Anticonvulsant drug regimen and cost of acute treatment for status epilepticus in a Philippine tertiary hospital: A retrospective cohort study

Background@#Status epilepticus (SE) is a neurological emergency requiring prompt evaluation and management to prevent disease refractoriness associated with significant mortality and morbidity. Thus, estimating costs attributable to the treatment of SE is important because of the severity of this disease. In the Philippines, healthcare provisions are mostly out-of-pocket expenses; hence the cost of treatment is a critical determinant for disease management. Unfortunately, the availability of data regarding the cost of illness of SE in developing countries is limited.@*Objectives@#To determine the frequently used anticonvulsant drug regimen and direct inpatient costs of acute treatment for status epilepticus within five years in a private tertiary hospital in the Philippines.@*Methods@#Records from patients diagnosed with SE who were admitted under or referred to the Adult Neurology Service in a private tertiary hospital from January 2015 to December 2019 were retrospectively evaluated. The SE type was classified as non-refractory (NRSE), refractory (RSE), and super refractory (SRSE). Demographic data, clinical features, SE type, etiology, antiepileptic drugs (AEDs) and anesthetic drugs used, total cost of AEDs and anesthetic drugs, total cost of 5-day hospitalization, and total cost of entire length of stay were recorded.@*Results@#We retrieved the records of 61 patients admitted for SE. Of these patients, 23 were classified as nonrefractory, 20 as refractory, and 18 as super refractory. Diazepam was given to all SE patients as first-line treatment. Valproic acid and levetiracetam were used as second-line treatments. The most frequently given anesthetic drug was midazolam. The mean hospitalization cost per patient was ₱52,0982.3 for SE, ₱659,638.7 for RSE, and ₱134,1451 for SRSE. The mean cost of 5-day hospitalization was ₱193,572.3 for NRSE, ₱358,808.5 for RSE, and ₱652,781 for SRSE. The mean cost of medications was ₱18,546 for NRSE, ₱30,780 for RSE, and ₱128,263 for SRSE.@*Conclusion@#The direct cost of SE varied depending on subtype and response to treatment. Costs increased with disease refractoriness. Direct inpatient treatment costs for SRSE were twice as high as that of NRSE and RSE.

Effect of lifestyle intervention holistic approach on blood glucose levels, health-related quality of life and medical treatment cost in type 2 diabetes mellitus patients

Type 2 Diabetes Mellitus (T2DM) is a costly, lifestyle-related disorder, its management is very critical and challenging hence lifestyle intervention may a cornerstone in the reversal and management of T2DM. This study designed to assess the impact of lifestyle intervention holistic (LIH) Model on blood glucose levels (BGL), Health-Related Quality of Life (HRQOL), and medical treatment cost in T2DM patients. This prospective, quasi-experimental study was conducted among 224 T2DM patients in Delhi Diabetes Research Center (DDRC), New Delhi. The study participants were allocated into two groups-Lifestyle Intervention Counseling (LIC) group received lifestyle-based counseling through the LIH model while the Usual-care group received only standard treatment. Study outcomes were assessed at baseline, 3rd, 6th, and 12th month and data were analyzed through SPSS. Study results revealed that LIC participants had decreased in fasting blood glucose 0.26 mg dL-1(-4.37 to 4.89), blood glucose postprandial -70.16 mg dL-1(-85.15 to -55.16), HbA1C -2.82% (-5.26 to -0.37), medicine cost (p < 0.004), hospitalization cost (p < 0.011), and cost of surgery (p < 0.0005). A significant improvement also observed in HRQOL and adherence towards a holistic model in LIC group. The study concludes that lifestyle-based counseling and its adherence was cost-effective and significantly improves BGL, HRQoL, and medical treatment in T2DM patients.

Estimación de costos unitarios directos de atención curativa de dengue en Ecuador 2020 / Estimate of direct unit costs of curative Dengue care in Ecuador 2020

El dengue es una enfermedad viral aguda transmitida a través de la picadura del mosquito (artrópodo) Aedes aegypti infectado con cualquiera de los serotipos de virus dengue. Son virus envueltos, de 40 a 50 nm de diámetro, con cápside icosaédrica y genoma de ácido ribonucleico (ARN) monocatenario, no segmentado, de polaridad positiva perteneciente al género flavivirus de la familia Flaviviridae. El análisis filogenético de las distintas cepas del virus dengue indica que la diseminación global ha dado lugar a distintos genotipos dentro de cada serotipo. En el quinquenio 2015-2020, en Ecuador, se notificaron en toda la región 76.085 casos de dengue. La atención unitaria hospitalaria para el tratamiento del dengue de las unidades de atención sanitaria hospitalarias (A, B, C), generaron un costo total promedio de 498,04 $ con una desviación estándar de ± 40,36, en el Ecuador para el año 2020. Cabe considerar, por otra parte, que el costo unitario directo promedio en ($) de la atención sanitaria en las entidades hospitalarias estudiadas en la presente investigación, generanron un gasto total para el tratamiento hospitalario de 9.585.114,02. Al mismo tiempo en los 2.135 pacientes diagnosticados con dengue que presentaron signos de alarma y requirieron cuatro días de hospitalización, señalando un gasto total para el tratamiento de 1.471.385,06. Por su parte los 51 pacientes que fueron diagnosticados con dengue grave, generaron un costo unitario total en las unidades hospitalarias de 134.152,54. Los resultados son conservadores, porque algunos componentes importantes no se incluyeron en los costos relacionados con el dengue.En ausencia de vacunación, y siendo los programas de control del vector la estrategia básica para mitigar la propagación del dengue, esta enfermedad seguirá produciendo una carga económica y social considerable en el Ecuador, lo que se refleja en el costo total de la enfermedad(AU)

Dengue is an acute viral disease transmitted through the bite of the mosquito (arthropod) Aedes aegypti infected with any of the dengue virus serotypes. They are enveloped viruses, 40 to 50 nm in diameter, with an icosahedral capsid and a single-stranded, non-segmented ribonucleic acid (RNA) genome of positive polarity belonging to the genus Flavivirus of the Flaviviridae family. Phylogenetic analysis of the different dengue virus strains indicates that global spread has given rise to different genotypes within each serotype. In the five-year period 2015-2020, in Ecuador, 76,085 cases of dengue were reported throughout the region. The hospital unit care for the treatment of dengue in the hospital health care units (A, B, C), generated an average total cost of $ 498.04 with a standard deviation of ± 40.36, in Ecuador for the year 2020. It should be considered, on the other hand, that the average direct unit cost in ($) of health care in the hospital entities studied in the present investigation, generated a total cost for hospital treatment of 9,585,114.02. At the same time, in the 2,135 patients diagnosed with dengue who presented alarm signs and required four days of hospitalization, indicating a total cost for treatment of 1,471,385.06. On the other hand, the 51 patients who were diagnosed with severe dengue, generated a total unit cost in the hospital units of 134,152.54. The results are conservative, because some important components were not included in the costs related to dengue. In the absence of vaccination, and with vector control programs the basic strategy to mitigate the spread of dengue, this disease will continue to produce an economic burden and considerable social in Ecuador, which is reflected in the total cost of the disease(AU)

Telemedicine: an ICT based healthcare approach to ensure health service for all

Background: Despite enormous efforts, healthcare service is still a daunting challenge area of Bangladesh healthcare systems. Bangladesh suffers from both a shortage of and geographic mal-distribution of human resource for health, as well as inadequate resources. Considering the challenges, telemedicine can be a blessing especially to the people living in hard-to-reach and rural areas. The current study was conducted on to measure the outcomes of providing telemedicine service at the field level.Methods: The study was conducted in Nagarkanda Upazilla of Faridpur district. Mixed method approaches including user experience and perception survey, case study and in-depth interview were adopted in order to bring a comprehensive scenario.Results: Around 50% of the users used to visit telemedicine center frequently. For quality of service provided from telemedicine service point, there were few benchmarks like service provider’s behavior, waiting time, accessibility, distance, cost of treatment, willingness to pay and referral mechanism. Telemedicine service centers were found situated within the reach of people (within 1-2 km of 83.30% km). 97% participants rated service provider’s behavior as good. Cost of treatment including diagnosis, prescription and medication was found within 501-3000 BDT for 60% of participants.Conclusions: Although the studied telemedicine service was not comprehensive in nature, it still helped to save time, reduce cost and most of all increased access to healthcare services.

Cost-effectiveness of insulin analogs from the perspective of the Brazilian public health system

ABSTRACT Human insulin is provided by the Brazilian Public Health System (BPHS) for the treatment of diabetes, however, legal proceedings to acquire insulin analogs have burdened the BPHS health system. The aim of this study was to perform a cost-effectiveness analysis to compare insulin analogs and human insulins. This is a pharmacoeconomic study of cost-effectiveness. The direct medical cost related to insulin extracted from the Ministry of Health drug price list was considered. The clinical results, i.e. reduction in glycated hemoglobin (HbA1c), were extracted by meta-analysis. Different scenarios were structured to measure the uncertainties regarding the costs and reduction in HbA1c. Decision tree was developed for sensitivity of Incremental Cost Effectiveness Ratio (ICER). A total of fifteen scenarios were structured. Given the best-case scenario for the insulin analogs, the insulins aspart, lispro, glargine and detemir showed an ICER of R$ 1,768.59; R$ 3,308.54; R$ 11,718.75 and R$ 2,685.22, respectively. In all scenarios in which the minimum effectiveness was proposed, lispro, glargine and detemir were dominant strategies. Sensitivity analysis showed that the aspart had R$ 3,066.98 [95 % CI: 2339.22; 4418.53] and detemir had R$ 6,163.97 [95% CI: 3919.29; 11401.57] for incremental costs. We concluded there was evidence that the insulin aspart is the most cost-effective.

Diabetes mellitus no Brasil: características clínicas, padrão de tratamento e custos associados ao cuidado da doença / Diabetes Mellitus in Brazil: clinical characteristics, standard treatment choice and cost

Objetivo: Descrever a utilização de recursos de saúde associados ao tratamento do Diabetes Mellitus tipo 2 (DM2) no sistema público de saúde brasileiro, assim como o padrão de tratamento e seus eventos adversos, a ocorrência de complicações vasculares e o controle metabólico nos pacientes. Métodos: Estudo observacional, retrospectivo, conduzido em 4 centros do Sistema Único de Saúde envolvendo pacientes com DM2. Os dados foram coletados dos prontuários médicos de setembro a dezembro de 2013. Foi conduzida análise descritiva considerando três faixas de duração da doença desde o seu diagnóstico e a estratificação dos pacientes de acordo com o período recordatório e presença de complicações vasculares. Resultados: 161 pacientes foram analisados. Os principais esquemas terapêuticos utilizados foram a combinação de metformina, insulina NPH e insulina regular; de glibenclamida e metformina; e metformina isolada. A associação metformina e insulina apresentou maior frequência de eventos adversos (28,9%) e a glibenclamida, metformina e insulina, menor frequência (5,7%). A maioria dos pacientes mostrou complicações microvasculares, sendo nefropatia e neuropatia frequentes em todos os estratos analisados. Em pacientes com DM2 avançado (≥ 15 anos de duração), a retinopatia mostrou-se prevalente. A frequência de eventos macrovasculares variou de 21,3% a 37,9% entre os grupos, sendo a doença coronariana a mais frequente. Um custo total médio de R$ 931,88±1.400,75 por paciente foi observado para os pacientes sem complicações vasculares e de R$ 1.212,37±1.012,38 para aqueles com complicações. Conclusão: Informações relevantes sobre o manejo de pacientes brasileiros com DM2 foram descritas, sugerindo alta frequência de complicações vasculares e maiores custos associados a elas.

Objective: The aim of this study is to describe the use of public health resources to Type 2 Diabetes Mellitus (T2DM) and its costs in Brazil. Furthermore, we describe the standard treatment choice and its related adverse events as well as patients' metabolic control and vascular complications. Methods: This observational and retrospective study was conducted in four public health centers from Brazilian Public Health System (SUS); a secondary assistance level for long-term treatment for outpatients with T2DM. Data were collected from medical records from September to December 2013. A descriptive analysis is available for three groups according to time of disease since diagnosis. The recall and vascular complications were also considered. Results: 161 patients were studied. The most frequent treatments were metformin in monotherapy, metformin + NPH insulin + regular insulin and metformin + glibenclamide. Metformin + insulin therapy had the highest rate of adverse events (28.9%), while glibenclamide + metformin + insulin therapy, the lowest rate (5.7%). The majority of patients developed microvascular complications, specially nephropathy and neuropathy. Retinopathy was the most frequent complication for the group of patients with end stage T2DM (≥ 15 years). The frequency of macrovascular events ranged from 21.3% to 37.9% between groups. Coronary disease was the most frequent macrovascular complications. The mean cost per patient was R$ 1.212,37±1.012,38 for patient group presenting vascular complications and R$ 931,88±1.400,75 for the group not presenting complications. Conclusion: We describe current use of public health resources regarding T2DM treatment in Brazil, as well as T2DM treatment´s characteristics.

Comparative Study on the Preventive Use of 3 Kinds of Cephalosporins for 1 066 Patients with Breast Lesion Resection in Shaanxi Province / 中国药房

OBJECTIVE:To compare the effects of prophylactic application of 3 different antibiotics on prognosis in patients underwent breast lesion resection. METHODS:1 066 patients with breast lasion resection from 12 hospitals of Shaanxi province were divided into trial group(360 cases),control group A(352 cases)and control group B(354 cases)according to random num-ber table. Trial group was given first generation cephalosporin cefazolin;control group A was given second generation cephalospo-rin cefuroxime;control group B was given third generation cephalosporin cefoperazone sodium and tazobactam sodium. The dosage regimens of 3 groups were as follows:relevant drug 2 g added into 0.9%Sodium chloride injection 100 ml,ivgtt,0.5 h before sur-gery,medication course≤24 h after surgery in trial group. Those indexes of 3 groups were observed,such as post-operative ADR, incision healing,infection,hospitalization duration,phamaceutical costs per capita. RESULTS:There was no statistical signifi-cance in the rate of incision healing and the rate of post-operative infection among 3 groups(P>0.05). The incidence of post-opera-tive ADR,hospitalization duration and phamaceutical costs per capita in observation group were significantly lower or shorter than in control group A and B,with statistical significance(P<0.05). CONCLUSIONS:Cefazolin is better than cefuroxime and cefo-perazone sodium and tazobactam sodium to reduce the postoperative adverse reaction,antibiotics cost per capita and hospital drug cost per capita,shorten the hospitalization duration.

Chronic Hepatitis C treatment for genotype 2 or 3 in Brazil: cost effectiveness analysis of peginterferon plus ribavirin as first choice treatment

Brazilian Guidelines to HCV treatment (2007) recommended that the first choice treatment for patients with chronic hepatitis C (CHC) and genotype 2 or 3 is interferon alpha (IFN) plus ribavirin (RBV) for 24 weeks. The aim of this study is compare the cost and effectiveness to Hepatitis C treatment in patients with genotype 2 or 3 of peginterferon alpha (PEG) as the first choice of treatment within PEG for those that do not respond to IFN. The target population is CHC patients with genotype 2 or 3 in Brazil. The interventions are: PEG-SEC (first IFN plus RBV for 24 weeks, after, for non-responders and relapsers subsequently PEG plus RBV for 48 weeks); PEG-FIRST24 (PEG+RBV for 24 weeks). The type of the study is cost-effectiveness analysis. The data sources are: Effectiveness data from meta-analysis conducted on the Brazilian population. Treatment cost from Brazilian micro costing study is converted into USD (2010). The perspective is the Public Health System. The outcome measurements are Sustained Viral Response (SVR) and costs. PEG-FIRST24 (SVR: 87.8%, costs: USD 8,338.27) was more effective and more costly than PEG-SEC (SVR: 79.2%, costs: USD 5,852.99). The sensitivity analyses are: When SVR rates with IFN was less than 30% PEG-FIRST is dominant. On the other hand, when SVR with IFN was more then 75% PEG-SEC is dominant (SVR=88.2% and costs USD $ 3,753.00). PEG-SEC is also dominant when SVR to PEG24 weeks was less than 54%. In the Brazilian context, PEG-FIRST is more effective and more expensive than PEG-SEC. PEG-SEC could be dominant when rates of IFN therapy are higher than 75% or rates of PEG24 therapy are lower than 54%.

O protocolo brasileiro de tratamento da Hepatite C (2007) recomendava como primeira escolha para pacientes com hepatite C crônica e portadores de genótipo 2 ou 3 o tratamento com interferona alfa (IFN) associada à ribavirina (RBV), por 24 semanas. O objetivo deste estudo é comparar o custo e a efetividade para pacientes com hepatite C crônica e portadores do genótipo 2 ou 3 o uso de peguinterferon (PEG) como primeiro escolha com o PEG como secunda escolha para aqueles que não responderam ao tratamento com IFN. A população alvo compreende pacientes com hepatite C crônica portadores de genótipo 2 ou 3 no Brasil. As intervenções são: PEG-SEC (IFN + RBV por 24 semanas, para os não respondedores e recidivantes tratamento subsequente com PEG + RBV por 48 semanas; PEG-FIRST24 (PEG + RBV por 24 semanas). O tipo de estudo envolvido é Análise de Custo Efetividade. Os dados de efetividade são provenientes de um metanálise de estudos brasileiros e os dados de custo do tratamento de um estudo de custo do contexto brasileiro. A perspectiva é o Sistema Público de Saúde. Os desfechos avaliados foram Resposta Viral Sustentada (RVS) e Custos. PEG-FIRST24 (RVS: 87,8%, costs: USD 8.338,27) foi mais efetivo e apresentou maior custo que PEG-SEC (RVS: 79,2%, custo USD 5.852,99). A análise de sensibilidade demonstrou que PEG-SEC é dominado por PEG-FIRST24 quando RVS com IFN for menor que 30%. Por outro lado, quando RVS com IFN for maior que 75% PEG-SEC é dominante (RVS=88.2% e custo USD $ 3.753,00). PEG-SEC é também dominante quando RVS para PEG24 for menor que 54%. Conclusão: No contexto brasileiro, PEG-FIRST é mais efetivo e mais custoso que PEG-SEC. PEG-SEC poderia ser dominante quando as taxas de RVS do tratamento com IFN forem superiores a 75% ou as taxas de PEG24 forem inferiores a 54%.

Study on Equivalent Value of Rural Main Cancer Treatment Costs / 中国卫生经济

In order to understand the cost of cancer in rural area, to evaluate the cost burden, the project content and treatment status. Typical sampling and random sampling survey are combined to investigate and account major expenditure and economic loss of cancer treatment and related items, analyzes its rationality and scientific, provide references for improving the level of cancer prevention and treatment.

Evaluation of Recombinant Factor VIIa Treatment for Massive Hemorrhage in Patients with Multiple Traumas

BACKGROUND: Recent studies and case reports have shown that recombinant factor VIIa (rFVIIa) treatment is effective for reversing coagulopathy and reducing blood transfusion requirements in trauma patients with life-threatening hemorrhage. The purpose of this study is to evaluate the effect of rFVIIa treatment on clinical outcomes and cost effectiveness in trauma patients. METHODS: Between January 2007 and December 2010, we reviewed the medical records of patients who were treated with rFVIIa (N=18) or without rFVIIa (N=36) for life-threatening hemorrhage due to multiple traumas at the Emergency Department of Pusan National University Hospital in Busan, Korea. We reviewed patient demographics, baseline characteristics, initial vital signs, laboratory test results, and number of units transfused, and then analyzed clinical outcomes and 24-hr and 30-day mortality rates. Thromboembolic events were monitored in all patients. Transfusion costs and hospital stay costs were also calculated. RESULTS: In the rFVIIa-treated group, laboratory test results and clinical outcomes improved, and the 24-hr mortality rate decreased compared to that in the untreated group; however, 30-day mortality rate did not differ between the groups. Thromboembolic events did not occur in both groups. Transfusion and hospital stay costs in the rFVIIa-treated group were cost effective; however, total treatment costs, including the cost of rFVIIa, were not cost effective. CONCLUSIONS: In our study, rFVIIa treatment was shown to be helpful as a supplementary drug to improve clinical outcomes and reduce the 24-hr mortality rate, transfusion and hospital stay costs, and transfusion requirements in trauma patients with life-threatening hemorrhage.

Treatment Cost for Typhoid Fever at Two Hospitals in Kolkata, India.

The purpose of this study was to estimate treatment cost for typhoid fever at two hospitals in Kolkata, India. This study was an incidence-based cost-of-illness analysis from the providers’ perspective. Microcosting approach was employed for calculating patient-specific data. Unit costs of medical services used in the calculation were directly measured from the study hospital by standard method. The study hospitals were selected based on accessibility to data and cooperation. Eighty-three Widal-positive and/or cultureconfirmed patients with typhoid fever during November 2003–April 2006 were included in the study. Most (93%) patients were children. Eighty-one percent was treated at the outpatient department. The average duration of hospitalization for child and adult patients was 8.4 and 4.2 days respectively. The average cost of treating children, adults, and all patients was US$ 16.72, 72.71, and 20.77 respectively (in 2004 prices). Recalculation based on 80% occupancy rate in inpatient wards (following the recommendation of the World Health Organization) found that the cost of treating children, adults, and all patients was US$ 14.53, 36.44, and 16.11 respectively.