Cost Of Medical Services Research Articles

THE ROLE OF SOCIAL AND PERSONAL INSURANCE IN PROVIDING PUBLIC WELFARE IN UKRAINE

Introduction. Achieving public welfare is impossible without an effective social protection system, which combines pension insurance, social insurance, health care, as well as material support in difficult life situations. Low budget funding for social protection of population necessitates the use of insurance instruments to neutralize major social risks. However, the role of social and personal insurance in the financial provision of social protection remains insufficient, and its potential in improving the welfare of Ukrainians is underestimated. However, the role of social and personal insurance in the financial provision of social protection remains insufficient, and its potential in improving the welfare of Ukrainians is underestimated. The purpose is to define the role and outline the prospects for the development of social and personal insurance in the context of ensuring public welfare in Ukraine. Results. The essence and main components of social welfare are revealed. It was found that the level of well-being of Ukrainians is ten times lower than in European countries. There are the main negative factors which influence the social protection system defined, in particular: low income and rising expenditures of the Pension Fund of Ukraine and the Social Insurance Fund of Ukraine, the widespread practice of minimizing SSPs by refusing to enter into classic employment contracts in favor of civil agreements with individual entrepreneurs, reduction of the number of insured persons working for hire, high level of labor emigration of Ukrainians. The health care system impact on the growth of public welfare in Ukraine is analyzed. The inefficiency of the current financial support model of the health care system is substantiated, which makes it necessary for households to pay for most of the cost of medical services. Tendencies in the development of the domestic health insurance market are highlighted. Perspectives. It is proposed to revise the principles of building accumulative pension insurance and introduce a budget-insurance model of financing the health care system, which will help to improve the welfare of the population of Ukraine.

Adherence to the evidence-based guidelines in the management of acute biliary pancreatitis: A case series

BackgroundAcute pancreatitis (AP) is considered one of the most common gastrointestinal disorders; the annual worldwide incidence for AP is 4.9–73.4 cases / 100,000 people and the total mortality rate is 4–8%, increasing to 33% in patients with infected necrosis. This study aims to assess the outcome of providing standardized evidence-based care to patients with acute biliary pancreatitis. MethodsThirty patients diagnosed with acute biliary pancreatitis, were enrolled in this study and managed according to the Japanese guidelines, 2015 with a complementary scope on other recent guidelines. ResultsOut of 30 patients in the study, 60% were females. Twenty-five cases were presented in the early phase of the disease while the rest presented in the late phase. Gallstones were the commonest cause (80%). The complications encountered were a systemic complication in one case, organ failure in three cases, and the local complications in the form of fluid collections in (43.3%) of cases.Out of 30 patients, 6 patients had an intervention. The main approach was minimally invasive techniques (4 cases), Open approach was performed in 2 cases. The total mortality rate was 10%. Most mild cases were discharged within one week from admission. Cases readmitted with recurrent attacks of acute pancreatitis were 3 cases, one male and 2 females. ConclusionBy applying guidelines in the management of acute biliary pancreatitis, we can reduce disease-related morbidity and mortality. Besides, we can reduce the costs of medical services with the proper investment of healthcare resources.

Patient Awareness of Cost of Treatment at a Government Sponsored Hospital in India

Introduction: To evaluate the awareness amongst the beneficiary about the costs of medical services in a hospital which provides all services at no cost and also to analyse whether education level of the beneficiary client, number of days stayed in hospital and their prior exposure of being treated on payment in other hospital has some bearing on cost estimation by the participants.
 Method: It was a cross sectional questionnaire based survey study. A total of 130 beneficiary clientele of a government hospital were interviewed. Two sample ‘t’ test and ANOVA were used for statistical analysis. Multivariate regression analysis was used to study effect of more than one independent variable on cost estimation. Scatter plot and box plots were used to study standard deviation.
 Results: It revealed poor awareness of people in cost estimation of medical expenses. A significant ‘p’ value of < 0.05 was observed with respect to length of stay (p = 0.003), treatment modality (p = 0.000) and multivariate variable (treatment technique along with exposure to treatment in paid hospital, p = 0.008).
 Conclusion: The beneficiary clientele in a hospital with free treatment generally not aware about the exuberant costs of treatment born by the state.

Security in Cloud Health Care

Cloud computing plays vital role in various services to the users. The application of cloud computing includes usage in business, media transmission, banking, health care, military application, insurance, wireless communication, etc. One such application using Cloud computing is health care. The patient health history is very significant for diagnostic analysis and decision making process. The healthcare data processing and communication technology (HDCT) is building a constant and secured health care data processing and sharing Electronic Health Services (EHS) are regularly utilized by the needy, specialists, and social insurance experts to diminish medical service cost and give productive human services forms health-cloud preserves the character-particular sensitive information for numerous purposes including biomedical research, medical health insurance groups, clinical statistics analysis, and many others. The various types of attacks and detection approaches in the healthcare have been reviewed in this work. It brings out the fact that the Electronic Health Data Record (EHDR) should be processed and transmitted in a secured and confidential environment while increasing accuracy and efficiency based on various algorithms such as machine learning.

The pharmacoeconomic analysis of the cost efficiency of trastuzumab in the adjuvant therapy of HER2 + early breast cancer

Breast cancer (BC) is the first among all oncological diseases in women and is one of the main causes of female mortality worldwide, including in Ukraine. The HER2 + subtype of breast cancer is characterized by the most unfavorable prognosis. The targeted drug trastuzumab significantly improves the 10-year survival rate of patients with HER2 + breast cancer, but at the same time significantly increases the cost of treatment.Aim. To assess pharmacoeconomically the adjuvant therapy of the early stage of HER2 + breast cancer with trastuzumab (Herceptin® medicine) from the perspective of the Ukrainian healthcare system.Materials and methods. The method of analytical modeling by Markov was used. Modeling was carried out on the basis of the results of a randomized, multicenter open clinical trial of phase III HERA. The time horizon of the model is 10 years. As an alternative to trastuzumab the standard adjuvant therapy regimens for breast cancer given in the current Protocol for the care of breast cancer patients were considered. According to the results of modeling by Markov the methods of “cost-effectiveness” and “cost-utility” were used. The efficiency criterion was the life years gained (LYG). The utility criterion was QALY. The cost of direct medical expenses was taken into account. The cost structure was determined by the Protocol. The cost of drugs was determined by the Register of the Ministry of Health of Ukraine as of 08/07/2019. The cost of medical services was determined by price lists. The cost of correcting side effects of chemotherapy was also taken into account. The discount was 3 % annually. The analysis of the sensitivity of the results was conducted to change the price of trastuzumab and the price of drugs of alternative adjuvant therapy regimens.Results. According to the modeling the average life expectancy of patients with HER2 + breast cancer in the trastuzumab group was 7.32 years, in the standard chemotherapy group it was 6.43 years. In the trastuzumab group, patients received 6.72 QALYs, while in the standard chemotherapy group – 5.80. The adjuvant therapy with trastuzumab gave the patients an additional 0.89 LYG and 0.92 QALY. The costs of treatment during the study in the trastuzumab group averaged 627115.5 UAH per one patient, in the group of the standard chemotherapy it was 501939.6 UAH. The incremental ratios ICER (the cost of 1 additional year of life) and ICUR (the cost of 1 additional QALY) were 140,833.8 UAH and 136088.8 UAH, respectively.Conclusions. The targeted drug trastuzumab is a medicine for the adjuvant therapy of the early stage HER2 + breast cancer with the evidence-based effectiveness. The adjuvant therapy regimen for HER2 + breast cancer with trastuzumab compared to the standard adjuvant chemotherapy with HER2 + is expensive, but gives better results. It gives an average of an additional 0.89 years of life and 0.92 QALY. The pharmacoeconomic analysis based on modeling by Markov and “cost-effectiveness” and “cost-utility”calculations allows considering the early stage adjuvant therapy of HER2 breast cancer with trastuzumab (Herceptin®) as an economically feasible medical technology in the healthcare of Ukraine today.

Prediction and Analysis of Medical expenses in General Hospitals in China based on GM (1, 1) Model

GM (1, 1) is a long-term forecasting model, which should be credible without large market volatility and policy changes. The purpose of carrying out cost accounting in hospital is to renew the concept of economic management of hospital and raise the cost consciousness of all staff through the accounting and management of hospital and medical service cost, so as to improve the economic benefit of hospital. The grey model has strict theoretical basis, its biggest advantage is practical, and the prediction result is relatively stable, which is suitable for forecasting a large number of data, and the prediction results are very accurate when the amount of data is small. The paper presents Prediction and Analysis of Medical expenses in General Hospitals in China based on GM (1, 1) Model.

PCV54 THE HEALTHCARE MANAGEMENT OF PATIENTS WITH THE CORONARY AND PERIPHERAL ARTERIAL DISEASES

Coronary arterial diseases (CAD) involves the reduction of blood flow to the heart muscle by cause of build-up of plague in the arteries of the heart. Peripheral arterial disease (PAD) is defined as a progressive stenosis or occlusion of any artery except coronary and intracranial arteries. Updated data about the treatment of patients with CAD and PAD are not available in Slovakia. The objective of the study is to obtain local information about the healthcare management of patients with CAD and PAD at high risk of ischemic events and their complications in Slovakia. Data gathering was conducted by qualitative survey. The non-standardized validated questionnaire was filled out in two stages for data consistency. The costs of medicines, hospitalization and medical services were evaluated according to the local available sources. No personal data of patients were involved. Total costs (without antiplatelet therapy) were quantified: CAD (any 3 months) – 238.79 €; PAD (any 3 months) – 185.83 €; acute heart attack (first 3 months) – 4,977.01 €; status after a heart attack (any 3 months) – 497.99 €; fatal heart attack – 7,057.51 €; acute ischemic stroke (first 3 months) – 3,093.59 €; status after an ischemic stroke (any 3 months) – 524.50 €; fatal ischemic stroke – 1,783.07 €; acute intracranial bleeding (first 3 months) – 2,848.23€; status after intracranial bleeding (any 3 months) – 125.78 €; fatal intracranial bleeding – 1,858.50 €; acute limb ischaemia (first 3 months) – 2,414.97 €; minor amputation (first 3 months) – 1,309.89 €; major amputation (first 3 months) – 1,527.69 €; gastrointestinal bleeding (first 3 months) – 2,761.93 €; venous thromboembolism (first 3 months) – 2,923.02 €; fatal heart failure – 656.70 €. The data from survey provided information about the cost of the disease, which can be used to the cost-effectiveness analysis.

PSY20 COST-EFFECTIVENESS ANALYSIS OF SECUKINUMAB IN THE TREATMENT OF PSORIATIC ARTHRITIS IN THE RUSSIAN FEDERATION

To compare the cost-effectiveness of prescribing biologics (secukinumab, golimumab, certolizumab pegol, ustekinumab, adalimumab, etanercept, and infliximab including biosimilars) for adult bio naïve patients with active psoriatic arthritis in Russia. Based on data on the efficacy of compared treatment regimens, data on the cost of drugs and medical services, as well as the frequency of their provision the cost-effectiveness analysis was carried out. According to national requirements for performance of cost-effectiveness results, we demonstrated difference (%) in the cost-effectiveness ratio between analysed treatment options. The study had a time horizon of 3 years. The discount rate was 3% per year. The evaluation of therapy effectiveness was based on ACR 20/50/70 response criteria. Cost-effectiveness ratio of secukinumab is on average 65% and 55% lower than the cost-effectiveness ratio of treatment with certolizumab pegol, golimumab, ustekinumab, adalimumab, etanercept and infliximab in the first and subsequent years of therapy, in accordance. Estimation of costs and efficacy showed that treatment with secukinumab is characterised by lower costs per unit of efficacy (ACR 20/50/70 response), relative to the indicators of the compared drugs in the first and subsequent years of therapy adult bio naïve patients with active psoriatic arthritis.

Comorbidity in elderly patients with atrial fibrillation affects the “cost of illness”

Objective: to analyze whether comorbidity affects the cost of treatment and medical services in elderly patients with atrial fibrillation (AF). Materials and methods. We conducted a retrospective analysis of 98 patients with AF. Comorbidity was evaluated using the CIRS-G scale (Cumulative Illness Rating Scale for Geriatrics) and the Charlson criterion. The “cost of illness” calculations included direct costs only. Results. In elderly patients with AF (mean age 74.7±8.8 years), high rate of comorbidity was typically found. Charlson comorbidity index amounted to 4.0±1.8, and the CIRS-G score – to 8.0±2.8. AF is often associated with heart diseases such as hypertension – 98.9%, coronary heart disease – 27.6%, and congestive heart failure – 76.5%. A patient with AF received on average 7.5±3.8 medications. Direct costs amounted to 18298.2±9440.4 RUB per patient with AF per year. Of this amount, 78.8% were spent for outpatient treatment, 16.5% for hospitalization and 4.7% for ambulance service. Cardiac medications comprised 66.4% of the total direct costs. In patients with high comorbidity, there are high costs of treatment of concomitant diseases, high secondary costs as well as costs for a doctor visit. Conclusion. An average elderly patient with AF receives 7.5±3.8 permanent medications, which correlates with the severity of comorbidity by the Charlson index (r=0.59; p=0.000) and the CIRS-G score (r=0.29; p=0.004). Management of such patients at the outpatient clinic is by large (66.4%) associated with direct costs of the prescribed medications. However, patients with high comorbidity still need more vital drugs, as the cost of treatment of concomitant diseases increases. Notably, these patients spend 4 times more funds for drugs without proven efficacy.

Link quality and energy utilization based preferable next hop selection routing for wireless body area networks

The rising population and cost of medical services triggered the new technologies including Wireless Body Area Networks (WBANs) based on smart and intelligent biosensors nodes for sensing and monitoring the patient vital signs. The biosensor nodes have implanted inside or outside the human body to send the medical information to medical centers. For data dissemination in these services, different types of solutions and model have been designed to address the interference, body movement, disconnection quality of services issues in the network. This paper presents an Energy Aware Routing (EAR) protocol to minimize energy utilization and select preferable next hop by evaluating the link quality of sensor nodes. The proposed protocol evaluates the energy level, link quality, and remaining energy level to balance the load, minimize the energy utilization, and enhance the data transmission. Various simulations have conducted to evaluate the proposed protocols performance in terms of energy consumption, data delivery, delay, and data throughput. Experimental results indicated that the proposed protocol has a better mechanism for date routing and better solution to minimize the energy of sensor nodes in WBANs.

The financial and time burden associated with phenylketonuria treatment in the United States

BackgroundPhenylketonuria (PKU) imposes a substantial burden on people living with the condition and their families. However, little is known about the time cost and financial burden of having PKU or caring for a child with the condition. Methods and findingsPrimary data were collected with a detailed cost and utilization survey. Primary outcomes included utilization and out-of-pocket costs of medical services, medical formula, and prescribed low-protein food consumption, as well as the time and perceived effort involved in following the PKU diet. Respondents were people living with PKU or parents of children with PKU identified through a state newborn screening program database. Secondary administrative claims data were also used to calculate mean total, insurer, and out-of-pocket payments in inpatient, outpatient (office visits, emergency room, and laboratory tests), and pharmacy settings for privately insured persons with PKU. Payments were calculated for sapropterin and for PKU formula.In primary data analysis (children n = 32, adults n = 52), annual out-of-pocket costs were highest for low-protein foods (child = $1651; adult = $967) compared with other categories of care. The time burden of PKU care was high; families reported spending more than 300 h per year shopping for and preparing special diet foods.In secondary data analysis, children 12–17 years old had the highest average medical expenditures ($54,147; n = 140) compared to children 0–11 years old ($19,057; n = 396) and adults 18 years and older ($40,705; n = 454). Medication costs were the largest contributor to medical costs, accounting for 61–81% of total costs across age groups. Sapropterin was the largest driver of medication costs, accounting for 85% of child medication costs and 92% of adult medication costs. ConclusionTreatment for PKU incurs a substantial time and cost burden on persons with PKU and their families. Estimated medical expenditures using claims data varied by age group, but sapropterin represented the largest cost for PKU treatment from a payer perspective across age groups.

Analysis of Safety, Medical Resource Utilization, and Treatment Costs by Drug Class for Management of Inflammatory Bowel Disease in the United States Based on Insurance Claims Data.

IntroductionConventional pharmaceutical interventions for inflammatory bowel disease (IBD) provide limited disease/symptom control and are associated with an increased risk of adverse events (AEs). These limitations increase patient morbidity, medical resource utilization (MRU), and costs.MethodsThe IQVIA™ Real-World Data Adjudicated Claims–US database was leveraged to identify adult patients (> 18 years) with Crohn’s disease (Crohn’s) or ulcerative colitis (UC), who were new and chronic users (≥ 60 days) of oral corticosteroids (OCS), immunosuppressants (IS), anti-tumor necrosis factor agents (anti-TNF) or combinations thereof. Using aminosalicylate-treated patients as a reference, we compared AE incidence, MRU, and medical costs across drug classes.ResultsThe analysis included 30,676 patients (Crohn’s: n = 14,528; UC: n = 16,148). OCS monotherapy was the strongest predictor of any AE occurring [Crohn’s: hazard ratio 1.62 (1.51–1.73); UC: hazard ratio 1.57 (1.49–1.66)]. A similar pattern was observed for severe infection and bone-related conditions. Patients with UC or Crohn’s receiving OCS or IS plus OCS were more likely to have emergency department visits, IBD-related hospitalizations/visits/procedures, and gastrointestinal surgery than were patients receiving other therapies. Annualized total medical costs (pharmacy plus hospital service costs) were greatest for anti-TNF plus IS or anti-TNF therapy in both Crohn’s and UC. Annualized medical service costs (excluding IBD drug costs) were highest for patients initiating OCS-containing therapies [Crohn’s: OCS, $27,041 (24,882–29,200) and OCS plus IS, $23,332 (19,889–26,775); UC: OCS, $19,659 (17,977–21,340)].ConclusionAlthough biologic therapies have higher pharmacy costs, treatment decisions should consider the increased AE risks and long-term MRU costs associated with chronic use of OCS-containing therapies.FundingThis study was funded by F. Hoffmann-La Roche Ltd. The journal’s Rapid Service Fee and Open Access publication were paid for by ApotheCom on behalf of Genentech, a member of the Roche group who funded the study.Electronic Supplementary MaterialThe online version of this article (10.1007/s12325-019-01095-1) contains supplementary material, which is available to authorized users.

Economic burden of migraine in Latvia and Lithuania: direct and indirect costs

BackgroundMigraine is a primary headache disorder which affects all aspects of life. The financial burden of migraine imposed on the society might be substantial. This study aims at estimating the economic cost of migraine in Latvia and Lithuania, including both direct and indirect costs. Direct costs encompass the costs of migraine-related health care resource utilization. Indirect costs are related to productivity loss, the potential or expected earnings lost due to migraine.MethodsDirect cost is assessed by using the prevalence method, a widely used cost-of-illness approach. The prevalence rate of migraine and the migraine-related health care resource utilization are proxied from the literature, whereas unit cost of medical services and procedures are retrieved from national databases and providers. For estimating the indirect cost of migraine, we follow the human capital approach. We quantify three components of indirect costs: reduced labour force participation, absence from work and reduced productivity while at work. The number of unemployed migraineurs, days missed from work and days lost due to impairment while at work are drawn from the literature. Unemployment rate and average income in Latvia and Lithuania are then inserted to assess indirect costs.ResultsWe find that the mean per-person total cost of migraine is €801 annually in Latvia, and €721 in Lithuania. In both countries around 30% of total cost is direct cost; cost related to a wide array of migraine-related medical services and interventions. The total cost of migraine is €112.26 million in Latvia, corresponding to 0.42% of Latvia’s GDP. The total cost of migraine is €149.62 million in Lithuania, corresponding to 0.35% of Lithuania’s GDP. In both countries two thirds of total cost is related to lost workdays due to absenteeism and presenteeism.ConclusionsThe financial burden of migraine imposed on the society is substantial in Latvia and Lithuania. Improvements in care for patients with migraine, such as easier access to structured headache assessment services, wider availability of various procedures and preventive medications would significantly increase direct costs. Nevertheless, this cost increase might be far outweighed by lower migraine-related productivity loss, especially as the prevalence of migraine is the highest in the most productive years of life.

Central and Eastern Europe as a medical tourism destination: a case study of Poland.

The medical tourism has been changing the healthcare scene especially in the developing countries which offer a combination of low costs for medical services and experienced medical personnel. It gives them the potential to become a target of choice for medical tourists. Therefore, the aim of the paper is verification of Central and Eastern Europe as a medical tourism destination (MTD). Research were conducted in the light of primary and secondary research. Survey data were collected from 282 German and British tourists, using a self-administered questionnaire. The results indicated that the medical associations are most frequently chosen associations with Poland. The MTD associations are able to develop marketing strategies for medical tourism entities and destination management organisations.

Limited effects of the comprehensive pricing healthcare reform in China

ObjectivesTo evaluate the effects of China's very recent comprehensive pricing healthcare reform, taking the patients' perspective. Study designTwo survey studies were conducted using the same protocol in Beijing in July 2017 and 2018, respectively. MethodsThe same questionnaire was used and contains two sections, with the first on demographic and personal information and the second on various assessments of the reform. ResultsFindings different from those in the government-led evaluations were made. Specifically, the majority of the patients thought the level of medical service fee and cost of medicine still high, and experienced no change or an increase in overall medical cost. The overall assessment of the reform was not sufficiently positive. Multiple problems in healthcare were identified. Development from 2017 to 2018 was not significantly positive. ConclusionsPatients' assessments of the reform were not as positive as those made in the government-led evaluations. In extending the reform to the whole country, the government and healthcare providers may need to further tune the reform to better serve the public.

Los Angeles Homelessness and the Access to Water, Sanitation, and Hygiene

Abstract. Homelessness is a problem increasingly visible in many urban and rural communities that have rendered these marginalized people invisible. In Los Angeles County, approximately 53,000 people experience homelessness in a single-night, 4,294 of which reside in downtown’s “Skid Row” (LASHA, 2018). In the past months, cases of hepatitis A and murine typhus outbreaks have been reported in Skid Row. These infectious diseases are associated with poor living environments and inadequate access to basic water, sanitation, and hygiene services (WaSH). Therefore, this study addresses homelessness using water insecurity as a lens to look beyond the provisioning of housing (a long-term goal). More specifically, it examines the consequences of water insecurity in the health and lives of people experiencing homelessness using 134 in-depth interviews and surveys collected in July–August 2018. The data we collected were abstracted and analysed in R studio to test for associations between differences in poor access to WaSH and demographic factors, and then visualized in ArcGIS Pro using Hot Spot analysis. The study findings highlight that 56% of all study participants reported difficulty accessing basic WaSH services. Of this total, 65% of women participants reported statistically significant differences in access to showers compared to men (p < 0.05). Additionally, racial differences were reported in the sample, with Hispanic/Latinx and mixed-racial groups having more difficulty in accessing laundry services, drinking water, and showers. Furthermore, temporal differences existed in access to WaSH services, with people resorting to use public spaces (sidewalks, alleyways, and buckets inside their tents) more often at night than morning-time, due to a lack of public facilities remaining open and available throughout the day. Since the data collection took place in the summer time, 43% of participants reported experiencing dehydration, but also diarrhoea (24.39%), and skin infections (20.33%), all which are attributed to their reduced access to WaSH services. Overall, the information gathered from this study provides a deeper understanding of the existing inequities in access to services. It also demonstrates that there is a need for better public policies to address homelessness with more equitable solutions including gender, race, age, and immigration status. In conclusion, increasing access to WaSH resources can be a form of an immediate intervention provided to the homeless in order to 1) restore their human dignity, 2) improve their living environments, which would then lead to 3) the reduction of future health outbreaks and cost of medical emergency services.

International medical tourism in the formation of the global segment of medical services

The article is devoted to the features of international medical tourism as a global segment of medical services. The most required by medical tourists types of treatment are considered.International medical tourism as a specific type of socially useful activity aimed at providing tourist services of medical and recreational nature in the form of temporary departure of an individual or group of persons abroad is explored. The methodology for calculating the medical tourism index is analyzed in detail. Based on the analysis of international experience, the most required by medical tourists types of treatment are identified.The main causes of the huge gap in the cost of medical services of the countries-leaders and states with newly-created markets are determined.

Health Care Resource Utilization and Costs Associated with Corticosteroid Use in Patients with Castration-Resistant Prostate Cancer: An Administrative Claims Analysis.

Corticosteroids are used in the management of castration-resistant prostate cancer (CRPC) to reduce tumor-related symptoms because of CRPC therapies. Since corticosteroids have been associated with a range of toxicities, their use may increase the economic burden sustained by patients with CRPC. However, the economic impact of using corticosteroids in patients with CRPC has not been well characterized. To assess the effect of previous corticosteroid use on health care resource utilization (HRU) and health care costs among men with CRPC. Using administrative claims data (2007-2016), adult chemotherapy-naive patients who initiated CRPC treatment following surgical or medical castration were identified. Based on the cumulative corticosteroid dose during the 12 months before CRPC treatment initiation, patients were grouped into 4 cohorts: no corticosteroid (0 gm), low corticosteroid (< 0.5 gm), medium corticosteroid (0.5-2.0 gm), and high corticosteroid (> 2.0 gm). All-cause HRU and costs (2017 U.S. dollars) were compared between cohorts during the 1-year study period following CRPC treatment initiation using the no corticosteroid cohort as reference. Multivariable regression models were used to adjust for baseline covariates, including age, region, index year, Charlson Comorbidity Index score, presence of bone metastases, baseline all-cause HRU, and corticosteroid-related clinical events during baseline. 9,425 patients were included (no corticosteroid = 6,765, low corticosteroid = 1,660, medium corticosteroid = 655, and high corticosteroid = 345). On average, patients in the no corticosteroid cohort were older and had a lower baseline HRU and comorbidity burden than patients in the other 3 cohorts. During the study period, patients with corticosteroid exposure (across all corticosteroid cohorts) had significantly more inpatient admissions (high corticosteroid vs. no corticosteroid adjusted incidence rate ratio [IRR] = 1.56; P < 0.001), emergency department visits (high corticosteroid vs. no corticosteroid adjusted IRR = 1.30; P = 0.001), and outpatient visits (high corticosteroid vs. no corticosteroid adjusted IRR = 1.11; P < 0.001). In addition, compared with the no corticosteroid cohort, patients with corticosteroid exposure had significantly higher monthly total costs (high corticosteroid vs. no corticosteroid adjusted difference = $2,600; P < 0.001), including medical service costs (high corticosteroid vs. no corticosteroid adjusted difference = $1,564; P < 0.001) and pharmacy costs (high corticosteroid vs. no corticosteroid adjusted difference = $825; P < 0.001). Cumulative corticosteroid exposure before CRPC treatment initiation was associated with significantly higher HRU and costs. This increase in economic burden was more prominent among patients with annual cumulative corticosteroid doses of more than 2.0 gm. These results suggest that previous corticosteroid use may result in a higher economic burden among patients with CRPC. This study was funded by Astellas Pharma (Northbrook, IL) and Medivation, a Pfizer Company (San Francisco, CA), the codevelopers of enzalutamide. The study sponsor was involved in the study design, data interpretation, and review. All authors contributed to the development of the manuscript and maintained control over the final content. Schultz and Wilson are employed by Astellas Pharma. Schultz owns stock in Gilead Sciences and Shire. Song and Yang are employed by Analysis Group, which received consultancy fees from Astellas Pharma. Ramaswamy is employed by Pfizer, and Lowentritt is employed by Chesapeake Urology and has served as a speaker and consultant for Astellas Pharma, Pfizer, Bayer, Dendreon, and Janssen. A synopsis of the current research was presented in poster format at the AMCP Managed Care & Specialty Pharmacy Annual Meeting 2019, which took place in San Diego, CA, on March 25-28, 2019.

Indonesia Hospital Cost Analysis: a Micro-Costing Approach

Efforts to develop the financing methods is needed to strengthen the Indonesia’s recently implemented universal health coverage system. Hospital cost data is urgently needed to calculate the unit cost of medical services that is important to evaluate the reimbursement rate setting. The most recent approach to calculate unit cost of medical services in hospital is micro-costing approach. This study aimed to perform a unit cost calculation using micro-costing approach in Indonesia’s district hospital in June-Dec 2016 from the provider perspective. The costing study followed the standard costing method and financial data were obtained through the hospital financial reports. Some financial data were directly measured since this study used bottom-up approach. This study showed that the unit cost was not relevant with the reference price set up by the government. It could be caused by different cost items and cost objects that had been employed in the study since the government tariff’s did not have clear and detailed information about the source of cost calculation. Micro-costing approach was useful as a precise method to calculate unit cost, even though rigorous efforts were needed to complete the data.

Direct healthcare costs of spinal disorders in Brazil.

To estimate the direct healthcare costs of spinal disorders in Brazil over 2016. This is a prevalence-based cost-of-illness study with a top-down approach from the perspective of the public healthcare system. All international Classification of Diseases codes related to spinal disorders were included. The following costs were obtained: (1) hospitalization; medical professional service costs; intensive care unit costs; companion daily stay; (2) outpatient (services/procedures). Data were analyzed descriptively and costs presented in US$. The healthcare system spent US$ 71.4 million, and inpatient care represented 58%. The number of inpatient days was 250,426, and there were 36,654 hospital admissions (dorsalgia and disk disorders representing 70% of the costs). More than 114,000 magnetic resonance scans and 107,000 computerized tomography scans were adopted. Men had more inpatient days (138,215) than women (112,211). Overall, the inpatient/outpatient cost ratio was twice as high for men. We demonstrated that the direct costs of spinal disorders in Brazil in 2016 were considerable. We also found a substantial amount of financial resources spent on diagnostic imaging. This is relevant as the routine use of diagnostic imaging for back pain is discouraged in international guidelines.