UNASSIGNED: Trauma-related injuries are the leading cause of death and disability in the active population, with devastating economic, health, and social consequences for nations. TThis study aimed to assess the economic burden of injuries in Iran.
UNASSIGNED: In this study, the economic impact of trauma in Iran in 2019 was estimated using a prevalence-based approach. The prevalence was estimated based on available statistics in Iran and the GBD website. Direct medical expenditures were calculated using a top-down approach. The cost of lost production due to injuries and premature death was also estimated using the DALY value. Microsoft Excel 2019 and Stata software version 13.0 were used for the analysis.
UNASSIGNED: In Iran, approximately 16,500,000 individuals were estimated to have sustained injuries in a single year. The average direct medical expenses for each trauma patient were around $226. Fractures contributed to 39% of the financial impact of trauma. The overall economic burden of trauma in Iran was calculated to be $10,214,403,423. Approximately 66% of this economic burden was attributed to lost productivity and premature death resulting from trauma, while direct medical costs made up 34%.
UNASSIGNED: The economic burden of trauma in Iran is expected to significantly rise in the future. It may be necessary to enhance awareness of injury-related mortality and disability, improve therapies, and expand evidence-based interventions to reduce the economic impact of injuries.

BACKGROUND: Pulmonary tuberculosis (PTB) is a prevalent chronic disease associated with a significant economic burden on patients. Using machine learning to predict hospitalization costs can allocate medical resources effectively and optimize the cost structure rationally, so as to control the hospitalization costs of patients better.
METHODS: This research analyzed data (2020-2022) from a Kashgar pulmonary hospital\'s information system, involving 9570 eligible PTB patients. SPSS 26.0 was used for multiple regression analysis, while Python 3.7 was used for random forest regression (RFR) and MLP. The training set included data from 2020 and 2021, while the test set included data from 2022. The models predicted seven various costs related to PTB patients, including diagnostic cost, medical service cost, material cost, treatment cost, drug cost, other cost, and total hospitalization cost. The model\'s predictive performance was evaluated using R-square (R2), Root Mean Squared Error (RMSE), and Mean Absolute Error (MAE) metrics.
RESULTS: Among the 9570 PTB patients included in the study, the median and quartile of total hospitalization cost were 13,150.45 (9891.34, 19,648.48) yuan. Nine factors, including age, marital status, admission condition, length of hospital stay, initial treatment, presence of other diseases, transfer, drug resistance, and admission department, significantly influenced hospitalization costs for PTB patients. Overall, MLP demonstrated superior performance in most cost predictions, outperforming RFR and multiple regression; The performance of RFR is between MLP and multiple regression; The predictive performance of multiple regression is the lowest, but it shows the best results for Other costs.
CONCLUSIONS: The MLP can effectively leverage patient information and accurately predict various hospitalization costs, achieving a rationalized structure of hospitalization costs by adjusting higher-cost inpatient items and balancing different cost categories. The insights of this predictive model also hold relevance for research in other medical conditions.

Background As the population ages, surgical intervention for degenerative spine conditions is increasing, and this causes a commiserate increase in healthcare expenditures associated with these procedures. Little research has been done on the effect of early-week versus later-week surgeries on patient outcomes, cost, and length of stay (LOS) in patients undergoing lumbar fusion surgery. The purpose of this study is to compare LOS, patient outcomes, and hospital costs between patients having surgery early in the week and later in the week. Methods A retrospective review of 771 patients undergoing a one-, two-, or three-level lumbar fusion from December 2020 to December 2023 at a single institution was performed. Demographics, surgical details, postoperative outcomes and cost were compared between patients who had surgery on Monday, Tuesday, and Wednesday, to those having surgery Thursday or Friday. Univariate and multivariate analyses were performed to compare the groups. Results There were no differences in age, sex, BMI, race, American Society of Anesthesiology (ASA) scores, Charlson Comorbidity Index (CCI) scores, number of operative levels or inpatient/outpatient status between early- and late-week surgeries. Postoperatively the only significant difference was cost, late-week surgeries were, on average, $3,697 more expensive than early-week surgeries ($26,506 vs. $22,809; p<0.001). On multivariate analysis late-week surgeries were 2.47 times more likely to have a non-home discharge (OR: 2.47, 95% CI: 1.24 to 4.95; p=0.010) and 2.19 times more likely to have a 30-day readmission (OR: 2.19, 95% CI:1.01 to 4.74; p=0.044) Additionally, late-week surgeries were $2,041.55 (β:2,041.55, 95% CI: 804.72 to 3,278.38; p=0.001) more expensive than early-week surgeries. Conclusions At our institution, patients undergoing one- to three-level lumbar fusion surgery on Thursday or Friday had a higher risk of non-home discharge, 30-day readmission, and incurred higher cost than those having early-week surgery. Further research is needed to elucidate the reasons for these findings and to evaluate interventions aimed at improving outcomes for patients undergoing surgery later in the week.

BACKGROUND: Comprehensive stroke centres across England have developed investment proposals, showing the estimated increases in mechanical thrombectomy (MT) treatment volume that would justify extending the standard hours to a 24/7 service provision. These investment proposals have been developed taking a financial accounting perspective, that is by considering the financial revenues from tariff income. However, given the pressure put on local health authorities to provide value for money services, an affordability question emerges. That is, at what additional MT treatment volume the additional treatment costs are offset by the additional health economic benefits, that is quality-adjusted life years (QALYs) and societal cost savings, generated by administering MT compared to standard care.
METHODS: A break-even analysis was conducted to identify the additional MT treatment volume required. The incremental hospital-related costs associated with the 24/7 MT extension were estimated using information and parameters from four relevant business cases. The additional societal cost savings and health benefits were estimated by adapting a previously developed Markov chain-based model.
RESULTS: The additional hospital-related annual costs for extending MT to a 24/7 service were estimated at a mean of £3,756,818 (range £1,847,387 to £5,092,788). On average, 750 (range 246 to 1,571) additional eligible stroke patients are required to be treated with MT yearly for the proposed 24/7 service extension to be affordable from a health economic perspective. Overall, the additional facility and equipment costs associated with the 24/7 extension would affect this estimate by 20%.
CONCLUSIONS: These findings support the ongoing debate regarding the optimal levels of MT treatment required for a 24/7 extension and respective changes in hospital organisational activities. They also highlight a need for a regional-level coordination between local authorities and hospital administrations to ensure equity provision in that stroke patients can benefit from MT and that the optimal MT treatment volume is reached. Future studies should contemplate reproducing the presented analysis for different health service provision settings and decision making contexts.

UNASSIGNED: Twin pregnancies are associated with higher risks of adverse neonatal outcomes compared to singleton pregnancies. The choice of delivery mode, when twin A presents cephalic, remains a subject of debate. In low- and middle-income countries, where healthcare resources are limited, the decision on the mode of delivery is even more critical.
UNASSIGNED: To evaluate the neonatal outcomes and the hospital costs of planned vaginal delivery compared to cesarean section (CS) in twin pregnancies with twin A presenting cephalic at Tenwek Hospital, Kenya.
UNASSIGNED: This retrospective cohort study analyzed data from all twin deliveries at Tenwek Hospital, Kenya from, April 1, 2017, to March 30, 2023. Maternal data, mode of delivery, and neonatal data were collected from delivery logs, electronic health records, and neonatal records. Neonatal outcomes were a composite of either Appearance, Pulse, Grimace, Activity, and Respiration score less than seven at 5 minutes, neonatal intensive care unit admission, resuscitation, birth trauma, or neonatal complications, including death before discharge from the hospital. A logistic regression model was created to assess the impact of the planned mode of delivery on neonatal outcomes, controlling for antenatal care clinic visits, noncephalic presentation of twin B, and birth weight category.
UNASSIGNED: The study included 177 twin deliveries: 129 (72.9%) were planned as vaginal deliveries and 48 (27.1%) were planned for CS. Among the planned vaginal deliveries, 66 (51.2%) experienced adverse outcomes, compared to 14 (29.2%) in the CS group (P=.009). Logistic regression showed that the odds of adverse outcomes were 0.35 times lower in the CS group compared to the planned vaginal delivery group (95% CI: 0.15-0.83; P=.017). The average total hospital costs for planned vaginal delivery were 104,608 Kenya Shillings (standard deviation 111,761) compared to 100,708 Kenya Shillings (standard deviation 75,468) for CS (P=.82).
UNASSIGNED: Planned cesarean deliveries in twin pregnancies with twin A presenting cephalic at Tenwek Hospital were associated with fewer adverse neonatal outcomes compared to planned vaginal deliveries. There was no significant difference in hospital costs. These findings raise the question of the safest mode of delivery for patients in a resource-constrained setting.

Adverse events (AEs) are a significant concern for healthcare systems. However, it is difficult to evaluate their influence because of the complexity of various medical services. This study aimed to assess the influence of AEs on the outcomes of hospitalized patients using a diagnosis-related group (DRG) database. We conducted a case-control study of hospitalized patients at a multi-district tertiary hospital with 2200 beds in China, using data from a DRG database. An AE refers to an unintended physical injury caused or contributed to by medical care that requires additional hospitalization, monitoring, treatment, or even death. Relative weight (RW), a specific indicator of DRG, was used to measure the difficulty of diagnosis and treatment, disease severity, and medical resources utilized. The primary outcomes were hospital length of stay (LOS) and hospitalization costs. The secondary outcome was discharge to home. This study applied DRG-based matching, Hodges-Lehmann estimate, regression analysis, and subgroup analysis to evaluate the influence of AEs on outcomes. Two sensitivity analyses by excluding short LOS and changing adjustment factors were performed to assess the robustness of the results. We identified 2690 hospitalized patients who had been divided into 329 DRGs, including 1345 patients who experienced AEs (case group) and 1345 DRG-matched normal controls. The Hodges-Lehmann estimate and generalized linear regression analysis showed AEs led to prolonged LOS (unadjusted difference, 7 days, 95% confidence interval [CI] 6-8 days; adjusted difference, 8.31 days, 95% CI 7.16-9.52 days) and excess hospitalization costs (unadjusted difference, $2186.40, 95% CI: $1836.87-$2559.16; adjusted difference, $2822.67, 95% CI: $2351.25-$3334.88). Logistic regression analysis showed AEs were associated with lower odds of discharge to home (unadjusted odds ratio [OR] 0.66, 95% CI 0.54-0.82; adjusted OR 0.75, 95% CI 0.61-0.93). The subgroup analyses showed that the results for each subgroup were largely consistent. LOS and hospitalization costs increased significantly after AEs in complex diseases (RW ≥ 2) and in relation to high degrees of harm subgroups (moderate harm and above groups). Similar results were obtained in sensitivity analyses. The burden of AEs, especially those related to complex diseases and severe harm, is significant in China. The DRG database serves as a valuable source of information that can be utilized for the evaluation and management of AEs.

BACKGROUND: The Diagnosis-Intervention Packet (DIP) payment system, initiated by China\'s National Healthcare Security Administration, is designed to enhance healthcare efficiency and manage rising healthcare costs. This study aims to evaluate the impact of the DIP payment reform on inpatient care in a specialized obstetrics and gynecology hospital, with a focus on its implications for various patient groups.
METHODS: To assess the DIP policy\'s effects, we employed the Difference-in-Differences (DID) approach. This method was used to analyze changes in total hospital costs and Length of Stay (LOS) across different patient groups, particularly within select DIP categories. The study involved a comprehensive examination of the DIP policy\'s influence pre- and post-implementation.
RESULTS: Our findings indicate that the implementation of the DIP policy led to a significant increase in both total costs and LOS for the insured group relative to the self-paying group. The study further identified variations within DIP groups both before and after the reform. In-depth analysis of specific disease groups revealed that the insured group experienced notably higher total costs and LOS compared to the self-paying group.
CONCLUSIONS: The DIP reform has led to several challenges, including upcoding and diagnostic ambiguity, because of the pursuit of higher reimbursements. These findings underscore the necessity for continuous improvement of the DIP payment system to effectively tackle these challenges and optimize healthcare delivery and cost management.

OBJECTIVE: To describe and analyze the aspects regarding the cost and length of stay for elderly patients with bone fractures in a tertiary reference hospital.
METHODS: A cross-sectional retrospective study using data obtained from medical records between January and December 2020. For statistical analysis, exploratory analyses, Shapiro-Wilk test, χ2 test, and Spearman correlation were used.
RESULTS: During the study period, 156 elderly patients (62.2% women) with bone fractures were treated. The main trauma mechanism was a fall from a standing height (76.9%). The most common type of fracture in this sample was a transtrochanteric fracture of the femur, accounting for 40.4% of cases. The mean length of stay was 5.25 days. The total cost varied between R$2,006.53 and R$106,912.74 (average of R$15,695.76) (updated values). The mean daily cost of hospitalization was R$4,478.64. A positive correlation was found between the length of stay and total cost. No significant difference in cost was observed between the two main types of treated fractures.
CONCLUSIONS: Fractures in the elderly are frequent, resulting in significant costs. The longer the hospital stay for treatment, the higher the total cost. No correlation was found between total cost and number of comorbidities, number of medications used, and the comparison between the treatment of transtrochanteric and femoral neck fractures.

OBJECTIVE: This study aimed to assess the economic efficiency of the acute medical unit (AMU) hospitalist care model, utilising patient outcomes (length of hospital stay, emergency department (ED)-length of hospital stay, in-hospital mortality) from a previous investigation.
METHODS: A retrospective cohort study was conducted using benefit-cost analysis from a societal perspective. Data relating to clinical factors, outcomes and medical costs were obtained from the electronic medical record database at our institution. Literature-based costing was applied to determine direct non-medical costs and indirect costs that could not be obtained directly.
METHODS: A tertiary care hospital in the Republic of Korea.
METHODS: We evaluated 6391 medical inpatients admitted through the ED from 1 June 2016 to 31 May 2017.
METHODS: The study compared multiple types of costs and benefits among inpatients from the ED between a non-hospitalist group and an AMU hospitalist group. Results This investigation found a significant reduction in medical costs and total costs in the AMU hospitalist group compared to the non-hospitalist group (30% reduction, 95% CI: 27.6-32.1%, P=0.000; 29.3% reduction, 95% CI: 27.0-31.5%, P=0.000; respectively). Furthermore, significant reductions in direct and indirect costs were found in the AMU hospitalist group compared to the non-hospitalist group (28.6% reduction, 95% CI: 26.6-30.5%, P=0.000; 23.3% reduction, 95% CI: 20.9-25.5%, P=0.000; respectively). The net-benefit and benefit-cost ratio (BCR) of the AMU hospitalist care group were US $6846 and 1.33 per patient admission, respectively.
CONCLUSIONS: The AMU hospitalist care model was associated with remarkable reductions in multiple costs. The results of the sensitivity analysis indicated that the net-benefit estimates of AMU hospitalist care were similar to the baseline estimates. Thus, the overall net-benefit of AMU hospitalist care was found to be largely positive.

BACKGROUND: Cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) are non-communicable diseases that impose a significant economic burden on healthcare systems, particularly in low- and middle-income countries. The purpose of this study was to evaluate the hospital treatment cost for cardiovascular disease events (CVDEs) in patients with and without diabetes and identify factors influencing cost.
METHODS: We conducted a retrospective, cross-sectional study using administrative data from three public tertiary hospitals in Malaysia. Data for hospital admissions between 1 March 2019 and 1 March 2020 with International Classification of Diseases 10th Revision (ICD-10) codes for acute myocardial infarction (MI), ischaemic heart disease (IHD), hypertensive heart disease, stroke, heart failure, cardiomyopathy, and peripheral vascular disease (PVD) were retrieved from the Malaysian Disease Related Group (Malaysian DRG) Casemix System. Patients were stratified by T2DM status for analyses. Multivariate logistic regression was used to identify factors influencing treatment costs.
RESULTS: Of the 1,183 patients in our study cohort, approximately 60.4% had T2DM. The most common CVDE was acute MI (25.6%), followed by IHD (25.3%), hypertensive heart disease (18.9%), stroke (12.9%), heart failure (9.4%), cardiomyopathy (5.7%) and PVD (2.1%). Nearly two-thirds (62.4%) of the patients had at least one cardiovascular risk factor, with hypertension being the most prevalent (60.4%). The treatment cost for all CVDEs was RM 4.8 million and RM 3.7 million in the T2DM and non-T2DM group, respectively. IHD incurred the largest cost in both groups, constituting 30.0% and 50.0% of the total CVDE treatment cost for patients with and without T2DM, respectively. Predictors of high treatment cost included male gender, non-minority ethnicity, IHD diagnosis and moderate-to-high severity level.
CONCLUSIONS: This study provides real-world cost estimates for CVDE hospitalisation and quantifies the combined burden of two major non-communicable disease categories at the public health provider level. Our results confirm that CVDs are associated with substantial health utilisation in both T2DM and non-T2DM patients.