Total Treatment Costs Research Articles

#101 : A Direct Healthcare Cost Analysis of Recombinant LH Versus hMG Supplementation on FSH During Controlled Ovarian Hyperstimulation in the GnRH-Antagonist Protocol

Background and Aims: We have previous proposed a retrospective matched-case control study comparing the effect of recombinant LH versus hMG supplementation on FSH during COH in the GnRH-antagonist protocol. The result showed the cumulative live birth rate (CLBR) was significantly higher the in the LH group (53% vs. 64%, p=0.02). In this study we aim to do the cost analysis between these two groups based on our previous study. Method: The analysis consisted of 425 IVF and ICSI cycles performed in Taichung Veterans General Hospital, Taiwan between 2013 and 2018 in our previous study. They were chosen by Propensity score matching with balanced age, anti-mullerian hormone (AMH) level, and oocyte retrieval date. There were 259 cycles in hMG ± FSH group and 166 cycles in LH ± FSH group. The total cost related to treatment of each patient was recorded. Results: The treatment cost was showed in Table 1. The total treatment cost per patient was significantly higher in the LH than in the hMG group (USD 4194.93 ± 713.6 vs. $ 4466.33 ± 793.18 p=0.001). However, the mean costs per live birth in the hMG goup was higher with US $7875.42, vs. US $6928.83 in the LH group. The analysis of CLBR in the two groups in different treatment cost range results were showed in Figure 1 and Table 2. The CLBR was almost higher in the LH group in each range except for range between USD 5000-5499. When treatment cost between $4000-4499, the CLBR was significantly higher in the LH group than in the hMG group (81.8% vs. 54.3% p=0.006). Conclusions: The cost analysis showed that recombinant LH is more cost effectiveness than hMG supplementation on FSH during COH in the GnRH-antagonist protocol.

Analisis Cost of Illness pada Pasien Diabetes Mellitus Dengan Terapi Glimepiride-Metformin Rawat Jalan Peserta BPJS di Puskesmas Ketapang II Kota Sampit

Diabetes mellitus is a chronic disease that affects the costs incurred by patients during illness. The financingissuedfor the treatment of diabetes mellitus diseases can be measured using Cost of Illness analysis. Research objectivestofind out the total cost of treatment of diabetes mellitus patients BPJS participants with Glymepiride-Metformintherapy for one year. The method this study used a non-probability sampling technique with an accidental sampling method. This research conducted at Ketapang II Health Center with sample total 45 people. The instrument usedastructured interview which was previously tested for validity. Data were analyzed using Microsoft Excel. Result andconclusion, the estimate total cost of treatment of diabetes mellitus with outpatient glimepiride-metformin therapyofIndonesia Health Insurance participants at Ketapang II Health Center in Sampit city for one year is Rp.623.760-Rp.4.475.520. The direct medical cost per patient is Rp.143.760 - Rp.2.787.120. Non-medical direct cost is Rp.0-Rp.188.400. Indirect cost is Rp.480.000 - Rp.1.500.000. High cost are more expensive but the frequencyof visitsand patient compliance are orderly so that the therapeutic effect achieved is good, while the lowcost is cheaper butthe frequency of patient visits and patient compliance are not orderly so that the therapeutic effect achievedislessgood and not maximal.

OP130 Estimating The Economic Burden Of HIV/AIDS In Türkiye Towards The Next Decade

IntroductionApproximately 34.8 million people globally are affected by HIV, 34,000 of whom are in Türkiye, and the impact of HIV continues to grow. Not providing the necessary treatment eventually leads to life threatening AIDS-related consequences. In this study, a descriptive analysis of the published official data on HIV/AIDS was undertaken to assess existing statistics and raise social awareness. The aim was to provide data that will help decision makers in future planning by forecasting the possible number of cases and treatment costs to 2030 using available statistics in Türkiye.MethodsThe forecast of HIV-infected patients, deaths, and healthcare costs to 2030 were calculated using linear regression based on data published between 1985 and 2022 in the literature or by official authorities. The proportion of past deaths caused by AIDS was used to forecast deaths, and the number of patients living with HIV was estimated indirectly using this forecast. Possible treatment expenditures related to HIV/AIDS in Türkiye were estimated based on published healthcare cost data and the number of living patients obtained by considering the possible increase in HIV/AIDS cases, future inflation predictions from the Turkish Central Bank, existing literature, and information from statista.com.ResultsEstimates suggested that 3,002 new cases of HIV/AIDS in 2021 will become 5,709 among a total of 74,227 living patients in 2030. The 598 deaths reported between 1985 and 2022 are predicted to rise to 1,256 by 2030. Estimation of the total treatment cost of HIV/AIDS was TRY1,051,026,183 (USD118,683,580) in 2021, which was estimated to reach TRY15,432,842,049 (USD296,450,696) by 2030. This consisted of outpatient visits (TRY246,710,838 [USD4,739,088]), laboratory tests (TRY2,072,489,815 [USD39,810,623]), inpatient visits (TRY1,352,192,479 [USD25,974,373]), management of complications (TRY3,371,126,960 [USD64,756,247]), and antiretroviral therapy drugs (TRY8,390,321,957 [USD161,170,365]).ConclusionsThe prevalence of HIV/AIDS is expected to rise by 137 percent by 2030, with the economic burden increasing 14.7 times in TRY (2.5 times in USD) from 2021 to 2030 in Türkiye. This proves the severity of the situation and the need for relevant policy measures for society.

Cost per Responder Analysis of Patients with Lenalidomide-Refractory Multiple Myeloma Who Received Cilta-Cel from the Cartitude-4 Trial

Introduction: Ciltacabtagene autoleucel (cilta-cel) is a chimeric antigen receptor-T cell (CAR-T) immunotherapy approved for patients with relapsed or refractory multiple myeloma (RRMM). In the phase 3 trial, CARTITUDE-4 (NCT04181827), cilta-cel demonstrated better efficacy than physician's choice (daratumumab plus pomalidomide and dexamethasone [DPd] or pomalidomide plus bortezomib and dexamethasone [PVd]) with an overall response rate (ORR) of 84.6% versus 67.3% and ≥complete response (CR) of 73.1% versus 21.8% (San-Miguel et al. New Engl J Med. 2023). The present analysis assessed the value of cilta-cel and physician's choice treatments within the CARTITUDE-4 trial from a US combined commercial and Medicare payer perspective using a novel cost per responder (CPR) model that incorporates efficacy and total treatment costs. Methods: A CPR analysis was conducted from a mixed payer perspective (67.7% commercial, 23.3% Medicare), comparing the direct medical cost per patient receiving cilta-cel versus physician's choice (87% DPd and 13% PVd, per distribution in the trial) over 25.4 months, the maximum observed period for the physician's choice arm in the CARTITUDE-4 trial. The model was developed using progression-free survival (PFS), overall survival (OS), time to next treatment, CR, stringent CR (sCR), and ORR endpoints from the CARTITUDE-4 trial to inform health status. A standard parametric approach was taken to extrapolate the PFS and OS beyond the trial period for each arm for analysis scenarios with longer follow-up. Resource use and costs associated with the administration process for each treatment were included: apheresis, bridging therapy, pre-conditioning treatment, infusion, drug acquisition, other medications (infection prophylaxis, antihistamine, and antipyretic), and monitoring (eg, labs, vital sign assessment, hematologist visit) for CAR-T; drug acquisition, administration, other medications, and monitoring for physician's choice. The base case assumed CAR-T infusion was entirely administered in the inpatient setting, and an additional scenario was included that considered the outpatient infusion setting (70% inpatient and 30% outpatient). Costs of managing grade 3 to 4 AEs and grade 1 to 4 AEs for cytokine release syndrome (CRS) and neurotoxicity were included. Costs of subsequent therapies were assigned following disease progression, and costs of terminal care were also considered upon death events. Model outcomes included total cost per treated patient, total cost per complete responder, and cost per month in PFS compared between cilta-cel and physician's choice of therapy. All costs were adjusted to 2023 US dollars based on the consumer price index for medical care. Results: The total cost (PFS and post-progression survival [PPS] combined) per treated patient was estimated as $693,009 for cilta-cel and $1,028,444 for physician's choice over 25.4 months. Total estimated costs per treated patient were lower for cilta-cel than physician's choice during PFS and PPS separately ($581,108 vs $765,169 and $111,901 vs $263,275, respectively). Treatment acquisition and subsequent treatment costs are key drivers of the total costs during PFS and PPS, respectively ($451,318 and $103,101 for cilta-cel; $726,356 and $249,005 for physician's choice). Total cost per complete responder was estimated to be lower for cilta-cel compared with physician's choice ($948,029 vs $4,717,634) (Figure). Total estimated cost per month in PFS was $30,814 for cilta-cel versus $58,113 for physician's choice (Figure). Scenario analysis with a lower percentage of patients receiving CAR-T infusion in inpatient settings led to lower cost per complete responder and lower cost per month in PFS for cilta-cel (70% inpatient and 30% outpatient, $940,431 and $30,520, respectively). Conclusions: Overall, cilta-cel offers substantial clinical and economic benefit for patients with RRMM. The CPR analysis of data from CARTITUDE-4 estimated that, for patients with RRMM, cost per complete responder, and cost per month in PFS for cilta-cel were remarkably lower compared to physician's choice (DPd or PVd). Treatment acquisition and subsequent treatment costs appear to be key drivers for total direct medical costs.

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.

Economic burden of Thalassemia treatment: An analysis from the Vietnam Social Security perspective.

Thalassemia is a genetic disorder that significantly impacts the health and well-being of individuals in Vietnam. This study aimed to assess the economic burden of Thalassemia treatment in Lam-Dong Province from the perspective of the Vietnam Social Security and to develop a model to forecast these costs. This study analyzed the medical records of all 288 health-insured Thalassemia patients who received treatment in Lam-Dong Province from 2019-2021. The annual economic burden was calculated as the total direct medical cost of treatment per patient over one year. Bayesian Model Averaging (BMA) was utilized to forecast economic burdens. The best fit model was selected based on evaluation criteria including the R2 value, the Bayesian information criterion (BIC), and posterior model probabilities. The study found that the average annual economic burden of Thalassemia treatment was VND 9,947,000 (±6,854,000), equivalent to approximately USD 426.7 (±294.0), with blood transfusions being the main contributor to costs (63%). Using BMA, the best fit model to forecast economic burdens included variables including patient age, sex, and length of hospitalization, with age being the key factor with the greatest impact on the increase in economic burden. These findings provided important information for policymakers in Vietnam, as they highlighted the significant economic burden of Thalassemia treatment in the country. By developing a model to forecast these costs, policymakers can make informed decisions on how to allocate resources and support individuals with Thalassemia and their families.

A center-based, ambulatory care concept for hidradenitis suppurativa improves patient outcomes and is also cost-effectiveness

Background Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease affecting approximately 1% of the population. The patient journey through the German health care system leads to high disease burden and substantial treatment costs. The EsmAiL study showed that an innovative, interprofessional, multimodal care-concept reduces disease activity and burden of HS compared to standard care. This paper examines the costs of treating HS in Germany and compares them with those of the innovative care concept implemented in EsmAiL. Methods EsmAiL was a two-arm, multicenter, prospective randomized controlled trial including 553 adults with HS. The study was registered in the German Clinical Trials Registry (DRKS00022135). The control group (CG) remained in standard care, whereas the intervention group (IG) was referred to specialized so-called ‘acne-inversa-centres (AiZ)’ where patients were treated with a structured, interdisciplinary approach. The present paper analyses the treatment costs for a subpopulation based on health insurance cost data from the two largest German health insurers. Quality-Adjusted Life Years (QALY) was assessed based on Dermatology Life Quality Index (DLQI). Results Total annual treatment costs per patient were €3,966.07 in standard care (n = 89) and €3,974.37 in the innovative care (n = 93). The costs per additional QALY amounted to €12,698.72 in the IG. Given the conventional and established threshold of €22,600 to €33,900 per QALY, the innovative treatment in AiZ proved to be cost-effective. Conclusion Treatment costs of HS are substantial and increase with disease severity. The new form of care is cost-effective and is expected to decrease costs in the long run.

Cost-effectiveness analysis of typhoid vaccination in Lao PDR

BackgroundTyphoid vaccination has been shown to be an effective intervention to prevent enteric fever and is under consideration for inclusion in the national immunization program in Lao PDR.MethodsA cost-utility analysis was performed using an age-structured static decision tree model to estimate the costs and health outcomes of introducing TCV. Vaccination strategies combined with five delivery approaches in different age groups compared to no vaccination were considered from the societal perspective, using the Gavi price of 1.5 USD per dose. The vaccination program was considered to be cost-effective if the incremental cost-effectiveness ratio was less than a threshold of 1 GDP per capita for Lao PDR, equivalent to USD 2,535 in 2020.ResultsIn the model, we estimated 172.2 cases of enteric fever, with 1.3 deaths and a total treatment cost of USD 7,244, based on a birth cohort of 164,662 births without TCV vaccination that was followed over their lifetime. To implement a TCV vaccination program over the lifetime horizon, the estimated cost of the vaccine and administration costs would be between USD 470,934 and USD 919,186. Implementation of the TCV vaccination program would prevent between 14 and 106 cases and 0.1 to 0.8 deaths. None of the vaccination programs appeared to be cost-effective.ConclusionsInclusion of TCV in the national vaccination program in Lao PDR would only be cost-effective if the true typhoid incidence is 25-times higher than our current estimate.

Evolution of Pharmacological Treatments and Associated Costs for Multiple Myeloma in the Public Healthcare System of Catalonia: A Retrospective Observational Study.

(1) Background: Our understanding of and treatment for multiple myeloma (MM) has advanced significantly, and new pharmacological treatments have promising benefits but high price tags. This study analyzes prescription patterns and pharmaceutical expenditure for MM treatments in Catalonia's public healthcare system over eight years. (2) Methods: A retrospective observational study examined MM treatment data from 2015 to 2022 in Catalonia, using healthcare registries from the Catalan Health Service to collect information on patients, medicines used, and treatment costs. (3) Results: A total of 4556 MM patients received treatment, with a rising trend in the number of treated patients each year from 902 in 2015 to 1899 in 2022. The mean age was 68.9 years, and patients were almost evenly distributed by gender (51.5% male). Most patients were treated with bortezomib (3338 patients), lenalidomide (2952), and/or daratumumab (1093). Most drugs showed increased utilization annually, most significantly for lenalidomide and daratumumab. The total pharmacological treatment cost throughout the entire study period was EUR 321,811,249, with lenalidomide leading with the highest total cost (EUR 157,236,784), and daratumumab exhibiting the highest increase in annual expenditure. (5) Conclusions: The study reveals a progressive increase in the number of MM patients treated and rising pharmaceutical costs. Lenalidomide and daratumumab incurred the highest costs. The findings highlight MM treatment's economic impact and the need to monitor prescription patterns and expenditures to optimize healthcare resources and decision making. Understanding these trends can guide resource allocation effectively.

Identification, removal of microplastics and surfactants from laundry wastewater using electrocoagulation method

Microplastics (MPs) and surfactants are generally recognized as emerging contaminants with complicated ecotoxicological impacts. The majority of study data refers to laundry wastewater as a substantial source of MPs and surfactants in the aquatic system, which reaches aquatic environments through sewer discharges even when wastewater treatment facilities retain them. This study focused on releasing and removing contaminants from laundry wastewater, particularly MPs and surfactants. The electrocoagulation method was used to remove the pollutants from laundry wastewater. According to the results, a reference load of 2 kg of synthetic materials releases 92,700 to 1,14,300 synthetic microfibers (MFs). MFs, surfactants, and chemical oxygen demand (COD) removal efficiency are higher at neutral pH. The percentage removal efficiency of MFs, surfactants, and COD was 97.9%, 91.2%, and 86.3%, respectively, at an operating time of 25 min, a current density of 300 A/m2 with optimum power consumption. The total operation cost of laundry wastewater treatment by electrocoagulation was US$0.53 /m3. The readers will gain a complete understanding of the removal of MFs and surfactants from laundry wastewater using the electrocoagulation technique.

160 Effect of Diets Containing Soybean Co-Products Formulated for High-Risk Stocker Cattle on Growth Performance, Morbidity and Mortality Associated with Respiratory Disease

Abstract The objectives of this study were to determine the effect of including soybean co-products on growth performance and respiratory disease incidence in high-risk stocker cattle. For this study, crossbred beef bulls and steers [n = 272; initial body weight (BW) 230.9 ± 19.7 kg] were purchased from local auction markets at 3 time points (load 1: n = 93 cattle; load 2: n = 91 cattle; load 3: n = 88 cattle). On day 0, cattle were processed (ear tagged, vaccinated, dewormed, ear notched for identification of cattle persistently infected with bovine viral diarrhea virus, castrated intact bulls), stratified by BW and allocated randomly to 1 of 8 pens (0.45 ha). Pens were assigned randomly to 1 of 3 dietary treatments: 1) a control supplement containing no soy co-products (CON); 2) a supplement containing soybean meal (SBM); or 3) a supplement containing soy oil (SBO). All supplements were isonitrogenous and isoenergetic. Cattle were fed supplements (2.45 kg DM/day) and offered bermudagrass hay for ad libitum intake for a 42-day trial. Body weights were taken on days 14, 28, 41, and 42 of the trial. Each morning, cattle were observed for signs of morbidity. If presenting with symptoms, cattle were pulled and rectal temperatures were recorded; if temperature exceeded 40°C, calves were treated according to a standard protocol. Cattle were deemed chronic if they received 3 antibiotic treatments and had an overall average daily gain (ADG) of less than 0.5 kg/d. Statistical analyses were performed using SAS 9.4, with PROC MIXED used for BW, ADG, and antibiotic cost analysis. Body weights were analyzed with the repeated measure of day and for treatment, day, and treatment by day interaction. PROC GLIMMIX was used for morbidity and mortality analyses. There was no treatment by day interaction (P = 0.99) or main effect of treatment (P = 0.86), but there was a day effect (P < 0.0001) with BW increasing throughout the trial. Average daily gain was not affected by treatment (P ≥ 0.42; 0.81 kg/d for SBM, 0.79 kg/d for SBO, and 0.76 kg/day for CON). Overall morbidity and mortality were 71% and 1%, respectively, and were not affected by treatment (P = 0.62 and P = 0.99, respectively). Relapse rates and chronics were not affected by treatment (P = 0.52 and P = 0.51, respectively). Total cost of antibiotic treatments was not different (P = 0.8; $30.37 for SBO, $28.95 for CON, and $28.52 for SBM). While the inclusion of soybean co-products did not affect BW, respiratory disease incidence, or cost of antibiotic treatments in high-risk stocker cattle, further work will focus on haptoglobin, hemocytology, and antibody titer responses during the receiving period.

Retrofitting of Bridge Slabs for Safety Railing Refurbishment in Italy: A State-of-the-Art Review

The recent accident of Mestre (northern Italy), which caused 21 fatalities due to a bus falling from a bridge, strongly highlighted the safety problem related to the presence of old railings along Italian roads. Bridge railings, also known as guardrails or parapets, serve the crucial function of preventing vehicles from accidentally driving off the edge of a bridge. Performance requirements of safety railings have been recently increased due to laws and technical standards enforced in Italy and Europe. However, many bridges along important roads, such as motorways and highways, are currently equipped with outdated safety railings since they were built before these regulations came into force. Therefore, many people are daily exposed to the risk of heavy accidents due to railing failures as well as vehicles and people eventually present below such structures. This paper aims to outline the technical problems and solutions in bridge refurbishment interventions devoted to increasing traffic safety as, for example, the installation of code-conforming railings, which often require the structural retrofit of bridge elements supporting the railing. To this end, several technical solutions are described and critically compared, and, finally, an economic analysis is reported to highlight the slab retrofit influence on the total intervention cost.

Tibial Plateau Fractures Complicated by Compartment Syndrome are Associated with a Three Times Higher Cost of Care.

To determine the impact of acute compartment syndrome (ACS) and identify cost-drivers of 1-year total treatment costs for operative tibial plateau fractures. Retrospective review. Level 1 Trauma Center. 337 patients with tibial plateau fractures, 24 of which were complicated by ACS. The primary outcome was total treatment cost over the first year for operatively treated tibial plateau fractures. The secondary objective was to use regression analysis to identify significant cost drivers. The diagnosis of ACS was associated with 2.85 times higher in total treatment cost (p < 0.001). Acute compartment syndrome demonstrated increased total treatment cost when controlling for polytrauma (p < 0.001) and post-operative infection (p < 0.001). Regression analysis identified 5 variables significantly associated with total cost of care: Body Mass Index, Injury Severity Score, ACS, Staged External Fixation, and Locking Fixation (p < 0.001; R2 = 0.57). The diagnosis of ACS had the largest impact on total cost with a 3.5x greater impact on cost compared to the next highest variable, staged external-fixation. Tibial plateau fractures complicated by ACS are associated with 2.85 times higher treatment costs over a 1-year period. There were 5 significant variables identified by regression analysis with ACS having the highest impact on total treatment. Together, these 5 factors account for 57% of treatment cost variability. Economic Level III. See Instructions for Authors for a complete description of levels of evidence.

A real-world, retrospective, observational study examining treatment patterns and clinical outcomes in patients with FLT3m + AML in Japan

Objective Acute myeloid leukemia (AML) is the most common form of leukemia among adults in Japan. This study aimed to understand the treatment patterns, health care resource utilization, and costs of FMS-like tyrosine kinase 3 mutation-positive (FLT3m+) AML patients in Japan. Methods A retrospective cohort study of Japanese FLT3m + AML patients was conducted using data extracted from a national hospital-based claims database provided by Medical Data Vision Co. Ltd. (MDV; Tokyo, Japan). Patients were identified from the MDV database between April 2008 and April 2021 inclusive. Results A total of 360 patients were included in this study. The study results suggest that cytarabine + anthracyclines was the most common first-line (1 L) treatment, accounting for 41.3% of the patients. FLT3 inhibitors (FLT3i) was the most common treatment across the study period (95.7%). The mean age of patients was 62.4 years, and most were 65 years or older. The median overall survival (OS) after initiating FLT3i treatment was 394 days. The median treatment duration of FLT3i was 88.5 days, while it was 66.0 days for patients treated with FLT3i within 60 days after hematopoietic stem cell transplantation (HSCT). The overall mean monthly total treatment cost was JPY 2,009,531.7/per patient per month (PPPM) (USD 17,967.9/PPPM). Conclusions The study found specific treatment patterns, trends and features in patients with FLT3m + AML. FLT3i was the most prescribed treatment across the study period and the overall median OS after initiating FLT3i treatment was over 1 year. The findings of this study could be helpful for clinicians to optimize treatment strategies for FLT3m + AML in Japan.

Chi phí chẩn đoán và điều trị cho người bệnh Viêm gan vi rút C mạn tính tại bệnh viện A Thái Nguyên, năm 2021

Objective: To calculate the average cost of outpatient chronic hepatitis C diagnosis and treatment from the view of Vietnam Social Security (VSS), A Thai Nguyen Hospital, in 2021; Methods: Cross-sectional descriptive study. Study is based on retrospective billing data from hospital discharge records with 257 Hepatitis C outpatients who completed treatment from May 2021 to Dec 2021 at Thai Nguyen A Hospital. Main findings: The average cost per case of diagnosis and treatment for chronic HCV patients in the non-cirrhotic stage or compensated cirrhosis is 30 million VND and 58 million VND for patients with decompensated cirrhosis. Drug costs account for more than 90% of the total cost of diagnosis and treatment of chronic HCV. Conclusions: The study provided evidence on the cost of diagnosis and treatment for VGC outpatients from the point of view of Vietnam Social Security at A Thai Nguyen hospital. The average total cost of diagnosis and treatment for 01 patient in the late stage with decompensated cirrhosis is double price for 01 patient in the early stages (no cirrhosis/compensated cirrhosis). In addition, drug costs account for more than 90% of the cost of diagnosis and treatment. Thai Nguyen province promote screening and treatment programs for HCV at an early stage such as without cirrhosis or with compensated cirrhosis. At the same time, implementing methods of drug procurement to reduce prices and continue to lobby for funding for the diagnosis and treatment of HCV to help reduce the burden of HCV in the locality. Keywords: Costing, Hepatities C, A Thai Nguyen Hospital

OTHER-13 A RETROSPECTIVE STUDY OF BRAIN TUMOURS IN YAOUNDE CAMEROON.

Abstract A brain tumour (BT) or intracranial tumour, is an abnormal mass of tissue where cells grow uncontrollably and unaffected by typical cell regulatory systems. In Sub-Saharan Africa, however, these tumours continue to go unnoticed. The aim of this 5-year retrospective study (January 2018 to March 2023), was to determine the relative frequency and histologic types of brain tumours that exist, and to analyze the costs of treatment and diagnostic methods used. The study was conducted within the oncology and neurosurgery departments of 2 Cameroonian hospitals: Yaoundé Central Hospital and Yaoundé General Hospital. A total of 78 complete case files, or 1.05% of all admissions to the various units, were analyzed. The male to female ratio was 0.95 (38M: 40F). 15.4% of cases involved patients below the age of 14. 84.6% involved patients 15years of age and above. 94.9% of the cases were primary brain tumours. In 60.3% of instances, individuals with primary brain tumours were between the ages of 22 and 57. Meningioma (30.8%) was the most common histological form, followed by astrocytoma (25.6%) and pituitary adenomas (16.7%). Most patients experienced symptoms of increased intracranial pressure, with headaches occurring 94.9% of the time. The average diagnostic cost was 235 000 CFA, average operation cost was 337 500 CFA, and average treatment cost was 750 000 CFA, putting the total cost at 1 322 500 CFA. The country's minimum wage is estimated at 40 000CFA (net income), with average household income of 100 000CFA.The age group that is most impacted is young adults, who were more likely to develop meningioma, astrocytoma, and pituitary adenomas than any other types of brain tumours. The total cost of treatment is 33 times the minimum wage or 13 times the average income. To evaluate the long-term outcome of patients with BTs, more research is required.

Kết quả thanh quyết toán chi phí khám chữa bệnh bảo hiểm y tế giữa Bệnh viện Đại học Y Dược Thành phố Hồ Chí Minh và cơ quan Bảo hiểm xã hội Thành phố Hồ Chí Minh năm 2021 - 2022

Objectives: Describe the results of reimbursement of medical expenses covered by health insurance between University Medical Center Ho Chi Minh City and Ho Chi Minh City Social Security Office in 2021-2022. The study was designed based on cross-sectional descriptive study method, using secondary data on health insurance payments. The total cost of medical examination and treatment with health insurance at the hospital was enormous, reaching 885 billion VND in 2021, 1,281 billion VND in 2022. The total comprehensive settled expenses with Social Insurance reached 99.96% in 2021 and 99.85% in 2022. In 2021, the rate of medical payment refusal in testings was the highest, accounting for 69.80%, followed by operations-procedures with 23.95% and medications accounting for 5,75%. In 2022, meditations refusal accounted for 63.70%, medical supplies for 19.33% and operations-procedures with 12.28%. In 2021-2022, the hospital did not exceed the total payment of medical expenses covered by health insurance. The causes of settlement refusals are drugs already included in surgery/procedure packages, mis-applying prices of technical services, inapproprate drug and testing prescriptions on medical records. The hospital need to invest strongly in information technology, effectively support medical staff in managing medical records, enhance inspections and reviews of drug and medical supply billing when performing surgery/procedure. Keywords: Settlement results, health insurance

The economic impact of treating hypertension in sub–Saharan Africa - A systematic review

Abstract Background Hypertension is a leading risk factor for cardiovascular diseases, with high numbers of undiagnosed and untreated patients in sub-Saharan Africa (SSA). While the disease poses a substantial social and economic burden for patients and health systems, research on the economic consequences remains scarce. This systematic review compared hypertension treatment costs in SSA and identified possible cost drivers and opportunities to reduce the economic burden. Methods A systematic search was performed in six databases (PubMed, Web of Science, CINAHL, ISPOR, EconLit and Google Scholar) for peer-reviewed articles published in English from inception to Jan. 2022. We included studies assessing the direct or indirect costs of hypertension treatment across SSA. All results were converted to 2021 US Dollars. Results Of 3999 initial articles, 33 were included in the systematic review. Only 12 of 48 SSA countries provided data on the economic burden of hypertension, and results varied according to their perspective and setting. Total treatment costs per patient ranged from monthly 2.70$ for medicine collection visits in Ghana to 46.24$ for emergency visits in Kenya for patients and from 6.52$ in Ghana to 28.19$ in Rwanda for providers. Medication costs had the most significant impact and were the most reported cost item. Treatment in higher-level hospitals and private institutions was considered more expensive. Single or combinative use of angiotensin-converting enzyme inhibitors, calcium channel blockers and diuretics were the cheapest treatment options across SSA. Conclusions Hypertension care poses a significant economic burden for health systems and patients. While the costs were heterogeneous according to measuring and financing methods, medication was identified as the most critical cost factor. Reducing medication costs, supporting patients through subsidies, using generics and cheaper therapy options should be considered. Key messages • Hypertension costs in sub-Saharan Africa are a significant burden mainly driven by medications. • Introducing targeted subsidies, generics, and low-priced therapies could reduce medication costs.

Cost-Effectiveness of a Comprehensive Primary Care Smoking Treatment Program

Smoking is the leading preventable cause of death and disease in the U.S. This study evaluates the cost-effectiveness from a healthcare system perspective of a comprehensive primary care intervention to reduce smoking rates. This pragmatic trial implemented electronic health record prompts during primary care visits and employed certified tobacco cessation specialists to offer proactive outreach and smoking cessation treatment to patients who smoke. The data, analyzed in 2022, included 10,683 patients in the smoking registry from 2017 to 2020. Pre-post analyses compared intervention costs to treatment engagement, successful self-reported smoking cessation, and acute health care utilization (urgent care, emergency department visits, and inpatient hospitalization). Cost per quality-adjusted life year was determined by applying conversion factors obtained from the tobacco research literature to the cost per patient who quit smoking. Tobacco cessation outreach, medication, and counseling costs increased from $2.64 to $6.44 per patient per month, for a total post-implementation intervention cost of $500,216. Smoking cessation rates increased from 1.3% pre-implementation to 8.7% post-implementation, for an incremental effectiveness of 7.4%. The incremental cost-effectiveness ratio was $628 (95% CI: $568, $695) per person who quit smoking, and $905 (95% CI: $822, $1,001) per quality-adjusted life year gained. Acute health care costs decreased by an average of $42 (95% CI: -$59, $145) per patient per month for patients in the smoking registry. Implementation of a comprehensive and proactive smoking cessation outreach and treatment program for adult primary care patients who smoke meets typical cost-effectiveness thresholds for healthcare.

Real-world treatment patterns, healthcare resource utilizationand costs among patients with peripheral T-cell lymphoma.

Objective: To evaluate treatment patterns, healthcare resource utilization (HRU)and costs among peripheral T-cell lymphoma (PTCL) patients in the USA. Methods: A retrospective cohort study, using theIQVIA PharMetrics® Plus claims database from 1April 2011 to 30November 2021, identified PTCL patients receiving systemic treatments. Three mutually exclusive subcohorts were created based on line of therapy (LOT): 1LOT, 2LOTand ≥3LOT. Common treatment regimens, median time on treatment, all-cause and PTCL-related HRU and costs were estimated. Results: Among 189 PTCL patients identified, 61.9% had 1LOT, 21.7% had 2LOTand 16.4% had ≥3LOT. The most common treatment regimens in the 1LOT were CHOP/CHOP-like, CHOEP/CHOEP-likeand brentuximab vedotin; monotherapies were most common in the 2LOT and ≥3LOT. All-cause and PTCL-related hospitalizations and prescriptions PPPM increased with increasing LOT. Nearly 70% of total treatment costs were PTCL related. Conclusion: Higher utilization of combination therapies in the 1LOT and monotherapies in subsequent LOTs were observed, alongside high PTCL-related costs.