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Purpose Improvements in the treatment of advanced cancer have increased life expectancy but have also increased the costs to healthcare systems, patients and their families. A systematic review is needed to summarize research work on the cost of cancer. The primary objective was to describe the characteristics and methodology of studies investigating the cost of cancer during the palliative phase. Secondary objectives were to assess whether palliative care interventions influence the costs of advanced cancer and to describe the costs explored and models used in cost-effectiveness studies. Method According to the PRISMA guideline (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), Pubmed, Web of Science, NHS, EconLit and Google Scholar databases were screened from 11/01/2020 to 03/01/2024. All types of methods about the costs of the palliative phase of solid cancer were accepted. Study characteristics, economic perspective, time horizon and the type of costs explored were collected. Results Of the 498 studies identified, 66 were included in the final analysis. Most (60%) used a retrospective methodology. Almost all (65, 98%) studied direct costs, and only 12 (18%) studied indirect costs. No article assessed intangible costs or the total cost of the palliative phase of cancer. The payer’s perspective was most commonly adopted (39, 59%). The time horizon was less than 6 months in most cases (41, 63%). Eighteen studies (86%) highlighted that PC interventions were cost-effective. Conclusion Existing evidence suggests that palliative care is cost-effective from the hospital and payer’s perspective. More research is needed to evaluate the cost of informal caregiving and out-of-pocket expenses borne by patients.

Schizophrenia is a disabling, chronic psychiatric disorder that poses numerous challenges in its management and consequences. It extols a significant cost to the patient in terms of personal suffering, on the caregiver as a result of the shift of burden of care from hospital to families, and on society at large in terms of significant direct and indirect costs that include frequent hospitalizations and the need for long-term psychosocial and economic support, as well as life-time lost productivity. ‘Burden of care’ is a complex construct that challenges simple definition, and is frequently criticized for being broad and generally negative. Frequently, burden of care is more defined by its impacts and consequences on caregivers. In addition to the emotional, psychological, physical and economic impact, the concept of ‘burden of care’ involves subtle but distressing notions such as shame, embarrassment, feelings of guilt and self-blame. The early conceptualization of ‘burden of care’ into two distinct components (objective and subjective) has guided research efforts until the present time. Objective burden of care is meant to indicate its effects on the household such as taking care of daily tasks, whereas subjective burden indicates the extent to which the caregivers perceive the burden of care. Research contributions in later years (1980s to the present) have added more depth to understanding of the construct of burden of care by exploring important determinants and factors that likely contribute or mediate the caregiver’s perception of burden of care. Several studies examined the role of gender, and reported that relatives of male patients with schizophrenia frequently experience more social dysfunction and disabilities than those of female patients. Similarly, a number of other studies documented the contribution of ethnicity and cultural issues to subjective burden of care. Although there is no complete agreement on whether a specific cluster of psychotic symptoms has the most impact on a caregiver’s burden of care, there is agreement that the severity of symptoms increases it. An extensive literature concerning family interventions in schizophrenia has demonstrated the positive impact of various family interventions in improving family environment, reducing relapse and easing the burden of care. Although the evidence of such positive impact of family interventions in schizophrenia is well documented, such interventions are neither widely used nor appropriately integrated in care plans, and are frequently underfunded. Although the cost of caregiving is considered to be significant, there are no reliable estimates of the costs associated with such care. The majority of available literature categorized the cost of burden of care among the indirect costs of schizophrenia in general. In recent years, attempts to compare the costs of caregiving in several countries have been reported in the evolving literature on this topic. ‘Burden of care’ as a complex construct certainly requires the development of appropriate methodology for its costing. In achieving a balance between the patients’ and caregivers’ perspectives, caregivers have to be included in the care plan and adequate information and support extended to the family and caregivers. Access to better treatment for patients, including medications, psychosocial interventions and rehabilitation services, are important basic elements in easing the burden on caregivers. Other measures such as availability of crisis management, provision of legally mandated community treatment to avert hospitalization, and well informed and balanced advocacy are also important. Although research efforts have been expanded in the last 3 decades, an urgent need exists for enhancing such efforts, particularly in the development and evaluation of effective family interventions strategies. There is also a need for continued improvement in the delivery of psychiatric services to the severely psychiatrically ill and their families. As there is a lack of reliable cost information about the family burden of care specific to schizophrenia, there is an urgent need to develop reliable approaches that can generate data that can inform in policy making and organization of services.

Hypertension is a common vascular disease and the main risk factor for cardiovascular diseases. Since the incidence of hypertension is rising in Ethiopia, one may expect that the household's cost of healthcare services related to the disease will increase in the near future. Yet the cost associated with the disease is not known. We aimed to estimate the total cost of hypertension illness and identify associated factors among patients attending hospitals in Southwest Shewa zone, Oromia regional state, Ethiopia. An institution-based cross-sectional study design was employed to conduct the study from 13 August to 2 September 2018. All hypertensive patients aged 18 years and older who were on follow-up were eligible for this study. The total cost of hypertension illness was estimated by summing the direct and indirect costs. Bivariate and multivariate linear regression analyses were performed to identify factors associated with hypertension costs of illnesses. A total of 349 patients participated in the study. The mean monthly total cost of hypertension illness was US$ 22.3 (95% CI, 21.3-23.3). Direct and indirect costs constitute 51% and 49% of the total cost, respectively. The mean direct cost of hypertension illness per patient per month was US$ 11.39 (95% CI, 10.6-12.1). Out of these, drugs comprised higher cost (31%), followed by food (25%). The mean indirect cost per patient per month was US$ 10.89 (95% CI, 10.4-11.4). In this study, the primary educational status, family size (4-6 and >6), distance from hospital (≥10 km), the presence of a companion and stage of hypertension (stage two) of patients were identified as the predictors of the cost of hypertension illnesses. The cost of hypertension illness was very high when compared to the monthly income of households, exposing patients to catastrophic costs. Hence, the government should give due attention to protect patients from catastrophic health expenditures.

Background Diabetes mellitus, particularly Type 2 diabetes (T2D), represents a significant global health challenge, with its prevalence steadily rising over the past few decades. This study was conducted with the aim of estimating the economic burden of T2D in Iran. Methods This study employed a prevalence-based approach to estimate the economic burden of T2D and its attributable complications in adults above 20 years old in Iran for 2022. Both direct medical costs and indirect costs were considered in our analysis. Direct medical costs included inpatient and outpatient costs attributable to T2D and its complications, while indirect costs encompassed absenteeism, presenteeism, inability to work, and premature mortality costs due to the disease. Results The findings showed that a total of 5,702,547 people, equivalent to 14.2% of Iranian adults, had T2D. The estimated total direct medical cost of T2D and its attributable complications in Iran in 2022 was 1,879.2 million US dollars (US$-PPP 6,676.9 million). Chronic kidney disease accounted for the largest proportion, followed by ischemic heart disease (IHD), and T2D itself. The total economic burden of T2D and its attributable complications in Iran in 2022, was estimated to be $2,905.7 million US dollars (US$-PPP 10,324.2 million). The direct medical cost constituted the majority of the economic burden (64.7%), while the inability to work due to these health conditions also contributes significantly (28.6%). Absenteeism (2.9%), presenteeism (1.7%), and premature mortality (2.2%) make up smaller proportions of the overall economic impact of T2D and its complications in Iran during that year. Conclusion Our study highlights the significant and diverse economic impact of T2D and its complications in Iran. This burden encompasses not only healthcare-related expenses but also negative impacts on society and productivity, as well as the occurrence of early death. To successfully address this burden, a comprehensive strategy is needed, which includes programs to prevent diabetes, better access to healthcare services, and increased social support for individuals with this long-term condition.

Hemodialysis is a renal replacement therapy for end-stage renal disease (ESRD) patients who consume substantial healthcare resources, which increases the economic burden. Plenty of factors affects the cost of hemodialysis treatment, particularly in resource-limited settings. Moreover, the demand for hemodialysis may decrease as the cost increases, but there is limited evidence in Ethiopia. Thus, this study aimed to estimate the cost of hemodialysis treatment among ESRD patients in the tertiary hospitals of Addis Ababa City and Amhara region, Ethiopia. An institutional-based cross-sectional study was conducted among 172 ESRD patients undergoing hemodialysis treatment. A structured questionnaire and patients' medical chart were used to estimate the costs, and the human capital approach was applied to calculate the indirect costs. A generalized linear model (GLM) was fitted after the modified park test to identify the associated factors. In the final GLM, a p-value of <0.05 and a 95% CI were used to declare the significant variables. The mean annual cost of hemodialysis treatment was 121,089.27ETB ($4466.59) ± 33,244.99 ($1226.29). The direct and indirect costs covered 77.0% and 23.0% of the total costs, respectively. Age (ex(b): 1.01, p-value <0.001), highest wealth status (ex(b): 1.09, p-value: 0.008), eight (ex(b): 1.27, p-value <0.001) and 12 visits/month (ex(b): 1.34, p-value <0.001), anemia (ex(b): 1.13, p-value <0.001), and comorbidity (ex(b): 1.09, p-value: 0.039) were the factors associated with the costs of hemodialysis treatment. The annual cost of hemodialysis treatment among ESRD patients was high compared to the national per capita health expenditure, and two-thirds covered by the direct medical costs. Old age, high wealth status, more visits, anemia, and comorbidity were factors associated with the costs of hemodialysis. Therefore, the healthcare system must make a great effort for cost reduction and reduce the patients with kidney disease before they reach end-stages.

Background: Financial burden on tuberculosis (TB) patients results in delayed treatment and poor compliance. We assessed pre- and post-diagnosis costs to TB patients. Methods: A longitudinal study among 735 new TB cases was conducted from January 2015 through June 2016 in 10 woredas (districts) of southwestern Ethiopia. Direct out-of-pocket, payments, and lost income (indirect cost) were solicited from patients during the first 2 months and at the end of treatment. Thus, we ascertained direct medical, nonmedical, and indirect costs incurred by patients during pre- and post-diagnosis periods. We categorized costs incurred from onset of illness until TB diagnosis as pre-diagnosis and that incurred after diagnosis through treatment completion as post-diagnosis. Pre- and post-diagnosis costs constitute total cost incurred by the patients. We fitted linear regression model to identify predictors of cost. Results: Between onset of illness and anti-TB treatment course, patients incurred a median (inter-quartile range (IQR)) of US$201.48 (136.7-318.94). Of the total cost, the indirect and direct costs respectively constituted 70.6 and 29.4%. TB patients incurred a median (IQR) of US$97.62 (6.43-184.22) and US$93.75 (56.91-141.54) during the pre- and post-diagnosis periods, respectively. Thus, patients incurred 53.6% of the total cost during the pre-diagnosis period. Direct out-of-pocket expenses during the pre- and post-diagnosis periods respectively amount to median (IQR) of US$21.64 (10.23-48.31) and US$35.02 (0-70.04). Patient delay days (p < 0.001), provider delay days (p < 0.001), number of healthcare facilities visited until TB diagnosis (p < 0.001), and TB diagnosis at private facilities (p = 0.02) independently predicted increased pre-diagnosis cost. Similarly, rural residence (p < 0.001), hospitalization during anti-TB treatment (p < 0.001), patient delay days (p < 0.001), and provider delay days (p < 0.001) predicted increased post-diagnosis costs. Conclusion: TB patients incur substantial cost for care seeking and treatment despite \"free service\" for TB. Therefore, promoting early care seeking, decentralizing efficient diagnosis, and treatment services within reach of peoples, and introducing reimbursement system for direct costs can help minimize financial burden to the patient.

Background As of 3 March 2023, Madagascar had reported 1,422 deaths from COVID-19. Up to now, there hasn't been a study to estimate the Total Present Value of Human Life lost TPVHL MADAGASCAR , productivity losses, and potential productivity losses averted through COVID-19 vaccination for use in advocacy. The study reported in this paper aimed to fill these information gaps. Methods The Human Capital Model (HCM) was used to estimate the TPVHL MADAGASCAR , which is the sum of the discounted value of human life losses among individuals in seven different age groups. The Present Value of Human Life for each age group PVHL i was calculated by multiplying the discount factor, the undiscounted years of life, the non-health gross domestic product (GDP) per capita, and the number of COVID-19 deaths in that age group. To test the robustness of the results, the HCM was rerun five times, assuming (i) a 5% discount rate, (ii) a 10% discount rate, (iii) Africa’s highest average life expectancy at birth of 78.76 years, (iv) the world's highest life expectancy of 88.17 years, (v) projected excess COVID-19 mortality of 11,418.66 deaths as of 3 March 2023 in Madagascar, and assuming different levels of vaccine coverage: 100%, 70%, 60.93%, and 8.266%. Results The 1,422 human lives lost due to COVID-19 had a TPVHL MADAGASCAR of Int$ 46,331,412; and an average of Int$ 32,582 per human life. Re-estimation of the HCM, using (i) discount rates of 5% and 10% reduced TPVHL MADAGASCAR by 23% and 53%, respectively; (ii) average life expectancies of 78.76 years and 88.17 years increased TPVHL MADAGASCAR by 23.7% and 39.5%, respectively; (iii) projected excess COVID-19 mortality of 11,418.66 augmented TPVHL MADAGASCAR by 703%. Furthermore, it is estimated that vaccinating 70% of the target population could potentially save the country Int$ 1.1 billion, equivalent to 1.94% of the GDP. Conclusions The COVID-19 pandemic has resulted in significant health and productivity losses for Madagascar. Optimizing COVID-19 vaccination coverage for the target population could substantially reduce these losses.

Seasonal influenza is a prevalent and highly contagious acute respiratory disease that, year on year, results in increased morbidity and mortality on a global scale. Because of the widespread and debilitating nature of the disease, annual influenza epidemics result in substantial workplace absenteeism, and the associated cost of lost productivity is a significant component of the substantial financial burden of the disease to society. The objective of this review was to identify studies that had attempted to quantify the impact of influenza upon otherwise healthy adults in terms of working days lost associated with an episode of influenza. Studies were included if they reported estimates of working days lost due to clinical, physician and/or self-diagnosis in adult patients or their dependants, or where this figure could be estimated from the data. Searches were conducted in MEDLINE, EMBASE, BIOSIS and the Cochrane Collaboration for articles published since 1995 in English, French or German. Of the 289 papers identified in the search, 28 (9.7%) met the inclusion criteria. The studies, involving study sites in North America, Western Europe, Asia and Australia, were categorized into three groups: (i) those reporting influenza diagnoses confirmed by laboratory testing, i.e. studies where influenza was the unambiguous cause of the working days lost (n = 7 studies reported in ten publications); (ii) those where influenza was confirmed by a physician without an accompanying laboratory test (n = 4 studies); and (iii) those where influenza was self-reported by study participants (n = 14 studies). Qualitative reporting of results was performed because of the large degree of heterogeneity observed between studies, potentially complicating the interpretation of any meta-analysis. The results from studies involving a laboratory-confirmed influenza diagnosis suggested that the mean number of working days lost ranged between 1.5 and 4.9 days per episode. Those papers that detailed working days lost per episode following physician diagnosis of influenza reported a range of 3.7–5.9 days per episode. Finally, estimates from papers reporting working days lost per episode of self-reported influenza ranged from <1 day to 4.3 days per episode. Influenza imposes a significant burden on society, and this review highlights the significant economic impact it causes, i.e. the loss of productivity caused by both absenteeism and by staff functioning at reduced capacity even after they have returned to work. A number of prophylaxis and treatment options exist for influenza and should be given serious consideration in an attempt to reduce the economic burden on society.

This study evaluated the incremental healthcare costs associated with Fragile X syndrome (FXS) for patients and their caregivers. Using administrative healthcare claims data (1999-2012), subjects with ≥ 1 FXS diagnosis (ICD-9-CM: 759.83) were matched 1:5 with non-FXS controls using high-dimensional propensity scores. Costs and resource utilization were examined. Among employees, payment for disability leave and absenteeism were also examined. We identified 590 FXS and 2,950 non-FXS individuals along with 647 and 2,611 caregivers, respectively. FXS patients and their caregivers experienced higher all-cause direct costs compared to control cohorts (total[SD]:$14,677[46,752] vs. $ 6,103[26,081];$5,259[19,360] vs. $ 2,120[6,425], respectively, p < 0.05). Employed FXS patients and caregivers had higher indirect costs compared to their controls (total[SD]:$4,477[5,161] vs. $ 1,751[2,556];$2,641[4,238] vs. $ 1,211[1,936], respectively, p < 0.05).

It has been found in the article that information about total cost influences informed management decisions on assortment policy, pricing, marketing policy, but the lack of normative regulation of the formation of this indicator leads to discussions in the terminological field and the subjective nature of its calculation. It is proved that costs included in the total cost of production (works, services) should be divided into the following three groups: by way of attribution to cost (direct, indirect), by the degree of influence of production on the level of costs (fixed, variable), by relation to the economic process (main, overhead). It is argued that not all overhead costs are indirect, so it is advisable to use the term «indirect costs» when allocating costs that cannot be directly attributed to a particular cost object. It is proposed to allocate indirect costs in the scale of the following five steps: division of costs into direct and indirect costs; grouping indirect costs into homogeneous groups; setting a materiality threshold for indirect costs; allocation of indirect costs between cost centers; selection of distribution bases and allocation of indirect costs between types of products (works, services). It is recommended to establish indirect cost allocation bases according to the following procedures: 1) identify those cost groups for which the selection of the allocation base is obvious or clearly recommended by experts; 2) to allocate those groups of costs, the magnitude of which is insignificant and there is no obvious distribution base. In this case, the most objective of the allocation base is to choose the amount of direct costs, taking into account the costs of maintenance and operation of the equipment; 3) if the magnitude of a specific group of indirect costs accounts for a large proportion of the total indirect costs and there is no apparent logical factor affecting their change, then it is appropriate to use correlation-regression analysis. As a result of validation of the calculation of the full cost of the proposed steps and rules, the possibility of obtaining the most correct value of its value, while optimizing the resources expended to perform the relevant calculations, was proved.