Annual Health Care Expenditures Research Articles

Obesity and the Economy: From Crisis to Opportunity

To the authors of this article, the economic stimulus program in Washington provides a unique opportunity to develop and institute a comprehensive national obesity initiative with immediate and long-term benefits to public health and the economy. They believe that part of the estimated $700 billion economic stimulus program should be invested in a national initiative to prevent obesity. This article provides an overview of the factors responsible for the obesity epidemic and highlights lifestyle choices among Americans that lead inevitably to obesity and obesity-related diseases, thereby addressing the need for a long-term national initiative to prevent obesity. An increasingly unhealthful lifestyle among the US population in the last 50 years has led to an obesity epidemic as a consequence of national economic, social, and policy decisions. During this time, government subsidies to industrial agriculture have supported low-cost high-calorie commodities―highly processed fat and sugar-based products―that have largely displaced a wide range of more expensive nutritious whole foods, such as fresh fruits and vegetables, once grown at low cost on family farms. One consequence of these policies is the increasing popularity of low cost fast food that contains a high amount of fat and low-quality carbohydrates and has little nutritional value or fiber. Coincident with increased energy consumption, the level of energy expenditure in the form of physical activity has sharply declined. In cities and suburban communities, there has been a reduction in consumer use of recreational or other facilities involving physical activity and limited money allocated to build or improve upon such facilities. Changes in family lifestyle contribute to obesity. Parents prepare few meals at home due to busy work schedules and the need to commute. Children have little time for recreational physical activities because of academic pressure; any free time available is used for sedentary activities such as television or computers. Reduced physical activity combined with psychosocial stress leads to an unhealthy diet, overeating and ultimately to increased fat deposition and obesity and greatly increase the risk of chronic diseases such as diabetes, myocardial infarction, and cancer. Current obesity-related costs amount to more than $100 billion per year, which represents 5% to 7% of annual health care expenditures. The authors suggest implementation of several projects that could be part of a planned national strategy to promote a healthy life style and reduce obesity. For Americans, addressing the obesity crisis will require a long-term integrated national program involving restructuring of US food production and distribution, together with major investments in social infrastructure. The authors believe that failure to act now will have devastating consequences for society much worse than the mortgage crisis.

The economic costs of diabetes: a population-based study in Tehran, Iran

The aim of the study was to determine the annual healthcare expenditures of an individual with diabetes in Tehran, between March 2004 and March 2005. This prevalence-based 'cost-of-illness' study was conducted in two phases. In the first phase, 23,707 randomly selected individuals were interviewed to gather a cohort of participants with diabetes. In the second phase, 710 diabetic patients and 904 age- and sex-matched controls were followed up for 1 year at intervals of 3 months and the direct (physician services, medications and devices, hospitalisation, laboratory, paraclinical and transport) and indirect (loss of productivity) expenditures were recorded. The excess costs of a person with diabetes were estimated through comparison with matched controls. The estimates were also extrapolated to the total population of Tehran and Iran. The costs were converted from the Iranian rial to the US dollar (exchange rate September 2004). Total annual direct costs of diabetic and control participants were $152.3 +/- 14.5 and $52.0 +/- 5.8, respectively, which is indicative of 2.92 times higher costs in diabetic patients. The most expensive components of direct costs were medications and devices, and hospitalisation in diabetic patients (28.7% and 28.6%, respectively). Total indirect costs were $39.6 +/- 2.4 and $16.7 +/- 1.1 in diabetic and non-diabetic individuals. The aggregate annual direct costs of diabetes were estimated to be $112.424 +/- 10.732 million and $590.676 +/- 65.985 million in Tehran and Iran, respectively. Diabetes complications contributed 53% of the aggregate excess direct costs of diabetes. Diabetes is an expensive medical problem in Iran and planning of national programmes for its control and prevention is necessary.

Death to sepsis: targeting apoptosis pathways in sepsis

Sepsis is a significant public health problem and is one of the leading causes of death in critically ill patients admitted to the intensive care unit. The cost, both in terms of lives lost and annual healthcare expenditures, from sepsis is staggering. Unfortunately, despite an increasing understanding of the unique molecular pathobiology of sepsis, mortality has remained more or less stable over the past decade. Moreover, promising therapies in preclinical models of sepsis have universally failed to live up to initial expectations in subsequent clinical trials. Multiple studies have demonstrated that apoptosis plays a major role in the pathobiology of sepsis and acute lung injury, making the apoptosis pathway an attractive target for therapy. Herein, the role of apoptosis in sepsis is briefly discussed, highlighting studies with one potential therapeutic agent targeting the apoptosis pathway.

A Return-on-Investment Analysis of the Health Promotion Program At the University of Minnesota

To determine the return-on-investment, if any, for the health promotion program adopted by the University of Minnesota in 2006. Regression analysis was used to determine the cost-savings in annual health care expenditures associated with three components of the program: a risk assessment, a risk management program, and a disease management (DM) program. Differences-in-differences equations with random effects were used to deal with selection bias. The analysis suggests that the DM reduced spending by about $1375 per year for each participant. The risk assessment and risk management components had no effect on spending in this initial year. DM reduced health care spending at the University of Minnesota, but not enough to generate a positive return-on-investment. A number of factors may qualify this conclusion.

Economic costs associated with type 1 diabetes

(IAsp) is a rapid-acting insulin analog developed for mealtime use. This study is intended to illustrate the implications of IAsp add-on in a real world setting for type 2 diabetic patients (T2DM) that are presently receiving basal therapy. Methods: T2DM patients having the same basal insulin with add-on IAsp were identified from a large commercial US health plan database between April 1, 2007 and September 30, 2008. Patients were required to have more than 90 days on treatment preand post-IAsp initiation. Patients with other bolus therapy were excluded. Wilcoxon signed rank test for continuous variables, McNemar’s Test for categorical variables were used to test the difference of self-comparison between before and after IAsp add on. results: A total of 1,739 patients with an average age of 56 years, were selected; 45% were female. After IAsp add-on, the percentage of patients using any OAD decreased from 64% pre-IAsp to 56% post-IAsp (P<0.001). In particular, Metformin decreased from 40% to 35%; TZDs decreased from 23% to 14%; Sulfonylureas decreased from 25% to 14%; Exenatide use decreased from 12% to 7%. All these percentage decreases were statistically significant. HbA1c decreased by 0.45% from 8.63%, pre-index, to 8.18%, post-index (p=0.002). With good glycemic control, total annual health care expenditures were statistically significantly lower after IAsp add-on compared to the preIAsp period ($44,304 vs $42,021; p=0.001). conclusion: With IAsp add-on to T2DM patients’ basal insulin regimen, fewer patients needed OADs and better glycemic control was achieved. Furthermore, patients on average experienced reduced health care utilization after IAsp add-on, which resulted in a significant cost saving for the health care payer.

A Modified No-fault Malpractice System Can Resolve Multiple Healthcare System Deficiencies

Medical professional liability in the United States, as measured by total premiums paid by physicians and healthcare facilities, costs approximately $30 billion a year in direct expenses, less than 2% of the entire annual healthcare expenditures. Only a fraction of those dollars reach patients who are negligently injured. Nonetheless, the tort system has far-reaching effects that create substantial indirect costs. Medical malpractice litigation is pervasive and physicians practice defensively to avoid being named in a suit. Those extra expenditures provide little value to patients. Despite an elaborate existing tort system, patient safety remains a vexing problem. Many injured patients are denied access to timely, reasonable remedies. We propose a no-fault system supplemented by a variation of the traditional tort system whereby physicians are incentivized to follow evidence-based guidelines. The proposed system would guarantee a substantial decrease in, but not elimination of, litigation. The system would lower professional liability premiums. Injured patients would ordinarily be compensated with no-fault disability and life insurance proceeds. To the extent individual physicians pose a recurrent danger, their care would be reviewed on an administrative level. Savings would be invested in health information technology and purchase of insurance coverage for the uninsured. We propose a financial model based on publicly accessible sources.

Implementation of a hospital-based wellness programme: Do cash incentives promote healthier behaviour?

In 2004, the Florida Hospital Zephyrhills developed an employee-based, volunteer programme known as the Lifestyle Incentives For Employees (LIFE) Plan to encourage weight management, exercise and cessation of tobacco use. The purpose of this study is to: (a) compare the health expenditure costs of 41 employees with continuous enrolment in the LIFE Plan and 32 employees who never enrolled in the LIFE Plan; and (b) describe the Wellsource Personal Wellness Profile data of the 620 LIFE Plan members since the inception of the programme, with emphasis on chronic medical conditions affecting number of sick days and hospital days. The data show a downward trend in the annual healthcare expenditures for LIFE Plan members. For the most commonly reported medical conditions from the profile data, individuals with hypertension, arthritis, back pain and joint pain have more sick days and more hospital days than individuals without these medical conditions. The LIFE Plan shows the possibility of reducing high health insurance costs using an employee-based health programme. By incorporating clear worksite health education messages to encourage behaviour changes that remedy chronic conditions, the longitudinal results are expected to contribute to greater cost reductions in the future.

Healthcare expenditures and patient satisfaction: cost and quality from the consumer's perspective in the US

ABSTRACTBackground: Both cost and quality of healthcare are major concerns in the United States. Using patient satisfaction as a quality indicator, we seek to identify the relationship between healthcare cost and quality from the perspective of the community-dwelling population in the United States.Methods: We examined a nationally representative sample of 13 980 adults (age ≥ 18 years) in the 2003 Medical Expenditure Panel Survey (MEPS). Given the idiosyncrasies of the cost data distribution, a recently developed extended estimating equation (EEE) model was employed to identify the relationship between patient satisfaction and healthcare expenditure, after controlling for individual demographic covariates, co-morbidity profile, and functional and activity limitations. A series of sensitivity analyses were conducted, in addition, to verify the identified relationship. All statistics were adjusted using the proper sampling weight from the MEPS data.Results: Average annual healthcare expenditures for 2003 ranged between $3923 and $6073 when grouped by patient satisfaction ratings with a mean value $4779 for all individuals who rated perceived satisfaction of their healthcare. We found that there is no statistically signif­icant relationship between patient satisfaction and total healthcare expenditure ( p = 0.60) and a non-monotonic relationship is not identified either. All sensitivity analyses results revealed a lack of relationship between patient satisfaction and healthcare expenditures.Limitations: Patient satisfaction might not reflect the quality of healthcare from an objective clinical standpoint. The identified cost–satisfaction relationship may not be extrapolated to other quality indicators. Due to the cross-sectional study design, no causal relationship could be inferred between patient satisfaction and healthcare expenditure.Conclusions: Our study adds to the literature on health­care cost and quality by suggesting that the improvement of patient satisfaction may not require additional health­care spending.

Theme Issue on Health of the Nation

A 232-YEAR-OLD “PATIENT” 1 HAS BEEN EXPERIENCing acute and chronic systemic health problems. Despite the concerted efforts of dedicated and superb physicians, the availability of state-of-theart medical treatments and technological advances, and trillions of dollars in annual health care expenditures, major aspects of the health, well-being, and prognosis for this complex “patient”—ie, the United States and its health care system—are, at best, less than optimal. For example, the United States ranks below several other industrialized nations in terms of several key health care indicators, such as life expectancy, infant mortality, and rates of obesity. Despite the world’s highest per capita health expenditures, the numbers of uninsured and underinsured continue to increase and are at an all-time high. Health care costs continue to escalate, threatening the long-term viability of government-based insurance systems such as Medicare and Medicaid and of some employer-based private health insurance. Moreover, the nation’s health care system is fragmented and difficult to negotiate, creating frustration for physicians and patients, as well as challenges for improving quality and efficiency in the delivery of medical care. Perhaps because these serious symptoms and signs affecting the nation’s health have continued to intensify and increase, health care has emerged as one of the leading domestic issues in the current US presidential campaign. In the past, suggested solutions have failed because they could not muster the necessary broad-based political support. While many of the current presidential candidates have (as in past presidential campaigns) put forth their plans, proposals, and promises, none of the proffered solutions, at least thus far, appears to have the degree of diagnostic precision nor the specific prescription necessary for improving the nation’s health in an effective, meaningful, and sustainable way. To focus additional attention on and continue the momentum of interest in this pressing topic, JAMA will publish a theme issue devoted to the “Health of the Nation” in October 2008. We invite authors to submit manuscripts on virtually any topic relevant to the issue of the nation’s health. High-quality original research papers that present new scientific information and solid data will receive highest priority. Potential topics include documentation of health status and understanding the health consequences and implications of inadequate care and underinsurance; evidence-based manuscripts that provide evidence for or propose rational steps toward finding solutions to improving the nation’s health care; analyses of factors influencing the composition of the nation’s health care workforce, including potential implications for improving health care delivery; rigorous econometric analyses that consider the financial ramifications of workable approaches to health system reform and systemwide economic solutions; and studies thatprovidecomparativeanalyses for improvingnationalhealth based on experience and perspectives from health systems in other countries. Systematic reviews and scholarly commentaries on these and other topics relevant to reforming health care and improving the nation’s health also will receive careful consideration. In addition, as in previous election years, we plan to invite the major presidential candidates to describe their specific plans for improving the nation’s health. Authors are encouraged to consult the Instructions for Authors for guidelines on manuscript preparation and submission. All submitted manuscripts will undergo JAMA’s usual rigorous editorial evaluation and review. Manuscripts received by June 1, 2008, will have the best chance of consideration for inclusion in the Health of the Nation theme issue of JAMA. We look forward to receiving manuscripts for this theme issue, with the hope that information in this issue will contribute to a more accurate “diagnosis,” will provide viable ideas and suggestions for effective “treatments,” and will help improve the short-term and longterm prognosis for the Health of the Nation.

Smoking in the home and children’s health

Objectives:We estimate for young children the annual excess health service use, healthcare expenditures, and disability bed days for respiratory conditions associated with exposure to smoking in the home in the...

Changes in Health Care Expenditure Associated with Gaining or Losing Health Insurance

Cross-sectional data suggest that changes in health insurance status are associated with expenditures. No national longitudinal analysis has examined this relationship. To evaluate the association between changes in health insurance status and expenditures. Cohort analyses using the 2000 to 2003 Medical Expenditure Panel Surveys. U.S. civilian noninstitutionalized population. Three 2-year cohorts that included 20,848 adults age 21 to 64 years who were stratified by insurance type (private, public, military, or none): 17,130 participants were insured in both years, 342 participants were insured in year 1 and were uninsured in year 2, 385 participants were uninsured in year 1 and were insured in year 2, and 2991 participants were uninsured in both years. Persons who were insured for longer than 2 months but less than 10 months or who switched insurance type were excluded (n = 4039). Annual health care expenditures (any or none; amount, contingent on any expenditure; and the difference between year 1 and year 2). Adjusted expenditure probabilities were similar among all participant groups while insured and were higher than those for all participant groups while uninsured: 92.1% (95% CI, 91.4% to 92.7%) in year 1 and 91.8% (CI, 90.9% to 92.5%) in year 2 for persons insured in both years, 74.2% (CI, 71.7% to 76.5%) in year 1 and 74.8% (CI, 72.1% to 77.4%) in year 2 for persons uninsured in both years, and 90.7% (CI, 87.1% to 93.4%) for persons insured in year 1 and 74.6% (CI, 69.4% to 79.2%) for persons uninsured in year 2. The pattern was also consistent for the group that was uninsured in year 1 but insured in year 2. Adjusted annual expenditures among all participant groups with insurance were similar; expenditures among participant groups without insurance were similar but were lower than those among participants with insurance. Consistent differences in expenditures between year 1 and year 2 were observed for all groups. Few participants changed insurance status. Changing insurance status is associated with changes in expenditures to levels that are similar to those for persons who are continuously insured or uninsured.

Potentially Inappropriate Medication Use and Healthcare Expenditures in the US Community-Dwelling Elderly

Potentially inappropriate medication (PIM) use is a major source of drug-related problems in the elderly. Few studies have quantified the effect of PIM use on total healthcare expenditures in the United States. : We sought to determine the relationship between PIM use and healthcare expenditure and to estimate the annual incremental healthcare expenditures related to PIM use in the community-dwelling elderly population in the United States in 2001. This was a retrospective cohort study. Participants were age 65 years or older who had no PIM use in rounds 1 and 2 of the 2000-2001 Medical Expenditure Panel Survey, a nationally representative survey of the US noninstitutionalized population. On the basis of the 2002 Beers criteria, PIM users were identified as those who had been prescribed at least one PIM during specified time periods in the study. Propensity scores were used to match PIM users and nonusers in the analysis examining differences in total healthcare expenditures. PIM utilization is a significant predictor for higher healthcare expenditures (P < 0.05). A conservative estimate of the incremental healthcare expenditures related to PIM use in the community-dwelling elderly population would be $7.2 billion (95% confidence interval, $3.4 billion-$15.7 billion) in the United States in 2001. PIM use is a major patient safety concern that results in increased healthcare expenditures. This study emphasizes the need for continued provider education to inform prescribers of the potential risks of using certain medications in the elderly and to improve prescribing practices.

The cost of being a woman: A National Study of Health Care Utilization and Expenditures for Female-Specific Conditions

An important component of women's health care is for conditions that are exclusive to women, yet little research has addressed the economic impact of health care for these conditions. The purpose of this study was to describe health care utilization for female-specific conditions, the incremental expenditures attributable to these conditions, and the overall incremental expenditures across the lifespan. We analyzed 3 years of a nationally representative survey of the US noninstitutionalized population, the 2000-2002 National Medical Expenditure Panel Survey, which included 25,361 females aged > or =14, representing 38,170 person-years. More than one fifth of women (21.2%) reported having a female-specific condition during a 1-year period, the most common of which were gynecologic disorders (7.4%); pregnancy-related conditions (6.4%); and menopausal symptoms (5.3%). The mean increment in annual total expenditures attributable to female-specific conditions ranged from $483 for menopausal disorders to $3,896 for female cancers. The annual total health care expenditures of women with female-specific conditions were estimated to be $108 billion, of which >40% ($43.3 billion) was attributable to female-specific conditions. Women with female-specific conditions who had no health insurance were less likely to have visited a doctor (p = .0002), filled a prescription (p = .001), and been hospitalized (p = .0001) for these conditions, but more likely to have visited an emergency department (p = .02) seeking treatment for these conditions. In this nationally representative sample of American women aged > or =14, female-specific conditions were common and substantially increased costs of health care.

Patient Safety in the Office-Based Setting

After studying this article, the participant should be able to: 1. Discern the importance of the physician's office administrative capacity. 2. Recognize the necessity of a system for quality assessment. 3. Assess which procedures are safe in the office-based setting. 4. Know the basic steps to properly evaluate patients for office-based plastic surgery. At least 44,000 Americans die annually as a result of preventable medical errors. Medical mistakes are the eighth leading cause of death in the United States, costing between $54.6 billion and $79 billion, or 6 percent of total annual national health care expenditures. Office-based procedures comprise a 10-fold increase in risk for serious injury or death as compared with an ambulatory surgical facility. This article reviews the literature on office-based patient safety issues. It places special emphasis on the statements and advisories published by the American Society of Plastic Surgeons' convened Task Force on Patient Safety in Office-Based Settings. This article stresses areas of increased patient safety concern, such as deep vein thrombosis prophylaxis and liposuction surgery. The article divides patient safety in health care delivery into three broad categories. First, patient safety starts with emphasis at the administrative level. The physician or independent governing body must develop a system of quality assessment that functions to minimize preventable errors and report outcomes and errors. Second, the clinical aspects of patient safety require that the physician evaluate whether the procedure(s) and the patient are proper for the office setting. Finally, this article gives special attention to liposuction, the most frequently performed office-based plastic surgery procedure. Patient safety must be every physician's highest priority, as reflected in the Hippocratic Oath: primum non nocere ("first, do no harm"). In the office setting, this priority requires both administrative and clinical emphasis. The physician who gives the healing touch of quality care must always have patient safety as the foremost priority.

(717): Healthcare expenditures in patients with herpes zoster pain and postherpetic neuralgia

Because existing data on medical costs associated with acute and persisting pain associated with herpes zoster are limited, healthcare expenditures were estimated in patients covered by commercial, Medicare, and Medicaid insurance. The MEDSTAT Group’s Marketscan Databases, composed of medical, pharmacy, and enrollment information, were used. Patients were included if they had evidence of a claim with a primary diagnosis of herpes zoster accompanied by a pain medication prescription or with a primary diagnosis of postherpetic neuralgia (PHN). The index date was first evidence of such a claim from 7/1/2001-12/31/2003. Patient demographics and healthcare expenditures were measured in the 6 months prior to the index date and the following 12 months for the commercial and Medicare cohorts; for the Medicaid cohort, follow-up was only 6 months because data were limited. A propensity score model was used to match controls to each insured cohort, controlling for differences in patient demographics (age, gender, location, insurance type, index year) and health status (Charlson Comorbidity Index, psychiatric diagnostic groups). A total of 1,032 commercial, 811 Medicare, and 604 Medicaid patients with herpes zoster pain or PHN were studied. Prior to matching, the cohorts and controls were significantly different in terms of demographics and health status. After matching, patient demographics were similar, but the health status of the cohorts was still significantly different, with the pain cohorts having greater comorbidities. The difference in average annual healthcare expenditures between the pain cohorts and their matched controls were $4,916 (p<0.01) in a commercial population, $2,695 (p<0.01) in a Medicare population, and $9,312 (p<0.01) in a Medicaid population. The additional healthcare expenditures associated with herpes zoster pain and PHN are considerable, averaging between $2,695 and $9,312 per year per patient depending on the population. Sponsored by grants from Endo Pharmaceuticals to The MEDSTAT Group and the University of Rochester. Because existing data on medical costs associated with acute and persisting pain associated with herpes zoster are limited, healthcare expenditures were estimated in patients covered by commercial, Medicare, and Medicaid insurance. The MEDSTAT Group’s Marketscan Databases, composed of medical, pharmacy, and enrollment information, were used. Patients were included if they had evidence of a claim with a primary diagnosis of herpes zoster accompanied by a pain medication prescription or with a primary diagnosis of postherpetic neuralgia (PHN). The index date was first evidence of such a claim from 7/1/2001-12/31/2003. Patient demographics and healthcare expenditures were measured in the 6 months prior to the index date and the following 12 months for the commercial and Medicare cohorts; for the Medicaid cohort, follow-up was only 6 months because data were limited. A propensity score model was used to match controls to each insured cohort, controlling for differences in patient demographics (age, gender, location, insurance type, index year) and health status (Charlson Comorbidity Index, psychiatric diagnostic groups). A total of 1,032 commercial, 811 Medicare, and 604 Medicaid patients with herpes zoster pain or PHN were studied. Prior to matching, the cohorts and controls were significantly different in terms of demographics and health status. After matching, patient demographics were similar, but the health status of the cohorts was still significantly different, with the pain cohorts having greater comorbidities. The difference in average annual healthcare expenditures between the pain cohorts and their matched controls were $4,916 (p<0.01) in a commercial population, $2,695 (p<0.01) in a Medicare population, and $9,312 (p<0.01) in a Medicaid population. The additional healthcare expenditures associated with herpes zoster pain and PHN are considerable, averaging between $2,695 and $9,312 per year per patient depending on the population. Sponsored by grants from Endo Pharmaceuticals to The MEDSTAT Group and the University of Rochester.

Prevalence, Correlates, and Costs of Patients With Poor Adjustment to Mixed Cancers

Approximately 2% to 3% of the Canadian society has experienced cancer. Literature indicates that there is poor adjustment to chronic illness. Individuals with poor adjustment to chronic illness have been found to disproportionately use more health services. The purpose of this study was to determine the prevalence, correlates, and costs associated with poor adjustment to mixed cancer. A consecutive sample (n = 171) of breast, lung, and prostate cancer patients at the Nova Scotia Regional Cancer Center were surveyed. Twenty-eight percent of the cancer group showed fair to poor adjustment to illness using the Psychological Adjustment to Illness Self-report Scale Psychological Adjustment to Illness Self-Report Scale raw score. Poor adjustment was moderately correlated with depression (r = 0.50, P < .0001) and evasive coping (r = 0.38, P < .0001) and unrelated to demographic variables. Depression explained 25% of the variance in poor adjustment to illness in regression analysis. Cancer patients with fair to poor adjustment to illness had statistically significantly higher annual healthcare expenditures (P < .002) than those with good adjustment to illness. Expenditure findings agree with previous literature on chronic illnesses. The prevalence of fair to poor adjustment in this cancer population using the Psychological Adjustment to Illness Self-Report Scale measure is similar to that reported for chronic illness to date, suggesting that only those with better adjustment consented to this study.

P132. Comparison of two level circumferential fusion vs. ProDisc-L

and 1.5 deg of intervertebral rotation at the fusion site. CONCLUSIONS: Flexion-extension studies of the spine are very common, and the associated annual healthcare expenditure is substantial. More importantly, the flexion-extension studies are presumably ordered to obtain important diagnostic information about abnormal intervertebral motion. Lastly, consistent agreement is important to be able to accurately report and compare research findings, and to develop effective treatment guidelines that use intervertebral motion assessments. The results of this study suggest that current, commonly used methods to clinically assess flexion-extension X-rays of the cervical spine do not provide reliable clinical information about intervertebral motion abnormalities. The current study further suggests that validated, computer-assisted methods to quantify intervertebral motion can dramatically improve agreement between observers when assessing flexion-extension X-rays of the cervical spine. DISCLOSURES: FDA device/drug: KIMAX QMA Image Analysis Software. Status: Approved for this indication. CONFLICT OF INTEREST: Author (JH) Grant Research Support: NIH 2 R44 NS45493.

UROLOGIC DISEASES IN AMERICA PROJECT: TRENDS IN RESOURCE USE FOR URINARY TRACT INFECTIONS IN MEN

Various types of urinary tract infection (UTI) occur in men. In this study we examined health care use trends, including epidemiological and economic factors, for UTI in men in the United States. The analytical methods used to generate these results have been described previously. Approximately 20% of all UTIs occur in men. Between 1988 and 1994 the overall lifetime prevalence of UTI was estimated to be 13,689/100,000 men. Orchitis rates, particularly in older men, are generally higher than those of cystitis or pyelonephritis. Approximately 10% of all inpatient care of men with UTI is for orchitis (12 to 14/100,000 population). Rates of outpatient hospital and physician office care for male UTI have increased in the last decade. Rates for emergency room care for UTI in elderly men (85 to 94 years old) were almost twice those in men younger than 85 years. The adjusted mean health care expenditure for privately insured men with UTI was 5,544 dollars in 1999 compared to 2,715 dollars for men without UTI. Total annual health care expenditures for men and women with UTI were 5,544 dollars and 5,407 dollars, respectively. Mean time lost from work was slightly higher for men. Based on composite data overall medical expenditures for men with UTI in the United States were estimated to be approximately 1.028 billion dollars in 2000. Health care use and economic data on UTIs in men revealed a number of intriguing trends. These results raise various important questions for future research.

Health Care Expenditures Associated With Overweight and Obesity Among US Adults: Importance of Age and Race

We estimated health care expenditures associated with overweight and obesity and examined the influence of age, race, and gender. Using 1998 Medical Expenditure Panel Survey data, we employed 2-stage modeling to estimate annual health care expenditures associated with high body mass index (BMI) and examine interactions between demographic factors and BMI. Overall, the mean per capita annual health care expenditure (converted to December 2003 dollars) was $3338 before adjustment. While the adjusted expenditure was $2127 (90% confidence interval [CI]=$1927, $2362) for a typical normal-weight White woman aged 35 to 44 years, expenditures were $2358 (90% CI=$2128, $2604) for women with BMIs of 25 to 29.9 kg/m(2), $2873 (90% CI=$2530, $3236) for women with BMIs of 30 to 34.9 kg/m(2), $3058 (90% CI=$2529, $3630) for women with BMIs of 35 to 39.9 kg/m(2), and $3506 (90% CI=$2912, $4228) for women with BMIs of 40 kg/m(2) or higher. Expenditures related to higher BMI rose dramatically among White and older adults but not among Blacks or those younger than 35 years. We found no interaction between BMI and gender. Health care costs associated with overweight and obesity are substantial and vary according to race and age.

Utilization and Medical Care Expenditures in Patients with Chronic Obstructive Pulmonary Disease

Objective To estimate annual healthcare utilization and expenditures for patients with chronic obstructive pulmonary disease (COPD) versus those without COPD, and to determine the attributable costs of treating the complications of COPD.