Annual Management Costs Research Articles

#5632 THE CLINICAL AND ECONOMIC BURDEN OF CHRONIC KIDNEY DISEASE IN GREECE

Abstract Background and Aims Chronic Kidney Disease (CKD) is a progressive disorder with a substantial clinical and economic burden. This burden is expected to grow, mainly because of the ageing population, and the increasing incidence of diabetes mellitus and arterial hypertension. The objective of this study is to provide insights into the clinical and economic burden of CKD in Greece. Method A cost of illness (COI) study has been performed to approximate the burden of CKD in Greece from the perspective of EOPYY (National Organization for Health Care Services Provision), with reference year 2022. The COI model employs a prevalence-based approach using national and international sources and approximates the annual direct cost of CKD. The direct costs included in this analysis are categorized into primary care, medication, hospitalization and renal replacement therapy (RRT) costs. Results It has been estimated that there about 1,115,991 patients with CKD (stages 1–5) in Greece, most of them in stage 3 (about 534,694), and about 15,337 receiving RRT or having received a kidney transplant. In 2032 this population is expected to increase to approximately 1,249,475 patients. The total annual direct cost of CKD was estimated at €845,936,094. The main cost driver was RRT, which accounted for roughly 49% (417 millions) of total cost of care, followed by hospitalizations 29% (246 millions) and medications 17% (143 millions). The progression of the disease is strongly correlated with an increase in the annual management cost. About 1.4% of the CKD population (RRT group) spent about half of the total CKD budget or more than 4% of the total public health expenditure, higher than other European countries. Conclusion CKD is creating a high and growing clinical and economic burden, largely driven by the RRT cost. There is an urgent need for public health strategies aiming at early detection and management of CKD.

PP45 The Cost-Of-Illness Of Diabetic Macular Edema In Italy

IntroductionDiabetic Macular Edema (DME) is an important complication of Diabetic Retinopathy (DR). Intravitreal steroids in slow-release systems represent a safe and effective therapeutic option for the management of DME, capable of improving patients’ quality of life by reducing the number of injections thus increasing the therapeutic adherence and the effectiveness of the treatment. This study aims to determine the economic impact of DME and the consequences, in terms of both expenditure and organizational impact, associated with a greater use of the intravitreal dexamethasone implant.MethodsThe analysis entailed the comparison between two scenarios: a first scenario based on the current use of therapeutic alternatives available in the Italian healthcare setting (as is) and an alternative scenario based on the assumption of an increased use of intravitreal dexamethasone implant (to be). The results of the analysis are expressed in terms of resource absorption associated with the two scenarios as well as in terms of the cost differential given by their comparison.ResultsDespite an increase in expenditure in terms of acquisition costs of pharmacological alternatives (EUR 898,362) and interventions provided (EUR 22,093,160), the greater use of prolonged-release dexamethasone allows for significant savings in terms of healthcare professionals’ time, follow-up and productivity losses incurred by patient/caregiver. These reductions in healthcare costs resulted in a saving of EUR 1,987,678 over a 5-year period. Such a reduction would allow, considering a total annual management cost of EUR 6,115 for the intravitreal dexamethasone, to treat 325 more patients at the same cost of the as is scenario based on the current rate of use of dexamethasone.ConclusionsIn a context characterized by the need to increase the allocative efficiency of economic resources, the recourse to therapeutic alternatives, such as prolonged release dexamethasone, allowing the reduction of costs for the management of a given pathology is crucial to generate more value for patients and the entire society.

Lifetime cost models for large, long-lived, street trees in Australia

ABSTRACT The costs of maintaining an urban street tree over its lifecycle have been considered in cost models. One used in Australia is a typical relationship between the cost and functional and aesthetic benefits of the urban shrub mass. But are these curves typical of larger, long-lived urban street trees growing under Australian conditions? The costs of maintaining an urban street tree under Australian management regimes, including purchase and planting costs of a common street tree species, herbicide and mulching costs, the cost of irrigation over the first summer after spring planting and of formatively pruning the young tree were calculated based on data obtained from Australian local government agencies. The research-modelled management of an urban tree under five scenarios based upon planting a 2–3 m tall tree with a safe useful life expectancy of 50 years. Scenarios included annual maintenance, regular pruning on a 5-year cycle after 15 years and a major arboricultural intervention in the final decade. The impact of longer lifespans of 100 or 150 years was also modelled. The curves demonstrated that costs associated with a street tree are high in the first 2–3 years of its life but much higher in the final year of life leading to removal but differed in shape from other models. The lifetime costs of maintaining a street tree depending on the management scenario are between AUD$2800 and AUD$6220 or AUD$56 and AUD$124.40 per annum. Doubling the lifespan of a street tree reduces the annual management cost by 30%.

Cost of managing atonic postpartum haemorrhage with uterine balloon tamponade devices in public health settings of Maharashtra, India: an economic microcosting study

ObjectivePostpartum haemorrhage (PPH) is the worldwide leading cause of preventable maternal mortality. India offers free treatment for pregnancy and related complications in its public health facilities. Management with uterine balloon...

English

This paper presents an analysis of the costs of protected areas (PAs) management in Ethiopia, specifically those managed by the Ethiopian Wildlife Conservation Authority. The authority is managing a network of protected area (PA) systems covering an area of about 29,950 km2. Primary and secondary data were used. A total of 3,045 rangers are required to effectively control illegal activities. The estimated number of rangers at basic level management ranges from 70 in Senkelle to 459 in Babile sanctuary with a mean (±SD) of 243.75 (± 6.52). The actual mean (±SD) patrol range covered by a single ranger is 53.2 (± 15.08), ranging from 1.22 km2 in Senkelle to 161.72 km2 per ranger in Geralle National Park. At basic level management the mean (±SD) patrol range covered by a single ranger is 8.81 (± 1.31), ranging from 0.8 km2 in Senkelle to 15.5 km2 in Halledighe. The total annual management cost was estimated between $10.5 million to $21.5 million. The mean (±S.D) annual expenditure for basic level management is $404.45/km2 (±164.32); ranging from $2333/km2 in Senkelle to $166/km2 in Halledighe. Cost Benefits Analysis showed the mean (±SD) return of investment was $129 (±41.42) for every $1 invested. Key words: Budget, cost benefits analysis, management cost, protected area, rangers.

A Study on the Factors Affecting the Management Cost of Multi-Family Housing in Each Living Area : Focused on the Busan Area

The annual management cost of multi-family housing in Korea is increasing significantly every year, and the interest of residents is also increasing as the total amount of management cost increases.,The purpose of this study is to analyze the characteristics of multi-family housing in Busan that affect the sharing management cost to improve the understanding of the management cost to the stakeholders of multi-family housing. The scope of the study was based on the data of the management cost of 2018 released to the K-apt management information system for multi-family housing subject to compulsory management in Busan, and the factors influencing them were identified through multiple regression analysis. The characteristics of the urban space structure and living area in 2030 in Busan were classified into Eastern, Western, and Central regions, and the characteristics affecting the sharing management cost by region were analyzed. As a result, the characteristics of the complex, management characteristics, and facility characteristics had different effects on each living area. In addition, the analysis results of factors affecting the sharing management cost of Busan and each living area showed that regional characteristics showed significant effects and differences in the sharing management cost.

Are direct oral anticoagulants an economically attractive alternative to low molecular weight heparins in lung cancer associated venous thromboembolism management?

Venous thromboembolism is highly prevalent in lung cancer patients. Low molecular weight heparins are recommended for long term treatment of cancer associated venous thromboembolism. Direct oral anticoagulants are however an interesting alternative as they are administered orally and don't require monitoring. There are currently studies comparing both their efficacy and tolerance for cancer patients and more and more guidelines suggest considering direct oral anticoagulants for cancer associated venous thromboembolism treatment. The objective of this study was to evaluate the budgetary impact that direct oral anticoagulants use would have for lung cancer associated venous thromboembolism treatment and prevention in France. An economic model was made to evaluate the cost of venous thromboembolism treatment and prevention among patients with primary lung cancer in France by two strategies: current guidelines versus direct oral anticoagulants use. The model was fed with clinical and economic data extracted from the French national health information system. The analysis was conducted from the national mandatory Health insurance point of view. The time horizon of the study was the evaluation of the annual management cost. Lung cancer associated venous thromboembolism management's mean cost was estimated of 836€ per patient, that is a total cost of about 40 million euros per year at a national level. A 76% decrease of this cost can be expected with direct oral anticoagulants use. However, despite their benefits, these treatments raise new issues (medication interactions, bleeding management), and would likely not be recommended for all patients.

Long-term health-related burden of adult congenital heart diseases in Hong Kong

Aims: This study aimed to examine the long-term clinical and economic burden of adults with congenital heart disease (ACHD) in Hong Kong. Methods: It retrospectively analyzed 336 consecutive ACHD patients who attended the Adult Congenital Heart Clinic between January 1, 2009 and December 31, 2014. Direct medical costs and clinical outcomes over the 5 years were calculated and documented. The economic evaluation was from the hospital’s perspective. Results: The median age of ACHD patients was 47 (31–62) years old, with female predominance (61.5%). Ventricular and atrial septal defects accounted for 70% and severe ACHD for 10% of the study cohort. The prevalence of arrhythmia and heart failure increased with the complexity of CHD. The total mean annual cost for managing each ACHD patient was USD 2,913. The annual cost of management of simple ACHD was USD 2,638 vs complex ACHD (USD 6,425) (p = 0.013). Conclusions: This study demonstrated severe ACHD patients accounted for higher cardiovascular morbidities in arrhythmias and heart failure with a higher cost of management.

The economic burden of bronchiectasis \u2013 known and unknown: a systematic review

BackgroundThe increasing prevalence and recognition of bronchiectasis in clinical practice necessitates a better understanding of the economic disease burden to improve the management and achieve better clinical and economic outcomes. This study aimed to assess the economic burden of bronchiectasis based on a review of published literature.MethodsA systematic literature review was conducted using MEDLINE, Embase, EconLit and Cochrane databases to identify publications (1 January 2001 to 31 December 2016) on the economic burden of bronchiectasis in adults.ResultsA total of 26 publications were identified that reported resource use and costs associated with management of bronchiectasis. Two US studies reported annual incremental costs of bronchiectasis versus matched controls of US$5681 and US$2319 per patient. Twenty-four studies reported on hospitalization rates or duration of hospitalization for patients with bronchiectasis. Mean annual hospitalization rates per patient, reported in six studies, ranged from 0.3–1.3, while mean annual age-adjusted hospitalization rates, reported in four studies, ranged from 1.8–25.7 per 100,000 population. The average duration of hospitalization, reported in 12 studies, ranged from 2 to 17 days. Eight publications reported management costs of bronchiectasis. Total annual management costs of €3515 and €4672 per patient were reported in two Spanish studies. Two US studies reported total costs of approximately US$26,000 in patients without exacerbations, increasing to US$36,00–37,000 in patients with exacerbations. Similarly, a Spanish study reported higher total annual costs for patients with > 2 exacerbations per year (€7520) compared with those without exacerbations (€3892). P. aeruginosa infection increased management costs by US$31,551 to US$56,499, as reported in two US studies, with hospitalization being the main cost driver.ConclusionsThe current literature suggests that the economic burden of bronchiectasis in society is significant. Hospitalization costs are the major driver behind these costs, especially in patients with frequent exacerbations. However, the true economic burden of bronchiectasis is likely to be underestimated because most studies were retrospective, used ICD-9-CM coding to identify patients, and often ignored outpatient burden and cost. We present a conceptual framework to facilitate a more comprehensive assessment of the true burden of bronchiectasis for individuals, healthcare systems and society.

Outcomes and management costs of peripheral arterial disease in France

BackgroundLittle is known about the characteristics and prognosis of patients with peripheral arterial disease (PAD) and related real-life health costs in France. MethodsA cohort of patients diagnosed with PAD between 2007 and 2011 was extracted from the French Echantillon Généraliste des Bénéficiaires (EGB) claims database. The patients were followed up from the date of PAD diagnosis. Their characteristics, incidence of death and other events, treatments, and costs were analyzed by comparison with age- and gender-matched PAD-free controls. ResultsThere were 5889 patients with PAD identified. Mean age was 70.8 years, and 68.1% of patients were male. Diabetes was present in 28.9% of patients (13.2% of controls), hypercholesterolemia in 52.9% (28.7%), and hypertension in 46.6% (12.3%); 4.9% of patients had a history of unstable angina or myocardial infarction (0.5%), and 6.0% had a history of stroke or transient ischemic attack (1.4%). At inclusion, 69.3% of patients were receiving antiplatelet drugs (17.3%), 52.3% statins (21.9%), 26.7% angiotensin-converting enzyme inhibitors (13.7%), and 24.2% angiotensin receptor blockers (16.6%). Cumulative mortality rates were 13.2% at 1 year and 19.4% at 2 years (3.2% and 6.5% in controls). Cumulative incidence rates of death and major cardiovascular events (myocardial infarction and ischemic stroke) were 15.7% (95% confidence interval [CI], 14.8%-16.6%) at 1 year and 22.9% (95% CI, 21.9%-24.0%) at 2 years vs 3.9% (95% CI, 3.4%-4.4%) and 7.8% (95% CI, 7.1%-8.5%) in controls. All differences were statistically significant (P < .05). Total annual management costs were €14,949 in the PAD group and €3812 in the control group. ConclusionsMortality is elevated and cardiovascular events are frequent among French PAD patients. PAD drug treatment guidelines are not fully implemented in France.

Forest property taxation under the generalized Faustmann formula

This article represents the first part of a two-part series on forest taxation and valuation. In this first part, I derive the formulas for five types of forest property taxation under the generalized Faustmann formula. They are the unmodified property tax, the site value tax, the flat property tax, as well as the gross and net forest revenue productivity taxes. The impacts of these taxes in terms of fiscal neutrality and tax burden are then examined. Fiscal neutrality examines whether the imposition of a tax will affect management decisions. Tax burden measures the magnitude of the reduction in the value of the land, known as the site burden, and that of the forest as a whole, known as the forest burden, as a result of the imposition of a property tax on forestland of different productivities. Analytical results indicate that all forest property taxes are theoretically not fiscally neutral. They will all shorten the optimal harvest age. This is in sharp contrast to the results under the classic Faustmann formula under which the latter 4 types of taxes are all known to be fiscally neutral. In terms of tax burden, the unmodified property tax, the flat property tax and the gross forest revenue productivity tax impose a heavier site burden on less productive land than on more productive land. The forest burden is age dependent. At age 0, all but the flat property tax imposes a lighter burden on less productive land. At the optimal harvest age, the unmodified property tax, the flat property tax and the gross forest revenue productivity tax impose a heavier burden on less productive land. The net forest revenue productivity tax imposes a heavier tax burden on the less productive land when the annual management cost is small. When the annual management cost is significant, the tax burden could become lighter on the less productive land. Only the site value tax imposes a lighter site and forest burden on the less productive land consistently.

A Review on Pharmacological Treatment of Idiopathic Parkinson’s Disease

Parkinson’s disease is the second most common chronic neurodegenerative disease of central nervous system predominant in elderly people characterised by tremor, akinesia, rigidity and gait disturbances. The annual cost of management of Parkinson’s disease is double than that of control population. Evidence- based management of Parkinson’s disease in developing nation is unmet needs. This article is authors’ endeavour to summarise the facts in different publications on Parkinson’s disease. Electronic databases like MEDLINE/Pub Med, Google Scholar, IMSEAR (Index Medicus for South-East Asia Region) and Scope med were extensively searched with MeSH (Medical Subject Headings) terms “Parkinson’s disease”, “treatment”, and “anti-Parkinson drugs” from the earliest possible date of 1966 to March 2017. Articles in any languages especially those published in recent years were given preference. This review deals mostly with evidence based management of Parkinson’s disease.

Marine reserve establishment and on-going management costs: A case study from New Zealand

While there is considerable international research focused on the conservation outcomes of marine protected areas (MPAs) and marine reserves (MRs) there is little information on the economic cost to establish and manage these protected areas. This study estimated the MR pre-establishment and establishment costs for the Taputeranga Marine Reserve (TMR) in New Zealand (NZ) and determined the annual management costs for this reserve and four further NZ MRs. Finally, the cost to local rock lobster fishers resulting from the displaced fishing effort once the TMR had been established was estimated. This research found that the TMR pre-establishment cost was approximately NZ$508,000, and the establishment process cost was approximately NZ$353,000. The annual management costs across the five reserves ranged between NZ$43,200 and NZ$112,500 between 2008/09 and 2010/11. The annual fishers displacement cost at TMR was approximately NZ$22,000 per annum. This research showed that on a unit area basis, small MRs in NZ are just as expensive to maintain as large MRs. This study also highlighted how volunteer effort helped to considerably reduce the monetary cost of the MR pre-establishment process. This research increases our understanding of establishment and management costs, and supports future planning of MRs both within NZ and internationally.

PND6 Economic Burden of Structural-Metabolic Epilepsy in Malaysia

PND6 ECONOMIC BURDEN OF STRUCTURAL-METABOLIC EPILEPSY IN MALAYSIA Salih M1, Bahari MB2, Shafie A3, Hassali MAA3, Al-lela OQB2, Abd AY4, Ganesan V5 1Department of Clinical Pharmacy, College of Pharmacy, The University of Mustansiriyah, Baghdad, Al-Baya, Iraq, 2Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, Penang, Malaysia, 3Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, Penang, Malaysia, 4College of Pharmacy, Al-Rashed University, Baghdad, Penang, Iraq, 5Department of Paediatrics, Hospital Pulau Pinang, Penang, Penang, Malaysia OBJECTIVES: To estimate the costs of management of children with structuralmetabolic epilepsy and to determine the cost-driving factors in the selected population. METHODS: This was a retrospective annual prevalence-based study that included patients who attended a paediatric neurology clinic in a tertiary referral centre in Malaysia. The total costs of epilepsy management were estimated from the provider (i.e., hospital) perspective, using a bottom-up, microcosting analysis. Medical chart/billing data (i.e., case reports) obtained from the hospital (i.e., provider) were collected to determine the resources used. Prices or cost data were standardised for the year 2010. RESULTS: The most expensive item in the costs list was antiepileptic drugs, whereas ultrasound examination represented the cheapest item. Hospitalisation and the use of non-antiepileptic drugs were the second and third most costly items, respectively. The cost of therapeutic drug monitoring comprised only a small proportion of the total annual expenditure. None of the demographic variables (i.e., gender, race, and age) significantly impacted the annual cost of epilepsy management. Similarly, child development and seizure type were also not associated with the cost of management. On the other hand, children who received polytherapy treatment, therapeutic drug monitoring, or adjuvant therapy with new antiepileptic drugs represented high-cost groups of patients. Moreover, the total annual cost of epilepsy management positively correlated with seizure frequency. CONCLUSIONS: This investigation was the first cost analysis study of epilepsy in Malaysia. The total annual cost of management for 120 patients with structural-metabolic epilepsy was RM 202,816 (i.e., RM 1690.13 per patient per year). The study findings highlight the importance of optimizing seizure control in reducing the cost of management.

Optimizing adherence in hypertension: a comparison of outcomes and costs using single tablet regimens vs individual component regimens

Background:Several studies have demonstrated that the use of single tablet regimens (STRs) in hypertension is associated with improved outcomes and reduced healthcare costs compared with individual component regimens. The objective was to carry out a retrospective analysis of a UK general practice population to test these conclusions in a UK context.Method:A retrospective cohort study was carried out using a primary care database (The Health Improvement Network; THIN), comparing 9929 hypertensive patients on STRs with 18,665 patients on individual component therapy. Data were collected for prescriptions, significant cardiovascular events, and out-patient referrals over a minimum follow-up period of 5 years after initiation of therapy. Current NHS costings were applied to the data, to arrive at an estimate of comparative resource use.Results:There were significantly more cardiovascular events in the individual component group than those treated with a single tablet regimen. Five year event rates: 8.3% vs 13.6%; Absolute Risk Reduction (ARR) = 5.3%; Number needed to treat (NNT) = 18.9. After correction for potential confounders, the hazard ratio was 0.74 (95%CI = 0.70–0.77), p < 0.0001. Hospital admission costs were lower in the STR group, but drug costs were higher. Overall, the mean annual management cost per patient was similar in the two groups (£191.49 vs £189.35).Key limitations:The study was based on a retrospective cohort and the result may therefore be influenced by unidentified confounders. It was not possible to identify the reasons for individual prescriptions, some of which may have been issued for reasons other than hypertension. Costings for some components of the outcome could not be assessed from the dataset and are therefore omitted from the analysis. Finally, no attempt was made to distinguish outcomes associated with individual classes of anti-hypertensives.Conclusions:This study confirms the association observed by other authors that patients treated with STRs are less likely to experience serious cardiovascular events than those on individual component therapy. In a UK context this analysis has shown that potential hospital savings broadly offset the additional drug acquisition costs associated with STRs. These agents can therefore be considered cost neutral.

Évaluation de l’incidence du zona, de la proportion des douleurs post-zostériennes, et des coûts associés dans la population française de 50 ans ou plus

Background Despite the perspective of vaccination against herpes zoster, there are few recent data available on the incidence of this disease, the proportion of postherpetic neuralgia cases, and associated disease management costs. This study was performed to evaluate these parameters in a representative sample of French physicians. Methods It was a retrospective, declarative study conducted from the medical files of patients who presented with herpes zoster and consulted in 2005, based on a random sample of GPs, dermatologists, neurologists, and physicians in pain clinics, weighted by demographic departmental distribution of patients aged 50 years and above. The analysis was performed on cases diagnosed by physicians themselves (incident cases). Results The annual incidence of herpes zoster was estimated at 8.99/1000 [8.34–9.64], all types of physicians pooled and at 8.67/1000 for GPs. This represents about 182,500 cases of herpes zoster in France in 2005 in patients aged 50 years and above. Incidence was slightly higher amongst women (1.3 times) and increased with age. Amongst the 777 cases of incident herpes zoster, 343 were complicated by postherpetic neuralgia one month after diagnosis. The proportion of patients presenting postherpetic neuralgia at 3 and 6 months was 32.1% and 17.6%, respectively. The annual cost of management of herpes zoster and postherpetic neuralgia was estimated at 170 [109–249] million euros, of which 61.0 million euros were covered by the national health insurance. Conclusion In this study, the incidence of herpes zoster observed in France in subjects aged 50 years and above is close to that already estimated in France and Europe. The proportion of postherpetic neuralgia is high and this painful complication may persist for several months after diagnosis of herpes zoster. To our knowledge, EPIZOD is the first study conducted in France to assess the cost of herpes zoster and of postherpetic neuralgia, the most frequent complication of this viral disease.

Genital warts incidence and healthcare resource utilisation in Australia

ObjectivesTo estimate for the first time the incidence and healthcare resource utilisation associated with genital warts (GW) in Australia prior to the human papillomavirus vaccination programme.MethodThe authors analysed data from...

Economic burden associated with the management of cervical cancer, cervical dysplasia and genital warts in Belgium

Objective: Human papillomavirus (HPV) infections can lead to cervical intraepithelial neoplasia (CIN) lesions, cervical cancer (CC) and genital warts (GWs). This study intended to assess the annual cost of CC, CIN and GW management in Belgium.Method: A retrospective study using a Belgian Hospital Disease Database (for yearly hospital cost of CC and GW patients) and a clinical expert survey were performed to assess the medical management of CC, CIN and GW patients. Belgian official sources were used to estimate the annual costs of management of CC, CIN and GW patients both from a healthcare payer perspectives (HCPP) and a societal perspective.Results: Based on the 667 patients diagnosed annually in Belgium with CC and an annual cost per patient of €9,716, the total annual cost of CC is €6.5 million (HCPP). The 10,495 estimated CIN 1, 2 and 3 patients led to an annual cost of €1.97 million (HCPP). The 7,989 estimated annual number of diagnosed GW patients led to an estimated annual cost of €2.53 million (HCPP).Conclusion: HPV-related diseases represent an important burden on Belgian society, especially when considering that the estimates in this study are probably underestimations, as the management costs of other HPV-related diseases (vulvar, vaginal, penile, oropharyngeal (pre-) cancers, recurrent respiratory papillomatosis etc.) are not included in this analysis.

Economic Implications of Osteoporosis-Related Femoral Fractures in Saudi Arabian Society

To assess the prevalence of proximal femoral fractures due to osteopenia and osteoporosis in the eastern province of Saudi Arabia and to estimate the cost of management of osteoporosis-related femoral fractures. This is a retrospective study of all patients admitted to the orthopaedic department of the King Fahd Hospital of the University, AlKhobar between January 2001 and December 2006. There were 63 patients admitted to the hospital with osteoporosis-related fractures and 43 sustained proximal femoral fractures. The cost of management of these patients from admission to discharge was analyzed. A verbal survey was carried with all the hospitals in the eastern province to establish the prevalence of osteoporosis-related femoral fractures for a 12 month period. There were 23 male and 20 female patients with average age of 72.11 years and the hospital stay was for 760 days. The cost of managing these patients was SR2.09 million (US$557,333.00) at the rate of SR48,712 (US$12,989.90) per patient. The survey of all hospitals in the eastern province of Saudi Arabia showed that 984 proximal femoral fractures occurred in a population of 164,121. The estimated cost was SR48 million (US$12.78 million) annually. On a national basis, with a population of 1,461,401 Saudis aged 50 years or more, 8,768 would suffer femoral fractures yearly at a cost of SR4.27 billion (US$1.14 billion). This study raises serious economic concerns. The annual cost of management of osteoporosis-related proximal femoral fractures in the eastern province of Saudi Arabia is US$12.78 million. As the Saudi Arabian population is aging and the number of elderly patients is bound to increase, with an accompanying increase in fractures, the impact on health care budgets will be tremendous.

Costs of detection and treatment of cervical cancer, cervical dysplasia and genital warts in the UK

ABSTRACTObjective: Infection with human Papillomavirus (HPV) is a necessary cause of cervical cancer (CC) and genital warts (GW). HPV vaccination studies have shown excellent efficacy against HPV-induced lesions. To assess the cost-effectiveness of a HPV quadrivalent (6, 11, 16 and 18) vaccine it is necessary to estimate the costs of managing current levels of HPV-related diseases. This study estimates the annual 2003 expenditures in the UK for CC screening, follow-up of abnormal findings, CC treatment and GW treatment.Design and methods: CC screening programmes provided the annual number of screening tests, their results and use of colposcopy procedures in women with abnormal findings. Incident CC cases and hospital admissions for CC in 2003 were used to estimate CC costs. Health Protection Agency data provided the annual number of new, recurrent or persistent cases of GW treated in Genitourinary Medicine (GUM) clinics. Treatment patterns for managing GW were estimated by GUM clinicians. The annual physician visits, tests, procedures, hospital admissions and topical genital wart medications were costed to estimate the total annual expenditures for CC and GW.Results: There were 4.8 million screening tests and 230 303 colposcopy procedures. Estimated costs for screening, management of abnormal and inadequate findings were £138.5 million. Annual management costs for incident and prevalent CC cases were £46.8 million. There were an estimated 76 457 incident and 55 657 recurrent/persistent GW cases in 2003. The costs for managing these cases were approximately £22.4 million. Total annual estimated costs for CC screening, management and treatment of GW were £208 million and ranged from £186.9 to £214 million based upon sensitivity analyses.Conclusions: The direct medical costs for the NHS associated with detection and management of CC, cervical dysplasia and treatment of GW in the UK are substantial. These medical costs are invaluable for future cost-effectiveness analyses of a quadrivalent HPV vaccine programme.