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Mowl ZK, LeFevre A, Ververs M. A comparison of total cost estimates between exclusive breast-feeding and breast milk substitute usage in humanitarian contexts. Public Health Nutr 2023; 26:3162-3172. [PMID: 37921005 PMCID: PMC10755374 DOI: 10.1017/s1368980023002434] [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: 05/08/2023] [Revised: 09/28/2023] [Accepted: 10/26/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE Using a model-based analysis, we calculated the total costs associated with the exclusive breast-feeding (EBF) and breast milk substitute (BMS) usage for one infant for six months within select humanitarian contexts to (a) determine if there is a notable difference in costs and (b) use these results to inform future creation of data-informed humanitarian response standard operating procedures. DESIGN The inputs and costing data were drawn from a mixture of local e-commerce vendors, peer-reviewed literature and personal communications with field-based humanitarian responders. To account for cost fluctuations, each input's costs along with low and high parameters are presented. All costs are presented in 2021 United States Dollars. SETTING Humanitarian responses within Indonesia and Jordan. PARTICIPANTS Not applicable. RESULTS There was a notable difference in the total cost of care in both selected locations across the study arms (Indonesia: $542; Jordan: $892). CONCLUSIONS Given the reality of limited funding for comprehensive humanitarian response around the world and the necessity of prioritising certain interventions, humanitarian response organisations should consider the notable cost difference between EBF and BMS usage (along with the proven health benefits of EBF). This difference should play a role in informing the future creation of standard operating procedures while also ensuring that all infants within a humanitarian crisis receive appropriate feeding.
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Affiliation(s)
| | - Amnesty LeFevre
- University of Cape Town School of Public Health, Cape Town, South Africa
| | - Mija Ververs
- Johns Hopkins Center for Humanitarian Health, Baltimore, MD21205, USA
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Maziarz RT, Devine S, Garrison LP, Agodoa I, Badaracco J, Gitlin M, Perales MA. Estimating the Lifetime Medical Cost Burden of an Allogeneic Hematopoietic Cell Transplantation Patient. Transplant Cell Ther 2023; 29:637.e1-637.e9. [PMID: 37364775 PMCID: PMC11035010 DOI: 10.1016/j.jtct.2023.06.013] [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: 04/03/2023] [Revised: 06/02/2023] [Accepted: 06/20/2023] [Indexed: 06/28/2023]
Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) has the potential for curative outcomes for a variety of hematologic malignancies. Current allo-HCT studies often describe the outcomes and costs in the near term; however, research on the lifetime economic burden post-allo-HCT remains limited. This study was conducted to estimate the average total lifetime direct medical costs of an allo-HCT patient and the potential net monetary savings from an alternative treatment associated with improved graft-versus-host disease (GVHD)-free, relapse-free survival (GRFS). A disease-state model was constructed using a short-term decision tree and a long-term semi-Markov partitioned survival model to estimate the average per-patient lifetime cost and expected quality-adjusted life years (QALYs) for an allo-HCT patient from a US healthcare system perspective. Key clinical inputs included overall survival, GRFS, incidence of both acute and chronic GVHD, relapse of the primary disease, and infections. Cost results were reported as ranges based on varying the percentage of chronic GVHD patients that remained on treatment after 2 years (15% or 39%). Over a lifetime, the average per-patient medical cost of allo-HCT was estimated to range from $942,373 to $1,247,917. The majority of the costs were for chronic GVHD treatment (37% to 53%), followed by the allo-HCT procedure (15% to 19%). The expected lifetime QALYs of an allo-HCT patient were estimated as 4.7. Lifetime per-patient treatment costs often exceed $1,000,000 for allo-HCT patients. Innovative research efforts focused on the reduction or elimination of late complications, particularly chronic GVHD, may provide the greatest value to improved patient outcomes.
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Affiliation(s)
- Richard T Maziarz
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon.
| | - Steven Devine
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Louis P Garrison
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, Washington
| | | | | | | | - Miguel-Angel Perales
- Adult Bone Marrow Transplantation Service. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
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Xia L, Gao L, Zhong Y, Wu Y, He J, Zou F, Jian R, Xia S, Chen C, Zhu S. Assessing the influencing factors of out-of-pocket costs on tuberculosis in Sichuan Province: a cross-sectional study. BMC Public Health 2023; 23:1391. [PMID: 37468877 DOI: 10.1186/s12889-023-16180-y] [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: 09/13/2022] [Accepted: 06/22/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Although diagnosis and treatment services for tuberculosis (TB) are provided free of charge in most countries, direct non-medical and indirect costs due to absenteeism, also place a significant burden on patients and their families. Sichuan Province has the second highest incidence of TB in China, with an incidence of approximately 100 cases per 100 000 people. However, there are limited research on out-of-pocket expenditure (OOPE) and its influencing factors in TB patients in Sichuan Province. METHODS A retrospective cross-sectional study was conducted on TB patients in designated medical institutions for TB in Sichuan Province from 2017-2021. A face-to-face questionnaire was conducted to obtain the information related to hospitalization of patients, and the multi-level regression model was used to analyse the factors that influence OOPE and total out-of-pocket expenditure (TOOPE) of TB patients. RESULTS A total of 2644 patients were investigated, and 74.24% of TB patients and their families experienced catastrophic total costs due to TB. The median total cost was 9223.37 CNY (1429.98 USD), in which the median direct and indirect costs of TB patients were 10185.00 CNY (1579.07 USD) and 2400.00 CNY (372.09 USD), respectively, and indirect costs contributed to 43% of total costs. The median OOPE and TOOPE costs were 6024.00 CNY (933.95 USD) and 11890.50 CNY (1843.49 USD), respectively. OOPE and TOOPE had common influencing factors including whether the patient's family had four or more members, a history of hospitalization, combination with other types of TB, the number of visits before diagnosis, and co-occurrence with chronic disease. CONCLUSIONS The OOPE and TOOPE for TB patients and their families in Sichuan Province are still heavy. In the long run, it is necessary to strengthen education and awareness campaigns on TB related knowledge, disseminate basic medical knowledge to the public, improve healthcare-seeking behavior, and enhance the healthcare infrastructure to improve the accuracy of TB diagnosis and reduce the significant OOPE and TOOPE faced by TB patients and their families in Sichuan Province.
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Affiliation(s)
- Lan Xia
- Department of Tuberculosis, Sichuan Provincial Center for Disease Control and Prevention, No.6 Middle School Road, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Lijie Gao
- Department of Epidemiology and Statistics, School of Medicine, Jinan University, Guangzhou, 510632, China
| | - Yin Zhong
- Department of Tuberculosis, Sichuan Provincial Center for Disease Control and Prevention, No.6 Middle School Road, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Ya Wu
- Department of Epidemiology and Statistics, School of Medicine, Jinan University, Guangzhou, 510632, China
| | - Jinge He
- Department of Tuberculosis, Sichuan Provincial Center for Disease Control and Prevention, No.6 Middle School Road, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Fengjuan Zou
- Department of Epidemiology and Statistics, School of Medicine, Jinan University, Guangzhou, 510632, China
| | - Ronghua Jian
- Department of Epidemiology and Statistics, School of Medicine, Jinan University, Guangzhou, 510632, China
| | - Sujian Xia
- Department of Epidemiology and Statistics, School of Medicine, Jinan University, Guangzhou, 510632, China
| | - Chuang Chen
- Department of Tuberculosis, Sichuan Provincial Center for Disease Control and Prevention, No.6 Middle School Road, Wuhou District, Chengdu, 610041, Sichuan Province, China.
| | - Sui Zhu
- Department of Epidemiology and Statistics, School of Medicine, Jinan University, Guangzhou, 510632, China.
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Boese CK, Lechler P, Frink M, Hackl M, Eysel P, Ries C. [Cost analysis of inpatient versus outpatient intravenous antibiotic treatment for periprosthetic joint infections : A simulation]. Orthopade 2021; 50:150-158. [PMID: 32076752 PMCID: PMC7862513 DOI: 10.1007/s00132-020-03889-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Hintergrund Die parenterale Antibiotikagabe im Rahmen der Therapie von periprothetischen Infektionen erfordert in der Regel eine stationäre Behandlung und geht mit hohen Kosten einher. Fragestellung Es wurden tatsächliche stationäre Behandlungskosten („inpatient parenteral antibiotic therapy“ [IPAT]) mit simulierten Kosten einer ambulanten Behandlung („outpatient parenteral antibiotic therapy“ [OPAT]) von Patienten mit periprothetischen Gelenkinfektionen verglichen. Die Auswertung erfolgte aus Perspektive der Kostenträger (gesetzliche Krankenversicherung [GKV]) und Leistungserbringer (Krankenhäuser). Material und Methoden Die Analyse und Simulation erfolgten auf Grundlage einer ICD-10 (Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme, 10. Revision) für das Behandlungsjahr 2015 mit der Diagnose T84. Ergebnisse Die simulierte Reduktion von 159 Bettentagen bei den in die Studie eingeschlossenen 12 Patienten erbrachte aus Sicht der Kostenträger eine Reduktion der Gesamtkosten um >18.000 €. Aus Perspektive der Leistungserbringer verbesserte sich der Reinerlös um >22.000 €. Die Gesamtkosten der OPAT für den Kostenträger beliefen sich auf >57.000 €. Für den Leistungserbringer zeigte sich in der Differenz von Poliklinikerlös und -kosten der OPAT ein Verlust von >1500 €. Diskussion Die OPAT ist für Leistungserbringer insgesamt finanziell vorteilhaft. Weitere Vorteile durch Opportunitätskosten erscheinen interessant. Für den Kostenträger ist die OPAT insbesondere durch die ambulanten Medikamentenkosten mit einem finanziellen Mehraufwand verbunden. Der niedergelassene Sektor sollte durch die anzunehmende Mehrbelastung ebenso wie der anzunehmende Patientenkomfort bedacht werden.
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Affiliation(s)
- Christoph Kolja Boese
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinik Köln (AöR), Joseph-Stelzmann-Str. 9, 50924, Köln, Deutschland.
| | - Philipp Lechler
- Klinik für Unfall- und Handchirurgie, Kreiskliniken Altötting, Altötting, Deutschland.,Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Gießen und Marburg, Marburg, Deutschland
| | - Michael Frink
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Gießen und Marburg, Marburg, Deutschland
| | - Michael Hackl
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinik Köln (AöR), Joseph-Stelzmann-Str. 9, 50924, Köln, Deutschland
| | - Peer Eysel
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinik Köln (AöR), Joseph-Stelzmann-Str. 9, 50924, Köln, Deutschland
| | - Christian Ries
- Klinik für Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
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Yu J, Judy JT, Parasuraman S, Sinha M, Weisdorf D. Inpatient Healthcare Resource Utilization, Costs, and Mortality in Adult Patients with Acute Graft-versus-Host Disease, Including Steroid-Refractory or High-Risk Disease, following Allogeneic Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2019; 26:600-605. [PMID: 31678539 DOI: 10.1016/j.bbmt.2019.10.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 08/09/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 11/29/2022]
Abstract
Acute graft-versus-host disease (GVHD) contributes to poor outcomes following allogeneic hematopoietic cell transplantation (HCT). Data are limited regarding the economic burden of acute GVHD, particularly steroid-refractory or high-risk (SR/HR) disease. This retrospective analysis of the Premier Healthcare Database reports inpatient healthcare resource utilization (HCRU), costs, and mortality during initial hospitalization for allogeneic HCT and through 100 days post-HCT among patients who developed acute GVHD, including a subgroup with SR/HR disease, compared with patients without GVHD. The analysis included adults discharged for first HCT between January 1, 2011, and June 30, 2016 (acute GVHD, n = 906; SR/HR acute GVHD, n = 158; no GVHD, n = 1529). During the initial hospitalization for HCT, patients with acute GVHD and SR/HR acute GVHD (n = 455 and 125, respectively) had significantly longer median lengths of stay (31 and 46 days versus 24 days) and higher median total costs ($153,849 and $205,880 versus $97,417) versus patients with no GVHD (n = 1529; P < .0001 for all). During the 100-day post-HCT period, patients with acute GVHD and SR/HR acute GVHD had higher readmission rates (78.3% and 77.2% versus 28.3%; P < .0001) and inpatient mortality rates (20.2% and 35.4% versus 8.9%; P < .0001) versus patients with no GVHD. In summary, acute GVHD, especially SR/HR disease, is associated with longer inpatient stays, higher readmission rates, and higher inpatient mortality compared with no GVHD.
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Affiliation(s)
- Jingbo Yu
- Incyte Corporation, Wilmington, Delaware.
| | | | | | | | - Daniel Weisdorf
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
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Polinder S, Haagsma J, Panneman M, Scholten A, Brugmans M, Van Beeck E. The economic burden of injury: Health care and productivity costs of injuries in the Netherlands. Accid Anal Prev 2016; 93:92-100. [PMID: 27177394 DOI: 10.1016/j.aap.2016.04.003] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 03/02/2016] [Accepted: 04/04/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Detailed information on health care costs and productivity costs for the whole spectrum of injuries is lacking. We measured the total costs of injuries by external-cause, injury groupings, age and sex. METHOD Injury patients visiting an Emergency Department in the Netherlands were included. Health service use and work absenteeism were estimated with national database data and a prospective follow-up study. Health care costs (direct costs) and productivity costs (indirect costs) were determined using the incidence-based Dutch Cost of Injury Model. RESULTS Total costs of injuries were €3.5 billion annually (€210/capita and €4300/patient); €2.0 billion healthcare costs and €1.5 billion productivity costs. Home and leisure injury subcategory falls caused 41% of total costs. Traffic injury was prominent in the 15-54 age group, mainly due to bicycle injuries. Sports injuries, in special football/soccer injuries, resulted in high costs in the 15-24 age group. Although costs per patient were comparable between males and females, health care costs were higher in females, whereas males have more than twice as high productivity costs. Health care costs were highest for hip fractures (€20,000/patient). Extremity fractures had high costs due to high incidences and high productivity costs per patient. CONCLUSION Our detailed cost model identified known risk groups, such as elderly females with hip fractures resulting from falls, as well as less obvious important high risk groups, such as young children falling from furniture, young males who sustained football/soccer injuries and bicycle injuries among all ages. This information is essential to assess additional priority areas for prevention.
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Affiliation(s)
- Suzanne Polinder
- Erasmus MC, Department of Public Health, PO Box 2040, 3000CA Rotterdam, The Netherlands.
| | - Juanita Haagsma
- Erasmus MC, Department of Public Health, PO Box 2040, 3000CA Rotterdam, The Netherlands
| | | | - Annemieke Scholten
- Erasmus MC, Department of Public Health, PO Box 2040, 3000CA Rotterdam, The Netherlands
| | | | - Ed Van Beeck
- Erasmus MC, Department of Public Health, PO Box 2040, 3000CA Rotterdam, The Netherlands
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