Direct Costs Research Articles

The Diagnosis and Treatment of Chronic Rhinosinusitis.

Chronic rhinosinusitis (CRS) is a heterogeneous condition characterized by local chronic inflammation of the mucous membranes of the nose and paranasal sinuses. It affects approximately 5% of the population. This review is based on relevant publications retrieved by a selective search of the literature, with particular attention to current national and international guidelines. CRS is defined by, and diagnosed on the basis of, a combination of symptoms and objective findings of nasal endoscopy and imaging studies. It markedly impairs quality of life and gives rise to both direct and indirect health care costs. In 20-45% of cases, CRS is associated with comorbid bronchial asthma and a significantly elevated risk of further diseases (e.g., COPD, OR 1.73; depression, HR 1.50; obstructive sleep apnea, OR 1.91; carcinoma, OR 1.14-5.30). CRS is primarily treated medically with topical steroids (standardized mean difference of nasal symptoms, -0.63 (95% confidence interval [-0.89; -0.37]; standardized mean difference of quality of life as measured by SNOT -22, -5.46 [-8.08; -2.84]), as well as with nasal lavage and, as an option, systemic steroids (and antibiotics where appropriate). If appropriate medical treatment fails to bring about adequate and sustained improvement, endoscopic surgery on the paranasal sinuses is indicated. This improves the individual symptoms, the overall symptom score, and patients' quality of life. Severe refractory CRS with nasal polyposis can be treated with biological agents. CRS calls for individually adapted medical and/or surgical treatment.

Patient-Reported Racial and Ethnic Disparities in Patients With Ulcerative Colitis: Results From the National Health and Wellness Survey.

Ulcerative colitis (UC) is an inflammatory condition characterized by chronic, disabling gastrointestinal symptoms that can have detrimental effects on psychological, social, and professional quality of life. Few studies have examined patient-reported outcomes (PROs) and economic outcomes among individuals with varying UC severity and across different racial/ethnic groups. This cross-sectional study assessed sociodemographic data, PROs, and economic outcomes for participants from the National Health and Wellness Survey (2018, 2019, and 2020) with UC. Multivariable analyses were used to assess the association of self-reported UC severity and race/ethnicity with health-related quality of life (HRQoL), work productivity and activity impairment (WPAI), healthcare resource utilization (HCRU), and medical costs. This study included 1500 participants with UC (1150 non-Hispanic White, 99 non-Hispanic Black, and 251 Hispanic). Moderate/severe disease was associated with significantly worse HRQoL and WPAI, greater HCRU, and higher direct medical costs than mild UC. Compared with non-Hispanic White participants, non-Hispanic Black participants reported better HRQoL, whereas Hispanic participants reported more HCRU and higher medical costs. Race/ethnicity significantly interacted with UC severity level in predicting labor force participation. Participants with moderate/severe disease had worse outcomes than those with mild UC. Additionally, racial/ethnic differences were found in HRQoL, employment, WPAI, HCRU, and direct medical costs. Notably, Hispanic participants showed distinct patterns, particularly in how disease severity influenced employment outcomes. Further research is needed to better understand the differential burden among patients across racial/ethnic groups.

The pathway to delivering injectable CAB for HIV prevention: strategies from global PrEP leaders leveraging an adapted version of the Intervention Scalability Assessment Tool (ISAT)

BackgroundLonger-acting cabotegravir (CAB) is a novel, safe, and efficacious pre-exposure prophylaxis (PrEP) for HIV prevention. As we near a time for CAB scale-up, the experience of global leaders in PrEP research and implementation can be leveraged to identify optimal strategies for scaling and integrating CAB into existing PrEP infrastructure worldwide.MethodsWe recruited leaders of HIV prevention clinical trials and large PrEP programs through a combination of purposive and snowball sampling for participation in individual interviews. We conducted interviews using a semi-structured guide that compared CAB to oral PrEP and sought perspectives on barriers and strategies for CAB scale-up. Interviews were conducted virtually, audio recorded, and transcribed. We used thematic analysis, grounded in an adapted version of the Intervention Scalability Assessment Tool (ISAT), to identify critical elements for optimizing delivery of CAB.ResultsFrom October 2021 to April 2022, we interviewed 30 participants with extensive experience in PrEP research, care, and programming. Participants worked in all seven WHO regions and reported a median of 20 years working in HIV and 10 years in PrEP. Participants agreed that CAB was efficacious and discrete, therefore having the potential to address current concerns about oral PrEP adherence and stigma. Participants indicated direct and indirect costs for provider training, expansion of existing medical infrastructure, and the current medication cost of CAB as major concerns for roll out. The true cost to the end-user and health system were unknown. There were some conflicting strategies on how to best address product targeting, presentation of efficacy, and timing of product availability with scale-up. Some thought that targeting CAB for the general population could normalize PrEP and decrease stigma, while others thought that prioritizing key populations could optimize impact by targeting those with highest risk. Overall, participants emphasized that to ensure successful CAB scale-up, communities and stakeholders must be involved at every stage of planning and implementation.ConclusionsOur evaluation found that although there is a clear and urgent need for additional HIV PrEP options beyond daily oral PrEP, CAB scale-up must be thoughtful, flexible, and based in lessons learned from oral PrEP rollout.

Network-level optimisation approach for bridge interventions scheduling

This paper introduces a novel extension of the multi-system optimisation method, known as the 3C concept, tailored for optimising budget allocation for bridge interventions at the network level. This extended methodology accounts for the interdependencies among bridges due to their spatial proximity within the network. It incorporates direct and user costs, bridge performance indicators, and a bridge deterioration model. A real-world case study involving a portfolio of 555 bridges demonstrates the practicality of the methodology, efficiently determining the optimal intervention sequence. Over an 18-year analysis period, the proposed methodology achieved a 23% reduction in total costs by combining repairs for bridges with high to severe damage and maintenance for the others. This represents a significant improvement compared to the traditional approach, used by bridge management agencies, which relies exclusively on maintenance. The optimised procedure outperforms human intuition in managing complex bridge networks, particularly over extended periods. This methodology can assist transportation agencies in implementing and exploring various scenarios by adjusting the time between consecutive interventions and budget constraints, supporting comprehensive analysis and informed decision-making.

Childbearing under different family policy schemes

Objective: This study assesses whether and how changes in family policies are associated with first and second births in Finland, Germany and the United Kingdom, and whether these associations differ by women’s education. Background: Family policies are expected to impact the direct and indirect costs of childbearing by providing resources that influence the monetary and non-monetary costs of having children. The countries analysed here have undergone substantial changes in family policy throughout the two decades analysed, but each country has changed different aspects of their policies, and they have done so in different policy environments. Method: We analysed women aged 18–44 and their transitions to first and second births using register data from Finland (N = 57,518 / 21,685) and panel data from Germany (G-SOEP, N=37,716 / 16,756) and the UK (BHPS and Understanding Society, N = 13,213 / 9,992) complemented with annual family policy information. The data were analysed using logistic regression models and interactions, and the results are presented as average marginal effects. Results: The results suggest that the association between changes in family policies and transitions to first and second child birth varied by birth parity, women’s education level, and between countries. For example in Finland, increases in paternity leave length were associated with greater propensities to transition to first birth for highly educated women, whereas increases in child allowances had a similar association for lower educated women. In Germany, reductions in maternity leave length were associated with increased transitions to first birth for higher educated women. In the UK, increases in maternity leave length were associated with greater transitions to first births among all women. Conclusion: The results highlight that to the extent that family policies influence fertility, they do so depending on both the country context and often differentially within countries based on women’s education level and birth parity.

An economic model to understand the cost-effectiveness of olanzapine orally dispersible tablets (ODT) and olanzapine film coated tablets as a group compared with other oral atypical antipsychotics for treating schizophrenia in Morocco

BackgroundAntipsychotic medications are the primary treatment for schizophrenia, with olanzapine being an effective medication for schizophrenia. The economic cost for each individual with schizophrenia is high, with antipsychotic medication being a major expense. This study aims to develop an economic decision model that compares different treatment options for schizophrenia patients, including olanzapine Orally Dispersible Tablets (ODT), olanzapine [ODT + Standard Oral Tablet (SOT)], risperidone (ODT + SOT), and aripiprazole (ODT + SOT), to determine their cost-effectiveness with an objective to optimize healthcare resource allocation in Morocco.MethodsThe study used published medical literature and a clinical expert panel to develop a decision analytic model. This model was designed to capture parameters such as adherence levels, treatment discontinuation, relapse with and without hospitalization, quality-adjusted life years (QALYs), treatment-related adverse events, healthcare resource utilization, and associated costs. The main outcomes of interest included the total annual direct cost per treatment, QALYs, and incremental cost-effectiveness ratio (ICER) per 1 QALY gained. One-way and probabilistic sensitivity analyses were employed to account for parameter uncertainty.ResultsAccording to the simulation model, the ODT and ODT + SOT as a group form of olanzapine was the most effective treatment option in terms of the lowest percentages of inpatient relapse, and patients who remained stable (11% and 79% respectively) than risperidone (19% and 62% respectively) and aripiprazole ODT (26% and 50% respectively) and ODT + SOT formulation groups. Olanzapine (ODT + SOT) therapy group was cost-effective when compared to the combined group of ODT + SOT forms of risperidone [ICER: Moroccan Dirham (MAD) 103,907], and aripiprazole (ICER: MAD 65,047). Additionally, olanzapine ODT was found to be cost-effective compared to olanzapine SOT with an ICER of MAD 3921, risperidone ODT with an ICER of MAD 1,02,298, risperidone SOT with an ICER of MAD 31,088, and aripiprazole ODT or SOT formulations. All the above ICERs fall under the willingness-to-pay threshold in Morocco of MAD 250,832.40. Sensitivity analyses confirmed the reliability of the findings.ConclusionsThe model concluded that olanzapine ODT is the most cost-effective first-line treatment option for schizophrenia in Morocco when compared to other atypical antipsychotic medications in ODT and SOT formulations.

The Association Between Direct Health Costs Related to Non-communicable Diseases and Physical Activity in Elderly People.

The aim of this study was to evaluate the association between direct health costs related to non-communicable diseases (NCDs) and the level of physical activity in Chinese elderly people. In this longitudinal study, 410 people over 64years old were selected from health centers. The direct health costs caused by NCDs were recorded on a weekly basis for a period of six months. Also, physical activity was measured using FitBit Flex2™ and as the number of daily steps as well as calories burned during this six month. The multiple linear regression analysis was used to identify the predictors of direct health costs caused by NCDs as the dependent variable. Age, gender, marital status, education level, currently working, Fitbit steps and calories, and BMI were entered into the model as predictor variables to perform a stepwise regression analysis. Four variables of age, BMI, Fitbit steps and Fitbit calories were able to enter the regression model. The model explained 24.8% of the variability of direct health costs due to NCDs. The strongest predictor of health costs was Fitbit calories (B = - 2.113, t = - 4.807, p < 0.001), followed by BMI (B = 1.267, t = 3.482, p < 0.001), Fitbit steps (B = - 1.157, t = - 3.118, p < 0.001), and age (B = 1.115, t = 2.599, p < 0.001). It can be said that having regular physical activity can reduce health costs due to NCDs in Chinese older people.

The economic burden of prostate cancer in Iran: a cross-sectional cost-of-illness study

ObjectiveThis study aims to assess the economic burden of prostate cancer in Iran by analyzing direct medical costs, direct non-medical costs, and indirect costs. We conducted a cross-sectional cost-of-illness study in Khorramabad, located in western Iran, during 2023, using a prevalence-based, bottom-up approach. Data were collected from 285 prostate cancer patients using questionnaires, interviews, and patient records.ResultsOur study estimated the economic burden of prostate cancer at $744,990. Direct medical costs accounted for 63.50% of this, totaling $153,330, with therapy being the largest component. Direct non-medical costs were $62,130, and indirect costs from productivity losses were $209,760. The calculated overall cost per patient was $2,614.88. Extrapolating from the 2021 Global Burden of Disease data, which reported approximately 83,000 prostate cancer patients in Iran, the national economic burden is estimated at $217,034,040. This substantial burden highlights the need for improved insurance coverage and early detection. The findings suggest that policymakers and healthcare providers in Iran should develop standardized cost analysis methods and enhance financial protection to alleviate economic strain and improve healthcare outcomes and sustainability.

The costs of implementing anaemia reduction interventions among women fish processors in Ghana

BackgroundAnaemia among women of reproductive age (WRA) remains persistently high in Ghana, affecting 41% in 2022. Women in low-income communities in Ghana engaged in fish processing activities are at increased risk of anaemia due to inadequate diets, exposure to infectious pathogens, and pollutants. The Invisible Fishers (IFs) project was implemented among women fish processors in their reproductive age in Central and Volta regions of Ghana to mitigate anaemia. Despite the efficacy, feasibility and scalability of the intervention, the cost of implementing the intervention is unknown. The objective of this study was to estimate the costs of implementing the IFs project in Ghana.MethodsWe used micro-costing approach to analyse the costs of implementing the IFs project. Data were collected as part of a pilot randomized control trial with three interventions: Behaviour Change Communication (BCC), Strengthening Market Engagement of fish processors plus Behaviour Change Communication (SME + BCC), and Fish Smoking Technology and Practices plus Behaviour Change Communication (FST + BCC). The interventions were delivered to 60 women fish processors in the Central region and 60 in Volta region. The cost of the intervention was estimated from the societal perspective. Economic costs were categorized as direct costs (i.e. personnel, transportation, meetings, training, and monitoring) and indirect cost (i.e. value of productive time lost due to women and community volunteers’ participation in the activities of the IFs project).ResultsThe FST + BCC had the highest average cost per beneficiary (US$11898.62), followed by the SME + BCC (US8962.93). The least expensive was the BCC (US$4651.93) over the intervention period of 18 months. Recurrent costs constituted the largest component of economic costs (98%). Key drivers of direct costs were personnel (58%), administrative expenses (14%), and transportation (7%).ConclusionThere is a high cost for implementing interventions included in the IFs project. Planning and scaling -up of the interventions across larger populations could bring about economies of scale to reduce the average cost of the interventions.

Comparative Effectiveness of Teledermatology Versus In-person Consultations: A Systematic Review of Diagnostic Information Elements

Context: Teledermatology is delivered through two primary methods: Live video conferencing, which enables real-time interaction between patients and doctors, and the store-and-forward technique, where images of skin lesions are sent over the internet for later examination. Objectives: This systematic review evaluates the concordance between in-person and telemedicine follow-up methods in dermatology. Methods: In February 2024, a comprehensive literature search was conducted across PubMed, Medline, ISI Web of Science, and the ACM Digital Library. Keywords such as "teledermatology," "telemedicine," and "mobile health" were used, following the PICOS criteria. Results: Initially, 716 articles were identified from the databases, along with four studies from the gray literature search. After removing duplicates, screening studies, and applying the inclusion and exclusion criteria, 21 studies were selected for the final review. These studies detailed follow-up procedures and assessed both direct and indirect costs and effectiveness. The consensus indicates that teledermatology reduces costs and satisfies both patients and healthcare professionals. Conclusions: Teledermatology has been shown to potentially increase the efficiency of follow-up care compared to traditional methods. However, further research is needed to develop standardized evaluation protocols and to more accurately measure and validate key variables. Publications suggest that teledermatology is cost-effective, reduces patient wait times, extends access to dermatological care in remote areas, and enhances satisfaction among patients, doctors, and nurses.

Analysis of Determining the Cost of Goods Production Using the Full Costing Method at UD. Aqqib Jaya Collection

This research aims to find out how to calculate production costs and determine the selling price of bags at UD. Aqqib Jaya Collection. The method used is a qualitative approach by conducting interviews, documentation and observation to collect information. The business owner is the main informant in the interview. The research results show that MSMEs calculate production costs manually without taking depreciation costs into account. Production costs are calculated by adding up raw material costs, direct labor costs, and other costs related to bag production. In the process of calculating production costs and determining the selling price of bags, business actors still experience obstacles related to understanding the field of accounting, especially in including depreciation costs.

The Economic Impact of Treatment Sequencing in Chronic Lymphocytic Leukemia in Canada Using Venetoclax plus Obinutuzumab.

Bruton tyrosine kinase inhibitors (BTKis) represent an advancement in chronic lymphocytic leukemia; however, these agents are administered continuously until disease progression or unacceptable toxicity, raising concerns about their affordability. Venetoclax in combination with obinutuzumab (VO) is a fixed-duration (12-month) treatment, approved in Canada in 2020. This study estimated the total cumulative cost of different treatment sequences and evaluated the economic impact of introducing treatment sequences with/without VO, from a Canadian health care system perspective. A 10-year partitioned survival model was developed, considering key clinical parameters and direct medical costs. Results were stratified by TP53 aberration. Treatment sequences starting with first-line (1L) VO resulted in lower 10-year cumulative costs compared to sequences starting with BTKis administered until disease progression, across both TP53 aberration subgroups. With a maximum of three lines of treatment over a 10-year period, cumulative costs were largely determined by the first two lines of treatment. When comparing sequences with the same 1L treatment, sequences with BTKis in second-line incurred greater costs compared to fixed-duration regimens. Overall, the economic impact of treating all patients with VO led to 10-year cumulative savings of CAD 169,341 and CAD 293,731 per patient, without and with TP53 aberration, respectively. These savings are mainly due to reductions in treatment costs associated with fixed treatment duration.

Cost-Utility Analysis of Erenumab Compared to Topiramate for Preventive Therapy of Migraine in Iran

Background: Migraine is a prevalent, chronic neurovascular disorder that incurs significant indirect costs due to productivity loss. Preventive therapy is an effective way to alleviate the societal and healthcare burden of migraine. Approximately 14% of both the global and Iranian populations are affected by migraine, which has substantial economic implications. Objectives: To determine the cost-effectiveness of Erenumab compared to Topiramate for migraine treatment in Iran. Methods: A three-state Markov model was used to evaluate the cost-effectiveness of Erenumab. The model considered both direct and indirect costs from a societal perspective. The incremental cost-effectiveness ratio (ICER) was calculated by determining the cost per quality-adjusted life year (QALY) gained. Costs and QALYs were discounted annually at 5.8% and 5%, respectively. Deterministic and probabilistic sensitivity analysis (PSA) were performed to assess the robustness of the model. Results: The average cost for patients using the Erenumab strategy was 16,836 USD over five years, whereas the average cost for the Topiramate strategy was estimated to be 2,660 USD. Additionally, the average QALYs for the Erenumab and Topiramate strategies were 3.64 and 3.46, respectively. The ICER for the Erenumab strategy was 78,923 USD/QALY. This ICER is significantly higher than the fixed Iranian willingness-to-pay (WTP) threshold of 2,456 USD. Conclusions: The study concludes that preventive treatment of migraine with Erenumab, compared to Topiramate, is not cost-effective in Iran based on current prices. Therefore, for Erenumab to be considered cost-effective, a significant price reduction is necessary for its entry into the Iranian pharmaceutical market.

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.