Direct Medical Burden Research Articles

PP71 Hospitalization Costs Associated With Advanced Non-Small Cell Lung Cancer In China: Real World Evidence From Jiangsu

IntroductionNon-small cell lung cancer (NSCLC) constitutes 85 percent of lung cancer diagnoses and poses an economic threat to the sustainability of healthcare services. This study was conducted to estimate hospitalization costs associated with advanced NSCLC without sensitizing EGFR (epidermal growth factor receptor) and ALK (anaplastic lymphoma kinase) alterations in China and explore the potential predictors.MethodsData linked with patients with advanced NSCLC (stage IIIB–IV) without sensitizing EGFR and ALK alterations were obtained from the electronic medical record system of one general hospital and one cancer hospital in Jiangsu province, China, ranging from January 2017 to December 2020. We excluded patients with lung metastases from tumors elsewhere in the body. The socio-demographic characteristics, disease-related characteristics, and hospitalization cost of eligible patients were extracted. We used the generalized linear model (GLM) to assess the potential influencing factors of hospitalization cost.ResultsPatients with advanced NSCLC (n=7,260) were included in this study. The median hospitalization cost of advanced NSCLC was USD11,540.47. The median hospitalization examination and test costs were USD1,539.46, and the median hospitalization drug cost was USD6,351.47. GLM results showed that patients aged 60 or older (95% Confidence Interval [CI]: -1019.1,128.6), who had no gene driver (95%CI: -1,681.6,-233.6) were more likely to have relatively lower hospitalization costs for advanced NSCLC. Patients treated in cancer hospital (95%CI: 1,329.1,2,620.0) and with non-squamous carcinoma (95%CI: 171.3, 1,235.4) may have higher hospitalization costs. Compared with Urban Employee Basic Medical Insurance, patients with free medical services (95%CI: 1,248.4,6,298.7) were associated with higher hospitalization costs. Patients with higher hospitalization frequency and longer length of hospital stay (p < 0.05) were linked to higher hospitalization costs.ConclusionsThe hospitalization costs linked to advanced NSCLC is considerable for patients, with drug costs accounting for the largest. More efforts still need to be made to alleviate the direct medical burden.

Investigation on Quality of Life and Economic Burden of Children with Cerebral Palsy in Changzhou.

Based on the data of children with cerebral palsy (CP) in Changzhou obtained by the Disabled Persons' Federation, this study sampled some children with CP and investigated their survival status, treatment cost, and family burden so as to provide scientific decision-making basis and policy suggestions for coping with disease hazards and improving children's quality of life. In this study, a simple random sampling method was used to conduct household surveys of the selected children with CP. The economic burden of CP is measured by direct and indirect methods, and the quality of life of patients of children with CP and their families is analyzed qualitatively and quantitatively by the EuroQol Five Dimensions (EQ-5D) Questionnaire. The average family economic burden of each case of CP in Changzhou was about 4,188,500 yuan, of which the direct medical burden was 205,800 yuan and the indirect economic burden was 3,982,700 yuan. The socioeconomic burden of CP in Changzhou is as high as about 2.244 billion yuan. From the EQ-5D measurement results of 55 children with CP, the average index score was 0.423, which was lower than the national general population level. The proportions of patients with CP who have problems in the five aspects of action, self-care, daily activities, pain/discomfort, and anxiety/depression are 72.73%, 81.82%, 81.82%, 83.64%, and 92.73%, respectively, which are significantly higher than those of the national general population. The average score of the Visual Analogue Scale (VAS) is 58.09, which is significantly lower than the national general population level. The only major factor affecting the quality of life of patients with CP and their families is the health status represented by the EQ-5D score. To liberate and develop the labor ability of patients and their direct caregivers through clinical treatment, rehabilitation, and special education is the most effective way to reduce the socioeconomic burden of CP. Relevant government departments should perform their duties, integrate social assistance resources, implement early intervention, and launch targeted support and assistance policy.

Economic Burden of Malignant Tumors — Yichang City, Hubei Province, China, 2019

What is already known about this topic?Malignant tumors are common chronic non-communicable disease and have caused serious health hazards to residents and heavy economic burden of disease to the society.What is added by this report?This is the first report on the economic burden of multiple types of malignant tumors in Yichang City. In 2019, the direct medical burden of lung cancer in Yichang was the highest, reaching 561.67 million CNY, and the indirect economic burden of lung cancer in Yichang was higher than that of other malignant tumors, costing 326.49 million CNY.What are the implications for public health practice?The results can provide evidence for the formulation of local cancer prevention and control strategies and public health decision-making.

COVID-19 healthcare cost and length of hospital stay in Turkey: retrospective analysis from the first peak of the pandemic

BackgroundDuring the COVID-19 pandemic, health care systems are under extreme pressure. This study analyzed health care resource use (HCRU) and costs in patients admitted to the hospital for COVID-19 and aimed to estimate the one-year direct medical cost of the disease in Turkey.MethodsThis retrospective cohort study was conducted between March and July 2020 in a tertiary hospital (n = 1056) in Istanbul. Patient demographics, clinical and treatment characteristics at admission, comorbidities, disease severity, and costs from a payer perspective were evaluated using the microcosting method. The results include LOS, hospital costs, and univariate and generalized linear models to investigate influencing factors. The data were extrapolated to provide a country-level estimate.ResultsThe mean length of stay was 9.1 days (SD 6.9). The mean length of stay was 8.0 days (4.7) for patients hospitalized in wards versus 14.8 days (SD 12.0) for patients hospitalized in the ICU. In univariate analysis, several factors, including O2 therapy (+ 3.7 days), high CRP > 41.8 mg/L (+ 3.8 days), and elevated ferritin (+ 3.5), were found to be associated with a longer LOS (p < 0.05).The direct annual medical cost of COVID-19 was estimated at PPP$ 2.1 billion. The COVID-19 pandemic resulted in a direct medical burden that corresponds to 2.0% of the government health expenditures and 0.8 per thousand of Turkey’s gross domestic product (GDP).ConclusionsEstimating the impact of this pandemic in terms of HCRU and costs to the health care system can help design strategies to manage the pandemic.

Direct medical burden of antimicrobial-resistant healthcare-associated infections: empirical evidence from China

Antimicrobial resistance (AMR) and healthcare-associated infections (HAIs) are among the biggest global public health challenges, and overlap widely. These infections cause significant morbidity and mortality, put pressure on health systems, and incur rising direct and indirect costs. This study analysed the direct medical burden attributable to AMR-HAIs in Chinese public tertiary hospitals, and aimed to inform both the medical regulators and hospital managers for better control of HAIs and containment of AMR. The propensity score matching method (γ= 0.25σ, nearest neighbor 1:1 matching) was applied to conduct a retrospective cohort study in five public tertiary hospitals in the Hubei province of China during 2013-2015. Descriptive analysis, Pearson's chi-squared test, Mann-Whitney U-test, Wilcoxon signed-rank test and paired/independent Z/T test were conducted. The statistically significant level was set at P<0.05. From 2013 to 2015 overall, the additional total medical expenditure per HAI-AMR inpatient was US$15,557.25 compared with that of the non-HAIs, and the additional length of per hospital stay of the HAI-AMR inpatient was 41 days compared with that of the non-HAIs (P<0.001). In combination with AMR, HAIs caused significant additional medical expenses and affected the turnover rate of hospital beds. Most of the increased medical costs fell to patients and their families. These findings call for more effective control of HAIs and containment of AMR. A national study is needed to estimate the medical, social and economic burden of HAIs in combination with AMR.

A systematic review of the economic burden of influenza in China

Objectives: To understand the status of studies about influenza economic burden in mainland China and summarize their major results. Methods: The words of influenza, flu, cost, economic, burden, effectiveness, benefit, utility, China, and Chinese, were used as search keywords. Journal papers published during 2000-2018 were searched from Chinese electronic databases (CNKI and Wanfang) and English electronic databases (PubMed, Web of science, EconLit and Cochrane Library). The language of literature was restricted to Chinese and English. A total of 23 effective documents were included, and the descriptive characteristics, research indexes and methods included in the literature were analyzed. The monetary unit used in this review is Chinese Yuan (CNY). Results: The 23 study sites were mainly in the relatively developed and populous regions. The total cost per capita of laboratory-confirmed influenza,of all age-group was reported in 6 literatures, and only 4 literatures reported it in out-patients (range: 768.0-999.9 CNY), Only one study reported this indicator in inpatients (9 832.0 CNY). One literature reported the total cost per capita of influenza-like illness,, which was 205.1 CNY. And one literature reported that the direct medical cost of inpatients per capita in children under 5 years of age was 6 072.0 CNY while two literature reported this index for the elderly over 60 years of age, ranging from 14 250.0 to 19 349.1 CNY. Four articles reported the economic burden of influenza in urban and rural areas, one of which showed that the related expenses of urban influenza inpatients accounted for 31% of the average annual income, while which for the rural flow was 113%. Conclusion: The average economic burden of lab-confirmed influenza case is higher than that of influenza-like illness, and there are differences in outpatient indirect expenses and inpatients direct medical expenses. The direct medical burden for the hospitalized 60-years-and-beyond influenza case group is heavier thar other age group. By region, the influenza associated individual economic burden in rural area is higher than that of urban area..

Prioritizing high-risk sub-groups in a multi-manufacturer vaccine distribution program

PurposeAnnual influenza epidemics cause great losses in both human and financial terms. The purpose of this paper is to propose a model for optimizing a large-scale influenza vaccination program (VP). The goal is to minimize the total cost of the vaccination supply chain while guaranteeing a sufficiently high level of population protection. From a practical point of view, the analysis returns the number of shipments and the quantity of vaccines in each periodic shipment that should be delivered from the manufacturers to the distribution center (DC), from the DC to the clinics, and from the clinics to each sub-group of customers during the vaccination season.Design/methodology/approachA mixed-integer programming optimization model is developed to describe the problem for a supply chain consisting of vaccine manufacturers, the healthcare organization (HCO) (comprising the DC and clinics), and the population being vaccinated (customers). The model suggests a VP that implemented by a nation-wide HCO.FindingsThe benefits of the proposed approach are shown to be particularly salient in cases of limited resources, as the model distributes demand backlogs in an efficient manner, prioritizing high-risk sub-groups of the population over lower-risk sub-groups. In particular, the authors show a reduction in direct medical burden of consumers, such as the need for doctors, hospitalization resources, and reduction of indirect, non-medical burden, such as loss of workdays.Practical implicationsDrawing from the extended enterprise paradigm, and, in particular, taking consumer benefits into account, the authors suggest an operational-strategic model that creates impressive added value in a highly constrained supply chain. The model constitutes a powerful decision tool for the deployment of large-scale seasonal products, and its implementation can yield multiple benefits for various consumer segments.Originality/valueThe model proposed herein constitutes a decision support tool comprising operational-tactical and tactical-strategic perspectives, which logistics managers can utilize to create an enterprise-oriented plan that takes into account medical and non-medical costs.

Hepatitis C Virus (HCV)-Related Arthritis and Arthralgia: The Epidemiologic and Economic Burden in the United States

Figure 1Introduction: Although arthralgia is a common symptom of HCV, a non-destructive inflammatory arthritis [similar to rheumatoid arthritis RA)] is also seen as an extrahepatic manifestation of HCV. The purpose of this study was to use a meta-analytic approach to determine the prevalence of HCV-related arthritis and its associated costs. Methods: Each study was considered after strict inclusion and exclusion criteria. The diagnosis was made by ICD-9, clinical diagnosis with exams and/or blood work. All studies were reviewed by three reviewers before study inclusion. When applicable, the reporting followed the recommendations of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. Random-effects model was used because statistical heterogeneity was found to be high. We performed random-effects univariate meta-regression when possible to explore the role of potential sources of heterogeneity related to the participant demographics (i.e. age, gender, country, and study design). The annual cost of the HCV-related arteritis in the U.S. (per-patient costs and utilization included inpatient, outpatient, pharmacy) was determined by Medicare billing data (2005-2010, inflated to 2014) multiplied by the number of HCV-infected individuals in the U.S. as determined by meta-analysis. Results: Thirteen studies included HCV-related arthralgia and four studies included data on HCVrelated arthritis. These studies included 1102 cases of arthralgia among 5015 HCV-infected individuals and 33 cases of arthritis among 10,970 HCV-infected individuals. The pooled prevalence of arthralgia among HCV was 24.7% (95% CI: 17.5% - 31.8%). The pooled prevalence of RA-like arthritis among HCV infected individuals was 1% (95% CI: 0-2%) whereas the prevalence in non-HCV controls was 0.09% similar to a population-based study results where the prevalence of rheumatoid arthritis for 2005 was 9.8 per 1000 among women and 4.1 per 1000 among men (Myasoedova et al. Arthritis and rheumatism 2010). The total direct medical burden caused by HCV-associated arthritis in the United States was estimated to be $11.0 million per year (from $1.0 mln to $21.9 mln in sensitivity analysis). Conclusion: The prevalence of arthralgia and RA-like arthritis is higher among the HCV patients than general population. These extrahepatic manifestations of HCV are associated with both a clinical and economic burden.

PCV55 - Direct Medical Burden And Readmission Rates Among Non-Elderly Patients With Acute Ischemic Stroke In The United States

PCV55 - Direct Medical Burden And Readmission Rates Among Non-Elderly Patients With Acute Ischemic Stroke In The United States

Work and productivity loss related to herpes zoster

Objective:To estimate absenteeism and presenteeism-related work loss due to herpes zoster (HZ) among working individuals of 50–64 years of age.Methods:This telephone survey included individuals with ≥1 insurance claim for HZ in the past year in administrative claims data from five US commercial health plans. Demographic information, characteristics of the HZ episode; impact of HZ on activities of daily living (ADL), and work days loss and productivity were surveyed.Results:Responses were obtained from 153 of 1654 individuals who were contacted and were eligible for the survey (9.3%). Most had moderate or severe HZ (72.6%). Close to two-thirds reported some impact of HZ on ADL such as shopping, housework/chores, and social engagement. About half (51%) reported missing work due to HZ, and about an equal percentage reported little or much worse productivity than usual due to HZ while at work. On average, age-adjusted absenteeism- and presenteeism-related work loss was estimated at 31.6 hours, and 84.4 hours, respectively, with a combined work loss of 116.0 hours per HZ episode in a working person of 50–64 years of age. Work loss tended to increase with age and the duration and severity of the HZ episode.Conclusions:The study documents a substantial societal burden of HZ-related work and productivity loss. This is important information to take into consideration, in addition to the direct medical burden, when making policy decisions around vaccine prevention of HZ.Limitations:The study may potentially be subject to selection bias due to low survey response rate and since only those cases who sought care for a HZ episode were captured. The study may also be subject to respondent recall bias. Finally, since some respondents could still be having the HZ episode at the time of survey, the study may potentially have under-estimated the work and productivity loss.

The burden of uncomplicated cases of chickenpox in Israel.

The aim of this study was to assess the direct medical burden and work loss associated with uncomplicated chickenpox in Israel. A total of 155 otherwise healthy children and adolescents with chickenpox were recruited from 10 physician offices in central Israel. Direct and indirect medical burdens were determined by caregiver interview. Mean age was 3.3+/-2.3 years. 51% of the patients were under 3 years of age. Each patient made on average 1.15 visits to a general practitioner. Most patients were taken to the Doctor's office only once during the illness while 23 patients (15%) were seen twice. Three patients were referred to the emergency room. Antihistamines (39%) and Calamine lotion (28%) were the most frequently prescribed medications, followed by acyclovir (17%) and antibiotics (6%). Following the patient's illness there were 72 cases of secondary spread of varicella to household members. The individuals who cared for the child missed a combined total of 2.5 days from work (on average per varicella episode). Israeli children acquire chickenpox at a younger age than children in North America and England and consume more prescribed medications. While the work loss in the present study was comparable to previous reports, the direct medical costs inflicted by this infection in Israel are not negligible even for uncomplicated cases.

The burden of uncomplicated cases of chickenpox in Israel.

The aim of this study was to assess the direct medical burden and work loss associated with uncomplicated chickenpox in Israel. A total of 155 otherwise healthy children and adolescents with chickenpox were recruited from 10 physician offices in central Israel. Direct and indirect medical burdens were determined by caregiver interview. Mean age was 3.3 +/- 2.3 years. 51% of the patients were under three years of age. Each patient made on average 1.15 visits to a general practitioner. Most patients were taken to the Doctor's office only once during the illness while 23 patients (15%) were seen twice. Three patients were referred to the emergency room. Antihistamines (39%) and Calamine lotion (28%) were the most frequently prescribed medications, followed by acyclovir (17%) and antibiotics (6%). Following the patient's illness there were 72 cases of secondary spread of varicella to household members. The individuals who cared for the child missed a combined total of 2.5 days from work (on average per varicella episode). Israeli children acquire chickenpox at a younger age than children in North America and England and consume more prescribed medications. While the work loss in the present study was comparable to previous reports, the direct medical costs inflicted by this infection in Israel are not negligible even for uncomplicated cases.

Medical costs of osteoporosis

Global healthcare expenditure has risen at an alarming rate over the past thirty years and the situation is most pronounced in the USA, which now spends 12% of its gross domestic product on healthcare. The greatest component of this expenditure is accounted for by the costs of hospitalisation, and is also particularly centred on the elderly sector of the population — a group that, relative to other sections of the population, will expand over the next thirty years. Osteoporosis, a chronic, disabling disorder, predominantly affects the elderly. Growth in the recognition and level of intervention in osteoporosis, when viewed alongside the increase in the elderly population, emphasises the need to examine the costs of osteoporosis against the already burgeoning healthcare bill. A detailed study in the USA in 1986 assessed the direct medical costs of osteoporosis in women over the age of 45: analysis included the costs of hospitalisation, nursing home care and outpatient services. The results of this survey revealed a figure for total direct costs of $5.15 billion, with hospital and nursing home care being the greatest contributors. A subsequent analysis of data for 1989 has shown expenditure to have risen to over $6 billion. This form of economic assessment of direct medical costs, based on discharge surveys and audit data, is likely to be reasonably accurate for osteoporosis-related hip and wrist fractures, which will generally present to hospitals, but less so for vertebral fractures, which have a varied clinical presentation. Quality of life, disability, socioeconomic factors — also costs to patients, relatives, or healthcare providers — are not accounted for by pure economic analyses of the direct medical burden. A pilot study performed in 1986 showed that osteoporotic patients had a reduced quality of life compared with age-matched controls, which progressively decreased with increasing severity of fracture. In addition to the large and escalating direct costs, osteoporosis needs to be more thoroughly investigated in respect of the total impact on patients, the socioeconomic burden and the utility value of therapeutic interventions.