Search

Background: The Asia-Pacific (APAC) region includes a significant proportion of the global population currently living with overweight and obesity. This modelling analysis was conducted to quantify the incidence of obesity-related comorbidities and change in obesity-related costs over 10 years with a hypothetical 10% weight loss in Australia, South Korea, Thailand, and India. Methods: An epidemiological-economic model was used to describe current prevalence and direct medical costs of ten obesity-related comorbidities, including type 2 diabetes and hypertension, in adults aged 20–69 years living with obesity, and estimate incidence and costs over 10 years. Incidence reduction and the associated savings by 2032 were then estimated for a 10% weight-loss scenario. Results: The total estimated medical costs for the ten obesity-related comorbidities in 2022 were 2.9, 7.5, 10.2, and 23.3 billion USD in Australia, South Korea, Thailand, and India, respectively. Costs increase to 6.9, 18.4, 23.5, and 44.3 billion USD in 2032, if insufficient action is taken. A 10% weight reduction would result in estimated savings of 0.3, 1.2, 2.2, and 3.0 billion USD in Australia, South Korea, Thailand, and India, respectively, in 2032, with cumulative savings over the 10-year period of 1.8, 7.0, 13.0, and 17.4 billion USD. Incidence of comorbidities were estimated to rise less in the weight-loss scenario. Conclusions: The financial, societal, and health benefits of a substantial but achievable 10% weight loss in adults living with obesity, and the consequences of insufficient action, are pronounced in the APAC region. To achieve sustained weight loss in the real world, policy actions for addressing barriers to obesity management are required. [ABSTRACT FROM AUTHOR]

AbstractObjectiveDesignSetting and subjectsMain outcome measureResultsConclusionsTo evaluate the impact of a compulsory pop-up form on the ordering pattern of proBNP blood tests by general practitioners in the Capital Region of Denmark.A follow-up study comparing the average number of proBNP tests ordered before and after the implementation of an intervention.From 2016 to 2021, the average number of proBNP tests increased by over 300%. In March 2022, a compulsory pop-up form was introduced in the electronic request system (WebReq), requiring general practitioners to select one of three indications for ordering proBNP, as recommended by the Danish Society of Cardiology. The study included 528 general practitioners in the Capital Region of Denmark, with data available from January 2020 to 2023, encompassing 83,576 proBNP results from 56,645 patients.The average number of proBNP tests ordered per month and the median level of proBNP before and after the intervention.Following the intervention, the average number of proBNP tests per month decreased by 60% over a 22-month follow-up period. The highest reduction was seen among general practitioners who previously ordered the most tests (≥3 per 1000 biochemical tests). In this group, the median proBNP level increased from 12.1 pmol/L before the intervention to 13.5 pmol/L after the intervention (p < 0.0001).This study demonstrates a significant decrease in the number of proBNP requests from general practitioners in the Capital Region of Denmark after the introduction of a pop-up form in the requisition system containing the current guidelines. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Method Results Conclusion Lyme borreliosis (LB) is the most common tick‐borne disease in Germany; however, data on the economic burden of LB are limited. In this study, we aim to report healthcare costs, healthcare resource utilisation (HCRU) and diagnostic consumption associated with LB by clinical manifestation.Using specific case definitions, patients with localised disease (erythema migrans [EM]) or disseminated disease (Lyme arthritis [LA], Lyme neuroborreliosis [LNB] and other rarer manifestations [OTH]) were identified from a claims database in 2016 and followed up for 3 years (2016–2019). After propensity score matching, excess costs and HCRU were calculated as the differences between each LB cohort and the matched control cohort.On a per‐patient basis, the excess all‐cause healthcare cost was €130 for EM during Quarter 1 of Year 1, and €1539 for LA, €3248 for LNB and €4137 for OTH during Year 1. Only for OTH, additional €1860 was observed in Year 2. No increase in costs was observed in Year 3. When extrapolated to all German patients with statutory health insurance, LB was associated with €64.5 million in excess costs. Although disseminated manifestations only accounted for 7.8% of all LB cases, they were responsible for 66% of overall costs. In addition, LB patients consumed healthcare resources of 1.4 million excess outpatient visits, 13,000 excess hospitalisations, 96,000 ELISAs and 65,000 Western blots.This study shows the substantial economic burden of LB to the German healthcare system. [ABSTRACT FROM AUTHOR]

Background: The impact of teleneurology on healthcare utilization (HCU) in MS is unknown. Objective: Evaluate the association between teleneurology and HCU. Methods: A retrospective longitudinal analysis of HCU among adult MS and clinically isolated syndrome (CIS) patients residing in the Cleveland/Akron area from July 2020 to July 2022. Negative binomial regression models evaluated the association between number of laboratory and MRI orders per visit and number of emergency visits per patient across patient groups with variable proportions of teleneurology visits. Results: A total of 3208 patients completed 15,795 visits. Patients using teleneurology had more visits (rate ratio (RR) 1.707–1.719, p < 0.001). Teleneurology visits had fewer laboratory (RR 0.571) and MRI orders (RR 0.693, p < 0.001). There was no difference in emergency care utilization for teleneurology patients (p ⩾ 0.05). More emergency visits were observed in Black (RR 1.414) and Medicaid (RR 1.893) patients, regardless of visit type (p < 0.001). Conclusion: Teleneurology visits were associated with fewer orders, suggesting teleneurology may be incorporated into healthcare models without increasing utilization related to the visit. Teleneurology was also associated with increased visit volumes but no difference in emergency HCU. More studies are needed to clarify the ultimate impact of teleneurology on overall HCU. More emergency visits, regardless of visit type, were observed among at-risk populations, warranting further investigation. [ABSTRACT FROM AUTHOR]

Background: Rural family caregivers (FCGs) in the United States often experience high economic costs. This randomized controlled trial compared a transitional palliative care intervention (TPC) to support FCGs of seriously ill care recipients (CRs) to an attention control condition. We evaluated the TPC's effect on healthcare use and out‐of‐pocket spending for both FCGs and CRs. Methods: TPC FCGs received teaching, guidance, and counseling via video calls for 8 weeks following CR discharge from the hospital. After discharge, a research assistant called all FCGs once a month for up to 6 months or CR death to collect self‐reported healthcare utilization (e.g., outpatient, emergency department, and hospital), out‐of‐pocket healthcare spending (e.g., deductibles and coinsurance), and health‐related travel costs (e.g., transportation, lodging, food) for FCGs and CRs. Incidence rate ratios (IRRs) were estimated using negative binomial regressions. Results: The study included 282 FCG–CR dyads across three U.S. states. Follow‐up over the 6‐month period was shortened by high CR mortality rates across both arms (29%), but was similar across arms. TPC reduced nights in the hospital for CR (IRR = 0.75; 95% confidence interval [CI] = 0.56–0. 99). Total out‐of‐pocket spending was not significantly different for TPC versus control. Across both groups, mean out‐of‐pocket spending for dyads was $1401.85, with healthcare payments contributing $1048.58 and transportation expenses contributing $136.79. TPC dyads reported lower lodging costs (IRR = 0.71; 95% CI = 0.56–0.89). Conclusions: This study contributes to evidence that palliative care interventions reduce the number of nights in the hospital for seriously ill patients. Yet, overall rural FCGs and seriously ill CRs experience substantial out‐of‐pocket economic costs in the 6 months following hospitalization. Transitional care intervention design should consider impacts on patient and caregiver spending. Clinicaltrials.gov # is NCT03339271. [ABSTRACT FROM AUTHOR]

Dexmedetomidine utilisation in paediatric patients is increasing. We hypothesised that intraoperative use of dexmedetomidine in children is associated with longer postanaesthesia care unit length of stay, higher healthcare costs, and side-effects. We analysed data from paediatric patients (aged 0–12 yr) between 2016 and 2021 in the Bronx, NY, USA. We matched our cohort with the Healthcare Cost and Utilization Project-Kids' Inpatient Database (HCUP-KID). Among 18 104 paediatric patients, intraoperative dexmedetomidine utilisation increased from 51.7% to 85.7% between 2016 and 2021 (P <0.001). Dexmedetomidine was dose-dependently associated with a longer postanaesthesia care unit length of stay (adjusted absolute difference [AD adj ] 19.7 min; 95% confidence interval [CI]: 18.0–21.4 min; P <0.001, median length of stay of 122 vs 98 min). The association was magnified in children aged ≤2 yr undergoing short (≤60 min) ambulatory procedures (AD adj 33.3 min; 95% CI: 26.3–40.7 min; P <0.001; P -for-interaction <0.001). Dexmedetomidine was associated with higher total hospital costs of USD 1311 (95% CI: USD 835–1800), higher odds of intraoperative mean arterial blood pressure below 55 mm Hg (adjusted odds ratio [OR adj ] 1.27; 95% CI: 1.16–1.39; P <0.001), and higher odds of heart rate below 100 beats min−1 (OR adj 1.32; 95% CI: 1.21–1.45; P <0.001), with no preventive effects on emergence delirium requiring postanaesthesia i.v. sedatives (OR adj 1.67; 95% CI: 1.04–2.68; P =0.034). Intraoperative use of dexmedetomidine is associated with unwarranted haemodynamic effects, longer postanaesthesia care unit length of stay, and higher costs, without preventive effects on emergence delirium. [ABSTRACT FROM AUTHOR]

Background: The decision to discontinue intensive care unit (ICU) treatment during the end-oflife stage has recently become a significant concern in Korea, with an observed increase in life-sustaining treatment (LST) withdrawal. There is a growing demand for evidence-based support for patients, families, and clinicians in making LST decisions. This study aimed to identify factors influencing LST decisions in ICU inpatients and to analyze their impact on healthcare utilization. Methods: We retrospectively reviewed medical records of ICU patients with neurological disorders, infectious disorders, or cancer who were treated at a single university hospital between January 1, 2019 and July 7, 2021. Factors influencing the decision to withdraw LST were compared between those who withdrew LST and those who did not. Results: Among 54,699 hospital admissions, LST was withdrawn in 550 cases (1%). Cancer was the most common diagnosis, followed by pneumonia and cerebral infarction. Among ICU inpatients, LST was withdrawn from 215 (withdrawal group). The withdrawal group was older (78 vs. 75 years, P=0.002), had longer total hospital stays (16 vs. 11 days, P<0.001), and higher ICU readmission rates than the control group. There were no significant differences in the healthcare costs of ICU stay between the two groups. Most LST decisions (86%) were made by family. Conclusions: The decisions to withdraw LST of ICU inpatients were influenced by age, readmission, and disease category. ICU costs were similar between the withdrawal and control groups. Further research is needed to tailor LST decisions in the ICU. [ABSTRACT FROM AUTHOR]

Background: Cognitive impairment (CI) raises risks for unplanned healthcare utilisation and expenditures and for premature mortality. It may also reduce risks for planned expenditures. Therefore, the net cost implications for those with CI remain unknown. Method: We examined differences in healthcare utilisation and cost between those with and without CI. Using administrative healthcare utilisation and cost data linked to the Singapore Chinese Health Study cohort, we estimated regression-adjusted differences in annual healthcare utilisation and costs by CI status determined by modified Mini-Mental State Exam. Estimates were stratified by ex ante mortality risk constructed from out-of-sample Cox model predictions applied to the full sample, with a separate analysis restricted to decedents. These estimates were used to project differential healthcare costs by CI status over 5 years. Results: Patients with CI had 17% higher annual cost compared to those without CI (SGD4870 versus SGD4177, P<0.01). Accounting for the greater mortality risk, individuals with CI cost 9% to 17% more over 5 years, or SGD2500 (95% confidence interval 1000-4200) to SGD3600 (95% confidence interval 1300-6000) more, depending on their age. Higher cost was mainly due to more emergency department visits and subsequent admissions (i.e. unplanned). Differences attenuated in the last year of life when costs increased dramatically for both groups. Conclusion: Ageing populations and higher rates of CI will further strain healthcare resources primarily through greater use of emergency department visits and unplanned admissions. Efforts should be made to identify at risk patients with CI and take appropriate remediation strategies. [ABSTRACT FROM AUTHOR]

Background: Economic burden studies can provide insights into the drivers leading to increasing healthcare costs. It can also provide a more holistic view of how diseases impact the welfare of patients and their families. Having concrete estimates of the economic burden across multiple diseases can help policymakers determine which diseases are economically more burdensome. This study aimed to review and summarise comprehensively economic burden studies across multiple diseases in the Nordic countries between 2000 and 2020. Methods: According to the 2020 PRISMA statement, a systematic literature review was conducted in PubMed, CINAHL, Academic Search Premier and Global Health databases using key terms related to the economic burden of any disease in Denmark, Finland, Greenland, Iceland, Norway and Sweden. Grey literature was also reviewed. Results: A total of 10,050 potential titles and abstracts were identified and screened, and 254 full-text papers that met the inclusion criteria were evaluated by two independent reviewers. Of these, 119 articles were included in a qualitative synthesis. Twenty-nine had clearly defined comparison groups, thus able to attribute the costs to the disease. Large variations concerning methodology and cost components were noted. Across diseases, the economic burden ranged from EUR 1668 per patient annually for chronic obstructive pulmonary disease to EUR 93,041 for multiple sclerosis. However, estimates varied widely, even within each disease. Conclusions: Our review highlights the need for more comparable economic burden studies. Future studies should focus on applying robust methodology and homogeneous cost-reporting methods to inform policymakers about which diseases are economically more burdensome. [ABSTRACT FROM AUTHOR]

We evaluate benefits of measuring temporal patterns of medication use using group-based trajectory modelling (GBTM) by finding associations between medication adherence (MA) and healthcare costs for which inconsistent results have been reported. We conducted a retrospective cohort study of 9,287, 1,660 and 10,242 users of antidepressants, bisphosphonates and statins, respectively, between 2012 and 2016, who participated in the 45 and Up Study in New South Wales, Australia. Associations between MA and subsequent 1-year healthcare cost components from generalized linear models and two-part models were compared across medications and MA measure types including GBTM and proportion of days covered (PDC). Compared to adherers, antidepressant users with declining adherence showed increased inpatient costs ($643 at p < 0.05). Bisphosphonate users with declining and consistently low adherence showed decreased osteoporotic inpatient costs ($387 at p < 0.05 and $419 at p < 0.05, respectively). All types of nonadherence were associated with reduced cost of the respective medications. GBTM revealed relationships between specific nonadherence types and healthcare costs, even in cases where no relationship was identified using the combined nonadherence PDC measure. With additional insights into the dynamics of nonadherence, GBTM could help clinicians and health policymakers design effective MA interventions, leading to improved health outcomes and pharmaceutical use. [ABSTRACT FROM AUTHOR]

Purpose: Residents have limited education regarding the cost of orthopaedic interventions. Orthopaedic residents' knowledge was surveyed in three scenarios involving an intertrochanteric femur fracture: 1) uncomplicated course with 2-day hospital stay; 2) complicated course necessitating ICU admission; and 3) readmission for pulmonary embolism management. Methods: From 2018 to 2020, 69 orthopaedic surgery residents were surveyed. Respondents estimated hospital charges and collections; professional charges and collections; implant cost; and level of knowledge depending on the scenario. Results: Most residents (83.6%) reported feeling "not knowledgeable". Respondents reporting "somewhat knowledgeable" did not perform better than those who reported "not knowledgeable". In the uncomplicated scenario, residents underestimated hospital charges and collections (p < 0.01; p = 0.87), and overestimated hospital charges and collections and professional collections (all p < 0.01) with an average percent error of 57.2%. Most residents (88.4%) were aware the sliding hip screw construct costs less than a cephalomedullary nail. In the complex scenario, while residents underestimated the hospital charges (p < 0.01), the estimated collections were closer to the actual figure (p = 0.16). In the third scenario, residents overestimated the charges and collections (p = 0.04; p = 0.04). Conclusions: Orthopaedic surgery residents receive little education regarding healthcare economics and feel unknowledgeable therefore a role for formal economic education during orthopaedic residency may exist. [ABSTRACT FROM AUTHOR]

STUDY QUESTION Is the long-term health care utilization of children born after ART more costly to the healthcare system in England than children born to mothers with no fertility problems? SUMMARY ANSWER Children born after ART had significantly more general practitioner (GP) consultations and higher primary care costs up to 10 years after birth, and significantly higher hospital admission costs in the first year after birth, compared to children born to mothers with no fertility problems. WHAT IS KNOWN ALREADY There is evidence that children born after ART are at an increased risk of adverse birth outcomes and a small increased risk of rare adverse outcomes in childhood. STUDY DESIGN, SIZE, DURATION We conducted a longitudinal study of 368 088 mother and baby pairs in England using a bespoke linked dataset. Singleton babies born 1997–2018, and their mothers, who were registered at GP practices in England contributing data to the Clinical Practice Research Datalink (CPRD), were identified through the CPRD GOLD mother–baby dataset; this data was augmented with further linkage to the mothers' Human Fertilisation and Embryology Authority (HFEA) Register data. Four groups of babies were identified through the mothers' records: a 'fertile' comparison group, an 'untreated sub-fertile' group, an 'ovulation induction' group, and an ART group. Babies were followed-up from birth to 28 February 2021, unless censored due to loss to follow-up (e.g. leaving GP practice, emigration) or death. PARTICIPANTS/MATERIALS, SETTING, METHODS The CPRD collects anonymized coded patient electronic health records from a network of GPs in the UK. We estimated primary care costs and hospital admission costs for babies in the four fertility groups using the CPRD GOLD data and the linked Hospital Episode Statistics (HES) Admitted Patient Care (APC) data. Linear regression was used to compare the care costs in the different groups. Inverse probability weights were generated and applied to adjust for potential bias caused by attrition due to loss to follow-up. MAIN RESULTS AND THE ROLE OF CHANCE Children born to mothers with no fertility problems had significantly fewer consultations and lower primary care costs compared to the other groups throughout the 10-years' follow up. Regarding hospital costs, children born after ART had significantly higher hospital admission costs in the first year after birth compared to those born to mothers with no fertility problems (difference = £307 (95% CI: 153, 477)). The same pattern was observed in children born after untreated subfertility and ovulation induction. LIMITATIONS, REASONS FOR CAUTION HFEA linkage uses non-donor data cycles only, and the introduction of consent for data use reduced the availability of HFEA records after 2009. The fertility groups were derived by augmenting HFEA data with evidence from primary care records; however, there remains some potential misclassification of exposure groups. The cost of neonatal critical care is not captured in the HES APC data, which may cause underestimation of the cost differences between the comparison group and the infertility groups. WIDER IMPLICATIONS OF THE FINDINGS The findings can help anticipate the financial impact on the healthcare system associated with subfertility and ART, particularly as the demand for these treatments grows. STUDY FUNDING/COMPETING INTEREST(S) C.C. and this work were funded by a UK Medical Research Council Career Development Award [MR/L019671/1] and a UK MRC Transition Support Award [MR/W029286/1]. X.H. is an Australia National Health and Medical Research Council (NHMRC) Emerging Leadership Fellow [grant number 2009253]. The authors declare no competing interest. TRIAL REGISTRATION NUMBER N/A. [ABSTRACT FROM AUTHOR]

Introduction: Cystic fibrosis (CF) is a life-limiting genetic disease caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA) is a CFTR modulator (CFTRm) that targets the underlying cause of CF. Based on safety and efficacy demonstrated in clinical trials, ELX/TEZ/IVA is approved in the US for the treatment of CF in people aged ≥ 2 years who have ≥ 1 F508del-CFTR mutation or a CFTR mutation that is responsive to ELX/TEZ/IVA based on in vitro data. While ELX/TEZ/IVA demonstrated unprecedented improvements in lung function and dramatic reductions in pulmonary exacerbations (PEx) and associated hospitalizations in clinical trials, a limited number of studies have examined the impact of ELX/TEZ/IVA on healthcare resource utilization (HCRU) and associated costs in a real-world setting. The aim of this retrospective study was to evaluate changes in PEx, HCRU, and associated non-CFTRm healthcare costs following initiation of ELX/TEZ/IVA among people with CF aged ≥ 12 years in the US. Methods: We evaluated the rates of PEx, HCRU, and associated costs before and after initiation of ELX/TEZ/IVA in people with CF aged ≥ 12 years using data from the Merative MarketScan® Commercial Claims and Encounters Database and the Merative Multi-State Medicaid Database from April 21, 2019 to December 31, 2020. Because the study period included time following the onset of the COVID-19 pandemic, we limited our primary analysis to the period prior to the pandemic (October 21, 2019 to March 12, 2020). Outcomes following the onset of the pandemic (March 13 to December 31, 2020) were examined in an exploratory analysis. Results: In both commercially insured and Medicaid-insured people with CF, ELX/TEZ/IVA was associated with reductions in PEx, hospitalizations, and associated costs prior to the COVID-19 pandemic, and these reductions were maintained following the onset of the pandemic. Conclusions: These findings suggest that ELX/TEZ/IVA reduces the burden and costs associated with PEx and hospitalizations in people with CF. [ABSTRACT FROM AUTHOR]

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.Design: Retrospective study.Methods: 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.Results: 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.Conclusion: 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. [ABSTRACT FROM AUTHOR]

We used a prevalence-based approach to estimate the economic costs associated with low muscle strength, as assessed using handgrip strength, in Canadian adults. We estimated the annual economic burden of low muscle strength at $3.0 billion, representing 2.2% of the 2021 Canadian burden of illness costs. The two most expensive chronic diseases attributable to low muscle strength were cardiovascular disease ($899 million) and type 2 diabetes ($880 million). A 10% decrease in the prevalence of low handgrip strength would save approximately $546 million per year, equivalent to an 18.1% cost reduction. Strategies to increase population-level muscle strength are needed to reduce healthcare costs and improve health. The economic cost associated with low muscle strength in Canadian adults is unknown. The total annual economic burden of low muscle strength in Canadian adults represents 2.2% of the overall burden of illness costs in 2021. We estimated that $546 million per year would be saved if the prevalence of low handgrip strength was reduced by 10%. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the extent of healthcare cost increase at population level due to childhood asthma. We aimed to investigate the cross-sectional relationship between asthma and healthcare costs among children aged 2 to 18 years and, in longitudinal analyses, whether costs increase with an increase in the duration of asthma prevalence. Study participants are 4175 and 4482 children of birth and kindergarten cohorts from the nationally representative Longitudinal Study of Australian Children for whom the linked Medicare cost data are available. The children were followed in all waves from the year 2004 to 2018. Generalized linear models were used to estimate the excess healthcare costs associated with asthma. The sum of Medicare Benefits Schedule and Pharmaceutical Benefits Scheme costs constitutes the total healthcare costs. Total excess healthcare costs associated with asthma among the 2- to 18-year-old children were A$4316 per child. At the population level, the estimated total excess Medicare costs associated with current asthma treatment among 2- to 18-year-old children were, on average, A$190.6 million per year (2018 population and price). Compared with the non-asthmatic children, peers with persistent asthma morbidity and treatment requirements had excess costs up to A$20 727 for the B cohort children until 14 years of age, whereas excess costs for the K cohort children were A$19 571 until 18 years of age. Asthma in children imposes a significant financial burden on the public health system. Higher excess healthcare costs of all asthmatic children than the costs of nonasthmatic children provide further economic justification for promoting preventive efforts at early ages. • For children aged 2 to 9 years only, healthcare costs, which are the sum of Medicare and pharmaceutical costs, are known for a few studied pediatric morbidities in the Australian context. • This study is the first to use a nationally representative Longitudinal Study of Australian Children to evaluate the excess healthcare costs of asthmatic children aged 2 to 18 years, age group-wise and longitudinally. • This new knowledge on the pattern of excess healthcare costs associated with asthma would inform healthcare policy makers about the target groups and how to design and implement project interventions. [ABSTRACT FROM AUTHOR]

Objective: Pressure ulcers are associated with prolonged lengths of stay, increased costs, and lower discharge rates in palliative care units. This study aimed to reveal pressure ulcers' risk factors, incidence, and prevalence in a palliative care unit. Materials and Methods: The data of 252 inpatients in a secondary-level palliative care unit were examined retrospectively. Patients were divided into groups according to pressure ulcer status, and data was comparatively analyzed. Pressure ulcer prevalence and incidence in the palliative care unit were calculated. Results: There were 137 (54.4%) males and 115 (45.6%) females. The mean age was 67.4 ± 16.7. Most of them were oncology patients (30.6%) and cerebrovascular patients (30.6%). Pressure ulcers' prevalence and incidence were 40.1% and 4.7%, respectively. The Braden score was a median of 13 (5-23). In patients with pressure ulcers, the Braden score and discharge home rate were significantly lower; admission from another intensive care unit, the length of stay, and the treatment costs were significantly higher. Conclusion: Pressure ulcers negatively affect the patient's length of stay in the palliative care unit, the discharge rate to home, and the financial burden on the healthcare system. Pressure ulcer risk analysis and a standardized care plan to prevent and treat pressure ulcers should be performed for cost-effective palliative care. [ABSTRACT FROM AUTHOR]

Background and Aim: Acute severe ulcerative colitis (ASUC) remains a significant cause of morbidity and healthcare utilization. This study aimed to characterize the total healthcare costs of ASUC, explore factors associated with significant cost over the 12 months following an index admission, and document outcomes including corticosteroid exposure. Methods: Patients admitted from January 2016 until January 2021 for ASUC to a tertiary inflammatory bowel disease (IBD) center in Australia were identified via retrospective chart review. Costs were calculated over a 12‐month period following index admission. Results: Seventy‐two patients (30 [42%] female, median age 39 [IQR 27–54] years) were included. The median length of stay of index admission was 6 days (IQR 5–10 days). The median cost of index admission was 7829 AUD, which was driven by the initial length of stay (P < 0.01) and requirement for colectomy (P < 0.01). Median total healthcare cost over the first 12 months was 13 873 AUD (IQR 9684–19 936 AUD), again predominately driven by the length of stay (P < 0.01) and requirement for colectomy (P < 0.01). Median cumulative corticosteroid use over 12 months inclusive of index hospitalization was 1760 mg (IQR 1560–2350 mg). Requirement for inpatient medical salvage therapy with infliximab was associated with increased corticosteroid requirement (P = 0.01). Conclusion: Healthcare expense related to ASUC remains high, driven predominantly by the length of stay during initial hospitalization and need for colectomy. From a healthcare cost perspective, novel methods to reduce inpatient hospital stay as well as need for colectomy may help reduce the economic and steroid burden of ASUC. [ABSTRACT FROM AUTHOR]

Aim: This systematic review examined recent studies on fragmented care of patients with chronic illnesses in the United States to examine the association between fragmented care and patient outcomes. Design: Systematic review. Methods: Studies published from January 1, 2012, to June 1, 2022, were selected from four electronic databases (PubMed, CINAHL, PsycINFO, and Web of Science), following the Cochrane protocols and PRISMA statements. Based on inclusion and exclusion criteria, ten studies that examined associations published between 2015 and 2021 were selected. A methodological assessment was conducted with the Quality Assessment Tool for Observational Cohort and Cross‐Sectional Studies. The studies selected for this systematic review were rated as having fair methodological rigor. The protocol of this review was registered in the International Prospective Register of Systematic Reviews (PROSPERO registration number: CRD42021285379). Because of the heterogeneity of the selected studies' data, a systematic narrative synthesis of the extracted data was conducted. Results: Three common measures for fragmented care and outcomes were synthesized. A synthesis of the studies found significant association between fragmented care and adverse outcomes of chronic illnesses (emergency department visits, utilization of diagnostic tests, and healthcare costs). Despite the heterogeneity of significant findings between fragmented care and patient outcomes, the relationship between these outcomes and fragmented care was significant. This systematic review provides clear evidence of the association between care fragmentation and its adverse effects on individuals with chronic illnesses. However, mixed relationship findings were also reported. Conclusion: Given the demands of overcoming fragmented care in healthcare settings in the United States, nurse managers, healthcare leaders, and policymakers should utilize this evidence to reduce fragmented care strategies. It is recommended that nurse researchers and other healthcare practitioners conduct further studies to understand the contexts and mechanisms of fragmented care and develop theoretical frameworks for care fragmentation and chronic illness outcomes. [ABSTRACT FROM AUTHOR]

Background Widespread implementation of immune checkpoint inhibitors (ICI) and targeted therapies for metastatic melanoma has led to a decline in melanoma-related mortality but increased healthcare costs. We aimed to determine how healthcare utilization varied by systemic, non-adjuvant melanoma treatment from 2016 to 2020. Patients and Methods Adults with presumed stage IV metastatic melanoma receiving systemic therapy from 2016 to 2020 were identified in Optum, a nationwide commercial claims database. Treatment groups were nivolumab, pembrolizumab, ipilimumab+nivolumab (combination-ICI), or BRAF+MEK inhibitor (BRAFi+MEKi) therapy. Outcomes included hospitalizations, days hospitalized, emergency room (ER) visits, outpatient visits, and healthcare costs per patient per month (pppm). Multivariable regression models were used to analyze whether cost and utilization outcomes varied by treatment group, with nivolumab as reference. Results Among 2018 adult patients with metastatic melanoma identified, mean (SD) age was 67 (15) years. From 2016 to 2020, nivolumab surpassed pembrolizumab as the most prescribed systemic melanoma therapy while combination-ICI and BRAFi+MEKi therapies remained stable. Relative to nivolumab, all other therapies were associated with increased total healthcare costs (combination-ICI: β = $47 600 pppm, 95%CI $42 200-$53 100; BRAFi+MEKi: β = $3810, 95%CI $365-$7260; pembrolizumab: β = $6450, 95%CI $4420-$8480). Combination-ICI and BRAFi+MEKi therapies were associated with more inpatient hospital days. Conclusions Amid the evolving landscape of systemic therapy for advanced melanoma, nivolumab monotherapy emerged as the most used and least costly systemic treatment from 2016 to 2020. Its sharp increase in use in 2018 and lower costs relative to pembrolizumab may in part be due to earlier adoption of less frequent dosing intervals. [ABSTRACT FROM AUTHOR]

Objective: To examine changes in use patterns, cost of healthcare services before and after the outbreak of the COVID-19 pandemic, and their impacts on expenditures for patients receiving treatment for depression, anxiety, eating disorders, and substance use. Methods: This cross-sectional study employed statistical tests to analyze claims in MarketScan® Commercial Database in March 2020-February 2021 and quarterly from March 2020 to August 2021, compared to respective pre-pandemic periods. The analysis is based on medical episodes created by the Merative™ Medical Episode Grouper (MEG). MEG is a methodology that groups medical and prescription drug claims to create clinically relevant episodes of care. Results: Comparing year-over-year changes, proportion of patients receiving anxiety treatment among all individuals obtaining healthcare services grew 13.7% in the first year of the pandemic (3/2020–2/2021) versus 10.0% in the year before the pandemic (3/2019–2/2020). This, along with a higher growth in price per episode (5.5% versus 4.3%) resulted in a greater increase in per claimant expenditure ($0.61 versus $0.41 per month). In the same periods, proportion of patients receiving treatment for depression grew 3.7% versus 6.9%, but per claimant expenditure grew by same amount due to an increase in price per episode (4.8%). Proportion of patients receiving treatment for anorexia started to increase 21.1% or more in the fall of 2020. Patient proportion of alcohol use in age group 18–34 decreased 17.9% during the pandemic but price per episode increased 26.3%. Patient proportion of opioid use increased 11.5% in March–May 2020 but decreased or had no significant changes in subsequent periods. Conclusions: We investigated the changes in use patterns and expenditures of mental health patients before and after the outbreak of the COVID-19 pandemic using claims data in MarketScan®. We found that the changes and their financial impacts vary across mental health conditions, age groups, and periods of the pandemic. Some changes are unexpected from previously reported prevalence increases among the general population and could underlie unmet treatment needs. Therefore, mental health providers should anticipate the use pattern changes in services with similar COVID-19 pandemic disruptions and payers should anticipate cost increases due, in part, to increased price and/or service use. [ABSTRACT FROM AUTHOR]

Background: Floods and torrential rains are natural disasters caused by climate change. Unfortunately, such events are more frequent and are increasingly severe in recent times. The 2018 Japan Floods in western Japan were one of the largest such disasters. This study aimed to evaluate the effect of the 2018 Japan Floods on healthcare costs and service utilization. Methods: This retrospective cohort study included all patients whose receipts accrued between July 2017 and June 2019 in Hiroshima, Okayama, and Ehime prefectures using the National Database of Health Insurance Claims. We used Generalized Estimating Equations (GEEs) to investigate yearly healthcare costs during the pre-and post-disaster periods, quarterly high-cost patients (top 10%), and service utilization (outpatient care, inpatient care, and dispensing pharmacy) during the post-disaster period. After the GEEs, we estimated the average marginal effects as the attributable disaster effect. Results: The total number of participants was 5,534,276. Victims accounted for 0.65% of the total number of participants (n = 36,032). Although there was no significant difference in pre-disaster healthcare costs (p = 0.63), post-disaster costs were $3,382 (95% CI: 3,254–3,510) for victims and $3,027 (95% CI: 3,015–3,038) for non-victims (p < 0.001). The highest risk difference among high-cost patients was 0.8% (95% CI: 0.6–1.1) in the fourth quarter. In contrast, the highest risk difference of service utilization was in the first quarter (outpatient care: 7.0% (95% CI: 6.7–7.4), inpatient care: 1.3% (95% CI: 1.1–1.5), and dispensing pharmacy: 5.9% (95% CI: 5.5–6.4)). Conclusion: Victims of the 2018 Japan Floods had higher medical costs and used more healthcare services than non-victims. In addition, the risk of higher medical costs was highest at the end of the observation period. It is necessary to estimate the increase in healthcare costs according to the disaster scale and plan for appropriate post-disaster healthcare service delivery. [ABSTRACT FROM AUTHOR]

Background : This study aimed to evaluate differences in healthcare resource utilization and cost among patients with controlled and uncontrolled asthma. Methods : Claims data from a German sickness fund was linked to patient survey data. Outpatient physicians enrolled patients and assessed asthma control using the ACTTM questionnaire. All-cause and asthma-specific healthcare resource use (HCRU)/costs were compared descriptively and based on multivariable models using a continuous ACTTM score. Results : Overall, 492 asthma patients were included (mean age: 53.8, 73.8% female). The mean/median ACTTM score was 19.9/20.7, with 183 patients (37.2%) classified as having uncontrolled asthma (mean ACTTM score<20) Patients with uncontrolled asthma had significantly more hospitalizations (p =.035) and medication prescriptions (p <.001), which resulted in higher total healthcare costs for asthma-related (€1785 vs. €1615; p =.004) and all-cause care (€4695 vs. €4117; p =.009). While controlling for baseline characteristics, multivariable models confirmed a negative association between asthma control and total all-cause healthcare costs (p =.008), total asthma-related costs (p =.008), and costs of medication prescriptions (p =.001). However, no significant association was found for all-cause (p =.062) and asthma-related hospitalization costs (p =.576). Conclusion : Considering continuous patient care, improving asthma control is not only desirable from a clinical perspective, but could also be an effective approach to reduce asthma-related HCRU and cost burden. [ABSTRACT FROM AUTHOR]

Summary: A hip fracture causes high morbidity and mortality. Frailty is associated with adverse outcomes and increased costs. Frailty measured using the Hospital Frailty Risk Score (HFRS) is associated with higher costs and adverse outcomes. HFRS is useful as a fuss-free frailty measurement in the management of older adults with hip fractures. Introduction: Hip fractures account for an increasing number of hospital admissions around the world and are associated with high rates of morbidity and mortality. Frailty is increasingly recognized to be associated with adverse outcomes and increased costs. The purpose of this study is to determine the association of the Hospital Frailty Risk Score (HFRS) with the healthcare cost and outcomes in older adults who present with a hip fracture. Methods: A retrospective analysis was performed on 1014 patients ≥ 60 years who presented with a hip fracture between January 2016 to June 2020. Each patient was classified into HFRS low, intermediate or high frailty cohorts. Demographics, hip fracture type, comorbidities, Charlson Comorbidity Index (CCI), American Society of Anesthesiologist score (ASA), costs, length of stay, time to surgery, complications, readmission rate and mortality were compared between the cohorts. Results: Median total hospitalization costs were significantly higher in the highest HFRS (SGD$22,432) patients as compared to intermediate (SGD$18,759) and low HFRS (SGD$15,671) patients. The difference between the high and low groups remains significant after adjusting for covariates using quantile regression. Similar results were shown for median length of stay (14 vs 10 vs 8 days), total number of complications (2 vs 1 vs 0) and adjusted time to surgery (p < 0.05). HFRS was not associated with 30-day readmission or 30-day or 1-year mortality. Conclusion: Frailty is associated with a marked increase in total costs in hip fracture patients. HFRS proved useful in estimating LOS and outcomes for older patients with hip fractures. [ABSTRACT FROM AUTHOR]

Objective: Tuberous sclerosis complex (TSC) is a rare multisystem disorder, often associated with epilepsy. This retrospective study aimed to identify patients with TSC, including those with epilepsy, from a French healthcare claims database, and to report incidence, prevalence, and healthcare costs and resource utilization. Methods: The anonymized French health insurance database (SNDS) covers almost the entire French population. Patients with TSC were identified as having ≥1 International Classification of Diseases, Tenth Revision (ICD‐10) diagnosis code Q85.1 or a long‐term disease (LTD) registration over the inclusion period (2006–2017). Patients with an ICD‐10 epilepsy code or who were dispensed ≥1 antiseizure medication (ASM) in the same year or after their TSC diagnosis were identified as having TSC with epilepsy. Newly diagnosed patients over the inclusion period constituted the incident cohort. Healthcare costs (patients with recorded costs only), healthcare resource use, and ASM dispensation are reported for patients with 2018 data. Results: In 2018, 3139 prevalent patients with TSC were identified (crude prevalence, 4.69 per 100 000); the incident cohort comprised 2988 patients (crude incidence, 0.44 per 100 000). Among patients with TSC, 67% (2101/3139) had epilepsy (mean [standard deviation, SD] age: 28.8 [18.8] years; male: 48%). Among patients with epilepsy, total mean (SD) annual healthcare costs were €11 413 (27 620) per capita (outpatient, 63%; inpatient, 37%), 46% were hospitalized during 2018 (mean [SD]: 1.8 [10.9] acute care visits per patient), and 65% visited a hospital specialist. Among patients with epilepsy, medication (mean [SD]: €4518 [12 102] per capita) was the greatest contributor (63%) to outpatient costs, and in 2018, 74% were dispensed ≥1 different ASM and 9% were dispensed ≥4 ASMs. Significance: TSC with epilepsy was associated with substantial healthcare costs and resource utilization, particularly outpatient and medication costs. Many patients with TSC with epilepsy were prescribed multiple ASMs, suggesting refractory epilepsy. [ABSTRACT FROM AUTHOR]

Aim: To quantify the healthcare costs associated with opioid use disorder among members in a public healthcare system and compare them with healthcare costs in the general population. Design: Retrospective cohort study. Setting: Inpatient and outpatient care settings of Israel's largest public healthcare provider (that covers 4.7 million members). Participants: Participants included 1173 members who had a diagnosis of opioid use disorder in the years between 2013 and 2018. Each patient was matched with 10 controls based on age and sex. Measurements: The main outcome was monthly healthcare costs. Findings The mean monthly healthcare cost of members with opioid use disorder was $1102 compared with $211 among controls (5.2‐fold difference; 95% CI, 4.6–6.0). After excluding members with heroin related diagnoses before the index date (to focus on prescription opioids), this healthcare cost ratio did not substantially change (4.6‐fold; 95% CI, 3.9–5.4). Members with opioid use disorder under the age of 65 years had a cost difference of 6.1‐fold (95% CI, 5.2–7.1), whereas those 65 years and older experienced cost difference of 3.4‐fold (95% CI, 2.6–4.5), compared with controls. The category with the highest cost for members with opioid use disorder was inpatient services, which was 8.7‐fold (95%CI, 7.2–10.4) greater than among controls. Conclusions: Healthcare costs among individuals with opioid use disorder in Israel's public health system are substantially higher than among controls, at least partially attributable to prescription opioid use disorder. Differences are greater among individuals under 65 years. [ABSTRACT FROM AUTHOR]

Background: Though critical to primary care, continuity of care has rarely been examined in China. This study aims to assess the relationship between continuity of care and healthcare costs among patients with chronic diseases within primary care settings in China. Methods: In this cross-sectional study, we used a social health insurance claims dataset of 1406 patients with hypertension and/or diabetes in Yuhuan City, Zhejiang Province collected in 2017–2019. We measured continuity of care using the Bice Boxer man Continuity of Care (COC) Index, Herfindahl Index (HI), Sequential Continuity of Care (SECON) Index, Usual Provider of Care (UPC), and a binary variable indicating whether a patient’s UPC was a primary care provider. We examined the associations between continuity of care and healthcare costs in the same period and the subsequent year, using ordinary least squares regression for the outpatient costs and two-part regression for the inpatient costs. Based on the regression coefficients, we predicted costs saved if each continuity measure was set to 1 from the status quo. Results: When optimum continuity were to be achieved, 7.12–27.29% of total outpatient costs and 55.38–73.35% of total inpatient costs could be saved compared to the status quo during the two-year study period. If optimum continuity were to be achieved in the first year, 7.47%–21.78% of total outpatient costs and 8.84–40.22% of total inpatient costs could be saved in the second-year. Conclusions: Care continuity indicators were consistently associated with reduced outpatient costs and hospitalization risks. Future health reform in China should further enhance continuity of care in primary care. [ABSTRACT FROM AUTHOR]

Childhood obesity affects around 7–8% of children in Ireland and is associated with increased risks of health complications. Data on healthcare resource use and the related costs for children with obesity are important for research, future service-planning, efforts to reduce the burden on families, and care pathways. However, there is little or no data available to describe these in Ireland. We undertook a retrospective chart review for 322 children attending a national paediatric weight management service to assess their hospital service utilisation, and the associated costs, over a four-year period. We used a micro-costing approach and estimated unit costs for different types of hospital services. Multivariable negative binomial regression analyses and Cragg hurdle models were used to assess characteristics associated with type, frequency and costs of hospital care. Eighty-two percent of children had severe obesity, and thirty-eight percent had a co-morbid condition. Over the four-year period, children had a mean of 27 (median 24, IQR 16–33) episodes of care at a mean cost of €2590 per child (median €1659, IQR 1026–3103). The presence of a co-morbid condition was associated with more frequent visits. Neither severity of obesity nor socioeconomic status were associated with overall service utilisation. The Cragg hurdle model did not identify statistically significant differences in hospital costs according to participant characteristics. Children with obesity frequently visit a variety of paediatric services and children with co-morbid conditions have greater levels of hospital utilisation. Further research is needed with larger sample sizes to explore variation in healthcare utilisation in this population, and the relationship between common co-morbidities and weight status. This would facilitate assessment of the implications for care pathways and examination of associations between patient outcomes and related healthcare costs and cost-effectiveness. [ABSTRACT FROM AUTHOR]

Osteopathic manipulative treatment (OMT) is used in both inpatient and outpatient settings. Evidence suggests that OMT can reduce both patients' recovery time and the financial cost of their acute medical treatment and rehabilitation. Multiple studies from neonatal intensive care units (NICUs) are presented in this article that demonstrate infants treated with OMT recover faster, are discharged earlier, and have lower healthcare costs than their non-OMT-treated counterparts. Data clearly show that adjunctive OMT facilitates feeding coordination in newborns, such as latching, suckling, swallowing, and breathing, and increases long-term weight gain and maintenance, which reduces hospital length of stay (LOS). Osteopathic techniques, such as soft tissue manipulation, balanced ligamentous tension, myofascial release, and osteopathic cranial manipulation (OCM), can reduce regurgitation, vomiting, milky bilious, or bloody discharge and decrease the need for constipation treatment. OMT can also be effective in reducing the complications of pneumonia in premature babies. Studies show the use of OCM and lymphatic pump technique (LPT) reduces the occurrence of both aspiration and environmentally acquired pneumonia, resulting in significantly lower morbidity and mortality in infants. Based on published findings, it is determined that OMT is clinically effective, cost efficient, a less invasive alternative to surgery, and a less toxic choice to pharmacologic drugs. Therefore, routine incorporation of OMT in the NICU can be of great benefit in infants with multiple disorders. Future OMT research should aim to initiate clinical trial designs that include randomized controlled trials with larger cohorts of infants admitted to the NICU. Furthermore, a streamlined and concerted effort to elucidate the underlying molecular mechanisms associated with the beneficial effects of OMT will aid in understanding the significant value of incorporating OMT into optimal patient care. [ABSTRACT FROM AUTHOR]

Background: Pulmonary alveolar proteinosis (PAP) is a rare clinical syndrome involving the accumulation of lipid-rich proteinaceous material in the alveoli. There is a paucity of published studies on this condition. To better characterize the demographics, complication rates, mortality, and healthcare costs of patients hospitalized for PAP in the United States, a secondary analysis on the Hospital Cost and Utilization Project's Nationwide Inpatient Sample (NIS) was performed on patients admitted from 2012 to 2014 with a diagnosis of pulmonary alveolar proteinosis.Methods: Using the NIS database, a secondary analysis was performed on 500 admissions with the diagnosis "pulmonary alveolar proteinosis." The clinical variables and outcome measures extracted were: patient demographics, hospital costs, length of stay, frequency of admissions, and inpatient mortality rate.Results: Among a weighted estimate of 500 hospital admissions from 2012 to 2014, the number of PAP admissions averaged 4.7 per million. The population was predominantly male (55%) with a mean age of 41.45 (CI 38.3-44.5) from all socioeconomic levels. Inpatient mortality was calculated to be 5%, which may result from the fact that the majority of admitted patients had few or no comorbid conditions (CCI 0.72). The most common procedure performed during admission was a bronchoalveolar lavage. Mean length of stay was 6.2 days (CI 3.9-8.5) and average cost of admission was $29,932.20 (CI 13,739-46,124). Of note, 50% of these admissions were considered "elective."Conclusions: Demographics of patients with PAP who have been hospitalized in the United States are similar to previously reported demographics from prior patient cohorts, specifically a male predominance and a mean age in the 40 s. The inpatient mortality rate of 5% we found is consistent with prior studies demonstrating good disease-specific survival rates. Notably, the cost per admission and overall annual cost associated with PAP hospitalization was calculated to be $29932.20 and $5 million respectively. This reflects the high economic cost associated with hospitalization of PAP patients, and provokes thought about ways to make treatment more cost-effective. [ABSTRACT FROM AUTHOR]

Introduction: Comparisons of healthcare utilization and expenditure among multiple sclerosis (MS) disease-modifying therapies (DMTs) are limited. Methods: In this retrospective cohort study using commercial insurance claims data of a US population (2010–2019), we compared healthcare utilization and costs in MS across different DMTs. We assigned patients to different treatment arms: no DMT (ND), high-efficacy (HE) DMT (alemtuzumab, B cell depletion, cladribine, and natalizumab), and standard-efficacy (SE) DMT (dimethyl fumarate, glatiramer acetate, interferon beta, sphingosine-1-phosphate receptor modulator, and teriflunomide). We obtained healthcare costs and occurrences of healthcare services: outpatient visits, emergency room visits, hospitalizations, MS-related magnetic resonance imaging (MRI). We quantified relapses (based on MS-related hospitalizations, as well as outpatient visits with prescription of high-dose steroids) and medical complexity (based on unique drug classes of prescriptions). We calculated covariate-adjusted incidence rate ratio of healthcare services using negative binomial regression with ND as reference and covariate-adjusted mean cumulative healthcare costs using a generalized linear model with log-link function and gamma distribution. Results: Among the 25,932 patients with MS (mean age 52.8 years, 75.2% women), both HE (mean age 54.0 years, 76.2% women) and SE (mean age 43.9 years, 75.6% women) groups had more non-pharmacy healthcare utilization than ND (mean age 57.6 years, 75.4% women), including overall outpatient doctor visits, neurology visits, and MS-related MRIs as well as relapses and medical complexities. Relative to ND, both HE and SE groups had higher pharmacy costs and overall healthcare costs 12 months after treatment initiation, despite having lower or equivalent non-pharmacy medical costs. In patients on DMT, pharmacy costs accounted for up to 65% of overall healthcare costs with over 85% of pharmacy costs attributable to DMT costs. Conclusion: DMT cost is a key driver of the overall healthcare expenditure in MS. Future comparative and cost-effectiveness studies integrating claims and electronic health records data with better balancing of patient characteristics are warranted. [ABSTRACT FROM AUTHOR]

Introduction: While it is recognized that there are costs associated with postoperative patient follow-up, risk assessments of catastrophic health expenditures (CHEs) due to surgery in sub-Saharan Africa rarely include expenses after discharge. We describe patient-level costs for cesarean section (c-section) and follow-up care up to postoperative day (POD) 30 and evaluate the contribution of follow-up to CHEs in rural Rwanda. Methods: We interviewed women who delivered via c-section at Kirehe District Hospital between September 2019 and February 2020. Expenditure details were captured on an adapted surgical indicator financial survey tool and extracted from the hospital billing system. CHE was defined as health expenditure of ≥ 10% of annual household expenditure. We report the cost of c-section up to 30 days after discharge, the rate of CHE among c-section patients stratified by in-hospital costs and post-discharge follow-up costs, and the main contributors to c-section follow-up costs. We performed a multivariate logistic regression using a backward stepwise process to determine independent predictors of CHE at POD30 at α ≤ 0.05. Results: Of the 479 participants in this study, 90% were classified as impoverished before surgery and an additional 6.4% were impoverished by the c-section. The median out-of-pocket costs up to POD30 was US$122.16 (IQR: $102.94, $148.11); 63% of these expenditures were attributed to post-discharge expenses or lost opportunity costs (US$77.50; IQR: $67.70, $95.60). To afford c-section care, 64.4% borrowed money and 18.4% sold possessions. The CHE rate was 27% when only considering direct and indirect costs up to the time of discharge and 77% when including the reported expenses up to POD30. Transportation and lost household wages were the largest contributors to post-discharge costs. Further, CHE at POD30 was independently predicted by membership in community-based health insurance (aOR = 3.40, 95% CI: 1.21,9.60), being a farmer (aOR = 2.25, 95% CI:1.00,3.03), primary school education (aOR = 2.35, 95% CI:1.91,4.66), and small household sizes had 0.22 lower odds of experiencing CHE compared to large households (aOR = 0.78, 95% CI:0.66,0.91). Conclusion: Costs associated with surgical follow-up are often neglected in financial risk calculations but contribute significantly to the risk of CHE in rural Rwanda. Insurance coverage for direct medical costs is insufficient to protect against CHE. Innovative follow-up solutions to reduce costs of patient transport and compensate for household lost wages need to be considered. [ABSTRACT FROM AUTHOR]

Background and objective: The study aimed to evaluate the direct and indirect costs of systemic sclerosis (SSc) in cases with and without interstitial lung disease (ILD). Methods: Cases diagnosed with SSc (2002–2015) were identified in the Danish National Patient Registry. Cases were matched 1:4 with non‐SSc controls from the general population. Data on costs were obtained from national databases. Excess cost was estimated as the annual cost per case subtracting the costs of the control. Results: We identified 1869 cases and 7463 controls. Total excess cost (direct healthcare, elderly care and indirect costs) in the SSc‐ILD cohort was €29,725, and €17,905 in the non‐ILD SSc cohort. In‐ and out‐patient contacts and forgone earnings were the key drivers of costs in both cohorts. Healthcare costs were higher before and after the diagnosis compared with the controls. Men incurred higher excess healthcare costs than women. Hospitalization and outpatient services were the key drivers of the gender‐associated differences. Income from employment decreased more rapidly after diagnosis in the SSc‐ILD cohort than in the non‐ILD SSc cohort. Public transfer income increased after diagnosis, with the most pronounced difference in the SSc‐ILD cohort. Disability pension was the key driver of public transfer income. Conclusion: SSc is associated with a significant individual and societal burden that is evident several years before and after the diagnosis. Total excess costs are higher in SSc‐ILD than in the non‐ILD SSc underlining the severity of pulmonary involvement. Initiatives to maintain work ability and to reduce hospital admissions may reduce the economic burden of SSc. In a cohort of 1869 cases and 7463 matched controls, we found a significant individual and societal burden of systemic sclerosis that is evident several years before and after the diagnosis. Total excess costs were highest in cases with concomitant interstitial lung disease, which underlines the severity of pulmonary involvement. [ABSTRACT FROM AUTHOR]

• More than four-fifths of patients involved in motorcycle road traffic crashes in this study had no form of medical insurance. • 46% of the patients spent more than 25% of their annual household income in health care services in a single event of motorcycle road crash. This is catastrophic as defined by WHO. • The willingness to pay approach of measuring health care cost is an easy method of estimating health care cost but it correlates poorly with the activity-based costing method. Motorcycle crashes are an increasing public health problem in low- and middle-income countries (LMICs). An accurate estimation of the economic burden of these crashes could be complex owing to a prevalent system of out-of-pocket (OOP) payment for health care services in these countries. Our study aims to objectively evaluate the cost implication of motorcycle Road Traffic Injuries (RTIs) among road crash victims managed at a major trauma reference hospital in Nigeria. Two economic evaluation methods were used to accurately reflect the cost-of-care (C-o-C) of each victim as well as for cross-validation. This is a prospective cohort study conducted between August 2020 and May 2021. All patients involved in motorcycle road traffic crashes presenting to the Emergency Department of the University College Hospital, Ibadan, Nigeria, were included in the study. For each patient, all medical expenses from the time of injury (T 0) to 30 days after injury (T 30) or Time to death (T D) – whichever occurred first, were valued in costs, and added (Activity-based costing or ABC), while also estimating overall cost-of-care (C-o-C) at T 30 or T D, using the willingness-to-pay (WTP) method. Following the WHO definition, catastrophic expenditure was defined as expenditure > 25% of the patient's estimated annual household income. Of the 150 consecutively managed motorcycle crashes victims during the study period, 112 had complete data. The median monthly household income for the cohort was $121 with 75% of them earning less than $180. The median cost-of-care (C-o-C), by ABC, was $242 ($143 - 828). For individual care items, expenditure on surgical intervention(s) was the highest followed by prosthesis and implant procurement, and radiological investigations. On the other hand, the estimated medical cost was $2356 (IQR $938 - 6475) by WTP. Only 14% had health insurance coverage. The overall expenditure was catastrophic for 46% of the patients. Monthly household income of < $180 (AOR=9.2; 95% CI=2.6–32.8; p < 0.001), absence of health insurance coverage (AOR=10.7; 95% CI=1.1–101.6; p = 0.040), and prolonged hospital stay above 14 days (AOR=25.1; 95% CI=5.5 -115.1; p = 0.001) were predictors of catastrophic expenditure. There was a weak positive correlation between actual cost-of-care using the ABC method and WTP (r = 0.247; p = 0.102). The aggregate cost of motorcycle RTIs is catastrophic for nearly half of the victims attending the University College Hospital, Ibadan. The willingness-to-pay method, though less tedious is often less reliable in these settings owing to a prevalent OOP payment system. This study identified the need to implement effective financial protection mechanisms against the high OOP expenditure faced by motorcycle crash victims in LMICs. [ABSTRACT FROM AUTHOR]

Background: Strong evidence indicates that excessive time spent sitting (sedentary behaviour) is detrimentally associated with multiple chronic diseases. Sedentary behaviour is prevalent among adults in Australia and has increased during the COVID-19 pandemic. Estimating the potential health benefits and healthcare cost saving associated with reductions in population sitting time could be useful for the development of public health initiatives. Methods: A sedentary behaviour model was developed and incorporated into an existing proportional, multi-state, life table Markov model (ACE-Obesity Policy model). This model simulates the 2019 Australian population (age 18 years and above) and estimates the incidence, prevalence and mortality of five diseases associated with sedentary behaviour (type 2 diabetes, stroke, endometrial, breast and colorectal cancer). Key model inputs included population sitting time estimates from the Australian National Health Survey 2014–2015, healthcare cost data from the Australian Institute of Health and Welfare (2015) and relative risk estimates assessed by conducting literature reviews and meta-analyses. Scenario analyses estimated the potential change in disease incidence as a result of changes in population sitting time. This, in turn, resulted in estimated improvements in long term health outcomes (Health-adjusted life years (HALYs)) and healthcare cost-savings. Results: According to the model, if all Australian adults sat no more than 4 h per day, the total HALYs gained would be approximately 17,211 with health care cost savings of approximately A$185 million over one year. Under a more feasible scenario, where sitting time was reduced in adults who sit 4 or more hours per day by approximately 36 min per person per day (based on the results of the Stand Up Victoria randomised controlled trial), potential HALYs gained were estimated to be 3,670 and healthcare cost saving could reach A$39 million over one year. Conclusions: Excessive sedentary time results in considerable population health burden in Australia. This paper describes the development of the first Australian sedentary behaviour model that can be used to predict the long term consequences of interventions targeted at reducing sedentary behaviour through reductions in sitting time. These estimates may be used by decision makers when prioritising healthcare resources and investing in preventative public health initiatives. [ABSTRACT FROM AUTHOR]

Objectives: Suficiencia is a large database that encompasses information of 15.1 million enrollees at ten health maintenance organizations (HMOs) on each healthcare service provided to patients, being the main source of information for estimating cost at the individual level. It constitutes a reliable tool for measuring prevalence and costs of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) in Colombia, where these data are scarce. The aim of this study is to describe and show the utility of the Suficiencia database for studies on RA and SLE in Colombia. Methods: To estimate the RA and SLE cost, patients were identified according to ICD-10 codes in the Suficiencia dataset for year 2015. We calculated the number of RA/SLE patients and their individual cost as the sum of all claims in each type of facility (i.e., inpatient, outpatient, emergency, domiciliary). We then estimated the total cost of care and average cost per patient. We also report RA and SLE prevalence. Results: The estimates of prevalence of RA and SLE were 737/100,000 and 117/100,000 respectively. Results show that the annual average healthcare cost of a person with RA is $1625, while the cost for a person with SLE is $1693. Women were more affected by these conditions, but men's care was more expensive. Conclusion: The cost of RA and SLE care in the developing world may be relatively high. Total cost represents about 4% of total healthcare expenses in Colombia. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to assess the cost-effectiveness profile of adherence to recommendations for the community management of patients discharged with a diagnosis of acute coronary syndrome (ACS).Methods: The cohort of 50 282 residents in the Lombardy Region (Italy) who were discharged with a diagnosis of ACS during 2011 to 2015 was followed up until 2018. Adherence to selected recommendations including drug therapies (DTs), outpatient controls, and rehabilitation, experienced during the first year after index discharge, was considered. Adherent and nonadherent cohort members were matched on high-dimensional propensity scores. Composite clinical outcomes (cardiovascular hospital admissions and all-cause mortality) and healthcare costs were assessed for a time horizon of 5 years. Cost-effectiveness profile of adherence to recommendations was measured through the incremental cost-effectiveness ratio, that is, the incremental cost for 1 day free from the composite clinical outcome.Results: Adherence to DTs, outpatient controls, and rehabilitation, respectively, regarded 39%, 81%, and 3% of cohort members. Compared with nonadherent patients, those adherent to DTs, outpatient controls, and rehabilitation had (1) a delay in the occurrence of the composite clinical outcome of 50, 43, and 73 days, respectively, and (2) lower (on average, €199 per year for DTs) and higher costs (€292 and €1024 for outpatient controls and rehabilitation). Cost-effectiveness profiles were better for patients with myocardial infarction than those with angina and for patients with more severe clinical complexity than those with milder conditions.Conclusions: Health-related and economic benefits are expected from improving adherence to international guidelines recommendations concerning outpatient treatments and monitoring of patients with ACS. [ABSTRACT FROM AUTHOR]

The burden and impact of non-communicable diseases (NCDs) are well documented, accounting for 70% of premature deaths globally. In Sub-Saharan Africa, rising NCDs are estimated to account for 27% of mortality by 2020, a 4% increase from 2005. This increase will inevitably lead to a higher demand for NCD treatment services, exerting pressure on limited public financial resources. To get a sense of the resources required to treat NCDs, it is necessary to estimate the costs associated with the diagnosis, treatment and management thereof. Typically, in estimating costs for health services, countries use historical patient level data combined with demographic trend data and non-patient level data to arrive at estimated future costs. This methodology relies heavily on the availability of data from a wide variety of sources stretching beyond the health sector. Low-and-middle-income countries often lack the requisite data and are compelled to use less efficient ways to determine resource allocation. This study explores the use of probability-based cost estimation to estimate the cost of delivering NCD treatment services in South Africa, one such data-poor environment. Probability-based cost estimation, in combination with deterministic cost estimation, is used in arriving at a cost estimate for NCD treatment services at primary healthcare facility level. On its own, deterministic cost estimation can determine total costs, provided all the input variables are known. This is not always possible because of the lack of one or more input variables. In most instances, the lacking input variable is the quantities at which specific conditions will be treated. This problem is addressed by using probability-based cost estimation through which a mean cost is calculated and applied to the target population as a whole, eliminating the need for quantities per condition. Thus, this model contains both deterministic and probabilistic cost estimation elements. [ABSTRACT FROM AUTHOR]

Background: The use of programmable ventriculoperitoneal shunt (P-VPS) in idiopathic normal pressure hydrocephalus (iNPH) has increased over the last two decades, however, there is no definitive evidence to favor them over non-programmable VPS (NP-VPS). Thus, there is a growing need for studies comparing these two procedures for their efficacy and safety profile in iNPH.Objective: In this study, we attempt to quantitatively summarize the findings of all the prospective and retrospective studies that have directly compared the P-VPS and NP-VPS in terms of efficacy, complications, or overall healthcare expenditure.Methods: A systematic search was performed of PubMed, the Cochrane Library databases, and Google Scholar for studies till June 2021 comparing the outcomes of P-VPS with NP-VPS. Four studies were finally included in the quantitative analysis. A trial sequential analysis was done to evaluate the need for further studies.Results: The total rates of subdural collection (odds ratio (OR) 1.03; 95% Confidence interval (CI): 0.73-1.46; P = 0.85; I2 = 12%) as well as surgically evacuated subdural collection (OR 0.46; 95% CI: 0.14-1.55; P = 0.21; I2 = 75%) were not significantly different for P-VPS compared to NP-VPS with pooled data. Similarly, the rate of postoperative infection was found to be similar between the two types of VPS (OR 0.98; 95% CI: 0.39-2.5; P = 0.97; I2 = 0%). The trial sequential analysis (TSA) for the need of surgical evacuation of subdural collection and shunt revision revealed that the meta-analysis of the currently accrued information is not conclusive.Conclusions: Though, associated with higher initial costs, P-VPS does not seem to result in increased healthcare costs in the long run while enabling the surgeon to titrate the opening pressure and avoiding additional surgical procedures like shunt revision or evacuation of subdural collection at least theoretically. However, further trials with a greater sample size are needed to confirm these findings as the current accrued information size is insufficient to reach an unequivocal verdict. [ABSTRACT FROM AUTHOR]

Background: This study describes treatment characteristics and healthcare costs prior to and following treatment change from somatostatin analog (SSA) monotherapy among a privately-insured NET patient population in the US. Methods: Patients with newly diagnosed NET and treated with SSA monotherapy were retrospectively identified in IBM MarketScan claims between 1/1/2014 and 3/31/2019. NET treatment change was captured ≥30 days after the SSA start date (earliest new treatment-index date). Healthcare costs (reimbursed amount in 2019 dollars) were reported for 1, 3, and 6months pre- and post-index intervals. Results: A total of 305 patients were identified (mean age: 58 years; female: 52%; metastatic disease: 49%). Most patients started on octreotide (81%) vs. lanreotide (19%). Common treatment changes included alternate SSA (38%), targeted therapy (30%), or chemotherapy (23%). Total costs increased on average by $13,272 between the month preceding and following treatment change (p<.001), with the highest increase among patients changing to targeted therapy ($19,677, p<.001) vs. an alternate SSA ($10,240, p<.001) or chemotherapy ($4,057, p=.155). The trajectory in mean cost difference using a 1, 3, and 6-month time period followed an increasing trend for patients who changed to targeted therapy (D$19,677, D$34,856, D$58,387) but was flat for patients who changed to the alternate SSA (D$10,240, D$10,026, D$11,727). Conclusions: Higher total healthcare costs were observed following treatment change from first-line SSA. Switching to the alternate SSA was associated with a fixed, one-time cost; whereas, switching to targeted therapy was associated with both an initial switching cost and a persistent monthly increase. [ABSTRACT FROM AUTHOR]

Aims: Rivaroxaban reduces stroke compared with warfarin in patients with non-valvular atrial fibrillation (NVAF). This study compared healthcare costs before and after stroke in NVAF patients treated with rivaroxaban or warfarin. Materials and methods: Using de-identified IBM MarketScan Commercial and Medicare databases, this retrospective cohort study (from 2011 to 2019) included patients with NVAF who initiated rivaroxaban or warfarin within 30 days after initial NVAF diagnosis. Patients who developed stroke were identified, and stroke severity was determined by the National Institutes of Health Stroke Scale (NIHSS) score, imputed by a random forest method. Total all-cause per-patient per-year (PPPY) costs of care were determined for patients: (1) who developed stroke during the pre- and post-stroke periods and (2) who remained stroke-free during the follow-up period. Treatment groups were balanced using inverse probability of treatment weighting. Results: A total of 13,599 patients initiated rivaroxaban and 39,861 initiated warfarin, of which 272 (2.0%) and 1,303 (3.3%), respectively, developed stroke during a mean follow-up of 28months. Among patients who developed stroke, PPPY costs increased from the pre-stroke to post-stroke period, with greater increases in the warfarin cohort relative to the rivaroxaban cohort. Overall, the costs increased by 1.78-fold for rivaroxaban vs 3.07-fold for warfarin; for less severe strokes (NIHSS < 5), costs increased 0.88-fold and 1.05-fold, respectively. Cost increases for more severe strokes (NIHSS ≥ 5) among rivaroxaban patients were half those for warfarin patients (3.19-fold vs 6.37-fold, respectively). Among patients without stroke, costs were similar during the follow-up period between the two treatment groups. Conclusions: Total all-cause costs of care increased in the post-stroke period, and particularly in the patients treated with warfarin relative to those treated with rivaroxaban. The lower rate of stroke in the rivaroxaban cohort suggests that greater pre-to post-stroke cost increases result from more strokes occurring in the warfarin cohort. [ABSTRACT FROM AUTHOR]

Objectives: To assess the economic impact of introducing biosimilar pegfilgrastim compared to the current standard granulocyte colony-stimulating factor (G-CSF) practice in France. Methods: A budget impact model was developed to investigate the impact of introducing pegfilgrastim biosimilar over 5 years. The model analysed drug acquisition costs, ambulatory costs, as well as costs associated with poor outcomes, and compared the current standard practice of long-acting and short-acting G-CSF to a revised practice including pegfilgrastim biosimilar in addition to standard practice treatments. The cost of switching to pegfilgrastim biosimilar, within a pharmacy setting, was analysed within the model using data from a survey of French pharmacists. Results: The budget impact model calculated a cost saving of €51,007,531 over 5 years switching from the current standard practice to pegfilgrastim biosimilar. A sensitivity analysis accounting for variation in pegfilgrastim biosimilar uptake of 1) 15% in year 1 and 1% in years 2–5 and 2) 15% in years 1–5, estimated savings ranging between €29,377,784 and €79,847,194, respectively. A further analysis predicted cost savings of €287,344,835 over 5 years with the extension of pegfilgrastim biosimilar, at an uptake of 15% in year 1 and 7% in years 2–4, to both long-acting and short-acting G-CSF groups compared to unchanged current practice. Conclusions: The introduction of pegfilgrastim biosimilar will help to reduce cost and alleviate some of the financial pressure on the French healthcare system. [ABSTRACT FROM AUTHOR]

The present study aims to determine the prevalence and distribution of sickle cell traits in Koraput district of Odisha along with the financial burden on households. A total of 1092 individuals of either sex, aged above 30 years, were randomly screened. Blood samples from each individual were collected and tested using the sodium metabisulphite (Na2S2O5) technique to determine the presence of the sickled red blood cell. Demographic information and family (n=552) expenditure on health were recorded. The prevalence of sickle cell hemoglobin was found to be 9.43% in the studied population. The sickle cell hemoglobin is widespread in Koraput district of Odisha state and more prevalent in scheduled castes (9.98%) than in tribal groups (3.33 %). The present study observed a tendency for the sickling rate to be higher in people of lower age groups. The average annual healthcare expenditure was very high (3% to 64.4% of the family income) in families with sickle cell hemoglobinopathies. In contrast, the healthcare expenditure was 0.78% to 18.4% in families without sickle cell hemoglobin. Furthermore, the study explored that due to the consanguineal marriage practice, hesitance and social stigma toward sickle cell carrier screening, the genetic load is increasing for the sickle cell trait in the studied population. [ABSTRACT FROM AUTHOR]

Background: The economic burden of stroke on the healthcare system has been previously described, but sex differences in healthcare costs have not been well characterized. We described the direct person-level healthcare cost in men and women as well as the various health settings in which costs were incurred following stroke.Methods: In this population-based cohort study of patients admitted to hospital with stroke between 2008 and 2017 in Ontario, Canada, we used linked administrative data to calculate direct person-level costs in Canadian dollars in the one-year following stroke. We used a generalized linear model with a gamma distribution and a log link function to compare costs in women and men with and without adjustment for baseline clinical differences. We also assessed for an interaction between age and sex using restricted cubic splines to model the association of age with costs.Results: We identified 101,252 patients (49% were women, median age [Q1-Q3] was 76 years [65-84]). Unadjusted costs following stroke were higher in women compared to men (mean ± standard deviation cost was $54,012 ± 54,766 for women versus $52,829 ± 59,955 for men, and median cost was $36,703 [$16,496-$72,227] for women versus $32,903 [$15,485-$66,007] for men). However, after adjustment, women had 3% lower costs compared to men (relative cost ratio and 95% confidence interval 0.97 [0.96,0.98]). The lower cost in women compared to men was most prominent among people aged over 85 years (p for interaction = 0.03). Women incurred lower costs than men in outpatient care and rehabilitation, but higher costs in complex continuing care, long-term care, and home care.Conclusions: Patterns of resource utilization and direct medical costs were different between men and women after stroke. Our findings inform public payers of the drivers of costs following stroke and suggest the need for sex-based cost-effectiveness evaluation of stroke interventions with consideration of costs in all care settings. [ABSTRACT FROM AUTHOR]

Objectives: Examine healthcare usage, pharmacy prescriptions and healthcare cost among people with Intellectual Disability (ID) who participate in Special Olympics (SO) compared to people with ID who do not participate in SO. In addition, a subanalysis was completed to compare SO athletes who participated in the Healthy Athlete program to those who had not. Methods: Ten years of data were extracted based on active claim and identification. Final analyses included non‐SO participants and SOWI athletes for healthcare and pharmacy. Results: SOWI athletes who participated in the Healthy Athlete program had significantly lower healthcare and pharmacy usage, and cost than SOWI athletes who did not participate controlling for race, ethnicity, and age. Conclusions: Public health programs may have variable levels of effectiveness when addressing health disparities for people with ID. [ABSTRACT FROM AUTHOR]

Solar ultraviolet radiation is one of the most common occupational carcinogens in Canada and is responsible for approximately 5,556 non-melanoma skin cancers per year. A large part of these cases are preventable by reducing solar ultraviolet radiation exposure. In this study, investigators estimated the potential economic impacts of different solar ultraviolet radiation reduction interventions among construction workers, as they are one of the largest at-risk occupational groups. Investigators performed an economic evaluation from a societal perspective, by comparing incremental costs in relation to incremental benefits achieved by two interventions—use of personal protective equipment by all exposed individuals and use of shade structure wherever and whenever feasible. Interventions costs were estimated for 2020–2050, and benefits with a 10-year delay, i.e., for the period 2030–2060. Economic evaluation estimates were reported by intervention costs, total costs of non-melanoma skin cancers cases averted, incremental cost per avert case, return on investment, and the break-even point. Various sensitivity analyses were undertaken with key parameters. Our findings indicate that if the rising trend of incidence continues, cases will be double in 2060, whereas by using personal protective equipment or shade structure, with the best-case scenario of full ultraviolet radiation removal, would result in 6,034 and 2,945 cases averted over 30 years, respectively. This translates into a total of $38.0 and $20.5 million of averted costs (all monetary values represented in 2017 Canadian dollars). Under this scenario investigators expect that by 2060, for every dollar invested in personal protective equipment and shade structures, $0.49 and $0.35 will be returned, respectively. Findings also suggested that under a conservative scenario, prevention of non-melanoma skin cancer cases by personal protective equipment and shade structures resulted in $5,812 and $7,355 incremental costs, respectively, over the 30-year period. This study provides important insights for decision makers about the potential impacts of solar ultraviolet radiation reduction interventions in the construction sector and other sectors with substantial outdoor work. Our estimates also can raise awareness of the importance of solar ultraviolet radiation reduction interventions. [ABSTRACT FROM AUTHOR]

Background: Our aim was to examine whether the length of stay, hospital charges and in-hospital mortality attributable to healthcare- and community-associated infections due to antimicrobial-resistant bacteria were higher compared with those due to susceptible bacteria in the Lebanese healthcare settings using different methodology of analysis from the payer perspective .Methods: We performed a multi-centre prospective cohort study in ten hospitals across Lebanon. The sample size consisted of 1289 patients with documented healthcare-associated infection (HAI) or community-associated infection (CAI). We conducted three separate analysis to adjust for confounders and time-dependent bias: (1) Post-HAIs in which we included the excess LOS and hospital charges incurred after infection and (2) Matched cohort, in which we matched the patients based on propensity score estimates (3) The conventional method, in which we considered the entire hospital stay and allocated charges attributable to CAI. The linear regression models accounted for multiple confounders.Results: HAIs and CAIs with resistant versus susceptible bacteria were associated with a significant excess length of hospital stay (2.69 days [95% CI,1.5-3.9]; p < 0.001) and (2.2 days [95% CI,1.2-3.3]; p < 0.001) and resulted in additional hospital charges ($1807 [95% CI, 1046-2569]; p < 0.001) and ($889 [95% CI, 378-1400]; p = 0.001) respectively. Compared with the post-HAIs analysis, the matched cohort method showed a reduction by 26 and 13% in hospital charges and LOS estimates respectively. Infections with resistant bacteria did not decrease the time to in-hospital mortality, for both healthcare- or community-associated infections. Resistant cases in the post-HAIs analysis showed a significantly higher risk of in-hospital mortality (odds ratio, 0.517 [95% CI, 0.327-0.820]; p = 0.05).Conclusion: This is the first nationwide study that quantifies the healthcare costs of antimicrobial resistance in Lebanon. For cases with HAIs, matched cohort analysis showed more conservative estimates compared with post-HAIs method. The differences in estimates highlight the need for a unified methodology to estimate the burden of antimicrobial resistance in order to accurately advise health policy makers and prioritize resources expenditure. [ABSTRACT FROM AUTHOR]

Introduction: Tumor necrosis factor inhibitors (TNFis) may be administered at a reduced dose to patients with ankylosing spondylitis (AS) for various reasons. However, in practice, there is insufficient evidence of how the dose reduction of TNFi is implemented and the amount of medical costs it reduces. In this study, we investigated treatment patterns among patients with AS who were administered various TNFis. The effect on medical costs related to AS was also investigated using Korea's insurance claims database. Methods: From the insurance claims database of the Health Insurance Review & Assessment Service in South Korea, patients with AS newly treated with TNFis (etanercept, adalimumab, golimumab, and infliximab) between July 1, 2013, and June 30, 2016, were enrolled. Patients treated with the TNFis were followed up for 2 years. Treatment patterns (continuation and discontinuation of TNFi) and dose reduction (< 50% of recommended dose) in patients who continued treatment were analyzed and compared among the TNFi groups using the Chi-square test. Healthcare costs between the dose reduction and maintenance groups were compared using general linear modeling. Results: Of 1352 patients, 764 (56.51%) continued using TNFis for 2 years, and 17.8% of these were administered reduced doses. TNFi dose reduction was the most frequent in 36 (24.83%) patients using etanercept, followed by those using adalimumab (21.97%), golimumab (11.70%), and infliximab (11.98%) (p = 0.0028). For each TNFi group, the total healthcare cost significantly decreased, that is, by 24.85% for adalimumab, 31.80% for etanercept, 26.34% for golimumab, and 35.52% for infliximab (p < 0.0001). Conclusions: TNFi dose reduction was identified in 17.8% of the patients with AS, and the patterns were different for each TNFi. Additionally, the dose reductions significantly reduced the medical costs associated with AS, that is, from 24.85 to 35.52% of the total medical expenditure. [ABSTRACT FROM AUTHOR]

Healthcare costs are a continual concern. To improve our cost-efficiency we must identify the direct costs of ocular injuries requiring hospitalization. The purpose of this study was to evaluate the direct costs of hospitalized ocular injuries in Texas. Retrospective cohort study using the Texas Hospital Inpatient Discharge Public Use Data File, 2013–2014. Persons hospitalized for ocular trauma were identified using ICD-9-CM codes. Injuries were subcategorized as ocular adnexal, open globe, or closed globe based on diagnosis and procedure codes and analyzed across three age groups: 18–44, 45–64, and >65 years. From 2013 to 2014, 1498 patients were hospitalized with ocular adnexal injuries, 644 with open globe injuries, and 2877 with closed globe injuries. Length of stay ranged from 2 to 4 days. The median total charges ranged between $34,576 and $55,409 across all injuries and groups. The largest portion of medical costs were due to radiology in the ocular adnexal and closed globe groups, and operating room charges in the open globe group. Median hospitalization costs for ocular injuries were between $34,576 and $55,409 for a 2–4 day length of stay. Open globe injuries had the shortest median lengths of stay, 2–3 days, and lower median total costs. Only in the open globe group were operative costs higher than radiology costs. Operative charges were lowest in the oldest age group, who also had longer lengths of stay. Our reported costs were lower than other nationally reported ocular injury costs for similar lengths of hospital stay. [ABSTRACT FROM AUTHOR]

Healthcare costs, including costs for laboratory tests, are increasing worldwide. One example is the measurement of vitamin D. General practitioners in the Capital Region of Denmark include a vitamin D status in approximately 20% of all laboratory requisitions. This study intended to examine the effect of a compulsory pop-up form in the electronic request system on the number of vitamin D tests and to monitor the indications. From 1 January 2017, we introduced a compulsory pop-up form in which the general practitioners had to state the indication for measuring vitamin D, choosing from a predefined set of indications. Intervention practitioners were compared with control practitioners before and after the intervention. General practices in the Capital Region of Denmark. In total, 572 general practitioners and 383,964 patients were included in the period from 1 January 2016 to 31 December 2018. Number of vitamin D tests and distribution of indications. We observed a drop in number of vitamin D requisitions to 70% (in 2017) and 75% (in 2018) relative to 2016. During the same period, the number of requisitions increased by 33% in a non-intervention group of practitioners. The indication 'Monitoring of treatment with vitamin D' was the most frequently used indication, recorded in 121,475 patients. A compulsory pop-up form reduces the number of vitamin D requests from general practitioners by 25%. The implication is that pop-up forms can be used to decrease healthcare costs. [ABSTRACT FROM AUTHOR]