Gao, Y.

Jia, W.

Zhou, S.

Xiao, G.

Li, Y.

Zhang, J.

Ke, W.

Zhang, C.

Yang, Y.

Ajuntament de Barcelona

Repositori Obert de Coneixement de l'Ajuntament de Barcelona

Gaseta municipal de Barcelona. Any 091, núm. 25 (20 set. 2004)

Gaseta municipal de Barcelona. Any 091, núm. 20 (30 juny 2004)

Gaseta municipal de Barcelona. Any 091, núm. 29 (30 oct. 2004)

Elsevier - Publisher Connector 

 VA L U E  I N  H E A LT H  1 8  ( 2 0 1 5 )  A 1 – A 3 0 7  A235
OBJECTIVES: HCV infection in Egypt is one of the highest in the World. The objective 
of the study is to support Egyptian decision makers by comparing different treat-
ment rates with the recent approved Hep C antiviral agents, and its implications on 
prevalence progress and associated costs. METHODS: The analysis was based on 
a 17-year Markov model.Patients would progress through the various HCV stages 
from F0 to F3 followed by cirrhosis. Following cirrhosis to other progressive stages 
up to hepatocellular carcinoma and liver related death. Patients could be cured 
spontaneously in state F0 or as a result of antiviral therapy in any state from F0 to 
cirrhosis at a cure rate of 92% in stages F0-F3 and a cure rate of 80% in the stage of 
cirrhosis. Cured patients would transition to the mortality risk of the age-matched 
general population. In each cycle, new incident patients were also introduced at a 
rate of approximately 128,000 or 2%. RESULTS: Treating 8% of the infected cases 
each year (450K viremic cases/year) would bring the prevalence to 1 million by 2030. 
A treatment rate of 1% (65Kcases/yr) or 5% (300Kcases/yr) would bring the preva-
lence to 5.5 million and 2.5 million respectively by 2030. Total annual costs would 
start at $1.3Billion in the first year of treatment for the 8% treatment rate but would 
decrease to $580million/yr by 2030. The 5% and 1% rates would start at $900million 
& $550million. CONCLUSIONS: A treatment rate of 450Kcases/yr would bring the 
prevalence to 1 million by 2030. Costs would be significantly high during the first 
5 years, but eventually would dop as the disease burden decreases. Alternative 
scenarios wouldn’t eliminate the disease by 2030. A screening policy need to be 
in place & health infrastructure assessed in preparation for the rising numbers of 
patients receiving treatment
PIN45
EcoNomIc BurdEN of commuNIty-AcquIrEd PNEumoNIA AmoNg Adults 
IN thE PhIlIPPINEs Its clINIcAl ANd PolIcy ImPlIcAtIoNs IN thE cAsE 
rAtE PAymENts of thE PhIlIPPINE hEAlth INsurANcE corPorAtIoN
Tumanan-Mendoza B.A.1, Mendoza V.2, Punzalan F.E.3, Reganit P.F.4, Bacolcol S.A.1
1Manila Doctors Hospital; University of the Philippines College of Medicine, Manila, Philippines, 
2De La Salle Health Sciences Institute, Dasmarinas, Cavite, Philippines, 3Manila Doctors 
Hospital; University of the Philippines College of Medicine & Philippine General Hospital, Manila, 
Philippines, 4University of the Philipines College of Medicine & Philippine General Hospital, 
Manila, Philippines
OBJECTIVES: To determine (1) the cost of hospitalization and 1-week post-dis-
charge, (2) the difference between estimated costs and the Philippine Health 
Insurance Corporation (PhilHealth) pneumonia case rate payments, and (3) the 
economic burden of community-acquired pneumonia (moderate and high-risk, 
CAP-MR and CAP-HR, respectively) among patients aged > 19 years old in the 
Philippines. METHODS: The study involved two tertiary private hospitals in the 
Philippines. Using the societal perspective, out-of-pocket expenses and productivity 
losses were computed. A base case and sensitivity analyses were performed and the 
economic burden of pneumonia was determined using Philhealth claims. RESULTS: 
The estimated cost of hospitalization for CAP-MR was PhP 36,153 - 113,633 (US$852 
– 2,678) and the1-week post-discharge cost for CAP-MR was PhP 1,450 – 8,800 (US$ 
34 – 207) The cost of hospitalization for CAP-HR was PhP 104,544 – 249,695 (US$2,464 
– 5,885) and PhP 101,248 – 243, 495 (US$2,386 – 5,739) with the use of either invasive 
ventilation or non-invasive ventilation, respectively. The post discharge cost for 
CAP-HR was PhP 1,716 – 10,529 (US$40 – 248). In comparison, the present PhilHealth 
case rate payments for CAP-MR is PhP 15,000 (US$354) and PhP 32,000 (US$754) 
for CAP-HR. Based on the number of PhilHealth claims for the year 2012 and the 
study results, the economic burden of pneumonia in 2012 was PhP 8.48 billion for 
CAP-MR and PhP 643.76 million for CAP-HR. CONCLUSIONS: The paper reported the 
hospitalization and follow-up costs of CAP-MR and CAP-HR based on the societal 
perspective. It showed significant difference from the current case rate payments 
of the Philippine Health Insurance Corporation.
PIN46
costs ANd chAllENgEs AssocIAtEd wIth dIAgNosIs ANd trEAtmENt of 
INfEctIoNs IN hosPItAlIzEd PAtIENts: A rEtrosPEctIvE us ElEctroNIc 
hEAlth dAtABAsE study
Durtschi A.J.1, Khangulov V.S.2, Peyerl F.W.2, Sammy Y.3
1Abbott Laboratories, Abbott Park, IL, USA, 2Boston Strategic Partners, Inc., Boston, MA, USA, 
3Abbott Laboratories, Baar, Switzerland
OBJECTIVES: While it is known that accurate and timely diagnosis and treatment of 
infections can present a major healthcare challenge, there is a lack of in-depth studies 
examining infection diagnosis and treatment practices and their associated costs in 
large real-world patient populations. The study objective was to examine infection 
prevalence, current diagnosis and treatment practices, and costs associated with 
managing patients with infections via retrospective analysis of a large US electronic 
health record database. METHODS: Patients with infections were identified based 
on the use of antimicrobial therapy for > 24 h following hospital admission. Infection 
type was identified using ICD-9 diagnosis coding. Patients were classified into four 
groups: (1) pneumonia, (2) sepsis without pneumonia, (3) other infectious etiology, 
and (4) non-infectious etiology initially suspected as infectious. Illness severity was 
assessed using the Acute Physiology Score. Diagnostic procedures and treatments 
were identified via ICD-9 procedure coding and pharmacy order data, respectively. 
Per-patient cost estimates ($USD), calculated over 15 days from admission, encom-
passed diagnostic tests, radiologic procedures, and antimicrobial and other pharma-
ceutical treatments. RESULTS: In total, 127,174 patient visits met inclusion criteria. 
Pneumonia was the most common infection type (20.1% of visits), followed by other 
infectious etiology (16.0%) and sepsis without pneumonia (7.0%). Non-infections ini-
tially suspected as infections represented 56.9% of visits. Overall, 62.5% of patients 
had medium or high illness severity. Length-of-stay was > 5 days for 49.2% of patients. 
Bacterial tests accounted for 92.4% of diagnostic tests, and antibiotics accounted 
for the majority (> 98%) of antimicrobial treatments. Suspected infections with non-
infectious etiology had the highest per-patient costs for low-severity ($14,228) and 
medium-severity patients ($12,551). For high-severity patients, pneumonia carried the 
highest per-patient cost ($14,541). CONCLUSIONS: This study demonstrates that the 
total costs (in 2014 US dollars) were estimated for each urgent ABR threat, for each 
year analyzed. RESULTS: The number of CRE- and C. diff-related hospitalizations 
increased during the study period (CRE: 109,304 in 2001 to 692,680 in 2012; C. diff: 
144,312 in 2001 to 359,395 in 2012) but decreased for N. gonorrhoeae (5,440 in 2001 
to 4,130 in 2012). The mean LOS for all hospitalizations in the US between 2001-
2012 was 4.58 days and mean per-patient cost of $16,168. LOS for all urgent threats 
decreased over time (LOS: N. gonorrhoeae, 2001: 4.05 days, 2012: 3.92 days; CRE, 2001: 
10.15 days, 2012: 6.98 days; and C. diff, 2001: 13.53 days, 2012: 10.41 days) while total 
costs increased for N. gonorrhoeae, (2001: $9,963, 2012: $14,675) and C. diff(2001: 
$36,896, 2012: $43,632) but not for CRE (2001: $27,356, 2012: $26,959). CONCLUSIONS: 
Although LOS among ABR-related hospitalizations in the US has decreased over 
time, costs for both N. gonorrhoeae and C. diff have increased, +47% and +18%, 
respectively. Future efforts to reduce the incidence of ABR infection will improve 
the public’s health as well as decrease the associated economic burden.
PIN42
dIrEct mEdIcAl costs ANd AssocIAtEd fActors IN PAtIENts wIth 
chroNIc hEPAtItIs B IN gugNgzhou, chINA: A fIvE-yEAr rEtrosPEctIvE 
cohort study
Gao Y.1, Jia W.2, Zhou S.1, Xiao G.2, Li Y.2, Zhang J.1, Ke W.1, Zhang C.1, Yang Y.1
1Guangdong Pharmaceutical University, Guangzhou, China, 2Guangzhou Eighth Peopleâ€ ™s 
Hospital, Guangzhou, China
OBJECTIVES: To describe direct medical costs and factors associated with 
three disease stages of chronic hepatitis B virus infection (CHB) in Guangzhou, 
China. METHODS: We conducted a retrospective cohort study of patients with 
CHB using a hospital information system database from 2008 to 2012 in the larg-
est specialized infection hospital in Guangdong Province, China. Average annual 
costs and cost components were calculated. Generalized estimating equations were 
applied to explore associations between factors and costs. All costs were adjusted 
to RMB in 2012 at a discounting rate of 5% per year. RESULTS: A total of 65,792 (58 
455 outpatients and 7 337 inpatients) were involved in the analysis. Number of 
visits/admissions (mean) per case per year for outpatient and inpatient were as 
follows: CHB: 4.56/1.12; Cirrhosis: 4.34/1.24; HCC: 2.46/1.13; and the correspond-
ing average costs per person-time were: CHB: 581.79 and 8994.90 RMB; Cirrhosis: 
670.71 and 16574.44 RMB; HCC: 643.69 and 20900.89 RMB, respectively. Antiviral 
(47.93%) and non-antiviral medicines (34.44%, including 16.99% of liver protec-
tors and 6.31% of traditional Chinese medicine) for outpatient were the main cost 
components. Inpatient non-antiviral medicine and lab test contributed 45.56% and 
23.38% of total costs; but antiviral medicine was only at 6.28% of total costs. Male, 
elder, antiviral patients, cirrhosis and HCC patients had statistically significant 
higher costs as compared with female, younger, non-antiviral and CHB patients. 
Among the outpatients, self-payment patients’ costs were the highest, followed by 
patients with medical insurance and free medical service, whereas opposite effect 
direction on costs was found in inpatients, and the differences were statistically 
significant. CONCLUSIONS: Direct medical costs of inpatients with CHB increase 
significantly as the disease progresses. Payment mode has different effect direc-
tion between outpatient and inpatient, indicating that reimbursement policy for 
clinic and hospitalized patients have an important role on direct medical costs in 
treating HBV.
PIN43
BurdEN ANd PrEdIctors of hosPItAlIzAtIoN costs AssocIAtEd wIth 
ANtI-INfEctIvE AdvErsE EvENts
Pawar A.M., McConeghy R.O., Caffrey A.R., Kogut S.
University of Rhode Island, Kingston, RI, USA
OBJECTIVES: To assess the burden of and identify predictors of hospitalization costs 
associated with adverse drug events (ADEs) related to anti-infectives that were 
present on admission (POA) in US hospitals. Furthermore, we sought to identify dif-
ferences in costs by gender and age groups. METHODS: Using the 2012 Nationwide 
Inpatient Sample, we identified ADEs associated with anti-infectives using diagnosis 
codes (ICD-9-CM) and E codes. Differences in average and median hospitalization 
costs between subgroups were assessed using t-tests and Wilcoxon non-parametric 
median tests. To assess predictors of cost, we developed a generalized linear model 
(GLM) using the Modified Park test, Box-Cox regression test, Akaike information 
criterion and residual analysis to improve model fit. Results were weighted to obtain 
nationally representative cost estimates in 2012 dollars. RESULTS: Our study identi-
fied 49,623 discharges with POA ADEs (national estimate= 248,095) associated with 
anti-infectives with a total cost of $2.1 billion (national estimate= $10.6 billion). The 
mean cost for each hospitalization was $43,499 (SD= $76,865, median= $23,565, 
interquartile range= $13,189-$45,424) with a range $275 to $2,995,306. The mean 
length of stay (LOS) was 6.64 days (SD= 7.84, median= 5) and ranged from 0 to 354 
days. Total hospitalization costs were significantly (p= < .0001) higher for males 
(4.50%) and those aged 65 years or older (3.34%). GLM with gamma family and log 
link was a better model compared to ordinary least-squares. Using this model, we 
identified several significant cost predictors: LOS, age at admission, race, gender, 
median household income, hospital bed size and numerous comorbidities. Our 
model estimated that the cost of hospitalization, which was $67,528 for LOS of 
one day, increased 11.20% with each day increase in LOS. Each year increase in age 
caused 0.05% increase in hospitalization costs. CONCLUSIONS: Our findings sug-
gest that ADEs associated with anti-infectives are more costly when they occur in 
older patients and among those with medical comorbidities.
PIN44
ImPAct of dIffErENt trEAtmENt rAtEs for hEPAtItIs c INfEctEd 
PAtIENts oN thE EPIdEmIologIc & EcoNomIc BurdEN IN EgyPt
Shelbaya A.1, Kuznik A.2, Salem M.3, Sadik K.4, Mankoula W.5
1Columbia University, New York, NY, USA, 2Lagos University, Lagos, Nigeria, 3Save The Children 
Egypt, Cairo, Egypt, 4Brandeis University, Waltham, MA, USA, 5Egyptian Ministry of Health, 
Cairo, Egypt
