Average Total Direct Cost Research Articles

Direct cost analysis of the second year post-allogeneic hematopoietic stem cell transplantation in the Bone Marrow Transplant Centre of Tunisia

ABSTRACTBackground: Hematopoietic stem cell transplantation (HSCT) is a medically complicated therapy with a long recovery time. In Tunisia, the National Health Insurance Fund (CNAM) covers only the first year post-transplantation, after which the costs are borne by the hospital.Objective: Describe complications that can occur during the second year post-allogeneic HSCT and calculate direct costs in different groups of patients.Methods: In this pharmacoeconomic study, medical records of the second year post-allogeneic HSCT were collected. Studied variables included frequent observed complications and medical and non-medical direct costs.Results: The average total direct cost in the population during the second year post-transplantation was $11,571, 97% of which represents direct medical costs Drugs accounted for the largest share (80%) of total direct costs, dominated by the cost of antifungals (52%) and antivirals (26%) drug . Cytomegalovirus status was seen in 9.3% of patients and was associated with a seven-fold increase in direct costs (p < 0.001).​​In patients who developed chronic GVHD, the average direct cost was three times higher than for those who did not (p = 0.032).Conclusion: Given the importance of direct costs in the post-transplantation period a review of the hospital financing mechanism and a new convention with the CNAM is crucial.​​

The direct and indirect costs associated with food hypersensitivity in households: A study in the Netherlands, Poland, and Spain

Background: Recent studies show that food hypersensitivity, such as food allergy or food intolerance, has the potential to affect direct, indirect and intangible economic costs experienced by individuals and their families. This research assesses the direct and indirect economic costs of food hypersensitivity at the household level in the Netherlands, Poland, and Spain. Methods: A self-administered postal survey was conducted (n=1558). Respondents with food hypersensitivity were clinically diagnosed cases recruited through clinical centres in Poland and Spain. In the Netherlands, food hypersensitivity cases were recruited through hospitals, patient organisations and advertisements. The controls formed the baseline sample and were obtained from households in which none of the members had food hypersensitivity. The monetary value of indirect costs, forgone time, was calculated using the opportunity cost method. The indirect and direct costs were expressed in purchasing power parity. Analysis of co-variance on the cost items was used to test the within-country differences between respondents with food hypersensitivity and respondents without food hypersensitivity, as well as across the three countries. Results: The average total direct and indirect costs across all countries for families with food hypersensitive family members are not higher than for households without food hypersensitive members. However, the intangible costs for food hypersensitive individuals appear to be higher than for individuals in the control group.Conclusions: These results do not support the hypothesis that all food allergies incur high costs to the individual. However, being hypersensitive to foods may have a negative impact on quality of life compared to people who are not food hypersensitive.

Cost analysis of multiple sclerosis in Brazil: a cross-sectional multicenter study.

BackgroundMultiple sclerosis (MS) is a central nervous system disease associated with irreversible progression of disability, which imposes a substantial socioeconomic onus. The objective of this study was to determine the economic impact of multiple sclerosis from the Brazilian household and healthcare system perspectives. Secondary objectives were to assess the impact of fatigue on daily living and health-related quality of life (HRQL) of MS patients.MethodsThis is a cross-sectional study in which Brazilian eligible patients attending eight major MS specialized sites answered an interview capturing data on demographics, disease characteristics and severity, comorbidities, resource utilization, fatigue, utilities and health-related quality of life from November/2011 to May/2012 . Costs were assessed considering a prevalence-based approach within 1 year of resource consumption and were estimated by multiplying the amount used by the corresponding unit cost. Patients were classified as having mild, moderate or severe disability according to the Expanded Disability Status Scale (EDSS).ResultsIn total, 210 patients who met eligibility criteria were included, 40 % had mild, 43 % moderate and 16 % severe disability; disability level was missing for 1 %. The average total direct cost per year was USD 19,012.32 (SD = 10,465.96), and no statistically significant differences were not observed according to MS disability level (p = 0.398). The use of disease modifying therapies (DMTs) corresponded to the majority of direct expenditures, especially among those patients with lower levels of disability, representing around 90 % of total costs for mild and moderate MS patients. It was also observed that expenses with medical (except DMTs) and non-medical resources are higher among patients with more severe disease. Worsening disability also had an important influence on health-related quality of life and self-perceived impact of fatigue on daily living.ConclusionOur data demonstrates the significant economic impact of MS on both Brazilian household and health system, in terms of DMTs and other disease management costs. When patients move upwards on the disease severity scale, costs with health resources other than drugs are significantly increased.

Prescription patterns and cost of illness in asthma and chronic obstructive pulmonary disease patients

Background: Although economic burden data of chronic obstructive pulmonary disease (COPD) and asthma for various countries are available, data among Indian population are unavailable. Thus, the aim of this study was to measure the prescription pattern and cost of illness (COI) of asthma and COPD patients. Methods: This prospective, observational, bottom-up study collected economic, diagnostic, and therapeutic data from 150 COPD and asthma patients. The study was carried out for an 8-month period at Princess Esra Hospital, a Unit of Owaisi Group of Hospitals, located at Shalibanda, Hyderabad, Telangana, India. Results: Societal perspective was used to account for both direct and indirect costs. Asthma and COPD account for Rs. 12,852 and Rs. 16,514 in annual direct costs per patient per year. Inpatient cost was considerably higher than the outpatient cost. Hospitalization costs ranked first in direct costs followed by laboratory examination and medication costs. Average annual total direct cost per patient for COPD (Rs. 5000–25,000) was considerably higher than asthma (Rs. 1000–20,000). Antibiotics, mucolytics, short-acting beta-2 agonists, long-acting beta-2 agonists, long-acting muscarinic antagonists, leukotriene receptor antagonists, corticosteroids, antihistamines, and methylxanthines were the common categories of drugs prescribed for the two disorders. Conclusion: In summary, we found that COI for asthma and COPD are substantial. Hospitalization and medication costs can be reduced by implementing preventive strategies including but not limited to home care services, rehabilitation therapies, smoking cessation programs, medication assessment, and patient compliance programs. Future researchers should examine the treatment strategies and interventions that may help to reduce the burden of COPD and asthma. The following core competencies are addressed in this article: Patient care, practice-based learning and improvement, systems-based practice.

A drug utilization and pharmacoeconomic study of anti-diabetic drugs prescribed to type 2 diabetes mellitus patients visiting the medicine out-patient department of a tertiary care hospital of north India

Background: Type 2 diabetes mellitus (T2DM) patients require anti-diabetic drugs on chronic basis, frequent monitoring of blood glucose levels and a number of laboratory investigations, all of which result in significant economic burden on the diabetes patients and the world economies. The purpose of this study was to analyse the prescribing pattern to highlight the current approaches to the rational use of anti-diabetic drugs in T2DM patients visiting the medicine out-patient department, and to calculate the economic burden of different anti-diabetic therapies prescribed to patients with T2DM in a tertiary care hospital of north India. Methods: This prospective study included T2DM patients visiting the out-patient department of medicine of a tertiary care hospital of Uttarakhand, India. Prescriptions of patients diagnosed as cases of T2DM were analysed as per the WHO drug use indicators. For pharmacoeconomic evaluation, the cost variation of different anti-diabetic therapies was compared using the cost-effectiveness analysis method. Results: 273 prescriptions from 148 men and 125 women were analysed. 805 drugs were prescribed to the patients with an average of 2.95 per encounter: 494 anti-diabetic drugs with an average of 1.81 drugs per patient, and 311 for co-morbid conditions. Of the 494 anti-diabetic drugs, 75.1% were oral anti-diabetic (OAD) agents and 24.9% were insulin’s. Metformin (209) and insulin aspart (42) were the most prescribed OAD and insulin, respectively. The pharmacoeconomic analysis included 138 patients. The cost per unit (1 mg/dl) reduction in fasting blood glucose was lowest with glipizide and metformin combination (INR 10.46) and highest with insulin degludec and insulin aspart combination (INR 217.38). The average total direct cost of therapy for two months was INR 2244.39 ± 2745.05 (INR 362.88 to INR 10806). 86.63% of the average total direct cost of therapy was attributed to anti-diabetic agents. Conclusions: Metformin was the most common OAD agent and insulin aspart was the most common injectable anti-diabetic drug prescribed in patients with T2DM. The newer anti-diabetic drugs sitagliptin and newer insulin analogues were also prescribed to a great extent. Overall, the prescribing trend was rational to a great extent and had improved since the earlier study in the same institute. The most cost-effective anti-diabetic therapy was combination therapy of glipizide and metformin. The cost of diabetes management is high, especially for insulin therapy.

In-Patient Trends and Complications After Total Ankle Arthroplasty in the United States

The number of total ankle arthroplasties (TAAs) performed annually in the United States has increased. The purpose of this study was to evaluate the in-patient demographics, complications, and readmission rates of patients after TAA at academic medical centers in the United States. The University HealthSystems Consortium administrative database was searched for patients who underwent TAA in 2007 to 2011. A descriptive analysis of demographics was performed, followed by a similar analysis of clinical benchmarks, including hospital length of stay, hospital direct cost, in-hospital mortality, and 30-day readmission rates. The study included 2340 adult patients with a mean age of 62 years (47% men and 53% women) who underwent TAA. The majority of patients were Caucasian (2073; 88.5%). Average hospital length of stay was 2.2±1.26 days. Average total direct cost for the hospital was $16,212±7000 per case, with 49.7% of patients having private insurance. In-hospital mortality was less than 1%, and overall complications were 1.4%. Complications after discharge included deep venous thrombosis (2.3%), reoperation (0.7%), and infection (3.2%). A readmission rate of 2.7% within the first 30 days from the time of discharge occurred. Total ankle arthroplasty in the United States is a relatively safe procedure with low overall complication rates. Patients who are male, have a history of community-acquired pneumonia, and have a larger number of preoperative comorbidities had a significant increased risk of developing 1 complication within 30 days of surgery.

Cost-Effectiveness of Laparoscopic Hysterectomy With Morcellation Compared With Abdominal Hysterectomy for Presumed Myomas

Study ObjectiveHysterectomy for presumed leiomyomata is 1 of the most common surgical procedures performed in nonpregnant women in the United States. Laparoscopic hysterectomy (LH) with morcellation is an appealing alternative to abdominal hysterectomy (AH) but may result in dissemination of malignant cells and worse outcomes in the setting of an occult leiomyosarcoma (LMS). We sought to evaluate the cost-effectiveness of LH versus AH. DesignDecision-analytic model of 100 000 women in the United States assessing the incremental cost-effectiveness ratio (ICER) in dollars per quality-adjusted life-year (QALY) gained (Canadian Task Force classification III). SettingU.S. hospitals. PatientsAdult premenopausal women undergoing LH or AH for presumed benign leiomyomata. InterventionsWe developed a decision-analytic model from a provider perspective across 5 years, comparing the cost-effectiveness of LH to AH in terms of dollar (2014 US dollars) per QALY gained. The model included average total direct medical costs and utilities associated with the procedures, complications, and clinical outcomes. Baseline estimates and ranges for cost and probability data were drawn from the existing literature. Measurements and Main ResultsEstimated overall deaths were lower in LH versus AH (98 vs 103). Death due to LMS was more common in LH versus AH (86 vs 71). Base-case assumptions estimated that average per person costs were lower in LH versus AH, with a savings of $2193 ($24 181 vs $26 374). Over 5 years, women in the LH group experienced 4.99 QALY versus women in the AH group with 4.91 QALY (incremental gain of .085 QALYs). LH dominated AH in base-case estimates: LH was both less expensive and yielded greater QALY gains. The ICER was sensitive to operative costs for LH and AH. Varying operative costs of AH yielded an ICER of $87 651/QALY gained (minimum) to AH being dominated (maximum). Probabilistic sensitivity analyses, in which all input parameters and costs were varied simultaneously, demonstrated a relatively robust model. The AH approach was dominated 68.9% of the time; 17.4% of simulations fell above the willingness-to-pay threshold of $50 000/QALY gained. ConclusionWhen considering total direct hospital costs, complications, and morbidity, LH was less costly and yielded more QALYs gained versus AH. Driven by the rarity of occult LMS and the reduced incidence of intra- and postoperative complications, LH with morcellation may be a more cost-effective and less invasive alternative to AH and should remain an option for women needing hysterectomy for leiomyomata.

Costs of admissions for cocaine/crack abuse: comparing general hospital and psychiatric hospital settings

Introduction: The current Brazilian model for the assistance of drug dependents does not differentiate admissions in psychiatric or general hospitals. There is no information on the distinct costs of those two modes of hospitalization. Aim: To compare the estimated costs of hospitalization for cocaine/ crack dependence in a psychiatric hospital and in a general hospital, in the context of public health care in the state of Minas Gerais, Brazil. Methods: Estimates of the daily average total direct costs of admissions for cocaine/crack dependence, using the method of activity based costs, in a public psychiatric hospital and in a public general hospital, in Minas Gerais, Brazil. Results: The average daily cost of hospitalization in a psychiatric hospital was estimated at R$ 368.65, and in a general hospital, at R$ 484.52, a difference of 31.4%. This difference was primarily due to staffing and services related costs. Conclusion: The costs of hospitalization for cocaine/crack dependence are higher in the general hospital than in the psychiatric hospital, in the context of public healthcare in Minas Gerais, Brazil.

Real-world comparative economics of a 12-gene assay for prognosis in stage II colon cancer.

3640 Background: Prior economic analysis of a 12-gene assay (Oncotype DX), compared with patterns of care reported in the NCCN database of patients with stage II, T3, DNA mismatch repair proficient (MMR-P) colon cancer, predicted that the assay would save medical costs and improve patient well-being (Hornberger et al. Value Health 2012). This study assessed the validity of those findings with actual adjuvant chemotherapy (aCT) recommendations. Methods: Outcomes and costs were estimated for patients with stage II, T3, MMR-P colon cancer using a Markov model. A study of 141 patients from 17 sites in the Mayo Clinic Cancer Research Consortium collected data on aCT recommended before and after knowledge of the 12-gene assay results (Srivastava et al. abstract). Quality-adjusted life years (QALY) and medical resource use after recurrence were computed using guideline-validated state-transition probability estimation methods. Risk of progression and incidence of adverse events with different aCT regimens were based on published literature. Drug and administration costs for aCT were obtained from 2012 Medicare fee schedules. One-way sensitivity analyses were conducted to evaluate parameter influence on economic impact. Results: After receiving the 12-gene assay results, physician recommendations in favor of aCT decreased 22% (95% CI 11%-32%; McNemar test p&lt;0.001) from 73 (52%) to 42 (30%) patients. Oxaliplatin aCT and 5-FU monotherapy recommendations each declined 11%. Average aCT costs decreased $3,228 for drugs, $750 for administration, and $3,168 for adverse events management. Overall, average total direct medical costs decreased $1,683. The net effect on average patient well-being was a gain of 0.102 QALYs. Total change in medical costs is most influenced by the cost of death due to colon cancer, time-preference discount rate, and the change in aCT recommendations. Savings are expected to persist even if the cost of oxaliplatin dropped by &gt;75% due to generic substitution. Conclusions: The 12-gene assayhas been shown to alter aCT recommendations for patients with stage II, T3, MMR-P colon cancer. This study provides real-world confirmation that these aCT changes reduce direct medical costs and improve patient well-being.

Direct cost and predictive factors for treatment in patients with ocular hypertension or early, moderate and advanced primary open-angle glaucoma: the CoGIS study in Germany

The main objectives of this analysis were to assess the treatment costs and to identify major cost drivers and factors predicting direct costs in German patients with ocular hypertension (OHT) or primary open-angle glaucoma (POAG). This non-interventional cross-sectional study was conducted in two university hospitals and 13 ophthalmology practices in Germany regions (Bavaria, Rhineland-Palatinate, North Rhine-Westphalia, Hamburg and Mecklenburg-Western Pomerania) between May 2009 and January 2010 to assess resource utilisation in patients with OHT (ICD-10: 40.0) or POAG (ICD-10: 40.1) at early, moderate or advanced stages, according to the European Glaucoma Society classification Guidelines. Treatment patterns and direct costs were evaluated retrospectively for 5 years. Resource utilisation data (medication, hospitalisation, outpatient surgery, visits to ophthalmologists) were abstracted from the charts, and unit costs were applied to estimate direct costs per year (in Euros, 2009), calculated from the perspective of the statutory health insurance in Germany (Gesetzliche Krankenversicherung). Factors predicting costs were assessed in multivariate regression analysis. One hundred and fifty-four patients (17.5% OHT, 27.9% early, 22.7% moderate, and 31.8% advanced POAG), on average 67 years old (SD 11) were included in the study. Average total annual direct costs per patient for OHT were <euro>226 (SD 117), for early POAG <euro>423 (SD 647), moderate <euro>493 (SD 385) and advanced POAG <euro>809 (SD 877). Glaucoma-related medications and hospitalisation represented the two major components of direct costs, increasing with the progression of glaucoma. In addition to treatment switches (p = 0.0001), factors predictive of an increase in total direct costs included the number of hospital interventions (p < 0.0001), disease-state changes since the start of treatment (p = 0.05), and current disease state (p = 0.05). Direct costs of treatment are higher in glaucoma compared to OHT and further increase in more severe glaucoma states. Additional treatment changes are major contributing factors to the increased treatment costs of glaucoma. If intraocular pressure can be controlled over the long term, progression to moderate and advanced states avoided, and patients remain on initial treatments, treatment costs could decline due to reduced and less expensive healthcare resource utilisation.

Real-world comparative economics of a 12-gene assay for prognosis in stage II colon cancer.

391 Background: Prior economic analysis of a 12-gene assay (Oncotype DX), compared with patterns of care reported in the NCCN database of patients with stage II, T3, DNA mismatch repair proficient (MMR-P) colon cancer, predicted that the assay would save medical costs and improve patient well-being (Hornberger et al., Value Health, 2012). This study assessed the validity of those findings with actual adjuvant chemotherapy (aCT) recommendations. Methods: Outcomes and costs were estimated for patients with stage II, T3, MMR-P colon cancer using a Markov model. A study of 141 patients from 17 sites in the Mayo Clinic Cancer Research Consortium collected data on aCT recommended before and after knowledge of the 12-gene assay results (Srivastava et al. abstract). Quality-adjusted life years (QALY) and medical resource use after recurrence were computed using guideline-validated state-transition probability estimation methods. Risk of progression and incidence of adverse events with different aCT regimens were based on published literature. Drug and administration costs for aCT were obtained from 2012 Medicare fee schedules. One-way sensitivity analyses were conducted to evaluate parameter influence on economic impact. Results: After receiving the 12-gene assay results, physician recommendations in favor of aCT decreased 22% (95% CI 11%-32%; McNemar test p&lt;0.001) from 73 (52%) to 42 (30%) patients. Oxaliplatin aCT and 5-FU monotherapy recommendations each declined 11%. Average aCT costs decreased $5,738 for drugs, $668 for administration, and $3,268 for adverse events management. Overall, average total direct medical costs decreased $4,203. The net effect on average patient well-being was a gain of 0.083 QALYs. Total medical costs are most influenced by change in aCT recommendations, 5-FU monotherapy efficacy, and oxaliplatin drug acquisition cost. Savings are expected to persist even if the cost of oxaliplatin dropped by &gt;75% due to generic substitution. Conclusions: The 12-gene assayhas been shown to alter aCT recommendations for patients with stage II, T3, MMR-P colon cancer. This study provides real-world confirmation that these changes in aCT reduce direct medical costs and improve patient well-being.

Health-care cost of diabetes in South India: A cost of illness study.

Objective:The objective of this study is to analyze the health-care cost by calculating the direct and indirect costs of diabetes with co-morbidities in south India.Methods:A prospective observational study was conducted at Rohini super specialty hospital (India). Patient data as well as cost details were collected from the patients for a period of 6 months. The study was approved by the hospital committee prior to the study. The diabetic patients of age >18 years, either gender were included in the study. The collected data was analyzed for the average cost incurred in treating the diabetic patients and was calculated based on the total amount spent by the patients to that of total number of patients.Findings:A total of 150 patients were enrolled during the study period. The average costs per diabetic patient with and without co-morbidities were found to be United States dollar (USD) 314.15 and USD 29.91, respectively. The average cost for those with diabetic complications was USD 125.01 for macrovascular complications, USD 90.43 for microvascular complications and USD 142.01 for other infections. Out of USD 314.15, the average total direct medical cost was USD 290.04, the average direct non-medical cost was USD 3.75 and the average total indirect cost was USD 20.34.Conclusion:Our study results revealed that more economic burden was found in male patients (USD 332.06), age group of 51-60 years (USD 353.55) and the patients bearing macrovascular complications (USD 142.01). This information can be a model for future studies of economic evaluations and outcomes research.

Cost Analysis of Cancer Side Effects Therapy in Cancer Patients in Rumah Sakit Prof. Dr. Margono Soekarjo Purwokerto

Cancer is the leading cause of death in Indonesia. Generally, cancer therapy use chemotherapy, radiation, surgery or combination of those. Various side effects caused by cancer therapy make the use of additional drugs. This leads to an increase in total cost incurred to cancer patients. The purpose of this study was to describe the treatment of cancer therapy’s side effects as well as the average cost of side effects treatment, and its percentage in the total cost of cancer patients in Rumah Sakit Margono Soekarjo. This research was a descriptive study with retrospective data by total sampling method obtained from patients’ medical and receipts records of five most common cancers (breast, nasopharynx, Non Hodgkins Lhympoma (NHL), ovarian, and cervix) during January-December 2010. The average cost of patient’s side effects treatment was calculated by the average cost of side effects compared to the average total direct costs incurred to cancer patients. The samples was obtained from the population of 2261 patients who met the inclusion criteria, that are 73 patients consist of 62 female patients and 11 male patients. The most common side effects of cancer therapy were nausea and vomiting (59.80%), nausea-vomiting, anemia, and pain (16.44%), and nausea-vomiting and anemia (15.07%). The most used therapy was vitamin B complex followed by histamine-2 inhibitor. The average cost of side effects for breast cancer was Rp 1,715,373 (8.73%), nasopharynx was Rp 1,149,049 (6.98 %); NHL was Rp 360,778 (1.97 %); ovary was Rp 911,118 (3.61 %) and cervical was Rp 1,416,027 (8.87 %). The results indicated that the hospital needs to pay more attention on nausea-vomiting effect of chemotherapy, and also cervical cancer side effects therapy as the most costly.Keywords: Cost Analysis, Cancer, Side Effects, Prof. Dr. Margono Soekarjo Hospital

The direct costs of raising external equity capital for US REIT IPOs

PurposeThe purpose of this paper is to investigate the total direct costs of raising external equity capital for US real estate investment trust (REIT) initial public offerings (IPOs).Design/methodology/approachThe study provides recent evidence on total direct costs for a comprehensive dataset of 125 US REIT IPOs from 1996 until June 2010. A multivariate OLS regression is performed to determine significant factors influencing the level of total direct costs and also underwriting fees and non‐underwriting direct expenses.FindingsThe study finds economies of scale in total direct costs, underwriting fees and non‐underwriting expenses. The equally (value) weighted average total direct costs are 8.33 percent (7.52 percent), consisting of 6.49 percent (6.30 percent) underwriting fees and 1.87 percent (1.22 percent) non‐underwriting direct expenses. The study finds a declining trend of total direct costs for post 2000 IPOs which is attributed to the declining trend in both underwriting fees and non‐underwriting direct expenses. Offer size is a critical determinant for both total direct costs and their individual components and inversely affects these costs. The total direct costs are found significantly higher for equity REITs than for mortgage REITs and are also significantly higher for offers listed in New York Stock Exchange (NYSE). Underwriting fees appear to be negatively influenced by the offer price, the number of representative underwriters involved in the issue, industry return volatility and the number of potential specific risk factors but positively influenced by prior quarter industry dividend yield and ownership limit identified in the prospectus. After controlling for time trend, the paper finds REIT IPOs incur higher non‐underwriting direct expenses in response to higher industry return volatility prior to the offer.Originality/valueThis paper adds to the international REIT IPO literature by exploring a number of new influencing factors behind total direct costs, underwriting fees and non‐underwriting direct expenses. The study includes data during the recent GFC period.

The economic burden of metastatic breast cancer: a U.S. managed care perspective

This study was performed to quantify the economic burden and identify drivers of direct costs of mBC. In a retrospective study of a de-identified administrative claims database of privately insured patients, women between 18 and 64 years of age were included if they had at least one claim with a diagnosis of breast cancer and subsequently one or more claims with a diagnosis of secondary malignancy between January 1, 2003 and December 31, 2009. The study sample was further classified into the following subgroups: (1) Endocrine therapy, (2) HER-2 targeted therapy, (3) Concomitant HER-2 targeted and endocrine therapy, (4) Cytotoxic chemotherapy, and (5) No-systemic therapy. Costs for medical resource utilization were calculated on a per patient per month (PPPM) basis. A total of 7,698 mBC patients were identified from 2003 to 2009 with an average age at index of ~52 years, and average follow up of 2.2 years. The average total direct medical costs for 7,698 mBC patients were $9,788 PPPM. Outpatient costs accounted for the majority of overall PPPM costs. Examining the five different mBC therapeutic subgroups revealed that patients who received no-systemic therapy had the highest costs at $13,926 PPPM, while patients who received systemic endocrine therapy had the lowest costs at $5,303 PPPM. This study demonstrated that mBC is associated with substantial healthcare costs in a non-Medicare patient population. Assuming average PPPM costs of $9,788 and an average life expectancy of 2.2 years, the total average expenditure to treat mBC would be ~$250,000 per patient.

A Retrospective Observational Single-Centre Study on the Burden of Immune Thrombocytopenia (ITP)

Background: German data on economic consequences of immune thrombocytopenia (ITP) are limited. Patients and Methods: A retrospective, observational study based on chart review of adult patients with a confirmed diagnosis of ITP was conducted at a German university hospital. Costs are presented from the hospital perspective. Results: Of 50 eligible patients, 45 could be classified by disease duration: 19 patients &lt; 3 months (38%, newly diagnosed ITP), 12 patients ≥ 3 to &lt; 12 months (24%, persistent ITP), 19 patients ≥ 12 months (38%, chronic ITP). Complications included 85 bleeding events in 43 patients, including 3 intracranial haemorrhages. Documented were 955 outpatient visits in 43 patients (86%) and 92 inpatient hospital admissions in 45 patients (90%). Of the 46 patients (92%) treated, all received corticosteroids, 25 (50%) intravenous immunoglobulin, and 7 (14%) further therapies. 12 patients (24%) underwent splenectomy. Average total direct medical costs (mean (standard deviation)) were 17,091 (18,859) per patient, 12,749 (11,663) in 17 newly diagnosed ITP patients with a 0.88-month (0.65 months) average disease duration, and 29,868 (29,397) in 13 chronic ITP patients with a 33.5-month (16.8 months) average disease duration. Inpatient stays were the main cost drivers. Conclusion: These data concerning current healthcare provision for ITP patients in Germany indicate considerable resource consumption and the need for more effective treatment options in individual patients.

Future direct and indirect costs of obesity and the influence of gaining weight: Results from the MONICA/KORA cohort studies, 1995–2005

Over the last two decades, the prevalence of obesity has risen worldwide. As obesity is a confirmed risk factor for a number of diseases, its increasing prevalence nurtures the supposition that obesity may present a growing and significant economic burden to society.The objective of this study is to analyse the correlation between body mass index (BMI) and future direct and indirect costs, as well as the correlation between changing BMI and future in(direct) costs. Health care utilisation and productivity losses were based on data from 2581 participants aged 25–65years (1994/95) from two cross-sectional, population-representative health surveys (MONICA/KORA-survey-S3 1994/95 and follow-up KORA-survey-F3 2004/05) in Augsburg, Germany.The predicted average adjusted total direct costs per year and per user were estimated to be €1029-(healthy weight), €1093-(overweight) and €1040-(obesity). There are significantly greater future costs in the utilisation of general practitioners per user and per year at higher obesity levels (€72; €75; €96).The average total direct costs per person for those who stay in the same BMI class are €982, €1000 and €973. An overweight participant who becomes obese incurs significant costs of internists of €160 compared with those who remain overweight (€124). An overweight user incurs indirect costs of €2474, compared with €2136 for those who remain a healthy weight.There is a trend for higher predicted (in)direct costs when people are overweight or obese compared with healthy weight persons 10years earlier. Potential cost savings could be attained if preventive programs effectively targeted these individuals.

Relative weight-related costs of healthcare use by children—Results from the two German birth cohorts, GINI-plus and LISA-plus

Obesity among children and adolescents is a growing public health burden. According to a national reference among German children and adolescents aged 3–17 years, 15% are overweight (including obese) and 6.3% are obese. This study aims to assess the economic burden associated with overweight and obesity in children based on a cross-sectional survey from two birth cohort studies: the GINI-plus – German Infant Nutritional Intervention plus Non-Intervention study (3287 respondents aged 9 to <12 years) and the LISA-plus study – Influence of life-style factors on the development of the immune system and allergies in East and West Germany (1762 respondents aged 9 to <12 years). Using a bottom-up approach, we analyse direct costs induced by the utilisation of healthcare services and indirect costs emerging from parents’ productivity losses. To investigate the impact of Body Mass Index (BMI) on costs, we perform various descriptive analyses and estimate a two-part regression model. Average annual total direct medical costs of healthcare use are estimated to be €418 (95% CI [346–511]) per child, split between physician (22%), therapist (29%), hospital (41%) and inpatient rehabilitation costs (8%). Bivariate analysis shows considerable differences between BMI groups: €469 (severely underweight), €468 (underweight), €402 (normal weight), €468 (overweight) and €680 (obese). Indirect costs make up €101 per year on average and tend to be higher for obese children, although this was not statistically significant. Drawing on these results, differences in healthcare costs between BMI groups are already apparent in children.

Hospital-Based Palliative Care Consultation: Effects on Hospital Cost

Palliative care consultation teams in hospitals are becoming increasingly more common. Palliative care improves the quality of hospital care for patients with advanced disease. Less is known about its effects on hospital costs. To evaluate the relationship between palliative care consultation and hospital costs in patients with advanced disease. An observational study of 3321 veterans hospitalized with advanced disease between October 1, 2004 and September 30, 2006. The sample includes 606 (18%) veterans who received palliative care and 2715 (82%) who received usual hospital care. October 1, 2004 and September 30, 2006. We studied the costs and intensive care unit (ICU) use of palliative versus usual care for patients in five Veterans Affairs hospitals over a 2-year period. We used an instrumental variable approach to control for unmeasured characteristics that affect both treatment and outcome. The average daily total direct hospital costs were $464 a day lower for the 606 patients receiving palliative compared to the 2715 receiving usual care (p < 0.001). Palliative care patients were 43.7 percentage points less likely to be admitted to ICU during the hospitalization than usual care patients (p < 0.001). Palliative care for patients hospitalized with advanced disease results in lower costs of care and less utilization of intensive care compared to similar patients receiving usual care. Selection on unobserved characteristics plays an important role in the determination of costs of care.

Comparison of Robot-Assisted Nephrectomy with Laparoscopic and Hand-Assisted Laparoscopic Nephrectomy

To compare the initial perioperative outcomes of our robot-assisted laparoscopic nephrectomies with laparoscopic and hand-assisted nephrectomies performed by 2 experienced laparoscopic surgeons. We retrospectively evaluated all patients who underwent laparoscopic (LN), hand-assisted (HALN), and robot-assisted laparoscopic nephrectomy (RALN) for benign and malignant diseases between August 2006 and December 2008. Data collected included patient age, body mass index, operative times, estimated blood loss, complications, and hospital stay. Radical nephrectomy was performed for renal neoplasms, and simple nephrectomy was performed for suspected benign diseases. In addition, average direct costs and total costs were calculated for each laparoscopic approach. Forty-six patients underwent LN, 20 underwent HALN, and 13 underwent RALN. The median operative time was 171, 210, and 168 minutes, respectively. LN, HALN, and RALN groups had similar median EBL [(100 mL (IQR=113 mL), 100mL (IQR=150 mL), and 100mL (IQR=125 mL); P=0.695], length of hospital stay [2.0d (IQR=1.0d), 3.0d (IQR=2.0d), and 2.0d (IQR=3.0d); P=0.233], and postoperative morphine equivalent analgesic requirements [33 mg (IQR=43 mg), 45 mg (IQR=50 mg), and 30 mg (IQR=16 mg); P=0.766]. Three patients (6%) in the LN group had complications, 2 (10%) in the HALN group had complications, and 4 (30%) in the RALN group had complications. The average total direct operating room costs were $5,500, $6,979, and $6,869 for the LN, HALN, and RALN groups, respectively. Early experience with robotic assistance for radical and simple nephrectomy offers no significant advantage over traditional laparoscopic or hand-assisted approaches. It was also more costly.