva, 4941492 Israel
| | - Tehila Avraham
- Department of Statistical Studies, Hebrew University, Jerusalem, Israel
| | - Ella Ophir
- Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel ; Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
| | - Jacob Bornstein
- Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel ; Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
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Krueger H, Andres EN, Koot JM, Reilly BD. The economic burden of cancers attributable to tobacco smoking, excess weight, alcohol use, and physical inactivity in Canada. ACTA ACUST UNITED AC 2016; 23:241-9. [PMID: 27536174 DOI: 10.3747/co.23.2952] [Citation(s) in RCA: 16] [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] [Indexed: 01/20/2023]
Abstract
OBJECTIVES The purpose of the present study was to calculate the proportion of cancers in Canada attributable to tobacco smoking (ts), alcohol use (au), excess weight (ew), and physical inactivity (pia); to explore variation in the proportions of those risk factors (rfs) over time by sex and province; to estimate the economic burden of cancer attributable to the 4 rfs; and to calculate the potential reduction in cancers and economic burden if all provinces achieved rf prevalence rates equivalent to the best in Canada. METHODS We used a previously developed approach based on population-attributable fractions (pafs) to estimate the cancer-related economic burden associated with the four rfs. Sex-specific relative risk and age- and sex-specific prevalence data were used in the modelling. The economic burden was adjusted for potential double counting of cases and costs. RESULTS In Canada, 27.7% of incident cancer cases [95% confidence interval (ci): 22.6% to 32.9%] in 2013 [47,000 of 170,000 (95% ci: 38,400-55,900)] were attributable to the four rfs: ts, 15.2% (95% ci: 13.7% to 16.9%); ew, 5.1% (95% ci: 3.8% to 6.4%); au, 3.9% (95% ci: 2.4% to 5.3%); and pia, 3.5% (95% ci: 2.7% to 4.3%). The annual economic burden attributable to the 47,000 total cancers was $9.6 billion (95% ci: $7.8 billion to $11.3 billion): consisting of $1.7 billion in direct and $8.0 billion in indirect costs. Applying the lowest rf rates to each province would result in an annual reduction of 6204 cancers (13.2% of the potentially avoidable cancers) and a reduction in economic burden of $1.2 billion. CONCLUSIONS Despite substantial reductions in the prevalence and intensity of ts, ts remains the dominant risk factor from the perspective of cancer prevention in Canada, although ew and au are becoming increasingly important rfs.
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Affiliation(s)
- H Krueger
- School of Population and Public Health, University of British Columbia, Vancouver, BC
| | | | - J M Koot
- School of Population and Public Health, University of British Columbia, Vancouver, BC
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Liu DP, Wang TA, Huang WT, Chang LY, Wang ET, Cheng SH, Yang MC. Disease burden of enterovirus infection in Taiwan: Implications for vaccination policy. Vaccine 2016; 34:974-80. [PMID: 26768128 DOI: 10.1016/j.vaccine.2015.12.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 08/25/2015] [Revised: 11/13/2015] [Accepted: 12/10/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study aimed to assess the disease burden and economic impacts of human nonpolio enteroviruses (NPEV) and enterovirus A71 (EV-A71) infection in Taiwan. MATERIALS AND METHODS We included children under five years old (n=983,127-1,118,649) with ICD-9-CM codes 0740 (herpangina) or 0743 (hand-foot-and-mouth disease) from the 2006 to 2010 National Health Insurance Database. Severity of enterovirus infection was assessed from outpatient/emergency visits, hospitalization (with/without intensive care unit [ICU] admission), infection with severe complications, and death. We estimated medical costs and indirect costs from the societal perspective. RESULTS The annual rates of NPEV events for children under five years old ranged from 13.9% to 38.4%, of which 5.1-8.8% were hospitalized. EV-A71 accounted for 7.8% of all NPEV medical costs, but 79.1% of NPEV ICU costs. Travel costs and productivity loss of caregivers were $37.1 (range: $24.5-$64.7) million per year. These costs were not higher in the EV-A71 dominant year ($34.4 million) compared with those in the other years. Productivity losses resulting from premature mortality by NPEV infection were $0.8 (range: $0.0-$2.9) million per year, of which 96.3% were caused by EV-A71. CONCLUSIONS Diseases associated with NPEV other than EV-A71 were responsible for most of the medical expenses. In addition, caregiver productivity loss by high rates of NPEV infection impacted the society much more than medical costs. A multi-valent vaccine that includes EV-A71 and other serotypes, for example coxsackievirus A16, may be beneficial to the health of children in Taiwan.
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Affiliation(s)
- Ding-Ping Liu
- Epidemic Intelligence Center, Centers for Disease Control, Taipei, Taiwan; Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan.
| | - Ting-Ann Wang
- Division of Acute Infectious Diseases, Centers for Disease Control, Taipei, Taiwan.
| | - Wan-Ting Huang
- Office of Preventive Medicine, Centers for Disease Control, Taipei, Taiwan; Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Luan-Yin Chang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - En-Tzu Wang
- Division of Acute Infectious Diseases, Centers for Disease Control, Taipei, Taiwan.
| | - Shou-Hsia Cheng
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan.
| | - Ming-Chin Yang
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan.
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de Vroome EMM, Uegaki K, van der Ploeg CPB, Treutlein DB, Steenbeek R, de Weerd M, van den Bossche SNJ. Burden of Sickness Absence Due to Chronic Disease in the Dutch Workforce from 2007 to 2011. J Occup Rehabil 2015; 25:675-84. [PMID: 25804926 DOI: 10.1007/s10926-015-9575-4] [Citation(s) in RCA: 32] [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] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
INTRODUCTION Chronic diseases are associated with productivity loss costs due to sickness absence. It is not always clear, however, which chronic diseases in particular are involved with how many sickness days and associated costs. OBJECTIVE To determine the prevalence, additional days of sickness absence, and associated costs of chronic diseases among the Dutch working population from 2007 to 2011. METHODS Prevalence of chronic diseases and additional days of sickness absence were derived from the Netherlands Working Conditions Survey (NWCS) from 2007 to 2011. The cost of each sickness absence day was based on linked personal income data. We used multiple regression analysis to derive the unconfounded additional days of sickness absence due to each chronic disease. RESULTS Annually, approximately 37 % of the Dutch working population reported some type of chronic physical or psychological disease. No clinically relevant changes in prevalence of specific chronic diseases were observed in the studied period, nor in the number of additional sickness absence days or associated costs. The national financial burden due to sickness absence associated with chronic musculoskeletal disorders amounted to €1.3 billion annually. CONCLUSIONS Chronic diseases result in substantial productivity loss due to sickness absence. Given the ageing population, the proposed increase in the state pension age and an increase in sedentary lifestyle and obesity, the prevalence of chronic diseases may be expected to rise. Coordinated efforts to maintain and improve the health of the working population are necessary to minimize socioeconomic consequences.
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Affiliation(s)
| | - Kimi Uegaki
- TNO - Work, Health and Care, PO Box 3005, 2301 DA, Leiden, The Netherlands
| | | | | | - Romy Steenbeek
- TNO - Work, Health and Care, PO Box 3005, 2301 DA, Leiden, The Netherlands
| | - Marjolein de Weerd
- TNO - Work, Health and Care, PO Box 3005, 2301 DA, Leiden, The Netherlands
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Guérin A, Sasane M, Wakelee H, Zhang J, Culver K, Dea K, Nitulescu R, Galebach P, Macalalad AR. Treatment, overall survival, and costs in patients with ALK-positive non-small-cell lung cancer after crizotinib monotherapy. Curr Med Res Opin 2015; 31:1587-97. [PMID: 26029864 DOI: 10.1185/03007995.2015.1057115] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 11/23/2022]
Abstract
BACKGROUND Limited post-crizotinib treatment options for ALK-positive non-small cell lung cancer (NSCLC) might lead to poor survival and high economic burden. OBJECTIVE To evaluate real-world treatment patterns, overall survival (OS), and costs following crizotinib discontinuation. METHODS This study used chart review and claims data. First, 27 participating US oncologists reviewed medical records of ALK-positive NSCLC patients who discontinued crizotinib monotherapy and reported patient demographic and clinical information, including post-crizotinib treatment and mortality. OS was estimated using Kaplan-Meier analyses. Second, three large administrative US claims databases were pooled. NSCLC patients were selected if they discontinued crizotinib monotherapy. Post-crizotinib costs were analyzed separately for patients who did or did not discontinue antineoplastic treatment after crizotinib monotherapy. All data were collected prior to ceritinib approval for this patient population. RESULTS A total of 119 ALK-positive NSCLC patients discontinued crizotinib monotherapy. Upon discontinuation, 42% had no additional antineoplastic treatment and 13% received radiation therapy only. The median OS post-crizotinib was 61 days; patients with brain metastases had shorter OS than those who did not (44 vs. 69 days, P = 0.018), and patients without further antineoplastic treatment had shorter OS than those who did (17 vs. 180 days, P < 0.001). From claims data, 305 ALK-positive NSCLC patients discontinued crizotinib monotherapy. After discontinuation, 72% had no additional antineoplastic treatment. Among patients who continued antineoplastic treatment, monthly healthcare costs averaged $22,160, driven by pharmacy ($9202), inpatient ($6419), and outpatient radiotherapy ($2888) and imaging ($1179) costs. Among patients who discontinued any antineoplastic treatment, monthly healthcare costs averaged $3423, mostly driven by inpatient costs ($2074). CONCLUSIONS After crizotinib monotherapy, most patients either received radiotherapy only or discontinued antineoplastic treatment altogether. OS after discontinuing crizotinib was poor and shorter among those with brain metastases than without, and among those without subsequent antineoplastic treatment than with. Patients who continued antineoplastic treatment incurred substantial healthcare costs.
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Affiliation(s)
- A Guérin
- a a Analysis Group Inc. , Boston , MA , United States
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Krueger H, Krueger J, Koot J. Variation across Canada in the economic burden attributable to excess weight, tobacco smoking and physical inactivity. Can J Public Health 2015; 106:e171-7. [PMID: 26285186 DOI: 10.17269/cjph.106.4994] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 05/05/2015] [Accepted: 04/26/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Tobacco smoking, excess weight and physical inactivity contribute substantially to the preventable disease burden in Canada. The purpose of this paper is to determine the potential reduction in economic burden if all provinces achieved prevalence rates of these three risk factors (RFs) equivalent to those of the province with the lowest rates, and to update and address a limitation noted in our previous model. METHODS We used a previously developed approach based on population attributable fractions to estimate the economic burden associated with these RFs. Sex-specific relative risk and age-/sex-specific prevalence data were used in the modelling. The previous model was updated using the most current data for developing resource allocation weights. RESULTS In 2012, the prevalence of tobacco smoking, excess weight and physical inactivity was the lowest in British Columbia. If age- and sex-specific prevalence rates from BC were applied to populations living in the other provinces, the annual economic burden attributable to these three RFs would be reduced by $5.3 billion. Updating the model resulted in a considerable shift in economic burden from smoking to excess weight, with the estimated annual economic burden attributable to excess weight now 25% higher compared to that of tobacco smoking ($23.3 vs. $18.7 billion). CONCLUSION Achieving RF prevalence rates equivalent to those of the province with the lowest rates would result in a 10% reduction in economic burden attributable to excess weight, smoking and physical inactivity in Canada. This study shows that using current resource use data is important for this type of economic modelling.
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Affiliation(s)
- Hans Krueger
- UBC School of Population and Public Health H. Krueger & Associates Inc..
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Gimenez E, Besses C, Boque C, Velez P, Kerguelen A, Cervantes F, Ferrer-Marin F, Perez-Encinas M, Rodriguez M, Gonzalez JD, Calzada R, Hernandez-Boluda JC. Indirect and non-medical economic burden, quality-of-life, and disabilities of the myelofibrosis disease in Spain. J Med Econ 2014; 17:435-41. [PMID: 24716650 DOI: 10.3111/13696998.2014.903257] [Citation(s) in RCA: 7] [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: 11/09/2022]
Abstract
INTRODUCTION Myelofibrosis is a non-frequent chronic myeloproliferative Philadelphia-negative chromosome neoplasm. It is a heavy incapacitating orphan disease and associated with high morbidity and mortality. In this context, indirect and non-medical costs are expected to be high. The main objective of this project is to estimate the economic burden of this disease in Spain. METHODS Thirty-three patients with a diagnosis of myelofibrosis for at least 1 year participated in a questionnaire in three Spanish centers. The study consisted of analyzing in various aspects the cost and impact of the disease; indeed, daily life time limitations with a need of informal care, symtomatology. Additionally, information concerning the clinical management of the disease was collected through a focus group of eight experts. RESULTS The mean age was 65 years. 15 of 33 patients were at their productive stage. Six had difficulties at work and eight have received informal care. Bone and muscular pain were the main symptoms of patients (72%). The estimated global indirect and non-medical costs of the disease were 86,315€ per patient (20% working and 80% informal care), which reached 104,153€ at productive stage patients (45%) and 168,459€ for more symptomatic patients. CONCLUSIONS The economic burden of indirect and non-medical costs of myelofibrosis are important (15,142€/annual) as a result, and should be considered in economic evaluation, as well as in preventive plans for patients and caregivers, despite the fact that studies with larger numbers of patients should be done.
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