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Economic Impact of Clinical Research to Research Centers and Opportunity Cost for the reimbursement System in Turkey

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Health 2015年第9期7卷 1124-1133页

作者： Güvenc Kockaya Meral Demir Pinar Daylan Kockaya Mehtap Tatar Ali Yagizüresin Istanbul University IstanbulTurkey Ministry of Health AnkaraTurkey Hacettepe University AnkaraTurkey

Introduction: Clinical research is a key component of drug development with a significant economic value. It has been reported that the development of a new molecule requires 10 - 15 years and costs almost $1.3 billion. Around 75% of the cost is spent on the Phase I-IV clinical research process. This study aimed to show the economic value of clinical research in Turkey. Methods: Clinical trial budgets were estimated from the raw data of the Report of Istanbul Medical Faculty Clinical Research (ITFKAR). In the research, the estimated cost of drugs used in the clinical trials for the Turkish reimbursement agency (SGK) was calculated to show the cost of medicines acquired through clinical research. Results: The total budget for sponsored pharmaceutical research was $107 million in Turkey, and the government saved close to $311,096,130 during 2006-2010, due to not reimbursing the patients for the drugs in the clinical trials. Conclusion: Despite the limitations of the study, the findings are unique for Turkey. The results can lead to revisiting the importance and economic value of clinical trials in Turkey.

关键词： Clinical Research Economic Impact reimbursement Research Centers Opportunity Cost

Feasible economic strategies to improve screening compliance for colorectal cancer in Korea

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World Journal of Gastroenterology 2005年第11期11卷 1587-1593页

作者： Sang Min Park Young Ho Yun Soonman Kwon Department of Family Medicine Quality of Cancer Care Branch School of Public Health

ABM: While colorectal cancer (CRC) is an ideal target for population screening, physician and patient attitudes contribute to low levels of screening uptake. This study was carried out to find feasible economic strategies to improve the CRC screening compliance in Korea. METHODS: The natural history of a simulated cohort of 50-year-old Korean in the general population was modeled with CRC screening until the age of 80 years. Cases of positive results were worked up with colonoscopy. After polypectomy, colonoscopy was repeated every 3 years. Baseline screening compliance without insurance coverage by the national health insurance (NHI) was assumed to be 30%. If NHI covered the CRC screening or the reimbursement of screening to physicians increased, the compliance was assumed to increase. We evaluated 16 different CRC screening strategies based on Markov model. RESULTS: When the NHI did not cover the screening and compliance was 30%, non-dominated strategies were colonoscopy every 5 years (COL5) and colonoscopy every 3 years (COL3). In all scenarios of various compliance rates with raised coverage of the NHI and increased reimbursement of colonoscopy, COL10, COL5 and COL3 were non-dominated strategies, and COL10 had lower or minimal incremental medical cost and financial burden on the NHI than the strategy of no screening. These results were stable with sensitivity analyses. CONCLUSION: Economic strategies for promoting screening compliance can be accompanied by expanding insurance coverage by the NHI and by increasing reimbursement for CRC screening to providers. COL10 was a cost-effective and cost saving screening strategy for CRC in Korea.

关键词： Cost-effectiveness analysis Colorectal cancer Screening Compliance National health insurance Coverage reimbursement

The impact of the New Cooperative Medical Scheme in Sangzhi County,Hunan Province

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Chinese Journal of Population,Resources and Environment 2013年第2期11卷 174-179页

作者： Jiangao Niu Deland Liu Renie Liu Tennison Liu School of Economics and Trade Shijiazhuang University of Economics Knox Grammar School Masada College

In August 2011,the Sangzhi County government,Hunan Province,adopted a series of new health care policies as a national pilot of the New Cooperative Medical Scheme(referred to as 2011 NCMS).These policies were designed to further resolve illness-led poverty and the poor state of health care in the local *** program had a positive impact and spread to other regions in Hunan *** paper will discuss the progress made as a result of the policies and several issues that challenge the scheme in practice.A total sample of 1212 individuals and 303 households were included in the analysis,and98 interviews were conducted with people related to the *** major findings indicate that the 201!NCMS has significantly reduced the out-of-pocket medical payment of rural residents,and also increased the township hospitals'patient ***,the medical scheme still faces many challenging issues during the *** the increasing interest among the Chinese policy makers in strengthening and promoting the Sangzhi Model,the impacts of the scheme deserve greater attention in practice so as to further improve NCMS in rural China.

关键词： New Cooperative Medical Scheme enrollment rate illness-led poverty reimbursement catastrophic expenditure

Dermatomyositis and polymyositis in total hip arthroplasty

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World Journal of Orthopedics 2021年第6期12卷 395-402页

作者： Samuel Rosas Michael Schallmo Anirudh Krishna Gowd Matthew Reynolds Akelman T David Luo Cynthia Lynn Emory Johannes Frank Plate Department of Orthopedic Surgery Wake Forest School of MedicineWinston SalemNC 27101United States Department of Orthopedic Surgery Atrium HealthcareCharlotteNC 28203United States

BACKGROUND Idiopathic inflammatory myopathies(IIM)are systemic autoimmune disorders such as dermatomyositis(DM),polymyositis(PM),inclusion body myopathy,and autoimmune necrotizing myopathy that,similar to osteoarthritis,affect quality of life and activities of daily ***,these patients are often burdened with chronic pain and disability;however,the outcomes and risk of total hip arthroplasty(THA)in this patient population remain *** To evaluate 90-d complications and costs in patients with these *** A retrospective case control study was designed by accessing data from the Medicare dataset available on the PearlDiver *** with IIM,here,those with DM and PM were matched based on possible confounding variables to a cohort without these diseases and with the same 10-year risk of mortality as defined by the Charlson Comorbidity Index Score(CCI).Univariate and multivariate analysis were performed to evaluate complications and t-tests to evaluate 90-d Medicare reimbursements as markers of costs after *** The total sample was 1090 patients with each cohort comprised of *** were 74.9%of the *** mean CCI was 5.89(SD 2.11).Those with IIM had increased rates of pneumonia[odds ratio(OR)1.45,P<0.001]and pulmonary embolism(OR 1.46,P=0.035)and decreased hematoma risks(OR 0.58,P=0.00).90-d costs were on average$1411 greater for those with IIM yet not significantly different(P=0.034).CONCLUSION Patients with IIM have an increased 90-d rate of pneumonia and pulmonary embolism concomitant with a decreased hematoma rate consistent with their procoagulatory *** attention to increased resource utilization in these patients is also warranted.

关键词： Dermatomyositis Arthroplasty Polymyositis Outcomes Charges reimbursement

Surgical wound classification in otolaryngology:A state-of-the-art review

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2022年第2期8卷 139-144页

作者： Jeffrey D.Bernstein David J.Bracken Shira R.Abeles Ryan K.Orosco Philip A.Weissbrod Department of Otolaryngology University of California San DiegoLa JollaCaliforniaUSA Department of Medicine Division of Infectious Disease and Global Public HealthUniversity of California San DiegoSan DiegoCaliforniaUSA Moores Cancer Center University of California San DiegoLa JollaCaliforniaUSA

Objective:To describe the issues related to the assignment of surgical wound classification as it pertains to Otolaryngology—Head&Neck surgery,and to present a simple framework by which providers can assign wound *** Sources:Literature ***:Surgical wound classification in its current state is limited in its *** has recently been disregarded by major risk assessment models,likely due to inaccurate and inconsistent reporting by providers and operative ***,if data accuracy is improved,this metric may be useful to inform the risk of surgical site *** an era of quality-driven care and reimbursement,surgical wound classification may become an equally important indicator of quality.

关键词： ENT health care spending OHNS otolaryngology quality improvement reimbursement surgical site infection wound classification

Compliance with SEP-1 guidelines is associated with improved outcomes for septic shock but not for severe sepsis

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Journal of Intensive Medicine 2022年第3期2卷 167-172页

作者： Shelly NBSloan Nate Rodriguez Thomas Seward Lucy Sare Lukas Moore Greg Stahl Kerry Johnson Scott Goade Robert Arnce Department of Primary Care College of MedicineKansas City University2901St.Johns Blvd.JoplinMO 64804USA Department of Quality Improvement Freeman Health SystemJoplinMO 64804USA Department of Mathematics Missouri Southern State UniversityJoplinMO 64801USA Department of Pharmacy Freeman Health SystemJoplinMO 64804USA

Background: In 2018, the Centers for Medicaid and Medicare Services (CMS) issued a protocol for the treatment of sepsis. This bundle protocol, titled SEP-1 is a multicomponent 3 h and 6 h resuscitation treatment for patients with the diagnosis of either severe sepsis or septic shock. The SEP-1 bundle includes antibiotic administration, fluid bolus, blood cultures, lactate measurement, vasopressors for fluid-refractory hypotension, and a reevaluation of volume status. We performed a retrospective analysis of patients diagnosed with either severe sepsis or septic shock comparing mortality outcomes based on compliance with the updated SEP-1 bundle at a rural community hospital. Methods: Mortality outcome and readmission data were extracted from an electronic medical records database from January 1, 2019, to June 30, 2020. International Classification of Diseases (ICD)-10 codes were used to identify patients with either severe sepsis or septic shock. Once identified, patients were separated into four populations: patients with severe sepsis who met SEP-1, patients with severe sepsis who failed SEP-1, patients with septic shock who met SEP-1, and patients with septic shock who failed SEP-1. A patient who met bundle criteria (SEP-1 criteria) received each component of the bundle in the time allotted. Using chi-squared test of homogeneity, mortality outcomes for population proportions were investigated. Two sample proportion summary hypothesis test and 95% confidence intervals (CI) determined significance in mortality outcomes. Results: Out of our 1122 patient population, 437 patients qualified to be measured by CMS criteria. Of the 437 patients, 195 met the treatment bundle and 242 failed the treatment bundle. Upon comparing the two groups, we found the probable difference in mortality rate between the met(14.87%) and failed bundle(27.69%) groups to be significant(95% CI: 5.28-20.34, P = 0.0013). However, the driving force of this result lies in the subgroup of patients w

关键词： SEP-1 Sepsis Early goal-directed therapy Centers for Medicaid and Medicare Services Quality improvement reimbursement

The Newly Established Unified Healthcare Fund (EOPYY): Current Situation and Proposed Structural Changes, towards an Upgraded Model of Primary Health Care, in Greece

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Health 2014年第9期6卷 809-821页

作者： Stefanos E. Karakolias Nikolaos M. Polyzos Department of Social Administration and Political Science Democritus University of Thrace Komotini Greece

Background: The National Organization for Healthcare Provision (EOPYY) constitutes simultaneously the monopsonistic healthcare insurer and a main provider of PHC in Greece. Currently, EOPYY is threatened by financial distress hence emerging a critical discussion on structural issues, providers’ reimbursement and gatekeeping revision. Objectives: To conduct a detailed analysis of the Greek social health insurance and PHC in order to propose consolidation policies. Methods: Search for raw data domestically and best practices internationally. Results: In Greece, PHC provision is fragmented leading patients to more expensive hospital care. Family physicians are a small portion of total physicians which, in combination with the free choice policy, results in non-gate-keeping despite growing co-payments. This necessitates the creation of a PHC network between EOPYY’s and NHS’s units and contracted professionals. This first evaluation has also revealed an irrational use of consolidated resources, which we propose to normalize through a new global budget system. Conclusions: Greek health insurance needs an immediate reform through which EOPYY would become an efficient pool of public and social health inflows. Besides, we suggest gate-keeping to be activated, proclaiming new EOPYY contracts with general practitioners and family pediatricians, applying a stricter referral system and reforming the reimbursement system.

关键词： EOPYY Healthcare Fund Health Insurance Primary Health Care reimbursement

Vision Screening in the Pediatrician’s Office

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Open Journal of Ophthalmology 2012年第2期2卷 9-13页

作者： Natario L. Couser Fatema Q. Esmail Amy K. Hutchinson The Department of Ophthalmology Emory University School of Medicine Atlanta USA.

Objective: To assess current practices, attitudes, and perceived barriers toward pediatric vision screening. Patients and Methods: A link to a 9-question survey was electronically distributed to a national sample of 6000 pediatricians through Medical Marketing Services Inc. Data were collected using Survey Monkey. Results: Email open rate was 11%;37% of those who opened the email responded (225 respondents). Over ninety percent of respondents perform some type of vision screening at least yearly, although age at which screening began varied, with two thirds of respondents instituting formal vision screening after three years. Fifty eight percent of respondents were either extremely unsatisfied, unsatisfied or only somewhat satisfied with their current screening method. Preferred methods of screening and confidence of pediatricians in their ability to detect pathology varied for children under versus over age three. The least frequently used methods for all age groups were autorefraction and photoscreening. The most commonly reported barriers to screening were inadequate training (48%), time required for exam (42%), and inadequate reimbursement (32%). Conclusions: Perceived barriers to vision screening in the pediatrician office have been previously identified, and photoscreening and autorefraction have been identified as a possible means to circumvent them. In spite of the addition of new procedural codes, pediatricians continue to report similar barriers to screening.

关键词： Pediatric Vision Screening Barriers reimbursement Pediatricians Photoscreening Autorefraction U.S. Preventative Services Task Force CPT 99174

Off-label use of targeted therapies in oncology

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World Journal of Clinical Oncology 2016年第2期7卷 253-257页

作者： Dominique Levêque Dominique Levêque Division of Pharmacyhôpital Hautepierre67000 StrasbourgFrance

Off-label use is defined by the prescription of a marketed drug outside the conditions described in the summary of product *** oncology,off-label prescribing of targeted therapies may occur in patients with other tumor types expressing the same *** associated to phenotypic approaches such as therapies against the tumoral vasculature(anti-angiogenic drugs) and new immunotherapies(checkpoint inhibitors) also carry the potential of alternative indications or ***-label use of targeted therapies is little documented and appears to be in the same range than that regarding older drugs with wide variations among *** compared with older agents,off-label use of targeted therapies is probably more rational through tumoral genotyping but is faced with a limited clinical support,reimbursement challenges related to the very high pricing and the cost of genotyping or molecular profiling,when applicable.

关键词： Targeted therapy Monoclonal antibody Off-label anticancer drug use reimbursement Enzyme inhibitor