[show abstract][hide abstract] ABSTRACT: We aimed to estimate the annual socioeconomic burden of coronary heart disease (CHD) in Korea in 2005, using the National Health Insurance (NHI) claims data.
A prevalence-based, top-down, cost-of-treatment method was used to assess the direct and indirect costs of CHD (International Classification of Diseases, 10th revision codes of I20-I25), angina pectoris (I20), and myocardial infarction (MI, I21-I23) from a societal perspective.
Estimated national spending on CHD in 2005 was $2.52 billion. The majority of the spending was attributable to medical costs (53.3%), followed by productivity loss due to morbidity and premature death (33.6%), transportation (8.1%), and informal caregiver costs (4.9%). While medical cost was the predominant cost attribute in treating angina (74.3% of the total cost), premature death was the largest cost attribute for patients with MI (66.9%). Annual per-capita cost of treating MI, excluding premature death cost, was $3183, which is about 2 times higher than the cost for angina ($1556).
The total insurance-covered medical cost ($1.13 billion) of CHD accounted for approximately 6.02% of the total annual NHI expenditure. These findings suggest that the current burden of CHD on society is tremendous and that more effective prevention strategies are required in Korea.
Journal of preventive medicine and public health = Yebang Ŭihakhoe chi. 09/2012; 45(5):291-300.
[show abstract][hide abstract] ABSTRACT: To develop a mapping algorithm for a conversion of the EORTC QLQ-C30 and EORTC QLQ BR-23 into the EQ-5D-derived utilities in metastatic breast cancer (MBC) patients.
We enrolled 199 patients with MBC from four leading Korean hospitals in 2009. EQ-5D utility, cancer-specific (QLQ-C30) and breast cancer-specific quality of life data (QLQ-BR23) and selected clinical and demographic information were collected from the study participants. Ordinary least squares regression models were used to model the EQ-5D using QLQ-C30 and QLQ-BR23 scale scores. To select the best model specification, six different sets of explanatory variables were compared.
Regression analysis with the multiitem scale scores of QLQ-C30 was the best-performing model, explaining for 48.7% of the observed EQ-5D variation. Its mean absolute error between the observed and predicted EQ-5D utilities (0.092) and relative prediction error (2.784%) was among the smallest. Also, this mapping model showed the least systematic errors according to disease severity.
The mapping algorithms developed have good predictive validity, and therefore, they enable researchers to translate cancer-specific health-related quality of life measures to the preference-adjusted health status of MBC patients.
Quality of Life Research 10/2011; 21(7):1193-203. · 2.41 Impact Factor
[show abstract][hide abstract] ABSTRACT: The recently-observed trend towards younger stroke patients in Korea raises economic concerns, including erosion of the workforce. We compared per-person lifetime costs of stroke according to the age of stroke onset from the Korean societal perspective.
A state-transition Markov model consisted of three health states ('post primary stroke event', 'alive post stroke', and 'dead') was developed to simulate the natural history of stroke. The transition probabilities for fatal and non-fatal recurrent stroke by age and gender and for non-stroke causes of death were derived from the national epidemiologic data of the Korean Health Insurance Review and Assessment Services and data from the Danish Monitoring Trends in Cardiovascular Disease study. We used an incidence-based approach to estimate the long-term costs of stroke. The model captured stroke-related costs including costs within the health sector, patients' out-of-pocket costs outside the health sector, and costs resulting from loss of productivity due to morbidity and premature death using a human capital approach. Average insurance-covered costs occurring within the health sector were estimated from the National Health Insurance claims database. Other costs were estimated based on the national epidemiologic data and literature. All costs are presented in 2008 Korean currency values (Korean won = KRW).
The lifetime costs of stroke were estimated to be: 200.7, 81.9, and 16.4 million Korean won (1,200 KRW is approximately equal to one US dollar) for men who suffered a first stroke at age 45, 55 and 65 years, respectively, and 75.7, 39.2, and 19.3 million KRW for women at the same age. While stroke occurring among Koreans aged 45 to 64 years accounted for only 30% of the total disease incidence, this age group incurred 75% of the total national lifetime costs of stroke.
A higher lifetime burden and increasing incidence of stroke among younger Koreans highlight the need for more effective strategies for the prevention and management of stroke especially for people between 40 and 60 years of ages.
BMC Public Health 08/2011; 11:646. · 2.08 Impact Factor
[show abstract][hide abstract] ABSTRACT: To examine consumers' attitudes toward direct-to-consumer advertising (DTCA) for prescription drugs in Korea.
We conducted a survey of 350 patients visiting community pharmacies to fill their prescriptions. Consumers' attitudes toward DTCA were assessed in terms of whether they felt DTCA was necessary, their trust in the information provided by DTCA, and their intention to use the information provided by DTCA. We examined consumers' preferences regarding the regulation of DTCA and their expectations of the effects of DTCA.
About 60% of the respondents responded that DTCA is necessary and that they intended to use the information from DTCA. Less than half of the respondents reported that they would trust DTCA information. About 70% of the participants expressed the need for prior vetting of the DTCA content. Respondents had the highest expectation on the effect of DTCA as an information source for patients. Positive consumer expectations regarding the effects of DTCA were significantly associated with positive consumer attitudes toward DTCA (odds ratio=4.70, 95% confidence interval: 2.25-9.82).
This study provides evidence that consumers in South Korea generally have positive attitudes toward DTCA. However, most of the respondents wanted a prior examination system of DTCA content to ensure that the information conveyed to them via DTCA was trustworthy. Policy-makers should be cautious and well-prepared if they decide to introduce DTCA in Korea.
Health Policy 06/2011; 101(3):260-8. · 1.51 Impact Factor
[show abstract][hide abstract] ABSTRACT: This study aims to compare the economic- and patient-reported outcomes between outpatient home-based and inpatient hospital-based chemotherapy in advanced colorectal cancer patients.
A total of 80 patients from Severance Hospital in Seoul, Korea, who had stage III colorectal cancer and underwent home-based (n = 40) or hospital-based chemotherapy (n = 40) with a FOLFOX regimen between January 2007 and April 2008 were enrolled. Patient satisfaction data were collected by a self-administered questionnaire survey. Based on hospital charge records, average cost (in 2008 Korean won (KW)) per chemotherapy session was estimated and compared between home- and hospital-based chemotherapy from a societal perspective.
Patients receiving chemotherapy at home showed higher satisfaction with their treatment (mean satisfaction score 3.58 ± 0.15, 5-point Likert-type scale, with a higher score indicating higher satisfaction) than did those treated at the hospital (3.23 ± 0.21; p < 0.01). After adjusting for differences in baseline characteristics between the two groups using multivariate analysis, those receiving home-based chemotherapy still showed significantly higher satisfaction than those undergoing hospital-based therapy (β = 0.271, p < 0.001). Additionally, home-based therapy reduced the cost per chemotherapy session by 16.6%, compared with hospital-based treatment (1,694,216 versus 2,030,383 KW, 1,200 KW ≈ 1 US dollar). The largest cost reduction was attributable to medical costs (-201,122 KW), followed by caregiver's opportunity costs (-135,000 KW).
Higher satisfaction and lower economic cost for home-based chemotherapy suggests that home-based chemotherapy could be a popular and cost-effective treatment option for colorectal cancer patients who are eligible for home-based chemotherapy.
Supportive Care in Cancer 05/2010; 19(7):971-8. · 2.09 Impact Factor
[show abstract][hide abstract] ABSTRACT: The lack of epidemiologic information on osteoporotic hip fractures hampers the development of preventive or curative measures against osteoporosis in South Korea. We conducted a population-based study to estimate the annual incidence of hip fractures. Also, we examined factors associated with post-fracture mortality among Korean elderly to evaluate the impact of osteoporosis on our society and to identify high-risk populations.
The Korean National Health Insurance (NHI) claims database was used to identify the incidence of hip fractures, defined as patients having a claim record with a diagnosis of hip fracture and a hip fracture-related operation during 2003. The 6-month period prior to 2003 was set as a 'window period,' such that patients were defined as incident cases only if their first record of fracture was observed after the window period. Cox's proportional hazards model was used to investigate the relationship between survival time and baseline patient and provider characteristics available from the NHI data.
The age-standardized annual incidence rate of hip fractures requiring operation over 50 years of age was 146.38 per 100,000 women and 61.72 per 100,000 men, yielding a female to male ratio of 2.37. The 1-year mortality was 16.55%, which is 2.85 times higher than the mortality rate for the general population (5.8%) in this age group. The risk of post-fracture mortality at one year is significantly higher for males and for persons having lower socioeconomic status, living in places other than the capital city, not taking anti-osteoporosis pharmacologic therapy following fracture, or receiving fracture-associated operations from more advanced hospitals such as general or tertiary hospitals.
This national epidemiological study will help raise awareness of osteoporotic hip fractures among the elderly population and hopefully motivate public health policy makers to develop effective national prevention strategies against osteoporosis to prevent hip fractures.
BMC Public Health 01/2010; 10:230. · 2.08 Impact Factor
[show abstract][hide abstract] ABSTRACT: Although hyperlipidemia is well recognized as a risk factor for cardiovascular disease (CVD), there has been no appraisal of the economic impact of statin therapy in Korea.
The aim of this model analysis was to determine the cost-effectiveness of statin therapy versus no treatment for the primary prevention of CVD over a lifetime in Korea, from a health care system perspective.
We developed the Korean Individual-Microsimulation Model for Cardiovascular Health Interventions (KIMCHI), an epidemiologic and economic Markov model of first-onset CVD in Korea in which all individuals began the simulation in the health state alive without CVD, and moved among the 4 health states (alive without CVD, alive with CVD, dead from CVD, and dead from non-CVD causes) in yearly cycles for any specified time horizon, up to 40 years. KIMCHI was populated with 372 subjects from the 2005 Korean National Health and Nutrition Examination Survey (KNHNES) who were aged > or =45 years, did not have a history of myocardial infarction or ischemic stroke, and met current Korean reimbursement criteria for treatment with lipid-lowering medications. The probability of first-onset CVD was estimated for each study participant individually, based on an Asian population-specific risk equation that relied on an individual's sex, age, serum total cholesterol, systolic blood pressure, current smoking status, diabetes mellitus status, and body mass index. Statin treatment was represented by a hybrid of atorvastatin and simvastatin (the most popular statins in Korea), the lipid-modifying effects of which were de rived from a published meta-analysis. Data regarding utilities and costs of CVD (both those covered and not covered by insurance) were derived from published local sources.
In the base case, the estimated incremental costutility ratio was 15,134,284 Korean won (KRW) per quality-adjusted life-year (QALY) gained, and the estimated incremental cost-effectiveness ratio was 20,657,829 KRW per life-year gained (LYG) (1200 KRW approximately US $1). Based on a willingness-to-pay (WTP) threshold of 30 million KRW per QALY saved, there was a 93.7% probability that statin therapy would be cost-effective. Given a WTP threshold of 20 million KRW per QALY, there was a 53.8% probability of being cost-effective. The probabilities at WTP thresholds of 30 and 20 million KRW per LYG were 62.4% and 25.8%, respectively.
Based on this analysis using data from the 2005 KNHNES and the KIMCHI model, statin therapy is likely to be cost-effective for the primary prevention of CVD among Koreans aged > or =45 years. The probability of being cost-effective was greater at a threshold of 30 million KRW per QALY (93.7%) than at 20 million KRW per QALY (53.8%).
[show abstract][hide abstract] ABSTRACT: Objectives: To estimate the medical expenditure associated with osteoporotic hip fracture in elderly Korean women from insurer's perspective.Methods: All claim records of women aged ≥50 years and diagnosed with hip fracture from 2002 to 2004 were obtained from the Korean National Health Insurance. The first 6 months were considered a “window period” during which patients with fractures were defined as incident cases if their initial records of visit or admission were observed after June 30, 2002. We included only those with claim records showing diagnosis of osteoporosis or prescription for antiosteoporosis drugs. For each patient, we calculated the cumulative claims amount related to the initial and follow-up treatment for 2 years after fracture.Results: A total of 22,247 patients were identified during 2.5 years. During the first year of fracture, an average of 3.28 visits and 0.97 admissions were recorded; during the second year, 0.35 visits and 0.02 admissions were recorded. The 2-year cost per patient was KRW3,175,467, 97.4% of which was incurred during first year.Conclusion: Exploring the economic burden of osteoporotic hip fracture in the elderly women is expected to motivate policymakers and clinicians to adopt effective treatment options for the disease prevention and expenditure control.
Value in Health 10/2009; 12(s3):S93 - S96. · 2.19 Impact Factor
[show abstract][hide abstract] ABSTRACT: To estimate the economic burden of osteoporotic vertebral fracture (VF) from a societal perspective.
From 2002 to 2004, we identified all National Health Insurance claims records for women >or= 50 years old with a diagnosis of VF. The first 6-months was defined as a "clearance period," Ysuch that patients were considered as incident cases if their first claim of fracture was recorded after June 30, 2002. We only included patients with >or= one claim of a diagnosis of, or prescription for, osteoporosis over 3 years. For each patient, we cumulated the claims amount for the first visit and for the follow-up treatments for 1 year. The hospital charge data from 4 hospitals were investigated to measure the proportion of the non-covered services. Face-to-face interviews were conducted with 106 patients from the 4 study sites to measure the out-of-pocket spending outside of hospitals.
During 2.5 years, 131,453 VF patients were identified. The patients had an average of 3.38 visits, 0.40 admissions and 6.36 inpatient days. The per capita cost was 1,909,690 Won: 71.5% for direct medical costs, 20.6% for direct non-medical costs and 7.9% for indirect costs. The per capita cost increased with increasing age: 1,848,078 Won for those aged 50-64, 2,084,846 Won for 65-74, 2,129,530 Won for 75-84 and 2,121,492 Won for those above 84.
Exploring the economic burden of osteoporotic VF is expected to motivate to adopt effective treatment options for osteoporosis in order to prevent the incidence of fracture and the consequent costs.
Journal of Preventive Medicine and Public Health 10/2008; 41(5):287-94.
[show abstract][hide abstract] ABSTRACT: Allergic rhinitis (AR) is common among children with asthma and exacerbates asthma symptoms. To assess the incremental utilization and cost of asthma-related health services due to concomitant AR among asthmatic children.
Asthma-related claims were extracted from the Korean National Health Insurance (NHI) claims database, which covers 97% of the population. Per-capita utilization and costs of asthma-related services were determined from the societal perspective.
Of 319,714 children (1-14 years old) with chronic asthma in 2003, 195,026 had concomitant AR (prevalence 610 per 1,000 asthmatic children). Children with AR had 1.14 times more outpatient visits, 1.30 times more emergency department (ED) visits, and 1.49 times more hospitalizations than children without AR. More children with AR used general hospitals (7.17%) than children without AR (3.23%). The ratios of unit pharmaceutical costs per outpatient visit, ED visit, and admission between children with and without AR were 1.27, 1.20, and 1.14. Total annual expenditure combining direct health care, transportation, and caregivers' costs, were $273 and $217 for children with and without AR, respectively.
Health service utilization and costs for asthma were greater for asthmatic children with AR. More frequent ED visits and admissions among asthmatic children with AR suggest poorer control and more frequent exacerbations. Higher unit cost of pharmaceuticals during visits, tendency to receive asthma care from a higher-level facility, and greater risk of ED visit or admission all contributed to the additional economic burden of AR.
Yonsei Medical Journal 09/2008; 49(4):521-9. · 1.31 Impact Factor
[show abstract][hide abstract] ABSTRACT: To assess the extent of consumer use of publicly released hospital performance information by the National Health Evaluation Program (HEP) in Korea.
A questionnaire survey with 385 outpatients visiting four general hospitals in Seoul.
The consumer use of performance information was assessed by the consumers' intention to: (1) recommend hospitals with good performance reports, according to HEP, to their relatives; (2) switch to other hospitals with a better performance and (3) keep the performance report for future use.
Overall, 52-75% of the respondents expressed their intention to use the hospital performance information. Logistic regression analysis results showed that people would use the performance information if they considered HEP to be effective in improving the quality of health care and the performance reports to be trustworthy and useful in choosing hospitals.
This study provides evidence that consumers in a health care system with few restrictions for provider choice, such as in Korea, have a high potential to utilize the provider performance information in their decision making. If public use of the performance information becomes common, policy makers should acknowledge the critical value of the quality of the performance report in order to avoid misleading consumers.
Health Policy 08/2008; 89(2):174-83. · 1.55 Impact Factor
[show abstract][hide abstract] ABSTRACT: We estimated the asthma-related health care utilization and costs in Korea from the insurer' s and societal perspective.
We extracted the insurance claims records from the Korea National Health Insurance claims database for determining the health care services provided to patients with asthma in 2003. Patients were defined as having asthma if they had > or =2 medical claims with diagnosis of asthma and they had been prescribed anti-asthma medicines. Annual claims records were aggeregated for each patient to produce patient-specific information on the total utilization and costs. The total asthma-related cost was the sum of the direct healthcare costs, the transportation costs for visits to healthcare providers and the patient's or caregivers' costs for the time spent on hospital or outpatient visits.
A total of 699,603 people were identified as asthma patients, yielding an asthma prevalence of 1.47%. Each asthma patient had 7.56 outpatient visits, 0.01 ED visits and 0.02 admissions per year to treat asthma. The per-capita insurance-covered costs increased with age, from 128,276 Won for children aged 1 to 14 years to 270,729 Won for those aged 75 or older. The total cost in the nation varied from 121,865 million to 174,949 million Won depending on the perspectives. From a societal perspective, direct healthcare costs accounted for 84.9%, transportation costs for 15.1% and time costs for 9.2% of the total costs.
Hospitalizations and ED visits represented only a small portion of the asthma-related costs. Most of the societal burden was attributed to direct medical expenditures, with outpatient visits and medications emerging as the single largest cost components.
Journal of Preventive Medicine and Public Health 09/2006; 39(5):397-403.
[show abstract][hide abstract] ABSTRACT: We wanted to evaluate the economic value of a pharmaceutical product, Kremezin, for treating patients with chronic renal failure (CRF) by estimating the amount of cost savings due to its effect for delaying the initiation of dialysis treatments.
We defined a conventional treatment for CRF accompanied by Kremezin therapy as 'the treatment group' and only conventional treatment as 'the alternative group.' The types of costs included were direct medical and non-medical costs and costs of productivity loss. The information on the effect of Kremezin was obtained from the results of earlier clinical studies. Cost information was derived from the administrative data for 20 hemodialysis and 20 peritoneal dialysis patients from one tertiary care hospital, and also from the administrative data of 10 hemodialysis patients from one free-standing dialysis center. Per-capita cost savings resulting from Kremezin therapy were separately estimated for the cases with delay for the onset of hemodialysis and the cases with immediate performance of peritoneal dialysis. By computing the weighted average for the cases of hemodialysis and peritoneal dialysis, the expected per-capita cost savings of a patient with CRF was obtained. Using a discount rate of 5%, future cost savings were converted to the present value.
The present value of cumulative cost savings per patient with CRF from the societal perspective would be 18,555,000-29,410,000 Won or 72,104,000-112,523,000 Won if Kremezin delays the initiation of dialysis by 1 or 4 years.
The estimated amount of cost savings resulting from treating CRF patients with Kremezin confirms that its effect for delaying the onset of dialysis treatments has a considerable economic value.
Journal of Preventive Medicine and Public Health 04/2006; 39(2):149-58.
[show abstract][hide abstract] ABSTRACT: To identify target services and determine national priorities among those services identified for a national quality assessment program of the Health Insurance Review Agency (HIRA) in Korea.
Target services were identified from published sources addressing quality problems, various quality-monitoring programs in other countries, suggestions from 26 medical specialty associations in Korea, and frequently reported consumer claims. Three steps were involved in the prioritization decision: (i) development of a set of priority criteria; (ii) expert panel survey to evaluate the extent to which individual services satisfy each of the priority criteria and to calculate mean priority ratings for individual services; and (iii) formation of four levels of priority groups-top, high-middle, middle, and low-according to the allocated priority ratings.
Five priority criteria were selected: "burden of the condition", "seriousness of the quality problem", "interest and demand of society", "acceptability", and "the feasibility of quality assessment". Among the 57 services identified as targets for the national quality assessment program, 10 were selected as having a top priority for quality assessment because of their high feasibility rating. These are: cardiac surgery; cataract surgery; tonsillectomy; appendectomy; tooth extraction; usage of albumin/globulin products; treatments for hypertension, pneumonia, and acute upper respiratory infection; and services provided by clinical laboratory centers.
The priority services identified from the studies will assist the HIRA in selecting target services and implementing the national assessment program.
International Journal for Quality in Health Care 05/2005; 17(2):157-65. · 1.79 Impact Factor
[show abstract][hide abstract] ABSTRACT: To assess the extent of continuous quality improvement (CQI) implementation in Korean hospitals and to identify its influencing factors.
Cross-sectional study by mailed questionnaire survey.
One hundred and seventeen staff members with responsibility for CQI at 67 hospitals with > or = 400 beds.
The degree of CQI implementation was measured using the Malcolm Baldrige National Quality Award Criteria (MBNQAC). Factors related to the degree of CQI implementation were the four components of the CQI pyramid, namely the cultural, technical, strategic, and structural attributes of individual hospitals.
The average CQI implementation score across the seven dimensions by MBNQAC was 3.34 on a 5-point scale. The highest score was achieved in the dimension of 'customer satisfaction' (3.88), followed by 'information/analysis' (3.59), and 'quality management' (3.35). Regression analysis showed that hospitals which better fulfilled technical requirements, such as improving information systems (P< 0.05), using more scientific CQI tools, and adopting systematic problem-solving approaches (P<0.01), tended to achieve higher degrees of CQI implementation. Although statistically insignificant, positive trends were observed for group/developmental culture and the degree of employee empowerment, and the use of prospective strategy.
It appears that the most important contributing factors to active CQI implementation in Korean hospitals were the use of scientific skills in decision-making and the adoption of a quality information system capable of producing precise and valid information.
International Journal for Quality in Health Care 10/2002; 14(5):383-91. · 1.79 Impact Factor
[show abstract][hide abstract] ABSTRACT: To assess the value of laser in situ keratomileusis (LASIK) by patient-reported outcomes using quality of life assessment.
This study included 288 consecutive patients treated by LASIK between July and December 2001 at two eye clinics. A Myopia-specific Quality of Life Questionnaire was developed in this study. The baseline quality of life corresponding to the situation where refractive error was corrected by glasses or contact lenses before LASIK treatment was evaluated by self-administered questionnaire. The evaluation was repeated at 4 days, and 1, 3, and 6 months after LASIK treatment. All question items were rated on a scale ranging from 1 (maximal dysfunction) to 5 (minimal dysfunction).
Factor analysis identified 34 questions in 4 subscales-visual function, visual symptoms, social role function, and psychological well-being. The Myopia-specific Quality of Life Questionnaire subscales proved to be internally consistent (Cronbach alpha = 0.70-0.95). Criterion validity was assessed by evaluating Spearman correlation between the overall or domain-specific quality of life and traditional measures of patient status. Overall Myopia-specific Quality of Life Questionnaire score changed from 3.21 preoperatively to 3.76, 4.00, 4.07, and 4.11 at 4 days, and 1, 3, and 6 months after surgery, respectively. Social role function showed the biggest improvement (score change: 1.51, P < .05), followed by psychological well-being (0.90, P < .05), visual function (0.72, P < .05), and visual symptoms (0.49, P < .05). Regression analysis results showed that the degree of uncorrected visual acuity, discomfort associated with myopia preoperatively, and location of eye center were significant factors affecting the magnitude of changes in quality of life after LASIK.
This study confirms that the value of LASIK went beyond the clinical achievement of refractive correction and extended to the improvement of quality of life.
Journal of refractive surgery (Thorofare, N.J.: 1995) 21(1):59-71. · 2.47 Impact Factor