Paul Ferdinand M Reganit

Economic Burden of Community-Acquired Pneumonia among Adults in the Philippines: Its Equity and Policy Implications in the Case Rate Payments of the Philippine Health Insurance Corporation

OBJECTIVES To determine 1) the cost of hospitalization, the 1-week postdischarge cost, the total cost, and the economic burden of community-acquired pneumonia among patients aged 19 years or older in the Philippines and 2) the difference between the estimated costs and the Philippine Health Insurance Corporation (PhilHealth) pneumonia case rate payments. METHODS The study involved two tertiary private hospitals in the Philippines. Using the societal perspective, both health care and non-health care costs were determined. A base-case analysis and sensitivity analyses were performed, and the economic burden of pneumonia was determined using PhilHealth claims. RESULTS The estimated cost of hospitalization for community-acquired pneumonia-moderate risk (CAP-MR) ranged from Philippine peso (PHP) 36,153 to 113,633 (US

A case control study on autopsy findings in sudden unexplained nocturnal death syndrome

852-2678) and its 1-week postdischarge cost ranged from PHP1450 to 8800 (US

Chronic Heart Failure Clinical Practice Guidelines’ Class 1-A Pharmacologic Recommendations: Start-to-End Synergistic Drug Therapy?

34-207). The cost of hospitalization for community-acquired pneumonia-high risk (CAP-HR) ranged from PHP104,544 to 249,695 (US

Smoking-attributable burden of lung cancer in the Philippines.

2464-5885) and PHP101,248 to 243, 495 (US

Cardiac events occurred commonly among apparently healthy Filipinos with the Brugada ECG pattern in the LIFECARE cohort

2386-5739) using invasive and noninvasive ventilation, respectively. The postdischarge cost for CAP-HR ranged from PHP1716 to 10,529 (US

PS 02-19 APOLIPOPROTEIN LEVELS IN PATIENTS WITH ACUTE CORONARY SYNDROME: A PIONEER STUDY

40-248). If only health care cost was considered, the cost ranged from PHP24,403 to 89,433 for CAP-MR and PHP92,848 to 213,395 for CAP-HR. The present PhilHealth case rate payments are PHP15,000 (US

PS 08-01 THE NEUTROPHIL-LYMPHOCYTE RATIO (NLR) PREDICTS SEVERITY OF STABLE CORONARY ARTERY DISEASE DETERMINED BY THE SYNTAX SCORE

354) and PHP32,000 (US

PS 02-23 ASSOCIATION OF THE PLATELET–LYMPHOCYTE RATIO (PLR) WITH OUTCOMES IN PATIENTS ADMITTED FOR ACUTE CORONARY SYNDROME

754) for CAP-MR and CAP-HR, respectively. Based on the number of PhilHealth claims for 2012 and the estimated health care cost, the economic burden of pneumonia in 2012 was PHP8.48 billion for CAP-MR and PHP643.76 million for CAP-HR. CONCLUSIONS The estimated health care cost of hospitalization is markedly higher than the PhilHealth case rate payments. As per the study results, the economic burden of pneumonia is, thus, significantly higher than PhilHealth estimates.

GW25-e0537 Association of the neutrophil–lymphocyte ratio (NLR) with outcomes in patients admitted for an acute coronary syndrome

Aim Sudden unexplained nocturnal death syndrome (SUNDS) has been linked to the Brugada syndrome. In some places, acute haemorrhagic pancreatitis is widely held to cause it. We conducted a systematic, controlled autopsy study on Filipino SUNDS victims to rule out structural heart findings as well as acute haemorrhagic pancreatitis as causes. Methods and results A case control autopsy study was conducted comparing SUNDS victims between 18 and 50 years of age who died within 1 h of symptom onset with age- and gender-matched controls. There were 24 SUNDS (mean age 34.5 years) and 24 controls (mean 32.7 years). The autopsy incidence of structural heart disease was 8.3% (95% CI (1% to 27%)) and focal pancreatic haemorrhage was 4.17% (95% CI (0.1% to 20%)) but zero for true acute haemorrhagic pancreatitis among SUNDS victims. Autopsy findings in SUNDS versus controls were not significantly different from each other, showing no diagnostic abnormality in any of the organs. There was no significant difference in the incidence of acute haemorrhagic pancreatitis in both the SUNDS and control groups. We did not find fetal dispersion of the atrioventricular (AV) node, sclerosis or fibrosis of the AV conduction system, in a substudy of SUNDS cases. Conclusions We have shown that there is no significant difference in the overall autopsy findings between SUNDS and controls. Autopsy findings were normal in 70% of SUNDS; no cardiac structural pathology was found in 87% of cases. Haemorrhagic pancreatitis is the cause of death in a minority of SUNDS. The cardiac conduction system is normal in a subgroup of SUNDS studied.

Smoking-attributable burden of lung cancer in the Philippines: a comparative risk assessment

Background:Chronic heart failure (HF) disease as an emerging epidemic has a high economic-psycho-social burden, hospitalization, readmission, morbidity and mortality rates despite many clinical practice guidelines’ evidenced-based and consensus driven recommendations that include trials’ initial-baseline data.Objective:To show that the survival and hospitalization-free event rates in the reviewed chronic HF clinical practice guidelines’ class I-A recommendations as initial HF drug therapy (IDT) is possibly a combination and ‘start-to-end’ synergistic effect of the add-on (‘end’) HF drug therapy (ADT) to the baseline (‘start’) HF drug therapy (BDT).Methodology:The references cited in the chronic HF clinical practice guidelines of the 2005, 2009, and 2013 American Heart Association/American College of Cardiology (AHA/ACC), the 2006 Heart Failure Society of America (HFSA), and the 2005, 2008, and 2012 European Society of Cardiology (ESC) were reviewed and compared with the respective guidelines’ and other countries’ recommendations.Results:The BDT using glycosides and diuretics is 79%-100% in the cited HF trials. The survival rates attributed to the BDT (‘start’) is 46%-89% and IDT (‘end’) 61%-92.8%, respectively. The hospitalization-free event rate of the BDT group: 47.1% to 85.3% and IDT group 61.8%-90%, respectively. Thus, the survival and hospitalization-free event rates of the ADT is 0.4%-15% and 4.6% to 14.7%, respectively. The extrapolated BDT survival is 8%-51% based on a 38% estimated natural HF survival rate for the time period109.Conclusion:The contribution of baseline HF drug therapy (BDT) is relevant in terms of survival and hospitalization-free event rates compared to the HF class 1-A guidelines initial drug therapy recommendations (IDT). Further, the proposed initial HF drug (‘end’) therapy (IDT) has possible synergistic effects with the baseline HF drug (‘start’) therapy (BDT) and is essentially the add on HF drug therapy (ADT) in our analysis. The polypharmacy HF treatment is a synergistic effect due to BDT and ADT.