Medical Care Costs Research Articles

Pattern of Organism and Drug Sensitivity on Culture and Sensitivity of Pus from Soft Tissue Abscesses in Pediatric Patients

Background: Soft tissue abscesses is one of the most commonly observed complication in children. This infection may impart the longer stay at hospital and also increase the cost of medical care. Objective: The study was carried out to find the pattern of organisms and the sensitivity of drugs from the pus produced in soft tissue abscesses among patients. Study design: It is cross-sectional study conducted from January 2020 to November 2022. Material and Methods: The study was conducted at the pediatric department of the Div. HQ teaching hospital Mirpur, Azad Jammu and Kashmir. The study was carried out on 160 patients having at least one abscess on their body. The study also collected information about the predisposing factor that could have led to abscess formation. The site of distribution of the abscess was also analyzed. The abundance of microorganisms that were isolated from the samples of abscesses was also studied. Results: it was found that in most of the patients (45.5%) the blunt trauma was the main cause of formation of abscess. The common cause of abscess at extremities was blunt trauma. The common cause of abscess at head and neck site was upper respiratory tract infection and lymphadenitis. The head and neck area along with lower limb was the site that had most of the abscess. Conclusion: In our study the blunt trauma at extremities was found to be main factor leading to pus formation from smooth tissue abscess among infants. The most common region where pus was formed was extremities, head and neck area and lower limb area. Keywords: klebsiella pneumonia and Soft tissue abscesses.

Treatment Sequencing Patterns and Associated Direct Medical Costs of Metastatic Breast Cancer Care in the United States, 2011 to 2021

Advances in treatment of metastatic breast cancer (MBC) led to changes in clinical practice and treatment costs in the US over the past decade. There is limited information on current MBC treatment sequences and associated costs by MBC subtype in the US. To identify treatment patterns by MBC subtype and associated anticancer and supportive drug costs from health care sector and Medicare perspectives. This economic evaluation analyzed data of patients with MBC obtained from the nationwide Flatiron Health database, an electronic health record-derived, deidentified database with data from community and academic practices across the US from 2011 to 2021. Participants included women aged at least 18 years diagnosed with MBC, who had at least 6 months of follow-up data, known hormone receptor (HR) and human epidermal growth factor receptor 2 (ERBB2) receptor status, and at least 1 documented line of therapy. Patients with documented receipt of clinical study drugs were excluded. Data were analyzed from June 2021 to May 2022. Outcomes of interest were frequency of different drug regimens received as a line of therapy by subtype for the first 5 lines and mean medical costs of documented anticancer treatment and supportive care drugs per patient by MBC subtype and years since metastatic diagnosis, indexed to 2021 US dollars. Among 15 215 patients (10 171 patients [66.85%] with HR-positive and ERBB2-negative MBC; 2785 patients [18.30%] with HR-positive and ERBB2-positive MBC; 802 patients [5.27%] with HR-negative and ERBB2-positive MBC; 1457 patients [9.58%] with triple-negative breast cancer [TNBC]) who met eligibility criteria, 1777 (11.68%) were African American, 363 (2.39%) were Asian, and 9800 (64.41%) were White; the median (range) age was 64 (21-84) years. The mean total per-patient treatment and supportive care drug cost using publicly available Medicare prices was $334 812 for patients with HR-positive and ERBB2-positive MBC, $284 609 for patients with HR-negative and ERBB2-positive MBC, $104 774 for patients with HR-positive and ERBB2-negative MBC, and $54 355 for patients with TNBC. From 2011 to 2019 (most recent complete year 1 data are for patients diagnosed in 2019), annual costs in year 1 increased from $12 986 to $80 563 for ERBB2-negative and HR-positive MBC, $99 997 to $156 712 for ERBB2-positive and HR-positive MBC, and $31 397 to $53 775 for TNBC. This economic evaluation found that drug costs related to MBC treatment increased between 2011 and 2021 and differed by tumor subtype. These findings suggest the growing financial burden of MBC treatment in the US and highlights the importance of performing more accurate cost-effectiveness analysis of novel adjuvant therapies that aim to reduce metastatic recurrence rates for early-stage breast cancer.

Historical Aspects of Herbal Use and Comparison of Current Regulations of Herbal Products between Mexico, Canada and the United States of America

Increased life expectancy and high costs of medicines and medical care have led to the use of herbal products. However, these items may contain toxic compounds that have an impact on public health. We will focus on the regulatory aspects and differences of these products marketed in the North American region (USA-Mexico-Canada) from government websites and selected literature. Mexico has an ancestral tradition of using plants for the treatment, improvement, and maintenance of human health as compared with Canada and the USA Currently, the use of herbal products in this region has a regulatory framework. The legal framework in these three countries is related to their history, idiosyncrasies, socio-economic and cultural aspects. Therefore, there are different public policies for herbal products consumed in the region. Mexico has a more specific classification of these products. In Canada, all herbal products are classified as natural health products and the safety and efficacy must be scientifically proven. In the USA, the development of botanical drugs is very recent. In particular, both herbal products classified as food supplements in Mexico and dietary supplements in the USA may have risks in both safety and efficacy.

Financial incentives for exercise and medical care costs

Financial incentives for exercise and medical care costs

Health Care Resource Utilization and Costs of CAR T Therapy in Patients with Large B-Cell Lymphoma: A Retrospective US Claims Database Analysis

Introduction: Despite its association with promising clinical outcomes, chimeric antigen receptor T-cell (CAR T) therapy may not be a feasible treatment option for some patients with relapsed or refractory large B-cell lymphoma (LBCL). Although more patients have been referred to CAR T therapy in recent years, many patients are still not treated due to anticipated costs and logistical challenges, particularly in the community setting (Gajra et al, Immunotherapy 2020). Because of long manufacturing times, patients often require bridging therapy prior to CAR T and a subset of patients die on bridging therapy without ever receiving CAR T (Chow et al, Am J Hematol 2020). Furthermore, more than one-half of patients relapse within 1 year of receiving CAR T therapy (Spiegel et al, Blood 2021). It is important to understand the clinical and economic burden associated with CAR T therapy. We assessed health care resource utilization (HCRU) and all-cause health care (medical and medication) costs from 30 days prior to through 90 days after infusion with tisagenlecleucel or axicabtagene ciloleucel CAR T therapy in patients with diffuse large B-cell lymphoma (DLBCL), the most common non-Hodgkin lymphoma (NHL) subtype, or primary mediastinal large B-cell lymphoma (PMBCL), another aggressive NHL subtype. Methods: This observational, retrospective cohort study analyzed MarketScan (IBM, Armonk, NY) administrative claims data for adult patients with DLBCL and PMBCL who received CAR T infusion therapy between October 1, 2017 and March 31, 2021, and who had continuous enrollment 6 months before and at least 90 days after the CAR T treatment date (index date). Those with mantle cell lymphoma or follicular lymphoma were excluded. Hospital length of stay (LOS) and HCRU from 30-days prior to 90-days post-infusion for inpatient and outpatient hospital visits and other facility visits were examined. All-cause medical, medication, and health care costs per patient were reported in 2021 US dollars. Results: A total of 106 patients (DLBCL, n=92; PMBCL, n=14) who received CAR T therapy (mean age, 55 years; men, 59%; commercial payer, 87%; CAR T brand information available, n=20 patients) were included in the analysis. A majority of patients (78 [74%]) had at least 5 outpatient hospital visits in the 30 days prior to CAR T therapy. Many were reported as having received bridging and/or lymphodepletion treatment prior to CAR T infusion (81 [76%]). CAR T therapy was administered in an inpatient setting for 92 patients (87%) with a mean (SD) LOS of 18.4 (11.3) days and a mean (SD) cost of $341,217 ($245,564) within 90 days. Among those receiving CAR T inpatient, 41 (45%) had intensive care unit (ICU) admissions during their stay. In the 90 days post-CAR T infusion, most patients (92 [87%]) had at least 5 outpatient hospital visits. Subsequent inpatient admissions occurred in 30 patients (28%), with a mean (SD) LOS of 12 (12.44) days and a mean (SD) cost of $83,952 ($105,961) within 90 days after CAR T infusion. From 30 days prior to 90 days after infusion, the mean (SD) total all-cause health care costs per patient, including those associated with CAR T therapy, were $511,139 ($293,631) (Figure). Conclusions: While CAR T therapy may be a treatment option as LBCL patients progress, patients face a considerable clinical and economic burden. Both the HCRU prior to infusion and after infusion included frequent outpatient hospital visits. Additionally, in this analysis, inpatient hospitalizations were the primary driver of HCRU and costs of CAR T therapy. Most patients received CAR T therapy on an inpatient basis, requiring prolonged stays. Nearly half of patients were admitted to the ICU and more than a quarter experienced secondary inpatient stays. Costs associated with the logistically challenging CAR T therapy within a month leading up to the infusion and up to 3 months post-infusion are substantial, averaging half a million dollars per patient, indicating a significant burden, given that a majority of the patients relapse within a year. These findings underscore the need for an accessible, off-the-shelf, and efficacious therapeutic option for LBCL patients. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Budget impact analysis of the use of Souvenaid in patients with prodromal Alzheimer’s Disease in Spain

IntroductionThe effectiveness, safety, and cost-effectiveness of the use of Souvenaid for Alzheimer’s disease (AD) have been previously evidenced. To complete the economic analysis, there is a need to assess whether society can afford it. The objective of this study was to carry out a budget impact analysis of the use of Souvenaid in Spain under the conditions of the LipiDidiet clinical trial from a societal perspective.MethodsWe built a population model that took into account all the cohorts of individuals with AD, their individual progression, and the potential impact of Souvenaid treatment on their trajectories. Patient progression data were obtained from mixed models. The target population was estimated based on the population forecast for 2020–2035 and the incidence of dementia. Individual progression to dementia measured by the Clinical Dementia Rating-Sum of Boxes was reproduced using mixed models. Besides the costs of treatment and diagnosis, direct costs of medical and non-medical care and indirect costs were included.ResultsThe epidemiological indicators and the distribution of life expectancy by stages validated the model. From the third year (2022), the differences in the cost of dementia offset the incremental cost of diagnosis and treatment. The costs of dependency reached €500 million/year while those of the intervention were limited to €40 million.ConclusionsSouvenaid, with modest effectiveness in delaying dementia associated with AD, achieved a positive economic balance between costs and savings. Its use in the treatment of prodromal AD would imply an initial cost that would be ongoing, but this would be offset by savings in the care system for dependency associated with dementia from the third year. These results were based on adopting a societal perspective taking into account the effect of treatment on the use of health, social, and family resources.

Factors Influencing Self-Management Behaviors among Hemodialysis Patients.

To investigate the factors affecting hemodialysis patients' self-management ability at a dialysis center in Taiwan. Taiwan has the highest incidence and prevalence of end-stage kidney disease (ESKD) in the world. Over 90% of patients with ESKD receiving hemodialysis (HD) and self-management behaviors are critical among these patients. Failure to adhere to self-managed care increases the cost of medical care and the risk of morbidity and mortality. In this cross-sectional study, a total of 150 HD patients were observed for their self-management behaviors and the factors influencing these behaviors including education level, comorbid conditions, biochemical analysis, depression, and social support, etc., were analyzed. Self-management behaviors in HD patients were significantly impaired in the presence of diabetes mellitus, hypertension, anemia, hypoalbuminemia, and depression. The major predictor of patients' self-management was depression, explaining 14.8% of the total variance. Further addition of social support, hypertension, and diabetes mellitus into the regression model increased the total explained variance to 28.6%. Of the various domains of self-management, the partnership domain received the highest score, whereas emotional processing received the lowest score. This study found the important factors influencing self-management behaviors; through this acknowledgement and early correction of these factors, we hope to improve HD patients' individual life quality and further decrease their morbidity and mortality.

Artificial intelligence based prediction models for individuals at risk of multiple diabetic complications: A systematic review of the literature.

The aim of this review is to examine the effectiveness of artificial intelligence in predicting multimorbid diabetes-related complications. In diabetic patients, several complications are often present, which have a significant impact on the quality of life; therefore, it is crucial to predict the level of risk for diabetes and its complications. International databases PubMed, CINAHL, MEDLINE and Scopus were searched using the terms artificial intelligence, diabetes mellitus and prediction of complications to identify studies on the effectiveness of artificial intelligence for predicting multimorbid diabetes-related complications. The results were organized by outcomes to allow more efficient comparison. Based on the inclusion/exclusion criteria, 11 articles were included in the final analysis. The most frequently predicted complications were diabetic neuropathy (n = 7). Authors included from two to a maximum of 14 complications. The most commonly used prediction models were penalized regression, random forest and Naïve Bayes model neural network. The use of artificial intelligence can predict the risks of diabetes complications with greater precision based on available multidimensional datasets and provides an important tool for nurses working in preventive health care. Using artificial intelligence contributes to a better quality of care, better autonomy of patients in diabetes management and reduction of complications, costs of medical care and mortality.

Blood ordering and utilization in patients undergoing elective general surgery procedures in a tertiary care hospital: A prospective audit.

Background Blood ordering is commonly done for patients undergoing major elective surgery. Excessive order of the blood for elective surgery leads to wastage of resources, time and workforce. Auditing preoperative blood ordering decreases the cost of medical care by avoiding unnecessary cross-match without compromising patient safety. Methods For this hospital-based audit, we collected data prospectively from July 2017 to June 2018 regarding the transfusion and transfusion indices, namely cross-match-totransfusion ratio (C/T ratio), transfusion probability (T%), transfusion index (TI) and maximum surgical blood ordering schedule (MSBOS) for elective surgeries done in the Department of Surgery. Results A total of 1151 patients were included in the study. A total of 160 units of blood were issued of which only 138 were transfused to 116 patients. Seventy-one procedures were included in the study. The C/T ratio was less than 2.5 for 16 procedures, T% was >50% for 9 procedures and MSBOS was more than 0.5 for 16 procedures. Conclusion Cross-matching is overused for elective surgical procedures. Only 16 of the 71 procedures had an ideal C/T ratio. Group and screen policy can be adopted for most of the commonly performed procedures, and cross-matching of blood may not be needed.

ПЛАТНЫЕ И БЕСПЛАТНЫЕ МЕДИЦИНСКИЕ УСЛУГИ: ИСТОРИЧЕСКИЕ ПАРАЛЛЕЛИ РАЗВИТИЯ

One of the most pressing issues has always been the question of the cost of medical care. The article shows that different periods of history were characterized by different costs of medical care. The history of the ancient world and the Middle Ages was characterized by both free medicine and paid in the form of products or material values. It was shown how Russian healthcare system and the formation of the cost of medical services are reflected in different periods of history. It has been noted that the need of all social strata and rulers for medical services since ancient times has turned medical service into an important component of society’s life. Therefore, medicine inevitably interacted with various social spheres. Throughout history, this relationship has depended on many factors. Many patients believe that medical care should be free, some argue that free care is ineffective, and that is why it is necessary to introduce paid medicine. It has been revealed that so far the balance between paid and free medicine in the world has not been reached.

The Financial Burden of Nephrolithiasis and Predictors of Disease-specific Financial Toxicity

ObjectiveTo characterize stone-related financial toxicity among US adults with kidney stones through validated questionnaires for financial toxicity and disease-specific health-related quality of life. Materials and MethodsWe performed a cross-sectional survey of adults with kidney stone disease from the general population ascertained through a national registry of volunteers (ResearchMatch). A computer-based survey queried stone event history and related costs for medical care, disease-specific quality of life (WISQOL), and an 11-item measure of stone-related financial toxicity (COST-11 score). Multivariable logistic regression was performed to evaluate predictors of financial toxicity, defined as having a COST-11 score ≤20. ResultsOf 942 responses, median COST-11 score was 29 (IQR 21-38), and 24.7% (N = 233) met criteria for disease-specific financial toxicity. Stone-formers with financial toxicity spent more out of pocket on stone-treatment in the previous year than patients with lower financial burden (P <.001) and were more likely to defer or delay recommended treatment due to anticipated cost (27% vs 3%; P <.001). Stone-specific financial toxicity was associated with poorer disease-specific health-related quality of life across all WISQOL domains (each P <.001). Multivariable logistic regression showed that female gender (OR 1.81; 95% CI 1.24-2.67), Medicaid compared to private insurance (OR 3.91; 95% CI 2.34-6.94), and stone passage in the previous year (OR 2.00; 95% CI 1.41-2.86) were independently associated with financial toxicity. ConclusionApproximately 1 in 4 individuals with kidney stone disease report disease-specific financial toxicity. These data suggest the financial burden of the condition may influence decision-making and associates with poorer disease-specific quality of life.

Delayed Diagnosis of West Nile Meningoencephalitis in a Patient Receiving Rituximab for Rheumatoid Arthritis

West Nile virus (WNV) neuroinvasive disease is associated with substantial morbidity and mortality. Clinical suspicion is usually confirmed with cerebrospinal (CSF) immunoglobulin M (IgM) detection using enzyme-linked immunoassay (ELISA) techniques. CSF polymerase chain reaction (PCR) is rarely used to confirm the disease and is not widely available. We present a detailed report offalse-negative WNV IgM in a patient receiving rituximab therapy for rheumatoid arthritis. She was exposed to the virus during peak immunosuppression and strong clinical suspicion was confirmed with WNV PCR, illustrating the importance of such consideration with the recent incremental use of rituximab therapy.Despite the lack of specific anti-viral treatment for WNV, delayed consideration and diagnosis of WNV in those who are immunosuppressed would expose them to a wide panel of testing, with a subsequent increase in the cost of medical care.

The effects of individual and community-level factors on community-based health insurance enrollment of households in Ethiopia.

IntroductionCommunity-based health insurance (CBHI) is a type of volunteer health insurance that has been adopted all over the world in which people of the community pool funds to protect themselves from the high costs of seeking medical care and treatment for the disease. In Ethiopia, healthcare services are underutilized due to a lack of resources in the healthcare system. The study aims to identify the individual and community level factors associated with community-based health insurance enrollment of households in Ethiopia.MethodsData from the Ethiopian mini demographic and health survey 2019 were used to identify factors associated with community-based health insurance enrollment of households in Ethiopia. Multilevel logistic regression analysis was used on a nationally representative sample of 8,663 households nested within 305 communities, considering the data’s layered structure. We used a p-value<0.05 with a 95% confidence interval for the results.ResultThe prevalence of community-based health insurance enrollment in Ethiopia was 20.2%. The enrollment rate of households in the scheme was high in both Amhara (57.9), and Tigray (57.9%) regions and low (3.0%) in the Afar region. At the individual level; the age of household heads, number of children 5 and under, number of household members, has land for agriculture, has a mobile telephone, receiving cash of food from the safety Net Program, Owning livestock, and herds of farm animals, wealth index, and at the community level; the region had a significant association with community-based health insurance enrollment.ConclusionBoth individual and community-level characteristics were significant predictors of community-based health insurance enrollment in households. Furthermore, the ministry of health, health bureaus, and other concerning bodies prioritize clusters with low health insurance coverage to strengthen health system financing and intervene in factors that negatively affect the CBHI enrollment of households.

Artificial Intelligence in the American Healthcare Industry: Looking Forward to 2030

Artificial Intelligence in the American Healthcare Industry: Looking Forward to 2030

Health insurance coverage patterns before and after a cancer diagnosis: Findings from adult patients with cancer in an integrated health system.

262 Background: Patients diagnosed with cancer experience intense medical care and high costs associated with the disease and its treatment. As a result, patients may consider changes to their health insurance coverage to adjust the medical benefits covered and/or the cost-sharing (e.g., annual maximum out-of-pocket [MOOP] limit) requirements. The purpose of this study was to assess the patterns of health insurance plan coverage patterns prior to and following a diagnosis of cancer among adult patients. Methods: Data from 13,237 patients aged ≥18, enrolled at Kaiser Permanente Northwest, diagnosed with cancer between Jan. 1, 2016–March 31, 2021 [index cancer], with ≥12 months of continuous health insurance coverage pre-cancer diagnosis were included. Patients enrolled in hospice prior to index cancer were excluded. Health insurance coverage outcomes included (1) coverage patterns (maintenance, interruption, termination, switch); (2) a composite of any coverage changes; and (3) cost-sharing patterns. Monthly health plan membership enrollment data was used to assess outcomes between two time periods: pre-diagnosis (12 months prior to index cancer) and post-diagnosis (12-18 months following index cancer). Patient sociodemographic, enrollment, health plan and clinical data were extracted from the electronic health record (EHR). Descriptive statistics were used to assess outcomes. Results: Approximately 40% of patients were ages 18-64, 54% were female and 9% were non-White. At index cancer diagnosis, 60% of patients had Medicare, 37% had a commercial plan and 3% had Medicaid. Among patients aged 18-64, 62% had any change in health insurance coverage between pre- to post-cancer diagnosis, including 41% who switched plans, 19% who terminated and 2% with an interruption. Among patients aged 65+, 50% of patients had any change in health insurance coverage, including 20% who switched plans, 30% who terminated and &lt; 1% with an interruption. For those who switched plans between the pre- to post-diagnosis periods, the most common patterns included switching out of commercial plans (-11% points) and switching into either Medicare (+9% points) or Medicaid (+5% points). Among all patients, 14% changed to a higher cost-sharing plan (difference in mean individual, in-network MOOP limit: $938) and 10% changed to a lower cost-sharing plan (difference in mean individual, in-network MOOP limit: -$1701). Conclusions: Our novel findings provide valuable information about health insurance plan coverage patterns among adults diagnosed with cancer and suggest a large proportion of patients may undergo changes to their health insurance coverage. Future studies that assess the implications of health insurance changes on care access and cancer outcomes are warranted.

Hermeneutic phenomenology of lived experience of family caregivers of critically-ill patients sustained by healthcare technologies in Benin City, Nigeria

Background: Critical illness causes a severe financial impact on households not only because of illness-related inability to work but also because of the cost of medical care. Although the patients have the potential for recovery, they are usually presented with a life-threatening situation. Our study aimed to explore the lived experience of family caregivers caring for critically-ill patients. Materials and Methods: A qualitative study using a hermeneutic phenomenological design, to explore the lived experience of ten family caregivers caring for critically-ill patients admitted to the University of Benin Teaching Hospital, Benin-city in 2022. This study followed a hermeneutic phenomenological design using an in-depth interview of ten family caregivers who met the inclusion criteria: a family member who participated actively in the care was included. Data were collected, transcribed, and analyzed using Nvivo software and Paul Ricoeur’s theory for interpretation. Results: Based on Paul Ricoeur’s theory of interpretation, five themes were identified as the experience of family caregivers: caring neglect, psychological support, and words of encouragement, lack of confidence in nursing intervention, hopeless situation, and financial burden. Conclusion: This study shows that understanding the experience of family caregivers provides better and quality care. It also found that the hospital management needs to be aware of the identified caring neglect among family caregivers and provide a comprehensive health policy to accommodate their physiological needs while in the hospital

Alcohol-Attributable Medical Costs in Commercially Insured and Medicaid Populations

Despite its social acceptance, excessive alcohol use remains among the top causes of preventable deaths in the U.S. Although there is a recognition of alcohol-related health and social costs, there are no current studies quantifying the medical costs incurred under health plans. This study estimates the direct medical costs attributable to excessive alcohol use using claims records from a large national insurer. The sample consists of adults with commercial insurance and Medicaid between 2008 and 2019. A case-control matched study design is used to compare individuals with a condition considered 100% attributable to alcohol by the Centers for Disease Control and Prevention with similar individuals. Medical care use and costs are examined over a 12-month follow-up. Costs are broken down by healthcare setting and health conditions as defined by the Centers for Disease Control and Prevention's Alcohol-Related Disease Impact diagnoses codes. We find that having a diagnosis attributable to alcohol is associated with higher annual per-person healthcare expenditures in both commercially insured and Medicaid-insured participants by $14,918 (95% CI=$14,540, $15,297) and $4,823 (95% CI=$4,489, $5,158), respectively. We find that 60%‒75% of the additional costs of excessive alcohol use are driven by heart disease and stroke; conditions of the liver, gallbladder, and pancreas; and certain cancers as well as acute conditions that may be attributable to alcohol. The findings suggest that public and private initiatives to target people vulnerable to the harms of excessive alcohol use may potentially help to cut down significant costs on the already strained healthcare system in the U.S.

Modeling the potential economic benefits of an oral SARS-CoV-2 vaccine during an outbreak of COVID-19

BackgroundGiven patient preferences, the choice of delivery modality for vaccines against SARS-CoV-2 has the potential to significantly impact both health and economic consequences of an outbreak of COVID-19. This study models the projected health and economic impact of an oral COVID-19 vaccine in the United States during an outbreak occurring between December 1, 2021 and February 16, 2022. MethodsA cost-of-illness economic decision analysis model is utilized to assess both the health and economic impact of an oral vaccine delivery platform compared with the status quo deployment of existing intramuscular vaccines against COVID-19. Health impact is assessed in terms of predicted cases, deaths, hospitalization days, intensive care unit admission days, and mechanical ventilation days averted. Health system economic impact is assessed based on the cost-of-illness averted derived from the average daily costs of medical care, stratified by severity. Productivity loss due to premature death is estimated based on regulatory analysis guidelines proposed by the U.S. Department of Health and Human Services. ResultsBased upon preference data, we estimate that the availability of an oral COVID-19 vaccine would increase vaccine uptake from 214 million people to 232 million people. This higher vaccination rate was estimated to result in 2,497,087 fewer infections, 25,709 fewer deaths, 1,365,497 fewer hospitalization days, 186,714 fewer Intensive Care Unit (ICU) days, and 80,814 fewer patient days requiring mechanical ventilation (MV) compared with the status quo. From a health systems perspective, this translates into $3.3 billion in health sector costs averted. An additional $139-$450 billion could have been averted in productivity loss due to a reduction in premature deaths.ConclusionsVaccine delivery modalities that are aligned with patient preferences have the ability to increase vaccination uptake and reduce both the health and economic impact of an outbreak of COVID-19. We estimate that the total economic impact of productivity loss and health systems cost-of-illness averted from an oral vaccine could range from 0.6%-2.9% of 2021 U.S, Gross Domestic Product (GDP).

AACR Cancer Progress Report 2022: Decoding Cancer Complexity, Integrating Science, and Transforming Patient Outcomes.

AACR Cancer Progress Report 2022: Decoding Cancer Complexity, Integrating Science, and Transforming Patient Outcomes.

Pregnancy costs with commercial insurance

Background Costs for obstetrical care may be increasing for both patients and insurers. Objective To examine predictors of and trends in the cost of medical care during pregnancy. Study design We performed a study of pregnancies from 2009 to 2019 covered by commercial insurance resulting in term, singleton delivery hospitalizations and included in the MarketScan database. The analysis categorized pregnancies based on whether delivery occurred via cesarean versus vaginal delivery and whether pre-gestational diabetes or chronic hypertension was present. We estimated inflation-adjusted total medical costs from 273 days before through 42 days after delivery hospitalization discharge. The analysis evaluated costs for inpatient services, outpatient services, and outpatient drugs separately and trended these costs over the study period. The analysis dichotomized total medical costs into insurer liability versus out-of-pocket patient costs. The study used quantile regression models fit separately to evaluate costs for vaginal and cesarean delivery including demographic and medical characteristics. Results The analysis included 1,952,432 pregnancies covered by commercial insurance. From 2009 to 2019, median total medical costs increased from $14,091 (IQR $11,122–$18,417) to $19,645 (IQR $14,676–$27,959) with median inpatient costs increasing 36% and median outpatient costs increasing 43%. Out-of-pocket costs rose 65% for inpatient services and 120% for outpatient services. Median total pregnancy costs were higher for women with chronic hypertension (median $22,268, IQR $16,809–$30,901, p < .01), pregestational diabetes (median $20,786, IQR $15,702–$28,714, p < .01), and cesarean delivery (median $20,098, IQR $15,748–$26,889 versus median $14,904, IQR $11,728–$19,785 for vaginal delivery, p < .01). In adjusted analyses, chronic hypertension, diabetes, and cesarean delivery were associated with increased median total costs. Conclusion Total and out-of-pocket medical costs for maternity care are increasing among commercially insured patients. Chronic hypertension, pregestational diabetes, and cesarean delivery are important predictors of costs.