Health-related Expenses Research Articles

Asymmetric Effect of Income on the Healthcare Expenditure in Türkiye

This paper examines the dynamics between income and health spending in Türkiye from 1988 to 2020, employing autoregressive distributed lag (ARDL) and nonlinear ARDL (NARDL) methodologies. One of the key findings of this study is the presence of an asymmetric relationship between variations in income and overall healthcare expenditure. This means that changes in income levels do not have uniform effects on health expenditure, and the direction of these effects depends on whether income is rising or falling. Interestingly, the research reveals that both increases and decreases in income lead to a rise in total health expenditure. However, the impact of income declines on health expenditure is more pronounced. In other words, when people experience a decrease in income, they tend to allocate a larger portion of their reduced resources to health-related expenses. This highlights the significant financial strain that income reductions can place on individuals and households when it comes to healthcare costs. This pattern of asymmetric effects also extends to government or compulsory health expenditures. When income falls, the government's role in funding health expenses becomes more prominent, as individuals rely more on public healthcare services during economic downturns. Furthermore, the study sheds light on the intriguing relationship between income shifts and voluntary or out-of-pocket health expenses. Positive income shifts are found to be associated with a reduction in voluntary health expenditure. This suggests that as people experience an improvement in their financial situation, they may opt for less costly or more efficient healthcare services, leading to a decrease in out-of-pocket expenses. Conversely, when income levels decrease, individuals may find themselves with limited options, potentially resorting to more expensive private healthcare services or bearing a greater burden of out-of-pocket expenses. This finding underscores the financial vulnerability that can accompany negative income shifts.

Empowering Communities : Reviving Traditional Medicine for Sustainable Health and Poverty Reduction

The objective of this study was to assess the knowledge and attitudes toward the utilization of traditional medicinal plants and their impact on health improvement and poverty alleviation among the residents of Barangay Mintal, Davao City. The primary goal was to provide essential baseline data to support the enhancement of Republic Act 8423 (PITAHC), which aimed to enhance the quality and delivery of healthcare services in the Philippines by developing traditional and alternative healthcare and integrating it into the national healthcare system. The study was conducted at Barangay Mintal, Davao City, with a population of 18,677 (City Population, 2020), the study focused on a community that, despite being highly urbanized and diverse in tribal representation, continued to rely on traditional herbal medicine for treating illnesses within their homes. The preference for herbal medicines stemmed from their accessibility, ease of preparation, cost-effectiveness, and perceived efficacy, in alignment with indigenous traditions. Utilizing in-depth interviews and documentation through qualitative analysis, the research sought to explore the community's knowledge and attitudes regarding herbal usage. The study aimed to determine whether such practices contributed to alleviating health-related expenses within families. Ten respondents, aged 18-60, were randomly selected for in-depth interviews, utilizing open-ended questions. The qualitative analysis brought to light the need for the revitalization of traditional herbal medicine practices within the barangay and health centers. Collaborative efforts with the Department of Health (DOH) were recommended, emphasizing the establishment of educational programs to raise community awareness. These programs would focus on improving practices, ensuring correct usage, and promoting the protection and conservation of medicinal plants. The findings also highlighted the importance of extending this knowledge to other barangays and schools.

Metformin-loaded PLGA microspheres combined with an in situ-formed injectable SA/BG hydrogel alleviate rotator cuff muscle degeneration

Rotator cuff tears are a prevalent musculoskeletal problem that affect many individuals and may result in substantial social and health-related expenses. Moreover, the muscular fat infiltration and dystrophy associated with rotator cuff tears have been persistent challenges in rotator cuff surgical repair and postoperative rehabilitation. In this study, an in situ-formed injectable sodium alginate (SA) and bioglass (BG) hydrogel consisting of poly (lactic-co-glycolic acid) (PLGA) microspheres containing metformin (SA/BG-PLGA-Met) was developed for the prevention of muscular fat infiltration and dystrophy. Metformin and silicon ions were slowly released by the combined hydrogel, resulting in long-term biological effects. Moreover, the hydrogel displayed excellent degradability and biocompatibility. Extracts of SA/BG-PLGA-Met inhibited the adipogenesis of 3T3-L1 cells and stimulated the myogenic differentiation of C2C12 cells in vitro. In a mouse model of rotator cuff degeneration, the SA/BG-PLGA-Met hydrogel inhibited fat infiltration and dystrophy of the supraspinatus muscle. Overall, the SA/BG-PLGA-Met hydrogel, as a novel biomaterial, has great clinical potential for preventing rotator cuff muscle fat infiltration and atrophy.

A Comparative Study: Deep Learning Approach to Predict Autism Spectrum Disorder Based on Q-Chat-10 Responses

Autism spectrum disorder (ASD) is a neurodevelopmental condition that has been observed to have an increasing incidence and significant health-related expenses. The timely identification of these burdens can mitigate their impact; however, current diagnostic protocols are protracted and entail significant expenses. The implementation of machine learning and, more recently, deep learning techniques presents promising remedies to improve ASD screening procedures. The present research introduces a deep learning framework for the purpose of forecasting autism spectrum disorder (ASD) utilizing responses obtained from the Q-Chat-10 questionnaire. The dataset employed in this study comprises 1054 records, encompassing ten behavioral traits and additional individual characteristics. The objective of this study is to improve the precision, efficacy, sensitivity, and specificity of autism spectrum disorder (ASD) predictions by contrasting the performance of a deep learning model with that of conventional machine learning models. The implementation of this technology has the potential to significantly optimize the ASD screening procedure, rendering it more affordable and convenient and ultimately assisting healthcare practitioners in their clinical judgment for prompt ASD identification.

Do educational inequalities between marital partners influence the empowerment of educated women in ECOWAS?

ABSTRACT In an environment where the question of women’s empowerment is a burning issue and where inequalities against women in education persist even though they are increasingly educated, it made sense to study the effect of educational inequalities between marital partners on women’s empowerment. Thus, using the latest rounds of the Demographic and Health Survey (DHS) women’s file from the four major West African economies including Nigeria (2013), Côte d’Ivoire (2011–12), Ghana (2014) and Senegal (2017), and then using a combination of internal and external instruments to better address issues related to the endogeneity of variables, we show that strong gender disparities in education negatively influence women’s financial and non-financial empowerment. The former is seen as the power of women to make decisions about spending their own and their spouse’s income and major household purchases. The second is the woman’s power to decide on health-related expenses and visits to relatives. Several other socio-demographic variables were likely to influence women’s empowerment. These include the woman’s household social status, age, labour market participation and religion.

N-nitrosodimethylamine-Contaminated Valsartan and Risk of Cancer: A Nationwide Study of 1.4 Million Valsartan Users.

Background Since July 2018, numerous lots of valsartan have been found to be contaminated with N-nitrosodimethylamine (NDMA). We aimed to assess the association between exposure to valsartan products contaminated with NDMA and the risk of cancer. Methods and Results This study was based on data from the Système National des Données de Santé, which is a national database that includes all French residents' health-related expenses. The target population was consumers of valsartan between January 1, 2013 and December 31, 2017, aged between 40 and 80 years old. The association of exposure to contaminated valsartan with the occurrence of any malignancy and cancer by location was evaluated by fitting Cox proportional hazards models weighted by the inverse probability of treatment. A total of 1.4 million subjects without any history of cancer were included. A total of 986 126 and 670 388 patients were exposed to NDMA-contaminated and uncontaminated valsartan, respectively. The use of the NDMA-contaminated valsartan did not increase the overall risk of cancer (adjusted hazard ratio [aHR], 0.99 [95% CI, 0.98-1.0]). However, exposed patients had a higher risk of liver cancer (aHR, 1.12 [95% CI, 1.04-1.22]) and melanoma (aHR, 1.10 [95% CI, 1.03-1.18]). We estimated a mean of 3.7 and 5.8 extra cases per year per 100 000 person-years of liver cancer and melanoma, respectively. Conclusions Our study was the largest to date to examine cancer risks associated with exposure to NDMA-contaminated valsartan. Our findings suggest a slight increased risk of liver cancer and melanoma in patients exposed to NDMA in regularly taken medications.

Catastrophic Expenditure for Health in the Philippines

Catastrophic Expenditure for Health in the Philippines

Routine surgeries during the COVID-19 pandemic: A French nationwide cohort study

BackgroundThe COVID-19 pandemic inevitably had consequences on routine surgical procedures. The objective was to quantify changes to five surgical procedures during the COVID-19 pandemic namely cataract surgery, hip and knee arthoplasties, coronary revascularization by angioplasty and definitive cardiac stimulation. Materials and methodAll hospitalizations with at least one act of each surgery between January 1, 2019, and June 30, 2021, were included from the database of all French residents’ health-related expenses. Percentage changes between observed and expected numbers of hospital stays were calculated for each surgery in 2020 and the first half of 2021 with 95% Confidence Intervals. Expected numbers were calculated from the number in 2019 by applying an average annual change between 2015 and 2019. The type of intervention (primary operation or reoperation/revision) and/or the emergency status were also considered. ResultsA total of 2,153,857 hospitalizations for cataract surgery (0.6% revision), 398,213 for hip arthroplasty (10.9% revision and 26.9% in emergency), 276,607 for knee arthroplasty (8.2% revision), 471,318 for coronary angioplasty (48.7% in emergency) and 178,441 for cardiac stimulation (27.6% revision) were included. Activity was lower than expected in 2020 (cataract surgery: −21.9% [−22.5;−21.4]; hip arthroplasty: −13.4% [−14.8;−12.0]; knee arthroplasty: −24.6% [−26.1;−23.0]; coronary angioplasty: −11.2% [−12.7;−9.7]) without any catch–up in the first half of 2021 (cataract surgery: −5.0% [−5.8;−4.3]; hip arthroplasty: −9.9% [−11.6;−8.2]; knee arthroplasty: −22.0% [−24.0;−20.1]; coronary angioplasty: −12,1% [−13.9;−10.4]). Revisions and non-elective interventions also decreased but to a lesser magnitude. Cardiac stimulation activity was almost in line with expectations (−2.6% [−4.9; −0.3]/+0.6 [−2.2; +3.4]). ConclusionThis study shows that there was a marked decrease in four routine surgeries compared to expectations through to at least the first half of 2021, despite the gradual national rollout of the vaccine.

Describing economic benefits and costs of nonstandard work hours: A scoping review.

The benefits of nonstandard work hours include increased production time and the number of jobs. While for some sectors, such as emergency services, around-the-clock work is a necessary and critical societal obligation, work outside of traditional daytime schedules has been associated with many occupational safety and health hazards and their associated costs. Thus, organizational- and policy-level decisions on nonstandard work hours can be difficult and are based on several factors including economic evaluation. However, there is a lack of systematic knowledge of economic benefits and costs associated with these schedules. We conducted a scoping review of the methodology and data used to examine the economic benefits and costs of nonstandard work hours and related interventions to mitigate risks. Ten studies met all our inclusion criteria. Most studies used aggregation and analysis of national and other large datasets. Costs estimated include health-related expenses, productivity losses, and projections of future loss of earnings. Cost analyses of interventions were provided for an obstructive sleep apnea screening program, implementation of an employer-based educational program, and increased staffing to cover overtime hours. A paucity of studies assess nonstandard work hours using economic terms. Future studies are needed to expand economic evaluations beyond the employer level to include those at the societal level because impacts of nonstandard work go beyond the workplace and are important for policy analysis and formulation. We pose the opportunity for researchers and employers to share data and resources in the development of more analyses that fill these research gaps.

IMPACT OF BIJU KRUSHAK KALYAN YOJANA (BKKY) IN ANGUL DISTRICT OF ODISHA

Villages and its farmers are the base of Odisha. But, when farmers suffer from ailments, they have to pay heavy economic, social and emotional price. Financial hazard and health related expenses led the farmer to suffer in poverty. Whereas, Biju Krushak Kalyan Yojana (BKKY) brought as a solution to farmers for their health security. The study was conducted in Angul district of Odisha under ex-post facto research design. 120 respondents from 10 villages of Angul block in Angul district of Odisha was selected for the study. Primary data were collected from the respondents with the help of pre-tested semi-structured interview schedule through personal interview. Data collected were subjected to statistical analysis and the identified that majority of the respondents were middle aged, illiterate, earns medium level of annual income, with medium level of mass media exposure and extension contact. Further added that, respondents reported positive impact on BKKY and socio-economic characteristics like education, income, mass media exposure and extension contact has positive and significant association with the impact of BKKY among the farmers. It was suggested to create awareness among farmers on benefits of BKKY, providing quality health consultations, proper knowledge at timely manner.

Impact of assumptions on future costs, disutility and mortality in cost-effectiveness analysis; a model exploration.

IntroductionIn cost-effectiveness analyses, the future costs, disutility and mortality from alternative causes of morbidity are often not completely taken into account. We explored the impact of different assumed values for each of these factors on the cost-effectiveness of screening for colorectal cancer (CRC) and esophageal adenocarcinoma (EAC).MethodsTwenty different CRC screening strategies and two EAC screening strategies were evaluated using microsimulation. Average health-related expenses, disutility and mortality by age for the U.S. general population were estimated using surveys and lifetables. First, we evaluated strategies under default assumptions, with average mortality, and no accounting for health-related costs and disutility. Then, we varied costs, disutility and mortality between 100% and 150% of the estimated population averages, with 125% as the best estimate. Primary outcome was the incremental cost per quality-adjusted life-year (QALY) gained among efficient strategies.ResultsThe set of efficient strategies was robust to assumptions on future costs, disutility and mortality from other causes of morbidity. However, the incremental cost per QALY gained increased with higher assumed values. For example, for CRC, the ratio for the recommended strategy increased from $15,600 with default assumptions, to $32,600 with average assumption levels, $61,100 with 25% increased levels, and $111,100 with 50% increased levels. Similarly, for EAC, the incremental costs per QALY gained for the recommended EAC screening strategy increased from $106,300 with default assumptions to $198,300 with 50% increased assumptions. In sensitivity analyses without discounting or including only above-average expenses, the impact of assumptions was relatively smaller, but best estimates of the cost per QALY gained remained substantially higher than default estimates.ConclusionsAssumptions on future costs, utility and mortality from other causes of morbidity substantially impact cost-effectiveness outcomes of cancer screening. More empiric evidence and consensus are needed to guide assumptions in future analyses.

Donor Financial Capacity Drives Racial Inequality in Medical Crowdsourced Funding

Abstract Americans facing large health-related expenses have increasingly turned to online crowdsourced funding for support, initiating 250,000 medical fundraisers on GoFundMe in 2018. Recent research indicates that these fundraisers yield inequitable outcomes, with White crowdfunding beneficiaries receiving higher levels of support than non-White beneficiaries. Researchers fear that racialized impressions of deservingness may be a driver of unequal returns in crowdfunding. However, rather than being a direct effect of interpersonal racism, differences in returns may be an indirect effect of the systemic racism that causes the social networks of Black and Hispanic Americans to have lower access to financial capital. This paper is the first to focus on how unequal access to monetary capital in networks of potential crowdfunding donors drives unequal returns for beneficiaries. I analyze a geographically stratified sample of 2,618 GoFundMe campaigns coded for perceived race and ethnicity of the beneficiary. I estimate donor financial capacity for each campaign based on the geography of Facebook friend networks and the most likely racial and ethnic makeup of the donor pool, based on donor surnames. I show that variations in the estimated income of potential donors can account for much of the deficit in returns. Thus, even in the absence of interpersonal discrimination, crowdfunding is unlikely to yield equitable outcomes given the current distribution of financial resources in the United States.

Requirements Engineering for Well-Being, Aging, and Health: An Overview for Practitioners

Well-Being, Aging, and Health (WBAH) are important aspects of life that affect us all. The requirements for WBAH systems have also become a topic of common interest for researchers from different disciplines. This is unsurprising, given that health-related expenses often represent about 10% of a country's gross domestic product, according to the World Health Organization.

Medical crowdfunding in a healthcare system with universal coverage: an exploratory study

BackgroundIn recent years, crowdfunding for medical expenses has gained popularity, especially in countries without universal health coverage. Nevertheless, universal coverage does not imply covering all medical costs for everyone. In countries with universal coverage unmet health care needs typically emerge due to financial reasons: the inability to pay the patient co-payments, and additional and experimental therapies not financed by the health insurance fund. This study aims at mapping unmet health care needs manifested in medical crowdfunding campaigns in a country with universal health coverage.MethodsIn this exploratory study we assess unmet health care needs in Germany by investigating 380 medical crowdfunding campaigns launched on Leetchi.com. We combine manual data extraction with text mining tools to identify the most common conditions, diseases and disorders which prompted individuals to launch medical crowdfunding campaigns in Germany. We also assess the type and size of health-related expenses that individuals aim to finance from donations.ResultsWe find that several conditions frequently listed in crowdfunding campaigns overlap with the most disabling conditions: cancer, mental disorders, musculoskeletal disorders, and neurological disorders. Nevertheless, there is no strong association between the disease burden and the condition which prompted individuals to ask for donations. Although oral health, lipoedema, and genetic disorders and rare diseases are not listed among leading causes of disability worldwide, these conditions frequently prompted individuals to turn to crowdfunding. Unmet needs are the highest for various therapies not financed by the health insurance fund; additional, complementary, and animal-assisted therapies are high on the wish list. Numerous people sought funds to cover the cost of scientifically poorly supported or unsupported therapies. In line with the social drift hypothesis, disability and bad health status being associated with poor socioeconomic status, affected individuals frequently collected donations for their living expenses.ConclusionsIn universal healthcare systems, medical crowdfunding is a viable option to finance alternative, complementary, experimental and scientifically poorly supported therapies not financed by the health insurance fund. Further analysis of the most common diseases and disorders listed in crowdfunding campaigns might provide guidance for national health insurance funds in extending their list of funded medical interventions. The fact of numerous individuals launching crowdfunding campaigns with the same diseases and disorders signals high unmet needs for available but not yet financed treatment. One prominent example of such treatment is liposuction for patients suffering from lipoedema; these treatments were frequently listed in crowdfunding campaigns and might soon be available for patients at the expense of statutory health insurance in Germany.

Crowdfunding for medical expenses in the United Kingdom

Abstract Background Medical crowdfunding is a rapidly growing phenomenon worldwide and a new means for patients to finance health related expenses. It raises many ethical concerns such as increasing inequities. In the UK, which operates a state-funded universal health care system, the phenomenon is unexpected and hasn't yet been studied. Our study aims at answering basic questions as who is using crowdfunding to fund health-related expenses, for what and why. Methods We have drawn the first 400 medical campaigns amongst 1,000 available on GoFundMe UK website. We used a content analysis method to extract data from narratives on age, sex, health condition and funds' purposes. Results Among the 400 campaigns, 1/2 requested funds for cancer care for both common and rare cancers, from which 1/3 disclosed a stage 4. A third of the sample sought funds to get treatment abroad, mostly in Germany and the US, for most part cancer therapies such as immunotherapy but also alternative therapies. A quarter of the sample sought support to alleviate financial burden associated with ill-health. Other purposes included getting private care in the UK (19%) and getting medical equipment (18%). Conclusions Our findings may put forward some gaps within the National Health Service (NHS) and social care such as issues to access therapies or equipment, lack of holistic care and inadequate welfare patient support. However, it does not explain fully the rise of crowdfunding that may also be a counterpart of patients' empowerment. For instance, patients can shift to the private sector, in the UK or abroad, when a treatment is not available within the NHS, such as high cost last-resort treatments for those with poor prognosis. We recommend policy makers to: use medical crowdfunding to inform policy,support patients to make empowered decisions,protect patients from commercial traps. Key messages Studying medical crowdfunding allows better understanding of patients’ perceived or actual unmet need for health and social care to inform policy development. This threat to equity should be addressed globally by providing patients with support to be empowered, with universal health coverage and by regulating better private facilities and health tourism.

Elucidation of Food Security as a Determinant of Malnutrition and Stunting on Children under Five Years: A Case of Insiza District, Matabeleland South, Zimbabwe

Introduction: Malnutrition remains a childhood scourge in Sub Saharan Africa, Southern Africa, Zimbabwe and in the Insiza District, in particular. The district is rich in mineral (gold) deposits, vibrant agricultural (animal husbandry) and diverse ecosystems that has potential support self-sufficiency of its population. However, the cause to <5-year-old malnutrition and stunting remain to opaque requiring elucidation.
 Materials and Methods: A mixed method approach, where both qualitative and quantitative research methods were used to elicit and describe in-depth people’s experiences on determinants of malnutrition and stunting in the Insiza District among the <5-year-olds. Statistical comparisons were performed by one-way analysis of variance (ANOVA), followed by Tukey-Kramer multiple comparison post hoc test using Graph Pad In Stat Software. Both probability and purposive sampling were used to triangulate and corroborate findings deriving meaning to explain the factors associated with wasting/ underweight.
 Results: Children with birth weights ±2.4kG were predominant in the study sample (57%) when compared to those who were born with 2.5-3.0 kG or >3.1 kG birth weights [19 fold more]. Two meals per day were taken frequently (57%) a mong adults comparable with birth weight underweight frequencies and feeding habits of infants <5-year-olds (53%), showing food insecurity in Isiza District. Households that lived on < US$1.00/day formed relatively the most prominent majority (73%) when compared to those who lived on US$0.87-1.67/day (23%) or US$1.87-2.50 (2%) or US$2.53-3.33 (2%). Health-related expenses (18.3%), education expenses (25%) and staple food related expenses (56.7%) took the bulk of the income without meaningful effect on child malnutrition. Fathers were over represented as household income usage decision markers in households with malnourished and stunted <5-year-olds (43%) compared to mothers, the family or both parents. Poverty was present in 65% of the households which had malnourished and or stunted children. Malnourishment was from nutritional deficit and non-nutritional lack (25%) while 20% had malnutrition from other determinants other than food consumption score.
 Conclusion: More than half (57%) children who developed malnutrition were underweight at birth and born in families with who had two meals a day (57%). Malnutrition was influenced negatively by marital status, household leadership, household income, size, religion, educations status and consumption scores.

"Tremendous financial burden":Crowdfunding for organ transplantation costs in Canada.

Online crowdfunding platforms such as GoFundMe are used to raise funds for health-related expenses associated with medical conditions such as organ transplantation. By investigating crowdfunding in Canadian organ transplantation, this study aimed to increase understanding of the motivations and outcomes of organ transplantation crowdfunding. Canadian liver and kidney transplantation campaigns posted to GoFundMe between May 30 & 31 2018 were identified and after exclusion, 258 kidney and 171 liver campaigns were included in study. These campaigns were coded for: worthiness of the campaign recipient, requested financial and non-monetary contributions, how monetary donations would be spent, and comments on the Canadian health system, among others. Results suggest Canadian organ donors, transplant candidates, recipients, and their families and caregivers experience significant financial difficulties not addressed by the public health system. Living and medication costs, transportation and relocation expenses, and income loss were the expenses most commonly highlighted by campaigners. Liver campaigns raised nearly half their goal while kidney campaigns received 11.5% of their requested amount. Findings highlight disease burden and the use of crowdfunding as a response to the extraordinary costs associated with organ transplantation. Although crowdfunding reduces some financial burden, it does not do so equitably and raises ethical concerns.

Cost-utility analysis of minimally invasive surgery for lung cancer: a randomized controlled trial.

Minimally invasive video-assisted thoracic surgery (VATS) was first introduced in the early 1990s. For decades, numerous non-randomized studies demonstrated advantages of VATS over thoracotomy with lower morbidity and shorter hospital stay, but only recently did a randomized trial document that VATS results in lower pain scores and better quality of life. Opposing arguments for VATS have always been increased costs and concerns about oncological adequacy. In this paper, we aim to investigate the cost-effectiveness of VATS. The study was designed as a cost-utility analysis of the first 12 months following surgery and was performed together with a clinical randomized controlled trial of VATS versus thoracotomy for lobectomy of stage 1 lung cancer during a 6-year period (2008-2014). All health-related expenses were retrieved from a national database (Statistics Denmark) including hospital readmissions, outpatient clinic visits, prescription medication costs, consultations with general practitioners, specialists, physiotherapists, psychologists and chiropractors. One hundred and three VATS patients and 103 thoracotomy patients were randomized. Mean costs per patient operated by VATS were 103108 Danish Kroner (Dkr) (€13818) and 134945 Dkr (€18085) by thoracotomy, making the costs for VATS 31837 Dkr (€4267) lower than thoracotomy (P < 0.001). The difference in quality-adjusted life years gained over 52 weeks of follow-up was 0.021 (P = 0.048, 95% confidence interval -0.04 to -0.00015) in favour of VATS. The median duration of the surgical procedure was shorter after thoracotomy (79 vs 100 min; P < 0.001). The mean length of hospitalization was shorter following VATS (4.8 vs 6.7 days; P = 0.027). The use of other resources was not significantly different between groups. The costs of resources were lower in the VATS group. This difference was primarily due to reduced costs of readmissions (VATS 29247 Dkr vs thoracotomy 51734 Dkr; P < 0.001) and costs of outpatient visits (VATS 51412 Dkr vs thoracotomy 61575 Dkr; P = 0.012). VATS is a cost-effective alternative to thoracotomy following lobectomy for stage 1 lung cancer. Economical outcomes as measured by quality-adjusted life years were significantly better and overall costs were lower for VATS. NCT01278888.

THE EFFECT OF RAPID EVALUATION AND TREATMENT UNITS ON HEART FAILURE READMISSION RATES: A RETROSPECTIVE ANALYSIS

Heart failure affects over 6.5 million Americans with prevalence expected to increase to over 8 million within the next ten years. The hospitalization of an estimated 80-85% of patients with acute heart failure (AHF) largely contributes to the health related expenses. Under the Affordable Care Act,

Modelling of lung cancer survival data for critical illness insurances

Modelling of critical illness survival data, being primary developed in the context of, e.g. health insurance contracts, also plays an important role in the currently analysed problems related to secondary insurance market. The aim of this contribution is two-fold. In the first part we describe how to construct a multiple state model for critical illness insurances, which takes into account that a probability of death for a dread disease sufferer depends on the duration of the disease and the survival probabilities are related to the disease stage. Then, in the second part, we focus on modelling of the probabilistic structure of the analysed model for a particular case of dread disease. Based on the actual data for the Lower Silesian Voivodship in Poland, we estimate the transition probabilities for the derived model in case of the risk of lung cancer. For this purpose we use the methodology developed for the construction of multi-state life tables, such as binomial, Poisson and ordinal logistic regression models. The obtained results can be directly used to build the multiple increment–decrement tables, which are useful to valuation not only critical illness insurances and life insurances with accelerated death benefits option but also to viatical settlement contracts and health-related expenses.