Cost Of Medical Services Research Articles

PCN145 COST EFFECTIVENESS OF FRUQUINTINIB VERSUS REGORAFENIB AS THE THIRD-LINE THERAPY FOR PATIENTS WITH METASTATIC COLORECTAL CANCER IN CHINA

This study aimed to assess the cost-effectiveness of Fruquintinib versus Regorafenib as the third-line therapyfor patients with metastatic colorectal cancer in China. A Three-state Markov model with monthly cycle was developed to estimate lifetime incremental cost-effectiveness ratio (ICER) of Fruquintinib versus Regorafenib as the third-line therapy for patients with metastatic colorectal cancer from Chinese health-care system perspective. Survival analysis was conducted to calculate transition probabilities using the data from two clinical trials (FRESCO and CONCUR) from which we also extracted the incidence of adverse events. Mortality rate and drug costs were derived from government published data. Costs for medical services were obtained from published literatures and a real world study about economic burden of Chinese metastatic colorectal cancer patients. Utilities applied to calculate the quality adjusted life years (QALYs) were obtained through literature review. Costs and QALYs were discounted at a 5% annual rate. One way sensitivity analysis and probabilistic sensitivity analysis were conducted to demonstrate the robustness of the results. Fruquintinib provided 0.74 QALYs at a cost of CNY 177863.75, whereas Regorafenib provided 0.79 QALYs at a cost of CNY 248277.29. Compared to Fruquintinib, the ICER of Regorafenib was CNY 1416749.10/QALY, which was above three times GDP per capita of China in 2017 (CNY 59660) as the threshold to define the cost-effectiveness. One-way sensitivity analysis showed the results were generally robust. Cost-effectiveness acceptability curves derived from the probabilistic sensitivity analysis demonstrated that Fruquintinib was 100% more cost-effective, when the threshold was three times GDP per capita of China. Compared to Regorafenib, Fruquintinib can be regarded as a cost-effective choice as the third-line therapy for patients with metastatic colorectal cancer in China.

PCN101 COST EFFECTIVENESS ANALYSIS COMPARING ENZALUTAMIDE, ABIRATERONE PLUS PREDNISONE AND CABAZITAXEL PLUS PREDINSONE FOR THE TREATMENT OF VISCERAL METASTATIC CASTRATION RESISTANT PROSTATE CANCER (MCRPC) POST DOCETAXEL FAILURE

Prostate cancer (PC) is the second leading cause of cancer death among men in the US. Approximately 165,000 men were diagnosed with new PC in the US in 2018. About 10-20 % will develop castration-resistant prostate cancer (CRPC) within 5 years of diagnosis; of these 70% will metastasize (mCRPC). Presence of visceral metastasis may affect survival. A cost-effectiveness analysis was conducted comparing enzalutamide (ENZ), abiraterone plus prednisone (ABI+PRD) and cabazitaxel plus prednisone (CAB+PRD) for visceral mCRPC post-docetaxel failure. Markov model with life-time horizon to estimate the incremental cost-effectiveness/utility ratios (ICER/ICUR) of direct medical costs per life-year (LY) and quality-adjusted life-year (QALY) gained from a US healthcare perspective (2018 US$; discount rate 3%/yr)). Inputs included drug and medical services costs, grade ≥3 adverse events with incidence >5%, physician follow up, blood and imaging tests. Kaplan-Meier curves from phase III trials were digitized and Weibull distributions were fitted to estimate overall (OS) and progression-free survival (PFS) transition probabilities. ICERs/ICURs were estimated in base case analyses, validated in probabilistic sensitivity analyses (PSA). Cost-effectiveness acceptability curves at various willingness-to-pay (WTP) thresholds were estimated. Models estimated mortality rates in 3 years’ time of 98.7 % for ABI+PRD, 83.8 % for CAB+PRD, and 86.8 % for ENZ treated patients. In 1.5 years’ time, estimated PFS rates were 14.47 % for ENZ, 0.27 % for CAB+PRD, and 0.51 % for ABI+PRD treated patients). LYs and QALYs gained were 1.58 and 0.79 respectively for ENZ, 1.20 and 0.58 for ABI+PRD, and 1.48 and 0.61 for CAB+PRD. At total costs of $157,830 for ENZ, $235,853 for ABI+PRD, and $496,756 for CAB+PRD, ENZ was cost-saving comparing to other therapies. All validated in PSAs. ENZ is cost-effectiveness compared to ABI+PRD and CAB+PRD. ABI+PRD is clinically less efficacious but less costly compared to CAB+PRD.

Treatment Level and Store Level Analyses of Healthcare Data

The presented research discusses general approaches to analyze and model healthcare data at the treatment level and at the store level. The paper consists of two parts: (1) a general analysis method for store-level product sales of an organization and (2) a treatment-level analysis method of healthcare expenditures. In the first part, our goal is to develop a modeling framework to help understand the factors influencing the sales volume of stores maintained by a healthcare organization. In the second part of the paper, we demonstrate a treatment-level approach to modeling healthcare expenditures. In this part, we aim to improve the operational-level management of a healthcare provider by predicting the total cost of medical services. From this perspective, treatment-level analyses of medical expenditures may help provide a micro-level approach to predicting the total amount of expenditures for a healthcare provider. We present a model for analyzing a specific type of medical data, which may arise commonly in a healthcare provider’s standardized database. We do this by using an extension of the frequency-severity approach to modeling insurance expenditures from the actuarial science literature.

The Economic Costs of Autism Spectrum Disorder: A Literature Review.

Autism is associated with a range of costs. This paper reviews the literature on estimating the economic costs of autism spectrum disorder (ASD). More or less 50 papers covering multiple countries (US, UK, Australia, Canada, Sweden, the Netherlands, etc.) were analysed. Six types of costs are discussed in depth: (i) medical and healthcare service costs, (ii) therapeutic costs, (iii) (special) education costs, (iv) costs of production loss for adults with ASD, (v) costs of informal care and lost productivity for family/caregivers, and (vi) costs of accommodation, respite care, and out-of-pocket expenses. A general finding is that individuals with ASD and families with children with ASD have higher costs. Education costs appear to be a major cost component for parents with children with ASD.

ПЕРСПЕКТИВЫ РАЗВИТИЯ КЛАСТЕРНОЙ МОДЕЛИ В СФЕРЕ ЗДРАВООХРАНЕНИЯ

In recent years, the effectiveness of national health systems has provoked wide-ranging public discussions. The rapid increase in the cost of medical services around the world has significantly exacerbated the problem of effectiveness of previously established health systems. As new priorities emerge, the need to search for innovative approaches to the medical industry and health services development, which can significantly reduce financial costs and increase their efficiency, broadens the problem field of health system research. Today, public health has become a space that requires managerial, institutional and political solutions to ensure the coordination of social and market interests. Currently, the market for new medical services is growing rapidly, but where is the money to increase the financing of high-tech medical care for poor citizens to be found? The article considers these problems within the framework of the cluster model as a possible institutional solution to promoting innovation in the public health realm. The analysis of the results of the clusterization strategy in the medical sphere of the European Union countries shows that health care clusters can be innovative tools for harmonizing public interests and particular interests of a purely economic nature. However, a number of factors impede the realization of such potential in practice. This is due to the lack of comprehensive programs for its development, which should coordinate the efforts of the main stakeholders – the State and local authorities, private companies, researchers and medical staff. Developing of “science cities” (“naukogrady”) as special areas where conditions for promoting international medical clusters are favorable for meeting public demands, market interests and innovative research can be an effective part of this agenda in Russia. The example of the science city of Troitsk shows that a developed infrastructure, a concentration of highly trained specialists and a conducive social environment constitute significant advantages for implementation of cluster programs.

SOCIAL SIGNIFICANCE AND ECONOMIC CONSEQUENCES OF RHEUMATIC DISEASES

Diseases of the musculoskeletal system are the most common pathologies of the modern society, yielding frequency only to diseases of respiratory and cardiovascular systems. Given the fact that they are occurred in a young, working-age population, as well as people in older age groups, the treatment of these patients consumed large financial resources, which results in a high socio-economic importance of rheumatic diseases in general. The article focuses on the prevalence of these forms of pathology in Russia and several foreign countries, material costs of the medical care of such patients (including direct, indirect and additional costs), the change of these ratios in connection with the increased longevity of the population, and the emergence of new high-tech methods of treatment, which led in some cases to a significant rise in the cost of medical services. There are discussed measures to optimize the treatment of these pathologies based on pharmaco-economic aspects.

Longitudinal cost of services in a homeless sample with cocaine use disorder

ABSTRACTHomeless people with cocaine use disorder have multiple comorbidities and costly service needs. This study examined service costs associated with cocaine use and substance service use in substance, psychiatric, and medical service sectors. 127 homeless participants with cocaine use disorder were interviewed annually. Self-report and agency-report service use and cost data were combined. Pairwise comparisons were made with cocaine abstinence and substance service use in relation to mean and yearly proportional service costs in 3 service sectors. Among substance service users, the achievement of abstinence was not associated with decreased substance service costs. Cocaine abstinence was associated with proportional reduction of substance service costs over time. Substance service use was associated with proportional reduction of psychiatric service costs over time among the abstinent subgroup. Conversely, substance service use was associated with continuing higher medical service expenditures in the abstinent subgroup and higher psychiatric service expenditures in those not abstinent. Homeless individuals who achieved cocaine abstinence after using substance services had decreased substance service expenditures. Individuals with continued substance service use had greater medical and psychiatric service costs. Policy-based on maximizing benefits while minimizing costs appears insufficiently complex to incorporate the multiple needs and associated with the costs of treating homeless populations.

Reimbursement scheme for China’s public hospitals from perspective of stakeholders

PurposePublic hospitals in China usually rely on revenues from medical services and medications to compensate for major costs given their nonprofit nature. The lack of government subsidies and unreasonable prices of medical services have led to high medical costs and unbalanced reimbursement system for public hospitals. There is a critical need of research on improvement of reimbursement system that will create positive effect on China’s health-care system. This paper aims to focus on four dimensions of stakeholders (government, patients, medical insurance agencies and social organization) and six major expenditures to explore reimbursement scheme for public hospitals in China with the purpose of relieving unbalanced income and expenditure of hospitals, avoiding medication markups and reducing medical expenses from patients.Design/methodology/approachIn this paper, the authors study reimbursement scheme for public hospitals from the perspective of four dimensions of stakeholders and how stakeholders reimburse six major expenditures of hospitals. A total of 128 effective samples were collected from financial data of 32 public hospitals through 2009-2012. This paper analyzes the econometric models of the selected revenue and expenditure. This paper analyzes the econometric models of the selected revenue and expenditure using linear regression. The linear relationship between each cost and different types of incomes (i.e. reimbursements from government, patients, insurance agencies and social organization) is analyzed before and after cancelling the medication markups.FindingsResults from empirical research verify that government reimbursement is insufficient, and using medication markups to compensate for medical service costs has become a serious problem for China’s public hospitals. To avoid the medication markups and improve the reimbursement scheme, government should reimburse labor cost, fixed assets cost and research cost; patients and medical insurance agencies should reimburse the costs of medical service, medication and administration/operations; and social organization should supplement the fixed assets cost.Originality/valueIn this study, the authors defined and classified stakeholders of reimbursement scheme for public hospitals in China, which help understand the roles and effects that different stakeholders can play in compensation. Along with the proposed reimbursement scheme framework, this study will help make effective implementation of new health-care reform program in China.

Influencing factors of health seeking behavior among rural residents of Yanchuan County in Yan'an City

Objective To understand the health seeking behavior among rural residents of Yanchuan County in Yan'an City and to analyze its influencing factors. Methods From July 2017 to August 2017, we selected 552 rural permanent residents of Yanchuan County in Yan'an City by convenience sampling. All of them were investigated with the self-designed health seeking behavior questionnaire for rural residents. The binary Logistic regression was used to analyze the influencing factors of health seeking behavior among rural residents. Results When rural residents were ill, 224 (40.58%) rural residents bought medicines for treatment, 216 (39.13%) knew disease related knowledge and 352 (53.01%) rural residents attended rural cooperative medical care. Binary Logistic regression showed that the influencing factors of health seeking behavior of rural residents included ages, monthly income, attending insurance or new rural cooperative medical care, knowing disease related knowledge, diet rules and the proportion of vegetables and meats each meal. Conclusions Health conscious of rural residents is weak; the health seeking behavior is traditional, backward and negative; they lack knowledge on health, medical treatment, health care and emergency treatment and their medical insurance participation is inactive. Government sector should pay attention to health seeking behavior of rural residents, strengthen the development of rural doctor team and clinics in villages and towns, improve medical care system and rural cooperative medical care so as to solve the problems high cost and difficulty of getting medical service among rural residents. Key words: Cross-sectional studies; Health seeking behavior; Rural residents; Influencing factors

Early Direct Costs of Diagnostic and Therapeutic Services for Patients with Cancer: A Descriptive Study in Semnan, Iran, 2011 - 2014

Objectives: Knowledge about the pattern and direct costs of medical services allocated to a given disease in a particular community can help to realize its economic burden in that community better regarding its socioeconomic features. A significant part of medical diagnostics and therapeutics for patients with cancer is made within three to six months after its detection, and their related costs are named as early direct costs. The current study aimed at evaluating the early direct costs of the incidence of cancer in a sample of Iranian patients. Methods: The current descriptive study was conducted on some patients with cancer referred to the only oncology clinic in Semnan city, Iran, from 2011 to 2014 for chemotherapy. Some primary information about the type of services received and their direct costs, and also some demographics and social characteristics were gathered from patients' medical records. Costs were converted to US dollars and their means ± standard deviation (SD) were reported. Results: Fifty patients participated in the study. The most common types of cancer were breast cancer (n = 18, 36%), followed by colorectal cancer (n = 13, 26%). Other types included the esophagus, gastric, pancreas, lymphoma, ovarian, leukemia, and nasopharyngeal carcinomas. The mean ± SD of cost for doctor visits was US$1666.58 ± 41.64, US$221.97 ± 149.72, for imaging, US$200.55 ± 86.62 for lab tests, US$693.70 ± 530.90 for drugs, US$375.18 ± 156.89 for chemotherapy, US$492.03 ± 774.87 for surgical hospitalization, and US$75.86 ± 40.26 for non-surgical services, with the total average cost of US$2164.52 ± 1156.56. The total calculated early direct costs to manage colorectal cancer were estimated US$3017.26, and for breast cancer US$1923.23. No difference was observed in the costs of services including doctor’s visits, imaging, laboratory tests, medications, or non-surgical services among the different subtypes of cancers; however, higher costs for chemotherapy and surgical services were specified to colorectal cancer. Conclusions: The study findings suggested that the economic burden of colorectal cancer in Iran was larger than the other types of cancer regarding its early direct costs.

Factors Affecting The Cost Gap Between INA CBGs Tariff and Hospital Tariff for Patients with Dengue Hemorrhagic Fever in Ngawi Regional Public Hospital, East Java

Background: Dengue Hemorrhagic Fever (DHF) has a high cost burden. Payment for hospital treatment was paid by Health insurance (BPJS) with a case based payment method in the era of the National Health Insurance. This method allowed the hospital to gain profit or loss. This study aimed to analyze the factors that influence the differences in Indonesian Cased Based Groups (INA CBGs) with the medical service costs for DHF in dr. Soeroto hospitals, Ngawi Regency. Subjects and Method: This study used an observational analytic study with a cross-sectional approach conducted at dr. Soeroto Hospital, Ngawi Regency, East Java in September - October 2019. A sample of 200 subjects was selected by using simple random sampling. The dependent variable was the difference in rate. The independent variables were class of care, length of stay, age, blood transfusion, comorbidity and complications. Data analysis was using multiple linear regression with Stata 13. Results: INA CBG rates (mean= Rp 6,120,000; SD= Rp 2,330,000) was lower than the cost of hospital treatment (mean= Rp 7,070,000; SD= Rp 4,650,000). There is a negative relationship between the difference in rates and it was statistically significant on the length of stay (b= 0.73; Cl 95%= -1,131,915 to -329,501; p= <0.001), patients’ age (b= 0.41; Cl 95%= -707,099 to -110,293; p= 0.008), blood transfusion action (b= 0.79; Cl 95%= -1,549,446 to -34,190; p= 0.041), and comorbidity (b= 1.14 ; Cl 95%= -1,817,112 to -474,641; p= 0.001). While there was a statistically insignificant relationship between classes of care (b= 0.42; Cl 95% = -931,443 to 82,607; p= 0.100) and complication (b= 0.34; Cl 95%= -1,093,208 to 408,223; p= 0.369). Conclusion: Difference in INA CBG rates and hospital medical service costs were affected by the class of care, length of stay, age, blood transfusion, comorbidity and complications. Keywords: INA-CBG’s rates , hospital rates, care cost, dengue hemorrhagic fever. Correspondence: Betty Nurizky Ariwardani. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta, Central Java, Indonesia. Email: bettyna175@gmail.com. Mobile: 082233243164. Journal of Health Policy and Management (2019), 4(3): 204-213 https://doi.org/10.26911/thejhpm.2019.04.03.08

The use of valuations of healthcare services in other countries (basic benefits basket) in the tariffing process

The Agency for Health Technology Assessment and Tariff System is national institution supervised by Minister of Health. Agency is an advisory body in the reimbursement process. One of the Agency’s roles is setting a tariff for publicly funded healthcare services. Determining the cost of medical services is one of the most important conditions for valuating these tariffs. As in most European countries, the system of financing in-patient care in Poland is based on the Diagnosis Related Group system (DRG). DRG systems were created to increase efficiency in the use of available resources, and consequently to improve the quality of medical care. In order to compare the method and level of financing healthcare services with their equivalent abroad, the Agency analyzes information from other countries, especially those with GDP per capita similar to that of Poland. The Agency searches for patient group classification methods, payment methods, the shape of services and all factors affecting the valuation of services. The article describes the Polish inpatient services system against the background of solutions functioning in the world. The pricing process was presented, with particular emphasis on the process of obtaining data on foreign tariffs and their impact on the construction and pricing of healthcare services in Poland.

Association between Social Capital, Mental Health and Quality of Life among Migrant Workers in Myanmar

Introduction: During these decades, Myanmar has faced mass internal migration as a result of pull and push factors. The concepts and concerns related to Quality of Life on internal migrant workers are different from the general population. Migration gives rise to huge stresses and depression. Methods and Materials: Cross-sectional study was conducted among 1,182 migrants. To assess socioeconomic status, health behaviors, mental health status, social capital, accessibility to health care services, and QOL. The Generalized Linear Mixed Model was used to determine the association between social capital, mental health and QOL after controlling the other covariates. Result: About one third of respondents were factory workers and had low level of education. Regarding the level of good, fair and poor QOL were 26.82% (95% CI: 24.37-29.42), 71/74% (95% CI: 69.10-74.24) and 1.44% (95% CI: 0.89-2.30) respectively. Cognitive social capital (AOR=2.51, 95%CI: 1.14-5.55 p value<0.05), structural social capital (AOR= 2.14, 95%CI: 1.22-3.76, p value=0.008) and depression (AOR= 2.13, 95%CI: 1.25-3.62, p value=0.006) were associated with QOL. Not like the other studies, stress was not associated with QOL. The other factors associated with good QOL were monthly family income, living with related family members in a house and burden of medical services costs. Discussion: Only one-fourth of internal migrant workers had good quality of life. The findings highlighted to develop policies aimed to improve QOL in order to reducing stress and depression among migrants by promoting social capital. In order to achieve the sustainable development goals, it is important to make investment on health of the migrant workers.

Justification of the need for application of telemedicine technologies for workers of enterprises located in hard-accessed regions of the Russian Federation

The article discusses the relevance of the use of automated medical technologies for employees of oil companies in remote regions of theRussian Federation. The theoretical base is studied and types of application of telemedicine technologies are considered. The statistics of the use of available technologies in the Northern regions, in particular, in the Khanty-Mansiysk district, is analyzed. It was determined the growth of popularity, as well as the need for the use of these technologies, due to the increase in population and harsh climatic conditions. The absence of application of telemedicine technologies in oil companies was revealed. The relevance of technology application was considered in more detail on the example of employees of PJSC Gazprom. The ratio of the working and administrative staff is analyzed, and it is revealed that 48.7% of the working staff work in shifts in the Northern regions of Russia, remote from settlements and do not have specialized medical centers in their territories, providing a full examination and quality treatment. Thus was proved the relevance of the use of telemedicine technologies, which are able to provide quality and timely medical aid workers to solve the problem of deficiencies of qualified doctors in remote villages, to reduce the cost of medical services, increase the investment attractiveness and improvement of the company image in the society.

Budget impact analysis of comprehensive genomic profiling in patients with advanced non-small cell lung cancer

Aims: Broad molecular profiling of patients with advanced non-small cell lung cancer (NSCLC) is strongly advised to optimize genomic matching with available targeted treatment options or investigational agents. Unlike conventional molecular diagnostic testing, or smaller hotspot panels, comprehensive genomic profiling (CGP) identifies genomic alterations across hundreds of clinically relevant cancer genes from a single tissue specimen. The present study sought to estimate the budget impact of increased use of CGP using a 324-gene panel (FoundationOne) vs non-CGP (represented by a mix of conventional molecular diagnostic testing and smaller NGS hotspot panels) and the number needed to test with CGP to gain 1 life year.Materials and methods: A decision analytic model was developed to assess the budget impact of increased CGP in advanced NSCLC from a US private payer perspective. Model inputs were based on published literature (epidemiology and treatment outcomes), real-world data (testing and rates, medical service costs), list prices for CGP and anti-cancer drugs, and assumptions for clinical trial participation.Results: Among 2 million covered lives, 532 had advanced NSCLC; 266 underwent molecular diagnostic testing. An increase in CGP among those tested, from 2% to 10%, was associated with $0.02 per member per month budget impact, of which $0.013 was attributable to costs of prolonged drug treatment and survival and $0.005 to testing cost. Approximately 12 patients would need to be tested with CGP to add 1 life year.Limitations: The model incorporated certain assumptions to account for inputs with a limited evidence profile and simplify the possible post-CGP treatments.Conclusions: An increase in CGP utilization from 2% to 10% among patients with advanced NSCLC undergoing molecular diagnostic testing was associated with a modest budget impact, most of which was attributable to increased use of more effective treatments and prolonged survival.

СУЧАСНИЙ СТАН І ПРОБЛЕМИ ФІНАНСУВАННЯ КАПІТАЛЬНИХ ВИДАТКІВ В УСТАНОВАХ НАЦІОНАЛЬНОЇ АКАДЕМІЇ МЕДИЧНИХ НАУК УКРАЇНИ

У статті розглянуто стан і проблеми фінансування капітальних видатків в установах НАМН України. Визначено основні джерела фінансового забезпечення оновлення основних засобів та напрямів їх використання. Досліджено механізм реалізації державних інвестиційних проектів на оновлення матеріально-технічної бази установ НАМН України. Визначено недоліки розрахунку вартості медичних послуг у контексті оновлення основних засобів для надання високоспеціалізованої медичної допомоги.

Cost of care for patients with metastatic castration-resistant prostate cancer initiating on docetaxel versus oral targeted therapies in the United States.

88 Background: Abiraterone acetate + prednisone and enzalutamide are approved oral targeted therapies (OTT) for metastatic castration-resistant prostate cancer (mCRPC) which have significant clinical benefit. However, their impact on healthcare cost relative to docetaxel (DOC) is not well understood. Methods: This retrospective cohort study used combined claims data from Truven MarketScan Commercial and Medicare Supplement Plan databases. Males ≥18 years with ≥1 prostate cancer diagnosis and a subsequent metastasis diagnosis were indexed on the first claim date of DOC or OTT between 1/1/2012 and 12/31/2016. ≥1 claim for an androgen deprivation therapy during the 12-month continuous enrollment period prior to metastasis was required; patients with end stage renal disease or other primary cancer were excluded. All-cause per patient per year (PPPY) costs were estimated in 2016 US dollars. A generalized linear model was used to compare adjusted costs between DOC and OTT cohorts. Results: A total of 1,159 and 200 mCRPC patients initiated on OTT and DOC, respectively. Mean follow up time for both cohorts was 1.2 years. Mean age of OTT patients was 75.1 (Standard Deviation = 10.7) years and mean Quan-Charlson Comorbidity Index (QCI) was 3.2 (1.9). Mean age of DOC patients was 65.9 (9.1) years; mean QCI was 2.9 (1.8). 21% of OTT and 56% of DOC patients were commercially insured. Following treatment initiation, total mean unadjusted all-cause PPPY costs were $144,350 ($80,606) and $137,814 ($84,405) for OTT and DOC cohort, respectively. The primary cost drivers were utilization of treatments indicated for mCRPC, outpatient encounters and inpatient hospitalizations. Total adjusted PPPY costs were higher for OTT than DOC patients ($141,008 vs. $125,318, p = 0.0012), mainly due to higher costs of treatments indicated for mCRPC ($80,443 vs. $55,820, p &lt; .0001). Medical costs (excluding mCRPC treatment) for OTT initiated patients were lower ($54,570 vs. $64,614, p = 0.0128). Conclusions: In a real-world setting, initiation on OTT was associated with higher overall cost of care for mCRPC compared with DOC. However, the cost of medical services was significantly lower when initiated on OTT.

Assessing the social determinants of health care costs for Medicaid-enrolled adolescents in Washington State using administrative data.

The study used administrative data to identify the social determinants that have the greatest impact on Medicaid expenditures in adolescence. Data were compiled using the Washington State Department of Social and Health Services Integrated Client Databases, which link data from state systems including Medicaid claims and social services receipt. Medical system and behavioral health service costs of over 180000 Medicaid-enrolled adolescents aged 12-17 were measured using integrated administrative data from Washington State. Social determinants of health, including child maltreatment and parent risk factors, were also measured. Two-stage regression models were used to identify factors associated with increased health care utilization and costs. Regression models revealed that the factors most predictive of higher health care costs were child abuse, child neglect, and instability in out-of-home placements related to foster care. Other social determinants of health, such as parent risk factors, were not associated with health care costs. Child maltreatment and placement instability impacted health care costs primarily through large increases in behavioral health utilization and costs. Prevention and early interventions for children and families to decrease child maltreatment and increase foster care placement stability could reduce overall health care costs.

Assessment of utilization of primary health care services among settled Fulani agro-pastoralists in Ogun State, Nigeria

Utilization of primary health care services among settled Fulani agro-pastoralists in Ogun State was assessed in this study. Sixty (60) respondents were purposefully selected and interviewed using an interview guide. The data obtained were analyzed using descriptive and inferential statistics. The study revealed that the mean age of the respondents was 35.82, 68.3% of the respondents were females and majority (80.0%) of the respondents have no formal education. The results showed that friends and relatives were the main sources of information on primary health care services. About 90.0% of the respondents had positive attitude towards the use of primary healthcare services. The study also revealed that respondents visits primary health facility for pharmacy/dispensary (95.0%), maternity (98.3%) and vaccination/immunization (86.7%). The result of the study revealed that the most pressing constraint faced by the agro-pastoralists was the distance of health facility from their settlement. Regression analysis showed that income, distance from home to health care center, information, attitude and constraints face influenced the utilization of primary healthcare services among the respondents. The study recommends that government should build health centres close to the agro-pastoralists to reduce the cost of medical services accessed by the pastoralists. Keywords: Fulani, healthcare, Ogun State, pastoralist, utilization

Pattern of self-medication amongst housewives vs working women in urban population in Southern Rajasthan

Background: The use of medications without prior medical consultation regarding indication, dosage, and duration of treatment is referred to as self-medication1. Self-medication has its own benefits regarding reduction in load and cost of medical services. Women are primarily responsible for the health needs of the family and self- medication is frequently practiced by them. Working environment may influence the attitude of women towards safe and rational self-medication. This study focuses on the pattern and attitude of women (housewives/ working) towards self- medication and influence of working atmosphere and exposure of women on self-medication.Methods: 170 women of age group 18-60 years were included in the study and after taking permission from Institutional ethics committee. Data was collected by making the participants fill a semi structured detailed questionnaire under observation of instructor. The data was analysed using Microsoft excel and compared by using Fischer exact test.Results: Most common ailment for which self-medication was practiced was pain. Working women primarily used pharmacist and house wives use old experience and family friends as primary source of information. Working women were more cautious about adverse drug reactions, drug-drug interactions, expiry date of medicine, reading instruction manual, use of counterfeit medicine and referring the experience to their known subjects as compare to housewives.Conclusions: Self-medication was prevalent in both the groups, though working environment has positive influence towards safe, responsible and rational self-medication. There is need for education regrading safe use of medicine and strict rules and regulations for availability of drugs.