OBJECTIVE: To describe the incidence, characteristics, outcomes and hospital costs of patients admitted to hospital following trauma in a health region in Aotearoa New Zealand over a 10-year period.
METHODS: A retrospective, observational study used data from the Te Manawa Taki (TMT) regional trauma registry to identify patients of all ages and injury severities that were admitted to hospital following injuries from 2013 to 2022, inclusive. This study reports on incidence of injuries with regard to age, gender, ethnicity, injury severity score (ISS), injury characteristics and direct cost to TMT facilities.
RESULTS: Searches identified 60,753 trauma events leading to patient admission to hospitals in the TMT region. Of these, 81.9% were low-severity trauma, 10.2% were moderate-severity trauma and 7.9% were high-severity trauma. There were statistically significant relationships between gender, ethnicity and ISS category. Males were more likely to be hospitalised for any traumatic injuries. High-severity trauma is dominated by road traffic injuries and low-severity trauma is dominated by falls. Advanced age was associated with higher injury severity. The direct cost of trauma care to TMT hospitals increased by 122% during the 10-year period.
CONCLUSIONS: The study has identified the incidence, demographic features, severity, costs and outcomes for trauma patients admitted to hospitals in the TMT region of Aotearoa New Zealand over a continuous 10-year period. The volumes and costs of injury represent a significant burden on the health system, individuals and communities. Detailed understanding of the causes and costs of injuries of all severities will inform prevention activities, clinical quality improvement and health service planning.

OBJECTIVE: To study the effects of transcutaneous electrical acupoint stimulation (TEAS) on length of stay (LOS) and hospitalization costs in postoperative inpatients.
METHODS: Two researchers collectively searched PubMed, Embase, Cochrane Library, China Network Knowledge Infrastructure, and Wanfang Database. The search time was set from the beginning to 25 April 2023, to identify randomized controlled trials articles that met the criteria. Statistical analyses were performed using the Stata software (version 16.0). The risk of bias was assessed using the Cochrane risk-of-bias tool, and publication bias was evaluated using a funnel plot and Egger\'s test. The quality of evidence was assessed according to the Grading of Recommendations Assessment, Development, and Evaluation approach.
RESULTS: Thirty-four randomized controlled trials were included. The main results showed that TEAS reduced hospitalization costs [standardized mean difference (SMD)=-1.92; 95% CI: -3.40, -0.43), LOS (SMD=-1.00; 95% CI: -1.30, -0.70) and postoperative LOS (SMD=-0.70; 95% CI: -0.91, -0.49] in postoperative patients. Subgroup analyses further revealed that TEAS was effective in reducing both the overall and postoperative LOS in patients undergoing multiple surgical procedures. It is worth noting that the observed heterogeneity in the results may be attributed to variations in surgical procedures, stimulation frequencies, and stimulation points utilized in different trials.
CONCLUSIONS: TEAS can help postoperative patients reduce their LOS and hospitalization cost. However, considering the bias identified and heterogeneity, the results of this review should be interpreted with caution.

The management implications of pricing healthcare services, especially hospitals, have received insufficient scholarly attention. Additionally, disciplinary overlaps have led to scattered academic efforts in this domain. This study performs a thematic synthesis of the literature and applies retrospective analysis to hospital service pricing articles to address these issues. The study\'s inputs were sourced from well-known online repositories, using a structured search string and PRISMA flow chart to select the pertinent documents. Our thematic analysis of pricing literature encompasses: (a) comprehension of hospital service pricing nature; (b) pricing objectives, strategies and practices differentiation; (c) presentation of factors impacting hospital service pricing. We observe that hospital pricing is an intricate and unclear matter. The terms \'pricing strategies\' and \'pricing practices\' are often used interchangeably in academic literature. Hospital service pricing is influenced by costs, demand and supply factors, market structure, pricing regulation and third-party reimbursements. The study\'s findings provide policy implications for service pricing in hospitals, in addition to suggesting avenues for future research on hospital pricing.

BACKGROUND: The rise of periprosthetic joint infections (PJIs) due to aging populations is steadily increasing the number of arthroplasties and treatment costs. This study analyzed the direct health care costs of PJI for total hip arthroplasty and total knee arthroplasty (TKA) in Europe.
METHODS: The databases PubMed, Scopus, Embase, Cochrane, and Google Scholar were systematically screened for direct costs of PJI in Europe. Publications that defined the joint site and the procedure performed were further analyzed. Mean direct health care costs were calculated for debridement, antibiotics, and implant retention (DAIR), one-stage, and 2-stage revisions for hip and knee PJI, respectively. Costs were adjusted for inflation rates and reported in US-Dollar (USD).
RESULTS: Of 1,374 eligible publications, 12 manuscripts were included in the final analysis after an abstract and full-text review. Mean direct costs of $32,933 were identified for all types of revision procedures for knee PJI. The mean direct treatment cost including DAIR for TKA after PJI was $19,476. For 2-stage revisions of TKA, the mean total cost was $37,980. For all types of hip PJI procedures, mean direct hospital costs were $28,904. For hip DAIR, one-stage and 2-stage treatment average costs of $7,120, $44,594, and $42,166 were identified, respectively.
CONCLUSIONS: Periprosthetic joint infections are associated with substantial direct health care costs. As detailed reports on the cost of PJI are scarce and of limited quality, more detailed financial data on the cost of PJI treatment are urgently required.

Adverse events (AEs) following thoracic surgery place considerable strain on healthcare systems. A rigorous evaluation of the economic impact of thoracic surgical AEs remains lacking and is required to understand the value of money of formal quality improvement initiatives. Our objective was to conduct a systematic review of all available literature focused on specific cost of postoperative AEs following thoracic surgery.
Systematic review of the economic literature was performed, following recommendations from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.
An economic search filter developed by the Canadian Agency for Drugs and Technologies in Health was applied, and MEDLINE, Embase and The Cochrane Library were searched from inception to January 2022.
We included English articles involving adult patients who underwent a thoracic surgical procedure with estimated costs of postoperative complications. Eligible study designs included comparative observational studies, randomised control trials, decision analytic or cost-prediction models, cost analyses, cost or burden of illness studies, economic evaluation studies and systematic reviews and/or meta-analyses of cost analyses and cost of illness studies.
Two reviewers independently screened titles and abstracts in the first stage and full-text articles of included studies in the second stage. Disagreements during abstract and full-text screening stages were resolved via discussion until a consensus was reached. Studies were appraised for methodological quality using the Critical Appraisal Skills Program checklist.
3349 studies were identified: 20 met inclusion criteria. Most were conducted in the USA (12/20), evaluating AE impact on hospital expenditures (18/20). 68 procedure-specific AE mean costs were characterised (USD$). The most commonly described were anastomotic leak (mean:range) (USD$49 278:$6 176-$133 002) and pneumonia ($12 258:$2608-$34 591) following esophagectomy, and prolonged air leak ($2556:$571-$3573), respiratory failure ($19 062:$11 841-$37 812), empyema ($30 189:$23 784-$36 595), pneumonia ($15 362:$2542-$28 183), recurrent laryngeal nerve injury ($16 420:$4224-$28 616) and arrhythmia ($6835:$5833-$8659) following lobectomy.
Hospital costs associated with AEs following thoracic surgery are substantial and varied. Quantifying costs of AEs enable future economic evaluation studies, which could help prioritising value-directed quality improvement to optimally improve outcomes and reduce costs.

BACKGROUND: Out of pocket (OOP) costs vary substantially by health condition, procedure, provider, and service location. Evidence of whether this variation is associated with indicators of healthcare quality and/or health outcomes is lacking.
METHODS: The current review aimed to explore whether higher OOP costs translate into better healthcare quality and outcomes for patients in inpatient settings. The review also aimed to identify the population and contextual-level determinants of inpatient out-of-pocket costs. A systematic electronic search of five databases: Scopus, Medline, Psych Info, CINAHL and Embase was conducted between January 2000 to October 2022. Study procedures and reporting complied with PRISMA guidelines. The protocol is available at PROSPERO (CRD42022320763).
RESULTS: A total of nine studies were included in the final review. A variety of quality and health outcomes were examined in the included studies across a range of patient groups and specialities. The scant evidence available and substantial heterogeneity created challenges in establishing the nature of association between OOP costs and healthcare quality and outcomes. Nonetheless, the most consistent finding was no significant association between OOP cost and inpatient quality of care and outcomes.
CONCLUSIONS: The review findings overall suggest no beneficial effect of higher OOP costs on inpatient quality of care and health outcomes. Further work is needed to elucidate the determinants of OOP hospital costs.
BACKGROUND: This study was funded by Medibank Better Health Foundation.

Bronchiectasis, a previously neglected condition, now has renewed research interest. There are a few systematic reviews that have reported on the economic and societal burden of bronchiectasis in adults, but none have reported on children. We undertook this systematic review to estimate the economic burden of bronchiectasis in children and adults.
What is the health care resource utilization and economic burden of bronchiectasis in adults and children?
We performed a systematic review identifying publications from Embase, PubMed, Web of Science, Cochrane (trials, reviews, and editorials), and EconLit about the economic burden and health care utilization in adults and children with bronchiectasis between January 1, 2001, and October 10, 2022. We used a narrative synthesis approach and estimated aggregate costs for several countries.
We identified 53 publications reporting on the economic burden and/or health care utilization of people with bronchiectasis. Total annual health care costs per adult patient ranged from 2021 $3,579 to $82,545 USD and were predominantly driven by hospitalization costs. Annual indirect costs including lost income because of illness (reported in only five studies) ranged from $1,311 to $2,898 USD. Total health care costs in children with bronchiectasis were $23,687 USD annually in the one study that estimated them. Additionally, one publication found that children with bronchiectasis missed 12 school days per year. We estimated aggregate annual health care costs for nine countries, ranging from $101.6 million per year in Singapore to $14.68 billion per year in the United States. We also estimated the aggregate cost of bronchiectasis in Australian children to be $17.77 million per year.
This review highlights the substantial economic burden of bronchiectasis for patients and health systems. To our knowledge, it is the first systematic review to include the costs for children with bronchiectasis and their families. Future research to examine the economic impact of bronchiectasis in children and economically disadvantaged communities, and to further understand the indirect burden of bronchiectasis on individuals and the community, is needed.

Although value-based healthcare (VBHC) views accurate cost information to be crucial in the pursuit of value, little is known about how the costs of care should be measured. The aim of this review is to identify how costs are currently measured in VBHC, and which cost measurement methods can facilitate VBHC or value-based decision making.
Two reviewers systematically search the PubMed/MEDLINE, Embase, EBSCOhost and Web of Science databases for publications up to 1 January 2022 and follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify relevant studies for further analysis.
Studies should measure the costs of an intervention, treatment or care path and label the study as \'value based\'. An inductive qualitative approach was used to identify studies that adopted management accounting techniques to identify if or how cost information facilitated VBHC by aiding decision-making.
We identified 1930 studies, of which 215 measured costs in a VBHC setting. Half of these studies measured hospital costs (110, 51.2%) and the rest relied on reimbursement amounts. Sophisticated costing methods that allocate both direct and indirect costs to care paths were seen as able to provide valuable managerial information by facilitating care path adjustments (39), benchmarking (38), the identification of cost drivers (47) and the measurement of total costs or cost savings (26). We found three best practices that were key to success in cost measurement: process mapping (33), expert input (17) and observations (24).
Cost information can facilitate VBHC. Time-driven activity-based costing (TDABC) is viewed as the best method although its ability to inform decision-making depends on how it is implemented. While costing short, or partial, care paths and surgical episodes produces accurate cost information, it provides only limited decision-making information. Practitioners are advised to focus on costing full care cycles and to consider both direct and indirect costs through TDABC.

As health systems transition to value-based care delivery models, reducing costs and improving quality of care without sacrificing either remains a challenge for many healthcare organizations. There is extensive research on hospital costs, however, works addressing the complex relationship between hospital costs and the quality of care have been limited. In this commentary, I expound on the scoping review on integrated hospital strategies by Wackers et al that aim to improve quality while lowering costs. Specifically, I reiterate the complexity of the relationship between cost and quality and delve into major interdependent themes identified by the authors as relevant for the implementation of hospitals\' integrated strategy.

BACKGROUND: In recent years, the world\'s health system faces with increasing trend of costs. In this regard, Hospital is one of the environments that consumes a large share of the total expenditure of the health system. Medications are one of the most expensive components in hospitals, which require appropriate measurements to control and reduce costs. The present systematic review was conducted to identify strategies and actions for cost containment in hospital.
METHODS: Using the PRISMA protocol, a systematic review of the texts was performed to identify strategies and actions for reducing drug cost. In this systematic review, the selected keywords were searched in the following databases: web of sciences, Scopus, PubMed, Google Scholar, and Embase. The inclusion criteria included English-language articles, hospital-level studies, and those studies performed on reducing and controlling hospital costs. The exclusion criteria also included the followings: primary health care studies, non-English language studies, health system studies, and studies solely focussed on the cost-effectiveness of a particular drug. The quality of these articles was investigated using the checklist adapted and modified in the present study.
RESULTS: A total of 4696 articles were identified from the reviewed databases and 26 articles were identified from some other sources. After removing duplicate studies and reviewing the title, summary, and full text of articles using reference check and supplemental search, 21 articles were finally included. A number of strategies or managerial actions were extracted from the final articles. According to the qualitative results, qualitative meta-synthesis was used and after eliminating duplicate solutions, the data were classified into five groups: procurement, storage, distribution, prescription, and use.
CONCLUSIONS: According to the increasing cost of medicines, some hospital managers now attempt to reduce hospital costs using drug chain management. Drug cost reduction strategies can be applied for any component of drug chain management such as procurement, storage, distribution, prescription, and use. Also, proper implementation of these strategies and rationalisation of drug use will result in more efficiency of the hospital.