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

2021 ◽  
Vol 17 (2) ◽  
pp. 116-126
Author(s):  
Dinasari Bekti Pratidina ◽  
Fithria Dyah Ayu Suryanegara ◽  
Diesty Anita Nugraheni

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

Author(s):  
Federico Solla ◽  
Eytan Ellenberg ◽  
Virginie Rampal ◽  
Julien Margaine ◽  
Charles Musoff ◽  
...  

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.


Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Alexander T Sandhu ◽  
Kathikeyan G ◽  
Ann Bolger ◽  
Emmy Okello ◽  
Dhruv S Kazi

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.


Author(s):  
Habibeh Mir ◽  
Farshad Seyednejad ◽  
Habib Jalilian ◽  
Shirin Nosratnejad ◽  
Mahmood Yousefi

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.


Author(s):  
Ross Simpson ◽  
James Signorovitch ◽  
Karthik Ramakrishnan ◽  
Jasmina Ivanova ◽  
Howard Birnbaum ◽  
...  

OBJECTIVE: To compare initiation with atorvastatin versus simvastatin among higher- and lower-risk employees in terms of subsequent risk of cardiovascular (CV) events and direct and indirect costs from the employer perspective. METHODS: Employees initiating atorvastatin or simvastatin were identified from a claims database (1999-2006) spanning 23 large, self-insured employers and stratified as 1) high-risk employees with prior CV events, diabetes or renal disorders and 2) low-to-intermediate-risk employees without these conditions. Propensity score matching was used to adjust for baseline differences between the atorvastatin and simvastatin cohorts, and two-year outcomes were compared between matched cohorts. Indirect costs included disability payments and medically-related absenteeism. Atorvastatin and simvastatin drug costs were imputed with recent prices to account for availability of generic simvastatin. RESULTS: Among 4,167 matched pairs of high-risk employees, initiation with atorvastatin vs. simvastatin was associated with similar rates of subsequent CV events (17.6 vs. 18.4%, P=0.37), higher direct medical costs ($17,590 vs. $17,377, P=0.002), similar indirect costs ($4,830 vs. $4,989, P=0.29) and higher total costs by $54 ($22,420 vs. $22,366, P=0.034). The majority of high-risk employees (62%) received low initial statin doses (atorvastatin ≤ 10 mg or simvastatin ≤ 20 mg). Among 9,326 matched pairs of low-to-intermediate risk employees, initiation with atorvastatin vs. simvastatin was associated with a lower rate of CV events (3.1 vs. 3.7%, p=0.030), lower direct medical costs ($8,400 vs. $8,436, P<0.001), similar indirect costs ($2,781 vs. $2,807; P=0.12) and lower total costs by $61 ($11,181 vs. $11,243, P<0.001). CONCLUSIONS: Among high-risk patients, initiation with atorvastatin vs. simvastatin was associated with no significant difference in CV events and higher total costs to employers. Among low-to-intermediate risk patients, initiation with atorvastatin vs. simvastatin was associated with fewer CV events and net cost savings to employers. Formulary policies reserving atorvastatin for higher-risk patients may not be beneficial from the employer perspective.


CNS Spectrums ◽  
2006 ◽  
Vol 11 (S13) ◽  
pp. 1-7
Author(s):  
Diane M. Sloan ◽  
Jacques LeLorier

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.


2021 ◽  
Vol 21 (S2) ◽  
Author(s):  
Shuo Yang ◽  
Ge Chen ◽  
Yueping Li ◽  
Guanhai Li ◽  
Yingfang Liang ◽  
...  

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.


2021 ◽  
Author(s):  
Saman Maaroufi ◽  
Mina Golestani ◽  
Mohammad Alizadeh ◽  
Ali Imani ◽  
Koustuv Dalal

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.


2021 ◽  
Vol 16 (2) ◽  
pp. 91-100
Author(s):  
F.A. Ayeni ◽  
O.O. Oyetunde ◽  
B.A. Aina ◽  
H.O. Yarah

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.


2020 ◽  
Author(s):  
Xiaohua Liang ◽  
Lun Xiao ◽  
Xue-Li Yang ◽  
Xue-Fei Zhong ◽  
Peng Zhang ◽  
...  

Abstract Background: During the coronavirus disease 2019 (COVID-19) pandemic, it is essential to evaluate the socioeconomic burden imposed on the Chinese health care system.Methods: We prospectively collected information from the Center for Disease Control and Prevention and the designated hospitals to determine the cost of public health care and hospitalization due to COVID-19. We estimated the resource use and direct medical costs per confirmed case and the costs associated with public health care per thousand people at the national level.Results: The average costs per case for specimen collection and nucleic acid testing (NAT) were $29.49 and $53.44, respectively, while the average cost of NAT for high-risk populations was $297.94 per capita. The average costs per thousand people for epidemiological surveys, disinfectant, health education and centralized isolation were $49.54, $247.01, $90.22 and $543.72, respectively. A single hospitalization for COVID-19 in China cost an average of $3,792.69 ($2,754.82-$5,393.76) in direct medical costs incurred only during hospitalization, while the total costs associated with hospitalization were estimated to have reached nearly $31,229.39 million in China as of 20 May 2020. The cost of public health care ($6.81 billion) was 20 times that of hospitalization.Conclusions: This study highlights the magnitude of resources needed to control the COVID-19 pandemic and treat COVID-19 cases. Public health measures implemented by the Chinese government have been valuable with regard to reducing the infection rate and may be cost-effective ways to control emerging infectious diseases.


2020 ◽  
Vol 5 (2) ◽  
pp. 407-415
Author(s):  
Noor Aisyah ◽  
◽  
Shela Puji Dina

The cost of illness is an important element in disease decision making because it can evaluate the economic burden of disease. One of them is breast cancer because breast cancer is a catastrophic disease. This study aims to determine direct medical costs, direct non-medical costs, indirect costs, and total costs based on a societal perspective in breast cancer patients at Ulin Hospital, Banjarmasin. This study is an observational analytic study with a prevalence-based cost of illness approach. Data was taken retrospectively for direct medical costs collected from patient medical records that met the inclusion and exclusion criteria, patient treatment data, and details of direct medical costs for the period January-July 2020. Direct non-medical costs and indirect costs were taken from the results of filling out a questionnaire to Breast cancer patients who have undergone treatment in the inpatient room of RSUD Ulin Banjarmasin. Data analysis used descriptive statistics to identify patient characteristics and the costs of breast cancer. The results of the study, the average direct medical cost of breast cancer patients at Ulin Banjarmasin Hospital was Rp. 6,281,700. The average direct non-medical cost was Rp. 416,780 and the average indirect cost was Rp. 229,820. Meanwhile, the average overall cost per episode of inpatient was Rp. 6,928,300


Sign in / Sign up

Export Citation Format

Share Document