S Varga

PHP84 REGIONAL DIFFERENCES IN ACUTE CARE HOSPITAL BED CAPACITIES FOLLOWING THE 2006–2008 HEALTH CARE REFORM IN HUNGARY

PHP80 CLINICAL EFFECTIVENESS OF PORTABLE ULTRASOUND IN SMALL EMERGENCY DEPARTMENTS: A SYSTEMATIC REVIEW Gaebel K, Kaulback K, Robertson D, Blackhouse G, Xie F, Assasi N, Goeree R McMaster University, Hamilton, ON, Canada OBJECTIVES: In the 2001 policy statement from the American College of Emergency Physicians, they considered a large number of conditions as primary indications for emergency ultrasonography (US). Early trials of US did not take place in emergency departments (EDs) and the US interpreter was not an emergency physician (EP). The objective of this review was to determine if there is evidence to evaluate whether US conducted by non-radiologists in a small emergency department is an effective diagnostic tool. METHODS: A systematic review was conducted to identify health technology assessments (HTAs), systematic reviews (SRs), meta-analyses (MAs), randomized controlled trials (RCTs), and controlled clinical trials published in the last 5 years. RESULTS: The search identified nine trials, and two systematic reviews. The primary indications in these reports were: trauma, deep vein thrombosis (DVT), pain, undifferentiated hypotension and US-guided procedures. Reports regarding US-guided procedures took place in small EDs and the success rates of US-guided cannulation were significantly larger compared to the traditional technique. Sensitivity and specificity estimates for EP performed US in the diagnosis of trauma, and DVT are high, and similar to those reported when radiologists interpreted the US scans. The addition of US in diagnosing pelvic pain increases physician confidence and was especially valuable in the evaluation of a patient who is also obese. The addition of an US protocol to standard care afforded physicians the ability to compile a significantly shorter and more accurate list of possible causes of non-traumatic undifferentiated hypotension. These results are inferred from trials from large urban hospitals. CONCLUSIONS: Diagnostic estimates obtained when EPs perform the US are comparable to those obtained when the US was performed by a radiologist. US is an effective tool in the hands of EPs in EDs, both small and large.

PDB28 HEALTH INSURANCE COST OF DIABETES MELLITUS IN HUNGARY: A COST OF ILLNESS STUDY

PDB24 DIRECT HEALTH CARE COSTS OF DIABETES MELLITUS IN HUNGARY Vokó Z, Nagyjanosi L, Kalo Z Eötvös Loránd University, Budapest, Hungary; Syreon Research Institute, Budapest, Hungary OBJECTIVES: Diabetes mellitus is responsible for a huge burden of disease. Our objective was to estimate the direct health-care costs of patients with diabetes in Hungary. METHODS: Real-world data were retreived from the National Health Insurance Fund database. Diabetic patients were defi ned as persons who fi lled in a prescription of oral antidiabetics (OAD) or insulin in Q3-Q4 2007. Study population was divided into two groups depending on whether they were hospitalized for major complications of diabetes in 2007–2008. Patients without hospitalization were further divided into three subgroups according to the use of drugs (only OAD, only insulin, OAD and insulin). In all subgroups, we estimated health-care costs for each cost item by age group in the whole study group and among those who actually used a particular service. Additionally, we took samples of patients who were hospitalized for specifi c complications, and estimated health-care costs for the fi rst and second year after the occurrence of the complication. Hungarian Forint values were converted to Euros by employing the 2008 GDP specifi c PPP exchange rate (1c = 157.64HUF). RESULTS: Mean health-care cost of 521,545 diabetic patients was c2125 in 2008. It was c4016 for those with hospitalization for complications, c1533 for OAD users without complications, and c2847 for insulin users without complications. Fifty-three percent of the total cost covered drug treatment and 27% acute hospital treatment; 26% of the total drug cost was spent on OADs and on insulin. CONCLUSIONS: Health-care cost of diabetes is already high in Hungary, especially care for its complications. Public health-care cost of diabetes exceeds 0.65% of GDP and 13% of total direct public health-care expenditure. Considering the burden of disease that manifests in premature mortality, reduction in QoL, and high cost, and the epidemiological trends, diabetes mellitus should be a public health priority in Hungary.

PHP7 BED OCCUPANCY RATE OF HUNGARIAN INTENSIVE CARE UNITS

therewith is price elastic. We estimate that approximately 40% of the increase in prescription volume results from REGO. Additionally to the increase in expenditures the sickness funds are facing a loss of income as less co-payment rates are paid. Prescriptions with prices lower than the co-payment rate are not paid by the insured anymore, but by the sickness funds. These low-price prescriptions cause a dramatic increase in volume, however, not a decisive increase in total expenditures. CONCLUSIONS: The time courses allow us to evaluate the effects of REGO. Furthermore they reveal information about the behaviour of the demand function, when the price drops to zero. The intention of REGO is to improve equity by protecting poorer and heavy users of prescription drugs from the financial burden of co-payments. Demand increases, when REGO reduces the price for prescription drugs to a 0. This could indicate an improvement in equity and access, however, affects on efficiency have to be shown in further analysis.