Annual Direct Costs Research Articles

Direct Medical Costs of Spinal Muscular Atrophy in the Catalonia Region: A Population-Based Analysis.

Spinal muscular atrophy (SMA) is a rare disorder, estimated to affect 1 per 10,000 live births. Patients affected with SMA often require intensive, chronic healthcare, which represents great social and economic costs. This study aimed to evaluate the direct medical costs of SMA, from the National Health System perspective in Catalonia, and provide regional data for the development of optimal disease management protocols and resource allocation decisions at the regional level. A retrospective, population-based study was designed based on admission records from primary care centres, hospitals and specialised care settings (inpatient and outpatient care), emergency services and extended care facilities obtained from a regional governmental claims database. A total of 396 patients met the inclusion criteria. Annual direct medical costs summed €58,606 per patient, taking into account the use of healthcare resources at all levels of care and excluding the cost of prescription medication. Specialised care represented 81% of the expenses that were mostly associated with respiratory manifestations of SMA. In the year 2016, 71.26% of patients with SMA had four or more systems affected by a chronic condition, versus 23.50% in the general population, which had an impact on healthcare use. Inpatient extended care and the increased presence of multimorbid chronic conditions in patientswith SMA must be taken into account in order to develop multidisciplinary treatment protocols that reflect the complexity of SMA. Forthcoming resource allocation decisions should reflect the intensive use of specialised care registered in patientswith SMA.

Direct non-medical and indirect costs of diabetes and its associated complications in Vietnam: an estimation using national health insurance claims from a cross-sectional survey

ObjectiveThe prevalence of diabetes in Vietnam has increased from 2.5% in 2007 to 5.5% in 2017, but the burden of direct non-medical and indirect costs is unknown. The objective of...

Postharvest losses at the farm level and its economy-wide costs: the case of the maize sector in Mozambique

ABSTRACTWith increasing population and demand for food, reducing food loss and waste is one of the greatest challenges worldwide. Current estimates point to over 1 billion tons of food lost and wasted worldwide, though nearly 10 percent of the global population is suffering from undernourishment and food insecurity. In Mozambique, about one-quarter of the population suffers from undernourishment and food insecurity. Estimates from FAO point to postharvest losses of maize in Mozambique at about 3.69 to 7.92 percent; this is less than one-fifth of the on-farm losses reported by other authors. In this study, an Equilibrium Displacement model is used to assess the economy-wide impact of postharvest losses of maize at the farm level. The impact of a 3 percent postharvest loss is tested. Results suggest that even this very conservative percentage of postharvest losses has a direct annual net cost of around $USD 28 million for both farmers and consumers domestically. This is equivalent to over 1 percent of the national budget. It is also higher than the average cost of food aid programs received over the last three years. Therefore, reducing postharvest losses of maize along with other interventions is crucial to achieve sustainable development and economic growth.

The Association Between Poor Glycemic Control and Health Care Costs in People With Diabetes: A Population-Based Study.

To analyze the differences in health care costs according to glycemic control in people with type 2 diabetes. Data on health care resource utilization from 100,391 people with type 2 diabetes were extracted from the electronic database used at the Catalan Health Institute. Multivariate regression models were carried out to test the impact of glycemic control (HbA1c) on total health care, hospital admission, and medication costs; model 1 adjusted for a variety of covariates, and model 2 also included micro- and macrovascular complications. Glycemic control was classified as good for HbA1c <7%, fair for ≥7% to <8%, poor for ≥8% to <10%, and very poor for ≥10%. Mean per patient annual direct medical costs were €3,039 ± SD €6,581. Worse glycemic control was associated with higher total health care costs: compared with good glycemic control, health care costs increased by 18% (€509.82) and 23% (€661.35) in patients with very poor and poor glycemic control, respectively, when unadjusted and by €428.3 and €395.1, respectively, in model 2. Medication costs increased by 12% in patients with fair control and by 28% in those with very poor control (model 2). Patients with poor control had a higher probability of hospitalization than those with good control (5% in model 2) and a greater average cost when hospitalization occurred (€811). Poor glycemic control was directly related to higher total health care, hospitalization, and medication costs. Preventive strategies and good glycemic control in people with type 2 diabetes could reduce the economic impact associated with this disease.

Analysis of the management and costs of headache disorders in Spain during the period 2011–2016: a retrospective multicentre observational study

ObjectivesTo investigate the number and characteristics of the Spanish population affected by headache disorders and the direct medical cost that these patients represent for the healthcare system.DesignA retrospective multicentre observational...

The economic burden of caregiving in epilepsy: An estimate based on a survey of US caregivers.

The burden of caregiving for persons with epilepsy (PWEs) has not been examined previously in the United States. We assessed the clinical impact and direct and indirect economic costs for caregivers of PWEs. An internet survey of 500 caregivers of PWEs was conducted from May to July 2015 using a combination of validated instruments and questions designed specifically for this survey. Caregivers were stratified by PWE age (adult/child) and disease severity (low: 0 vs high: 1+seizures in the prior month). Annual self-reported direct and indirect costs were reported per caregiver and extrapolated to all US caregivers. The economic burden of caregiving for PWEs was defined as the difference between costs for caregivers and the general population. Caregivers reported that PWEs averaged 11.4 seizures in the prior month. Eighty percent of respondents were female and the average age was 44.3. Since becoming a caregiver, many reported anxiety (52.8%), depression (41.0%), and insomnia (30.8%). Annual mean direct medical costs for caregivers of children with low vs high seizure frequency were $4344 and $10162, respectively. Costs for caregivers of adult PWEs were $4936 and $8518. Mean indirect costs associated with caregiving for a child with low vs high seizure frequency were $20529 and $40137; those for caregivers of an adult were $13981 and $28410. The cost estimates are higher vs the general US population; annual per-person healthcare utilization costs were $2740 and productivity loss costs were $5015. When extrapolating to the US population of PWE caregivers, annual costs exceeded $62 billion vs $14 billion for the general population, resulting in a caregiver burden of nearly $48 billion. The clinical and economic burden of caregivers for PWE were substantial, and greatest for those caring for children with frequent seizures. The impact on caregivers should be considered when estimating the value of interventions that control epilepsy.

Cost of Managing Type 2 Diabetes Before and After Initiating Dipeptidyl Peptidase 4 Inhibitor Treatment: A Longitudinal Study Using a French Public Health Insurance Database

IntroductionDiabetes is a growing epidemic that imposes a substantial economic burden on healthcare systems. This study aimed to evaluate the cost of managing type 2 diabetes (T2D) with dipeptidyl peptidase 4 inhibitors (DPP4Is) using real-world data.MethodThis longitudinal study used data from the French EGB (Echantillon Généraliste des Bénéficiaires) database. The annual average direct healthcare cost of treating patients with T2D was calculated 3 years prior and 3 years after initiation of DPP4I therapy. Actual total ambulatory and hospital care expenditure for the 3 years after DPP4I initiation was compared to projected costs. The distribution of costs across all care modalities was assessed over the 6-year period.ResultsAmbulatory and hospital care expenditure data for 919 patients with T2D starting DPP4I therapy alone or in combination in 2013 were analyzed. A total of 526 patients (57.2%) were still being treated with DPP4I 3 years after DPP4I initiation. Regardless of the treatment regimen, the ambulatory and hospital care costs increased above projected costs in the first year following DPP4I initiation, and then declined during the second and third years to levels in line with or below projected values for patients using DPP4Is as an add-on therapy. The increase in total expenditure in the first year following DPP4I initiation and the subsequent decline in costs in the second and third years were both associated with general trends in consumption across all aspects of patient care.ConclusionDespite an initial increase in healthcare expenditure, concomitant with reevaluation of patient care, this study showed that initiation of DPP4Is as an add-on therapy in French patients with T2D was associated with care expenditure that was in line or below predicted values within the 3 years following treatment initiation. Additional studies are required to evaluate the economic impact of the long-term treatment benefits.Electronic Supplementary MaterialThe online version of this article (10.1007/s13300-020-00760-x) contains supplementary material, which is available to authorized users.

P771 Increasing prevalence and direct health care cost of inflammatory bowel disease: A population-based evidence from a western Canadian province

Abstract Background More than 0.3% of the populations in Europe, North America, and Oceania live with inflammatory bowel disease (IBD). Canada has increasing prevalence trends of IBD with 1% of Canadians estimated to have IBD by 2030. Evidence about IBD prevalence and health care costs over time can contribute to health resources allocation and health care planning. Our study aimed to 1) estimate the prevalence and direct health care costs of IBD in the province of Saskatchewan (SK), Canada, and 2) test if trends in the prevalence and direct health care costs of IBD increased over two decades. Methods We conducted a retrospective population-based cohort study using administrative health data of SK between 1999/00 and 2016/17 fiscal years. A validated case definition was used to identify prevalent IBD cases. The costing method adopted by the Canadian Institute for Health Information was used to estimate direct health care costs in 2013/14 Canadian dollars among IBD cases. Generalised linear models (GLMs) with generalised estimating equations were used to test the trends. Negative binomial and gamma distributions were used to, respectively, model prevalence and health care cost trends. Sex and age group were covariates in all models; the Charlson comorbidity index was also included in the cost model. Annual prevalence rates and direct health care cost estimates with their 95% confidence intervals (95%CI) were reported. Results In 2016, there were 6468 (Crohn’s disease: 3663 [56.63%], ulcerative colitis: 2805 [43.37%]) IBD cases ascertained in SK. The number of prevalent cases increased over the analysis period by 56%. The total direct health care costs increased from $7.8 million in 1999 to $50.8 million in 2016. The average annual IBD prevalence increased from 341/100,000 (95%CI 340–341) in 1999 to 664/100,000 (95%CI 663–665) in 2016, a 3.3% (95%CI 2.4–4.3) average annual increase. The total average annual direct health care costs of IBD increased from $1.8 (95%CI $1.6–2.0) thousand per patient in 1999 to $7.1 (95%CI $6.7–7.5) thousand per patient in 2016, an average annual increase of 9.2% (95% CI 8.5–9.8), Figure 1. Conclusion In the Canadian province of SK, prevalence and direct health care costs, respectively, tripled and quadrupled over two decades. Our results provide relevant information and analysis on the burden of IBD in SK. These findings are in agreement with previous studies from other provinces. The evidence of constant increasing prevalence and health care cost trends of IBD needs to be recognised by health care decision-makers to promote cost-effective health care policies at provincial and national levels and respond to the needs of patients living with IBD.

P373 Telemedicine and inflammatory bowel disease: Results of the IBD assistant pilot project

Abstract Background Telemedicine enables proper and immediate monitoring of the patient’s current health state, followed by well-timed and customised treatment. The aim of our study was to assess feasibility and safety of telemonitoring in Czech patients with inflammatory bowel disease (IBD). Furthermore, we wanted to evaluate the impact of telemonitoring on the number of outpatient′s visits and direct health-care cost. Methods We performed randomised controlled study including patients with IBD in stable remission on conventional therapy who were randomised either to telemonitoring (IBDA) or control (CTRL) group and were followed-up for 12 months. All IBDA patients had access to a specific web application which contained a set of questioners assessing disease activity and complications which were filled-in at least every 3 months. Evaluation of clinical activity was accompanied by measurement of faecal calprotectin (FC) at home using CalproSmart test. Individuals in the CTRL group were followed under the standard conditions as other outpatients. Results A total of 131 were included (42% males; 47% with Crohn′s disease) and randomised to IBDA (n = 94) or control group (n = 37). HBI/pMayo activity indexes were not significantly different at baseline (p = 0.636 and p = 0.853) and end of study (p = 0.517 and p = 0.890) in the two groups. Similarly, no significant difference in inflammatory markers (C-reactive protein, FC) was observed in either group (p&amp;gt;0.05). The occurrence of intercurrent infections (0.93 vs. 0.81 cases of infection/patient-year, p = 0.87) or the need for hospitalisations (1 vs. 0) was similar between the groups. The number of outpatient visits was significantly lower in the IBDA than in the CTRL group (median number in IBDA group 0, in the CTRL group 4.2 visits, respectively, p &amp;lt; 0.0001). Telemedicine led to a reduction in the direct annual health-care cost of patient follow-up by ~25% compared with the standard care. Conclusion Results of the first Czech IBD telemedicine study confirm the effectiveness and safety of the telemedicine approach, which led to a reduction in outpatient visits and savings in health-care costs while maintaining a high standard of health care. Acknowledgements: Supported by the IBD-Comfort Endowment Fund.

Time to Include Nonalcoholic Steatohepatitis in the Management of Patients With Type 2 Diabetes.

Nonalcoholic fatty liver disease (NAFLD) is today the most common cause of chronic liver disease and second only to viral hepatitis as a cause of liver transplantation in the U.S. (1,2). It encompasses conditions from simple steatosis (NAFL), believed to be associated with slow disease progression, to the more severe and progressive form known as nonalcoholic steatohepatitis (NASH). NASH is characterized by hepatocellular injury in the form of hepatocyte ballooning (necrosis) and predominantly lobular inflammation. The severity of hepatic fibrosis is defined in stages. They range from stage F0, or no fibrosis, to mild (stage F1), moderate (stage F2, with zone 3 sinusoidal fibrosis plus periportal fibrosis), or advanced fibrosis, with bridging fibrosis (stage F3) or cirrhosis (stage F4). NASH may lead to cirrhosis and to the development of hepatocellular carcinoma, but even moderate-to-severe fibrosis (F2-F3) is associated with higher mortality (1,2). Advanced liver fibrosis and cirrhosis occur more often in obesity but, in particular, in patients with type 2 diabetes (T2D) (3). Endocrinologists should be aware that patients with NAFLD are also at a two- to threefold increased risk of both progression from prediabetes to diabetes and development of cardiovascular disease (4,5). Taken together, there is a consensus that patients with T2D and NASH are at a much higher risk of hepatic and extrahepatic morbidity and premature death than in the absence of liver disease. Within this context, Younossi et al. (6) report in the current issue of Diabetes Care an important study on the clinical and economic burden of NASH in patients with T2D in the U.S. This is so far the most comprehensive effort to systematically outline the magnitude of the problem in patients with diabetes. The authors used 2017 annual direct medical costs attributed to diagnosed diabetes reported by the …

The direct and indirect costs of axial spondyloarthritis(axSpA) in Singapore.

To estimate the economic annual direct and indirect costs of axial spondyloarthritis (axSpA) in Singapore, and to identify factors associated with these costs. A retrospective, cross-sectional, Institutional Review Board-approved study was conducted. A questionnaire was administered to the patients between 2013 and 2016 from the Singapore General Hospital (SGH) spondyloarthritis registry. Direct medical costs and indirect costs were estimated using the SGH database and the human capital approach respectively. Multivariate analyses using generalized linear model with gamma distribution and a log-linked function was conducted to identify factors associated with these total, direct and indirect costs. All costs were adjusted to 2017 using the Singapore Consumer Price Index and converted to 2017 US dollars (USD) by purchasing power parity. A total of 135 consecutive patients were included in the study, with a mean age of 40.4±13.2years. The overall annual total economic cost to society was around USD 74790820, with annual direct cost being the main component of total cost (90.8%). Annual direct cost was around USD 67931457, while annual indirect cost was around USD 6855951. Presence of extra-spinal symptoms (ever) was associated with an increase in total and direct costs. Higher education level and Patient Global Assessment were associated with an increase in indirect costs. Lack of employment was associated with a decrease in indirect costs. The disease burden of axSpA in Singapore is not trivial given that the disease is relatively common. This highlights the need for measures to accommodate patients with axSpA economically in Singapore.

Cost Analysis of Health Facility Electronic Integrated Disease Surveillance and Response in One District in Sierra Leone.

Global health security depends on effective surveillance systems to prevent, detect, and respond to disease threats. Real-time surveillance initiatives aim to develop electronic systems to improve reporting and analysis of disease data. Sierra Leone, with the support of Global Health Security Agenda partners, developed an electronic Integrated Disease Surveillance and Response (eIDSR) system capable of mobile reporting from health facilities. We estimated the economic costs associated with rollout of health facility eIDSR in the Western Area Rural district in Sierra Leone and projected annual direct operational costs. Cost scenarios with increased transport costs, decreased use of partner personnel, and altered cellular data costs were modeled. Cost data associated with activities were retrospectively collected and were assessed across rollout phases. Costs were organized into cost categories: personnel, office operating, transport, and capital. We estimated costs by category and phase and calculated per health facility and per capita costs. The total economic cost to roll out eIDSR to the Western Area Rural district over the 14-week period was US$64,342, a per health facility cost of $1,021. Equipment for eIDSR was the primary cost driver (45.5%), followed by personnel (35.2%). Direct rollout costs were $38,059, or 59.2% of total economic costs. The projected annual direct operational costs were $14,091, or $224 per health facility. Although eIDSR equipment costs are a large portion of total costs, annual direct operational costs are projected to be minimal once the system is implemented. Our findings can be used to make decisions about establishing and maintaining electronic, real-time surveillance in Sierra Leone and other low-resource settings.

Incidence and economic burden of sarcoidosis in years 2011-2015 in Silesian voivodeship, Poland.

Background:Sarcoidosis is a rare, chronic systemic disease. Earlier data (2006-2010) suggest that the incidence of pulmonary sarcoidosis in Silesian voivodeship increased, however there is no current data on other clinical forms of the disease.Objectives:The aim of presented study was an analysis of the actual epidemiological situation of sarcoidosis with simultaneous estimation of treatment cost financed from public funds.Methods:Epidemiological descriptive study concerned registered cases of sarcoidosis diagnosed in adult inhabitants of the Silesian voivodeship in years 2011-2015. Secondary epidemiological data on the main diagnosis and co-morbidity were obtained from the National Health Fund (NFZ) database in Katowice. Territorial and temporal variability of standardized incidence rates were analysed with simultaneous estimation of treatment costs reimbursed from the state budget.Results:Pulmonary sarcoidosis was the most frequently registered clinical form of such disease in the Silesian voivodeship (65% of total cases). The highest number of cases was diagnosed in the age 35–54 years, frequently in men than in women. Significantly decrease of the standardized incidence of sarcoidosis noticed between 2011 and 2015 is related with observed lower number of total cases of pulmonary disease. Observed territorial variability of the sarcoidosis incidence requires future, well-planned studies. The annual average direct cost of sarcoidosis treatment is high and exceed 538 EUR per patient.Conclusions:It was confirmed that sarcoidosis in the Silesian Voivodeship is a rare disease, however reimbursed direct costs of treatment remains very high. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (1): 43-52)

Cost-Utility Analysis of Saxagliptin/Dapagliflozin Versus Gliclazide and Insulin Glargine: Economic Implications of the Outcomes of the CVD-Real Studies I and II.

Diabetes treatment cost represents an ever-growing problem. The adoption of new drugs in therapy, although they can guarantee an improvement in patient’s quality of life, can meet obstacles when it involves an increase in costs. We decided to compare the costs and benefits of the new saxagliptin and dapagliflozin combination versus traditional therapies. Bodyweight loss and the sharp reduction in hypoglycemic episodes were the 2 main clinical outcomes that emerged from registered studies of saxagliptin and dapagliflozin compared with the sulfonylureas. These results, combined with the good cardiovascular risk profile, led to develop a cost-utility analysis. We aimed to show the economic value of this new association therapy. We carried out a cost-utility analysis from the Italian National Healthcare System (NHS) perspective, focused on direct costs related to the treatment and management of main diabetes complications. Utility scores adopted have been measured based on the patient’s perception of weight changes. In light of the better durability profile of saxagliptin/dapagliflozin compared with gliclazide, we also considered a simulation scenario to assess the impact on costs of switching to basal insulin, starting from gliclazide and the fixed combination, respectively, and based on the related probabilities to switch. To assess the robustness of the results, a 1-way sensitivity analysis was performed by changing the main parameters by ±20%. Furthermore, the sensitivity of the results was tested considering the addition of a percent discount, because the purchase costs of drugs are usually subject to hidden discounts. We calculated the total direct annual cost per patient of saxagliptin/dapagliflozin versus gliclazide and insulin glargine for patients with type 2 diabetes mellitus not achieving glycemic control on metformin plus saxagliptin alone, dapagliflozin alone, or gliclazide at a lower dosage. Total treatment costs have been obtained adding the direct cost of the drug, needles, glycemic self-monitoring, hypoglycemic events, cardiovascular complications, and effect on consumption of other drugs. The total direct cost of saxagliptin/dapagliflozin fixed dose combination was €414.62 higher than gliclazide (€1.067.72 vs €653.10), and greater than basal insulin, with a difference of €166.99 (€1067.72 vs €900.72). Despite the higher annual direct total cost, the additional cost per quality-adjusted life year (QALY) gained, compared with gliclazide, has been €11 517, and €4639, when compared with insulin glargine in the base-case scenario, and the robustness of the results has been shown in the sensitivity analysis. The results of our cost-utility analysis, expressed as incremental cost-effectiveness ratios, were fully compliant with the threshold adopted for Italy. Then, saxagliptin/dapagliflozin can be considered a cost-effective oral hypoglycemic agent. The positive effect of this drug on the quality of life, induced by the bodyweight loss, has allowed this outcome, despite the higher annual cost per patient, mainly determined by the drug purchase cost.

Estimation of direct cost of managing rheumatoid arthritis treatment to Pakistani patients using real-world follow-up data.

This study aimed to estimate annual direct cost attributed to rheumatoid arthritis (RA) treatment from a patient's perspective using real-world patient follow-up data from hospitals' electronic database. A prospective 1-year study was conducted in rheumatology clinics of tertiary care hospitals of Karachi, Pakistan. Cost-of-illness methodology was used and all patient data related to costs of rheumatologist visits, physical therapy sessions, medications, assistive devices and laboratory investigations were obtained directly in printed hardcopies from patient electronic databases using their medical record numbers. Transportation cost was calculated from patient-reported log books. Data were analyzed through IBM SPSS version 23. Patients were asked to sign a written consent and the study was ethically approved. The mean age of patients (N=358) was 48years. Most patients (73.7%) were female, married (86%) and had basic education (71.8%). Average cost of rheumatologist visits was PKR 11510.61 (USD: 72.05) while it was PKR 66947.37 (USD: 419.07) for physical therapy sessions. On average, medicines and medical devices costs were estimated at PKR 10104.23 (USD: 63.25) and PKR 7848.48 (USD: 49.13) respectively. Cost attributed to diagnostic and laboratory charges was PKR 1962.12 (USD: 12.28) and travel expense was PKR 6541 (USD: 40.95). The direct expenditure associated with managing RA was PKR 37558 (USD: 235.1). All costs were reported per annum. Patient with RA in Pakistan pay a considerable amount of their income for managing their condition. Most patients have no provision for insurance which is a need considering the nature of the disease and associated productivity loss that would significantly lower income as the disease progresses.

A contemporary and comprehensive analysis of the costs of stroke in the United States

BackgroundWhile several studies have determined direct costs associated with stroke there is a paucity of research involving indirect costs, especially in younger patients. AimPerform a cost of illness analysis for ischemic and non-traumatic hemorrhagic stroke in the US involving both direct and indirect costs in all age groups. MethodsNationally representative data was obtained from the Medical Expenditure Panel Survey (2003–2014). Subjects were dichotomized based on reported history of stroke. Two-part econometric models were used to estimate the adjusted incremental direct expenditure for patients with stroke. We used generalized linear model with family gamma, log link for the adjusted analysis of annual wage, a negative binomial regression model for the adjusted analysis of missed-work day, and a logistic regression model to estimate the probability of full-year employment. Loss of productivity due to premature death was computed using Present-Value of one life and annual number of deaths from 2014 National Vital Statistics. All costs are represented in 2016 US-dollar values. ResultsOut of 253,235,052 participants, 8,101,159 (3.2%) reported history of stroke. Weighted samples of 10,155 stroke participants and 314,694 control group were compared. Adjusted annual direct costs for each stroke participant was $4317 (95% CI: $3828–$4807) greater than control resulting in a net $38 billion incremental expenditure. Based on salary difference, missed workdays, and mortality, indirect cost from under-employment was $38.1 billion and from premature mortality was $30.4 billion. ConclusionTotal aggregate of $103.5 billion expenditure was incurred with 66% being from indirect costs based on 2016 US-dollar values.

Evolution of NAFLD and Its Management.

The global prevalence of nonalcoholic fatty liver disease (NAFLD) is estimated to be 25% and continues to rise worldwide in the setting of the obesity epidemic. This increase is especially concerning because NAFLD is often a progressive disease that can be associated with significant complications such as liver cirrhosis, hepatocellular carcinoma, and an increase in liver-related and overall mortality. Because of the devastating complications and comorbidities, NAFLD is a very costly disease for the healthcare system, with estimated annual direct medical costs exceeding $100 billion in the United States alone. Given this progressive course, it is imperative to make the diagnosis in patients with risk factors (metabolic syndrome, weight gain, and insulin resistance/diabetes). Once the diagnosis is made, the focus should shift to treatment and monitoring for the development of associated complications. Given that currently no pharmaceutical intervention is approved for the treatment of NAFLD, focus shifts instead to mitigation of risk factors through avoidance of foods that are rich in red meat, trans fats, refined carbohydrates, and high-fructose corn syrup; are low fiber; and have high energy density. The landmark of treatment, however, continues to be weight loss and improvement of insulin resistance, often through a multimodality approach. The current manuscript reviews the clinical phenotypes of NAFLD, its risk factors, and pathogenesis, as well as treatment options including lifestyle modifications and dietary interventions, medical therapies, endoscopic bariatric interventions, and bariatric surgery.

Analysis of Direct Private Investment: The Case of Bachelor’s Level in Community College

The costs spent by students or parents while attaining education are called the direct private costs which are usually placed outside and inside the domain of educational institutions. The present study is a quantitative survey that aims to conduct a comparative analysis of institutional and non-institutional direct private costs. Furthermore, it tries to find the size of institutional and non-institutional direct private costs at Bachelor’s level education in Nepal. For these purposes, I have selected a community based college from Kathmandu valley purposively and 90 students of Bachelor’s level (30 each from the faculty of humanities, education and management) were selected using simple random sampling technique. The findings of the study reveal that the average college related institutional unit cost per student was Rs. 24730.57, university related institutional cost was Rs. 5982.23; and total annual institutional unit cost was Rs. 30712.80. Likewise, it was found that a student has expensed Rs. 46411.63 as non-institutional direct private cost in a year. Total annual average direct private cost of education (institutional plus non-institutional) was Rs. 77124.43 at Bachelor’s level of community based college in the capital city of Nepal.

Cost of chronic and episodic migraine patients in continuous treatment for two years in a tertiary level headache Centre

BackgroundMigraine is one of the most common neurological diseases and an estimated 1.04 billion people worldwide have been diagnosed with migraine. Available data suggest that migraine is world widely associated with a high economic burden, but there is great variability in estimated costs that depends on the geographical, methodological and temporal differences between the studies. The purpose of this study was to quantify the annual direct cost of episodic migraine (EM) and chronic migraine (CM), both for the patient and for the National Health System (NHS), using data from subjects who attended an Italian tertiary headache centre. Furthermore, we evaluated comparatively the impact of gender and age on the economic burden of migraine.MethodsWe conducted a retrospective and non-interventional observational analysis of the electronic medical records of subjects with EM and CM who consecutively attended the Regional Referral Headache Centre of Rome and undergoing continuous treatment in the 2 years prior to 31 January 2019. This approach was intended to prevent distorsions due to natural fluctuations in migraine status over time. The collected data included demographic characteristics, number of specialist visits, consumption of medications, diagnostic tests, accesses in the emergency department (ED) and days of hospitalization due to the pathology.ResultsOur sample consisted of 548 patients (85.4% women and 14.6% men): 65.5% had CM and 34.5% had EM. The average annual expenditure per patient was €1482. 82.8% of the total cost (€1227) was covered by the NHS. The main item of expenditure were medications that represented 86.8% (€1286), followed by specialist visits (10.2%), hospitalizations for (1.9%), diagnostic tests for (1%) and ED visits for (0.1%). Costs were significantly higher for women than men (€1517 vs. €1274, p = 0.013) and increased with age (p = 0.002). The annual direct cost of CM was 4.8-fold higher than that of EM (€2037 vs. €427, p = 0.001).ConclusionOur results provide a valuable estimate of the annual direct cost of CM and EM patients in the specific setting of a tertiary headache centre and confirm the high economic impact of migraine on both the NHS and patients.

The Clinical, Economic, and Humanistic Burden of Patients with β-Thalassemia: A US-Centric Review of the Literature

Introduction: β-thalassemia is a genetic blood disease characterized by ineffective erythropoiesis due to defective hemoglobin production that manifests as potentially fatal anemia. Patients with β-thalassemia rely on regular, lifelong red blood cell transfusions (RBCTs) for survival and suffer from multi-system complications, physical manifestations, and decreased health-related quality of life (HRQoL) due to iron overload and continual RBCTs. This literature review aims to describe the disease burden associated with β-thalassemia. Methods: Electronic databases (MEDLINE®, Embase®, Cochrane Library) were searched to identify articles in the English language assessing the clinical, economic, and humanistic burden of β-thalassemia in North America and Europe. Articles were selected based on predefined criteria including appropriate study design, disease state, country, and outcome measures. Results: Patients with β-thalassemia who received regular RBCTs were significantly more likely to develop ≥ 1 iron overload-related comorbidity than matched, non-thalassemia controls (P &lt; 0.0001). Other iron-related issues included cardiac disease (observed in 13-30% of patients), hypogonadism (17-22%), diabetes (10-18%), osteoporosis (16%), hypothyroidism (12%), liver disease (4%), and hypoparathyroidism (2%). RBCTs also introduced the risk of transfusion reactions (48-50%), infections (24-65%), and development of alloantibodies (19-23%). Mortality rate for the US population was 1.9%. The direct annual cost per regularly transfused patient with β-thalassemia was significantly higher than in matched controls (USD 128,062 vs USD 5,438; P &lt; 0.001; 2016 USD). The main annual cost drivers per patient were iron chelation therapy (48%; USD 61,974) and RBCTs (31%; USD 39,723). Indirect costs for β-thalassemia were impacted by unemployment, reported at 33% among patients with β-thalassemia versus 24% for the general US population. Patients scored significantly worse on 5 subdomains (physical functioning, role-physical, general health, social functioning, and role-emotional) of the Short Form-36 (SF-36) HRQoL questionnaire compared with the general US population (all P &lt; 0.0001) with the greatest impairments seen in the general health subdomain (P &lt; 0.0001). Clinically meaningful reductions in physical functioning, role-physical, and general health scores were observed for patients with β-thalassemia aged &lt; 65 years with transfusion-related iron overload. Bodily pain was reported by 56-69% of patients with β-thalassemia, and pain interfered with patient physical and emotional functioning HRQoL outcomes. Increasing age correlated with higher numbers of pain responses (P &lt; 0.001). Psychiatric comorbidities were found in 24% of patients with β-thalassemia, and mood disorders, including depression and anxiety, were associated with overall significantly poorer physical and mental HRQoL (P &lt; 0.001). Conclusions: β-thalassemia is associated with a substantial clinical, economic, and humanistic burden in the USA. Patients with β-thalassemia experience reduced life expectancy, significant comorbidities, considerable direct healthcare costs, unemployment, and impaired HRQoL. There is a need for more effective management and therapeutic options for these patients. Disclosures Mearns: Celgene Corporation: Employment. Udeze:Celgene Corporation: Employment. Copher:Celgene Corporation: Employment. Sheth:CRSPR/Vertex: Other: Clinical Trial Steering committee; Apopharma: Other: Clinical trial DSMB; Celgene: Consultancy.