Average Direct Medical Cost Research Articles

Study of the Cost Effectiveness of Therapy in Hypertention Patients in Hospital

Hypertension is where the blood pressure is > 140 mmHg and > 90 mmHg. Combination therapy is needed if a single antihypertensive has not been able to control the desired blood pressure target while the cost of treatment is increasing from time to time. The purpose of this study was to determine the cost-effective combination therapy for antihypertensive drugs in hypertensive patients in an inpatient setting. This study is a descriptive study with a pharmacoeconomic analysis approach using the Cost Effectiveness Analysis (CEA) method which was carried out retrospectively. Data were collected using the Total Sampling technique with 93 patients which were then analyzed to determine the cost-effective therapy based on ACER and ICER. The results showed that hypertension was mostly experienced by patients aged 50-60 years, male sex was more than female. HT stage 2 is often experienced by patients. Type II DM is the most common comorbidity. The lowest ACER value is Rp. 65.195.77. The lowest ICER value is Rp. 7.047.2551 when compared with standard therapy, namely CCB + ACEI. The combinations used in the inpatient unit include two combinations of 42 patients (45.16%) three combinations of 37 patients (39.78%), four combinations 6 (6.45%) five combinations of 8 patients (8.6%). The lowest average direct medical cost is the combination of ACEI antihypertensive + Diuretic + -Blocker Rp. 2.765.262. The cost effective therapy based on ACER and ICER values is a combination of Diuretics + CCB + ACEI + Blockers with an ACER value of Rp. 65,195.77 and also dominant.            Â

Direct medical costs of ischemic heart disease in urban Southern China: a 5-year retrospective analysis of an all-payer health claims database in Guangzhou City.

This study aimed to estimate the direct medical costs and out-of-pocket (OOP) expenses associated with inpatient and outpatient care for IHD, based on types of health insurance. Additionally, we sought to identify time trends and factors associated with these costs using an all-payer health claims database among urban patients with IHD in Guangzhou City, Southern China. Data were collected from the Urban Employee-based Basic Medical Insurance (UEBMI) and the Urban Resident-based Basic Medical Insurance (URBMI) administrative claims databases in Guangzhou City from 2008 to 2012. Direct medical costs were estimated in the entire sample and by types of insurance separately. Extended Estimating Equations models were employed to identify the potential factors associated with the direct medical costs including inpatient and outpatient care and OOP expenses. The total sample included 58,357 patients with IHD. The average direct medical costs per patient were Chinese Yuan (CNY) 27,136.4 [US dollar (USD) 4,298.8] in 2012. The treatment and surgery fees were the largest contributor to direct medical costs (52.0%). The average direct medical costs of IHD patients insured by UEBMI were significantly higher than those insured by the URBMI [CNY 27,749.0 (USD 4,395.9) vs. CNY 21,057.7(USD 3,335.9), P < 0.05]. The direct medical costs and OOP expenses for all patients increased from 2008 to 2009, and then decreased during the period of 2009-2012. The time trends of direct medical costs between the UEBMI and URBMI patients were different during the period of 2008-2012. The regression analysis indicated that the UEBMI enrollees had higher direct medical costs (P < 0.001) but had lower OOP expenses (P < 0.001) than the URBMI enrollees. Male patients, patients having percutaneous coronary intervention operation and intensive care unit admission, patients treated in secondary hospitals and tertiary hospitals, patients with the LOS of 15-30 days, 30 days and longer had significantly higher direct medical costs and OOP expenses (all P < 0.001). The direct medical costs and OOP expenses for patients with IHD in China were found to be high and varied between two medical insurance schemes. The type of insurance was significantly associated with direct medical costs and OOP expenses of IHD.

Treatment costs for patients with Streptococcus suis infection in Northern Thailand: a hospital-based observational study of 14-year data

BackgroundStreptococcus suis (S.suis) is a neglected zoonotic disease that imposes a significant economic burden on healthcare and society. To our knowledge, studies estimating the cost of illness associated with S.suis treatment are limited, and no study focuses on treatment costs and potential key drivers in Thailand. This study aimed to estimate the direct medical costs associated with S.suis treatment in Thailand and identify key drivers affecting high treatment costs from the provider’s perspective.MethodsA retrospective analysis of the 14-year data from 2005–2018 of confirmed S.suis patients admitted at Chiang Mai University Hospital (CMUH) was conducted. Descriptive statistics were used to summarize the data of patients’ characteristics, healthcare utilization and costs. The multiple imputation with predictive mean matching strategy was employed to deal with missing Glasgow Coma Scale (GCS) data. Generalized linear models (GLMs) were used to forecast costs model and identify determinants of costs associated with S.suis treatment. The modified Park test was adopted to determine the appropriate family. All costs were inflated applying the consumer price index for medical care and presented to the year 2019.ResultsAmong 130 S.suis patients, the average total direct medical cost was 12,4675 Thai baht (THB) (US$ 4,016), of which the majority of expenses were from the “others” category (room charges, staff services and medical devices). Infective endocarditis (IE), GCS, length of stay, and bicarbonate level were significant predictors associated with high total treatment costs. Overall, marginal increases in IE and length of stay were significantly associated with increases in the total costs (standard error) by 132,443 THB (39,638 THB) and 5,490 THB (1,715 THB), respectively. In contrast, increases in GCS and bicarbonate levels were associated with decreases in the total costs (standard error) by 13,118 THB (5,026 THB) and 7,497 THB (3,430 THB), respectively.ConclusionsIE, GCS, length of stay, and bicarbonate level were significant cost drivers associated with direct medical costs. Patients’ clinical status during admission significantly impacts the outcomes and total treatment costs. Early diagnosis and timely treatment were paramount to alleviate long-term complications and high healthcare expenditures.

Healthcare resource utilization and cost of pneumococcal disease in children in Germany, 2014–2019: a retrospective cohort study

BackgroundSince the introduction of higher valency pneumococcal conjugate vaccines in 2009, recent estimates on the economic burden of pediatric pneumococcal disease (PD) in Germany have been lacking. This study estimates healthcare resource utilization (HCRU) and medical cost associated with PDs in children < 16 years old in Germany from 2014–2019.MethodsA nationally representative sample from the Institute for Applied Health Research (InGef) German claims database was used, covering approximately 5% of the total German population. Episodes of pneumococcal pneumonia (PP), all-cause pneumonia (ACP), invasive pneumococcal disease (IPD), and acute otitis media (AOM) in children aged < 16 years were identified using ICD-10-GM codes. HCRU was estimated from annual rates of outpatient visits, outpatient antibiotic prescriptions and inpatient admissions, divided by person-years (PY) at-risk. Average direct medical costs per episode were estimated as the total cost of all HCRU, divided by the total number of episodes. The Mann–Kendall test was used to assess monotonic time trends from 2014–2019.Results During 2014–2019, 916,805 children aged < 16 years were followed up for a total of 3,608,716 PY. The average costs per episode for out-versus inpatient care associated with PP and ACP were €67 (95% CI 58–76) versus €2,606 (95% CI 1,338–3,873), and €63 (95% CI 62–63) versus €620 (95% CI 598–641), respectively. For IPD, the average medical cost per episode for out-versus inpatients were €30 (95% CI 19–42) versus €6,051 (95% CI 3,323–8,779), respectively. There were no significant trends in HCRU or costs for IPD or pneumonia over the study period, except for a significant reduction in ACP outpatient visits. A significant decrease in rate of outpatient visits and antibiotic prescribing for recurrent AOM was observed, in addition to an increase in rates of hospital admissions for simple AOM. This was paralleled by a significant increase in inpatient costs per episode for treating AOM overall, and simple AOM, over the study period.Conclusions The HCRU and cost per episode of pneumonia and IPD did not vary significantly from 2014–2019, but increased for AOM. The economic burden of pneumonia, IPD, and AOM remains substantial in Germany.

Cost Analysis of Diagnosis and Treatment of Tobacco-Related Cancer.

Tobacco use is the leading cause of cancer, accounting for approximately 20% of all cancer deaths and 70% of lung cancer deaths worldwide. The use of tobacco has multiple consequences; it damages health and pushes the household below the poverty line. The treatment of cancer is very costly. The study attempts to determine the cost associated with the diagnosis and treatment of tobacco-related cancer in Nepal. A descriptive cross-sectional study was conducted among 103 patients from public and private hospitals in 2019. Patients with the second and third stages of cancer who had ever used tobacco were randomly selected for the study purpose. All patients who met the inclusion criteria were selected for interviews. The data were analyzed using SPSS version 22, and summarized in descriptive form only. The total cost of tobacco-related cancer was NPR 9,81,370 per patient in 2019. A patient's average direct medical cost was found to be NPR 5,88,740 (60%), whereas the average direct non-medical cost was NPR 1,23,147(13%). The wage loss as a result of illness accounted for over one-fourth (27%) of the total cost. Approximately one-sixth of the patients sold their property for the treatment of cancer. The majority of the cancer patients were found to be illiterate or with primary education only, and financially dependent on their families. Treatment of cancer is costly and patients in Nepal can hardly afford the expenses. Enrolling clients in health insurance and increasing the government subsidy by raising the tax on tobacco products can be a long-term source of health financing to protect patients from sliding into poverty. The increased price of tobacco due to an increase in tax would reduce tobacco consumption, particularly among youth and the poor.

Direct Medical Costs and Accordance of INA-CBG's Claims on Covid-19 Patients at Anutapura Hospital

Background: The pandemic Covid-19 has had an impact on various aspects of life, both socially and economically. One of the government's responsibilities is in financing the treatment of Covid-19 patients, which is stated in the Decree of the Minister of Health of the Republic of Indonesia Number HK.01.07/MENKES/5673/2021 regarding technical instructions for claiming the cost of Covid-19 services. Objectives: This study aimed to determine the average direct medical costs and according to the INA-CBGs rates for Covid-19 patients and the effect of length of stay, severity and comorbidities on the total cost from a hospital perspective. Material and Methods: This study was an observational descriptive study, used a sample of patients diagnosed with Covid-19 inpatients at Anutapura Hospital Palu in 2020. The sample was used 134 patients, who met the inclusion and exclusion criteria. The data collected includes patient characteristics, direct medical costs (consultation fees, visits, rooms, medical procedures, medical devices, examinations and drugs) and INA-CBGS rates. Results: the Covid-19 patients were hospitalized for 14 days (65.67%) with severe severity (92.54%), patients without comorbidities (comorbidities) (74.63%) and included in the group with INA-CBGs code was A-4-13-III (92.54%). The average direct medical cost of the patient was Rp. 5,371,333, with the largest cost being the room fee, which was 32.57% of the total cost. The average INA-CBG's tariff was Rp. 123,019,851. Conclusions: The INA-CBGs tariff was higher than direct medical costs with a difference of Rp. 117,648,518. The results of the linear regression test, it was found that there was a partial or simultaneous effect between length of hospitalization, severity and incidence of comorbidities on total direct medical costs.

Clinical and economic burden of healthcare-associatedinfections: A prospective cohort study.

Healthcare-associated infections (HAIs) have become a serious public health problem. Despite the fact that implementing evidence-based infection control strategies could prevent HAIs and save billions of dollars, Ethiopia lacks national surveillance studies on the rate, economic, and clinical burden of HAIs. To assess the clinical and economic burden of HAIs in hospitalized patients at Ayder comprehensive specialized hospital. A prospective cohort study design was conducted in patients with and without HAIs. A review of medical records, interviews, and patient bills was used to extract necessary information. The patients in the two arms were matched based on age, sex, Charlson comorbidity index, and ward type. Measurable factors were compared between infected and uninfected patients using the paired ttest or McNemar's test, as appropriate. Logistic regression was used to identify predictors of in-hospital mortality. Stata 14.1 was used to conduct all analyses. A total of 408 patients, 204 with HAIs and 204 without HAIs were included in the study. In-hospital mortality was higher in patients with HAI (14.7% vs 7.8%, P = 0.028). Patients with HAI stayed an average of 8.3 days longer than controls (18.85 vs 10.59, P<0.001). The average direct medical costs for patients with HAI were 3033 Ethiopian birrs (ETB) higher than controls (4826 vs 1793, P<0.001). The presence of HAIs (AOR: 2.22, 95% CI: 1.13-4.39) and admission to intensive care units (AOR: 3.39, 95% CI: 1.55-7.40) were significant predictors of in-hospital mortality. HAIs have a significant impact on in-hospital mortality, the length of extra hospital stays, and extra costs for medical care. Patients admitted to intensive care units and those with HAIs were found to be significant predictors of in-hospital mortality. Interventions must be implemented to prevent HAIs, especially in patients admitted to intensive care units.

DIRECT MEDICAL COST AND LENGTH OF STAY OF HYPERTENSION PATIENTS AT PRIVATE HOSPITAL IN YOGYAKARTA

The province that ranks fourth with the highest incidence of hypertension in Indonesia is the Special Region of Yogyakarta (DIY). Hypertension therapy is carried out in a not short period, so it becomes an economic burden for people with hypertension and the government. This study aims to determine the relationship between the length of hospitalization and direct medical costs—an analytical observational research method with retrospective data collection and data from class III inpatient hypertensive medical records. The calculation of costs is viewed from a payer's perspective—descriptive and analytical data analysis to determine the relationship between the length of hospitalization and direct medical costs. The study's results of 41 patients met the criteria; 53.65% were women aged 22-59 years (53.65%). The most widely used antihypertensive drug was the combination of amlodipine + candesartan (26.82%). The average direct medical costs for hypertensive patients were IDR 7,039,515. The highest direct medical cost component is the cost of other drugs and medical equipment. The component of direct medical costs is the lowest cost of antihypertensive drugs. The average length of hospitalization for hypertensive patients is 6.14 days. There was a significant relationship (p=0.000) between the length of hospitalization and direct medical costs. The conclusion of this study is a significant relationship (p = 0.000) between the length of hospitalization and direct medical costs

A Cost-effectiveness Analysis of Adding Cetuximab to the First-line Treatment of Metastatic Colorectal Carcinoma in Iran; Considering Genetic Screening for Precision Medicine.

This study aimed to evaluate the cost-effectiveness of cetuximab in different genetic populations of metastatic colorectal carcinoma patients, including KRAS and RAS wild types and mutants, when added to FOLFIRI treatment regimens for evidence-based disease management in Iran. A Markov decision model was designed in TreeAge software with the three states of stable, progress, and death. Clinical outcomes were extracted from published clinical studies, and costs were extracted from the Iranian local data. The primary outcome was an incremental cost-effectiveness ratio (ICER) in the simulated population. The cost-utility model from the perspective of the health system indicated that the average direct medical costs of a patient that has not been genetically screened are $56,985.27 and $20,767.74 in FOLFIRI + cetuximab and FOLFIRI regimens, respectively. However, costs per patient in the KRAS wild-type population were $21,845.52 in FOLFIRI and $78,321.22 in FOLFIRI + cetuximab. In RAS wild-type patients, FOLFIRI and FOLFIRI + cetuximab costs per patient were $23,111.62 and $84,976.39, respectively. Incremental QALYs for the above scenarios were 0.069, 0.193, and 0.285, respectively. Therefore, the ICER of add-on cetuximab in Iran compared to the treatment alternatives in the scenarios with and without KRAS screening was $520,771.55/QALY, $292,768.16/QALY, and $217,460.51/QALY. Although genetic screening in precision medicine reduces costs per outcome, according to the willingness-to-pay threshold of $4349.50 in the Iranian health system, add-on cetuximab to the FOLFIRI regimen is not a cost-effective strategy even with genetic screening and a 20% price reduction.

COST-EFFECTIVENESS ANALYSIS OF ANTIBIOTIC USAGE IN DIABETIC FOOT ULCUS PATIENTS IN DOKTER SOEKARDJO TASIKMALAYA HOSPITAL

Objective: Diabetic foot ulcers is sores on the skin surface until it penetrates the skin layer caused by infection, which is require high costs for treatment. This puts a considerable burden on the patient's family, health agencies and society in general. The purpose of this study was to describe the direct medical costs and cost-effective antibiotics for diabetic foot ulcer patients at Dokter Soekardjo Tasikmalaya Hospital. Methods: The research method is retrospectively with a purposive sampling technique. The research subjects included 24 hospitalized diabetic foot ulcer patients who received antibiotic treatment ceftriaxone with metronidazole or meropenem with metronidazole. The effectiveness of therapy was determined by the Length of Stay (LOS). Direct medical costs were obtained from medical costs, treatment costs, laboratory costs, and radiology costs. Results: The average direct medical cost for the combination of ceftriaxone and metronidazole antibiotics was Rp. 4 668 062 and for the combination of meropenem antibiotics with metronidazole was Rp. 9 093 830. The effectiveness of the antibiotic ceftriaxone with metronidazole was 47%. Conclusion: The cost-effective antibiotic was ceftriaxone with metronidazole which has the lowest ACER value Rp. 9 932 046 and the ICER value is Rp. 22 128 840.

The economic burden of low back pain in KwaZulu-Natal, South Africa: A prevalence-based cost-of-illness analysis from the healthcare provider's perspective.

Low back pain (LBP) is a multifactorial and the most prevalent musculoskeletal disorder, whose economic burden is of global concern. Evidence suggests that the burden of LBP in increasing and will continue rising with the greatest burden occurring in low-and-middle-income-countries (LMICs). This study sought to determine the economic burden of LBP in KwaZulu-Natal, South Africa from the providers perspective. We used a retrospective prevalence-based cost-of-illness methodology to estimate the direct medical cost of LBP. Direct medical costs constituted costs associated with healthcare utilisation in inpatient care, outpatient care, investigations, consultations, and cost of auxiliary devices. We used diagnostic-specific data obtained from hospital clinical reports. All identifiable direct medical costs were estimated using a top-down approach for costs associated with healthcare and a bottom-up approach for costs associated with inpatient and outpatient care. The prevalence of chronic low back pain CLBP was 24.3% (95% CI: 23.5-25.1). The total annual average direct medical costs associated with LBP was US$5.4 million. Acute low back pain (ALBP) and CLBP contributed 17% (US$0.92 million) and 83% (US$4.48 million) of the total cost, respectively. The per patient total annual average direct medical cost for ALBP and CLBP were US$99.43 and US$1,516.67, respectively. The outpatient care costs contributed the largest share (38.9%, US$2.10 million) of the total annual average direct medical cost, 54.9% (US$1.15 million) of which was attributed to nonsteroidal-anti-inflammatory drugs (NSAIDs). The total average cost of diagnostic investigations was estimated at US$831,595.40, which formed 15.4% of the average total cost. The economic burden of LBP is high in South Africa. Majority of costs were attributed to CLBP. The outpatient care costs contributed the largest share percent of the total cost. Pain medication was the main intervention strategy, contributing more than half of the total outpatient costs. Measures should be taken to ensure guideline adherence. Focus should also be placed towards development of prevention measures to minimise the cost.

Understanding the socioeconomic costs of dystrophic epidermolysis bullosa in Europe: a costing and health-related quality of life study

BackgroundDystrophic epidermolysis bullosa (EB) is a family of rare genetic dermatological conditions. Recent evidence indicated that in addition to its detrimental implications on patient health-related quality of life (HRQoL), there are substantial socioeconomic cost implications, especially regarding direct non-medical costs. This study aims to understand the burden of dystrophic EB (DEB) in Europe, using a primary EB patient-level dataset.MethodsA bottom-up, cross-sectional, study design was adopted for non-institutionalised patients diagnosed with EB who received outpatient care across EU5 countries: France, Germany, Italy, Spain, and the United Kingdom. A prevalence-based approach was used to estimate resource utilisation from a societal perspective, including direct (medical and non-medical) and indirect costs for patients and caregivers. Patient and caregiver outcomes were obtained using the EQ-5D questionnaire.ResultsA sample of 91 DEB patients was analysed. Overall, average EU5 annual cost per patient was estimated at €53,359, ranging from €18,783 (France) to €79,405 (Germany). Average EU5 annual direct medical costs were estimated at €8357 (15.7% of total), ranging from €5658 (France) to €12,576 (Germany); average direct non-medical costs were estimated at €41,353 (77.5% of total), ranging from €11,961 (France) to €57,000 (Germany); and average indirect costs were estimated at €3649 (6.8% of total), ranging from €1025 (Italy) to €9930 (United Kingdom). Costs varied across patients with different disability but also between children and adults. The mean EQ-5D index score for adult DEB patients ranged between 0.304 (United Kingdom) and 0.541 (Germany), with an EU5 average of 0.456, whereas the mean EQ-5D visual analogue scale score ranged between 47.5 (Germany) and 70.0 (France), with an EU5 average of 61.9. Limitations included potential patient selection bias, recall bias, and exclusion of bandaging and related costs.ConclusionsThe study revealed a substantial socioeconomic burden for DEB in Europe, attributable mostly to high direct non-medical costs, with the majority of patients requiring support from caregivers at home. Compared to the average economic burden of the overall EB patient population, costs for DEB patients are higher across all components of direct medical, direct non-medical and indirect costs.

Cost Effectiveness Analysis of Captopril And Amlodipine in Hypertensive Patients with Diabetes Mellitus at Magelang Regency Health Center

Backgrounds: Hypertension and Diabetes Mellitus are interrelated diseases and have a strong predisposition to the occurrence of cardiovascular disease and atherosclerosis. BPJS Kesehatan states that the cost of hypertension services has increased every year, indicating the need to control costs through pharmacoeconomic studies. One method that can be used is cost-effectiveness analysis. Find out the effective drugs in terms of cost and therapy. Aim: To determine the cost-effectiveness of Captopril and Amlodipine for hypertensive patients with co-morbidities of diabetes mellitus at the Magelang District Health Center. Methods: This study was conducted retrospectively with medical record data for 2019-2020. The sample in this study was 35 with 15 groups of 10 mg/day amlodipine and 20 groups of 25 mg/day captopril. The outcome assessed was the number of patients who achieved the therapeutic target for 1 month using the drug. Results: The percentage of therapeutic effectiveness of amlodipine 10 mg/day was 86,7% while captopril 25 mg was 60%. The average direct medical cost of the amlodipine 10 mg/day is Rp10.429,30 greater than captopril 25 mg/day, which is Rp7.298,80. The ACER value of amlodipine 10 mg/day was Rp. 12.023,00 and captopril 25 mg/day was Rp. 12.164,00. Calculation of ICER value of the average direct medical cost of the 10 mg/day amlodipine group is Rp10.423,93 greater than captopril 25 mg/day, which is Rp7.298,80. Conclusion : Amlodipine is more cost-effective than captopril with an ACER value of RP. 12.023,00.

Costs Associated with Adverse Drug Reactions Among HIV/TB Patients in Thailand.

PurposeTo assess the direct and indirect costs associated with adverse drug reactions (ADRs) in patients receiving treatment regimens for human immunodeficiency virus (HIV) infection and tuberculosis (TB) in selected Thai hospitals.Patients and MethodsThis was a retrospective study conducted between October 2014 and September 2019 at three public hospitals in Thailand. Data were obtained from a medical database and spontaneous ADR reporting system of each study site. The out-of-pocket health payments and indirect costs were determined via interviewing. All costs were updated to 2021.ResultsA total of 432 eligible patients who experienced ADRs due to HIV and TB treatment, and 93 patients were interviewed to determine direct non-medical and indirect costs. The average direct medical cost for ADR was USD 5.65 for mild cases, USD 156.54 for moderate cases, and USD 1,242.45 for severe cases. For direct non-medical costs, the average cost per episode was USD 27.29 in mild ADR, USD 70.86 in moderate ADR and USD 270.66 in severe ADR. The indirect cost incurred in each mild, moderate and severe ADR was USD 41.86, USD 89.34, and USD 552.60, respectively. The Stevens-Johnson syndrome (SJS) had the highest management costs.ConclusionADRs associated with anti-tuberculosis drugs and antiretroviral drugs seem to have a substantial economic impact from a societal perspective. These findings would be useful for increasing awareness and encouraging early avoidance of ADRs.

Direct medical cost of metformin and metformin-glimepiride in type 2 diabetes mellitus patients

Diabetes mellitus (DM) requires long-term therapy. Selection of the right therapy was very important to provide optimal results at an affordable cost. One of the main standards of oral antidiabetic therapy prescribed for type 2 DM (T2DM) is metformin, either alone or in combination therapy. The purpose of this study was to describe the direct medical costs in type 2 DM patients between metformin and metformin-glimepiride therapy. This research was an observational and descriptive. Demographic and clinical data were taken prospectively from the complete medical records of data patients with the main diagnosis of DM who fulfilled the inclusion criteria in the period January 2019–November 2020 at RSU Nene Mallomo Sidenreng Rappang, South Sulawesi and the two Public Health Centers namely Puskesmas Galur. II and Panjatan II Kulon Progo Yogyakarta. Cost data includes total medical costs from the hospital/ healthcare perspective (cost of drugs, doctor's services and checkups, fees for checking Fasting Blood Glucose/ Gula darah Puasa (GDP) and Blood Glucose Level While/ Gula Darah Sewaktu (GDS)) and total costs from the Badan Penyelenggara Jaminan Sosial (BPJS)/ payer perspective (INA-CBG's rates) were covered by insurance. The results showed that the average direct medical costs at the hospital and the two Public Health Centers respectively were metformin therapy in IDR (Indonesian Rupiah) namely IDR 120.736 and IDR 9.072,- and metformin-glimepiride therapy of IDR 126.298,- and IDR 18.634,-. It can be concluded that the average direct medical cost of metformin therapy is lower than metformin-glimepiride therapy.

The direct cost of dialysis supported by families for patients with chronic renal failure in Ouagadougou (Burkina Faso)

BackgroundChronic renal failure can lead to dialysis and/or a kidney transplant in the final stage. The number of patients under dialysis has increased considerably in the world and particularly in sub-Saharan Africa. Dialysis is a very expensive care. This is the reason why this study on the costs of dialysis management was initiated in Burkina Faso. The objective of the study is to determine the direct medical and non-medical costs of managing chronic renal failure among dialysis patients in Ouagadougou in 2020.MethodsAn analytical cross-sectional study was conducted. Data were collected in the hemodialysis department of three public university hospitals in Ouagadougou, Burkina Faso. All dialysis patients with chronic renal failure were included in the study. Linear regression was used to investigate the determinants of the direct medical and non-medical cost of hemodialysis.ResultsA total of 290 patients participated in this study, including children, adults, and the elderly with extremes of 12 and 82 years. Almost half of the patients (47.5%) had no income. The average monthly total direct cost across all patients was 75842 CFA or US$134.41.The average direct medical cost was 51315 CFA or US$90.94 and the average direct non-medical cost was 24 527 CFA or US$43.47. Most of the patients (45.2%) funded their hemodialysis by their own source.The multivariate analysis showed that the presence of an accompanying person during treatment, residing in a rural area, ambulatory care, use of personal cars, and treatment at the dialysis center of Yalgado Teaching Hospital were associated with higher direct costs.ConclusionThe average cost of dialysis services borne by the patient and his family is very high in Burkina Faso, since it is 2.1 times higher than the country's minimum interprofessional wage (34664 CFA or US$61.4). It appears that the precariousness of the means of subsistence increases strongly with the onset of chronic renal failure requiring dialysis. Thus, to alleviate the expenses borne by dialysis patients, it would be important to extend the government subsidy scheme to the cost of drugs and to promote health insurance to ensure equitable care for these patients.

Financial Burden and Average Cost of COVID-19 per Patient Admitted to the Intensive Care Unit in Kuwait

Introduction: COVID-19 pandemic imposed a massive impact on constrained healthcare resources especially Intensive Care Units beds. Nevertheless, few studies have explored direct medical costs of ICU admissions and the financial burden associated with them.Aim: Our aim is to estimate the average direct medical cost of COVID-19 admitted to ICU per patient and per diem as well as the associated financial burden.Methods: A stochastic financial model was developed in accordance with Kuwait Task Force guidelines for COVID-19 management in ICU.Results: Our results showed the average cost of COVID-19 patients admitted in the ICU per patient and per diem to be 16,471 KWD (53,354 USD) and 1,643 KWD (5,422 USD) respectively. While the financial burden over one fiscal year amounted to 15,795,830 KWD (52,126,239 USD).Conclusion: This estimate can guide policy makers, researchers and financial analysts to follow a data driven decisions in planning and budgeting healthcare resources for this concurrent event or similar future events.

Clinical benefit and cost-effectiveness analysis of liquid biopsy application in patients with advanced non-small cell lung cancer (NSCLC): a modelling approach

PurposeTargeted therapies are effective therapeutic approaches in advanced stages of NSCLC and require precise molecular profiling to identify oncogenic drivers. Differential diagnosis on a molecular level contributes to clinical decision making. Liquid biopsy (LB) use has demonstrated its potential to serve as an alternative to tissue biopsy (TB) particularly in cases where tissue sampling is not feasible or insufficient. We aimed at evaluating the cost-effectiveness of ctDNA-based LB use (molecular multigene testing) according to German care guidelines for metastatic NSCLC.MethodsA Markov model was developed to compare the costs and clinical benefits associated with the use of LB as an add-on to TB according to the guidelines for NSCLC patients. Usual care TB served as comparator. A microsimulation model was used to simulate a cohort of non-squamous NSCLC patients stage IV. The parameters used for modelling were obtained from the literature and from the prospective German CRISP registry (“Clinical Research platform Into molecular testing, treatment, and outcome of non-Small cell lung carcinoma Patients”). For each pathway, average direct medical costs, and QALYs gained per patient were used for calculating incremental cost-effectiveness ratios (ICER).ResultsThe use of LB as an add-on was costlier (€144,981 vs. €144,587) but more effective measured in QALYs (1.20 vs. 1.19) for the care pathway of NSCLC patients (ICER €53,909/QALY). Cost-effectiveness was shown for EGFR-mutated patients (ICER €-13,247/QALY).ConclusionIncluding LB as an add-on into the care pathway of advanced NSCLC has positive clinical effects in terms of QALYs accompanied by a moderate cost-effectiveness.

Ondansetron and metoclopramide: a comparative analysis of effectiveness and cost in hospitalized patients with hyperemesis gravidarum

Background: Hyperemesis Gravidarum (HG) is nausea and vomiting which interfere pregnant women’s daily activities.Ondansetron (ODN) is often used off label for the treatment of hyperemesis gravidarum. This study aimed to analyze theefficacy and cost of ondansetron versus metoclopramide (MCP), a drug that has been used in the standard regimen for thetreatment of HG. patients in the largest hospital in Jakarta during year 2012 to 2016.Method: The research was conducted with a cross-sectional study design on respondents with criteria, namely pregnantpatients hospitalized with HG at Dr. Cipto Mangunkusumo Hospital from 2012-2016. Assessment of clinical effectiveness wascarried out by looking at the day’s duration until the symptoms of nausea and vomiting stopped. Furthermore, a cost analysiswas carried out by calculating the average direct medical costs associated with the HG’s condition.Result: The effectiveness of both antiemetics was not statistically significant (p = 0.370). The average cost per patient withondansetron compared to metoclopramide was not significantly different (p = 0,966).Conclusion: There was no difference in the effectiveness and cost of ODN versus MCP for the treatment of hyperemesisgravidarum.

Calculation of Direct Medical Costs and Indirect Costs in Patients with Covid-19 Hospitalized in the Intensive Care Unit in Golestan Province

Background: Healthcare policymakers and planners use the economic burden of the disease to determine the total cost of an outcome, illness, or accident imposed on the country. The aim of this study was to calculate the direct and indirect medical costs in Covid-19 patients with critical conditions hospitalized in the intensive care unit in Golestan province.&#x0D; Methods: This descriptive-analytical study was a partial economic evaluation performed cross-sectionally, and included all hospitalized patients with critical conditions in the first 6 months of 2020 in a public hospital in the Covid-19 center (158 patients).The required data were collected from patients' records by the hospital information system. Data analysis and calculation of direct medical and indirect costs of the disease in this research study was carried out based on the incidence approach and bottom-up method from the perspective of the society.&#x0D; Results: The average direct medical cost per hospitalized patient in a critical condition was 214, 926, 500 rials. Hospitalization and pharmaceutical services accounted for the largest share of the costs. The average indirect cost for each patient in a critical condition was estimated at 959,577,714 rials.&#x0D; Conclusion: The results of the study showed a huge economic burden of Covid-19 on society and the health system. The high prevalence of this disease has imposed huge economic damages on society and the country's health system.