Journal of Preventive Medicine and Public Health

Brief Report

Characteristics and Health Care Spending of Persistently and Transiently High-cost Older Adults in Korea: Sungchul Park, Giryeon Bae; J Prev Med Public Health. 2023;56(5):475-480. Published online September 4, 2023; DOI: https://doi.org/10.3961/jpmph.23.270

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Abstract Summary PDF: Objectives
This study examined differences in health care spending and characteristics among older adults in Korea by high-cost status (persistently, transiently, and never high-cost).
Methods
We identified 1 364 119 older adults using data from the Korean National Insurance Claims Database for 2017-2019. Outcomes included average annual total health care spending and high-cost status for 2017-2019. Linear regression was used to estimate differences in the outcomes while adjusting for individual-level characteristics.
Results
Persistently and transiently high-cost older adults had higher health care spending than never high-cost older adults, but the difference in health care spending was greater among persistently high-cost older adults than among transiently high-cost older adults (US$20 437 vs. 5486). Despite demographic and socioeconomic differences between transiently high-cost and never high-cost older adults, the presence of comorbid conditions remained the most significant factor. However, there were no or small differences in the prevalence of comorbid conditions between persistently high-cost and transiently high-cost older adults. Rather, notable differences were observed in socioeconomic status, including disability and receipt of Medical Aid.
Conclusions
Medical risk factors contribute to high health care spending to some extent, but social risk factors may be a source of persistent high-cost status among older adults in Korea.; Summary

Korean summary
- 한국에서 65세 이상의 고령층 고비용 환자 그룹 내에서 두 개의 이질적인 그룹을 발견하였다. - 지속적으로 고비용인 환자는 일시적으로 고비용인 환자보다 의료비 지출이 유의미하게 더 많았다. - 두 그룹의 특성을 비교한 결과, 건강요인의 차이도 있었지만 그보다는 사회적 요인의 차이가 더 컸다.

Key Message
- High-cost older adults are heterogeneous in terms of health care spending and sample characteristics in Korea. - Persistently high-cost older adults had significantly higher health care spending than transiently high-cost older adults. - Medical risk factors contribute to high health care spending to some extent, but social risk factors may be a source of persistent high-cost status among older adults.

Special Articles

The Primary Process and Key Concepts of Economic Evaluation in Healthcare: Younhee Kim, Yunjung Kim, Hyeon-Jeong Lee, Seulki Lee, Sun-Young Park, Sung-Hee Oh, Suhyun Jang, Taejin Lee, Jeonghoon Ahn, Sangjin Shin; J Prev Med Public Health. 2022;55(5):415-423. Published online August 24, 2022; DOI: https://doi.org/10.3961/jpmph.22.195

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Economic evaluations in the healthcare are used to assess economic efficiency of pharmaceuticals and medical interventions such as diagnoses and medical procedures. This study introduces the main concepts of economic evaluation across its key steps: planning, outcome and cost calculation, modeling, cost-effectiveness results, uncertainty analysis, and decision-making. When planning an economic evaluation, we determine the study population, intervention, comparators, perspectives, time horizon, discount rates, and type of economic evaluation. In healthcare economic evaluations, outcomes include changes in mortality, the survival rate, life years, and quality-adjusted life years, while costs include medical, non-medical, and productivity costs. Model-based economic evaluations, including decision tree and Markov models, are mainly used to calculate the total costs and total effects. In cost-effectiveness or costutility analyses, cost-effectiveness is evaluated using the incremental cost-effectiveness ratio, which is the additional cost per one additional unit of effectiveness gained by an intervention compared with a comparator. All outcomes have uncertainties owing to limited evidence, diverse methodologies, and unexplained variation. Thus, researchers should review these uncertainties and confirm their robustness. We hope to contribute to the establishment and dissemination of economic evaluation methodologies that reflect Korean clinical and research environment and ultimately improve the rationality of healthcare policies.

Summary

Korean summary
보건의료분야에서 경제성 평가는 의약품과 진단검사 및 치료법 등 의료기술에 대한 평가에서 널리 활용되고 있다. 본 연구에서는 경제성 평가절차를 경제성 평가 설계, 결과 산출, 비용산출, 모형 구축 및 분석, 비용-효과성 결과 제시 및 불확실성 평가와 의사 결정 단계로 나누어 주요 개념과 쟁점들을 소개하였다.

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β-Lactam allergy delabeling is safe and saves costs in Primary Care
Joaquín Quiralte, María del Robledo Ávila, Isabel Domínguez, Estela Menéndez, José Miguel Cisneros, Ana Belén Guisado
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Epidemiology and Health.2023; 45: e2023057. CrossRef

Measuring Trends in the Socioeconomic Burden of Disease in Korea, 2007-2015: Tae Eung Kim, Ru-Gyeom Lee, So-Youn Park, In-Hwan Oh; J Prev Med Public Health. 2022;55(1):19-27. Published online January 31, 2022; DOI: https://doi.org/10.3961/jpmph.21.594

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Abstract Summary PDF Supplementary Material

This study estimated the direct and indirect socioeconomic costs of 238 diseases and 22 injuries from a social perspective in Korea from 2007 to 2015. The socioeconomic cost of each disease group was calculated based on the Korean Standard Disease Classification System. Direct costs were estimated using health insurance claims data provided by the National Health Insurance Service. The numbers of outpatients and inpatients with the main diagnostic codes for each disease were selected as a proxy indicator for estimating patients’ medical use behavior by disease. The economic burden of disease from 2007 to 2015 showed an approximately 20% increase in total costs. From 2007 to 2015, communicable diseases (including infectious, maternal, pediatric, and nutritional diseases) accounted for 8.9-12.2% of the socioeconomic burden, while non-infectious diseases accounted for 65.7-70.7% and injuries accounted for 19.1-22.8%. The top 5 diseases in terms of the socioeconomic burden were self-harm (which took the top spot for 8 years), followed by cirrhosis of the liver, liver cancer, ischemic heart disease, and upper respiratory infections in 2007. Since 2010, the economic burden of conditions such as low back pain, falls, and acute bronchitis has been included in this ranking. This study expanded the scope of calculating the burden of disease at the national level by calculating the burden of disease in Koreans by gender and disease. These findings can be used as indicators of health equality and as useful data for establishing community-centered (or customized) health promotion policies, projects, and national health policy goals.

Summary

Korean summary
2007년에서 2015년 기간의 건강보험 자료 등을 이용하여, 해당기간의 경제적 질병부담을 측정하였으며, 해당 기간동안 경제적 질병부담은 20%의 증가를 나타내었다. 동 기간동안 비감염성 질환의 경제적 질병부담의 비율은 약 70%로 나타났으며, 감염성 질환은 약 10%, 손상은 20%로 나타났다. 한편 개별 질병군 기준으로는 자살을 포함한 자해가 1위를 차지한 해가 가장 많았다.

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Katarzyna Helon, Małgorzata Wisłowska, Krzysztof Kanecki, Paweł Goryński, Aneta Nitsch-Osuch, Krzysztof Bonek
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Sung Cheol Park, Min-Seok Kang, Jae Hyuk Yang, Tae-Hoon Kim
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Wonbin Choi, Hyunji Koo, Kyeong Hye Jeong, Eunyoung Kim, Seung-Hun You, Min-Taek Lee, Sun-Young Jung
Korean Journal of Clinical Pharmacy.2023; 33(3): 168. CrossRef
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Brief Report

Determinants of Hospital Inpatient Costs in the Iranian Elderly: A Micro-costing Analysis: Ebrahim Hazrati, zahra Meshkani, Saeed Husseini Barghazan, Sanaz Zargar Balaye Jame, Nader Markazi-Moghaddam; J Prev Med Public Health. 2020;53(3):205-210. Published online May 16, 2020; DOI: https://doi.org/10.3961/jpmph.19.250

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Abstract PDF: Objectives
Aging is assumed to be accompanied by greater health care expenditures. The objective of this retrospective, bottom-up micro-costing study was to identify and analyze the variables related to increased health care costs for the elderly from the provider’s perspective.
Methods
The analysis included all elderly inpatients who were admitted in 2017 to a hospital in Tehran, Iran. In total, 1288 patients were included. The Mann-Whitney and Kruskal-Wallis tests were used.
Results
Slightly more than half (51.1%) of patients were males, and 81.9% had a partial recovery. The 60-64 age group had the highest costs. Cancer and joint/orthopedic diseases accounted for the highest proportion of costs, while joint/orthopedic diseases had the highest total costs. The surgery ward had the highest overall cost among the hospital departments, while the intensive care unit had the highest mean cost. No statistically significant relationships were found between inpatient costs and sex or age group, while significant associations (p<0.05) were observed between inpatient costs and the type of ward, length of stay, type of disease, and final status. Regarding final status, costs for patients who died were 3.9 times higher than costs for patients who experienced a partial recovery.
Conclusions
Sex and age group did not affect hospital costs. Instead, the most important factors associated with costs were type of disease (especially chronic diseases, such as joint and orthopedic conditions), length of stay, final status, and type of ward. Surgical services and medicine were the most important cost items.; Summary

Original Articles

Estimating Influenza-associated Mortality in Korea: The 2009-2016 Seasons: Kwan Hong, Sangho Sohn, Byung Chul Chun; J Prev Med Public Health. 2019;52(5):308-315. Published online August 23, 2019; DOI: https://doi.org/10.3961/jpmph.19.156

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Abstract Summary PDF

Objectives
Estimating influenza-associated mortality is important since seasonal influenza affects persons of all ages, causing severe illness or death. This study aimed to estimate influenza-associated mortality, considering both periodic changes and age-specific mortality by influenza subtypes.
Methods
Using the Microdata Integrated Service from Statistics Korea, we collected weekly mortality data including cause of death. Laboratory surveillance data of respiratory viruses from 2009 to 2016 were obtained from the Korea Centers for Disease Control and Prevention. After adjusting for the annual age-specific population size, we used a negative binomial regression model by age group and influenza subtype.
Results
Overall, 1 859 890 deaths were observed and the average rate of influenza virus positivity was 14.7% (standard deviation [SD], 5.8), with the following subtype distribution: A(H1N1), 5.0% (SD, 5.8); A(H3N2), 4.4% (SD, 3.4); and B, 5.3% (SD, 3.7). As a result, among individuals under 65 years old, 6774 (0.51%) all-cause deaths, 2521 (3.05%) respiratory or circulatory deaths, and 1048 (18.23%) influenza or pneumonia deaths were estimated. Among those 65 years of age or older, 30 414 (2.27%) all-cause deaths, 16 411 (3.42%) respiratory or circulatory deaths, and 4906 (6.87%) influenza or pneumonia deaths were estimated. Influenza A(H3N2) virus was the major contributor to influenza-associated all-cause and respiratory or circulatory deaths in both age groups. However, influenza A(H1N1) virus–associated influenza or pneumonia deaths were more common in those under 65 years old.
Conclusions
Influenza-associated mortality was substantial during this period, especially in the elderly. By subtype, influenza A(H3N2) virus made the largest contribution to influenza-associated mortality.

Summary

Korean summary
계절 인플루엔자는 심각한 호흡기 합병증으로 진행할 수 있어 질병 부담의 추산이 중요한 질병이다. 현재까지는 연령별, 인플루엔자 연관 사망을 정확하게 추산하기 어려웠으나, 본 연구에서는 이를 추산하기 위해 고안된 다양한 방법 중 음이항 회귀 분석을 이용하여 2009년부터 2016년간 인플루엔자 아형별 연관 사망을 추산하였다. 그 결과, 전체 사망자 중 65세 미만에서 약 6,774명, 65세 이상에서 약 30,414명의 연간 인플루엔자 사망이 추산되었고, 이는 특히 인플루엔자 아형 중 전체 연령에서 A(H3N2) 연관 사망이 가장 많은 비율을 차지했다.

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Has the Copayment Ceiling Improved Financial Protection in the Korean National Health Insurance System? Evidence From the 2009 Policy Change: Tae-Jin Lee, Chelim Cheong; J Prev Med Public Health. 2017;50(6):393-400. Published online November 9, 2017; DOI: https://doi.org/10.3961/jpmph.17.151

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Abstract PDF

Objectives
To relieve the financial burden faced by households, the Korean National Health Insurance (NHI) system introduced a “copayment ceiling,” which evolved into a differential ceiling in 2009, with the copayment ceiling depending on patients’ income. This study aimed to examine the effect of the differential copayment ceiling on financial protection and healthcare utilization, particularly focusing on whether its effects varied across different income groups.
Methods
This study obtained data from the Korea Health Panel. The number of households included in the analysis was 6555 in 2008, 5859 in 2009, 5539 in 2010, and 5372 in 2011. To assess the effects of the differential copayment ceiling on utilization, out-of-pocket (OOP) payments, and catastrophic payments, various random-effects models were applied. Utilization was measured as treatment days, while catastrophic payments were defined as OOP payments exceeding 10% of household income. Among the right-hand side variables were the interaction terms of the new policy with income levels, as well as a set of household characteristics.
Results
The differential copayment ceiling contributed to increased utilization regardless of income levels both in all patients and in cancer patients. However, the new policy did not seem to reduce significantly the incidence of catastrophic payments among cancer patients, and even increased the incidence among all patients.
Conclusions
The limited effect of the differential ceiling can be attributed to a high proportion of direct payments for services not covered by the NHI, as well as the relatively small number of households benefiting from the differential ceilings; these considerations warrant a better policy design.

Summary

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Special Article

Strategies for Appropriate Patient-centered Care to Decrease the Nationwide Cost of Cancers in Korea: Jong-Myon Bae; J Prev Med Public Health. 2017;50(4):217-227. Published online June 16, 2017; DOI: https://doi.org/10.3961/jpmph.17.069

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Abstract PDF Supplementary Material

In terms of years of life lost to premature mortality, cancer imposes the highest burden in Korea. In order to reduce the burden of cancer, the Korean government has implemented cancer control programs aiming to reduce cancer incidence, to increase survival rates, and to decrease cancer mortality. However, these programs may paradoxically increase the cost burden. For examples, a cancer screening program for early detection could bring about over-diagnosis and over-treatment, and supplying medical services in a paternalistic manner could lead to defensive medicine or futile care. As a practical measure to reduce the cost burden of cancer, appropriate cancer care should be established. Ensuring appropriateness requires patient-doctor communication to ensure that utility values are shared and that autonomous decisions are made regarding medical services. Thus, strategies for reducing the cost burden of cancer through ensuring appropriate patient-centered care include introducing value-based medicine, conducting cost-utility studies, and developing patient decision aids.

Summary

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Review

A Systematic Review of the Economic Evaluation of Telemedicine in Japan: Miki Akiyama, Byung-Kwang Yoo; J Prev Med Public Health. 2016;49(4):183-196. Published online June 22, 2016; DOI: https://doi.org/10.3961/jpmph.16.043

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Abstract PDF

Objectives
There is no systematic review on economic evaluations of telemedicine in Japan, despite over 1000 trials implemented. Our systematic review aims to examine whether Japan’s telemedicine is cost-saving or cost-effective, examine the methodological rigorousness of the economic evaluations, and discuss future studies needed to improve telemedicine’s financial sustainability.
Methods
We searched five databases, including two Japanese databases, to find peer-reviewed articles published between January 1, 2000 and December 31, 2014 in English and Japanese that performed economic evaluations of Japan’s telemedicine programs. The methodological rigorousness of the economic analyses was assessed with a well-established checklist. We calculated the benefit-to-cost ratio (BCR) when a reviewed study reported related data but did not report the BCR. All cost values were adjusted to 2014 US dollars.
Results
Among the 17 articles identified, six studies reported on settings connecting physicians for specialist consultations, and eleven studies on settings connecting healthcare providers and patients at home. There are three cost-benefit analyses and three cost-minimization analyses. The remaining studies measured the benefit of telemedicine only, using medical expenditure saved or users’ willingness-to-pay. There was substantial diversity in the methodological rigorousness. Studies on teledermatology and teleradiology indicated a favorable level of economic efficiency. Studies on telehomecare gave mixed results. One cost-benefit analysis on telehomecare indicated a low economic efficiency, partly due to public subsidy rules, e.g., a too short budget period.
Conclusions
Overall, telemedicine programs in Japan were indicated to have a favorable level of economic efficiency. However, the scarcity of the economic literature indicates the need for further rigorous economic evaluation studies.

Summary

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Original Articles

Economic Burden of Colorectal Cancer in Korea: Ju-Young Byun, Seok-Jun Yoon, In-Hwan Oh, Young Ae Kim, Hye-Young Seo, Yo-Han Lee; J Prev Med Public Health. 2014;47(2):84-93. Published online March 31, 2014; DOI: https://doi.org/10.3961/jpmph.2014.47.2.84

14,540 View
148 Download
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Abstract PDF

Objectives

The incidence and survival rate of colorectal cancer in Korea are increasing because of improved screening, treatment technologies, and lifestyle changes. In this aging population, increases in economic cost result. This study was conducted to estimate the economic burden of colorectal cancer utilizing claims data from the Health Insurance Review and Assessment Service.

Methods

Economic burdens of colorectal cancer were estimated using prevalence data and patients were defined as those who received ambulatory treatment from medical institutions or who had been hospitalized due to colorectal cancer under the International Classification of Disease 10th revision codes from C18-C21. The economic burdens of colorectal cancer were calculated as direct costs and indirect costs.

Results

The prevalence rate (per 100 000 people) of those who were treated for colorectal cancer during 2010 was 165.48. The economic burdens of colorectal cancer in 2010 were 3 trillion and 100 billion Korean won (KRW), respectively. Direct costs included 1 trillion and 960 billion KRW (62.85%), respectively and indirect costs were 1 trillion and 160 billion (37.15%), respectively.

Conclusions

Colorectal cancer has a large economic burden. Efforts should be made to reduce the economic burden of the disease through primary and secondary prevention.

Summary

Citations

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Cost of illness for colorectal cancer in Japan - a time trend and future projections (1996–2035) based on governmental statistics
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Determinants of Health Care Expenditures and the Contribution of Associated Factors: 16 Cities and Provinces in Korea, 2003-2010: Kimyoung Han, Minho Cho, Kihong Chun; J Prev Med Public Health. 2013;46(6):300-308. Published online November 28, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.6.300

10,858 View
119 Download
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Abstract PDF

Objectives

The purpose of this study was to classify determinants of cost increases into two categories, negotiable factors and non-negotiable factors, in order to identify the determinants of health care expenditure increases and to clarify the contribution of associated factors selected based on a literature review.

Methods

The data in this analysis was from the statistical yearbooks of National Health Insurance Service, the Economic Index from Statistics Korea and regional statistical yearbooks. The unit of analysis was the annual growth rate of variables of 16 cities and provinces from 2003 to 2010. First, multiple regression was used to identify the determinants of health care expenditures. We then used hierarchical multiple regression to calculate the contribution of associated factors. The changes of coefficients (R²) of predictors, which were entered into this analysis step by step based on the empirical evidence of the investigator could explain the contribution of predictors to increased medical cost.

Results

Health spending was mainly associated with the proportion of the elderly population, but the Medicare Economic Index (MEI) showed an inverse association. The contribution of predictors was as follows: the proportion of elderly in the population (22.4%), gross domestic product (GDP) per capita (4.5%), MEI (-12%), and other predictors (less than 1%).

Conclusions

As Baby Boomers enter retirement, an increasing proportion of the population aged 65 and over and the GDP will continue to increase, thus accelerating the inflation of health care expenditures and precipitating a crisis in the health insurance system. Policy makers should consider providing comprehensive health services by an accountable care organization to achieve cost savings while ensuring high-quality care.

Summary

Citations

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The Impact of Public Housing Investments on the Economic Development of Provinces: The Case of Turkey (TOKI)
Banu Tantan, Sevkiye Sence Turk
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Dilek Atılgan, Enver Günay
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The Economic Burden of Epilepsy in Korea, 2010: Jaehun Jung, Hye-Young Seo, Young Ae Kim, In-Hwan Oh, Yo Han Lee, Seok-Jun Yoon; J Prev Med Public Health. 2013;46(6):293-299. Published online November 28, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.6.293

9,850 View
126 Download
11 Crossref

Abstract PDF

Objectives

The purposes of this study were to evaluate the prevalence of epilepsy and to estimate the cost of epilepsy in Korea, 2010.

Methods

This study used a prevalence based approach to calculate the cost of epilepsy. Claims data from the Korean national health insurance and data from the Korea health panel, the Korea National Statistical Office's records of causes of death, and labor statistics were used to estimate the cost of epilepsy. Patients were defined as those who were hospitalized or visited an outpatient clinic during 2010 with a diagnosis of epilepsy (International Classification of Diseases 10th revision codes G40-G41). Total costs of epilepsy included direct medical costs, direct non-medical cost and indirect costs.

Results

The annual prevalence of treated epilepsy was 228 per 100 000 population, and higher in men. The age-specific prevalence was highest for teenagers. The total economic burden of epilepsy was 536 billion Korean won (KW). Indirect cost (304 billion KW) was 1.3 times greater than direct cost (232 billion KW). By gender, the male (347 billion KW) were more burdened than the female (189 billion KW). The estimated cost in young age younger than 20 years old was 24.5% of the total burden of epilepsy.

Conclusions

A significant portion of the economic burden of epilepsy is borne by people in young age. To reduce the economic burden of epilepsy, effective prevention and treatment strategies are needed.

Summary

Citations

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Economic assessment of convulsive status epilepticus: Investigating socioeconomic correlations in hospitalization costs and outcomes in Northern India
Ahmad Ghayas Ansari, Ariba Nasar, Hiba Nasar
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Evaluation of persistence and healthcare utilization in patients treated with anti-seizure medications as add-on therapy: A nationwide cohort study in South Korea
Ji Woong Lee, Jung-Ae Kim, Min Young Kim, Sang Kun Lee
Epilepsy & Behavior.2022; 126: 108459. CrossRef
Cost of Illness of Epilepsy and Associated Factors in Patients Attending Adult Outpatient Department of University of Gondar Referral Hospital, Northwest Ethiopia
Piniel Melkamu, Yaregal Animut, Amare Minyihun, Asmamaw Atnafu, Mezgebu Yitayal
Risk Management and Healthcare Policy.2021; Volume 14: 2385. CrossRef
Cost–benefit analysis, cost-effectiveness analysis, and impact of antiepileptic drugs on the risk of fracture in patients with epilepsy: A nationwide cohort study
Hsin-Hsuan Cheng, Pei-Tseng Kung, Bo-Ren Wang, Li-Ting Chiu, Wen-Chen Tsai
Epilepsy & Behavior.2020; 103: 106851. CrossRef
Introducing big data analysis using data from National Health Insurance Service
EunJin Ahn
Korean Journal of Anesthesiology.2020; 73(3): 205. CrossRef
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Eugen Trinka, Patrick Kwan, ByungIn Lee, Amitabh Dash
Epilepsia.2019; 60(S1): 7. CrossRef
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Neurology.2018; 90(1): 28. CrossRef
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Changwoo Shon, Hyung-Yun Choi, Jae-Jun Shim, So-Youn Park, Kyung Suk Lee, Seok-Jun Yoon, In-Hwan Oh
Japanese Journal of Infectious Diseases.2016; 69(1): 18. CrossRef
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Alla Guekht, Maria Mizinova, Igor Kaimovsky, Oksana Danilenko, Elisa Bianchi, Ettore Beghi
Epilepsy & Behavior.2016; 64: 122. CrossRef

Use of Drug-eluting Stents Versus Bare-metal Stents in Korea: A Cost-minimization Analysis Using Population Data: Hae Sun Suh, Hyun Jin Song, Eun Jin Jang, Jung-Sun Kim, Donghoon Choi, Sang Moo Lee; J Prev Med Public Health. 2013;46(4):201-209. Published online July 31, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.4.201

8,393 View
82 Download
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Abstract PDF

Objectives

The goal of this study was to perform an economic analysis of a primary stenting with drug-eluting stents (DES) compared with bare-metal stents (BMS) in patients with acute myocardial infarction (AMI) admitted through an emergency room (ER) visit in Korea using population-based data.

Methods

We employed a cost-minimization method using a decision analytic model with a two-year time period. Model probabilities and costs were obtained from a published systematic review and population-based data from which a retrospective database analysis of the national reimbursement database of Health Insurance Review and Assessment covering 2006 through 2010 was performed. Uncertainty was evaluated using one-way sensitivity analyses and probabilistic sensitivity analyses.

Results

Among 513 979 cases with AMI during 2007 and 2008, 24 742 cases underwent stenting procedures and 20 320 patients admitted through an ER visit with primary stenting were identified in the base model. The transition probabilities of DES-to-DES, DES-to-BMS, DES-to-coronary artery bypass graft, and DES-to-balloon were 59.7%, 0.6%, 4.3%, and 35.3%, respectively, among these patients. The average two-year costs of DES and BMS in 2011 Korean won were 11 065 528 won/person and 9 647 647 won/person, respectively. DES resulted in higher costs than BMS by 1 417 882 won/person. The model was highly sensitive to the probability and costs of having no revascularization.

Conclusions

Primary stenting with BMS for AMI with an ER visit was shown to be a cost-saving procedure compared with DES in Korea. Caution is needed when applying this finding to patients with a higher level of severity in health status.

Summary

Citations

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A cost analysis comparing telepsychiatry to in-person psychiatric outreach and patient travel reimbursement in Northern Ontario communities
Eva Serhal, Tanya Lazor, Paul Kurdyak, Allison Crawford, Claire de Oliveira, Rebecca Hancock-Howard, Peter C Coyte
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The Socioeconomic Burden of Coronary Heart Disease in Korea: Hoo-Sun Chang, Han-Joong Kim, Chung-Mo Nam, Seung-Ji Lim, Young-Hwa Jang, Sera Kim, Hye-Young Kang; J Prev Med Public Health. 2012;45(5):291-300. Published online September 28, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.5.291

12,545 View
118 Download
31 Crossref

Abstract PDF

Objectives

We aimed to estimate the annual socioeconomic burden of coronary heart disease (CHD) in Korea in 2005, using the National Health Insurance (NHI) claims data.

Methods

A prevalence-based, top-down, cost-of-treatment method was used to assess the direct and indirect costs of CHD (International Classification of Diseases, 10th revision codes of I20-I25), angina pectoris (I20), and myocardial infarction (MI, I21-I23) from a societal perspective.

Results

Estimated national spending on CHD in 2005 was $2.52 billion. The majority of the spending was attributable to medical costs (53.3%), followed by productivity loss due to morbidity and premature death (33.6%), transportation (8.1%), and informal caregiver costs (4.9%). While medical cost was the predominant cost attribute in treating angina (74.3% of the total cost), premature death was the largest cost attribute for patients with MI (66.9%). Annual per-capita cost of treating MI, excluding premature death cost, was $3183, which is about 2 times higher than the cost for angina ($1556).

Conclusions

The total insurance-covered medical cost ($1.13 billion) of CHD accounted for approximately 6.02% of the total annual NHI expenditure. These findings suggest that the current burden of CHD on society is tremendous and that more effective prevention strategies are required in Korea.

Summary

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Special Article

Cost Effectiveness of Interventions to Promote Screening for Colorectal Cancer: A Randomized Trial: Swati Misra, David R. Lairson, Wenyaw Chan, Yu-Chia Chang, L. Kay Bartholomew, Anthony Greisinger, Amy McQueen, Sally W. Vernon; J Prev Med Public Health. 2011;44(3):101-110. Published online May 17, 2010; DOI: https://doi.org/10.3961/jpmph.2011.44.3.101

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Abstract PDF

Objectives

Screening for colorectal cancer is considered cost effective, but is underutilized in the U.S. Information on the efficiency of "tailored interventions" to promote colorectal cancer screening in primary care settings is limited. The paper reports the results of a cost effectiveness analysis that compared a survey-only control group to a Centers for Disease Control (CDC) web-based intervention (screen for life) and to a tailored interactive computer-based intervention.

Methods

A randomized controlled trial of people 50 and over, was conducted to test the interventions. The sample was 1224 partcipants 50-70 years of age, recruited from Kelsey-Seybold Clinic, a large multi-specialty clinic in Houston, Texas. Screening status was obtained by medical chart review after a 12-month follow-up period. An "intention to treat" analysis and micro costing from the patient and provider perspectives were used to estimate the costs and effects. Analysis of statistical uncertainty was conducted using nonparametric bootstrapping.

Results

The estimated cost of implementing the web-based intervention was $40 per person and the cost of the tailored intervention was $45 per person. The additional cost per person screened for the web-based intervention compared to no intervention was $2602 and the tailored intervention was no more effective than the web-based strategy.

Conclusions

The tailored intervention was less cost-effective than the web-based intervention for colorectal cancer screening promotion. The web-based intervention was less cost-effective than previous studies of in-reach colorectal cancer screening promotion. Researchers need to continue developing and evaluating the effectiveness and cost-effectiveness of interventions to increase colorectal cancer screening.

Summary

Citations

Citations to this article as recorded by

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Original Article

Cost-Utility Analysis of the Cochlear Implant.: Hoo Yeon Lee, Hee Nam Kim, Han Joong Kim, Jae Young Choi, Eun Cheol Park; J Prev Med Public Health. 2004;37(4):353-358. Published online November 30, 2004

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Abstract PDF: OBJECTIVE
To determine the quality of life and cost consequences for deaf adults who received a cochlear implant. METHODS: The data from 11 patients, post-lingual deaf adults who received cochlear implants from 1990 to 2002, underwent cost-utility analysis. The average age of the participants was 49.6 years. The main outcomes were direct cost per quality-adjusted life-year (QALY) using the visual analog scale (VAS), health utility index (HUI), EuroQol (EQ-5D), and quality well-being (QWB), with costs and utilities being discounted 3% annually. RESULTS: Recipients had an average of 5.6 years of implant use. Mean VAS scores increased by 0.33, from 0.27 before implantation to 0.60 at survey. HUI scores increased by 0.36, from 0.29 to 0.65, EQ-5D scores increased by 0.26, from 0.52 to 0.78, and QWB scores increased by 0.16, from 0.45 to 0.61. Discounted direct costs were $22, 320, yielding $19, 223/QALY using VAS, $17, 387/QALY using HUI, $24, 604/QALY using EQ-5D, and $40, 474/QALY using QWB. Cost-utility ratios using VAS, HUI, and EQ-5D were all below $25, 000 per QALY, except using QWB. CONCLUSION: Cochlear implants in post-lingual deaf adult have a positive effect on quality of life at reasonable direct costs and appear to produce a net saving to society.; Summary

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