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1.
Artigo em Inglês | MEDLINE | ID: mdl-33066327

RESUMO

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.


Assuntos
Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/terapia , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/economia , Pneumonia Viral/mortalidade , Pneumonia Viral/terapia , Idoso , Infecções por Coronavirus/economia , Feminino , Humanos , Masculino , Pandemias/economia , Pneumonia Viral/economia , Arábia Saudita/epidemiologia , Análise de Sobrevida
2.
Epidemiol Psychiatr Sci ; 29: e169, 2020 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-32996442

RESUMO

AIMS: Many people who are homeless with severe mental illnesses are high users of healthcare services and social services, without reducing widen health inequalities in this vulnerable population. This study aimed to determine whether independent housing with mental health support teams with a recovery-oriented approach (Housing First (HF) program) for people who are homeless with severe mental disorders improves hospital and emergency department use. METHODS: We did a randomised controlled trial in four French cities: Lille, Marseille, Paris and Toulouse. Participants were eligible if they were 18 years or older, being absolutely homeless or precariously housed, with a diagnosis of schizophrenia (SCZ) or bipolar disorder (BD) and were required to have a high level of needs (moderate-to-severe disability and past hospitalisations over the last 5 years or comorbid alcohol or substance use disorder). Participants were randomly assigned (1:1) to immediate access to independent housing and support from the Assertive Community Treatment team (social worker, nurse, doctor, psychiatrist and peer worker) (HF group) or treatment as usual (TAU group) namely pre-existing dedicated homeless-targeted programs and services. Participants and interviewers were unmasked to assignment. The primary outcomes were the number of emergency department (ED) visits, hospitalisation admissions and inpatient days at 24 months. Secondary outcomes were recovery (Recovery Assessment Scale), quality of life (SQOL and SF36), mental health symptoms, addiction issues, stably housed days and cost savings from a societal perspective. Intention-to-treat analysis was performed. RESULTS: Eligible patients were randomly assigned to the HF group (n = 353) or TAU group (n = 350). No differences were found in the number of hospital admissions (relative risk (95% CI), 0.96 (0.76-1.21)) or ED visits (0.89 (0.66-1.21)). Significantly less inpatient days were found for HF v. TAU (0.62 (0.48-0.80)). The HF group exhibited higher housing stability (difference in slope, 116 (103-128)) and higher scores for sub-dimensions of S-QOL scale (psychological well-being and autonomy). No differences were found for physical composite score SF36, mental health symptoms and rates of alcohol or substance dependence. Mean difference in costs was €-217 per patient over 24 months in favour of the HF group. HF was associated with cost savings in healthcare costs (RR 0.62(0.48-0.78)) and residential costs (0.07 (0.05-0.11)). CONCLUSION: An immediate access to independent housing and support from a mental health team resulted in decreased inpatient days, higher housing stability and cost savings in homeless persons with SCZ or BP disorders.


Assuntos
Serviços Comunitários de Saúde Mental/métodos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pessoas em Situação de Rua/psicologia , Habitação/estatística & dados numéricos , Adulto , Alcoolismo/complicações , Alcoolismo/epidemiologia , Transtorno Bipolar/complicações , Transtorno Bipolar/epidemiologia , Comorbidade , Feminino , França/epidemiologia , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Avaliação de Programas e Projetos de Saúde/métodos , Qualidade de Vida , Esquizofrenia/complicações , Esquizofrenia/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
3.
BMC Public Health ; 20(1): 1464, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993588

RESUMO

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.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/economia , Influenza Humana/economia , Vacinação/economia , Adulto , Inglaterra , Feminino , Recursos em Saúde , Hospitalização/estatística & dados numéricos , Humanos , Classificação Internacional de Doenças , Masculino , Pessoa de Meia-Idade , Estações do Ano , Vacinação/estatística & dados numéricos
4.
Cochrane Database Syst Rev ; 9: CD012780, 2020 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-32996586

RESUMO

BACKGROUND: Serious illness is often characterised by physical/psychological problems, family support needs, and high healthcare resource use. Hospital-based specialist palliative care (HSPC) has developed to assist in better meeting the needs of patients and their families and potentially reducing hospital care expenditure. There is a need for clarity on the effectiveness and optimal models of HSPC, given that most people still die in hospital and also to allocate scarce resources judiciously. OBJECTIVES: To assess the effectiveness and cost-effectiveness of HSPC compared to usual care for adults with advanced illness (hereafter patients) and their unpaid caregivers/families. SEARCH METHODS: We searched CENTRAL, CDSR, DARE and HTA database via the Cochrane Library; MEDLINE; Embase; CINAHL; PsycINFO; CareSearch; National Health Service Economic Evaluation Database (NHS EED) and two trial registers to August 2019, together with checking of reference lists and relevant systematic reviews, citation searching and contact with experts to identify additional studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) evaluating the impact of HSPC on outcomes for patients or their unpaid caregivers/families, or both. HSPC was defined as specialist palliative care delivered by a palliative care team that is based in a hospital providing holistic care, co-ordination by a multidisciplinary team, and collaboration between HSPC providers and generalists. HSPC was provided to patients while they were admitted as inpatients to acute care hospitals, outpatients or patients receiving care from hospital outreach teams at home. The comparator was usual care, defined as inpatient or outpatient hospital care without specialist palliative care input at the point of entry into the study, community care or hospice care provided outside of the hospital setting. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. We assessed risk of bias and extracted data. To account for use of different scales across studies, we calculated standardised mean differences (SMDs) with 95% confidence intervals (CIs) for continuous data. We used an inverse variance random-effects model. For binary data, we calculated odds ratio (ORs) with 95% CIs. We assessed the evidence using GRADE and created a 'Summary of findings' table. Our primary outcomes were patient health-related quality of life (HRQoL) and symptom burden (a collection of two or more symptoms). Key secondary outcomes were pain, depression, satisfaction with care, achieving preferred place of death, mortality/survival, unpaid caregiver burden, and cost-effectiveness. Qualitative data was analysed where available. MAIN RESULTS: We identified 42 RCTs involving 7779 participants (6678 patients and 1101 caregivers/family members). Twenty-one studies were with cancer populations, 14 were with non-cancer populations (of which six were with heart failure patients), and seven with mixed cancer and non-cancer populations (mixed diagnoses). HSPC was offered in different ways and included the following models: ward-based, inpatient consult, outpatient, hospital-at-home or hospital outreach, and service provision across multiple settings which included hospital. For our main analyses, we pooled data from studies reporting adjusted endpoint values. Forty studies had a high risk of bias in at least one domain. Compared with usual care, HSPC improved patient HRQoL with a small effect size of 0.26 SMD over usual care (95% CI 0.15 to 0.37; I2 = 3%, 10 studies, 1344 participants, low-quality evidence, higher scores indicate better patient HRQoL). HSPC also improved other person-centred outcomes. It reduced patient symptom burden with a small effect size of -0.26 SMD over usual care (95% CI -0.41 to -0.12; I2 = 0%, 6 studies, 761 participants, very low-quality evidence, lower scores indicate lower symptom burden). HSPC improved patient satisfaction with care with a small effect size of 0.36 SMD over usual care (95% CI 0.41 to 0.57; I2 = 0%, 2 studies, 337 participants, low-quality evidence, higher scores indicate better patient satisfaction with care). Using home death as a proxy measure for achieving patient's preferred place of death, patients were more likely to die at home with HSPC compared to usual care (OR 1.63, 95% CI 1.23 to 2.16; I2 = 0%, 7 studies, 861 participants, low-quality evidence). Data on pain (4 studies, 525 participants) showed no evidence of a difference between HSPC and usual care (SMD -0.16, 95% CI -0.33 to 0.01; I2 = 0%, very low-quality evidence). Eight studies (N = 1252 participants) reported on adverse events and very low-quality evidence did not demonstrate an effect of HSPC on serious harms. Two studies (170 participants) presented data on caregiver burden and both found no evidence of effect of HSPC (very low-quality evidence). We included 13 economic studies (2103 participants). Overall, the evidence on cost-effectiveness of HSPC compared to usual care was inconsistent among the four full economic studies. Other studies that used only partial economic analysis and those that presented more limited resource use and cost information also had inconsistent results (very low-quality evidence). Quality of the evidence The quality of the evidence assessed using GRADE was very low to low, downgraded due to a high risk of bias, inconsistency and imprecision. AUTHORS' CONCLUSIONS: Very low- to low-quality evidence suggests that when compared to usual care, HSPC may offer small benefits for several person-centred outcomes including patient HRQoL, symptom burden and patient satisfaction with care, while also increasing the chances of patients dying in their preferred place (measured by home death). While we found no evidence that HSPC causes serious harms, the evidence was insufficient to draw strong conclusions. Although these are only small effect sizes, they may be clinically relevant at an advanced stage of disease with limited prognosis, and are person-centred outcomes important to many patients and families. More well conducted studies are needed to study populations with non-malignant diseases and mixed diagnoses, ward-based models of HSPC, 24 hours access (out-of-hours care) as part of HSPC, pain, achieving patient preferred place of care, patient satisfaction with care, caregiver outcomes (satisfaction with care, burden, depression, anxiety, grief, quality of life), and cost-effectiveness of HSPC. In addition, research is needed to provide validated person-centred outcomes to be used across studies and populations.


Assuntos
Cuidadores/estatística & dados numéricos , Serviços Hospitalares de Assistência Domiciliar/economia , Cuidados Paliativos/economia , Cuidados Paliativos/métodos , Assistência Terminal/economia , Assistência Terminal/métodos , Assistência Ambulatorial/economia , Viés , Cuidadores/psicologia , Análise Custo-Benefício , Família , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Hospitalização/economia , Humanos , Neoplasias/mortalidade , Neoplasias/terapia , Manejo da Dor/estatística & dados numéricos , Satisfação do Paciente , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Avaliação de Sintomas/estatística & dados numéricos
5.
BMC Public Health ; 20(1): 1374, 2020 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-32907562

RESUMO

BACKGROUND: Influenza epidemics significantly weight on the Brazilian healthcare system and its society. Public health authorities have progressively expanded recommendations for vaccination against influenza, particularly to the pediatric population. However, the potential mismatch between the trivalent influenza vaccine (TIV) strains and those circulating during the season remains an issue. Quadrivalent vaccines improves vaccines effectiveness by preventing any potential mismatch on influenza B lineages. METHODS: We evaluate the public health and economic benefits of the switch from TIV to QIV for the pediatric influenza recommendation (6mo-5yo) by using a dynamic epidemiological model able to consider the indirect impact of vaccination. Results of the epidemiological model are then imputed in a health-economic model adapted to the Brazilian context. We perform deterministic and probabilistic sensitivity analysis to account for both epidemiological and economical sources of uncertainty. RESULTS: Our results show that switching from TIV to QIV in the Brazilian pediatric population would prevent 406,600 symptomatic cases, 11,300 hospitalizations and almost 400 deaths by influenza season. This strategy would save 3400 life-years yearly for an incremental direct cost of R$169 million per year, down to R$86 million from a societal perspective. Incremental cost-effectiveness ratios for the switch would be R$49,700 per life-year saved and R$26,800 per quality-adjusted life-year gained from a public payer perspective, and even more cost-effective from a societal perspective. Our results are qualitatively similar in our sensitivity analysis. CONCLUSIONS: Our analysis shows that switching from TIV to QIV to protect children aged 6mo to 5yo in the Brazilian influenza epidemiological context could have a strong public health impact and represent a cost-effective strategy from a public payer perspective, and a highly cost-effective one from a societal perspective.


Assuntos
Análise Custo-Benefício , Vacinas contra Influenza , Influenza Humana/prevenção & controle , Saúde Pública , Vacinação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Pré-Escolar , Economia Médica , Feminino , Hospitalização/economia , Humanos , Lactente , Vírus da Influenza B/classificação , Vírus da Influenza B/imunologia , Vacinas contra Influenza/economia , Vacinas contra Influenza/imunologia , Influenza Humana/economia , Influenza Humana/epidemiologia , Influenza Humana/virologia , Pessoa de Meia-Idade , Modelos Econômicos , Anos de Vida Ajustados por Qualidade de Vida , Estações do Ano , Incerteza , Vacinação/economia , Adulto Jovem
6.
PLoS One ; 15(8): e0236480, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32813687

RESUMO

BACKGROUND: The Government of Ontario, Canada, announced hospital funding reforms in 2011, including Quality-based Procedures (QBPs) involving pre-set funds for managing patients with specific diagnoses/procedures. A key goal was to improve quality of care across the jurisdiction. METHODS: Interrupted time series evaluated the policy change, focusing on four QBPs (congestive heart failure, hip fracture surgery, pneumonia, prostate cancer surgery), on patients hospitalized 2010-2017. Outcomes included return to hospital or death within 30 days, acute length of stay (LOS), volume of admissions, and patient characteristics. RESULTS: At 2 years post-QBPs, the percentage of hip fracture patients who returned to hospital or died was 3.13% higher in absolute terms (95% CI: 0.37% to 5.89%) than if QBPs had not been introduced. There were no other statistically significant changes for return to hospital or death. For LOS, the only statistically significant change was an increase for prostate cancer surgery of 0.33 days (95% CI: 0.07 to 0.59). Volume increased for congestive heart failure admissions by 80 patients (95% CI: 2 to 159) and decreased for hip fracture surgery by 138 patients (95% CI: -183 to -93) but did not change for pneumonia or prostate cancer surgery. The percentage of patients who lived in the lowest neighborhood income quintile increased slightly for those diagnosed with congestive heart failure (1.89%; 95% CI: 0.51% to 3.27%) and decreased for those who underwent prostate cancer surgery (-2.08%; 95% CI: -3.74% to -0.43%). INTERPRETATION: This policy initiative involving a change to hospital funding for certain conditions was not associated with substantial, jurisdictional-level changes in access or quality.


Assuntos
Administração Financeira/economia , Hospitalização/economia , Hospitais , Análise de Séries Temporais Interrompida/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Economia Hospitalar , Feminino , Insuficiência Cardíaca/economia , Fraturas do Quadril/economia , Fraturas do Quadril/cirurgia , Humanos , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Pneumonia/economia , Neoplasias da Próstata/economia , Neoplasias da Próstata/cirurgia
7.
PLoS Med ; 17(8): e1003247, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32764761

RESUMO

BACKGROUND: Patients with opioid use disorder (OUD) who are hospitalized for serious infections requiring prolonged intravenous antibiotics may face barriers to discharge, which could prolong hospital length of stay (LOS) and increase financial burden. We investigated differences in LOS, discharge disposition, and charges between hospitalizations for serious infections in patients with and without OUD. METHODS AND FINDINGS: We utilized the 2016 National Inpatient Sample-a nationally representative database of all discharges from US acute care hospitals. The population of interest was all hospitalizations for infective endocarditis, epidural abscess, septic arthritis, or osteomyelitis. The exposure was OUD, and the primary outcome was LOS until discharge, assessed by using a competing risks analysis to estimate adjusted hazard ratios (aHRs). Adjusted odds ratio (aOR) of discharge disposition and adjusted differences in hospital charges were also reported. Of 95,470 estimated hospitalizations for serious infections (infective endocarditis, epidural abscess, septic arthritis, and osteomyelitis), the mean age was 49 years and 35% were female. 46% had Medicare (government-based insurance coverage for people age 65+ years), and 70% were non-Hispanic white. After adjustment for potential confounders, OUD was associated with a lower probability of discharge at any given LOS (aHR 0.61; 95% CI 0.59-0.63; p < 0.001). OUD was also associated with lower odds of discharge to home (aOR 0.38; 95% CI 0.33-0.43; p < 0.001) and higher odds of discharge to a post-acute care facility (aOR 1.85; 95% CI 1.57-2.17; p < 0.001) or patient-directed discharge (also referred to as "discharge against medical advice") (aOR 3.47; 95% CI 2.80-4.29; p < 0.001). There was no significant difference in average total hospital charges, though daily hospital charges were significantly lower for patients with OUD. Limitations include the potential for unmeasured confounders and the use of billing codes to identify cohorts. CONCLUSIONS: Our findings suggest that among hospitalizations for some serious infections, those involving patients with OUD were associated with longer LOS, higher odds of discharge to post-acute care facilities or patient-directed discharge, and similar total hospital charges, despite lower daily charges. These findings highlight opportunities to improve care for patients with OUD hospitalized with serious infections, and to reduce the growing associated costs.


Assuntos
Disparidades em Assistência à Saúde/tendências , Hospitalização/tendências , Infecções/epidemiologia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Índice de Gravidade de Doença , Adulto , Idoso , Estudos Transversais , Feminino , Disparidades em Assistência à Saúde/economia , Hospitalização/economia , Humanos , Infecções/economia , Infecções/terapia , Cobertura do Seguro/economia , Cobertura do Seguro/tendências , Masculino , Medicare/economia , Medicare/tendências , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/economia , Transtornos Relacionados ao Uso de Opioides/terapia , Estados Unidos/epidemiologia
8.
PLoS One ; 15(8): e0237509, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32810157

RESUMO

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.


Assuntos
Custos de Cuidados de Saúde , Linfoma Difuso de Grandes Células B , Padrões de Prática Médica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/economia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Criança , Pré-Escolar , Análise Custo-Benefício , Ciclofosfamida/economia , Ciclofosfamida/uso terapêutico , Bases de Dados Factuais , Doxorrubicina/economia , Doxorrubicina/uso terapêutico , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Formulário de Reclamação de Seguro/estatística & dados numéricos , Japão/epidemiologia , Linfoma Difuso de Grandes Células B/economia , Linfoma Difuso de Grandes Células B/mortalidade , Linfoma Difuso de Grandes Células B/terapia , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/economia , Terapia Neoadjuvante/estatística & dados numéricos , Padrões de Prática Médica/economia , Padrões de Prática Médica/estatística & dados numéricos , Prednisona/economia , Prednisona/uso terapêutico , Estudos Retrospectivos , Rituximab/administração & dosagem , Rituximab/economia , Rituximab/uso terapêutico , Análise de Sobrevida , Vincristina/economia , Vincristina/uso terapêutico , Adulto Jovem
9.
Am J Prev Med ; 59(3): 445-448, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32703700

RESUMO

INTRODUCTION: This study aims to quantify out-of-pocket spending associated with respiratory hospitalizations for conditions similar to those caused by coronavirus disease 2019 and to compare out-of-pocket spending differences among those enrolled in consumer-directed health plans and in traditional, low-deductible plans. METHODS: This study used deidentified administrative claims from the OptumLabs Data Warehouse (January 1, 2016-August 31, 2019) to identify patients with a respiratory hospitalization. It compared unadjusted out-of-pocket spending among consumer-directed health plan enrollees with that among traditional plan enrollees using difference of mean significance tests and repeated the analysis separately by age category and calendar year quarter. These data were collected on a rolling basis by OptumLabs and were analyzed in March 2020. RESULTS: Commercially insured consumer-directed health plan enrollees had significantly higher out-of-pocket spending than traditional plan enrollees, and these differences were largest among younger populations. The largest difference in out-of-pocket spending occurred during the first half of the year. CONCLUSIONS: Consumer-directed health plan enrollees may experience differential financial burden from a hospitalization related to coronavirus disease 2019. Although some insurers are waiving cost-sharing payments for coronavirus disease 2019 treatment, self-insured employers remain exempt. As of now, policy responses may be insufficient to reduce the financial burden on consumer-directed health plans enrollees with respiratory hospitalizations related to coronavirus disease 2019.


Assuntos
Infecções por Coronavirus/terapia , Planos de Assistência de Saúde para Empregados/economia , Gastos em Saúde/estatística & dados numéricos , Hospitalização/economia , Pneumonia Viral/terapia , Adolescente , Adulto , Fatores Etários , Criança , Pré-Escolar , Infecções por Coronavirus/economia , Custo Compartilhado de Seguro , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Pandemias/economia , Pneumonia Viral/economia , Estados Unidos , Adulto Jovem
10.
Proc Natl Acad Sci U S A ; 117(33): 19873-19878, 2020 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-32727898

RESUMO

Following the April 16, 2020 release of the Opening Up America Again guidelines for relaxing coronavirus disease 2019 (COVID-19) social distancing policies, local leaders are concerned about future pandemic waves and lack robust strategies for tracking and suppressing transmission. Here, we present a strategy for triggering short-term shelter-in-place orders when hospital admissions surpass a threshold. We use stochastic optimization to derive triggers that ensure hospital surges will not exceed local capacity and lockdowns are as short as possible. For example, Austin, Texas-the fastest-growing large city in the United States-has adopted a COVID-19 response strategy based on this method. Assuming that the relaxation of social distancing increases the risk of infection sixfold, the optimal strategy will trigger a total of 135 d (90% prediction interval: 126 d to 141 d) of sheltering, allow schools to open in the fall, and result in an expected 2,929 deaths (90% prediction interval: 2,837 to 3,026) by September 2021, which is 29% of the annual mortality rate. In the months ahead, policy makers are likely to face difficult choices, and the extent of public restraint and cocooning of vulnerable populations may save or cost thousands of lives.


Assuntos
Infecções por Coronavirus/epidemiologia , Modelos Logísticos , Pneumonia Viral/epidemiologia , Quarentena/métodos , Distância Social , Capacidade de Resposta ante Emergências/organização & administração , Infecções por Coronavirus/economia , Infecções por Coronavirus/prevenção & controle , Efeitos Psicossociais da Doença , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Pandemias/economia , Pandemias/prevenção & controle , Pneumonia Viral/economia , Pneumonia Viral/prevenção & controle , Quarentena/economia , Quarentena/organização & administração , Capacidade de Resposta ante Emergências/economia , Tempo , Populações Vulneráveis
11.
Med Care ; 58(8): 722-726, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32692138

RESUMO

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.


Assuntos
Custos de Cuidados de Saúde/normas , Tempo de Internação/economia , Obesidade Pediátrica/economia , Adolescente , Criança , Pré-Escolar , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Tempo de Internação/estatística & dados numéricos , Masculino , Obesidade Pediátrica/diagnóstico , Estados Unidos
12.
Am Surg ; 86(6): 643-651, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32683960

RESUMO

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.


Assuntos
Colecistectomia/estatística & dados numéricos , Doenças da Vesícula Biliar/cirurgia , Adulto , Idoso , Colecistectomia/economia , Comorbidade , Feminino , Doenças da Vesícula Biliar/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/economia , Humanos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/economia , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
13.
Pharm. pract. (Granada, Internet) ; 18(2): 0-0, abr.-jun. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-194060

RESUMO

OBJECTIVE: This study aims to estimate the length of stay and hospitalisation cost of hypoglycaemia, and to identify determinants of variation in the length of stay and hospitalisation cost among individual patients with type 1 or 2 diabetes mellitus. METHODS: A cross-sectional study was conducted using inpatients records for patients with diabetes mellitus who had been hospitalised due to hypoglycaemic events in two private hospitals in Amman, Jordan between January 2009 and May 2017. All hospitalisation costs were inflated to the equivalent costs in 2017. Hospitalisation cost was estimated from the patient's perspective in Jordanian dinars (JOD). Descriptive analyses and correlation between sociodemographic or clinical characteristics with the cost and length of stay were explored. Predictors of hypoglycaemic hospitalisation cost and length of stay were determined using logistic regression. RESULTS: During the study period a total of 126 patients with diabetes mellitus were hospitalised due to an incident of hypoglycaemia. The mean patient age was 64.2 (SD=19.6) years; half were male. Patients admitted for hypoglycaemia stayed in hospital for a median duration of two days (IQR=2 days). The median cost of hospitalisation for hypoglycaemia was 163.2 JOD (USD 230.1) (IQR=216.3 JOD). We found that the Glasgow coma score was positively associated with length of stay (0.345, p = 0.008), and older age was correlated with higher hospitalisation cost (0.207, p = 0.02). Patients with a family history of diabetes had higher hospitalisation costs and longer duration of stay (0.306 and 0.275, p < 0.05). In addition, being a male patient (0.394, p < 0.05) and with an absence of smoking history was associated with longer duration of stay (0.456, p < 0.01), but not with higher hospitalisation cost. CONCLUSIONS: Costs associated with the incidence of hypoglycaemic events are not low and constitute a large cost component of managing and treating diabetes mellitus. Male patients and patients having a family history of diabetes should receive extra care and education on the prevention of hypoglycaemic events, and a treatment de-intensification approach should be considered if necessary, so we can prevent its associated hospitalisation costs and length of stay


No disponible


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Hospitalização/economia , Tempo de Internação/economia , Hipoglicemia/economia , Hipoglicemia/epidemiologia , Hipoglicemia/etiologia , Complicações do Diabetes , Estudos Transversais , Modelos Logísticos
15.
Value Health ; 23(6): 697-704, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32540226

RESUMO

OBJECTIVES: Hospice use reduces costly aggressive end-of-life (EOL) care (eg, repeated hospitalizations, intensive care unit care, and emergency department visits). Nevertheless, associations between hospice stays and EOL expenditures in prior research have been inconsistent. We examined the differential associations between hospice stay duration and EOL expenditures among newly diagnosed patients with cancer, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and dementia. METHODS: In the Surveillance, Epidemiology, and End Results-Medicare data, we identified 240 246 decedents diagnosed with the aforementioned conditions during 2001 to 2013. We used zero-inflated negative binomial regression models to examine the differential associations between hospice length of services and EOL expenditures incurred during the last 90, 180, and 360 days of life. RESULTS: For the last 360 days of expenditures, hospice stays beyond 30 days were positively associated with expenditures for decedents with COPD, CHF, and dementia but were negatively associated for cancer decedents (all P<.001) after adjusting for demographic and medical covariates. In contrast, for the last 90 days of expenditures, hospice stay duration and expenditures were consistently negatively associated for each of the 4 patient disease groups. CONCLUSIONS: Longer hospice stays were associated with lower 360-day expenditures for cancer patients but higher expenditures for other patients. We recommend that Medicare hospice payment reforms take distinct disease trajectories into account. The relationship between expenditures and hospice stay length also depended on the measurement duration, such that measuring expenditures for the last 6 months of life or less overstates the cost-saving benefit of lengthy hospice stays.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Cuidados Paliativos na Terminalidade da Vida/economia , Medicare/economia , Assistência Terminal/economia , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Cuidados Paliativos na Terminalidade da Vida/estatística & dados numéricos , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/economia , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Medicare/estatística & dados numéricos , Programa de SEER , Assistência Terminal/estatística & dados numéricos , Fatores de Tempo , Estados Unidos
16.
Value Health ; 23(6): 743-750, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32540232

RESUMO

OBJECTIVES: Markov models characterize disease progression as specific health states based on clinical or biological measures. However, these measures are not always collected outside clinical trials. In this article, an alternative approach is presented that uses real-world data to define the health states and to model transitions between them, specific to a local setting, to estimate the cost-effectiveness of telemonitoring (TM) versus no TM for heart failure. METHODS: The incidence of hospitalization for usual care was estimated from hospital episode statistics (HES) data in the United Kingdom and converted into a monthly transition matrix with 5 health states (4 states are defined based on the number of hospitalizations in the previous year and death) to estimate the cost-effectiveness of TM in a local UK primary care trust (PCT) using probabilistic sensitivity analysis from a healthcare perspective. RESULTS: Geographical variation in hospitalization rates were present, which led to different health state transition matrices in different localities. In the PCT that was evaluated, TM accrued mean additional costs of £3610 and 0.075 additional quality-adjusted life-years (QALYs) compared with usual care per patient, resulting in a mean incremental cost effectiveness ratio of £48 172/QALY. CONCLUSIONS: The use of administrative data to define health states and transition matrices based on health service events is feasible, and TM was not cost-effective in our analysis. Given the increasing emphasis on using real-world evidence, it is likely that these approaches will be used more in the future.


Assuntos
Insuficiência Cardíaca/terapia , Hospitalização/estatística & dados numéricos , Cadeias de Markov , Telemedicina/métodos , Análise Custo-Benefício , Progressão da Doença , Nível de Saúde , Insuficiência Cardíaca/economia , Hospitalização/economia , Humanos , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/métodos , Anos de Vida Ajustados por Qualidade de Vida , Avaliação da Tecnologia Biomédica , Telemedicina/economia , Reino Unido
17.
J Prev Med Public Health ; 53(3): 205-210, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32498146

RESUMO

OBJECTIVES: Aging is assumed to be accompanied by greater health care expenditures. The objective of this retrospective, bottom-up micro-costing study was to identify and analyze the variables related to increased health care costs for the elderly from the provider's perspective. METHODS: The analysis included all elderly inpatients who were admitted in 2017 to a hospital in Tehran, Iran. In total, 1288 patients were included. The Mann-Whitney and Kruskal-Wallis tests were used. RESULTS: Slightly more than half (51.1%) of patients were males, and 81.9% had a partial recovery. The 60-64 age group had the highest costs. Cancer and joint/orthopedic diseases accounted for the highest proportion of costs, while joint/orthopedic diseases had the highest total costs. The surgery ward had the highest overall cost among the hospital departments, while the intensive care unit had the highest mean cost. No statistically significant relationships were found between inpatient costs and sex or age group, while significant associations (p<0.05) were observed between inpatient costs and the type of ward, length of stay, type of disease, and final status. Regarding final status, costs for patients who died were 3.9 times higher than costs for patients who experienced a partial recovery. CONCLUSIONS: Sex and age group did not affect hospital costs. Instead, the most important factors associated with costs were type of disease (especially chronic diseases, such as joint and orthopedic conditions), length of stay, final status, and type of ward. Surgical services and medicine were the most important cost items.


Assuntos
Custos e Análise de Custo , Custos Hospitalares/classificação , Custos Hospitalares/estatística & dados numéricos , Hospitalização/economia , Pacientes Internados , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
18.
Int J Infect Dis ; 97: 182-189, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32474199

RESUMO

OBJECTIVES: To evaluate the cost-effectiveness of introducing a domestic pneumococcal conjugate vaccine (PCV7-TT) into the Cuban National Immunization Program (NIP). METHODS: We compared PCV7-TT given at two, four and six months of age to a scenario without PCV7-TT, over a ten-year period (2020-2029). We calculated the cost (Cuban pesos - CUP) per Disability Adjusted Life Year (DALY) averted from a Government perspective. We compared results from a static cohort model and a parsimonious prediction model informed by the serotype distribution among pneumococcal carriers and cases. We ran probabilistic and deterministic uncertainty analyses. RESULTS: PCV7-TT could prevent 6897 (95% uncertainty interval, 4344-8750) hospitalizations and 189 (115-253) deaths in children <5 years of age, over the period 2020-2029. This could cost around 25 million (20-31) discounted CUP but would be offset by treatment cost savings of around 23 million (14-31). A parsimonious model predicted less favourable impact and cost-effectiveness but the cost per DALY averted was still less than 0.4 times the current GDP per capita. CONCLUSIONS: PCV7-TT is likely to be cost-effective in Cuba. The impact of the vaccine would need to be carefully monitored following its introduction into the NIP.


Assuntos
Programas de Imunização/economia , Infecções Pneumocócicas/economia , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/administração & dosagem , Vacinas Pneumocócicas/economia , Algoritmos , Pré-Escolar , Estudos de Coortes , Análise Custo-Benefício , Cuba , Feminino , Custos de Cuidados de Saúde , Hospitalização/economia , Humanos , Lactente , Masculino , Infecções Pneumocócicas/imunologia , Infecções Pneumocócicas/microbiologia , Vacinas Pneumocócicas/imunologia , Anos de Vida Ajustados por Qualidade de Vida , Streptococcus pneumoniae/imunologia , Vacinas Conjugadas/administração & dosagem , Vacinas Conjugadas/economia , Vacinas Conjugadas/imunologia
19.
Prev Med ; 139: 106186, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32593730

RESUMO

OBJECTIVE: Explore the impact of the Great Recession on domestic violence (DV) related hospitalizations and emergency department (ED) visits in California. METHODS: Hospital and ED data were drawn from California's Office of Statewide Health Planning and Development (OSHPD). DV-related hospitalizations and ED visits in California were analyzed between January 2000 and September 2015 (53,596), along with total medical costs. Time series were divided into pre-recession (Jan 2000-Nov 2007) and recession/post-recession (Dec 2007-Sept 2015) periods. RESULTS: The medical cost of DV-related hospitalizations alone was estimated as $1,136,165,861. A dramatic increase in DV episodes was found potentially associated with the Great Recession. The number of ED visits per month tripled from pre- to post-recession (104.9 vs. 290.6), along with an increased number of hospitalizations (77.1 vs. 95.6); African Americans and Native Americans were disproportionally impacted. In addition, psychiatric comorbidities, severe DV episodes, in-hospital mortality and charge per hospitalization escalated. The rise in DV hospitalizations and ED visits beginning in December 2007 was mainly attributable to physical abuse episodes in adults; minors had no change in DV trends. DISCUSSION: Recessions are frequent in modern economies and are repeated cyclically. Our study provides critical information on the effects of the 2007 financial crisis on DV-related healthcare service utilization in California. Given the current financial crisis associated with COVID-19, which expert predict could extend for years, the results from this study shine a spotlight on the importance of DV-related screening, prevention and response.


Assuntos
Violência Doméstica/estatística & dados numéricos , Recessão Econômica , Serviço Hospitalar de Emergência/estatística & dados numéricos , Custos de Cuidados de Saúde , Hospitalização/estatística & dados numéricos , Adolescente , Adulto , Idoso , California , Criança , Pré-Escolar , Violência Doméstica/economia , Serviço Hospitalar de Emergência/economia , Utilização de Instalações e Serviços , Feminino , Hospitalização/economia , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
20.
Am Heart J ; 226: 13-23, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32502880

RESUMO

Little is known about the impact of accountable care organizations (ACO) on hospitalized heart failure (HF) patients, a high-cost and high-risk population. OBJECTIVE: We linked Medicare fee-for-service claims from 2013 to 2015 with data from American Heart Association Get With The Guidelines-HF registry to compare HF care, post-discharge outcomes, and total annual Medicare spending by ACO status at discharge. METHODS: Using adjusted Cox models and accounting for competing risks of death, we compared all-cause mortality and readmission at 1 year by ACO status with reporting of hazard ratios (HR) and 99% confidence intervals (CI). RESULTS: The study included 45,259 HF patients from 300 hospitals, with 21.1% assigned to an ACO. Patient characteristics were similar between the two groups with a few exceptions. The ACO patients lived in geographic areas with higher median income ($54400 [IQR $48600-65900] vs $52300 [$45900-61200], P < .0001). Compliance with four HF-specific quality measures was modestly higher in the ACO group (80% vs 76%, P < .0001). In adjusted analysis, ACO status was associated with similar all-cause readmission (HR: 1.03; 99% CI: 0.99, 1.07) but lower risk of 1-year mortality (HR: 0.85; 99% CI: 0.85, 0.90) compared with non-ACO status. Median Medicare spending in the calendar year of hospitalization was similar (ACO $42,737 [IQR $23,011-72,667] vs non-ACO $42,586 [$22,896-72,518], P = 0.06). CONCLUSIONS: Among Medicare patients hospitalized for HF, participation in an ACO was associated with similar rates of all-cause readmission and no associated cost reductions compared with non-ACO status. There was a lower risk of 1-year mortality associated with ACO participation, which warrants further evaluation.


Assuntos
Organizações de Assistência Responsáveis , Custos de Cuidados de Saúde , Insuficiência Cardíaca/economia , Insuficiência Cardíaca/terapia , Hospitalização/economia , Medicare , Idoso , Idoso de 80 Anos ou mais , Planos de Pagamento por Serviço Prestado , Feminino , Humanos , Masculino , Resultado do Tratamento , Estados Unidos
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