Healthcare Budget Research Articles

Empowering trainees through understanding learning theory and changes in medical education.

Background: Empowering trainees to think critically about decision making should result in the National Health Service (NHS) being more efficient and cost effective, thereby reducing the wastage of precious NHS resources on unnecessary investigations, treatment, and consequently putting patients at risk. There is a major shift from acquiring knowledge to critical analysis and synthesis of information for decision making. Trainees must understand how healthcare systems function and consequences of their decisions on budgets and patient care. Equally, faculty need to appreciate that their role is changing from information provider to facilitator of learning through feedback and supervision, role modelling, and innovator of learning approaches. Methods: A survey of 100 postgraduate trainees from the Severn Deanery was conducted on SurveyMonkey in March 2020 and January 2021. The survey consisted of eight questions focusing on trainee responses to participation in clinical decision-making in the inpatient setting. An additional question on communication with the patient was included in the second iteration. Results: With a response rate of 80, only 35% of trainees had their findings regularly verified by the consultant. One third of trainees reported that decisions were made by the consultant without asking their opinion on investigations or management. It was unusual for trainees to have any interaction with patients on consultant ward rounds and to understand the rationale for the requested investigations. Conclusion: The poor consultant trainee interaction represents a serious lost opportunity for experiential learning with real time feedback. Training programmes should support trainees being given opportunities to nurture analytical, problem-solving skills, dealing with uncertainty among other attributes of patient management. Trainees need to become competent through the art of critical thinking and develop a professional identity. Through this they develop confidence and competence leading to better patient outcomes, and prevention of the depletion of healthcare budgets.

New Diabetes Guidelines: Impact on Eligibility for Sodium-Glucose Cotransporter-2 Inhibitors and Glucagon-like Peptide-1 Receptor Agonists in Canada

ObjectivesRecent diabetes guidelines call for prescribing sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) for end-organ indications (cardiovascular disease [CVD], heart failure and chronic kidney disease) and for primary prevention of CVD in adults with multiple risk factors. Our aim was to assess the effect of new guidelines on the prevalence of SGLT2i/GLP-1RA–eligible adults, and their current rates of SGLT2i/GLP-1RA use. MethodsA cross-sectional study was conducted of Canadian adults (age ≥18 years) with diabetes on June 30, 2020, using electronic medical record data from primary care practices in 5 provinces (Alberta, Manitoba, Newfoundland, Ontario and Québec). Indications were determined from comorbidities, lab values and cardiovascular risk factors. ResultsEnd-organ indications were present in 34.1% of adults for SGLT2i and in 17.1% for GLP-1RA (CVD only). Rates of SGLT2i and GLP-1RA use were only 14.0% and 4.3%, respectively, in those with end-organ indications. The majority of these individuals had glycated hemoglobin ≤7.0%. The combination of end-organ and primary prevention indications increased eligibility for SGLT2i to 62.6%, and for GLP-1RA to 59.1%. ConclusionsThe implications of this sizeable reclassification of adults as SGLT2i/GLP-1RA indicated on health-care budgets and cost-effectiveness requires further study. In the meantime, targeted efforts are necessary to improve SGLT2i/GLP-1RA use in those with end-organ indications that have robust evidence of cardiovascular and kidney benefit from newer agents.

Would universal general practitioner care impact Irish adolescents’ utilisation?

IntroductionHealth systems’ characteristics influence individuals’ health care utilisation. Unlike their European neighbours the majority of Irish citizens pay for General Practitioner (GP) care. The current strategy for health care reform proposes universal GP care (i.e. the removal of GP care fees), to be introduced on a phased basis, prioritising under 18s. MethodsEmploying data from the Growing Up in Ireland survey, and controlling for health care need, and other predisposing and enabling factors, propensity score matching is used to estimate the effect of GP cover (free GP care at point of use) on GP utilisation over a 12-month period amongst 16/17 year olds (n= 4308). ResultsResults indicate having GP cover increases the average number of GP consultations by 38% per annum. When the sample is restricted to individuals without chronic conditions, a 42% increase in annual number of GP consultations is found. It is reasonable to expect that extending free GP care via a universal care model would be associated with a higher propensity to utilise GP services amongst 16/17 year olds. ConclusionsThis has economic implications for health care budgets and workforce planning. While most adolescents are healthy, investment in their health provides current and future health benefits; however a universal system will require investment, necessitating displacement of resources elsewhere, to meet demand.

Pharmacoeconomic analysis of the application of follitropin alfa in combination with assisted reproductive technologies

Objective: to evaluate clinical-economic feasibility and impact of follitropin alfa on the state healthcare budget of the Russian Federation in the population of women with diagnosed infertility and poor ovarian response, who undergo treatment with assisted reproductive technologies (ART).Material and methods. A cost minimization analysis to evaluate clinical-economic feasibility of follitropin alfa in women with infertility and poor ovarian response who underwent ART was performed. The model of the budget impact analysis included the costs required for the ovarian stimulation of patients distributed by various variants of their management. The current practice involved the application only of fixed dose combinations (FDC) of follitropin alfa + lutropin alfa. The expected practice suggested a change in the approach by shifting 25% of patients with poor ovarian response from FDC of follitropin alfa + lutropin alfa to follitropin alfa. A time horizon of modeling was 1 year.Results. The cost minimization analysis demonstrated that the application of drug with international nonproprietary name follitropin alfa is characterized by the cost cut of 12,020 rubles (–21.56%) per patient compared with FDС of follitropin alpha + lutropin alpha. The results of budget impact analysis showed that a shift of 25% of population from FDC of follitropin alfa + lutropin alfa to follitropin alfa could cut direct medical costs by 7.96 million rubles per year (–5.39%).Conclusion. Evaluation of clinical-economic feasibility and budget impact analysis showed that the application of follitropin alfa during ovarian stimulation in women with infertility and poor ovarian response leads to a decrease in budget expenses.

Costs of oxygen therapy for interstitial lung disease and chronic obstructive pulmonary disease: A retrospective study from a universal healthcare system

RATIONALE & OBJECTIVES: Oxygen is prescribed for patients with interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD). This study compared the per capita financial costs of home oxygen therapy in ILD and COPD. METHODS Adults with either ILD or COPD who initiated home oxygen between 2010-2017 at the Vancouver Coastal Health Home Oxygen Program were analyzed retrospectively using a chart review. The monthly cost of oxygen equipment, home visits by oxygen providers and respiratory therapists, as well as overnight oximetry studies, were collected for each year of oxygen utilization, adjusted to 2018 Canadian Dollars. The Wilcoxon Rank Sum Test was used to compare monthly oxygen costs and flow rates between the two diseases. MEASUREMENTS AND RESULTS: A total of 99 patients with ILD and 1017 with COPD initiated oxygen therapy between 2010-2017. Both cohorts had a higher per capita cost of home oxygen in month 1 compared to months 2-24 (ILD: ($202.57 ± $88.88 versus $142.21 ± $59.01, P < 0.001; COPD: $222.85 ± $102.52 versus $156.65 ± $60.50, P < 0.001). COPD was more costly after the initial month, corresponding to greater frequency of using continuous long-term oxygen compared to oxygen only with ambulation. Patients with ILD had higher mean ambulatory oxygen flow rate for all months (P < 0.001). CONCLUSION Per capita costs of home oxygen therapy were comparable between ILD and COPD, with the main difference in costs related to the use of ambulatory versus continuous long-term oxygen. These findings will aid healthcare budget planning for both ILD and COPD.

Lock to Unlock

The COVID-19 pandemic forced for first lockdown in India in March 2020. Resurgence of COVID-19 cases has forced many states in India to reintroduce the movement restrictions in March 2021. With four times increase in number of cases, many hospitals are swamped with patients, shortage of doctors and healthcare workers, shortage of personal protective equipment (PPEs), medications, and oxygen. The second wave led to out of pocket expenditures, hike in health care budget, burnouts among the health care workers (HCWs), migration, and hampered education system. The crisis was due to insufficient oxygen and beds, repeated changes in the treatment protocol and testing strategies, violence against HCWs and front line workers (FLWs), vaccination hesitancy to vaccination shortage, and increased morbidity to mortality. The quarantine and isolation of HCWs and FLWs become difficult due to the insufficient workforce. This formed as an opportunity leading to public–private partnership for patient care and successful vaccination. The pandemic brought the concept of advanced technologies and inventions such as use of Robotics, Apps such as Arogyasetu and CoWin, Ventilators, and O2 plants (O2 concentrator), and self-testing kits (COVISELF). Apart from the COVID appropriate behaviors, mass vaccination and newly approved treatments, the policymakers can stabilize the country with helping hand from industries, development of workforce, adequate production, and supply of medicines-vaccine and PPEs to rejuvenate the healthcare industry at the earliest.

Cross fertilisation of Public Health and Translational Research.

Public health is defined as the science of protecting the safety and improving the health of communities through education, policy-making and research for the prevention of disease (Gatseva and Argirova in J Public Health 19(3):205–6, 2011, 10.1007/s10389-011-0412-8; Winslow in Mod Med 2(1306):183–91, 1920. 10.1126/science.51.1306.23; What is public health. Centers for Disease Control Foundation. Centers for Disease Control, Atlanta, https://www.cdcfoundation.org/what-public-health; What is the WHO definition of health? from the Preamble to the Constitution of WHO as adopted by the International Health Conference, New York, On 7 April 1948. The definition has not been amended since. 22 July 1946; signed by the representatives of 61 States (Official Records of WHO, no. 2, p. 100) and entered into force, 19 June;1948. https://web.archive.org/web/20190307113324/https:/www.who.int/about/who-we-are/frequently-asked-questions). Translational research in healthcare is not only useful and satisfying for the researchers to bring their work to market but it would also support public health by bringing affordable, attainable and scalable solutions to the community at large. This is of high significance because instead of increasing the GDP spent in public health, we should focus on the increasing the translational research spending, as this would lead to improved solutions. Hence, the public health offering would reach a larger community at an improved cost. The COVID-19 pandemic and the huge number of lives it claimed exposes challenges in the public health. The pandemic has caused economic and social disruption to millions of people around the world, with many falling into extreme poverty. In early 2021, it was estimated nearly 690 million people are undernourished and by end of 2021 to increase further by 132 million (Joint statement by ILO, FAO, IFAD and WHO. Impact of COVID-19 on people's livelihoods, their health and our food systems https://www.who.int/news/item/13-10-2020-impact-of-covid-19-on-people's-livelihoods-their-health-and-our-food-systems). The spending for public health has increased many folds during the pandemic and this is where translational research in healthcare can play a transformative role to reduce the burden on government healthcare budget (Covid-19 and its impact on Indian society. https://timesofindia.indiatimes.com/readersblog/covid-19-and-its-impact-on-india/covid-19-and-its-impact-on-indian-society-27565/). Over the past decade, public health research has started playing a major role in Indian academic settings. COVID-19 pandemic has further highlighted the role of public health. However, the potential of using technological advancement has not been fully utilised. This is where translational research and public health can play a role to tap the full potential of technology. This review paper explores the public health practices to understand the different practices to examine how both public health and translational research can cross-fertilise. It concludes with a short discussion on implications on policymakers.

Development of a decision analytical framework to prioritise operating room capacity: lessons learnt from an empirical example on delayed elective surgeries during the COVID-19 pandemic in a hospital in the Netherlands

ObjectiveTo develop a prioritisation framework to support priority setting for elective surgeries after COVID-19 based on the impact on patient well-being and cost.DesignWe developed decision analytical models to estimate the...

Ritonavir-Boosted Exposure of Kinase Inhibitors: an Open Label, Cross-over Pharmacokinetic Proof-of-Concept Trial with Erlotinib.

BackgroundAlthough kinase inhibitors (KIs) are generally effective, their use has a large impact on the current health care budget. Dosing strategies to reduce treatment costs are warranted. Boosting pharmacokinetic exposure of KIs metabolized by cytochrome P450 (CYP)3A4 with ritonavir might result in lower doses needed and subsequently reduces treatment costs. This study is a proof-of-concept study to evaluate if the dose of erlotinib can be reduced by co-administration with ritonavir.MethodsIn this open-label, cross-over study, we compared the pharmacokinetics of monotherapy erlotinib 150 mg once daily (QD) (control arm) with erlotinib 75 mg QD plus ritonavir 200 mg QD (intervention arm). Complete pharmacokinetic profiles at steady-state were taken up to 24 h after erlotinib intake for both dosing strategies.ResultsNine patients were evaluable in this study. For the control arm, the systemic exposure over 24 h, maximum plasma concentration and minimal plasma concentration of erlotinib were 29.3 μg*h/mL (coefficient of variation (CV):58%), 1.84 μg/mL (CV:60%) and 1.00 μg/mL (CV:62%), respectively, compared with 28.9 μg*h/mL (CV:116%, p = 0.545), 1.68 μg/mL (CV:68%, p = 0.500) and 1.06 μg/mL (CV:165%, p = 0.150) for the intervention arm. Exposure to the metabolites of erlotinib (OSI-413 and OSI-420) was statistically significant lower following erlotinib plus ritonavir dosing. Similar results regarding safety in both dosing strategies were observed, no grade 3 or higher adverse event was reported.ConclusionsPharmacokinetic exposure at a dose of 75 mg erlotinib when combined with the strong CYP3A4 inhibitor ritonavir is similar to 150 mg erlotinib. Ritonavir-boosting is a promising strategy to reduce erlotinib treatment costs and provides a rationale for other expensive therapies metabolized by CYP3A4.

Awareness of fetal movements and care package to reduce fetal mortality (AFFIRM): a trial-based and model-based cost-effectiveness analysis from a stepped wedge, cluster-randomised trial

BackgroundThe AFFIRM intervention aimed to reduce stillbirth and neonatal deaths by increasing awareness of reduced fetal movements (RFM) and implementing a care pathway when women present with RFM. Although there is uncertainty regarding the clinical effectiveness of the intervention, the aim of this analysis was to evaluate the cost-effectiveness.MethodsA stepped-wedge, cluster-randomised trial was conducted in thirty-three hospitals in the United Kingdom (UK) and Ireland. All women giving birth at the study sites during the analysis period were included in the study. The costs associated with implementing the intervention were estimated from audits of RFM attendances and electronic healthcare records. Trial data were used to estimate a cost per stillbirth prevented was for AFFIRM versus standard care. A decision analytic model was used to estimate the costs and number of perinatal deaths (stillbirths + early neonatal deaths) prevented if AFFIRM were rolled out across Great Britain for one year. Key assumptions were explored in sensitivity analyses.ResultsDirect costs to implement AFFIRM were an estimated £95,126 per 1,000 births. Compared to standard care, the cost per stillbirth prevented was estimated to be between £86,478 and being dominated (higher costs, no benefit). The estimated healthcare budget impact of implementing AFFIRM across Great Britain was a cost increase of £61,851,400/year.ConclusionsPerinatal deaths are relatively rare events in the UK which can increase uncertainty in economic evaluations. This evaluation estimated a plausible range of costs to prevent baby deaths which can inform policy decisions in maternity services.Trial registrationThe trial was registered with www.ClinicalTrials.gov, number NCT01777022.

"Biosimilar, so it looks alike, but what does it mean?" A qualitative study of Danish patients' perceptions of biosimilars.

Biosimilars are highly similar follow‐on products for biologics that can foster biologics competition. Questionnaire studies have attempted to gauge the patient perspective on biosimilars, but none have delved deeper into how patients view biologics and switching of these. Considering Denmark has one of the highest biosimilar uptakes worldwide, the aim of this study was to investigate how Danish patients with psoriasis, arthritic diseases or inflammatory bowel disease perceive biosimilars. Twelve participants were semi‐structurally interviewed in either a focus group or an internet‐based, individual interview between May 2019 and July 2019. Content analysis was inductively applied. Participants on originators voiced more reluctance towards using biosimilars than those already using them. Both participants using originator and biosimilar products expressed concerns about reoccurrence of disease symptoms due to differences in effectiveness and safety. Participants generally struggled with understanding biosimilarity, and they voiced a need to be well‐informed about switching. They were all aware of and accepted how healthcare budget restrictions played a role in the push to use biosimilars. To improve biosimilar uptake and willingness to switch to a biosimilar, patient‐centred information on efficacy and safety and explanation of the societal benefits of the savings from using biosimilars must be carefully communicated.

Medical costs of children admitted to the neonatal intensive care unit: The role and possible economic impact of WES in early diagnosis

It has been estimated that at least 6.0% of neonates admitted to the Neonatal Intensive Care Unit remains genetically undiagnosed because genetic testing is not routinely performed. The objective of this study is to provide an overview of average healthcare costs for patients admitted to the Neonatal Intensive Care Unit and to assess possible impact of implementing Whole Exome Sequencing (WES) on these total healthcare costs. Hereto, we retrospectively collected postnatal healthcare data of all patients admitted to the level IV Neonatal Intensive Care Unit at the Radboudumc (October 2013–October 2015) and linked unit costs to these healthcare consumptions. Average healthcare costs were calculated and a distinction between patients was made based on performance of genetic tests and the presence of congenital anomalies. Overall, on average €26,627 was spent per patient. Genetic costs accounted for 2.3% of all costs. Healthcare costs were higher for patients with congenital anomalies compared to patients without congenital anomalies. Patients with genetic diagnostics were also more expensive than patients without genetic diagnostics. We next modelled four scenarios based on clinical preselection. First, when performing trio-WES for all patients instead of current diagnostics, overall healthcare costs will increase with 22.2%. Second, performing trio-WES only for patients with multiple congenital anomalies will not result in any cost changes, but this would leave patients with an isolated congenital anomalies untested. We therefore next modelled a scenario performing trio-WES for all patients with congenital anomalies, increasing the average per patient healthcare costs by 5.3%. This will rise to a maximum of 5.5% when also modelling for an extra genetic test for clinically selected patients to establish genetic diagnoses that are undetectable by WES. In conclusion, genetic diagnostic testing accounted for a small fraction of total costs. Implementation of trio-WES as first-tier test for all patients with congenital anomalies will lead to a limited increase in overall healthcare budget, but will facilitate personalized treatments options guided by the diagnoses made.

‘Cost-effectiveness of the three EMA-approved adjuvant systemic therapies in patients with high-risk melanoma: a model-based economic evaluation’

Background: The introduction of adjuvant systemic treatment has significantly improved recurrence-free survival (RFS) in patients with resectable high risk melanoma. This new indication of immune checkpoint inhibitors and targeted therapy has considerably impacted healthcare budget. To inform policy makers and treating physicians about the value of these treatments, a cost-effectiveness analysis (CEA) of the adjuvant treatment options approved by the European Medicines Agency (EMA) for patients with resected stage III melanoma was conducted.

Co-payments and equity in care: enhancing hospitalisation policy for Palestine refugees in Lebanon

BackgroundThis paper measures the impact of introducing a 10% co-payment on secondary care hospitalization costs for Palestine refugees living in Lebanon (PRL) in all UNRWA contracted hospitals, except for the Red Crescent Society. This ex-post analysis provides a detailed insight on the direction and magnitude of the policy impact in terms of demand by hospital type, average length of stay and treatment costs.MethodsWith a complete population episode level dataset, we use multinomial logit, negative binomial, and linear models to estimate impacts on the different dependent variables, controlling for disease, patient and hospital characteristics.ResultsAfter the implementation patients were at least 4 pp (p <0.01) more likely to choose a Red Crescent Society hospital for secondary care, instead of one with co-payment. Average length of stay was not affected in general, despite the increase in control at all UNRWA contracted hospitals. Except for the decrease in UNRWA contribution, did not find a statistically significant impact of the co-payment on costs, nor for the provider or for the patient. Findings suggest that introducing a 10% co-payment for secondary hospital care had an impact on patients’ health care budget, leading to demand shifts towards cheaper options - i.e., patients had to chose care based on financial constraints rather than on their treatment preferences.ConclusionBefore changing healthcare payment schemes in different types of hospitals, facilities offering free of charge treatment should be assessed and prepared for potential demand shifts to avoid overcapacity and the collapse of health care services for such a fragile population. In addition, exemptions from co-payments should be considered for patients with severe health conditions and financial constraints, who, according to our results, are the most likely to change their pattern of care due to an increase in treatment costs.

Factors Contributing For Breast Cancer In Pakistan

Breast cancer is the most common malignancy among women around the Globe. Asian countries have highest ratio of breast cancer. About 60 % cases from Asian countries due to lack of health care facilities and awareness about breast cancer in general population. Classification based on age, stage of disease, location of development and family history. Breast cell tumor due to gene mutation prognosis the disease into malignancies. Symptoms may appear in early stage or late stages of disease.Material and method:The literature review was conducted through different sources such as Google scholars, PubMed, MEDLINE and data base. The key words was used breast cancer incidence in Pakistan, prevalence of breast cancer, causes of breast cancer in Pakistan. Only those studies was selected published during the period of 2010 to 2020 and published in English.Results:From this literature review, following factors has been identified, effecting on breast cancer development. Lack of knowledge about breast cancer development. Lack of health care facilities in rural areas, family history and economic problems.Conclusion:Pakistani women are unaware of breast cancer knowledge. Low health care budget, early identification of disease, family history of breast cancer are major contributing factors of breast cancer.

Dijabetesna nefropatija - klinička slika, tok i savremene mogućnosti lečenja

Diabetic kidney disease (DBD) is one of the major complications of diabetes (DM) and the leading cause of chronic kidney disease (CKD) worldwide. About 10% of patients with DBD progress to terminal HBB, and the rest die mostly due to cardiovascular disorders and infection even before they need treatment for kidney replacement. The main strategies to prevent the development and alleviate the progression of DBB in recent decades have been intensive glycemic con trol and blockade of the renin-angiotensin-aldosterone system. However, this approach did not achieve optimal results. Taking into account the increase in patients with DBB, high spending from the health care budget and the development of new therapeutic possibilities with significant kidney protection, the International Society of Nephrology issued in 2020. (Kidney Disease: Improving Global Outcomes (KDIGO) Guideline) is the first guide to treating patients with DBB. This review paper aims to point out phenotypic variability and present recent advances in the treatment of DBB.

Duplex ultrasound derived maximal systolic acceleration can be a reliable and rapid alternative to ankle brachial pressure indices for the diabetic population with lower extremity arterial disease; a prospective, observational cohort study.

Objectives: Ankle brachial pressure index (ABPI) is limited for diabetic patients. This can have costly impacts upon patient's quality of life along with healthcare budgets, with diabetic care equating to approximately 10% of NHS expenditure.11 We aimed to determine whether ultrasound waveform parameters are an alternative for quantifying lower extremity peripheral arterial disease (PAD) where ABPI is unreliable. Design: This was a prospective, observational study. Waveform parameters, systolic rise time (SRT), maximal systolic acceleration (AccMax) and peak systolic velocity (PSV) were recorded at ankle and compared to the ABPI and an aorta-ankle duplex ultrasound scan (DUS) as gold standard. Setting: Measurements were obtained by a Clinical Vascular Scientist at the Royal Free Hospital. Participants: Participants (≥18yrs) with known PAD, but without previous vascular intervention were allocated to non-diabetic control (n = 24) and diabetic test groups (n = 22). Outcome measures: The primary outcome measure was the correlation of novel ultrasound derived indices to PAD severity. The secondary outcome was the efficacy of this correlation in the diabetic population. Results: AccMax was most powerful in detecting PAD in both groups when compared to ABPI in the controls (r = 0.805; p < 0.01) and to DUS in control and test groups (r = −0.633 to −0.643; p < 0.01). In the test group, PSV did not consistently quantify PAD. SRT measurements were inconclusive throughout. Conclusion: AccMax is a rapid alternative tool for diagnosing PAD in diabetic patients. With further research, this simple test may prove useful for monitoring PAD progression in patients unsuitable for ABPI, reducing the need for lengthy repeat duplex scans.

FINANCING OF SPORTS AND HEALTH ACTIVITIES AT MACRO AND MESO LEVELS

Introduction. Russia's war against Ukraine has affected the economic and political life of recent times, which is well considered in the financial sphere of sports and security services. This influence affects all elements of the socio-economic mechanism of the industry: types and kinds of subjects of sports and health activities, sources of funding, economic conditions, features of public policy in this area and more. Increased spending on economic activity, security, the judiciary and defense has led to a significant reduction in spending on spiritual and physical development. The purpose of the article is to analyze the financing of sports and health activities in the macro and meso levels. Method (methodology). The study uses general scientific methods, in particular: comparison - to compare the averages of the best government spending in Ukraine and the Organization for Economic Cooperation and Development; statistical analysis - analysis of the financing of sports and health activities in Ukraine. Results. The analysis of the results of the comparison of the average indicators of the best public expenditures in Ukraine and the countries of the Organization for Economic Cooperation and Development shows significant deviations in the field of health care. analyzed that Ukraine has significantly less money (almost 5% less as a percentage of the State budget) for health care than the country of the Organization for Economic Cooperation and Development. The analysis showed that in 2021, in connection with the year 2020, the largest expenditures of the State Budget for the preparation and participation of national teams in the Paralympic and Deaflympic Games (+ 4546.5%), the costs of preparation and participation of national teams in international competitions games, games, etc.) increased by 542.4%, expenditures on the development of sports among people with disabilities, their physical rehabilitation increased by 169.9%, state support of the sports association "Dynamo" increased by 147.6% . It is emphasized that the expressed tendencies of increasing the amount of budget funding for the development of sports and physical culture in Ukraine will allow to achieve the previously set ambitious goals for the Olympic Games in 2030-2032 in Ukraine.

POSA271 A Comparative Analysis of Pricing and Reimbursement of Cystic Fibrosis Medicines in Europe

Cystic fibrosis conductance regulator (CFTR) gene modulators, ivacaftor, lumacaftor/ivacaftor and tezacaftor/ivacaftor, have substantially improved patients’ lives yet significantly burden healthcare budgets. This analysis aims to compare pricing and reimbursement of aforementioned cystic fibrosis medicines, developed by Vertex Pharmaceuticals, Inc., across European countries. Clinical trial registries, national databases, health technology assessment reports and grey literature of Belgium, the Netherlands, Ireland, the United Kingdom, France, Germany, Denmark, Sweden, Switzerland, Austria, Spain and Poland were consulted. Publicly available efficacy results, prices, reimbursement statuses, economic evaluations, budget impacts and managed entry agreements of CFTR modulators were reported. All interventions improved lung clearance and expiratory volume. Lowest prices were captured in Switzerland at €426 per DDD, €307 per DDD and €186 per ADD for Kalydeco®, Orkambi® and Symkevi®, respectively. Spain had the highest prices for Kalydeco® and Symkevi® at €851 per DDD and €337 per ADD, whereas Orkambi® was most expensive in Poland at €983 per DDD. In all countries, treatments were deemed not to be cost-effective. The annual budget impact of these CFTR gene modulators varied between countries and depended on factors such as local product prices, size of target population, scope of costs and discounting. However, all modulators were fully reimbursed in majority of countries except for France, Germany, Sweden and Poland that decided on partial or no reimbursement. Managed entry agreements were confidential but commonly adopted to address financial uncertainties. Discrepancies in reimbursement decisions and prices for Kalydeco®, Orkambi® and Symkevi® across European countries were detected. More transparency and increased country collaboration might stimulate uniform patient access to these cystic fibrosis medicines.

Importance of bitewing radiographs for the early detection of interproximal carious lesions and the impact on healthcare expenditure in Japan.

BackgroundGlobally, the direct cost of dental caries is approximately $298B yearly, consuming 5–10% of national healthcare budgets. Bitewing radiographs (BWR) are the standard method of diagnosing interproximal dental caries. In Japan, bitewing radiographs are rarely used. This retrospective observational study was conducted to measure the potential economic impact of carious lesions left undiagnosed and untreated due to this omission of bitewing radiographs.MethodsThe total number of existing carious lesions, the number of undiagnosed lesions, and costs of treating these lesions were calculated from the national database of Ministry of Health, Labor and Wellness in Japan between June 2013 and 2017. The number of affected teeth was estimated using prevalence data and undiagnosed lesions were estimated. The expense associated with treating progressed lesions was calculated using the standard Japanese fee structure. BWR trends were assessed, and analyses were performed to understand the differences between states and populations over time.ResultsThe average number of BWR taken monthly per office was 48.3±1.1 (average ± SD). It was calculated that an average of 6,429,155 lesions went undiagnosed per month, 93.5 teeth per practice, and 1.6 teeth per patient. The cost of treating lesions that went undiagnosed and then progressed into more invasive restorations was estimated to be between $57M–$218M more (difference between NaF varnish and class II restorations), and $150M–$443M more (difference between Class II restoration and crown or crown with RCT).ConclusionsBWRs are crucial in diagnosing a significant number of carious lesions. There is considerable impact on health and cost to the national health system due to undiagnosed lesions. Practitioners need to be educated on reading and understanding BWR, and policy should be changed to cover BWR.