Total Direct Costs Research Articles

Impact of oral early antiviral therapies for mild–moderate COVID-19 in the outpatient’s setting during Omicron era: a pharmacoeconomic analysis

BackgroundMolnupiravir (MOL) and nirmatrelvir/ritonavir (NIR) decreased mortality and hospital admissions in high-risk patients with mild to moderate COVID-19. Nevertheless, there is a lack of data about the pharmacoeconomic impact of these antivirals in the Omicron era. We conducted a pharmacoeconomic analysis assessing the medical costs of the use of these antivirals compared to those occurred in people who refused the treatment.MethodsThe study included the first 50 patients vaccinated against SARS-CoV-2 of each month who experienced mild to moderate COVID-19 and were consecutively treated with oral antivirals at Padua University Hospital between February 1, 2022, and June 30, 2022. In addition, all consecutive patients who met the criteria for antiviral therapy during this period but opted not to receive treatment were included as control group. The two groups were compared in terms of costs associated with emergency department visits and hospitalizations, which were identified as the primary outcomes of the study.ResultsNine-hundred-sixty-one patients were analysed, mean age was 67.72 ± 15.19 years and 49% were males. The most prevalent comorbidities were cardiovascular disease (57%), obesity (18) and diabetes mellitus (18%). Two-hundred-fifty-one (26%) patients were treated with MOL (group A), 252/961 (26%) were treated with NIR (group B) and 458/961 (48%) refused antiviral therapy (group C). While a generally more favourable outcomes was observed in the early treated group, no statistically significance differences between hospitalization or emergency department visits were found between group A and C and between group B and C. Total direct medical costs were statistically significantly higher both comparing group A (671.42 ± 460€) vs. group C and comparing group B (1008.42 ± 1562€) vs. group C (446.58 ± 4977€). The main cost driver associated with the increased cost was the antiviral therapy. The average hospitalization cost was 19,334.3 ± 27,030€ for group C, 8956.2 ± 7412€ for group B and 10,267.2€ for group A.ConclusionsIn the context of the Omicron variant during the COVID-19 pandemic, the use of early oral antiviral agents in vaccinated individuals was found to be more expensive compared to avoid treatment, primarily due to the high costs associated with it. To enhance the efficiency in resource allocation, it is essential to pursue policies aimed at reducing drug costs, along with conducting further pharmaco-economic studies.

Cost Analysis Related to Diagnosis, Treatment and Management of Cervical Cancer in Antigua and Barbuda: A Prevalence-Based Cost-of-Illness Study

Cervical cancer remains a significant public health issue globally. In Antigua and Barbuda, cervical cancer is ranked among the top five most common cancers in terms of incidence and mortality among females. There is no evidence that the costs of diagnosing, treating, and managing this cancer have been studied before in Antigua and Barbuda. From the providers’ perspective, this study aimed to estimate costs associated with cervical cancer in Antigua and Barbuda. The prevalence-based cost-of-illness methodology was used to assess patient data abstracted from four study sites for the period 2017–2021, and to derive the annual prevalence. Top-down and bottom-up costing approaches were used to estimate direct medical costs. Costs were computed using the 2021 price level and converted to United States Dollars (USD). Total annual direct medical costs of cervical cancer were estimated at USD 0.24 million (ranging between USD 0.19 million and USD 0.30 million). Major cost drivers were treatment (USD 112,863.76), post-treatment side-effects care (USD 67,406.57), and the diagnostic process (USD 26,238.58). The overall direct medical unit costs for managing a case were estimated at USD 115,822.09. Our study reflects the current estimates for managing cervical cancer and provides evidence to complement cervical cancer prevention and cost containment measures in Antigua and Barbuda.

RECLAMATION COST CALCULATION OF PT. X IN SORONG CITY, SOUTHWEST PAPUA PROVINCE

Reclamation is an effort carried out throughout the mining process to organize, restore, and enhance the quality of the environment and ecosystem, so that the area can function again according to its intended purpose. In the mining industry, companies are required to conduct reclamation. Before carrying out reclamation, the company must calculate the required reclamation costs. PT. X is one of the companies engaged in andesite mining, which is administratively located in Saoka Village, Maladumes District, Sorong City, Southwest Papua Province. After completing the mining activities, PT. X will carry out reclamation by planting pine trees during the period from 2024 to 2028. Based on this, it is necessary to calculate the reclamation costs to determine the expenses the company will incur for this activity. The reclamation cost calculations are based on the Minister of Energy and Mineral Resources Decree Number 1827/K/30/MEM/2018, which outlines the guidelines for implementing Good Mining Engineering Principles. Reclamation costs consist of both direct and indirect costs. Based on the research findings, the total direct and indirect costs that PT. X must incur for reclamation activities from 2024 to 2028 are IDR 359,238,257 and IDR 119,972,490, respectively. Therefore, the total reclamation costs PT. X will incur for the reclamation activities from 2024 to 2028 amount to IDR 479,210,747

Effects of alcohol-related problems on the costs of frequent emergency department use: an economic analysis of a case-control study in Spain.

Alcohol-related problems increase the probability of frequent emergency department (ED) use. In this study, we compared the direct healthcare expenses incurred during a single visit among frequent and non-frequent ED users and analyzed the impact of alcohol-related issues in healthcare costs arising from ED usage. The study relied on secondary analyses of economic data from a 1:1 matched case-control study with the primary aim of identifying the clinical characteristics of hospital ED frequent users in a Mediterranean European environment with a public, universal, and tax-funded health system. The participants ranged in age from 18 to 65 years and underwent ED visits at a high-complexity Spanish hospital (cases ≥5 times, controls <5) from December 2018 to November 2019. Each case was matched to a control with the same age, gender, and date of attendance at the ED. Clinical data and direct healthcare costs for a single ED visit were obtained by a retrospective review of the first electronic medical register. Costs and duration of stay were compared between cases and controls using paired-samples t-tests, and ED users with and without alcohol-related problems were compared using bivariate (independent-samples t-tests, one-way analysis of variance, Chi square tests, and multiple linear regression) and multivariate analyses (multiple linear regression models with backward stepwise selection algorithm, and dependent variable: total mean direct costs). Among 609 case-control pairs (total n = 1218), mean total healthcare direct costs per ED visit were 22.2% higher among frequent compared with non-frequent users [mean difference 44.44 euros; 95% confidence interval (CI) 13.4-75.5; t(608) = 2.811; p = 0.005]. Multiple linear regression identified length of stay, triage level, ambulance arrival, and the specialty discharging the patient as associated with total healthcare costs for frequent users. In bivariate analyses, a history of alcohol-related problems was associated with a 32.5% higher mean total healthcare costs among frequent users [mean difference 72.61 euros; 95% confidence interval 25.24-119.97; t(320.016) = 3.015; p = 0.003]. The findings confirm the high cost of frequent ED use among people with alcohol-related problems, suggesting that costs could be reduced through implementation of intervention protocols.

Estimating the Economic Burden of COVID-19: Findings from Southern Iran

Background and Objective COVID-19 is an acute respiratory disease that poses a significant threat to public health. Recognizing the impact and costs associated with this disease can assist policymakers in making informed decisions about the allocation of resources. Therefore, this study estimated the economic burden of COVID-19 from a societal perspective, focusing on patients admitted to the referral hospital for this disease in southern Iran in 2022. Methods This descriptive and analytical study employed a random sampling method to select patients admitted to hospitals affiliated with Jiroft University of Medical Sciences in southern Kerman, Iran. The sampling period spanned from March 2020 to February 2021. In total, 450 patients were included in this study. A researcher-made checklist was used as the data collection tool. The data were then analyzed using a t-test, ANOVA, and Pearson correlation coefficient. The analysis was performed using SPSS23, with the significance level set at 0.05. Results The study estimated the total direct cost, total indirect cost, total cost of the studied patients, and the economic burden of COVID-19 disease as 600,211.89, 193,667.28, 793,879.17, and 4,186,389.48 dollars, respectively. A statistically significant correlation was found between length of stay (r=0.858, p&lt;0.001), type of insurance (F=2.853, P=0.023), and total direct cost. Conclusion Based on these results, it is evident that COVID-19 has imposed a substantial economic burden. The study findings emphasize the need for decision-makers to take measures and implement effective interventions to address COVID-19. This can be achieved by controlling risk factors, drawing upon successful experiences from other countries, and following recommendations provided by international organizations. By reducing the number of infections, the economic burden associated with the disease can be alleviated.

Impact of the COVID-19 pandemic on direct medical costs of acute coronary syndrome admissions in Yogyakarta, Indonesia

The number of admissions, therapeutic management, and clinical results of acute coronary syndrome (ACS) have been extensively reported. However, the economic impact of ACS therapy has been ignored. This study examined the effect of the COVID-19 pandemic on direct medical costs for ACS hospitalizations in Yogyakarta, Indonesia. A retrospective study of patients with ACS admitted to one of three hospitals during March to August in 2019, 2020, and 2021 was conducted. Direct medical costs from a provider’s perspective were estimated using the charges. All costs were reported in Indonesian Rupiah (IDR) at a 2021 value. Multiple linear regression analysis was used to evaluate the impact of the pandemic on total direct medical costs. The total direct medical costs associated with ACS admission per patient during the pandemic period was approximately 40% higher than that during the pre-COVID period (28.41 vs. 20.33 million IDR or 1976.90 vs. 1414.65 USD). A substantial impact of the COVID-19 pandemic on total direct medical costs still remained after adjusting the ACS types, hospital types, length of stay, percutaneous coronary intervention, in-hospital mortality, and delay time of onset to first medical contact. Given the limited health budget, reallocation of health care resources must be prioritized to maintain the provision of essential health care for those who timely treatment is crucial.

Cost-Effectiveness of the National Diabetes Prevention Program: A Real-World, 2-Year Prospective Study.

We evaluated the real-world cost-effectiveness of the National Diabetes Prevention Program (NDPP) for people with prediabetes in a large workforce with employer-sponsored health insurance. We performed difference-in-differences analyses using individual-level health insurance claims and survey data for 5,948 adults with prediabetes who enrolled (n = 575) or did not enroll (n = 5,373) in the NDPP to assess NDPP's effects on health economic outcomes. We assessed direct medical costs for the year before the NDPP enrollment/index date and for 2 years thereafter; EuroQol 5-Dimension 5-level questionnaire (EQ-5D-5L) utility scores at baseline, 1 year, and 2 years; and quality-adjusted life-years (QALYs) over 2 years. We used propensity score weighting to adjust for potential bias due to self-selection for enrollment, multiple imputation to handle missing data, and bootstrapping to produce CIs. We adopted a health care sector perspective and discounted costs and QALYs at 3% annually. Costs were expressed in 2020 U.S. dollars. Compared with nonenrollees, each NDPP enrollee had an average reduction of $4,552 (95% CI -13,231, 2,014) in 2-year total direct medical costs. Cost savings were primarily related to hospitalizations, outpatient visits, and emergency room visits. Compared with nonenrollees, each enrollee had no difference in EQ-5D-5L utility scores at 2 years or QALYs gained over 2 years. The uncertainty analyses found that enrollment in the NDPP had an 88% probability of saving money and 84% probability of being cost-effective at a willingness-to-pay threshold of $100,000/QALY-gained over 2 years. In this real-world population with prediabetes, enrollment in the NDPP was likely to provide cost savings.

The estimation of healthcare cost of kidney transplantation in Japan using large-scale administrative databases.

The financial burden of kidney replacement therapy (KRT) is considerable, and detailed information on KRT costs is essential for managing these huge healthcare costs. However, cost analyses for kidney transplantation (KTx) are limited in Japan. This study aimed to report the healthcare costs of KTx recipients in Japan based on large medical receipt data. This cost analysis of KTx recipients using the Japan Medical Data Center Claims Database between January 2005 and August 2020 identified living donor KTx (LDKT) and deceased donor KTx (DKT) recipients. The primary outcome was the total direct healthcare costs of KTx recipients. As an exploratory analysis, we examined the factors that contributed to the increase in the costs of LDKT. In total, 84 LDKT and 17 DKT recipients were included in this study. The total healthcare costs for LDKT and DKT recipients during the first year after KTx were 6,639,982 and 6,840,450 JPY/year, respectively. However, after the second year post-KTx, total healthcare costs decreased to 1,735,931 and 1,348,642 JPY/year for LDKT and DKT recipients, respectively. During the first year, inpatient costs accounted for > 70% of the total healthcare costs, whereas pharmaceutical costs accounted for more than half after the second year post-KTx. The use of everolimus and male sex were associated with higher and lowertotal healthcarecosts in the first and subsequent years after LDKT, respectively. Using large-scale administrative databases, this study revealed the total healthcare costs of KTx in Japan and provided valuable information for the health technology assessment of KTx.

Cost-effectiveness of midomafetamine-assisted therapy (MDMA-AT) in chronic and treatment-resistant post-traumatic stress disorder of moderate or higher severity: A health-economic model.

To explore the cost-effectiveness of midomafetamine-assisted therapy (MDMA-AT) compared to placebo with therapy (PT) in US healthcare settings. A health state-transition model was used to analyze the cost-effectiveness of MDMA-AT for treating patients with chronic PTSD of moderate or higher severity. Both treatment arms consisted of 3 preparation (90-min), 3 interventional (8-h), and 9 integration (90-min) sessions, lasting ~4 months total. All sessions included psychotherapy, with interventional also including MDMA or placebo. After receiving treatment, patients were distributed across health states of No PTSD (not meeting PTSD diagnostic criteria), Non-Severe PTSD (treatment responders), Severe PTSD (treatment non-responders), and death. Each state had unique healthcare costs and utilities sourced from real-world data analysis and patient data from MDMA-AT clinical trials (including long-term follow-up). The base-case analysis considered the payer's perspective with a 5-year horizon, 3.5% annual cost and effect discounts, and an assumed MDMA medication price of $12,000 per session. Trial-derived utilities and US life tables mortality data were used to calculate quality-adjusted life years (QALY). The main outcome was an incremental cost-effectiveness ratio (ICER) with a $150,000 willingness-to-pay (WTP) threshold. The base-case ICER was $83,845 per QALY. Total direct costs were $64,745 in the MDMA-AT and $33,132 in the PT arms ($31,613 increment). The costs of intervention were $48,376 for MDMA-AT and $12,376 for PT. The highest MDMA medication cost to fit under the WTP threshold was $20,314 per session. Costs related to PTSD healthcare visits and other PTSD treatments were lower with MDMA-AT than PT (-$2,511 and -$1,877 increments, respectively). Utility benefits were higher in MDMA-AT than PT, with 3.691 and 3.314 QALYs generated over 5 years, respectively (0.377 QALY increment). These data suggest MDMA-AT may be a cost-effective treatment compared to PT for patients with chronic PTSD of moderate or higher severity.

From Clinical to Non-clinical Outcomes in the Treatment of HIV: An Economic and Organizational Impact Assessment.

The aim of this study was to define the economic and organizational impacts related to a broader utilization of bictegravir/emtricitabine/alafenamide (BIC/FTC/TAF) in Italian clinical practice. A budget impact analysis-representing the evolution of the Italian National Healthcare Service (NHS) healthcare expenditure over 3years-was developed, considering the overall Italian population treated for human immunodeficiency virus (HIV). Model input variables were treatment history, therapeutic regimen, development of adverse events, achievement of an undetectable viral load and total direct healthcare costs. Besides the BIA, an organizational impact assessment was conducted to determine the impact on the use of healthcare resources, assessing the release of organizational hospital assets, focusing on the management of drug-related adverse events. Data were collected from scientific evidence, Italian national and regional legislations and healthcare professionals' reports. To verify the robustness of the economic and organizational impact assessment, sensitivity analyses were performed. Results demonstrate economic savings of about 26million euros in total health spending, assuming a higher penetration rate for BIC/FTC/TAF. This change in the current case mix would lead to a reduction in the specific costs related to adverse event management (0.9million euros; -2.09%) and in the medical management of patients (38million euros; -7.79%), with a positive impact on the achievement of virological control. From an organizational perspective, a wider use of BIC/FTC/TAF generates a reduction in the utilization of healthcare resources due to a decrease in adverse events and complications. The model estimated a 19.64% reduction in HIV-related inpatient days, which freed up healthcare professional time. Capable of improving both economic and organizational sustainability for the entire HIV care continuum, BIC/FTC/TAF is an efficient therapeutic strategy for people with HIV.

Long-term clinical outcomes and healthcare resource utilization in male and female patients following hospitalization for heart failure.

Heart failure (HF) is a leading cause of hospitalization, and sex differences in care have been described. We assessed sex-specific clinical outcomes and healthcare resource utilization following hospitalization for HF. This was an exploratory analysis of patients hospitalized for HF across 10 Canadian hospitals in the Patient-Centered Care Transitions in HF (PACT-HF) cluster-randomized trial. The primary outcome was all-cause mortality. Secondary outcomes included all-cause readmissions, HF readmissions, emergency department (ED) visits, and healthcare resource utilization. Outcomes were obtained via linkages with administrative datasets. Among 4441 patients discharged alive, 50.7% were female. By 5 years, 63.6% and 65.5% of male and female patients, respectively, had died (p = 0.19); 85.4% and 84.4%, respectively, were readmitted (p = 0.35); and 72.2% and 70.9%, respectively, received ED care without hospitalization (p = 0.34). There were no sex differences in mean [SD] number of all-cause readmissions (males, 2.8 [7.8] and females, 3.0 [8.4], p = 0.54), HF readmissions (males, 0.9 [3.6] and females, 0.9 [4.5], p = 0.80), or ED visits (males, 1.8 [11.3] and females, 1.5 [6.0], p = 0.24) per person. There were no sex differences in mean [SD] annual direct healthcare cost per patient (males, $80 334 [116 762] versus females, $81 010 [112 625], p = 0.90), but males received more specialist, multidisciplinary HF clinic, haemodialysis, and day surgical care, and females received more home visits, continuing/convalescent care, and long-term care. Annualized clinical events were highest in first year following index discharge in both males and females. Among people discharged alive after hospitalization for HF, there were no sex differences in total and annual deaths, readmissions, and ED visits, or in total direct healthcare costs. Despite similar risk profiles, males received relatively more specialist care and day surgical procedures, and females received more supportive care. ClinicalTrials.gov NCT02112227.

Analisis Minimalisasi Biaya Terapi Antibiotik Ceftriaxone dan Cefotaxime Pada Pasien Pneumonia di Instalasi Rawat Inap RSUD Kabupaten Kediri

Pneumonia is an infection caused by pathogenic microorganisms such as microbes, bacteria, fungi and viruses that cause inflammation of the lung tissue. The prevalence of pneumonia has increased every year. The first-line therapy used at the Kediri District Hospital is the use of ceftriaxone and cefotaxime antibiotics. Decision making on antibiotic use has an influence on the amount of medical costs incurred by patients. This study aims to determine which antibiotics are more cost-minimal and whether there is a significant difference between the use of ceftriaxone and cefotaxime antibiotic therapy at Kediri District Hospital. The design of this study was cross sectional, data collection was done retrospectively. The analysis method used independent t-test statistical test. The perspective in this study was seen through the provider, namely the hospital, a total of 215 pneumonia patients and the sample for this study was 63 patients. With 32 patients receiving ceftriaxone antibiotic therapy and 31 patients receiving cefotaxime antibiotic therapy. Total direct medical costs were categorized into four types of costs, namely treatment costs, antibiotic costs, other drug costs, laboratory and radiology costs. The average total direct medical costs of patients who received ceftriaxone antibiotic therapy were more cost minimal than patients who received cefotaxime antibiotics, namely Rp.2,296,449 and Rp.2,464,470. The results of the difference test using independent t-test statistics show a p-value of 0.219 so that it can be interpreted that there is no significant difference.

Surgical Castration as an Alternative to Improve Systemic Treatment for Advanced Prostate Cancer: A Window of Opportunity for Developing Countries.

The Brazilian Public Health System (BPHS) serves approximately 71,730 patients with prostate cancer (PC) every year for which androgen deprivation therapy (ADT) is the primary treatment for patients with advanced hormone-sensitive prostate cancer (aHSPC). Androgen receptor pathway inhibitors (ARPIs) are not accessible through the BPHS. Using the BPHS as a model, this study assesses the long-term economic effect of surgical versus medical castration in aHSPC treatment to strategize cost reduction and the incorporation of ARPI in developing countries. Data of patients with aHSPC (ie, TxN1M0 ineligible for local treatment or TxNxM1) from the BPHS database were analyzed from January 1, 2011, to December 31, 2021, using the TECHTRIALS artificial intelligence platform. The main outcomes were quantitative and descriptive analyses as well as a cost analysis of surgical versus chemical castration. Of the 274,519 patients with aHSPC who received active treatment during the 11-year study period, 90% (n = 246,683) underwent chemical castration and 10% (n = 27,836) underwent bilateral subcapsular orchiectomy (BSO). The median duration of chemical castration was 28 months. The BPHS spent an estimated total of $665,552,091.40 US dollars (USD) on chemical castration and $5,939,348.47 USD on BSO, respectively. The cost per patient was $2,698 USD and $213.37 USD for chemical castration and BSO, respectively. Hypothetically, if all patients with aHSPC had undergone BSO, the total direct cost for the BPHS would have been $42,774,832.20 USD, saving $622,777,259.20 USD over 11 years, making it possible to offer low-dose abiraterone to 65% of aHSPC patients. On the basis of this extensive financial analysis from the world's largest public health system database, BSO appears to be a valuable alternative to chemical castration for treating aHSPC. In resource-limited environments, the cost savings from using BSO may allow access to drugs that will improve survival such as ARPIs.

An Early-Stage Economic Evaluation of Superabsorbent Wound Dressings for the Management of Moderately to Highly Exuding Leg Ulcers in Slovakian Settings

ABSTRACT BACKGROUND The management of chronic leg ulcers, including venous leg ulcers (VLUs), causes a considerable economic and clinical burden to healthcare systems. Factors such as nursing time, hospital care, and wound dressings account for approximately 85% of the total cost. Superabsorbent dressings (eg, superabsorbent polymers [SAPs]) are recommended as a first-line treatment for moderately to highly exuding VLUs. OBJECTIVE To assess the cost-effectiveness of utilizing SAPs compared with the standard of care (SoC) for managing patients with moderately to highly exuding VLUs within the Slovakia healthcare settings. METHODS The decision-analytic modeling method used a Markov process as microsimulation, with a time horizon of 6 months, from the perspective of the third-party payer in Slovakia. All model inputs were based on data identified through systematic literature reviews. RESULTS According to model predictions, the use of SAPs instead of SoC in patients with moderately to highly exuding leg ulcers in Slovakian settings would lead to an improved healing rate of 2.2%, incremental health-related quality of life of 0.143 quality-adjusted life-weeks, and total direct cost savings of €75 (USD $82) per patient over a 6-month period. CONCLUSIONS The evaluation’s results align with clinical recommendations that endorse superabsorbent wound dressings as the preferred first-line treatment for moderately to highly exuding VLUs. The findings support the use of these dressings as a cost-saving solution for the National Insurance in Slovakia, when compared with SoC.

Economic burden of short-acting beta-2 agonist (SABA) overuse among asthma patients in Türkiye: a cost analysis with respect to the updated GINA treatment recommendations.

This cost of illness study aimed to determine economic burden of short-acting β2-agonist (SABA) overuse in Türkiye from payer perspective with respect to the updated GINA 2022 treatment recommendations. A total of 3,034,879 asthma patients comprised the study population, via estimations extrapolated from the Türkiye arm of the global SABINA III study. The economic burden (costs related to the drug use and severe exacerbations) was compared in subgroups of overall (≥ 0 canisters/year) vs. GINA-recommended (0-2 canisters/year, hypothetical population) SABA use and in subgroups of appropriate use (0-2 canisters/year, real population) vs. overuse (≥ 3 canisters/year) of SABA with extrapolation of SABINA Türkiye data to the Türkiye asthma population. Recommended SABA use was predicted to prevent 127,505 of 157,512 severe exacerbations per year in mild asthma patients and 2,668,916 of 3,262,800 severe exacerbations per year in moderate-severe asthma patients. Annual cost burden of not applying recommended SABA use (overall [≥ 0 canisters/year] vs. GINA-recommended [0-2 canisters/year] SABA use) in mild asthma and moderate-severe asthma patients was calculated to be €20.43 million and €427.65 million in terms of severe exacerbations, and to be €829,352 and €7.20 million in terms of drug costs, respectively. The total annual economic burden arising from not applying recommended SABA use was estimated to be €456.11 million. Appropriate use (0-2 canisters/year) vs. overuse (≥ 3 canisters/year) of SABA was associated with decreased frequency of severe exacerbations per year in mild asthma (from 129,878 to 27,634) and moderate-severe asthma (from 2,834,611 to 428,189) patients. SABA overuse in mild and moderate-severe asthma patients was estimated to yield an additional annual cost of €16.38 million and €385.59 million, respectively in terms of severe exacerbations, and a total €11.30 million additional drug cost. The overall annual economic burden arising from SABA overuse was estimated to be €413.27 million. The estimated annual total economic burden arising from not applying recommended SABA use (€456.11 million) and SABA overuse (€413.27 million) with respect to the updated GINA 2022 treatment recommendations indicates the substantial cost burden of SABA overuse to the Turkish National Health System, corresponding up to 26% of the total direct cost of asthma reported in our country.

Clinical and economic burden of otitis media in children under 5 years of age in the United States: A retrospective study

ABSTRACT Reductions in all-cause otitis media (OM) following widespread pneumococcal conjugate vaccine use have plateaued. Granular burden of disease data are needed to guide evaluation and implementation of new measures targeting OM prevention. We conducted a retrospective study to assess the incidence and treatment costs of OM, tympanostomy tube placement (TTP), and hearing loss in children aged <5 years in the United States (US). OM episodes and TTP between 2016 and 2017 were identified in IBM MarketScan Commercial Claims and Encounters, Medicare Supplemental and Coordination of Benefits, and Multi-Medicaid databases using diagnosis codes (ICD-10). The incidence rate per 100,000 person-years (IR) of OM in <5-year-olds was 62,726 in Commercial/Medicare databases and 55,874 in Medicaid. IRs peaked at 9–<12 months (115,552 and 110,960, respectively). Approximately 5% and 4% of OM episodes in the respective databases had TTP (IR 3233 and 2404). Around 2% of children with OM had hearing loss (IR 1468 and 1109, respectively), of whom 41% had TTP. We estimated that there were 11.1 million OM episodes in 2020 costing USD 4.8 billion. 243,618 children were estimated to have OM with hearing loss at a direct total cost of USD 637 million, or 13% of the overall cost. The clinical and economic burden attributable to OM in the US was high in children aged <5 years during the study period. Novel approaches are needed to improve and broaden vaccine-induced protection against OM and its complications. The study results could guide policymakers considering age-specific interventions to reduce the OM burden.

Patient evaluated economic impact of keratoconus in New Zealand

ABSTRACT Clinical relevance Few studies have investigated the economic burden of keratoconus to patients and society including a patient’s lifetime expenditure. Analysing disease cost is important in advocating funding and planning for appropriate management and treatment. Background Keratoconus can be an expensive disease, including costs associated with visual rehabilitation and surgery. This study aimed to assess direct and indirect expenditures incurred by keratoconus subjects, to estimate the lifetime per capita cost and the total costs of keratoconus per year in Auckland, New Zealand. Methods A cross-sectional study where participants with keratoconus were recruited from public and private clinics to complete an anonymous questionnaire. A keratoconus health expenditure questionnaire was used to assess direct and indirect expenditures for participants. Estimated lifetime per capita costs and total direct and indirect costs associated with keratoconus were calculated. Results Responses from 110 participants were recorded. Most participants (55.5%) were between the ages of 21 and 30, 59.1% were male, and Pacific People were over-represented (14.5%) compared to the national population. The prevalence of visual rehabilitation was low with 74.5% of participants never wearing contact lenses and 32.7% of subjects wearing spectacles purchased over 24 months prior. Few participants (26.5%) had subsidised care, including private health insurance with optical cover or the contact lens subsidy. Total direct and indirect costs are estimated to be NZD 30.9 million per year with an estimated lifetime per capita out-of-pocket cost of NZD 79,254. Conclusion Subjects with keratoconus experience significant direct and indirect costs with limited subsidisation from the government and private health insurance. The significant out-of-pocket costs required for managing keratoconus are likely a significant barrier to accessing appropriate visual rehabilitation in New Zealand.

Comparative study on the epidemiological characteristics and hazards of respiratory syncytial virus and influenza virus infections among elderly people

ObjectiveTo investigate the epidemiological characteristics and infections of respiratory syncytial virus (RSV) and influenza viruses in hospitalized elderly patients with respiratory tract infections in Suzhou City, China, and to compare the differences in clinical characteristics and economic burden associated with these two infections.MethodsIn this prospective study, pathogenetic testing and clinical data for hospitalized patients aged 60 years and older with respiratory tract infections were collected in five hospitals through stratified cluster sampling from December 2023 to May 2024. Comparative study on epidemic characteristics, clinical features and costs of cases who infected RSV alone and influenza alone were conducted.ResultsAmong 1,894 cases included, the RSV positivity rate was 5.91% during the 2023–2024 winter-spring season, while the influenza positivity rate was 9.61%. RSV-B was the predominant subtype of RSV, and influenza A (primarily H3N2) was the dominant strain among the influenza-positive cases. Compared with cases infected influenza virus alone, those infected RSV alone had lower occurrence frequency of fever (18.8% vs. 35.7%, P = 0.004), higher occurrence frequency of complications of lower respiratory tract infections (70.8% vs. 54.8%, P = 0.011), higher direct medical costs ($996.2 vs. $841.1, P = 0.017) and total costs ($1019.7 vs. $888.1, P = 0.036). RSV single infection is more common in female cases (P = 0.007) and diabetic cases (P = 0.007) than influenza virus single infection.ConclusionsDuring the winter and spring months, RSV is the second most common pathogen after influenza virus among older adults hospitalized for respiratory infections in Suzhou, China. Patients infected RSV are more likely to develop complications with lower respiratory tract infections and have higher medical costs than the influenza. RSV infection in the elderly should be emphasized, especially in female patients and diabetic patients.

Deprescribing of proton pump inhibitors in older patients: A cost-effectiveness analysis.

Over-prescribing of proton-pump inhibitors (PPIs) is widely observed in older patients. Clinical findings have showed that deprescribing service significantly decreased inappropriate PPIs utilization. We aimed to examine the cost-effectiveness of PPI deprescribing service from the perspective of Hong Kong public healthcare provider. A decision-analytic model was constructed to examine the clinical and economic outcomes of PPI deprescribing service (deprescribing group) and usual care (UC group) in a hypothetical cohort of older PPI-users aged ≥65 years in the ambulatory care setting. The model inputs were retrieved from literature and public data. The model time-frame was one-year. Base-case analysis and sensitivity analysis were performed. Primary model outcomes were direct medical cost and quality-adjusted life-years (QALYs) loss. In base-case analysis, the deprescribing service (versus UC) reduced total direct medical cost by USD235 and saved 0.0249 QALY per PPI user evaluated. The base-case results were robust to variation of all model inputs in one-way sensitivity analysis. In probabilistic sensitivity analysis, the deprescribing group was accepted as cost-effective (versus the UC group) in 100% of the 10,000 Monte Carlo simulations. In conclusion, the PPI deprescribing service saved QALYs and reduced total direct medical cost in older PPIs users, and showed a high probability to be accepted as the cost-effective option from the perspective of public healthcare provider in Hong Kong.

Matched Comparison Examining the Effect of Obesity on Clinical, Economic, and Humanistic Outcomes in Patients with BipolarI Disorder.

BipolarI disorder (BD-I) is associated with an increased risk of obesity, but few studies have evaluated the real-world clinical, humanistic, and economic effects associated with obesity in people with BD-I. This was a retrospective, cross-sectional analysis of responses to the 2016 and 2020 National Health and Wellness surveys. Respondents (18-64years) with a self-reported physician diagnosis of BD-I were matched to controls without BD-I based on demographic and health characteristics. Respondents were categorized by body mass index as underweight/normal weight (< 25kg/m2), overweight (25 to < 30kg/m2), or obese (≥ 30kg/m2). Multivariable regression models were used to compare obesity-related comorbidities, healthcare resource utilization (HCRU), health-related quality of life (HRQoL), work productivity, and indirect and direct costs. Before matching, the BD-I cohort was younger than the non-BD-I cohort and included more female and white respondents and a greater proportion covered by Medicaid or Medicare. After matching, the BD-I and non-BD-I cohorts had similar characteristics. A total of 5418 respondents (BD-I, n = 1806; matched controls, n = 3612) were analyzed. Obese respondents with BD-I reported the highest adjusted prevalences of high blood pressure (50%), high cholesterol (35%), sleep apnea (27%), osteoarthritis (17%), type2 diabetes (12%), and liver disease (4%). Obesity in respondents with BD-I was associated with the lowest HRQoL scores. Measures of work impairment were highest in respondents with BD-I and obesity, as was HCRU. Respondents with BD-I and obesity had the highest associated total indirect and direct medical costs ($25,849 and $44,482, respectively). Obese respondents with BD-I had greater frequencies of obesity-related comorbidities, higher HCRU, lower HRQoL, greater work impairments, and higher indirect and direct medical costs. These findings highlight the real-world burden of obesity in people with BD-I and the importance of considering treatments that may reduce this burden.