OBJECTIVE: To quantify the economic value of the Sirolimus Eluting Stent (CYPHER(TM)) in treating acute coronary heart disease (CHD), and to assist in determining an adequate level of reimbursement for CYPHER(TM) in Korea. METHODS: A decision-analytical model, developed by the Belgium Health Economics Disease Management group, was used to investigate the incremental cost-effectiveness of CYPHER(TM) versus conventional stenting. The time horizon was five years. The probabilities for clinical events at each node of the decision model were obtained from the results of large, randomized, controlled clinical trials. The initial care and follow-up direct medical costs were analyzed. The initial costs consisted of those for the initial procedure and hospitalization. The follow-up costs included those for routine follow-up treatments, adverse reactions, revascularization and death. Depending on the perspective of the analysis, the costs were defined as insurance covered or total medical costs (=sum of insurance covered and uncovered medical costs). The cost data were obtained from the administrative data of 449 patients that received conventional stenting from five participating Korean hospitals during June 2002. Sensitivity analyses were performed for discount rates of 3, 5 and 7%. Since the major clinical advantage of CYPHER(TM) over conventional stenting was the reduction in the revascularization rates, the economic value of CYPHER(TM), in relation to the direct medical costs of revascularization, were evaluated. If the incremental cost of CYPHER(TM) per revascularization avoided, compared to conventional stenting, was no higher than that of a revascularization itself, CYPHER(TM) would be considered as being cost-effective. Therefore, the maximum acceptable level for the reimbursement price of CYPHER(TM) making the incremental cost-effectiveness ratio equal to the cost of a revascularization was identified. RESULTS: The average weighted initial insurance covered and total medical costs of conventional stenting were about 6, 275, 000 and 8, 058, 000 Won, respectively. The average weighted sum of the initial and 5-year follow-up insurance covered and total medical costs of conventional stenting were about 13, 659, 000 and 17, 353, 000 Won, respectively. The estimated maximum level of reimbursement price of CYPHER(TM) from the perspectives of the insurer and society were 4, 126, 897 ~ 4, 325, 161 and 4, 939, 939 ~ 5, 078, 781 Won, respectively. CONCLUSION: By evaluating the economic value of CYPHER(TM), as an alternative to conventional stenting, the results of this study are expected to provide a scientific basis for determining the acceptable level of reimbursement for CYPHER(TM).
Belgium ; Coronary Disease* ; Cost-Benefit Analysis ; Decision Support Techniques ; Disease Management ; Follow-Up Studies ; Hospitalization ; Humans ; Insurance ; Insurance Carriers ; Korea ; Sirolimus* ; Stents*

A lower use of preventive intervention in low socioeconomic populations has been described in countries with universal coverage health care systems, but little is known about the possible socioeconomic inequalities in secondary prevention in a universal health insurance system. Data from the 2010-2013 Korea National Health and Nutrition Examination Survey, a nationwide survey, were analyzed. A total of 20,044 subjects older than 30 years of age were included after excluding subjects with missing data. Prevalence ratios were calculated using Poisson regression models with robust variance to explore factors associated with the prevalence, unawareness, and inappropriate control of hypertension. Hypertension prevalence decreased with increasing education and income level. We observed an inverse association between education level and undiagnosed hypertension among women, but not men. Socioeconomic level was not associated with inadequate control of hypertension among men or women. Future interventions should include primary prevention efforts targeted at lower socioeconomic populations to reduce disparities. There is substantial room for improvement in secondary prevention efforts. Monitoring strategies may highlight gaps in the preventive and care services offered to the most vulnerable individuals and encourage governments and practitioners to address these gaps.

PURPOSE: The healthy worker effect is an important issue in occupational epidemiology. This study was conducted to propose a new method to test the relation between exposure and mortality in the presence of the healthy worker effect. METHODS: In this study, the healthy worker hire effect was assumed to operate as a confounding variable of health status at the beginning of employment and healthy worker survival effect as a confounding and intermediate variable of employment status. In addition, the proposed method reflects the length bias sampling caused by changing of an employment status. Simulation studies were also carried out to compare the proposed method with Cox's time dependent covariates models . RESULTS: The theoretical development of the healthy worker survival effect is based on the result that an observation with change of an employment status requires that the survival time without intermediate event exceeds the waiting time for the intermediate event. According to our simulation studies, both the proposed method and Cox's time dependent covariates model which includes the change of employment status as time dependent covariates seem to be satisfactory at 5% significance level. However, Cox's time dependent covariates models without or with the change of employment status as time fixed covariate are unsatisfactory. The proposed test is superior in power to tests based on Cox's model. CONCLUSIONS: The healthy worker effect may not be controlled by classical Cox's proportional hazards models. The proposed method performed well in the presence of healthy worker effect in terms of level and power
Bias (Epidemiology) ; Confounding Factors (Epidemiology) ; Employment ; Epidemiology ; Healthy Worker Effect* ; Mortality ; Proportional Hazards Models

BACKGROUND: The smoking rate of adult male is 68.2% in Korea and that of adolescent and women has risen recently. Ministry of Health and Welfare plans to raise the price of cigarettes by 1,000 Won per pack this year in hopes of securing funds to aid the underprivileged and discourage excessive smoking. In this study, we tried to find the relationship between tobacco price increase and willingness to quit smoking among university students, and the factors associated with willingness to quit smoking. METHOD: The data were collected by questionnaire survey from 225 university students living in Seoul. The questionnaire contained items on age, sex, smoking history, economical status and the intention to quit smoking when the tobacco price be raised. RESULT: The proportion of smokers who has the intention to quit smoking if the price of tobacco be raised by 3,000 Won was 46.2%. The factors associated with willingness to quit smoking were age of initiating smoking, opinion for price of cigarette, self efficacy scores, current plans to quit smoking, and viewpoint of changes in the rate of smokers. CONCLUSION: The results showed that tobacco price rises will increase willingness to quit smoking among university students.
Adolescent ; Adult ; Female ; Financial Management ; Hope ; Humans ; Intention ; Korea ; Male ; Self Efficacy ; Seoul ; Smoke* ; Smoking Cessation ; Smoking* ; Tobacco Products ; Tobacco* ; Surveys and Questionnaires

PURPOSE: Many studies from the past have indicated that women tend to have lower self- esteem than men. This cross-sectional study looks for this tendency in a medical school in Korea, where men are still thought to comprise much of a dominating force despite the current growth in number of female students in student body. Along with the cross-examination of possible gender difference in self-esteem, the significant and relevant factors will also be sought and discussed. METHODS: Questionnaires were obtained from 202 junior and senior students (125 male and 77 female students) in a medical school in Korea. Self-esteem was determined using the Rosenberg self-esteem scale (reliability = 86% in our study). Multiple regression analysis was used to determine gender difference in self-esteem and statistical relevance in each covariate. RESULTS: There was no statistically significant difference in self-esteem between male and female medical students. Significant factors related to self-esteem include school rank, physical attractiveness, and depression, among which of them, depression was the strongest. CONCLUSION: Innate limitation of cross-sectional studies and evaluation of selected junior and senior students of a single medical school could possibly explain for the absence of gender difference in self-esteem in this study. Academic achievement and physical attractiveness are shown to be positive factors for self-esteem, while depression puts negative force in one's self-esteem.
Cross-Sectional Studies ; Depression ; Female ; Humans ; Korea ; Male ; Schools, Medical ; Students, Medical* ; Surveys and Questionnaires

PURPOSE: Korea started breast cancer screening as part of the National Cancer Screening Program (NCSP) in 1999. In order to identify under-served groups, we investigated mammography uptake in the National Breast Cancer Screening Program. MATERIALS AND METHODS: The study population was participants in the National Breast Cancer Screening Program from 2004 to 2008. We analyzed participation rates by insurance type, age group, and area of residence. RESULTS: Total participation rates for breast cancer screening increased from 18.2% in 2004 to 35.0% in 2008. The participation rate in the group aged 60 to 69 years showed the greatest increase, 21.3%, among the four age groups. Although the screening rate increased continuously, the participation rate of the Medical Aid Program (MAP) group was low compared to the National Health Insurance (NHI) group. Moreover, the increasing trend of mammography uptake in the MAP group was much lower than that of the NHI group. CONCLUSION: The participation rate for breast cancer screening in the NCSP in Korea has increased. However, the participation rate in mammography among MAP recipients is still lower than that of NHI beneficiaries. To increase mammography uptake, it is important to make it available to everyone by ensuring inclusion of all population subgroups.
Aged ; Breast ; Breast Neoplasms ; Early Detection of Cancer ; Humans ; Insurance ; Korea ; Mammography ; Mass Screening ; National Health Programs ; Patient Participation

OBJECTIVE: The National Cancer Screening Program (NCSP) began in 1999. In this report, we evaluate the results of the NCSP for cervical cancer in 2009 and provide participation rates in an organized cervical cancer screening program in Korea. METHODS: Using data obtained from the National Cancer Screening Information System, cervical cancer screening participation rates were calculated. Recall rates, defined as the proportion of abnormal cases among women screened, were also estimated with 95% confidence intervals. RESULTS: The target population of cervical cancer screening in 2009 included 4,577,200 Korean women aged 30 and over, 1,349,668 of whom underwent the Papanicolaou smear test (29.5% participation rate). Compared with the participation rate of women covered by the National Health Insurance Program (31.3%), the participation rate of women covered by the Medical Aid Program was lower (18.4%). Participation rates also varied in different age groups (the highest of 39.3% in women aged 50 to 59 and the lowest of 14.4% in those aged 70 and older), and different areas (the highest of 34.1% in Busan and the lowest of 21.5% in Chungnam). The overall recall rate for cervical cancer screening was 0.41% (95% confidence interval, 0.40 to 0.42). CONCLUSION: According to our study, efforts to facilitate participation and reduce disparities in cervical cancer screening among Korean women are needed.
Age Distribution ; Aged ; Early Detection of Cancer ; Female ; Health Services Needs and Demand ; Humans ; Information Systems ; Insurance, Health ; Korea ; Mass Screening ; National Health Programs ; Uterine Cervical Neoplasms ; Vaginal Smears

Purpose: To confirm that the phaco chop method using an illuminated chopper (iChopper; Oculight, Seongnam, Korea) can reduce cataract surgery complications, and that even beginners can safely and effectively perform phaco chop. Methods: We retrospectively analyzed the medical records of the first 30 phaco chop cases using illuminated chopper of four cataract surgeons. Four ophthalmologists had a variety of empirical backgrounds, from those who have experienced more than 10,000 cataract surgery, to beginners who have experienced 20 cataract surgery. Results: Of the total 120 eyes, two eyes (1.67%) had posterior capsule rupture. The chopping method was changed from phaco chop to stop and chop in three eyes (2.5%) including one eye with brown cataract with pseudoexofoliation syndrome and two eyes with nuclear opacity grade ≥5. Conclusions The rates of posterior capsule rupture of phaco chop using an illuminated chopper were very low in four surgeons with various experiences and who became proficient shortly in phaco chop.

BACKGROUND: Weekend admission is known for having association with increased mortality attributed by poor quality of care and severe patients. We investigated the association between hospital admission on weekends and the in-hospital mortality rates of patients with cardiovascular disease. Furthermore, we examined this association stratified by admission via emergency room or not. METHODS: We analyzed claim data provided by the Health Insurance Review & Assessment in 2013. In total, 80,817 cardiovascular patients were included in this study, which treated in-hospital mortality (early and during total length of stay) as a dependent variable. A generalized linear mixed effects model was used. We conducted subgroup analyses stratified by admission via emergency room or not. RESULTS: Patients who admitted on weekend showed higher in-hospital mortality both early (odds ratio [OR], 1.48; 95% confidence interval [CI], 1.23–1.78) and during total length of stay (OR, 1.17; 95% CI, 1.02–1.33) compared to those admitted on weekdays. Patients who were admitted to the hospital on a weekend by emergency room were more likely to experience early in-hospital mortality compared to those admitted on weekdays. Furthermore, we found that patients not admitted to the hospital through the emergency department were more likely to experience both early and total length of stay in-hospital mortality. CONCLUSION: Our study shows higher in-hospital mortality rates for cardiovascular patients admitted on weekends. Efforts to improve the quality of care on weekend are important to mitigate the ‘weekend effect’ and improve patient outcomes.
Cardiovascular Diseases ; Emergency Service, Hospital ; Hospital Mortality ; Hospitalization ; Humans ; Insurance, Health ; Korea ; Length of Stay ; Mortality ; Quality of Health Care

Objectives: ：The turnover rate of mental health workers in community mental health institutes is remarkably high.We explored the mediating effects of perceived work value on the relationship between burnout and turnover intention among mental health professionals working for community mental health centers and addiction centers. Methods: ：A total of 161 mental health workers completed this survey. We administered the Maslach Burnout Inventory-General Survey (MBI-GS) and the Michigan Organizational Assessment Questionnaire (MOAQ) (which explores turnover intention). Perceived work value was assessed using two items of the Scale of Resilience to Burnout.Associations were sought using the t-test, analysis of variance, correlation analyses, and hierarchical regression analyses. Results: ：The burnout level was significantly negatively correlated with perceived work value. Burnout was significantly positively correlated with turnover intention, and perceived work value significantly negatively correlated. Bootstrapping showed that perceived work value partially mediated the relationship between burnout and turnover intention. Conclusion ：Perceived work value may buffer turnover intention caused by burnout. Creation of an environment in which mental health workers feel that their work is valuable is important to prevent resignations.