Asymptomatic long-term carriers of Shigatoxin producing Escherichia coli (STEC) are regarded as potential source of STEC-transmission. The prevention of outbreaks via onward spread of STEC is a public health priority. Accordingly, health authorities are imposing far-reaching restrictions on asymptomatic STEC carriers in many countries. Various STEC strains may cause severe hemorrhagic colitis complicated by life-threatening hemolytic uremic syndrome (HUS), while many endemic strains have never been associated with HUS. Even though antibiotics are generally discouraged in acute diarrheal STEC infection, decolonization with short-course azithromycin appears effective and safe in long-term shedders of various pathogenic strains. However, most endemic STEC-strains have a low pathogenicity and would most likely neither warrant antibiotic decolonization therapy nor justify social exclusion policies. A risk-adapted individualized strategy might strongly attenuate the socio-economic burden and has recently been proposed by national health authorities in some European countries. This, however, mandates clarification of strain-specific pathogenicity, of the risk of human-to-human infection as well as scientific evidence of social restrictions. Moreover, placebo-controlled prospective interventions on efficacy and safety of, e.g., azithromycin for decolonization in asymptomatic long-term STEC-carriers are reasonable. In the present community case study, we report new observations in long-term shedding of various STEC strains and review the current evidence in favor of risk-adjusted concepts.

OBJECTIVE: The purpose of this study was to assess the annual socio-economic burden of stroke in the Russian Federation from the position of the state.
METHODS: Based on official statistics on morbidity and mortality due to stroke (2019), the results of a survey of patients or caregivers (680 respondents) and cost indicators of 2022, the social and economic burden of stroke during the 1st year after the acute period is modeled. All cost estimates are made from the position of the state.
RESULTS: In 2019 435.2 thousand cases of stroke have been registered in the Russian Federation, 30% of those patients died during the year after the acute episode, thus annually up to 1.7 million years of life are lost. According to our study, stroke accounted for 2% of all days of disability paid by Social Insurance Fund in 2019 and 9% of cases of primary receiving of disability. More than 139 thousand working people assisted their relatives who suffered a stroke, 59.2 thousand of them were forced to change jobs, 18 thousand people left work due to the need to care for a relative. The economic burden of stroke amounted to more than 490 billion rubles. or 0.3% of GDP. The average costs per 1 registered case of hemorrhagic stroke amounted to 0.93 million rubles, ischemic - 1.2 million rubles, of which about 10% are medical costs, 5% are non-medical costs and 85% are costs associated with loss of productivity.
CONCLUSIONS: Stroke causes a significant socio-economic burden for the state in the Russian Federation, the economic losses within 1 year is equal to the 0.3% of the country\'s annual GDP. The main contribution to the stroke economic and social burden is not only mortality, but also disability, leading to incapacitation of patients who have suffered a stroke, as well as to a reduction in the contribution to the economy of their relatives who help and care for them.
UNASSIGNED: Оценка годового социально-экономического бремени инсульта в РФ с позиции государства.
UNASSIGNED: На основании данных официальной статистики о заболеваемости и смертности по причине инсульта (2019 г.), результатов опроса пациентов или лиц, осуществляющих за ними уход (680 респондентов) и стоимостных показателей 2022 г., смоделировано социальное и экономическое бремя инсульта в течение одного года после развития заболевания. Все оценки затрат выполнены с позиции государства.
UNASSIGNED: В 2019 г. в РФ было зарегистрировано 435,2 тыс. случаев инсульта, при этом доля умерших в течение года, среди перенесших инсульт, составила около 30%. Таким образом, инсульт стал причиной потери 1,7 млн лет жизни. Установлено, что перенесенным инсультом были обусловлены 2% от всех оплаченных ФСС дней нетрудоспособности в 2019 г. и 9% случаев первичного признания инвалидами. Более 139 тыс. работающих людей оказывали помощь перенесшим инсульт родственникам, из них 59,2 тыс. были вынуждены сменить работу, 18 тыс. человек оставили работу в связи с необходимостью ухода за родственником. Экономическое бремя инсульта составило более 490 млрд руб. или 0,3% ВВП. Средние затраты на 1 зарегистрированный случай геморрагического инсульта составили 0,93 млн руб., ишемического — 1,2 млн руб., из которых медицинские затраты составили 10%, немедицинские — 5%. Затраты, связанные с утратой производительности, достигли 85%.
UNASSIGNED: В РФ инсульт и его последствия приводят к формированию значительного социально-экономического бремени для государства, возникающий в течение 1 года после инсульта экономический ущерб сопоставим с 0,3% годового ВВП страны. Основную роль в формировании бремени инсульта играют не только высокая смертность, но и инвалидизация, приводящая к постоянной утрате трудоспособности пациентами, перенесшими инсульт, а также к сокращению вклада в экономику их родственников, оказывающих им помощь и осуществляющих уход.

The coronavirus disease 2019 (COVID-19) pandemic has continued for more than 3 years, placing a huge burden on society worldwide. Although the World Health Organization (WHO) has declared an end to COVID-19 as a Public Health Emergency of International Concern (PHEIC), it is still considered a global threat. Previously, there has been a long debate as to whether the COVID-19 emergency will eventually end or transform into a more common infectious disease from a PHEIC, and how should countries respond to similar pandemics in the future more time-efficiently and cost-effectively. We reviewed the past, middle and current situation of COVID-19 based on bibliometric analysis and epidemiological data. Thereby, the necessity is indicated to change the paradigm from reactive healthcare services to predictive, preventive and personalised medicine (PPPM) approach, in order to effectively protect populations against COVID-19 and any future pandemics. Corresponding measures are detailed in the article including the involvement of multi-professional expertise, application of artificial intelligence, rapid diagnostics and patient stratification, and effective protection, amongst other to be considered by advanced health policy.

OBJECTIVE: Motor Neuron Diseases (MND) are rare diseases but have a high impact on affected individuals and society. This study aims to perform an economic evaluation of MND in Germany.
METHODS: Primary patient-reported data were collected including individual impairment, the use of medical and non-medical resources, and self-rated Health-Related Quality of Life (HRQoL). Annual socio-economic costs per year as well as Quality-Adjusted Life Years (QALYs) were calculated.
RESULTS: 404 patients with a diagnosis of Amyotrophic Lateral Sclerosis (ALS), Spinal Muscular Atrophy (SMA) or Hereditary Spastic Paraplegia (HSP) were enrolled. Total annual costs per patient were estimated at 83,060€ in ALS, 206,856€ in SMA and 27,074€ in HSP. The main cost drivers were informal care (all MND) and disease-modifying treatments (SMA). Self-reported HRQoL was best in patients with HSP (mean EuroQoL Five Dimension Five Level (EQ-5D-5L) index value 0.67) and lowest in SMA patients (mean EQ-5D-5L index value 0.39). QALYs for patients with ALS were estimated to be 1.89 QALYs, 23.08 for patients with HSP and 14.97 for patients with SMA, respectively. Cost-utilities were estimated as follows: 138,960€/QALY for ALS, 525,033€/QALY for SMA, and 49,573€/QALY for HSP. The main predictors of the high cost of illness and low HRQoL were disease progression and loss of individual autonomy.
CONCLUSIONS: As loss of individual autonomy was the main cost predictor, therapeutic and supportive measures to maintain this autonomy may contribute to reducing high personal burden and also long-term costs, e.g., care dependency and absenteeism from work.

UNASSIGNED: To achieve universal healthcare coverage (UHC), the rare disease (RD) population must also receive quality healthcare without financial hardship. This study evaluates the impact of RDs in Hong Kong (HK) by estimating cost from a societal perspective and investigating related risk of financial hardship.
UNASSIGNED: A total of 284 RD patients and caregivers covering 106 RDs were recruited through HK\'s largest RD patient group, Rare Disease Hong Kong, in 2020. Resource use data were collected using the Client Service Receipt Inventory for Rare disease population (CSRI-Ra). Costs were estimated using a prevalence-based, bottom-up approach. Risk of financial hardship was estimated using catastrophic health expenditure (CHE) and impoverishing health expenditure (IHE) indicators. Multivariate regression was performed to identify potential determinants.
UNASSIGNED: Annual total RD costs in HK were estimated at HK$484,256/patient (United States (US) $62,084). Direct non-healthcare cost (HK$193,555/US$24,814) was the highest cost type, followed by direct healthcare (HK$187,166/US$23,995), and indirect (HK$103,535/US$13,273) costs. CHE at the 10% threshold was estimated at 36.3% and IHE at the $3.1 poverty line was 8.8%, both significantly higher than global estimates. Pediatric patients reported higher costs than adult patients (p < 0.001). Longer years since genetic diagnosis was the only factor significantly associated with both total costs (p = 0.026) and CHE (p = 0.003).
UNASSIGNED: This study serves as the first in the Asia Pacific region to simultaneously assess the societal costs and financial hardship related to RDs and highlights the importance of an early genetic diagnosis. These results contribute to existing evidence on the globally ubiquitous high costs of RDs, warranting collaboration between different stakeholders to include RD population in UHC planning.
UNASSIGNED: Health and Medical Research Fund, and the Society for the Relief of Disabled Children.

Background The cost of critical illness treatment is generally recognized as expensive and increasing in India. Critical illness of the individual will affect the socioeconomic status of the individual and the family. The direct and indirect costs of intensive care and its impact on the socioeconomic status of critically ill patients and their families need to be estimated. The present study was carried out to evaluate the socioeconomic burden of critically ill patients admitted to ICUs in Eastern India. Methods A descriptive survey was conducted to measure the socioeconomic burden. One hundred fifteen critically ill patients and their family members were conveniently selected for the study. Critically ill patients admitted to ICUs and those who were bedridden for more than seven days along with anyone the family member, i.e., spouse, father, or mother, were included in the study to estimate the impact of long-term illness on the care providers in the family. Socio-demographic and socioeconomic burdens were analyzed through the interview method. Results Half (49.6%) of the critically ill patients were heads of the family, and their employment is the primary source of income for the family members. Most (60.9%) of the patients belonged to lower socioeconomic status. Critically ill patients spend a maximum (38169.6±3996.2) amount for pharmaceutical expenses. Eventually, the family members accompanying patients lost maximum working days because of the long length of hospital stay. Below upper-lower (p=0.046) class socioeconomic family, age less than 40 (p=0.018) years, and those families depending (p=0.003) on patients\' income significantly reported higher socioeconomic burden. Conclusions Critical care hospitalization of patients increases the socioeconomic burden on the whole family, especially in lower-middle-income countries like India. It soberly affects younger age group patients with low socioeconomic status and families depending on the patient\'s income during their man days.

Frailty fractures place a significant socioeconomic burden on the health care system. The Italian Society of Orthopaedics and Traumatology (SIOT) is proceeding to fracture liaison service (FLS) model accreditation in several Italian Fracture Units (FUs), which provides a multidisciplinary approach for the management of the fragility fracture patient.
BACKGROUND: Osteoporosis and the resulting fragility fractures, particularly femoral fractures, place significant socioeconomic burdens on the health care system globally. In addition, there is a general lack of awareness of osteoporosis, resulting in underestimation of the associated risks and suboptimal treatment of the disease. The fracture liaison service (FLS) represents an exemplary model of post-fracture care that involves a multidisciplinary approach to the frail patient through the collaboration of multiple specialists. The purpose of this article is to highlight the path undertaken by the Italian Society of Orthopaedics and Traumatology (SIOT) for the purpose of certification of numerous FLS centers throughout Italy.
METHODS: SIOT is proceeding with international FLS accreditation in several Italian Fracture Units (FUs), following the creation of a model that provides specific operational and procedural steps for the management of fragility fractures throughout the country. FUs that decide to join the project and implement this model within their facility are then audited by an ACCREDIA-accredited medical certification body.
RESULTS: The drafted FLS model, thanks to the active involvement of a panel of experts appointed by SIOT, outlines a reference operational model that describes a fluid and articulated process that identifies the procedure of identification, description of diagnostic framing, and subsequent initiation of appropriate secondary prevention programs for fractures of individuals who have presented with a recent fragility fracture of the femur.
CONCLUSIONS: Accreditation of this prevention model will enable many facilities to take advantage of this dedicated diagnostic-therapeutic pathway for the purpose of fracture prevention and reduction of associated health and social costs.

BACKGROUND: Bronchiolitis is a seasonal, global acute lower respiratory tract infection caused by respiratory syncytial virus (RSV) and is a leading cause of hospital admission in young children. A peer-led (parents to parents) intervention was implemented to empower parents of children at risk of bronchiolitis and reduce hospital admissions. This paper reported the evaluation that aimed to gain the perspectives and experiences of five key stakeholder groups.
METHODS: A qualitative remote interview-based design, informed by Appreciative Inquiry was used. Thematic analysis was used.
RESULTS: Sixty-five stakeholders participated: parents (n = 43; mothers, n = 42), Parent Champions (n = 9), Children\'s Centre Managers (n = 8), Children\'s Centre Group Leaders (n = 11), and Core Team (n = 4). An overarching theme \'Parents reaching out to parents\' was supported by five sub-themes (Raising awareness and sharing knowledge; Creating connection, trust, and confidence; Flourishing in their role as a Parent Champion; Rising to the challenges; and Knowledge is power, prevention is key: the government needs to know this.) Conclusions: Parent-to-parent peer support via the Parent Champions was perceived positively by parents who wanted to learn and improve the lives and health of their children. Parent Champions were successful in delivering information. Considering the socioeconomic burden of bronchiolitis to services and families, the potential for an upstream, relatively low cost, high-reach innovative intervention, as evidenced in this project, seems a valuable opportunity for improving children\'s respiratory health.

Myasthenia gravis (MG) is a chronic autoimmune disorder, which is characterized by fatigable muscle weakness with frequent ocular signs and/or generalized muscle fatigue, and occasionally associated with thymoma. MG patients and their families face a significant socio-economic burden. This population is often experiencing unemployment, unwilling job transfers and decreased income.
This study aimed to estimate the annual costs from a societal perspective in a triple dimension of direct health care costs, direct non-health care costs (formal and informal care) and labor productivity losses in MG patients from Bulgaria, as well as to identify the main clinical and demographical cost drivers.
A bottom-up, cross-sectional, cost-of-illness analysis of 54 adult MG patients was carried out in 2020. To collect data on demographic characteristics, health resource utilization, informal care and productivity losses, questionnaires were administered to and completed by patients.
Median annual costs of MG in Bulgaria were 4,047 EUR per patient. Direct costs slightly outweighed indirect costs, with drugs cost item having the biggest monetary impact. Despite the zero-inflated median, hospitalizations also influenced the direct costs by an estimated amount of 1,512 EUR in the 3rd quartile. Social services and professional caregiver costs were found to be almost missing, with the vast majority of patients reporting reliance on informal caregivers. Severe generalized disease, disease crises, and recurrent infections were confirmed as statistically significant cost driving factors. There were no severe generalized MG patients in the bottom quartile of the total costs distribution. It should be noted that in both cases of crises or infections, the overall increase in the total costs was mainly due to higher indirect costs observed. Reliance on family members as informal caregivers is routine among Bulgarian MG patients. This phenomenon is likely due to the lack of access to appropriate social services. Moreover, it is directly related with higher disease burden and significant inequalities. There is a need for further research on MG in Bulgaria in order to design targeted health policies that meet the needs and expectations of these patients.

OBJECTIVE: This study aimed to evaluate the socio-economic burden imposed on the Chinese healthcare system during the coronavirus disease 2019 (COVID-19) pandemic.
METHODS: A cross-sectional study was used to investigate how COVID-19 impacted health and medical costs in China. Data were derived from a subdivision of the Centers for Disease control and Prevention of China.
METHODS: We prospectively collected information from the Centers for Disease Control and Prevention and the designated hospitals to determine the cost of public health care and hospitalisation due to COVID-19. We estimated the resource use and direct medical costs associated with public health.
RESULTS: The average costs, per case, for specimen collection and nucleic acid testing (NAT [specifically, polymerase chain reaction {PCR}]) in low-risk populations were $29.49 and $53.44, respectively; however, the average cost of NAT in high-risk populations was $297.94 per capita. The average costs per 1000 population for epidemiological surveys, disinfectant, health education and centralised isolation were $49.54, $247.01, $90.22 and $543.72, respectively. A single hospitalisation for COVID-19 in China cost a median of $2158.06 ($1961.13-$2325.65) in direct medical costs incurred only during hospitalisation, whereas the total costs associated with hospitalisation of patients with COVID-19 were estimated to have reached nearly $373.20 million in China as of 20, May, 2020. The cost of public health care associated with COVID-19 as of 20, May, 2020 ($6.83 billion) was 18.31 times that of hospitalisation.
CONCLUSIONS: This study highlights the magnitude of resources needed to treat patients with COVID-19 and control the COVID-19 pandemic. Public health measures implemented by the Chinese government have been valuable in reducing the infection rate and may be cost-effective ways to control emerging infectious diseases.