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

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

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2021.29 ◽

2021 ◽

pp. 1-4

Author(s):

Federico Solla ◽

Eytan Ellenberg ◽

Virginie Rampal ◽

Julien Margaine ◽

Charles Musoff ◽

...

Keyword(s):

Indirect Costs ◽

Medical Costs ◽

Pediatric Hospital ◽

Terror Attack ◽

Direct And Indirect Costs ◽

Terror Attacks ◽

Direct Medical Costs ◽

Annual Budget ◽

The Difference ◽

The Cost

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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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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Cost-Minimization Analysis of Non-Invasive and Invasive Mechanical Ventilation for De Novo Acute Hypoxemic Respiratory Failure in an Eastern European Setting

Acta Medica Bulgarica ◽

10.2478/amb-2019-0003 ◽

2019 ◽

Vol 46 (1) ◽

pp. 17-20

Author(s):

V. Ilieva ◽

T. Mihalova ◽

Yo. Yamakova ◽

R. Petkov ◽

B. Velev

Keyword(s):

Mechanical Ventilation ◽

Respiratory Failure ◽

Cost Minimization ◽

Invasive Mechanical Ventilation ◽

Medical Costs ◽

Non Invasive ◽

Saps Ii ◽

Direct Medical Costs ◽

Saps Ii Score ◽

Significant Difference

Abstract Introduction: In the light of constant pressure for minimizing healthcare costs we made a cost-minimization analysis comparing invasive mechanical ventilation (IMV) and non-invasive ventilation (NIV) as treatment for hypoxemic acute respiratory failure (ARF). Aim: The primary objective was to estimate the direct medical costs generated by a patient on IMV and NIV. A secondary objective was to identify which aspect of the treatment was most expensive. Material and Methods: This is a single center retrospective study including 36 patients on mechanical ventilation due to hypoxemic ARF, separated in two groups – NIV (n = 18) and IMV (n = 18). We calculated all direct medical costs in Euro and compared them statistically. Results: On admission the PaO2/FiO2 and SAPS II score were comparable in both groups. We observed a significant difference in the costs per patient for drug treatment (NIV: 616.07; IQR: 236.68, IMV:1456.18; IQR:1741.95, p = 0.005), consumables (NIV: 16.47; IQR: 21.44, IMV: 98.79; IQR: 81.52, p < 0.001) and diagnostic tests (NIV: 351; IQR: 183.88, IMV: 765.69; IQR: 851.43, p < 0.001). We also computed the costs per patient per day and there was a significant difference in the costs in all above listed categories. In both groups the highest costs were for drug treatment – around 61%. Conclusions: In the setting of hypoxemic ARF NIV reduces significantly the direct medical costs of treatment in comparison to IMV. The decreased costs in NIV are not associated with severity of disease according to the respiratory quotient and SAPS II score.

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Abstract P90: Cardiovascular and Economic Outcomes Following Initiation of Atorvastatin versus Simvastatin in an Employed Population Stratified by Cardiovascular Risk

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.4.suppl_1.ap90 ◽

2011 ◽

Vol 4 (suppl_1) ◽

Author(s):

Ross Simpson ◽

James Signorovitch ◽

Karthik Ramakrishnan ◽

Jasmina Ivanova ◽

Howard Birnbaum ◽

...

Keyword(s):

High Risk ◽

Cost Savings ◽

Indirect Costs ◽

Medical Costs ◽

Matched Pairs ◽

Intermediate Risk ◽

Direct Medical Costs ◽

Significant Difference ◽

Risk Patients ◽

Employer Perspective

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.

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Direct and indirect costs of families with a child with acute lymphoblastic leukaemia in an academic hospital in China: a cross-sectional survey

BMJ Open ◽

10.1136/bmjopen-2019-030511 ◽

2019 ◽

Vol 9 (7) ◽

pp. e030511

Author(s):

Yijiong Ren ◽

Xin Li

Keyword(s):

Acute Lymphoblastic Leukaemia ◽

Lymphoblastic Leukaemia ◽

Rural Families ◽

Indirect Costs ◽

Urban Families ◽

Medical Costs ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Direct And Indirect Costs ◽

Three Phase

ObjectivesTo estimate the direct and indirect costs in families with a child with acute lymphoblastic leukaemia (ALL) in China.DesignA single-site, cross-sectional survey of primary caregiver of a child with ALL was performed.Setting and participantsWe analysed the total costs incurred on the completion of the first three-phase treatment (induction, consolidation and intensification), which requires intensive hospitalisation. Eligible patients were (1) diagnosed with ALL between 2010 and 2012 at Shanghai Children’s Medical Center (SCMC), (2) aged 0–14 years at diagnosis and (3) completed the first three-phase treatment at SCMC. The data were collected between October 2014 and December 2014.Outcome measuresWe decomposed the total costs into three categories: (1) direct medical costs, which were further divided into outpatient and inpatient costs; (2) direct non-medical costs, which referred to expenses incurred in relation to the illness; and (3) indirect costs due to productivity loss.ResultsA total of 161 patients were included in the study. Direct medical costs accounted for about 51.7% of the overall costs, and the rest of 48.3% of the total costs were attributed to direct non-medical costs and indirect costs. Regarding families with different household registration type (rural vs urban), the total costs were significantly different between the two groups (US$36 125 vs US$25 593; p=0.021). Specifically, urban families incurred significantly larger indirect costs than rural families (US$12 343 vs US$4157; p=0.018). Although the direct non-medical costs were not significantly different, urban families spent more money on hygiene cleaning products and auxiliary treatment equipment (p=0.041) and gifts and treats (p=0.034) than rural families.ConclusionsThe financial burden faced by the Chinese families with a child with ALL was tremendous, and the distributions of costs among the three categories were different between urban and rural families.

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Analisis beban ekonomi kejadian luar biasa campak di Daerah Istimewa Yogyakarta

Berita Kedokteran Masyarakat ◽

10.22146/bkm.11629 ◽

2016 ◽

Vol 32 (12) ◽

pp. 473 ◽

Cited By ~ 1

Author(s):

Akhmad Mukhibin ◽

Hari Kusnanto ◽

Riris Andono Ahmad

Keyword(s):

Economic Burden ◽

Survey Design ◽

Secondary Data ◽

Indirect Costs ◽

Medical Costs ◽

Total Direct Cost ◽

Direct And Indirect Costs ◽

Dominant Component ◽

Duration Of Illness ◽

Measles Outbreak

Economic burden analysis of measles outbreak in the Special Region of Yogyakarta 2015Purpose This study aimed to analyze the economic burden due to outbreaks of measles in the household sector in Yogyakarta.Methods This research was a descriptive study with survey design, with data collected of direct and indirect costs for patients exposed to measles, by conducting interviews of 177 respondents using a questionnaire. Secondary data was compared in the form of outbreaks of measles in 2014 and 2015, to research in February-March, 2016.Results The number of outbreaks of measles patients who visited health facilities reached 163 patients (92.09%). Total medical costs were IDR 17.982.000, non-medical costs IDR 7.804.900, so the total direct cost of IDR was 25.786.900 (average IDR 145. 700). Total indirect costs were IDR 11.720.000 (average IDR 156. 300). The economic burden of measles outbreak was IDR 37.506.900 (average IDR 211. 900). Generally, the cost that is paid out of pocket amounted to 6.32% of household income, not yet considered catastrophic. Regression analysis showed the duration of illness averaged more than 10 days (p = 0.002 with some status of hospitalization (p = 0.000).Conclusions The economic burden of outbreaks of measles in the province in 2015 was IDR 37.506.900, including direct and indirect costs. Medical costs are the dominant component of direct costs. The factors that were related to the economic burden are the duration of illness of more than 10 days and inpatient status. There needs to be an advocacy to the community about the use of health care and prevention of measles by way of measles immunization.

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Evaluation Parameter of Excessive Daytime Sleepiness for Obstructive Sleep Apnea Patients

Sleep Medicine Research ◽

10.17241/smr.2021.01116 ◽

2021 ◽

Vol 12 (2) ◽

pp. 110-117

Author(s):

Sang Hoo Park ◽

Woo Yong Bae ◽

Sangjun Kim ◽

Young Gun Kim

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

Upper Airway ◽

Public Health Problem ◽

Poor Performance ◽

Obstructive Sleep ◽

Significant Difference ◽

Clinical Records

Background and Objective Obstructive sleep apnea (OSA) is a sleep-related breathing disorder caused by repetitive obstruction of the upper airway. Repetitive obstruction of the upper airway causes impaired gaseous exchange, resulting hypoxia, hypercapnia, and frequent arousals of sleep architecture. Polysomnography (PSG) is a gold standard for diagnosing OSA. Excessive daytime sleepiness (EDS) is a common accompanying daytime symptoms in OSA patients. Since EDS can cause unexpected events such as traffic accident or poor performance in workplace, it is regarded as a significant public health problem. Therefore, accurate assessment and prediction of this symptom is important. The Epworth Sleepiness Scale (ESS) and multiple sleep latency test are most commonly used to evaluate EDS, but their efficacies are controversial. The purpose of this study is to find the parameter to evaluate and predict the EDS for OSA patients.Methods We retrospectively reviewed the medical records of 88 OSA patients. Patients were divided into two groups according to the presence of EDS. We analyzed the clinical records, questionnaire scores, and PSG data to find the difference between two groups.Results ESS was 10.64 ± 4.28 in EDS patients and 8.63 ± 4.86 in non-EDS patients. ESS showed a statistically significant difference between two groups (p = 0.044). Also, the percentage of 1st stage non-REM sleep in total sleep time (N1%) was 25.09 ± 15.24 in EDS patients and 18.97 ± 10.30 in non-EDS patients and showed a statistically significant difference between groups (p = 0.033). Patients’ weight was 81.59 ± 20.52 in EDS patients and 74.14 ± 12.63 in non-EDS patients and showed a statistically significant difference between groups (p = 0.046).Conclusions ESS, N1% and patients’ weight were significant parameter which is related with the presence of EDS for OSA patients. These parameters will be useful in evaluating the presence of EDS for OSA patients. Also, in patients diagnosed with sleep disorder with high N1%, EDS must be accurately evaluated as well.

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