ABSTRACT
From an ethical perspective, resource limitations provide a challenge for healthcare providers. Handling disclosure of the financial details of treatment options in a way that empowers patients, even in the face of extreme poverty, requires careful consideration of the personal preferences and motivations of each patient. This article will consider the high costs of dialysis for patients experiencing extreme poverty in light of various ethical principles, including informed consent and truth-telling. It will conclude that a graduated method of disclosing the physical and financial burdens of each treatment option is the best way forward, particularly for healthcare workers engaged in resource-limited settings.
ABSTRACT
OBJECTIVES@#Using the patient’s perspective, the study’s objective was to estimate the economic cost of treatment for adult schizophrenia patients in a tertiary hospital using key informant interviews.@*METHODS@#A guided structured key informant interview was done to determine key practices in the treatment of adult schizophrenic patients in the charity and pay in-patient and out-patient settings of the tertiary hospital. Cost of treatment included direct (medication, room and board, professional fees, ancillaries) and indirect costs (productivity losses of both patient and caregiver) and was computed based on 1 to 4 week length of stay for inpatients and varying intervals of follow-up for outpatients. Total costs were computed depending on the treatment setting.@*RESULTS@#Twenty nine members of the Department of Psychiatry, involving 5 psychiatric nursing staff, 13 residents-in-training, 4 fellows-in-training and 7 consultants were interviewed. The cost, for charity inpatient care, may range from PhP 2332.00 to PhP 44,861.00 (USD 50.88 to 978.86). For charity outpatient care, this may range from PhP 2892.00 to PhP 21,3612.00 (USD 63.10 to 4660.96) annually. For pay patients, costs were estimated to range from PhP15347.00 to PhP 24,6831.00 (USD 334.87 to 5385.80) for inpatient care and PhP 17,292.00 to PhP 1,125,600.00 (USD 377.31 to 25681.04) for outpatient care. The factor that influenced costs the most was the choice of medication. As of October 15, 2015, 1 USD = 45.83 PhP.@*CONCLUSION@#Schizophrenia is a chronic psychiatric illness that places a significant financial burden on patients and their caregivers. Based on the data gathered, patients’ and their families could spend from as low as 2332 to as high as 1,125,600 pesos depending on the treatment setting.
Subject(s)
SchizophreniaABSTRACT
This study was aimed to assess the impacts of policy reform under the Indonesian National Health Insurance (NHI) program called Jaminan Kesehatan Nasional on medicine use and treatment costs in type 2 diabetes mellitus (T2DM) outpatients. A longitudinal time-series design was conducted retrospectively to observe patient’s treatment and cost data to T2DM outpatients in five hospitals in Jakarta Province. The medicine use and treatment costs were compared before and after the NHI by Wilcoxon test. The 466 patients were included in the analysis. The implementation of the NHI had several impacts on decreasing medicine use indicators such as the average number of medicine prescribed, non-diabetes mellitus (DM) medicines the originator brand and generic products (p < 0.05). The cost of treatment, medicines and DM medicines also decreased (p < 0.05). However the cost of non-DM medicines did not change after the NHI implementation. The proportion of the cost of medicines to the cost of treatment was high; 70% of the cost of treatment was for medicines. In conclusion this study highlights the implementation of NHI had positive impacts on reducing medication usage and treatment costs. The high cost of medicines requires attention to prevent inefficiency in treatment.
ABSTRACT
Objective To assess the length of stay,early complication and cost of treatment in radical cystectomy (RC) patients with different Charlson Comorbidity Index Score (CCI).Methods A prospective study of a total of 102 patients who underwent RC between March 2012 and August 2014 in Center for Research of Urology in Yunnan Province,China.They were divided into three groups:69 cases in CCI=0 or 1group,19 cases in CCI=2 group,14 cases in CCI≥3 group.Comorbidities were graded according to CCI,and each patient was followed-up for 3 months after RC.Length of stay,early complications and treatment cost were analyzed by statistics.Results A total of 102 patients were analyzed.There were obvious differences with respect to length of stay,early complication and cost of treatment comparing patients in each CCI group,H=20.722,6.025,and 7.047,P＜0.05.The incidence of diversion-related early complications in patients with different CCI showed significant difference,H=7.100,P＜0.05,however,the non diversionrelated early complications did not show significant difference between patients with different CCI,H=2.590,P＞0.05.Conclusions Patients with different CCI showed difference in the length of stay,early complication and cost of treatment in RC patients with different CCI.CCI≥3 might help to identify patients at risk for early complications after RC,especially in the orthotopic urinary diversion operation.Patients' complication should be evaluated standardized before operation and these should be included in patients' consideration.
ABSTRACT
Objective To evaluate the effect of assertive case management on relapse and health economic evalua?tion in schizophrenics living in communities. Methods Two hundred outpatients were randomly divided into the study group (107 enrolled, 107 completed) which received assertive case management and the control group (93 enrolled, 91 completed) which received normal management treatment for 12 months. Clinical global impression scale (CGI) and the cost of treatment were assessed every three months. Medication adherence and family burden were evaluated before treat?ment and 3, 6 and 12 months after the treatment using Medication Adherence Rating Scale (MARS) and Family Burden Instructing, respectively. Results The study group was less likely to relapse compared with the control group over the 12-month follow-up and the relapse rates were 1.9%and 11.0%in study and control groups, respectively (P<0.01). The repeated-measures analysis of variance indicated that time main effect was significant in severity of illness factor score of CGI (P<0.01). The time main effect and group main effect in factor 1 and factor 3 scores of MARS were significant (all P<0.05) and there was an interaction effect in factor1 score of MARS (P<0.01). In the study group, time effect were signifi?cant in factor 1 score of MARS (P<0.01). The time main effects in indirect cost and total cost were significant and so were interaction effects in direct cost and total cost (P<0.05). In the study group, time effects were significant in direct cost and total cost (P<0.01). Comparison of FBI dimensions before and after the intervention showed that family relation?ship was much more decreased in the study group than in the control group (P<0.01). Conclusions Assertive Case Man?agement can reduce the recurrence of schizophrenia living in communities, improve compliance medication and family re?lationship as well as reduce the cost of treatment.
ABSTRACT
A latenciação é uma importante ferramenta no processo de desenvolvimento de fármacos, pois através dela, diversas barreiras biológicas que limitam o uso de um agente terapêutico podem ser superadas. Assim, esta estratégia permite a reintrodução de substâncias anteriormente descartadas por suas propriedades indesejáveis e o aprimoramento de novos fármacos, antes mesmo que sejam lançados na terapêutica. Embora a latenciação apresente vantagens clínicas, não existem estudos demonstrando a vantagem econômica do uso de pró-fármacos em relação às substâncias precursoras. Dessa forma, o objetivo do presente trabalho foi elaborar um perfil comparativo do custo do tratamento entre pró-fármacos e seus respectivos fármacos precursores, disponíveis no mercado farmacêutico brasileiro, visando demonstrar a real importância da latenciação como ferramenta norteadora para o desenvolvimento de fármacos e, principalmente, a viabilidade financeira do uso de pró-fármacos. Constatou-se que seis do total de pró-fármacos analisados apresentaram-se financeiramente mais vantajosos que os seus precursores e, mesmo para os pró-fármacos que tiveram custo mais elevado, a vantagem clínica alcançada justifica sua utilização.
Prodrug design is an important tool in the drug discovery process, since many biological barriers that limit the use of a drug may be overcome by a prodrug precursor. This strategy allows the improvement of new drugs before they are marketed and also enables the reintroduction of substances previously discarded for their undesirable properties. Although clinical advantages of prodrug design are well-established, there are no studies demonstrating the economic benefits of using prodrugs rather than the intended drugs. The aim of this study was to elaborate a technical report on the relative cost of treatments carried out with prodrugs or with the related drugs. This study was intended to demonstrate the real importance of prodrug design as a guiding tool for drug development and the financial viability of the use of prodrugs. It was found that six of the analyzed prodrugs were financially advantageous compared to the actual drugs and that, even for the prodrugs that had a higher cost, the clinical advantage justified their therapeutic use.
Subject(s)
Health Care Costs , Pharmaceutical Preparations/chemical synthesis , Reaction TimeABSTRACT
Objective: To determine the cost of treatment for schizophrenic patients in Social Security scheme, Thailand. Methods: The paper reviewed available evidence in Thailand on the cost of schizophrenia treatment in different hospital settings and data of health service utilization obtained from various sources. The sensitivity analysis of direct health care cost of schizophrenia was conducted in social security system, both in outpatient and inpatient services. The cost for schizophrenia coverage per individual social security applicant was estimated in different contexts. Results: The total cost of treatment depends on the service utilization rate and unit cost of treatment. The annual direct health care cost of schizophrenic outpatients in Thai social security scheme was averagely estimated at about 171 million Baht. (Range: 28.5 million to 372 million Baht in sensitivity analysis). The annual direct health care cost of schizophrenic inpatients in Thai social security scheme was averagely estimated about 265.3 million Baht (Range; 22.7 million to 531 million Baht in sensitivity analysis). Aggregation the outpatient and inpatient treatment for schizophrenic employees accounted for 436.5 million Baht/year (Range from 436.5 million to 903 million Baht). The cost for schizophrenia coverage per individual social security applicant was about 48 Baht/year. (Range 5.63 Baht to 99.22 Baht). Conclusion: This study illustrated the cost of schizophrenia treatment in Thai social security scheme in various contexts, which might be useful in planning, preparing, budgeting and decision making. However, the huge societal impacts of schizophrenia should be carefully considered for policy makers.