Outpatient Treatment Costs Research Articles

Costs of non-multidrug-resistant pulmonary tuberculosis and of preventive treatment in Germany – An update

BackgroundOnly 4076 new cases of tuberculosis (TB) were reported in Germany in 2022; of those 184 were multidrug-resistant TB (MDR-/RR-TB). MethodsBased on the current therapy guidelines of the German Central Committee against Tuberculosis and most recent renumeration data of the Statutory Health Insurances (SHI), this study estimates the mean in- and outpatient costs per adult infectious pulmonary non-MDR-TB patient, together with costs arising from Rifampicin (RIF)-based short-course options of tuberculosis preventive treatment (TPT) of their close contacts. ResultsFrom the insurance perspective, the mean inpatient cost (rounded) per adult case was 6138 EUR (SD±2810 EUR) for standard therapy; the cost of primary outpatient treatment only amounted to 1930 EUR and the cost of outpatient treatment post-hospital to 1093 EUR. The mean weighted cost was 6377 EUR (SD±2357 EUR), a drop of 27 % vs. 2019. This is mainly due to a decrease in hospitalizations of 5.6 %, and, given hospital treatment, by a 95 EUR decrease in the per-day reimbursement rate for TB patients who are hospitalized for at least 14 days. In contrast, the mean costs of TPT per person were 466 EUR (RIF solely over 4 months) and 423 EUR (RIF combined with Isoniazid over 3 months). ConclusionWhile costs for active non-MDR-TB treatment in Germany have clearly decreased thanks to increased engagement on the part of the private practice sector and lower reimbursement rates in hospital, the comparatively high costs of short-course TPT have surprisingly significant economic impact. This negative development can be countered through diligent selection of close contacts persons of infectious TB cases before using IGRA testing to detect latent TB, to minimize the number of those persons who are tested falsely determined to be at risk and needlessly undergo TPT.

Cost-benefit evaluation of advanced therapy lines in metastatic triple-negative breast cancer in Germany

BackgroundTriple-negative breast cancer (TNBC) is responsible for 10–20% cases of breast cancer and is resulting in rising healthcare costs. Thus, health-economic evaluations are needed to relate clinical outcomes and costs of treatment options and to provide recommendations of action from a health-economic perspective.MethodsWe investigated the cost-benefit-ratio of approved treatment options in metastatic TNBC in Germany by applying the efficiency frontier approach. These included sacituzumab-govitecan (SG), eribulin, vinorelbine, and capecitabine. Clinical benefit was measured as (i) median overall survival (mOS) and (ii) health-related quality of life (HRQoL) in terms of time to symptom worsening (TSW). To assess medical benefits, literature was systematically reviewed in PubMed for (i) and (ii), respectively. Treatment costs were calculated considering annual direct outpatient treatment costs from a statutory healthcare payer perspective. It was intended that both, (i) and (ii), yield an efficiency frontier.ResultsAnnual direct outpatient treatment costs amounted to EUR 176,415.21 (SG), EUR 47,414.14 (eribulin), EUR 13,711.35 (vinorelbine), and EUR 3,718.84 (capecitabine). Systematic literature review of (i) and statistical analysis resulted in OS values of 14.3, 9.56, 9.44, and 7.46 months, respectively. Capecitabine, vinorelbine, and SG are part of the efficiency frontier including OS. The highest additional benefit per additional cost was determined for vinorelbine, followed by SG. Systematic review of (ii) revealed that no TSW data of TNBC patients receiving vinorelbine were available, preventing the presentation of an efficiency frontier including HRQoL.ConclusionsVinorelbine is most cost-effective, followed by SG. Health-economic evaluations support decision-makers to assess treatment options within one indication area. In Germany, the efficiency frontier can provide decision support for the pricing of innovative interventions. Results of our analysis may thus guide reimbursement determination.

Direct treatment cost of patients with psoriatic arthritis disease covered by the social health insurance at the National Hospital of Dermatology and Venereology from 2021 to 2022

Objective: Estimate the direct medical costs of treating psoriatic arthritis (PsA), including in-patient and out-patient treatment costs. Methods: The retrospective study follows a prevalence-based approach, collecting all patients with PsA undergoing treatment at the National Hospital of Dermatology and Venereology from July 1, 2021 to December 31, 2022. Data collected included demographic characteristics and costs covered by the social health insurance (SHI). Results: Among the 74 patients included in the study, 64 patients received outpatient treatment, eight patients received both outpatient and inpatient treatment, and two patients received inpatient treatment only. The average monthly cost of outpatient treatment was 1.7 ± 2.2 million VND, with an average of 0.7 ± 0.3 outpatient visits per month. The average cost for an inpatient treatment session was 6.8 ± 6.2 million VND, with an average duration of 16.2 ± 20.9 days. Conclusions: We have analyzed the economic burden of PsA from SHI perspective and shown medication costs accounted for the highest proportion of expenses in all cost categories. Keywords: Direct medical costs, Health insurance, Psoriatic arthritis

OUT-OF-POCKET EXPENDITURE ON OUT-PATIENT CARE IN EAG STATES: AN ANALYSIS BASED ON NSSO 75TH ROUND DATA

Regardless of their socio-economic status, everyone has the human right to receive healthcare. Since the Indian government spends so little on health care, healthcare spending has been a major source of concern. However, most of the literature in India on determinants of health spending has focused on hospitalization, and there are relatively fewer separate studies on health-seeking behaviour and expenditure in outpatient departments. The purpose of this study was to determine the patterns of health-care-seeking behaviour and the pattern of expenditure incurred by households during outpatient care in Empowered Action Group (EAG) States. The present study used secondary data from the latest 75th round of National Sample Survey (NSS) conducted from July 2017 to July 2018 on the key indicators of social consumption in India: Health. The finding suggest that the seeking behaviour of ailing persons as outpatients, across EAG states only limited population access to public sources of healthcare (36.8% in rural and 27.3% in urban). Rajasthan (46.7%), Madhya Pradesh (41.5%), Bihar (32.9% rural), and Uttar Pradesh (31.3%) have the highest percentage of outpatient who expressed dissatisfaction with the standard of public health services in rural areas. Among EAG states of urban areas, Uttar Pradesh (42.6%) have the highest percentage of not satisfied with the quality of care by government sources. Among EAG states, Significant inter-state variation was observed, with Rajasthan (Rs. 886) reporting the highest expenditure for outpatient treatment and Chhattisgarh (Rs. 350) reporting the lowest in rural areas. However, Uttar Pradesh (Rs. 1194) reported the highest and Odisha (Rs. 508) reported the lowest expenditure incurred on outpatient care by ailing persons in urban areas. The amount that each state spends on healthcare varies greatly, which causes inter-state differences in the cost of outpatient treatment in EAG states. As a result, the government needs to control the cost of medications and diagnostic tests and ensure that plans for outpatient care include coverage. KEYWORDS: Outpatient care, out-of-pockect expenditure, EAG states,

HSD6 The CONNACT Program for Knee Osteoarthritis Can Potentially Lower 2-Year Costs of Outpatient Treatment

HSD6 The CONNACT Program for Knee Osteoarthritis Can Potentially Lower 2-Year Costs of Outpatient Treatment

Economic costs for outpatient treatment of eating disorders in Japan

BackgroundFew studies have examined the economic costs of outpatient care for eating disorders in Japan. This study aimed to clarify the reimbursement for outpatient treatment of eating disorders and compare the costs between the departments of Psychosomatic Medicine and Psychiatry in Japan.MethodA multicenter, prospective, observational study of patients with an eating disorder was conducted in the Psychosomatic Medicine departments of three centers and the Psychiatry departments of another three centers in Japan. We analyzed medical reimbursement for an outpatient revisit, time of clinical interviews, and the treatment outcome measured by the Eating Disorder Examination Questionnaire (EDE-Q) global scores and body mass index (BMI) at 3 months. Multivariate linear regression models were performed to adjust for covariates.ResultsThis study included 188 patients in the Psychosomatic Medicine departments and 68 in the Psychiatry departments. The average reimbursement cost for an outpatient revisit was 4670 yen. Even after controlling for covariates, the Psychosomatic Medicine departments had lower reimbursement points per minute of interviews than the Psychiatry departments (coefficient = − 23.86; 95% confidence interval = − 32.09 to − 15.63; P < 0.001). In contrast, EDE-Q global scores and BMI at 3 months were not significantly different between these departments.ConclusionsThis study clarifies the economic costs of treating outpatients with eating disorders in Japan. The medical reimbursement points per interview minute were lower in Psychosomatic Medicine departments than in Psychiatry departments, while there were no apparent differences in the treatment outcomes. Addressing this issue is necessary to provide an adequate healthcare system for patients with eating disorders in Japan.

Costs of Healthcare for Children with Inflammatory Bowel Diseases (IBD) in Poland.

The last two decades have seen an increase in the incidence of inflammatory bowel disease (IBD) in many regions of the world, which has had a significant impact on both the social and economic burden of governments and healthcare systems. The aim of this study was to determine the level of hospitalization and outpatient treatment costs for children and adolescents with Crohn's disease and ulcerative colitis, depending on age, location, and activity of the disease. Methods were a retrospective analysis of the medical documentation of 240 children with IBD, hospitalized in the Gastroenterology Ward, Department of Pediatrics Medical University of Silesia (Katowice, Poland), along the three years follow up. The costs of treatment consisted of calculations of the supply of oral and intravenous drugs, calculations of the costs of laboratory tests, imaging, and consultations, as well as person-day costs. The most important results, determined with high costs of IBD treatment, are associated with younger age, high disease activity, localization in the small intestine in Crohn's disease (CD), and inflammatory changes in the entire colon in Ulcerative Colitis (UC). During the observation, it was noticed that the shortening of the hospitalization time did not significantly affect the total costs, which remained at a stable level.

Costs of psychotropics for outpatients with bipolar disorder in Japan; the MUSUBI 2016 survey

Background Although the costs of bipolar disorder (BD) treatments are associated with local and universal factors, data from non-Western countries remain limited. The associations between clinical features and costs of outpatient pharmacotherapy have not been well characterize. To estimate the costs of outpatient BD treatments and their associations with clinical features in a Japanese population, we investigated with special reference to the costs of medicines constituted the bulk of the total healthcare expense and were steadily increasing. Methods The Multicenter Treatment Survey for Bipolar Disorder (MUSUBI) retrospectively evaluated 3130 patients with BD who visited 176 Japanese psychiatric outpatient clinics in 2016. Clinical features and drug prescriptions were recorded, and the total daily costs of psychotropic drug treatment were calculated. The annual medical costs related to outpatient BD treatments in Japan were estimated based on the corresponding demographics. The associations between daily medical costs and patients’ clinical features were analyzed using multiple regression analysis. Results The daily costs of psychotropic drugs ranged from zero to JPY3245 (mean, JPY349 equivalent to USD32.5) and were exponentially distributed. The annual costs for outpatients BD treatments were approximately 51.9 billion Japanese yens (519 million US dollars). Subsequent multiple regression analysis revealed that social adjustment, depressive symptoms, age, rapid cycling, psychotic symptoms, and comorbid mental disorders correlated strongly with the daily cost of psychotropic drugs. Conclusion The estimated annual costs for outpatient BD treatment in Japan were equivalent to those in OECD countries (except for the US) and higher than those in some Asian countries. The cost of psychotropic treatments was associated with individual characteristics and psychopathological conditions. Key Messages Psychotropic treatment for an outpatient with bipolar disorder has a daily cost approximately JPY350. The annual outpatient treatment cost for bipolar disorder in Japan was estimated to 51.9 billion Japanese yen in 2016. Individual characteristics and psychopathological conditions affected the cost of drug treatment.

Epidemiology and socioeconomic consequences of work-related pelvic and acetabular fractures recorded in the German Social Accident Insurance

IntroductionPelvic and acetabular fractures can result from work-related accidents and frequently require lengthy medical treatments. Consequently, high medical costs as well as delayed or absent return to work can be the consequence. Therefore, we aimed to study the socioeconomic consequences of work-related pelvic and acetabular fractures. Materials and methodsThis retrospective study investigated work-related pelvic and acetabular fractures recorded in the German Social Accident Insurance in 2011 and 2017, in terms of age, sex, type of accident, duration of incapacity to work, reductions in earning capacity, costs for outpatient and inpatient treatment and costs for pension and severance pay. ResultsAmong a total of 606 injuries in 2011 and 619 injuries in 2017, male patients and patients between 40 and 65 years were predominantly affected. Acetabular fractures caused higher rates of long absence from work of 6–12 months (2011: 24.7% vs. 9.5–16.9%; 2017: 26.1% vs. 6.1–11.0%) and >12 months (2011: 15.8% vs. 9.8–10.2%; 2017: 13.3% vs. 1.9–8.2%) as well as more cases with a reduction in earning capacity of at least 20% (2011: 61 vs. ≤27 cases; 2017: 39 vs. ≤12 cases) compared to pelvic ring fractures. The total costs for pelvic ring and acetabular fractures in the German social accident insurances amounted € 18,726,630 and € 9637,189 in the periods 2011–2020 and 2017–2020, respectively. The average costs per case for treatment and rehabilitation until 2020 was € 19,079 for injuries from 2011 and € 13,629 for injuries from 2017. Acetabular fractures were found to be the most cost-intensive injuries compared to anterior, posterior or complex pelvic ring fractures. ConclusionsWork-related pelvic and especially acetabular fractures have a considerable socioeconomic impact in the German Social Accident Insurance. Measures to prevent work-related accidents and to improve treatment of pelvic injuries can help to reduce their socioeconomic burden.

Current status and cost burden of non-first-line treatment in ITP: A multicenter study based on real-world data in China

BackgroundEltrombopag, the first TPO-RA approved for the treatment of ITP, resulted in rapid and sustained increases in platelet counts, significant reductions in bleeding events and concomitant medications, and an acceptable tolerability profile. This study aimed to explore the current status of ITP treatment with eltrombopag as the target drug and the utilization of medical resources from the perspective of hospitals. MethodsData collection was based on two parts: real-world data and expert interviews. Real-world data of outpatients with ITP who received second-line treatment or other treatment from 1 year before to 1 year after eltrombopag admission were collected to analyze the current status of non-first-line treatment in ITP outpatients. Ten specialist physicians were interviewed to collect parameters such as efficacy, safety, and medical cost of ITP treatment regimens. ResultThe real-worlddata showed that among non-first-line treatment, market share of second-line treatment was lower than that of other treatment before the admission of eltrombopag, and the market share of second-line treatment was the higher than that of other treatment after the admission of eltrombopag in both adult and pediatric ITP patients. After the admission of eltrombopag, the annual outpatient drug-related treatment costs for adults with ITP increased by ￥13717.05, and the annual outpatient drug-related treatment costs for children with ITP increased by ￥7762.90. The results of expert interviews showed that more patients switched from other treatment to second-line treatment after the admission of eltrombopag in clinical. Eltrombopag demonstrated superior efficacy, safety and higher adherence in second-line treatment. ConclusionsThe new oral TPO-RA drugs have improved the treatment options for ITP patients, and more patients accept eltrombopag for non-first-line treatment. After eltrombopag admission, the annual outpatient drug-related treatment costs increased for both adult and pediatric patients. Nevertheless, by reason of advantages of its efficacy, tolerance, medication adherence and other aspects, eltrombopag has become an important drug in the non-first-line treatment of ITP.Additional comprehensive research is needed to verify the results.

Therapeutic leave and direct inpatient healthcare costs in inpatients with mental illness

AimsBalancing the economic costs related to mental illness is a pressing matter globally. Scarce monetary and staff resources impose an ongoing challenge. Therapeutic leaves (TL) are an established clinical tool in psychiatry possibly improving therapy outcome and potentially lowering direct mental healthcare costs in the long term. We thus examined the association between TL and direct inpatient healthcare costs. MethodsWe analyzed the association between the number of TL and direct inpatient healthcare costs in a sample of 3151 inpatients, using a tweedie multiple regression model, including eleven confounders. Using multiple linear (bootstrap) and logistic regression models we assessed the robustness of our results. ResultsThe tweedie model showed that the number of TL was associated with lower costs following the initial inpatient stay (B = –.141, CI 95% = [–0.225, –.057], p < 0.001). Results of the multiple linear and the logistic regression models matched those of the tweedie model. ConclusionOur findings suggest a link between TL and direct inpatient healthcare costs. TL might lower direct inpatient healthcare costs. In the future RCTs might examine whether an increased utilization of TL leads to a reduction of outpatient treatment costs and evaluate the association of TL with outpatient treatment costs and indirect costs. The systematic use of TL during inpatient treatment could reduce healthcare costs following the initial inpatient stay which is highly relevant due to global rise of mental illness and the associated financial pressure on healthcare systems.

Outpatient care concept and potential inpatient cost savings associated with the administration of dalbavancin – A real-world data and retrospective cost analysis

BackgroundThe treatment of acute bacterial skin and skin structure infections (ABSSSI) usually involves intravenous (i.v.) antibiotics requiring hospitalisation and increasing hospital costs. Since 2014, dalbavancin is approved for ABSSSIs treatment. However, evidence of its health economic impact on the German healthcare system is still limited. MethodsDiagnosis-related groups (DRG) based cost analysis was used to evaluate real-world data (RWD) from a German tertiary care center. All patients treated with i.v. antibiotics in the Department of Dermatology and Venereology at the University Hospital of Cologne were included to detect potential cost savings from a payer perspective. Thus, for the inpatient care German diagnosis-related groups (G-DRG) tariffs, length of stay (LOS), main- and secondary DRG-diagnoses and for the outpatient setting ‘Einheitlicher Bewertungsmaßstab’ (EBM) codes were evaluated. ResultsThis retrospective study identified 480 inpatient cases treated for ABSSSI between January 2016 until December 2020. Complete cost data were available for 433 cases and the detection of long-hospital-stay patients based on surcharges for exceeding the upper limit LOS led to 125 cases (29%) including 67 females (54%) and 58 males (46%) with an overall mean age of 63.6 years; all treated for International Classification of Diseases (ICD −10th revision) code A46 ‘erysipelas’. A sub-analysis focussed on DRG J64B with a total of 92 cases exceeding the upper limit LOS by a median of 3 days resulted in a median surcharge of €636 (mean value €749; SD €589; IQR €459-€785) per case. In comparison, we calculated outpatient treatment costs of approximately €55 per case. Thus, further treatment of these patients in an outpatient setting before exceeding the upper limit LOS might result in a cost-saving potential of approximately €581 per case. ConclusionDalbavancin appears a cost-efficient option to reduce inpatient treatment costs by transitioning to an outpatient setting of patients with ABSSSI potentially exceeding the upper limit LOS.

EFFICIENCY OF SCREENING AND EARLY DIAGNOSIS OF MALIGNANT NEOPLASMS: ECONOMIC ASPECT

The article is devoted to the study of the economic aspects of screening and early diagnosis of malignant neoplasms. The differences between such elements of the fight against oncological diseases as screening and early cancer diagnosis are analyzed, and socio-economic criteria for evaluating the program of oncological diagnosis of patients are determined by a number of factors, including: costs of outpatient and inpatient treatment, losses from mortali-ty of the population, costs of equipment, personnel and information technology. It is established that in order to compare the cost-effectiveness of screening and early diagnosis of malignant neoplasms, it is necessary to compare the costs of conducting these types of diagnostics with the costs of treating cancers at the initial stage, as well as with possible social losses that the choice in favor of early cancer diagnosis may lead to.

Cost of Surgical Treatment of Obesity and Its Impact on Healthcare Expense-Nationwide Data from a Polish Registry.

Weight loss surgery is linked to health benefits and may reduce the cost to the public healthcare systems. The aim of this study was to assess the cost and cost-structure in the one-year periods before and after a bariatric surgery in the Polish nationwide registry. The study included 2390 obese adults which underwent surgical treatment for obesity in 2017. The cost structure and the total costs per patient for one year before bariatric surgery, preoperatively, and for one year after surgery were analyzed. The total cost of the postoperative period was about PLN 3 million lower than during the preoperative period. After bariatric surgery, a reduction of approximately 59% in costs associated with hospital treatment was observed. The costs of outpatient specialist services, hospital treatment, psychiatric care, and addiction treatment also significantly decreased. There was a negative correlation between the changes in the cost of treatment of patients undergoing obesity surgery and their age. The health care cost during the period of one year after bariatric surgery is lower than in the year preceding the surgery (a greater cost difference is observed in younger people). This is mainly influenced by the reduction in costs associated with hospital treatment.

Risk of COVID-19 and Cost Burden in End-Stage Renal Disease Patients and Policy Implications for Managing Nephrology Services during the COVID-19 Pandemic.

The aim of this study was to evaluate the risk of COVID-19 in end-stage renal disease (ESRD) patients, the cost burden of the COVID-19 pandemic on the management of ESRD and the cost of catheter infections. In this multicentre, retrospective study, data were obtained from the records of four dialysis centres providing care for ESRD patients in Northern Cyprus. Of the 358 ESRD patients that were receiving haemodialysis (HD) 13 were diagnosed with COVID-19. The average cost of HD treatment per patient was $4822.65 in 2019 and $3759.45 in 2020 (p ≤ 0.001). The average control cost of HD treatment per patient was $618.80 in 2019 and $474.03 in 2020 (p ≤ 0.001). The outpatient treatment costs of catheter infections were not significantly different in 2019 (before) compared to 2020 (after) the pandemic ($54.61 in 2019 compared to $54.74 in 2020, p = 0.793). However, the inpatient treatment costs were significantly greater before the pandemic compared to after the pandemic ($315.33 in 2019 compared to $121.03 in 2020, p = 0.015). The costs for monitoring COVID-19 transmission in patients having ESRD management were significantly higher in HD compared to in peritoneal dialysis (PD) and transplants. Since there is a high risk of transmission of infections in the hospital environment during a pandemic, it is important to implement alternative ESRD management methods, such as enhancing transplants in populations, switching to PD, and implementing home dialysis programmes to reduce the risk of infection and associated complications, as well as the health costs associated with infection monitoring.

Patient clusters and cost trajectories in the Swiss Atrial Fibrillation cohort

ObjectiveEvidence on long-term costs of atrial fibrillation (AF) and associated factors is scarce. As part of the Swiss-AF prospective cohort study, we aimed to characterise AF costs and their development...

Estimating treatment costs for uncomplicated diabetes at a hospital serving refugees in Kenya

Diabetes mellitus (DM) is increasing markedly in low- and middle-income countries where over three-quarters of global deaths occur due to non-communicable diseases. Unfortunately, these conditions are considered costly and often deprioritized in humanitarian settings with competing goals. Using a mixed methods approach, this study aimed to quantify the cost of outpatient treatment for uncomplicated type-1 (T1DM) and type-2 (T2DM) diabetes at a secondary care facility serving refugees in Kenya. A retrospective cost analysis combining micro- and gross-costings from a provider perspective was employed. The main outcomes included unit costs per health service activity to cover the total cost of labor, capital, medications and consumables, and overheads. A care pathway was mapped out for uncomplicated diabetes patients to identify direct and indirect medical costs. Interviews were conducted to determine inputs required for diabetes care and estimate staff time allocation. A total of 360 patients, predominantly Somali refugees, were treated for T2DM (92%, n = 331) and T1DM (8%, n = 29) in 2017. Of the 3,140 outpatient consultations identified in 2017; 48% (n = 1,522) were for males and 52% (n = 1,618) for females. A total of 56,144 tests were run in the setting, of which 9,512 (16.94%) were Random Blood Sugar (RBS) tests, and 90 (0.16%) HbA1c tests. Mean costs were estimated as: $2.58 per outpatient consultation, $1.37 per RBS test and $14.84 per HbA1c test. The annual pharmacotherapy regimens cost $91.93 for T1DM and $20.34 for T2DM. Investment in holistic and sustainable non-communicable disease management should be at the forefront of humanitarian response. It is expected to be beneficial with immediate implications on the COVID-19 response while also reducing the burden of care over time. Despite study limitations, essential services for the management of uncomplicated diabetes in a humanitarian setting can be modest and affordable. Therefore, integrating diabetes care into primary health care should be a fundamental pillar of long-term policy response by stakeholders.

Retrospective Cohort Study of the 12-Month Epidemiology, Treatment Patterns, Outcomes, and Health Care Costs Among Adult Patients With Complicated Urinary Tract Infections

BackgroundLimited data are available in the United States on the 12-month epidemiology, outpatient (OP) antibiotic treatment patterns, outcomes, and costs associated with complicated urinary tract infections (cUTIs) in adult patients.MethodsA retrospective observational cohort study of adult patients with incident cUTIs in IBM MarketScan Databases between 2017 and 2019 was performed. Patients were categorized as OP or inpatient (IP) based on initial setting of care for index cUTI and were stratified by age (<65 years vs ≥65 years). OP antibiotic treatment patterns, outcomes, and costs associated with cUTIs among adult patients over a 12-month follow-up period were examined.ResultsDuring the study period, 95 322 patients met inclusion criteria. Most patients were OPs (84%) and age <65 years (87%). Treatment failure (receipt of new unique OP antibiotic or cUTI-related ED visit/IP admission) occurred in 23% and 34% of OPs aged <65 years and ≥65 years, respectively. Treatment failure was observed in >38% of IPs, irrespective of age. Across both cohorts and age strata, >78% received ≥2 unique OP antibiotics, >34% received ≥4 unique OP antibiotics, >16% received repeat OP antibiotics, and >33% received ≥1 intravenous (IV) OP antibiotics. The mean 12-month cUTI-related total health care costs were $4697 for OPs age <65 years, $8924 for OPs age >65 years, $15 401 for IPs age <65 years, and $17 431 for IPs age ≥65 years.ConclusionsThese findings highlight the substantial 12-month health care burden associated with cUTIs and underscore the need for new outpatient treatment approaches that reduce the persistent or recurrent nature of many cUTIs.

Health Resource Utilization and Associated Health Care Costs of Biologic Disease-Modifying Antirheumatic Drugs in German Patients With Psoriatic Arthritis.

To investigate health care costs associated with biologic disease-modifying antirheumatic drugs (bDMARDs) in a German real-world cohort of adult biologics-naive patients with psoriatic arthritis (PsA). Claims data from the Institute for Applied Health Research Berlin (InGef) research database for patients with a PsA diagnosis and bDMARD claims record (index date) between January 1, 2014, and December 31, 2017, and no bDMARD prescriptions for 365 days before the index date were retrospectively analyzed. Primary outcomes were determination of health care resource utilization and associated annual health care costs for overall and individual bDMARDs in the 12-month pre-index and post-index periods. These outcomes were compared between persistent and nonpersistent groups. Nonpersistence was defined as treatment gap or switch to a bDMARD other than the index therapy. Among 10,954 patients with a PsA diagnosis, 348 were eligible. Although mean ± SD post-index costs were significantly higher in the persistent group than the nonpersistent group (€27,869 ± 8,001 versus €21,897 ± 10,600, P < 0 .001) due to higher bDMARD acquisition costs (€23,996 ± 4,818 versus €16,427 ± 9,033, P < 0.001), persistence reduced inpatient treatment costs (-€760), outpatient treatment costs (-€192), other drug costs (-€724), and sick leave costs (-€601). Although initiation of bDMARDs increased the total health care costs irrespective of persistence status, partial cost offsets were observed in the persistent patient population.

SYSTEMIC INFECTION WITH SINGLE OR MULTI-ORGAN DAMAGE CAUSED BY INADEQUATELY MANAGED CHRONIC WOUNDS: A CASE SERIES.

SUMMARYChronic wounds are often underestimated condition with increasingly growing inpatient and outpatient treatment costs. Since the patient population affected by chronic wounds is heterogeneous and includes diabetes, chronic venous insufficiency and peripheral artery disease patients, with additional differences in gender, age, previous medical history, treatment of chronic wounds is highly personalized and dependent on a variety of factors. This paper aims to highlight the problems that the chronic wound patient population is facing during the COVID-19 pandemic: from higher probability of an undesirable disease outcome to the fact that many of them have limited access to primary care providers and to the regular and continuous care that their condition demands. This paper describe three patients with chronic wounds. Each of the patients had a significant worsening of their chronic wounds during the COVID-19 pandemic: either following an active SARS-CoV-2 infection or due to the limited access to primary care. The cases described here highlight the necessity of providing proper and regular care for all patients during the COVID-19 pandemic, regardless of the current state of the healthcare system and the adversities and hurdles it currently faces, to prevent the pandemic from becoming a syndemic.