Cost Of Nursing Care Research Articles

THE EFFECT OF GERMANY’S LONG-TERM CARE STRENGTHENING ACT II ON NURSING HOME USE

Abstract In Germany, out-of-pocket costs for nursing home care have substantially increased during the last years. There is an ongoing discussion whether these out-of-pocket costs should be capped. However, a decrease in costs may increase nursing home use and the social costs of nursing home care. This study analyzes how a change in out-of-pocket costs for nursing home care affects nursing home use. We use discontinuities in out-of-pocket costs that arose from Germany’s Long-Term Care Strengthening Act II in 2017. The Long-Term Care Strengthening Act II decreased average nursing home care costs for people with higher care needs and increased average costs for people with lower care needs. Long-term care insurance data are analyzed using a regression discontinuity design. There is no significant change in nursing home use among people who enter long-term care with relatively high care needs. However, there is a significant decrease in nursing home use among those who enter long-term care with relatively low care needs. The results are robust regarding different specifications of the model. We conclude that the elasticity of nursing home use depends on the level of care needs. For people with high care needs, nursing home care is often without alternatives, whereas people with lower care needs may substitute nursing home care with informal care. A generous public policy does not necessarily increase demand for nursing home care.

Cost of in-patient management of COVID-19 patients in a general hospital in Kuwait

BackgroundAmong the GCC countries affected by COVID-19 infections, Kuwait has been significantly impacted, with 658,520 cases and 2,563 deaths reported by the WHO on September 30, 2022. However, the impact of the COVID-19 epidemic on Kuwait’s economy, especially in the healthcare sector, remains unknown. Objective: This study aims to determine the total cost of managing COVID-19 in-patients in Kuwait.MethodA cross-sectional design was employed for this study. A total of 485 COVID-19 patients admitted to a general hospital responsible for COVID-19 cases management were randomly selected for this study from May 1st to September 31st, 2021. Data on sociodemographic information, length of stay (LOS), discharge status, and comorbidities were obtained from the patients’ medical records. The data on costs in this study cover administration, utility, pharmacy, radiology, laboratory, nursing, and ICU costs. The unit cost per admission was calculated using a step-down costing method with three levels of cost centers. The unit cost was then multiplied by the individual patient’s length of stay to determine the cost of care per patient per admission.FindingsThe mean cost of COVID-19 in-patient care per admission was KD 2,216 (SD = 2,018), which is equivalent to USD 7,344 (SD = 6,688), with an average length of stay of 9.4 (SD = 8.5) days per admission. The total treatment costs for COVID-19 in-patients (n = 485) were estimated to be KD 1,074,644 (USD 3,561,585), with physician and nursing care costs constituting the largest share at 42.1%, amounting to KD 452,154 (USD 1,498,529). The second and third-largest costs were intensive care (20.6%) at KD 221,439 (USD 733,893) and laboratory costs (10.2%) at KD 109,264 (USD 362,123). The average cost for severe COVID-19 patients was KD 4,626 (USD 15,332), which is almost three times higher than non-severe patients of KD 1,544 (USD 5,117).ConclusionManaging COVID-19 cases comes with substantial costs. This cost information can assist hospital managers and policymakers in designing more efficient interventions, especially for managing high-risk groups.

S-24-1: OLD HABITS DIE HARD. REDUCED-SODIUM SCHOOL LUNCHES IN ELEMENTARY SCHOOLS WILL CREATE A NEW LOW-SODIUM EATING HABIT IN JAPAN

To prevent future cerebrovascular disorders, the most important lifestyle improvement measure for Japanese people, who have a high prevalence of hypertension and especially high salt intake, is to reduce salt intake by less than 6 g/day, but progress is slow. If this trend continues, medical and nursing care costs are expected to increase further in the future. However, it is frustrating to verbally instruct patients who have already developed the habit of eating a high-salt diet on how to reduce salt intake, and younger people, who are less health-conscious, are less interested in salt reduction. Therefore, it is desirable to create a society in which people can reduce salt intake naturally living a normal life. As a first step toward this goal, we need to promote a low-sodium dietary education for children and low-sodium school lunches at elementary schools. This is because high-salt eating habits do not begin in adulthood, but rather are the accumulation of eating habits from childhood, and we think that acquiring the basics of healthy eating habits as a child will be a major prevention of lifestyle-related diseases, including hypertension, throughout life. In 2012, a group led by the Japanese Society of Hypertension held the “Salt Reduction Summit in Kure 2012’’, combining research with a salt reduction experience event for the public. One of the goals of the summit was to educate on the importance of salt reduction to children through a program involving children, teachers, government officials, and chefs. This led to the start of reduced-sodium school lunches in elementary schools in Kure City. Initially, the amount of salt per school lunch was 3.1 g, but this was reduced to 2.0 g by 2021. The salt content was gradually reduced every year, so the goal was achieved without any discomfort and there were no leftover meals. With the introduction of low salt school lunches and providing education on salt reduction by school nutrition teachers, children and their parents’ generation are becoming more interested in salt reduction. The Japanese Society of Hypertension also holds various events for children. If reduced-sodium school lunch programs spread not only through Japan but also around the world, by the time children become adults, the public's preference will be for low-sodium foods, and food companies will appreciate benefits of selling low-sodium products and thereby creating a low-sodium society. As a result, we hope that healthy life expectancy will increase.

COSTS OF DEMENTIA CARE AND EARLY-STAGE PREVENTIVE NURSING: A COMPARATIVE BIG DATA STUDY IN OSAKA

Abstract Data show a substantial increase in the costs of dementia care nationally and globally. We assessed the factors increasing financial pressure, and found an association between the costs and the severity of dementia. We suggest that early diagnosis and preventive nursing care can reduce the deterioration associated with dementia, and therefore the overall costs of dementia care. The purpose of this study was to determine the relationship between the costs of dementia care and early-stage preventive nursing care in a sample of people with dementia aged 65 to 85 years, using the Medical Care Insurance and Osaka Prefecture Long-Term Care Insurance Database (N = 17973). We found that early care might have a significant effect on formal care costs in the early period of dementia but did not influence the medical care costs of dementia. During the first 5 years, the long-term care costs of people with dementia with an initial care level of Support 1/2 (one type of care level of Japanese long-term care insurance system, and the participants receive preventive services) were $4,389, while people with an initial care level of Care 1/2 (the other type of care level, and the participants receive nursing services) were $12,333. About 20% of people who received preventive care recovered, suggesting that preventive nursing care can restore the ability of people with early-stage dementia. This might be the reason for the reduction in long-term care costs. This research provides a basis for supporting preventive nursing care and extending healthy lifespans.

Paying for the view? How nursing home prices affect certified staffing ratios.

Many countries limit public and private reimbursement for nursing care costs for social or financial reasons. Still, quality varies across nursing homes. We explore the causal link between case-mix adjusted nurse staffing ratios as an indicator of care quality and different price components in Swiss nursing homes. The Swiss reimbursement system limits and subsidizes the care price at the cantonal level, which implicitly limits staffing ratios, while the residents cover the nursing home-specific lodging price privately. To estimate causal effects, we exploit (i) the exogeneity of the Swiss care price regulation, (ii) nursing-home fixed effects estimations and (iii) instrumental variables for the lodging price. Our estimates show a positive impact of prices on certified staffing ratios. We find that a 10% increase in care prices increases certified staffing ratios by 3-4%. A comparable 10% increase in lodging prices raises certified staffing ratios by 1.5-10% (depending on the model). Our findings highlight that price limits for nursing care impose a limit on staffing ratios. Furthermore, our results indicate that providers circumvent price limits by increasing lodging prices that are privately covered. Thus, this cost shifting implicitly shifts the financial burden to the residents.

The Challenge of Severe Obesity in Nursing Homes from the Perspective of Administrators

This study provides input from nursing home administrators on their challenges (financial, quality, staffing) in caring for severely obese residents. In addition, we report on how changes due to the COVID-19 pandemic have affected care for people with obesity in nursing homes (NHs). Caring for those with severe obesity is a major challenge in NHs and creates several dilemmas related to appropriate nursing care, equipment choice, and potential excess resident care costs. Little is known about how facilities respond to these dilemmas while maintaining the quality of care.

Direct and indirect costs and cost-driving factors in adults with tuberous sclerosis complex: a multicenter cohort study and a review of the literature

BackgroundTuberous sclerosis complex (TSC) is a monogenetic, multisystem disorder characterized by benign growths due to TSC1 or TSC2 mutations. This German multicenter study estimated the costs and related cost drivers associated with organ manifestations in adults with TSC.MethodsA validated, three-month, retrospective questionnaire assessed the sociodemographic and clinical characteristics, organ manifestations, direct, indirect, out-of-pocket (OOP), and nursing care-level costs among adult individuals with TSC throughout Germany from a societal perspective (costing year: 2019).ResultsWe enrolled 192 adults with TSC (mean age: 33.4 ± 12.7 years; range: 18–78 years, 51.6% [n = 99] women). Reported TSC disease manifestations included skin (94.8%) and kidney and urinary tract (74%) disorders, epilepsy (72.9%), structural brain defects (67.2%), psychiatric disorders (50.5%), heart and circulatory system disorders (50.5%), and lymphangioleiomyomatosis (11.5%). TSC1 and TSC2 mutations were reported in 16.7% and 25% of respondents, respectively. Mean direct health care costs totaled EUR 6452 (median EUR 1920; 95% confidence interval [CI] EUR 5533–7422) per patient over three months. Medication costs represented the major direct cost category (77% of total direct costs; mean EUR 4953), and mechanistic target of rapamycin (mTOR) inhibitors represented the largest share (68%, EUR 4358). Mean antiseizure drug (ASD) costs were only EUR 415 (6%). Inpatient costs (8%, EUR 518) and outpatient treatment costs (7%; EUR 467) were important further direct cost components. The mean care grade allowance as an approximator of informal nursing care costs was EUR 929 (median EUR 0; 95% CI EUR 780–1083) over three months. Mean indirect costs totaled EUR 3174 (median EUR 0; 95% CI EUR 2503–3840) among working-age individuals (< 67 years in Germany). Multiple regression analyses revealed mTOR inhibitor use and persistent seizures as independent cost-driving factors for total direct costs. Older age and disability were independent cost-driving factors for total indirect costs, whereas epilepsy, psychiatric disease, and disability were independent cost-driving factors for nursing care costs.ConclusionsThis three-month study revealed substantial direct healthcare, indirect healthcare, and medication costs associated with TSC in Germany. This study highlights the spectrum of organ manifestations and their associated treatment needs in the German healthcare setting. Trial registration: DRKS, DRKS00016045. Registered 01 March 2019, http://www.drks.de/DRKS00016045.

An Analysis of Inconsistent Methodology to Compute Permanent Future Nursing Care Costs in Personal Injury Claim

Restitutio in integrum has been the underlying basis of assessment for damages under the corrective compensation scheme of the law of tort. This doctrine commands restoration of the claimant to the pre-existing condition prior to the commission of the tort. While this basis of assessment has no apparent problem in respect of pecuniary part of the claimable damages in a personal injury claim, however, from another side of the spectrum, there is an inconsistent methodology as to how to precisely calculate the ‘price’ of pain or even future loss. As a result, judicial activism plays its part in promoting its creativity of solution to the problem, leading to inconsistent methodology on this spectrum of damages that bears diverse output. The objective of this paper is to highlight the flaws of the inconsistent methodology for the assessment of permanent future nursing care. The method used for this research is by tracing the relevant authorities that use the various methods of computing the multiplier and analysing the outcome of each method. The findings revealed anomalies of output as each method produces different output without any qualification on why a particular method is chosen. This flaw in the computation of the multiplier for future losses other than related to loss of earnings should not remain viable as there is no consistency of the output based on similar factual circumstances. One of the solutions for this debacle is to forgo lump sum payment altogether and move towards structured settlement payment.

Analyzing Cost-Effectiveness of Allocating Neurointerventionist for Drive and Retrieve System for Patients with Acute Ischemic Stroke

ObjectivesThere are regional disparities in implementation rates of endovascular thrombectomy due to time and resource constraints such as endovascular thrombectomy specialists. In Hokkaido, Japan, Drive and Retrieve System (DRS), where endovascular thrombectomy specialists perform early endovascular thrombectomies by traveling from the facilities where they normally work to facilities closer to the patient. This study analyzed the cost-effectiveness of allocating a endovascular thrombectomy specialist for DRS to treat stroke patients. Materials and methodshe number of ischemic stroke patients expected to receive endovascular thrombectomy in Hokkaido in 2015 was estimated. It was assumed that an additional neutointerventionist was allocated for DRS. The analysis was performed from the government's perspective, which includes medical and nursing-care costs, and the personnel cost for endovascular thrombectomy specialist. The analysis was conducted comparing the current scenario, where patients received endovascular thrombectomy in facilities where endovascular thrombectomy specialists normally work, with the scenario with DRS within 60 min drive distance. Patient transport time was analyzed using geographic information system, and patient severity was estimated from the transport time. The primary outcome was incremental cost-effectiveness ratio (ICER) in each medical area which was calculated from the incremental costs and the incremental quality-adjusted life years (QALYs), estimated from patient severity using published literature. The entire process was repeated 100 times. ResultsDRS was most cost-effective in Kamikawachubu area, where the ICER was $14,173±16,802/QALY, significantly lower than the threshold that the Japanese guideline suggested. ConclusionsSince DRS was cost-effective in Kamikawachubu area, the area should be prioritized when a endovascular thrombectomy specialist for DRS is allocated as a policy.

Heparin-free distal radial artery approach to cardiac catheterisation and the small radial recurrent artery.

Radial artery access has transformed cardiac catheterisation, allowing it to be performed in a daycase setting, saving both hospital beds, and nursing care costs. However, there are two common and seemingly diametrically opposite complications. These are radial artery occlusion and forearm haematoma; the former could be reduced by heparin, but at the expense of precipitating the latter. These complications increase proportionally to the size of radial artery sheath used. Interestingly, by cannulating the radial artery more distally beyond its bifurcation in the hand, the distal radial approach appears to be the 'one stone, two birds' or the synchronous Chinese idiom, 'yīshí'èrniăo's' solution, reducing both complications at the same time. Extending this further and downsizing to a 4Fr catheter system, heparin use could be spared altogether, without complications, and haemostasis achieved with short manual pressure at the puncture site. Hence, further cost savings by foregoing commercial compression bands, and abolishing access site care for nurses. We illustrate the above strategy in a patient with challenging radial anatomy, made simple and easy.

Economic Burden Bore by Patients and Families because of stroke: Policy Assessment

AbstractStroke to this day is still a disease that causes a high disability. In the future, it will require a prohibitive cost so that it has an impact on the socio-economic consequences for patients and their families. The price is prohibitive so that the impact on socioeconomic implications for patients and their families. Because of that, the purpose of the study is to estimate the cause of the cost that causes an economic burden from a stroke. The method that is used is a content analysis by doing a further literature review from various sources, from journal to textbook from a national level to international. Literature studies show that direct medical cost, which is rehabilitation, and nursing care cost is identified as the leading contributor to the high price of economic burden from a stroke. High costs incurred cause family to experience catastrophic financial disaster; it even impacts to drop welfare level. Social preventive action is needed to reduce the high prevalence of stroke to reduce the cost, to protect every household from financial disaster from a stroke.

Sepsis Among Medicare Beneficiaries: 1. The Burdens of Sepsis, 2012–2018*

To provide contemporary estimates of the burdens (costs and mortality) associated with acute inpatient Medicare beneficiary admissions for sepsis. Analysis of paid Medicare claims via the Centers for Medicare & Medicaid Services DataLink Project. All U.S. acute care hospitals, excluding federally operated hospitals (Veterans Administration and Defense Health Agency). All Medicare beneficiaries, 2012-2018, with an inpatient admission including one or more explicit sepsis codes. None. Total inpatient hospital and skilled nursing facility admission counts, costs, and mortality over time. From calendar year (CY)2012-CY2018, the total number of Medicare Part A/B (fee-for-service) beneficiaries with an inpatient hospital admission associated with an explicit sepsis code rose from 811,644 to 1,136,889. The total cost of inpatient hospital admission including an explicit sepsis code for those beneficiaries in those calendar years rose from $17,792,657,303 to $22,439,794,212. The total cost of skilled nursing facility care in the 90 days subsequent to an inpatient hospital discharge that included an explicit sepsis code for Medicare Part A/B rose from $3,931,616,160 to $5,623,862,486 over that same interval. Precise costs are not available for Medicare Part C (Medicare Advantage) patients. Using available federal data sources, we estimated the aggregate cost of inpatient admissions and skilled nursing facility admissions for Medicare Advantage patients to have risen from $6.0 to $13.4 billion over the CY2012-CY2018 interval. Combining data for fee-for-service beneficiaries and estimates for Medicare Advantage beneficiaries, we estimate the total inpatient admission sepsis cost and any subsequent skilled nursing facility admission for all (fee-for-service and Medicare Advantage) Medicare patients to have risen from $27.7 to $41.5 billion. Contemporary 6-month mortality rates for Medicare fee-for-service beneficiaries with a sepsis inpatient admission remain high: for septic shock, approximately 60%; for severe sepsis, approximately 36%; for sepsis attributed to a specific organism, approximately 31%; and for unspecified sepsis, approximately 27%. Sepsis remains common, costly to treat, and presages significant mortality for Medicare beneficiaries.

Flexible and Affordable Methods of Paying for Long-Term Care Insurance

With the expected dramatic increase in the number of older people requiring care, and the tightening of public funding, individuals will be increasingly expected to contribute to, and plan for, their own care in later life. However, history shows us that people are very reluctant to save for their care to the extent that there are no longer any providers of traditional prefunded long-term care insurance products in the United Kingdom to help address this problem. In this article, we consider a a disability-linked annuity that provides benefit payments toward the cost of both domiciliary and residential nursing care. We investigate different ways in which individuals can purchase this product with the goal of minimizing the impact on their living standards, hence making the purchase of the product more palatable. In addition to the traditional methods of purchasing insurance out of income and savings, we show that this product can also be purchased by making use of assets such as residential property. This flexibility would allow individuals to have control over the timing of their payments to fit around their lifestyle, particularly for those with low retirement incomes. It follows that some people will be more attracted to particular payment methods than others, and a framework is presented that segments people according to individual circumstances. A model is developed showing how the annuity works and how premiums are calculated.

Cost Effectiveness of Drive and Retrieve System in Hokkaido for Acute Ischemic Stroke Patient Treatment Using Geographic Information System

Background and Purpose: Although endovascular thrombectomy combined with recombinant tissue-type plasminogen activator is effective for treatment of acute ischemic stroke, regional disparities in implementation rates of those treatments have been reported. Drive and retrieve system, where a qualified neurointerventionist travels to another primary stroke center for endovascular thrombectomy, has been practiced in parts of Hokkaido, Japan. This study aims to simulate the cost effectiveness of the drive and retrieve system, which can be a method to enhance equality and cost effectiveness of treatments for acute ischemic stroke. Materials and methods: The number of patients who had acute ischemic stroke in 2015 is estimated. Those patients are generated according to the population distribution, and thereafter patient transport time is analyzed in the 3 scenarios (1) 60-minute drive scenario, (2) 90-minute drive scenario, in which the drive and retrieve system operates within 60-minute or 90-minute driving distance (3) without the system, using geographic information system. Incremental cost-effectiveness rate, quality-adjusted life years, and medical and nursing care costs are estimated from the analyzed transport time. Findings: The incremental cost-effectiveness rate by implementing the system was dominant. Cost reductions of $213,190 in 60-minute drive scenario, and $247,274 in the 90-minute scenario were expected, respectively. Such benefits are the most significant in Soya, Emmon, Rumoi, and Kamikawahokubu medical areas. Conclusions: The drive and retrieve system could enhance regional equality and cost effectiveness of ischemic stroke treatments in Hokkaido, which can be achieved using existing resources. Further studies are required to clarify its cost effectiveness from hospital perspective.

Regulation and current status of patient safety content in pre-registration nurse education in 27 countries: Findings from the Rationing - Missed nursing care (RANCARE) COST Action project.

Patient safety, as a contemporary health care concern, must remain a priority for nurse educators. This on-line consultation, carried out within the RANCARE COST Action project, determined to establish how patient safety teaching is incorporated into pre-registration education of nurses across 27 countries. How nursing is regulated within countries was examined, along with national guidelines related to nurse education. HEIs were asked to provide details of pre-registration nurse training and how patient safety is taught within programmes. The results confirm that the topic of patient safety is generally not explicitly taught, rather it remains a hidden element within the curriculum, taught across many subjects. Variation in how nursing is regulated exists across the countries also, with the professionalization of nursing remaining a challenge in some states. No guidelines exist at EU level which address how patient safety should be taught to nursing students, and as yet regulatory bodies have not put forward criteria on the subject. As a result individual HEIs determine how patient safety should be taught. The WHO guidelines for teaching patient safety are currently underutilized in nurse education, but could offer a structure and standard which would address the deficits identified in this work.

Association Between Receipt of a Medically Tailored Meal Program and Health Care Use

ImportanceWhether interventions to improve food access can reduce health care use is unknown.ObjectiveTo determine whether participation in a medically tailored meal intervention is associated with fewer subsequent hospitalizations.Design, Setting, and ParticipantsA retrospective cohort study was conducted using near/far matching instrumental variable analysis. Data from the 2011-2015 Massachusetts All-Payer Claims database and Community Servings, a not-for-profit organization delivering medically tailored meals (MTMs), were linked. The study was conducted from December 15, 2016, to January 16, 2019. Recipients of MTMs who had at least 360 days of preintervention claims data were matched to nonrecipients on the basis of demographic, clinical, and neighborhood characteristics.InterventionsWeekly delivery of 10 ready-to-consume meals tailored to the specific medical needs of the individual under the supervision of a registered dietitian nutritionist.Main Outcomes and MeasuresInpatient admissions were the primary outcome. Secondary outcomes were admission to a skilled nursing facility and health care costs (from medical and pharmaceutical claims).ResultsThere were 807 eligible MTM recipients. After matching, there were 499 MTM recipients, matched to 521 nonrecipients for a total of 1020 study participants (mean [SD] age, 52.7 [14.5] years; 568 [55.7%] female). Prior to matching and compared with nonrecipients in the same area, health care use, health care cost, and comorbidity were all significantly higher in recipients. For example, preintervention mean (SD) inpatient admissions were 1.6 (6.5) in MTM recipients vs 0.2 (0.8) in nonrecipients (P < .001), and mean health care costs were $80 617 ($312 337) vs $16 138 ($68 738) (P < .001). Recipients compared with nonrecipients were also significantly more likely to have HIV (21.9% vs 0.7%, P < .001), cancer (37.9% vs 11.3%, P < .001), and diabetes (33.7% vs 7.0%, P < .001). In instrumental variable analyses, MTM receipt was associated with significantly fewer inpatient admissions (incidence rate ratio [IRR], 0.51; 95% CI, 0.22-0.80; risk difference, −519; 95% CI, −360 to −678 per 1000 person-years). Similarly, MTM receipt was associated with fewer skilled nursing facility admissions (IRR, 0.28; 95% CI, 0.01-0.60; risk difference, −913; 95% CI, −689 to −1457 per 1000 person-years). The models estimated that, had everyone in the matched cohort received treatment owing to the instrument (and including the cost of program participation), mean monthly costs would have been $3838 vs $4591 if no one had received treatment owing to the instrument (difference, −$753; 95% CI, −$1225 to −$280).Conclusions and RelevanceParticipation in a medically tailored meals program appears to be associated with fewer hospital and skilled nursing admissions and less overall medical spending.

Integrating traditional Chinese medicine healthcare into dementia care plan by reducing the need for special nursing care and medical expenses.

Reducing the need for advanced nursing care and medical expenses is an essential concern of dementia care. We investigated the impact of traditional Chinese medicine (TCM) on advanced nursing care and medical costs.We used Longitudinal Health Insurance Database to implement a cohort study of patients with dementia between 1997 and 2012 in Taiwan. Data from the onset of dementia to 1st advanced nursing care for the endotracheal tube, urinal indwelling catheterization, and nasogastric tube were assessed using Cox regression proportional hazards model, and independent t test was used to determine the difference of hospitalization costs and days. We also used ANOVA test to compare the hospital cost, hospital stay, and numbers according to different duration of TCM.We assessed 9438 new diagnosed patients with dementia without advanced nursing care were categorized into 2 groups: 4094 (43.4%) TCM users, and 5344 (56.6%) non-TCM users. In the TCM groups, 894 (21.8%) patients were declared as advanced nursing care, while 1683 (31.5%) patients were in non-TCM group. Cox proportional hazard regression indicated that using TCM may decrease the need for advanced nursing care (adjusted hazard ratio (aHR) = 0.61, 95% confidence interval [95% CI]: 0.56–0.66) compared to non-TCM. The TCM users have lower hospitalization costs and hospitalization time compared to non-TCM users.Integrating TCM healthcare into dementia care was found to be associated with a lower need for advanced nursing care, hospitalization costs, and admission time with more benefits from longer durations of TCM use.

The epidemiology and economic burden of hip fractures in Israel

BackgroundHip fractures increase the risks of mortality and major morbidity in the elderly. Hip fractures are associated with chronic pain, reduced mobility, disability and increasing dependence. We evaluated the direct costs incurred to the Israeli healthcare system in 2013 as a result of hip fracture injuries in elderly patients.MethodsHip fractures costs evaluation consisted of first-year and long-term direct costs. Data on the incidence of hip fractures resulting in hospitalizations were retrieved from the Israeli Ministry of Health’s (MOH) Central Database of Hospital Admissions. Hospitalization, rehabilitation and nursing utilization rates and costs were estimated based on the professional literature and according to the MOH’s price list.ResultsDuring 2013, 6285 elderly patients were hospitalized in Israel due to hip fractures. Direct costs of hip fracture, comprising hospitalization, rehabilitation and nursing costs incurred during the first year after the injury, were estimated at 454 million New Israeli Shekels (NIS; 83,841 NIS per person). Long-term nursing care costs in 2013 were 265 million NIS, with an average cost of approximately 49,000 NIS for 1600 elderly persons receiving long-term nursing care as a result of a hip fracture. Overall, the total direct costs of hip fracture in the elderly population in Israel in 2013 were 719 million NIS.ConclusionsThe direct costs of hip fractures in Israel among the elderly are approximately 719 million NIS per year. The majority of costs are associated with the first year following the injury. To reduce healthcare costs in Israel, changes in the country’s healthcare policy on hip fractures are required. For example, there is a need for a program for detecting high- risk populations, and for early intervention following the injury.

Costs of informal nursing care for patients with neurologic disorders: A systematic review.

To systematically review the economic burden of informal nursing care (INC), often called informal care, caused by multiple sclerosis (MS), Parkinson disease (PD), and epilepsy, with special attention to disease severity. We systematically searched MEDLINE, PsycINFO, and NHS Economic Evaluation Database for articles on the cost of illness of the diseases specified. Title, abstract, and full-text review were conducted in duplicate by 2 researchers. The distribution of hours and costs of INC were extracted and used to compare the relevance of INC across included diseases and disease severity. Seventy-one studies were included (44 on MS, 17 on PD, and 10 on epilepsy). Studies on epilepsy reported an average of 2.3-54.5 monthly hours of INC per patient. For PD, average values of 42.9-145.9 hours and for MS average values of 9.2-249 hours per patient per month were found. In line with utilized hours, costs of INC were lowest for epilepsy (interquartile range [IQR] 229-1,466 purchasing power parity US dollars [PPP-USD]) and similar for MS (IQR 4,454-11,222 PPP-USD) and PD (IQR 1,440-7,117 PPP-USD). In addition, costs of INC increased with disease severity and accounted for 38% of total health care costs in severe MS stages on average. The course of diseases and disease severity matter for the amount of INC used by patients. For each of the neurologic disorders, an increase in the costs of INC, due to increasing disease severity, considerably contributes to the rise in total health care costs.

Direct Medical Costs of Type 2 Diabetes in France: An Insurance Claims Database Analysis.

ObjectivesOur objects was to estimate the direct healthcare costs of type 2 diabetes mellitus (T2DM) in France in 2013.MethodsData were drawn from a random sample of ≈600,000 patients registered in the French national health insurances database, which covers 90% of the French population. An algorithm was used to select patients with T2DM. Direct healthcare costs from a collective perspective were derived from the database and compared with those from a control group to estimate the cost of diabetes and related comorbidities. Overall direct costs were also compared according to the diabetes therapies used throughout the year 2013.ResultsCost analysis was available for a sample of 25,987 patients with T2DM (mean age 67.5 ± standard deviation 12.5; 53.9% male) matched with a control group of 76,406 individuals without diabetes. Overall per patient per year medical expenditures were €6506 ± 10,106 in the T2DM group as compared with €3668 ± 6954 in the control group. The cost difference between the two groups was €2838 per patient per year, mainly due to hospitalizations, medication and nursing care costs. Total per capita annual costs were lowest for patients receiving metformin monotherapy (€4153 ± 6170) and highest for those receiving insulin (€12,890). However, apart from patients receiving insulin, costs did not differ markedly across the different oral treatment patterns.ConclusionExtrapolating these results to the whole T2DM population in France, total direct costs of diagnosed T2DM in 2013 was estimated at over €8.5 billion. This estimate highlights the substantial economic burden of this condition on society.Electronic supplementary materialThe online version of this article (doi:10.1007/s41669-017-0050-3) contains supplementary material, which is available to authorized users.