Health resource utilization and the economic burden of patients with wet age-related macular degeneration in Thailand

AIM: To determine healthcare resource utilization and the economic burden associated with wet age-related macular degeneration(AMD) in Thailand ·METHODS: This study included patients diagnosed with wet AMD that were 60 years old or older,and had best corrected visual acuity(BCVA) measured at least two times during the follow-up period. We excluded patients having other eye diseases. Two separate sub-studies were conducted. The first sub-study was a retrospective cohort study; electronic medical charts were reviewed to estimate the direct medical costs. The second sub-study was a cross-sectional survey estimating the direct non-medical costs based on face-to-face interviews using a structured questionnaire. For the first sub-study,direct medical costs,including the cost of drugs,laboratory,procedures,and other treatments were obtained. For the second sub-study,direct non-medical costs,e.g. transportation,food,accessories,home renovation,and caregiver costs,were obtained from face-to-face interviews with patients and/ or caregivers. ·RESULTS: For the first sub-study,sixty-four medical records were reviewed. The annual average number of medical visits was 11.1 ±6.0. The average direct medical costs were $3 604 ±4 530 per year. No statistically-significant differences of the average direct medical costs among the BCVA groups were detected(P =0.98). Drug costs accounted for 77% of total direct medical costs. For direct non-medical costs,67 patients were included. Forty-eight patients(71.6%) required the accompaniment of a person during the out-patient visit. Seventeen patients(25.4%) required a caregiver at home. The average direct non-medical cost was $2 927 ±6 560 per year. There were no statistically-significant differences in the average costs among the BCVA groups(P =0.74). Care-giver cost accounted for 87% of direct non-medical costs.·CONCLUSION: Our study indicates that wet AMD is associated with a substantial economic burden,especially concerning drug and care-giver costs.

Thirty-day readmission in patients with heart failure with preserved ejection fraction:Insights from the nationwide readmission database

BACKGROUND There are rising numbers of patients who have heart failure with preserved ejection fraction(HFpEF).Poorly understood pathophysiology of heart failure with preserved and reduced ejection fraction and due to a sparsity of studies,the management of HFpEF is challenging.AIM To determine the hospital readmission rate within 30 d of acute or acute on chronic heart failure with preserved ejection fraction and its effect on mortality and burden on health care in the United States.METHODS We performed a retrospective study using the Agency for Health-care Research and Quality Health-care Cost and Utilization Project,Nationwide Readmissions Database for the year 2017.We collected data on hospital readmissions of 60514 adults hospitalized for acute or acute on chronic HFpEF.The primary outcome was the rate of all-cause readmission within 30 d of discharge.Secondary outcomes were cause of readmission,mortality rate in readmitted and index patients,length of stay,total hospitalization costs and charges.Independent risk factors for readmission were identified using Cox regression analysis.RESULTS The thirty day readmission rate was 21%.Approximately 9.17%of readmissions were in the setting of acute on chronic diastolic heart failure.Hypertensive chronic kidney disease with heart failure(1245;9.7%)was the most common readmission diagnosis.Readmitted patients had higher in-hospital mortality(7.9%vs 2.9%,P=0.000).Our study showed that Medicaid insurance,higher Charlson co-morbidity score,patient admitted to a teaching hospital and longer hospital stay were significant variables associated with higher readmission rates.Lower readmission rate was found in residents of small metropolitan or micropolitan areas,older age,female gender,and private insurance or no insurance were associated with lower risk of readmission.CONCLUSION We found that patients hospitalized for acute or acute on chronic HFpEF,the thirty day readmission rate was 21%.Readmission cases had a higher mortality rate and increased healthcare resource utilization.The most common cause of readmission was cardio-renal syndrome.