The economic impact of diabetes: Assessing incremental direct costs in Australia using linked administrative data.

Economic grand rounds: Prevalence and cost of treating mental disorders among elderly recipients of Medicare services.

High direct incremental healthcare costs post-fracture are seen in the first year, but total costs from a third-party healthcare payer perspective eventually fall below pre-fracture levels. We attribute this to higher mortality among fracture cases who are already the heaviest users of healthcare ("healthy survivor bias"). Economic analyses that do not account for the possibility of a long-term reduction in direct healthcare costs in the post-fracture population may systematically overestimate the total economic burden of fracture. High healthcare costs in the first 1-2 years after an osteoporotic fracture are well recognized, but long-term costs are uncertain. We evaluated incremental costs of non-traumatic fractures up to 5 years from a third-party healthcare payer perspective. A total of 16,198 incident fracture cases and 48,594 matched non-fracture controls were identified in the province of Manitoba, Canada (1997-2002). We calculated the difference in median direct healthcare costs for the year pre-fracture and 5 years post-fracture expressed in 2009 Canadian dollars with adjustment for expected age-related healthcare cost increases. Incremental median costs for a hip fracture were highest in the first year ($25,306 in women, $21,396 in men), remaining above pre-fracture baseline to 5 years in women but falling below pre-fracture costs by 5 years in men. In those who survived 5 years following a hip fracture, incremental costs remained above pre-fracture costs at 5 years ($12,670 in women, $7,933 in men). Incremental costs were consistently increased for 5 years after spine fracture in women. Total incremental healthcare costs for all incident fractures combined showed a large increase over pre-fracture costs in the first year ($137 million in women, $57 million in men), but fell below pre-fracture costs within 3-4 years. Elevated total healthcare costs were seen at year 5 in women after wrist, humerus and spine fractures, but these were somewhat offset by decreases in total healthcare costs for other fractures. High direct healthcare costs post-fracture are seen in the first year, but total costs eventually fall below pre-fracture levels. Among those who survive 5 years following a fracture, healthcare costs remain above pre-fracture levels.

SummaryThe study examined long-term direct and indirect economic burden of osteoporotic fractures among postmenopausal women. Healthcare costs among fracture patients were substantial in first year after fracture and remained higher than fracture-free controls for 5 years which highlight needs for early detection of high-risk patients and continued management for osteoporosis.IntroductionThis study compared direct and indirect healthcare costs between postmenopausal women and demographically matched controls in the 5 years after incident non-traumatic fracture, and by fracture type in commercially insured and Medicare populations.MethodsTwo hundred twenty-six thousand one hundred ninety women (91,925 aged 50–64 years; 134,265 aged ≥ 65 years) with incident non-traumatic fracture (hip, vertebral, and non-hip non-vertebral (NHNV)) from 2008 to 2017 were identified. Patients with fracture were directly matched (1:1) to non-fracture controls based on demographic characteristics. Direct healthcare costs were assessed using general linear models, adjusting for baseline costs, comorbidities, osteoporosis diagnosis, and treatment. Indirect costs associated with work loss due to absenteeism and short-term disability (STD) were assessed among commercially insured patients. Costs were standardized to 2018 US dollars.ResultsOsteoporosis diagnosis and treatment rates prior to fracture were low. Patients with fracture incurred higher direct costs across 5-year post-index compared with non-fracture controls, regardless of fracture type or insurance. For commercially insured hip fracture patients, the mean adjusted incremental direct healthcare costs in years 1, 3, and 5 were $59,327, $6885, and $3241, respectively. Incremental costs were lower, but trends were similar for vertebral and NHNV fracture types and Medicare-insured patients. Commercially insured patients with fracture had higher unadjusted indirect costs due to absenteeism and STD in year 1 and higher adjusted indirect costs due to STD at year 1 (incremental cost $5848, $2748, and $2596 for hip, vertebral, and NHNV fracture).ConclusionsA considerable and sustained economic burden after a non-traumatic fracture underscores the need for early patient identification and continued management.

This study aimed to examine the national variation in government-subsidised healthcare costs of residents in long-term care facilities (LTCFs) and costs differences by resident and facility characteristics. A retrospective population-based cohort study was conducted using linked national aged and healthcare data of older people (=65years) living in 2112 LTCFs in Australia. Individuals' pharmaceutical, out-of-hospital, hospitalisation and emergency presentations direct costs were aggregated from the linked healthcare data. Average annual healthcare costs per resident were estimated using generalised linear models, adjusting for covariates. Cost estimates were compared by resident dementia status and facility characteristics (location, ownership type and size). Of the 75,142 residents examined, 70% (N=52,142) were women and 53.4% (N=40,137) were living with dementia. The average annual healthcare cost (all costs in $A) was $9233 (95% CI $9150-$9295) per resident, with hospitalisation accounting for 47.2% of the healthcare costs. Residents without dementia had higher healthcare costs ($11,097, 95% CI $10,995-$11,200) compared to those with dementia ($7561, 95% CI $7502-$7620). Residents living in for-profit LTCFs had higher adjusted average overall annual healthcare costs ($11,324, 95% CI $11,185-$11,463) compared to those living in not-for-profit ($11,017, 95% CI $10,895-$11,139) and government ($9731, 95% CI $9365-$10,099) facilities. The healthcare costs incurred by residents of LTCFs varied by presence of dementia and facility ownership. The variation in costs may be associated with residents' care needs, care models and difference in quality of care across LTCFs. As hospitalisation is the biggest driver of the healthcare costs, strategies to reduce preventable hospitalisations may reduce downstream cost burden to the health system.

To determine the incremental increases in health care utilization and expenditures associated with sleep disorders. Adults with a diagnosis of a sleep disorder (International Classification of Diseases, 10th Revision, code G47.x) within the medical conditions file of the 2018 Medical Expenditure Panel Survey medical conditions file were identified. This dataset was then linked to the consolidated expenditures file and comparisons in health care utilization and expenditures were made between those with and without sleep disorders. Multivariate analyses, adjusted for demographics and comorbidities, were conducted for these comparisons. Overall, 5.6% ± 0.2% of the study population had been diagnosed with a sleep disorder, representing approximately 13.6 ± 0.6 million adults in the United States. Those with sleep disorders were more likely to be non-Hispanic, White, and female, with a higher proportion with public insurance and higher Charlson Comorbidity Scores. Adults with sleep disorders were found to have increased utilization of office visits (16.3 ± 0.8 vs 8.7 ± 0.3, P < .001), emergency room visits (0.52 ± 0.03 vs 0.37 ± 0.02, P < .001), and prescriptions (39.7 ± 1.2 vs 21.9 ± 0.4, P < .001) vs those without sleep disorders. The additional incremental health care expenses for those with sleep disorders were increased in all examined measures: total health care expense ($6,975 ± $800, P < .001), total office-based expenditures ($1,694 ± $277, P < .001), total prescription expenditures ($2,574 ± $364, P < .001), and total self-expenditures for prescriptions ($195 ± $32, P < .001). Sleep disorders are associated with significantly higher rates of health care utilization and expenditures. By using the conservative prevalence estimate found in this study, the overall incremental health care costs of sleep disorders in the United States represents approximately $94.9 billion. Huyett P, Bhattacharyya N. Incremental health care utilization and expenditures for sleep disorders in the United States. J Clin Sleep Med. 2021;17(10):1981-1986.

ObjectivesTo evaluate the annual direct medical costs and the impact of SLE disease severity and flares on incremental costs in autoantibody positive SLE patients (pts) managed by specialists.MethodsA retrospective study...

BackgroundTobacco smoking remains a global public health challenge, contributing to preventable mortality and morbidity and imposing substantial burdens on health care costs. We investigated whether direct health care costs differ substantially between self-reported tobacco smokers and non-smokers.MethodsThis systematic literature review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Medline PubMed, Embase, PubMed Central, and Scopus were searched to identify studies of direct health care costs between smokers and non-smokers for participants aged ≥18 years. All observational, prospective, retrospective, and non-randomized comparative studies were considered. Data extraction included mean annual health care costs (± SD) for both groups. Mean differences (MD) in annual health care costs between smokers and non-smokers, expressed in 2025 US dollars, were compared and adjusted for a 12-month period and inflated to 2025 using consumer price indices.ResultsOf 873 studies identified, 11 were included in quantitative synthesis, which compared 19,759,529 smokers with 206,913,108 non-smokers for direct health care costs. Mean age ranged from 34.5–60.6 years for smokers and 34.3–65.1 years for non-smokers. Mean annual health care costs ranged from $65,640–$1297.1 for smokers and $54,564–$724.4 for non-smokers. Annual incremental direct health care costs for smokers versus non-smokers ranged from –$458 (95% CI [confidence interval]: –2011.0 to 1,095.0) to $11,076 (95% CI: 10,211.9 to 11,940.1) in 2025 US dollars. Meta-analysis revealed smoking generally incurred greater health care costs than non-smoking, with a mean annual incremental cost of $1916.5 (95% CI: –439.9 to 4,272.9). The result was not statistically significant (MD = 1,916.5; p = 0.111). Substantial heterogeneity was observed (I2 = 99.9%). Sensitivity analysis excluding studies of chronic disease yielded a reduced incremental cost for the general population, with a statistically significant difference (MD = 583.9, p = 0.02), although heterogeneity remained high (I2 = 98.0%).ConclusionThis meta-analysis supports the assertion that smoking substantially increases direct health care costs compared with non-smoking, particularly for the general population.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-025-03318-0.

Economic burden of osteoarthritis- multi-country estimates of direct and indirect costs from the BISCUITS study.

The aim of this study was to apply the findings of the European Stroke Prevention Study 2 (ESPS-2) to a paper that quantified and described the annual cost of ischaemic stroke in New Zealand, and to compare the cost of alternative drug regimens in the secondary prevention of ischaemic stroke. Comparisons were made between the costs of low-dosage aspirin (acetylsalicylic acid) monotherapy and a combination of modified-release dipyridamole and low-dosage aspirin. Differences in undiscounted costs were calculated over a 2-year period. The New Zealand cost per stroke event was multiplied by the ESPS-2 incremental reduction in stroke events to derive the cost of strokes avoided. As the focus of the paper was on direct medical costs, the primary perspective adopted was that of a healthcare provider or funder, but a societal perspective was also considered by evaluation of direct nonmedical and indirect costs. Compared with aspirin monotherapy, combination therapy generated incremental net direct costs of 18.22 New Zealand dollars ($NZ) per patient or $NZ18,223 per 1000 patients. However, individually, each treatment regimen resulted in direct cost savings when compared with placebo: combination therapy $NZ905.16 per patient; aspirin monotherapy $NZ923.39 per patient (a difference between the 2 regimens of $NZ18.22 per patient). Total direct and indirect incremental cost savings were $NZ40.96 per patient, and $NZ40,963 per 1000 patients, for the combination therapy. The analysis demonstrates that changing patients from low-dosage aspirin to a combination therapy of modified-release dipyridamole plus low-dosage aspirin would result in a small rise in incremental direct costs (using our conservative assumptions relating to hospital and continuing institutional care costs). If less conservative unit cost assumptions were adopted, a more likely outcome would be a saving in direct incremental costs of up to $NZ400 per patient treated.

Psychotropic polypharmacy is not uncommon among cancer patients and may contribute to the increased direct health care cost burden in this population. To estimate average direct health care costs in the year following cancer diagnosis among cancer patients receiving psychotropic polypharmacy compared with those without psychotropic polypharmacy, using a multivariable analysis framework. A retrospective cross-sectional study was conducted among patients aged 18 years and older diagnosed with the most commonly occurring cancers (breast, prostate, lung, and colorectal) in the United States during 2011-2012 using the deidentified Optum Clinformatics Data Mart commercial claims database. Psychotropic polypharmacy was defined as concurrent use of 2 or more psychotropic medications for at least 90 days. Direct health care costs in the year following cancer diagnosis were estimated as total medical payments made by the health plans and were derived from claims files. A generalized linear regression model with log-link function and gamma distribution was used to model average direct health care costs, controlling for baseline patient demographic and clinical covariates. Average annual direct health care costs for cancer patients with psychotropic polypharmacy ($53,497; SD $72,590) were higher than those without psychotropic polypharmacy ($38,255; SD $59,844), with an unadjusted average cost difference of $15,242 (P < 0.0001). In the adjusted regression model, the average difference in costs shrunk to $5,888 but remained notable. When examined by type of cancer, average direct health care costs for all cancer patients with psychotropic polypharmacy were significantly higher than those for patients without psychotropic polypharmacy, except for colorectal cancer patients. Overall health care costs were higher among cancer patients with psychotropic polypharmacy compared with those without psychotropic polypharmacy. Our findings support the need for future research to better understand the benefits and risks of psychotropic polypharmacy, given its potential to cause adverse health outcomes and avoidable health care utilization and costs for this vulnerable patient population. This study was funded by the American Association of Colleges of Pharmacy (AACP) New Investigator Award mechanism, which was received by Vyas. Aroke was partially supported by the AACP grant for conducting data analysis of the study. Kogut is partially supported by Institutional Development Award Number U54GM115677 from the National Institute of General Medical Sciences of the National Institutes of Health, which funds Advance Clinical and Translational Research (Advance-CTR). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health and the AACP. The authors report no conflicts of interest. An abstract of this study was presented as a poster at the American Association of Colleges of Pharmacy Annual Meeting on July 22, 2018, in Boston, MA.

Incremental direct and indirect cost burden attributed to endometriosis surgeries in the United States

Background:Ankylosing Spondylitis (AS) is a disease associated with a high number of comorbidities, chronic pain, functional disability, and resource consumption.Objectives:This study aimed to estimate the burden of disease for patients diagnosed with AS in Spain.Methods:Data from 578 unselected patients with AS were collected in 2016 for the Spanish Atlas of Axial Spondyloarthritis via an online survey. The estimated costs were: Direct Health Care Costs (borne by the National Health System, NHS) and Direct Non-Health Care Costs (borne by patients) were estimated with the bottom-up method, multiplying the resource consumption by the unit price of each resource. Indirect Costs (labour productivity losses) were estimated using the human capital method. Costs were compared between levels of disease activity using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score (&lt;4 or low inflammation versus ≥4 or high inflammation) and risk of mental distress using the 12-item General Health Questionnaire (GHQ-12) score (&lt;3 or low risk versus ≥3 or high risk).Results:The average annual cost per patient with AS in 2015 amounted to €11,462.3 (± 13,745.5) per patient. Direct Health Care Cost meant an annual average of €6,999.8 (± 9,216.8) per patient, to which an annual average of €611.3 (± 1,276.5) per patient associated with Direct Non-Health Care Cost borne by patients must be added. Pharmacological treatment accounted for the largest percentage of the costs borne by the NHS (64.6%), while for patients most of the cost was attributed to rehabilitative therapies and/or physical activity (91%). The average annual Indirect Costs derived from labour productivity losses were €3,851.2 (± 8,484.0) per patient, mainly associated to absenteeism. All categories showed statistically significant differences (p&lt;0.05) between BASDAI groups (&lt;4 vs ≥4) except for the Direct Non-Healthcare Cost, showing a progressive rise in cost from low to high inflammation. Regarding the 12-item General Health Questionnaire (GHQ-12), all categories showed statistically significant differences between GHQ-12 (&lt;3 vs ≥3), with higher costs associated with higher risk of poor mental health (Table 1).Table 1.Average annual costs per patient according to BASDAI and GHQ-12 groups (in Euros, 2015)NDirect Health CostsDirect Non-Health CostsIndirect CostsTotal CostBASDAI&lt;4917,592.0*557.32,426.5*10,575.8*≥43769,706.9*768.05,104.8*15,579.7*Psychological distress (GHQ-12)&lt;31468,146.8*493.6*3,927.2*12,567.6*≥32609,772.9*807.2*4,512.3*15,092.5*Total5786,999.8611.33,851.211,462.3* p &lt;0.05Conclusion:Direct Health Care Costs, and those attributed to pharmacological treatment in particular, accounted for the largest component of the cost associated with AS. However, a significant proportion of the overall costs can be further attributed to labour productivity losses.Acknowledgments:Funded by Novartis Farmacéutica S.A.Disclosure of Interests:María Merino: None declared, Olta Braçe: None declared, Almudena González: None declared, Álvaro Hidalgo-Vega: None declared, Marco Garrido-Cumbrera: None declared, Jordi Gratacos-Masmitja Grant/research support from: a grant from Pfizzer to study implementation of multidisciplinary units to manage PSA in SPAIN, Consultant of: Pfizzer, MSD, ABBVIE, Janssen, Amgen, BMS, Novartis, Lilly, Speakers bureau: Pfizzer, MSD, ABBVIE, Janssen, Amgen, BMS, Novartis, Lilly

Cardiorespiratory Fitness in Middle Age and Health Care Costs in Later Life

Acute coronary syndrome (ACS) is the most common cause of morbidity and mortality in Italy and worldwide. Aim of this study was to evaluate the average annual direct healthcare costs for the treatment of patients with a recent hospitalization for ACS. The direct medical costs of patients with a first ACS hospitalization (index event) in the period from 1 January 2008 to 31 December 2008 were estimated for a 1-year follow-up period. The resource consumption was measured in terms of: reimbursed drugs, diagnostic procedures, outpatient visits, and hospitalizations. The analysis was performed from the Italian National Health Service perspective. A total of 2,758,872 subjects were observed, 7082 (35.8% women) of whom being hospitalized for ACS during the accrual period (2.6 ‰). Among patients with ACS, 60% were medically treated, 33.1% were treated with percutaneous coronary intervention (PCI), and 6.9% died during the index hospitalization. Dual antiplatelet treatment (ASA plus clopidogrel) was prescribed in 25.9% of the medically treated ACS patients and in 70.1% of the ACS patients treated with PCI. The average yearly cost per patient for the total ACS population was 11,464€/year (drugs 1,304€; hospitalizations 9,655€; diagnostic and outpatient visits 505€). The average annual cost was 10,862€ for medically treated patients and 14,111€ for patients treated with PCI. Patients who died of cardiovascular events during follow up had an average cost of 16,231€/patient. Patients with ACS had higher direct healthcare costs, their management and rehospitalizations being the main cost drivers.

Background:Treatment burden of Systemic Lupus Erythematosus (SLE) is considered high. There are no studies in Colombia that includes the estimation of an incremental cost associated to SLE.Objectives:To estimate the direct cost associated to SLE in contributory healthcare scheme in Colombia. To estimate prevalence and characterize SLE population affiliated in the contributory healthcare scheme in Colombia. To estimate the direct healthcare cost in patients with and without SLE and the effect of being diagnosed with SLE in the total direct cost during a period of two years.Methods:The present study was carried out with an administrative database that includes all the enrollees in the contributive health scheme for a period of 4 years. It was established an operative definition to identify individuals with the disease in order to make the descriptive analysis and calculation of prevalence. every patient was aged 18 or older on index date. Additionally, as the length of follow-up period was fixed to two years, all patients whose index 14 date had been greater than 1st January 2016 were excluded from the study sample (Figure 1). The variables considered in this part of the study were demografiphc), clinical (Charlson Comorbidity Index) and cost-related variables, which was the outcome variable of the study, this cost was made up of the sum of all medical costs, regardless of whether they were related or not to SLE. Costs were adjusted for inflation, to values in 2017. To evaluate the effect of having SLE vs. not having, on the direct cost in health, propensity scores analysis was used to reduce differences in the baseline characteristics. Three groups were formed based on disease severity: high (patients who had renal failure), medium (patients in intensive care unit at least once but without renal failure) and low (remaining SLE patients) (See table 1).Results:From 2014 to 2017, 21,993 SLE patients were identified. Women represented 87.4% of the cases, 5428 patients were selected to make up the sample of SLE patients. the number of patients without diagnosis of SLE was 19,419,540. From this population was drawn randomly a 10% size sample, to make up the potential control sample. To estimate the incremental cost of having SLE it was used multivariate regression through a GAM model. The estimated average annual total cost of a patient with SLE was $6,139,046 COP vs. non-SLE patient cost of $4,113,191 COP. Meanwhile the adjusted incremental cost of SLE vs non-SLE was $2,025,855 COP. Subsequently, adjusted incremental cost was estimated taking into account the levels of severity. In the Table 1 are presented the mean values of incremental costs and 95% confidence intervals.Table 1.Incremental cost by degree of severityDegree of SeverityAverage adjust incremental cost per year (in COP)Confidence interval construction methodConfidence interval (95 %) (in COP)High$ 19,930,931.67t-interval$16,525,728.01, $ 23,336,135.32Bootstrap$17,088,627.49, $ 23,068,518.89Medium$7,248,201.04t-interval$2,123,742.99, $12,372,659.09Bootstrap$3,460,932.89, $11,688,205.25Low$ 885,300.40t-interval$642,925.6, $ 1,127,675.2Bootstrap$ 688,197.5, $ 1,098,098.2Conclusion:Although the prevalence of SLE in Colombia is relatively low, the direct costs generated for this disease might be very high. The annual cost for a SLE patient was $2,025,855 COP greater than the cost of a non-SLE patient. When considering the severity levels of the disease, it was found a $ 19,930,931.67 incremental cost estimate for high level of severity. In the medium level, the estimate was $ 7,248,201.04. Meanwhile, a patient in the low severity level had a $ 885,300.40 incremental cost.