Making decisions of when to intervene on bridges taking into consideration more than owner costs is a growing field of interest in earthquake engineering. In particular, bridges can be considered critical links in hig...Making decisions of when to intervene on bridges taking into consideration more than owner costs is a growing field of interest in earthquake engineering. In particular, bridges can be considered critical links in highway networks because of their seismic vulnerability in terms of direct and indirect losses. This paper aims at defining a general criteria capable of taking into account both these costs in a simplified and efficient formulation. Indirect losses generally neglected elsewhere, are taken into consideration by applying a formulation that assesses investment efficiency. The presented formulation follows the one proposed for buildings by L. Kantorovich, 1975. Direct costs are computed from a Performance Based Earthquake Engineering （PBEE） methodology by the Pacific Earthquake Engineering Research （PEER） center. The problem considers two competitive objectives （maximizing economic efficiency and minimizing costs） in a multi-objective structural optimization procedure. The formulation has been applied to a case study aimed at strengthening a benchmark bridge. The optimum investment has been assessed between several isolated configurations.展开更多
Background: There are few studies on the cost of glaucoma management in developing country, especially in Togo, there are no data on the cost of POAG management. Aims: To determine the annual direct cost of the manage...Background: There are few studies on the cost of glaucoma management in developing country, especially in Togo, there are no data on the cost of POAG management. Aims: To determine the annual direct cost of the management of POAG, to evaluate the annual economic weight of the management of POAG and to determine the factors associated with the annual economic weight of the management. Methods: We conducted a retrospective and descriptive study over a period of 12 months from January 1 to December 31, 2019 based on the records of patients followed for POAG in AFIA Eye Clinic in Lomé-Togo. The annual direct cost was defined by the sum of the costs of consultations, explorations and treatments. We defined the direct cost per patient and per year and related to the average annual income. It was said to be catastrophic at 20% or more of the estimated annual income. Chi 2 and Fisher tested the comparison of proportions. We conducted univariate and multivariate logistic regression to search correlations. Results: During the study period, 150 patient records were included. The average age was 47.24 ± 17.09 years and the sex ratio was 0.82. The cost of the diagnosis was 112.18 ± 22.26 €. The average cost of consultations was 19.46 ± 11.35 € and that of explorations was 92.71 ± 10.91 €. The annual cost of treatment per patient was 165.52 ± 110.16 €. The annual global direct cost of POAG management per patient was 277.69 ± 132.42 €. Compared to the annual income of 1166.29 €, the economic weight of the glaucoma management was 23.8%. This direct cost was catastrophic for 32.1% of patients in the study (44/150 of people with no care). Compared to the guaranteed inter-professional minimum wage (SMIG) of 640.30 €, the economic direct cost weight was 43.3%. Risk factors significantly associated with the direct cost were age over 40 (OR = 1.05 and p = 0.032), liberal profession (OR = 4.72 and p = 0.04), the absence of health insurance (OR = 6.68 and p = 0.017) and the use carbonic anhydrase inhibitors (OR = 7.4 and p = 0.012) and prostaglandin analogues (OR of 38.2 and p Conclusion: This first study on the direct cost of POAG management in Lomé showed that the economic burden glaucoma represents for the patient, his family and society. The data from this study will allow health decision-makers to adopt strategies to mitigate the effects of glaucoma on the economy.展开更多
Introduction: Malaria is both a disease caused by poverty and a cause of poverty. Malaria is the leading cause of morbidity and mortality in Mali and is among the ten countries with the highest number of malaria cases...Introduction: Malaria is both a disease caused by poverty and a cause of poverty. Malaria is the leading cause of morbidity and mortality in Mali and is among the ten countries with the highest number of malaria cases and deaths. The objective was to estimate the direct economic cost borne by families in the treatment of severe malaria in children aged 0 - 5 years at the CSREF in Fana. Methodology: The study was cross-sectional, conducted from July 2017 to June 2018 with inclusion criteria and prospective data collection. The methodology was based on estimating the direct economic cost of severe malaria. Results: The sample consisted of 109 cases out of a total of 944 hospitalizations;59% of whom were boys and the 25 - 36 month age group was the most affected. The complications frequently encountered were severe anemia (50 cases) or 45.8%;convulsions (35 cases) or 32.1% and finally severe sepsis (8 cases) or 7.3%. The average direct cost was 25,324 Franc CFA (58.95 US Dollars) of which 66% represented the costs of medicines and consumables against 4% for the consultation. This cost was more than half the minimum wage in Mali. Conclusion: Despite the difficulties in estimating the cost in hospitals, the results obtained give us an estimate of the economic burden borne by families in the management of severe malaria cases among children in the district of Fana. Support is needed for parents in the fight against malaria in rural Mali.展开更多
Due to its chronic nature with severe complications, diabetes needs costly prolonged treatment and care. The high economic burden of diabetes is particularly threatening low and middle income countries. World-wide, st...Due to its chronic nature with severe complications, diabetes needs costly prolonged treatment and care. The high economic burden of diabetes is particularly threatening low and middle income countries. World-wide, studies have shown that the cost of diabetes per person is much higher than the per capita health expenditure. This study is the first to estimate the direct and indirect cost of diabetes in Morocco. The direct cost of diabetes was computed by assuming three scenarios of prices (low, medium and high) due to different prices of insulin, oral drugs and other items used in diabetes treatment and care. Indirect costs of diabetes were estimated by the lifetime forgone earnings caused by premature death and disability due to diabetes. The direct cost of diabetes in Morocco was estimated to be between US $0.47 and US $1.5 billion whereas the indirect cost was estimated to be around US $2 billion accounting for 57% of the total cost of diabetes under the high cost scenario, 69% under the medium scenario and 81% under the low cost scenario. The average per capita indirect cost was estimated to be US $1113, relatively higher than the direct cost of diabetes which was seen to vary from US$ 259 to US $830. The results yielded by this study were compared to those obtained by similar studies in different regions and countries of the world. As a conclusion, the findings of this study indicate a high economic burden of diabetes and stress the importance that Moroccan health decision makers should give to sensitisation, early diagnosis and treatment of diabetes especially with the crucial growing trend of diabetes prevalence.展开更多
BACKGROUND Drug utilization research has an important role in assisting the healthcare administration to know,compute,and refine the prescription whose principal objective is to enable the rational use of drugs.Resear...BACKGROUND Drug utilization research has an important role in assisting the healthcare administration to know,compute,and refine the prescription whose principal objective is to enable the rational use of drugs.Research in developing nations relating to the cost of treatment is scarce when compared with developed countries.Thus,the drug utilization research studies from developing nations are most needed,and their number has been growing.AIM To evaluate patterns of utilization of antipsychotic drugs and direct medical cost analysis in patients newly diagnosed with schizophrenia.METHODS The present study was observational in type and based on a retrospective cohort to evaluate patterns of utilization of antipsychotic drugs using World Health Organization(WHO)core prescribing indicators and anatomical therapeutic chemical/defined daily dose indicators.We also calculated direct medical costs for a period of 6 months.RESULTS This study has found that atypical antipsychotics are the mainstay of treatment for schizophrenia in every age group and subcategories of schizophrenia.The evaluation based on WHO prescribing indicators showed a low average number of drugs per prescription and low prescribing frequency of antipsychotics from the National List of Essential Medicines 2015 and the WHO Essential Medicines List 2019.The total mean drug cost of our study was 1396 Indian rupees.The total mean cost due to the investigation in our study was 1017.34 Indian rupees.Therefore,the total mean direct medical cost incurred on patients in our study was 4337.28 Indian rupees.CONCLUSION The information from the present study can be used for reviewing and updating treatment policy at the institutional level.展开更多
Background:Tuberculosis(TB)disproportionately impacts socially vulnerable populations,including migrants.This study aimed to investigate the utilization of TB care services and the financial burden on TB patients duri...Background:Tuberculosis(TB)disproportionately impacts socially vulnerable populations,including migrants.This study aimed to investigate the utilization of TB care services and the financial burden on TB patients during 2020–2021 in Shanghai and to examine differences between local and migrant patients.Methods:A retrospective survey was conducted in three districts of Shanghai among drug-sensitive TB patients who initiated treatment on or after January 24,2020,and had completed treatment by the time of the interview in 2021.The study used a designed sampling ratio of 1∶1 for both local and migrant populations,and examined the use of outpatient and inpatient care,as well as the direct costs of treatment.Descriptive analyses and statistical tests were utilized to assess differences in patient characteristics between locals and migrants,with and without a residence permit.Logistic regression was used to examine the impact of migrant status on service usage and financial burden,after adjusting for demographic and socioeconomic factors.Results:The study included a total of 196 TB patients,comprising 88 locals and 108 migrants.No significant differences in the average number of outpatient visits were observed between migrant and local patients.Migrants with a residence permit(RP)had the highest hospitalization rate(92.86%),followed by migrants without an RP(86.84%),and then local patients(79.55%).The median out-of-pocket(OOP)payment for the entire treatment course,including medical and non-medical costs,was 15,845 yuan for migrants without an RP,with descending amounts for migrants with an RP,and then local patients(P<0.001).The proportion of patients incurring OOP payments exceeding 20%of their annual household income was also highest among migrants without an RP(57.14%).Regression analysis indicated that migrants without an RP faced the highest financial risk during TB treatment.Even migrants with an RP showed significantly higher financial risk compared to local patients(P<0.05).Conclusions:During 2020–2021,the utilization of TB care in Shanghai was high among both local and migrant TB patients.Nevertheless,significant financial burdens were more pronounced among migrant patients without RP.展开更多
Analysis of the Direct Operating Cost(DOC) of aircraft is an important step towards achieving financially sustainable aviation operations. However, the value of the DOC for different aircraft types and flight scenario...Analysis of the Direct Operating Cost(DOC) of aircraft is an important step towards achieving financially sustainable aviation operations. However, the value of the DOC for different aircraft types and flight scenarios is not widely available. In this study, we perform a systematic analysis of the DOC of every wide-body passenger aircraft currently in production, using the method of the Association of European Airlines(AEA). The elements of the DOC, e.g. financial costs, maintenance costs, and flight costs, are evaluated individually. Several realistic flight scenarios are considered, each with differences in route distance, fuel price, passenger number, and seating arrangement. For each flight scenario, the most cost-efficient aircraft type is identified and evaluated in the context of operations from Hong Kong International Airport. The information provided in this study could be useful to airline operators and policy makers.展开更多
Objective: Limited data are available on the direct costs of hospitalization owing to thromboembolism and bleeding in patients with atrial fibrillation (AF) in China. Such data are essential for policy development, se...Objective: Limited data are available on the direct costs of hospitalization owing to thromboembolism and bleeding in patients with atrial fibrillation (AF) in China. Such data are essential for policy development, service planning, and cost-effectiveness analysis of new therapeutic strategies. This study aimed to provide detailed data regarding in-hospital direct costs for these pa-tients, compare the costs at different scenarios, and identify independent factors that may predict the costs. Methods: We collected data regarding in-hospital direct costs among patients with AF who were hospitalized owing to ischemic stroke (IS), transient ischemic attack (TIA), intracranial hemorrhage (ICH), or major gastrointestinal bleeding. All data were collected from 7 representative tertiary referral hospitals and 3 secondary care hospitals from December 2009 to October 2014. Results: In total, 312 eligible patients with thromboembolism and 143 patients with major bleeding were identified, and their hospital charts were reviewed. The median in-hospital direct costs were 17,857 Chinese Yuan (CNY) for IS and 16,589 CNY for TIA (equivalent to 2907 US dollars and 2701 US dollars, respectively). For patients with major bleeding, the costs were 27,924 CNY for ICH and 18,196 CNY for major gastrointestinal bleeding (equivalent to 4546 US dollars and 2962 US dollars, respec-tively). The direct costs were mainly driven by medications, which accounted for approximately 33.4%-36.1% in different groups of patients. The direct costs were highly related to the hospital level and National Institutes of Health Stroke Scale scores in patients with thromboembolism; in patients with ICH, the factors included hospital level, warfarin treatment before admission, and prior hospitalization for stroke. Conclusions: Given the high prevalence, AF-related thromboembolism and bleeding impose considerable economic burden on the Chinese society. Efforts to improve the management of AF may confer substantial economic benefits.展开更多
Background and purpose: The rising cost of health care is of concern worldwide, in particular, for cancer care. The costs of treatment, including chemotherapeutic drugs and radiotherapy, are no exceptions. The purpose...Background and purpose: The rising cost of health care is of concern worldwide, in particular, for cancer care. The costs of treatment, including chemotherapeutic drugs and radiotherapy, are no exceptions. The purpose of this study is to explore the direct medical cost of radiotherapy and the annual increasing trend of expenditures in Taiwan. Methods: This study utilized data retrieving from the original claim data of the reimbursement of the Health Insurance Research Database (HIRD) derived from Taiwan’s Health Insurance (HI) program. Detailed data on the direct medical cost within the radiotherapy process for beneficences were extracted from inpatient expenditures by admissions (DD) and ambulatory care expenditures by visits (CD) database according to the reimbursed expenditure code of radiotherapy from January 1, 2000 to December 31, 2005. Prescriptions for radiotherapy were retrieved and the direct medical costs for radiotherapy were collected based on the NHI reimbursement price list of 2005. The annual increasing trend of expenditures was also explored according to the perspective of Bureau Health Insurance of Taiwan. Results: The total direct medical costs of radiotherapy for cancer patients were increasing from 2000 to 2005, which were estimated to US $7.80 million, US $8.09 million, US $7.58 million, US $10.7 million, US $12.2 million and US $15.9 million in 2000, 2001, 2002, 2003, 2004 and 2005, respectively. The increased percentage corresponded to the total healthcare expenditures claimed was increased substantially from 0.82% in 2000 to 1.22% in 2005. The total direct medical costs within the radiotherapy process were also increased gradually if identified by different types of radiotherapy and teaching hospital levels. The direct medical costs attribute to radiotherapy, compared to total health care expenditures in Taiwan, were similar to the costs of anticancer drugs for cancer patients annually. Conclusions: The direct medical costs of radiation therapy increased substantially each year. Further cost analysis on radiation therapy is needed in years beyond 2005.展开更多
Pollutant gases emitted from the civil jet are doing more and more harm to the environ- ment with the rapid development of the global commercial aviation transport. Low environmental impact has become a new requiremen...Pollutant gases emitted from the civil jet are doing more and more harm to the environ- ment with the rapid development of the global commercial aviation transport. Low environmental impact has become a new requirement for aircraft design. In this paper, estimation method for emis- sion in aircraft conceptual design stage is improved based on the International Civil Aviation Orga- nization （ICAO） aircraft engine emissions databank and the polynomial curve fitting methods. The greenhouse gas emission （CO2 equivalent） per seat per kilometer is proposed to measure the emis- sions. An approximate sensitive analysis and a multi-objective optimization of aircraft design for tradeoff between greenhouse effect and direct operating cost （DOC） are performed with five geom- etry variables of wing configuration and two flight operational parameters. The results indicate that reducing the cruise altitude and Mach number may result in a decrease of the greenhouse effect but an increase of DOC. And the two flight operational parameters have more effects on the emissions than the wing configuration. The Pareto-optimal front shows that a decrease of 29.8% in DOC is attained at the expense of an increase of 10.8% in greenhouse gases.展开更多
BACKGROUND Infliximab was the first approved biologic treatment for moderate to severe Crohn's disease(MS-CD) in China. However, the cost-effectiveness of infliximab maintenance therapy(IMT) for MS-CD relative to ...BACKGROUND Infliximab was the first approved biologic treatment for moderate to severe Crohn's disease(MS-CD) in China. However, the cost-effectiveness of infliximab maintenance therapy(IMT) for MS-CD relative to conventional maintenance therapy remained unclarified.AIM To assess the cost-effectiveness of IMT for MS-CD in Chinese patients from the perspective of Chinese public insurance payer.METHODS A cohort of MS-CD patients managed in a Chinese tertiary care hospital was created to compare IMT with conventional maintenance therapy(CMT) for clinical outcomes and direct medical costs over a 1-year observation time using conventional regression analyses. A decision-analytic model with the generated evidence was constructed to assess the cost-effectiveness of IMT relative to CMT using reimbursed medical costs.RESULTS Based on the included 389 patients, IMT was associated with significantly higher disease remission chance [odds ratio: 4.060, P = 0.003], lower risk of developing new complications(odds ratio: 0.527, P = 0.010), higher utility value for quality of life(coefficient 0.822, P = 0.008), and lower total hospital costs related to disease management(coefficient-0.378, P = 0.008) than CMT. Base-case cost-effectiveness analysis estimated that IMT could cost Chinese health insurance payers $55260 to gain one quality-adjusted life year(QALY). The cost-effectiveness of IMT was mainly driven by the estimate of quality of life, treatment efficacy of maintenance therapy, mortality risk associated with active disease, and unit price of infliximab. The probability that IMT was cost-effective at a willingness-to-pay threshold of three times gross domestic product [2018 Chinese gross domestic product per capita(GDPPC)] was 86.4%.CONCLUSION IMT significantly improved real-world health outcomes and cost the Chinese public health insurance payers less than one GDPPC to gain one QALY in Chinese MS-CD patients.展开更多
文摘Making decisions of when to intervene on bridges taking into consideration more than owner costs is a growing field of interest in earthquake engineering. In particular, bridges can be considered critical links in highway networks because of their seismic vulnerability in terms of direct and indirect losses. This paper aims at defining a general criteria capable of taking into account both these costs in a simplified and efficient formulation. Indirect losses generally neglected elsewhere, are taken into consideration by applying a formulation that assesses investment efficiency. The presented formulation follows the one proposed for buildings by L. Kantorovich, 1975. Direct costs are computed from a Performance Based Earthquake Engineering （PBEE） methodology by the Pacific Earthquake Engineering Research （PEER） center. The problem considers two competitive objectives （maximizing economic efficiency and minimizing costs） in a multi-objective structural optimization procedure. The formulation has been applied to a case study aimed at strengthening a benchmark bridge. The optimum investment has been assessed between several isolated configurations.
文摘Background: There are few studies on the cost of glaucoma management in developing country, especially in Togo, there are no data on the cost of POAG management. Aims: To determine the annual direct cost of the management of POAG, to evaluate the annual economic weight of the management of POAG and to determine the factors associated with the annual economic weight of the management. Methods: We conducted a retrospective and descriptive study over a period of 12 months from January 1 to December 31, 2019 based on the records of patients followed for POAG in AFIA Eye Clinic in Lomé-Togo. The annual direct cost was defined by the sum of the costs of consultations, explorations and treatments. We defined the direct cost per patient and per year and related to the average annual income. It was said to be catastrophic at 20% or more of the estimated annual income. Chi 2 and Fisher tested the comparison of proportions. We conducted univariate and multivariate logistic regression to search correlations. Results: During the study period, 150 patient records were included. The average age was 47.24 ± 17.09 years and the sex ratio was 0.82. The cost of the diagnosis was 112.18 ± 22.26 €. The average cost of consultations was 19.46 ± 11.35 € and that of explorations was 92.71 ± 10.91 €. The annual cost of treatment per patient was 165.52 ± 110.16 €. The annual global direct cost of POAG management per patient was 277.69 ± 132.42 €. Compared to the annual income of 1166.29 €, the economic weight of the glaucoma management was 23.8%. This direct cost was catastrophic for 32.1% of patients in the study (44/150 of people with no care). Compared to the guaranteed inter-professional minimum wage (SMIG) of 640.30 €, the economic direct cost weight was 43.3%. Risk factors significantly associated with the direct cost were age over 40 (OR = 1.05 and p = 0.032), liberal profession (OR = 4.72 and p = 0.04), the absence of health insurance (OR = 6.68 and p = 0.017) and the use carbonic anhydrase inhibitors (OR = 7.4 and p = 0.012) and prostaglandin analogues (OR of 38.2 and p Conclusion: This first study on the direct cost of POAG management in Lomé showed that the economic burden glaucoma represents for the patient, his family and society. The data from this study will allow health decision-makers to adopt strategies to mitigate the effects of glaucoma on the economy.
文摘Introduction: Malaria is both a disease caused by poverty and a cause of poverty. Malaria is the leading cause of morbidity and mortality in Mali and is among the ten countries with the highest number of malaria cases and deaths. The objective was to estimate the direct economic cost borne by families in the treatment of severe malaria in children aged 0 - 5 years at the CSREF in Fana. Methodology: The study was cross-sectional, conducted from July 2017 to June 2018 with inclusion criteria and prospective data collection. The methodology was based on estimating the direct economic cost of severe malaria. Results: The sample consisted of 109 cases out of a total of 944 hospitalizations;59% of whom were boys and the 25 - 36 month age group was the most affected. The complications frequently encountered were severe anemia (50 cases) or 45.8%;convulsions (35 cases) or 32.1% and finally severe sepsis (8 cases) or 7.3%. The average direct cost was 25,324 Franc CFA (58.95 US Dollars) of which 66% represented the costs of medicines and consumables against 4% for the consultation. This cost was more than half the minimum wage in Mali. Conclusion: Despite the difficulties in estimating the cost in hospitals, the results obtained give us an estimate of the economic burden borne by families in the management of severe malaria cases among children in the district of Fana. Support is needed for parents in the fight against malaria in rural Mali.
文摘Due to its chronic nature with severe complications, diabetes needs costly prolonged treatment and care. The high economic burden of diabetes is particularly threatening low and middle income countries. World-wide, studies have shown that the cost of diabetes per person is much higher than the per capita health expenditure. This study is the first to estimate the direct and indirect cost of diabetes in Morocco. The direct cost of diabetes was computed by assuming three scenarios of prices (low, medium and high) due to different prices of insulin, oral drugs and other items used in diabetes treatment and care. Indirect costs of diabetes were estimated by the lifetime forgone earnings caused by premature death and disability due to diabetes. The direct cost of diabetes in Morocco was estimated to be between US $0.47 and US $1.5 billion whereas the indirect cost was estimated to be around US $2 billion accounting for 57% of the total cost of diabetes under the high cost scenario, 69% under the medium scenario and 81% under the low cost scenario. The average per capita indirect cost was estimated to be US $1113, relatively higher than the direct cost of diabetes which was seen to vary from US$ 259 to US $830. The results yielded by this study were compared to those obtained by similar studies in different regions and countries of the world. As a conclusion, the findings of this study indicate a high economic burden of diabetes and stress the importance that Moroccan health decision makers should give to sensitisation, early diagnosis and treatment of diabetes especially with the crucial growing trend of diabetes prevalence.
文摘BACKGROUND Drug utilization research has an important role in assisting the healthcare administration to know,compute,and refine the prescription whose principal objective is to enable the rational use of drugs.Research in developing nations relating to the cost of treatment is scarce when compared with developed countries.Thus,the drug utilization research studies from developing nations are most needed,and their number has been growing.AIM To evaluate patterns of utilization of antipsychotic drugs and direct medical cost analysis in patients newly diagnosed with schizophrenia.METHODS The present study was observational in type and based on a retrospective cohort to evaluate patterns of utilization of antipsychotic drugs using World Health Organization(WHO)core prescribing indicators and anatomical therapeutic chemical/defined daily dose indicators.We also calculated direct medical costs for a period of 6 months.RESULTS This study has found that atypical antipsychotics are the mainstay of treatment for schizophrenia in every age group and subcategories of schizophrenia.The evaluation based on WHO prescribing indicators showed a low average number of drugs per prescription and low prescribing frequency of antipsychotics from the National List of Essential Medicines 2015 and the WHO Essential Medicines List 2019.The total mean drug cost of our study was 1396 Indian rupees.The total mean cost due to the investigation in our study was 1017.34 Indian rupees.Therefore,the total mean direct medical cost incurred on patients in our study was 4337.28 Indian rupees.CONCLUSION The information from the present study can be used for reviewing and updating treatment policy at the institutional level.
文摘Background:Tuberculosis(TB)disproportionately impacts socially vulnerable populations,including migrants.This study aimed to investigate the utilization of TB care services and the financial burden on TB patients during 2020–2021 in Shanghai and to examine differences between local and migrant patients.Methods:A retrospective survey was conducted in three districts of Shanghai among drug-sensitive TB patients who initiated treatment on or after January 24,2020,and had completed treatment by the time of the interview in 2021.The study used a designed sampling ratio of 1∶1 for both local and migrant populations,and examined the use of outpatient and inpatient care,as well as the direct costs of treatment.Descriptive analyses and statistical tests were utilized to assess differences in patient characteristics between locals and migrants,with and without a residence permit.Logistic regression was used to examine the impact of migrant status on service usage and financial burden,after adjusting for demographic and socioeconomic factors.Results:The study included a total of 196 TB patients,comprising 88 locals and 108 migrants.No significant differences in the average number of outpatient visits were observed between migrant and local patients.Migrants with a residence permit(RP)had the highest hospitalization rate(92.86%),followed by migrants without an RP(86.84%),and then local patients(79.55%).The median out-of-pocket(OOP)payment for the entire treatment course,including medical and non-medical costs,was 15,845 yuan for migrants without an RP,with descending amounts for migrants with an RP,and then local patients(P<0.001).The proportion of patients incurring OOP payments exceeding 20%of their annual household income was also highest among migrants without an RP(57.14%).Regression analysis indicated that migrants without an RP faced the highest financial risk during TB treatment.Even migrants with an RP showed significantly higher financial risk compared to local patients(P<0.05).Conclusions:During 2020–2021,the utilization of TB care in Shanghai was high among both local and migrant TB patients.Nevertheless,significant financial burdens were more pronounced among migrant patients without RP.
文摘Analysis of the Direct Operating Cost(DOC) of aircraft is an important step towards achieving financially sustainable aviation operations. However, the value of the DOC for different aircraft types and flight scenarios is not widely available. In this study, we perform a systematic analysis of the DOC of every wide-body passenger aircraft currently in production, using the method of the Association of European Airlines(AEA). The elements of the DOC, e.g. financial costs, maintenance costs, and flight costs, are evaluated individually. Several realistic flight scenarios are considered, each with differences in route distance, fuel price, passenger number, and seating arrangement. For each flight scenario, the most cost-efficient aircraft type is identified and evaluated in the context of operations from Hong Kong International Airport. The information provided in this study could be useful to airline operators and policy makers.
文摘Objective: Limited data are available on the direct costs of hospitalization owing to thromboembolism and bleeding in patients with atrial fibrillation (AF) in China. Such data are essential for policy development, service planning, and cost-effectiveness analysis of new therapeutic strategies. This study aimed to provide detailed data regarding in-hospital direct costs for these pa-tients, compare the costs at different scenarios, and identify independent factors that may predict the costs. Methods: We collected data regarding in-hospital direct costs among patients with AF who were hospitalized owing to ischemic stroke (IS), transient ischemic attack (TIA), intracranial hemorrhage (ICH), or major gastrointestinal bleeding. All data were collected from 7 representative tertiary referral hospitals and 3 secondary care hospitals from December 2009 to October 2014. Results: In total, 312 eligible patients with thromboembolism and 143 patients with major bleeding were identified, and their hospital charts were reviewed. The median in-hospital direct costs were 17,857 Chinese Yuan (CNY) for IS and 16,589 CNY for TIA (equivalent to 2907 US dollars and 2701 US dollars, respectively). For patients with major bleeding, the costs were 27,924 CNY for ICH and 18,196 CNY for major gastrointestinal bleeding (equivalent to 4546 US dollars and 2962 US dollars, respec-tively). The direct costs were mainly driven by medications, which accounted for approximately 33.4%-36.1% in different groups of patients. The direct costs were highly related to the hospital level and National Institutes of Health Stroke Scale scores in patients with thromboembolism; in patients with ICH, the factors included hospital level, warfarin treatment before admission, and prior hospitalization for stroke. Conclusions: Given the high prevalence, AF-related thromboembolism and bleeding impose considerable economic burden on the Chinese society. Efforts to improve the management of AF may confer substantial economic benefits.
文摘Background and purpose: The rising cost of health care is of concern worldwide, in particular, for cancer care. The costs of treatment, including chemotherapeutic drugs and radiotherapy, are no exceptions. The purpose of this study is to explore the direct medical cost of radiotherapy and the annual increasing trend of expenditures in Taiwan. Methods: This study utilized data retrieving from the original claim data of the reimbursement of the Health Insurance Research Database (HIRD) derived from Taiwan’s Health Insurance (HI) program. Detailed data on the direct medical cost within the radiotherapy process for beneficences were extracted from inpatient expenditures by admissions (DD) and ambulatory care expenditures by visits (CD) database according to the reimbursed expenditure code of radiotherapy from January 1, 2000 to December 31, 2005. Prescriptions for radiotherapy were retrieved and the direct medical costs for radiotherapy were collected based on the NHI reimbursement price list of 2005. The annual increasing trend of expenditures was also explored according to the perspective of Bureau Health Insurance of Taiwan. Results: The total direct medical costs of radiotherapy for cancer patients were increasing from 2000 to 2005, which were estimated to US $7.80 million, US $8.09 million, US $7.58 million, US $10.7 million, US $12.2 million and US $15.9 million in 2000, 2001, 2002, 2003, 2004 and 2005, respectively. The increased percentage corresponded to the total healthcare expenditures claimed was increased substantially from 0.82% in 2000 to 1.22% in 2005. The total direct medical costs within the radiotherapy process were also increased gradually if identified by different types of radiotherapy and teaching hospital levels. The direct medical costs attribute to radiotherapy, compared to total health care expenditures in Taiwan, were similar to the costs of anticancer drugs for cancer patients annually. Conclusions: The direct medical costs of radiation therapy increased substantially each year. Further cost analysis on radiation therapy is needed in years beyond 2005.
基金supported by the Fundamental Research Funds for the Central Universities (NUAA NN2012071)China Postdoctoral Science Foundation (2011M500919)
文摘Pollutant gases emitted from the civil jet are doing more and more harm to the environ- ment with the rapid development of the global commercial aviation transport. Low environmental impact has become a new requirement for aircraft design. In this paper, estimation method for emis- sion in aircraft conceptual design stage is improved based on the International Civil Aviation Orga- nization （ICAO） aircraft engine emissions databank and the polynomial curve fitting methods. The greenhouse gas emission （CO2 equivalent） per seat per kilometer is proposed to measure the emis- sions. An approximate sensitive analysis and a multi-objective optimization of aircraft design for tradeoff between greenhouse effect and direct operating cost （DOC） are performed with five geom- etry variables of wing configuration and two flight operational parameters. The results indicate that reducing the cruise altitude and Mach number may result in a decrease of the greenhouse effect but an increase of DOC. And the two flight operational parameters have more effects on the emissions than the wing configuration. The Pareto-optimal front shows that a decrease of 29.8% in DOC is attained at the expense of an increase of 10.8% in greenhouse gases.
基金Supported by Zhejiang Medical and Health Science and Technology Project,No. 2020KY608Natural Science Foundation of Zhejiang Province,No. LQ19H030013。
文摘BACKGROUND Infliximab was the first approved biologic treatment for moderate to severe Crohn's disease(MS-CD) in China. However, the cost-effectiveness of infliximab maintenance therapy(IMT) for MS-CD relative to conventional maintenance therapy remained unclarified.AIM To assess the cost-effectiveness of IMT for MS-CD in Chinese patients from the perspective of Chinese public insurance payer.METHODS A cohort of MS-CD patients managed in a Chinese tertiary care hospital was created to compare IMT with conventional maintenance therapy(CMT) for clinical outcomes and direct medical costs over a 1-year observation time using conventional regression analyses. A decision-analytic model with the generated evidence was constructed to assess the cost-effectiveness of IMT relative to CMT using reimbursed medical costs.RESULTS Based on the included 389 patients, IMT was associated with significantly higher disease remission chance [odds ratio: 4.060, P = 0.003], lower risk of developing new complications(odds ratio: 0.527, P = 0.010), higher utility value for quality of life(coefficient 0.822, P = 0.008), and lower total hospital costs related to disease management(coefficient-0.378, P = 0.008) than CMT. Base-case cost-effectiveness analysis estimated that IMT could cost Chinese health insurance payers $55260 to gain one quality-adjusted life year(QALY). The cost-effectiveness of IMT was mainly driven by the estimate of quality of life, treatment efficacy of maintenance therapy, mortality risk associated with active disease, and unit price of infliximab. The probability that IMT was cost-effective at a willingness-to-pay threshold of three times gross domestic product [2018 Chinese gross domestic product per capita(GDPPC)] was 86.4%.CONCLUSION IMT significantly improved real-world health outcomes and cost the Chinese public health insurance payers less than one GDPPC to gain one QALY in Chinese MS-CD patients.
