Cost-Effectiveness Analysis of Hospice-Palliative Care for Adults with Terminal Cancer in South Korea / 대한내과학회지

BACKGROUND/AIMS: Although there is growing interest in hospice-palliative care, little information is available on the effects of such care in South Korea. Addressing this research gap, i.e., determining the cost-effectiveness of hospice-palliative care in South Korea, will help guide policy. Thus, the aim of this study was to evaluate the cost-effectiveness analysis of hospice-palliative care in adults diagnosed with terminal cancer. METHODS: We used a Markov model to construct a decision tree, for an analysis comparing the general ward with the hospice-palliative ward in terms of patient quality of life and cost-effectiveness. Cost and quality of life were estimated based on published Korean studies. Cost-effectiveness was calculated as the incremental cost relative to the incremental effect. Additionally, a one-way sensitivity analysis was performed to test the robustness of the results. RESULTS: Hospice-palliative ward care was more cost-effective than general ward care. The incremental cost was 290,401 Korean won (KRW) and the incremental effect was −0.25. The incremental cost-effectiveness ratio was −1,174,045 KRW. A similar pattern of results was obtained in the sensitivity analysis. CONCLUSIONS: Our results suggest that hospice-palliative ward care is more cost-effective than general ward care.

Cost-Effectiveness Analysis of Hospice-Palliative Care for Adults with Terminal Cancer in South Korea / 대한내과학회지

BACKGROUND/AIMS@#Although there is growing interest in hospice-palliative care, little information is available on the effects of such care in South Korea. Addressing this research gap, i.e., determining the cost-effectiveness of hospice-palliative care in South Korea, will help guide policy. Thus, the aim of this study was to evaluate the cost-effectiveness analysis of hospice-palliative care in adults diagnosed with terminal cancer.@*METHODS@#We used a Markov model to construct a decision tree, for an analysis comparing the general ward with the hospice-palliative ward in terms of patient quality of life and cost-effectiveness. Cost and quality of life were estimated based on published Korean studies. Cost-effectiveness was calculated as the incremental cost relative to the incremental effect. Additionally, a one-way sensitivity analysis was performed to test the robustness of the results.@*RESULTS@#Hospice-palliative ward care was more cost-effective than general ward care. The incremental cost was 290,401 Korean won (KRW) and the incremental effect was −0.25. The incremental cost-effectiveness ratio was −1,174,045 KRW. A similar pattern of results was obtained in the sensitivity analysis.@*CONCLUSIONS@#Our results suggest that hospice-palliative ward care is more cost-effective than general ward care.

Association between Parents' Country of Birth and Adolescent Depressive Symptoms: the Early Stages of Multicultural Society

BACKGROUND: This study aims to determine whether significant associations exist between the parents' country of birth and adolescent depressive symptoms in the early stages of a multicultural society. METHODS: We used data from the 2012–2016 Korea Youth Risk Behavior Web-based Survey, which included responses from 327,357 individuals. Participants were classified into groups according to their parent's country of birth. Logistic regression analysis was used to examine the significance of the associations. RESULTS: Adolescents whose parents were born abroad are more likely to have depressive symptoms (odds ratio [OR] = 1.68; 95% confidence interval [CI], 1.33–2.12) than adolescents whose parents were native Koreans. Respondents whose father was born in North Korea or Japan or Taiwan show greater odds of depressive symptoms than respondents whose parents were native Korean. CONCLUSION: Adolescents whose parents were born abroad are more likely to have depressive symptoms. Multicultural family support policies should be implemented in consideration of the characteristics of the parents' country of birth.

Effects of Physician Volume on Readmission and Mortality in Elderly Patients with Heart Failure: Nationwide Cohort Study

PURPOSE: Readmission and mortality rates of patients with heart failure are good indicators of care quality. To determine whether hospital resources are associated with care quality for cardiac patients, we analyzed the effect of number of physicians and the combined effects of number of physicians and beds on 30-day readmission and 1-year mortality. MATERIALS AND METHODS: We used national cohort sample data of the National Health Insurance Service (NHIS) claims in 2002–2013. Subjects comprised 2345 inpatients (age: >65 years) admitted to acute-care hospitals for heart failure. A multivariate Cox regression was used. RESULTS: Of the 2345 patients hospitalized with heart failure, 812 inpatients (34.6%) were readmitted within 30 days and 190 (8.1%) had died within a year. Heart-failure patients treated at hospitals with low physician volumes had higher readmission and mortality rates than high physician volumes [30-day readmission: hazard ratio (HR)=1.291, 95% confidence interval (CI)=1.020–1.633; 1-year mortality: HR=2.168, 95% CI=1.415–3.321]. Patients admitted to hospitals with low or middle bed and physician volume had higher 30-day readmission and 1-year mortality rates than those admitted to hospitals with high volume (30-day readmission: HR=2.812, 95% CI=1.561–5.066 for middle-volume beds & low-volume physicians, 1-year mortality: HR=8.638, 95% CI=2.072–36.02 for middle-volume beds & low-volume physicians). CONCLUSION: Physician volume is related to lower readmission and mortality for heart failure. Of interest, 30-day readmission and 1-year mortality were significantly associated with the combined effects of physician and institution bed volume.

Projection of Breast Cancer Burden due to Reproductive/Lifestyle Changes in Korean Women (2013-2030) Using an Age-Period-Cohort Model / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The aim of this study was to estimate the burden of breast cancer that can be attributed to rapid lifestyle changes in South Korea in 2013-2030. MATERIALS AND METHODS: An age-period-cohort model was used to estimate the incidence and mortality. The Global Burden of Disease Study Group methodwas used to calculate the years of life lost and years lived with disability in breast cancer patients using a nationwide cancer registry. The population attributable riskswere calculated using meta-analyzed relative risk ratios and by assessing the prevalence of risk factors. RESULTS: Women’s reproductive/lifestyle changes, including advanced maternal age at first childbirth (from 37 to 85 disability-adjusted life years [DALYs] per 100,000 person-years), total period of breastfeeding (from 22 to 46 DALYs per 100,000 person-years), obesity (from 37 to 61 DALYs per 100,000 person-years), alcohol consumption (from 19 to 39 DALYs per 100,000 person-years), oral contraceptive use (from 18 to 27 DALYs per 100,000 person-years), and hormone replacement therapy use (from 2 to 3 DALYs per 100,000 person-years) were identified as factors likely to increase the burden of breast cancer from 2013 to 2030. Approximately, 34.2% to 44.3% of the burden of breast cancer could be avoidable in 2030 with reduction in reproductive/lifestyle risk factors. CONCLUSION: The rapid changes of age structure and lifestyle in South Korea during the last decade are expected to strongly increase the breast cancer burden over time unless the risk factors can be effectively modified.