Financial Burden For Patients Research Articles

Psychiatric diagnoses are common after liver transplantation and are associated with increased health care utilization and patient financial burden.

Psychiatric disorders after liver transplantation (LT) are associated with worse patient and graft outcomes, which may be amplified by inadequate treatment. We aimed to characterize the burden of psychiatric disorders, treatment patterns, and associated financial burden among liver transplantation recipients (LTRs). IQVIA PharMetrics (R) Plus for Academics-a large health plan claims database representative of the commercially insured US population-was used to identify psychiatric diagnoses among adult LTRs and assess treatment. Multivariable logistic regression analysis identified factors associated with post-LT psychiatric diagnoses and receipt of pharmacotherapy. Patient financial liability was estimated using adjudicated medical/pharmacy claims for LTRs with and without psychiatric diagnoses. Post-LT psychiatric diagnoses were identified in 395 (29.5%) of 1338 LTRs, of which 106 (26.8%) were incident cases. Treatment varied, with 67.3% receiving pharmacotherapy, 32.1% psychotherapy, 21.0% combination therapy, and 21.5% no treatment. Among 340 LTRs on psychotropic medications before transplant, 24% did not continue them post-LT. Post-LT psychiatric diagnoses were independently associated with female sex, alcohol-associated liver disease (ALD), prolonged LT hospitalization (>2 wk), and pre-LT psychiatric diagnosis. Incident psychiatric diagnoses were associated with female sex, ALD, and prolonged LT hospitalization. Patients with a post-LT psychiatric diagnosis had higher rates of hospitalization (89.6% vs. 81.5%, p <0.001) and financial liability (median $5.5K vs. $4.6K USD, p =0.006). Having a psychiatric diagnosis post-LT was independently associated with experiencing high financial liability >$5K. Over 1 in 4 LTRs had a psychiatric diagnosis in a large national cohort, yet nearly a quarter received no treatment. LTRs with psychiatric diagnoses experienced increased health care utilization and higher financial liability. Sociodemographic and clinical risk factors could inform high-risk subgroups who may benefit from screening and mitigation strategies.

#254 PaCE CKD: examining health status and financial burden in patients with chronic kidney disease: assessing the non-clinical burden of disease

Abstract Background and Aims There is a detrimental effect of chronic kidney disease (CKD) on health states, with many patients worldwide experiencing considerable symptom burden and development of comorbidities, leading to frequent medical appointments and hospitalisations. Patients experience disease-associated financial strain as their ability to work is impaired. The aim of this multinational study was to characterise the non-clinical burden of CKD by quantifying the effect of CKD on health states and productivity in patients versus general population in several regions. Method Patients with early (stages 1-3) to advanced (stages 4-5) of CKD, including those receiving dialysis treatment, in Germany, Mexico, Taiwan, the UK, and the US were enrolled to a cross-sectional non-interventional survey measuring: Scores were compared with a general population cohort, matched 1:1 in sample size against patient cohorts and for demographic characteristics (e.g. age and area of residence). Results Across five countries, an average of 201 (range: 190–212) patients were enrolled, of whom 42% were receiving dialysis in Germany, 57% in Mexico, and 55% in the UK with smaller proportions of patients on dialysis cohorts in the US (32%) and Taiwan (15%). Haemodialysis was the most prevalent mode of dialysis in all countries, with most patients receiving dialysis in a clinic or hospital. Enrolled patients who had received a kidney transplant accounted for 11.5% on average across all countries. Compared with general population, people with CKD experienced a 24% reduction in mean [SD] EQ-5D utility scores, with patients in the US experiencing the greatest disparity in health states (0.64 [0.27] versus 0.95 [0.08]). Patients with CKD reported significantly more problems across all EQ-5D domains in Germany, Mexico, the US, and UK than general population cohorts. The highest percentage of patients reporting problems was in Mexico, with 81.4% reporting problems in usual activities compared with 4.4% in the general population. Patients receiving dialysis reported a mean EQ-VAS value of 70.3 compared with 91.8 in non-dialysis dependent patients, indicating that treatment burden negatively contributes towards patients perception of their health. In addition to impaired health states, patients reported elevated impairment across work and non-work activities in all countries. Patients reported increased rates of absenteeism, presenteeism, work impairment and non-work activity impairment, with the greatest impairment observed in the UK of 46.4% in non-work activity impairment compared with the general population. Conclusion These results indicate that people with CKD experience substantial burden of disease that extends beyond its clinical aspects. Decision makers should consider broader disease effects when addressing the burden of CKD.

Abstract PO4-11-06: Survey of Questionnaires on the Efficacy and Cost of Scalp Cooling Devices in Breast Cancer Patients

Abstract &amp;lt; Background &amp;gt; Scalp cooling devices have demonstrated effectiveness in mitigating chemotherapy-induced alopecia, with an approximate reported success rate of 50% in hair preservation. Nevertheless, their utilization may lead to adverse effects and financial burdens for patients. Our institution introduced the Paxman scalp cooling system in 2021 for breast cancer patients undergoing perioperative chemotherapy, with its application extending to over 120 cases. An out-of-pocket expense of 16,000 yen ($110) per chemotherapy session is required, separate from insurance-covered treatments. We conducted a retrospective evaluation using patient questionnaires and medical records to assess the efficacy and cost-related satisfaction concerning scalp cooling devices. &amp;lt; Methods &amp;gt; The subjects consisted of breast cancer patients who had undergone at least one session of chemotherapy with scalp cooling devices at our institution. Objective assessment of hair preservation was performed through head photographs taken during the usage of the cooling devices and recorded in the medical charts. The evaluation was carried out using CTCAE version 4, and statistical analysis of relationships was conducted utilizing Stata version 18 and the χ² test. &amp;lt; Results &amp;gt; Responses were collected from 91 patients (survey response rate: 96%). The median age of the patients was 51 years (range: 28-80). The regimens of chemotherapy included anthracycline-based (A) in 10 patients (11%), taxane-based (T) in 19 patients (21%), A-T combination in 57 patients (63%), and HER2-targeted therapy in 38 patients (42%). The results of questionnaire revealed, besides scalp cooling, patients incurred a median cost of 131,000 yen($922) for wigs and 10,000 yen($70) for hair care and other expenses. 61 individuals (67%) completed the scalp cooling treatment during the chemotherapy. The reasons for discontinuation of scalp cooling were mainly discomfort due to tightness (33%), followed by the time-consuming nature of the process (30%), hair loss (26%), and excessive cold sensation (26%) (Multiple answers allowed). Regarding the benefits and drawbacks of scalp cooling devices, 50 patients (56%) expressed satisfaction for scalp cooling, 26 patients (29%) had neutral feelings, 14 patients (16%) expressed unsatisfied, and one response was unknown. Regarding the device's cost, 14 patients (16%) were satisfied, 35 patients (40%) were neutral, 39 patients (44%) were unsatisfied, and three responses was unknown. Among the 52 patients who continued using the device until their final chemotherapy session and could assess the head photographs, the hair loss grades were as follows: grade 0 in 9 patients (17%), grade 1 in 22 patients (42%), and grade 2 in 21 patients (40%). A correlation was observed between the objective hair loss grade and satisfaction with the device's efficacy (p &amp;lt; 0.01), while no significant correlation was found between satisfaction and the cost (p = 0.21) (attached table). &amp;lt; Discussion &amp;gt; Although more than half of the patients who utilized scalp cooling devices expressed satisfaction with their efficacy, merely 16% expressed satisfaction with the associated costs. Addressing patient financial burdens, including expand to insurance coverage, becomes imperative for future considerations. Table. The relation between hair preservation and satisfaction for efficacy and cost. A correlation was observed between the objective hair loss grade and satisfaction with the device's efficacy (p &amp;lt; 0.01), while no significant correlation was found between satisfaction and the cost (p = 0.21) Citation Format: Haruru Kotani, Nari Kureyama, Maho Kusudo, Rie Komaki, Akira Nakakami, Yuka Endo, Ayumi Kataoka, Akiyo Yoshimura, Masaya Hattori, Masataka Sawaki, Hiroji Iwata. Survey of Questionnaires on the Efficacy and Cost of Scalp Cooling Devices in Breast Cancer Patients [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-11-06.

Treatment-Free Remission in Chronic Myeloid Leukemia.

With the discovery of tyrosine kinase inhibitors (TKIs), overall survival in patients with chronic myeloid leukemia (CML) now approaches that of the general population. While these TKIs have proven to be lifesaving, remaining on them lifelong creates both physical and financial burdens for patients. Recently, multiple trials have begun looking into the efficacy of trialing patients off these TKIs to see if they can sustain treatment-free remission (TFR). TFR eligibility is currently limited to a small population of patients with both robust and sustained responses to TKIs. Currently, for those who attempt a trial of TFR, the average success rates are promising, with anywhere from 38 to 54% of patients experiencing sustained TFR. For those who fail to maintain sustained TFR, safety results to date are reassuring, with almost all patients successfully responding to the re-initiation of TKIs, with death and disease progression being very rare complications. Moving forward, research is being conducted to more accurately risk stratify patients at diagnosis and pair them with optimized upfront treatment regimens aimed at increasing candidacy for the trial of TFR.

A Clinico-Epidemiological Study to Assess the Impact on Quality of Life and Financial Burden in Patients with Dermatophytosis

A Clinico-Epidemiological Study to Assess the Impact on Quality of Life and Financial Burden in Patients with Dermatophytosis

Effects of breastfeeding in postoperative complication in pediatric population: a systematic review.

Surgical complications in younger patients can lead to infections, delayed healing, prolonged hospital stays, and other negative outcomes, significantly affecting their recovery. This study explores the potential impact of breastfeeding on mitigating these complications, aiming to enhance our understanding of postoperative care for paediatric and adolescent patients. The authors conducted a systematic search on databases such as PubMed, Scopus, Web of Science, and EMBASE, using relevant MESH keywords, adhering to the "Preferred Reporting Items for Systematic Reviews and Meta-analysis" methodology. Quality assessments were performed, and studies scoring above 70% were included for standardized data incorporation. Data extraction followed Cochrane Consumers and Communication Review group's guidelines. Bias and ethical criteria were considered and provided valuable evidence to answer the research question. Among 402 initially reviewed articles, six met inclusion criteria: 3 observational cohort studies, 2 systematic reviews, and 1 randomized controlled trial. The selected literature consistently demonstrates a significant reduction in postoperative infection rates and improved outcomes. Breastfeeding shortened postoperative hospital stays, accelerated recovery, and enhanced nutritional status, potentially reducing healthcare resource utilization and patient financial burden. Lower mortality and morbidity rates were also observed. This systematic review provides compelling evidence of breastfeeding's positive impact on surgical outcomes in the paediatric population. While the authors' findings support the benefits of breastfeeding in this age group, further large-scale, multicenter research is needed to provide stronger evidence for guiding clinical practices.

Physician Perspectives on the Nonclinical Factors That Contribute to Decision-Making for Advanced Prostate Cancer Care: A Qualitative Study

Introduction: Promising new treatments exist for advanced prostate cancer. Decision-making is complicated: there are minimal comparative effectiveness data; differing routes of administration, drug mechanisms of action, and side effects; and significant price differences. These challenges contribute to variations in care and quality, treatment disparities, and lack of concordance with patient values. The aim of this study was to examine physician perspectives of factors influencing decision-making for first-line advanced prostate cancer treatments. Methods: We conducted a qualitative descriptive study of physicians who treat patients with advanced prostate cancer from September 2021 to June 2022. Participants were purposively sampled from across the United States. Results: Twenty-seven physicians participated. We identified 17 domains and three overarching themes affecting physician decision-making for advanced prostate cancer care. The themes were as follows: (1) physician and practice factors affect prescribing decisions, (2) health practice resource availability affects the likelihood that patients will receive the recommended treatment and that the treatment will be in-line with patients' values, and (3) patient nonclinical factors influence physician decision-making, but patient values could be better incorporated into prescribing decisions. Based on the analyses, we constructed a preliminary framework of clinician decision-making for advanced prostate cancer. Conclusions: Physicians perceive that nonclinical patient, physician, and practice factors affect decision-making. These factors, therefore, must be considered when implementing programs to optimize a physician's ability to provide quality cancer care, reduce health care disparities and patient financial burden, and provide patient goal concordant care. The preliminary theoretical model of clinician decision-making for advanced prostate cancer care may also be used to inform these efforts.

A New Generation of Gene Therapies as the Future of Wet AMD Treatment.

Age-related macular degeneration (AMD) is an eye disease and the most common cause of vision loss in the Western World. In its advanced stage, AMD occurs in two clinically distinguished forms, dry and wet, but only wet AMD is treatable. However, the treatment based on repeated injections with vascular endothelial growth factor A (VEGFA) antagonists may at best stop the disease progression and prevent or delay vision loss but without an improvement of visual dysfunction. Moreover, it is a serious mental and financial burden for patients and may be linked with some complications. The recent first success of intravitreal gene therapy with ADVM-022, which transformed retinal cells to continuous production of aflibercept, a VEGF antagonist, after a single injection, has opened a revolutionary perspective in wet AMD treatment. Promising results obtained so far in other ongoing clinical trials support this perspective. In this narrative/hypothesis review, we present basic information on wet AMD pathogenesis and treatment, the concept of gene therapy in retinal diseases, update evidence on completed and ongoing clinical trials with gene therapy for wet AMD, and perspectives on the progress to the clinic of "one and done" therapy for wet AMD to replace a lifetime of injections. Gene editing targeting the VEGFA gene is also presented as another gene therapy strategy to improve wet AMD management.

Study on the trend of congenital heart disease inpatient costs and its influencing factors in economically underdeveloped areas of China, 2015-2020: a case study of Gansu Province.

Economic data on congenital heart disease are scarce in economically underdeveloped areas of China. Therefore, this study aimed to shed light on the level and changing trend of congenital heart disease inpatients' economic burden in underdeveloped areas. This study used a multi-stage stratified cluster sampling method to select 11,055 inpatients with congenital heart disease from 197 medical and health institutions in Gansu Province. Their medical records and expenses were obtained from the Hospital Information System. Univariate analysis was conducted using the rank sum test and Spearman rank correlation. Quantile regression and random forest were used to analyze the influencing factors. From 2015 to 2020, the average length of stay for congenital heart disease patients in Gansu Province was 10.09 days, with an average inpatient cost of USD 3,274.57. During this period, the average inpatient costs per time increased from USD 3,214.85 to USD 3,403.41, while the average daily inpatient costs increased from USD 330.05 to USD 376.56. The average out-of-pocket costs per time decreased from USD 2,305.96 to USD 754.77. The main factors that affected the inpatient costs included length of stay, cardiac procedure, proportion of medications, age, and hospital level. Congenital heart disease causes a significant economic burden on both families and society. Therefore, to further reduce the patient's financial burden, the length of stay should be reasonably reduced, and the rational distribution of medical resources should be continuously promoted to ensure equitable access to healthcare services.

Extended-Spectrum β-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae: Risk Factors and Economic Burden Among Patients with Bloodstream Infections.

Although Extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae (ESBL-EK) significantly contribute to bloodstream infections, their economic repercussions remain largely unquantified. We performed a retrospective analysis of inpatients diagnosed with Escherichia coli or Klebsiella pneumoniae bacteremia in a tertiary hospital from January 2020 to December 2022 in Guangzhou, China. We employed the chi-square test to examine ESBL risk factors and utilized propensity score matching (PSM) to negate baseline confounding factors, assessing economic burden through disability-adjusted life years (DALYs), hospital costs and productivity losses. We employed mediation analysis to eliminate confounding factors and better identify ESBL sources of burden related. We found 166 ESBL-EC/KP BSI patients (52.2% of the total examined 318 patients). Post-PSM analysis revealed that ESBL-producing EC/KP will reduce the effectiveness of empirical medication by 19.8%, extend the total length of hospitalization by an average of 3 days, and increase the patient's financial burden by US$2047. No significant disparity was found in overall mortality and mean DALYs between the groups. Mediation analysis showed that the link between ESBL and hospital costs is predominantly, if not entirely, influenced by the appropriateness of empirical antibiotic treatment and length of hospital stay. Patients with BSI due to ESBL-producing ESBL-EK incur higher costs compared to those with non-ESBL-EK BSI. This cost disparity is rooted in varying rates of effective empirical antimicrobial therapy and differences in hospital stay durations. A nuanced approach, incorporating a thorough understanding of regional epidemiological trends and judicious antibiotic use, is crucial for mitigating the financial impact on patients.

Effect of pranayama on pulmonary functions and heart rate variability in patients with mild-to-moderate persistent bronchial asthma

Background: The global burden of bronchial asthma is on the rise. Asthma is a disorder of airflow obstruction associated with deranged pulmonary functions and autonomic imbalance. Though past studies have shown the beneficial effects of various asanas and breathing exercises in bronchial asthma, the role of such non-pharmacological alternative modalities in reducing morbidity and financial burden in patients is far from clear. Aims and Objectives: To assess the effect of Pranayama techniques on pulmonary functions and heart rate variability parameters in bronchial asthma patients. Materials and Methods: In our present study, we have recruited patients with mild-to-moderate bronchial asthma after taking written and informed consent. These patients were then asked to perform three pranayama techniques, namely Suryanadi, Bhastrika, and Kapalabhati pranayama, for 30 min a day, 3 days a week, for up to 4 weeks. Pulmonary function test parameters (forced vital capacity [FVC], forced expiratory volume in 1st s [FEV1], FEV1/FVC, peak expiratory flow rate) and Autonomic function test parameters (Time domain: mean HR, mean RR, NN50, pNN50, SDNN; Frequency domain: very low frequency (LF), LF, LF/high frequency (HF) ratio, total power) were compared before and after the intervention using a paired t-test. Results: After the intervention, improvements were recorded in pulmonary functions. Furthermore, pranayama was found to cause a shift in the sympathovagal balance toward the parasympathetic system. However, the changes recorded were not statistically significant. This shows further research in this field is required with a larger sample size, which may yield statistically significant data. Conclusion: Thus, we conclude that pranayama can be a useful alternative therapy for reducing morbidity and mortality in bronchial asthma patients.

The financial burden after liver transplantation is significant among commercially insured adults: A large US National Cohort.

Liver transplantation (LT) is lifesaving for patients with cirrhosis; however, the resultant financial burden to patients has not been well characterized. We aimed to provide a nationally representative portrayal of patient financial burden after LT. Adult recipients of LT from 2006 to 2021 were identified using IQVIA PharMetrics® Plus for Academics-a large nationally representative claims database of commercially insured Americans. Patient financial liability (ie, what patients owe) was estimated using the difference between allowed and paid costs for adjudicated medical/pharmacy claims. Descriptive statistics were provided stratified by the financial liability group within 1 year after LT. Multivariable logistic regression modeling identified factors associated with high/extreme liability adjusting for covariates. Potential indirect costs of post-LT care were estimated based on hourly wages lost for care. Among 1412 recipients of LT, financial liability was heterogeneous-~3% had no liability and 21% had extreme liability > $10K for 1-year post-LT care; most (69%) paid between $1 and 10K, with 48% having liability >$5K. Factors associated with >$5K liability included older age, insurance/enrollment type, US region, history of HCC, and simultaneous liver-kidney transplant (for liability >$10K). Medication costs comprised ~30% of outpatient financial liability. Potential indirect costs from wages lost were $2,201-$6,073 per person, depending on an hourly wage. In a large national cohort of commercially insured recipients of LT, financial liability was highly variable across sociodemographic and clinical characteristics; nearly 1 out of 2 recipients of LT owed >$5K for 1 year of post-LT care. Transplant programs should help patients anticipate potential costs and identify vulnerable populations who would benefit from enhanced financial counseling.

Co-delivery of oxaliplatin prodrug liposomes with Bacillus Calmette-Guérin for chemo-immunotherapy of orthotopic bladder cancer

To reduce recurrence rate after transurethral resection of bladder tumor, long-term intravesical instillations of Bacillus Calmette-Guérin (BCG) and/or chemotherapeutic drugs is the standard treatment for non-muscle invasive bladder carcinoma. However, the main challenges of intravesical therapy, such as short retention time and poor permeability of drugs in the bladder, often require frequent and high-dose administrations, leading to significant adverse effects and financial burden for patients. Aiming at addressing these challenges, we developed a novel approach, in which the cell-penetrating peptide modified oxaliplatin prodrug liposomes and a low-dose BCG were co-delivered via a viscous chitosan solution (LRO-BCG/CS). LRO-BCG/CS addressed these challenges by significantly improving the retention capability and permeability of chemotherapy agents across the bladder wall. Then, oxaliplatin triggered the immunogenic cell death, and the combination of BCG simultaneously further activated the systemic anti-tumor immune response in the MB49 orthotopic bladder tumor model. As a result, LRO-BCG/CS demonstrated superior anti-tumor efficacy and prolonged the survival time of tumor-bearing mice significantly, even at relatively low doses of oxaliplatin and BCG. Importantly, this combinational chemo-immunotherapy showed negligible side effects, offering a promising and well-tolerated therapeutic strategy for bladder cancer patients.

The GLAMM1 Study - Global Access to Myeloma Medications: Potential Barriers to Chimeric Antigen Receptors (CART) and T-Cell-Engaging Bispecific Antibodies (TCE) Globally

Introduction: Novel B cell maturation antigen (BCMA) directed therapies including chimeric antigen receptor- T (CART) such as idecabtagene vicleucel (ide-cel) and ciltacabtagene autoleucel (cilta-cel) have been approved since 2021. More recently in 2022, the first BCMA-directed T-cell-engager (TCE), teclistamab (tec), was also approved for the treatment of relapsed/ refractory multiple myeloma (RRMM). Unfortunately, limited access to these therapies worldwide appears to be a major challenge. This study aims to gain insight into the variation in access to these therapies, and barriers to access. Methods: This study was an electronic survey of 176 hematologists/oncologists in centers across the globe outside the USA who treat MM and was conducted in collaboration with US Myeloma Innovations Research Collaborative (USMIRC). The survey was distributed from June 18 th 2023, to July 15 th 2023. Sections included demographics of respondents, availability of drugs in the country, and barriers to access. The respondents categorized each medication as “easily accessible”, “moderately accessible,” “not readily accessible” or “no access”. To categorize a country/region as having “adequate access”, the cut-off was 60% of responders affirming easy/moderately easy access. We investigated whether higher healthcare spending in a country is associated with better drug accessibility. Health expenditure (HE) of a country's Gross domestic product (GDP) from the World Bank was utilized to categorize countries into two groups: “High healthcare investing nations” (HHIN), which included countries spending &amp;gt;10% of their GDP on healthcare, while “Low healthcare investing nations” (LHIN) included countries spending &amp;lt;10% on healthcare. An interim analysis is reported. Results: There were 95 (54%) completed responses from 33 countries. Most (51%) were university-based academic centers and only 17% were centers with a dedicated focus in plasma cell disorders. Only 17% reported adequate access to ide-cel and 16% to cilta-cel, while a limited, yet higher number of respondents had adequate access to tec (23%). Refer to Table 1 Access to CART (ide-cel and cilta-cel): Globally, only 3 of the 33 (9%) countries had access to ide-cel, cilta-cel or both (France, Morocco, Saudi-Arabia). All other countries had limited access. When grouped by continent, none of the continents had adequate access to CART. Both HHIN and LHIN countries had limited access to CART. Access to TCE (tec): Seven of the 33 (21%) countries had adequate access to tec (Switzerland, Netherlands, France, Portugal, Czech Republic, Morrocco, Saudi Arabia). All other countries had limited access. When grouped by continent, although Europe had the most access, none of the continents had adequate access to TEC. Both HHIN and LHIN countries had limited access to TCE, although relatively, TEC was more accessible compared to CART. Figure 1 summarizes access to CART and TCE Barriers to access: Other than Europe, the most common barrier for ide-cel, cilta-cel and tec was cited as financial burden for patients. Financial burden for patients as a top barrier for each of the products by continent was as follows: Asia (83%), South America (64%), Africa (71%) Australia (100%), and North America (100%). In Europe, for CART, financial burden remained a top barrier (50%) along with local agency approval (50% for ide-cel, 44% for cilta-cel). In Europe, the most cited barrier for TCE was the financial burden for patients (44%), while (33%) of oncologists reported no barrier to TCE. Reimbursement for CART and TCE in Europe requires phase 3 randomized controlled trial data, which is just emerging since 2022 for CART and relatively increased access may be due to the presence of compassionate use programs. Conclusion : The survey is the first attempt to highlight the significantly limited global access to novel therapies (ide-cel, cilta-cel, and tec) for the treatment of RRMM. All continents including HHIN had limited access to CART and TCE. Noticeably, CART is less accessible than TCE, even though approved earlier. The main barrier to both CART and TCE is reported as financial burden for patients. USMIRC in collaboration with oncologists worldwide, global agencies, governments, regulatory agencies, policymakers and industry partners, is planning to further explore restrictions to access to CART and TCE and strategies to overcome these barriers.

Outcomes of prophylactic lauromacrogol injection versus non-injection in patients with endogenous cesarean scar pregnancy treated by hysteroscopic surgery: a retrospective cohort study

BackgroundThis study aimed to investigate the efficacy of hysteroscopic surgery for endogenous cesarean scar pregnancy (CSP) and the value of prophylactic ultrasound-guided local injection of lauromacrogol.MethodsThis retrospective study included 131 patients diagnosed with endogenous CSP who underwent hysteroscopic surgery at the Hangzhou Fuyang Women and Children Hospital between January 2018 and May 2022. Lauromacrogol (10–20 mL) was administered within 24 h preoperatively using an ultrasound-guided vaginal injection to 78 patients (L group) versus not administered to 53 patients (non-L group). Their clinical data and outcomes were analyzed.ResultsMean gestational age, gestational mass size, and uterine scar thickness and median preoperative blood β-human chorionic gonadotropin levels of the non-L versus L groups were 46.26 versus 45.01 days, 2.05 versus 2.39 cm, 0.35 versus 0.32 cm, and 19850.0 versus 26790.0 U/L, respectively (P > 0.05 for each). The non-L and L groups had similar success rates (98.1% vs. 98.7%, P = 1.0). Complications related to lauromacrogol administration, including abdominal pain, massive bleeding, and bradycardia, were experienced by 46.2% (36/78; P < 0.001) of L group patients. The non-L had a significantly shorter mean hospital stay (4.85 ± 1.12 vs 5.44 ± 1.08 days) and lower total cost (6148.75 ± 1028.71 vs 9016.61 ± 1181.19) (P < 0.01).ConclusionsHysteroscopic surgery is effective and safe for patients with endogenous CSP. Prophylactic lauromacrogol injection increases the incidence of complications and costs. Direct hysteroscopic surgery can reduce pain and financial burden in patients with endogenous CSP and save medical resources for other patients.

Real-World Patterns of Care and Financial Burden of Patients with Follicular Lymphoma in the United States

Introduction: Follicular lymphoma (FL) is the most common indolent non-Hodgkin lymphoma and accounts for nearly a quarter of cases. As a heterogenous disease with an estimated 20% having progression of disease within 24 months of first FL therapy, FL often quickly becomes relapsed or refractory (R/R) to current therapy. The objective of this study was to evaluate the real-world treatment patterns, time to next treatment, and associated costs and healthcare resource utilization (HCRU) in patients with FL in the United States. Methods: A retrospective observational study was conducted using an integrated real-world database including linked data from the Symphony Integrated Dataverse (IDV ®), electronic medical records, specialty pharmacy, and in-office dispensing datasets. Patients were included in the study if they were ≥ 18 years old and initiated a first-line (1L), second-line (2L), third-line (3L), or fourth-line (4L) of therapy for FL between 1/1/2019 and 12/31/2022. Patients were categorized by line of therapy into non-mutually exclusive cohorts based on the date of initiation of their treatment regimen. Each line of therapy cohort was followed for a minimum of 90 days through lost to follow-up or end of the study period (3/31/2023). Patients were also required to have continuous pre-index enrollment of 365 days to record baseline comorbidities. Demographics, clinical characteristics, and treatment regimens were examined for each line of therapy cohort. Within each line of therapy, patients were categorized into 6 mutually exclusive subgroups based on their treatment regimens: bendamustine + rituximab (BR), rituximab monotherapy (R-mono), cyclophosphamide, doxorubicin, prednisone, rituximab + vincristine (R-CHOP), bendamustine + obinutuzumab (BO), lenalidomide + rituximab (R2), and other treatments for all other regimens. Advancement to the next line of therapy, treatment regimen distribution, and switching for each cohort and subgroup were evaluated during the follow-up period. Treatment duration, time to next treatment (TTNT), HCRU and pharmacy costs were measured for each cohort and treatment regimen during the follow-up period. HCRU included outpatient visits and hospital claims, reported as per patient per month (PPPM) over the time on each treatment regimen. Results: The study population included 9,579 patients initiating 1L, and then 3,061, 952 and 263 patients who received 2L, 3L, and 4L, respectively. The median follow-up was 719 days (1L), 652 days (2L), 578 days (3L), and 468 (4L). Mean age at index was similar across treatment lines, ranging from 66.7 years (1L) to 67.9 years (4L). Males represented a little under half (47.3%) in 1L cohort but increased slightly with subsequent lines (49.3%, 2L; 54.9%, 3L; 70% 4L). The most common baseline comorbidities across treatment lines were hypertension (1L=35.2%; 2L=32.3%; 3L=29.8%; and 4L=28.1%) and gastrointestinal disease (1L=23.9%; 2L=22.2%; 3L=22.2%; and 4L=22.1%). Across all treatment lines, R-mono was the most common regimen (1L=34.1%; 2L=29.0%; 3L=23.8%; and 4L=18.6%) followed by BR (1L=32.8%; 2L=17.3%; 3L=12.0%; and 4L=11.4%), and R-CHOP (1L=14.5%; 2L=12.8%; 3L=10.1%; and 4L=9.5%). Median TTNT across all regimens was 417 days (159, 691) in 1L, 444.5 days (225, 661) in 2L, 414 days (174, 784) in 3L, and 382.5 days (200.5, 599.5) in 4L (Figure 1). Mean (standard deviation; SD) of all-cause outpatient visits PPPM were 5.99 (4.86) in 1L, 6.06 (5.42) in 2L, 6.27 (6.04) in 3L, and 6.25 (5.95) in 4L. Mean (SD) of FL-specific outpatient visits PPPM were 4.59 (4.00) in 1L, 4.49 (4.31) in 2L, 4.57 (4.93) in 3L, and 4.42 (4.65) in 4L. The mean all-cause hospitalizations PPPM were 0.35 (1.72) in 1L, 0.79 (3.36) in 2L, 1.94 (6.29) in 3L, and 1.85 (5.00) in 4L. The mean FL-related hospitalizations PPPM were 0.13 (0.76) in 1L, 0.18 (1.02) in 2L, 0.36 (1.56) in 3L, and 0.45 (2.12) in 4L (Figure 2). Average pharmacy costs PPPM increased from $1,033 ($3,963.8) in 1L to $2,166.6 ($6,001.1) in 2L, and $2,943.7 ($6,413.1) to $3,374.1 ($7,361.3) in 3L and 4L, respectively. Conclusions: Real-world treatment patterns for patients with FL were shown to be mostly consistent with clinical guidelines. This study highlighted that TTNT decreased while hospitalizations and pharmacy costs increased as line of therapy progressed, suggesting high financial burden and unmet need for better treatment options for R/R FL patients.

Geographic accessibility to palliative care clinicians for patients with newly diagnosed stage 4 cancer in the United States.

84 Background: Early integration of palliative care is recommended for patients with newly diagnosed advanced cancer. However, many patients with cancer only receive this essential care during hospitalization or at the end of life, likely resulting in poor symptom management and increased morbidity, suffering, and financial burden for patients and families. This study aimed to examine disparities in geographical access to palliative care in the US. Methods: The study utilized data from the 2018-2019 National Cancer Database (NCDB) and CMS Medicare Physician and Other Practitioners dataset. Included patients were newly diagnosed with stage 4 cancer with geographic information for patients’ residential and their treating facilities’ zip codes. We geocoded the addresses of practices where physicians provided palliative care services 2018 -2019. The OpenStreetMap and Open Source Routing Machine (OSRM) model was employed to estimate the travel distance between patients' residences and the nearest palliative care clinician, as well as between their treating facilities and the nearest palliative care clinicians. Results: 335,191 stage 4 cancer patients and 1,063 clinicians who specialize in palliative care were included in the analysis. The most common cancer diagnoses were lung (28.8%), colorectal (10.2%), pancreatic (7.8%), and breast (4.9%) cancers. Distance to the nearest palliative care clinician was more than 12.5 miles for 63.4% of patients and 45.4% of treating facilities, and more than 50 miles for 24.1% of patients and 19.1% of treating facilities (Table). Patients who lived ≥50 miles away from the nearest palliative care clinic tended to be White, have a lower household income, and live in rural areas. Facilities located ≥50 miles away from the nearest palliative care clinics tended to be in rural areas and community or comprehensive community facilities. (all p&lt;0.0001). Conclusions: 63.4% and 24.1% patients with newly diagnosed stage 4 cancers lived at least 12.5 miles and 50 miles from their nearest palliative care clinicians. Geographic disparities in palliative care availability underscore the need for policy and practice interventions aimed at improving equitable access to palliative care for patients with advanced cancer.[Table: see text]

Financial burden of coronary artery bypass grafting in India: implications for catastrophic health expenditure and healthcare access.

Cardiovascular diseases (CVD) have become a leading cause of mortality in India. High costs of coronary artery bypass grafting (CABG) impose a financial burden in patients often resulting in catastrophic health expenditure (CHE). CHE and distressed financing have significant microeconomic and macroeconomic implications. CHE depletes savings, forces asset disposal, and perpetuates poverty. At a macroeconomic level, the burden of CVD impacts gross domestic product, economic productivity, healthcare budgets, and social welfare. Addressing these challenges requires a multifaceted approach. Prioritizing accessible and affordable healthcare systems with robust financial risk protection is essential. Widespread adoption of health insurance, including government-sponsored schemes, can provide financial protection. Expanding public healthcare infrastructure, implementing price regulations, promoting generic medicines, and encouraging preventive measures for coronary artery disease (CAD) are crucial steps to reduce the burden of CABG costs and improve healthcare access.

Current Trends in Autologous Breast Reconstruction and the Implications of Impending Changes to Insurance Reimbursement.

Introduction In 2019, the Centers for Medicare & Medicaid Services (CMS) combined all autologous breast flap procedures under one billing code, effective from December 31, 2024. This change will result in equal insurance reimbursement rates for popular flap options, such as transverse rectus abdominis muscle (TRAM) and deep inferior epigastric perforator (DIEP) flaps, which were previously billed separately using S-codes based on complexity. Methods This study aimed to analyze insurance code changes for autologous breast reconstruction flap procedures. Data were collected from the American Society of Plastic Surgeons' annual plastic surgery statistics reports, including specific insurance codes and case volumes from 2007 to 2020. A comprehensive analysis was conducted to assess recent trends in flap utilization rates, documenting any modifications or additions to the existing codes and their implementation years. Results The study analyzed billing codes and case volumes for autologous breast reconstruction procedures, with a focus on the DIEP flap and other alternatives. Non-autologous breast reconstruction procedures showed consistently higher case volumes compared to autologous procedures from 2007 to 2020. Notably, the popularity of the DIEP flap surpassed that of other flap options after 2011. Conclusion The removal of S-codes for autologous breast reconstruction by CMS and the subsequent potential decrease in insurance coverage for the DIEP flap may lead to a decrease in its utilization and a shift towardmore invasive options, like the TRAM flap. This change could result in financial burdens for patients and widen socioeconomic disparities in breast reconstruction, limiting access to preferred reconstructive methods and impacting patient autonomy and overall well-being.

Analisis Peran Program Jaminan Kesehatan Nasional (JKN) dalam Mengurangi Beban Finansial Pasien: Studi Literature

Insurance or coverage is an agreement, whereby an insurer binds himself to the insured by receiving a premium, to provide compensation to him because of a loss, damage or loss of profits that may be suffered due to an uncertain event (Book of Commercial Laws) Criminal Code) of the Republic of Indonesia Article 246). The interesting things to analyze are first, the form of worker protection in the National Health Insurance (JKN) program and second, the problems in its application. The model used in this work is a literature review, in which information that is suitable for the problem being investigated is sought from various references and sources. Following is the selection of scientific articles: The selection of scientific articles is done by searching the PubMed, ScienceDirect and Google Scholar databases for relevant articles published in the 2019-2023 period. The selected articles must meet the established inclusion and exclusion criteria. Determination of Inclusion and Exclusion Criteria: The inclusion criteria used in this study include articles on "Analysis of the effectiveness of health insurance in reducing the patient's financial burden" and studies conducted at the provincial or national level. Exclusion criteria were articles that did not meet the inclusion criteria, articles that were not related to the research topic, and articles published before 2019.&#x0D; Keywords: Insurance, JKN, Patient Finances