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1.
Sci Rep ; 10(1): 18422, 2020 10 28.
Artículo en Inglés | MEDLINE | ID: mdl-33116179

RESUMEN

We use an individual based model and national level epidemic simulations to estimate the medical costs of keeping the US economy open during COVID-19 pandemic under different counterfactual scenarios. We model an unmitigated scenario and 12 mitigation scenarios which differ in compliance behavior to social distancing strategies and in the duration of the stay-home order. Under each scenario we estimate the number of people who are likely to get infected and require medical attention, hospitalization, and ventilators. Given the per capita medical cost for each of these health states, we compute the total medical costs for each scenario and show the tradeoffs between deaths, costs, infections, compliance and the duration of stay-home order. We also consider the hospital bed capacity of each Hospital Referral Region (HRR) in the US to estimate the deficit in beds each HRR will likely encounter given the demand for hospital beds. We consider a case where HRRs share hospital beds among the neighboring HRRs during a surge in demand beyond the available beds and the impact it has in controlling additional deaths.


Asunto(s)
Infecciones por Coronavirus/economía , Costos de la Atención en Salud/estadística & datos numéricos , Pandemias/economía , Neumonía Viral/economía , Creación de Capacidad/economía , Creación de Capacidad/estadística & datos numéricos , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Instituciones de Salud/economía , Instituciones de Salud/estadística & datos numéricos , Humanos , Control de Infecciones/economía , Control de Infecciones/estadística & datos numéricos , Modelos Estadísticos , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Estados Unidos
3.
Artículo en Inglés | MEDLINE | ID: mdl-33066327

RESUMEN

OBJECTIVES: Assess the survival of hospitalized coronavirus disease 2019 (COVID-19) patients across age groups, sex, use of mechanical ventilators (MVs), nationality, and intensive care unit (ICU) admission in the Kingdom of Saudi Arabia. METHODS: Data were retrieved from the Saudi Ministry of Health (MoH) between 1 March and 29 May 2020. Kaplan-Meier (KM) analyses and multiple Cox proportional-hazards regression were conducted to assess the survival of hospitalized COVID-19 patients from hospital admission to discharge (censored) or death. Micro-costing was used to estimate the direct medical costs associated with hospitalization per patient. RESULTS: The number of included patients with complete status (discharge or death) was 1422. The overall 14-day survival was 0.699 (95%CI: 0.652-0.741). Older adults (>70 years) (HR = 5.00, 95%CI = 2.83-8.91), patients on MVs (5.39, 3.83-7.64), non-Saudi patients (1.37, 1.01-1.89), and ICU admission (2.09, 1.49-2.93) were associated with a high risk of mortality. The mean cost per patient (in SAR) for those admitted to the general Medical Ward (GMW) and ICU was 42,704.49 ± 29,811.25 and 79,418.30 ± 55,647.69, respectively. CONCLUSION: The high hospitalization costs for COVID-19 patients represents is a significant public health challenge. Efficient allocation of healthcare resources cannot be emphasized enough.


Asunto(s)
Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/terapia , Costos de la Atención en Salud/estadística & datos numéricos , Hospitalización/economía , Neumonía Viral/mortalidad , Neumonía Viral/terapia , Anciano , Infecciones por Coronavirus/economía , Femenino , Humanos , Masculino , Pandemias/economía , Neumonía Viral/economía , Arabia Saudita/epidemiología , Análisis de Supervivencia
4.
Z Gastroenterol ; 58(9): 855-867, 2020 Sep.
Artículo en Alemán | MEDLINE | ID: mdl-32947631

RESUMEN

BACKGROUND: The economic effects of spontaneous bacterial peritonitis (SBP), nosocomial infections (nosInf) and acute-on-chronic liver failure (ACLF) have so far been poorly studied. We analyzed the impact of these complications on treatment revenues in hospitalized patients with decompensated cirrhosis. METHODS: 371 consecutive patients with decompensated liver cirrhosis, who received a paracentesis between 2012 and 2016, were included retrospectively. DRG (diagnosis-related group), "ZE/NUB" (additional charges/new examination/treatment methods), medication costs, length of hospital stay as well as different kinds of specific treatments (e. g., dialysis) were considered. Exclusion criteria included any kind of malignancy, a history of organ transplantation and/or missing accounting data. RESULTS: Total treatment costs (DRG + ZE/NUB) were higher in those with nosInf (€â€Š10,653 vs. €â€Š5,611, p < 0.0001) driven by a longer hospital stay (23 d vs. 12 d, p < 0.0001). Of note, revenues per day were not different (€â€Š473 vs. €â€Š488, p = 0.98) despite a far more complicated treatment with a more frequent need for dialysis (p < 0.0001) and high-complex care (p = 0.0002). Similarly, SBP was associated with higher total revenues (€â€Š10,307 vs. €â€Š6,659, p < 0.0001). However, the far higher effort for the care of SBP patients resulted in lower daily revenues compared to patients without SBP (€â€Š443 vs. €â€Š499, p = 0.18). ACLF increased treatment revenues to €â€Š10,593 vs. €6,369 without ACLF (p < 0.0001). While treatment of ACLF was more complicated, revenue per day was not different to no-ACLF patients (€â€Š483 vs. €â€Š480, p = 0.29). CONCLUSION: SBP, nosInf and/or ACLF lead to a significant increase in the effort, revenue and duration in the treatment of patients with cirrhosis. The lower daily revenue, despite a much more complex therapy, might indicate that these complications are not yet sufficiently considered in the German DRG system.


Asunto(s)
Insuficiencia Hepática Crónica Agudizada/economía , Infecciones Bacterianas/economía , Infección Hospitalaria/economía , Grupos Diagnósticos Relacionados/economía , Costos de la Atención en Salud/estadística & datos numéricos , Peritonitis/economía , Insuficiencia Hepática Crónica Agudizada/terapia , Infecciones Bacterianas/terapia , Infección Hospitalaria/complicaciones , Infección Hospitalaria/terapia , Grupos Diagnósticos Relacionados/estadística & datos numéricos , Alemania/epidemiología , Humanos , Tiempo de Internación , Cirrosis Hepática/complicaciones , Peritonitis/tratamiento farmacológico , Estudios Retrospectivos
5.
BMC Public Health ; 20(1): 1464, 2020 Sep 29.
Artículo en Inglés | MEDLINE | ID: mdl-32993588

RESUMEN

BACKGROUND: The winter pressure often experienced by NHS hospitals in England is considerably contributed to by severe cases of seasonal influenza resulting in hospitalisation. The prevention planning and commissioning of the influenza vaccination programme in the UK does not always involve those who control the hospital budget. The objective of this study was to describe the direct medical costs of secondary care influenza-related hospital admissions across different age groups in England during two consecutive influenza seasons. METHODS: The number of hospital admissions, length of stay, and associated costs were quantified as well as determining the primary costs of influenza-related hospitalisations. Data were extracted from the Hospital Episode Statistics (HES) database between September 2017 to March 2018 and September 2018 to March 2019 in order to incorporate the annual influenza seasons. The use of international classification of disease (ICD)-10 codes were used to identify relevant influenza hospitalisations. Healthcare Resource Group (HRG) codes were used to determine the costs of influenza-related hospitalisations. RESULTS: During the 2017/18 and 2018/19 seasons there were 46,215 and 39,670 influenza-related hospital admissions respectively. This resulted in a hospital cost of £128,153,810 and £99,565,310 across both seasons. Results showed that those in the 65+ year group were associated with the highest hospitalisation costs and proportion of in-hospital deaths. In both influenza seasons, the HRG code WJ06 (Sepsis without Interventions) was found to be associated with the longest average length of stay and cost per admission, whereas PD14 (Paediatric Lower Respiratory Tract Disorders without Acute Bronchiolitis) had the shortest length of stay. CONCLUSION: This study has shown that influenza-related hospital admissions had a considerable impact on the secondary healthcare system during the 2017/18 and 2018/19 influenza seasons, before taking into account its impact on primary health care.


Asunto(s)
Costos de la Atención en Salud/estadística & datos numéricos , Hospitalización/economía , Gripe Humana/economía , Vacunación/economía , Adulto , Inglaterra , Femenino , Recursos en Salud , Hospitalización/estadística & datos numéricos , Humanos , Clasificación Internacional de Enfermedades , Masculino , Persona de Mediana Edad , Estaciones del Año , Vacunación/estadística & datos numéricos
6.
Value Health ; 23(9): 1210-1217, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32940239

RESUMEN

OBJECTIVES: Significant literature exists on the effects of medication adherence on reducing healthcare costs, but less is known about the effect of medication adherence among Medicare low-income subsidy (LIS) recipients. This study examined the effects of medication adherence on healthcare costs among LIS recipients with diabetes, hypertension, and/or heart failure. METHODS: This retrospective study analyzed Medicare claims data (2012-2013) linked to the Area Health Resources Files. Using measures developed by the Pharmacy Quality Alliance, adherence to 11 medication classes was studied among patients with 7 possible combinations of the diseases mentioned. Adherence was measured in 8 categories of proportion of days covered (PDC): ≥95%, 90% to <95%, 85% to <90%, 80% to <85%, 75% to <80%, 50% to <75%, 25% to <50%, and <25%. Annual Medicare costs were compared across adherence categories. A generalized linear model was used to control for patient/community characteristics. RESULTS: Among patients with only one disease, such as diabetes, patients with the lowest adherence (PDC < 25%) had $3152/year higher Medicare costs than patients with the highest adherence (PDC ≥ 95%; $11 101 vs $7949; P < .05). The adjusted costs among patients with PDC < 25% was $1893 higher than patients with PDC ≥ 95% ($9919 vs $8026; P < .05). Among patients with multiple chronic conditions, patients' adherence to medications for fewer diseases had higher costs. CONCLUSIONS: Greater medication adherence is associated with lower Medicare costs in the Medicare LIS population. Future policy affecting the LIS program should encourage better medication adherence among patients with chronic diseases.


Asunto(s)
Diabetes Mellitus Tipo 2/epidemiología , Costos de la Atención en Salud/estadística & datos numéricos , Insuficiencia Cardíaca/epidemiología , Hipertensión/epidemiología , Medicare/estadística & datos numéricos , Cumplimiento de la Medicación/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Comorbilidad , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Insuficiencia Cardíaca/tratamiento farmacológico , Humanos , Hipertensión/tratamiento farmacológico , Medicare/economía , Estudios Retrospectivos , Estados Unidos
7.
Lancet Glob Health ; 8(10): e1282-e1294, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32971051

RESUMEN

BACKGROUND: Worldwide, smoking tobacco causes 7 million deaths annually, and this toll is expected to increase, especially in low-income and middle-income countries. In Latin America, smoking is a leading risk factor for death and disability, contributes to poverty, and imposes an economic burden on health systems. Despite being one of the most effective measures to reduce smoking, tobacco taxation is underused and cigarettes are more affordable in Latin America than in other regions. Our aim was to estimate the tobacco-attributable burden on mortality, disease incidence, quality of life lost, and medical costs in 12 Latin American countries, and the expected health and economic effects of increasing tobacco taxes. METHODS: In this modelling study, we developed a Markov probabilistic microsimulation economic model of the natural history, medical costs, and quality-of-life losses associated with the most common tobacco-related diseases in 12 countries in Latin America. Data inputs were obtained through a literature review, vital statistics, and hospital databases from each country: Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, Honduras, Mexico, Paraguay, Peru, and Uruguay. The main outcomes of the model are life-years, quality-adjusted life-years, disease events, hospitalisations, disease incidence, disease cost, and healthy years of life lost. We estimated direct medical costs for each tobacco-related disease included in the model using a common costing methodology for each country. The disease burden was estimated as the difference in disease events, deaths, and associated costs between the results predicted by the model for current smoking prevalence and a hypothetical cohort of people in each country who had never smoked. The model estimates the health and financial effects of a price increase of cigarettes through taxes, in terms of disease and health-care costs averted, and increased tax revenues. FINDINGS: In the 12 Latin American countries analysed, we estimated that smoking is responsible for approximately 345 000 (12%) of the total 2 860 921 adult deaths, 2·21 million disease events, 8·77 million healthy years of life lost, and $26·9 billion in direct medical costs annually. Health-care costs attributable to smoking were estimated to represent 6·9% of the health budgets of these countries, equivalent to 0·6% of their gross domestic product. Tax revenues from cigarette sales cover 36·0% of the estimated health expenditures caused by smoking. We estimated that a 50% increase in cigarette price through taxation would avert more than 300 000 deaths, 1·3 million disease events, gain 9 million healthy life-years, and save $26·7 billion in health-care costs in the next 10 years, with a total economic benefit of $43·7 billion. INTERPRETATION: Smoking represents a substantial health and economic burden in these 12 countries of Latin America. Tobacco tax increases could successfully avert deaths and disability, reduce health-care spending, and increase tax revenues, resulting in large net economic benefits. FUNDING: International Development Research Centre (IDRC), Canada.


Asunto(s)
Costo de Enfermedad , Costos de la Atención en Salud/estadística & datos numéricos , Fumar/economía , Fumar/epidemiología , Impuestos/economía , Productos de Tabaco/economía , Humanos , América Latina/epidemiología , Cadenas de Markov , Modelos Económicos , Impuestos/estadística & datos numéricos , Productos de Tabaco/estadística & datos numéricos
8.
PLoS One ; 15(9): e0239306, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32946537

RESUMEN

Patient satisfaction, a healthcare recipient's reaction to salient aspects of their service experience, has been considered an important metric of the overall quality of healthcare in both advanced and developing countries. Given the growing number of studies on patient satisfaction in developing and transitioning countries, publications using high-quality patient surveys in these countries remain scarce. This study examines factors associated with inpatient satisfaction levels using nationwide, large-scale interview data from 10,143 randomized and voluntary patients of 69 large and public hospitals in Vietnam during 2017-2018. We find that older patients, poor patients, female patients, patients with lower levels of education, patients not working for private enterprises (or foreign enterprises), and rural patients reported higher levels of overall satisfaction. Health insurance is found to have positive influence on overall patient satisfaction, primarily driven by limiting patient concerns about treatment costs, as well as increasing positive perceptions of hospital staff. We further find that patients who paid extra fees for their hospital admission expressed higher scores for hospital living arrangements and medical staff, but were mostly dissatisfied with treatment costs. These findings have important policy implications for current policy makers in Vietnam as well as for other countries with limited healthcare resources and ongoing healthcare reforms.


Asunto(s)
Reforma de la Atención de Salud/tendencias , Satisfacción del Paciente , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Costos de la Atención en Salud/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Hospitales Públicos/economía , Humanos , Pacientes Internos/psicología , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Servicios de Salud Rural , Vietnam/epidemiología , Adulto Joven
9.
Artículo en Inglés | MEDLINE | ID: mdl-32872616

RESUMEN

This study used the Korean National Health Insurance (NHI) claims database from 2011 to 2017 to estimate the incidence and the incidence-based cost of cervical cancer and carcinoma in situ of cervix uteri (CIS) in Korea. The primary outcome was the direct medical cost per patient not diagnosed with cervical cancer (C53) or CIS (D06) 2 years prior to the index date in the first year after diagnosis. A regression analysis was conducted to adjust for relevant covariates. The incidence of cervical cancer tended to decrease from 2013 to 2016, while that of CIS increased. In particular, the incidence rate of CIS in women in their 20 s and 30 s increased by 56.8% and 28.4%, respectively, from 2013 to 2016. The incidence-based cost of cervical cancer and CIS was USD 13,058 and USD 2695 in 2016, respectively, which increased from 2013. Multivariate regression analysis suggested that age was the most influential variable of the cost in both patient groups, and the cost was highest in those aged over 60, i.e., the medical cost was significantly lower in younger women than their older counterparts. These findings suggest that targeting younger women in cervical cancer prevention is a reasonable option from both economic and public health perspectives.


Asunto(s)
Costos de la Atención en Salud/estadística & datos numéricos , Neoplasias del Cuello Uterino , Adulto , Factores de Edad , Carcinoma in Situ/economía , Carcinoma in Situ/epidemiología , Costo de Enfermedad , Bases de Datos Factuales/estadística & datos numéricos , Femenino , Humanos , Incidencia , Persona de Mediana Edad , Programas Nacionales de Salud/economía , Programas Nacionales de Salud/estadística & datos numéricos , Lesiones Precancerosas/economía , Lesiones Precancerosas/epidemiología , República de Corea/epidemiología , Proyectos de Investigación , Neoplasias del Cuello Uterino/economía , Neoplasias del Cuello Uterino/epidemiología , Adulto Joven
10.
Plast Reconstr Surg ; 146(2): 177e-186e, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32740586

RESUMEN

BACKGROUND: Evidence-based practices in medicine are linked with a higher quality of care and lower health care cost. For trigger finger, identifying patient factors associated with nonadherence to evidence-based practices will aid physicians in treatment decisions. The objectives were to (1) determine patient factors associated with treatment nonadherence, (2) examine the success rates of steroid injections, and (3) evaluate the economic consequences of nonadherence to treatment recommendations. METHODS: The authors used data from the Clinformatics DataMart database from 2010 to 2017 to conduct a population-based analysis of patients with single-digit trigger finger. The authors calculated rates of steroid injection success and examined associations between injection success and patient factors using chi-square tests. In addition, the authors analyzed differences in the cost to the insurer, the cost to the patient, and total cost. RESULTS: A total of 29,722 patients were included in this analysis. Injection success rates were similar for diabetic (72 percent) and nondiabetic patients (73 percent), women (73 percent), and men (73 percent). Nonetheless, diabetics (OR, 1.4; 95 percent CI, 1.4 to 1.5; p < 0.001) and women (OR, 1.2; 95 percent CI, 1.1 to 1.2; p < 0.001) were significantly more likely to receive nonadherent treatment. In total, $23 million (U.S. dollars) were spent on nonadherent trigger finger care. CONCLUSIONS: Diabetics and women have increased odds of having surgery without a prior steroid injection, despite similar success rates of steroid injections compared to nondiabetics and men. Because performing surgical release before any steroid injections may represent a higher cost treatment option, providers should provide steroid injections before surgery for all patients regardless of diabetes status or sex to minimize overtreatment. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Asunto(s)
Diabetes Mellitus/epidemiología , Glucocorticoides/administración & dosificación , Procedimientos Ortopédicos/economía , Cooperación del Paciente/estadística & datos numéricos , Trastorno del Dedo en Gatillo/terapia , Anciano , Costos y Análisis de Costo/estadística & datos numéricos , Medicina Basada en la Evidencia/economía , Medicina Basada en la Evidencia/métodos , Medicina Basada en la Evidencia/estadística & datos numéricos , Femenino , Estudios de Seguimiento , Glucocorticoides/economía , Costos de la Atención en Salud/estadística & datos numéricos , Humanos , Inyecciones Intralesiones/economía , Inyecciones Intralesiones/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Procedimientos Ortopédicos/estadística & datos numéricos , Factores de Riesgo , Factores Sexuales , Resultado del Tratamiento , Trastorno del Dedo en Gatillo/economía
12.
PLoS One ; 15(8): e0237509, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32810157

RESUMEN

Limited data are available regarding treatment patterns, healthcare resource utilization (HCRU), treatment costs and clinical outcomes for patients with diffuse large B-cell lymphoma (DLBCL) in Japan. This retrospective database study analyzed the Medical Data Vision database for DLBCL patients who received treatment during the identification period from October 1 2008 to December 31 2017. Among 6,965 eligible DLBCL patients, 5,541 patients (79.6%) received first-line (1L) rituximab (R)-based therapy, and then were gradually switched to chemotherapy without R in subsequent lines of therapy. In each treatment regimen, 1L treatment cost was the highest among all lines of therapy. The major cost drivers i.e. total direct medical costs until death or censoring across all regimens and lines of therapy were from the 1L regimen and inpatient costs. During the follow-up period, DLBCL patients who received a 1L R-CHOP regimen achieved the highest survival rate and longest time-to-next-treatment, with a relatively low mean treatment cost due to lower inpatient healthcare resource utilization and fewer lines of therapy compared to other 1L regimens. Our retrospective analysis of clinical practices in Japanese DLBCL patients demonstrated that 1L treatment and inpatient costs were major cost contributors and that the use of 1L R-CHOP was associated with better clinical outcomes at a relatively low mean treatment cost.


Asunto(s)
Costos de la Atención en Salud , Linfoma de Células B Grandes Difuso , Pautas de la Práctica en Medicina , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/economía , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Niño , Preescolar , Análisis Costo-Beneficio , Ciclofosfamida/economía , Ciclofosfamida/uso terapéutico , Bases de Datos Factuales , Doxorrubicina/economía , Doxorrubicina/uso terapéutico , Femenino , Costos de la Atención en Salud/estadística & datos numéricos , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Humanos , Formulario de Reclamación de Seguro/estadística & datos numéricos , Japón/epidemiología , Linfoma de Células B Grandes Difuso/economía , Linfoma de Células B Grandes Difuso/mortalidad , Linfoma de Células B Grandes Difuso/terapia , Masculino , Persona de Mediana Edad , Terapia Neoadyuvante/economía , Terapia Neoadyuvante/estadística & datos numéricos , Pautas de la Práctica en Medicina/economía , Pautas de la Práctica en Medicina/estadística & datos numéricos , Prednisona/economía , Prednisona/uso terapéutico , Estudios Retrospectivos , Rituximab/administración & dosificación , Rituximab/economía , Rituximab/uso terapéutico , Análisis de Supervivencia , Vincristina/economía , Vincristina/uso terapéutico , Adulto Joven
13.
Int J Behav Nutr Phys Act ; 17(1): 101, 2020 08 10.
Artículo en Inglés | MEDLINE | ID: mdl-32778110

RESUMEN

BACKGROUND: Few studies have examined relationships between physical activity (PA) during mid-age and health costs in women. The aim of this study was to investigate associations between PA levels and trajectories over 12 years with medical and pharmaceutical costs in mid-age Australian women. METHODS: Data from 6953 participants in the Australian Longitudinal Study on Women's Health (born in 1946-1951) were analysed in 2019. PA was self-reported in 2001 (50-55y), 2007 (56-61y) and 2013 (62-67y). PA data were linked with 2013-2015 data from the Medicare (MBS) and Pharmaceutical (PBS) Benefits Schemes. Quantile regression was used to examine associations between PA patterns [always active, increasers, decreasers, fluctuaters or always inactive (reference)] with these medical and pharmaceutical costs. RESULTS: Among women who were consistently inactive (< 500 MET.minutes/week) in 2001, 2007 and 2013, median MBS and PBS costs (2013 to 2015) were AUD4261 and AUD1850, respectively. Those costs were AUD1728 (95%CI: 443-3013) and AUD578 (95%CI: 426-729) lower among women who were consistently active in 2001, 2007 and 2013 than among those who were always inactive. PBS costs were also lower in women who were active at only one survey (AUD205; 95%CI: 49-360), and in those whose PA increased between 2001 and 2013 (AUD388; 95%CI: 232-545). CONCLUSION: Maintaining 'active' PA status was associated with 40% lower MBS and 30% lower PBS costs over three years in Australian women. Helping women to remain active in mid-life could result in considerable savings for both women and the Australian government.


Asunto(s)
Ejercicio Físico , Costos de la Atención en Salud/estadística & datos numéricos , Costos de la Atención en Salud/tendencias , Programas Nacionales de Salud/economía , Salud de la Mujer/economía , Anciano , Australia/epidemiología , Femenino , Humanos , Estudios Longitudinales , Persona de Mediana Edad
14.
Am J Trop Med Hyg ; 103(1): 295-302, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32653050

RESUMEN

Lymphatic filariasis (LF) is endemic in 72 countries; 15 million persons live with chronic filarial lymphedema. It can be a disabling condition, frequently painful, leading to reduced mobility, social exclusion, and depression. The Global Program to Eliminate Lymphatic Filariasis aims to stop new infections and care for affected persons, but morbidity management has been initiated in only 38 countries. We examine economic costs and benefits of alleviating chronic lymphedema and its effects through simple limb care. We use economic and epidemiological data from 12 Indian states in which 99% of Indians with filariasis reside. Using census data, we calculate the age distribution of filarial lymphedema and predict the burden of morbidity of infected persons. We estimate lifetime medical costs and lost earnings due to lymphedema and acute dermatolymphangioadenitis (ADLA) with and without community-based limb-care programs. Programs of community-based limb care in all Indian endemic areas would reduce costs of disability by 52%, saving a per person average of US$2,721, equivalent to 703 workdays. Per-person savings are 185 times the program's per-person cost. Chronic lymphedema and ADLA impose a substantial physical and economic burden in filariasis-endemic areas. Low-cost programs for lymphedema management based on limb washing and topical medication are effective in reducing the number of ADLA episodes and stopping progression of disabling lymphedema. With reduced disability, people can work longer hours per day, more days per year, and in more strenuous, higher paying jobs, resulting in important economic benefits to themselves, their families, and their communities.


Asunto(s)
Filariasis Linfática/economía , Adolescente , Adulto , Factores de Edad , Anciano , Niño , Costo de Enfermedad , Análisis Costo-Beneficio , Progresión de la Enfermedad , Filariasis Linfática/epidemiología , Filariasis Linfática/terapia , Femenino , Costos de la Atención en Salud/estadística & datos numéricos , Política de Salud , Humanos , India/epidemiología , Masculino , Persona de Mediana Edad , Adulto Joven
15.
S Afr Med J ; 110(4): 296-301, 2020 Mar 30.
Artículo en Inglés | MEDLINE | ID: mdl-32657741

RESUMEN

BACKGROUND: There has been no comprehensive study determining the financial burden of breast cancer in the South African (SA) public sector. OBJECTIVES: To develop a method to determine the cost of breast cancer treatment with chemotherapy per episode of care and to quantify the associated costs relating to chemotherapy at Groote Schuur Hospital (GSH), a government hospital in SA. These costs included costs associated with the management of adverse events arising from chemotherapy. METHODS: Retrospective patient-level data were collected for 200 patients from electronic databases and patient folders between 2013 and 2015. Direct medical costs were determined from the health funder's perspective. The information collected was categorised into the following cost components: chemotherapy medicines, support medicines, administration of chemotherapy, laboratory tests, radiology scans and imaging, doctor consultations and adverse events. Time-and-motion studies were conducted on a set of new patients and the data obtained were used for the study sample of 200 patients. All the above costs were used to determine the cost of chemotherapy per episode of care. The episode of care was defined as the care provided from 2 months prior to the date of commencing chemotherapy (pre-chemotherapy phase), during chemotherapy (treatment phase) and until 6 months after the date when the last cycle of chemotherapy was administered (follow-up phase). RESULTS: A method was developed to determine the episode-of-care costs for breast cancer at GSH. The total direct medical cost for treatment of breast cancer at GSH for 200 patients was ZAR3 154 877, and the average episode-of-care cost per patient was ZAR15 774. The average cost of management of adverse events arising from the various treatment modalities was ZAR13 133 per patient. It was found that the cost of treating a patient with adverse events was 1.8 times higher than the cost of treating a patient without adverse events. Of the patients, 86.5% managed to complete their prescribed chemotherapy treatment cycles, and the average cost of treatment of these patients was 1.3 times more than the average cost for patients who could not complete their treatment, based on the number of treatment cycles received. CONCLUSION: A comprehensive method to determine the costs associated with breast cancer management per episode of care was developed, and costs were quantified at GSH according to the treatment protocol used at the hospital.


Asunto(s)
Antineoplásicos/economía , Carcinoma de Mama in situ/tratamiento farmacológico , Neoplasias de la Mama/tratamiento farmacológico , Carcinoma Ductal de Mama/tratamiento farmacológico , Carcinoma Lobular/tratamiento farmacológico , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/economía , Costos de la Atención en Salud/estadística & datos numéricos , Hospitales Públicos/economía , Adulto , Anciano , Carcinoma de Mama in situ/economía , Carcinoma de Mama in situ/patología , Neoplasias de la Mama/economía , Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/economía , Carcinoma Ductal de Mama/patología , Carcinoma Lobular/economía , Carcinoma Lobular/patología , Quimioterapia Adyuvante/economía , Técnicas de Laboratorio Clínico/economía , Diagnóstico por Imagen/economía , Costos de los Medicamentos/estadística & datos numéricos , Episodio de Atención , Femenino , Humanos , Persona de Mediana Edad , Terapia Neoadyuvante/economía , Cuidados Paliativos/economía , Honorarios por Prescripción de Medicamentos/estadística & datos numéricos , Derivación y Consulta/economía , Estudios Retrospectivos , Sudáfrica , Estudios de Tiempo y Movimiento , Adulto Joven
16.
Am Surg ; 86(6): 643-651, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32683960

RESUMEN

BACKGROUND: Cholecystectomy is a common procedure with significantly varied outcomes. We analyzed differences in comorbidities, outcomes, and cost of cholecystectomy by acute care surgery (ACS) versus hepatopancreaticobiliary (HPB) surgery. STUDY DESIGN: Patients were retrospectively identified between 2008 and 2015. Exclusion criteria included the following: (1) part of another procedure; (2) abdominal trauma; (3) ICU admission; vasopressors. RESULTS: One hundred and twenty-six ACS and 122 HPB patients were analyzed. The HPB subset had higher burden of comorbid disease and significantly lower projected 10-year survival (87.4% ACS vs 68.5% HPB, P < .0001). Median lengths of stay were longer in HPB patients (2 vs 5 days, P < .0001) as were readmission rates (30-day 5.6% vs 13.1%, P = .040; 90-day 7.9% vs 20.5%, P = .005). Median cost was higher including operative supply cost ($969.42 vs $1920.66, P < .0001) and total cost of care ($7340.66 vs $19 338.05, P < .0001). A predictive scoring system for difficult gallbladders was constructed and a phone application was created. CONCLUSION: Cholecystectomy in a complicated patient can be difficult with longer hospital stays and higher costs. The utilization of procedure codes to explain disparities is not sufficient. Incorporation of comorbidities needs to be addressed for planning and reimbursement.


Asunto(s)
Colecistectomía/estadística & datos numéricos , Enfermedades de la Vesícula Biliar/cirugía , Adulto , Anciano , Colecistectomía/economía , Comorbilidad , Femenino , Enfermedades de la Vesícula Biliar/economía , Costos de la Atención en Salud/estadística & datos numéricos , Hospitalización/economía , Humanos , Tiempo de Internación/economía , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Readmisión del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/economía , Estudios Retrospectivos , Factores de Riesgo , Adulto Joven
17.
Med Care ; 58(8): 689-695, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32692134

RESUMEN

BACKGROUND: Although complementary and alternative medicine (CAM) has been associated with reduced morbidity among adults with chronic back pain, less is known about the association between CAM use and health care expenditures. OBJECTIVES: The objective of this study was to first estimate health care expenditures of adult CAM users and nonusers with chronic back pain and then assess CAM's influence on health care expenditures. RESEARCH DESIGN: This was an ambidirectional cohort study. DATA: Linked National Health Interview Survey (2012) and Medical Expenditure Panel Survey (2013-2014). MEASURES: CAM use was defined as 3 or more visits to a practitioner in the 12 months before the National Health Interview Survey interview. Covariates included age, sex, race-ethnicity, and body mass index. The outcome was annual health care expenditures (overall and within 8 categories, including office-based visits and prescription medication). ANALYSES: Survey-weighted, covariate adjusted predicted marginal means models were applied to quantify health care expenditures. Survey-weighted, covariate adjusted linear and logistic regression models were used to investigate CAM's influence on expenditures, and the Z mediation test statistic was applied to quantify the independent effects of CAM. RESULTS: Overall, health care expenditures were significantly lower among CAM users with chronic back pain compared with non-CAM users for both 2013 and 2014: $8402 versus $9851 for 2013; $7748 versus $10,227 in 2014, annual differences of -$1499 (95% confidence interval: -$1701 to -$1197) and -$2479 (95% confidence interval: -$2696 to -$2262), respectively (P<0.001). Adult CAM users also had significantly lower prescription medication as well as outpatient expenses (P<0.001). CAM use was identified as a partial mediator to health care expenditures. CONCLUSION: CAM use is associated with lower overall health care expenditures, driven primarily by lower prescription and outpatient expenditures, among adults with chronic back pain in the United States.


Asunto(s)
Dolor de Espalda/economía , Terapias Complementarias/estadística & datos numéricos , Costos de la Atención en Salud/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Adulto , Anciano , Dolor de Espalda/terapia , Estudios de Cohortes , Terapias Complementarias/métodos , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Estados Unidos
18.
Med Care ; 58(8): 722-726, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32692138

RESUMEN

BACKGROUND: Childhood obesity is linked with adverse health outcomes and associated costs. Current information on the relationship between childhood obesity and inpatient costs is limited. OBJECTIVE: The objective of this study was to describe trends and quantify the link between childhood obesity diagnosis and hospitalization length of stay (LOS), costs, and charges. RESEARCH DESIGN: We use the National Inpatient Sample data from 2006 to 2016. SUBJECTS: The sample includes hospitalizations among children aged 2-19 years. The treatment group of interest includes child hospitalizations with an obesity diagnosis. MEASURES: Hospital LOS, charges, and costs associated with a diagnosis of obesity. RESULTS: We find increases in obesity-coded hospitalizations and associated charges and costs during 2006-2016. Obesity as a primary diagnosis is associated with a shorter hospital LOS (by 1.8 d), but higher charges and costs (by $20,879 and $6049, respectively); obesity as a secondary diagnosis is associated with a longer LOS (by 0.8 d), and higher charges and costs of hospitalizations (by $3453 and $1359, respectively). The most common primary conditions occurring with a secondary diagnosis of obesity are pregnancy conditions, mood disorders, asthma, and diabetes; the effect of a secondary diagnosis of obesity on LOS, charges, and costs holds across these conditions. CONCLUSIONS: Childhood obesity diagnosis-related hospitalizations, charges, and costs increased substantially during 2006-2016, and obesity diagnosis is associated with higher hospitalization charges and costs. Our findings provide clinicians and policymakers with additional evidence of the economic burden of childhood obesity and further justify efforts to prevent and manage the disease.


Asunto(s)
Costos de la Atención en Salud/normas , Tiempo de Internación/economía , Obesidad Pediátrica/economía , Adolescente , Niño , Preescolar , Femenino , Costos de la Atención en Salud/estadística & datos numéricos , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Humanos , Lactante , Tiempo de Internación/estadística & datos numéricos , Masculino , Obesidad Pediátrica/diagnóstico , Estados Unidos
19.
PLoS One ; 15(7): e0235736, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32673350

RESUMEN

Globally, about one in four people develop a psychiatric disorder during their lifetime. Specifically, the lifetime prevalence of schizophrenia is about 0.48%, and schizophrenia can have detrimental effects on a patient's life. Therefore, estimating the economic burden of schizophrenia is important. We investigated the cost-of-illness trend of schizophrenia in South Korea from 2006 to 2016. The cost-of-illness trend was estimated from a societal perspective using a prevalence-based approach for direct costs and a human capital approach for indirect costs. We utilized information from the following sources: 1) National Health Insurance Service, 2) Korean Statistical Information Service, Statistics Korea, 3) the National Survey of Persons with Disabilities, 4) Budget and Fund Operation Plan, Ministry of Justice, 5) Budget and Fund Operation Plan, Ministry of Health and Welfare, and 6) annual reports from the National Mental Health Welfare Commission. Direct healthcare costs, direct non-healthcare costs, and indirect costs by sex and age group were calculated along with sensitivity analyses of the estimates. The cost-of-illness of schizophrenia in Korea steadily increased from 2006 to 2016, with most costs being indirect costs. Individuals in their 40s and 50s accounted for most of the direct and indirect costs. Among indirect costs, the costs due to unemployment were most prevalent. Our estimation implies that schizophrenia is associated with a vast cost-of-illness in Korea. Policymakers, researchers, and physicians need to put effort into shortening the duration of untreated psychosis, guide patients to receive community-care-based services rather than hospital-based services and empower lay people to learn about schizophrenia.


Asunto(s)
Costo de Enfermedad , Costos de la Atención en Salud/estadística & datos numéricos , Gastos en Salud/estadística & datos numéricos , Programas Nacionales de Salud/economía , Esquizofrenia/economía , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , República de Corea/epidemiología , Esquizofrenia/epidemiología , Esquizofrenia/terapia , Adulto Joven
20.
Lancet Public Health ; 5(7): e404-e413, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32619542

RESUMEN

BACKGROUND: One possible policy response to the burden of diet-related disease is food taxes and subsidies, but the net health gains of these approaches are uncertain because of substitution effects between foods. We estimated the health and cost impacts of various food taxes and subsidies in one high-income country, New Zealand. METHODS: In this modelling study, we compared the effects in New Zealand of a 20% fruit and vegetable subsidy, of saturated fat, sugar and salt taxes (each set at a level that increased the total food price by the same magnitude of decrease from the fruit and vegetable subsidy), and of an 8% so-called junk food tax (on non-essential, energy-dense food). We modelled the effect of price changes on food purchases, the consequent changes in fruit and vegetable and sugar-sweetened beverage purchasing, nutrient risk factors, and body-mass index, and how these changes affect health status and health expenditure. The pre-intervention intake for 340 food groups was taken from the New Zealand National Nutrition Survey and the post-intervention intake was estimated using price and expenditure elasticities. The resultant changes in dietary risk factors were then propagated through a proportional multistate lifetable (with 17 diet-related diseases) to estimate the changes in health-adjusted life years (HALYs) and health system expenditure over the 2011 New Zealand population's remaining lifespan. FINDINGS: Health gains (expressed in HALYs per 1000 people) ranged from 127 (95% uncertainty interval 96-167; undiscounted) for the 8% junk food tax and 212 (102-297) for the fruit and vegetable subsidy, up to 361 (275-474) for the saturated fat tax, 375 (272-508) for the salt tax, and 581 (429-792) for the sugar tax. Health expenditure savings across the remaining lifespan per capita (at a 3% discount rate) ranged from US$492 (334-694) for the junk food tax to $2164 (1472-3122) for the sugar tax. INTERPRETATION: The large magnitude of the health gains and cost savings of these modelled taxes and subsidies suggests that their use warrants serious policy consideration. FUNDING: Health Research Council of New Zealand.


Asunto(s)
Asistencia Alimentaria , Alimentos/economía , Costos de la Atención en Salud/estadística & datos numéricos , Salud Poblacional/estadística & datos numéricos , Impuestos , Adulto , Femenino , Frutas/economía , Humanos , Masculino , Modelos Estadísticos , Nueva Zelanda , Verduras/economía
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