Indirect Expenses Research Articles

Health insurance coverage and out-of pocket expenditure

Introduction: Catastrophic health spending is one of the major factors pushing people into poverty. Reducing “out-of-pocket expenditure (OOPE)” on health through health insurance coverage is an effective approach. The objectives of this study are (1) to estimate health insurance coverage among rural and urban households (HHs) and (2) to determine the proportion of income spent on health as OOPE among the selected HHs. Material and Methods: A cross-sectional study was conducted in rural and urban parts of district Faridabad, Haryana. A sample of 374 were taken from rural and urban areas. The unit of the study was HHs in both the areas. The proportion of income spent on health care (both direct and indirect expenses included) as OOPE was taken as outcome variable. Results: Health insurance coverage was higher among urban HHs (58.0%) as compared to the rural (38.5%). The rural population was availing of private consultation, laboratory, and pharmacy services to a greater extent than the urban; hence, they were spending a substantial proportion of their income on health-care services. The majority of the HHs in the rural and urban areas spent up to 20% of their income on health care. Conclusion: Universal health coverage without health insurance is unlikely.

Out-of-pocket expenditures, catastrophic household finances, and quality of life among hemodialysis patients in Kerala, India.

Kidney replacement therapy in chronic kidney disease patients can result in catastrophic health costs, pushing them into poverty in lower middle-income countries. There are only limited studies from India focusing on the financial hardship of these patients. Data on direct nonmedical and indirect cost of hemodialysis (HD) are also limited. This study aims to find the different components of cost for HD and its association with quality of life (QOL) among HD patients. Primary objective was to find the cost of HD, which include direct medical, direct nonmedical and indirect cost. Secondary objective was to study whether the ratio of out-of-pocket (OOP) payments for HD to household income can affect the QOL. The QOL was assessed using EQ-5D-5L instrument. Catastrophic health care expenditure was defined as OOP health care expenditure exceeding 40% of the household income and distress financing as borrowing money or selling assets to meet the OOP expenditure for treatment. Of the 152 patients enrolled for the study, 103 (67.8%) were males. Mean age was 60.9 ± 12.5 years. Monthly OOP expenditure for dialysis was USD 478.4 (362.6-663.6) of which direct nonmedical and indirect expenses constitute USD 115.6 (88.4-292.4). Median percentage of household income spent for dialysis was 194.5 (IQR 128-297). One hundred and forty-two (93.4%) had catastrophic healthcare expenditure and 76 (50%) had distressing health care expenditure. On multivariable linear regression, proportion of total household income spend for dialysis was associated with poor QOL in patients undergoing HD; coefficient=-0.04 (95% CI -0.008 - 0.092), p=0.039. Nonmedical direct and indirect cost is substantial among patients undergoing HD. Nine of 10 patients had catastrophic health care expenditure, which pushed 50% of the patients to distress financing.

Atopic Dermatitis in Latin America: A Roadmap to Address Data Collection, Knowledge Gaps, and Challenges.

Atopic dermatitis (AD) is a systemic, multifactorial disease that causes significant morbidity and health care burden in Latin America (LA). Data on AD are scarce in LA. Lack of disease registries and non-standardized study methodologies, coupled with region-specific genetic, immunological, and environmental factors, hamper data collection. A panel of LA experts in AD was given a series of relevant questions to address before a conference. Each narrative was discussed and edited through numerous rounds of deliberation until achieving consensus. Identified knowledge gaps in AD research were updated prevalence, adult-disease epidemiology, local phenotypes and endotypes, severe-disease prevalence, specialist distribution, and AD public health policy. Underlying reasons for these gaps include limited funding for AD research, from epidemiology and public policy to clinical and translational studies. Regional heterogeneity requires that complex interactions between race, ethnicity, and environmental factors be further studied. Informed awareness, education, and decision making should be encouraged.

Resource utilization and futile management in terminally ill cancer patients: A perspective from hospital-based palliative care program in Saudi Arabia.

e24006 Background: The palliative care needs for cancer patients are on the rise across MENA region (Middle East and North Africa) with economical and quality of health-care implications. We believe this is the first reported study in the Saudi Arabia about resource utilization and futile management from a hospital-based palliative care program for terminally ill cancer patients. Methods: The data was collected retrospectively, the data collection took palace in the year 2018. The data collection tool consisted of seven parts, 1- Patient’s information, 2- Initial diagnostic procedures, 3- Imaging procedures 4- Pathology and laboratories workup, 5- Treatment modalities (if any), 6-Healthcare facility and resources utilization, 7- Palliative care utilization. Results: A total of 103 patients were included, their median age 66 years (20-94), and (58%) were females, the majority of the cases had stage IV cancer 99 (96.1%), half of them with gastrointestinal cancer 44 (42.7%). During their stay under PCU, 59 (57.3%) had chest X-rays, 21.4% ECG and 14.6% Abdominal ultrasound, various types of Computed Topographies (CT) were done for 18 patients (17.4%). Daily multiple times glucose checking was done for all patients, and complete blood count was done for 81.6%. Only 31 patients (30%) visited the Emergency Department ED after being transferred to PCU, 83 patients (80.6%) had no outpatient clinic visit at all. The median duration for palliative care was 17 days, while the median duration for oncology service is 193 days. The majority of the patients (n = 68) died within 30 days from transfer to palliative care, among them 4 patients (4 %) died on the same day of transfer. No statistically significant differences were found between males and females regarding the days from diagnosis to palliative transfer, days from diagnosis to palliative referral, the number of visits to ED, and the number of non- ICU admissions. Conclusions: Many patients were exposed to unnecessary procedures with no clinical implications, e.g. CT scans, EKGs, daily multiple labs. There is a significant delay in transferring the patients to palliative care service, policies and regulations are needed for timely transfer to palliative care services for cancer patients. Early complex advance care planning is an essential tool to combat futile management. 100% deaths in palliative care unit may reflect limitations for palliative care providers for alternate placements. Predominant use of palliative care unit for the end of life care would drive health care cost to higher level from direct and indirect expenses.

WHAT IS REWARD BASED CROWDFUNDING? RBS IN INDIA

In today’s world of ability and innovation, the population is occupied with varied business ideas. From promoter’s sight, generation of business proposal is less complicated than composition for the fund for its application. At present, the businessmen have several choices from that they'll prepare funds particularly shares, banks, personal lenders, capital establishments and different monetary organizations. however still there are varied frequent expenses that don't seem to be supported by these organization. To trot out these initial capital and indirect expenses a replacement idea has aroused that's crowdfunding. Crowdfunding is wide utilized in developed countries like America whereas in Asian nation, the population continues to be less privy to it. the current analysis study is completed with Associate in Nursing intention to spot the event of crowdfunding in Asian nation. For this several analysis studies drained {india|India|Republic of Asian nation|Bharat|Asian country|Asian nation} and out of doors India are referred

Cost of breast cancer diagnosis and treatment in India: a scoping review protocol

IntroductionBreast cancer is the foremost cause for mortality among women. The non-communicable disease imposes significant economic expenses to communities. Its economic impact includes both direct and indirect healthcare costs. This...

Profitability of Hybrid Marigold Flower Cultivation in Madhya Pradesh: An Assessment

Marigold flower, the most important commercial flower in India and Madhya Pradesh is one of the highest marigold flowers producing state. This study was carried out to estimate the cost and returns of hybrid marigold flower cultivation using primary data collected during the year of 2017-18 from 120 growers selected from Ratlam and Indore districts of Madhya Pradesh. The operating expenses incurred during production of hybrid variety of marigold i.e. cost A1 was assessed to be ` 79252, ` 88026 and ` 84627 per ha for small, medium and large size growers, respectively. Considering all direct and indirect expenses, i.e. cost C3 was estimated to be ` 160331, ` 174817 and ` 173763 per ha for three categories. It was found that the highest net income ` 150911 per ha was received by medium size growers for hybrid variety followed by large growers (` 136103/ha) and small growers (` 134965/ha).

Socio-economic burden of disease: Survivorship costs for bladder cancer

BackgroundIn this cost-of-illness study, we analysed the socio-economic burden of bladder cancer survivorship for the ten years after initial treatment in Germany during 2000, 2010 and 2020. MethodsBladder cancer follow-up guidelines were extracted from the European Association of Urology. Per patient costs were estimated with a micro-costing approach considering direct and indirect medical expenses derived from literature and official scales of tariffs. Three perspectives covering costs for patients, providers, and insurers were included to estimate societal costs. ResultsMean 10-year follow-up costs per patient amounted to EUR 2214 for low-risk, EUR 4758 for medium-risk, and EUR 11,325 for high-risk non-muscle invasive bladder cancer (NMIBC) in 2020. The mean economic burden of muscle-invasive and metastatic bladder cancer (MIBC) was EUR 8994 per patient. Overall expenditure rose by 65% from 2000 to 2020 across all cancer stages (p < 0.001). While insurers covered 38% of costs in 2000, only 31% of costs were reimbursed in 2020 (p < 0.001). 58% of high-risk NMIBC follow-up resources were consumed by physician-patient visits and 17% by medical imaging (x-ray, CT-IVU, ultrasound). Spending was unevenly distributed across follow-up years (years 1–2: 43%, years 3–5: 29%, years 5–10: 28%). ConclusionsThe rising socio-economic burden of follow-ups signifies the relevance of cancer survivorship for the healthcare system and society. This burden must be evenly distributed across stakeholders and considered in cost-effectiveness evaluations of novel anti-cancer drugs.Policy summaryPersonalized, equitable, and effective follow-up schedules covered by insurance funds are necessary to care for cancer survivors.

The out-of-pocket cost of breast cancer care at a public tertiary care hospital in Nigeria: an exploratory analysis.

Introductionin Nigeria, the incidence of breast cancer has increased by over 80% in the last four decades. This study quantifies the out-of-pocket (OOP) cost of breast cancer management and the associated rate of catastrophic healthcare expenditure (CHE) at a public tertiary care facility in Ile-Ife, Nigeria.Methodspatients treated between December 2017 - August 2018 were identified from a prospective breast cancer database. A questionnaire was developed to capture the total cost of care, including direct and indirect expenses. Three commonly used thresholds for a CHE were used in this analysis. The cost of radiotherapy and targeted therapy were captured separately.Resultsdata was collected from 22 eligible patients. Sixty-eight percent had no form of health insurance. The mean cost of diagnosis and treatment was $2,049 (SD $1,854). At a threshold of 10% and 25% of annual income, 95% and 86% of households experienced a CHE. Based on a household´s capacity-to-pay, 90% experienced a CHE. The mean cost of radiotherapy was $462 (SD $223) and the mean cost of trastuzumab was $6,568 (SD $2,766). Cost precluded surgery in 14% of patients with resectable disease. As a result of accessing treatment, 72% of households had to borrow money and 9% of households interrupted a child´s education.Conclusionthe out-of-pocket cost of breast cancer care in Nigeria is significant. This results in a CHE for 68-95% of households, which has significant health and economic sequelae. Greater financial protection is essential as the burden of breast cancer increases in Nigeria.

A Study on Improvement of Tax Credits for Revitalization of Film and Video Industry

COVID 19 팬데믹 상황은 극장에 다수의 사람이 모일 수 없게 하고, 소비자들은 대부분의 영상콘텐츠를 비대면으로 향유하도록 강요받고 있으며, 바야흐로 메타버스 시대의 도래는 영상콘텐츠를 향유하는 매체를 획기적으로 다양화하고 있다. 작금의 여러 가지 대내외 여건의 변화에도 불구하고 그래도 역시 중요한 것은 결국 콘텐츠 그 자체이다. 양질의 콘텐츠를 지속적으로 창작하고 상품화할 수 있는 시장환경이 필요하다. 이를 위해서는 정부의 적극적인 지원과 관심이 필요하다. 산업으로서의 영상콘텐츠는 규제와 진흥 및 성장을 필요로 하는 점에서는 다른 여타의 산업분야와 유사하다고 말할 수 있으나, 일반 제조업에서와는 다른 “Soft Power”로서의 산업 자체의 특성을 고려한 지원과 정책을 마련할 필요가 크다. 2021년 세법개정안에서 국내 OTT사업자에 대해서도 영상콘텐츠 제작비 세액공제 대상으로 포함시킨 것은 이러한 시대상을 반영한 합리적인 선택이었다고 평가할 수 있다. 그러나 세액공제율이 다른 선진국에 비해 상대적으로 낮고 국내제작비에 국한한 지원에 불과하며 그 일몰시한이 내년으로 다가오는 문제점이 지적될 수 있다. 특히 해외와 국내 병행제작이 늘어나고 있는 추세에서 해외에서 납부한 세액을 우리나라의 법인세 등을 신고납부할 때 공제하여 이중과세를 제거함에 있어서도 외국납부세액 전액을 세액공제할 수 있도록 공제한도규제를 개선하고 한도초과액의 이월공제를 실질적으로 보장하여 해외 제작 영상콘텐츠기업의 세부담을 대폭 완화하여 글로벌 경쟁력을 확보할 수 있도록 지원하여야 할 것이다. 그밖에 연구개발비 세액공제를 적용함에 있어서도 기존의 제조업 중심의 물적 시설요건을 배제하고 콘텐츠 기획 개발 활동을 연구개발비 세액공제 대상으로 명시하는 등 소프트 파워로서의 영상콘텐츠기업에 걸맞는 세제로 탈바꿈하도록 하여 본래 의도한 입법취지가 제대로 살아날 수 있도록 영상콘텐츠산업 관련 지원 세제를 개선할 것을 제안한다.This article aims to present the legal improvement of tax credits for Korean Film and Video industry, whch is main stream of media platforms in the era of Metaverse. Since 2017 film industry of Korea receives indepen- dent benefits of tax credit: so called, film and video tax credit. But the rate and subject of the film and video tax credit is ralatively small and poor in comparison to the western countries like USA, Canads, England, France etc. Contents are so called ‘Soft Power’. Film and video industry can not satisfy the conditions of tax credits, wich is made originally for the manufacturing industry. Currently the rate of tax credit for film and video company is 3%(mid-sized company 7%, small business 10%). The deadline of tax credit is 31.12.2022. This article proposes to double the rate: 6%(mid-sized company 14%, small business 20%) and to extend the deadline: 31.12.2025. The author proposes also to include the ‘OTT’ company to the tax credit subject. OTT is getting more competing with traditional film and video companies. Further- more the foreign tax credit must be deregulated: the deduction limit should be eliminated by disallowing of direct and indirect expense deduction. Also R&D tax credit must be allowed without material requirements: and affilli- ated research institute and dedicated departments etc. Through all these suggestions it is highly expected that Korean film and video industry will grow one step further than before.

Profit Calculation in a Late 14th Century Sole Proprietorship: The Case of Francesco Datini

ABSTRACT This paper examines the Profit on merchandise accounts (a forerunner of the income statement) in a sole proprietorship in Pisa that officially operated between 1386 and 1392, but took several months to finally end its activities, which it did in 1393. The Profit on merchandise account was where the balance on each goods account was transferred when all the items recorded in it were sold. The principal contribution of this paper is the identification of a unique approach to medieval product costing that ensured indirect expenses on merchandise were recovered from customers when sales took place, while earning an average return of over 10 percent on those costs. It also highlights the problems encountered when working with archival material that has deteriorated over time; and presents a research method that reconstructs missing data using the trail to original entries and contra entries recorded in double entry.

Clinical and economic justification of screening for mucopolysaccharidosis type I in children at groups of risks

Background.Mucopolysaccharidosis Type I (MPS I) has clinical heterogeneity without specific symptoms leading to difficulties with diagnostic on time. In-depth screening for MPS I in children has aim of early detection and timely treatment with an enzyme replacement therapy.Aim.The purpose of this study was to conduct a clinical and economic assessment of the feasibility of screening for MPS I in children at group of risks.Materials and methods.Model for evaluation of the social-economic burden of MPS I with calculation of expenditures has been created. Costs of diagnosed and non-diagnosed patients in group of risks were identified, including direct medical costs (pharmacotherapy, out-patient cure, hospital admission, complications treatment, hematopoietic stem cell transplantation; direct non-medical (payments for disability); indirect (expenses related to the reduction or loss of the ability to work of one of the parents performing the duties of caring for a disabled child).Results.The weighted average cost per 1 diagnosed patient with mild forms of MPS I with selective screening, was 405,974.22 rubles, which is 184,421.85 rubles less vs average cost per 1 undiagnosed patient. The management and treatment of patients with mild forms of MPS I after selective screening will allow saving up to 17.7 million rubles/year, which would possible to additionally screen 705 patients. Taking into account the size of the population of patients with undiagnosed MPS I, currently the costs for this group amount to 56.7 million rubles, while the «overspend» of budget funds for untimely diagnosis of MPS I for this cohort of children is about 22.6 million rubles/year.Conclusion.Selective screening for MPS I in children at group of risks is economically proved and can lead to treatment on-time for disability and complications prevention.

Clinical and economic assessment of the therapy of acute kidney injury in sepsis with continuous combined methods of renal replacement therapy

Objective: complex assessment of clinical and economic effectiveness as well as saving of the state budget assets within the therapy of patients with sepsis/septic shock based on different technologies of blood purification.Methods. Evaluation of direct and indirect costs of the eight blood purifcation methods. The target population includes adult patients 18+ with septic acute kidney injury. The study was conducted in compliance with acting Standards on Clinical Economic Studies used in the Russian Federation.The study methods included evaluation of existing randomized clinical studies and trials with data from network meta-analyses and systematic reviews of the target technologies. The direct medical and indirect non-medical costs were calculated and analyzed in respect of cost-effectiveness and budget impact analyses.Results. Direct and indirect costs were calculated for the sorption devices oXiris (Baxter International Inc.), Toraymyxin (Toray Medical Co.), Alteco LPS Adsorber (Alteco Medical AB), Toxipak (POKARD NPF), Desepta.LPS (BIOTECH M NPP), CytoSorb (CytoSorbents Inc.), HA330 (Jafron Biomedical Co.), Desepta (BIOTECH M NPP) for two time-horizons: 1-year period and 5-years period with discounting. For both periods, the use of oXiris hemoflter results in the least economic burden for the state budget.Conclusion. The use of blood purifcation in septic patients therapy is associated with considerable direct and indirect fnancial expenses, the amount of which and consequential budget saving depend on the technology of blood purifcation applied. The actual tariff compensation policy evidently demands revising.

Analysis of the impact on the health care budget and consumers of the use of the preparation of omega-3 acid ethyl esters90 in the treatment of patients with atherogenic dyslipidemia.

Aim To evaluate economic results of using omega-3 acid ethyl esters 90 for primary prevention of cardiovascular catastrophes in patients with residual hypertriglyceridemia (HTG).Material and methods The economic evaluation of using the medicine omega-3 acid ethyl esters 90 in the system of drug provision of the population of the Russian Federation was performed by analyzing the effect on the budget using a pharmacoeconomic model developed with the Microsoft Office Excel 2016 software. The effect of omega-3 acid ethyl esters 90 was evaluated in 555 643 patients with residual HGT (Moscow). The study lasted for one year. Results of the meta-analysis by A.A. Bernasconi et al. (2020) were used as a source of efficacy data. The following direct and indirect medical expenses for treatment of cardiovascular complications of residual HTG were taken into account in this study: expenses for drug therapy; expenses for therapy and rehabilitation for nonfatal complications; expenses for fatal outcomes; state support for disability; foregone per capita gross domestic product resulting from losses of earnings due to temporary incapacity to labor by people of work-able age; and salary payments for temporary incapacity to work.Results Using omega-3 acid ethyl esters 90 in 555 643 patients with residual HTG will allow preventing 1 437 fatal ischemic cardiovascular complications (including 564 deaths from ischemic heart disease and 1 128 cases of myocardial infarction (MI), including 558 fatal cases of MI). Furthermore, the difference in expenses compared to the high-dose statin treatment alone will be 359 252 253 rubles or 0.32 %.Conclusion The results of this comprehensive pharmacoeconomical study showed that the use of omega-3 acid ethyl esters 90 in patients with residual HGT is an economically preferrable strategy compared to high-dose statin treatment alone and does not influence significantly the budgetary expenses as a part of the State Guarantee of Free Medical Care to the Citizens of the Russian Federation (increase in expenses by 0.32 % compared to the current practice). At the same time, the use of omega-3 acid ethyl esters 90 results in a 10% decrease in the number of fatal ischemic cardiovascular complications.

Long-Term Neurological Sequelae and Disease Burden of Japanese Encephalitis in Gansu Province, China.

Background and objects:The study aimed to evaluate the long-term neurological sequelae and the disease burden of JE in Gansu, China.Methods:JE patients were included as study population from 2005–2011 in Gansu, and a follow-up survey was conducted in 2007–2014. Pair-matched healthy individuals were selected as controls. All subjects underwent a neurological examination and intelligence quotient (IQ) and memory quotient (MQ) assessments. Then, the disability-adjusted life years (DALYs), and direct and indirect medical expenses were systematic assessed.Results:Forty-four point seven percent of the JE patients had objective neurological deficits, compared with 2.4% of controls. Subnormal intelligence was found in 21.2% of JE subjects, compared with 1.2% control who exhibited a mildly reduced IQ. Abnormal MQ scores were noted in 56.3% JE subjects, compared with only 12.7% controls. Prevalence of each sequelae caused by JE were significantly higher in adults than in younger subjects. Furthermore, median DALY lost due to JE was 9.2 per subject. Median economic cost of JE was approximately $2776.6 per subject and significantly higher in adults than in younger subjects.Findings and Conclusions:JE patients suffered from severe neurological sequelae and high disease burden, resulting in a significant downstream burden for both the patients (especially adults) and the healthcare system.

Sulfur Biogeochemical Cycle of Marine Sediments

Complex interactions between microbial communities and geochemical processes drive the major element cycles and control the function of marine sediments as a dynamic reservoir of organic matter. Sulfate reduction is globally the dominant pathway of anaerobic mineralisation and is the main source of sulfide. The effective re-oxidation of this sulfide at the direct or indirect expense of oxygen is a prerequisite for aerobic life on our planet. Although largely hidden beneath the oxic sediment surface, the sulfur cycle is therefore critical for Earth’s redox state. This Geochemical Perspectives begins with a brief primer on the sulfur cycle of marine sediments and a description of my own scientific journey through nearly fifty years of studies of sulfur geochemistry and microbiology. Among the main objectives of these studies were to quantify the main processes of the sulfur cycle and to identify the microbial communities behind them. Radiotracers in combination with chemical analyses have thereby been used extensively for laboratory experiments, supported by diverse molecular microbiological methods. The following sections discuss the main processes of sulfate reduction, sulfide oxidation and disproportionation of the inorganic sulfur intermediates, especially of elemental sulfur and thiosulfate. The experimental approaches used enable the analysis of how environmental factors such as substrate concentration or temperature affect process rates and how concurrent processes of sulfate reduction and sulfide oxidation drive a cryptic sulfur cycle. The chemical energy of sulfide is used by chemolithotrophic bacteria, including fascinating communities of big sulfur bacteria and cable bacteria, and supports their dark CO2 fixation, which produces new microbial biomass. During the burial and aging of marine sediments, the predominant mineralisation processes change through a cascade of redox reactions, and the rate of organic matter degradation drops continuously over many orders of magnitude. The main pathways of anaerobic mineralisation and the age control of the organic matter turnover are discussed. In the deep methanic zone, only a few percent of the entire degradation process remains, which provides a small boost of substrate for sulfate reduction through the process of anaerobic methane oxidation. The stable isotopes of sulfur provide an additional tool to understand these diagenetic processes, whereby the combination of microbial isotope fractionation and open system diagenesis generate a differential diffusion flux of the isotopes. In relation to the organic carbon cycle of the seabed and the contribution of methane, the paper discusses the global sulfur budget and the role of sulfate reduction for organic matter mineralisation in different depth regions of the ocean – from coast to deep sea. The published estimates of these parameters are evaluated and compared. Finally, the paper looks at future perspectives with respect to gaps in our current understanding and the need for further studies.

Assessment of Household Catastrophic Total Cost of Tuberculosis and Its Determinants in Cairo: Prospective Cohort Study

BackgroundOne goal of the End tuberculosis (TB) Strategy is to see no TB-affected households experiencing catastrophic costs. Therefore, it is crucial for TB-elimination programs to identify catastrophic costs and their main drivers in order to establish appropriate health and social measures. This study aimed to measure the percent of catastrophic costs experienced by Egyptian TB patients and to identify its determinants.MethodsWe conducted a prospective cohort study with 151 Egyptian TB patients recruited from two chest dispensaries from the Cairo governate from May 2019 to May 2020. We used a validated World Health Organization TB patient-cost tool to collect data on patients’ demographic information, household income, and direct and indirect expense of seeking TB treatment. We considered catastrophic TB costs to be total costs exceeding 20% of the household’s annual income.ResultsOf the patients, 33% experienced catastrophic costs. The highest proportion of the total came in the pretreatment stage. Being the main breadwinner, experiencing job loss, selling property, and the occurrence of early coronavirus disease 2019 lockdown were independent determinants of the incidence of catastrophic costs. Borrowing money and selling property were the most-often reported coping strategies adopted.ConclusionDespite the availability of free TB care under the Egyptian National TB Program, nearly a third of the TB patients incurred catastrophic costs. Job loss and being the main breadwinner were among the significant predictors of catastrophic costs. Social protection mechanisms, including cash assistance and insurance coverage, are necessary to achieve the goal of the End TB Strategy.

Challenges of Cost-Effectiveness Analyses of Novel Therapeutics for Inherited Retinal Diseases

To investigate the challenges and potential improvement strategies of cost-effectiveness analyses performed for therapeutics targeting inherited retinal diseases (IRDs). Perspective. A literature review was conducted with discussion of current limitations and improvement recommendations. Cost-effectiveness analysis (CEA) performed for IRD therapeutics has multiple limitations. First, the available methods used to measure health-related quality of life and health utilities can be inaccurate when used in IRDs. Second, the financial burden to patients and society from vision impairment associated with IRDs has been inadequately studied and includes a variety of expenditures ranging from direct costs of IRD specialty health care to indirect expenses associated with daily living activities. Third, our collective understanding is limited in the areas of IRD natural history and health benefits gained from new IRD treatments (eg, gene therapies). In addition, the therapeutic effect from a patient perspective and its duration of action are not fully understood. Due to the scarcity of data, CEA for newly approved therapies has relied on assumptions and creations of predictive models for both costs and health benefits for these new therapeutics in order to calculate the incremental cost-effectiveness ratio. CEA studies performed for IRD therapeutics have been limited by the established health utilities in ophthalmology and the lack of disease-specific information. The assumptions and extrapolations in these studies create substantial uncertainty in incremental cost-effectiveness ratio results. An improved framework is required for CEA of IRD therapeutics in order to determine the cost-effectiveness of each therapy brought from clinical trials to clinical practice.

Monetizing the Burden of Childhood Asthma Due to Traffic Related Air Pollution in the Contiguous United States in 2010.

Background: Traffic-related air pollution (TRAP) refers to the wide range of air pollutants emitted by traffic that are dispersed into the ambient air. Emerging evidence shows that TRAP can increase asthma incidence in children. Living with asthma can carry a huge financial burden for individuals and families due to direct and indirect medical expenses, which can include costs of hospitalization, medical visits, medication, missed school days, and loss of wages from missed workdays for caregivers. Objective: The objective of this paper is to estimate the economic impact of childhood asthma incident cases attributable to nitrogen dioxide (NO2), a common traffic-related air pollutant in urban areas, in the United States at the state level. Methods: We calculate the direct and indirect costs of childhood asthma incident cases attributable to NO2 using previously published burden of disease estimates and per person asthma cost estimates. By multiplying the per person indirect and direct costs for each state with the NO2-attributable asthma incident cases in each state, we were able to estimate the total cost of childhood asthma cases attributable to NO2 in the United States. Results: The cost calculation estimates the total direct and indirect annual cost of childhood asthma cases attributable to NO2 in the year 2010 to be $178,900,138.989 (95% CI: $101,019,728.20–$256,980,126.65). The state with the highest cost burden is California with $24,501,859.84 (95% CI: $10,020,182.62–$38,982,261.250), and the state with the lowest cost burden is Montana with $88,880.12 (95% CI: $33,491.06–$144,269.18). Conclusion: This study estimates the annual costs of childhood asthma incident cases attributable to NO2 and demonstrates the importance of conducting economic impacts studies of TRAP. It is important for policy-making institutions to focus on this problem by advocating and supporting more studies on TRAP’s impact on the national economy and health, including these economic impact estimates in the decision-making process, and devising mitigation strategies to reduce TRAP and the population’s exposure.

The Use of Crowdfunding to Support Radiation Therapy Cancer Treatments.

The purpose of this study was to assess patients' use of a crowdfunding platform to raise funds for radiation treatment and to better understand the direct and indirect costs associated with treatments. The GoFundMe crowdfunding database was queried for four unique categories related to radiation treatment campaigns. Covariates identified included clinical and demographic variables, and associations between amount raised and these predictors were analyzed using a generalized linear model. While 56% percent of campaigns cited direct costs associated with treatment, 73.4% of campaigns cited indirect costs related to treatment. Indirect expenses related to travel (31.7%) as well as living expenses (29.2%) were cited most often across all four treatment categories. This study enhances understanding regarding patients use of crowdfunding for radiation treatment. Increased focus should be placed on discussing the indirect costs of care with patients and their families.