Average Patient Cost Research Articles

Preoperative nutritional evaluation of prostate cancer patients undergoing laparoscopic radical prostatectomy.

Background and objectiveProstate cancer (PCa) is one of the most common malignant tumors in men. Geriatric Nutritional Risk Index (GNRI) is an objective index for evaluating nutritional status of elderly people over 65 years old. The aim of the current study was to explore the correlation and predictive value between GNRI and postoperative recovery and complications in PCa patients undergoing laparoscopic radical prostatectomy (LRP).MethodsTaking 98 as the GNRI boundary value, 96 PCa patients (aged≥65 y) undergoing LRP in the Department of Urology, Affiliated Hospital of North Sichuan Medical College from January 2018 to December 2020 were grouped into malnutrition group (MNg, 34 patients, 35.4%) and normal nutrition group (NNg, 62 patients, 64.6%). Basic information, laboratory examination indexes, operation conditions, postoperative complications and postoperative recovery indexes of patients were recorded and retrospectively analyzed. Clavien-Dindo Classification System (CDCS) was used to assess postoperative complications. T-test was used to analyze differences between the two groups. ROC curve was generated to determine the predictive value of GNRI for postoperative complications.ResultsPercentage of complications was significantly higher in MNg group compared with that in NNg group (P < 0.01). The average grade based on CDCS was significantly lower in NNg group compared with that in MNg group (P < 0.01). Body weight, Body Mass Index (BMI), preoperative hemoglobin value (HGB), serum albumin (ALB) values of MNg and NNg were significantly positively correlated with GNRI (P<0.01). Incidence and severity of postoperative complications of MNg patients were significantly higher compared with those of NNg patients (P<0.05). Average hospitalization cost of MNg patients was higher in MNg patients compared with that of NNg patients (P<0.05). Duration of post-anesthesia care unit (PACU), duration of antibiotic use and duration of indwelling drainage tube were longer in MNg patients compared with those in NNg patients (P<0.05). Furthermore, volume of indwelling drainage tube was higher in MNg patients compared with that in NNg patients (P<0.05).ConclusionGNRI is an effective and reliable tool for evaluation of preoperative nutritional status of prostate cancer patients. The findings showed that GNRI is correlated with postoperative recovery and complications, and is an effective predictive marker.

Complication and cost analysis of transbronchial lung cryobiopsy and awake video-assisted thoracic surgery in diagnosis of interstitial lung disease.

Aim and introduction:Diagnosing of interstitial lung disease (ILD) is difficult and expensive. The standard diagnostical approaches to ILD are bronchoalveolar lavage, transbronchial lung biopsy, transbronchial lung cryobiopsy (TBLC) and surgical lung biopsy (SLB). SLB is gold standard for the confident diagnosis of ILD but because of the poor performance of the patients it’s use is limited. We conducted a retrospective study to point out that TBLC plays an important role in diagnosis of ILD and has fewer complications and lower cost than awake video-assisted thoracic surgery (AVATS).Material and methods:132 patients who underwent TBLC and AVATS with a pre-diagnosis of ILD in our hospital between 2015 and 2020 were evaluated retrospectively. Diagnosis rates, complications and costs were recorded.Results:There were no non-diagnostic materials in 44 patients in AVATS arm. Prolonged air leak was observed in 11(25.0%) of the patients, and six of them (13.6%) were discharged with Heimlich Valve (HV). Median length of stay in the hospital was 8 days, while average patient cost was $515.9 (415.2-2662.9) in the AVATS arm. Non-diagnostic material was obtained from 10 (11.3%) of 88 patients in TBLC arm. Six (6.8%) of them had pneumothorax, only one of them required a chest tube. No patient was discharged with HV (p=0.001). Median cost for each patient with a median hospital stay of 2.0 (1.0-21.0) (p<0.001) days was $171.9 (80.8-1493.3) (p<0.001).Discussion:Although TBLC is behind AVATS in terms of diagnostic accuracy, it may be an alternative diagnostic tool in the diagnosis of interstitial lung disease due to its acceptable safety profile and cost-effectiveness.

Patient-specific and healthcare real-world costs of atrial fibrillation in individuals treated with direct oral anticoagulant agents or warfarin

BackgroundAnticoagulant therapies are used to prevent atrial fibrillation-related strokes, with warfarin and direct oral anticoagulant (DOAC) the most common. In this study, we incorporate direct health care costs, drug costs, travel costs, and lost working and leisure time costs to estimate the total costs of the two therapies.MethodsThis retrospective study used individual-level patient data from 4000 atrial fibrillation (AF) patients from North Karelia, Finland. Real-world data on healthcare use was obtained from the regional patient information system and data on reimbursed travel costs from the database of the Social Insurance Institution of Finland. The costs of the therapies were estimated between June 2017 and May 2018. Using a Geographical Information System (GIS), we estimated travel time and costs for each journey related to anticoagulant therapies. We ultimately applied therapy and travel costs to a cost model to reflect real-world expenditures.ResultsThe costs of anticoagulant therapies were calculated from the standpoint of patient and the healthcare service when considering all costs from AF-related healthcare visits, including major complications arising from atrial fibrillation. On average, the annual cost per patient for healthcare in the form of public expenditure was higher when using DOAC therapy than warfarin therapy (average cost = € 927 vs. € 805). Additionally, the average annual cost for patients was also higher with DOAC therapy (average cost = € 406.5 vs. € 296.7). In warfarin therapy, patients had considerable more travel and time costs due the different implementation practices of therapies.ConclusionThe results indicated that DOAC therapy had higher costs over warfarin from the perspectives of the patient and healthcare service in the study area on average. Currently, the cost of the DOAC drug is the largest determinator of total therapy costs from both perspectives. Despite slightly higher costs, the patients on DOAC therapy experienced less AF-related complications during the study period.

Cost-Effectiveness of Combination of Baricitinib and Remdesivir in Hospitalized Patients with COVID-19 in the United States: A Modelling Study.

IntroductionBaricitinib–remdesivir (BARI-REM) combination is superior to remdesivir (REM) in reducing recovery time and accelerating clinical improvement among hospitalized patients with coronavirus disease 2019 (COVID-19), specifically those receiving high-flow oxygen/noninvasive ventilation. Here we assessed the cost-effectiveness of BARI-REM versus REM in hospitalized patients with COVID-19 in the USA.MethodsA three-state model was developed addressing costs and patient utility associated with COVID-19 hospitalization, immediate post hospital care, and subsequent lifetime medical care. Analysis was performed from the perspective of a payer and a hospital. Both perspectives evaluated two subgroups: all patients and patients who required oxygen. The primary measures of benefit in the model were patient quality-adjusted life years (QALYs) accrued during and after hospitalization, cost per life years gained, cost per death avoided, and cost per use of mechanical ventilation avoided.ResultsIn the base-case payer perspective with a lifetime horizon, treatment with BARI-REM versus REM resulted in an incremental total cost of $7962, a gain of 0.446 life years and gain of 0.3565 QALYs over REM. The incremental cost-effectiveness ratios of using BARI-REM were estimated as $22,334 per QALY and $17,858 per life year. The base-case and sensitivity analyses showed that the total incremental cost per QALY falls within the reduced willingness-to-pay threshold of $50,000/QALY applied under health emergencies. In all hospitalized patients, treatment with BARI-REM versus REM reduced total hospital expenditures per patient by $1778 and total reimbursement payments by $1526, resulting in a $252 reduction in net costs per patient; it also resulted in a net gain of 0.0018 QALYs and increased survival of COVID-19 hospitalizations by 2.7%.ConclusionOur study showed that BARI-REM is cost-effective compared to using REM for hospitalized patients with COVID-19. The base-case results of this cost-effectiveness model were most sensitive to average annual medical costs for recovered patients.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-021-01982-6.

Abstract 10289: Costs of Endoscopic vs Open Vein Harvesting for Coronary Artery Bypass Grafting: Insights from the Regroup Trial

Introduction: Endoscopic Vein Harvesting (EVH) provides comparable rates in major adverse cardiac events to Open Vein Harvest (OVH) based on the intermediate-term results of the REGROUP Trial. Value based purchasing places more pressure to examine whether minimally invasive techniques, e.g., EVH, yield intended or unintended economic effects. The objective of this study was to compare health care costs between participants randomized to EVH or OVH during coronary artery bypass graft (CABG) surgery in the REGROUP trial. Hypothesis: We hypothesized that EVH would result in lower discharge and follow-up costs compared to the traditional OVH. Methods: Department of Veterans Affairs Cooperative Studies Program #588 (Clinicaltrials.gov NCT01850082) randomized 1150 participants (574 OVH, 576 EVH) at 16 VA medical centers. We linked participants to VA administrative data in VA’s Corporate Data Warehouse and extracted activity-based cost data starting with the index surgery. We analyzed discharge costs for the index surgery as well as follow-up costs in 30-day periods for EVH vs. OVH, comparing results from different statistical models to test for robustness. All costs were standardized to 2020 US dollars. Results: The unadjusted average cost for CABG patients with EVH and OVH was $76,607 (SD $43,883) and $75,368 (SD $45,900), respectively; the costs include both facility and provider costs. Despite the skewed variation in costs, there were no significant differences in discharge costs and high-cost patients were equally likely in both groups. We also found no significant differences in follow-up costs; the average follow-up period was 33 months (maximum follow-up was 85 months). The results were highly robust to the statistical model. Conclusions: Endoscopic harvesting was not associated with a reduction in costs for the index CABG surgery or follow-up care, nor was it associated with increased costs through unintended events. Therefore, the choice to provide endoscopic harvesting should be based on surgeon and patient preferences.

Cost-effectiveness of hemodialysis, peritoneal dialysis and kidney transplantation at dr Sadjito General Hospital in 2018-2020

Background: Chronic kidney disease (CKD) is a non-communicable disease with high morbidity and mortality. Treatment options for CKD patients are kidney transplantation, hemodialysis, and peritoneal dialysis. Kidney transplantation remains the best option for CKD patients, which has the best Quality of Life compared to other therapies. The cost of therapy for CKD patients is relatively high. Even in developed countries, renal replacement therapy costs are still a burden on the health system and a public health problem. Therefore, this study aims to compare the cost of care for CKD patients undergoing kidney transplantation, hemodialysis, and peritoneal hemodialysis at dr. Sardjito General Hospital, Indonesia.Methods: This study was a retrospective cohort study of patients who underwent kidney transplantation, continuous ambulatory peritoneal dialysis (CAPD) or hemodialysis from January 2018 to December 2020 at dr. Sardjito General Hospital. We reviewed the medical records, and the data collected was ordinal, numeric, and categorical data. The data was then coded and processed using SPSS version 25.0. The results are presented in descriptive form, tables, or diagrams.Results: In this study, we found 87 CKD samples. Thirty patients underwent kidney transplantation, 27 patients underwent CAPD, and 30 patients were randomly assigned to undergo routine hemodialysis. Based on the data obtained from this study, the average cost incurred in the first year for patients undergoing kidney transplantation at dr. Sardjito General Hospital amounted to 384.6 million IDR. For CAPD patients, it was 93.7 million IDR, and the average cost for patients undergoing outpatient hemodialysis routinely was 104.1 million IDR. The estimated average cost incurred in the third year after the procedure for kidney transplant patients is 393.7 million IDR, CAPD patients 273.7 million IDR, and patients undergoing routine hemodialysis 307.8 million IDR. The estimated average cost incurred for CKD patients undergoing kidney transplantation was 402.7 million IDR in the fifth year. For CAPD patients was 273.7 million IDR, and for patients undergoing routine hemodialysis was 511.5 million IDR.Conclusions: The results showed a difference in costs between kidney transplantation, CAPD and hemodialysis. The kidney transplant cost is much more expensive than CAPD and hemodialysis, but the monthly cost is much cheaper than the other two procedures. In the third year estimation, the costs incurred for CAPD and hemodialysis will be close to the costs incurred for kidney transplantation. In the fifth year, the costs for kidney transplantation will be smaller than the costs for CAPD and hemodialysis.

Direct medical cost of nephropathy in patients with type 2 diabetes.

Although it is known in the literature that the medical cost due to the complications of diabetes mellitus (DM) is high, data about the effect of diabetic kidney disease (DKD) on medical cost are limited. The aim of this study is to investigate the cost of hospitalized patients with nephropathy due to type 2 DM, the parameters closely related to this cost and the effect of diabetic nephropathy stage on medical hospitalization costs. The study group consisted of 141 patients with DKD, and the control group consisted of 111 patients with DM without chronic complications in this retrospective study. The demographic characteristics, duration of diabetes and HbA1c values of the patients were recorded at the time of their first hospitalization, medical hospitalization costs, and the length of stay in hospital were recorded for a year from the date of hospitalization. The total medical hospitalization costs of the patients were divided into two groups as cost of medications and supplies and service cost. Patients with DKD were compared according to their dialysis status and nephropathy stages. While the average cost of a patient with DKD was 603 (283-1267) United States Dollars (USD), the average cost of a DM patient without complications was 222 (141-292) USD (p < 0.05). It was observed that the patients with DKD had higher medical hospitalization costs and length of stay in hospital compared to patients with diabetes without complications. In addition, it was observed that the medical hospitalization costs and the length of stay in hospital were significantly higher in patients undergoing dialysis than patients who did not undergo dialysis (p < 0.05 for each). An independent relation was found between average cost and duration of diabetes in patients with DKD (p < 0.05). No relation was found between diabetic nephropathy stage and medical hospitalization costs (p > 0.05 for each). The estimated cost of treatment of DKD is higher than patients with uncomplicated diabetes. If preventive measures are not taken for DKD, it will continue to be a heavy economic burden.

Long-Term Medicare Costs Associated With Opioid Analgesic Therapy vs Spinal Manipulative Therapy for Chronic Low Back Pain in a Cohort of Older Adults

ObjectivesThe purpose of this study was to compare Medicare healthcare expenditures for patients who received long-term treatment of chronic low back pain (cLBP) with either opioid analgesic therapy (OAT) or spinal manipulative therapy (SMT). MethodsWe conducted a retrospective observational study using a cohort design for analysis of Medicare claims data. The study population included Medicare beneficiaries enrolled under Medicare Parts A, B, and D from 2012 through 2016. We assembled cohorts of patients who received long-term management of cLBP with OAT or SMT (such as delivered by chiropractic or osteopathic practitioners) and evaluated the comparative effect of OAT vs SMT upon expenditures, using multivariable regression to control for beneficiary characteristics and measures of health status, and propensity score weighting and binning to account for selection bias. ResultsThe study sample totaled 28,160 participants, of whom 77% initiated long-term care of cLBP with OAT, and 23% initiated care with SMT. For care of low back pain specifically, average long-term costs for patients who initiated care with OAT were 58% lower than those who initiated care with SMT. However, overall long-term healthcare expenditures under Medicare were 1.87 times higher for patients who initiated care via OAT compared with those initiated care with SMT (95% CI 1.65-2.11; P < .0001). ConclusionsAdults aged 65 to 84 who initiated long-term treatment for cLBP via OAT incurred lower long-term costs for low back pain but higher long-term total healthcare costs under Medicare compared with patients who initiated long-term treatment with SMT.

COST EVALUATION OF STROKE THERAPY COMPARED TO INA-CBGs ON INPATIENTS AT ANUTAPURA HOSPITAL

ABSTRACTStroke is the third cause of death in the world after heart disease, cancer, and disability including disability categorized based on its severity: mild (I), moderate (II), and severe (III) severity. This study aims to determine the difference total cost of ischemic and hemorrhagic stroke therapy, each, with INA-CBGs rates. The method of data collection was conducted retrospectively taken from medical record data, and on patient medical expenses. The subject were ischemic and hemorrhagic stroke patients hospitalized from 2016-2017 at Anutapura Hospital who met the inclusion and exclusion criteria. There were 134 patients who met the inclusion criteria, 68% were ischemic stroke patients and 32% were hemorrhagic stroke patients. The result of research showed that there were significant differences in costs (p &lt;0.05) between hospital real costs and INA-CBGs rates. The average total real cost of treatment for ischemic stroke therapy was IDR 7,360,196.70 and the cost of the INA-CBGs was IDR 7,427,251.65 for 91 inpatients; and the average total cost of patients with hemorrhagic stroke therapy took IDR 10,606,834.34 with average of INA CBG’s rate at IDR 4,399,393.02 for 43 inpatients. The conclusion is both of stroke therapy proved significant difference compared to BPJS claimed amount of money.Keywords: pharmacoeconomic, cost analysis, ischemic stroke, haemorrhage stroke, INA-CBG’s rate.

Patient costs for prevention of mother-to-child HIV transmission and antiretroviral therapy services in public health facilities in Zimbabwe.

Zimbabwe has made large strides in addressing HIV. To ensure a continued robust response, a clear understanding of costs associated with its HIV program is critical. We conducted a cross-sectional evaluation in 2017 to estimate the annual average patient cost for accessing Prevention of Mother-To-Child Transmission (PMTCT) services (through antenatal care) and Antiretroviral Treatment (ART) services in Zimbabwe. Twenty sites representing different types of public health facilities in Zimbabwe were included. Data on patient costs were collected through in-person interviews with 414 ART and 424 PMTCT adult patients and through telephone interviews with 38 ART and 47 PMTCT adult patients who had missed their last appointment. The mean and median annual patient costs were examined overall and by service type for all participants and for those who paid any cost. Potential patient costs related to time lost were calculated by multiplying the total time to access services (travel time, waiting time, and clinic visit duration) by potential earnings (US$75 per month assuming 8 hours per day and 5 days per week). Mean annual patient costs for accessing services for the participants was US$20.00 [standard deviation (SD) = US$80.42, median = US$6.00, range = US$0.00-US$12,18.00] for PMTCT and US$18.73 (SD = US$58.54, median = US$8.00, range = US$0.00-US$ 908.00) for ART patients. The mean annual direct medical costs for PMTCT and ART were US$9.78 (SD = US$78.58, median = US$0.00, range = US$0.00-US$ 90) and US$7.49 (SD = US$60.00, median = US$0.00) while mean annual direct non-medical cost for US$10.23 (SD = US$17.35, median = US$4.00) and US$11.23 (SD = US$25.22, median = US$6.00, range = US$0.00-US$ 360.00). The PMTCT and ART costs per visit based on time lost were US$3.53 (US$1.13 to US$8.69) and US$3.43 (US$1.14 to US$8.53), respectively. The mean annual patient costs per person for PMTCT and ART in this evaluation will impact household income since PMTCT and ART services in Zimbabwe are supposed to be free.

208. Improvements in outcomes and cost after adult spinal deformity corrective surgery between 2008 and 2019

<h3>BACKGROUND CONTEXT</h3> As surgical methods and technology advance, so should improvements in patient outcomes and cost effectiveness. <h3>PURPOSE</h3> To assess whether patient outcomes and cost effectiveness have improved over the past 10 years. <h3>STUDY DESIGN/SETTING</h3> Retrospective. <h3>PATIENT SAMPLE</h3> This study included 1,236 adult spinal deformity (ASD) patients. <h3>OUTCOME MEASURES</h3> Complications, reoperations, health related quality of life measures (HRQL), total cost, utility gained, quality adjusted life years (QALYs). <h3>METHODS</h3> ASD patients with baseline (BL) and up to 2-year (2Y) HRQL data between the years of 2008-2019 were included. Incomplete yearly data from 2008 and 2019 were combined with 2009 and 2018, respectively. ANCOVA established estimated marginal means for outcome measures (complication rates, reoperations, HRQLs, total cost, utility gained, QALYs, cost efficiency [cost per QALY]) by year of initial surgery adjusting for covariates including age, gender, decompression or osteotomy, surgical approach, invasiveness, and BL deformity (pelvic tilt, pelvic incidence, lumbar lordosis). Trend-line slope indicated yearly changes. Cost was calculated using the PearlDiver database and assessed for complications/major complications and comorbidities according to CMS.gov definitions. These costs represented national averages of Medicare pay-scales for services within a 30-day window including length of stay and death differentiated by complication/comorbidity, revision, and surgical approach. Internal cost data were based on individual patient DRG codes, limiting revisions to those within 2 years of the initial surgery. <h3>RESULTS</h3> A total of 1,236 patients (2009: 117 patients, 2010: 97, 2011: 75, 2012: 45, 2013: 106, 2014: 127, 2015: 115, 2016: 204, 2017: 202, 2018: 148) were included with no significant differences in baseline ODI by year. There was an overall decrease in rates of any complication (0.78 vs 0.61), any reoperation (0.25 vs 0.10), and minor complication (0.54 vs 0.37) between 2009 and 2018 (all p<0.05). Minor complications decreased by 2.48% per year (R2=0.5179), with a 1.84% yearly decrease in any complication (R2=0.8322), 1.33% decrease in any reoperation (R2=0.2211), and 0.82% decrease in major complication (R2=0.1435). BL to 2Y difference in SF-36 PCS had the greatest improvement (0.2526 increase per year, R2=0.3985) and ODI BL to 2Y difference improved by 0.3687 per year (R2=0.3683). National average 2Y cost decreased at a yearly rate of $3,194 (R2=0.6602), 2Y utility gained had a yearly increase of 0.0041 (R2=0.57), 2Y QALYs gained increased yearly by 0.008 (R2=0.57), and 2Y cost per QALY decreased yearly by $39,953 (R2=0.6778). Adjusting for inflation since 2009, internal DRG data verified the trend of national average costs, as overall costs (including revisions within 2Y) have decreased at a rate of $793 each year (R2=0.0483). This resulted in a decrease in cost per QALY at 2Y of $19,903 per year (R2=0.3181). <h3>CONCLUSIONS</h3> Between 2008 and 2019, rates of complications have decreased concurrently with improvements in patient reported outcomes, resulting in improved cost effectiveness according to national Medicare average and individual patient cost data. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Comparison of out-of-pocket cost between apixaban and enoxaparin for extended-duration venous thromboembolism prophylaxis in gynecologic oncology patients

<h3>Objectives:</h3> To compare out-of-pocket cost between apixaban and enoxaparin for prevention of postoperative venous thromboembolism (VTE) in gynecologic oncology patients. Current guidelines recommend low molecular weight heparin for thromboprophylaxis following gynecologic cancer surgery, but new evidence suggests that oral apixaban may provide another safe and effective alternative. Recent publications have suggested apixaban more cost-effective, however these data do not evaluate out-of-pocket cost. <h3>Methods:</h3> This retrospective study was approved by the institutional QIAB. Patients undergoing open surgery for gynecologic malignancy qualified for this study. Test claims for apixaban 2.5 mg by mouth twice daily and enoxaparin 40 mg subcutaneously daily for 28 days were submitted for each patient prior to surgery. Patient copays, number of patients requiring prior authorization, and number of patients without prescription insurance were collected. <h3>Results:</h3> A total of 86 consecutive patients had test claims sent for both apixaban and enoxaparin thromboprophylaxis between July 2020 and October 2020. The average patient out-of-pocket cost to complete 28 days of apixaban prophylaxis was $73.95 (median $42.84, range $0-448.45). The average patient cost to complete 28 days of enoxaparin prophylaxis was $38.08 (median $10, range $0-260.91). Partial fills were allowed for 4 of 5 enoxaparin prescriptions that required prior authorization. A total of 5 apixaban prescriptions (5.8%) required prior authorization for full 28 days. A total of 5 patients (5.8 %) did not have prescription insurance. Cash price for enoxaparin was nearly double the cash price of apixaban. A total 6 patients' (7 %) insurance was not contracted with our pharmacy. A single patient (1.2%) required enoxaparin via specialty pharmacy. A total of 2 patients (2.3 %) were enrolled in the institution's financial assistance per the institution. <h3>Conclusions:</h3> Patients prescribed extended-duration venous thromboembolism prophylaxis may face higher out-of-pocket costs with apixaban than with enoxaparin. Prior authorizations can often take 48 to 72 hours for approval. Sending test claims prior to surgery can help identify prescriptions that will need prior authorizations so prescriptions can be sent earlier to avoid discharge delays and patient nonadherence. There may not be a one size fits all solution and individualized patient care should be considered. Future research areas should evaluate patient adherence with a twice daily oral pill vs a once daily injection.

Treatments costs associated with inpatient clinical deterioration

AimsThis study aimed to quantify the health economic treatment costs of clinical deterioration of patients within 72 h of admission via the emergency department. MethodsThis study was conducted between March 2018 and February 2019 in two hospitals in regional New South Wales, Australia. All patients admitted via the emergency department were screened for clinical deterioration (defined as initiation of a medical emergency team call, cardiac arrest or unplanned admission to Intensive Care Unit) within 72 h through the site clinical deterioration databases. Patient characteristics, including pre-existing conditions, diagnosis and administrative data were collected. Results1600 patients clinically deteriorated within 72 h of hospital admission. Linked treatment cost data were available for 929 (58%) of these patients across 352 Australian Refined Diagnosis Related Groups. The average (standard deviation) treatment costs for patients who deteriorated within 72 h was $26,778 ($34,007) compared to $7727 ($12,547). The average hospital length of stay of the deterioration group was nearly 8 days longer than patients without deterioration. When controlling for length of stay and Australian Refined Diagnosis Related Group codes, the incremental cost per episode of deterioration was $14,134. ConclusionClinical deterioration within 72 h of admission is associated with increased treatment costs irrespective of diagnosis, hospital length of stay and age. Implementation of interventions known to prevent patient deterioration require evaluation.

Real World Management of Multiple Myeloma in Asia: Treatment Pattern and Cost

Introduction:Multiple myeloma (MM) is the second most common hematologic malignancies in the world. New approved therapeutic agents have improved the survival rates of myeloma patients. However, it is often unclear what is the best treatment in different settings, and the treatment cost is rising. In this study, we assess the way MM is treated in a developed country in Asia.Methods:A retrospective study of newly diagnosed MM patients from June 2009 to April 2017 from Singapore was conducted. The analysis focused on the age of patient, medication regimes used for different lines of treatment, whether autologous stem cell transplant (SCT) was received and the estimated cost of treatment. Treatment free period (TFP) was measured as time from the end date of previous treatment to the start date for the next treatment. The time to next treatment (TTNT) was measured from the start date of the first treatment to the start date of the next line of treatment.Results:A total of 143 patients were included in the analysis. Among the 96 (67.1%) patients under 65 years old, only 73 (76%) received autologous SCT treatment. Overall, 56 (39.2%) of the patients progressed and received second (2nd) line treatment, while 21 (14.7%) and 9 (6.3%) received 3rd and 4th line treatment respectively. The most frequently used drugs for 1st line treatment were Bortezomib (75.5%), Dexamethasone (87.4%), Thalidomide (63.6%) and Cyclophosphamide (53.8%). This reflects that the 2 most commonly used regimens for 1st line treatment are VCD and VTD. For 2nd line treatment, Lenalidomide (50%) and Dexamethasone (94.6%) were the main drugs used, reflecting that RD was the predominant regimen used in this phase. For 3rd line treatment, Dexamethasone (100%), Pomalidomide (38.1%), Cyclophosphamide (33.3%) and Lenalidomide (33.3 %) were the main drugs used.Focusing on individual drugs, while Lenalidomide was only used 7.7% of the time for 1st line treatment, usage increased to 50% and 33.3% for 2nd and 3rd line treatment respectively. For Pomalidomide, while usage was low at 0% and 7.1% for 1st and 2nd line treatment respectively, it increased to 38.1% for 3rd line treatment. Bortezomib, Thalidomide and Cyclophosphamide were predominantly used as 1st line treatment choices, with usage rates of 75.5%, 63.6% and 53.8% respectively. Their usage rates were significantly reduced in 2nd and 3rd line treatment.The average treatment cost per TFP (weeks) among 56 patients who progressed to 2nd line treatment was $673.81/week. The average cost increased to $2,239/week and $11,556.56/week for the patients who received 3rd and 4th line treatment respectively. For SCT patients (30 patients progressed to 2nd line, 7 patients to 3rd line, and 4 patients to 4th line), the average cost per TFP was $705.87/week, $2,078.66/week and $35,854.20/week for 2nd, 3rd and 4th line of treatment respectively. For non-SCT patients (26 patients progressed to 2nd line, 14 patients to 3rd line, and 5 patients to 4th line), the average cost per TFP was $603.64/week, $2,333.25/week and $5,959.72/week for 2nd, 3rd and 4th line of treatment respectively.The average TTNT per patient for 1st, 2nd and 3rd treatment line progression was 128.8, 58.7 and 75.5 weeks respectively. The average TTNT per SCT patient was 142.4, 65.6 and 74.9 weeks for 1st, 2nd and 3rd treatment line progression respectively, as compared to 113.1, 55.2 and 75.9 weeks for non-SCT patients. Overall, the average treatment cost per week of TTNT was $409.18, $798.10 and $2,167.92 for 1st, 2nd and 3rd treatment line progression respectively - the average cost for SCT patients was $496.91, $736.23 and $2,855.34, while the average cost for non-SCT patients was $281.81, $834.81 and $1,625.58 respectively.Conclusions:Treatment for multiple myeloma remains expensive. While the benefits of subsequent lines of treatment decreases, the average treatment cost increases. With the increasing availability of expensive but yet more effective treatments, these could be incorporated early into the treatment regimen to maximise therapeutic benefit. Despite the higher cost of these drugs, cost-effectiveness could be improved, or at least remain similar if TTNT can be greatly prolonged. [Display omitted] DisclosuresChng:Janssen China R&D: Research Funding.

Analysis of Chronic Disease Direct Cost at Public Primary Health Cares in Indonesia

Objectives: This study aims to analyze the of drug costs for patients with chronic diseases in the capitation system in public primary health cares (Public PHCs).&#x0D; Materials and Methods: This research is a quantitative study with an observational cross-sectional approach at 16 Public PHCs. Data collection used the retrospective method. The total sample was 293 outpatients in 2016.&#x0D; Results: The results showed that 63% of patients are female. The most patients are aged between 56-65 years (37%). The average drug cost for patients receiving more than 3 types of drugs is IDR 7,726. The biggest drug cost is patients with DM type 2 with which the average cost is IDR 7.400. And the metformin treatment is 17 (6%) patients with the cost IDR 4,500,-. Chi-square analysis shows that the quantity of drug items, type of disease and prescriptions there are have significant effect on drug cost (p-value &lt;0.05). However, gender and age group there are no significant effect on drug cost (p-value &gt;0.05). Drug prescriptions are an important component in managing chronic diseases patients. Prescribing costs provide important information in the sustainability of the management of chronic disease programs.&#x0D; Conclusion: This study recommends that the prolanis policy in public PHCs is focused on the elderly age group patients and female group.&#x0D; Bangladesh Journal of Medical Science Vol.20(4) 2021 p.762-767

Findings from a caries risk assessment registry quality improvement initiative in an oral health partnership model.

This quality improvement study evaluates the impact of a caries risk assessment (CRA) registry on the following: percentage of children with a documented CRA, receipt of preventive and restorative services, and costs of care. We used 2014-2019 data for patients aged 0-17 years from 22 locations in a group practice in Wisconsin. Paired t-tests and Wilcoxon signed-rank tests were used to evaluate changes over time in the following practice-level outcomes: CRA documentation, fluoride receipt, continuing care procedures, restorative procedures, total procedures, and inflation-adjusted costs of care. The same tests were used to compare average procedures and cost for patients a) enrolled and not enrolled in the registry, b) with and without CRA documentation, and c) at high and low caries risk. CRA documentation increased from 13percent in 2014 to 87percent in 2019 (P < 0.0001). There were statistically significant increases in the average number of continuing care procedures (from 1.47 to 1.54, P < 0.001), average total procedures (from 7.40 to 8.36, P < 0.001), and inflation-adjusted average cost (from $491.51 to $553.37, P < 0.001) after accounting for multiple comparisons. The average number of restorative procedures decreased, with borderline statistical significance. Average cost was stable for registry-enrolled patients and increased for those not enrolled. The registry achieved the primary goal of improving CRA documentation among children. This quality improvement initiative appears to have had value-enhancing effects by promoting increased receipt of preventive services and decreased restorative services, while maintaining stable average cost of care for registry-enrolled patients over time.

Cost-utility of talazoparib monotherapy treatment for locally advanced or metastatic breast cancer in Spain

Breast cancer is one of the most frequent malignancies. The aim of the article is to analyse the cost-utility ratio and budgetary impact of talazoparib treatment for patients with locally advanced or metastatic gBRCA + breast cancer from the perspective of the Spanish National Health System. Analyses were based on the EMBRACA clinical trial and the model was constructed according to “partitioned survival analysis”. Two scenarios were considered in order to compare talazoparib with the alternatives of capecitabine, vinorelbine and eribulin: 1. Chemotherapy in patients pre-treated with anthracyclines/taxanes and, 2. A second- and subsequent-line treatment option. Treatment types following relapse were recorded in the mentioned clinical trial. The effectiveness measure used was quality-adjusted life years (QALY). The average health cost of patients treated at 43 months with talazoparib was 84,360.86€, whilst current treatment costs were 26,683.90€. The effectiveness of talazoparib was 1.93 years of survival (1.09 QALY) relative to 1.58 years (0.83 QALY) in the treatment group. The incremental cost-utility ratio was 252,420.04€/QALY. This represents the additional cost required to earn an additional QALY when changing from regular treatment to talazoparib. Regarding budgetary impact, the number of patients susceptible to receiving treatment with between 94 and 202 talazoparib was estimated, according to scenario and likelihood. The 3-year cost difference was between 6.9 and 9 million euros. The economic evaluation conducted shows an elevated incremental cost-utility ratio and budgetary impact. Taking these results into account, the price of talazoparib would have to be lower than that taken as a reference to reach the cost-utility thresholds.

Healthcare Costs Associated with Complications in Patients with Type 2 Diabetes among 1.85 Million Adults in Beijing, China.

We aimed to provide reliable regression estimates of expenditures associated with various complications in type 2 diabetics in China. In total, 1,859,039 type 2 diabetes patients with complications were obtained from the Beijing Medical Claim Data for Employees database from 2008 to 2016. We estimated costs for complications using a generalized estimating equation model adjusted for age, sex, and the incidence of various complications. The average total cost for diabetic patients with complications was 17.12 thousand RMB. Prescribed drugs accounted for 63.4% of costs. We observed a significant increase in costs in the first year after the onset of complications. Compared with costs before the incidence of complications, the additional costs per person in the first year and >1 year after the event would be 10,631.16 RMB and 1150.71 RMB for cardiovascular disease, 1017.62 RMB and 653.82 RMB for cerebrovascular disease, and 301.14 RMB and 624.00 RMB for kidney disease, respectively. The estimated coefficients for outpatient visits were relatively lower than those of inpatient visits. Complications in diabetics exert a significant impact on total healthcare costs in the first year of their onset and in subsequent years. Our estimates may assist policymakers in quantifying the economic burden of diabetes complications.

Health care services utilization and cost in the last year of life in Colombia: a retrospective study

Introduction: Health care costs at the end of life cause a high expenditure on health care resources. The implementation of integrated palliative care programs has proven to be cost-efficient. The study aimed to analyze the consumption and cost of health care resources during the last year of life of patients who are not part of a palliative care program. Methods: A descriptive, longitudinal and retrospective study was conducted in patients of a Colombian health insurance company who died in 2013 due to pathologies that were susceptible and non-susceptible to palliative care. Causes of death were obtained from official death certificates. McNamara et al. strategy of classification was applied and adapted to assess services received during the last year of life. Analysis of costs was conducted by pathologies at different levels of care. Results: 3,392 deaths in 2013 (70% susceptible to palliative care and 30% non-susceptible to palliative care). Total health care cost: USD 47,550,155. Patients susceptible to palliative care were responsible for 84% of the year’s expenditure (the annual expenditure) (USD 40 million). There were significant differences between the average costs for susceptible and non-susceptible palliative care patients (USD 16,878 versus USD 7,433 per year, p &lt; 0.001). The average cost per patient for the last three months of life represented 52% of the expenditure during the last year of life (USD 8,754). The last month of life was 25.6% of the expenditure during the last year of life (USD 4,324). Conclusions: Cost of care for the last three months of life of susceptible palliative care patients generates a huge health care expenditure, mainly attributable to hospital care cost. The implementation of a palliative care program could decrease these assistance costs.

Quality of Life and Concurrent Procedures in Truncal Body Contouring Patients: A Single-Center Retrospective Study.

Body contouring procedures provide patients with a meaningful improvement in health-related quality of life (QoL). We aim to compare the difference between the QoL in patients undergoing a single post-bariatric abdominal body contouring procedure (BCP) and those undergoing two or more concurrent procedures. Patients evaluated for post-bariatric BCP were identified and administered the BODY-Q©. Patient demographics, clinical and operative characteristics, surgical outcomes, cost data, and absolute change in QoL scores were analyzed using descriptive statistics, chi-square, and Mann-Whitney U-test, between patients who underwent single (SP), double (DP), or triple (TP) concurrent procedures. A total of 45 patients were included. The median age was 52 years old ([IQR] ±13). The majority were female (71.1%) and African-American (55.5%). The most common single procedure was panniculectomy (75%). Surgical site occurrences, readmissions, and the complication composite outcome did not differ between groups (p>0.05). No difference was seen between SP and DP QoL score (p>0.05). The DP had a statistically lower net QoL score compared with TP cohort in four domains. The SP had a statistically lower net QoL score compared with the TP in three domains. Average total cost for patients receiving an SP was $8,048.44, compared with $19,063.94 for DP (p<0.01), and $19,765.02 for TP (p>0.05). Body contouring procedures are associated with improvements in QoL irrespective of the number of concurrent procedures. Further improvement in psychological well-being occurs for patients who proceed with double concurrent procedures, albeit with an increase in cost. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .