Analysis of the Treatment Costs of Malignant Tumor Diseases in China’s Hunan Province Based on“System of Health Account 2011”

Objective: To calculate and analyze the treatment costs of malignant tumors in Hunan Province in 2019, and to provide data support for the formulation and implementation of policies by the health department. Methods: Refer to the "2019 Hunan Province Health Finance Annual Report" and "2019 Hunan Province Health Statistics Summary", based on the “System of Health Account 2011”, calculate and analyze the disease types, beneficiaries, institutional distribution and financing status of malignant tumors diseases. Results: In 2019, the total cost of malignant tumor treatment in Hunan Province was 440,596,800 yuan. The top five were malignant tumors of digestive organs (40.10%), malignant tumors of respiratory and intrathoracic organs (17.62%), and malignant tumors of breast (12.24%), female genital organ malignant tumors (9.88%) and lip, oral cavity and pharynx malignant tumors (6.87%). The 35 to 79-year-old age group has higher treatment costs. The costs are concentrated in general hospitals. Funding sources mainly come from government financing and family health expenditure. The main influencing factors of malignant tumor hospitalization expenses are gender, length of stay, age, drug proportion, institution level and medical institution type.Conclusions: The disease burden of malignant tumors is relatively serious; primary medical and health institutions lack health resources; and household health expenditure accounts for a relatively high proportion. Therefore, hierarchical diagnosis and treatment should be promoted reasonably, focused on key diseases and populations, and medical security policies should be improved to ensure that patients with malignant tumors and their families’ economic burden of disease can be reduced.

Comprehensive economic evaluation of enhanced recovery after surgery in hepatectomy

Background Enhanced recovery after surgery (ERAS) is attracting extensive attention and being widely applied to reduce postoperative stress and accelerate recovery. However, the economic benefits of ERAS are less clarified at the social level. We aimed to assess the economic impact of ERAS in hepatectomy from the perspectives of patients, hospitals and society, as well as identify the approach to create the economic benefits of ERAS. Methods By combining the literature and national statistical data, the cost-effectiveness framework was clarified, and parameter values were determined. Cost-effectiveness analysis, cost–benefit analysis and cost-minimisation analysis were used to compare ERAS and conventional treatment from the perspectives of patients, hospitals and society. The capital flow diagram was used to analyse the change between them. Results ERAS significantly reduced the economic burden of disease on patients ($8935.02 vs $10,470.02). The hospital received an incremental benefit in ERAS (the incremental benefit cost ratio value is 1.09), and the total social cost was reduced ($5958.67 vs $6725.80). Capital flow diagram analysis demonstrated that the average daily cost per capita in the ERAS group increased ($669.51 vs $589.98), whereas the benefits depended on the reduction of hospital stay and productivity loss. Conclusion The mechanism by which ERAS works is to reduce the average length of stay, thereby reducing the economic burden and productivity loss on patients and promoting the hospital bed turnover rate. Therefore, ERAS should further focus on accelerating the rehabilitation process, and more economic support (such as subsidies) should be given to hospitals to carry out ERAS.

The Treatment Pattern and Economic Burden of Homozygous Familial Hypercholesterolemia in China: A Study based on a Patient-Survey

Objective: The study aimed to investigate the treatment pattern and economic burden of homozygous familial hypercholesterolemia (HoFH) in China, and to evaluate the incidence rate of catastrophic health expenditure (CHE) of HoFH patients and their families.Methods: Patients with HoFH diagnosed and treated in Beijing An’Zhen Hospital was included. A questionnaire was developed to investigate and capture the relevant variables of the participants.Results: A total of 120 HoFH patients were investigated, and the number of children (age under 18) was 1.2 times more than adults (age above 18). There were 113 patients with basic medical insurance (including 61 patients with new rural cooperative medical insurance), 4 patients with commercial insurance and 3 patients without any insurance. There were 35 patients with atherosclerotic cardiovascular disease (ASCVD), including 29 adults and 6 children. Only 6 pediatric patients achieved their low-density lipoprotein cholesterol (LDL-C) treatment targets, and all 54 adult patients did not achieve it. The most commonly used treatment method was diet control with lipid-lowering drugs (16.67%), followed by diet control and lipid-lowering drugs using separately (16.67%). The proportion of patients whose annual personal income reached GDP per capita in 2019 was only 2.5%. The total economic burden of disease was 5,529,100 CNY / year, including direct medical costs of 3,427,200 CNY / year, direct non-medical costs of 1,504,500 CNY / year and indirect costs of 611,300 CNY / year; the per capita economic burden of disease was 46,100 CNY / year, including direct medical costs of 28,600 CNY / year, direct non-medical costs of 12,500 CNY / year and indirect costs of 5,100 CNY / year. There were 32 families with CHE due to the disease, accounting for 26.67%.Conclusion: Patients with HoFH in China are generally at young age, and the economic burden of disease for the family is heavy. The existing treatment is not effective, and it is easy to cause premature death due to ASCVD.

What COVID-19 has taught the world

Background: A novel coronavirus (SARS-CoV-2) has captured global recognition in a short period of time by dramatically impacting people's everyday lives and emerged as a public health emergency. Undoubtedly, it shows that lessons learned from past coronavirus epidemics such as the Middle East Respiratory Syndrome (MERS) and the Serious Acute Respiratory Syndrome (SARS) were not adequate and thus left us ill-prepared to deal with the challenges presently raised by the COVID-19 pandemic. Methods: COVID-19 adds to the list of previous outbreaks of infectious disease epidemics that try to remind us that we live in an ecosystem where the relationship between human and animal life, and the environment must be respected in order to survive and prosper. Rapid urbanization and our forestland invasion have created a new interface between humans and wildlife, and have exposed humans to unfamiliar species, frequently involving unfamiliar organisms and exotic wildlife. Findings: Every pandemic is nature’s way of reminding us that the interrelationship between all forms of existence needs to be recognized. To limit new infectious outbreaks, the transdisciplinary ‘One Health’ solution incorporating ‘Health in All Policy’ involving all stakeholders especially environmental health and social sciences is being advocated . Conclusion: Savings and investments should be made by everyone to meet the unexpected. Stigmatization and prejudice among individuals in the world should be discouraged. Special attention should be paid to the elderly, as their immune system is weak. Health and safety precautions such as physical distancing and health hygiene etiquettes should be considered as part of life. Global experience teaches that containment steps and active tracing of contacts are effective to minimize the economic burden of disease and enhance knowledge of disease processes, health issues, disease emergence, and re-emergence. These lessons will help us to battle future pandemics.

Cancer Costs and Economic Burden

Cancer and its treatment result in the harm of economic resources and opportunities for patients, families, employers, and society. These losses include fiscal loss, morbidity, reduced excellence of life, and premature death. When estimating the economic burden of disease, the monetary valuation of resources wont to treat, so the loss of opportunities because of illness is measured as costs and finds out the components.

Societal Cost of Ischemic Stroke in Romania: Results from a Retrospective County-Level Study

Background: Health policies in transitioning health systems are rarely informed by the economic burden of disease due to scanty access to data. This study aimed to estimate direct and indirect costs for first-ever acute ischemic stroke (AIS) during the first year for patients residing in Cluj, Romania, and hospitalized in 2019 at the County Emergency Hospital (CEH). Methods: The study was conducted using a mixed, retrospective costing methodology from a societal perspective to measure the cost of first-ever AIS in the first year after onset. Patient pathways for AIS were reconstructed to aid in mapping inpatient and outpatient cost items. We used anonymized administrative and clinical data at the hospital level and publicly available databases. Results: The average cost per patient in the first year after stroke onset was RON 25,297.83 (EUR 5226.82), out of which 80.87% were direct costs. The total cost in Cluj, Romania in 2019 was RON 17,455,502.7 (EUR 3,606,505.8). Conclusions: Our costing exercise uncovered shortcomings of stroke management in Romania, particularly related to acute care and neurorehabilitation service provision. Romania spends significantly less on healthcare than other countries (5.5% of GDP vs. 9.8% European Union average), exposing stroke survivors to a disproportionately high risk for preventable and treatable post-stroke disability.

Economic Burden of Major Diseases in China in 2013

Studies on the economic burden of disease (EBD) can estimate the social benefits of preventing or curing disease. The majority of studies focus on the economic burden of a single or regional disease; however, holistic or national research is rare in China. Estimating the national EBD can provide evidence for policy makers. We used the top-down method to assess the economic burden of 30 types of diseases between urban and rural areas in China. The two-step model was used to evaluate the direct economic burden of disease (DEBD), while the human capital method was used to assess the indirect economic burden of disease (IEBD). The total economic burden of 30 types of diseases in China was between $13.39 and 803.00 billion in 2013. The average total economic burden of disease (TEBD) in cities was $81.39 billion, while diseases in villages accounted for $50.26 billion. The range of direct and indirect EBD was $5.77–494.52 billion, and the range in urban areas was $0.61–20.34 billion. The direct and indirect EBD in rural areas accounted for $5.88–277.76 billion and $0.59–11.39 billion, respectively. There was a large difference between the economic burden of different diseases. The economic burden of urban diseases was more significant than the burden for the rural. The top five most economically burdensome diseases were myocardial infarction coronary artery bypass, acute myocardial infarction, cerebral hemorrhage, acute upper gastrointestinal bleeding and acute appendicitis.

A multi-stakeholder multicriteria decision analysis for the reimbursement of orphan drugs (FinMHU-MCDA study)

Background Patient access to orphan medicinal products (OMPs) is limited and varies between countries, reimbursement decisions on OMPs are complex, and there is a need for more transparent processes to know which criteria should be considered to inform these decisions. This study aimed to determine the most relevant criteria for the reimbursement of OMPs in Spain, from a multi-stakeholder perspective, and using multicriteria decision analysis (MCDA). Methods An MCDA was developed in 3 phases and included 28 stakeholders closely related to the field of rare diseases (6 physicians, 5 hospital pharmacists, 7 health economists, 4 patient representatives and 6 members from national and regional health authorities). Initially [phase A], a bibliographic review was conducted to identify the potential reimbursement criteria. Then, a reduced advisory board (8 members) proposed, selected, and defined the final list of criteria that could be relevant for reimbursement. A discrete choice experiment (DCE) [phase B] was developed to determine the relevance and relative importance weight of such criteria according to the stakeholders’ preferences by choosing between pairs of hypothetical financing scenarios. A multinomial logit model was fitted to analyze the DCE responses. Finally [phase C], the advisory board review the results using a deliberative process. Results Thirteen criteria were selected, related to 4 dimensions: patient population, disease, treatment, and economic evaluation. Nine criteria were deemed relevant for decision-making and associated with a higher relative importance: Health-related quality of life (HRQL) (23.53%), treatment efficacy (14.64%), availability of treatment alternatives (13.51%), disease severity (12.62%), avoided costs (11.21%), age of target population (7.75%), safety (seriousness of adverse events) (4.72%), quality of evidence (3.82%) and size of target population (3.12%). The remaining criteria had a < 3% relative importance: economic burden of disease (2.50%), cost of treatment (1.73%), cost-effectiveness (0.83%) and safety (frequency of adverse events) (0.03%). Conclusion The reimbursement of OMPs in Spain should be determined by its effect on patient’s HRQL, the extent of its therapeutic benefit from efficacy and the availability of other therapeutic options. Furthermore, the severity of the rare disease should also influence the decision along with the potential of the treatment to avoid associated costs.

Economic burden of disease progression among multiple myeloma patients who have received transplant and at least one line of therapy in the US

Effects of disease progression on healthcare resource utilization (HRU) and costs among multiple myeloma (MM) patients with ≥1 line of therapy (LOT) who received their first stem cell transplant (SCT) within 1 year of initial MM diagnosis were estimated using a large US claims database. Disease progression was defined as advancement to the next LOT, bone metastasis, hypercalcemia, soft tissue plasmacytoma, skeletal related events, acute kidney disease, or death within 12 months of LOT initiation. Annual HRU and costs in the first three LOTs (L1–L3) were compared for patients with versus without disease progression using inverse probability of treatment weighting to adjust for differences between groups in baseline characteristics. In all LOTs, mean annual hospitalizations and healthcare costs were greater for patients with versus without progression. Total incremental annual costs among patients with versus without progression in L1–L3 were $18,359, $87,055, and $71,917, respectively, among LOTs initiated between 2006 and 2018. In LOTs initiated between 2013 and 2018, the figures were $46,024, $100,329, and $101,942 in L1–L3, respectively. The economic burden of disease progression is substantial in this population of MM patients who underwent SCT and received systemic anti-myeloma therapy.