Patient Annual Costs Research Articles

Trends and variations in utilization and costs of radiotherapy for prostate cancer: A SEER medicare analysis from 2007 through 2016

OBJECTIVETo assess recent changes and disparities in utilization and costs of radiotherapy in Medicare beneficiaries with prostate cancer. METHODSSurveillance, Epidemiology and End Results (SEER) –Medicare linked data from 2006-2016 were used to identify continuously enrolled Medicare beneficiaries with a first-time diagnosis of prostate cancer who, within 12 months of diagnosis, underwent at least one radiotherapy related service. Trends in the utilization of different radiotherapy techniques over time, yearly changes in per-patient costs of radiotherapy, and effect of socio-demographic and clinical characteristics on total cost were measured. Per patient annual costs, annual incidence of prostate cancer, and utilization of radiotherapy were used to estimate total costs of radiotherapy to the Medicare program. RESULTSFor Medicare beneficiaries with a first-time diagnosis of prostate cancer, the utilization of intensity modulated radiation therapy (IMRT), proton therapy, and stereotactic body radiation therapy (SBRT) increased 23.62%, 0.74% and 1.61% respectively (p <0.0001) while brachytherapy decreased 17.04% (p <0.0001). Cost per beneficiary decreased $340.24 (95% CI: $136.05 - $544.43) annually (p = 0.0065). Age, registry region, and Gleason score were all associated with expenditures. The total cost to the Medicare program was estimated at US $1.16 billion in the year 2016. DISCUSSIONIn Medicare beneficiaries with prostate cancer treated with radiotherapy, IMRT is the primary mode of treatment. Utilization of brachytherapy decreased significantly despite the efficacy and cost-effectiveness. Although per patient costs have decreased, the share of patient responsibility remained unaltered across years. The current costs to Medicare of radiotherapy for newly diagnosed prostate cancer patients is substantial.

Management of diabetes and associated costs in a complex humanitarian setting in the Democratic Republic of Congo: a retrospective cohort study

ObjectiveWe aimed to evaluate an Integrated Diabetic Clinic within a Hospital Outpatient Department (IDC-OPD) in a complex humanitarian setting in North Kivu, Democratic Republic of Congo. Specific objectives were to:...

Smoking Status and Cost of Illness in Patients with Depressive Disorder Based on the National Health Survey in Spain

Background: Twenty-one percent of subjects with depressive disorder (DD) smoke. This prevalence is expected to be related to healthcare resources utilization (HRU) and sick leave, thereby accounting for substantial costs to the National Health System (NHS) and to society that still need to be characterized. The objective was to estimate cost of illness in patients with DD according to their smoking status. Methods: We used the 2011/2012 National Health Survey to document HRU and lost-workday equivalents (LWDE). Men and women 18+ years old with a DD self-reported to a physician in the past 12 months were categorized into: smokers (daily smokers), former smokers, and never smokers. HRU and LWDE were computed on an annualized basis. Multivariate general linear models adjusted for sex, age, and comorbidities were applied. Results: Data from 1,816 subjects (381 smokers, 290 former smokers, and 1,145 never smokers) were analyzed. Smokers had higher total per patient annual costs (thousands, €3.14), and higher annual healthcare costs (€2.53) than former smokers (€2.35, p < .1; and €1.93, p < .05) and never smokers (€2.42, p < .05; and €2.06, p < .1): with excess costs of €0.79 and €0.72 for total annual costs and €0.60 and €0.47 for annual healthcare costs (p = .029 and p = .056, respectively). Conclusions: Smoking DD subjects were associated with higher HRU and costs from both the societal and healthcare perspectives, when compared with former and never smokers in the Spanish general population. Supporting people with DD to quit smoking might therefore be a value-for-money health policy in Spain.

PSY6 Economic Efficiency of Ferric Carboxymaltose to Treat or Prevent Iron Deficiency Anemia: Value to the Portuguese Hospitals

Among the approved intravenous iron formulations, ferric carboxymaltose (Ferinject®) is the most efficacious in the treatment or prevention of iron deficiency anemia, it's less burdensome to administer (easier and shorter time administration) and it reduces the need for expensive resource utilization like erythropoietin and blood transfusions. The objective was to develop a tool to assess the relative cost-efficiency of different intravenous iron formulations in the perspective of the Portuguese hospitals. A fully parameterizable Microsoft® Excel based tool was developed to compare the economic efficiency of intravenous iron formulations available to the Portuguese hospitals: ferric carboxymaltose (Ferinject®); ferric hydroxide saccharose (generic and Venofer®); ferric hydroxide dextran (Cosmofer®). Economic efficiency was calculate as the balance between hospitals incurred costs relative to the number of patients to be treated, the dose and number of administrations of intravenous iron, and the need for erythropoietin and blood transfusions. The tool default values are from a literature review used to populate the model. The tool allows studying the cost and benefits of treating/preventing chronic kidney disease, inflammatory bowel disease, chemotherapy, and orthopedic surgery related anemia. Ferric hydroxide saccharose (generic) is to the most used and lower price intravenous iron in Portugal. Relative to generic ferric hydroxide saccharose (FHS), ferric carboxymaltose (FC) is estimated to lower mean per patient annual costs in all four anemic conditions in major hospitals: 3,087.60€ (FC) vs. 3,482.20€ (FHS) for chronic kidney disease; 2,195.75€ (FC) vs. 2,427.4€ (FHS) for inflammatory bowel disease; 3,626.17€ (FC) vs. 3,793.13€ (FHS) for chemotherapy; and 3,485.74€ (FC) vs. 3,849.47€ (FHS) for orthopedic surgery. These results were consistent irrespective of the type of hospital. This is a valuable tool to inform hospital decison makers about the economic value of ferric carboxymaltose as compared to other intravenous iron formulations.

Cost of healthcare for patients with migraine in five European countries: results from the International Burden of Migraine Study (IBMS).

Migraine is a disabling neurological disease that affects 14.7 % of Europeans. Studies evaluating the economic impact of migraine are complex to conduct adequately and with time become outdated as healthcare systems evolve. This study sought to quantify and compare direct medical costs of chronic migraine (CM) and episodic migraine (EM) in five European countries. Cross-sectional data collected via a web-based survey were screened for migraine and classified as CM (≥15 headache days/month) or EM (<15 headache days/month), and included sociodemographics, resource use data and medication use. Unit cost data, gathered using publicly available sources, were analyzed for each type of service, stratified by migraine status. Univariate and multivariate log-normal regression models were used to examine the relationship between various factors and their impact on total healthcare costs. This economic analysis included data from respondents with migraine in the UK, France, Germany, Italy, and Spain. CM participants had higher level of disability and more prevalent psychiatric disorders compared to EM. CM participants had more provider visits, emergency department/hospital visits, and diagnostic tests; the medical costs were three times higher for CM than EM. Per patient annual costs were highest in the UK and Spain and lower in France and Germany. CM was associated with higher medical resource use and total costs compared to EM in all study countries, suggesting that treatments that reduce headache frequency could decrease the clinical and economic burden of migraine in Europe. Comparing patterns of care and outcomes among countries may facilitate the development of more cost-effective care, and bring greater recognition to patients affected by migraine.

Custos e eficácia da toxina botulínica tipo A no tratamento do blefaroespasmo essencial e espasmo hemifacial

To evaluate the costs and efficacy of type A botulinum toxin in the treatment of essential blepharospasm and hemifacial spasm. Pacients with essential blepharospasm and hemifacial spasm had their files analyzed. All patients were treated with type A botulinum toxin (Dysport) between April 2002 and May 2004 at the Oculoplastic Clinics of "Santa Casa de São Paulo". Twenty-seven patients presented essential blepharospasm and 23 presented hemifacial spasm. Information about the patient's degree of satisfaction after treatment, complaints and personal costs were recorded by a questionnaire, and information about the costs of Dysport treatment were obtained at the administration department of "Santa Casa de São Paulo". Wilcoxon and Mann-Whitney tests were used for statistical analysis. 1- The annual treatment costs were R Dollars 1,239.32 for essential blepharospasm and R Dollars 661.72 for hemifacial spasm. 2- The patient's annual costs were R Dollars 145.48 for essential blepharospasm and R Dollars 6.07 for hemifacial spasm. 3- The hospital's annual costs for the treatment were R Dollars 1,095.84 for essential blepharospasm and R Dollars 535.65 for hemifacial spasm. 4- Dysport treatment is successful in both essential blepharospasm and hemifacial spasm. The costs of essential blepharospasm and hemifacial spasm treatment with Dysport are high, mainly because of the toxin price. On economic analysis of health, we can conclude that this procedure has an excellent cost-benefit ratio.