Economic Burden of Diseases In Poland

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Objectives: Adult severe sepsis is one of the most expensive conditions treated in hospitals and represents an economic burden to western health-care systems. However, there is presently no uniform standardized ICD-9-CM algorithm to identify severe sepsis at a population-level. Our aim is to compare two established diagnostic coding strategies in terms of hospital resource utilization.  Methods: Population-based longitudinal study using the 2006-2011 nationwide hospital discharge database. Episodes of severe sepsis were identified by two ICD-9-CM coding strategies: a) those assigned explicit ICD-9-CM codes (995.92, 785.52); and b) those assigned combined ICD-9-CM infection and organ dysfunction codes by modified Martin criteria. We calculated hospital charges based on the National Health Service charges for DRGs. Trends were assessed as to annual percent changes (APC) using joinpoint regression analysis.  Results: Roughly 62% of severe sepsis episodes identified were assigned explicit ICD-9-CM codes and 38% combination codes. Trend analysis showed that despite a shorter hospital stay in the explicit code cohort (12 vs. 14 days, p< 0.001), mean cost per case was significantly higher in this cohort (14 665 €  versus 12 404 € , p< 0.001) and differences in this variable increased over the six-year period with an APC of 5.1% in the combination and of 7.8% in the explicit cohort. Of note, average costs per case showed an especially increasing trend in hospitalizations captured as 785.52 (septic shock).  Conclusions: The great use of explicit codes in Spain has an extensive influence on adult severe sepsis hospital resource utilization estimates. Variability in coding practices must be taken into account when interpreting severe sepsis hospital-related financial burden. These data will help inform health care decision-making and resource planning. PHS131 Avoidable Hospitalizations Through Effective Primary Care At A Pediatric Hospital In The Colombian Caribbean Alvis L1, Castillo I1, Vivas-Consuelo D2, Alvis Guzman N3, Orozco J4 de Cartagena, Cartagena de Indias, Colombia, 2Uni, Valencia, Colombia, 3Universidad de Cartagena. Centro de Investigación y Docencia. Hospital Infantil Napoleón Franco Pareja, Cartagena de Indias, Colombia, 4COOSALUD EPS, Cartagena de Indias, Colombia 1Universidad

Objectives: To estimate the proportion of avoidable hospitalizations occurred through effective primary care (AH-ACSC) and their respective costs for 2014 at Children’s Hospital Napoleon Franco Pareja of Cartagena de Indias, Colombia.  Methods: A descriptive study of hospital discharges generated in a pediatric hospital in the Colombian Caribbean during 2014. The discharges diagnostic codes from the International Classification of Diseases ICD-10- that are included in the list of AH- ACSC used by Alfradique were selected then each of the diagnostic groups was analyzed in terms of their percentage share and medium care costs estimated during hospitalization. Results: In the year 2014 a total of 21308 hospitalizations occurred of which 6641 were considered preventable, this represented one third of the total hospitalizations. The most common avoidable hospitalizations were lower respiratory diseases and asthma. The AH- ACSCs that reported higher average hospital stay were heart failure and cerebral-vascular diseases. The total cost of preventable hospitalizations was USD 1,637,084 representing a 27 % of total hospital costs during 2014. Lower respiratory diseases hospitalizations represented one fifth of the total cost while skin infections hospitalizations represented 16.8 % .The hospitalizations with the highest average cost were caused by heart failure and cerebral-vascular diseases while hospitalizations for strep throat, nose and ears reported the lowest average cost.  Conclusions: Greater efforts were required in primary care given to the pediatric population to strengthen interventions strategies for instance Comprehensive Care Illness plan for Early Childhood-IMCI, hence with an optimal performance of this strategy we can reduce avoidable hospitalizations. Furthermore an improvement in the adhesion of children with chronic diseases like asthma and even diabetes must be done PHS132 Social And Economic Value of Portuguese Community Pharmacies In Public Health Félix J1, Ferreira D1, Afonso-Silva M1, Gomes M1, Ferreira C1, Vandewalle B1, Marques S1, Mota M1, Costa S2, Cary M2, Teixeira I2, Paulino E3, Macedo B3, Barbosa M4 Consultores, Lisboa, Portugal, 2Center for Health Evaluation & Research, Lisbon, Portugal, 3Portuguese Pharmaceutical Society, Lisbon, Portugal, 4Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal

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Objectives: Community pharmacies are major contributors to health care systems across the world. Few studies on the economic evaluation of community pharmacist’s Public Health interventions in Portugal have been conducted, most of them disease / intervention specific. This study aimed to estimate the social and economic benefits of current and potential future community pharmacists’ Public Health interventions in Portugal.  Methods: The social and economic value of community pharmacists’ interventions, excluding medication supply, was estimated through a decision-model. Model inputs included effectiveness data, quality of life and health resource consumption obtained from data collected over 25 years in Portuguese pharmacies, from literature review and adapted to Portuguese reality by an expert panel. The estimated economic value was the result of non-remunerated pharmacy interventions plus health resource consumption potentially avoided. Social and economic value of community pharmacists’ interventions derives from the comparison of two scenarios: “with intervention” versus “without intervention”.  Results: It is estimated that current community pharmacists’ interventions in Portugal provide a gain in quality of life of 8.3% and an economic value of 879.6 million euros (M€ ), including 342.1M€  in non-remunerated pharmacy interventions and 448.1M€  in avoided expense with health resource consumption. Interventions to improve adherence and chronic disease interventions in hypertension, diabetes, hyperlipidemia and asthma/COPD generate 54% (474.5 M€ ) of this benefit. Future

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community pharmacists’ interventions may provide an additional increase of 6.9% in quality of life and be associated with an economic value of 144.8M€ : 120.3M€  in non-remunerated interventions and 24.5M€  in potential savings with health resource consumption.  Conclusions: Community pharmacists’ interventions provide considerable benefit in quality of life and economic value. An increased range of interventions including a greater integration in primary and secondary care, among other transversal interventions, may add further social and economic value to the society. PHS133 Impact of Continuity of Care on Care And Costs For Chronic Disease Cheng J, Ku H Chang Gung University, Tao-Yuan, Taiwan

Objectives: Continuity of care is an important public health issue worldwide. The quality of care may be compromised due to lack of coordinated care, particularly for individuals with chronic diseases who need intensive and comprehensive care. Furthermore, medical costs may increase due to suboptimal and duplicate care. Therefore, this study aimed to examine the impact of continuity of care on medical care and costs of those with chronic diseases.  Methods: The National Health Insurance claims database of a representative sample of Taiwanese population was adopted for this study. Adult individuals who had outpatient visits for heart failure, hypertension, diabetes mellitus, hyperlipidemia, chronic obstructive pulmonary disease, or asthma were included. Their use of medical care in the first year of follow-up was adopted for estimating continuity of care index. Their use and costs of health services in the second year were used to measure medication possession ratio, admission to hospital or emergency department, and disease-related costs. Logistic regression models and generalized linear models were adopted for analyses.  Results: The mean age of the subjects in each disease ranged from 46 to 64, and 49%-62% of the subjects in each disease were male. Individuals with higher continuity of care index were more likely to adhere to their medication regimen, and had a lower probability of being admitted to emergency department or hospital. In individuals with heart failure, diabetes mellitus, and chronic obstructive pulmonary disease, higher continuity of care index led to lower total cost.  Conclusions: This study identified the impact of continuity of care on the care and costs of medical services for chronic diseases. Better continuity of care led to better medical adherence and a lower risk of being admitted to hospital or emergency department. PHS134 Economic Burden of Diseases In Poland Lesniowska J Kozminski University, Warsaw, Poland

Objectives: Identification of the diseases and disabilities that encumber the economy the most, is extremely important. An accurate analysis of the economic burden by specific diseases and disabilities and their interrelationships, particularly in the publicly financed areas, can significantly support the improvement of the allocative efficiency of resources in health. This study is the first comprehensive study on the direct and indirect costs of all diseases and for some selected disorders their related complications, in Poland. Complications of the following diseases have been analysed: depressive episode and recurrent depressive.  Methods: In order to estimate the direct medical costs of disorders and for some selected disorders the costs of their complications, data from the National Health Fund were used with related etiological fraction calculus. This data includes the costs of outpatient consultation, hospitalization, rehabilitation, and drugs. Indirect costs embraced costs of lost productivity due to absenteeism and inability to work (handicap) caused by these diseaeses, and costs of lost productivity due to the premature mortality. They were calculated upon Social Insurance Institution and Central Statistic Office datasets using human capital method.  Results: The total cost of diseases in Poland (including lost productivity of persons insured in Agricultural Social Insurance Fund) amount to EUR 37,9 billion, of which 61% (EUR 23.0 billion) is the cost of lost productivity (indirect), and 39% (EUR 14.9 billion) is the cost of health-care services (direct). Analysis of costs of selected mental disorders and their complicatios indicates that costs of disease-related complications are much higher than disease itself (total costs of mental disorders – EUR 372,2 million, total costs of mental-related complications – EUR 1,127 billion).  Conclusions: The conducted analysis indicates that diseases constitute a significant burden for the Polish economy. Total cost of diseases constitutes 9.5% of the GDP in Poland (the indirect cost is 6.06% of GDP). PHS135 Economic Evaluation of The Portuguese Needle Exchange Programme In Community Pharmacies (NEP-CP) Borges M1, Gouveia M2, Fiorentino F1, Jesus G1, Cary M3, Guerreiro JP3, Costa S3, Vaz Carneiro A1 1Center for Evidence Based Medicine, Faculty of Medicine, University of Lisbon, Lisbon, Portugal, 2Católica Lisbon School of Business and Economics, Lisbon, Portugal, 3Center for Health Evaluation & Research, Lisbon, Portugal

Objectives: To conduct a cost-effectiveness analysis comparing two scenarios of the Needle Exchange Program (NEP) in Portugal: with and without community pharmacies (CP).  Methods: Health gains were measured by the number of HIV and HCV infections avoided. The number of infections in each scenario was estimated based on a standard model in the literature (Jacobs et al, 1994) calibrated to the national epidemiological situation taking into account the trend of infections’ incidence and the characteristics of Injecting Drug Users (IDU). The costs per averted infection were taken from the national literature. The estimates of the NEP-CP costs include costs incurred by CP and by other institutions that participate