OBJECTIVES: Lichen planus is a dermatological disease characterized by itchy reddish-purple polygon-shaped skin lesions. The aim of our study was to calculate the annual health insurance treatment cost of lichen planus in Hungary. METHODS: The data were derived from the financial database of the Hungarian National Health Insurance Fund Administration (NHIFA), the only health care financing agency in Hungary. We analyzed the number of patients and the health insurance treatment cost for the year 2017. The following cost categories were included into the study: out-patient care, laboratory diagnostics, medical imaging, acute in-patient care, chronic in-patient care and drugs. Patients with lichen planus were identified with the following codes of the International Classification of Diseases 10threvision: L43. RESULTS: The number of patient underwent outpatient care was 3,013 (59.8 % women and 40.2 % men) with a mean age of 54.90 years (women: 57.56 years; men: 50.94 years). Number of patients admitted to in-patient hospital care was 145 (75.9 % women and 24.1 % men) with a mean age of 61.48 years (women: 64.42 years; men: 52.23 years). For the treatment of patients with lichen planusin 2017 the Hungarian National Health Insurance Fund Administration spent 57.282 million Hungarian Forint (HUF) which equals 185.255 Euro (EUR). Major cost drivers were acute inpatient care (35.6 % of total health insurance costs), outpatient care (28.1 %) and pharmaceuticals (26.8 %). CONCLUSIONS: Lichen planus represent a significant burden for the Hungarian health insurance system. The occurrence of the disease is more common in women both in outpatient and inpatient care. There is a significant difference (outpatient: 6.61 years; inpatient: 12.19 years) in the onset of the disease between women and men.
Objectives: Universal childhood vaccination (UVV) against varicella has not been implemented in Chile. The benefits and costs of introducing UVV under various possible vaccination scenarios were explored through modelling. MethOds: A dynamic transmission model of varicella infection, with proportionate mixing in a static population, and with time, age, and vaccination-status varying force of infection, was calibrated based on the Chilean population and Argentinean seroprevalence data. Rates of healthcare utilization and costs were from a recent observational study. Five vaccination strategies based on the current vaccination visits in the pediatric vaccination programme were considered, with first dose given at either 12 months (90% coverage) or 18 months (85% coverage), and a second dose either not administered, or given at 18 months (85% coverage)or 6 years (85% coverage). Three different types of varicella vaccines (highly-, moderately-, and weakly-effective) were hypothesized. The resulting 15 vaccination scenarios were compared to a novaccination scenario. Benefits and costs were calculated from the payer and societal perspectives over a 25-year time horizon, and discounted at 3% annually. Results: The model estimated over 200,000 varicella cases annually in Chile in the absence of varicella vaccination. All vaccination scenarios reduced the number of cases by 86.0-99.7% and all were cost-saving. One-dose strategies with a highly-or moderatelyeffective vaccine were the most cost-saving scenarios, saving $239M-$252M over 25 years. Cost-benefit ratios were 2.63-3.53 for one-dose and 1.92-2.52 for two-dose scenarios. The optimum vaccination scenario from a cost perspective was one dose at 12 months with 90% coverage; two doses given at 12 and 18 months reduced morbidity and mortality the most. cOnclusiOns: Both one-and two-dose UVV programs are predicted to be cost-saving in Chile. The optimum strategy based on cost-benefit ratios from a societal perspective is vaccination with a single dose of a highly-or moderately-effective varicella vaccine at 12 months.
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