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The last two decades have seen an increase in the incidence of inflammatory bowel disease (IBD) in many regions of the world, which has had a significant impact on both the social and economic burden of governments and healthcare systems. The aim of this study was to determine the level of hospitalization and outpatient treatment costs for children and adolescents with Crohn's disease and ulcerative colitis, depending on age, location, and activity of the disease. Methods were a retrospective analysis of the medical documentation of 240 children with IBD, hospitalized in the Gastroenterology Ward, Department of Pediatrics Medical University of Silesia (Katowice, Poland), along the three years follow up. The costs of treatment consisted of calculations of the supply of oral and intravenous drugs, calculations of the costs of laboratory tests, imaging, and consultations, as well as person-day costs. The most important results, determined with high costs of IBD treatment, are associated with younger age, high disease activity, localization in the small intestine in Crohn's disease (CD), and inflammatory changes in the entire colon in Ulcerative Colitis (UC). During the observation, it was noticed that the shortening of the hospitalization time did not significantly affect the total costs, which remained at a stable level. [ABSTRACT FROM AUTHOR]

Purpose: To compare the costs associated with medications and travel of patients with smear-proven bacterial keratitis and fungal keratitis in a tertiary care center in India. Methods: Retrospective analysis of case records of a cohort of patients who presented between April 2017 and March 2018 to a tertiary care center in India, with infectious keratitis who were smear-positive for bacteria or fungi, and whose costs of treatment and travel were supported by a philanthropic program. Results: In total, 672 case records of 177 smear-positive bacterial keratitis (BK) and 495 smear-positive fungal keratitis (FK) were included in the study. Further, 62% of BK and 75% of FK received more than one antimicrobial drug (P < 0.001). The mean total medication cost (INR) was significantly more in FK (959.1 ± 675.2) compared to BK (674.9 ± 463.7) (P < 0.0001). The mean medication cost (INR) per visit was also more for FK (201.1 ± 109.4) compared to BK (155.2 ± 84.1) (P < 0.0001). The mean total medication cost was significantly more for FK for both patients who healed with medical treatment (611.6 ± 395.6 for BK, 801.5 ± 599.9 for FK, P = 0.0005) and for patients who required TPK (953.7 ± 653.1 for BK, 1374.6 ± 701.5 for FK, P = 0.0023) compared to their respective counterparts in BK. Conclusion: Patients with fungal keratitis incurred significantly more on medications compared to patients with bacterial keratitis irrespective of whether they had healed with successful medical treatment or required therapeutic keratoplasty. Prolonged duration of treatment and the high costs of antifungal medications account for the significant economic burden of fungal keratitis.

Purpose: To compare the costs associated with medications and travel of patients with smear-proven bacterial keratitis and fungal keratitis in a tertiary care center in India.Methods: Retrospective analysis of case records of a cohort of patients who presented between April 2017 and March 2018 to a tertiary care center in India, with infectious keratitis who were smear-positive for bacteria or fungi, and whose costs of treatment and travel were supported by a philanthropic program.Results: In total, 672 case records of 177 smear-positive bacterial keratitis (BK) and 495 smear-positive fungal keratitis (FK) were included in the study. Further, 62% of BK and 75% of FK received more than one antimicrobial drug (P < 0.001). The mean total medication cost (INR) was significantly more in FK (959.1 ± 675.2) compared to BK (674.9 ± 463.7) (P < 0.0001). The mean medication cost (INR) per visit was also more for FK (201.1 ± 109.4) compared to BK (155.2 ± 84.1) (P < 0.0001). The mean total medication cost was significantly more for FK for both patients who healed with medical treatment (611.6 ± 395.6 for BK, 801.5 ± 599.9 for FK, P = 0.0005) and for patients who required TPK (953.7 ± 653.1 for BK, 1374.6 ± 701.5 for FK, P = 0.0023) compared to their respective counterparts in BK.Conclusion: Patients with fungal keratitis incurred significantly more on medications compared to patients with bacterial keratitis irrespective of whether they had healed with successful medical treatment or required therapeutic keratoplasty. Prolonged duration of treatment and the high costs of antifungal medications account for the significant economic burden of fungal keratitis. [ABSTRACT FROM AUTHOR]

Introduction and Objective Recently in Western countries, a new approach to treatment and patient care, called personcentred care (PCC), has gained recognition. In Poland, this approach is not widely known despite its positive results demonstrated in terms of improving the quality of treatment, rehabilitation and care, as well as reducing costs. The aim of the study is presentation of the definition of PCC, and significant differences between diverse types of care, as well as indication of the fundamental routines of PCC. Person-centreed care The fundamental element of PCC is seeing a patient in a broad context, not only through the prism of the illness, but above all perceiving this patient as a person with all capabilities and limitations. The word „patient” tends to objectify and reduce a person to a recipient of medical services. PCC means a departure from the model in which a patient is a passive subject of medical intervention, towards the model where a contractual agreement is made involving the patient as an active partner in own care and the decision-making process. Co-creation of a partnership between the patient, his/her family, and health care professionals is an essential element of PCC. This approach is based on three pillars: partnership, patient narration and documentation. Summary Person-centred care can improve the quality of services provided by healthcare. This approach also presents significant potential in cost containment by better use of the patient›s resources and his/her social network, as well as by creating synergies with support proposed by the healthcare system.

The last two decades have seen an increase in the incidence of inflammatory bowel disease (IBD) in many regions of the world, which has had a significant impact on both the social and economic burden of governments and healthcare systems. The aim of this study was to determine the level of hospitalization and outpatient treatment costs for children and adolescents with Crohn’s disease and ulcerative colitis, depending on age, location, and activity of the disease. Methods were a retrospective analysis of the medical documentation of 240 children with IBD, hospitalized in the Gastroenterology Ward, Department of Pediatrics Medical University of Silesia (Katowice, Poland), along the three years follow up. The costs of treatment consisted of calculations of the supply of oral and intravenous drugs, calculations of the costs of laboratory tests, imaging, and consultations, as well as person-day costs. The most important results, determined with high costs of IBD treatment, are associated with younger age, high disease activity, localization in the small intestine in Crohn’s disease (CD), and inflammatory changes in the entire colon in Ulcerative Colitis (UC). During the observation, it was noticed that the shortening of the hospitalization time did not significantly affect the total costs, which remained at a stable level.

Introduction Few studies have examined the course of eating disorders and the respective treatments based on insurance data, even though they provide representative information. Objectives To assess the epidemiology, treatments, duration of illness, costs of treatment in a data set of a public health insurance. Methods Data provided by a German health insurance (data from 4.2 million members from 2005-2010). A matched control group based on age and gender without an eating disorder diagnosis was used for comparisons. Results 2.734 cases with the diagnoses of an eating disorder (anorexia nervosa AN, bulimia nervosa BN or combination ANBN) were identified. More than 92% of the patients were female. The relative risk for personality disorders, depressive disorders, alcohol abuse and obsessive-compulsive disorders was highly increased. Most of the patients with BN (53.04%) or AN (41.57%) were treated in out-patient care, and many were only treated for three months, whereas most of the patients with ANBN were treated for a longer time. 3-19% with BN, AN or ANBN were treated only in in-patient care. The in-patient costs of treatment for the year of the diagnosis were 5471.15€ for BN, 9080.26€ for AN, 10809.16€ for ANBN and 339.37€ for the control group. Conclusions Our findings suggest that patients with ANBN diagnosis have a severe and longer course of treatment. Furthermore, contrary to national guidelines for eating disorders, there is a considerable proportion of patients with BN or AN that are treated only in in-patient care. Disclosure No significant relationships.

Objective: to estimate the cost of treatment in patients with complicated osteoporosis (OP) in the first year after fracture under the conditions of the Moscow municipal healthcare system.Patients and methods. The investigation enrolled 196 women (mean age, 65.8±9.1 years) who had sustained fractures at five major osteoporotic sites (proximal hip (PH), distal forearm (DF), surgical humeral neck, vertebral column, and medial and/or lateral ankle). A unified questionnaire that included data on inpatient and outpatient treatment, patients' personal costs, and social benefits, as well as tariffs on services of the Moscow City Fund of Obligatory Health Insurance was used to estimate the cost of treatment for complicated OP during one year after fracture.Results. The direct cost of treatment for PH fracture amounted to 101,243 rubles and was significantly higher (p < 0.01) than that for fractures at other sites: DF (22,080 rubles); humeral neck (39,855 rubles), vertebral column (51,167 rubles), and ankle (43,345 rubles). The average cost of treatment in terms of indirect costs of treatment for complicated OP during a year was as high as 61,151 rubles. In the overall cost structure for the disease, hospital costs accounted for 44%; social benefits were 12% and the cost of antiosteoporotic drugs was only 7%, which was associated with the fact that the latter were rarely prescribed by primary healthcare physicians.Conclusion. Costs of treatment in patients with complicated OP in Moscow were estimated in relation to the site of low-energy fracture. The disease was shown to cause considerable economic losses regardless of the site of osteoporotic fracture; however, the cost of antiosteoporotic drugs has an insignificant share in the overall cost structure for treatment. At the same time, secondary prevention of OP requires that combination antiosteoporotic therapy should be performed in all patients who have sustained low-energy fracture.

Copyright of Journal of Health Policy, Insurance & Management / Polityka Zdrowotna is the property of Insurance Institute in Poland and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Juvenile arthritis — is the most common chronic rheumatic disorder among children, which causes rapid development of disability, decrease of the quality of life, social and psychological dysadaptation. In the majority of cases the main pathogenetic treatment is methotrexate, however when there is resistance or intolerability of this drug, therapy with genetically engineered biological agents is indicated. Aim: to develop measures of optimization of medical support for children with juvenile arthritis according to analysis of its medical and social as well as economic consequences at regional level. Patients and methods: the epidemiologic study included screening questionnaires of 43 907 children with subsequent examination of those of them with inflammatory swelling of the joints during 1 year. Formation of regional registry of children with juvenile arthritis has been performed in the Republic of Bashkortostan since 2003, regional component of the federal on-line registry has been functioning since 2011. The prevalence of juvenile arthritis, its social and economic consequences and the «costs of the disease» were established. In total there were registered 474 patients with juvenile arthritis, among them 62 receive treatment with genetically engineered biological agents. Results: an order of providing the children with juvenile arthritis with medical agents is established — in-patient treatment is performed within the framework of specialized (including high-tech) medical care; genetically engineered biological drugs for out-patient therapy are purchased at the expense of republican state resources in the network of the social support of certain population groups («regional benefit»).

Celem artykułu jest analiza bezpośrednich kosztów diagnostyki i leczenia pacjentów z podejrzeniem udaru mózgu, poniesionych w Szpitalnym Oddziale Ratunkowym 111 Szpitala Wojskowego w Poznaniu. Analizie poddano 288 pacjentów, w tym 180 kobiet i 108 mężczyzn. Badanie zostało przeprowadzone dla potrzeb racjonalizacji kosztów SOR. Z przeprowadzonych badań wynika, że największym kosztem, sięgającym około 75%, jest diagnostyka medyczna, w której najdroższym elementem jest badanie komputerowe głowy. Pozostałe koszty to wynagrodzenia lekarzy i farmakoterapia. Obniżenie kosztów leczenia pacjentów z podejrzeniem udaru mózgu można uzyskać poprzez stosowanie tylko leków o udokumentowanej skuteczności w tym zespole neurologicznym.

Purpose: Latest publications state equal efficacy of a recently introduced new percutaneous technique ('ultra-mini PCNL', UMP) and flexible ureteroscopy (fURS) in the treatment of medium-size urinary stones. Today we face challenges concerning cost-effectiveness and reduction of in-hospital length of stay. In this retrospective study, we compare clinical outcome parameters and costs of treatment (endoscopes and disposables) of both techniques. Methods: Thirty patients treated by UMP at two tertiary university centres were matched to 30 fURS patients from previously recorded databases. Data analysis included operating time, length of stay, stone-free rates (SFR), complications (>Clavien II), ancillary procedures (presurgical ureteral stenting, secondary ureteral stenting or placement of a nephrostomy tube, secondary procedures) and costs for disposable materials and instruments (endoscopes, as calculated per procedure). Results: We found no significant differences in operating times (UMP vs. fURS: 121/102 min), hospital length of stay (2.3/2.0 days), SFR (84/87 %) and complications (7/7 %). Costs for disposable materials and endoscopes were 656 euro (UMP) and 1,160 euro (fURS) per procedure. Conclusions: UMP and fURS are both safe and effective in the treatment of medium-size urinary stones. Costs for endoscopes and disposable materials are significantly lower in UMP. [ABSTRACT FROM AUTHOR]

Introduction: Laparoscopy has been a standard procedure in most medical centres providing surgical services for many years. Both the range and number of laparoscopic procedures performed are constantly increasing. Over the last decade, laparoscopic procedures have been successfully applied both in emergency and oncological surgery. However, treatment costs have become a more important factor in choosing between open or laparoscopic procedures. Aim: To present the total real costs of open and laparoscopic cholecystectomy, appendectomy and sigmoidectomy. Material and methods: Between 1 May 2010 and 30 March 2015 in the Department of Thoracic Surgery, General and Oncological Surgery, Medical University of Lodz, and in the Department of General Surgery of the Saint John of God Hospital, Lodz, doctors performed 1404 cholecystectomies, 392 appendectomies and 88 sigmoidectomies. A total of 97% of the cholecystectomy procedures were laparoscopic and 3% were open. Similarly, 22% of total appendectomies were laparoscopic and 78% were open, while 9% of sigmoidectomies were laparoscopic and 91% open. Results: The requirement for single-use equipment in laparoscopic procedures increases the expense. However, after adding up all other costs, surprisingly, differences between the costs of laparoscopic and open procedures ranged from 451 PLN/€ 114 for laparoscopic operations to 611 PLN/€ 153 for open operations. Conclusions: Laparoscopic cholecystectomy, considered the standard surgery for treating gallbladder diseases, is cheaper than open cholecystectomy. Laparoscopic appendectomy and sigmoidectomy are safe methods of minimally invasive surgery, slightly more expensive than open operations. Of all the analyzed procedures, one-day laparoscopic cholecystectomy is the most profitable. The costs of both laparoscopic and open sigmoidectomy are greatly underestimated in Poland. [ABSTRACT FROM AUTHOR]

Aim of the study: To assess resource utilization and costs of treatment with lanreotide AUTOGEL 120 mg (ATG120) administered as part of routine acro-megaly care in Poland. Material and methods: A multicentre, non-interventional, observational study on resource utilization in Polish acrome-galic patients treated with ATG120 at 4 weeks or extended (> 4 weeks) dosing interval. The study recruited adult acromegalic patients treated medically for ≥ 1 year including at least 3 injections of ATG120. Data on dosing interval, aspects of administration, and resource utilization were collected prospectively during 12 months. Costs were calculated in PLN from the public health-care payer perspective for the year 2013. Results: 139 patients were included in the analysis. Changes in dosing regimen were reported in 14 (9.4%) patients. Combined treatment was used in 11 (8%) patients. Seventy patients (50%) received ATG120 at an extended dosing interval; the mean number of days between injections was 35.56 (SD 8.4). ATG120 was predominantly administered in an out-patient setting (77%), by health-care professionals (94%). Mean time needed for preparation and administration was 4.33 and 1.58 min, respectively, mean product wastage - 0.13 mg. Patients were predominantly treated in an out-patient setting with 7.06 physician visits/patient/ year. The most common control examinations were magnetic resonance imaging of brain and brain stem (1.36/ patient/year), ultrasound of the neck (1.35/patient/year), GH (1.69/patient/ year), glycaemia (1.12/patient/year), IGF-1 (0.84/patient/year), pituitary-thyroid axis hormone levels assessment (TSH-0.58/patient/year,T4-0.78/patient/ year). There were 0.43 hospitaliza- tions/patient/year. For direct medical costs estimated at PLN 50 692/patient/ year the main item was the costs of ATG120 (PLN 4103.87/patient/month; 97%). The mean medical cost, excluding pharmacotherapy, was PLN 1445/pa-tient/year (outpatient care - 49%, hospitalization - 23%, diagnostics/laboratory tests - 28%). Conclusions: These results represent the current use of ATG120 in the population of Polish acromegalic patients in a realistic clinical setting. Findings that 50% of patients could be treated with dose intervals of longer than 28 days support the potential of ATG120 to reduce the treatment burden. [ABSTRACT FROM AUTHOR]

In this study we discuss the microbiological markers used to set up the water potability for human consumption, sanitation basics and costs of treatment and microbiological monitoring of water for human consumption in Brazil. The microbiological quality of water is closely associated with the concentration of chlorine. There is discussion of the exclusive adoption of the current microbiological markers used to attest the potability of the water for consumption and the necessity or not of adding new microbiological markers. The literature demonstrates some cases where monitoring showed failures to establish the safety of the water consumed and the evidence presented in this article cannot be ignored. The presence of contaminating microorganisms in drinking water and the high cost of waterborne diseases are closely linked with basic sanitation. It mainly affects developing countries, because of limited resources and sanitation basics. Each Brazilian spends US$ 0.25 per month intended to be subjected to evaluation and microbiological monitoring for quality control; it does not include analysis for fungi and H. pylori. 39 % of Brazilian families spend 8.00 % of income to pay the tariff of water and sewage. This suggests an expansion of the microbiological markers used to establish the potability of water. [ABSTRACT FROM AUTHOR]

Objectives: The main objective of this work is to quantify the number of hospitalizations caused by smoking, estimate the costs of hospital treatment and to estimate contribution of smoking to mortality in the Czech Republic (CR) in 2002.Methods: The estimate of the proportion by which smoking contributed to hospitalizations and to mortality in the CR was computed using the method of smoking-attributable fractions (SAF). The SAF was computed from relative risks established in the American study Cancer Prevention Study II and from estimates of the prevalence of smoking in the CR from a nationwide study conducted in 2002.Results: In 2002, based on data provided by the General Health Insurance Company, there were 145,336 hospitalizations, and the total cost of hospital treatment was estimated as 4.727,612 (in thousands) CZK. The total number of deaths caused by smoking was 20,550 (95% CI: 18,851-22,262), 14,525 in men and 6,025 in women. Deaths caused by smoking represented 19% of the total nationwide mortality for 2002. Earlier estimates were published by Peto and Lopez for 1995 (22,300 deaths caused by smoking) and 2000 (17,746 deaths). The estimate arrived by authors using the SAF method for 2002 corresponds quite well with that by Peto and Lopez for 2000.Conclusions: The high morbidity and mortality rate related to smoking is directly connected to high prevalence of smoking in the Czech Republic. An effective tobacco control policy, including restrictive measures on availability of tobacco products combined with preventive programmes and smoking cessation programmes, could contribute to the reduction of smoking and save lives and treatment costs caused by smoking. [ABSTRACT FROM AUTHOR]

Abstract: Background: Hand injuries are considered to be the most frequent body injuries, the treatment of which is of long duration and great community expense. The aim of this study was to define the most frequent causes of hand injury in the investigated materials; the severity of hand injuries and outcome of treatment performed in the typical trauma surgery ward; and overall costs of hand-injury treatment. Methods: Between 1987 and 2000, 1199 patients (average age 37.0 years (± 15) were treated for complex hand injuries in II Surgery Clinic in Cracow. Causes, places, and mechanisms of hand injuries were evaluated as were types and duration of treatment. We also estimated also total (direct and indirect) treatment costs. Results: Of all hand injuries, 45.3% occurred at home and 19.7% at work. Hand injuries caused by mechanical equipment predominated (34.9%) and were the most severe. Up to 26.7% of injuries occurred after alcohol consumption. Average total treatment time was 76.9 days (± 67). Hand impairment of variable severity was found in 58.5% of patients. Indirect costs constituted a dominant part of overall costs (96%). Conclusions: The complex treatment of the injured hand at specialist centers allows for shorter treatment duration, improved treatment results, and decreased indirect expenses. [Copyright &y& Elsevier]

Copyright of Herz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Few studies have examined the course of eating disorders and the respective treatments based on insurance data, even though they provide representative information. Objectives: To assess the epidemiology, treatments, duration of illness, costs of treatment in a data set of a public health insurance. Methods: Data provided by a German health insurance (data from 4.2 million members from 2005-2010). A matched control group based on age and gender without an eating disorder diagnosis was used for comparisons. Results: 2.734 cases with the diagnoses of an eating disorder (anorexia nervosa AN, bulimia nervosa BN or combination ANBN) were identified. More than 92% of the patients were female. The relative risk for personality disorders, depressive disorders, alcohol abuse and obsessive-compulsive disorders was highly increased. Most of the patients with BN (53.04%) or AN(41.57%) were treated in out-patient care, and many were only treated for three months, whereas most of the patients with ANBN were treated for a longer time. 3-19% with BN, AN or ANBN were treated only in in-patient care. The in-patient costs of treatment for the year of the diagnosis were 5471.15€ for BN, 9080.26€ for AN, 10809.16€ for ANBN and 339.37€ for the control group. Conclusions: Our findings suggest that patients with ANBN diagnosis have a severe and longer course of treatment. Furthermore, contrary to national guidelines for eating disorders, there is a considerable proportion of patients with BN or AN that are treated only in in-patient care. [ABSTRACT FROM AUTHOR]

Copyright of Medizinische Klinik (Urban & Vogel) is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The objective of this paper is to present statistical models of costs based on new data obtained from manufacturers of a menu of treatment technologies suitable for small water systems. This analysis would be of interest to water management engineers and planners. We classify these technologies into six classes, depending on the contaminants removed. Our statistical results show that average costs (including capital, operating and maintenance) of production of these technologies depend on the flow rate as well as the number of contaminants removed. The larger the flow rate the lower the cost per volume treated and the more contaminants are removed, the higher the cost, for any given flow rate. One of our major finding is that for surface waters except those with high color and turbidity, UV-based treatment technologies can be cost effective. However, for any particular system, water engineers would take site-specific features into account to determine what technology is most appropriate. [ABSTRACT FROM AUTHOR]

Introduction: Epidermolysis bullosa hereditaria (HEB) is a hereditary (autosomal dominant/recessive) rare disease with extremely low prevalence, 0.01 - 0.09 in 10 000 people in the European Union. The main symptom of EB is blistering in different areas of the body due to highly sensitive skin. The only and efficient therapy of choice still remains regular use of medical devices (MD). Aim: We examined Recessive dystrophic EB, RDEB and Junctional EB, EBJ in relation to accessibility and cost of MD needed for their one-month treatment in the Slovak republic. Materials and Methods: Monthly demands of RDEB or EBJ were provided by the Slovak patients'organization Debra SR. For information about the MD such as the price, reimbursement by health insurance, patients' contribution to the payment, prescription, indication and amount limits, the official documents provided by Ministry of Health in the SR were used. Conclusions: Although dressing material is only a small part of the complex care of EB, it might be financially devastating for the patient and his/her family, as well as inefficient as the only health care. However, the rarity of the disease combined with the solidarity of the Slovak health care system forms opportunities to built clear rules acceptable for both sides: the health care payers as well as the patients. [ABSTRACT FROM AUTHOR]

Abstract: Hip fractures are a burden to both society and the individual. The aim of this study was to describe the frequency of osteoporosis and the in-hospital treatment costs of patients with hip fractures admitted to Hacettepe University Faculty of Medicine Hospital. Patients with a hip fracture who were admitted to the Orthopedics and Traumatology wards between April 2003 and December 2006 were interviewed and 50 of them were enrolled prospectively in the study protocol. Patient characteristics, predisposing factors for fractures and hospital costs were recorded as well as laboratory test results and bone mineral density measurements. The mean age was 74.2 years and 72% of the patients were women. Sixty-four percent of them presented with an intertrochanteric fracture. The patient population was significantly debilitated with a high prevalence of vitamin D insufficiency and secondary hyperparathyroidism. No association was shown with T scores and dietary habits and lifestyle characteristics of patients. In 34% of patients in whom measurements were available, no osteoporosis could be documented. The mean hospital expenditure was $5983. Factors affecting the total cost were age and functional status of the patient and the duration of hospital stay, independent of the type of fracture and surgical procedure used. [Copyright &y& Elsevier]

Aims: This study attempts to explore how high treatment costs can result in people foregoing necessary treatment., Methods: Health care professionals (HCPs) were invited to complete a questionnaire survey, in which they were requested to imagine that they had locally recurrent head and neck cancers. They were then asked to choose a treatment in each of the 3 scenarios, which differed only in the cost of treatment., Results: Majority would choose the cheapest treatment option if treatment costs mirrored that in real life. But majority would opt for the treatment that gave the greatest median survival, if cost was not an issue., Conclusion: High cost of treatment can be a strong deterrent to patients who need and can benefit from those treatments.

Since the introduction of the diagnosis-related groups (DRG) system with cost-related and entity-specific flat-rate reimbursements for all in-patients in 2004 in Germany, economics have become an important focus in medical care, including breast centers. Since then, physicians and hospitals have had to gradually take on more and more financial responsibilities for their medical care to avoid losses for their institutions. Due to financial limitations of resources, most medical services have to be adjusted to correlating revenues, which results in the development of a variety of active measures to understand, steer, and optimize costs, resources and related processes for breast cancer treatment. In this review, the challenging task to implement microeconomic management at the clinic level for breast cancer treatment is analyzed from breast cancer-specific publications. The newly developed economic management perspective is identified for different stakeholders in the healthcare system, and successful microeconomic projects and future aspects are described.