The economic impact of a COVID-19 illness from the perspective of families seeking care in a private hospital in India.

Background: The Covid-19 pandemic had a tremendous impact that caused significant morbidity, mortality, and financial stress for families. Our study aimed to determine the Out-of-pocket expenses and economic impact of a Covid-19 illness for households where patients were admitted to a private hospital in India. Methodology: This was a cost-of-illness study from a tertiary care academic institute where adult patients diagnosed with COVID-19 from May 2020 to June 2021 were included. Patients with an admission of less than one day or who had any form of insurance were excluded. The clinical and financial details were obtained from the hospital information system and a cross-sectional survey. This was stratified across three clinical severity levels and two epidemiological waves. Results: The final analysis included 4445 patients, with 73 % admitted in Wave 1 and 99 patients interviewed. For patients with severity levels 1, 2 and 3, the median admission days were 7, 8 and 13 days respectively. The total cost of illness (general category) was $934 (₹69,010), $1507 (₹111,403) and $3611 (₹266,930) and the direct medical cost constituted 66%, 77% and 91% of the total cost for each level respectively. Factors associated with higher admission costs were higher age groups, male gender, oxygen use, ICU care, private admission, increased duration of hospital stay and Wave 2. The median annual household income was $3247 (₹240,000) and 36% of families had to rely on more than one financial coping strategies, loans with interest being the commonest one. The lockdown period affected employment and reduced income for a considerable proportion of households. Conclusion: A Covid admission of higher severity was a significant financial burden on families. The study reaffirms the need for collaborative and sustainable health financing systems to protect populations from hardships.$-US Dollar; ₹- Indian Rupees.

Total costs of inpatient treatment for COVID-19 in a tertiary hospital in Serbia.

BACKGROUND: Our study aimed to identify the total costs of inpatient treatment for coronavirus disease 2019 (COVID-19) in a tertiary institution in Serbia, an upper-middle-income country in Southeast Europe. METHODS: An observational, retrospective, cost-of-illness study was performed from the perspective of the National Health Insurance Fund and included a cohort of 78 females and 118 males admitted to the COVID-19 ward units of a tertiary center during the first wave of the pandemic. RESULTS: The median of the total costs in the non-survivors subgroup (n =43) was 3,279.16 Euros [interquartile range (IQR): 4,023.34; range: 355.20-9,909.61) which is higher than in the survivors (n =153) subgroup 747.10 Euros (IQR: 1,088.21; 46.71-3,265.91). The cut-off value of 156.46 Euros regarding the total costs per day was estimated to have 95.3 % sensitivity and 91.5 % specificity for predicting patients' dismal prognosis, with the area under the curve (AUC) of 0.968 (95 % confidence interval: 0.940-0.996, p <0.001). CONCLUSIONS: Direct medical inpatient treatment costs for COVID-19 represent a significant economic burden. The link between increased costs and an ultimate unfavorable outcome should be further explored.HIPPOKRATIA 2022, 26 (2):62-69.

Disease burden due to COVID-19 in Taiwan: Disability-adjusted life years (DALYs) with implication of Monte Carlo simulations.

BACKGROUND: The novel coronavirus disease 2019 (COVID-19) has affected a large number of countries. Informing the public and decision makers of the COVID-19's economic burdens is essential for understanding the real pandemic impact. METHODS: COVID-19 premature mortality and disability impact in Taiwan was analyzed using the Taiwan National Infectious Disease Statistics System (TNIDSS) by estimating the sex/age-specific years of life lost through death (YLLs), the number of years lived with disability (YLDs), and the disability-adjusted life years (DALYs) from January 2020 to November 2021. RESULTS: Taiwan recorded 1004.13 DALYs (95% CI: 1002.75-1005.61) per 100,000 population for COVID-19, with YLLs accounting for 99.5% (95% CI: 99.3%99.6%) of all DALYs, with males suffering more from the disease than females. For population aged ≥ 70 years, the disease burdens of YLDs and YLLs were 0.1% and 99.9%, respectively. Furthermore, we found that duration of disease in critical state contributed 63.9% of the variance in DALY estimations. CONCLUSIONS: The nationwide estimation of DALYs in Taiwan provides insights into the demographic distributions and key epidemiological parameter for DALYs. The essentiality of enforcing protective precautions when needed is also implicated. The higher YLLs percentage in DALYs also revealed the fact of high confirmed death rates in Taiwan. To reduce infection risks and disease, it is crucial to maintain moderate social distancing, border control, hygiene measures, and increase vaccine coverage levels.

Burden of illness associated with overweight and obesity in patients hospitalized with COVID-19 in the United States: analysis of the premier healthcare database from April 1, 2020 to October 31, 2020.

BACKGROUND: SARS-CoV-2 (COVID-19) continues to be a major public health issue. Obesity is a major risk factor for disease severity and mortality associated with COVID-19. OBJECTIVE: This study sought to estimate the healthcare resource use and cost outcomes in patients hospitalized with COVID-19 in the United States (US) according to body mass index (BMI) class. METHODS: Retrospective cross-sectional study analyzing data from the Premier Healthcare COVID-19 database for hospital length-of-stay (LOS), intensive care unit (ICU) admission, ICU LOS, invasive mechanical ventilator use, invasive mechanical ventilator use duration, in-hospital mortality, and total hospital costs from hospital charge data. RESULTS: After adjustment for patient age, gender, and race, patients with COVID-19 and overweight or obesity had longer durations for mean hospital LOS (normal BMI = 7.4 days, class 3 obesity = 9.4 days, p < .0001) and ICU LOS (normal BMI = 6.1 days, class 3 obesity = 9.5 days, p < .0001) than patients with normal weight. Patients with normal BMI had fewer days on invasive mechanical ventilation compared to patients with overweight and obesity classes 1-3 (6.7 days vs. 7.8, 10.1, 11.5, and 12.4, respectively, p < .0001). The predicted probability of in-hospital mortality was nearly twice that of patients with class 3 obesity compared to patients with normal BMI (15.0 vs 8.1%, p < .0001). Mean (standard deviation) total hospital costs for a patient with class 3 obesity is estimated at $26,545 ($24,433-$28,839), 1.5 times greater than the mean for a patient with a normal BMI at $17,588 ($16,298-$18,981). CONCLUSIONS: Increasing levels of BMI class, from overweight to obesity class 3, are significantly associated with higher levels of healthcare resource utilization and costs in adult patients hospitalized with COVID-19 in the US. Effective treatment of overweight and obesity are needed to reduce the burden of illness associated with COVID-19.

The COVID-19 pandemic has caused many people to be seriously ill. People who are overweight are more likely to get sicker from COVID-19 infection and to require hospitalization.In our study, we compared patients who have normal weight to people who have overweight or obesity to understand how excess weight affects their experiences with COVID-19. We looked at: (1) how overweight and obesity is related to how long patients with COVID-19 stay in the hospital, (2) if they stayed in the intensive care unit (ICU) and how long they spent there, (3) whether they needed help breathing with the use of a ventilator and how long they needed a ventilator, (4) if they died during their hospital stay, and (5) how much their hospital stay cost.We found that people who have overweight or obesity stayed in the hospital longer, were more likely to need to stay in the ICU, and were in the ICU longer. They were also more likely to need help breathing with the use of a ventilator and needed that help for a longer time. People who have overweight or obesity died during their hospital stay more often than people with a normal BMI. The costs associated with people who have overweight or obesity were higher than people who have a normal BMI.Overall, this study shows that having overweight or obesity is a significant risk factor for poor outcomes from COVID-19 infection. Treatment for obesity and overweight is needed to help improve outcomes from future pandemics.

Cost of Illness in Patients With COVID-19 Admitted in Three Brazilian Public Hospitals.

OBJECTIVES: The severity and transmissibility of COVID-19 justifies the need to identify the factors associated with its cost of illness (CoI). This study aimed to identify CoI, cost predictors, and cost drivers in the management of patients with COVID-19 from hospital and Brazil's Public Health System (SUS) perspectives. METHODS: This is a multicenter study that evaluated the CoI in patients diagnosed of COVID-19 who reached hospital discharge or died before being discharged between March and September 2020. Sociodemographic, clinical, and hospitalization data were collected to characterize and identify predictors of costs per patients and cost drivers per admission. RESULTS: A total of 1084 patients were included in the study. For hospital perspective, being overweight or obese, being between 65 and 74 years old, or being male showed an increased cost of 58.4%, 42.9%, and 42.5%, respectively. From SUS perspective, the same predictors of cost per patient increase were identified. The median cost per admission was estimated at US$359.78 and US$1385.80 for the SUS and hospital perspectives, respectively. In addition, patients who stayed between 1 and 4 days in the intensive care unit (ICU) had 60.9% higher costs than non-ICU patients; these costs significantly increased with the length of stay (LoS). The main cost driver was the ICU-LoS and COVID-19 ICU daily for hospital and SUS perspectives, respectively. CONCLUSIONS: The predictors of increased cost per patient at admission identified were overweight or obesity, advanced age, and male sex, and the main cost driver identified was the ICU-LoS. Time-driven activity-based costing studies, considering outpatient, inpatient, and long COVID-19, are needed to optimize our understanding about cost of COVID-19.

Prevalence and economic burden of depression and anxiety symptoms among Singaporean adults: results from a 2022 web panel.

BACKGROUND: Major depressive disorder (MDD) and generalized anxiety disorder (GAD) are leading causes of disability and premature mortality. At a global level, over 300 million people are estimated to suffer from major depressive disorders, equivalent to 4·4% of the world's population. Pandemic era stressors have increased rates for depression and anxiety by upwards of 25%. The goal of this study is to estimate the prevalence and economic burden of depression and anxiety symptoms in Singapore after the peak of the COVID-19 pandemic. METHODS: An existing web panel was queried between April 2022 and June 2022. Adult participants aged > 21 years old who screened positive for depression and anxiety symptoms based on the Patient Health Questionnaire-4 (PHQ-4) Screener were eligible for participation. Prevalence estimates were quantified by dividing the number of respondents who screened positive for these symptoms by the total number of respondents. Participants who screened positive were asked about healthcare utilization, days missed from work, and reduced productivity due to these symptoms. These values were then monetized and scaled based on prevalence and population counts to generate per capita and total annual costs. RESULTS: Two thousand three hundred forty-eight respondents filled out the PHQ-4 depression/anxiety screener on behalf of the 5,725 adults living in their households (including respondents themselves). Prevalence estimates were calculated based on the responses recorded for these 5,725 adults. 14.1% adults had symptoms consistent with depression and 15.2% had symptoms consistent with anxiety. In total, 20.0% may experience symptoms consistent with at least one of these two conditions, yet approximately half reported never being formally diagnosed. 350 respondents screened positive for depression or anxiety symptoms and thus were eligible to fill out the healthcare utilization, presenteeism, and absenteeism survey. Direct annual healthcare costs due to depression and anxiety symptoms averaged Singapore dollar (SGD) $1,050 for these respondents. The employed subset (n = 304) missed an extra 17.7 days of work on average per year, which translates to SGD $4,980 per worker. These workers also reported being ~ 40% less productive at work, which equates to SGD $28,720 in economic losses annually. In total, these symptoms caused SGD $15.7 billion in increased costs. Presenteeism accounts for 81.6% of this total (SGD $12.8 billion), absenteeism for 14.2% (SGD $2.3 billion) and healthcare accounts for 4.2% (SGD $0.7 billion). CONCLUSIONS: The health and economic burden associated with depression and anxiety symptoms is large in Singapore, representing 2.9% of Singapore's gross domestic product (GDP). Employers and governments should look to identify effective remediation strategies, including strategies to address the high rates of undiagnosed cases. Increasing psychiatric resources, general practitioner mental health competency, access to peer support, and increased efforts to reduce mental health stigma should be considered to address this growing public health crisis.

The methodological quality of economic evaluations of measles outbreaks: A systematic review of cost-of-illness studies.

OBJECTIVES: To identify the main cost components included in the economic evaluations of measles outbreaks, their items and cost drivers, and evaluate the quality of costing methodology, analyzing the key features that may affect the validity of these studies in countries with different income levels. METHODS: We systematically searched multiple databases EMBASE, MEDLINE (via PubMed), Biblioteca Virtual em Saúde do Ministério da Saúde (BVS MS), NHS Economic Evaluation Database (NHS EED) and NHS Health Technology Assessment (NHS HTA) (via The Centre for Reviews and Dissemination Library - CRD), and EconLit, SCOPUS, and Web of Science, selecting cost analysis and cost of illness studies (COI) of measles outbreaks. Two independent reviewers screened articles for relevance and extracted the data. The quality of costing methods was assessed using a guide to critical evaluation of COI studies. We performed a qualitative narrative synthesis. RESULTS: Twenty-two studies were reviewed. Most studies evaluated outbreaks that occurred from 2011 to 2013 and 2017 to 2019. Total costs varied from $40,147 to $39.3 million. Per case cost varied from $168 to $49,439. The main drivers of measles outbreak costs were outbreak response, personnel, and productivity losses. Most studies (20/22) did not report the costing methodology adopted, the degree of disaggregation used in the identification and measurement of resource and costs components and the method for the valuation of resource and cost components. CONCLUSIONS: The quality of the costing methodology, its transparency and accuracy are essential to the validity of these studies results and their potential use to allocate public health resources in the most efficient manner and to inform measles outbreak control strategies, with rapid and effective response.

Modelling the potential health and economic benefits of reducing population sitting time in Australia.

BACKGROUND: Strong evidence indicates that excessive time spent sitting (sedentary behaviour) is detrimentally associated with multiple chronic diseases. Sedentary behaviour is prevalent among adults in Australia and has increased during the COVID-19 pandemic. Estimating the potential health benefits and healthcare cost saving associated with reductions in population sitting time could be useful for the development of public health initiatives. METHODS: A sedentary behaviour model was developed and incorporated into an existing proportional, multi-state, life table Markov model (ACE-Obesity Policy model). This model simulates the 2019 Australian population (age 18 years and above) and estimates the incidence, prevalence and mortality of five diseases associated with sedentary behaviour (type 2 diabetes, stroke, endometrial, breast and colorectal cancer). Key model inputs included population sitting time estimates from the Australian National Health Survey 2014-2015, healthcare cost data from the Australian Institute of Health and Welfare (2015) and relative risk estimates assessed by conducting literature reviews and meta-analyses. Scenario analyses estimated the potential change in disease incidence as a result of changes in population sitting time. This, in turn, resulted in estimated improvements in long term health outcomes (Health-adjusted life years (HALYs)) and healthcare cost-savings. RESULTS: According to the model, if all Australian adults sat no more than 4 h per day, the total HALYs gained would be approximately 17,211 with health care cost savings of approximately A$185 million over one year. Under a more feasible scenario, where sitting time was reduced in adults who sit 4 or more hours per day by approximately 36 min per person per day (based on the results of the Stand Up Victoria randomised controlled trial), potential HALYs gained were estimated to be 3,670 and healthcare cost saving could reach A$39 million over one year. CONCLUSIONS: Excessive sedentary time results in considerable population health burden in Australia. This paper describes the development of the first Australian sedentary behaviour model that can be used to predict the long term consequences of interventions targeted at reducing sedentary behaviour through reductions in sitting time. These estimates may be used by decision makers when prioritising healthcare resources and investing in preventative public health initiatives.

Economic burden of the novel coronavirus infection: a systematic review

Background. The sudden emergence and rapid spread of the novel coronavirus infection (COVID-19) caused tremendous burden on the health care system including the economic one. In this regard, many questions concerning the prioritization of funding for various restrictive and preventive procedures have arisen;also the introduction of various intervention methods for monitoring and timely treatment of post-COVID consequences became an urgent problem. These challenges actualized the development of pharmacoeconomic methods that improve the quality of decisions making in such extreme conditions. Objective(s): to systematize available studies on the assessment of the global economic burden of the novel coronavirus infection. Material and methods. A feature of the proposed review design was the highlighting of the observed shortcomings and areas in which scientists make additions to the assessment methods taking into account the chronology of the pandemic determining changes in the information field. Therefore, an analysis was made of 80 studies published in 2020-2022 and dedicated to the assessment and forecast of the global economic burden of COVID-19. The main inclusion criteria for the studies was the estimation of COVID-19 global burden. The search was carried out in PubMed/MEDLINE, Web of Science, Scopus, and eLibrary databases. Using a predefined data collection form, two reviewers independently extracted information characterizing the studies. Results. An analysis of the publications showed a fairly wide variety of studies in the field of the COVID-19 burden, including those determined by the difference in observation objects, analysis methods, factors taken into account, etc. Scientists actively use international (73.8%) and national (90%) databases, and surveys (57.5%). Predominantly, the estimates involve the calculation of quality-adjusted life years lost (QALY) (66.3%), 37.6% of the studies are based on the results of constructing scenario models, 28.8% consume algorithms of epidemiological SIR (susceptible, infected, or recovered) models, and 66.3% provide for cost assessment. As part of the estimated economic burden, the loss of productivity (26.3% of publications), the introduction of vaccination (32.5%), comorbidity (25%), post-COVID complications (17.5%) are considered. Conclusion. A significant interest of the world scientific community in assessing the COVID-19 global burden is observed, determined by the search for the most effective study methods. Further investigations in this area should focus on detailing within the estimated economic burden of losses associated with post-COVID-19 complications, including their various combinations, as well as on the analysis of the correlation and mutual compensation of effects from various types of treatment, with a deeper study of indirect losses. The results of this work will be also useful in conducting similar studies, including for determining their design and applying modern mathematical modeling tools. Copyright © 2022 Obstetrics, Gynecology and Reproduction. All rights reserved.

Cost of Illness of COVID-19 and Its Consequences on Health and Economic System.

The outbreak of COVID-19 has had destructive influences on social and economic systems as well as many aspects of human life. In this study, we aimed to estimate the economic effects of COVID-19 at the individual and societal levels during a fiscal year. This cost of illness analysis was used to estimate the economic burden of COVID-19 in Iran. Data of the COVID-19 patients referred to the hospitals affiliated to Bushehr University of Medical Sciences in 2021 were collected through the Hospital Information System (HIS). The study methodology was based upon the human capital approach and bottom-up technique. The COVID-19 pandemic has resulted in 9711 confirmed hospital cases and 717 deaths in Bushehr province during the study period. The direct and indirect costs were estimated to be $1446.06 and $3081.44 per patient. The economic burden for the province and country was estimated to be $43.97 and $2680.88 million. The results showed that the economic burden of this disease particularly premature death costs is remarkably high. Therefore, in order to increase the resiliency of the health system and the stability in service delivery, preventive-oriented strategies have to be more seriously considered by policymakers.

The burden of non-SARS-CoV2 viral lower respiratory tract infections in hospitalized children in Barcelona (Spain): A long-term, clinical, epidemiologic and economic study.

BACKGROUND: Viral lower respiratory tract infections (LRTI) are the leading cause of hospitalization in children. In Catalonia (Spain), information is scarce about the burden of viral LRTIs in paediatric hospitalizations. The aim of this study is to describe epidemiological, clinical, virological and economic features of paediatric hospitalizations due to viral LRTI. METHODS: From October 2012 to December 2020, children aged <16 years admitted to a tertiary paediatric hospital in Catalonia (Spain) with confirmed viral LRTI were included in the study. Virus seasonality, prevalence, age and sex distribution, clinical characteristics, hospital costs and bed occupancy rates were determined. RESULTS: A total of 3,325 children were included (57.17% male, 9.44% with comorbidities) accounting for 4056 hospitalizations (32.47% ≤ 12 months): 53.87% with wheezing/asthma, 37.85% with bronchiolitis and 8.28% with pneumonia. The most common virus was respiratory syncytial virus (RSV) (52.59%). Influenza A was associated with pneumonia (odds ratio [OR] 7.75) and caused longer hospitalizations (7 ± 31.58 days), while RSV was associated with bronchiolitis (OR 6.62) and was the most frequent reason for admission to the paediatric intensive care unit (PICU) (11.23%) and for respiratory support (78.76%). Male sex, age ≤12 months, chronic conditions and bronchiolitis significantly increased the odds of PICU admission. From October to May, viral LRTIs accounted for 12.36% of overall hospital bed days. The total hospitalization cost during the study period was €16,603,415. CONCLUSIONS: Viral LRTIs are an important cause of morbidity, hospitalization and PICU admission in children. The clinical burden is associated with significant bed occupancy and health-care costs, especially during seasonal periods.

Forecast of the socioeconomic burden of COPD in the Russian Federation in 2022

Chronic obstructive pulmonary disease (COPD) is characterized by a high level of morbidity and mortality and is associated with significant social and economic losses for the health care system and society. Aim. To predict the socio-economic burden of COPD in the Russian Federation in 2022, including the cost of drug treatment. Methods. The socio-economic burden of COPD in the Russian Federation in 2022 was predicted with and without taking into account the impact of COVID-19. The analysis of the cost of illness included the calculation of direct and indirect costs due to COPD. Data of Federal State Statistics Service, the State Guarantee Program of Free Medical Care for Citizens of Russian Federation, and data from the regional register of drug treatment of patients with COPD were used. Costs of medical care (ambulatory, hospital, and emergency care) were calculated based on compulsory health insurance tariffs. The disability benefits payments were calculated based on number of disabled persons and the amount of the disability benefit in each group. Indirect costs (or economic losses) included losses from products which were not produced due to disability and premature mortality of working-aged adults. Results. The predicted total economic losses due to COPD in 2022 will be 428.5 billion rubles when taking into account the impact of COVID-19, and 378.9 billion rubles when not accounting for COVID-19. Losses in the economy due to decreased labor productivity because of premature deaths (86%) are major part of the main burden. The cost of drug therapy for patients with COPD in outpatient settings will amount to over 17 billion rubles. Conclusion. Potential economic burden of COPD in 2022 depends on the incidence of COVID-19 and could be 0.34% of the GDP. Priority should be given to measures aimed at preventing the occurrence of COPD by correcting risk factors in the population, early diagnosis, slowing the progression of the disease and preventing exacerbations. Prevention of respiratory infections including COVID-19 in patients with COPD plays a special role.

USE of TELEMEDICINE for FOLLOW-UP of LUPUS NEPHRITIS in the COVID-19 OUTBREAK: ONE-YEAR, PRAGMATIC RANDOMISED CONTROLLED TRIAL

Background: Patients with systemic lupus erythematosus (SLE) are at increased risk of severe COVID-19 due to the underlying disease, comorbidities and use of immuno-suppressants (IS). An alternative option would be to adopt telemedicine (TM) to maintain medical care while minimizing exposure. Despite being widely adopted during the pandemic, the evidence supporting the use of TM in rheumatology has been limited. Objectives: We primarily aimed to evaluate the effectiveness to maintain disease activity control using TM delivered care compared to conventional in-person follow-up in patients with lupus nephritis (LN). The secondary objectives were to compare the patient reported outcomes, safety and cost-of-illness from the patient's perspective between the 2 modes of health care delivery. Methods: This was a 1-year, single-center, RCT conducted at a regional hospital in Hong Kong. From May 2020, consecutive adult patients with a SLE according to the 2019 EULAR/ACR classifcation criteria followed up at the LN clinic were invited to participate in the study. Participants were randomized 1:1 to either TM (TM group) or standard FU (SF group). Patients randomized to receive TM FU were scheduled for a video consultation via a commerical software ZOOM. Patients in the SF group received standard in-person outpatient care. SLE disease activity at each consultation was assessed by SLEDAI-2k and physician global assessment (PGA). Results: A total of 144 patients with LN were randomized and 3 patients self-withdrew from the study. The mean age was 44.5±11.4 years and the median time from diagnosis to randomization was 168 months (range: 1-528). Most of the patients had class III, IV or V LN (87.2%) and were on prednisolone (89.4%, median dose 5mg daily). Many of them (68.1%) were on IS. While 66.0% of the patients were in lupus low disease activity state (LLDAS), none had disease remission. There were no baseline differences, including demographics, SLEDAI-2k (TM: 3.8±2.3, SF: 3.2±2.2, p=0.13, PGA (TM: 6.2±6.5, SF: 4.6±5.9, p=0.13) and SLE damage index (TM: 1.1±1.3, SF: 0.8±1.1, p=0.10), between the 2 groups. At one year, 80.0% and 80.2% of the patients in the TM group and SF group were in LLDAS or remission respectively. SLE disease activity indices including SLEDAI-2k, PGA, proteinuria amount and serum anti-ds-DNA level remained similar between the 2 groups. Within the study period, 28 (40%) patients in the TM group and 21 (29.6%) patients in the SF group had disease fare (p=0.20). There were no differences in the SF-36, lupusQoL and HADS scores between the 2 groups at the end of the study. The overall patient satisfaction score was higher in the TM group with a signifcantly shorter waiting time before seeing doctors. At the end of the study, 67.9% of the overall participants agreed to (versus 15.0% who did not agree to) use TM as a mode of future FU. The mean indirect costs of illness (HKD26,681 vs HKD12,016, p=0.20) and the out-of-pocket costs for health care services were similar between the 2 groups (TM: HKD13,547 vs SF: HKD12,297, p=0.83) in one year. The total number of FU was similar (TM: 6.0±2.0, SF: 5.7±1.7, p=0.40). However, signifcantly more patients in the TM group (29/70, 41.4% vs 4/71, 5.6%;p<0.01) requested change mode of FU. The proportion of patients requiring hospitalization during the study period was also higher in the TM group (TM: 23/70, 32.9% vs 11/71, 15.5%;p=0.02). After adjusting for age and pred-nisolone dosage, not being in LLDAS at baseline was the predictor of hospitalization (OR 3.4, 95%CI 1.20-9.65). None of the participants was tested positive for COVID-19. Conclusion: TM FU resulted in similar 1-year disease activity control and better satisfaction in patients with LN compared to standard care. However, a signifcant proportion of patients cared by TM required in-person visits or were hospitalized. The results of the study suggest that TM delivered care could help minimizing exposure to COVID-19, but it needs to be complemented by physical visits, particularly in those with unstable d sease.

Effect of communication with mobile devices in hospitalized patients due to COVID-19.

OBJECTIVE: To identify the effect of mobile communication devices on the clinical evolution of hospitalized patients with SARS-CoV-2 pneumonia. MATERIALS AND METHODS: Controlled clinical trial, done from December 2020 to May 2021 in which patients with a diagnosis of SARS-CoV-2 pneumonia, both sexes, older than 18 years, with O2 saturation greater than 70% and lesser than 90% at admission were included. Two groups were formed, the independent variable was the availability of a mobile device: Group 1: patients with communication with relatives through video calls and Group 2: patients without communication with relatives. Dependent variables were days of in-hospital stay, hospitalization costs, comorbidities, complications, outcome: death or discharge, anxiety and depression. RESULTS: The most frequent complications were: metabolic disorder, endotracheal intubation and multiple organ failure, there were no significant differences between groups. The average length of in-hospital stay was 12.64 days, there were no differences between the two groups and no differences were found in the outcome. The cost per patient (bed days, medications, paraclinical studies and imaging studies) was 110,848.59 Mexican pesos (5542 American dollars). CONCLUSIONS: The use of mobile communication devices in the areas did not improve the clinical evolution of hospitalized patients diagnosed with COVID-19 pneumonia. Nor did it reduce costs of care or days of hospital stay. (English) [ FROM AUTHOR] OBJETIVO: Identificar el efecto de los dispositivos móviles de comunicación en la evolución clínica de pacientes hospitalizados con neumonía por SARS-CoV-2. MATERIALES Y MÉTODOS: Ensayo clínico controlado, efectuado de diciembre de 2020 a mayo de 2021, en el que se incluyeron pacientes con diagnóstico de neumonía por SARS-CoV-2, de uno y otro sexo, mayores de 18 años, con saturación de O2 mayor al 70% y menor al 90% al ingreso. Se conformaron dos grupos, la variable independiente fue la disponibilidad de un dispositivo móvil: En el grupo 1 se incluyeron pacientes con comunicación con familiares a través de videollamadas y en el grupo 2 pacientes sin comunicación con familiares. Las variables dependientes fueron días de estancia intrahospitalaria, costos de hospitalización, comorbilidades, complicaciones, desenlace: defunción o alta, ansiedad y depresión. RESULTADOS: Las complicaciones más frecuentes fueron: descontrol metabólico, intubación endotraqueal e insuficiencia orgánica múltiple, no hubo diferencias significativas entre los grupos. El promedio de días de hospitalización fue de 12.64 días, no hubo diferencias entre ambos grupos y tampoco se encontraron en el desenlace. El costo por paciente (días-cama, medicamentos, estudios paraclínicos y estudios de gabinete) fue de 110,848.59 pesos mexicanos (5542 dólares estadounidenses). CONCLUSIONES: El uso de dispositivos móviles de comunicación en las áreas no mejoró la evolución clínica de pacientes hospitalizados con diagnóstico de neumonía por COVID-19. Tampoco disminuyó los costos de atención ni los días de hospitalización. (Spanish) [ FROM AUTHOR] Copyright of Medicina Interna de Mexico is the property of Colegio de Medicina Interna de Mexico and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Changes in food-related costs during the COVID-19 pandemic among families managing food allergy.

Background: The COVID-19 pandemic has affected the supply, cost, and demand for certain foods, but it is not clear how these changes have affected food-allergic households. Objective: To describe the changes in food-related costs that have followed COVID-19, as reported by higher- and lower-income households with a food-allergic member. Methods: Between May 1-June 30, 2020, Canadian households, with at least one food-allergic member, completed an online survey on food shopping and preparation habits before and during the COVID-19 pandemic. The sample was divided into binary groups, either higher or lower than the sample median income. Data were analyzed using descriptive statistics and multiple regression. Results: The sample was comprised of 102 participants (i.e., 51/ income group). The three most common food allergies amongst both groups were peanuts, tree nuts and milk. Since the start of the pandemic, both groups reported greater monthly direct grocery costs, although costs amongst the higher-income group were twice as high as the lower-income group ($212.86 vs. $98.89, respectively). Indirect food preparation costs were similarly elevated. Higher-income households with food procurement difficulties reported increased indirect shopping costs following the outbreak of COVID-19, whereas those without such difficulties reported decreased costs. Lower-income households with allergies to milk, wheat, or eggs (i.e., staple allergy) experienced a larger change in indirect food preparation costs following the outbreak of COVID-19 relative to those with other food allergies ($244.58 vs. -$20.28, respectively; p = 0.03). Conclusion: Both higher and lower income households with food allergy reported greater direct food costs and indirect food preparation costs following the COVID-19. Households with staple allergy and those with difficulties finding their typical food items were particularly affected.

Changes in the pattern and disease burden of acute respiratory viral infections before and during the COVID-19 pandemic.

OBJECTIVES: We conducted a comparative analysis of the differences in the incidence of 8 acute respiratory viruses and the changes in their patterns before and during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: Three sentinel surveillance systems of the Korea Disease Control and Prevention Agency and data from the Health Insurance Review and Assessment Service were analyzed. The average numbers of reported cases and the related hospital admissions and outpatient data were compared between April 2018-2019 and 2020-2021. Changes in the disease burden and medical expenditures between these 2 time periods were evaluated. RESULTS: During the COVID-19 pandemic, the number of reported cases of all acute respiratory viral infections, except for human bocavirus, decreased significantly. Data from the Health Insurance Review and Assessment Service also showed decreases in the actual amount of medical service usage and a marked reduction in medical expenditures. CONCLUSION: Non-pharmacological interventions in response to COVID-19 showed preventive effects on the transmission of other respiratory viruses, as well as COVID-19. Although COVID-19 had a tremendous impact on society as a whole, with high social costs, there were also positive effects, such as a reduction in the incidence of acute respiratory viral infections.

Cost of illness for COVID-19 inpatients in West Nusa Tenggara, Indonesia

Background: COVID-19 is still a pandemic worldwide, including in Indonesia. The high number of COVID-19 cases, especially in West Nusa Tenggara (NTB), has a financial impact, considering that inpatient costs are borne by the government. Objective: To calculate the cost of illness for COVID-19 inpatients at the NTB Provincial hospital. Method: The method used was the cost of illness from a payer’s perspective. The population consisted of 822 patients. Results: The total direct medical cost of COVID-19 patients at the NTB Provincial hospital in 2020 was IDR 45,589,962,670, with an average of IDR 55,462,242. The average cost of COVID-19 inpatients without comorbidities was IDR 45,545,441 and IDR 71,926,056 for those with comorbidities. Conclusion: The total cost of illness of COVID-19 in West Nusa Tenggara, Indonesia, was high. Therefore, preventive efforts are needed to reduce the incidence of COVID-19 in Indonesia, especially in West Nusa Tenggara.

The economic burden of influenza among adults aged 18 to 64: A systematic literature review.

While the economic burden of influenza infection is well described among adults aged 65 and older, less is known about younger adults. A systematic literature review was conducted to describe the economic burden of seasonal influenza in adults aged 18 to 64 years, to identify the main determinants of direct and indirect costs, and to highlight any gaps in the existing published evidence. MEDLINE and Embase were searched from 2007 to February 7, 2020, for studies reporting primary influenza-related cost data (direct or indirect) or absenteeism data. Of the 2613 publications screened, 51 studies were included in this review. Half of them were conducted in the United States, and 71% of them described patients with influenza-like illness rather than laboratory-confirmed disease. Only 12 studies reported cost data specifically for at-risk populations. Extracted data highlighted that within the 18- to 64-year-old group, up to 88% of the economic burden of influenza was attributable to indirect costs, and up to 75% of overall direct costs were attributable to hospitalizations. Furthermore, within the 18- to 64-year-old group, influenza-related costs increased with age and underlying medical conditions. The reported cost of influenza-related hospitalizations was found to be up to 2.5 times higher among at-risk populations compared with not-at-risk populations. This review documents the considerable economic impact of influenza among adults aged 18 to 64. In this age group, most of the influenza costs are indirect, which are generally not recognized by decision makers. Future studies should focus on at-risk subgroups, lab-confirmed cases, and European countries.

Direct and indirect cost of COVID-19 patients in Iran.

OBJECTIVES: This study aimed to estimate the cost of COVID-19 patients and some affecting factors in Iran. METHODS: This was a prevalence-based cost-of-illness study based on a bottom-up costing approach which was conducted from March 2020 to July 2020. Data were extracted from the hospital's Hospital Information System (HIS) and Cost-of-illness (COI) assessment checklist. Indirect costs were assessed based on the Human Capital Approach. Data were analyzed using SPSS software version 22 and Microsoft EXCEL 2016. RESULTS: A total of 745 Covid-19 patients were included in the analysis. The mean total cost was estimated at 8813.15 (PPP, Current International $), accounting for 60% of GDP per capita. The mean direct and indirect cost was 3362.49 (PPP, Current International $) (38% of the total cost and 23% of the GDP per capita), and 5450.66 (PPP, Current International $) (62% of the total cost and 37% of the GDP per capita), respectively. The mean hospitalization cost was higher among patients who died and those who were covered by supplemental insurance. Also, the costs of disease experienced a dramatic rise with increasing age. For different scenarios in terms of outbreak rate, hospitalization rate and mortality rate, the total estimated cost of illness for Covid-19 ranged from 6263 million (PPP, Current International $) to 63,474 million (PPP, Current International $). CONCLUSIONS: Covid-19 imposes a substantial financial burden on people, health care systems, insurance organizations and the country's economy as a whole. Since the economic burden of this disease increases dramatically by increasing disease outbreak, more attention should be paid to the development and implementation of appropriate preventive programs.

Understanding the Economic Value and Impacts on Informal Carers of People Living with Mental Health Conditions.

Informal carers play a vital role in supporting people living with mental health conditions, but comparatively little is known about the economic value of caring. This study undertook an online survey of adult informal carers supporting adults with mental health conditions to better understand the impacts of caring on carer quality of life, levels of loneliness, finances and employment, as well as estimate the economic value of time spent caring. In total, 712 carers participated in the multi-national survey between August 2019 and April 2020. A total of 17% were male, with a mean age of 53, and 68% supported a child living with a mental health condition. A total of 56% of care recipients were male, with a mean age of 37. Adverse impacts on quality of life, loneliness and personal finances were greatest in carers living with care recipients. Overall mean weekly hours of care were 43.42, rising to 65.41 for carers living with care recipients. Mean weekly costs of care per carer ranged from €660 to €2223 depending on living arrangements. Annual costs ranged between €34,960 and €125,412, depending on living arrangements and valuation method. Informal care costs are substantial, and policy makers should consider investing more in carer support, especially for carers living with care recipients.