A B S T R A C T PurposeTo describe trends in the aggressiveness of end-of-life (EOL) cancer care in a universal health care system in Ontario, Canada, between 1993 and2004, and to compare with findings reported in the United States. MethodsA population-based, retrospective, cohort study that used administrative data linked to registry data. Aggressiveness of EOL care was defined as the occurrence of at least one of the following indicators: last dose of chemotherapy received within 14 days of death; more than one emergency department (ED) visit within 30 days of death; more than one hospitalization within 30 days of death; or at least one intensive care unit (ICU) admission within 30 days of death. ResultsAmong 227,161 patients, 22.4% experienced at least one incident of potentially aggressive EOL cancer care. Multivariable analyses showed that with each successive year, patients were significantly more likely to encounter some aggressive intervention (odds ratio, 1.01; 95% CI, 1.01 to 1.02). Multiple emergency department (ED) visits, ICU admissions, and chemotherapy use increased significantly over time, whereas multiple hospital admissions declined (P Ͻ .05). Patients were more likely to receive aggressive EOL care if they were men, were younger, lived in rural regions, had a higher level of comorbidity, or had breast, lung, or hematologic malignancies. Chemotherapy and ICU utilization were lower in Ontario than in the United States. ConclusionAggressiveness of cancer care near the EOL is increasing over time in Ontario, Canada, although overall rates were lower than in the United States. Health system characteristics and patient or physician cultural factors may play a role in the observed differences.

Background A significant share of the cost of cancer care is concentrated in the end-of-life period. Although quality measures of aggressive treatment may guide optimal care during this timeframe, little is known as to whether these metrics affect costs of care. Methods We used population data to identify a cohort of patients who died of cancer in Ontario, Canada (2005 to 2009). Individuals were categorized as having received aggressive end-of-life care or not, according to quality measures related to acute institutional care or chemotherapy administration in the end-of-life period. Costs (2009 $CAN) were collected over the last month of life by linking health system administrative databases. Multivariable quantile regression was used to identify predictors of increased costs. Results Among 107,253 patients, the mean per patient cost over the final month was $18,131 for patients receiving aggressive care and $12,678 for patients receiving non-aggressive care (p<0.0001). Patients who received chemotherapy in the last 2 weeks of life also sustained higher costs compared to those who did not (p<0.0001). For individuals receiving end-of-life care in the highest cost quintile, early and repeated palliative care consultation was associated with reduced mean per patient costs. On multivariable analysis, chemotherapy in the 2 weeks of life remained predictive of increased costs (median increase $536; p<0.0001) whereas access to palliation remained predictive for lower costs (median decrease $418; p<0.0001). Conclusions Cancer patients who receive aggressive end-of-life care incur 43% higher costs than those managed non-aggressively. Palliative consultation may partially offset these costs and offer resultant savings.

Objective: HIV testing is the only method to confirm people infected with HIV. There are many models providing HIV testing services. HIV testing cost is an important component for the investment and strategic direction of policies and programs on HIV. This paper describes HIV testing costs of HIV confirmatory testing by using three rapid diagnostic tests at district level (POCT- Point of Care testing). Methods: cross-sectional study design was employed, costs are calculated using the cost-allocation method based on the proportion of resources used for the personnel, investment such as infrastructure and equipments, routine operational costs including test kits and consumable supplies, administration and training, fuel costs using for HIV testing in the laboratory, transporting the sample to province for HIV positived confirmation and HIV confirmatory test at the province. Five district health centers (DHC) thực hiện mô hình can thiệp POCT HIV were studied, HIV tests were conducted for 4,636 clients in 2016. Results : 201 HIV positive cases were detected; after implementing the POCT model to confirm HIV status at these five DHCs, the cost per HIV screening test case is 7,4 USD on average; and cost per an HIV comfirmatory test is 206,8 USD. Conclusion: Applying the POCT model of HIV helps reducethe cost of HIV testing because of saving cost for sample transportion and implementing confirm HIV detected more in provincal standard laboratory. It should be expanded to use especially limitted resource settings in Vietnam Keywords: HIV, HIV test, POCT, cost

Palliative care is measures aimed at improving the quality of life of patients and their families, who arefacing problems related to life-threatening illness, through the prevent and reduce the burden they endure by early recognition, comprehensive assessment, and treatment of pain and other problems such as physical, psychological, social, and spiritual symptoms.Objectives: Describe the current situation of palliative care needs of HIV/AIDS patients inpatient treatedat Nhan Ai Hospital in 2022.Subjects and methods: A cross-sectional descriptive study was carried out. Currently with a sample sizeof 180 HIV/AIDS patients being treated at Nhan Ai Hospital from January 2022 to October 2022.Results: Patients with HIV/AIDS have a high need for palliative care. In which, the rate of needingmedical information is 91.7%, the rate having the need for care support is 84.5%, the rate having the need for communication and relationship is 83.6%, the rate having The need for spiritual support is 78.3% and the rate for material needs is 85.7%. These results are very high, proving that the need for health care care of HIV/AIDS patients is very large.Conclusion: Patients with HIV/AIDS have high needs for different groups of care needs. The largestdemand for medical information accounted for 91.7% and the smallest was the need for emotional supportaccounted for 78.3%. It is necessary to understand the needs of the patient in order to have appropriatepalliative care for people living with HIV.