Estimated Direct Medical Cost of Osteoporosis in Saudi Arabia: A Single-Center Retrospective Cost Analysis

Osteoporosis and its complications are a major health concern in Saudi Arabia, and the prevalence of osteoporosis is on the rise. The aim of this study was to estimate the direct healthcare cost for patients with osteoporosis. A retrospective study was carried out among adult patients with osteoporosis in a teaching hospital in Saudi Arabia. A bottom-up approach was conducted to estimate the healthcare resources used and the total direct medical cost for the treatment of osteoporosis and related fractures. The study included 511 osteoporosis patients, 93% of whom were female. The average (SD) age was 68.5 years (10.2). The total mean direct medical costs for patients without fractures were USD 975.77 per person per year (PPPY), and for those with osteoporotic fractures, the total direct costs were USD 9716.26 PPPY, of which 56% of the costs were attributable to surgery procedures. Prior to fractures, the main cost components were medication, representing 61%, and physician visits, representing 18%. The findings of this study indicated the economic impact of osteoporosis and related fractures. With the aging population in Saudi Arabia, the burden of disease could increase significantly, which highlights the need for effective prevention strategies to minimize the economic burden of osteoporosis.

Treatment pattern and direct medical costs of pediatric outpatients with actuate respiratory infection at X hospital in Jambi

Introduction: Acute respiratory infection is common among the general public. Such disease and its associated symptoms encourage higher consumption of medicine. Varied medications for ARI patients incur different costs of each patient, which eventually lead to higher healthcare costs. Objectives: To identify the treatment patterns and direct medical costs among ARI pediatric patients at X Hospital in Jambi. Methods: This research was an observational study with retrospective data collection. The samples were collected in 2018. Results: The results showed that the most-frequently administered antibiotic for ARI pediatric patients was cefixime (29.17%), while the most-commonly used supportive therapy for ARI pediatric patients was the combination of antihistamines, antipyretics-analgesics, decongestant, and corticosteroid (16.67%). The total direct medical cost to ARI pediatric patients was IDR 191,097. Conclusion: The mean direct medical cost for ARI therapy was IDR 191,097. More administered therapy resulted in higher medical costs. Keywords: ARI, child, antibiotics, direct medical costs

Direct Healthcare Costs Associated with Oligoarticular Juvenile Idiopathic Arthritis at a Single Center

Oligoarticular juvenile idiopathic arthritis (JIA) is a common disease in pediatric rheumatology. The management of oligoarticular JIA can result in a considerable economic burden. This study is a four-year, retrospective cost identification analysis performed to determine the annual direct cost of care for patients with oligoarticular JIA and possible predictive clinical factors. Direct healthcare costs were defined as those associated with office visits, laboratory studies, hospital admissions, joint injections, medications, infusions, radiology tests, and emergency room visits. Disease characteristics and patient information included ANA status, gender, age at diagnosis, duration from diagnosis to initial visit during the study period, and whether uveitis had been diagnosed. We identified 97 patients with oligoarticular JIA eligible for the study. The median age of diagnosis was 4.3 years. Positive ANA were noted in 75% of patients. 34% of patients received at least one intra-articular steroid injection. 32% of patients were prescribed a biologic during the study period, predominantly with other medications, while 23% of patients received only NSAIDs. 20% of patients were prescribed oral steroids. The average total direct medical cost in this study per year for an oligoarticular JIA patient was $3929±6985. Medications accounted for 85% of annual direct medical costs. Clinic visits and laboratory testing accounted for 8% and 5%, respectively. Patient characteristics and demographics were tested for association with direct medical costs by the Wilcoxon rank sum test and Kruskal-Wallis test. Patients who were ANA positive had increased annual costs compared to patients who are ANA negative. ANA-positive patients were found to have statistically significant costs, particularly, in laboratory tests, procedural costs, radiology costs, and medication costs. The results reported here provide information when allocating healthcare resources and a better understanding of the economic impact oligoarticular JIA has on the United States healthcare system.

Type 2 diabetes and healthcare resource utilisation in the Kingdom of Bahrain

Background Type 2 diabetes is a growing health challenge in the Kingdom of Bahrain, and the disease exerts significant pressure on the healthcare system. The aim of this study was to assess the annual costs and understand the drivers of those costs in the country. Methods A sample of 628 patients diagnosed with type 2 diabetes were randomly selected from primary healthcare diabetes clinics, and the direct medical and indirect costs due to type 2 diabetes were analysed for a one-year period. The study used patients’ medical records, interviews and standardised frequency questionnaires to obtain data on demographic and clinical characteristics, complication status, treatment profile, healthcare resource utilisation and absenteeism due to diabetes. The indirect costs were estimated by using the human capital approach. The direct medical and indirect costs attributable to type 2 diabetes were extrapolated to the type 2 diabetes population in Bahrain. Results In 2015, the total direct medical cost of type 2 diabetes was 104.7 million Bahraini dinars (BHD), or 277.9 million US dollars (USD), and the average unit cost per person with type 2 diabetes (1162 BHD, or 3084 USD) was more than three times higher than for a person without the condition (372 BHD, or 987 USD). The healthcare costs for patients with both micro- and macrovascular complications were more than three times higher than for patients without complications. Thus, 9% of the patients consumed 21% of the treatment costs due to complications. Complications often lead to hospital admission, and 20% of the patients consumed almost 60% of the healthcare costs attributable to type 2 diabetes due to hospital admissions. The indirect cost due to absenteeism was 1.23 million BHD (3.26 million USD). Conclusion Type 2 diabetes exerts significant pressure on Bahrain’s healthcare system – primarily due to costly diabetes-related complications. It is therefore important to optimise the management and control of type 2 diabetes, thereby reducing the risk of disabling and expensive complications.

PHARMACOECONOMIC EVALUATION OF ACUTE EXACERBATIONS OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE AT A TERTIARY CARE TEACHING HOSPITAL IN NORTH KARNATAKA, INDIA

Objective: The objective of the study was to evaluate the burden of cost in patients of acute exacerbations of chronic obstructive lung disease (COPD).Methods: A prospective, observational study was conducted in COPD patients over a period of 6 months in general medicine and pulmonary wards of Navodaya Medical College Hospital and Research Centre, Raichur, Karnataka, India. Direct medical and non-medical cost were included in the burden of cost. From the drug rate manual of hospital, cost for drugs and investigation were calculated.Results: Overall 100 COPD patients were enrolled in which 92 were male and 8 were female with a mean age of 60.33±10.98. The patients participated in this study were stayed in the hospital with mean±standard deviation (SD) value of 9±3. Minimum total direct medical cost was Rs. 1149.00 and maximum was Rs. 13,510.00 with a mean±SD 3297.48±1634.226, in which medicine cost was high (mean 2746.63). Minimum total direct non-medical cost was Rs. 100.00 and maximum was Rs. 3470.00 with a mean±SD 700.7±487.121, in which food expenses was high (mean 549.55). Maximum total direct cost was Rs.16,980.00 and minimum was 1349.00 with a mean± SD 3998.18±1921.47. Direct medical cost contributes 79.56% and direct non-medical cost contribute 20.44% of total direct cost.Conclusion: COPD has a substantial impact on health-care costs particularly for hospitalization. Exacerbation prevention resulting in reduced need for inpatient care could lower costs. The development of pharmacoeconomic is at an infancy stage in India at the moment, despite the rapid growth of clinical research. In a country with scarce resources and an ever-growing population with diverse health-care needs, health economics (Pharmacoeconomic evaluation) plays a pivotal role in determining the delivery of equitable and cost-effective health services.

Analisis Cost-Effectiveness Seftazidim Generik pada Pasien Kanker Payudara di Rumah Sakit Kanker “Dharmais” Jakarta, 2012

ABSTRACTAdministration of ceftazidime shortened duration of neutropenia and hospitalization days in breast cancer patients who had infection after myelosupressive chemotherapy. Cost-effectiveness analysis (CEA) as one of pharmacoeconomic methods was important to determine treatment attaining effect for lower cost. The aim of this study was to comparethe total direct medical cost and effectiveness, which was measured from length-of-stay (LOS), of generic ceftazidime A and B usage, and to decide which ceftazidime that was more cost-effective in early-stage and late-stage breast cancer patients at National Cancer Center Dharmais Hospital Jakarta year 2012. The study design was non-experimental withcomparative study retrospectively on secondary data from medical records and administrative data in 2012. Samples were taken by using total sampling method. The number of samples were 9 patients, which included 7 patients with generic ceftazidime A and 2 patients with generic ceftazidime B. The total direct medical cost of generic ceftazidime A in early-stage and late-stage breast cancer patients, respectively Rp 15.930.407,45 and Rp 15.962.519,25, were higher than generic B, respectively Rp 6.716.225,21 and Rp 7.147.956,92. Median LOS of generic A ceftazidime in early-stage and late-stage breast cancer patients, respectively 7 days and 10 days, were longer than generic B, respectively 3 days and 4 days. According to CEA result, generic ceftazidime B was more cost-effective than generic A.ABSTRAKPemberian seftazidim dapat mempersingkat durasi neutropenia dan lama hari rawat inap pada pasien kanker payudara yang mengalami infeksi setelah kemoterapi mielosupresif. Analisis cost-effectiveness merupakan salah satu metode farmakoekonomi yang penting untuk menentukan obat efektif dengan biaya yang lebih rendah. Penelitian dilakukan untuk membandingkan total biaya medis langsung dan efektivitas yang dilihat dari lama hari rawat penggunaan seftazidim generik A dan B, serta menentukan seftazidim yang lebih cost-effective pada pasien kanker payudara stadium awal dan lanjut di Rumah Sakit Kanker “Dharmais” Jakarta, 2012. Desain penelitian yang digunakan adalah studi komparatif secara retrospektif terhadap data rekam medis dan administrasi tahun 2012. Pengambilan sampel dilakukan secara total sampling. Jumlah pasien yang dilibatkan dalam analisis 9 pasien, yaitu 7 pasien menggunakan seftazidim generik A dan 2 pasien menggunakan seftazidim generik B. Median total biaya medis langsung kelompok generik A pada pasien kanker stadium awal maupun lanjut berturut-turut sebesar Rp 15.930.407,45 dan Rp 15.962.519,25 lebih tinggi dibanding generik B, berturut-turut sebesar Rp 6.716.225,21 dan Rp 7.147.956,92. Median lama hari rawat kelompok generik A pada pasien kanker stadium awal maupun lanjut berturut-turut 7 hari dan 10 hari, lebih panjang dibanding generik B, berturut-turut 3 hari dan 4 hari. Berdasarkan hasil penelitian disimpulkan bahwa seftazidim generik B lebih cost-effective dibanding generik A.

Under-recognized pertussis in adults from Asian countries: a cross-sectional seroprevalence study in Malaysia, Taiwan and Thailand

SUMMARYSurveillance data on the burden of pertussis in Asian adults are limited. This cross-sectional study evaluated the prevalence of serologically confirmed pertussis in adults with prolonged cough in Malaysia, Taiwan and Thailand. Adults (⩾19 years) with cough lasting for ⩾14 days without other known underlying cause were enrolled from outpatient clinics of seven public and/or private hospitals. Single blood samples for anti-pertussis toxin antibodies (anti-PT IgG) were analysed and economic impact and health-related quality of life (EQ-5D) questionnaires assessed. Sixteen (5·13%) of the 312 chronically coughing adults had serological evidence of pertussis infection within the previous 12 months (anti-PT IgG titre ⩾62·5 IU/ml). Three of them were teachers. Longer duration of cough, paroxysms (75% seroconfirmed, 48% non-seroconfirmed) and breathlessness/chest pain (63% seroconfirmed, 36% non-seroconfirmed) were associated with pertussis (P< 0·04). Of the seroconfirmed patients, the median total direct medical cost per pertussis episode in public hospitals (including physician consultations and/or emergency room visits) was US$13 in Malaysia, US$83 in Taiwan (n= 1) and US$26 in Thailand. The overall median EQ-5D index score of cases was 0·72 (range 0·42–1·00). Pertussis should be considered in the aetiology of adults with a prolonged or paroxysmal cough, and vaccination programmes considered.

Abstract 144: Cost of Cardiovascular Disease Episodes among Patients with Hypertension

Background: Because of its high prevalence and direct contribution to cardiovascular diseases (CVD), hypertension is among the most expensive components of CVD, representing nearly 50% of the total direct medical cost of CVD in the U.S. Yet, little is known about the per-patient cost of CVD episodes among hypertensives. Methods: This study used insurance claims data from over 16,000 individuals diagnosed with hypertension and enrolled in a private health insurance plan between 2008 and 2010. About one million medical and pharmacy insurance claims generated by these hypertensive patients were extracted for the analysis. Six CVD were included in the study: Myocardial infarction (MI), unstable angina (UA), stable angina (SA), transient ischemic attack (TIA), stroke, and congestive heart failure (CHF). Direct medical costs (ambulatory, emergency, hospital visits and medications) for each CVD were obtained on a weekly basis over 26 weeks before and after a recorded CVD episode. Per-patient direct medical costs were estimated by taking a before-after difference in cost, corrected by censoring due to deaths and insurance plan exits. Average costs were segmented by age groups (40-64 and 65 or over). Costs were adjusted to 2010 U.S. dollars. Results: The most expensive CVD episode among hypertensives was UA ($17,704; 95%CI $11,632-22,644), followed by MI ($13,480; 95%CI $8,328-18,752), stroke ($13,223; 95%CI $8,080-17,556), CHF ($12,462; 95%CI $9,734-15,335), SA ($6,991; 95%CI $4,178-9,947), and TIA ($5,787; 95%CI $2,671-9,670). CVD costs converged to pre-event cost levels within the next 4 to 14 months after the recorded CVD episode. Some CVD costs (CHF, UA, MI) rose 1 to 3 weeks before the recorded event, while others (stroke, TIA, SA) clearly started during the week of the recorded event (see Figure 1 comparing CHF and stroke). For the former, pre-event costs explained up to 30% of total costs. Conclusions: Cost estimates of CVD episodes among hypertensive patients are consistent with results from the scarce literature in this area. Moreover, our study finds evidence of increased medical resource utilization weeks before the recording of the CVD episode. Omitting these pre-event costs leads to an underestimate of the true costs of CVD.

A Review of Exenatide in the Treatment of Type 2 Diabetes Mellitus

Diabetes Mellitus (DM) is a chronic disease, with a rapidly increasing worldwide incidence and prevalence. Diabetes accounts for 8% of the US population, according to the United States Centers for Disease Control and Prevention. In terms of individuals, this number comes to a staggering 24 million. 1 In 2007, the total direct medical cost of treating diabetes and its associated complications was $116 billion. More than half of this is spent in treating its complications, both micro and macrovasular. Indirect costs in terms of disability, loss of work or premature mortality amounted to an additional $58 billion. 2 Several trials have shown the benefits of improved glycemic control on microvasular complications 3 – 7 and a propensity to reduce macrovasular disease. Furthermore tight glycemic control early in the disease, so called the legacy effect, has shown to reduce mortality. 5 However, these and several other trials have shown the progressive and unrelenting nature of the disease. Reduced efficacies of existing medications over prolonged periods, and continued beta cell dysfunction have lead to unmet glycemic targets. In addition, current antidiabetic medications have significant side effects most of which include hypoglycemia and weight gain. All the above points are rasion d'être that new additional therapies are needed. Recently, new classes of agents targeting the incretin system have become available. These can be divided into two broad categories; glucagon like peptide-1 (GLP-1) agonists/analogs (exenatide, liraglutide), and dipeptidyl peptidase-4 (DPP-4) inhibitors (sitagliptin, vildagliptin, and Saxagliptin (undergoing phase 3 trials)). Exenatide, a 39-amino acid peptide produced in the salivary gland of the Gila monster lizard, is a GLP-1 agonist. It is the first of its class approved for use as adjunctive therapy, in patients with Type 2 diabetes mellitus (T2DM). Current data suggests that exenatide, in combination with metformin, glyburide, or a glitazone, results in significant reductions in fasting and postprandial plasma glucose and hemoglobin A1c (HbA1c). Apart form gastrointestinal side effects, exenatide is relatively well tolerated and does not cause hypoglycemia when used alone. Additionally, the drug serves to promote moderate weight loss. The authors aim to provide a comprehensive overview of exenatide, detail its mechanism of action, and discuss its role in the present day treatment of patients with T2DM.