Browsing by Author "Malhan, Simten"

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Ankara'da bir vakıf üniversitesine bağlı semt polikinliğine başvuran hastaların tamamlayıcı sağlık sigortasına bakış açılarının değerlendirilmesi
(Başkent Üniversitesi Sosyal Bilimler Enstitüsü, 2014) İnce, Gülay; Malhan, Simten
Sosyal güvenlik, bir ülkede yaşayan tüm insanları ve çalışma yaşamını doğrudan ya da dolaylı olarak etkileyen temel bir sistemdir. Sosyal güvenlik sisteminde gerçekleştirilen reformlar sonucunda genel sağlık sigortası oluşturulmuştur. Genel Sağlık Sigortası kişilerin ekonomik gücüne ve arzulu olup olmadığına bakılmaksızın, ortaya çıkacak hastalık riskine karşı, toplumun bütün fertlerinin sağlık hizmetlerinden yaygın ve etkin bir şekilde yararlanmasını sağlayan, sağlık sistemidir. Ancak genel sağlık sigortası modeli sunmuş olduğu temel teminat paketi ile optimal sağlık beklentilerini karşılamaya yetmemektedir. Tamamlayıcı sağlık sigortasının devreye girmesiyle genel sağlık sigortası da sağlıklı bir şekilde işleyebilecektir. Tamamlayıcı Sağlık Sigortası Sosyal güvenlik kurumu tarafından kapsama alınmayan ya da kapsama alındığı halde genel sağlık sigortalısı ve bakmakla yükümlü olduğu kişiler tarafından ilave ücret ödemesi gerektiren sağlık hizmetlerini, özel sigorta aracılığı ile sigorta kapsamına almaktır. Tamamlayıcı sağlık sigortası ile vatandaşların kolay erişebileceği nitelikli sağlık hizmeti seçenekleri artacaktır. Bu çalışmanın amacı, Ankara’da Bir Vakıf Üniversitesine Bağlı Semt Polikliniğine Başvuran Hastaların sosyo-demografik özellikleri, sağlık sorunları ve sağlık harcamaları çerçevesinde tamamlayıcı sağlık sigortasına bakış açılarının tespit edilmesidir. Veri toplamak için Sigorta Şirketi anketleri derlenerek oluşturulan anket 278 hastaya uygulanmıştır. Toplanan veriler SPSS 18.0 paket programı kullanılarak bilgisayara girilmiş ve değerlendirilmiştir. Çalışmanın sonucunda araştırmaya katılan kişilerin büyük ölçüde tamamlayıcı sağlık sigortasının farkında olmadıkları, farkında olan kişilerin ise önemli bir bölümünün tamamlayıcı sağlık sigortasına sıcak bakmadığı belirlenmiştir. Tamamlayıcı sağlık sigortasına bu yaklaşımın en önemli nedeni, sigorta şirketlerine duyulan güvensizlik ve yeterli tanıtımın yapılmaması olarak belirlenmiştir. Türkiye’de Tamamlayıcı sağlık sigortası uygulamasına geçilmeden önce, yapılan bu çalışmanın Türkiye genelinde daha büyük bir örneklemle genişletilmesi Tamamlayıcı Sağlık Sigortası ile ilgili yasal ve pratik düzenlemelerin geliştirilmesinde yararlı olabileceği düşünülmektedir.
Ankara'da faaliyet gösteren tıbbi cihaz firmalarının sağlık uygulama tebliği (SUT) hakkındaki görüşleri
(Başkent Üniversitesi Sosyal Bilimler Enstitüsü, 2015) Asil Yılmaz, Gülçin; Malhan, Simten
Günümüzde sağlık sektöründe yaşanan gelişmeler ile birlikte tıbbi cihaz sektörü de her geçen gün gelişmekte ve teknolojik olarak ileri gitmektedir. Tıbbi cihazlar ve tıbbi malzemeler sağlık sektöründeki en önemli yapı taşlarındandır. Tıbbi malzeme veya tıbbi bir ürün olmadan hastanelerde hasta tedavisinin yapılamayacağı bilinen bir gerçektir. Tüm dünya sağlık sektörünün yapı taşı olan tıbbi ürünleri üretmek ve satmak için çaba harcamaktadır. Sosyal Güvenlik Kurumu tarafından yayınlanan Sağlık Uygulama Tebliğinde (SUT), tıbbi malzeme bedellerinin hangi tedavilerde ödeneceği ve bu bedellerin ne kadarının karşılanacağı belirtilmektedir. Malzeme bedellerinin istenilen şekilde karşılanmaması, tıbbi cihaz firmalarınca birçok soruna neden olmaktadır. Çalışmanın amacı; Ankara'da üretici veya ithalatçı konumunda bulunan tıbbi cihaz firmalarının Sağlık Uygulama Tebliği (SUT) hakkındaki görüşlerinin belirlenmesidir. Veri toplamak için 5 sayfa ve 18 sorudan oluşan bir anket formu kullanılmıştır. Çalışma 1 Kasım 2014 ile 9 Ocak 2015 tarihleri arasında gerçekleştirilmiştir. Toplanan veriler SPSS 18.0 paket programı kullanılarak bilgisayara girilmiş ve değerlendirilmiştir. Çalışmanın sonucunda, Ankara'da faaliyet gösteren tıbbi cihaz firmalarının Sağlık Uygulama Tebliği (SUT) hakkındaki görüşleri ve yorumları toplanmış, ardından analiz edilmiştir. Bu sonuçlar doğrultusunda firmaların büyük bir çoğunluğu Sağlık Uygulama Tebliği (SUT) fiyatlandırmalarından memnun olmadığını belirtmiştir. Yapılan bu çalışmanın Türkiye genelinde daha fazla firmaya ulaşılarak genişletilmesi ile Sağlık Uygulama Tebliği (SUT) ile ilgili yasal ve pratik düzenlemelerin geliştirilmesinde yararlı olabileceği düşünülmektedir. Today, together with developments in the health sector in developing and advanced medical device industry is to go every day. Medical devices and medical supplies are the most important building blocks in the health sector. Without medical supplies or a medical product is a well known hospital treatment of the patient can not be done. All over the world the health sector to produce medical products that carry the structure and striving to sell. Published by the Social Security Administration in Health Application Communique, payable in which treatment of medical materials cost and how much of this amount is stated to be met. Failure to meet the cost of materials as desired, medical device companies of causes many problems. The aim of the study Health Application Communique of the medical device manufacturer or importer company located in Ankara to determine their views about. A questionnaire consisting of 5 pages and 18 questions were used to collect data. Study was conducted between January 9, 2015 November 1, 2014 with dates. The collected data were entered into the computer using the SPSS 18.0 software package and evaluated. In conclusion, Health Application Communique of medical device companies operating in Ankara on the opinions and comments collected, then analyzed. The vast majority of firms in these results Health Application Communique is not satisfied with the pricing. This study carried out in Turkey by expanding company reaching more Health Application Communique is thought to be useful in the development of legal and practical arrangements.
Assessment of the Direct Medical Costs of Type 2 Diabetes Mellitus and its Complications in Turkey
(2014) Malhan, Simten; Oksuz, Ergun; Babineaux, Steven M.; Ertekin, Ali; Palmer, James P.; 0000-0002-5723-5965; K-8238-2012
Purpose: To estimate the direct annual medical costs of Type 2 diabetes and its complications in diagnosed patients in Turkey. Material and Method: A cost-of-illness model was developed. The prevalence of Type 2 diabetes was derived from the Turkish Diabetes Epidemiology Study, estimated as 13.7% in adults, with one-third of patients previously undiagnosed. Complication costs were extracted from the records of 7095 patients at a Turkish tertiary care hospital in 2009. For each modelled complication, acute phase costs were applied to globally derived incidence rates, and one-year follow-up costs were applied to globally derived prevalence rates. Costs and frequencies of ongoing antihyperglycaemic treatment and disease management were derived from treatment guidelines and Turkish hospital records. Parameter variation was performed. Results: The cost of Type 2 diabetes in diagnosed patients was estimated at between 11.4 to 12.9 billion Turkish Lira, 1% of Gross Domestic Product. Cardiovascular complications comprised the largest share of total medical costs (between 24.3% and 32.6%), followed by renal complicationsrelated costs (between 25% and 28.3%) and concomitant cardiovascular and antihypertensive medication costs (between 14.2% and 16%). Antihyperglycaemic medications and screening costs comprised between 10.9% to 12.3% and between 4.4% to 5% of total costs, respectively. Discussion: Type 2 diabetes is a disease burden and economic burden in Turkey; the complications cost is higher than the cost of disease control. For preventing complications, any activities effect positively limited resources and also quality of life.
Cost of hemophilia A in Turkey: an economic disease burden analysis
(2021) Malhan, Simten; Oksuz, Ergun; Antmen, Bulent; Ar, Muhlis Cem; Balkan, Can; Kavakli, Kaan; 0000-0002-5723-5965; 34355649; K-8238-2012
Objective: Hemophilia A is the second most common bleeding disorder causing patients to have lifelong follow-up and treatment. Despite being a rare disease, hemophilia A has a high economic burden on individuals and the public. The purpose of this study was to estimate the total disease cost of hemophilia A in Turkey. Materials and Methods: Data used in this analysis were collected through literature review, including studies conducted in Turkey in December 2018. A disease burden analysis was performed by modeling hemophilia A-related costs among patients, their relatives, and the social security system. Two expert panels were held to evaluate real-world data sources and to provide further information. All direct medical and non-medical costs were calculated annually from the Social Security Institution of the Republic of Turkey perspective, while indirect costs were estimated from the patient and community perspective. Results: For the calendar year of 2018, the number of hemophilia A patients in Turkey were estimated to be 5,055, with an average weight of 64.7 kg. The average annual direct medical, direct non-medical, and indirect costs of hemophilia A were calculated as euro93,268 ($109,286; (sic)502,717), euro2,533 ($2,968; (sic)13,655), and euro7,957 ($9,323; (sic)42,888) per patient, respectively, with a total annual cost of euro103,759 ($121,578; (sic)559,259). For the management of patients with inhibitors (4.9%), the average annual total cost was calculated to be euro325,439 ($381,330; (sic)1,754,117) per patient. The total annual disease burden of hemophilia A in 2018 was estimated to be about euro524 million ($614 million; (sic)2.82 billion), which corresponded to 1.6% of the total health expenditure in Turkey. Conclusion: The most important reason hemophilia A has a significant economic burden in Turkey is that replacement therapy is expensive. The major cost contributor was identified as factor replacement therapy. With inhibitor development, the average annual cost increased more than 3-fold.
Cost of illness among patients with diabetic foot ulcer in Turkey
(2016) Oksuz, Ergun; Malhan, Simten; Sonmez, Bilge; Tekin, Rukiye Numanoglu; 0000-0002-5723-5965; 27795820; K-8238-2012
AIM To evaluate the annual cost of patients with Wagner grade 3-4-5 diabetic foot ulcer (DFU) from the public payer's perspective in Turkey. METHODS This study was conducted focused on a time frame of one year from the public payer's perspective. Cost-of-illness (COI) methodology, which was developed by the World Health Organization, was used in the generation of cost data. By following a clinical path with the COI method, the main total expenses were reached by multiplying the number of uses of each expense item, the percentage of cases that used them and unit costs. Clinical guidelines and real data specific to Turkey were used in the calculation of the direct costs. Monte Carlo Simulation was used in the study as a sensitivity analysis. RESULTS The following were calculated in DFU treatment from the public payer's perspective: The annual average per patient outpatient costs $579.5 (4.1%), imaging test costs $283.2 (2.0%), laboratory test costs $284.8 (2.0%), annual average per patient cost of intervention, rehabilitation and trainings $2291.7 (16.0%), annual average per patient cost of drugs used $2545.8 (17.8%) and annual average per patient cost of medical materials used in DFU treatment $735.0 (5.1%). The average annual per patient cost for hospital admission is $7357.4 (51.5%). The average per patient complication cost for DFU is $210.3 (1.5%). The average annual per patient cost of DFU treatment in Turkey is $14287.70. As a result of the sensitivity analysis, the standard deviation of the analysis was $5706.60 (n = 5000, mean = $14146.8, 95% CI: $13988.6-$14304.9). CONCLUSION The health expenses per person are $-PPP 1045 in 2014 in Turkey and the average annual per patient cost for DFU is 14-fold of said amount. The total health expense in 2014 in Turkey is $-PPP 80.3 billion and the total DFU cost has a 3% share in the total annual health expenses for Turkey. Hospital costs are the highest component in DFU disease costs. In order to prevent DFU, training of the patients at risk and raising consciousness in patients with diabetes mellitus (DM) will provide benefits in terms of economy. Appropriate and efficient treatment of DM is a health intervention that can prevent complications.
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.
Economic Burden Of Lung Cancer In Turkey: A Cost Of Illness Study From Payer Perspective
(2021) Cicin, Irfan; Oksuz, Ergun; Karadurmus, Nuri Nuri; Malhan, Simten; Gumus, Mahmut; Yilmaz, Ulku; Cansever, Levent; Cinarka, Halit; Cetinkaya, Erdogan; Kiyik, Murat; Ozet, Ahmet; 0000-0002-5723-5965; 34173876; K-8238-2012
Background This study was designed to estimate economic burden of lung cancer in Turkey from payer perspective based on expert panel opinion on practice patterns in clinical practice. Methods In this cost of illness study, direct medical cost was calculated based on cost items related to outpatient visits, laboratory and radiological tests, hospitalizations/interventions, drug treatment, adverse events and metastasis. Indirect cost was calculated based on lost productivity due to early retirement, morbidity and premature death resulting from the illness, the value of lost productivity due to time spent by family caregivers and cost of formal caregivers. Results Cost analysis revealed the total per patient annual direct medical cost for small cell lung cancer to be euro8772), for non-small-cell lung cancer to be euro10,167. Total annual direct medical cost was euro497.9 million, total annual indirect medical cost was euro1.1 billion and total economic burden of lung cancer was euro1.6 billion. Hospitalization/interventions (41%) and indirect costs (68.6%) were the major cost drivers for total direct costs and the overall economic burden of lung cancer, respectively. Conclusions Our findings indicate per patient direct medical costs of small cell lung cancer and non-small-cell lung cancer to be substantial and comparable, indicating the substantial economic burden of lung cancer in terms of both direct and indirect costs. Our findings indicate that hospitalization/interventions cost item and indirect costs were the major cost drivers for total direct costs and the overall economic burden of lung cancer, respectively. Our findings emphasize the potential role of improved cancer prevention and early diagnosis strategies, by enabling cost savings related to drug treatment and metastasis management cost items, in sustainability of cancer treatments.
Economic Burden of Pediatric Asthma in Turkey: A Cost of Illness Study from Payer Perspective
(2020) Sekerel, Bulent Enis; Turktas, Haluk; Bavbek, Sevim; Oksuz, Ergun; Malhan, Simten; 0000-0002-5723-5965; 32687785; K-8238-2012
OBJECTIVES: To estimate economic burden of pediatric asthma in Turkey from payer perspective. MATERIALS AND METHODS: This cost of illness study was based on identification of per patient annual direct medical costs for the management of pediatric asthma in Turkey from payer perspective. Average per patient direct medical cost was calculated based on cost items related to outpatient visits, laboratory and radiological tests, hospitalizations and interventions, drug treatment and equipment, and co-morbidities/complications. RESULTS: Based on total annual per patient costs calculated for outpatient admission ($113.14), laboratory-radiological tests ($35.94), hospitalizations ($725.92), drug treatment/equipment ($212.90) and co-morbidities/complications ($144.62) cost items, total per patient annual direct medical cost related to management of pediatric asthma was calculated to be $1,232.53 from payer perspective. Hospitalizations and interventions (58.9%) was the main cost driver. Direct cost for managing controlled and uncontrolled pediatric asthma were calculated to be $530.17 [key cost driver: drugs/equipment (40.0%)] and $1,023.16 [key cost driver: hospitalization/interventions (59.0%)], respectively. CONCLUSION: Our findings indicate that managing patients with pediatric asthma pose a considerable burden to health economics in Turkey, with hospitalizations identified as the main cost driver and two-fold cost increment in case of uncontrolled disease.
Efficacy and Cost-Effectivity Analysis of Outpatient Parenteral Antimicrobial Therapy Unit in Infectious Disease Clinical Practices: Turkey Perspective
(2021) Bastug, Aliye; Oksuz, Ergun; Kazancioglu, Sumeyye; Malhan, Simten; Ozbay, Bahadir Orkun; Bodur, Hurrem; 0000-0002-5723-5965; 33709495; K-8238-2012
Background Outpatient parenteral antimicrobial treatment (OPAT) has become a common treatment modality in developed countries. OPAT units are not widespread in Turkey, and their cost-effectivity analysis has not been studied, yet. Aims To analyze the clinical efficacy and cost-effectiveness of the OPAT unit, based on a 1000-bed teaching hospital. Methods The records of patients, who were treated between October 2013 and December 2017, in an OPAT unit of a tertiary hospital in Ankara, were obtained retrospectively. The cost that would arise if the patients were hospitalized for the same treatment period with the same diagnosis was calculated and compared with the actual treatment cost of the patients in the OPAT unit. Results A total of 594 patients who received antimicrobial treatment at the OPAT unit were enrolled. The mean age of the patients was 55.39 +/- 16.37 years and 313 (52.7%) were males. Based on the end-of-treatment goals, 98.5% of the patients reached the treatment goal. An indirect cost analysis revealed that the OPAT unit was 487.625 94 TL/129.008 78 $ less costly than inpatient parenteral antibiotic treatment. In other words, OPAT cost was 75% of the equivalent inpatient costs. It was also determined that a total of 7078 bed days and 11.9 bed days per person were saved. Conclusions OPAT units should be expanded increasingly in Turkey. The evaluation together with the health care system conditions in Turkey revealed that the OPAT program is safe, effective, and cost-efficient.
Evaluation of the Methods Used for the Vital Signs Measurement in Hospitalized Patients
(2018) Numanoglu, Rukiye; Kocak, Onur; Malhan, Simten; Oksuz, Ergun; 0000-0002-5723-5965; K-8238-2012
In general, vital signs measurements which includes measurement of blood pressure, body temperature, pulse and oxygen levels provide very important information about the health status of the hospitalized patients and the effects of treatment. Measurements and documentation of the vital signs carried out by nurses at hospitals. In this study, the methods used in vital signs measurements of hospitalized patients were evaluated by observations and interviews at a foundation university hospital and the advantages and disadvantages of the existing technologies were determined. As a result of interviews with healthcare providers and observations, it was determined that vital signs measurements of hospitalized patients were performed by 2 different methods. The mean time of vital signs measurements were determined as 3 minutes and 4 seconds (SD: 00:31) in medical treatment patients, 2 minutes and 11 seconds (SD: 00:18) in surgical patients, and 2 minutes and 37 seconds (SD: 00:37) in all patients. It was determined that the measurement results were recorded in the patient physical file in an average of 1 minute 2 seconds (SD: 00:52) and it was revealed that 15% of the measurement records were wrong, 26.9% were delayed and 10.6% were not recorded which performed by the nurses. It was also determined that the measurement results were not included in the hospital information system. It is thought that vital findings will provide important data for artificial intelligence studies in the following period with the recording of the results of the measurement to the electronic environment.
Five-Year Trends in Direct Costs of Chronic Obstructive Pulmonary Disease in Turkey: COPDTURKEY-3
(2021) Ozdemir, Tarkan; Kilic, Hatice; Demirci, Nilgun Yilmaz; Ozdilekcan, Cigdem; Bektemur, Guven; Turkkani, Mustafa Hamidullah; Malhan, Simten; Hasanoglu, H. Canan; Koc, Orhan; Ozturk, Can; 35110213
OBJECTIVE: Chronic obstructive pulmonary disease (COPD) is one of the major causes of mortality and morbidity worldwide. The aim of this study was to reveal the trend in direct costs related to COPD between 2012 and 2016, and to evaluate hospital costs in 2016, together with their subcomponents. MATERIAL AND METHODS: A population-based descriptive study was conducted using administrative healthcare data in Turkey. The total direct cost of COPD diagnosis-treatment for each year from 2012 to 2016, was calculated. The distribution of the hospital's COPD-related costs for the year 2016 was also examined, together with morbidity data. RESULTS: The direct costs of the patients who were admitted to step 1, step 2, and step 3 health care centers between 2012 and 2016 increased by 41% [895 041 403TL ($496 930 501) in 2012 to 1 263 288 269TL ($417 834 197) in 2016]; the increase was 60% and 24%, for inpatient and outpatient groups respectively. In the year 2016, the direct total cost was 1003TL ($332) per patient. In 2016, mean specialist consultations per patient with mean cost per specialist consultation, and mean emergency visits per patient with mean cost per emergency visit, were 1.7, 42 TL ($14), and 0.4, 71TL ($23) respectively. For the inpatient group, the mean number of hospitalizations per patient, mean number of hospitalization days, and the mean cost per hospitalization were 0.4, 6.5, and 1926T1 ($637), respectively. CONCLUSION: When the readmissions of patients with COPD were evaluated together with the costs, and compared with the statistics from other countries, it was found that the costs per patient were lower in Turkey. However, the reasons for the significant rise in inpatient costs compared to outpatient costs should be investigated. Further investigations are required regarding pulmonary rehabilitation, home health care services, preventive measures for infections, management of comorbidities, and treatment optimization, which may reduce hospitalizations.
The impact of addressing modifiable risk factors to reduce the burden of cardiovascular disease in Turkey
(2019) Balbay, Yucel; Gagnon-Arpin, Isabelle; Malhan, Simten; Oksuz, Mehmet Ergun; Sutherland, Greg; Dobrescu, Alexandru; Villa, Guillermo; Ertugul, Gulnihal; Habib, Modhar; 0000-0002-5723-5965; 31483303; K-8238-2012
Objective: Our study aimed to estimate the impact of addressing modifiable risk factors on the future burden of cardiovascular diseases (CVD) in the general population and in two high-risk populations (heterozygous familial hypercholesterolemia and secondary prevention) for Turkey. Methods: One model investigated the impact of reaching the World Health Organization (WHO) voluntary targets for tobacco use, hypertension, type 2 diabetes, obesity and physical inactivity in the general population. Another model estimated the impact of reducing LDL-cholesterol in two high-risk populations through increased access to effective treatment. Inputs for the models include disease and risk factor prevalence rates, a population forecast, baseline CVD event rates, and treatment effectiveness, primarily derived from the published literature. Direct costs to the public health care system and indirect costs from lost production are included, although the cost of programs and pharmacological interventions to reduce risk factors were not considered. Results: The value of reaching WHO risk factor reduction targets is estimated at US$9.3 billion over the next 20 years, while the value of reducing LDL-cholesterol is estimated at up to US$8.1 billion for high-risk secondary prevention patients and US$691 million for heterozygous familial hypercholesterolemia patients. Conclusion: Efforts to achieve WHO risk factor targets and further lower LDL-cholesterol through increased access to treatment for high-risk patients are projected to greatly reduce the growing clinical and economic burden of CVD in Turkey.
Koah üzerine klinik yol çalışması: Başkent Üniversitesi Hastanesi'nde bir uygulama
(Başkent Üniversitesi Sosyal Bilimler Enstitüsü, 2009) Alşan, Yasemin; Malhan, Simten
Günümüzde saglık kurumları yöneticileri kurumdaki hizmet yönetimini hem klinik hem de maliyet etkin bir sekilde yürütmek zorundadırlar. Saglık kurumları hizmet organizasyonlarıdır, hastaların saglık hizmetlerinden beklentilerinin artması, yeni tedavi metodları ve ilaçlar nedeniyle bu kurumlar açık ve çevresine uyum saglayan bir sistemin içinde olmalıdırlar. Klinik yollar saglık kurumları gibi karmasık bir yapıya sahip organizasyonlarda personelin koordinasyonunu saglaması ve bilgi alısverisini arttırması, hasta verilerini daha düzenli hale getirmesi, güncel rehberleri uygulamalara dahil etmesi yönünden uygun bir yönetim aracıdır. Bu çalısmada, 2007 yılı 2. yarısında Baskent Üniversitesi Ankara Hastanesi Gögüs Hastalıkları Bölümü’ne basvurmus KOAH hastalarının retrospektif olarak tıbbi kayıtları incelenmistir. Baskent Üniversitesi Hastanesi’nde KOAH üzerine klinik yol olusturulmustur. Sonuçlar uluslar arası klinik rehberlerle karsılastırılmıstır. Today, health care executives should carry out service management both clinically and cost effective in the institution. Health care institutions are service organizations, due to patient’s expectations from health care services increased, innovative treatment methods and medications, this institutions should accomodate the environment and be in an open system. Clinic pathways are suitable management tool for complex structured organizations like health care institutions due to providing staff coordination and increasing information interchange, making patient data more systematic, including current guidelines to the practices. In this research study, within 2. half of the year 2007, medical records of COPD patients applied to Baskent University Ankara Hospital Chest Diseases Department, examined retrospectively. Clinic pathway is made for COPD in Baskent University Hospital. Conclusions are compared with international clinic guidelines.
Modeling the burden of cardiovascular disease in Turkey
(2018) Malhan, Simten; Oksuz, Mehmet Ergun; Balbay, Yucel; Gagnon-Arpin, Isabelle; Sutherland, Greg; Dobrescu, Alexandru; Villa, Guillermo; Ertugrul, Gulnihal; Habib, Mohdhar; 0000-0002-5723-5965; 30297582; K-8238-2012
Objective: This study aims to estimate the current and future burden of cardiovascular diseases (CVD) in Turkey. Methods: A burden-of-disease model was developed that included inputs on population growth, prevalence, and incidence of ischemic disease (IHD) and cerebrovascular disease (CeVD), prevalence of modifiable risk factors, mortality rates, and relationship between risk factors and IHD/ CeVD. Direct costs to the public health-care system and indirect costs from lost production due to premature mortality, hospitalizations, disability, and absenteeism were considered. Results: We estimated that in 2016, 3.4 million Turkish adults were living with CVD, including 2.5 million affected by IHD, and 0.9 million by CeVD. This prevalence is projected to increase to 5.4 million by 2035. The economic burden of CVD was estimated at US$10.2 billion in 2016, projected to increase twofold to US$19.4 billion by 2035. Conclusion: Our study confirms that the current burden of CVD is significant, and that it is projected to increase at a steep rate over the next two decades. This growing burden of disease will likely create significant pressure on the public health-care system in the form of direct health-care costs, as well as on society in the form of lost productivity. (Anatol J Cardiol 2018; 20: 235-40)
Patient Characteristics And Management Practices In Chronic Myeloid Leukemia In Turkey: Reflections From An Expert Meeting
(2022) Eskazan, Ahmet Emre; Ali, Ridvan; Alnigenis, Ebru; Ayyildiz, Orhan; Haznedaroglu, Ibrahim; Kirkizlar, Onur; Kurtoglu, Erdal; Malhan, Simten; Oksuz, Ergun; https://orcid.org/0000-0002-5723-5965; 35184657; K-8238-2012
Introduction The therapeutic landscape of chronic myeloid leukemia (CML) has evolved significantly since the introduction of imatinib. The European LeukemiaNet (ELN) recommendations serve as a guide for diagnosis, treatment, and monitorization of CML, but availability and accessibility of diagnostic tools and medications affect their applicability. Areas covered This article provides an overview of the current clinical management of CML in Turkey with reference to the key outputs of the online expert meeting held in November 2020. The applicability of the ELN 2020 recommendations for treating CML in clinical practice was also discussed. Expert opinion Imatinib is the only reimbursed and the most preferred first-line treatment in CML restricting the upfront use of second-generation tyrosine kinase inhibitors (TKIs), thereby limiting the applicability of treatment-free remission approach in Turkey. The ELN recommendations about using the EUTOS Long-Term Survival (ELTS) score for risk assessment and focusing on patient reported outcomes and quality of life can be enhanced with educational activities. The widespread availability of standardized technical infrastructure for diagnosing and monitoring CML will contribute to better disease management. Establishing a sustainable national database for CML is valuable for observing patient characteristics and disease outcomes as well as the impact of treatment patterns over time.
Profilaktik antibiyotik kullanımının maliyet analizi
(Başkent Üniversitesi Sosyal Bilimler Enstitüsü, 2008) Moray, Gökhan; Malhan, Simten
Saglık sektörü aksak rekabet piyasasında çalısmakta ve fiyatlar devlet düzenlemelerine tabi tutulmaktadır. Bu sektörde arz ve talep taraflarca degistirilebilmektedir. Bunun temel sebebi hizmeti sunan ve alan arasındaki bilgi asimetrisidir. Sunulan her ekstra hizmet hem hastaya hem de devlete ek bir yük getirmektedir. Bu tezde hekimin profilaktik antibiyotik (PAB) kullanımı nedeniyle ortaya çıkabilecek ek maliyetler belirlenmeye çalısılmıstır. Bir üniversite hastanesinde, bir ay içerisinde yapılan 325 temiz ve temiz-kontamine ameliyatta kullanılan PAB, ASHP Cerrahide Antimikrobiyal Profilaksi Rehberine göre incelenmistir. Varsa yapılan uygunsuz PAB kullanımının yaratacagı maliyet farkın ortaya konması amaçlanmıstır. Çalısmaya dahil 325 ameliyatın 238’inde “seklen” dogru uygulama yapılmıstır. Bunlardan 30’unda rehberin önerdigi gibi AB kullanılmamıstır, 84’ünde rehberin önerdigi gibi AB profilaksisi yapılmıstır ama AB türü yanlıs seçilmistir, 16’sında rehberin önerdigi türde AB verilmis ancak süre asılmıstır, 108’inde ise rehberin önerdigi AB, rehberin öngördügü süre boyunca kullanılmıstır. Çalısmaya dahil 325 ameliyatın 87’sinde ise PAB kullanımı temel ilkelerine uyulmamıstır. Bunların 71’inde PAB kullanımı önerilmezken hastalara PAB verilmis, kalan 16’sında ise PAB kullanılması gerekirken verilmemistir. Vakaların tamamı degerlendirildiginde “olması gereken” maliyet 3070,71 YTL iken, “neden olunan” maliyet 7518,08 YTL olarak gerçeklesmistir. Çalısmada PAB kullanılan 279 vakada, doz ve süre degistirilmeksizin sadece esdegerleri arasından en ucuzları kullanılsaydı ortaya çıkacak maliyet 6213,50 YTL olacaktı. Bir baska ifade ile kurum, hekimin belirledigi ilaçla aynı etken maddeye sahip esdeger ilaçlardan en ucuzunu seçmeyerek 1,2 kat daha fazla bir maliyeti kabullenmistir. Sonuç olarak saglık sektöründeki binlerce kalemden biri olan PAB kullanımında akılcı kullanım kriterlerine uyuldugu takdirde ülke genelinde anlamlı bir tasarruf saglamak mümkün olacaktır diyebiliriz. In health sector the supply and demand can be manuplated by the parts because of the knowledge asymmetry between the producer and consumer. Every additional services mean, extra onerousness for both the client and the government. In this study the cost of improper prophylactic antibiotic (PAB) usage was evaluated. Threehundredtwentyfive clean and clean-contaminated surgical operations which were performed within a month at a university hospital, were evaluated according to a specific guideline. In 238 of these operations the PAB usage was “formally” correct. In 30 of these PAB was not used as the guideline recommended. In 84, the guideline recommended PAB usage, the surgeons used a PAB but it was different than the recommended one. In 16, a proper PAB was administered longer than it was recommended. In 108, PAB usage was exactly proper. In 87 of 325 operations the PAB usage was “formally” incorrect. In 71 cases, PAB was used when it was not recommended, and in 16, PAB was not given even it was recommended. Total PAB usage cost was calculated as 7518,08 YTL, but if the rules of the guideline had been stirctly applied, the “probable cost” should be 3070,71 YTL. When we calculated the total PAB cost with the prices of the cheapest equivalent drugs, the “probable cost” should be 6213,50 YTL. In conclussion it is possible to make a great amount of savings for country-wide by just motivating a rational PAB using policy.
Sağlık kurumları işletmeciliği Lisans programlarının müfredatlarının incelenmesi
(Başkent Üniversitesi Sosyal Bilimler Enstitüsü, 2015) Dalkılıç, Sema; Malhan, Simten
Sağlığın ve dolayısıyla sağlık kurumlarının hayatımızdaki yeri tartışılamayacak kadar önemlidir. Tek amacı insan hayatı olan sağlık kurumlarını diğer işletmelerden ayıran birden fazla özelliği vardır. Bu özelliklerden en önemlisi, sağlık kurumunda çalışan kişilerin profesyonel meslek sahibi olmaları gerektiğidir. Böylesi önemli bir kurumun yönetilmesi, elbette profesyonel kişiler tarafından yapılmalıdır. Sağlık kurumları yöneticiliğine meslek olarak bakıldığında çok fazla yetkinlik gerektiren, profesyonellik ve özel bir eğitim alınması gerekliliği açık bir şekilde ortadadır. Ülkemizde özellikle son zamanlarda sağlık kurumları yöneticiliği eğitimine verilen önem ile üniversitelerde lisans ve lisansüstü eğitim program sayıları artmıştır. 2004 yılında sadece 2 üniversitede bulunan sağlık kurumları yöneticiliği programları (sağlık kurumları işletmeciliği, sağlık yönetimi, sağlık idaresi), 2014 yılına gelindiğinde Kıbrıs‘taki üniversiteler de dâhil 46 üniversitede bulunmaktadır. Bunların %54‘ ü devlet üniversitesidir. Ülkemizde sağlık kurumları yöneticiliği programlarına farklı puan türlerinde öğrenci alıp, farklı fakültelerde ve sağlık yüksekokullarında eğitimi verilmektedir. Programların isminde ve bulundukları fakültelerde bir standart olmadığı gibi eğitim müfredatında da standart yoktur. Bu yüzden Amerika ve Kanada'da sağlık yönetimi alanında lisans eğitimi veren kurumların akreditasyonunu değerlendiren CAHME (Sağlık Yönetimi Eğitimi Akreditasyon Komitesi) 'nin alan ile ilgili gereksinimler çerçevesinde müfredatla ilgili temel kriterleri baz alınarak Türkiye‘deki müfredatlar değerlendirilmiştir. Değerlendirmeye müfredatına ulaşılabilen 33 üniversite dahil edilmiştir. Müfredat değerlendirmesine göre, programın isim ve bulundukları fakültelerdeki farklılık müfredata yansımamıştır. Ayrıca üniversite müfredatlarına verilen puanlara göre 33 üniversiteden 14‘ü standartlara uygun müfredata sahip olmadığı gözlenmiştir. Place of health and therefore the health institutions as important as in our lives will not be discussed. The sole purpose of human life, health institutions have more than one features which distinguish them from other health institutions. The most important of these features, people working in health care institutions should be professional. Management of such an important institution, of course, should be done by professionals. As far as the profession of management of health institutions, which requires a lot of competence, professionalism and should be taken as a special education is clearly obvious. In our country, especially lately with emphasis on the education of health care management, number of undergraduate and graduate programs at universities has increased. There were only two health care management undergraduate program at the university in 2004, but in 2014 including universities in Cyprus is located in 46 universities. These 54% are state universities. In our country, students are accepted to college with different types of points and education is provided different faculties and health schools. There is no standard curriculum like as names and faculty of the program. That‘s why the curriculum in Turkey are evaluated based on the basic criteria regarding the curriculum in the framework requirements of the field of CAHME that evaluate the accreditation of undergraduate education institutions in the healthcare management field in US and Canada. Evulation is included in the 33 universities curriculum can be reached. According to the curriculum evaluation, differences in the program's name and faculty were not reflected in the curriculum. In addition according to the scores given to the university curriculum, it was observed that 14 of the 33 universities have a curriculum in accordance with standards.
Scenarios to Manage The Hepatitis C Disease Burden and Associated Economic Impact of Treatment in Turkey
(2017) Ormeci, Necati; Malhan, Simten; Balik, Ismail; Ergor, Gul; Razavi, Homie; Robbins, Sarah; 29027109
Hepatitis C virus (HCV) infection is a significant health problem. The aim of this study is to evaluate the cost-effectiveness of HCV treatment and estimate its economic burden in Turkey. An Excel-based disease progression model was used to estimate the HCV-infected population for 2015-2030. Direct costs in US dollars (USD) including diagnostic, laboratory, and healthcare costs were provided by experts in the country. Indirect costs were estimated as lost productivity using the World Health Organization (WHO) disability-adjusted life years (DALYs) metric from the Global Burden of Disease study. Three scenarios were developed to estimate the cost-effectiveness of HCV treatment through 2030: Base 2016, Increase Treatment and SVR (where SVR is sustained virological response), and WHO Targets. Additionally, the WHO Targets scenario was assessed at three different treatment price points: 10,900 USD, 16,730 USD (base cost), and 27,285 USD. Cumulative total direct and indirect costs (2015-2030) for the WHO Targets scenario were estimated to be 10.8 billion USD, or a 1.5 % increase compared with Base 2016. However, by the following decade, due to a marked decline in DALYs, cumulative direct and indirect costs were estimated to be 45 % less when compared with Base 2016. At a threshold of 9125 USD, all scenarios were cost-effective. By implementing the WHO Targets scenario, Turkey would be able to lower HCV prevalence by 80 % and reduce the total number of liver-related deaths by > 65 % by 2030. Treating HCV infection in the country is cost-effective if healthcare and indirect costs are taken into consideration.