Direct Costs Research Articles

Developing a cost-predictive model for hospital construction projects

ABSTRACT Hospital construction projects require the integration of innovative technologies, making them complex and challenging to estimate accurately. Without reliable guidelines, lists of considerations, or predictive models, decision-makers may choose an unsuitable contractor, leading to cost overruns and project delays. This research used quantitative and qualitative methods, including expert opinions and focus groups, to address this issue and identify critical factors affecting cost estimation in hospital construction. Using multi-regression analysis, historical data was analyzed to establish a cost-predictive model. The study identified 24 factors that determine the most critical criteria affecting the cost estimation of hospital construction. This model can evaluate the estimated direct cost provided to decision-makers in the early stages of the project with over 95% accuracy. The research results can assist professionals in the construction industry in better estimating and managing the costs of hospital construction projects, reducing risks, and improving project outcomes. Key findings indicate that specific components such as site and electrical works show average percentage errors of 8.02% and 5.11%, respectively, highlighting areas prone to cost estimation inaccuracies. This insight directs focus on improving accuracy in these critical sectors, thus further refining cost management strategies for hospital construction projects.

Quantitative sustainability assessment for in-situ electrical resistance heating coupled with steam enhanced extraction: An effective approach for the development of green remediation technologies

There is a lack of quantitative methodology for the sustainability assessment based on field data in the process of innovative technology development for groundwater remediation. This study developed a quantitative assessment framework, a model based on the life cycle assessment integrated with best management practices (LCA-BMPs), to evaluate the environmental, economic, and social sustainability of in-situ electrical resistance heating coupled with steam enhanced extraction (ERH-SEE), an innovative technology being demonstrated in the field. The results indicated that ERH-SEE offered better environmental sustainability performance compared to ERH only, with a reduction in carbon emissions by 52.6 %. ERH-SEE also significantly reduces human toxicity, resource consumption, and ecosystem impacts under the same remediation scenarios. The further assessment indicated that if taking the renewable energy share in energy structure in different countries into consideration, higher shares of renewable energy used in energy supplies can substantially reduce the environmental footprint of the studied scenarios. The economic sustainability assessment results showed that ERH-SEE was more sustainable than ERH only, as it reduces direct economic costs by 35.7 % and provides higher levels of worker employment. Regarding the social sustainability, ERH-SEE involved more complex operational procedures and presented more health risk exposure scenarios compared to ERH only, resulting in slightly more pronounced worker safety issues. Based on the final normalized results, the overall sustainability results of ERH-SEE and ERH only were 78.4 and 61.5, respectively, demonstrating that the sustainability performance of ERH-SEE was better than ERH only. It can be concluded that the application of ERH-SEE in groundwater remediation where significant heterogeneities occur in subsurface can increase the sustainability in developing countries, due to the lower percentage in renewable electricity in the energy supply. This study provided new insights into the technology development for the remediation of soil and groundwater contamination.

The Economic Burden of Type 2 Diabetes Mellitus in Pakistan: A Cost of Illness Study.

Type 2 Diabetes Mellitus (T2DM) is a highly prevalent disease with a chronic nature and poses a significant health burden worldwide, with no exception in Pakistan. Hence, this study aimed to explore the financial burden of T2DM in Pakistan through cost of illness analysis. A prevalence-based, cross-sectional study was conducted using a structured data collection tool from the patient's perspective. Through structured interviews by trained data collectors, the data regarding direct medical costs, direct non-medical costs, and indirect costs were collected and further verified through prescriptions and bills. After testing the normality of data, mean and median with interquartile range were used to present cost data, while non-parametric tests, i.e., the Mann-Whitney U test and the Kruskal-Wallis test, were used to assess factors associated with costs, as cost data were not normally distributed. The study included 522 participants, with a majority being female (54%) and aged between 41 and 60 years (64%). The mean annual total cost per patient was USD 235.1 (median = USD 162.8), comprising direct medical costs, 93.2% (mean = USD 219.2; median = USD 150.0), direct non-medical costs, 5.3% (mean = USD 12.4; median = USD 7.1), and indirect costs, 1.5% (mean = USD 3.5; median = USD 1.9). Costs were significantly higher for patients with advanced age, high literacy, higher household incomes, duration of diabetes, more than one complication, and using combination therapy. The economic burden of T2DM in Pakistan is substantial, with medication costs being the largest component. Effective management strategies and policy interventions are crucial to mitigate this burden and improve the economic and health outcomes for diabetic patients.

Variations in out-of-pocket spending and factors influencing catastrophic health expenditure of households with patients suffering from chronic conditions in four districts in Sri Lanka

IntroductionHealthcare financing systems, dependent on out-of-pocket expenditure(OOPE), impose a heavy burden on those who use the services regularly, such as patients suffering from chronic diseases. High OOPE for health services leads to decreased utilization of the services and/or catastrophic health expenditure, which would significantly impede the achievement of Universal Health coverage.ObjectiveWe aimed to determine variations in OOPE and factors associated with Catastrophic Health Expenditure (CHE) of households with patients suffering from non-communicable diseases(NCDs) in four districts.Methods A survey was conducted among 2344 adult patients having selected NCD/s. Multi-stage stratified cluster sampling selected respondents from 4 districts representing urban, rural, semi-urban, and estate. Data was collected using a validated interviewer-administered questionnaire. Logistic regression identified the predictors of CHE(> 40%). Significance was considered as 0.05.ResultsCommon NCDs were hypertension(29.1%), diabetes(26.8.0%), hyperlipidaemia(9.8%) and asthma(8.2%). Only 13% reported complications associated with NCDs. Fifty-six percent(N = 1304) were on regular clinic follow-up, and majority utilized western-medical government hospitals(N = 916,70.2%). There were 252 hospital admissions for chronic-disease management in the past 12 months. Majority(86%) were admitted to government sector hospitals. Most patients incurred nearly SLR 3000 per clinic visit and SLR 3300 per hospital admission. CHE was beyond 40% for 13.5% of the hospital admissions and 6.1% of the regular clinic follow-up. Patients admitted to private sector hospitals had 2.61 times higher CHE than those admitted to government sector hospitals.ConclusionsPatients with NCDs incurred high OOPE and faced CHE during healthcare seeking in Sri Lanka. The prevalence of NCDs and complications were high among the participants. Patients with chronic conditions incur high OOPE for a single clinic visit and a hospital admission. Patients incur high OOPE on direct medical costs, and district-wise variations were observed. The proportion with more than 40% CHE on monthly clinic care was high. Patients being followed up in the government sector are more likely to have CHE when obtaining healthcare and are more likely to face barriers in obtaining needed health services. The services rendered to patients with chronic conditions warrant a more integrative approach to reduce the burden of costs and related complications.

Patients’ health care resources utilization and costs estimation across cardiovascular risk categories: insights from the LATINO study

BackgroundAtherosclerotic Cardiovascular Disease (ASCVD) is a global public health concern. This study aimed to estimate the healthcare resource utilization (HRU) and costs stratified by cardiovascular disease (CVD) risk categories using real-world evidence, in a regional population in Portugal.MethodsThis is a retrospective observational study, using data from Electronic Health Records between 2017 and 2021. Patients aged ≥ 40 years, and with at least one general practitioner (GP) appointment in the 3 years before 31st of December 2019, were included. CVD risk categories were determined based on 2021 ESC prevention guidelines. HRU encompassed hospital data (hospitalizations, outpatient and emergency room visits) and GP appointments. Total direct costs per patient were calculated based on the reference cost of the Portuguese legislation for payment methodology on Diagnosis-Related Groups (DRGs).ResultsAnalysis of 3 122 695 episodes, revealed consistent HRU and costs across the five years. Very high-risk patients, showed higher HRU, particularly in hospital admissions. Costs tended to rise with higher CVD risk level. Very high-risk patients with ASCVD had higher costs for hospital admissions, while low-to-moderate risk patients had higher costs for GP visits. Despite a smaller proportion, very high-risk patients with prior ASCVD represent the highest costs per patient across healthcare settings (from 115€ in emergency visits to 2 673€ in hospitalizations), followed by very high-risk patients without prior ASCVD (ASCVD-risk equivalents).ConclusionThis study revealed a substantial HRU and costs by patients with very high CVD risk, particularly those with prior ASCVD. Moreover, ASCVD-risk equivalents emerge as notable consumers, emphasizing the importance of risk assessment and preventive measures in cost-effective management of these patients.

Evaluating Antibiotic Misuse and Cost Analysis Among Hospitalized Dengue Virus-Infected Adults: Insights From a Retrospective Cohort Study.

Dengue is a prevalent cause of acute febrile illness, predominantly in Asia, where it necessitates supportive care without the need for antibiotics. This study aimed to evaluate antibiotic usage and analyze hospitalization costs among adults infected with the dengue virus. This retrospective cohort study was conducted at the Hospital for Tropical Diseases, Thailand, in 2022. Two independent reviewers assessed all adult cases with confirmed dengue from 2016 to 2021. Determinants of inappropriateness were analyzed using Poisson regression. The study included 249 participants with over half presenting with severe dengue or dengue with warning signs upon admission. The cumulative incidence of antibiotic use was 9.3% (95% CI, 8.23-10.47), predominantly involving empirical treatment strategies. Ceftriaxone and doxycycline were the most frequently prescribed antibiotics. Notably, patients who received empirical antibiotics showed no definite or presumed bacterial infections. Among those who received definite strategies, inappropriate durations, including both short treatments and the overuse of broad-spectrum antibiotics, were observed. A private ward admission was identified as a significant predictor of inappropriate use, with an incidence rate ratio of 4.15 (95% CI, 1.16-14.82) compared with intensive care unit admission. Direct medical costs did not differ significantly between appropriate and inappropriate uses. The incidence of antibiotic use among dengue cases was moderate; however, inappropriate use by indication was observed. Antimicrobial stewardship strategies should be encouraged, particularly in patients with dengue with warning signs admitted to a general or private ward. Direct medical costs between appropriate and inappropriate use were comparable.

Is it worth screening quarry workers for TB infection in high-incidence areas? A cost-benefit analysis

BackgroundTuberculosis (TB) infection screening of high-risk groups is an important strategy for achieving End TB targets. A TB infection screening program was implemented for quarry workers from a Portuguese high-incidence area in 2018–2022. We aimed to calculate the cost-benefit of the screening program from the societal perspective. MethodsWe calculated medical and non-medical direct and indirect screening costs and compared them with the cost savings from averted cases of TB disease. We estimated the number of potentially averted TB disease cases based on the risk of progression of TB infection to TB disease found in the literature. ResultsDuring the screening program, 997 workers were screened. TB infection was diagnosed in 215 workers, 150 of those initiated preventive treatment. Screening program total costs were €136,295. Twenty-nine TB cases were potentially prevented, what would have costed €152,386. Savings of €16,091 were obtained (€4516, €40898, and -€29322 from the workers, employers, and NHS, respectively). ConclusionsThe monetary benefit of a TB infection screening program directed to quarry workers in a high-incidence area was greater than its cost. Companies and workers saved substantially more money. TB infection tests that are better predictors of progression to TB disease could reduce NHS costs.

Economic impacts of tourism demand on the European food and accommodation industry

Sustainability strategies have become central topics in the literature on tourism development, given the significant increase in tourism demand in Europe. This study examines the economic (cost) impact of increased tourism demand on the European Food and Accommodation Industry. We employed three distinct models — pooled linear regression, flexible nonparametric, and semiparametric smooth coefficients — using data spanning European countries from 2005 to 2020. Our findings reveal the heterogeneous impacts of tourist arrivals and length of stay on costs. Although the direct effects were predominantly positive, the indirect effects were found to be negative, resulting in a minor overall negative effect on the average. Furthermore, we found that the proportion of domestic tourists has a notable impact on costs, revealing that higher proportions are linked to lower direct costs but higher indirect costs on average. These findings provide valuable insights for industry stakeholders and policymakers alike.

Evolution of evolvability in rapidly adapting populations.

Mutations can alter the short-term fitness of an organism, as well as the rates and benefits of future mutations. While numerous examples of these evolvability modifiers have been observed in rapidly adapting microbial populations, existing theory struggles to predict when they will be favoured by natural selection. Here we develop a mathematical framework for predicting the fates of genetic variants that modify the rates and benefits of future mutations in linked genomic regions. We derive analytical expressions showing how the fixation probabilities of these variants depend on the size of the population and the diversity of competing mutations. We find that competition between linked mutations can dramatically enhance selection for modifiers that increase the benefits of future mutations, even when they impose a strong direct cost on fitness. However, we also find that modest direct benefits can be sufficient to drive evolutionary dead ends to fixation. Our results suggest that subtle differences in evolvability could play an important role in shaping the long-term success of genetic variants in rapidly evolving microbial populations.

A cost-of-illness study of eosinophilic esophagitis in Italy: assessing direct and indirect costs

BackgroundEosinophilic esophagitis (EoE) is a chronic and progressive type 2 inflammatory disease affecting the esophagus. Its prevalence has increased in recent years due to increased awareness, evolving clinical guidelines, and heightened sensitivity among healthcare professionals managing the condition. The exact causes behind EoE’s development remain unknown, and its clinical presentation varies, often leading to significant diagnostic delays depending on the age at which symptoms manifest. Consequently, achieving long-term disease control through heightened awareness becomes imperative. EoE generates a significant clinical burden, resulting in substantial economic consequences for patients, healthcare systems, and society. This study aimed to assess the economic and social impacts on EoE patients within the Italian context.MethodsA cost-of-illness analysis was conducted from two perspectives: the National Health System (NHS) and the societal perspective. This analysis encompassed direct healthcare, indirect healthcare, and non-healthcare costs. Data were collected and assessed through a survey administered to a panel of expert clinicians and EoE-affected patients.ResultsManaging EoE incurs a significant burden on healthcare systems, amounting to €6,852.28 per patient per year. The primary cost component appears to be direct costs, comprising 60.73% of the total cost per patient for this condition, while indirect costs contribute to 29.68% of the overall management expenses.ConclusionThis analysis underscores a substantial financial burden on both the healthcare system and patients affected by eosinophilic esophagitis. It emphasizes the imperative need for a continuous and combined effort from clinicians, patients, and families to promptly recognize symptoms and adaptive behavior to mitigate diagnostic delays.

Economic Burden of Huntington's Disease: Analysis from a Brazilian Tertiary Care Perspective.

Huntington's disease (HD) exerts significant impacts on individuals and families worldwide. Nevertheless, data on its economic burden in Brazil are scarce, revealing a critical gap in understanding the associated healthcare costs. This study was conducted at a tertiary neurology outpatient clinic in Brazil with the aim of assessing annual healthcare service utilization and associated costs for HD patients. We conducted a cross-sectional observational study involving 34 HD patients. A structured questionnaire was applied to collect data on direct medical costs (outpatient services, medications), non-medical direct costs (complementary therapies, mobility aids, home adaptations), and indirect costs (lost productivity, caregiver costs, government benefits) over one year. Significant economic impacts were observed, with average annual direct medical costs of $4686.82 per HD patient. Non-medical direct and indirect costs increased the financial burden, highlighting extensive resource utilization beyond healthcare services. Thirty-three out of 34 HD patients were unemployed or retired, and 16 relied on government benefits, reflecting broader socioeconomic implications. Despite the dataset's limitations, it provides crucial insights into the economic impact of HD on patients and the Brazilian public health system. The findings underscore the urgent need for a more comprehensive evaluation of the costs to inform governmental policies related to HD. Future research is needed to expand the data pool and develop a nuanced understanding of the economic burdens of HD to help formulate effective healthcare strategies for patients.

Multidisciplinary optimization methodology for truss-braced wing aircraft using high-fidelity structure sizing

In this research, a method is developed to optimize the truss-braced wing aircraft configuration in a multidisciplinary design framework. Physics-based high-fidelity methods, that can capture the nature of the configuration changes, are employed for the disciplines where the existing classical methods are not reliable. High-fidelity geometry modeling, structure loading, structure optimization, and aeroelastic sizing methods are integrated into the aircraft multidisciplinary design and optimization. The developed algorithm is applied for the multi-objective optimization of a regional jet aircraft to minimize the cost and weight. The results demonstrate that the cost-optimum solution converges to a higher aspect ratio wing equipped with a higher bypass ratio engine, and a 7.94% reduction in the direct operating cost can be achieved. On the other hand, the weight-optimum wing planform tends to a slightly lower aspect ratio wing with a lower bypass ratio engine, while a 6.18% reduction in take-off weight is achieved. In addition to that, the findings of this study highlight the considerable effect that the engine technology has on the optimum layout, which suggests that the engine technology and its performance should also be a part of the design optimization process. The developed modular framework offers further optimization potential for the truss-braced wing aircraft, as more detailed models can be integrated.

Budget impact analysis on the Italian healthcare system of roxadustat for the treatment of anemia due to chronic kidney disease

Objective: The aim of this study was to evaluate the economic consequences of the introduction of roxadustat on the market as treatment for chronic kidney disease (CKD)-related anaemia in Italy. Method: A budget impact model was developed to assess the economic impact of the introduction of roxadustat for the management of patient with CKD-related anaemia. The analysis was conducted considering National Health Service (NHS) perspective and three years’ time horizon. Eligible population for the treatment with roxadustat was estimated through published literature and clinicians’ support. Direct healthcare costs included drug acquisition (list prices for base case) and administration costs, monitoring costs, cost per blood transfusion, costs related to the management of adverse events and dialysis costs. Results: The model estimated a three years expenditure associated with the management of patients with CKD-related incident anaemia in Italy of about € 260 and € 44.6 million for non-dialysis dependent (NDD) and dialysis-dependent (DD) patients respectively. The introduction of roxadustat on the market could generate a reduction in the expenditure related to the iron supplementation both for NDD and for DD patients (−€ 397,305 and −€ 50,135 over three years of the analysis, respectively) and a reduction in the pharmaceutical expenditure for NDD patients (−€ 2.3 million, −€ 7.5 million and −€ 13 million at first, second and third year of the analysis). Overall, the introduction of roxadustat could generate a saving for NHS approximately equal to € 2.3, € 7.5 and € 13 million at first, second and third year of the analysis. Conclusion: The introduction of roxadustat could generate a reduction in the expenditure for the management of patients with CKD anaemia. A scenario analysis which used tender prices for ESAs and hypothesis of confidential discount for roxadustat showed that the saving for NHS will be kept if roxadustat’s discount is greater than 60.3%.

Costs of treating type 2 diabetes mellitus and its complications

The major driver of the costs of treating patients with diabetes mellitus type 2 (DM2) is its complications, which in developing countries are a consequence of poor glycemic control due to the low availability of novel, innovative antidiabetic drugs. We aimed to determine the ratio of direct medical costs arising from DM2 to the direct costs of its complications, as well as their main predictors. This was a retrospective cohort study of health care utilization and direct medical costs for adults with DM2, with (inpatients) or without (outpatients) complications. The utilization data were multiplied by the unit prices of drugs and services reimbursed by the Serbian Republic Health Insurance Fund to obtain direct costs. In total, 205 inpatients and 60 outpatients with DM2 participated in the study. Key drivers of the costs of treating diabetes complications in hospitals are consultations with specialist clinicians (B = 0.025 [0.003–0.047]), use of reserve antibiotics (B = 0.022 [0.007–0.036]), biochemical tests (B = 0.038 [0.022–0.055]) and length of stay in the hospital (B = 0.011 [0.009–0.013]). On the other hand, the number of encounters with general practitioners (B = 0.179 0.115–0.242) and the number of ultrasound examinations are strongly correlated with the total costs of treating outpatients with DM2 (B = 0.234 [0.054–0.414]). None of the outpatients included in the study were prescribed novel antidiabetic drugs. Overall, the costs of treating DM2 in Serbia are considerable and mainly driven by the 2–11-fold higher costs of complications vs. the costs of the disease itself.

The Economic Burden of Atherosclerotic Cardiovascular Disease in Italy.

Atherosclerotic cardiovascular diseases remain the primary cause of mortality in Italy. Individuals with a history of acute coronary syndrome, peripheral arterial disease, and ischemic stroke/transient ischemic attack face an elevated risk of recurrent major adverse cardiovascular events, including mortality. The population aging, coupled with increasing risk factors such as diabetes mellitus and obesity, exacerbates the disease's economic impact. This study aims to comprehensively assess the economic burden of atherosclerotic cardiovascular diseases in Italy, specifically focusing on direct healthcare costs. We analyzed real-world data from administrative databases in the Marche region and Local Health Unit Umbria 2. The economic burden of patients discharged with acute coronary syndrome, peripheral arterial disease, and ischemic stroke/transient ischemic attack was evaluated, with a focus on direct costs associated with hospitalizations, drugs, and outpatient visits. Results were stratified by age, sex, comorbidities at baseline, and adherence to lipid-lowering therapy and antihypertensive agents. Annually, nearly 350,000 patients were hospitalized for peripheral arterial disease, acute coronary syndrome, or ischemic stroke/transient ischemic attack. Direct health costs averaged €7190 per patient over a 2-year follow-up, with hospitalizations accounting for nearly 70% of the total. Male patients incurred significantly higher costs (€7467) than female patients (€6625). Costs correlated positively with age and with the number of baseline comorbidities, with a range from €5259 (0-1 comorbidities) to €17,095 (4+ comorbidities). Costs were significantly lower in adherent subjects (€6813) compared with non-adherent subjects (€7757). This study provides valuable insights into the economic implications of atherosclerotic cardiovascular diseases in Italy, emphasizing the necessity of a comprehensive approach to preventive measures, optimal medication adherence, and lifestyle modifications to mitigate its impact.

Cost, Cost-effectiveness and Survival Impact Assessment for A Better Management of Colorectal Cancer Patients: A Single Centre Comprehensive Analysis.

The world healthcare systems are currently challenged by the accumulating burden of colorectal cancer (CRC), and cancer registries represent an important segment for prevention and developing management plans, being useful in providing data regarding incidence, mortality, survival, exposure to carcinogens, lifestyle. Retrospective data from CRC patients in Romania was used to assess survival impact, costs, and cost-effectiveness considering three crucial aspects: pharmacology, chemo-/radio-therapy, and hospitalization for care and management of these patients. 423 CRC patients from the Institutional Cancer Registry of the Prof. Dr. Ion Chiricuta Institute of Oncology in Cluj-Napoca, Romania were included in the cost analysis. For the assessment of cost efficiency of the primary treatment strategy, we collected data regarding direct medical costs associated with surgery, radiotherapy and medication, as well as the afferent day or continuous hospitalization, for each patient. For the cost-effectiveness analysis we used the method of estimation of incremental cost-effectiveness ratio. No compelling differences regarding survival time were observed in different therapeutic options per CRC stage. Substantial differences in cost effectiveness among therapeutic options in the same stage of several thousand Euros in stages I-III, while for stage IV, the ICER was more than 100,000 Euros per life saved. Systematic evaluation of costs, cost-effectiveness, and survival impact, helps healthcare systems can make informed decisions to improve the management of colorectal cancer patients, optimizing outcomes while minimizing financial burden.

Lifecycle Assessment and Multi-Parameter Optimization of Lightweight Cement Mortar with Nano Additives.

With the growing global concerns regarding sustainable development in the building and construction industries, concentration only on the engineering properties of building materials can no longer meet the requirements. Although some studies have been implemented based on the lifecycle assessment of lightweight cement-based materials, very few attempts have been made pertaining to multi-criteria optimization, especially when fly ash cenospheres are used as lightweight aggregates and nano additives are incorporated as modifying admixtures. This investigation utilized cenospheres as fine aggregates to produce green, sustainable, lightweight cement mortar. Multi-walled carbon nanotubes at 0.05, 0.15, and 0.45% were binarily added, together with 0.2, 0.6, and 1.0% of nano silica to improve the mechanical performance. Strength tests were conducted to measure the flexural and compressive behaviors, combined with a cradle-to-gate lifecycle assessment and direct cost analysis to assess the environmental and economic viability. Integrated indexes and the TOPSIS method were adopted to systematically evaluate the mortar mixes and determine the optimal mix. The outcomes show that nano additives worked synergically to enhance the mechanical properties of the mortars. The utilization of cenospheres effectively reduced environmental impacts and improved economic feasibility. Nano additives significantly affected the sustainability and economic viability; in particular, the utilization of multi-walled carbon nanotubes increased the material costs. To minimize the impact of the price of multi-walled carbon nanotubes, it is proposed to binarily use less expensive nano silica. In the multi-parameter optimization, the mix with 0.05% multi-walled carbon nanotubes and 0.02% nano silica was recommended to be the optimal mix.

Deep neck space infections of odontogenic origin are costly and preventable.

Deep neck space infections (DNSI), caused by the spread of an odontogenic infection to the floor of the mouth and neck, are potentially life-threatening but preventable. We explored the total cost of illness (COI) for patients with DNSI of odontogenic origin. Cross-sectional, register-based, multi-centre study of the health economics of DNSI treatment. Included were patients aged > 18 years who were treated in hospital for DNSI of odontogenic origin. Subjects were identified from the regional healthcare database VEGA based on the International Classification of Diseases (ICD) codes and surgical procedure codes. The cost per patient (CPP) values for the hospital care, prescription medications and sick leave were extracted. In total, 148 patients were included. The average length of the hospital stay was 6 days. Total COI was estimated as 15,400 EUR per patient and 2,280,000 EUR in total. Direct costs accounted for 93% of the COI, and indirect costs were 7%. The total COI for patients with DNSI of odontogenic origin was six-fold higher than the average COI for patients in otorhinolaryngology (ORL) care. Preventing DNSI will entail substantial cost savings for the specialised healthcare units and will have a significant impact on the patients.

‘ … You become a prisoner of your life’: A qualitative study exploring the experience of joint pain and accessing care in Hai, Tanzania

The increased prevalence of non-communicable diseases (NCDs) in recent years has led many Low- and Middle-Income Countries (LMICs), including Tanzania, to develop policies to manage their burden. Musculoskeletal (MSK) conditions, such as arthritis, account for 20% of all years lived with disability in LMICs, but the NCD strategies rarely address them. There is substantial research on the disruption MSK conditions cause to people's lives within High-Income Countries, but very little is known about the lived experiences in LMICs. We investigated the experience of MSK conditions in 48 in-depth qualitative interviews with participants from the Hai District in Tanzania, East Africa, all of whom had a MSK disorder (confirmed through clinical examination as part of a broader study). We found that loss of mobility and pain associated with MSK disorders severely limits people's everyday lives and livelihoods. Help from others, mainly those within a household, is necessary for most tasks and those with limited or no support experience particular problems. We found barriers to accessing care and treatment in the form of high direct and indirect (through travel) care costs within formal health services in Tanzania. We argue for increased attention to the growing problem of MSK disorders in LMICs and that this agenda should be driven by a patient-centred approach which designs services accessible to the target population and designed to recognise their embodied expertise.

Cost-effectiveness of ace inhibitors versus ARBs in heart failure management.

Heart failure is a chronic condition that imposes a significant burden on healthcare systems worldwide. Effective management is crucial for improving patient outcomes and reducing costs. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) are widely used to manage heart failure by reducing cardiac strain and preventing disease progression. Despite their common use, ACE inhibitors and ARBs differ in mechanisms, cost, and potential side effects. ACE inhibitors have long been the standard treatment, while ARBs are often prescribed to patients intolerant to ACE inhibitors, particularly due to side effects like cough. Given these differences, evaluating the cost-effectiveness of these treatments is essential. This study compares the cost-effectiveness of ACE inhibitors and ARBs from a healthcare system perspective, considering both direct medical costs and health outcomes. A cost-effectiveness analysis was conducted using a decision-analytic Markov model to simulate heart failure progression in a hypothetical cohort. Data inputs included clinical trial outcomes, real-world effectiveness data, direct medical costs (medications, hospitalizations, monitoring), and utility values for quality of life. The primary outcome measures were the cost per quality-adjusted life year gained and the incremental cost-effectiveness ratio. Sensitivity analyses tested the robustness of results, and subgroup analyses were conducted based on age and disease severity. The base-case analysis showed that ACE inhibitors were associated with lower overall costs and slightly higher quality-adjusted life years than ARBs. Sensitivity analyses revealed that variations in key parameters, such as transition probabilities, mortality rates, and healthcare expenses, had limited impact on the overall cost-effectiveness conclusions. Subgroup analyses indicated that ACE inhibitors and ARBs exhibited similar cost-effectiveness profiles for patients aged <65 and ≥65 years. However, among patients with severe heart failure, ARBs demonstrated a higher incremental cost-effectiveness ratio compared with ACE inhibitors, suggesting reduced cost-effectiveness in this subgroup. ACE inhibitors are likely a more cost-effective option for managing heart failure than ARBs, particularly from a healthcare system perspective. The findings underscore the importance of tailoring treatment decisions to individual patient factors, preferences, and clinical conditions, providing valuable insights for healthcare policy and practice, particularly regarding cost-effectiveness across patient subgroups.