Pharmacoeconomic Aspects of Treating Hemorrhoidal Disease - Cost of Illness Study Based on Data from Balkan Country with Recent History of Social and Economic Transition

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MO519THE COST OF CHRONIC KIDNEY DISEASE BEFORE RENAL REPLACEMENT THERAPY IN MOROCCO: A COST OF ILLNESS STUDY

Background and Aims Chronic kidney disease (CKD) is a leading public health problem in Morocco, its consequences and costs have implications for public health policy. The present study aimed to estimate the social cost of CKD before the start of renal replacement therapy in a Moroccan region. Method A cross-sectional cost of illness study, using bottom-up approach was performed at the department of nephrology in university hospital of Fez during 2020, among stages 3 to 5 CKD patients, followed up for at least one-year. The analyzed costs include the following annual expenditures: hospitalizations, outpatient visits, day care hospital, drugs, laboratory tests, imaging, and medical specialized acts. Non-medical costs such as transportation and indirect costs like loss of productivity were also assessed. Determinants of CKD cost were identified by univariate analysis using t test, ANOVA or non-parametric tests, p < 0.05 is the level of statistical significance. Results Eighty-eight patients were included (63.6% women, mean age: 61.8±14.0 years), 76.1% were on CKD stage 4 or 5. The estimated annual social cost of CKD was 2231,12 US$ (95% CI, 1676,09-2793,93 US$). The direct cost accounted for 99,5% (direct medical cost: 91,2%, direct non-medical cost: 8,3%), and the indirect cost accounted for 0,5 % of the social cost. Hospitalizations, diagnosis and treatments represented the main expenses of the direct medical cost (32,2%, 29,7%, 32,2% respectively). The social cost components were not significantly different between CKD stages. Conclusion The cost of CKD in its early stages still lower than the cost of renal replacement therapy, which brings the light on the necessity of secondary prevention of CKD to postpone or prevent the progression toward ESRD.

Cutaneous melanoma: cost of illness under Brazilian health system perspectives

Background The landscape of cutaneous melanoma (CM) diagnosis, staging, prognosis, and treatment has undergone fundamental changes in the past decade. While the benefits of new health resources are recognized, there is a distinct lack of accurate cost-of-illness information to aid healthcare decision makers. Methods The cost-of-illness study for CM was conducted from the perspective of two health systems in Brazil: the public health system (Unified Health System, SUS) and the private health system (Health Management Organization, HMO). The study considered the direct medical cost in a bottom-up analysis, using melanoma incidence, knowledge of the disease’s progression, and the overall survival rates. The executional costs for the complete healthcare delivery cycle were investigated considering different disease stages and possible clinical course variations. The structural cost was assessed qualitatively considering the health value chain in Brazil. Results CM represents a critical financial burden in Brazil, and the cost of illness varied according to the health system and by stage at diagnosis. HMO patient costs are approximately 10-fold and 90-fold more than a SUS patient in the early-stage and advanced disease, respectively. Overall, spending on advanced disease patients can be up to 34-fold (SUS) or 270-fold (HMO) higher than that required for the early-stage disease. Given the massive amount of resources spent by the SUS and HMO, significant efforts must be made to improve the health value chain to deliver the right mix of medical care goods and services using available resources. Conclusion The cost-of-illness study for CM has the potential to inform policymakers and decision-makers regarding the economic burden that melanoma impose on a society in terms of the use of health care services, assisting them in making projections of future health care costs and resource allocation decisions. We believe that cost-of-illness analysis from a strategic perspective could be of help in assessing executional costs and be used to support the change in structural costs required for long-term strategies related to the health value chain.