Analysis of Direct Treatment Cost for Exacerbation of Chronic Obstructive Pulmonary Disease in E Hospital from October 2019 to March 2020

This study analyzes the direct treatment cost for exacerbation of chronic obstructive pulmonary disease (COPD) at the Department of Pulmonology, E Hospital from October 2019 to March 2020. The study results show that the average direct treatment cost for exacerbation of COPD was VND 9,102,311.71; the highest cost was VND 36,304,614 and the lowest cost, VND 2,309,961. Among the direct treatment cost components, drug cost showed the highest proportion, followed by hospital bed, then surgical procedures, tests, diagnostic imaging, functional exploration, examination and medical supplies. The cost of antibiotics accounted for 57.76% of the drug cost. The average number of hospitalization days was 10.77, closely relating to the direct cost. Besides, age and comorbidity also affected the number of hospitalization days. The average health insurance support for each patient was up to 94.46% of the total treatment cost. The results also show that the cost of treatment in Vietnam is lower than some countries in the region and the proportions of the cost components presented in different studies in Vietnam are different. Keywords Direct cost, exacerbation of COPD, E hospital. [1] Ngo Quy Chau, Nguyen Lan Viet, Nguyen Dat Anh, Pham Quang Vinh, Internal Pathology, Medical Publishing House 1 (2018) 42-50 (in Vietnamese).[2] R.A. Pauwels, A.S. Buist, P.M.A. Calverley, C. R. Jenkins, S. Hurd Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 163 (2001) 1256–1276. https://doi.org/10.1164/ajrccm.163.5.2101039[3] https://www.chestnet.org/News/Press-Releases /2014/07/CDC-reports-36-billion-in-annual financial-cost-of-COPD-in-US (15/10/2019)[4] S.D. Sullivan, S.D. Ramsey, T.A. Lee, The economic burden of COPD. Chest 2000 Feb 117(2), 5S-9S.https://journal.chestnet.org/article/S0012-3692(15)52748-7/fulltext[5] Vanfleteren, E.G.W. Lowie, et al Clusters of comorbidities based on validated objective measurements and systemic inflammation in patients with chronic obstructive pulmonary disease American journal of respiratory and critical care medicine 187(7) (2013) 728-735. https://www.atsjournals.org/doi/full/10.1164/rccm.201209-1665oc [6] Doan Quynh Huong Analysis of direct costs of inpatient treatment for EPI in Respiratory Center of Bach Mai Hospital from 2013-2015, 2017 (in Vietnamese).[7] Vu Xuan Phu, Duong Viet Tuan, Nguyen Thu Ha et al., Inpatient treatment costs of patients with chronic obstructive pulmonary disease at central lung hospital, 2009, Journal of Practical Medicine 1 (2012) 51-53 (in Vietnamese).http://yhth.vn/chi-phi-dieu-tri-noi-tru-cua-benh-nhan-benh-phoi-tac-nghen-man-tinh-tai-benh-vien-phoi-trung-uong-nam-2009_t3254.aspx[8] C.S. Rand, M. Nides, M.K. Cowles, R.A. Wise, J. Connett, Long-term metered-dose inhaler adherence in a clinical trial. The lung health study research group. Am J Respir Crit Care Med, Aug 152(2) (1995) 580-8. https://doi.org/10.1164/ajrccm.152.2.7633711[9] Phan Thi Thanh Hoa, Clinical features, clinical and direct treatment costs of patients with chronic obstructive pulmonary disease at Respiratory Center - Bach Mai Hospital Graduation thesis general practitioner, Hanoi Medical University 2013 (in Vietnamese).

The Economic impact of Lower Extremity Amputations in Diabetics. A retrospective study from A Tertiary Care Hospital of Faisalabad, Pakistan

Background: Among the various complications of diabetes, lower-extremity amputation due to diabetic foot is a common problem. In Pakistan, 6-7% of patients with diabetes suffer from diabetic foot ulceration. Objectives: Our primary objective was to explore the frequency of diabetic foot amputations, and the secondary objective was to calculate the economic burden of these preventable surgeries on the health budget of the provincial government. Materials & Methods: It was a retrospective cross-sectional observational study conducted after obtaining approval from the Ethical Review Committee of Allied hospital, Faisalabad Medical University. The data of diabetic foot patients who underwent amputations between July 2017 and December 2017 were retrieved from three Surgical Units (I, II & III), using a purposive sampling technique. All amputations carried out for reasons other than diabetic foot were excluded. The direct medical cost of one diabetic foot amputation was calculated via a local survey of the various private hospitals of Faisalabad. The indirect costs in terms of loss of productivity and disability costs, transport costs, rehabilitation costs were not included in this study. The data were evaluated by using SPSS Version 23. Results: A total of 85 patients were included in our study. The male to female ratio was 2.7 to 1. The mean direct treatment cost for minor amputation was PKR 46926.00 ± 11730.90 ($382.35 ± 95.58), and the mean direct treatment cost for major amputation was PKR 53720.00 ± 12401.24 ($437.71 ± 101.40). Out of 85 amputations, 63 (74%) were major amputations, and the remaining 22 (26%) were minor amputations. The total cost for 63 major amputations was PKR 3,384,360 ($27568.91) and for 22 minor amputation was PKR 1,032,372 ($8409.67). The net cost came out to be PKR 4,416,732 ($35978.59) for all the 85 cases being reported in a tertiary care hospital of Faisalabad for six months. Conclusion: Diabetic foot, a preventable complication of long-term diabetes mellitus, has an economic burden on the hospital budget, which, if adequately addressed via primary prevention programme, can yield not just economical but medical benefits as well.

UNSTABLE ANGINA

Objective: To determine the direct treatment cost of unstable angina (UA) withlow molecular weight heparin (LMWH) in conservative management. Study design: Prospectivestudy. Settings: Government cardiovascular hospital and private tertiary care hospital, Karachi.Study period: One year. Method: All 487 patients with either sex having cardiac history ofischemic heart disease, presenting chest pain diagnosed to have unstable angina admitted inhospital for 2-8 days were recruited and entered in study. The current prospective study wasdesigned to analyze the direct treatment cost of UA with LMWH. Data was collected throughproforma and results were analyzed by SPSS version 20. Results: Results were represented interms of percentages, frequencies and means of cost contribution of LMWH. All costs valuesconverted from Pakistani currency (PKR) into US dollars ($) as per exchange rate of 2014. Lessnumber of prescriptions found for fondaparinux (24.85%) than enoxaparin (70%). The estimatedmean of drug cost particularly observed in three treatment groups of patients who receivedenoxaparin, fondaparinux and dalteparin was $36, $ 15 and $ 47 correspondingly. Moreover,4 days total direct cost of enoxaparin and fondaparinux was $191, $ 84 and 6 days treatmentcosts $ 149 with dalteparin to treat a single case of UA. It has been found that fondaparinuxsignificantly lowers the cost of care in comparison to enoxaparin and dalteparin. Conclusion:Current analysis concluded that in the treatment of unstable angina, fondaparinux found to bea dominant strategy that simultaneously lowers the cost of care in conservative management.