This study aimed to determine the burden of sepsis with focal infections in the resourcelimited context of Indonesia and to propose national prices for sepsis reimbursement. Methods: A retrospective observational study was conducted from 2013-2016 on cost of surviving and non-surviving sepsis patients from a payer perspective using inpatient billing records in four hospitals. The national burden of sepsis was calculated and proposed national prices for reimbursement were developed. Results: Of the 14,076 sepsis patients, 5,876 (41.7%) survived and 8,200 (58.3%) died. The mean hospital costs incurred per surviving and deceased sepsis patient were US$1,011 (SE AE 23.4) and US$1,406 (SE AE 27.8), respectively. The national burden of sepsis in 100,000 patients was estimated to be US$130 million. Sepsis patients with multifocal infections and a single focal lower-respiratory tract infection (LRTI) were estimated as being the two with the highest economic burden (US$48 million and US$33 million, respectively, within 100,000 sepsis patients). Sepsis with cardiovascular infection was estimated to warrant the highest proposed national price for reimbursement (US$4,256). Conclusions: Multifocal infections and LRTIs are the major focal infections with the highest burden of sepsis. This study showed varying cost estimates for sepsis, necessitating a new reimbursement system with adjustment of the national prices taking the particular foci into account.
Objective: This study aimed to evaluate the impacts of deep surgical site infections (dSSIs) regarding hospital readmissions, prolonged length of stay (LoS), and estimated costs. Patients and Methods: We designed and applied a matched case-control observational study using the electronic health records at the University Medical Center Groningen in the Netherlands. We compared patients with dSSI and non-SSI, matched on the basis of having similar procedures. A prevailing topology of surgeries categorized as clean, clean-contaminated, contaminated, and dirty was applied. Results: Out of a total of 12,285 patients, 393 dSSI were identified as cases, and 2864 patients without SSIs were selected as controls. A total of 343 dSSI patients (87%) and 2307 (81%) controls required hospital readmissions. The median LoS was 7 days (P 25-P 75 : 2.5-14.5) for dSSI patients and 5 days (P 25-P 75 : 1-9) for controls (p-value: <0.001). The estimated mean cost per hospital admission was €9,016 (SE±343) for dSSI patients and €5,409 (SE±120) for controls (p<0.001). Independent variables associated with dSSI were patient's age ≥65 years (OR: 1.334; 95% CI: 1.036-1.720), the use of prophylactic antibiotics (OR: 0.424; 95% CI: 0.344-0.537), and neoplasms (OR: 2.050; 95% CI: 1.473-2.854). Conclusion: dSSI is associated with increased costs, prolonged LoS, and increased readmission rates. Elevated risks were seen for elderly patients and those with neoplasms. Additionally, a protective effect of prophylactic antibiotics was found.
Objectives: In France, despite a large access to new effective HCV treatments, 43% of HCV infected patients remain unattainable because undiagnosed. We studied the epidemiological and economic impacts of five potential screening strategies in the French context. Methods: The screening strategy was modelled using a decision tree representing the key steps of screening including taking up screening, having a positive serology, having a positive confirmation RNA-test after a positive serology, initiating treatment and having a sustained virological response (SVR). The current situation was based on the currently observed screening rates (4.7% per year for the general population (GenPop), 96% at five years for People Who Inject Drugs (PWID) and 11% for immigrants), and treatment rates (95% for the GenPopGenPop, 72% for PWID, and 41% for immigrants). Alternative scenarios included an intensified screening program targetting PWID and immigrants, with a status quo for the GenPop, and several additional intensified screening modalities aimed at the GenPop depending on the age groups with the objective of screening 90% of the GenPop in five years, associated with an intensification for PWID and immigrants. Results: Intensified screening program for18-80 years subjects was the most effective strategy, avoiding 18,100 cirrhosis and 7,200 deaths, which leads to an Incremental Cost-Effectiveness Ratio (ICER) of 10,155 V/QALY. Conclusions: GenPop screening programs seem to be the only options to significantly reduce the rate of undiagnosed HCV patients. These options can be cost-effective if they are integrated in the routine care with the implication of the general practitioners (GP).
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