Average Medical Costs Research Articles

Direct non-medical and indirect costs of glaucoma care in a Nigerian Tertiary Eye Clinic

BackgroundDirect non-medical costs are health expenditures which are not part of the cost of medical services such as cost of transportation, feeding and accommodation while indirect cost represents the productivity losses incurred as a result of seeking medical care.PurposeTo estimate the direct non-health care cost and indirect cost the loss of earning per visit incurred by glaucoma patients attending glaucoma clinic in National Eye Centre, Kaduna.MethodsA hospital based cross-sectional study conducted over three months (November, 2017–January 2018). One hundred and fifty (150) consecutive glaucoma patients on follow up visits to the glaucoma clinic were recruited (50 per month). The study was conducted using a structured interviewer-administered questionnaire. The study estimated the patients’ monthly income, the method of funding glaucoma treatment, direct and indirect cost of treatment of glaucoma and the productivity loss during the course of a visit to the glaucoma clinic.ResultsOf the 150 persons that participated in the study, 81 (54%) were males with a M: F of 1:1.2 The mean age of the respondents was 55.36 years ± 13.7SD. Majority of the respondents 90(66.7%) fell within the professional or skilled groups of occupation. The direct non-health costs recorded in this study were transportation (96.5%), accommodation (3.2%) and feeding (0.3%). The estimates were higher than the average monthly cost of medications. Respondents of the professional group had a higher mean productivity loss (₦3091 per visit) compared to the skilled (₦783) and unskilled groups (₦176).ConclusionParticipants in this study, incurred a high direct non-medical and indirect cost. The direct non-medical cost was higher for patients who had to travel to access glaucoma care while indirect cost was higher among professional who had to travel to access care.

Association between Home-Base Primary Care and Post-Discharge Outcomes among Older Adults in Korea

This study aimed to evaluate the association between home-based primary care (HBPC) and postdischarge outcomes in Korean older adults. HBPC was a service that provided medical care by visiting the homes of older adults with limited mobility. In this study, data from the National Health Insurance Service (NHIS) were used, and groups with and without HBPC services were matched 1:1 through propensity score matching. Cox proportional hazards model and linear regression analysis were performed to compare the HBPC group with the control group. Overall, 1580 older adults in Korea who used HBPC services after discharge from hospital and 1580 propensity score-matched older adults who did not use HBPC services were included. For 30-day readmission, hospitalizations, and admission to long-term care hospitals or facilities after discharge, this study used a Cox proportional hazards regression model. And linear regression analysis was performed considering that the dependent variable was a continuous variable to examine the average total medical costs after discharge from acute hospital. Older adults who used HBPC services exhibited a lower risk of readmission for the same disease (risk reduction of 0.66, 95% CI 0.50, 0.87) and hospitalization (risk reduction of 0.58, 95% CI 0.46, 0.73) compared with those who did not use HBPC services. The annual average total medical cost was $4764 lower for older adults who used HBPC services than for those who did not (95% CI -6469.49,-3057.52). There was no significant difference in the risk of admission to long-term care hospitals or facilities. HBPC services had a positive effect on reducing 30-day readmission due to the same disease, hospitalization, and annual average total medical costs among older adults after discharge.

Impact of a Restrictive Formulary on glycemic control compared with an Open Formulary

AbstractIntroductionIn 2019, California Governor Gavin Newsom introduced executive order N‐01‐19, which transitioned California's Medicaid (Medi‐Cal) health plan pharmacy benefits from multiple managed care plans to a single‐payer system. This transition occurred on January 1, 2022, and Medi‐Cal stopped enforcing formulary restrictions for beneficiaries.ObjectivesThis study compared glycemic control of hemoglobin A1c in a pharmacist‐led diabetes clinic during an open versus restrictive formulary.MethodsThis is a retrospective cohort study of Medi‐Cal patients seen in a pharmacist‐led diabetes clinic at Kern Medical in Bakersfield, California between January 2021 and September 2022. All new patients with type 2 diabetes and an A1c greater than 6.9% seen at the clinic between January and September 2021 were classified as the Restrictive Formulary group and those seen between January and September 2022 were the Open Formulary group. The primary end point was mean change in A1c at first follow‐up. Secondary end points included attainment of an A1c <7%, change in weight, blood pressure, cholesterol, and statin use, and change in estimated monthly drug expenditure for glucose‐lowering medications per patient. Safety end points included diabetes‐related visits to Kern Medical's emergency room and hospitalizations.ResultsWhile both the Restrictive and Open Formulary groups had significant reductions in mean A1c from a baseline of −0.74 ± 2.1 (p = 0.02) and − 2.7 ± 2.4 (p < 0.001), respectively, the magnitude of A1c reduction was greater in the Open group (p < 0.001). For secondary outcomes, the Open group saw a higher utilization of agents with known cardiovascular and renal benefits. The Open group had a modest weight reduction (−2.5 kg ± 4.4 kg, p = 0.027). There was no significant difference in the cost of diabetes therapy between the two groups (p = 0.12).ConclusionsAn open formulary resulted in better glycemic control without significantly increasing the average monthly cost of diabetes medications.

Costs and Outcomes of Clostridioides difficile Infections in Germany: A Retrospective Health Claims Data Analysis.

Health claims data are a valuable resource for health services research, enabling analysis of the costs of hospitalizations, outpatient visits, procedures, and medications, and providing an improved understanding of the economic burden and underlying cost drivers for a given health condition. Since no recent data were available from Germany on the medical costs and clinical outcomes of Clostridioides difficile infections (CDI), this study assessed the economic burden of CDI and all-cause mortality in adults in Germany. A retrospective cohort study was conducted using a large, anonymized administrative health claims research database from Germany from which an age- and sex-representative sample of 4 million insured persons covered by approximately 60 statutory health insurances was extracted. Propensity score matching was conducted on age, sex, comorbidities, and antibiotic use to identify four matched controls (i.e., patients without CDI) for every eligible adult patient with CDI (i.e., case) in the study cohort. Costs, healthcare resource utilization, and CDI-attributable all-cause mortality were assessed. Overall, there were 15,342 CDI cases in the study cohort. One-year mortality in CDI cases (45.7%) was more than fourfold that of matched non-CDI controls (11.0%). In the year following the index date, average mortality-adjusted medical costs per person-time for CDI cases were almost fivefold that of matched non-CDI controls, representing a cost difference of €31,459, mainly driven by inpatient treatment. Overall excess costs for CDI cases were estimated at approximately €1.6 billion within 1year after diagnosis. CDI in Germany is associated with a high clinical and economic burden, including significantly higher mortality, costs, and healthcare resource utilization, in patients with CDI versus their matched patients without CDI. This has important implications for patients, healthcare providers, and the healthcare system.

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

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

Unveiling the chasm of economic burden from metastatic prostate cancer through a nationwide retrospective cohort study

Objective To analyze the clinical and economic consequences of the progression to castration-resistant status for patients with metastatic hormone-sensitive prostate cancer (mHSPC) and metastatic castration-resistant prostate cancer (mCRPC) in South Korea. Methods This retrospective cohort study was conducted using National Health Insurance claims data from 2013 to 2021. Patients defined as newly diagnosed with mHSPC had an index date of first claim for metastatic PC between 2015 and 2016 and no exposure to CRPC medicines during the washout period. All-cause monthly medical and end-of-life costs were described for mHSPC and mCRPC. Descriptive statistics were used to analyze medical costs, and generalized estimating equations were used to evaluate the correlation between medical costs and significant variables, including disease progression, death, and clinical characteristics. Results Of the 3,739 patients with mHSPC included (mean 72.9 years), 779 progressed to mCRPC. The overall study population underwent a median 60.48-month follow-up period. The average monthly medical cost depending on CRPC progression was 1.5 times higher in the mCRPC than in the mHSPC group ($1,734.2 vs. $1,185.4). Monthly medical costs for those who progressed to mCRPC were 2.4 times higher one year after progression than one year before. In all groups, the average total medical costs gradually increased near mortality. Disease progression and death had a significant correlation with medical costs, by 1.7 times and 2.46 times, respectively. Conclusion This study highlights the economic and health benefits of preventing progression to castration resistance in patients with mHSPC based on real-world data.

Analisis Minimalisasi Biaya Terapi Antibiotik Ceftriaxone dan Cefotaxime Pada Pasien Pneumonia di Instalasi Rawat Inap RSUD Kabupaten Kediri

Pneumonia is an infection caused by pathogenic microorganisms such as microbes, bacteria, fungi and viruses that cause inflammation of the lung tissue. The prevalence of pneumonia has increased every year. The first-line therapy used at the Kediri District Hospital is the use of ceftriaxone and cefotaxime antibiotics. Decision making on antibiotic use has an influence on the amount of medical costs incurred by patients. This study aims to determine which antibiotics are more cost-minimal and whether there is a significant difference between the use of ceftriaxone and cefotaxime antibiotic therapy at Kediri District Hospital. The design of this study was cross sectional, data collection was done retrospectively. The analysis method used independent t-test statistical test. The perspective in this study was seen through the provider, namely the hospital, a total of 215 pneumonia patients and the sample for this study was 63 patients. With 32 patients receiving ceftriaxone antibiotic therapy and 31 patients receiving cefotaxime antibiotic therapy. Total direct medical costs were categorized into four types of costs, namely treatment costs, antibiotic costs, other drug costs, laboratory and radiology costs. The average total direct medical costs of patients who received ceftriaxone antibiotic therapy were more cost minimal than patients who received cefotaxime antibiotics, namely Rp.2,296,449 and Rp.2,464,470. The results of the difference test using independent t-test statistics show a p-value of 0.219 so that it can be interpreted that there is no significant difference.

A Prevalence-Based Study to Estimate Cost of Illness of Rheumatoid Arthritis in a Tertiary Care Hospital in India

Background: Rheumatoid arthritis (RA) is a chronic progressive inflammatory condition with high cost of management and significant impact on the patient and healthcare system. Hence, there is a need to estimate and analyze the economic impact of RA. Materials and Methods: It was a cross-sectional prospective follow-up single-center study at a tertiary care hospital conducted over a period of 02 years and 06 months from September 2019 to February 2022 after ethical committee clearance. Results: A total of 189 RA patients were included after excluding 15 patients. The male-to-female ratio was 0.687. The mean age of the study population was 44.74 ± 5.2 years. The mean yearly average cost of management of RA was Rs 29155.1 ± 18234.1, of which 49.6% was direct medical, 19.4% was direct non-medical, and 31% was indirect costs. Of average direct medical costs, cost toward non-steroidal anti-inflammatory drugs (NSAIDs) was 3.1%; conventional disease-modifying antirheumatic drugs (DMARDs) was 36.3%; and laboratory, radiology investigations, and consultations was 6.4%, 1.48%, and 12.3%, respectively. Factors, such as longer duration of treatment, use of biologic DMARDs, loss of productive workdays, extraarticular manifestations, and management of complications, were associated with higher cost of treatment of RA. Conclusions: This study quantifies the economic burden of the RA by measuring costs incurred toward all aspects of the patient’s life including the indirect costs due to loss of workdays. The knowledge of cost will help in financial management by patients and healthcare providers.

Economic burden of knee joint replacement in Iran

BackgroundThe knee is the most commonly afflicted weight-bearing joint. Osteoarthritis of the knee is regarded as one of the most commonly diagnosed causes of disability in the elderly. Knee joint replacement can be regarded as a final solution for Osteoarthritis of the knee in which the joint is worn out, accompanied by clinical symptoms such as pain, deformity, and limited movement.Aimthis study sought to estimate the economic burden of knee joint replacement procedures carried out in Iran.MethodThis cross-sectional descriptive study utilized the Incidence-based approach to assess the economic burden of knee joint replacement surgeries conducted in Iran during 2022, estimating the costs of the disease from a societal perspective. The sampling method employed was random sampling, and the sample size consisted of 300 patients. Direct costs were calculated employing the top-down approach, while indirect costs were estimated using the human capital approach. Microsoft Excel was employed for data analysis.ResultThe average direct medical costs of the knee replacement procedure per patient were $10,076.87 and $13,099.93 in the public and private sectors, respectively. The average direct non-medical costs of knee joint replacement surgery are $1123.64, with companion costs constituting most of the direct non-medical costs. Finally, the economic burden of the knee joint replacement surgery was estimated at $67340417.28.ConclusionDespite insurance coverage, knee joint replacement surgery in Iran incurs substantial costs. With the anticipated rise in the elderly population, the frequency of these procedures is expected to increase, amplifying the economic burden on the Iranian public.

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

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

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

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

Medical costs in the peridiagnosis period of various biopsy-confirmed kidney diseases in South Korea.

In-depth investigation is imperative to scrutinize medical costs associated with the periods before and after biopsies for diverse kidney diseases in South Korea. Long-term epidemiological data, including follow-up information, is essential for comparing risks linked to various kidney diseases and their adverse outcomes. Patients diagnosed with glomerulonephritis (GN), tubulointerstitial nephritis (TIN), and acute tubular necrosis (ATN) at Seoul National University Hospital between 2012 and 2018 were included. We linked the prospective cohort data of biopsy-confirmed kidney disease patients (KORNERSTONE) from our study hospital to the national claims database of Korea, covering both medical events and insured costs. We analyzed medical costs during the periods before and after kidney biopsies, categorized by specific diagnoses, and delved into adverse prognostic outcomes. Our study involved 1,390 patients with biopsy-confirmed GN, TIN, and ATN. After diagnosis, monthly average medical costs increased for most kidney diseases, excluding membranous nephropathy, Henoch-Schönlein purpura, and amyloidosis. The most substantial yearly average medical cost increase was observed in the ATN, acute TIN (ATIN), and chronic TIN (CTIN) groups. Costs rose for most kidney disease categories, except for amyloidosis. Higher myocardial infarction, stroke, and death rates were noted in CTIN, ATIN, and ATN compared to other types, with lupus nephritis displaying the highest end-stage kidney disease progression rate. In South Korea, medical costs for the majority of GN, TIN, and ATN patients increased following kidney biopsy diagnosis. This current data provides valuable epidemiological insights into the medical costs and prognosis of various kidney diseases in the country.

Economic Burden of Huntington's Disease: Analysis from a Brazilian Tertiary Care Perspective.

Huntington's disease (HD) exerts significant impacts on individuals and families worldwide. Nevertheless, data on its economic burden in Brazil are scarce, revealing a critical gap in understanding the associated healthcare costs. This study was conducted at a tertiary neurology outpatient clinic in Brazil with the aim of assessing annual healthcare service utilization and associated costs for HD patients. We conducted a cross-sectional observational study involving 34 HD patients. A structured questionnaire was applied to collect data on direct medical costs (outpatient services, medications), non-medical direct costs (complementary therapies, mobility aids, home adaptations), and indirect costs (lost productivity, caregiver costs, government benefits) over one year. Significant economic impacts were observed, with average annual direct medical costs of $4686.82 per HD patient. Non-medical direct and indirect costs increased the financial burden, highlighting extensive resource utilization beyond healthcare services. Thirty-three out of 34 HD patients were unemployed or retired, and 16 relied on government benefits, reflecting broader socioeconomic implications. Despite the dataset's limitations, it provides crucial insights into the economic impact of HD on patients and the Brazilian public health system. The findings underscore the urgent need for a more comprehensive evaluation of the costs to inform governmental policies related to HD. Future research is needed to expand the data pool and develop a nuanced understanding of the economic burdens of HD to help formulate effective healthcare strategies for patients.

A systematic review of the economic burden of colorectal cancer.

Colorectal cancer is the third most common cancer in the Western Hemisphere. It is the third most common cancer in men after prostate and lung cancers and the second most common cancer in women after breast cancer. According to some studies, the incidence and prevalence of colorectal cancer is increasing rapidly. In the present study, a systematic review of the articles related to the economic burden of colorectal cancer was carried out. The articles were taken from the following databases: SID, Medline/Pubmed, Embase, Scopus, Web of Science, NHS Economic Evaluation Database (EED), Econlit, and Google Scholar. Furthermore, the PICOTS model was used to select the inclusion criteria. The quality of the articles' methodologies was evaluated using Drummond's checklist. Then, some data were extracted from relevant articles, in terms of year, place of research, sample size, costing approach, type of measured costs, average direct medical costs, average direct nonmedical costs, and average indirect costs. The data from 37 studies dealing with the costs of patients with colorectal cancer were extracted. Most of the studies were conducted in the United States, and the social perspective was the most common perspective to measure the costs. According to the majority of the studies, direct medical costs were considered the greatest driver in causing the economic burden of colorectal cancer. The costs of hospitalization, medicine, surgery, chemotherapy, and radiotherapy accounted for the largest share of direct medical costs, and the costs of transportation, accommodation, and home care were the greatest share of direct nonmedical costs. Furthermore, the costs associated with disability, absenteeism, and premature death were identified as the main drivers of indirect costs. The findings of this study showed that colorectal cancer imposes great direct and indirect costs on families, the health system, and society. The best way to deal with this disease and, hence, to reduce its economic burden is to take comprehensive preventive measures and modify the lifestyle. In addition, health policymakers can limit the costs of this disease by expanding the screening program.

A pharmacoeconomic study on Jan Aushadhi generics versus branded pharmaceutical formulations in India

Background: Healthcare costs are a major burden on the society of developing countries like India. Countries like India try to limit healthcare costs in support of generic medicine. So, the Indian government initiated the Jan Aushadhi scheme in 2008 to provide high-quality generic medication at a low cost. Aim: The aim of the study was to compare the cost difference between Jan Aushadhi generic pharmaceutical formulations and branded medications in Tamil Nadu. Settings and Design: Pharmaco economic - Cost minimization observational study. Methods and Material: Study Duration: Five months, from February 2023 to June 2023. Study Place: 10 Jan Aushadhi outlets from various districts of Tamil Nadu. Sampling technique: Convenience sampling technique Statistical analysis used: Mean median, mode and Percentage. Results: A total of 729 medications were available in 10 Jan Aushadhi outlets. The Jan Aushadhi outlet has the most cardiovascular medications and the fewest antimalarial medications among different categories of drugs. Erythropoietin has the biggest cost difference between the average cost of branded medications and Jan Aushadhi drug costs, while Digoxin has the lowest cost difference. Antitubercular drugs, Oxytocics, Antileprosy drugs, Antiparkinsonism categories of drugs also delisted in Jan Aushadhi outlet. Conclusions: Compared to branded drugs, Jan Aushadhi's generic drugs are 64.65 % less costly on an average as observed in our study. The manufacturer of Jan Aushadhi shops is a WHO and GMO-certified company, and they manufacture branded drugs. So, there will be no quality compromise in Jan Aushadhi’s generic drugs.

Owner experience and veterinary involvement with unlicensed GS-441524 treatment of feline infectious peritonitis: a prospective cohort study.

Feline Infectious Peritonitis (FIP) has historically been a fatal coronavirus disease in cats. In recent years, the therapeutic agent GS-441524, developed by Gilead Sciences, was found to be a successful treatment for FIP in most patients in clinical trials. However, this particular drug has remained stalled in the therapeutic pipeline, leaving patients and cat owners without a licensed medication. In the meantime, online social media platforms began to emerge, connecting cat owners with a community of citizen non-veterinary professionals sourcing unlicensed GS-441524. This study prospectively followed participants (N = 141) that successfully completed 12 weeks of treatment, capturing their treatment experiences with self-administered GS-441524-like medication. A one-time survey was administered to enrolled participants with mixed format of questions (open-ended and multiple-choice) asking about treatment administration techniques, observed side effects of GS-441524, accrued cost, veterinarian involvement, impact on the cat-human bond, and social media usage. Our results show cat owners experienced a shift in treatment modality from injectable GS-441524 to pill formulation across the treatment period. The average total cost of medication has decreased since 2021 to approximately USD 3100, and participants reported the human-animal bond being affected negatively. Additionally, there was an increased trend in veterinarian awareness of GS-441524-like therapeutics and monitoring of clients undergoing treatment. Social media usage was reported as being important at the beginning of treatment to establish treatment administration but lessened by the end of treatment. This study is the first detailed, prospective account of owner experiences with unlicensed GS-441524, raising an important discussion surrounding citizen veterinary medicine.

Cost Analysis of Oral Phenazopyridine vs Intravesical Lidocaine for Preprocedural Analgesia for Intradetrusor OnabotulinumtoxinA Injections.

Office administration of intradetrusor onabotulinumtoxinA is commonly used to treat overactive bladder. For preprocedure analgesia, either 50 mL 2% intravesical lidocaine instillation for 20 to 30 minutes or 200 mg oral phenazopyridine can be used. Phenazopyridine is associated with shorter appointment times and is noninferior to lidocaine for pain control in this setting. We performed a cost analysis of phenazopyridine vs lidocaine for analgesia before office intradetrusor onabotulinumtoxinA injection for the treatment of idiopathic overactive bladder. A health care sector-perspective cost analysis was performed. The following assumptions were made: (1) similar efficacy of each medication in providing adequate analgesia, (2) similar physician ease of performing the procedure with either analgesic, and (3) similar patient satisfaction with either analgesic. Average cost of medications, adverse reactions, nursing tasks, and office visit time were found in publicly available data. Sensitivity analyses were performed using TreeAge Pro 2021, R1 software. Phenazopyridine is less costly compared to lidocaine per visit for office intradetrusor onabotulinumtoxinA injection ($827 vs $925). A difference of $98 per procedure provides a total annual cost savings of over $24 million if all procedures are performed with phenazopyridine instead of lidocaine. Sensitivity analysis showed that phenazopyridine remained less costly under most circumstances, and threshold analysis provided exact circumstances under which phenazopyridine is no longer cost saving. Phenazopyridine provides cost savings compared to lidocaine for analgesia before office intradetrusor onabotulinumtoxinA injection for the treatment of idiopathic overactive bladder. If adopted by providers nationwide, phenazopyridine may reduce health care spending and minimize office visit time while maintaining patient pain control and satisfaction.

Effects of a Diagnosis-Related Group Payment Reform on Length and Costs of Hospitalization in Sichuan, China: A Synthetic Control Study.

Diagnosis-related group (DRG) payment policies are increasingly recognized as crucial instruments for addressing health care overprovision and escalating health care costs. The synthetic control method (SCM) has emerged as a robust tool for evaluating the efficacy of health policies worldwide. This study focused on Panzhihua city in Sichuan Province, a pilot city for DRG payment reform implementation, serving as the treatment group. In contrast, 20 nonpilot cities within the province were utilized as potential control units. A counterfactual control group was constructed to evaluate the changes in average inpatient stay duration and health care organization costs following the DRG payment reform initiated in 2018. Focusing on Panzhihua, Sichuan Province, the analysis reveals that following the reform in March 2018, the average length of hospital stay in Panzhihua decreased by 1.35 days during 2019-2021. Additionally, the average cost per hospitalization dropped by 855.48 RMB, the average cost of medication per hospitalization decreased by 68.51 RMB, and the average cost of diagnostic and therapeutic procedures per hospitalization declined by 136.37 RMB. While global evidence backs DRGs for efficiency and cost reduction, challenges persist in addressing emerging issues like new conditions. Since its introduction in 2018, the DRG payment reform in Sichuan Province has effectively reduced both the duration of hospital stays and the operational costs of health care facilities. However, potential drawbacks include compromised service quality and an elevated risk of patient readmission, indicating a need for further refinement in the implementation of DRG payment reforms in China.

Analysis of Real Hospital Cost on Ina-Cbgs Rates for Cesarean Section Patients

A caesarean section is an artificial birth that is carried out by making a small incision in the abdominal wall and uterine wall, but the uterus must be intact and the fetus weighs >500 grams. The high cost of a cesarean section has prompted the Indonesian government to launch the National Health Insurance (JKN) program as an implementation of the National Health Insurance (JKN) which has been regulated regarding to the payment patterns to advanced health facilities by applying Indonesian Case Based Groups (INA-CBG's). This study aims to determine the difference between real hospital cost rates and INA-CBGs rates for payment of claims by JKN participants for caesarean section inpatients at Dr. Soedomo Regional Hospital Trenggalek. The research method is analytical observation with a cross sectional approach which refers to the hospital's perspective by comparing the direct medical costs of BPJS’s (Social Security Agency on Health) participant patients and the INA-CBG's rates. The populations of this study were BPJS recipients of class I, II, III inpatients who received mild category of caesarean section at Dr. Soedomo Regional Hospital Trenggalek in 2020. The sample used in this study was medical record documents that met the inclusion and exclusion criteria. Purposive sampling method was used. In treatment of I, II, III classes, a significant difference was found between the average total direct medical costs of mild category of caesarean section patients (O-6-10-I) compared to the INA-CBGs rates. The treatment of class I had a difference of IDR 886,582. (p<0.05). The treatment of class II had a difference of IDR 754,881. (p<0.05) and the treatment of Class III, the difference obtained was IDR 1,109,368. (p<0.05).

A comparative study of real hospital costs and INA-CBG rates for stroke in Indonesia

Background: The claim payment method in JKN program uses the prospective Indonesian Case Base Groups (INA-CBG) method, in which the rate has been determined before health services are provided based on the diagnosis code group. This potentially causes a discrepancy in the costs incurred by health facilities. Objective: This systematic review aimed to provide an overview of the comparison of actual hospital costs with the INA-CBG rates of the JKN program for inpatient stroke. Method: The collection method used a PRISMA flowchart on several databases. This systematic review is a comparative study comparing the significance of the average actual direct medical costs with the INA-CBG rates. Result: Cost differences on intracerebral haemorrhage (I619) and unspecified stroke diagnosis (I64) consistently give a negative difference around IDR 110,659 – IDR 8,184,007/patient/episode. Medicine and medical equipment are the most significant components of stroke treatments. Factors that significantly influence direct medical costs are the length of stay (LOS), class of JKN, and age. Conclusion: Cost differences can be influenced by several factors that can affect the direct medical costs of hospitals. The factor that has the most influence on the amount of direct medical cost is LOS.