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...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.展开更多
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 cas...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.展开更多
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 State...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.展开更多
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 ...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.展开更多
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 Navila...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.展开更多
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 malar...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.展开更多
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 ...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.展开更多
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 bloo...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.展开更多
AIM To estimate annual direct and indirect costs for patients diagnosed with irritable bowel syndrome(IBS) and subtypes.METHODS Patients completed a standardized questionnaire concerning usage of healthcare resources,...AIM To estimate annual direct and indirect costs for patients diagnosed with irritable bowel syndrome(IBS) and subtypes.METHODS Patients completed a standardized questionnaire concerning usage of healthcare resources, travel costs, meals, and productivity loss of patients when seeking treatment for IBS. Total annual costs per patient were calculated as the sum of direct(including medical and nonmedical) and indirect costs. Total annual costs per patient among various IBS subtypes were compared. Analysis of variance and bootstrapped independent sample t-tests were performed to determine differences between groups after controlling for IBS subtypes.RESULTS A total of 105 IBS patients(64.80% female), mean age of 57.12 years ± 10.31 years), mean disease duration of 4.31 years ± 5.40 years, were included. Total annual costs per patient were estimated as CNy18262.84(USD2933.08). Inpatient and outpatient healthcare use were major cost drivers, accounting for 46.41%and 23.36% of total annual costs, respectively. Productivity loss accounted for 25.32% of total annual costs. The proportions of direct and indirect costs were similarto published studies in other countries. Nationally, the total costs of managing IBS would amount to CNy123.83 billion(USD1.99 billion). Among the IBS subtypes, total annual costs per patient of IBS-M was highest at CNy18891.18(USD3034). Furthermore, there was significant difference in productivity loss among IBS subtypes(P = 0.031).CONCLUSION IBS imposes a huge economic burden on patients and healthcare systems, which could account for 3.3% of the total healthcare budget for the entire Chinese nation. More than two-thirds of total annual costs of IBS consist of inpatient and outpatient healthcare use. Among the subtypes, IBS-M patients appear to have the greatest economic burden but require further confirmation.展开更多
文摘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.
文摘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.
文摘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.
文摘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.
文摘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.
文摘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.
文摘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.
文摘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.
文摘AIM To estimate annual direct and indirect costs for patients diagnosed with irritable bowel syndrome(IBS) and subtypes.METHODS Patients completed a standardized questionnaire concerning usage of healthcare resources, travel costs, meals, and productivity loss of patients when seeking treatment for IBS. Total annual costs per patient were calculated as the sum of direct(including medical and nonmedical) and indirect costs. Total annual costs per patient among various IBS subtypes were compared. Analysis of variance and bootstrapped independent sample t-tests were performed to determine differences between groups after controlling for IBS subtypes.RESULTS A total of 105 IBS patients(64.80% female), mean age of 57.12 years ± 10.31 years), mean disease duration of 4.31 years ± 5.40 years, were included. Total annual costs per patient were estimated as CNy18262.84(USD2933.08). Inpatient and outpatient healthcare use were major cost drivers, accounting for 46.41%and 23.36% of total annual costs, respectively. Productivity loss accounted for 25.32% of total annual costs. The proportions of direct and indirect costs were similarto published studies in other countries. Nationally, the total costs of managing IBS would amount to CNy123.83 billion(USD1.99 billion). Among the IBS subtypes, total annual costs per patient of IBS-M was highest at CNy18891.18(USD3034). Furthermore, there was significant difference in productivity loss among IBS subtypes(P = 0.031).CONCLUSION IBS imposes a huge economic burden on patients and healthcare systems, which could account for 3.3% of the total healthcare budget for the entire Chinese nation. More than two-thirds of total annual costs of IBS consist of inpatient and outpatient healthcare use. Among the subtypes, IBS-M patients appear to have the greatest economic burden but require further confirmation.
