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PHS25. Direct health care costs in patients with pulmonary arterial hypertension in the national institute of cardiology "ignacio chávez" (nic), mexico city

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PHS25. Direct health care costs in patients with pulmonary arterial hypertension in the national institute of cardiology "ignacio chávez" (nic), mexico city

VALUE IN HEALTH 16 (2013) A1-A298 A189
analyzed for 365 days after and before the accrual period. RESULTS: On a total of
2,962,498 subjects observed, 594 patients were hospitalized for melanoma (53.4%
males) during 2009 (prevalence rate: 20.0 per 100,000). Among them, 43% had at
least one chronic comorbidity, hypertension is the most common (14.6%)
followed by combination of dyslipidemia and hypertension (3.0%). Therapy for
melanoma is made both in and outside the hospital. Interferon alfa-2b was the
most prescribed treatment outside the hospital with an average cost of €110,
followed by Temozolomide (€40.7) and Erythropoietin (€39.6). During one-year of
follow-up, 13% of patients was hospitalized for chemotherapy with an average
cost of €7398. This amount covers also drug treatment cost during
hospitalization. The average yearly cost/patient for population with melanoma
was €4777 (hospitalizations: 70.8%, drugs: 14.4%, diagnostic examinations:
14.8%), with an higher cost for the subgroup of patient already in treatment the
previous year before the accrual period (€6156 vs €4361). If we consider the
subgroup of patient with metastatic melanoma (N=176), the overall cost rises at
€15,984, most of it (60%) due to drug costs for specific therapy of melanoma and
chemotherapy. Surprisingly methotrexate and cyclophosphamide appear in the
top five list of prescribed drugs. CONCLUSIONS: This study shows high cost of
patients with melanoma and how real world practice therapy, especially for
metastatic melanoma, seems to be far from the guidelines recommendation.
This suggests to create a regional network to correctly redirect therapeutic
choices.
PHS24
COST-OF-ILLNESS STUDIES IN DIABETES MELLITUS: A SYSTEMATIC REVIEW
Ng CS1, Lee JYC1, Toh MPHS2, Ko Y1
1National University of Singapore, Singapore, Singapore, 2National Healthcare Group, Singapore,
Singapore, Singapore
OBJECTIVES: Diabetes mellitus (DM) is recognised as a major health problem. Its
chronic nature and complications make it a costly disease. The aim of this study
is two-fold: (1) to describe the methods used in the identified cost-of-illness (COI)
studies of DM and (2) to summarise their study findings regarding the economic
impact of DM. METHODS: This is a systematic review of MEDLINE and Scopus
journal articles reporting the cost of type-1 and/or type-2 DM that were
published in English from 2007 to 2011. Costs reported in the included studies
were converted to US dollars for comparison purposes. RESULTS: The systematic
search yielded 30 articles that met the predetermined criteria. The studies varied
considerably in their study design, perspective and included cost categories.
Estimates for the total annual costs of DM ranged from US$141.6 million to
US$174 billion; direct costs ranged from US$150 to US$14,060 per patient per year
(pppy) whereas indirect costs ranged from US$39.6 to US$7,164 pppy. Inpatient
cost was the major contributor to direct cost in half of the studies that included
inpatient costs, physician services and medications. In addition, patients with
DM consumed significantly more health care resources and incurred higher
health care costs than patients without DM. CONCLUSIONS: There is a
considerable economic burden associated with DM, not only on the health care
system, but also on the individual and society as a whole. Future research should
focus on improving methods of estimating costs, enhancing the interpretation of
study findings and facilitating comparisons between studies.
PHS25
DIRECT HEALTH CARE COSTS IN PATIENTS WITH PULMONARY ARTERIAL
HYPERTENSION IN THE NATIONAL INSTITUTE OF CARDIOLOGY "IGNACIO
CHÁVEZ" (NIC), MEXICO CITY
Rely K1, Pulido Zamudio T2, Escamilla C3, Ramírez-Neria P2, Vazquez A4, Cañedo A5
1CEAHealthTech, Mexico City, D.F., Mexico, 2Instituto Nacional de Cardiología - Ignacio Chávez,
Mexico City, Mexico, 3INSP, Mexico City, Mexico, 4Actelion Pharmaceuticals Mexico, Mexico City,
Mexico, 5Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
OBJECTIVES: To evaluate the cost of Pulmonary Arterial Hypertension (PAH) to
health services in Mexico based on epidemiological trends, to project this
estimate to 2012. METHODS: Retrospective medical chart review using data from
the NIC. Clinical and resource utilization data for all patients admitted to the NIC
with PAH between January 1, 2009 and 2011 were collected and the mean
treatment costs per person were calculated by assigning appropriate unit cost
data to all resource use. A prevalence based approach was used to estimate the
economic burden of PAH. Contemporary data were obtained from
epidemiological studies, government datasets, and other sources to estimate
prevalence. National costs (US dollar 2012) of treatment for PAH were estimated
by extrapolation of mean cost estimate per person to national incidence data for
PAH. Because of uncertainties surrounding some of our estimates such as
prevalence, one way sensitivity analyses were undertaken. RESULTS: A total of
113 PAH patients were identified and their demographic and clinical
characteristics, patterns of care were examined. The mean age was 38 years, and
83% were female. The average per patient annual cost was $ 10,869 without
specific treatment (min $ 137; max $155,928). The annual cost for the treatment
of a single PAH patient per year with specific therapy (Bosentan) was calculated
in $31.433. Aggregate national health care expenditures for treatment of PAH
were USD 46.6 million In multivariate analysis, length of hospital stay, stay in
ICU, were all significant independent predictors of treatment CONCLUSIONS:
Treatment costs of PAH in Mexico are substantial and primarily driven by the
intensity of hospital treatment. With the expected increase in the incidence of
PAH in Mexico over the coming decades, these results emphasize the need for
effective preventive and acute medical care.
PHS26
DIRECT MEDICAL COST AND QUALITY OF LIFE OF DIASTOLIC HEART FAILURE
IN HONG KONG
Lee VW, Yan B, Chan CY, Leung AW, Yu CM, Lam YY
The Chinese University of Hong Kong, Shatin, Hong Kong
OBJECTIVES: The current study aimed to examine direct medical cost and
humanistic outcome of diastolic heart failure (DHF) management in Hong Kong.
Whether the presence of comorbidities, including hypertension, diabetes and
renal impairment, affect the cost and humanistic outcome was also evaluated.
METHODS: Retrospective, non-randomized study design was adopted. Subjects
were recruited from the Heart Failure Registry of the Prince of Wales Hospital in
Hong Kong between 2006 and 2008 and completion of the Minnesota Living with
Heart Failure Questionnaire (MLHFQ) at 3 designated time pints to be eligible.
Patients with significant valvular disorder were excluded. One year medical
records since admission were reviewed. Heart failure related admissions, clinic
visits, cardiovascular drugs, laboratory and diagnostic tests were recorded. The
costs and MLHFQ scores in patients with or without hypertension, diabetes, and
renal impairment were compared. Non-parametric Wilcoxon Signed Rank and
Mann-Whitney tests were used. A p-value < 0.05 was considered statistically
significant. RESULTS: A total of 73 DHF patients were included. The mean 1-year
direct medical cost was USD 20,098 (1 USD = 7.75 HKD), with in-patient care cost
contributing to the largest proportion (72.2%) of the total cost. Patients with
diabetes or renal impairment were associated with a higher cost of DHF
management. Significant difference was found in the renal impairment group
(median cost: USD 24,763 versus USD 12,789 in no impairment group, p=0.023).
The mean MLHFQ scores of the subjects improved significantly from baseline
30.81±13.89 to 12 months 15.84 ±11.32 (p<0.0005). CONCLUSIONS: The cost of
management of DHF was shown to be enormous and further increased in the
presence of comorbidities. With the aging population in Hong Kong, the
incidence of DHF is expected to increase progressively. Further studies are
demanded to guide more optimal medical resource allocation for DHF
management.
PHS27
AN INCIDENCE MODEL OF THE COST OF ADVANCED PROSTATE CANCER IN
SPAIN
Hart WM1, Nazir J2
1EcoStat Consulting UK Ltd, Sidestrand, UK, 2Astellas Pharma Europe Ltd., Chertsey, UK
OBJECTIVES: Prostate cancer is the second leading cancer diagnosed among
men. In Spain the incidence of prostate cancer was 100.4 cases per 100,000
males. Advanced prostate cancer is cancer that has spread outside of the
prostate capsule and may involve other parts of the body, most commonly to the
lymph nodes and bones . The aim of this study was to estimate the lifetime costs
of a cohort of advanced prostate cancer patients diagnosed in Spain in 2012.
METHODS: An economic model was developed in EXCEL incorporating Spanish
incidence, mortality and cost data supplemented with data from the
international literature. Progression from Stage III to Stage IV was permitted.
Costs were discounted. Lifetime costs were presented on an individual basis and
for the entire cohort of newly diagnosed Stage III and Stage IV prostate cancer
patients. RESULTS: Lifetime costs for advanced prostate cancer were
approximately 23,032 € per patient. Using the projected incident cases for 2012,
the total cost for the incident cohort of patients in 2012 would amount to 172
million euros. These results were more sensitive to changes in the ongoing costs
(post initial 12 months) of Stage III prostate cancer, the rate of progression from
Stage III to Stage IV and the discount rate applied to costs. CONCLUSIONS: This
study provides an estimate of the lifetime costs of advanced prostate cancer in
Spain and a framework for further research. Until improved long-term
prospective or observational data do become available the current results
indicate that the burden of advanced prostate cancer is substantial and will
increase due to an increasing number of new cases and reductions in mortality.
Any treatments that could potentially reduce the economic burden of the disease
should be of interest to health care decision makers given the context of limited
resources in Europe.
PHS28
EVALUATION OF HEALTH CARE COST OF DIABETES WITH CO-MORBIDITIES IN
SOUTH INDIA- A COST OF ILLNESS STUDY
Mateti UV1, Akari S2, Buchireddy K3, Anantha NN1
1Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, India, 2St.Peter's
Institute of Pharmaceutical Sciences, Warangal, India, 3Rohini Super Specialty Hospital,
Warangal, India
OBJECTIVES: To evaluate the health care cost of diabetes with co-morbidities by
using cost of illness analysis. METHODS: A prospective observational study was
conducted for a period of six months at Rohini super specialty hospital, AP,
India. The patients were identified during ward rounds and by regular case
record reviews during study period. The enrolled patients were followed from
the day of admission till the day of discharge and the relevant study data
including total direct costs which include direct medical costs, cost of laboratory
investigations, cost of consultation, cost of hospitalization, direct nonmedical
cost includes the transportation cost to hospital and indirect costs which include
days lost from work or productivity, was documented in case record form.
RESULTS: A total of 150 patients were enrolled during the study period. The
average cost per diabetic patient without complications was Rs. 1623 this
includes the average total direct medical cost was Rs.1483 (91.37%), the average
direct non medical cost was Rs. 20 (1.23%) and the average total indirect cost was
Rs. 120 (7.4%) compared to for those with diabetes complications, Rs. 7706 for
macrovascular complications, Rs. 4907 for microvascular complications and Rs.
2810 others infections. The cost for the treat diabetes with co morbidities was
found to be Rs. 17046, the average total direct medical cost was Rs. 15738
(92.41%), the average direct non medical cost was Rs. 204 (1.12%) and the average
total indirect cost was Rs. 1104 (6.47%). CONCLUSIONS: Our study results
... Отчасти это подтверждается тем, что существует достоверная зависимость прямых затрат на ЛАГ от ФК. Пациенты с ФК IV имели затраты больше, чем пациенты с ФК II и ФК III [26,27]. Однако средняя стоимость назначенной терапии достоверно не отличалась в этих группах, из чего можно сделать вывод, что увеличение расходов при увеличении ФК в данных когортах не связано с назначаемой ЛАГ-специфической терапией, а обусловлено именно тяжестью пациента, что увеличивает, в свою очередь, частоту госпитализаций и объем сопутствующей терапии [26]. ...
... Суммарное расчетное экономическое бремя составило 46,6 млн дол. США [27]. Вероятно, такой результат связан с разной стоимостью ЛАГ-специфической терапии и используемыми препаратами в различных странах. ...
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Full-text available
Pulmonary hypertension (PH) is a progressive disease which is characterized with the increase of pulmonary artery pressure and pulmonary vascular resistance. Such condition leads to right ventricular heart failure and premature death of patients. Pulmonary arterial hypertension (PAH) has the status of an orphan disease. However in Russia only idiopathic PH is included in the list of 24 life-threatening and chronic progressive rare diseases, while other forms of PH are not in it. Inclusion in this list guarantees drug provision for patients at the expense of the regional budget, while patients with other forms of PH can rely on free medication only if they have a disability. The lack of criteria for revising this list as well as the imperfection of legal regulation in the field of drug support for orphan diseases leads to high disability, a significant decrease in the duration and quality of life of patients with PH. As part of a multicriteria approach, a clinical and economic analysis of the disease burden can be one of the tools for policy development and decision-making on the distribution of funding in the healthcare. The article provides a review of the economic burden of various forms of PH in the world.
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