Gyula Jozsef Nagy

Background and objectives Anemia is a serious heath concern due to its high prevalence in the global population. Its occurrence in surgical patients varies greatly and correlates with worse outcomes. Higher costs and severe complications could also result from insufficient iron status. An effective way to mitigate the burden of iron deficiency could be the adoption of national patient blood management (PBM) programs. This study aimed to quantify the potential health economic benefits of implementing preoperative anemia management (the first pillar of PBM) with ferric carboxymaltose (FCM) in Romanian hospitals. Methods An already published decision-tree-based health economic model was adapted and populated with Romanian cost and epidemiological data from 2019. Cardiac (coronary artery bypass grafting) and non-cardiac (hip and knee arthroplasty) elective surgery cases were analyzed. Costs of complications per discharged case were assessed on the basis of data from ten local hospitals. Results A total of 14,641 cases met the inclusion criteria. On the basis of our sample of ten hospitals, the complication costs per case ranged from €1067.43 (for stroke) to €2896.14 (for sepsis with pneumonia). The health economic model simulated two scenarios. In the first scenario, all cases with anemia received FCM treatment. The total savings at the national level total were at least €1,500,875. In the second scenario half of the cases with anemia received treatment, resulting in savings of €363,779. Conclusions Our results suggest that introducing iron deficiency anemia treatment with FCM in case of elective surgical interventions results in considerable cost reduction for the healthcare system.

Background: Chronic kidney disease or chronic renal failure is a progressive condition defined as abnormalities of kidney structure or function, present for longer than 3 months. It is estimated to affect more than 10% of the general population worldwide. Management of CKD represents an especially large burden for the health systems of low- and middle-income countries, and it has been recognized as a leading public health problem. Previous research articles reported an age-adjusted prevalence of 7.6% for Romania, but the hospital costs generated by CKD are unknown. The present research article aimed to measure the hospital costs and one-year national healthcare budget impact of CKD, excepting the chronic care costs of RRTs. Methods: In this retrospective study we reviewed the electronic health records of 4 University, 3 County and 5 City hospitals from 1^st of January 2019 to 31^st of December 2019 in order to calculate costs related to hospitalization due to chronic kidney disease. Inclusion criteria were defined as: CKD-related diagnostic codes or dialysis-related procedures in medical cases (without surgical interventions). KDIGO severity grades 1-5 were considered, including dialysis costs. The costs generated by the chronic care of RRTs were not considered here. Hospitalization cost calculation was based on hospital controlling methodology including direct, indirect and overhead costs. For the national-level burden study, we analyzed the health claim records of all public and private hospitals for 2019. Results: In 2019 a total number of 229 276 cases reported chronic kidney disease in Romania. The average hospital costs per patient episode was €917.1, with significantly higher costs in cases with complications or higher severity grades. The total hospitalization cost-related budget impact in 2019 was €210 million. Conclusions: The high hospitalization costs of CKD (representing 2.6% of the NHIH budget, not considering the funds for sick leave) cause major impact on the national health payer`s budget. Preventive strategies, early diagnosis and management as well as health education measures could act as means of mitigation. Our results should warn the public health policy decision makers about the importance of this disease.