Direct Medical Costs Research Articles

Rate and direct medical costs of cesarean sections among supplementary health plan holders living in the state of São Paulo, Brazil: 2015-2021.

Brazil has the second largest cesarean section rate in the world. Differences in rates exist between the public and private health sectors. This study used data on admissions of supplementary health plan holders aged between 10 and 49 years living in the state of São Paulo admitted between 2015 and 2021 to determine cesarean section rates and costs in the private health sector. We conducted a partial economic analysis in health from a supplementary health perspective focusing on the direct medical costs of admissions. A total of 757,307 admissions were analyzed with total costs amounting to R$7.701 billion. The cesarean section rate over the period was 80%. Rates were lowest in young women (69%) and highest in the oldest age group (86%), exceeding 67% across all groups. The rate was 71% higher than in public services. The proportion of admissions with use of the intensive care unit was higher among cesarian deliveries. The median cost of a cesarean was 15% higher than that of a normal delivery and twice as high in insurance companies than healthcare cooperatives. There is an opportunity to apply policies that are widely used in public services to the private sector with the aim of reducing cesarean rates in private services, direct costs of admission, and the cost of supplementary health plans.

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.

Cost Analysis of Outpatient Colectomy in a Tertiary Center: A Projected Medico-Economic Evaluation

Aim of the study: Short stay processes are incentives to unburden chronically stressed healthcare systems. The aim of this study is to analyze financial implications of day admission (DAS) and outpatient strategies for colon resections in a prospective payment system (PPS) using Diagnosis Related Group (DRG) coding. Methods: Consecutive patients undergoing left and right colonic resections between January 1, 2019 and December 31, 2020 were included. Medico-economic evaluations of the virtual outpatient and day admission surgery groups based on predefined criteria were compared to the identical group of patients who underwent surgery in the actual traditional inpatient setting. In a second step, postoperative complications of the virtual outpatient group were assessed. Cost-revenue analysis was performed using a micro-costing approach including direct medical costs. Results: Overall (N = 257), 97 (37.7%) colectomies would have been potentially eligible for an outpatient strategy. The global costs of the actual inpatient strategy totaled USD 3 634 392 with a global revenue of USD 3 571 069, corresponding to a cost coverage rate of 98%. The result of the virtual DAS strategy would have been a net loss of USD 15 800 (coverage rate of 99%) due to 4 low length of stay outliers triggering a reimbursement reduction and preventing a positive net result of USD 16 208. The pilot reference outpatient case’s revenue and cost amounted to respectively USD 7479 and USD 6911 (cost coverage of 108%). Conclusion: From both any given hospital and healthcare system point of view, elective outpatient colectomy for selected patients is the most cost-saving option. However, in a prospective payment system implemented to avoid bad incentives, the latter can unintentionally disadvantage best performing hospitals and impede widespread adoption of high-value strategies.

Taxa e custos médicos diretos de cesáreas em beneficiárias da saúde suplementar no estado de São Paulo, Brasil: 2015 a 2021

Abstract Brazil has the second largest cesarean section rate in the world. Differences in rates exist between the public and private health sectors. This study used data on admissions of supplementary health plan holders aged between 10 and 49 years living in the state of São Paulo admitted between 2015 and 2021 to determine cesarean section rates and costs in the private health sector. We conducted a partial economic analysis in health from a supplementary health perspective focusing on the direct medical costs of admissions. A total of 757,307 admissions were analyzed with total costs amounting to R$7.701 billion. The cesarean section rate over the period was 80%. Rates were lowest in young women (69%) and highest in the oldest age group (86%), exceeding 67% across all groups. The rate was 71% higher than in public services. The proportion of admissions with use of the intensive care unit was higher among cesarian deliveries. The median cost of a cesarean was 15% higher than that of a normal delivery and twice as high in insurance companies than healthcare cooperatives. There is an opportunity to apply policies that are widely used in public services to the private sector with the aim of reducing cesarean rates in private services, direct costs of admission, and the cost of supplementary health plans.

Estimation of the Three Phases by Direct Cost of Care for Non-surviving Patients with Cancer: A National Population-based Patient-level Study.

Background: Determining the cost structure of medical care from diagnosis to the death of patients with cancer is crucial for establishing budgets to support patients with cancer. The breakdown of the cost estimation in distinct phases of survival is essential for optimizing the allocation of limited funds. Therefore, this study aims to examine the patterns of direct medical costs of cancer care associated with seven major cancer types and estimate cost thresholds to distinguish each phase based on the incurred cost. Methods: In this nationwide, population-based study, we used claims data from the National Health Insurance Service, Korea. Patients newly diagnosed with cancer since 2006 and who died in 2016-2017 were enrolled, and their use of medical services during cancer survival from at least 6 months up to 12 years was observed. The monthly cost exhibited a non-linear function with two unknown thresholds resembling a U-shape; therefore, we fitted three linear segment models. Individual costs were assessed by dividing the survival time into the initial, continuing, and terminal phases by estimated thresholds, and the average medical cost for each phase was calculated. Results: Based on survival durations of 12 years or less, the initial phase occurred within 1.1-4.8 months after diagnosis, while the terminal phase was observed in 1.4-4.7 months before death. The length of these two phases increased with the increased survival time of the patients. Medical costs in these phases ranged from $4067-7431 and $3127-6114 (US dollars), respectively, regardless of the variations in survival time. However, the average costs in the continuing phase were higher for patients with a short survival time. Conclusions: This study highlights the cost dynamics in cancer care through a breakdown of the phases of survival. It suggests that through a more refined definition of the initial and terminal phases, the average cost in these stages increases, indicating the significant implications of the findings for resource allocation and tailored financial support strategies for patients with cancer with varying prognoses.

Economic Burden of Hepatitis B at Different Stages of the Disease: A Systematic Review Study.

Viral hepatitis is the most prevalent liver disease in the world. This disease imposes a great economic burden on families and the health system. This study was conducted to investigate the economic burden of hepatitis B at different ages of the disease using a systematic review method. Using the systematic review method, the researcher extracted articles related to the economic burden of hepatitis B at different stages of the disease using domestic and international databases including SID, MEDLINE/PubMed, Embase, Web of Science, NHS Economic Evaluation Database (EED), EconLit, and Google Scholar before April 2020 and used the PICOTS framework to select the inclusion criteria. Quality assessment of methodology of the studies was evaluated using Drummond's checklist. After searching for articles based on inclusion and exclusion criteria, 18 articles were included in the final analysis. The findings showed that the highest mean direct medical costs were $ 2748 for chronic hepatitis B, $ 18903 for compensated cirrhosis, $35668 for decompensated cirrhosis, and $93228 for liver cancer. In all of the studies, the highest mean direct medical costs were those of liver transplantation ($ 355000). The treatment costs of diseases related to chronic hepatitis B increase significantly at different stages the disease progression. Although vaccination actions can reduce the disease, we require more investment in the health system infrastructure to provide patients' access to hepatitis drugs and reduce their direct payments.

The annual economic burden incurred by heart failure patients in Vietnam: a retrospective analysis.

Heart failure (HF) is a chronic condition associated with substantial mortality and hospitalisation, resulting in costly inpatient visits. The healthcare systems of several countries, including Vietnam, experience considerable difficulty in dealing with the enormous fiscal burden presented by HF. This study aims to analyse the direct medical costs associated with HF inpatient treatment from the hospital perspective. This study retrospectively analysed the electronic medical records of patients diagnosed with HF from 2018 to 2021 at Military Hospital 175 in Vietnam. The sample consisted of 906 hospitalised patients (mean age: 71.2 ± 14.1 years). The financial impact of HF was assessed by examining the direct medical expenses incurred by the healthcare system, and the costs of pharmaceutical categories used in treatment were explored. The cumulative economic burden of HF from 2018 to 2021 was US$1,068,870, with annual costs ranging from US$201,670 to US$443,831. Health insurance covered 72.7% of these costs. Medications and infusions, and medical supplies accounted for the largest expenses, at 29.8% and 22.1%, respectively. The medication HF group accounted for 13.01% of these expenses, of which the costliest medications included nitrates (2.57%), angiotensin II receptor blockers (0.51%), ivabradine (0.39%), diuretics (0.24%), and mineralocorticoid receptor antagonists (0.23%). Comorbidities and the length of hospital stay significantly influenced annual treatment costs. The study reveals that HF significantly impacts Vietnam's healthcare system and citizens, requiring a comprehensive understanding of its financial implications and efficient management of medical resources for those diagnosed. This study highlights the substantial economic burden of HF on Vietnam's healthcare system, with medication costs, particularly antithrombotic drugs, representing the largest expense. Most healthcare costs were covered by health insurance, and expenses were significantly influenced by comorbidity and length of hospital stay. These findings can inform healthcare policy, resource allocation and optimise management strategies in Vietnam.

Assessment of Diabetes Mellitus Prevalence and Associated Complications among Patients at Jinja Regional Referral Hospital

In recent years, Africa has witnessed a notable shift in its disease landscape from acute infectious conditions to chronic non-communicable diseases like diabetes. The economic impact of diabetes and its complications has become a significant concern, affecting individuals, families, healthcare systems, and national economies through direct medical costs and productivity loss. Uganda, in particular, has observed a rising prevalence of diabetes, with the Uganda Diabetes Association reporting a 1.4% prevalence, accounting for approximately 500,000 individuals affected. This surge in diabetes presents a dual challenge as both a public health issue and an economic burden, necessitating vigilant monitoring and stringent management. Recognizing its profound public health implications in terms of morbidity, mortality, and cost, a comprehensive investigation into the prevalence and complications of diabetes mellitus was conducted at Jinja Regional Referral Hospital (JRRH). Using a retrospective facility-based cross-sectional study design encompassing qualitative and quantitative approaches, this research reviewed 784 patient records admitted to JRRH from January 2018 to December 2018. The findings revealed a notably high prevalence of diabetes mellitus at 8.2%. Noteworthy gender disparities were observed, with a higher prevalence among males (12%) than females (6%) within the studied population. Moreover, urban dwellers exhibited a higher susceptibility to diabetes compared to rural counterparts, and the risk was observed to escalate with age. Complications associated with diabetes mellitus were alarmingly prevalent, reaching 89.23%, predominantly characterized by microvascular complications, accounting for 56.90%. Despite the severity of complications, the case fatality rate stood at 1.54%, lower than the documented 4%, possibly influenced by a spectrum of contributing factors both positive and negative. The study underscores the urgency for increased focus on diabetes care in Jinja, emphasizing the imperative for further research, robust health education initiatives, and enhanced funding allocation toward managing this escalating health concern. Keywords: Diabetes Mellitus, Diseases, Public Health, Complications, Males and Females.

Chi phí trực tiếp dành cho y tế của người bệnh đái tháo đường nội trú tại khoa nội tiết bệnh viện đa khoa trung tâm Tiền Giang năm 2022

The study describe the direct medical costs of diabetic inpatients at the Department of Endocrinology at Tien Giang General Hospital in 2022. The research method is cross-sectional descriptive, review medical records and payment slips of 384 patients with diabetes at the Department of Endocrinology who were discharged. Data were analyzed using Excel with mean, median, maximum, minimum and standard deviation. The results showed that the total cost of one treatment session of an inpatient diabetes patient average was 4,476,407 (± 3,982,110) VND. Cost of day/bed accounted for 42.2%; drugs 26.7%; testing 15.6%; surgical procedures 7.7%; diagnostic imaging 5.9%; Consumables 1.9%. The cost of diabetes with kidney complications increased 2.1 times, foot infections increased 4.3 times, and increased 5 times when complications with foot infections and comorbidities were combined. To contribute to reducing the economic burden for patients, it is necessary to strengthen inpatient and outpatient management of diabetes, control foot infections and kidney complications, and strengthen communication and education to increase the patient's knowledge in treatment adherence and prevention of complications.

Evaluating Economic Outcomes: Single-Use Aspirin vs. Aspirin-Clopidogrel in Ischemic Stroke Patients Based on Barthel Index Scores

Ischemic stroke is a catastrophic disease that causes large costs in Indonesia. The high prevalence of stroke results in increased morbidity and mortality rates, which will impact the socioeconomic status of stroke patients. Cost Effectiveness Analysis (CEA) is a method in pharmaco-economics that aims to make decisions regarding the rational choice of therapy and evaluate the economic impact on ischemic stroke patients. This study aims to determine the Incremental Cost Effectiveness Ratio (ICER) value of antiplatelet therapy in the aspirin-clopidogrel combination group and the single aspirin group in ischemic stroke patients treated at the Regional General Hospital. Dr. M. Djamil Padang. The clinical parameter observed was the Barthel Index (BI) value. This research is a descriptive study with retrospective data collection using medical record data and the Hospital Management Information System (SIMRS) at RSUD Dr. M.Djamil Padang. The cost data shows the total direct medical costs incurred in treating ischemic stroke. Based on the results obtained, the Incremental Cost Effectiveness Ratio (ICER) value is IDR (-) 401,302. 71 per 1% increase. In this study it can be concluded that the aspirin-clopidogrel combination has better cost effectiveness than aspirin alone.

Burden of narcolepsy in Japan: A health claims database study evaluating direct medical costs and comorbidities

ObjectiveThis study aimed to determine the burden of narcolepsy in terms of direct medical costs and comorbidities and compare it with the respective burden of schizophrenia, epilepsy, and ulcerative colitis as controls. MethodsPatients diagnosed with narcolepsy (at least once based on the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, code G47.4) between April 2017 and March 2022 were identified on the health insurance claims database compiled by JMDC Inc. Patients with schizophrenia (F20), epilepsy (G40), and ulcerative colitis (K51) were matched as controls. Direct medical costs (including inpatient, outpatient, and medication costs) and comorbidities were analyzed. ResultsWe identified 4,594 patients with narcolepsy (≥18 years), 18,376 with schizophrenia, 18,376 with epilepsy, and 4,594 with ulcerative colitis. The total annual direct medical cost per person with narcolepsy was 349,188 JPY. The cost for narcolepsy was less than that for schizophrenia, epilepsy, and ulcerative colitis. Several comorbidities, such as sleep apnea, attention deficit hyperactivity disorder (ADHD), and obesity were more prevalent in the narcolepsy group. ConclusionsThe total direct cost for narcolepsy was approximately three times higher than the national medical expense for people aged 15–44 years (122,000 JPY in 2020), but lower than the total cost for all control diseases. The patients with narcolepsy were also likely to have comorbidities that affected their burden. These findings can contribute to future discussions on medical expense assistance programs for patients with narcolepsy.

Economic Burden of Huntington’s Disease in China: Results from a National-Wide Cross-Sectional Study

Background: Huntington’s disease (HD) poses a significant socio-economic burden globally. Existing research on HD’s economic burden predominantly comes from Western settings, leaving a gap in data from Asian countries. This study aimed to assess the economic burden of HD in China and identify cost-driving factors. Methods: This study used data from a 2019 nationwide cross-sectional survey of individuals affected by rare diseases in China. Data included socio-demographic characteristics, income, disease stage, health and social insurance coverage status, treatment-seeking behaviour, and costs. Logistic regression and linear regression were used to explore potential contributors to treatment-seeking behaviour and associated costs. Results: Of the 269 individuals with HD included in this study, 80.6% were actively seeking treatment. The average annual direct medical cost, direct non-medical cost, and indirect cost were 3,265.65, 805.82, and 801.97 Euros, respectively. Compared to participants with early-stage HD, those with middle- or advanced-stage HD reported higher direct medical costs (coefficient 1,612.70, 95% confidence interval [CI]: [141.92, 3,083.48] and 2,398.58, 95% CI: [791.16, 4,006.00], respectively). However, the disease stage was not significantly associated with direct non-medical costs or indirect costs. Conclusions: This study provides crucial insights into the economic burden of HD in China. It emphasises a need for targeted policies that better cater to the financial needs of HD patients.

Economic burden attributable to healthcare-associated infections at western China hospitals: 6 Year, prospective cohort study

Healthcare-associated infections (HAIs) represent a major threat to patient safety and are associated with significant economic burden. Calculating the costs attributable to HAIs is challenging given the various sources of bias. Although HAIs as a reasonably preventable medical harm should have been closely linked to medical insurance incentives, there was little linkage between HAIs and medicare in western China owing to the lack of economic evaluation data. The present study aimed to generate estimates of the attributable costs associated with HAIs and the magnitude of costs growth. In this cohort study designed horizontally and vertically from 2016 to 2022, we compared outcomes of randomly sampling patients with HAIs and individually matched patients without HAIs in two cohorts at a 6-year interval at 34 hospitals in western China. The primary outcome was the direct medical cost for the entire hospital stay, converted to US dollars ($ for the benchmark year), discounted at 3% annually, and estimated separately in the full analysis set (FAS) and the per protocol set (PPS). We used multiple linear regression to adjust the discounted costs and to assess subgroups effects within each cohort. We nested a dynamic vertical comparison of costs attributable to HAIs between the front and rear cohorts. A total of 230 patients with HAIs in 2016 and 204 patients with HAIs in 2022 were enrolled. After a 1:1 match, all 431 pairs were recruited as FAS, of which 332 pairs as PPS met all matching restrictions. Compared to the 2016 cohort in FAS, the patients with HAIs in 2022 had a significantly older age (64.40±16.45 years), higher repeat hospitalization rate (65 [32.02%] of 203), and lower immune function (69 [33.99%] of 203). The discounted costs and adjusted-discounted costs for patients with HAIs in the 2022 cohort were found to be significantly higher than those of patients without HAIs (discounted costs: $5484.60 [IQR 8426.03] vs $2554.04(4530.82), P<0.001; adjusted-discounted costs: $5235.90 [3772.12] vs $3040.21(1823.36), P<0.001, respectively), and also higher than those of patients with HAIs in the 2016 cohort (discounted costs: $5484.60 [8426.03] vs $3553.00 [6127.79], P<0.001; adjusted-discounted costs: $5235.90 [3772.12] vs $3703.82 [3159.14], P<0.001, respectively). In vertical comparison of PPS, the incremental costs of the 2022 cohort are 1.48 times higher than those of the 2016 cohort ($964.63(4076.15) vs $652.43 [2533.44], P= 0.084). This meticulously designed study in western China has successfully and accurately examined the economic burden attributable to HAIs. Their rapidly increasing tendency poses a serious challenge to patients, hospitals, and the medical insurance. A closer linkage between HAIs and ongoing motivating system changes is urgently needed in western China.

The Financial Implications of Pancreatic Surgery: The Hospital Is the Big Winner, Not the Surgeon!

High-volume pancreatic surgery centers require a significant investment in expertise, time, and resources to achieve optimal patient outcomes. A detailed understanding of the economics of major pancreatic surgery is limited among many clinicians and hospital administrators. A greater consideration of these financial aspects may in fact have implications for enhancing clinical care and for a broader sustainability of high-volume pancreatic surgery programs. In this retrospective observational study, patients who underwent pancreaticoduodenectomy (PD), total pancreatectomy, or distal pancreatectomy at one academic medical center during the fiscal year 2021 were evaluated. Detailed hospital charges and professional fees were obtained for patients using the Qlik perioperative database. Clinical data for the study cohort were gathered from a prospectively maintained, IRB-approved pancreatic surgery database. Charges for the 91-day perioperative period were included. A P < 0.05 was considered significant. During the study period, 159 evaluable patients underwent 1 of 3 designated pancreatic resections included in the analysis. Ninety-seven patients (61%) were diagnosed with adenocarcinoma and 70% (n = 110) underwent PD. The total charges (combined professional and hospital charges) for the cohort encompassing the entire perioperative period were $20,661,759. The median charge per patient was $130,306 (interquartile range [IQR], $34,534). The median direct cost of care was $23,219 (IQR, $6321) and the median contribution margin per case was $10,092 (IQR, $22,949). The median surgeon professional fee charges were $7700 per patient (IQR, $1296) as compared to $3453 (IQR, $1,144) for professional fee receipts (45% of the surgeon charge). The differences between the professional fee charges and receipts per patient were also considerable for other health care professionals such as anesthesiologists ($4945 charges vs $1406 receipts [28%]) and pathologists ($3035 charges vs $680 receipts [22%]). The surgeon professional fees were only 6% of the total charges, while the professional fees for anesthesiology and pathology were 4% and 2% of the total charges, respectively. Supply charges were 3% of the total charges. Longer operative time was correlated with increased hospital and anesthesia charges, without a significant increase in surgeon charges (P < 0.001, P < 0.001, and P = 0.2, respectively). Male sex, diabetes, and low serum albumin correlated with greater total hospital charges (P = 0.01, P = 0.01, and P = 0.03, respectively). The role of the surgeon in the perioperative clinical care of major pancreatic resection patients is crucial and important and is by no means limited to the operative day. Nevertheless, in the context of the current US health care system, the reimbursement to the surgeon in the form of professional fees is a relatively small fraction of the total health care receipts for these patients. This imbalance necessitates a substantial financial partnership between hospitals and their pancreatic surgery units to ensure the long-term viability of these programs.

The economic burden of autism spectrum disorder with and without intellectual disability in China: A nationwide cost-of-illness study

ObjectiveThe economic burden of autism spectrum disorder (ASD) on individuals, their families and society as a whole is poorly understood. Accurate figures are crucial for economic estimates and service planning. MethodsThe total lifetime individual costs and annual societal costs of ASD in China were estimated with a prevalence-based, gross cost of illness approach and data from multiple sources. The direct medical costs in outpatient and inpatient settings from the electronic health records (EHRs) of hospitals, and direct nonmedical costs from a national survey were included. The indirect costs were from both the national survey and the estimation using human capital methods. Age-specific lifetime incremental societal costs were measured. Comorbidity-related and unrelated costs were analyzed separately. ResultsThe discounted lifetime cost for an individual with ASD in China was $2.65 million (at 2020 prices, $) for those without intellectual disability (ID) and $4.61 million (at 2020 prices, $) for those with ID. The total cost of ASD amounted to $41.8 billion in 2020. Productivity loss were major cost drivers for ASD individuals without ID. Direct nonmedical costs (rehabilitation or adult care costs etc.) were major drivers for ASD individuals with ID. In a lifetime course, the total annual costs for middle aged and elderly (>42 years) were highest, followed by transitional adults (18–29 years) and preschoolers, both for individuals with or without ID. The distribution of costs over the lifespan varied by the cost category. ConclusionsASD imposes a substantial economic burden on families and health care systems. Sectors and services coordination should be given policy considerations.

The Impact of Teduglutide on Real-Life Health Care Costs in Children with Short Bowel Syndrome

ObjectivesTo analyze the real-life health care costs of home parenteral nutrition (HPN) in children with short bowel syndrome with intestinal failure (SBS-IF) before and after treatment with teduglutide, and to compare those with costs of children with SBS-IF not treated with teduglutide. Study DesignAll consecutive children with SBS-IF on HPN treated with subcutaneous teduglutide starting from 2018 through 2020 in a tertiary French referral center were retrospectively included. These patients were matched to children with SBS-IF on HPN followed during the same 3-year period who were eligible for the teduglutide but were not treated. HPN direct medical costs included: home-care visits, HPN bags, hospital admissions, and teduglutide. A comparison of costs before/after treatment, and between patients treated/not treated was performed. ResultsSixty children were included: 30 (50%) treated with teduglutide and 30 (50%) untreated. In the treated group, the median total costs of HPN significantly decreased after 1 (p<0.001) and 2 years of treatment (p<0.001) from 59.454 euros/year/patient to 43.885 euros/year/patient and 34.973 euros/year/patient, respectively. Comparing patients treated and not treated, the total HPN costs/year/patient were similar at baseline (p=0.6) but were significantly lower in the teduglutide-treated group after 1 (p=0.006) and 2 years of treatment (p<0.001). When adding the cost of teduglutide into the analysis, the total cost increased significantly in the treated group, and remained much higher even after modeling a reduction in the cost of the drug to 1/3 the present cost and PN weaning (p<0.001). ConclusionsTreatment with teduglutide is associated with a significant reduction in the annual costs of HPN but still remains expensive because of the drug itself. Finding cost saving strategies is essential.

Cost-utility of a multicomponent intervention for fibromyalgia versus usual care: a pragmatic randomised controlled trial.

To perform an economic evaluation on a multicomponent intervention programme for patients with fibromyalgia syndrome compared with usual clinical practice in primary care. A cost-utility analysis was conducted alongside a pragmatic randomised controlled trial (ClinicalTrials.gov: https://clinicaltrials.gov/ct2/show/record/NCT04049006) from a societal perspective, a human capital approach, and a 1-year time horizon. Patients diagnosed with fibromyalgia syndrome from the public health system in south Catalonia, Spain. Crude and adjusted incremental cost- utility ratios were estimated to compare the treatment strategies based on cost estimations (direct medical costs and productivity losses) and quality-adjusted life years. One-way and 2-way deterministic sensitivity analyses were performed. The final analysed sample comprised 297 individuals, 161 in the intervention group and 136 in the control group. A crude incremental cost-utility ratio of € 1,780.75 and an adjusted ratio of € 851.67 were obtained, indicating that the programme significantly improved patients' quality of life with a cost-increasing outcome that fell below the cost-effectiveness threshold. The sensitivity analysis confirmed these findings when varying large cost components, and showed dominance when increasing session attendance. The proposed multicomponent intervention programme was cost-effective compared with usual care for fibromyalgia, which supports its addition to standard practice in the regional primary care service.

Societal costs of illness for infantile epileptic spasms syndrome and evolutionary cost prediction in the era of WHO’s IGAP

BackgroundTo achieve the goal of improving the quality of life for persons with epilepsy within the framework of the WHO’s Intersectoral Global Action Plan (IGAP), our study aimed to assess the societal financial burden linked to infantile epileptic spasms syndrome (IESS), ensuring that children afflicted with IESS receive high-quality healthcare without enduring substantial financial constraints. MethodsBetween August 2022 and March 2023, 92 children with IESS (male: female: 2:1), recently diagnosed or previously followed-up, were recruited. We gathered costs for drugs, tests, and medical services, along with legal guardians’ monthly income. Total expenditure was determined by multiplying unit costs by the yearly service usage commencing from the onset. Time series analysis was utilised to forecast the financial burden from 2022 to 2032. ResultsClinicians' first choice of treatment was ACTH (n = 60, 65·2%), prednisolone (n = 25, 27·2%), and vigabatrin (n = 7, 7·6%) and the median cost of treatment during the initial year was INR 39,010 [USD 479·2]. The median direct medical, direct non-medical, and indirect cost were INR 31,650 [USD 388·4], INR 6581 [USD 80·8], and INR 10,100 [USD 124·07], respectively. Families lost a median of 12 days of work annually. Drug costs and loss of wages were the key factors in the financial burden. The projected and adjusted figures exhibited an incremental growth rate of 2·6% tri-annually. InterpretationThis pioneering study in developing countries, the first of its kind, evaluates the societal cost, financial hardship, and trajectory of incremental cost in IESS. The primary drivers of the financial burden were pharmacological treatment and family work adjustments. The government shoulders 62% of the financial burden, and projected a triannual growth of 2·6% from 2022 to 2032. Our results rationalize policymakers' focus on incorporating IESS into social security programs, particularly in developing countries.

Short-term and long-term financial toxicity from breast cancer treatment: a qualitative study.

The rising cost of breast cancer treatment has increased patients' financial burden, intensifying an already stressful treatment process. Although researchers increasingly recognize the harmful impact of medical and nonmedical costs associated with cancer treatment, understanding patients' perspectives of financial toxicity is limited. We aimed to explore the topic of financial toxicity through the lived experiences of patients with breast cancer from groups at risk of social and economic marginalization. We conducted semi-structured interviews with 50 women with breast cancer from four specific groups: Black women, Medicaid enrollees, rural residents, and women age ≤ 40. We transcribed, coded, and analyzed the data using deductive and inductive approaches. Two overarching themes captured patients' experiences of financial toxicity: short-term and long-term impacts. Short-term stressors included direct medical (e.g., co-pays, premiums), nonmedical (e.g., transportation, lodging), and indirect (e.g., job loss, reduced work hours) costs. Early in their treatments, patients' focus on survival took precedence over financial concerns. However, as the treatment course progressed, fear of consequences from compounding costs of care and financial distress negatively impacted patients' lifestyles and outlooks for the future. Programs addressing financial toxicity that look beyond early-phase interventions are needed. Specifically, patients struggling with the accumulation of treatment costs and the resultant stress require ongoing support. Long-term support is especially needed for groups vulnerable to financial instability and social marginalization.

Analisis Biaya dan Luaran Klinik Terapi Remdesivir dibandingkan Favipiravir pada COVID-19 Derajat Sedang: Perspektif Provider

The COVID-19 pandemic cases affect health and the economy and have become a burden for the global community. Effective and specific antiviral for COVID-19 is still controversial and has yet to be found. Antiviral use is the main mitigation strategy that tends to be more cost-effective but varies in effectiveness and cost depending on various factors. This study aims to evaluate the effectiveness, safety, and cost of antiviral therapy in moderate COVID-19. This observational-analytic study used a retrospective cohort design. Subjects were hospitalized patients with moderate COVID-19 who received antivirals in July-October 2021 and January-March 2022. Therapy effectiveness was measured by lowered NLR (Neutrophil-to-Lymphocyte Ratio) to a normal level and length of stay (LOS). Drug safety includes adverse drug events. The cost of therapy was calculated based on the hospital’s perspective (provider), using direct medical costs. A total of 170 patients were divided into two groups (94 patients remdesivir and 76 patients favipiravir). In this arm, there were 45 patients with lowered NLR (21 patients reached the target and 24 patients did not). The effectiveness of favipiravir and remdesivir was 70.6% and 32.1%. Remdesivir may lower NLR (2.92) versus favipiravir (1.55). Favipiravir had a shorter LOS than remdesivir (8 vs 9 days). Adverse drug events observed in remdesivir were nausea (47.9%) and abdominal pain (22.3%), while in favipiravir nausea (53.9%) and vomiting (22.4%). The average total cost of remdesivir is higher than favipiravir (IDR 19,772,985 vs IDR 13,819,727). Favipiravir has higher efficacy and a shorter LOS with a lower average total cost than remdesivir.