搜索结果：Journal of health economics and outcomes research

General practitioners (GPs) play a pivotal role in a patient's health care journey. However, demands on general practice, including complex patient management, workforce shortages, and health system fragmentation, have been shown to adversely impact the delivery of high-quality care and health outcomes. Integrated care models, particularly those that offer virtual care options, can support improved access to quality care and efficiency of health care delivery across metropolitan and rural areas. The SUSTAIN model of care was created to provide an accessible option for integrated care. It consists of centralized pediatricians supporting GPs in their practice through virtual coconsultations, virtual "lunch and learn" case discussions, and phone or email support. There is limited evaluation literature on integrated models of care being implemented in a primary care setting where the GP and family are face to face and the non-GP specialist is virtual. To address this gap, a comprehensive implementation evaluation of the SUSTAIN model of care was conducted. This study aimed to examine what, why, and how different factors impact the uptake of the SUSTAIN model of care from the perspectives of the SUSTAIN pediatricians and metropolitan and rural GPs in New South Wales, Australia. A qualitative study was conducted as part of a mixed methods implementation evaluation of the SUSTAIN model of care. Data were collected via recorded online focus groups and interviews with GPs, practice managers, and pediatricians at 6 and 12 months after the commencement of SUSTAIN. Data were analyzed thematically using iterative thematic analysis informed by the Consolidated Framework of Implementation Research. Eighteen focus groups and 13 interviews were conducted. GPs, practice managers, and pediatricians found the SUSTAIN model acceptable, with the flexibility and practicality of the model highlighted. GPs valued the learning opportunities, collaboration, and support they gained from working alongside the pediatricians. Virtual delivery through telehealth was viewed as a positive means of receiving specialist support that would otherwise be inaccessible to many practices. Increased efficiency in workflow and working at the top of scope in pediatric care as well as opportunities for meaningful professional relationships and increased family trust in GP-delivered care were recognized as key benefits that enhanced uptake. The current landscape of Australian general practice, with fee-for-service billing and workflow pressures, was recognized as a barrier to engagement with SUSTAIN. GPs and pediatricians highlighted that more appropriate remuneration to support co-consultation is vital to the sustainability and scalability of the SUSTAIN model. The SUSTAIN model of care expands on our understanding of the benefits of integrated GP-pediatrician models of care in general practice by demonstrating the utility of a pediatrician supporting a GP in their practice via telehealth across metropolitan and rural environments in New South Wales, Australia.

Older adults and individuals with certain underlying conditions are at elevated risk of severe influenza complications. This study quantifies the burden of influenza and influenza-like illness (ILI) in Germany focusing on these high-risk groups. This cohort study is based on claims data of a large statutory health insurance fund. Influenza/ILI was identified through International Classification of Diseases version 10 (ICD-10) codes J09-J11. Among insured individuals, the incidence of medically attended influenza/ILI, hospitalizations, complications, and direct healthcare costs were estimated for three consecutive influenza seasons from 2016-2017 to 2018-2019. Healthcare resource use, complications, and costs attributable to influenza were estimated through comparison with a matched control group. Analyses were stratified by age and prevalence of underlying conditions. Approximately 7 million individuals were included in each season. Influenza/ILI incidence decreased with age, but hospitalizations were most common among older adults. One in five cases aged 80+ years was hospitalized. In all age groups, individuals with underlying conditions had a higher incidence of influenza/ILI and of complications than those without underlying conditions. Direct costs per influenza/ILI case ranged from €133.28 (2016-2017) to €218.99 (2018-2019) and were higher in older adults and in individuals with underlying conditions. Underdiagnosis and misclassification of influenza in administrative claims may occur, particularly in the outpatient setting. Only selected complications were examined; exclusion of cardiovascular and neurological consequences likely results in an underestimation of the influenza/ILI burden. Indirect costs, e.g. through productivity losses are not considered. Influenza/ILI significantly impacts the German healthcare system, with older adults and individuals with underlying conditions contributing disproportionately to the observed burden. Risks of severe outcomes and direct costs are highest in older adults, particularly those aged 80+ years, while children with underlying conditions also contribute substantially to the observed burden. These groups are important targets for preventive interventions. Influenza (flu) is a common respiratory infection that can cause serious illness, particularly in older adults and people with long-term health conditions. This study examined how often people in Germany were diagnosed with the flu or flu-like illness, how many were hospitalized, how often certain complications occurred, and what it cost the healthcare system.We used health insurance records from one of Germany’s largest public health insurers, covering approximately 7 million people per year across three flu seasons (2016–2019). We identified flu cases using diagnostic codes and compared them to a matched group of people without flu to estimate the true impact of the illness.Flu was most commonly diagnosed in young children, but hospitalization was far more frequent in older adults. One in five people aged 80 years and older who were diagnosed with the flu required hospital treatment. People with underlying health conditions—such as heart disease, respiratory conditions, or weakened immune systems—were more likely to be diagnosed with flu, to develop complications, and be hospitalized.The average direct healthcare cost per flu case ranged from €133 to €219 per season, rising to over €800 in adults aged 80 and above. Across Germany, total flu-related direct costs were estimated at between €105 million and €228 million per season, with roughly half attributable to people aged 60 and older.These findings highlight the importance of targeted vaccination programs for older adults and people with underlying health conditions to reduce the burden of flu in Germany.

Prostate cancer (CaP) disproportionately affects Black men in the United States, leading to significant disparities in incidence, survival, and quality of life (QoL). Treatment-related side effects, including urinary dysfunction, pain, fatigue, and psychological distress, contribute to poor long-term outcomes. There is an urgent need for culturally-tailored, technology-based interventions to support symptom self-management and survivorship care. This study aims to develop, refine, and evaluate the Survivorship App for Ethnically Diverse Black Prostate Cancer Survivors (SAFE-CaPS), a tailored mobile health intervention designed to enhance QoL, improve symptom self-management, and provide psychosocial support. This 12-month stratified randomized clinical trial will enroll 248 Black survivors with CaP (including native born, African-born, and Caribbean-born men) into the SAFE-CaPS intervention arm and standard care (SC) control group (1:1 allocation). Eligible participants are self-identified Black men (including native born, African-born, and Caribbean-born) aged 40 to 80 years with a confirmed CaP diagnosis within the past 5 years who own or are willing to use a smartphone. SC will consist solely of routine oncology or primary care follow-up, including clinic visits, referrals, and supportive services as needed, with no digital components. The SAFE-CaPS intervention, developed using the Insight platform, includes daily and weekly ecological momentary assessments of pain, urinary and bowel symptoms, sleep, fatigue, sexual function, mood, physical activity, and diet; adaptive educational modules addressing treatment-related side effects and culturally grounded survivorship concerns; automated symptom alerts prompting nurse follow-up and provider notification; and engagement features such as reminders, goal-setting, and literacy-appropriate content. Intervention content incorporates culturally tailored messaging, patient narratives, and feedback from prior qualitative work with ethnically diverse Black CaP. Stratified randomization will ensure balanced representation of ethnic subgroups. Primary outcomes include overall QoL. Secondary outcomes include specific symptom domains, mental health (depression and anxiety), health care engagement, and app acceptability. Assessments will occur at baseline, 3, 6, 9, and 12 months, and linear mixed models with intent-to-treat principles will evaluate intervention effects over time. The study was funded in 2024, institutional review board approval was received in mid-2024, and the study began recruitment on August 24, 2025. Overall, 6 participants have been enrolled, with 2 in the SAFE-CaPS intervention and 4 in SC. Recruitment is expected to conclude in July 2027. Data analysis will occur in late 2027, with article preparation and publication planned for mid-2028 and early 2029. We hypothesize that SAFE CaPS participants will experience greater improvements in QoL, reduced symptom burden, and higher engagement in care compared to SC. This study will provide critical evidence on the feasibility, acceptability, and preliminary effectiveness of a culturally tailored mobile health intervention designed to enhance survivorship outcomes among Black survivors with CaP, informing future large-scale trials and real-world implementation. ClinicalTrials.gov NCT06651359; https://clinicaltrials.gov/study/NCT06651359. PRR1-10.2196/81503.

Despite advances in treatment, pulmonary arterial hypertension (PAH) remains a progressive condition with the onset of disease often in working-aged adults, leading to substantial economic burden and increased healthcare resource utilization despite the rarity of the disease. The aim of this study was to estimate productivity loss for patients with PAH. This was a retrospective cohort study of the Milliman Consolidated Health Cost Guidelines Source Data and the Merative MarketScan Commercial dataset between 01/01/2018 and 09/30/2023. Adult patients diagnosed and treated for PAH between 01/01/2019 and 08/31/2023 were identified and followed through the earliest of end of enrollment, or end of data. Outcomes were described as average workdays lost to receive healthcare services per-patient per-year (PPPY) and further assessed by healthcare setting. The cost of productivity loss was calculated based on the annual median household income. The study included 1,588 commercially insured patients (mean age 52 years, 63% female). Between 2019-2023, the mean number of workdays lost ranged between 21 and 23 PPPY, equating to over 8% of annual workdays. The cost of loss of productivity ranged from $8,828 to $9,599 PPPY (in 2023 dollars). Across all study years, the largest proportion of workdays lost were attributed to emergency room (ER)/observation, followed by office visits, and outpatient facilities, altogether comprising two-thirds of total workdays lost. Inpatient hospitalization-related workday loss was approximately 11% of total workdays lost. Over the study period, the largest change in workdays lost was observed for ER/observation. This study demonstrates substantial workdays lost due to health services utilization among patients with PAH, further adding to the overall economic burden of PAH. Quantifying productivity loss in PAH patients provides critical insight into the broader societal costs of the disease, supporting the inclusion of indirect costs in future economic evaluations and healthcare policy decisions. Pulmonary arterial hypertension (PAH) is a rare but serious disease that often affects working-age adults. Even with advances in treatment, PAH continues to cause a substantial healthcare cost burden. This study looked at how much work people with PAH miss because of their medical needs.Health insurance data from 2019 to 2023 was used to identify working-age adults with PAH and measure the number of workdays lost each year due to receiving healthcare. The cost of missed workdays was estimated using average household income.On average, each person with PAH missed about 21 to 23 workdays per year, which is more than 8% of the total annual workdays. The value of this lost productivity ranged from $8,828 to $9,599 per person per year. Most missed workdays were due to emergency room visits, office visits, and outpatient care, while hospital stays accounted for about 11% of total workdays lost.These findings show that people living with PAH lose a substantial amount of work time because of their condition, resulting in high indirect costs. Understanding this productivity loss is important for future decisions about healthcare policies and the economic impact of PAH.

Sickle cell disease (SCD) disproportionately affects racial and ethnic minority groups in the US and is associated with high levels of morbidity and health care utilization. However, population-level geographic differences and temporal variation in SCD hospitalization outcomes remain incompletely characterized. To assess temporal and regional patterns of SCD hospitalizations in New York State from 2009 through 2022. This retrospective cross-sectional study analyzed inpatient SCD hospitalizations recorded in the New York State Statewide Planning and Research Cooperative System deidentified database between January 1, 2009, and December 31, 2022. The analytic sample included 42 271 hospitalizations after exclusion of records with missing demographic, cost, or facility information. Data analysis was conducted from July 17, 2024, to February 14, 2025. Hospitalization with SCD across 8 state-defined health service areas. Outcomes included regional distribution of hospitalizations, mean length of stay, mean total charges, and trends in severity of illness and risk of mortality as defined by the All Patient Refined Diagnosis Related Groups classification system. Demographic and regional distributions were compared across years and regions. Among 42 271 SCD hospitalizations (21 777 female [51.5%]), most occurred among individuals identified as Black (35 318 [83.6%) compared with White (750 [1.8%]), multiracial (242 [0.6%]), and other race or ethnicity 5956 (14.1%) and were aged 18 to 29 (16 794 [39.7%]) or 30 to 49 years (13 480 [31.8%]). New York City accounted for the largest proportion of hospitalizations statewide. There were significant differences in the length of stay and total charges across service areas; Central New York had the longest mean (SD) length of stay of 6.3 (7.3) days, followed by the Hudson Valley (6.2 [7.2]) days, while Long Island had the highest mean (SD) total charges at $59 476.3 ($63 823.5). The proportion of hospitalizations classified as major severity increased from 751 of 5897 (12.7%) in 2009 to 1011 of 3709 (27.3%) in 2022, and the proportion classified as major risk of mortality increased from 170 of 5897 (2.9%) to 469 of 3709 (12.6%) during the same period. Long Island had the highest proportion of hospitalizations with major risk of mortality (93 of 970 [9.6%]), whereas New York City exhibited one of the lower proportions of major risk of mortality (1531 of 27 923 [5.5%]) despite high hospitalization volume. In this cross-sectional study, geographic and temporal differences in SCD hospitalization outcomes were observed across New York State during a 14-year period. These findings suggest the need for region-specific strategies to improve access to specialized care, reduce severe outcomes, and optimize health care resource use for individuals living with SCD.

Income is a key social determinant of health, yet its influence on health system performance may differ across settings. Cross-national comparisons can help identify where income-related disparities are most pronounced and inform targeted policy responses; the US and South Korea are 2 members of the Organisation for Economic Co-operation and Development with high poverty rates but different health systems. To compare health system performance and income-related inequalities in health system performance between the US and South Korea. This repeated cross-sectional study including nationally representative samples of noninstitutionalized adults from the US and South Korea used data from the Medical Expenditure Panel Survey (MEPS; 2010-2019), National Health and Nutrition Examination Survey (NHANES; 2009-2018), Korean Health Panel Study (KHPS; 2010-2019), and Korean National Health and Nutrition Examination Survey (KNHANES; 2010-2019). Data were analyzed from March 2024 to March 2025. Annual household income, categorized into country-specific deciles. The main outcomes were 30 indicators across 6 domains: health care spending, health care utilization, access to care, health status, behavioral risk factors, and clinical outcomes. To evaluate income-related inequalities in outcomes, adjusted mean values across income deciles were estimated using regression models. The sample included 224 168 US adults (female: 51.1% in MEPS, 51.7% in NHANES) and 179 452 South Korean adults (female: 52.4% in KHPS, 56.1% in KNHANES). Mean (SD) age was 46.6 (18.0) years in MEPS, 46.5 (17.4) years in NHANES, 47.7 (16.2) years in KHPS, and 50.5 (17.1) years in KNHANES. US adults had higher mean total health care spending (lowest income decile: $7852 [95% CI, $7456-$8247]; highest decile: $6510 [95% CI, $6218-$6802]) than South Korean adults (lowest decile: $1184 [95% CI, $1105-$1263]; highest decile: $1025 [95% CI, $950-$1100]) despite similar levels of self-reported good health. A 1-decile increase in income was associated with a difference of -$142 (95% CI, -$179 to -$104) in total health care spending in the US compared with -$33 (95% CI, -$41 to -$25) in South Korea. A 1-decile increase in income was associated with an increase of 2.4 (95% CI, 2.3-2.5) percentage points (pp) in self-reported good health in the US compared with 1.5 (95% CI, 1.4-1.6) pp in South Korea. Income-related disparities in preventive service use were also larger in the US, ranging from 0.2 (95% CI, 0.2-0.2) pp for cervical cancer screening to 4.0 (95% CI, 3.9-4.1) pp for dental checkups. In South Korea, disparities ranged from 0.6 (95% CI, 0.4-0.8) pp for dental checkups to 2.0 (1.8-2.2) pp for routine checkups. Similar income gradients were observed in access to care and behavioral risk factors. Differences in clinical outcomes were modest in both countries. In this cross-sectional study, income was associated with disparities in health system performance in both the US and South Korea, with larger differences by income in the US. The findings suggest that structural and systemic policy efforts are needed to address income-based health inequalities, particularly in the US.

Patients with cancer are at higher risk of adverse financial events (AFEs) compared with individuals without cancer. However, little is known about how personal finances affect cancer care, particularly at the end of life (EOL). To investigate the association between AFEs and health care use and costs at EOL among patients with cancer. In this cohort study, Western Washington Surveillance, Epidemiology, and End Results cancer registry cases were linked to claims from commercial payers and Medicare and to credit records from TransUnion. Patients with American Joint Committee on Cancer stage I to IV solid tumors who died between January 1, 2013, and December 31, 2019, were identified. Data analysis was performed from January 2023 and June 2025. Emergency department (ED) and inpatient visits in the last 3 months of life, place of death, and mean adjusted health care costs per patient were compared between patients with vs without new AFEs in the 2 years preceding EOL (charge-offs, third-party collections, tax liens, delinquent mortgage payments, foreclosures, or repossessions). A multivariate logistic regression analysis evaluated the association between AFEs and the outcomes of ED or inpatient visits and inpatient death. Health care costs in the last 3 and 6 months of life were analyzed using 2-part models to account for zero costs and right-skewed positive expenditures; adjusted average treatment effects were estimated. A total of 10&#x202f;826 patients (median [IQR] age, 75 [69-83] years; 5877 [54%] male; 932 [8.6%] with AFEs) were included. Patients with AFEs were more likely to have multiple ED or inpatient visits (odds ratio [OR], 1.41; 95% CI, 1.22-1.62; P&#x2009;<&#x2009;.001) and die in a hospital (OR, 1.50; 95% CI, 1.30-1.75; P&#x2009;<&#x2009;.001). Mean (SD) adjusted total health care costs were higher in patients with AFEs than those without in the last 3 months ($35&#x202f;115 [$1415] vs $31&#x202f;031 [$389]) and 6 months ($57&#x202f;401 [$2181] vs $51&#x202f;602 [$581]) of life, yielding a mean adjusted incremental costs in the AFE group of $4084 (95% CI, $1287-$7087; P&#x2009;=&#x2009;.006) and $5799 (95% CI, $1235-$9996; P&#x2009;=&#x2009;.01), respectively. In this cohort study, AFEs were associated with greater ED and inpatient use, higher risk of inpatient death, and higher care costs at EOL. These findings point to the need for future studies investigating whether interventions that mitigate financial hardship could improve the EOL experience and decrease health care costs for patients with cancer.

Depression is one of the leading causes of disease burden worldwide, with profound effects on quality of life, productivity, and life expectancy. In the United States, its prevalence is particularly high, placing substantial strain on both public health systems and economic stability. Despite advances in treatment and growing awareness, depression remains underdiagnosed and undertreated, especially among low-income and vulnerable populations. As the burden of mental illness continues to rise, quantifying its long-term health and economic impacts is essential for guiding healthcare policy and resource allocation. This study projects the future burden of depression in the United States by estimating healthcare expenditures and mortality for 2023-2032, drawing on nationally representative datasets including the Behavioral Risk Factor Surveillance System (BRFSS), the National Survey on Drug Use and Health (NSDUH), and the Healthcare Cost and Utilization Project (HCUP). Using linear regression modeling, the analysis examines trends in prevalence, healthcare utilization, treatment costs, and mortality, highlighting both direct healthcare costs and indirect costs from lost productivity and premature death. While linear modeling offers a straightforward approach to trend estimation, it may not fully capture nonlinear dynamics in depression prevalence and outcomes, and results should be interpreted with this limitation in mind. By 2030, the annual economic burden of major depressive disorder is projected to exceed $540 billion, with nearly 3,000 depression-related deaths annually. These findings underscore the urgent need for early intervention, expanded access to care, and targeted policies to address treatment disparities, thereby reducing both the economic and human toll of depression.

Antiretroviral therapy (ART) has become a cornerstone of human immunodeficiency virus (HIV) management. However, a challenge in HIV care and policy is ensuring individuals remain engaged in care and on treatment over time. Discontinuation of ART is common for various reasons, and prolonged treatment interruptions can lead to worse health outcomes at the individual level and increased HIV transmissions at the public health level. A cost-consequence analysis was conducted to evaluate the economic and public health impact of reducing the interval to ART restart among people with HIV (PWH) who have disengaged from care. A state transition disease model was developed to calculate the economic benefits from improving treatment restart patterns from a United States healthcare payer perspective. Two hypothetical cohorts of 1000 PWH who discontinued ART were compared: a standard-of-care cohort where restart occurs 32 weeks after discontinuation, and a comparator cohort exploring the impact of reducing the time between ART discontinuation and restart to 12 weeks. Individuals were assigned to CD4-related health states, and rates of viral suppression were considered. Four outcomes, ART costs, CD4 health state costs, CD4-related mortality, and new HIV transmissions were calculated over a three-year time horizon. Cost savings from averted HIV cases were valued based on the lifetime excess healthcare costs for a PWH. Increasing the proportion of individuals restarting ART and reducing time to restart was estimated to avert 88 HIV transmissions. This corresponds to a number needed to treat, defined as the number of PWH who would need to experience the earlier restart pattern of the comparator cohort, of 11 to avoid one new transmission, and $101&#x2009;083&#x2009;857 lifetime cost savings. Cost savings attributable to improved CD4 counts in the cohort were also found. Enhancing ART restart patterns improves health and provides considerable cost savings by improving individuals' CD4 counts and reducing new HIV transmissions from people who are viremic. Effective policies to promote care engagement and treatment adherence are predicted to improve the health of PWH and reduce new HIV cases.

Duchenne muscular dystrophy (DMD) is a rare, X-linked inherited disorder starting in early childhood, characterized by progressive muscle loss and weakness, causing disability, loss of ambulation, and cardiopulmonary failure. Economic modeling is required to assess cost-effectiveness of new DMD therapies, but there are challenges from limitations and variations in currently available data. To assess the burden of DMD on patients, caregivers and healthcare systems, identifying inputs for cost-effectiveness models to inform economic assessments. Two systematic literature reviews (SLRs) were conducted. One SLR was performed to identify health state utility values (HSUV, original date 2019 with a 2023 update) and another to identify and cost data (original date 2023). Both SLRs were updated in 2024. Databases searched included Embase, MEDLINE, Centre for Reviews and Dissemination and EconLit, with additional hand-searching. PRISMA guidelines were followed. For each SLR, title/abstract and full-text screening were performed by two independent reviewers before data extraction. Validated quality assessment tools were used. Across both SLRs, the burden increased as DMD progressed from early to late stages, indicated by decreasing HSUVs and increasing healthcare resource use and costs. The results highlighted large increases in burdens between early nonambulatory and late nonambulatory DMD in studies using the typical 4-state progression model. Recent publications using an 8-stage natural history model reported gradual increases in burden. There was heterogeneity between studies and a lack of long-term data in both SLRs. The results highlighted the complex nature of progressive DMD, with heterogeneity and lack of long-term data across the studies. The findings suggest that HUI-3 may be the preferred tool for HSUV measurement in DMD, and the 8-stage natural history model may be preferable to typical 4-state models of DMD progression, to account for the observed heterogeneity and non-linear progression of this rare disease. These data indicate that the burden on patients, caregivers, and healthcare systems increases as DMD progresses. A wide range of inputs for economic modeling were identified, including insights into the way that the stages of DMD should be modeled to accurately reflect progression.

Immunoglobulin-G4-related disease (IgG4-RD) is a rare recurring fibroinflammatory autoimmune condition that can affect multiple organs. Although it is gaining recognition, few studies have assessed the clinical and economic burden of this disease. This study aimed to characterize patients with IgG4-RD in the United States and describe healthcare resource utilization (HRU) and costs before and after diagnosis. This retrospective cohort study used a validated algorithm to identify commercially insured adult patients with IgG4-RD from health plan claims data obtained from the IQVIA PharMetrics Plus database (January 1, 2011, to June 30, 2022). The index date was defined as the date of the first observed IgG4-RD-related diagnosis. The baseline and study periods were defined as the 12 months before and after diagnosis, respectively. Demographic characteristics were reported on the index date. Clinical characteristics, IgG4-RD-related treatments, and all-cause HRU and healthcare costs (2022 US dollars, payer's perspective) were reported during the baseline and study periods. A total of 295 patients with IgG4-RD were included in the study. Comorbid burden was substantial, with hypertension (31.5%), hyperlipidemia (22.4%), and type 2 diabetes (17.3%) being the most common comorbidities after diagnosis. Most patients received IgG4-RD-related treatment before (60.3%) and after (87.8%) diagnosis, with prednisone being the most common (71.5% after diagnosis). Pancreatic and biliary involvement each occurred in nearly a third of patients. Annual HRU was high before (mean of 30.4 outpatient [OP] visits; 22.7% with &#x2265;1 inpatient [IP] admission, lasting a mean of 9.0 days) and after diagnosis (mean of 40.7 OP visits; 35.3% with &#x2265;1 IP admission, lasting a mean of 10.6 days). Mean annual healthcare costs were 1.5 times higher after diagnosis ($69,753) than before diagnosis ($45,844), predominantly driven by increased OP and IP costs. Patients with IgG4-RD had a substantial clinical and economic burden, including high rates of glucocorticoid use, HRU, and healthcare costs both before and after diagnosis. This may suggest a need for earlier detection and improved management of this complex condition. This study provides important insights into the high clinical and economic burden observed in IgG4-RD. Future studies are warranted to gain a deeper understanding of the possible impact of management strategies on patient outcomes.

The adverse impacts of chronic pain extend far beyond the physical sensation itself. Chronic pain, an age-related condition, exacerbates geriatric disease burden and drives a central sensitivity-neuropsychiatric complex, necessitating urgent preventive care. This study aimed to investigate the impact of chronic pain on two sensitive diseases, depression, and abilities decline in basic or physical activities (functional limitation) among the inpatients in older adults and explore the attributable hospital costs related to chronic pain. Participants were sourced from the 2021-2022 Inpatient Discharge Dataset of Sichuan Province, Diagnosis of depression, functional limitation, and chronic pain were identified using International Classification of Diseases, 10th Revision (ICD-10) codes. Logistic regression models were employed to analyze the association between chronic pain and depression and functional limitation. Furthermore, total hospital costs, out-of-pocket costs and length of stay (LOS) were compared between patients (depression and functional limitation) with chronic pain and without using Propensity score matching and Multivariable linear regression. The analysis included 38,372 and 4,996 inpatients in the depression and functional limitation cohorts, respectively. Chronic pain was significantly associated with both outcomes, yielding odds ratios (ORs) of 1.24 (95% CI: 1.20-1.27) for depression and 1.60 (1.44-1.78) for functional limitation (all p&#x202f;<&#x202f;0.001), and the effect intensified as the number of painful areas increased. Compared to those without pain, depression patients with chronic pain incurred 68.2% higher total hospital costs ( &#x3b2; =0.52, p&#x202f;<&#x202f;0.001), 169.1% higher out-of-pocket ( &#x3b2; =0.99, p&#x202f;<&#x202f;0.001) and 60.0% higher LOS ( &#x3b2; =0.47, p&#x202f;<&#x202f;0.001). Among patients with Functional limitation, chronic pain also significantly increased log-transformed total costs ( &#x3b2; =0.20), out-of-pocket ( &#x3b2; =0.51), and LOS ( &#x3b2; =0.30), representing relative increases of 22.1, 66.5, and 35.0%, respectively (all p&#x202f;<&#x202f;0.05). These economic impacts were more pronounced among patients with multi-area pain. This study provides empirical evidence linking chronic pain to deteriorated psychological and physical health among older adults. It highlights the increased burden of the disease and hospitalization, with a particular emphasis on the dangers of multi-area pain. These findings emphasize that prioritizing mental health-focused pain management in outpatient and emergency settings is crucial for preventing avoidable hospitalizations and hospitalization costs in older adults.

This study examined the prevalence of post-traumatic stress disorder (PTSD) diagnoses among pregnant women who delivered in hospitals in the United States between 2016 and 2020, and explored associations with adverse pregnancy outcomes, hospital length of stay, and hospital costs. This cross-sectional study utilised survey-weighted data from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) to estimate sample characteristics and prevalence trends. Logistic regression models were used to analyse associations between PTSD and adverse pregnancy outcomes. Length of hospital stay and hospital costs were examined using negative binomial and generalised linear models with log link and gamma distribution, respectively. PTSD prevalence increased from 236.3 to 545.8 per 100,000 delivery hospitalisations between 2016 and 2020 (p&#x2009;<&#x2009;0.001; average annual percentage change [AAPC] 23.0%). PTSD was associated with a higher prevalence of comorbidity, increased odds of preterm delivery (adjusted odds ratio [aOR] 1.13; 95% CI 1.08-1.18), and increased odds of fetal growth restriction (aOR 1.09; 95% CI 1.01-1.17, p&#x2009;=&#x2009;0.03). Longer hospital stays and higher costs were also observed among women with PTSD. These findings highlight a rising prevalence of PTSD among pregnant women who delivered in hospitals in the United States over the study period. PTSD was associated with higher prevalence of comorbidity, and increased length of stay and hospital cost. Further research is warranted to investigate the reasons behind the trend, and to clarify the temporal relationship between prenatal PTSD and adverse pregnancy outcomes.

Multifocal motor neuropathy (MMN) is a rare, progressive neurological disease characterized by asymmetrical limb weakness. The real-world healthcare burden of MMN is not well established. To characterize the epidemiology, diagnostic procedures, treatment patterns, healthcare resource utilization (HCRU), and healthcare spending associated with MMN in patients in the US. This retrospective, observational claims study extracted data from the Humana Healthcare Research Database, comprising US Medicare Advantage plan members. Eligible patients were aged 18-89 years, had &#x2265;2 nondiagnostic medical claims (the first being the index date) associated with an MMN diagnosis code (January 1, 2017-June 30, 2022), and continuous enrollment for 12 months pre-index (baseline) and post-index (follow-up). Patients with amyotrophic lateral sclerosis, chronic inflammatory demyelinating neuropathy, or immunosuppressant use were excluded. Outcomes were assessed during the baseline and follow-up periods. Deidentified data were extracted for 248 patients with MMN. Median (Q1, Q3) age at index was 70.0 (62.0, 77.0) years; most patients were male (53.6%) and White (78.2%). Diagnostic procedures included (baseline/follow-up periods) spinal magnetic resonance imaging (21.4%/18.1%), nerve conduction studies (19.8%/14.5%), and electromyography (17.7%/15.3%). Anticonvulsants, pain medications, corticosteroids, and central muscle relaxants were the most commonly used medications. Overall, 5.2% of patients had intravenous immunoglobulin (IVIG) during follow-up. Mean (standard deviation [SD]) time from index to IVIG initiation was 63.1 (52.2) days, with 6.5 (5.4) administrations, 28.7 (22.9) days between administrations, and 147.5 (133.9) days of total treatment. For all-cause HCRU, 23.8% of patients had &#x2265;1 inpatient stay in the baseline period, with mean (SD) length of stay of 12.7 (14.5) days; during follow-up, 27.8% of patients had &#x2265;1 inpatient stay (length of stay, 13.4 [16.2] days). During the baseline/follow-up periods, 43.1%/46.8% of patients had &#x2265;1 emergency department visit, and 18.5%/28.6% used telehealth services. Median all-cause spending (baseline/follow-up) was 11 &#x2009; 299 / 16&#x2009;074 for total healthcare, 6745 / 10&#x2009;630 for medical resources, and 1374 / 1701 for pharmacy. Further studies are needed to enhance our understanding of the real-world diagnostic and treatment patterns associated with MMN and to determine long-term clinical outcomes. These real-world data highlighted the considerable burden associated with MMN on the healthcare system and patients.

Hearing, vision and cognitive impairments are common yet frequently underrecognized among older adults. Although these impairments affect quality of life, functional independence and psychological well-being, there are no published data on the prevalence and consequences of these impairments in relation to Australian home care populations. This protocol outlines a cross-sectional investigation into the prevalence of hearing, vision and cognitive impairments and their associations with quality of life, functional ability and psychosocial well-being among older Australians receiving home care services. A total of 369 participants aged 65 years and older will be recruited from home care services across Australia. Standardized assessment tools will be used to assess hearing, vision and cognitive function, quality of life, daily living activities, mental health and social participation. Multi-variable regression models will explore the impact of sensory and cognitive impairments on health and well-being outcomes. With ageing populations, it is increasingly important to support older people to live independently in their own homes rather than needing to move into residential aged care. This study will facilitate understanding of the prevalence and impact of sensory and cognitive impairments among the older Australian home care population. Findings may inform strategies to support health ageing in place, including service planning, care coordination and workforce training. Older adults receiving home care services and individuals with lived experience of sensory and cognitive impairments contributed to the study design. A Patient and Public Involvement advisory group and a stakeholder steering group will guide study implementation.

IntroductionFinancial toxicity (FT) is more prevalent among rural-dwelling cancer survivors who also face greater cancer care-related travel burdens. We sought to examine how FT and travel burdens may pose dual burdens for cancer survivors, and assess their effects on care experiences and subsequent cost-coping strategies.MethodsRapid qualitative analysis of semi-structured interviews with rural-dwelling cancer survivors who screened positive for FT per the COmprehensive Score for financial Toxicity (COST) measure. Our analysis was structured around three inductive themes: rural-dwelling patients' experiences of cancer treatment while navigating FT, patient perceptions of travel burdens undertaken in the course of accessing cancer care, and perceived implications of both FT and travel burdens for care on HRQoL.ResultsThe (n = 12) participants in our study were mostly women, with a median age of 60.1. The median COST score was 9.5, indicating a high degree of FT, and the median round-trip travel distance was 25.6 miles. Participants reported cost-coping strategies to reduce travel-associated costs, such as "stacking" appointments to reduce travel costs and taking advantage of non-medical assistance offered by health systems' financial assistance programs (e.g., gas cards). Participants also reported shared burdens with caregivers who also shouldered costs.ConclusionsEstimates of travel distances to cancer care likely understate travel burdens, because they do not capture the frequency of appointments and their associated indirect and opportunity costs for cancer survivors experiencing FT. Financial assistance for cancer survivors should be responsive to the dual and cumulative financial and travel burdens of cancer care. Rural-dwelling cancer survivors are more likely to experience Financial Toxicity (FT) in tandem with greater cancer care-related travel burdens. This qualitative study sought to examine how FT and travel burdens may pose dual burdens for cancer survivors, and assess their effects on care experiences and subsequent cost-coping strategies. We conducted semi-structured interviews with (n = 12) participants sampled from the Lessening the Impact of Financial Toxicity (LIFT) study, an intervention that screened for FT and provided site-based financial navigation services and supports. Interview participants were mostly women, with a median age of 60.1. The median COmprehensive Score for financial Toxicity (COST) score was 9.5, indicating a high degree of FT, and the median round-trip travel distance was 25.6 miles. Participants reported cost-coping strategies to reduce travel-associated costs, such as &#x201c;stacking&#x201d; appointments to reduce travel costs and taking advantage of non-medical assistance offered health systems&#x2019; financial assistance programs (e.g., gas cards). Participants also reported shared burdens with caregivers who also shouldered costs. Concomitant caregivers- or cancer survivors who were also caregivers- were especially in need to supports to mitigate the dual burdens of cancer care-related FT and travel burdens.

This study evaluated the associations between achieving treatment goals and patient-reported outcomes (PROs) and healthcare resource utilisation (HCRU) among patients with rheumatoid arthritis (RA) on advanced treatment. Retrospective cohort analyses of deidentified data from an established registry. US-based single-centre registry between 2003 and 2024. Data from patients with RA in the Brigham and Women's Hospital Rheumatoid Arthritis Sequential Study registry were analysed using multivariable regression analyses. Patients were classified into four groups based on Clinical Disease Activity Index (CDAI) scores at baseline and 1&#x2009;year (consistently at/not at target, gain or lose target). Patients who were consistently at target were further classified into remission, very low disease activity (LDA) and LDA subgroups. PROs (Multidimensional Health Assessment Questionnaire (MDHAQ) overall, pain, fatigue scores) and HCRU (surgery rates, durable medical equipment (DME) use) were assessed over 2 years.The primary endpoint compared MDHAQ PROs and surgery and DME HCRU among the four primary groups. The secondary endpoint assessed the association between maintaining LDA and achieving remission at follow-up with PROs and HCRU. Among 637&#x2009;patients with CDAI data, 257 (40%) had LDA at baseline; 57 (22%) lost target at 1&#x2009;year. Of 380 (60%) patients with CDAI >10&#x2009;at baseline, 115 (30%) attained LDA. Patients not attaining LDA had higher surgery risk, DME use and MDHAQ scores. Of 200 (31%) patients with LDA at baseline and 1&#x2009;year, 89 (45%) achieved remission, 79 (40%) very LDA and 32 (16%) LDA. Remission was associated with reduced DME use (adjusted OR (AOR) 5.4 (95%&#x2009;CI 1.9 to 15.4)&#x2009;at year 1 and AOR 4.4 (95%&#x2009;CI 1.7 to 11.1)&#x2009;at year 2) and improved MDHAQ scores compared with LDA (overall unadjusted mean 0.07 vs 0.5&#x2009;at year 1 and 0.09 vs 0.4&#x2009;at year 2; p<0.001), with no differences in surgery rates (AOR 1.9 (95%&#x2009;CI 0.7 to 5.6)&#x2009;at year 1 and AOR 1.9 (95%&#x2009;CI 0.8 to 4.4)&#x2009;at year 2). Achieving and maintaining LDA is challenging for patients with RA but leads to better functional outcomes and reduced DME use. Patients who achieve remission have further improvements.

The prevention of the mother-to-child transmission (PMTCT) of HIV is a vital strategy in reducing paediatric HIV infections. However, the delivery of PMTCT services is frequently impeded by resource constraints within the healthcare systems. This study investigates the systemic barriers affecting PMTCT implementation in Ghana and examines the disconnection between health policy design, priority setting, and on-the-ground realities. The study employed the qualitative approach using a case study research design. The purposive sampling technique was used in selecting the health facilities, with an in-depth interview guide used to solicit views from healthcare providers and mothers participating in PMTCT services. Braun and Clarke's thematic analysis was employed in analysing the data on the perceptions of infrastructural and resource-related challenges affecting PMTCT services. Participants identified several key barriers, including the absence of dedicated office spaces, a limited outpatient department (OPD) capacity, inadequate storage for antiretroviral therapy (ART) medications, and shortages of HIV-testing equipment affecting care delivery and access. These issues, alongside workforce limitations and supply chain disruptions, were found to significantly undermine the delivery and effectiveness of PMTCT services. The study underscores the need for context-aware health policy development. Effective priority setting and benefits package design must be informed by frontline insights, taking into account infrastructural deficits, human resource constraints, and systemic bottlenecks. Aligning national initiatives, such as the StEPS programme, with operational realities is essential for enhancing PMTCT outcomes.

Research suggests that multi-modal prehabilitation can improve quality of life and clinical outcomes. There is, however, limited evidence on the effect of prehabilitation on hospital resource use. This is a non-randomised observational cohort evaluation. The intervention group were patients receiving multi-modal prehabilitation (Active Together) before surgery for colorectal, lung or upper gastrointestinal cancer between January 2022 and March 2024. Patients who declined to participate in Active Together and historical patient data (2017-2021) were used as comparator groups. Outcome measures were length of hospital stay, length of critical care stay, total number of days spent in hospital as a readmission within 90 days following surgery, and one-year survival rate. Three hundred and five patients completed prehabilitation, 96 patients declined to join the service, and 869 patients were included in the historical dataset. Active Together colorectal patients spent less time in critical care than historical colorectal patients (0.9 vs 1.2 days, p&#x2009;=&#x2009;0.011). Whereas Active Together lung patients spent longer in critical care than historical lung patients (2.5 vs 1.7 days, p&#x2009;<&#x2009;0.001). One-year survival rate was greater in Active Together patients compared to the declined group (95% vs 85%, p&#x2009;=&#x2009;0.013) but did not differ significantly from the historical group (95% vs 92%, p&#x2009;=&#x2009;0.140). The probability of prehabilitation being more cost-effective than not receiving prehabilitation was 58%, 60%, and 59% for colorectal, lung and upper gastrointestinal patients, respectively. The impact of prehabilitation on healthcare resource use was mixed with promising evidence of a positive effect of prehabilitation and rehabilitation on overall survival. There were notable differences between tumour groups in these outcomes which warrants further investigation. Future research is needed to build on these findings by including a larger sample size, a wider range of tumour groups, and a longer follow up period.