The Direct and Indirect Costs of Treating the Victims of the 2016 Nice Terror Attacks in a Single Pediatric Hospital

Abstract Objective: To analyze the cost of the terror attack in Nice in a single pediatric institution. Methods: We carried out descriptive analyses of the data coming from the Lenval University Children’s Hospital of Nice database after the July 14, 2016 terror attack. The medical cost for each patient was estimated from the invoice that the hospital sent to public insurance. The indirect costs were calculated from the hospital’s accounting, as the items that were previously absent or the difference between costs in 2016 versus the previous year. Results: The costs total 1.56 million USD, corresponding to 2% of Lenval Hospital’s 2016 annual budget. Direct medical costs represented 9% of the total cost. The indirect costs were related to human resources (overtime, sick leave), revenue shortfall, and security and psychiatric reinforcement. Conclusion: Indirect costs had a greater impact than did direct medical costs. Examining the level and variety of direct and indirect costs will lead to a better understanding of the consequences of terror acts and to improved preparation for future attacks.

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Abstract 19839: Clinical and Economic Burden of Rheumatic Heart Disease in Low-Income Nations: Estimating the Cost-of-Illness in India and Uganda

Circulation ◽

10.1161/circ.130.suppl_2.19839 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Alexander T Sandhu ◽

Kathikeyan G ◽

Ann Bolger ◽

Emmy Okello ◽

Dhruv S Kazi

Keyword(s):

Heart Disease ◽

Rheumatic Heart Disease ◽

Cost Of Illness ◽

Economic Burden ◽

Indirect Costs ◽

Medical Costs ◽

Discrete State ◽

Direct Medical Costs ◽

The Cost ◽

Rheumatic Heart

Introduction: Rheumatic heart disease (RHD) strikes young adults at their peak economic productivity. Defining the global economic burden of RHD may motivate investments in research and prevention, yet prior approaches considering only medical costs may have underestimated the cost of illness. Objectives: To estimate the clinical and economic burden of RHD in India and Uganda. Outcomes were disability-adjusted life years (DALYs), direct medical costs, and indirect costs due to disability and premature mortality (2012 USD). Methods: We used a discrete-state Markov model to simulate the natural history of RHD using country-, age-, and gender-specific estimates from the literature and census data. We estimated direct medical costs from WHO-CHOICE and Disease Control and Prevention 3 publications. We conservatively estimated indirect costs (lost earnings and imputed caregiver costs) from World Bank data using novel economic methods. Results: In 2012, RHD generated 6.1 million DALYs in India and cost USD 10.7 billion (Table 1), including 1.8 billion in direct medical costs and 8.9 billion in indirect costs. During the same period, RHD produced 216,000 DALYs in Uganda, and cost USD 414 million, and, as in India, indirect costs represented the majority (88%) of the cost of illness. In both countries, women accounted for the majority (71-80%) of the DALYs; in Uganda, women bore 75% of the total cost. In sensitivity analyses, higher progression rates for subclinical disease doubled direct costs and DALYs. Conclusion: RHD exacts an enormous toll on the populations of India and Uganda, and its economic burden may be grossly underestimated if indirect costs are not systematically included. Women bear a disproportionate clinical burden from pregnancy-related complications. These results suggest that effective prevention and screening of RHD may represent a sound public health investment, particularly if targeted at high-risk subgroups such as young women.

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Cost of lung cancer in East Azerbaijan province, in Iran, in 2017

International Journal of Pharmaceutical and Healthcare Marketing ◽

10.1108/ijphm-08-2019-0055 ◽

2020 ◽

Vol 14 (3) ◽

pp. 461-470

Author(s):

Habibeh Mir ◽

Farshad Seyednejad ◽

Habib Jalilian ◽

Shirin Nosratnejad ◽

Mahmood Yousefi

Keyword(s):

Lung Cancer ◽

Length Of Hospital Stay ◽

Indirect Costs ◽

Medical Costs ◽

Content Type ◽

Direct Medical Costs ◽

Hospitalization Costs ◽

Illness Study ◽

East Azerbaijan ◽

The Cost

Purpose Costs estimation is essential and important to resource allocation and prioritizing different interventions in the health system. The purpose of this paper is to estimate the costs of lung cancer in Iran, in 2017. Design/methodology/approach This was a prevalence-based cost of illness study with a bottom-up approach costing conducted from October 2016 to April 2017. The sample included 645 patients who referred to Imam Reza hospital, Tabriz, Iran, in 2017. Follow-up interviews were every two months. Hospitalization costs extracted from the patient’s record and outpatient costs, nondirect medical costs and indirect costs collected using questionnaire. SPSS software version 22 was used for the data analysis. Findings Mean direct medical costs, nondirect medical costs and indirect costs amounted to 36,637.02 ± 23,515.13 PPP (2016) (251,313,217.83 Rials), 2,025.25 ± 3,303.72 PPP (2016) (16,613,202.53 Rials) and 48,348.55 ± 34,371.84 PPP (2016) (396,599,494.56 Rials), respectively. There was a significant and negative correlation between direct medical costs, direct nonmedical costs, indirect costs and age at diagnosis, and there was a significant and positive correlation between the length of hospital stay and direct medical cost. Originality/value As the cost of lung cancer is substantial and there have been little studies in this area, the objective of this study is to investigate the cost of lung cancer and present ways to tackle this.

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The cost of systemic therapy for metastatic colorectal carcinoma in Slovenia: discrepancy analysis between cost and reimbursement

Radiology and Oncology ◽

10.2478/raon-2014-0046 ◽

2015 ◽

Vol 49 (2) ◽

pp. 200-208 ◽

Cited By ~ 2

Author(s):

Tanja Mesti ◽

Biljana Mileva Boshkoska ◽

Mitja Kos ◽

Metka Tekavčič ◽

Janja Ocvirk

Keyword(s):

Health Insurance ◽

Side Effects ◽

Systemic Therapy ◽

Medical Costs ◽

Hospital Treatment ◽

Cost Assessment ◽

Actual Cost ◽

Direct Medical Costs ◽

The Difference ◽

The Cost

AbstractBackground. The aim of the study was to estimate the direct medical costs of metastatic colorectal cancer (mCRC) treated at the Institute of Oncology Ljubljana and to question the healthcare payment system in Slovenia.Methods. Using an internal patient database, the costs of mCRC patients were estimated in 2009 by examining (1) mCRC direct medical related costs, and (2) the cost difference between payment received by Slovenian health insurance and actual mCRC costs. Costs were analysed in the treatment phase of the disease by assessing the direct medical costs of hospital treatment with systemic therapy together with hospital treatment of side effects, without assessing radiotherapy or surgical treatment. Follow-up costs, indirect medical costs, and nonmedical costs were not included.Results. A total of 209 mCRC patients met all eligibility criteria. The direct medical costs of mCRC hospitalization with systemic therapy in Slovenia for 2009 were estimated as the cost of medications (cost of systemic therapy + cost of drugs for premedication) + labor cost (the cost of carrying out systemic treatment) + cost of lab tests + cost of imaging tests + KRAS testing cost + cost of hospital treatment due to side effects of mCRC treatment, and amounted to €3,914,697. The difference between the cost paid by health insurance and actual costs, estimated as direct medical costs of hospitalization of mCRC patients treated with systemic therapy at the Institute of Oncology Ljubljana in 2009, was €1,900,757.80.Conclusions. The costs paid to the Institute of Oncology Ljubljana by health insurance for treating mCRC with systemic therapy do not match the actual cost of treatment. In fact, the difference between the payment and the actual cost estimated as direct medical costs of hospitalization of mCRC patients treated with systemic therapy at the Institute of Oncology Ljubljana in 2009 was €1,900,757.80. The model Australian Refined Diagnosis Related Groups (AR-DRG) for cost assessment in oncology being currently used is probably one of the reasons for the discrepancy between pay-outs and actual costs. We propose new method for more precise cost assessment in oncology.

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Cost consequences analysis of hypertensive outpatients: a study in a private hospital in Yogyakarta special province

Jurnal Ilmiah Farmasi ◽

10.20885/jif.vol17.iss2.art2 ◽

2021 ◽

Vol 17 (2) ◽

pp. 116-126

Author(s):

Dinasari Bekti Pratidina ◽

Fithria Dyah Ayu Suryanegara ◽

Diesty Anita Nugraheni

Keyword(s):

Clinical Outcome ◽

Antihypertensive Therapy ◽

Private Hospital ◽

Indirect Costs ◽

Medical Costs ◽

Patient’S Perspective ◽

Direct Medical Costs ◽

Significant Difference ◽

The Cost ◽

Real Costs

Background: Hypertension is a chronic disease that requires long-term treatment and has an impact on the cost of treatment. The costs will be greater given the loss of productivity, family burden, and social life impacted by hypertension based on patient’s perspective. Objective: The purpose of the study was to determine the costs and clinical outcome of antihypertensive therapy from the patient's perspective and to identify the discrepancies between the costs and the INA-CBGs (Indonesia Case Based Groups) tariff. Methods: The research was an observational study with a cross-sectional design. The targeted population was outpatients who had received antihypertensive therapy for at least 1 month at a private hospital in Yogyakarta. The costs included direct medical costs, direct non-medical costs, and indirect costs, while the clinical outcomes were patient’s blood pressure. The descriptive analysis was carried out to describe the characteristics of the research subjects, the clinical outcome, and the cost. Analysis of the discrepancies between the costs and the INA-CBGs tariff used the Mann-Whitney test and One-Sample t-test. Results: The results showed that the average direct medical costs, direct non-medical costs, and indirect costs from the patient’s perspective were IDR359,408.00, IDR24,617.00, and IDR 40,583.00, respectively. There was a significant difference between the real costs and the rate of INA-CBGs based on the results of statistical tests, while the cost discrepancy was IDR5,287,045.00. Conclusion: The direct non-medical costs and indirect costs of hypertensive outpatients were less than the direct medical costs. A significant difference occurred between the real costs and INA CBG’s tariff. Keywords: hypertension, cost consequences, pharmacoeconomics, patient’s perspective

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Comparing Expenditures in Depressed Patients Treated with Venlafaxine ER and SSRIs

CNS Spectrums ◽

10.1017/s1092852900028054 ◽

2006 ◽

Vol 11 (S13) ◽

pp. 1-7

Author(s):

Diane M. Sloan ◽

Jacques LeLorier

Keyword(s):

Cost Effectiveness ◽

Selective Serotonin Reuptake Inhibitors ◽

Cost Savings ◽

Indirect Costs ◽

Patient Characteristics ◽

Medical Costs ◽

Direct Medical Costs ◽

Medical Visits ◽

Study Results ◽

The Cost

AbstractDepression is a chronic illness whose true costs to society are unclear. The costs associated with depression are direct (drugs and treatment), indirect (absenteeism and loss of productivity), and intangible (quality of life). Direct costs are usually easy to quantify. Indirect costs often test the ingenuity of researchers whose results are, at best, crude approximations. Intangible costs are elusive and may never be measured with any degree of accuracy. To compound matters further, many patients with depression have never been diagnosed, which complicates the cost accounting analysis of depression from a societal perspective. What is clear is that the worldwide costs of depression are climbing The overall costs of treating depression attributable to drug therapy are modest. The appropriate choice of antidepressant therapy is likely to be the product that provides the highest effectiveness in terms of overall costs. As a result, it is important that prescribers have an idea of the benefit derived from the cost of drugs, and how the cost effectiveness of different drugs compare.Previous studies of antidepressant cost effectiveness have suggested that the use of venlafaxine, which costs more than generic selective serotonin reuptake inhibitors (SSRIs), may be no more costly when total costs (eg, how many drugs were prescribed, how many medical or emergency room visits patients had, and how often they were hospitalized) are calculated. The objectives of this retrospective, populationbased, database study were to identify patient characteristics and factors associated with the choice of antidepressant in order to assess differences in persistence, healthcare utilization, and direct medical costs associated with venlafaxine and SSRI pharmacotherapy.Study results indicated that in this real-world setting, medical costs were similar among depressive patients treated with venlafaxine and SSRIs. The higher purchase price of venlafaxine was balanced by cost savings due to fewer hospitalizations and fewer outpatient medical visits. Differences in drug treatment may also partially explicate the observed differences in average direct medical costs between venlafaxine and SSRIs.

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The trend of direct medical costs and associated factors in patients with chronic hepatitis B in Guangzhou, China: an eight-year retrospective cohort study

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-021-01429-6 ◽

2021 ◽

Vol 21 (S2) ◽

Author(s):

Shuo Yang ◽

Ge Chen ◽

Yueping Li ◽

Guanhai Li ◽

Yingfang Liang ◽

...

Keyword(s):

Cohort Study ◽

Hepatitis B ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Associated Factors ◽

Medical Insurance ◽

Medical Costs ◽

Direct Medical Costs ◽

B Virus ◽

The Cost

Abstract Background Although the expenses of liver cirrhosis are covered by a critical illness fund under the current health insurance program in China, the medical costs associated with hepatitis B virus (HBV) related diseases is not well addressed. In order to provide evidence to address the problem, we investigated the trend of direct medical costs and associated factors in patients with chronic HBV infection. Methods A retrospective cohort study of 65,175 outpatients and 12,649 inpatients was conducted using a hospital information system database for the period from 2008 to 2015. Generalized estimating equations (GEE) were applied to explore associations between annual direct medical costs and corresponding factors, meanwhile quantile regression models were used to evaluate the effect of treatment modes on different quantiles of annual direct medical costs stratified by medical insurances. Results The direct medical costs increased with time, but the proportion of antiviral costs decreased with CHB progression. Antiviral costs accounted 54.61% of total direct medical costs for outpatients, but only 6.17% for inpatients. Non-antiviral medicine costs (46.06%) and lab tests costs (23.63%) accounted for the majority of the cost for inpatients. The direct medical costs were positively associated with CHB progression and hospitalization days in inpatients. The direct medical costs were the highest in outpatients with medical insurance and in inpatients with free medical service, and treatment modes had different effects on the direct medical costs in patients with and without medical insurance. Conclusions CHB patients had a heavy economic burden in Guangzhou, China, which increased over time, which were influenced by payment mode and treatment mode.

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Direct and Indirect Costs Associated With Non-invasive Treatments in Obesity and Overweight Patients

10.21203/rs.3.rs-251166/v1 ◽

2021 ◽

Author(s):

Saman Maaroufi ◽

Mina Golestani ◽

Mohammad Alizadeh ◽

Ali Imani ◽

Koustuv Dalal

Keyword(s):

Public Health Problem ◽

Indirect Costs ◽

Medical Costs ◽

Herbal Remedies ◽

Direct And Indirect Costs ◽

Non Invasive ◽

Basic Diet ◽

Obesity And Overweight ◽

Significant Difference ◽

Clinical Records

Abstract Background: Obesity and overweight are a global public health problem causing several chronic diseases which can lead to various degrees of morbidity and mortality. These medical conditions cause economic costs and complications. The purpose of the present study to estimate the direct and indirect costs incurred by obese and overweight patients with non-invasive treatments in Tabriz, north-western Iran.Methods: The number of 247 patients were studied by cross-sectional approach and used cost of illness's prevalence approach assessing the total costs (direct and indirect) of obesity and overweight through interview and assessing relevant clinical records. The study conducted over three months from December 2018 to February 2019 in Tabriz, capital of East Azerbaijan province, Iran. Direct costs included hospitalization, para-clinical medications and outpatient visits for treatment of obesity and overweight. Loss of productivity, days of restricted activity and days in bed, cost of wasting time, transportation costs and nursing expenditure were estimated as indirect costs in the present study. For estimating direct and indirect costs, we used the bottom-up costing approach. The foreign exchange rate used in the analysis was 42000 Iranian Rial = 1US$ (December-February 2018).Results: The mean three months cost per patient is 38529697 IRR (equivalent to $91.73 USD), Direct medical costs have a most significant part of total costs with 36765292 IRR (87.53USD) per three months (95%). Direct non-medical costs were 1380484 IRR (3.28USD) per patient (4%) and indirect costs were estimated 383981 IRR ($0.9USD) per patient (1%). The results of the analysis of variance showed that there was a significant difference between the four strategies in three months. Among the therapeutic strategies, the most changes in body mass index (BMI) occurred in patients who used Basic diet with several types of medicines strategy (p<0.001). Tukey post hoc showed BMI Changes in a patient with a Basic diet with herbal remedies was minimum (p<0.001). According to results in the first month, BMI has a significant reduction over three months. Regarding costs, the analysis showed that Patients who used the Basic diet strategy incurred the lowest costs (p<0.001) and the highest costs are related to patients with a Basic diet with several types of medicines (p<0.001).Conclusions: The results of the present study are useful in improving health policymakers and researchers in motivating to do more studies in particular for adopting new policies depending on the level of insurance coverage and their problems which patients deal with during the treatment period.

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Economic Burden of Tuberculosis Diabetes Co-Morbidity in Tuberculosis Patients Attending Two Chest Clinics in Lagos State

Nigerian Journal of Pharmaceutical Research ◽

10.4314/njpr.v16i2.11s ◽

2021 ◽

Vol 16 (2) ◽

pp. 91-100

Author(s):

F.A. Ayeni ◽

O.O. Oyetunde ◽

B.A. Aina ◽

H.O. Yarah

Keyword(s):

Direct Medical Cost ◽

Medical Cost ◽

Indirect Costs ◽

Medical Costs ◽

Female Patients ◽

Direct Medical Costs ◽

Tb Treatment ◽

Co Morbidity ◽

Lagos State ◽

Significant Burden

Background: Diabetes mellitus (DM) increases the risk of developing tuberculosis (TB) three-fold. The cost of accessing care for TB-DM co-morbidity poses a significant burden on patients, as they bear both direct and indirect costs of treatment, mostly of out-of-pocket.Objective: To estimate the direct medical cost of illness in patients with TB-DM co-morbidity in two chest clinics in Lagos State.Materials and Methods: An observational study, carried out in two chest clinics in Lagos State to evaluate direct medical costs associated with TBDM co-morbidity during TB treatment. A semi structured questionnaire, pharmacy price list of drugs and an online transportation service lara.ng was employed to document and quantify prescribed medications, laboratory investigations, number of clinic attendance and attendant transportation costs.Results: Among the participants, 53.8% were females. The mean age was 50.7±9.7 years. The total direct medical and non-medical costs for TBDM management was NGN8,604,819 (USD24,585.20) for the duration of TB treatment. Average cost per patient (CPP) was NGN179,384.85 (USD512.53). This was equivalent to 49.8% of the current national minimum wage. Male patients incurred more mean direct medical cost than female patients (NGN26, 647.90 vs NGN24, 020.40), while female patients incurred more mean direct non-medical costs than the males (NGN22, 314.30 versus NGN13, 041.70). Patients aged 60 years and above incurred the highest mean direct costs compared to other age groups.Conclusion: Direct medical costs are substantial in TBDM co-morbidity and increase with age.

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Urgent Care Costs of Uncontrolled Asthma in Canada, 2004

Canadian Respiratory Journal ◽

10.1155/2005/478764 ◽

2005 ◽

Vol 12 (8) ◽

pp. 435-436 ◽

Cited By ~ 18

Author(s):

Soo Jin Seung ◽

Nicole Mittmann

Keyword(s):

Emergency Department ◽

Indirect Costs ◽

Emergency Department Visits ◽

Urgent Care ◽

Uncontrolled Asthma ◽

Physician Visits ◽

Direct And Indirect Costs ◽

Drug Treatments ◽

The Cost ◽

Care Costs

It has been more than a decade since Krahn evaluated the direct and indirect costs of asthma in Canada. Asthma is often uncontrolled and the cost of providing urgent care has not been determined. Hospitalizations, unscheduled physician visits, emergency department visits, drug treatments and ambulance rides are resources used by the uncontrolled asthmatic population, resulting in $162 million in costs annually. Improved control of asthma could decrease these costs.

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Animal production studies in Jamaica. IV. The costs of developing and maintaining pangola grass pastures

The Journal of Agricultural Science ◽

10.1017/s0021859600060792 ◽

1964 ◽

Vol 62 (2) ◽

pp. 179-186 ◽

Cited By ~ 2

Author(s):

B. L. Nestel

Keyword(s):

Indirect Cost ◽

Direct Cost ◽

Inverse Relationship ◽

Indirect Costs ◽

Animal Production ◽

Direct And Indirect Costs ◽

Production Studies ◽

Total Range ◽

The Cost

The cost of developing and maintaining pangola grass pastures has been examined under a range of conditions. The direct cost of improving pastures to the stage where they were established as 5–10 acre, fenced, watered units of pangola grass was about £30 per acre. Under favourable conditions this cost could be reduced to £20, but with difficult land or poor techniques the cost could rise to £40 or more per acre. In addition to the direct cost of establishment there was an indirect cost due to land being out of use or stock numbers having to be reduced. This indirect cost appeared to be highest on lands where planting costs were least. It was suggested that there might be an inverse relationship between direct and indirect costs which tended to narrow the total range of establishment costs.

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