Average Total Treatment Costs Research Articles

COVID-19 and Acute Myocardial Infarction: Exploring Clinical Factors and Treatment Expenditures

Background: The concurrence of acute myocardial infarction (AMI) with COVID-19 can complicate the clinical conditions of patients and affect the patterns of hospital resource utilization. This study aimed to investigate and analyze the direct treatment costs of AMI patients with concurrent COVID-19. Methods: This cross-sectional study collected and analyzed clinical data, including symptoms, readmission, and interventions, and treatment cost data for all patients at Tehran Heart Center using SPSS26 software. The mean medical costs of patients from January through May 2022 were also calculated. Results: The COVID-19 group was composed of 72.9% male and 27.1% female patients, whereas the non-COVID-19 group consisted of 67.3% male and 32.7% female patients. Most of the patients in the COVID-19 group (60%) were in the elderly age group (>65 y). The length of stay was 8.70±5.84 days for the COVID-19 group and 6.31±4.42 days for the non-COVID-19 group. The mortality rate in the COVID-19 group was 24%, higher than the 5% rate in the other group. Additionally, the average total treatment costs were $6384.54±$6760.13 in the COVID-19 group and $6362.49±$4343.07 in the non-COVID-19 group (P>0.78 and P>0.050). Conclusion: The study found that the COVID-19 group had a significantly higher in-hospital mortality rate than the non-COVID-19 group. During the follow-up period, the incidence of complications (chest pain and heart failure) was higher in the non-COVID-19 group. It also showed that longer hospital stays resulted in higher treatment costs.

Coping Strategies for Financial Burden of Family for the Children with Autism Spectrum Disorder

Background: Autism Spectrum Disorder (ASD) is a neurodevelopment disorder and an emerging public health issue globally which is associated with huge burden to the family, community and the nation. Study was conducted to find out the coping strategies for financial burden of the family with ASD children. Methods: A cross-sectional study on 154 children with ASD was carried out from July 2015 to June 2016 where data were collected from two special schools and two specialized hospitals of Dhaka city. Data were collected by face-to-face interview with semi-structured questionnaire following systematic random sampling technique. Informed written consent was taken from the parents. Results: Majority (73.4%) of the children were male and average monthly family income and total treatment cost was Tk. 41785.7 and Tk. 23076.62 respectively. However, coping strategies were adopted by the family “changing lifestyle” (96.8%), “accepting the reality” (100%), “minimizing family investment” (90.3%). Again, 52.5% families minimized family investment as coping strategies, 52.2% families had financial constraint as consequences of financial burden, which were significantly higher in comparison with others (p<0.05). Conclusion: ASD foist huge financial burden to the families of affected children. To compensate this financial burden, families adopted different coping strategies like changing lifestyle, taking social support, relying on religion, minimizing family investment, accepting reality etc. Appropriate early diagnostic facilities should be available to estimate the actual burden of the country. Bangladesh Armed Forces Med J Vol 56 No (2) December 2023, pp 38-44

Analysis Of The Cost Effectiveness Of Oral Iron Cleaning Drugs Between Deferipron And Deferasiroks In Patients With Thalasemia Major At Bhayangkara Kindergarten Hospital. Ii Setukpa Lemdiklat Polri

Thalassemia is a blood disorder characterized by reduced or absent synthesis of globin chains, particularly thalassemia major, imposes significant financial burdens due to the lifelong need for blood transfusions and iron chelation drugs. This research aims to assess the cost and efficacy of oral iron chelators, specifically deferasirox and deferiprone, in treating thalassemia major patients at Setukpa Lemdiklat Polri Tk—II Hospital in 2023. The data were retrospectively gathered through total sampling from patients' medical records and the hospital information system. The findings indicate that the average total treatment cost for thalassemia major patients using deferasirox (IDR 52,969,775,-) is higher than deferiprone (IDR 49,407,613,-). Deferasirox exhibits greater effectiveness (1,364 ng/mL) than deferiprone (1,210 ng/mL). The cost-effectiveness ratio of deferasirox (IDR 38,834,-) is lower than that of deferiprone (IDR 40,833,-). Transitioning from deferiprone to deferasirox incurs an additional IDR 23,130 per unit cost. The average cost-effectiveness ratio suggests that deferasirox is more economically efficient than deferiprone.thalassemia major

The economic burden of leprosy treatment to households in Ghana: A cross-sectional study in the Volta Region of Ghana.

Despite the known detrimental socio-economic consequences of leprosy morbidity, disability and social exclusion at the household level, research investigating the precise economic burden of leprosy remains scarce. This study aims to address this gap by examining the socio-economic burden of leprosy in Ho municipality in the Volta Region of Ghana. This was a cross-sectional cost of illness study, and quantitative data were collected from leprosy patients between October and December 2023. Data collected included socio-demographic characteristics, direct and indirect costs related to treatment of leprosy from the patient's perspective. Stata version 14 was used for the analysis. A total of 35 respondents participated in the study, comprising 51.43% females and 48.57% males. All respondents (100%) reported having a valid National Health Insurance Scheme membership. The average total cost of leprosy treatment per patient, encompassing both direct and indirect expenses, was US$361.54 (SD ± 286.87). Disaggregating this cost further revealed a medical cost of US$44.30, a non-medical cost of US$47.07 and an indirect cost of US$290.16. The estimated annual household income of respondents was US$446.4 and 60% of respondents incurred expenditure that was more than 10% of their annual income and were deemed to have experienced catastrophic payment. Patients with sequelae incurred additional costs of US$46 (range: US$8.3-US$166.7) per case. The costs of treating leprosy were considerably high leading to catastrophic health payments. This highlights the need for an all-encompassing strategy that addresses medical, non-medical and indirect costs. Implementing targeted support programs and ensuring medication affordability are key steps towards mitigating the economic susceptibility of leprosy patients and facilitating successful treatment outcomes.

Chi phí chẩn đoán và điều trị cho người bệnh Viêm gan vi rút C mạn tính tại bệnh viện A Thái Nguyên, năm 2021

Objective: To calculate the average cost of outpatient chronic hepatitis C diagnosis and treatment from the view of Vietnam Social Security (VSS), A Thai Nguyen Hospital, in 2021; Methods: Cross-sectional descriptive study. Study is based on retrospective billing data from hospital discharge records with 257 Hepatitis C outpatients who completed treatment from May 2021 to Dec 2021 at Thai Nguyen A Hospital. Main findings: The average cost per case of diagnosis and treatment for chronic HCV patients in the non-cirrhotic stage or compensated cirrhosis is 30 million VND and 58 million VND for patients with decompensated cirrhosis. Drug costs account for more than 90% of the total cost of diagnosis and treatment of chronic HCV. Conclusions: The study provided evidence on the cost of diagnosis and treatment for VGC outpatients from the point of view of Vietnam Social Security at A Thai Nguyen hospital. The average total cost of diagnosis and treatment for 01 patient in the late stage with decompensated cirrhosis is double price for 01 patient in the early stages (no cirrhosis/compensated cirrhosis). In addition, drug costs account for more than 90% of the cost of diagnosis and treatment. Thai Nguyen province promote screening and treatment programs for HCV at an early stage such as without cirrhosis or with compensated cirrhosis. At the same time, implementing methods of drug procurement to reduce prices and continue to lobby for funding for the diagnosis and treatment of HCV to help reduce the burden of HCV in the locality. Keywords: Costing, Hepatities C, A Thai Nguyen Hospital

Cost-minimization analysis of pneumonia treatment in Indonesia

Pneumonia is one of the significant causes of death in developing countries, including Indonesia. As the capital of West Java, Bandung is one of the cities with the highest pneumonia cases in this province. The objective of this study was to conduct cost-minimization analysis of pneumonia treatment in Indonesia by using one of the private hospitals in Bandung as a reference case. The use of cefuroxime and ceftizoxime was considered in adult hospitalized patients. In addition, ampicillin-sulbactam and ceftriaxone usage was compared in pediatric hospitalized patients. A cross-sectional descriptive study was applied by collecting data retrospectively from medical records of adult and pediatric patients who met the inclusion criteria at one of the private hospitals in Bandung from January 2017 to December 2018. We applied the following inclusion criteria: (i) adult (> 20 years old) and pediatric (0–5 years old) patients who were diagnosed with pneumonia; and (ii) adult patients who received cefuroxime or ceftizoxime antibiotic therapy and pediatric patients who received ampicillin-sulbactam or ceftriaxone antibiotic therapy. We excluded patients who were diagnosed with any other co-morbidities and who did not complete the treatment. The result showed that drug cost was the primary contributor to total treatment cost in adult and pediatric patients. We calculated the average total treatment cost with ceftizoxime and cefuroxime in adult patients at $149.39 and $193.05, respectively, and the average total treatment cost with ampicillin-sulbactam and ceftriaxone in pediatric patients at $202.83 and $192.77, respectively. We also estimated the LoS in a group of ceftizoxime and cefuroxime in adult patients at 3.8 and 4.1 days, respectively, and the LoS in a group of ampicillin-sulbactam and ceftriaxone in pediatric patients at 3.9 and 5.3 days, respectively. In conclusion, using ceftizoxime to treat hospitalized pneumonia in adult patients would require less cost and yield shorter LoS than cefuroxime. Using ampicillin-sulbactam to treat hospitalized pneumonia in pediatric patients would require higher costs and yield shorter LoS than ceftriaxone.

Prevalence and predictive factors for infertility-related stress among infertile couples: A cross-sectional study from Jordan and the occupied Palestinian territories.

To assess the level of infertility-related stress, associated socio-economic, and demographic factors among infertile couples living in Jordan and those living under the chronic Israeli-Palestinian conflict in the occupied Palestinian territories. A cross-sectional study was carried out in a number of fertility and reproductive clinics in Jordan and occupied Palestinian territories over a period of 6 months. Trained clinical pharmacists interviewed the identified couples. A total of 443 participants were interviewed. Three variables were significantly and independently associated with global stress scores. The need of parenthood appears higher in women than men among infertile couples in Jordan and Palestine (p=0.005). The country of origin (p<0.001) made the greatest contribution of unique variance followed by family type (p=0.035). Additionally, a significant contribution to the model was carried out by the number of clinicians who followed up on the case (p=0.013). The average total cost of treatment since the problem had been diagnosed was 2936±4529 Jordanian dinar, which may be of concern to both Jordanians and Palestinians given the limited resources available in developing nations. This study shows a significant degree of stress among infertile couples. The place of origin, family structure, and presence of medical insurance had a significant impact on the infertility global stress score. This study emphasizes the necessity for specific psychological therapies that are currently lacking in public healthcare practices in both Jordan and Palestine.

Economic Burdens for Treatment of Patients With Type 2 Diabetes in North Thailand: A Hospital-Based Observational Study.

PurposeDiabetes and its complications pose an economic burden to healthcare systems, family, and society. Therefore, this study aimed to estimate the real-world financial burden of type 2 diabetes (T2D) treatment, complications, and cardiovascular death.Materials and MethodsAn electronic database of the largest university-affiliated hospital in the North of Thailand was retrieved for a 10-year period (2009-2019). We used the International Classification of Disease 10th Revision codes of diabetes and complications to obtain relevant patient records. All included records based on the inclusion and exclusion criteria were analyzed. Expenditures for diabetes treatment, complications, and cardiovascular death for two years were reported as mean, standard deviation, median, and interquartile range.ResultsOf a total of 9,161 patient records, the average age of patients was 57.8 ± 12.7 years. The average total outpatient cost was THB 22,874 ± 38,066 (US$ 759 ± 1,264) for the first year and THB 23,462 ± 34,441 (US$ 779 ± 1,143) for the second year. The average inpatient expenditure was THB 160,790 ± 411,607 (US$ 5,338 ± 13,666) for the first year and THB 181,804 ± 190,257 (US$ 6,036 ± 6,317) for the second year. Drug was the main component for outpatient expenditure while surgery was the main component for inpatient expenditure. Diabetes patients with complications incurred a greater cost of treatment than those without complications. Cardiovascular death led to about seven times higher cost of treatment than the average total cost of diabetes treatment. Heart failure complications (THB 846,345 ± 752,884 or US$ 28,099 ± 24,996) had the highest inpatient costs compared with other complications in the first year. Stroke complications (THB 71,927 ± 143,414 or US$ 2,388 ± 4,761) had the highest outpatient costs compared with other complications. In general, the first-year expenditure was higher than the second year for all complications.ConclusionsDiabetes incurs a substantial financial burden resulting from its complications. Effective management of diabetes with a multi-sectoral effort from government, providers, patients, and private is required.

Hospital Price Transparency Rule Exposes Muddied Costs for Head and Neck Radiotherapy in One State.

Financial toxicity due to cancer treatment is a significant concern for patients. To increase transparency related to treatment costs, the Hospital Price Transparency Final Rule (HPTFR) was passed on January 1, 2021. We used hospital pricing documentation to explore the costs of head and neck cancer (HNC) radiotherapy in Ohio, hypothesizing a large variance in cost based on geography. Radiation oncology facilities were identified using the Ohio Hospital Association (OHA) website. The reported technical charges for Current Procedural Terminology (CPT) codes commonly billed in the definitive management of HNC with radiotherapy were recorded, and total treatment costs (TTCs) were calculated. Of 254 OHA-listed hospitals, 102 had radiation oncology facilities. Seven facilities were excluded due to a lack of pricing data, leaving 95 facilities in 40 of 88 counties. Median TTC was $176,496. Average TTC was $184,831 (SD: $83,982). The 22 rural hospitals charged less compared with nonrural hospitals, with a difference in medians of $72,084.38 (P<0.001). No difference was found between the TTCs of nonprofit and public hospitals (P=0.348) nor between academically affiliated and nonacademically affiliated hospitals (P=0.247). There is no correlation between county median household income and TTC (R2=0.0007). Rather, TTCs varied drastically across counties, regardless of income levels. There is a wide range of treatment costs for HNC patients receiving definitive radiotherapy in Ohio, and no variables fully explain this variance. Further policies are needed to improve the quality, quantity, and accessibility of health care data to address financial toxicity.

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

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

Costs comparison of treating diabetic macular edema with aflibercept, ranibizumab or dexamethasone at 1 year in France (INVICOST study).

Purpose:INVICOST, a medico-economic analysis, compared costs of managing treatment-naive patients with diabetic macular edema (DME) receiving intravitreal injections (IVIs) of aflibercept (AFL), dexamethasone implant (DXI) or ranibizumab (RAN) over 1 year.Methods:Healthcare resource use and associated costs were estimated using individual patient data from INVICTUS, a prospective, open-label, monocentric study. Healthcare costs comprised direct medical costs such as drug acquisition and administration, consultations and ophthalmological procedures. Costs were assessed from the French National Health Insurance perspective using published national tariffs expressed in 2019 euros.Results:Of the 60 treated eyes, 48 had no treatment switch; 14 received AFL, 19 received DXI and 15 received RAN. AFL-treated eyes received an average of 6.5 IVIs, DXI-treated patients received 2 IVIs and RAN-treated received 6.8 IVIs. All treated eyes received an initial prescription for adjunctive ocular medications and 349 follow-up procedures were performed including an average of 3.9 optical coherence tomography and 3.2 retinography procedures per eye. Average total direct cost of per-eye treatment was €4516 (€1128–€8257). Average cost was €5782 for eyes treated with AFL, €2779 with DXI and €5536 with RAN. Drug therapy was the cost driver: €4394 (76%) for AFL, €1915 for DXI (69%) and €4268 (77%) for RAN.Conclusion:The difference in total treatment cost is largely explained by the significantly lower frequency of IVI and annual cost of therapy with DXI, compared with AFL and RAN. INVICOST is the first study comparing treatment costs with AFL, DXI and RAN in France in current clinical practice.

Cost-effectiveness implications of increasing the efficiency of the extended-release naltrexone induction process for the treatment of opioid use disorder: a secondary analysis.

In a US randomized-effectiveness trial comparing extended-release naltrexone (XR-NTX) with buprenorphine-naloxone (BUP-NX) for the prevention of opioid relapse among participants recruited during inpatient detoxification (CTN-0051), the requirement to complete opioid detoxification prior to initiating XR-NTX resulted in lower rates of initiation of XR-NTX (72% XR-NTX versus 94% BUP-NX). This was a retrospective secondary analysis of CTN-0051 trial data, including follow-up data over 24-36weeks. Eight community-based, inpatient-detoxification and follow-up outpatient treatment facilities in the United States. A total of 283 participants randomized to receive XR-NTX. Efficiency was estimated using a multivariable generalized structural equation model to explore simultaneous determinants of XR-NTX induction and induction duration (detoxification+residential days). Cost-effectiveness was estimated from the health-care sector perspective and included expected costs and quality-adjusted life-years (QALYs). Treatment site was the only modifiable factor that simultaneously increased the likelihood of XR-NTX induction and decreased induction duration. Incorporating the higher predicted probability of XR-NTX induction, and fewer predicted days of detoxification and subsequent residential treatment into the cost-effectiveness framework, reduced the incremental average 24-week total cost of XR-NTX treatment from $5317 more than that of BUP-NX (P=0.01) to a non-statistically-significant difference of $1016 (P=0.63). QALYs gained remained similar across arms. Adopting an efficient model of extended-release naltrexone initiation could result in extended-release naltrexone and buprenorphine-naloxone being of comparable economic value from the health-care sector perspective over 24-36weeks for patients seeking treatment for opioid use disorder at an inpatient detoxification facility.

Evaluating the Impact of Intensive Case Management for Severe Vocational Injuries on Work Incapacity and Costs

Purpose This study investigates the impact of an intensive case management program on sick leave days, permanent work incapacity levels and treatment costs for severe vocational injuries set up by the French National Insurance Fund in five health insurance districts. Methods The method employed relies on a four-step matching procedure combining Coarsened Exact Matching and Propensity Score Matching, based on an original administrative dataset. Average Treatment effects on the Treated were estimated using a parametric model with a large set of covariates. Results After one-year follow-up, workers in the treatment group had higher sickness absence rates, with 22 extra days, and the program led to 2.7 (95% CI 2.3–3.1) times more diagnoses of permanent work incapacity in the treatment group. With an estimated yearly operational cost of 2,722 € per treated worker, the average total extra treatment cost was 4,569 € for treated workers, which corresponds to a cost increase of 29.2% for the insurance fund. Conclusions The higher costs found for the treatment group are mainly due to longer sick leave duration for the moderate severity group, implying higher cash transfers in the form of one-off indemnities. Even though workers in the treated group have more diagnoses of permanent work incapacity, the difference of severity between groups is small. Our results on longer sick leave duration are partly to be explained by interactions between the case managers and the occupational physicians that encouraged patients to stay longer off-work for better recovery, despite the higher costs that this represented for the insurance fund and the well-documented adverse side effects of longer periods off-work.

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&gt;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.

National practice patterns and direct medical costs for prostate cancer in Korea across a 10\u2009year period: a nationwide population-based study using a national health insurance database

BackgroundA complete enumeration study was conducted to evaluate trends in national practice patterns and direct medical costs for prostate cancer (PCa) in Korea over a 10-year retrospective period using data from the Korean National Health Insurance Service.MethodsReimbursement records for 874,924 patients diagnosed between 2002 and 2014 with primary PCa according to the International Classification of Disease (ICD) 10th revision code C61 were accessed. To assess direct medical costs for patients newly diagnosed after 2005, data from 68,596 patients managed between January 2005 and 31 December 2014 were evaluated.ResultsFrom 2005 to 2014, the total number of PCa patients showed a 2.6-fold increase. Surgery and androgen deprivation therapy were the most common first-line treatment, alone or within the context of combined therapy. Surgery as a monotherapy was performed in 23.5% of patients in 2005, and in 39.4% of patients in 2014. From 2008, the rate of robot-assisted RP rose sharply, showing a similar rate to open RP in 2014. Average total treatment costs in the 12 months post-diagnosis were around 10 million Korean won. Average annual treatment costs thereafter were around 5 million Korean won. Out-of-pocket expenditure was highest in the first year post-diagnosis, and ranged from 12 to 17% thereafter.ConclusionsBetween 2005 and 2014, a substantial change was observed in the national practice pattern for PCa in Korea. The present data provide a reliable overview of treatment patterns and medical costs for PCa in Korea.

PND68 COST-EFFECTIVENESS OF OCRELIZUMAB COMPARED TO FINGOLIMOD OR DMF IN RELAPSING-REMITTING MULTIPLE SCLEROSIS IN CZECH REPUBLIC

The aim of this work was to show the base case cost-effectiveness of ocrelizumab compared with fingolimod or dimethyl fumarate (DMF) for the second line treatment of highly active RRMS from payer perspective. A global cohort multi-state Markov cost-utility model reflecting health states based on disease classification and severity was developed. Two key clinical manifestations are reported in RRMS, an exacerbation of symptoms (known as relapses) and progressing disability over time based on EDSS. The probability of changing EDSS state (disability progression) or experiencing a relapse was determined by natural history data (underlying disease progression of patients not on therapy) as well as conversion from RRMS to SPMS. Treatments were assumed to delay the progression of disease and reduce the frequency of relapses in RRMS; by applying a treatment effect to natural history data. Treatment effects, annual relapse rate and confirmed disability progression were taken from NMA. Relevant hazard rates for target subgroup of pooled OPERA 1 & 2 cohorts were used in the model. Patient utility has been sourced from literature. Discount rates 3% for costs and outcomes, half cycle correction and model cycle length 1 year was applied. Treatment was discontinued from all-cause or if EDDS achieved 7. Over a timeframe of 30 years, the average total cost of patient treatment with ocrelizumab was $239,264, with an average 1.13 QALY gained against fingolimod and 2.60 QALY gained against DMF. Compared to fingolimod, the incremental cost was $5,567, corresponding to ICER $4,928 per QALY. Compared to DMF, the incremental cost was $27,862, corresponding to ICER $10,742 per QALY. Use of ocrelizumab is cost-effective for the second line treatment of highly active relapsing-remitting multiple sclerosis in a Czech public healthcare setting and resulted in greater QALY versus comparators in the base case.

Outcomes and costs of treating hepatitis C patients with second-generation direct-acting antivirals: results from the German Hepatitis C-Registry.

Chronic hepatitis C virus infection is associated with a significant health burden. Long-term consequences are the development of liver cirrhosis and hepatocellular carcinoma. The introduction of direct-acting antivirals (DAA) has led to an increase in sustained virologic response rates (SVR), but is accompanied by higher treatment costs. The aim of this study was to assess the outcomes and costs of treating hepatitis C virus infected patients with DAAs in clinical practice in Germany. Data were derived from a noninterventional study including a pharmacoeconomic subset of 2673 patients with genotypes 1 and 3 who initiated and completed treatment between February 2014 and February 2017. Sociodemographic and clinical parameters as well as resource utilization were collected using a web-based data recording system. Costs were calculated using official remuneration schemes. The mean age of the patients was 54.6 years; 48% were men. 93.5% of all patients achieved an SVR. The average total treatment costs were &OV0556;67 979 (&OV0556;67 131 medication costs, &OV0556;824 ambulatory care, &OV0556;24 hospital costs). The average costs per SVR of &OV0556;72 705 were calculated. Differences in SVR and costs according to genotype, treatment regimen, treatment experience, and cirrhosis were observed. Quality-of-life data showed no or a minimal decrease during treatment. This analysis confirms high SVR rates for newly introduced DAAs in a real-world setting. Costs per SVR estimated are comparable to first-generation DAA. Given the fact that the costs for the currently used treatment regimens have declined, it can be assumed that the costs per SVR have also decreased. Our insight into real-world outcomes and costs can serve as a basis for a comparison with the mentioned newly introduced treatment regimens.

Estimating the Health and Economic Impact of Universal Varicella Vaccination in Jordan

BackgroundTo evaluate the impact of adding universal varicella vaccination (UVV) to the existing childhood vaccination programme in Jordan, and identify the most cost-effective strategy.MethodsA dynamic transmission model of varicella infection was calibrated to available varicella seroprevalence data within the region and validated against local epidemiological data. Local direct and indirect costs and healthcare utilization data were used. We considered the health and economic impact of one dose UVV administered concurrently with MMR at 12 months of age with 95% coverage, and two dose strategies with short (6 month) and long (4 year) intervals between First and Second dose. We took the societal perspective (direct and indirect costs) and discounted costs and QALYs by 3%/year to assess cost-effectiveness.ResultsThe model estimated the current burden of varicella at 172,000 cases/year, an incidence rate of 2,200/100,000 persons. In the 5th/25th year after vaccination, all strategies substantially reduced total varicella incidence by 89.5%/96.6% (1 dose), 92.3%/98.0% (2 dose short), and 90.5%/98.3% (2 dose long), compared with no vaccine (Figure 1). In the absence of vaccination, an estimated $47.89 M ($28.81 M direct, $19.08 indirect) was spent annually on varicella treatment. The average annual total treatment costs over 25 years from the societal perspective were $4.01M (1 dose), $3.34M (2 dose short), and $3.43M (2 dose long). Considering a willingness to pay (WTP) threshold of $3,600 USD / QALY and the societal perspective, the 1 dose program was the most cost-effective with cost savings of $83.40 USD and health gain of 4.127 × 10−5 QALYs per person. 2 dose programs are similarly cost-saving and highly effective, compared with a scenario of no vaccination; however, moving incrementally from a 1 dose strategy, incremental cost-effectiveness ratios (ICERS) were $6.9M/QALY (short vs. 1 dose) and $13.5M/QALY (long vs. short), both well as above the WTP threshold. All strategies reached.ConclusionOne or two dose UVV in Jordan will significantly reduce varicella disease burden and is cost saving relative to no vaccine over 25 years.Disclosures W. Hayajneh, Merck & Co., Inc.: Consultant, Consulting fee. J. Maalouf, Merck & Co., Inc.: Employee, Salary. B. Kuter, Merck & Co., Inc.: Employee, Salary.T. Weiss, Merck & Co., Inc.: Employee, Salary. V. Daniels, Merck & Co., Inc.: Employee, Salary. L. Wolfson, Merck & Co., Inc.: Employee, Salary.

ECONOMIC BUDERN AND TREATMENT COST OF FALLS, BURNS, AND TRAFFIC INJURIES IN CHILDREN

Introduction: Child injury is a significant burden for community health care in Vietnam. Besides the fatal injuries, millions of children need hospital care for non-fatal injuries. Investigation on treatment cost and economic burden of the most common non-fatal injuries such as falls, burns, and traffic injuries is very necessary. Objectives: (1) Describe the patterns of falls, burns, and traffic injuries among children admitted with injuries to the Quang Nam Pediatric Hospital; (2) Analyze the treatment cost for falls, burns, and traffic injuries of these patients. Methods: A cross-sectional study on 424 pediatric patients under 16 year old admitted with falls, burns, and traffic injuries to the Quang Nam Pediatric Hospital from 01/6/2014 to 31/3/2015. Results: Most of participants admitted to the hospital for falls (66%), traffic injuries (22,4%). Mild injuries was dominated, burns and traffic injuries were more serious in almost cases and the average of PTS index was 9.4 points. Average total treatment cost was 1,259,200 VN dong, direct cost accounted for 68.4% of total treatment cost. Treatment costs of burns and traffic injuries were higher than that of falls. Key words: burden of disease, treatment cost, injury, children

A cost comparison of warfarin vs enoxaparine or new oral anticoagulants used for the treatment of patients with pulmonary embolism.

Recently, novel oral anticoagulants (rivaroxaban, dabigatran, apixaban) have been approved for pulmonary embolism (PE) treatment. Each anticoagulant used during initial and maintenance therapy has direct and indirect costs for healthcare systems. Demonstrating the costs of treatment with different anticoagulants in a specific patient group will be helpful for clinicians determining treatment strategies. Retrospective data of 118 patients with PE who were hospitalized and treated with warfarin for at least 3 months were evaluated. Direct medical and nonmedical costs were calculated. True costs with warfarin and modeled costs with rivaroxaban, dabigatran, apixaban and enoxaparine were calculated and compared for maintenance therapy. Estimated costs of initial and maintenance treatment with different anticoagulants were compared for the 49 patients with low complication risk. The average total cost of maintenance treatment with warfarin was found to be higher than the novel oral anticoagulants (€286.5 for warfarin, €233.3 for rivaroxaban, €231.7 for dabigatran, and €229.6 for apixaban). In patients with low complication risk, who could be treated without hospitalization, alternative treatment regiments were found to cost less than warfarin treatment (€883.1 for warfarin, €254.3 for rivaroxaban, €238 for apixaban, and €810.6 for enoxaparine). Maintenance therapy with novel oral anticoagulant costs less than warfarin treatment. In patients with lower complication risks, alternative regimens that do not require hospitalization could cost less.