Hospital Expenditures Research Articles

Acute clinical and financial outcomes of on- versus off-pump coronary artery bypass grafting in octogenarians

BackgroundCoronary artery bypass surgery in octogenarians is associated with increased postoperative morbidity. Off-pump coronary artery bypass surgery eliminates potential complications of cardiopulmonary bypass, but its use remains controversial. This study aimed to evaluate the clinical and financial impact of off-pump coronary artery bypass surgery compared to conventional coronary artery bypass surgery among this high-risk population. MethodsPatients ≥80 years undergoing first-time, isolated, elective coronary artery bypass surgery were identified using the 2010–2019 Nationwide Readmissions Database. Patients were grouped into off-pump or conventional coronary artery bypass surgery cohorts. Multivariable models were developed to assess the independent associations between off-pump coronary artery bypass surgery and key outcomes. ResultsOf ∼56,158 patients, 13,940 (24.8%) underwent off-pump coronary artery bypass surgery. On average, the off-pump cohort was more likely to undergo single-vessel bypass (37.3 vs 19.7%, P < .001). After adjustment, undergoing off-pump coronary artery bypass surgery was associated with similar odds of in-hospital mortality (adjusted odds ratio 0.90, 95% confidence interval 0.73–1.12) relative to conventional bypass. Additionally, the off-pump and conventional coronary artery bypass surgery groups were comparable in odds of postoperative stroke (adjusted odds ratio 1.03, 95% confidence interval 0.78–1.35), cardiac arrest (adjusted odds ratio 0.99, 95% confidence interval 0.71–1.37), ventricular fibrillation (adjusted odds ratio 0.89, 95% confidence interval 0.60–1.31), tamponade (adjusted odds ratio 1.21, 95% confidence interval 0.74–1.97), and cardiogenic shock (adjusted odds ratio 0.94, 95% confidence interval 0.75–1.17). However, the off-pump coronary artery bypass surgery cohort was linked with an increased likelihood of ventricular tachycardia (adjusted odds ratio 1.23, 95% confidence interval 1.01–1.49) and myocardial infarction (adjusted odds ratio 1.34, 95% confidence interval 1.16–1.55). Furthermore, those undergoing off-pump coronary artery bypass surgery demonstrated reduced odds of non-home discharge (adjusted odds ratio 0.91, 95% confidence interval 0.83–0.99) and a decrement in hospitalization expenditures ($-1,290, 95% confidence interval –$2,370 to $200). ConclusionOff-pump coronary artery bypass surgery was linked with increased odds of ventricular tachycardia and myocardial infarction, but no difference in mortality. Our findings point to the safety of conventional coronary artery bypass surgery in octogenarians. Yet, future work is needed to consider long-term outcomes in this complex surgical cohort.

Use of hospital care among Dutch diabetes patients.

To provide insight into healthcare resource utilization and hospital expenditure of patients treated for diabetes in Dutch hospitals. We conducted an observational cohort study of 193 840 patients aged ≥18 years and treated for diabetes mellitus in 65 Dutch hospitals in 2019 to 2020, using real-world reimbursement data. Consultations, hospitalizations, technology use, total hospital and diabetes care costs (encompassing all care for diabetes itself) were assessed during 1-year follow-up. In addition, expenditure was compared with that in the general Dutch population. Total hospital costs for all patients with diabetes were €1 352 690 257 (1.35billion) per year, and 15.9% (€214 963 703) was associated with treatment of diabetes. Mean yearly costs per patient were €6978, with diabetes care costs of €1109. Mean hospital costs of patients exceeded that of the Dutch population three- to sixfold. Total hospital costs increased with age, whereas diabetes expenditure decreased with age (18-40 years, €1575; >70 years, €932). Of all patients with diabetes, 51.3% (n = 99 457) received care related to cardiovascular complications. Micro- and macrovascular complications, or a combination, increased hospital costs (1.4-5.3 times higher). The hospital resource use of Dutch diabetes patients is high, with a large burden of cardiovascular complications. Resource use is rooted mainly in hospital care of diabetes-related complications, not in the treatment of diabetes. Early treatment and prevention of complications remain imperative to taper future healthcare expenditure on patients with diabetes.

Coping with COVID: Performance of China's hierarchical medical system during the COVID-19 pandemic.

The COVID-19 pandemic has challenged the health system worldwide. This study aimed to assess how China's hierarchical medical system (HMS) coped with COVID-19 in the short-and medium-term. We mainly measured the number and distribution of hospital visits and healthcare expenditure between primary and high-level hospitals during Beijing's 2020-2021 pandemic relative to the 2017-2019 pre-COVID-19 benchmark period. Hospital operational data were extracted from Municipal Health Statistics Information Platform. The COVID-19 period in Beijing was divided into five phases, corresponding to different characteristics, from January 2020 to October 2021. The main outcome measures in this study include the percentage change in inpatient and outpatient emergency visits, and surgeries, and changing distribution of patients between different hospital levels across Beijing's HMS. In addition, the corresponding health expenditure in each of the 5 phases of COVID-19 was also included. In the outbreak phase of the pandemic, the total visits of Beijing hospitals declined dramatically, where outpatient visits fell 44.6%, inpatients visits fell 47.9%; emergency visits fell 35.6%, and surgery inpatients fell 44.5%. Correspondingly, health expenditures declined 30.5% for outpatients and 43.0% for inpatients. The primary hospitals absorbed a 9.51% higher proportion of outpatients than the pre-COVID-19 level in phase 1. In phase 4, the number of patients, including non-local outpatients reached pre-pandemic 2017-2019 benchmark levels. The proportion of outpatients in primary hospitals was only 1.74% above pre-COVID-19 levels in phases 4 and 5. Health expenditure for both outpatients and inpatients reached the baseline level in phase 3 and increased nearly 10% above pre-COVID-19 levels in phases 4 and 5. The HMS in Beijing coped with the COVID-19 pandemic in a relatively short time, the early stage of the pandemic reflected an enhanced role for primary hospitals in the HMS, but did not permanently change patient preferences for high-level hospitals. Relative to the pre-COVID-19 benchmark, the elevated hospital expenditure in phase 4 and phase 5 pointed to hospital over-treatment or patient excess treatment demand. We suggest improving the service capacity of primary hospitals and changing the preferences of patients through health education in the post-COVID-19 world.

Explanations for variations in hospital expenditures among four large California counties

ObjectiveTo investigate competing explanations for why Medicare Fee for Service (FFS) and private sector payments lead to hospital cost variations in Californian counties.Data sourcesRatios of private to Medicare hospital costs were obtained from state-based all-payer claims databases. Demographics were estimated from the U.S. Census Bureau and the California Health Interview Survey. Medicaid and Medicare spending was obtained from Kaiser Family Foundation. Medicare Advantage enrollment was obtained from the California Department of Health Care Services and market consolidation was estimated using the Herfindahl–Hirschman Index (HHI).Study designPer capita costs, demographics, Medicaid and Medicare spending, Medicare Advantage enrollment, and HHI scores were compared for San Francisco (SF), Sacramento, Los Angeles (LA), and San Diego (SD).Principal findingsLA hospitals had the lowest per capita private insurer costs, but the highest Medicare FFS costs. The findings might be explained by a lower HHI for LA, indicating a more competitive market, than SD, SF, and Sacramento.ConclusionsMedicare FFS hospital costs do not provide an accurate representation of health care spending in Californian counties. In more competitive markets, private insurance companies can negotiate lower prices, while oversupply may allow facilities to increase volume in Medicare FFS.

A comparison of tertiary level NICU costs for infants born

Human milk-based fortifiers (HMBF) are more costly than bovine milk-based fortifiers (BMBF); but, the efficacy of human or bovine fortification for infants born <1250 g has yet to be fully elucidated. Our objective was to determine the effect of fortifier source on tertiary neonatal costs. Costs associated with tertiary neonatal care, including direct and indirect hospital expenditures, feed-related costs and physician billing were analysed retrospectively for participants of OptiMoM (NCT02137473), a blinded RCT comparing fortifier type for babies born <1250 g. A generalized linear model of cost according to fortifier type was created. Mean [95% confidence interval] daily costs per patient, adjusted for birth gestation and weight, was significantly greater in the human than the BMBF group ($3,452 [$3,186 - $3,740] Canadian dollars (CAD) versus $2,451 [$2,257 - $2,662] CAD) respectively, p < 0.0001). HMBF usage entails additional costs on NICU stay that should be considered with implementation.

Thyroid surgery outcomes in octogenarians: A national analysis

BackgroundThe incidence of thyroid pathology increases with age. Yet octogenarians may face increased rates of complications after thyroid surgery. Using a nationally representative cohort, we evaluated the outcomes of thyroidectomy among octogenarians. MethodsAll patients ≥55 years who underwent inpatient thyroidectomy were identified using the 2010 to 2020 National Readmissions Database. Patients ≥80 years were classified as octogenarians (others: nonoctogenarians). Multivariable models were built to evaluate independent associations between octogenarians and key clinical and financial outcomes. ResultsOf 120,164 hospitalizations, 9,163 (7.6%) were octogenarians. The proportion of octogenarians undergoing thyroidectomy increased from 7.7% (2010) to 8.7% (2020) (nptrend <0.001). Octogenarians were more frequently female (72.1 vs 70.5%, P < .001), presented with a higher Elixhauser comorbidity index (3 [2–4] vs 2 [1–3], P < .001), and more commonly faced thyroid cancer (41.3 vs 32.7%, P < .001). After risk adjustment, octogenarians were associated with greater odds of experiencing any perioperative complication (adjusted odds ratio 1.36, 95% confidence interval 1.25–1.48). Octogenarians were further linked with greater odds of respiratory (adjusted odds ratio 1.82, 95% confidence interval 1.52–2.17) and renal complications (adjusted odds ratio 1.90, 95% confidence interval 1.45–2.49), dysphagia (adjusted odds ratio 1.51, 95% confidence interval 1.33–1.72), laryngeal edema (adjusted odds ratio 2.03, 95% confidence interval 1.30–3.18), vocal cord paralysis (adjusted odds ratio 1.79, 95% confidence interval 1.53–2.09), and stridor (adjusted odds ratio 1.42, 95% confidence interval 1.01–2.00). No difference in hypocalcemia was observed. Furthermore, octogenarians demonstrated an increased likelihood of in-hospital mortality (adjusted odds ratio 6.34, 95% confidence interval 3.11–12.53), hospitalization expenditures (+$910, 95% confidence interval +$420–1,400), and nonelective readmission within 30 days of discharge (adjusted odds ratio 1.54, 95% confidence interval 1.32–1.79). ConclusionOctogenarians are associated with greater morbidity after thyroidectomy. Patients ≥80 years should be counseled about increased perioperative risk when discussing surgical versus nonsurgical treatments for thyroid disease.

Health and social burden of alcohol use disorders in an industrial population of India

Background: In the last two decades the rate of alcohol consumption has substantially increased in India but the socioeconomic burden of alcohol use disorders (AUD) is understudied. Methods: 48613 patients admitted from January 2009 to December 2018 for diseases directly or indirectly related to alcohol use (40.1% of total admission) were analysed. Retrospective analysis of prospectively maintained data was used as current study design. Diagnosis were arrived at by history, clinical examination and relevant investigations. Social data included demography, alcohol related information, social, emotional, psychological aspects and occupation related issues. Results: There was a rising trend of both direct (59.3%) and indirect (40.7%) alcohol related disorders over the years with the following rates: injuries (30.6%), gastrointestinal disorders (16.7%), AUD (6.2%), other substance abuse (4.1%), seizures (1.7%), infections (16.7%), only diabetes mellitus (1.9%), gastrointestinal cancer (4%), cardiovascular disease (4.3%), neurovascular disease (8%) and chronic kidney disease (5.8%). 39.7% patients had pulmonary tuberculosis. This entailed a yearly hospital expenditure of INR 165.54 million and an additional INR 10.3 million for work absenteeism. 37.6% died whereas disability and poor work productivity led to relocation and premature retirement in 7.2%. Social aspects revealed early initiation of drinking (73% at &lt;30 years of age) at instances of family/ friend in a conducive setting of easy availability and permissive “drinking environment” furthered by vissisitudes in later life. Heavy consumption of spirits (average 118 gm/day), often in binges, fortends serious health consequences. Conclusions: Alcohol related socioeconomic burden is rapidly rising in India and needs urgent attention.

Epidemiology data on the cost and outcomes associated with pediatric acute kidney injury.

Hospitalized children with acute kidney injury (AKI) have not been extensively studied for clinical outcomes including hospital stay, the need for mechanical ventilation, mortality rates, and healthcare utilization. We hypothesize significant financial costs and increased morbidity and mortality associated with pediatric AKI. This is a retrospective study of pediatric patients (age ≤18 years) included in the Kids' Inpatient Database (KID) between January 1, 2016, and December 31, 2021. The results of the data analysis were utilized for comparative testing between the AKI and non-AKI cohorts. The study included 4842 children [with AKI (n = 2424) and without AKI (n = 2418)]. The odds of mortality (p = 0.004) and mechanical ventilation (p < 0.001) were observed to be significantly higher among those with AKI as compared to those without AKI. Additionally, the median (IQR) duration of stay in the hospital (p < 0.001) and total cost (p < 0.001) were significantly higher among those with AKI vs. those without AKI. AKI in children was associated with higher odds of mortality, longer duration of hospital stay, increased requirement of mechanical ventilation, and increased hospital expenditure. The scientific community can utilize this information to better understand the outcomes associated with this disease process in this patient population. This article has thoroughly evaluated epidemiologic data associated with pediatric acute kidney injury (AKI) in hospitalized patients This study assesses mortality, hospital expenditure, and other factors to strengthen single-center and few multi-center studies and provides novel data regarding insurance and cost associated with pediatric AKI With increased knowledge of current epidemiology and risk factors, the scientific community can better understand prevention and outcomes in hospitalized children with AKI.

A novel information extraction model integrating multi-granularity global information for medical dialogue

Electronic medical records (EMRs) are one of the ways to help doctors effectively manage and analyze patient medical records. These EMRs can not only help doctors save a lot of time in analyzing medical records, but also reduce the hospital's demand for doctors and reduce the hospital's expenditure cost. Therefore, we propose a novel information extraction model integrating multi-granularity global information to efficiently extract information about a patient's physical condition in a doctor-patient dialogue. Experimental results show that our model achieves better results compared to the baseline model, indicating the effectiveness of the model.

Non-pharmaceutical interventions for COVID-19 reduced the incidence of infectious diseases: a controlled interrupted time-series study

BackgroundNon-pharmaceutical interventions (NPIs) have been implemented worldwide to suppress the spread of coronavirus disease 2019 (COVID-19). However, few studies have evaluated the effect of NPIs on other infectious diseases and none has assessed the avoided disease burden associated with NPIs. We aimed to assess the effect of NPIs on the incidence of infectious diseases during the COVID-19 pandemic in 2020 and evaluate the health economic benefits related to the reduction in the incidence of infectious diseases.MethodsData on 10 notifiable infectious diseases across China during 2010–2020 were extracted from the China Information System for Disease Control and Prevention. A two-stage controlled interrupted time-series design with a quasi-Poisson regression model was used to examine the impact of NPIs on the incidence of infectious diseases. The analysis was first performed at the provincial-level administrative divisions (PLADs) level in China, then the PLAD-specific estimates were pooled using a random-effect meta-analysis.ResultsA total of 61,393,737 cases of 10 infectious diseases were identified. The implementation of NPIs was associated with 5.13 million (95% confidence interval [CI] 3.45‒7.42) avoided cases and USD 1.77 billion (95% CI 1.18‒2.57) avoided hospital expenditures in 2020. There were 4.52 million (95% CI 3.00‒6.63) avoided cases for children and adolescents, corresponding to 88.2% of total avoided cases. The top leading cause of avoided burden attributable to NPIs was influenza [avoided percentage (AP): 89.3%; 95% CI 84.5‒92.6]. Socioeconomic status and population density were effect modifiers.ConclusionsNPIs for COVID-19 could effectively control the prevalence of infectious diseases, with patterns of risk varying by socioeconomic status. These findings have important implications for informing targeted strategies to prevent infectious diseases.

The impacts of public hospital comprehensive reform policies on hospital medicine cost, revenues and healthcare expenditures 2014-2019: An analysis of 103 tertiary public hospitals in China.

To explore the impact of implementation of the comprehensive public hospital reform policy (CPHRP) on medicine costs, revenues and medical expenditures in tertiary public hospitals in China. The data of this study was collected from local administrations to obtain operational data of healthcare institutions and medicine procurement data for 103 tertiary public hospitals from 2014 to 2019. The propensity matching score method and the difference-in-difference method were used jointly to assess the impact of reform policies on tertiary public hospitals. After the implementation of the policy, drug revenue in the intervention group decreased by ¥ 86.3 million (p = 0.076) compared to the control group; medical service revenue increased by ¥ 108.5 million (p < 0.001); government financial subsidies increased by ¥ 20.3 million (p = 0.085); the average medicine cost per outpatient and emergency visit decreased by ¥ 15.2 (p = 0.062); the average medicine cost per hospitalization decreased by ¥ 504 (p = 0.040); however, the medicine cost decreased by ¥ 38.2 million (p = 0.351), the average cost per visit for outpatient and emergency decreased by ¥ 0.562 (p = 0.966), the average cost per hospitalization decreased by ¥ 152 (p = 0.844), which are not significant. The implementation of reform policies has changed the revenue structure of public hospitals; the proportion of drug revenue decreased, while the proportion of service income increased, especially in service income and government subsidies. Meanwhile, the average medicine cost of outpatient, emergency, and inpatient visits per time were all reduced, which played a certain role in reducing the disease burden of patients.

Comparison of medical care expenditure between participants and non-participants of exercise class for middle-aged and elderly women

Objectives This study aimed to compare and verify the medical care expenditure of participants and non-participants of exercise classes for middle-aged and elderly women.Methods This study compares and analyzes the medical care expenditure of two groups. The total amount of outpatient treatment, pharmacies, and hospitalization expenditures will be referred to as medical care expenditure. The participating and control groups were 6,576 women aged between 60 and 69 years with a 4-year insurance by the National Health Insurance. The participating group composed 416 women who participated in the exercise class for 2 years and whose hospitalization and outpatient treatment expenditures for 1 year before the exercise class were 0 yen and <500,000 yen, respectively. The control group were matched with the participating group for 1:1 in age and medical care expenditure. Wilcoxon's signed rank test was used to compare the medical costs of the groups. The significance level was set at <5%.Result In comparing the medical care expenditure between years, both groups had increased medical care expenditure and there was no significant difference in the medical care expenditure between the groups within each year; however, the increased medical care expenditure was lower in the participating group than that in the control group. The outpatient treatment and pharmacies expenditures for aged <65 years who participated in ≥15 exercise classes in both years was significantly lower for the participating group compared to that of the control group of the same age group. The hospitalization expenditure was significantly lower in the participating group for all age groups and aged <65 years group after participating in exercise classes.Conclusion Women who continually participate in exercise classes could further reduce their medical care expenditure, especially for those aged ≤65 years.

Impacts of Outpatient Payment Reforms on Volume and Expenditures in Public Hospitals: Evidence from a Quasi-Experimental Analysis in Zhejiang, China.

China developed an innovative episode-based payment scheme for outpatient care, namely "Ambulatory Patient Groups (APGs) + capitation" payment, to constrain inflation in outpatient expenditures. This study aimed to assess the effects of this payment method on volume and expenditures in Chinese public hospitals. A quasi-experimental study was conducted with 7 municipal and 12 county hospitals from Jinhua as the intervention group and 15 municipal and 24 county hospitals from three neighbouring cities as the control group. The payment reform was introduced to municipal and county hospitals in the intervention group in January 2020 and January 2021, respectively. Monthly data on volumes and outpatient expenditures were collected from each hospital from January 2019 to December 2021. Controlled interrupted time-series analyses were performed to determine the effects of the funding reforms. Outpatient visits in municipal hospitals decreased by 1417.54 (p=0.048) per month on average compared with control ones after the reform was implemented, whilst that in county hospitals increased by 1058.04 (p=0.041) per month on average. The trend of drug expenditures (β 7=-1.41, p=0.019) in municipal hospitals dropped, which was accompanied by an immediate reduction in consumable expenditures (β 6 =-6.89, p=0.044). The funding reform also led to the significant declines in drug (β 6=-10.96, p=0.009) and consumable (β 6=-4.78, p=0.041) expenditures in county hospitals. Municipal hospitals experienced the drop in the trend of total outpatient expenditures (β 7=-3.99, p=0.018) over the same period. The strength of the "AGPs + capitation" payment for outpatient care lies in its ability to control the excessive growth of medical expenses through correcting inappropriate incentives. However, minimising potential cost-shifting and risk-shifting to uninsured service items should be given attention.

When States Mandate Hospital Community Benefit Reports, Provision Increases.

We examined the variation in community benefit and charity care reporting standards mandated by states to determine whether state-mandated community benefit and charity care reporting is associated with greater provision of these services. We used 2011-2019 data from IRS Form 990 Schedule H for 1,423 nonprofit hospitals to create a sample of 12,807 total observations. Random effects regression models were used to examine the association between state reporting requirements and community benefit spending by nonprofit hospitals. Specific reporting requirements were analyzed to determine whether certain requirements were associated with increased spending on these services. Nonprofit hospitals in states that required reports spent a higher percentage of total hospital expenditures on community benefits (9.1%, SD = 6.2%) compared to states without these requirements (7.2%, SD = 5.7%). A similar association between the percentage of charity care and total hospital expenditures (2.3% and 1.5%) was found. The greater number of reporting requirements was associated with lower levels of charity care provision, as hospitals allocated more resources to other community benefits. Mandating the reporting of specific services is associated with greater provision of certain specific services, but not all. A concern is that when many services must be reported, the provision of charity care might be reduced as hospitals choose to allocate their community benefit dollars to other categories. As a result, policymakers may want to focus their attention on the services they most want to prioritize.

Cost-Benefit of Real-Time Multiplex PCR Testing of SARS-CoV-2 in German Hospitals.

The current Omicron COVID-19 pandemic has significant morbidity worldwide. Assess the cost-benefit relation of implementing PCR point-of-care (POCT) COVID-19 testing in the emergency rooms (ERs) of German hospitals and in the case of inpatient admission due to other acute illnesses. A deterministic decision-analytic model simulated the incremental costs of using the Savanna® Multiplex RT-PCR test compared to using clinical judgement alone to confirm or exclude COVID-19 in adult patients in German ERs prior to hospitalization or just prior to discharge. Direct and indirect costs were evaluated from the hospital perspective. Nasal or nasopharyngeal swabs of patients suspected to have COVID-19 by clinical judgement, but without POCT, were sent to external labs for RT-PCR testing. In probabilistic sensitivity analysis, assuming a COVID-19 prevalence ranging between 15.6-41.2% and a hospitalization rate between 4.3-64.3%, implementing the Savanna® test saved, on average, €107 as compared to applying the clinical-judgement-only strategy. A revenue loss of €735 can be avoided when SARS-CoV-2 infection in patients coming unplanned to the hospital due to other acute illnesses are excluded immediately by POCT. Using highly sensitive and specific PCR-POCT in patients suspected of COVID-19 infection at German ERs may significantly reduce hospital expenditures.

Ethnic-Regional Differences in the Allocation of High Complexity Spending in Brazil: Time Analysis 2010-2019.

The following paper presents as a research problem the ethnic-regional differences in the allocation of high complexity spending in Brazil in an analysis from 2010 to 2019. This is a descriptive research in which a generalized linear model (GLM) was developed to analyze these hospital expenditures with high complexity procedures. The total spending on high complexity procedures in Brazil has increased over the past decade. The study shows that the lowest average expenditures are found in the North and Northeast regions. When comparing the spending between different ethnicities, it was observed that the only decrease between the years 2010 and 2019 was in the amount spent on procedures in indigenous people. The spending on male patients was significantly higher compared to female patients. The highest expenditures, on the other hand, are concentrated in the regions of state capitals favoring the strengthening of hub municipalities. Geographic inequalities in access still persist, even with most states already offering almost all procedures. The Brazilian territory is very heterogeneous and needs to organize its health system by regions, therefore integrated public policies and economic and social development are urgently needed.

Applicability of Vericiguat to Patients Hospitalized for Heart Failure in the United States

BackgroundIn January 2021, vericiguat, a soluble guanylate cyclase stimulator, was approved by the U.S. Food and Drug Administration (FDA) to reduce the risk of cardiovascular death and heart failure (HF) hospitalization among patients with a recent worsening HF event based on the VICTORIA (VerICiguaT Global Study in Subjects with Heart Failure with Reduced Ejection Fraction) trial. ObjectivesThis study sought to leverage a contemporary U.S. registry of patients hospitalized for heart failure (HF) to characterize patients who may be candidates for vericiguat based on FDA label and the VICTORIA trial eligibility criteria. MethodsThe authors studied patients hospitalized for HF with ejection fraction (EF) <45% across 525 sites in the GWTG-HF (Get With The Guidelines–Heart Failure) registry between January 2014 and December 2020. Approximate FDA label criteria (excluding estimated glomerular filtration rate [eGFR] <15 mL/min/1.73 m2, dialysis, or patients with heart transplantation or durable mechanical circulatory support) and eligibility criteria for the VICTORIA trial were applied to the GWTG-HF cohort. ResultsAmong 241,057 patients with EF <45% in the GWTG-HF registry, 221,730 (92%) could be candidates for vericiguat under the FDA label and 92,249 (38%) would have been eligible for the VICTORIA trial. The most frequent reasons for ineligibility for the FDA label were eGFR <15 mL/min/1.73 m2 (5.7%) and dialysis (1.6%). Although there were greater proportions of women and Black patients in the GWTG-HF registry, most clinical characteristics were qualitatively similar with patients enrolled in the VICTORIA trial. Among Medicare beneficiaries in the GWTG-HF registry eligible for vericiguat by either FDA label or VICTORIA trial criteria, 12-month postdischarge rates of mortality (36%-37%), HF hospitalization (33%-35%), all-cause hospitalization (64%-66%), and mean health care expenditure (U.S. $25,106-$25,428) were high. ConclusionsData from a large, contemporary U.S. registry of patients actively hospitalized for HF with EF <45% suggest that approximately 4 in 10 patients meet the criteria of the VICTORIA trial and that more than 9 in 10 patients are potential candidates for vericiguat based on the FDA label. Contemporary Medicare beneficiaries hospitalized for HF with EF <45% and eligible for vericiguat face high rates of postdischarge mortality and readmission and accrue substantial health care costs.

Complete Recovery of 94 Vaccinated and Non-Vaccinated Cases from COVID-19 Treated at Home with Favipiravir, Dexamethasone, Antibiotics, and Other Supportive Medicines and Care

Objective: In 2002-2003 an extraordinary outbreak of coronavirus infection known as Severe Acute Respiratory Syndrome Corona virus or SARS CoV infection occurred in south China and eventually spread in 28 countries around the world with 8096 cases. In December 2019, Corona virus infected disease 19 or COVID-19 or SARS CoV-2 first occurred in Wuhan, South China and rapidly spread all over the world. All the leading viral disease research group and clinical Institutions have been trying hard to find an effective antiviral regime to curve the COVID-19 mortality and morbidity. The preventive vaccinations for COVID-19 are in vogue with mixed response. The objective of this study was to provide treatment for COVID-19 cases at home at the earliest with proper selection and combination of medicines to stop the mortality, morbidity and heavy hospital expenditure. Methods: All the study cases were from Kolkata, India. Considering infectivity and mortality of SARSCoV-2, primarily all the clinical history including clinical data of the cases were collected through mobile media (smart phone). The accumulated data had been recorded in history sheets which were finally completed after the recovery of the cases by personal interview or interview of the family members in case of death. The majority cases were diagnosed by RT-PCR and rest by Rapid antigen test or by symptoms. The study could be labelled as an open label study considering all the facts and figures and outcome involved in the study design of this clinical research. This study included 123 COVID-19 cases, at an age range, 10-85 Years (mean age 48·66±17·69; median age 51 years). Out of these cases, 94 cases between 22-85 years (mean age 50·44±16·83; median age 53years) were selected for home treatment up to 2 weeks with our formulated protocol consisting of Favipiravir, Dexamethasone Antibiotics (Azithromycin/ Clarithromycin or Doxycycline), Pantoprazole and Doxophylline. Out of 94 cases only two cases had experienced little fall of oxygen saturation and treated with oxygen at home and Doxophylline. All the 94 cases treated with the protocol completely recovered after two weeks without any residual symptoms. The rest 29 cases, treated outside in hospitals or clinics and designated as external cases were used for comparison. Results: Out of total of 29 COVID-19 external cases, 25 cases had taken ivermectin for COVID-19 treatment of which 19 cases recovered with various post COVID symptoms. Six cases were unresponsive to ivermectin and were admitted to hospital and out of them one patient expired. All the 94 cases, treated at home by our protocol, had recovered completely from the disease without any residual symptoms and the recovery period was shortened. we found that, our formulated protocol for COVID-19 was an absolute success. Conclusion: From the study it is concluded that COVID-19 cases can be treated effectively at home without any casualty provided that the cases are diagnosed and treated with proper medicines at the earliest.

Translation and validation of the revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) for evaluating the effectiveness of acute pain services in the Indian population.

Translation and validation of the revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) for evaluating the effectiveness of acute pain services in the Indian population.

Economic burden of acute myeloid leukemia on patients in a resource-limited tertiary hospital in the Philippines

IntroductionThe remission induction treatment for acute myeloid leukemia (AML) has remained unchanged in the resource-limited setting in the Philippines. AML treatment consists of induction chemotherapy followed by high dose consolidation chemotherapy or allogeneic hematopoietic stem cell transplantation. In the Philippines, the Filipino household bears the burden of health care cost of hospitalization expenditure. Insights into the treatment costs becomes an essential requirement as these guides the allocation of resources to scheme health programs. MethodThis study involved a retrospective cohort analysis of AML patients who underwent treatment for AML. Review of the statements of account per admission per patient during treatment for remission induction, consolidation, relapsed and refractory disease and best supportive care from 2017 to 2019. Of the 251 eligible patients, 190 patients were included. ResultThe mean healthcare expenditure for remission induction chemotherapy (Phase 1) was US $2, 504.78 (Php 125,239.29). While 3 to 4 cycles of consolidation chemotherapy cost an average of US $3,222.72 (Php 162,103.20). For patients who had relapsed and refractory disease, an additional mean cost of US $3,163.32 (Php 159,115.28) and US $2, 914.72 (Php 146,610.55) were incurred, respectively. The average cost of palliative care was US $1,687.00 (Php 84,856.59). ConclusionThe cost of chemotherapy and other therapeutics bear most of the weight of the direct healthcare cost. The cost of AML treatment represents a significant economic burden for patients and the institution. The cost increases as patients proceed through subsequent lines of treatment for induction failure. Existing subsidy for health insurance benefits could still be improved for appropriate source allocation of resources.