Cost Of Medical Treatment Research Articles

Outcomes of Self-Care in Clients with Heart Failure before and after Treatment, using a Case Management Approach

Purpose: Heart failure (HF) is a clinical syndrome that is the final stage of most types of heart diseases. Thailand - in the Asia-Pacific region - has an unusually high incidence as the risk factors for heart disease increase due to population structure changes. This article aims to compare the self-care of heart failure clients before and after treatment using case management. Methods: A quasi-experimental research design was employed with 30 clients who were treated at the Khon Kaen University Heart Failure Clinic (KKU-HF) between April 2017 and March 2018. The research tool was a 2-part questionnaire that included demographic data and the comparison of scores of self-care before and after treatment using case management. Inferential statistics and paired t-test were used to analyze the data. Results: Most of the clients were males (80%), and most of them (56.67 %) were around 60 years of age and older. A comparison of scores for knowledge and understanding of self-care, before and after the treatment, showed a statistically significant improvement at the level of 0.05. Self-care behavior had also improved. The general quality of life had improved by up to 66.67%. Conclusion and Implications: The goal of this research study was to reduce the rate of re-hospitalization, the cost of medical treatment, and the death rate of heart failure clients. The findings can be used not only to develop self-care systems of the Khon Kaen University Heart Failure Clinic (KKU-HF) but also for other clinics to adopt.

Occupational Stress and Its Economic Cost in Hong Kong: The Role of Positive Emotions.

There has been less research on the costs of occupational stress attributed to certain job stressors in Chinese contexts. This study identified and validated common job stressors and estimated the economic cost in Hong Kong. The role of positive emotions in alleviating the economic costs of job stressors was also examined. Both qualitative and quantitative approaches were adopted. The findings obtained from five focus group discussions and a survey validated five common job stressors: Job insecurity; quantitative workload; organizational constraints; interpersonal conflicts; and work/home interface. A total of 2511 employees were surveyed, with 2032 valid questionnaires returned (925 males, 1104 females, and 3 unidentified, whose ages ranged from 18 to 70 years). The economic costs were estimated by combining the costs of absenteeism, presenteeism, and medical expenses. Absenteeism mainly caused by job stressors of the work/home interface, job insecurity, and quantitative workload accounted for an annual economic cost of HK$550 million to HK$860 million. The annual economic cost due to presenteeism mainly caused by job stressors of job insecurity, interpersonal conflict, quantitative workload, and organizational constraints ranged from HK$1.373 billion to HK$2.146 billion. The cost of medical treatments associated with occupational stress was HK$2.889 billion to HK$4.083 billion. Therefore, the total annual economic cost of occupational stress was approximately HK$4.81 billion to HK$7.09 billion. Positive emotions, representing a less explored individual factor in the cost of occupational stress studies, was found to be negatively correlated with presenteeism and buffered the negative impact of job stressors on absenteeism. The theoretical contributions and practical implications of findings are discussed.

WITHDRAWN: Health data analytics: Framework & review on tool & technology

Abstract Big Data Analytics (B.D.A.) is a fast-growing field with the capability to provide useful, clear, and in-depth understanding solutions to healthcare applications. There are many dimensions of big data having issues with its usage, such as managing volume, velocity, variety veracity and value, characteristics such as integrity accuracy and interpretation. However, such challenges do not restrain us from using and exploring big data as a source of evidence in clinical application. This obtains the need to examine health care information to control and reduce the increased cost of medical treatment and improve patient's treatment outcomes. The goal is to describe the ability and capability of big data analytics in health care. This paper describes a review on the developing field of big data analytics in healthcare, discusses the advantages, and provides an architectural framework and methodology. It also investigates the data sources and suggests the platforms/tools for analytics, techniques, technologies, and also presents the challenges and conclusions. This paper concludes that Big data analytics in health care is a promising field for providing more in-depth insight from the massive volume of data sets and functional outcomes.

Medical cost of care by line of treatment (LoT) in Medicare Fee-for-Service (FFS) beneficiaries with KRAS-mutated metastatic non-small cell lung cancer (mNSCLC).

63 Background: While no targeted therapy is currently approved for patients with KRAS-mutated mNSCLC, new therapies are being developed for patients with KRAS p.G12C-mutated NSCLC. However, real-world evidence on cost of care in managing this population is currently lacking. This study addresses this gap by describing costs of mNSCLC patients with KRAS mutations, stratified by LoT and relative to exposure to a PD(L)1 inhibitor [PD(L)1i]. Methods: Medicare FFS claims (100% sample, Parts A/B) and the PROGNOS NSCLC Explorer dataset were linked to identify patients with mNSCLC, a positive KRAS biomarker test result, and anti-cancer treatment from July 2014 - June 2018. Patients were followed from date of metastasis and stratified by LoT and prior and current exposure to PD(L)1i. Mean total medical costs included all Medicare-covered Parts A/B costs. On treatment medical costs during each LoT were reported per patient per month (PPPM) and were categorized as anti-cancer drug costs or medical management costs (excluding anti-cancer drugs). Results: 438 beneficiaries met inclusion criteria: median age 75 years, 54% female, 91% white, 116 with G12C mutations. 1L patients receiving PD(L)1i had higher total medical costs ($14,331) than those not receiving PD(L)1i ($10,055). Total medical cost of care was similar between patients on 1L ($12,178) and 2L/3L ($12,042). Although total cost of care was similar among 2L/3L patients, irrespective of PD(L)1i exposure status, the medical management costs in patients who progressed after a PD(L)1i or had never received a PD(L)1i were almost twice the medical management costs of the PD(L)1i treated patients. Conclusions: This study demonstrates a high economic burden exists among Medicare patients with KRAS-mutated mNSCLC who have progressed after 1L therapy and for whom there are no targeted treatment options available. [Table: see text]

Cost-utility analysis of newborn hepatitis B immunization in Beijing

ABSTRACT Objectives To evaluate cost-utility of universal Hepatitis B vaccination program in the Beijing city (Beijing). Methods A decision-Markov model was constructed to determine the cost-utility of the universal immunization program for infants (universal vaccination program) by comparing with a hypothetic nonvaccination strategy in Beijing. Parameters in models were extracted from Beijing Center for Disease Control and Prevention (CDC) annual work report, Beijing health statistical yearbook, National Health Survey report, Beijing 1% population sample survey report, Beijing Health and Medical Price Monitoring Data Platform, and public literatures. The incremental cost‑utility ratio (ICUR) was used to compare alternative scenarios. One-way sensitivity analysis and probabilistic sensitivity analysis were used to assess parameter uncertainties. Results The universal vaccination program had increased the utility and reduced cost among infants born in 2016 in Beijing. The ICUR was CNY −24,576.61 (US$ −3779.16) per QALY for universal vaccination program comparing with non-vaccination scenario from healthcare perspective. It was estimated that the universal vaccination would save direct medical treatment cost of CNY 2,262,869,173.50 (US$ 347,962,414.43) and prevent loss of 18322.25 QALYs within lifetime of target cohort. Discount rate accounted for the most remarkable influence on ICUR in one-way sensitivity analysis. The result of probabilistic sensitivity analysis illustrated that all of the ICURs were located in the fourth quadrant of the cost-utility incremental plot undergone 5000 times of Monte Carlo simulation. Conclusions Current universal hepatitis B vaccination program in Beijing was highly cost utility. The investment was reasonable for current universal vaccination program in Beijing.

Early osteoarthritis: development of diagnostic criteria

Early osteoarthritis (OA) is a poorly studied problem, the importance of which is due to both the prevalence of OA in the population and the high medical and economic costs of treatment and rehabilitation in patients with this disease. The accumulating data indicate that the earlier active management of patients with OA may lead to a better long-term prognosis; to date, however, the very formulation of the concept of «early osteoarthritis», as well as the holistic clinical diagnostic criteria of the disease, have not been fully formulated. The paper considers the problem associated with the elaboration of approaches to diagnosing early OA with clinical, laboratory, and modern instrumental examinations.

Pharmacoeconomic analysis of protrombin complex concentrate (Octaplex preparation) use in intracerebral hemorrhage

Topicality. Anticoagulant therapy (ACT) is the basis for the prevention and treatment of venous thromboembolic complications (VTEU) after myocardial infarction (MI), acute brain disorders, atrial fibrillation (AF). As an ACT, the indirect anticoagulant warfarin is most commonly used but it may cause small and large bleedings. When developing intracerebral hemorrhage (ICH) on the background of warfarin therapy for reverse hemostatic therapy (RHT), it is recommended to use fresh frozen plasma (FFP) or of prothrombin complex concentrates (CPC).Aim. To evaluate the pharmacoeconomic feasibility of the CPC (Octaplex drug) use comparing to the emergency dose support for warfarin-associated ICH according to Ukrainian health care system.Materials and methods. Determination of the results of blood coagulant activity restoration in warfarin-associated ICH with different drugs and associated costs have been performed on soil modeling using the “decision tree” method. The model has been developed on the basis of a randomized trial of the use of FFP and CPC Octaplex warfarin-associated ICH. On the basis of modeling, the methods “total disease cost”, “cost minimization”, “cost-effectivenes” were used. The primary efficacy criterion was the proportion of patients in whom the recovery of the INR within three hours after the onset of RHT was successful. As an additional performance criterion, time was used to recover the INR. They took into account the cost of direct medical expenses, the structure of which was determined in accordance with the current Protocol. The cost of medical treatment has been determined according to the MOH registry as of 7.08.2019. The cost of medical services has been taken from the price lists in licensed clinics. A sensitivity analysis of the results has been performed prior to changes in therapy efficacy data and changes in CPC pricing.Results and discussion. Determination of direct medical expenses in accordance with the Protocol of the ICH showed that when used for the RHT FFP they amount to 154 911,2 UAH, CPC – 172 773,4 UAH. In the overall cost structure of treating a patient with ICH, the cost of RHT is almost one third. The rate of recovery of INR is an important factor that determines the time of stopping of ICR and, in turn, influences the further prognosis of the disease. Reverse CPC therapy compared to FFP allows to increase the rate of INR recovery 37 times. More than 7 times the number of patients with ICH, who manage to normalize the blood clotting index during the critical 3 hours, is increasing. The Coefficient of Cost Effectiveness (CER) for the primary criterion and the additional criterion when using a CPC is lower by 6.7 and 72.7 times, respectively. That is, using a CPC instead of a FFP is economically feasible. Sensitivity analysis confirmed the robustness of the results. By reducing the price of the CPC by 30%, it becomes the dominant medical technology, that is, providing the best clinical outcome at a lower cost.Conclusions. Pharmacoeconomic analysis with the use of tree modeling by the decision of the RHT results of warfarin-associated intracerebral hemorrhage with alternative drugs of FFP and CPC Octaplex allows to consider the use of CPC Octaplex economically viable medical technology in the current health protection conditions in Ukraine.

In Vitro Antibacterial Activity of Crude Extracts of Artocarpus heterophyllus Seeds against Selected Diarrhoea-Causing Superbug Bacteria.

The current upsurge in resistance to conventional antibiotics, as well as high cost of orthodox medical treatment, called for the use of medicinal plants as an alternative therapy. This research was aimed at determining the antibacterial activity of Artocarpus heterophyllus seed extracts (Jackfruit as it is locally called) in the treatment of diarrhoea. Ethanolic and hexanolic seed crude extracts of the plant were screened for antidiarrhoeal activity against bacteria isolated from clinical samples (methicillin-resistant and susceptible Staphylococcus aureus, multidrug-resistant Pseudomonas aeruginosa, ciprofloxacin-resistant Salmonella typhimurium, and third-generation cephalosporin-resistant Escherichia coli). Plant phytochemical screening was conducted using standard methods. The antibacterial activity was carried out using the agar well diffusion method and compared to the standard antibiotics ceftriaxone and vancomycin. The minimum inhibitory concentration was determined by the microbroth dilution method, whereas the minimum bactericidal concentration was determined by plating out from microtitre plates with no visible growth. The results of phytochemical screening revealed the presence of tannins, flavonoids, reducing sugars, cardiac glycosides, saponins, and steroids from the prepared crude extracts. The ethanolic and hexanolic extracts had activity on multidrug-resistant Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus, and methicillin-susceptible Staphylococcus aureus with the mean and standard error zone of inhibition that ranged from 8.5 ± 0.5 to 16.5 ± 0.25 mm; however, the extracts were found not to have activity on resistant E. coli and Salmonella typhimurium. The ethanolic crude extract had the lowest MIC and MBC values of 31.25 and 125 mg/ml, respectively, compared to the hexane extract which had the MIC and MBC values of 62.50 and 250 mg/ml, respectively. This provides the evidence for its usage as an alternative herbal remedy for the treatment of diarrhoea caused by susceptible and methicillin-resistant Staphylococcus aureus and multidrug resistant Pseudomonas aeruginosa.

PMU6 Evaluation of the Application of the Hospital Management Program for Prevention and Treatment of Venous Thrombosis Based on Information Technology

To evaluate the clinical effect and cost-effectiveness of the hospital management programfor prevention and treatment of venous thrombosis based on information technology. Inpatients with deep venous thrombosis were included in the study. Relevant data from January to May 2016 were selected as the control group and those from June to December 2016 as the trial group. T test was used for comparison among groups, and X2test was used for inter-group comparison of count data. This study uses incremental cost effectiveness ratio to analyze the effectiveness of the program. A total of 75 VTE patients were diagnosed in the control group and 117 patients in the trial group. There was no significant difference in age and sex between two groups. After the implementation of VTE prevention management program, the rate of treatment increased (81.9% vs 63.2%, p=0.017), VTE caused deaths decreased (0case vs 2cases). The average length of Stay (14.7d vs 17.9d, p>0.05) in the trial group was reduced by 3.2 days compared with the control group, and the difference was not statistically significant. The average hospitalization cost of the patients during the trial group was 45330.5 RMB, and the control group was 47037.2 RMB, but the difference was not statistically significant (P>0.05). This management program is to embed risk assessment tools into HIS system, HIS system can realize automatic calculation of risk level and early warning management for high-risk patients who need intervention. Therefore, the improvement of this management program has no cost increase and has increased clinical implementation effect, so this management program is cost-effective. Establishing an information-based hospital management system for prevention and treatment of venous thromboembolism can effectively improve the early diagnosis and intervention rate of VTE patients in our hospital, effectively reduce the risk of VTE without increasing the cost of medical treatment.

Need for pharmacoeconomic consideration of antiepileptic drugs monotherapy treatment in persons with epilepsy

ObjectiveNewer antiepileptic drugs (AEDs) are expected to have less adverse effects (AEs) and drug interactions as compared to conventional AEDs but the high cost is the major limitation for their use. This study evaluated variation in the cost of treatment with newer and conventional AEDs through its correlation with treatment efficacy and AEs in persons with epilepsy (PWE). MethodsThis cross-sectional study included PWE (28.9 ± 9.9 years) having focal and generalized seizures on conventional [valproate, carbamazepine, phenytoin] or newer AEDs [levetiracetam, oxcarbazepine] for >6 months. Seizure frequency during the study (6 months) was compared to that within 6 months before the study. Other parameters assessed were Quality of life in epilepsy, Pittsburgh Sleep Quality Index, Gastrointestinal Quality of life Index, and Liverpool AEs Profile. The cost of treatment was determined as direct, indirect, and intangible costs. The incremental cost-effectiveness ratio (ICER) analysis was also performed. ResultsOut of 214 PWE, 51.4% were on newer AEDs. Newer and conventional AEDs did not differ significantly in seizure frequency reduction (60.29 vs. 53.09%), quality of life parameters, though these were improved significantly during the study period. The direct medical cost and total cost of treatment were lesser with conventional AEDs (p < 0.001 in both) than newer AEDs, but the intangible cost did not differ. The total cost of treatment was significantly influenced by factors (as per regression analysis) including the type of AEDs (significant difference between valproate, carbamazepine, and levetiracetam), frequency of seizures, cost of medicine (70.34% of total cost), hospital admission, and treatment of AEs. As per ICER, newer AEDs need an additional USD 8.39 per unit reduction in seizure frequency. ConclusionNewer AEDs have comparatively better efficacy, though not significant than conventional AEDs. However, the additional cost per unit improvement is quite high with newer AEDs, necessitating pharmacoeconomic consideration in epilepsy treatment.

Estimating the Direct Medical Outpatient Costs of Diagnosis and Treatment of Trichomoniasis Among Commercially Insured Patients in the United States, 2016 to 2018.

We used 2016-2018 outpatient claims data to calculate direct outpatient medical costs per case of trichomoniasis in 2019 US dollars. The outpatient, drug, and total costs per treated case of trichomoniasis were $174, $39, and $213, respectively. Total costs were higher for female patients ($220) than for male patients ($158).

Post-marketing pharmaco-economics evaluation of Jinye Baidu Granules

To evaluate the economy and applicability of Jinye Baidu Granules in the treatment of acute upper respiratory tract infection, a randomized, double-blind, positive drug parallel control clinical trial was conducted in this study. Stratified block random, double-blind and double simulation test was used. The experimental group took Jinye Baidu Granules, 10 g/time, three times a day, and Compound Shuanghua Granules placebo, 6 g/time, four times a day. The control group took Compound Shuanghua Granules, 6 g/time, 4 times a day, and Jinye Baidu Granules placebo, 10 g/time, 3 times a day. The course of treatment was 5 days. The total cost of this study included direct medical cost and indirect medical cost. The incremental cost-effect analysis method was used for evaluation. Treeage Pro software was used to build a pharmaco-economics model and make statistical analysis. Patients from 10 hospitals were divided into experimental group(304 cases) and control group(302 cases). The baseline values of age, sex ratio, clinical symptoms and signs scores, and important physical examination indexes of the two groups were compared. After 5 days of treatment, the cost per capita of the experimental group was(388.06±94.17) Yuan, and that of the control group was(378.47±95.46) Yuan. The cost of direct medical treatment per capita was(271.24±54.11) Yuan for the experimental group and(264.88±112.71) Yuan for the control group. The average cost of indirect medical treatment was(116.82±82.75) Yuan in the experimental group and(113.59±87.77) Yuan in the control group, with no significant difference in the cost of medical treatment per capita, the cost of direct medical treatment per capita and the cost of indirect medical treatment per capita between both groups. The results of incremental cost-effect analysis based on the total score difference in symptoms and signs after 5 days of treatment showed that ICER=23.39 Yuan/score, which was less than the willingness to pay 100 Yuan/score determined through expert interviews. The experimental group had economic advantages over the experimental group, with the economic probability of 53%. Sensitivity analysis supported the robustness of the results. The results of incremental cost-effect analysis based on the total recovery rate of symptoms and signs showed that compared with the experimental group, the control group had lower cost, better effect and absolute economic advantage, with a corresponding probability of 55%. Based on the above results, it is concluded that there is no significant difference in economic outcome between Jinye Baidu Gra-nules and Compound Shuanghua Granules in the treatment of acute upper respiratory tract infection.

Comparative Proteomics and Secretomics Revealed Virulence and Antibiotic Resistance-Associated Factors in Vibrio parahaemolyticus Recovered From Commonly Consumed Aquatic Products.

Vibrio parahaemolyticus is a seafoodborne pathogen that can cause severe gastroenteritis and septicemia diseases in humans and even death. The emergence of multidrug-resistant V. parahaemolyticus leads to difficulties and rising costs of medical treatment. The bacterium of environmental origins containing no major virulence genes (tdh and trh) has been reported to be associated with infectious diarrhea disease as well. Identification of risk factors in V. parahaemolyticus is imperative for assuming food safety. In this study, we obtained secretomic and proteomic profiles of V. parahaemolyticus isolated from 12 species of commonly consumed aquatic products and identified candidate protein spots by using two-dimensional gel electrophoresis and liquid chromatography tandem mass spectrometry techniques. A total of 11 common and 28 differential extracellular proteins were found from distinct secretomic profiles, including eight virulence-associated proteins: outer membrane channel TolC, maltoporin, elongation factor Tu, enolase, transaldolase, flagellin C, polar flagellin B/D, and superoxide dismutase, as well as five antimicrobial and/or heavy metal resistance-associated ABC transporter proteins. Comparison of proteomic profiles derived from the 12 V. parahaemolyticus isolates also revealed five intracellular virulence-related proteins, including aldehyde-alcohol dehydrogenase, outer membrane protein A, alkyl hydroperoxide reductase C, phosphoenolpyruvate-protein phosphotransferase, and phosphoglycerate kinase. Additionally, our data indicated that aquatic product matrices significantly altered proteomic profiles of the V. parahaemolyticus isolates with a number of differentially expressed proteins identified. The results in this study meet the increasing need for novel diagnosis candidates of the leading seafoodborne pathogen worldwide.

Cultural innovation in the face of modernization: a study of emerging community-based care in rural Cambodia

ABSTRACT Based on anthropological fieldwork in Pursat province, Cambodia, this article explores the socio-cultural background to the recent expansion of a unique Buddhist ritual called sângkeahăh in Khmer. This ritual can be regarded as an emerging practice of community-based care in the face of the rapid modernization and development that has been unfolding in rural Cambodia since the 1990s. It is performed at the houses of ill persons in villages, and the donations collected through the ritual are given to their family; participants are motivated first by merit-making and second by the acute awareness of increasing medical treatment costs. In addition to moving care from the private to the public sphere, the ritual represents a cultural articulation of a traditional practice of care at the grassroots level of the society, a unique case of a bottom-up response to modernization that the local culture and values support. The ethnographic description and analysis of this article contribute to deepening our understanding of the nature of community in rural Cambodia, cultural transformation in rural South East Asia, and the relationship between religion and care.

A Study on Level of Customers Satisfaction Towards Mediclaim Insurance Policy in Madurai City

Health is a human right. Its accessibility and affordability have to be ensured. Health insurance provides an affordable way for the insured and his family to stay healthy and get medical care when an emergency health issue situation arises. The escalating cost of medical treatment is beyond the reach of the common man. Mediclaim or medical insurance is one of the most recent forms of insurance. Today with expensive treatment costs, even a mere health check-up has become unaffordable for many. It can extract a major amount of savings in just a few days or hours. But under the shelter of a medical insurance plan, the person can get relieved from this tension. As medical insurance policy offers to reimburse a pre-defined percentage of expenses incurred such as doctors consultation fees, pathological tests, x-ray, hospitalization, medicine, follow-ups, etc., The main purpose behind purchasing a health cover by the insured is to avail of quality health treatment without any burden of medical bills. A facility like cashless hospitalization entitles the insured to avail of the treatment on a cashless basis. Insured perception depends on the quality of service and products offered by the insurer according to the insured need. The purpose of this research is to study the level of satisfaction of the insured regarding the mediclaim policy in Madurai city. The research has been carried out to understand the cost of insured dissatisfaction and to determine the areas where the insurer needs to focus and strengthen its customer relationship. Therefore, an attempt has been made to study the perception of the insured regarding the mediclaim policy in Madurai city.

Analysis of direct economic burden of occupational asthma

Objective: To analyze the direct economic burden of occupational asthma patients and provide economic basis for the government to rationally allocate health resources. Methods: In September 2019, colleted the case data of 53 patients diagnosed with occupational asthma who were hospitalized in our hospital from December 2008 to December 2018, and analyze the impact of gender, age, diagnosis time, ducation level, allergen type to the length of stay, hospitalization cost, medical technology diagnosis and treatment costs, western medicine costs, average daily hospitalization costs and other indicators. Results: The average length of hospitalization for occupational asthma patients was (38.7±8.1) days, and the average hospitalization cost was 14743 yuan, of which medical technology diagnosis and treatment costs, western medicine costs, and comprehensive medical service costs accounted for the top three, 42.5% (331977/781369) , 32.0% (249942/781369) , 19.6% (153268/781369) respectively. Hospitalization days for occupational asthma patients has decreased significantly in 2014-2018 (P<0.05) . There were no significant differences in hospitalization costs, medical technology diagnosis and treatment costs, western medicine costs, and average daily hospitalization costs for occupational asthma patients caused by different allergens (isocyanates, persulfates and phthalic anhydrides) (P>0.05) . Hospitalization days, hospitalization costs, medical technology diagnosis and treatment costs, western medicine costs, and average daily hospitalization costs of patients with moderate occupational asthma were significantly higher than those of mild patients (P<0.05) . Conclusion: Early detection of occupational asthma patients and early intervention can reduce the economic burden on patients and society.

The pharmacoeconomic analysis of olaparib (Linparza®) application for the supporting therapy of patients with BRCA-mutated platinum-sensitive recurrent ovarian cancer

Among women, one of the common localizations of malignant tumors is ovarian cancer (OC). Two genes have been identified, and their mutations lead to hereditary forms of breast and ovarian cancer – BRCA1 and BRCA2. Women with BRCA-associated OC respond better to targeted drugs and have better survival rates against specific treatments. Targeted drugs for the treatment of BRCA-mutated OC are specific inhibitors of enzymes of the group poly- (ADP-ribose) polymerase (PARP). Currently, the only PARP inhibitor registered in Ukraine is olaparib (Linparza® drug, AstraZeneca, United Kingdom).Aim. To assess the economic feasibility of the targeted olaparib therapy (Linparza® drug) for patients with BRCA mutated platinum-sensitive recurrent ovarian cancer (BRCA-MPS ROC) from the standpoint of the Ukrainian healthcare system.Materials and methods. Determination of treatment outcomes and associated costs was performed using Markov analytical modeling based on the results of a randomized multicenter, open-label phase II clinical trial D0810C0019-Study 19. The model time horizon is 15 years. Clinical efficacy and safety of olaparib and placebo (WW strategy) were compared as the supportive therapy for patients with BRCA-MPS ROC. Based on the results of Markov simulation the methods of “cost-effectiveness” and “cost-utility” were used. Years of the saved life (LYG) were used as a criterion of efficiency. The QALY index was used as a criterion of utility. The cost of direct medical expenses, which structure was determined in accordance with the current Protocol, was taken into account. The cost of medical treatment was determined according to the register of the Ministry of Health of Ukraine as of 7.08.2019. The cost of medical services was determined according to the available price lists. The cost of correction of side effects of the chemotherapy was also considered. Discounting was determined at the level of 5 % annually. The sensitivity analysis of the results was performed on the price and dose of olaparib and the observation horizon.Results. According to the simulation, the average life expectancy of patients with BRCA mutated platinum-sensitive recurrent ovarian cancer when using olaparib (Linparza® drug) as a supportive antitumor therapy is 4.8 LYG compared to 2.56 LYG in the WW strategy group. The olaparib supportive care strategy provides the patient with 3.61 years of quality of life compared to 1.87 years in the WW group. Thus, the use of olaparib provides the patient with an additional 2.24 years of life and 1.74 additional QALY. The total costs for the simulated period in the group of olaparib averaged 1893410.7 UAH, and in the WW group – 47466.9 UAH. The incremental coefficients of ICER (cost of 1 additional year of life) and ICUR (cost of 1 additional year of quality life) amounted to 824564,4 UAH, and 1063162.2 UAH, respectively.Conclusions. The pharmacoeconomic analysis based on Markov modeling and cost-effectiveness and cost-utility calculations has shown that olaparib (Linparza® drug) is highly effective in the treatment of BRCA-mutated platinum-sensitive recurrent ovarian cancer; it almost doubles the patients’ survival without recurrence. At the same time, olaparib is an expensive drug. The transition of half of the patients with BRCA-mutated platinum-sensitive recurrent ovarian cancer from the “watch-and-wait” strategy to the treatment with olaparib requires an additional annual cost of 10,548,250.3 UAH.

Recent Progresses in Sensitive Determination of Drugs of Abuse by Capillary Electrophoresis

Background: Today, “drugs of abuse” pose serious social problems such as many crimes, medical treatment costs, and economic repercussions. Several worldwide clinical laboratories use analytical separation methods to analyze their patient samples for drugs and poisons. In this way, they provide qualitative and quantitative data on the substances in various biological matrices (e.g., urine, plasma or serum, saliva, and breath). Methods: An extensive review of the published articles indicates that the use of Capillary Electrophoresis (CE) coupled with sensitivity enhancing methods is a very attractive area of interest in the assay of drugs of abuse. Results: This review was prepared to have a comprehensive study on applications of sensitivity enhancing methods on the determination of drugs of abuse especially from 2007 to present. The sample preconcentration approaches almost address all methods from online preconcentration (both electrophoretic and chromatographic-based methods) to offline preconcentration. Furthermore, detection system modification and capillary column fabrications were investigated in order to increase the detection sensitivity of complex samples in CE. Conclusion: The present review summarizes the most recent developments in the detection of drugs of abuse using CE. Although CE still has a limitation in sensitive detection, several publications in recent years have proposed valuable methods to overcome this problem.

Challenges Facing Medical Tourism in Jordan from View of Tourism Decision Makers

Viewpoint of a sample of decision-makers in the Jordanian Ministry of Tourism. To achieve this goal, a questionnaire of 13 items was constructed. After verifying its validity and consistency, it was applied to a random sample of (180) members of the tourism decision makers in the sector. Therapeutic tourism, data were entered into the SPSS program for analysis. The results also showed that there were no statistically significant differences in the challenges facing medical tourism in Jordan due to the two sex variables with scientific qualification, while statistically significant differences appeared due to the impact of the experience variable. In light of the previous results, the researcher recommended the necessity to take into consideration the list of challenges revealed by the current study and work to solve them in order to promote medical tourism in Jordan. The need to review the cost of medical treatment and reduce taxes as much as possible in this sector, where the high cost represents the most prominent challenges facing the tourism sector in general and particularly medical tourism.

THE ECONOMIC RATIONALE FOR THE USE OF OUTPATIENT PLEURODESIS IN THE TREATMENT OF MALIGNANT PLEURAL EFFUSIONS

Introduction. Exudative tumor pleurisy affects up to 100 000 people a year in Russia, up to 400 000 people a year in Europe. Inpatient treatment of such patients is associated with certain costs, and there are also queues for treatment in oncology hospitals. An outpatient pleurodesis can reduce these problems. The objective was to compare pharmacoeconomic parameters for inpatient pleurodesis and outpatient pleurodesis to determine the most cost-effective treatment option. Methods and materials. 179 patients in the clinic of the Federal State Budgetary Institution Scientific Research Center for Oncology named after N. N. Petrov of the Russian Ministry of Health underwent pleurodesis using various methods (talc, bleocin, combined). The effectiveness of the methods and the direct medical costs of treatment were evaluated. The effectiveness of a stationary thoracoscopic pleurodesis was evaluated according to foreign literature, and the direct medical costs of treatment were calculated. Based on the obtained results, the pharmacoeconomic indicators of CER and ICER were calculated. Results. Direct medical costs for stationary thoracoscopic pleurodesis amounted to 35056.4 rubles with an efficiency of 89 %. Direct medical costs for outpatient pleurodesis were: for talc pleurodesis – 8051.7 rubles, for bleocin and combined pleurodesis – 11799.2 rubles. CER amounted to: for a thoracoscopic pleurodesis in the hospital – 393.9, for talc pleurodesis – 115.35, for bleocin pleurodesis – 188.7, for combined pleurodesis – 155.8. ICER in relation to stationary pleurodesis was 1406.4 for talc pleurodesis, 877.6 for bleocin pleurodesis, 1748.6 for combined pleurodesis. Conclusion . CER was almost 3 times lower with outpatient pleurodesis, which makes it the most cost-effective option for the treatment of tumor exudative pleurisy. ICER was maximal in combined pleurodesis, which makes it preferred among outpatient pleurodesis options. Based on the obtained data, it can be argued that the use of ambulatory pleurodesis as an initial stage of care for patients with tumor exudative pleurisy is economically justified.