Analysis Of Direct Medical Costs Research Articles

Healthcare Schemes to overcome financial toxicity of COVID-19: A Retrospective Single Center Study

BackgroundIndian healthcare system was nearly crashed during the pandemic and victims of COVID-19 experienced huge health related economic burden. Thus, we aimed to quantify the direct medical cost associated with COVID-19 management along with the healthcare schemes. MethodsA retrospective study was conducted for the duration of 8 months where the data of COVID-19 patients of one year (2020-2021) was collected from the medical record department. The data of COVID-19 patients of age 18 to 65 years with confirmed diagnosis based on RT-PCR test were included in the study whereas the data of special population such as pregnant, hemodialysis and patient undergoing surgery were excluded. ResultsOut of 1011 COVID-19 patients, 63.5% were males and 36.5% were female with the mean age of 43.8±14.5 years and with 9.47 days mean length of hospitalization. On direct medical cost analysis, USD 1060.92 was the total median expenses which includes COVID package plus outside COVID package expenses. Similarly, USD 728 and USD 51.1 were the median amount claimed through healthcare schemes and median co-payments respectively. The total median expenses with and without healthcare schemes were found to be USD 1061.37 and USD 1052.94 respectively whereas co-payments with and without schemes were USD 26.005 and USD 1046.64. ConclusionHealthcare schemes are the best strategy to overcome the direct medical cost associated with the management of the disease. Quantifying the medical cost could provide an insight to develop effective policy to counteract the financial toxicity among patients.

Сравнительный клинико-экономический анализ коррекции миопии с использованием лазерных кераторефракционных операций и контактных линз

Purpose. To conduct a comparative clinical and economic analysis of myopia correction using laser keratorefractive surgery and contact lenses. Material and methods. An analysis of direct medical costs was carried out for the following main items: the cost of surgery, contact lenses and solution for their injury. The sources of information were the official websites of 25 clinics and 13 opticians in Moscow. Calculations when using contact lenses were carried out for 312 days a year. All calculations are presented for 1 eye. Financial costs in the remote period were discounted at a rate of 5%. 1 USD = 78.32 rubles. Results. The median cost of the FemtoLASIK procedure was 76600 rubles, personalized FemtoLASIK – 82,000 rubles, refractive lenticular extraction – 110,000 rubles. The cost of one day of using contact lenses with a solution for their storage was: one-day – 83.0 (excluding the cost of the solution), 14-day – 29.0 rubles, 30-day – 21.5 rubles, 90-day – 8.2 rub. The cost of using one-day contact lenses after 5 years is 101,451 rubles, 14-day contact lenses with a storage solution – 35,447 rubles, 30-day – 26,279 rubles, 90-day – 10,023 rubles. Conclusion. The analysis revealed that the financial costs of one-day contact lenses already after 4 years exceed the cost of myopia correction using FemtoLASIK and personalized FemtoLASIK methods and amount to 85,219 rubles, and also after 6 years exceed the cost of refractive lenticular extraction operation and amount to 115,944 rubles. Keywords: cost-effectiveness, FemtoLASIK, SMILE, CLEAR, contact lenses

Treatment of tibial bone defects: pilot analysis of direct medical costs between distraction osteogenesis with an Ilizarov frame and the Masquelet technique

PurposeThe cost implications of limb reconstruction techniques have not been adequately investigated. Aim of this pilot study was to compare the direct medical cost of tibial bone defects managed with distraction osteogenesis–Ilizarov method (ILF), or with Masquelet technique (MIF).MethodsData of 20 random patients treated in a single centre were analysed. Inclusion criteria included acute tibial defects, or post-debridement of nonunions with complete follow-up and successful union. The endpoint of clinical efficacy was the time-to-defect union. Comparisons were made between equally sized subgroups (ILF vs. MIF).ResultsThe average defect length was 5.6 cm (2.6–9.6 cm). The overall cost of 20 cases reached £452,974 (mean £22,339, range £13,459–£36,274). Statistically significant differences favoring the MIF were found regarding the average time-to-union; number of surgeries, of admissions and follow-up visits, as well as the mean intraoperative cost (£8857 vs. £14,087). These differences lead to significant differences of the mean cost of the overall treatment (MIF £18,131 vs. ILF £26,126). Power analysis based on these data indicated that 35 patients on each group would allow detection of a 25% difference, with an alpha value of 0.05 and probability (power) of 0.9.ConclusionsThe results and analysis presented highlight factors affecting the high financial burden, even in a best-case scenario, this type of surgery entails. Larger pivotal studies should follow to improve the cost efficiency of clinical practice.

COMPARATIVE PHARMACOECONOMIC ANALYSIS OF SELF-CONTROL OF DIABETES MELLITUS USING GLUCOMETERS.

The aim: To pharmacoeconomic analysis of direct medical costs for self-control of diabetes in Ukraine, Moldova and Georgia. Our observational, cross-sectional study aims at finding out the real costs of covering expenses in order to make decisions on the reimbursement of self-control means. Materials and methods: 1) International and national clinical guidelines for diabetes; 2) information about the prices of glucometers, test strips from online pharmacy services. Systematization, generalization and pharmacoeconomic analysis of direct medical costs were used in the study. Results: Based on the generalization of recommendations on the frequency of blood glucose control, 3 scenarios were identified, according to which the costs were calculated: Type 1 diabetes; Type 2 diabetes (insulin therapy); Type 2 diabetes (oral hypoglycemic therapy). The authors conducted pharmacoeconomic analysis of direct medical costs for self-control of DM for PWD in Ukraine, Moldova and Georgia. The study shows that the lowest cost of self-control is provided in Ukraine, in addition, Ukraine has a wider choice of glucometers and test strips. It was revealed that the pharmaceutical markets for glycometers in the three countries depends on the import of equipment. Conclusions: It is advisable to introduce in Ukraine the reimbursement of self-control devices, namely, glucometers and test strips for all categories of PWD, which will contribute to self-control and, as a result, will be able to prevent the development of complications. Certification of continuous glucose monitoring systems will increase access to new technologies that are already widely used in many countries.

POSB117 Analysis of Direct Medical Costs in Adult Patients with Sickle Cell Disease in Colombia

POSB117 Analysis of Direct Medical Costs in Adult Patients with Sickle Cell Disease in Colombia

Comparative pharmacoeconomic analysis of biologicals used for metastatic urothelial carcinoma

Objective: to determine the economic and clinical consequences of using atezolizumab in metastatic urothelial cancer compared with pembrolizumab and nivolumab.Materials and methods. An assessment of the effectiveness and safety of medicines for urothelial cancer was carried out on the basis of a systematic search and review of clinical studies and an analysis of direct medical costs for medicines from public procurement in Moscow in 2019-2020 and information from official instructions for medical use.Results. Systematic search identifies 4, 4 and 7 clinical trials of nivolumab, pembrolizumab and atezolizumab, respectively, as well as 2 meta-analyses. The obtained data on the efficacy and safety did not allow us to identify greater or lesser effective options. Calculation of cost of three months therapy revealed that the cost of atezolizumab (935 thousand rubles) is 7 % lower vs. pembrolizumab (1 million rubles) and 18 % lower vs. nivolumab (1,136 million rubles). Thus, when using atezolizumab instead of pembrolizumab or atezolizumab, budget savings may occur, or allowing additional therapy to be provided to every 14th or every 6th patient, respectively within fixed budget.Conclusion. The use of atezolizumab in metastatic urothelial cancer led to budget savings or the possibility of additional treatment coverage with immuno-oncological therapy.

Direct Medical Cost Analysis Among Coronary Heart Disease and Heart Failure Outpatients at One Hospital

Long-term treatment of cardiovascular disease may give impact in a high burden of medical cost for the patient. A concern arises whether the health budget allocation prepared by the Indonesian Government through "Jaminan Kesehatan Nasional" program is enough to cover medical cost for the outpatient treatment. This study aims to calculate the direct medical cost of patients with coronary heart disease and heart failure and compare it with the Indonesian Case Base Groups (INA-CBGs) tariff. This is a prospective and observational study carried out in one of the public hospitals in East Java between February and April 2015. All data related to outpatients with coronary heart disease and heart failure were analysed. Direct medical cost analysis in this study calculated from a combination of cost of medication, health professional services, electrocardiography, emergency care services, and laboratory test component, then it was compared with INA-CBGs tariff from ICD 10. Total of 390 patients included were 387 patients with coronary heart disease (99.23%) and three (3) patients with heart failure (0.77%). Average direct medical cost for patients with coronary heart disease and heart failure were IDR 130.593,6 (range IDR 50.282 – IDR 385.911) and IDR 128.587 (range IDR 112.832 – IDR 140.103), respectively. Even though this study showed that budget allocation of INA-CBGs could cover the average direct medical cost of patients with both of diseases, some patients had a direct medical cost higher than the limit of INA-CBGs allocation. Therefore, an optimal interprofessional collaboration between physician and pharmacist needed to provide medical treatment based on patient needs and keep it within budget allocation range.

Estimation of lung cancer diagnosis and treatment costs based on a patient-level analysis in Catalonia (Spain).

BackgroundAssessing of the costs of treating disease is necessary to demonstrate cost-effectiveness and to estimate the budget impact of new interventions and therapeutic innovations. However, there are few comprehensive studies on resource use and costs associated with lung cancer patients in clinical practice in Spain or internationally. The aim of this paper was to assess the hospital cost associated with lung cancer diagnosis and treatment by histology, type of cost and stage at diagnosis in the Spanish National Health Service.MethodsA retrospective, descriptive analysis on resource use and a direct medical cost analysis were performed. Resource utilisation data were collected by means of patient files from nine teaching hospitals. From a hospital budget impact perspective, the aggregate and mean costs per patient were calculated over the first three years following diagnosis or up to death. Both aggregate and mean costs per patient were analysed by histology, stage at diagnosis and cost type.ResultsA total of 232 cases of lung cancer were analysed, of which 74.1% corresponded to non-small cell lung cancer (NSCLC) and 11.2% to small cell lung cancer (SCLC); 14.7% had no cytohistologic confirmation. The mean cost per patient in NSCLC ranged from 13,218 Euros in Stage III to 16,120 Euros in Stage II. The main cost components were chemotherapy (29.5%) and surgery (22.8%). Advanced disease stages were associated with a decrease in the relative weight of surgical and inpatient care costs but an increase in chemotherapy costs. In SCLC patients, the mean cost per patient was 15,418 Euros for limited disease and 12,482 Euros for extensive disease. The main cost components were chemotherapy (36.1%) and other inpatient costs (28.7%). In both groups, the Kruskall-Wallis test did not show statistically significant differences in mean cost per patient between stages.ConclusionsThis study provides the costs of lung cancer treatment based on patient file reviews, with chemotherapy and surgery accounting for the major components of costs. This cost analysis is a baseline study that will provide a useful source of information for future studies on cost-effectiveness and on the budget impact of different therapeutic innovations in Spain.

FRI0425 Longitudinal analysis of direct medical costs for systemic lupus erythematosus in british columbia, canada: A population-based study

BackgroundSystemic lupus erythematosus (SLE) is a rare and chronic disease with high health care resource utilization due to disease activity as well as comorbidities secondary to the disease itself or...

Pharmaco-economic analysis of direct medical costs of metastatic colorectal cancer therapy with XELOX or modified FOLFOX-6 regimens: Implications for health-care utilization in Australia

The objective of this economic evaluation, which was based on patients from two randomized controlled clinical trials (NO16966 and NO16967), was to compare direct medical costs to the Australian health-care system of capecitabine plus oxaliplatin (XELOX) and bolus and/or infusional 5-fluorouracil (5-FU) plus folinic acid combined with oxaliplatin (modified [m] FOLFOX-6) in first-line and second-line treatment of advanced or metastatic colorectal cancer (mCRC). Direct medical costs were estimated for five treatment settings from a public and private hospital. The costs included in evaluation were for drug acquisition, preparation (oxaliplatin, bolus and infusional 5-FU), administration and wastage. The cost of drug acquisition was calculated based on dosage data and the mean number of treatment cycles from the pivotal studies NO16966 and NO16967. There were no costs associated with preparing capecitabine and leucovorin. An oncology grouping and costing study was performed to determine the relevant administration costs associated with central venous access devices, their placement, maintenance and removal (for oxaliplatin administration) and the continuous infusion of 5-FU via a continuous ambulatory delivery device pump or infuser. This economic evaluation has shown that treating mCRC patients with XELOX in the first and second-line settings results in average cost savings of $9110 and $7113, respectively, compared with mFOLFOX-6. A multi-way sensitivity analysis demonstrated that the use of XELOX remained cost-saving from an Australian government health budget perspective. The use of XELOX, compared with mFOLFOX-6, for the treatment of mCRC is cost-saving in the Australian government health budget.

PCN95 Pharmacoeconomic Analysis of Direct Medical Costs Associated With the Treatment of Advanced Esophago-Gastric Cancer Therapy With Xeloda or 5-Fluorouracil (5-FU) Regimens: Implications for Health Care Utilisation in Australia

PCN95 Pharmacoeconomic Analysis of Direct Medical Costs Associated With the Treatment of Advanced Esophago-Gastric Cancer Therapy With Xeloda or 5-Fluorouracil (5-FU) Regimens: Implications for Health Care Utilisation in Australia

Capecitabine or Infusional 5-fluorouracil for Gastroesophageal Cancer: A Cost–Consequence Analysis

In patients with advanced gastroesophageal cancer, the phase iii Randomized ECF for Advanced and Locally Advanced Esophagogastric Cancer 2 (real-2) trial demonstrated equivalent clinical efficacy when capecitabine (x) was substituted for 5-fluorouracil (5fu) in the epirubicin-cisplatin-5fu (ecf) regimen. The present analysis compares the direct medical costs associated with both regimens. This cost-consequence analysis of direct medical costs took resource utilization data from the real-2 trial where available. Direct medical costs were derived from the perspective of the Canadian public health care system in 2008 Canadian dollars. Mean cost per patient on each treatment arm was calculated. Drug costs from start of treatment until first progression, including pre- and post-chemotherapy medications and administration costs, totalled $5,344 for ecx as compared with $3,187 for ecf. Costs for treatment of adverse events were estimated at $2,621 for ecx as compared with $3,397 for ecf. An additional cost of $873 was associated with insertion of an implanted venous access. Total incremental cost of ecx over ecf was $508. In advanced gastroesophageal cancer, capecitabine is an attractive alternative to 5fu. Although the drug cost per se is greater, use of capecitabine is associated with decreased consumption of hospital resources. Not only does capecitabine fit with patient preference for oral therapy, it also avoids the inconvenience and complications of central venous access.

Retrospective health care claims database analysis of direct medical costs of newly diagnosed patients (pts) with hepatocellular carcinoma (HCC) in the United States.

6078 Background: Incidence of HCC is rising in the United States. Published cost data of HCC are obsolete, as pt populations analyzed were from >10 y ago and treatment options have dramatically changed. The objective of this study was to update the literature by quantifying incremental direct medical costs and full resource use of HCC from a current U.S. perspective and using patient level data. Methods: Deidentified, individual-level healthcare claims data from MarketScan were retrospectively analyzed. Pts diagnosed 1/07-12/08 with ≥2 primary HCC claims (ICD9 155.0); continuous enrolment; ≥180 days coverage before HCC; no prior claims for secondary HCC (ICD9 197.7), transarterial chemoembolization (TACE), liver transplant, or hospice were included. Pts were followed from HCC diagnosis until healthcare coverage end or 3/31/09 and matched 5:1 to subjects without HCC by 10-y age increments, sex, health plan type, and U.S. census region. Univariate and multivariate analysis was conducted at per member per month (PMPM) level. Results: Mean age of HCC pts (n=1475) was 62.6 y and matched cohort (n=7375) was 62.1 y; 67.9% in each group were male. Incremental univariate and multivariate annualized total medical expenses of HCC pts were $87,240 and $36,996 greater, respectively, than those without HCC. HCC treatment procedures were 32.2% of outpt costs (19.6% IV chemo, 10.5% TACE). Conclusions: This retrospective U.S. database analysis quantified significantly greater costs among HCC patients than those without HCC and that older agents are still commonly used. Additional expenses were largely attributed to inpt costs, while one-third of outpt costs were attributed to procedures. Cost expenditures have increased considerably based on data from 10 y ago. These data may be useful to support future cost analyses and cost effectiveness model of HCC. Univariate costs, mean PMPM ($) HCC pts HCC-free subjects Cost ratio P value Inpt 3,745 238 15.71 < 0.0001 Procedures 231 TACE 145 RFA 39 IV chemo 46 Outpt 3,774 386 9.77 < 0.0001 Procedures 1,217 TACE 397 SIRT 56 RFA 25 IV chemo 739 Drug 529 153 3.46 < .0001 Sorafenib 280 Total 8,048 778 10.35 < 0.0001 Pt-mos (n) 12,116 119,510 Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Bayer Amylin, Astellas Pharma, Bayer, Bayer-Onyx, Exhalenz, Gilead, Ikaria, Pfizer, Salix, sanofi-aventis, Takeda, Vertex Bayer Bayer, Gilead, Intercept, Roche, Salix, sanofi-aventis Up-to-Date

Preliminary cost-consequence analysis of the INTEREST trial, a randomized trial of docetaxel versus gefitinib as 2nd line therapy in advanced non-small cell lung cancer

8110 Background: The INTEREST trial is the first to demonstrate non-inferiority of EGFR TKI gefitinib compared to standard second-line chemotherapy (docetaxel) in NSCLC,with better quality of life in gefitinib-treated patients. Methods: A cost-consequence analysis of direct medical costs was undertaken, given non-inferiority of the two study arms, from the perspective of the Canadian public health system. Direct medical costs (2007 CAD$)were applied to resources (e.g study treatment, toxicity management) obtained from INTEREST trial data in the public domain. Mean overall cost per patient on each treatment arm was calculated from the start of treatment until first progression. Incremental costs over best supportive care (BSC), based on an analysis of the TAX317 trial, are also calculated. Results: The mean total cost per patient treated with gefitinib was $10,840 and $8,613 for docetaxel, resulting in an incremental cost of gefitinib treatment over docetaxel of $2,227. Drug costs are the major driver, $10,515 for gefitinib (6.5 cycles) versus $6,942 for docetaxel (4.4 cycles). Limited data on toxicity management, (e.g. febrile neutropenia, anemia, rash), are available, and cost estimates are $325 for gefitinib and $1,671 for docetaxel-treated patients. Additional hospitalization data were not available and therefore not included in these estimates. Based on published cost data for BSC, the incremental cost of gefitinib over BSC is estimated at $12,916 with available data, with an incremental cost effectiveness ratio of $37,988/life-year gained. Conclusion: Gefitinib second-line has similar efficacy compared to docetaxel with better quality of life. While drug costs for gefitinib are greater, costs for toxicity management are substantially less, and underestimated in this analysis. Gefitinib second-line is an attractive and affordable alternative for patients with advanced NSCLC. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration AstraZeneca Oncology, sanofi-aventis

Evolution of costs of care for cystic fibrosis patients after clinical guidelines implementation in a French network

Objectives The aim of this study was to evaluate how advances in CF management in France between 2000 and 2003 impacted CF-related costs. Methods The analysis of direct medical costs was done in 2000 and 2003 from the perspective of the French national healthcare insurance system. The patients, 65 in 2000 and 64 in 2003, were followed-up in one pediatric and one adult CF reference center (CFRC). We quantified and valued CF-related home and hospital care costs. Results We found an average cost of €16 474/patient/year in 2000, and €22 725 in 2003 (based on the 2003 euro value). Hospital care increased from 15% of the total cost in 2000 to 22% in 2003. Medications accounted for 45% of the total cost for the two periods, with an average cost of €7229/patient/year in 2000 and €10 336 in 2003. Home intravenous antibiotic therapy accounted for 20% of the total cost for the two periods. Conclusions We highlighted an increase in CF care costs between 2000 and 2003, which might be related to the changes in practice patterns that followed guidelines implementation, such as the use of new medications (dornase alpha and tobramycin) and more frequent follow-up in the CFRC.

Travoprost versus latanoprost combinations in glaucoma:economic evaluation based on visual field deficit progression

ABSTRACTObjective: Changes in intraocular pressure (IOP) are known to be related to visual field deficit progression, although multiple models of this relationship exist. In addition, visual functioning is known to affect medical costs. The objective of this study was to project visual field deficitprogression and subsequent costs based on clinical trial data.Research design and methods: Using data from a randomized, 12‐month, double-masked study, we compared the use of a fixed combination of travoprost 0.004%/timolol 0.5% (T/T) versus a fixed combination of latanoprost 0.005%/timolol 0.5% (L/T) on visual field deficit progression and associated costs. We applied published algorithms linking IOP to visual field changes to calculate the likelihood of visual field deterioration by treatment group. Differences in medical care costs were estimated using guideline-recommended practice patterns, Medicare hospital costs, and published estimates of differences in hospitalization by visual functioning.Main outcome measures: Increase in visual field deficit progression rates, increase in annual hospital days per subject, and increase in annual hospital, outpatient, and total costs per subject.Results: Predicted visual field deficit progression for T/T patients was less than that for L/T patients (not statistically significant). Projected annual medical care costs were $43 lower for T/T vs. L/T patients.Conclusions: By applying published algorithms linking IOP to visual field changes, this study projected long-term visual field deficit and associated costs. Use of a fixed travoprost/timolol solution may lead to less long-term visual field deficit progression and lower annual medical care costs than a fixed latanoprost/timolol solution.Discussion: The use of clinical trial data may limit the applicability of these findings. However, this analysis of direct medical costs only is likely a conservative estimate of the costs associated with visual field deficits.

Direct Medical Cost of Asthma in Ankara, Turkey

Background: There has been no documented data regarding the cost of asthma in our country. Objective: In this 1-year prospective study, we aimed to determine the annual cost of asthma in Ankara, Turkey. Methods: Direct medical cost analysis was performed in 118 patients. Results: Mean annual direct medical costs of asthma were USD 1,465.7 ± 111.8 per capita. Medication cost comprised the majority (81%) of the total direct cost. Mean direct medical costs according to the stage of disease were USD 172.5 ± 51.7, 860.7 ± 70.2, 1,671.6 ± 141.8 and 3,491.9 ± 417.6 for stage 1 (n = 4), 2 (n = 54), 3 (n = 46) and 4 (n = 14) patients, respectively. Conclusions: In this first study to document the cost of asthma for our region, direct cost of asthma was found to be increased with the severity of the illness. Considering the fact that medication cost comprises the major fraction of the direct cost, cost-effectiveness trials to determine the effective treatment with optimal cost for different asthma stages should be the next step.

Economic burden of cardiovascular disease associated with excess body weight in U.S. adults

Background: Excess body weight (EBW), which continues to become more prevalent, is a clear contributor to cardiovascular disease (CVD), the leading cause of death and disability among U.S. adults. Information on the economic impact of CVD associated with EBW is lacking, however. Objective: To estimate the direct medical costs of CVD associated with EBW. Methods: We conducted a population-based analysis of direct medical costs by linking the 1995 National Health Interview Survey and the 1996 Medical Expenditure Panel Survey. The study subjects are adults (aged ≥25 years, excluding pregnant women) in the non-institutionalized, civilian population in 1996. Results: The prevalence of CVD among people in the normal weight (body mass index [BMI] ≥18.5 to <25), overweight (BMI ≥25 to <30), and obese (BMI ≥30) groups was 20%, 28%, and 39%, respectively. There were 12.95 million CVD cases among overweight people, more than 25% of which was associated with overweight. There were 9.3 million CVD cases among obese people, of which more than 45% was associated with obesity. This extra disease burden led to $22.17 billion in direct medical costs in 1996 ($31 billion in 2001 dollars, 17% of the total direct medical cost of treating CVD). Conclusions: The strong positive association between EBW and CVD, and the significant economic impact of EBW-associated CVD demonstrate the need to prevent EBW among U.S. adults.