Assessment of Direct Medical Cost of Hospitalized COVID-19 Adult Patients in Kuwait During the First Wave of the Pandemic.

Objective: This study aims to estimate the direct medical cost of COVID-19 hospitalizations and to utilize prevalence estimates from Jaber Al-Ahmad Hospital to estimate the direct medical cost of all hospitalized adult patients in Kuwait using a decision tree analysis. Methods: A cost-of-illness model was developed. The Ministry of Health perspective was considered, direct medical costs were estimated from July 1st to September 30th, using a bottom-up approach. The mean cost per hospitalized patient was estimated using a decision analysis model. Prevalence estimates of ambulance use, use of ER, ICU admission, and mortality were considered in the current study. Patients aged 18 years and above with a confirmed diagnosis of COVID-19 were included. One-way sensitivity analysis and probabilistic sensitivity analysis (PSA) were performed. Results: Data for 2986 patients were analyzed. The mean age was 61 (SD= 11) years old. Most of the patients were Kuwaiti (2864, 95.91%), and more than half were females (1677, 56.16%). Of the total hospital admissions, 417 patients (14%) were admitted to the ICU. The average length of the hospital stay was 11 (SD= 9) days, and among all hospital admissions, 270 (9.04%) patients died. The total estimated direct medical cost of hospitalized patients at Jaber Al-Ahmad Hospital was $47,213,768 (14,283,203.6 KD). The average cost of hospital stay per patient was estimated at $15,498 (4,688.60 KD). The weighted average cost per hospitalized patient in Kuwait was estimated at $16,373 (4,953.08 KD). The total direct medical cost of hospitalized COVID-19 patients in Kuwait during the study period was estimated at $174,372,450 (52,751,502 KD). Conclusion: The COVID-19 pandemic constituted a significant burden on the Kuwaiti healthcare system. The findings of this study urge the need for preventive care strategies to reduce adverse health outcomes and the economic impact of the pandemic.

The annual economic burden incurred by heart failure patients in Vietnam: a retrospective analysis.

Introduction: Heart failure (HF) is a chronic condition associated with substantial mortality and hospitalisation, resulting in costly inpatient visits. The healthcare systems of several countries, including Vietnam, experience considerable difficulty in dealing with the enormous fiscal burden presented by HF. This study aims to analyse the direct medical costs associated with HF inpatient treatment from the hospital perspective. Materials and methods: This study retrospectively analysed the electronic medical records of patients diagnosed with HF from 2018 to 2021 at Military Hospital 175 in Vietnam. The sample consisted of 906 hospitalised patients (mean age: 71.2 ± 14.1 years). The financial impact of HF was assessed by examining the direct medical expenses incurred by the healthcare system, and the costs of pharmaceutical categories used in treatment were explored. Results: The cumulative economic burden of HF from 2018 to 2021 was US$1,068,870, with annual costs ranging from US$201,670 to US$443,831. Health insurance covered 72.7% of these costs. Medications and infusions, and medical supplies accounted for the largest expenses, at 29.8% and 22.1%, respectively. The medication HF group accounted for 13.01% of these expenses, of which the costliest medications included nitrates (2.57%), angiotensin II receptor blockers (0.51%), ivabradine (0.39%), diuretics (0.24%), and mineralocorticoid receptor antagonists (0.23%). Comorbidities and the length of hospital stay significantly influenced annual treatment costs. Conclusion: The study reveals that HF significantly impacts Vietnam's healthcare system and citizens, requiring a comprehensive understanding of its financial implications and efficient management of medical resources for those diagnosed. This study highlights the substantial economic burden of HF on Vietnam's healthcare system, with medication costs, particularly antithrombotic drugs, representing the largest expense. Most healthcare costs were covered by health insurance, and expenses were significantly influenced by comorbidity and length of hospital stay. These findings can inform healthcare policy, resource allocation and optimise management strategies in Vietnam.

The economic burden of bipolar disorder: a case study in Southern Iran.

BACKGROUND: Bipolar Disorder (BD) imposes considerable economic and social burdens on the community. Therefore, the present study aimed to determine the economic burden of bipolar disorder in patients referred to single-specialty psychiatric hospitals at the secondary and tertiary care level in 2022. METHODS: This partial economic evaluation was conducted as a cross-sectional study in the south of Iran in 2022, and 916 patients were selected through the census method. The prevalence-based and bottom-up approaches were used to collect cost information and calculate the costs, respectively. The data on Direct Medical Costs (DMC), Direct Non-Medical Costs (DNMC), and Indirect costs (IC) were obtained using the information from the patients' medical records and bills as well as the self-reports by the patients or their companions. The human capital approach was also used to calculate IC. FINDINGS: The results showed that in 2022, the annual cost of bipolar disorder was $4,227 per patient. The largest share of the costs was that of DMC (77.66%), with hoteling and ordinary beds accounting for the highest expenses (55.40%). The shares of DNMC and IC were 6.37% and 15.97%, respectively, and the economic burden of the disease in the country was estimated at $2,799,787,266 as well. CONCLUSION: In general, the costs of bipolar disorder treatment could impose a heavy economic burden on the community, the health system, the insurance system, and the patients themselves. Considering the high costs of hoteling and ordinary beds, it is suggested that hospitalization of BD patients be reduced by managing treatment solutions along with prevention methods to reduce the economic burden of this disease. Furthermore, in order to reduce the costs, proper and fair distribution of psychiatrists and psychiatric beds as well as expansion of home care services and use of the Internet and virtual technologies to follow up the treatment of these patients are recommended.

Proximal femur fracture: Direct medical costs of hospital treatment.

INTRODUCTION: Proximal femur fractures are one of the most common injuries in older adults representing a serious health condition in developed as well as developing countries. AIM: This study aimed to assess the hospitalization costs of the proximal femur fracture. METHODS: We conducted a prospective descriptive study spread over six months about patients hospitalized and operated on for proximal femur fractures. In order to estimate the cost we referred to the nomenclature of professional acts and the prices set by the Ministry of Public Health and the Ministry of Finance. RESULTS: The study included 100 patients, 55 females and 45 males with an average age of 76 years. The average hospital length of stay was 5 days. The preoperative stay was at a mean of three days. The average total hospitalization cost for these fractures was 2877 Tunisian Dinars depending on the type of fracture and surgical treatment. The main components of the costs were hospital stay costs and human resources costs 40%, cost of the implant 25.9%, cost of consumables 12%, operating cost 10%, cost of additional examinations 9% and cost of medications 2%. CONCLUSION: Proximal femur fractures represent an important cause of health resource consumption. To reduce the cost of hospital care, we recommend limiting the length of hospital stay as much as possible, investing in total hip and hemi-arthroplasties and adapting economical behavior taking into account the cost of consumables.

Medication adherence and costs of medical care among patients with Parkinson's disease: an observational study using electronic medical records.

BACKGROUND: Adherence to antiparkinsonian drugs (APDs) is critical for patients with Parkinson's disease (PD), for which medication is the main therapeutic strategy. Previous studies have focused on specific disorders in a single system when assessing clinical factors affecting adherence to PD treatment, and no international comparative data are available on the medical costs for Chinese patients with PD. The present study aimed to evaluate medication adherence and its associated factors among Chinese patients with PD using a systematic approach and to explore the impact of adequate medication adherence on direct medical costs. METHODS: A retrospective analysis was conducted using the electronic medical records of patients with PD from a medical center in China. Patients with a minimum of two APD prescriptions from January 1, 2016 to August 15, 2018 were included. Medication possession ratio (MPR) and proportion of days covered were used to measure APD adherence. Multiple linear regression analysis was used to identify factors affecting APD adherence. Gamma regression analysis was used to explore the impact of APD adherence on direct medical costs. RESULTS: In total, 1,712 patients were included in the study, and the mean MPR was 0.68 (± 0.25). Increased number of APDs and all medications, and higher daily levodopa-equivalent doses resulted in higher MPR (mean difference [MD] = 0.04 [0.03-0.05]; MD = 0.02 [0.01-0.03]; MD = 0.03 [0.01-0.04], respectively); combined digestive system diseases, epilepsy, or older age resulted in lower MPR (MD = -0.06 [-0.09 to -0.03]; MD = -0.07 [-0.14 to -0.01]; MD = -0.02 [-0.03 to -0.01], respectively). Higher APD adherence resulted in higher direct medical costs, including APD and other outpatient costs. For a 0.3 increase in MPR, the two costs increased by $34.42 ($25.43-$43.41) and $14.63 ($4.86-$24.39) per year, respectively. CONCLUSIONS: APD adherence rate among Chinese patients with PD was moderate and related primarily to age, comorbidities, and healthcare costs. The factors should be considered when prescribing APDs.

Disease Burden and Inpatient Management of Children with Acute Respiratory Viral Infections during the Pre-COVID Era in Germany: A Cost-of-Illness Study.

Respiratory viral infections (RVIs) are common reasons for healthcare consultations. The inpatient management of RVIs consumes significant resources. From 2009 to 2014, we assessed the costs of RVI management in 4776 hospitalized children aged 0-18 years participating in a quality improvement program, where all ILI patients underwent virologic testing at the National Reference Centre followed by detailed recording of their clinical course. The direct (medical or non-medical) and indirect costs of inpatient management outside the ICU ('non-ICU') versus management requiring ICU care ('ICU') added up to EUR 2767.14 (non-ICU) vs. EUR 29,941.71 (ICU) for influenza, EUR 2713.14 (non-ICU) vs. EUR 16,951.06 (ICU) for RSV infections, and EUR 2767.33 (non-ICU) vs. EUR 14,394.02 (ICU) for human rhinovirus (hRV) infections, respectively. Non-ICU inpatient costs were similar for all eight RVIs studied: influenza, RSV, hRV, adenovirus (hAdV), metapneumovirus (hMPV), parainfluenza virus (hPIV), bocavirus (hBoV), and seasonal coronavirus (hCoV) infections. ICU costs for influenza, however, exceeded all other RVIs. At the time of the study, influenza was the only RVI with antiviral treatment options available for children, but only 9.8% of influenza patients (non-ICU) and 1.5% of ICU patients with influenza received antivirals; only 2.9% were vaccinated. Future studies should investigate the economic impact of treatment and prevention of influenza, COVID-19, and RSV post vaccine introduction.

Cost of illness due to respiratory syncytial virus acute lower respiratory tract infection among infants hospitalized in Argentina.

BACKGROUND: Information is scarce regarding the economic burden of respiratory syncytial virus (RSV) disease in low-resource settings. This study aimed to estimate the cost per episode of hospital admissions due to RSV severe disease in Argentina. METHODS: This is a prospective cohort study that collected information regarding 256 infants under 12 months of age with acute lower respiratory tract infection (ALRTI) due to RSV in two public hospitals of Buenos Aires between 2014 and 2016. Information on healthcare resource use was collected from the patient's report and its associated costs were estimated based on the financial database and account records of the hospitals. We estimated the total cost per hospitalization due to RSV using the health system perspective. The costs were estimated in US dollars as of December 2022 (1 US dollar = 170 Argentine pesos). RESULTS: The mean costs per RSV hospitalization in infants was US$587.79 (95% confidence interval [CI] $535.24 - $640.33). The mean costs associated with pediatric intensive care unit (PICU) admission more than doubled from those at regular pediatric wards ($1,556.81 [95% CI $512.21 - $2,601.40] versus $556.53 [95% CI $514.59 - $598.48]). CONCLUSIONS: This study shows the direct economic impact of acute severe RSV infection on the public health system in Argentina. The estimates obtained from this study could be used to inform cost-effectiveness analyses of new preventive RSV interventions being developed.

Subjective and objective financial toxicity among colorectal cancer patients: a systematic review.

BACKGROUND: Colorectal cancer (CRC) is the third most common cancer type worldwide. Colorectal cancer treatment costs vary between countries as it depends on policy factors such as treatment algorithms, availability of treatments and whether the treatment is government-funded. Hence, the objective of this systematic review is to determine the prevalence and measurements of financial toxicity (FT), including the cost of treatment, among colorectal cancer patients. METHODS: Medline via PubMed platform, Science Direct, Scopus, and CINAHL databases were searched to find studies that examined CRC FT. There was no limit on the design or setting of the study. RESULTS: Out of 819 papers identified through an online search, only 15 papers were included in this review. The majority (n = 12, 80%) were from high-income countries, and none from low-income countries. Few studies (n = 2) reported objective FT denoted by the prevalence of catastrophic health expenditure (CHE), 60% (9 out of 15) reported prevalence of subjective FT, which ranges from 7 to 80%, 40% (6 out of 15) included studies reported cost of CRC management- annual direct medical cost ranges from USD 2045 to 10,772 and indirect medical cost ranges from USD 551 to 795. CONCLUSIONS: There is a lack of consensus in defining and quantifying financial toxicity hindered the comparability of the results to yield the mean cost of managing CRC. Over and beyond that, information from some low-income countries is missing, limiting global representativeness.

National and Local Direct Medical Cost Burden of COPD in the United States From 2016 to 2019 and Projections Through 2029.

BACKGROUND: Despite the significant burden posed by COPD to health care systems, there is a lack of up-to-date information quantifying the general COPD burden, costs, and long-term projections to various stakeholders in the United States. RESEARCH QUESTION: What are the updated state-specific and nationwide estimates of the COPD disease burden and direct costs in 2019, along with projections of COPD-attributable medical costs through 2029? STUDY DESIGN AND METHODS: A cross-sectional, retrospective study design using the 2016 to 2019 Medical Expenditure Panel Survey, 2019 American Community Survey, and 2019 Behavioral Risk Factor Surveillance System data was applied to generate COPD-attributable expenditure estimates. Cost projections for the years 2020 to 2029 were based on 2017 national population projections reported by the US Census Bureau, and all costs were adjusted to 2019 US dollars. RESULTS: In total, 4,135 people living with COPD were included; a higher proportion had other concurrent conditions such as cardiovascular-related conditions compared with people without COPD (n = 86,021). Overall, in 2019, COPD-attributable medical costs after adjusting for demographic characteristics and 19 concurrent conditions (including COPD-related and non-COPD-related conditions) were estimated at $31.3 billion, with state-specific cost estimates reporting wide variation, from $44.8 million in Alaska to $3.1 billion in Florida. Nationwide COPD-attributable medical costs borne by payer type were as follows: private insurance, $11.4 billion; Medicare, $10.8 billion; and Medicaid, $3.0 billion. Projections of national medical costs attributable to COPD are reported to increase to $60.5 billion in 2029. INTERPRETATION: Understanding the current disease and economic burden of COPD in the United States, along with the projected costs attributable to COPD in the next decade, will highlight unmet needs and gaps in care that help inform health care decision-makers in planning future actions to alleviate this disease burden.

The direct medical cost of breast cancer management in a provincial hospital of Papua New Guinea: A cost of illness study of consecutive patients from 2017 to 2022.

BACKGROUND: Breast cancer is a major global health, gender and socioeconomic challenge. In PNG it is the leading cause of female mortality. Understanding direct medical costs related to breast cancer management can direct resource allocation and investment in breast cancer screening, treatment, infastructure and training. METHODS: A cost of illness study was conducted amongst patients with breast cancer at Alotau Provincial Hospital from the 12th of January 2017-9 th of August 2022. A bottom up approach of micro costing was applied to estimate the patient and hospital perspectives of direct medical costs. RESULTS: The total cost of breast cancer management was K1,624,656.14 (US$471,150.28). 58.5 % (n = 38) of patients with breast cancer did not undergo any form of surgery. Hospital costs accounted for 99.7 % (K1,620,156.14, US$469,845.28) of the total direct medical costs. The average cost per patient was K24,994.71 (US$ 7248.47). The dollar conversion was 1 KINA = 0.29 USD. CONCLUSION: Investment in screening, diagnosis and treatment is crucial in addressing the burden of breast cancer in PNG. POLICY SUMMARY: Provincial hospitals (in PNG) must invest in and implement the 2015 National Cancer Control Policy strategies that aim to develop hospital based cancer registries, human resources, equip health systems, improve cancer screening, improve diagnostics, research, funding and treatment for breast cancer control.

Direct Healthcare Cost of Ischemic Stroke Management in Morocco.

BACKGROUND: Strokes are a group of heterogeneous conditions that can cause lasting brain damage, long-term disability, or even death. In Morocco, the management of this disease generates important expenses and increases the financial burden on health care. In order to rationalize the expenses and to direct the budgetary policy in healthcare, we aimed to estimate the cost of ischemic stroke (IS) management in Morocco through this study. METHODS: A cost-of-illness study was conducted between March 2018 and March 2019 at the neurology department of the Hassan II University Hospital, Fez. We included all patients who were admitted, during this period, to the department for IS. The collected data included sociodemographic information, and all details regarding the patient's medical management (diagnosis, treatment, etc.). The cost was estimated using a "bottom-up micro-costing" approach with a societal perspective. RESULTS: A total of 267 individuals were included in this study with a female predominance (56.6%); the mean age was 66.93 ± 14.83 years. The total cost of ischemic stroke management per patient per year was estimated at $3674.32 ± 1340.81, with a high share related to hospitalization at $1415.06 ± 1015.53. A statistically significant association was found between total cost and age (p=0.014), National Institutes of Health Stroke Scale (NIHSS) score (p≤0.001), and length of hospitalization (p≤0.001); however, no association was found with other factors (sex, complication, Rankin score, etc.). CONCLUSION: Ischemic strokes are relatively frequent in Morocco. Their management generates an important cost, which is influenced by several factors such as severity of the disease and the duration of hospitalization. This cost can be decreased by rationalizing the expenses and acting on various risk factors of ischemic strokes.

Management of Chronic Kidney Disease in Morocco: A Cost-of-Illness Study.

INTRODUCTION: Chronic kidney disease (CKD) is a global public health problem. The aim of this study is to estimate the mean annual direct medical cost per patient with CKD before the start of renal replacement therapy (RRT) in Morocco. METHODS: This is a cross-sectional cost-of-illness study, using a prevalence approach among adults with CKD before RRT in a Moroccan university hospital. Information on direct medical costs was collected from the patient's report and associated costs were estimated according to national tariff/fee catalogues. We computed annual direct medical costs using society perspective. Costs were then estimated and compared according to CKD stages, health insurance categories, and monthly income. RESULTS: Eighty-eight participants were included; 63.6% of them were female, their mean age was 61.8±14.0 years, and 76.1% were in stages 4 or 5. The estimated annual direct medical cost of CKD was estimated at $ 2008.80 (95%CI 1528.28-2489.31), Hospitalization, diagnosis, and treatment represented the main expenses of the direct medical cost (32.2%, 29.7%, and 32.2%, respectively). The direct medical cost components were not significantly different between CKD stages. CONCLUSION: The cost of CKD in Morocco in its early stages is still lower than the cost of RRT, which brings to light the necessity of secondary prevention of CKD to postpone or prevent the progression to end-stage renal disease.

Economic burden of lung cancer in Morocco: A cost of illness study.

INTRODUCTION: Lung cancer is the most common cancer in men and the second most common cancer in women. It is associated with substantial economic impact in terms of direct and indirect costs. The main objective of this study is to estimate the direct medical cost of lung cancer management in Morocco MATERIALS AND METHODS: A cost-of-illness study was conducted among patients treated at the Mohammed VI Center of Cancer (Casablanca) in 2019. The costs were estimated from the societal perspective using a bottom-up approach. The materials and procedures used were identified and quantified retrospectively from the information system and files. Their monetary value was calculated according to official prices published by the national health insurance agency. The horizon time adopted was 12 months. RESULTS: The study included 271 patients, with an average age of 62.5 ± 9.5 years. Of these, 93.4 % were men and 92.1 % were former smokers. In terms of cancer staging, 68.3 % of patients were in stage IV while 28.8 % were in stage III. Adenocarcinoma was present in 43.5 % of cases. Patients underwent an average of 10.6 ± 5.1 radiological investigations, 56.1 ± 30.9 biological tests, and 24.1 ± 11.7 consultations. The average direct medical cost was 4455.3 USD (95 % CI: 4037.4-4873.2). Chemotherapy accounted for 19.9 % of the total cost, while radiological investigations and drugs accounted for 18.7 % and 17.6 %, respectively. Diagnostic tests and radiotherapy each accounted for 7.6 % of the total cost, while biological tests accounted for 7.5 % and hospitalizations accounted for 7.1 %. The cost was statistically higher in young patients (p = 0.017), in patients with adenocarcinoma (p < 0.0001), in patients with stage II tumor (< 0.00001), in patients who have undergone surgery (p = 0.002), chemotherapy (p < 0.0001), radiotherapy (p < 0.001) and in those without metastases (p < 0.0001). CONCLUSION: These results provide evidence to support the ratification of the Framework Convention on Tobacco Control and the full adherence of the Kingdom of Morocco to the MPOWER measures.

Treatment costs for patients with Streptococcus suis infection in Northern Thailand: a hospital-based observational study of 14-year data.

BACKGROUND: Streptococcus suis (S.suis) is a neglected zoonotic disease that imposes a significant economic burden on healthcare and society. To our knowledge, studies estimating the cost of illness associated with S.suis treatment are limited, and no study focuses on treatment costs and potential key drivers in Thailand. This study aimed to estimate the direct medical costs associated with S.suis treatment in Thailand and identify key drivers affecting high treatment costs from the provider's perspective. METHODS: A retrospective analysis of the 14-year data from 2005-2018 of confirmed S.suis patients admitted at Chiang Mai University Hospital (CMUH) was conducted. Descriptive statistics were used to summarize the data of patients' characteristics, healthcare utilization and costs. The multiple imputation with predictive mean matching strategy was employed to deal with missing Glasgow Coma Scale (GCS) data. Generalized linear models (GLMs) were used to forecast costs model and identify determinants of costs associated with S.suis treatment. The modified Park test was adopted to determine the appropriate family. All costs were inflated applying the consumer price index for medical care and presented to the year 2019. RESULTS: Among 130 S.suis patients, the average total direct medical cost was 12,4675 Thai baht (THB) (US$ 4,016), of which the majority of expenses were from the "others" category (room charges, staff services and medical devices). Infective endocarditis (IE), GCS, length of stay, and bicarbonate level were significant predictors associated with high total treatment costs. Overall, marginal increases in IE and length of stay were significantly associated with increases in the total costs (standard error) by 132,443 THB (39,638 THB) and 5,490 THB (1,715 THB), respectively. In contrast, increases in GCS and bicarbonate levels were associated with decreases in the total costs (standard error) by 13,118 THB (5,026 THB) and 7,497 THB (3,430 THB), respectively. CONCLUSIONS: IE, GCS, length of stay, and bicarbonate level were significant cost drivers associated with direct medical costs. Patients' clinical status during admission significantly impacts the outcomes and total treatment costs. Early diagnosis and timely treatment were paramount to alleviate long-term complications and high healthcare expenditures.

The Direct and Indirect Costs of Cancer among the Lower-Income Group: Estimates from a Pilot and Feasibility Study.

BACKGROUND: Healthcare in Malaysia is largely publicly funded, however, cancer could still result in out-of-pocket (OOP) expenses, which may burden the affected patients. This is especially relevant to those in the lower-income group. This pilot study was conducted to estimate the direct and indirect costs of cancer and evaluate the feasibility of obtaining these costs information from the lower-income cancer patients undergoing treatment. METHODS: A cross-sectional study of patients with cancer was conducted in Hospital Kuala Lumpur between September and October 2020. Self-reported data from the patients were collected using face-to-face interviews. Detailed information about cancer-related OOP expenses including direct medical, direct non-medical, and productivity loss in addition to financial coping strategies were collected. Costs data were estimated and reported as average annual total costs per patient. RESULTS: The mean total cost of cancer was estimated at MYR 7955.39 (US$ 1893.46) per patient per year. The direct non-medical cost was the largest contributor to the annual cost, accounting for 46.1% of the total cost. This was followed by indirect costs and direct medical costs at 36.0% and 17.9% of the total annual costs, respectively. Supplemental food and transportation costs were the major contributors to the total non-medical costs. The most frequently used financial coping strategies were savings and financial support received from relatives and friends. CONCLUSION: This study showed that estimation of the total cost of cancer from the patient's perspective is feasible. Considering the significant impact of direct non-medical and indirect costs on the total costs, it is vital to conduct further exploration of its cost drivers and variations using a larger sample size.

Change in coronary heart disease hospitalization after chronic disease management: a programme policy in China.

This study aims at examining changes in coronary heart disease (CHD) hospitalization associated with a novel county-scale chronic disease management (CDM) programme policy implemented in March 2019 in China during the 13th Five-Year period (2016-2020). The CDM programme was designed to improve the health of populations with chronic diseases by means of an integrated way involving both county-level public hospitals and primary care institutes. Data originated from the medical files of CHD inpatients discharged from a secondary hospital from January 2017 to December 2020. A total of 6111 CHD patient records were collected. Univariate and multivariate regression analyses were performed to assess changes in hospitalization direct medical costs and length of stay of CHD patients. The mean direct medical cost of CHD hospitalization was 8419.73 Yuan, and the mean length of stay was 7.57 days. Results suggested that the implementation of CDM reduced hospitalization direct medical cost and bed days by about 23% (1956.12 Yuan at means) and 11.5% (almost 1 day at means), respectively. In addition, a further decreasing trend in medical costs over time was associated with chronic disease management. It is implied that chronic disease management is an effective way of relieving the medical and financial burden of hospitalization.

Describing financial toxicity among cancer patients in different income countries: a systematic review and meta-analysis.

Background: There is limited evidence of financial toxicity (FT) among cancer patients from countries of various income levels. Hence, this study aimed to determine the prevalence of objective and subjective FT and their measurements in relation to cancer treatment. Methods: PubMed, Science Direct, Scopus, and CINAHL databases were searched to find studies that examined FT. There was no limit on the design or setting of the study. Random-effects meta-analysis was utilized to obtain the pooled prevalence of objective FT. Results: Out of 244 identified studies during the initial screening, only 64 studies were included in this review. The catastrophic health expenditure (CHE) method was often used in the included studies to determine the objective FT. The pooled prevalence of CHE was 47% (95% CI: 24.0-70.0) in middle- and high-income countries, and the highest percentage was noted in low-income countries (74.4%). A total of 30 studies focused on subjective FT, of which 9 used the Comprehensive Score for FT (COST) tool and reported median scores ranging between 17.0 and 31.9. Conclusion: This study shows that cancer patients from various income-group countries experienced a significant financial burden during their treatment. It is imperative to conduct further studies on interventions and policies that can lower FT caused by cancer treatment.

Delay in psychiatric hospitalization from the diagnosis of first-episode schizophrenia and its association with clinical outcomes and direct medical costs: a nationwide, health insurance data-based study.

BACKGROUND: Early intervention is essential for improving the prognosis in patients with first-episode schizophrenia (FES). The Mental Health Act limits involuntary hospitalization in South Korea to cases where an individual exhibits both a mental disorder and a potential for harming themselves or others, which could result in a delay in the required treatment in FES. We investigated the effect of delay in the first psychiatric hospitalization on clinical outcomes in FES. METHODS: The South Korean Health Insurance Review Agency database (2012-2019) was used. We identified 15,994 patients with FES who had a record of at least one psychiatric hospitalization within 1 year from their diagnosis. A multivariate linear regression model and a generalized linear model with a gamma distribution and log link were used to examine associations between the duration from the diagnosis to the first psychiatric admission and clinical outcomes as well as direct medical costs after 2 and 5 years. RESULTS: Within both the 2-year and the 5-year period, longer durations from the diagnosis to the first psychiatric admission were associated with an increase in the number of psychiatric hospitalizations (2-y: B = 0.003, p = 0.003, 5-y: B = 0.007, p = 0.001) and an increase in direct medical costs (total: 2-y: B = 0.005, p < 0.001, 5-y: B = 0.004, p = 0.005; inpatient care: 2-y: B = 0.005, p < 0.001, 5-y: B = 0.004, p = 0.017). CONCLUSIONS: Earlier psychiatric admission from the diagnosis is associated with a decrease in the number of psychiatric admissions as well as in direct medical costs in patients with FES.

Medical service utilisation and direct medical cost of depression: a cross-sectional analysis of urban medical claims data from China.

OBJECTIVES: Depression is becoming a growing cause of disability, suicides and disease burden. It incurred substantial costs to societies all over the world. Estimating the medical costs of depression will provide implications for related policies and interventions. However, there is scarce of evidence on the economic costs of depression in China. The aim of this study is to assess depression-related medical service utilisation, the direct medical costs of depression and potential associated factors. SETTINGS: This study used data that comprised 5% random sample of claims data from China's Urban Basic Medical Insurance between January 2013 and December 2016. Beneficiaries' demographic information, diagnoses and cost of outpatient and inpatient services were recorded in the data set. PARTICIPANTS: 26 123 patients with depression were identified as the study population in this study. PRIMARY AND SECONDARY OUTCOME MEASURES: The information on health service utilisation and cost was extracted based on the condition that depression was claimed as the index disease. RESULTS: From 2013 to 2016, weighted average annual total medical cost of depression in urban China was RMB2706.92, and the annual out-of-pocket cost was RMB786.4. The annual total medical cost of depression among urban residents in China was estimated to be 4.4 billion RMB (95% CI 4.15 to 4.67) (US$ 0.70, 95% CI 0.66 to 0.74). Nearly 65% of medical costs (RMB 1795.7 or US$ 285.0) were accounted by inpatient expenditure, and tertiary hospitals were the main provider of depression treatment. Depression-related medical care utilisation and direct costs were associated with gender, age, insurance status, severity of depression and diagnosis. Medication costs and medical service contributed to 41.7% and 56.6% of the average depression-related medical costs. CONCLUSION: Depression poses a considerable burden on both the health system and the individual in urban China. Specific policies to strengthen the mental health resources in primary and secondary hospitals are in urgent need, and effective treatment strategies are important to prevent a progression and recurrence of depression, as well as an increase in medical cost.