Research on Current Curative Expenditure and Influencing Factors Among Cardiovascular and Cerebrovascular Diseases Based on “System of Health Accounts 2011”

Background: This study aims to research the total current curative expenditure (CCE) of cardiovascular and cerebrovascular diseases (CVDs) and their influencing factors in Xinjiang, China. Methods: Through multistage stratified cluster sampling, the sample information of patients with CVDs in Xinjiang, in 2017, was collected. Under the framework of “System of Health Accounts 2011,” the top-down allocation method was used to calculate the CCE of CVDs. Multiple linear regression was used to analyze the influencing factors. Results: The CCE of CVDs in Xinjiang was 10.574 billion yuan; 86.81% of the CCE was spent in hospitals, of which 67.22% went to general hospitals. Coronary heart disease, hypertension, and cerebral infarction were the top three diseases among the treatment cost of CVDs, accounting for 74.20% of the total treatment cost. The CCE of older adults aged 65 years and above accounted for 43.51%. The main factors affecting the hospitalization cost were length of stay, grade of the medical institution, operation, age, payment method, and gender. Conclusions: CVDs consume numerous health funds in Xinjiang; prevention and control work focus on older adults. Further, the flow of treatment cost institutions is unreasonable; thus, the role of primary medical institutions in the prevention and treatment of chronic diseases should be strengthened. Reducing the length of hospital stay can effectively control the CCE.

Cylindrical intensive vs. double surface LED phototherapy for neonatal hyperbilirubinemia

Background High bilirubin levels may lead to complications such as bilirubin encephalopathy or even death. Therefore, neonatal hyperbilirubinemia patients require appropriate treatment in the form of phototherapy or exchange transfusion. With the advancement of technology, various types of phototherapy, such as the cylindrical intensive phototherapy (bilisphere) and double LED, are now available. Objective To compare cylindrical intensive phototherapy to double surface LED phototherapy in neonatal hyperbilirubinemia. Methods This cohort study was conducted in neonates with hyperbilirubinemia at at Syamsudin SH Hospital, Sukabumi, West Java, who were treated with either cylindrical intensive phototherapy or double surface LED phototherapy. The variables observed were subjects’ characteristics, bilirubin levels pre- and post-therapy, duration of phototherapy, length of stay, and total treatment cost. The data were analyzed using univariate and bivariate analyses. Results Of 47 neonates, the mean bilirubin levels were 19.36 mg/dL pre-therapy and 12.26 mg/dL post-therapy. Subjects’ overall mean duration of phototherapy was 24 hours, mean length of stay was 1 day, and mean cost of treatment was IDR 813,175. There was no significant difference in the bilirubin decrease between the cylindrical intensive phototherapy and double LED groups. However, there were significant differences between the cylindrical intensive phototherapy and double LED groups in duration of phototherapy (10.75 vs. 75.17 hours, respectively (P<0.000), mean length of stay (1 vs. 3.13 days, respectively (P<0.000), and total cost of treatment (IDR 598,918 vs. IDR 1,036,747, respectively P<0.000). Conclusion While the decrease in bilirubin was not significantly different in neonatal hyperbilirubinemia patients who underwent cylindrical intensive phototherapy compared to double LED therapy, cylindrical intensive phototherapy relates to significant shorter phototherapy duration, length of stay, and total treatment cost. Hence, cylindrical intensive phototherapy phototherapy is considered to be more time-efficient and cost-efficient than double LED phototherapy.

ANTIMICROBIAL AGENT’S UTILIZATION AND COST PATTERN IN MEDICAL INTENSIVE CARE UNIT OF A TERTIARY CARE HOSPITAL

Objective: The objective of this study was to evaluate the utilization and cost pattern of AMAs (Antimicrobial Agents) in the Medical ICU of a tertiary care teaching hospital, and to determine the predictor of antimicrobial number per day. Methods: A prospective cross-sectional study was carried out and a total of 101 patients were studied. The drugs were classified into different groups according to the World Health Organization’s ATC (Anatomical Therapeutic Chemical) Classification System. Results: The mean [95% confidence interval (CI)] duration of ICU stay was 7.11 (5.70-8.52) days and the mortality rate in the ICU was 42.6%. The AMAs DDD (Defined Daily Dose) per 100 patient days and number of AMAs per prescription were 296.64 and 2.65, respectively. Piperacillin-tazobactam was the most commonly utilized AMAs followed by metronidazole, meropenem, fluconazole, and colistin. The mean number [95% CI] of AMAs, DDD, and cost (INR) per patient were 18.82 (14.05-23.59), 21.09 (15.36-26.81) and 25,827 (18,716-32,939) respectively. The AMAs constituted 88.53% of the total treatment cost. Meropenem was the most costly AMA (32.10% of the total AMAs cost) followed by imipenem-cilastatin (20.50%), colistin (14.65%), piperacillin-tazobactam (8.40%), and clindamycin (4.47%). The independent predictor for the antimicrobial number per day was acute physiology and chronic health evaluation II (APACHE-II) score at admission and nosocomial infections. Conclusion: The AMAs, DDD per 100 patient days, and number per prescription were higher. This leads to a higher cost of AMAs per patient and the AMAs cost out of the total cost as compared to previous studies. We suggest, there is a need to formulate and implement an antimicrobial restriction policy.

Intervening factors in the costs of fluoridation in water supply systems: a case study in seven population sizes

ABSTRACT The aim of this study was to analyze the costs of fluoridation in water supply systems of different population sizes. A case study was carried out comprising cities in the state of Espírito Santo, Brazil. The costs of initial installation, the chemical product, the operation of the system, and the control of fluoride levels between the years 2012 and 2017 were considered. The annual per capita cost of the treatment was calculated to estimate the fluoridation weight concerning the total expenses. The fluoridation annual per capita cost ranged from R$ 20.14 (US$ 7.23) in towns with less than two thousand inhabitants to R$ 0.39 (US$ 0.14) in cities with a population of approximately 520 thousand inhabitants. In systems that supply up to 30 thousand inhabitants, the running cost was responsible for most of the expenses, ranging from 98.2 to 84%. For cities with 520 thousand inhabitants, the costs with the chemical product corresponded to 74.7% of the expenses. Compared with the total treatment cost, the water fluoridation cost ranged from 0.2 to 0.6% for population sizes of 30 thousand inhabitants or more and varied from 1.3 to 7.3% for towns with less than 10 thousand inhabitants. Considering that the decision-making process is complex in the field of public policies, and decision-makers suffer multiple influences as for different policy alternatives, knowing the implications of population size for costs is essential for informed decision-making.

Costs comparison of treating diabetic macular edema with aflibercept, ranibizumab or dexamethasone at 1 year in France (INVICOST study)

Purpose: INVICOST, a medico-economic analysis, compared costs of managing treatment-naive patients with diabetic macular edema (DME) receiving intravitreal injections (IVIs) of aflibercept (AFL), dexamethasone implant (DXI) or ranibizumab (RAN) over 1 year. Methods: Healthcare resource use and associated costs were estimated using individual patient data from INVICTUS, a prospective, open-label, monocentric study. Healthcare costs comprised direct medical costs such as drug acquisition and administration, consultations and ophthalmological procedures. Costs were assessed from the French National Health Insurance perspective using published national tariffs expressed in 2019 euros. Results: Of the 60 treated eyes, 48 had no treatment switch; 14 received AFL, 19 received DXI and 15 received RAN. AFL-treated eyes received an average of 6.5 IVIs, DXI-treated patients received 2 IVIs and RAN-treated received 6.8 IVIs. All treated eyes received an initial prescription for adjunctive ocular medications and 349 follow-up procedures were performed including an average of 3.9 optical coherence tomography and 3.2 retinography procedures per eye. Average total direct cost of per-eye treatment was €4516 (€1128–€8257). Average cost was €5782 for eyes treated with AFL, €2779 with DXI and €5536 with RAN. Drug therapy was the cost driver: €4394 (76%) for AFL, €1915 for DXI (69%) and €4268 (77%) for RAN. Conclusion: The difference in total treatment cost is largely explained by the significantly lower frequency of IVI and annual cost of therapy with DXI, compared with AFL and RAN. INVICOST is the first study comparing treatment costs with AFL, DXI and RAN in France in current clinical practice.

Treatment effectiveness and economic evaluation of different pulp treatments of primary molars: a retrospective study

Background This study focused on the primary molars meeting the indications partially overlapping of indirect pulp treatment (IPT), pulpotomy and pulpectomy.The aims were to compare the effectiveness and cost of these three treatments and apply cost-effectiveness analysis to provide guidance for physicians and parents.Materials and Methods The subjects were children whose primary molars were treated with IPT, pulpotomy or pulpectomy from May 2014 to May 2015 in the Peking University School of Stomatology. The general information, treatment information and total treatment cost of patients were collected. Tooth survival time, cost and survival time: cost ratio were compared between the IPT group and the pulpotomy group, and between the pulpotomy group and the pulpectomy group.Results The survival time: cost ratio of the IPT group was 3.56 ± 0.14 d/Yuan, which was significantly higher than the pulpotomy group (1.46 ± 0.056 d/Yuan; P < 0.001); which was in turn significantly higher than the pulpectomy group (0.89 ± 0.038 d/Yuan; P < 0.001).Conclusion IPT had the lowest survival time: cost ratio, indicating this procedure was more economical at a 2.5-3-year follow-up compared with pulpotomy. Pulpotomy was found to be more economical than pulpectomy.

The clinical efficacy of novel vacuum suction ureteroscopic lithotripsy in the treatment of upper ureteral calculi

This study investigated the clinical efficacy of a novel vacuum suction ureteroscopic approach in the treatment of upper ureteral calculi. A total of 160 patients with impacted upper ureteral calculi were included in this study. 50 patients underwent rigid ureteroscopic lithotripsy, 54 patients underwent flexible ureteroscopic lithotripsy, and 56 patients underwent vacuum suction ureteroscopic lithotripsy. The operative time, length of hospitalization, stone-free rate, complication rate and total treatment cost were compared among the three groups. Subgroup analysis was performed based on the stone diameter over and below 1.5 cm. Compared with the other two groups, the vacuum suction ureteroscopy group had higher stone-free rate at 3–5 days (90.0% vs. 61.9% vs. 55.6%, P < 0.05) and 1 month (96.4% vs. 77.7% vs. 74.0%, P < 0.05) postoperatively. In subgroup analysis, the stone-free rate of the vacuum suction ureteroscopy group was significantly higher when the stone diameter was > 1.5 cm at 1 month postoperatively ( P < 0.05); however, there were no differences in postoperative complications.( P > 0.05). In conclusion, the novel vacuum suction ureteroscopic lithotripsy has significantly improved the stone-free rate especially in complicated cases; however the complication and cost was not increased.

Retrograde intrarenal surgery or percutaneous nephrolithotomy in the treatment of impacted proximal ureteric calculi

The objective of this study was to compare the clinical efficacy of retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) in the treatment of impacted proximal ureteric calculi. This was a retrospective study on surgical outcomes of 202 patients with impacted proximal ureteric calculi. Overall, 140 and 62 were treated with RIRS and PCNL, respectively. The effects of the choice of the surgical method on the surgical outcomes were evaluated by preoperatively scoring patients with high-risk factors related to stone characteristics and analyzing these scores. Compared to the RIRS group, the surgical duration of the PCNL group was significantly shorter (51.69 ± 25.07 min vs. 67.46 ± 27.12 min, p < 0.05), stone-free rate (SFR) was significantly increased (98.4% vs. 72.10%, p < 0.05), and total treatment cost was lower (US $1678.61 ± 714.86 vs. US $3901.45 ± 1069.46, p < 0.05). Preoperatively, the efficacy of PCNL was higher than that of RIRS based on the higher scores observed. The results indicated PCNL had a better SFR and higher surgical efficacy, whereas RIRS had higher surgical safety parameters, a shorter perioperative period, but a lower initial SFR. PCNL is often more advantageous for complicated impacted proximal ureter stone.

A prototype of textile wastewater treatment using coagulation and adsorption by Fe/Cu nanoparticles: Techno-economic and scaling-up studies

This study aims to investigate the efficiency of a pilot prototype system comprising coagulation/flocculation, filtration, and nano-bimetallic iron/copper (Fe/Cu) degradation and adsorption units for the removal of chemical oxygen demand (COD), biological oxygen demand (BOD), color, total nitrogen (TN), total phosphorus (TP), and TSS from real textile wastewater. The total removal efficiencies of the system were 96, 98, 82, 69, 88, and 97%, respectively, using 0.5 g/L ferric chlorides as a coagulant under an optimum adsorption condition of pH 6.0, nano-dosage 1.4 g/L, contact time 80 min, and stirring rate 250 r/min at room temperature. Adsorption isotherms indicated that the removal of COD and TP obeys both Koble–Corrigan and Freundlich adsorption models, removal of color obeys both Koble–Corrigan and Hill adsorption models, and removal of TN and TSS obeys Koble–Corrigan and Khan models, respectively. Avrami kinetic models adequately describe the adsorption data for COD, BOD, TN, and TSS, while pseudo-second-order and intraparticle models described the removal mechanism of color and TSS, respectively. An artificial neural network (ANN) with r2-value exceeding 0.98 is accurate and can be used with confidence in predicting removal efficiencies of the targeted parameters. Sensitivity analysis results showed that the initial concentration was the most influential parameter for TSS removal with relative importance greater than 25%, while the bimetallic Fe/Cu dosage was the most influential factor for all other studied parameters with relative importance greater than 40%. The total treatment cost of the proposed system per m3 after scaling up was found to be US$4.5 for reuse of the treated water for the irrigation of forest trees.

Rapid assessment of avoidable blindness-based healthcare costs of diabetic retinopathy in Hungary and its projection for the year 2045

Background/aimsThe purpose of this study was to estimate the total healthcare cost associated with diabetic retinopathy (DR) in the population aged 18 years and older in Hungary, and its projection for the year 2045.MethodsA cost model was developed based on the standardised rapid assessment of avoidable blindness with the diabetic retinopathy module (RAAB+DRM) methodology and recently reported prevalent-based cost of illness model. Projection for 2045 was made based on the estimation for increasing diabetes mellitus (DM) prevalence of the International Diabetes Federation. Costs were analysed from the perspective of the healthcare system and the patients. Our DR cost model was constructed according to the Scottish DR grading scale and based on the DR severity stadium.ResultsThe total DR-associated healthcare cost was US$145.8 million in 2016 and will increase to US$169.0 million by 2045. The two major cost drivers were intravitreal antivascular endothelial growth factor injections and vitrectomies in this study (US$126.4 million in 2016 and US$146.5 million in 2045); they amounted to 86.7% of the total treatment cost of DR. The DR-related cost per patient was US$180.5 in Hungary.ConclusionsThe cost per patient for treating DR was lower in Hungary than in other countries. Due to the increasing socioeconomic burden of proliferative DR and diabetes-related blindness, it would be important to invest in DR screening, prevention and early treatment. Our new RAAB-based cost of DR model may facilitate comparisons of DR treatment costs across countries.