Total Treatment Costs Research Articles

Treatment-Related Cost Analysis of Terlipressin for Adults with Hepatorenal Syndrome with Rapid Reduction in Kidney Function.

Hepatorenal syndrome (HRS), a special form of acute kidney failure, is a rare, acute, life-threatening complication of cirrhosis and has a very poor prognosis. Terlipressin (TERLIVAZ®) is the first and only pharmacological treatment approved by Food and Drug Administration (September 2022) to improve kidney functionfor adults with HRS with rapid reduction in kidney function. We constructed a decision analytic economic model to estimate the cost per complete response/HRS reversal of terlipressin+albumin from a United States hospital perspective. A decision analytic model was developed to estimate the HRS treatment-related cost per response over an HRS hospitalization (assuming 14days). Patients can experience either HRS reversal (complete response) or no HRS reversal (partial/no response) upon receipt of treatment. The efficacy, safety, and treatment duration data were from published head-to-head randomized international trials. Total treatment cost comprised drug acquisition and treatment-related costs (intensive care unit [ICU], dialysis [intermittent or continuous], pulse oximetry monitoring for terlipressin, and adverse events) sourced from the published literature. Cost per response, defined as the total treatment cost per HRS reversal was estimated for each treatment. The number needed to treat (NNT), defined as the number of patients treated to achieve HRS reversal in 1 additional patient, was estimated. Cost per response of terlipressin+albumin was lower than midodrine and octreotide+albumin (M&O) (US$85,315 vs. $467,794) and norepinephrine+albumin ($81,614 vs. $139,324). NNT for HRS reversal was 2 patients with terlipressin+albumin vs. M&O+albumin and 4 patients with terlipressin+albumin vs. norepinephrine+albumin, respectively. The analysis shows that terlipressin is a cost-effective treatment due to its higher efficacy and administration in the non-ICU setting. Terlipressin is a value-based treatment option for appropriate adults with HRS with rapid reduction in kidney function.

Cost-effectiveness analysis of camrelizumab combination with radiotherapy for management of advanced/metastatic esophageal squamous cell carcinoma

Purpose: To determine the cost-effectiveness and efficacy of camrelizumab when combined with radiotherapy in the management of advanced/metastatic esophageal squamous cell carcinoma (ESCC).Methods: A retrospective analysis was carried out on clinical information of 115 patients with advanced/metastatic ESCC admitted to Huai'an Cancer Hospital between February 2017 and January 2021. Based on therapeutic modality, patients were distributed into control group (CG, 55 cases, cisplatin + paclitaxel chemotherapy) and study group (SG, 60 cases, camrelizumab + radiotherapy regimen). Clinical efficacy, adverse effects, cost indicators (total cost of treatment, out-of-pocket costs, medical insurance cost), serum tumor marker levels (CEA, CYFRA21-1, SCC-Ag), immune function (IgA, IgG, IgM), and quality of life were compared between the two groups.Results: The objective remission rate (ORR) in SG (80 %) was significantly higher than in CG (61.8 %) (p < 0.05). Serum levels of CEA, CYFRA21-1, SCC-Ag in both groups and symptom scores decreased, while serum IgA, IgG, IgM, function, and overall quality of life score increased, but the improvement was greater in SG after 6 weeks of treatment (p < 0.05). Study group had significantly higher out-of-pocket expenses, health insurance costs, total costs, and cost/effectiveness than CG (p < 0.05).Conclusion: Camrelizumab combined with radiotherapy in the treatment of advanced/metastatic ESCC is efficacious, improves immune function, reduces serum tumor marker levels, and prolongs the survival time of patients. Clinical studies using larger population should be carried out to validate the findings of this study.

Cost-Effectiveness Analysis of Long-acting Injectable Once-monthly of Aripiprazole Compared with Long-acting Injectable Once-monthly Paliperidone Palmitate for the Treatment of Stable Schizophrenia Patients in Thailand

Objective: Long-acting injectable (LAI)-aripiprazole and LAI-paliperidone palmitate are both second-generation antipsychotics that have been introduced to increase drug compliance in patients. These attributes are expected to enhance drug compliance, particularly in stable patients. The previous studies demonstrated that the efficacy of LAI-aripiprazole and LAI-paliperidone palmitate is controversial. Nevertheless, the costs of treatments and adverse events of both LAI-aripiprazole and LAI-paliperidone palmitate are unlikeness. As there had been no previous cost-effectiveness studies comparing the use of LAI-aripiprazole and LAI-paliperidone palmitate in Thailand, this study was carried out to investigate the matter. Materials and Methods: This study analysed the cost-effectiveness of LAI-aripiprazole compared with LAI-paliperidone palmitate in the treatment of stable schizophrenia, by using the Markov model from a societal perspective. Results: The total cost of treatment with LAI-aripiprazole and LAI-paliperidone palmitate was 1,334,919.05 baht and 1,329,818.79 baht, respectively, while the quality-adjusted life years (QALYs) were both 16.35 years. Life-year of the treatment with LAI-aripiprazole and LAI-paliperidone was 24.27 years and 24.25 years, respectively. The cost-effectiveness ratios (CER) of the treatment with LAI-aripiprazole and LAI-paliperidone palmitate were 81,652.85 baht/QALY gained and 81,330.94 baht/QALY gained, respectively. Conclusion: In Thailand, the treatment of stable schizophrenia with LAI-aripiprazole was shown to provide similar benefits to LAI-paliperidone palmitate in terms of QALYs, despite being more costly. Comparatively, LAI-aripiprazole exhibited better clinical efficacy and led to a longer average life expectancy than LAI-paliperidone. Treatment with LAI-aripiprazole may be dominant strategy, especially with a 2% reduction in drug cost. The results could contribute to appropriate decision-making by policymakers.

Cost Analysis of High-Flow Oxygen Therapy Compared with Conventional Oxygen Therapy in Severe COVID-19 in Colombia: Data from a Randomized Clinical Trial.

A randomized clinical trial (HiFlo-COVID-19 Trial) showed that among patients with severe COVID-19, treatment with high-flow oxygen therapy (HFOT) significantly reduced the need for invasive mechanical ventilation support and time for clinical recovery compared with conventional oxygen therapy (COT). However, the cost of this strategy is unknown. We examined total cost of HFOT treatment compared with COT in real-world setting. We conducted a post-trial-based cost analysis from the perspective of a managed competition healthcare system, using actual records of billed costs. Cost categories include general ward, intensive care unit, procedures, imaging, laboratories, medications, supplies, and others. A total of 188 participants (mean age 60, 33% female) were included. Average costs (and standard deviation) in the HFOT group were USD $7992 (7394) and in the COT group USD $ 10,190 (9402). Differences, however, did not reach statistical significance (P=0.093). However, resource use was always less costly for the HNFO group, with an overall percentage decrease of 27%. Two categories make up 72% of all savings: medications (41%) and intensive care unit (31%). For patients in ICU with severe COVID-19 the cost of treatment with HFOT as compared to COT is likely to be cost-saving due to less use of medications and length of stay in ICU.

A new fuzzy approach and bankruptcy theory in risk estimation in Waste Load Allocation.

In this paper, we developed a simulator-optimizer model based on risk analysis to determine Waste Load Allocation (WLA). A new Fuzzy index as Fuzzy Risk Index (FRI) was linked with multi-objective optimization to minimize FRI for the environmental stakeholder and the total cost of sewage treatment for the polluting industries as the other collective stakeholder. Afterwards, the conflict was resolved with the help of Nash bargaining and bankruptcy approach (Constrained Equal Awards Rule). The model was run using quantitative/qualitative data for the KhoramAbad River. To check the efficiency of FRI, the process followed for WLA was reimplemented by the Monte Carlo simulation (MCS). A comparison between the two approaches revealed that the outcomes derived from Fuzzy arithmetic across all aspects, encompassing river qualitative simulation, nondominated curve, Nash bargaining's agreed point, and bankruptcy output, closely mirrored the results of MCS. The notable distinction lies in the drastic reduction of the model's execution time by a factor of 450.

Medical service utilization by children with physical or brain disabilities in South Korea

BackgroundChildren with physical or brain disabilities experience several functional impairments and declining health complications that must be considered for adequate medical support. This study investigated the current medical service utilization of children expressing physical or brain disabilities in South Korea by analyzing medical visits, expenses, and comorbidities.MethodsWe used a database linked to the National Rehabilitation Center of South Korea to extract information on medical services utilized by children with physical or brain disabilities, the number of children with a disability, medical visits for each child, medical expenses per visit, total medical treatment cost, copayments by age group, condition severity, and disability type.ResultsBrain disorder comorbidities significantly differed between those with mild and severe disabilities. Visits per child, total medical treatment cost, and copayments were higher in children with severe physical disabilities; however, medical expenses per visit were lower than those with mild disabilities. These parameters were higher in children with severe brain disabilities than in mild cases. Total medical expenses incurred by newborns to three-year-old children with physical disorders were highest due to increased visits per child. However, medical expenses per visit were highest for children aged 13–18.ConclusionMedical service utilization varied by age, condition severity, and disability type. Severe cases and older children with potentially fatal comorbidities required additional economic support. Therefore, a healthcare delivery system for children with disabilities should be established to set affordable medical costs and provide comprehensive medical services based on disability type and severity.

Genetic selection for reduced health treatment costs in Holstein cows: implications from a long-term study.

The objective of this study was to estimate genetic parameters of health treatment cost of Holstein cows from producer-recorded health treatments in 8 herds over an 8-yr period of time. Genetic parameters of health treatment cost were estimated in first (n = 2,214), second (n = 1,487) and third (n = 800) parities of US Holstein cows. The health treatments were uniformly defined and consistently recorded by 8 high-performance dairy herds in Minnesota from 2008 to 2015. A fixed treatment cost was assigned to 14 types of health treatments, and the cost included the mean veterinary expense obtained from the veterinary clinics that serviced the 8 herds, pharmaceuticals, and labor cost. The labor cost was $18/h, and the time incurred for each type of health treatment was determined from interviews with the herd owners. The 14 types of health treatment costs were partitioned into 5 categories: mastitis (including mastitis diagnostic test), reproduction (cystic ovary, retained placenta, and metritis), lameness (hoof treatments), metabolic (milk fever, displaced abomasum, ketosis, and digestive), and miscellaneous (respiratory, injury, and other). Health treatment cost for each cow was summed by category within lactation and also across categories within lactation. The estimates of heritability for health treatment cost were 0.13, 0.04, 0.10, 0.12, and 0.04 for the mastitis, reproduction, lameness, metabolic, and miscellaneous categories, respectively, in first parity. Genetic correlations between categories of health treatment cost in first parity were greatest for mastitis and reproduction (r = 0.85); however, phenotypic correlations between all categories were small (r < 0.16). Total health treatment cost had a large genetic correlation with somatic cell score (0.93) and 305-d milk production (0.44) in first parity; however, the genetic correlation (-0.60) between total health treatment cost and udder depth in first parity indicated a genetic relationship exists between shallow udders and less total health treatment cost. Total health treatment cost across categories had a heritability estimate of 0.25 in first parity, 0.16 in second parity, and 0.17 in third parity. Consequently, genetic selection for reduced health treatment cost should be possible by using producer-recorded health treatment records supplemented with treatment costs.

Healthcare use and direct medical costs in a cleft lip and palate population: an analysis of observed and protocolized care and costs

This study was performed to describe observed healthcare utilization and medical costs for patients with a cleft, compare these costs to the expected costs based on the treatment protocol, and explore the additional costs of implementing the International Consortium for Health Outcomes Measurement (ICHOM) Standard Set for Cleft Lip and Palate (CL/P). Forty patients with unilateral CL/P between 0 and 24 years of age, treated between 2012 and 2019 at Erasmus University Medical Center, were included. Healthcare services (consultations, diagnostic and surgical procedures) were counted and costs were calculated. Expected costs based on the treatment protocol were calculated by multiplying healthcare products by the product prices. Correspondingly, the additional expected costs after implementing the ICHOM Standard Set (protocol + ICHOM) were calculated. Observed costs were compared with protocol costs, and the additional expected protocol + ICHOM costs were described. The total mean costs were highest in the first year after birth (€5596), mainly due to surgeries. The mean observed total costs (€40,859) for the complete treatment (0–24 years) were 1.6 times the expected protocol costs (€25,198) due to optional, non-protocolized procedures. Hospital admissions including surgery were the main cost drivers, accounting for 42% of observed costs and 70% of expected protocol costs. Implementing the ICHOM Standard Set increased protocol-based costs by 7%.

Operative vs. conservative treatment of AC-Joint Dislocations Rockwood grade ≥ III -An economical and clinical evaluation-

IntroductionAcromioclavicular joint dislocations (ACD) are one of the most common shoulder injuries. There is no consensus in how to treat higher graded ACD ≥ Rockwood grade III. This study compares operative versus conservative treatment regarding costs and clinical outcome parameters.Materials and MethodsThis retrospective, consecutive case-control-study includes 14 patients. Seven operatively treated patients were matched, by Rockwood grade, with seven conservatively treated patients. The cost was extracted out of the clinical- and insurance-based cost sheets and furthermore these include the loss of earnings. Clinical examination, demographic data as well as different outcome-questionnaires were recorded.ResultsThere were no significant differences between operative and conservative treated patients for outcome Questionnaires. Of note, there was a significantly higher incidence of tenderness over the AC-joint (p = 0.0038) postoperatively. As expected, economical evaluation showed various findings in favor of the conservative treatment. The costs for medical services (11012.39vs.1163.81USD; p = 0.0061), days of hospitalization (3.3vs.0days; p < 0.0001); total cost for medical treatment (30262.17 vs. 7833.82 USD; p = 0.0358) were significantly higher in the operative group.ConclusionEven with a limited case number and a retrospective study design almost all clinical results were equal in both groups. Operative therapy of higher graded ACDs (Rockwood > III) compared to conservative is economically inefficient. Under consideration of clinical comparable results, indications for operative treatment should be set very carefully.

Hepatitis C Elimination in Moldova Is Feasible and Cost-Saving: A Modeling Study.

Moldova, an upper-middle-income country in Eastern Europe, is facing a high burden of hepatitis C virus (HCV). Our objective was to assist the National Agency of Public Health of Moldova in planning to achieve the World Health Organization's HCV elimination goals by 2030. This study adapted a previously developed microsimulation model to simulate the HCV epidemic in Moldova from 2004 to 2050. Model outcomes included temporal trends in HCV infection, prevalence, mortality, and total cost of care, including screening and treatment. We evaluated scenarios that could eliminate HCV by 2030. Multiple strategies could lead to HCV elimination in Moldova by 2030. A realistic scenario of a 20% annual screening and 80% treatment rate would require 2.75 million individuals to be screened and 65 000 treated by 2030. Compared to 2015, this program will reduce HCV incidence by 98% and HCV-related deaths by 72% in 2030. Between 2022 and 2030, this strategy would cost $17.5 million for HCV screening and treatment. However, by 2050, the health system would save >$85 million compared to no investment in elimination efforts. HCV elimination in Moldova is feasible and can be cost saving, but requires resources to scale HCV screening and treatment.

Assessment of Direct Costs of Admission Due to Presumed Microbial Keratitis in a Tertiary Referral Hospital in Thailand: A 7-Year Retrospective Study.

To evaluate the direct healthcare cost of admission and examine the effects of cost drivers of treating presumed microbial keratitis (MK) at a tertiary referral hospital. Retrospective study. A total of 741 patients who presented with MK were included. All information regarding costs was collected, and demographic data were employed for risk factor analysis. The total cost of treating MK over a 7-year period at Rajavithi Hospital was US$14,514,625.04, while the median cost was US$10,840.17 per patient (Q1-3, US$5866.56-24,172.28). The medical professional services were the highest cost category in terms of both total cost of treatment over 7 years and median cost per patient, accounting for US$6,474,718.43 and US$5235.20 (Q1-3, US$2582.79-10,474.24) respectively. In 2020, the total cost of treatment declined, corresponding with fewer hospitalized patients; however, the median cost per patient was the highest of all years, amounting to US$15,089.90 (Q1-3, US$8064.17-29102.50), while the median cost per patient from 2014 to 2019 was US$9969.96 (Q1-3, US$5177.98-21,942.68). Statistical significance was found in the median cost per patient in 2020 compared to the median cost per patient in 2014-2019 (p-value 0.019). Risk factors associated with the more expensive cost of treatment were longer length of stay (LOS); age more than 60 years old; readmission; diabetes mellitus (DM); hypertension; and heart disease. There were several key factors impacting the direct healthcare costs of severe MK treatment. Medical professional services emerged as the most substantial cost category, while longer hospital stays, older age groups, readmission cases, and comorbidities such as diabetes mellitus, hypertension, and heart disease were all linked to elevated treatment expenses. There were no statistically significant differences in the direct medical expenses during hospitalization associated with treating severe MK, whether the culture results were positive or negative, or regardless of the type of cultured organism utilized.

Time-Driven Activity-Based Costing of Prosthetic Dental Treatment

Purpose: Health systems worldwide have sustainability concerns due to rising demand and healthcare services costs. Value-based healthcare (VBHC) may solve all sustainability challenges by improving health outcomes. Improving outcomes is the only effective approach to cutting healthcare expenses. Cost-assessment methodologies that can give high-quality cost information are required to implement value-based initiatives. Time-driven activity-based costing (TDABC) method, a cost component of VBHC, has been increasingly adopted to close the cost-information gap.&#x0D; Materials &amp; Methods: The study calculates prosthetic dental treatment costs with the time-driven activity-based costing method. Data for this study were collected from the prosthesis department of a dental hospital in 2019. &#x0D; Results: The department's total practical capacity was estimated as 1,365,888 min for dentists and 328,320 minutes for patient consultants. The dentist capacity cost rate was calculated as 1.71 TL/min and for a patient consultant as 0.69 TL/min. Total prosthetic dental treatment costs range between 252.7TL and 304TL, depending on complications, emergencies, consultation or sedation needs.&#x0D; Conclusion: Activity-Based Costing provides accurate cost information and improves the process by making costs and activities more transparent. The prosthetic dental treatment process was presented transparently in the study. The costing model was designed to be expanded concerning the patient's urgency, the consultation and sedation needs. The cost of only one procedure was calculated in the study, and it is planned to evaluate all department activities in future research.

Economic burden of adult patients with β-thalassaemia major in mainland China

Backgroundβ-thalassaemia major poses a substantial economic burden, especially in adults. We aimed to estimate the economic burden of adult patients with β-thalassaemia major from a societal perspective using the real-world data. According to the clinical guideline, we also estimated the annual medical costs for patients with the same body weight and calculated the lifetime medical costs over 50 years in mainland China.MethodsThis was a retrospective cross-sectional study. An online survey with snowball sampling covering seven provinces was conducted. We extracted patient demographics, caregiver demographics, disease and therapy information, caring burden, and costs for adult patients diagnosed with β-thalassaemia major and their primary caregivers. In the real world, we estimated the annual direct medical cost, direct nonmedical cost, and indirect cost. In addition, we calculated the annual direct medical cost and lifetime direct medical cost by weight with discounted and undiscounted rates according to the clinical guideline.ResultsDirect medical costs was the main driver of total cost, with blood transfusion and iron chelation therapy as the most expensive components of direct medical cost. In addition, adult patients with β-thalassaemia major weighing 56 kg were associated with an increase of $2,764 in the annual direct medical cost using the real-world data. The undiscounted and discounted (5% discount rate) total lifetime treatment costs were $518,871 and $163,441, respectively.ConclusionsPatients with β-thalassaemia major often encounter a substantial economic burden in mainland China. Efforts must be made to help policymakers develop effective strategies to reduce the burden and pevalence of thalassaemia.

Evaluation of the efficacy of ureteroscopic lithotripsy for proximal impacted ureter stones based on a new scoring standard: a bicentric matched-pair analysis.

To evaluate the clinical efficacy of ureteroscopic lithotripsy (URSL) in the treatment of proximal impacted ureter stones (PIUS) based on a new scoring standard in two medical centers. The data of 45 patients with Complicated PIUS (total stone score ≥ 3) and 350 with Simple PIUS (total stone score < 3) who underwent URSL were collected in this retrospective study between January 2015 and June 2022. The definition and scoring standards for preoperative high-risk factors associated with stones included whether the diameter of the stone was > 2cm, stone density was > 1000 HU, there was a history of lithotripsy, the degree of hydronephrosis was greater than moderate, and there was an infection. Scores for stones were then assigned (yes = 1, no = 0), and the Complicated stone case was defined as a total stone score ≥ 3; the Simple stone case was defined as a total stone score < 3. During the same period, 45 patients were selected from the patients with Simple stone cases as the control group, matched at a 1:1 ratio to index Complicated stone cases with regard to age, sex, and BMI. Perioperative data were compared between the two groups. All 90 operations were successfully completed. Compared to the Simple cases group, the surgical duration of the Complicated group was significantly longer (59.69 ± 28.06min vs. 73.46 ± 27.12min, p < 0.05), and stone-free rate (SFR) was significantly lower (88.89 vs. 68.9%, p < 0.05). There was a significant difference in complication rate between the two groups regarding Clavien grade I, II, or III complications (20.0% in Complicated cases group vs. 8.9% in Simple cases group, p = 0.037). As for the length of the hospital stay and the total treatment cost, the two groups have no difference. For Simple stone cases, URSL had a better SFR and higher surgical efficacy, whereas complicated stone cases had a high complication rate and long operation time. Thus, we suggest that URSL is the preferred choice for Simple stone cases rather than complicated stone cases.

Genetic evaluation of health costs in US organic Holstein calves and cows

Minimizing the incidence of disease on organic dairy farms is important for both economic and animal welfare purposes. The objective of this study was to estimate genetic parameters for total disease treatment costs using producer-recorded treatments in organic Holstein dairy calves and cows. Individual cow and calf health data were collected from 16 USDA certified organic farms from across the United States. Eleven of these farms provided treatment costs for some or all of the following cow health issues (mean cost): mastitis ($46.10), milk fever ($39.05), ketosis ($29.81), metritis ($28.66), retained placenta ($45.59), displaced abomasum ($439.71), lameness ($66.36), indigestion ($22.94), respiratory ($48.35), and died ($64.98). These farms also provided the following health costs for calves (mean cost): respiratory ($56.37) and scours ($25.21). Costs included consultant fees, therapeutics, and producer labor. The total lactational health cost (HCOST) was analyzed using animal models adjusted for the fixed effects of lactation and herd and the random effect of herd-year-season of calving with animal relationships based on the blending of pedigree and genomic relationships established from 2,347 genotyped cows. Along with HCOST, the binary traits stayability and presence of disease were included in a trivariate model such that lactations absent of disease were considered to be missing HCOST. To estimate the genetic relationship between nulliparous and primiparous health costs, a 2-trait linear model was fitted for total nulliparous health costs (NHCOST) and first lactation HCOST. The most expensive cow-lactation was $643.86 and 26.5% of lactations encountered disease. The heritability for HCOST was 0.03 ± 0.01, and the repeatability was 0.21 ± 0.01. The heritability of NHCOST was 0.06 ± 0.01, and the genetic correlation between NHCOST and HCOST was 0.98 ± 0.51. Traits representing the repeated nature of disease have a genetic component that should foster improved disease resistance among organic Holstein dairy cows. However, total cost of disease did not lead to gains in genetic variation over consideration of disease traits considered as binary variables and is a more laborious phenotype to obtain, diminishing its appeal for use in routine genetic evaluations.

Cost of treating sick young infants (0-59 days) with Possible Serious Bacterial Infection in resource-constrained outpatient primary care facilities: An insight from implementation research in two districts of Haryana and Uttar Pradesh (India).

Information on the average and incremental costs of implementing alternative strategies for treating young infants 0-59 days old in primary health facilities with signs of possible serious bacterial infection (PSBI) when a referral is not feasible is limited but valuable for policymakers. Direct activity costs were calculated for outpatient treatment of PSBI and pneumonia in two districts of India: Palwal, Haryana and Lucknow, Uttar Pradesh. These included costs of staff time and consumables for initial assessment, classification, and referrals; recommended treatment of fast breathing (oral amoxicillin for seven days) and PSBI (injection gentamicin and oral amoxicillin for seven days); and daily assessments. Indirect operational costs included staff training; staff time cost for general management, supervision, and coordination; referral transport; and communication. The average cost per young infant treated for recommended and acceptable treatment for PSBI was 16 US dollars (US$) (95% CI = US$15.4-16.3) in 2018-19 and US$18.5 in 2022 (adjusted for inflation) when all direct and indirect operational costs were considered. The average cost of recommended treatment for pneumonia was US$10.1 (95% CI = US$9.7-10.6) or US$11.7 in 2022, per treated young infant. The incremental cost 2018-2019 for supplies, medicines, and operations (excluding staff time costs) per infant treated for PSBI was US$6.1 and US$4.3 and for pneumonia was US$3.5 and US$2.2 in Palwal and Lucknow, respectively. Operation and administrative costs were 25% in Palwal and 12% in Lucknow of the total PSBI treatment costs. The average cost per live birth for treating PSBI in each population was US$5 in Palwal and US$3 in Lucknow. Higher operation costs for social mobilisation activities in Palwal led to the empowerment of families and timely care-seeking. Costs of treatment of PSBI with the recommended regimen in an outpatient setting, when a referral is not feasible, are under US$20 per treated child and must be budgeted to reduce deaths from neonatal sepsis. The investment must be made in activities that lead to successful identification, prompt care seeking, timely initiation of treatment and follow-up.

Cost-Effectiveness of Hospice Palliative Care for Patients With Cancer and Family Caregivers: A Multicenter Study in Kazakhstan

ObjectivesIn Kazakhstan, palliative care is offered through hospices, cancer centers, general hospitals, and mobile teams to approximately 107 000 patients in need. As a country with a transitional economy and a newly implemented social healthcare insurance system, Kazakhstan seeks a cost-effective allocation of limited resources for end-of-life care. This study aimed to assess cost-effectiveness of hospice-based palliative care for patients with cancer compared with the current standard of care provided in cancer centers across the country and, thereby, provide a better understanding for policy making regarding palliative care. MethodsA total of 182 family caregivers were recruited, 104 from 3 hospices and 78 from 3 palliative care units of cancer centers. Patients’ state of health and family caregivers’ burden were assessed with the Palliative Outcome Scale and the Zarit Burden Interview. Direct medical and nonmedical costs and family caregivers’ out-of-pocket expenses associated with palliative care were collected. One-way and probabilistic sensitivity analysis was conducted by generating 1000 resamples using bootstrapping with Monte-Carlo simulation. ResultsAfter 14 days of inpatient palliative care, patients’ mean Palliative Outcome Scale score was 2.5 points better in the hospice group than the cancer center group. Family caregiver burden was 4.5 points better in the hospice group. Mean treatment costs were $31 lower for the hospice group. There was a statistically significant correlation between the total cost of treatment and patients’ quality of life (r = 0.58). Probabilistic sensitivity analysis showed that hospice-based care has better outcomes and lower costs than care provided in cancer centers in 80% of tested scenarios. ConclusionHospice-based palliative care is cost-effective compared with the care provided in palliative units of cancer centers in resource-limited settings in Kazakhstan.

Cost Effectiveness Analysis Treatment of Pediatric Pneumonia Antibiotic Ceftriaxon and Cefotaxime at Dr. Chasbullah Abdulmadjid Hospital

Introduction: Pneumonia is inflammation in the lung parenchyma. Inflammation occurs due to infection by various organisms like bacteria, viruses, and others. This infection eventually causes the emergence of several signs and symptoms. Ceftriaxone and cefotaxime are antibiotics that are commonly and effectively used in the treatment of pneumonia. Methods: The purpose of this study is to determine the total cost of pneumonia treatment provided during hospitalization at RSUD Bekasi City. This research uses the method descriptive research with data retrieval retrospectively. The sample in this research totaled 68 patients, 34 patients used ceftriaxone antibiotics and 34 patients used cefotaxime antibiotics. Results: Cefotaxime antibiotic therapy is a more cost-effective therapy compared to Ceftriaxone. This study found the effectiveness of Ceftriaxone 88% and Cefotaxime 70% but did not reach 100% effectiveness due to the large number of patients whose length of stay (LOS) and respiration rate (RR) did not reach the target. The result showed that the average cost of treating patients with Ceftriaxone was Idr 2,171,651 and the average cost of treating patients with Cefotaxime was Idr 2,467,422. Conclusion: Ceftriaxone antibiotic therapy is a more cost-effective therapy compared to Cefotaxime which can be, seen from the ACER Ceftriaxone value of IRp. 24,677 and ICER value of Rp. -16,431.651 and the average cost of treating patients using Cefotaxime was Idr 2,467,422.

Efficacy of Sublingual Immunotherapy in Allergic Rhinitis Patients with Asthma: A Systematic Review and Meta-Analysis.

Sublingual immunotherapy (SLIT) has been widely applied to treat patients with allergic rhinitis (AR). However, meta-analyses on the efficacy of SLIT in AR patients with asthma are still limited. Literature without language limitation published before October 28, 2022, were retrieved from PubMed, EMBASE, and Cochrane Library. STATA 16.0 software was used for the meta-analysis of the extracted data. The results reported were symptom scores, drug scores, adverse effects rates, and cost of treatment. Ten studies involving 1722 patients met the inclusion criteria. The total rhinitis score (TRSS) (weighted mean difference [WMD] = -1.23, 95% CI: -1.39--1.06, P < .001) and total asthma symptom score (TASS) (WMD = -1.00, 95% CI: -1.12-0.89, P < .001) were significantly lower in the SLIT group than the placebo group. The SLIT group had higher rates of treatment-related adverse events (relative risk [RR] = 2.82, 95% CI: 1.77-4.48, P < .001) and total costs of treatment (standardized mean difference [SMD] = 0.71, 95% CI: 0.45-0.97, P < .001). There was no significant difference in inhaled corticosteroids (ICS) dose (P = .195), fractional exhaled nitric oxide (FeNO) (P = .158), forced expiratory volume in 1 s (FEV1) (P = .237), and direct costs of treatment (P = .630) between the SLIT and placebo groups. SLIT may be a therapeutic method for improving rhinitis symptoms and asthma symptoms in AR patients with asthma. However, as there was significant heterogeneity in results, more high-quality and well-designed studies are needed in the future to elucidate the efficacy of SLIT.

Cost-sharing and horizontal compensation scheme of regional sulfur dioxide treatment: Evidence from China.

Establishing a reasonable cost-sharing and compensation mechanism for air pollution control is a prerequisite for realizing inter-regional cooperative treatment. Taking inter-provincial sulfur dioxide (SO2) emissions in China from 2005 to 2019 as the research object, this paper proposes a data-driven approach to establish a cost-sharing index system of regional SO2 treatment in four dimensions and construct a cost-sharing and compensation scheme using the entropy-TOPSIS method. The results revealed that there are significant spatial and temporal differences in the treatment cost of SO2 emission, and the total SO2 treatment costs at the national level increased first and then decreased during the study period, meanwhile, the regional SO2 treatment costs are much higher in the less economically developed regions such as the central and western regions than in economically developed eastern coastal regions. The design of the cost-sharing and compensation mechanism of SO2 treatment should consider the regional differences in abatement capacity, abatement potential, abatement responsibility, and development demands. The economically developed regions should share higher treatment costs according to their historical cumulative abatement responsibilities, and provide economic compensation and technical support to the less economically developed regions. Specifically, the marginal abatement cost in the more economically developed eastern region is much higher than that in the less economically developed central and western areas due to their large abatement responsibility and strong reduction capacity but insufficient abatement potential, so the eastern regions can transfer part of their abatement responsibility to the central and western regions using economic compensation. Reasonable cost sharing and horizontal compensation can help promote regional cooperation and synergistic management in air pollution abatement. Finally, corresponding policy recommendations are given to provide a decision basis for cross-regional cooperation in air pollution control.