Marcin Czech

The analysis of the costs of one month of ambulatory drug therapy in the group of elderly aged 80 and over following hospital discharge

Background: It is thought that at least one medication is taken by up to 60% of elderly people. What is more, in US elderly people living in the community take on average four medications, while home-care residents take averagely seven drugs a day. The above-mentioned facts, in the light of current demographic changes of the structure of population, indicate the growing cost of ambulatory drug therapy of the elderly.

Aim of the study: To analyze the costs of one month of ambulatory drug therapy in the group of elderly aged 80 and over following hospital discharge. Moreover, the relation between the number of pills and drugs taken in general, concomitant illnesses and costs of therapy were assessed.

Materials and methods: The retrospective analysis of medical documentation of 116 patients aged 80 and over was performed. The costs of therapy were calculated accordingly to the prices published in The Drug Index. Co-morbid illnesses were classified accordingly to the International Classification of Diseases (ICD-10). Analysis in the age subgroups was performed.

Results: Mean age was 85.2 ± 4.2y-rs, group consisted of 62 women and 27 men; 27 patients were excluded from further analysis. Mean number of prescribed drugs was 7.6 ± 2.9 (min.–max.: 1–16), mean number of prescribed pills was 8.8 ± 4.3 (min.–max.: 0–23). Patients in the examined group suffered from 5.8 ± 2.0 chronic diseases averagely. Mean cost of one month of ambulatory drug therapy was 135.9 ± 95.7 PLN (min.–max.: 1,96–625,9 PLN). Significant relations between the costs of ambulatory drug therapy and the number of chronic diseases (r = 0.51, p < 0.0001) as well as the number of pills (r = 0.68, p < 0.001) and drugs (r = 0.74, p < 0.001) were observed. The differences in the subgroups were observed.

Conclusions: The high co-morbidity observed in the elderly results in the need for taking a great number of drugs and consequently causes high costs of ambulatory drug therapy. When planning ambulatory treatment, it is important to analyze the patients’ and their families’ financial situation, and when necessary provide economical support.

Economic and epidemiological aspects of the immunisation program against pertussis in Poland

The aim of this study is to evaluate the cost-effectiveness of vaccination against pertussis in epidemiological and economic terms. The estimation was based on available epidemiological data linked to an obligatory vaccination programme and morbidity in the Polish population. The economic evaluation included data on funds spent on the purchase of vaccines and the cost of outpatient and hospital treatment of patients spent from the state budget. The analysis of epidemiological data confirmed that the decrease in the level of vaccination of the population in combination with shortening the time of immunization resulted in an increase in the incidence of whooping cough. Economic analysis showed that the costs associated with the implementation of a vaccination program are lower than the direct costs of treatment of pertussis per patient. Vaccinations should be a fundamental tool in the fight against infectious diseases despite emerging reports of adverse events or evasion of vaccination. There are economic and epidemiological arguments for broadening the scope of vaccination against pertussis as well as extending the vaccination calendar by inclusion of currently recommended (not financed by the state) vaccines.