Direct medical costs of tuberculosis patients and its influencing factors in Hainan Province / 中国热带医学

@#Abstract： Objective　To investigate and analyze the factors influencing the direct medical costs of tuberculosis patients in Hainan Province, so as to provide scientific reference for reducing the medical burden of patients and adjusting the medical insurance reimbursement policies in the local area. Methods　Using the total health expenditure accounting data of Hainan Province in 2020, including the outpatient and inpatient data of 14 provincial medical institutions, 235 city and county level medical institutions, and other relevant data from the 2020 Hainan Statistical Yearbook and Health Financial Yearbook, the direct medical costs of tuberculosis patients in the province in that year were calculated, and the influencing factors were explored using single factor analysis and multivariate generalized linear model. Results　The final number of cases included in this study was 11 979, including 7 526 males (62.83%) and 4 453 females (37.17%). The total direct medical costs of patients were 43.207 3 million yuan, of which the total outpatient costs were 2.733 9 million yuan (6.32%) and the total inpatient costs were 40.473 4 million yuan (93.67%). In the cost composition analysis, the drug cost was 17.971 million yuan (41.44%), the examination cost was 8.854 7 million yuan (20.49%), other costs were 16.445 5 million yuan (38.06%), and the median (quartile) M(P25,P75) direct medical cost of each patient was 177.50 (66.73,764.89) yuan. The multivariate generalized linear model analysis showed that hospitalization, new rural cooperative medical insurance (NRCMI) and urban employee medical insurance were the influencing factors of the increase in direct medical costs of tuberculosis patients the median (quartile) M(P25,P75) of direct medical costs are 10 425.04 (6 560.87,17 374.9), 10 246.5 (5 871.28,17 220.33), 3 177.2 (293.09,7 730.23) yuan respectively; the OR(95%CI) values were -3.505 (-3.499- -3.517), 1.559 (1.551-1.569) and 2.191 (2.188-2.207) respectively. Conclusions　The direct medical costs of tuberculosis patients in Hainan Province are high. Hospitalization, the new rural cooperative medical insurance and the medical insurance for urban workers are the influencing factors of the increase in costs.

Carga económica de la enfermedad neumocócica en niños de edad preescolar en el Policlínico Docente Playa / Economic burden of pneumococcal disease in pre-school age children from Playa Teaching Policlinic

Introducción: El cálculo de la carga económica de las enfermedades neumocócicas en niños de edad preescolar en el nivel primario de salud en Cuba contribuye a visualizar la necesidad de buscar vías para prevenir su padecimiento. Objetivo: Estimar la carga económica de la enfermedad neumocócica en niños de edad preescolar en el Policlínico Docente de Playa en el 2016. Métodos: Se realizó un estudio descriptivo transversal. Para estimar la carga económica se aplicó el enfoque del costo de la enfermedad sobre la base de la incidencia, desde la perspectiva institucional. Para calcular el costo de atención por paciente se empleó el método de costeo paciente tipo. Resultados: La otitis media aguda fue la enfermedad de mayor incidencia, con el 49 por ciento de los casos seguida por la neumonía con el 47 por ciento. El costo esperado de la enfermedad fue entre 47,97 CUP y 103,38 CUP para la otitis media aguda, de entre 83,99 CUP y 194,94 CUP para la neumonía y entre 105,69 CUP y 189,97 CUP para la meningitis y la sepsis. Dentro de los procesos, las visitas al hogar presentaron el mayor gasto y dentro de las partidas, el salario. La enfermedad neumocócica representó una carga económica de 8849,15 CUP para el área de salud estudiada. Conclusiones: La enfermedad neumocócica en niños no presenta alto nivel de incidencia en el área del Policlínico Docente de Playa, pero representa una carga económica para los servicios de salud en el primer nivel de atención. Estos costos son susceptibles a disminuir con la introducción de la vacuna antineumocócica conjugada(AU)

Introduction: Calculation of the economic burden caused by pneumococcal diseases in pre-school age children in the primary health care of Cuba contributes to visualize the need for finding ways to prevent them. Objective: To estimate the economic burden caused by the pneumococcal disease in pre-school age children from Playa Teaching Policlinic during 2016. Methods: It was conducted a descriptive cross-sectional study. For estimating the economic burden, it was used the approach of cost of the disease based on the incidence and from the institutional perspective. For calculating the cost of the care per patient, it was used the method of cost-patient-type. Results: Acute otitis media was the disease with higher incidence with 49 percent of the cases, followed by pneumonia with 47 percent . The expected cost by diseases was among 47,97 CUP (Cuban peso) and 103,38 CUP for acute otitis media; among 83,99 CUP and 194,94 CUP for pneumonia; and among 105,69 CUP and 189,97 CUP for meningitis and sepsis. Within the processes, home visits showed the higher expense, and among the entries, it was the salary. Pneumococcal disease represented an economic burden of 8849,15 CUP for the studied health area. Conclusions: Pneumococcal disease in children does not represent a high level of incidence in the area of Playa Teaching Policlinic, but it represents an economic burden for health services in the primary care level. These costs are likely to decrease with the introduction of the pneumococcal conjugate vaccine(AU)

Costs of acute otitis media in children in a city of the Colombian Caribbean coast / Costos de la otitis media aguda en niños de una ciudad de la costa caribe colombiana

Abstract Introduction: Acute otitis media is the main cause of consultation, antibiotic use, and ambulatory surgery in developed countries; besides, it is associated with an important economic burden. However, non-medical indirect costs of acute otitis media, which are relevant in this pathology, have been underestimated. Objective: To estimate the costs of acute otitis media in pediatric patients in Cartagena, Colombia. Materials and methods: We conducted a prospective study of micro-costing between 2014 and 2015. The direct and indirect costs of acute otitis media were determined through forms applied to parents or caregivers. Loss of productivity was estimated based on the monthly legal minimum wage of 2014 (COP $616.000) (USD $308). Results: A total of 62 episodes of acute otitis media occurred. The total economic costs attributed per episode was COP $358,954 (standard deviation: SD ± COP $254,903, i.e., USD $179). The total economic burden was COP $22,503,141 (USD $11,250), the indirect costs per episode were COP $101,402 (USD $51), and the average care time spent by parents was 3.7 days. Conclusion: The estimated costs of acute otitis media in this study were lower than the costs estimated in a review of high-income countries and similar to those of low-income countries such as Nigeria. Information on total costs (direct and indirect) of acute otitis media is necessary for public health decision-making and for full cost-effectiveness assessments.

Resumen Introducción. La otitis media aguda es la principal causa de consultas médicas, de uso de antibióticos y de cirugías ambulatorias en los países desarrollados. Está asociada con una significativa carga económica, pero sus costos indirectos no médicos, los cuales son relevantes en esta enfermedad, se han subestimado. Objetivo. Estimar los costos de la otitis media aguda en pacientes pediátricos en Cartagena, Colombia. Materiales y métodos: Se hizo un estudio prospectivo de microcosteo entre el 2014 y el 2015. Se determinaron los costos directos e indirectos de la otitis media aguda mediante encuestas a los padres o cuidadores. La pérdida de productividad se estimó con base en el salario mínimo legal vigente mensual del 2014(COP$616.000) (USD$308). Resultados. Se presentaron 62 episodios de otitis media aguda. Los costos económicos totales por episodio fueron de COP $358.954 (desviación estándar, DE: ± $254.903) (USD $179). La carga económica total fue de COP $22'503.141 (USD $11.250), los costos indirectos por episodio fueron de COP $101.402 (USD $51) y el tiempo promedio empleado por los padres en el cuidado fue de 3,7 días. Conclusiones. Los costos estimados de la otitis media aguda en el presente estudio fueron menores a los estimados en países con ingresos altos y similares a los de países con ingresos bajos como Nigeria, según una revisión bibliográfica. La información sobre los costos totales directos e indirectos de la otitis es necesaria para la adopción de decisiones en salud pública y para hacer evaluaciones económicas completas de costo-efectividad.

The prevalence and related direct medical costs of chronic complications among patients with type 2 diabetes in China / 中华内分泌代谢杂志

Objective To estimate the prevalence and related direct medical costs of chronic complications,especially cardiovascular diseases,cerebrovascular diseases,and nephropathy in patients with type 2 diabetes mellitus (T2DM) in China.Method Data were extracted from the hospital information system(HIS) database of 4 top level Chinese hospitals from January 1st,2012 to May 31st,2017.Patients with T2DM were identified through international classification of diseases,tenth version (ICD-10) diagnosis supplemented with Chinese descriptions.The prevalences of complications including cardiovascular diseases,cerebrovascular diseases,nephropathy,diabetic foot,lower extremity vascular diseases,diabetic retinopathy,and diabetic neuropathy were estimated among all identified patients with T2DM.The costs per hospitalization and per outpatient visit under the primary diagnoses of each chronic complication were further estimated.Results There were 61 139 patients with T2DM,with mean age of(62.1 ± 13.6) years,50.5％ being males.66.8％ of them had chronic complications,and patient suffered from more than 2 complications on average.The most common complication was nephropathy (30.5％),followed by diabetic neuropathy (26.8％),diabetic retinopathy (26.3％),cardiovascular disease (24.9％),and cerebrovascular disease (19.2％).The cost per hospitalization was highest for cardiovascular disease(21 176 yuan),followed by diabetic foot disease(18 999 yuan) and cerebrovascular disease (16 583 yuan).The cost per outpatients visit varied from 826 to 976 yuan across different complications except for lower extremity vascular diseases (522 yuan).Conclusions The majority of patients with T2DM suffered from chronic complications.The occurrence and development of chronic complications,especially cardiovascular diseases,cerebrovascular diseases,and nephropathy,led to increased direct medical costs among patients with T2DM.Effective interventions,such as regular physical examinations and proper glycemic control,should be implemented to prevent complications among the diabetic patients.

Analysis of direct medical costs and their influencing factors for in-patients with Multiple Mye-loma:Based on the reimbursement claim database in Guangzhou, China / 中国卫生政策研究

Objective:To study the direct medical expenses for inpatients with Multiple Myeloma and explore its influencing factors. Methods:A total of 1386 hospitalization records were collected using the reimbursement claim database in Guangzhou City during the period from January 2009 to December 2011 , which covered the entire enroll-ees of Urban Employee Basic Medical Insurance ( UEBMI) and Urban Resident Basic Medical Insurance ( URBMI) . Multivariate logarithmic regression models were used to analyze the influencing factors of direct hospitalization costs. Results:During the period from 2009 to 2011 , the total costs of inpatients with Multiple Myeloma were 19319 . 16 , 17364. 76 and 21427. 44 Yuan, and the individual out-of-pocket cash payments were 7049. 37, 5216. 5 and 6475. 39 Yuan respectively. The major influencing factors on direct medical costs of inpatients with the aforesaid disease were identified to be age, health insurance type, hospital level and length of hospitalization. Besides, the proportion of drug expenses as per average occupancy rate among UEBMI and URBMI cases during three years were 61. 92% and 69. 22% respectively. Conclusion: The direct medical costs for inpatients with Multiple Myeloma are high and the medicine cost is the main component of total medical expenses. In addition, the economic burden is higher for patients with URBMI than for those with UEBMI for treating Multiple Myeloma.

Direct medical costs of treating Mexican children under 2 years of age with respiratory syncytial virus

Background. Respiratory syncytial virus (RSV) is the most frequent etiologic agent causing lower respiratory tract infection in children <2 years of age. Between 0.5 and 3% of patients will require hospitalization. The aim of this study was to estimate the direct medical cost of treating children <2 years old with suspicion of RSV at the Instituto Mexicano del Seguro Social (IMSS). Methods. Direct medical costs were estimated from an institutional perspective. Medical records were reviewed from patients <2 years of age who attended emergency services in second-level hospitals including subjects who required hospitalization. Estimated costs were obtained with the microcosting technique using the institutional costs from IMSS (year 2010). Costs were reported in USD (year 2011). Results. When analyzing total medical costs, outpatient management yielded a cost of $230.0 ± $10.30 U.S. dollars (USD), whereas hospitalized patients exhibited an average cost of $8,313.20 ± $595.30 USD. The main components of outpatient management costs were emergency visits, specialist consultations and diagnostic testing (41.6%, 32.7% and 10.7% of the total cost, respectively). In the case of hospitalized patients, intensive care unit cost (89.3%) and overall hospitalization cost (6.5%) represented 95.7% of the total cost. Conclusions. RSV is a disease that represents a significant economic burden for health care institutions, although most patients are treated on an outpatient basis.

Economic evaluation of the use of exogenous pulmonary surfactants in preterm newborns in a Mexican population / Evaluación económica de la utilización de surfactantes pulmonares exógenos en recién nacidos pretérmino en población mexicana

OBJECTIVE: To estimate the cost-effectiveness ratio of surfactant rescue treatment of premature infants with respiratory distress syndrome (RDS) who are covered by the Medical Insurance for a New Generation. MATERIALS AND METHODS: A cost-effectiveness evaluation was conducted from the third-payer perspective. Comparisons were made between the use of bovine surfactant (BS) therapy and without BS therapy. A decision tree model with a lifetime horizon was used where the measurements of effectiveness were life years gained (LYG) and quality-adjusted life years (QALYs). A 5% discount rate was considered for costs and health outcomes. All costs are expressed in Mexican pesos 2009. RESULTS: Incremental cost-effectiveness ratios (ICER) were MXN$136670 per LYG and MXN$125250 per QALY. CONCLUSION: Surfactant therapy was confirmed as a cost-effective strategy in accordance with World Health Organization criteria of three per capita gross domestic product (GDP) per QALY in premature infants with RDS in Mexico.

OBJETIVO: Estimar la razón de costo efectividad incremental del tratamiento de surfactante de rescate en pacientes pretérmino con Síndrome de Dificultad Respiratoria (SDR) cubiertos por el Seguro Médico para una Nueva Generación. MATERIAL Y MÉTODOS: Evaluación de costo-efectividad desde la perspectiva del tercer pagador. Los comparadores fueron la terapia de surfactante bovino y la alternativa de no emplear ésta. Se utilizó un árbol de decisión que consideró la esperanza de vida como horizonte temporal y las medidas de efectividad fueron los años de vida ganados (AVG) y los años de vida ajustados por calidad de vida ( AVAC).Resultados en pesos mexicanos del 2009. RESULTADOS: Las RCEI por AVG y AVAC fueron de MXN$136670 y MXN$125250. CONCLUSIÓN: La razón de costo por AVG y AVAC para la terapia de surfactantes en pacientes prematuros con SDR en México fue menor a tres veces el PIB per cápita, por lo que es una estrategia costo-efectiva según los criterios de la OMS.