Healthcare Resource Consumption Research Articles

Artificial intelligence for training and reporting infection prevention measures in critical wards.

Healthcare associated infections (HAI) are a major concern. Infections and sepsis are prevalent causes of prolonged hospitalization, healthcare resources consumption, and mortality. Infection prevention and control (IPC) measures need to be encouraged with the purpose to become standard protocol. Hand hygiene represents the most important measure to prevent the spread of infections. Poor hand hygiene is often due to: the belief that the use of gloves replaces hand hygiene, lack of good example from colleagues and superiors, sinks that are difficult to access or insufficient in number, staff often too busy / not enough time, poor knowledge of guidelines and protocols. Artificial intelligence was recently integrated in hand washing devices; this can implement training on a daily basis but also is an objective method to assess the efficacy of the IPC measures adopted. The benefit–cost ratio of this approach needs to be discussed.

Understanding the Scope of Acute Care Vascular Surgery at a Tertiary Academic Medical System

The restructuring of nonelective general surgery and nationwide implementation of the acute care surgery paradigm has improved patient outcomes and healthcare resource utilization. Although vascular surgery maintains one of the highest acuity rates among surgical specialties, the acute care vascular surgery (ACVS) practice model has not been widely accepted. In the present study, we investigate the scope and burden of ACVS at a tertiary academic medical system. All vascular surgical procedures performed at three hospitals comprising a large tertiary academic medical system were retrospectively queried through electronic medical records. Data were collected on procedure, acuity, timing of intervention, primary service, admission type, and total costs and charges. Patients were stratified by acuity of surgical intervention, with ACVS being defined as urgent or emergent operation. A total of 12,689 vascular surgeries were performed from 2018 to 2022. ACVS procedures comprised 22.1% of this total (n=2,803; 12.5% urgent, 9.6% emergent), with an annual burden ranging from 19.1% to 28.3%. Vascular surgeons served as primary surgeon in 91.3% of ACVS and cosurgeon in 8.7%. Fourteen separate surgical specialties requested acute vascular assistance, with the most frequently consulting specialties, including trauma or acute care surgery (ACS) (n=109, 3.9%) and cardiac surgery (n=74, 2.6%). ACVS cases were more frequently performed during after-hours (30.7% vs 11.6%) and on weekends (27.1% vs 2.0%) compared with elective vascular procedures (P<0.0001 each). The majority of ACVS cases originated from inpatient (n=2,353, 85.0%) and emergency department (n=379, 13.5%) consultations. Overall, ACVS generated $37.5 million in charges, accounting for 14% of total procedure-related charges over the study period. ACVS comprises a substantial portion of modern vascular practice and is associated with significant human and healthcare resource expenditure. These data support the development of practice models dedicated to acute vascular surgical care.

Healthcare resource utilization and related cost among hospitalized patients with prurigo nodularis: a retrospective cohort study using Italian health claims data.

Prurigo nodularis (PN) is a chronic, inflammatory skin disease characterized by intense itch. Little evidence exists on the burden of PN in Italy. This real-world analysis aimed to investigate the healthcare resource consumption and related direct costs of patients hospitalized for PN. The analysis utilized the administrative databases of healthcare units that cover approximately 12 million inhabitants across Italy. Adult patients were included by ICD-9-CM=698.3 (lichen simplex chronicus; neurodermatitis circumscripta; PN) as proxy of PN diagnosis, from 01/2010 to 09/2021, and had 1 year of data availability before (baseline) and after (follow-up) hospitalization (index date). These patients were 1:2 matched by age, sex, and index date (year) to adults without such hospitalization in the baseline period (matched non-PN controls). The analysis comprised 295 PN-hospitalized patients, matched with 590 non-PN individuals (mean age 63.2 years, 43.7% female). At baseline, patients had a greater comorbidity burden than non-PN controls, including higher prevalence of hypertension (56.6% vs. 36.6%, respectively), dyslipidemia (26.4% vs. 18.0%), diabetes (24.4% vs. 12.5%) and mental health conditions (14.9% vs. 7.8%). During 1-year follow-up, PN-hospitalized patients had significantly higher resource consumption than matched controls, in terms of mean number of prescriptions most commonly prescribed in PN patients (5.1 vs. 1.9, P<0.001), other drugs (11.7 vs. 6.5, P<0.001), all-cause hospitalization (1.4 vs. 0.1, P<0.001) and outpatient services (5.4 vs. 2.5, P<0.001). Mean annual all-cause healthcare costs for patients over 1-year follow-up were € 3847 total (€ 875 drugs, € 2652 hospitalization, € 320 outpatient services), higher than those for the matched controls, of € 711 total (P<0.001) (€ 353 drugs, € 228 hospitalization, € 130 outpatient services). Patients hospitalized for PN had a higher comorbidity burden at baseline and greater healthcare resource consumption during 1-year follow-up compared to matched controls, with a 5.4-fold increase in all-cause healthcare costs, indicating substantial clinical burden and remaining unmet need in these patients.

The cost of keeping patients waiting: retrospective treatment-control study of additional healthcare utilisation for UK patients awaiting elective treatment.

Long waiting times for elective hospital treatments are common in many countries. This study seeks to address a deficit in the literature concerning the effect of long waits on the wider consumption of healthcare resources. We carried out a retrospective treatment-control study in a healthcare system in South West England from 15 June 2021 to 15 December 2021. We compared weekly contacts with health services of patients waiting over 18 weeks for treatment ('Treatments') and people not on a waiting list ('Controls'). Controls were matched to Treatments based on age, sex, deprivation and multimorbidity. Treatments were stratified by the clinical specialty of the awaited hospital treatment, with healthcare usage assessed over various healthcare settings. Wilcoxon signed-rank tests assessed whether there was an increase in healthcare utilisation and bootstrap resampling was used to estimate the magnitude of any differences. A total of 44,616 patients were waiting over 18 weeks (the constitutional target in England) for treatment during the study period. There was an increase (p < 0.0004) in healthcare utilisation for all specialties. Patients in the Cardiothoracic Surgery specialty had the largest increase, with 17.9 [interquartile-range: 4.3, 33.8] additional contacts with secondary care and 17.3 [-1.1, 34.1] additional prescriptions per year. People waiting for treatment consume higher levels of healthcare than comparable individuals not on a waiting list. These findings are relevant for clinicians and managers in better understanding patient need and reducing harm. Results also highlight the possible 'false economy' in failing to promptly resolve long elective waits.

Loneliness impact on healthcare utilization in primary care: A retrospective study

BackgroundAn increased number of patients seek help for loneliness in primary care. ObjectiveTo analyze whether loneliness was associated with a higher utilization of healthcare facilities. MethodsObservational, retrospective study based on the review of routinely coded data in the digital medical record system in a random sample of patients aged 65 or older, stratified by population size of their residence area. A minimum sample size was estimated at 892 medical records. Loneliness was defined as the negative feeling that arises when there is a mismatch between the quantity and quality of a person's social relationships and those, they desire. Thirty-three primary care nurses (30 females and 3 males) were reviewing the data. ResultsA total of 932 medical records of patients were reviewed (72% belonged to female patients). Of these, 657 individuals were living alone (71.9%). DeJong Scale average scores was 8.9 points (SD 3.1, 95CI 8.6–9.1). The average annual attendance to primary care ranged from 12.2 visits per year in the case of family practice, 10.7 nurse, 0.7 social workers. The average number of home visits was 3.2, and the urgent consultations attended at health centers were 1.5 per year. Higher feelings of loneliness were associated with extreme values in the frequency of healthcare resource usage. Compared to their peers of the same age, the additional healthcare resource consumption amounted to €802.18 per patient per year. ConclusionLoneliness is linked to higher healthcare resource usage in primary care, with individuals experiencing poorer physical and mental health utilizing these resources up to twice as much as their peers of the same age.

Call for a Singapore National Action Plan for Sepsis (SNAPS): Stop sepsis, save lives.

Sepsis is a life-threatening organ dysfunction syndrome caused by a dysregulated host response to an infection.1 It affects up to 48.9 million people globally every year and causes 11 million sepsis-related deaths, accounting for 1 in every 5 deaths worldwide.2 The huge disease burden leads to significant consumption of healthcare resources due to longer hospitalisation and the need for intensive care.3 The resultant economic impact is tremendous; for instance, the 1-year incremental costs of sepsis to the healthcare system in Ontario, Canada approximates CAD 1 billion.3 In addition to the complexity of care required for sepsis, the higher healthcare costs incurred may be explained by the post-sepsis syndrome. Sequelae of sepsis include physical, psychological and medical complications.4

Italian healthcare resource consumption for patients on hemodialysis treated for chronic kidney disease-associated pruritus (CKD-aP).

Chronic kidney disease-associated pruritus (CKD-aP) affects patients on hemodialysis. This study identified hemodialysis patients presumably affected or not affected by CKD-aP and integrated healthcare costs, from the perspective of the Italian administrative healthcare data. Through cross-linkage of Italian administrative healthcare data collected between 2015 and 2017 (accrual period) in the database of Fondazione ReS (Ricerca e Salute), patients undergoing in-hospital/outpatient hemodialysis were selected. Cohorts with and without CKD-aP were created based on the presence/absence of CKD-aP-related treatment (according to common clinical practice and guidelines) supplies and assessed in terms of CKD-aP-related treatments and mean healthcare costs per capita paid by the Italian National Health Service (INHS). Of 1,239 people on hemodialysis for ≥2 years, CKD-aP affected 218 patients. Patients with CKD-aP were older and with more comorbidities. During the follow-up year, on average, the INHS spent €37,065 per case, €31,286 per control and € 35,988 per non-CKD-aP subject. High-efficiency dialytic therapies performed to people on hemodialysis with CKD-aP largely weighed on the overall mean annual cost. This real-world study identified patients on chronic hemodialysis potentially treated for CKD-aP. Interestingly, high-efficiency dialysis seems the most frequent and expensive choice for the treatment of CKD-aP. The discovery of appropriate and effective treatments for this condition might offer cost offsets.

Risk Factors Associated with Pyogenic Spinal Infections among Intravenous Drug Users and Nonusers.

To identify the differences in patient factors, presentation, treatment course, and outcomes of intravenous drug users (IVDA) vs. nonusers (non-IVDA) presenting with pyogenic spinal infections. Study Design/Setting. Retrospective case series. We identified all cases involving spinal infections at our institution between May 2017 and January 2023. Postsurgical infections were excluded, and patients were separated into IVDA and non-IVDA groups. The patient charts were reviewed and analyzed for statistical or clinically significant differences using RStudio (2019 version 3.6.2). Our institutional review board approved this study, IRB# 2020-277, iRISID-2023-1384. Fifty patients (29 males and 21 females) with primary pyogenic spinal infections were included in our study. There were fourteen patients (28.0%) in the IVDA group. The mean age in the IVDA group was 50.6 vs. 61.9 years (p < 0.05) in the non-IVDA group. The average length of stay (LOS) in the IVDA group was 15.8 vs. 14.0 days (p = 0.54) in the non-IVDA group, with no significant difference in readmissions or disposition. Twenty-three non-IVDA patients were diagnosed with diabetes, while eight IVDA patients had a psychiatric diagnosis (other than substance abuse). There were no significant differences in microbial isolate or the duration of antibiotics. In our study population, there is a high incidence of intravenous drug abuse (IVDA), psychiatric disease, diabetes, and chronic kidney disease. Analysis shows a trend of two distinct patient populations. Patients without a history of IVDA were significantly older than those with IVDA and significantly more likely to have medical comorbidities including hyperlipidemia, diabetes, chronic kidney disease, and malignancy than those with IVDA history. Patients with IVDA were younger with significantly higher rates of smoking and psychiatric disorders. IVDA patients struggled to receive continued psychiatric/addiction treatment after discharge, an area for significant improvement. Due to a small sample size and single urban institution setting, this study may be underpowered to demonstrate differences in healthcare resource consumption.

Asthma and obstructive sleep apnea: Unveiling correlations and treatable traits for comprehensive care.

Asthma and obstructive sleep apnea (OSA) are common respiratory disorders. They share characteristics such as airway obstruction, poor sleep quality, and low quality of life. They are often present as comorbidities, along with obesity, gastroesophageal reflux disease (GERD), and allergic rhinitis (AR), which impacts the disease's control. In recent years, there has been discussion about the association between these conditions and their pathophysiological and clinical consequences, resulting in worse health outcomes, increased healthcare resource consumption, prolonged hospital stays, and increased morbidity and mortality. Some studies demonstrate that treatment with continuous positive airway pressure (CPAP) can have a beneficial effect on both pathologies. This review summarizes the existing evidence of the association between asthma and OSA at their pathophysiological, epidemiological, clinical, and therapeutic levels. It intends to raise awareness among healthcare professionals about these conditions and the need for further research.

The role of the general practictioner in the management of urinary calculi.

The prevalence of kidney stones tends to increase worldwide due to dietary and climate changes. Disease management involves a high consumption of healthcare system resources which can be reduced with primary prevention measures and prophylaxis of recurrences. In this field, collaboration between general practitioners (GPs) and hospitals is crucial. a panel composed of general practitioners and academic and hospital clinicians expert in the treatment of urinary stones met with the aim of identifying the activities that require the participation of the GP in the management process of the kidney stone patient. Collaboration between GP and hospital was found crucial in the treatment of renal colic and its infectious complications, expulsive treatment of ureteral stones, chemolysis of uric acid stones, long-term follow-up after active treatment of urinary stones, prevention of recurrence and primary prevention in the general population. The role of the GP is crucial in the management and prevention of urinary stones. Community hospitals which are normally led by GPs in liaison with consultants and other health professional can have a role in assisting multidisciplinary working as extended primary care.

EPH255 Healthcare Resource Consumption of Patients with Cardiovascular Events after Exacerbations of Chronic Obstructive Pulmonary Disease in Italy: Results from the EXACOS-CV Study

EPH255 Healthcare Resource Consumption of Patients with Cardiovascular Events after Exacerbations of Chronic Obstructive Pulmonary Disease in Italy: Results from the EXACOS-CV Study

EPH200 Healthcare Resource Consumption of Patients with Chronic Obstructive Pulmonary Disease Treated with Triple and Dual Therapy and Experiencing an Acute Exacerbation

EPH200 Healthcare Resource Consumption of Patients with Chronic Obstructive Pulmonary Disease Treated with Triple and Dual Therapy and Experiencing an Acute Exacerbation

EPH137 Healthcare Resource Consumption and Direct Costs of Patients Newly Diagnosed with Acute Myeloid Leukemia from a Large Italian Administrative Database

EPH137 Healthcare Resource Consumption and Direct Costs of Patients Newly Diagnosed with Acute Myeloid Leukemia from a Large Italian Administrative Database

PT8 Five-Year Healthcare Resource Consumption and Direct Costs of Women with a New Diagnosis of Hr+/HER2- Breast Cancer Primary or Advanced: Analysis of a Large Italian Administrative Database

PT8 Five-Year Healthcare Resource Consumption and Direct Costs of Women with a New Diagnosis of Hr+/HER2- Breast Cancer Primary or Advanced: Analysis of a Large Italian Administrative Database

Comparison of Condensed to Standard Schedule of High Dose Cytarabine Consolidation for Acute Myeloid Leukemia in First Complete Remission

Background Traditionally, acute myeloid leukemia (AML) consolidation therapy for patients less than 60 years old with low to intermediate risk disease has been treated with high dose cytarabine (HDAC) cycles given on days 1, 3, and 5 (HDAC-135). However, more recent publications have assessed alternative dosing, namely administering HDAC on days 1, 2, and 3 (HDAC-123). National Comprehensive Cancer Network (NCCN) Guidelines for AML discuss this alternative dosing for HDAC and do not recommend one over another. A prospective study found that there was no cumulative hematologic toxicity and no change in survival when comparing HDAC-123 to HDAC-135 5. As a result, Northside Hospital began using HDAC-123 in patients less than 60 years old for AML consolidation therapy. The purpose of this study was to assess the safety, efficacy, and health care resource consumption associated with HDAC-135 versus the condensed HDAC-123 regimen at Northside Hospital. Methods This single-center, retrospective study included patients with AML between 18 and 60 years old who received at least one cycle of HDAC-123 or HDAC-135 at Northside Hospital Atlanta's outpatient clinic from January 1, 2018 to January 1, 2023. The primary outcome was time to hematologic recovery of white blood cell (WBC), absolute neutrophil count (ANC), and platelets. Secondary endpoints were the amount of transfusions needed, incidence of documented infections, rate of hospital admission, and length of hospital stay. Results A total of 51 patients were included. Twenty one patients received a cumulative total of 39 cycles of HDAC-123 and 30 patients received a cumulative total of 57 cycles of HDAC-135. Overall, baseline characteristics were similar between groups although hemoglobin and hematocrit were significantly lower in the HDAC-123 group. In the HDAC-123 group compared to the HDAC-135 group, the median day of WBC recovery was 15 and 24 days, respectively (p &amp;lt; 0.001). The median day of ANC recovery was 16 and 28 days, respectively (p &amp;lt; 0.001). The median day of platelet recovery was 16 and 20 days, respectively (p &amp;lt; 0.001). Conclusion The results of this retrospective review support the findings of other studies. HDAC-123 demonstrated a significantly reduced time to WBC, ANC, and platelet recovery compared to HDAC-135. HDAC-123 was also was associated with lower rates of microbiologically documented infections but did require more RBC transfusions. HDAC-123 may be preferred over HDAC-135 for consolidation therapy in patients less than 60 years old.

Cost of Patients with Alzheimer's Disease in Spain According to Disease Severity.

Alzheimer's disease (AD) has been associated with great healthcare and non-healthcare resource consumption. The aim of this study was to estimate the burden of AD in Spain according to disease severity from a societal perspective. A self-administered questionnaire was designed by the researchers and completed by the informal caregivers of patients with AD, reporting data on themselves as caregivers and on the AD patients for whom they care. The patients' sociodemographic and clinical data, their healthcare and non-healthcare resource consumption in the previous 12 months, and the impact of the disease on labor productivity were compiled. Data collected on informal caregivers included sociodemographic data and the impact of caring for a person with AD on their quality of life and labor productivity. Costs were estimated by multiplying the number of consumed resources by their unit prices. The cost of informal care was assessed using the proxy good method, and labor productivity losses were estimated using the human capital method. Costs were estimated by disease severity and are presented per patient per year in 2021 euros (€). The study sample comprised 171 patients with AD aged 79.1 ± 7.4 years; 68.8% were female, time from diagnosis was 5.8 ± 4.1 years, diagnosis delay was 1.8 ± 2.3 years, and the mean Cumulative Illness Rating Scale-Geriatric (CIRS-G) total was score 8.2 ± 6.0. According to disease severity, 14% had mild cognitive impairment or mild AD, 43.9% moderate AD, and 42.1% severe AD. The average annual cost per patient was €42,336.4 in the most conservative scenario. The greatest proportion of this cost was attributed to direct non-healthcare costs (86%, €36,364.8), followed by direct healthcare costs (8.6%, €3647.1), social care costs (4.6%, €1957.1), and labor productivity losses (less than 1%, €367.4). Informal care was the highest cost item, representing 80% of direct non-healthcare costs and 69% of the total cost. The total direct non-healthcare cost and total cost were significantly higher in moderate to severe disease severities, compared to milder disease severity. AD poses a substantial burden on informal caregivers, the national healthcare system, and society at large. Early diagnosis and treatment to prevent disease progression could reduce this economic impact.

Should the Carbon Footprint of Care be Taken into Account When Choosing a Treatment for Lymphoma? a Case Application on Mantle Cell Lymphoma

OBJECTIVE While climate change represents the greatest threat of the current century on human health, the carbon footprint of the healthcare sector represents 7-10% of occidental countries green house gas (GHG) emissions. Purchases, mostly of drugs and medical devices, represent about 50% of emissions. Oncology and hematology are suspected to be particularly carbon intensive, as they require long term and frequent consumption of healthcare resources. Here, we estimate the carbon footprint associated with different therapeutic strategies (including chemo-free or high dose chemotherapy) in patients with Mantle Cell Lymphoma (MCL) and discuss their future health impacts. METHODS Standard immunochemotherapy based versus chemo-free strategies were compared both in 1) the ≤65 years old/fit and 2) in the &amp;gt;65 years old/unfit populations. Namely, we compared 1) immunochemotherapy induction (rituximab, dexamethasone, cytarabine, and a platinum derivative) followed by autologous stem-cell transplantation and 3-year rituximab maintenance (LyMa) to obinituzumab, ibrutinib, venetoclax combination (OIV), and 2) rituximab, bendamustine combination (RB) to rituximab, ibrutinib combination (RI). These treatment schemes were considered to have similar clinical efficacy in each sub-group of patients. Carbon footprints were estimated by considering drugs, medical devices, hospital stays, car journeys, medical biology and imaging consumption in the French context. Drug specific method (including production, packaging and transport with or without R&amp;D, sales, general and administrative costs), and non-drug specific methods using mean emission factors based on their costs (kgCO2eq/€ from the French Environment Agency (ADEME) and the US Environmentally-Extended Input-Output (USEEIO) models) were applied to estimate drug carbon footprints and were compared in a sensitivity analysis. Carbon footprints were translated into future disability adjusted life years (DALY, a metric similar to quality adjusted life years QALY) expected to be lost in the future using the ReCiPe 2016 model. RESULTS The carbon footprint of each therapeutic strategy varied from 6.6 to 69.1 tCO2eq. In each, &amp;gt;70% of the total carbon footprint was related to drug purchase. A larger fraction (10-70%) of the carbon footprint of biotherapies (rituximab, obinituzumab) and low-cost small molecules (cotrimoxazole, valaciclovir) is related to their production while it is smaller (&amp;lt;10%) for high-cost small molecules (ibrutinib, venetoclax) that require higher R&amp;D, sales, general and administrative costs. In the ≤65 years old/fit population, treating a patient with LyMa leads to the emission of 16.8 tCO2eq corresponding to an estimated 0.21 [95%CI 0.08-0.51] induced DALY. Treating a patient with OIV for 5 years leads to the emission of 69.1 t CO2eq (0.86 [0.35-2.09] DALY) whereas stopping the treatment at 2 years leads to the emission of 36.6 tCO2eq (0.46 [0.19-1.11] DALY). In the &amp;gt;65 years old/unfit population, treating a patient with RB leads to the emission of 6.6 tCO2eq (0.08 [0.03-0.2] DALY) while treating a patient with RI for 5 years leads to the emission of 41.1 tCO2eq (0.51 [0.21-1.25] DALY) whereas stopping the treatment at 2 years leads to the emission of 22.7 tCO2eq (0.28 [0.12-0.69] DALY). These estimates have to be taken with caution, as they are highly dependent on the method chosen. Using non-drug specific ADEME or USEEIO mean emission factors increase the carbon footprint of 2 year OIV from 36.6 tCO2eq to 164 tCO2eq and 313 tCO2eq, respectively. On the contrary, only accounting for drug production, packaging and transport diminishes its carbon footprint to 10.8 tCO2eq. Detailed discussion on the models, on the impact of R&amp;D and on the use of generic/biosimilar drugs will be provided at the congress. CONCLUSIONS Treatment of patients with MCL is associated with a significant carbon footprint. Integrating their carbon footprint in the therapeutic decisions (such as length of treatment) could lead to significant decreases in carbon emissions that could translate into less health damages to future generations. Drug specific carbon accounting methods seem more adapted than nonspecific ones to estimate the carbon footprint of high cost drugs . Future research is required to determine more precisely the carbon footprint of drugs and therapeutic strategies in patients with hematological malignancies.

Self-reported urinary incontinence in women is higher with increased age, lower educational level, lower income, number of comorbidities, and impairment of mental health. Results of a large, population-based, national survey in Portugal.

Urinary incontinence (UI) is a common condition in women. The aim of this study is to analyze women with self-reported UI, focusing on socio-demographic data, health-related conditions and comorbidities, and their impact on healthcare resources. We analyzed data from a population-based survey with a representative sample of Portuguese women aged ≥ 18years (n = 10,465). Women with self-reported symptoms of UI were distributed according to age, education level, and household income. The comparison of comorbidities and use of healthcare resources between the UI and non-UI groups was adjusted for age, education, and body mass index. We computed weighted prevalence and adjusted prevalence ratios with 95% confidence intervals using Poisson regression. Female UI prevalence was 9.9%, increasing with age (6.3% for 18- to 39-year-old, 40.8% for 75- to 85-year-old women). The prevalence decreased with education level (36.8% in women with no education, 4.6% in women with more than 12years of education) and household income (29.8% in the 2nd quintile of income, 9.9% in the 5th quintile). Women with UI had a higher level of comorbidities, especially cardiovascular, respiratory, and mental health disorders. UI was also associated with higher consumption of healthcare resources. UI is highly prevalent among Portuguese women. It increases with age, low education level, and low household income. The use of healthcare resources was higher, possibly related with associated comorbidities. Though obtained in a single European country, these data may be useful to design a comprehensive management of UI in other parts of the western world.

Estrategias de prevención de la insuficiencia cardiaca: enfoque integral en diferentes momentos de la enfermedad

Heart failure (HF) is considered a public health problem that affects a significant proportion of the population, especially older adults, leading to substantial morbidity, mortality, and high healthcare costs. Therefore, it becomes necessary to adopt prevention strategies from initial medical care and follow-up as a primary healthcare measure. With the aging population, the increase in cardiovascular risk factors in the general population, a higher survival rate after cardiovascular ischemic events, and an increase in life expectancy, the prevalence and incidence of HF is expected to rise in the upcoming years. The development of symptomatic heart failure is associated with a worsening prognosis despite treatment in accordance with current guidelines, making it a significant source of healthcare resource consumption. Hence, it is relevant to discuss the levels of HF prevention through interventions on risk factors, the disease's progression in those in the early stages of HF, as well as in those in the established and advanced stages of the disease to understand the impact of preventive measures on prognosis when implemented at different stages of the disease.

Profile, Healthcare Resource Consumption and Related Costs in ANCA-Associated Vasculitis Patients: A Real-World Analysis in Italy.

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) are rare autoimmune diseases triggering inflammation of small vessels. This real-world analysis was focused on the most common AAV forms, granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA), to describe patients' demographic and clinical characteristics, therapeutic management, disease progression, and the related economic burden. A retrospective analysis was conducted on administrative databases of a representative sample of Italian healthcare entities, covering approximately 12 million residents. Between January 2010 and December 2020, adult GPA patients were identified by payment waiver code or hospitalization discharge diagnosis, and MPA patients by payment waiver code with or without hospitalization discharge diagnosis. Clinical outcomes were evaluated through AAV-related hospitalizations, renal failure onset, and mortality. Economic analysis included healthcare resource utilization deriving from drugs, hospitalizations, and outpatient specialist services. The related mean direct costs year/patient were also calculated in patients stratified by presence/absence of glucocorticoid therapy and type of inclusion criterion (hospitalization/payment waiver code). Overall, 859 AAV patients were divided into GPA (n=713; 83%) and MPA (n=146; 17%) cohorts. Outcome indicators highlighted a clinically worse phenotype associated with GPA compared to MPA. Cost analysis during follow-up showed tendentially increased expenditures in glucocorticoid-treated patients versus untreated (overall AAV: €8728 vs. €7911; GPA: €9292 vs. €9143; MPA: €5967 vs. €2390), mainly driven by drugs (AAV: €2404 vs. €874; GPA: €2510 vs. €878; MPA: €1881 vs. €854)and hospitalizations. Among AAV forms, GPA resulted in a worse clinical picture, higher mortality, and increased costs. This is the first real-world pharmaco-economic analysis on AAV patients stratified by glucocorticoid use on disease management expenditures. In both GPA and MPA patients, glucocorticoid treatment resulted in higher healthcare costs, mostly attributable to medications, and then hospitalizations, confirming the clinical complexity and economic burden for management of patients with autoimmune diseases under chronic immunosuppression.