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

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

This article discusses the importance of considering costs and resources when making clinical decisions in the intensive care unit (ICU), specifically focusing on the use of vasopressor medications. The cost of medications, including vasopressors, accounts for a significant portion of total ICU charges and continues to rise. Different vasopressor medications have varying costs, and their use should be carefully considered by ICU clinicians. While there is interest in using multiple vasopressors in patients with septic shock, the benefits and harms of these medications, as well as their costs, should be taken into account. The article emphasizes the need for evidence-based decision-making, formulary systems, and consideration of individual patient factors when prescribing vasopressors. Additionally, it highlights the importance of addressing evidence gaps through further research and the ethical responsibility of considering cost-effectiveness in order to achieve distributive justice in healthcare. [Extracted from the article]

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

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

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

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

Microbial keratitis (MK) is the fourth leading cause of blindness globally, imposing a substantial burden on the healthcare system. This study aims to determine the cost composition of MK patients and explore factors influencing these expenses. We analyzed the demographics, clinical features, and costs of 602 MK patients treated at Beijing Tongren Hospital from June 2021 to October 2023. The analysis revealed the average total cost of treating MK was USD 1646.8, with a median of USD 550.3 (IQR: 333.3–1239.1). Patients with Acanthamoeba keratitis (AK) incurred the highest median total costs at USD 706.2 (IQR: 399.2–3370.2). Additionally, AK patients faced the highest costs for ophthalmic exams and laboratory tests (both p < 0.001), while patients with fungal keratitis (FK) and viral keratitis (VK) experienced higher medication costs. Costs varied significantly with the severity of MK, especially for outpatients at severity level 4, which was markedly higher than levels 1–3 (USD 1520.1 vs. USD 401.0, p < 0.001). Delayed presentation also resulted in increased costs (USD 385.2 vs. USD 600.3, p < 0.001). Our study highlights the financial burden associated with MK treatment and underscores the importance of timely and accurate diagnosis and intervention. [ABSTRACT FROM AUTHOR]

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

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

Background The decision to discontinue intensive care unit (ICU) treatment during the end-of-life stage has recently become a significant concern in Korea, with an observed increase in life-sustaining treatment (LST) withdrawal. There is a growing demand for evidence-based support for patients, families, and clinicians in making LST decisions. This study aimed to identify factors influencing LST decisions in ICU inpatients and to analyze their impact on healthcare utilization. Methods We retrospectively reviewed medical records of ICU patients with neurological disorders, infectious disorders, or cancer who were treated at a single university hospital between January 1, 2019 and July 7, 2021. Factors influencing the decision to withdraw LST were compared between those who withdrew LST and those who did not. Results Among 54,699 hospital admissions, LST was withdrawn in 550 cases (1%). Cancer was the most common diagnosis, followed by pneumonia and cerebral infarction. Among ICU inpatients, LST was withdrawn from 215 (withdrawal group). The withdrawal group was older (78 vs. 75 years, P=0.002), had longer total hospital stays (16 vs. 11 days, P

Abstract Background We aimed to describe healthcare resource utilization (HCRU) and healthcare costs in patients with newly confirmed lupus nephritis (LN) in the United States over a 5-year follow-up period. Methods This retrospective, longitudinal cohort study (GSK Study 214102) utilized administrative claims data to identify individuals with a newly confirmed diagnosis of LN between August 01, 2011, and July 31, 2018, based on LN-specific International Classification of Diseases diagnosis codes. Index was the date of first LN-related diagnosis code claim. HCRU, healthcare costs, and incidence of systemic lupus erythematosus (SLE) flares were reported annually among eligible patients with at least 5 years continuous enrollment post-index. Results Of 2,159 patients with a newly confirmed diagnosis of LN meeting inclusion and exclusion criteria, 335 had at least 5 years continuous enrollment post-index. HCRU was greatest in the first year post-LN diagnosis across all categories (inpatient admission, emergency room [ER] visits, ambulatory visits, and pharmacy use), and trended lower, though remained substantial, in the 5-year follow-up period. Among patients with LN and HCRU, the mean (standard deviation [SD]) number of ER visits and inpatient admissions were 3.7 (4.6) and 1.8 (1.5), respectively, in Year 1, which generally remained stable in Years 2–5; the mean (SD) number of ambulatory visits and pharmacy fills were 35.8 (25.1) and 62.9 (43.8), respectively, in Year 1, and remained similar for Years 2–5. Most patients (≥ 91.6%) had ≥ 1 SLE flare in each of the 5 years of follow-up. The proportion of patients who experienced a severe SLE flare was higher in Year 1 (31.6%) than subsequent years (14.3–18.5%). Total costs (medical and pharmacy; mean [SD]) were higher in Year 1 ($44,205 [71,532]) than subsequent years ($29,444 [52,310]–$32,222 [58,216]), driven mainly by inpatient admissions (Year 1: $21,181 [58,886]; subsequent years: $7,406 [23,331]–$9,389 [29,283]). Conclusions Patients with a newly confirmed diagnosis of LN have substantial HCRU and healthcare costs, particularly in the year post-diagnosis, largely driven by inpatient costs. This highlights the need for improved disease management to prevent renal damage, improve patient outcomes, and reduce costs among patients with renal involvement.

Melissa H Roberts,1 David M Mannino,2,3 Douglas W Mapel,4 Orsolya Lunacsek,5 Shahla Amin,5 Eileen Farrelly,5 Norbert Feigler,6 Michael F Pollack6 1College of Pharmacy, University of New Mexico, Albuquerque, NM, USA; 2College of Medicine, University of Kentucky, Lexington, KY, USA; 3COPD Foundation, Miami, FL, USA; 4Northern Arizona Pulmonary Associates, Flagstaff, AZ, USA; 5Global Consulting, Cencora, Conshohocken, PA, USA; 6BioPharmaceuticals, US Medical, AstraZeneca, Wilmington, DE, USACorrespondence: Michael F Pollack, BioPharmaceuticals, Global Medical Evidence, AstraZeneca, Wilmington, DE, USA, Email michael.pollack1@astrazeneca.comPurpose: Chronic obstructive pulmonary disease (COPD) is a progressive disease associated with reduced life expectancy, increased morbidity, mortality, and cost. This study characterized the US COPD burden, including socioeconomic and health-related quality of life (HRQoL) outcomes.Study Design and Methods: In this retrospective, cross-sectional study using nationally representative estimates from Medical Expenditures Survey (MEPS) data (2016– 2019), adults (≥ 18 years) living with and without COPD were identified. Adults living without COPD (control cohort) and with COPD were matched 5:1 on age, sex, geographic region, and entry year. Demographics, clinical characteristics, socioeconomic, and generic HRQoL measures were examined to include a race-stratified analysis of people living with COPD.Results: A total of 4,135 people living with COPD were identified; the matched dataset represented a weighted non-institutionalized population of 11.3 million with and 54.2 million people without COPD. Among people living with COPD, 66.3% had ≥ 1 COPD-related condition; 62.7% had ≥ 1 cardiovascular condition, compared to 33.5% and 50.5% without COPD. More people living with COPD were unemployed (56.2% vs 45.3%), unable to work due to illness/disability (30.1% vs 12.1%), had problems paying bills (16.1% vs 8.8%), reported poorer perceived health (fair/poor: 36.2% vs 14.4%), missed more working days due to illness/injury per year (median, 2.5 days vs 0.0 days), and had limitations in physical functioning (40.1% vs 19.4%) (all P< 0.0001). In race-stratified analyses for people living with COPD, people self-reporting as Black had higher prevalence of cardiovascular-risk conditions, poorer socioeconomic and HRQoL outcomes, and higher healthcare expenses than White or Other races.Conclusion: Adults living with COPD had higher clinical disease burden, lower socioeconomic status, and reduced HRQoL than those without, with greater disparities among Black people living with COPD compared to White and other races. Understanding the characteristics of patients helps address care disparities and access challenges.Keywords: COPD, burden of illness, healthcare cost, race/ethnicity

Design. Retrospective review. Objective. Characterize negative reviews of spine surgeons in the United States. Summary. Physician rating websites significantly influence the selection of doctors by other patients. Negative experiences are impacted by various factors, both clinical and nonclinical, geography, and practice structure. The purpose of this study was to evaluate and categorize negative reviews of spine surgeons in the United States, with a focus on surgical versus nonsurgical reviewers. Methods. Spine surgeons were selected from available online professional society membership directories. A search for reviews was performed on Healthgrades.com, Vitals.com, and RateMDs. com for the past 10 years. Free response reviews were coded by complaint, and qualitative analysis was performed. χ2 and Fisher exact tests were used to compare categorical variables, and multiple comparisons were adjusted with Benjamini-Hochberg correction. A binary logistic regression model was performed for the top three most mentioned nonclinical and clinical complaint labels. A P-value <0.05 was considered statistically significant. Results. A total of 16,695 online reviews were evaluated, including 1690 one-star reviews (10.1%). Among one-star reviews, 64.7% were written by nonsurgical patients and 35.3% by surgical patients. Nonclinical and clinical comments constituted 54.9% and 45.1% of reviews, respectively. Surgeons in the South had more "bedside manner" comments (43.3%, P <0.0001), while Northeast surgeons had more "poor surgical outcome" remarks compared with all other geographic regions (14.4%, P< 0.001). Practicing in the South and Northeast were independent predictors of having complaints about "bedside manner" and "poor surgical outcome," respectively. Conclusion. Most one-star reviews of spine surgeons were attributed to nonsurgical patients, who tended to be unsatisfied with nonclinical factors, especially "bedside manner." However, there was substantial geographic variation. These results suggest that spine surgeons could benefit from focusing on nonclinical factors (bedside manner), especially among nonoperative patients, and that regional nuances should be considered in delivering spine care. [ABSTRACT FROM AUTHOR]

Introduction: Real-world data are used to inform decision-makers and optimise therapeutic management for patients with ulcerative colitis (UC) and Crohn's disease (CD). We analysed data on the epidemiology (by using proxies of prevalence and incidence), patient characteristics, treatment patterns and associated healthcare direct costs for the management of patients with UC and patients with CD in Italy. Methods: This retrospective observational study used administrative databases from eight Local Health Units geographically distributed across Italy. Adult patients with a hospitalisation and/or an exemption for UC or CD were included. Study outcomes were summarised descriptively, and limited statistical tests were performed. Results: At baseline, 9255 adults with UC and 4747 adults with CD were included. Mean (standard deviation) age at inclusion was 54.0 (18.4)/48.6 (18.1) years, for UC/CD. The estimated average incidence of UC and CD for the period 2013–2020 was 36.5 and 18.7 per 100,000, respectively. The most frequently prescribed drug category for patients with UC/CD was conventional treatment [mesalazine and topical corticosteroids (67.4%/61.1%), immunomodulators and systemic corticosteroids (43.2%/47.7%)], followed by biologic treatments (2.1%/5.1%). The mean annual total direct cost per patient was 7678 euro (€), for UC and €6925 for CD. Conclusion: This analysis, carried-out in an Italian clinical setting, may help to optimise therapy for patients with UC and CD and provide relevant clinical practice data to inform decision-makers. Plain Language Summary: Data from clinical practice can be used to guide healthcare decisions and optimise treatment for patients with ulcerative colitis and Crohn's disease. This study used anonymised patient information from almost four million individuals across Italy to describe the epidemiology, patient characteristics, treatment patterns and healthcare costs of patients with ulcerative colitis and Crohn's disease. Adults with an Italian National Health System code in their records associated with the diagnosis of ulcerative colitis or Crohn's disease were included. Baseline characteristics were balanced between groups and rates of perceived incidence were numerically similar to the results reported in similar Italian studies. This study found that patients with ulcerative colitis and Crohn's disease were most often prescribed conventional treatments, and biological treatments were least-commonly prescribed. More than half of patients with ulcerative colitis and nearly half of those with Crohn's disease were persistent with first (index) treatment of mesalazine and topical corticosteroids and with biologic index treatment during the follow-up period. Switch occurred in up to approximately a quarter of patients with ulcerative colitis and Crohn's disease. The main factors that predicted switch were index biologic for ulcerative colitis and baseline comorbidities for Crohn's disease. The average direct cost per patient in 1 year was 7678 euro (€) for ulcerative colitis and €6925 for Crohn's disease. The results of this analysis may help to optimise therapy for patients with ulcerative colitis and Crohn's disease, and to inform decision-makers in healthcare systems on which treatment options provide value for money and benefit patients. [ABSTRACT FROM AUTHOR]

Background: We aimed to describe healthcare resource utilization (HCRU) and healthcare costs in patients with newly confirmed lupus nephritis (LN) in the United States over a 5-year follow-up period. Methods: This retrospective, longitudinal cohort study (GSK Study 214102) utilized administrative claims data to identify individuals with a newly confirmed diagnosis of LN between August 01, 2011, and July 31, 2018, based on LN-specific International Classification of Diseases diagnosis codes. Index was the date of first LN-related diagnosis code claim. HCRU, healthcare costs, and incidence of systemic lupus erythematosus (SLE) flares were reported annually among eligible patients with at least 5 years continuous enrollment post-index. Results: Of 2,159 patients with a newly confirmed diagnosis of LN meeting inclusion and exclusion criteria, 335 had at least 5 years continuous enrollment post-index. HCRU was greatest in the first year post-LN diagnosis across all categories (inpatient admission, emergency room [ER] visits, ambulatory visits, and pharmacy use), and trended lower, though remained substantial, in the 5-year follow-up period. Among patients with LN and HCRU, the mean (standard deviation [SD]) number of ER visits and inpatient admissions were 3.7 (4.6) and 1.8 (1.5), respectively, in Year 1, which generally remained stable in Years 2–5; the mean (SD) number of ambulatory visits and pharmacy fills were 35.8 (25.1) and 62.9 (43.8), respectively, in Year 1, and remained similar for Years 2–5. Most patients (≥ 91.6%) had ≥ 1 SLE flare in each of the 5 years of follow-up. The proportion of patients who experienced a severe SLE flare was higher in Year 1 (31.6%) than subsequent years (14.3–18.5%). Total costs (medical and pharmacy; mean [SD]) were higher in Year 1 ($44,205 [71,532]) than subsequent years ($29,444 [52,310]–$32,222 [58,216]), driven mainly by inpatient admissions (Year 1: $21,181 [58,886]; subsequent years: $7,406 [23,331]–$9,389 [29,283]). Conclusions: Patients with a newly confirmed diagnosis of LN have substantial HCRU and healthcare costs, particularly in the year post-diagnosis, largely driven by inpatient costs. This highlights the need for improved disease management to prevent renal damage, improve patient outcomes, and reduce costs among patients with renal involvement. [ABSTRACT FROM AUTHOR]

Excessive fine particulate matter (PM2.5) and ozone (O3) are invisible killers affecting our wellbeing and safety, which cause great harm to people's health, cause serious healthcare and economic losses, and affect the sustainable development of the social economy. The effective evaluation of the impact of pollutants on the human body, the associated costs, and the reduction of regional compound air pollution is an important research direction. Taking Beijing–Tianjin–Hebei (BTH) as the research area, this study constructs a comprehensive model for measuring the healthcare costs of PM2.5 and O3 using the Environmental Benefits Mapping and Analysis Program (BenMAP) as its basis. First, this study establishes a health impact assessment model and calculates the number of people affected by PM2.5 and O3 exposure using the health impact function in the BTH region. Then, the willingness to pay (WTP) and cost of illness (COI) methods are used to estimate the healthcare costs inflicted by the two pollutants upon residents from 2018 to 2021. The calculation results show that the total healthcare costs caused by PM2.5 and O3 pollution in BTH accounted for 1%, 0.7%, 0.5%, and 0.3% of the regional GDP in 2018, 2019, 2020, and 2021, respectively. Based on the research results, to further reduce these high healthcare costs, we propose policy suggestions for PM2.5 and O3 control in the BTH region. [ABSTRACT FROM AUTHOR]

IntroductionThe current financing of public-sector district hospitals in India relies on historical budget allocations rather than actual utilization or healthcare needs. We utilized empirical data on healthcare delivery costs to develop the financing framework for these hospitals using a blended payment approach.MethodsThe primary data on cost of delivering services in 27 district hospitals across nine states of India was analysed along with indicators influencing the demand and supply of health services. Payment for outpatient, inpatient, and indirect services was assessed using the risk adjusted global budget, case-based bundled payment, and per-bed-global budget, respectively. Risk adjustment weights were computed by regressing the cost of outpatient care with demand and supply side factors which are likely to influence the utilization or the prices. Budget impact analysis was conducted to assess the fiscal implications of this payment approach, accounting for current care standards and two scenarios: upgrading district hospitals to Indian Public Health Standards (IPHS) or medical colleges.ResultsThe average annual budget for a district hospital in India is estimated at ₹326 million (US$3.35 million), ranging from ₹66 million to ₹2.57 billion (US$0.8–31.13 million). Inpatient care comprises the largest portion (78%) of the budget. Upgrading to IPHS-compliant secondary hospitals or medical colleges would increase average budgets by 131 and 91.5%, respectively.ConclusionImplementing a blended payment approach would align funding with healthcare needs, enhance provider performance, and support ongoing financing reforms aimed at strategic purchasing and universal health coverage.

ABSTRACT Background Cancer is a critical public health issue that imposes a considerable economic burden, especially in low‐resource countries. In Bangladesh, there has been a noticeable lack of research focusing on the economic burden associated with cancer. Aims: This study aimed to examine the economic burden of cancer care and the contributing factors. Methods This cross‐sectional study included 623 cancer patients. Data were collected between January and May 2022. The magnitude of the economic burden (no burden to extreme burden) was the outcome variable. A logistic regression model was performed to determine the associated factors of the economic burden of cancer. Results Overall, 34% of cancer survivors experienced extreme economic burden due to treatment costs. Patients with prostate (relative risk ratio, RRR = 23.24; 95% confidence interval, CI: 1.97, 273.70), bone (RRR = 5.85; 95% CI: 1.10, 31.04), and liver cancer (RRR = 4.94; 95% CI: 1.29, 18.9) reported significantly higher extreme economic burden compared to patients with other cancers. The economic burden was significantly higher for patients diagnosed with Stage III (RRR = 38.69; 95% CI: 6.17, 242.72) and Stage IV (RRR = 24.74; 95% CI: 3.22, 190.11) compared to Stage 0. Patients from low‐income households suffered from nine times more extreme burden (RRR = 8.85; 95% CI: 4.05, 19.36) compared with those from high‐income households. Conclusion Our study found a disproportionately high economic burden among patients with cancer, across disease sites, stages, and income quintiles. The burden was significantly higher among patients with prostate, bone, and liver cancer, and those diagnosed with advanced stage. The findings underscore the importance of early cancer detection before metastasis which may lead to more efficient treatment, avoid disease progression, lower disease management costs, and better health outcomes. Patients from low‐income households experience an extreme economic burden due to cancer, highlighting the need for affordable healthcare services, financial support, and healthcare subsidies.

Laren D Tan,1 Anthony A Hilliard,2 Ricardo L Peverini,3 Robert D Martin,4 Tamara L Thomas,5 Trevor G Wright,6 Lyndon C Edwards,6 Angela M Lalas,6 Helen M Staples-Evans,6 Barbara J Sharp,7 Stella L Ahn-Kim,7 Kent A Hansen,6 Richard H Hart8 1Department of Medicine, Pulmonary, Critical Care, Hyperbaric and Sleep Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA; 2Department of Medicine, Cardiology, Loma Linda University School of Medicine, Loma Linda, CA, USA; 3Department of Pediatrics, Neonatology, Loma Linda University School of Medicine, Loma Linda, CA, USA; 4Department of Anesthesia, Loma Linda University School of Medicine, Loma Linda, CA, USA; 5Department of Emergency Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA; 6Loma Linda University Health, Loma Linda, CA, USA; 7Loma Linda University School of Medicine, Loma Linda, CA, USA; 8Department of Preventive Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USACorrespondence: Laren D Tan, Email Latan@llu.eduAbstract: Navigating the healthcare conundrum in the Blue Zone of Loma Linda, California, requires understanding the unique factors that make this region stand out in terms of health and longevity. But more important is understanding the healthcare system sustaining the Blue Zone in Loma Linda, California. In an era marked by soaring healthcare costs and diminishing reimbursement rates, hospitals and physicians face an unprecedented challenge: providing excellent patient care while maintaining financial sustainability. This leadership perspective publication paper delves into the multifaceted struggles encountered by healthcare and hospital leaders, exploring the root causes, implications, and potential solutions for this complex issue. As we examine the evolving healthcare landscape, we aim to shed light on the critical need for innovative approaches to sustain the future of healthcare excellence in one of the five original Blue Zones.Keywords: blue zone, Loma Linda, healthcare cost, leadership healthcare, longevity, California

Muhammad Subhan Arshad,1,2 Faleh Alqahtani,3 Muhammad Fawad Rasool1 1Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan; 2Department of Pharmacy, Southern Punjab Institute of Health Sciences, Multan, 60000, Pakistan; 3Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi ArabiaCorrespondence: Muhammad Fawad Rasool; Faleh Alqahtani, Email fawadrasool@bzu.edu.pk; afaleh@ksu.edu.saAbstract: Diabetes Mellitus (DM) is a highly prevalent non-communicable disease with high mortality and morbidity, which imposes a significant financial impact on individuals and the healthcare system. The identification of various cost components through cost of illness analysis could be helpful in health-care policymaking. The current systematic review aims to summarize the economic burden of DM in the Eastern Mediterranean Region (EMR) countries. The original studies published in the English language between January 2010 and June 2023 reported the cost of DM was identified by searching four different databases (Google Scholar, PubMed, Science Direct, and Cochrane Central). Two reviewers independently screened the search results and extracted the data according to a predefined format, whereas the third reviewer’s opinion was sought to resolve any discrepancies. The costs of DM reported in the included studies were converted to USD dates reported in the studies. After the systematic search and screening process, only 10 articles from EMR countries met the eligibility criteria to be included in the study. There are substantial variations in the reported costs of DM and the methodologies used in the included studies. The mean annual cost per patient of DM (both direct and indirect cost) ranged from 555.20 USD to 1707.40 USD. The average annual direct cost ranged from 155.8 USD to 5200 USD and indirect cost ranged from 93.65 USD to 864.8 USD per patient. The studies included in the review obtained a median score of 8.65 (6.5 &boxh; 11.5) on the quality assessment tool based on Alison’s checklist for evaluation of cost of illness studies. There is a significant economic burden associated with DM, which directly affects the patients and healthcare system. Future research should focus on refining cost estimation methodologies, improving the understanding of study findings, and making it easier to compare studies.Keywords: cost of illness, economic cost, healthcare cost, direct cost, indirect cost, diabetes

The value of hospital care to patients is expressed as a combination of reduced healthcare costs, fewer medical complications, and improved patient satisfaction. Few studies highlight the value hospitals provide to their patients through hip replacement surgery.This study aims to define a methodology for inter-hospital comparison purposes that can assess the value of hip replacement management to patients by using indicators of costs, medical complications, and patient outcomes.We identified medical complications and costs from medico-administrative data collected by three hospitals. We associated a Disability Adjusted Life Years (DALYs) impact with medical complications, readmissions (within 30 days), and hospital mortality. Costs were analysed from a social security perspective. Patient outcomes were collected through a questionnaire-based survey after hip surgery. To compare the three hospitals, we created a composite indicator by standardizing each dependent variable and combining a weighting of importance provided by patients.This study analysed 342 hospital stays. The mean (standard deviation) number of DALYs per stay was estimated to be more than 0.0028 (0.016) for a mean (standard deviation) cost of €4,834 (€3,665). The composite indicator allowed hospitals to be ranked and areas for improvement to be identified. In our case mix, Hospital 3 is the lowest-ranked hospital, with excessively high costs and a relatively low level of satisfaction compared to the others.The simultaneous evaluation of medical complications, patient outcomes, and costs is a prerequisite for quality improvement efforts by managers and practitioners. In our opinion, this experiment, which sought to estimate the value hospitals bring to patients, may be viewed as the first step towards value-based purchasing in Belgium.

BackgroundPhysical activity (PA) confers numerous benefits to health and health care costs, yet most adults are not meeting recommended PA guidelines. Stress may be a factor that influences PA behavior. Research investigating the impact of stress on PA has yielded inconsistent findings. Most studies find that stress negatively impacts PA, but there is some evidence that habitual exercising buffers this association.ObjectiveThis study aims to examine the relationship between stress and exercise habits among habitual exercisers with internet-connected home fitness equipment (Peloton Bike) during the COVID-19 lockdown.MethodsParticipants were recruited through Facebook (N=146) and asked to complete an internet-based survey that assessed COVID-19-related stressors, perceived stress associated with those stressors, and general perceived stress. Self-reported exercise was assessed on the survey using the Godin Leisure-time Exercise Questionnaire (GLTEQ). Participants were also asked for consent to access their Peloton usage data through the Peloton platform. From their usage data, the frequency and duration of cycling classes was calculated for 4 weeks prior to and 12 weeks following the survey. Hierarchical regression equations tested the association between stress reported on the survey and subsequent exercise participation. Exercise participation was quantified both as the frequency and duration of Peloton cycling over the 12 weeks following the survey and as self-reported moderate to vigorous activity on a second survey completed by a subset of participants 12 weeks after the initial survey.ResultsThere were 146 participants in our Peloton analysis sample and 66 in the self-reported exercise analysis. Peloton user data showed that study participants cycled frequently (mean 5.9 times per week) in the month prior to the initial survey, and that presurvey Peloton use was a strong predictor of exercise frequency (R2=0.57; F2,143=95.27; P

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

Objective: Incremental healthcare costs attributed to back pain, and characterisation by patient and clinical factors have rarely been documented. This study aimed to assess annual healthcare resource utilisation and costs associated with back pain in primary care. Methods: Using the IQVIA Medical Research Data (IMRD), patients with back pain were identified (study period: 01 January 2006 to 31 December 2015) using diagnostic records and analgesics prescriptions (n = 133,341), and propensity score matched 1:1 to patients without back pain. The annual incremental costs of back pain associated with consultations and prescriptions were estimated and extrapolated to a national level. Sensitivity analysis was conducted by restricting the study population to the most recent diagnosis of back pain. Variations in cost were assessed stratified by gender, age-groups, deprivation, and comorbidity categories. Results: The mean age was 57 years, and 62% were females in both the case and control groups. The total incremental healthcare costs associated with back pain was £32.5 million in 2015 (£35.9 million in 2020), with per-patient cost of £244 (£265 in 2020) per year. On a national level, this translated to an estimated £3.2 billion (£3.5 billion in 2020). Eighty percent of the costs were attributed to consultations; and female gender, older age, higher deprivation, and higher comorbidity were all associated with increased mean healthcare costs of patients with back pain. Conclusion: Our findings confirm the substantial healthcare costs attributed to back pain, even with primacy care costs only. The data also revealed significant cost variations across socio-demographic and clinical factors. [ABSTRACT FROM AUTHOR]

Background: Prior research has demonstrated that individuals with peripheral artery disease (PAD) often have comorbid opioid use disorder (OUD) and major depressive disorder (MDD), with limited data regarding their impact on readmission outcomes, length of stay, and cost. This study aimed to investigate these healthcare utilization outcomes in patients with PAD who have comorbid OUD and MDD. Methods: Data were obtained from the National Readmission Database from 2011 through 2018. The study population included all hospitalizations with PAD as the primary or secondary diagnosis, from which hospitalizations with OUD and MDD were extracted using appropriate ICD-9/10 diagnosis codes. Primary outcomes were 30-day and 90-day readmission, total cost, and total length of stay within the calendar year. We created hierarchical multivariable logistic regression models examining OUD with and without MDD, with a random effect for healthcare facility location. Results: From 2011 to 2018, 13,265,817 weighted admissions with PAD were identified. These admissions were segmented into four categories: No OUD/No MDD (12,056,466), OUD/No MDD (323,762), No OUD/MDD (867,641), and OUD/MDD (17,948). The group with No OUD/No MDD was used as the reference group for all subsequent comparisons. Regarding 30-day and 90-day readmissions, patients with OUD/MDD had odds of 1.14 (95% CI 1.10, 1.18) and 1.09 (95% CI 1.06, 1.13), respectively. Patients with OUD/No MDD bore the highest median cost of $64,354 (IQR $30,797–137,074), and patients with OUD/MDD marked the lengthiest median stay of 6.01 days (IQR 2.01–13.30). Conclusion: This study found a significant association between these comorbidities and outcomes and therefore calls for targeted interventions and pain management strategies. [ABSTRACT FROM AUTHOR]

Living with an ostomy is often associated with costly complications. This study examined the burden of illness the first two years after ostomy creation. Data from Danish national registries included all adult Danes with an ostomy created between 2002 and 2014. Four cohorts consisted, respectively, of 11,385 subjects with a colostomy and 4,574 with an ileostomy, of which 1,663 subjects had inflammatory bowel disease (IBD) and 1,270 colorectal cancer as cause of their ileostomy. The healthcare cost was significantly higher for cases versus matched controls for all cohorts. In the first year, the total healthcare cost per person-year was €27,962 versus €4,200 for subjects with colostomy, €29,392 versus €3,308 for subjects with ileostomy, €15,947 versus €2,216 when IBD was the underlying cause, and €32,438 versus €4,196 when it was colorectal cancer. Healthcare costs decreased in the second year but remained significantly higher than controls. Hospitalization and outpatient services were primary cost drivers, with ostomy-related complications comprising 8–16% of hospitalization expenses. Compared to controls, subjects with an ostomy bear a significant health and financial burden attributable to ostomy-related complications, in addition to the underlying disease, emphasizing the importance of better ostomy care to enhance well-being and reduce economic strain. [ABSTRACT FROM AUTHOR]

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

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

Introduction: The American Heart Association Life's Simple 7 schema can be used to categorize patients’ cardiovascular health status as poor, intermediate, or ideal on the basis of smoking, BMI, physical activity, dietary patterns, blood pressure, cholesterol, and fasting blood sugar. This study examined the association between cardiovascular health status and subsequent healthcare utilization. Methods: This was an observational cohort study of adults from an integrated healthcare delivery system—Kaiser Permanente Northern California—that had outpatient care between 2013 and 2014. Patients were categorized by American Heart Association cardiovascular health status: poor, intermediate, or ideal. Individual-level healthcare utilization and costs in 2015 were accumulated for each patient and compared across the 3 cardiovascular health categories and stratified by age groups. Results: A total of 991,698 patients were included in the study. A total of 194,003 (19.6%) were aged 18–39 years; 554,129 (55.9%) were aged 40–64 years; and 243,566 (24.6%) were aged ≥65 years. A total of 259,931 (26.2%) had ideal cardiovascular health; 521,580 (52.6%) had intermediate cardiovascular health; and 210,187 (21.2%) had poor cardiovascular health. Healthcare utilization measured by average relative cost per patient increased monotonically across age categories (p

Abstract Rationale There is a lack of real-world characterization of healthcare costs and associated cost drivers in patients with pulmonary hypertension secondary to chronic obstructive pulmonary disease (PH-COPD). Objectives To examine (1) excess healthcare resource utilization (HCRU) and associated costs in patients with PH-COPD compared to COPD patients without PH; and (2) patient characteristics that are associated with higher healthcare costs in patients with PH-COPD. Methods This study analyzed data from the IQVIA PharMetrics® Plus database (OCT2014-MAY2020). Patients with PH-COPD were identified by a claims-based algorithm based on PH diagnosis (ICD-10-CM: I27.0, I27.2, I27.20, I27.21, I27.23) after COPD diagnosis. Patients aged ≥40 years and with data available ≥12 months before (baseline) and ≥6 months after (follow-up) the first observed PH diagnosis were included. Patients with other non-asthma chronic pulmonary diseases, PH associated with other causes, cancer, left-sided heart failure (HF), PH before the first observed COPD diagnosis, or right-sided/unspecified HF during baseline were excluded. Patients in the PH-COPD cohort were matched 1:1 to COPD patients without PH based on propensity scores derived from baseline patient characteristics. Annualized all-cause and COPD/PH-related (indicated by a primary diagnosis of COPD or PH) HCRU and costs during follow-up were compared between the matched cohorts. Baseline patient characteristics associated with higher total costs were examined in a generalized linear model in the PH-COPD cohort. Results A total of 2,224 patients with PH-COPD were identified and matched to COPD patients without PH. Patients with PH-COPD had higher all-cause HCRU and annual healthcare costs ($51,435 vs. $18,412, p

Microbial keratitis (MK) is the fourth leading cause of blindness globally, imposing a substantial burden on the healthcare system. This study aims to determine the cost composition of MK patients and explore factors influencing these expenses. We analyzed the demographics, clinical features, and costs of 602 MK patients treated at Beijing Tongren Hospital from June 2021 to October 2023. The analysis revealed the average total cost of treating MK was USD 1646.8, with a median of USD 550.3 (IQR: 333.3–1239.1). Patients with Acanthamoeba keratitis (AK) incurred the highest median total costs at USD 706.2 (IQR: 399.2–3370.2). Additionally, AK patients faced the highest costs for ophthalmic exams and laboratory tests (both p < 0.001), while patients with fungal keratitis (FK) and viral keratitis (VK) experienced higher medication costs. Costs varied significantly with the severity of MK, especially for outpatients at severity level 4, which was markedly higher than levels 1–3 (USD 1520.1 vs. USD 401.0, p < 0.001). Delayed presentation also resulted in increased costs (USD 385.2 vs. USD 600.3, p < 0.001). Our study highlights the financial burden associated with MK treatment and underscores the importance of timely and accurate diagnosis and intervention.

This study aimed to describe clinical characteristics and direct medical costs associated with disease treatment in Colombia patients with asthma from 1 healthcare provider. This was a descriptive study with a retrospective data collection from a healthcare provider's electronic medical records in Colombia. A clinical, demographic, and healthcare resource utilization profile was developed over a 12-month observation period after the identification of eligible patients. To determine the mean cost per patient per year, the total frequencies of resource utilization were added, and the result was multiplied by the unit cost of each of them. A total of 7919 patients were included in the analysis. The mean ± SD cost per patient per year ranged from $189.5 ± $1.900.6 to $240.2 ± $1.903.6 depending on the price guidebook. The total cost had been driven by the medication use (79% of total cost) and by the outpatient visits (20% of total cost). In the population analyzed, the mean total direct cost per patient per year of asthma was $189.5 and $240.2, depending on the cost source. Direct medical costs were higher in cases classified as severe and in the adult and elderly population. When comparing the sources of resource utilization, it was found that the mean cost per patient obtained from real-life data is lower than the theoretical cost obtained from the bottom-up method with quantification of resources from experts. It is important to consider limitations related to study design and the evolving landscape of asthma treatments. [ABSTRACT FROM AUTHOR]

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

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

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

Rationale: There is a lack of real-world characterization of healthcare costs and associated cost drivers in patients with pulmonary hypertension secondary to chronic obstructive pulmonary disease (PH-COPD). Objectives: To examine (1) excess healthcare resource utilization (HCRU) and associated costs in patients with PH-COPD compared to COPD patients without PH; and (2) patient characteristics that are associated with higher healthcare costs in patients with PH-COPD. Methods: This study analyzed data from the IQVIA PharMetrics® Plus database (OCT2014-MAY2020). Patients with PH-COPD were identified by a claims-based algorithm based on PH diagnosis (ICD-10-CM: I27.0, I27.2, I27.20, I27.21, I27.23) after COPD diagnosis. Patients aged ≥40 years and with data available ≥12 months before (baseline) and ≥6 months after (follow-up) the first observed PH diagnosis were included. Patients with other non-asthma chronic pulmonary diseases, PH associated with other causes, cancer, left-sided heart failure (HF), PH before the first observed COPD diagnosis, or right-sided/unspecified HF during baseline were excluded. Patients in the PH-COPD cohort were matched 1:1 to COPD patients without PH based on propensity scores derived from baseline patient characteristics. Annualized all-cause and COPD/PH-related (indicated by a primary diagnosis of COPD or PH) HCRU and costs during follow-up were compared between the matched cohorts. Baseline patient characteristics associated with higher total costs were examined in a generalized linear model in the PH-COPD cohort. Results: A total of 2,224 patients with PH-COPD were identified and matched to COPD patients without PH. Patients with PH-COPD had higher all-cause HCRU and annual healthcare costs ($51,435 vs. $18,412, p<0.001) than matched COPD patients without PH. Among patients with PH-COPD, costs were primarily driven by hospitalizations (57%), while COPD/PH-related costs accounted for 13% of all-cause costs. Having a higher comorbidity burden and a prior history of COPD exacerbation were major risk factors for higher total all-cause costs among patients with PH-COPD. Conclusions: Treatment strategies focusing on preventing hospitalizations and managing comorbidities may help reduce the burden of PH-COPD. [ABSTRACT FROM AUTHOR]

The article presents the discussion on Occupational ergonomic factors (OEF) include physical exertion, demanding posture, repetitive work. Topics include examining the prevalence, years lived with disability (YLD), healthcare costs, and productivity losses of LBP attributable to OEF by age, sex; and LBP worldwide were in need of rehabilitation, and unmet rehabilitation services.

Background: Surgical practice has hospitalization of patients for surgery and treatment as an inherent part of it; after which the patients are found fit for discharge. There is however a group of patients who remain on bed even after they have been deemed fit for discharge. This study aimed to determine the number of days surgical patients classified as having prolonged stay remain in hospital after they were deemed fit for discharge and identify the reasons for this. Methods: Surgical patients still on bed more than 48 hours after they were discharged who consented to participate in the study were recruited. Results: A total of 341 patients were recruited. The mean duration of stay after discharge was 17.6± 13 days. The specialty with the highest number of patients was Neurosurgery. Lack of finance and absence of a caregiver were the causes (96.5% and 3.5% respectively). The top three suggestions by patients on how to reduce prolonged hospital stay were bill waiver for indigent patients, reduced cost of health care services and financial aid by philanthropists. Conclusion: The mean number of days patient remained in hospital after discharge was 17.6 days. Financial reasons and absence of a caregiver are the major reasons for prolonged hospital stay. There is a need for a multi-sectoral approach to improve enrollment in the National Health Insurance Scheme and provide social support for patients in need of care post-discharge to reduce the adverse effects of prolonged hospital stay on the hospital and patients.

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

Abstract Background Triple therapy is recommended for patients with chronic obstructive pulmonary disease (COPD) who remain symptomatic despite dual therapy. The optimal timing of triple therapy following an exacerbation of COPD is unknown. The outcomes of prompt (≤ 30 days) vs. delayed (31–180 days) initiation of single-inhaler triple therapy with fluticasone furoate, umeclidinium, and vilanterol (FF/UMEC/VI) following an exacerbation of COPD were examined. Methods This was a retrospective cohort study of linked English primary (Clinical Practice Research Datalink) and secondary (Hospital Episode Statistics) care data. Patients aged ≥ 35 years with COPD were indexed on the first and/or earliest date of exacerbation between November 15, 2017 and March 31, 2019 with subsequent FF/UMEC/VI initiation within 180 days. Patients were required to be continuously registered with a general practitioner for ≥ 12 months prior to and following index. Subsequent exacerbations, direct medical costs, and hospital readmissions were compared between prompt and delayed initiators. Inverse probability of treatment weighting was used to adjust for measured confounders between cohorts. Results Overall, 1599 patients were included (prompt: 393, delayed: 1206). After weighting, prompt initiators had numerically lower moderate/severe exacerbations compared with delayed initiators (rate ratio: 0.87, 95% confidence interval [CI]: 0.76–1.01, p = 0.0587). Both all-cause and COPD-related 30-day hospital readmissions were significantly lower among patients with prompt initiation compared with delayed initiators (all-cause: 23.6% vs. 34.6%, odds ratio [95% CI]: 0.58 [0.36–0.95], p = 0.0293; COPD-related: 20.3% vs. 30.6%, odds ratio [95% CI]: 0.58 [0.35–0.96], p = 0.0347). Prompt initiators also had numerically lower all-cause total costs and significantly lower COPD-related costs per-person-per year compared with delayed initiators (COPD-related: £742 vs. £801, p = 0.0016). Conclusion Prompt initiation of FF/UMEC/VI following a moderate/severe exacerbation was associated with fewer subsequent exacerbations, fewer hospital readmissions, and lower COPD-related medical costs compared with delayed initiation.

Somporn Chantra,1,2 Peranut Chotcomwongse,1 Supachase Jittreprasert,1 Wirapha Senarak,1,&ast; Anyarak Amornpetchsathaporn,1,&ast; Parinee Kemchoknatee,1,2 Paisan Ruamviboonsuk1,2 1Department of Ophthalmology, Rajavithi Hospital, Bangkok, Thailand; 2College of Medicine, Rangsit University, Bangkok, Thailand&ast;These authors contributed equally to this workCorrespondence: Somporn Chantra, Department of Ophthalmology, Rajavithi Hospital, 2 Phayatai Road, Bangkok, 10400, Thailand, Tel +66 86-541-3765, Email chantrasomporn@yahoo.comObjective: To evaluate the direct healthcare cost of admission and examine the effects of cost drivers of treating presumed microbial keratitis (MK) at a tertiary referral hospital.Design: Retrospective study.Methods: A total of 741 patients who presented with MK were included. All information regarding costs was collected, and demographic data were employed for risk factor analysis.Results: The total cost of treating MK over a 7-year period at Rajavithi Hospital was US&dollar;14,514,625.04, while the median cost was US&dollar;10,840.17 per patient (Q1– 3, US&dollar;5866.56– 24,172.28). The medical professional services were the highest cost category in terms of both total cost of treatment over 7 years and median cost per patient, accounting for US&dollar;6,474,718.43 and US&dollar;5235.20 (Q1– 3, US&dollar;2582.79– 10,474.24) respectively. In 2020, the total cost of treatment declined, corresponding with fewer hospitalized patients; however, the median cost per patient was the highest of all years, amounting to US&dollar;15,089.90 (Q1– 3, US&dollar;8064.17– 29102.50), while the median cost per patient from 2014 to 2019 was US&dollar;9969.96 (Q1– 3, US&dollar;5177.98– 21,942.68). Statistical significance was found in the median cost per patient in 2020 compared to the median cost per patient in 2014– 2019 (p-value 0.019). Risk factors associated with the more expensive cost of treatment were longer length of stay (LOS); age more than 60 years old; readmission; diabetes mellitus (DM); hypertension; and heart disease.Conclusion: There were several key factors impacting the direct healthcare costs of severe MK treatment. Medical professional services emerged as the most substantial cost category, while longer hospital stays, older age groups, readmission cases, and comorbidities such as diabetes mellitus, hypertension, and heart disease were all linked to elevated treatment expenses. There were no statistically significant differences in the direct medical expenses during hospitalization associated with treating severe MK, whether the culture results were positive or negative, or regardless of the type of cultured organism utilized.Keywords: corneal ulcer, infectious keratitis, healthcare cost, economic burden

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

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

Background: India is facing dual challenges caused by a rapid increase in burden of non-communicable diseases, marking epidemiological transition and an unprecedented expansion of geriatric population. The elderly faces a higher burden of disease due to a decline in their physical and immune systems, resulting in greater need and utilization of healthcare. The expanding geriatric population is inadequately supported by appropriate healthcare services which is essential for healthy ageing. Out-of-pocket expenditure on health carries significant adverse impacts. In order to lessen the financial burden of out-of-pocket medical expenses, the healthcare needs of the elderly ought to be addressed. Objectives: To assess the healthcare utilization pattern and out-of-pocket expenditure on healthcare among geriatric population in central Kerala. Methodology: A community based cross-sectional study was conducted among 150 elderly individuals, systematically sampled from 5 randomly selected wards of Adat Gram Panchayat in Thrissur district, Kerala. Data on sociodemographic characteristics, healthcare utilization and healthcare expenditure were collected using a pretested, semi-structured questionnaire by one-to-one interview. Appropriate statistical tests were used for analysis. Results: Mean age of respondents was calculated to be 72.64 ± 7.42. Majority (63.3%) preferred to utilize private health facility. 88.7% followed modern system of medicine. 43.3% had availed health insurance. Most commonly reported morbidities among elderly were Diabetes, hypertension and dyslipidaemia. The median direct medical cost was ?3000 (?560, ?4200) while the median direct non-medical cost was ?300 (?200, ?500). The total median out-of-pocket expenditure on healthcare among elderly was ?3550. Conclusion: Increasing burden of chronic diseases in elderly, high private healthcare utilization and suboptimal health insurance coverage leads to an increase in out-of-pocket expenditure on healthcare. Measures should be adopted for strengthening of health services and expanding insurance coverage among elderly, which in turn will reduce burden of out-of-pocket health expenditure.

Abstract Background and Aim Acute severe ulcerative colitis (ASUC) remains a significant cause of morbidity and healthcare utilization. This study aimed to characterize the total healthcare costs of ASUC, explore factors associated with significant cost over the 12 months following an index admission, and document outcomes including corticosteroid exposure. Methods Patients admitted from January 2016 until January 2021 for ASUC to a tertiary inflammatory bowel disease (IBD) center in Australia were identified via retrospective chart review. Costs were calculated over a 12‐month period following index admission. Results Seventy‐two patients (30 [42%] female, median age 39 [IQR 27–54] years) were included. The median length of stay of index admission was 6 days (IQR 5–10 days). The median cost of index admission was 7829 AUD, which was driven by the initial length of stay (P

Abstract Background The combination of immunotherapy and chemotherapy for extensive-stage small-cell lung cancer (ES-SCLC) was primarily carried out with a combination of immune checkpoint inhibitors (ICIs) and platinum-etoposide (EP). It is likely to be more effective in treating ES-SCLC than EP alone, but could result in high healthcare costs. The study aimed to investigate the cost-effectiveness of this combination therapy for ES-SCLC. Methods We searched literature from the following databases: PubMed, Embase, Cochrane Library, and Web of Science for studies on cost-effectiveness of immunotherapy combined with chemotherapy for ES-SCLC. The literature search period was up to April 20, 2023. The quality of the studies was evaluated using the Cochrane Collaboration's tool and Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Results A total of 16 eligible studies were included in the review. All studies met CHEERS recommendations, and all randomized controlled trials (RCTs) in these studies were rated as having low risk of bias using the Cochrane Collaboration's tool. The treatment regimens compared were ICIs plus EP or EP alone. All studies mainly used incremental quality-adjusted life year and incremental cost-effectiveness ratio as outcomes. Most ICIs plus EP treatment regimens were not cost-effective based on corresponding willingness-to-pay thresholds. Conclusions Adebrelimab plus EP and serplulimab plus EP were probably cost-effective for ES-SCLC in China, and serplulimab plus EP was probably cost-effective for ES-SCLC in the U.S. Lowering the price of ICIs and selecting ES-SCLC patients who were sensitive to ICIs could improve the cost-effectiveness of the ICIs-combined treatment.