Costs Associated with the Treatment of Clostridioides Difficile Infections

Background: Clostridioides difficile, as the main cause of infectious diarrhoea in hospitalised patients, is a considerable challenge for medical personnel (hospital environment) who have direct contact with the patient, as well as being of interest to public health specialists. Financial issues related to the occurrence of the above-mentioned micro-organism are being increasingly raised. Due to the scale of the phenomenon, we are beginning to pay attention to the significant system costs caused by the diagnosis and treatment of CDI infection and its complications. Studies indicate that the nosocomial infection of C. difficile complicates hospitalisation, by increasing the cost by more than half and extending patient’s stay by an average of 3.6 days. Material and methods: The aim of this study was to attempt to calculate the estimated costs associated with the prolonged hospitalisation of patients with nosocomial CDI infection, using the example of a hospital in Lodz. A total of 53 completed hospitalisations of patients treated in the period of January–August 2018 were analysed, during which hospital Clostridioides difficile infection was identified. For the purposes of this study, statistical data collected in the hospital’s IT system were also analysed, covering 44,868 hospitalisations in the Jan–Aug 2018 period, during which no hospital infection occurred. They was a control group, in which the analysed cases were compared. The obtained data in the study determined how long each patient with Clostridioides difficile infection stayed in the hospital (from the moment infection was diagnosed until the day of hospital discharge), and which diagnosis related groups (DRG) (according to National Health Fund guidelines) were assigned. The average length of patient stay without infection within a given DRG group in each hospital ward was also determined. The collected materials became the initial point for the final analysis of hospital costs and the length of hospital stay caused by Clostridioides difficile infection. Results: Clostridioides difficile infection extended the hospital stay by an average of almost 12 days. The average cost of prolonged hospitalisation due to CDI infection (according to the average cost per person-day) was about PLN 7148 (1664 EUR), which gave a total value of about PLN 378,860.6 (88,240.5 EUR) in the examined period. At the same time, the average expenditure from the National Health Fund for hospitalisation due to CDI infections increased by about PLN 6627 (1542.8 EUR), which in the analysed period translated into over PLN 351,232.0 (81,505.5 EUR) (according to settlements with the National Health Fund). The outcome indicates that there is a clear relation between CDI and the anticipated length of hospitalisation of patients without an infection.

Traumatic Knee Injuries in 2016–2019 – an Analysis of Newly Diagnosed Patients Based on NHF Data Reporting

Background. Traumatic musculoskeletal injuries are more and more frequently regarded as an important health, social and economic problem. According to WHO statistics, injuries are a major present-day health problem. The main aim of the study is to identify the number of new patients who sustained knee structure injuries during a year and to classify them based on data on services provided under National Health Fund agreements. Material and Methods. Information on the number of patients with a knee injury was obtained in a three stage process. First an inventory of relevant diagnoses was determined. Then, the National Health Fund data from 2016–2019 was queried in accordance with the adopted methodology and assumptions. The analysis was based on the report submitted by the NHF in response to the query. Results. According to the NHF reporting data, knee injuries affect approx. 244,000 people per year. There are slightly more men (approx. 52%) than women (48%). People aged 11-20 years constitute the most numerous group of patients with knee injuries, with approx. 41,342 cases per year. The most frequently reported diagnoses in both groups were S80.0 Contusion of knee (approx. 30%), S83.6 Sprain and tear of other and unspecified parts of knee (approx. 21%) and M23.8 Other internal derangements of knee (approx. 9%). According to available data, the overall rate of knee injuries in 2019 was 6.4 per 1000 population. Conclusions. 1. Knee injuries pose a major health problem. In Poland, according to the reporting data, approx. 244,000 knee injuries occur every year. 2. Knee injuries are more common among men than women, and people aged 11–20 years constitute the most numerous group of patients. 3. The National Health Fund reporting data is a very valuable source of information on the magnitude of the problem of injuries.

Schizophrenic patients with type 2 diabetes: An 8-year population-based observational study

This paper presents a realistic evaluation of the prevalence of type 2 diabetes mellitus (T2DM) among Polish schizophrenic patients who have sought treatment through the Polish National Health Fund in the years 2010–2017. Data from the National Health Fund database was used and T2DM and schizophrenia groups were defined according to International Classification of Diseases (ICD-10) codes. Demographic data were collected from the web page of Statistics Poland (GUS). The annual prevalence of T2DM and schizophrenia was estimated, and the age groups were categorised into eight sets. The incidence of schizophrenia in T2DM patients in the years 2010–2017 was measured, including relative risk and 95% confidence interval (95% CI). The incidence of T2DM has been assessed in various subtypes of schizophrenia. In the eight years of follow-up study, 1,481,642 patients with schizophrenia were included, of which 185,205 were also diagnosed with T2DM. This accounted for 12.50% of all patients with schizophrenia. The trend of comorbid schizophrenia (F20) and T2DM (E11) in the general population of patients with schizophrenia, who sought treatment through the National Health Fund, was relatively stable in the years 2010–2017. The relative risk of T2DM in those with schizophrenia was 8.33 (95% CI 8.23–8.43) in 2017. Taking actions to enable the detection of diabetes in patients with concomitant schizophrenia is well-grounded, although these actions should be gender-dependent. There is also a need to take adequate actions to improve the efficiency of diabetological care among patients with schizophrenia.

Evolution of health social security expenditure in Chile: A review of financial aggregates from 2000 to 2018

Introduction In Chile, there is controversy regarding the magnitude of financing for the health system. Some experts state that more resources are needed, while others refer to the problems that may arise in managing a growing pool of resources. Aim This article aims to offer evidence to encourage critical discussion through a time series analysis of the leading financial aggregates in constant 2018 Chilean pesos of the Chilean social security in the period from 2000 to 2018. Methods We did an observational, descriptive, longitudinal, and time series trend analysis study. Financial aggregates are organized according to social security definitions and by financial administrators—the public National Health Fund and the private health insurers. Results Social security health spending has increased almost four-fold in the study period. After enacting the Explicit Guarantees in Health, the National Health Fund expanded more than the private health insurance system due to government allocations to the National Health Fund. In contrast, individual contributions decreased steadily every year during the study period. Per capita expenditure was higher in the private health insurance system. However, the per capita expenditure of the private insurance system over the public health fund has gradually decreased over time. Conclusion Firstly, Chile increased its health spending at a rate higher than observed in other Organization for Economic Co-operation and Development countries. Secondly, it transitioned from financing health mainly through workers’ contributions to growing prominence of the government’s overall contribution. In the wake of the announced health reform, the discussion of health funding will include employers’ role in health financing.

Impact of Alpha-Adrenergic Receptor Antagonists on outcomes in patients with heart failure. A post-hoc analysis using National Health Fund database

BackgroundThe alpha-adrenolytics (AA) are not recommended in patients with EF reduced heart failure due to safety concerns. The aim of our study was to assess the safety of AA in patients hospitalized due to exacerbation of HF and the influence of these drugs on long-term endpoints.MethodsData collected by the National Health Fund was used. Patients hospitalized due to HF exacerbation were included. The primary outcome was all-cause mortality and the secondary was the first readmission due to HF or all-cause death occurring more than 30 days after discharge.ResultsOf 140 668 patients hospitalized in the year 2013 n=53317 were included and followed for a median of 56.3 months. AA patients had lower long-term mortality (52.8% vs. 54.9%, unadjusted P=0.038). The treatment with AA positively and affected long-term survival (adjHR 0.82, 95%CI 0.78-0.87, P<0.001), as well as secondary endpoint (adjHR 0.85, 95%CI 0.81-0.90, P<0.001).Cox analysis in the subgroup treated with beta-blockers revealed that treatment with AA was associated with lower mortality (adjHR 0.82, 95%CI 0.75-0.90, P<0.001) and lower incidence of secondary endpoint (adjHR 0.85, 95%CI 0.78-0.92, P<0.001). ConclusionsIn compliant patients hospitalized due to HF exacerbation post discharge treatment with AA was safe and beneficial.

Model funkcjonalny HB-HTA z koordynującą rolą Narodowego Funduszu Zdrowia

The functional model of Hospital-Based Health Technology Assessment with coordinating role of the Polish National Health Fund The article presents the concept and the conduct of the HB-HTA (Hospital-Based Health Technology Assessment) project implementation with coordi­nating role of the Polish National Health Fund. The main stakeholders of the HB-HTA process were identified, together with their interests and barriers in the area of the implementation of HB-HTA in Poland.