Costs of treating community-acquired bacterial bronchopneumonia in pediatric patients

Relevance. Health management has not escaped the pressure of the current epidemiological situation. In a complex scenario, characterized by the COVID-19 pandemic, the daily dynamics become more complex and greater agility is required for decision-making. Much of the success of those decisions is determined by access to timely information, especially in crisis conditions and limited resources. For this reason, health organizations are interested in knowing the costs of pathologies that frequently constitute causes of hospitalization. In this sense, community - acquired bacterial bronchopneumonia stands out, which is a disease that frequently causes hospitalization of pediatric patients. Objective. This article aims to carry out a partial retrospective financial evaluation in order to determine the costs associated with the treatment of community-acquired bacterial bronchopneumonia in pediatric patients. Materials and methods. The study was developed from the perspective of the health institution General Hospital Guillermo Luis Fernndez Hernndez - Baquero in the city of Moa. For this, the analysis - synthesis and comparative methods were used, as well as the methodology to calculate and analyze disease costs. Results. The research focused on the January-March quarters of the years 2017 and 2018 and provided valuable accounting information regarding the direct and indirect costs of the treatment of the pathology in question, which serves as a tool for the correct management of the hospital institution. Conclusion . The direct costs exceeded the indirect costs and the items that most affected the total cost were the salaries of the workers, food, and medicines used to treat the disease. The need to develop digital health was evidenced, with special emphasis on digital medical records to facilitate access to them and thus avoid the loss of information due to its deterioration. The study provides useful information to the management of the health institution, which serves as support for budget analysis and future projections.

The cost of care for children hospitalised with Invasive Group A Streptococcal Disease in Australia

Background Invasive Group A Streptococcal (iGAS) disease exerts an important burden among Australian children. No Australian hospitalisation cost estimates for treating children with iGAS disease exist, so the financial impact of this condition is unknown. Aim To determine the minimum annual healthcare cost for children (< 18 years) hospitalised with iGAS disease in Australia from a healthcare sector perspective. Methods A cost analysis including children with laboratory-confirmed iGAS disease hospitalised at the Royal Children’s Hospital (Victoria, Australia; July 2016 to June 2019) was performed. Results were extrapolated against the national minimum iGAS disease incidence. This analysis included healthcare cost from the 7 days prior to the index admission via General Practitioner (GP) and Emergency Department (ED) consultations; the index admission itself; and the 6 months post index admission via rehabilitation admissions, acute re-admissions and outpatient consultations. Additional extrapolations of national cost data by age group, Aboriginal and Torres Strait Islander ethnicity and jurisdiction were performed. Results Of the 65 included children, 35% (n = 23) were female, 5% (n = 3) were Aboriginal and Torres Strait Islander, and the average age was 4.4 years (SD 4.6; 65% aged 0–4). The iGAS disease related healthcare cost per child was $67,799 (SD $92,410). These costs were distributed across the 7 days prior to the index admission via GP and ED consultations (0.2 and 1.1% of total costs, respectively), the index admission itself (88.7% of the total costs); and the 6 months post index admission via rehabilitation admissions, acute re-admissions and outpatient consultations (5.3, 4.5 and 0.1% of total costs, respectively). Based on a national minimum paediatric incidence estimation of 1.63 per 100,000 children aged < 18 (95%CI: 1.11–2.32), the total annual healthcare cost for children with iGAS in 2019 was $6,200,862. The financial burden reflects the overrepresentation of Aboriginal and Torres Strait Islander people in the occurrence of iGAS disease. Costs were concentrated among children aged 0–4 years (62%). Conclusion As these cost estimations were based on a minimum incidence, true costs may be higher. Strengthening of surveillance and control of iGAS disease, including a mandate for national notification of iGAS disease, is warranted. Trial registration The current study is a part of ongoing iGAS surveillance work across seven paediatric health services in Australia. As this is not a clinical trial, it has not undergone trial registration.

Patient Decision and Experience in the Multi-channel Appointment Context: An Empirical Study (Preprint)

BACKGROUND Long waiting time for treatment in the outpatient department has long been a complaint and influence patient experience. It is critical to schedule patients for doctors to reduce patient waiting time. Nowadays, the multi-channel appointment has been provided for patients to get medical services, especially for those with severe illnesses and remote distance. OBJECTIVE This study aims to explore the factors influencing patient appointment channel choice in the context of multi-channel appointments, and how channel choice affects the waiting time for offline visiting. METHODS We collected outpatient appointment records from both online and offline appointment channels to conduct our empirical research. The empirical analysis is conducted into two steps. We first analyze the relationship between appointment channel choice and patient waiting time, and then the relationships between three determinants and appointment channel choice. The ordinary least squares and the logistic regression model are used to obtain empirical results. RESULTS Our results show that a patient with an online appointment decision has a shorter consultation waiting time compared with a patient with on-site appointment (β = -0.320, p<0.001). High-quality resource demand (β = 0.349, p<0.001), high-severity disease (β = 0.011, p<0.001), and high non-disease costs (β = 0.039, p<0.001) create an obvious incentive for patients to make appointments via the Internet. Further, only the effect of non-disease cost on channel choice is lower for patients with multiple visit histories (β = -0.021, p<0.001). CONCLUSIONS Our study confirms the effect of Internet use on reducing patient waiting time. Patients consider both health-related risk factors and cost-related risk factors to make decisions on appointment channels. Our study produces several insights, which have implications for channel choice and patient behavior literature. More importantly, these insights as a whole, contribute to the design of appointment systems of hospitals.

Management and Burden of Acute Migraine at the Emergency Department in Southwest China: a Retrospective Study

Background:Migraine is the most common cause of headache patients for medical consultation to emergency department (ED). However, the management and cost of those patients are less known. Our study aimed to survey detailed diagnosis, clinical characteristics, management, and cost of migraine patients in the emergency department in ChinaMethods:We performed a retrospective study from April 1, 2014, and September 31, 2020, at West China Hospital. This study enrolled patients with migraine diagnoses and analyzed their investigations, medical treatment and cost during their stay at ED. Results:Our study included 300 patients, 77.3% were female and the mean age was 38 years. 36% were conducted cranial CT scan. Non-steroidal anti-inflammatory drugs (NSAIDs) were the most used at ED. We found that none of the patients received triptans nor prophylaxis medicine. The mean cost of emergency room visits was 57.17USD.Conclusion:Our study found that most migraine patients who came to the ED were not receiving the evidence-based acute treatment. A timely referral system should be established to minimize the disease costs of patients.

Estimating the Financial Impact of Livestock Schistosomiasis on Traditional Subsistence and Transhumance Farmers Keeping Cattle, Sheep and Goats in Northern Senegal

Background: Schistosomiasis is a disease that poses major threats to human and animal health, as well as the economy, especially in sub-Saharan Africa (SSA). Furthermore, its zoonotic nature and the presence of hybrid species complicate efforts to achieve the new World Health Organization’s roadmap for neglected tropical diseases target of elimination. Whilst many studies have evaluated the economic impact of schistosomiasis in humans, only one has been performed to date in livestock in SSA and none in Senegal. The aim of this study was to estimate the financial impact of livestock schistosomiasis in selected regions of Senegal.Methods: Stochastic partial budget models were developed in RiskAmp add-in for Excel for a one-year period to estimate the disease costs on local traditional farmers in twelve villages from the Lac de Guiers and Barkedji regions, Senegal. Disease costs were the sum of disease losses and expenditures and included reduced income due to production losses (e.g. reduced milk yield), expenditures saved (e.g. concentrate feed saved due to disease), additional costs (e.g. testing and treatment, buying replacement animals), and additional income (e.g. selling of diseased animals). The models were parameterised using primary data from cross-sectional surveys and focus group discussions, as well as secondary data from scientific literature and available statistics. Two scenarios were defined based on the most common practices reported: scenario 1 modelled a situation in which the farmers tested and treated their livestock for schistosomiasis; whilst scenario 2 modelled a situation in which there was no tests nor treatment. The model was run with 10,000 iterations for a period of one year; results were expressed in XOF, i.e., the West African CFA franc (1 XOF is equivalent to 0.0014 GBP) with the median and 95% confidence range. Sensitivity analyses were conducted to assess the impact of uncertain variables on the output. Results: For scenario 1, the median disease costs per year and head of cattle, sheep, and goats, respectively, were estimated at XOF -13,408, XOF -27,227 and XOF -27,694. For scenario 2, the disease costs per year and head of cattle, sheep, and goats, respectively, were estimated at XOF -49,296 , XOF -70,072 and XOF -70,281. Sensitivity analyses indicated that the market prices for young and adult, healthy and sick animals had the biggest impact on the disease costs for all species.Conclusions: Our findings suggest that the financial impact of livestock schistosomiasis on traditional subsistence and transhumance farmers in North Senegal is substantial. Consequently, treating livestock schistosomiasis with an effective control strategy has the potential to generate substantial benefits to farmers and their families. Our results can also serve as a baseline for future cost-benefit and cost-effectiveness analyses for potential regional treatment campaigns for schistosomiasis in livestock.

Adverse events and estimated costs with the combination of ipilimumab and nivolumab in metastatic melanoma patients.

e21529 Background: The combination of ipilimumab and nivolumab in metastatic melanoma patients increases response rates (RR) and survival outcomes. As checkpoint inhibitors bear a significant financial impact on the healthcare system, we performed a study that addresses the global costs of the treatment, focusing on immune-related adverse event (irAE) management costs. Methods: We conducted a retrospective analysis of 62 metastatic melanoma patients treated with ipilimumab and nivolumab at the Oncology Department of Lausanne University Hospital (CHUV) between June 1, 2016 and August 31, 2019. The frequency of irAEs, the duration, management, and outcomes were evaluated. All melanoma-specific costs were analyzed by mining the electronic healthcare record and billing data of the hospital. Results: The median follow-up was 32 months (range 20-1066 days). In our cohort, 54/62 (87%) patients presented at least one irAE, and 22/62 (35%) presented a grade 3 irAE. One patient died from an irAE (pneumonitis). The most common irAEs were diarrhea 23/62 (37%) any grade, 8/62 (13%) grade 3-4; hepatitis 22/62 (36%) any grade, 9/62 (15%) grade 3-4; and skin rash 21/62 (34%) any grade, 6/32 (10%) grade 3-4. The overall response rate was 29/62 (47%), with 15/62 (24%) of complete response (CR) and 14/62 (23%) of partial response (PR). The majority of patients who had a CR 13/15 (87%) and 20/28 (71%) of overall responders presented a grade 3-4 toxicity, and there were no responses in patients without toxicity. However, toxicity does not imply response, as only 29/54 (54%) of patients with toxicity (any grade) and 20/31 (65%) (grade 3-4) responded. The toxicity costs represent only 3% on average of the total expenses per patient. The most significant contributions were medication costs (44%) and disease costs (39%, mainly disease-related hospitalization costs). Patients with a CR had the lowest global cost per week (2,860 USD, converted from CHF) despite the associated toxicities and patients who had progressive disease, the highest one (9,999 USD). Except for the one patient who had a grade 5 toxicity (7,472 USD/week), we observe that less severe toxicity grades (11,603 USD/week for grade 1), or even the absence of toxicity (12,266 USD/week), are associated to higher median costs per week (against 4,039 USD/ week for grade 4 and 3,524 USD/week for grade 3). Conclusions: The cost of toxicities was unexpectedly small (only 3%) compared to the total costs, especially medication costs (44%). Also, patients with a higher degree of toxicity had lower costs and better outcomes.

Health Impact and Cost-Effectiveness of Implementing Gender-Neutral Vaccination With the 9-Valent Human Papillomavirus Vaccine in Belgium

Background: Routine human papillomavirus (HPV) immunization in Belgium is currently regionally managed, with school-aged girls receiving the 9-valent HPV (9vHPV) vaccine in Flanders and Wallonia-Brussels with a national catch-up program for females only. This study will assess whether expanding these programs to gender-neutral vaccination (GNV) with the 9vHPV vaccine is a cost-effective strategy in Belgium.Methods: A validated HPV-type transmission dynamic model estimated the potential health and economic impact of regional vaccination programs, comparing GNV versus female-only vaccination (FOV) with the 9vHPV vaccine in individuals aged 11–12 years in Flanders, GNV with the 9vHPV vaccine versus FOV with the 2-valent HPV (2vHPV) vaccine in individuals aged 12–13 years in Wallonia-Brussels, and national catch-up GNV versus FOV with the 9vHPV vaccine for those aged 12–18 years. Vaccination coverage rates of 90, 50, and 50% in both males and females were used in the base cases for the three programs, respectively, and sensitivity analyses were conducted. All costs are from the third-party payer perspective, and outcome measures were reported over a 100-year time horizon.Results: GNV with the 9vHPV vaccine was projected to decrease the cumulative incidence of HPV 6/11/16/18/31/33/45/52/58-related diseases relative to FOV in both Flanders and Wallonia-Brussels. Further reductions were also projected for catch-up GNV with the 9vHPV vaccine, including reductions of 6.8% (2,256 cases) for cervical cancer, 7.1% (386 cases) and 18.8% (2,784 cases) for head and neck cancer in females and males, respectively, and 30.3% (82,103 cases) and 44.6% (102,936 cases) for genital warts in females and males, respectively. As a result, a GNV strategy would lead to reductions in HPV-related deaths. Both regional and national catch-up GNV strategies were projected to reduce cumulative HPV-related disease costs and were estimated to be cost-effective compared with FOV with incremental cost-effectiveness ratios of €8,062, €4,179, and €6,127 per quality-adjusted life-years in the three programs, respectively. Sensitivity analyses were consistent with the base cases.Conclusions: A GNV strategy with the 9vHPV vaccine can reduce the burden of HPV-related disease and is cost-effective compared with FOV for both regional vaccination programs and the national catch-up program in Belgium.

Incidence of household catastrophic and impoverishing health expenditures among patients with Breast Cancer in Iran

Background Breast cancer disease is the most common cancer among Iranian women and imposing a significant financial burden on the households. This study calculated out-of-pocket (OOP), catastrophic health expenditure (CHE), and impoverishing health spending attributed to breast cancer in Iran. Methods In this cross-sectional household study, clinical and financial information on breast cancer and also household information (expenditures and income) were obtained through face-to-face interviews and completing a questionnaire by 138 women with this disease in 2019. We applied three non-food expenditure thresholds of 40, 20, and 10% to defining the CHE. Disease costs included periodical visits, diagnostic services, hospitalization care, treatment and rehabilitation services, home, and informal care. Households were disaggregated into socioeconomic status quintiles based on their Adult Equivalent values standardized monthly consumption expenditures. To identify the factors affecting these indicators, we performed the two different multivariate logistic regression models. Results This study finds that each patient had a monthly average OOP payment of $US 97.87 for the requested services, leading to impoverished of 5.07% and exposed 13.77% of their households to CHE. These indicators have been mainly concentrated among the poor, as they have spent a large part of their meager income on buying the needed services, and for this purpose, most of them forced to sell their assets, borrow, or take a bank loan. Conclusions The patients in lower SES quintiles can be protected from impoverishing and catastrophic health spending by expanding insurance coverage, providing financial risk protection programs, and increasing access to quality and effective public sector services. Alongside, expanding inpatient coverage and adding drug benefits for the poor can significantly decrease their OOP payments.