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BackgroundDuring the COVID-19 pandemic, Asians/Asian Americans have experienced co-occurring threats of anti-Asian racism, economic challenges, and negative mental and physical health symptoms.ObjectivesWe examined the co-occurrence of COVID-19-related anti-Asian discrimination and collective racism, economic stressors, and mental and physical health challenges for Asians/Asian Americans during the COVID-19 pandemic. We also examined Asian/Asian American subgroups associated with these threats.MethodsNationally representative data from the 2021 Asian American and Native Hawaiian/Pacific Islander COVID-19 Needs Assessment Project (unweighted N = 3,508) were used to conduct a latent profile analysis to identify unique typologies of the co-occurrence of these threats. We also conducted chi-square analyses to investigate subgroup differences by latent profile.ResultsWe identified five distinct latent profiles: multi-threat impact, low impact, collective racism, health challenges, and economic/health challenges. Forty percent of Asians/Asian Americans were in the multi-threat impact profile, indicating high levels across COVID-19-related threats. Subgroup analyses revealed significant differences in profile membership. East Asians, US-born Asians/Asian Americans, and those aged 25-44 seemed to be particularly affected by the proposed syndemic; results also differed by income.ConclusionAsians/Asian Americans have experienced co-occurring and interrelated threats during COVID-19 that suggest the presence of a syndemic. Results from our study point to vulnerable Asian/Asian American subgroups and the need for targeted public health efforts to address racism, health challenges, and economic challenges in the context of COVID-19.

Since the late 1990s, the number of college student loan debtors has increased rapidly in Japan. Despite the uniqueness of Japanese higher education policies in terms of tuition levels and heavy reliance on educational loans rather than grants, few studies have focused on the influence of student loans on adult youths' lives. This study is the first to provide a detailed analysis of the relationship between student loan debt and youth life events. We explored the impact of student loan debt on family formation, using a data set of college graduates collected in 2017. We employed survival analysis methods to understand the relationship between student loan debt and marital decisions, and negative binomial models to analyze the impact of this debt on childbearing. The results showed that 2-year college graduate women with student loan debt were more likely to delay marital decisions than women without student loan debt. Taking out student loans also had a negative correlation to childbearing, which was also stronger for 2-year college graduate women. In conclusion, this study revealed that the Japanese government's reliance on student loans has unexpected consequences. Even following recent reforms, student loan debt continues to be a major financial burden for young Japanese people and is likely to negatively affect family formation in Japan, which has already seen a decline in marriage and fertility rates over the last few decades. Our results call for additional policies to mitigate the negative influence of the Japanese college student aid system. [ABSTRACT FROM AUTHOR]

Background: Healthcare fragmentation and lack of care coordination are longstanding problems in cancer care. This study's goal was to provide in-depth understanding of how the organization and fragmentation of healthcare impacts the experiences of patients with advanced cancer and their families, especially near the end-of-life. Methods: This mixed-methods quality improvement study took place at a large multi-specialty healthcare organization in Northern California. Electronic health record data was used to identify patients with advanced cancer and their characteristics. Data were collected 10/2019-05/2022 through periodic patient surveys and in-depth interviews with sampled family members, including open-ended questions about overall healthcare experiences. Data were analyzed using inductive thematic analysis. Results: Overall, 281/482 (58.3%) patients with advanced cancer completed surveys. Surveyed patients' mean age was 68 (SD: 12.8) years, 53% were male, 73% White, 14.2% Asian, 1.4% Black, 3.9% Other; 8.9% Hispanic, and 19.2% were deceased within 12 months. Twenty-four family members completed in-depth interviews: 17/24 (70.8%) were spouses, 62.5% were female and 50% were interviewed after the patient's death. Respondents were generally positive about health care team interactions, but consistently brought up the negative impacts of the organization of healthcare, "It is not the fault of the health care team - it is the way the system works." Three major challenges were identified. (1) Systemic healthcare care fragmentation, including difficulties navigating care across providers and institutions, "It seems like everything is like an isolated incident... there's no overall, big picture viewpoint." (2) Administrative burdens, "In the end I gave up [scheduling care] because I was tired of calling." (3) Financial burdens, "This oncologist wanted to put him on a drug...but it was $4000 a month." Respondents described these challenges leading to worse quality of care, health, and quality of life, and loss of trust in the national healthcare system. Conclusions: These findings illustrate how care fragmentation and administrative and financial burdens lead to worse quality care and distrust of healthcare. Better coordination of patient-centered care, and a fundamental restructuring of a highly fragmented national healthcare system are required to meet the needs of patients with complex conditions like advanced cancer and their families. [ABSTRACT FROM AUTHOR]

Introduction: Rural informal caregivers (IC) experience major financial and economic constraints in caring for their older family members. Rurality combined with increased caregiving demands and intensity, poor economic opportunities, and limited financial resources and policies create multiple financial stressors and can lead to poor financial well-being. A cross-sectional survey was conducted to understand how caregiving demands, intensity, and duration impact the subjective financial well-being of rural caregivers of older adults. Methods: Informal caregivers (N = 196) residing in 12 rural counties in the central North Region of the Midwestern US participated in the survey. Ordinary Least Squares and Linear Probability Model regressions were conducted to measure the association among the study variables. Results: Our findings showed a moderate level of subjective financial well-being among informal caregivers (average = 51.62; SD 14.52). Caregiving intensity negatively affected financial well-being (β = −1.470, p < 0.05). More than half of informal caregivers (58%) were not satisfied with their household income, and 30% found it difficult to meet their family's needs with their current income status. Discussion and Conclusions: Longer hours of care are associated with financial burden and insecurity and can significantly influence the financial health and well-being of rural informal caregivers of older adults. Older caregivers were found to manage their financial constraints more effectively. Future comparative and longitudinal studies with a more diverse sample are required to infer long-term interactions among the different variables in this study. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To evaluate the drug wastage and additional costs (in INR) resulting from leftover or unused drugs due to limited vial strength options, and to propose vial size recommendations to pharmaceutical companies tailored to Indian requirements. Material and Methods: A total of 500 adult patients attending daycare oncology were prospectively evaluated. Mean, median, mode and left over or unused drug dose for each chemotherapy drugs were calculated. The economic loss estimation was done considering the unit cost for the drug. Result: The overall drug wastage for 500 prescriptions was 57,836 mg, accounting for 8.67% of the total prescribed dose. This resulted in an economic loss of 1,02,562 INR, which is 6.26% of the total cost. The highest proportions of drug wastage were observed for vincristine (28.72%), etoposide (23.20%), bleomycin (18.5%), pemetrexed (17.10%), nab-paclitaxel (16.37%), vinblastine (14.70%), Adriamycin (11.76%), and carboplatin (11.36%). The maximum economic loss was attributed to carboplatin (19.66%), nab-paclitaxel (17%), etoposide (14.5%), oxaliplatin (9.45%), and pemetrexed (7%). In combination chemotherapy regimens, gemcitabine-cisplatin-nab-paclitaxel (18.52%), pemetrexed-carboplatin (11.82%), and carboplatin-etoposide (8.97%) were responsible for the highest monetary losses due to drug wastage. Conclusion: Drug wastage due to oversized chemotherapy vials imposes significant financial and environmental burdens. We recommend offering additional vial size options for carboplatin, etoposide, gemcitabine, nab-paclitaxel, irinotecan, vincristine, and 5-FU. We hope this will reduce drug wastage to below 1-2%. [ABSTRACT FROM AUTHOR]

Aims: Technological advances and the current shortage of donor organs have contributed to an increase in the number of left ventricular assist device (LVAD) implantations in patients with end‐stage heart failure. Demographic change and medical progress might raise the number of these patients, resulting in a further increase in the number of LVAD implantations. The aim of this study was to evaluate the long‐term costs of LVAD therapy and identify diagnoses resulting in expensive stays. Methods and results: In this retrospective analysis of prospectively collected data, all patients after implantation of a second‐ or third‐generation LVAD by 31 March 2022 were included. In addition to demographic and survival data, revenues and case mix points were determined for each patient. Of the 163 patients included, 75.5% were male. The mean age at LVAD implantation was 52 ± 14 years. The mean survival was 1458 ± 127 days. During follow‐up, the total inpatient treatment time per patient was 70 ± 87 days. The average duration of outpatient treatment was 55.1%, based on the total duration of support. The average revenue per patient for the implant stay was $193 192.35 ± $111 801.29, for inpatient readmissions $52 068.96 ± $116 630.00, and for outpatient care $53 195.94 ± $62 363.53. Conclusions: LVAD implantation in patients with end‐stage heart failure leads to improved survival but a significant increase in treatment costs. Further multi‐centre studies are necessary in order to be able to assess the effects of long‐term LVAD treatment on the healthcare system. [ABSTRACT FROM AUTHOR]

Abstract Background Healthcare fragmentation and lack of care coordination are longstanding problems in cancer care. This study’s goal was to provide in-depth understanding of how the organization and fragmentation of healthcare impacts the experiences of patients with advanced cancer and their families, especially near the end-of-life. Methods This mixed-methods quality improvement study took place at a large multi-specialty healthcare organization in Northern California. Electronic health record data was used to identify patients with advanced cancer and their characteristics. Data were collected 10/2019-05/2022 through periodic patient surveys and in-depth interviews with sampled family members, including open-ended questions about overall healthcare experiences. Data were analyzed using inductive thematic analysis. Results Overall, 281/482 (58.3%) patients with advanced cancer completed surveys. Surveyed patients’ mean age was 68 (SD: 12.8) years, 53% were male, 73% White, 14.2% Asian, 1.4% Black, 3.9% Other; 8.9% Hispanic, and 19.2% were deceased within 12 months. Twenty-four family members completed in-depth interviews: 17/24 (70.8%) were spouses, 62.5% were female and 50% were interviewed after the patient’s death. Respondents were generally positive about health care team interactions, but consistently brought up the negative impacts of the organization of healthcare, “It is not the fault of the health care team - it is the way the system works.” Three major challenges were identified. (1) Systemic healthcare care fragmentation, including difficulties navigating care across providers and institutions, “It seems like everything is like an isolated incident… there’s no overall, big picture viewpoint.” (2) Administrative burdens, “In the end I gave up [scheduling care] because I was tired of calling.” (3) Financial burdens, “This oncologist wanted to put him on a drug…but it was $4000 a month.” Respondents described these challenges leading to worse quality of care, health, and quality of life, and loss of trust in the national healthcare system. Conclusions These findings illustrate how care fragmentation and administrative and financial burdens lead to worse quality care and distrust of healthcare. Better coordination of patient-centered care, and a fundamental restructuring of a highly fragmented national healthcare system are required to meet the needs of patients with complex conditions like advanced cancer and their families.

Abstract Aims Technological advances and the current shortage of donor organs have contributed to an increase in the number of left ventricular assist device (LVAD) implantations in patients with end‐stage heart failure. Demographic change and medical progress might raise the number of these patients, resulting in a further increase in the number of LVAD implantations. The aim of this study was to evaluate the long‐term costs of LVAD therapy and identify diagnoses resulting in expensive stays. Methods and results In this retrospective analysis of prospectively collected data, all patients after implantation of a second‐ or third‐generation LVAD by 31 March 2022 were included. In addition to demographic and survival data, revenues and case mix points were determined for each patient. Of the 163 patients included, 75.5% were male. The mean age at LVAD implantation was 52 ± 14 years. The mean survival was 1458 ± 127 days. During follow‐up, the total inpatient treatment time per patient was 70 ± 87 days. The average duration of outpatient treatment was 55.1%, based on the total duration of support. The average revenue per patient for the implant stay was $193 192.35 ± $111 801.29, for inpatient readmissions $52 068.96 ± $116 630.00, and for outpatient care $53 195.94 ± $62 363.53. Conclusions LVAD implantation in patients with end‐stage heart failure leads to improved survival but a significant increase in treatment costs. Further multi‐centre studies are necessary in order to be able to assess the effects of long‐term LVAD treatment on the healthcare system.

Perhaps the most traumatic experience for a parent is watching their child suffer in front of their eyes. Parenting, by its very nature, is a stressful activity; however, the stress of caring for an autistic child along with the myriad challenges it brings, can take a toll on parents’ health. To meet the complex demands of a child with Autism Spectrum Disorder (ASD), families can suffer from emotional, financial, and even physical burdens, which in turn leave them with little time for self-care and can lead to mounting sleep deprivation. In this review, an attempt has been made to understand the various challenges and stresses faced by the parents of a child with ASD. This review specifically focuses on mental health challenges, lack of sufficient time for self-care, problems related to communication, challenges associated with caring for an autistic child, stigmatisation related to mental health disorders, and the financial burdens faced by the parents of autistic children.

Abstract Background Social risk such as housing instability, trouble affording medical care and food insecurity are a downstream effect of social determinants of health (SDOHs) and are frequently associated with worse health. SDOHs include experiences of racism, sexism and other discrimination as well as differences in income and education. The collective effects of each social risk a person reports are called cumulative social risk. Cumulative social risk has traditionally been measured through counts or sum scores that treat each social risk as equivalent. We have proposed to use item response theory (IRT) as an alternative measure of person-reported cumulative social risk as IRT accounts for the severity in each risk and allows for more efficient screening with computerized adaptive testing. Methods We conducted a differential item functioning (DIF) analysis comparing IRT-based person-reported cumulative social risk scores by income and education in a population-based sample (n = 2122). Six social risk items were analyzed using the two-parameter logistic model and graded response model. Results Analyses showed no DIF on an IRT-based cumulative social risk score by education level for the six items examined. Statistically significant DIF was found on three items by income level but the ultimate effect on the scores was negligible. Conclusions Results suggest an IRT-based cumulative social risk score is not biased by education and income level and can be used for comparisons between groups. An IRT-based cumulative social risk score will be useful for combining datasets to examine policy factors affecting social risk and for more efficient screening of patients for social risk using computerized adaptive testing.

Perhaps the most traumatic experience for a parent is watching their child suffer in front of their eyes. Parenting, by its very nature, is a stressful activity; however, the stress of caring for an autistic child along with the myriad challenges it brings, can take a toll on parents' health. To meet the complex demands of a child with Autism Spectrum Disorder (ASD), families can suffer from emotional, financial, and even physical burdens, which in turn leave them with little time for self-care and can lead to mounting sleep deprivation. In this review, an attempt has been made to understand the various challenges and stresses faced by the parents of a child with ASD. This review specifically focuses on mental health challenges, lack of sufficient time for self-care, problems related to communication, challenges associated with caring for an autistic child, stigmatisation related to mental health disorders, and the financial burdens faced by the parents of autistic children. [ABSTRACT FROM AUTHOR]

Background: Social risk such as housing instability, trouble affording medical care and food insecurity are a downstream effect of social determinants of health (SDOHs) and are frequently associated with worse health. SDOHs include experiences of racism, sexism and other discrimination as well as differences in income and education. The collective effects of each social risk a person reports are called cumulative social risk. Cumulative social risk has traditionally been measured through counts or sum scores that treat each social risk as equivalent. We have proposed to use item response theory (IRT) as an alternative measure of person-reported cumulative social risk as IRT accounts for the severity in each risk and allows for more efficient screening with computerized adaptive testing. Methods: We conducted a differential item functioning (DIF) analysis comparing IRT-based person-reported cumulative social risk scores by income and education in a population-based sample (n = 2122). Six social risk items were analyzed using the two-parameter logistic model and graded response model. Results: Analyses showed no DIF on an IRT-based cumulative social risk score by education level for the six items examined. Statistically significant DIF was found on three items by income level but the ultimate effect on the scores was negligible. Conclusions: Results suggest an IRT-based cumulative social risk score is not biased by education and income level and can be used for comparisons between groups. An IRT-based cumulative social risk score will be useful for combining datasets to examine policy factors affecting social risk and for more efficient screening of patients for social risk using computerized adaptive testing. [ABSTRACT FROM AUTHOR]

Objective: To assess economic and social issues faced by cirrhotic patients & its financial burden for developing nations like Pakistan. Method: This cross-sectional study was carried out at the Department of Gastroenterology & Hepatology, Shaikh Zayed Hospital, Lahore, Pakistan during the period between July & December 2019. Patients with liver cirrhosis were recruited and information regarding disease, financial status, treatment expenses & dependency was recorded. Results: A total of 450 patients were recruited, 272 (60%) were males & 178 (40%) were females, with mean age 55.4±6.2 years. HCV was cause of cirrhosis in 86% of cases, 65% were diagnosed incidentally and 39.6% were illiterate. About 82.7% were urban while only 28.7% own their own home. Co-morbid conditions including diabetes, hypertension & ischemic heart disease were present in 54% of cases. Monthly income was

Background: To date, the prolonged treatment duration and expensive second-line anti-tuberculosis drugs (SLDs) for multidrug-resistant tuberculosis (MDR-TB) can impose a significant financial burden, which may negatively impact treatment outcomes. This study examines the effect of a subsidy policy on treatment outcomes of MDR-TB patient.. Methods: We collected demographic and drug resistance data of all registered MDR-TB patients between April 2011 and December 2019 in Shanghai, China. Documentation of financial support received was routinely maintained until December 2021. We employed multivariate logistic regression to assess the association between financial support and treatment outcomes, estimating odds ratios (ORs) and their corresponding 95% confidence intervals (CIs). Results: Of the 865 patients, 70.6% (611/865) achieved treatment success. The median amount compensated under the subsidy policy was 2359 United States dollar (USD), with an interquartile range from 1116 to 5652 USD. A positive association was found between benefiting from the subsidy policy and higher rate of treatment success, with an adjusted OR of 2.95 (95% CI, 2.03–4.28). Among the 641 patients covered by the policy, the adjusted OR comparing those with higher versus lower reimbursement was 1.74 (95% CI, 1.16–2.61). Conclusions: Financial support policies for MDR-TB patients demonstrate a positive influence on treatment outcomes.

There is an ongoing economic crisis in Ghana which has the potential to strain household finances, alter dietary patterns, and push people into a state of food insecurity. While rural areas have traditionally been the focus of food security research and interventions in Sub-Saharan Africa, there is growing evidence of the challenges faced by urban residents which warrants investigation. This study aims to assess the current status of food security among urban households in Ghana, and examine the impact of the economic crisis on food dietary decisions and food security. This study surveyed 401 random sampling participants in two major urban areas, Accra and Takoradi. The structured questionnaire included the Food Insecurity Experience Scale (FIES), and additional questions on income allocation to food and dietary changes. The results show a significant prevalence of food insecurity among urban households in Ghana, with over half of the respondents experiencing moderate to severe food insecurity. The economic crisis has notably impacted food expenditures, with 81 % of participants reporting changes in their income allocation to food, and 75 % reducing the variety of foods they consume. A substantial portion of respondents now spends between 31 and 50 % of their total income on food which is an indication of the financial burden they face. Ordinal logistic regression identified household income as a critical factor influencing food security, with unemployed and lower-income individuals facing a significantly higher risk. These results emphasize the urgent need for both immediate food assistance, and long-term strategies to strengthen food systems and improve the economic situation to reduce vulnerability. Implementing the recommendations from these findings could contribute towards achieving Sustainable Development Goal 2 in Ghana.

Copay accumulator programs, which exclude the benefit of manufacturer patient assistance from annual maximum out‐of‐pocket costs, shift costs for expensive oncology drugs from plans to patients. Legislation is ongoing to protect patients from these potentially harmful redefinitions of cost‐sharing. [ABSTRACT FROM AUTHOR]

Goal: This study aimed to examine provincial differences in patient spending for cancer care and reductions in household spending including decisions to forego care in Canada. Methods: Nine-hundred and one patients with cancer, from twenty cancer centers across Canada, completed a self-administered questionnaire (P-SAFE version 7.2.4) (344 breast, 183 colorectal, 158 lung, and 216 prostate) measuring direct and indirect costs and spending changes. Results: Provincial variations showed a high mean out-of-pocket cost (OOPC) of CAD 938 (Alberta) and a low of CAD 280 (Manitoba). Differences were influenced by age and income. Income loss was highest for Alberta (CAD 2399) and lowest for Manitoba (CAD 1126). Travel costs were highest for Alberta (CAD 294) and lowest for British Columbia (CAD 67). Parking costs were highest for Ontario (CAD 103) and lowest for Manitoba (CAD 53). A total of 41% of patients reported reducing spending, but this increased to 52% for families earning

While there is growing evidence about the financial burden of completing long, compulsory (mostly unpaid) placements for social work students, this Australian study contemporizes existing research by exploring this issue in the current context (2020–2022), during which time we have experienced the COVID-19 pandemic, the related economic problems, and modified ASWEAS standards. The data is drawn from 372 undergraduate and Masters (qualifying) students across four universities in different states and explores their experiences of financial stress associated with current placement arrangements; their sources of income and employment arrangements; and how they navigated balancing paid work around placement, or how they supported themselves if they did not work alongside placement. The study evidences no improvement in the situation facing social work students in Australia despite modest ASWEAS modifications that offered limited flexibility around placement requirements during 2020 and 2021 due to the COVID-19 pandemic. The findings contribute to an expanding body of research that indicates the current model of field education is unsustainable for both social work students and the profession and confirms that urgent changes are required for the social work profession to consider our student population in its social justice mandate. [ABSTRACT FROM AUTHOR]

Purpose: Metastatic breast cancer (MBC) patients often face substantial financial burden due to prolonged and expensive therapy. However, in-depth experiences of financial burden among MBC patients are not well understood. Methods: Qualitative interviews were conducted to describe the experiences of financial burden for MBC patients, focusing on the drivers of financial burden, their experience using their health insurance, accessing financial assistance, and any resulting cost-coping behaviors. Interviews were transcribed and qualitatively analyzed using a descriptive phenomenological approach to thematic analysis. Results: A total of n = 11 MBC patients or caregiver representatives participated in the study. MBC patients were on average 50.2 years of age (range: 28–65) and 72.7% non-Hispanic White. MBC patients were diagnosed as metastatic an average of 3.1 years (range: 1–9) before participating in the study. Qualitative analysis resulted in four themes including (1) causes of financial burden, (2) financial assistance mechanisms, (3) health insurance and financial burden, and (4) cost-coping behaviors. Both medical and non-medical costs drove financial burden among participants. All participants reported challenges navigating their health insurance and applying for financial assistance. Regardless of gaining access to assistance, financial burden persisted for nearly all patients and resulted in cost-coping behaviors. Conclusion: Our findings suggest that current systems for health insurance and financial assistance are complex and difficult to meet patient needs. Even when MBC patients accessed assistance, excess financial burden persisted necessitating use of financial coping-behaviors such as altering medication use, maintaining employment, and taking on debt. [ABSTRACT FROM AUTHOR]

Simple Summary: We investigated financial toxicity in Japanese patients with metastatic renal cell carcinoma using the COST tool. Despite universal coverage, patients in Japan had similar levels of financial toxicity as in other countries. There was a positive correlation between the FACT-G total score and the COST score. Age < 65 years and not having private health insurance were associated with higher financial toxicity. Information on the financial toxicity experienced by Japanese patients with metastatic renal cell carcinoma (mRCC) is lacking, even though Japan has its own unique public health insurance system. Thus, a web-based survey was conducted to evaluate the financial toxicity experienced by Japanese mRCC patients using the COmprehensive Score for financial Toxicity (COST) tool. This study enrolled Japanese patients who underwent, or were undergoing, systemic therapy for mRCC. The outcomes evaluated were the distribution of COST scores, the correlation between COST and quality of life (QOL) assessed by the Functional Assessment of Cancer Therapy-General (FACT-G) scale, and demographic factors associated with financial toxicity. The median (range) COST score was 19.0 (3.0–36.0). The Pearson correlation coefficient for COST and FACT-G total scores was 0.40. Univariate analysis revealed that not having private health insurance and lower household income per year were significantly associated with lower COST scores. Multivariate analyses showed that age < 65 years and not having private health insurance were significantly associated with lower COST scores. This study revealed that Japanese mRCC patients experience adverse financial impacts even under the universal health insurance coverage system available in Japan, and financial toxicity negatively affects their QOL. [ABSTRACT FROM AUTHOR]

Background: In the United States, Medicare beneficiaries diagnosed with cancer often face significant financial challenges due to the expensive nature of cancer treatments and increased cost-sharing responsibilities. However, there is limited knowledge regarding the financial hardships and healthcare utilizations faced by those enrolled in Medicare Advantage (MA) compared to those in traditional fee-for-service Medicare (TM) during the COVID-19 pandemic. Our study aims to investigate the subjective financial hardships experienced by individuals enrolled in TM and MA and to determine whether these two Medicare programs exhibit differences in healthcare utilization during the pandemic. Methods: We utilized data from the 2020–2022 National Health Interview Survey (NHIS), focusing on nationally representative samples of cancer survivors aged 65 or older. Financial hardship was categorized into three distinct groups: material (e.g., problems with medical bills), psychological (e.g., worry about paying), and behavioral (e.g., delayed care due to cost). Healthcare utilization included wellness visits (preventive care), emergency care services, hospitalizations, and telehealth. We used survey design-adjusted analysis to compare the study outcomes between MA and TM. Results: Among a weighted sample of 4.4 million Medicare beneficiaries with cancer (mean age: 74.9), 76% were enrolled in MA plans. Cancer survivors with a college degree (59.3% vs. 49.8%) and high family income (38.2% vs. 31.1%) were more likely to enroll in MA plans. There were no significant differences in any material, psychological, or behavioral financial hardship domains between beneficiaries with MA and TM plans except forgone counseling due to cost. For healthcare utilization measures, cancer survivors in MA were more likely than those in TM to have flu vaccination (77.2% vs. 70.1%) and experience lower hospitalizations (16.0% vs. 20.0%). However, there were no differences in other health service utilizations between MA and TM. Conclusion: While no significant differences were observed in any materialized, psychological, or behavioral financial hardships, older cancer survivors enrolled in MA plans were more likely to receive vaccinations and lower hospitalization rates during COVID-19. Although other preventive or primary care visits (i.e., wellness visits) were higher, their difference did not reach statistical significance. As MA grows in popularity, it is essential to consistently monitor and evaluate the performance and outcomes of Medicare plans for cancer survivors as we navigate the post-pandemic landscape. [ABSTRACT FROM AUTHOR]

Goal: This study aimed to examine provincial differences in patient spending for cancer care and reductions in household spending including decisions to forego care in Canada. Methods: Nine-hundred and one patients with cancer, from twenty cancer centers across Canada, completed a self-administered questionnaire (P-SAFE version 7.2.4) (344 breast, 183 colorectal, 158 lung, and 216 prostate) measuring direct and indirect costs and spending changes. Results: Provincial variations showed a high mean out-of-pocket cost (OOPC) of CAD 938 (Alberta) and a low of CAD 280 (Manitoba). Differences were influenced by age and income. Income loss was highest for Alberta (CAD 2399) and lowest for Manitoba (CAD 1126). Travel costs were highest for Alberta (CAD 294) and lowest for British Columbia (CAD 67). Parking costs were highest for Ontario (CAD 103) and lowest for Manitoba (CAD 53). A total of 41% of patients reported reducing spending, but this increased to 52% for families earning

This study aims to establish the significance of social determinants of health and prevalent co-morbidities on multiple indicators for quality of care in patients admitted to the Burn and Surgical Intensive Care Unit (ICU). We performed a retrospective analysis of population group data for patients admitted at the Burn and Surgical ICU from January 1, 2016, to November 18, 2019. The primary outcomes were length of hospital stay (LOS), mortality, 30-day readmission, and hospital charges. Pearson's chi-square test for categorical variables and t-test for continuous variables were used to compare population health groups. We analyzed a total of 487 burn and 510 surgical patients. When comparing ICU patients, we observed significantly higher mean hospital charges and length of stay (LOS) in BICU v. SICU patients with a history of mental health ($93,259.40 v. $50,503.36, p = 0.013 and 16.28 v. 9.16 days, p = 0.0085), end-stage-renal-disease (ESRD) ($653,871.05 v. $75,746.35, p = 0.0047 and 96.15 v. 17.53 days, p = 0.0104), sepsis ($267,979.60 v. $99,154.41, p = <0.001 and 39.1 v. 18.42 days, p = 0.0043), and venous thromboembolism (VTE) ($757,740.50 v. $117,816.40, p = <0.001 and 93.11 v. 20.21 days, p = 0.002). Also, higher mortality was observed in burn patients with ESRD, ST-Elevation Myocardial Infarction (STEMI), sepsis, VTE, and diabetes mellitus. 30-day-readmissions were greater among burn patients with a history of mental health, drug dependence, heart failure, and diabetes mellitus. Our study provides new insights into the variability of outcomes between burn patients treated in different critical care settings, underlining the influence of comorbidities on these outcomes. By comparing burn patients in the BICU with those in the SICU, we aim to highlight how differences in patient backgrounds, including the quality of care received, contribute to these outcomes. This comparison underscores the need for tailored healthcare strategies that consider the unique challenges faced by each patient group, aiming to mitigate disparities in health outcomes and healthcare spending. Further research to develop relevant and timely interventions that can improve these outcomes. • Social factors affect BICU and SICU patients differently. • BICU patients with mental health, renal disease, sepsis, and thrombosis face higher costs and LOS. • BICU patients with renal disease, heart attack, sepsis, thrombosis, and diabetes see higher death rates. • BICU patients with mental health, addiction, heart failure, and diabetes face more readmissions. [ABSTRACT FROM AUTHOR]

Provide an overview of the methods used to estimate the cost of sports-related injury published to date, and to highlight considerations and opportunities for future research. Scoping review. Scopus, MEDLINE and CINHAL were searched from 1st January 2000 to 1st January 2023. Studies were screened by two independent reviewers and were eligible if they reported on a cost analysis or cost estimation of sports related injury. Thirty-one studies fulfilled the inclusion criteria. Twenty-seven studies (87 %) were published since 2014. The type of costs included direct healthcare costs (12 studies), indirect costs (10 studies) and a combination of both (9 studies). Twenty-one studies (68 %) used a bottom-up costing approach to measure costs of sports injury and estimated direct costs from the service rates or fee schedules of health systems, hospital, insurance companies or national insurance boards. A top-down approach was used in seven studies (23 %) to estimate the indirect salary cost of time-loss injuries using data from publicly available resources. Ten studies were from the cost perspective of a sporting organisation (32 %). There was a lack of explicit reporting of the costing method used and the perspective of those bearing the costs. Estimating the cost of sports injuries is an emerging area of research, with publications increasing in recent years. However, there remains a lack of methodological guidance to inform or appraise these studies. The expansion of established cost of illness checklists with sport injury explanations to guide future cost of sports injury studies is recommended. [ABSTRACT FROM AUTHOR]

Purpose of Review: There are substantial costs associated with orthopedic injury and management. These costs are likely not experienced equally among patients. At the level of the healthcare and hospital systems, disparities in financial burden and patient demographics have already been identified among orthopedic trauma patients. Accordingly, disparities may also arise at the level of the patient and how they experience the cost of their care. We sought to determine (1) how patient demographics are associated with financial burden/toxicity and (2) if patients experience disproportionate financial burden/toxicity and social support secondary to their economic standing. Recent Findings: It has been described that there is an inequitable experience in clinical and economic outcomes in certain socioeconomic demographics leading to disparities in financial burden. It has been further reported that orthopedic injury, management, and outcomes are not experienced equitably among all demographic and socioeconomic groups. Summary: Ten articles met inclusion criteria, among which financial burden was disproportionately experienced amid orthopedic trauma patients across age, gender, race, education, and marital status. Financial hardship was also unequally distributed among different levels of income, employment, insurance status, and social deprivation. Younger, female, non-White, and unmarried patients experience increased financial burden. Patients with less education, lower income, limited or no insurance, and greater social deprivation disproportionately experienced financial toxicity compared to patients of improved economic standing. Further investigation into policy changes, social support, and barriers to appropriate care should be addressed to prevent unnecessary financial burden and promote greater patient welfare. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to quantify the out-of-pocket (OOP) costs and perceived financial burden among Australian men with localised prostate cancer in the first 6 months after diagnosis, by primary management option. Methods: This cost-analysis quantified OOP costs using administrative claims data and self-reported survey data. Financial burden was assessed using the COmprehensive Score for financial Toxicity–Functional Assessment of Chronic Illness Therapy (COST-FACIT) tool. Participants were recruited into a randomised control trial from public or private treatment centres in Victoria and Queensland. Generalised linear models were used to predict OOP costs and COST-FACIT scores. Results: Median total OOP costs within 6 months of diagnosis for 256 Australian patients with localised prostate cancer was A$1172 (A$343–2548). Up to 50% of the sample reported A$0 costs for most medical services. Compared with those managed with active surveillance, men having active treatment had 6.4 (95% CI: 3.2–12.7) times greater total OOP costs. Management option, higher Gleason score at diagnosis and having multiple comorbidities were significant predictors of higher OOP costs. Overall high scores on the COST-FACIT indicated low levels of financial burden for the entire sample. Conclusion: Largely attributable to being managed with active surveillance, Australian men diagnosed with localised prostate cancer reported relatively low OOP costs and financial burden in the first 6 months post-diagnosis. Together with clinical outcomes, clinicians can use this up to date evidence on costs and perceived financial burdens to assist localised prostate cancer patients and their families make informed decisions about their preferred management option. What is known about the topic? International evidence suggests that men with low-risk prostate cancer managed with active surveillance initially incur lower out-of-pocket costs than those managed with active treatment. What does this paper add? Australian men with low-risk prostate cancer report low out-of-pocket costs and financial burden in the first 6 months post-diagnosis. Compared with those managed with active surveillance, men having active treatment had 6–7 times greater out-of-pocket expenses. What are the implications for practitioners? Being managed by active surveillance as the primary management option for low-risk prostate cancer reduces the financial burdens associated with a cancer diagnosis. [ABSTRACT FROM AUTHOR]

A significant health problem affecting thousands of people worldwide is end-stage renal disease (ESRD). Haemodialysis and kidney transplantation are the two main forms of treatment. Despite the fact that kidney transplantation is a more effective and affordable treatment option, many ESRD patients still undergo haemodialysis due to a variety of reasons, including a lack of opportunity for transplantation, financial limitations and a lack of available donors. By examining the cost and quality of life connected with kidney transplantation and haemodialysis, this research aims to contribute to the economic assessment of ESRD treatments. A total of 268 recipients of kidney transplants and 225 patients receiving haemodialysis made up the study's sample size. It was carried out at Medanta – The Medicity in Gurugram, Haryana. Haemodialysis costs ₹550,000 per year, while the average expense for a kidney transplant is ₹880,000. However, a straightforward projection indicates that in about 20 months, the cost of haemodialysis patients will equal that of transplant patients. In terms of life satisfaction, kidney transplant recipients reported higher levels of general fulfilment with healthcare services than haemodialysis patients. With a ratio of 1.6:1.75 in terms of expenses versus quality of life (QoL), transplantation of kidneys was found to be more advantageous. [ABSTRACT FROM AUTHOR]

Financial toxicity (FT) refers to the negative impact of health-care costs on clinical conditions. In general, social determinants of health, especially poverty, socioenvironmental stressors, and psychological factors, are increasingly recognized as important determinants of non-communicable diseases, such as chronic kidney disease (CKD), and their consequences. We aim to investigate the prevalence of FT in patients at different stages of CKD treated in our universal health-care system and from pediatric nephrology, hemodialysis, peritoneal dialysis and renal transplantation clinics. FT will be assessed with the Patient-Reported Outcome for Fighting Financial Toxicity (PROFFIT) score, which was first developed by Italian oncologists. Our local ethics committee has approved the study. Our population sample will answer the sixteen questions of the PROFFIT questionnaire, seven of which are related to the outcome and nine the determinants of FT. Data will be analyzed in the pediatric and adult populations and by group stratification. We are confident that this study will raise awareness among health-care professionals of the high risk of adverse health outcomes in patients who have both kidney disease and high levels of FT. Strategies to reduce FT should be implemented to improve the standard of care for people with kidney disease and lead to truly patient-centered care. [ABSTRACT FROM AUTHOR]

Purpose: People with cancer commonly rely on loved ones as informal caregivers during and after treatment. Costs related to caregiving and their association with caregiver financial burden are not well understood. Methods: Results include data from 964 caregivers of African American cancer survivors in the Detroit Research on Cancer Survivors (ROCS) cohort. Caregiving costs include those related to medications, logistics (e.g., transportation), and medical bills. Financial burden measures included caregiver financial resources, strain, and difficulty paying caregiving costs. Prevalence ratios (PR) and 95% confidence intervals (CI) of associations between costs and high financial burden were calculated using modified Poisson models controlling for caregiver characteristics. Results: Caregivers included spouses (36%), non-married partners (8%), family members (48%), and friends (9%). Nearly two-thirds (64%) of caregivers reported costs related to caregiving. Logistical costs were the most common (58%), followed by medication costs (35%) and medical bills (17%). High financial hardship was reported by 38% of caregivers. Prevalence of high financial hardship was 52% (95% CI: 24%, 86%) higher among caregivers who reported any versus no caregiver costs. Associations between caregiver costs and high financial burden were evident for costs related to medications (PR: 1.33, 95% CI: 1.12, 1.58), logistics (PR: 1.57, 95% CI: 1.29, 1.92), and medical bills (PR: 1.57, 95% CI: 1.28, 1.92). Conclusions: Most caregivers experienced costs related to caregiving, and these costs were associated with higher prevalence of high caregiver financial burden. Implications for Cancer Survivors: Informal caregivers experience financial hardship related to cancer along with cancer survivors. [ABSTRACT FROM AUTHOR]

Background: Innovative treatments have improved cancer survival but also increased financial hardship for patients. While demographic factors associated with financial hardship among cancer survivors are known in the USA, the role of geography is less clear. Methods: We evaluated prevalence of forgoing care due to cost within 12 months by US Census region (Northeast, North Central/Midwest [NCMW], South, West) by demographic factors (age, sex, race/ethnicity) among 217,981 cancer survivors aged 18 to 82 years from the 2015–2019 Behavioral Risk Factor Surveillance System survey. We summarized region- and group-specific prevalence of forgoing physician visits due to cost and used multilevel logistic regression models to compare regions. Results: The prevalence of forgoing physician visits due to cost was highest in the South (aged < 65 years: 19–38%; aged ≥ 65: 4–21%; adjusted odds ratios [OR], NCMW versus South, OR: 0.63 [0.56–0.71]; Northeast versus South, OR: 0.63 [0.55–0.73]; West versus South, OR: 0.73 [0.64–0.84]). Across the USA, including regions with broad Medicaid expansion, younger, female, and persons of color most often reported cost-related forgoing physician visits. Conclusion: Forgoing physician visits due to cost among cancer survivors is regionally clustered, raising concerns for concentrated poor long-term cancer outcomes. Underlying factors likely include variation in regional population compositions and contextual factors, such as Medicaid expansion and social policies. Disproportionate cost burden among survivors of color in all regions highlight systemic barriers, underscoring the need to improve access to the entire spectrum of care for cancer survivors, and especially for those most vulnerable. [ABSTRACT FROM AUTHOR]

Diabetic foot ulcer is a debilitating complication of long‐standing diabetes mellitus. Patients lose their earning potential, face repeated hospitalizations, and are forced to bear heavy treatment costs. This places an enormous financial burden on the patients and their families. This study seeks to ascertain the out‐of‐pocket expenditure among these patients and correlate it with their risk factor profile. In this hospital‐based cross‐sectional study, a total of 154 patients with diabetic foot ulcers or amputations have been studied with an elaborate patient questionnaire and relevant clinical examinations. The costs incurred and the risk factors of the patients were analyzed for statistical association. The median total annual out‐of‐pocket expenditure for the management of diabetic foot ulcers among the study participants was found to be ₹29 775 (₹9650–₹81 120) ($378.14 [$122.56–$1030.22]). Out of the total expenditure, 58.49% went towards direct medical costs, 5.64% towards direct non‐medical costs, and 35.88% for indirect costs. Medications, ulcer dressing and periodic debridement have accounted for 79.26% of direct medical costs. Transportation (61.37%) and patient's loss of income (89.45%) account for the major costs under the direct non‐medical and indirect cost categories, respectively. A high ulcer grade and area, long ulcer duration, and past history of ulcers have higher expenditure. Patients seeking treatment from private establishments and those engaged in professional/skilled occupations have higher expenses. Adequate dressing of foot ulcers and proper footwear are associated with lower treatment expenditure. 68.8% of the participants have faced catastrophic expenditure due to treatment costs of diabetic foot ulcers. Adequate glycaemic control and proper foot care are necessary. Patients must seek medical care at the earliest in case of foot ulceration. Clinicians must provide proper wound care, institute effective antibiotics, and manage the complications. Government and insurance schemes are required to alleviate the patients' financial burden. [ABSTRACT FROM AUTHOR]

This study aimed to assess the socio-economic impact of sickle cell disease (SCD) on families of patients receiving care at the SCD clinic of Aminu Kano Teaching Hospital (AKTH) in Kano, Northwest Nigeria. The research adopted a descriptive cross-sectional approach, involving the participation of 273 individuals selected through a multi-stage sampling method. Data was gathered using semi-structured interviews and subjected to analysis using SPSS software. The study achieved a 100 % response rate, with 84 % of the participants being females. The average age of the participants was 35.1 ± 8.6 years, and a significant proportion (79.9 %) reported a monthly income of thirty thousand naira or less. The findings of the study revealed that SCD had a notable social impact, affecting 93.5 % of participants occasionally and 5.8 % most of the time. Furthermore, a substantial financial burden was experienced by 54.2 % of respondents most of the time and 45.1 % occasionally. The research also highlighted the significant influence of SCD on guardians' employment status, income levels, time spent in hospitals, medical expenditures, and overall quality of life. These findings underscore the considerable social and financial challenges faced by guardians of SCD patients. Study results supports prioritizing affordable healthcare access for families affected by SCD to alleviate the burdens they face.

Abstract Background When children are diagnosed of cancer, parents face varied financial issues. Among some of the identifiable factors that cause financial challenges among breastfeeding mothers include the high cost of childhood cancer care. The high cost of childhood cancer care could impede the sustainability of access to prompt care. There is paucity of literature on the financial burdens faced by breastfeeding mothers with children diagnosed with cancer in Ghana. Therefore, this study sought to explore the financial burden faced by mothers with breastfeeding children diagnosed with cancer. Methods The study employed qualitative exploratory descriptive design. One-on-one interviews were conducted among 13 mothers with breastfeeding children diagnosed of cancer. Permission was sought for data to be recorded, transcribed concurrently and inductive content analysis done. Results Three main themes emerged after data analysis: High cost (sub-themes; expensive medications, laboratory investigation fees, and cost of mothers’ feeding), Public support (sub-themes; appeal for funds, national health insurance scheme) and Self-financing (loans, personal savings). Most of the breastfeeding mothers narrated that high cost of childhood cancer care generated financial distress to them. They shared that the cost involved in purchasing their children’s cancer medications, paying for laboratory investigations and feeding themselves to produce adequate breastmilk to feed their children were challenging. Some of the mothers self-financed the cost of their children’s cancer care through loans and personal savings. Conclusion Government and other stakeholders should allocate annual budget and funds towards childhood cancer care to lessen the financial burden breastfeeding mothers caring for children with cancer experience.

Out-of-pocket payments for health care as one of the ways of health care financing is present in numerous countries and can lead to a financial burden of healthcare. This could lead to restrictions on other necessary goods and lower the expected standard of living. The frequency of out-of-pocket payments is often associated with gender and age. Biological and socio-economic differences between the genders and differences that arise in the aging process can influence the more frequent occurrence of financial burdens due to out-of-pocket payments. There is a difference between men and women aged 65 and over in the prevalence of chronic and malignant diseases, differences in the use of health care, self-assessment of health, poverty, financial independence, and the type of household. All mentioned can lead to a different frequency of out-of-pocket payments and the financial burden of health care.

Jason Robert Guertin,1– 3 Mahée Gilbert-Ouimet,1,4 Michèle Dugas,5 Valérie Carnovale,5 Laura Jalbert,5 Olha Svyntozelska,2,5 Juliette Demers,5 Léonie Matteau,2,4 Frédéric Bergeron,6 Annie LeBlanc2,5 1Centre de recherche du Centre de recherche du CHU de Québec-Université Laval, Quebec City, Quebec, Canada; 2Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada; 3Centre de recherche en organogénèse expérimentale de l’Université Laval/LOEX, Quebec City, Quebec, Canada; 4Department of Health Sciences, Université du Québec À Rimouski, Levis, Quebec, Canada; 5VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada; 6Bibliothèque-Direction des services-conseils, Université Laval, Quebec City, Quebec, CanadaCorrespondence: Jason Robert Guertin, Centre de recherche du CHU de Québec – Université Laval, Axe Santé des Populations et Pratiques Optimales en Santé, Hôpital du Saint-Sacrement, 1050 chemin Sainte-Foy, local J1-11, Quebec City, Québec, G1S 4L8, Canada, Tel +1 418-682-7511, ext 82516, Email jason.guertin@fmed.ulaval.caBackground: Interest in the financial burden of informal caregivers has been growing. Unfortunately, it remains unclear which method(s) should be used when quantifying this burden.Purpose: We conducted a scoping review aimed at identifying which methods have been used to conduct such work and quantified their performance. We were also interested in examining how sex and gender considerations were considered within selected studies.Data Sources: Using a standardized approach, we identified studies published between 2012 and 2022 that aimed to document the financial burden of caregivers to child and adolescent patients. Our search strategy was applied to the MEDLINE, Embase, CINHAL, and Academic Search Premier databases.Study Selection: Manuscript selection was performed by pairs of reviewers.Data Extraction: Data extraction was performed by one reviewer with a second reviewer performing quality control. Results were reported using a narrative approach.Data Synthesis: We identified 9801 unique citations, of which 200 were included in our review. Selected studies covered various disease area (eg, infection/parasitic diseases [n = 31, 16%]) and included quantitative (n = 180, 90%), qualitative (n = 4, 2%) and mixed study designs (n = 16, 8%). Most studies (n = 182, 91%) used questionnaires/surveys, either alone or in combination with other methods, to assess caregivers’ financial burden. Less than half (n = 93, 47%) of studies reported on caregivers’ sex and none reported on their gender.Conclusion: We conducted an unrestricted review of published studies examining caregiver’s financial burden which allowed us to identify general methodological trends observed in this literature. We believe this work may help improve future studies focusing on this important issue.Keywords: scoping review, caregivers, financial burden, sex and gender considerations, methods

Patients and physicians do not know the cost of medical procedures. Opaque medical billing thus contributes to exorbitant, rising medical costs, burdening the healthcare system and individuals. After criticizing two proposed solutions to the problem of opaque medical billing, I argue that the Centers for Medicare and Medicaid Services should pursue a rule requiring that patients be informed by the physician of a reasonable out-of-pocket expense estimate for non-urgent procedures prior to services rendered. [ABSTRACT FROM AUTHOR]

Aims: To describe nursing practices for financial toxicity management based on nurses' perceptions. Materials & methods: A survey was conducted with 615 oncology nurses in Japan, focusing on nurses' perspectives on the importance of financial toxicity, nursing practices to manage financial toxicity and factors inhibiting its management. Results: A total of 521 participated, of whom 266 respondents (51.1%) considered nurses' role important, and they engaged in a significantly higher proportion of nursing practices. Participants with greater perceptions of their role included certified or specialized nurses and nurses responsible for outpatient care. Conclusion: Interventions leveraging the expertise of certified or specialized nurses and nurses involved in outpatient care could help to spread proactive nurse practices addressing financial toxicity. Oncology nurses who recognized the importance of the nursing role in addressing financial toxicity engaged in a significantly higher proportion of nursing practices aimed at addressing this issue. [ABSTRACT FROM AUTHOR]

Background: The financial toxicity of cancer causes higher morbidity and mortality. As the financial burden due to head and neck cancer (HNC) in European healthcare systems with legally established compulsory health insurance is still poorly understood, we set up an investigation to assess the financial impact of HNC. Methods: Between August 2022 and March 2023, HNC consecutive patients (n = 209) attending the cancer aftercare program of a university hospital in an outpatient setting were surveyed utilizing self-administered questionnaires about their socioeconomic situation, income loss, and out-of-pocket payments (OOPPs). Results: The majority of HNC patients (n = 119, 59.5%) reported significant financial burden as a consequence of OOPP (n = 100, 50.0%) and/or income loss (n = 51, 25.5%). HNC patients reporting financial burden due to OOPP had on average 1,716 € per year costs related to their disease, whereas patients reporting an income loss had a mean monthly income loss of 620.53 €. Advanced UICC (7th edition, 2017) stage, T3 or T4 category, and larynx/hypopharynx cancer are significant predictors of financial burden. Conclusion: HNC survivors suffer from significant financial burden after HNC treatment, even in Germany with a healthcare system with statutory health insurance. The findings from this study offer valuable insights for healthcare professionals and policymakers, helping them acknowledge the economic impact of HNC. [ABSTRACT FROM AUTHOR]

To investigate a broad array of costs and perceived financial burden (FB) faced by families of NICU graduates both during hospitalization and after discharge. Cross-sectional survey-based study design. A survey measuring socio-demographics, direct non-medical costs, indirect costs, social support and perceived FB was developed. One-hundred-twenty-two pairs of parents of NICU graduates participated in the study. Most of the families (87.7%) experienced FB due to NICU hospitalization. The median cost of visiting infant during NICU admission was 615 euros (range: 42,7320). FB correlated with cost for drugs (ρ =.271, p <.05, 95%CI:[.020,.490]), dietary supplement (ρ =.385, p <.05, CI:[.010,.665]), behavioral disorders (ρ = −.186, p <.05, 95%CI:[−.356, −.003]), language delay (ρ =.243, p <.01, CI:[−.408, −.063]) and comorbidities (ρ = −.206, p <.05, 95% CI:[−.374, −.024]). Transportation costs due to medical visits (ρ =.415, p <.01, 95% CI:[.239,.564]) and therapy sessions (ρ =.517, p <.05, CI:[.121,.771]) correlated with higher FB. Grandparents of the infant were the most frequent source of help (86.1%). Families having infants with adverse outcome experienced more hospitalizations after NICU discharge (p <.05) and higher FB (p <.01) than families with typically developing infant. Lack of government financial help was associated with higher perceived FB (CI:[1.117,29.127], p <.05). Conclusions: Our findings demonstrated that parents of NICU graduates experience high rates of FB, highlighting their sources (e.g., grandparents support) and difficulties (e.g., private therapy costs) through the lens of patient perspective. Our study promotes reflection on policies which should be adopted from the European health services that are similar to the Italian one to support NICU graduate families and reduce inequalities. What is Known: • Families of NICU graduates face several kinds of costs during hospitalization and after discharge. What is New: • NICU hospitalization is a multifaceted event that impact financial burden experienced by families. • NICU graduate families whose infant had adverse outcome and felt lack of financial help from local policy makers experience higher rates of financial burden. [ABSTRACT FROM AUTHOR]

Background: Emerging literature suggests that LGBTQ+ cancer survivors are more likely to experience financial burden than non‐LGBTQ+ survivors. However, LGBTQ+ cancer survivors experience with cost‐coping behaviors such as crowdfunding is understudied. Methods: We aimed to assess LGBTQ+ inequity in cancer crowdfunding by combining community‐engaged and technology‐based methods. Crowdfunding campaigns were web‐scraped from GoFundMe and classified as cancer‐related and LGBTQ+ or non‐LGBTQ+ using term dictionaries. Bivariate analyses and generalized linear models were used to assess differential effects in total goal amount raised by LGBTQ+ status. Stratified models were run by online reach and LGBTQ+ inclusivity of state policy. Results: A total of N = 188,342 active cancer‐related crowdfunding campaigns were web‐scraped from GoFundMe in November 2022, of which N = 535 were LGBTQ+ and ranged from 2014 to 2022. In multivariable models of recent campaigns (2019–2022), LGBTQ+ campaigns raised $1608 (95% CI: −2139, −1077) less than non‐LGBTQ+ campaigns. LGBTQ+ campaigns with low (26–45 donors), moderate (46–87 donors), and high (88–240 donors) online reach raised on average $1152 (95% CI: −$1589, −$716), $1050 (95% CI: −$1737, −$364), and $2655 (95% CI: −$4312, −$998) less than non‐LGBTQ+ campaigns respectively. When stratified by LGBTQ+ inclusivity of state level policy states with anti‐LGBTQ+ policy/lacking equitable policy raised on average $1910 (95% CI: −2640, −1182) less than non‐LGBTQ+ campaigns from the same states. Conclusions and Relevance: Our findings revealed LGBTQ+ inequity in cancer‐related crowdfunding, suggesting that LGBTQ+ cancer survivors may be less able to address financial burden via crowdfunding in comparison to non‐LGBTQ+ cancer survivors—potentially widening existing economic inequities. [ABSTRACT FROM AUTHOR]

Background: Current literature states that 6.2 million adults in the United States are living with heart failure. Studies investigating the impact of congestive heart failure (CHF) following primary total knee arthroplasty (TKA) are scarce. Hence, this research aimed to investigate whether individuals with congestive heart failure (CHF) undergoing primary total knee arthroplasty (TKA) experience: (1) longer durations of in-hospital stay; (2) increased incidences of health complications; and (3) a higher financial load. Methods: A retrospective query using the 100% Parts A and B of the Medicare claims was performed. Cohorts of interest were identified using International Classification of Disease, Ninth Revision (ICD-9) and Current Procedural Terminology. Inclusion criteria for the study group consisted of patients with CHF undergoing primary TKA, whereas patients without CHF undergoing primary TKA served as the comparison cohort. Results: The query yielded 1,101,169 patients (CHF = 183,540; case-matched = 917,629). Patients with CHF had longer in-hospital LOS (5- vs. 4-days) and a higher incidence and odds of developing 90-day medical complications (49.22% vs. 7.45%) following primary TKA. CHF patients incurred higher day of surgery and total global ninety-day episode of care costs compared to their matched counterparts. Conclusion: This study illustrated those patients with preexisting CHF undergoing a primary TKA have longer in-hospital lengths of stay and higher rates of morbidity and financial burden. With the increasing prevalence of CHF worldwide, orthopedists and other healthcare professionals can utilize the information provided in this study to educate patients and establish comprehensive treatment plans to help mitigate postoperative effects associated with CHF. [ABSTRACT FROM AUTHOR]

Objective: Surgical site infection (SSI) is an unsettled complication seen in any surgery. The aim of this study is to assess the rate of postoperative SSIs between total laparoscopic hysterectomy (TLH) and total abdominal hysterectomy (TAH). Can the rate of SSI be reduced with the use of a laparoscopic mode of hysterectomy over abdominal? Materials and Methods: It was a retrospective comparative study. The study was conducted in the obstetrics and gynecology department at a tertiary care center from June 2016 to March 2020. A total of 300 patients who underwent hysterectomy either via laparoscopic or abdominal route were included in the study. They were subdivided into two groups: a total of 167 underwent TLH (Group 1) and 133 had TAH (Group 2). The results were compared. It included the age and body mass index of the patient, indication of surgery, size of the uterus, intraoperative blood loss, postoperative SSIs, duration of hospital stay, and readmission rates. Results: It was found a high rate of SSI in TAH (82.4% vs. 17.6%, P < 0.001, Cramer's V-0.18), the operative time taken (75 ± 25 min vs. 128 ± 52 min, P < 0.001), and the mean blood loss during TLH (110 ± 30 ml vs. 160 ± 116 ml, P < 0.001) was found significant for patients. The hospital stay after TLH was found to be significantly shorter (4 ± 2.47 days vs. 7 ± 2.43, P < 0.001). Conclusion: TLH has improved the psychological, physical, and financial burden on the health care department. Thus, it has proved a preferred route over TAH. [ABSTRACT FROM AUTHOR]

Background: Several recent studies have highlighted the advantages of early decompressive surgery for patients with spinal epidural abscesses, specifically in terms of neurological function and overall quality of life. However, these studies predominantly advocate for surgery within 24 hours of admission, a time frame that may prove challenging for many hospitals because of limited operating room availability and bed occupancy. Consequently, it is pertinent to investigate whether a more flexible definition of "early surgery" yields observable benefits for patients to address these practical constraints. Materials and Methods: In this 10-year retrospective study, we analyzed the electronic medical records of 130 patients who underwent decompressive surgery for epidural abscess. Patients were categorized into three groups based on the time intervals between admission and surgery: ≤24 hours (n = 24), 24 to 72 hours (n = 26), and >72 hours (n = 80). Comparative assessments of demographic data, clinical presentations, and preoperative imaging characteristics revealed no statistically significant differences. We conducted separate analyses at 24 hours (n = 24 vs n = 106) and 72 hours (n = 50 vs n = 80) to explore the effects of different cutoff times. Neurological improvement (American Spinal Injury Association Impairment Scale [AIS] grade), daily living function (modified Prolo scale) changes 6 months postdischarge, and financial burden (hospitalization and postoperative stay duration, total expenditure) were evaluated as outcome measures. In addition, we compared the outcomes of patients within the 24- to 72-hour time range with those in the ≤24- and >72-hour group to determine any differences among the three groups. Results: Significant changes in AIS grade (1.17 vs 0.66, P = 0.019) and modified Prolo scale (4.21 vs2.90, P = 0.011) were observed in the 24-hour group, whereas no such changes were seen in the 72-hour group. However, both groups showed reductions in financial bur- den, including hospitalization duration (24-hour group: 27.8 vs 46.8 days, P < 0.001 ; 72-hour group: 31.3 vs 50.7 days, P < 0.001) and total cost (24-hour group: $6551 vs $11,024, P < 0.001; 72-hour group: $6709 vs $12,406, P < 0.001). When analyzing the subgroup of patients with a time interval between 24 and 72 hours, we observed a loss of beneficial effects on AIS grade changes (1.2 vs 0.6, P = 0.045) and modified Prolo scale improvement (4.2 vs 3.1, P = 0.044) compared with the ≤24-hour group. However, this subgroup still exhibited positive effects in terms of reduced financial burden, including hospitalization duration (34.6 vs 50.7 days, P = 0.002) and total cost ($6851 vs $12,406, P < 0.001), when compared with the >72-hour group. Conclusions: Our findings indicate that delaying decompressive surgery up to 72 hours after admission negates its benefits in enhancing neurological recovery and restoring daily life capacity. Nonetheless, this surgical approach continues to provide financial advantages by alleviating the financial burden on patients and the health care system. Further research with a larger sample size is recommended to deepen our understanding of these advantages. [ABSTRACT FROM AUTHOR]