Average Direct Medical Cost Research Articles

Direct Healthcare Costs Associated with Oligoarticular Juvenile Idiopathic Arthritis at a Single Center.

Oligoarticular juvenile idiopathic arthritis (JIA) is a common disease in pediatric rheumatology. The management of oligoarticular JIA can result in a considerable economic burden. This study is a four-year, retrospective cost identification analysis performed to determine the annual direct cost of care for patients with oligoarticular JIA and possible predictive clinical factors. Direct healthcare costs were defined as those associated with office visits, laboratory studies, hospital admissions, joint injections, medications, infusions, radiology tests, and emergency room visits. Disease characteristics and patient information included ANA status, gender, age at diagnosis, duration from diagnosis to initial visit during the study period, and whether uveitis had been diagnosed. We identified 97 patients with oligoarticular JIA eligible for the study. The median age of diagnosis was 4.3 years. Positive ANA were noted in 75% of patients. 34% of patients received at least one intra-articular steroid injection. 32% of patients were prescribed a biologic during the study period, predominantly with other medications, while 23% of patients received only NSAIDs. 20% of patients were prescribed oral steroids. The average total direct medical cost in this study per year for an oligoarticular JIA patient was $3929 ± 6985. Medications accounted for 85% of annual direct medical costs. Clinic visits and laboratory testing accounted for 8% and 5%, respectively. Patient characteristics and demographics were tested for association with direct medical costs by the Wilcoxon rank sum test and Kruskal-Wallis test. Patients who were ANA positive had increased annual costs compared to patients who are ANA negative. ANA-positive patients were found to have statistically significant costs, particularly, in laboratory tests, procedural costs, radiology costs, and medication costs. The results reported here provide information when allocating healthcare resources and a better understanding of the economic impact oligoarticular JIA has on the United States healthcare system.

PCN50 Disease Burden of Chronic Myeloid Leukemia UNDER Current Treatment Pattern in China

To estimate the disease burden of Chronic Myeloid Leukemia (CML) under current treatment pattern in China. A decision-analytic model was constructed to simulate the Chinese patients with CML and the age and gender-matched Chinese general population over lifetime time horizon for the differences in overall survival, quality-adjusted life years (QALY), and lifetime direct medical costs. Literature search was conducted to identify appropriate evidence to estimate the model variables. Base case analysis and sensitivity analysis were conducted for the point estimations and uncertainty of the disease burden of CML. The Chinese CML patients were associated with reduced average overall survival by 6.878 years (26.555 years vs. 33.433 years), reduced average QALY by 7.390 QALY (23.281 QALY vs. 30.671 QALY), and increased average life-time direct medical costs by ¥837,811 (¥1,014,394 vs. ¥176,583) under current treatment pattern. The reduced QALY associated with CML was highly sensitive to first-line treatment effect of imatinib for the chronic phase of CML (change: 1.818 QALY), utility of disease remission (change:1.809 QALY), the rate of allogeneic stem cell transplantation (difference: 1.624 QALY), and best supportive care rate (difference: -1.082). The lifetime direct medical costs associated with CML was highly sensitive to the rate of first-line imatinib treatment (change: ¥-141,906), mortality of blast phase of CML (change: ¥-130,926), and effects of first-line imatinib treatment (change: ¥-91,115). The probabilistic sensitivity analysis with 5,000 Monte Carlo simulations estimated the median and 95% credible interval of reduced QALY ( -7.399 QALY, -8.555 to -6.338 QALY) and increased lifetime direct medical costs (¥844,685, ¥748,593 to ¥964,283). The disease burden of CML in Chinese patients was mainly characterized with reduced overall survival, reduced QALY, and increased medical costs that were highly sensitive to first-line treatment with imatinib, stem cell transplantation rate, and mortality of blast phase of CML.

PGI6 DISEASE BURDEN OF MODERATE TO SEVERE CROHN'S DISEASE UNDER CURRENT TREATMENT PATTERN IN CHINA

To estimate the disease burden of moderate to severe Crohn's disease (MS-CD) under current treatment pattern in China. A decision-analytic model was constructed to simulate the Chinese patients with MS-CD and the age and gender-matched Chinese general population over lifetime time horizon for the differences in overall survival, quality-adjusted life years (QALYs), and lifetime direct medical costs. Literature search was conducted to identify appropriate evidence to estimate the model variables. Base case analysis and sensitivity analysis were conducted for the point estimations and uncertainty of the disease burden of MS-CD. The Chinese MS-CD patients were associated with reduced average overall survival by 2.221 years (42.794 years vs. 45.014 years), reduced average QALY by 7.666 QALY (34.063 QALY vs. 41.768 QALY), and increased average life-time direct medical costs by ¥681,910 (¥893,807 vs. ¥211,897). The reduced QALY associated with MS-CD was highly sensitive to quality of life of disease remission (change: 12.079 QALYs) and active disease (change: 1.009 QALYs),mortality of active disease (change:-1.280 QALYs), and treatment effect of infliximab for induction therapy (change: 0.939) and immunosuppressants for maintenance therapy (change: -0.905). The lifetime direct medical costs associated with MS-CD was highly sensitive to administration of infliximab for maintenance therapy (change: ¥426,022), compliance of infliximab (change: ¥-347,445), drug acquisition costs of infliximab (change: ¥244,187), and hospital costs associated with active disease (change: ¥211,009). The probabilistic sensitivity analysis with 5,000 Monte Carlo simulations estimated the median and 95% credible interval of reduced QALY ( -7.076 QALY, -15.136 to -3.186 QALY) and increased lifetime direct medical costs (¥694,054, ¥363,376 to ¥1,215,003). The disease burden of MS-CD in Chinese patients was mainly characterized with reduced QALY and increased medical costs that were highly sensitive to quality of life, infliximab treatment, and activity disease .

PCN43 Disease Burden of NON-SMALL CELL Cancer UNDER Current Treatment Pattern in China

To estimate the disease burden of non-small cell lung cancer (NSCLC) under current treatment pattern in China. A decision-analytic model was constructed to simulate the Chinese patients with NSCLC and the age and gender-matched Chinese general population over lifetime time horizon for the differences in overall survival, quality-adjusted life years (QALY), and lifetime direct medical costs. Literature search was conducted to identify appropriate evidence to estimate the model variables. Base case analysis and sensitivity analysis were conducted for the point estimations and uncertainty of the disease burden of NSCLC. The Chinese NSCLC patients were associated with reduced average overall survival by 17.111 years (3.859 years vs. 20.970 years), reduced average QALY by 14.939 QALY (2.709 QALY vs. 17.649 QALY), and increased average life-time direct medical costs by ¥147,109 (¥274,251 vs. ¥127,143) under current treatment pattern. The reduced QALY associated with NSCLC was sensitive to the risks of distant metastasis associated with stage II (change: -0.705 QALY) and stage I (change:-0.423 QALY), proportion of advanced NSCLC at diagnosis (change:- 0.568 QALY), and radical surgery rate (change: -0.520). The lifetime direct medical costs associated with NSCLC was sensitive to the mortality after the treatment failure with clozotinib (change: ¥-32,649), treatment effects of clozotinib (change: ¥-32,065), and proportion of advanced NSCLC at diagnosis (change: ¥-23,853). The probabilistic sensitivity analysis with 5,000 Monte Carlo simulations estimated the median and 95% credible interval of reduced QALY ( -15.168 QALY, -16.072 to -14.263 QALY) and increased lifetime direct medical costs (¥160,604, ¥119,079 to ¥218,626). The disease burden of NSCLC in Chinese patients was characterized with reduced overall survival, reduced QALY, and increased medical costs that were sensitive to risk of distance metastasis, radical surgery rate, distribution of advanced NSCLC at diagnosis, and the treatment effects of clozotinib for advanced NSCLC.

PCN45 Disease Burden of Breast Cancer UNDER the Current Treatment Pattern in China

To estimate the disease burden of breast cancer (BC) under the current treatment pattern in China. A decision-analytic model was constructed to simulate the Chinese patients with BC and the age and gender-matched Chinese general population over lifetime time horizon for the differences in overall survival, quality-adjusted life years (QALY), and lifetime direct medical costs. A literature search was conducted to estimate the model variables. Base case analysis and sensitivity analysis were conducted for the point estimations and uncertainty of the disease burden of BC. The Chinese BC patients were associated with reduced average overall survival by 7.054 years (20.933 years vs. 27.987 years), reduced average QALY by 9.651 QALY (14.727 QALY vs. 24.378 QALY), and increased average lifetime direct medical costs by ¥534,867 (¥692,056 vs. ¥157,189). The reduced QALY associated with BC was sensitive to utility of stage I (change: 0.482 QALY) and stage II BC (change: 0.947 QALY), risk of disease recurrence after radical mastectomy (change: -0.886 QALY), proportions of stage I (change: 0.870 QALY) and stage IV BC at diagnosis (change: -0.857 QALY). The increased lifetime direct medical costs associated with BC was sensitive to medical costs of progressive disease (change: ¥172,362), treatment response to exemestane (change: ¥-91,035), and the mortality of progressive disease (change: ¥-51,827). The probabilistic sensitivity analysis with 5,000 Monte Carlo simulations estimated the median and 95% credible interval of reduced QALY (-9.881 QALY; -11.306 to -8.386 QALY ) and increased lifetime direct medical costs (¥548,992, ¥464,895 to ¥650,181). The disease burden of BC in Chinese patients was characterized by reduced overall survival, reduced QALY, and increased medical costs that were sensitive to disease stage distribution at diagnosis, utility of early-stage BC, exemestane treatment, and the mortality and medical costs of progressive disease.

PIN24 Disease Burden of Progressive Chronic Hepatitis C in China

To estimate the disease burden of progressive chronic hepatitis C (CHC) in China. A decision-analytic model was constructed to simulate the Chinese patients with progressive CHC and the age and gender-matched Chinese general population over lifetime time horizon for differences in overall survival, quality-adjusted life years (QALY), and lifetime direct medical costs. Literature search was conducted to identify appropriate evidence to estimate the model variables. Base case analysis and sensitivity analysis were conducted for the point estimations and uncertainty of the disease burden of progressive CHC. The base case analysis estimated that progressive CHC reduced the average overall survival by 9.701 years (24.320 years vs. 34.021 years), reduced average QALY by 10.480 QALY (19.611 QALY vs. 30.091 QALY), and increased average life-time direct medical costs by ¥45,472 (¥223,408 vs. ¥177,937). The lifetime QALY associated with CHC was highly sensitive to patient age of fibrosis stage 1 to 4 (change: 2.185 QALY, 2.508 QALY, 2.036 QALY, 3.157 QALY), and utility of fibrosis stage 4 patients (change: 1.375 QALY). The lifetime direct medical costs associated with CHC was highly sensitive to patient age of fibrosis stage 2 to 4 (change: ¥-30,270, ¥-28,305, ¥-40,345), direct medical cost (change: ¥29,844) and mortality (change: ¥-22,983) associated with hepatocellular carcinoma. The probabilistic sensitivity analysis with 10,000 Monte Carlo simulations estimated that the median and 95% credible interval of reduced QALY (-10.419 QALY, -11.532 QALY to -9.609 QALY) and increased lifetime direct medical costs ( ¥45,654, ¥39,414 to ¥54,000). The disease burden of progressive CHC in Chinese patients was mainly characterized with reduced overall survival and reduced QALY that were highly sensitive to patient age and quality of life associated with fibrosis stages.

PCN49 Disease Burden of Classical Hodgkin Lymphoma UNDER Current Treatment Pattern in China

To estimate the disease burden of classical Hodgkin lymphoma (cHL) under current treatment pattern in China. A decision-analytic model was constructed to simulate the Chinese patients with cHL and the age and gender-matched Chinese general population over lifetime time horizon for the differences in overall survival, quality-adjusted life years (QALY), and lifetime direct medical costs. Literature search was conducted to identify appropriate evidence to estimate the model variables. Base case analysis and sensitivity analysis were conducted for the point estimations and uncertainty of the disease burden of cHL. The Chinese cHL patients were associated with reduced average overall survival by 13.453 years (27.317 years vs. 40.770 years), reduced average QALY by 12.449 QALY (24.448 QALY vs. 36.897 QALY), and increased average life-time direct medical costs by ¥262,040 (¥451,395 vs. ¥189,355) under current treatment pattern. The reduced QALY associated with cHL was highly sensitive to disease recurrence after the treatment for early stage of cHL (change: -15.349 QALY), patient age (change: 4.561 QALY), and quality of life of early stage of cHL (change: 2.106QALY). The lifetime direct medical costs associated with cHL was highly sensitive to the disease recurrence after the treatment for early stage of cHL (change: ¥637,508), treatment effect of pembrolizumab (change: ¥-303,899), mortality of progressive disease (change: ¥-243,770), and patient weight (change: ¥115,609). The probabilistic sensitivity analysis with 5,000 Monte Carlo simulations estimated the median and 95% credible interval of reduced QALY ( -11.580 QALY, -21.642 to -5.442 QALY) and increased lifetime direct medical costs (¥275,349, ¥-2,296 to ¥1,200,886). The disease burden of cHL in China was characterized with reduced overall survival, reduced QALY, and increased medical costs that were sensitive to patient demographics, disease recurrence, quality of life, treatment effect of pembrolizumab, and the mortality of progressive disease.

PIN16 Disease Burden of Progressive Chronic Hepatitis B in China

To estimate the disease burden of the progressive chronic Hepatitis B (CHB) in China. A decision-analytic model was constructed to simulate the Chinese patients with progressive CHB and the age and gender-matched Chinese general population over lifetime time horizon for the differences in overall survival, quality-adjusted life years (QALY), and lifetime direct medical costs. Literature search was conducted to identify appropriate evidence to estimate the model variables. Base case analysis and sensitivity analysis were conducted for the point estimations and uncertainty of the disease burden of CHB. The base case analysis estimated that the progressive CHB patients were associated with reduced overall survival by 17.866 years (24.067 years vs. 41.934 years), reduced average QALY by 20.717 QALY (17.153 QALY vs. 37.870 QALY), and increase average life-time direct medical costs by ¥64,774 (¥261,163 vs. ¥196,389). The QALY associated with progressive CHB was highly sensitive to patient age of fibrosis stage 1 (change: 2.796 QALY), 2(change: 2.426 QALY,) and 4, (2.323 QALY),quality of life of fibrosis stage 1 (change: 1.891 QALY) and 2 (change: 1.864 QALY). The lifetime direct medical costs associated with CHB was highly sensitive to mortality of hepatocellular carcinoma(change: ¥-80,991) and decompensated cirrhosis (change: ¥-49,701), patient age of fibrosis stage 1(change: ¥-44,824) and 4 (change: ¥-45,011), direct medical cost associated with decompensated cirrhosis (change: ¥44,407). The probabilistic sensitivity analysis with 10,000 Monte Carlo simulations estimated that the median and 95% credible interval of reduced QALY (-20.550 QALY, -21.673 QALY to -19.317 QALY) and increased lifetime direct medical costs (¥68,948, ¥25,153 to ¥132,781). The disease burden of progressive CHB in China was mainly characterized with reduced overall survival and reduced QALY that were highly sensitive to patient age associated with fibrosis and the risk of hepatocellular carcinoma.

Comparison of direct medical cost between ramipril and candesartan in hospitalized acute decompensated heart failure at West Nusa Tenggara Regional Hospital

Introduction: Pharmacoeconomy is the field of study regarding costs analysis associated with the use of drugs in health care. The purpose of pharmacoeconomics is to compare a different drug used in the treatment with the same condition or can be the opposite, i.e. comparing different treatments in different circumstances. The purpose of this study is to determine and compare the average efficiency of direct medical costs between ramipril and candesartan combination drug in hospitalized heart failure patients with a payer perspective at the West Nusa Tenggara Regional General Hospital, Mataram, Indonesia.Method: This study is part of an economic evaluation of direct medical cost analysis research in hospitalized heart failure patients with a payer perspective. Study design using a retrospective approach involving 45 patients with heart failure who met the study inclusion criteria and exclusion criteria. Independent t-test was used to compare the direct medical cost between ramipril and candesartan.Results: The average gross total cost of using ramipril combination was Rp. 4,197,011 while the average total cost of using candesartan combination was Rp. 3,099,088. These results indicate there are savings in the average total cost of treatment for heart failure using candesartan that is Rp. 1,097,923. Candesartan combination provides the lowest value and is a more efficient choice compared to ramipril combination. Meanwhile, after t-test comparison reveal no significant different average direct medical costs in patients using the ramipril combination compared with the candesartan combination (p>0.05).Conclusion: The results of this study indicate that there is no significant difference between the average direct medical costs in patients using ramipril compared with candesartan combination.

Economic evaluation of the direct cost resulting from childhood poisoning in Morocco: micro-costing analysis

BackgroundThe analysis of the economic burden for childhood poisoning has great value in Morocco where there still exists a paucity of information on the subject. The objective of this study was to explore the economic costs of unintentional and intentional poisoning in children in the region of Rabat-Salé-Kénitra, Morocco.MethodsA prospective study of children younger than 15 years with a poisoning diagnosis conducted between March and July 2016 in the Children’s University Hospital of Rabat, Morocco. The source of data for this study was questionnaire that collected information on the costs, the epidemiological and the socio-economic characteristics of childhood poisoning.ResultsEighty-seven patients were interviewed during the study period (39 females and 48 males). The majority of poisoning cases (98.85%) were accidental and 1.15% were intentional. Drugs, snake bites and scorpion stings, carbon monoxide, food, plants, household products, illegal drugs, pesticides, petroleum and industrial chemicals products were caused the poisoning. Of all the hospitalized patients, 77 (88.5%) were admitted to the emergency department and 5 (5.7%) were admitted to the intensive care unit. The average direct medical costs and the average direct non-medical costs of providing poison treatment were USD 127 and USD 30 per child, respectively. Total average direct cost of USD 157 (127 + 30) represented 60% of the national minimum wage per month in Morocco. Total direct medical costs accounted for 80%, as against 20% direct non-medical costs. The mean ± SD length of stay (LOS) for children with poisoning was 2.15 ± 1.87 days with a range variated between 0 day and 10 days.ConclusionsOverall, this study confirms that the costs of childhood poisoning are not negligible costs in Morocco. Therefore, the prevalence and the costs of childhood poisoning can be reduced by monitoring an open communication between parents, the Poison Control Centre of Morocco (MPCC) and physicians in order to increase the vigilance of parents against the risks related to unintentional poisoning that can be prevented with more awareness.

The economic burden of prostate cancer \u2013 a Swedish prevalence-based register study

BackgroundIncidence and prevalence of prostate cancer in Sweden have increased markedly due to prostate-specific antigen (PSA) testing. Moreover, new diagnostic tests and treatment technologies are expected to further increase the overall costs. Our aims were (i) to estimate the societal costs for existing testing, diagnosis, management and treatment of prostate cancer, and (ii) to provide reference values for future cost-effectiveness analyses of prostate cancer screening and treatment.MethodsTaking a societal perspective, this study aimed to investigate the annual cost of prostate cancer in Sweden using a prevalence-based cost-of-illness approach. Resource utilisation and related costs within Stockholm Region during 2016 were quantified using data from the Stockholm PSA and Biopsy Register and other health and population registers. Costs included: (i) direct medical costs for health care utilisation at primary care, hospitals, palliative care and prescribed drugs; (ii) informal care; and (iii) indirect costs due to morbidity and premature mortality. The resource utilisation was valued using unit costs for direct medical costs and the human capital method for informal care and indirect costs. Costs for the Stockholm region were extrapolated to Sweden based on cancer prevalence and the average costs by age and resource type.ResultsThe societal costs due to prostate cancer in Stockholm in 2016 were estimated to be €64 million Euro (€Mn), of which the direct medical costs, informal care and productivity losses represented 62, 28 and 10% of the total costs, respectively. The total annual costs extrapolated to Sweden were calculated to be €281 Mn. The average direct medical cost, average costs for informal care and productivity losses per prevalent case were €1510, €828 and €271, respectively. These estimates were sensitive to assumptions related to the proportion of primary care visits associated with PSA testing and the valuation method for informal care.ConclusionThe societal costs due to prostate cancer were substantial and constitute a considerable burden to Swedish society. Data from this study are relevant for future cost-effectiveness evaluations of prostate cancer screening and treatment.

COST OF ILLNESS OF INPATIENT PEDIATRIC MENINGITIS PATIENTS HOSPITALIZED IN YOGYAKARTA

This research to determine the average cost of illness of inpatient pediatric meningitis patients hospitalized in the hospitals in Yogyakarta. It was a pharmacoeconomic study using the cost of illness method. The calculation of the cost in the care of inpatient pediatric meningitis patients according to a societal perspective was conducted observatively with a cross sectional design. Cost of illness analysis included calculating the costs of direct medical, direct non-medical, and indirect cost. Data were collected from a type-A public hospital and a type-B privatehospital in Yogyakarta by taking medical records, detailed data on meningitis patient care costs, and interviews using questionnaires with caregivers. Analysis of cost of illness calculations applied descriptive analysis methods. In this study, 11 inpatient pediatric meningitis patients were obtained. The average cost of illness for the treatment of inpatient pediatric meningitis patients was IDR 26,224,586±12,814,789, consisting of the average direct medical cost of IDR 23,831,813±12,222,885 (90.88%), the average direct non-medical cost of IDR 1,787,955±832,353 (6.82%), and the average indirect cost of IDR 604,818±337,389 (2.31%). Components of direct medical cost with the largest percentage were drugs and medical supplies (26.46%); while the largest direct non-medical cost were the expenditure of additional needs for the patient's family (72.18%). The indirect cost component came from the reduction of the patient's parents' income while the patient is hospitalized.

BIAYA MEDIK LANGSUNG PASIEN STROKE NON-HEMORAGIK KELAS PERAWATAN 3 RSUD K.R.M.T WONGSONEGORO SEMARANG

The most common stroke in Indonesia is non-hemorrhagic stroke (SNH), which occurs in 85-87% of all stroke cases. Stroke requires expensive costs because the process of treating stroke patients is done in a long time and routine. SNH patients who go to K.R.M.T Wongsonegoro Hospital Semarang every year increase in number. This study aims to determine the amount of direct medical costs for treatment class 3 SNH patients at K.R.M.T Wongsonegoro Hospital Semarang and their compliance with Indonesian Case Based Groups (INA-CBG) rates. This study is a pharmacoeconomic study with a hospital perspective on direct medical costs using retrospective data for the October-December 2018 period. The object of this study is the medical record and billing data from the Hospital Information and Management System SNH patients participating in the National Health Insurance treated in treatment class 3. Based on the results of medical record tracking and billing data for SNH patients, 64 patients were known. The number of female patients was 41 people (64.06%). Most of the patients (93.75%) were over 45 years old. A total of 27 patients included in the category of mild SNH and 37 patients in the category of moderate SNH. The average direct medical cost for SNH patients in the mild category is IDR 3,005,019 ± 1,010,931, - and the compliance with INA-CBG’s tariff was 92.59%. The average direct medical cost for SNH patients in the moderate category is IDR 3,602,846 ± 1,259,001 and the compliance with INA-CBG rates of 94.59%.

The Effectiveness of Postoperative Antibiotics following Appendectomy in Pediatric Patients: A Cost Minimization Analysis

Background: Appendicitis has a high occurrence and is frequently indicated in pediatric abdominal surgery. However, up to 33% of affected children may not present with distinct symptoms, and young children may be a typical or show delayed presentation of symptoms. Appendectomy is one of the most common emergent surgeries to treat appendicitis. After an appendectomy, prophylaxis antibiotics are required to abate infections at the location of surgery and have been shown to reduce postoperative surgical complications significantly. Objective: The purpose of this investigation was to determine the most cost-effective prophylactic antibiotic combination between ceftriaxone-metronidazole and cefotaxime-metronidazole following appendectomy. Methods: A retrospective observational study was conducted using investigations with a similar design and pediatric medical records from 2011 until 2013 from a referral hospital in Bandung City. All direct medical costs related to pediatric appendectomy were collected and discounted. Independent Student’s t-test and chi-square analysis were used. Results: The average total cost of ceftriaxone-metronidazole was USD 393.83/patient and that of cefotaxime-metronidazole was USD 397.89/patient. There were no significant differences in average direct medical costs between treatments with ceftriaxone-metronidazole and cefotaxime-metronidazole (p=0.383). The analysis suggests that both antibiotic combinations have the same effectiveness and cost. For the combinations of ceftriaxone-metronidazole and cefotaxime-metronidazole, approximately USD 1.88 and USD 2.28 were required, respectively, to reduce one day of hospitalization after an appendectomy. Additionally, to increase one percent of cure rate, an amount of USD 19.70 and USD 24.89 was required for ceftriaxone-metronidazole and cefotaxime-metronidazole, respectively. Conclusion: Both therapies investigated were effective as a postoperative antibiotic. However, the combination of ceftriaxone and metronidazole may be more cost-efficient.

Cost of Illness Diabetes Melitus Tipe 2 dan Komplikasinya pada Peserta Jaminan Kesehatan Nasional (JKN) di Rawat Jalan Rumah Sakit Condong Catur Yogyakarta

Type 2 diabetes mellitus is a chronic disease that requires lifelong therapy and high service costs so that the use of antidiabetic drugs affects the patient's therapeutic costs. The purpose of this study was to determine the cost of outpatient type 2 diabetes mellitus therapy for National Health Insurance (JKN) participants in Condong Catur Hospital Yogyakarta. The research method used is observational. The parameters measured are calculating the average direct medical costs (drug costs, doctor's examination and consultation fees, laboratory costs, medical treatment costs), and comparison between the costs of oral drugs, insulin, oral and insulin. The results of normality tests with Shapiro-Wilk (microvascular, microvascular and macrovascular), Kolmogorrov-Smirnov (macrovascular) p0.05 indicate that data are not normally distributed, the results of the Kruskal Wallis test of the three groups (microvascular, macrovascular, microvascular and microvascular) show that differences are not normally distributed significant (p = 0.001).The results showed that the microvascular group therapy costs Rp 3,164,733.58 per month, the macrovascular group Rp 9,984,566.85 per month, the microvascular and macrovascular groups Rp 11,260,372.39 per month. The cost of therapy is based on the microvascular group drug Rp. 408,567.78 per month, the macrovascular group Rp. 1,245,987.48 per month, the microvascular and macrovascular groups Rp. 1,786,270.68 per month so that statistically from the three complications groups show significant differences p = 0,001 (p 0,005). The difference in the difference between the total real costs and the total INA-CBG's rates, the microvascular group Rp -38,741.14 per patient, the macrovascular group Rp -10,914.03 per patient, while in the microvascular and macrovascular group Rp 3,272.90 per patient shows that from to three groups of complications were not significantly different p = 0.207 (p 0.005). Statistically it can be concluded that the cost of therapy based on antidiabetic drugs in the three groups of complications shows a significant difference. There is no significant difference in the difference between the real costs in the three groups of complications

Cost Effectiveness Analysis of Candesartan Therapy in Comparison to Candesartan-Amlodipine Therapy on Hypertensive Outpatients.

BACKGROUND:he achievement of optimal hypertension therapy requires cost-effective medicine. The treatment of hypertensive patients needs for long-term medication have made medical costs a prime issue in health economics.AIM:This study aims to determine the cost effectiveness of candesartan therapy compared to candesartan-amlodipine therapy on hypertensive outpatients.METHODS:This is a prospective cohort study that compares candesartan therapy to candesartan-amlodipine therapy at a public hospital from payers’ perspective. The outcome is the percentage of targeted blood pressure decrease after three months of therapy. The cost effectiveness analysis uses the Incremental Cost Effectiveness Ratio (ICER) based on the ratio of cost difference to the outcome in both therapy groups.RESULTS:As many as 111 patients participated in this research, comprising 40 candesartan therapy patients and 71 patients with the combination of candesartan-amlodipine. Of the participants, 63.96% were female, 57.66% were aged 60 or older, and 56.32% had diabetes mellitus as the most common complication. Results show that the average direct medical cost per patient for a therapy of three months with candesartan was IDR 1,050,536 ± 730,007 and IDR 760,040 ± 614,290 for a candesartan-amlodipine therapy. The mean decline of systolic and diastolic blood pressure under candesartan therapy is less than that of candesartan-amlodipine, although without any significant difference (p > 0.05). It follows that the effectiveness of candesartan (85%) is greater than that of the candesartan-amlodipine combination (84.50%). Candesartan therapy is thereby more cost-effective with an ICER value of IDR 580,993/%.CONCLUSION:Hypertension therapy by candesartan is more cost-effective than candesartan-amlodipine therapy with a cost addition of IDR 580,993.

COST-EFFECTIVENESS ANALYSIS OF THE COLLABORATIVE STEPPED CARE INTERVENTION FOR LATE-LIFE DEPRESSION

Late-life depression is a burden on society because it is costly and have a significant adverse effect on the quality of life. The aim of this study is to evaluate the cost-effectiveness of the collaborative stepped care intervention for depression among community-dwelling older adults compared to care as usual from a societal perspective. The intervention was piloted from 2016-2019 in Hong Kong. The study used a two-armed quasi-experimental design. Eventually, 412 older people were included (314 collaborative stepped care, 98 care as usual). Baseline measures and 12-month follow-up measures were assessed using questionnaires. We applied the 5-level EQ-5D version (EQ-5D-5L) and the Client Service Receipt Inventory (CSRI) respectively measuring quality-adjusted life-year (QALY) and health care utilization. The average annual direct medical cost in the intervention group was USD 6,589 (95% C.I., 4,979 to 8,199) compared to US$ 6,167 (95% C.I., 3,702 to 8,631) in the care as usual group. The average QALYs gained was 0.036 higher in the collaborative stepped care group, leading to an incremental cost-effectiveness ratio (ICER) of US$ 11,722 per QALY, lower than the cost-effectiveness threshold suggested by The National Institute for Health and Clinical Excellence. The study showed that collaborative stepped care was a cost-effective intervention for late-life depression over service as usual.

Cost of screening for lung cancer in Australia.

Lung cancer screening can reduce lung cancer mortality. Australian cost estimates are important to inform policy but remain uncertain. To describe the first direct medical costs associated with lung cancer screening in Australia. Single-centre prospective screening cohort. Healthy volunteers (age 60-74 years, current or former smokers quit <15 years prior to enrolment, ≥30 pack-years exposure) underwent baseline and two annual incidence computed tomography (CT) screening scans. Health status and healthcare usage data were collated for 5 years. The main outcome measures were: rates of lung cancer; individual healthcare resource use derived from multiple data sources adjusted to 2018 Australian Medicare Benefits Schedule values. A total of 256, 239, 233 participants was screened at each round respectively; 12 participants were diagnosed with lung cancer during screening and 2 during follow-up: 9 underwent surgery, 4 received concurrent chemoradiation, 1 received palliative chemotherapy. One surgical case died from lymphoma 1407 days after diagnosis, all other surgical cases survived >5 years. Non-surgical median survival post-diagnosis was 654 days. Gross trial cost was Australian dollar (AU$) 965 665 (AU$397 396 CT scans; AU$29 303 false-positive scan work-up; AU$96 340 true-positive scan workup; AU$336 914 lung cancer treatment; AU$104 712 lung cancer follow-up post-treatment). Average total direct medical cost per participant was AU$3 768. Average direct cost of surgery was AU$22 659; average non-surgical cost was AU$47 395 (radiotherapy, chemotherapy, palliative care). Advanced cancer cost more to treat and had worse survival than early cancer. Screening costs are similar to international studies and suggest that lung cancer early detection could limit treatment costs and improve outcomes.

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

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

The Economic Impact of Asthma Treatment on Patients, 2014-2017: The Vietnamese Experience from a Public Hospital

To estimate the economic burden of asthma treatment by quantifying direct medical expenditures at one of Southern Vietnam's public hospitals base on the hospital perspective.A retrospective, prevalence-based, cost-of-illness analysis was developed using the hospital's electronic medical record data to calculate the economic burden of asthma (ICD-10 code J45, J46) through direct medical costs from January 2014 to December 2017. All costs were converted to US dollars and to the year 2018. Data were analyzed using descriptive statistics. The potential correlations between variables were evaluated using the chisquare test and bootstrap difference.The average direct medical cost of asthma was estimated to range from $34.7 to $55.3 per - outpatient and $45.1 to $107.2 per - inpatient annually. The total economic burdens for 4 years from 2014 to 2017 were $110,387.4 from outpatients and $13,413.8 from inpatients. The most influential component was medication cost.Asthma places a high economic burden on individuals and the healthcare system in Vietnam. The findings of this study provide health administrators with important evidence to enhance surveillance of the disease and to allow suitable drafting of national health policy.