Medical Costs of Stroke Care Between Women With and Without Dysmenorrhea: A Population-Based Comparison

Objective: This study investigated the medical care costs of stroke type between age-matched cohorts with and without dysmenorrhea using the National Health Insurance Research Database (NHIRD).Methods: We collected all 66,048 women with dysmenorrhea and 66,048 women without dysmenorrhea whose age (15-44-year-old) and index year (from 1997 to 2013) were matched for comparison. We assessed the incidence and compared the risk of stroke and stroke subtype in two cohorts. The proportional distributions of stroke subtypes by age between the two cohorts were compared among the women with stroke, and their hospitalization rate was also estimated. In addition, medical cost, length of stay, and the medical cost within 30 days after stroke were compared between the two cohorts.Results: The stroke risk in dysmenorrhea was greater than comparisons (HR = 1.26, 95% CI = 1.11–1.42). Proportionally, hemorrhagic stroke (HS) significantly decreased with age in both cohorts, whereas ischemic stroke (IS) significantly increased with age when both cohorts were combined. The dysmenorrhea cohort had a higher portion of transient cerebral ischemia (TIA) stroke than comparisons (31.3 vs. 24.2%, p = 0.01) and a lower risk of hospitalization for IS (OR = 0.48, 95% CI = 0.21–0.69). Among the four-stroke subtypes, the cost of care for TIA was the least (US$157 ± 254). The average cost for stroke care was not significantly different between women with and without dysmenorrhea.Conclusion: The hospitalization rate and medical costs of TIA are lower than other types. All women should prevent and treat TIA as soon as possible to avoid recurrence or progression to major stroke events and reduce medical costs, regardless of whether they have dysmenorrhea.

Methodological Challenges in Estimating the Lifetime Medical Care Cost Externality of Obesity

There is a great deal of variability in estimates of the lifetime medical care cost externality of obesity, partly due to a lack of transparency in the methodology behind these cost models. Several important factors must be considered in producing the best possible estimate, including age-related weight gain, differential life expectancy, identifiability, and cost model selection. In particular, age-related weight gain represents an important new component to recent cost estimates. Without accounting for age-related weight gain, a study relies on the untenable assumption that people remain the same weight throughout their lives, leading to a fundamental misunderstanding of the evolution and development of the obesity crisis. This study seeks to inform future researchers on the best methods and data available both to estimate age-related weight gain and to accurately and consistently estimate obesity’s lifetime external medical care costs. This should help both to create a more standardized approach to cost estimation as well as encourage more transparency between all parties interested in the question of obesity’s lifetime cost and, ultimately, evaluating the benefits and costs of interventions targeting obesity at various points in the life course.

Estimation of the direct cost of epilepsy among Sudanese epileptic patients

Background Epilepsy is a common disease, and its economic consequences are manifested in frequent hospital visits, examinations and treatments. Objective To estimate the direct costs of epilepsy among Sudanese epileptic patients. Design and methods The study was conducted on some clinical cases of epilepsy patients in Sudan. Data on clinical characteristics, utilization of medical services, and costs were collected from 380\ patients using a standardized pre-tested format. The patients’ approval was obtained as necessary. Results Direct medical care costs was (2,395 Sudanese Pounds “SDG”, 417 American Dollars “USD”) per year per patient, of which antiepileptic drugs was the major component (1,587 SDG, 276 USD). Other costs are medical consultations and hospitalization charges (SDG 148, 26 USD), investigations cost (146 SDG, 25 USD), and cost of travel to clinics (514 SDG, 90 USD). Nonmedical direct cost - in form of traditional healers' visits were reported by 13.5% of the patients and estimated to be (1,422 SDG, 251 USD) per patient per year. The overall mean annual cost for epilepsy per patient in our clinic was approximately (2,724 SDG, 474 USD). Conclusion The economic burden of epilepsy patients is relatively high, and payers in Sudan have many characteristics and significant differences from other countries.

Early Detection of Readmission Risk for Decision Support Based on Clinical Notes

Hospital readmission shortly after discharge is contributing to rising medical care costs. Attempts have been exerted to reduce readmission rates by predicting patients at high risk of this episode on the basis of unstructured clinical notes. Discharge summary as part of the clinical prose is effective at modeling readmission risk. However, the predictive value of notes written upon discharge offers few opportunities to reduce the chance of readmission because the target patient might have already been discharged. This paper presents the use of early clinical notes in building a machine learning model to predict readmission at 48 h immediately after a patient's admission. Extensive feature engineering, testing multiple algorithms, and algorithm tuning were performed to enhance model performance. A risk scoring framework that combines the data- and knowledge-driven feature scores in risk computation was developed. The proposed predictive model showed better prognostic capability than the machine learning model alone in terms of the ability to detect readmission. In specific, the proposed algorithm showed improvements of 11%–28% in sensitivity and 1%–3% in the area-under-the-receiver operating characteristic curve.

Can Home Palliative Care services reduce Emergency Department visits? Piedmont Experience, 2013-2018

Background Home-based Palliative Care (HPC) ensures multi-disciplinary medical, nursing, rehabilitation and psychological assistance for people with severe disabilities or with progressive end-stage disorders like cancer, promoting the continuity of care in home setting. Emergency Department (ED) visits in palliative care patients are considered an indicator of poor quality in home care services, since ED visits in these patients are not essential and potentially avoidable. There is still no agreement in literature about the efficacy of HPC in reducing the use of ED. However, recent studies demonstrated that HPC increases patient satisfaction while reducing use of medical services like ED, symptom burden and medical costs. The objective of this study was to evaluate if patients assisted by HPC have a reduction of ED visits compared to the 90-day period before HPC admission. Methods A retrospective study using the administrative regional database of Piedmont (Italy) was conducted on the cohort of 4433 patients admitted to HPC from 2013 to 2018. ED visits during period A (90-days before HPC) and period B (during HPC) were compared for each patient, taking into account avoidable or unavoidable visits based on triage examination. Results During period A, patients had 2880 ED visits, 1934 were considered avoidable (67%). During period B, 2050 ED visits were recorded, 994 were considered avoidable (48%). Patients receiving HPC had a reduction of overall ED visits (IRR 0.87, IC 95% 0.82-0.92) as well as avoidable ED visits (IRR 0.63, IC 95% 0.58-0.67). Unavoidable ED visits increased during HPC (IRR 1.36, IC 95% 1.24-1.49), as a consequence of disease progression. Conclusions Home-based Palliative Care is associated with a significant reduction of the use of overall Emergency Department visits (-13%) and ED avoidable visits (-37%). Since it reduces medical care costs and burden of patients and caregivers at the end of life, Home-based Palliative Care delivery should be increased. Key messages Home-based Palliative Care is associated with a reduction of the use of overall Emergency Department visits and avoidable ED visits, reducing medical care costs and burden of patients and caregivers. Home-based Palliative Care delivery should be encouraged and increased, aiming to an early enrolment as well as an increase of the patients.

Comparing Medical Care Costs using Bayesian Credible Intervals for the Ratio of Means of Delta-Lognormal Distributions

When considering the medical care costs data with a high proportion of zero items of two inpatient groups, comparing them can be estimated using confidence intervals for the ratio of the means of two delta-lognormal distributions. The Bayesian credible interval-based uniform-beta prior (BCIh-UB) is proposed and compared with the generalized confidence interval (GCI), fiducial GCI (FGCI), the method of variance estimates recovery (MOVER), BCIh based on Jeffreys’ rule prior (BCIh-JR), and BCIh based on the normal-gamma prior (BCIh-NG). The coverage probability (CP), average length (AL), and lower and upper error rates were the performance measures applied for assessing the methods through a Monte Carlo simulation. A numerical evaluation showed that BCIh-UB had much better CP and AL than the others even with a large difference between the variances and with a high proportion of zero. Finally, to illustrate the efficacy of BCIh-UB, the methods were applied to two sets of medical care costs data.