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Background: Medical Tourism has received significant attention worldwide as the most remarkable phenomenon in the tourism industry. Medical Tourism was considered a medical tourist’s behavior concerning the push/pull factors and three fundamental flows to assess the BTD model (Birthplace-Transportation-Destination). The present study aimed to unearth determinable factors of medical tourism based on a geographical model named BTD in Iran. Methods: Firstly, with 301 respondents and 11 expert judges, after literature review, item building, and some assessments, the primary checklist leads to 49 items. Two next steps, some processes were common, including sample-to-item ratio (10.12, 10.24), the Cronbach's alpha (over 0.81, 0.85-0.96), Bartlett's Test (both were significant), and KMO (0.896, 0.915). Finally, EFA in the first study and PCA in the second study were assessed and reported. In the third study, to check multicollinearity, the VIF (1.809-2.917), AVE (0.50-0.55), and CR (0.59-0.68) were calculated. Then, AVE was compared with SIC. Ultimately, SEM was conducted that the 3-factor model, especially without the Mahalanobis distance, indicates better results. The study is developed in five cities called Khorasan, Tabriz, Tehran, Fars, and Isfahan. Results: Regardless of cost, other significant factors were recognized, including birthplace-related factors, transportation-related factors, and destination-related factors. Conclusion: As can be seen, the construction and the push/pull factors surveyed to assess the BTD model covering all main flows were well defined. Meaningful statistical relationships support the internal and external validity of the multidimensional construct. Therefore, present results are functional for interested sectors, and researchers must not disregard the market.

Antithrombin (AT) deficiency is a severe thrombophilia associated with increased rates of maternal morbidity, mortality, and greater healthcare resource utilization during pregnancy and postpartum. Two large U.S. healthcare databases were queried for women aged 15–44 with delivery-related encounters: Cerner Real-World Data (CRWD, 01/01/2000–12/31/2021) and Premier Healthcare Database (PHD, 01/01/2016–01/01/2019). Individuals receiving cardiopulmonary bypass were excluded. Three cohorts were created: 1) Individuals who had AT levels tested any time between 9-months pre- through 3-months post-delivery (CRWD Test Cohort); 2) individuals prescribed AT concentrate (ATc) within 1-year pre- or 1-year post-delivery in CRWD (CRWD Medication Cohort); and 3) the same criteria as 2) applied to PHD (PHD Medication Cohort). There were 5411 individuals in the CRWD Test Cohort, 13 in the CRWD Medication Cohort and 38 in the PHD Medication Cohort. Demographic and baseline clinical characteristics were similar across cohorts. AT level testing occurred pre-delivery in 47.9 % of the CRWD Test Cohort and 23.1 % of the CRWD Medication Cohort. ATc was administered during the delivery hospitalization to 0.1 %, 23.1 % and 50.0 % of the CRWD Test, CRWD Medication, and PHD Medication Cohorts, respectively. Across cohorts, 5.4–7.9 % of individuals experienced thrombosis during the delivery-related encounter. Mean (SD) total costs for delivery through 1-year post-delivery were $190,894 ($276,893) with $123,763 ($177,122) of total costs related to abnormal coagulation. Opportunities exist to enhance the care of pregnant individuals with low AT levels throughout pregnancy, aiming for optimal maternal outcomes. [Display omitted] • We analyzed a large cohort of real-world pregnancies with suspected AT deficiency. • Rates of VTE and maternal mortality were high in the observed cohorts. • Negative clinical outcomes increased as antithrombin levels decreased. • Healthcare resource utilization/costs were higher for delivery than U.S. averages. • Deficiencies in antithrombin testing and treatment indicate need for improved care. [ABSTRACT FROM AUTHOR]

Background: Dupilumab is a novel monoclonal antibody that recently received US Food and Drug Administration approval for the treatment of chronic rhinosinusitis with nasal polyps. Endoscopic sinus surgery (ESS) has been the mainstay of treatment for patients refractory to initial medical therapy. Data comparing the cost‐effectiveness of these treatments are scarce. The objective of this study is to compare the cost‐effectiveness of dupilumab and ESS treatment for patients with chronic rhinosinusitis with nasal polyps refractory to medical therapy. Methods: A cohort‐style Markov decision tree economic evaluation with 10‐year time horizon was performed. The two comparative treatment strategies were dupilumab therapy or ESS followed by postoperative maintenance therapy. Patients with response to treatment continued with either maintenance or dupilumab therapy; patients with no response underwent ESS. The primary outcome measure was incremental cost per quality‐adjusted life‐year calculated from Sino‐Nasal Outcome Test (SNOT‐22) scores. Sensitivity analyses were performed including discounting scenarios and a probabilistic sensitivity analysis. Results: The dupilumab strategy cost $195,164 and produced 1.779 quality‐adjusted life‐years. The ESS strategy cost $20,549 and produced 1.526 quality‐adjusted life‐years. This implies an incremental cost of $691,691 for dupilumab for every 1‐unit increase in quality‐adjusted life‐year compared with ESS. Probability sensitivity analysis indicated that ESS was more cost‐effective than dupilumab in all iterations. Conclusions: While dupilumab and ESS may demonstrate similar clinical effectiveness, ESS remains the most cost‐effective treatment option and should remain the standard of care for patients with chronic rhinosinusitis with nasal polyps refractory to medical therapy. [ABSTRACT FROM AUTHOR]

Objectives: The SARS‐CoV‐2 pandemic disrupted health care services. Previous reports estimated reductions in demand and supply of dental care services, but actual changes have not been reported. The present report depicts a perspective of trends in claims from private dental practice in the United States during 2019 and 2020. Methods: Private dental insurance paid claims data from a data warehouse (encompassing 66+ carriers in the United States) were obtained for children and adults (treatments identified by their American Dental Association Code of Dental Procedures and Nomenclature [CDT]), encompassing a 5% random sample of all records between January 2019 and December 2020. A market‐based treatment classification placed CDT codes into one of four categories based on the likelihood of being associated with urgent/emergency care. Results: Claims for 3.8 million patients constituted the 5% random sample for analyses. Substantial drops in the provision of treatment items were quantified for a large segment of private dental insurance plans at a national level, showing differential impacts in dental care categories. Conclusions: Week‐by‐week, detailed descriptions of demand/availability changes in dental care throughout the first year of the 2020 SARS‐CoV‐2 pandemic were obtained through contrasting perspectives in 2019. Provision of dental care and associated impacts fluctuated over time subject to treatment urgency, but also modified as the weeks/months of dental office lockdowns ebbed in and out of the dental market. [ABSTRACT FROM AUTHOR]

Background: The long‐term impact of affordable care organizations (ACOs) on cancer spending remains unknown. The authors examined whether practices that became ACOs altered their spending for patients with cancer in the first 4 years after ACO implementation. Methods: By using national Medicare data from 2011 to 2017, a random sample of 20% of fee‐for‐service Medicare beneficiaries aged 65 years and older with cancer was obtained (n = 866,532), and each patient was assigned to a practice. Practices that became ACOs in the Medicare Shared Savings Program were matched to non‐ACO practices. Total, cancer‐specific, and service category‐specific yearly spending per patient was calculated. A difference‐in‐differences model was used to determine spending changes associated with ACO status for patients with cancer in the 4 years after ACO implementation. Results: The introduction of ACOs did not have a significant impact on overall spending for patients with cancer in the 2 years after ACO implementation (difference, −$38; 95% CI, −$268, $191; P =.74). Changes in spending also did not differ between ACO and non‐ACO patients within service categories or among the 11 cancer types examined. The lack of difference in spending for patients with cancer in ACO and non‐ACO practices persisted in the third and fourth years after ACO implementation (difference, −$120; 95% CI, −$284, $525; P =.56). Conclusions: ACOs did not significantly change spending for patients with cancer in the first 4 years after their implementation compared with non‐ACOs. This prompts a reevaluation of the current efficacy of ACOs in reducing spending for cancer care and may encourage policymakers to reconsider the incentive structures of ACOs. Lay Summary: Accountable care organizations (ACOs) were developed to curtail health care spending and improve quality, but their effects on cancer spending in their first 2 years have been minimal.The long‐term impact of ACOs on cancer spending remains unknown.By using data from 866,532 Medicare beneficiaries with cancer, the authors observed that the association of a practice with an ACO did not significantly change total yearly spending per patient in the first 4 years after ACO implementation.This finding prompts a reevaluation of the current efficacy of ACOs in reducing spending for cancer care. Medicare accountable care organizations (ACOs) have not significantly changed spending for patients with cancer in the first 4 years after their implementation compared with non‐ACOs. This prompts a reevaluation of the current efficacy of ACOs in reducing spending for cancer care. [ABSTRACT FROM AUTHOR]

Background: Pregnant patients with pre-existing diabetes mellitus (DM) are at increased risk for development or progression of existing diabetic retinopathy (DR). A quality improvement project was initiated to improve DR screening during pregnancy at a safety net hospital. This article highlights the utility and generalizability of our telemedicine-based screening model. Materials and Methods: In April 2018, we implemented a photographic retinal screening system in the Maternal Fetal Medicine (MFM) clinic at Santa Clara Valley Medical Center in San Jose, CA. The system is intended to screen all pregnant patients with pre-existing diabetes (type 1 and 2). Retinal images are automatically uploaded to a secure server and interpreted by a retina specialist (C.K.P.). Results: A total of 71 pregnant patients with pre-existing DM were seen in the MFM clinic during the study period. Sixty-six of 71 patients (93.0%) were screened compared with 69.1% in the year prior. Of the 64 patients screened with readable images 11 (17.2%) had DR, whereas 53 did not. Forty-nine of the 64 (74.2%) patients screened underwent screening using the new nonmydriatic system in the MFM clinic. Only 7 out of 47 (14.9%) patients with readable images in the MFM clinic required referral to the ophthalmology clinic. Conclusion: Our model for DR screening in pregnant patients in safety net hospitals is effective in improving screening rates and expediting evaluation and treatment for those in need. This system can prevent irreversible vision loss in pregnant patients and provides an effective framework for ophthalmic care in a safety net hospital system.

Background: This descriptive, analytic study aimed to compare the costs of 10 types of Global Budget Payment System (GBPS) surgery in Imam Reza Hospital, Mashhad City, Iran, in 2016 with the prices in the GBPS. Methods: From hospital-discharge data and patients’ bills, we identified 10 types of GBPS surgeries performed in Imam Reza hospital. The patients were grouped according to the surgical procedures performed in the 10 GBPS category. Data on hospital charges and cost-to-charge ratios were used to assess charges and costs for specific resources, as well as for the hospitalization overall. The researcher received training from the experts in the field of hospital accounting to learn how to determine the charge of GBPS surgeries. Results: The results showed that in some surgeries such as hysterectomy, natural delivery, C-section, tonsillectomy, hernia repair, and appendectomy, charges of services were higher than their average prices GBPS and in arteriovenous anastomosis surgery, cholecystectomy, tympanoplasty, and thyroidectomy were lower than average prices GBPS. One of the main goals of Iran’s Ministry of Health in developing GBPS was to provide a unified framework for managing admission and treatment costs in state-owned hospitals. The obtained data were analyzed by the Wilcoxon signed-rank test and the independent samples t test with 0.05 statistical significance. The results of this study and similar works show that most hospitals have completely neglected this aspect of GBPS. Conclusion: A fact that is reflected in the wide-ranging variations in the charge of GBPS surgeries in different hospitals despite their being paid based on the same rates and guidelines.

Most randomised controlled trials (RCTs) in oncology are now funded by the pharmaceutical industry. We explore the extent to which RCT design, results and interpretation differ between industry-funded and non-industry-funded RCTs. In this cross-sectional analysis, a structured literature search was used to identify all oncology RCTs published globally during 2014–2017. Industry funding was identified based on explicit statements in the publication. Descriptive statistics were used to compare elements of trial methodology and output between industry- and non-industry-funded RCTs. The study sample included 694 RCTs; 71% were funded by industry. Industry-funded trials were more likely to test systemic therapy (97% versus 62%; P < 0.001), palliative-intent therapy (71% versus 41%; P < 0.001) and study breast cancer (20% versus 12%; P < 0.001). Industry-funded trials were larger (median sample size 474 versus 375; P < 0.001) and more likely to meet their primary end point (49% versus 41%; P < 0.001). Among positive trials, there were no differences in the magnitude of benefit between industry- and non-industry-funded RCTs. Trials funded by industry were published in journals that had a significantly higher median impact factor (21, interquartile range 7, 28) than non-industry-funded trials (impact factor 12, interquartile range 5, 24; P = 0.005); this persisted when adjusted for whether a trial was positive or negative. The vast majority of oncology RCTs are now funded by industry. Industry-funded trials are larger, more likely to be positive, predominantly test systemic therapies in the palliative setting and are published in higher impact journals than trials without industry support. • Industry funded trials tested systemic therapy more than Non-Industry funded trials. • Industry-funded trials were more likely to study palliative treatment. • Industry-funded trials were more likely to meet their primary endpoint. • Industry funded trials studied breast cancer more often. • No difference in clinical benefit between industry and non industry funded trials [ABSTRACT FROM AUTHOR]

Aim: To describe the treatment landscape and associated economic burden for myelodysplastic syndrome in Japan. Methods: We studied nationwide retrospective claims data from 2008 to 2019. The study cohort was categorized into patients receiving transfusion, erythropoiesis-stimulating agent, erythropoiesis-stimulating agent + transfusion, azacitidine, azacitidine + transfusion and others. Results: Our study found that the azacitidine + transfusion group had the highest medical cost and severity of disease compared with the other groups. In those patients, healthcare resource utilization and the costs of transfusions, including iron chelation therapy, increased medical costs. Conclusion: Our retrospective analysis provides a current snapshot of real-world treatment patterns and associated incremental economic costs of iron chelation therapy with the presence of transfusions that drive an increase in total costs. [ABSTRACT FROM AUTHOR]

Mortality and life expectancy at birth are considered some of the most important aspects of human economic development. Over the last three centuries, both of these indicators have practically doubled in all geographic and demographic parts of the world. This article examines how life expectancy, health care investments, and the medical innovations closely related to these investments affect mortality reduction and, ultimately, economic growth. It also studies economic growth's reverse effect on life expectancy and public health and discusses factors that over several centuries shaped current life expectancies in various countries. Next, it indicates the following as primary factors in health care's contribution to gross domestic product: investment activities and the introduction of innovative technologies into the health care system. Finally, it analyzes the effect of these factors on economic growth. [ABSTRACT FROM AUTHOR]

Cannabis is the most commonly consumed recreational drug in the world. As more states legalize cannabis use in some form, the incidence of cannabinoid hyperemesis syndrome (CHS) is expected to rise. CHS is a constellation of symptoms including severe cyclical nausea and vomiting and epigastric or periumbilical abdominal pain as a result of long-term cannabis use. Recognizing the diagnosis and educating patients on the benefits of cessation is essential, as these patients often undergo extensive and repeated evaluations in the clinic, emergency department, and inpatient setting that could be avoided with extensive history taking and early recognition of the syndrome. In this study, we compared costs incurred by patients in various settings to determine if there is a difference between patients with and without CHS. Although there were not statistically significant cost differences between groups for all cost categories, it is clear that patients with CHS consume considerably more health care dollars than patients who deny cannabis use, and obtaining a detailed social history is imperative to prevent unnecessary workups and increased financial burden on the health care industry. [ABSTRACT FROM AUTHOR]

Background: Insomnia is associated with worsened clinical outcomes among Alzheimer's disease dementia (AD) patients, increased caregiver burden, and healthcare utilization.Objective: This study aimed to characterize the incremental healthcare burden of insomnia in AD using real-world data.Methods: A retrospective observational study was conducted on AD patients selected from the IBM® MarketScan Commercial and Medicare Supplemental Databases. AD patients with claims-based evidence of insomnia were direct matched to a non-insomnia cohort based on demographic factors. Healthcare utilization and associated costs were assessed for a 12-month follow-up period.Results: A total of 3,500 insomnia AD patients and 9,884 non-insomnia AD patients were analyzed. The insomnia cohort had a higher comorbidity burden at baseline (mean score on Charlson Comorbidity Index 2.5 versus 2.2, p < 0.001) and higher proportions of patients with baseline diagnoses for other conditions including depression: 40%, insomnia cohort versus 25%, non-insomnia (p < 0.001). AD patients with insomnia were more likely to have a claim for inpatient hospitalizations (39.8%versus 32.3%), emergency room services (56.4%versus 48.0%), and skilled-nursing services (42.6%versus 31.9%) (all p < 0.05). Mean total annual healthcare costs during the 12-month follow-up period were significantly higher among AD patients with insomnia as compared to those without. (Mean costs: $37,356 versus $27,990, p < 0.001).Conclusion: AD patients with comorbid insomnia are more likely to use higher-cost healthcare services such as inpatient hospitalization, and skilled nursing, and have higher total healthcare costs. This real-world analysis provides evidence that AD disease management should consider proper treatment of comorbid insomnia due to the incremental burden and cost implications. [ABSTRACT FROM AUTHOR]

Objective: The costs of open and endovascular revascularisation to treat peripheral artery disease (PAD) have not been fully established. This study examined the costs of both the index admission and any readmissions to hospital within 30 days of discharge for people having revascularisation at a single centre in Australia.Methods: This was a retrospective analysis of prospectively collected data. Eligible participants were those presenting with chronic limb ischaemia requiring revascularisation between 2002 and 2017. Generalised linear modelling was used to estimate mean (95% confidence interval [95% CI]) hospital costs for the index and readmission hospital treatments.Results: A total of 302 participants presenting with intermittent claudication (n=219; 72.5%) or chronic limb threatening ischaemia (n=83; 27.5%) treated by open (n=116; 38.4%) or endovascular (n=186; 61.6%) revascularisation were included. Forty-eight (48) (15.9%) participants were readmitted within 30 days of discharge from their index admission. The mean estimated index admission hospital cost was AUD$13,827 (95% CI, $11,935-$15,818) per person. This cost was significantly greater for open as compared to endovascular revascularisation (p<0.001). The mean estimated hospital cost was AUD$15,324 ($10,944-$19,966) per person readmitted. When comparing participants treated before and after 2010, the total hospital costs decreased, mainly due to decreased lengths of hospital stay for open procedures.Conclusions: In this study the hospital costs were less for endovascular than open revascularisation of chronic limb ischaemia. Costs decreased over time. Readmission is an important contributor to the overall costs of peripheral revascularisation. [ABSTRACT FROM AUTHOR]

Objective To evaluate the direct costs of various spinal surgical procedures within 1 year of follow-up and to compare the profiles of neurosurgeons and orthopedic surgeons. Methods All spinal procedures performed within a 10-month period in patients covered by a private insurance company were included. Costs related to the spinal interventions were systematically registered in the company database. Associated costs during the 1-year follow-up were recorded. Results In total, 1,862 patients were included, with a total cost of €11,050,970, of whom 34.8% underwent noninstrumented lumbar decompression (€3,473), 27.1% dorsolumbar instrumented fusion (€6,619), 14.6% nucleoplasty (€1,323), 13.5% cervical surgery (€4,463), 3.4% kyphoplasty (€4,200), 2.9% scoliosis (€15,414), 1.2% oncologic surgery (€5,590), 0.5% traumatic compression (€7,844), and 4.7% (€1,343) other minor interventions (mainly rhizotomies). Approximately 42% of patients required reinterventions within the first year, with a global extra cost of €7,280,073; 11% were referred to the pain clinic, with a €114,663 cost; 55.5% were men; and the most common age range of patients who received an intervention was 65–75 years. Neurosurgeons performed 60% of all interventions. Noninstrumented lumbar operations were performed by neurosurgeons twice as often as instrumented operations, and they performed 76% of cervical operations. Orthopedic surgeons performed 2.5 times more instrumented than noninstrumented lumbar operations, and almost all scoliosis and rhizotomy procedures. Conclusion The direct costs of spinal surgery in Spain were generally lower than those reported in other European Union countries and the United States. Neurosurgeons and orthopedic surgeons had different spine surgical profiles and costs.

The financial success of a radiology department is crucial to the well-being of both the hospital and the community it serves. Radiology trainees should therefore be conscious of how the department maintains its value within the health system. The purpose of this review is to provide a concise foundational resource for contemporary radiology residents and fellows to understand the basic financial operations of a hospital-based radiology department and to demonstrate its importance in supporting clinical activities. The radiology report is at the heart of reimbursement. Coders use this tool to assign International Classification of Diseases and Current Procedural Terminology codes to file reimbursement claims. Medicare, commanding the highest market share for third-party payers, sets algorithmic standards for compensation practices. Private insurers contract with hospitals, and providers use these systems or create their own contractual framework. Radiology leaders strategically balance these revenue streams with various departmental costs utilizing tools such as budgets and forecasts to ensure long-term organizational viability. Notably, payment practices in the United States are transforming from fee-for-service to value-based care. The roles of the radiologist and the radiology report are evolving with it. Examples of value-based payment models are accountable care organizations and bundled payments. Radiologists participating in these models are increasingly expected to be stewards of imaging utilization and effectively manage health care resources. Within this context of a globally changing incentive structure, trainees must reconceptualize their educational experience to equip themselves for both current and future types of clinical practice. [ABSTRACT FROM AUTHOR]

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Objective: To assess the cost-effectiveness of management strategies for patients presenting with chest pain and suspected coronary heart disease (CHD): (1) cardiovascular magnetic resonance (CMR); (2) myocardial perfusion scintigraphy (MPS); and (3) UK National Institute for Health and Care Excellence (NICE) guideline-guided care.Methods: Using UK data for 1202 patients from the Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease 2 trial, we conducted an economic evaluation to assess the cost-effectiveness of CMR, MPS and NICE guidelines. Health outcomes were expressed as quality-adjusted life-years (QALYs), and costs reflected UK pound sterling in 2016-2017. Cost-effectiveness results were presented as incremental cost-effectiveness ratios and incremental net health benefits overall and for low, medium and high pretest likelihood of CHD subgroups.Results: CMR had the highest estimated QALY gain overall (2.21 (95% credible interval 2.15, 2.26) compared with 2.07 (1.92, 2.20) for NICE and 2.11 (2.01, 2.22) for MPS) and incurred comparable costs (overall £1625 (£1431, £1824) compared with £1753 (£1473, £2032) for NICE and £1768 (£1572, £1989) for MPS). Overall, CMR was the cost-effective strategy, being the dominant strategy (more effective, less costly) with incremental net health benefits per patient of 0.146 QALYs (-0.18, 0.406) compared with NICE guidelines at a cost-effectiveness threshold of £15 000 per QALY (93% probability of cost-effectiveness). Results were similar in the pretest likelihood subgroups.Conclusions: CMR-guided care is cost-effective overall and across all pretest likelihood subgroups, compared with MPS and NICE guidelines. [ABSTRACT FROM AUTHOR]

Background: Dizziness/vertigo is one of the most common symptoms for which people seek healthcare. However, the healthcare expenditure attributable to dizziness/vertigo in South Korea remains poorly understood. We investigated the healthcare costs due to six major disorders causing dizziness/vertigo using claims data., Methods: The healthcare costs were evaluated using all the claims data submitted to the Health Insurance Review and Assessment Service from January 1 to December 31, 2022. The six major vestibular disorders included for analysis were benign paroxysmal positional vertigo (BPPV), psychogenic/persistent postural perceptual dizziness (PPPD), vascular vertigo/dizziness (VVD), vestibular migraine (VM), Meniere's disease (MD), and vestibular neuritis (VN)., Results: During the 1-year study period, 4.1% of adults aged 20 or older visited hospitals due to dizziness/vertigo in South Korea. Compared to the general population, the patients with dizziness/vertigo were more often elderly, female, and residents of small towns. The total healthcare cost for the six major vestibular disorders was ₩547.8 billion (approximately $406.5 million). BPPV incurred the highest annual healthcare cost (₩183.5 billion, 33.5%), followed by VVD (₩158.8 billion, 29.0%), MD (₩82.2 billion, 15.0%), psychogenic/PPPD (₩60.3 billion, 11.0%), VN (₩32.9 billion, 6.0%), and VM (₩30.1 billion, 5.5%). The mean healthcare cost per hospital visit due to dizziness/vertigo was ₩96,524 (95% confidence interval, ₩96,194-₩96,855), 30% higher than the average (₩73,948) of the overall healthcare cost per hospital visit over the same period., Conclusion: Owing to higher healthcare costs for dizziness/vertigo and increased prevalence of dizziness/vertigo in the aged population, healthcare costs due to dizziness/vertigo will increase rapidly in South Korea. Thus, a guideline for cost-effective management of dizziness/vertigo should be established to reduce the healthcare costs due to these common symptoms., Competing Interests: Dr. Ji-Soo Kim serves as an Associate Editor of Frontiers in Neuro-otology and on the editorial boards of the Journal of Clinical Neurology, Frontiers in Neuro-ophthalmology, Journal of Neuro-ophthalmology, and Journal of Vestibular Research, Journal of Neurology and Medicine. The other authors have nothing to disclose., (© 2024 The Korean Academy of Medical Sciences.)

To evaluate the impact of a community health worker intervention (CHW) (referred to as Personalized Support for Progress (PSP)) on all-cause health care utilization and cost of care compared with Enhanced Screening and Referral (ESR) among women with depression. A total of 223 patients (111 in PSP and 112 in ESR randomly assigned) from three women's health clinics with elevated depressive symptoms were enrolled in the study. Their electronic health records were queried to extract all-cause health care encounters along with the corresponding billing information 12 months before and after the intervention, as well as during the first 4-month intervention period. The health care encounters were then grouped into three mutually exclusive categories: high-cost (> US$1000 per encounter), medium-cost (US$201–$999), and low-cost (≤ US$200). A difference-in-difference analysis of mean total charge per patient between PSP and ESR was used to assess cost differences between treatment groups. The results suggest the PSP group was associated with a higher total cost of care at the baseline; taking this baseline difference into account, the PSP group was associated with lower mean total charge amounts (p = 0.008) as well as a reduction in the frequency of high-cost encounters (p < 0.001) relative to the ESR group during the post-intervention period. Patient-centered interventions that address unmet social needs in a high-cost population via CHW may be a cost-effective approach to improve quality of care and patient outcomes. [ABSTRACT FROM AUTHOR]

Objective: We aimed to investigate the influence of income level on guideline-directed medical therapy (GDMT) prescription rates and prognosis of patients with heart failure (HF) following implementation of a nationwide health insurance programme.Methods: A total of 633 098 hospitalised patients with HF from 1996 to 2013 were identified from Taiwan National Health Insurance Research Database. Participants were classified into low-income, median-income and high-income groups. GDMT utilisation, in-hospital mortality and postdischarge HF readmission, and mortality rates were compared.Results: The low-income group had a higher comorbidity burden and was less likely to receive GDMT than the other two groups. The in-hospital mortality rate in the low-income group (5.07%) was higher than in the median-income (2.47%) and high-income (2.51%) groups. Compared with the high-income group, the low-income group had a significantly higher risk of postdischarge HF readmission (adjusted HR (aHR): 1.29, 95% CI 1.27 to 1.31), all-cause mortality (aHR: 1.98, 95% CI 1.95 to 2.02) and composite HF readmission/all-cause mortality (aHR: 1.54, 95% CI 1.52 to 1.56). These results were generally consistent among the population after propensity matching (low vs high: HR=2.08 for mortality and 1.36 for HF readmission; median vs high: HR=1.23 for mortality and 1.12 for HF readmission; all p<0.001) and after inverse probability of treatment weighting (low-income vs high-income group: HR: 2.19 for mortality and 1.16 for HF readmission; median-income vs high-income group: HR: 1.53 for mortality and 1.09 for HF readmission; all p<0.001). Lower utilisation of GDMT and poorer prognosis in lower-income hospitalised patients with HF appeared to mitigate over time.Conclusions: Low-income patients with HF had nearly a twofold increase in the risk of in-hospital mortality and postdischarge events compared with the high-income group, partly due to lower GDMT utilisation. The differences between postdischarge HF outcomes among various income groups appeared to mitigate over time following the implementation of nationwide universal health coverage. [ABSTRACT FROM AUTHOR]

Background: Family meetings facilitate the exploration of issues and goals of care however, there has been minimal research to determine the benefits and cost implications. Aims: To determine: (1) if family caregivers of hospitalised patients referred to palliative care who receive a structured family meeting report lower psychological distress (primary outcome), fewer unmet needs, improved quality of life; feel more prepared for the caregiving role; and receive better quality of end-of-life care; (2) if outcomes vary dependant upon site of care and; (3) the cost-benefit of implementing meetings into routine practice. Design: Pragmatic cluster randomised trial involving palliative care patients and their primary family caregivers at three Australian hospitals. Participants completed measures upon admission (Time 1); 10 days later (Time 2) and two months after the patient died (Time 3). Regression analyses, health utilisation and process evaluation were conducted. Results: 297 dyads recruited; control (n = 153) and intervention (n = 144). The intervention group demonstrated significantly lower psychological distress (Diff: –1.68, p < 0.01) and higher preparedness (Diff: 3.48, p = 0.001) at Time 2. No differences were identified based on quality of end of life care or health utilisation measures. Conclusions: Family meetings may be helpful in reducing family caregiver distress and enhancing their preparedness for the caregiving role and it appears they may be conducted without increased hospital health utilisation impacts; although opportunity costs need to be considered in order to routinely offer these as a standardised intervention. Additional health economic examination is also advocated to comprehensively understand the cost-benefit implications. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN12615000200583 [ABSTRACT FROM AUTHOR]

Introduction: The clinical effectiveness of a 'rule-out' acute coronary syndrome (ACS) strategy for emergency department patients with chest pain, incorporating a single undetectable high-sensitivity cardiac troponin (hs-cTn) taken at presentation, together with a non-ischaemic ECG, remains unknown.Methods: A randomised controlled trial, across eight hospitals in the UK, aimed to establish the clinical effectiveness of an undetectable hs-cTn and ECG (limit of detection and ECG discharge (LoDED)) discharge strategy. Eligible adult patients presented with chest pain; the treating clinician intended to perform investigations to rule out an ACS; the initial ECG was non-ischaemic; and peak symptoms occurred <6 hours previously. Participants were randomised 1:1 to either the LoDED strategy or the usual rule-out strategy. The primary outcome was discharge from the hospital within 4 hours of arrival, without a major adverse cardiac event (MACE) within 30 days.Results: Between June 2018 and March 2019, 632 patients were randomised; 3 were later withdrawn. Of 629 patients (age 53.8 (SD 16.1) years, 41% women), 7% had a MACE within 30 days. For the LoDED strategy, 141 of 309 (46%) patients were discharged within 4 hours, without MACE within 30 days, and for usual care, 114 of 311 (37%); pooled adjusted OR 1.58 (95% CI 0.84 to 2.98). No patient with an initial undetectable hs-cTn had a MACE within 30 days.Conclusion: The LoDED strategy facilitates safe early discharge in >40% of patients with chest pain. Clinical effectiveness is variable when compared with existing rule-out strategies and influenced by wider system factors.Trial Registration Number: ISRCTN86184521. [ABSTRACT FROM AUTHOR]

Background: Operating room (OR) costs are a large portion of healthcare expenses. This study evaluates the impact of a surgeon‐targeted surgical receipt cost feedback system on OR supply costs in sinonasal surgery and individual components contributing to procedural cost. Methods: Itemized weekly surgical receipts detailing individual case supply costs were analyzed before and after the implementation of a non‐incentivized surgeon cost feedback system between January 2017 and June 2019. Supply cost data collected 15 months prior to intervention was compared to cost data 15 months after implementation of the weekly automated receipt dissemination to surgeons. Chi square test was used for categorical data and the Wilcoxon test was used to compare change in cost. Univariate and mediation analyses were performed to assess variables impacting cost. Results: Of 502 sinonasal procedures analyzed, 239 were before and 264 after cost feedback implementation. There were no significant differences in age/gender, or indication for surgery. The median OR supply cost decreased from $1229.64 to $1097.22 (p = 0.02) after receipt implementation. There were effects of procedure type (p = 0.02), circulating nurse specialization (p < 0.001), steroid eluting stent (p = 0.002), and sinus drill (p < 0.001) on cost. Mediation analysis confirmed full mediation by decreasing use of steroid‐eluting stents. Conclusion: Surgeon cost feedback in the form of individualized OR surgical receipts is an effective model to reduce supply cost per case in sinonasal surgery. [ABSTRACT FROM AUTHOR]

Background: This descriptive, analytic study aimed to compare the costs of 10 types of Global Budget Payment System (GBPS) surgery in Imam Reza Hospital, Mashhad City, Iran, in 2016 with the prices in the GBPS. Methods: From hospital-discharge data and patients’ bills, we identified 10 types of GBPS surgeries performed in Imam Reza hospital. The patients were grouped according to the surgical procedures performed in the 10 GBPS category. Data on hospital charges and cost-to-charge ratios were used to assess charges and costs for specific resources, as well as for the hospitalization overall. The researcher received training from the experts in the field of hospital accounting to learn how to determine the charge of GBPS surgeries. Results: The results showed that in some surgeries such as hysterectomy, natural delivery, C-section, tonsillectomy, hernia repair, and appendectomy, charges of services were higher than their average prices GBPS and in arteriovenous anastomosis surgery, cholecystectomy, tympanoplasty, and thyroidectomy were lower than average prices GBPS. One of the main goals of Iran’s Ministry of Health in developing GBPS was to provide a unified framework for managing admission and treatment costs in state-owned hospitals. The obtained data were analyzed by the Wilcoxon signed-rank test and the independent samples t test with 0.05 statistical significance. The results of this study and similar works show that most hospitals have completely neglected this aspect of GBPS. Conclusion: A fact that is reflected in the wide-ranging variations in the charge of GBPS surgeries in different hospitals despite their being paid based on the same rates and guidelines. [ABSTRACT FROM AUTHOR]

In this paper, we propose and defend three economic arguments for permitting assisted dying. These arguments are not intended to provide a rationale for legalising assisted suicide or euthanasia in and of themselves; rather, they are supplementary arguments that should not be neglected when considering the ethics of assisted dying. The first argument is that permitting assisted dying allows consenting patients to avoid negative quality-adjusted life years, enabling avoidance of suffering. The second argument is that the resources consumed by patients who are denied assisted dying could instead be used to provide additional (positive) quality-adjusted life years for patients elsewhere in the healthcare system who wish to continue living and to improve their quality of life. The third argument is that organ donation may be an additional potential source of quality-adjusted life years in this context. We also anticipate and provide counterarguments to several objections to our thesis. Taken together, the cumulative avoidance of negative quality-adjusted life years and gain in positive quality-adjusted life years suggest that permitting assisted dying would substantially benefit both the small population that seeks assisted suicide or euthanasia, and the larger general population. As such, denying assisted dying is a lose–lose situation for all patients. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to estimate annual direct cost attributed to rheumatoid arthritis (RA) treatment from a patient's perspective using real‐world patient follow‐up data from hospitals' electronic database. Methods: A prospective 1‐year study was conducted in rheumatology clinics of tertiary care hospitals of Karachi, Pakistan. Cost‐of‐illness methodology was used and all patient data related to costs of rheumatologist visits, physical therapy sessions, medications, assistive devices and laboratory investigations were obtained directly in printed hardcopies from patient electronic databases using their medical record numbers. Transportation cost was calculated from patient‐reported log books. Data were analyzed through IBM SPSS version 23. Patients were asked to sign a written consent and the study was ethically approved. Results: The mean age of patients (N = 358) was 48 years. Most patients (73.7%) were female, married (86%) and had basic education (71.8%). Average cost of rheumatologist visits was PKR 11 510.61 (USD: 72.05) while it was PKR 66 947.37 (USD: 419.07) for physical therapy sessions. On average, medicines and medical devices costs were estimated at PKR 10 104.23 (USD: 63.25) and PKR 7848.48 (USD: 49.13) respectively. Cost attributed to diagnostic and laboratory charges was PKR 1962.12 (USD: 12.28) and travel expense was PKR 6541 (USD: 40.95). The direct expenditure associated with managing RA was PKR 37 558 (USD: 235.1). All costs were reported per annum. Conclusion: Patient with RA in Pakistan pay a considerable amount of their income for managing their condition. Most patients have no provision for insurance which is a need considering the nature of the disease and associated productivity loss that would significantly lower income as the disease progresses. [ABSTRACT FROM AUTHOR]

Background: The direct costs associated with different diagnostic algorithms to localize cerebrospinal fluid (CSF) rhinorrhea have not been described. Methods: A decision‐tree analysis of imaging modalities used to localize CSF rhinorrhea was performed to compare associated direct costs. The primary outcome was cost, which was determined based on reimbursement data published by the Centers for Medicare and Medicaid Services in 2018. The model was parameterized after a literature review of published studies was performed from 1990 to 2018 to estimate the sensitivity CSF rhinorrhea localization of the following radiographic modalities: high‐resolution computed tomography (HRCT), magnetic resonance cisternography (MRC), and CT cisternography (CTC). In addition to base case analysis, 1‐way sensitivity analyses were also performed to evaluate the robustness of results to changes in model parameters. Results: Among patients with a high suspicion for CSF rhinorrhea, use of HRCT followed by exploration in the operating room if preliminary HRCT was negative was found to be the optimal localization modality from a cost perspective ($172.25). The next least costly algorithm was HRCT followed by MRC ($294.10). Imaging algorithms beginning with CTC were the next least costly modality ($727.37). Sensitivity analyses generally supported HRCT to be the optimal initial radiographic strategy over a wide range of parameter values. Conclusion: This work advocates HRCT as first‐line modality to localize CSF rhinorrhea from a cost perspective. Although algorithms beginning with MRC were on average $35 more expensive than those starting with CTC, associated risks of CTC were not modeled and may play a role in decision making. [ABSTRACT FROM AUTHOR]

Background: Child mortality is the most crucial indicator of national progress and a reflection of not only the health system performance but also the wealth (budget) utilization and goal achievements. Many developing nations have recorded progress in this dimension but those of the Arabian Gulf (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and United Arab Emirates) show remarkable progress and achievements.Methods: Using the latest update of United Nations Inter-agency Group for Child Mortality Estimation 2017, an attempt is made here to review and appraise their achievements in child mortality reduction since 1950s taking into account Under 5 mortality, infant mortality, and neonatal mortality.Results: This review finds a rapid decline in child mortality in the Arabian Gulf in a short span of 50 years, which is in line with the achievement of Sustainable Development Goals.Conclusions: There is a remarkable budget allocation and investment in health system building, improving the other contributing sectors like water, sanitation, hygiene, nutrition, and life style modifications apart from the usual health care interventions.

Air pollution, aeroallergens, allergic rhinitis, chronic rhinosinusitis, particulate matter, quality of life, health care economics Physician characteristics, industry transfers, and pharmaceutical prescribing: empirical evidence from Medicare and the physician payment sunshine act. Keywords: air pollution; aeroallergens; allergic rhinitis; chronic rhinosinusitis; health care economics; particulate matter; quality of life EN air pollution aeroallergens allergic rhinitis chronic rhinosinusitis health care economics particulate matter quality of life 1521 1523 3 11/26/21 20211101 NES 211101 Section 6002 of the Affordable Care Act of 2010, known as the "Sunshine Act", requires that physicians disclose transfers of value from private industry. [Extracted from the article]

Background: Addressing the challenges of asthma has involved various approaches, including the examination of costs associated with hospitalization. However, there is a limited number of studies that have investigated the actual expenses incurred by hospital settings in caring for asthma patients. This study aims to describe the costs, predictors, and breakdown of expenditures in different categories., Design and Methods: A retrospective cohort study was conducted, involving 314 hospital stays of patients over 12 years old who were admitted for asthma and classified under APR-DRG 141 (asthma). Univariate and multiple linear regression analyses were performed., Results: The median cost, regardless of DRG severity, amounted to 2.314€ (1.550€-3.847€). Significant variations were observed when the sample was stratified based on the severity of DRG, revealing a cost gradient that increases with severity. The length of stay followed a similar trend. Six predictors were identified: age, admission to intensive care, asthma severity, severity level of the DRG, winter admission, and length of stay. The cost breakdown showed that 44% constituted direct costs, 25% were indirect costs, 26% were attributed to medical procedures performed outside the patient unit, and 5% were related to medication administration., Conclusions: This study initiates a discussion on the role of reducing hospital costs in strategies aiming at controlling asthma-related costs. We argue that cost reduction cannot be achieved solely at the hospital level but must be approached from a public health perspective. This includes promoting high-quality outpatient care and addressing factors leading to poor adherence to the care plan., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

This article goes through the major components of the health care return-on-investment equation, from spending to outcomes, and attempts to identify major causes for its underperformance compared with other types of enterprise. It also explores the role of "middlemen" in prescription drug pricing (broadly defined as any market participant other than the drug manufacturer and the provider/patient, including—but not limited to—insurance companies, pharmacy benefit managers [PBMs], and health plans) and teases out the mechanisms by which PBMs, in particular, contribute to overall health care costs and the types of risks and returns they endure. Like any economic system, the health care system is a net zero-sum construct, whereby costs and benefits are traded off or exchanged between components of the value chain involuntarily (e.g., by regulatory or legal mandate) or voluntarily (e.g., by economic incentive). Ultimately, the question for policymakers as it relates to health care reform is to determine what combination of such exchanges leads to the best overall outcomes. This question of optimization, however, is undoubtedly challenging and complex, and can bring to bear economic, social, political, and moral dimensions. In light of these considerations, the article concludes by touching upon some perspectives for the future and ideas for reform, including payer reform, delivery disintermediation by technology, and consumer-driven health care. [ABSTRACT FROM AUTHOR]

To assess the incremental direct medical costs of a population-based cohort of incident systemic lupus erythematosus (SLE) for the first five years after diagnosis, and impact of socioeconomic status (SES) on such incremental costs. From the administrative health databases in British Columbia, Canada, we identified all adults with newly-diagnosed SLE from 1996 to 2010 and obtained a sample from the general non-SLE population matched on sex, age, and calendar-year. We captured costs for outpatient encounters, hospitalisations, and dispensed medications. Using two-part generalised linear models, we estimated per-person-year incremental costs of SLE (difference in costs between SLE and non-SLE, controlling for covariates) during the first five years after diagnosis, and assessed differences in incremental costs across SES groups. We included 4679 newly-diagnosed SLE (86% identified from hospitalisations or rheumatologists) and 23,219 non-SLE individuals. Per-person direct costs for SLE in the first year after diagnosis averaged $13,038 (2013 Canadian), with 61% from hospitalisations, 23% from outpatient encounters, and 16% from medications; costs for non-SLE averaged $2,431. Following adjustment, incremental costs of SLE during the first five years after diagnosis averaged $10,078 per-person-year (95% CI=$2062–$32,254). Predicted incremental hospitalisation, outpatient, and medication costs were all significantly-greater for the low-SES patients versus high-SES (additional $1922 per-person-year in incremental costs for low-SES). Similar patterns were observed when restricting to those followed the full five-years after index date. Even in a single-payer, publicly-funded healthcare setting, low SES at SLE diagnosis was associated with significantly-greater direct medical costs for the management of SLE and associated complications. [ABSTRACT FROM AUTHOR]

Affordability of care is a major concern for many in the United States. Part of the affordability of care issue is unanticipated medical bills. A 2018 poll found that unexpected medical costs were the public's greatest affordability concern, ahead of prescription drug costs and even food or rent or mortgage. An important cause of unexpected medical bills is the surprise insurance network gap. The term "surprise billing" is commonly used to describe this problem of unanticipated out-of-network (OON) care, though this is a misnomer because it is actually a "surprise insurance gap." This gap can have significant consequences for patients and families. Hospital-based specialties like radiology have been implicated in the issue. Part of solving this problem includes determining an appropriate reimbursement for physicians who provide unanticipated OON care to patients. The two most commonly proposed methods to determine insurance company reimbursement to providers for OON services are use of a benchmark value and alternative dispute resolution. There is risk in trying to "price set" with a benchmark value. Establishing a predetermined value for services to mitigate against unexpected bills could have unintended and significant consequences, including disrupting good-faith negotiations between insurance companies and providers and impacting access to care. The data indicate that an alternative dispute resolution process can protect patients, lower the frequency of unexpected OON bills, and reduce costs. [ABSTRACT FROM AUTHOR]

This plan for a Nurse Practitioner (NP)-Directed Overactive Bladder Program describes how the NP may link current theory and evidence to improve efficiency, attrition, revenue, and productivity for a urologic practice. These four terms are defined with illustrations of how to make this program a reality. [ABSTRACT FROM AUTHOR]

Several studies have documented improved outcomes at high-volume hospitals for neurosurgery. However, the relationship between neurosurgical volume and costs remains poorly understood. Using neurosurgery-specific Diagnosis-Related Groups (DRG) codes, we identified adult neurosurgical admissions in the National Inpatient Sample from 2002 to 2014. We stratified hospitals by annual neurosurgical volume as high-volume (top 20%) or low-volume centers (bottom 80%). We performed survey-weighted regression analyses to examine the impact of case volume on inpatient costs. A total of 12,129,029 admissions underwent neurosurgery from 2002 to 2014, with 59.6% treated at high-volume hospitals. Patients at high-volume centers were more likely to have private insurance, higher risk of mortality scores, and higher DRG weight procedures than those at low-volume centers (P < 0.001). High-volume hospital admissions were on average 9% or $1791 more expensive than their low-volume counterparts. However, after adjustment for patient, hospital, and case-mix differences, high-volume hospitals were 4.3% less expensive than low-volume centers ($21,825 vs. $22,924; P < 0.01). The southern United States, which had the biggest volume, showed the highest savings (6.5%). High-volume hospitals provide more cost-effective neurosurgical care. Centralization of care at high-volume neurosurgical institutions may be a promising strategy to delivering higher-value care, achieving better outcomes at lower costs. [ABSTRACT FROM AUTHOR]

Background: The use of bilateral internal thoracic arteries (BITA) for coronary artery bypass grafting (CABG) may improve survival compared with CABG using single internal thoracic arteries (SITA). We assessed the long-term costs of BITA compared with SITA.Methods: Between June 2004 and December 2007, 3102 patients from 28 hospitals in seven countries were randomised to CABG surgery using BITA (n=1548) or SITA (n=1554). Detailed resource use data were collected from the initial hospital episode and annually up to 5 years. The associated costs of this resource use were assessed from a UK perspective with 5 year totals calculated for each trial arm and pre-selected patient subgroups.Results: Total costs increased by approximately £1000 annually in each arm, with no significant annual difference between trial arms. Cumulative costs per patient at 5-year follow-up remained significantly higher in the BITA group (£18 629) compared with the SITA group (£17 480; mean cost difference £1149, 95% CI £330 to £1968, p=0.006) due to the higher costs of the initial procedure. There were no significant differences between the trial arms in the cost associated with healthcare contacts, medication use or serious adverse events.Conclusions: Higher index costs for BITA were still present at 5-year follow-up mainly driven by the higher initial cost with no subsequent difference emerging between 1 year and 5 years of follow-up. The overall cost-effectiveness of the two procedures, to be assessed at the primary endpoint of the 10-year follow-up, will depend on composite differences in costs and quality-adjusted survival.Trial Registration Number: ISRCTN46552265. [ABSTRACT FROM AUTHOR]

Newborn screening (NBS) is a public health program that detects genetic conditions in neonates enabling treatment before clinical symptoms manifest. Severe combined immune deficiency (SCID) is a primary immune deficiency found in the absence of functioning T and B lymphocytes. Hematopoietic cell transplantation is a potentially curative treatment if received within the first 42 months of life; without treatment, this condition is fatal in the first 2 years of life due to severe opportunistic infections. SCID was added to the recommended uniform panel of conditions for inclusion in state NBS programs in 2010. This manuscript examines the societal costs and benefits of NBS for SCID in Arkansas and implications to health services and social welfare. Total cost per year of all NBS for SCID and resulting early treatment for one patient with SCID in Arkansas is estimated at $1,078,714. Cost of late treatment of one patient with SCID is estimated at $1.43 million. Based on an expected diagnosis of one patient per year in Arkansas, this results in an estimated net cost savings for NBS for SCID in Arkansas of $351,286 per year. Based on cost‐effectiveness analysis, NBS for SCID in Arkansas is cost‐effective, with higher societal benefit than cost. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the direct costs of various spinal surgical procedures within 1 year of follow-up and to compare the profiles of neurosurgeons and orthopedic surgeons. Methods: All spinal procedures performed within a 10-month period in patients covered by a private insurance company were included. Costs related to the spinal interventions were systematically registered in the company database. Associated costs during the 1-year follow-up were recorded. Results: In total, 1,862 patients were included, with a total cost of €11,050,970, of whom 34.8% underwent noninstrumented lumbar decompression (€3,473), 27.1% dorsolumbar instrumented fusion (€6,619), 14.6% nucleoplasty (€1,323), 13.5% cervical surgery (€4,463), 3.4% kyphoplasty (€4,200), 2.9% scoliosis (€15,414), 1.2% oncologic surgery (€5,590), 0.5% traumatic compression (€7,844), and 4.7% (€1,343) other minor interventions (mainly rhizotomies). Approximately 42% of patients required reinterventions within the first year, with a global extra cost of €7,280,073; 11% were referred to the pain clinic, with a €114,663 cost; 55.5% were men; and the most common age range of patients who received an intervention was 65-75 years. Neurosurgeons performed 60% of all interventions. Noninstrumented lumbar operations were performed by neurosurgeons twice as often as instrumented operations, and they performed 76% of cervical operations. Orthopedic surgeons performed 2.5 times more instrumented than noninstrumented lumbar operations, and almost all scoliosis and rhizotomy procedures. Conclusion: The direct costs of spinal surgery in Spain were generally lower than those reported in other European Union countries and the United States. Neurosurgeons and orthopedic surgeons had different spine surgical profiles and costs. [ABSTRACT FROM AUTHOR]

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Background: Healthcare costs are increasing in the USA and Canada and a substantial portion of health spending is devoted to services that do not improve health outcomes. Efforts to reduce waste by adopting evidence-based clinical practice guideline recommendations have had limited success. We sought insight into improving health system efficiency through understanding cardiologists' perceptions of factors that influence clinical decision-making.Methods: In this descriptive qualitative study, we conducted in-depth interviews with 18 American and 3 Canadian cardiologists. We used conventional content analysis including inductive and deductive approaches for data analysis and mapped findings to the ecological systems framework.Results: Physicians reported that major determinants of practice included interpersonal interactions with peers, patients and administrators; financial incentives and system factors. Patients' insurance status represented an important consideration for some cardiologists. Other major influences included time constraints, fear of litigation (less prominent in Canada), a sense that their obligation was never to miss any underlying pathology, and patient demands. The need to bring income into their health system influenced American cardiologists' practice; personal income implications influenced Canadian cardiologists' practice. Cardiologists reported that knowledge limitations and logistical challenges limit their ability to assist patients with cost considerations. All these considerations were more influential than guidelines; some cardiologists expressed a high level of scepticism regarding guidelines.Conclusions: Clinical decision-making by cardiologists is shaped by individual, interpersonal, organisational, environmental, financial and sociopolitical influences and only to a limited extent by guideline recommendations. Successful strategies to achieve efficient, evidence-based care will require addressing socioecological influences on decision-making. [ABSTRACT FROM AUTHOR]

Introduction: Brucellosis is a common infectious disease between humans and animals, which continues to be a health problem in our country. Considering that Fasa County is one of the high prevalence areas of this disease, the aim of this study was to investigate the epidemiologic status of brucellosis during the years 2009-2017. Materials and Methods: This study was conducted as a cross-sectional study. Information about Brucellosis was obtained from the deputy health department of Fasa University of Medical Sciences. Data were encoded and analyzed by SPSS 22 software. Frequency, mean, and standard deviation were used to analyze the data and the results were presented in the form of a table and a chart. Results: The highest frequency was in 2008 with 67 cases (17.8%) and the least frequent in 2016 with 25 cases (6.6%). Of these, 343 cases (91.2%) were newly diagnosed and the rest were defeat treatment or recurrence of the disease. All Iranian patients and most of them were from men. The mean age of the patients was 34.15 ± 8.31 years. Most of the jobs associated with the disease for livestock and agriculture with a frequency of 37 percent (139) and then Housekeeping with a frequency of 26.9 percent (101 cases). Most participants were from rural areas. Conclusion: The results of the study showed that the incidence of the disease was reduced. But this disease is still a health problem in the city, which requires training and inter-departmental collaboration to control the disease. [ABSTRACT FROM AUTHOR]

Introduction: The use of economics in planning for the cost of health services is a part of the health system policies. Service providers and recipients should have sufficient information about the economic components in order to have an integral economic program. The aim of this study was to evaluate the pediatric residents knowledge about the economic components for patient treatment. Materials and Methods: This cross-sectional study was conducted for the pediatric residents of Mashhad university of medical sciences in the spring of 2014 with a questionnaire containing 19 questions. The validity of questionnaire was measured by Cranach's alpha and the reliability by pediatrics professors. Results: Overall 10% of the residents had correct knowledge about the percentage of insurance payment. About the cost of one night stay in the general wards, 24% and for ICU, 2% had the right information. None of them was familiar with the price of 10 grams of intravenous immunoglobulin, 5% of them had the right idea about the cost of a common prescription. Scores of residents were calculated and classified from weak to excellent. Conclusion: This study showed that the residents information was insufficient about health care costs and it had no relation with the academic years. [ABSTRACT FROM AUTHOR]