Economic Aspects Of Health Care Research Articles

The impact of monoclonal antibody drugs on healthcare economics in the treatment of multiple sclerosis and neuromyelitis optica spectrum disorders

AbstractThe launch of highly efficacious monoclonal antibody (mAb) drugs has profoundly changed the therapeutic strategy for multiple sclerosis and neuromyelitis optica spectrum disorders (NMOSD). However, the newly developed mAb drugs, especially those used in treating NMOSD, are quite expensive, resulting in a significant medical and economic burden. Early use of these drugs is expected to reduce the frequency of relapse and the accumulation of disability, preserve the quality of life of patients, and improve their life expectancy. In selecting therapeutic drugs, it is necessary not only to consider the efficacy and safety of the drugs, but also to consider the cost‐effectiveness of each drug for each patient, considering the economic aspects of health care. However, the cost‐effectiveness of mAb drugs in treating multiple sclerosis and NMOSD has not been fully verified. Japan is rapidly emerging as a hyper‐aged society, unlike any other in the world, and the rising cost of medical care is an urgent issue that needs to be addressed and resolved. Out‐of‐pocket expenses of individual patients are not a major issue in Japan as medical, costs for multiple sclerosis and NMOSD are subsidized by public medical insurance; however, the judicious use of mAb drugs is required to ensure cost‐effectiveness.

Is physiotherapy an underused approach to prevent surgery in selective musculoskeletal disorders?

Objectives: The purpose of the literature review was to appraise the evidence that an early physiotherapy intervention helps to prevent the surgery in selective musculoskeletal disorders. A search of Google Scholar, Web of Science, Scopus, and PubMed was carried out utilizing the terms (“physiotherapy”, “surgery” OR “exercise, surgery” OR “rehabilitation”, “surgery”).
 Methods: The article titles and abstracts were screened for eligibility and included in the review. The recent literature evidently emphasized that physiotherapy has opted in selective musculoskeletal problems to avoid and delay surgeries.
 Results: Regardless of recommended conservative treatment option and effectiveness of physiotherapy, a massive gap can be observed between its evidence and practice. Conversely, overuse of diagnostic imaging, surgeries, and medications is present in clinical practice. In most of the clinical problems the long-term outcomes were reported the same with surgical and physiotherapy intervention. Likewise, patients can also get the advantage of better clinical outcome and cost-effectiveness with physiotherapy as compared to surgical intervention.
 Conclusion: The cost-effectiveness is an important factor in low-income countries where economic aspects of health care are highly considered. These advantages of physiotherapy should be considered by the clinicians, policymakers, patients, and included in the clinical guidelines.
 Bangladesh Journal of Medical Science Vol.20(2) 2021 p.409-413

Dynamics of bone tissue metabolism in the complex treatment of chronic posttraumatic osteomyelitis of long bones

Introduction: Chronic post-traumatic osteomyelitis is a complex problem of modern traumatology and orthopedics, affecting, in addition to medical, social and economic aspects of healthcare. When planning treatment, it is necessary to take into account the metabolic state of the bone tissue, since the effect of an infectious pathogen goes far beyond the classical lytic process, disrupting the balance of bone formation and bone resorption in various ways. The study is devoted to the study of the dynamics of parameters reflecting the metabolism of bone tissue in patients receiving complex therapy for chronic post-traumatic osteomyelitis of long bones. Aim: To study the dynamics of metabolic disorders of bone tissue in patients with orthopedic infection of long bones and large joints under conditions of ongoing complex etiotropic and compensatory therapy for 6 months, the timing of bone tissue consolidation within 2 years from the moment of surgery. Materials and methods: The study was prospective, observational, comparative, exploratory, involving 138 patients with post-traumatic chronic osteomyelitis of the long bones. Complex therapy included a combination of surgical treatment with antibacterial, anti-inflammatory therapy and drug correction of the revealed disorders of bone metabolism. The timing of the consolidation of bone defects after treatment and the dynamics of indicators of bone metabolism were studied. Results: The similarity of the periods of consolidation of different segments in the conditions of the described therapy was shown; the time period corresponding to the most pronounced dynamics of changes (correction) of violations was determined (3 months from the beginning of treatment); shows the effectiveness of metabolic therapy for the treatment of osteoarticular infections in various anatomical segments of the extremities. The results corresponds both to the results of the previous study and to the pathophysiological aspects of bone metabolism described in the literature. Conclusion: the timing of consolidation in the treatment of metabolic disorders is generally similar; the greatest changes in the parameters of bone metabolism are recorded within 3 months after the start of therapy. Also, the metabolic therapy regimen can be considered as universal for all segments.

Why the Economic Aspects of Healthcare are not Unique.

Frequent claims suggest that healthcare and its production are not only different from other goods, but that they differ to such an extent that healthcare should be viewed as unique. Various features of healthcare, such as the lack of a perfect market and the existence of information asymmetry, are cited as evidence of this claim. However, such a view results from unduly emphasising the characteristics of healthcare as being atypical. This article redresses this imbalance by taking an alternative approach and examines the ways in which the economic aspects of healthcare are similar to those of other goods. It was found that the differential aspects are less distinctive than claimed and the economic aspects of healthcare are not unique.

Exploring New Practice Models Delivering Orthopedic Care

Health care delivery models are undergoing rapid transformation in response to market, regulatory, and demographic trends. Many of the new models of delivery are centrally planned structures with attributes dictated by statute. An understanding of these models is essential if physicians wish to retain an influential voice in patient care. Accountable Care Organizations, Medical Homes, Bundled Payment, and Episode of Care are terms even sports medicine physicians must become familiar with to positively affect the delivery of health care in the near future. By embracing both the clinical and economic aspects of health care, surgeons will be in a better position to make health care reform responsive to actual patient needs.

Gesundheitssystem und gesundheitsökonomische Aspekte

Although many health care reforms have been enacted in the last few years in Germany, many of the key points in the current social health care system have been retained from former times. All those introductions for an effective health care system from the last 150 years beginning with mandatory guild membership via Bismarck's social laws to the modern health care systems in Germany with the current problems of financing the heavy burden in the German budget are reported. Data and facts on the current health care system are provided. In the following two articles of this series ambulatory and inpatient treatment in the light of economic aspects of health care are reported.

Costs of vaginal delivery and Caesarean section at a tertiary level public hospital in Islamabad, Pakistan

BackgroundPublic hospitals in developing countries, rather than the preventive and primary healthcare sectors, are the major consumers of healthcare resources. Imbalances in rational, equitable and efficient allocation of scarce resources lie in the scarcity of research & information on economic aspects of health care. The objective of this study was to determine the average cost of a spontaneous vaginal delivery and Caesarean section in a tertiary level government hospital in Islamabad, Pakistan and to estimate the out of pocket expenditures to households using these services.MethodsThis hospital based cost accounting cross sectional study determines the average cost of vaginal delivery and Caesarean section from two perspectives, the patient's and the hospital. From the patient's perspective direct and indirect expenditures of 133 post-partum mothers (65 delivered by Caesarean section & 68 by spontaneous vaginal delivery) admitted in the maternity general ward were determined. From the hospital perspective the step down methodology was adopted, capital and recurrent costs were determined from inputs and cost centers.ResultsThe average cost for a spontaneous vaginal delivery from the hospital's side was 40 US$ (2688 rupees) and from the patient's perspective was 79 US$ (5278 rupees). The average cost for a Caesarean section from the hospital side was 162 US$ (10868 rupees) and 204 US$ (13678 rupees) from the patient's side. Average monthly household income was 141 ± 87 US$ for spontaneous vaginal delivery and 168 ± 97 US$ for Caesarean section. Three fourth (74%) of households had a monthly income of less than 149 US$ (10000 rupees).ConclusionThe apparently "free" maternity care at government hospitals involves substantial hidden and unpredicted costs. The anticipated fear of these unpredicted costs may be major factor for many poor households to seek cheaper alternate maternity healthcare.

Lay perceptions of genetic testing in Germany and Israel: the interplay of national culture and individual experience

Germany and Israel represent opposite regulatory approaches and bioethical outlooks regarding genetic testing. This study examines lay attitudes (including attitudes of people affected by genetic diseases) in both countries towards genetic testing of adults, focusing on the differences between cultural and personal argumentations, as well as between affected and non-affected perspectives. With regard to three major emerging themes – medical technology/technocratic medicine; economic aspects of healthcare; and personal decision-making – a national contrast was apparent on the cultural level of argumentation, but not in the personal context of decision-making or in the concerns of people affected by genetic diseases. We conclude by discussing the interplay of national culture and individual experience in constructing arguments about the harms and benefits of genetic testing, and the implications for the study of cross-cultural bioethics in the context of “genetic responsibility”.

Quality, safety and costs of integrative medicine

In Europe, the use of complementary and alternative medicine (CAM) has increased markedly over the last few years. However, evidence for the effectiveness of most CAM methods, with the exception of the treatment for some conditions, is currently insufficient. Nevertheless, the growing CAM market has an important impact on patient treatment options, on the alternatives offered by providers, and on health insurance company decisions. In order to provide patients with the best care possible, a constructive dialogue between conventional and complementary medicine is both necessary and desirable. High-quality patient care should be based on efficacy, effectiveness and safety, and could result in an integrative treatment combining both conventional medicine and CAM. Safety is an important issue, and more large-scale, systematic evaluations are needed. For a combination of CAM with conventional medicine, more knowledge about treatment interactions is necessary. Some quality aspects could be addressed through targeted research projects. However, for more practice-related aspects, quality management systems should be implemented. Quality management could be an effective tool to ensure a safe and effective treatment for the patients. It also has the potential to increase efficiency by optimizing the treatment processes. For political and health insurance company decisions, the economic aspects of health care play an ever increasing role and are producing a number of cost-effectiveness analyses of CAM.

Cost-effectiveness of neonatal surgery: first greeted with scepticism, now increasingly accepted

Mortality rates in neonatal surgery have dropped markedly, illustrating the enormous progress made. Yet, new questions have arisen. To mention one, health care budgets have tightened. It follows that the effects of medical interventions should be weighted against their costs. As evidence was particularly sparse, we set out to analyse cost-effectiveness of neonatal surgery. The purpose of this article is to summarise our findings and to review recent studies. Moreover, this article explains the relevance of cost-effectiveness analysis and explores how cost-effectiveness interacts with other determinants of health care priority setting. Our research revealed that treatments for two common diagnostic categories in neonatal surgery (congenital anorectal malformations and congenital diaphragmatic hernia) produce good cost-effectiveness. Other groups also published cost-effectiveness studies in the field of neonatal surgery, although their number is still small. Contemporaneously, the economic aspects of health care have captured the interest of policy makers. Importantly, this is not to say that there are no other factors playing a role in priority setting, foremost among which are ethical questions and arguments of equity. This article concludes that, according to present evidence, neonatal surgery yields good value for money and contributes to equity in health.

Teaching entrepreneurship in senior design courses

A senior design capstone course can provide students with the opportunity to develop communication, interpersonal, and design skills and to learn about the product development process and project management. It is an excellent tool for preparing students for careers in biomedical engineering, especially those interested in employment with medical device companies. The author suggests that educators and design instructors should provide the opportunity for students to develop the skills and acquire the knowledge needed for successful careers in biomedical engineering. This includes development of (i) communication, interpersonal, teamwork, and design skills, (ii) an understanding of the legal, regulatory, and economic aspects of healthcare and the medical industry and (iii) basic business literacy. For additional in-depth entrepreneurial education, a graduate management degree with concentration in entrepreneurship might be the best approach. In order to develop an entrepreneurial perspective in all biomedical engineering students, teachable moments that are themselves in many of these courses should be taken advantage of.

The Business Ethics within Bioethics

L eonard Weber's Business Ethics in Healthcare is a well-timed and important book to add to the growing collection of new monographs and articles on organizational and economic aspects of health care. Unlike some of the other new texts, the book focuses primarily on the business of health care delivery. It does not deal directly with issues in clinical, professional, or biotechnological ethics. It addresses business ethics issues. Weber distinguishes health care organizations from other kinds of businesses because of their focus on health

Cost-Effectiveness of Population-Based Genetic Hemochromatosis Screening

Objective: Evaluation of the costs of a population-based genetic hemochromatosis (HH) screening. Methods: We performed a decision tree analysis and subsequently quantified the screening and treatment costs and the effect on life expectancies. Assumptions were based on literature data and expert opinions. Results: Under the very conservative assumptions of a 10% penetrance, a carrier frequency of 10%, a mean age of onset of complications of 54 years, and a 90% compliance with treatment (phlebotomy), we calculated the cost to be 7.26 EUR per tested person versus 1.62 EUR per nontested person (1 EUR ≈ 1 USD). The life expectancies for a 25-year-old male are 48.99843 years (if not tested) versus 48.99970 years (if tested). Although increased life expectancy for the entire population as a result of screening is negligible, for the 1 in 4,000 men who could benefit from it, an average of 2,000 extra days will be gained. By dividing the difference of cost by the difference of life expectancy, we calculated the cost for one life year gained to be 4,441 EUR. Under less stringent conditions (higher penetrance, higher carrier frequency) the costs decrease substantially. Conclusion: Costs of population-based genetic HH screening are very acceptable compared to the costs of other health care measures. We conclude that genetic HH screening is feasible under economic aspects of health care.

Do drug costs affect physicians' prescription decisions?

To study the impact of the cost of pharmaceuticals on physicians' decisions about drug prescription. A simulation protocol for the treatment of two patients, one with mild and the other with a severe form of urinary tract infection (UTI), was designed. Thirty family physicians in outpatient clinics and 30 physicians in the internal medicine wards of a Community Hospital participated in the project. They had to prescribe treatment for the patients twice: at phase I, when the drug cost was unknown, and at phase II, after 2 months, when the price of the drugs was brought to their attention. The physicians selected the medication from a list of drugs commonly used for the treatment of UTIs. Analysis of the findings indicates that an awareness of drug costs affects prescription decisions among physicians in hospital wards, whereas family physicians showed a preference for less expensive drugs even before they were informed about drug costs. An extrapolation of the results shows that knowledge about the cost of the drugs usually administered for treatment of UTI, could save at least IS 112,883 ($34,207) a month to Kupat Holim Klalit (KHK) the health insurance institution to which the outpatient clinics and the hospital belong. When economic aspects of healthcare are considered, information on drug costs may be an important factor in physicians' decision-making processes and for saving pharmaceutical expenses.

The economics of lung cancer

Lung cancer remains the leading cause of cancer death in most Western countries. Despite several decades of clinical trials, the introduction of new approaches to management, and improvements in supportive care, the outlook for most patients diagnosed with carcinoma of the lung remains poor. Small improvements in outcome have been achieved, in particular by the reduction of surgical morbidity and mortality, in those patients with operable non-small cell lung cancer (NSCLC). Furthermore, the use of combined modality therapy in locally advanced NSCLC offers the promise of better results [8,9], as does the combination of radiotherapy and chemotherapy in limited stage small cell lung cancer [6]. The rising demand for health care services coupled with static or decreasing resources with which to pay for them has resulted in increasing interest in the economic analysis of medical interventions. Research into the economic aspects of health care is now carried out or supported by health care professionals, government, the insurance industry and the pharmaceutical industry. Each of these groups brings to the field their own particular biases and vested interests, and the interpretation of studies needs to be carried out with recognition of this fact. Both the pharmaceutical industry [4], and governments [l] have recognised the potential importance of economic analysis in health care, the former to aid in the promotion of new and expensive products, and the latter to limit the costs of the very same interventions. In common with other areas of medical practice, the economic aspects of caring for patients with lung cancer has also attracted growing interest in recent years. The

Reemergence of self-induced abortions

Two cases of adolescent females attempting self-induced abortions are presented. Many ramifications and complications of illegal abortions are discussed as they affect the patient and society. In addition, we discuss the future of medical education as well as the economic aspects of health care in relationship to illegal abortions.

The Costs of Hospital Infection Control in a Developing Country

In the early 1970s, a significant proportion of US hospitals voluntarily developed infection control programs. At that time, there were no economic incentives for those programs,1 but there was a consensus that, ethically, healthcare providers had to do everything possible to reduce the risks of nosocomial infections to their lowest possible level. However, in the late 1970s, medical costs began to rise considerably, and this led ultimately to changes in the methodology of reimbursement of hospitals. At this point, there was a certain economic pressure to determine the economic gains or losses of nosocomial infection control programs. The question was promptly addressed by controlled studies that evaluated the direct costs of hospitalization in particular categories of nosocomial infections2,3 and by different methods for estimating the costs of hospital infections.4,5 In addition, the infection control programs were validated in US hospitals by the SENIC project. This study demonstrated that up to one-third of nosocomial infections could be prevented by effective control programs.6 In developing countries, the economic and ethical aspects of nosocomial infections are closely connected and cannot be analyzed independently. This is a consequence of the responsibility of governments for all healthcare programs. Funding for immunization, control of endemic diseases, supplementary food for pregnant women and infants, and primary healthcare and funding for hospital care come from the same budget. There are private hospitals and health insurance, but less than 10% of the population can pay for it. Currently, when third-world countries are afflicted by a serious economic crisis and available resources for healthcare are severely limited, the decision of how much must be spent in each program is a huge problem for health administrators. Each cent added to a specific health program comes from the budget of another equally important one. In this setting, the economic aspect of healthcare plays a crucial role, and we may argue that the only ethically correct decision is to allocate resources in programs that show socially useful cost-benefit rates. Furthermore, an efficient economic follow-up of a particular program would permit the early detection of resource waste within the program. Paradoxically, in developing countries, there are very few studies focusing on the economic aspects of healthcare in general and on hospital infection control in particular. The article by Cavalcante et al in this issue of the Infection Control and Hospital Epidemiology7 discusses some important aspects regarding the control of nosocomial infections in a developing country. One of the most important topics is the overuse of antibiotics. This is not a problem restricted to developing countries; there is some evidence that the magnitude of the problem is larger in the third world.8,9 An effective infection control program may result in substantial improvement of proper antibiotic use. This is particularly true for antibiotic prophylaxis of surgical wound infection, where educational programs can significantly reduce the overuse of antibiotics. There are several other strategies that are being performed with success in some Brazilian hospitals, such as the use of preprinted forms where physicians

Expensive medical and surgical technology.

In summary, new developments in technology, as applied to medical and surgical practice, are to be encouraged, which is just as well, since they are probably inevitable. But they also call for critical assessment and, perhaps, a measure of formal control. It is, however, important that the criteria for their acceptance (or rejection) should not be limited to economic considerations but should also include their clinical applicability and their likely effect on outcomes.

Epidemiology of aging and its effects on the nervous system.

Aging emerges as a condition of major concern in relation to humane and economic aspects of health care for the balance of this century and future times to come. Persons in the United States older than age 65 years are expected to more than double in number between now and the year 2020. Already, one out of every five people 85 years and older in the United States is a patient in a nursing home, with neurologic diseases being responsible for the infirmity for well over half. Inherited and degenerative diseases of the nervous system are overwhelmingly a problem of aging. To solve the problem will demand the most vigorous effort and cooperation on the part of both public and private health resources.

Commentary

the recent past. The article he presented at the conference emphasized that things such as the quality of medical care also need to get our attention, and there was also an undertone of uneasiness in his article about the widespread emphasis on costs and on the economic aspects of health care. In assessing this part of Dr. Luft's article, we need to think a bit about whether or not we could have an excessively high quality of medical care. In thinking about this, as in thinking about so many other questions involving health, it is useful to look at the problem in a general way, treating health as one of the many things that human beings seek and viewing medical care as one of the many ways in which we maintain our lives and our health.