Costo-efectividad de la calidad del control prenatal con respecto al bajo peso al nacer en el Cauca / Antenatal control quality cost-effectiveness regarding low birth weight in Cauca

Antecedentes: El departamento del Cauca en Colombia es multiétnico, multicultural y biodiverso, también con grandes diferencias en bajo peso al nacer (BPN), mortalidad perinatal y mortalidad neonatal tardía entre municipios. Objetivo: Determinar la relación de costo-efectividad del control prenatal (CPN) cuando ha tenido buena calidad frente al que ha tenido calidad deficiente con respecto al BPN en el departamento del Cauca entre 2018 y 2020. Método: Evaluación económica con diseño epidemiológico de una cohorte histórica desde la perspectiva de la institución pagadora. Se calculó la razón incremental de costo-efectividad (RICE), análisis de sensibilidad e impacto presupuestal. Resultados: La incidencia de BPN fue del 8,3% (348/4182). La calidad deficiente en el CPN incrementó el riesgo de BPN (OR: 3,38; IC95%: 1,05-8,2) y la buena calidad tuvo una mejor relación de costo-efectividad (RICE: USD 2727,75), con posición dominante frente a la calidad deficiente (6,14 veces el PIB per cápita de ahorro) y con un impacto presupuestal de USD 2.904.392. Conclusiones: La buena calidad del CPN en el departamento del Cauca durante 2018-2020 fue costo-efectiva y dominante por ser de menor costo y mayor efectividad.

Background: The department of Cauca in Colombia is multiethnic, multicultural, and biodiverse, also with large differences in low birth weight (LBW), perinatal mortality, and late neonatal mortality among municipalities. Objective: To determine the cost-effectiveness relationship of antenatal care (ANC) when it has had good quality compared to that which has had poor quality with respect to low birth weight in the department of Cauca between 2018 and 2019. Method: Economic evaluation with epidemiological cohort design historical from the perspective of the payer institution. Incremental cost-effectiveness ratio (RICE), sensitivity analysis, and budgetary impact were calculated. Results: The incidence of LBW was 8.3% (348/4182). Poor quality in ANC increased the risk of LBW (OR: 3.38; CI95%: 1.05-8.2), good quality had a better cost-effectiveness ratio (RICE: USD 2727.75), with dominant position against poor quality (6.14 times the GDP/capita savings) with a budgetary impact of USD 2,904,392. Conclusions: The good quality of the ANC in the department of Cauca during 2018-2020 was cost-effective and dominant because it is lower cost and more effective.

Economic burden of acute myeloid leukemia on patients in a resource-limited tertiary hospital in the Philippines

ABSTRACT Introduction: The remission induction treatment for acute myeloid leukemia (AML) has remained unchanged in the resource-limited setting in the Philippines. AML treatment consists of induction chemotherapy followed by high dose consolidation chemotherapy or allogeneic hematopoietic stem cell transplantation. In the Philippines, the Filipino household bears the burden of health care cost of hospitalization expenditure. Insights into the treatment costs becomes an essential requirement as these guides the allocation of resources to scheme health programs. Method: This study involved a retrospective cohort analysis of AML patients who underwent treatment for AML. Review of the statements of account per admission per patient during treatment for remission induction, consolidation, relapsed and refractory disease and best supportive care from 2017 to 2019. Of the 251 eligible patients, 190 patients were included. Result: The mean healthcare expenditure for remission induction chemotherapy (Phase 1) was US $2, 504.78 (Php 125,239.29). While 3 to 4 cycles of consolidation chemotherapy cost an average of US $3,222.72 (Php 162,103.20). For patients who had relapsed and refractory disease, an additional mean cost of US $3,163.32 (Php 159,115.28) and US $2, 914.72 (Php 146,610.55) were incurred, respectively. The average cost of palliative care was US $1,687.00 (Php 84,856.59). Conclusion: The cost of chemotherapy and other therapeutics bear most of the weight of the direct healthcare cost. The cost of AML treatment represents a significant economic burden for patients and the institution. The cost increases as patients proceed through subsequent lines of treatment for induction failure. Existing subsidy for health insurance benefits could still be improved for appropriate source allocation of resources.

El costo esperado de cáncer en Chile / The expected cost of cancer in Chile

BACKGROUND: Cancer is a public health priority in Chile. AIM: To estimate the expected annual cost of cancer in Chile, due to direct costs of health services, working allowances and indirect costs for productivity losses. MATERIAL AND METHODS: We undertook an ascendent costing methodology to calculate direct costs. We built diagnostic, treatment and follow-up cost baskets for each cancer type. Further, we estimated the expenditure due to sick leave subsidies. Both estimates were performed either for the public or private sector. Costs related to productivity loss were estimated using the human capital approach, incorporating disease related absenteeism premature deaths. The time frame for all estimates was one year. RESULTS: The annual expected costs attributed to cancer was $1,557 billion of Chilean pesos. The health services expected annual costs were $1,436 billion, 67% of which are spent on five cancer groups (digestive, hematologic, respiratory, breast and urinary tract). The expected costs of sick leave subsidies and productivity loss were $48 and $71 billion, respectively. CONCLUSIONS: Cancer generates costs to the health system, which obliges health planners to allocate a significant proportion of the health budget to this disease. The expected costs estimated in this study are equivalent to 8.9% of all health expenditures and 0.69% of the Gross Domestic Product. This study provides an updated reference for future research, such as those aimed at evaluating the current health policies in cancer.

Provider Costs of Treating Colorectal Cancer in Government Hospital of Malaysia

@#Background: The incidence of colorectal cancer (CRC) is rapidly rising in several Asian countries, including Malaysia, but there is little data on health care provider costs in this region. The aim of this study was to estimate the cost of CRC management from the perspective of the health care provider, based on standard operating procedures. Methods: A combination of top-down approach and activity-based costing was applied. The standard operating procedure (SOP) for CRC was developed for each stage according to national data and guidelines at the University of Malaya Medical Centre (UMMC). The unit cost was calculated and incorporated into the treatment pathway in order to obtain the total cost of managing a single CRC patient according to the stage of illness. The cost data were represented by means and standard deviation and the results were demonstrated by tabulation. All cost data are presented in Malaysian Ringgit (RM). The cost difference between early stage (Stage I) and late stage (Stage II–IV) was analysed using independent t-test. Results: The cost per patient increased with stage of CRC, from RM13,672 (USD4,410.30) for stage I, to RM27,972 (USD9,023.20) for Stage IV. The early stage had statistically significant lower cost compared to late stage t(2) = −4.729, P = 0.042. The highest fraction of the cost was related to surgery for Stage I, but was superseded by oncology day care treatment for Stages II–IV. CRC is a costly illness. From a provider perspective, the highest cost was found in Stages III and IV. The early stages conserved more resources than did the advanced stages of cancer. Conclusion: Early diagnosis and management of CRC, therefore, not only affects oncologic prognosis, but has implications for health care costs. This adds further justification to develop and implement CRC screening programmes in Malaysia.

How much to invest in glycemic control of a patient with diabetes mellitus type 2? A constant dilemma for the Brazilian Public Health System (SUS)

Diabetes mellitus type 2 (DM2) affects millions of people worldwide and causes several complications for the patient, consuming large sums of financial resources from the health services. This study aims to estimate the financial investment of DM2 treatment for glycemic control of the patient, from the point of view of the municipal Public Health System (SUS). The Delphi technique was used to validate the opinion of a team of judges, specialists in DM2, and health service managers, on the investment necessary for glycemic control of patients with DM2 through the application of questionnaires. In order for the patient to achieve glycated hemoglobin (A1c) < 7%, an investment of US$ 2,419.06 (value/patient/year) is necessary. As the value of A1c increases, investment is reduced. This result reveals the intention to allocate resources for the prevention of DM2 and its complications

Supporting Low-income Cancer Patients: Recommendations for the Public Financial Aid Program in the Republic of Korea / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: As the recent term of “financial toxicity” implies, cancer causes a treatment-related financial harm. Financial Aid Program for Cancer Patient (FAPCP) is a government’s financial support for low-income patients in the Republic of Korea. This study aimed to describe FAPCP applicants’ condition and to investigate factors influencing financial burden, which would provide the basis for implementing a strategy for FAPCP administration. MATERIALS AND METHODS: The telephone survey results from 2,700 FAPCP participants were analyzed, including demographic, socioeconomic, and disease characteristics and experiences associated with financial burden and the actions or measures to cope with them. RESULTS: Overall, 87.6% experienced financial burden more than moderate degree, 39.2% got financial help/a loan, 17.8% disposed of their property, and 10.2% changed or stopped treatment owing to medical costs. Monthly household income was connected to financial burden, and the highest income group was associated with the lowest financial burden (odds ratio [OR], 0.21; 95% confidence interval [CI], 0.11 to 0.38) and the lowest rate of changing/stopping care (OR, 0.23; 95% CI, 0.05 to 1.00). Parents of childhood cancer patients got financial help/a loan (OR, 2.24; 95% CI, 1.03 to 4.88) and disposed of their property (OR, 3.18; 95% CI, 1.40 to 7.22) more frequently, and Medical Aids applicants showed the highest rate of changing/stopping care (OR, 3.01; 95% CI, 1.89 to 4.78). CONCLUSION: FAPCP targets low income groups; however, financial burden and the consequent actions taken still exist disproportionately, depending on the income of the applicants. FAPCP should focus on more vulnerable groups including Medical Aid applicants and parents of childhood cancer patients, by increasing funds and expanding their support coverage.

Survey of Patient’s Comprehension of Home Medical Care and Pharmaceutical Intervention Using Factor Analysis / 社会薬学

Because of societal aging, Japanese pharmacists have an increasingly important role in home medical care. This is particularly true because more pharmacists are required to perform physical assessments to optimize patient treatment. However, few investigations have examined whether patients understand the role of pharmacists and the importance of home medical care. In this study, a questionnaire was provided to 260 patients aged 20-90 years to determine patients’ attitudes toward home medical care and pharmaceutical interventions. After conducting factor analysis, items related to home medical care were excluded at the stage of exploratory factor analysis, indicating that patients are not interested in home medical care. However, regarding pharmaceutical interventions, the questionnaire revealed that 42% of the patients required the pharmacists to provide information regarding the prescribed drugs during home medical care visits. Furthermore, it was demonstrated that 85% of the patients were unaware that physical assessments are also perform by pharmacists. In contrast, >50% of the patients believed that pharmacists had an important role in physical assessment interventions.

Impacto de la utilización de la red propia de una aseguradora privada sobre los costos de atención ambulatoria / The cost impact of a private insurer's own network upon outpatient care

Objetivo. Medir el impacto de la red propia (proveedores verticalmente integrados) de una aseguradora privada sobre los costos médicos ambulatorios de sus asegurados, a través de un análisis econométrico. Se busca verificar si un mayor uso de la red propia reduce los costos en los que la aseguradora incurre, de acuerdo con lo que sugiere la literatura especializada. Material y métodos. Estudio basado en una regresión lineal múltiple sobre los datos de una aseguradora privada. La variable dependiente es el costo per cápita de los servicios ambulatorios. Las variables explicativas son la adherencia a la red propia y una serie de variables para especificar mejor el modelo. Resultados. En relación con la cobertura de los costos de atención ambulatoria, si los demás factores se mantienen constantes, se observa que los asegurados con alta adherencia a la red propia presentan menores costos de atención que aquéllos con baja adherencia. Conclusión. El proceso decisorio sobre qué servicios y en qué grado debe ser aplicado a cada persona, por condiciones particulares de la oferta como el hecho de reunir recurso humano en sedes propias bajo reglas formales, presenta un impacto en los costos de atención en salud. Condiciones particulares de la oferta producen variaciones en la forma como son empleados los recursos.

Objective. Econometric analysis that seeks to measure the cost impact of a private insurer's own network upon outpatient care for its policyholders, own network refers to vertical integrated providers. The purpose is to assess whether greater use of its own network reduces the costs that the insurer incurred, according to what specialized literature suggests. Materials and methods. Study based on a multiple linear regression on data from a private insurer. The dependent variable is per capita cost of outpatient services. The explanatory variables are adherence to the own network and a number of variables to specify better the model. Results. With all other factors constant, in relation to covering the costs of outpatient care, it is noted that policyholders with high adhesion to their own network are less expensive than whose with low adhesion. Conclusions. The decision-making process about what services and what grade should be applied to each person by special conditions of the offer as the aggregation of human resources in own offices under formal rules has an impact on health care costs. Particular supply conditions cause variations in how resources are used.

Financiamiento público del gasto total en salud: un estudio ecológico por países según niveles de ingreso / Public funding of the total health expenditure: an ecological study by countries according to income levels / Financiamento público da despesa total em saúde: um estudo ecológico por países por nível de renda

En las últimas décadas el gasto total en salud (GTS) ha aumentado tanto en las economías desarrolladas como en las emergentes. El presente trabajo es un estudio ecológico descriptivo y mixto. Tomando una muestra de 192 países agrupados por niveles de ingresos, se analizó: i) los patrones de financiamiento público del GTS, ii) la proporción que representó el gasto público en salud en los gastos generales de gobierno, y iii) la hipótesis de Globerman y Vining referida a la existencia de una correlación negativa entre el financiamiento público y el GTS como porcentaje del PBI. Los resultados muestran que los gobiernos que más se involucran en el sector salud poseen en promedio un GTS per cápita más alto. Asimismo, la relación entre financiamiento público del GTS y GTS como porcentaje del PBI es negativa y estadísticamente significativa solo en los países ricos de la OCDE y en los pobres.

Over the last decades, total health expenditure (the) has increased, not only in developed economies but also in emerging ones. This paper is a descriptive and mixed ecological study. We took a sample of 192 countries grouped by income levels, and analyzed i) the patterns of public funding of the, ii) the share of public health expenditure in the general government budgets, and iii) the Globermann and Vining hypothesis about the existence of a negative correlation between the proportion of the financed by the governments and the as a percentage of the gdp. We found that governments most involved in the health sector showed, on average, a higher per capita the. We also found that the relationship between public funding of the and the the as a percentage of gdp is negative and statistically significant only in rich oecd countries and the poor ones.

Nas últimas décadas a despesa total em saúde (DTS) aumentou tanto nas economias desenvolvidas como nas emergentes. O presente trabalho é um estudo ecológico descritivo e misturado. Tomando uma amostra de 192 países agrupados por nível de renda, foram analisados: i) os padrões de financiamento público do DTS, ii) a proporção que representou a despesa pública em saúde nas despesas gerais de governo, e iii) a hipótese de Globerman e Vining referida à existência de uma correlação negativa entre financiamento público e DTS como porcentagem do PBI. Os resultados demostram que os governos que mais estão envolvidos com o setor da saúde possuem em média um DTS per capita mais alto. Além disso, a relação entre financiamento público do DTS e DTS como porcentagem do PBI é negativa e estatisticamente significativa apenas nos países ricos da OCDE e nos pobres.

Consequences of obstructive sleep apnoea.

A plethora of medical consequences have been associated with the syndrome of obstructive sleep apnoea (OSA). These are global, affecting nearly every body function, and have been related to two key pathophysiological findings in sleep apnoea: repetitive falls in oxyhaemoglobin saturation during sleep, and recurrent arousals from sleep which terminate apnoea episodes. Sufferers of OSA may experience daytime sleepiness, which has been measured both subjectively using the Epworth Sleepiness Scale and the Stanford Sleepiness Scale, but also objectively, using Multiple Sleep Latency Testing, Maintenance of Wakefulness testing, and the Oxford Sleep Resistance test. In addition to the loss of alertness, sleep apnoea contributes to memory deficits, reduced vigilance, impaired executive function, increased risk for automobile and occupational accidents, and decreased quality of life. Importantly, afflicted individuals experience improvements in these outcomes with treatment. Taken together, this evidence forms a compelling basis to identify and treat latent cases of sleep apnoea. Not only do patients have the opportunity to achieve improvements in these outcomes and health-related quality of life, but the enormous economic burden that untreated apnoea imposes on the health care system may be eased.

Some economic issues of treatment of hypertension / Монголын Анагаах Ухаан

Goal: The aim of the study was to identify economic burden from hypertention in Ulaanbaatar and develop some recommenadations. Material and Method: The top down approach was used to calculate direct costs of hypertension in five hospitals of the secondary and tertiary levels. To calculate cost of hypertension financial reports and cost centres data were used. A self-administered questionnaire was used to calculate indirect costs from the disease. Patients, admitted to six UB district and three tertiary level hospitals due to hypertension filled in the questionnaire. Data was analysed using SPSS 15 programme.Results: Some 114 patients were surveyed. The average cost of hypertension was 143914 ± 38189.5 (average bed days 8.7) and 264756 ± 40760.4¥ (average bed days 9.5) in the selected district and tertiary level hospitals respectively. The average cost for per out-patient visit was 4237 ± 2123.5¥ in the selected district hospitals and 3,162 ± 308.3¥ in the selected tertiary level hospitals. The indirect costs included transport cost to and from hospital, food, transport cost of relatives to visit them, cost of medications, and some other expenses related to their admission. Average indirect cost of an admission of patients with the hypertension was 253,395 and 212,717.44¥ in district and tertiary level hospitals respectively. Economic burden from temporary loss of working ablility due to hypertension was 177.1 millions tugrigs. National average wage was 300500¥ in 2009. Some 65.8% of respondents used antihypertension drugs at least once a day and average cost was 653.4¥ per patient per day. Annual and 10 years drug use estimates were 238491 and 2.3 million tugrigs per patient respectively (Inflation and price changes were not counted).Conclusion: Indirect and direct costs for admission were 1.1 billion (49.6%) and 939 million (42.5%) tugrigs respectively. Cost of hypertension in Ulaanbaatar was 2.2 billion tugrigs in 2009 and it is 1.1% of total health sector financing.

Effect of Allergic Rhinitis on the Use and Cost of Health Services by Children with Asthma

PURPOSE: Allergic rhinitis (AR) is common among children with asthma and exacerbates asthma symptoms. To assess the incremental utilization and cost of asthma-related health services due to concomitant AR among asthmatic children. MATERIALS and METHODS: Asthma-related claims were extracted from the Korean National Health Insurance (NHI) claims database, which covers 97% of the population. Per-capita utilization and costs of asthma-related services were determined from the societal perspective. RESULTS: Of 319,714 children (1-14 years old) with chronic asthma in 2003, 195,026 had concomitant AR (prevalence 610 per 1,000 asthmatic children). Children with AR had 1.14 times more outpatient visits, 1.30 times more emergency department (ED) visits, and 1.49 times more hospitalizations than children without AR. More children with AR used general hospitals (7.17%) than children without AR (3.23%). The ratios of unit pharmaceutical costs per outpatient visit, ED visit, and admission between children with and without AR were 1.27, 1.20, and 1.14. Total annual expenditure combining direct health care, transportation, and caregivers' costs, were dollar 273 and dollar 217 for children with and without AR, respectively. CONCLUSION: Health service utilization and costs for asthma were greater for asthmatic children with AR. More frequent ED visits and admissions among asthmatic children with AR suggest poorer control and more frequent exacerbations. Higher unit cost of pharmaceuticals during visits, tendency to receive asthma care from a higher-level facility, and greater risk of ED visit or admission all contributed to the additional economic burden of AR.

Os custos do Programa de Saúde da Família de Porto Alegre - 1998 e 2002 / The cost of the Family Health Program in Porto Alegre - 1998 and 2002

Este estudo pretende, por meio da perspectiva das ciências econômicas, ampliar a compreensão sobre funcionamento do sistema de saúde, utilizando o instrumental disponível nesta área do conhecimento, as avaliações econômicas, para avaliar uma importante política pública proposta pelo governo federal e implantada em todo o país: o Programa de Saúde da Família. Nesta primeira aproximação será feito um estudo de caso do município de Porto Alegre, no período de 1998 a 2002. O objetivo do estudo é criar um instrumento de gestão dos custos do programa, que permita o monitoramento e redirecionamento das ações quando se fizer necessário. Foi feita extensa revisão da literatura e, para a construção do instrumento de gestão de custos, foi necessário o levantamento dos processos de trabalho, da estrutura gerencial da secretaria e por fim dos dados de despesa e produção para o calculo dos custos do programa. O estudo demonstrou que não houve variação importante dos custos totais do programa no período, mas houve grande variação em algumas categorias especificas de custo. Além disso, mostrou que as diferentes unidades de saúde possuem diferentes custos que estão relacionados com o tamanho da equipe ou com a população adscrita.

This study aims at a broader understanding of the functioning of the health system from the perspective of economics, utilizing the tools made available by this area for evaluating an important public policy proposed by the Brazilian federal government: the Family Health Program. This first approach consists in a case study conducted in the city of Porto Alegre during the period 1998-2002. The purpose of this study was creating an instrument for the cost management of the program allowing for monitoring and redirecting actions when necessary. An extensive review of the literature was carried out and data about the work processes, the organizational structure of the secretariat in charge and cost and production of the program were collected for constructing the cost management instrument. The study showed no important variation in the total cost of the program during the period but considerable variations in some specific cost categories. Furthermore it was shown that different health units involve different costs related to the size of the team or to the target population.

Custo-efetividade: comparação entre o modelo tradicional e o Programa de Saúde da Família / Cost-effectiveness analysis: comparison of traditional

Este é um estudo de custo-efetividade da provisão da Atenção Básica por meio de duas alternativas de modelos de Atenção Básica . o modelo .tradicional. e o Programa de Saúde da Família. Em um primeiro momento, é feita a discussão teórica sobre avaliação econômica, explicitando toda a sua complexidade e, em um segundo, é realizado um estudo de caso no município de Porto Alegre. Os dados demonstram que o Programa de Saúde da Família foi mais custo-efetivo

This study analyses the cost-effectiveness of primary health care on the basis of two alternative models of health care delivery the .traditional. model and the Family Health Program of the Unified Health System. Firstly we make a theoretical approach to health economics assessment in all its complexity, and then we carry out a cost-effectiveness analysis based on a case study in the city of Porto Alegre. The data showed the Family Health Program to be more cost effective

The Survey for the Actual Condition of Drug Medication and Development of Health Care Cost Associated with Toxic Liver Injury in Korean; A Multicenter Study for the Detection and the Development of Nationwide Reporting System of Toxic Liver Injury / 대한간학회지

BACKGROUNDS/AIMS: In Korea, interests in health and health care costs have been increased along with the increase of mean survival rate and income level. The aim of this study is to investigate the actual condition of drug medication and burden of health care cost. METHODS: A total of 1,434 subjects in four tertiary medical centers were enrolled in this study. The questionnaires were obtained between March 2005 and September 2005. Based on this information, the actual condition of drug medication and health care cost were analyzed. RESULTS: The mean age of the subjects was 55.0+/-11.4 years (16-87 years). The male and female ratio was 1.74:1. The subjects with drug medication except for doctor's prescription are presently 26.6% and were 40.9% in the past. Traditional medicine (39.6%) and health food (29.9%) are more frequently used than herbal medicine (5.8%) and medical supplies (4.2%) now. In the past, herbal medicine (14.6%) was more frequently used compared with the present. The side effects of drug medication were developed in 90 subjects (7.5%). The total mean health care costs were 895,000 won/year, the herbal medicine, 834,000 won/year, the health food, 950,000 won/year, and the traditional medicine, 324,000 won/year. CONCLUSIONS: In this study, the subjects with other drug medications without doctor's prescription were as high as ever. The frequency of the use of the herbal medicine was decreased. However, the frequency for the use of the health food and traditional medicine have relatively increased. The side effects and additional large amounts of health care costs were occurred.

The Socioeconomic Effects of Tobacco Smoking

It is well known that tobacco smoking is an establishedor probable cause of many different diseases, and approximately four million people die every year from tobacco-refated diseases. In Korea the estimation of the health care cost of smoking and direct and indirect economic loss from smoking in 1995 were over two trillion won and about 3.5 trillion won, respectively. Smoking and also passive smoking decrease the productivity of workers. Fires related to cigarette smoking are the leading cause of civilian fire deaths, and the health care-cost for burn patients is also substantial. So it seems obvious that non-smoking would save health carerelated money. However, previous studies have shown that it is difficult to determine whether the decrease of smoking population would save money. Smokers tend to suffer more from a large variety of diseases, but they die earlier than non-smokers. On the other hand, non-smokers tend to spend more money on health care because they live longer, Recent studies have suggested that smoking cessation saves health care costs in the short term. In the long run, however, smoking cessation would increase health care costs.