Browsing by Author "Gonen, Mustafa Sait"

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Cost-Effectiveness Analysis of Remdesivir Treatment in COVID-19 Patients Requiring Low-Flow Oxygen Therapy: Payer Perspective in Turkey
(2021) Oksuz, Ergun; Malhan, Simten; Gonen, Mustafa Sait; Kutlubay, Zekayi; Keskindemirci, Yilmaz; Jarett, James; Sahin, Toros; Ozcagli, Gokcem; Bilgic, Ahmet; Bibilik, Merve Ozlem; Tabak, Ozlem; 0000-0002-5723-5965; 34379304; K-8238-2012
Introduction This study aims to evaluate the cost-effectiveness of remdesivir compared to other existing therapies (SoC) in Turkey to treat COVID-19 patients hospitalized with < 94% saturation and low-flow oxygen therapy (LFOT) requirement. Methods We compared remdesivir as the treatment for COVID-19 with the treatments in the Turkish treatment guidelines. Analyses were performed using data from 78 hospitalized COVID-19 patients with SpO(2) < 94% who received LFOT in a tertiary healthcare facility. COVID-19 episode costs were calculated for 78 patients considering the cost of modeled remdesivir treatment in the same group from the payer's perspective. The incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY) was calculated for remdesivir versus the SoC for the population identified. For Turkey, a reimbursement threshold value between USD 8599 (1 x per capita gross domestic product-GDP) and USD 25.797 (3 x GDP) per QALY was used. Results In the remdesivir arm, the length of hospital stay (LOS) was 3 days shorter than the SOC. The low ventilator requirement in the remdesivir arm was one factor that decreased the QALY disutility value. In patients who were transferred to intensive care unit (ICU) from the ward, the mean LOS was 17.3 days (SD 13.6), and the mean cost of stay was USD 155.3/day (SD 168.0), while in patients who were admitted to ICU at baseline, the mean LOS was 13.1 days (SD 13.7), and the mean cost of stay was USD 207.9/day (SD 133.6). The mean cost of episode per patient was USD 3461.1 (SD 2259.8) in the remdesivir arm and USD 3538.9 (SD 3296.0) in the SOC arm. Incremental QALYs were estimated at 0.174. Remdesivir treatment was determined to be cost saving vs. SoC. Conclusions Remdesivir, which results in shorter LOS and lower rates of intubation requirements in ICU patients than existing therapies, is associated with higher QALYs and lower costs, dominating SoC in patients with SpO(2) < 94% who require oxygen support.
COVID-19 healthcare cost and length of hospital stay in Turkey: retrospective analysis from the first peak of the pandemic
(2021) Oksuz, Ergun; Malhan, Simten; Gonen, Mustafa Sait; Kutlubay, Zekayi; Keskindemirci, Yilmaz; Tabak, Fehmi; 0000-0002-5723-5965; 34623528; K-8238-2012
Background During the COVID-19 pandemic, health care systems are under extreme pressure. This study analyzed health care resource use (HCRU) and costs in patients admitted to the hospital for COVID-19 and aimed to estimate the one-year direct medical cost of the disease in Turkey. Methods This retrospective cohort study was conducted between March and July 2020 in a tertiary hospital (n = 1056) in Istanbul. Patient demographics, clinical and treatment characteristics at admission, comorbidities, disease severity, and costs from a payer perspective were evaluated using the microcosting method. The results include LOS, hospital costs, and univariate and generalized linear models to investigate influencing factors. The data were extrapolated to provide a country-level estimate. Results The mean length of stay was 9.1 days (SD 6.9). The mean length of stay was 8.0 days (4.7) for patients hospitalized in wards versus 14.8 days (SD 12.0) for patients hospitalized in the ICU. In univariate analysis, several factors, including O-2 therapy (+ 3.7 days), high CRP > 41.8 mg/L (+ 3.8 days), and elevated ferritin (+ 3.5), were found to be associated with a longer LOS (p < 0.05). The direct annual medical cost of COVID-19 was estimated at PPP$ 2.1 billion. The COVID-19 pandemic resulted in a direct medical burden that corresponds to 2.0% of the government health expenditures and 0.8 per thousand of Turkey's gross domestic product (GDP). Conclusions Estimating the impact of this pandemic in terms of HCRU and costs to the health care system can help design strategies to manage the pandemic.
Influence of Exercise on Leptin, Adiponectin and Quality of Life in Type 2 Diabetics
(2015) Dede, Nesrin Dogan; Ipekci, Suleyman Hilmi; Kebapcilar, Levent; Arslan, Mihriban; Kurban, Sevil; Yildiz, Mustafa; Gonen, Mustafa Sait
Purpose: This study aimed to investigate the influence of aerobic exercise on the quality of life and leptin and adiponectin levels in patients with type 2 diabetes mellitus. Material and Method: Patients were randomized into two groups: aerobic exercise-training and control group. Parameters were assessed at baseline and end of the twelve-week follow-up for 60 type 2 diabetic patients who completed the program. The 36-item Short Form Health Survey was administered to the patients. Results: The exercise-training group results showed a decrease in adiponectin and leptin levels, a reduction of waist circumference and percentage of body fat (p=0.007, 0.023, 0.012 and 0.048, respectively). The leptin levels in the aerobic exercise group were positively correlated with body mass index (r=0.303, p=0.021) and percentage of body fat (r=0.371, p=0.005); they were negatively correlated with physical problems (r=-0.482; p=0.009) and pain (r=-0.540; p=0.003). Exercise led to statistically significant improvements in the SF-36 physical functioning and mental health subscales (p=0.020 and 0.023, respectively). Discussion: The association of better HbA1c, waist circumference, and percentage of body fat with improved mental and physical scores may be related to a decrease in leptin levels, despite a significant reduction in serum adiponectin levels.