Search

Abstract Introduction Invasive meningococcal disease (IMD) caused by Neisseria meningitidis is a rapidly progressing, rare disease that often presents as meningitis or sepsis. It mostly affects infants and adolescents, with high fatality rates or long-term sequelae. In the Netherlands, serogroup B (MenB) is most prevalent. We aimed to estimate the economic burden of MenB-related IMD between 2015 and 2019, including direct and indirect medical costs from short- and long-term sequelae, from a societal perspective. Methods IMD incidence was based on laboratory-based case numbers from the Netherlands Reference Laboratory for Bacterial Meningitis (Amsterdam UMC, Amsterdam, the Netherlands); there were 74 MenB cases on average per year in the study period 2015–2019. Case-fatality rate (3.8%) and percentage of patients discharged with sequelae (46%) were derived from literature. Direct costs included treatment costs of the acute phase, long-term sequelae, and public health response. Indirect costs were calculated using the human capital (HCA) and friction costs (FCA) approaches, in which productivity losses were estimated for patients and parents during the acute and sequelae phases. Costs were discounted by 4% yearly. Results Estimated costs due to MenB IMD in an annual cohort were €3,094,199 with FCA and €9,480,764 with HCA. Direct costs amounted to €2,974,996, of which 75.2% were related to sequelae. Indirect costs related to sequelae were €52,532 with FCA and €5,220,398 with HCA. Conclusion Our analysis reflects the high economic burden of MenB-related IMD in the Netherlands. Sequelae costs represent a high proportion of the total costs. Societal costs were dependent on the applied approach (FCA or HCA). Graphical Plain Language Summary

Introduction: Invasive meningococcal disease (IMD) caused by Neisseria meningitidis is a rapidly progressing, rare disease that often presents as meningitis or sepsis. It mostly affects infants and adolescents, with high fatality rates or long-term sequelae. In the Netherlands, serogroup B (MenB) is most prevalent. We aimed to estimate the economic burden of MenB-related IMD between 2015 and 2019, including direct and indirect medical costs from short- and long-term sequelae, from a societal perspective. Methods: IMD incidence was based on laboratory-based case numbers from the Netherlands Reference Laboratory for Bacterial Meningitis (Amsterdam UMC, Amsterdam, the Netherlands); there were 74 MenB cases on average per year in the study period 2015–2019. Case-fatality rate (3.8%) and percentage of patients discharged with sequelae (46%) were derived from literature. Direct costs included treatment costs of the acute phase, long-term sequelae, and public health response. Indirect costs were calculated using the human capital (HCA) and friction costs (FCA) approaches, in which productivity losses were estimated for patients and parents during the acute and sequelae phases. Costs were discounted by 4% yearly. Results: Estimated costs due to MenB IMD in an annual cohort were €3,094,199 with FCA and €9,480,764 with HCA. Direct costs amounted to €2,974,996, of which 75.2% were related to sequelae. Indirect costs related to sequelae were €52,532 with FCA and €5,220,398 with HCA. Conclusion: Our analysis reflects the high economic burden of MenB-related IMD in the Netherlands. Sequelae costs represent a high proportion of the total costs. Societal costs were dependent on the applied approach (FCA or HCA). Graphical Plain Language Summary: [ABSTRACT FROM AUTHOR]

The paper discusses the Russian features of management accounting of production costs in medium and small enterprises, which being properly organized and functioning, provide an opportunity to use information the performance improving of the organization. Its multi-variance, enshrined in domestic accounting standards, involves the use of various approaches to the formation of costs, in particular, the normative method, which is the subject of this study. Based on the results of the work, as an optimization measure for material-intensive industries, the authors propose to use material costs as a basis for distributing indirect costs and ones for auxiliary production instead of the major employees’ wages. The methodology is based on a systematic and dialectical approach, observation, systematization, analysis, grouping, classification and generalization of data; as well as on such accounting tools as costing and double entry. The specific experience in management cost accounting using the example of an enterprise producing paving tiles will give an opportunity to develop a practical base of works out in determining the stages of costing and the features of the costs specifications of the main and auxiliary production based on the facts of economic life.

The calculation of aircraft cost is stated necessary to assess the economic feasibility of their operation, as well as in agriculture, the possibility of acquiring new ones, and to justify air transportation tariffs. (Research purpose) The research purpose is to substantiate the methodology and calculate the prime cost of using BAS-137 VIM unmanned aerial system for the application of pesticides, fertilizers and other agrochemicals. (Materials and methods) When developing the methodology for calculating the prime cost of using an unmanned aerial system for applying pesticides and fertilizers, the Guidelines for determining the cost of domestic and international flights for Russian airlines were used. (Results and discussion) We have obtained the main dependences of the prime cost of using BAS-137 VIM for the introduction of working fluids: on the application rate, the field rut length, the distance of approach to the refueling place, and the operating flight speed. (Conclusions) The authors developed a methodology for calculating the prime cost of using an unmanned aerial system for applying pesticides and fertilizers, including direct and indirect operating costs. It was found out that at the working fluid application rates of 5-100 liters per hectare, the changes in the cost of using BAS-137 VIM are within the range from 280.9 to 1315.5 rubles per hectare. At an application rate of 10 liters per hectare within the rut length of 0.3-2.0 kilometers, the application prime cost is 307.1-529.5 rubles per hectare. It was obtained that at the application rates of 5-20 liters per hectare and the rut length of 0.6-1.0 kilometers, the prime cost will be the lowest, within the range of 264-369 rubles per hectare at an operating flight speed of 60 kilometers per hour and within the range of 482-587 rubles per hectare at a flying speed of 30 kilometers per hour. It was shown that with a twofold increase in BAS-137 VIM operating speed, the prime cost decreases by 1.2-1.5 times.

The method of costs allocation for equipment maintenance and operation has been analyzed. It is especially important to properly allocate costs by type of product at those industrial enterprises, where a complex range of products is produced as a result of a single production process. The main method for calculating the product cost unit in industry is calculating the product cost and expense budget. Differentiated methods should be used in allocating indirect costs between particular products or types of products, depending on the nature of a cost, its economic nature, and its connection with the process of forming production cost. In calculating production cost, costs for production maintenance and management are identified, having a very diverse composition. A big group of expenses connected with equipment operation (depreciation on operating equipment and vehicles; maintenance repair of the equipment and shop-floor travelers; wear of low-value tools; the wages of workers engaged in equipment maintenance; maintenance materials) is singled out in a special spending pattern. It is established that quite accurate results are also used in a number of industries. For example, the method of allocation of indirect costs allows the maintenance costs and equipment operation costs to be reasonably allocated, thus making it possible to more accurately calculate the production cost and make management decisions on this basis. It should be noted that, since indirect costs include a large number of various production costs, which differ in many economic respects, allocation of all indirect costs should not be carried out on a single basis.

Teamir Abadi,1 Anagaw Derseh Mebratie2 1Health Bureau Health Care Financing Reform Case Team, Tigray Regional Health Bureau, Mekelle, Ethiopia; 2School of Public Health, Addis Ababa University, Addis Ababa, EthiopiaCorrespondence: Teamir AbadiTigray Regional Health Bureau, Mekelle, EthiopiaTel +251914423809Fax +251344408830Email teamirabadi2@gmail.comBackground: The government of Ethiopia introduced an exemption policy that guarantees free maternal healthcare services from public providers. This policy aims to ensure financial protection and enhance utilization of services especially for low-income people. However, patients in most cases incur health expenditure when seeking health care. This paper aims to assess direct and indirect medical costs of treating maternal complications and associated factors at a public hospital in Northern Ethiopia.Methods: An institution-based cross-sectional study design was carried on 267 mothers with complications. A multivariate linear regression model at 5% level of significance was used to analyze factors driving the outcome.Results: The median cost was more than seven times the monthly minimum wage, and this may cause severe financial consequences for the poor. Direct medical costs accounted for the major share (68%) of total cost, and this was mainly driven by lack of diagnostic services at public facilities and paying for private providers. Expenditure for treatment of maternal complications is positively associated with income, absence from work, travel time to the facility and being diagnosed at a private facility.Conclusion: The overall evidence in this study poses a concern about the context in which fee exemption reforms are being implemented.Keywords: maternal complications, treatment, direct and indirect costs, Mekelle, Ethiopia

Background: Multiple sclerosis (MS) places a considerable financial burden on the society. However, data quantifying the contemporary cost burden in France are lacking. Objective: This cost-of-illness study aimed to estimate the direct and indirect costs associated with MS in France. Methods: Between October 2020-November 2020, 208 French adults with a confirmed diagnosis of MS were recruited via MSCopilot® (a new MS self-assessment digital solution) and several MS patient networks. Indirect costs were estimated using a combination of top-down and bottom-up approaches. Direct costs were retrieved from Assurance Maladie (i.e. national system of health insurance) publications. Out-of-pocket expenses (OOPEs) incurred by MS patients were also reported. All costs were expressed in €2020. Data from the survey were extrapolated to the overall French MS population. Results: MS exerted an annual cost burden of €2.7 billion on the French society (indirect costs: €1.3 billion; direct costs: €1.4 billion). Mean annual costs were €27,164.7 per-patient, with indirect and direct costs accounting for 48.1% and 51.9% of the total annual costs, respectively. OOPEs contributed over €90 million to the total annual costs. Conclusions: MS imposes a substantial cost burden on the French society, with approximately half of the total annual costs driven by indirect costs. [ABSTRACT FROM AUTHOR]

Daniel Asrat Kassa,1 Solomon Mekonnen,2 Adane Kebede,1 Tsegaye Gebremedhin Haile1 1Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; 2Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Tsegaye Gebremedhin HaileDepartment of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, PO Box 196, Gondar, EthiopiaTel +251-921279362Email tsegishg27@gmail.comPurpose: 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.Patients and Methods: 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.Results: 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.Conclusion: 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.Keywords: burden of ESRD, direct costs, indirect costs, GLM, hemodialysis, Ethiopia

Occupational health and safety (OHS), as a fundamental human right, forms the basis of the obligation of employers to employees, requiring employers to do what is right. Responsible management practices encompass cognisance of sustainability, responsibility as well as legal, financial and moral aspects related to OHS compliance. As point of departure, an overview of core OHS criteria for small businesses is provided, with reference to awareness of these criteria in the G20 countries. This article utilises quantitative and qualitative data analysis to examine the reasons why small business owners/managers comply with occupational health and safety directives, such as the Occupational Health and Safety Act (OHS Act) and the Compensation for Occupational Injuries and Diseases Act (COIDA) in South Africa, determine if such reasons for compliance culminate in actual compliance, and determine the perceived effect of direct and indirect costs of OHS incidents. A total of 350 small business owners/managers took part in this study. The findings indicate that whilst small business owners/ managers realise the rationale behind OHS compliance in terms of moral, legal and financial components, moral aspects related to OHS compliance are deemed most important. Small business owners/managers thus seem to realise the importance of OHS compliance. However, when it comes to adhering to their responsibility in terms of general safety regulations of the OHS Act and registration with the Compensation Fund as specified in the COIDA (as examples of actual compliance), small business owners/managers’ compliance does not reflect such realisation. A model to enhance OHS standards in small businesses, encompassing legal, moral and financial rationales, is proposed. [ABSTRACT FROM AUTHOR]

Concerns related to production costs in general, their analysis and, implicitly, the methods used for this purpose derive from the need of economic agents to produce high quality products, while seeking to incur costs as low as possible. It can be said that this issue must be given the necessary attention because only through a continuous analysis of production costs companies may survive and develop in an increasingly unfavorable, unstable economic environment, marked by fierce competition in all areas of activity and a continuous increase in the prices of used resources. Cost analysis represents an important area in the efficient operation of the enterprise in terms of limited resources, its task being to provide the necessary information to managers in order to develop strategic decisions. [ABSTRACT FROM AUTHOR]

Background: Third leading cause of mortality in the world is cancer, with more than 12 million new cases and nearly 7.6 million deaths in 2007. The time estimation of healthcare costs of patients with cancer is an important component in developing national programs and policies of cancer. The present study aimed to investigate the epidemiology and costs of hospitalization of patients with cancer who were admitted to a regional referral center of the eastern Iran. Methods: The present research was descriptive and had a cross-sectional and population-based design. It was conducted on all patients with cancer in a regional referral center in eastern Iran in 2018. The files of hospitalized cancer patients with disease codes of C0 to D48/9 and all patients who were admitted to the center for the treatment of cancer in 2018 and those who were discharged, were extracted and classified based on international codes of ICD10. Costs of the present study consisted of four categories including direct costs of cancer patients, direct costs of admission due to the cancer, direct outpatient costs, and indirect costs. Statistical data analysis was done by using criteria such as frequency, mean, and standard deviation through STATA Version 11. Results: During the study, 1467 cancer patients were referred to Omid Hospital of Mashhad. Among them, 49.9% were males and 50.1% were females. 183 patients were in age range of 56-60 years. The highest prevalence and hospitalization were related to cancer of gastrointestinal organs (36%), and the highest hospital cost belonged to cancers involving bone, cartilage and joints (51.855 USD). The total cost of treating cancer patients was 1074990 USD and the average cost of cancer patients was 73278 USD per patient. Hoteling with a portion of 28% comprised the highest cost. The patients’ share of out of pocket payment for treatment cost was 7% and the governmental share was 6%. The highest cost of treatment for cancer patients was paid by insurance companies (87%). Discussion: The research results indicated that cancer patients bore high direct and indirect costs during their treatment; hence, new policies for reducing costs in these cases are needed. The increasing number of cancer patients and their treatment costs requires the active participation of all responsible organizations along with continuing financial support by financial institutions such as banks or charities and the development of appropriate government policies on supporting these patients.

Aim: to assess the socio-economic burden of smoking in the Russian Federation for 2017.Materials and methods. The socio-economic burden was calculated and extrapolated to the entire population of smokers in Russia and then compared with equal sized populations of quitters and non-smokers.Results. In 2017, the burden of tobacco smoking (including the direct costs of medical care and payment for temporary disability, as well as indirect costs - the under-received gross domestic product (GDP) due to temporary disability) was 510.6 billion rubles. The difference between the smokers and the equal-sized non-smoking population is 327.6 billion rubles. The difference between the smokers and the equalsized population of quitters was 216.1 billion rubles.Conclusion. Costs associated with smoking are sizable. Helping quit tobacco smoking (government anti-smoking measures, pharmacotherapy etc.) will not only improve the quality of life and health expectancy of smokers but also save a considerable amount of budget funds.

Background: Major neurocognitive disorders (major NCD) predominantly affect the elderly. Major NCD results in significant morbidity and socioeconomic burden.Objectives: To estimate the individual cost of care of a person with major NCD according to disease severity and component costs.Methods and Material: Fifty patients of major NCD with primary caregivers attending memory clinic of tertiary care center were included. A detailed questionnaire administered after inclusion provided demographic and clinical information. Caregivers were interviewed about details of care provided. Cognitive function was assessed by Hindi mental state examination (HMSE), and major NCD severity was determined by clinical dementia rating scale (CDR).Results: The annual cost of care per patient with mild to moderate and severe major MCD was INR 78288 and INR 167808, respectively. Costs increased with increasing severity of the disease. Direct nonmedical costs were significantly higher than direct medical costs in severe major NCD group and vice versa was found in mild to moderate major NCD group.Conclusion: Increasing population of elderly and prevalence of major NCD suggest an economic burden on caring families and hence the government. Comprehensive health policy toward providing affordable care to people with major NCD is the need of the hour. [ABSTRACT FROM AUTHOR]

Introduction: It is essential to use the correct injection technique (IT) to avoid skin complications such as lipohypertrophy (LH), local inflammation, bruising, and consequent repeated unexplained hypoglycemia episodes (hypos) as well as high HbA1c (glycated hemoglobin) levels, glycemic variability (GV), and insulin doses. Structured education plays a prominent role in injection technique improvement. The aim was to assess the ability of structured education to reduce (i) GV and hypos, (ii) HbA1c levels, (iii) insulin daily doses, and (iv) overall healthcare-related costs in outpatients with T2DM who were erroneously injecting insulin into LH. Methods: 318 patients aged 19–75 years who had been diagnosed with T2DM for at least 5 years, were being treated with insulin, were routinely followed by a private network of healthcare centers, and who had easily seen and palpable LH nodules were included in the study. At the beginning of the 6-month run-in period (T−6), all patients were trained to perform structured self-monitoring of blood glucose and to monitor symptomatic and severe hypos (SyHs and SeHs, respectively). After that (at T0), the patients were randomly and equally divided into an intervention group who received appropriate IT education (IG) and a control group (CG), and were followed up for six months (until T+6). Healthcare cost calculations (including resource utilization, loss of productivity, and more) were carried out based on the average NHS reimbursement price list. Results: Baseline characteristics were the same for both groups. During follow-up, the intra-LH injection rate for the CG progressively decreased to 59.9% (p < 0.001), a much smaller decrease than seen for the IG (1.9%, p < 0.001). Only the IG presented significant decreases in HbA1c (8.2 ± 1.2% vs. 6.2 ± 0.9%; p < 0.01), GV (247 ± 61 mg/dl vs. 142 ± 31 mg/dl; p < 0.01), insulin requirement (− 20.7%, p < 0.001), and SeH and SyH prevalence (which dropped dramatically from 16.4 to 0.6% and from 83.7 to 7.6%, respectively; p < 0.001). In the IG group only, costs—including those due to the reduced insulin requirement—decreased significantly, especially those relating to SeHs and SyHs, which dropped to €25.8 and €602.5, respectively (p < 0.001). Conclusion: Within a 6-month observation period, intensive structured education yielded consistently improved metabolic results and led to sharp decreases in the hypo rate and the insulin requirement. These improvements resulted in a parallel drop in overall healthcare costs, representing a tremendous economic advantage for the NHS. These positive results should encourage institutions to resolve the apparently intractable problem of LH by financially incentivizing healthcare teams to provide patients with intensive structured education on proper injection technique. Trial Registration: Trial registration no. 118/15.04.2018, approved by the Scientific and Ethics Committee of Campania University "Luigi Vanvitelli," Naples, Italy, and by the institutional review board (IRB Min. no. 9926 dated 05.05.2018). [ABSTRACT FROM AUTHOR]

ABSTRACT Carnivore depredation gives rise to direct costs for killed and injured animals as well as indirect costs due to productivity losses and additional labor requirements. Our aim was to investigate indirect costs to sheep farmers in Sweden due to carnivore depredation and presence. We estimated these costs using survey data describing conditions in 2013. Reproduction and time spent on fence maintenance and taking care of animals were analyzed to isolate effects of carnivore exposure from other factors that affect these variables. Results indicate that both high carnivore densities and attacks are associated with comparatively lower sheep reproduction. Farmers who experienced an attack spent much more on labor for maintaining fences, searching for lost animals, and bringing the animals in for the night. Results suggest that the indirect cost per adult female sheep is EUR23 for nonattacked herds in areas with high carnivore densities; EUR71 in herds that were attacked and where sheep are kept on fenced grazing land; and EUR100 on attacked summer‐pasture farms, where free‐range grazing is applied. A flat rate compensation per adult female sheep, differentiated between herds in areas with high carnivore density that have not been attacked and herds that have been attacked could be used to compensate sheep farmers for these costs. © 2019 The Wildlife Society.

The method of costs allocation for equipment maintenance and operation has been analyzed. It is especially important to properly allocate costs by type of product at those industrial enterprises, where a complex range of products is produced as a result of a single production process. The main method for calculating the product cost unit in industry is calculating the product cost and expense budget. Differentiated methods should be used in allocating indirect costs between particular products or types of products, depending on the nature of a cost, its economic nature, and its connection with the process of forming production cost. In calculating production cost, costs for production maintenance and management are identified, having a very diverse composition. A big group of expenses connected with equipment operation (depreciation on operating equipment and vehicles; maintenance repair of the equipment and shop-floor travelers; wear of low-value tools; the wages of workers engaged in equipment maintenance; maintenance materials) is singled out in a special spending pattern. It is established that quite accurate results are also used in a number of industries. For example, the method of allocation of indirect costs allows the maintenance costs and equipment operation costs to be reasonably allocated, thus making it possible to more accurately calculate the production cost and make management decisions on this basis. It should be noted that, since indirect costs include a large number of various production costs, which differ in many economic respects, allocation of all indirect costs should not be carried out on a single basis. [ABSTRACT FROM AUTHOR]

Margarethe E Wacker,1 Katharina Kitzing,1,2 Rudolf A Jörres,3 Reiner Leidl,1,4 Holger Schulz,5 Stefan Karrasch,3,5 Annika Karch,6 Armin Koch,6 Claus F Vogelmeier,7 Rolf Holle1 On behalf of the COSYCONET Study Group 1Institute of Health Economics and Health Care Management, Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Neuherberg, 2Institute for Medical Information Processing, Biometrics and Epidemiology (IBE), LMU Munich, 3Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, 4Institute of Health Economics and Health Care Management, Munich Center of Health Sciences, Ludwig-Maximilians-Universität München, Munich, 5Institute of Epidemiology I, Helmholtz Zentrum Mu¨nchen GmbH, German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Neuherberg, 6Institute for Biostatistics, Hannover Medical School, Hannover, 7Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Member of the German Center for Lung Research, Marburg, Germany Background: Although patients with COPD often have various comorbidities and symptoms, limited data are available on the contribution of these aspects to health care costs. This study analyzes the association of frequent comorbidities and common symptoms with the annual direct and indirect costs of patients with COPD. Methods: Self-reported information on 33 potential comorbidities and symptoms (dyspnea, cough, and sputum) of 2,139 participants from the baseline examination of the German COPD cohort COSYCONET was used. Direct and indirect costs were calculated based on self-reported health care utilization, work absence, and retirement. The association of comorbidities, symptoms, and COPD stage with annual direct/indirect costs was assessed by generalized linear regression models. Additional models analyzed possible interactions between COPD stage, the number of comorbidities, and dyspnea. Results: Unadjusted mean annual direct costs were €7,263 per patient. Other than COPD stage, a high level of dyspnea showed the strongest driving effect on direct costs (+33%). Among the comorbidities, osteoporosis (+38%), psychiatric disorders (+36%), heart disease (+25%), cancer (+24%), and sleep apnea (+21%) were associated with the largest increase in direct costs (p

Diabetes is projected to become one of the world's main disabler and killer within the next 25 years. Type 2 diabetes mellitus (T2DM) due to its chronicity and incident complications is not only consuming patient's household budget but also the overall healthcare budget. To estimate the annual cost incurred and proportion of family income spent for management of T2DM in the community, a community-based cross-sectional study was conducted among T2DM patients aged ≥ 40 years residing in the field practice area of a Medical College in Karnataka. A total of 809 subjects were included using stratified random sampling with proportionate sample technique. A pretested questionnaire was used to assess direct and indirect costs incurred for disease management in the last 1 year. Data was entered and analyzed using SPSS version 15.0. The annual median (IQR) total cost incurred for the management of diabetes mellitus was estimated to be USD 73.2 which included direct cost of USD 62.2 (27.9–138.2) and indirect cost of USD 6.7 (2.2–22.6). The direct medical cost included USD 5.2 (< 1–9.43), USD 5.2 (2.9–10.4), USD 58.6 (20.8–124.0), and USD 217.7 (116.1–718.6) per person annually for consultation, investigation, medications, and hospitalization, respectively. The direct non-medical cost included USD 3.8 (1.7–10.8) and USD 3.0 (2.0–5.2) annually for the travel and food. On an average, 3% and 21% of the total family income was spent on outpatient and inpatient services, respectively. Annual cost incurred predominantly included direct costs of which medication and hospitalization expenses contributed a major portion. [ABSTRACT FROM AUTHOR]

Background. This paper presents a case study of an automated clinical laboratory in a large urban academic teaching hospital in the North of Italy, the Spedali Civili in Brescia, where four laboratories were merged in a unique laboratory through the introduction of laboratory automation. Materials and Methods. The analysis compares the preautomation situation and the new setting from a cost perspective, by considering direct and indirect costs. It also presents an analysis of the turnaround time (TAT). The study considers equipment, staff and indirect costs. Results. The introduction of automation led to a slight increase in equipment costs which is highly compensated by a remarkable decrease in staff costs. Consequently, total costs decreased by 12.55%. The analysis of the TAT shows an improvement of nonemergency exams while emergency exams are still validated within the maximum time imposed by the hospital. Conclusions. The strategy adopted by the management, which was based on re-using the available equipment and staff when merging the pre-existing laboratories, has reached its goal: introducing automation while minimizing the costs.

Modern dünyada inşaat projelerinin maliyetleri: henüz ”ihtiyaç” ortaya çıktığı andan itibaren önemle üzerinde çalışılması; tasarım, ölçüm, ön maliyet uygulama ve kullanım evreleri ile birlikte yıkım ve temizleme işlemlerini de içeren “yaşam boyu maliyet” döngüsü içinde irdelenmesi gereken bir konu mahiyetinde bulunmaktadır. Tarih boyunca önemli inşaat projelerinin dizayn ve yönetim uygulamaları ile hayata geçirdikleri uygulamaların içinde maliyet hesaplama ve yönetim uygulamalarının da büyük önem arz ettiği malumdur. Yapımları yüzlerce yıl süren yapıların sadece teknik yetersizlikten değil ekonomik şartlardan da zamansal olarak etkilendiği bilinmektedir. Projelendirme ve süre sınırları belirlenen bir yapım projesinin ihaleye çıkılması demek, bu projenin belirtilen kalite ve süre şartları kapsamında en uygun maliyetle nasıl ve kim tarafından vücuda getirilebileceğinin belirlenmesi anlamına gelmektedir. Her yapım projesi kendine has nitelikler içermekte ve her proje üzerinde tüm teknik, mali, ekonomik analizlerin yapılmasının yanı sıra maliyet analizlerinin de gereken doğrulukta ve nitelikte yapılarak sürekli izlenmesi; proje amaçlarının gerçekleştirilmesi yolunda en önemli uygulamalar arasında yer almaktadır. Her taahhütçü firmada bu doğrultuda hesaplamalar ve uygulamalar yaparak; geçmiş bilgilerini harmonize edip sürekli gelişen bir bilgi bankası oluşturarak hayati kıymeti olan verilerini kendi kullanımına hazır hale getirmelidir. Bu çalışmada; yurdumuzda ve dünyada yapım firmalarının maliyet belirleme ve yönetme uygulamalarına ait literatür araştırılıp, Bursa’da faaliyet gösteren orta ve küçük ölçekli inşaat firmalarında görev yapan uzman teknik ve idari personellere yapılan bir anket yardımı ile bu firmalarca; hangi tip inşaat projeleri için hangi maliyet hesaplama yaklaşımlarının kullanıldığı, direk ve endirekt maliyetlerin ilişkilerinin nasıl gerçekleştirildiği ve maliyet yönetimi/kontrolü uygulamalarının nasıl yapıldığı ile ilgili veriler elde edilmiştir. Edinilen bilgiler, tablolar ve grafikler yardımı ile anlamlandırılmış, istatistiki analizler yapılmıştır. Elde edilen bulgular yardımı ile daha bilinçli ve donanımlı tercihler ve uygulamalar yapması beklenen yapım firmalarımızın; hata düzeyi en düşük derecede olan maliyet tahminleri yapmaları ve ulusal ekonominin gelişimine dünya inşaat sektöründe daha fazla yer almaları için katkıda bulunulması ümit edilmektedir

This paper examines the possibility of application of the activity-based costing in a company engaged in drying fruit. Activity Based Costing (ABC) was developed due to the shortcomings of traditional cost accounting systems, which was shown to have serious limitations, on one hand, and due to the need for more accurate cost price, on the other. This is of great importance for business decision making, which requires quality data and information, because the intense technical and technological progress has significantly altered the environment companies operate in. Along with this fact, major changes in cost structure occurred, which reflected through the increase of the indirect cost portion, and decrease of direct labor and material costs. Traditional cost accounting methods allocate indirect production costs using keys which are no longer appropriate for the new circumstances, and therefore typically allocate unreasonably high amount of indirect costs to those products which are produced in larger series. ABC cost accounting system firstly allocates indirect costs to pre-defined activities, and afterwards carries them to cost and profit drivers. The application of ABC costing in Serbia is at the very beginning. Having in mind that the privatization and the restructuring phase in the economy is followed by the establishment of a new management with fresh ideas, this can be a good timing for companies to introduce modern approach and modern methods of cost accounting. ABC method is very convenient for application in service companies, food processing industry, confectionery companies, driers, sugar refineries, breweries, dairies, mills etc. [Projekat Ministarstva nauke Republike Srbije, br. III 46001, Razvoj i primena novih i tradicionalnih tehnologija u proizvodnji konkurentnih prehrambenih proizvoda sa dodatom vrednošću na evropsko i svetsko tržište - Stvorimo bogatstvo iz bogatstva Srbije]

Purpose: We aimed to evaluate the excess direct and indirect costs associated with epilepsy.Methods: From the Danish National Patient Registry (1998-2013), we identified people within all ages with an epilepsy diagnosis and matched them to control individuals. Additionally, partners of people with epilepsy were identified, who were compared with control partners. Direct costs included frequencies and costs of hospitalizations and weighted outpatient use according to diagnosis-related group, and specific outpatient costs based on data from the Danish Ministry of Health. The use and costs of drugs were based on data from the Danish Medicines Agency. The frequencies of visits and hospitalizations, and costs from general practice were derived from data from the National Health Security. Indirect costs included labor supply-based income data, and all social transfer payments obtained from Coherent Social Statistics.Results: A greater percentage of people with epilepsy and their partners compared with respective control subjects received social services (sick pay or disability pension). Those with epilepsy had a lower employment rate than did controls for equivalent periods up to eight years before the diagnosis was made. Mortality was significantly higher in people with epilepsy than in control individuals (hazard ratio 2.38 (95% CI: 2.34, 2.41). The additional direct and indirect annual costs of epilepsy compared with controls were €11,223 for persons with epilepsy and €2,494 for their partners.Conclusion: Epilepsy has major socioeconomic consequences for individual patients, their partners and society. [ABSTRACT FROM AUTHOR]

Se realizó un estudio descriptivo y retrospectivo para la evaluación económica parcial, del tipo descripción de costos, de la atención hospitalaria y vigilancia de laboratorio de 22 196 pacientes con presunto diagnóstico de dengue, ingresados en 3 hospitales del municipio de Santiago de Cuba durante la epidemia ocurrida en el bienio 2006-2007. Se determinaron los costos directos e indirectos de hospitalización y vigilancia de laboratorio, y se revisó detalladamente la documentación económica existente en los diferentes centros de costes. De la población santiaguera, 2,3 % estaba afectada por dengue, con preponderancia de la forma clásica y confirmación en 50 % de los que ingresaron. Predominaron los costos totales por concepto de hospitalización ($ 11 246 037,18), que representaron 95,1 %, de los cuales 79,8 % provenían de gastos directos y eran superiores a los originados por la vigilancia de laboratorio. Se recomendó realizar una estimación de los gastos generados por la lucha antivectorial y las campañas educativas durante esta epidemia, como complemento de esta investigación.A descriptive and retrospective study was carried out for the partial economic evaluation, of cost description type, of the hospital care and laboratory monitoring of 22 196 patients with presumptive diagnosis of dengue, admitted in 3 hospitals of Santiago de Cuba municipality during the epidemic occurred in 2006 - 2007. The direct and indirect costs of hospitalization and laboratory monitoring were determined, and the existing economic data were reviewed in detail in different cost centers. Of the Santiago population, 2.3% were affected by dengue, with a predominance of the classic form and confirmation in 50% of those admitted The total expenses for hospitalization ($11 246 037,18) prevailed, representing 95.1%, of which 79.8% came from direct expenses and were higher than those arising from laboratory monitoring. It was recommended to estimate the expenses incurred by the vector control and educational campaigns during this epidemic as a complement of this study.

Objective. To evaluate direct and indirect costs per quality adjusted life year (QALY) for different initial treatment strategies in very early RA. Methods. The 1-year data of the treatment in the Rotterdam Early Arthritis Cohort trial were used. Patients with a high probability (>70%) according to their likelihood of progressing to persistent arthritis, based on the prediction model of Visser, were randomized into one of following initial treatment strategies: (A) initial triple DMARD therapy (iTDT) with glucocorticoids (GCs) intramuscular (n = 91); (B) iTDT with an oral GC tapering scheme (n = 93); and (C) initial MTX monotherapy (iMM) with GCs similar to B (n = 97). Data on QALYs, measured with the Dutch EuroQol, and direct and indirect cost were used. Direct costs are costs of treatment and medical consumption, whereas indirect costs are costs due to loss of productivity. Results. Average QALYs (S.D.) for A, B and C were, respectively, 0.75 (0.12), 0.75 (0.10) and 0.73 (0.13) for Dutch EuroQol. Highest total costs per QALY (S.D.) were, respectively, €12748 (€ 18767), € 10380 (€15 608) and €17 408 (€21 828) for strategy A, B and C (P = 0.012, B vs C). Direct as well as indirect costs were higher with iMM (strategy C) compared with iTDT (strategy B). Higher direct costs were due to ~40% more biologic usage over time. Higher indirect costs, on the other hand, were caused by more long-term sickness and reduction in contract hours. iTDT was>95% cost-effective across all willingness-to-pay thresholds compared with iMM. Conclusion. iTDT was more cost-effective and had better worker productivity compared with iMM. [ABSTRACT FROM AUTHOR]

Background: Practices regarding hospitalisation of children at diagnosis of type 1 diabetes vary both within countries and internationally, and high-quality evidence of best practice is scarce. The objective of this study was to close some of the gaps in evidence by comparing two alternative regimens for children diagnosed with type 1 diabetes: hospital-based care and hospital-based home care (HBHC), referring to specialist care in a home-based setting. Methods: A randomised controlled trial, including 60 children aged 3–15 years, took place at a university hospital in Sweden. When the children were medically stable, they were randomised to either the traditional, hospital-based care or to HBHC. Results: Two years after diagnosis there were no differences in HbA1c (p = 0.777), in episodes of severe hypoglycaemia (p = 0.167), or in insulin U/kg/24 h (p = 0.269). Over 24 months, there were no statistically significant differences between groups in how parents’ reported the impact of paediatric chronic health condition on family (p = 0.138) or in parents’ self-reported health-related quality of life (p = 0.067). However, there was a statistically significant difference regarding healthcare satisfaction, favouring HBHC (p = 0.002). In total, healthcare costs (direct costs) were significantly lower in the HBHC group but no statistically significant difference between the two groups in estimated lost production (indirect costs) for the family as a whole. Whereas mothers had a significantly lower value of lost production, when their children were treated within the HBHC regime, fathers had a higher, but not a significantly higher value. The results indicate that HBHC might be a cost-effective strategy in a healthcare sector perspective. When using the wider societal perspective, no difference in cost effectiveness or cost utility was found. Conclusions: Overall, there are only a few, well-designed and controlled studies that compare hospital care to different models of home care. The results of this study provide empirical support for the safety and feasibility of HBHC when a child is diagnosed with type 1 diabetes. Our results further indicate that the model of care may have an impact on families’ daily living, not only during the initial period of care but for a longer period of time. [ABSTRACT FROM AUTHOR]

Objectives: This study evaluated the association of body mass index (BMI) with health-related quality of life (HRQoL), health utilities, health care resource utilization, productivity, activity impairment, and the associated costs. Methods: Results were from the 2013 EU5 (France, Germany, Italy, Spain, UK) National Health and Wellness Survey, a nationally representative, online survey of respondents aged ≥18 years. Analyses focused on normal weight (BMI ≥18.5 kg/m2 and BMI ,25 kg/m2), overweight (BMI ≥25 kg/m2 and BMI <30 kg/m2), Obese Class (OC) I (BMI ≥30 kg/m2 and BMI <35 kg/m2), OC II (BMI ≥35 kg/m2 and BMI <40 kg/m2), and OC III (BMI ≥40 kg/m2) respondents. Outcomes included HRQoL (Short Form [SF]-36v2), health utilities (SF-six dimension [6D]), productivity loss (Work Productivity and Activity Impairment questionnaire), and resource utilization (provider visits, emergency room visits, and hospitalizations) in the past 6 months. Direct and indirect costs were estimated from the literature. Generalized linear regression models predicted outcomes as a function of BMI, adjusting for covariates (age, sex, comorbidities). Results: Among 58,364 respondents, 46.9% were normal weight, 34.5% were overweight, 12.5% were OC I, 4.0% were OC II, and 2.1% were OC III. Metabolic comorbidities increased as BMI increased. After adjustments, all three OC respondents exhibited significantly lower HRQoL than normal weight respondents. Health utilities (normal weight: 0.720; overweight: 0.718; OC I: 0.703; OC II: 0.683; OC III: 0.662) declined with an increase in BMI (all P<0.05 vs normal). Among employed respondents (57.7%), overall work impairment increased as BMI increased. Normal (vs all OCs) had lower activity impairment and fewer provider visits, lower indirect costs (normal weight: €7,974; overweight: €7,825; OC I: €8,465; OC II: €9,394; OC III: €10,437), and lower total direct costs (normal weight: €516; overweight: €553; OC I: €583; OC II: €605; OC III: €717), all P<0.05. Conclusion: Increased BMI was associated with worse HRQoL, greater comorbidities, higher direct and indirect costs, and worse health utilities. Weight management may improve patient outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Malaria remains a real problem of public health. Its hospital care generates important expenditures for affected households. The present study aimed to estimate direct and indirect costs of severe child malaria in reference hospitals in Kinshasa. Methodology: This prospective study included 1,350 children under 15 years of age suffering from severe malaria. The study was performed between 1 January and 30 November, 2011. Data were collected in nine reference hospitals. The studied parameters were direct pre-hospital costs, direct hospital costs, and indirect costs. Costs were assessed from the household point of view. Results: Median costs associated with the disease ranged from 114 USD in confessional hospitals to 173 USD in state hospitals and 308 USD in private hospitals. Direct pre-hospital median costs ranged between 3 and 11 USD. Direct hospital costs reached 72 USD in confessional hospitals, 139 USD in state hospitals, and 254 USD in private hospitals. Indirect costs ranged from 22 USD in state hospitals to 30 USD in confessional hospitals and 46 USD in private hospitals, regardless of the status of the accompanying parent or guardian. Factors explaining the variability of costs were the neurological form of malaria, indirect recourse to hospital, socioeconomic level, type of prescribing person, child's status upon leaving the hospital, and child's transfusion status. Conclusions: The care of severe child malaria appeared to be expensive in private and state hospitals. A state subsidy of health care and regulation of the private sector would contribute to the reduction of malaria's financial impact. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Agricultural Sciences, Belgrade is the property of University of Belgrade, Faculty of Agriculture and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective The study aims to examine real-world effects of duloxetine treatment for low back pain ( LBP). Methods The study identified employees with ≥1 LBP diagnosis and ≥1 duloxetine prescription within a year after LBP diagnosis from a privately insured claims database (2004-2007). Duloxetine-treated employees were propensity score matched to employees initiating another pharmacological/noninvasive treatment in the same month from LBP diagnosis. Treatment patterns and costs were compared over the 6 months following treatment initiation. Results Relative to controls, duloxetine-treated employees (N = 753) had significantly lower rates of other pharmacological/noninvasive therapies and a similar LBP surgery rate (1.7% vs 2.8%, P = 0.1573). Duloxetine-treated employees, despite higher pharmacy costs, had similar direct (health care) costs ($4,935 vs $5,649, P = 0.2662), and significantly lower indirect (workloss) costs ($1,723 vs $2,198, P = 0.0036). Conclusions Duloxetine treatment in LBP employees was associated with reduced rates of many nonsurgical therapies and lower indirect costs. The findings are limited by the observational study design and unmeasured potential confounders. [ABSTRACT FROM AUTHOR]

Background: Smoking is seen as the most important single risk to health today, and is responsible for a high financial burden on healthcare systems and society. This population-based cross-sectional study compares healthcare utilisation, direct medical costs, and costs of productivity losses for different smoking groups: current smokers, former smokers, and never smokers. Methods: Using a bottom-up approach, data were taken from the German KORA F4 study (2006/2008) on self-reported healthcare utilisation and work absence due to illness for 3,071 adults aged 32-81 years. Unit costs from a societal perspective were applied to utilisation. Utilisation and resulting costs were compared across different smoking groups using generalised linear models to adjust for age, sex, education, alcohol consumption and physical activity. Results: Average annual total costs per survey participant were estimated as €3,844 [95% confidence interval: 3,447-4,233], and differed considerably between smoking groups with never smokers showing €3,237 [2,802-3,735] and former smokers causing €4,398 [3,796-5,058]. There was a positive effect of current and former smoking on the utilisation of healthcare services and on direct and indirect costs. Total annual costs were more than 20% higher (p<0.05) for current smokers and 35% higher (p<0.01) for former smokers compared with never smokers, which corresponds to annual excess costs of €743 and €1,108 per current and former smoker, respectively. Conclusions: Results indicate that excess costs for current and former smokers impose a large burden on society, and that previous top-down cost approaches produced lower estimates for the costs of care for smoking-related diseases. Efforts must be focused on prevention of smoking to achieve sustainable containment on behalf of the public interest. [ABSTRACT FROM AUTHOR]

To measure the economic output/input ratios for the various options of prevention of rheumatic fever/rheumatic heart disease (RF/RHD) and check the viability of primary prevention vis-à-vis secondary and tertiary preventions. Cost accounting of the various prevention options was calculated for each variable as available in literature. Actual data as obtainable for the financial year ending March 2006 were computed for the Pondicherry population. Both direct and indirect costs (including community/social costs) were worked out using mostly primary data, and wherever necessary, secondary data. Certain scientific assumptions were used where exact data was not available. Primary prevention is the definite viable economic option (1:1.56) compared to secondary (1: 1.07) and tertiary (1: 0.12) preventions. In fact, the current stress on only secondary and tertiary preventions is found to be economically unviable. It is postulated that primary prevention as a practical policy in tackling RF and RHD can be recommended. [ABSTRACT FROM AUTHOR]