Consumers Of Medical Care Research Articles

Organizational and economic factors of assessing the management of accessibility and quality of medical care in the Republic of Tatarstan

BACKGROUND: Today, when assessing the availability and quality of medical care, objective criteria and indicators prevail, and the factor of patient feedback as end consumers is practically not taken into account, which does not allow us to form a comprehensive view and get closer to solving this problem. AIM: To identify the factors that have the greatest impact on patients' assessment of the availability and quality of medical care, to study the influence degree of organizational and economic problems of medical organizations on this assessment and to develop quantitative indicators for managing this indicator. MATERIAL AND METHODS: The study was conducted using a questionnaire from October to December 2023 based on medical organizations of the Republic of Tatarstan. Two types of questionnaires were compiled. The first questionnaire was for consumers of medical care, covering 2,419 patients of hospitals and clinics from all cities and districts of the Republic of Tatarstan. The second questionnaire was for medical personnel. A total of 20,330 medical workers took part in the survey: 5,206 doctors, 10,841 nurses, 4,283 junior medical personnel from all types of medical organizations, including central republican hospitals, city and district hospitals and clinics of Tatarstan. The results of the questionnaires were processed by means of correlation and regression analysis using the least squares method. RESULTS: It was revealed that for patients of medical organizations the most significant factors in assessing the quality of medical care were: (1) queues and constant waiting (50.5% of respondents); (2) inability to see a specialist (48.9%); (3) unavailability of diagnostic procedures (biochemical blood test, computed tomography and magnetic resonance imaging, ultrasound; 40.7%); (4) inattention, indifference of medical workers (27.5%). Factors in the work of medical institutions and personnel that had the greatest impact on patients' assessments of the indicator of availability and quality of medical care were identified: stress at work, overload and high work pressure, dissatisfaction with salary. The regression coefficients of the identified factors allow them to be used as indicators of management decisions aimed at increasing the importance of availability and quality of medical care. CONCLUSION: Patient assessments obtained by medical organizations as a result of feedback allow not only to bring the level of availability and quality of medical care as close as possible to the expectations and needs of patients, but also to identify areas of management influence to improve it.

INFLIXIMAB MARKET SHARE AND ASSOCIATED COST SAVINGS FOLLOWING BIOSIMILAR MARKET ENTRY

Abstract BACKGROUND Biologic medications have transformed treatment for autoimmune conditions, including inflammatory bowel disease (IBD), but have also contributed to rising healthcare expenditures in the United States (US). Biosimilars, which are highly similar in safety and efficacy to the originator biologic, were introduced to create competition and reduce cost. Limited studies exist evaluating the impact biosimilars have had on biologic market share and cost savings. The objective of this study was to evaluate the impact infliximab biosimilars have had on the cost and market share of the infliximab originator product. METHODS Infliximab claims were reviewed and analyzed using the Merative MarketScan Commercial Claims and Encounters Database. Using only outpatient claims, both the infliximab originator and biosimilars were identified using Current Procedural Terminology codes from January 1, 2015, to December 31, 2021. Patients with commercial insurance, ages 0 to 64 years, and receiving infliximab for any indication were included. The Medical Care Consumer Price Index was used to adjust for inflation to December 2021 dollars. Outcomes of interest included market share of all infliximab products, cost per infliximab infusion, and cost per vial (one vial=100 mg) of the medication. RESULTS There were 471,748 claims for infliximab infusions that met our inclusion criteria, with 42,100 unique patients, 55% female, and a median age of 40 (inter-quartile range (IQR) 26 – 52) years old at the time of medication initiation. Indications for infliximab products included IBD (67%), rheumatoid arthrtiis (18%), psoriasis (9%), ankylosing spondylitis (5%), other (4%), with some patients receiving infliximab for multiple indications. Utilization of infliximab biosimilars increased over time, reaching the highest utilization in December 2021, accounting for 24% of the market share. The median cost of the infliximab originator peaked at $1,491 per vial in December 2017, 13 months after market entry of the first biosimilar (infliximab-dyyb). The cost of the infliximab originator then decreased by 45% over time, reaching a low of $821 per vial in December 2021. Had infliximab biosimilars not been introduced to the market, the projected cost of the infliximab originator in December 2021 would have increased by 20% to $1793 per vial. Thus, infliximab biosimilars contributed to a theoretical decrease of 55% in the cost of infliximab originator during the time period studied. CONCLUSIONS The market share of infliximab biosimilars in the US has steadily increased since their introduction in 2016. The competition of infliximab biosimilars has contributed to the decrease in cost of both the infliximab originator and biosimilar products. Future studies are needed to determine if patients are seeing an out-of-pocket savings because of biosimilar introduction.

Социальное доверие и недоверие в сфере российского здравоохранения в период пандемии COVID-19: теоретико-методологические подходы и источники негативизации

Introduction. The article discusses theoretical approaches and methodological limitations of sociological research of trust and distrust to the healthcare services in the framework of the COVID-19 pandemic. The main difficulties are caused by the stable cognitive fashion for the quantitative measurement of trust/distrust indices. It leads to the illusion of understanding public opinion and social moods to this issue. The cognitive framework is also associated with the fundamental evaluative opposition of society's trust to medical care as a blessing and distrust as a socio-cultural barrier to the development of the healthcare system. Methods. The study is based on the methodology of sociological constructivism. Such approach makes it possible to study both mental and institutional factors that shape the crisis of public confidence to the health care services. Results and its discussion. The authors argue that social trust is constructed as a result of activity and requires directed efforts, an active position of key agents. Taking into account the neoliberal transformation of the healthcare institution in modern Russia, behavioral indicators of trust should be supplemented with information about objective indicators of the accessibility and quality of medical care. Based on empirical data, the dynamics of public opinion on the effectiveness of the Russian healthcare system and its main problems in a complex epidemiological situation are analyzed. The leading sources of negative social attitudes to the healthcare system during the COVID-19 pandemic are the following: aggressive policy of media; political decisions which are not always consistent and justified; claims for social control, external intervention in private space and strategies of medical activity in the society. The authors came to the conclusion that the COVID-19 pandemic only changed the structure of social attitude to the health care services, escalated chronic difficulties, but did not affect significantly the downward vector of consumer confidence in the health care system. The conclusion is made about the need for both systemic regulation of institutional mechanisms of trust, and increasing the reserve of personal responsibility and adaptive potential of consumers of medical care. In this regard, the relevance of sociological research in public health and healthcare will only increase in the post-coronavirus period. The synthesis of quantitative, qualitative assessments of trust and objective indicators of the availability and quality of medical care will make it possible to explain the dynamics of ideas, values and attitudes that shape the background of the social mood; to predict alternative scenarios and vectors for the transformation of the healthcare institution, depending on the semantic content of social trust / distrust to medical organizations.

The Phenomenon of social (dis)trust of the Russian society in the institute for health protection in the context of the Covid-19 pandemic: cognitive illusions and methodological problems

The article reveals methodological guidelines of the scientific study of healthcare system as a space for the construction and reproduction of social trust/distrust in Russian society. It is investigated how the consequences of the COVID-19 pandemic, in terms of media rhetoric and health policy of the last decades, have affected trust in healthcare institute in Russia today. The cognitive limitation of the modern concepts is connected with the reduction of social trust to positive perceptions of health services and their external accessibility, although it should rather be about the result of influence of the social situation, culture as well as individual traits, social values, attitudes and self-preservation behavioral patterns. It is shown that there is methodological turn significance from quantitative sociological assessments of medical care consumers’ satisfaction to qualitative interpretive practices of different institutional agents’ activities that allow revealing the deep socioeconomic, organizational, managerial and socio-cultural factors of distrust in the healthcare sphere. The author comes to conclusion that the polyparadigmality and multidisciplinary constitute the key conceptual advantage of sociological methodology, since social trust in healthcare is a complex and layered reality, with its own internal dynamics and structure.

1708. Impacts of age and season on rates of hospitalization for respiratory syncytial virus (RSV) in infants in the United States and their use of mechanical ventilation and charges

BackgroundRespiratory Syncytial Virus (RSV) infection is the leading cause of hospitalization in infants below age 12 months and highest below age 6 months. Despite considerable evidence on the clinical predictors of RSV hospitalizations, little is known about their cost, its drivers and their relation to age and season.MethodsWe used the National Inpatient Sample to examine RSV inpatient admissions and their average charge from 2009 to 2011. This 3-year data set includes a large, nationally representative all-payer sample of 37,376 RSV admissions of infants in the US under age 12 months recorded by month. We calculated the rate per 1000 infants of RSV hospitalizations, the share receiving mechanical ventilation (MV), and the mean charge per admission (separated by use of MV) with 95% confidence intervals by age and season, excluding incomplete data. We adjusted charges to Jan 2020 based on the medical care Consumer Price Index.ResultsThese data confirm that rates of hospitalization by age were highest for infants 1 month of chronological age (2.42 times the annualized average) and declined steadily thereafter. The percentage of hospitalizations with MV declined from months < 1 to 4, with subsequent fluctuations (Fig 1). Charges exceeded the annual average only for infants aged < 1 and 1 month (Fig 2). In 2020 prices, hospitalization charges per episode averaged $175,211 with MV vs. $17,313 without MV, totaling $1.51 billion annually for the birth cohort of 4.04 million infants ($374 per infant). As only 4.5% of hospitalizations had MV, those without MV comprised 67.5% of aggregate yearly charges. Admissions were highly seasonal, with the rate in the highest month (Feb) 341 times that in the lowest month (July). However, utilization of MV (Fig 3) tended to be lower in the RSV season but depended mostly on age. While average charges were higher outside the RSV season, their seasonal pattern was similar for admissions with and without MV.Fig. 1. Share of hospitalizations with RV (bars) vs. rate of RSV hospitalizations (line) by age Fig. 2. Charges (bars) vs. rate of RSV hospitalizations (line) by age Fig. 3. Utilization of MV (bars) vs RSV hospitalization rate (line) by seasonConclusionRSV in infants under one year generate substantial hospital charges. While each of the small share of infants receiving MV is expensive, infants with MV are not the main driver of costs (Fig 4). Rather, the large number and share (94.5%) of hospitalizations without MV is the major determinant of aggregate charges (Fig 5). Fig. 4. Relation between use of mechanical ventilation (MV) [bars] and RSV hospitalization rate [lines] by season and age (in months) Fig. 5. Hospitalization charges (bars) vs RSV hospitalization rate (line) by season DisclosuresDonald S. Shepard, PhD, Sanofi Pasteur (Grant/Research Support)

1526. The economic impact of respiratory syncytial virus (RSV) in infants in the United States: systematic literature review

BackgroundRespiratory syncytial virus (RSV) is a human orthopneumovirus spread by direct contact with symptomatic, infected individuals. An estimated 587,000 RSV LRTIs result in inpatient or outpatient encounters annually among US infants (Rainisch et al 2019). The health care costs associated with RSV include medical costs to insurers, governments, and households, travel, and loss of wages.Initial summary of Inpatient and Ambulatory Medical Costs p Infant w RSV.JPG Jun 17th, 2020 @ 2:44 PM 852 x 572 122.3 Kb MethodsA systematic literature review of the costs associated with children who have RSV was conducted. Following PRISMA methodology, key search terms were searched within article titles and abstracts through PubMed, EconLit, and Scopus. A total of 1,942 unique abstracts were screened independently by two authors and reduced to 180 articles after applying inclusion and exclusion criteria. The number of included articles after reviewing the full text was 66. Costing results were adjusted to USD2020 based on the Medical Care Consumer Price Index.ResultsCosting results were reported mainly for medical costs in inpatient settings. Initial results show that annual mean inpatient costs per RSV patient range among individual studies from $9,825 (SD=$25,227) for full term infants to $26,120 (SD unspecified) for late preterm infants (Table 1). Costing results vary by gestational age, with late preterm infants having an annual mean inpatient cost almost 1.6 times that of a full term infant. Inpatient costs for RSV infants are higher for commercial pay versus Medicaid, for both full term infants (commercial mean=$16,489 SD=$31,068, Medicaid mean=$10,291 SD=$64,625) and late preterm infants (commercial mean=$23,836; SD=$43,709, Medicaid mean=$18,864 SD=$28,716). Annual RSV ambulatory costs per infant vary between $4,371 (SD=$13,411) and $19,963 (SD=$27,269), depending on gestational age. Other relevant RSV costs include preventative drug costs, such as palivizumab (average $11,954 per infant).ConclusionThe literature describes the economic impact of RSV primarily for hospitalization of children with underlying comorbidities. There is a need to better understand costing results for RSV, including the burden in ambulatory settings and indirect costs to families affected.Disclosures All Authors: No reported disclosures

Cost Analysis of Adjunctive Hydrocortisone Therapy for Septic Shock: U.S. Payer Perspective.

To conduct a cost analysis of adjunctive hydrocortisone therapy for severe septic shock from the perspective of a third-party payer in the United States. Estimates of outcomes were aggregate data from the Adjunctive Corticosteroid Treatment in Critically Ill Patients with Septic Shock and Activated Protein C and Corticosteroids for Human Septic Shock trials. In these trials, the outcomes of interests were ICU length of stay, vasopressor-free days, ventilation-free days, and the proportion of patients receiving blood transfusion. Each outcome was monetized into a set of mutually exclusive components and was aggregated to estimate the cost-per-patient based on each trial. Cost inputs for each outcome were obtained from literature and adjusted based on the medical care consumer price index. To estimate the budget impact using adjunctive hydrocortisone therapy, per-patient avoided cost was multiplied by expected septic shock annual incidence. Deterministic one-way sensitivity analysis evaluated the robustness of the findings, and Monte Carlo simulation estimated 95% CI of the findings. A total of 103 medical-surgical ICU (69 for Adjunctive Corticosteroid Treatment in Critically Ill Patients with Septic Shock and 34 for Activated Protein C and Corticosteroids for Human Septic Shock). Adults greater than or equal to 18 years old with septic shock. Adjunctive hydrocortisone therapy (hydrocortisone at a dose of 200 mg/d for 7 d for Adjunctive Corticosteroid Treatment in Critically Ill Patients with Septic Shock and hydrocortisone at a 50 mg IV bolus every 6 hr and fludrocortisone as a 50 μg tablet once daily). Per Adjunctive Corticosteroid Treatment in Critically Ill Patients with Septic Shock, adjunctive hydrocortisone therapy showed a 90-day monetized benefit of $8,111 (95% CI, $3,914-$12,307) per patient, driven by improvements in ICU-free days, vasopressor-free days, ventilation-free days, and blood transfusion proportion. The total estimated annual impact of adjunctive hydrocortisone therapy, in 2019 dollars, was $750 million. Per Activated Protein C and Corticosteroids for Human Septic Shock, adjunctive hydrocortisone therapy showed a 90-day monetized benefit of $25,539 per patient (95% CI, $22,853-$28,224), driven by improvements in ICU free-days, vasopressor-free days, and ventilation-free days. The total estimated annual impact of adjunctive hydrocortisone therapy, in 2019 dollars, was $2.3 billion. The deterministic one-way sensitivity analysis showed the cost of ICU stays to be the most influential factor in both analyses. The sensitivity analysis using the reported median showed a greater monetized benefit of $10,658 (Adjunctive Corticosteroid Treatment in Critically Ill Patients with Septic Shock) and $30,911 (Activated Protein C and Corticosteroids for Human Septic Shock) per patient. Using adjunctive hydrocortisone therapy yields a significant monetized benefit based on inputs from the Adjunctive Corticosteroid Treatment in Critically Ill Patients with Septic Shock and Activated Protein C and Corticosteroids for Human Septic Shock trials.

Heart Failure Related Costs and Health Care Resource Utilization Following An Emergency Department (ED) Visit For Worsening Heart Failure: A Claims Data Analysis

Introduction Heart failure (HF) affects nearly 6.5 million people in the US and it is the leading cause of hospitalizations in adults >65 with costs accounting for 17% of overall national health expenditures. We conducted an analysis to evaluate the HF-related cost and healthcare resource utilization (HCRU) associated with worsening HF (WHF) in patients presenting to an ED and 1.) Managed as an outpatient or 2.) Hospitalized for 1-3 days. Methods Patients (≥18) with a hospitalized/outpatient WHF ED episode were identified using IBM® MarketScan® Commercial and Medicare Supplemental Databases (2012-2017). For the hospitalized cohort, WHF was defined as an inpatient claim with a primary diagnosis of HF and HF/HF-related DRG codes, with ED service category and length of stay (LOS) 1-3 days. For the outpatient cohort, WHF was defined as an outpatient claim with the presence of a primary diagnosis of HF, along with a procedure code for IV furosemide with an ED service category. Patients continuously enrolled 6 months before and 3 months post the index date (first WHF episode) were followed until 30 days. 30-day HF-related medical costs (including index and through day 30) and HCRU were measured. All costs included were unadjusted gross, including payer and patient costs and inflated to $2019 using the Medical Care Consumer Price Index. Results 41,522 and 11,585 patients with WHF were identified in the hospitalized and outpatient cohorts, respectively. Comorbidities were similar between cohorts. Frequent conditions included COPD, diabetes, renal disease, peripheral vascular disease and cerebrovascular disease. Most of the hospitalized cohort (60.5%) had a LOS of 1-2 days. Unadjusted mean 30-day HF-related total medical costs (Table 1) were $14,469.83 (hospitalized) and $5,593.15 (outpatient). In the outpatient cohort, 16.1% of patients had at least one more consecutive WHF visit following the index visit. In this population, 30-day hospitalization rates were 3.3% and 6.7% for the hospitalized and outpatient cohorts, respectively. Conclusion WHF presenting to the ED and requiring a 1-3 day inpatient admission or outpatient management is associated with extensive healthcare costs and resource utilization. These findings highlight the importance of developing new home-based treatments for WHF that could result in potential cost savings to the healthcare system.

The problem of adherence to treatment from the standpoint of the sociology of medicine

Objective: to substantiate adherence to treatment as a form of social responsibility of citizens from the standpoint of the sociology of patients. Material and methods. The work uses the principles and methods of the sociology of medicine. A sociological survey of a representative sample of medical care consumers (880 people) on adherence to treatment was conducted, and a model of compliance ratio as a model for subsequent drug therapy was substantiated. Results and discussion. The performed survey has shown that every second patient learns about their rights from the mass media. Men are significantly less likely than women to follow medical prescriptions (p &lt; 0.01). Women are significantly more likely to trust the doctor's opinion about treatment, if they disagree, they are more likely to turn to another specialist, while men are significantly more likely to simply refuse treatment and other recommendations from the attending doctor. The respondents called their own laziness and / or aversion to taking medications as the main reason for non-compliance with treatment. Conclusion. Low social responsibility of patients for compliance with the doctor's recommendations has been found. The concept «adherence to treatment» has been introduced into the problem field of the sociology of medicine.

ИНСТИТУЦИОНАЛЬНЫЕ УСЛОВИЯ И МЕХАНИЗМЫ СГЛАЖИВАНИЯ СОЦИАЛЬНОГО НЕРАВЕНСТВА ПОТРЕБИТЕЛЕЙ МЕДИЦИНСКОЙ ПОМОЩИ В РОССИЙСКОМ ОБЩЕСТВЕ

В статье рассматриваются практические подходы к снижению степени дифференциации потребления медицинской помощи в современном российском обществе. Актуальность исследования продиктована необходимостью создания доступного и эффективного пространства здравоохранения в России. Новизна работы заключается в определении противоречия между явными функциями и реальными интересами различных агентов в системе здравоохранения. Особое внимание уделяется последствиям сокращения государственного участия в сфере здравоохранения. Доказывается, что в основном интересы государства и потребителей в сфере медицинского обеспечения сходятся. Однако общество до сих пор ожидает поддержки и заботы со стороны государства, а государство постепенно снижает степень своего участия. Автором выделены теоретические и методологические предпосылки социологического понимания социальных различий в сфере потребления медицинской помощи, а также определен комплекс мер позитивизации поведенческих стратегий акторов в контексте трансформации института здравоохранения в современной России. Сглаживание дифференциации потребления медицинской помощи зависит от функционирования регулирующего, интериоризирующего и воспроизводящего институциональных механизмов. Показано, что институциональный механизм – это система согласования и упорядочения интересов различных агентов посредством разработки и установления формальных и неформальных социальных норм в сфере здравоохранения с их последующей интериоризацией и социальным воспроизводством. Особое внимание уделяется анализу поведенческих и структурных измерений неравенства в доступности медицинской помощи. Обосновывается идея о том, что усиление государственного контроля − необходимая мера в сфере медицинского обеспечения, но стимулы к модернизации здравоохранения в бюджетно-страховой модели крайне слабы. Автор приходит к выводу о возможности сглаживания социального неравенства потребителей медицинской помощи посредством конкретизации гарантий бесплатной медицинской помощи и ответственности агентов, сокращения непосредственных платежей пациентов, интеграции процесса лечения, социального диалога и инфосоциализации агентов.

What Makes Consumers Satisfied?

What Makes Consumers Satisfied?

Billed and Paid Amounts for Preventive Procedures in Dental Medicaid.

To examine trends and variations in billed and paid amounts for preventive dental procedures by race/ethnicity, age, and sex in Wisconsin dental Medicaid. We analyzed data from the 2001 to 2013 Wisconsin Medicaid claims database for preventive dental procedures for children and adults. Billed and paid amounts for preventive dental procedures were aggregated over a visit and adjusted for inflation based on the Medical Care Consumer Price Index produced by the Bureau of Labor Statistics for 2013. Quantile regression was used to examine the trends over time and the effect of patient demographics. At the 50th and 75th percentiles, the overall billed amounts for preventive dental procedures were $84.97 and $105.53, and the paid amounts were $35.80 and $41.66, respectively. At the 75th percentile, there was a $2.24 increase per year in the billed amount and a $26.88 overall increase from 2001 to 2013. In the paid amount, there was a $1.34 decrease per year for an overall $16.07 decrease from 2001 to 2013. Billed and paid claims for racial/ethnic minority enrollees were $1 to $3 higher per visit at the 75th percentile when compared with those of Whites. Regarding the billed:paid ratio, White, African American, and Hispanic enrollees had values of 50% to 52%, whereas American Indians had the lowest value at 47.7%. At the 75th percentile, children aged 10 to 19 y had significantly higher billed ($26.73) and paid ($9.92) amounts than did adults aged 20 to 69 y. The billed amount increased over time, and the paid amount decreased after adjustment for inflation. In addition, there was a wide gap between billed and paid amounts over time. This study highlights clear differences between paid and billed amounts in Wisconsin dental Medicaid. The financial health of dental practices is dependent on appropriate reimbursement for dental services provided; thus, information of this nature could serve as a proxy performance measure for access to preventive dental care. Findings from this study could be used by policy makers and dental Medicaid program managers to develop outcome metrics to improve access to preventive dental services.

PCV47 - Extended Thromboprophylaxis With Betrixaban Is Cost-Effective In Acutely ILL Medical Patients

The APEX trial demonstrated that prophylaxis of venous thromboembolism (VTE) with betrixaban from hospital admission through post-discharge (35-42 days) in acutely ill medical patients reduced VTE events without significant increase in major bleeding vs standard-duration prophylaxis (6-14 days) with enoxaparin. Here, we analyzed the cost-effectiveness of this new thromboprophylaxis regimen with betrixaban versus standard-duration enoxaparin. We adopted our previously published decision-tree model to compare two thromboprophylaxis strategies from a US health care provider perspective among a hypothetical cohort of 10,000 acutely ill medical patients who are at risk of VTE: betrixaban (160 mg loading dose followed by 80 mg once daily for 35 days; $396) versus enoxaparin (40 mg daily for 9 days; $284). To estimate VTE-related deaths within 35 days that might have been averted by thromboprophylaxis, the model incorporated a clinical care path, including primary and secondary VTE prophylaxis as well as treatment of thromboprophylaxis-related adverse events. Parameter values and costs were estimated for each node in the decision tree based on publically available health data. All costs were converted to 2017 USD based on the US medical care consumer index. For the base-case scenario, among a hypothetical cohort of 10,000 acutely ill medical patients at increased VTE risk, betrixaban was estimated to reduce risk of death by 0.16% and save nearly $1.8M (or $178.27 per patient treated). One-way sensitivity analyses indicated that betrixaban would dominate enoxaparin assuming: a) the cost of 35-day betrixaban was <$15.94 per dose (<$574 per 36 doses); b) the clinically relevant recognized bleeding rate was ≤3.8% or c) the VTE rate was ≤7.2%. Based on the rates of clinical events reported in the APEX study, thromboprophylaxis with betrixaban from admission through post-discharge in acutely ill medical patients is likely to prevent additional deaths and reduce costs compared with standard-duration thromboprophylaxis with enoxaparin.

Abstract 135: Extended Thromboprophylaxis With Betrixaban is Cost-effective in Acutely Ill Medical Patients

Objectives: The APEX trial demonstrated that prophylaxis of venous thromboembolism (VTE) with betrixaban from hospital admission through post-discharge (35-42 days) in acutely ill medical patients reduced VTE events, including symptomatic VTEs, without significant increase in major bleeding versus standard-duration prophylaxis (6-14 days) with enoxaparin. Based on these data, betrixaban has been approved by the FDA for prophylaxis of VTE in adult patients hospitalized for an acute medical illness who are at risk for thromboembolic complications. Here, we analyzed the cost-effectiveness of this new thromboprophylaxis regimen with betrixaban versus standard-duration thromboprophylaxis with enoxaparin. Methods: We adopted our previously published decision-tree model to compare two thromboprophylaxis strategies from a US health care provider perspective among a hypothetical cohort of 10,000 acutely ill medical patients who are at risk of VTE: betrixaban (160 mg loading dose followed by 80 mg once daily for 35 days; $396) versus enoxaparin (40 mg daily for 9 days; $284). To estimate VTE-related deaths within 35 days that might have been averted by thromboprophylaxis, the model incorporated a clinical care path, including primary and secondary VTE prophylaxis as well as treatment of thromboprophylaxis-related adverse events. Parameter values and costs were estimated for each node in the decision tree based on publically available health data. All costs were converted to 2017 USD based on the US medical care consumer index. Results: For the base-case scenario, among a hypothetical cohort of 10,000 acutely ill medical patients at increased VTE risk, betrixaban was estimated to reduce risk of death by 0.16% and save nearly $1.8M (or $178.27 per patient treated). One-way sensitivity analyses indicated that betrixaban would dominate enoxaparin assuming: a) the cost of 35-day betrixaban was &lt;$15.94 per dose (&lt;$574 per 36 doses); b) the clinically relevant recognized bleeding rate was ≤3.8% or c) the VTE rate was ≤7.2%. Conclusions: Based on the rates of clinical events reported in the APEX study, extended-duration thromboprophylaxis with betrixaban from hospital admission through post-discharge in acutely ill medical patients is likely to prevent additional deaths and reduce costs compared with standard-duration thromboprophylaxis with enoxaparin.

Модальные модели социального поведения потребителей медицинской помощи в российском обществе

Модальные модели социального поведения потребителей медицинской помощи в российском обществе

Autonomy in Tension: Reproduction, Technology, and Justice.

Respect for autonomy is a central value in reproductive ethics, but it can be a challenge to fulfill and is sometimes an outright puzzle to understand. If a woman requests the transfer of two, three, or four embryos during fertility treatment, is that request truly autonomous, and do clinicians disrespect her if they question that decision or refuse to carry it out? Add a commitment to justice to the mix, and the challenge can become more complex still. Is it unfair for insurance policies to exclude from coverage the costs of giving fertility to those who lack it or restoring fertility in those who have lost it? What does "just reproduction" look like in the face of multifarious understandings of both justice and autonomy and in light of increasingly complex and costly reproductive technologies? In today's dialogue about reproduction, medicine, and ethics in the United States, old ethical issues-such as whether women ought to be allowed to access pregnancy termination-are more contested than they have been in decades, while new technologies-like those used to edit the genes of human embryos-suggest that our species could face unprecedented questions about who should exist. As we considered the discussions accompanying these issues and contemplated a special report responding to them, we found ourselves consistently circling back to two ethical commitments: respect for autonomy and the pursuit of justice. As one of the nine essays in this collection asks, why should certain women receive help to establish a pregnancy while others are thrown in jail when they miscarry or their child is stillborn? Respect for autonomy is required where individuals have the ability to make fully informed and voluntary choices. Yet does respecting autonomy require acceding to all the choices of patients or consumers of medical care? We consider these and related questions in this special report from the Hastings Center Report.

Concept and Development of Resident Training Program for General Competencies

Resident training programs in South Korea lag far behind that of advanced countries. Given the problems the current system in South Korea has, it is time to consider a new resident training system, resident training for general competencies. Training for the general competencies was practiced in medical fields in advanced countries such as the USA, Canada, and the UK as early as 20 years ago. This system has rendered itself a key component of resident training. Although a few theoretical procedures on general competencies have been practiced in South Korea, the awareness of this concept is still very weak, and the application of the theory to actual training is a long way off from becoming effective. It is urgent for South Korea to adopt competency- and outcome-based training for general competencies. To this end, the knowledge of the concept of this type of training should be improved. Also, the system should be carefully designed to cover a doctor’s whole career, and be applied immediately. The competency- and outcome-based training for general competencies is a system that assures high level qualifications. It reflects the needs of our society under the recognition that a professional organization should be committed and accountable in order to respond to social demands. As the benefits of the new training system reach the public and medical care consumers, training-related expenses should be borne by social costs.

PCV46 - Cost Consequence Analysis of Two Different Active Flowable Hemostatic Matrices in Cardiac Surgery Patients (Us Hospital Provider Perspective)

The model objective is to estimate and compare the cost consequences to hospitals, using two different active flowable hemostatic matrices (i.e. Floseal and Surgiflo) in cardiac surgery. Using clinical outcomes from a published retrospective (US Premier Hospital Database) comparative effectiveness analysis of two hemostatic matrices in cardiac surgery patients[1], a cost-consequence framework was utilized to model the economic impact to hospitals of their use. The average annual number of cardiac surgeries and costing of major and minor complications, blood transfusions, and surgical revisions was analyzed using the 2012 Healthcare Cost and Utilization Project’s (HCUP’s) National Inpatient Sample (NIS) database (represents 95% of all U.S. community hospital discharges). Cost of hemostatic matrices and operating room (OR) was obtained from RED BOOK™ and published literature. All costs were adjusted to 2015 dollars using medical care consumer price index (CPI-medical care). One-way (OWSA) and probabilistic sensitivity analyses were performed by varying all variables within the 95% confidence interval (CI) of the point estimate or ±20% when CI was not available. [1] Tackett et al., 2014, Real-World Outcomes of Hemostatic Matrices in Cardiac Surgery, Journal of Cardiothoracic and Vascular Anesthesia doi:10.1053/j.jvca.2014.05.010. Results suggest that by using Floseal (rather than Surgiflo), a hospital performing 245 cardiac surgeries annually could avoid 11 major complications, 31 minor complications, 9 surgical revisions, 79 blood transfusions, and 260 hrs. of OR time. Avoiding these outcomes corresponds to net annualized cost savings of $1.43 million, with complication avoidance as the largest contributor to this cost saving. The risk of surgical revisions, minor and major complications had the largest impact on savings in the OWSA. Monte-Carlo simulations showed that annual savings were greater than $1.43 million, in 56% of iterations. This analysis supports that using Floseal instead of Surgiflo in cardiac surgery could potentially lead to sizable cost savings to hospitals.

Case management for frail older adults through tablet computers and Skype

ABSTRACTBackground: Frail older adults are high consumers of medical care due to their age and multiple chronic conditions. Regular contact with a case manager has been proven to increase well-being of frail older adults and reduce their number of health-care visits. Skype calls through tablet PCs can offer easier communication. Objective: This paper examines frail older adults’ use of tablet computers and Skype, with their case managers.Method: Interviews were conducted on 15 frail older adults. A content analysis was used to structure and analyze the data. Results: The results indicate that tablet computers were experienced in a positive way for most frail older adults. Conflicting feelings did emerge, however, as to whether the frail elderly would adopt this in the long run. Skype needs to be tested further as to whether this is a good solution for communication with their case managers. Strong technical support and well-functioning technology are important elements to facilitate use. Conclusion: Using Skype and tablet PCs do have potential for frail older adults, but need to be tested further.

Who Are the Big Medical Care Spenders?

The top 5 percent of medical care consumers account for 50 percent of medical care expenditures, which is 9 percent of annual U.S. GDP. We offer new theoretical and empirical evidence that not just poor health, but the path to poor health, can better predict big spenders. Modeling the full distribution of expenses using the Health and Retirement Survey, we find that a 10 percent decline in health increases the probability of participation in the top 5 percent by 22 percent. Focusing on health dynamics gives policy makers new avenues to address high medical care costs.