Factor Configurations with Governance as Conditions for Low HIV/AIDS Prevalence in HIV/AIDS Recipient Countries: Fuzzy-set Analysis

This paper aims to investigate whether good governance of a recipient country is a necessary condition and what combinations of factors including governance factor are sufficient for low prevalence of HIV/AIDS in HIV/AIDS aid recipient countries during the period of 2002-2010. For this, Fuzzy-set Qualitative Comparative Analysis (QCA) was used. Nine potential attributes for a causal configuration for low HIV/AIDS prevalence were identified through a review of previous studies. For each factor, full membership, full non-membership, and crossover point were specified using both author's knowledge and statistical information of the variables. Calibration and conversion to a fuzzy-set score were conducted using Fs/QCA 2.0 and probabilistic tests for necessary and sufficiency were performed by STATA 11. The result suggested that governance is the necessary condition for low prevalence of HIV/AIDS in a recipient country. From sufficiency test, two pathways were resulted. The low level of governance can lead to low level of HIV/AIDS prevalence when it is combined with other favorable factors, especially, low economic inequality, high economic development and high health expenditure. However, strengthening governance is a more practical measure to keep low prevalence of HIV/AIDS because it is hard to achieve both economic development and economic quality. This study highlights that a comprehensive policy measure is the key for achieving low prevalence of HIV/AIDS in recipient country.

Cost-Effectiveness Analysis of Adjuvant Hormonal Treatments for Women with Postmenopausal Hormone-Receptor Positive Early Breast Cancer in the Korean Context / 한국유방암학회지

PURPOSE: This study aims to evaluate the cost-effectiveness of two aromatase inhibitors for the adjuvant treatment of women with postmenopausal hormone receptor positive early breast cancer, and to find the most reasonable treatment option when the population is stratified by the nodal status. METHODS: A Markov model was developed with defining six Markov states based on breast cancer progression. The annual probabilities of recurrence by adjuvant treatment (anastrozole, letrozole, and tamoxifen) were estimated from the published studies in the overall population and in the node negative and node positive groups. The costs of the defined breast cancer events were measured by the micro-costing method based on the 2009 National Health Insurance Fee Schedule and the third Clinical Guideline of Breast Cancer Treatment. Anastrozole and letrozole were compared with tamoxifen respectively, using the same Markov model. The incremental cost-effectiveness ratios for the overall population and each subgroup were estimated. RESULTS: Anastrozole was more effective and costly than tamoxifen with anastrozole costing an additional Korean Won (KRW) 22,461,689 per quality-adjusted life year (QALY). Letrozole showed a similar incremental cost of KRW 21,004,142 per QALY. In the node negative group, anastrozole was the most cost-effective with an incremental cost of KRW 19,717,770 per QALY, while letrozole was the most cost-effective with an incremental cost of KRW 8,150,512 per QALY for the node positive group. The sensitivity analysis showed that these results were robust. CONCLUSION: The subgroup analysis clearly demonstrated which treatment was superior among the aromatase inhibitors in terms of the cost-effectiveness. Such a finding was not confirmed for the case of the overall population. The implication of this study is that the decision makers should be careful when generalizing the cost-effectiveness results. The stratified analysis in this context may help reach a reasonable decision for allocating medical resources.

A national survey of postoperative pain managements in hospitals from the national health insurance database / 대한마취과학회지

BACKGROUND: A postoperative pain management has been considered as an important issue in surgery. However, any systematic information or standard method about it has not been so far provided for clinicians in Korea. This study aims to analyze the current practices of in-hospital postoperative pain controls and suggest clinical implications. METHODS: A descriptive statistical analysis was adopted to review a nationwide distribution of postoperative pain control methods for the types of patients, surgery, hospitals, specialties, and analgesia. The data is based on the medical claims database of Health Insurance Review Agency (HIRA), which covers all reimbursement claims from hospitals in Korea. All inpatient surgery cases implemented during one year were included in the analysis. RESULTS: It was reported that 1,539,662 cases out of total 1,891,596 inpatient surgery cases were associated with one or more types of analgesia in 2005. The most frequent type of inpatient surgery was bone surgery (24.4%). In all cases related with analgesia, bone surgery took the highest percentage of 28.6%. It was also revealed that the most frequently used postoperative pain management was oral or external use of NSAID (non steroidal anti-inflammatory drug), which was 75.0% of all analgesia treatments. An epidural PCA (patient controlled analgesia), IV PCA (intra-venous patient controlled analgesia) and epidural opioid bolus were 0.2%, 0.2% and 0.1%, respectively, of all analgesia treatments. CONCLUSIONS: The results would certainly be useful to develop a clinical practice guideline in postoperative pain management to enhance patient outcomes.

The Costs of Postoperative Pain Management in South Korea

PURPOSE: There have been few studies carried out on the costs of after-surgery pain therapy in hospitals. This analysis was conducted to estimate the health care costs and to understand aspects of resource utilization for post-operative pain management in South Korea. METHODS: The direct health care costs for postoperative pain management were estimated by the type of analgesia and surgery. The claims database of the Health Insurance Review Agency (HIRA) was the main data source for this study. It covered all the reimbursement claims from medical care institutions. The average resource use included the length of stay, the total hospitalization cost, the total analgesia cost and the total pharmacy cost. The total analgesia cost was measured as the mean of all the analgesia subgroups, and this encompassed the procedure costs and drug costs. RESULTS: The average length of stay was 12.0 days per case and the total analgesia cost for surgery averaged 131,555 won (equivalent to US$146.2), which was 4.2% of the total hospitalization cost. The total pharmacy cost on the average was 626,805 won (US$696.5), which was 20.0% of the total hospitalization cost. This study shows that the costs of epidural patient-controlled analgesia were the highest among the 11 analgesia types, with 49.5% of its costs being the material cost. CONCLUSION: This study provides a variety of information about how the costs and patterns of health resources that are used for post-operative pain management are structured in South Korea. It is the first cost analysis using the database for the entire Korean population. Understanding the patterns of resource use correctly may be an important first step in designing efficient pain therapy for patients.

The societal cost of rotavirus infection in South Korea / 소아과

PURPOSE: This study aims to estimate the financial cost of rotavirus infection in Korea in the year of 2005. METHODS: The incidence rates used were from the epidemiological profile at Jeoungeub District (5.8 cases/1,000 children <5 years old for inpatients, and 22.65 cases/1,000 children <5 years old for outpatients, per year). The health care cost per capita of rotavirus infection (ICD code: A08.0) was extracted from the Health Insurance Review and Assessment Service database in Korea. The patient survey was conducted to capture information about non-medical costs and associated productivity loss incurred by adult caregivers. RESULTS: The number of annual national cases among children <5 years old with rotavirus infection was estimated to be 69,122 (i.e., 55,030 outpatients and 14,092 inpatients). The total cost of rotavirus infection was estimated at 13.3 billion Korean won, comprising 11 billion Korean won (82.7%) of direct medical costs, 1.6 billion Korean won (12.0%) of direct non-medical costs (e.g., transportation and supplies), and 0.68 billion Korean won (5.1%) of productivity lost by adult caregivers. CONCLUSION: Rotavirus infection carries not only medical costs but also non-medical and indirect costs; together, these costs incur a significant burden on South Korean society. The impact of rotavirus on quality of life and health among patient caregivers was not considered in this study, but it does merit further research.

The societal cost of rotavirus infection in South Korea / 소아과

PURPOSE: This study aims to estimate the financial cost of rotavirus infection in Korea in the year of 2005. METHODS: The incidence rates used were from the epidemiological profile at Jeoungeub District (5.8 cases/1,000 children <5 years old for inpatients, and 22.65 cases/1,000 children <5 years old for outpatients, per year). The health care cost per capita of rotavirus infection (ICD code: A08.0) was extracted from the Health Insurance Review and Assessment Service database in Korea. The patient survey was conducted to capture information about non-medical costs and associated productivity loss incurred by adult caregivers. RESULTS: The number of annual national cases among children <5 years old with rotavirus infection was estimated to be 69,122 (i.e., 55,030 outpatients and 14,092 inpatients). The total cost of rotavirus infection was estimated at 13.3 billion Korean won, comprising 11 billion Korean won (82.7%) of direct medical costs, 1.6 billion Korean won (12.0%) of direct non-medical costs (e.g., transportation and supplies), and 0.68 billion Korean won (5.1%) of productivity lost by adult caregivers. CONCLUSION: Rotavirus infection carries not only medical costs but also non-medical and indirect costs; together, these costs incur a significant burden on South Korean society. The impact of rotavirus on quality of life and health among patient caregivers was not considered in this study, but it does merit further research.

Social Support and Self-rated Health Status in a Low Income Neighborhood of Seoul, Korea / 예방의학회지

OBJECTIVES: To assess the distribution of social support, and explore its effects on self-rated health status in a low income neighborhood of Seoul, Korea. METHODS: In September 2001 we conducted a survey in a low income neighborhood of Seoul, Korea, in which 862 residents, aged 18 years or over, participated. We measured the general sociodemographic characteristics, self-rated health status and social support with the instrument developed from Korean translation of the Medical Outcomes Study Social Support Survey (MOS-SSS) scale of the US. Logistic regression was used to identify the determinants of social support, and explore its effects on self-rated health status. RESULTS: Lower social class, women or divorced people had much less social support compared to higher social class, men or those never married, respectively. Those families on much lower income also received less social support. Social support has a positive impact on the self-rated health status, which remains statistically significant even when other relevant variables are adjusted. CONCLUSIONS: This study suggests that social support has an important role in health, and the socially disadvantaged have lower social support. Therefore, to improve the health status of the poor, it is necessary to encourage community participation, and develop strategies that could strengthen their provision of social support.