Cost Utility Research Articles

Health economic studies of antimicrobial stewardship programmes: A scoping review

Aims To conduct a scoping review of health economic evaluations of antimicrobial stewardship programmes (ASP). Our purpose was to summarise findings and to review different approaches taken. Methods We reviewed economic evaluation studies retrieved from a number of sources, assessing the costs and effects of ASP. We described and synthesised data from studies published between 2002 and 2023 that included measures of both costs and effects/benefit of interventions. Results Eight studies met the inclusion criteria. Six studies estimated cost-effectiveness, and two studies assessed cost utility. We found no cost-benefit studies. One of the studies was based on a randomised controlled trial. None of the studies took a broad perspective to include societal benefits that might arise from less resistant organisms on the environment contingent on reductions of prescriptions of broad-spectrum antibiotics. Conclusion Limited evidence on the cost-effectiveness of Antimicrobial Stewardship Interventions studies suggests that the implementation of strategies to reduce antimicrobial resistance is worth the investment. However, producing a summary measure of ASP interventions is limited not just by the paucity of studies, but also heterogeneity of intervention types, variation in the implementation contexts and different methodological approaches.

Cost-Utility Analysis of Trastuzumab-Emtansine Versus Trastuzumab for the Treatment of Residual Invasive HER-2-Positive Breast Cancer in Iran

Background: Breast cancer is one of the most common types of cancer in women, and its incidence is increasing in Iran. HER-2-positive breast cancer is invasive and often associated with poorer outcomes. Patients with this type of breast cancer can develop resistance to medications like trastuzumab. Trastuzumab-emtansine (TDM1) is a medication developed to reduce cancer cell resistance to trastuzumab. The TDM1 has been shown to decrease the incidence of death and recurrence in breast cancer. Objectives: This study aimed to evaluate the cost-utility and calculate the budget impact of TDM1 versus trastuzumab for the treatment of residual invasive HER-2-positive breast cancer. Methods: A Markov model with a lifetime horizon was developed, incorporating four health states. Women aged 45 with residual invasive HER-2-positive breast cancer entered the model. The study adopted a healthcare system perspective, with costs reported in 2021 US dollars. Discount rates of 7% for costs and 3% for utility values were applied. Utility values and transition probabilities were derived from published literature. Costs were estimated based on guidelines, expert opinions, and Iranian tariffs. Iran’s pharmacoeconomic threshold of 1085$ was used for comparison. The incremental cost-effectiveness ratio (ICER) and budget impact of TDM1 were calculated, and sensitivity analyses were conducted to assess the robustness of the model. Results: The model indicated that treatment with TDM1 resulted in a 1.59 quality-adjusted life year (QALY) increase, with an additional cost of 1408$. This was deemed cost-effective, considering Iran’s pharmacoeconomic threshold of 1085$ (calculated ICER: 886$ per QALY gained). One-way sensitivity analysis revealed that the model was sensitive to the costs of TDM1 and trastuzumab, the discount rates for utility values and costs, and the probability of achieving invasive disease-free survival (IDFS). Probabilistic sensitivity analysis showed that 59.61% of simulations fell below Iran’s pharmacoeconomic threshold, supporting the model's robustness. The budget impact analysis revealed that the additional budget required for TDM1 treatment over a three-year period was 1,120,546$ compared to trastuzumab. Conclusions: Although TDM1 imposes higher costs, it is more cost-effective than trastuzumab for the treatment of residual invasive HER-2-positive breast cancer in Iran.

Cost Utility of Various Biologic Versus Endoprosthetic Reconstruction for Primary Bone Sarcoma of the Knee

Background: Currently, the treatment of primary bone sarcoma has been developed to increase survival rate and enable patients to undergo limp sparing surgery. The cost-utility study of reconstructive surgery methods could also benefit developing treatment plans as well as national policies. Materials and Methods: The present research was conducted among 27 patients with primary bone sarcoma of the knee undergoing limp sparing surgery by analyzing the cost-utility of various biologic versus endoprosthesis reconstruction. The result reported in the quality-adjusted-life years (QALY), cost per year of well-being (Cost/QALY), ratio of additional sanitary years (QALY gain), and creating alternatives to adjust costs to an acceptable range with one-way sensitivity analysis. Results: The QALY of endoprosthesis was the highest at 5.316 years, while the lowest number was recycled bone autograft at 3.712 years. Compared with the Cost/QALY, the recycled bone autograft indicated the most breakeven method, while endoprosthesis showed the lowest. For analyzing by QALY gain, the additional investment totaled 171,314.27 THB. Conclusion: Prosthesis as a good option, have side effects and the highest number of QALY but did not breakeven. However, reducing the cost by 27.004% was almost the same as the most breakeven method. For this method, an additional investment, equivalent to the minimum wage in Thai law averaging within 1 year, was not needed because this extra investment cost only about the minimum Thai civil servant salary for 1 year. Keywords: Primary bone sarcoma of the knee; Bone reconstruction around the knee; Cost-utility analysis; Various biologic versus endoprosthesis reconstruction

Effects of turmeric addition to broiler starter on growth performance, nutrient digestibility, and production economics

The research aimed to assess how feeding broiler chicks’ diets supplemented with turmeric meal affected their growth performance, nutrient digestibility, and production economics. A four-week feeding trial was conducted with 120 unsexed day-old Arbor Acres Plus broiler chicks, which were randomly assigned to four dietary groups, each containing three replicates of ten chicks. The dietary treatments included T1 (control), T2, T3, T4, and T5, with turmeric inclusion levels of 0%, 0.25%, 0.50%, 0.75%, and 1.0%, respectively. Data were gathered on growth performance, nutrient utilization, and production costs. Significant differences (p<0.05) were noted in average daily feed intake (ADFI), ranging from 37.64 to 52.22 g, and feed conversion ratio (FCR), varying from 1.98 to 2.61. However, dietary turmeric did not significantly impact nutrient utilization across the groups. The cost of feed per kilogram increased with higher inclusion levels, while T5 demonstrated the lowest feed cost per chick, as well as for feed cost per weight gain and total production cost. The study concluded that incorporating turmeric up to 1.0% in broiler diets significantly enhanced feed efficiency without adversely affecting nutrient utilization. Thus, using turmeric at this level is a beneficial strategy for optimizing production costs related to feed expenditure per weight gain.

Medical costs of treating myasthenia gravis in patients who need intravenous immunoglobulin (IVIg) – a register-based study

BackgroundSeveral innovative treatments are expected for myasthenia gravis (MG) in the coming years. Healthcare payers usually require cost-effectiveness analyses before reimbursement. We aimed to investigate resource utilization and direct medical costs for patients with MG treated with intravenous immunoglobulin (IVIg) to inform such analyses.MethodsWe identified patients with MG in the Norwegian Patient Registry based on at least two hospital encounters with an MG diagnosis (ICD-10 G70.0) from 1 Jan 2010 to 31 Dec 2021. IVIg treatment was identified by medical procedure and Anatomical Therapeutic Chemical (ATC) codes (RPGM05 and J06BA02). Using Diagnosis-Related Group (DRG) cost weights, we estimated direct medical costs for each year following the first MG diagnosis.ResultsOver the study period, 1083 patients were diagnosed with MG in Norway, of whom 155 (14.3%) were treated with IVIg. No significant differences in age or sex were observed between IVIg and non-IVIg patients. Compared with non-IVIg patients, IVIg-patients had 2.3 times higher direct medical costs during the first year after MG diagnosis (EUR 35,714 vs. EUR 15,457) and 3.1 times higher costs during the second year (EUR 19,119 vs. EUR 6256). In the fifth year after diagnosis, IVIg-patients still had higher costs and resource utilization than non-IVIg patients (EUR 9953 vs. EUR 5634).ConclusionIVIg treatment represents an important marker for high direct medical costs among patients with MG. The costs continue to be high during the first five years after MG diagnosis.

A Pharmacoeconomic Study of Post-Exposure Prophylaxis Strategies for Influenza Virus Infections in Japan.

Vaccines can prevent influenza (flu) infections and are cost-effective for society and healthcare. However, the cost-effectiveness of post-exposure prophylaxis as a follow-up strategy is unclear. This study aims to evaluate the cost utility of post-exposure prophylaxis and treatment strategies with neuraminidase inhibitors and a cap-dependent endonuclease inhibitor for flu infections from the perspective of healthcare costs in Japan. A base-case analysis was used to compare oseltamivir, zanamivir, and laninamivir for neuraminidase inhibitors and baloxavir marboxil for the endonuclease inhibitor. The costs of the first visit to a physician and pharmacy were excluded because of the policy on out-of-pocket expenses for post-exposure prophylaxis in Japan. Direct medical costs include the second physician visit, pharmacy and hospital admission expenses, and drug prices, based on the 2020 Japanese Medical Fee Index. The EuroQol-5Dimention-5Level was utilized to measure healthy participants' quality of life scores, with a time horizon of 14days. Deterministic and probabilistic sensitivity analyses were conducted. We have found baloxavir marboxil as the post-exposure prophylaxis agent and laninamivir as the treatment agent to be the most cost-effective strategy in Japan, followed by oseltamivir as the post-exposure prophylaxis agent and zanamivir as the treatment agent. Baloxavir marboxil and oseltamivir are cost-effective prophylactic agents for flu from the perspective of healthcare costs in Japan. This strategy to select baloxavir marboxil or oseltamivir would be helpful to manage a formulary for post-exposure prophylaxis in Japan.

Cost-effectiveness of human papillomavirus (HPV) vaccination in Tunisia: a modelling study

ObjectivesThe objective of this study is to assess the cost utility of the implementation of the human papillomavirus (HPV) vaccination programme in Tunisia in addition to the current cytology screening...

Healthcare resource utilization and related cost of non-HIV comorbidity management in people with HIV in a Spanish cohort from 2007-2016

Objective To estimate the cost and healthcare resource utilization (HRU) associated with the prevalence of comorbidities in people living with HIV (PLWH) in a Spanish cohort over ten years. Methods: Cohort study carried out at the HIV outpatient clinic of the University Hospital Virgen del Rocío based on data collected during 2007-2016. PLWH with at least one follow-up visit were included. Comorbidities were determined by examining diagnostic codes in the electronic medical records. Costs were estimated from hospitalizations, emergency and non-HIV visits, laboratory tests for conditions unrelated to HIV infection, HIV antiretroviral therapy, and other non-HIV diagnostic tests. A linear regression was performed with non-ART costs as the dependent variable and patient characteristics (sex, HIV transmission route, age, CD4, comorbidities, and infection duration) as independent variables. Results: The study included 2,798 PLWH; 83% were men with a mean age of 38.6 years. Overall, 52.5% of PLWH had at least one non-HIV comorbidity and 21.2% had ≥3 comorbidities. The most prevalent comorbidities were hepatitis C (25.3%) and hypertension (22.9%). The presence of comorbidities increased the total healthcare cost up to 80% in PLWH with ≥3 comorbidities compared with those without comorbidities (over a 10-year period (115,867.3€vs 64,290.7€, p < 0.001). The number of comorbidities was linked to higher healthcare costs in PLWH in the adjusted model. Conclusion: Comorbidities raised the total healthcare costs for PLWH, with a greater impact on those with multiple comorbidities compared to those with few or none. Both clinical and economic decision-makers must consider and assess the cost of comorbidities when evaluating HIV treatment guidelines or recommendations.

Health care costs and service utilization in the first year following moderate to severe traumatic injury.

Most of the previous studies on costs following trauma have focused solely on in-hospital costs and costs associated with the acute treatment and early rehabilitation. As a result, post-hospital costs are often neglected in the estimation of total costs. We aimed to describe service utilization and total costs for health care services, rehabilitation services, and social support in the periods 0-6 months and 7-12 months after moderate-to-severe traumatic injury. Further, we explored costs and their associations with sociodemographic, clinical and injury-related variables. Data were obtained from a prospective, 12 months follow-up study of patients in all ages with moderate-to-severe traumatic injury determined by a New Injury Severity Score (NISS) > 9, admitted directly or within 72h to the trauma referral centres in year 2020. Data on utilization of health care and rehabilitation services from the Norwegian Patient Register (NPR), the Municipal patient and user register (KPR), and the Norwegian Control and Payment of Health Reimbursements Database (KUHR) were used. A total of 601 patients were included, 24% with moderate and 76% with severe injuries. The overall mean total health care cost per patient in the first year after traumatic injury was 846,877 (SD 1,042,649) Norwegian Kroner (NOK). The mean total cost of rehabilitation per patient was 251,487 (SD 317,050) NOK. Most costs were attributable to secondary care in the first six months post-injury. Severely injured patients had a higher health care utilization and average cost compared to those with moderate injury. Injury severity factors were the most prominent cost drivers, and number of injuries, severe head, spine, and extremity injuries were significantly associated with higher costs during the first year following trauma. The findings give a holistic insight into health care utilization and costs for patients across all ages with complex needs following trauma and can contribute to the planning and provision of services for this patient group.

A Hardware-Efficient Novelty-Aware Spike Sorting Approach for Brain-Implantable Microsystems.

Unsupervised spike sorting, a vital processing step in real-time brain-implantable microsystems, is faced with the prominent challenge of managing nonstationarity in neural signals. In long-term recordings, spike waveforms gradually change and new source neurons are likely to become activated. Adaptive spike sorters combined with on-implant training units effectively process the nonstationary signals at the cost of high hardware resource utilization. On the other hand, static approaches, while being hardware-friendly, are subjected to decreased processing performance in such recordings where the neural signal characteristics gradually change. To strike a balance between the hardware cost and processing performance, this study proposes a hardware-efficient novelty-aware spike sorting approach that is capable of dealing with both variated spike waveforms and spike waveforms generated from new source neurons. Its improved hardware efficiency compared to adaptive ones and capability of dealing with nonstationary signals make it attractive for implantable applications. The proposed novelty-aware spike sorting especially would be a good fit for brain-computer interfaces where long-term, real-time interaction with the brain is required, and the available on-implant hardware resources are limited. Our unsupervised spike sorting benefits from a novelty detection process to deal with neural signal variations. It tracks the spike features so that in case of detecting an unexpected change (novelty detection) both on and off-implant parameters are updated to preserve the performance in new state. To make the proposed approach agile enough to be suitable for brain implants, the on-implant computations are reduced while the computational burden is realized off-implant. The performance of our proposed approach is evaluated using both synthetic and real datasets. The results demonstrate that, in the mean, it is capable of detecting 94.31% of novel spikes (wave-drifted or emerged spikes) with a classification accuracy (CA) of 96.31%. Moreover, an FPGA prototype of the on-implant circuit is implemented and tested. It is shown that in comparison to the OSORT algorithm, a pivotal spike sorting method, our spike sorting provides a higher CA at significantly lower hardware resources. The proposed circuit is also implemented in a 180-nm standard CMOS process, achieving a power consumption of 1.78[Formula: see text][Formula: see text] per channel and a chip area of 0.07[Formula: see text]mm2 per channel.

Decentralized peer-to-peer energy trading in microgrids: Leveraging blockchain technology and smart contracts

Microgrids are regarded as vital components in contemporary realm of energy system improvement, resilience, and sustainability. In this paper a novel decentralized peer-to-peer energy trading system leveraging blockchain technology is proposed. The proposed model not only demonstrates the implementation of blockchain technology in microgrids but also transforms the energy sector by emphasizing decentralization, security and efficiency. This research aims to enhance the energy trading system by including smart contracts written on the Ethereum network. Energy Token and Demand Response contracts are integrated to enable dynamic interactions inside microgrids, which leads to a transparent, secure, and efficient energy trading system. Moreover, automation of energy transactions and elimination of intermediaries ensure cost effectiveness and utilization of excess energy potentially reduce dependency on the main grid. A microgrid system is designed in Simulink for distributed energy trading. Energy credits are represented by standard ERC-20 digital token and then demand response contract dynamically adjusts rewards and energy prices based on energy production and consumption. the ERC-20 contract manages the token transaction and then demand response contract enforces governance rules. The purpose of a demand response contract is to enable the automatic and efficient control of energy usage in response to changing demand and supply conditions. The use of the Web3 library further facilitates a direct and smooth connection between the blockchain network and microgrids. The results demonstrate the successful implementation of both smart contracts, making trading possible at noon when the combined generation from solar array and energy management system exceed the energy demand.

Clinical burden, treatment, and disease control in patients with chronic spontaneous urticaria: Real-world evidence.

Chronic spontaneous urticaria (CSU) is an unpredictable inflammatory skin condition with substantial clinical burden that affects 0.23-0.78% of the United States population. To describe the incidence and prevalence of patients with a record of CSU diagnosis, treatment patterns, disease control, and clinical and economic burden in a United States (US) cohort of patients with CSU. Adults with a record of CSU diagnosis within the US HealthVerity claims database were eligible. Age- and sex-adjusted prevalence/incidence rates were calculated for January 2017 to December 2022. Clinical characteristics were described during the 1 year prior to CSU diagnosis (baseline) and the time after (follow-up). Proxy events representing uncontrolled CSU (any record of prescriptions for corticosteroids, biologics, or immunosuppressants [excluding all antihistamines and over-the-counter medication] or any CSU-related inpatient admissions or emergency room or urgent care visits) were used to identify patients with uncontrolled CSU. Health care resource utilization (HCRU) and health care costs were described. Overall, 200,298 patients were followed-up for a median of 2.3 years after diagnosis. Estimated cumulative prevalence of diagnosed CSU was 0.57% (women: 0.80%; men: 0.32%). The average annual incidence rate was 0.08%. Corticosteroids were the most prescribed treatment during follow-up among the 166,195 patients prescribed ≥1 treatment (94.3%). Proxy events were observed in 59.1% of patients. HCRU and health care costs increased from baseline in patients with uncontrolled CSU during follow-up. Of patients with CSU who were prescribed treatment, >50% experienced uncontrolled CSU, which was associated with increased HCRU and health care costs.

Research on the optimal configuration method of shared energy storage basing on cooperative game in wind farms

Aiming at the problems of low energy storage utilization and high investment cost that exist in the separate configuration of energy storage in power-side wind farms, a capacity optimization method based on cooperative game for wind farm-side shared energy storage power plant is proposed. Firstly, the wind power output scenarios on different typical days are clustered using the Latin hypercubic sampling method and the k-means method; then, the capacity optimization model of the shared energy storage plant is established with the objective of minimizing the total cost of constructing the shared energy storage plant in wind farms; secondly, the cooperative allocation strategy based on the Shapley value is designed to allocate the total cost of investing in and constructing the shared energy storage system; finally, it is demonstrated through examples that the method proposed in this paper effectively reduces the cost of the total investment in the energy storage system for new energy power plants, reduces the cost of wind abandonment penalties for new energy power plants, improves the output effect of new energy power plants, and increases the utilization rate of the shared energy storage power plant.

Impact of a health literacy sensitive model of care in outpatient nephrology dietetic clinics.

Inadequate health literacy in people with chronic kidney disease is associated with poorer disease management and greater complications. Adherence to the renal diet is known to be suboptimal and patient feedback about the renal diet suggests that patients leave nephrology clinics feeling confused. The present study aimed to evaluate the impact of a health literacy sensitive model of care (MOC) in outpatient nephrology dietetic clinics. This quasi-experimental non-randomised pre-post study recruited adults attending three renal dietitian clinics. The revised MOC consisted of a renal diet question prompt sheet, teachback, and plain language materials and instructions. Outcomes assessed included clinical, dietary, patient-reported satisfaction and quality of life. Differences between and within groups were analysed using paired t-tests, independent sample t-tests (or non-parametric equivalent), chi-squared and McNemar's tests. Linear mixed models evaluated change in total diet quality score, fruit, vegetable, protein and dairy intake with time as a fixed effect and a random subject specific effect. Fail to attend rates at the initial appointments were lower in the revised MOC (21.5% vs. 9.1%). The revised MOC was associated with significantly improved fruit (p = 0.03) and vegetable (p = 0.003) intake and an improved proportion with adequate diet quality (p = 0.03). These impacts were of moderate effect size (d = 0.5, 95% confidence interval = 0.0-1.0). The revised MOC was also associated with greater satisfaction at baseline (p = 0.04) and higher acceptability scores for all questions at the review appointments. Quality of life improved clinically but not significantly in the revised MOC (p = 0.92). This low-cost health literacy sensitive intervention is a promising strategy to improve fruit and vegetable intake in adults attending renal dietitian clinics. Further research to determine fidelity of teachback use and cost utility analysis would be beneficial. Larger scale trials powered to detect changes in quality of life would also be informative.

Blockchain-backed resilient strategies in a stochastic supply chain sourcing and distribution environment under disruption: implications for B2B sector

Purpose With the changing landscape of the globalised business world, business-to-business supply chains face a turbulent ocean of disruptions. Such is the effect that supply chains are disrupted to the point of failure, supply is halted and its adverse effect is seen on the consumer. While previous literature has extensively studied risk and resilience through mathematical modelling, this study aims to envision a novel supply chain model that integrates blockchain to support visibility and recovery resilience strategies. Design/methodology/approach The stochastic bi-objective (cost and shortage utility) optimisation-based mixed-integer linear programming model integrates blockchain through a binary variable, which activates at a particular threshold risk-averse level of the decision-maker. Findings Firstly, visibility is improved, as identified by the average reduction of penalties by 36% over the different scenarios. Secondly, the average sum of shortages over different scenarios is consequently reduced by 36% as the recovery of primary suppliers improves. Thirdly, the feeling of shortage unfairness between distributors is significantly reduced by applying blockchain. Fourthly, unreliable direct suppliers resume their supply due to the availability of timely information through blockchain. Lastly, reliance on backup suppliers is reduced as direct suppliers recover conveniently. Research limitations/implications The findings indicate that blockchain can enhance visibility and recovery even under high-impact disruption conditions. Furthermore, the study introduces a unique metric for measuring visibility, i.e. penalty costs (lower penalty costs indicate higher visibility and vice versa). The study also improves upon shortages and recoveries reported in prior literature by 6%. Finally, blockchain application caters to the literature on shortage unfairness by significantly reducing the feeling of shortage unfairness among distributors. Practical implications This study establishes blockchain as a pro-resilience technology. It advocates that organisations focus on investing in blockchain to enhance their visibility and recovery, as it effectively reduces absolute shortages and feelings of shortage unfairness while improving recovery and visibility. Originality/value To the best of the authors’ knowledge, this is a unique supply chain model study that integrates a technology such as blockchain directly as a binary variable in the model constraint equations while also focusing on resilience strategies, costs, risk aversion and shortage unfairness.

Energy Aware Optimal Virtual Machine Scheduling in Cloud Environment Using Hybridized Egret Swarm with Sea Lion Optimization Algorithm

With emergence of advanced technologies, the internet plays as the essential role to share the information across the world. With emergence of large number of users, the data quality gets affected thus; it leads to cause burden in scheduling where it provides fewer services to the users. Due to this existence, the cloud computing technology emerges to offer better services. Certainly, the optimal scheduling process of a Virtual Machine (VM) becomes challenging in the larger size of data in cloud environments. Modern systems and data centers place a high priority on energy consumption. Thus, it provides poor performance regarding energy usage and throughput analysis marked in the traditional techniques. In order to consider aforementioned issues, a novel VM scheduling mechanism is introduced for allocating and managing resources in cloud. The major scope of this developed VM scheduling process tends to minimize energy consumption. The developed Hybrid Egret Swarm-based Sea Lion Optimization (HES-SLO) algorithm is implemented to allocate resources based on several objective functions like execution time, energy or power consumption, cost, and resource utilization. Thus, the overall performance analysis takes place, where the developed VM scheduling model is compared with the traditional VM allocation mechanisms to verify the efficacy. In this validation, the HES-SLO attains 21.16%, 4.903%, 0.17%, and 7.86% for energy consumption, resource utilization, execution time, and throughput analysis. Based on the entire validation, it shows greater performance by compared with existing approaches.

Healthcare utilization and costs following molecular diagnostic testing among patients with vaginitis.

Aim: Vaginitis and other vaginal discharge syndromes lead to high healthcare utilization. Molecular tests like syndromic multiplex real-time (RT) polymerase chain reaction (PCR)-based tests are highly sensitive and specific at diagnosing the infectious causes of vaginitis. This study compared the healthcare resource utilization (HCRU) and direct all-cause healthcare costs among patients with vaginitis in the US receiving next-day syndromic multiplex RT-PCR tests with those receiving other PCR tests or no diagnostic test of interest. Patients & methods: This retrospective study utilized claims data from IQVIA PharMetrics® Plus database to identify adult patients with a diagnosis for vaginitis (first claim=index) from January 2021 to April 2023, with 6months of continuous enrollment prior to (baseline) and after index (follow-up). Pairwise comparisons were conducted between RT-PCR and 1:1 propensity matched Other PCR and No Test subcohorts for all-cause HCRU and costs during follow-up. Results: Each of the RT-PCR, Other PCR and No Test subcohorts included 1946 matched patients. Mean(SD) follow-up total cost was significantly lower for the RT-PCR than the No Test subcohort ($5607[$15,122] vs $6680[$20,751], p=0.0023). Mean(SD) overall outpatient and other medical service costs were lower for RT-PCR versus Other PCR (outpatient: $2964[$9666] vs $3174[$7113], p=0.0110; other medical: $1961[$9244] vs $2099[$6475], p=0.0002) and No Test subcohorts (outpatient: $2964 [$9666] vs $4067[$12,341], p<0.0001; other medical: $1961[$9244] vs $2973[$11,685]; p<0.0001). A lower proportion had any outpatient service HCRU in RT-PCR versus Other PCR subcohort (92.6% vs 94.2%, p=0.0349). A lower proportion had any other medical service claim in RT-PCR versus Other PCR (78.3% vs 83.2%, p<0.0001) and No Test subcohorts (78.3% vs 83.0%, p=0.0001). Physician office, emergency room (ER), prescription use and costs were similar between the subcohorts. Conclusion: The use of syndromic multiplex RT-PCR diagnostics with next day test results in patients with vaginitis was associated with lower outpatient costs and total healthcare costs than those in the no test cohort over 6months. These findings indicate that use of syndromic multiplex RT-PCR diagnostics may contribute to improved patient management compared with clinical diagnosis alone.

Hospitalization due to pneumococcal disease in the Unified Health System in Brazil: A retrospective analysis of administrative data

IntroductionCommunity-Acquired Pneumonia (CAP) caused by pneumococcus and Invasive Pneumococcal Disease (IPD) pose a substantial economic burden on health systems. The objective of the present study is to explore hospitalization costs of pneumococcal disease in the public health system in Brazil, the Unified Health System. MethodsRetrospective analysis of administrative data on hospitalized cases of pneumococcal disease from January 2019 to July 2023. Hospitalization cases recorded with ICD-10 codes of CAP due to S. pneumoniae and IPD were retrieved from DATASUS, the inpatient information system of the Unified Health System in Brazil. Costs were converted to US dollars by Using Purchasing Power Parity (USD-PPP). Absolute number of hospitalizations, costs of hospitalizations and healthcare resource utilization were presented descriptively. The annual cost estimate was calculated. Differences in costs by type of clinical presentation and age group were assessed. Factors associated with higher costs were explored by multiple linear regression models. ResultsA total of 22,498 hospitalization episodes were analyzed. Total cost of hospitalizations was USD-PPP 13,958,959 (BRL 34,659,578) with an annual mean estimate of USD-PPP 3,045,591 (BRL 7,562,090). Cost per hospitalization episode was significantly higher for meningitis, followed by septicemia, CAP and arthritis, with median values ranging from USD-PPP 190.93 to 615.14 (BRL 476.20 to 1529.02). (Kruskal-Wallis χ2 = 6473, df = 3, p-value < 0.0001). Costs were significantly higher among individuals aged 60-years and older. (Kruskal-Wallis test; χ2 = 773.53; df = 2, p-value < 0.0001). There were differences in age at hospitalization, length of stay, and ICU utilization among types of clinical presentations. ConclusionsOur findings reveal the economic burden associated with pneumococcal disease in the Unified Health System in Brazil. Hospitalization costs were higher for cases of meningitis and among individuals aged 60-years and above.

Healthcare utilisation of 282,080 individuals with long COVID over two years: a multiple matched control, longitudinal cohort analysis.

To investigate healthcare utilisation and cost in individuals with long COVID (LC) at population level. Case-control cohort analysis with multiple age-, sex-, ethnicity-, deprivation-, region- and comorbidity-matched control groups: (1) COVID only, no LC; (2) pre-pandemic; (3) contemporary non-COVID; and (4) pre-LC (self-controlled, pre-COVID pandemic). National, population-based, linked UK electronic health records (British Heart Foundation/NHS England Secure Data Environment). Adults aged ≥18 years with LC between January 2020 and January 2023. Healthcare utilisation (number of consultations/visits per person: primary care (general practitioner [GP]), secondary care (outpatient [OP], inpatient [IP] and emergency department [ED], investigations and procedures) and inflation-adjusted cost (£) for LC and control populations per month, calendar year and pandemic year for each category. A total of 282,080 individuals with LC were included between January 2020 and January 2023. The control groups were COVID only, no LC (n = 1,112,370), pre-pandemic (n = 1,031,285), contemporary non-COVID (n = 1,118,360) and pre-LC (n = 282,080). Healthcare utilisation per person (per month/year) was higher in LC than controls across GP, OP and ED. For IP, LC had higher healthcare utilisation than pre-LC and contemporary non-COVID (all p < 0.0001). Healthcare utilisation of the LC group increased progressively between 2020 and 2023, compared with controls. Median cost per patient/year was also higher in individuals with LC than all control groups. LC has been associated with substantial, persistent healthcare utilisation and cost over the last three years. Future funding, resources and staff for LC prevention, treatment and research must be prioritised to reduce sustained primary and secondary healthcare utilisation and costs.

The impact of caregiver and intended mode of birth on the public cost of care: Cost analysis of maternity and neonatal care in New Zealand

ProblemWomen who receive midwifery continuity-of-care require fewer interventions, generating significant cost savings for health services. Existing cost models were based on studies including low-risk pregnancies, limiting generalisability. BackgroundNew Zealand (NZ) is the only high-income country with a fully integrated midwifery continuity of care model facilitating study of real-world costs by model of care. AimTo compare healthcare utilisation and pregnancy-related public healthcare cost for private obstetricians and other community maternity caregivers (GPs, midwives), and planned caesarean compared to intended vaginal birth, within the NZ continuity-of-care maternity system. MethodsPopulation-based cohort study including singleton pregnancies under private obstetrician and community maternity care with live birth January 2016 - June 2020. Administrative data were used to identify healthcare utilisation and associated cost for mothers and their infant(s) until 1 year post birth, using generalised linear model techniques. Findings248,424 singleton pregnancies were included. Adjusted mean costs were significantly higher for private obstetricians than community maternity caregivers (mostly midwives) ($1,096, 95 % CI $813 – 1,378). Elective caesarean section was more costly than intended vaginal birth ($4,316, 95 % CI $4,105 – 4,527). Within each intended mode of birth, pregnancies cared for by private obstetricians were more costly than community maternity caregivers. DiscussionConsistent with existing literature, continuity of care by independently practicing midwives was less costly in NZ after adjustment for demographic and clinical differences. ConclusionsFunding structures and population pregnancy risk profile are important considerations in the implementation of midwifery-led continuity of care models. Statement of significanceProblem: Health systems seek to improve maternity care and contain healthcare budgets.What is already known: Women cared for by continuity-of-care midwives experience lower rates of preterm birth, obstetric intervention, and improved satisfaction compared to other models of care. It has been reported as cost-effective in a clinical trial setting among low-risk women.What this paper adds: This study uses real-world data from New Zealand, the only country with fully integrated midwifery continuity-of-care, to establish that midwifery care is cost-saving for public healthcare systems compared to maternity care provided by private obstetricians, when adjusted for obstetric risk factors.