Insurance Administration Research Articles

Statistics on disability pensioners is important for assessing injury burden

Abstract Introduction We have little information about long term effects of injuries resulting in disability. In addition to human suffering and reduced quality of life, these consequences of injuries inflict a heavy burden on the national economy. All persons in Norway aged 16 - 66 years are entitled to disability pension benefits from the National Insurance Administration (NIA) if their working capacity is permanently reduced by at least 50 % due to disease, injury or defect. The burden of injuries in terms of “New disability pensioners” (NDP) related to traffic injuries was assessed in a study for the years 1992-97 and in a follow up study for 2005-12. Methods Each year, a number of persons will be registered as NDP in the Disability register of NIA. Between 1992 and 2012 accident types were classified by an additional code, one of them denoting traffic injury. To calculate rates, the number of NDP are related to the number of persons in Norway on the 1st of January minus the number of persons holding a disability pension at that time (risk population) and are shown as NDP pr 100 000 of the risk population. Results The rates for NDP due to traffic injuries increased from 16.8 in 1992 to 23.0 in 1997, an average annual increase of 7.4 %. These rates were compared with the mortality rates in the age group 15-64 years due to traffic injuries from 1988-1993. The average time lag between an injury and getting a disability pension is 4 years. These rates were 9.3 in 1988 and 6.4 in 1993, an average annual decrease of 6.2 %. The follow up study for 2005-2017 confirmed more or less this increasing trend in NDP due to traffic injuries. Conclusions The rate of NDP due to traffic injuries is increasing while mortality rates for same age group is decreasing. This might reflect that our emergency medicine now saves more and more lives, however many of them ending up as disabled. We need to get valid statistics on disability enabling us to describe the burden of traffic injuries.

The impact of diabetes pay-for-performance program on hyperglycemic hyperosmolar state (HHS)

Abstract Background To examine the effects of a diabetes pay-for-performance (P4P) program on the negative metabolic outcome: hyperglycemic hyperosmolar state (HHS) of patients in Taiwan. Methods Four years (2008∼2011) of data from the National Health Insurance Administration (NHIA) databases were examined. P4P patients included those who were newly enrolled in the P4P group in 2010, and consecutively included in 2011. Patients were never enrolled are defined as non-P4P group in these two years. The caliper matching method and a generalized estimating equation were used to estimate difference-in-differences models (baseline year 2009) and examine the effects of the P4P program on the count of the adverse outcome. Results The P4P program was associated with decreases in the incident of HHS (IRR 0.53, P = 0.02). Conclusions The disease management component of the diabetes P4P program can be beneficial for reducing the incidences of HHS. Key messages • The disease management component of the diabetes P4P program can be beneficial for reducing the incidences of HHS. • The disease management component of the diabetes P4P program is important.

Identifying Barriers to Implementing Complementary and Integrative Health Therapies in Rhode Island Health Care Systems: A Qualitative Approach.

Introduction: Complementary and integrative health (CIH) therapies are widely used and make up billions of dollars in out-of-pocket expenditures. This quality improvement project aimed to identify stakeholders' perceptions of implementing CIH therapies in health care systems to examine the barriers and facilitators to CIH implementation in Rhode Island (RI). Methods: A qualitative approach guided by the Consolidated Framework for Implementation Research (CFIR) was used to conduct interviews with key stakeholder groups: health care administrators, health insurance administrators, physicians, and CIH practitioners. Interviews were analyzed by directed content analysis of transcripts with CFIR as the a priori coding framework. Results: Eleven subconstructs within four major domains were most prominent in interviews across all stakeholder groups. Key barriers in the "innovation" domain include a perceived lack of evidence and credibility of CIH therapies, logistical and administrative complexity of implementation, high costs to patients, and little financial incentive for hospitals and insurance companies. The "outer setting" domain highlights the utility of market pressure in decision making to implement CIH and the role of health policy. The "inner setting" domain demonstrates the varied personal beliefs about CIH, credentialing challenges, and the dissonance between medical system priorities and patient needs. Positive facilitation of implementation is marked by personal exposure to CIH and provider satisfaction in the "implementation process" domain. Conclusion: CIH therapies offer the medical system low risk and effective interventions that meet patient needs not currently met by Western medicine. However, implementation is difficult due to poor perception of evidence and lack of financial gain for the medical system. Acupuncture and massage may be modalities better situated for implementation in the RI medical system. Further education, awareness, and advocacy for CIH therapies would help meet patients' needs for CIH availability.

Does environmental regulation matter for healthcare utilisation in China? An interrupted time series study.

In recent years, China has implemented a series of environmental regulation policies to improve air quality, but the health effects of these policy changes need to be accurately clarified and quantified. The objective of this study was to empirically examine the effects of levying construction dust pollution fees on healthcare utilisation in a southern city of China. The study used a unique administrative insurance claim dataset from the city's Urban Employee Basic Medical Insurance scheme between 2013 and 2015. The sample included 69,961 enrolees. An interrupted time series design was employed to investigate whether and how the healthcare utilisation of enrolees changed after the policy change. The results showed that this environmental regulation policy did not affect the inpatient utilisation of enrolees but did negatively impact outpatient utilisation. In addition, outpatient utilisation of chronic disease coverage decreased for patients with chronic diseases, including diabetes and hypertension. This study provides evidence that enhancing environmental regulations helps reduce medical costs, which can benefit China and other developing countries to improve environmental quality and promote public health.

Cost-Utility Analysis of Bilateral Cochlear Implants for Children With Severe-to-Profound Sensorineural Hearing Loss in Taiwan.

Cochlear implants are an option for children with sensorineural hearing loss who do not benefit from hearing aids. Although bilateral cochlear implantation (CI) has been shown to enhance hearing performance and quality of life, its cost-effectiveness remains unclear. This study aimed to evaluate the cost-effectiveness of bilateral CI compared with bimodal hearing for children with sensorineural hearing loss in Taiwan from both the perspectives of patients and Taiwan's National Health Insurance Administration (TNHIA). A four-state Markov model was utilized in the study, including "use the first internal device," "use the second internal device," "use the third internal device," and "death." Health utility values were obtained from a local survey of health professionals and then adjusted by a scale to reflect both the negative impact of aging on hearing and the time needed to develop the full benefit of treatment in the earliest years of life. The cost data were derived from a caregiver survey, hospital databases, clinical experts, and the TNHIA. The incremental cost-effectiveness ratio (ICER) was calculated over the lifetime horizon and presented as cost per quality-adjusted life year (QALY) to evaluate the cost-effectiveness of simultaneous bilateral CI, sequential bilateral CI, and bimodal hearing. In addition, one-way sensitivity analyses and probabilistic sensitivity analyses were conducted to investigate the impact of uncertainty and the robustness of the model. The base-case analysis showed that children with bilateral CI gained more QALYs while incurring more costs when compared with those with bimodal hearing. From the TNHIA perspective, compared with bimodal hearing, the ICER of simultaneous bilateral CI was New Taiwan Dollars 232,662 per QALY whereas from the patient perspective, the ICER was New Taiwan Dollars 1,006,965 per QALY. Moreover, simultaneous bilateral CI dominated sequential bilateral CI from both perspectives. Compared with bimodal hearing, the ICER of sequential bilateral CI did not exceed twice the gross domestic product per capita in Taiwan from either perspective. One-way sensitivity analysis demonstrated that the utility gain of bilateral CI compared with bimodal hearing was the most impactful parameter from both perspectives. Probabilistic sensitivity analysis confirmed the robustness of the base-case analysis results. Our findings reveal that bilateral CI was cost-effective when using the threshold of one to three times the 2022 gross domestic product per capita in Taiwan from both the TNHIA and patient perspectives. Future research incorporating cost and effectiveness data from other dimensions is needed to help decision-makers assess the cost-effectiveness of bilateral CI more comprehensively.

A case study of lean digital transformation through robotic process automation in healthcare

Under Taiwan's National Health Insurance (NHI) system, it's crucial for all healthcare providers to accurately submit medical expense claims to the National Health Insurance Administration (NHIA) to avoid incorrect deductions. With changes in healthcare policies and adjustments in hospital management strategies, the complexity of claiming rules has resulted in hospitals expending significant manpower and time on the medical expense claims process. Therefore, this study utilizes the Lean Six Sigma DMAIC (Define, Measure, Analyze, Improve, Control) management approach to identify wasteful and non-value-added steps in the process. Simultaneously, it introduces Robotic Process Automation (RPA) tools to replace manual operations. After implementation, the study effectively reduces the process time by 380 min and enhances Process Cycle Efficiency (PCE) from 69.07 to 95.54%. This research validates a real-world case of Lean digital transformation in healthcare institutions. It enables human resources to be allocated to more valuable and creative tasks while assisting hospitals in providing more comprehensive and patient-centric services.

Cost-effectiveness analysis of granulocyte colony-stimulating factors for the prophylaxis of chemotherapy-induced febrile neutropenia in patients with breast cancer in Taiwan.

To examine the cost-effectiveness of using granulocyte colony-stimulating factor (G-CSF) for primary or secondary prophylaxis in patients with breast cancer from the perspective of Taiwan's National Health Insurance Administration. A Markov model was constructed to simulate the events that may occur during and after a high-risk chemotherapy treatment. Various G-CSF prophylaxis strategies and medications were compared in the model. Effectiveness data were derived from the literature and an analysis of the National Health Insurance Research Database (NHIRD). Cost data were obtained from a published NHIRD study, and health utility values were also obtained from the literature. Sensitivity analyses were performed to assess the uncertainty of the cost-effectiveness results. In the base-case analysis, primary prophylaxis with pegfilgrastim had an incremental cost-effectiveness ratio (ICER) of NT$269,683 per quality-adjusted life year (QALY) gained compared to primary prophylaxis with lenograstim. The ICER for primary prophylaxis with lenograstim versus no G-CSF prophylaxis was NT$61,995 per QALY gained. The results were most sensitive to variations in relative risk of febrile neutropenia (FN) for pegfilgrastim versus no G-CSF prophylaxis. Furthermore, in the probabilistic sensitivity analysis, at a willingness-to-pay threshold of one times Taiwan's gross domestic product per capita, the probability of being cost-effective was 88.1% for primary prophylaxis with pegfilgrastim. Our study suggests that primary prophylaxis with either short- or long-acting G-CSF could be considered cost-effective for FN prevention in breast cancer patients receiving high-risk regimens.

The efficacy of combining ondansetron with dexamethasone in delayed chemotherapy-induced nausea and vomiting

Background: Chemotherapy is the primary recourse for patients with cancer that cannot be treated using local surgery or radiotherapy. Its practical application often leads to adverse effects, including nausea and vomiting. Objective: This study determined the efficacy of oral ondansetron and oral dexamethasone as an antiemetic regimen among patients covered by the National Health Insurance. Methods: This cross-sectional study, conducted at one of the largest hospitals in South Kalimantan, Indonesia, involved 114 chemotherapy patients who received a combination antiemetic regimen of ondansetron and dexamethasone. Data on the incidence of delayed nausea and vomiting after chemotherapy were collected using the Index Nausea Vomiting and Retching (INVR) questionnaire from March to May 2023. Results: A cohort of 114 individuals were enrolled in the present investigation, with 57.02% and 42.98% of the participants receiving non-anthracycline and anthracycline-based treatment protocols, respectively. The results showed that only 1.84% of patients did not experience chemotherapy-related adverse events, 13.16% experienced mild symptoms, 21.84% had moderate symptoms, 55.26% faced severe symptoms, and 7.89% suffered from intense symptoms of nausea and vomiting. Conclusion: The antiemetic regimen covered by Badan Penyelenggara Jaminan Sosial (BPJS) (Social Insurance Administration Organization), consisting of a combination of ondansetron and dexamethasone, is moderately effective in preventing chemotherapy-induced delayed nausea and vomiting.

Validating use of diagnostic codes in Canadian administrative data for identification of adverse drug events.

While diagnostic codes from administrative health data might be a valuable source to identify adverse drug events (ADEs), their ability to identify unintended harms remains unclear. We validated claims-based diagnosis codes for ADEs based on events identified in a prospective cohort study and assessed whether key attributes predicted their documentation in administrative data. This was a retrospective analysis of 3 prospective cohorts in British Columbia, from 2008 to 2015 (n = 13 969). We linked prospectively identified ADEs to administrative insurance data to examine the sensitivity and specificity of different diagnostic code schemes. We used logistic regression to assess which key attributes (e.g., type of event, symptoms and culprit medications) were associated with better documentation of ADEs in administrative data. Among 1178 diagnosed events, the sensitivity of the diagnostic codes in administrative data ranged from 3.4 to 52.6%, depending on the database and codes used. We found that documentation was worse for certain types of ADEs (dose-related: odds ratio [OR]: 0.32, 95% confidence interval [CI]: 0.15, 0.69; nonadherence events (OR: 0.35, 95% CI: 0.20, 0.62), and better for those experiencing arrhythmias (OR: 4.19, 95% CI: 0.96, 18.28). ADEs were not well documented in administrative data. Alternative methods should be explored to capture ADEs for health research.

SOCIAL HEALTH INSURANCE ADMINISTRATION BODY PARTICIPANTS’ SATISFACTION ON DECISION TO USE MOBILE APPLICATION

Mobile JKN is an application developed by Social Health Insurance Administration Body to provide easy access to information about the National Healthcare Insurance Program (JKN Program). The number of participants in the Social Security Agency on Health (BPJS Health) has almost reached 250 million people. The government must manage public services so Social Security Agency on Health participants can access health facilities conveniently. The study aims to analyze the Social Security Agency on Health participants’ satisfaction with the decision to use the Mobile JKN application using the Expectancy Disconfirmation Model (EDM). EDM described how perceived expectations and performance influence public satisfaction. The study method is quantitative, with the study unit being Social Security Agency on Health participants and locus in Bogor. Structural Equation Modeling (SEM), a multivariate data analysis technique, was used in this study to examine the data and assess the intricate relationships between the constructs and indicators. The data processing technique uses SmartPLS. The finding shows that using the mobile JKN application has positively impacted user satisfaction. The Social Security Agency on Health participants were satisfied after utilizing the Mobile JKN application to access healthcare services.

Analyzing COVID-19 and Air Pollution Effects on Pediatric Asthma Emergency Room Visits in Taiwan.

(1) Background: An asthma exacerbation that is not relieved with medication typically requires an emergency room visit (ERV). The coronavirus disease 2019 (COVID-19) pandemic began in Taiwan in January of 2020. The influence of the COVID-19 pandemic on pediatric ERVs in Taiwan was limited. Our aim was to survey pediatric asthma ERVs in the COVID-19 era; (2) Methods: Data were collected from the health quality database of the Taiwanese National Health Insurance Administration from 2019 to 2021. Air pollution and climatic factors in Taipei were used to evaluate these relationships. Changes in the rates of pediatric asthma ERVs were assessed using logistic regression analysis. Poisson regression was used to evaluate the impact of air pollution and climate change; (3) Results: The rate of pediatric asthma ERVs declined in different areas and at different hospital levels including medical centers, regional and local hospitals. Some air pollutants (particulate matter ≤ 2.5 µm, particulate matter ≤ 10 µm, nitrogen dioxide, and carbon monoxide) reduced during the COVID-19 lockdown. Ozone increased the relative risk (RR) of pediatric asthma ERVs during the COVID-19 period by 1.094 (95% CI: 1.095-1.12) per 1 ppb increase; (4) Conclusions: The rate of pediatric asthma ERVs declined during the COVID-19 pandemic and ozone has harmful effects. Based on these results, the government could reduce the number of pediatric asthma ERVs through healthcare programs, thereby promoting children's health.

Compound Conway-Maxwell Poisson Gamma Distribution: Properties and Estimation

The distribution of a random sum of random events is called a compound distribution. It involves a counting (discrete) distribution to model the number of occurrences of the random event in a fixed time period and a continuous distribution to model the outcome of the random event. It has applications in the fields of actuarial sciences, meteorology etc. For example, in modelling insurance loss amounts through compound distributions, the number of claims and the claim amounts are used to calculate the total claim amount of a portfolio. The number of claims is modelled through a discrete distribution and the claim amounts are modelled through continuous distributions. Generally, Poisson distribution is used in compound models as the discrete distribution and such models are known as compound Poisson models. However, the equi-dispersion property of the Poisson distribution hinders its application in scenarios where the underlying count data is either over- or under-dispersed. In this paper, a two-parameter Poisson distribution, namely, Conway-Maxwell Poisson (CMP) distribution, which handles both over- and under-dispersed data, is considered as the counting distribution, and the corresponding compound CMP distribution is developed. Some mathematical properties of the distribution are derived and a methodology to estimate the parameters using the likelihood approach is proposed. A numerical illustration of the proposed methodology is given through a simulation study. An application of the compound CMP model is illustrated through transportation security administration (TSA) insurance claim data. Also, the estimation of the risk measures associated with the TSA claim data is discussed.

Tasa de interés de los créditos de consumo y recaudación del impuesto general a las ventas en Perú

Objective: Determine the correlation between the interest rate on consumer loans and the collection of the Value Added Tax in Peru during the period 2011-2022. Methods: The research was descriptive and correlational in nature. To measure the relationship between the variables, the Spearman correlation coefficient was used, which is suitable for data that do not meet the normality conditions. A total of 144 monthly observations were analyzed, obtained from the Superintendence of Banking, Insurance and Pension Fund Administrators and the National Superintendency of Customs and Tax Administration. Results: There is a positive correlation between the interest rate on consumer loans and the collection of the value added tax in the period from January 2011 to December 2022. Conclusion: When the interest rate on consumer loans increases, so does the collection of the Value Added Tax. However, the relationship between these variables is not constant and may be subject to changes at different times.

Analysis of Factors Affecting Patient Satisfaction of Social Health Insurance Administration Body Participants Non-Beneficiaries of Contribution Assistance at Kasih Ibu Lhokseumawe Hospital Year 2022

<div><table cellspacing="0" cellpadding="0" align="left"><tbody><tr><td align="left" valign="top"><p><em>Patient satisfaction is an important and main thing that must be the attention of health facilities in providing their services. Factors that affect inpatient satisfaction are as follows: doctor services, nursing services, medical support services, administrative services, inpatient room facilities. This study aims to analyze the factors that affect patient satisfaction of Social Security Organizing Agency</em><em> </em><em>Non-</em><em> Beneficiaries of </em><em>Contribution Assistance Recipients participants at Kasih Ibu Lhokseumawe Hospital in 2022. The location of this study was conducted at Kasih Ibu Hospital which is located at Jalan Merdeka No. 17 Lhokseumawe City.The number of samples in the study was 207 hospitalized patients. This study uses multiple logistic regression test analysis with modeling at the level of meaning p < 0.05 and CI (Confidence Interval) and the variables that are model candidates have p values < 0.25. Next to find out the significant variables using a confidence interval of 95% (=0.05). Doctor services, nursing services, drug availability, inpatient room facilities, health worker competency facilities, Nurse service variables are the most dominant variables affecting patient satisfaction of </em> <em>Social Health Insurance Administration Body participants who are non-recipients of contribution assistance at Kasih Ibu Lhokseumawe General Hospital.</em><em> </em><em></em></p></td></tr></tbody></table></div><strong><em>Keywords : External Factors, Internal Factors, Patient Satisfication, Participants</em></strong>

Factors Causing Pending Claims at Nyi Ageng Serang Regional General Hospital

Nyi Ageng Serang Regional General Hospital submits monthly collective claims for the Social Health Insurance Administration Body patients. Based on the observations made at the Nyi Ageng Serang Regional General Hospital, the Social Health Insurance Administration Body claim file was pending by the Social Health Insurance Administration Body verifier because it needed to be confirmed. The pending claims will cause the payment of claims from the Social Health Insurance Administration Body to the hospital to be delayed, and it might affect service activities and financing for the hospital. Pending claims must be explored more deeply to the causal factors so they can be handled appropriately. This study aims to describe the factors causing pending claims for the Social Health Insurance Administration Body at the Nyi Ageng Serang Regional General Hospital. Data collection techniques used observation techniques, documentation studies, and interviews. Data analysis was performed using descriptive analysis. External factors that have caused pending claims include discrepancies in claim rates with the Minister of Health Regulations, incorrect codes, and incomplete codes. Meanwhile, the internal factors causing pending claims, according to the 5M management element, were the Man, Material, and Method factors.

Abstract A129: Association of concordance with guidelines of the National Comprehensive Cancer Network and overall survival in Puerto Rican women with endometrial cancer

Abstract Background: Endometrial cancer represents a significant burden in Puerto Rico, as it is one of the most common cancers among women. Although it has a favorable prognosis when diagnosed early, it remains the fifth leading cause of cancer-related deaths among women living in Puerto Rico. This highlights the need to address healthcare disparities and improve the quality of the healthcare system. Treatment guidelines are designed to assist healthcare professionals in offering the best possible care to patients by providing evidence-based suggestions. Implementing standardized practices is crucial to enhancing healthcare quality outcomes. Our objective was to assess the concordance of National Comprehensive Cancer Network (NCCN) guidelines for endometrial cancer treatment and its association with overall survival. Methods: Data on endometrial cancer patients aged 18 years and older diagnosed between 2009 and 2015 was obtained from the Puerto Rico Central Cancer Registry, linked to the Puerto Rico Health Insurance Administration database (n=2,114). The association between clinical aspects, health system, and socioeconomic factors with receipt of guideline-concordant treatment was evaluated using logistic regression. Overall survival (OS) was calculated using the Kaplan-Meier method. Univariate and multivariate-adjusted Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between guideline-concordant treatment and OS. Results: In our cohort, 53.9% of patients received guideline-concordant treatment. Patients receiving treatment at a Commission on Cancer (CoC)-accredited facility are twice as likely to receive guideline-concordant treatment than non-accredited facilities (95% CI: 1.71-2.98). Individuals who received an assessment from a gynecologist oncologist are 90.0% more likely to receive treatment based on NCCN guidelines than those who did not (95% CI: 1.56-2.32). Private insured patients are 28.0% more likely to receive guideline-concordant treatment than Medicaid patients (95% CI: 1.02-1.61). In Cox regression models, guideline-concordant treatment was associated with a lower mortality risk compared to women who did not receive guideline-concordant treatment (95% CI: 0.59- 0.89). Conclusion: Receiving guideline-concordant treatment is a strong predictor of improved survival rates in endometrial cancer patients. Additionally, patients treated at CoC-accredited hospitals and by gynecologic oncologists tend to receive higher-quality care. Given that guidelines based on effective treatment standards have been demonstrated to enhance cancer patient outcomes, we must encourage and support factors contributing to their increased adoption. By doing so, we can strive to improve the prognosis and overall well-being of individuals affected by endometrial cancer in Puerto Rico. Citation Format: Yisel Pagan-Santana, Karen J. Ortiz-Ortiz, Maira Castañeda-Avila, Ruth Rios-Motta. Association of concordance with guidelines of the National Comprehensive Cancer Network and overall survival in Puerto Rican women with endometrial cancer [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A129.

Black cancer patients navigating a health-care system of racial discrimination.

Exposure to racial discrimination may exacerbate disparities throughout the cancer care continuum. Therefore, we explored how experiences of racial discrimination in the health-care setting manifest for Black cancer patients and how it contributes to racial disparities in cancer care. This qualitative analysis used semistructured in-depth interviews with Black cancer survivors not on active treatment from May 2019 to March 2020. All interviews were audio recorded, professionally transcribed, and uploaded into Dedoose software for analysis. We identified major themes and subthemes that highlight exposure to racial discrimination and its consequences for Black cancer patients when receiving cancer care. Participants included 18 Black cancer survivors, aged 29-88 years. Most patients experienced racial discrimination when seeking care. Participants experienced racial discrimination from their interactions with health-care staff, medical assistants, front desk staff, and health insurance administrators. Exposure to overt racial discrimination in the health-care setting was rooted in racial stereotypes and manifested through verbal insults such as physicians using phrases such as "you people." These experiences impacted the ability of the health-care delivery system to demonstrate trustworthiness. Patients noted "walking out" of their visit and not having their health issues addressed. Despite experiences with racial discrimination, patients still sought care out of necessity believing it was an inevitable part of the Black individual experience. We identified that exposure to racial discrimination in the health-care setting is pervasive, affects health-seeking behaviors, and degrades the patient-clinician relationship, which may likely contribute to racial disparities in cancer care.

Asthma Exacerbation during the COVID-19 Pandemic

Introduction: Asthmatics, especially uncontrolled asthmatics, must be vigilant during the COVID-19 pandemic to avoid major respiratory complications. This study aimed to describe these characteristics in emergency unit patients with asthma and COVID-19 at Haji General Hospital, Surabaya, an East Java referral hospital. Methods: The study gathered medical information on 160 asthma patients from March to December 2021. The collected data were related to socioeconomics, allergy history, family allergy history, and medications. Results: 160 confirmed cases of asthma occurred during COVID-19 at Haji General Hospital, Surabaya. Most adult asthma sufferers were women (59.2%), high school graduates (31.25%), housewives (21.2%), had payment method with Social Health Insurance Administration Body (BPJS) insurance (73.8 %), had a history of drug allergies (11.5%), had no family history of allergies (50.8%), and used albuterol control drugs (10.7%). Meanwhile, the majority of children with asthma were boys (53.3%), did not attend school or did not finish elementary school (33.3%), did not work (33.3%), had payment method with BPJS (73.3%), had a history of allergies to seafood and cow's milk respectively (10%), had no family history of allergies (40%), and used albuterol control drugs (16.7%). Conclusion: The proportion of asthma in the emergency unit was dominated by women over 18 years old with a high school education. Most patients were housewives and used BPJS. Many of them had a history of allergies to medications (not asthma medication), and there was no family history of allergies. Commonly used medications were albuterol to control asthma.

THE MAIN STAGES OF FORMATION AND DEVELOPMENT OF THE SOCIAL INSURANCE ADMINISTRATION OF THE POLISH REPUBLIC

In the first part of the review article devoted to the history of the development and formation of the Social Insurance Administration of the Republic of Poland, the main stages of its formation are considered. The prerequisites for its occurrence and the current structure are analyzed through the use of comparative and factor analysis, retrospective and statistical-analytical research methods. The existing national statistics of the Republic of Kazakhstan as a tool for collecting and accumulating information on the nomenclature list of occupational diseases, injuries and fatal accidents as part of their monitoring, as well as creating a database of statistical data, does not take into account the influence of many negative factors of the working environment. In this regard, at the national level, there is a need for a unified approach to strategic static studies of all types of negative factors of the working environment, working conditions. The scientific justification of this process is aimed at finding, adapting, developing and testing the best international practices and ways to introduce the latest forms of digital statistical reporting tools, which is impossible without a retrospective analysis. At the moment, the state policy in the field of labor protection has a preventive orientation, which is reflected in the need to automate the processes of forming and implementing statistical observations of the state of labor protection. This should be preceded by work to radically improve the domestic system of statistical observations, taking into account the best practices of the OECD countries. One of such striking examples is Poland's developments based on its own historical background, as well as on modern principles, standards and approaches of Eurostat.

Cost-effectiveness of pemigatinib as a second-line treatment for advanced intrahepatic cholangiocarcinoma with fibroblast growth factor receptor 2 fusions in Taiwan: from the evidence of the phase II trial and the perspective of Taiwan's National Health Insurance Administration

BackgroundIn December 2022, the Taiwan National Health Insurance Administration (NHIA) announced the reimbursement of three dosages of pemigatinib 4.5 mg, 9 mg, and 13.5 mg for treating advanced intrahepatic cholangiocarcinoma (ICC) with fibroblast growth factor receptor 2 (FGFR2) fusions/rearrangements and set the reimbursement price for pemigatinib 4.5 mg at NT$6600. This study aims to analyze the cost-effectiveness of pemigatinib 13.5 mg as a second-line treatment compared to mFOLFOX and 5-FU chemotherapy for advanced ICC patients with FGFR2 fusions/rearrangements from the perspective of Taiwan’s NHIA.MethodsThis study used a 3-state partitioned survival model to analyze the 5 year cost-effectiveness of pemigatinib as a second-line treatment for advanced ICC patients in whom first-line gemcitabine-based chemotherapy failed and to compare the results with those for the mFOLFOX and 5-FU chemotherapy regimens. Overall survival and progression-free survival were estimated from the FIGHT-202 trial (pemigatinib), ABC-06 trial (mFOLFOX), and NIFTY trial (5-FU). The price of pemigatinib 13.5 mg was set at the potentially highest listing price (NT$17,820). Other parameters of utility, disutility, and costs related to advanced ICC were obtained from the published literature. The willingness-to-pay threshold was three times the forecasted gross domestic product per capita in 2022 (NT$2,928,570). A 3% discount rate was applied to quality-adjusted life-years (QALYs) and costs. Several scenario analyses were performed, including a gradual price reduction for pemigatinib. Deterministic sensitivity analysis, probabilistic sensitivity analysis (PSA), and value of information were performed to assess uncertainty.ResultsPemigatinib was not cost-effective compared to mFOLFOX or 5-FU in the base-case analysis. When the price of pemigatinib was reduced by 50% or more, pemigatinib gained a positive net monetary benefit (mFOLFOX: NT$55,374; 5-FU: NT$92,437) and a 72% (mFOLFOX) and 77.1% (5-FU) probability of being cost-effective. Most of the uncertainty came from the medication cost of pemigatinib, health state utility, and the overall survival associated with pemigatinib.ConclusionsAccording to the NCCN guidelines, the daily use of pemigatinib 13.5 mg at the hypothesized NHIA price of NT$17,820/13.5 mg was not cost-effective compared to mFOLFOX or 5-FU. The price reduction scenario suggested a 50% price reduction, NT$8910 per 13.5 mg, for advanced ICC patients with FGFR2 fusions/rearrangements.