Outpatient Care Costs Research Articles

Healthcare costs and hospitalizations in US patients with type 2 diabetes and cardiovascular disease: A retrospective database study (OFFSET).

AimTo investigate the budget implications of treatment with glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs) versus other glucose‐lowering treatment (here termed ‘standard of care’ [SoC]) during 2012‐2019.Materials and MethodsGLP‐1 RA‐naïve adults with type 2 diabetes (T2D) in the IBM MarketScan database with at least one glucose‐lowering medication claim within 6 months after their first cardiovascular disease (CVD) hospitalization were included (index date was the date of first claim for a GLP‐1 RA for the GLP‐1 RA group, and the date of the first claim, independent of medication type, for the SoC group). Monthly healthcare costs and hospitalization risk over 12 months postindex date were compared for those who initiated a GLP‐1 RA posthospitalization versus those with a claim for any other glucose‐lowering medication.ResultsPostindex date, mean observed total costs were lower for patients receiving a GLP‐1 RA compared with SoC ($3853 vs. $4288). In adjusted analysis, both groups had similar total healthcare costs (P = .56). This was driven by significantly lower inpatient and outpatient costs and higher drug costs in the GLP‐1 RA group compared with SoC (P < .001). Risks of all‐cause (adjusted hazard ratio: 0.85) and CVD‐related hospitalization (0.76) were significantly lower in the GLP‐1 RA group compared with SoC (P < .001). Similar results were observed in a subgroup with atherosclerotic CVD.ConclusionsThese findings suggest that, in US patients with T2D and a CVD‐related hospitalization, the added medical cost of treatment with GLP‐1 RAs is offset by lower inpatient and outpatient care costs, resulting in budget neutrality against SoC.

Pediatric Concurrent Hospice Care: Cost Implications of a Hybrid Payment Model.

Implementation of concurrent hospice care led to a new hybrid payment model that combines hospice payments with payments for non-hospice medical care. Little is known about the cost implications of this new hybrid payment model. The purpose was to identify costs and compare concurrent care and standard hospice care costs by estimating the average incremental Medicaid cost of care over time. Using national Medicaid data of 18147 hospice children and a multilevel generalized linear model, we calculated the incremental costs of receiving concurrent vs standard hospice care. We used the total cost of care over the last year of life. Increments for the analysis were hospice length of stay, stratified to 1 day, 2-14 days, and 15 + days. Overall, compared to standard hospice care, enrollment in concurrent hospice care was significantly associated with an increase in outpatient care and prescription drug costs. For a stay of 1 day, concurrent hospice care decreased inpatient costs and increased costs of prescription drugs. For stays between 2 and 14 days, concurrent hospice decreased total costs and inpatient costs, but increased prescription drug costs. With a hospice stay of 15 + days, concurrent hospice had significantly higher costs across all measures, including total costs, inpatient costs, outpatient costs, and prescription drug costs. This study provides critical insight into incremental costs of receiving concurrent vs standard hospice care. More research is needed to understand how concurrent hospice lengthy hospice stays are associated with increases of costs.

Costs of Treatment of Acute Antibody-Mediated Rejection in Kidney Transplant Recipients

Antibody-mediated rejection (AMR) remains challenging in kidney transplant recipients. It may negatively impact the graft survival, and its treatment is associated to relatively high expenses. The aim of our study was to assess the costs of treatment of acute AMR in the Polish settings. A total of 11 kidney transplant recipients with acute AMR diagnosed between September 2016 and August 2019 and treated in our center were included. Direct costs of inpatient and outpatient care in the first year after AMR diagnosis from the perspective of a transplant center were retrospectively calculated. The costs of treatment of acute AMR were considerably high, with a mean 1-month cost of treatment 12,718 PLN (∼€2925; ∼3307 US dollars). That means that costs of management of kidney transplant recipients with acute AMR are almost 2-fold higher than hemodialysis. Intravenous immunoglobulin was responsible for the majority (55%) of costs. Treatment of acute AMR increases the costs of post-kidney transplant care in involved patients. Therefore, efforts should be made to minimize the risk for acute AMR. Despite its potential clinical benefits, management of acute AMR is even more expensive than dialysis. Therefore, further cost-effectiveness analyses are needed to justify the spending and to establish the best treatment regimens.

Observational retrospective study calculating health service costs of patients receiving surgery for chronic rhinosinusitis in England, using linked patient-level primary and secondary care electronic data

ObjectivesChronic rhinosinusitis (CRS) symptoms are experienced by an estimated 11% of UK adults, and symptoms have major impacts on quality of life. Data from UK and elsewhere suggest high economic...

Costs of providing hospital-based psychotic disorder treatment in Indonesia

Background Mental illness prevalence is increasing globally and has caused a significant economic burden. However, information from developing countries regarding this issue is still limited. Aims To estimate the cost of treating psychotic disorders in outpatient and inpatient wards in a provincial referral mental health hospital in West Java province, Indonesia. Methods We collected data on the direct cost of treating psychotic disorders within 2014–2015. Billing data from 1565 patients were used to calculate inpatient cost, while micro-costing was used to estimate outpatient cost. One hundred and five patients visiting the hospital were interviewed to estimate indirect costs, for example, patients’ and caretakers’ travel, meal, and opportunity costs. Results For inpatient care, the average direct and indirect cost/patient/episode are USD328.84 and USD213.22, respectively. For outpatient care, the direct and indirect costs are USD148,484.83/year (USD25.38/visit) and USD88,503.70/year (USD15.13/visit), respectively. The total societal cost of treating patients in the hospital is USD1,085,310.21/year (39% is an indirect cost, dominated by productivity loss). Conclusion The societal cost of treating psychotic disorders is large and potentially catastrophic to the patients. Early treatment for mental illness may avoid the high costs and lead to better productivity. Potential access barriers such as financial factors and stigma should be addressed.

Trends and characteristics of primary pyogenic spine infections among people who do and do not inject drugs: Northeast New York State, 2007 to 2018

Background: Pyogenic spine infections (PSIs) are challenging to diagnose and treat. People who inject drugs (PWID) are at increased risk and contribute to rising PSI incidence. Objective: To analyze trends and characterize PSI in persons who do and do not inject drugs in northeast New York State (NYS), a predominantly rural region. Methods: A retrospective study of PSI patients at a regional tertiary care hospital from 2007 to 2018 was conducted. PSI incidence, population demographics, microbiology, surgical interventions, length of stay (LOS), and costs were compared between injection substance use disorder (ISUD) and non-ISUD cohorts. Results: Two hundred and seventy patients (59 ISUD and 211 non-ISUD) were included in this study. PSI incidence due to ISUD increased 1175% during the study time periods. The median age of the ISUD and non-ISUD cohorts was 39 and 65, respectively. Staphylococcus aureus was the most common causative organism, although a variety of bacterial and fungal pathogens were identified. Nearly half of the patients in each cohort required surgical intervention. Median acute care LOS was 12 days and comparable between cohorts. However, the ISUD cohort was frequently discharged against medical advice, or transferred back to acute care hospitals to complete antibiotic courses. Median inpatient hospital costs were approximately $25,000 and were comparable between cohorts. These costs do not reflect inpatient costs once the patient was transferred back to the referring hospital, nor costs for outpatient care. Medicaid and Medicare were the most common primary insurance payers for the ISUD and non-ISUD cohorts, respectively. Conclusions: Incidence of PSI has increased significantly coincident with the opioid epidemic and has had significant impact on a large, rural region of NYS. PSIs consume large amounts of healthcare resources. This study can inform hospitals and public health agencies regarding the need for substance abuse harm reduction strategies.

Effects of whole-body MRI on outpatient health service costs: a general-population prospective cohort study in Mecklenburg-Vorpommern, Germany

ObjectiveWhole-body MRI (wb-MRI) is increasingly used in research and screening but little is known about the effects of incidental findings (IFs) on health service utilisation and costs. Such effects are...

Average direct costs of outpatient, hospital, and home care provided to patients with chronic wounds

RESUMO Objetivo: Analisar os custos diretos médios da assistência ambulatorial, hospitalar e domiciliar prestada aos pacientes com feridas crônicas. Método: Pesquisa quantitativa, exploratório-descritiva, do tipo estudo de caso, realizada numa Unidade de Tratamento Integral de Ferida. Obtiveram-se os custos multiplicando-se o tempo despendido pelos profissionais pelo custo unitário da mão de obra da respectiva categoria, somando-se aos custos dos materiais e terapias tópicas. Resultados: Os custos da assistência ambulatorial corresponderam a US$4,25 (DP ± 7,60), da hospitalar a US$3,87 (DP ± 17,27) e da domiciliar a US$3,47 (DP ± 5,73). Nessas três modalidades, os custos diretos com os curativos e consultas médicas foram os mais representativos: US$7,76 (DP ± 9,46) e US$6,61 (DP ± 6,54); US$7,06 (DP ± 24,16) e US$15,60 (DP ± 0,00); US$4,09 (DP ± 5,28) e US$15,60 (DP ± 0,00), respectivamente. Conclusão Considerando a assistência integral aos pacientes com feridas crônicas, o custo direto médio total foi de US$10,28 (DP ± 17,21), sendo a modalidade ambulatorial a mais representativa na sua composição. Constatou-se diferença estatística significante (valor p = 0,000) entre os custos da assistência domiciliar e ambulatorial, domiciliar e hospitalar e ambulatorial e hospitalar.

Average direct costs of outpatient, hospital, and home care provided to patients with chronic wounds.

To analyze the average direct costs of outpatient, hospital, and home care provided to patients with chronic wounds. Quantitative, exploratory-descriptive case study, carried out in a Comprehensive Wound Care Unit. Costs were obtained by multiplying the time spent by professionals by the unit cost of labor in the respective category, adding to the costs of materials and topical therapies. Outpatient care costs corresponded to US$4.25 (SD ± 7.60), hospital care to US$3.87 (SD ± 17.27), and home care to US$3.47 (SD ± 5.73). In these three modalities, direct costs with dressings and medical consultations were the most representative: US$7.76 (SD ± 9.46) and US$6.61 (SD ± 6.54); US$7.06 (SD ± 24.16) and US$15.60 (SD ± 0.00); US$4.09 (SD ± 5.28) and US$15.60 (SD ± 0.00), respectively. Considering comprehensive care for patients with chronic wounds, the mean total direct cost was US$10.28 (SD ± 17.21), with the outpatient modality being the most representative in its composition. There was a statistically significant difference (p value = 0.000) between the costs of home and outpatient, home and hospital, and outpatient and hospital care.

Estimating the cost of oral health services for 2018/19 financial year at public health facilities in two KwaZulu-Natal districts, South Africa: A retrospective study

Aim: To estimate the cost of the provision of oral health services in the public health facilities in uMgungundlovu and eThekwini districts of KwaZulu-Natal during the financial year 2018/19. Materials and Methods: The study was a retrospective costing analysis using the provider’s perspective for estimating the cost for the period from April 1, 2018 to March 31, 2019. A mixed costing approach in which secondary data were obtained from the human resources system and the Basic Accounting System (BAS) package. Primary data that was collected at facility level included dental headcount, type of diagnosis, medication prescribed, and consumables utilized. The cost of supply for medicines were obtained for individual items commonly used by dental practitioners during consultation from the Pharmaceutical Supply Chain Management Unit. The costs are quoted in USD based on an average exchange of R13.25 per USD in 2018. Results: The total dental headcount across the 16 facilities was 206,309 for the 2018/19 financial year. The mean cost for dental outpatient curative care per patient per facility was $45.65 [95% confidence interval (CI): $32.88–$58.42]. The estimated total dental health expenditure across the Province based on an average unit cost per patient per facility equals to 0.86% (95% CI: 0.62%–1.10%) of the total provincial expenditure. Conclusion: The costs of dental outpatient curative care in the current study are higher than other studies and may be indicative of technical inefficiencies within the health system. We recommend that an audit of oral health services be conducted that could identify the technical inefficiencies and provide a platform for re-orientation of oral health service.

Catheter ablation in hospitalized patients diagnosed with atrial fibrillation: real-world evidence from Italian health administrative databases.

Catheter ablation (CA) is recommended for treating paroxysmal/persistent atrial fibrillation (AF) as an alternative to antiarrhythmic drugs after failure or intolerance, or as first-line in limited cases. This study has described patients affected by AF and treated or not with CA, from the perspective of the Italian National Healthcare System (INHS). From the healthcare administrative data collected in the ReS (Ricerca e Salute) database, from 2016 to 2017, patients with main/secondary diagnosis of AF (index date) were split into two cohorts by presence/absence of CA procedure in the same hospital discharge form. The cohorts were characterized by gender, age, comorbidities. Consumptions (DDD) of antiarrhythmic, anticoagulant, antiplatelet and antihypertensive drugs, hospitalizations for AF, hemorrhagic stroke/intracranial hemorrhage, ischemic stroke/transient ischemic attack, extra cranial major bleeding and heart failure, outpatient specialist care and healthcare costs paid by the INHS were assessed. Out of >5 million inhabitants in 2016-2017, 33,940 patients were hospitalized with a diagnosis of AF, 990 (2.9%) were treated with CA in the same hospitalization (32,950 without CA). Patients with CA were mostly males (66.8%; 48.5% without CA). On average, they were aged (±SD) 65±12 (78±11 without CA) and affected by one comorbidity (≥3 in patients without CA). During the observational period, beta-blockers were the most prescribed to both cohorts, followed by antiarrhythmic drugs to patients with CA and by direct oral anticoagulants to those without. The 29.7% of subjects with CA were hospitalized due to relevant cardiovascular diagnoses during the previous year (7.4% without CA) and 93.4% in the first follow-up year (29.7% without CA). The 80-90% of cohorts resorted to the outpatient specialist care. Electrocardiograms and the cardiology visits were performed to the 62.5% and 31.1% of the cohort with CA (39.5% and 13% without CA) in the first follow-up year. On average, the INHS spent about € 4000 in the previous year and around € 10,000 in the first follow-up year per patient of both cohorts, while around € 3000 and € 4000 for a patient respectively with and without CA. At least half of the total costs were due to hospitalizations, followed by pharmaceuticals and outpatient specialist care. This study confirm a post-CA suboptimal monitoring.

Catastrophic Health Expenditure and Distress Financing Among Patients With Nondialysis Chronic Kidney Disease in Uddanam, India

Catastrophic Health Expenditure and Distress Financing Among Patients With Nondialysis Chronic Kidney Disease in Uddanam, India

Predictors and Trends of MDR/RR-TB in Shenzhen China: A Retrospective 2012-2020 Period Analysis.

PurposeWe analyzed the trends and predictors of multidrug-resistant (MDR) or rifampicin-resistant (RR) tuberculosis (TB) in culture-positive cases in Shenzhen during 2012–2020, after the implementation of improved strategies (scale-up molecular drug susceptibility testing [mDST], expansion of DST eligibility, and generous reimbursement of MDR-TB outpatient care costs).Materials and MethodsWe retrospectively extracted and analyzed data from the TB Information System on drug-resistant pulmonary tuberculosis diagnosed in Shenzhen during the 2012–2020 period. We analyzed trends in RR- and MDR-TB rates in new cases during 2012–2018 and 2018–2020 periods, and among previously-treated cases during 2012–2017 and 2017–2020 periods, using Cochran-Armitage tests. We generated multivariate logistic regression models to analyze demographic predictors of MDR/RR-TB rates.ResultsWe found 21,367 positive mycobacterial cultures in Shenzhen during the 2012–2020 period, and 19,951 (93.4%) were identified as Mycobacterium tuberculosis and had DST results (92.0% of those were mDST-based). Of these patients with DST results, 1630 (8.2%) were RR-TB, and 1142 (5.7%) were MDR-TB. Of the RR-TB, 70% were MDR-TB. The MDR/RR-TB rate in new TB cases increased significantly during the 2012–2018 period (Ptrend < 0.05), but it decreased in the 2018–2020 period (Ptrend > 0.05, with a significant trend for MDR-TB). Among previously treated cases, the temporal MDR/RR-TB rate trends did not differ significantly (Ptrend > 0.05). Our multivariate analysis showed that age younger than 30 years, housework service/unemployment, local residency, and previous TB treatment were all predictors of MDR/RR-TB. The percentage of patients with MDR-TB on treatment increased from 49.4% in 2012 to 70.5% in 2020. The treatment success rate of patients with MDR-TB during the 2012–2018 period was 71%.ConclusionDuring the study period in Shenzhen, the cases of MDR/RR-TB were detected, and the treatment enrollment increased and the MDR-TB rates decreased gradually after 2017. Decreasing trends may reflect the efficacy of improved strategies; however, their long-term impact on the MDR-TB burden remains to be investigated. The predictors of MDR-TB identified in our study should be considered when developing targeted MDR-TB control strategies.

Traumatic Brain Injury (TBI) and Chronic Kidney Disease (CKD) in Veterans: Risk, Survival and Costs

<h3>Research Objectives</h3> To investigate the risk for Chronic Kidney Disease (CKD) among veterans diagnosed with Traumatic Brain Injury (TBI) and an age-matched non-TBI cohort, along with the impact of comorbid TBI-CKD on survival and Veterans Health Administration (VHA) costs. <h3>Design</h3> Veterans were followed from 2000 through 2015. <h3>Setting</h3> VHA Medical Centers and Community Based Outpatient Centers. <h3>Participants</h3> 181,521 veterans with TBI and 291,015 veterans without TBI. <h3>Interventions</h3> Logit models were estimated to examine the association of veteran socio-demographics with the odds of a CKD diagnosis. A Cox proportional hazards model was estimated to examine the association of no TBI/no CKD vs TBI only vs CKD only vs TBI and CKD with survival. Generalized linear and seemingly unrelated regression models were used to estimate the association of no TBI/no CKD vs TBI only vs CKD only vs TBI and CKD with annual per veteran VHA total, inpatient, outpatient, pharmacy, and community care costs. <h3>Main Outcome Measures</h3> Risk of CKD, survival and VHA costs. <h3>Results</h3> Veterans with TBI had higher covariate-adjusted odds (OR 1.14; 95% CI:1.11, 1.18) of having CKD. Relative to neither condition, there was an increased hazard of death for veterans with co-occurring TBI and CKD (HR 1.62: 95% CI:1.58, 1.66). TBI-CKD impact on total annual cost per veteran was $42,996 (95% CI $33,657, $52,336. The marginal impact of TBI-CKD diagnosis on annual inpatient VHA costs per veteran was $19,262 (95% CI $15,975: $22,550); on annual outpatient VHA costs per veteran $18,263 (95% CI $14,922: $21,604); on annual pharmacy VHA costs per veteran $4,003 (95% CI $3,051: $4,955), and on annual community care costs per veteran $1,693 (95% CI $870: $2,516). <h3>Conclusions</h3> Veterans with TBI are at higher risk for CKD and those with comorbid TBI-CKD had higher mortality and VHA costs relative to neither condition. <h3>Author(s) Disclosures</h3> This material is based upon work supported by the U.S. Army Medical Research and Materiel Command and from the U.S. Department of Veterans Affairs Long-Term Impact of Military-Relevant Brain Injury Consortium (LIMBIC) Award No. l01 HX003155.

Traumatic Brain Injury in Veterans: Social Determinants, Survival and Costs

<h3>Research Objectives</h3> To investigate the association between veteran socio-demographics and clinical factors with the likelihood of having a Traumatic Brain Injury (TBI), and the association of TBI with survival and Veterans Health Administration (VHA) costs. <h3>Design</h3> A retrospective study of veterans diagnosed with TBI and age-matched cohort without TBI were followed 2000-2015. <h3>Setting</h3> Veterans using VHA Medical Centers and Community Based Outpatient Clinics. <h3>Participants</h3> 181,521 veterans diagnosed with TBI and 291,015 veterans without TBI. <h3>Interventions</h3> Logit models were estimated to examine the association of veteran socio-demographics with the odds of a TBI diagnosis. A Cox proportional hazards model was estimated to examine the association of TBI with survival. Generalized linear and seemingly unrelated regression models were used to estimate the association of TBI with annual per veteran VHA costs. Costs were adjusted for inflation to 2019 values. <h3>Main Outcome Measures</h3> Risk of Traumatic Brain Injury, Veteran Survival and VHA total, inpatient, outpatient, pharmacy and community care costs. <h3>Results</h3> Non-Hispanic Blacks (OR 1.85; 95% CI 1.81:1.88), Hispanic (OR 1.94; 95% CI 1.88:2.00)), and veterans with 3+ mental (OR 5.83; 95% CI 5.68:5.98) and 3+ physical comorbidities (OR 2.47; 95% CI 2.42:2.52) had higher odds of TBI. Veterans with TBI were more likely to die (HR 1.16: 95% CI:1.14:1.17). Veterans with TBI had higher total annual VHA costs by $19,808 (95% CI $13,900: $25,715), The marginal impact of TBI on annual inpatient VHA costs per veteran was $10,295 (95% CI $7,431: $13,158) and outpatient costs was $9,255 (95% CI: $6,528: $11,981). The marginal impact of TBI on annual community care costs per veteran was $234 (95% CI $16: $451). <h3>Conclusions</h3> TBI imposes a significant burden on patient mortality as well as VHA costs. Minority veterans and those with multiple mental health and physical comorbidities are at higher risk for TBI. <h3>Author(s) Disclosures</h3> Disclaimer: This material is based upon work supported by the U.S. Army Medical Research and Materiel Command and from the U.S. Department of Veterans Affairs Long-Term Impact of Military-Relevant Brain Injury Consortium (LIMBIC) Award No. l01 HX003155.

Comparing the average cost of outpatient care of public and for-profit private providers in India

IntroductionUnderstanding the cost of care associated with different kinds of healthcare providers is necessary for informing the policy debates in mixed health-systems like India’s. Existing studies reporting Out of Pocket Expenditure (OOPE) per episode of outpatient care in public and private providers in India do not provide a fair comparison because they have not taken into account the government subsidies received by public facilities. Public and private health insurance in India do not cover outpatient care and for-profit providers have to meet all their costs out of the payments they take from patients.MethodsThe average direct cost per acute episode of outpatient care was compared for public providers, for-profit formal providers and informal private providers in Chhattisgarh state of India. For public facilities, government subsidies for various inputs were taken into account. Resources used were apportioned using Activity Based Costing. Land provided free to public facilities was counted at market prices. The study used two datasets: a) household survey on outpatient utilisation and OOPE b) facility survey of public providers to find the input costs borne by government per outpatient-episode.ResultsThe average cost per episode of outpatient care was Indian Rupees (INR) 400 for public providers, INR 586 for informal private providers and INR 2643 for formal for-profit providers and they managed 39.3, 37.9 and 22.9% of episodes respectively. The average cost for government and households put together was greater for using formal for-profit providers than the public providers. The disease profile of care handled by different types of providers was similar. Volume of patients and human-resources were key cost drivers in public facilities. Close to community providers involved less cost than others.Conclusions and recommendationsThe findings have implications for the desired mix of public and private providers in India’s health-system. Poor regulation of for-profit providers was an important structural cost driver. Purchasing outpatient care from private providers may not reduce average cost. Policies to strengthen public provisioning of curative primary care close to communities can help in reducing cost.

Unbalanced Treatment Costs of Breast Cancer in China: Implications From the Direct Costs of Inpatient and Outpatient Care in Liaoning Province.

The increasing incidence of breast cancer and its financial burden highlights the need for controlling treatment costs. This study aimed to assess the direct costs of inpatient and outpatient care for breast cancer patients in Liaoning Province to provide a policy reference for cost containment. Based on the System of Health Accounts 2011 (SHA 2011), systematic data collection was conducted via multistage stratified cluster random sampling. A total of 1160 health institutions, including 83 hospitals, 16 public health institutions, 120 primary health institutions, and 941 outpatient institutions were enrolled in 2017. A database was established containing 20 035 patient-level medical records from the information system of these institutions. Curative care expenditure (CCE)was calculated, and generalized linear modeling was performed to determine cost-related factors. In 2017, the CCE for breast cancer was approximately CNY 830.19 million (US$122.96 million) in Liaoning province (0.7% of the total health expenditure and 9.9% of cancer-related healthcare costs). Inpatient care costs were estimated to be CNY 617.27 million (US$91.42 million), accounting for 74.4% of the CCE for breast cancer, almost three times as large as outpatient costs (25.6%). The average inpatient and outpatient costs for breast cancer were estimated to be CNY 12 108 (US$1793) and CNY 829 (US$123) per visit. Medication cost was the main cost driver, which comprised 84.0% of the average outpatient cost and 37.2% of the mean inpatient cost. Breast cancer imposes a large economic burden on patients and the social health insurance system. Results show an irrational cost pattern of inpatient and outpatient services, with patients relying excessively on inpatient services for treatment. Promoting outpatient care whenever relevant is conducive to cost containment and rational utilization of resources.

ЕSTIMATION OF SOCIO-ECONOMIC BURDEN OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE FOR A 5-YEAR PERIOD: A REGIONAL ASPECT

The aim of the study was to estimate the economic damage by COPD, including direct medical and non-medical costs and indirect costs associated with premature deaths of working-age individuals.Materials and methods. First, estimation of the economic COPD burden in Astrakhan region (AR) was carried out using the clinical and economic analysis of the "cost of illness" (COI). Direct medical costs of inpatient, outpatient, ambulance and emergency medical care, as well as direct non-medical costs associated with the disability benefits payments, were taken into account. Indirect costs were defined as economic losses from undelivered products due to premature deaths of working-age individuals.Results. From 2015 to 2019, the economic COPD burden in AR amounted to 757.11 million rubles in total, which is equivalent to 0.03% of the gross regional product covering a five-year period of the study. Direct medical and non-medical costs totaled 178.02 million rubles. In the structure of direct medical expenses, expenses for inpatient, as well as ambulance and emergency medical care during the study period, increased by 92.5% and 45.5%, respectively. While the costs for the outpatient care decreased by 31.9%, the increase in direct non-medical costs associated with the disability benefits payments, increased by 5.1% (2019). Indirect losses amounted to 579.09 million rubles.Conclusion. The structure of the main damage is dominated by indirect losses in the economy associated with premature deaths of working-age individuals. In the structure of direct medical costs, inpatient care costs prevailed. These studies indicate the need to continue an advanced analysis of the economic burden of COPD, as well as to optimize the treatment and prevention of the exacerbations development of this disease.

The effect of influenza and pneumococcal vaccination in the elderly on health service utilisation and costs: a claims data-based cohort study

BackgroundTo date, cost-effectiveness of influenza and pneumococcal vaccinations was assumed in several health economic modelling studies, but confirmation by real-world data is sparse. The aim of this study is to assess the effects on health care utilisation and costs in the elderly using real-world data on both, outpatient and inpatient care.MethodsRetrospective community-based cohort study with 138,877 individuals aged ≥ 60 years, insured in a large health insurance fund in Thuringia (Germany). We assessed health care utilisation and costs due to influenza- or pneumococcal-associated diseases, respiratory infections, and sepsis in 2015 and 2016. Individuals were classified into four groups according to their vaccination status from 2008 to 2016 (none, both, or either only influenza or pneumococcal vaccination). Inverse probability weighting based on 236 pre-treatment covariates was used to adjust for potential indication and healthy vaccinee bias.ResultsInfluenza vaccination appeared as cost-saving in 2016, with lower disease-related health care costs of − €178.87 [95% CI − €240.03;− €117.17] per individual (2015: − €50.02 [95% CI − €115.48;€15.44]). Cost-savings mainly resulted from hospital inpatient care, whereas higher costs occurred for outpatient care. Overall cost savings of pneumococcal vaccination were not statistically significant in both years, but disease-related outpatient care costs were lower in pneumococci-vaccinated individuals in 2015 [− €9.43; 95% CI − €17.56;− €1.30] and 2016 [− €12.93; 95% CI − €25.37;− €0.48]. Although we used complex adjustment, residual bias cannot be completely ruled out.ConclusionInfluenza and pneumococcal vaccination in the elderly can be cost-saving in selective seasons and health care divisions. As cost effects vary, interpretation of findings is partly challenging.

Fractures in untreated patients with osteoporosis in Germany: an InGef healthcare insurance database analysis.

Osteoporosis is a skeletal disease that manifests as bone mineral density loss and low-trauma fractures. This database analysis describes the characteristics of untreated osteoporosis patients, and their rate of fractures, health resource utilization, and cost burden. From the InGef database (2011-2016), eligible patients (≥ 70 years) untreated for osteoporosis were identified via a recorded diagnosis of osteoporosis (ICD-10 codes M80/M81) or an initial fragility fracture (index point). All patients were followed up for fractures post index. Direct costs included inpatient, outpatient, pharmacy, and ancillary care costs. A total of 144,752 patients (mean age 79 years; 73% female, median follow-up of 3.2 years) met the eligibility criteria; 23% had a history of fractures. Forty-eight percent of patients had cardiac diseases, 32% diabetes, and 27% cerebrovascular disease. Thirty percent (43,514) of patients had at least one post-index fracture; two or more post-index fractures were experienced in 7% (10,262) of patients. Median time from index date to first fracture was 145.5 days. Bisphosphonates were the most prescribed osteoporosis treatment following a first fracture post-index (n = 4102, 9.2%). There was a total of 107,055 patients (74.0%) who had at least one all-cause hospital stay. The total number of fracture-related admissions was 63,595 and that of outpatient visits was 323,460. A total of 34,764 (24%) patients died during follow-up. Costs for fracture-related care for patients directly contributed to a cost burden of €786 million. Osteoporosis patients and patients who sustain a fragility fracture remain undertreated for osteoporosis, increasing their risk of future fractures. Diagnosing and treating this group of patients should remain a priority to alleviate the clinical and economic burden of osteoporosis-related fractures.