ABSTRACT
OBJECTIVES: The aim was to determine the direct impact of the COVID-19 pandemic on Spain's health budget. METHODS: Budget impact analyses based on retrospective data from patients with suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) admitted to a Spanish hospital between February 26 and May 21, 2020. Direct medical costs from the perspective of the hospital were calculated. We analyzed diagnostic tests, drugs, medical and nursing care, and isolation ward and ICU stays for three cohorts: patients seen in the emergency room only, hospitalized patients who tested positive for SARS-CoV-2, and patients who tested negative. RESULTS: The impact on the hospital's budget for the 3 months was calculated at 15,633,180, 97.4% of which was related to health care and hospitalization. ICU stays accounted for 5.3% of the total costs. The mean cost per patient was 10,744. The main costs were staffing costs (10,131 to 11,357 /patient for physicians and 10,274 to 11,215 /patient for nurses). Scenario analysis showed that the range of hospital expenditure was between 14,693,256 and 16,524,924. The median impact of the pandemic on the Spanish health budget in the sensitivity analysis using bootstrapped individual data was 9357 million (interquartile range [IQR], 9071 to 9689) for the conservative scenario (113,588 hospital admissions and 11,664 ICU admissions) and 10,385 million (IQR, 110,030 to 10,758) for the worst-case scenario (including suspected cases). CONCLUSION: The impact of COVID-19 on the Spanish public health budget (12.3% of total public health expenditure) is greater than multiple sclerosis, cancer and diabetes cost.
ABSTRACT
OBJECTIVE: Secondary effects and drug reactions relative to collagenase Clostridium histolyticum treatment for Dupuytren's contracture are frequent. In only a few cases these secondary effects are considered serious. The mechanism that produces these effects of production is not well understood. CLINICAL REPORT: We present the case report of a woman with fifth finger interphalangeal joint treatment with generalized skin rash as a complication of collagenase Clostridium histolyticum treatment. DISCUSSION: We discuss treatment, causes and mechanisms of this rare complication from this treatment and review the bibliography about mechanisms for the different types of immunological reactions that may occur after treatment with collagenase Clostridium histolyticum and the possibility of crossed reactions with Clostridiopeptidase A used to treat skin lacerations.
Subject(s)
Dermatitis/etiology , Dupuytren Contracture/drug therapy , Microbial Collagenase/adverse effects , Clostridium histolyticum , Female , Humans , Treatment OutcomeABSTRACT
When validating oral chemotherapy, pharmacists should confirm the suitability and correctness of the prescription, applying the same safety standards as those used for parenteral cytostatic drugs. There are an increasing number of cancers for which orally administered drugs are available, which increases patient satisfaction as these drugs can be taken at home without the need to visit a hospital. As oral cytostatic treatments increase, so does the importance of ensuring optimal treatment compliance. The new oral cytostatic agents are less toxic, reduce indirect costs and imply less loss of time for patients and their families. However, the cost of these agents should be below a threshold acceptable for society. As an aid to decision making, pharmacoeconomic tools should be used.
