Gestión de casos: Análisis de costo eficiencia en continuidad de cuidados de Pacientes crónicos complejos / Case management: cost-effectiveness analysis in continuity of patient care of the Complex Chronic Patients Unit

Objetivo: Evaluar la relación entre los costes asociados al número y días de ingresos previos y posteriores a la inclusión a la Unidad de pacientes crónicos complejos (PCC). Métodos: Se realizó un análisis de coste-efectividad, descriptivo, con cálculo de medias y desviaciones típicas; además de utilizar la t-Student para muestras pareadas, con el software SPSS v20.0, para un nivel de significación alfa <0,05. Los resultados del cómputo se obtuvieron de la Unidad de Codificación de los pacientes captados por la enfermera gestora de casos, y que sobrevivieron un año en seguimiento por la Unidad PCC. Resultados: Se captaron un total de 132 PCC, con un total de 563 ingresos previos, a 204 post inclusión. La media de número de ingresos al año antes fue de 4,27 (DT: 3,35), y se redujo a 1,55 (DT: 1,74). Por otro lado, el número de días de estancia hospitalaria total se redujo de 3.835 a 1.897 días, que equivale una diferencia de coste estimado en 11165.164,36 de euros. La media de días de ingreso antes fue de 29,05, y se redujo a 14,37 días, encontrando una significación estadística (p<0,001) entre días de ingresos previos y posteriores. Conclusiones: La inclusión en la Unidad PCC garantiza, mediante el liderazgo por la enfermera gestora de casos, una mejora coste-efectiva sin gastos añadidos, por optimizar recursos ya existentes interniveles asistenciales, mediante la identificación de PCC y sus necesidades prioritarias, planificación al alta con informes individualizados y garantizando el contacto. (AU)

Objective: Evaluate the relationship between the costs associated with the number and days of admission before and after inclusion in the Complex Chronic Patients Unit (CCP). Methods: A descriptive cost-effectiveness analysis was performed, with calculation of arithmetic averages and standard deviations; in addition to using the t-Student for paired samples, with the SPSS Enfermería GlobalNº 72 Octubre 2023Página 78v20.0 software, for a significance level alpha <0.05. The results of the computation were obtained from the Coding Unit of the patients recruited by the case manager nurse, who survived one year of follow-up by the CCP Unit. Results: A total of 132 CCP were recruited, with a total of 563 previous admissions, which were reduced to 204 post inclusion. The average number of admissions of the previous year was 4.27 (SD: 3.35), and it was reduced to 1.55 (SD: 1.74). On the other hand, the number of days of total hospital stay was reduced from 3,835 to 1,897 days, which is equivalent to a difference in estimated cost of 11,165,164.36 euros. The average number of days of admission before was 29.05, and it was reduced to 14.37 days, finding a statistical significance (p<0.001) between days of admission before and after. Conclusions: Inclusion in the CCP Unit guarantees, through the leadership of the case manager nurse, a cost-effective improvement without added expenses, by optimizing already existing interlevel care resources, through the identification of CCP and their priority needs, discharge planning with reports individualized and guaranteeing contact. (AU)

Comparisons between White and Black Patients Hospitalized with Postliver Transplant Complications/Failure.

OBJECTIVES: The impact of race on patients presenting to North American hospitals with postliver transplant complications/failure (PLTCF) has not been studied fully. We compared in-hospital mortality and resource utilization outcomes between White and Black patients hospitalized with PLTCF. METHODS: This was a retrospective cohort study that evaluated the years 2016 and 2017 from the National Inpatient Sample. Regression analysis was used to determine in-hospital mortality and resource utilization. RESULTS: There were 10,805 hospitalizations for adults with liver transplants who presented with PLTCF. White and Black patients with PLTCF made up 7925 (73.3%) hospitalizations from this population. Among this group, 6480 were White (81.7%) and 1445 were Black (18.2%). Blacks were younger than Whites (mean age ± standard error of the mean: 46.8 ± 1.1 vs 53.6 ± 0.39 years, P < 0.01). Blacks were more likely to be female (53.9% vs 37.4%, P < 0.01). Charlson Comorbidity Index scores were not significantly different (scores ≥3: 46.7% vs 44.2%, P = 0.83). Blacks had significantly higher odds for in-hospital mortality (adjusted odds ratio 2.9, confidence interval [CI] 1.4-6.1; P < 0.01). Hospital charges were higher for Blacks compared with Whites (adjusted mean difference $48,432; 95% CI $2708-$94,157, P = 0.03). Blacks had significantly longer lengths of hospital stays (adjusted mean difference 3.1 days, 95% CI 1.1-5.1, P < 0.01). CONCLUSIONS: Compared with White patients hospitalized for PLTCF, Black patients had higher in-hospital mortality and resource use. Investigation into causes leading to this health disparity is needed to improve in-hospital outcomes.

Impact of Advance Care Planning on the Hospitalization-Associated Utilization and Cost of Patients with Alzheimer's Disease-Related Disorders Receiving Primary Care via Telehealth in a Provider Shortage Area: A Quantitative Pre-Study.

Telehealth has been adopted as an alternative to in-person primary care visits. With multiple participants able to join remotely, telehealth can facilitate the discussion and documentation of advance care planning (ACP) for those with Alzheimer's disease-related disorders (ADRDs). We measured hospitalization-associated utilization outcomes, instances of hospitalization and 90-day re-hospitalizations from payors' administrative databases and verified the data via electronic health records. We estimated the hospitalization-associated costs using the Nevada State Inpatient Dataset and compared the estimated costs between ADRD patients with and without ACP documentation in the year 2021. Compared to the ADRD patients without ACP documentation, those with ACP documentation were less likely to be hospitalized (mean: 0.74; standard deviation: 0.31; p < 0.01) and were less likely to be readmitted within 90 days of discharge (mean: 0.16; standard deviation: 0.06; p < 0.01). The hospitalization-associated cost estimate for ADRD patients with ACP documentation (mean: USD 149,722; standard deviation: USD 80,850) was less than that of the patients without ACP documentation (mean: USD 200,148; standard deviation: USD 82,061; p < 0.01). Further geriatrics workforce training is called for to enhance ACP competencies for ADRD patients, especially in areas with provider shortages where telehealth plays a comparatively more important role.

Global Variations in Heart Failure Etiology, Management, and Outcomes.

Importance: Most epidemiological studies of heart failure (HF) have been conducted in high-income countries with limited comparable data from middle- or low-income countries. Objective: To examine differences in HF etiology, treatment, and outcomes between groups of countries at different levels of economic development. Design, Setting, and Participants: Multinational HF registry of 23 341 participants in 40 high-income, upper-middle-income, lower-middle-income, and low-income countries, followed up for a median period of 2.0 years. Main Outcomes and Measures: HF cause, HF medication use, hospitalization, and death. Results: Mean (SD) age of participants was 63.1 (14.9) years, and 9119 (39.1%) were female. The most common cause of HF was ischemic heart disease (38.1%) followed by hypertension (20.2%). The proportion of participants with HF with reduced ejection fraction taking the combination of a ß-blocker, renin-angiotensin system inhibitor, and mineralocorticoid receptor antagonist was highest in upper-middle-income (61.9%) and high-income countries (51.1%), and it was lowest in low-income (45.7%) and lower-middle-income countries (39.5%) (P < .001). The age- and sex- standardized mortality rate per 100 person-years was lowest in high-income countries (7.8 [95% CI, 7.5-8.2]), 9.3 (95% CI, 8.8-9.9) in upper-middle-income countries, 15.7 (95% CI, 15.0-16.4) in lower-middle-income countries, and it was highest in low-income countries (19.1 [95% CI, 17.6-20.7]). Hospitalization rates were more frequent than death rates in high-income countries (ratio = 3.8) and in upper-middle-income countries (ratio = 2.4), similar in lower-middle-income countries (ratio = 1.1), and less frequent in low-income countries (ratio = 0.6). The 30-day case-fatality rate after first hospital admission was lowest in high-income countries (6.7%), followed by upper-middle-income countries (9.7%), then lower-middle-income countries (21.1%), and highest in low-income countries (31.6%). The proportional risk of death within 30 days of a first hospital admission was 3- to 5-fold higher in lower-middle-income countries and low-income countries compared with high-income countries after adjusting for patient characteristics and use of long-term HF therapies. Conclusions and Relevance: This study of HF patients from 40 different countries and derived from 4 different economic levels demonstrated differences in HF etiologies, management, and outcomes. These data may be useful in planning approaches to improve HF prevention and treatment globally.

Differences in Treatment Patterns and Outcomes of Acute Myocardial Infarction for Low- and High-Income Patients in 6 Countries.

Importance: Differences in the organization and financing of health systems may produce more or less equitable outcomes for advantaged vs disadvantaged populations. We compared treatments and outcomes of older high- and low-income patients across 6 countries. Objective: To determine whether treatment patterns and outcomes for patients presenting with acute myocardial infarction differ for low- vs high-income individuals across 6 countries. Design, Setting, and Participants: Serial cross-sectional cohort study of all adults aged 66 years or older hospitalized with acute myocardial infarction from 2013 through 2018 in the US, Canada, England, the Netherlands, Taiwan, and Israel using population-representative administrative data. Exposures: Being in the top and bottom quintile of income within and across countries. Main Outcomes and Measures: Thirty-day and 1-year mortality; secondary outcomes included rates of cardiac catheterization and revascularization, length of stay, and readmission rates. Results: We studied 289 376 patients hospitalized with ST-segment elevation myocardial infarction (STEMI) and 843 046 hospitalized with non-STEMI (NSTEMI). Adjusted 30-day mortality generally was 1 to 3 percentage points lower for high-income patients. For instance, 30-day mortality among patients admitted with STEMI in the Netherlands was 10.2% for those with high income vs 13.1% for those with low income (difference, -2.8 percentage points [95% CI, -4.1 to -1.5]). One-year mortality differences for STEMI were even larger than 30-day mortality, with the highest difference in Israel (16.2% vs 25.3%; difference, -9.1 percentage points [95% CI, -16.7 to -1.6]). In all countries, rates of cardiac catheterization and percutaneous coronary intervention were higher among high- vs low-income populations, with absolute differences ranging from 1 to 6 percentage points (eg, 73.6% vs 67.4%; difference, 6.1 percentage points [95% CI, 1.2 to 11.0] for percutaneous intervention in England for STEMI). Rates of coronary artery bypass graft surgery for patients with STEMI in low- vs high-income strata were similar but for NSTEMI were generally 1 to 2 percentage points higher among high-income patients (eg, 12.5% vs 11.0% in the US; difference, 1.5 percentage points [95% CI, 1.3 to 1.8 ]). Thirty-day readmission rates generally also were 1 to 3 percentage points lower and hospital length of stay generally was 0.2 to 0.5 days shorter for high-income patients. Conclusions and Relevance: High-income individuals had substantially better survival and were more likely to receive lifesaving revascularization and had shorter hospital lengths of stay and fewer readmissions across almost all countries. Our results suggest that income-based disparities were present even in countries with universal health insurance and robust social safety net systems.

Costs and Survival of Patients having Experienced a Hospitalized Fall-Related Injury in France: A Population-Based Study.

OBJECTIVES: To assess the annual costs 2 years before and 2 years after a hospitalized fall-related injury (HFRI) and the 2-year survival among the population 75+ years old. DESIGN: We performed a population-based, retrospective cohort study using the French national health insurance claims database. SETTING AND PARTICIPANTS: Patients 75+ years old who had experienced a fall followed by hospitalization, identified using an algorithm based on International Classification of Diseases codes. Data related to a non-HFRI population matched on the basis of age, sex, and geographical area were also extracted. METHODS: Cost analyses were performed from a health insurance perspective and included direct costs. Survival analyses were conducted using Kaplan-Meier curves and Cox regression. Descriptive analyses of costs and regression modeling were carried out. Both regression models for costs and on survival were adjusted for age, sex, and comorbidities. RESULTS: A total of 1495 patients with HFRI and 4484 non-HFRI patients were identified. Patients with HFRI were more comorbid than the non-HFRI patients over the entire periods, particularly in the year before and the year after the HFRI. Patients with HFRI have significantly worse survival probabilities, with an adjusted 2.14-times greater risk of death over 2-year follow-up and heterogeneous effects determined by sex. The annual incremental costs between patients with HFRI and non-HFRI individuals were €1294 and €2378, respectively, 2 and 1 year before the HFRI, and €11,796 and €1659, respectively, 1 and 2 years after the HFRI. The main cost components differ according to the periods and are mainly accounted for by paramedical acts, hospitalizations, and drug costs. When fully adjusted, the year before the HFRI and the year after the HFRI are associated with increase in costs. CONCLUSIONS AND IMPLICATIONS: We have provided real-world estimates of the cost and the survival associated with patients with HFRI. Our results highlight the urgent need to manage patients with HFRI at an early stage to reduce the significant mortality as well as substantial additional cost management. Special attention must be paid to the fall-related increasing drugs and to optimizing management of comorbidities.

Hospitalization costs of injury in elderly population in China: a quantile regression analysis.

BACKGROUND: Trauma in the elderly is gradually growing more prevalent as the aging population increases over time. The purpose of this study is to assess hospitalization costs of the elderly trauma population and analyze the association between those costs and the features of the elderly trauma population. METHODS: In a retrospective analysis, data on trauma patients over 65 who were admitted to the hospital for the first time due to trauma between January 2017 and March 2022 was collected from a tertiary comprehensive hospital in Baotou. We calculated and analyzed the hospitalization cost components. According to various therapeutic approaches, trauma patients were divided into two subgroups: non-surgical patients (1320 cases) and surgical patients (387 cases). Quantile regression was used to evaluate the relationship between trauma patients and hospitalization costs. RESULTS: This study comprised 1707 trauma patients in total. Mean total hospitalization costs per patient were ¥20,741. Patients with transportation accidents incurred the highest expenditures among those with external causes of trauma, with a mean hospitalization cost of ¥24,918, followed by patients with falls at ¥19,809 on average. Hospitalization costs were dominated by medicine costs (¥7,182 per capita). According to the quantile regression results, all trauma patients' hospitalization costs were considerably increased by length of stay, surgery, the injury severity score (16-24), multimorbidity, thorax injury, and blood transfusion. For non-surgical patients, length of stay, multimorbidity, and the injury severity score (16-24) were all substantially linked to higher hospitalization costs. For surgical patients, length of stay, injury severity score (16-24), and hip and thigh injuries were significantly associated with greater hospitalization costs. CONCLUSIONS: Using quantile regression to identify factors associated with hospitalization costs could be helpful for addressing the burden of injury in the elderly population. Policymakers may find these findings to be insightful in lowering hospitalization costs related to injury in the elderly population.

Out-of-Pocket Spending for Non-Birth-Related Hospitalizations of Privately Insured US Children, 2017 to 2019.

Importance: Privately insured US children account for 40% of non-birth-related pediatric hospitalizations. However, there are no national data on the magnitude or correlates of out-of-pocket spending for these hospitalizations. Objective: To estimate out-of-pocket spending for non-birth-related hospitalizations among privately insured children and identify factors associated with this spending. Design, Setting, and Participants: This study is a cross-sectional analysis of the IBM MarketScan Commercial Database, which reports claims from 25 to 27 million privately insured enrollees annually. In the primary analysis, all non-birth-related hospitalizations of children 18 years and younger from 2017 through 2019 were included. In a secondary analysis focused on insurance benefit design, hospitalizations that could be linked to the IBM MarketScan Benefit Plan Design Database and were covered by plans with a family deductible and inpatient coinsurance requirements were analyzed. Main Outcomes and Measures: In the primary analysis, factors associated with out-of-pocket spending per hospitalization (sum of deductibles, coinsurance, and copayments) were identified using a generalized linear model. In the secondary analysis, variation in out-of-pocket spending was assessed by level of deductible and inpatient coinsurance requirements. Results: Among 183 780 hospitalizations in the primary analysis, 93 186 (50.7%) were for female children, and the median (IQR) age of hospitalized children was 12 (4-16) years. A total of 145 108 hospitalizations (79.0%) were for children with a chronic condition and 44 282 (24.1%) were covered by a high-deductible health plan. Mean (SD) total spending per hospitalization was $28 425 ($74 715). Mean (SD) and median (IQR) out-of-pocket spending per hospitalization were $1313 ($1734) and $656 ($0-$2011), respectively. Out-of-pocket spending exceeded $3000 for 25 700 hospitalizations (14.0%). Factors associated with higher out-of-pocket spending included hospitalization in quarter 1 compared with quarter 4 (average marginal effect [AME], $637; 99% CI, $609-$665) and lack of chronic conditions compared with having a complex chronic condition (AME, $732; 99% CI, $696-$767). The secondary analysis included 72 165 hospitalizations. Among hospitalizations covered by the least generous plans (deductible of $3000 or more and coinsurance of 20% or more) and most generous plans (deductible less than $1000 and coinsurance of 1% to 19%), mean (SD) out-of-pocket spending was $1974 ($1999) and $826 ($798), respectively (AME, $1123; 99% CI, $1069-$1179). Conclusions and Relevance: In this cross-sectional study, out-of-pocket spending for non-birth-related pediatric hospitalizations were substantial, especially when they occurred early in the year, involved children without chronic conditions, or were covered by plans with high cost-sharing requirements.

Racial Disparities in the Cost of Unplanned Hospitalizations after Breast Reconstruction.

BACKGROUND: Given the national attention to disparities in health care, understanding variation provided to minorities becomes increasingly important. This study will examine the effect of race on the rate and cost of unplanned hospitalizations after breast reconstruction procedures. METHODS: The authors performed an analysis comparing patients undergoing implant-based and autologous breast reconstruction in the Healthcare Cost and Utilization Project. The authors evaluated the rate of unplanned hospitalizations and associated expenditures among patients of different races. Multivariable analyses were performed to determine the association among race and readmissions and health care expenditures. RESULTS: The cohort included 17,042 patients. The rate of an unplanned visit was 5%. The rates of readmissions among black patients (6%) and Hispanic patients (7%) in this study are higher compared with white patients (5%). However, after controlling for patient-level characteristics, race was not an independent predictor of an unplanned visit. In our expenditure model, black patients [adjusted cost ratio, 1.35 (95% CI, 1.11 to 1.66)] and Hispanic patients [adjusted cost ratio, 1.34 (95% CI, 1.08 to 1.65)] experienced greater cost for their readmission compared with white patients. CONCLUSIONS: Although race is not an independent predictor of an unplanned hospital visit after surgery, racial minorities bear a higher cost burden after controlling for insurance status, further stimulating health care disparities. Adjusted payment models may be a strategy to reduce disparities in surgical care. In addition, direct and indirect measures of disparities should be used when examining health care disparities to identify consequences of inequities more robustly.

Differences in the pattern and cost of hospital care between Indigenous and non-Indigenous Australians with cirrhosis: an exploratory study.

BACKGROUND: Liver diseases are important contributors to the mortality gap between Indigenous and non-Indigenous Australians. AIMS: This cohort study examined factors associated with hospital admissions and healthcare outcomes among Indigenous Australians with cirrhosis. METHODS: Patient-reported outcomes were obtained by face-to-face interview (Chronic Liver Disease Questionnaire and Short Form 36 (SF-36)). Clinical data were extracted from medical records and through data linkage for 534 patients (25 indigenous). Cumulative overall survival (Kaplan-Meier), rates of hospital admissions and emergency presentations, and costs were assessed by indigenous status. Incidence rate ratios (IRR; Poisson regression) were reported. RESULTS: Indigenous Australians admitted to hospital with cirrhosis had lower educational status compared with non-indigenous patients (79.2% vs 43.4%; P < 0.001). The two groups had, in general, similar clinical characteristics including disease severity (P = 0.78), presence of cirrhosis complications (P = 0.67), comorbidities (P = 0.62), rates of cirrhosis-related admissions (P = 0.86) and 5-year survival (P = 0.30). However, indigenous patients had a lower score in the SF-36 domain related to bodily pain (P = 0.037), more cirrhosis admissions via the emergency department (IRR = 1.42, 95% confidence interval (CI) 1.10-1.83) and fewer planned cirrhosis admissions (IRR = 0.32, 95% CI 0.14-0.72). The total cost for cirrhosis-related hospital admissions for 534 patients over 6 years (July 2012 to June 2018) was A$13.7 million. The cost of cirrhosis-related hospital admissions was double for indigenous patients (cost ratio = 2.04, 95% CI 2.04-2.05). CONCLUSIONS: Our data highlight the disparities in health service use and patient-reported outcomes, despite having similar clinical profiles. Integration between primary care, Aboriginal Community Controlled Health Organisations and liver specialists is critical for appropriate health service delivery and effective use of resources. Chronic liver disease costs the community dearly.

Hospitalization cost of Pressurized Intraperitoneal Aerosol chemotherapy (PIPAC).

INTRODUCTION: Pressurized Intraperitoneal Aerosol chemotherapy (PIPAC) is a new surgical technique for the treatment of unresectable peritoneal carcinomatosis. Very little data is available on the costs of this treatment in France as there is currently no code for PIPAC in the French Common Classification of Medical Acts (CCAM). Our objective was to estimate the mean cost of hospitalization for PIPAC in two French public teaching hospitals. METHODS: The mean cost of hospitalization was estimated from the mean fixed-rate remuneration paid to the hospital and the mean additional costs of treatment paid by the hospital. At discharge a patient's hospitalization is classified into a diagnosis related group, which determines the fixed-rate remuneration paid to the hospital (obtained from the national hospitals database - PMSI). Costs of medical devices and drug treatments specific to PIPAC, not covered by the fixed-rate remuneration, were obtained from the hospital pharmacies. RESULTS: Between July 2016 and November 2021, 205 PIPAC procedures were performed on 79 patients (mean procedures per patient = 2.6). Mean operating room occupancy was 165 min. The mean fixed-rate remuneration received by the hospitals per PIPAC hospitalization was €4031. The actual mean cost per hospitalization was €6562 for a mean length-of-stay of 3.3 days. Thus, each PIPAC hospitalization cost the hospital €2531 on average. CONCLUSION: The current reimbursement of PIPAC treatment by the national health system is insufficient and represents only 61% of the real cost. The creation of a new fixed-rate remuneration for PIPAC taking into account this cost differential is necessary.

Estimating the economic impact of acute coronary syndrome in New Zealand over time (ANZACS-QI 64): a national registry-based cost burden study.

OBJECTIVES: To estimate the changes in costs associated with acute coronary syndrome (ACS) admissions in New Zealand (NZ) public hospitals over a 12-year period. DESIGN: A cost-burden study of ACS in NZ was conducted from the NZ healthcare system perspective. SETTING: Hospital admission costs were estimated using relevant diagnosis-related groups and their costs for publicly funded casemix hospitalisations, and applied to 190 364 patients with ACS admitted to NZ public hospitals between 2007 and 2018 identified from routine national hospital datasets. Trends in the costs of index ACS hospitalisation, hospital admissions costs, coronary revascularisation and all-cause mortality up to 1 year were evaluated. All costs were presented as 2019 NZ dollars. PRIMARY OUTCOME MEASURES: Healthcare costs attributed to ACS admissions in NZ over time. RESULTS: Between 2007 and 2018, there was a 42% decrease in costs attributed to ACS (NZ$7.7 million (M) to NZ$4.4 M per 100 000 per year), representing a decrease of NZ$298 827 per 100 000 population per year. Mean admission costs associated with each admission declined from NZ$18 411 in 2007 to NZ$16 898 over this period (p<0.001) after adjustment for key clinical and procedural characteristics. These reductions were against a background of increased use of coronary revascularisation (23.1% (2007) to 38.1% (2018)), declining ACS admissions (366-252 per 100 000 population) and an improvement in 1-year survival post-ACS. Nevertheless, the total ACS cost burden remained considerable at NZ$237 M in 2018. CONCLUSIONS: The economic cost of hospitalisations for ACS in NZ decreased considerably over time. Further studies are warranted to explore the association between reductions in ACS cost burden and changes in the management of ACS.

Epidemiology, healthcare utilization, and related costs among patients with IPF: results from a German claims database analysis.

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a progressive form of fibrosing interstitial pneumonia with poor survival. This study provides insight into the epidemiology, cost, and disease course of IPF in Germany. METHODS: A cohort of incident patients with IPF (n = 1737) was identified from German claims data (2014-2019). Incidence and prevalence rates were calculated and adjusted for age differences compared with the overall German population. All-cause and IPF-related healthcare resource utilization as well as associated costs were evaluated per observed person-year (PY) following the initial IPF diagnosis. Finally, Kaplan-Meier analyses were performed to assess time from initial diagnosis to disease deterioration (using three proxy measures: non-elective hospitalization, IPF-related hospitalization, long-term oxygen therapy [LTOT]); antifibrotic therapy initiation; and all-cause death. RESULTS: The cumulative incidence of IPF was estimated at 10.7 per 100,000 individuals in 2016, 10.9 in 2017, 10.5 in 2018, and 9.6 in 2019. The point prevalence rates per 100,000 individuals for the respective years were 21.7, 23.5, 24.1, and 24.1. On average, ≥ 14 physician visits and nearly two hospitalizations per PY were observed after the initial IPF diagnosis. Of total all-cause direct costs (€15,721/PY), 55.7% (€8754/PY) were due to hospitalizations and 29.1% (€4572/PY) were due to medication. Medication accounted for 49.4% (€1470/PY) and hospitalizations for 34.8% (€1034/PY) of total IPF-related direct costs (€2973/PY). Within 2 years of the initial IPF diagnosis (23.6 months), 25% of patients died. Within 5 years of diagnosis, 53.1% of patients had initiated LTOT; only 11.6% were treated with antifibrotic agents. The median time from the initial diagnosis to the first non-elective hospitalization was 5.5 months. CONCLUSION: The incidence and prevalence of IPF in Germany are at the higher end of the range reported in the literature. The main driver for all-cause cost was hospitalization. IPF-related costs were mainly driven by medication, with antifibrotic agents accounting for around one-third of the total medication costs even if not frequently prescribed. Most patients with IPF do not receive pharmacological treatment, highlighting the existing unmet medical need for effective and well-tolerated therapies.

Hospitalization costs of coronaviruses diseases in upper-middle-income countries: A systematic review.

BACKGROUND: COVID-19, SARS and MERS are diseases that present an important health burden worldwide. This situation demands resource allocation to the healthcare system, affecting especially middle- and low-income countries. Thus, identifying the main cost drivers is relevant to optimize patient care and resource allocation. OBJECTIVE: To systematically identify and summarize the current status of knowledge on direct medical hospitalization costs of SARS, MERS, or COVID-19 in Upper-Middle-Income Countries. METHODS: We conducted a systematic review across seven key databases (PubMed, EMBASE, BVS Portal, CINAHL, CRD library, MedRxiv and Research Square) from database inception to February 2021. Costs extracted were converted into 2021 International Dollars using the Purchasing Power Parity-adjusted. The assessment of quality was based on the protocol by the BMJ and CHEERS. PROSPERO 2020: CRD42020225757. RESULTS: No eligible study about SARS or MERS was recovered. For COVID-19, five studies presented cost analysis performed in Brazil, China, Iran, and Turkey. Regarding total direct medical costs, the lowest cost per patient at ward was observed in Turkey ($900.08), while the highest in Brazil ($5,093.38). At ICU, the lowest was in Turkey ($2,984.78), while the highest was in China ($52,432.87). Service care was the most expressive (58% to 88%) cost driver of COVID-19 patients at ward. At ICU, there was no consensus between service care (54% to 87%) and treatment (72% to 81%) as key burdens of total cost. CONCLUSION: Our findings elucidate the importance of COVID-19 on health-economic outcomes. The marked heterogeneity among studies leaded to substantially different results and made challenging the comparison of data to estimate pooled results for single countries or regions. Further studies concerning cost estimates from standardized analysis may provide clearer data for a more substantial analysis. This may help care providers and policy makers to organize care for patients in the most efficient way.

Gastos de bolsillo por gastroenteritis a causa de rotavirus en el Hospital Pediátrico de Cienfuegos, 2019 - 2020 / Out-Of-Pocket Expenses for Gastroenteritis Due to Rotavirus at Cienfuegos Pediatric Hospital, 2019 - 2020

Introducción: La hospitalización por enfermedades diarreicas agudas en menores de cinco años de edad puede generar gastos importantes para la familia. Objetivo: Estimar el gasto de bolsillo y el costo indirecto por la atención a pacientes menores de cinco años de edad hospitalizados por gastroenteritis a causa de rotavirus. Métodos: Estudio de descripción de costos. Se empleó el microcosteo para estimar el costo directo médico (servicio y medicamentos) y no médico (transporte, alimentación, aseo), así como las pérdidas de productividad para el paciente y su familia y las fuentes de financiamiento. Se trabajó con 132 pacientes hospitalizados en el Hospital Pediátrico de Cienfuegos entre septiembre de 2019 y febrero de 2020 con gastroenteritis y test rápido de rotavirus positivo. El gasto se analizó según la situación económica referida y la edad del paciente. Resultados: La media del gasto de bolsillo total fue de CUP 809,66 (IC 95 por ciento 757,57 - 861,75); el 50,8 por ciento por alimentación, el 31,4 por ciento por aseo y un 17,8 por ciento por transportación. Los hogares con mejor situación económica gastaron más (< 0,001). El 87,2 por ciento de las familias utilizó alguna fuente de recursos adicional a sus ingresos habituales. Se afectaron 2,39 personas (IC 95 por ciento 2,27 - 2,52) y se reportó una pérdida de 5,51 días laborales (IC 95 por ciento 5,21 - 5,8). El costo indirecto promedio fue de CUP 418,8 (IC 95 por ciento 382,36 - 455,24). Conclusiones: La hospitalización de un menor de cinco años por gastroenteritis aguda a causa de rotavirus en Cienfuegos significa una carga económica considerable para los hogares, en especial para los de mejor situación económica(AU)

Introduction: Hospitalization for acute diarrheal diseases in children under five years of age can generate significant expenses for the family. Objective: To assess the out-of-pocket expense and the indirect cost for the care of patients under five years of age hospitalized for gastroenteritis due to rotavirus. Methods: This is cost description study. Microcosting was used to estimate the direct medical cost (service and medication) and non-medical cost (transportation, food, cleaning), as well as the productivity losses for patients and their family and the sources of financing. We worked with 132 patients hospitalized at Cienfuegos Pediatric Hospital from September 2019 to February 2020 with gastroenteritis and a positive rotavirus rapid test. Expenditure was analyzed according to the economic situation referred to and the age of the patient. Results: The mean total out-of-pocket expense was CUP 809.66 (95percent CI 757.57 - 861.75); 50.8percent for food, 31.4percent for cleaning and 17.8percent for transportation. Households with better economic situation spent more (<0.001). 87.2percent of the families used some source of resources in addition to their usual income. 2.39 people were affected (95percent CI 2.27 - 2.52) and a loss of 5.51 working days was reported (95percent CI 5.21 - 5.8). The average indirect cost was CUP 418.8 (95percent CI 382.36 - 455.24). Conclusions: The hospitalization of a child under five years of age for acute gastroenteritis due to rotavirus in Cienfuegos represents a considerable economic burden for families, especially for those with better economic situation(AU)

Profile and costs of dengue hospitalizations in Southeast Pará from the SUS perspective (2000-2015) / Perfil e custos das internações por dengue no Sudeste do Pará na perspectiva do SUS (2000-2015) / Perfil y costos de las hospitalizaciones por dengue en el Sudeste de Pará en la perspectiva del SUS (2000-2015)

Background and objectives: Considering the little evidence associated with dengue hospitalizations, their public expenditures in Southeast Pará and its relevance to the public health in Brazil, this study aims to demonstrate the records of hospitalizations and expenses associated with this arbovirus between 2000 and 2015 from the perspective of the Unified Health System (SUS). Methods: This is a descriptive research that sought to assess the records and expenses (USD) of hospitalization caused by dengue (SUS code: 74500457, 74300440, 0303010010) and severe dengue (SUS code: 74300628, 74500627, 0303010029), as well as their associated deaths (CID: A90 and A91), respectively, from the SIH/SUS and SIM/SUS from 2000 to 2015 for all 39 municipalities in the southeast of Pará. Results: A total of 1206 deaths, 22,860 individuals with dengue and 306 with severe dengue underwent services in the SUS between 2000 and 2015, representing 23,166 hospitalizations (23,613: dengue and 313: severe dengue), in which Bom Jesus do Tocantins and Goianésia do Pará represent the municipalities with the highest number of hospitalizations associated with dengue. Conclusion: It is possible to verify the relevance of continuing efforts to combat and fight dengue in southeastern Pará. It reinforces the need to conduct studies that contribute to a better understanding of the distribution of hospitalizations and deaths in the different municipalities of the state of Pará, as well as reflections on the epidemiological and economic scenario for the implementation of a rational and efficient decision-making process.(AU)

Justificativa e objetivos: Considerando as poucas evidências associadas às internações por dengue, seus gastos públicos no Sudeste do Pará e sua relevância para a saúde pública no Brasil, este estudo tem como objetivo demonstrar os registros de internações e gastos associados a esta arbovirose entre 2000 e 2015 a partir da perspectiva do Sistema Único de Saúde (SUS). Métodos: Trata-se de uma pesquisa descritiva que buscou avaliar os registros e gastos (USD) de internação por dengue (código SUS: 74500457, 74300440, 0303010010) e dengue grave (código SUS: 74300628, 74500627, 0303010029), bem como seus óbitos associados (CID: A90 e A91), respectivamente, do SIH/SUS e SIM/SUS de 2000 a 2015 para todos os 39 municípios do sudeste paraense. Resultados: Um total de 1.206 óbitos, 22.860 indivíduos com dengue e 306 com dengue grave foram atendidos no SUS entre 2000 e 2015, representando 23.166 internações (23.613: dengue e 313: dengue grave), nas quais Bom Jesus do Tocantins e Goianésia do O Pará representa os municípios com maior número de internações associadas à dengue. Conclusão: É possível verificar a relevância da continuidade dos esforços de combate e combate à dengue no sudeste paraense. Reforça a necessidade da realização de estudos que contribuam para um melhor entendimento da distribuição das internações e óbitos nos diferentes municípios do estado do Pará, bem como reflexões sobre o cenário epidemiológico e econômico para a implementação de um processo decisório racional e eficiente. Fazendo processo.(AU)

Justificación y objetivos: Considerando la poca evidencia asociada a las hospitalizaciones por dengue, sus gastos públicos en el Sudeste de Pará y su relevancia para la salud pública en Brasil, este estudio tiene como objetivo demostrar los registros de hospitalizaciones y gastos asociados a este arbovirus entre 2000 y 2015 a partir de la perspectiva del Sistema Único de Salud (SUS). Métodos: Se trata de una investigación descriptiva que buscó evaluar los registros y gastos (USD) de hospitalización por dengue (código SUS: 74500457, 74300440, 0303010010) y dengue grave (código SUS: 74300628, 74500627, 0303010029), así como sus muertes asociadas (CID: A90 y A91), respectivamente, del SIH/SUS y SIM/SUS de 2000 a 2015 para los 39 municipios del sureste de Pará. Resultados: Un total de 1206 muertes, 22.860 personas con dengue y 306 con dengue grave fueron atendidos en el SUS entre 2000 y 2015, lo que representa 23.166 hospitalizaciones (23.613: dengue y 313: dengue grave), en las que Bom Jesus do Tocantins y Goianésia hacen Pará representan los municipios con mayor número de hospitalizaciones asociadas al dengue. Conclusión: Es posible verificar la relevancia de continuar los esfuerzos para combatir y luchar contra el dengue en el sureste de Pará. Refuerza la necesidad de realizar estudios que contribuyan a una mejor comprensión de la distribución de hospitalizaciones y muertes en los diferentes municipios del estado de Pará, así como reflexiones sobre el escenario epidemiológico y económico para la implementación de una decisión racional y eficiente. proceso de fabricación.(AU)

A baseline profile of the Queensland Cardiac Record Linkage Cohort (QCard) study.

BACKGROUND: Cardiovascular disease (CVD) is one of the leading causes of death in Australia. Longitudinal record linkage studies have the potency to influence clinical decision making to improve cardiac health. This paper describes the baseline characteristics of the Queensland Cardiac Record Linkage Cohort study (QCard). METHODS: International Classification of Disease, 10th Revision Australian Modification (ICD-10-AM) diagnosis codes were used to identify CVD and comorbidities. Cost and adverse health outcomes (e.g., comorbidities, hospital-acquired complications) were compared between first-time and recurrent admissions. Descriptive statistics and standard tests were used to analyse the baseline data. RESULTS: There were 132,343 patients with hospitalisations in 2010, of which 47% were recurrent admissions, and 53% were males. There were systematic differences between characteristics of recurrent and first-time hospitalisations. Patients with recurrent episodes were nine years older (70 vs. 61; p < 0.001) and experienced a twice higher risk of multiple comorbidities (3.17 vs. 1.59; p < 0.001). CVD index hospitalisations were concentrated in large metropolitan hospitals. CONCLUSIONS: Our study demonstrates that linked administrative health data provide an effective tool to investigate factors determining the progress of heart disease. Our main finding suggests that recurrent admissions were associated with higher hospital costs and a higher risk of having adverse outcomes.