No abstract available.
Cost Savings*

Health economic analyses are comparative analysis of healthcare technologies or health strategies and their alternative options in terms of their costs and consequences.1 By doing health economic analysis, we can obtain incremental cost-outcome ratios, the relation of the estimated additional costs, and the estimated additional outcomes saved or lost using alternative healthcare technology.2 They can provide useful data to doctors, patients, policymakers, and the public about choices that can affect health, especially the use of resources.

In essence, economic evaluation aims to characterize the efficiency of healthcare interventions. It provides a structured approach to measuring and comparing the health outcomes and costs of competing alternative interventions over time and across populations.

This study aims to estimate the costs of various unintentional injuries in Ba Vi district during one year, and to describe how the economic burden of unintentional injuries was distributed between households, government and the health insurance agency. Our cohort study involved four cross sectional household surveys among sampled communities in Ba Vi district during the year 2000, each asking about injuries in the preceding 3 months. The costing system in public health care in Viet Nam was applied as well as information from the victims. The total cost of injuries for the Ba Vi district was estimated to be 3.412.539.000 VND. Equivalent to the yearly income of 1800 people. 90% of this economic burden fell on households, only 8% on government and 2% on the health insurance agency. The cost of a severe injury to the victim corresponded to approximately 7 months of earned income. Home and traffic injuries together accounted for more than 80% of the total cost, 45% and 38% respectively.
Cost of Illness ; Wounds and Injuries ;

Based on limited sources of mortality data, the majority of the deaths occurred in working age groups with highest productivity, 30-49 and 50-64, and the under 5 age group. Using the YPLL65 as indicator, the 0-4 group has the largest burden of disease, followed by the 30-49 group, and the 5-29 group. Within the 0-4 group, females have a larger burden of disease than males, in contrast to all other age group. In general, injury became the leading cause of death (accounted for nearly 40% of YPLL65), followed by perinatal causes. Injury in males is consistently higher or equal to that of females. Drowning is the leading cause of injury among females while overall accidents and transportation-related injuries are the most important contributors to the burden of injury in males. The construction of cause-eliminated life tables affirms the important role of the heaviest contributors of burden of disease in Chi Linh (e.g. cardiovascular disease, injury and cancer) while infectious diseases are in the decline. Of note, elimination of the cardiovascular diseases would contribute best to increasing life expectancy.
Cost of Illness ; disease ; mortality

Background: Shigella-induced diarrhea has been considered a major health problem leading to high morbidity and mortality. This disease can lead to dire consequences; however, the true burden of the disease, including the costs and sequalae associated with shigellosis is not yet known. Objectives: (1) To describe the health seeking behavior and the way of payment of population when suffering Shigella; (2) To identify and analyze the direct household costs associated with the treatment of diarrhea due to Shigella. Subjects and method: 290 patients of all ages with positive Shigella diarrhea admitted to public health facilities in Nha Trang, Khanh Hoa province in the period from August 2002 to January 2004 were included in the study. The subjects were divided into three age groups, the first 0-5, second 5-18 and the last one was over 18 years old. Patients and their relatives were interviewed at three stages - day 7, day 14 and day 90 - to obtain all the required information. Results: 134 of 290 patients (47%) paid for using the other health care services before admission to the study\u2019s facilities. The average direct cost per episode for the patients at group aged 0-5 was 129,000 VND, group aged 6-18 was 59,267 VND and over 18 years old was 173,531 VND; it was 131.960 VND for three groups. Comparison with the average household expenditure for health care, it was higher in the poorer group and it was lower three times than the richest group. The average direct medical cost per episode was higher the average direct non-medical cost per episode for all groups. Conclusions: The average direct cost per episode of Shigellosis treatment was rather high especially the average direct cost for the treatment at the health facility. It was also high compared with the average expenditure for health per capita so that it becomes large economic burden for households.
Direct cost ; Shigella ; treatment

Cost of Illness ; Risk Assessment

Most of important variables measured in medicine are in numerical forms or continuous in nature. New instruments and tests are constantly being developed for the purpose of measuring various variables, with the aim of providing cheaper, non-invasive, more convenient and safe methods. When a new method of measurement or instrument is invented, the quality of the instrument has to be assessed. Agreement and reliability are both important parameters in determining the quality of an instrument. This article will discuss some issues related to methods comparison study in medicine for the benefit of medical professional and researcher. METHOD: This is a narrative review and this article review the most common statistical methods used to assess agreement and reliability of medical instruments that measure the same continuous outcome. The two methods discussed in detail were the Bland-Altman Limits of Agreement, and Intra-class Correlation Coefficient (ICC). This article also discussed some issues related to method comparison studies including the application of inappropriate statistical methods, multiple statistical methods, and the strengths and weaknesses of each method. The importance of appropriate statistical method in the analysis of agreement and reliability in medicine is also highlighted in this article. CONCLUSION: There is no single perfect method to assess agreement and reliability; however researchers should be aware of the inappropriate methods that they should avoid when analysing data in method comparison studies. Inappropriate analysis will lead to invalid conclusions and thus validated instrument might not be accurate or reliable. Consequently this will affect the quality of care given to a patient.
Costs and Cost Analysis

Computer-assisted spine surgery (CASS) is a new discipline involving application of computer engineering and mechanical engineering to spine surgery. The tools used most commonly include preoperative surgical simulation, intraoperative navigation, and robot-assisted surgery. Surgical simulation has been utilized for both clinical and basic research. Navigation in spine surgery has focused on guidance of screw placement, however, due to limited accuracy and high cost, its use is somewhat sparse. CASS may be combined with minimal invasive spine surgery in the near future. Further validation of clinical accuracy issues and surgical outcomes as well as cost-benefit analysis is required.
Cost-Benefit Analysis ; Spine*

Objective. This pilot study aimed to determine the epidemiologic burden of hospitalization for bronchial asthma in acute exacerbation. Methods. We used a descriptive cross-sectional study to describe the demographic profile, comorbidities and level of control of patients admitted for bronchial asthma in acute exacerbation admitted to the Philippine General Hospital from May 1 to October 31 2019. The study computed for the admission rate and compared the average cost of hospitalization (diagnostics, therapeutics and room) using direct costing to the total reimbursable cost from PhilHealth. Associations between patient characteristics (age, type of admission) and hospitalization cost were also determined. Results. We enrolled 45 patients in the study. The admission rate was 8/month. The mean cost of admission was significantly higher than the reimbursable amount from PhilHealth (Php 20,074.63 versus Php 9000) (p = 0.004). Cost of hospitalization was significantly higher in pay patients versus charity (p = 0.001 for diagnostics, p = 0.005 for treatment and p = 0.001 for room cost), in patients with poorly controlled asthma (p = 0.020 for diagnostics and p = 0.014 for room cost) and those with frequent short-acting beta-agonist (SABA) use (p = 0.001). Conclusion. Asthma remains an economic burden for the Filipino patient. Persistent SABA use, perceived asthma control of patients and increased expenses associated with an asthma exacerbation admission lead to significant out-of-pocket expenditure.
Asthma ; Costs and Cost Analysis

Introduction: Well-differentiated thyroid carcinoma (WDTC) is the most common type of thyroid cancer with a notable increasing incidence worldwide. It is prevalent among Filipino descent as compared to other nationalities. Its good prognosis and high survival rate predispose patients to lifetime surveillance with incomplete response, instead of death, as outcome measure. This eventually leads to increase in cost of care, utilization, and allocation of medical resources for the survivors of the disease. Thyroglobulin immunoradiometric assay (Tg IRMA) and I-131 diagnostic whole-body scan (dWBS) are two nuclear medicine procedures that are part of WDTC surveillance. Due to their varied availability in Asia-Pacific, most clinicians measure thyroglobulin (Tg) alone due to perceived cost-effectiveness. Objective: This study aims to analyze the cost-effectiveness of two nuclear medicine procedures used in WDTC surveillance, namely thyroglobulin immunoradiometric assay and I-131 diagnostic whole-body scan, in detecting incomplete response. Methodology: Three clinical guidelines on WDTC management were reviewed to identify frequency, total number and expenditure for surveillance, namely from the University of the Philippines-Philippine General Hospital in 2008 (PGH 2008), American Thyroid Association in 2015 (ATA 2015), and the Department of Health (DOH 2021). A Markov model was constructed to simulate a 36-month surveillance with complete and incomplete response to treatment as disease states. Parameter values like rate of incomplete response in WDTC patients, prognostic values per each surveillance test, and other relevant data were collected from literature search and established data. The cost of surveillance was based on the rates offered by Philippine General Hospital (PGH) Radioisotope Laboratory as of November 2022. One-way sensitivity was done to check robustness of results. Results: ATA 2015 incurs the most expenses, amounting to PHP 14,600.00 to 20,450.00 ($ 254.19 – 356.04) for three years of surveillance, followed by DOH 2021 (PHP 11,700.00 – 15,600.00 or $ 203.74 – 271.65), and PGH 2008 (PHP 3,900.00 – 6,825.00 or $ 67.91 – 118.85). The thyroglobulin IRMA arm costs lower (PHP 17,784.00 or $ 309.74) than I-131 dWBS (PHP 271,875.00 or $ 4,735.13) in detecting incomplete response. I-131 dWBS should cost around PHP 570.00 (or $ 9.92) to be as cost-effective as the thyroglobulin IRMA. Conclusion This study has identified that thyroglobulin IRMA is more cost-effective than I-131 diagnostic whole-body scan in detecting incomplete response in WDTC patients. This supports the perceived cost-effectiveness of thyroglobulin measurement in surveillance, even without diagnostic whole body-scans. This study also identified that the new DOH 2021 guidelines will incur lesser expenditure in using nuclear medicine procedures for surveillance as compared to ATA 2015 guidelines. Local clinicians may also find it easier to follow as it is more suitable to the Philippine setting.
Cost-Effectiveness Analysis