What are the top most costly diseases for USA? The alignment of burden of illness with prevention and screening expenditures

Background: It was the intention of the authors to generate a list of the top diseases responsible for the greatest financial expense in the United States. This listing would then inform policymakers as to the highest priority target conditions. With such information available, funding for the NIH could be accomplished based upon factual criteria rather than political clout or uninformed consensus. Method: The first step was a literature review to explore articles and reports which were published about the cost of illness (COI) up to December 2009. Therefore the source of the data used in this investigation was obtained from this retrospective search approach. Results: With reference to total cost for disease, first was HCVD with 475.3 billion US dollars, followed by alcohol abuse and substance at 300.6 billion US dollars, digestive diseases at 259.6 billion US dollars, cancer at 239.5 billion US dollars and mental disease at 216,6 billion US dollars. Conclusion: As has been seen, the total societal costs of the diseases do not synch with the degree of attention paid to these various disease states. Several of the diseases have very powerful and vocal support organizations that encourage attention and clinical research support. On the other hand we hear very little about efforts against allergic rhinitis or infectious and parasitic diseases.

Tuberculosis Control Priorities Defined by Using Cost-Effectiveness and Burden of Disease

Objective To define TB control priorities using cost-effectiveness and burden of disease.Methods An assumed cohort of 2 000 cases was set up based on age-specific incidence of 794 newly registered smear-positive cases in Beijing in1994.Prognostic trees and model diagrams of infectivity with natural history and DOTS intervention were constructed based on the epidemiological parameters.Results DOTS reduced 89.19% of YLL,78.90% of YLD,and 99.98% of infectivity BOD.One DALY could be saved with 45.70% Yuan by DOTS with 3% discount.Sensitivity analysis showed that discount had effect on CER.Weight of age was insensitive to CER.The higher the DOTS coured rate,the more the cost-effectiveness.Conclusions DOTS is a good cost-effectiveness TB control strategy.Cost-effectiveness and burden of disease can be used to define TB control priorities.

Economic Burden of Illness of the Cervical Cancer Treatment Protocol in Bangladesh

Background: Cervical cancer is a significant health concern in Bangladesh, with high mortality rates due to limited awareness and costly treatments. The disease stages influence treatment protocols, ranging from surgery and radiotherapy for early stages to chemotherapy and radiation for advanced stages, but survival rates decrease as the cancer progresses. Objective: The objective of this study is to determine the economic impact of the disease and recommend cost-efficient strategies for prevention and treatment. Methods: A population-based, cross-sectional study was conducted with a stratified sample of cervical cancer patients from selected healthcare facilities across Bangladesh. Data collection involved structured interviews and validated questionnaires. The study measured the economic impact, treatment costs, and other related expenses. Quantitative data analysis was performed using SPSS v22, MS-Excel, and R Programming, with Multivariate regression analysis and Post Hoc tests, including the chi-square test, applied to selected indicators. Results: All respondents in the study were female, aged 34 - 75, with 72.3% aged 40 - 50. Most were illiterate (38.6%) and housewives (95.0%). Additionally, 98% were married, 85.10% married before age 18, and 46.50% experienced their first menstruation before age 12. Families typically had a monthly income of 10,000 - 30,000 Taka, spending similar amounts on treatment. Significant relationships were found between educational qualifications, occupation, personal hygiene practices, history of oral contraceptive use, and age of marriage (p Conclusion: The article emphasizes the impact of monthly family income on cervical cancer treatment costs, stressing the need for comprehensive support services to address the financial and emotional burdens faced by patients. Improving access to quality care and implementing measures can enhance outcomes for cervical cancer patients in Bangladesh.

Burden of pediatric hepatitis C

Hepatitis C virus(HCV)is a major health burden infecting 170-210 million people worldwide.Additional 3-4millions are newly-infected annually.Prevalence of pediatric infection varies from 0.05%-0.36%in the United States and Europe;up to 1.8%-5.8%in some developing countries.The highest prevalence occurs in Egypt,sub-Saharan Africa,Amazon basin and Mongolia.HCV has been present in some populations for several centuries,notably genotypes 1 and 2 in West Africa.Parenteral anti-schistosomal therapy practiced in the 1960s until the early 1980s had spread HCV infection throughout Egypt.Parenteral acquisition of HCV remains a major route for infection among Egyptian children.Insufficient screening of transfusions,unsterilized injection equipment and re-used needles and syringes continue to be major routes of HCV transmission in developing countries,whereas vertical transmission and adolescent high-risk behaviors(e.g.,injection drug abuse)are the major routes in developed countries.The risk of vertical transmission from an infected mother to her unborn/newborn infant is approximately 5%.Early stages of HCV infection in children do not lead to marked impairment in the quality of life nor to cognitive,behavioral or emotional dysfunction;however,caregiver stress and family system strain may occur.HCV slowly progresses to serious complications as cirrhosis(1%-2%)and hepatocellular carcinoma(HCC)especially in the presence of risk factors as hemolytic anemias,obesity,treated malignancy,and concomitant human immune deficiency and/or hepatitis B virus co-infection.HCV vaccine remains elusive to date.Understanding the immune mechanisms in patients who successfully cleared the infection is essential for vaccine development.The pediatric standard of care treatment consists of pegylated interferon-α2a or b plus ribavirin for 24-48 wk.The new oral direct acting antivirals,approved for adults,need further evaluation in children.Sustained virologic response varies depending on the viral load,genotype,duration of infection,degree of aminotransferase elevation,adiposity and single nucleotide polymorphisms of interleukin(IL)-28B locus.The goals of treatment in individual patients are virus eradication,prevention of cirrhosis and HCC,and removing stigmatization;meanwhile the overall goal is decreasing the global burden of HCV.IL-28B polymorphisms have been also associated with spontaneous clearance of vertically acquired HCV infection.The worldwide economic burden of HCV for children,families and countries is estimated to be hundreds of millions of US dollars per year.The United States,alone,is estimated to spend 199-336 million dollars in screening,monitoring and treatment during one decade.The emotional burden of having an HCV infected child in a family is more difficult to estimate.

Cost of illness among patients with diabetic foot ulcer in Turkey

AIM To evaluate the annual cost of patients with Wagner grade 3-4-5 diabetic foot ulcer(DFU) from the public payer's perspective in Turkey.METHODS This study was conducted focused on a time frame of one year from the public payer's perspective. Cost-ofillness(COI) methodology, which was developed by the World Health Organization, was used in the generation of cost data. By following a clinical path with the COI method, the main total expenses were reached by multiplying the number of uses of each expense item, the percentage of cases that used them and unit costs. Clinical guidelines and real data specific to Turkey were used in the calculation of the direct costs. Monte Carlo Simulation was used in the study as a sensitivity analysis.RESULTS The following were calculated in DFU treatment from the public payer's perspective: The annual average per patient outpatient costs $579.5(4.1%), imaging test costs $283.2(2.0%), laboratory test costs $284.8(2.0%), annual average per patient cost of intervention, rehabilitation and trainings $2291.7(16.0%), annual average per patient cost of drugs used $2545.8(17.8%)and annual average per patient cost of medical materials used in DFU treatment $735.0(5.1%). The average annual per patient cost for hospital admission is $7357.4(51.5%). The average per patient complication cost for DFU is $210.3(1.5%). The average annual per patient cost of DFU treatment in Turkey is $14287.70. As a result of the sensitivity analysis, the standard deviation of the analysis was $5706.60(n = 5000, mean = $14146.8, 95%CI: $13988.6-$14304.9). CONCLUSION The health expenses per person are $-PPP 1045 in 2014 in Turkey and the average annual per patient cost for DFU is 14-fold of said amount. The total health expense in 2014 in Turkey is $-PPP 80.3 billion and the total DFU cost has a 3% share in the total annual health expenses for Turkey. Hospital costs are the highest component in DFU disease costs. In order to prevent DFU, training of the patients at risk and raising consciousness in patients with diabetes mellitus(DM) will provide benefits in terms of economy. Appropriate and efficient treatment of DM is a health intervention that can prevent complications.

Navigated laser in diabetic macular edema: the impact of reduced injection burden on patients and physicians-who wins and who loses?

We inquired the impact of reduced therapy discontinuation in diabetic macular edema(DME) on physician's revenue considering anti-vascular endothelial growth factor(VEGF) monotherapy and its combination with Navilas treatment. Data were collected on injection frequency, treatment discontinuation and reimbursement fees for DME treatment with anti-VEGF compared to anti-VEGF in combination with navigated laser. Based on these data an economic model was built to compare physicians revenue over a 5y period using either therapy for 4 European countries and the USA. Due to patients' higher therapy adherence, physicians using navigated laser therapy with anti-VEGF generate similar or higher revenues compared to VEGF monotherapy in all analyzed countries. The use of Navilas decreases the patient's injection burden at the same clinical outcome, while the physician's revenue remained stable or increased. Therewith, therapy discontinuation in DME can be reduced using the combination therapy with Navilas.

Malaria and Its Economic Burden among Pregnant Women in Rivers State, Nigeria

Background:?Malaria remains a public health concern in sub-Saharan Africa especially in pregnant women because of the potential risk to the life of the mother and risk of transmission to the foetus. Treatment of malaria imposes a great economic burden on households, governments, and ultimately slows down the pace of economic development in these countries. Methods:?This study estimates the economic burden of malaria among pregnant women in Nigeria, using a cross sectional survey, conducted in 8 public health institutions from the three senatorial districts of Rivers State. The data was collected from a sample of 1008 pregnant women visiting antenatal clinics using the open data kit (ODK) pretested questionnaires by trained personnel. Results:?The results show that malaria has a direct economic burden of about N5826.21 or 16.18 United States Dollar (USD) for outpatient treatment including diagnostic tests and about N18,271 or 50.75?USD using an exchange rate of N360:1?USD, for inpatient treatment. A significant statistical association was established between malaria diagnosis and socio-economic status of participants (p-value Conclusion:?Though the intangible cost could not be identified, the study has shown that malaria imposes huge economic burden on households especially poor households. There is need for government to intensify its efforts in malaria eradication schemes. Efforts should be made to put in place a free malaria treatment policy for vulnerable groups like pregnant women. Furthermore, involvement of health systems in reducing the cost of treatment will decrease the economic burden on the households.

The Implication of Unreliable Urban Water Supply Service: The Case of Vendor Water Cost in Langata Sub County, Nairobi City, Kenya

Studies on urban water supply service improvements continue to draw interest across the world. The pressure on freshwater resources is increasing in every region in the face of an increasing demand and climate change dynamics. Langata sub County in Nairobi city, Kenya faces drought induced water shortage and households rely on water vending and bottled water purchases to augment the inadequate municipal water supplies. Little to our knowledge has been done to assess the cost implication of such a practice here. So the study used household survey method to collect monthly households’ water bills comprising;utility company, water tanker delivery and bottled water purchase from a randomly sampled 382 households spread within the five wards;Karen, South C, Mugumoini, Nairobi West and Nyayo Highrise. The gated communities identified are 57. Simple stochastic analysis of the data was done after data cleaning using MS Excel. It was found that the municipal water serves up to 91.15% of the total average household monthly water demand with a cost share of 27.91%. Water tanker delivery meets 8.61% of the household water demand with a cost share of 50.74%. The bottled water purchases serve 0.24% of a typical household water demand with a total cost share of 21.35%. The water supply deficit which is a mere 8.85% met by tanker deliveries and bottled water purchases has a total average cost share of 72.09%. The computed cost burden is 258%. This means that the households pay more than two and a half times extra above the utility bill per month. The study recommends a new water policy that will incorporate the role of water vendors operated on a cooperative model by the gated communities using standard guidelines.

Medical Resource Utilizations and Economic Burden in Chinese Cancer Patients with Chemotherapy-induced Anemia:A Populational Database Study

Objective： Most of published studies emphasized the medical cost of treating chemotherapy-induced anemia （CIA） by using specific agents, for example, epoetin α, epoetin β, darbepoetin α or combined with red blood cell transfusions, however, the investigation of the overall medical resources utilizations and economic burden of CIA is still limited. Besides, such studies which emphasized Chinese population still lack. The aim of this study is to investigate the medical resource utilization and the economic burden of Chinese cancer patients with CIA by using a populational representative claim database. Methods： The data for this study are from the 2000-2003 Population Health Insurance Research Database （PHIRD） in Taiwan. On the basis of issuing catastrophic illness cards in the enrollment data files, a total of 26,053 beneficiaries were identified from the PHIRD, who were newly diagnosed with these four cancers in 2001 and 2002 （2001： n=12,954; 2002： n=13099）. A generalized linear model （GLM） was employed for analyzing the differences of medical resource utilization and economic burden between the anemic and non-anemic groups. Results： Analyses showed that the anemic patients were significantly more likely to have longer length of hospital stay than non-anemic patients （P〈0.05） across all these four cancers and in two study periods （except women breast cancer in 2002/03）. As regards the health care expenditures, the average one-year total medical cost was USD$8,982 （2001/02） and USD$8,990 （2002/03） for anemic patients among these four cancers, and USD$7,769 （2001/02） and USD$7713 （2002/03） for non-anemic patients （P〈0.0001）. As for ambulatory costs, anemic patients＇ was significantly higher than non-anemic patients＇ for lung cancer （in 2001/02）, women breast cancer （in 2001/02 and 2002103） and the summarized data （in 2001/02）. As for inpatient costs, anemic patients＇ was significantly higher than non-anemic patients＇ for gastric cancer （in 2002/03）, colon and rectal cancer （in 2001/02 and 2002/03）, lung cancer （in 2001/02 and 2002/03）, women breast cancer （in 2001/02） and the summarized data （in 2001/02 and 2002/03）. Conclusion： This study is the first study to demonstrate that cancer patients who receive chemotherapy and with anemia utilize more medical resources and have heavier economic burden among Chinese cancer patients. Although the Population Health Insurance Program in Taiwan was established to provide more low-burdened medical care for all cancer patients, further effort is still needed to reduce the economic burden for cancer patients who have specific complications.

企业税负结构、税收成本粘性与全要素生产率

从税源的纳税人结构来看,我国税收收入主要源于企业,宏观层面的税制结构在微观领域主要投射为企业税负结构,税制结构对经济效率的宏观影响会通过企业税负结构对微观全要素生产率的促进或抑制来实现。因此,基于上市公司微观主体实证检验企业税负结构变化对微观全要素生产率的影响,可以验证税制结构对经济效率的宏观治理效应。研究结果表明:现行以间接税为主的企业税负结构对全要素生产率具有显著的抑制作用,具体表现为企业增值税负与企业所得税负比值越大,对全要素生产率抑制作用越强。进一步研究结果表明:企业税负结构是通过增加税收成本粘性对全要素生产率产生抑制作用;在当前税收立法水平与税制安排下,税收征管在企业税负结构抑制全要素生产率中发挥了正向调节作用。

搜索引擎、人工智能与行政负担

学习成本是行政负担的重要维度之一,但是相关研究并不多。搜索引擎是公民找政府办事的主要入口之一,本文聚焦搜索引擎如何影响政民互动中的学习成本。研究显示,商业开发和政府提供的搜索引擎服务降低了公民与政府打交道的学习成本,但是也因为设计缺陷和过度商业化而增加行政负担。进一步的分析发现,随着以大语言模型为代表的生成式人工智能在搜索引擎中的深度应用,政民互动的学习成本会持续降低,并会带来合规成本和心理成本的下降。本文讨论了新一代人工智能技术对行政负担,特别是学习成本的潜在影响,并提出了对策建议和未来研究方向。

广州市某医院脑梗死患者疾病经济负担研究

目的分析脑梗死患者次均住院费用,特别是次均住院自负费用的结构以及影响因素,为缓解患者疾病经济负担提供参考依据。方法运用描述性统计分析对广州市某三甲医院2015—2022年脑梗死出院患者的次均费用及费用结构进行比较分析,并采用多重线性分析法研究影响患者次均住院自负费用的因素。结果脑梗死患者次均住院费用增长放缓,年均增长率为2.86%;费用结构逐步优化,2022年次均技术劳务费占比47.41%;脑梗死患者次均住院自负费用呈增长趋势,年均增长率5.96%,且受住院时间、病例分型、付费方式以及患者来源等因素共同影响。结论脑梗死患者的疾病经济负担仍然较重,医疗机构应不断规范诊疗行为,加强临床路径管理,政府应该不断完善社会保障体系,降低患者的疾病经济负担。

绿色税制改革影响企业ESG表现——基于企业成本视角

提高重污染企业ESG表现是实现我国企业绿色高质量发展的重要来源。从本质上讲,ESG能有效衡量企业绿色转型的程度,绿色税制改革会降低企业成本,进而促使重污染企业绿色转型。本文基于2015~2022年沪深A股上市公司数据研究发现,绿色税制改革能够通过降低企业的税收负担、权益资本成本和债权融资成本,进而提升重污染企业的ESG表现。进一步分析表明,绿色税制改革对重污染企业ESG的促进效应在融资约束高的企业、非国有企业和地区法治环境好的企业中更为突出;绿色税制改革能够通过提升企业ESG水平进而提高企业绩效,降低其短债长用与破产风险。这些结果表明,绿色税制改革能够有效降低企业成本,助推重污染企业绿色高质量发展。本文拓展了绿色税制改革政策效应的相关研究,并从企业成本视角为重污染企业绿色转型提供了有益参考。

企业社保缴费抑制了企业的就业吸纳能力吗?——基于上市公司数据的分析

社保成本负担是指企业社保缴费在总劳动力成本中的占比;社保压力水平是指企业社保缴费在新增产值(利润)中的占比。运用上市公司数据,通过两阶段系统GMM估计发现,企业社保缴费上升导致准固定成本上升,企业降低劳动力需求,社保成本负担抑制企业的就业吸纳能力;企业社保缴费对企业利润的负向影响弱于其倒逼效应,追求长期规模增长最大化的企业短期内放弃了利润最大化目标,社保压力水平不构成抑制企业就业吸纳能力的因素。异质性分析显示,大部分企业是出于劳动力成本上升的现象制定降低劳动力需求的决策,而非由于企业社保缴费造成利润挤压的事实。研究结论为企业社保缴费征缴原则转变提供了理论与数据支撑。

涉税环境信息新增如何影响企业实际税负和税费成本?——基于环境保护税改革的实证研究

中国税制改革日益重视纳税人涉税信息的完整性和准确性。随着税务机关掌握更多的纳税人涉税环境信息,企业实际税负和税费成本将会受到什么影响?本文以2014—2020年上市公司为样本,以2018年环境保护税改革为政策冲击,研究涉税环境信息新增对企业实际税负和税费成本的影响。研究发现,涉税环境信息新增显著降低了企业实际税负和税费成本。异质性分析发现,涉税环境信息新增对国有企业实际税负和非国有企业税费成本具有显著的负向影响;涉税环境信息新增显著提高了企业的所得税和流转税成本,降低了环境保护税成本。机制分析发现,企业研发投入是涉税环境信息新增影响企业实际税负和税费成本的机制变量,该机制变量从减少企业实际缴纳税费和扩大生产规模两方面降低企业实际税负和税费成本。本文的研究结论为持续推进环境保护税改革提供了实证依据。

福建省某三甲医院2016—2023年子宫内膜癌患者的住院费用比较

目的探讨子宫内膜癌(endometrial cancer,EC)患者的住院费用情况。方法选取福建省立医院2016年1月—2023年12月收治的100例EC患者进行回顾性分析,研究EC患者的基本情况与住院费用构成和变化趋势。结果100例EC患者各变量占比最高的分别为:年龄>45~60岁(51%)、住院天数>10~20 d(69%)、医保支付(84%)、手术(79%)、一般病例类型(67%)、有合并症/并发症(63%)。与2016—2019年的患者住院费用相比,2020—2023年患者的抗菌药费(728.54±32.13)元、西药费(4654.23±243.53)元更低,且患者的手术治疗费(7178.24±359.46)元、非手术治疗项目费(555.28±13.64)元、护理费(1226.37±33.61)元、麻醉费(1921.35±185.42)元、诊断费(3542.35±254.63)元、其他医疗费(4857.42±166.28)元、总费用(32147.59±1324.28)元均更高,差异有统计学意义(P<0.05)。结论EC患者的住院总费用存在上涨趋势,患者的经济负担较重。

2010—2020年新疆宫颈癌经济负担及筛查覆盖率的影响研究

目的:探讨新疆宫颈癌患者住院费用情况,评估和预测提高筛查覆盖率对宫颈癌防治的影响,对宫颈癌防治策略提出建议。方法:利用2010—2020年10 256例新疆宫颈癌住院患者病案首页信息,分析其住院费用及影响因素,利用Markov模型预测筛查覆盖率对宫颈癌防治的影响。结果:近年来新疆宫颈癌患者住院费用持续上涨,次均住院费用从27946.83元增长至51260.00元,影响住院费用的因素主要有是否进行HPV检测、治疗方式、病理分期、住院时间以及年龄,提高宫颈癌筛查覆盖率可降低发病率、死亡率。结论:新疆宫颈癌患者直接医疗经济负担较重,筛查是防治宫颈癌的有效手段,应继续加强宫颈癌健康知识宣教,提高疫苗接种率和筛查覆盖率,促进早诊早治措施的推广。

知识产权损害赔偿的阶梯式精确性理念

我国法院普遍秉持高度精确性的损害赔偿理念,很少认可推断方法,导致原告很难证明实际损失或侵权获利的确切数额,只能大量适用法定赔偿,赔偿数额的精确性较低。比较法上降低原告证明难度的方法有二:一是降低原告的证明标准,二是在原告与被告之间分配证明责任,蕴含了阶梯式精确性理念。根据这一理念,原告只需通过推断等方法初步证明实际损失或侵权获利的合理数额,就可完成证明责任,随后由被告进一步举证提升赔偿数额的精确性。阶梯式精确性理念可以大幅提升实际损失和侵权获利的适用比例,以较低的成本提升赔偿数额的精确性,优于现有做法,值得我国法院采纳。以电商平台案件为例,应用该理念的关键是提出推断实际损失和侵权获利的阶梯式方法。

老年慢性病病人医院感染危险因素及经济负担现状调查

目的:分析老年慢性病病人医院感染危险因素及经济负担,为针对性降低老年慢性病病人医院感染发生率及经济负担提供依据。方法:回顾性分析某公立三级甲等医院于2022年1月1日—12月31日收治老年慢性病病人的住院信息,采用倾向指数匹配法将医院感染组与非医院感染组进行1∶1病例匹配分析估算医院感染增加的病人经济负担,并采用边际分析法估算医院感染导致的医院经济负担。结果:本研究纳入了老年慢性病病人1147例,老年慢性病人医院感染率为8.89%,高龄、使用呼吸机、留置导尿管和接受过手术均是老年慢性病人发生医院感染的危险因素,接受过手术对老年慢性病人医院感染预测效能的曲线下面积(AUC)为0.799[95%CI(0.747,0.851)],预测效能最佳,年龄对老年慢性病人医院感染预测效能的AUC为0.729[95%CI(0.670,0.788)],预测效能最低。与非感染组比较,感染组老年慢性病人经济负担增加了6131.90元/例。2022年因老年慢性病导致医院经济损约18.82万元,损失利润率与医院感染率系数为2.34。结论:医院感染的发生会对病人、家庭、医院造成较大经济负担。西药费、抗菌药物费是降低医疗成本的关键突破口。医院管理者应加强对老年慢性病病人医院感染的监控、定期评估老年慢性病病人的免疫状态、严格控制呼吸机和导尿管的使用指征、加强院感培训,提高临床医护人员感控意识,及时识别和报告感染病例。

我国肺癌疾病的直接住院费用负担现状及其问题

目的:了解我国肺癌的直接费用负担现状,提出相应的政策建议。方法:利用《中国卫生统计年鉴》和“北京市卫生统计资料”,以及我国10家三级甲等医院的现场调查数据,估算我国肺癌患者直接医疗费用负担及其增长,分析费用结构和变化情况。结果:我国肺癌住院总费用年均增长速度达16.15%(1996—2005年),肺癌患者日均费用增长速度达12.85%,其中,检查费年均增长率达21.94%,化验费为17.86%,治疗费为16.32%;北京市各年肺癌费用增长趋势与全国情况相近;被调查的10家三甲医院2005年数据结果显示,在肺癌患者的人均住院费用中,药费比例为39.94%,治疗费比例为24.77%,检查费比例为14.06%,化验费比例为4.57%。结论:面对肺癌造成的日益沉重的经济负担,应从降低发病率和控制病种费用两方面入手:首先加大肺癌的预防措施力度,如控烟、改善环境等;其次,完善适合国情的肺癌治疗指南,推动规范化治疗,并且在此基础上建立适当的经济激励机制,保证规范的顺利实施。