Medical Cost Data Research Articles

Low-, moderate-, and high-risk obesity in association with cost drivers, costs over the lifecycle, and life expectancy

BackgroundThe prevalence of low-, moderate-, and high-risk obesity has been increasing globally. Our aim was to estimate the societal burden of these three obesity classes in the Austrian population by taking a societal–annual perspective and an individual–life-cycle perspective. Secondly, we sought to identify the respective cost drivers and the effects on life expectancy.MethodsWe used population-weighted survey data on the distribution of body mass index (BMI) and data on relative risks regarding 83 diseases. Using fractional polynomial regressions, we estimated relative risks per BMI unit for about 30 cost-intensive diseases up to BMI values of 50. The approach for the cost analysis was based on the use of population-attributable fractions applied to direct medical and indirect cost data. Macro-disease-specific data regarding cost factors came from cost-of-illness statistics and administrative sources.ResultsAbout 8.2% of deaths and 4.6% of health expenditure are attributable to obesity in Austria in 2019, causing 0.61% of GDP loss. A third of annual direct and indirect costs came from class 2 and class 3 obesity. From an individual perspective, life-cycle costs of class 2 and class 3 obesity were 1.9 and 3.6 times the costs of class 1 obesity, respectively. At the age of 45, people with high-risk obesity are about to lose approximately 4.9 life years and 9.7 quality-adjusted life years.ConclusionsWe have extended the method of population-attributable fractions, allowing us to estimate differences in the life-cycle direct medical and indirect costs between low-, moderate-, and high-risk obesity. We found that the lifetime costs of obesity are strikingly different between obesity classes, which has been veiled in the societal—annual perspective. Our findings provide a foundation for evaluating public health interventions aimed at combating obesity in order to mitigate the escalating individual and societal burden resulting from obesity prevalence and complications in the future.

ANALYSIS OF COST EFFECTIVENESS OF ANTIBIOTIC USE IN TYPHOD FEVER PATIENTS AT KARTINI RANGKASBITUNG HOSPITAL IN 2022

The high prevalence rate of typhoid fever is one of the health problems in Indonesia. Antibiotic therapy is the only therapy that can be used to treat the main cause of typhoid fever. Antibiotics are a type of drug therapy that requires a lot of budgets to procure. This study aims to find out the most cost-effective type of antibiotic for treating typhoid fever. This research was conducted at Kartini Rangkasbitung Hospital using observational research methods with a cross-sectional approach. The data used uses secondary data conducted retrospectively. This research uses medical record data and cost data. This study was divided into three groups, namely ciprofloxacin tablets, intravenous ceftriaxone, levofloxacin tablets and intravenous levofloxacin. Based on the calculation results, the ACER value of ceftriaxone is IDR 2,955,250, the ACER value of IV levofloxacin is IDR 2,727,306, and the ACER value of levofloxacin tablets is IDR 3,047,337. The ICER value from the comparison between levofloxacin tablets and ceftriaxone is IDR 43,250. The most cost-effective antibiotic is the antibiotic levofloxacin in intravenous form.

Cost-Effectiveness of Addressing Retinopathy of Prematurity in Rwanda

ABSTRACT Purpose With the expansion of neonatal care in sub-Saharan Africa (SSA), an increasing number of premature babies are at risk to develop retinopathy of prematurity (ROP). Previous studies have quantified the cost-effectiveness of addressing ROP in middle-income countries, but few have focused on SSA. This study estimates the cost of a national program for ROP screening and anti-VEGF injection treatment in Rwanda compared to the status quo. Methods Medical cost data were collected from King Faisal Hospital in Rwanda (July 2022). Societal burden of vision loss included lost productivity and quality-adjusted life years (QALYs). Published data on epidemiology and natural history of ROP were used to estimate burden and sequelae of ROP in Rwanda. Cost of a national program for screening and treating a one-year birth cohort was compared to the status quo using a decision analysis model. Results Cost of ROP screening and treatment was $738 per infant. The estimated equipment cost necessary for the startup of a national program was $58,667. We projected that a national program could avert 257 cases of blindness in the cohort and increase QALYs compared to the status quo. Screening and treatment for ROP would save an estimated $270,000 for the birth cohort from reductions in lost productivity. Conclusion The cost of screening and anti-VEGF treatment for ROP is substantially less than the indirect cost of vision loss due to ROP. Allocating additional funding towards expansion of ROP screening and treatment is cost-saving from a societal perspective compared to current practice.

A terminal trend model for longitudinal medical cost data and survival

A terminal trend model for longitudinal medical cost data and survival

Longitudinal varying coefficient single-index model with censored covariates.

It is of interest to health policy research to estimate the population-averaged longitudinal medical cost trajectory from initial cancer diagnosis to death, and understand how the trajectory curve is affected by patient characteristics. This research question leads to a number of statistical challenges because the longitudinal cost data are often non-normally distributed with skewness, zero-inflation, and heteroscedasticity. The trajectory is nonlinear, and its length and shape depend on survival, which are subject to censoring. Modeling the association between multiple patient characteristics and nonlinear cost trajectory curves of varying lengths should take into consideration parsimony, flexibility, and interpretation. We propose a novel longitudinal varying coefficient single-index model. Multiple patient characteristics are summarized in a single-index, representing a patient's overall propensity for healthcare use. The effects of this index on various segments of the cost trajectory depend on both time and survival, which is flexibly modeled by a bivariate varying coefficient function. The model is estimated by generalized estimating equationswith an extended marginal mean structure to accommodate censored survival time as a covariate. We established the pointwise confidence interval of the varying coefficient and a test for the covariate effect. The numerical performance was extensively studied in simulations. We applied the proposed methodology to medical cost data of prostate cancer patients from the Surveillance, Epidemiology, and End Results-Medicare-Linked Database.

Medical Costs Estimation Using Linear Regression Method

Medical costs are a significant issue in the health sector. High healthcare cost lead to the need to anticipate financial risks for individuals and insurance providers. Therefore, medical cost data analysis is necessary to estimate future medical expenses. This research implements data mining techniques using Simple and Multiple Linear Regression methods to estimate medical costs. The dataset used consists of insurance claim data obtained from Kaggle, which includes attributes such as age, gender, body mass index, number of children, smoking habits, region, and medical charges. The research findings that Multiple Linear Regression outperforms Simple Linear Regression in estimating the provided dataset, with R2 value of 80% and lower ?? MSE and MAE values than Simple Linear Regression. The application of linear regression in insurance claim data analysis can provide significant benefits for patients, hospitals, and insurance providers. Overall, this research highlights the effectiveness of data mining techniques, specifically linear regression, in estimating healthcare costs.

Hospitalizations due to respiratory syncytial virus (RSV) infections in Germany: a nationwide clinical and direct cost data analysis (2010-2019).

Clinical and direct medical cost data on RSV-related hospitalizations are relevant for public health decision-making. We analyzed nationwide data on RSV-coded hospitalizations from Germany in different age and risk groups. Assessment of RSV-coded hospitalizations (ICD-10-GM RSV-code J12.1/J20.5/J21.0 as primary discharge diagnosis) from 01/2010 to 12/2019, using remote data retrieval from the Hospital Statistics Database of the German Federal Statistical Office. Overall, 205,352 RSV-coded hospitalizations (198,139 children < 18years, 1,313 adults, 5,900 seniors > 59years) were reported (median age < 1year, IQR 0; 1; 56% males, 32% with RSV pneumonia). Annual median RSV-coded hospitalization incidence was 24.8/100,000 persons (IQR 21.3; 27.5); children reported a median incidence of 145.8 (IQR 130.9; 168.3). Between 2010 and 2019, hospitalization incidence increased 1.7-fold/15.1-fold/103-fold in children/adults/seniors. Adults and seniors reported higher rates of underlying chronic conditions, complications, and intensive care treatment than children; of 612 in-hospital fatalities, 103/51/458 occurred in children/adults/seniors. Per-patient mean costs varied between 3286€ ± 4594 in 1-4-year-olds and 7215€ ± 13,564 among adults. Increased costs were associated with immune disorders (2.55-fold increase compared to those without), nervous system disorders (2.66-fold), sepsis (7.27-fold), ARDS (12.85-fold), intensive care (4.60-fold) and ECMO treatment (16.88-fold). The economic burden of RSV-related hospitalizations in Germany is substantial, even when only considering cases with RSV-coded as the primary discharge diagnosis. Children represented the vast majority of RSV-coded hospitalizations. However, adults and seniors hospitalized for RSV were at a higher risk of severe complications, required more costly treatments, and had higher fatality rates; although their RSV-coded hospitalization incidence showed a clear upward trend since 2017, their true hospitalization incidence is still likely to be underestimated due to lack of routine RSV testing in these age groups. Hence, new treatments and vaccines for RSV ideally should also target adults and seniors in addition to children.

The economic impact of obesity in Kuwait: a micro-costing study evaluating the burden of obesity-related comorbidities

Objective44% of Kuwait’s population live with obesity and the health consequences place a significant burden on the public health system. This study provides an assessment of the cost burden of obesity-related comorbidities (ORC).MethodsA retrospective micro-costing analysis was conducted to quantify the direct cost associated with ORCs. ORCs and their cost categories were informed by a systematic literature review and validated by a local steering committee comprising three experts. Seventy public sector clinicians and eight hospital procurement staff were surveyed to provide healthcare resource utilization estimates and medical resource cost data, respectively. The annual cost of each ORC and the cost drivers were also validated by the steering committee.ResultsIndividuals in Kuwait with any single ORC incurred direct healthcare costs ranging 1,748–4,205 KWD annually. Asthma, chronic kidney disease and type 2 diabetes were the costliest ORCs, incurring an annual cost that exceeds 3,500 KWD per patient. Hypertension, angina and atrial fibrillation were the least costly ORCs. In general, costs were driven by drug costs and resources allocated to address treatment-related adverse events.LimitationsIn the absence of an official patient registry in Kuwait, our study provides a conservative estimate of direct costs derived from a nationwide survey. Additionally, the cost estimates in this study assumes that a patient with obesity will only experience one ORC. In reality, multi-morbid states may incur additional costs that are not currently captured.ConclusionsOur study confirms that ORCs generate a significant financial burden to the public payer. The study provides an economic case for policymakers to recognize the exigency for obesity prevention and control in accordance with the ORC prevalence, and the need for sustainable investments towards body-mass index management to prevent individuals from developing multiple comorbidities.

Instrumental variable analysis for cost outcome: Application to the effect of primary care visit on medical cost among low-income adults.

Medical cost data often consist of zero values as well as extremely right-skewed positive values. A two-part model is a popular choice for analyzing medical cost data, where the first part models the probability of a positive cost using logistic regression and the second part models the positive cost using a lognormal or Gamma distribution. To address the unmeasured confounding in studies on cost outcome under two-part models, two instrumental variable (IV) methods, two-stage residual inclusion (2SRI) and two-stage prediction substitution (2SPS) are widely applied. However, previous literature demonstrated that both the 2SRI and the 2SPS could fail to consistently estimate the causal effect among compliers under standard IV assumptions for binary and survival outcomes. Our simulation studies confirmed that it continued to be the case for a two-part model, which is another nonlinear model. In this article, we develop a model-based IV approach, Instrumental Variable with Two-Part model (IV2P), to obtain a consistent estimate of the causal effect among compliers for cost outcome under standard IV assumptions. In addition, we develop sensitivity analysis approaches to allow the evaluation of the sensitivity of the causal conclusions to potential quantified violations of the exclusion restriction assumption and the randomization of IV assumption. We apply our method to a randomized cash incentive study to evaluate the effect of a primary care visit on medical cost among low-income adults newly covered by a primary care program.

Compliance to genomic test recommendations to guide adjuvant chemotherapy decision-making in the case of hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer, in real-life settings.

Genomic tests are a useful tool for adjuvant chemotherapy decision-making in the case of hormone receptor-positive (HR+), and human epidermal growth factor receptor 2-negative (HER2-) breast cancer with intermediate prognostic factors. Real-life data on the use of tests can help identify the target population for testing. French multicentric study (8 centers) including patients, all candidates for adjuvant chemotherapy for HR-positive, HER2-negative early breast cancer. We describe the percentage of tests performed outside recommendations, according to the year of testing. We calculated a ratio defined as the number of tests required to avoid chemotherapy for one patient, and according to patient and cancer characteristics. We then performed a cost-saving analysis using medical cost data over a period of 1 year from diagnosis, calculated from a previous study. Finally, we calculated the threshold of the ratio (number of tests required to avoid chemotherapy for one patient) below which the use of genomic tests was cost-saving. A total of 2331 patients underwent a Prosigna test. The ratio (performed test/avoided chemotherapy) was 2.8 [95% CI: 2.7-2.9] in the whole population. In the group following recommendations for test indication, the ratio was 2.3 [95% CI: 2.2-2.4]. In the case of non-abidance by recommendations, the ratio was 3 [95% CI: 2.8-3.2]. Chemotherapy was avoided in 841 patients (36%) following the results of the Prosigna test. The direct medical costs saved over 1 year of care were 3,878,798€ and 1,718,472€ in the group of patients following test recommendations. We calculated that the ratio (performed test/avoided chemotherapy) needed to be under 6.9 for testing to prove cost-saving. The use of genomic testing proved cost-saving in this large multicentric real-life analysis, even in certain cases when the test was performed outside recommendations.

Cost effectiveness analysis of ceftriaxone and levofloxacin for therapy of urinary tract infection at Soebandi public hospital

Background: An ideal therapeutic option should be effective and have a low cost. The first-line therapy of urinary tract infection (UTI) includes cephalosporin and fluoroquinolone. Objective: To find out which antibiotic therapy is more cost-effective between ceftriaxone and levofloxacin using a cost-effectiveness analysis test. Method: The study was conducted retrospectively using medical records and patient direct medical cost data for 2019 and 2020. The records of 21 patients met the inclusion criteria. Data processing and decision-making were carried out using descriptive and inferential statistical analysis, average cost-effectiveness (ACER) calculations, and a cost-effectiveness grid. The outcome parameter used in a cost-effectiveness analysis was the percentage of effectiveness of empirical therapy. Result: The results showed that 61.9% of patients received ceftriaxone and 38.1% received levofloxacin. The average length of hospitalisation of UTI patients with levofloxacin therapy was shorter than those treated with ceftriaxone (four versus five days) with a p-value = 0.066. The average cost of ceftriaxone treatment was higher than that of levofloxacin (IDR 2,352,307 versus IDR 1,867,183). Based on statistical analysis carried out on each component of direct medical cost, the results were not significantly different between the cost of treatment with ceftriaxone or levofloxacin (p = 0.107). The percentage of effectiveness of empirical therapy using levofloxacin was higher than ceftriaxone (100% versus 90.5%). ACER value of total levofloxacin cost (IDR 18,672 per percentage effectiveness) has a lower value compared to ceftriaxone (IDR 26,000 per percentage effectiveness). Conclusion: Using the cost-effectiveness grid, levofloxacin is a more effective therapy, therefore the treatment of UTIs at Soebandi public hospital using levofloxacin are more cost-effective.

Kernel Estimation of Bivariate Time-Varying Coefficient Model for Longitudinal Data with Terminal Event

We propose a nonparametric bivariate time-varying coefficient model for longitudinal measurements with the occurrence of a terminal event that is subject to right censoring. The time-varying coefficients capture the longitudinal trajectories of covariate effects along with both the followup time and the residual lifetime. The proposed model extends the parametric conditional approach given terminal event time in recent literature, and thus avoids potential model misspecification. We consider a kernel smoothing method for estimating regression coefficients in our model and use cross-validation for bandwidth selection, applying undersmoothing in the final analysis to eliminate the asymptotic bias of the kernel estimator. We show that the kernel estimates follow a finite-dimensional normal distribution asymptotically under mild regularity conditions, and provide an easily computed sandwich covariance matrix estimator. We conduct extensive simulations that show desirable performance of the proposed approach, and apply the method to analyzing the medical cost data for patients with end-stage renal disease. Supplementary materials for this article are available online.

Cost-effectiveness analysis of digital therapeutics for home-based cardiac rehabilitation for patients with atrial fibrillation after catheter ablation.

In recent years, numerous guidelines and expert consensuses have recommended that digital technologies and products, such as digital therapeutics (DTx), be incorporated into cardiac rehabilitation (CR). The study aims to compare the cost-effectiveness of DTx for home-based CR (HBCR) with that of the conventional HBCR for patients with atrial fibrillation (AF) after catheter ablation in a real-world clinical setting. Based on a single-center, prospective, blinded, randomized, parallel controlled trial of DTx-based HBCR for AF patients after catheter ablation, 100 AF patients undergoing catheter ablation were selected and randomized at a 1:1 ratio into a UC group (conventional HBCR) and DT group (DTx-based HBCR). The intervention lasted for 12 weeks. Medical cost data and clinical efficacy data (VO2max) were acquired from trial data. Effect data (QALYs, anxiety and depression status, health beliefs related to cardiovascular disease, and exercise self-efficacy) were obtained from a patient questionnaire. The cost-effectiveness analysis was conducted to assess the economic benefits of DTx-based HBCR versus conventional HBCR, and the robustness of the results was verified by sensitivity analysis. In the DT group (n = 49), the mean QALYs increased 0.119 ± 0.09, VO2max increased 9.3 ± 8.0 mL/(min*kg), anxiety, depression, health belief, and exercise self-efficacy had improved, and the total medical cost was 75,080.55 ± 19,746.62 CNY. In the UC group (n = 48), the mean QALYs increased 0.077 ± 0.06, VO2max increased 4.9 ± 6.6 mL/(min*kg), anxiety, depression, health belief, and exercise self-efficacy had improved, and the total medical cost was 73,972.66 ± 16,582.04 CNY. The difference in the medical cost was 1107.89 CNY, and the incremental cost-effectiveness ratio was 33,572.42 CNY/QALY, which was lower than the willingness-to-pay threshold of 85,698 CNY (China's per capita GDP in 2022). DTx-based HBCR is more effective and cost-effective than conventional HBCR.

Estimation of Medical Costs for Ischemic Stroke Patients - From the Perspective of a Health Care Provider

The increasing prevalence of stroke has presented challenges to all countries. Since 2007, stroke has been one of the leading causes of death in Malaysia. Furthermore, the number of strokes is expected to increase steadily. Certainly, all parties are concerned, particularly considering the socioeconomic burden that must be borne. As a result, the community and health-care providers must measure the number required to cover the medical expenses associated with a stroke. The estimated medical costs are based on the medical costs of ischemic stroke patients treated at Hospital Canselor Tuanku Mukhriz, which involved a total of 2161 stroke patients between 2016 and 2020. Demographic factors such as age and gender, as well as clinical factors such as severity, length of stay (LOS), and comorbid factors, were used to determine the medical costs of ischemic stroke patients. A logarithmic transformation was carried out on the medical cost to create a more suitable medical cost estimating model, considering the skewed nature of the medical cost data of ischemic stroke patients. As a result of the multiple linear regression analysis, age, LOS, severity level, type of comorbidity such as hypertension, ischemic heart disease (IHD), atrial fibrillation (AF), smoking and alcohol habits were found to have a significant effect on these medical costs. However, a patient's medical costs are unaffected by gender or type of comorbidity, such as diabetes or hyperlipidemia. Furthermore, it was discovered that increased LOS, severity levels, or the presence of comorbidities such as IHD, AF, and smoking habits all increased patients' medical costs. Medical costs, on the other hand, were found to be lower in patients who were older, consumed alcohol, and had hypertension.

Clinical and therapeutic characteristics and medical cost of managing cancer patients in Al-Anbar, Iraq: A cross-sectional study

BackgroundCancer is a complex disease that is one of the leading causes of death. This study aimed to investigate the clinical and therapeutic characteristics, as well as the medical cost of managing adult cancer patients in Al-Anbar city in Iraq from the patient's perspective. MethodThis was a prospective cross-sectional study that was carried out at the Al-Anbar Oncology Centre between September and December 2021. Direct medical cost data includes the cost of treatment, healthcare professional visits, laboratory tests, and surgery. Furthermore, patients were contacted and asked to estimate the direct non-medical costs (transportation costs) connected with their disease, as well as describe side effects of their cancer therapy. Logistic regression was used to identify variables associated with higher cancer management costs. ResultsThis study included 500 patients in total. The median overall management cost is 2,765.0 $(IQR: 3,888.7$). The median cancer management cost differed statistically significantly depending on the stage of the disease, with stage two patients having a lower median cost than other patients (p < 0.05). Patients suffering from colon and brain cancer having significantly higher costs (p ≤ 0.05). The median duration of disease was 1.0 year (IQR: 1.0 year). More than half the patients (65.4 %) were at stages three and four. Breast cancer (among females), ovarian cancer (among females), and lymphoma were the most common types of cancer, accounting for 53.9 %, 10.5 %, and 8.6 %, respectively. Almost all patients (99.8 %) were undergoing chemotherapy. More than half of the patients (64.8 %) had surgery to manage their disease, and 16.6 % had radiotherapy as part of their treatment plan. The most widely utilized chemotherapy therapeutic classes were antimicrotubular and platinum analogues with 34.0 % and 33.6 %, respectively. The most common cancer therapy side effects were nausea and vomiting, hair loss, and appetite loss,with85.2 %, 75.2 %, and 54.2 %, respectively. ConclusionBreast cancer (in females), ovarian cancer (in females), and lymphoma are the mostcommon types of cancerin Iraq. More research on the risk factors for these types of cancer is needed. Furthermore, additional economic studies from other perspectives are required to highlight the economic burden of cancer in Iraq.

A state-by-state and regional analysis of the direct medical costs of treating musculoskeletal injuries among US Army trainees

IntroductionLow physical activity (PA) and physical fitness (PF) are well-known factors for chronic diseases generally and cardiovascular diseases specifically. The economic burden from these chronic diseases is also well documented, as is their disproportionate prevalence among states in the Southern region of the U.S. Low PA and PF have also become recognized factors impacting military readiness and national security. Specifically, low PA and PF are highly correlated with musculoskeletal injures (MSKIs), now considered the greatest medical impediment to military readiness. Prior research shows low PF and MSKI incidence are greater among Army recruits from Southern states, however no previous research has investigated the economic impact of MSKIs at the state- and regional-level. The aim of this study was to determine the economic impact of MSKIs among U.S. Army initial military trainees on a state- and regional-basis. MethodsRosters for recruits entering U.S. Army Initial Military Training (IMT) for fiscal year 2017 were obtained (n = 103,487). Roster data included the unique personal identifier, demographics with postal zip code, training start/end dates, and height and weight and were subsequently linked to medical encounters and cost data from the Military Health System Data Repository. Trainees with one or more MSKIs were considered injury cases (n = 33,509) and were stratified by gender. The percent of trainee MSKI cases was calculated as number of injury cases divided by total number of trainees. For each injury case, the direct medical cost for MSKIs was calculated. The percent of trainees and direct medical costs for MSKIs were aggregated to home-state and regional-levels for the four U.S. Census tract regions. A test for equality of proportions was performed at state- and regional-levels to investigate differences in percent of trainees with MSKIs by state/region. A one-way ANOVA was used to investigate possible differences in medical cost/trainee by region. Results34% (n = 33,509) of all trainees sustained at least one MSKI. State-specific MSKI percentages showed ten states having the greatest percentage of trainees with at least one MSKI, eight of which were from the South region (AL, FL, GA, LA, MS, NC, SC, TN). The South was the only region to have a statistically significantly higher percentage of trainees with MSKIs at 34% (p < 0.001), as compared to all other regions. The total direct medical cost of treating MSKIs among all trainees was $14,891,563. The South was the costliest region ($7,168,997), accounted for nearly 50 % of the total national cost, and had the highest mean MSKI cost/trainee. DiscussionThis study was the first in demonstrating the disproportionate economic burden Southern states pose to the U.S. Department of Defense resulting from its significantly higher MSKI cost. PA and PF are known to ameliorate chronic disease and MSKI burden among general and military populations. Therefore, increasing PA and PF among all young Americans, and specifically those living in Southern states, is imperative for improving public health and reducing the economic and practical burden of MSKIs on military readiness and national security.

Direct and indirect costs of acute diarrhea in children under five years of age in Indonesia: Health facilities and community survey

SummaryBackgroundDiarrhea remains a major cause of child morbidity and mortality in low- and middle-income countries. Reliable data on the economic burden of diarrhea is required to support the selection of appropriate health intervention programs. This study aimed to estimate the costs of acute diarrhea in children under five years of age in Indonesia, a large middle-income country with a substantial diarrheal burden.MethodsDirect medical cost data were extracted retrospectively for 1050 children under five years of age with acute diarrhea receiving inpatient care across 45 health facilities in seven Indonesian provinces during 2017–2020. Direct medical costs for children treated in outpatient settings were estimated by collecting unit costs associated with standard diarrhea case management in children. A structured interview of 240 caregivers of inpatients was also conducted retrospectively to estimate direct non-medical costs as well as indirect costs from caregiver income loss.ResultsThe weighted average direct medical cost for treatment of acute diarrhea as an inpatient and outpatient across health facility types was US$99.8 (SD±$56.8)(35% room costs, 29% professional fees, 26% medication costs, 10% diagnostic costs) and US$7.6 (SD±$4.3) (34% diagnostic costs, 28% medication costs, 27% professional fees, 10% registration fees), respectively. The average direct non-medical household cost for an acute diarrheal admission was US$4.90 and the indirect cost was US$9.90.ConclusionThere is a significant economic burden associated with acute diarrhea in children in Indonesia. This study, based on a wide variety of health care settings and geographical regions, provides data to inform the economic evaluation of rotavirus vaccines and other diarrheal prevention programs.FundingThis work was supported by a research grant from the Murdoch Children's Research Institute (MCRI) and PATH; and the Indonesian Technical Advisory Group on Immunization (ITAGI).

Cost-effectiveness of seasonal influenza vaccination in pregnant women, healthcare workers and adults >= 60 years of age in Lao People’s Democratic Republic

BackgroundPregnant women, healthcare workers (HW), and adults >= 60 years have shown an increased vulnerability to seasonal influenza virus infections and/or complications. In 2012, the Lao People's Democratic Republic (Lao PDR) initiated a national influenza vaccination program for these target groups. A cost-effectiveness evaluation of this program was undertaken to inform program sustainability. MethodsWe designed a decision-analytical model and collected influenza-related medical resource utilization and cost data, including indirect costs. Model inputs were obtained from medical record abstraction, interviews of patients and staff at hospitals in the national influenza sentinel surveillance system and/or from literature reviews. We compared the annual disease and economic impact of influenza illnesses in each of the target groups in Lao PDR under scenarios of no vaccination and vaccination, and then estimated the cost-effectiveness of the vaccination program. We performed sensitivity analyses to identify influential variables. ResultsOverall, the vaccination of pregnant women, HWs, and adults >= 60 years could annually save 11,474 doctor visits, 1,961 days of hospitalizations, 43,027 days of work, and 1,416 life-years due to laboratory-confirmed influenza illness. After comparing the total vaccination program costs of 23.4 billion Kip, to the 18.4 billion Kip saved through vaccination, we estimated the vaccination program to incur a net cost of five billion Kip (599,391 USD) annually. The incremental cost per life-year saved (ICER) was 44 million Kip (5,295 USD) and 6.9 million Kip (825 USD) for pregnant women and adults >= 60 years, respectively. However, vaccinating HWs provided societal cost-savings, returning 2.88 Kip for every single Kip invested. Influenza vaccine effectiveness, attack rate and illness duration were the most influential variables to the model. ConclusionProviding influenza vaccination to HWs in Lao PDR is cost-saving while vaccinating pregnant women and adults >= 60 is cost-effective and highly cost-effective, respectively, per WHO standards.

Marginalized Two-Part Joint Modeling of Longitudinal Semi-Continuous Responses and Survival Data: With Application to Medical Costs

Non-negative continuous outcomes with a substantial number of zero values and incomplete longitudinal follow-up are quite common in medical costs data. It is thus critical to incorporate the potential dependence of survival status and longitudinal medical costs in joint modeling, where censorship is death-related. Despite the wide use of conventional two-part joint models (CTJMs) to capture zero-inflation, they are limited to conditional interpretations of the regression coefficients in the model’s continuous part. In this paper, we propose a marginalized two-part joint model (MTJM) to jointly analyze semi-continuous longitudinal costs data and survival data. We compare it to the conventional two-part joint model (CTJM) for handling marginal inferences about covariate effects on average costs. We conducted a series of simulation studies to evaluate the superior performance of the proposed MTJM over the CTJM. To illustrate the applicability of the MTJM, we applied the model to a set of real electronic health record (EHR) data recently collected in Iran. We found that the MTJM yielded a smaller standard error, root-mean-square error of estimates, and AIC value, with unbiased parameter estimates. With this MTJM, we identified a significant positive correlation between costs and survival, which was consistent with the simulation results.

Cost-effectiveness analysis of treatment with varenicline for nicotine dependence compared with smoking cessation without pharmacotherapy in the real world.

Smoking is an important public health issue. Although measures to support smoking cessation have been implemented worldwide, smokers often fail to quit smoking after receiving pharmacotherapies for nicotine dependence. The present study evaluated the cost-effectiveness of varenicline for smoking cessation compared with no pharmacotherapy using actual paid medical cost data in Japan. This was a retrospective cohort study of 3657 subjects who had quit smoking with varenicline or no pharmacotherapy. We extracted health examination and medical claim data from a health insurer database for the period 2012-2015. We calculated the incremental cost-effective ratio (ICER) of varenicline using actual paid medical costs for nicotine dependence and the number needed to treat to maintain smoking cessation compared with no pharmacotherapy, considering sex, age, income, and occupation. The 1- and 2-year smoking cessation maintenance rates were 69.7% and 62.4%, respectively. We found that 8.8% of subjects who quit smoking used varenicline for nicotine dependence and the cost per person was Japanese Yen (JPY) 52 177 (U.S. dollars [USD] 474; USD 1=JPY 110). The ICER of varenicline was dominant when comparing 2-year cessation with 1-year cessation. Male, age <40 years, low income, and manufacturing workers were the most cost-effective variables. The cost-effective variables of varenicline in the real world were investigated. The results of this study strengthen the evidence regarding which type of people should be targeted for measures to support smoking cessation using varenicline.