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Kazemi Z, Emamgholipour S, Daroudi R, Yunesian M, Hassanvand MS. Estimation and determinants of direct hospitalisation cost for coronary heart disease in a low-middle-income country: evidence from a nationwide study in Iranian hospitals. BMJ Open 2024; 14:e074711. [PMID: 39117417 PMCID: PMC11407203 DOI: 10.1136/bmjopen-2023-074711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Coronary heart disease (CHD) is the most prevalent type of cardiovascular disease in Iran. This study aims to investigate the estimation and determinants of direct hospitalisation cost for patients with CHD in Iranian hospitals. METHODS We identified patients with CHD in Iran in 2019-2020. Data were gathered from the Iran Health Insurance Organisation information systems and the Ministry of Health and Medical Education. This was a cross-sectional prevalence-based study. Generalised linear models were used to find the determinants of hospitalisation cost for patients with CHD. A total of 86 834 patients suffering from CHD were studied. RESULTS Mean hospitalisation cost per CHD patient was US$382.90±US$500.72 while the mean daily hospitalisation cost per CHD patient was US$89.71±US$89.99. In-hospital mortality of CHD was 2.52%. Hospitalisation accommodation and medications had the highest share of hospitalisation costs (25.59% and 22.63%, respectively). Men spent 1.12 (95% CI 1.11 to 1.13) times more on hospitalisation costs compared with women, and individuals aged 60 to 69 had hospitalisation costs 1.04 (95% CI 1.02 to 1.06) times higher than those in the 0-49 age range. Patients insured by the Iranian Fund have significantly higher costs 1.17 (95% CI 1.14 to 1.19) than the Rural fund. Hospitalisation costs for patients with CHD who received surgery and angiography were significantly 2.36 (95% CI 2.30 to 2.43) times higher than for patients who did not undergo surgery and angiography. CONCLUSION Applying CHD prevention strategies for men and the middle-aged population (50-70 years) is strongly recommended. Prudent use and prescribing of medications will be helpful to reduce hospitalisation cost.
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Affiliation(s)
- Zohreh Kazemi
- Department of Health Information Technology, Ferdows Faculty of Medical Sciences, Birjand University of Medical Sciences, Birjand, Iran (the Islamic Republic of)
- Department of Health Management, policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Sara Emamgholipour
- Department of Health Management, policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Rajabali Daroudi
- Department of Health Management, policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
- National Center for Health Insurance Research, Tehran, Iran (the Islamic Republic of)
| | - Masud Yunesian
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Mohammad Sadegh Hassanvand
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
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Wanjau MN, Kivuti-Bitok LW, Aminde LN, Veerman JL. The health and economic impact and cost effectiveness of interventions for the prevention and control of overweight and obesity in Kenya: a stakeholder engaged modelling study. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2023; 21:69. [PMID: 37735408 PMCID: PMC10512507 DOI: 10.1186/s12962-023-00467-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 08/15/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND The global increase in mean body mass index has resulted in a substantial increase of non-communicable diseases (NCDs), including in many low- and middle-income countries such as Kenya. This paper assesses four interventions for the prevention and control of overweight and obesity in Kenya to determine their potential health and economic impact and cost effectiveness. METHODS We reviewed the literature to identify evidence of effect, determine the intervention costs, disease costs and total healthcare costs. We used a proportional multistate life table model to quantify the potential impacts on health conditions and healthcare costs, modelling the 2019 Kenya population over their remaining lifetime. Considering a health system perspective, two interventions were assessed for cost-effectiveness. In addition, we used the Human Capital Approach to estimate productivity gains. RESULTS Over the lifetime of the 2019 population, impacts were estimated at 203,266 health-adjusted life years (HALYs) (95% uncertainty interval [UI] 163,752 - 249,621) for a 20% tax on sugar-sweetened beverages, 151,718 HALYs (95% UI 55,257 - 250,412) for mandatory kilojoule menu labelling, 3.7 million HALYs (95% UI 2,661,365-4,789,915) for a change in consumption levels related to supermarket food purchase patterns and 13.1 million HALYs (95% UI 11,404,317 - 15,152,341) for a change in national consumption back to the 1975 average levels of energy intake. This translates to 4, 3, 73 and 261 HALYs per 1,000 persons. Lifetime healthcare cost savings were approximately United States Dollar (USD) 0.14 billion (USD 3 per capita), USD 0.08 billion (USD 2 per capita), USD 1.9 billion (USD 38 per capita) and USD 6.2 billion (USD 124 per capita), respectively. Lifetime productivity gains were approximately USD 1.8 billion, USD 1.2 billion, USD 28 billion and USD 92 billion. Both the 20% tax on sugar sweetened beverages and the mandatory kilojoule menu labelling were assessed for cost effectiveness and found dominant (health promoting and cost-saving). CONCLUSION All interventions evaluated yielded substantive health gains and economic benefits and should be considered for implementation in Kenya.
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Affiliation(s)
- Mary Njeri Wanjau
- School of Medicine & Dentistry, Griffith University, Gold Coast campus, Parklands Drive, Southport, Queensland, QLD 4222 Australia
- School of Nursing Sciences, University of Nairobi, P.O. Box 19676-00200, Nairobi, Kenya
| | - Lucy W. Kivuti-Bitok
- School of Medicine & Dentistry, Griffith University, Gold Coast campus, Parklands Drive, Southport, Queensland, QLD 4222 Australia
| | - Leopold N. Aminde
- School of Medicine & Dentistry, Griffith University, Gold Coast campus, Parklands Drive, Southport, Queensland, QLD 4222 Australia
- Non-communicable Disease Unit, Clinical Research Education Networking & Consultancy, Douala, Cameroon
| | - J. Lennert Veerman
- School of Medicine & Dentistry, Griffith University, Gold Coast campus, Parklands Drive, Southport, Queensland, QLD 4222 Australia
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Xie P, Li X, Guo F, Zhang D, Zhang H. Direct medical costs of ischemic heart disease in urban Southern China: a 5-year retrospective analysis of an all-payer health claims database in Guangzhou City. Front Public Health 2023; 11:1146914. [PMID: 37228711 PMCID: PMC10203198 DOI: 10.3389/fpubh.2023.1146914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/11/2023] [Indexed: 05/27/2023] Open
Abstract
Introduction This study aimed to estimate the direct medical costs and out-of-pocket (OOP) expenses associated with inpatient and outpatient care for IHD, based on types of health insurance. Additionally, we sought to identify time trends and factors associated with these costs using an all-payer health claims database among urban patients with IHD in Guangzhou City, Southern China. Methods Data were collected from the Urban Employee-based Basic Medical Insurance (UEBMI) and the Urban Resident-based Basic Medical Insurance (URBMI) administrative claims databases in Guangzhou City from 2008 to 2012. Direct medical costs were estimated in the entire sample and by types of insurance separately. Extended Estimating Equations models were employed to identify the potential factors associated with the direct medical costs including inpatient and outpatient care and OOP expenses. Results The total sample included 58,357 patients with IHD. The average direct medical costs per patient were Chinese Yuan (CNY) 27,136.4 [US dollar (USD) 4,298.8] in 2012. The treatment and surgery fees were the largest contributor to direct medical costs (52.0%). The average direct medical costs of IHD patients insured by UEBMI were significantly higher than those insured by the URBMI [CNY 27,749.0 (USD 4,395.9) vs. CNY 21,057.7(USD 3,335.9), P < 0.05]. The direct medical costs and OOP expenses for all patients increased from 2008 to 2009, and then decreased during the period of 2009-2012. The time trends of direct medical costs between the UEBMI and URBMI patients were different during the period of 2008-2012. The regression analysis indicated that the UEBMI enrollees had higher direct medical costs (P < 0.001) but had lower OOP expenses (P < 0.001) than the URBMI enrollees. Male patients, patients having percutaneous coronary intervention operation and intensive care unit admission, patients treated in secondary hospitals and tertiary hospitals, patients with the LOS of 15-30 days, 30 days and longer had significantly higher direct medical costs and OOP expenses (all P < 0.001). Conclusions The direct medical costs and OOP expenses for patients with IHD in China were found to be high and varied between two medical insurance schemes. The type of insurance was significantly associated with direct medical costs and OOP expenses of IHD.
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Affiliation(s)
- Peixuan Xie
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xuezhu Li
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Feifan Guo
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Donglan Zhang
- Division of Health Services Research, New York University Long Island School of Medicine, Mineola, NY, United States
| | - Hui Zhang
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, China
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Kazemi Z, Emamgholipour Sefiddashti S, Daroudi R, Ghorbani A, Yunesian M, Hassanvand MS, Shahali Z. Estimation and predictors of direct hospitalisation expenses and in-hospital mortality for patients who had a stroke in a low-middle income country: evidence from a nationwide cross-sectional study in Iranian hospitals. BMJ Open 2022; 12:e067573. [PMID: 36523213 PMCID: PMC9748924 DOI: 10.1136/bmjopen-2022-067573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Stroke is the second most prevalent cardiovascular disease in Iran. This study investigates the estimation and predictors of hospitalisation expenses and in-hospital mortality for patients who had a stroke in Iranian hospitals. SETTING Patients who had a stroke in Iran between 2019 and 2020 were identified through the data collected from the Iran Health Insurance Organization and the Ministry of Health and Medical Education. This study is the first to conduct a pervasive, nationwide investigation. DESIGN This is a cross-sectional, prevalence-based study. Generalised linear models and a multiple logistic regression model were used to determine the predictors of hospitalisation expenses and in-hospital mortality for patients who had a stroke. PARTICIPANTS A total of 19 150 patients suffering from stroke were studied. RESULTS Mean hospitalisation expenses per patient who had a stroke in Iran amounted to US$590.91±974.44 (mean±SD). Mean daily hospitalisation expenses per patient who had a stroke were US$55.18±37.89. The in-hospital mortality for patients who had a stroke was 18.80%. Younger people (aged ≤49 years) had significantly higher expenses than older patients. The OR of in-hospital mortality in haemorrhagic stroke was significantly higher by 1.539 times (95% CI, 1.401 to 1.691) compared with ischaemic and unspecified strokes. Compared with patients covered by the rural fund, patients covered by Iranian health insurance had significantly higher costs by 1.14 times (95% CI, 1.186 to 1.097) and 1.319 times (95% CI, 1.099 to 1.582) higher mortality. There were also significant geographical variations in patients who had a stroke's expenses and mortality rates. CONCLUSION Applying cost-effective stroke prevention strategies among the younger population (≤49 years old) is strongly recommended. Migration to universal health insurance can effectively reduce the inequality gap among all insured patients.
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Affiliation(s)
- Zohreh Kazemi
- Department of Health Management and Economics, Tehran University of Medical Sciences, Tehran, Iran
- National Center for Health Insurance Research, Tehran, Iran
| | | | - Rajabali Daroudi
- Department of Health Management and Economics, Tehran University of Medical Sciences, Tehran, Iran
- National Center for Health Insurance Research, Tehran, Iran
| | - Askar Ghorbani
- Department of Neurology, Tehran University of Medical Sciences School of Medicine, Tehran, Iran
| | - Masud Yunesian
- Department of Research Methodology and Data Analysis, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Zahra Shahali
- National Center for Health Insurance Research, Tehran, Iran
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Pérez-Lamela C, Franco I, Falqué E. Impact of High-Pressure Processing on Antioxidant Activity during Storage of Fruits and Fruit Products: A Review. Molecules 2021; 26:5265. [PMID: 34500700 PMCID: PMC8434123 DOI: 10.3390/molecules26175265] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 12/16/2022] Open
Abstract
Fruits and fruit products are an essential part of the human diet. Their health benefits are directly related to their content of valuable bioactive compounds, such as polyphenols, anthocyanins, or vitamins. Heat treatments allow the production of stable and safe products; however, their sensory quality and chemical composition are subject to significant negative changes. The use of emerging non-thermal technologies, such as HPP (High Pressure Processing), has the potential to inactivate the microbial load while exerting minimal effects on the nutritional and organoleptic properties of food products. HPP is an adequate alternative to heat treatments and simultaneously achieves the purposes of preservation and maintenance of freshness characteristics and health benefits of the final products. However, compounds responsible for antioxidant activity can be significantly affected during treatment and storage of HPP-processed products. Therefore, this article reviews the effect of HPP treatment and subsequent storage on the antioxidant activity (oxygen radical absorbance capacity (ORAC) assay), 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging capacity assay, ferric reducing antioxidant power (FRAP) assay, 2,2'-azino-bis-(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) radical scavenging capacity assay or Trolox equivalent antioxidant capacity (TEAC) assay), and on the total phenolic, flavonoid, carotenoid, anthocyanin and vitamin contents of fruits and different processed fruit-based products.
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Affiliation(s)
- Concepción Pérez-Lamela
- Nutrition and Bromatology Group, Department of Analytical and Food Chemistry, Faculty of Sciences, University of Vigo—Ourense Campus, E32004 Ourense, Spain
| | - Inmaculada Franco
- Food Technology Area, Faculty of Sciences, University of Vigo—Ourense Campus, E32004 Ourense, Spain;
| | - Elena Falqué
- Analytical Chemistry Group, Department of Analytical and Food Chemistry, Faculty of Sciences, University of Vigo–Ourense Campus, E32004 Ourense, Spain;
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