Lower Medical Costs Research Articles

Comparison of low-dose morphine intrathecal analgesia and sufentanil PCIA in elderly patients with hip fracture undergoing single spinal anesthesia \u2014 a randomized clinical trial

BackgroundThe complications of postoperative pain, such as hypertension, hypermetabolism, irritability, and postoperative cognitive dysfunction, significantly affect the postoperative rehabilitation of elderly patients. Intrathecal morphine prolongs analgesia after surgery, but has been implicated in nausea and vomiting, pruritus, postoperative respiratory depression, or apneic episodes. The present study explored the effect and safety of low-dose morphine used adjunctively with bupivacaine during single spinal anesthesia or sufentanil patient-controlled intravenous analgesia (PCIA) in elderly patients with hip fracture surgery. Since elderly patients often need anticoagulant therapy in the early postoperative period, single spinal anesthesia was involved in completing the operation in this study.MethodsEighty elderly patients aged 70–85 years who underwent elective hip fracture surgery with single spinal anesthesia were divided into two groups, 12.5 mg of 0.5% hyperbaric bupivacaine with 100 µg of morphine (morphine group, group M) and 12.5 mg of 0.5% hyperbaric bupivacaine with 100 µg of sufentanil PCIA (sufentanil group, group S). The analgesia scores using the visual analogue scale (VAS), the Brinell comfort scale (BCS) were evaluated at 6, 12, 24, and 48 h after operation, and adverse reactions were recorded such as nausea and vomiting, pruritus, sedation, respiratory depression, and POD (postoperative delirium) with Delirium Rating Scale-r 98.ResultsWithin 24 h after operation, the analgesic and BCS scores of group M were better than those of group S (P < 0.05). Group M had higher frequency of skin pruritus than group S within 24 h, and the difference was statistically significant. The incidence of POD in group M (2 cases) was lower than that in group S (6 cases) (5.71% vs 18.18%) (P < 0.05) with the DRS-r 98 scores. No significant difference was observed in nausea and vomiting between the two groups, and the difference of severe respiratory depression was not found in both groups.ConclusionCompared with sufentanil PCIA, low-dose intrathecal morphine has a satisfactory analgesic effect, and little effect on the patient's cognitive function with low medical cost. Under effective respiratory monitoring, it can be used safely and effectively in elderly patients with hip fracture.Trial registrationRegistered with the Chinese Clinical Trial Registry under ChiCTR2100042706. 26/01/2021.

Price and Quality in the Generic Pharmaceutical Market.

Price and Quality in the Generic Pharmaceutical Market.

A Clinical Perspective of the Multifaceted Mechanism of Metformin in Diabetes, Infections, Cognitive Dysfunction, and Cancer.

In type 2 diabetes, ecological and lifecourse factors may interact with the host microbiota to influence expression of his/her genomes causing perturbation of interconnecting biological pathways with diverse clinical course. Metformin is a plant-based or plant-derived medicinal product used for the treatment of type 2 diabetes for over 60 years and is an essential drug listed by the World Health Organization. By reducing mitochondrial oxidative phosphorylation and adenosine triphosphate (ATP) production, metformin increased AMP (adenosine monophosphate)-activated protein kinase (AMPK) activity and altered cellular redox state with reduced glucagon activity, endogenous glucose production, lipogenesis, and protein synthesis. Metformin modulated immune response by directly reducing neutrophil to lymphocyte ratio and improving the phagocytic function of immune cells. By increasing the relative abundance of mucin-producing and short-chain-fatty-acid-producing gut microbes, metformin further improved the host inflammatory and metabolic milieu. Experimentally, metformin promoted apoptosis and reduced proliferation of cancer cells by reducing their oxygen consumption and modulating the microenvironment. Both clinical and mechanistic studies support the pluripotent effects of metformin on reducing cardiovascular–renal events, infection, cancer, cognitive dysfunction, and all-cause death in type 2 diabetes, making this low-cost medication a fundamental therapy for individualization of other glucose-lowering drugs in type 2 diabetes. Further research into the effects of metformin on cognitive function, infection and cancer, especially in people without diabetes, will provide new insights into the therapeutic value of metformin in our pursuit of prevention and treatment of ageing-related as well as acute and chronic diseases beyond diabetes.

IDF21-0380 An integrated diabetes ecosystem to address patient barriers in low-income communities in Philippines

Background: Diabetes in the Philippines is considered as a major public health concern. Diabetes care in the Philippines has challenges with respect to access to healthcare resources and government insurance coverage, With the national insurance system not covering comprehensive care and the private insurance companies only offer limited diabetes coverage. Patients mainly rely on the out-of-pocket system of healthcare for outpatient services such as lab procedures and medications. The high cost serves as a disincentive and contributes to low adherence and suboptimal care. Consequently, poor access to glycaemic monitoring and adherence to treatment impairs prevention of complications There is a need to improve diabetes care and its access in the Philippines to reduce overall clinical and economic burden. Aim: To evaluate an integrated diabetes care program addressing the healthcare awareness needs, screening, and accessibility of low cost medications to people living with Type 2 Diabetes (T2DM) and to also reinforce medical training to HCPs, to bring better outcomes in Diabetes care. Method: A stratified multistage sampling design was adopted where stratification was done on the geographical distribution and population size to provide a sample of individuals representing the Philippine population. A community inclusive approach was taken to understand patient barriers and develop services to address those challenges. All field workers (FW) underwent training before commencing field work. Field activities began with mapping procedures, spreading awareness, collection of data points like BMI, administering questionnaires, collecting Fasting Plasma Glucose (FPG) values, referring to health care providers, supplying of low-cost medications, etc. The program involved multi-organizational approach to provide comprehensive care, including diagnostics and monitoring devices (glucometers, strips). The program also provided insulins at 10 cents per day promise to patients ($2.5/vial) vs significantly higher market prices. With a door-to-door delivery method, patients could save long commutes to pharmacies and hospitals. Results: A total of 14,275 community residents were approached by FW to spread awareness about diabetes. One thousand nine hundred and forty-two people were screened using the risk assessment questionnaire and advised for FPG tests. Out of 1,942 people who took FPG test, 1,040 (56%) had FBG ≤99 mg/dl, 500 (26%) had FBG between 100 –125 mg/dl (prediabetes) and 352 (18%) had FBG ≥126 mg/dl. Among the 352 patients with diabetes, 22 (6.2%) patients had an HbA1c value of ≥ 9%. Based on the recommendations, HCPs prescribed insulin to 42 patients, of which, only 12 patients adhered to treatment with the low priced insulin. The treating HCPs also underwent a comprehensive medical educational module on diabetes where the impact of program was measured with pre and post-test questionnaire. The knowledge scores of pre & post training was recorded among HCPs (22.5/24 vs. 20/24) and nurses (18.3/24 vs. 15.7/24). The follow up of the12 patients on insulin is under progress and the outcome data will be updated on completion of 6 months. Discussion: This effort provides comprehensive data to understand how an evolving diabetes ecosystem involving awareness, screening, diagnosis, and affordable treatment (insulin) supplemented with medical education empowering HCPs can lead to better health outcomes among patients with T2DM.

Opportunity loss: care team job satisfaction and urgent care, emergency department, and hospital costs for patients with cardiovascular disease.

This study evaluates the association between primary care team job satisfaction and urgent care, emergency department, and hospital costs for their patients with cardiovascular disease (CVD). Electronic health record (EHR)-extracted observational study alongside a cross-sectional health care professional survey. A total of 143 health professionals, including physicians and clinical staff, at 5 US primary care clinics participated in a cross-sectional survey about job satisfaction. Urgent care visits, emergency department visits, hospital visit days, and medical costs in the past 12 months for each care team's panel of patients were extracted from the EHR. Three-level hierarchical modelling evaluated the link between team job satisfaction, urgent care visits, emergency department visits, hospital visit days, and medical care costs in the past 12 months for the team's patients with diagnosed CVD. Teams with higher satisfaction with their freedom of work methods, work hours, and income were associated with fewer hospital days (odds ratio = 0.85, 0.72, and 0.81, respectively) and lower medical care costs -$474, -$650, and -$397 per patient, respectively) for their patients with CVD. Overall job satisfaction was not significantly associated with cost of care. Health care employee job satisfaction in primary care is an important factor to consider in efforts to lower medical costs for patients with CVD.

Assessment of textbook outcome after lobectomy for early-stage non-small cell lung cancer in a Korean institution: A retrospective study.

BackgroundTextbook outcome (TO) has been introduced as a novel composite measure for lung cancer surgery. We investigated TO after lobectomy for early‐stage non‐small cell lung cancer (NSCLC) in a Korean tertiary hospital and its prognostic implications for overall survival and recurrence.MethodsBetween January 2012 and December 2017, 418 consecutive patients who underwent lobectomy for clinical stages I and II NSCLC were identified and retrospectively reviewed. TO was defined as complete resection (negative resection margins and sufficient lymph node dissection), no 30‐day or in‐hospital mortality, no reintervention within 30 days, no readmission to the intensive care unit, no prolonged hospital stay (<14 days), no hospital readmission within 30 days, and no major complications. Propensity score matching analysis was performed to investigate the association between TO, medical costs, and long‐term outcomes.ResultsOf 418 patients, 277 (66.3%) achieved TO. The most common events leading to TO failure were prolonged air leakage (n = 54, 12.9%) and prolonged hospital stay (n = 53, 12.7%). Male sex (odds ratio [OR] = 2.148, p = 0.036) and low diffusing capacity for carbon monoxide (OR = 0.986, p = 0.047) were significant risk factors for failed TO in multivariate analysis. In matched cohorts, achieving TO was associated with lower medical costs and better overall survival but not cancer recurrence.ConclusionsTO is associated with low medical cost and favorable overall survival; thus, surgical teams and hospitals should make efforts to improve the quality of care and achieve TO.

Racial and Ethnic Disparities in Cost-Related Barriers to Medication Adherence Among Patients With Glaucoma Enrolled in the National Institutes of Health All of Us Research Program

Ability to afford medication is a major determinate of medication adherence among patients. To determine cost-related barriers to medication adherence by race and ethnicity in a nationwide cohort of patients with glaucoma. This cross-sectional study included patients with glaucoma enrolled in the National Institutes of Health All of Us Research Program, a nationwide longitudinal cohort of US adults, with more than 300 000 currently enrolled. Individuals with a diagnosis of glaucoma based on electronic health record diagnosis codes who participated in the Health Care Access and Utilization survey and had complete data on all covariates were studied. Data were collected from June 2016 to March 2021, and data were analyzed from August to November 2021. Race and ethnicity defined as non-Hispanic African American, non-Hispanic Asian, Hispanic, and non-Hispanic White. Logistic regression was used to evaluate the association between reported cost-related barriers to medication adherence (could not afford prescription medication, skipped medication doses to save money, took less medication to save money, delayed filling a prescription to save money, asked for lower-cost medication to save money, bought prescriptions from another country to save money, and used alternative therapies to save money) and race and ethnicity, adjusting multivariable models by age, gender, health insurance status, education, and income. Odds ratios of these barriers were obtained by race and ethnicity, with non-Hispanic White race as the reference group. Of 3826 included patients with glaucoma, 481 (12.6%) were African American, 119 (3.1%) were non-Hispanic Asian, 351 (9.2%) were Hispanic, and 2875 (75.1%) were non-Hispanic White. The median (IQR) age was 69 (60-75) years, and 2307 (60.3%) were female. After adjusting for confounders, non-Hispanic African American individuals (odds ratio, 1.82; 95% CI, 1.34-2.44) and Hispanic individuals (odds ratio, 1.77; 95% CI, 1.25-2.49) were more likely than non-Hispanic White individuals to report not being able to afford medications. Further, despite having the lowest rate of endorsing difficulty affording medications, non-Hispanic White individuals were equally likely to ask for lower-cost medication from their clinicians as individuals of racial and ethnic minority groups. In this study, there was significantly higher odds of self-reported difficulty affording medications among non-Hispanic African American and Hispanic individuals compared with non-Hispanic White individuals. Clinicians should be proactive and initiate discussions about costs in an effort to promote medication adherence and health equity among patients.

Barriers to implementation of enhanced recovery after surgery (ERAS) by a multidisciplinary team in China: a multicentre qualitative study

ObjectiveTo explore the attitudes and barriers encountered in the implementation of enhanced recovery after surgery (ERAS) in China from the perspective of multidisciplinary team members.DesignBased on Donabedian’s structure–process–outcome (SPO) model,...

Relationship between the appropriateness of antibiotic treatment and clinical outcomes/medical costs of patients with community-acquired acute pyelonephritis: a multicenter prospective cohort study

BackgroundInappropriate use of antibiotics not only increases antibiotic resistance as collateral damage but also increases clinical failure rates and medical costs. The purpose of this study was to determine the relationship between the appropriateness of antibiotic prescription and outcomes of community-acquired acute pyelonephritis (CA-APN).MethodsA multicenter prospective cohort study was conducted at eight hospitals in Korea between September 2017 and August 2018. All hospitalized patients aged ≥ 19 years who were diagnosed with CA-APN on admission were recruited. The appropriateness of empirical and definitive antibiotics, as well as the appropriateness of antibiotic treatment duration and route of administration, was evaluated in accordance with the guideline and expert opinions. Clinical outcomes and medical costs were compared between patients who were administered antibiotics ‘appropriately’ and ‘inappropriately.’ResultsA total of 397 and 318 patients were eligible for the analysis of the appropriateness of empirical and definitive antibiotics, respectively. Of them, 10 (2.5%) and 18 (5.7%) were administered ‘inappropriately’ empirical and definitive antibiotics, respectively. Of the 119 patients whose use of both empirical and definitive antibiotics was classified as ‘optimal,’ 57 (47.9%) received antibiotics over a longer duration than that recommended; 67 (56.3%) did not change to oral antibiotics on day 7 of hospitalization, even after stabilization of the clinical symptoms. Patients who were administered empirical antibiotics ‘appropriately’ had shorter hospitalization days (8 vs. 10 days, P = 0.001) and lower medical costs (2381.9 vs. 3235.9 USD, P = 0.002) than those who were administered them ‘inappropriately.’ Similar findings were observed for patients administered both empirical and definitive antibiotics ‘appropriately’ and those administered either empirical or definitive antibiotics ‘inappropriately’.ConclusionsAppropriate use of antibiotics leads to better outcomes, including reduced hospitalization duration and medical costs.

Phytochemical Profile, Biological Properties, and Food Applications of the Medicinal Plant Syzygium cumini.

Syzygium cumini, locally known as Jamun in Asia, is a fruit-bearing crop belonging to the Myrtaceae family. This study aims to summarize the most recent literature related to botany, traditional applications, phytochemical ingredients, pharmacological activities, nutrition, and potential food applications of S. cumini. Traditionally, S. cumini has been utilized to combat diabetes and dysentery, and it is given to females with a history of abortions. Anatomical parts of S. cumini exhibit therapeutic potentials including antioxidant, anti-inflammatory, analgesic, antipyretic, antimalarial, anticancer, and antidiabetic activities attributed to the presence of various primary and secondary metabolites such as carbohydrates, proteins, amino acids, alkaloids, flavonoids (i.e., quercetin, myricetin, kaempferol), phenolic acids (gallic acid, caffeic acid, ellagic acid) and anthocyanins (delphinidin-3,5-O-diglucoside, petunidin-3,5-O-diglucoside, malvidin-3,5-O-diglucoside). Different fruit parts of S. cumini have been employed to enhance the nutritional and overall quality of jams, jellies, wines, and fermented products. Today, S. cumini is also used in edible films. So, we believe that S. cumini’s anatomical parts, extracts, and isolated compounds can be used in the food industry with applications in food packaging and as food additives. Future research should focus on the isolation and purification of compounds from S. cumini to treat various disorders. More importantly, clinical trials are required to develop low-cost medications with a low therapeutic index.

Strategies commercially-insured families use to manage the cost of asthma care: a qualitative interview study

Objective Families affected by asthma report difficulty adhering to care regimens because of high medication costs, coupled with increased cost sharing required by some insurance plans. To inform efforts to support adherence, we conducted a qualitative study to explore how families manage asthma care costs. Methods We conducted phone interviews with commercially-insured, US adults (n = 59) who had asthma and/or a child with asthma. Our purposive sample included participants with high- and low/no-deductible health plans. We analyzed data using thematic content analysis to identify strategies for managing asthma care costs and to assess strategies’ implications for adherence. Results Our analysis identified four overarching strategies for managing asthma care costs. First, participants used prevention strategies to avoid costly acute care by minimizing exposure to asthma triggers and adhering strictly to preventive medication regimens. Second, participants used shopping strategies to reduce costs, including by comparing medication prices across pharmacies, using medication coupons or free samples, and switching to lower-cost medications. Third, budgeting strategies involved putting aside funds, including in tax-exempt health savings accounts, or taking on debt to pay for care. Finally, some participants sought to reduce costs by forgoing recommended care, including by skipping medication doses or replacing prescribed medications with alternative therapies. Conclusion Commercially-insured families use a wide range of strategies to manage asthma care costs, with both positive and negative implications for adherence. Our typology of asthma cost management strategies can inform insurance redesign and other interventions to help families safely reduce costs and maximize adherence to recommended care.

Survival, treatment regimens and medical costs of women newly diagnosed with metastatic triple-negative breast cancer

Individuals diagnosed with metastatic triple-negative breast cancer (mTNBC) suffer worse survival rates than their metastatic non-TNBC counterparts. There is little information on survival, treatment patterns, and medical costs of mTNBC patients in Asia. Therefore, this study aimed to examine 5-year survival, regimens of first-line systemic therapy, and healthcare costs of mTNBC patients in Taiwan. Adult females newly diagnosed with TNBC and non-TNBC as well as their survival data, treatment regimens and costs of health services were identified and retrieved from the Cancer Registry database, Death Registry database, and National Health Insurance (NHI) claims database. A total of 9691 (19.27%) women were identified as TNBC among overall BC. The 5-year overall survival rate of TNBC and non-TNBC was 81.28% and 86.50%, respectively, and that of mTNBC and metastatic non-TNBC was 10.81% and 33.46%, respectively. The majority of mTNBC patients received combination therapy as their first-line treatment (78.14%). The 5-year total cost in patients with metastatic non-TNBC and with mTNBC was NTD1,808,693 and NTD803,445, respectively. Higher CCI scores were associated with an increased risk of death and lower probability of receiving combination chemotherapy. Older age was associated with lower 5-year medical costs. In sum, mTNBC patients suffered from poorer survival and incurred lower medical costs than their metastatic non-TNBC counterparts. Future research will be needed when there are more treatment options available for mTNBC patients.

The Positive Effect of Mindfulness-Based Cancer Recovery on Cancer-Related Fatigue in a Transitional Health Management Model

Compared with general fatigue, cancer-related fatigue is characterized by rapid onset, high severity, substantial energy expenditure, long duration, unpredictability, and inability of relief. There has been no effective treatment for it so far, which greatly affects the patients' self-care ability and quality of life. It has been proved in previous studies that mindfulness-based cancer recovery (MBCR) can effectively alleviate the negative reactions of cancer patients such as fatigue, pain and fear during the treatment process and enhance the level of cancer recovery. In this article, we propose to intervene in cancer-related fatigue by resorting to mindfulness based on a "hospital-family transitional health management model". It is expected that this model will play a positive role in the adjuvant treatment of cancer-related fatigue because of its operability and low medical cost.

Effects of Mobilization among Critically Ill Patients in the Intensive Care Unit: A Single-center Retrospective Study.

ABSTRACTObjectives:This study investigated the effect of early mobilization [EM; physical rehabilitation with the intensity needed to sit on the edge of the bed started within 5 days of intensive care unit (ICU) admission] in relation to improvements in gait independence and other clinical outcomes.Methods:This retrospective single-center study evaluated patients aged at least 18 years who stayed in the ICU for at least 48 h and were categorized into EM and late mobilization (LM; physical rehabilitation started more than 5 days after ICU admission) groups. Outcomes were compared after adjusting for 20 background factors by propensity score matching and inverse probability of treatment weighting. The primary outcome was independent gait at discharge. The secondary outcomes were medical costs, 90-day survival, and durations of ICU and hospital stays.Results:Of 177 patients, 85 and 92 were enrolled in the EM and LM groups, respectively. Propensity score matching created 37 patient pairs. There was no significant difference in the 90-day survival rate (P=0.308) or medical costs (P=0.054), whereas independent gait at discharge (P=0.025) and duration of hospital stay (P=0.013) differed significantly. Multivariate logistic regression analysis showed that EM was independently associated with independent gait at discharge (P=0.011) and duration of hospital stay (P=0.010) but was not associated with 90-day survival (odds ratio: 2.64, 95% confidence interval: 0.67–13.12, P=0.169).Conclusions:Early mobilization in the ICU did not affect 90-day survival and did not lower medical costs but was associated with independent gait at discharge and shorter hospital stays.

P-L10 Individualized Enhanced recovery after surgery improves postoperative outcomes in hepatocellular carcinoma patients

Abstract Background Hepatocellular carcinoma (HCC) patients often undergo curative liver resection to treat this form of cancer. Hepatectomy is, however, a form of major surgery associated with many significant risks including prolonged hospitalization, high costs, impaired physiological function, and high postoperative complication rates. Enhanced recovery after surgery (ERAS) is a multidisciplinary approach that seeks to expedite postoperative recovery in patients undergoing major surgeries in order to lower postoperative complication rates. This study was thus designed to assess the efficacy and safety of individualized ERAS approaches in patients undergoing hepatectomy. Methods In total, we retrospectively analyzed data from 90 HCC patients that underwent hepatectomy between October 2018 and August 2019. All patients met the study enrollment criteria and provided written informed consent to participate. All studies were approved by the Hospital Research Ethics Committee and were consistent with the Declaration of Helsinki. Patients were randomly divided into two groups (n = 45 each) based on the employed perioperative treatment strategies: a conventional treatment group and an ERAS treatment group. Key outcomes were then compared between groups, including postoperative pain scores, duration of postoperative hospitalization, medical costs, and rates of readmission. Results ERAS treatment was associated with lower postoperative pain scores at 24, 48, and 72 h post-treatment (P &amp;lt; 0.05), with a shorter postoperative hospitalization duration (8.16 days vs.10.49 days; P &amp;lt; 0.004), and with lower medical costs (P &amp;lt; 0.004) as compared to traditional treatment. No significant differences in complication rates (P &amp;gt; 0.05) or readmission rates (P &amp;gt; 0.557) were observed between these groups. Conclusions Individualized ERAS improves patient postoperative recovery more effectively than traditional treatment in patients undergoing hepatectomy.

A population-based assessment of the post-operative complications rates and 30-day mortality associated with lower limb amputations at a tertiary care center in Riyadh, Saudi Arabia

Objectives: There is no consensus on the postoperative 30-day mortality, complication rates, and their risk factors post lower limb amputations (LLA) in the literature, especially in Saudi Arabia. To address this gap, we assessed these three parameters in our patients who underwent LLAs. Methods: We conducted a retrospective cross-sectional study in King Abdulaziz Medical City, Riyadh, Saudi Arabia, between 2015 and 2019. Using non-probability purposive sampling, we targeted 318 adults who underwent LLA at our hospital. The primary outcome variables were postoperative 30-day mortality and complications, such as stump pain, wound infections, hemorrhage, and acute kidney injury. In addition, we collected data on demographics, comorbidities, and clinical course from electronic medical records. Results: We assessed 318 patients (mean age = 65.7 [SD = 0.840] years), most of whom were male patients (68.6%) with endocrine and metabolic disorders (92.1%). Most amputees (87.1%) had peripheral vascular diseases as the main indication for LLA at an above-knee level (62.6%). The 30-day mortality and complication rates were 6.6% and 74%, respectively. Intermediate complications predominated (57%), with stump pain (17.3%) and phantom limb pain (15.4%) being the most common. Thirty-day mortality was significantly associated with some patient characteristics and comorbid kidneys and neurological disorders. The immediate, intermediate, and late complications were significantly related to smoking and several renal, vascular, and respiratory disorders. Conclusion: Calculating the 30-day mortality and complication rates after LLA and mapping the associated risk factors helped identify high-risk patients, deliver better treatment, lower medical costs, and establish protective measures.

1387. Impact of Cytomegalovirus Prophylaxis on Healthcare Resource Use and Costs among Kidney Transplant Recipients: A United States Renal Data System-Medicare Linked Database Study

BackgroundCytomegalovirus (CMV) management requires a balance between reducing the risk of CMV infection and avoiding anti-viral toxicities. Limited information is available on the impact of CMV prophylaxis on the healthcare resource use (HCRU) and costs among adult kidney transplant recipients (KTRs) in the United States. Therefore, we examined HCRU and cost associated with CMV prophylaxis stratified by the CMV risk categories among KTRs at 1-year post-KT. MethodsWe identified a cohort of 22,918 adults first-time KTRs during 2011–2017 using the US Renal Data System registry-linked Medicare data. Additional inclusion criteria were to have continuous coverage in Medicare Part A & B for ≥ 6-month pre- and ≥ 12-month post KT and Medicare Part D for ≥12-month post-KT. CMV prophylaxis was confirmed as ≥ 1 prescription fill for valacyclovir/(val)ganciclovir prophylaxis doses within 28 days post-KT. ResultsCMV prophylaxis was utilized in 86%, 82%, and 32% of high, intermediate, and low-risk KTRs with an average cost of prophylaxis per KTRs of &16,241, &9481, and &8,648, respectively. In no prophylaxis groups, valganciclovir was utilized in 52%, 34%, and 36% of KTRs (as either pre-emptive or deferred therapy) with an average cost of &6,719, &2,722, and &431 among high, intermediate, and low-risk KTRs, respectively. Among high-risk KTRs, CMV prophylaxis group had a significantly higher prescription drug cost (&26,060 vs. &13,433) but a lower average direct healthcare medical cost (&84,914 vs. &101,268), mainly due to lower all-cause hospitalization cost (&56,758 vs. &69,852) (Table 1). CMV prophylaxis group had lower rates of all-cause rehospitalization, and CMV-and opportunistic infection (OIs)-related hospitalization compared to no prophylaxis (Table 2). In high-risk KTRs, nearly 32% had myelosuppressive events-related hospitalization, and 15% filled granulocyte colony-stimulating factors with an average cost of &4,695 per treated KTR.ConclusionCMV prophylaxis had a higher cost of medications but had a lower medical cost with including all-cause and CMV-related hospitalizations. Myelosuppressive events were frequent and resource-intensive especially in high and intermediate-risk KTRs. Disclosures Amit D. Raval, PhD, Merck and Co., Inc. (Employee) Yuexin Tang, PhD, JnJ (Other Financial or Material Support, Spouse’s employment)Merck & Co., Inc. (Employee, Shareholder)

Economic Burden of Cancer Treatment in a Region in South India: A Cross Sectional Analytical Study

Introduction:The rising cost of cancer diagnosis and treatment has imposed a huge financial burden on the affected households. Understanding the nature of this burden will help us to formulate plans to avoid financial distress among the same. Objective:The study aims to estimate the Out of Pocket Expenditure (OOPE) for the management of selected solid cancers among the Out-Patient Department (OPD) of Regional Cancer Centre in South India and to determine the proportion of families experiencing Catastrophic Health Expenditure (CHE) due to the same. Methods:A hospital based cross sectional analytical study was undertaken in the authors’ institute in South India. 474 solid cancer patients were interviewed in OPD of Radiation Oncology by a trained data collector. Sociodemographic variables, costs incurred under various headings and expenditure details of participants were obtained. Direct Medical and Direct Non-Medical costs were calculated, and its total was used as the OOPE. Costs were presented as mean with its standard error. Incidence of CHE was calculated using the 40% threshold on the Capacity to pay and was expressed as proportions with 95% confidence interval. Appropriate statistical tests were used to look for statistically significant differences in the study groups. Results:The average OOP expenditure incurred by a cancer patient was INR 35,817 (USD 523.6) for male and INR 20,496 (USD 299.6) for female. Males had a significantly higher OOPE than females. The prevalence of catastrophic health expenditure (CHE) was 61.6% at the 40% CTP threshold. Patients who used insurance schemes had higher prevalence of CHE than those who did not use insurance schemes (65.5% vs 60.7%, p value 0.351). Conclusion:Cancer care provided through public institutions had a low direct medical cost, but the indirect cost seemed to be extremely high. Public based financial assistance is the need of the hour to help the cancer affected families.

AACE2021-A-1095: An Integrated Diabetes Ecosystem to Address Patient Barriers in Low-Income Communities in Philippines

Diabetes in the Philippines is considered as a major public health concern.1 Diabetes care in the Philippines has challenges with respect to access to healthcare resources and government insurance coverage. With the national insurance system not covering comprehensive diabetes care and the private insurance companies only offering limited diabetes coverage patients mainly rely on the out-of-pocket system of healthcare for outpatient services such as laboratory procedures and daily medications. Furthermore, the high cost involved serves as a disincentive and contributes to low adherence and suboptimal care. Consequently, poor access to glycaemic monitoring and adherence to treatment impairs prevention of complications2 There is a need to improve diabetes care and its access in the Philippines to reduce overall clinical and economic burden. Aim: To evaluate an integrated diabetes care program addressing the healthcare awareness needs, screening, and accessibility of low cost medications to people living with Type 2 Diabetes(T2DM) and to also reinforce medical training in HCPs to bring better outcomes in Diabetes care. A stratified multistage sampling design was adopted for this project. Stratification was done based on the geographical distribution, population size, and socioeconomic status to provide a sample of individuals representing the Philippine population. A community-inclusive approach was taken to understand patient barriers and develop services to address those challenges. All field workers underwent intensive training before commencing field work. Pre-field activities began by seeking and obtaining approval from the local health authorities. Field activities began with mapping procedures, spreading awareness, listing of households, collection of data points like BMI, administering questionnaires, collecting FPG values, referring to health care providers, supplying of low-cost medications, etc. The program involved multi-organizational approach to provide comprehensive care, including diagnostics and monitoring devices (glucometers, strips). The program also provided insulins at 10 cents per day promise to patients ($2.5/vial) vs. significantly higher market prices. With a door-to-door delivery method, patients could save long commutes to pharmacies and hospitals. A total of 14,275 community residents were approached by field workers to spread awareness about diabetes. One thousand nine hundred and forty-two people were screened using the risk assessment questionnaire and advised for FBG tests. Out of 1,942 people who took FBG test, 1,040 (56%) had FBG <99 mg/dl, 500 (26%) had FBG between 100 – 125 mg/dl (prediabetes) and 352 (18%) had FBG >126 mg/dl (diabetes). Among the 352 patients with diabetes, 22 (6.2%) patients had an HbA1c value of > 9%. Based on the guideline recommendations, HCPs prescribed insulin to 42 patients, of which, only 12 patients adhered to treatment with the low priced insulin. The treating HCPs also underwent a comprehensive medical educational module on diabetes where the impact of program was measured with pre- and post-test questionnaire. The knowledge scores of pre- and post-training was recorded among doctors (22.5/24 vs. 20/24) and nurses (18.3/24 vs. 15.7/24). The follow up of the12 patients on insulin is under progress and the outcome data will be updated on completion of 6 months. This effort provides comprehensive data to understand how an evolving diabetes ecosystem involving awareness, screening, diagnosis, and affordable treatment (insulin) supplemented with medical education empowering HCPs can lead to better health outcomes among patients with T2DM.

Current status and thoughts of non-surgical treatment of knee osteoarthritis

Knee osteoarthritis (KOA) is a worldwide disease, and also the main cause of pain and disability in the motor system. Due to the aging population in China, extension of life expectancy and increased number of obese people, the number of people affected by KOA continues to surge. Neither surgical nor non-surgical treatment can change the disease process, but these interventions can reduce pain and disability. The treatment principle of KOA is to start with non-surgical treatment, which has been considered as the first choice for KOA patients due to its advantages of less complications, minimal invasiveness, and low medical cost. This article describes the non-surgical treatment of KOA, aiming to provide new insights into the clinical treatment of KOA.