Direct Medical Care Costs Research Articles

Patient information, communication and competence empowerment in oncology (PIKKO) \u2013 evaluation of a supportive care intervention for overall oncological patients. Study protocol of a non-randomized controlled trial

BackgroundCancer patients have to undergo a difficult medical therapy and are also confronted with various psychological, social and economic problems. Support is available from many providers, but patients often gain no access to it. Accordingly, there is a need for a single point of contact that can provide advice, information and assistance. In the state of Saarland, Germany, a supportive new consulting and information path (PIKKO) for all types of cancer is currently evaluated by the German Cancer Society, the Cancer Society of the Saarland, three statutory health insurances and the Jena University Hospital. PIKKO is designed to improve quality of life, self-efficacy, health literacy and patient satisfaction and to reduce psychological distress, related health care costs and the days of inability to work. This methodical work presents the process and analysis planning of this evaluation.MethodsThe study population includes all cancer types, both new and existing diseases. PIKKO (with patient navigator, oncological knowledge database, specialized oncological counseling) is evaluated within a controlled, non-randomized, comparative, multicenter, longitudinal design. In addition to patient surveys, data from statutory health insurances and utilization data from the web database are collected, and interviews with patient navigators and doctors are carried out. Patients are assigned to a control (usual care) or an intervention group (u. c. + PIKKO). Primary outcome is the health related quality of life (SF-12) six months after baseline. Secondary outcomes are self-efficacy (GSE), psychological distress such as depression (PHQ-9) or anxiety (GAD-7), health literacy (HLS-EU-Q47) and patient satisfaction in health care (Qualiskope-A). Furthermore, the time course of direct costs of medical care (e.g. work disability days) and usage data of the intervention modules are analyzed. Among other statistical procedures, we use t-tests, univariate tests and growth curve models.DiscussionIf PIKKO proves to be effective, recommendations can be made to health organizations, which should lead to the concept being rolled out throughout Germany and included into oncological guidelines. We expect PIKKO to be a useful addition to usual cancer care, helping to improve the quality of life of cancer patients and reduce healthcare costs.Trial registrationThis study was retrospectively registered in the German Clinical Trial Register under DRKS00016703 (21.02.2019, the reason for the delay was the prioritization of the study management in the first year to establish the new approach into practice). https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00016703

PRS26 MEDICAL COST IN UPPER RESPIRATORY TRACT INFECTIONS IN CHILDREN IN AMBULATORY CARE

The aim of this study was to estimate the direct cost per episode and the annual cost for URTI in children in Ambulatory Health Centers of the Ministry of Public Health (MPH) of Ecuador. This is a cost of illness study of medical costs with a provider perspective and a micro-costing approach. This includes medical care, tests, diagnosis and medication as principal resources. The International Classification of Disease (ICD) – 10 was used for selection of the diagnosis criteria for URTI. The data source for the resources use and data collection included in this study were the Electronic Health Records (EHR) of all the patients from one Health Center of the Ministry of Public Health in Ecuador. We included 380 electronic health records of children 1 – 18 years old. We found a re-consultation rate of 22,89%, a medicine prescription rate of 95.52% and an antibiotic prescription rate of 45,26%. Complementary use of laboratory tests and imaging were low. The first medical consultation accounted for 71,9% of the total cost of URTI, the following visits accounted for 11.82% and medication accounted for 14,68%. Antibiotics accounted for 58,92% of the total cost of medication. The direct medical cost to the MPH of Ecuador of one episode of URTI in children in primary care was around $19.5 (95% CI: $18.73, $20.27) and the total cost of URTI cases in children to the MPH in 2017 accounted for $ 26.4 m (95% CI: $25.380 m to $27.47 m). Re-consultation and the prescription of medication represent an important part of the direct cost of medical care of URTI.

Costo anual de la atención médica de pacientes con dermatitis atópica moderada a grave en México. Estudio multicéntrico

In Mexico, the economic burden of medical care for patients with atopic dermatitis is unknown. To determine the annual direct medical costs of the treatment for patients with moderate to severe atopic dermatitis who receive medical attention at "Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado" (Institute for Social Security and Social Services for State Workers, better known as ISSSTE), as well as the main variables associated with it. A multicenter, retrospective cohort study. Clinical records of patients with moderate to severe atopic dermatitis were reviewed and a multivariate analysis was designed by using a generalized linear model. 65 patients were included; 41 of them (63.07 %) had moderate atopic dermatitis, and 24 (36.92 %) had severe AD; 39 (60 %) of them were female patients. In groups with severe atopic dermatitis, statistically significant differences were observed in matters of the duration of the evolution of the disease, comorbidities, intense pruritus, and depression. The average annual cost of medical care for patients with moderate atopic dermatitis was 1527 ± 623 USD, and for patients with severe atopic dermatitis the cost was 9487 ± 8990 USD. Significant differences were observed in dermatology consultations, referrals, laboratory and diagnostic studies, and the number of drugs prescribed by physicians. With the multivariate analysis, it was identified that the highest cost was presented by severe patients (p = 0.0001) who were younger and had comorbidities, along with diagnosis of depression. The severity of atopic dermatitis, the age average, the presence of comorbidities, and the diagnosis of depression are the variables with the highest association and impact on the direct cost of medical care.

Economic damage of risk factors associated with morbidity and mortality from major chronic non-communicable diseases in Russia in 2016

Aim.To assess the socioeconomic damage of risk factors associated with morbidity and mortality from major chronic non-communicable diseases (CNCDs) in the Russian population in 2016.Material and methods.The following RF were included in the analysis: smoking, alcohol abuse, high salt intake, insufficient consumption of vegetables and fruits, consumption of processed red meat, low physical activity, obesity, hypertension (HTN), which have a significant causal relationship with the major CNCDs: cardiovascular diseases (CVDs), type 2 diabetes, chronic obstructive pulmonary disease (COPD), cancer of 10 locations (lung, breast, cervix, ovary, prostate, kidney, stomach, liver, pancreas, colon). Based on the data on the RF prevalence in the Russian population by ESSE-RF study and relative risks by large studies, the population attributable risk for each CNCD was estimated. We used the data of the Federal State Statistics Service, annual forms of Federal Statistical Observation, as well as the results of the Government Guarantee Program for free medical care and the corresponding diagnosis-related groups for 2016. The direct costs of the healthcare system and economic losses due to morbidity and mortality from the major CNCDs associated with the considered RF are determined. The calculations were performed in Microsoft Excel 10.0.Results.Indirect losses due to premature mortality prevail over direct costs of medical care and disability benefits in the economic damage structure of each RF. The largest damage of four major CNCDs was associated with HTN — 869,9 billion rubles, which is equivalent to 1,01% of gross domestic product (GDP). The next places were taken by obesity — 605,8 billion rubles (0,7% of GDP), smoking — 421,4 billion rubles (0,49% of GDP) and low physical activity — 273,0 billion rubles. (0,32% of GDP). The contribution of improper feeding (high salt intake, insufficient consumption of vegetables and fruits, consumption of processed red meat) amounted to 0,17% of GDP (145,3 billion rubles), 0,19% of GDP (160,9 billion rubles) and 0,10% of GDP (83,4 billion rubles), respectively. Alcohol abuse made the smallest contribution to CNCD-related damage — 82,5 billion rubles (0.1% of GDP). This is due to the low prevalence of alcohol abuse in the Russian population according to ESSE-RF study.Conclusion.Assessment of the economic damage of CNCD RF allows determining the priority areas in healthcare and substantiating the effectiveness of CNCD preventive measures aimed at reducing the RF impact, and, consequently, the burden on the healthcare system and the national economy.

Economic damage of risk factors associated with morbidity and mortality from major chronic non-communicable diseases in Russia in 2016

Aim. To assess the socioeconomic damage of risk factors associated with morbidity and mortality from major chronic non-communicable diseases (CNCDs) in the Russian population in 2016. Material and methods. The following RF were included in the analysis: smoking, alcohol abuse, high salt intake, insufficient consumption of vegetables and fruits, consumption of processed red meat, low physical activity, obesity, hypertension (HTN), which have a significant causal relationship with the major CNCDs: cardiovascular diseases (CVDs), type 2 diabetes, chronic obstructive pulmonary disease (COPD), cancer of 10 locations (lung, breast, cervix, ovary, prostate, kidney, stomach, liver, pancreas, colon). Based on the data on the RF prevalence in the Russian population by ESSE-RF study and relative risks by large studies, the population attributable risk for each CNCD was estimated. We used the data of the Federal State Statistics Service, annual forms of Federal Statistical Observation, as well as the results of the Government Guarantee Program for free medical care and the corresponding diagnosis-related groups for 2016. The direct costs of the healthcare system and economic losses due to morbidity and mortality from the major CNCDs associated with the considered RF are determined. The calculations were performed in Microsoft Excel 10.0. Results. Indirect losses due to premature mortality prevail over direct costs of medical care and disability benefits in the economic damage structure of each RF. The largest damage of four major CNCDs was associated with HTN — 869,9 billion rubles, which is equivalent to 1,01% of gross domestic product (GDP). The next places were taken by obesity — 605,8 billion rubles (0,7% of GDP), smoking — 421,4 billion rubles (0,49% of GDP) and low physical activity — 273,0 billion rubles. (0,32% of GDP). The contribution of improper feeding (high salt intake, insufficient consumption of vegetables and fruits, consumption of processed red meat) amounted to 0,17% of GDP (145,3 billion rubles), 0,19% of GDP (160,9 billion rubles) and 0,10% of GDP (83,4 billion rubles), respectively. Alcohol abuse made the smallest contribution to CNCD-related damage — 82,5 billion rubles (0.1% of GDP). This is due to the low prevalence of alcohol abuse in the Russian population according to ESSE-RF study. Conclusion. Assessment of the economic damage of CNCD RF allows determining the priority areas in healthcare and substantiating the effectiveness of CNCD preventive measures aimed at reducing the RF impact, and, consequently, the burden on the healthcare system and the national economy.

Dreaming of a New World Where Alzheimer's Is a Treatable Disorder.

Alzheimer’s disease (AD) is the most common form of dementia. It’s a chronic and untreatable neurodegenerative disease with irreversible progression and has important social and economic implications in terms of direct medical and social care costs. Despite prolonged and expensive efforts employed by the scientific community over the last few decades, no effective treatments are still available for patients, and the development of disease-modifying drugs is now a really urgent need. The recent failure of clinical trials based on the immunotherapeutic approach against amyloid-β(Aβ) protein questioned the validity of the “amyloid cascade hypothesis” as the molecular machinery causing the disease. Indeed, most attempts to design effective treatments for AD have been based until now on molecular targets suggested to be implicated in AD pathogenesis by the amyloid cascade hypothesis. However, mounting evidence from scientific literature supports the view of AD as a multifactorial disease that results from the concomitant action of multiple molecular players. This view, together with the lack of success of the disease-modifying single-target approaches, strongly suggests that AD drug design needs to be shifted towards multi-targeted compounds or drug combinations acting synergistically on the main core features of disease pathogenesis. The discovery of drug candidates targeting multiple factors involved in AD would greatly improve drug development. So, it is reasonable that upcoming strategies for the design of preventive and/or therapeutic agents for AD point to a multi-pronged approach including more than one druggable target to definitely defeat the disease.

The Direct Medical Care Costs Associated with Gastric Cancer in a Third-level Hospital in Iran

Background: Approximately 20 million individuals are afflicted with cancer worldwide. Gastric cancer is the fourth leading cause of death in the world today. The aim of this study was to evaluate the direct medical care costs of gastric cancer patients in a tertiary teaching hospital in Iran. Methods: The present study is descriptive-analytical, carried out in two main stages. In the first stage we designed a form based on valid international guidelines. The second step identified the costs of diagnosis and treatment of gastric cancer. To analyze the cost data, descriptive statistics such as mean and standard deviation were utilized. We used nonparametric statistical tests such as Mann-Whitney, Wilcoxon in SPSS 16 software for data analysis. Results: In this study, the records of 449 gastric cancer patients who had referred to Omid tertiary teaching hospital of Mashhad between the years 2005 and 2015 were studied. According to the results, the highest average costs were related to patient hospitalization costs. Based on the significance level of the Mann Whitney test, no remarkable difference could be seen in the total costs of metastatic and non-metastatic patients (P-value: P> 0.05). Conclusion: Organizations such as: insurance agencies, charities and financial institutions need to adopt new policies to reduce patients’ expenditures, remove financial barriers and prevent patients from facing catastrophic costs.

Direct cost of medical care in patients with gonarthrosis

ObjectiveTo determine the cost of medical care in patients with gonarthrosis. Material and methodsCost study in patients over 40 years of age with gonarthrosis, diagnosed according to the radiological classification of Kellgren and Lawrence. The average annual cost (euros) was estimated taking the unit cost plus average use of services such as family medicine, imaging, laboratory, electrodiagnosis, orthopaedics, hospitalisation, physical therapy, surgery, nutrition, preoperative assessment and medication. Projections based on assumptions were made for three scenarios. ResultsGrade 2 gonarthrosis predominated at 39.7% (95% confidence interval, 33.8–45.6). The annual cost of care for a patient with gonarthrosis was €108.87 in the intermediate scenario, €86.73 in the lower cost scenario and €132.60 in the higher cost scenario. For a population of 119,530,753 inhabitants, with 10,937,064 gonarthrosis patients, the annual cost in the intermediate scenario was €1,190,685,273 and represented 4.48% of the health expenditure. ConclusionThe average annual cost of gonarthrosis is relatively low, but when related to prevalence and prevalence trends, it can become a serious problem for health services.

Comparative modeling of socio-economic burden among smokers, nonsmokers and former smokers

Aim : to assess the socio-economic burden of smoking in the Russian Federation for 2017. Materials and methods . The socio-economic burden was calculated and extrapolated to the entire population of smokers in Russia and then compared with equal sized populations of quitters and non-smokers. Results. In 2017, the burden of tobacco smoking (including the direct costs of medical care and payment for temporary disability, as well as indirect costs - the under-received gross domestic product (GDP) due to temporary disability) was 510.6 billion rubles. The difference between the smokers and the equal-sized non-smoking population is 327.6 billion rubles. The difference between the smokers and the equalsized population of quitters was 216.1 billion rubles. Conclusion. Costs associated with smoking are sizable. Helping quit tobacco smoking (government anti-smoking measures, pharmacotherapy etc.) will not only improve the quality of life and health expectancy of smokers but also save a considerable amount of budget funds.

Direct medical cost of oropharyngeal cancer among patients insured by Medicaid in Texas

ObjectivesThe aim of this study was to estimate the direct 2-year mean incremental medical care costs for incident oropharyngeal cancer (OPC) from the perspective of the Texas Medicaid program. MethodsOPC patients treated from 2008 to 2012 were selected in the Texas Medicaid database. Using a two-step 1:1 propensity score matching method, we selected controls to determine the differential cost associated with OPC. Monthly and yearly direct costs were estimated for 2 years after the cancer diagnosis. For patients without 2-year complete follow-up, a generalized linear model with gamma distribution and log link function was applied to predict costs for the censored months. ResultsA total of 352 patients with OPC and the same number of controls were included in the study. Among OPC patients, 204 (58%) were covered by Medicaid and Medicare, and 148 patients (42%) were insured under Medicaid only. The adjusted first- and second-year mean differential costs were $45,102 and $11,684 for Medicaid-only enrollees and $5734 and $2162 for Medicaid-Medicare dual-eligible enrollees, respectively. Being male, Hispanic, Medicaid-only eligible, living in the Harlingen region, and having more comorbidities were positively associated with monthly cost. Lubbock residents experienced lower costs. ConclusionsThe direct incremental medical costs associated with OPCs among patients insured by Texas Medicaid were substantial in the first 2 years after cancer diagnosis and should be considered in assessing the economic consequences of increasing the investment in HPV vaccination in Texas.

Cervical, Vaginal, and Vulvar Cancer Costs Incurred by the Medicaid Program in Publicly Insured Patients in Texas.

To determine from the perspective of the State of Texas, the direct medical care costs associated with cervical, vaginal, and vulvar cancers in Texas Medicaid enrollees. We conducted a case-control study and searched Texas Medicaid databases between 2008 and 2012 for eligible cancer patients. A comparison group was selected for each cancer site using a 2-step 1:1 propensity score matching method. Patients were followed for 2 years after cancer diagnosis to estimate monthly and yearly direct medical costs. For each cancer site, the differential cost between patients and the matched comparison individuals was the estimated cost associated with cancer. The study included 583 cervical, 62 vaginal, and 137 vulvar cancer patients and equal numbers of cancer-free comparison individuals. Among the cases, 322 cervical cancer patients, 46 vaginal cancer patients, and 102 vulvar cancer patients were Medicaid-Medicare dual eligible enrollees. For Medicaid-only enrollees, the adjusted first- and second-year mean total differential costs were US $19,859 and $3,110 for cervical cancer, US $19,627 and $4,582 for vaginal cancer, and US $7,631 and $777 for vulvar cancer patients, respectively. For Medicaid-Medicare dual eligible enrollees, adjusted first- and second-year mean total differential costs incurred by Medicaid were US $2,565 and $792 for cervical cancer, US $1,293 and $181 for vaginal cancer, and US $1,774 and $1,049 for vulvar cancer patients, respectively. The direct medical costs associated with cervical, vaginal, and vulvar cancers in Texas Medicaid were substantial in the first 2 years after cancer diagnosis, but dual eligibility for Medicare coverage attenuated Medicaid costs.

Cost Benefit of High-Dose vs Standard-Dose Influenza Vaccine in a Long-Term Care Population During an A/H1N1-Predominant Influenza Season

ObjectivesInfluenza is a leading cause of avoidable admissions for nursing home (NH) residents. We previously evaluated the effectiveness of a high-dose trivalent influenza vaccine (HD) compared to a standard-dose influenza vaccine (SD) through a cluster-randomized trial of NH residents. Fewer residents from facilities randomized to HD were hospitalized. In this article, we extend our analyses to consider direct medical care costs relative to vaccine costs for HD ($31.82/dose) as compared to SD ($12.04/dose). DesignPost hoc, cost-benefit analysis. Setting and participantsFrom the participating NH facilities (n = 817), we identified Medicare fee-for-service enrollees who were long-stay residents (>100 days) at the start of the 2013-2014 influenza season (November 1–May 31). The intervention was residence in a facility randomized to HD or SD influenza vaccine. MethodsWe summed expenditures from long-stay NH residents' Medicare Part A, B, and D fee-for-service claims and compared person-level expenditures between residents of facilities offering HD vs SD. Expenditures were adjusted for clustering of residents within NHs, person-time, and prespecified covariates using 2-part, generalized linear models with bootstrapped standard errors. We examined the incremental cost-benefit of HD vs SD vaccines from a payer perspective. ResultsThere were 18,605 and 18,658 Medicare fee-for-service long-stay residents in facilities offering HD and SD, respectively. Person- and facility-adjusted total expenditures differed by $546 (P = .006). The $20 incremental cost of HD to SD offset adjusted expenditures for a net benefit of $526 per NH resident and a financial return on investment of 546/20 = 27:1. Conclusions/implicationsThe use of HD influenza vaccine in long-stay NH residents reduced total health care expenditures for a net benefit despite HD being more expensive per dose. These cost offsets applied to Medicare beneficiaries residing in NHs could result in important savings to the Medicare program.

Assessing the Need for a Biosimilar: A Systematic Literature Review of the Treatment Burden of Rituximab in Hematological Malignancies

BACKGROUND: Advanced targeted therapies have improved survivals and efficacies in patients with certain hematology conditions. However, the treatment costs and safety are some concerns among healthcare providers, patients, and payers.OBJECTIVES: To identify and characterize the treatment burden of rituximab, focusing on drug cost, toxicity, and other treatment-related costs in hematological malignancies, given the anticipated market entry of biosimilar products.[1]METHODS: We conducted a systematic literature review (SLR) using the online version of Index Medicus identified relevant publications using pertinent search terms (see Table) to capture treatment-related cost and non-cost burden publications in English language, publication dates 01/01/2010 to 01/24/2018.RESULTS: Of the 704 publications returned in the search, a total of 28 US and ex-US treatment burden studies (9 cost, 16 non-cost, and 3 drug route comparison studies) were included in the review. US (4) and ex-US (5) treatment cost studies found that direct medical costs of care were dramatically increased with the addition of rituximab or that rituximab represented a large proportion of total costs of care. For publications with calculated benefits associated with treatment, the addition of rituximab to CT was coupled with life-year gains and lower mortality. A large observational study found no difference in all-cause hospitalization rates in the 12 months following rituximab treatment. While studies designed to evaluate rituximab toxicity have found the addition of rituximab to CT to be associated with a general increase in incidence of adverse events (AEs) overall, 1 prospective study found no subsequent decline in quality of life (QOL), and another prospective study observed a significant increase in time without disease symptoms or toxicity (8.33 months) and less time spent in relapse. Both rituximab maintenance (after successful induction) and retreatment at progression were associated with a decline in illness-related anxiety (1randomized, Phase III trial in indolent non-Hodgkin lymphoma), while rituximab maintenance was associated with significantly decreased pain and other illness-related symptoms vs observation (2 studies). Five studies (3 US; 2 ex-US) analyzed infusion-related reactions (IRRs) and/or rapid infusion use. Overall, IRRs, especially with first infusions, were common (40%-63%), but primarily low-grade (I-II), and rituximab was usually well-tolerated on same-day rechallenge. Marked patient time was saved with rapid infusion. An SLR and meta-analysis of rapid rituximab infusion further characterized rapid infusion, identifying all IRRs as Grade I or II with a pooled incidence of 2.6%. Three ex-US studies evaluated economic endpoints comparing intravenous and subcutaneous (SC) preparation and administration of rituximab. One study calculated higher labor costs for SC rituximab, while 2 studies calculated lower staff time for SC rituximab; all studies identified shorter patient treatment/chair time for SC rituximab.CONCLUSIONS: We found that the treatment-related cost burden of rituximab in malignant conditions is substantial, while its associated toxicity is relatively low, and patient QOL is maintained or improved. Incident and increased toxicities associated with rituximab added to CT may or may not be exclusively attributable to rituximab. Administration rate and route influence economic endpoints with rituximab use. These findings highlight the potential economic benefit of lower-cost biosimilar rituximab products for patients, health care systems, and payers.[1] This Abstract is not intended to refer to any particular biosimilar product or use thereof. DisclosuresJames:Teva: Consultancy; Roche: Consultancy. Trautman:Teva: Consultancy; Roche: Consultancy. Hoehn:Teva: Employment. Szabo:Teva: Employment. Tang:Teva: Employment.

Direct medical costs for patients with schizophrenia: a 4-year cohort study from health insurance claims data in Guangzhou city, Southern China

BackgroundSchizophrenia is one of the leading public health issues in psychiatry and imposes a heavy financial burden on the healthcare systems. This study aims to report the direct medical costs and the associated factors for patients with schizophrenia in Guangzhou city, Southern China.MethodsThis was a retrospective 4-year cohort study. Data were obtained from urban health insurance claims databases of Guangzhou city, which contains patients’ sociodemographic characteristics, direct medical costs of inpatient and outpatient care. The study cohort (including all the reimbursement claims submitted for schizophrenia inpatient care during November 2010 and October 2014) was identified using the International Classification of Diseases Tenth version (F20). Their outpatient care information was merged from outpatient claims database. Descriptive analysis and the multivariate regression analysis based on Generalized Estimating Equations model were conducted.ResultsA total of 2971 patients were identified in the baseline. The cohort had a mean age of 50.3 years old, 60.6% were male, and 67.0% received medical treatment in the tertiary hospitals. The average annual length of stay was 254.7 days. The average annual total direct medical costs per patient was 41,972.4 Chinese Yuan (CNY) ($6852.5). The inpatient costs remained as the key component of total medical costs. The Urban Employee Basic Medical Insurance enrollees with schizophrenia had higher average costs for hospitalization (CNY42,375.1) than the Urban Resident Basic Medical Insurance enrollees (CNY40,917.3), and had higher reimbursement rate (85.8% and 61.5%). The non-medication treatment costs accounted for the biggest proportion of inpatient costs for both schemes (55.8% and 64.7%). Regression analysis suggested that insurance type, age, hospital levels, and length of stay were significantly associated with inpatient costs of schizophrenia.ConclusionsThe direct annual medical costs of schizophrenia were high and varied by types of insurance in urban China. The findings of this study provide vital information to understand the burden of schizophrenia in China. Results of this study can help decision-makers assess the financial impact of schizophrenia.

The Impact of Inflammatory Bowel Disease in Canada 2018: Direct Costs and Health Services Utilization.

The Impact of Inflammatory Bowel Disease in Canada 2018: Direct Costs and Health Services Utilization.

Trauma craneal no accidental en niños: costo económico directo de la atención médica en un hospital de tercer nivel

Abusive head trauma (AHT) is an extreme form of physical abuse that is produced by abruptly shaking an infant or toddler. To describe the direct economic cost of care during hospitalization of 14 children with confirmed diagnosis of AHT in a pediatric hospital. Analysis of the cost of disease in patients with AHT attended to between 2001 and 2010. Partial direct economic cost of medical care (days of hospital stay, laboratory tests and imaging studies, surgical procedures and subspecialist consultations) was calculated adjusting for inflation, with year 2001 taken as base year. Patients were classified in three groups (moderate, severe and fatal AHT). Descriptive and sensitivity analysis was carried out. Patients with severe AHT generated higher medical care costs ($105,794.88 ± 33,201.91) in comparison with the group of moderate ($37,012.95, ± 7,154.87) and fatal AHT ($18,595.04 ± 6424.47) (p <0.05). Total cost was $665,467.98 Mexican pesos ($71,249.25 international dollars). Total cost for the 14 patients was an elevated figure, as in other parts of the world. The direct economic cost is closely related to the severity of the clinical presentation.

Epidemiology and direct costs of atopic dermatitis in Poland based on the National Health Fund register (2008–2017)

IntroductionEpidemiological data indicate significant differences in atopic dermatitis (AD) prevalence between countries.AimThe purpose of this study is to (i) analyse the recorded prevalence of atopic dermatitis (diagnoses of AD reported to the Polish National Health Fund (NHF)) and to (ii) estimate direct costs of medical care for AD incurred by the NHF.Material and methodsThe analysis was based on data reported to the database of the public payer (NHF). The prevalence rates were calculated using the NHF data and population estimates were obtained from the Central Statistical Office of Poland (GUS).ResultsIn 2017, the annual prevalence rate of AD in the Polish population was 32.5 per 10,000 inhabitants (34.7/10,000 for women and 30.1/10,000 for men). The highest prevalence was observed in the youngest age groups (300/10,000 in children up to 4 years of age and 141/10,000 in 5–9-year-olds). The prevalence rate decreased with age and AD was the least prevalent in patients over 85 years of age (4/10,000). In 2008–2017, NHF expenditure on AD treatment varied between PLN 19.9 million (EUR 5.6 million) in 2008 and PLN 28.4 million (EUR 6.5 million) in 2016.ConclusionsThe prevalence rates of AD in Poland estimated on the basis of NHF data are significantly lower than those reported in previous epidemiological studies conducted in Poland and worldwide. This may indicate that the prevalence of AD in the Polish population is underestimated or that there are no adequate disease control measures in patients with a confirmed diagnosis.

Medical Costs for Osteoporosis-Related Fractures in High-Risk Medicare Beneficiaries.

To estimate the incremental direct medical care costs associated with first fracture observable in high-risk older adults. Retrospective analysis of claims and survey data over a 3-year period from the Health and Retirement Study (HRS), a nationally representative biennial study of individuals aged 50 and older. United States. Participants were HRS respondents who consented to have their Medicare claims data linked to the HRS data, were aged 65 or older, had at least 1 risk factor for fracture observable in the data, and experienced a fracture between 1996 and 2008 (n = 689) and their propensity score-matched controls (n = 689). Total Medicare, inpatient, outpatient, emergency department, physician office visit, and prescription drug care expenditures were primary outcomes. Two-staged generalized linear models were estimated using a difference-in-differences model. Fracture cases' total Medicare expenditures increased by $13,929 (95% confidence interval (CI)=$11,920-15,938, p <.001) more than those of matched controls from the year before the index or fracture date to 1 year after the index date. Inpatient expenditures of $12,751 (95% CI=$10,790-14,7111, p < .001) more for fracture cases than comparison cases primarily drove this increase. Two and 3 years after fracture, there were no significant differences in growth in expenditures between the two groups. Results did not vary according to whether the fracture was at the hip or other site. Fractures impose a significant economic burden, especially in the first year after the fracture, in Medicare beneficiaries with at least 1 risk factor for fracture. Our sample was limited to community-dwelling individuals, and we are unable to control for fracture history before the study period. Costs may be greater for those in skilled nursing and similar facilities and for those who have had a previous fracture. J Am Geriatr Soc 66:2298-2304, 2018.

Budget Impact Analysis of a Renal Point-of-Care Test in Dutch Community Pharmacies to Prevent Antibiotic-Related Hospitalizations.

ObjectivesMedication errors that lead to adverse drug reactions are a key cause of unintentional patient harm and subsequent economic burden. To prevent this, measurement of renal function could be considered. The aim of this study was to determine the budget impact of obtaining and evaluating renal function in community pharmacies in the Netherlands to prevent antibiotic-related hospitalizations.MethodsA decision model was built to simulate the process of antibiotic prescriptions in community pharmacies with and without the use of a point-of-care test (PoCT) in patients aged 65 years and older. By using a PoCT, the number of patients with renal function values available increases, leading to the possibility of dose adjustment when necessary. In turn, this might avoid hospitalizations. For this study, real-life patient data were used from 351 community pharmacies. Direct costs of renal function screening, antibiotic treatments, and medical care due to antibiotic-related hospitalization were included.ResultsThe budget impact analysis showed annual cost-savings of €86 per patient through the availability of renal function values in Dutch community pharmacies. Savings were mostly due to avoided hospitalizations.ConclusionObtaining and evaluating renal function in community pharmacies by point of care tests is expected to be cost-saving in the Netherlands.Electronic supplementary materialThe online version of this article (10.1007/s40258-018-0426-2) contains supplementary material, which is available to authorized users.

Medical Care Costs Associated with Genital Warts for Commercially Insured US Patients.

Genital warts are caused by infection with human papillomavirus (HPV) and are associated with significant morbidity. Primary prevention of genital warts is possible through HPV vaccination, but vaccination rates remain low in the USA. When deciding to implement HPV vaccination programs, public health officials and policy makers rely on cost-effectiveness studies that accurately reflect costs associated with morbidity and mortality. However, previous information on the cost of treating genital warts was outdated. We estimated the mean direct medical care costs associated with genital warts in the USA. This was a retrospective case-control study of patients diagnosed with genital warts and matched controls. We used commercial healthcare claims data from 2011 through 2014 to estimate total 1- and 2-year costs from date of diagnosis. We used a generalized linear model to identify factors associated with monthly costs. We identified 34,686 eligible cases of genital warts during the period 2011-2014. The first 2-year mean direct medical cost differences between cases and controls were US$6737 for the USA. Costs were significantly higher in the first 3months following diagnosis and were higher among older individuals, women, those with co-morbidities or psychiatric illnesses, and those located in the south and southwest USA. The mean direct cost of treating genital warts is approximately US$6700 in the first 2years after diagnosis in the USA. These data can assist policy makers in decisions with respect to allocation of resources to implement HPV vaccine programs.