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Pannu S, Exline MC, Bednash JS, Englert JA, Diaz P, Bartlett A, Brock G, Wu Q, Davis IC, Crouser ED. SCARLET (Supplemental Citicoline Administration to Reduce Lung injury Efficacy Trial): study protocol for a single-site, double-blinded, placebo-controlled, and randomized Phase 1/2 trial of i.v. citicoline (CDP-choline) in hospitalized SARS CoV-2-infected patients with hypoxemic acute respiratory failure. Trials 2024; 25:328. [PMID: 38760804 DOI: 10.1186/s13063-024-08155-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 05/07/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND The SARS CoV-2 pandemic has resulted in more than 1.1 million deaths in the USA alone. Therapeutic options for critically ill patients with COVID-19 are limited. Prior studies showed that post-infection treatment of influenza A virus-infected mice with the liponucleotide CDP-choline, which is an essential precursor for de novo phosphatidylcholine synthesis, improved gas exchange and reduced pulmonary inflammation without altering viral replication. In unpublished studies, we found that treatment of SARS CoV-2-infected K18-hACE2-transgenic mice with CDP-choline prevented development of hypoxemia. We hypothesize that administration of citicoline (the pharmaceutical form of CDP-choline) will be safe in hospitalized SARS CoV-2-infected patients with hypoxemic acute respiratory failure (HARF) and that we will obtain preliminary evidence of clinical benefit to support a larger Phase 3 trial using one or more citicoline doses. METHODS We will conduct a single-site, double-blinded, placebo-controlled, and randomized Phase 1/2 dose-ranging and safety study of Somazina® citicoline solution for injection in consented adults of any sex, gender, age, or ethnicity hospitalized for SARS CoV-2-associated HARF. The trial is named "SCARLET" (Supplemental Citicoline Administration to Reduce Lung injury Efficacy Trial). We hypothesize that SCARLET will show that i.v. citicoline is safe at one or more of three doses (0.5, 2.5, or 5 mg/kg, every 12 h for 5 days) in hospitalized SARS CoV-2-infected patients with HARF (20 per dose) and provide preliminary evidence that i.v. citicoline improves pulmonary outcomes in this population. The primary efficacy outcome will be the SpO2:FiO2 ratio on study day 3. Exploratory outcomes include Sequential Organ Failure Assessment (SOFA) scores, dead space ventilation index, and lung compliance. Citicoline effects on a panel of COVID-relevant lung and blood biomarkers will also be determined. DISCUSSION Citicoline has many characteristics that would be advantageous to any candidate COVID-19 therapeutic, including safety, low-cost, favorable chemical characteristics, and potentially pathogen-agnostic efficacy. Successful demonstration that citicoline is beneficial in severely ill patients with SARS CoV-2-induced HARF could transform management of severely ill COVID patients. TRIAL REGISTRATION The trial was registered at www. CLINICALTRIALS gov on 5/31/2023 (NCT05881135). TRIAL STATUS Currently enrolling.
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Affiliation(s)
- Sonal Pannu
- Division of Pulmonary, Critical Care and Sleep Medicine of the Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Matthew C Exline
- Division of Pulmonary, Critical Care and Sleep Medicine of the Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Joseph S Bednash
- Division of Pulmonary, Critical Care and Sleep Medicine of the Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Joshua A Englert
- Division of Pulmonary, Critical Care and Sleep Medicine of the Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Philip Diaz
- Division of Pulmonary, Critical Care and Sleep Medicine of the Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Amy Bartlett
- Center for Clinical and Translational Sciences, The Ohio State University, Columbus, OH, USA
| | - Guy Brock
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - Qing Wu
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - Ian C Davis
- Department of Veterinary Biosciences, The Ohio State University, Columbus, OH, USA.
| | - Elliott D Crouser
- Division of Pulmonary, Critical Care and Sleep Medicine of the Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
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Chen M, Yang J, Hou H, Zheng B, Xia S, Wang Y, Yu J, Wu G, Sun H, Jia X, Ning H, Chang H, Zhang X, Yuan Y, Wang Z. Analysis of factors influencing hospitalization cost of patients with distal radius fractures: an empirical study based on public traditional Chinese medicine hospitals in two cities, China. BMC Health Serv Res 2024; 24:605. [PMID: 38720277 PMCID: PMC11080218 DOI: 10.1186/s12913-024-10953-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/04/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Distal radius fractures (DRFs) have become a public health problem for all countries, bringing a heavier economic burden of disease globally, with China's disease economic burden being even more acute due to the trend of an aging population. This study aimed to explore the influencing factors of hospitalization cost of patients with DRFs in traditional Chinese medicine (TCMa) hospitals to provide a scientific basis for controlling hospitalization cost. METHODS With 1306 cases of DRFs patients hospitalized in 15 public TCMa hospitals in two cities of Gansu Province in China from January 2017 to 2022 as the study object, the influencing factors of hospitalization cost were studied in depth gradually through univariate analysis, multiple linear regression, and path model. RESULTS Hospitalization cost of patients with DRFs is mainly affected by the length of stay, surgery and operation, hospital levels, payment methods of medical insurance, use of TCMa preparations, complications and comorbidities, and clinical pathways. The length of stay is the most critical factor influencing the hospitalization cost, and the longer the length of stay, the higher the hospitalization cost. CONCLUSIONS TCMa hospitals should actively take advantage of TCMb diagnostic modalities and therapeutic methods to ensure the efficacy of treatment and effectively reduce the length of stay at the same time, to lower hospitalization cost. It is also necessary to further deepen the reform of the medical insurance payment methods and strengthen the construction of the hierarchical diagnosis and treatment system, to make the patients receive reasonable reimbursement for medical expenses, thus effectively alleviating the economic burden of the disease in the patients with DRFs.
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Affiliation(s)
- Mengen Chen
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102400, China
- School of Management, Beijing University of Chinese Medicine, Beijing, 102400, China
| | - Jingyu Yang
- School of Health Management, Gansu University of Chinese Medicine, Lanzhou, 730000, China
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Haojia Hou
- School of Public Health, Gansu University of Chinese Medicine, Lanzhou, 730000, China
| | - Baozhu Zheng
- School of Stomatology, Capital Medical University, Beijing, 100050, China
| | - Shiji Xia
- School of Management, Beijing University of Chinese Medicine, Beijing, 102400, China
| | - Yuhan Wang
- School of Management, Beijing University of Chinese Medicine, Beijing, 102400, China
| | - Jing Yu
- School of Management, Beijing University of Chinese Medicine, Beijing, 102400, China
| | - Guoping Wu
- School of Management, Beijing University of Chinese Medicine, Beijing, 102400, China
| | - Henong Sun
- School of Management, Beijing University of Chinese Medicine, Beijing, 102400, China
| | - Xuan Jia
- School of Management, Beijing University of Chinese Medicine, Beijing, 102400, China
| | - Hao Ning
- School of Management, Beijing University of Chinese Medicine, Beijing, 102400, China
| | - Hui Chang
- School of Management, Beijing University of Chinese Medicine, Beijing, 102400, China
| | - Xiaoxi Zhang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102400, China
- School of Management, Beijing University of Chinese Medicine, Beijing, 102400, China
- Guang'anmen Hospital, China Academy of Chinese Medicine Sciences, Beijing, 100053, China
| | - Youshu Yuan
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102400, China
- School of Management, Beijing University of Chinese Medicine, Beijing, 102400, China
| | - Zhiwei Wang
- School of Management, Beijing University of Chinese Medicine, Beijing, 102400, China.
- National Institute of Chinese Medicine Development and Strategy, Beijing, 102400, China.
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Abdow VP, Marable JK, Moore ES. A Qualitative Study of Factors Influencing Hospital Participation in the Healthcare Equality Index. J Healthc Qual 2024; 46:177-187. [PMID: 38214608 DOI: 10.1097/jhq.0000000000000426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
ABSTRACT Gender and sexual minority individuals experience higher rates of mistreatment and discrimination in healthcare compared with their non-lesbian, gay, bisexual, transgender, queer, and other nonheterosexual (LGBTQ+) peers. The Healthcare Equality Index (HEI) aims to create more inclusive environments and to provide metrics for quality improvement. Currently, only one adult hospital in the District of Columbia has earned the highest recognition from the HEI. Our institution is part of the same regional health system as this hospital, yet has never been evaluated by the HEI. This study explores the knowledge, attitudes, and perceptions surrounding the HEI at our institution to assess the feasibility of its participation. During the study period of July 2021 to June 2022, a total of 12 physicians, administrators, and educators from both hospitals and our affiliated school of medicine were interviewed. All participants expressed support after HEI requirements and improving inclusivity for LGBTQ+ patients. Participants at the other hospital cited unanimous support amongst hospital administrators as key for successful HEI implementation. Participants also mentioned cost, staff shortages, and the school of medicine's religious affiliation as potential barriers to this goal. Ultimately, hospital implementation of HEI guidelines is feasible despite shifting institutional priorities and resource limitations through greater stakeholder buy-in and streamlining a systemwide approach.
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Muhanga M, Jesse A, Ngowi E. Community responses to corona virus disease (COVID-19) in Africa in the face of "Infodemic": A scoping review. Parasite Epidemiol Control 2024; 25:e00345. [PMID: 38463547 PMCID: PMC10924126 DOI: 10.1016/j.parepi.2024.e00345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 01/21/2024] [Accepted: 02/26/2024] [Indexed: 03/12/2024] Open
Abstract
Globally, Corona Virus Disease (COVID-19) has significantly affected communities in various aspects. The World Health Organization proposed different measures to prevent the pandemic. However, these measures in some instances have not effectively minimized the impacts of COVID-19, due to innumerable factors, inter alia, considerable "infodemic" related to myths, misinformation, and misconceptions. Knowledge of the "infodemic" on COVID -19 can lead to effective interventions to rid societies of COVID-19, hence reduction of COVID-19-related risks and outcomes. This article explores the "COVID-19 infodemic" that affected community responses to COVID-19 in Africa. The study employed a scoping review approach involving peer-reviewed articles from numerous search engines and databases. The keywords involved in the search query were: "COVID-19 infodemic, COVID-19 false news, COVID-19 in Africa, 'knowledge of COVID-19, 'myths, misinformation, and misconceptions on COVID-19, 'history of COVID-19', 'community responses to COVID-19 in Africa". Findings show that 5G technology transferred coronavirus, high temperature and alcohol can kill coronavirus, blacks are immune to COVID-19, COVID-19 vaccine development has been rushed hence not very effective and safe and also causes infertility. Diverse community responses have been registered which in some ways frustrated efforts in combating the pandemic. Therefore, the "infodemic" consisting of myths, misconceptions, and misinformation have been resulting from the history of COVID-19 which first affected white people more than blacks. Also, low knowledge of how the virus is transmitted and affect human being; and the notion that COVID-19 affects richer than poor people, hence since white people are richer than black people then they were the first to be affected by the pandemic. Obviously in presence of such myths, misconceptions, and misinformation; community responses in combating COVID-19 have not been very effective in Africa. For these interventions to be effective, collective efforts involving various stakeholders to raise awareness of COVID-19 are needed.
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Affiliation(s)
- Mikidadi Muhanga
- Department of Development and Strategic Studies, College of Social Sciences & Humanities, Sokoine University of Agriculture, Tanzania
| | - Angela Jesse
- Department of Development and Strategic Studies, College of Social Sciences & Humanities, Sokoine University of Agriculture, Tanzania
| | - Edwin Ngowi
- Department of Development and Strategic Studies, College of Social Sciences & Humanities, Sokoine University of Agriculture, Tanzania
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Chang E, Li H, Zheng W, Zhou L, Jia Y, Gu W, Cao Y, Zhu X, Xu J, Liu B, You M, Liu K, Wang M, Huang W. Economic Evaluation of COVID-19 Immunization Strategies: A Systematic Review and Narrative Synthesis. Appl Health Econ Health Policy 2024:10.1007/s40258-024-00880-6. [PMID: 38598091 DOI: 10.1007/s40258-024-00880-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/17/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVES This study aimed to systematically assess global economic evaluation studies on COVID-19 vaccination, offer valuable insights for future economic evaluations, and assist policymakers in making evidence-based decisions regarding the implementation of COVID-19 vaccination. METHODS Searches were performed from January 2020 to September 2023 across seven English databases (PubMed, Web of Science, MEDLINE, EBSCO, KCL-Korean Journal Dataset, SciELO Citation Index, and Derwent Innovations Index) and three Chinese databases (Wanfang Data, China Science and Technology Journal, and CNKI). Rigorous inclusion and exclusion criteria were applied. Data were extracted from eligible studies using a standardized data collection form, with the reporting quality of these studies assessed using the Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022). RESULTS Of the 40 studies included in the final review, the overall reporting quality was good, evidenced by a mean score of 22.6 (ranging from 10.5 to 28). Given the significant heterogeneity in fundamental aspects among the studies reviewed, a narrative synthesis was conducted. Most of these studies adopted a health system or societal perspective. They predominantly utilized a composite model, merging dynamic and static methods, within short to medium-term time horizons to simulate various vaccination strategies. The research strategies varied among studies, investigating different doses, dosages, brands, mechanisms, efficacies, vaccination coverage rates, deployment speeds, and priority target groups. Three pivotal parameters notably influenced the evaluation results: the vaccine's effectiveness, its cost, and the basic reproductive number (R0). Despite variations in model structures, baseline parameters, and assumptions utilized, all studies identified a general trend that COVID-19 vaccination is cost-effective compared to no vaccination or intervention. CONCLUSIONS The current review confirmed that COVID-19 vaccination is a cost-effective alternative in preventing and controlling COVID-19. In addition, it highlights the profound impact of variables such as dose size, target population, vaccine efficacy, speed of vaccination, and diversity of vaccine brands and mechanisms on cost effectiveness, and also proposes practical and effective strategies for improving COVID-19 vaccination campaigns from the perspective of economic evaluation.
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Affiliation(s)
- Enxue Chang
- School of Health Management, Harbin Medical University, Harbin, China
| | - Haofei Li
- School of Health Management, Harbin Medical University, Harbin, China
| | - Wanji Zheng
- School of Health Management, Harbin Medical University, Harbin, China
| | - Lan Zhou
- School of Health Management, Harbin Medical University, Harbin, China
| | - Yanni Jia
- School of Health Management, Harbin Medical University, Harbin, China
| | - Wen Gu
- School of Health Management, Harbin Medical University, Harbin, China
| | - Yiyin Cao
- School of Health Management, Harbin Medical University, Harbin, China
| | - Xiaoying Zhu
- School of Elderly Care Services and Management, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
- Nossal Institute for Global Health, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
| | - Juan Xu
- Cancer Hospital Chinese Academy of Medical Sciences, Shenzhen Center, Shenzhen, China
| | - Bo Liu
- Shenzhen Health Capacity Building and Continuing Education Center, Shenzhen, China
| | - Mao You
- National Health Development Research Center, Beijing, 100191, China
| | - Kejun Liu
- National Health Development Research Center, Beijing, 100191, China.
| | - Mingsi Wang
- School of Health Management, Harbin Medical University, Harbin, China.
| | - Weidong Huang
- School of Health Management, Harbin Medical University, Harbin, China.
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Choi NG, Marti CN, Choi BY, Kunik MM. Healthcare Cost Burden and Self-Reported Frequency of Depressive/Anxious Feelings in Older Adults. J Gerontol Soc Work 2024; 67:349-368. [PMID: 38451780 PMCID: PMC10978223 DOI: 10.1080/01634372.2024.2326683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 01/11/2024] [Indexed: 03/09/2024]
Abstract
Using the 2018-2021 National Health Interview Survey data, we examined the associations between healthcare cost burden and depressive/anxious feelings in older adults. Nearly12% reported healthcare cost burden and 18% daily/weekly depressive/anxious feelings. Healthcare cost burden was higher among women, racial/ethnic minorities, those with chronic illnesses, mobility impairment, and those with Medicare Part D, but lower among individuals with Medicare-Medicaid dual eligibility, Medicare Advantage, VA/military insurance, and private insurance. Daily/weekly depressive/anxious feelings was higher among healthcare cost burden reporters. The COVID-19 pandemic-related medical care access problems were also associated with a higher risk of reporting healthcare cost burden and depression/anxiety.
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Affiliation(s)
- Namkee G. Choi
- Steve Hicks School of Social Work, University of Texas at Austin
| | - C. Nathan Marti
- Steve Hicks School of Social Work, University of Texas at Austin
| | - Bryan Y. Choi
- Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine and BayHealth
| | - Mark M. Kunik
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety; Michael E. DeBakey VA Medical Center; Director, VA South Central Mental Illness Research, Education and Clinical Center; and Baylor College of Medicine
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Martínez-Briseño D, Fernández-Plata R, Pérez-Padilla R, Higuera-Iglesias A, Castillejos-López M, Casas-Medina G, Sierra-Vargas P, Ahumada-Topete VH. Determinants of COVID-19 Hospitalization Costs in a Referral Hospital for Respiratory Diseases. Arch Bronconeumol 2024; 60:246-249. [PMID: 38350818 DOI: 10.1016/j.arbres.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 02/15/2024]
Affiliation(s)
- David Martínez-Briseño
- Hospital Epidemiology and Infectology Unit, National Institute of Respiratory Diseases Ismael Cosío Villegas, Tlalpan, Mexico
| | - Rosario Fernández-Plata
- Hospital Epidemiology and Infectology Unit, National Institute of Respiratory Diseases Ismael Cosío Villegas, Tlalpan, Mexico.
| | - Rogelio Pérez-Padilla
- Department of Research in Tobacco and COPD, National Institute of Respiratory Diseases Ismael Cosío Villegas, Tlalpan, Mexico.
| | - Anjarath Higuera-Iglesias
- Hospital Epidemiology and Infectology Unit, National Institute of Respiratory Diseases Ismael Cosío Villegas, Tlalpan, Mexico
| | - Manuel Castillejos-López
- Hospital Epidemiology and Infectology Unit, National Institute of Respiratory Diseases Ismael Cosío Villegas, Tlalpan, Mexico
| | - Guillermo Casas-Medina
- Department of Health Economics, National Institute of Respiratory Diseases Ismael Cosío Villegas, Tlalpan, Mexico
| | - Patricia Sierra-Vargas
- Clinical Research Subdirectorate, National Institute of Respiratory Diseases Ismael Cosío Villegas, Tlalpan, Mexico
| | - Víctor Hugo Ahumada-Topete
- Hospital Epidemiology and Infectology Unit, National Institute of Respiratory Diseases Ismael Cosío Villegas, Tlalpan, Mexico
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Fried S, Bar-Shai A, Frydman S, Freund O. Transition of care interventions to manage severe COVID-19 in the ambulatory setting: a systematic review. Intern Emerg Med 2024; 19:765-775. [PMID: 38104299 DOI: 10.1007/s11739-023-03493-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/17/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Severe COVID-19, with the need in supplemental oxygen and hospitalization, leads to major burden on patients and healthcare systems. As a result, safe and effective ambulatory treatment strategies for severe COVID-19 are of urgent need. In this systematic review, we aimed to evaluate interventions to transition care to the ambulatory setting for patients with active severe COVID-19 that required supplemental oxygen. METHODS We searched Medline, Scopus, Web of Science, and DOAJ databases to identify articles with original data published until the 1st of April 2023. Characteristics and outcomes of interventions to transition care to home management were reviewed. Given the heterogeneous settings and outcomes studied, a meta-analysis was not performed. RESULTS Of the 235 studies identified, 11 observational studies, with 2645 patients, were included. The interventions were initiated from the emergency department, observation units or inpatient units, and included continuous home telemonitoring (n = 8), mobile applications (n = 2), and patient-initiated medical contact (n = 3). Included patients had an overall short length of hospital stay, high readmission rates, and positive patients' feedback. There was a lack of prospective controlled data and cost-effectiveness analyses. CONCLUSION Our findings highlight the potential in treating severe COVID-19 at the ambulatory setting and the lack of high-quality data in this field. Dedicated medical teams, adjusted monitoring methods, improving clinical trajectory, and correct inclusion settings are needed for safe and effective transition of care.
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Affiliation(s)
- Sabrina Fried
- The Institute of Pulmonary Medicine, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine Tel Aviv University, Tel-Aviv, Israel
| | - Amir Bar-Shai
- The Institute of Pulmonary Medicine, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine Tel Aviv University, Tel-Aviv, Israel
| | - Shir Frydman
- Internal Medicine B, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Weizmann 6, Tel-Aviv, Israel
| | - Ophir Freund
- The Institute of Pulmonary Medicine, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine Tel Aviv University, Tel-Aviv, Israel.
- Internal Medicine B, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Weizmann 6, Tel-Aviv, Israel.
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Datta BK, Coughlin SS, Fazlul I, Pandey A. COVID-19 and health care-related financial toxicity in the United States: Evidence from the 2022 National Health Interview Survey. Am J Infect Control 2024; 52:392-399. [PMID: 37956731 DOI: 10.1016/j.ajic.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 11/03/2023] [Accepted: 11/04/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Despite the common perception of the socioeconomic burden of the COVID-19 pandemic, quantification of the relationship between COVID-19 and indicators of health care-related financial toxicity in the general population has been limited. This study aimed to provide estimates of these relationships in a nationally representative sample of the US adult population. METHODS Using the data on 27,480 adults from the 2022 National Health Interview Survey, we fitted multivariable logistic regression models to assess the differential risks of financial toxicity as manifested by the financial hardship in paying medical bills, delayed and forgone medical care, and medication nonadherence, by COVID-19 diagnosis, severity, and duration of symptoms. RESULTS We found that compared to individuals not having COVID-19, individuals with severe symptoms of COVID-19 were 1.86, 1.50, 1.76, and 1.77 times more likely to experience financial hardship, delay medical care, forgo medical care, and skip/delay/take less medication, respectively. Similarly, individuals with symptoms lasting for 3 or more months were 1.94, 1.65, 1.87, and 2.20 times more likely to experience these measures of financial toxicity, respectively. CONCLUSIONS The estimates of the relationship between COVID-19 and financial toxicity will facilitate effective communications for policy actions aimed at alleviating the burden of the COVID-19 pandemic.
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Affiliation(s)
- Biplab Kumar Datta
- Institute of Public and Preventive Health, Augusta University, Augusta, GA; Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA.
| | - Steven S Coughlin
- Institute of Public and Preventive Health, Augusta University, Augusta, GA; Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA
| | - Ishtiaque Fazlul
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA
| | - Ajay Pandey
- Department of Biological Sciences, Augusta University, Augusta, GA
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Assiri AM, Alsubaie FSF, Amer SA, Almuteri NAM, Ojeil R, Dhopte PR, Alsaqa'aby M, Alotaibi AFM. The economic burden of viral severe acute respiratory infections in the Kingdom of Saudi Arabia: A nationwide cost-of-illness study. IJID Reg 2024; 10:80-86. [PMID: 38173861 PMCID: PMC10762365 DOI: 10.1016/j.ijregi.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/22/2023] [Accepted: 11/22/2023] [Indexed: 01/05/2024]
Abstract
Objectives The authors conducted a study to estimate the rising disease and economic burden of viral severe acute respiratory infections and their management, including COVID-19, respiratory syncytial virus, and influenza types A and B, in early and delayed diagnosis scenarios in the Kingdom of Saudi Arabia from a national perspective. Methods This cross-sectional study was conducted in May 2022 using a de novo Excel-based universal cost-of-illness calculator model. The study used primary data, such as expert interviews, as well as secondary data from a thorough literature search. Results The total economic burden of viral severe acute respiratory infections in patients with an early diagnosis was lower than those with a delayed diagnosis among patients with complications, both from the payer's (United States dollar [USD] 3846 million vs USD 4726 million) and societal (USD 4048 million vs USD 5020 million, respectively) perspectives. The major cost driver of the total economic burden for both early and delayed diagnosis was disease management costs: 49% (USD 1880 million) and 58% (USD 2730 million), respectively. Conclusions In the Kingdom of Saudi Arabia, the total economic burden for COVID-19, influenza (epidemic phase), and respiratory syncytial virus was higher with a delayed diagnosis vs an early diagnosis, emphasizing the importance of using a broader diagnostic method.
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Affiliation(s)
- Abdullah M. Assiri
- Deputyship for Preventive Health, Ministry of Health, Riyadh, Saudi Arabia
| | | | - Samar A. Amer
- Deputyship for Preventive Health, Ministry of Health, Riyadh, Saudi Arabia
| | | | - Rita Ojeil
- Health Economic and Outcomes Research (HEOR)—Real-World Evidence (RWE) department, IQVIA, Beirut, Lebanon
| | - Pratik Ramesh Dhopte
- Health Economic and Outcomes Research (HEOR)—Real-World Evidence (RWE), IQVIA, India
| | - Mai Alsaqa'aby
- Health Economic and Outcomes Research (HEOR)—Real-World Evidence (RWE), IQVIA Solutions Limited, Riyadh, KSA
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11
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Wang Y, Zhang P, Zhou X, Rolka D, Imperatore G. Impact of the COVID-19 Pandemic on Medical Expenditures Among Medicare Fee-for-Service Beneficiaries Aged ≥67 Years With Diabetes. Diabetes Care 2024; 47:452-459. [PMID: 38227901 PMCID: PMC11005216 DOI: 10.2337/dc23-1679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/11/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVE To compare total and out-of-pocket (OOP) medical expenditures between pre-COVID-19 (March 2019 to February 2020) and COVID-19 (March 2020 to February 2022) periods among Medicare beneficiaries with diabetes. RESEARCH DESIGN AND METHODS Data were from 100% Medicare fee-for-service claims. Diabetes was identified using ICD-10 codes. We calculated quarterly total and OOP medical expenditures at the population and per capita level in total and by service type. Per capita expenditures were calculated by dividing the population expenditure by the number of beneficiaries with diabetes in the same quarter. Changes in expenditures were calculated as the differences in the same quarters between the prepandemic and pandemic years. RESULTS Population total expenditure fell to $33.6 billion in the 1st quarter of the pandemic from $41.7 billion in the same prepandemic quarter; it then bounced back to $36.8 billion by the 4th quarter of the 2nd pandemic year. The per capita total expenditure fell to $5,356 in the 1st quarter of the pandemic from $6,500 in the same prepandemic quarter. It then increased to $6,096 by the 4th quarter of the 2nd pandemic year, surpassing the same quarter in the prepandemic year ($5,982). Both population and per capita OOP expenditures during the pandemic period were lower than the prepandemic period. Changes in per capita expenditure between the pre-COVID-19 and COVID-19 periods by service type varied. CONCLUSIONS COVID-19 had a significant impact on both total and per capita medical expenditures among Medicare beneficiaries with diabetes. The COVID-19 pandemic was associated with lower OOP expenditures.
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Affiliation(s)
- Yu Wang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ping Zhang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Xilin Zhou
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Deborah Rolka
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
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12
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Pereira ACEDS, Gallo LG, Oliveira AFDM, de Oliveira MRF, Peixoto HM. Costs of hospital admissions due to COVID-19 in the federal capital of Brazil: a study based on hospital admission authorizations. Braz J Infect Dis 2024; 28:103744. [PMID: 38670167 PMCID: PMC11099317 DOI: 10.1016/j.bjid.2024.103744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/21/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
This is a cost analysis study based on hospital admissions, conducted from the perspective of the Brazilian Unified Health System (SUS), carried out in a cohort of patients hospitalized at the University Hospital of Brasília (UHB) due to Severe Acute Respiratory Infections (SARI) caused by COVID-19, from April 1, 2020, to March 31, 2022. An approach based on macro-costing was used, considering the costs per patient identified in the Hospital Admission Authorizations (HAA). Were identified 1,015 HAA from 622 patients. The total cost of hospitalizations was R$ 2,875,867.18 for 2020 and 2021. Of this total, 86.41 % referred to hospital services and 13.59 % to professional services. The highest median cost per patient identified was for May 2020 (R$ 19,677.81 IQR [3,334.81-33,041.43]), while the lowest was in January 2021 (R$ 1,698.50 IQR [1,602.70-2,224.11]). The high cost of treating patients with COVID-19 resulted in a high economic burden of SARI due to COVID-19 for UHB and, consequently, for SUS.
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Affiliation(s)
| | - Luciana G Gallo
- Universidade de Brasília, Núcleo de Medicina Tropical, Zika, Arbovirus and other Infections Cohort Studies (ZARICS), Brasília, DF, Brazil
| | | | - Maria Regina F de Oliveira
- Universidade de Brasília, Núcleo de Medicina Tropical, Programa de Pós-Graduação em Medicina Tropical, Brasília, DF, Brazil; Universidade de Brasília, Núcleo de Medicina Tropical, Zika, Arbovirus and other Infections Cohort Studies (ZARICS), Brasília, DF, Brazil; Instituto de Avaliação de Tecnologia em Saúde (IATS), Porto Alegre, RS, Brazil
| | - Henry M Peixoto
- Universidade de Brasília, Núcleo de Medicina Tropical, Programa de Pós-Graduação em Medicina Tropical, Brasília, DF, Brazil; Universidade de Brasília, Núcleo de Medicina Tropical, Zika, Arbovirus and other Infections Cohort Studies (ZARICS), Brasília, DF, Brazil; Instituto de Avaliação de Tecnologia em Saúde (IATS), Porto Alegre, RS, Brazil
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13
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Pisaneschi G, Tarani M, Di Donato G, Landi A, Laurino M, Manfredi P. Optimal social distancing in epidemic control: cost prioritization, adherence and insights into preparedness principles. Sci Rep 2024; 14:4365. [PMID: 38388727 PMCID: PMC10883963 DOI: 10.1038/s41598-024-54955-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/19/2024] [Indexed: 02/24/2024] Open
Abstract
The COVID-19 pandemic experience has highlighted the importance of developing general control principles to inform future pandemic preparedness based on the tension between the different control options, ranging from elimination to mitigation, and related costs. Similarly, during the COVID-19 pandemic, social distancing has been confirmed to be the critical response tool until vaccines become available. Open-loop optimal control of a transmission model for COVID-19 in one of its most aggressive outbreaks is used to identify the best social distancing policies aimed at balancing the direct epidemiological costs of a threatening epidemic with its indirect (i.e., societal level) costs arising from enduring control measures. In particular, we analyse how optimal social distancing varies according to three key policy factors, namely, the degree of prioritization of indirect costs, the adherence to control measures, and the timeliness of intervention. As the prioritization of indirect costs increases, (i) the corresponding optimal distancing policy suddenly switches from elimination to suppression and, finally, to mitigation; (ii) the "effective" mitigation region-where hospitals' overwhelming is prevented-is dramatically narrow and shows multiple control waves; and (iii) a delicate balance emerges, whereby low adherence and lack of timeliness inevitably force ineffective mitigation as the only accessible policy option. The present results show the importance of open-loop optimal control, which is traditionally absent in public health preparedness, for studying the suppression-mitigation trade-off and supplying robust preparedness guidelines.
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Affiliation(s)
- Giulio Pisaneschi
- Department of Information Engineering, University of Pisa, Pisa, Italy
| | - Matteo Tarani
- Department of Information Engineering, University of Pisa, Pisa, Italy
| | | | - Alberto Landi
- Department of Information Engineering, University of Pisa, Pisa, Italy
| | - Marco Laurino
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Piero Manfredi
- Department of Economics and Management, University of Pisa, Pisa, Italy.
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14
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Faramarzi A, Norouzi S, Dehdarirad H, Aghlmand S, Yusefzadeh H, Javan-Noughabi J. The global economic burden of COVID-19 disease: a comprehensive systematic review and meta-analysis. Syst Rev 2024; 13:68. [PMID: 38365735 PMCID: PMC10870589 DOI: 10.1186/s13643-024-02476-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 01/31/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has caused a considerable threat to the economics of patients, health systems, and society. OBJECTIVES This meta-analysis aims to quantitatively assess the global economic burden of COVID-19. METHODS A comprehensive search was performed in the PubMed, Scopus, and Web of Science databases to identify studies examining the economic impact of COVID-19. The selected studies were classified into two categories based on the cost-of-illness (COI) study approach: top-down and bottom-up studies. The results of top-down COI studies were presented by calculating the average costs as a percentage of gross domestic product (GDP) and health expenditures. Conversely, the findings of bottom-up studies were analyzed through meta-analysis using the standardized mean difference. RESULTS The implemented search strategy yielded 3271 records, of which 27 studies met the inclusion criteria, consisting of 7 top-down and 20 bottom-up studies. The included studies were conducted in various countries, including the USA (5), China (5), Spain (2), Brazil (2), South Korea (2), India (2), and one study each in Italy, South Africa, the Philippines, Greece, Iran, Kenya, Nigeria, and the Kingdom of Saudi Arabia. The results of the top-down studies indicated that indirect costs represent 10.53% of GDP, while the total estimated cost accounts for 85.91% of healthcare expenditures and 9.13% of GDP. In contrast, the bottom-up studies revealed that the average direct medical costs ranged from US $1264 to US $79,315. The meta-analysis demonstrated that the medical costs for COVID-19 patients in the intensive care unit (ICU) were approximately twice as high as those for patients in general wards, with a range from 0.05 to 3.48 times higher. CONCLUSIONS Our study indicates that the COVID-19 pandemic has imposed a significant economic burden worldwide, with varying degrees of impact across countries. The findings of our study, along with those of other research, underscore the vital role of economic consequences in the post-COVID-19 era for communities and families. Therefore, policymakers and health administrators should prioritize economic programs and accord them heightened attention.
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Affiliation(s)
- Ahmad Faramarzi
- Department of Health Economics and Management, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran.
| | - Soheila Norouzi
- Department of Health Economics and Management, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran
| | - Hossein Dehdarirad
- Department of Medical Library and Information Science, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Siamak Aghlmand
- Department of Health Economics and Management, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran
| | - Hasan Yusefzadeh
- Department of Health Economics and Management, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran
| | - Javad Javan-Noughabi
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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15
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Lam CM, Sanderson M, Vu DT, Sayed D, Latif U, Chadwick AL, Staats P, York A, Smith G, Velagapudi V, Khan TW. Musculoskeletal and Neuropathic Pain in COVID-19. Diagnostics (Basel) 2024; 14:332. [PMID: 38337848 PMCID: PMC10855145 DOI: 10.3390/diagnostics14030332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
Chronic pain constitutes a significant disease burden globally and accounts for a substantial portion of healthcare spending. The COVID-19 pandemic contributed to an increase in this burden as patients presented with musculoskeletal or neuropathic pain after contracting COVID-19 or had their chronic pain symptoms exacerbated by the virus. This extensive literature review analyzes the epidemiology of pain pre-pandemic, the costs associated with the COVID-19 pandemic, the impact of the virus on the body, mechanisms of pain, management of chronic pain post-pandemic, and potential treatment options available for people living with chronic pain who have had or are currently infected with COVID-19.
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Affiliation(s)
- Christopher M. Lam
- Department of Anesthesiology, Pain, and Perioperative Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA; (C.M.L.); (M.S.); (D.T.V.); (D.S.); (U.L.); (A.L.C.); (A.Y.)
| | - Miles Sanderson
- Department of Anesthesiology, Pain, and Perioperative Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA; (C.M.L.); (M.S.); (D.T.V.); (D.S.); (U.L.); (A.L.C.); (A.Y.)
| | - Dan T. Vu
- Department of Anesthesiology, Pain, and Perioperative Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA; (C.M.L.); (M.S.); (D.T.V.); (D.S.); (U.L.); (A.L.C.); (A.Y.)
| | - Dawood Sayed
- Department of Anesthesiology, Pain, and Perioperative Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA; (C.M.L.); (M.S.); (D.T.V.); (D.S.); (U.L.); (A.L.C.); (A.Y.)
| | - Usman Latif
- Department of Anesthesiology, Pain, and Perioperative Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA; (C.M.L.); (M.S.); (D.T.V.); (D.S.); (U.L.); (A.L.C.); (A.Y.)
| | - Andrea L. Chadwick
- Department of Anesthesiology, Pain, and Perioperative Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA; (C.M.L.); (M.S.); (D.T.V.); (D.S.); (U.L.); (A.L.C.); (A.Y.)
| | - Peter Staats
- National Spine and Pain Centers, Frederick, MD 21702, USA;
| | - Abigail York
- Department of Anesthesiology, Pain, and Perioperative Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA; (C.M.L.); (M.S.); (D.T.V.); (D.S.); (U.L.); (A.L.C.); (A.Y.)
| | - Gabriella Smith
- School of Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA; (G.S.); (V.V.)
| | - Vivek Velagapudi
- School of Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA; (G.S.); (V.V.)
| | - Talal W. Khan
- Department of Anesthesiology, Pain, and Perioperative Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA; (C.M.L.); (M.S.); (D.T.V.); (D.S.); (U.L.); (A.L.C.); (A.Y.)
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16
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Nakhaee M, Khandehroo M, Esmaeili R. Cost of illness studies in COVID-19: a scoping review. Cost Eff Resour Alloc 2024; 22:3. [PMID: 38238797 PMCID: PMC10797972 DOI: 10.1186/s12962-024-00514-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 01/10/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Human communities suffered a vast socioeconomic burden in dealing with the pandemic of coronavirus disease 2019 (COVID-19) globally. Real-word data about these burdens can inform governments about evidence-based resource allocation and prioritization. The aim of this scoping review was to map the cost-of-illness (CoI) studies associated with COVID-19. METHODS This scoping review was conducted from January 2019 to December 2021. We searched cost-of-illness papers published in English within Web of Sciences, PubMed, Google Scholar, Scopus, Science Direct and ProQuest. For each eligible study, extracted data included country, publication year, study period, study design, epidemiological approach, costing method, cost type, cost identification, sensitivity analysis, estimated unit cost and national burden. All of the analyses were applied in Excel software. RESULTS 2352 records were found after the search strategy application, finally 28 articles met the inclusion criteria and were included in the review. Most of the studies were done in the United States, Turkey, and China. The prevalence-based approach was the most common in the studies, and most of studies also used Hospital Information System data (HIS). There were noticeable differences in the costing methods and the cost identification. The average cost of hospitalization per patient per day ranged from 101$ in Turkey to 2,364$ in the United States. Among the studies, 82.1% estimated particularly direct medical costs, 3.6% only indirect costs, and 14.3% both direct and indirect costs. CONCLUSION The economic burden of COVID-19 varies from country to country. The majority of CoI studies estimated direct medical costs associated with COVID-19 and there is a paucity of evidence for direct non-medical, indirect, and intangible costs, which we recommend for future studies. To create homogeneity in CoI studies, we suggest researchers follow a conceptual framework and critical appraisal checklist of cost-of-illness (CoI) studies.
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Affiliation(s)
- Majid Nakhaee
- Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Masoud Khandehroo
- Department of Community Medicine, School of Medicine, Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Reza Esmaeili
- Department of Public Health, School of Health, Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Imam Khomeini Avenue, Gonabad, Khorasan, 9691793718, Iran.
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17
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Zwerwer LR, Kloka J, van der Pol S, Postma MJ, Zacharowski K, van Asselt ADI, Friedrichson B. Mechanical ventilation as a major driver of COVID-19 hospitalization costs: a costing study in a German setting. Health Econ Rev 2024; 14:4. [PMID: 38227207 PMCID: PMC10790444 DOI: 10.1186/s13561-023-00476-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/21/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND While COVID-19 hospitalization costs are essential for policymakers to make informed health care resource decisions, little is known about these costs in western Europe. The aim of the current study is to analyze these costs for a German setting, track the development of these costs over time and analyze the daily costs. METHODS Administrative costing data was analyzed for 598 non-Intensive Care Unit (ICU) patients and 510 ICU patients diagnosed with COVID-19 at the Frankfurt University hospital. Descriptive statistics of total per patient hospitalization costs were obtained and assessed over time. Propensity scores were estimated for length of stay (LOS) at the general ward and mechanical ventilation (MV) duration, using covariate balancing propensity score for continuous treatment. Costs for each additional day in the general ward and each additional day in the ICU with and without MV were estimated by regressing the total hospitalization costs on the LOS and the presence or absence of several treatments using generalized linear models, while controlling for patient characteristics, comorbidities, and complications. RESULTS Median total per patient hospitalization costs were €3,010 (Q1 - Q3: €2,224-€5,273), €5,887 (Q1 - Q3: €3,054-€10,879) and €21,536 (Q1 - Q3: €7,504-€43,480), respectively, for non-ICU patients, non-MV and MV ICU patients. Total per patient hospitalization costs for non-ICU patients showed a slight increase over time, while total per patient hospitalization costs for ICU patients decreased over time. Each additional day in the general ward for non-ICU COVID-19 patients costed €463.66 (SE: 15.89). Costs for each additional day in the general ward and ICU without and with mechanical ventilation for ICU patients were estimated at €414.20 (SE: 22.17), €927.45 (SE: 45.52) and €2,224.84 (SE: 70.24). CONCLUSIONS This is, to our knowledge, the first study examining the costs of COVID-19 hospitalizations in Germany. Estimated costs were overall in agreement with costs found in literature for non-COVID-19 patients, except for higher estimated costs for mechanical ventilation. These estimated costs can potentially improve the precision of COVID-19 cost effectiveness studies in Germany and will thereby allow health care policymakers to provide better informed health care resource decisions in the future.
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Affiliation(s)
- Leslie R Zwerwer
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
- Center for Information Technology, University of Groningen, Groningen, The Netherlands.
| | - Jan Kloka
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Simon van der Pol
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Health-Ecore, Zeist, The Netherlands
| | - Maarten J Postma
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Health-Ecore, Zeist, The Netherlands
- Department of Economics, Econometrics and Finance, Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
| | - Kai Zacharowski
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Antoinette D I van Asselt
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Benjamin Friedrichson
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
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18
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Kapinos KA, Peters RM, Murphy RE, Hohmann SF, Podichetty A, Greenberg RS. Inpatient Costs of Treating Patients With COVID-19. JAMA Netw Open 2024; 7:e2350145. [PMID: 38170519 PMCID: PMC10765267 DOI: 10.1001/jamanetworkopen.2023.50145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 11/15/2023] [Indexed: 01/05/2024] Open
Abstract
Importance With more than 6.2 million hospitalizations due to COVID-19 in the US, recognition of the average hospital costs to provide inpatient care during the pandemic is necessary to understanding the national medical resource use and improving public health readiness and related policies. Objective To examine the mean cost to provide inpatient care to treat COVID-19 and how it varied through the pandemic waves and by important sociodemographic patient characteristics. Design, Setting, and Participants This cross-sectional study used inpatient-level data from March 1, 2020, to March 31, 2022, extracted from a repository of clinical, administrative, and financial information covering 97% of academic medical centers across the US. Main Outcomes and Measures Cost to produce care for each stay was calculated using direct hospital costs to provide care adjusted for geographic differences in labor costs using area wage indices. Results The sample included 1 333 404 stays with a primary or secondary COVID-19 diagnosis from 841 hospitals. The cohort included 692 550 (52%) men, with mean (SD) age of 59.2 (17.5) years. The adjusted mean cost of an inpatient stay was $11 275 (95% CI, $11 252-$11 297) overall, increasing from $10 394 (95% CI, $10 228-$10 559) at the end of March 2020 to $13 072 (95% CI, $12 528-$13 617) by the end of March 2022. Patients with specific comorbidities had significantly higher mean costs than their counterparts: those with obesity incurred an additional $2924 in inpatient stay costs, and those with coagulation deficiency incurred an additional $3017 in inpatient stay costs. Stays during which the patient required extracorporeal membrane oxygenation (ECMO) had an adjusted mean cost of $36 484 (95% CI, $34 685-$38 284). Conclusions and Relevance In this cross-sectional study, an adjusted mean hospital cost to provide care for patients with COVID-19 increased more than 5 times the rate of medical inflation overall. This appeared to be explained partly by changes in the use of ECMO, which increased over time.
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Affiliation(s)
| | - Richard M. Peters
- Department of Population Health, Dell Medical School, The University of Texas at Austin
| | - Robert E. Murphy
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston
| | | | - Ankita Podichetty
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston
| | - Raymond S. Greenberg
- Peter O'Donnell Jr. School of Public Health, The University of Texas Southwestern Medical Center, Dallas
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19
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Li R, Lu P, Fairley CK, Pagán JA, Hu W, Yang Q, Zhuang G, Shen M, Li Y, Zhang L. Cost-Effectiveness of the Second COVID-19 Booster Vaccination in the USA. Appl Health Econ Health Policy 2024; 22:85-95. [PMID: 37910314 DOI: 10.1007/s40258-023-00844-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE To assess the cost effectiveness of the second COVID-19 booster vaccination with different age groups. METHODS We developed a decision-analytic Susceptible-Exposed-Infected-Recovered (SEIR)-Markov model by five age groups (0-4 years, 5-11 years 12-17 years, 18-49 years, and 50+ years) and calibrated the model by actual mortality in each age group in the USA. We conducted five scenarios to evaluate the cost effectiveness of the second booster strategy and incremental benefits if the strategy would expand to 18-49 years and 12-17 years, from a health care system perspective. The analysis was reported according to the Consolidated Health Economic Evaluation Reporting Standards 2022 statement. RESULTS Implementing the second booster strategy for those aged ≥ 50 years cost $823 million but reduced direct medical costs by $1166 million, corresponding to a benefit-cost ratio of 1.42. Moreover, the strategy also resulted in a gain of 2596 quality-adjusted life-years (QALYs) during the 180-day evaluation period, indicating it was dominant. Further, vaccinating individuals aged 18-49 years with the second booster would result in an additional gain of $1592 million and 8790 QALYs. Similarly, expanding the vaccination to individuals aged 12-17 years would result in an additional gain of $16 million and 403 QALYs. However, if social interaction between all age groups was severed, vaccination expansion to ages 18-49 and 12-17 years would no longer be dominant but cost effective with an incremental cost-effectiveness ratio (ICER) of $37,572 and $26,705/QALY gained, respectively. CONCLUSION The second booster strategy was likely to be dominant in reducing the disease burden of the COVID-19 pandemic. Expanding the second booster strategy to ages 18-49 and 12-17 years would remain dominant due to their social contacts with the older age group.
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Affiliation(s)
- Rui Li
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi, China
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Pengyi Lu
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi, China
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - José A Pagán
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY, USA
| | - Wenyi Hu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
- Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Australia
| | - Qianqian Yang
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi, China
| | - Guihua Zhuang
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi, China
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, 710061, Shaanxi, China
| | - Mingwang Shen
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi, China.
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, 710061, Shaanxi, China.
| | - Yan Li
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Lei Zhang
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi, China.
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
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20
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Bonnell LN, Clifton J, Natkin LW, Hitt JR, Littenberg B. The association of self-perceived changes due to COVID-19 with mental and physical health among adult primary care patients with multiple chronic conditions: A US-based longitudinal study. J Multimorb Comorb 2024; 14:26335565231222148. [PMID: 38250744 PMCID: PMC10798126 DOI: 10.1177/26335565231222148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 12/05/2023] [Indexed: 01/23/2024]
Abstract
Introduction This study explores the association between self-perceived personal and community changes due to COVID-19 and health among vulnerable primary care patients experiencing multiple chronic conditions. Methods Between September 2017 and February 2021, we obtained data from 2,426 primary care patients managing multiple chronic conditions from across the United States. We assessed the relationship between self-perceived personal and community changes due to COVID-19 and change in health measured by the PROMIS-29 mental and physical health summary scores, GAD-7 (anxiety), andPHQ-9 (depression), and DASI (functional capacity) adjusting for relevant demographic, neighborhood characteristics, and county covariates. Results After adjustment, self-perceived personal and community changes due to COVID-19 were associated with significantly worse mental health summary scores (ß = -0.55; 95% Confidence Interval (CI) = -0.72, -0.37), anxiety (ß = 0.28; 95% CI = 0.16, 0.39), depression (ß = 0.35; 95% CI = 0.22, 0.47), and physical health summary scores (ß = -0.44; 95% CI = 0.88, 0.00). There was no association with functional capacity (ß = - 0.05; 95% CI = -0.16, 0.05). Discussion Among adults managing multiple chronic conditions, self-perceived personal and community changes due to COVID-19 were associated with health. This vulnerable population may be particularly susceptible to the negative effects of COVID-19. As we do not know the long-term health effects of COVID, this paper establishes a baseline of epidemiological data on COVID-19 burden and health among primary care patients with multiple chronic conditions.
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Affiliation(s)
- Levi N Bonnell
- University of Vermont College of Medicine, Burlington VT, USA
| | - Jessica Clifton
- University of Vermont College of Medicine, Burlington VT, USA
| | - Lisa W Natkin
- University of Vermont College of Medicine, Burlington VT, USA
| | - Juvena R Hitt
- University of Vermont College of Medicine, Burlington VT, USA
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21
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Yang J, Andersen KM, Rai KK, Tritton T, Mugwagwa T, Reimbaeva M, Tsang C, McGrath LJ, Payne P, Backhouse BE, Mendes D, Butfield R, Naicker K, Araghi M, Wood R, Nguyen JL. Healthcare resource utilisation and costs of hospitalisation and primary care among adults with COVID-19 in England: a population-based cohort study. BMJ Open 2023; 13:e075495. [PMID: 38154885 PMCID: PMC10759085 DOI: 10.1136/bmjopen-2023-075495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 12/11/2023] [Indexed: 12/30/2023] Open
Abstract
OBJECTIVES To quantify direct costs and healthcare resource utilisation (HCRU) associated with acute COVID-19 in adults in England. DESIGN Population-based retrospective cohort study using Clinical Practice Research Datalink Aurum primary care electronic medical records linked to Hospital Episode Statistics secondary care administrative data. SETTING Patients registered to primary care practices in England. POPULATION 1 706 368 adults with a positive SARS-CoV-2 PCR or antigen test from August 2020 to January 2022 were included; 13 105 within the hospitalised cohort indexed between August 2020 and March 2021, and 1 693 263 within the primary care cohort indexed between August 2020 and January 2022. Patients with a COVID-19-related hospitalisation within 84 days of a positive test were included in the hospitalised cohort. MAIN OUTCOME MEASURES Primary and secondary care HCRU and associated costs ≤4 weeks following positive COVID-19 test, stratified by age group, risk of severe COVID-19 and immunocompromised status. RESULTS Among the hospitalised cohort, average length of stay, including critical care stays, was longer in older adults. Median healthcare cost per hospitalisation was higher in those aged 75-84 (£8942) and ≥85 years (£8835) than in those aged <50 years (£7703). While few (6.0%) patients in critical care required mechanical ventilation, its use was higher in older adults (50-74 years: 8.3%; <50 years: 4.3%). HCRU and associated costs were often greater in those at higher risk of severe COVID-19 than in the overall cohort, although minimal differences in HCRU were found across the three different high-risk definitions. Among the primary care cohort, general practitioner or nurse consultations were more frequent among older adults and the immunocompromised. CONCLUSIONS COVID-19-related hospitalisations in older adults, particularly critical care stays, were the primary drivers of high COVID-19 resource use in England. These findings may inform health policy decisions and resource allocation in the prevention and management of COVID-19.
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Affiliation(s)
- Jingyan Yang
- Pfizer Inc, New York, New York, USA
- The Institute for Social and Economic Research and Policy, Columbia University, New York, New York, USA
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22
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Tamai M, Taba S, Mise T, Yamashita M, Ishikawa H, Shintake T. Effect of Ethanol Vapor Inhalation Treatment on Lethal Respiratory Viral Infection With Influenza A. J Infect Dis 2023; 228:1720-1729. [PMID: 37101418 PMCID: PMC10733743 DOI: 10.1093/infdis/jiad089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/12/2023] [Accepted: 04/03/2023] [Indexed: 04/28/2023] Open
Abstract
Ethanol (EtOH) effectively inactivates enveloped viruses in vitro, including influenza and severe acute respiratory syndrome coronavirus 2. Inhaled EtOH vapor may inhibit viral infection in mammalian respiratory tracts, but this has not yet been demonstrated. Here we report that unexpectedly low EtOH concentrations in solution, approximately 20% (vol/vol), rapidly inactivate influenza A virus (IAV) at mammalian body temperature and are not toxic to lung epithelial cells on apical exposure. Furthermore, brief exposure to 20% (vol/vol) EtOH decreases progeny virus production in IAV-infected cells. Using an EtOH vapor exposure system that is expected to expose murine respiratory tracts to 20% (vol/vol) EtOH solution by gas-liquid equilibrium, we demonstrate that brief EtOH vapor inhalation twice a day protects mice from lethal IAV respiratory infection by reducing viruses in the lungs without harmful side effects. Our data suggest that EtOH vapor inhalation may provide a versatile therapy against various respiratory viral infectious diseases.
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Affiliation(s)
- Miho Tamai
- Immune Signal Unit, Okinawa Institute of Science and Technology, Tancha 1919-1, Onna-son, Okinawa 904-0495, Japan
| | - Seita Taba
- Quantum Wave Microscopy Unit, Okinawa Institute of Science and Technology, Tancha 1919-1, Onna-son, Okinawa 904-0495, Japan
| | - Takeshi Mise
- Quantum Wave Microscopy Unit, Okinawa Institute of Science and Technology, Tancha 1919-1, Onna-son, Okinawa 904-0495, Japan
| | - Masao Yamashita
- Quantum Wave Microscopy Unit, Okinawa Institute of Science and Technology, Tancha 1919-1, Onna-son, Okinawa 904-0495, Japan
| | - Hiroki Ishikawa
- Immune Signal Unit, Okinawa Institute of Science and Technology, Tancha 1919-1, Onna-son, Okinawa 904-0495, Japan
| | - Tsumoru Shintake
- Quantum Wave Microscopy Unit, Okinawa Institute of Science and Technology, Tancha 1919-1, Onna-son, Okinawa 904-0495, Japan
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23
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Thyagaturu H, Roma N, Angirekula A, Thangjui S, Bolton A, Gonuguntla K, Sattar Y, Chobufo MD, Challa A, Patel N, Bondi G, Raina S. Trends and Outcomes of Type 2 Myocardial Infarction During the COVID-19 Pandemic in the United States. Korean Circ J 2023; 53:829-839. [PMID: 37880873 PMCID: PMC10751182 DOI: 10.4070/kcj.2023.0063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/22/2023] [Accepted: 07/18/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There is limited data on the impact of type 2 myocardial infarction (T2MI) during the coronavirus disease 2019 (COVID-19) pandemic. METHODS The National Inpatient Sample (NIS) database from January 2019 to December 2020 was queried to identify T2MI hospitalizations based on the appropriate International Classification of Disease, Tenth Revision-Clinical Modification codes. Monthly trends of COVID-19 and T2MI hospitalizations were evaluated using Joinpoint regression analysis. In addition, the multivariate logistic and linear regression analysis was used to compare in-hospital mortality, coronary angiography use, and resource utilization between 2019 and 2020. RESULTS A total of 743,535 patients hospitalized with a diagnosis of T2MI were identified in the years 2019 (n=331,180) and 2020 (n=412,355). There was an increasing trend in T2MI hospitalizations throughout the study period corresponding to the increase in COVID-19 hospitalizations in 2020. The adjusted odds of in-hospital mortality associated with T2MI hospitalizations were significantly higher in 2020 compared with 2019 (11.1% vs. 8.1%: adjusted odds ratio, 1.19 [1.13-1.26]; p<0.01). In addition, T2MI hospitalizations were associated with lower odds of coronary angiography and higher total hospitalization charges, with no difference in the length of stay in 2020 compared with 2019. CONCLUSIONS We found a significant increase in T2MI hospitalizations with higher in-hospital mortality, total hospitalization costs, and lower coronary angiography use during the early COVID-19 pandemic corresponding to the trends in the rise of COVID-19 hospitalizations. Further research into the factors associated with increased mortality can increase our preparedness for future pandemics.
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Affiliation(s)
- Harshith Thyagaturu
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Nicholas Roma
- Department of Internal Medicine, St. Luke's University Health Network, Bethlehem, PA, USA.
| | | | - Sittinun Thangjui
- Department of Internal Medicine, Bassett Healthcare Network, Cooperstown, NY, USA
| | - Alex Bolton
- University of Iowa College of Public Health, Iowa City, IA, USA
| | - Karthik Gonuguntla
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Yasar Sattar
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Muchi Ditah Chobufo
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Abhiram Challa
- Department of Medicine, University of Kansas School of Medicine, Wichita, KS, USA
| | - Neel Patel
- Department of Internal Medicine, New York Medical College/Landmark Medical Center, Woonsocket, RI, USA
| | - Gayatri Bondi
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA
| | - Sameer Raina
- Department of Cardiology, Stanford University School of Medicine, CA, USA
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24
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Kisiel MA, Lee S, Janols H, Faramarzi A. Absenteeism Costs Due to COVID-19 and Their Predictors in Non-Hospitalized Patients in Sweden: A Poisson Regression Analysis. Int J Environ Res Public Health 2023; 20:7052. [PMID: 37998283 PMCID: PMC10671172 DOI: 10.3390/ijerph20227052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND This study aimed to estimate absenteeism costs and identify their predictors in non-hospitalized patients in Sweden. METHODS This cross-sectional study's data were derived from the longitudinal project conducted at Uppsala University Hospital. The mean absenteeism costs due to COVID-19 were calculated using the human capital approach, and a Poisson regression analysis was employed to determine predictors of these costs. RESULTS The findings showed that the average absenteeism cost due to COVID-19 was USD 1907.1, compared to USD 919.4 before the pandemic (p < 0.001). Notably, the average absenteeism cost for females was significantly higher due to COVID-19 compared to before the pandemic (USD 1973.5 vs. USD 756.3, p = 0.001). Patients who had not fully recovered at the 12-month follow-up exhibited significantly higher costs than those without symptoms at that point (USD 3389.7 vs. USD 546.7, p < 0.001). The Poisson regression revealed that several socioeconomic factors, including age, marital status, country of birth, educational level, smoking status, BMI, and occupation, along with COVID-19-related factors such as severity at onset, pandemic wave, persistent symptoms at the follow-up, and newly introduced treatment for depression after the infection, were significant predictors of the absenteeism costs. CONCLUSIONS Our study reveals that the mean absenteeism costs due to COVID-19 doubled compared to the year preceding the pandemic. This information is invaluable for decision-makers and contributes to a better understanding of the economic aspects of COVID-19.
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Affiliation(s)
- Marta A. Kisiel
- Environmental and Occupational Medicine, Department of Medical Sciences, Uppsala University, 751 05 Uppsala, Sweden
| | - Seika Lee
- Department of Neurobiology, Care Sciences and Society, Primary Care Medicine, Karolinska Institute, 171 77 Stockholm, Sweden;
| | - Helena Janols
- Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, 751 05 Uppsala, Sweden;
| | - Ahmad Faramarzi
- Department of Health Economics and Management, School of Public Health, Urmia University of Medical Sciences, Urmia 57147-83734, Iran
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25
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May L, Robbins EM, Canchola JA, Chugh K, Tran NK. A study to assess the impact of the cobas point-of-care RT-PCR assay (SARS-CoV-2 and Influenza A/B) on patient clinical management in the emergency department of the University of California at Davis Medical Center. J Clin Virol 2023; 168:105597. [PMID: 37742483 DOI: 10.1016/j.jcv.2023.105597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/08/2023] [Accepted: 09/17/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Rapid detection of SARS-CoV-2 is crucial for reduction of transmission and clinical decision-making. Several rapid (<30 min) molecular point-of-care (POC) tests based on nucleic acid amplification exist for diagnosis of SARS-CoV-2 & Influenza A/B infections. METHODS This unblinded, pre-post study enrolled consecutive patients with symptoms/signs consistent with SARS-CoV-2 infection presenting to the University of California, Davis emergency department (ED). Outcomes following implementation of the cobas® SARS-CoV-2 & Influenza A/B test for use on the cobas Liat System (intervention: December 2020-May 2021) were compared with previous standard-of-care using centralized laboratory reverse transcriptase polymerase chain reaction (RT-PCR) methods (control: April 2020-October 2020). RESULTS Electronic health records of 8879 symptomatic patient visits were analyzed, comprising 4339 and 4540 visits and 538 and 638 positive SARS-CoV-2 PCR test results in the control and intervention periods, respectively. Compared with the control period, turnaround time (TAT) was shorter in the intervention period (median 0.98 vs 12.30 h; p < 0.0001). ED length of stay (LOS) was generally longer in the intervention period compared with the control period, but for those SARS-CoV-2-negative who were admitted, ED LOS was shorter (median 12.53 vs 17.93 h; p < 0.0001). The rate of antibiotic prescribing was lower in the intervention than in the control period (42.86% vs 49.16%; p < 0.0001) and antiviral prescribing was higher (7.64% vs 5.49%; p < 0.0001). CONCLUSION This real-world study confirms faster TAT with a POC RT-PCR method in an emergency care setting and highlights the importance of rapid SARS-CoV-2 detection to aid patient management and inform treatment decisions.
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Affiliation(s)
- Larissa May
- Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento, California, USA
| | | | | | - Kamal Chugh
- Roche Molecular Systems, Pleasanton, California, USA
| | - Nam K Tran
- Department of Emergency Medicine, University of California, Davis, Sacramento, California, USA.
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26
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Vardavas C, Zisis K, Nikitara K, Lagou I, Marou V, Aslanoglou K, Athanasakis K, Phalkey R, Leonardi-Bee J, Fernandez E, Condell O, Lamb F, Sandmann F, Pharris A, Deogan C, Suk JE. Cost of the COVID-19 pandemic versus the cost-effectiveness of mitigation strategies in EU/UK/OECD: a systematic review. BMJ Open 2023; 13:e077602. [PMID: 37907290 PMCID: PMC10619092 DOI: 10.1136/bmjopen-2023-077602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/18/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVES The economic burden of COVID-19 pandemic is substantial, with both direct and indirect costs playing a significant role. DESIGN A systematic literature review was conducted to estimate the cost of the COVID-19 pandemic and the cost-effectiveness of pharmaceutical or non-pharmaceutical interventions. All cost data were adjusted to the 2021 Euro, and interventions compared with null. DATA SOURCES Ovid MEDLINE and EMBASE were searched from January 2020 through 22 April 2021. ELIGIBILITY CRITERIA Studies regarding COVID-19 outbreak or public health preparedness measures or interventions with outcome measures related to the direct and indirect costs for disease and preparedness and/or response in countries of the European Union (EU), the European Economic Area (EEA), the UK and the Organisation for Economic Co-operation and Development (OECD) of all relevant epidemiological designs which estimate cost within the selected time frame were considered eligible. DATA EXTRACTION AND SYNTHESIS Studies were searched, screened and coded independently by two reviewers with high measure of inter-rater agreement. Data were extracted to a predefined data extraction sheet. The risk of bias was assessed using the Consensus on Health Economic Criteria checklist. RESULTS We included data from 41 economic studies. Ten studies evaluated the cost of the COVID-19 pandemic, while 31 assessed the cost-benefit of public health surveillance, preparedness and response measures. Overall, the economic burden of the COVID-19 pandemic was found to be substantial. Community screening, bed provision policies, investing in personal-protective-equipment and vaccination strategies were cost-effective. Physical distancing measures were associated with health benefits; however, their cost-effectiveness was dependent on the duration, compliance and the phase of the epidemic in which it was implemented. CONCLUSIONS COVID-19 pandemic is associated with substantial short-term and long-term economic costs to healthcare systems, payers and societies, while interventions including testing and screening policies, vaccination and physical distancing policies were identified as those presenting cost-effective options to deal with the pandemic, dependent on population vaccination and the Re at the stage of the pandemic.
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Affiliation(s)
- Constantine Vardavas
- School of Medicine, University of Crete, Heraklion, Greece
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts, USA
| | - Konstantinos Zisis
- School of Medicine, University of Crete, Heraklion, Greece
- Department of Public Health Policy, University of West Attica, Egaleo, Greece
| | | | - Ioanna Lagou
- School of Medicine, University of Crete, Heraklion, Greece
| | - Valia Marou
- School of Medicine, University of Crete, Heraklion, Greece
| | | | | | - Revati Phalkey
- Public Health England, London, UK
- University of Nottingham, Nottingham, UK
| | - Jo Leonardi-Bee
- Centre for Evidence-Based Healthcare, School of Medicine, University of Nottingham, Nottingham, UK
| | - Esteve Fernandez
- Tobacco Control Unit, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain
| | - Orla Condell
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Favelle Lamb
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Frank Sandmann
- European Centre for Disease Prevention and Control, Solna, Sweden
| | | | - Charlotte Deogan
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Jonathan E Suk
- European Centre for Disease Prevention and Control, Solna, Sweden
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Mozaffari E, Chandak A, Gottlieb RL, Chima-Melton C, Read SH, Lee E, Der-Torossian C, Gupta R, Berry M, Hollemeersch S, Kalil AC. Remdesivir Is Associated With Reduced Mortality in COVID-19 Patients Requiring Supplemental Oxygen Including Invasive Mechanical Ventilation Across SARS-CoV-2 Variants. Open Forum Infect Dis 2023; 10:ofad482. [PMID: 37869410 PMCID: PMC10588622 DOI: 10.1093/ofid/ofad482] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/20/2023] [Indexed: 10/24/2023] Open
Abstract
Background This comparative effectiveness study investigated the effect of remdesivir on in-hospital mortality among patients hospitalized for coronavirus disease 2019 (COVID-19) requiring supplemental oxygen including low-flow oxygen (LFO), high-flow oxygen/noninvasive ventilation (HFO/NIV), or invasive mechanical ventilation/extracorporeal membrane oxygenation (IMV/ECMO) across variant of concern (VOC) periods. Methods Patients hospitalized for COVID-19 between December 2020 and April 2022 and administered remdesivir upon admission were 1:1 propensity score matched to patients not administered remdesivir during their COVID-19 hospitalization. Analyses were stratified by supplemental oxygen requirement upon admission and VOC period. Cox proportional hazards models were used to derive adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for 14- and 28-day mortality. Results Patients treated with remdesivir (67 582 LFO, 34 857 HFO/NIV, and 4164 IMV/ECMO) were matched to non-remdesivir patients. Unadjusted mortality rates were significantly lower for remdesivir-treated patients at 14 days (LFO: 6.4% vs. 8.8%; HFO/NIV: 16.8% vs. 19.4%; IMV/ECMO: 27.8% vs. 35.3%) and 28 days (LFO: 9.8% vs. 12.3%; HFO/NIV: 25.8% vs. 28.3%; IMV/ECMO: 41.4% vs. 50.6%). After adjustment, remdesivir treatment was associated with a statistically significant reduction in in-hospital mortality at 14 days (LFO: aHR, 0.72; 95% CI, 0.66-0.79; HFO/NIV: aHR, 0.83; 95% CI, 0.77-0.89; IMV/ECMO: aHR, 0.73; 95% CI, 0.65-0.82) and 28 days (LFO: aHR, 0.79; 95% CI, 0.73-0.85; HFO/NIV: aHR, 0.88; 95% CI, 0.82-0.93; IMV/ECMO: aHR, 0.74; 95% CI, 0.67-0.82) compared with non-remdesivir treatment. Lower risk of mortality among remdesivir-treated patients was observed across VOC periods. Conclusions Remdesivir treatment is associated with significantly reduced mortality among patients hospitalized for COVID-19 requiring supplemental oxygen upon admission, including those requiring HFO/NIV or IMV/ECMO with severe or critical disease, across VOC periods.
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Affiliation(s)
| | | | - Robert L Gottlieb
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas, USA
- Baylor Scott & White Research Institute, Dallas, Texas, USA
- Department of Internal Medicine, Burnett School of Medicineat TCU, Fort Worth, Texas, USA
- Department of Interal Medicine, Texas A&M Health Science Center, Dallas, Texas, USA
| | - Chidinma Chima-Melton
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, UCLA Health, Torrance, California, USA
| | | | | | | | | | - Mark Berry
- Gilead Sciences, Foster City, California, USA
| | | | - Andre C Kalil
- Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
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28
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Horga A, Saenz R, Yilmaz G, Simón-Campos A, Pietropaolo K, Stubbings WJ, Collinson N, Ishak L, Zrinscak B, Belanger B, Granier C, Lin K, C Hurt A, Zhou XJ, Wildum S, Hammond J. Oral bemnifosbuvir (AT-527) vs placebo in patients with mild-to-moderate COVID-19 in an outpatient setting (MORNINGSKY). Future Virol 2023:10.2217/fvl-2023-0115. [PMID: 37928891 PMCID: PMC10621114 DOI: 10.2217/fvl-2023-0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/29/2023] [Indexed: 11/07/2023]
Abstract
Aim: This phase III study assessed the efficacy/safety/antiviral activity/pharmacokinetics of bemnifosbuvir, a novel, oral nucleotide analog to treat COVID-19. Patients & methods: Outpatient adults/adolescents with mild-to-moderate COVID-19 were randomized 2:1 to bemnifosbuvir/placebo. Time to symptom alleviation/improvement (primary outcome), risk of hospitalization/death, viral load and safety were evaluated. Results: Although the study was discontinued prematurely and did not meet its primary end point, bemnifosbuvir treatment resulted in fewer hospitalizations (71% relative risk reduction), COVID-19-related medically attended hospital visits, and COVID-19-related complications compared with placebo. No reduction in viral load was observed. The proportion of patients with adverse events was similar; no deaths occurred. Conclusion: Bemnifosbuvir showed hospitalization reduction in patients with variable disease progression risk and was well tolerated. Clinical Trial Registration: NCT04889040 (ClinicalTrials.gov).
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Affiliation(s)
| | | | - Gürdal Yilmaz
- Karadeniz Technical University, Trabzon, 61080, Turkey
| | | | | | | | - Neil Collinson
- Roche Products Limited, Welwyn Garden City, AL7 1TW, Hertfordshire, UK
| | - Laura Ishak
- Atea Pharmaceuticals, Inc, Boston, MA 02110, USA
| | | | | | - Catherine Granier
- Roche Products Limited, Welwyn Garden City, AL7 1TW, Hertfordshire, UK
| | - Kai Lin
- Atea Pharmaceuticals, Inc, Boston, MA 02110, USA
| | - Aeron C Hurt
- F. Hoffmann-La Roche Ltd, Basel, 4070, Switzerland
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29
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Gholipour K, Behpaie S, Iezadi S, Ghiasi A, Tabrizi JS. Costs of inpatient care and out-of-pocket payments for COVID-19 patients: A systematic review. PLoS One 2023; 18:e0283651. [PMID: 37729207 PMCID: PMC10511135 DOI: 10.1371/journal.pone.0283651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/13/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE To identify the costs of hospital care for patients with COVID-19 and the amount of out-of-pocket payments. METHODS We conducted a systematic review using Scopus and WEB OF SCIENCE and PubMed databases in April 5, 2022 and then updated in January 15, 2023. English articles with no publication year restrictions were included with study designs of cost-of-illness (COI) studies, cost analyses, and observational reports (cross-sectional studies and prospective and retrospective cohorts) that calculated the patient-level cost of care for COVID-19. Costs are reported in USD with purchasing power parity (PPP) conversion in 2020. The PROSPERO registration number is CRD42022334337. RESULTS The results showed that the highest total cost of hospitalization in intensive care per patient was 100789 USD, which was reported in Germany, and the lowest cost was 5436.77 USD, which was reported in Romania. In the present study, in the special care department, the highest percentage of total expenses is related to treatment expenses (42.23 percent), while in the inpatient department, the highest percentage of total expenses is related to the costs of hospital beds/day of routine services (39.07 percent). The highest percentage of out-of-pocket payments was 30.65 percent, reported in China, and the lowest percentage of out-of-pocket payments was 1.12 percent, reported in Iran. The highest indirect cost per hospitalization was 16049 USD, reported in USA, and the lowest was 449.07 USD, reported in India. CONCLUSION The results show that the COVID-19 disease imposed a high cost of hospitalization, mainly the cost of hospital beds/day of routine services. Studies have used different methods for calculating the costs, and this has negatively impacted the comparability costs across studies. Therefore, it would be beneficial for researchers to use a similar cost calculation model to increase the compatibility of different studies. Systematic review registration: PROSPERO CRD42022334337.
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Affiliation(s)
- Kamal Gholipour
- Tabriz Health Services Management Research Center, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sama Behpaie
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shabnam Iezadi
- Research Center for Emergency and Disaster Resilience, Red Crescent Society of the Islamic Republic of Iran, Tehran, Iran
| | - Akbar Ghiasi
- HEB School of Business & Administration, University of the Incarnate Word, San Antonio, Texas, United States of America
| | - Jafar Sadegh Tabrizi
- Tabriz Health Services Management Research Center, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
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Sobczyk K, Holecki T, Rogalska A. The impacts of the COVID-19 pandemic on indirect costs of mental illness and behavioral disorders in Poland. Front Public Health 2023; 11:1207389. [PMID: 37790719 PMCID: PMC10544582 DOI: 10.3389/fpubh.2023.1207389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/30/2023] [Indexed: 10/05/2023] Open
Abstract
Introduction In various research, the estimation of the disease's economic burden has been taken into consideration. But given the fact that different settings will have distinguished consequences, determining the economic burden of COVID-19 in the studied environment is of great importance. As a result, this study aimed to show the change in indirect costs of mental health problems due to the COVID-19 pandemic in Poland. Methods and Results Indirect costs related to mental health problems were analyzed from the perspective of the Social Insurance Institution in Poland. In 2021, they amounted to about 285.8 billion PLN (Polish currency) [61.1 billion EUR (European currency)], up 6% from the previous year. A large increase in spending on disability benefits was observed for 2019-2021 (+14.7%). Disease groups generating the highest expenditures in the structure of total expenditures on incapacity benefits in 2021 in Poland were mental health problems (16.7% of total expenditures). Expenditures on disability benefits related to mental health problems incurred by Social Security in 2021 amounted to about 7.42 billion PLN [1.6 billion EUR] and were 19.4% higher than in 2019 (before the pandemic). In the 2012-2019 period, there was a significant decrease in expenses related to inpatient rehabilitation (41.3%), while in 2020-2021, these expenses decreased several times as the epidemiological situation related to the COVID pandemic reduced access to such services. Discussion This is the first study on the economic burden of COVID-19 indirect costs in Poland. Calculating the economic impact is crucial, particularly when there is a large disease outbreak and countries are severely constrained by financial resources. Doing so could aid in the development of effective social security policies. As shown in this study, the indirect costs of absenteeism expenses due to mental health problems increased significantly during the COVID-19 pandemic. It is necessary to take all possible measures, both in the field of primary and secondary prevention, to prevent disability and exclusion from the labor market of people affected by mental health problems, which is justified by epidemiological data and financial data on the expenses incurred by Social Security for social insurance benefits.
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Affiliation(s)
- Karolina Sobczyk
- Department of Economics and Health Care Management, Faculty of Public Health in Bytom, Medical University of Silesia in Katowice, Katowice, Poland
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Konda SR, Esper GW, Meltzer-Bruhn AT, Ganta A, Egol KA. The Cost We Bear: Financial Implications for Hip Fracture Care Amidst the COVID-19 Pandemic. J Am Acad Orthop Surg 2023; 31:990-994. [PMID: 37279163 DOI: 10.5435/jaaos-d-22-00611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 05/07/2023] [Indexed: 06/08/2023] Open
Abstract
INTRODUCTION The purpose of this study was to assess the impact of COVID-19 on the cost of hip fracture care in the geriatric/middle-aged cohort, hypothesizing the cost of care increased during the pandemic, especially in COVID+ patients. METHODS Between October 2014 and January 2022, 2,526 hip fracture patients older than 55 years were analyzed for demographics, injury details, COVID status on admission, hospital quality measures, and inpatient healthcare costs from the inpatient admission. Comparative analyses were conducted between: (1) All comers and high-risk patients in the prepandemic (October 2014 to January 2020) and pandemic (February 2020 to January 2022) cohorts and (2) COVID+ and COVID- patients during the pandemic. Subanalysis assessed the difference in cost breakdown for patients in the overall cohorts, the high-risk quartiles, and between the prevaccine and postvaccine pandemic cohorts. RESULTS Although the total costs of admission for all patients, and specifically high-risk patients, were not notably higher during the pandemic, further breakdown showed higher costs for the emergency department, laboratory/pathology, radiology, and allied health services during the pandemic, which was offset by lower procedural costs. High-risk COVID+ patients had higher total costs than high-risk COVID- patients ( P < 0.001), most notably in room-and-board ( P = 0.032) and allied health ( P = 0.023) costs. Once the pandemic started, subgroup analysis demonstrated no change in the total cost in the prevaccine and postvaccine cohort. CONCLUSION The overall inpatient cost of hip fracture care did not increase during the pandemic. Although individual subdivisions of cost signified increased resource utilization during the pandemic, this was offset by lower procedural costs. COVID+ patients, however, had notably higher total costs compared with COVID- patients driven primarily by increased room-and-board costs. The overall cost of care for high-risk patients did not decrease after the widespread administration of the COVID-19 vaccine. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Sanjit R Konda
- From the Department of Orthopedic Surgery, Division of Orthopedic Trauma Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY (Konda, Esper, Meltzer Bruhn, Ganta, and Egol) and the Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Richmond Hill, NY (Konda, Egol, and Ganta)
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McGrath LJ, Moran MM, Alfred T, Reimbaeva M, Di Fusco M, Khan F, Welch VL, Malhotra D, Cane A, Lopez SMC. Clinical outcomes of COVID-19 and influenza in hospitalized children <5 years in the US. Front Pediatr 2023; 11:1261046. [PMID: 37753191 PMCID: PMC10518399 DOI: 10.3389/fped.2023.1261046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 08/21/2023] [Indexed: 09/28/2023] Open
Abstract
Introduction We compared hospitalization outcomes of young children hospitalized with COVID-19 to those hospitalized with influenza in the United States. Methods Patients aged 0-<5 years hospitalized with an admission diagnosis of acute COVID-19 (April 2021-March 2022) or influenza (April 2019-March 2020) were selected from the PINC AI Healthcare Database Special Release. Hospitalization outcomes included length of stay (LOS), intensive care unit (ICU) admission, oxygen supplementation, and mechanical ventilation (MV). Inverse probability of treatment weighting was used to adjust for confounders in logistic regression analyses. Results Among children hospitalized with COVID-19 (n = 4,839; median age: 0 years), 21.3% had an ICU admission, 19.6% received oxygen supplementation, 7.9% received MV support, and 0.5% died. Among children hospitalized with influenza (n = 4,349; median age: 1 year), 17.4% were admitted to the ICU, 26.7% received oxygen supplementation, 7.6% received MV support, and 0.3% died. Compared to children hospitalized with influenza, those with COVID-19 were more likely to have an ICU admission (adjusted odds ratio [aOR]: 1.34; 95% confidence interval [CI]: 1.21-1.48). However, children with COVID-19 were less likely to receive oxygen supplementation (aOR: 0.71; 95% CI: 0.64-0.78), have a prolonged LOS (aOR: 0.81; 95% CI: 0.75-0.88), or a prolonged ICU stay (aOR: 0.56; 95% CI: 0.46-0.68). The likelihood of receiving MV was similar (aOR: 0.94; 95% CI: 0.81, 1.1). Conclusions Hospitalized children with either SARS-CoV-2 or influenza had severe complications including ICU admission and oxygen supplementation. Nearly 10% received MV support. Both SARS-CoV-2 and influenza have the potential to cause severe illness in young children.
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Kaso AW, Mohammed E, Agero G, Churiso G, Kaso T, Ewune HA, Hailu A. Assessment of hospitalisation costs and their determinants among Covid-19 patients in South Central Ethiopia. BMC Health Serv Res 2023; 23:948. [PMID: 37667355 PMCID: PMC10478187 DOI: 10.1186/s12913-023-09988-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/30/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (Covid-19) pandemic is a global public health problem. The Covid-19 pandemic has had a substantial impact on the economy of developing countries, including Ethiopia.This study aimed to determine the hospitalisation costs of Covid-19 and the factors associated with the high cost of hospitalisation in South Central Ethiopia. METHODS A retrospective cost analysis of Covid-19 patients hospitalised between July 2020 and July 2021 at Bokoji Hospital Covid-19 Treatment Centre was conducted using both the micro-costing and top-down approaches from the health system perspective. This analysis used cost data obtained from administrative reports, the financial reports of the treatment centre, procurement invoices and the Covid-19 standard treatment guidelines. The Student's t-test, Mann-Whitney U test or Kruskal-Wallis test was employed to test the difference between sociodemographic and clinical factors when appropriate.To identify the determinants of cost drivers in the study population, a generalised linear model with gamma distribution and log link with a stepwise algorithm were used. RESULTS A total of 692 Covid-19 patients were included in the costing analysis. In this study, the mean cost of Covid-19-infected patients with no symptoms was US$1,073.86, with mild symptoms US$1,100.74, with moderate symptoms US$1,394.74 and in severe-critically ill condition US$1,708.05.The overall mean cost was US$1,382.50(95% CI: 1,360.60-1,404.40) per treated episode.The highest mean cost was observed for personnel, accounting for 64.0% of the overall cost. Older age, pre-existing diseases, advanced disease severity at admission, admission to the intensive care unit, prolonged stay on treatment and intranasal oxygen support were strongly associated with higher costs. CONCLUSIONS This study found that the clinical management of Covid-19 patients incurred significant expenses to the health system. Factors such as older age, disease severity, presence of comorbidities, use of inhalation oxygen therapy and prolonged hospital stay were associated with higher hospitalisation costs.Therefore, the government should give priority to the elderly and those with comorbidities in the provision of vaccination to reduce the financial burden on health facilities and health systems in terms of resource utilisation.
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Affiliation(s)
- Abdene Weya Kaso
- Department of Public Health, College of Health Science, Arsi University, Assela, Ethiopia.
| | - Esmael Mohammed
- Bokoji Primary Hospital, Oromia Health Bureau, Bokoji, Ethiopia
| | - Gebi Agero
- Department of Public Health, College of Health Science, Arsi University, Assela, Ethiopia
| | - Gemechu Churiso
- Department of Medical Laboratory, College of Medicine and Health Science, Dilla University, Dila, Ethiopia
| | - Taha Kaso
- Department of Surgery, College of Health Science, Arsi University, Assela, Ethiopia
| | - Helen Ali Ewune
- Department of Public Health, College of Medicine and Health Science, Dilla University, Dila, Ethiopia
| | - Alemayehu Hailu
- Faculty of Health and Social Science, Section for Global Health and Rehabilitation, Western Norway University of Applied Sciences, Bergen, Norway
- Bergen Centre for Ethics and Priority Setting, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Obiri-Yeboah D, Bena J, Alwakeel M, Buehler L, Makin V, Zhou K, Pantalone KM, Lansang MC. Association of Metformin, Dipeptidyl Dipeptidase-4 Inhibitors, and Insulin with Coronavirus Disease 2019-Related Hospital Outcomes in Patients with Type 2 Diabetes. Endocr Pract 2023; 29:681-685. [PMID: 37301375 PMCID: PMC10250053 DOI: 10.1016/j.eprac.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 05/24/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The effects of diabetes medications on COVID-19 hospitalization outcomes have not been consistent. We sought to determine the effect of metformin, dipeptidyl peptidase-4 inhibitors (DPP-4i), and insulin on admission to the intensive care unit (ICU), need for assisted ventilation, development of renal insufficiency, and mortality in patients admitted with COVID-19 infection after controlling for clinical variables and other relevant diabetes-related medications in patients with type 2 diabetes mellitus (DM). METHODS This was a retrospective study of patients hospitalized with COVID-19 from a single hospital system. Univariate and multivariate analyses were performed that included demographic data, glycated hemoglobin, kidney function, smoking status, insurance, Charlson comorbidity index, number of diabetes medications, and use of angiotensin-converting enzyme inhibitors and statin prior to admission and glucocorticoids during admission. RESULTS A total of 529 patients with type 2 DM were included in our final analysis. Neither metformin nor DPP4i prescription was associated with ICU admission, need for assisted ventilation, or mortality. Insulin prescription was associated with increased ICU admission but not with need for assisted ventilation or mortality. There was no association of any of these medications with development of renal insufficiency. CONCLUSIONS In this population, limited to type 2 DM and controlled for multiple variables that have not been consistently studied (such as a measure of general health, glycated hemoglobin, and insurance status), insulin prescription was associated with increased ICU admission. Metformin and DPP4i prescriptions did not have an association with the outcomes.
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Affiliation(s)
- Derrick Obiri-Yeboah
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - James Bena
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Mahmoud Alwakeel
- Respiratory Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Lauren Buehler
- Department of Endocrinology, Conway Medical Center, Conway, South Carolina
| | - Vinni Makin
- Department of Endocrinology and Metabolism, Cleveland Clinic, Cleveland, Ohio
| | - Keren Zhou
- Department of Endocrinology and Metabolism, Cleveland Clinic, Cleveland, Ohio
| | - Kevin M Pantalone
- Department of Endocrinology and Metabolism, Cleveland Clinic, Cleveland, Ohio
| | - M Cecilia Lansang
- Department of Endocrinology and Metabolism, Cleveland Clinic, Cleveland, Ohio.
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Klein A, Bastard M, Hemat H, Singh S, Muniz B, Manangama G, Alayyan A, Tamanna AH, Barakzaie B, Popal N, Kakar MAZ, Poulet E, Finger F. Factors associated with adverse outcomes among patients hospitalized at a COVID-19 treatment center in Herat, Afghanistan. PLOS Glob Public Health 2023; 3:e0001687. [PMID: 37619213 PMCID: PMC10449473 DOI: 10.1371/journal.pgph.0001687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 06/30/2023] [Indexed: 08/26/2023]
Abstract
Though many studies on COVID have been published to date, data on COVID-19 epidemiology, symptoms, risk factors and severity in low- and middle-income countries (LMICS), such as Afghanistan are sparse. To describe clinical characteristics, severity, and outcomes of patients hospitalized in the MSF COVID-19 treatment center (CTC) in Herat, Afghanistan and to assess risk factors associated with severe outcomes. 1113 patients were included in this observational study between June 2020 and April 2022. Descriptive analysis was performed on clinical characteristics, complications, and outcomes of patients. Univariate description by Cox regression to identify risk factors for an adverse outcome was performed. Adverse outcome was defined as death or transfer to a level 3 intensive care located at another health facility. Finally, factors identified were included in a multivariate Cox survival analysis. A total of 165 patients (14.8%) suffered from a severe disease course, with a median time of 6 days (interquartile range: 2-11 days) from admission to adverse outcome. In our multivariate model, we identified male gender, age over 50, high O2 flow administered during admission, lymphopenia, anemia and O2 saturation < = 93% during the first three days of admission as predictors for a severe disease course (p<0.05). Our analysis concluded in a relatively low rate of adverse outcomes of 14.8%. This is possibly related to the fact that the resources at an MSF-led facility are higher, in terms of human resources as well as supply of drugs and biomedical equipment, including oxygen therapy devices, compared to local hospitals. Predictors for severe disease outcomes were found to be comparable to other settings.
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Ortega-Chen C, Van Buren N, Kwack J, Mariano JD, Wang SE, Raman C, Cipta A. Palliative Extubation: A Discussion of Practices and Considerations. J Pain Symptom Manage 2023; 66:e219-e231. [PMID: 37023832 DOI: 10.1016/j.jpainsymman.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/27/2023] [Accepted: 03/26/2023] [Indexed: 04/08/2023]
Abstract
Palliative extubation (PE), also known as compassionate extubation, is a common event in the critical care setting and an important aspect of end-of-life care.1 In a PE, mechanical ventilation is discontinued. Its goal is to honor the patient's preferences, optimize comfort, and allow a natural death when medical interventions, including maintenance of ventilatory support, are not achieving desired outcomes. If not done effectively, PE can cause unintended physical, emotional, psychosocial, or other stress for patients, families, and healthcare staff. Studies show that PE is done with much variability across the globe, and there is limited evidence of best practice. Nevertheless, the practice of PE increased during the coronavirus disease 2019 pandemic due to the surge of dying mechanically ventilated patients. Thus, the importance of effectively conducting a PE has never been more crucial. Some studies have provided guidelines for the process of PE. However, our goal is to provide a comprehensive review of issues to consider before, during, and after a PE. This paper highlights the core palliative skills of communication, planning, symptom assessment and management, and debriefing. Our aim is to better prepare healthcare workers to provide quality palliative care during PEs, most especially when facing future pandemics.
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Affiliation(s)
- Christina Ortega-Chen
- Department of Geriatrics and Palliative Medicine (COC), Kaiser Permanente Southern California, Panorama City, California, USA.
| | - Nicole Van Buren
- Department of Geriatrics and Palliative Medicine (NVB, JK,JDM, SEW, AC), Kaiser Permanente Southern California, West Los Angeles, California, USA
| | - Joseph Kwack
- Department of Geriatrics and Palliative Medicine (NVB, JK,JDM, SEW, AC), Kaiser Permanente Southern California, West Los Angeles, California, USA
| | - Jeffrey D Mariano
- Department of Geriatrics and Palliative Medicine (NVB, JK,JDM, SEW, AC), Kaiser Permanente Southern California, West Los Angeles, California, USA; Kaiser Permanente Bernard J. Tyson School of Medicine (JDM, AC), Pasadena, California, USA
| | - Susan Elizabeth Wang
- Department of Geriatrics and Palliative Medicine (NVB, JK,JDM, SEW, AC), Kaiser Permanente Southern California, West Los Angeles, California, USA
| | - Charlene Raman
- Department of Graduate and Medical Education (CR), Kaiser Permanente Southern California Los Angeles Medical Center, Los Angeles, California, USA
| | - Andre Cipta
- Department of Geriatrics and Palliative Medicine (NVB, JK,JDM, SEW, AC), Kaiser Permanente Southern California, West Los Angeles, California, USA; Kaiser Permanente Bernard J. Tyson School of Medicine (JDM, AC), Pasadena, California, USA
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Uno S, Goto R, Honda K, Tokuda M, Kamata H, Chubachi S, Yamamoto R, Sato Y, Homma K, Uchida S, Namkoong H, Uwamino Y, Sasaki J, Fukunaga K, Hasegawa N. Healthcare costs for hospitalized COVID-19 patients in a Japanese university hospital: a cross-sectional study. Cost Eff Resour Alloc 2023; 21:43. [PMID: 37455306 DOI: 10.1186/s12962-023-00453-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND A health-economic evaluation related to COVID-19 is urgently needed to allocate healthcare resources efficiently; however, relevant medical cost data in Japan concerning COVID-19 are scarce. METHODS This cross-sectional study investigated the healthcare cost for hospitalized COVID-19 patients in 2021 at Keio University Hospital. We calculated the healthcare costs during hospitalization using hospital claims data and investigated the variables significantly related to the healthcare cost with multivariable analysis. RESULTS The median healthcare cost per patient for the analyzed 330 patients was Japanese yen (JPY) 1,304,431 (US dollars ~ 11,871) (interquartile range: JPY 968,349-1,954,093), and the median length of stay was 10 days. The median healthcare cost was JPY 798,810 for mild cases; JPY 1,113,680 for moderate I cases; JPY 1,643,909 for moderate II cases; and JPY 6,210,607 for severe cases. Healthcare costs increased by 4.0% for each additional day of hospitalization; 1.26 times for moderate I cases, 1.64 times for moderate II cases, and 1.84 times for severe cases compared to mild cases; and 2.05 times for cases involving ICU stay compared to those not staying in ICU. CONCLUSIONS We clarified the healthcare cost for hospitalized COVID-19 patients by severity in a Japanese university hospital. These costs contribute as inputs for forthcoming health economic evaluations for strategies for preventing and treating COVID-19.
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Affiliation(s)
- Shunsuke Uno
- Department of Infectious Diseases, Keio University School of Medicine, 35, Shinanomachi, Shinjuku, Tokyo, Japan.
| | - Rei Goto
- Graduate School of Business Administration, Keio University, Yokohama, Kanagawa, Japan
- Graduate School of Health Management, Keio University, Fujisawa, Kanagawa, Japan
| | - Kimiko Honda
- Graduate School of Health Management, Keio University, Fujisawa, Kanagawa, Japan
- Center of Health Economics and Health Technology Assessment, Keio University Global Research Institute, Tokyo, Japan
| | - Machiko Tokuda
- Graduate School of Health Management, Keio University, Fujisawa, Kanagawa, Japan
| | - Hirofumi Kamata
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shotaro Chubachi
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Ryo Yamamoto
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yukio Sato
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Koichiro Homma
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Sho Uchida
- Department of Infectious Diseases, Keio University School of Medicine, 35, Shinanomachi, Shinjuku, Tokyo, Japan
| | - Ho Namkoong
- Department of Infectious Diseases, Keio University School of Medicine, 35, Shinanomachi, Shinjuku, Tokyo, Japan
| | - Yoshifumi Uwamino
- Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Naoki Hasegawa
- Department of Infectious Diseases, Keio University School of Medicine, 35, Shinanomachi, Shinjuku, Tokyo, Japan
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Upadhyay P, Reddy J, Proctor T, Sorel O, Veereshlingam H, Gandhi M, Wang X, Singh V. Expanded PCR Panel Testing for Identification of Respiratory Pathogens and Coinfections in Influenza-like Illness. Diagnostics (Basel) 2023; 13:2014. [PMID: 37370910 DOI: 10.3390/diagnostics13122014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 05/30/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
While COVID-19 has dominated Influenza-like illness (ILI) over the past few years, there are many other pathogens responsible for ILI. It is not uncommon to have coinfections with multiple pathogens in patients with ILI. The goal of this study was to identify the different organisms in symptomatic patients presenting with ILI using two different high throughput multiplex real time PCR platforms. Specimens were collected from 381 subjects presenting with ILI symptoms. All samples (nasal and nasopharyngeal swabs) were simultaneously tested on two expanded panel PCR platforms: Applied Biosystems™ TrueMark™ Respiratory Panel 2.0, OpenArray™ plate (OA) (32 viral and bacterial targets); and Applied Biosystems™ TrueMark™ Respiratory Panel 2.0, TaqMan™ Array card (TAC) (41 viral, fungal, and bacterial targets). Results were analyzed for concordance between the platforms and for identification of organisms responsible for the clinical presentation including possible coinfections. Very good agreement was observed between the two PCR platforms with 100% agreement for 12 viral and 3 bacterial pathogens. Of 381 specimens, approximately 58% of the samples showed the presence of at least one organism with an important incidence of co-infections (~36-40% of positive samples tested positive for two and more organisms). S. aureus was the most prevalent detected pathogen (~30%) followed by SARS-CoV-2 (~25%), Rhinovirus (~15%) and HHV6 (~10%). Co-infections between viruses and bacteria were the most common (~69%), followed by viral-viral (~23%) and bacterial-bacterial (~7%) co-infections. These results showed that coinfections are common in RTIs suggesting that syndromic panel based multiplex PCR tests could enable the identification of pathogens contributing to coinfections, help guide patient management thereby improving clinical outcomes and supporting antimicrobial stewardship.
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Affiliation(s)
| | - Jairus Reddy
- HealthTrackRx R&D Division, Denton, TX 76207, USA
| | - Teddie Proctor
- Thermo Fisher Scientific, 180 Oyster Point Blvd, South San Francisco, CA 94080, USA
| | - Oceane Sorel
- Thermo Fisher Scientific, 180 Oyster Point Blvd, South San Francisco, CA 94080, USA
| | - Harita Veereshlingam
- Thermo Fisher Scientific, 180 Oyster Point Blvd, South San Francisco, CA 94080, USA
| | - Manoj Gandhi
- Thermo Fisher Scientific, 180 Oyster Point Blvd, South San Francisco, CA 94080, USA
| | - Xuemei Wang
- Thermo Fisher Scientific, 180 Oyster Point Blvd, South San Francisco, CA 94080, USA
| | - Vijay Singh
- HealthTrackRx R&D Division, Denton, TX 76207, USA
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Horga A, Kuritzkes DR, Kowalczyk JJ, Pietropaolo K, Belanger B, Lin K, Perkins K, Hammond J. Phase II study of bemnifosbuvir in high-risk participants in a hospital setting with moderate COVID-19. Future Virol 2023; 18:489-500. [PMID: 38051993 PMCID: PMC10308776 DOI: 10.2217/fvl-2023-0064] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/02/2023] [Indexed: 11/07/2023]
Abstract
Background Bemnifosbuvir, a novel, oral, nonmutagenic, nonteratogenic nucleotide analogue inhibits SARS-CoV-2 replication in vitro. Materials & methods Adults in hospital settings with moderate COVID-19 were randomized 1:1 bemnifosbuvir/placebo. Study amended to two parts after interim analysis; part B enrollment limited owing to evolving standard of care. Results Although the study ended early and did not meet the primary efficacy end point, bemnifosbuvir was well tolerated and did not contribute to all-cause mortality. Compared with placebo, bemnifosbuvir treatment resulted in 0.61 log10 greater viral load mean change on day 2; trend sustained through day 8. Treatment-emergent adverse events were similar in both groups; most were mild/moderate, unrelated to study drug. Conclusion Our results suggest a potential role for bemnifosbuvir in blunting COVID-19 progression. Clinical Trial Registration NCT04396106 (ClinicalTrials.gov).
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Affiliation(s)
| | - Daniel R. Kuritzkes
- Brigham & Women's Hospital, Division of Infectious Disease, Boston, MA 02115, USA
| | | | | | | | - Kai Lin
- Atea Pharmaceuticals, Boston, MA 02110, USA
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Gregoriano C, Rafaisz K, Schuetz P, Mueller B, Fux CA, Conen A, Kutz A. Burden of disease in patients hospitalised with COVID-19 during the first and second pandemic wave in Switzerland: a nationwide cohort study. Swiss Med Wkly 2023; 153:40068. [PMID: 37190990 DOI: 10.57187/smw.2023.40068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
AIM OF THE STUDY The first and second waves of the COVID-19 pandemic led to a tremendous burden of disease and influenced several policy directives, prevention and treatment strategies as well as lifestyle and social behaviours. We aimed to describe trends of hospitalisations with COVID-19 and hospital-associated outcomes in these patients during the first two pandemic waves in Switzerland. METHODS In this nationwide retrospective cohort study, we used in-hospital claims data of patients hospitalised with COVID-19 in Switzerland between January 1st and December 31st, 2020. First, stratified by wave (first wave: January to May, second wave: June to December), we estimated incidence rates (IR) and rate differences (RD) per 10,000 person-years of COVID-19-related hospitalisations across different age groups (0-9, 10-19, 20-49, 50-69, and ≥70 years). IR was calculated by counting the number of COVID-19 hospitalisations for each patient age stratum paired with the number of persons living in Switzerland during the specific wave period. Second, adjusted odds ratios (aOR) of outcomes among COVID-19 hospitalisations were calculated to assess the association between COVID-19 wave and outcomes, adjusted for potential confounders. RESULTS Of 36,517 hospitalisations with COVID-19, 8,862 (24.3%) were identified during the first and 27,655 (75.7%) during the second wave. IR for hospitalisations with COVID-19 was highest during the second wave and among patients above 50 years (50-69 years: first wave: 31.49 per 10,000 person-years; second wave: 62.81 per 10,000 person-years; RD 31.32 [95% confidence interval [CI]: 29.56 to 33.08] per 10,000 person-years; IRR 1.99 [95% CI: 1.91 to 2.08]; ≥70 years: first wave: 88.59 per 10,000 person-years; second wave: 228.41 per 10,000 person-years; RD 139.83 [95% CI: 135.42 to 144.23] per 10,000 person-years; IRR 2.58 [95% CI: 2.49 to 2.67]). While there was no difference in hospital readmission, when compared with the first wave, patients hospitalised during the second wave had a lower probability of death (aOR 0.88 [95% CI: 0.81 to 0.95], ARDS (aOR 0.56 [95% CI: 0.51 to 0.61]), ICU admission (aOR 0.66 [95% CI: 0.61 to 0.70]), and need for ECMO (aOR 0.60 [95% CI: 0.38 to 0.92]). LOS was -16.1 % (95% CI: -17.8 to -14.2) shorter during the second wave. CONCLUSION In this nationwide cohort study, rates of hospitalisations with COVID-19 were highest among adults older than 50 years and during the second wave. Except for hospital readmission, the likelihood of adverse outcomes was lower during the second pandemic wave, which may be explained by advances in the understanding of the disease and improved treatment options.
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Affiliation(s)
- Claudia Gregoriano
- Medical University Department, Division of General Internal and Emergency Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Kris Rafaisz
- Medical University Department, Division of General Internal and Emergency Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Philipp Schuetz
- Medical University Department, Division of General Internal and Emergency Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Beat Mueller
- Medical University Department, Division of General Internal and Emergency Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christoph A Fux
- Medical University Department, Division of General Internal and Emergency Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
- Department of Infectious Diseases and Infection Prevention, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Anna Conen
- Medical University Department, Division of General Internal and Emergency Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
- Department of Infectious Diseases and Infection Prevention, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Alexander Kutz
- Medical University Department, Division of General Internal and Emergency Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Alinia C, Bolbanabad AM, Moradi G, Shokri A, Ghaderi E, Adabi J, Rezaei S, Piroozi B. Burden of COVID‐19 disease in Kurdistan province in west of Iran using disability‐adjusted life years. Health Sci Rep 2023; 6:e1154. [PMID: 36970642 PMCID: PMC10033847 DOI: 10.1002/hsr2.1154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 01/08/2023] [Accepted: 03/02/2023] [Indexed: 03/25/2023] Open
Abstract
Background and Aims During the coronavirus disease 2019 (COVID‐19) pandemic, about seven million people were infected with the disease, of which more than 133,000 died. Health policymakers need to know the extent and magnitude of the disease burden to decide on how much to allocate resources for disease control. The results of this investigation could be helpful in this field. Methods We used the secondary data released by the Kurdistan University of Medical Sciences between February 2020 to October 2021 to estimate the age‐sex standardized disability‐adjusted life years (DALY) by the sum of the years of life lived with disability (YLD) and the years of life lost (YLL). We also applied the local and specific values of the disease utility in the calculations. Results The total DALY was estimated at 23316.5 and 1385.5 per 100,000 populations The YLD and YLL constituted 1% and 99% of the total DALY, respectively. The DALY per 100,000 populations was highest in the men and people aged more than 65 years, but the prevalence was the highest in people under the age of 40. Conclusions Compared to the findings of the “burden of disease study 2019,” the burden of COVID‐19 in Iran is ranked first and eighth among communicable and noncommunicable diseases, respectively. Although the disease affects all groups, the elderly suffer the most from it. Given the very high YLL of COVID‐19, the best strategy to reduce the burden of COVID‐19 in subsequent waves should be to focus on preventing infection in the elderly population and reducing mortality.
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Affiliation(s)
- Cyrus Alinia
- Healthcare Management & Economics Department, School of Public HealthUrmia University of Medical SciencesUrmiaIran
| | - Amjad M. Bolbanabad
- Social Determinants of Health Research Center, Research Institute for Health DevelopmentKurdistan University of Medical SciencesSanandajIran
| | - Ghobad Moradi
- Social Determinants of Health Research Center, Research Institute for Health DevelopmentKurdistan University of Medical SciencesSanandajIran
| | - Azad Shokri
- Social Determinants of Health Research Center, Research Institute for Health DevelopmentKurdistan University of Medical SciencesSanandajIran
| | - Ebrahim Ghaderi
- Social Determinants of Health Research Center, Research Institute for Health DevelopmentKurdistan University of Medical SciencesSanandajIran
| | - Jalil Adabi
- Social Determinants of Health Research Center, Research Institute for Health DevelopmentKurdistan University of Medical SciencesSanandajIran
| | - Satar Rezaei
- School of Public HealthKermanshah University of Medical SciencesKermanshahIran
| | - Bakhtiar Piroozi
- Healthcare Management & Economics Department, School of Public HealthUrmia University of Medical SciencesUrmiaIran
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Di Fusco M, Marczell K, Thoburn E, Wiemken TL, Yang J, Yarnoff B. Public health impact and economic value of booster vaccination with Pfizer-BioNTech COVID-19 vaccine, bivalent (original and omicron BA.4/BA.5) in the United States. J Med Econ 2023; 26:509-524. [PMID: 36942976 DOI: 10.1080/13696998.2023.2193067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
OBJECTIVE To assess the public health impact and economic value of booster vaccination with the Pfizer-BioNTech COVID-19 Vaccine, Bivalent in the United States. METHODS A combined cohort Markov decision tree model estimated the cost-effectiveness and budget impact of booster vaccination compared to no booster vaccination in individuals aged ≥5 years. Analyses prospectively assessed three scenarios (base case, low, high) defined based upon the emergence (or not) of subvariants, using list prices. Age-stratified parameters were informed by literature. The cost-effectiveness analysis estimated cases, hospitalizations and deaths averted, Life Years (LYs) and Quality Adjusted Life Years (QALYs) gained, the incremental cost-effectiveness ratio (ICER), the net monetary benefit (NMB), and the Return on Investment (ROI). The budget impact analyses used the perspective of a hypothetical 1-million-member plan. Sensitivity analyses explored parameter uncertainty. Conservatively, indirect effects and broad societal benefits were not considered. RESULTS The base case predicted that, compared to no booster vaccination, the Pfizer-BioNTech COVID-19 Vaccine, Bivalent could result in ∼3.7 million fewer symptomatic cases, 162 thousand fewer hospitalizations, 45 thousand fewer deaths, 373 thousand fewer discounted QALYs lost, and was cost-saving. Using a conservative value of $50,000 for 1 LY, every $1 invested yielded estimated $4.67 benefits. Unit costs, health outcomes and effectiveness had the greatest impact on results. At $50,000 per QALY gained, the booster generated a 34.2 billion NMB and probabilistic sensitivity analyses indicated a 92% chance of being cost-saving and 98% of being cost-effective. The bivalent was cost-saving or highly cost-effective in high and low scenarios. In a hypothetical 1-million-member health plan population, the vaccine was predicted to be a budget-efficient solution for payers. CONCLUSIONS Booster vaccination with the Pfizer-BioNTech COVID-19 Vaccine, Bivalent for the US population aged ≥5 years could generate notable public health impact and be cost-saving based on the findings of our base case analyses.
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Affiliation(s)
| | - Kinga Marczell
- Evidera, Bocskai út 134-146, Dorottya Udvar, E épület 2. emelet, Budapest, Hungary
| | | | | | - Jingyan Yang
- Pfizer Inc., New York, NY USA
- Institute for Social and Economic Research and Policy, Columbia University, New York, NY, USA
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Walmsley T, Rose A, John R, Wei D, Hlávka JP, Machado J, Byrd K. Macroeconomic consequences of the COVID-19 pandemic. Econ Model 2023; 120:106147. [PMID: 36570545 PMCID: PMC9768433 DOI: 10.1016/j.econmod.2022.106147] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 11/30/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
We estimate the economic impacts of COVID-19 in the U.S. using a disaster economic consequence analysis framework implemented by a dynamic computable general equilibrium (CGE) model. This facilitates identification of relative influences of several causal factors as "shocks" to the model, including mandatory business closures, disease spread trajectories, behavioral responses, resilience, pent-up demand, and government stimulus packages. The analysis is grounded in primary data on avoidance behavior and healthcare parameters. The decomposition of the influence of various causal factors will help policymakers offset the negative influences and reinforce the positive ones during the remainder of this pandemic and future ones.
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Affiliation(s)
- Terrie Walmsley
- Center for Risk and Economic Analysis of Threats and Emergencies (CREATE), USC, Los Angeles, CA, USA
- Department of Economics, Dana and David Dornsife College of Letters, Arts and Sciences, University of Southern California (USC), Los Angeles, CA, USA
| | - Adam Rose
- Center for Risk and Economic Analysis of Threats and Emergencies (CREATE), USC, Los Angeles, CA, USA
- Sol Price School of Public Policy, USC, Los Angeles, CA, USA
| | - Richard John
- Center for Risk and Economic Analysis of Threats and Emergencies (CREATE), USC, Los Angeles, CA, USA
- Department of Psychology, Dana and David Dornsife College of Letters, Arts and Sciences, USC, Los Angeles, CA, USA
| | - Dan Wei
- Center for Risk and Economic Analysis of Threats and Emergencies (CREATE), USC, Los Angeles, CA, USA
- Sol Price School of Public Policy, USC, Los Angeles, CA, USA
| | - Jakub P Hlávka
- Center for Risk and Economic Analysis of Threats and Emergencies (CREATE), USC, Los Angeles, CA, USA
- Sol Price School of Public Policy, USC, Los Angeles, CA, USA
- Leonard D. Schaeffer Center for Health Policy & Economics, USC, Los Angeles, CA, USA
| | - Juan Machado
- Center for Risk and Economic Analysis of Threats and Emergencies (CREATE), USC, Los Angeles, CA, USA
| | - Katie Byrd
- Center for Risk and Economic Analysis of Threats and Emergencies (CREATE), USC, Los Angeles, CA, USA
- Department of Psychology, Dana and David Dornsife College of Letters, Arts and Sciences, USC, Los Angeles, CA, USA
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Cardoso RB, Marcolino MAZ, Marcolino MS, Fortis CF, Moreira LB, Coutinho AP, Clausell NO, Nabi J, Kaplan RS, Etges APBDS, Polanczyk CA. Comparison of COVID-19 hospitalization costs across care pathways: a patient-level time-driven activity-based costing analysis in a Brazilian hospital. BMC Health Serv Res 2023; 23:198. [PMID: 36829122 PMCID: PMC9955521 DOI: 10.1186/s12913-023-09049-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 01/09/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic raised awareness of the need to better understand where and how patient-level costs are incurred in health care organizations, as health managers and other decision-makers need to plan and quickly adapt to the increasing demand for health care services to meet patients' care needs. Time-driven activity-based costing offers a better understanding of the drivers of cost throughout the care pathway, providing information that can guide decisions on process improvement and resource optimization. This study aims to estimate COVID-19 patient-level hospital costs and to evaluate cost variability considering the in-hospital care pathways of COVID-19 management and the patient clinical classification. METHODS This is a prospective cohort study that applied time-driven activity-based costing (TDABC) in a Brazilian reference center for COVID-19. Patients hospitalized during the first wave of the disease were selected for their data to be analyzed to estimate in-hospital costs. The cost information was calculated at the patient level and stratified by hospital care pathway and Ordinal Scale for Clinical Improvement (OSCI) category. Multivariable analyses were applied to identify predictors of cost variability in the care pathways that were evaluated. RESULTS A total of 208 patients were included in the study. Patients followed five different care pathways, of which Emergency + Ward was the most followed (n = 118, 57%). Pathways which included the intensive care unit presented a statistically significant influence on costs per patient (p < 0.001) when compared to Emergency + Ward. The median cost per patient was I$2879 (IQR 1215; 8140) and mean cost per patient was I$6818 (SD 9043). The most expensive care pathway was the ICU only, registering a median cost per patient of I$13,519 (IQR 5637; 23,373) and mean cost per patient of I$17,709 (SD 16,020). All care pathways that included the ICU unit registered a higher cost per patient. CONCLUSIONS This is one of the first microcosting study for COVID-19 that applied the TDABC methodology and demonstrated how patient-level costs vary as a function of the care pathways followed by patients. These findings can be used to develop value reimbursement strategies that will inform sustainable health policies in middle-income countries such as Brazil.
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Affiliation(s)
- Ricardo Bertoglio Cardoso
- grid.8532.c0000 0001 2200 7498National Institute of Science and Technology for Health Technology Assessment (IATS) (project: 465518/2014-1), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil ,grid.8532.c0000 0001 2200 7498Graduate Program in Epidemiology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Miriam Allein Zago Marcolino
- grid.8532.c0000 0001 2200 7498National Institute of Science and Technology for Health Technology Assessment (IATS) (project: 465518/2014-1), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil ,grid.8532.c0000 0001 2200 7498Graduate Program in Epidemiology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Milena Soriano Marcolino
- grid.8430.f0000 0001 2181 4888Internal Medicine Division, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Camila Felix Fortis
- grid.8532.c0000 0001 2200 7498National Institute of Science and Technology for Health Technology Assessment (IATS) (project: 465518/2014-1), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Leila Beltrami Moreira
- grid.8532.c0000 0001 2200 7498School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil ,grid.414449.80000 0001 0125 3761Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Ana Paula Coutinho
- grid.414449.80000 0001 0125 3761Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Nadine Oliveira Clausell
- grid.8532.c0000 0001 2200 7498School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil ,grid.414449.80000 0001 0125 3761Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Junaid Nabi
- grid.38142.3c000000041936754XHarvard Business School, Boston, MA USA
| | - Robert S. Kaplan
- grid.38142.3c000000041936754XHarvard Business School, Boston, MA USA
| | - Ana Paula Beck da Silva Etges
- grid.8532.c0000 0001 2200 7498National Institute of Science and Technology for Health Technology Assessment (IATS) (project: 465518/2014-1), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil ,grid.8532.c0000 0001 2200 7498Graduate Program in Epidemiology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil ,grid.412519.a0000 0001 2166 9094School of Technology, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Carisi Anne Polanczyk
- National Institute of Science and Technology for Health Technology Assessment (IATS) (project: 465518/2014-1), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. .,Graduate Program in Epidemiology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. .,School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. .,Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
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Somani ST, Firestone RL, Donnelley MA, Sanchez L, Hatfield C, Fine J, Wilson MD, Duby JJ. Impact of Vaccination on Cost and Course of Hospitalization Associated with COVID-19 Infection. Antimicrob Steward Healthc Epidemiol 2023; 3:e19. [PMID: 36714292 PMCID: PMC9879923 DOI: 10.1017/ash.2022.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/18/2022] [Accepted: 11/26/2022] [Indexed: 06/18/2023]
Abstract
OBJECTIVE Examine the impact of vaccination status on hospital cost and course for patients admitted with COVID-19 infection. DESIGN Retrospective cohort study characterizing vaccinated and unvaccinated individuals hospitalized for COVID-19 between April 2021 to January 2022. SETTING Large academic medical center. METHODS Patients were included if they were greater than 18 years old, fully vaccinated or unvaccinated against COVID-19, and admitted for COVID-19 infection. PATIENTS 437 consecutively admitted patients for COVID-19 infection met inclusion criteria. Of these, 79 were excluded for unknown or partial vaccination status, transfer from an outside hospital, or multiple COVID-19 related admissions. RESULTS Overall, 279 (77.9%) unvaccinated patients compared to 79 (22.1%) vaccinated patients were hospitalized with a diagnosis of COVID-19. Average length of stay was significantly lower in the vaccinated group (6.47 days versus 8.92 days, P = 0.03). Vaccinated patients experienced a 70.6% lower risk of ICU admission (OR = 0.29, 95% CI 0.12-0.71, P = 0.006). The unadjusted cost of hospitalization was not found to be statistically significant ($119,630 versus $191,146, P = 0.06). After adjusting for age and comorbidities, vaccinated patients experienced a 26% lower cost of hospitalization compared to unvaccinated patients (P = 0.004). Unvaccinated patients incurred a significantly higher cost of hospitalization per day ($29,425 vs $13,845 P < 0.0001). Unvaccinated patients (n = 118, 42.9%) were more likely than vaccinated patients (n = 16, 20.3%) to require high-flow oxygen or mechanical ventilation (OR = 2.95, 95% CI 1.62-5.38, P = 0.0004). CONCLUSION Vaccinated patients experienced a lower cost of hospitalization after adjusting for age and comorbidities and shorter length of stay compared to unvaccinated patients admitted for COVID-19.
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Affiliation(s)
- Selina T. Somani
- Department of Pharmacy, University of California Davis Health, Sacramento, California
| | - Rachelle L. Firestone
- Department of Pharmacy, University of California Davis Health, Sacramento, California
| | - Monica A. Donnelley
- Department of Pharmacy, University of California Davis Health, Sacramento, California
| | - Luciano Sanchez
- Department of Pharmacy, University of California Davis Health, Sacramento, California
| | - Chad Hatfield
- Department of Pharmacy, University of California Davis Health, Sacramento, California
| | - Jeffrey Fine
- Division of Biostatistics, University of California Davis, Sacramento, California
| | - Machelle D. Wilson
- Division of Biostatistics, University of California Davis, Sacramento, California
| | - Jeremiah J. Duby
- Department of Pharmacy, University of California Davis Health, Sacramento, California
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Yuan S, Li T, Chu C, Wang X, Liu L. Treatment cost assessment for COVID-19 inpatients in Shenzhen, China 2020-2021: facts and suggestions. Front Public Health 2023; 11:1066694. [PMID: 37213645 PMCID: PMC10192705 DOI: 10.3389/fpubh.2023.1066694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 04/17/2023] [Indexed: 05/23/2023] Open
Abstract
Background Knowledge regarding the treatment cost of coronavirus disease 2019 (COVID-19) in the real world is vital for disease burden forecasts and health resources planning. However, it is greatly hindered by obtaining reliable cost data from actual patients. To address this knowledge gap, this study aims to estimate the treatment cost and specific cost components for COVID-19 inpatients in Shenzhen city, China in 2020-2021. Methods It is a 2 years' cross-sectional study. The de-identified discharge claims were collected from the hospital information system (HIS) of COVID-19 designated hospital in Shenzhen, China. One thousand three hundred ninety-eight inpatients with a discharge diagnosis for COVID-19 from January 10, 2020 (the first COVID-19 case admitted in the hospital in Shenzhen) to December 31, 2021. A comparison was made of treatment cost and cost components of COVID-19 inpatients among seven COVID-19 clinical classifications (asymptomatic, mild, moderate, severe, critical, convalescent and re-positive cases) and three admission stages (divided by the implementation of different treatment guidelines). The multi-variable linear regression models were used to conduct the analysis. Results The treatment cost for included COVID-19 inpatients was USD 3,328.8. The number of convalescent cases accounted for the largest proportion of all COVID-19 inpatients (42.7%). The severe and critical cases incurred more than 40% of treatment cost on western medicine, while the other five COVID-19 clinical classifications spent the largest proportion (32%-51%) on lab testing. Compared with asymptomatic cases, significant increases of treatment cost were observed in mild cases (by 30.0%), moderate cases (by 49.2%), severe cases (by 228.7%) and critical cases (by 680.7%), while reductions were shown in re-positive cases (by 43.1%) and convalescent cases (by 38.6%). The decreasing trend of treatment cost was observed during the latter two stages by 7.6 and 17.9%, respectively. Conclusions Our findings identified the difference of inpatient treatment cost across seven COVID-19 clinical classifications and the changes at three admission stages. It is highly suggestive to inform the financial burden experienced by the health insurance fund and the Government, to emphasize the rational use of lab tests and western medicine in the COVID-19 treatment guideline, and to design suitable treatment and control policy for convalescent cases.
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Affiliation(s)
- Shasha Yuan
- Institute of Medical Information & Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ting Li
- National Clinical Research Centre for Infectious Diseases, The Third People's Hospital of Shenzhen, Shenzhen, China
- Centre for Environment and Population Health, School of Medicine and Dentistry, Griffith University, Brisbane, QLD, Australia
| | - Cordia Chu
- Centre for Environment and Population Health, School of Medicine and Dentistry, Griffith University, Brisbane, QLD, Australia
| | - Xiaowan Wang
- Institute of Medical Information & Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- *Correspondence: Xiaowan Wang
| | - Lei Liu
- National Clinical Research Centre for Infectious Diseases, The Third People's Hospital of Shenzhen, Shenzhen, China
- Lei Liu
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Kim N, Aly A, Craver C, Garvey WT. Burden of illness associated with overweight and obesity in patients hospitalized with COVID-19 in the United States: analysis of the premier healthcare database from April 1, 2020 to October 31, 2020. J Med Econ 2023; 26:376-385. [PMID: 36812069 DOI: 10.1080/13696998.2023.2183679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND SARS-CoV-2 (COVID-19) continues to be a major public health issue. Obesity is a major risk factor for disease severity and mortality associated with COVID-19. OBJECTIVE This study sought to estimate the healthcare resource use and cost outcomes in patients hospitalized with COVID-19 in the United States (US) according to body mass index (BMI) class. METHODS Retrospective cross-sectional study analyzing data from the Premier Healthcare COVID-19 database for hospital length-of-stay (LOS), intensive care unit (ICU) admission, ICU LOS, invasive mechanical ventilator use, invasive mechanical ventilator use duration, in-hospital mortality, and total hospital costs from hospital charge data. RESULTS After adjustment for patient age, gender, and race, patients with COVID-19 and overweight or obesity had longer durations for mean hospital LOS (normal BMI = 7.4 days, class 3 obesity = 9.4 days, p < .0001) and ICU LOS (normal BMI = 6.1 days, class 3 obesity = 9.5 days, p < .0001) than patients with normal weight. Patients with normal BMI had fewer days on invasive mechanical ventilation compared to patients with overweight and obesity classes 1-3 (6.7 days vs. 7.8, 10.1, 11.5, and 12.4, respectively, p < .0001). The predicted probability of in-hospital mortality was nearly twice that of patients with class 3 obesity compared to patients with normal BMI (15.0 vs 8.1%, p < .0001). Mean (standard deviation) total hospital costs for a patient with class 3 obesity is estimated at $26,545 ($24,433-$28,839), 1.5 times greater than the mean for a patient with a normal BMI at $17,588 ($16,298-$18,981). CONCLUSIONS Increasing levels of BMI class, from overweight to obesity class 3, are significantly associated with higher levels of healthcare resource utilization and costs in adult patients hospitalized with COVID-19 in the US. Effective treatment of overweight and obesity are needed to reduce the burden of illness associated with COVID-19.
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Affiliation(s)
- Nina Kim
- Novo Nordisk Inc., Plainsboro, NJ, USA
| | | | - Chris Craver
- Craver Research Services, Huntersville, North Carolina
| | - W Timothy Garvey
- Department of Nutrition Sciences, The University of Alabama at Birmingham, Birmingham, AL, USA
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Muacevic A, Adler JR, Ferraro B, Durkin M, Krinock M, Durkin M. A Rare Case of ST-Segment Elevation Myocardial Infarction and Left Ventricular Thrombus in a Dextrocardia Patient With COVID-19 Infection. Cureus 2023; 15:e33527. [PMID: 36779150 PMCID: PMC9906126 DOI: 10.7759/cureus.33527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2023] [Indexed: 01/11/2023] Open
Abstract
Acute coronary syndrome (ACS) is an increasingly common finding among patients presenting with Coronavirus Disease 2019 (COVID-19) pneumonia. While cardiovascular disease alone remains one of the most common causes of death among COVID-19 patients in the United States, its heightened prevalence with COVID-19 pneumonia has been well documented. Here we present the case of a 58-year-old male with an extensive cardiac history including coronary artery disease (CAD) with multiple drug-eluting stents (DES) placed and an episode of cardiac arrest requiring implantable cardioverter defibrillator (ICD) placement. He presented to the Emergency Department originally complaining of chest pain, shortness of breath, and fatigue, and was found to be positive for COVID-19 pneumonia. Cardiac catheterization demonstrated extensive CAD and evaluation for coronary artery bypass grafting (CABG) was warranted. Shortly after, the patient experienced an acute thrombotic episode in the left anterior descending (LAD) coronary artery and underwent successful emergent high-risk percutaneous coronary intervention (PCI) with DES placement. The patient was also found to have a left ventricular thrombus requiring anticoagulation. Despite his complex course, the patient had a very favorable outcome.
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49
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Kohli MA, Maschio M, Joshi K, Lee A, Fust K, Beck E, Van de Velde N, Weinstein MC. The potential clinical impact and cost-effectiveness of the updated COVID-19 mRNA fall 2023 vaccines in the United States. J Med Econ 2023; 26:1532-1545. [PMID: 37961887 DOI: 10.1080/13696998.2023.2281083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/06/2023] [Indexed: 11/15/2023]
Abstract
AIMS To assess the potential clinical impact and cost-effectiveness of COVID-19 mRNA vaccines updated for fall 2023 in adults aged ≥18 years over a 1-year analytic time horizon (September 2023-August 2024). MATERIALS AND METHODS A compartmental Susceptible-Exposed-Infected-Recovered model was updated to reflect COVID-19 cases in summer 2023. The numbers of symptomatic infections, COVID-19-related hospitalizations and deaths, and costs and quality-adjusted life-years (QALYs) gained were calculated using a decision tree model. The incremental cost-effectiveness ratio (ICER) of a Moderna updated mRNA fall 2023 vaccine (Moderna Fall Campaign) was compared to no additional vaccination. Potential differences between the Moderna and the Pfizer-BioNTech fall 2023 vaccines were also examined. RESULTS Base case results suggest that the Moderna Fall Campaign would decrease the expected 64.2 million symptomatic infections by 7.2 million (11%) to 57.0 million. COVID-19-related hospitalizations and deaths are expected to decline by 343,000 (-29%) and 50,500 (-33%), respectively. The Moderna Fall Campaign would increase QALYs by 740,880 and healthcare costs by $5.7 billion relative to no vaccine, yielding an ICER of $7700 per QALY gained. Using a societal cost perspective, the ICER is $2100. Sensitivity analyses suggest that vaccine effectiveness, COVID-19 incidence, hospitalization rates, and costs drive cost-effectiveness. With a relative vaccine effectiveness of 5.1% for infection and 9.8% for hospitalization for the Moderna vaccine versus the Pfizer-BioNTech vaccine, use of the Moderna vaccine is expected to prevent 24,000 more hospitalizations and 3300 more deaths than the Pfizer-BioNTech vaccine. LIMITATIONS AND CONCLUSIONS As COVID-19 becomes endemic, future incidence, including patterns of infection, are highly uncertain. The effectiveness of fall 2023 vaccines is unknown, and it is unclear when a new variant that evades natural or vaccine immunity will emerge. Despite these limitations, our model predicts the Moderna Fall Campaign vaccine is highly cost-effective across all sensitivity analyses.
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Affiliation(s)
| | | | | | - Amy Lee
- Quadrant Health Economics Inc., Cambridge, ON, Canada
| | - Kelly Fust
- Quadrant Health Economics Inc., Cambridge, ON, Canada
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50
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Abraham I, Lee KKC, Gregg M. Journal of Medical Economics in review: high impact articles from 2022. J Med Econ 2023; 26:303-307. [PMID: 36840388 DOI: 10.1080/13696998.2023.2178690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Affiliation(s)
- Ivo Abraham
- Professor of Pharmacy, Medicine, and Clinical Translational Sciences, University of Arizona, Tucson, AZ, USA
| | - Kenneth K C Lee
- Professor of Pharmacy, School of Pharmacy, Taylors University, Malaysia
| | - Mike Gregg
- Executive Editor, Taylor & Francis, London, UK
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