Medical Costs Research Articles

Health, economic and social burden of tobacco in Latin America and the expected gains of fully implementing taxes, plain packaging, advertising bans and smoke-free environments control measures: a modelling study

ObjectiveTo investigate the tobacco-attributable burden on disease, medical costs, productivity losses and informal caregiving; and to estimate the health and economic gains that can be achieved if the main tobacco...

Cost of Pegfilgrastim for the Prophylaxis of Chemotherapy-induced Febrile Neutropenia in Patients with Breast Cancer Receiving Perioperative Chemotherapy in Daily Practice in Japan: A Posthoc Analysis in a Single-center Retrospective Study.

This study aimed to estimate the medical costs associated with febrile neutropenia (FN) prophylaxis with pegfilgrastim and evaluate its impact on survival outcomes in daily practice in Japan. In this single-center retrospective study, we obtained data from 296 Japanese patients with breast cancer receiving fluorouracil, epirubicin, and cyclophosphamide (FEC)-100 chemotherapy; the patients were divided into the pegfilgrastim and non-pegfilgrastim groups. We analyzed the median costs of chemotherapy, drugs for all adverse events (AEs) and FN, and hospitalization due to FN. We also assessed the survival outcomes. The pegfilgrastim group showed a significantly higher median total cost (JPY 872320.0 vs. JPY 466715.0, p<0.001). This difference was associated with the prophylactic use of pegfilgrastim. The median costs of the drugs for all AE treatments were JPY 9030.4 and JPY 24690.6, with the non-pegfilgrastim group showing a significantly higher cost (p<0.001). In 11 patients hospitalized for FN management, no significant difference in hospitalization cost was observed between the pegfilgrastim and non-pegfilgrastim groups (JPY 512390.0 vs. JPY 307555.0, p=0.102). No significant difference in the 3-year overall survival was observed between the pegfilgrastim and non-pegfilgrastim groups (79.9% vs. 88.3%, p=0.672). In this study, although the total medical cost in daily practice increased because of primary prophylaxis with pegfilgrastim, the 3-year overall survival was not impacted by the use of pegfilgrastim. Our study data suggested that the primary prophylaxis pegfilgrastim should be used during FEC-100 chemotherapy based on the patient-related FN risk factors, instead of routine use.

Ergonomic Risk Assessment and Mitigation Strategies for Retail Workers: Insights from a Case Study in Dungun

Manual handling activities contribute to 40% of musculoskeletal disorders (MSDs), leading to long-term discomfort, disability, medical costs, and financial hardships for workers, while employers face lower productivity and compensation costs. An ergonomic assessment was conducted among employees at ABC Hardware in Dungun to identify ergonomic risk factors, determine the likelihood of harm affecting workers' musculoskeletal health, and recommend control measures to improve workers' health and well-being. Utilizing a combination of interviews, observations, and questionnaires based on established ergonomics guidelines, the research highlights the prevalence of MSDs among workers engaged in manual handling tasks, emphasizing the need for ergonomic interventions and awareness to enhance workplace safety and employee well-being. Findings from the ergonomic assessment revealed significant discomfort and risk factors related to awkward postures, repetitive motions, forceful exertion, and static positions. Specific ergonomic issues identified include discomfort in the upper back, thighs, and knees among storekeepers, and neck and lower back pain among warehouse workers. Service desk representatives were found to experience discomfort related to static postures and repetitive motions. The study recommends advanced ergonomic assessments such as Rapid Entire Body Assessment (REBA), Occupational Repetitive Assessment (OCRA), and Rapid Upper Limb Assessment (RULA), along with improvements in ergonomic practices and tools. Implementing job rotation, providing ergonomic equipment, and conducting training on proper lifting techniques are essential to address the identified risks. This research highlights the critical role of ergonomic practices in preventing MSDs and improving overall workplace safety.

Economic Evaluation of Fasting Mimicking Diet vs Standard Care in Diabetic Patients on Dual or Triple Medications at Baseline in the United States: A Cost-Utility Analysis

ObjectivesAccording to most guidelines, dietary interventions are essential in the management of diabetes. Fasting has emerged as potential therapeutic regimes for diabetes. The proof-of-concept study and the fasting in diabetes treatment trial are the first to explore the clinical impact of the Fasting Mimicking Diet (FMD) in patients with type 2 diabetes mellitus. Their results showed that FMD cycles improve glycemic management and can be integrated into usual care complementary to current guidelines. This economic evaluation aims to assess the 10-year quality-of-life effects, cost implications, and cost-effectiveness of adding a 3-year FMD program to diabetes standard care in diabetic population on dual or triple medications at baseline from the perspective of the US payer. MethodsWe constructed a microsimulation model in TreeAge using a published US-specific diabetes model. The model was populated using FMD effectiveness outcomes and publicly available clinical and economic data associated with diabetes complications, use of diabetes medications, hypoglycemia incidence, direct medical costs in 2021 USD, quality of life, and mortality. All benefits were discounted by 3%. ResultsThis cost-utility analysis showed that the FMD program was associated with 11.4% less diabetes complications, 67.2% less overall diabetes medication use, and 45.0% less hypoglycemia events over the 10-year simulation period. The program generated an additional effectiveness benefit of 0.211 quality-adjusted life year and net monetary benefit of 41 613 USD per simulated patient. Thus, the FMD program is cost saving. ConclusionsThese results indicate that the FMD program is a beneficial first-line strategy in T2DM management.

The Clinical Characteristics, Treatment and Prognosis of Tuberculosis-Associated Chronic Obstructive Pulmonary Disease: A Protocol for a Multicenter Prospective Cohort Study in China.

Tuberculosis and chronic obstructive pulmonary disease (COPD) are significant public health challenges, with pulmonary tuberculosis recognized as a pivotal risk factor for the development of COPD. Tuberculosis-associated COPD is increasingly recognized as a distinct phenotype of COPD that potentially exhibits unique clinical features. A thorough understanding of the precise definition, clinical manifestations, prognosis, and most effective pharmacological strategies for tuberculosis-associated COPD warrants further investigation. This prospective, observational cohort study aims to enroll over 135 patients with tuberculosis-associated COPD and 405 patients with non-tuberculosis-associated COPD, across seven tertiary hospitals in mainland China. The diagnosis of tuberculosis-associated COPD will be established based on the following criteria: (1) history of pulmonary tuberculosis with standard antituberculosis treatment; (2) suspected pulmonary tuberculosis with radiological evidence indicative of tuberculosis sequelae; (3) no definitive history of pulmonary tuberculosis but with positive interferon-gamma release assay results and radiological signs suggestive of tuberculosis. At baseline, demographic information, medical history, respiratory questionnaires, complete blood count, interferon-gamma release assays, medications, spirometry, and chest computed tomography (CT) scans will be recorded. Participants will be followed for one year, with evaluations at six-month intervals to track the longitudinal changes in symptoms, treatment, lung function, and frequencies of COPD exacerbations and hospitalizations. At the final outpatient visit, additional assessments will include chest CT scans and total medical costs incurred. The findings of this study are expected to delineate the specific characteristics of tuberculosis-associated COPD and may propose potential treatment options for this particular phenotype, potentially leading to improved clinical management and patient outcomes.

Does environmental regulation matter for healthcare utilisation in China? An interrupted time series study.

In recent years, China has implemented a series of environmental regulation policies to improve air quality, but the health effects of these policy changes need to be accurately clarified and quantified. The objective of this study was to empirically examine the effects of levying construction dust pollution fees on healthcare utilisation in a southern city of China. The study used a unique administrative insurance claim dataset from the city's Urban Employee Basic Medical Insurance scheme between 2013 and 2015. The sample included 69,961 enrolees. An interrupted time series design was employed to investigate whether and how the healthcare utilisation of enrolees changed after the policy change. The results showed that this environmental regulation policy did not affect the inpatient utilisation of enrolees but did negatively impact outpatient utilisation. In addition, outpatient utilisation of chronic disease coverage decreased for patients with chronic diseases, including diabetes and hypertension. This study provides evidence that enhancing environmental regulations helps reduce medical costs, which can benefit China and other developing countries to improve environmental quality and promote public health.

Urinary incontinence due to pregnancy – the impact of hormones and biofeedback therapy

Abstract In this article, attention is drawn to the serious problem of the occurrence of urinary incontinence because of pregnancy. The condition is problematic mainly in the elderly, as well because of the first and each subsequent pregnancy. Urinary incontinence can be a reason for social and professional exclusion, psychological problems and rising medical costs worldwide. Pregnancy as a complex process is a major factor in the occurrence of urinary incontinence in women at a younger age, consisting of hormones and all the procedures associated with childbirth. The physiotherapist has many tools that clearly affect how quickly the patient will recover, and one of them is biofeedback therapy. The process of treating incontinence needs further research and improved guidelines, as the condition is one of the most common complications of pregnancy, with a high risk of recurrence.

Economic Evaluation of Cervical Cancer Screening by HPV DNA, VIA, and Pap smear Methods in Indonesia.

Cervical cancer occurs 80% in developing country including Indonesia and take place in the first rank of incidence rate and third rank in mortality rate in Asian Pacific. Natural history of cervical cancer gives a potential to get accurate screening method. Cervical cancer screening m in Indonesia use VIA and Pap smear method for women in age range 30 to 50 years old. Recently, HPV DNA test has been recommended in international and national policy as primary screening method for cervical cancer. This research aims to asses cost-effectiveness and economic implications of specific cervical cancer screening modalities. Cost-effectiveness analysis was conducted from societal perspective. Cost data was collected from four hospitals in Indonesia. Direct medical costs were derived from discussions with an expert panel and hospital billing data, aligning with current practice guidelines. Direct and indirect non-medical costs were estimated from patient interviews. Effectiveness data for the screening methods were extracted from a systematic review of existing literature. Markov model design was used for cost-effectiveness analysis. Budget impact analysis used healthcare perspective method from its billing for cervical cancer patients. Cervical cancer screening costs are calculated using direct medical, non-medical, and indirect expenses. Regarding to cost-effective analysis by incremental cost-effective ratio (ICER), pap smear for every 3 and 5 years is more cost-effective than VIA. HPV DNA also has the potential to be cost-effective. The budget impact analysis investigates scenarios, with a focus on negotiation-based cost reductions for HPV DNA testing. Controlling HPV DNA tariffs at USD 8.76 proves cost-effective. In conclusion, pap smear is the most cost-effective modality, while HPV DNA has the potential to be cost-effective by reducing the unit cost. Despite favorable outcomes, challenges in implementation suggest a phased approach for resource equalization before full deployment.

Automated Classification System Based on YOLO Architecture for Body Condition Score in Dairy Cows.

Body condition score (BCS) is a common tool used to assess the welfare of dairy cows and is based on scoring animals according to their external appearance. If the BCS of dairy cows deviates from the required value, it can lead to diseases caused by metabolic problems in the animal, increased medication costs, low productivity, and even the loss of dairy cows. BCS scores for dairy cows on farms are mostly determined by observation based on expert knowledge and experience. This study proposes an automatic classification system for BCS determination in dairy cows using the YOLOv8x deep learning architecture. In this study, firstly, an original dataset was prepared by dividing the BCS scale into five different classes of Emaciated, Poor, Good, Fat, and Obese for images of Holstein and Simmental cow breeds collected from different farms. In the experimental analyses performed on the dataset prepared in this study, the BCS values of 102 out of a total of 126 cow images in the test set were correctly classified using the proposed YOLOv8x deep learning architecture. Furthermore, an average accuracy of 0.81 was achieved for all BCS classes in Holstein and Simmental cows. In addition, the average area under the precision-recall curve was 0.87. In conclusion, the BCS classification system for dairy cows proposed in this study may allow for the accurate observation of animals with rapid declines in body condition. In addition, the BCS classification system can be used as a tool for production decision-makers in early lactation to reduce the negative energy balance.

Abstract P333: Predicted Nationwide Health and Economic Impacts of the AMA MAP TM Hypertension Program to Improve Hypertension Control

Introduction: Lack of actionable blood pressure (BP) measurements, therapeutic inertia, and suboptimal patient self-management are three key barriers to better BP control. To help address these barriers, the American Medical Association developed the Measure Accurately, Act Rapidly, and Partner with Patients Hypertension (MAP TM HTN) quality improvement program. Methods: To estimate the 10-year health and economic outcomes achieved when healthcare delivery systems adopt MAP HTN, HealthPartners Institute's ModelHealth™: Cardiovascular disease (CVD) microsimulation model was applied to conduct “what if” analyses for adopting MAP HTN nationwide and in care delivery systems of varying size. MAP HTN targets patients aged 18 to 85 years with diagnosed hypertension. To account for newly diagnosed hypertensive patients over time and outcomes that follow exposure to the program after age 85, the simulation model predicted outcomes for a dynamic cross-section of U.S. adults aged 18 to 100 years. This study was conducted from the health care sector perspective, including that of the payers for medical services and the health care delivery system that provides these services. Risk equations to predict the incidence of CVD events were derived from Framingham Heart Study data and are based upon the following risk factors: age, sex, body mass index, systolic BP (SBP), lipid levels, smoking status, diabetes status, and CVD history. Modeled outcomes over 10 years included prevalence of SBP ≥140 mmHg; incidence of cardiovascular disease (CVD) events and CVD-related mortality; averted medical costs in 2021 U.S. dollars; and net costs. Results: Nationwide adoption of MAP HTN was predicted to improve mean BP control by 4.3% and prevent 601000 CVD events, with 85000 fewer myocardial infarctions, 164000 fewer strokes and 120000 fewer CVD deaths over 10 years as compared to usual care. The majority (93%) of the estimated $17.9 billion in averted costs were among Medicare beneficiaries. Total costs of implementing MAP HTN was $12.6 billion, resulting in a predicted $5.3 billion in net savings to the health care sector over 10 years. Small and large care delivery organizations could economically benefit from implementing MAP HTN at varying levels (5-50%) of shared cost savings from payers. Conclusions: The model demonstrates that AMA’s MAP HTN has the potential to improve population health and provide a positive business case by averting future myocardial infarctions, strokes, and CVD deaths.

Budget Impact Analysis of Olaparib for the Management of Patients with Homologous Recombination Repair (HRR)-Mutated Castration-Resistant Metastatic Prostate Cancer in Argentina.

The aim of this study was to perform a budget impact analysis (BIA) of introducing olaparib treatment for adult patients with metastatic castration-resistant prostate cancer in Argentina. A BIA model was used to estimate the cost difference between the current scenario (without olaparib) and the new scenario (incorporation of olaparib) for a third-party payer over a 5-year time horizon. The budgetary impact is estimated at the national health system level and by healthcare sectors in Argentina. Input parameters were obtained from the literature and validated by local expert opinion. Direct medical costs were obtained from both the Institute for Clinical Effectiveness and Health Policy (IECS) unit cost database and public data in Argentina. The microcosting estimation was used for key variables of the analysis. All costs are reported in US dollars (US$) as for October 2022 (1 US$ = 152.59 Argentine pesos). One-way sensitivity analyses and scenario analyses were conducted to evaluate the model robustness. The incorporation of olaparib, with a wholesale price per pack of US$3176, was associated with a weighted average of the budget impact per member per month (PMPM) of US$0.0191 for the national health system, being slightly higher than the estimated budgeted high impact threshold (US$0.0153). The PMPM budget impact for a 5-year average ranged between US$0.007 (public sector) and US$0.033 (private sector). The duration of treatment with olaparib was the most influential parameter in the budget impact results. The introduction of olaparib for the treatment of metastatic castration-resistant prostate cancer has a high budget impact for Argentina's health system. These findings are informative to support policy decisions aimed to expand the current treatment landscape for prostate cancer.

Optimizing care pathways: A study of the urgent dispatch program and its impact on emergency department visits

IntroductionThe use of acute hospital-level care at home (hospital-at-home) for patients who are chronically ill has led to decreased medical costs, amount of sedentary time, and hospital admissions. Our large integrated healthcare system identified the need to develop a mechanism through which to decrease emergency department (ED) visits in this patient population by creating a home acute care program called Urgent Dispatch. The primary objective of this study was to determine the medical condition for referral and seven and 30-day ED visit rates. MethodsThis was a retrospective cohort of all patients referred to the Urgent Dispatch program from April 1, 2021, through February 28, 2022. We assessed encounters for patient demographics, referral source, reason for visit, number of at home visits, total number of days in the program, and determined if the patient had an ED encounter within seven and 30 days of participation in the program. The healthcare system includes 10 hospitals (academic, community and rural), 17 emergency departments (hospital-based and freestanding) and their associated outpatient clinics. ResultsA total of 2218 orders were placed with 1530 (70.8 %) resulting in enrollment in the Urgent Dispatch program. The majority were elderly (75 ± 15.6), white (70 %), female (64.4 %), and had Medicare as their primary insurance (82 %). The average number of visits made by Urgent Dispatch was 1.46 (SD ± 0.95). The average number of days enrolled in the program was 2.4 (SD ± 4.1). The top three referral sources to the program were outpatient primary care (42 %), home care (28 %) and emergency medicine (20 %). The top body systems requiring a visit were cardiovascular (22 %), general (18 %), and respiratory (17.2 %). Of the 1530 urgent dispatch referrals, 19.8 % (n = 303) had an ED visit within seven days, 12 % (n = 183) had an ED visit within eight to 30 days, and 68.2 % (n = 1044) had no ED visit. ConclusionA home-based care model of healthcare delivery for patients with chronic medical conditions can provide effective care, with 80.2 % of patients avoiding an ED visit within seven days and 68.2 % avoiding an ED visit within 30 days.

Discontinuation of β-blocker therapy in stabilised patients after acute myocardial infarction (SMART-DECISION): rationale and design of the randomised controlled trial

IntroductionThere is a lack of evidence to support the effectiveness of prolonged β-blocker therapy after stabilisation of patients with acute myocardial infarction (AMI) without heart failure (HF) or left ventricular...

Out-of-pocket medical expenditures, remittances and health outcomes in China.

This study examines the relationship between out-of-pocket medical expenditures, remittances and health outcomes in China using Ordinary Least Squares (OLS) and Propensity Score Matching (PSM) methods. The analysis is based on data from the Global Financial Inclusion database by the World Bank (2021), encompassing a sample of 3,446 individuals. The results indicate that out of-pocket expenditure has a negative impact on health outcomes, while remittance shows a positive association across all age groups, including reproductive and non-reproductive populations. These findings suggest that high out-of-pocket medical costs may hinder access to healthcare services and lead to poorer health outcomes. Conversely, remittance plays a beneficial role in improving health outcomes, highlighting the potential of financial support to positively impact the well-being of individuals.

Health economic evaluation of an artificial intelligence (AI)-based rapid nutritional diagnostic system for hospitalised patients: A multicentre, randomised controlled trial

Background & aimsMalnutrition is prevalent among hospitalised patients, and increases the morbidity, mortality, and medical costs; yet nutritional assessments on admission are not routine. This study assessed the clinical and economic benefits of using an artificial intelligence (AI)-based rapid nutritional diagnostic system for routine nutritional screening of hospitalised patients. MethodsA nationwide multicentre randomised controlled trial was conducted at 11 centres in 10 provinces. Hospitalised patients were randomised to either receive an assessment using an AI-based rapid nutritional diagnostic system as part of routine care (experimental group), or not (control group). The overall medical resource costs were calculated for each participant and a decision-tree was generated based on an intention-to-treat analysis to analyse the cost-effectiveness of various treatment modalities. Subgroup analyses were performed according to clinical characteristics and a probabilistic sensitivity analysis was performed to evaluate the influence of parameter variations on the incremental cost-effectiveness ratio (ICER). ResultsIn total, 5763 patients participated in the study, 2830 in the experimental arm and 2933 in the control arm. The experimental arm had a significantly higher cure rate than the control arm (23.24% versus 20.18%; p = 0.005). The experimental arm incurred an incremental cost of 276.52 CNY, leading to an additional 3.06 cures, yielding an ICER of 90.37 CNY. Sensitivity analysis revealed that the decision-tree model was relatively stable. ConclusionThe integration of the AI-based rapid nutritional diagnostic system into routine inpatient care substantially enhanced the cure rate among hospitalised patients and was cost-effective. RegistrationNCT04776070 (https://clinicaltrials.gov/study/NCT04776070)

Bereaved Parents’ Perspectives on Financial Toxicity at End of Life for Children with Cancer: A Qualitative Study

ObjectiveTo explore financial toxicity (FT) experienced by the parents of children with cancer at end-of-life (EOL), including exploring differences by race and ethnicity. Study designWe performed secondary analysis of semi-structured interviews of bereaved parents’ perspectives on quality EOL care. Fifty-five interviews were conducted in California and Alabama representing 48 children (0-21 years at time of death) who died of cancer ≥6 months prior. Quotes related to FT were identified and iteratively grouped into themes without an a priori framework. ResultsMost participants were non-Hispanic White (30; 55%), and the most common diagnoses were non-central nervous system solid tumors (16; 33%) and central nervous system tumors (16; 33%). Children died at a mean age of 11 and a median of 4 years prior to the interview. Almost all parents (52; 95%) discussed FT, including all Black and Hispanic parents. Parents identified transportation, housing, other basic needs, funeral costs, and medical costs as well as work disruptions as contributors to FT at EOL. Barriers to financial wellness included navigating insurance, insufficient financial support from the hospital, and long-term FT from treatment. Many parents discussed how the hospital and community served as facilitators of financial wellness. In some cases, finances prevented families from accessing nursing services and mental health support and affected EOL decisions. ConclusionsAs FT affected almost all families’ EOL experience, pediatric oncology programs should routinely screen for FT at EOL and ensure they have the resources to respond.

Factors associated with the use of pharmacopuncture in addition to acupuncture in South Korea: An analysis of a nationally representative panel.

Pharmacopuncture is a widely used Korean medicine treatment, but its usage patterns and associated factors remain unclear. This study aimed to explore factors related to the use of pharmacopuncture alongside acupuncture and investigate the associated medical cost burden in South Korea. We analyzed the 2019 Korea Health Panel Annual Data, focusing on adult outpatients who received acupuncture alone or both acupuncture and pharmacopuncture (PA). We employed individual-level and visit-level approaches, using chi-square tests, t-tests, and binary logistic regression for analysis. Among 1280 patients, 10% were PA users. Logistic regression showed that PA use was significantly associated with being aged 30 to 49 (odd ratio [OR] = 2.531; P = .009), having an education level of elementary school or lower (OR = 2.571; P = .011), and being in the 2nd (OR = 1.914; P = .041) or 3rd income percentile (OR = 1.925; P = .020). Of 13,101 medical visits, 5.80% involved PA, with PA visits incurring significantly higher costs than acupuncture only visits (KRW 4438.33 vs 14,700.16; P < .001). Arthritis, shoulder disorders, and other joint conditions were more prevalent among PA visits (P < .001). This study reveals socioeconomic factors influencing pharmacopuncture use and highlights potential health inequalities in its access in South Korea. The higher costs associated with PA visits suggest a need for considering its inclusion in health insurance coverage. Future research should focus on the effectiveness, cost-effectiveness, and standardization of pharmacopuncture to address unmet healthcare needs and inform policy decisions.

Patient and clinic staff perspectives on the implementation of a long-acting injectable antiretroviral therapy program in an urban safety-net health system

BackgroundLong-acting injectable cabotegravir plus rilpivirine (LAI CAB/RPV) has several potential benefits over daily oral formulations for HIV treatment, including the potential to facilitate long-term adherence and reduce pill fatigue. We aimed to assess facilitators of and barriers to LAI CAB/RPV implementation and delivery through the perspectives of physicians and clinical staff, and the experiences of LAI CAB/RPV use among people living with HIV (PLWH) at a Ryan-White supported safety-net clinic in North Texas.MethodsWe conducted semi-structured interviews with recruited clinic staff (physicians, nurses, and support staff) involved with LAI CAB/RPV implementation and PLWH who switched to LAI CAB/RPV and consented to participate in individual interviews. Data were collected from July to October 2023. Our interview guide was informed by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM), and Proctor Implementation Outcomes frameworks. Qualitative data were analyzed using a rapid qualitative analysis approach to summarize key themes.ResultsWe recruited and interviewed 15 PLWH who transitioned to LAI CAB/RPV and 11 clinic staff serving these patients. PLWH conveyed that emotional and informational support from family or a trusted clinician influenced their decision to switch to LAI CAB/RPV. PLWH also reported that injectable treatment was more effective, convenient, and acceptable than oral antiretroviral therapy. Clinic staff and physicians reported that staff training, pharmacist-led medication switches, flexible appointments, refrigeration space and designated room for injection delivery facilitated implementation. Clinic staff cited medication costs, understaffing, insurance prior authorization requirements, and lack of medication access through state drug assistance programs as critical barriers.ConclusionsOur study offers insights into real-world experiences with LAI usage from the patient perspective and identifies potential strategies to promote LAI CAB/RPV uptake. The barriers to and facilitators of LAI CAB/RPV program implementation reported by clinic staff in our study may be useful for informing strategies to optimize LAI CAB/RPV programs.

Predicting hospitalization costs for pulmonary tuberculosis patients based on machine learning

BackgroundPulmonary tuberculosis (PTB) is a prevalent chronic disease associated with a significant economic burden on patients. Using machine learning to predict hospitalization costs can allocate medical resources effectively and optimize the cost structure rationally, so as to control the hospitalization costs of patients better.MethodsThis research analyzed data (2020–2022) from a Kashgar pulmonary hospital’s information system, involving 9570 eligible PTB patients. SPSS 26.0 was used for multiple regression analysis, while Python 3.7 was used for random forest regression (RFR) and MLP. The training set included data from 2020 and 2021, while the test set included data from 2022. The models predicted seven various costs related to PTB patients, including diagnostic cost, medical service cost, material cost, treatment cost, drug cost, other cost, and total hospitalization cost. The model’s predictive performance was evaluated using R-square (R2), Root Mean Squared Error (RMSE), and Mean Absolute Error (MAE) metrics.ResultsAmong the 9570 PTB patients included in the study, the median and quartile of total hospitalization cost were 13,150.45 (9891.34, 19,648.48) yuan. Nine factors, including age, marital status, admission condition, length of hospital stay, initial treatment, presence of other diseases, transfer, drug resistance, and admission department, significantly influenced hospitalization costs for PTB patients. Overall, MLP demonstrated superior performance in most cost predictions, outperforming RFR and multiple regression; The performance of RFR is between MLP and multiple regression; The predictive performance of multiple regression is the lowest, but it shows the best results for Other costs.ConclusionThe MLP can effectively leverage patient information and accurately predict various hospitalization costs, achieving a rationalized structure of hospitalization costs by adjusting higher-cost inpatient items and balancing different cost categories. The insights of this predictive model also hold relevance for research in other medical conditions.

The Cost of Unhealthy Days: A New Value Assessment.

For-profit companies addressing disparities in social determinants of health (SDOH), also known as SDOH Industry companies, often lack member-level claims data to evaluate their organizational interventions. Health-related quality of life (HRQOL) measures, such as the Centers for Disease Control and Prevention's Healthy Days Measure, offer a unique proxy metric to evaluate impact. This retrospective study sought to explore the association between self-reported physically and mentally unhealthy days with health care costs among a Medicare Advantage (MA) population. A cross-sectional study of MA members receptive to a companion care program, and thus likely to have unmet social needs, was conducted. The analysis included members with recorded baseline unhealthy days and complete claims data (n = 2,354). Least squares regression analyses were performed to determine the relationship between baseline medical costs, physically unhealthy days, and mentally unhealthy days. A review of Major Diagnostic Categories (MDCs) was also included to elucidate the strength of the Healthy Days Measure as an indicator of the burden of health conditions. Each additional unhealthy day reported was associated with an increase in 30-day medical costs of $60 and $34 for physically and mentally unhealthy days, respectively. Unhealthy days and costs increased with an increasing number of MDCs. Compared with previous studies linking unhealthy days and health care expenditure, these data reveal the potential for even higher savings by reducing the number of unhealthy days in a high-risk population. This evidence supports using unhealthy days as a HRQOL measure and as an important tool for cost estimations.