Costs of breast cancer treatment incurred by women in Vietnam

Background There is a paucity of research on the cost of breast cancer (BC) treatment from the patient’s perspective in Vietnam. Methods Individual-level data about out-of-pocket (OOP) expenditures on use of services were collected from women treated for BC (n = 202) using an online survey and a face-to-face interview at two tertiary hospitals in 2019. Total expenditures on diagnosis and initial BC treatment were presented in terms of the mean, standard deviation, and range for each type of service use. A generalised linear model (GLM) was used to assess the relationship between total cost and socio-demographic characteristics. Results 19.3% of respondents had stage 0/I BC, 68.8% had stage II, 9.4% had stage III, none had stage IV. The most expensive OOP elements were targeted therapy with mean cost equal to 649.5 million VND ($28,025) and chemotherapy at 36.5 million VND ($1575). Mean total OOP cost related to diagnosis and initial BC treatment (excluding targeted therapy cost) was 61.8 million VND ($2667). The mean OOP costs among patients with stage II and III BC were, respectively, 66 and 148% higher than stage 0/I. Conclusions BC patients in Vietnam incur significant OOP costs. The cost of BC treatment was driven by the use of therapies and presentation stage at diagnosis. It is likely that OOP costs of BC patients would be reduced by earlier detection through raised awareness and screening programmes and by providing a higher insurance reimbursement rate for targeted therapy.

Analysis of Drug Compliance among Patients Suffering from Deep Vein Thrombosis

Objective: The objective of current research was to identify the compliance of commonly prescribed antithrombotic drug among patients who suffering from Deep Vein Thrombosis (DVT). Methodology: Descriptive cross-sectional research on adults with age of 18-65 years suffering from DVT were conducted on medicine department of Shaheed Mohtarma Benazir Bhutto Medical University Hospital of Larkana. Three hundred and forty eight DVT patients were consecutive selected during the period of six months from January 2021 to June 2021. Data of DVT patients was collected by using standard proforma and analyzed with statistical package of social sciences (SPSS) version 25. Results: Majority of DVT patients evaluated during study period were male 237 (61.7%) patients and 147 (38.3%) DVT patients were female. Mean age of DVT patients was 43.78 ± 12.43 (18-65) years. Most of the patients were in age group of 51-65 years having 126 (32.8%) patients followed by 41-50 years having 104 (27.1%) patients, 31-40 years having 93 (24.2%) patients and 18-30 years having 61 (15.9%) patients. Majority of DVT patients were from urban areas 217 (56.5%) patients followed by rural areas 167 (43.5%) patients. Drug compliance in illiterate patients was 107 (36.1%). Drug compliance in indoor job patients was 102 (34.5%) whereas drug compliance in jobless patients was 59 (19.1%). Drug compliance in positive medication history was 207 (69.9%). Drug compliance in Hypertensive patients was 33 (11.1%) in congestive heart failure patients 27 (9.1%), in ischemic stroke 15 (5.1%). Whereas, the drug compliance among diabetes mellitus patients was 13 (4.4%). Overall drug compliance with antithrombotic drugs was reported in 296 (77.1%) DVT patients. Conclusion: Current research concludes that rate of drug compliance was high in patients of DVT with rivaroxaban followed by warfarin and heparin, whereas long duration of therapy, polypharmacy, side effects of therapy, cost of therapy, continuous monitoring, injectables, diet restrictions and ADRs of therapy were the most commonly reported factors of non-compliance.

Comparative Study of Compliance and Factors Affecting Compliance among Commonly Used Drugs in Deep Vein Thrombosis Patients

Objectives: The objective of current research was to identify the compliance of antithrombotic drug (heparin, warfarin and Rivaroxaban) and factors of non-compliance associated with heparin, warfarin and rivaroxaban. Methodology: A cross-sectional, observational study was conducted on patients suffering from Deep Vein Thrombosis (DVT) at government teaching hospital of Larkana. 348 DVT patients were selected by using online sample calculator software. Data was collected by using pre validated questionnaire after taking patient consent; finally the data was analyzed with statistical package of social sciences (SPSS) version 25. Results: The compliance with rivaroxaban was present in 103 (80.5%) patients followed by heparin drug compliance in 95 (74.2%) DVT patients and warfarin drug compliance in 98 (76.6%) DVT patients. Non-compliance factors with rivaroxaban were; cost in 4 (16.0%) patients, polypharmacy in 6 (24.0%) patients, side effects in 4 (16.0%) patients and prolong therapy in 11 (44.0%) patients. Non-compliance factors with heparin were; monitoring in 13 (39.4%) patients, diet restriction in 6 (18.2%) patients, injectable in 10 (30.3%) patients and ADR in 4 (12.1%) patients. Non-compliance factors with warfarin were; cost in 4 (13.3%) patients, polypharmacy in 8 (26.7%) patients, prolong therapy in 5 (16.7%) patients and ADR in 13 (43.3%) patients. Conclusion: This study concludes that rate of drug compliance was high in patients of DVT with rivaroxaban followed by warfarin and heparin, whereas long duration of therapy, polypharmacy, side effects of therapy, cost of therapy, continuous monitoring, injectables, diet restrictions and ADRs of therapy were the most commonly reported factors of non-compliance.

Procalcitonin-guided protocol use and impact on intensive care unit and antibiotic management: a pilot study

Objective: To assess the procalcitonin protocol use and its impact on antibiotic therapy management of critically ill patients in the intensive care unit (ICU). Method: An observational descriptive and retrospective study conducted in an adult ICU with 28 beds from the Brazilian Unified Health System (SUS). Results: This present study observed a 78% (90/116) of PCT protocol adherence in the studied ICU. We observed a reduction in days of antibiotic treatment (DOT) going from 14 to 8,5 treatment-day duration (5.49 ± 2.2 days), impacting the overall antibiotic therapy cost for a decrease of 40.91%. Conclusion: The study revealed that PCT use was associated with substantial benefits, reducing hospital costs and days of exposure to antibiotic therapy applied to patients affected by infectious diseases in critical care settings.

Uptake of new antidiabetic medicines in 11 European countries

Background Several new antidiabetic medicines (GLP-1 receptor agonists, DPP-4 inhibitors, and SGLT-2 inhibitors) have been approved by the European Medicines Agency since 2006. The aim of this study was to evaluate the uptake of new antidiabetic medicines in European countries over a 10-year period. Methods The study used IQVIA quarterly value and volume sales data January 2006–December 2016. The market uptake of new antidiabetic medicines together with intensity of prescribing policy for all antidiabetic medicines were estimated for Austria, Croatia, France, Germany, Hungary, Italy, Poland, Slovenia, Spain, Sweden, and the United Kingdom. The following measures were determined: number of available new active substances, median time to first continuous use, volume market share, and annual therapy cost. Results All countries had at least one new antidiabetic medicine in continuous use and an increase in intensity of prescribing policy for all antidiabetic medicines was observed. A tenfold difference in median time to first continuous use (3–30 months) was found. The annual therapy cost in 2016 of new antidiabetic medicines ranged from EUR 363 to EUR 769. Among new antidiabetic medicines, the market share of DPP-4 inhibitors was the highest. Countries with a higher volume market share of incretin-based medicines (Spain, France, Austria, and Germany) in 2011 had a lower increase in intensity of prescribing policy. This kind of correlation was not found in the case of SGLT-2 inhibitors. Conclusions This study found important differences and variability in the uptake of new antidiabetic medicines in the included countries.

Digital health technologies for pediatric pain

The rapid growth in digital health technologies in the last two decades means that several new tools have become available to monitor and manage chronic, recurrent, and acute pain in children and adolescents. These tools include the internet (and associated social support networks), mobile phones, and telemedicine, as well as virtual reality and other high-technology distraction interventions. The benefits of digital health technology-based pain therapies include improved treatment accessibility and satisfaction, and potential decreases in therapy cost. Digital health therapies for children and adolescents with pain represent exciting treatment possibilities. Future, rigorous research into the design and effectiveness testing of these therapies will shed more light on how digital health technologies might decrease pain intensity and improve the quality of life for children and adolescents with chronic, recurrent, and acute pain.