Direct Medical Expenditures Research Articles

Health Care Expenditure in United States Adults With Heart Failure With and Without Diabetes

The health costs for heart failure (HF) among individuals with and without diabetes can help understand the conjoint burden of diabetes and HF. Using the 2008–2019 US national Medical Expenditure Panel Survey data including 2,019 adults with HF and a 2-part adjusted model, we estimated mean and adjusted incremental direct medical expenditures related to diabetes. The total direct expenditures for individuals with HF increased by 27%: $24,725 (95% confidence interval [CI]: $20,457-$28,993) in 2008-2009 to $31,426 (95% CI: $25,705-$37,147) in 2018-2019. The expenditures rose by 34% among those with diabetes. Inpatient costs represented the highest fraction of costs ∼ 43.3 % and were 8% higher among those with diabetes vs. those without diabetes. The drug costs accounted for 24% of all costs, increased by 44%, and were 86% higher among HF patients with diabetes vs. those without diabetes. The adjusted excess costs among individuals with HF and diabetes vs. HF without diabetes was $6,818 (95% CI: 2,241-11,395); the corresponding excess costs for drugs and medical costs other than drugs were $3,297 (95% CI: 2,168-4,426) and $3,554 (95% CI: -777-7,886). Among US adults with HF, the estimated adjusted total direct excess costs were $5.2 billion per year higher among individuals with diabetes vs. those without diabetes. In conclusion, diabetes is associated with substantially increased health care costs among patients with HF, suggesting the need for an integrated management of diabetes and HF.

Trends in direct health care costs among US adults with atherosclerotic cardiovascular disease with and without diabetes

ObjectivePopulation-based national data on the trends in expenditures related to coexisting atherosclerotic cardiovascular diseases (ASCVD) and diabetes is scarce. We assessed the trends in direct health care expenditures for ASCVD among individuals with and without diabetes, which can help to better define the burden of the co-occurrence of diabetes and ASCVD.MethodsWe used 12-year data (2008–2019) from the US national Medical Expenditure Panel Survey including 28,144 U.S individuals aged ≥ 18 years. Using a two-part model (adjusting for demographics, comorbidities and time), we estimated mean and adjusted incremental medical expenditures by diabetes status among individuals with ASCVD. The costs were direct total health care expenditures (out-of-pocket payments and payments by private insurance, Medicaid, Medicare, and other sources) from various sources (office-based visits, hospital outpatient, emergency room, inpatient hospital, pharmacy, home health care, and other medical expenditures).ResultsThe total direct expenditures for individuals with ASCVD increased continuously by 30% from $14,713 (95% confidence interval (CI): $13,808–$15,619) in 2008–2009 to $19,145 (95% CI: $17,988–$20,301) in 2008–2019. Individuals with diabetes had a 1.5-fold higher mean expenditure that those without diabetes. A key driver of the observed increase in direct costs was prescription drug costs, which increased by 37% among all individuals with ASCVD. The increase in prescription drug costs was more pronounced among individuals with ASCVD and diabetes, in whom a 45% increase in costs was observed, from $5184 (95% CI: $4721–$5646) in 2008–2009 to $7501 (95% CI: $6678–$8325) in 2018–2019. Individuals with ASCVD and diabetes had $5563 (95% CI: $4643–$6483) higher direct incremental expenditures compared with those without diabetes, after adjusting for demographics and comorbidities. Among US adults with ASCVD, the estimated adjusted total direct excess medical expenditures were $42 billion per year among those with diabetes vs. those without diabetes.ConclusionsIn the setting of ASCVD, diabetes is associated with significantly increased health care costs, an increase that was driven by marked increase in medication costs.

Age-specific Multimorbidity Patterns and Burden on All-Cause Mortality and Public Direct Medical Expenditure: A Retrospective Cohort Study

ObjectiveTo evaluate age-specific multimorbidity patterns and morbidity burden on mortality and healthcare expenditure across age groups.Patients and MethodsRetrospective observational study between January 1, 2009 to December 31, 2017 using electronic health records in Hong Kong: Individuals were stratified by age (< 50, 50–64, 65–79, ≥ 80), and sub-classified by number of morbidities (0, 1, 2, 3, ≥ 4) out of 21 common chronic conditions. Clustering analyses were conducted to identify specific patterns of multimorbidity. Association between the number as well as combinations of morbidities and all-cause mortality and public expenditure was examined.Results4,562,832 individuals with a median follow-up of 7 years were included. Mental disorders were the top morbidities among young individuals, while cardiovascular diseases were prevalent in the elderly. An increased number of morbidities was associated with a greater relative risk for mortality and medical expenditure, and this relationship was stronger among younger patients. Compared to individuals in the same age group without morbidity, the hazard ratios (HR; 95% CI) of all-cause mortality in patients aged < 50 and ≥ 80 with two comorbidities 3.81 (3.60–4.03) and 1.38 (1.36–1.40), respectively, which increased to 14.22 (9.87–20.47) and 2.20 (2.13–2.26), respectively, as the number of morbidities increased to ≥ 4. The stroke-hypertension cluster was shown to be associated with the highest HR of mortality 2.48 (2.43–2.53) among all identified clusters arising from the clustering analysis.ConclusionGiven the stronger association between multimorbidity and all-cause mortality and greater opportunity costs in younger populations, prevention and management of early-onset multimorbidity are warranted. (248 words)

Analysis of Health-Related Quality of Life and Incurred Costs Among Human Immunodeficiency Virus, Tuberculosis, and Tuberculosis/HIV Coinfected Outpatients in Indonesia

ObjectivesA growing interest in healthcare costs and patients’ health-related quality of life (HRQoL) exists in the context of the increasing importance of health technology assessment in countries with high numbers of the HIV and tuberculosis (TB) patient populations, such as Indonesia. This study aimed to analyze the HRQoL and out-of-pocket (OOP) costs of HIV, TB, and TB/HIV coinfected participants in a city in Indonesia with a high prevalence of HIV and TB. MethodsA cross-sectional survey was conducted in the voluntary counseling and testing and lung clinics of Bekasi City Public Hospital (Indonesia) from January to March 2018. Patients’ HRQoL was measured using the EQ-5D-5L questionnaire, whereas OOP costs were extracted from a semistructured questionnaire. ResultsOf the 460 eligible participants, 82% resided in the city, 48% of them were married, and their median age was 34 years. Less than half were insured, and more than half had no source of income. The median values of health utilities for participants with HIV, TB, and TB/HIV were perceived as potentially high (1.0, 0.9, and 0.8, respectively). The TB/HIV coinfected outpatients had the highest OOP costs (US$94.5), with the largest contribution coming from direct medical OOP expenditures. Taking loans from family members was adopted as a financial strategy to overcome inadequate household incomes and high treatment costs. ConclusionThis study suggests that TB/HIV coinfection potentially lowers HRQoL and increases healthcare costs and the need for economic analysis to underpin cost-effective treatment in such patients.

Economic Burden of Trauma-Related Injuries in Iran in 2019.

Trauma-related injuries are the leading cause of death and disability in the active population, with devastating economic, health, and social consequences for nations. TThis study aimed to assess the economic burden of injuries in Iran. In this study, the economic impact of trauma in Iran in 2019 was estimated using a prevalence-based approach. The prevalence was estimated based on available statistics in Iran and the GBD website. Direct medical expenditures were calculated using a top-down approach. The cost of lost production due to injuries and premature death was also estimated using the DALY value. Microsoft Excel 2019 and Stata software version 13.0 were used for the analysis. In Iran, approximately 16,500,000 individuals were estimated to have sustained injuries in a single year. The average direct medical expenses for each trauma patient were around $226. Fractures contributed to 39% of the financial impact of trauma. The overall economic burden of trauma in Iran was calculated to be $10,214,403,423. Approximately 66% of this economic burden was attributed to lost productivity and premature death resulting from trauma, while direct medical costs made up 34%. The economic burden of trauma in Iran is expected to significantly rise in the future. It may be necessary to enhance awareness of injury-related mortality and disability, improve therapies, and expand evidence-based interventions to reduce the economic impact of injuries.

Healthcare Resource Use and Costs Among Individuals with Vitiligo and Psychosocial Comorbidities: Retrospective Analysis of an Insured US Population.

This study aimed to describe healthcare resource utilization and costs among individuals with vitiligo who were diagnosed with ≥1 psychosocial comorbidity, using data from US claims databases. A retrospective, observational cohort analysis of the IBM MarketScan Commercial and Medicare supplemental claims databases for US individuals with vitiligo aged ≥12 years and a first vitiligo claim between January 1 and December 31, 2018, was undertaken to assess psychosocial burden, including mental and behavioral health comorbidities. Of the 12,427 individuals included in the analysis, nearly 1 in 4 (23.5%) who had vitiligo were also diagnosed with ≥1 psychosocial comorbidity. A greater percentage of these individuals versus those who were not diagnosed with a psychosocial comorbidity had a vitiligo-related prescription claim (50.2% vs 45.4%; P<0.0001), especially for oral corticosteroids (25.4% vs 16.6%; P<0.0001) and low-potency topical corticosteroids (9.0% vs 7.6%; P<0.05). Total vitiligo-related healthcare resource utilization and costs were consistent among individuals with and without psychosocial comorbidity despite significantly (P<0.05) higher vitiligo-related ER visit utilization and expenditure among those with psychosocial comorbidity. Furthermore, individuals diagnosed with vitiligo and ≥1 psychosocial comorbidity had significantly (P<0.0001) greater utilization of all-cause mean prescription claims (25.0 vs 12.8), outpatient services (other than physician and ER visits: 19.5 vs 11.3), outpatient physician visits (10.1 vs 6.4), inpatient stays (0.6 vs 0.1), and ER visits (0.4 vs 0.2) and incurred significantly higher mean (SD) direct medical expenditures ($18,804 [$46,621] vs $9833 [$29,094] per patient per year; P<0.0001). Individuals with vitiligo who were diagnosed with ≥1 psychosocial comorbidity incurred greater total all-cause but not vitiligo-related healthcare resource utilization and expenditures than those without diagnosis of psychosocial comorbidities. Identification of psychosocial comorbidities in individuals with vitiligo may be important for multidisciplinary management of vitiligo to reduce overall burden for individuals with vitiligo.

Estimating the economic burden of colorectal cancer in China, 2019-2030: A population-level prevalence-based analysis.

Colorectal cancer (CRC) is one of the most common cancers worldwide. Comprehensive data on the economic burden of CRC at a population-level is critical in informing policymaking, but such data are currently limited in China. From a societal perspective, the economic burden of CRC in 2019 was estimated, including direct medical and nonmedical expenditure, disability, and premature-death-related indirect expenditure. Data on disease burden was taken from the GBD 2019 and analyzed using a prevalence-based approach. The per-person direct expenditure and work loss days were from a multicenter study; the premature-death-related expenditure was estimated using a human capital approach. Projections were conducted in different simulated scenarios. All expenditure data were in Chinese Yuan (CNY) and discounted to 2019. In 2019, the estimated overall economic burden of CRC in China was CNY170.5 billion (0.189% of the local GDP). The direct expenditure was CNY106.4 billion (62.4% of the total economic burden), 91.4% of which was a direct medical expenditure. The indirect expenditure was CNY64.1 billion, of which 63.7% was related to premature death. The predicted burden would reach CNY560.0 billion in 2030 given constant trends for disease burden; however, it would be alternatively reduced to <CNY515.2 billion if the cancer prevention and control goals set by the United Nations and China for 2030 are achieved. The population-level economic burden of CRC in China in 2019 seemed noteworthy, with the direct expenditure accounting for more than half. Without effectively reducing exposure to modifiable factors and expanding screening coverage, the burden would continue increasing.

OGC P29 Cost of complications after Upper Gastrointestinal Cancer surgery: the case for pre-habilitation illustrated

Abstract Background Upper Gastro Intestinal (UGI) cancer surgery carries considerable risk and cost in terms of human and financial resource. Reported complication rates after oesophagectomy and gastrectomy are 65% and 42% respectively and can range from relatively minor morbidity to major life-threatening events, all with the potential to increase Length of Stay (LoS) and cost which can be graded by the Clavien-Dindo (CD) system. This study aimed to study the impact of complications on LoS and quantify the associated economic costs. Methods Consecutive 754 patients with UGI cancer (420 oesophageal, 334 gastric), undergoing potentially curative treatment (median age 67 yr., 590 m, 164 f, 684 Adeno Ca, 36 SCC, 205 Ivor-Lewis oesophagectomy, 146 Trans Hiatal oesophagectomy, 142 total gastrectomy, 134 subtotal gastrectomy, 97 open and close, 11 Three-stage oesophagectomy, 10 salvage resections, 8 oesophagogastrectomy) were studied. The cost of each night’s stay was limited to direct costs, including ward and medical staff expenditure. Results Median LoS was 13 (IQR-7) days. The number of patients related to CD score were; Zero-326, I-41, II-224, IIIa-44, IIIb-28, IVa-36, IVb-4 and V-16, with median LoS of 11, 14, 14, 23, 25, 32, 44 and 9 days respectively. The added LoS for each complication cohort was 3 days for CD I and II, then 12, 14, 21, and 33 days for CD IIIa, IIIb, IVa and IVb respectively. Average added cost for each grade of complication per patient was £844.44 for CD I and II, £3,377.76 for IIIa, £8,519.40 for IIIb, £14,927.70 for IVa and £36,047.85 for IVb. Conclusions Overall hospital and CC LoS increased related to complication grade, other than CD V, with an average ward cost per additional day of £281.48 and CC cost of £1426.15. Average cost of an uncomplicated oesophagectomy or gastrectomy was estimated to be £16,544. As well as the adverse impact on patients’ recovery and well-being, complications have a large fiscal impact on healthcare systems and in many cases can dwarf the first treatment cost. These findings illustrate a strong clinical and business case for investment in effective strategies to boost complication free surgery including pre-habilitation.

Personal Financial Burdens of Multiple Myeloma: A Deep Dive into the Patient's Journey Using Qualitative Interview

Background: As multiple myeloma (MM) treatments continue to advance rapidly potentially enabling patients to coexist with MM as a chronic disease, understanding the personal financial burden these patients and their family caregivers bear is critical. Most previous studies have analyzed direct medical costs mainly focusing on medication and hospital visits, but a broader analysis covering the overall financial burden on the disease journey has not been extensively explored. Our study aims to explore and understand the diverse types of financial burdens experienced by MM patients who are newly diagnosed or relapsed and their family caregivers personally aside from medical expenditures along their disease and treatment journey. Methods: We used cross-sectional study using mixed methods by integrating quantitative and qualitative data. The study was conducted at Samsung Medical Centre in Seoul, Korea from October 2021 to December 2022. Patients and their caregivers were recruited at out-patient clinics, and 60-90 minutes semi-structured interviews were conducted via face-to-face or telephone. We used thematic analysis to identify and organize qualitative data into the patterns of theme. Quantitative data including clinical and socio-demographic information of the study participants were obtained from survey and/or patients' Electronic Medical Records. Results: Overall, 80 participants were enrolled: 41 patients and 39 family caregivers. Clinical/socio-demographic information and the distribution of study participants are on the Table 1. In our study direct medical costs (e.g., treatment and medication fee) itself demonstrated minimal impact on personal financial burdens since cancer patients cover only about 5% of the total medical expense upon public healthcare insurance policy in Korea. Surprisingly, more than half of patients were reported to have experienced greater financial burdens in indirect or non-medical expenses. Five main types of personal financial burdens incurred by MM and its treatment were categorized through thematic analysis with quotes from qualitative interview in Figure 2. Within the realm of medical costs, some patients experienced financial burden with the inadequate support before their diagnosis is determined or with non-reimbursed medication on active treatment. Moreover, the additional financial burden from non-medical costs manifested conspicuously both directly and indirectly. Such as time and money for the transportation for outpatient treatment, unpaid leave for hospital visits or hospitalization and productivity loss significantly impacted both patients and caregivers. Interestingly, symptoms from disease or adverse events led to considerable unexpected personal spending in some cases. For instance, neuropathy, a common side effect of MM treatment, compelled some patients to purchase a vehicle with autonomous cruise or resort to increased taxi use due to fears related to driving. Other costs included services or aids (massage, bath or thermo-therapy) for neuropathy home remedies, increased grocery expenses due to appetite loss, and housekeeping expenses arising from fatigue and insomnia. Similarly, ‘health-conscious consumption’ was also observed to increase in some case, such as dietary supplements or organic foods. A cost that is difficult to generalize but shouldn't be overlooked in a long-term, macro perspective is the loss of opportunity costs due to disease or treatment (e.g. decrease in long-term investments, giving up job-seeking activities). This was particularly noticeable in those who were younger or self-employed. Discussion: Everyone has their own individual circumstances, and the financial impact of these circumstances varies considerably, making quantification challenging. Moreover, the significance of a given sum of money can vary individually. Thus, we sought to examine the economic impacts and financial burden on the disease journey within the diverse lives of individuals through a qualitative lens. Our qualitative approach revealed that the financial burden of disease/treatment in each individual's life can be felt incomparably greater than what previous quantitative research had estimated only for direct medical expenditures. Our findings should also underscore the need for comprehensive strategies to alleviate the personal financial burdens borne by MM patients and their caregivers.

Out-of-Pocket Expenditure for Antenatal Care Amid Free Health Care Provision: Evidence From a Large Pregnancy Cohort in Rural Sri Lanka.

Global evidence suggests that high out-of-pocket (OOP) expenditure negatively affects health service utilization and creates an economic burden on households during pregnancy. This study aimed to estimate the magnitude and associated factors of OOP expenditure for antenatal care (ANC) in a rural Sri Lankan setting by following up with a large pregnancy cohort (The Rajarata Pregnancy Cohort [RaPCo]) in Anuradhapura District, Sri Lanka. Data were collected from July 2019 to May 2020. An interviewer-administered questionnaire was used to collect socioeconomic data and OOP expenditures in the first trimester. Self-administered questionnaires were used monthly to collect OOP expenditures in the second and third trimesters. In-depth financial information of 1,558 pregnant women was analyzed using descriptive statistics, nonparametric statistics, and a multiple linear regression model. The majority of participants used both government and private health facilities for ANC. The mean (standard deviation [SD]) OOP expenditure per ANC visit was US$4.18 (US$4.19), and the mean (SD) OOP expenditure for total ANC was US$57.74 (US$80.96). Pregnant women who used only free government health services also spent 28% and 14% of OOP expenditure on medicines and laboratory investigations. Household income (P<.001), household expenditure (P<.1), used health care mode (P<.05), maternal morbidities (P<.05), and the number of previous pregnancies (P<.1) were the statistically significant independent predictors of OOP expenditure. OOP expenditure per visit for ANC equals half of the daily household expenditure. Despite having freely available government health facilities, most pregnant women tend to use both government and private health facilities and incur higher OOP expenditure. Free government health care users also incur a direct medical OOP expenditure for medicines and laboratory investigations. Monthly household income, expenditure, used health care mode, maternal morbidities, and the number of previous pregnancies are independent predictors of OOP expenditure.

Incremental burden on health-related quality of life, health service utilization and direct medical expenditures associated with cognitive impairment among non-institutionalized people with diabetes aged 65 years and older.

To quantify the incremental health and economic burden associated with cognitive impairment (CI) among non-institutionalized people with diabetes ≥65 years in the United States. Using 2016-2019 Medical Expenditure Panel Surveys data, we identified participants ≥65 years with diabetes. We used propensity score weighting to quantify the CI-associated incremental burden on health-related quality of life measured by the 12-item Short Form Survey (SF-12), including the mental component summary score, physical component summary score and health utility. We also compared the annual health service utilization and expenditures on ambulatory visits, prescriptions, home care, emergency room (ER), hospitalizations and total annual direct medical expenditures. We included 5094 adults aged ≥65 with diabetes, of whom 804 had CI. After propensity score weighting, CI was associated with a lower mental component summary score (-8.4, p < .001), physical component summary score (-5.2, p < .001) and health utility (-0.12, p < .001). The CI group had more ambulatory visits (+4.4, p = .004) and prescriptions (+9.9, p < .001), with higher probabilities of having home care (+11.3%, p < .001) and ER visits (+8.2%, p = .001). People with CI spent $5441 (p < .001) more annually, $2039 (p = .002) more on prescriptions, $2695 (p < .001) more on home care and $118 (p < .001) more on ER visits. There is no statistically significant difference in the utilization and expenditure of hospitalizations. CI was associated with worse health-related quality of life, higher health service utilization and expenditures. Our findings can be used to monitor the health and economic burden of CI in non-institutionalized older persons with diabetes.

Economic aspects of the fixed combinations of lipid lowering medicines in group risks patients

Relevance. Cardio-vascular diseases (CVD) are the one of the main reasons of mortality and disability. Hypercholesterinemia is a factor of CVD progression, and thus it should be corrected. Combination of statin + ezetemib is an effective option of a medical technology for this purpose. Pharmacoeconomic analysis of rosuvastatin and ezetemib fixed combination (FC) has been performed in this work in comparison with free combination (FrC) of these drugs.Materials and methods. Modelling of FC vs FrC in groups of CVD risk has been performed on 1–5 years horizon based on the local epidemiologic published data with aim of economic analysis. Efficacy of FC and FrC, direct medical costs, including cost of drugs, hospitalizations etc. were taken into account also. ICER has been calculated and compared with willingness to pay.Results. FC usage instead FrC can prevent 2960–3055 deaths and 8880–9164 admissions to hospital caused CVD. FC decrease of ambulance cost as well as others direct medical expenditures in compare with FrC treatment on 9,3 bln RUR per 5 years. ICER has been calculated and has negative (dominant) result.Conclusion. FC usage is an economic dominant technology in compare with FrC for hypercholesterolemia control.

Out of pocket expenditure on cancer patients at a tertiary care hospital of Lucknow

The increasing cost of cancer diagnosis and its management has led to a huge financial burden and noticed to be one of the major contributors to poverty. Out-of-pocket expenses (OOPE) significantly impact patients households work as well as experience to cancer treatment. Understanding its nature of burden will guide us in formulation of plans to avoid financial distress among the cancer patients.A tertiary care hospital based cross-sectional observational and analytical study was conducted on 120 cancer patients attending surgical OPD at King Georges Medical University, Lucknow, from July 2020 to November 2021. Sociodemographic and economic variables, costs incurred under various headings and expenditure details of the subjects were obtained by pre-designed, pre-tested, semi-structured questionnaire. Direct medical and direct non-medical costs were calculated, and its total was used as the OOPE. Appropriate statistical tests were applied wherever applicable.Overall mean out-of-pocket expenditure by study participants was Rs 79925.5 (51776-121651). The expense on direct medical expenditure was Rs 45151(30051, 90051) and indirect non-medical expenditure was Rs 10000(5000,14000). We found significantly higher OOPE in subjects residing more than 100 km away from Lucknow (P = 0.017), with gall bladder cancer (P = 0.001), who were diagnosed with cancer while screening (P =0.034), who were diagnosed at Private clinic/hospital (P = &amp;#60; 0.001) and delayed treatment (P = 0.023). Cancer patients experience significant OOPE following their diagnosis. Its impact on patient wellbeing with their treatment decisions need to be further studied.

Real-World Costs and Cost-Effectiveness Analysis of Rabbit-Antithymocyte Globulin Versus Oxymetholone in Acquired Aplastic Anemia in Thailand

ObjectivesThis study aimed to compare rabbit-antithymocyte globulin and cyclosporine (rATG/CsA) with oxymetholone in terms of direct medical expenditures and economic evaluation in severe acquired aplastic anemia (SAA) and very severe acquired aplastic anemia (vSAA) patients. MethodsPatients with SAA/vSAA who initiated treatment with rATG/CsA or oxymetholone between 2004 and 2018 were included. Trial-based cost-effectiveness evaluation in healthcare provider perspective was performed. Direct medical costs were retrieved from hospital database, inflated, and converted to 2020 US dollar (30.01 Baht per US dollar). One-way sensitivity analysis and probabilistic sensitivity analysis by nonparametric bootstrap was performed. ResultsAfter 2-year follow-up, the total mean (SD) direct medical expenditures per patient for oxymetholone and rATG/CsA group were $8 514.48 ($12 595.67) and $41 070.88 ($22 084.04), respectively. Nevertheless, oxymetholone had significant lower survival rate than rATG/CsA (P=.001) but higher in second-year blood transfusion need (71.4% vs 18.2%) and hospitalization (14.3% vs 0%). The incremental cost-effectiveness ratio was $45 854.08 per life-year gained when rATG/CsA was used instead of oxymetholone (95% CI $24 244.03-$143 496.67 per life-year gained). The probabilistic sensitivity analysis indicated that rATG/CsA had no chance of being cost-effective for SAA/vSAA when willingness to pay threshold of one to 3 times of national gross domestic product per capita was applied. ConclusionsOxymetholone remains a viable alternative in resource-limited country. Despite its high cost, the rATG/CsA is a preferred treatment option because of the significant advantages on reducing mortality, treatment complications, and hospitalization.

Economic evaluation of toripalimab plus chemotherapy compared with chemotherapy as first-line treatment for advanced esophageal squamous cell carcinoma in China

ABSTRACT Objectives The purpose of this study was to compare the cost-effectiveness of toripalimab versus Chemotherapy for patients with advanced esophageal squamous cell carcinoma (ESCC) from the perspective of the Chinese healthcare system. Methods A partitioned survival model was designed. Clinical data on survival was taken from the JUPITER-06 trials. Direct medical expenditures and utilities were gathered from published literature and a local database. One-way and probability sensitivity methods were used to evaluate the model’s robustness. Results Compared with chemotherapy alone, toripalimab offered an incremental cost of $8950.427 with an additional 0.294 QALYs, yielding an ICER of 30,443.629$/QALYs first-line therapy for advanced ESCC. The ICER was below the threshold of willingness to pay in China, indicating that the toripalimab group had a cost-effective advantage. Sensitivity analysis showed that the ICERs were most sensitive to the utility of PD, but all the parameters had no significant impact on the model’s outcomes. Conclusion Toripalimab may be a cost-effective first-line treatment choice in our research when compared to chemotherapy alone for patients with advanced ESCC.

Progressive supranuclear palsy’s economical burden: the use and costs of healthcare resources in a large health provider in Israel

BackgroundProgressive supranuclear palsy (PSP) is a rare and fatal neurodegenerative movement disorder with no disease modifying therapy currently available. Data on the costs associated with PSP are scarce. This study aims to assess the direct medical expenditure of patients with PSP (PwPSP) throughout disease course.MethodsThis retrospective cohort study is based on the data of a large state-mandated health provider in Israel. We identified PwPSP who were initially diagnosed between 2000 and 2017. Each PwPSP was randomly matched to three health-plan members without PSP by birth-year, sex, and socioeconomic status. Healthcare resources’ utilization and related costs were assessed.ResultsWe identified 88 eligible PwPSP and 264 people in the reference group; mean age at diagnosis was 72.6 years (SD = 8.4) and 53.4% were female. The annual direct costs of PwPSP have risen over time, reaching US$ 21,637 in the fifth year and US$ 36,693 in the tenth year of follow-up vs US$ 8910 in the year prior diagnosis. Compared to people without PSP, PwPSP had substantially higher medical expenditure during the years prior- and post-index date.ConclusionThe present study demonstrates higher economic burden, which increases with time, in PwPSP as compared to those without.

Smoking and healthcare expenditure reductions associated with the California Tobacco Control Program, 1989 to 2019: A predictive validation.

Previous research used data through 2008 to estimate a model for the effect of the California Tobacco Control Program (CTCP) that used cumulative real per capita tobacco control expenditure to predict smoking behavior (current adult smoking prevalence and mean cigarette consumption per current smoker). Predicted changes in smoking behavior due to the CTCP were used to predict its effect on health care expenditure. This research updates the model using the most recently available data and estimates CTCP program effect through 2019. The data used in the previous research were updated, and the original model specification and a related predictive forecast model were re-estimated. The updated regression estimates were compared to those previously published and used to update estimates of CTCP program effect in 2019 dollars. There was no evidence of structural change in the previously estimated model. The estimated effect of the CTCP program expenditures on adult current smoking prevalence and mean consumption per adult current smoker has remained stable over time. Over the life of the program, one additional dollar per capita of program expenditure was associated with a reduction of current adult smoking prevalence by about 0.05 percentage point and mean annual consumption per adult current smoker by about 2 packs. Using updated estimates, the program prevented 9.45 (SE 1.04) million person-years of smoking and cumulative consumption of 15.7 (SE 3.04) billion packs of cigarettes from 1989 to 2019. The program produced cumulative savings in real healthcare expenditure of $544 (SE $82) billion using the National Income and Product Accounts (NIPA), and $816 (SE $121) billion using the Center for Medicare and Medicaid Services (CMS) measure of medical costs. During this time, the CTCP expenditure was $3.5 billion. A simple predictive model of the effectiveness of the CTCP program remained stable and retains its predictive performance out-of-sample. The updated estimates of program effect suggest that CTCP program has retained its effectiveness over its 31-year life and produced a return on investment of 231 to 1 in direct CMS medical expenditure.

Out-of-pocket expenditures and financial risks associated with treatment of vaccine-preventable diseases in Ethiopia: A cross-sectional costing analysis.

Vaccine-preventable diseases (VPDs) remain major causes of morbidity and mortality in low- and middle-income countries (LMICs). Universal access to vaccination, besides improved health outcomes, would substantially reduce VPD-related out-of-pocket (OOP) expenditures and associated financial risks. This paper aims to estimate the extent of OOP expenditures and the magnitude of the associated catastrophic health expenditures (CHEs) for selected VPDs in Ethiopia. We conducted a cross-sectional costing analysis, from the household (patient) perspective, of care-seeking for VPDs in children aged under 5 years for pneumonia, diarrhea, measles, and pertussis, and in children aged under 15 years for meningitis. Data on OOP direct medical and nonmedical expenditures (2021 USD) and household consumption expenditures were collected from 995 households (1 child per household) in 54 health facilities nationwide between May 1 and July 31, 2021. We used descriptive statistics to measure the main outcomes: magnitude of OOP expenditures, along with the associated CHE within households. Drivers of CHE were assessed using a logistic regression model. The mean OOP expenditures per disease episode for outpatient care for diarrhea, pneumonia, pertussis, and measles were $5·6 (95% confidence interval (CI): $4·3, 6·8), $7·8 ($5·3, 10·3), $9·0 ($6·4, 11·6), and $7·4 ($3·0, 11·9), respectively. The mean OOP expenditures were higher for inpatient care, ranging from $40·6 (95% CI: $12·9, 68·3) for severe measles to $101·7 ($88·5, 114·8) for meningitis. Direct medical expenditures, particularly drug and supply expenses, were the major cost drivers. Among those who sought inpatient care (345 households), about 13·3% suffered CHE, at a 10% threshold of annual consumption expenditures. The type of facility visited, receiving inpatient care, and wealth were significant predictors of CHE (p-value < 0·001) while adjusting for area of residence (urban/rural), diagnosis, age of respondent, and household family size. Limitations include inadequate number of measles and pertussis cases. The OOP expenditures induced by VPDs are substantial in Ethiopia and disproportionately impact those with low income and those requiring inpatient care. Expanding equitable access to vaccines cannot be overemphasized, for both health and economic reasons. Such realization requires the government's commitment toward increasing and sustaining vaccine financing in Ethiopia.

Healthcare Scheme to Overcome Financial Burden Associated with Chemoradiation Therapy in Head and Neck Cancer Patients: A Retrospective Single Centre Study.

Head and neck cancer (HNC) is third highest prevalent cancer among Indian which constitutes about 25-30% of all the cancer in India. Further, out-of-pocket expenditure (OOPE) covers around 67% of total healthcare expenditure and direct medical cost is key factor responsible for raised OOPE in India. Thus, we aimed to quantify total direct medical cost and OOPE associated with HNC management among HNC patients using "Ayushman Bharat Arogya Karnataka scheme" (ABArK scheme). A retrospective study was conducted for the duration of 6 months to collect the data related to total direct medical cost, coverage of "ABArK Scheme" and OOPE of past 2 years of HNC patients. The data of HNC patients above 18 years of age utilizing "ABArK scheme" were included in the study whereas data of patients utilizing other healthcare schemes and incomplete data on target schemes were excluded. A total of 196 patients (54.1%) utilized the "ABArK Scheme" out of 362 HNC patients treated in past 2 years. Among 196 patients, males (76.5%) were predominant over females (23.5%) with the mean age of 53.60 ± 11.58 years. We found that INR 17,370,279 as the total direct medical expenditure for the management of HNC patients of which around 87.465% was covered by "ABArK Scheme" minimizing the OOPE up to INR 3,297,970. Thus, Introduction and implementation of novel healthcare policies like "ABArK Scheme" can counteract financial burden of cancer management by significantly reducing OOPE which could be milestone achievement for the low-middle income countries like India.

Economic burden of childhood overweight and obesity: A systematic review and meta-analysis.

To update existing literature and fill the gap in meta-analyses, this meta-analysis quantitatively evaluated the worldwide economic burden (in 2022 US $) of childhood overweight and obesity in comparison with healthy weight. The literature search in eight databases produced 7756 records. After literature screening, 48 articles met the eligibility criteria. The increased annual total medical costs were $237.55 per capita attributable to childhood overweight and obesity. Overweight and obesity caused a per capita increase of $56.52, $14.27, $46.38, and $1975.06 for costs in nonhospital healthcare, outpatient visits, medication, and hospitalization, respectively. Length of hospital stays increased by 0.28 days. Annual direct and indirect costs were projected to be $13.62 billion and $49.02 billion by 2050. Childhood obesity ascribed to much higher increased healthcare costs than overweight. During childhood, the direct medical expenditures were higher for males than for females, but, once reaching adulthood, the expenditures were higher for females. Overall, the lifetime costs attributable to childhood overweight and obesity were higher in males than in females, and childhood overweight and obesity resulted in much higher indirect costs than direct healthcare costs. Given the increased economic burden, additional efforts and resources should be allocated to support sustainable and scalable childhood obesity programs.