Reimbursement Coverage Research Articles

Oral nutritional supplements improve clinical outcomes and are cost-effective for hospitalized patients in China

ObjectiveThis study assessed the therapeutic benefits and modeled the cost-effectiveness of oral nutritional supplements (ONS) in China. MethodsData were collected from 27 152 adult inpatients between January 1, 2018, and December 31, 2020. Propensity score matching was used for balancing the baseline characteristics between the ONS group and non-ONS group. A decision-tree model was developed to assess the cost-effectiveness of ONS for patients with nutritional risk, and the incremental cost-effectiveness ratio was the metric to determine the most cost-effective strategy. One-way sensitivity and probabilistic sensitivity analyses were conducted to assess the model's stability. In addition, subgroup analysis was conducted based on clinical characteristics. Differences in clinical outcomes between the groups were compared using Student's t test, Mann–Whitney U test, or chi-square test. ResultsThe ONS group displayed significantly lower levels of prealbumin, albumin, hemoglobin, and BMI than the non-ONS group at admission. The incidence of malignant tumors, intestinal obstruction, and inflammatory bowel disease was significantly higher in the ONS group than the non-ONS group. The ONS group had a significantly higher effective rate than the non-ONS group (51.7% versus 50.3%, P < 0.05). Analysis of the decision-tree model revealed that the ONS group experienced an increase in cost of 19 850.96 yuan but achieved an additional 1.3406 effectiveness rate, resulting in an incremental cost-effectiveness ratio of 14 807.51, which fell below China's 2020 per capita gross domestic product of 71 965 yuan. Sensitivity analysis further confirmed the robustness of the model. ConclusionsONS are demonstrated a high rate of efficacy, although patients currently using ONS are typically in a severe disease state. In addition, ONS is cost-effective. We suggest that the reimbursement coverage of ONS be expanded to include in-hospital patients who are at high nutritional risk.

PP26 Critical Review Of The Reimbursement Process For Software As A Medical Device And Challenges In South Korea

IntroductionThe global artificial intelligence (AI) healthcare market is predicted to grow rapidly. Various technologies for AI-based Software as Medical Device (SaMD) have been developed, and demand for their health insurance reimbursement coverage is increasing. Reimbursement policies for new medical technologies need to be thoroughly examined, despite their role in stimulating the market. The reason is that health insurance finance can have significant impact on the entire country, including patients, providers, and industry.MethodsBased on guidelines for applying Korea’s innovative medical technologies, especially AI-based imaging medical technology, to health insurance, we examined outcome factors such as procedures and benefits. After the guidelines’ publication in 2019, we examined their impact on the medical device market through changes in the number of clinical trials and identified cases in which health insurance was listed.ResultsThe process of registering SaMD’s health insurance occurs in accordance with the existing medical technology evaluation system, and it can take up to 460 days from application to approval. If new technologies, including SaMDs demonstrate significant improvement in diagnostic capabilities and cost-effectiveness compared to existing practices, separate health insurance claims are available. Since the scheme’s announcement in 2019, items approved for SaMD clinical trials have increased (2018: ‘n=4; 2020: n=44; 2021: n=37). However, as of November 2022, only one was listed for health insurance benefits (VUNO Med-DeepBrain®), and one case was not listed on benefits but was recognized for its innovation and entered the market on the premise of suspending the health technology assessment process and accumulating real-world data (VUNO Med-DeepCARS®).™ DeepBrain® is a deep learning-based image reading technology costing about KRW80,000 (USD60) higher than conventional brain-magnetic resonance imaging and readings.ConclusionsThe number of SaMDs attempting clinical trials is increasing, but there is a low number of cases of reimbursement because most technologies are often classified as existing technologies and do not receive additional compensation. Since SaMD continuously is developed by accumulating data and feedback, a flexible system that can reflect this is required.

Patient access to precision medicine: Correlation of immune checkpoint inhibitor (ICI) usage in non-small cell lung cancer (NSCLC) with patient household income levels across multiple Asian markets.

e18629 Background: 1st line (1L) advanced/metastatic NSCLC patients wild-type (WT) for EGFR, ALK and ROS1 have been shown to benefit from treatment with ICIs, and these drugs have been incorporated into most treatment guidelines for this cancer. However, some patients cannot afford these costly treatment options, especially in countries where reimbursement coverage is partial/absent. This study uses real-world data to explore the correlation between monthly household income levels (MHHI) and ICI shares in Thailand, Indonesia, Vietnam, Taiwan and mainland China. Methods: Ipsos’ Oncology Monitor is a physician-reported syndicated patient record database. 532 cancer-treating physicians (Thailand = 37, Indonesia = 30, Vietnam = 80, Taiwan = 40, China = 345) were screened for specialty, role and caseload and submitted data on 1,134 1L WT stage IIIB/IV NSCLC patients (aggregate) with known MHHI. Data were collected (online + pen &amp; paper) from July ’21 – June ’22. Results: In all 5 countries, a correlation was observed between MHHI and the percentage of WT patients in each cohort receiving an ICI as part of their current 1L therapy. In Thailand and Vietnam, share of ICIs was ≤10% for patients in the study earning &lt; 39,999 THB and &lt; 12,000,001 VND, respectively. This compared to an ICI share of 79% among the most affluent Thai patients ( &gt; 1,000,000 THB) and 35% among the highest-income Vietnamese patients ( &gt; 12,000,000 VND). In Indonesia, all 8 patients prescribed an ICI were in the highest income bracket ( &gt; 10,000,000 IDR). In Taiwan, the correlation was less pronounced, but those earning &lt; 40,000 NTD per household were still least likely to receive an ICI. In China, patients with a MHHI above 10,000 CNY were most likely to be given an ICI. Conclusions: Results from this study suggest that, among this cohort, there is a clear link between patient household income and likelihood to be prescribed an ICI across 5 different Asian markets. While all patients should have access to the most optimal treatment based on their diagnosis and molecular profile, this does not appear to be a reality in the clinical setting, based on data from this real-world evidence study in Asia. More must be done to ensure equal access to all, regardless of country of residence or income. [Table: see text]

Reimbursement Coverage Decision Making for Digital Health Technologies in South Korea: Does It Fit the Value Framework Used in Traditional Medical Technologies?

ObjectivesThe introduction of digital health technologies (DHTs) that have the potential to improve health outcomes and lower the costs of healthcare services has seen an explosion in recent years. Indeed, the expectation that these innovative technologies can ultimately fill a gap in the patient-healthcare provider model of care with the hope of bending the continuously increasing healthcare expenditure curve has not yet been realized in many countries including South Korea (from herein referred to as Korea). We examine reimbursement coverage decision making status for DHTs in South Korea. MethodsWe examine the regulatory landscape, health technology assessment process, and reimbursement coverage determination for DHTs in Korea. ResultsWe identified the specific challenges and opportunities for reimbursement coverage of DHTs. ConclusionsTo ensure DHTs can be used effectively in medical practice, a more flexible and nontraditional approach to assessment, reimbursement, and payment determination is required.

Cost effectiveness of innovative anti-cancer drugs and reimbursement decisions in China

ObjectivesBecoming the bottleneck of patient access to new drugs, the reimbursement coverage process in China started to engage health economic evaluations. This study aimed to quantify the potential impacts of cost-effectiveness profiles on reimbursement coverage in China. MethodsCost and effectiveness measures of both reimbursable and non-reimbursable indications of newly covered anti-cancer drugs from 2017 to 2021 were collected from the literature since official documents were not accessible. The measures included incremental costs-effectiveness ratios (ICERs), incremental quality-adjusted life years (QALYs), incremental costs, acquisition costs, population sizes of target patient groups, availability of overall survival evidence in clinical trials, the language of literature, country of origin of the drug, and the year of initial coverage. Logistic regressions were used to examine the impacts of cost and effectiveness measures. ResultsSeventy-four anti-cancer drugs were newly covered from 2017 to 2021. We identified 64 and eight ICERs of reimbursable and non-reimbursable indications of the newly covered anti-cancer drugs. Of note, nine reimbursable indications of the newly covered anti-cancer drugs did not have corresponding literature evidence. The regression results suggested that ICER was not associated with reimbursement coverage. By contrast, incremental QALYs and patient population size by cancer type were positively associated with coverage, while acquisition costs were negatively associated with coverage. ConclusionsClinical benefits, acquisition costs, and the disease burden of the target population associated with new anti-cancer drugs are likely important considerations of reimbursement decisions in China. However, the importance of value-based pricing should be reinforced and investigated in the future when official documents become accessible. Public interest summaryAccess to new health technologies through reimbursement is critical to the public. Since 2017, Chinese healthcare and health insurance agencies have adopted health technology appraisals to expedite reimbursement decisions of new drugs, among which anti-cancer drugs accounted for the greatest proportion. The appraisals largely relied on health economic evaluations. In the current study, we quantified the potential impacts of cost-effectiveness profiles on the reimbursement of new anti-cancer drugs in China. We did not identify any significant association between reimbursement and incremental cost-effectiveness ratio, the latter of which is the primary measure of drug economic profiles. On the upside, incremental quality-adjusted life years (QALYs) were positively associated with reimbursement coverage, whereas acquisition costs had a negative association. To secure patient access to high-value anti-cancer drugs via reimbursement in China, it is vital to reinforce the consideration of cost-effectiveness evidence.

P47 Understanding Evidence Requirements for Diagnostic Devices for Reimbursement and Market Access: Insights and Lessons From Review of NICE Diagnostics Assessment Reports (2011-2022)

Personalized medicine driven by diagnostics has potential to improve patient outcomes and save costs for payers. However, a significant number of diagnostics are unable to receive reimbursement coverage for market access. The objective of this analysis was to understand the evidence requirements for diagnostics based on review of NICE Health Technology Assessment (HTA) reports.

Amyloidosis Tissue Confirmation for Tafamidis EligibilityUsing Transverse Carpal Ligament and Tenosynovium Biopsy.

In most Canadian provinces, eligibility criteria for public reimbursement coverage for tafamidis for treatment of transthyretin amyloidosis cardiomyopathy (ATTR-CM) include tissue biopsy confirmation of amyloidosis. Carpal tunnel syndrome requiring surgical release is common in ATTR-CM. We report our experience performing simultaneous transverse carpal ligament and tenosynovium biopsy during CTR, with all patients positive for amyloidosis, facilitating initiation of tafamidis.

HPR45 Impact of Nilotinib Reimbursement Coverage on the Use of Tyrosine Kinase Inhibitors (TKI) for Chronic Myeloid Leukemia (CML) in Chinese Tertiary Care Hospitals: A Retrospective Analysis

HPR45 Impact of Nilotinib Reimbursement Coverage on the Use of Tyrosine Kinase Inhibitors (TKI) for Chronic Myeloid Leukemia (CML) in Chinese Tertiary Care Hospitals: A Retrospective Analysis

Are We Ready for a New Approach to Comparing Coverage and Reimbursement Policies for Medical Nutrition in Key Markets: An ISPOR Special Interest Group Report

ObjectivesHealthcare policy makers should ensure optimal patient access to medical nutrition (MN) as part of the management of nutrition-related disorders and conditions. Questions remain whether current healthcare policies reflect the clinical and economic benefits of MN. The objective of this article is to characterize coverage and reimbursement of MN, defined as food for special medical purposes/medical food for a diverse set of countries, including Australia, Belgium, Brazil, Canada, China, France, Germany, Hong Kong, Italy, Japan, The Netherlands, Singapore, Spain, United Kingdom, and United States. MethodsData sources included published literature and online sources. ISPOR’s Nutrition Economics Special Interest Group developed a data collection form to guide data extraction that included reimbursement coverage, years that reimbursement policies were established, and presence of a formal health technology assessment (HTA) for MN technologies. ResultsReimbursement coverage of MN technologies varied across the countries that were reviewed. All but 3 countries limited coverage to specific formulations of products, regardless of demonstrated clinical benefit. The year that reimbursement policies were established varied across countries (ranging from 1984 to 2017), and only 4 countries regularly update policies. France and Brazil are the only countries with a formal HTA process for MN technologies. ConclusionsMost countries have limited MN reimbursement, have not updated reimbursement policies, and lack HTA for MN technologies. These limitations may lead to suboptimal access to MN technologies where they are indicated to manage nutrition-related disorders and conditions, with the potential of negatively affecting patient and healthcare system outcomes.

The reimbursement coverage decisions and pricing rules for medical devices in Taiwan.

Medical technology is undergoing rapid transformations, and the classifications of medical devices have also expanded greatly; therefore, it is necessary to develop appropriate reimbursement policies and pricing mechanisms in a timely manner. This paper aims to introduce the reimbursement coverage and pricing rules for medical devices in Taiwan. In addition, this paper identifies and evaluates available health technology assessments (HTA) and literature on published websites concerning medical device decision-making processes and pricing systems in South Korea and Japan, which are near Taiwan and have similar reimbursement coverage processes. Reimbursement policy and pricing mechanisms are constantly being revised in Taiwan, Japan, and South Korea. Recently, all three countries attempted to establish new reimbursement coverage decision-making and pricing rules, adopting a differentiated approach based on the level of evidence required for the appropriated reimbursement in terms of a feasible evaluation mechanism for providing patients with more effective medical devices. This article is expected to contribute to providing references to new reimbursement coverage decision-making and pricing rules.

Policy Updates on Access to and Affordability of Innovative Medicines in China

IntroductionIn China, efforts to qualify innovative medical products for reimbursement used to be subject to substantial delays after regulatory approval due to fiscal and bureaucratic barriers. In this review, we surveyed the Chinese government’s most recent initiatives to improve access to innovative medicines from both the regulatory and the reimbursement aspects, which not only accelerated the launching of drugs in the Chinese market but also expanded the reimbursement coverage of such products. We also provided a discussion of the current challenges. Areas CoveredWe provided a comprehensive review of the updates in China’s national reimbursement listing policies of medicines. Expert OpinionAs the most recognized regulatory shortcuts, priority and conditional approvals have expedited the authorization of many innovative medicines. In addition, the national negotiation process was institutionalized to enable timely access to innovative medicines through the National Reimbursement Drug List, leading examples of which were new anticancer drugs. Other impactful reimbursement policies in recent years included dynamic updates of the National Reimbursement Drug List, manufacturer-initiated reimbursement coverage applications, and parallel fund robustness tests and pharmacoeconomic analyses for price estimation. Recent administrative efforts have substantially improved the access to and affordability of innovative medicines in China. Nevertheless, standardized and transparent evidence appraisal processes need to be established for informed decision making in the future.

Estimation of the cost-effective threshold of a quality-adjusted life year in China based on the value of statistical life

Cost-effective threshold (CET) is essential for health technology assessment and decision-making based on health economic evaluations. Recently, it has been argued that the commonly used once and three times of gross domestic product (GDP) per capita CETs of a quality-adjusted life year (QALY) are not necessarily empirically supported in all countries. Therefore, we aimed to estimate the CET of a QALY as times of GDP per capita in China, of which the reimbursement coverage decisions are increasingly engaging economic evaluations. Estimates on the value of statistical life (VSL) in China were identified from several studies in the literature and converted to times of GDP per capita, the weighted average of which was used for subsequent calculation. By pooling data on population mortality, health utility, and age distribution, we estimated the value of a statistical QALY (VSQ) from VSL using an established mathematical process, which represented the theoretical upper bound of CET. The corresponding point estimate and theoretical lower bound were obtained using their numerical relationships with the upper bound. Scenarios analyses were also conducted. The estimated CET, its upper bound, and its lower bound were 1.45, 2.90, and 1.16 times of GDP per capita in China, respectively. In different scenarios, the estimated CET varied but was greater than once GDP per capita in most cases. As such, the CET of a QALY in China is close to 1.5 times of GDP per capita, which should be benchmarked for future ICER-based coverage decisions.

Analysis of the Expansion of the Reimbursement Coverage and Value-based Pricing for Anticancer Drugs in South Korea

Analysis of the Expansion of the Reimbursement Coverage and Value-based Pricing for Anticancer Drugs in South Korea

Exploring Why People With Type 2 Diabetes Do or Do Not Persist With Glucagon-Like Peptide-1 Receptor Agonist Therapy: A Qualitative Study.

OBJECTIVEDespite the demonstrated benefits of glucagon-like peptide 1 (GLP-1) receptor agonist therapy, adherence and persistence with this therapy is often challenging. The purpose of this study was to expand current understanding of patients’ experiences, motivations, and challenges relevant to their persistence with GLP-1 receptor agonist therapy.DESIGN AND METHODSThis noninterventional, cross-sectional, qualitative study used face-to-face interviews with 36 adults with type 2 diabetes who had been treated with at least one GLP-1 receptor agonist medication. Inclusion criteria were: ≥18 years of age, diagnosed with type 2 diabetes, and currently treated with a GLP-1 receptor agonist for ≥1 month at the time of screening (“continuers”) or discontinued use of a GLP-1 receptor agonist ≤1 year of screening but with a total ≥1 month of treatment (“discontinuers”). Interviews were conducted using a semi-structured qualitative interview guide that included open-ended questions and probes to obtain both spontaneous and prompted input from participants about their current and past treatment experiences with GLP-1 receptor agonist therapy.RESULTSAmong continuers (n = 16), the most commonly identified facilitators supporting the decision to continue were the observations of improved glucose control (50%) and weight loss (55%). Among discontinuers (n = 20), the most commonly identified challenges leading to treatment discontinuation were side effects (55%) and high cost (50%). Continuers were more likely than discontinuers to receive clinically relevant information from their health care team, including facts about GLP-1 receptor agonist medications, likely treatment benefits, the importance of gradual dose titration, and the need to adjust diet after initiation.CONCLUSIONAlthough cost is a major obstacle to treatment continuation, it can only be resolved through changes in ongoing reimbursement coverage and policies. However, many other obstacles could potentially be addressed (e.g., reducing side effects with gradual dosage titration and setting appropriate expectations regarding efficacy) through more collaborative patient-clinician interactions before initiating therapy.

Transition of Nurse Practitioner Faculty Practice and Student Clinicals to Telehealth: Response to the COVID-19 Pandemic

The COVID-19 pandemic forced the US health care system to evaluate alternative care delivery strategies to reduce the risk of coronavirus transmission to patients and health care providers. Telehealth modalities are a safe and effective alternative to face-to-face visits for primary and psychiatric care. Federal policy makers approved changes to telehealth reimbursement coverage and allowed flexibility of location for patients and providers. This article describes the transition of patient visits to telehealth by nurse practitioner faculty at an academic medical center to maintain continuity of care of underserved patient populations. This pivot facilitated resumption of clinical learning experiences for nurse practitioner students.

Assessing the effects of National Health Insurance reimbursement policy revisions for anti-osteoporotic drugs in Korean women aged 50 or older.

IntroductionThe Korean National Health Insurance revised its reimbursement criteria to expand coverage for anti-osteoporotic drug treatments in 2011 (expanding diagnostic criteria and the coverage period for anti-osteoporotic therapy) and 2015 (including osteoporotic fracture patients regardless of bone mineral density). We examined whether the two revisions contributed to an increase in the prescription rates of anti-osteoporotic drugs in Korea.MethodsWe used the Health Insurance Review and Assessment Service-National Patient Sample data from 2010 through 2016. A segmented regression analysis of interrupted time series was performed to assess changes in the monthly prescription rates of anti-osteoporotic drugs among women aged 50 or older, defined as the proportion of elderly women prescribed with anti-osteoporotic drugs.ResultsBoth the levels (i.e., abrupt jump or drop) and the trends (i.e., slope) of the prescription rates of anti-osteoporotic drugs in the general population, osteoporotic patients, and osteoporotic fracture patients showed no significant changes after the first revision. However, there was a significant increase in the trends in the general population (β = 0.0166, p = 0.0173) and in osteoporotic patients (β = 0.1128, p = 0.0157) after the second revision. Women aged 65 to 79 years were the most significantly increased group in terms of the treatment proportion after the second revision because the trend was significant after the second revision in all three study populations (β = 0.0300, 0.1212, 0.1392, respectively; p < 0.05).ConclusionsAlthough the two revisions expanded reimbursement coverage, only the second revision on reimbursing based on osteoporotic fracture regardless of bone mineral density was associated with increasing the proportion of post-menopausal women being treated with anti-osteoporotic drugs.

Trends in the pricing and reimbursement of new anticancer drugs in South Korea: an analysis of listed anticancer drugs during the past three years

ABSTRACT Objective: This study aimed to examine patient accessibility to new anticancer drugs including reimbursement coverage, time to listing, and listing price during the recent 3 years after the introduction of alternative pricing and reimbursement pathways in South Korea. Methods: Anticancer drugs were selected for analysis from the new drugs reviewed from January 2017 to March 2020. Descriptive statistics were used to present the levels of the listing prices. Pearson’s correlation analysis was used to analyze the relationship between the list price in comparison to the External Reference Price(ERP) and the time to listing. Results: Thirty-two anticancer drugs were included in analysis. The average time to listing for these drugs was 36.7 months. The ratio of the listing price in comparison with Average Adjusted Price from seven reference countries was from 12.6% to 90.2%. Pearson’s correlation coefficient for the correlation between the ratio of the listing price to the ERP and the time to listing was −0.37 and was statistically significant (p = 0.035). Conclusions: Policies that relate to the scope of reimbursement, time to reimbursement, and list price should be able to equally reflect patient accessibility and national health insurance finances, as well as the impact on industry as a whole.

Drug Utilization and Drug Pricing in the Private Primary Healthcare System in Malaysia: An Employer Price Control Mechanism.

Uncontrolled drug pricing in the private healthcare system in Malaysia leads to high drug prices; however, its impact on employee drug utilization and employer reimbursement coverage is unclear. This study examined patterns of drug pricing and drug utilization among employees covered by employer medical insurance. A drug price control mechanism was also devised for the employer to ensure fair benefits to all parties without compromising the quality of patient care. This retrospective study was conducted among International Islamic University Malaysia (IIUM) community members who sought outpatient treatment at the IIUM panel of health clinics serviced by general practitioners from January 2016 to September 2019. Prescription data (drug type, dose, quantity, duration, price, and manufacturer), patient characteristics (age, sex, and diagnosis) and total charges were extracted from the claims database of PMCare, the insurance company managing IIUM medical claims. Patterns of commonly prescribed drugs, drug pricing, profit margins, and total charges per clinic visit were evaluated. Descriptive statistics were used, and all analyses were performed using Stata v15.1. There were a total of 161,146 prescriptions for 10,150 patients in the IIUM community during the study period (48.85% women, mean ± standard deviation; age: 26.33 ± 17.63 years). The most commonly prescribed drug was paracetamol (25.3%), followed by chlorpheniramine (9.46%), cetirizine (7.3%), diphenhydramine (6.13%), loratadine (4.57%), and diclofenac (4.36%). Generic paracetamol (500 mg), which serves as a prime example for details on drug pricing, is commonly charged between Ringgit Malaysia (RM) 5 and 10 for 10 tablets with a profit between 2,400 and 4,900% according to the average cost price of RM 0.20 per 10 tablets. Most patients were charged within the approved coverage limit of RM 45 per clinic visit, with only 2.41% of patients being charged with costs that exceeded this limit. Uncontrolled drug pricing in the private healthcare system in Malaysia indicates that drug prices differ greatly across private healthcare providers most of the prices were charged with high profit margins. Employers may consider a multilayer capping system to prevent inappropriate drug pricing, which will inevitably benefit patients clinically and economically and provide greater patient access to better drug treatment.

PCN198 Access Status of Oncology Medicines Depending on Genetic Profiling in Turkey

Efforts to develop new oncology treatments have gained momentum for personalized treatment perspective in terms of genetic profiling. New personalized therapies developed in recent years achieve success in defeating cancer. This study aims to identify the patient access status of oncology medicines for personalized medicine with genetic profiling in Turkey. The information about the oncology medicines depending on genetic profiling was obtained from the FDA & EMA`s official site. The data on the license status, access, and reimbursement coverage of the identified drugs in Turkey are obtained from the List of Licensed Products published by the Turkish Pharmaceutical and Medical Device Agency and Health Implementation Communiqué published by the Social Security Institution. As a result of the analyzes, 66 oncology personalized medicine approved by the FDA or EMA for personalized oncology medicines depending on gene profiling were determined. The medicines identified for 25 different genes which are distributed as 30.3% -lung cancer, 21.2% -e leukemia, 16.6% - breast cancer, 13.6% - melanoma and the rest are kidney, colon, ovarian, prostate, bladder, thyroid, colon and liver cancers indicated, It was analyzed that 59% and 40.9% of the FDA or EMA approved personalized oncology medicines are licensed and not-licensed in Turkey, respectively. 81% of not-licensed are not under reimbursement coverage. However, 77% of licensed personalized oncology medicines are under reimbursement coverage. The average reimbursement coverage of all 66 personalized medicine is calculated as 51%. Depending on the analysis, it is seen that the Social Security Institution (SGK) which is the reimbursement authority of Turkey covers the majority of personalized oncology medicines with the license.

PIN56 Cost of COVID-19 Patients Treatment in Turkey

The first case and first death of COVID-19 in Turkey were officially announced on March 10 and March 15, 2020, respectively. Ministry of Health (MoH) of Turkey prepared a clinical guideline and published the guideline in March 2020 for guiding the clinicians for COVID-19 patients management across the country. Social Security Institution (SGK) increased the reimbursement coverage and prices for COVID-19 patients management. This study aimed to calculate the cost of management of patients infected with COVID-19 in Turkey. An expert opinion form was prepared depending on the MoH of Turkey`s COVID-19 Treatment Guideline. The form has been answered by 5 physicians from Istanbul, Ankara, and Kocaeli cities, where the majority of COVID-19 patients were diagnosed. The cost of management of COVID-19 patients has been calculated depending on MoH`s guideline and analysis of expert opinion forms. The updated SGK reimbursement list prices were used to calculate the cost. It was calculated that 17.40% of COVID-19 patients required hospitalization, 7.4% of hospitalized patients required intensive care unit stay in Turkey depending on the expert opinion form. The cost of outpatient, inpatient, and intensive care unit stay depending on expert opinion per patient were calculated as 367,04 , 16,534.09, and 66,278.23, respectively. The same costs depending on the MoH's guideline per patient were calculated as 198,64, 19.133,98, and 47.872,08 respectively. The analysis calculated per patient treatment cost of COVID-19 patients in Turkey depending on the Ministry of Health of Turkey`s COVID-19 treatment guideline and expert opinions. It is seen that real cost which was represented by experts may be higher than MoH`s guideline offers, except inpatient. These findings should be re-evaluated including real-life data with further analysis.