Investigation of the Effect of Aging on Health Costs: A Systematic Review

Background & Objectives: Aging and the need for more health care in the elderly population have incurred large expenditures. Based on the importance of the aging population phenomenon and the increase in lifetime in recent decades, this study aimed to systematically review the studies on costs of elderly health care. Methods: In this systematic review, the articles published in PubMed Google Scholar, Science Direct, Scopus, and Ovid Medline databases from 2000 to 2017 were derived using a systematic search strategy. Results: The results of the reviewed studies showed that by increasing the consumption of long-term care and home care, the costs would increase and by reducing the consumption of acute hospital care, such costs would decrease. Based on the results, the average cost of elderly health care in the reviewed studies was 48101 US dollars in 2015. Moreover, the highest average costs were for inpatient services (19003US dollars) and long-term care and home care (12583US dollars). Conclusion: Considering the high costs of hospitalization of the elderly, measures like establishment of day care centers and home care instead of hospitalization should be taken into consideration in the elderly health care programs to reduce the number of hospitalizations. Key¬words: Aging, the Elderly, Health Costs, Hospital Costs, Systematic Review Citation: Rezapour A, Arabloo J, Alipour V, Alipour S. Investigation of the Effect of Aging on Health Costs: A Systematic Review. Journal of Health Based Research 2020; 5(4): 411-22. [In Persian

Comparison of video-assisted thoracoscopic surgery with thoracotomy for treatment of chronic empyema: A systematic review study

Context:Empyema is a respiratory disease that has increased seriously in the past two decades. The usual treatments for stage III patients include thoracotomy and video-assisted thoracoscopic surgery. Hence, a systematic review of the literature was conducted to investigate the effectiveness and safety of the two procedures. Methods:Electronic databases of PubMed, Cochrane Library, Scopus, NIHR HTA, Embase, Magiran, and SID were searched from 1990 until the end of June 2018. We used the Critical Appraisal Skills Programme (CASP) checklist for quality assessment. Data analysis was performed in Stata software. The pooled effectiveness results were demonstrated in Forest plats. Results:Among 2,228 records initially retrieved, four studies entered the final stage of review, among which three were included in the meta-analysis. The findings showed no significant difference between the two methods of thoracoscopic surgery and thoracotomy in the treatment of organizational empyema in terms of duration of surgical operation (MD = 1.33, %95 CI:-0.66-3.31, P = 0.18). Postoperative hospital stay was not statistically different between the two surgical methods (MD = 1.68, %95 CI:-0.20-3.56, P = 0.08). In terms of safety, there was no particular risk for patients across the surgeries. Conclusions:There is no statistically significant difference between video-assisted thoracoscopic surgery and thoracotomy in terms of effectiveness and safety. Nevertheless, the results should be considered cautiously due to the little number of included studies

Educational Costs of Residents in a Teaching Hospital: a case study

Background & Objectives: Residents spend much of their time at the hospitals to earn their required educational skills and although they act as a kind of human resource in the hospital, they increase hospital costs. The present study was designed to calculate the share of educational costs of different medical residents in hospitals. Methods: In this descriptive and applied study performed in one of the hospitals affiliated to Iran University of Medical Sciences, the hospital cost items of education of residents in different medical fields during the academic year of 2017-2018 were identified by use of two scenarios. Results: In short, mean educational cost of one resident in the studied academic year was about 5357$based on the first scenario and about 5404$ according to the second scenario. Based on both scenarios, salaries paid to residents accounted for more than 50% of the costs followed by the cost of consumed materials by residents. Forensic Medicine and Anesthesiology residency programs had respectively the lowest and highest share of costs in both scenarios. Conclusion: The cost of training in the hospital is different among residency fields based on the required tests and errors in each field. But, in order to save hospital costs, the culture of optimal use of materials as well as medical equipment should be taught to residents. Key­words: Education Economics, Costing, Direct Costs, Residents, Teaching hospital ­Citation: Aleboyeh MR, Reza pour A, Meshkani Z, Alipour V, Soleimani movahed M. Educational Costs of Residents in a Teaching Hospital: a case study. Journal of Health Based Research 2019; 5(2): 117-30

Economic burden of cardiovascular diseases before and after Iran’s health transformation plan: Evidence from a referral hospital of Iran

Background: Different countries have set different policies to control and decrease the costs of cardiovascular diseases (CVDs). Iran was aiming to reduce the economic burden of different disease by a recent reform from named as health transformation plan (HTP). This study aimed to examine the economic burden of CVDs before and after of HTP. Methods: This cross-sectional study was conducted on 600 patients with CVDs, who were randomly selected from a specialized cardiovascular hospital in the north-west of Iran. Direct and indirect costs of CVDs were calculated using the cost of illness and human capital approaches. Data were collected using a researcher-made checklist obtained from several sources including structured interviews, the Statistical Center of Iran, Iran’s Ministry of Cooperatives, Labor, and Social Welfare, the central bank of Iran, and the data of global burden of disease obtained from the Institute for Health Metrics and Evaluation to estimate direct and mortality costs. All costs were calculated in Iranian Rials (IRR). Results: Total costs of CVDs were about 5571 and 6700 billion IRR before and after the HTP, respectively. More than 62% of the total costs of CVDs accounted for premature death before (64.89%) and after (62.01%) the HTP. The total hospitalization costs of CVDs was significantly increased after the HTP (p = 0.038). In both times, surgical services and visiting had the highest and lowest share of hospitalization costs, respectively. The OOP expenditure decreased significantly and reached from 54.2 to 36.7%. All hospitalization costs, except patients’ OOP expenditure, were significantly increased after the HTP about 1.3 times. Direct non-medical costs reached from 2.4 to 3.3 billion before and after the HTP, respectively. Conclusion: Economic burden of CVDs increased in the north-west of Iran after the HTP due to the increase of all direct and indirect costs, except the OOP expenditure. Non-allocation of defined resources, which coincided with the international and national political and economic challenges in Iran, led to unsustainable resources of the HTP. So, no results of this study can be attributed solely to the HTP. Therefore, more detailed studies should be carried out on the reasons for the significant increase in CVDs costs in the region

Post-operative ascites of unknown origin after laparoscopic cholecystectomy: Case report

Introduction and importance: Post Laparoscopic cholecystectomy ascites is a rare complication that might be due to biliary leak, lymph duct injuries, infections, peritoneal reaction bowel injuries, malignancies and etc.& nbsp;Case presentation: Here we have reported post-cholecystectomy ascites presented with hypovolemic shock in a women of unknown origin. Different possible etiologies have been ruled out for her but her intra-peritoneal secretions had been decreased about one week of hospitalization and was discharged without figuring out its etiology.& nbsp;Clinical discussion: Post-cholecystectomy ascites is a rare condition that could be caused by biliary leak, lymphatic leak, ovarian hyper stimulation syndrome, infections, peritoneal reactions and malignancies that all of them should be considered for these patients to manage their problem.& nbsp;Conclusion: The exact cause of ascites in the presented case was still unknown and the condition was controlled by administration of corticosteroids, octreotide, albumin, and insertion of the stents in biliary ducts. More investigation esp. on immunologic causes are needed

Comparison of Insulin Expression Levels in White Blood Cells of infants with and without Family History of Type II Diabetes

Background: Type II diabetes is known as one of the most important, prevalent, and expensive diseases of mankind. Late diagnosis and subsequent delayed initiation of treatment or surveillance of patients create a variety of problems for affected individuals. This has raised increasing concerns for public health authorities throughout the world. In the current study, we aimed to find a new approach for early identification of high-risk individuals at initial months of their life. This allows us to take preventive measures as early as possible.Materials and Methods: In our study, 102 infants - from one to six months - were selected and placed in two case and control groups. The case group contained 52 babies with at least one of their parents identified as a type II diabetic patient. The control group comprised 50 babies with no family history of type II diabetes in paternal and maternal first-degree relatives. Afterwards, the expression level of insulin gene was analyzed in white blood cells of both groups. Information related to infants - referred to outpatient and inpatient wards of three main pediatric hospitals placed in Tehran - and their parents were collected through questionnaires within a two-year period. The study inclusion criteria for infants were confirmed type II diabetes in at least one of their parents, the absence of any metabolic disorder, and the absence of any disturbing vital signs. After drawing 2 ml of babies’ peripheral blood, total RNA of white blood cells (WBC) was extracted, and used for cDNA synthesis. Real-Time PCR was then applied to quantitatively evaluate the expression levels of insulin gene. The results of Real-Time PCR were statistically analyzed by non-parametric tests of Mann-Whitney and Kruskal-Wallis.Results: The expression of insulin gene was observed in white blood cells of all samples. However, there was a significant difference in expression levels between case and control groups (p<0.05). There was a statistically significant difference in mean levels of gene expression among babies with diabetic mother, and healthy groups (RQ=0.5, P-value=0.002), but this value wasn’t significant for babies with diabetic father (RQ=0.78, P>0.05).Conclusion: Numerous genes contribute to the development of diabetes and novel disease-causing genes are increasingly being discovered. Identification of disease-prone individuals through examining merely one underlying gene is complicated and challenging. Interestingly, all of these abnormally functioning genes finally manifest themselves in the altered expression levels of insulin gene. The expression status of insulin gene in WBCs could be suggested as a useful approach for identification of individuals at high risk for developing diabetes. This paves the way for taking appropriate measures at infancy period in order to prevent the disease as well as inhibit its various side effects in the following years of patient’s life

Comparing the Results of two Cost Sharing Approaches in Calculating the Cost of Hospital Services: a case study

Background & Objectives: Calculation of hospital services costs, especially the allocated costs, is a complicated process due to the great number of hospital services, as well as the interdependence between different centers. Considering the interrelationships between all departments in the hospital, cost analysis is possible only through the mutul sharing approach, which can provide more accurate information for researchers and managers in order to decide on a costs analysis. Methods: The present study was a descriptive study that was conducted in 2017 in a selected educational hospital affiliated to Iran University of Medical Sciences. Data collection was done through observation, interview and investigating financial documents. After identifying the active centers and the appropriate cost drivers, the cost of important services in final sectors was calculated by using two methods of one-way sharing and mutual sharing through simultaneous equations. Results: In comparison of one-way and mutaul sharing approach, all overhead, intermediate and total costs showed deviation. The greatest deviation between these two approaches was found in the parturition and ophthalmology departments and related to the cesarean with 16 million rials and the lacrimal duct cathetering with 13 million rials, respectively. Conclusion: The findings of this study showed that if hospitals managers calculate their services costs by activity-based cost and through mutual cost sharing approach, they can benefit from the correct costreportings and by having a clear image can make management decisions appropriately. Key¬words: Activity-based costing, One-way sharing, Mutual sharing, Teaching hospital Citation: Alipour V , Rezapour A , Meshkani Z, Farabi H, Mazdaki A, Hakimi N. Comparing the Results of two Cost Sharing Approaches in Calculating the Cost of Hospital Services: a case study. Journal of Health Based Research 2018; 4(3): 273-87. [In Persian

The Economic Burden of Acute Myeloid Leukemia in Iran

Background: Cancer imposes a significant economic burden on the health system and society. Acute myeloid leukemia (AML) is the third deadliest leukemia and is one of the leading health problems worldwide. The present study aimed to estimate the economic burden of AML in Iran for 2020. Methods: In this study, we estimated a prevalence-based on the cost-of-illness of the AML in Iran. A societal perspective was considered, in which the direct costs and productivity losses with the adoption of the human capital approach in the AML cases were estimated for 2020. Moreover, in the present study, several resources including national cancer registry reports, hospital records, occupational data, and interviews with experts were cited. Results: Approximately 98% of patients with AML received induction therapy. The AML economic burden was $33,243,107.39. Indirect costs accounted for 60$) of this amount, and direct medical costs and direct non-medical costs make up for 19% (6,359,380.88$) and 16$) of this estimated economic burden, respectively Conclusion: The economic burden of AML in Iran is very remarkable and due to the increasing prevalence of this disease, it is expected to increase gradually. Having insights into the costs associated with the disease provide an excellent opportunity for health policymakers and managers to effectively improve resource allocation

The Cost of Internal and Neurosurgery ICUs in a Selected Teaching Hospital: A Case Study

Background & Objectives: Intensive Care Unit (ICU) is the most important units in hospitals, which imposes high costs to patients. This unit is considered as one of the high-cost unit for providing End-of-Life Services. The cost analysis of the ICUs can help managers decide on how to provide the services of this unit. Methods: In this descriptive study, the total cost of Internal and Neurosurgery ICUs in a selected teaching hospital affiliated to Iran University of Medical Sciences in 2017, was evaluated using top-down approach. The financial records of the units and data on the cost drivers were collected from accounting and related units, respectively. Results: About 7% of the total hospital costs was related to the ICUs. The direct costs allocated to the internal and neurosurgery units were about $2261000 and$928000, respectively. Payments, medicines, and hospital consumables had the highest share of costs, respectively. By considering the total costs, the units as well as services studied were loss-making. Conclusion: Given that the hospital is a teaching one, teaching students about saving resources reduces the costs. Also, by providing home health care services for patients at the end-of-life stage hospitalized in the ICUs can also help the hospital achieve its financial goals. Key¬words: Activity-based costing, Overhead cost, Cost of End-of-Life services, Teaching hospital, Intensive care units Citation: Mehrinezhad S, Sarabi A, Rezapour A, Shokri A, Zahra Meshkani Z, Alipour V, et al. The Cost of Internal and Neurosurgery ICUs in a Selected Teaching Hospital: A Case Study. Journal of Health Based Research 2018; 4(3): 219-23. [In Persian