Average Annual Cost Research Articles

Estimating the minimal cost of delivering nutrition-specific and nutrition-sensitive interventions in Ethiopia.

The Ethiopia Food and Nutrition Strategy (FNS 2021-2030) aims to provide evidence-based, nutrition-specific, and sensitive interventions to address malnutrition. A costing exercise was done to estimate the minimum financing needed to implement nutrition interventions for the ten-year FNS, and further analysis was made to estimate the investment required to implement the prioritised recommended Lancet series interventions for 10 years. Activity-based costing methodology was used to carry out the FNS costing for nutrition interventions prioritised by the different line ministries, and then estimated costs to implement the 2021 recommended Lancets interventions were examined from the FNS. The minimum cost of implementing the National FNS was estimated to be US$ 2.55bn with an average annual cost of US$ 250 million over 10 years (2021-2030). The cost of nutrition-sensitive approaches represents US$ 1.8 billion (72%) and nutrition-specific US$ 704 million (28%) of the total cost of the FNS. The Lancet series intervention costs accounted for US$ 1.7 billion (66%) of the total cost of the strategy. In this costing, half of the strong/moderate evidence (7 out of 13) Lancet interventions are costed. Therefore, the strategy's costing should be revised every 3 years to integrate new evidence and consider lessons from real expenditure. Furthermore, the need to establish a nutrition expenditure tracking system is urgent.

Economic Burden of Haemophilia from a Societal Perspective: A Scoping Review.

Haemophilia is a rare genetic bleeding disorder that leads to musculoskeletal complications. The high cost of haemophilia treatment necessitates a thorough evaluation of its economic burden. However, due to the difficulty of estimating direct non-medical, indirect, and intangible costs, studies often underestimate the actual economic burden of haemophilia. This scoping review aims to summarise economic studies in haemophilia conducted from a societal perspective. A systematic search across eight scholarly databases, grey literature, and reference lists until the5th of July 2023 was conducted to identify relevant studies. The inclusion criteria encompassed full-text, English-language publications of economic analyses in congenital haemophilia from a societal perspective. Model-based studies and those adopting a payer perspective were excluded. Costs were adjusted to international dollars (I$) and US dollars (US$) in 2022 for comparability. Out of 2993 potential sources identified, 25 studies met the inclusion criteria, covering 7226 persons with haemophilia across 22 countries. All studies reported direct medical costs, with four excluding the cost of haemostatic therapy. Fifteen studies reported direct formal non-medical costs, while eight reported direct informal non-medical costs. All but one study reported the indirect costs. The average annual costs of haemophilia varied widely based on treatment modality, disease severity, geographical location, and included cost categories. When including the cost of clotting factor replacement therapy (CFRT), the total cost for severe haemophilia without inhibitors ranged from 1566 I$ to 700,070 I$ per person per year (lowest value reported in India and highest in the United States). CFRT represented up to 99.9% of the total cost for those receiving prophylaxis and up to 95.1% for episodic treatment. Haemostatic therapies accounted for 82% of the total cost in patients with inhibitors. There is a significant heterogeneity in defining cost categories required for a comprehensive economic analysis from a societal perspective. While haemostatic therapies constitute a substantial portion of the overall cost, direct non-medical and indirect costs are crucial as they are often paid out-of-pocket and may impede access to treatment. It is essential for haematologists and economists to establish a standardised costing framework for future studies, particularly in the era of novel therapies.

Cost analysis of adding hypertension and diabetes management into routine HIV care in Mbarara and Ibanda districts, Uganda.

In 2016, Uganda introduced services for hypertension and diabetes in selected HIV clinics. We evaluated the costs associated with scaling up these services in HIV clinics in Mbarara and Ibanda districts, Uganda. We estimated the annual costs of providing hypertension and diabetes services using an activity-based costing approach from the health system perspective in ten randomly selected HIV clinics in Mbarara and Ibanda districts. Cost inputs included 2023 data on costs of medications, health provider time, salaries, training costs, and monitoring costs. We determined the average annual cost and medication costs for hypertension and diabetes treatment per enrolled adult patient, stratified by type of health facility. The total annual cost of hypertension and diabetes management services in ten selected HIV clinics was estimated to be $413,850 (range: $8,386 - 186,973). The annual average clinic-level cost per enrolled patient was estimated at $14 (range: $7 - 31). Of the total annual cost, the cost of provider time for initial and follow-up visits represented the largest cost component in 5/10 clinics (mean: 37%, range [13-58%]). In 4/10 clinics, the major cost components were the costs of medication, diagnostic tests, and related supplies (mean: 37%, range [10-75%]). The average cost per enrolled adult patient was $11 at public facilities and $21 in private not-for-profit facilities. The average medication cost per patient for hypertension was $24 (range: $7 - 97) annually; $13 at public facilities and $50 at private not-for-profit facilities. For diabetes treatment, the average annual medication cost per patient was estimated at $14 (range: $6 - 35); $11 at public facilities and $22 at private not-for-profit facilities. Adding hypertension and diabetes management to routine HIV care might be feasible based on the estimated annual cost per patient. Hypertension and diabetes treatment was more costly in private not-for-profit facility-based clinics than at public facilities. This variation was primarily driven by higher medication procurement prices at private facilities, revealing a potential area for optimizing costs through improved procurement practices.

Excess costs of depression among a population-based older adults with chronic diseases in Singapore.

There is limited evidence on the economic burden of depression among the older population in Singapore. We aim to evaluate the impact of depression on healthcare expenditure and productivity loss among older adults with chronic diseases in Singapore. Using the data from the Well-being of the Singapore Elderly study (WiSE), a 2011 national representative survey of older adults aged 60 years and above, 2510 respondents were included in this study. The sample comprised 44% male and 56% female respondents with 75% respondents aged between 60 and 74 years old. Healthcare utilisation data was obtained from respondents and healthcare cost was tabulated by multiplying each service unit by the unit cost price. These services include care from polyclinic doctors, private general practitioners (GP), outpatient specialists and inpatient care. We modelled the relationship of healthcare cost and depression using two-part models (probit & generalised linear model - loglink and gamma distribution). For total healthcare expenditure, older adults with both depression and chronic diseases were associated with an average annual incremental cost of $7940 (95% CI 1490-14400; p = 0.016), compared to those without these conditions. They were also associated with an average incremental cost of $257 (95% CI 38.7-475; p = 0.021) for primary care. Likewise, in the case of specialist outpatient clinics, they had an average incremental cost of $970 (95% CI 163-1780; p = 0.018). However, for inpatient setting, the average incremental cost of $6180 (95% CI 418-12800; p = 0.066) was not significant. Additionally, older adults with depression and chronic diseases contribute to an annual productivity loss of $676 (95% CI 346-1010; p < 0.001). This study provides evidence that there are significant incremental costs associated with depression amongst the older adults with chronic diseases in Singapore's primary healthcare setting. The increased somatic presentations among the depressed older adults and the underdiagnosis of depression in primary care may contribute to higher utilisation of healthcare resources which entail higher expenditure. This is one of the first studies to look at the cost of depression using a representative sample of Singaporean older adults and taking into account the multi-ethnic nature of the population. Analyses were restricted to a cross-sectional design, and data relied heavily on the accuracy of self-report utilisation on health care services which was subjected to recall bias. Depression was found to inflate the total healthcare expenditure among older adults with chronic disease by two-fold. This study provides evidence that there are significant incremental costs associated with depression among the older adults with chronic diseases, demonstrating a need for more resources to improve systematic and clinical care for depressed older adults with chronic diseases.

Clinical profile of herpes zoster-related hospitalizations and complications: A French population-based database study

To estimate the incidence of hospitalization with a diagnosis of herpes zoster (HZ) and post-herpetic neuralgia (PHN) in France between 2013 and 2020, overall and stratified by age-group and immune status. Retrospective observational, database study, using the French hospital discharge database, which includes private and public data for all day-care and inpatient stays. Adults aged ≥18 years, hospitalized between January 1, 2013, and December 31, 2020, with a diagnosis of HZ or PHN were included. Overall, 62 077 adults had a first hospitalization with a diagnosis of HZ or PHN during the observation period. HZ and/or PHN incidence ranged between 14.6 and 16.3 hospitalizations/100 000 persons and was highest in people aged ≥80 years (97.6 hospitalizations/100 000 persons). The immunocompromised (IC) population accounted for 22% of the overall study population. IC patients had longer lengths of stay for HZ per episode compared with non-IC patients (15.5 ± 19.4 days vs 12.2 ± 13.5 days) and higher in-patient mortality (8% vs 4%). Average annual hospitalization costs per patient were higher in the IC vs non-IC population (€8018 vs €5603). Older age increases hospitalization rates up to 6-fold and IC status increases in-patient mortality up to two-fold.

Stability analysis and multi-objective optimization of methanol steam reforming for on-line hydrogen production

The potential solution to hydrogen storage and transportation challenges is provided by liquid fuel-based on-line hydrogen production. An online hydrogen production device has been constructed and the stable output of hydrogen at 6.8 bar under dynamic conditions of 6–13 Nm3/h has been achieved. To achieve optimal economic and thermodynamic performances, the mathematical models for mass, energy, and techno-economics are constructed based on field test data. The Non-Dominated Sorting Genetic Algorithm is employed to update temperature splitting points between multi-stage heat exchangers, targeting multi-objective optimization of heat exchange area, system energy efficiency, and annual average cost. Pareto optimal solutions indicate that such optimization can improve system energy efficiency by 0.03%–3.76% and decrease the hydrogen production cost from 0.004 $/kg to 0.599 $/kg. This work demonstrates the feasibility and effectiveness of multi-objective optimization for online hydrogen production system design and offers important guidance for decision-making in heat exchange network schemes.

Effects of the Affordable Care Act on Contraception, Pregnancy, and Pregnancy Termination Rates.

To investigate the effects of the Affordable Care Act (ACA) and its elimination of cost-sharing on contraception utilization, pregnancy rates, and abortion rates. We conducted a retrospective cohort study within a healthcare system serving over 4.5 million insured members across 21 medical centers and 250 clinics. The study included women aged 18-45 with continuous health plan membership for at least two years in the pre-ACA (2007-2012) and post-ACA (2013-2018) periods. We analyzed out-of-pocket (OOP) costs for contraception, including oral contraceptives and long-acting reversible contraception (LARC), before and after the ACA's implementation. We then examined how the elimination of OOP costs affected contraception use, pregnancy rates, and abortion rates. The study identified 1,523,962 women of childbearing age. In 2013, cost sharing for contraception sharply declined, with average annual OOP costs dropping from $88-$94 pre-ACA to nearly zero post-ACA. Contraceptive use increased overall, rising from 30.2% pre-ACA to 31.9% by the study's end, with a notable rise in LARC use. In interrupted time-series analyses, while contraception use continued to increase post-ACA, new pregnancy rates declined at a faster rate than pre-ACA, and abortion rates continued to fall, though at a slightly slower pace than pre-ACA (p<0.05 for all trends). The Affordable Care Act's elimination of contraception cost-sharing led to increased contraception use, particularly LARC methods, and contributed to declines in both pregnancy and abortion rates. This suggests that improving access to effective contraception is a key strategy in reducing unintended pregnancies.

A sustainable joint economic lot size model for supplier selection under carbon emissions: A case study

Selecting suppliers strategically is a critical challenge in supply chain design, particularly in a dynamic global marketplace where maintaining competitiveness and sustainability is essential. Supplier location is a key factor that significantly impacts supply chain sustainability. Hence, this study proposes a new Sustainable Joint Economic Lot Size (S-JELS) model that integrates average annual cost and total amount of emissions associated with annual activities related to both buyer and supplier. The developed model accounts for costs and emissions from the buyer’s purchasing, inventory management, and transportation activities, as well as from the supplier’s production, packaging, and delivery processes. Additionally, the model incorporates various transportation modes, including shipping, trucking, and rail, to more accurately assess the environmental impact of different supply chain strategies. The proposed JELS model can support managers performing sustainable purchasing decisions and assess a sustainable supplier selection. The developed model is applied in a leather case study characterized by high resource intensity, significant environmental impacts, and complex global logistics to accomplish supplier selection between one domestic and one international supplier, aiming to determine the most sustainable strategy in terms of cost and emission

Optimizing vaccination to reduce waste and boost coverage in Primary Health Care Units

Abstract Background In immunization, vaccine consumption typically exceeds the number of recipients. The number of doses per vial influences wastage and vaccination coverage goals. In Brazil, 48% of the National Immunization Program’s vaccines are multidose, with 4 having limited shelf-life post-opening. Strategies to reduce wastage aim to optimize dose utilization, enhance process quality, and broaden coverage effectiveness. The objective was to outline strategies for reducing wastage and expanding coverage for children under 5 in 14 São Paulo city Primary Health Care Units (PHCUs). Methods The Lean Six Sigma approach guided the stages. A group conducted contextual analysis to identify PHCU barriers. Data on wasted doses and vaccination were gathered. Weekly meetings for data analysis began in May 2023, following DMAIC phases: Define, Measure, Analyze, Improve, Control. An action plan stemmed from these phases for PHCU implementation. Results Data analysis, from January 2022 to June 2023, revealed a significant vaccine wastage trend, reaching 59% from January to December 2022 and increasing to 63% from January to June 2023. This wastage incurs an average annual cost of R$614,416.26, due to lost doses from expiration after vial opening and expiration of shelf life. The vaccines analyzed were BCG, Oral Polio Vaccine (OPV), Measles, Mumps, and Rubella (MMR), and Yellow Fever. At the project start in May 2023, vaccination coverage was 90%, increasing to 93% afterward. This rise resulted from actions taken and improved data monitoring. Post-project, vaccine wastage reduced by 7 percentage points (from 62% to 56%). Conclusions Addressing vaccine wastage and expanding vaccination coverage for children under 5 are critical in healthcare. Utilizing Lean Six Sigma, key issues in PHCUs were identified, leading to an action plan that reduced wastage, increased coverage, and standardized processes. Key messages • Vaccines are valuable resources and wasting them means reducing financial resources in health. • Vaccination coverage is crucial to protect the population’s health, prevent disease outbreaks, and maintain the country’s economic health, reducing costs for treating preventable diseases.

Healthcare Costs of Hospitalizations Due to Aspergillosis and 25-Year Trends in Spain, 1997–2021

In the last 40 years, a significant increase in the incidence of lung infections by Aspergillus has been reported. The scarcity of studies that describe the costs of aspergillosis indicates that the economic impact of aspergillosis in the hospital environment is greater than that of other fungal infections. The objective of the study was to evaluate the direct healthcare costs associated with aspergillosis in the Spanish National Health System from 1997 to 2021. A retrospective nationwide longitudinal descriptive study was designed to review hospital records from the Minimum Basic Data Set of patients admitted to hospitals of the National Health System from 1997 to 2021, with a diagnosis of aspergillosis. A total of 44,586 patients were admitted for aspergillosis in the Spanish National Health System. There was a progressive increase in the average annual cost from 1997 to 2012, which reached a maximum peak, EUR 1,395,154.21 (±2,155,192.87). It decreased between 2014 and 2019, but increased again in 2020 and 2021, EUR 28,675.79 (±30,384.12). The Pearson correlation coefficient revealed a weak negative correlation between age and hospital costs and a moderate positive correlation between average length of stay and hospital costs. Our data show that the economic impact of hospitalizations for aspergillosis is significant and increasing at a rate proportionally higher than that of other prevalent diseases. Costs related to Aspergillus infection are associated mainly with respiratory diseases. The results of this economic evaluation may be useful for health authorities to develop a future economic strategy for managing this fungal infection.

Tracking Blood Product Wastage over a 6-year Period in Virginia Commonwealth University Medical Center

Abstract Introduction/Objective Blood transfusions are a necessary practice for hospital emergency and surgical department. In emergent situations, blood components are in unmonitored settings during transit of critically ill patients. Any unused blood products are returned to the blood banks outside of a controlled temperature environment and are no longer viable to use. This study seeks to collect the average amount of blood products wasted in the Emergency and Surgery Department at Virginia Commonwealth University’s (VCU) Main Hospital. In addition, the study intends to highlight the budget that is impacted by these wasted blood units. Methods/Case Report Emergency Stock Records of VCU’s Hospital Emergency Department, Operating Room, Children’s Hospital of Richmond’s (CHoR) Emergency Department, and the CHoR’s Operating Room were collected and accumulated by the Transfusion Service’s Quality Assurance Coordinator. VCU’s Main Hospital Emergency Department monitors blood unit viability with a sensitive temperature indicator on each unit of blood stored in unmonitored refrigerators. Blood units above 10 degrees Celsius trigger the indicator and are required to be discarded. Our study collected a tally of these discarded units due to a triggered temperature indicator from 2018 to 2023. Acquisition cost per blood unit was estimated to be approximately $250 and overhead cost per unit was estimated to be $760. Results (if a Case Study enter NA) From 2018 to 2023, VCU’s health system wasted an average of 89.16 blood units per year due to the triggered temperature indicators, with a total of 535 units wasted over six years. The average annual cost of the wasted units totaled $90,058.33 per year ($22,291.67 and $67,766.67 in acquisition and overhead costs, respectively); cumulative cost over the 6 years amounted to $540,350 ($133,750 and $406,600 in acquisition and overhead costs, respectively). Conclusion With a notable number of resources and funding lost in the process due to blood unit wastage, an administrative discussion should focus on the use of high-level remote- controlled automated refrigerators in lieu of manual temperature indicator to reduce the expenditure and wastage of blood products.

Maintenance Costs, Time, and Efforts Following Implant Therapy With Fixed Restorations Over an Observation Period of 10 Years: A Randomized Controlled Clinical Trial.

To assess the costs and efforts of maintenance therapy following implant treatment with fixed restoration over an observation period of 10 years. This randomized controlled clinical trial included 64 patients who were randomly assigned to receive one of two implant systems (AST or STM) and fixed restoration. Patients were included in a regular maintenance program and were examined at loading, 1, 3, 5, 8, and 10 years. Outcome measures included technical and biological complications, time, efforts, and costs to resolve them. A total of 97 implants were placed in 64 patients (AST: 54, STM: 43). Patient recall rates at 5 and 10 years were 89% and 67%. In general, technical complications were resolved within one to two appointments (mean = 1.5), and biological complications required a mean of 1.3 appointments. The overall regular maintenance time for the period of 10 years amounted to 77 min per year. Technical complications occurred in 39.5% of the patients, with screw-loosening being the most common one (43.4% of all complications). The most time-consuming technical complication was abutment fracture (94 min ± 68), followed by screw fracture (84 min ± 38). The prevalence of peri-implant mucositis on the patient level was 30.2%, and it was 9.3% for peri-implantitis. The average annual maintenance costs amounted to 9% of the initial cost of the implant treatment over the period of 10 years. Additional regular maintenance costs and costs due to the treatment of potential complications have to be taken into consideration when placing dental implants. The majority of technical complications could be resolved within one appointment, whereas the time needed to treat biological complications varied between one and three appointments for peri-implantitis.

Drug utilization and medication adherence for the treatment of psoriatic arthritis: an Italian study.

This study aims to evaluate the persistence, treatment adherence and drug cost associated with biologic and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) in the management of psoriatic arthritis (PsA) in Italy, with a focus on biosimilar drugs. This was a retrospective observational study involving eight hospital pharmacies, between January 2017 and December 2020, on naïve patients with at least one b/tsDMARD dispensation indicated for PsA. Patients were followed up for 12 months and persistence and adherence were evaluated by proportion of days covered (PDC). The originator and biosimilar for adalimumab and etanercept were compared. Furthermore, the real annual cost per patient based on adherence to therapy was calculated. Patients initiating b/tsDMARDs for PsA had a mean persistence of 263 days and 48.6% remained persistent for 1 year. Adherent patients (PDC ≥ 0.8) were 47.6% for the overall population. Similar persistence and adherence were observed between patients treated with the adalimumab originator and its biosimilar, while patients treated with the etanercept originator showed lower persistence and adherence compared to those treated with its biosimilar (mean persistence: 222 vs. 267 days, patient persistent at 1 year: 29.4% vs. 51.5%, mean PDC: 0.53 vs. 0.70, adherent patients: 23.5% vs. 51.5%). The average annual drug cost ranged from €8,724 (etanercept) to €14,783 (ustekinumab), with an annual saving of more than €2,500 by using biosimilars. Poor adherence to medications contributes to suboptimal clinical outcomes. The comparison between biosimilar and originator offers further evidence in support of the biosimilar to optimizing resources in healthcare.

Provider costs of treating opioid dependence with extended-release buprenorphine in Australia.

The costs of providing medication-assisted treatment for opioid dependence can determine its scale of provision. To provide estimates of the costs of extended-release buprenorphine (BUP-XR), we performed a bottom-up costing analysis of provider operational treatment costs. Data were collected in a single-arm open label trial of BUP-XR injections conducted in specialist public drug treatment services and primary care private practices in three Australian states (the CoLAB study). The unit costs of resources used for each activity were combined with quantities used at each participating facility to arrive at the average annual cost per client. One hundred participants across the six health facility sites received monthly subcutaneous BUP-XR injections administered by a health-care practitioner. The average cost of providing 1 year of treatment per participant was $6656 ($6026-$8326). Screening cost (initial assessment and medical history) was $282 while monthly follow-up appointments cost $531 per client. The main cost driver was the monthly treatment costs accounting for 79% of the average annual client cost, with medication costs comprising 95% of this cost. With medication costs making up the largest proportion of treatment costs, treatment using BUP-XR has the potential to free up other health system resources, for example, staff time. The costs reported in this study can be used in an economic evaluation to estimate the net benefit or cost-effectiveness of BUP-XR especially when compared to other opioid agonist treatments.

Indirect costs assessment and intangible costs description of rheumatoid arthritis patients with biological therapy in Morocco: ECORAM Study.

The aims of study are to estimate the indirect costs and intangible costs of RA in Morocco and to identify the factors likely to influence these costs among suffering patients. In the current study, data were collected by face-to-face interviews using a questionnaire in addition to the patient's files. Indirect costs including productivity losses and formal care, and intangible costs such as the cessation of physical and leisure activities, family care and divorce or remaining single until menopause's age for women due to the disease were reported for 110 RA patients. The results show that among patients who lost totally or partially their salary, the annual average costs is $2337.73 ± 1649.80 per patient, with a minimum and a maximum of $600 and $9630 respectively. As regards formal care, only 13 patients reported that they paid for care services; the annual average cost was $421.84 ± 261.34 with a minimum of $252 and a maximum of $1200. Statistical analysis revealed significant differences between annual lost salary and gender (p = .04) disease duration (p = .016) and sport/leisure activities cessation (p = .08). Besides the burden in terms of productivity loss and caregivers' costs, the intangible costs are considerable, especially those related to divorce and spinsterhood. These conclusions may contribute to the understanding of the socio-economic impact of the disease and to the development of strategies for better governance of RA in Morocco.

Comparison of Reference and Biosimilar Medications for Pediatric Noninfectious Uveitis.

Compare outcomes and costs of TNF-alpha inhibitor biosimilars to reference medications in the treatment of pediatric NIU. Patients 18 years old or below treated with reference or biosimilar TNF-alpha inhibitor for noninfectious uveitis and had a history of active ocular inflammation with at least 1 month of ophthalmology follow-up from January 1, 2013, to June 1, 2023, were included. Retrospective chart review was performed. Nineteen patients met the inclusion criteria. Mean age was 9.3±4.0 years, and 47.4% (9/19) were female. Of the patients who were on infliximab at any time point in their disease course (n=9), the mean duration on infliximab was 3.6 years (42mo). Of the patients on biosimilar infliximab (n=10), the mean duration was 0.82 years (9.8mo). Mean flares/year was 0.22±0.3 on infliximab and 0.15±0.3 on biosimilar infliximab. The average annual cost was $42,298.97 for infliximab (n =9), $41,141 for infliximab-dyyb (n=9), and $40,950 for infliximab-axxq (n=1). Reasons for switching to biosimilar infliximab from adalimumab included a combination of insurance mandate (100%), worsening disease activity (37.5%), or other issues such as noncompliance (37.5%). The most common reason for biosimilar initiation was insurance mandate. Compared with the reference infliximab, pediatric patients had fewer number of flares per year on biosimilar infliximab, but they were also on the biosimilar for a shorter duration of time compared with the reference which may confound an accurate assessment. Biosimilar infliximab had a lower cost profile compared with reference infliximab.

Treatments, medical expenses and complications of hospital outpatient healthcare associated with stroke in patients with diabetes in China: a retrospective analysis of the Beijing Municipal Medical Insurance Database

ObjectivesDiabetes is closely associated with risk of stroke and its adverse sequelae. Approximately 20%–33% of patients with stroke have diabetes. In China, however, it is unclear how stroke affects healthcare...

Cost savings from medication reviews in community pharmacies for nursing home residents in Estonia: a case study

BackgroundThe aim of this study is to assess the cost savings from medication reviews conducted for individuals living in nursing homes in Estonia. Medication reviews performed as part of the automated dose dispensing (ADD) service by community pharmacies might help identify suboptimal medicine regimens.MethodsWe use a case study approach to identify suboptimal use of medication in treatment plans and estimate the potential cost saving from medication reviews. To achieve this, we assess 101 treatment plans submitted for medication review by nursing homes in Estonia between 2021 and 2023. Additionally, we run OLS regressions to identify the most important determinants of medication cost savings.ResultsWe estimate an average direct cost saving of €43.62 per patient per year, which corresponds to 8.27% of the average annual medication costs. If medication reviews were conducted for all elderly individuals over 75 years old who use six or more prescription medicines, nearly 2% of Estonia’s pharmaceutical budget could be saved. Regression analysis indicates that the most significant contributors to these cost savings are suboptimal use of generics, incorrect dosages (too high), and the elimination of incorrect medications.ConclusionsOur study suggests that annual medication reviews conducted as part of the ADD service might help reduce medication expenditure when offered to a wider public.

Lichen Sclerosus is a high-cost diagnosis, compounded by comorbid conditions

Introduction and Objective: In the past decade, there have been significant advancements in understanding the etiology, molecular mechanisms, and best treatment options for lichen sclerosus (LS). However, to date, there is a lack of published data on the costs of care, associated comorbidities, and quality of life related to the condition. Therefore, this study aims to investigate the global costs associated with the treatment of LS using a contained insurance dataset. Methods: Deidentified 12-month data from 2022 to 2023 for a northeastern private insurer of teachers and municipal workers was queried to analyze costs associated with a diagnosis of LS (ICD-10 code L90.0). Comorbidities were also queried. Descriptive statistics were utilized to describe the population’s expenditures. Johns Hopkins Adjusted Clinical Groups (ACG) risk assessment was utilized to determine future costs. Z-tests were utilized to determine the differences in rates of comorbidities, and T-tests for differences in cost. Results: The database included all 4,306 members. Average annual cost per member was $9,280, average age was 35.5 years, behavioral health prevalence was 26%, and 53% were female. Cost for members with a behavioral health condition was $18,125 (2.0-fold) and $6,219 average cost for members without (0.7-fold). LS was present in 161 (3.7%) members, with average age of 42.0, prevalence of behavioral health 37%, and 62% were female. The presence of lichen sclerosus was associated with a 3.5-fold increase in average cost per member ($32,437 annually). For those with LS and a behavioral health condition, cost was $53,539 (5.8-fold average per member) compared to $19,901 (2.1-fold average plan cost) for those with LS and no BH condition. Median cost for those with LS was $8,755 compared to $2,056 for the entire cohort which was a significant difference (P < 0.0001). Incidence of behavioral health conditions, low back pain, obesity, chronic obstructive pulmonary disease, hyperlipidemia and hypertension were increased in the LS group versus the plan population (P < 0.01). Pharmaceutical expenditure for those with LS was a median of $267.58 compared to $94.80 average for the entire cohort (P < 0.0001). Conclusions: The presence of LS in this privately insured population significantly raises costs, exacerbated by elevated rates of mental health and other comorbidities, highlighting the need for comprehensive care addressing these complexities to improve health outcomes and reduce overall expenses.

The cost-of-illness of multiple sclerosis in Jordan

ABSTRACT Background Multiple Sclerosis (MS) imposes a significant financial burden on health-care systems. This study aims to determine the cost-of-illness (COI) for MS in Jordan, a country where data on the economic impact of MS are scarce. Methods Data were collected for one year, annual COI was estimated using a cross-sectional snowball sampling design. Eligible patients completed a self-reported questionnaire to provide sociodemographic, physician visit, and diagnostic and laboratory test data. Indirect costs were estimated using an adjusted Human Capital Approach. Results This study included 383 patients, (73% females, 61% between 26-45). Eighty % took disease-modifying therapies (DMTs), and 40% had relapses in that year. One-third use non-DMTs and equipment for assistance. The average annual cost per patient was $11,719 (direct costs=$11,252, indirect costs=$467). The total annual cost for all participants was $748,299. The estimated cost of non-DMT, medical tools, diagnostic tests, and hospitalization per patient was $53, 51, 99, and 235 respectively. Conclusion High costs of DMTs state the necessity of resource optimization in Jordan public healthcare facilities. Such findings yield policy-informing actionable insights, suggesting strategic investments in more cost-effective DMTs with potential improvement in accessibility and reduction in the overall economic burden faced by both patients and governments.