广西城市居民冠心病治疗费用预测研究

目的了解和预测冠心病的治疗费用，分析费用增长的原因，为控制费用增长提供最佳途径和最宜阶段的建议。方法分层随机抽样调查1997～2001年各级医院经确诊的冠心病病人住院和门诊治疗费用，采用曲线拟合法（1gy =a＋bx）和文献综合的方法进行预测分析。结果治疗费用的提高是各种因素综合作用的结果，即例均费用的上涨：患病率的升高；人口数量的增长以及随之而来的医疗服务利用率的提高等。结论冠心病与其他慢性病一样，其费用控制的根本在于发病率和患病率的降低。     

广西城市居民冠心病的疾病经济负担分析研究

目的对广西城市居民冠心病经济负担进行分析。方法资料来源于分层随机调查1997—2001年各级医院确诊的冠心病病人住院和门诊治疗费用及政府部门统计报表。主要利用直接医疗费用计算疾病负担。结果冠心病病人2003年例均门诊费用和例均住院费用分别为203．89元和9477．63元；2003年35岁以上城市居民因冠心病而损失的伤残调整寿命年(DALY)为1．91DALYs／千人口，造成间接经济损失总和为1181.65万元。结论冠心病给广西城市居民带来沉重的经济负担，且呈上升趋势，因此，应积极开展冠心病的预防工作。     

对三种慢性病个人自付费用的定量研究

深圳市南山区于１９９５年元月起试行社会共济与个人帐户相结合的医疗保险新模式．为了了解实行个人帐户以后，慢性病患者个人自付的费用水平及承受能力，以及社会统筹医疗基金的自付水平，笔者于１９９４年１２月在深圳市某综合医院（三级甲等）的心血管内科、人工肾科、内分泌科，对冠心病、糖尿病、慢性肾病病人的门诊治疗费用情况进行了调查及专家咨询，并就费用自付比例与物价上涨因素对慢性病人门诊治疗费用的影响程度进行了估算、分摊及预测，旨在为深圳市医疗保险的立法提供决策依据。一、全年门诊医疗费用估算（一）冠心病假如病人…     

保险偿付模式对慢性病个人自付费用水平影响程度的定量研究

对对深圳市某三级甲等综合的冠心病、糖尿病、慢性肾病病人的门诊治费用进行了实地调查，并通过咨询专家，就不同保险方案规定的医疗费胜自付比例和笺价上涨因素，对三种慢性病人门诊治疗费用的影响程度进行了估算、分摊和预测，旨在为医疗保险制度的完善提供决策依据。     

医疗保险偿付模式对慢性病个人自付费用水平影响程度的定量研究

对深圳市某三级甲等综合医院的冠心病、糖尿病、慢性肾病病人的门诊治疗费用进行了实地调查,并通过咨询专家,就不同保险方案规定的医疗费用自付比例和物价上涨因素,对三种慢性病人门诊治疗费用的影响程度进行了估算、分摊和预测,旨在为医疗保险制度的完善提供决策依据。     

浅析实施结核病归口管理工作对湖北省结核病控制的影响

结核病的控制主要是发现和彻底治疗传染源,而有效治疗传染源的方法就是进行规则短程化疗和全程督导管理,关键在于落实病人的归口管理〔１〕。本文就归口管理工作对我省结核病控制的影响进行了分析和评价。资料和方法　资料来源于我省１９９８年５月底至６月初省项目办组织的对全省１９９７～１９９８年结防工作的抽查,着重抽查了７县（市）第一人民医院肺结核病人的归口管理情况。按照“湖北省结核病归口管理实施办法”的规定,检查肺结核病人的疫情登记、报告和治疗、管理资料,了解病人住院期间的医疗费用,分析结防机构一个季度登记的…     

初诊精神分裂症病人住院与非住院治疗的对照研究

通过对40例初诊精神分裂症病人住院与非住院治疗的对照研究，采用BPRS、SDSS进行评定，统计1年的治疗费用，结果两组病人的疗效及社会功能情况无显著统计学差异。非住院组病人的服药顺应性好于住院病人而治疗费用明显低于住院病人，提出非住院治疗对解决精神分裂症这一反复发作性、持续性的特征导致长期大量的经费开支问题具有重要意义。     

高血压合并冠心病怎样选用降压药

高血压合并冠心病的病人，发生再次心肌梗死或猝死的机会要高于不合并高血压的冠心病病人，因此，合并冠心病的高血压病人更应积极进行降压治疗。     

儿童严重营养不良经济有效的治疗方法

完美的病人照顾方案应考虑到病人的社会，家庭背景，考虑到家庭对病人的疾病和治疗的作用，ＡｎｎＡｓｈｗｏｒｔｈ等在ＨｅａｌｔｈＰｏｌｉｃｙａｎｄＰｌａｎｎｉｎｇ杂志１９９７年第２期撰文，从治疗效果与费用角度评价了一项治疗儿童严重营养不良的最佳方案，家庭照顾方案。     

灌云县结核病治疗依从性及社会经济和临床影响因素研究

目的 了解结核病人治疗的依从性以及影响治疗依从性的社会经济及临床影响因素．方法 以2003年6月1日至2005年5月31日的330例初治和143例复治肺结核病人作为研究对象。进行治疗期2个月末、5个月末和治疗结束的随访问卷调查。结果 初治和复治病人2个月治疗依从率分别为90．0％和84．6％，全程治疗依从率分别为90．0％和79．7％。BMI指数、出现副作用和药品费用影响常住病人抗结核治疗的依从性。随着BMI指数的升高，结核病人更倾向于依从抗结核治疗（OR=1．21，P=0．035）；出现副作用的结核病人依从性差于无副作用病人（OR=0．14。P=0．020）；在治疗过程中支付较低费用的病人依从性优于最高费用组（OR=44．52，P=-0．038）。结论 灌云县结核病的治疗具有较高的依从率．初治病人的治疗依从性高于复治病人．药物副作用和由此引发的医疗费用正成为该地区结核病治疗依从的障碍．     

The cost of preventing coronary heart disease

The incidence of coronary heart disease (CHD) can be reduced by preventive measures. We know what it costs to treat CHD, but lack even the most rudimentary estimates of what it might cost to reduce the incidence by means of population wide strategies of prevention. American and Australian experience shows that such strategies achieve results. Even in Britain, where official spending on prevention is relatively small, health publicity has succeeded in bringing about marked reductions in the household consumption of animal fats and in cigarette smoking. Yet we know virtually nothing about the cost of bringing about a given reduction in CHD mortality by preventive measures. Estimates of such costs would be useful in persuading public authorities to spend more on prevention.     

The Socioeconomic Burden of Coronary Heart Disease in Korea

Objectives

We aimed to estimate the annual socioeconomic burden of coronary heart disease (CHD) in Korea in 2005, using the National Health Insurance (NHI) claims data.

Methods

A prevalence-based, top-down, cost-of-treatment method was used to assess the direct and indirect costs of CHD (International Classification of Diseases, 10th revision codes of I20-I25), angina pectoris (I20), and myocardial infarction (MI, I21-I23) from a societal perspective.

Results

Estimated national spending on CHD in 2005 was $2.52 billion. The majority of the spending was attributable to medical costs (53.3%), followed by productivity loss due to morbidity and premature death (33.6%), transportation (8.1%), and informal caregiver costs (4.9%). While medical cost was the predominant cost attribute in treating angina (74.3% of the total cost), premature death was the largest cost attribute for patients with MI (66.9%). Annual per-capita cost of treating MI, excluding premature death cost, was $3183, which is about 2 times higher than the cost for angina ($1556).

Conclusions

The total insurance-covered medical cost ($1.13 billion) of CHD accounted for approximately 6.02% of the total annual NHI expenditure. These findings suggest that the current burden of CHD on society is tremendous and that more effective prevention strategies are required in Korea.     

A cost-effectiveness analysis of exercise as a health promotion activity.

We used cost-effectiveness analysis to estimate the health and economic implications of exercise in preventing coronary heart disease (CHD). We assumed that nonexercisers have a relative risk of 2.0 for a CHD event. Two hypothetical cohorts (one with exercise and the other without exercise) of 1,000 35-year-old men were followed for 30 years to observe differences in the number of CHD events, life expectancy, and quality-adjusted life expectancy. We used jogging as an example to calculate cost, injury rates, adherence, and the value of time spent. Both direct and indirect costs associated with exercise, injury, and treating CHD were considered. We estimate that exercising regularly results in 78.1 fewer CHD events and 1,138.3 Quality Adjusted Life Years (QALYs) gained over the 30-year study period. Under our base case assumptions, which include indirect costs such as time spent in exercise, exercise does not produce economic savings. However, the cost per QALY gained of $11,313 is favorable when compared with other preventive or therapeutic interventions for CHD. The value of time spent is a crucial factor, influencing whether exercise is a cost-saving activity. In an alternative model, where all members of the cohort exercise for one year, and then only those who like it or are neutral continue, exercise produces net economic savings as well as reducing morbidity.     

A model for evaluating the cost-effectiveness of cholesterol-lowering treatment.

We describe and illustrate the use of a generalizable model for evaluating the cost-effectiveness of alternative cholesterol-lowering treatments. We combine standard incidence-based techniques for measuring the cost of illness with logistic risk functions from the Framingham Heart Study to project, for persons with known coronary risk characteristics, the likelihood of developing coronary heart disease (CHD) over a lifetime as well as a number of related outcomes, including the expected loss of years of life due to CHD, the expected lifetime direct and indirect costs of CHD, and the changes in these outcomes that would result from cholesterol-lowering treatment.     

Evidence-based estimation of health care cost savings from the use of omega-3 supplementation among the elderly in Korea

BACKGROUND/OBJECTIVESBy the year 2050, thirty-eight percent of the Korean population will be over the age of 65. Health care costs for Koreans over age 65 reached 15.4 trillion Korean won in 2011, accounting for a third of the total health care costs for the population. Chronic degenerative diseases, including coronary heart disease (CHD), drive long-term health care costs at an alarming annual rate. In the elderly population, loss of independence is one of the main reasons for this increase in health care costs. Korean heath policies place a high priority on the prevention of CHD because it is a major cause of morbidity and mortality.SUBJECTS/METHODSThis evidence-based study aims to the estimate potential health care cost savings resulting from the daily intake of omega-3 fatty acid supplementation. Potential cost savings associated with a reduced risk of CHD and the medical costs potentially avoided through risk reduction, including hospitalizations and physician services, were estimated using a Congressional Budget Office cost accounting methodology.RESULTSThe estimate of the seven-year (2005-2011) net savings in medical costs resulting from a reduction in the incidence of CHD among the elderly population through the daily use of omega-3 fatty acids was approximately 210 billion Korean won. Approximately 92,997 hospitalizations due to CHD could be avoided over the seven years.CONCLUSIONSOur findings suggest that omega-3 supplementation in older individuals may yield substantial cost-savings by reducing the risk of CHD. It should be noted that additional health and cost benefits need to be revisited and re-evaluated as more is known about possible data sources or as new data become available.     

The Direct Cost and Incidence of Systemic Fungal Infections

Objectives: In this study we determined the incidence and direct inpatient and outpatient costs of systemic fungal infections (candidiasis, aspergillosis, cryptococcosis, histoplasmosis) in 1998.
Methods: Using primarily the National Hospital Discharge Survey (NHDS) for incidence and the Maryland Hospital Discharge Data Set (MDHDDS) for costs, we surveyed four systemic fungal infections in patients who also had HIV/AIDS, neoplasia, transplant, and all other concomitant diagnoses. Using a case-control method, we compared the cases with controls (those without fungal infections with the same underlying comorbidity) to obtain the incremental hospitalization costs. We used the Student's t -test to determine significance of incremental hospital costs. We modeled outpatient costs on the basis of discharge status to calculate the total annual cost for systemic fungal infections in 1998.
Results: For 1998, the projected average incidence was 306 per million US population, with candidiasis accounting for 75% of cases. The estimated total direct cost was $2.6 billion and the average per-patient attributable cost was $31,200. The most commonly reported comorbid diagnoses with fungal infections (HIV/AIDS, neoplasms, transplants) accounted for only 45% of all infections.
Conclusion: The cost burden is high for systemic fungal infections. Additional attention should be given to the 55% with fungal disease and other comorbid diagnoses.     

Cost-benefit analysis of a plant sterol containing low-fat margarine for cholesterol reduction

For decreasing the risk of coronary heart disease (CHD) it has been proposed to enrich food such as margarine with plant sterol esters which have been shown to reduce total and LDL cholesterol concentrations, two of the major risk factors. A Markov model was developed to assess the costs and benefits of consuming a low-fat plant sterol containing margarine (PS margarine). A health insurer's perspective was taken with a time frame of 10 years. Transition probabilities for CHD and CHD-related death were calculated on the basis of the Framingham risk equations. These were applied to a representative sample of the German population. The alteration in cholesterol levels after intake of PS margarine was estimated based on a meta-analysis of ten randomized controlled trials with parallel or crossover design that found a reduction of 5.7% in total cholesterol. Average annual costs of CHD were assumed to be at 3,000 euro. Costs for "no CHD" and "CHD-related death" were set to 0 euro since the intervention would solely be paid by the consumers. Sensitivity analyses were performed with regard to annual costs, risk estimation, PS margarine reduction in total cholesterol, discount factor, and risk of CHD-related death. The 10-year CHD risks are 6.1% (PS margarine) vs. 6.5% (control). Thus expected 10-year CHD costs are 696 euro (PS margarine) vs. 748 euro (control). The cost savings of 52 euro varied between 32 euro and 74 euro in the sensitivity analysis. A projection at the level of the population for which evidence (randomized controlled trials) exists that plant sterols lower cholesterol (25.35 million) leads to a reduction of 117,000 CHD cases over 10 years and a cost reduction of 1.3 billion euro for this time period (sensitivity analysis 0.8-1.9 billion euro).     

Comparing the clinical and economic effects of clinical examination, pulse oximetry, and echocardiography in newborn screening for congenital heart defects: a probabilistic cost-effectiveness model and value of information analysis

OBJECTIVES: Congenital heart defects (CHD) are an important cause of death and morbidity in early childhood, but the effectiveness of alternative newborn screening strategies in preventing the collapse or death--before diagnosis--of infants with treatable but life-threatening defects is uncertain. We assessed their effectiveness and efficiency to inform policy and research priorities. METHODS: We compared the effectiveness of clinical examination alone and clinical examination with either pulse oximetry or screening echocardiography in making a timely diagnosis of life-threatening CHD or in diagnosing clinically significant CHD. We contrasted their cost-effectiveness, using a decision-analytic model based on 100,000 live births, and assessed future research priorities using value of information analysis. RESULTS: Clinical examination alone, pulse oximetry, and screening echocardiography achieved 34.0, 70.6, and 71.3 timely diagnoses per 100,000 live births, respectively. This finding represents an additional cost per additional timely diagnosis of 4,894 pounds and 4,496,666 pounds for pulse oximetry and for screening echocardiography. The equivalent costs for clinically significant CHD are 1,489 pounds and 36,013 pounds, respectively. Key determinants of cost-effectiveness are detection rates and screening test costs. The false-positive rate is very high with screening echocardiography (5.4 percent), but lower with pulse oximetry (1.3 percent) or clinical examination alone (.5 percent). CONCLUSIONS: Adding pulse oximetry to clinical examination is likely to be a cost-effective newborn screening strategy for CHD, but further research is required before this policy can be recommended. Screening echocardiography is unlikely to be cost-effective, unless the detection of all clinically significant CHD is considered beneficial and a 5 percent false-positive rate acceptable.     

2018—2021年成都市非EV - A71感染手足口病患者住院费用及其影响因素研究

目的 了解成都市非EV - A71手足口病患者住院费用及其影响因素。方法 通过成都市公共卫生临床中心病案管理系统,收集2018—2021年手足口病住院病人信息。采用秩和检验、多元线性回归分析不同血清型患者费用的影响因素。结果 共纳入2 310例手足口病患者,直接医疗费用中位数为4 187元。秩和检验结果显示,CV - A10患者的住院天数、重症的费用差异有统计学意义（U = - 4.40, - 3.59; P＜0.05）;CV - A16患者的住院天数、高热的费用差异有统计学意义（U = - 4.90, - 2.51; P＜0.05）;CV - A6患者的性别、住院天数、并发症、重症、支付方式的费用差异有统计学意义（U = - 2.81, - 13.54, - 4.00, - 4.28;H = 13.65; P＜0.05）;其他肠道病毒患者的住院天数、并发症、重症、支付方式的费用差异有统计学意义（U = - 7.46, - 3.25, - 2.45;H = 13.14;P＜0.05）;混合感染患者高热的费用差异有统计学意义（U = - 2.40, P＜0.05）。多元线性回归结果显示,除混合感染外,住院天数是所有患者费用的影响因素。在CV - A10、CV - A6和其他肠道病毒中重症患者的费用更高;在CV - A6和其他肠道病毒中有并发症的患者费用更高。高热是混合感染患者费用的影响因素。结论 成都市非EV - A71感染手足口病患者的病毒血清型不同,费用的影响因素也有所不同。