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BackgroundJuvenile Idiopathic Arthritis (JIA) requires complex care that generate elevated costs, which results in a high economic impact for the family. The aim of this systematic review was to collect and cluster the information currently available on healthcare costs associated with JIA after the introduction of biological therapies.MethodsWe comprehensively searched in MEDLINE, EMBASE, Web of Science, Scopus, and Cochrane Databases for studies from January 2000 to March 2021. Reviewers working independently and in duplicate appraised the quality and included primary studies that report total, direct and/or indirect costs related to JIA for at least one year. The costs were converted to United States dollars and an inflationary adjustment was made.ResultsWe found 18 eligible studies including data from 6,540 patients. Total costs were reported in 10 articles, ranging from $310 USD to $44,832 USD annually. Direct costs were reported in 16 articles ($193 USD to $32,446 USD), showing a proportion of 55 to 98 % of total costs. Those costs were mostly related to medications and medical appointments. Six studies reported indirect costs ($117 USD to $12,385 USD). Four studies reported costs according to JIA category observing the highest in polyarticular JIA. Total and direct costs increased up to three times after biological therapy initiation. A high risk of reporting bias and inconsistency of the methodology used were found.ConclusionThe costs of JIA are substantial, and the highest are derived from medication and medical appointments. Indirect costs of JIA are underrepresented in costs analysis.

Copyright © 2020 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L.U. All rights reserved., © 2020 Sociedade Portuguesa de Cardiologia. Published by Elsevier Espa ̃na, S.L.U. This is an open access article under the CC-BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)., Introduction and objectives: Cardiovascular disease is the leading cause of death in Portugal and atherosclerosis is the most common underlying pathophysiological process. The aim of this study was to quantify the economic impact of atherosclerosis in Portugal by estimating disease-related costs. Methods: Costs were estimated based on a prevalence approach and following a societal perspective. Three national epidemiological sources were used to estimate the prevalence of the main clinical manifestations of atherosclerosis. The annual costs of atherosclerosis included both direct costs (resource consumption) and indirect costs (impact on population productivity). These costs were estimated for 2016, based on data from the Hospital Morbidity Database, the health care database (SIARS) of the Regional Health Administration of Lisbon and Tagus Valley including real-world data from primary care, the 2014 National Health Interview Survey, and expert opinion. Results: The total cost of atherosclerosis in 2016 reached 1.9 billion euros (58% and 42% of which was direct and indirect costs, respectively). Most of the direct costs were associated with primary care (55%), followed by hospital outpatient care (27%) and hospitalizations (18%). Indirect costs were mainly driven by early exit from the labor force (91%). Conclusions: Atherosclerosis has a major economic impact, being responsible for health expenditure equivalent to 1% of Portuguese gross domestic product and 11% of current health expenditure in 2016.

BACKGROUND: It is well known that early start of drug use can lead users to psychosocial problems in adulthood, but its relationship with users’ direct healthcare costs has not been well established OBJECTIVES: To estimate the direct healthcare costs of drug dependency treated at a community mental health service, and to ascertain whether early start of drug use and current drug use pattern may exert influences on these costs. DESIGN AND SETTING: Retrospective cross-sectional study conducted at a community mental health service in a municipality in the state of São Paulo, Brazil. METHODS: The relationships between direct healthcare costs from the perspective of the public healthcare system, age at start of drug use and drug use pattern were investigated in a sample of 105 individuals. A gamma-distribution generalized linear model was used to identify the cost drivers of direct costs. RESULTS: The mean monthly direct healthcare costs per capita for early-start drug users in 2020 were 1,181.31 Brazilian reais (BRL) (274.72 United State dollars (USD) according to purchasing power parity (PPP)) and 1,355.78 BRL (315.29 USD PPP) for late-start users. Early start of drug use predicted greater severity of cannabis use and use of multiple drugs. The highest direct costs were due to drug dependence combined with alcohol abuse, and due to late start of drug use. CONCLUSIONS: Preventive measures should be prioritized in public policies, in terms of strengthening protective factors before an early start of drug use.

Introduction Nasal polyps are a multifactorial inflammatory condition of the upper airways. Nasal polyps typically affect middle-aged and elderly patients, average age at diagnosis is 40 to 60, and men are affected more commonly than women. Aim To analyse the reported prevalence of nasal polyps in the Polish population, including demographics and co-morbidities, and to estimate the costs of outpatient and hospital (inpatient) services financed by the National Health Fund. Material and methods Statistical analysis of data extracted from the National Health Fund (NHF) registers for 2008-2018. Results In 2018, the recorded prevalence of nasal polyps in Poland was 52.0/10,000 population (0.52%), amounting to 64.6/10,000 (0.65%) in men and 40.2/10,000 (0.40) in women. Nasal polyps were much more frequent in patients aged 55-59 (98.1/10000) and 75-79 years (98.7/10,000). Among men, the highest prevalence was found in the 75-79 age group (164.3/10,000 population), and among women in the 55-59 age group (75.1/10,000). In 2018, the Polish NHF spent PLN 17.2 million (equivalent to EUR 4.0 million/USD 4.7 million) on health services related to the diagnosis of nasal polyps. Hospital services accounted for 77.4% of the total cost. Conclusions Nasal polyps are more than one and a half times as prevalent in men than in women. The recorded prevalence of nasal polyps increases with age, with the rates peaking in those between 75 and 79 years old, and is more often in urban than rural areas.

Background: Rotavirus (RV) is the most common cause of severe gastroenteritis (GE) in infants and young children worldwide and is associated with a significant clinical and economic burden. The objective of this study was to analyze the characteristics, healthcare resource utilization and the direct medical costs related to RVGE hospitalizations.Methods: An observational, multicenter, cross-sectional study was conducted from June 2013 to May 2018 at the pediatric departments of 12 hospitals from different Spanish regions. Children under 5 years of age admitted to the hospital with a confirmed diagnosis of RVGE were selected. Data on clinical characteristics, healthcare resource use and costs were collected from patient records and hospital databases.Results: Most children hospitalized for RVGE did not have any previous medical condition or chronic disease. Forty-seven percent had previously visited the ER, 27% had visited a primary care pediatrician, and 15% had received pharmacological treatment prior to hospital admission due to an RVGE episode. The average length of a hospital stay for RVGE was 5.6 days, and the mean medical costs of RVGE hospitalizations per episode ranged from 3,940€ to 4,100€. The highest direct medical cost was due to the hospital stay.Conclusion: This study shows a high burden of health resource utilization and costs related to the management of cases of RVGE requiring hospitalization. RV vaccination with high coverage rates should be considered to minimize the clinical and economic impacts of this disease on the health care system.

Aim The aim of this study was to provide a comprehensive overview of previously published cost- of-illness studies in stroke or transient ischemic attack (TIA) in Germany. Method A literature search via PubMed and Embase was conducted to identify studies providing estimates of the economic burden of stroke published before June 2019. A study was included if it reported total costs of stroke or costs of a specific stroke treatment phase in Germany. Studies that considered stroke only as a consequence of other diseases or risk factors and therefore did not focus on the detailed description of stroke-related costs were excluded. To ensure comparability between the included studies, all cost estimates were adjusted to 2018 values using consumer price indices (CPI) obtained from the German Federal Statistical Office. Results The search yielded 482 hits. Another three publications were detected by manual search. Sixty-six of them were identified for full-text review. Sixteen out of these studies met the predefined criteria and were therefore included for data -extraction. The average direct medical costs ranged from (sic)14,240 to (sic)44,060. If productivity losses were estimated, indirect costs after stroke varied between (sic)2,470 and (sic)17,860. Inpatient costs were accountable for the largest cost factor in the first year after stroke. In the following years, outpatient treatment and nursing costs dominated. Conclusion The results of the included studies reveal a high economic burden of stroke. In addition, the systematic review demonstrates the need for consistent approaches to measure costs to ensure comparability and identify cost drivers for future demand on care., Zielsetzung Ziel dieser Studie war es, eine umfassende Übersicht über die Literatur zu Kosten des Schlaganfalls oder der transitorischen ischämischen Attacke (TIA) in Deutschland zu geben. Methodik Es wurde eine systematische Literaturrecherche in PubMed und Embase durchgeführt, um kostenberichtende Studien zu Schlaganfall und TIA, die vor Juni 2019 veröffentlicht wurden, zu identifizieren. Studien wurden eingeschlossen, sofern die Gesamtkosten, eine spezifische Kostenkategorie oder mindestens eine Behandlungsphase nach einem Schlaganfall oder einer TIA dargestellt wurde. Dagegen wurden Studien ausgeschlossen, die den Schlaganfall lediglich als Folge einer anderen Erkrankung oder eines Risikofaktors berücksichtigt haben, soweit dort keine separate Beschreibung der schlaganfallspezifischen Kosten vorgenommen wurde. Um die Vergleichbarkeit der Studienergebnisse zu gewährleisten, wurden alle Kostenschätzungen mithilfe des Verbraucherpreisindex des Statistischen Bundesamtes auf das einheitliche Preisjahr 2018 angepasst. Ergebnisse Die Suchen in den Datenbanken ergaben 482 Treffer zuzüglich 3 Handrechercheartikeln, von denen 66 Studien für die Volltextüberprüfung ausgewählt wurden. Davon wurden schlussendlich 16 Studien in die Ergebnissynthese eingeschlossen. Die durchschnittlichen direkten Kosten lagen zwischen 14 240 € und 44 060 € pro Patient. Wenn indirekte Kosten erhoben wurden, lagen diese zwischen 2470 € und 17 860 €. Im ersten Jahr nach einem Schlaganfall stellten die stationären Kosten den größten Kostenblock dar, während die ambulanten Behandlungs- und Pflegekosten insbesondere in den Folgejahren dominierten. Schlussfolgerung Die Ergebnisse der Studien betonen die monetäre Relevanz des Schlaganfalls für das deutsche Gesundheitssystem. Daneben verdeutlicht die Übersichtsarbeit die Notwendigkeit einheitlicher Ansätze zur Erhebung und Analyse von Krankheitskosten, um eine Vergleichbarkeit zu gewährleisten und Handlungsbedarf anhand kostentreibender Aspekte identifizieren zu können.

BackgroundNational economies are increasingly facing the challenge of having to finance the prevention and treatment of human diseases, and of having to compensate for the resulting loss of economic production. Physical inactivity is demonstrably closely related to the risk of developing certain disease group. Physical inactivity results in direct and indirect burdens that the present study intends to quantify in Hungary for the period between 2005 and 2017.MethodsBased on the data of the Hungarian public finances, this study determines the direct and indirect costs incurred by Hungary due to illnesses, and, through the PAR method, it quantifies the financial burden of physical inactivity incurred by the Hungarian Treasury.ResultsThe total financial burden of illnesses in Hungary showed a decreasing tendency from 2005 to 2017, even though the year 2017 saw an increase in costs compared to 2014. Similarly, while total public expenditure on illnesses associated with physical inactivity increased by 2017 when compared to 2009, the total amount attributable to medical conditions stemming from physical inactivity still showed a decrease of 2 billion HUF in the overall period. The biggest economic burden is posed by cardiovascular diseases, hypertension and type 2 diabetes.ConclusionsThe increase in the economic burden associated with physical inactivity can be attributed to the combined effect of two factors: changes in total expenditure on specific disease groups (which showed an increase in the period under review) and changes in the physical activity levels of the Hungarian population (which showed an improvement over the period under review). Initiatives in Hungary aimed at encouraging an active lifestyle from childhood onwards should be continued since – beyond the initial impact that has already been felt to some extent in recent years - these initiatives will come to their full fruition in the coming decades.

Background Limiting treatment to those recommended by the American Academy of Orthopaedic Surgeon Clinical Practice Guidelines has been suggested to decrease costs by 45% in the year prior to total knee arthroplasty, but this only focuses on expenditures leading up to, but not including, the surgery and not the entire episode of care. We evaluated the treatment costs following knee osteoarthritis (OA) diagnosis and determined whether these are different for patients who use intra-articular hyaluronic acid (HA) and/or knee arthroplasty. Methods Claims data from a large commercial database containing de-identified data of more than 100 million patients with continuous coverage from 2012 to 2016 was used to evaluate the cumulative cost of care for over 2 million de-identified members with knee OA over a 4.5-year period between 2011 and 2015. Median cumulative costs were then stratified for patients with or without HA and/or knee arthroplasty. Results Knee OA treatment costs for 1,567,024 patients over the 4.5-year period was $6.60 billion (mean $4210/patient) as calculated by the authors. HA and knee arthroplasty accounted for 3.0 and 61.5% of the overall costs, respectively. For patients who underwent knee arthroplasty, a spike in median costs occurred sooner for patients without HA use (around the 5- to 6-month time point) compared to patients treated with HA (around the 16- to 17-month time point). Conclusions Non-arthroplasty therapies, as calculated by the authors, accounted for about one third of the costs in treating knee OA in our cohort. Although some have theorized that limiting the use of HA may reduce the costs of OA treatment, HA only comprised a small fraction (3%) of the overall costs. Among patients who underwent knee arthroplasty, those treated with HA experienced elevated costs from the surgery later than those without HA, which reflects their longer time to undergoing knee arthroplasty. The ability to delay or avoid knee arthroplasty altogether can have a substantial impact on the cost to the healthcare system.

Daniel Asrat Kassa,1 Solomon Mekonnen,2 Adane Kebede,1 Tsegaye Gebremedhin Haile1 1Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; 2Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Tsegaye Gebremedhin HaileDepartment of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, PO Box 196, Gondar, EthiopiaTel +251-921279362Email tsegishg27@gmail.comPurpose: Hemodialysis is a renal replacement therapy for end-stage renal disease (ESRD) patients who consume substantial healthcare resources, which increases the economic burden. Plenty of factors affects the cost of hemodialysis treatment, particularly in resource-limited settings. Moreover, the demand for hemodialysis may decrease as the cost increases, but there is limited evidence in Ethiopia. Thus, this study aimed to estimate the cost of hemodialysis treatment among ESRD patients in the tertiary hospitals of Addis Ababa City and Amhara region, Ethiopia.Patients and Methods: An institutional-based cross-sectional study was conducted among 172 ESRD patients undergoing hemodialysis treatment. A structured questionnaire and patients’ medical chart were used to estimate the costs, and the human capital approach was applied to calculate the indirect costs. A generalized linear model (GLM) was fitted after the modified park test to identify the associated factors. In the final GLM, a p-value of < 0.05 and a 95% CI were used to declare the significant variables.Results: The mean annual cost of hemodialysis treatment was 121,089.27ETB ($4466.59) ± 33,244.99 ($1226.29). The direct and indirect costs covered 77.0% and 23.0% of the total costs, respectively. Age (ex(b): 1.01, p-value < 0.001), highest wealth status (ex(b): 1.09, p-value: 0.008), eight (ex(b): 1.27, p-value < 0.001) and 12 visits/month (ex(b): 1.34, p-value < 0.001), anemia (ex(b): 1.13, p-value < 0.001), and comorbidity (ex(b): 1.09, p-value: 0.039) were the factors associated with the costs of hemodialysis treatment.Conclusion: The annual cost of hemodialysis treatment among ESRD patients was high compared to the national per capita health expenditure, and two-thirds covered by the direct medical costs. Old age, high wealth status, more visits, anemia, and comorbidity were factors associated with the costs of hemodialysis. Therefore, the healthcare system must make a great effort for cost reduction and reduce the patients with kidney disease before they reach end-stages.Keywords: burden of ESRD, direct costs, indirect costs, GLM, hemodialysis, Ethiopia

Background Clinical factors, such as tumor thickness, ulceration and growth phase have a role as prognostic factors for stage I melanoma. However, it is still under debate whether these variables influence the related direct costs. We aimed to investigate which clinical factors represent direct health care “cost drivers” for stage I melanoma. Materials and method Analyses were conducted on a cohort of patients diagnosed with stage I melanoma. Differences in the costs incurred by different groups of patients were examined using Mann-Whitney or Kruskal-Wallis non-parametric tests. Log linear multivariate analysis was used to identify the clinical drivers of the total direct costs one and two years after diagnosis. The study was conducted from the perspective of Italy's National Health care System. Results One year after diagnosis, patients whose melanomas had a Breslow thickness ≥0.8 mmin (compared with those with lower thickness) and a vertical growth phase (compared with those with radial growth) incurred higher costs for hospitalization, as well as higher overall costs. One year after their diagnosis, treatment of patients with stage I melanoma in the vertical growth phase costs 50% more (95% CI: 22–85%) than their counterparts with a radial growth pattern, resulting in an estimated absolute increase of € 256.23. Having a tumor thicker than 0.8 mm prompted an increase of 91% (95% CI: 43–155%) in the costs (€955.24 in absolute terms). Conclusion Our data indicate a heterogeneity in the direct costs of stage I melanoma patients during the first year after diagnosis, which can be partly explained by clinical prognostic factors, like tumor thickness and growth pattern.

Background The analysis of the economic burden for childhood poisoning has great value in Morocco where there still exists a paucity of information on the subject. The objective of this study was to explore the economic costs of unintentional and intentional poisoning in children in the region of Rabat-Salé-Kénitra, Morocco. Methods A prospective study of children younger than 15 years with a poisoning diagnosis conducted between March and July 2016 in the Children’s University Hospital of Rabat, Morocco. The source of data for this study was questionnaire that collected information on the costs, the epidemiological and the socio-economic characteristics of childhood poisoning. Results Eighty-seven patients were interviewed during the study period (39 females and 48 males). The majority of poisoning cases (98.85%) were accidental and 1.15% were intentional. Drugs, snake bites and scorpion stings, carbon monoxide, food, plants, household products, illegal drugs, pesticides, petroleum and industrial chemicals products were caused the poisoning. Of all the hospitalized patients, 77 (88.5%) were admitted to the emergency department and 5 (5.7%) were admitted to the intensive care unit. The average direct medical costs and the average direct non-medical costs of providing poison treatment were USD 127 and USD 30 per child, respectively. Total average direct cost of USD 157 (127 + 30) represented 60% of the national minimum wage per month in Morocco. Total direct medical costs accounted for 80%, as against 20% direct non-medical costs. The mean ± SD length of stay (LOS) for children with poisoning was 2.15 ± 1.87 days with a range variated between 0 day and 10 days. Conclusions Overall, this study confirms that the costs of childhood poisoning are not negligible costs in Morocco. Therefore, the prevalence and the costs of childhood poisoning can be reduced by monitoring an open communication between parents, the Poison Control Centre of Morocco (MPCC) and physicians in order to increase the vigilance of parents against the risks related to unintentional poisoning that can be prevented with more awareness.

Background Triptans are the most commonly prescribed acute treatments for migraine; however, not all triptan users experience adequate response. Information on real-world resource use and costs associated with triptan insufficient response are limited. Methods A retrospective claims analysis using US commercial health plan data between 2012 and 2015 assessed healthcare resource use and costs in adults with a migraine diagnosis newly initiating triptans. Patients who either did not refill triptans but used other non-triptan medications or refilled triptans but also filled non-triptan medications over a 24-month follow-up period were designated as potential triptan insufficient responders. Patients who continued filling only triptans (i.e. triptan-only continuers) were designated as potential adequate responders. All-cause and migraine-related resource use and total (medical and pharmacy) costs over months 1–12 and months 13–24 were compared between triptan-only continuers and potential triptan insufficient responders. Results Among 10,509 new triptan users, 4371 (41%) were triptan-only continuers, 3102 (30%) were potential triptan insufficient responders, and 3036 (29%) did not refill their index triptan or fill non-triptan medications over 24 months’ follow-up. Opioids were the most commonly used non-triptan treatment (68%) among potential triptan insufficient responders over 24 months of follow-up. Adjusted mean all-cause and migraine-related total costs were $5449 and $2905 higher, respectively, among potential triptan insufficient responders versus triptan-only continuers over the first 12 months. Conclusions In a US commercial health plan, almost one-third of new triptan users were potential triptan insufficient responders and the majority filled opioid prescriptions. Potential triptan insufficient responder patients had significantly higher all-cause and migraine-related healthcare utilization and costs than triptan-only continuers.

As per data provided by the WHO, about one third of death cases due to cancer are caused by risk factors that can be modified. Also, according to data provided by several authors, 4 modifiable risk factors cause 70% of malignant neoplasm cases that could have been prevented. Malignant neoplasms occupy the 2nd rank place in mortality structure in the Russian Federation. A significant share of analyzed malignant neoplasms can potentially be prevented provided that risk factors are corrected; therefore, investments into prevention should be a core in any activity aimed at public health improvement. Our goal was to evaluate economic losses that occurred due to most common oncologic diseases related to behavioral risk factors among population in Russia in 2016 (including costs borne by the public healthcare and losses in the economy). Our analysis comprised direct expenses borne by the public healthcare or, in other words, money spent on oncologic diseases treatment, direct funds allocated to pay disability allowances and temporary disability payments as well as indirect losses in the economy associated with untimely deaths and disability among employable population. Aggregated economic losses that occurred due to 10 most common malignant neoplasms included into our analysis amounted to 241.3 billion rubles or 0.3% of the country GDP in 2016. Direct expenses accounted for 71.7% of the total losses while GDP losses caused by untimely deaths and disability amounted to 28.3%. The highest direct expenses borne by the public healthcare were due to colorectal cancer (52 billion rubles) and cancer in the trachea, bronchial tubes, and lungs (50 billion rubles). Our data indicate it is necessary to invest into oncologic diseases prevention and treatment. These investments can produce a significant economic effect in long-term period thus making for economic growth.

Background Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common inherited kidney diseases characterized by progressive development of renal cysts and numerous extra-renal manifestations, eventually leading to kidney failure. Given its chronic and progressive nature, ADPKD is expected to carry a substantial economic burden over the course of the disease. However, there is a paucity of evidence on the impact of ADPKD from a societal perspective. This study aimed to estimate the direct and indirect costs associated with ADPKD in the United States (US). Methods A prevalence-based approach using data from scientific literature, and governmental and non-governmental organizations was employed to estimate direct healthcare costs (i.e., medical services, prescription drugs), direct non-healthcare costs (i.e., research and advocacy, donors/recipients matching for kidney transplants, transportation to/from dialysis centers), and indirect costs (i.e., patient productivity loss from unemployment, reduced work productivity, and premature mortality, caregivers’ productivity loss and healthcare costs). The incremental costs associated with ADPKD were calculated as the difference between costs incurred over a one-year period by individuals with ADPKD and the US population. Sensitivity analyses using different sources and assumptions were performed to assess robustness of estimates and account for variability in published estimates. Results The estimated total annual costs attributed to ADPKD in 2018 ranged from $7.3 to $9.6 billion in sensitivity analyses, equivalent to $51,970 to $68,091 per individual with ADPKD. In the base scenario, direct healthcare costs accounted for $5.7 billion (78.6%) of the total $7.3 billion costs, mostly driven by patients requiring renal replacement therapy ($3.2 billion; 43.3%). Indirect costs accounted for $1.4 billion (19.7%), mostly driven by productivity loss due to unemployment ($784 million; 10.7%) and reduced productivity at work ($390 million; 5.3%). Total excess direct non-healthcare costs were estimated at $125 million (1.7%). Conclusions ADPKD carries a considerable economic burden, predominantly attributed to direct healthcare costs, the majority of which are incurred by public and private healthcare payers. Effective and timely interventions to slow down the progression of ADPKD could substantially reduce the economic burden of ADPKD.

INTRODUCTION: Asthma, allergic rhinitis, atopic dermatitis, and food allergy affect approximately 20% of the global population. Few studies describe the burden of the totality of these diseases and only a handful studies provide a comprehensive overview of the socioeconomic impact of these diseases. AREAS COVERED: For this narrative review, we searched Pubmed using selected keywords and inspected relevant references using a snowballing process. We provide an overview of the socioeconomic burden of allergic diseases (in particular, asthma, allergic rhinitis, atopic dermatitis, and food allergy). The focus of this review is on their epidemiology (incidence, prevalence), burden (disability-adjusted life years, quality of life), and direct and indirect costs (absenteeism and presenteeism). We have put special emphasis on differences between countries. EXPERT COMMENTARY: Both the prevalence and the burden of allergic diseases are considerable with prevalence varying between 1% and 20%. We identified a plethora of studies on asthma, but studies were generally difficult to compare due to the heterogeneity in measures used. There were only few studies on the burden of food allergy; therefore, more studies on this allergy are required. For future studies, we recommend standardizing epidemiologic, socioeconomic impact, and quality of life measures of allergic diseases.

Introduction Hypertension, particularly untreated, leads to serious complications and contributes to high costs incurred by the whole society. The aim of the review was to carry out a social and economic comparison of various categories of hypertension costs from different countries. Material and methods The study was a systematic review. PubMed, Cochrane Library and Google Scholar databases were searched. Hypertension costs were analyzed in 8 cost categories. An attempt was made to determine whether selected economic and social factors (such as HDI or GDP) influenced hypertension costs. Results The review included data from 15 countries: Brazil, Cambodia, Canada, China, Greece, Indonesia, Italy, Jamaica, Kyrgyzstan, Mexico, Poland, Spain, USA, Vietnam and Zimbabwe. The papers included in the review were heterogeneous with respect to cost categories, which made comparisons difficult. The average total costs of hypertension for all the studied countries, calculated per person, amounted to 630.14 Int$, direct costs – 1,497.36 Int$, and indirect costs – 282.34 Int$. The ranking of countries by costs and by selected economic and social indices points at the possible relationship between these indices and hypertension costs. Conclusions The costs of hypertension calculated per country reached the region of several dozen billion Int$. Other sources usually showed lower costs than those presented in this review. This indicates a growth in costs from year to year and the future increasing burden on society. Globally uniform cost terminology and cost calculation standards need to be developed. That would facilitate making more informed decisions regarding fund allocation in hypertension management schemes.

Background There is a paucity of research on the cost of breast cancer (BC) treatment from the patient’s perspective in Vietnam. Methods Individual-level data about out-of-pocket (OOP) expenditures on use of services were collected from women treated for BC (n = 202) using an online survey and a face-to-face interview at two tertiary hospitals in 2019. Total expenditures on diagnosis and initial BC treatment were presented in terms of the mean, standard deviation, and range for each type of service use. A generalised linear model (GLM) was used to assess the relationship between total cost and socio-demographic characteristics. Results 19.3% of respondents had stage 0/I BC, 68.8% had stage II, 9.4% had stage III, none had stage IV. The most expensive OOP elements were targeted therapy with mean cost equal to 649.5 million VND ($28,025) and chemotherapy at 36.5 million VND ($1575). Mean total OOP cost related to diagnosis and initial BC treatment (excluding targeted therapy cost) was 61.8 million VND ($2667). The mean OOP costs among patients with stage II and III BC were, respectively, 66 and 148% higher than stage 0/I. Conclusions BC patients in Vietnam incur significant OOP costs. The cost of BC treatment was driven by the use of therapies and presentation stage at diagnosis. It is likely that OOP costs of BC patients would be reduced by earlier detection through raised awareness and screening programmes and by providing a higher insurance reimbursement rate for targeted therapy.

Background Fracture liaison service (FLS) is a secondary prevention model for identification of patients at risk for fragility fractures. Aims This study was conducted to evaluate the number and costs of secondary prevention of low-energy fractures in the city of Kouvola in Finland. Methods Women aged ≥ 45 years and men ≥ 60 years treated in the emergency department with a low-energy fracture were identified. Laboratory testing, BMI, and DXA scans were performed. Fracture Risk Assessment Tool was used. The direct FLS costs were calculated. Survival was analyzed using univariate and multivariate analysis and the life-table method. Results 525 patients with 570 fractures were identified. The mean age of women was 73.8 years and of men 75.9 years. Most patients sustained wrist (31%), hip (21%) or proximal humerus (12%) fractures. 41.5% of the patients had osteoporosis according to DXA scans. 62% of patients used calcium and vitamin D daily and 38% started anti-osteoporotic medication. Protective factors for survival were: age Discussion Many low-energy fracture types were associated with excess mortality. The use of anti-osteoporotic medication was not optimal. Conclusions FLS increased the catchment of low-energy fracture patients and was inexpensive. However, identification, evaluation and post-fracture assessment of patients should be expedited. Rehabilitation of hip fracture patients needs to be improved.

Background In South Africa (SA), stroke is the second highest cause of mortality and disability. Apart from being the main killer and cause of disability, stroke is an expensive disease to live with. Stroke costs include death and medical costs. Little is known about the stroke burden, particularly the stroke direct costs in SA. Identification of stroke costs predictors using appropriate statistical methods can help formulate appropriate health programs and policies aimed at reducing the stroke burden. Analysis of stroke costs have in the main, concentrated on mean regression, yet modelling with quantile regression (QR) is more appropriate than using mean regression. This is because the QR provides flexibility to analyse the stroke costs predictors corresponding to quantiles of interest. This study aims to estimate stroke direct costs, identify and quantify its predictors through QR analysis. Methods Hospital-based data from 35,730 stroke cases were retrieved from selected private and public hospitals between January 2014 and December 2018. The model used, QR provides richer information about the predictors on costs. The prevalence-based approach was used to estimate the total stroke costs. Thus, stroke direct costs were estimated by taking into account the costs of all stroke patients admitted during the study period. QR analysis was used to assess the effect of each predictor on stroke costs distribution. Quantiles of stroke direct costs, with a focus on predictors, were modelled and the impact of predictors determined. QR plots of slopes were developed to visually examine the impact of the predictors across selected quantiles. Results Of the 35,730 stroke cases, 22,183 were diabetic. The estimated total direct costs over five years were R7.3 trillion, with R2.6 billion from inpatient care. The economic stroke burden was found to increase in people with hypertension, heart problems, and diabetes. The age group 55–75 years had a bigger effect on costs distribution at the lower than upper quantiles. Conclusions The identified predictors can be used to raise awareness on modifiable predictors and promote campaigns for healthy dietary choices. Modelling costs predictors using multivariate QR models could be beneficial for addressing the stroke burden in SA.

Background Caesarean section (C-section) delivery is an important indicator of access to life-saving essential obstetric care. Yet, there is limited understanding of the costs of utilising C-section delivery care in sub-Saharan Africa. Thus, we estimated the direct and indirect patient cost of accessing C-section in Tanzania. Methods Cross-sectional survey data of 2012 was used, which covered 3000 households from 11 districts in three regions. We interviewed women who had given births in the last 12 months before the survey to capture their experience of care. We used a regression model to estimate the effect of C-section on costs, while the degree of inequality on C-section coverage was assessed with a concentration index. Results C-section increased the likelihood of paying for health care by 16% compared to normal delivery. The additional cost of C-section compared to normal delivery was 20 USD, but reduced to about 11 USD when restricted to public facilities. Women with C-section delivery spent an extra 2 days at the health facility compared to normal delivery, but this was reduced slightly to 1.9 days in public facilities. The distribution of C-section coverage was significantly in favour of wealthier than poorest women (CI = 0.2052, p Conclusions C-section is a life-saving intervention but is associated with significant economic burden especially among the poor families. More health resources are needed for provision of free maternal care, reduce inequality in access and improve birth outcomes in Tanzania.

This study quantifies the wide-ranging health care costs affecting patients living with IBD, including the annualized direct and indirect costs of care for patients with IBD, the longitudinal drivers of these costs, and the cost of care for newly diagnosed patients., Background The Crohn’s & Colitis Foundation’s Cost of Inflammatory Bowel Disease (IBD) Care Initiative seeks to quantify the wide-ranging health care costs affecting patients living with IBD. We aimed to (1) describe the annualized direct and indirect costs of care for patients with Crohn’s disease (CD) or ulcerative colitis (UC), (2) determine the longitudinal drivers of these costs, and (3) characterize the cost of care for newly diagnosed patients. Methods We analyzed the Optum Research Database from the years 2007 to 2016, representing commercially insured and Medicare Advantage–insured patients in the United States. Inclusion for the study was limited to those who had continuous enrollment with medical and pharmacy benefit coverage for at least 24 months (12 months before through 12 months after the index date of diagnosis). The value of patient time spent on health care was calculated as number of workplace hours lost due to health care encounters multiplied by the patients’ estimated average wage derived from the Bureau of Labor Statistics. Comparisons between IBD patients and non-IBD patients were analyzed based on demographics, health plan type, and length of follow-up. We used generalized linear models to estimate the association between total annual costs and various patient variables. Results There were 52,782 IBD patients (29,062 UC; 23,720 CD) included in the analysis (54.1% females). On a per-annual basis, patients with IBD incurred a greater than 3-fold higher direct cost of care compared with non-IBD controls ($22,987 vs $6956 per-member per-year paid claims) and more than twice the out-of-pocket costs ($2213 vs $979 per-year reported costs), with all-cause IBD costs rising after 2013. Patients with IBD also experienced significantly higher costs associated with time spent on health care as compared with controls. The burden of costs was most notable in the first year after initial IBD diagnosis (mean = $26,555). The study identified several key drivers of cost for IBD patients: treatment with specific therapeutics (biologics, opioids, or steroids); ED use; and health care services associated with relapsing disease, anemia, or mental health comorbidity. Conclusion The costs of care for IBD have increased in the last 5 years and are driven by specific therapeutics and disease features. In addition, compared with non-IBD controls, IBD patients are increasingly incurring higher costs associated with health care utilization, out-of-pocket expenditures, and workplace productivity losses. There is a pressing need for cost-effective strategies to address these burdens on patients and families affected by IBD.

Autism is associated with a range of costs. This paper reviews the literature on estimating the economic costs of autism spectrum disorder (ASD). More or less 50 papers covering multiple countries (US, UK, Australia, Canada, Sweden, the Netherlands, etc.) were analysed. Six types of costs are discussed in depth: (i) medical and healthcare service costs, (ii) therapeutic costs, (iii) (special) education costs, (iv) costs of production loss for adults with ASD, (v) costs of informal care and lost productivity for family/caregivers, and (vi) costs of accommodation, respite care, and out-of-pocket expenses. A general finding is that individuals with ASD and families with children with ASD have higher costs. Education costs appear to be a major cost component for parents with children with ASD. ispartof: JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS vol:49 issue:7 pages:2873-2900 ispartof: location:United States status: published

Introduction Epidemiological data indicate significant differences in atopic dermatitis (AD) prevalence between countries. Aim The purpose of this study is to (i) analyse the recorded prevalence of atopic dermatitis (diagnoses of AD reported to the Polish National Health Fund (NHF)) and to (ii) estimate direct costs of medical care for AD incurred by the NHF. Material and methods The analysis was based on data reported to the database of the public payer (NHF). The prevalence rates were calculated using the NHF data and population estimates were obtained from the Central Statistical Office of Poland (GUS). Results In 2017, the annual prevalence rate of AD in the Polish population was 32.5 per 10,000 inhabitants (34.7/10,000 for women and 30.1/10,000 for men). The highest prevalence was observed in the youngest age groups (300/10,000 in children up to 4 years of age and 141/10,000 in 5–9-year-olds). The prevalence rate decreased with age and AD was the least prevalent in patients over 85 years of age (4/10,000). In 2008–2017, NHF expenditure on AD treatment varied between PLN 19.9 million (EUR 5.6 million) in 2008 and PLN 28.4 million (EUR 6.5 million) in 2016. Conclusions The prevalence rates of AD in Poland estimated on the basis of NHF data are significantly lower than those reported in previous epidemiological studies conducted in Poland and worldwide. This may indicate that the prevalence of AD in the Polish population is underestimated or that there are no adequate disease control measures in patients with a confirmed diagnosis.

Background This study was designed to estimate economic burden of lung cancer in Turkey from payer perspective based on expert panel opinion on practice patterns in clinical practice. Methods In this cost of illness study, direct medical cost was calculated based on cost items related to outpatient visits, laboratory and radiological tests, hospitalizations/interventions, drug treatment, adverse events and metastasis. Indirect cost was calculated based on lost productivity due to early retirement, morbidity and premature death resulting from the illness, the value of lost productivity due to time spent by family caregivers and cost of formal caregivers. Results Cost analysis revealed the total per patient annual direct medical cost for small cell lung cancer to be €8772), for non-small-cell lung cancer to be €10,167. Total annual direct medical cost was €497.9 million, total annual indirect medical cost was €1.1 billion and total economic burden of lung cancer was €1.6 billion. Hospitalization/interventions (41%) and indirect costs (68.6%) were the major cost drivers for total direct costs and the overall economic burden of lung cancer, respectively. Conclusions Our findings indicate per patient direct medical costs of small cell lung cancer and non-small-cell lung cancer to be substantial and comparable, indicating the substantial economic burden of lung cancer in terms of both direct and indirect costs. Our findings indicate that hospitalization/interventions cost item and indirect costs were the major cost drivers for total direct costs and the overall economic burden of lung cancer, respectively. Our findings emphasize the potential role of improved cancer prevention and early diagnosis strategies, by enabling cost savings related to drug treatment and metastasis management cost items, in sustainability of cancer treatments.

The global burden of myopia is growing. Myopia affected nearly 30% of the world population in 2020 and this number is expected to rise to 50% by 2050. This review aims to analyze the impact of myopia on individuals and society; summarizing the evidence for recent research on the prevalence of myopia and high myopia, lifetime pathological manifestations of myopia, direct health expenditure, and indirect costs such as lost productivity and reduced quality of life (QOL). The principal trends are a rising prevalence of myopia and high myopia, with a disproportionately greater increase in the prevalence of high myopia. This forecasts a future increase in vision loss due to uncorrected myopia as well as high myopia-related complications such as myopic macular degeneration. QOL is affected for those with uncorrected myopia, high myopia, or complications of high myopia. Overall the current global cost estimates related to direct health expenditure and lost productivity are in the billions. Health expenditure is greater in adults, reflecting the added costs due to myopia-related complications. Unless the current trajectory for the rising prevalence of myopia and high myopia change, the costs will continue to grow. The past few decades have seen the emergence of several novel approaches to prevent and slow myopia. Further work is needed to understand the life-long impact of myopia on an individual and the cost-effectiveness of the various novel approaches in reducing the burden.

Backgrounds Breast cancer is the most prevalent cancer among women. Breast cancer imposes a considerable economic burden on the health system. This study aimed to compare the cost of breast cancer among patients who referred to private and public hospitals in Iran (2017). Methods This was a prevalence-based cost of illness study. A total of 179 patients were selected from private and public hospitals using the census method. The researcher-constructed checklist was used for data collection. Data were analyzed using SPSS software version 22. Results The estimated total mean (SD) direct cost of patients who referred to the private hospital and the public hospital was $10,050 (19,480) and $3960 (6780), respectively. Further, the total mean indirect cost of patients who referred to the private hospital was lower than those referring to the public hospital at $1870 (15 % of total costs) and $22,350 (85 % of total costs), respectively. These differences were statistically significant (P Conclusions Breast cancer imposes a substantial cost on patients, health insurance organizations and the whole society in Iran. Therefore, the adoption of effective measures for the prevention and early diagnosis of breast cancer is urgently needed.

Background Community-acquired pneumonia (CAP), especially pneumococcal CAP (P-CAP), is associated with a heavy burden of illness as evidenced by high rates of intensive care unit (ICU) admission, mortality, and costs. Although well-defined acutely, determinants influencing long-term burden are less known. This study assessed determinants of 28-day and 1-year mortality and costs among P-CAP patients admitted in ICUs. Methods Data regarding all hospital and ICU stays in France in 2014 were extracted from the French healthcare administrative database. All patients admitted in the ICU with a pneumonia diagnosis were included, except those hospitalized for pneumonia within the previous 3 months. The pneumococcal etiology and comorbidities were captured. All hospital stays were included in the cost analysis. Comorbidities and other factors effect on the 28-day and 1-year mortality were assessed using a Cox regression model. Factors associated with increased costs were identified using log-linear regression models. Results Among 182,858 patients hospitalized for CAP in France for 1 year, 10,587 (5.8%) had a P-CAP, among whom 1665 (15.7%) required ICU admission. The in-hospital mortality reached 22.8% at day 28 and 32.3% at 1 year. The mortality risk increased with age > 54 years, malignancies (hazard ratio (HR) 1.54, 95% CI [1.23–1.94], p = 0.0002), liver diseases (HR 2.08, 95% CI [1.61–2.69], p 75 years old, p = 0.008), chronic cardiac (+ 11% [0.02–0.19], p = 0.019), and respiratory diseases (+ 11% [0.03–0.18], p = 0.006). Conclusions P-CAP in ICU-admitted patients was associated with a heavy burden of mortality and costs at one year. Older age was associated with both early and 1-year increased mortality. Malignant and chronic liver diseases were associated with increased mortality, whereas chronic cardiac failure and chronic respiratory disease with increased costs. Trial registration N/A (study on existing database)

The elderly might differ from the general population when facing surgery, due to their lack of reserve, comorbidities, and other frailty conditions. This is also related to the emergency abdominal surgery. Considering that almost half of all emergency surgical procedures are performed in the elderly and given the increasing aging population, an analysis of the implications of the economic burden of emergency abdominal surgery in the elderly needs to be undertaken. To this regard, both direct and indirect costs that may emerge when the focus is on this specific group of patients are considered. Through a narrative literature review, this chapter aims at identifying the economic consequences of emergency abdominal surgery in the elderly given the conventional procedures and the laparoscopy. The finding will shade lights on the role of the laparoscopy procedure and will contribute to raise the awareness about the need to undertake dedicated actions from the health professionals’ perspective as well as from the hospital managers’ one.

Background The aim of this cross-sectional survey was to compare the health-economic consequences for allergic rhinitis (AR) patients treated with sublingual Immunotherapy (SLIT) in terms of direct and indirect costs with a reference population of patients receiving standard of care pharmacological therapy. Methods Primary objective was to analyse the health-economic consequences of SLIT for grass pollen allergy in Sweden vs reference group waiting for subcutaneous immunotherapy (SCIT). A questionnaire was mailed to two groups of AR patients. Results The questionnaire was distributed to 548 patients, 307 with SLIT and 241 in reference group (waiting for SCIT). Response rate was 53.8%. Mean annual costs were higher for reference patients than SLIT group; € 3907 (SD 4268) vs € 2084 (SD 1623) p Conclusions SLIT seems to be a cost-beneficial way to treat seasonal AR. This information might be used to guide future recommendations.

(1) Background: European guidelines provide recommendations for services and care for people with autism spectrum disorder (ASD), but not all interventions are generally available. Knowledge of service use and costs and wider societal costs in Europe is limited; (2) Method: Using an international sample, we analysed services and costs in 357 children (4–6.99 years) with ASD based on parent reports. Costs were transformed into EU-28 average using purchasing power parity; (3) Results: 122 children (34%) received specialist autism services; 149 (42%) received sensory/motor therapy; 205 (57%) received speech/language therapy; 35 (10%) received play therapy; 55 (15%) received behavioural interventions; 31 (9%) received social skills training; 47 (13%) participated in therapeutic recreational activities; and 59 (17%) received other services. The total number of hours for these services combined over two months was M = 34 (SD = 63; range: 0 –372). Estimated total costs of health-related services were M = 1210 EUR (SD = 2160 EUR); indirect societal costs were M = 1624 EUR (SD = 1317 EUR). Regression analyses suggested that costs rise with age and presence of intellectual disabilities, but not with severity of autism; (4) Conclusions: The high extent of community-based services indicates good accessibility but also considerable variation in the receipt of services. The costs of autism services are considerable. Further research is needed to investigate whether services received match individual needs.

Background Microvascular free tissue transfer (FTT) is a reliable method for reconstruction of complex soft tissue defects. The goal of this study was to utilize time-driven activity-based cost (TDABC) accounting to measure the total cost of care of FTT and identify modifiable cost drivers. Methods A retrospective review was performed on patients requiring FTT at a single, level-I academic trauma center from 2013 to 2019. Patient and surgical characteristics were collected, and six prospective FTT cases were observed via TDABC to collect direct and indirect costs of care. Results When stratified by postoperative stay at intensive care units (ICUs), the average cost of care was $21,840.22, while cases without ICU stay averaged $6,646.61. The most costly category was ICU stay, averaging $8,310.99 (40.9% of nonstratified overall cost). Indirect costs were the second most costly category, averaging $4,388.07 (21.6% of nonstratified overall cost). Overall, 13 of 100 reviewed cases required some form of revision free-flap, increasing cumulative costs to $7,961.34 for cases with non-ICU stay and $22,233.85 for cases with ICU stay, averaging up to $44,074.07 for patients who stayed in the ICU for both procedures. An increase in cumulative cost was also observed within the timeframe of the investigation, with average costs of $8,484.00 in 2013 compared to $45,128 for 2019. Conclusion Primary drivers for cost in this study were ICU stay and revision/reoperation. Better understanding the cost of FTT allows for cost reduction through the development of new protocols that drive intraoperative efficiency, reduce ICU stays, and optimize outcomes.

IntroductionTreatments of interstitial lung diseases (ILDs) mainly focus on disease stabilization and relief of symptoms by managing inflammation or suppressing fibrosis by (in part costly) drugs. To highlight economic burden of drug treatment in different ILD-subtypes we assessed cost trends and therewith-associated drivers.MethodsUsing data from the German, observational HILDA study we estimated adjusted mean medication costs over 36-month intervals using one- and two-part Generalized Estimating Equation (GEE) regression models with a gamma distribution and log link. Next, we determined factors associated with costs.ResultsIn Idiopathic pulmonary fibrosis (IPF) mean per capita medication costs increased from €1442 before to €11,000€ at the end of study. In non-IPF subtypes, the increase took place at much lower level. Mean per capita ILD-specific medication costs at the end of the study ranged between €487 (other ILD) and €9142 (IPF). At baseline, higher FVC %predicted values were associated with lower medication costs in IPF (−9%) and sarcoidosis (−1%). During follow up higher comorbidity burden escalated costs in progressive fibrosing ILD (PF-ILD) (+52%), sarcoidosis (+60%) and other ILDs (+24%). The effect of disease duration was not uniform, with cost savings in PF-ILD (−8%) and sarcoidosis (−6%), but increased spending in IPF (+11%).ConclusionPharmacological management of ILD, in particular of IPF imposes a substantial economic burden on the healthcare system. Strategies to reduce comorbidity burden and early treatment may reduce the impact of ILDs on the healthcare system.

INTRODUCTION: Poor specific economic information are available for the different Multiple Sclerosis (MS) courses: relapsing remitting (RRMS), secondary progressive (SPMS) and primary progressive (PPMS). This study aims to fill this gap.METHODS: A cost of illness study was conducted. Clinical information of patients treated in a major MS Center located in Lombardy, in the period 2004-2010, were linked with administrative data of Lombardy Healthcare System. We assessed the mean cost per patient-year and its association with different MS characteristics.RESULTS: The study identified 869 patients (83.9% RRMS, 8.5% SPMS, 7.2% PPMS). RRMS reported the highest cost per patient-year with a mean of € 5,623 in Expanded Disability Status Scale (EDSS) 0-3, € 8,675 in EDSS 3.5-6.5, and € 7,451 in EDSS 7-9. The PPMS patients reported the lower annual mean cost per patient in all EDSS categories. The mul-tivariate analysis reported a significant association between cost per patient-year and EDSS categories, relapse and use of Disease Modifying Therapies but not to MS courses, age and sex.CONCLUSION: This study provides a complete picture of MS courses direct costs at the different disability levels. The results can help to better understand the burden of each MS courses and the cost-effectiveness of different interventions.

Asthma is a heterogeneous chronic disease of airways. One of its endotypes is eosinophilic asthma, accompanied by both peripheral blood and airway eosinophilia, where severe eosinophilia is usually associated with more severe asthma. Anti - interleukin-5 (IL-5) monoclonal antibodies (MAb) can reduce eosinophil counts in peripheral blood and tissues in asthma patients. The first drug of this class registered in Russia was reslizumab.Comparative clinical and economic analysis of reslizumab use in patients with allergic asthma and eosinophilia.Omalizumab was chosen as a reference drug, because until now it was the only MAb for the treatment of severe asthma in Russia. The study population included patients with allergic asthma with both high levels of IgE and high eosinophil counts in peripheral blood, i.e. individuals eligible for both omalizumab and reslizumab treatment. A decrease in the number of exacerbations requiring prescription of systemic corticosteroids and an increase in QALY index was used as efficacy criteria. An indirect comparative study was used, because no direct comparison has been conducted to date. As a result, reslizumab demonstrated a statistically significant reduction in the frequency of clinically significant asthma exacerbations compared with omalizumab. The utility of the both asthma treatment strategies was compared using Markov models, taking into account the frequency of exacerbations, their severity, as well as decrease in QALYs due to exacerbations. The time horizon was 12 months.Reslizumab treatment was 37.2% less expensive compared with omalizumab for the patients who are equally eligible for the both drugs. The calculated cost - effectiveness and cost - utility ratios were in favor of reslizumab. Budget impact analysis showed a significant effect of reslizumab on reducing budget costs. If reslizumab is used in 4250 patients (an estimated number of patients with severe allergic asthma and eosinophilia in Russia), this would reduce the costs for their treatment by up to 4896 million rubles per year.For patients with severe allergic eosinophilic asthma who are equally eligible for the both drugs, reslizumab can be considered a more reasonable medical technology in terms of pharmacoeconomics when compared with omalizumab.Цель исследования. Сравнительный клинико - экономический анализ применения реслизумаба у пациентов с атопической бронхиальной астмой и эозинофилией. Материалы и методы. В качестве лекарственного препарата сравнения выбран омализумаб, поскольку до настоящего времени он являлся единственным моноклональным антителом (МАТ) для лечения тяжелой астмы в России. Популяция пациентов включала больных атопической астмой как с высокими уровнями IgE, так и с высоким уровнем эозинофилов в периферической крови, т. е. лиц, которым показаны как омализумаб, так и реслизумаб. В качестве критерия эффективности использовали снижение числа обострений, требовавших назначения системных глюкокортикостероидов, а также увеличение показателя QALY. Использовали непрямое сравнительное исследование, так как прямое сравнение до настоящего времени не проводили. В результате продемонстрировано, что использование реслизумаба приводило к статистически значимому снижению частоты клинически значимых обострений астмы по сравнению с использованием омализумаба. Полезность двух стратегий терапии астмы сравнивали с использованием марковских моделей, с учетом частоты обострений, их тяжести, а также потерь QALY вследствие обострения. Горизонт моделирования составил 12 мес. Результаты. Терапия реслизумабом оказалась на 37,2% менее затратной по сравнению с омализумабом для пациентов, которым в равной степени могут быть показаны оба препарата. Вычисленные соотношения «затраты - эффективность» и «затраты - полезность» были в пользу реслизумаба. Анализ влияния на бюджет продемонстрировал значительный эффект реслизумаба на сокращение расходов бюджета. Для 4250 пациентов (ориентировочное число пациентов с тяжелой атопической астмой и эозинофилией в России) использование реслизумаба могло бы сократить расходы на их терапию на сумму до 4896 млн рублей в год. Заключение. В сравнении с омализумабом, для пациентов с тяжелой атопической эозинофильной астмой, которым в равной степени показаны оба препарата, реслизумаб может быть рассмотрен в качестве более целесообразной с фармакоэкономических позиций медицинской технологии.

Background/Aim: This cross-sectional study estimated direct cancer-related health care, productivity and informal care costs for a six-month period for different states of breast cancer (BC). Patients and Methods: A total of 827 BC patients answered a questionnaire enquiring about informal care, work capacity, and demographic factors. Direct health care resource use and productivity costs were obtained from registries. Mutually exclusive groups were formed based on disease state and time from diagnosis: primary treatment (first six months after diagnosis), rehabilitation (>six months after diagnosis), remission (>1.5 years after diagnosis), and metastatic. Results: Mean total costs were: primary treatment (sic)22,876, rehabilitation (sic)3,456, remission (sic)1,728, and metastatic (sic)24,320. Mean direct health care costs were: primary treatment (sic)11,798, rehabilitation (sic)2,398, remission (sic)1,147, and metastatic (sic)13,923. Mean productivity costs varied between 18-39% and indirect costs (productivity and informal care costs) between 31-48% of the total costs. Conclusion: Direct medical costs were highest, but indirect costs constituted up to half of the total costs and are essential when estimating the total cost burden, as many patients are of working age.

The spread of HIV infection with the consequent death from AIDS removes some resources from the economy, impedes the preservation of human capital in the economy and undermines the foundations of economic development. The analysis of foreign and domestic research demonstrates the difficulty of assessing the impact of HIV infection on economic development. There is a variety of approaches and methods used for these assessments. Thus, the search for an optimal model to assess the impact of HIV infection on economic development becomes increasingly relevant. We have substantiated the calculation the economic burden of the disease caused by HIV infection. The proposed method for assessing socio-economic losses due to premature mortality from HIV infection includes three main types: the explicit economic costs from the premature mortality of the working-age population, the implicit costs from the premature mortality of the incapable population and the implicit economic costs from premature mortality of women of child-bearing age due to their inability to participate in the reproduction of the labour force.. The magnitude of the region’s gross regional product (GRP) losses from fatal HIV infection increased 1.85 times between the years 2012 and 2016. As a result, of premature mortality from HIV infection, the Sverdlovsk oblast GRP decreased by 1.68 % in 2016, total losses were 16.2 billion roubles. In the structure of the total losses, about 70 % are implicit losses associated with the mortality of women of child-bearing age and therefore, the loss of the opportunity to increase the population of the region. The further direction of the research is to assess the socio-economic impact of investments in HIV treatment on the quality of life in the region. © 2018 Institute of Economics Ural Branch of the Russian Academy of Sciences.

Parkinson's disease is a progressive, disabling neurodegenerative disorder associated with significant economic burden for patients and caregivers. The objective of this study was to compare the direct and indirect economic burden of Parkinson's patients' caregivers with demographically matched controls in the United States, in the 5 years after first diagnosis of Parkinson's disease. Policyholders (18-64 years old) linked to a Parkinson's disease patient (≥2 diagnoses of Parkinson's disease; first diagnosis is the index date) from January 1, 1998 to March 31, 2014, were selected from a private-insurer claims database and categorized as Parkinson's caregivers. Eligible Parkinson's caregivers were matched 1:5 to policyholders with a non-Parkinson's dependent (controls). Multivariable regression adjusted for baseline characteristics estimated direct costs (all-cause insurer cost [medical and prescription] and comorbidity-related medical costs; patient out-of-pocket costs) and indirect costs (disability and medically related absenteeism costs). Income progression was also compared between cohorts. A total of 1211 eligible Parkinson's caregivers (mean age, 56 years; 54% female) were matched to 6055 controls. In adjusted analyses, Parkinson's caregivers incurred significantly higher year 1 total all-cause insurer costs ($8999 vs $7117) and medical costs ($7081 vs $5568) (both P < 0.01) and higher prescription costs (range for years 1-5, $2506-2573 vs $1405-$1687) and total out-of-pocket costs ($1259-1585 vs $902-$1192) in years 1-5 (all P < 0.01). Parkinson's caregivers had significantly higher adjusted indirect costs in years 1-3 (range for years 1-3, $2054-$2464 vs $1681-$1857; all P < 0.05) and higher cumulative income loss over 5 years ($5967 vs $2634 by year 5; P for interaction = 0.03). Parkinson's caregivers exhibited higher direct and indirect costs and greater income loss compared with matched controls. © 2018 International Parkinson and Movement Disorder Society © 2018 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society. This study and manuscript were funded by AbbVie. The design, study conduct, and financial support for the study were provided by AbbVie. AbbVie participated in the study design, research, interpretation of data, writ- ing, reviewing, and approving the manuscript. Sí