搜索结果：Costs

Occupational asthma (OA) is a significant public health concern due to its high prevalence and socioeconomic burden. In Tunisia, direct costs of OA have not been previously evaluated, highlighting an important knowledge gap for health policy planning. This study aimed to assess the direct cost of OA in the private sector of central Tunisia and identify factors influencing this cost. A retrospective claims-based cohort study was conducted using data from the National Health Insurance Fund (CNAM) on OA cases recognised between 2015 and 2017 in the governorates of Sousse, Monastir, Mahdia and Kairouan, central Tunisia. Direct costs were estimated from the CNAM payer perspective. The costs were tracked from the date of recognition until 31 December 2020 and expressed in 2020 Tunisian dinars (TND). Statistical analyses included univariate tests and generalized linear models (GLM) with gamma family and log link for right-skewed cost data, reporting adjusted incidence rate ratios (aIRR) with Huber-White (HC1) robust standard errors. A total of 157 cases of OA were analyzed, predominantly female (75.8%), with a mean age of 43.41&#x2009;&#xb1;&#x2009;7.29 years. The textile sector represented 72% of cases. High-molecular weight allergens, particularly vegetable textile dust (70.7%), were the agents most frequently implicated. The median total direct cost was 4,593.52 TND (&#x20ac;1,467.24) per case [IQR: 3,408.00-6,871.72]. The median annualized cost was 1,114.03 TND (&#x20ac;355.94) per person-year. Cash benefits (96.8% of patients) dominated over in-kind benefits (22.9%). In multivariate analysis, age&#x2009;&#x2265;&#x2009;40 years was the only significant independent predictor of medical costs (adjusted incidence rate ratio [aIRR]&#x2009;=&#x2009;2.84, 95% CI: 1.59-5.07; p&#x2009;<&#x2009;0.001), whereas no clinical or demographic factor predicted indemnity costs. Univariate analysis additionally identified male sex (p&#x2009;=&#x2009;0.04), higher PPD rate (p&#x2009;<&#x2009;0.001), and absence of prior occupational disease history (p&#x2009;=&#x2009;0.001) as factors associated with higher total direct costs. This study highlights the considerable direct costs associated with occupational asthma in central Tunisia's private sector, and the resulting burden placed on the healthcare system and the affected workforce. These findings underscore the need to strengthen primary prevention strategies, particularly in the textile industry, to reduce both the health and economic impact of this disease.

Eculizumab, a humanized monoclonal antibody, inhibits activation of complement component C5. For patients with atypical hemolytic uremic syndrome, the introduction of eculizumab has markedly improved survival, restoring life expectancy close to that of the general population. The long-acting C5 complement inhibitor (CI) ravulizumab has since expanded treatment options, offering extended dosing intervals. In 2023, the first eculizumab biosimilars received market authorization. This study aims to evaluate the short-term economic impact of CIs from a German healthcare payer perspective. An economic model with weekly cycles and a time horizon of one year was developed to assess treatment costs for eculizumab originator, eculizumab biosimilars, and ravulizumab in adult patients with atypical hemolytic uremic syndrome, based on a standard adult body weight of 77.7&#xa0;kg. The analysis included direct drug acquisition costs calculated on a milligram basis, obtained from publicly available German price databases and outpatient reimbursement regulations, as well as preparation costs for infusions. Treatment costs were analyzed up to 52 weeks to reflect short-term and annual treatment periods. All costs are presented in euros (2025), and no discounting was performed. Milligram-based prices were estimated at &#x20ac;12.92 for eculizumab biosimilar, &#x20ac;17.87 for eculizumab originator, and &#x20ac;13.63 for ravulizumab. After 13 weeks, cumulative costs were &#x20ac;124,941 (biosimilar), &#x20ac;172,466 (originator), and &#x20ac;127,062 (ravulizumab). After 52 weeks, costs reached &#x20ac;421,439, &#x20ac;581,836, and &#x20ac;352,463, respectively. At treatment initiation, the eculizumab biosimilar appears to be the most cost-efficient option among CIs in Germany, offering cost savings relative to both the originator and the long-acting agent. Sequential use of different CIs may therefore represent a cost-saving option.

BackgroundDuchenne muscular dystrophy (DMD) is a severe X-linked neuromuscular disorder causing progressive muscle loss and early death. Despite global evidence on its burden, data from Sweden remain limited.ObjectiveThis study described the natural history of DMD, treatment patterns, healthcare resource utilization, and direct medical and non-medical costs among patients with DMD and their caregivers in Sweden.MethodsA retrospective, observational matched cohort study was conducted using data from the Swedish National Registry for Neuromuscular Disorders linked to national health and social registers. Patients diagnosed with DMD and their caregivers were compared to matched population controls. Disease progression was classified into four stages based on the HERCULES model.ResultsA total of 211 DMD patients (mean age at diagnosis: 4.9 years) and 877 comparators were included. Patients experienced progressive loss of function, spending on average 3.8, 4.8, 4.8, and 7.4 years in stages 1-4, respectively. Glucocorticoid use was high (84% on either prednisolone or deflazacort). Annual direct medical costs were significantly higher for DMD patients (&#x20ac;14,590 vs. &#x20ac;660). Direct non-medical costs, predominantly for personal assistance, increased substantially with disease stage, representing 89% of total DMD-related costs (&#x20ac;135,671 annually).ConclusionsDMD is a severe disorder marked by prolonged time in the later stages of the disease and increasing need for support. DMD imposes a significant economic burden in Sweden, with direct non-medical costs far exceeding direct medical costs. These findings highlight the need for and value of early and effective interventions to delay disease progression and alleviate societal burden.

Heart failure (HF) is associated with high hospitalization rates and substantial healthcare costs. Pharmacist-collaborative interventions in HF can optimize medication management and have been shown to reduce hospitalizations, but their economic impact in hospital settings remains unclear. Estimate the healthcare payer cost of pharmacist-collaborative care in patients attending a HF clinic at a large Belgian hospital. A microsimulation model was developed to estimate the healthcare payer cost of pharmacist-collaborative care in patients attending a HF clinic at a large Belgian hospital. The model compared total avoided hospitalization costs and pharmacist-related costs over a one-year horizon. Patient-level variability and parameter uncertainty were incorporated using Monte Carlo simulation. Input parameters, including number needed to treat (NNT) to avoid a hospitalization, pharmacist full-time equivalent (FTE) and annual cost, hospitalization cost, and weekly patient throughput, were represented by probabilistic distributions. Cost impact was summarized as mean, median and 95% credible intervals (CrI). Determinants of cost impact were explored using multivariable linear regression. The NNT threshold for cost neutrality was estimated. Across all simulations, the intervention achieved cost savings in 96.2% of scenarios, with mean annual savings of &#x20ac;93,899 (median &#x20ac;88,834; 95% CrI: &#x20ac;-4,350 to &#x20ac;226,549). Regression analysis indicated that each additional patient managed per week increased annual savings by &#x20ac;16,760 (p < 0.001), and each &#x20ac;1 increase in hospitalization cost increased savings by &#x20ac;17.25 (p < 0.001). In contrast, each one-unit increase in NNT was associated with a decrease in cost savings of &#x20ac;2,115 (p < 0.001). The patient-level NNT required for cost neutrality was 74. Pharmacist-collaborative interventions in HF care are highly likely to generate cost savings, particularly in HF clinics with higher patient throughput or settings with higher hospitalization costs. These quantitative thresholds provide practical guidance for the allocation and scaling of pharmacist resources in multidisciplinary HF programs.

To evaluate the cost-effectiveness of IRF versus SNF discharge following stroke from a US healthcare payer perspective. We developed a decision analytic model to simulate 90-day outcomes among stroke survivors discharged to IRFs or SNFs. Inpatient rehabilitation facilities (IRFs) provide higher-intensity therapy than skilled nursing facilities (SNFs) and are associated with better outcomes but are perceived as more costly. Adults (&#x2265; 18 years) with either ischemic or hemorrhagic stroke who required institutional post-acute care services to an IRF or SNF. Not applicable MAIN OUTCOME MEASURES: Modeled outcomes included mortality, disability (modified Rankin Scale 0-2 vs. 3-6), community discharge, and readmission. Costs (2024 US Dollar) included rehabilitation stay, long-term care, home health, and readmissions. Utilities for four health states (home vs. long-term care; minor vs. moderate disability) were applied to estimate 90-day quality-adjusted life years (QALYs). Secondary analyses incorporated functional recovery using AM-PAC and Functional Independence Measure (FIM) domains. One-way and probabilistic sensitivity analyses tested robustness. In the base case, IRF was the dominant strategy, with lower 90-day mean costs ($43,062 vs. $49,319) and greater effectiveness (0.57 vs. 0.37 QALYs), yielding incremental savings of $6,257 per patient. Functional analyses confirmed IRF dominance, with higher probabilities of clinically meaningful improvement in AM-PAC mobility (86% vs. 30%), AM-PAC self-care (91% vs. 37%), and FIM mobility (60% vs. 26%). IRF remained cost-effective across wide parameter ranges and in 81% of 10,000 probabilistic simulations. Among stroke survivors requiring institutional rehabilitation, discharge to IRF was associated with greater effectiveness and lower 90-day costs compared with SNF discharge, supporting equitable access to intensive rehabilitation.

BackgroundSystemic lupus erythematosus is a chronic autoimmune disease associated with heightened cardiovascular risk. Data on the impact of systemic lupus erythematosus on outcomes following heart failure hospitalization remain limited. This study aimed to evaluate whether systemic lupus erythematosus is independently associated with 90-days readmission and other clinical outcomes among patients hospitalized with heart failure.MethodsWe conducted a retrospective cohort study using the 2016-2017 Nationwide Readmissions Database to evaluate the association of systemic lupus erythematosus with 90-days readmission after heart failure hospitalization. Adults &#x2265;18&#xa0;years with an index admission for heart failure were included. The primary outcome was 90-days all-cause readmission. Secondary outcomes included in-hospital mortality, median length of stay, and hospitalization costs. Multivariable Cox proportional hazards were used to identify independent predictors of outcomes.ResultsAmong 1,625,731 patients hospitalized with heart failure, 9096 had comorbid systemic lupus erythematosus. Compared with non-systemic lupus erythematosus patients, those with systemic lupus erythematosus were younger (mean age 61 vs 72&#xa0;years), predominantly female, and more likely to have socioeconomic disadvantage and a higher comorbidity burden. The 90-days readmission rate was significantly higher in the systemic lupus erythematosus cohort (41%) versus the non-systemic lupus erythematosus cohort (34%) (HR: 1.07; 95% CI: 1.02-1.12; p = 0.010). In-hospital mortality did not differ significantly between groups; however, mortality during readmissions was nearly doubled compared with index admissions (5.4% vs 2.9%). SLE patients had a median length of stay of 4&#xa0;days (vs 4 days in non-SLE) and incurred median hospitalization costs of USD 32,872 (13% higher than non-SLE patients). Independent predictors of readmission included Medicaid insurance, weekend admission, renal failure, myocardial infarction, and discharge to a non-home setting, whereas female sex, treatment at metropolitan teaching hospitals, and comorbid hypertension or diabetes were associated with a lower risk of readmission.ConclusionSystemic lupus erythematosus is independently associated with an increased risk of 90-days readmission following heart failure hospitalization, contributing to greater healthcare utilization and costs. These findings highlight the need for tailored strategies for transitional care, multidisciplinary follow-up, and socioeconomic support.

Dialysis patients with heart failure with reduced ejection fraction (HFrEF) are frequently excluded from kidney transplantation due to high perioperative risk. We evaluated whether a multidisciplinary cardiorenal clinic could optimise guideline-directed medical therapy (GDMT), improve cardiac function, enable transplantation, and reduce healthcare costs. Eleven dialysis patients were treated. Median LVEF improved from 30% to 47% (p&#x2009;<&#x2009;0.01). After 29 months follow-up, 7 patients underwent transplantation and 4 remained active on the waiting list. Five-year estimated costs were &#xa3;166,338 for dialysis versus &#xa3;47,908 following transplantation. HFrEF optimisation may restore transplant eligibility while substantially reducing long-term healthcare expenditure.

Respiratory syncytial virus (RSV) represents a major healthcare, economic, and social burden, particularly among infants. The present study aims to evaluate, from a public health perspective, the economic impact of implementing a universal immunization strategy with nirsevimab in the Community of Madrid (CM).A cost-benefit analysis was conducted from both healthcare and societal perspectives using real-world observational data. The study included all newborns between April 1 and December 31, 2023. The follow-up period corresponded to the RSV epidemic season (October 2023-March 2024). Data sources included administrative, clinical, vaccination, and epidemiological surveillance records. Direct costs included primary care, emergency services, and hospitalizations-with and without intensive care-while indirect costs captured parental productivity losses. A probabilistic model with Monte Carlo simulations (100,000 iterations) was used to assess uncertainty, and the internal rate of return (IRR) was calculated for different dose price scenarios. The study included 37,689 newborns. The incidence density of healthcare events was consistently lower among immunized children. The IRR was 62% at a price of &#x20ac;209 per dose, remaining positive up to &#x20ac;330 per dose. At the base price (&#x20ac;209 per dose), the intervention was cost-beneficial in 100% of simulations. Universal immunization with nirsevimab in the CM proved to be cost-beneficial and robust across various price scenarios, supporting its inclusion in child public health programs.&#xa0;Conclusion: Universal immunization with nirsevimab in the CM proved to be cost-beneficial and robust across various price scenarios, supporting its inclusion in child public health programs. What is known: &#x2022; Respiratory syncytial virus (RSV) causes a major clinical and economic burden in infants due to high hospitalization and emergency care rates during seasonal epidemics. &#x2022; Clinical trials and modeling studies suggest that nirsevimab effectively prevents RSV disease and may be economically favorable, but real-world cost-benefit evidence remains limited. What is new: &#x2022; This study presents a real-world, population-based cost-benefit analysis of a universal nirsevimab immunization campaign using administrative and clinical data from a regional birth cohort. &#x2022; Universal immunization was cost-beneficial from both healthcare and societal perspectives across a wide range of price scenarios, demonstrating robust economic returns under real-life conditions.

Chronic hepatitis C (HCV) is a major cause of cirrhosis and hepatocellular carcinoma. In the UK, the principal risk factor for HCV is injecting drug use. The introduction of direct acting anti-virals (DAA's) have transformed HCV care, with cure rates of over 95%. However, HCV is often asymptomatic, and reinfection is a concern. Modelling and real-life studies demonstrate the potential effectiveness of a contact tracing approach for finding people who have acquired HCV through injecting drug use. However, it is not used routinely in the UK. This qualitative study was undertaken to assess the acceptability of a contact tracing approach to identify people who have injected drugs with an index patient recently diagnosed with HCV. Twelve people with lived or living experience of injecting drug use and an HCV diagnosis were interviewed using semi-structured interview topic guides. Participants were purposefully selected according to the inclusion criteria and to ensure there was an even spread of male and female participants. Sekhon's Theoretical Framework of Acceptability, incorporating seven components (affective attitude, burden, ethicality, intervention coherence, opportunity cost, perceived effectiveness, and self-efficacy) was used to analyse data from interview transcripts. A sample of 12 people who inject drugs in the UK indicated that a contact tracing approach was acceptable across two components of Sekhon's acceptability framework: affective attitude and ethicality. Participants broadly found the idea of tracing people who may be at risk of contracting HCV acceptable, and the approach aligned with their value systems. A contact tracing approach would help alleviate concerns about putting other people's lives at risk through HCV transmission and was seen as a 'sensible' way of finding people at risk. However, there were caveats to this acceptability. Contact tracing approaches delivered by mainstream health, or governmental organisations increased burden, opportunity costs and perceived effectiveness of a contact tracing approach for HCV, particularly within contexts of exclusion and criminalisation of people who inject drugs. Burden and opportunity costs were also affected by individual experiences and risks of violence, sexual violence and abuse. There was a lack of knowledge of contact tracing approaches amongst respondents, leading to a lack of intervention coherence and misunderstandings of what contact tracing was and how it would work. Trusted relationships with NGOs and HCV specialist nurses reduced burden and increased confidence and ability (self-efficacy) to engage with a contact tracing approach. People who inject drugs broadly perceive contact tracing as an acceptable method of finding people who are at risk of HCV. However, this acceptability is based on specific modes of delivery through trusted organisations. Findings further highlight the importance of naming and describing contact tracing approaches appropriately, as well as assessing and mitigating against potential risk to index patients, to increase self-efficacy and capacity to engage. Considering these findings, the potential for expanding existing contact tracing approaches should be explored to ensure the UK reaches and maintains its elimination targets.

Research on substance use and decision-making relates reward sensitivity, cost insensitivity, and inconsistent use of cost information to greater substance use severity. However, little work tests how people compare rewards to costs within the same choice. Further, no work examines how the comparison of rewards to costs varies across different contexts. We administered a new cost-benefit variant of a probabilistic learning task to a diverse community sample with elevated rates of substance use (N&#x2009;=&#x2009;130). Individuals with more years of regular substance use tended not to repeat safe choices particularly in contexts where doing so was advantageous, and repeated risky choices after they incurred losses regardless of context. Individuals with more years of regular substance use also showed reduced discrimination between loss magnitudes, selecting the risky choice even as loss magnitudes increased. Computational modeling parameters indicated that these individuals under-weighted losses, though this relationship weakened when accounting for age. Altogether, these results suggest that decreased sensitivity to cost information may characterize continued substance use despite incurring negative consequences.

Ammonia is commonly known as a major air pollutant and serves as a vital ingredient in numerous industrial processes, such as the production of nitrogen-based fertilizers, textiles, and biofuels. This not only raises the costs of agricultural production but also impedes sustainable farming practices. As a result, monitoring ammonia emission has become a crucial task to improve nitrogen efficiency and reduce environmental impacts. Traditional detection methods, such as spectrometry, chromatography, and gas detection tubes, often involve high costs, complexity, and aren't user friendly. In this study, a novel colorimetric paper sensor based on NH2-MIL-125 MOF and bromocresol green (BCG) for measurement of ammonium as ammonia gas in agricultural fertilizer samples was developed. To optimize the sensor performance, a design of experiments (DOE) approach was used to investigate the effect of various factors, such as the concentrations of NH2-MIL-125 MOF and bromocresol green (BCG) on the sensor response. The color change which is primarily observed in the B color value in the RGB (red, green, blue) color model, shows a strong correlation with ammonia concentration. The limits of detection (LOD) and limit of quantification (LOQ) for the B color value were determined to be 0.33&#x202f;mg&#x202f;L-1 and 1.1&#x202f;mg&#x202f;L-1, respectively. These values indicate high sensitivity of the sensor, with a coefficient of determination (R2) of 0.9220 for the B color value confirming its high accuracy. The sensor response reached its highest level after 60&#x202f;min. The sensor response is aligned with the RGB color model, providing a user-friendly and effective tool for assessing fertilizer quality in situ and monitoring ammonia release in real time. The comparative study indicated that the MOF combined with bromocresol green offers superior performance for ammonia detection compared to bromocresol green alone. The sensor takes advantage of the high surface area and ammonia adsorption capacity of NH2-MIL-125 MOF, combined with the colorimetric response of BCG to ammonia.

Anticholinergic (ACh) and central nervous system (CNS)-active drug burdens may be associated with adverse outcomes in older adults. This study assessed these burdens and examined their associations with adverse in-hospital outcomes. A retrospective cross-sectional analysis was conducted among 13&#x2009;607 hospitalizations in patients aged &#x2265;60&#x2009;years in 2024. ACh burden was assessed using the 2022 CRIDECO Anticholinergic Load Scale, and the 2023 Beers Criteria were used to assess CNS-active burden. For each exposure, hospitalizations were classified as having no, low, or high burden. The primary outcome was a composite of delirium, cognitive impairment, falls or fractures. Secondary outcomes included length of stay, in-hospital mortality and hospitalization costs. Separate multivariable regression models were used to estimate associations with ACh and CNS-active burdens. Low and high ACh burdens were identified in 30.24% and 63.65% of hospitalizations, respectively; the corresponding proportions for CNS-active burden were 49.17% and 21.99%. Compared with no ACh burden, high ACh burden was associated with the primary outcome (adjusted odds ratio [aOR] 8.40; 95% confidence interval [CI] 3.46-20.38), whereas low ACh burden was not. Compared with no CNS-active burden, both low (aOR 4.67; 95% CI 2.67-8.18) and high (aOR 32.64; 95% CI 19.06-55.89) CNS-active burdens were also associated with this outcome. High burden in either group was associated with longer hospital stay, higher mortality and greater costs. ACh and CNS-active burdens were associated with adverse in-hospital outcomes, supporting consideration of routine inpatient medication reviews to identify potentially harmful cumulative drug burden.