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Personalized Medicine Sep 2023Personalized medicine has allowed for knowledge at an individual level for several diseases and this has led to improvements in prevention and treatment of various types... (Review)
Review
Personalized medicine has allowed for knowledge at an individual level for several diseases and this has led to improvements in prevention and treatment of various types of neoplasms. Despite the greater availability of tests, the costs of genomic testing and targeted therapies are still high for most patients, especially in low- and middle-income countries. Although value frameworks and health technology assessment are fundamental to allow decision-making by policymakers, there are several concerns in terms of personalized medicine pharmacoeconomics. A global effort may improve these tools in order to allow access to personalized medicine for an increasing number of patients with cancer.
Topics: Humans; Precision Medicine; Medical Oncology; Neoplasms; Economics, Medical; Technology Assessment, Biomedical
PubMed: 37602420
DOI: 10.2217/pme-2022-0008 -
Nature Oct 2023
Topics: Humans; Biomedical Research; Post-Acute COVID-19 Syndrome
PubMed: 37853144
DOI: 10.1038/d41586-023-03225-w -
Journal of Medical Ethics Sep 2023
Topics: Humans; Pregnancy; Female; Trust; Informed Consent; Ethics, Medical; Parturition
PubMed: 37344202
DOI: 10.1136/jme-2023-109210 -
BMC Musculoskeletal Disorders May 2024Musculoskeletal conditions constitute a remarkable portion of disability cases in the military. This study evaluated the distribution and types of musculoskeletal...
AIM
Musculoskeletal conditions constitute a remarkable portion of disability cases in the military. This study evaluated the distribution and types of musculoskeletal problems and estimated the direct and indirect costs due to these complaints in an Iranian military hospital.
METHODS
All medical records of patients with musculoskeletal complaints that were referred to the medical committee of a military hospital, including rheumatology, orthopedics, and neuro-surgical specialists, from 2014 to 2016, were reviewed. Details of each complaint and the final opinion of the medical committees were recorded. The cost of each diagnostic step was calculated based on the recorded data. The treatment costs were estimated for each complaint by calculating the average cost of treatment plans suggested by two specialists, a physical medicine and a rheumatologist. The estimated cost for each part is calculated based on the army insurance low. Indirect costs due to absences, inability to work, and disability were assessed and added to the above-mentioned direct costs. Statistical analysis was performed using SPSS version 21.
RESULTS
2,116 medical records of the committee were reviewed. 1252 (59.16%) cases were soldiers (who had to spend two years of mandatory duty in the army), and 864 (40.83%) cases were non-soldiers. The three most common complaints were fractures (301 cases, 14.22%), low back pain due to lumbar disc bulges and herniations (303 cases, 14.31%), and genu varus/genu valgus (257 cases, 12.14%). The most affected sites were the lower limbs and vertebral column. According to an official document in these subjects' records, 4120 person-days absent from work were estimated annually, and nearly $1,172,149 of annual economic impact was calculated.
CONCLUSION
Musculoskeletal problems are common in the army, and establishing preventive strategies for these conditions is essential. The conservative and medical approach and the proper education for correct movement and the situation should be mentioned for the reduction of disability and its economic burden on the army's staff.
Topics: Humans; Hospitals, Military; Iran; Musculoskeletal Diseases; Male; Adult; Female; Military Personnel; Middle Aged; Young Adult; Retrospective Studies; Health Care Costs; Cost of Illness; Adolescent
PubMed: 38762467
DOI: 10.1186/s12891-024-07511-0 -
Praxis May 2024Aims: The aim of the present study was to analyze the cost awareness of cardiological tests and procedures among medical students, residents and doctors in Switzerland...
Aims: The aim of the present study was to analyze the cost awareness of cardiological tests and procedures among medical students, residents and doctors in Switzerland and discuss trends in cost perception in health expenditures. Methods: Using an online questionnaire, participants (randomly recruited by mailing lists, messaging app or via direct contact) had to estimate the costs of the 13 predefined cardiological procedures services, diagnostic tests and procedures in Swiss Francs (CHF). Short technical descriptions of the procedures and tests were provided. Estimated costs were considered accurate if they were within ±25 % of the reimbursement rate. Participant groups were defined: medical students, residents, hospital-based physicians and cardiologists in private practice (practitioners). Results: A total of 939 participants (172 physicians and 767 medical students) were enrolled. The overall proportion of medical gestures estimated correctly within ±25% of the reimbursement rate ranged from 10 % (students) to 55 % in practitioners. Residents (26 %) and hospital-based physicians (38 %) performed intermediately. In general, the costs were overestimated. Conclusions: The level of cost knowledge of cardiological tests and procedures among medical students, residents and doctors in Switzerland is modest. In general, the costs were overestimated. Increasing experience seems to sharpen the accuracy of cost estimation. Overestimation of costs is potentially problematic: Either in systems of governmental defined global budget or systems with substantial out-of-pocket costs for patients, overestimated costs will result in more restrictive ordering than it would be appropriate and affordable for the individual patient.
Topics: Humans; Switzerland; Students, Medical; Male; Female; Adult; Surveys and Questionnaires; Health Expenditures; Cardiology; Attitude of Health Personnel; Internship and Residency; Middle Aged
PubMed: 38864102
DOI: 10.23785/PRAXIS.2024.05.003 -
Saudi Journal of Kidney Diseases and... Nov 2023Hemodialysis (HD) and peritoneal dialysis (PD) treatments impact the economic burden and psychological distress faced by end-stage kidney disease (ESKD) patients and... (Review)
Review
Hemodialysis (HD) and peritoneal dialysis (PD) treatments impact the economic burden and psychological distress faced by end-stage kidney disease (ESKD) patients and their caregivers. This review aimed to discuss the concept of an economic burden and the economic burden of different treatment options, and to highlight research gaps regarding the scarcity of previous studies relating economic burden to psychological well-being. We searched five electronic databases for papers published in 2010-2020. Papers focusing on measures of the economic burden from the government's perspective and diseases other than ESKD were excluded. Out of the 6635 publications identified, 10 publications were included. Three categories of economic burden were identified, namely, direct medical costs, direct non-medical costs, and indirect costs. Direct medical costs required the highest expenditure, whereas the lowest economic burden was for indirect costs. HD patients incurred a higher economic burden than PD patients. Most of the studies were carried out in Asia. The results of the research suggest that the economic burden may affect patients and caregivers, but it is unclear whether the economic burden affects the psychological well-being of the patients and caregivers. Very few studies have assessed the relationship between economic burden and psychological well-being, and further research is needed to gain further insight into the relationship between these two variables.
Topics: Humans; Cost of Illness; Kidney Failure, Chronic; Caregivers; Health Care Costs; Renal Dialysis; Peritoneal Dialysis; Caregiver Burden
PubMed: 38725213
DOI: 10.4103/sjkdt.sjkdt_81_22 -
JMA Journal Oct 2023Clinical practice guidelines (CPGs) consist of clinical questions (CQs) and corresponding recommendations. Considering the estimation of body of evidence, patients'...
Comparison of Recommendations Made by Committee Members with and without Financial Conflict of Interest on Japanese Guideline of Treatment of Hyperuricemia and Gout, Third Edition.
Clinical practice guidelines (CPGs) consist of clinical questions (CQs) and corresponding recommendations. Considering the estimation of body of evidence, patients' opinions, and medical economics, recommendations can vary depending on the votes of the committee members of CPGs. Taking this into consideration, concerns have already been raised on how financial conflict of interest (COI) potentially influences recommendations. In this study, we developed the third edition of guideline for the management of hyperuricemia and gout. This CPG was composed of seven CQs and recommendations. The direction and strength of the recommendations were determined by votes. There are three CQs. Individual questions asked whether uric acid-lowering-agents (ULAs) could be applied to hyperuricemic patients with chronic kidney disease (CKD) (CQ A), hypertension (CQ B), or heart failure (CQ C) to prevent organ damage. We examined whether the absence (18 members) or presence (8 members) of COIs of committee members could influence the votes. In total, 26 committee members with and without COI have equally determined the direction and strength of recommendations. In CQ A, members without financial COIs and those with financial COI selected conditional recommendation for the use of ULAs in patients with CKD (without COI, 17/18; with COI, 7/8). In CQ B, members without financial COIs and those with financial COI selected conditional recommendation against the use of ULAs in hypertensive patients (without COI, 14/18; with COI, 5/8). In CQ C, members without financial COIs and those with financial COIs have selected conditional recommendation against the use of ULAs in patients suffering from heart failure (without COI, 15/18; with COI, 4/8). We found that members with financial COIs have determined their recommendations in the same direction and strength as those without financial COIs.
PubMed: 37941684
DOI: 10.31662/jmaj.2023-0067 -
Frontiers in Public Health 2023Oral health disorders significantly contribute to the global incidence of chronic diseases. Nudge interventions have demonstrated effectiveness in enhancing people's... (Review)
Review
BACKGROUND
Oral health disorders significantly contribute to the global incidence of chronic diseases. Nudge interventions have demonstrated effectiveness in enhancing people's decision-making and self-management capacities in a cost-efficient manner. As a result, these interventions could be valuable tools for fostering improved oral care habits. This critical review explores potential behavioral nudges applicable to promoting oral health.
METHODS
A thorough electronic literature search was conducted on Scopus, Embase, and PubMed databases for papers published post-2008. The search focused on empirical evidence concerning the direct and indirect application of Nudge theory in oral health enhancement. In addition, the investigation included the nudge intervention's role in managing common non-communicable disease risk factors (tobacco, alcohol, and sugar) and their use in other health sectors.
RESULTS AND CONCLUSION
There is a dearth of studies on behavioral economics, particularly those involving reward and reminder techniques. However, various successful nudge interventions have been identified in other sectors that aim to improve health decisions. These include strategies encouraging healthier nutritional choices, tobacco and alcohol cessation, medication compliance, routine physical activity, and regular health check-ups. Such interventions can also have direct or indirect positive impacts on oral health. Implementing these interventions within an oral care framework could promote oral health due to similar underlying cognitive mechanisms. However, different types of nudge interventions have varying degrees of effectiveness. Furthermore, factors such as the method of delivery and the characteristics of the targeted population significantly influence the outcome of the intervention. Hence, it is imperative to conduct extensive studies in diverse socioeconomic settings to fully understand the potentials, limitations, and impacts of nudge interventions in promoting oral health.
Topics: Humans; Health Promotion; Oral Health; Economics, Behavioral; Risk Factors; Self-Management
PubMed: 38145077
DOI: 10.3389/fpubh.2023.1243246 -
Human Vaccines & Immunotherapeutics Dec 2024The "reemergence of pertussis" has elicited international concerns, occurring paradoxically amidst the expansion of immunization programs. This study was aimed to...
The "reemergence of pertussis" has elicited international concerns, occurring paradoxically amidst the expansion of immunization programs. This study was aimed to evaluate quantitatively the economic burden and identify the determinants that influence the cost associated with treating pertussis in Chinese children. We evaluated the economic burden by Chinese children diagnosed with pertussis at the Children's Hospital, Zhejiang University School of Medicine in 2022. Direct medical expenses and the utilization of medical resources attributed to pertussis were calculated. A generalized linear regression model was applied to analyze the determinants that were associated with the direct medical expenses among patients. Among the 1110 pertussis patients included in the study, 1060 were outpatients and 50 were inpatients. The average direct medical cost was ¥1878.70(i.e. $279.33). Living in urban areas (OR:1.27, = .04), complications (OR:1.40, < .001), hospitalization (OR:10.04, < .001), and ≥ 3 medical visits (OR:3.71, < .001) were associated with increased direct medical expenses. Having received four doses of the pertussis vaccine was associated with reduced direct medical expenses (OR:0.81, = .04). This study underscores a substantial economic burden of pertussis in Hangzhou, with pronounced implications for patients residing in urban areas, experiencing complications, requiring hospitalization, having multiple medical consultations, or lacking comprehensive pertussis vaccination.
Topics: Humans; Whooping Cough; China; Male; Female; Child, Preschool; Infant; Cost of Illness; Child; Pertussis Vaccine; Health Care Costs; Hospitalization; Adolescent; Vaccination
PubMed: 38647026
DOI: 10.1080/21645515.2024.2343199 -
American Journal of Perinatology May 2024Parents of children with medical complexity experience substantial financial burdens. It is unclear how neonatal intensive care unit (NICU) clinicians prepare new...
OBJECTIVE
Parents of children with medical complexity experience substantial financial burdens. It is unclear how neonatal intensive care unit (NICU) clinicians prepare new parents of medically complex infants for this reality. This study explored new parent awareness of health care costs, desire to discuss costs with clinicians, and impact of costs on parents' medical decision-making.
STUDY DESIGN
The study design comprised semistructured interviews and surveys of parents of infants with medical complexity currently or previously in a NICU. Conventional content analysis was performed on interview transcripts, and descriptive analyses were applied to surveys.
RESULTS
Thematic saturation was reached with 27 families (15 NICU families and 12 post-NICU families) of diverse race/ethnicity/education/household income. Most were worried about their infants' current/future medical expenses and approximately half wanted to discuss finances with clinicians, only one parent had. While finances were not part of most parent's NICU decision-making, some later regretted this and wished cost had been incorporated into treatment choices. The family desire to discuss costs did not vary by family financial status. Parents described their infant's health care costs as: "We are drowning"; and "We'll never pay it off."
CONCLUSION
Most parents were worried about current and future medical expenses related to their infant's evolving medical complexity. Many wanted to discuss costs with clinicians; almost none had. NICU clinicians should prepare families for the future financial realities of pediatric medical complexity.
KEY POINTS
· Many families want to discuss costs with NICU clinicians.. · Some families want costs to be a part of medical decisions.. · Few families currently discuss costs with NICU providers..
Topics: Humans; Infant, Newborn; Intensive Care Units, Neonatal; Parents; Female; Male; Decision Making; Adult; Stress, Psychological; Health Care Costs; Surveys and Questionnaires; Cost of Illness
PubMed: 36130670
DOI: 10.1055/a-1948-2580