A209OBJECTIVES: Decisions on palliative chemotherapy (CT) for advanced gastric cancer require trade-offs between potential benefits and risks for patients. Healthcare providers and payers agreed that patient preferences should be considered. We conducted a CBC study in patients with mGC or mGEJ-Ca from Germany to evaluate their preferences when trading-off between treatment tolerability, quality of life and survival benefit. METHODS: German oncologists were contacted to identify patients with mGC or mGEJ-Ca who had completed ≥ 2 cycles of palliative CT (ongoing or completed). The primary objective was the quantitative evaluation of patient preferences for palliative CT in this population by CBC analysis. The CBC matrix, developed based on 6 in-depth qualitative interviews, spanned the 3 attributes ability to self-care as a key component for quality of life, treatment toxicity and survival benefit (3-4 factor levels each, 15 iterations). A minimum of 50 participants was needed. Eligible consenting patients completed the 45min standardized CBC-survey, choosing systematically among profiles. CBC models were estimated by mixed-logit regression (MLR) and hierarchical Bayes analysis (HB). Estimates of importance for each attribute and factor-level were calculated. RESULTS: Overall, 55 patients participated in the survey (78% male, median age 63yrs, 82% currently receiving CT). Patients considered low treatment toxicity as most important (45% relative importance, MLR analysis), followed by ability to self-care (32%) and an additional survival benefit of up to 3 months (3 months 23%, 2 months 18%, 1 month 11%). The MLR analysis showed high validity (certainty 37.9%, chi square p< 0.01, root likelihood 0.505). The HB analysis yielded similar results. CONCLUSIONS: Patient preferences related to palliative CT of gastric cancer can appropriately be assessed by CBC analysis. Though patients' varied experiences with chemotherapy may have impacted specific responses, across the population of patients with mGC or mGEJ-Ca improved treatment tolerability and quality of life were ranked highest.
Due to the generic competition, the patients' access to drugs containing montelukast sodium increased significantly: the DOT increased, the co-payment decreased. Orv Hetil. 2018; 159(17): 682-687.
A71OBJECTIVES: Diagnosis related groups (DRG) like financing method was introduced in Hungary in 1993 for acute care hospital reimbursement. Due to the increased activity of the hospitals, an upper ceiling, the so called performance volume limit (PVL) was introduced in acute care hospital financing in 2006. The aim of our study was to analyze the effect of performance volume limit on DRG based hospital financing on the example of a Hungarian tertiary teaching hospital, the Clinical Centre of the University of Pécs. METHODS: Data derived from the financial database of the National Health Insurance Fund Administration, the only health care financing agency in Hungary. We analyzed the annual DRG based health insurance revenues with and without performance volume limit ceiling. We calculated the proportion of hospital activity over that ceiling measured by DRG cost-weights. The period 2007-2013 was involved into the study. RESULTS: We found a significant loss in DRG reimbursement due to performance volume limit. The annual loss in DRG reimbursement varied between 2.4-10.5 million USD between 2007-2013. The highest revenue loss was observed in 2009, and after 2009 the financial loss decreased to 7.0 (2010), 5.2 (2011), 3.0 (2012) and 2.8 (2013) million USD. This annual revenue loss represented 3.0-14.9 % of the annual revenues of the Clinical Centre of the University of Pécs. CONCLUSIONS: The introduction of performance volume limit into the DRG based hospital financing resulted in a partial loss of hospitals' revenues. The Clinical Centre of the University of Pécs experienced significant loss its revenues due to this regulation.
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