Medical Expenses Research Articles

Association of oral frailty with medical expenditure in older Japanese adults: The study of late-stage older adults in Tottori (START Tottori).

This study aimed to determine the association between annual medical expenses and oral frailty in later-stage older adults (aged ≥ 75 years). No studies have investigated the association between medical costs and oral frailty, which would elucidate the association between oral frailty and the deterioration of mental and overall physical function. In this cross-sectional study, 2190 adults (860 men and 1330 women aged 75-94 years) covered by the Medical System for the Elderly and residing in Tottori Prefecture, Japan, between April 2016 and March 2019, were included. Participants were classified into three groups: healthy, pre-orally frail or orally frail, based on dental health screening findings. The medical and dental expenses over the years, number of days of consultations and comorbidities were obtained from the Japanese Health Insurance Claims Database. The number of days of medical and dental consultations and annual medical expenses for outpatient care differed among the three study groups. A significant association was observed between oral frailty and high annual expenses for outpatient medical and dental care. Oral frailty was associated with higher medical expenses in participants with poor masticatory function. Higher and lower dental expenses were associated with subjective poor masticatory function and subjective impairment of swallowing function respectively. Medical and dental expenses for orally frail older adults are high, indicating that oral frailty may be related to the occurrence and severity of diseases other than oral health issues. Future studies should examine the mechanism by which oral weakness affects physical and mental functions.

Obstacles to the Development of Physiotherapy in Iran

Background: Despite the breadth and diversity of physiotherapy healthcare services, the entry of physiotherapists into the field of prevention and also direct access of physiotherapists to patients in the world for 10 years ago, Iranian physiotherapists have not had direct access to clients, yet. One way to overcome the current situation and move towards the growth and development of the profession is to identify the opportunities and threats of the field. The purpose of this study is to explain the obstacles to the professional development of physiotherapy from the point of view of graduates of this field. Methods: In a qualitative study of the content analysis type, the experiences of 12 physiotherapy scholars in three levels of study, bachelor’s, master’s and doctorate were obtained through a structured and semi-in-depth face-to-face interview. Simultaneously, as the data was collected, the data was analyzed based on Granheim and Ludman’s content analysis method. Results: A total of 28 codes were extracted to explain the obstacles to the development of physiotherapy in Iran, which include “low attention to professional ethics”, “inefficient policies of the Ministry of Health, Treatment and Medical Education” and “traditional teaching methods”. Conclusion: If the adherence to the principles of professional ethics is not strengthened, the policies of the Ministry of Health and Medical Education (MHTME) cannot facilitate the growth and development of the profession, and fundamental changes in the education and training of students will not take place, not only will the quality of physiotherapy services be lower than international standards, but many high medical expenses will also be imposed on people and insurances.

A Novel Stochastic Model for Human Norovirus Dynamics: Vaccination Impact with Lévy Noise

The epidemic norovirus causes vomiting and diarrhea and is a highly contagious infection. The disease is affecting human lives in terms of deaths and medical expenses. This study examines the governing dynamics of norovirus by incorporating Lévy noise into a stochastic SIRWF (susceptible, infected, recovered, water contamination, and food contamination) model. The existence of a non-negative solution and its uniqueness are proved after model formulation. Subsequently, the threshold parameter is calculated, and this number is used to explore the conditions under which disease tends to exist in the population. Likewise, additional conditions are derived that ensure the elimination of the disease from the community. It is proved that the norovirus is extinct whenever the threshold parameter is less than one and it persists for Rs>1. The work assumes two working examples to numerically explain the theoretical findings. Simulations of the study are visually presented, and comparisons are made. The results of this study suggest a robust approach for handling complex biological and epidemic phenomena.

Health economics study of paliperidone palmitate in the treatment of schizophrenia: a 12-month cohort study

BackgroundTo analyze the economic benefits of paliperidone palmitate in the treatment of schizophrenia.MethodsWe collected 546 patients who met the diagnostic criteria for schizophrenia according to the 《International Statistical Classification of Diseases and Related Health Problems,10th》(ICD-10). We gathered general population data such as gender, age, marital status, and education level, then initiated treatment with paliperidone palmitate. Then Follow-up evaluations were conducted at 1, 3, 6, 9, and 12 months after the start of treatment to assess clinical efficacy, adverse reactions, and injection doses. We also collected information on the economic burden before and after 12 months of treatment, as well as the number of outpatient visits and hospitalizations in the past year to analyze economic benefits.ResultsThe baseline patients totaled 546, with 239 still receiving treatment with paliperidone palmitate 12 months later. After 12 months of treatment, the number of outpatient visits per year increased compared to before (4 (2,10) vs. 12 (4,12), Z=-5.949, P < 0.001), while the number of hospitalizations decreased (1 (1,3) vs. 1 (1,2), Z = 5.625, P < 0.001). The inpatient costs in the direct medical expenses of patients after 12 months of treatment decreased compared to before (5000(2000,12000) vs. 3000 (1000,8050), P < 0.05), while there was no significant change in outpatient expenses and direct non-medical expenses (transportation, accommodation, meal, and family accompanying expenses, etc.) (P > 0.05); the indirect costs of patients after 12 months of treatment (lost productivity costs for patients and families, economic costs due to destructive behavior, costs of seeking non-medical assistance) decreased compared to before (300(150,600) vs. 150(100,200), P < 0.05).ConclusionPalmatine palmitate reduces the number of hospitalizations for patients, as well as their direct and indirect economic burdens, and has good economic benefits.

Caregiver burden among parents of school-age children with asthma: a cross-sectional study.

To investigate the caregiver burden of parents of school-age children with asthma and analyze the factors influencing their caregiver burden. A convenience sampling method was used to select 366 parents of school-age children with asthma who visited the outpatient departments of three tertiary hospitals in Sichuan Province, China, from January 2021 to July 2021. A general information questionnaire and the Caregiver Burden Inventory (CBI) were used to assess the current caregiver burden and analyze the influencing factors. The caregiver burden score of parents of school-age children with asthma was 27 (17, 39), with 40.43% of parents experiencing moderate to high levels of burden. Detailed results of univariate analysis showed that there were significant differences in caregiver burden scores based on parents' gender, highest education level, number of children, occupation, family history of asthma, monthly family income, annual medical expenses for the child, child's gender, whether the child had undergone lung function tests, number of emergency visits due to asthma exacerbation in the past 3 months, and whether the child had missed school due to asthma exacerbation in the past 3 months (p < 0.1). Detailed results of multivariate analysis showed that parents' gender, occupation, family history of asthma, monthly family income, annual medical expenses for the child, number of emergency visits due to asthma exacerbation in the past 3 months, and whether the child had missed school due to asthma exacerbation in the past 3 months were independent risk factors for caregiver burden in parents of school-age children with asthma (p < 0.05). Parents of school-age children with asthma experience a certain level of caregiver burden, with over one-third of parents experiencing moderate to high levels of burden. Being a mother, being a worker, having no family history of asthma, having low monthly family income, having high annual medical expenses for the child, having frequent emergency visits due to asthma exacerbation in the past 3 months, and having missed school due to asthma exacerbation in the past 3 months are independent risk factors for caregiver burden in parents of school-age children with asthma, healthcare providers should develop feasible coping strategies, such as paying attention to caregivers' psychological condition to reduce the burden of caring for parents of school-age children with asthma. The entire society should also make efforts in improving social support and strengthening healthcare coverage in order to achieve the aforementioned goals.

The influence of the national drug price negotiation policy reform on the medical expenses of patients in Xuzhou City: an interrupted time series analysis.

To reduce the burden of patients' medical care, the Xuzhou Municipal Government has initiated an exploratory study on the supply model and categorized management of nationally negotiated drugs. This study aims to understand the extent to which Xuzhou's 2021 reform of the National Drug Price Negotiation (NDPN) policy has had a positive impact on the healthcare costs of individuals with different types of health insurance. The Interrupted Time Series Analysis method was adopted, and the changes in average medical expenses per patient, average medical insurance payment cost per patient and actual reimbursement ratio were investigated by using the data of single-drug payments in Xuzhou from October 2020 to October 2022. Following the implementation of the policy, there was a significant decrease in the average medical expenses per patient of national drug negotiation in Xuzhou, with a reduction of 62.42 yuan per month (p < 0.001). Additionally, the average medical insurance payment cost per patient decreased by 44.13 yuan per month (p = 0.01). Furthermore, the average medical expenses per patient of urban and rural medical insurance participants decreased by 63.45 yuan (p < 0.001), and the average monthly medical insurance payment cost per patient decreased by 57.56 yuan (p < 0.04). However, the mean total medical expenditures for individuals enrolled in employee medical insurance decreased by 63.41 yuan per month (p < 0.001), whereas the monthly decrease was 22.11 yuan per month (p = 0.21). On the other hand, there was no discernible change in the actual reimbursement ratio. After the adoption of the NDPN policy, a noticeable decline has been observed in the average medical expenses per patient and the mean cost of the average medical insurance payment per patient, although to a limited extent. Notably, the reduction in employee medical insurance surpasses that of urban and rural medical insurance.

Analysis of the direct economic impact of smoking-related hospitalizations in Italy.

Tobacco-related diseases have a substantial economic impact in terms of medical expenses, loss of productivity, and premature death. Tobacco use is estimated to be responsible for more than 90000 deaths each year in Italy. We aimed to evaluate the annual direct economic impact on the National Health System of hospitalizations attributable to tobacco smoking in Italy. We analyzed data from all the hospitalizations of patients aged ≥30 years that occurred in Italy for 12 selected tobacco-related diseases, during 2018. These diseases included oropharyngeal cancer, esophageal cancer, gastric cancer, lung cancer, pancreatic cancer, bladder cancer, laryngeal cancer, ischemic heart disease, stroke, diseases of arteries, arterioles, and capillaries, pneumonia and influenza, and chronic obstructive pulmonary disease. We obtained information on 984322 hospital discharge records, including each hospitalization's direct costs. Using relative risk estimates from the scientific literature, we computed the population attributable fraction for various tobacco-related diseases to estimate the economic impact attributable to tobacco smoking. One-third of all hospitalizations occurred in 2018 in Italy among people aged ≥30 years for 12 tobacco-related diseases were found to be attributable to smoking, accounting for a total cost of €1.64 billion. Among the diseases considered, those with the highest expenditures attributable to tobacco smoking were ischemic heart disease, cerebrovascular disease, and lung cancer, accounting for €556 million, €290 million, and €229 million, respectively. Tobacco has a substantial economic impact in Italy, accounting for around 6% of the total cost of hospitalizations in 2018. This figure is expected to be largely underestimated due to several conservative assumptions adopted in the statistical analyses. It is imperative to prioritize comprehensive tobacco control measures to counteract the huge healthcare costs due to tobacco smoking.

Home Mechanical Ventilation in Children: Complications and Benefits—A Two-Year Experience at a Referral Children's Hospital

Background: The rising prevalence of chronic respiratory failure in pediatric patients necessitates a detailed evaluation of home mechanical ventilation (HMV). Objectives: This study assesses the advantages of HMV devices, focusing on cases from Imam Hussein Children's Hospital. Methods: This research involved 20 children who required long-term ventilation and were admitted to both general and intensive care units at Imam Hussein Children's Hospital in Isfahan. Before discharge, a team of HMV experts trained the parents on the proper use of the ventilation devices. Post-discharge, the educational needs of the parents were assessed continuously, with regular home visits conducted by a nurse and a representative from the ventilator supplier. Results: Approximately 73% of the children demonstrated therapeutic effectiveness following HMV implementation. About 35% of parents observed no adverse effects in their children. The average cost savings from reduced ICU rehospitalizations was significant at 347.59%, and there was a 65.09% reduction in the costs associated with general ward hospitalizations. Conclusions: The adoption of HMV has led to improved health outcomes, substantial reductions in medical expenses, and shorter hospital stays. It is advisable to plan for broader implementation of HMV in children who require long-term ventilation.

Comparative Interrupted Time Series Analysis of Medical Expenses in Patients with Intertrochanteric Fracture Who Underwent Internal Fixation and Hemiarthroplasty.

The objective of this study was to assess postoperative direct medical expenses and medical utilization of elderly patients who underwent either hemiarthroplasty (HA) or internal fixation (IF) for treatment of a femoral intertrochanteric fracture and to analyze differences according to surgical methods and age groups. Data from the 2011 to 2018 Korean National Health Insurance Review & Assessment Service database were used. Risk-set matching was performed for selection of controls representing patients with the same sex, age, and year of surgery. A comparative interrupted time series analysis was performed for evaluation of differences in medical expenses and utilization between the two groups. A total of 10,405 patients who underwent IF surgery and 10,405 control patients who underwent HA surgery were included. Medical expenses were 18% lower in the IF group compared to the HA group during the first year after the fracture (difference-in-difference [DID] estimate ratio 0.82, 95% confidence interval [CI] 0.77-0.87, P<0.001), and 9% lower in the second year (DID estimate ratio 0.91, 95% CI 0.85-0.99, P=0.018). Length of hospital stay was significantly shorter in the IF group compared to the HA group during the first two years after time zero in the age ≥80 group. A noticeable increase in medical expenses was observed for patients who underwent HA for treatment of intertrochanteric fractures compared to those who underwent IF over a two-year period after surgery. Therefore, consideration of such findings is critical when designing healthcare policy support for management of intertrochanteric fractures.

Clinical impact and financial feasibility of remote oncology pharmacists' roles in community oncology practices.

1545 Background: The clinical and financial impact of oncology-trained pharmacists in the community oncology setting has not been well documented. The US Oncology Network has introduced a novel remote oncology pharmacist model which provides clinical services to oncology community practices to alleviate the burden on oncologists, enhance patient care, and improve workflows. Methods: Oncology-trained pharmacists remotely reviewed chemotherapy regimens across 12 community oncology practices. Pharmacists identified opportunities to modify therapy based on clinical criteria, waste reduction, and/or financial stewardship. These modifications were discussed with the treatment team or implemented in accordance with practice-approved policies. Clinical and financial metrics were tracked to assess the overall impact of the pharmacist interventions and provider time saved. Results: From January 1, 2023, through December 31, 2023, 27,938 reviews were documented for 19,962 patients. Among these reviews, the majority (14,572, 73%) required modification by the pharmacist, and many (3,005, 21%) were deemed clinically significant by the intervening pharmacist. The most common clinically significant interventions included changes to anticancer drug doses (1155, 38%), modifications to supportive care (742, 25%) and recommendations for additional monitoring (426, 14%). Across 12 practices, 63 drug-related workflow policies were implemented allowing pharmacists to autonomously auto-substitute products, order laboratory tests and adjust chemotherapy doses. These policies saved over 600 hours of physician time. Pharmacist involvement resulted in medication-related margin improvements totaling $9.3M. Practices also experienced a $4.3M reduction in the total cost of care in medication expenses. The cost of the pharmacists during this period was $1.4M, equating to a 560% return on investment compared to margin improvement. Conclusions: Community oncology practices operate within a resource-constrained model with limited access to oncology pharmacists. As invaluable members of the care team, pharmacists identified opportunities to significantly enhance clinical care by focusing on medication safety, dosing, and regimen optimization, while demonstrating a tremendous financial impact on small-scale budgets. Oncology-trained pharmacists play a vital role in alleviating care burden of the clinical team by collaboratively developing practice-approved policies and reviewing clinical orders in a high-risk patient population.

Effect of centralized volume-based procurement of drugs on business performance of listed pharmaceutical enterprises

Since March 2018, China has conducted five rounds of negotiations for the inclusion of drugs in the medical insurance system and implemented eight batches of centralized drug procurement. The role of the medical insurance department as a strategic purchaser in the pharmaceutical market has been continuously strengthened, playing a crucial role in controlling the unreasonable growth of medical expenses and reducing the economic burden on patients. The policy of centralized drug procurement, by exchanging quantity for price, can significantly reduce drug prices and lower the profit level of companies. However, being included in the centralized drug procurement catalog can bring a substantial and stable market share to the winning companies. Therefore, the impact of the centralized drug procurement policy on the operational performance of winning companies and how their business decisions should be adjusted remain to be thoroughly explored from both theoretical and empirical perspectives. To assess the impact of the centralized drug procurement policy on the operational performance of companies, this study takes publicly listed pharmaceutical manufacturing companies from 2016 to 2020 as the sample and conducts empirical analysis using methods such as difference in difference (propensity score) matching (PSM-DID). The results showed that the centralized volume-based procurement of drugs policy had a significant negative impact on the business performance of bidding listed pharmaceutical manufacturing companies, indicating that the increase in the sales of bidding drugs could not fully make up for the profit loss caused by the price reduction in the short term. Pharmaceutical manufacturing companies should further adjust their market competition strategies, actively engage in research and development innovation. The government should guide pharmaceutical companies to improve their operational performance while ensuring the quality of drug supply by optimizing the supporting innovative incentive policies in the centralized drug procurement policy.

Analysis of Influencing Factors of Major Depression After Spinal Cord Injury.

To analyze the risk factors of major depressive disorder (MDD) after spinal cord injury (SCI). Patients with SCI in our hospital from February 2020 to February 2023 were selected as the study objects. According to the Hamilton Depression Scale (HAMD) score, patients with 36~75 points were included in the major depression group, and 0~35 points were included in the non-major depression group. The general sociological characteristics (age, gender, educational level, place of residence, family economic status, payment method of medical expenses, marital status) and disease-related characteristics (course of disease, cause of injury, neurological level of injury, type of injury, degree of pain) of all patients were collected, and the items with differences were selected for logistic regression analysis to analyze the risk factors for major depression in patients with spinal cord injury. Totally 216 patients were enrolled in our study, including 45 patients (18.98%) had moderate-to-severe depression and 175 patients (81.02%) had non-severe depression. Univariate analysis showed that gender (χ2 = 11.865, P < .001), course of disease (χ2 = 12.967, P < .001), family economic status (χ2 = 8.610, P = .003), educational level (χ2 =15.287, P < .001), neurological level of injury (χ2 = 9.013, P = .003) and pain level (χ2 = 16.673, P < .001) were statistically significant differences between the 2 groups. Multivariate logistic regression analysis showed that gender [odds ratio (OR) (95 % CI) = 3.986 (1.743~9.116), P = .001], course of disease [OR (95 % CI) = 4.033 (1.818~8.947), P = .001], family economic status [OR (95 % CI) = 3.136 (1.449~6.785), P = .004], educational level [OR (95 % CI) = 4.332 (1.998~9.388), P = .000], neurological level of injury [OR (95 % CI) = 2.848 (1.414~5.734), P = .003], and pain level [OR (95 % CI) = 5.767 (2.309~14.404), P < .001] were risk factors for major depressive disorder in SCI patients. Gender, disease duration, family economic status, education level, level of nerve injury, and pain level may be the independent risk factors of MDD incidence in patients with spinal cord injury.

Trends in Nationally Notifiable Infectious Diseases in Humans and Animals during COVID-19 Pandemic, South Korea.

We investigated trends in notifiable infectious diseases in both humans and animals during the COVID-19 pandemic in South Korea and compared those data against expected trends had nonpharmaceutical interventions (NPIs) not been implemented. We found that human respiratory infectious diseases other than COVID-19 decreased by an average of 54.7% after NPIs were introduced. On the basis of that trend, we estimated that annual medical expenses associated with respiratory infections other than COVID-19 also decreased by 3.8% in 2020 and 18.9% in 2021. However, human gastrointestinal infectious diseases and livestock diseases exhibited similar or even higher incidence rates after NPIs were instituted. Our investigation revealed that the preventive effect of NPIs varied among diseases and that NPIs might have had limited effectiveness in reducing the spread of certain types of infectious diseases. These findings suggest the need for future, novel public health interventions to compensate for such limitations.

Occupation and demand for health services in Italy: Ways and means to reduce the opportunity costs imposed on patients

This paper explores whether and to which extent employment condition and working hours influence individuals’ decision process in consuming primary care. The hypothesis is that the higher the workers’ opportunity cost in terms of earning forgone, the less the demand for General Practitioner (GP) visits. Using survey data provided by the Italian National Institute of Statistics (ISTAT), we estimate a negative binomial regression model of GP visits as a function of employment related variables, controlling for a rich set of individual demographic characteristics, socio-economic variables, health status, supply and geographical factors. We show that self-employed workers, managers and cadres use significantly less primary care services notwithstanding the access is free. We conclude that they have higher opportunity costs than white and blue collars since they suffer more from the loss of earnings related to the absence from work. Self-employed individuals often face barriers to accessing healthcare services, such as lack of employer-sponsored health insurance and concerns about lost income during time off for medical appointments. As a result, they may delay seeking healthcare until their condition becomes more severe, leading to poorer health outcomes. Managers and cadres, on the other hand, may have greater access to healthcare services due to higher income levels and better job benefits. However, they may still face challenges such as long working hours and job-related stress, which can impact their ability to prioritize their health and seek timely medical care.From a policy perspective, our results suggest potential policy interventions aimed at addressing barriers to healthcare access for self-employed workers and promoting equitable healthcare utilization across different employment groups. Policy recommendations may include measures to enhance financial support (tax deductions for medical expenses, subsidies for health insurance premiums, or grants to cover the costs of healthcare-related absences from work), increase healthcare accessibility (enhancing the availability of mobile clinics, and extending operating hours for primary care facilities to accommodate the needs of working individuals) and raise awareness about preventive care among self-employed workers (workplace wellness programs, and incentives for regular health check-ups, screenings and healthy lifestyle choices, can encourage managers and self-employed workers to prioritize preventive measures). These policy implications are essential for ensuring equitable and universal access to healthcare services for all workers, regardless of their employment status.

Diabetes control in public assistance recipients and free/low-cost medical care program beneficiaries in Japan: a retrospective cross-sectional study

IntroductionPrevious research has highlighted the association between socioeconomic factors and diabetes management. This study aimed to elucidate the blood glucose control status among individuals with low income (ie, recipients of...

Supply chain/transaction cost insights into the profitability of health insurers during 2020, the start of COVID‐19

AbstractVarious US populations make up different health care markets/segments, and health insurers specialize in serving specific populations. US health insurers soared in profits during 2020, the first year of the Covid‐19 pandemic. The profit gains were unequal among segments. This research uses a supply chain/transaction costs economics (SC/TCE) model to find insights into the profitability differences. The SC/TCE model consists of three spheres of profitability determinants: health care characteristics, transactions costs differentials, and governance methods. Our univariate analyses combined with weighted regression results reveal that, for Medicaid, a significant increase in profitability was associated with a decrease in medical expenses, whereas the opposite is observed for the group and Medicare Advantage plans. Another finding is that transaction costs differentials led to significant increases in profitability for group and Medicare plans with opposite results for Medicaid plans. These results provide important practical implications for policymakers.

THE SOCIODEMOGRAPHICS INFLUENCE IN THE KNOWLEDGE, PERCEPTION, AND BEHAVIOR OF OSTEOPOROSIS IN MALANG: A COMMUNITY-BASED STUDY

Background: Osteoporosis is a major global health issue that results in disability and high medical expenses. It can significantly impact both individuals and their caregivers, leading to pain, limitations in daily activities, and emotional distress. Purpose: This study observed the association of sociodemographic factors in affecting knowledge, perception, and behavior related to osteoporosis in a rural area of Malang, Indonesia. Methods: A cross-sectional study was conducted in a rural area of Malang to assess the knowledge, perception, and behavior of adults (≥18 years old) toward osteoporosis. Participants were asked to fill in a validated questionnaire, which was selected randomly using a multistage stratified sampling technique. Collected data were analyzed on SPSS for Windows version 25.0. Results: The study included 376 randomly selected participants from various rural areas in Malang. The subjects mostly were within the 51-60 age group (34.0%), with female respondents accounting for 73.4% of the sample. On average, participants scored 1.8 (±2.5) for knowledge, 12.0 (±2.1) for perception, and 12.2 (±2.9) for behavior regarding osteoporosis. Both age and education levels showed associations with knowledge and perception, while only age was significantly linked to behavior concerning osteoporosis. Conclusions: Our study revealed a strong association between low educational levels, especially among the elderly, and the lack of knowledge, perceptions, and behavior toward osteoporosis.

Clinical characteristics, effectiveness and cost of different treatment methods for invasive Klebsiella pneumoniae liver abscess syndrome.

Bacterial liver abscess is one of the common infectious diseases of the digestive system. Invasive Klebsiella pneumoniae liver abscess syndrome (IKLAS) refers to cases where, in addition to liver abscess, there are migratory infections foci or other invasive manifestations. The clinical characteristics and risk factors of IKLAS are not fully elucidated, and there is a lack of research on the effectiveness and cost-effectiveness of different treatment methods. This study aims to compare the clinical characteristics of patients with IKLAS and non-IKLAS, and explore effective and economical treatment methods. This retrospective study collected medical records of patients with Klebsiella pneumoniae liver abscess treated at Xiangya Hospital of Central South University from January 2010 to December 2023. A total of 201 patients were included, dividing into an IKLAS group (n=37) and a non-IKLAS group (n=164). Differences in demographics, symptoms and signs, laboratory indicators, imaging characteristics, comorbidities, treatment methods, treatment outcomes, and direct treatment costs between 2 groups were analyzed. The study also compared the effectiveness and costs of different treatment methods. Compared with the non-IKLAS group, the proportion of patients with diabetes, Quick Sequential Organ Failure Assessment (qSOFA)≥2, immune deficiency, anemia, and thrombocytopenia in the IKLAS group was higher, and the level of procalcitonin at the onset in the IKLAS group was also higher (all P<0.05). In terms of symptoms and signs, the IKLAS group had a higher proportion of visual abnormalities and a lower proportion of complaints of abdominal pain (both P<0.05). In terms of complications, the incidence of combined pleural effusion, pulmonary infection, acute renal failure, respiratory failure, and multiple organ failure was higher in the IKLAS group (all P<0.05). The IKLAS group had a higher proportion of patients treated with antibiotics alone (24.32% vs 11.59%), while the non-IKLAS group had a higher proportion of patients treated with antibiotics combined with puncture and drainage (86.59% vs 64.86%, both P<0.05). The overall effective rate of the IKLAS group (83.78%) was lower than that of the non-IKLAS group (95.73%), and the treatment and drug costs were higher (all P<0.05). The treatment method of antibiotics combined with surgical resection of infectious foci showed a 100% improvement rate, antibiotics combined with abscess puncture and drainage had an 84.9% improvement rate, and in antibiotics alone had an 82.1% improvement rate, with statistical differences among the 3 treatment methods (P<0.05). In terms of treatment costs, antibiotics alone were the most expensive (P<0.05). Patients with IKLAS have poorer prognosis and higher direct medical costs. The combination of abscess puncture and drainage or surgery has a higher improvement rate and lower hospitalization costs compared to antibiotics alone, suggesting that surgical intervention may reduce antibiotic costs and save medical expenses.

Recent trends in bone metastasis treatments: A historical comparison using the new Katagiri score system.

Bone metastasis has various negative impacts. Activities of daily living (ADL) and quality of life (QOL) can be significantly decreased, survival may be impacted, and medical expenses may increase. It is estimated that at least 5% cancer patients might be suffering from bone metastases. In 2016, we published the Comprehensive Guidelines for the Diagnosis and Treatment of Bone Metastasis. Since then, the therapeutic outcomes for patients have gradually improved. As life expectancy is a major determinant of surgical intervention, the strategy should be modified if the prolongation of survival is to be achieved. To monitor how bone metastasis treatment has changed before and after launch of our guidelines for bone metastasis. For advanced cancer patients with bone metastasis who visited the Department of Clinical Oncology at Akita University hospital between 2012 and 2023, parameters including the site and number of bone metastases, laboratory data, and survival time, were extracted from electronic medical records and the Katagiri score was calculated. The association with survival was determined for each factor. Data from 136 patients were obtained. The 1-year survival rate for the poor prognosis group with a higher Katagiri score was 20.0% in this study, which was 6% and an apparent improvement from 2014 when the scoring system was developed. Other factors significantly affecting survival included five or more bone metastases than less (P = 0.0080), and treatment with chemotherapy (P < 0.001), bone modifying agents (P = 0.0175) and immune checkpoint inhibitors (P = 0.0128). In recent years, advances in various treatment methods have extended the survival period for patients with advanced cancer. It is necessary not only to simply extend survival time, but also to maintain ADL and improve QOL. Various therapeutic interventions including surgical approach for bone metastasis, which is a disorder of locomotor organs, are increasingly required. Guidelines and scoring system for prognosis need to be revised promptly.

A Study For: Socio-cultural Environment and the Microinsurance

The poor are much more exposed to the dangers from their surroundings. They live in unhealthy environment where even proper sanitation is not available. Natural calamities like floods, drought, earth quake etc. hit them the hardest. An unfortunate event like Illness or death in the family can change the living standard of the poor for the worse. Cost of medical care being prohibitive, s/he consumes lots of (already diminished) resources from the family. Since they do not have adequate savings, such an episode drives them to either sell their assets or borrow money from local money lenders at high interest rates. According to World Health Organization report (2006), out of total health expenditure in India, 73% happens through out-of pocket spending. This is a very precarious situation as it exposes the poor household to sudden spurt in unplanned and unexpected medical expenses. So, how do we ensure that the poor, or the ‘excluded’ face this ever-threatening risk to their lives and livelihood? Insurance as a concept was introduced in 19th century to do exactly that - protect the poor! But over a period of time, it became a financial tool for the rich. Affordability being one of the prime reasons but exposure and access being other important reason for low penetration in this segment.