Annual Direct Healthcare Costs Research Articles

Prevention of low back pain in the military cluster randomized trial: effects of brief psychosocial education on total and low back pain–related health care costs

Background contextEffective strategies for preventing low back pain (LBP) have remained elusive, despite annual direct health care costs exceeding $85 billion dollars annually. In our recently completed Prevention of Low Back Pain in the Military (POLM) trial, a brief psychosocial education program (PSEP) that reduced fear and threat of LBP reduced the incidence of health care–seeking for LBP. PurposeThe purpose of this cost analysis was to determine if soldiers who received psychosocial education experienced lower health care costs compared with soldiers who did not receive psychosocial education. Study design/SettingThe POLM trial was a cluster randomized trial with four intervention arms and a 2-year follow-up. Consecutive subjects (n=4,295) entering a 16-week training program at Fort Sam Houston, TX, to become a combat medic in the U.S. Army were considered for participation. MethodsIn addition to an assigned exercise program, soldiers were cluster randomized to receive or not receive a brief psychosocial education program delivered in a group setting. The Military Health System Management Analysis and Reporting Tool was used to extract total and LBP-related health care costs associated with LBP incidence over a 2-year follow-up period. ResultsAfter adjusting for postrandomization differences between the groups, the median total LBP-related health care costs for soldiers who received PSEP and incurred LBP-related costs during the 2-year follow-up period were $26 per soldier lower than for those who did not receive PSEP ($60 vs. $86, respectively, p=.034). The adjusted median total health care costs for soldiers who received PSEP and incurred at least some health care costs during the 2-year follow-up period were estimated at $2 per soldier lower than for those who did not receive PSEP ($2,439 vs. $2,441, respectively, p=.242). The results from this analysis demonstrate that a brief psychosocial education program was only marginally effective in reducing LBP-related health care costs and was not effective in reducing total health care costs. Had the 1,995 soldiers in the PSEP group not received PSEP, we would estimate that 16.7% of them would incur an adjusted median LBP-related health care cost of $517 compared with the current 15.0% soldiers incurring an adjusted median cost of $399, which translates into an actual LBP-related health care cost savings of $52,846 during the POLM trial. However, it is likely that the unaccounted for direct and indirect costs might erase even these small cost savings. ConclusionThe results of this study will help to inform policy- and decision-making regarding the feasibility of implementing psychosocial education in military training environments across the services. It would be interesting to explore in future research whether cost savings from psychosocial education could be enhanced given a more individualized delivery method tailored to an individual's specific psychosocial risk factors.

Budget Impact Analysis of Tapentadol Extended Release for the Treatment of Moderate to Severe Chronic Noncancer Pain

BackgroundOpioids are commonly used to manage chronic pain. Although traditional μ-opioids are effective in reducing pain, they are often associated with opioid-induced side effects (OISEs) that can limit treatment effectiveness. Studies have shown that tapentadol extended release (ER) has a lower incidence of gastrointestinal adverse events than oxycodone controlled release (CR) at equianalgesic doses. ObjectiveA model was developed to estimate the budget impact of placing tapentadol ER on a hypothetical US health plan formulary of Schedule II long-acting opioids. MethodsWe estimated annual direct health care costs for patients who received 6-month therapy with long-acting formulations of tapentadol, oxycodone, morphine, hydromorphone, oxymorphone, or fentanyl. Costs included medications, copayments, OISE management, and switching/discontinuation. Published estimates of incidence/prevalence, OISEs, and pain management resources and costs were used. The base case analysis assumed a 10% formulary share of tapentadol ER with a 10% decrease of oxycodone CR. The resulting per-member per-month (PMPM) formulary cost differences and results of a 1-way sensitivity analysis are reported. ResultsIn a health plan of 500,000 members, 2600 (0.52%) are estimated to experience chronic pain annually. Adding tapentadol ER to the formulary was associated with an annual budget savings of $148,945 ($0.0248 PMPM). This savings was achieved through a decrease in both pharmacy costs ($144,062; $0.0240 PMPM) and medical costs ($4883; $0.0008 PMPM). Cost decreases were driven by lower daily average consumption and fewer OISEs with tapentadol ER versus oxycodone CR, leading to reduced resource utilization over 6 months of treatment. Sensitivity analyses showed results were most sensitive to drug acquisition costs. ConclusionsOur results suggest that replacing 10% of oxycodone CR's formulary share with tapentadol ER would decrease the overall budget of a health plan with 500,000 members. Placing tapentadol ER on a health plan formulary may result in a reduction in both pharmacy and medical costs.

Projection of Body Mass Index (BMI), Chronic Conditions and Healthcare Costs in Canada: An Application of Microsimulation

Obesity among Canadians is an important public health issue given health risks and economic impact. A micro-simulation model was developed to project health outcomes and healthcare costs of potential public health strategies to reduce obesity levels. The Population Health Model is a microsimulation model, which ages populations representative of Canada, one individual at a time, until death. Multivariate regression equations were estimated from the longitudinal National Population Health Survey to simulate plausible dynamics of BMI, chronic conditions, and death. Per capita annual direct healthcare costs by BMI, sex and age categories were estimated by combining resource use (from Statistics Canada national health surveys) and unit costs (from Canadian Institute for Health Information). Simulated per capita total cost for 2012 are higher for obese ($2,283) than for overweight ($1,726), underweight ($1,298) and normal weight ($1,284) categories. Prevalence of heart disease, diabetes and hypertension are respectively projected to be 5.2%, 6.6% and 18.2% in 2020 under the baseline scenario. However, 2020 prevalence would be lowered to 5.0%, 6.0% and 17.1% if BMI trajectories were instantly reduced by 5% (by means such as better nutrition, higher physical activity) from 2012 onwards. 2020 direct healthcare costs would be reduced by 2.7% (relative to costs without BMI reduction). The potential beneficial impact of reducing obesity in the Canadian population is evaluated quantitatively through micro-simulation modeling.

Retrospective analysis of clinical and economic results of genotyping at-risk patients to guide narcotic detoxification

Genotyping technology was used to guide narcotic detoxification efforts using Suboxone and other interventions and the clinical outcomes were determined. The patients were genotyped using the Proove Narcotic Risk Test using Real Time PCR TaqMan assay. Patients were enrolled in the NESP Suboxone narcotic detoxification program over a 90 day period with ongoing maintenance therapy based on genotype over two years. The subjects were chronic pain patients dependent on Rx narcotics [n=159] of which 82% [121 patients] had a successful outcome and of the 18% [27 patients] that were outside the category, 90% [24 patients] had a s successful initial outcome but due to subsequent medical problems or additional surgery by other healthcare professionals are now back on chronic Narcotic therapy. The remaining 3 relapsed for no medical reason the annual direct healthcare costs of these patients was reduced by $1.694M. The ROI was 0.28 or about $500,000 in the first year and 2.8 over two years. This compares favorably with other programs. Thus by genotyping patients and using the information to identify candidates for narcotic detoxification programs, the patient , physician and payer can benefit from improved clinical outcomes and cost savings over a multi-year period. This study was supported by a grant from Proove Biosciences Inc. Genotyping technology was used to guide narcotic detoxification efforts using Suboxone and other interventions and the clinical outcomes were determined. The patients were genotyped using the Proove Narcotic Risk Test using Real Time PCR TaqMan assay. Patients were enrolled in the NESP Suboxone narcotic detoxification program over a 90 day period with ongoing maintenance therapy based on genotype over two years. The subjects were chronic pain patients dependent on Rx narcotics [n=159] of which 82% [121 patients] had a successful outcome and of the 18% [27 patients] that were outside the category, 90% [24 patients] had a s successful initial outcome but due to subsequent medical problems or additional surgery by other healthcare professionals are now back on chronic Narcotic therapy. The remaining 3 relapsed for no medical reason the annual direct healthcare costs of these patients was reduced by $1.694M. The ROI was 0.28 or about $500,000 in the first year and 2.8 over two years. This compares favorably with other programs. Thus by genotyping patients and using the information to identify candidates for narcotic detoxification programs, the patient , physician and payer can benefit from improved clinical outcomes and cost savings over a multi-year period. This study was supported by a grant from Proove Biosciences Inc.

Direct healthcare costs and resource consumption after acute coronary syndrome: a real-life analysis of an Italian subpopulation

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.

The economic burden of atherothrombosis in Greece: results from the THESIS study

The aim of this study was to estimate the total annual cost of patients with or at risk for atherothrombosis in Greece. A multicentre, cost-of-illness study was conducted between January 2007 and December 2009. In the study, 800 patients with coronary artery disease, cerebrovascular disease, or peripheral artery disease (PAD) or multiple cardiovascular risk factors (MRF) were recruited. Direct and indirect cost data were assessed at patients' enrolment in the study, and at 6 and 12 months of follow-up. The annual total cost was €6,017/patient. This cost ranged from €10,098/patient with PAD to €1,813/patient with MRF. The annual direct health-care cost was €5,056/patient. This cost escalates from €1,623/patient with MRF to €8,697/patient with PAD. The total annual expenditures related to atherothrombosis, in Greece, were estimated to be €7.5 billion at the national level. The findings of the current study indicate the high economic burden of atherothrombosis in Greece.

National Burden of Pediatric Hospitalizations for Inflammatory Bowel Disease

: The objective of the present study was to quantify the national pediatric inpatient inflammatory bowel disease (IBD) burden in terms of the number of IBD-related hospitalizations, the number of days spent in the hospital, and hospitalization costs. : Hospitalizations for children and adolescents 20 years and younger with a primary diagnosis of either Crohn disease (CD) or ulcerative colitis (UC) were selected from the 2006 Kids' Inpatient Database (KID). Length of the hospital stay in days (LOS) and charges for the hospitalization were found directly in the Kids' Inpatient Database, and cost was calculated using the hospital's cost-to-charge ratio. Predictor variables included patient characteristics, such as age and severity of illness, and hospital characteristics. Ordinary-least-squares regressions were developed and estimated to explain hospitalization costs. : In 2006, there were 10,777 IBD-related hospitalizations. The total and mean costs for CD were $66.3 million and $10,176 (95% confidence interval [CI] $9647-$10,705), and for UC were $48.6 million and $11,836 (95% CI $10,760-$12,912). For CD, 0- to 5-year-old patients had the highest mean LOS (8.10, 95% CI 5.53-10.67, days) and mean cost ($13,894, 95% CI $9053-$18,735), whereas, for UC, 11- to 15-year-old patients had the highest mean LOS (7.49, 95% CI 6.88-8.10, 95% CI 5.53-10.67, days) and mean cost ($13,407, 95% CI $11,704-$15,110). : For a pediatric disease with a rather low prevalence rate, the estimated annual inpatient pediatric burden of IBD is a sizeable $152.4 million (2010 US$) and 64,985 days spent in the hospital. As medications and outpatient treatments improve for the treatment of IBD, there is an opportunity for significant reduction in inpatient burden.

Socioeconomic Assessment of Meat Protein Extracts (MPE) as a New Means of Reducing the U.S. Population’s Salt Intake

Excessive salt intake causes a number of cardiovascular diseases, such as strokes and hypertension. This is a burden on the individual as well as on society, because these diseases are fatal and costly to treat and live with. Much of the salt comes from processed meat such as sausages, ham, and bacon and has, so far, been hard to avoid because of consumer taste preference as well as the technological benefits. Meat protein extract (MPE) is a broth of hydrolyzed protein which can reduce the salt in processed meat by more than one third without compromising on taste and functionality. This study estimates the socioeconomic impacts of implementing MPE widely across the United States (US) by relating the national salt intake reduction potential of MPE (5%) to a broad range of health, societal, and individual factors derived from the literature. Results show that benefits for society are substantial and MPE could be part of the solution for the problem of excessive salt intake. MPE could deliver 25% of the U.S. ‘National Salt Reduction Initiative’ goals, avoid approximately 1 million hypertension cases and save around USD 1.6 billion in annual direct healthcare costs. Verification indicates that these estimates are conservative.

Economic burden of depression in South Korea

A recent national survey in South Korea indicated that the 12-month prevalence rate of major depressive disorder was 2.5%. Depressive disorders may lead to disability, premature death, and severe suffering of patients and their families. This study estimates the economic burden of depression in Korea from a societal perspective. Annual direct healthcare costs associated with depression were calculated based on the National Health Insurance database. Annual direct non-healthcare costs were estimated for transport. Annual indirect costs were estimated for the following components of productivity loss due to illness such as morbidity (absenteeism and presenteeism) and premature mortality. Indirect costs were estimated using the large national psychiatric epidemiological surveys in Korea. The human capital approach was used to estimate indirect costs. The total cost of depression was estimated to be $4,049 million, of which $152.6million represents a direct healthcare cost. Total direct non-healthcare costs were estimated to be $15.9 million. Indirect costs were estimated at $3,880.5 million. The morbidity cost was $2,958.9 million and the mortality cost was $921.6 million. The morbidity cost was identified as the largest component of overall cost. Depression is a considerable burden on both society and the individual, especially in terms of incapacity to work. The Korean society should increase the public health effort to prevent and detect depression in order to ensure that appropriate treatment is provided. Such actions will lead to a significant reduction in the total burden resulting from depression.

The utilization of health care services by children with Foetal Alcohol Syndrome in the Western Cape, South Africa

The rates of Foetal Alcohol Syndrome (FAS) and Partial Foetal Alcohol Spectrum (PFAS) in South Africa are the highest reported worldwide. There is a paucity of research examining the health care costs of caring for children with FAS or PFAS in this country. A cross-sectional analytical study was conducted using an interviewer-administered questionnaire amongst caregivers of children (0–12 years) with FAS/PFAS in the Western Cape to estimate the utilization of health care services; the annual direct and indirect health care costs per child as well as the total cost to society for providing health care services to children with FAS/PFAS. It was found that the median number of annual visits to public health care facilities per child was 8 (IQR 4 to 14). The total average annual cost per child was $1039.38 (95% CI: $808.68; $1270.07) and the total annual societal cost for the Western Cape was $70,960,053.68 (95% CI: $5,528,895.48; $86,709,971.13). Caregivers in receipt of a social support grant reported spending significantly less on health care for a child with FAS/PFAS (Fisher's exact p = 0.004). These study results confirm the significant burden of FAS/PFAS on the Western Cape economy and the health care system which has significant implications for FAS prevention.

Cost of diabetes: comparison of disease-attributable and matched cohort cost estimation methods

Objective:To estimate and compare the annual direct healthcare cost among Type 1 (T1DM) and Type 2 (T2DM) diabetes patients using two cost estimation methods: (1) DM-attributable cost and (2) all cause case–control cost.Research design and methods:An administrative claims cohort study using the HealthCore Integrated Research Database (HIRD®) identified T1DM and T2DM patients age ≥18 and <65 years between 1/1/2006 – 12/31/2006. DM patients (cases) were matched 1:1 with non-DM patients (controls) by age, gender, state, and commercial plan type (HMO, PPO, POS). All patients had continuous eligibility for calendar years 2006–07. DM-attributable cost was assessed by summing medical claims for DM (ICD-9-CM codes 250.xx) and pharmacy claims for anti-hyperglycemic agents, and all cause health care cost was assessed for cases and controls, for the calendar year 2007.Results:A total of 12,096 T1DM and 256,245 T2DM cases and matched controls were identified. T1DM and T2DM cases had significantly higher average baseline comorbidities and Deyo–Charleson Comorbidity scores than controls (2.17 vs. 0.23 and 1.62 vs. 0.39, respectively, p < 0.0001 for both).While DM attributable cost estimation resulted in a mean annual cost of $6247 for T1DM and $3002 for T2DM in 2007, the mean annual (per patient) all-cause total cost estimation using the case–control method resulted in a difference of $10,837 ($14,060 for cases, vs. $3223 for controls) for T1DM; and $4217 ($8070 for cases, vs. $3853 for controls) for T2DM.Conclusions:The DM-attributable cost method underestimated costs by 42% for T1DM and 29% for T2DM compared to the case–control method. The difference was smaller but still significant (33% for T1DM and 14% for T2DM) when multivariate technique was used. Patients with DM may use a substantial amount of medical and pharmacy services not directly attributable to DM, and attributable cost method may underestimate the total cost of DM. This study has limitations inherent to the retrospective claims data analysis and generalizability of results is limited to those from similar population.

Direct healthcare costs of patients with type 2 diabetes using long-acting insulin analogues or NPH insulin in a basal insulin-only regimen

Aims To compare direct healthcare costs incurred by patients with type 2 diabetes in Denmark prescribed long-acting insulin analogues (LAIA) or intermediate-acting human insulin (NPH) in a basal-only regimen. Methods Demographic and socio-economic patient characteristics, hospital utilisation data, primary care visits, specialist physician visits and prescription data were extracted from registers covering the Danish population. Patients receiving basal insulin were identified during a 1-year inclusion period (2005) and allocated to a LAIA ( n = 303) or NPH group ( n = 8523). LAIA patients were then matched with NPH patients using propensity scores based on observable covariates. Annual direct healthcare costs were determined during a <2-year analysis period (2005–2006). Results Direct healthcare costs, including prescription costs, were equivalent between groups. However, while most cost items were similar between groups, ambulatory visit costs were significantly lower in LAIA-treated patients ( p = 0.03), whereas insulin pharmacy costs were significantly lower in NPH-treated patients ( p < 0.001). Conclusion There was no difference in direct healthcare costs between patients using LAIAs or NPH insulin.

Involvement in the US criminal justice system and cost implications for persons treated for schizophrenia

BackgroundIndividuals with schizophrenia may have a higher risk of encounters with the criminal justice system than the general population, but there are limited data on such encounters and their attendant costs. This study assessed the prevalence of encounters with the criminal justice system, encounter types, and the estimated cost attributable to these encounters in the one-year treatment of persons with schizophrenia.MethodsThis post-hoc analysis used data from a prospective one-year cost-effectiveness study of persons treated with antipsychotics for schizophrenia and related disorders in the United States. Criminal justice system involvement was assessed using the Schizophrenia Patients Outcome Research Team (PORT) client survey and the victimization subscale of the Lehman Quality of Life Interview (QOLI). Direct cost of criminal justice system involvement was estimated using previously reported costs per type of encounter. Patients with and without involvement were compared on baseline characteristics and direct annual health care and criminal justice system-related costs.ResultsOverall, 278 (46%) of 609 participants reported at least 1 criminal justice system encounter. They were more likely to be substance users and less adherent to antipsychotics compared to participants without involvement. The 2 most prevalent types of encounters were being a victim of a crime (67%) and being on parole or probation (26%). The mean annual per-patient cost of involvement was $1,429, translating to 6% of total annual direct health care costs for those with involvement (11% when excluding crime victims).ConclusionsCriminal justice system involvement appears to be prevalent and costly for persons treated for schizophrenia in the United States. Findings highlight the need to better understand the interface between the mental health and the criminal justice systems and the related costs, in personal, societal, and economic terms.

Empirical view of opioid dependence.

The impact of opioid dependence on employers, managed care, and society is significant. Inappropriate use of narcotic analgesics leads to uncontrolled pain management, dependence, and may lead to patient deaths, creating a tremendous cost burden to the health care system. To provide an overview of the clinical and economic impact of treating opioid dependence on managed care, employers, and society. An estimated 6% to 15% of people in the United States abuse drugs, and approximately 20% of Americans report using prescription opioids for nonmedical use. This is associated with an annual cost of nearly half a trillion dollars, taking into account the medical, economic, social, and criminal impact of this abuse. A recent study showed that patients who abuse opioids generate mean annual direct health care costs 8.7 times higher than nonabusers. The National Survey on Drug Use and Health (NSDUH), conducted by the Substance Abuse and Mental Health Services Administration (SAM HSA), found that patients who report opioid abuse miss more than 2.2 days of work monthly, compared with the 0.83 days per month reported for the average person. Presenteeism and productivity are also affected by misuse and dependence on opioids. The costs associated with opioid dependence are significant. Physicians, employers, and managed care organizations must be proactive in appropriately diagnosing and treating patients who suffer from substance abuse disorders in order to lessen this economic burden.

Economic burden of prescription opioid misuse and abuse.

Prescription opioid abuse and its associated costs are a problem in the United States, with significant epidemiologic and economic consequences. The breadth and depth of these consequences are not fully understood at present. To summarize published, English-language biomedical evidence pertaining to the epidemiology and costs of prescription opioid analgesic misuse and abuse and to describe efforts to reduce the burden of these problems. Published English-language articles on the epidemiology and economics of abuse, misuse, or diversion of prescribed opioid analgesics in the United States were identified by searching PubMed, Web of Science, the Cumulative Index to Nursing and Allied Health Literature database (CINAHL), EconLit, and PsycInfo, using (economics OR epidemiology) AND (misuse OR abuse) AND opioid as search terms or Medical Subject Heading (MeSH) terms. Article bibliographies were also searched manually for applicable papers. The search was limited to articles published from 1995 through July 2009. The literature search identified 2,347 titles, of which all but 41 were excluded as not pertaining specifically to the epidemiology or economics of prescription opioid abuse or misuse in the United States. In 2006, approximately 5.2 million individuals in the United States reported using prescription analgesics nonmedically in the prior month, up from 4.7 million in 2005. The total cost of prescription opioid abuse in 2001 was estimated at $8.6 billion, including workplace, health care, and criminal justice expenditures. One study of commercially insured beneficiaries in the United States found that mean per-capita annual direct health care costs from 1998 to 2002 were nearly $16,000 for abusers of prescription and nonprescription opioids compared with approximately $1,800 for nonabusers who had at least 1 prescription insurance claim. The economic burden of prescription opioid misuse and abuse is large. While the existing evidence indicates that persons who abuse or misuse prescription opioids incur higher costs and health care resource use, differences in methods used to explore this question make estimating the actual societal burden imposed by this problem difficult. Efforts to establish and maintain a balance between access to these drugs for legitimate pain management while decreasing the risk of abuse and misuse are critically important and include such tools as patient and provider education, patient screening, and use of technology.

An assessment of the economic and heart health benefits of replacing saturated fat in the diet with monounsaturates in the form of rapeseed (canola) oil

SummaryThere is a well‐established requirement for the UK population to reduce the saturates content of its diet from around 13.3% energy (E) intake to 10% E intake (including alcohol) and to improve fat quality by increasing monounsaturated fatty acid (MUFA) intake. Canola (rapeseed) oil is one of the richest sources of dietary MUFAs and is a good source of the omega‐3 polyunsaturated fatty acid (PUFA) alpha‐linolenic acid. Recent advances using conventional plant breeding have led to the development of high‐oleic canola, which has an increased level of MUFA and greater oxidative stability, making it suitable for a wide range of culinary purposes including frying.Around 7% of dietary saturated fatty acid (SFA) intake in adults derives from potatoes (fried potatoes and chips) and savoury snacks, with the value increasing to 13%–15% SFA in 4–18‐year‐olds. Traditionally, frying oils have been high in saturates content and their replacement with lower SFA alternatives provides the opportunity for food manufactures to lower SFA content of food with minimal consumer intervention. It has been estimated that at least half of the SFA in this category of foods can be replaced.In this review of literature, ten intervention studies were identified, where SFAs and/or carbohydrates were replaced by rapeseed oil, and the effect on blood lipids were reported. Results from these studies were pooled using standard meta‐analysis methods. The standard mean differences in total cholesterol (Total‐C) and low‐density lipoprotein cholesterol (LDL‐C) were 0.86 mmol/l [95% confidence interval (CI): −1.05 to −0.66] (ten studies) and 0.87 mmol/l (95% CI: −1.07 to −0.66) (nine studies), respectively, both significant (P &lt; 0.0001) and non‐heterogeneous (P &gt; 0.1).Using the pooled data, it can be calculated that each gram of SFA intake reduction was associated with reductions in both Total‐C and LDL‐C of 0.03 mmol/l, while each gram increase in either MUFA or PUFA reduced Total‐C by 0.05 and 0.09, respectively, and LDL‐C by 0.04 mmol/l and 0.08 mmol/l, respectively. It was also calculated that each 10 g increase in MUFA or rapeseed oil intake was associated with a reduction in Total‐C of 9.8% and 5.8%, respectively.In 2006, annual direct healthcare costs associated with coronary heart disease were estimated at £3.2 billion and the overall cost to the UK economy was nearly £9.0 billion. Assuming 3.5 g total fat (typically 30% E SFA) is replaced by 3.5 g rapeseed oil, then it can be predicted that Total‐C will be reduced by 1.9%, equivalent to an annual reduction of £61 million direct health costs and £171 million total costs.

Cost-effectiveness model comparing olanzapine and other oral atypical antipsychotics in the treatment of schizophrenia in the United States.

BackgroundSchizophrenia is often a persistent and costly illness that requires continued treatment with antipsychotics. Differences among antipsychotics on efficacy, safety, tolerability, adherence, and cost have cost-effectiveness implications for treating schizophrenia. This study compares the cost-effectiveness of oral olanzapine, oral risperidone (at generic cost, primary comparator), quetiapine, ziprasidone, and aripiprazole in the treatment of patients with schizophrenia from the perspective of third-party payers in the U.S. health care system.MethodsA 1-year microsimulation economic decision model, with quarterly cycles, was developed to simulate the dynamic nature of usual care of schizophrenia patients who switch, continue, discontinue, and restart their medications. The model captures clinical and cost parameters including adherence levels, relapse with and without hospitalization, quality-adjusted life years (QALYs), treatment discontinuation by reason, treatment-emergent adverse events, suicide, health care resource utilization, and direct medical care costs. Published medical literature and a clinical expert panel were used to develop baseline model assumptions. Key model outcomes included mean annual total direct cost per treatment, cost per stable patient, and incremental cost-effectiveness values per QALY gained.ResultsThe results of the microsimulation model indicated that olanzapine had the lowest mean annual direct health care cost ($8,544) followed by generic risperidone ($9,080). In addition, olanzapine resulted in more QALYs than risperidone (0.733 vs. 0.719). The base case and multiple sensitivity analyses found olanzapine to be the dominant choice in terms of incremental cost-effectiveness per QALY gained.ConclusionThe utilization of olanzapine is predicted in this model to result in better clinical outcomes and lower total direct health care costs compared to generic risperidone, quetiapine, ziprasidone, and aripiprazole. Olanzapine may, therefore, be a cost-effective therapeutic option for patients with schizophrenia.

Annual Direct and Indirect Health Care Costs of Chronic Idiopathic Urticaria

To estimate annual direct and indirect health care costs in patients with chronic idiopathic urticaria (CIU) managed with conventional therapies. A cost analysis consisting of a survey-guided and retrospective medical record review of direct and indirect health care costs from a societal perspective in patients with CIU. The Johns Hopkins University allergy and dermatology ambulatory clinics. Fifty adults with active CIU were recruited in sequential order. Individuals who were taking corticosteroids or other immunosuppressants in the month before enrollment were excluded from the study. We estimated direct health care costs, which included laboratory, medication, outpatient visit, and emergency department and hospital visit costs. We also estimated indirect costs, which included earnings lost owing to travel to outpatient visits and absences from work owing to CIU-related illness. Patients with CIU consumed a mean (SD) of $2047 ($1483) annually. Because CIU is primarily an outpatient disease, medication costs alone accounted for 62.5% ($1280) of the total annual cost. Indirect costs accounted for 15.7% ($322) of the total costs. High medication costs, followed by total indirect costs, result in the largest economic burden among patients with CIU. High medication costs may place low-income patients at risk for suboptimal treatment and increased burden due to poorly controlled disease. Our estimated total health care costs for CIU are comparable to those of other skin diseases such as vitiligo and bullous disease.

Economic burden of schizophrenia in South Korea.

This study estimates the treated prevalence of schizophrenia and the annual costs associated with the illness in Korea in 2005, from a societal perspective. Annual direct healthcare costs associated with schizophrenia were estimated from National Health Insurance and Medical Aid records. Annual direct non-healthcare costs were estimated for incarceration, transport, community mental health centers, and institutions related to schizophrenia. Annual indirect costs were estimated for the following components of productivity loss due to illness: unemployment, reduced productivity, premature mortality, and caregivers' productivity loss using a human capital approach based on market wages. All costs were adjusted to 2005 levels using the healthcare component of the Consumer Price Index. The treated prevalence of schizophrenia in 2005 was 0.4% of the Korean population. The overall cost of schizophrenia was estimated to be $ 3,174.8 million (3,251.0 billion Won), which included a direct healthcare cost of $ 418.7 million (428.6 billion Won). Total direct non-healthcare costs were estimated to be $ 121 million (123.9 billion Won), and total indirect costs were estimated at $ 2,635.1 million (2,698.3 billion Won). Unemployment was identified as the largest component of overall cost. These findings demonstrate that schizophrenia is not rare, and that represents a substantial economic burden.

Pharmacist Intervention to Improve Medication Adherence in Heart Failure

Patients with heart failure who take several prescription medications sometimes have poor adherence to their treatment regimens. Few interventions designed to improve adherence to therapy have been rigorously tested. To determine whether a pharmacist intervention improves medication adherence and health outcomes compared with usual care for low-income patients with heart failure. Randomized, controlled trial conducted from February 2001 to June 2004. University-affiliated, inner-city, ambulatory care practice. 314 low-income patients 50 years of age or older with heart failure confirmed by their primary care physician. Patients were randomly assigned to intervention (39% [n = 122]) or usual care (61% [n = 192]) groups and were followed for 12 months. A pharmacist provided a 9-month multilevel intervention, with a 3-month poststudy phase. An interdisciplinary team of investigators designed the intervention to support medication management by patients who have low health literacy and limited resources. Primary outcomes were adherence, as measured by using electronic prescription monitors, and exacerbations requiring emergency department care or hospital admission. Secondary outcomes included health-related quality of life, patient satisfaction with pharmacy services, and total direct costs. During the 9-month intervention period, medication adherence was 67.9% and 78.8% in the usual care and intervention groups, respectively (difference, 10.9 percentage points [95% CI, 5.0 to 16.7 percentage points]). However, these salutary effects dissipated in the 3-month postintervention follow-up period, in which adherence was 66.7% and 70.6%, respectively (difference, 3.9 percentage points [CI, -5.9 to 6.5 percentage points]). Medications were taken on schedule 47.2% of the time in the usual care group and 53.1% of the time in the intervention group (difference, 5.9 percentage points [CI, 0.4 to 11.5 percentage points]), but this effect also dissipated at the end of the intervention (48.9% vs. 48.6%, respectively; difference, 0.3 percentage point [CI, -5.9 to 6.5 percentage points]). Emergency department visits and hospital admissions were 19.4% less (incidence rate ratio, 0.82 [CI, 0.73 to 0.93]) and annual direct health care costs were lower ($-2960 [CI, $-7603 to $1338]) in the intervention group. Because electronic monitors were used to ascertain adherence, patients were not permitted to use medication container adherence aids. The intervention involved 1 pharmacist and a single study site that served a large, indigent, inner-city population of patients. Because the intervention had several components, intervention effects could not be attributed to a single component. A pharmacist intervention for outpatients with heart failure can improve adherence to cardiovascular medications and decrease health care use and costs, but the benefit probably requires constant intervention because the effect dissipates when the intervention ceases. ClinicalTrials.gov registration number: NCT00388622.