Expenses For Drugs Research Articles

The economic impact of different blood glucose monitoring systems in the diabetic patient: Analysis of real-world data from an Italian local health authority

This analysis compared the direct healthcare costs of two blood glucose self-monitoring systems, conventional strips vs. flash glucose monitoring (FGM) in a real-world clinical practice setting of an Italian Local Health Unit (LHU). Cost-effectiveness evaluation of FGM was also performed. A retrospective analysis was conducted using administrative databases of the LHU of Barletta-Andria-Trani province (BAT). During the inclusion period (January 2017–June 2019), patients with at least one prescription for multiple daily injection (MDI) insulin therapy were identified, and stratified by prescriptions for either FGM, or ≥ 1100 strips/year or < 1100 strips/year. The index-date was that of the first FGM/strip prescription. After balancing groups by propensity score matching (PSM), total direct healthcare costs at one-year follow-up were analysed. Among 3560 strip users, 809 (22.7%) had ≥ 1100 strips/year, 2751 (77.3%) < 1,100 strips/year, while 101 used FGM. The average annual costs were €3614 in the patients with ≥ 1100 strips and €4064 for FGM (P = 0.288), with similar expenses for drugs (respectively €1981 vs. €2251, P = 0.336), and outpatient services (€382 vs. €520, P = 0.263). Hospitalization costs tended to be lower in FGM users than strips users (respectively €271 vs. €459, P = 0.393) and this difference compensated the higher device costs (€1,022 and €791, P < 0.001). The present real-life analysis showed that above 70% diabetics receive lower strip prescriptions than recommended. The economic data revealed that, in front of a higher device cost, FGM resulted in reduced expenditures for hospitalizations, demonstrating an Incremental Cost-effectiveness ratio (ICER) = €362.90/quality-adjusted life years (QALY) for patients adherent to the treatment, with controlled diabetes. The limitations of the analysis lie in its observational design and the reduced availability of passive mobility data (related to the flows of the pharmaceutical database, that of hospitalizations and specialist services) as to 2019, which could have led to cost underestimation.

Real-World Analysis of Outcomes and Economic Burden in Patients with Chronic Kidney Disease with and without Secondary Hyperparathyroidism among a Sample of the Italian Population.

This real-world analysis evaluated the clinical and economic burden of non-dialysis-dependent CKD patients with and without secondary hyperparathyroidism (sHPT) in Italy. An observational retrospective study was conducted using administrative databases containing a pool of healthcare entities covering 2.45 million health-assisted individuals. Adult patients with hospitalization discharge diagnoses for CKD stages 3, 4, and 5 were included from 1 January 2012 to 31 March 2015 and stratified using the presence/absence of sHPT. Of the 5710 patients, 3119 were CKD-only (62%) and 1915 were CKD + sHPT (38%). The groups were balanced using Propensity Score Matching (PSM). Kaplan-Meier curves revealed that progression to dialysis and cumulative mortality had a higher incidence in the CKD + sHPT versus CKD-only group in CKD stage 3 patients and the overall population. The total direct healthcare costs/patient at one-year follow-up were significantly higher in CKD + sHPT versus CKD-only patients (EUR 8593 vs. EUR 5671, p < 0.001), mostly burdened by expenses for drugs (EUR 2250 vs. EUR 1537, p < 0.001), hospitalizations (EUR 4628 vs. EUR 3479, p < 0.001), and outpatient services (EUR 1715 vs. EUR 654, p < 0.001). These findings suggest that sHPT, even at an early CKD stage, results in faster progression to dialysis, increased mortality, and higher healthcare expenditures, thus indicating that timely intervention can ameliorate the management of CKD patients affected by sHPT.

Out-of-pocket Expenses and Time Spent on Clinic Visits Among HIV Pre-exposure Prophylaxis Users and Other Clinic Attendees in Eswatini

User costs constitute a barrier to the uptake of HIV pre-exposure prophylaxis (PrEP), but their magnitude appears rarely assessed. In this prospective observational study, we assessed self-reported out-of-pocket expenses (OOPE) and time spent on clinic visits during a PrEP demonstration project in Eswatini. At six public primary care clinics, 240 PrEP users and other clinic attendees were interviewed after a clinic visit. Among the 79.2% of clinic attendees reporting any medical OOPE (e.g., expenses for consultations or drugs) and/or non-medical OOPE (e.g., expenses for transport, food, or phone use), the median total OOPE was $1.36 (IQR 0.91–1.96). Non-medical OOPE occurred mostly due to transport expenses. The median travel time for a clinic visit was 1.0 h (IQR 0.67–2.0). The median time spent in the clinic was 2.0 h (IQR 1.15–3.0). The median opportunity cost of a clinic visit was $7.54 (IQR 5.42–11) when valuing time spent on a clinic visit with Eswatini’s per-capita gross domestic product. Our findings can guide measures to reduce the user costs of PrEP in Eswatini and other contexts in which oral PrEP is provided through health care facilities.

Direct out-of-pocket expenditure of tuberculosis treatment in intensive phase in Kalutara District, Sri Lanka

BackgroundTuberculosis (TB) is a communicable disease. Financial risk protection is a key target to achieve in end TB strategy. Out-Of-Pocket Expenditure (OOPE) consisted of expenses bore by patients for their illnesses after subtracting third-party payments such as insurance. Despite the free health care in Sri Lanka, TB patients have to pay for various expenses (e.g., expenses for travel, food, drugs, medical investigations, and cost of accompanied person/bystander). ObjectivesThe main objective of this study was to estimate direct OOPE and find the association between direct OOPE and noncompliance to TB treatment in intensive phase. MethodsA cross-sectional study was conducted with TB patients who were registered in Kalutara-district chest clinic for period of six months (n = 267). Interviewer-administered questionnaire (consisted of sections on socio-demographic characteristics, treatment compliance, sources and amount of OOPE, etc.) was used to collect data. Mean median, minimum, maximum and interquartile range were calculated in each component of OOPE. ResultsQuestionnaire were administered for 252 patients (male = 160, 63.5%). Mean total direct non-medical cost for one DOTS visit (without accompanied person) was 435.40 (IQR = 420.00) Sri Lankan Rupees (SLR) (i.e., 2.45 United State Dollars (USD)). A patient without an accompanying person spent 26124.00 SLR (435.40 per day into 60 days) (i.e., 146.76 USD) for transport and food during the intensive phase. During the intensive phase, the mean medical cost for one patient was 6444.66 LKR (IQR = 6400) (i.e., 36.21 USD). OOPE was not associated with noncompliance to TB treatment in intensive phase (p = 0.29). ConclusionsThere was no association between OOPE and noncompliance. The direct OOPE for TB treatment in the intensive phase was high. Therefore, it is necessary to develop strategies to reduce OOPE during TB treatment especially in intensive phase.

Impact of operation duration on short-term and long-term prognosis in patients undergoing radical colorectal surgery.

Purpose: The objective of this study was to evaluate the impact of operation duration on short- and long-term outcomes of colorectal cancer patients following surgical resection.Methods: 6224 consecutive patients who underwent radical colorectal surgery were retrospectively assessed and were divided into short operation duration group (SOD) and long operation duration group (LOD) according to the operation duration cutoff value of 110 minutes.Results: Compared with patients in LOD group, patients in SOD group had significantly lower total costs in hospital, reduced expenses for drugs and antibiotics, shorter length of stay (LOS) in hospital and in the ICU. Moreover, 5-year overall survival (OS) and disease-free survival (DFS) for patients in the SOD group were markedly higher than for patients in the LOD group. Mutivariate regression analysis indicated that longer operation duration was associated with poor prognosis, with a hazard ratio of 1.004 (1.003, 1.005) for OS and 1.005 (1.003, 1.006) for DFS. Finally, surgeons' qualifications had meaningful correlation with operation duration (r= 0.450).Conclusions: Operation duration is an independent risk factor for patients' short-term and long-term outcome after radical colorectal surgery. Improve the surgical skills of the surgeon may shorten the operation duration, and further improve the outcome for patients.

Tính toán chi phí đầy đủ của gói tầm soát ung thư đường tiêu hóa tại bệnh viện đa khoa Phương Đông năm 2020

Objective: This study aims to "Calculate the full cost of the screening package for gastrointestinal cancer by 2020 at Oriental General Hospital". Method: Estimate the full cost from the service provider's point of view. The costs taken into account include the cost of depreciation of builidings and infratructure; equipment depreciation costs; personel costs; drugs cost, consumable supplies and chemicals; regular maintenancee cost; electricity and water costs, environmental sanitation, laundry, waste treatment and other recurrent expenses. Costs are divided into direct and indirect costs. The direct cost is calculated by aggregating the manpower cost; expenses for drugs, consumable supplies and chemicals; depreciation costs for direct infrastructure and equipment; direct recurrent costs of package execution procedures. Indirect costs include costs from indirect departments / departments that cannot directly allocate costs to activities using the appropriate allocation criteria for package delivery procedures. Results: The cost of the gastrointestinal cancer screening package is VND 2,463,917. The direct cost is l,693,946 VND (68.75%), of which the largest cost is the drugs cost, consumables (VTH), chemicals is 543,578 VND. Indirect costs are 769,971 VND (31.25%), of which the largest cost is salary, bonus, indirect departmental allowances is 486,906 VND. Conclusion: This study provides important evidence for hospital administrators to make appropriate, effective and timely business decisions, in order to develop reasonable incentive and promotional policies for the business of examination packages; and to develop strategies to well control the cost incurred but constantly improve service quality in order to creating competitive advantages with other hospitals in the region. Keywords: Cost, cost accounting, gastrointestinal cancer screening, Oriental Hospital.

Prediction of medical expenditures of diagnosed diabetics and the assessment of its related factors using a random forest model, MEPS 2000-2015.

To predict the medical expenditures of individual diabetics and assess the related factors of it. Cross-sectional study. Data were collected from the US household component of the medical expenditure panel survey, 2000-2015. Random forest (RF) model was performed with the programs of randomForest in R software. Spearman correlation coefficients (rs), mean absolute error (MAE) and mean-related error (MRE) was computed to assess the prediction of all the models. Total medical expenditure was increased from $105 Billion in 2000 to $318 Billion in 2015. rs, MAE and MRE between the predicted and actual values of medical expenditures in RF model were 0.644, $0.363 and 0.043%. Top one factor in prediction was being treated by the insulin, followed by type of insurance, employment status, age and economical level. The latter four variables had no impact in predicting of medical expenditure by being treated by the insulin. Further, after the sub-analysis of gender and age-groups, the evaluating indicators of prediction were almost identical to each other. Top five variables of total medical expenditure among male were same as those among all the diabetics. Expenses for doctor visits, hospital stay and drugs were also predicted with RF model well. Treatment with insulin was the top one factor of total medical expenditure among female, 18-, 25- and 65-age-groups. Additionally, it indicated that RF model was little superior to traditional regression model. RF model could be used in prediction of medical expenditure of diabetics and assessment of its related factors well.

PMU83 PATIENT-FOCUSED OUTCOMES IN THE AMNOG-PROCESS - STATUS QUO AND QUO VADIS

As a response to rising expenses for drugs a new law (AMNOG) was introduced on January 1st, 2011 in Germany. It regulates the costs of a drug regarding its benefit for the patient including the investigation of Patient-Focused Outcomes (PFOs). The benefit-assessment is carried out by the Institute for Quality and Efficiency in Health Care (IQWiG) as an advising authority and the Federal Joint Committee (G-BA) as the price-forming authority. The aim of this study is a comparative analysis of G-BA’s results with IQWiG’s results investigating particularly extent and probability of the benefit confirmed for PFOs. Of all completed benefit-assessments between January 1st, 2011 and January 1st, 2019 the results regarding the drugs benefit were retrieved from the G-BA website. Extracted were extent and probability of the benefit. If no benefit was detected for a PFO, the reason against the positive decision was established. The information was collected for G-BA’s and IQWiG’s results and the outcomes of the two authorities were compared. From 428 detected indications at least one PFO was used on 282 indications. A benefit was confirmed in 142 indications by the pharmaceutical company, in 42 by IQWiG and in 48 by G-BA. The benefits extent was detected better by G-BA than by IQWiG (on average one category higher). A category-changing difference between G-BA and IQWiG in probability was not detectable. Regarding the reasons against the confirmation of a benefit, the most frequent one is that there were no statistically significant/clinically relevant benefits detectable. This observation applies for both IQWiG and G-BA. Even though PFOs are already used in many indications, the chances of success are low. If a higher success might be possible when the other influences – besides the lack of statistical significance and clinical relevance – are eliminated, must be explored further.

Medical expenditures for colorectal cancer diagnosis and treatment: A 10-year high-level-hospital-based multicenter retrospective survey in China, 2002-2011.

ObjectiveColorectal cancer (CRC) causes a substantial burden of disease in China and the evidence of economic burden triggered is fundamental for priority setting. The aim of this survey was to quantify medical expenditures and the time trends for CRC diagnosis and treatment in China.MethodsFrom 2012 to 2014, a hospital-based multicenter retrospective survey was conducted in 13 provinces across China. For each eligible CRC patient diagnosed from 2002 to 2011, clinical information and expenditure data were extracted using a uniform questionnaire. All expenditure data were reported in Chinese Yuan (CNY) using 2011 values.ResultsOf the 14,536 CRC patients included, the average age at diagnosis was 58.2 years and 15.8% were stage-I cases. The average medical expenditure per patient was estimated at 37,902 CNY [95 % confidence interval (95% CI): 37,282−38,522], and the annual average increase rate was 9.2% from 2002 to 2011 (P for trend <0.001), with a cumulative increase of 2.4 times (from 23,275 CNY to 56,010 CNY). The expenditure per patient in stages I, II, III and IV were 31,698 CNY, 37,067 CNY, 38,918 CNY and 42,614 CNY, respectively (P<0.001). Expenditure significantly differed within various subgroups. Expenses for drugs contributed the largest proportion (52.6%).ConclusionsThese conservative estimates illustrated that medical expenditures for CRC diagnosis and treatment in tertiary hospitals in China were substantial and increased rapidly over the 10 years, with drugs continually being the main expense by 2011. Relatively, medical expenditures are lower for CRC in the earlier stages. These findings will facilitate the economic evaluation of CRC prevention and control in China.

ASSESSMENT OF PARENTS’ SATISFACTION WITH PRIMARY HEALTH CARE PROVIDED TO THEIR CHILDREN IN POLYCLINICS

Background. Patients' satisfaction with medical care as a "subjective" component of a medical organization rating can be distorted by some factors. The aim of this study was to identify factors related to the medical care process in children's polyclinics that determine the parents' satisfaction with primary health care provided to their children. Methods. The sociological study by means of questioning of 215 parents (mothers) of children patients (0-17 years old) who received medical care in children's polyclinics in Arkhangelsk was carried out. Parents' satisfaction with primary health care was assessed according to three criteria: organization of the children's polyclinics work, satisfaction with the service process, and the presence (absence) of additional financial expenses for medical drugs. Binary logistic regression analysis was used to identify factors associated with the parents' satisfaction with primary health care provided to their children. Results. A half of the respondents (55.8 %, 95 % CI: 49.4-62.0) was satisfied with primary health care provided to their children. The respondents' satisfaction with medical care was significantly influenced by factors related to their personal communication with the pediatricians and medical personnel. Long wait (more than 1 month) for laboratory and instrumental examinations, additional consultations with specialists were not statistically significantly associated with parents' satisfaction with primary health care. Conclusion. Results of the study help to understand the mechanism of the development of the "patients' satisfaction with medical care"; indicate that "the proportion of parents who are satisfied with medical care" is not an independent criterion for the quality of medical care in children's polyclinics. Parents' satisfaction with primary health care provided to their children is determined by factors related to the quality of personal contact with the pediatrician.

PP.07.18] CHRONIC KIDNEY DISEASE, END STAGE RENAL DISEASE, AND KIDNEY TRANSPLANTATION IN SURINAME

Objective: The high hypertension and diabetes burden in low and middle income countries is expected to lead to an increase in chronic kidney disease (CKD) and the need of renal replacement therapy. We aimed to estimate the prevalence of CKD and end stage renal disease (ESRD), and assess the availability of kidney transplantation in Suriname, a middle income country with a current population size of nearly 574.000 persons of mainly South Asian and African descent. Our previous studies showed that around 80% of the adult population is prehypertensive or hypertensive, and around 26% has prediabetes or diabetes. Design and method: We analysed data of the Healthy Life in Suriname (HELISUR) study, a random population sample, to estimate the number of patients with CKD (eGFR <60 ml/min/1.73 m2) and ESRD (eGFR <15 ml/min/1.73 m2); and analysed data of dialysis centers to assess the number of patients on renal replacement therapy. Results: We found that around 2% of the adult population had CKD (est. n = 11.500). Of these, 63% had an eGFR of 30–59; 28% of 15–29, and 9% of <15 mL/min/1.73 m2 (est. n = 1035). The number of patients on hemodialysis has starkly increased in the past years. In 2014, 516 patients were on maintenance dialysis. The majority of these patients (76%) had a history of hypertension, 47% had a history of diabetes, and 30% had both conditions. There was no health care facility to provide renal transplants or predialysis care. Although all patients had health insurance, patients experienced difficulties in accessing dialysis. In particular transportation to the clinic and out-of-pocket expenses for drugs were unaffordable for low-income patients. Conclusions: The high cardiovascular risk burden in Suriname creates a challenge for the health-care system to provide and sustain renal replacement therapy. Kidney transplantation is not available in Suriname. A previous study showed this to be mainly due to the lack of technical means to perform the procedure and the lack of eligible donors. Thus, our results highlight the need for effective population-based strategies to reduce the cardiovascular disease burden of hypertension and diabetes, and prevent kidney failure.

Long-Term Outcomes and Socioeconomic Impact of Japanese Encephalitis and Acute Encephalitis Syndrome in Uttar Pradesh, India

Background: Acute encephalitis syndrome (AES) is a public health problem in India. One of the causes is the Japanese encephalitis (JE), but in many patients this infection can be ruled out. The current hospital-based surveillance was conducted on patients with AES and JE. No comparative study on the long-term outcomes of JE vs. non-JE AES was available from India and there was no study on socioeconomic impact of the illness. Objectives: The current study aimed at comparing the long-term outcomes of JE vs. non-JE AES and studying the socioeconomic impact of AES on the population of Uttar Pradesh, India. Methods: Patients with AES discharged from hospital were followed-up by hospital or home visits, or telephone interviews. Functional outcomes and sequelae were compared between the patients with JE and non-JE AES by the Glasgow outcome scale (GOS), Liverpool outcome scale (LOS), and child & adolescent scale of participation (CASP). Socioeconomic impact and coping mechanisms were studied by the semi-structured qualitative methods. Results: A total of 91 patients (29 with JE, 62 with non-JE AES) were followed-up based on the mean (SD) duration of 21.9 (5.6) months after discharge from hospital. Functional outcomes were significantly worse in the cases with JE, but there was no significant difference in CASP scores between the groups. Only 4 patients with JE got financial help from the government. In the rest, almost all the expenses for travel, hospitalization, drugs, and investigation were borne by the families themselves. Most of the families borrowed money from relatives, while some mortgaged or sold their land and/or jewelry. Rehabilitation services were seldom available as it needed travelling to cities. The joint family system has a cushioning effect, however, providing physical and mental support. Conclusions: AES is a serious illness with severe long-term sequelae in survivors. Functional outcomes got worse in the patients with JE compared with the ones with non-JE AES. The illness had a severe socioeconomic impact and all expenses should be borne by poor families. Rehabilitation remained an unmet need. Some supports were provided through the joint family system.

Lysosomal Storage Diseases: Challenges in Multiprofessional Patient Care with Enzyme Replacement Therapy

Background Due to their rarity studies in (ultra-) rare diseases are difficult. Only for a minority of these diseases causal therapies are available. Development and production of enzyme replacement therapies (ERT) for example are challenging and expensive. The number of patients is low, costs per patient are high. We will focus on the challenges of providing long-term ERT to patients with lysosomal storage diseases (LSD) in an out- and inpatient setting based on a literature search in Pubmed and own experience. Many ERTs for LSDs have a positive cost-benefit ratio. Possible side-effects are severe allergic reactions. ERT is covered by the insurance companies when prescribed by a physician, however they are liable to recourse by the insurance company as the expenses for drugs of the prescribing physician will be above average. In most cases the recourse can be averted if diagnoses of individual patients are disclosed. Intravenous infusion of ERT is not well-regulated in Germany/Austria. Infusion on a ward is safe however often not covered by the insurance companies as patients do not stay overnight. Another option is infusion in a day-care setting, however the lump sum paid for infusion does not cover costs for ERT. On an individual basis, reimbursement for medication (ERT) has to be negotiated with the insurance companies before infusion takes place. Home infusions are feasible, however careful evaluations of the infusion-team and the risk for side-effects have to be performed on an individual basis, legal issues have to be considered. In- and outpatient ERT of patients with LSDs is challenging but feasible after individual evaluation of patient and infusion team.

ФАРМАКОЭКОНОМИЧЕСКИЙ АНАЛИЗ ЭФФЕКТИВНОСТИ АНТИБАКТЕРИАЛЬНОЙ ТЕРАПИИ НОЗОКОМИАЛЬНОЙ ПНЕВМОНИИ

There was performed a prospective pharmacoeconomic study of effectiveness of different variants of antibacterial therapy in 118 patients diagnosed with nosocomial pneumonia who were treated in specialized departments of General hospital to identify the most effective treatment regimens from the point of view of pharmacoeconomics. Taking into account the characteristics of the local microbiological pattern and the spectrum of sensitivity to antibiotics of the most commonly encountered microorganisms in this hospital there were selected the drugs that have high activity against these pathogens. The patients were divided into groups: the first group (n=57) included the patients with early nosocomial pneumonia including 37 patients receiving combination therapy with Levofloxacin and Ceftazidime, 20 patients with Amoxiclav monotherapy; the second group (n=61) consisted of patients with later nosocomial pneumonia; 34 patients had combined treatment with Amikacin and Cefoperazone/Sulbactam, 27 patients had Imipenem monotherapy. The evaluation and analysis of clinical effectiveness with the method &amp;#34;cost-effectiveness&amp;#34; were done. It was found out that in all compared groups there is a high effectiveness of antibacterial drugs starting from 61%. The highest integral factor of clinical efficacy was in the group of Imipenem (86.1%), then in the group of Levofloxacin and Ceftazidime (71.5%), in the group of Amikacin and Cefoperazon/Sulbactam (70%), in the group of Amoxiclav (61%). Noteworthy is that only in the group of Imipenem there was no need for additional antibacterial therapy and there was short term treatment. While analyzing the cost-effectiveness correlation, it was found out that the least cost per unit of effectiveness was the cost of treatment with the combination of Levofloxacin and Ceftazidime for patients with early nosocomial pneumonia and the cost of therapy with Amikacin and Cefoperazon/Sulbactam in patients with late nosocomial pneumonia. Despite the high cost of a single dose, there was a reduction in the cost while using Imipenem due to the decrease of the time of treatment of patients in the hospital and the intensive care unit and no expenses for additional antibacterial drugs. Imipenem can be used as monotherapy as an alternative to the standard combination therapy in severe nosocomial pneumonia, primarily in patients located in intensive care unit.

Hepatitis C among healthcare personnel: secondary data analyses of costs and trends for hepatitis C infections with occupational causes.

BackgroundHepatitis C infection is a global public health issue. Chronic hepatitis C infection is associated with significant morbidity and mortality. The aim of this study is to describe the costs for occupationally-cased hepatitis C infections based on data from an accident insurance carrier.MethodsThis study is a secondary analysis based on the Database of a German Institution for Statutory Accident Insurance. The analysis is based on a sample of insured parties whose hepatitis C infections were recorded as occupational diseases between 1996 and 2013. The analysis is based on recognised hepatitis C cases and incorporates records registered between 1 January 2000 and 31 December 2014.ResultsWithin the study period, the number of reported and recognised hepatitis C cases declined by 73 and 86% respectively. The majority of recognised hepatitis C cases (n = 1.121) were female, older than 40 years and were active in a medical nursing profession. In the study period, the costs came to a total of € 87.9 million, of which 60% was attributable to pension payments (€ 51,570,830) and around 15% was attributable to pharmaceutical and medicinal products (€ 12,978,318). Expenses for drugs exhibited heavy increases in 2012 (from around € 500,000–800,000 to € 1.7 million) and 2014 (to € 2.5 million) in particular. Pension payments came to € 1.6 million in 2000 and rose continuously to over € 4 million in 2014. Expenses for occupational rehabilitation accounted for less than 1%.ConclusionsFor hepatitis C infections as an occupational disease, a considerable increase in costs has been observed in recent years, while the number of reports has declined heavily. This rise in costs is explained by the increase in pension payments and, since 2012, by a rise in the costs for drugs. The high costs of anti-viral therapies is offset by the potential for considerable treatment benefits. Healing the infection is expected to generate long-term cost savings for statutory accident insurance carriers, and also for social security systems.

Cost-Sharing Rates Increase During Deep Recession: Preliminary Data From Greece.

Background: Measures taken over the past four years in Greece to reduce pharmaceutical expenditure have led to significant price reductions for medicines, but have also changed patient cost-sharing rates for prescription drugs. This study attempts to capture the resulting increase in patients’ out-of-pocket (OOP) expenses for prescription drugs during the 2011-2014 period. Methods: The authors conducted a retrospective review of financial data derived from 39 883 prescriptions, dispensed at three randomly chosen pharmacies located in Lamia, central Greece. Results: The study recorded an average contribution rate per prescription as follows: 11.28% for 2011 (95% CI: 10.76-11.80), 14.10% for 2012, 19.97% for 2013, and 29.08% for 2014. Correspondingly, the mean patient charge per prescription for 2011 was €6.58 (95% CI: 6.22-6.94), €8.28 for 2012, €8.35 for 2013, and €10.87 for 2014. During the 2011-2014 period, mean percentage rate of patient contribution increased by 157.75%, while average patient charge per prescription in current prices increased by 65.22%. The use of a newly introduced internal reference price (IRP) system increased the level of prescription charge at a rate of 2.41% for 2012 (100% surcharge on patients), 26.24% for 2013 (49.95% on patients and 50.04% on the appropriate health insurance funds), and 47.72% for 2014 (85.06% on patients and 14.94% on funds). Conclusion: Increased cost-sharing rates for prescription drugs can reduce public pharmaceutical expenditure, but international experience shows that rising OOP expenses can compromise patients’ ability to pay, particularly when it comes to chronic diseases and vulnerable populations. Various suggestions could be effective in refining the cost-sharing approach by giving greater consideration to chronic patients, and to the poor and elderly.

The Economic Burden of Out-of-Pocket Medical Expenditures Before and after Implementation of the Medicare Prescription Drug Program

Older Americans, although covered by Medicare, bear a large economic burden of medical expenses in the form of premiums for Medicare and supplemental plans, as well as the cost of uncovered or under-covered medical services. This study compares the patterns of this economic burden in 2010 with the baseline year of 2005. The period covered was marked by economic shocks, health care technology innovations and major Medicare reforms, including implementation of the prescription drug (Part D) program and changes in premium rules. Consequently, we present a description of the economic burden and do not attempt to make causal inferences. The definition of expenditures is limited to three components of out-of-pocket (OOP) medical spending: premiums, prescription drugs costs, and health services. While this definition is a limitation of the study, it also allows the researchers to focus on the costs most likely to be affected by improved access to prescription drugs and premium reforms.This paper found that:• Overall, the economic burden (expressed as a percent of income spent on OOP expenditures and premiums) averaged 18.5 percent of 2010 income, with top decile spending at 32 percent or more of their income going to health care. • A typical beneficiary spent 1.4 percentage points less of their income in 2010 than in 2005. When this burden is decomposed, we observed that the share of income spent for prescription drugs declined by 1.3 percentage points. This was the major component of the decline in this burden. The burden of premiums increased over the period, offsetting some of the gains from declining expenses for prescription drugs.• These gains were mostly observed at the high end of the burden distribution, i.e., those who were spending more than 20 percent of their income on health care. This group had lower incomes, on average, and were much less likely to possess employer-sponsored supplemental (or self-purchased) coverage. • Dual eligibles experienced a lower economic burden in 2010, even though their incomes were also significantly lower compared to the rest of the Medicare beneficiaries. Compared to other Medicare beneficiaries, they experienced relatively larger reductions in economic burden between 2005 and 2010.The policy implications of this paper are:• We observed some relief in the economic burden of prescription drug expenditures and overall health care, particularly for those who were most vulnerable to financial strains.• Our observations were consistent with the intended direction of policies implemented during the period. However, one can argue that the size of the gains was unremarkable when compared to the scope of the Part D reform. • Medicaid continued to fulfill its role as a safety net for those who are most vulnerable to financial strains. The relatively higher rate of decline for duals or low-income beneficiaries suggests that key components of the reform (premium- and cost-sharing assistance) are reaching the intended targets.• Affordability of high-cost drugs for the management of chronic conditions continues to be a major national health policy challenge. Medicare policy changes are likely to continue affecting out-of-pocket cost exposure to medications, particularly with the introduction and expansion in use of very high-priced specialty medications. Given the size and the unequal distribution of the economic burden of health care, we conclude that the economic burden needs to be a continuous concern when policy alternatives are discussed.

Standard strategies for diagnosis and treatment of patients with newly diagnosed Parkinson disease: FRANCE.

In France, newly diagnosed patients with Parkinson disease (PD) are mostly referred by a general practitioner (GP) to a public (hospital-based) or private practice neurologist for confirmation of the diagnosis and treatment initiation. Most neurologists rely on a clinical evaluation according to National Health Authority (HAS) recommendations and guidelines.1 MRI scans and dopamine transporter imaging are increasingly being performed for the differential diagnosis of atypical parkinsonism, for drug-induced parkinsonism and tremor, in early-onset patients, or to deal with the anxiety of patients and their families. Clinical scales such as the Unified Parkinson's Disease Rating Scale are scarcely used in routine practice. Therapeutic strategies are not or little affected by who is covering the cost of treatment or by how medical facilities and professionals are reimbursed, ensuring that health care guidelines are usually respected. Indeed, the expenses for drugs and other inpatient and ambulatory health care are almost fully covered by the health insurance within the frame of chronic diseases (“ Affection de longue duree n°16 ”), providing that the parkinsonian syndrome is irreversible and requires the administration of antiparkinsonian drugs for at least 6 months. Some newly diagnosed patients, before being registered by the free care system for chronic diseases, may only have partial coverage of costs (65%). However, most of them have complementary private insurance allowing full reimbursement of their expenses.

Costs of Eye Care Services: Prospective Study from a Faith-based Hospital in Zambia

Purpose: To estimate the mean costs of cataract surgery and refractive error correction at a faith-based eye hospital in Zambia.Methods: Out-of-pocket expenses for user fees, drugs and transport were collected from 90 patient interviews; 47 received cataract surgery and 43 refractive error correction. Overhead and diagnosis-specific costs were determined from micro-costing of the hospital. Costs per patient were calculated as the sum of out-of-pocket expenses and hospital costs, excluding user fees to avoid double counting.Results: From the perspective of the hospital, overhead costs amounted to US$31 per consultation and diagnosis-specific costs were US$57 for cataract surgery and US$36 for refractive error correction. When including out-of-pocket expenses, mean total costs amounted to US$128 (95% confidence interval [CI] US$96--168) per cataract surgery and US$86 (95% CI US$67--118) per refractive error correction. Costs of providing services corresponded well with the user fee levels established by the hospital.Conclusion: This is the first paper to report on the costs of eye care services in an African setting. The methods used could be replicated in other countries and for other types of visual impairments. These estimates are crucial for determining resources needed to meet global goals for elimination of avoidable blindness.

Cost for Treatment of Chronic Lymphocytic Leukemia in Specialized Institutions of Ukraine

ObjectiveThe aim of this study was to identify, from a health care perspective, the cost of treatment for chronic lymphocytic leukemia in specialized hospitals in Ukraine. MethodsCost analysis was performed by using retrospective data between 2006 and 2010 from patient-file databases of two specialized hospitals (145 patients). Uncertainty was assessed by using bootstrapping and multivariate sensitivity analyses. Linear regression analysis was used to analyze whether patients’ characteristics are related to health care costs. In addition, one-way analysis of variance (Welch test) and paired-sample t test were conducted to compare mean costs of treatment between the two hospitals and mean expenses for drugs and in-hospital stay. ResultsThe average annual cost for a patient’s drug treatment is 2047 EUR. The cost of hospitalization was significantly lower (t = 5.026; significance two-tailed = 0.000) and equal to 541 EUR per person, resulting in total expenditures of 2589 EUR. Mean total costs in the bootstrap analysis were equal to 2584 EUR (median 2576 EUR, 97.5th percentile 3223 EUR; 2.5th percentile 1987 EUR). The regression analysis did not reveal a relation between patients’ characteristics and health care costs, although hospital choice was an influential parameter (β = −0.260; significance = 0.002). Significant difference in mean costs of two analyzed hospitals was also confirmed by one-way analysis of variance (Welch statistics 19.222, P = 0.000). ConclusionsDrug treatment comprises the largest portion of total costs, but differences between hospitals exist. Because many patients in Ukraine pay out of pocket for in-hospital drugs, these costs are a high economic burden for patients with chronic lymphocytic leukemia.