Costs of Hospital Stay in Specialized Diabetic Foot Department in Russia.

BACKGROUND: Diabetic foot ulcer (DFU) is considered to be one of the most common and costly diabetic complications. The approach unanimously recommended for patients with DFU is treatment by a multidisciplinary foot care team, which in Russia mainly is limited to few federal and regional hospitals. Currently, financing schemes for medical institutions are changing, thus raising the issue of setting adequate tariffs. OBJECTIVE: To identify the cost of treatment in the specialized diabetic foot department and determinants of variation in cost among individual patients with DFU in the Russian setting from the perspective of a health care organization. METHODS: We collected data on treatment cost per admission to the Diabetic Foot Department of the Endocrinology Scientific Center and information on patients' characteristics derived from medical records. Data on costs were analyzed, and descriptive statistics are reported. A standard multiple regression analysis was performed to identify the main drivers of treatment cost for patients with DFU. RESULTS: The mean treatment cost was €3051. The mean cost of treatment for patients with DFU was significantly higher than that for diabetic patients without this complication. The most relevant predictors of the costs of treatment for patients with DFU were surgery provided and length of stay in hospital. CONCLUSIONS: The cost for treatment of DFU by a multidisciplinary team in the federal medical institution was substantially higher than basic medical insurance tariff for this disease. Because revascularization procedures appeared to be the main cost driver, our results stress the need for careful implementation of this type of treatment for patients with DFU.

The Cost of Melanoma and Kidney, Prostate, and Ovarian Cancers in Russia.

OBJECTIVE: The objective of this study was to assess the total annual economic burden of melanoma and kidney, prostate, and ovarian cancers in Russia using the unified methods. METHODS: The general prevalence-based cost-of-illness model was developed to evaluate the annual health and social care costs and value of lost productivity attributable to the following cancers: melanoma and kidney, prostate, and ovarian cancers from the perspective of the overall governmental budget. All costs were calculated using the "bottom-up" costing technique for the total population of patients with studied cancer, including both newly diagnosed patients stratified by cancer stage and patients diagnosed in previous years who were still alive in the study year. RESULTS: The lowest aggregate annual cost was found for melanoma-€17.48 million (52.4% health care costs, 34.9% social care costs, 12.7% attributed to productivity loss) and the highest-€84.52 million-for prostate cancer (72.0%, 19.0%, and 9.0%, respectively). Estimations for kidney and ovarian cancers were €45.33 and €45.56 million, respectively, with a similar distribution (42.5%-45.2% health care costs, 39.0%-40.3% social care costs, 14.5%-18.5% lost productivity). Cost for a newly diagnosed patient was several times higher than for a patient diagnosed in previous years (€1144- €1947 vs. €145-€417, respectively). For patients in the first year after diagnosis, the major part of economic burden was attributed to health care costs, whereas for those diagnosed before the study year, costs not related to health were more prominent, except for prostate cancer. CONCLUSIONS: The economic impact of cancers is more prominent during the first year after diagnosis. A considerable part of the economic burden of cancer lies outside the health sector.