Insurance Administration Research Articles

Importance of medication adherence in treatment needed diabetic retinopathy

We aim to investigate the role of medication adherence history in treatment needed diabetic retinopathy (TNDR). We conducted a retrospective nested case–control study using 3 population-based databases in Taiwan. The major one was the 2-million-sample longitudinal health and welfare population-based database from 1997 to 2017, a nationally representative random sample of National Health Insurance Administration enrolled beneficiaries in 2010 (LHID2010). The national death registry and national cancer registry were also checked to verify the information. The outcome was defined as the TNDR. The Medication possession ratio (MPR) was defined as the ratio of total days of diabetes mellitus (DM) medication supply divided by total observation days. MPR ≥ 80% was proposed as good medication adherence. The association of MPR and the TNDR was analyzed. Other potential confounders and MPR ratio were also evaluated. A total of (n = 44,628) patients were enrolled. Younger aged, male sex and patients with less chronic illness complexity or less diabetes complication severity tend to have poorer medication adherence. Those with severe comorbidity or participating pay-for-performance program (P4P) revealed better adherence. No matter what the characteristics are, patients with good MPR showed a significantly lower likelihood of leading to TNDR after adjustment with other factors. The protection effect was consistent for up to 5 years. Good medication adherence significantly prevents treatment needed diabetic retinopathy. Hence, it is important to promote DM medication adherence to prevent risks of diabetic retinopathy progression, especially those who opt to have low medication adherence.

Prevalence of Dental Caries and Periodontal Disease of High School Students Aged 15 to 18 Years in Taiwan.

The purpose of this study was to assess the prevalence and distribution of dental caries and periodontal disease in Taiwanese high school students aged 15–18. A total of 1069 Taiwanese students participated in a cross-sectional nationwide dental survey. By using a stratified method based on the National Health Insurance administration regions, 24 high schools were randomly sampled in different areas of Taiwan. The participants were examined with dental mirrors and community periodontal index (CPI) probes without using radiographs, to measure dental caries and periodontal status. Demographic information and other relevant risk indicators for the two diseases were gathered via a self-report questionnaire. In this study population, the weighted mean decayed, missing and filled teeth (DMFT) scores for ages 15 to 18 were 5.2, 6.1, 6.1, and 5.7. The weighted mean decayed, missing and filled surfaces (DMFS) scores were 9.0, 12.0, 13.1, and 11.2 at ages 15, 16, 17, and 18, respectively. Additionally, 88.2% of the subjects had periodontal disease, with calculus as the most prevalent type. Moreover, 5.2% of these students showed loss of attachment. There was no significant association between dental caries and periodontal disease. Dental caries and periodontal disease were prevalent among Taiwanese high school students in this national dental survey.

Incidence, prevalence, and economic burden of sarcoidosis in Puerto Rico: Estimates from a government health insurance claims database.

To estimate the epidemiology of sarcoidosis in Puerto Rico. Patients with a diagnosis of sarcoidosis between January 2015 and December 2018 were selected from the Puerto Rico Health Insurance Administration Administración de Seguros de Salud de Puerto Rico claims database. The International Classification of Diseases-Tenth Revision coding for sarcoidosis was used for case detection and utilization of health care services. Cases by sex and age were evaluated. A total of 488 individuals with sarcoidosis were identified over the 4-year study. The median age at diagnosis was 59 years old. The average annual incidence rate was 9.9/100,000. The baseline prevalence was 14.9 per 100,000. Females represented 68.4% of the cases. Patients with lung and unspecified sarcoidosis predominate with 45.6% and 28.2% of cases, respectively. Overall, the yearly cost of health care utilization and medications per patient was $234 and $13,638, respectively. Annual incidence rate and the median age of sarcoidosis in Puerto Ricans are among the highest and oldest reported globally. The demographic profile of sarcoidosis in Puerto Rico presents a patient in the mid-to advanced age, mostly female. While costs for medications were relatively high for a patient with sarcoidosis, the economic burden of the disease to the national health care system is not substantial.

Risk of early- and late-onset Alzheimer disease and related dementia in adults with cerebral palsy.

To examine the risk of Alzheimer disease and related dementia (ADRD) among adults with cerebral palsy (CP). Using administrative insurance claims data for 2007 to 2017 in the USA, we identified adults (45y or older) with a diagnosis of CP (n=5176). Adults without a diagnosis of CP were included as a typically developing comparison group (n=1 119 131). Using age, sex, ethnicity, other demographic variables, and a set of chronic morbidities, we propensity-matched individuals with and without CP (n=5038). Cox survival models were used to estimate ADRD risk within a 3-year follow up. The unadjusted incidence of ADRD was 9 and 2.4 times higher among cohorts of adults 45 to 64 years (1.8%) and 65 years and older (4.8%) with CP than the respective unmatched individuals without CP (0.2% and 2.0% among 45-64y and 65y or older respectively). Fully adjusted survival models indicated that adults with CP had a greater hazard for ADRD (among 45-64y: unmatched hazard ratio 7.48 [95% confidence interval {CI} 6.05-9.25], matched hazard ratio 4.73 [95% CI 2.72-8.29]; among 65y or older: unmatched hazard ratio 2.21 [95% CI 1.95-2.51], matched hazard ratio 1.73 [1.39-2.15]). Clinical guidelines for early screening of cognitive function among individuals with CP need updating, and preventative and/or therapeutic services should be used to reduce the risk of ADRD.

Improvement the Healthcare Quality of Emergency Department after the Cloud-Based System of Medical Information-Exchange Implementation.

Background: The National Health Insurance has been implemented in Taiwan since 1995. The government established a medical information-exchange system to reduce duplicate medications and examinations, which have inhibited healthcare expenditures. The potential benefit of medical information exchange about healthcare quality in emergency departments (ED) was worthy of evaluating; Methods: The inquiry rate of cloud data for patients’ information in Taiwanese National Health Insurance Administration was defined as a factor, and the healthcare quality included the ratio of staying more than 48 h in the ED and the hospitalization rate within 8 h from ED by triage levels of 1, 2, and 3 in different levels of hospitals from 2013 to 2019. Poisson regression analysis was used to quantify time trends of the query rate of the MediCloud system, the rate of staying more than 48 h in ED, admission rate within 8 h in ED, and the effect of healthcare quality in ED after MediCloud system implementation; Results: The health information exchange decreased the rate of staying over 48 h in the ED of medical centers. It also improved the early hospitalization of urgent ED patients in regional hospitals; Conclusions: Through medical information exchange to understand patients’ current conditions, we can reduce crowding in the ED of medical centers and facilitate rapid hospitalization of urgent patients in regional hospitals. According to these findings, the government should establish medical information exchange to improve the healthcare quality of ED.

Behavior Paying Premium to the Independent Participants in Healthcare Social Insurance Administration Office

Premiums non-compliance leads to the Healthcare Social Insurance Administration Office (henceforth, will be referred to as BPJS Kesehatan) budget deficit, resulting in an accumulation of debt claims in various health facilities and an impact on the quality and quantity of health services in health facilities. As of March 2019, 38% of independent National Health Insurance (JKN) participants in Gorontalo City were not compliant to pay dues. This study objective to assess the relationship between willingness to pay with compliance behavior to pay premiums for BPJS Kesehatan independent participants. This study uses a cross-sectional study design. The population was 8,594 people who were independent BPJS Kesehatan participants with a sample of 95 people using accidental sampling techniques. Data were collected through interviews using a questionnaire, data analysis using Chi-Square test. The results showed that the distribution of the level of compliance paying BPJS premiums independently was still 64.2%. Distribution of the willingness to pay by 85%. There is a significant relationship between Willingness To Pay (WTP) with compliance paying dues with p = 0.031. There is a relationship between WTP with compliance to pay the premiums of BPJS Kesehatan independent participants in the inpatient installation at RSUD Prof. Dr. H. Aloei Saboe in Gorontalo City.

Effects of establishing a financing scheme for outpatient care on inpatient services: empirical evidence from a quasi-experiment in China

The relationship between outpatient and inpatient care is central to the current healthcare reform debate especially in developing countries. Despite the importance of this relationship to health policy makers, empirical evidence, particularly evidence that can be interpreted as causal is limited and inconclusive. This paper examines the effects of establishing a financing scheme for outpatient care on inpatient utilization and expenditure in China's Urban Employee Basic Medical Insurance scheme. Under a quasi-experimental design, we use a unique administrative insurance claim dataset and conduct a difference-in-differences analysis. Our results indicate that after the policy change, total number of admissions and total inpatient expenditure of the enrollees decreased by 0.47% and 6.05% respectively, which imply outpatient and inpatient care are substitutes, and the reduction in cost-sharing can release the underuse of the outpatient care, so as to reduce those excessive demands for inpatient care. Moreover, we present evidence that the effects on the admissions of Ambulatory Care Sensitive Conditions which should be sensitive to outpatient care intervention are relatively limited because of the lower reimbursement cap, inadequate capacity of the local primary care providers and stickiness in patients' healthcare-seeking behaviors. While the enrollees aged over 55 and retirees are more vulnerable to the medical prices, and the enrollees living in the central districts are more responsive because of the better and more accessible primary care.

Community flood vulnerability and risk assessment: An empirical predictive modeling approach

AbstractEffective assessment of flood vulnerability and risk is essential for communities to manage flood hazards. This paper presents an empirical modeling methodology to predict flood vulnerability and risk, considering factors of hazard distribution, property exposure, built environment, and socio‐demographic and economic characteristics of a community. Vulnerability is empirically modeled as the expected fraction of property loss that is uninsured within a community (i.e., census tract) given water depth. Risk is derived as the expected annual uninsured property loss and loss ratio. The proposed framework is applied to the state of North Carolina in the United States. For model calibration, modeled flood loss data from Hurricanes Matthew in 2016 and Florence in 2018 and insurance claims data from the Federal Insurance and Mitigation Administration's National Flood Insurance Program are used. The Federal Emergency Management Agency's National Flood Hazard Layer is adopted, along with empirical probability distribution of water depth given flood event, to characterize hazard distribution. Results demonstrate how the presented methodology can be used to predict annual loss in terms of currency and to highlight hotspots of flood vulnerability and risk. Future work is needed to reduce uncertainty associated with limited hazard information available to the public.

Digital health care in China and access for older people

Digital health care in China and access for older people

PCN80 Estimating the Difference in Annual out-of-Pocket Costs for Relugolix and Leuprolide for Medicare Patients with Metastatic Prostate Cancer

Relugolix is a once daily oral androgen-deprivation therapy (ADT) approved in December 2020 in the U.S. for the treatment of advanced prostate cancer. Results from its head-to-head phase III randomized controlled trial demonstrated comparable efficacy to leuprolide injections given every three months. Relugolix provides a new alternative for ADT compared to currently available injectables, and it is therefore important to compare the difference in out-of-pocket (OOP) costs for patients between these two therapies. We estimated the OOP costs for the average Medicare patient receiving relugolix 120mg once daily or leuprolide 22.5mg every 3 months for 12-calendar months in 2021. Relugolix OOP costs were calculated based on the 2021 Medicare Part D cost sharing structure using relugolix’s January 2021 wholesale-acquisition-cost (WAC) of $2,313 for a 30-day supply. Leuprolide OOP costs were calculated based on the 2021 Medicare Part B deductible of $203 and patients paying 20% of treatment costs. Leuprolide’s January 2021 Medicare average-sale price (ASP) of $228.93 per 7.5mg (J9217) plus 6% was used to calculate the price of leuprolide. Calculations were made with the assumption that patients did not have any additional co-insurance or financial assistance and did not include calculation of insurance premiums or administration costs. The total costs for 12-months of relugolix was estimated to be $27,756 while the total cost of 12-months leuprolide (4 injections) was estimated to be $2,912. The estimated annual OOP costs for relugolix was $3,731 while the estimated annual OOP costs for leuprolide was $745. Therefore, relugolix cost approximately $2,986 more OOP for one-year of treatment compared to leuprolide. While relugolix is the first orally available ADT, its use is associated with a substantially higher OOP cost for Medicare patients. Prescribers should consider the full risk versus benefits when deciding between relugolix and leuprolide, including the potential financial implications for patients.

Study on Intensive Care Unit Nutritional Protocol Based on Timing of National Health Insurance Coverage in Taiwan

ObjectivesAggressive nutritional intervention may improve the outcomes of critically ill patients. Therefore, the National Health Insurance Administration (NHIA) in Taiwan revised its relevant fee schedule. On October 1, 2019, nutritional care items for intensive care unit (ICU) patients, covered by the NHIA under the category of nutritional care fees, were introduced to reflect real clinical needs. MethodsThis retrospective cohort study was conducted in a medical center ICU. The study period was January 1, 2019 to May 31, 2020, before and after the start of national health insurance (NHI) coverage of new nutritional care items for ICU patients. A total of 5292 patients were recruited and divided into two groups based on timing of NHI coverage. There were 1591 patients included in the analysis (751 in the non-NHI group and 840 in the NHI group). In the NHI group, the following nutritional protocol was implemented: First visit was at 48hr following admission to the ICU with 2 follow up visits over the next 5 days, then 3 visits the following week. Patient demographics, daily nutritional data, and outcomes were collected to investigate the impact of this protocol. ResultsBoth groups were given the same nutritional intervention initially. However, there were significant differences in nutritional intervention following the incorporation of this treatment protocol in the ICU. Closely monitored nutritional intervention met critical requirements without overfeeding and led to shorter ICU stays (non-NHI 8.11 ± 6.69 days vs NHI 7.12 ± 7.43 days, p < 0.01). ConclusionsNutritional care plan based on frequent assessments and interventions by dietitians is associated with reduced ICU stays for critically ill patients. Funding SourcesNone.

PENGARUH KELENGKAPAN PERSYARATAN ADMISI PASIEN BPJS TERHADAP EFEKTIVITAS PELAYANAN DI RSUD KABUPATEN SUMEDANGPENGARUH KELENGKAPAN PERSYARATAN ADMISI PASIEN BPJS TERHADAP EFEKTIVITAS PELAYANAN DI RSUD KABUPATEN SUMEDANG

This study aimed to determine the effect of completeness of admission requirement for BPJS (Social Insurance Administration Organization) for inpatients on to effectiveness of admission services in Sumedang General Hospital. Data collection method is by distributing questionnaires and interview which is equipped with literature review that have close relevance to the subject matter. The result showed Spearman rank correlation coefficient value 0.97 is in the interval from 0.8 to 1.000 which is categorized as very strong and it is known that the completeness of admission requirements for BPJS patients hospitalized affects the effectiveness of admission services by 94, 09%. As for the obstacles in completing BPJS patient admission requirements are, (1) NIK (Population Registration Number) BPJS is not in accordance with the NIK contained in the KTP / Family Card, (2) Patients with delinquent payments / late from the 10th to pay BPJS health insurance and (3) No BPJS center facilities in Sumedang General Hospital. The advice given are that the (1) Family / patient should not ignore the NIK contained on the BPJS card when they making the BPJS health insurance, (2) Family / patient must consider about the payment of BPJS insurance payment ant make it as priority, the payment not later than 10th in every month and (3) Sumedang General Hospital should have special facilities or rooms for BPJS centers, so that everything that is problematic with the health BPJS card will be quickly handled

Selected Articles from This Issue

Stomach cancer is the third most common cause of cancer-related death globally. Incidence and mortality rates have declined overall across circumpolar nations however, regional studies have shown an unequal cancer burden among some subpopulations. Simkin and colleagues combined nearly 20 years of data from population-based cancer registries across eight circumpolar nations to examine cancer trends by sub-region and ethnicity/race. The authors found strong declines of incidence and mortality overall however, some northern and Indigenous populations experience elevated incidence and mortality rates. There is a need to address inequities observed among circumpolar subpopulations that may benefit from coordinated international action.The AYA Horizon Study focuses on a diverse cohort of 11,072 adolescent and young adult women diagnosed with cancer in California and North Carolina. Detailed cancer treatment and assisted reproductive technology (ART) information are collected through health system databases, administrative insurance claims, and national ART clinic reporting systems. An ancillary online survey in this population provides complementary information on patient experience, perspectives and barriers for fertility issues among respondents. This study by Nichols and colleagues will provide unique opportunities to examine fertility and pregnancy outcomes among women of reproductive age who are diagnosed with cancer.Progestins have long been hypothesized to be protective for ovarian cancer. Phung and colleagues have provided additional evidence of this relationship using data 7,977 women with ovarian cancer and 11,820 control women. Ever use of depot-medroxyprogesterone acetate, an injectable progestin-only contraceptive, was associated with a 35% decreased risk of ovarian cancer with longer duration of use associated with lower risk. The effect the authors observed was greater than what was observed for combined oral contraceptives and similar to that of parity. The findings shed light on the etiology of ovarian cancer and are of particular interest given the rise in popularity of progestin-releasing intrauterine devices.Both prostate cancer and type 2 diabetes are becoming more common, as people live longer and are increasingly overweight. Vihervuori and colleagues examined the link between anti-diabetic medication use and prostate cancer survival taking into account simultaneous use of multiple drugs. Risk of prostate cancer death was higher among antidiabetic drug users overall compared to non-users, also separately among insulin and metformin users. The risk association is driven by underlying hyperglycemia, as adjustment for blood glucose level ameliorates the risk increase. Poorly controlled type 2 diabetes should be considered as a risk factor for prostate cancer death.

Self-actuated telematics implementation aimed at insurance covers of fleets

These benefits of the Usages-Based Insurances for the car that covers the overall traditional ratings techniques are also have been examined for writing more than the four decades. Despite these adoption in the insurance the markets act as a moderate. This paper looks to set up the practicality of presenting armada the Telematics based Insurances by the investigating the view of the insurance administrators, following specialist organizations and corporate armada proprietors. At its center, the investigation includes a kind of SWOT-examination to assess the Telematics based Insurances against customary premium rating systems. 25 keys partners in the Malta, a nation with an insurance industry that speaks to others in microcosm, were met to build up our investigation. Everyone affirm so that neighborhood back up plans have interests in such insurance conspires as upgraded armada the board and observing convert into an improved insurance hazard. The discoveries introduced here have suggestions for all partners as this is contend for telematics upgradation of armada board, TBI improves risk administration for back up plans and appropriation of this innovation is subject to telematics suppliers expanding the apparent control by safety net providers over dealing with this innovation.

Effect of a Pay-for-Performance Program on Renal Outcomes Among Patients With Early-Stage Chronic Kidney Disease in Taiwan.

With the promising outcomes of the pre-ESRD (end-stage renal disease) pay-for-performance (P4P) program, the National Health Insurance Administration (NHIA) of Taiwan launched a P4P program for patients with early chronic kidney disease (CKD) in 2011, targeting CKD patients at stages 1, 2, and 3a. This study aimed to examine the long-term effect of the early-CKD P4P program on CKD progression. We conducted a matched cohort study using electronic medical records from a large healthcare delivery system in Taiwan. The outcome of interest was CKD progression to estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m2 between P4P program enrolees and non-enrolees. The difference in the cumulative incidence of CKD progression between the P4P and non-P4P groups was tested using Gray's test. We adopted a cause-specific (CS) hazard model to estimate the hazard in the P4P group as compared to non-P4P group, adjusting for age, sex, baseline renal function, and comorbidities. A subgroup analysis was further performed in CKD patients with diabetes to evaluate the interactive effects between the early-CKD P4P and diabetes P4P programs. The incidence per 100 person-months of disease progression was significantly lower in the P4P group than in the non-P4P group (0.44 vs. 0.69, P<.0001), and the CS hazard ratio (CS-HR) for P4P program enrolees compared with non-enrolees was 0.61 (95% CI: 0.58-0.64, P<.0001). The results of the subgroup analysis further revealed an additive effect of the diabetes P4P program on CKD progression; compared to none of both P4P enrolees, the CS-HR for CKD disease progression was 0.60 (95% CI: 0.54-0.67, P<.0001) for patients who were enrolled in both early-CKD P4P and diabetes P4P programs. The present study results suggest that the early-CKD P4P program is superior to usual care to decelerate CKD progression in patients with early-stage CKD.

Adverse pregnancy outcomes in women with Behçet's disease: population-based registry linkage study in Taiwan.

To estimate the risks of adverse pregnancy outcomes in women with Behçet's disease (BD) METHODS: Data collected by the Taiwan National Health Insurance Administration between 2001 and 2012 was used for our study. A total of 2,350,339 pregnancies from the Taiwan National Health Insurance database and birth registry were identified. Maternal history of BD in women was ascertained. A comparison was made to determine whether BD increased the risk of health issues associated with pregnancy and fetal outcomes. Using an adjusted generalized estimating equation model, we estimated the odds ratios (ORs) and 95% confidence intervals (CIs) for fetal-neonatal and maternal outcomes. There were 99 pregnancies in women with BD and 2,350,240 pregnancies in women without BD. The OR and 95% CI of puerperal cerebrovascular disorders were 12.08 (1.7-85.9), and those of gestational diabetes were 1.89 (1.1-3.25). Both were higher than the values in general pregnant women after adjusting for age, infant sex, urban residence, income, occupation, birth year, and Charlson Comorbidity Index. However, there were no adverse fetal outcomes in pregnant women with BD. Patients with BD have no significant risks of multiple complications except for puerperal cerebrovascular disease and gestational diabetes during pregnancy. Close monitoring of blood sugar is suggested. Furthermore, neonatal outcomes were not influenced by BD. Key Points • Patients with Behçet's disease are at a risk of puerperal cerebrovascular disease and gestational diabetes during pregnancy. • The odds ratio and 95% confidence interval for puerperal cerebrovascular disorders were 12.08 (1.7-85.9), and those for gestational diabetes were 1.89 (1.1-3.25). • Pregnant patients with Behçet's disease have no risks of neonatal outcomes.

Attitudes Toward Implementing E-Government in Health Insurance Administration

Health insurance administration (HIA), a governmental institution that provides health insurance services for citizens in Jordan, is investing in an electronic health insurance administration (EHIA) system. This paper aims to explore the main factors influencing users' intention to adopt EHIA in Jordan, where little research focused on such systems. Using a quantitative approach, a sample of 315 citizens was utilized, and an instrument of 30 items was used. Findings revealed that perceived ease of use, perceived usefulness, information technology background, and social influence are major predictors of citizens' intention to use EHIA. In contrast, perceived security and perceived trust are not significant toward the adoption process. Jordanian government should focus on the ease and usefulness of the system to encourage citizens to use EHIA system, where substantial efforts need to be exerted to advance citizens' skills in using e-government applications. In addition, Jordanian authorities should utilize social media effectively to illustrate the significance of EHIA system for citizens.

RELATIONSHIP BETWEEN INCOME LEVEL, PERCEPTION OF HEALTH SERVICES AND CADRES’S ACTIVITY WITH COMPLIANCE WITH PAYMENT OF INDEPENDENT NATIONAL HEALTH ASSURANCE IN KOLAKA DISTRICT

Background:Every year, the social insurance administration organisation (BPJS Kesehatan) always experiences a very large deficit. The high number of deficits experienced by the social insurance administration organisation (BPJS Kesehatan) is due to the low level of compliance of contribution payments by independent participants. The purpose of this study was to determine the relationship between income levels, patient perceptions of health services and activeness of cadres with compliance with payment of dues to participants in the Independent National Health Insurance, Kolaka District.&#x0D; Methods:This type of research is a quantitative study with a cross sectional study approach. The population in this study were all 1075 independent National Health Insurance participants. The sample size was 89 respondents who were taken by proportional random sampling. The data were obtained using a questionnaire and then analyzed descriptively and inferentially using the Chi Square test.&#x0D; Result:The results showed that there was a relationship between income levels, patient perceptions of health services and the activeness of cadres with compliance with the payment of dues for participants in the independent national health insurance in Kolaka District, where the p-value &lt;?= 0.05.&#x0D; Conclusion:Perception of health services is the most related factor in comparison to the level of income and activity of the cadres. It is hoped that the social insurance administration organisation (BPJS Kesehatan) will carry out strategies in an effort to increase the regularity or compliance of the independent national health insurance participants and increase the number of cadres.

Younger age increases the risk of sustaining multiple concomitant injuries with an ACL rupture.

Anterior cruciate ligament (ACL) tears have a major impact on the individual and society. Long term effects may be mediated by injuries that occur concurrently to the ACL tear. The purpose of this study was to describe in a nationwide cohort the traumatic meniscal injuries and bone marrow lesions concomitant to ACL tears, their age and sex distribution and the rate any association with ACL reconstruction. All ACL tears in Iceland from 2006 to 2011 and their concomitant bone marrow lesions and meniscal injuries were identified from MRI reports. These injuries were further classified by location, sex and age. The cohort was divided into under 17, 17-29, 30-49 and above 50 to reflect likely differences in the mechanisms of injury and risk factors that may vary with age. Data from the Icelandic Social Insurance Administration were used identify all those who were operated. Descriptive analysis was performed to show the proportion of ACL injured knees sustaining concomitant injuries and how these injuries varied with age, sex, and subsequent treatment RESULTS: 1365 knees with ACL ruptures were included. Only 13% of knees had no concomitant injury identified. Overall, 57% of knees had a bone marrow lesion in at least one location and 70% of knees had at least one traumatic meniscal injury. A greater number of combined lateral tibial and femoral bone marrow lesion was seen in younger age groups (χ2 (3) = 113.32, p < 0.0001). Bruises in the medial compartment were the least common concomitant injuries. More injuries were related to higher chances of ACL reconstruction (OR 1.6, 95% CI 1.4-1.7). Age was associated with risk of all injury types and locations with older age generally being associated with fewer injuries. In an ACL ruptured cohort, the overall incidence of BMLs may be lower and meniscus injuries higher than previously reported. However, these injuries are more prevalent in the younger cohort potentially resulting in a poorer long-term prognosis. Knowledge of the association between age and concomitant injuries will help guide rehabilitation. II.

Cost-utility analysis of stereotactic body radiotherapy plus cetuximab in previously irradiated recurrent squamous cell carcinoma of the head and neck

ABSTRACT Background This study aimed to estimate the cost-utility of stereotactic body radiotherapy (SBRT) plus cetuximab for patients with previously irradiated recurrent squamous cell carcinoma of the head and neck. Methods We constructed a Markov health-state transition model to simulate costs and clinical outcomes of recurrent squamous cell carcinoma of the head and neck. Model parameters were derived from the published literature and the National Health Insurance Administration reimbursement price list. Incremental cost-effectiveness ratio and the net monetary benefit were calculated from a health payer perspective. The impact of uncertainty was modeled with one-way and probabilistic sensitivity analyses. Results In the base-case, SBRT plus cetuximab compared to SBRT alone resulted in an ICER of NT$ 840,455 per QALY gained. In the one-way sensitivity analysis, the utility of progression-free state for patients treated with SBRT plus cetuximab or SBRT alone and the cost of progression-free survival for SBRT+Cet were the most sensitive parameters in the model. Probabilistic sensitivity analysis showed that the probability of cost-effectiveness at a willingness-to-pay threshold of NT$ 2,252,340 per QALY was 100% for SBRT plus cetuximab but 0% for SBRT alone. Conclusions This study showed that SBRT+Cet was cost-effective and benefited patients with previously irradiated rSCCHN.