Estimates Of Indirect Costs Research Articles

Foslevodopa/foscarbidopa (LDp/CDp) in advanced Parkinson’s Disease (aPD): demonstration of savings from a societal perspective in the UK

Aims In advanced Parkinson’s disease (aPD), adequate 24-hour control of OFF-time may not be achievable using oral/transdermal therapies. Clinical trials of foslevodopa/foscarbidopa (LDp/CDP) demonstrate meaningful reductions in OFF-time and OFF-related sleep disturbance in aPD. Previous analyses have only considered direct medical costs: this analysis considers a broader societal perspective (direct non-medical costs, informal care, loss of earnings, productivity, and tax). Methods Inputs for the societal impact model were taken from a cost-utility model comparing LDp/CDp with best medical treatment (BMT), accepted by the UK National Institute of Health and Care Excellence (NICE). Quintiles of normalized OFF-time across a 16-hour waking day in each treatment group were applied to literature-based estimates for direct medical, non-medical, and indirect costs. The resulting state-specific cost estimates were applied to the modelled aPD patient population. Results The model estimates the potential UK population for LDp/CDp at 17,505. Continuous 24-hour delivery of LDp/CDp results in greater time spent in OFF-time states 0–1 (0–4 hours of OFF-time/16-hour waking day) vs BMT alone. Net savings if all eligible patients receive LDp/CDp are £79.1 M in year 1, £235.4 M in year 2, rising to £262.2 M in year 3, declining to £222.9 M in year 4 and £153.7 M in year 5 as disease progresses and the efficacy of LDp/CDp declines. The estimated total net savings are £953 M after 5 years. Results are robust in scenario analyses (excluding costs of excessive sleepiness, earnings loss, productivity, and tax loss). Limitations A NICE-accepted model was used as the economic modelling basis for the societal impact model, however, much of the data was derived from Adelphi datasets, with the potential for inconsistent definitions. Conclusion When considered from a societal perspective, the use of LDp/CDp in aPD patients inadequately controlled on oral therapy is associated with net healthcare and societal annual savings of over £79.1 M vs BMT.

Green Wheels, Greener Wallets: Economic Viability of Last-Mile Delivery Fleet Electrification in Case of Latvia

The analysis of internal combustion engine vehicle (ICEV) usage habits in the DPD Latvija company and the study of the specifics of its last-mile delivery transport business will allow to understand whether electromobility solutions can make the company more efficient. The question addressed in the research is whether the electrification of the delivery vehicle fleet can reduce transport expenses for the company and under what conditions. For estimation of direct and indirect costs of transport acquisition and usage Total Cost of Ownership (TCO) is used. The company’s daily operation parameters and technical data of the used vehicles VW e-Crafter and VW Crafter 35 Kasten/long base are considered in the study. Net Present Value (NPV) and Internal Rate of Return (IRR) calculation methods are used for analyzing the investment project. The expense of the creation of electrical vehicle charging infrastructure is not considered, because the company’s daily routine allows to cover all charging processes overnight by using domestic sockets together with Mode 2 chargers. All technical data and calculations were made for deliveries in a city cycle. In financial terms of owning delivery transport, the company is using a 5-year operational lease with 0% first payment. The obtained results in terms of TCO comparison showed a slight advantage by using EV after 5 years of last-mile delivery service per 1 vehicle – 706.98 Euro at 31200km a year or 100km in the working day of 6-day working week (156000km in 5-year is under 160000 warranty condition). The calculation is performed for DPD Latvija 213 ICE vans of a total 240-vehicle fleet. Results of NPV, NPVI, and IRR with a comparison rate of 10.6% for EV case clearly show a sufficiently good return. The Net Present Value of the solution is 89271.92 Euro and the Internal rate of return is 48.05%. The study proves that the electrification of the last-mile delivery company's fleet is economically justified and within 5 years. In the process of electrification, the company will reduce its expenses – by 1.45%, which increases the net annual profit by 0.13%. The main conclusion is that the company will not incur losses by switching to an environmentally friendly vehicle, the capital investment in a realistic scenario pays off already from the 3rd year. Nevertheless, the authors of the study recommend evaluating delivery vehicles with higher driving range parameters, because during peak delivery and seasons with cold weather, the company may experience unplanned downtime and expenses due to the need for additional charging time at public charging networks on the road, that could lead to financial losses and need for TCO calculation corrections.

Estimates of Direct Medical and Indirect Costs Associated With COVID-19 Among U.S. Active Duty Army Soldiers.

This study estimated the direct medical and indirect costs associated with coronavirus disease 2019 (COVID-19) diagnoses among U.S. active duty (AD) Army service members (SMs). These cost estimates provide the U.S. Military with a better understanding of the financial burden of COVID-19 and provide a foundation for cost-effectiveness estimates. The study was approved as Public Health Practice (#17-605) by the U.S. Army Public Health Center, Public Health Review Board. U.S. AD Army SMs with COVID-19 were identified using an Army COVID-19 testing and surveillance database. Encounters for these SMs were captured from medical record where International Classification of Disease Tenth Revision, Clinical Modification code U07.1 was in the first or second diagnostic position. Analyses were conducted on SMs with COVID-19 who either had no healthcare encounters in the Military Health System (MHS); at least one MHS COVID-19 inpatient hospitalization; or at least one MHS outpatient COVID-19 encounter. Coronavirus disease 2019 (COVID-19) costs captured from the encounters were used to develop direct medical cost estimates. Literature on COVID-19 recovery post-hospitalization, along with the number of COVID-19 hospitalizations and outpatient visits from encounters were used to describe the intensity of COVID-19 care. Estimates of the indirect cost of lost duty were based on SMs salary information, along with recovery time, bed days, or outpatient visit time. The indirect cost of limited duty was estimated using the time associated with the Department of Defense (DoD) COVID-19 pandemic mitigation strategies in place when these SMs were identified as positive for COVID-19. Coronavirus disease 2019 (COVID-19) cost estimates were developed for the Army using data from 19,086 SMs identified as positive for COVID-19 between June 1, 2020, and December 31, 2020. Direct medical costs, or the amount paid by the DoD to facilities for COVID-19 care, averaged $606 per SM with an encounter. Indirect costs for lost duty or the cost for recovery and the time taken to seek care for COVID-19 averaged $319 per SM, while indirect costs for limited duty or isolation associated with COVID-19 averaged $4,111 per SM or $411 per day. Service members (SMs) with an inpatient hospitalization averaged 4.8 bed days (range 1-43) and 266 recovery hours while SMs who sought outpatient care for COVID-19 averaged two outpatient visits (range 1-60 visits). The direct medical costs of a COVID-19 encounter in the MHS ($606) are a small portion of the costs for a SM with COVID-19. Indirect costs of lost and limited duty associated with COVID-19 averaged seven times higher ($4,331) and accounted for the vast majority of costs. Recognition of these costs is important especially given that soldiers in the hospital or in quarters being quarantined are complete losses of manpower to the Army. While the COVID-19 pandemic is ongoing and prevention, treatment, and mitigation efforts continue to evolve, having reliable estimates of direct medical and indirect costs from this study allows the U.S. Army and MHS to better account for the cost of this pandemic for its population.

Economic burden of osteoarthritis- multi-country estimates of direct and indirect costs from the BISCUITS study.

Data from 'BISCUITS', a large Nordic cohort study linking several registries, were used to estimate differences in average direct and indirect costs between patients with osteoarthritis and controls (matched 1:1 based on birth year and sex) from the general population in Sweden, Norway, Finland and Denmark for 2017. Patients≥18 years with≥1 diagnosis of osteoarthritis (ICD-10: M15-M19) recorded in specialty or primary care (the latter available for a subset of patients in Sweden and for all patients in Finland) during 2011-2017 were included. Patients with a cancer diagnosis (ICD-10: C00-C43/C45-C97) were excluded. Productivity loss (sick leave and disability pension) and associated indirect costs were estimated among working-age adults (18-66 years). In 2017, average annual incremental direct costs among adults with osteoarthritis (n=1,157,236) in specialty care relative to controls ranged between €1,259 and €1,693 (p<0.001) per patient across all countries. Total average annual incremental costs were €3,224-€4,969 (p<0.001) per patient. Healthcare cost differences were mainly explained by osteoarthritis patients having more surgeries. However, among patients with both primary and secondary care data, primary care costs exceeded the costs of surgery. Primary care constituted 41 and 29 % of the difference in direct costsin Sweden and Finland, respectively. From a societal perspective, the total economic burden of osteoarthritis issubstantial, and the incremental cost was estimated to €1.1-€1.3 billion yearly for patients in specialty care across the Nordic countries. When including patients in primary care, incremental costs rose to €3 billion in Sweden and €1.8 billion in Finland. Given the large economic impact, finding cost-effective and safe therapeutic strategies for these patients will be important.

The 2023 Impact of Inflammatory Bowel Disease in Canada: Executive Summary.

The burden of inflammatory bowel disease (IBD) (i.e., associated direct and indirect costs, prevalence of disease, personal impact to the individual and to caregivers) continues to increase in Canada. The prevalence of IBD has increased since Crohn's and Colitis Canada's 2018 Impact of IBD report from an estimated 270,000 Canadians living with IBD in 2018 to an estimated 322,600 Canadians living with IBD today in 2023. Consequently, associated costs of IBD have also dramatically increased from an estimated $2.57 billion in 2018 to an estimated $5.38 billion in 2023; this increase is due to multiple factors including increased prevalence of disease, inflation, and additional identified factors (e.g., presenteeism, costs of childcare). Beyond the economic impact of IBD, these diseases have a significant impact on people living with the disease and their caregivers, including different presentations of disease, different commonly associated extra-intestinal manifestations or comorbid conditions, and different barriers to accessing care. In this supplementary issue, we review: Evolving trends in the epidemiology of IBD; updated estimates of indirect and direct costs (including out-of-pocket costs) associated with IBD; information specific to IBD in children, adolescents, and seniors; issues related to IBD pertaining to sex and gender; information specific to risks associated with COVID-19 and cancer related to IBD; an overview of current treatments for IBD; and evolving care models, including access to care.

The health and economic burden of musculoskeletal disorders in Belgium from 2013 to 2018

IntroductionLow back pain (LBP), neck pain (NKP), osteoarthritis (OST) and rheumatoid arthritis (RHE) are among the musculoskeletal (MSK) disorders causing the greatest disability in terms of Years Lived with Disability. The current study aims to analyze the health and economic impact of these MSK disorders in Belgium, providing a summary of morbidity and mortality outcomes from 2013 to 2018, as well as direct and indirect costs from 2013 to 2017.MethodsThe health burden of LBP, NKP, OST and RHE in Belgium from 2013 to 2018 was summarized in terms of prevalence and disability-adjusted life years (DALY) using data from the Belgian health interview surveys (BHIS), the INTEGO database (Belgian registration network for general practitioners) and the Global Burden of Diseases study 2019. The economic burden included estimates of direct medical costs and indirect costs, measured by cost of work absenteeism. For this purpose, data of the respondents to the BHIS-2013 were linked with the national health insurance data (intermutualistic agency [IMA] database) 2013–2017.ResultsIn 2018, 2.5 million Belgians were affected by at least one MSK disorder. OST represented the disorder with the highest number of cases for both men and women, followed by LBP. In the same year, MSK disorders contributed to a total of 180,746 DALYs for female and 116,063 DALYs for men. LBP appeared to be the largest contributor to the health burden of MSK. Having at least one MSK disorder costed on average 3 billion € in medical expenses and 2 billion € in indirect costs per year, with LBP being the most costly.ConclusionMSK disorders represent a major health and economic burden in Belgium. As their burden will probably continue to increase in the future, acting on the risk factors associated to these disorders is crucial to mitigate both the health and economic burden.

Catastrophic Costs among Tuberculosis-Affected Households in Egypt: Magnitude, Cost Drivers, and Coping Strategies.

Despite national programs covering the cost of treatment for tuberculosis (TB) in many countries, TB patients still face substantial costs. The end TB strategy, set by the World Health Organization (WHO), calls for "zero" TB households to be affected by catastrophic payments by 2025. This study aimed to measure the catastrophic healthcare payments among TB patients in Egypt, to determine its cost drivers and determinants and to describe the coping strategies. The study utilized an Arabic-validated version of the TB cost tool developed by the WHO for estimating catastrophic healthcare expenditure using the cluster-based sample survey with stratification in seven administrative regions in Alexandria. TB payments were considered catastrophic if the total cost exceeded 20% of the household's annual income. A total of 276 patients were interviewed: 76.4% were males, 50.0% were in the age group 18-35, and 8.3% had multidrug-resistant TB. Using the human capital approach, 17.0% of households encountered catastrophic costs compared to 59.1% when using the output approach. The cost calculation was carried out using the Egyptian pound converted to the United States dollars based on 2021 currency values. Total TB cost was United States dollars (USD) 280.28 ± 29.9 with a total direct cost of USD 103 ± 10.9 and a total indirect cost of USD 194.15 ± 25.5. The direct medical cost was the main cost driver in the pre-diagnosis period (USD 150.23 ± 26.89 pre diagnosis compared to USD 77.25 ± 9.91 post diagnosis, p = 0.013). The indirect costs (costs due to lost productivity) were the main cost driver in the post-diagnosis period (USD 4.68 ± 1.18 pre diagnosis compared to USD 192.84 ± 25.32 post diagnosis, p < 0.001). The households drew on multiple financial strategies to cope with TB costs where 66.7% borrowed and 25.4% sold household property. About two-thirds lost their jobs and another two-thirds lowered their food intake. Being female, delay in diagnosis and being in the intensive phase were significant predictors of catastrophic payment. Catastrophic costs were high among TB households in Alexandria and showed wide variation according to the method used for indirect cost estimation. The main cost driver before diagnosis was the direct medical costs, while it was the indirect costs, post diagnosis.

Economic costs and Predictors of occupation-related Injuries in Ethiopian sugar industries from the Employer’s perspective: top-down approach and friction method

BackgroundFor many industrial workers, occupational injuries are a common health and safety concern. However, sufficient information on the economic costs and predictors of occupation-related injuries from the perspective of employers is lacking in developing countries, including Ethiopia. The objective of this study was to close this gap by quantifying the economic costs and predictors of occupation-related injuries in Ethiopian manufacturing industries from the employer’s perspective.MethodsA cross-sectional study was employed to estimate the employer-side economic cost of occupation-related injuries from December 2021 to March 2022. This study used a top-down approach to compute direct costs, while the friction method was used for indirect cost estimation. Injury data were obtained from the Bureau of Labour and Social Affairs and the industries, while cost data were from workers’ compensation records. The insurance company’s injury compensation record was triangulated with industries’ data. The study collected primary data via an interview-administered, semi-structured questionnaire from 1136 randomly selected injured cases. Statistical analysis was carried out with STATA version 14 software. The study employed a generalized linear model to identify predictors of total cost by considering the non-normal distribution of the total cost. Exponentiate coefficients with a 95% confidence interval were used to express the direction and strength of the association.ResultsThe survey participation rate was 100%. From the perspective of the employers, the total cost of occupation–related injury was 22,587,635.32 Ethiopian birr (537,800.84 $).Indirect and direct costs accounted for 65.86 and 34.14% of the overall expenses, respectively. Long-term absence from work (exp (b) = 0.85), having a sleeping disorder (exp (b) = 0.90), co-morbidity (exp (b) = 0.85), and severity (type) of injury (exp (b) = 1.11) were predictors significantly associated with the total cost variability in the fully adjusted model.ConclusionsEmployers’ toll of occupation-related injuries has severe economic implications. The influential factors that elevated the total cost variation were: long-term absence from work, unsafe acts of the workers, having a sleeping disorder, co-morbidity, and severity (type) of injury. Therefore, the identified modifiable factors are the areas of intervention to reduce the cost of occupation-related injuries.

Severe Aplastic Anemia: A Systematic Literature Review on Costs of Illness

Introduction: Aplastic anemia (AA) is a rare and potentially life-threatening disorder of inherited or acquired bone marrow failure, progressively leading to pancytopenia. AA has an annual incidence estimated at 2 cases per million in Europe and US/Canada, which tends to be significantly higher in East Asia. Severe clinical presentations of the disease constitute hematological emergencies and incur a substantial economic burden to health systems, patients, and caregivers. Our systematic literature review (SLR) of costs of illness of severe AA (SAA) globally describes the economic implications of the disease. Methods: This SLR was conducted using MEDLINE (through PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Web of Science, National Health Service Economic Evaluation Database, and the National Health Service Health Technology Assessment Database. The objective was to identify records of studies published from inception up until 31 May 2022, reporting estimates of direct, indirect, and total costs of illness of SAA in any currency. No eligibility criteria concerning study type, language, geography, or time limits were employed. Retrieved records were screened for eligibility by two reviewers independently and any disagreements were resolved by a third investigator. Extracted data were then quality checked. Costs were adjusted and converted to 2021 US dollars. Results: The search identified 768 publications, of which 28 were selected for full-text review and 11 were included in the final analysis. Four studies were from the USA and one each from Sweden, Germany, France, South Africa, Mexico, Brazil, and China. Five studies presented retrospective analyses of real-world data, five reported cost-effectiveness treatment data and one estimated the budget impact of treatment for SAA. Two studies presented cost estimates by age strata and one evaluated SAA treatment-related costs in children. The mean per patient monthly direct cost ranged from $430 (immunosuppressive therapy (IST), China) to $40,107 (IST, USA). The mean direct cost in children treated for SAA amounted to $18,029 and for patients ≤21 years of age the total cost of illness was estimated between $979 and $23,351 per patient. SAA-related costs were lower among older patients. None of the studies reported informal care or indirect costs. Overall, the cost key driver were prescription medications. However, the associated costs to prescription medicines were counterbalanced by reduced hospitalizations, outpatient costs and rescue medication used. Conclusions: To the best of our knowledge, no study has systematically reviewed the literature for estimates pertaining to the economic impact of SAA. Available evidence on the costs of illness of the disease is extremely limited and considerably heterogenous in terms of geographical territories. Further research is needed to identify excess costs and cost variations so as to improve disease management practices in purpose of attaining better patient outcomes and disease prognosis at lower cost.

Author Response: The Economic Burden of Multiple Sclerosis in the United States: Estimate of Direct and Indirect Costs.

Author Response: The Economic Burden of Multiple Sclerosis in the United States: Estimate of Direct and Indirect Costs.

Editors' Note: The Economic Burden of Multiple Sclerosis in the United States: Estimate of Direct and Indirect Costs.

Editors' Note: The Economic Burden of Multiple Sclerosis in the United States: Estimate of Direct and Indirect Costs.

Reader Response: The Economic Burden of Multiple Sclerosis in the United States: Estimate of Direct and Indirect Costs.

Reader Response: The Economic Burden of Multiple Sclerosis in the United States: Estimate of Direct and Indirect Costs.

Indirect Cost Estimation of Winter Storm–Induced Power Outage in Texas

Indirect Cost Estimation of Winter Storm–Induced Power Outage in Texas

ECONOMIC BURDEN OF THE MOST COMMON INFECTIOUS DISEASES IN CHILDREN IN SLOVENIA

Background: In Slovenia, infectious diseases are in children are common cause of visits to primary care physicians, of hospital admissions and the cause of death. They also represent a significant economic burden.Methods: We analyzed routinel calculated data from the data bases of the National Institute of Public Health of the Republic of Slovenia International Journal of Research Granthaalayah (2022), National Institute of Public Health of the Republic of Slovenia (2022) for the time period 2005. We analyzed data with the particular attention on the most frequent or the most expensive infectious diseases of children, Data were classified from recommended literature from CDC Atlanta, according to the most to the International Classification of diagnoses ICD-9 precoded to ICD-10.Results: Our cost estimate is made from a disease costing model, included estimates of direct and indirect costs for selected infectious diseases in 2005. The cost was amounted to EUR 14620187 for children aged 0 to 6 years and EUR 4408773 for children aged 7 to14 years, which account for a 16.97% share of all diseases for children aged 0-6 years and 17.3% of all diseases for children aged 7-14 years. This cost included the cost of first examination in general practice at the primary level, costs, prices calculated from the first examination by a specialist at the secondary level, the cost of hospital of treatment, and the cost of the lost human capital. For children aged 0 to 6 years has the highest costs due to lower respiratory tract infectious due to hospital treatment, and upper respiratory infectious due to visit a doctor. For children aged 7 to 14 years costs were higher of abdominal and intestinal infectious due to hospital treatment and upper respiratory infections due to visit a doctor.Conclusions: In the analysis we estimated the burden of common infectious diseases of children in Slovenia and related economic costs by using routinely collected data. The results are important for monitoring and forecasting health care and health care cost in Slovenia. We expect that the use of information on the burden will bring about more attention to the quality and completeness of the clinical data Preedy and Watson (2010).

Cost-effectiveness of adding oseltamivir to primary care for influenza-like-illness: economic evaluation alongside the randomised controlled ALIC4E trial in 15 European countries

BackgroundOseltamivir is usually not often prescribed (or reimbursed) for non-high-risk patients consulting for influenza-like-illness (ILI) in primary care in Europe. We aimed to evaluate the cost-effectiveness of adding oseltamivir to usual primary care in adults/adolescents (13 years +) and children with ILI during seasonal influenza epidemics, using data collected in an open-label, multi-season, randomised controlled trial of oseltamivir in 15 European countries.MethodsDirect and indirect cost estimates were based on patient reported resource use and official country-specific unit costs. Health-Related Quality of Life was assessed by EQ-5D questionnaires. Costs and quality adjusted life-years (QALY) were bootstrapped (N = 10,000) to estimate incremental cost-effectiveness ratios (ICER), from both the healthcare payers’ and the societal perspectives, with uncertainty expressed through probabilistic sensitivity analysis and expected value for perfect information (EVPI) analysis. Additionally, scenario (self-reported spending), comorbidities subgroup and country-specific analyses were performed.ResultsThe healthcare payers’ expected ICERs of oseltamivir were €22,459 per QALY gained in adults/adolescents and €13,001 in children. From the societal perspective, oseltamivir was cost-saving in adults/adolescents, but the ICER is €8,344 in children. Large uncertainties were observed in subgroups with comorbidities, especially for children. The expected ICERs and extent of decision uncertainty varied between countries (EVPI ranged €1–€35 per patient).ConclusionAdding oseltamivir to primary usual care in Europe is likely to be cost-effective for treating adults/adolescents and children with ILI from the healthcare payers’ perspective (if willingness-to-pay per QALY gained > €22,459) and cost-saving in adults/adolescents from a societal perspective.

The Economic Burden of Multiple Sclerosis in the United States: Estimate of Direct and Indirect Costs.

Background and ObjectivesA recent report estimated that approximately 1 million adults were living with multiple sclerosis (MS) in the United States. Although MS is rarely the direct cause of death, its debilitating effects on normal body functions can result in considerable disruption to daily living and life roles including work, physical independence, mobility, social interaction, and participation in leisure activities. This study estimated the total economic burden of MS in the United States in 2019.MethodsThis study used a prevalence-based approach to estimate the national economic burden of MS. Claims from 3 sources (Medicare Current Beneficiary Survey, Medicare Standard Analytical File, and Optum de-identified Normative Health Information System) were used to obtain direct costs and a survey was developed to collect indirect costs (e.g., labor market productivity losses, costs of paid and unpaid caregivers, home modification) from 946 patients with MS (PwMS). Direct medical costs reflected the difference in the total average annual amount paid for PwMS vs matched controls without MS. Future earnings loss due to premature death attributable to MS was calculated using Centers for Disease Control and Prevention mortality data and Medicare claims data.ResultsThe estimated total economic burden was $85.4 billion, with a direct medical cost of $63.3 billion and indirect and nonmedical costs of $22.1 billion. Retail prescription medication (54%); clinic-administered drugs, medication, and administration (12%); and outpatient care (9%) were the 3 largest components of the direct costs. The average excess per-person annual medical costs for PwMS was $65,612; at $35,154 per person, disease-modifying therapies (DMTs) accounted for the largest proportion of this cost. The cost per DMT user ranged from $57,202 to $92,719, depending on sex–age strata. The average indirect and nonmedical costs were $18,542 per PwMS and $22,875 per PwMS if caregivers' costs were included. Lost earnings due to premature death, presenteeism, and absenteeism losses were the largest indirect cost components.DiscussionMS is a costly chronic disease, with direct costs of prescription drugs and indirect productivity loss being important cost drivers. Our findings suggested that the burden of MS in the United States has been underestimated.

Pressure injuries in Australian public hospitals: A cost of illness study

BackgroundPressure injuries are a leading hospital adverse event, yet they are mostly preventable. Understanding their financial costs will help to appreciate the burden they place on the health system and assist in better planning and management of health expenditures to prevent pressure injuries. ObjectiveTo estimate the cost of pressure injuries in Australian public hospitals in 2020 demonstrating its economic burden in a well–resourced health system. MethodsA cost of illness study with a 12-month time horizon was conducted. Resource use for the treatment of pressure injuries and productivity loss due to pressure injuries were derived using a bottom-up approach. Parameters of the cost estimates were obtained from secondary sources and literature syntheses. A simulation with 10,000 draws was used to generate statistical properties of the cost estimates. ResultsBased on a prevalence of 12.9%, the total cost of pressure injuries in Australian public hospitals was $9.11 billion [95% confidence intervals: 9.02, 9.21]. The two largest shares of costs were accounted for by the opportunity cost of excess length of stay of $3.60 billion [3.52, 3.68] and treatment costs of $3.59 billion [3.57, 3.60]. Productivity loss associated with pressure injuries amounts to $493 million [482, 504]. Hospital-acquired pressure injuries account for a total of $5.50 billion [5.44, 5.56], whereas pressure injuries present on admissions costed $3.71 billion [3.70, 3.72]. In terms of severity, Stage 2 pressure injuries contributed the most to total treatment costs, total excessive length of stay, and total loss of healthy life years. Australian society is willing to pay $1.43 billion [1.40, 1.45] to save 6,701 [6,595; 6,807] healthy life years lost by pressure injury. ConclusionsReducing preventable pressure injuries and stopping the progression of Stage 1 pressure injuries will likely result in an immense cost-saving for Australia and will likely have similar benefits for other countries with comparable profiles. Tweetable abstractAustralian public hospital study provides comprehensive analysis of the cost of pressure injury, including estimates of direct and indirect medical costs, and indirect non-medical costs - such as productivity and quality of life.

Economic and Humanistic Burden of Triple-Negative Breast Cancer: A Systematic Literature Review.

BackgroundTriple-negative breast cancer (TNBC) accounts for 10–20% of all breast cancers (BCs). It is more commonly diagnosed in younger women and often has a less favorable prognosis compared with other BC subtypes.ObjectiveThe objective of this study was to provide a literature-based extensive overview of the economic and humanistic burden of TNBC to assist medical decisions for healthcare payers, providers, and patients.MethodsA systematic literature review was performed using multiple databases, including EMBASE, MEDLINE, Econlit, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews, from database inception to 16 May 2021. In addition, a targeted search was performed in the Northern Light Life Sciences Conference s database from 2016 through June 2021. The bibliographies of included articles were reviewed to identify other potentially relevant publications. Quality assessment of the included studies was conducted.ResultsThe review identified 19 studies assessing the economic burden and 10 studies assessing the humanistic burden of TNBC. Studies varied widely in study design, settings, patient populations, and time horizons. The estimates of mean per-patient annual direct medical costs ranged from around $20,000 to over $100,000 in stage I–III TNBC and from $100,000 to $300,000 in stage IV TNBC. Healthcare costs and resource utilization increased significantly with disease recurrence, progression, and increased cancer stage or line of therapy. Compared with the costs of systemic anticancer therapy, cancer management costs comprised a larger portion of total direct costs. The estimates of indirect costs due to productivity loss ranged from $207 to $1573 per patient per month (all costs presented above were adjusted to 2021 US dollars). Cancer recurrence led to significantly reduced productivity and greater rates of leaving the workforce. A rapid deterioration of health utility associated with disease progression was observed in TNBC patients. Treatment with pembrolizumab or talazoparib showed significantly greater improvements in health-related quality of life (HRQoL) compared with chemotherapy, as measured by EORTC QLQ-C30, QLQ-BR23, and FACT-B.ConclusionTNBC is associated with a substantial economic burden on healthcare systems and societies and considerably reduced productivity and HRQoL for patients. This study synthesized the published literature on the economic and humanistic burden of TNBC and highlighted the need for continued research due to the rapidly changing landscape of TNBC care.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40273-021-01121-7.

APPROACHES TO ESTIMATING INDIRECT COSTS IN HEALTHCARE: MOTIVATIONS FOR CHOICE

When performing health economic evaluations all costs and expected benefits (in terms of clinical effectiveness, utility, monetary benefits) should be taken into account. Costs are direct and indirect: concerning the latter, two main methods have been developed. The Human Capital Approach (HCA) considers the gross salary in the days of absence from work due to illness; the method based on the Friction Costs (FC), instead, considers equally the value of productivity, but the losses are limited to the period of illness when it is necessary to replace the absent worker. This paper conducts a review of the literature contributions for European countries and aims at identifying common trends within geographical areas. Estimation of indirect costs in different European areas may reflect the real cost of health services across countries and schematize the conditions under which a certain method should be preferred. Overall, cost analyses applying HCA are the most frequent, while studies based on FC are more common in the Netherlands, where this method had been developed. The reasons to apply HCA or FC may depend on the institutional context, for example, the flexibility in the job market, and the epidemiologic environment.

POSC38 Study on the Management of Carriers in Hereditary Transthyretin Amyloidosis (EMPATIA): Economic and Healthcare Resource Utilization in Spain

Hereditary transthyretin amyloidosis with polyneuropathy (ATTR-PN) is a rare and multisystemic disease. Scarce evidence about its economic burden has been published, especially regarding carriers and early stage patients. To characterize these populations, a descriptive study was developed in Spain. Secondary endpoints were estimation of the use and costs of healthcare resource utilization (HRU) and estimation of indirect costs from a societal perspective.