Radiation therapy remains the key cost driver of oncology inpatient treatment

DRGKB: a knowledgebase of worldwide diagnosis-related groups' practices for comparison, evaluation and knowledge-guided application

As a prospective payment method, diagnosis-related groups (DRGs)'s implementation has varying effects on different regions and adopt different case classification systems. Our goal is to build a structured public online knowledgebase describing the worldwide practice of DRGs, which includes systematic indicators for DRGs' performance assessment. Therefore, we manually collected the qualified literature from PUBMED and constructed DRGKB website. We divided the evaluation indicators into four categories, including (i) medical service quality; (ii) medical service efficiency; (iii) profitability and sustainability; (iv) case grouping ability. Then we carried out descriptive analysis and comprehensive scoring on outcome measurements performance, improvement strategy and specialty performance. At last, the DRGKB finally contains 297 entries. It was found that DRGs generally have a considerable impact on hospital operations, including average length of stay, medical quality and use of medical resources. At the same time, the current DRGs also have many deficiencies, including insufficient reimbursement rates and the ability to classify complex cases. We analyzed these underperforming parts by domain. In conclusion, this research innovatively constructed a knowledgebase to quantify the practice effects of DRGs, analyzed and visualized the development trends and area performance from a comprehensive perspective. This study provides a data-driven research paradigm for following DRGs-related work along with a proposed DRGs evolution model. Availability and implementation: DRGKB is freely available at http://www.sysbio.org.cn/drgkb/. Database URL: http://www.sysbio.org.cn/drgkb/.

Cost awareness among intensivists in their daily clinical practice: a prospective multicentre study

BACKGROUND

Better cost-awareness is a prerogative in achieving the best benefit/risk/cost ratio in the care. We aimed to assess the cost-awareness of intensivists in their daily clinical practice and to identify factors associated with accurate estimate of cost (50-150% of the real cost).

METHODS

We performed a prospective observational study in seven French ICUs. We compared the estimate of intensivists of the daily costs of caring with the real costs on a given day. The estimates covered five categories (drugs, laboratory tests, imaging modalities, medical devices, and waste) whose sum represented the overall cost.

RESULTS

Of the 234 estimates made by 65 intensivists, 70 (29.9%) were accurate. The median overall cost estimate (€330 [170; 620]) was significantly higher than the real cost (€178 [124; 239], p < 0.001). This overestimation was found in four categories, in particular for waste (€40 [15; 100] vs. €1.1 [0.6; 2.3], p < 0.001). Only the laboratory tests were underestimated (€65 [30; 120] vs. €106 [79; 138], p < 0.001). Being aware of the financial impact of prescriptions was factor associated with accurate estimate (OR: 5.05, 95%CI:1.47-17.4, p = 0.01). However, feeling able to accurately perform estimation was factor negatively associated with accurate estimate (OR: 0.11, 95%CI: 0.02-0.71, p = 0.02).

CONCLUSION

French intensivists have a poor awareness of costs in their daily clinical practice. Raising awareness of the financial impact of prescriptions, and of the cost of laboratory tests and waste are the main areas for improvement that could help achieve the objective of the best care at the best cost.

Current scenario and challenges of clinical pharmacists to implement pharmaceutical care in DRG/DIP payment hospitals in China: a qualitative interview study

Purpose

The Diagnosis-Related Group (DRG) or Diagnosis-Intervention Packet (DIP) payment system, now introduced in China, intends to streamline healthcare billing practices. However, its implications for clinical pharmacists, pivotal stakeholders in the healthcare system, remain inadequately explored. This study sought to assess the perceptions, challenges, and roles of clinical pharmacists in China following the introduction of the DRG or DIP payment system.

Methods

Qualitative interviews were conducted among a sample of clinical pharmacists. Ten semi-structured interviews were conducted, either online or face to face. Thematic analysis was employed to identify key insights and concerns related to their professional landscape under the DRG or DIP system.

Results

Clinical pharmacists exhibited variable awareness levels about the DRG or DIP system. Their roles have undergone shifts, creating a balance between traditional responsibilities and new obligations dictated by the DRG or DIP system. Professional development, particularly concerning health economics and DRG-based or DIP-based patient care, was highlighted as a key need. There were calls for policy support at both healthcare and national levels and a revised, holistic performance assessment system. The demand for more resources, be it in training platforms or personnel, was a recurrent theme.

Conclusion

The DRG or DIP system's introduction in China poses both opportunities and challenges for clinical pharmacists. Addressing awareness gaps, offering robust policy support, ensuring adequate resource allocation, and recognizing the evolving role of pharmacists are crucial for harmoniously integrating the DRG or DIP system into the Chinese healthcare paradigm.

Use of social media for the improvement of radiation safety knowledge among Saudi Arabian radiographers

BACKGROUND

Radiographers have used social media networks for education, research, professional development and other purposes. However, in Saudi Arabia, there are no studies on the use of social media by radiographers. Therefore, the objective of this research was to evaluate the use of social media for the improvement of radiation safety knowledge among Saudi Arabian radiographers.

METHODS

A questionnaire was designed to collect the data from Saudi Arabian radiographers. The questionnaire was created using Google Forms and was sent to 530 radiographers using WhatsApp. In total, 159 participants completed and returned the questionnaire through WhatsApp. The response rate was 30%. Basic descriptive statistics were employed to analyse the data.

RESULTS

Most of the participants (79.9%) thought that social media could be used as a tool for the improvement of radiation safety knowledge. Also, almost half of participants (49.7%) employed social media when they needed to obtain information about radiation protection. Similarly, a majority of respondents (69.2%) used social media when they required information related to radiation safety. In addition, 81.7% of participants observed on video the existing information on radiation safety. Also, 71.7% of them were disposed to expand the use of social media to obtain information for radiation protection in their professional activities.

CONCLUSION

The results indicate that social media can help to improve radiation safety knowledge among Saudi Arabian radiographers. Consequently, participants were willing to increase the use of these tools in their professional work.

Cardiovascular disease trends in Nepal - An analysis of global burden of disease data 2017

Cardiovascular diseases (CVDs) are the leading cause of disease burden globally, disproportionately affecting low and middle-income countries. The continued scarcity of literature on CVDs burden in Nepal has thwarted efforts to develop population-specific prevention and management strategies. This article reports the burden of CVDs in Nepal including, prevalence, incidence, and disability basis as well as trends over the past two decades by age and gender. We used the Institute of Health Metrics and Evaluation's Global Burden of Diseases database on cardiovascular disease from Nepal to describe the most recent data available (2017) and trends by age, gender and year from 1990 to 2017. Data are presented as percentages or as rates per 100,000 population. In 2017, CVDs contributed to 26·9% of total deaths and 12·8% of total DALYs in Nepal. Ischemic heart disease was the predominant CVDs, contributing 16·4% to total deaths and 7·5% to total DALYs. Cardiovascular disease incidence and mortality rates have increased from 1990 to 2017, with the burden greater among males and among older age groups. The leading risk factors for CVDs were determined to be high systolic blood pressure, high low density lipoprotein cholesterol, smoking, air pollution, a diet low in whole grains, and a diet low in fruit. CVDs are a major public health problem in Nepal contributing to the high DALYs with unacceptable numbers of premature deaths. There is an urgent need to address the increasing burden of CVDs and their associated risk factors, particularly high blood pressure, body mass index and unhealthy diet.

Assessment of Cancer Care Costs in Disease-Specific Cancer Care Pathways

In view of an efficient use of the Italian National Health Service-funded healthcare resources, a novel data-processing strategy combining information from multiple sources was developed in a regional cancer network of northern Italy. The goal was to calculate the annual overall cost of care pathways of six disease groups in 10,486 patients. The evaluation was conceived as a population-based cost description from the perspective of the Italian National Health Service. Costs occurred during a defined time period for a cross-section of patients at varying stages of their disease were measured. The total cancer care cost was €81,170,121 (11.1% of total local health expenditure), with a cost per patient of €7741.17 and a cost per capita of €204.62. Surgical, inpatient and day-hospital medical admissions, radiotherapy, drugs, outpatient care, emergency admissions, and home and hospice care accounted for 21.2%, 24.1%, 6.2%, 28.2%, 14.0%, 0.9%, and 5.4% of the total cost, respectively. The highest cost items included drugs (cost per capita, €22.95; 11.2% of total cost) and medical admissions (€14.51; 7.1%) for blood cancer, and surgical (€14.56; 7.1%) and medical admissions (€13.60; 6.6%) for gastrointestinal cancer. The information extracted allows multidisciplinary cancer care teams to be more aware of the costs of their clinical decisions.

Oncological Diseases and Social Costs Considerations on Undertaken Health Policy Interventions

The growing incidence and prevalence of civilization diseases is prompting national and transnational entities to seek instruments that would reverse epidemiological trends. Not without significance is the need to design such solutions that are going to provide an improved relation between the costs incurred to maintain health or recovery and the profit for citizens of continuing to function in good health. In its strategic documents, the European Union indicates the most important development goals in each financial perspective and the tools necessary to achieve them. In the Europe 2020 strategy, a cohesion policy was indicated as an important tool for the implementation of development goals, focusing on supporting activities leading to the equalisation of economic and social conditions in all regions of EU countries. The implementation of one of the three basic priorities of the Europe 2020 strategy, which is inclusive growth-supporting an economy with a high level of employment and ensuring social and territorial cohesion-assumes, among others, that in 2020, the population at risk of poverty and social exclusion will decrease by 20 million and that the employment rate in the EU will increase to 75%. Meeting the objectives will not be possible without a holistic coordinated approach to healthcare at the national and regional level in accordance with the principle of "health in all policies". It also requires the involvement of various sources of financing, including structural funds. The EU's prioritisation of the problems related to ensuring decent conditions for achieving health resulted in the mobilisation of structural funds for actions taken in the healthcare sector. Of particular importance are those actions which are taken to prevent, alleviate, and prevent oncological diseases. An additional contribution to undertaking actions aimed at preventing oncological diseases are the high and often neglected social costs incurred by societies. The goal of the article was to identify and evaluate actions taken in this area in Poland. It was achieved by analysing the literature on the subject and statistical data, and conducting induction based on the above-mentioned sources.

Macroeconomic environment and insurance-mortality relationship: An analysis of gender-based disparity among non-elderly adult patients of melanoma and lung cancer

OBJECTIVE

Cancer patients exhibit disparity in mortality risks across demographic divisions as well as insurance groups. The effects of macroeconomic environment also vary for such strata. This study analyses the gaps between mortality risks for male and female cancer patients with and without insurance and examines how such gaps transform over time with macroeconomic shifts.

METHODS

Demographic, clinical and treatment records of 45,750 melanoma and 91,157 lung cancer patients diagnosed in 2007-2009 and 2011-2013 were extracted from Surveillance, Epidemiology and End Results (SEER) database. Kaplan-Meier test was applied to ascertain survival probability of each insurance group, while Cox proportional hazard model was used to assess relative mortality risk for Medicaid and uninsured patients, for the whole data as well as separately for both time periods and genders.

RESULTS

Both the hazard ratios and change thereof over time are greater for female patients without insurance, than for male patients. More than any insurance-gender subgroup, uninsured female patients of melanoma have much increased hazard ratios, from 1.41 [95% confidence interval (CI), 1.04-1.92] to 2.22 [95% CI, 1.67-2.94].

CONCLUSION

Despite diagnostic improvements and technology advancements, the adverse effects of macroeconomic crisis are associated with increased relative mortality risks for cancer patients without insurance, more for women than men.

Dynamics of Health Care Financing and Spending in Serbia in the XXI Century

Serbia is an upper-middle income Eastern European economy. It has inherited system of health provision and financing, which is a mixture of Soviet Semashko and German Bismarck models. So far, literature evidence on long-term trends in health spending remains scarce on this region. Observational descriptive approach was utilized relying on nationwide aggregate data reported by the Republic Health Insurance Fund (RHIF) and the Government of Serbia to the WHO office. Consecutively, the WHO Global Health Expenditure Database was used. Long-term trends were extrapolated on existing data and underlying differences were analyzed and explained. The insight was provided across two distinctively different periods within 2000-2016. The first period lasted from 2000 till 2008 (the beginning of global recession triggered by Lehman Brothers' bankruptcy). This was a period of strong upward growth in ability to invest in health care. Spending grew significantly in terms of GDP share, national and per capita reported expenditures. During the second period (2009-2016), after the beginning of worldwide economic crisis, Serbia was affected in a way that its health expenditure growth in PPP terms slowed down effectively fluctuating around plateau values from 2014 to 2016. Serbia health spending showed promising signs of steady growth in its ability to invest in health care. Consolidation marked most of the past decade with certain growth rates in recent years (2017-2019), which were not captured in these official records. The future national strategy should be devised to take into account accelerated population aging as major driver of health spending.

Patient-based cost-effectiveness analysis of FOLFIRI versus FOLFOX7 for advanced gastric adenocarcinoma in China: A 4-year prospective randomised phase II study

BACKGROUND

Using data from the 4-year follow-up results of an open, randomised, phase II study, this patient-based cost-effectiveness analysis compares mFOLFIRI (irinotecan, 5-fluorouracil and leucovorin, the IRI arm) with mFOLFOX7 (oxaliplatin, 5-fluorouracil and leucovorin, the OXA arm) as first-line treatments in patients with locally advanced gastric adenocarcinoma (GC).

METHODS

A Markov model was created based on previous results reported at the 2016 Gastrointestinal Cancers Symposium to evaluate mFOLFIRI and mFOLFOX7 for advanced GC quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were examined as the primary outcomes.

RESULTS

For the evaluable 128 patients, treatment efficacy was 0.59 QALYs for the IRI arm and 0.70 QALYs for the OXA arm, with a total cost of $13,861.34 for the IRI arm and $14,127.30 for the OXA arm. Hence, the ICER was $2,417.82 per QALY the OXA arm, which was below the threshold of 3 × per capita GDP of China. For subgroup analysis of those receiving mFOLFIRI followed by mFOLFOX7 (the IRI arm) and the reverse (the OXA arm), the OXA arm gained 0.44 more QALYs than the IRI arm with a total cost of $28,890.09 for the IRI arm and $31,147.30 for the OXA arm. However, the cost per QALY was also lower for the OXA arm than for the IRI arm, and the cost per QALY gained was $5,129.55 (below the Chinese WTP).

CONCLUSION

mFOLFOX7 is a very high cost-effective alternative as the first-line treatment for those patients with advanced GC compared with mFOLFIRI.

Model-based cost-effectiveness analysis of external beam radiation therapy for the treatment of localized prostate cancer: a systematic review

Background

External beam radiotherapy is the recommended but expensive treatment option for localized prostate cancer. Prostate cancer is the most common cancer in men worldwide. A cost-effectiveness study is needed given the excessive cost of radiotherapy treatment and the high prevalence of prostate cancer. The aim of this systematic review was to assess and identify studies that examined model based economic evaluation of external beam radiation therapy for the treatment of localized prostate cancer.

Methods

A systematic review of the published literature was conducted through MEDLINE, NHS EED (NHS Economic Evaluation Database), and Cochrane databases with a specific search strategy. The literatures were searched according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. At first 1046 citations were identified. The extracted files were imported into the Rayyan systematic review site for inclusion or exclusion based on the defined criteria. Studies included in this review were articles published between 2003 and 2017, and that conducted full-economic evaluations of the modality of external beam radiotherapy for the treatment of localized prostate cancer.

Results

There were 12 studies that satisfied the inclusion and exclusion criteria. Seven studies compared intensity modulated radiation therapy (IMRT) with three-dimensional conformal radiation therapy (3D-CRT), two compared IMRT with stereotactic body radiation therapy (SBRT) another two-paper assessed IMRT with proton beam therapy (PBT). One paper compared the three external-beam radio therapy options of IMRT, SBRT and PBT. Most of the studies were originated from the US and analyzed the cost data from the payer’s perspective. Most studies were supported that IMRT was cost effective when it compared with 3D-CRT. Compared with IMRT, SBRT was found to be cost-effective.

Conclusions

There are limited number of studies exist on the cost effectiveness of radiation therapy options for the treatment of localize prostate cancer across Europe. Most studies are originated from the US Medicare payer Perspective. Further research is need that investigate the cost effectiveness of these radiation therapy options from the societal perspective in Europe.

Electronic supplementary material

The online version of this article (10.1186/s12962-019-0178-3) contains supplementary material, which is available to authorized users.

Cost-effectiveness of colorectal cancer screening in Ukraine

Background

Colorectal cancer is one of the most common cancers worldwide and is associated with high mortality when detected at a later stage. There is a paucity of studies from low and middle income countries to support the cost-effectiveness of colorectal cancer screening. We aim to analyze the cost-effectiveness of colorectal cancer screening compared to no screening in Ukraine, a lower-middle income country.

Methods

We developed a deterministic Markov cohort model to assess the cost-effectiveness of three colorectal cancer screening strategies [fecal occult blood test (FOBT) every year, flexible sigmoidoscopy with FOBT every 5 years, and colonoscopy every 10 years] compared to no screening. We modeled outcomes in terms of cost per quality-adjusted life-years (QALYs) over a lifetime time horizon. We performed sensitivity analyses on treatment adherence, test characteristics and costs. Analyses were conducted from the perspective of the Ministry of Health of Ukraine.

Results

The base-case lifetime cost-effectiveness analysis showed that all three screening strategies were cost saving compared to no screening, and among the three strategies, colonoscopy every 10 years was the dominant strategy compared to no screening with standard adherence to treatment. When decreased adherence to treatment was modeled, colonoscopy every 10 years was the most cost-effective strategy with an incremental cost-effectiveness ratio of $843 per QALY compared with no screening.

Conclusion

Our findings indicate that colorectal cancer screening can save money and improve health compared to no screening in Ukraine. Colonoscopy every 10 years is superior to the other screening modalities evaluated in this study. This knowledge can be used to concentrate efforts on developing a national screening program in Ukraine.

Brain metastases in non-small cell lung cancer patients on epidermal growth factor receptor tyrosine kinase inhibitors: symptom and economic burden

OBJECTIVE

This study describes the symptom and economic burden associated with brain metastases (BM) in patients with non-small cell lung cancer (NSCLC) receiving epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (EGFR-TKIs).

METHODS

This retrospective study included adults with ≥2 medical claims, within 90 days, for lung cancer and ≥1 administration of EGFR-TKIs. Based on ICD-9 codes, patients were stratified into cohorts by type of metastases (BM, other metastases [OM], or no metastases [NM]), and by when the metastasis diagnosis occurred (synchronous or asynchronous).

RESULTS

The population (synchronous BM [SBM] = 24, synchronous OM [SOM] = 23, asynchronous BM [ASBM] = 15, asynchronous OM [ASOM] = 49, NM = 85) was mostly female (57%), average age 69 years (SD = 11). SBM patients experienced more fatigue and nausea/vomiting compared with SOM and NM patients and more headaches and loss of appetite than NM patients. ASBM was associated with more fatigue, nausea/vomiting, headaches, pain/numbness, altered mental status, and seizures than NM, and more headaches and pain/numbness than ASOM. SBM patients experienced a greater increase in per-member-per-month all-cause total healthcare costs after diagnosis ($20,301) vs SOM ($9,131, p = .001) and NM ($2,493, p = .001). ASBM's cost increase between baseline and follow-up ($7,867) did not differ from ASOM's ($4,947, p = .195); both were larger than NM ($2,493, p = .001 and p = .009, respectively).

LIMITATIONS

EGFR mutation status was inferred based on EGFR-TKI treatment, not by molecular testing. Patients were from US commercial insurance plans; results may not be generalizable to other populations.

CONCLUSIONS

Among patients with EGFR-TKI-treated NSCLC, patients with BM experienced more symptoms and, when diagnosed synchronously, had significant increases in total medical costs vs patients with OM and NM. Therapeutic options with central nervous system activity may offer advantages in symptomatology and costs in EGFR-mutated patients with BM.

Possible Uses of Data from Hospital Discharge Reports

Almost all countries in the world keep some form of hospital discharge report (HDR). Although there are many variations, every report contains such data as patient demographics, the main cause of hospitalization, comorbidities, the length of stay in hospital and outcome. The advantages of using data obtained from HDRs are numerous: The data from HDRs are already collected in a designated centre and thus easily available and relatively cheap; HDRs contain information for many previous years; they are sometimes more reliable than data obtained through any other method; and finally, they provide a large and representative database. HDRs databases can be connected with other databases using a unified patient identification number. The limitations of using data obtained through HDRs are as follows: inconsistencies in defining and coding diagnoses and applied procedures, common underestimations of comorbidity, limited possible applications in specific studies and partial coverage of inpatient institutions. The prediction that in the future, a growing number of diagnostic and treatment procedures will be performed on an outpatient basis will also limit the use of HDRs. When electronic recordkeeping becomes a practice, we may assume that these data will no longer be needed. There is no perfect model for collection and processing data regarding hospitalized patients. HDRs, with their advantages and disadvantages, currently represent the best way to perceive the size, type, quality and efficiency of the health care services provided to patients at the secondary and tertiary level.

Within the triangle of healthcare legacies: comparing the performance of South-Eastern European health systems

OBJECTIVE

Inter-regional comparison of health-reform outcomes in south-eastern Europe (SEE).

METHODS

Macro-indicators were obtained from the WHO Health for All Database. Inter-regional comparison among post-Semashko, former Yugoslavia, and prior-1989-free-market SEE economies was conducted.

RESULTS

United Nations Development Program Human Development Index growth was strongest among prior-free-market SEE, followed by former Yugoslavia and post-Semashko. Policy cuts to hospital beds and nursing-staff capacities were highest in post-Semashko. Physician density increased the most in prior-free-market SEE. Length of hospital stay was reduced in most countries; frequency of outpatient visits and inpatient discharges doubled in prior-free-market SEE. Fertility rates fell for one third in Post-Semashko and prior-free-market SEE. Crude death rates slightly decreased in prior-free-market-SEE and post-Semashko, while growing in the former Yugoslavia region. Life expectancy increased by 4 years on average in all regions; prior-free-market SEE achieving the highest longevity. Childhood and maternal mortality rates decreased throughout SEE, while post-Semashko countries recorded the most progress.

CONCLUSIONS

Significant differences in healthcare resources and outcomes were observed among three historical health-policy legacies in south-eastern Europe. These different routes towards common goals created a golden opportunity for these economies to learn from each other.

Disability, Work Absenteeism, Sickness Benefits, and Cancer in Selected European OECD Countries-Forecasts to 2020

Background

Disability either due to illness, aging, or both causes remains an essential contributor shaping European labor markets. Ability of modern day welfare states to compensate an impaired work ability and absenteeism arising from incapacity is very diverse. The aims of this study were to establish and explain intercountry differences among selected European OECD countries and to provide forecasts of future work absenteeism and expenditures on wage replacement benefits.

Methods

Two major public registries, European health for all database and Organization for Economic Co-operation and Development database (OECD Health Data), were coupled to form a joint database on 12 core indicators. These were related to disability, work absenteeism, and sickness benefits in European OECD countries. Time horizon 1989–2013 was observed. Forecasting analysis was done on mean values of all data for each single variable for all observed countries in a single year. Trends were predicted on a selected time horizon based on the mean value, in our case, 7 years up to 2020. For this purpose, ARIMA prediction model was applied, and its significance was assessed using Ljung–Box Q test.

Results

Our forecasts based on ARIMA modeling of available data indicate that up to 2020, most European countries will experience downfall of absenteeism from work due to illness. The number of citizens receiving social/disability benefits and the number being compensated due to health-related absence from work will decline. As opposed to these trends, cancer morbidity may become the top ranked disability driver as hospital discharge diagnoses. Concerning development is the anticipated bold growth of hospital discharge frequencies due to cancer across the region. This effectively means that part of these savings on social support expenditure shall effectively be spent to combat strong cancer morbidity as the major driver of disability.

Conclusion

We have clearly growing work load for the national health systems attributable to the clinical oncology acting as the major disability contributor. This effectively means that large share of these savings on public expenditure shall effectively be spent to combat strong cancer morbidity. On another side, we have all signs of falling societal responsibility toward the citizens suffering from diverse kinds of incapacity or impaired working ability and independence. Citizens suffering from any of these causes are likely to experience progressively less social support and publicly funded care and work support compared to the golden welfare era of previous decades.

The New and Old Europe: East-West Split in Pharmaceutical Spending

HIGHLIGHTS

Since the geopolitical developments of 1989, former centrally planned economies of Eastern Europe followed distinctively different pathways in national pharmaceutical expenditure evolution as compared to their free market Western European counterparts.

Long term spending on pharmaceuticals expressed as percentage of total health expenditure was falling in free market economies as of 1989. Back in early 1990s it was at higher levels in transitional Eastern European countries and actually continued to grow further.

Public financing share of total pharmaceutical expenditure was steadily falling in most Central and Eastern European countries over the recent few decades. Opposed scenario were EU-15 countries which successfully increased their public funding of prescription medicines for the sake of their citizens.

Pace of annual increase in per capita spending on medicines in PPP terms, was at least 20% faster in Eastern Europe compared to their Western counterparts. During the same years, CEE region was expanding their pharmaceuticals share of health spending in eight fold faster annual rate compared to the EU 15.

Private and out-of-pocket expenditure became dominant in former socialist countries. Affordability issues coupled with growing income inequality in transitional economies will present a serious challenge to equitable provision and sustainable financing of pharmaceuticals in the long run.

Review of Diagnosis-Related Group-Based Financing of Hospital Care

Since the 1990s, diagnosis-related group (DRG)-based payment systems were gradually introduced in many countries. The main design characteristics of a DRG-based payment system are an exhaustive patient case classification system (ie, the system of diagnosis-related groupings) and the payment formula, which is based on the base rate multiplied by a relative cost weight specific for each DRG. Cases within the same DRG code group are expected to undergo similar clinical evolution. Consecutively, they should incur the costs of diagnostics and treatment within a predefined scale. Such predictability was proven in a number of cost-of-illness studies conducted on major prosperity diseases alongside clinical trials on efficiency. This was the case with risky pregnancies, chronic obstructive pulmonary disease, diabetes, depression, alcohol addiction, hepatitis, and cancer. This article presents experience of introduced DRG-based payments in countries of western and eastern Europe, Scandinavia, United States, Canada, and Australia. This article presents the results of few selected reviews and systematic reviews of the following evidence: published reports on health system reforms by World Health Organization, World Bank, Organization for Economic Co-operation and Development, Canadian Institute for Health Information, Canadian Health Services Research Foundation, and Centre for Health Economics University of York. Diverse payment systems have different strengths and weaknesses in relation to the various objectives. The advantages of the DRG payment system are reflected in the increased efficiency and transparency and reduced average length of stay. The disadvantage of DRG is creating financial incentives toward earlier hospital discharges. Occasionally, such polices are not in full accordance with the clinical benefit priorities.

Current Trends and Emerging Future of Indocyanine Green Usage in Surgery and Oncology: An Update

BACKGROUND

Indocyanine green (ICG) is a widely available dye of clinical importance that has been used for more than 50 years. Near-infrared (NIR) ICG fluorescence imaging has found a niche in cancer care since 2005, and was reviewed in 2011. There is a need for a comprehensive update and we aim to provide this through a review of the most recent literature.

METHODS

A systematic review of the literature using PubMed, EMBASE, and MEDLINE databases of articles published from 2000 to June 2015 evaluated topics pertinent to NIR fluorescence imaging with ICG in the diagnosis and surgical treatment of cancer. Articles previously referenced in a 2011 review and a 2015 meta-analysis were excluded, while articles that referenced future directions and economics were included in this current review.

RESULTS

Since 2011, the literature has grown exponentially, with significant advances at the molecular level. Significant findings from 89 select articles and 10 reviews, most of which were published between 2011 and 2015, are summarized. Preclinical studies are currently underway investigating tumor-specific fluorescence and targeted therapeutic delivery. The potential for ICG exists at every level of cancer care, from diagnosis to surveillance.

CONCLUSION

The indications, applications, and potential for ICG have grown exponentially in the past decade; an updated review of the literature is overdue and we present the most comprehensive review to date.

Five-year survival and costs of care in metastatic colorectal cancer: conventional versus monoclonal antibody-based treatment protocols

AIM

To evaluate the costs and survival estimates of metastatic colorectal carcinoma patients treated with conventional cytostatic protocols and adjuvant monoclonal antibodies (mAbs).

METHODS

Retrospective randomized case series and cost-of-illness analysis was used. Metastatic colorectal carcinoma cases (62) were randomly selected from the archive of the largest university military hospital in Southeastern Europe.

RESULTS

A 6-month longer survival was attributed to mAbs (p = 0.581). Conventional protocols incurred € 5137 (95% CI: € 3758-€ 6517) versus € 22,113 (95% CI: € 16,201-€ 28,025) total direct medical costs in mAb-based group. ICER of € 32,108 per life year gained attributable to mAbs three-fold exceeded informal willingness to pay threshold of Serbia.

CONCLUSION

mAbs adjuvant protocols had modest positive impact on 5-year survival rates. Costs were driven by targeted biologicals, but significantly higher costs of care were recorded in mAb-treated group in other domains, as well. More selective prescription and reimbursement criteria should be applied to increase cost-effectiveness of targeted oncology agents.