Average Total Expenditure Research Articles

Cancer Care in Africa: An Overview of Resources.

PurposeAccording to predictions from the International Agency for Research on Cancer, over the next 5 years, the annual number of new cases of cancer in Africa will grow to more than one million. Together with the immense loss in human life, there is a considerable economic setback attached to this number. However, most African nations are far from adequately scaling up their capacity to control cancer.MethodsThis study reviews the published data on the existing cancer control resources in Africa. It is, to our knowledge, the first combined effort looking at all resources available on the continent regarding cancer care.ResultsThe total number of 102 cancer treatment centers, including general oncology centers, gynecologic oncology or other single-organ malignancy units, and pediatric oncology and palliative care establishments, is not sufficient to cover the increasing needs of the African population affected by cancer. In addition, the continental average total health expenditure per capita amounts to only US$82.ConclusionThis review could serve as a starting point for devising realistic solutions meant to improve the prevention and management of malignant disease on the African continent.

Health care expenditures associated with depression in adults with cancer.

The rates of depression in adults with cancer have been reported as high as 38%-58%. How depression affects overall health care expenditures in individuals with cancer is an under-researched area. To estimate excess average total health care expenditures associated with depression in adults with cancer by comparing those with and without depression after controlling for demographic, socioeconomic, access to care, and other health status variables. Cross-sectional data on 4,766 adult survivors of cancer from 2006-2009 of the nationally representative household survey, Medical Expenditure Panel Survey (MEPS), were used. The patients were older than 21 years. Cancer and depression were identified from the patients' medical conditions files. Dependent variables consisted of total, inpatient, outpatient, emergency department, prescription drugs, and other expenditures. Ordinary least square (OLS) on logged dollars and generalized linear models with log-link function were performed. All analyses (SAS 9.3 and STATA12) accounted for the complex survey design of the MEPS. Overall, 14% of individuals with cancer reported having depression. In those with cancer and depression, the average annual health care expenditures were $18,401 compared with $12,091 in those without depression. After adjusting for demographic, socioeconomic, access to care, and other health status variables, those with depression had about 31.7% greater total expenditures compared with those without depression. Total, outpatient, and prescription expenditures were higher in individuals with depression than in those without depression. Individuals with cancer and depression were significantly more likely to use emergency departments (adjusted odds ratio, 1.46) compared with their counterparts without depression. Cancer patients who died during the reporting year were excluded. The financial burden of depression may have been underestimated because the costs of end-of-life care are high. The burden for each cancer type was not analyzed because of the small sample size. In adults with cancer, those with depression had higher health care utilization and expenditures compared with those without depression. One author was partially supported by the National Institute of General Medical Sciences, U54GM104942.

Healthcare Expenditures Associated with Depression Among Individuals with Osteoarthritis: Post-Regression Linear Decomposition Approach.

Depression is common among individuals with osteoarthritis and leads to increased healthcare burden. The objective of this study was to examine excess total healthcare expenditures associated with depression among individuals with osteoarthritis in the US. Adults with self-reported osteoarthritis (n = 1881) were identified using data from the 2010 Medical Expenditure Panel Survey (MEPS). Among those with osteoarthritis, chi-square tests and ordinary least square regressions (OLS) were used to examine differences in healthcare expenditures between those with and without depression. Post-regression linear decomposition technique was used to estimate the relative contribution of different constructs of the Anderson's behavioral model, i.e., predisposing, enabling, need, personal healthcare practices, and external environment factors, to the excess expenditures associated with depression among individuals with osteoarthritis. All analysis accounted for the complex survey design of MEPS. Depression coexisted among 20.6 % of adults with osteoarthritis. The average total healthcare expenditures were $13,684 among adults with depression compared to $9284 among those without depression. Multivariable OLS regression revealed that adults with depression had 38.8 % higher healthcare expenditures (p < 0.001) compared to those without depression. Post-regression linear decomposition analysis indicated that 50 % of differences in expenditures among adults with and without depression can be explained by differences in need factors. Among individuals with coexisting osteoarthritis and depression, excess healthcare expenditures associated with depression were mainly due to comorbid anxiety, chronic conditions and poor health status. These expenditures may potentially be reduced by providing timely intervention for need factors or by providing care under a collaborative care model.

PCV98 - Socioeconomic Factors And Prescribed Medicines Expenditures Associated With Antihyperlipidemic Therapy; A Comparison Between Hyperlipidemia Patients With And Without Treatment

As reported by the Centers for Disease Control and Prevention (CDC) more than half of adults with high blood cholesterol level did not receive any treatment. Untreated high blood cholesterol can lead to coronary heart diseases. The primary objective of this study is to describe and contrast the socioeconomic factors between treated and untreated patients with hyperlipidemia. Secondary objective is to compare prescribed medicines expenditures between the two groups. This study conducted cross-sectional secondary data analyses using 2012 Medical Expenditures Panel Survey (MEPS). Study subjects consisted of US civilian, non-institutionalized adults diagnosed with high blood cholesterol. Series of statistical comparisons on socioeconomic factors, and prescribed medicines expenditures and utilizations between hyperlipidemia patients with any FDA-approved lipid lowering agent and hyperlipidemia patients without lipid lowering agents. The Andersen Behavioral Model was applied to define the socioeconomic factors. SAS 9.3 statistical software was used for all analyses including sample weights and standard errors adjustments. Approximately 19 million patients had high blood cholesterol related events in 2012. The average age of treatment group was older than the average age of no-treatment group, 64 and 62 years old respectively, (p<0.001). 95% of hyperlipidemia patients with high income had treatment, on the contrary, 93% of hyperlipidemia patients with near poor income had treatment. The average total prescription expenditures for patients with treatment was higher than patients without treatment, $3032 and $2509 respectively, (p<0.001). The study findings showed substantial number of hyperlipidemia patients without treatment. Also there were some socioeconomic differences between treatment group and no-treatment group. Further research is recommended to understand the complex role of socioeconomic factors in hyperlipidemia therapy to make more effective policies and programs designed to improve treatment for one of the major chronic conditions in the United States.

Health care utilization and expenditures of persons with diabetes comorbid with anxiety disorder: a national population-based cohort study

ObjectiveThe aim of this study was to investigate and compare health care utilization and expenditures between persons with diabetes comorbid with and without anxiety disorder in Taiwan. MethodsHealth care utilization and expenditures among persons with diabetes with and without comorbid anxiety disorder in the period 2000–2004 were examined using the Taiwan's National Health Insurance claims data. Health care utilization included outpatient visits and use of hospital inpatient services, while expenditures included outpatient, inpatient and total medical expenditures. General estimation equation (GEE) models were used to analyze the factors associated with outpatient visits and expenditures, and multiple logistic regression analysis was applied to identify factors associated with hospitalization. ResultsIn the study period, the average number of annual outpatient visits was 43.11–50.37 and 29.82–31.42 for persons with diabetes comorbid with anxiety disorder and for those without anxiety disorder, respectively. The average annual total expenditure was NT$74,875–92,781 and NT$63,764–81,667, respectively. Controlling for covariates, the GEE models revealed that age and time were associated with outpatient visits. Income and time factor were associated with total expenditure. ConclusionsHealth care utilization and expenditures for persons with diabetes with comorbid anxiety disorder are significantly higher than those without anxiety disorder. The factors associated with health care utilization and expenditures are age, income and time.

Chronic Condition Combinations and Health Care Expenditures and Out-of-Pocket Spending Burden Among Adults, Medical Expenditure Panel Survey, 2009 and 2011

IntroductionLittle is known about how combinations of chronic conditions in adults affect total health care expenditures. Our objective was to estimate the annual average total expenditures and out-of-pocket spending burden among US adults by combinations of conditions.MethodsWe conducted a cross-sectional study using 2009 and 2011 data from the Medical Expenditure Panel Survey. The sample consisted of 9,296 adults aged 21 years or older with at least 2 of the following 4 highly prevalent chronic conditions: arthritis, diabetes mellitus, heart disease, and hypertension. Unadjusted and adjusted regression techniques were used to examine the association between chronic condition combinations and log-transformed total expenditures. Logistic regressions were used to analyze the relationship between chronic condition combinations and high out-of-pocket spending burden.ResultsAmong adults with chronic conditions, adults with all 4 conditions had the highest average total expenditures ($20,016), whereas adults with diabetes/hypertension had the lowest annual total expenditures ($7,116). In adjusted models, adults with diabetes/hypertension and hypertension/arthritis had lower health care expenditures than adults with diabetes/heart disease (P < .001). In adjusted models, adults with all 4 conditions had higher expenditures compared with those with diabetes and heart disease. However, the difference was only marginally significant (P = .04).ConclusionAmong adults with arthritis, diabetes, heart disease, and hypertension, total health care expenditures differed by type of chronic condition combinations. For individuals with multiple chronic conditions, such as heart disease and diabetes, new models of care management are needed to reduce the cost burden on the payers.

Influence of payer source on treatment and outcomes in colorectal cancer patients in a university hospital in Thailand.

The study aimed to compare the 2 main types of insurance used by colorectal cancer (CRC) patients in a university hospital in Thailand: universal coverage (UC) and 'Civil Servant Medical Benefit Scheme' (CSMBS) in terms of hospital expenditure and survival outcomes. CRC cases in stages I-IV who were operated on and had completed their adjuvant therapy in Songklanagarind Hospital from 2004 through 2013 were retrospectively reviewed regarding their hospital expenditure, focusing on surgical and chemotherapy costs. Of 1,013 cases analyzed, 524 (51.7%) were in the UC group while 489 (48.3%) belonged to the CSMBS group. Cases with stage IV disease were significantly more frequent in the UC group. Average total treatment expenditure (TTE) was 143,780 Thai Baht (THB) (1 US$=~30 THB). The TTE increased with tumor stage and the chemotherapy cost contributed the most to the TTE increment. TTE in the CSMBS group was significantly higher than in the UC group for stage II-III CRCs. The majority of cases in the UC group (65.5%) used deGramont or Mayo as their first line regimen, and the proportion of cases who started with a capecitabine-based regimen (XELOX or Xeloda®) was significantly higher in the CSMBS group (61.0% compared to 24.5% in the UC group, p-value<0.01). On survival analysis, overall survival (OS) and progress free survival in the CSMBS group were significantly better than in the UC group. The 5-year OS in the CSMBS and UC groups were 84.3% and 74.6%, respectively (p-value<0.01). In conclusion, the study indicates that in Thailand, the type of insurance influences resource utilization, especially the choice of chemotherapy, in CRC cases. This disparity in treatment, in turn, results in a gap in treatment outcomes.

Treatment Expenditure Pattern of Epileptic Patients: A Study from a Tertiary Care Hospital, Kolkata, India

Introduction. Neurological diseases are very important causes of prolonged morbidity and disability leading to profound financial loss. Epilepsy is one of the most important neurological disorders. It being a cost intensive disorder poses a significant economic burden to the country. Aims and Objectives. The study was conducted among the persons with epilepsy (PWE) to assess their expenditure pattern for epilepsy treatment and its rural urban difference. Materials and Methods. 315 PWE selected by systematic random sampling and their caregivers were interviewed with the predesigned, pretested semistructured proforma. Subsequently data were compiled and analyzed using SPSS 18.0 software. Results and Conclusion. Majority of the study population were in the age group of 16–30 years. Majority belonged to classes IV and V of Prasad socioeconomic status scale. Average total expenditure per month for treatment of epilepsy was 219 INR, mainly contributed by drugs, travel, investigations, and so forth. Rural population was having higher treatment expenditure for epilepsy specially for travel and food and lodging in order to get epilepsy treatment. Wage loss in the last three months was present in 42.86% study subjects which was both affected by seizure episodes and travel for visits. Better district care would have helped in this situation.

Depression treatment and short-term healthcare expenditures among elderly Medicare beneficiaries with chronic physical conditions

BackgroundResearch on the impact of depression treatment on expenditures is nascent and shows results that vary from negative associations with healthcare expenditures to increased expenditures. However many of these studies did not include psychotherapy as part of the depression treatment. None of these studies included “no treatment” as a comparison group. In addition, no study has included a broad group of chronic physical conditions in studying depression treatment expenditures.ObjectiveWe determined the association between depression treatment and short-term healthcare expenditures using a nationally representative sample of Medicare beneficiaries with chronic physical conditions and depression.MethodIn this retrospective cohort study, we examined the association between depression treatment in the baseline year and healthcare expenditures in the following year using data from 2000 through 2005 of the Medicare Current Beneficiary Survey (MCBS), a nationally representative survey of Medicare beneficiaries. Using the rotating panel design of MCBS, we derived five two-year cohorts: 2000–2001, 2001–2002, 2002–2003, 2003–2004, and 2004–2005. The study sample included 1,055 elderly Medicare beneficiaries aged 65 or over. We compared healthcare expenditures of no depression treatment group with depression treatment groups using t-tests. Linear regressions of log-transformed dollars were used to assess the relationship between depression treatment and healthcare expenditures after controlling for demographic, socio-economic, health status, lifestyle risk factors, year of observation and baseline expenditures.ResultsCompared to no depression treatment ($16,795), the average total expenditures were higher for those who used antidepressants only ($17,425) and those who used psychotherapy with or without antidepressants ($19,733). After controlling for the independent variables, antidepressant use and psychotherapy with or without antidepressants were associated with 20.2% (95% CI: 14.1-26.7%) and 29.4% (95% CI: 18.8-41.0%) increase in total expenditures, respectively. We observed that depression treatment was positively associated with inpatient, medical provider and prescription drug expenditures.ConclusionAmong the elderly Medicare beneficiaries with chronic physical conditions, depression treatment was associated with greater short-term healthcare expenditures. Future research needs to replicate these findings and also examine whether depression treatment reduces expenditures over a longer period of time.

Co-occurring chronic conditions and healthcare expenditures associated with Parkinson's disease: A propensity score matched analysis

BackgroundThe objective of this study was to ascertain co-occurring chronic conditions and expenditures associated with Parkinson's disease among elderly individuals (age ≥ 65 years). MethodsA retrospective, cross-sectional matched case–control design with data from Medical Expenditure Panel Survey (MEPS), a nationally representative survey of households in the United States was used. Elderly with Parkinson's disease (N = 350) were compared to a matched control group (N = 1050) based on propensity scores. Ordinary Least Squares regressions on logged dollars were performed to understand the association between Parkinson's disease and expenditures. All analyses accounted for the complex survey design of the MEPS and were conducted in SAS 9.3. ResultsAmong elderly, the average total expenditures were $15,404 for those with Parkinson's disease and $13,333 for those without Parkinson's disease. Results from regressions revealed that elderly with Parkinson's disease had 109% greater total expenditure compared to those without Parkinson's disease, when only demographic and socioeconomic variables were entered in the model. When co-occurring chronic conditions were additionally included in the model, those with Parkinson's disease had 84% greater expenditures compared to those without Parkinson's disease. ConclusionsExcess expenditures associated with Parkinson's disease are partially driven by co-occurring conditions among individuals with Parkinson's disease.

Reducing the costs of paediatric antibiotic prescribing in the community by implementing guideline recommendations

Italian children receive a high number of antibiotic prescriptions, and the use of second-choice antibiotics is common. A few studies in other countries have demonstrated that the implementation of international guidelines for the most common paediatric diseases may reduce the associated costs. A cost analysis of the expenditure for antibiotic prescriptions in outpatient children in the Lombardy region (Italy) and for each of the region's local health units (LHUs) was performed using a pharmacoepidemiological approach. The safety and cost impact associated with a quali-quantitative improvement in antibiotic prescribing was estimated. The data source was the Lombardy region's prescription database (year 2008) for outpatient children <14 years old. The average total expenditure for each package, and per capita, was calculated for each active substance considered and for each LHU. An estimate of the possible cost reduction was elaborated using, as a reference, the prescription profile of a group of paediatricians that has been involved in initiatives concerning care for years. The hospital admission rates for acute respiratory infections (ARI) and their major complications were evaluated at the regional level and in the group of children followed by the reference paediatricians. The cost reduction estimate reveals a possible decrease in antibiotic expenditure of about 3·6 million euros (-19·5%) in the Lombardy region. Large variability was observed between different LHUs (-33·3 to +9·2% of difference). The hospital admission rate was not different when comparing the group of children followed by the reference paediatricians to the rest of the study population, but the hospital admission rate for ARI was lower in the reference group (χ(2) = 16·4, P < 0·001). This is the first Italian study to evaluate the costs related to a specific prescription profile, which already exists in the real setting, hypothesizing its application in a large outpatient child population of the same geographical area. The results show that by improving prescribing appropriateness, it is possible to reduce the expenditure associated with antibiotic prescriptions to outpatient children in the Lombardy region by about one-fifth. The lower rate of hospital admissions for ARI suggests that the adopted profile is also beneficial to children's health.

Body Composition of Female Senior Inhabitants of Biała Podlaska vs Their Physical Activity

Abstract Introduction. The aim of this study was to analyze body composition of female inhabitants of Biała Podlaska aged 60 years and older and characterized by different levels of physical activity. Material and methods. The study material were results from a survey conducted with 180 female inhabitants of Biała Podlaska aged 60 years and older (x 65.30 ± 4.68). The women were analyzed for body height, body mass, BMI and body composition. Their physical activity was determined using the IPAQ questionnaire and according to results achieved the women were classified into two groups: low physical activity (n=132), and moderate and high physical activity (n=48). The average frequency, duration and weekly energy expenditure of physical activities undertaken by the respondents were estimated in both groups. In addition, a social enquiry was conducted that enabled gathering information on the level of education, marital status and family status of the women. Results achieved were elaborated statistically. Results. The marital status 2 2 (χ2 =11.001, p&lt;0.05) and family status (χ2 = 4.113, p&lt;0.05) of the female senior inhabitants of Biała Podlaska were 2 modifying their physical activity to a greater extent that the educational status did (χ2 = 30.360, p&gt;0.05). In addition, significant correlations were observed between absolute values of tissue components of the body and physical activity of the senior women. The average total energy expenditure in the group with a low physical activity accounted for 236.5 MET, whereas in the group with moderate and high physical activity - for 2255.3 MET. Conclusions. The study demonstrated that not only time devoted to physical activity but also its intensity affected the levels of tissue components. Results achieved in the survey indicate the necessity of continuing studies to examine correlations between body composition and physical activity of older population.

Annual Report on Health Care for Children and Youth in the United States: Trends in Racial/Ethnic, Income, and Insurance Disparities Over Time, 2002–2009

ObjectiveTo examine trends in children's health access, utilization, and expenditures over time (2002–2009) by race/ethnicity, income, and insurance status/expected payer. MethodsData include a nationally representative random sample of children in the United States in 2002–2009 from the Medical Expenditure Panel Survey (MEPS) and a nationwide sample of pediatric hospitalizations in 2005 and 2009 from the Healthcare Cost and Utilization Project (HCUP). ResultsThe percentage of children with private insurance coverage declined from 65.3% in 2002 to 60.6% in 2009. At the same time, the percentage of publicly insured children increased from 27.0% in 2002 to 33.1% in 2009. Fewer children reported being uninsured in 2009 (6.3%) compared to 2002 (7.7%). The most significant progress was for Hispanic children, for whom the percentage of uninsured dropped from 15.0% in 2002 to 10.3% in 2009. The uninsured were consistently the least likely to have access to a usual source of care, and this disparity remained unchanged in 2009. Non-Hispanic whites were most likely to report a usual source of care in both 2002 and 2009. The percentage of children with a doctor visit improved for whites and Hispanics (2009 vs 2002). In contrast, black children saw no improvement during this time period. Between 2002 and 2009, children's average total health care expenditures increased from $1294 to $1914. Average total expenditures nearly doubled between 2002 and 2009 for white children with private health insurance. Among infants, hospitalizations for pneumonia decreased in absolute number (41,000 to 34,000) and as a share of discharges (0.8% to 0.7%). Fluid and electrolyte disorders also decreased over time. Influenza appeared only in 2009 in the list of top 15 diagnoses with 11,000 hospitalization cases. For children aged 1 to 17, asthma hospitalization increased in absolute number (from 119,000 to 134,000) and share of discharges (6.6% to 7.6%). Skin infections appeared in the top 15 categories in 2009, with 57,000 cases (3.3% of total). ConclusionsDespite significant improvement in insurance coverage, disparities by race/ethnicity and income persist in access to and use of care. Hispanic children experienced progress in a number of measures, while black children did not. Because racial/ethnic and socioeconomic disparities are often reported as single cross-sectional studies, our approach is innovative and improves on prior studies by examining population trends during the time period 2002–2009. Our study sheds light on children's disparities during the most recent economic crisis.

Burden of Household Environmental Tobacco Smoke on Medical Expenditure for Japanese Women: A Population-Based Cohort Study

BackgroundThe economic consequences of environmental tobacco smoke (ETS) have been simulated using models. We examined the individual-level association between ETS exposure and medical costs among Japanese nonsmoking women.MethodsThis population-based cohort study enrolled women aged 40 to 79 years living in a rural community. ETS exposure in homes at baseline was assessed with a self-administered questionnaire. We then collected health insurance claims data on direct medical expenditures from 1995 through 2007. Using generalized linear models with interaction between ETS exposure level and age stratum, average total monthly expenditure (inpatient plus outpatient care) per capita for nonsmoking women highly exposed and moderately exposed to ETS were compared with expenditures for unexposed women. We performed separate analyses for survivors and nonsurvivors.ResultsWe analyzed data from 4870 women. After adjustment for potential confounding factors, survivors aged 70 to 79 who were highly exposed to ETS incurred higher expenditures than those who were not exposed. We found no significant difference in expenditures between moderately exposed and unexposed women. Total expenditures were not significantly associated with ETS exposure among survivors aged 40 to 69 or nonsurvivors of any age stratum.ConclusionsWe calculated individual-level excess medical expenditures attributable to household exposure to ETS among surviving older women. The findings provide direct evidence of the economic burden of ETS, which is helpful for policymakers who seek to achieve the economically attractive goal of eliminating ETS.

Direct medical expenditure associated with rheumatoid arthritis in a nationally representative sample from the medical expenditure panel survey

To quantify the incremental direct medical expenditure associated with rheumatoid arthritis (RA) in the US population from a payer's perspective. A probability-weighted sample of adult respondents from the Medical Expenditure Panel Survey (2008) was used to identify a cohort of patients with RA and compared to a control cohort without RA. Annual expenditure outcomes, including total expenditure and subgroups related to pharmacy, office-based visits, emergency department visits, hospital inpatient stays, and residual expenditures were estimated. Differences between the RA and control cohort were adjusted for sociodemographic factors, employment status, insurance coverage, health behavior, and health status using a generalized linear model with log link and gamma distribution. Statistical inferences on difference in expenditures between RA and non-RA controls were based on nonparametric cluster bootstrapping using percentiles. The adjusted average annual total expenditure of the RA cohort in 2008 US dollars (USD) was $13,012 (95% confidence interval [95% CI] $1,737-$47,081), while that of the control cohort was $4,950 (95% CI $567-$17,425). The incremental total expenditure of the RA patients as compared to non-RA controls was $2,085 (95% CI $250-$7,822). RA patients also had a significantly higher pharmacy expenditure of $5,825 (95% CI $446-$30,998) that was on average $1,380 (95% CI $94-$7,492) higher as compared to the controls. The summated total incremental expenditure of all RA patients in the US was $22.3 billion (2008 USD). RA exerts considerable incremental economic burden on US health care, which is primarily driven by the incremental pharmacy expenditure.

Examining inequities in incidence of catastrophic health expenditures on different healthcare services and health facilities in Nigeria.

ObjectiveThere is limited evidence about levels of socio-economic and other differences in catastrophic health spending in Nigeria and in many sub-Saharan African countries. The study estimated the level of catastrophic healthcare expenditures for different healthcare services and facilities and their distribution across socioeconomic status (SES) groups.MethodsThe study took place in four Local Government Areas in southeast Nigeria. Data were collected using interviewer-administered questionnaires administered to 4873 households. Catastrophic health expenditures (CHE) were measured using a threshold of 40% of monthly non-food expenditure. We examined both total monthly health expenditure and disaggregated expenditure by source and type of care.ResultsThe average total household health expenditure per month was 2354 Naira ($19.6). For outpatient services, average monthly expenditure was 1809 Naira ($15.1), whilst for inpatient services it was 610 Naira ($5.1). Higher health expenditures were incurred by urban residents and the better-off SES groups. Overall, 27% of households incurred CHE, higher for poorer socioeconomic groups and for rural residents. Only 1.0% of households had a member that was enrolled in a health insurance scheme.ConclusionThe worse-off households (the poorest SES and rural dwellers) experienced the highest burden of health expenditure. There was almost a complete lack of financial risk protection. Health reform mechanisms are needed to ensure universal coverage with financial risk protection mechanisms.

Ambulatory Physical Activity in Swiss Army Recruits

The aim of this study was to objectively assess and compare the type, duration and intensity of physical activity during the basic training provided by each of 5 selected Swiss Army occupational specialties. The first objective was to develop and validate a method to assess distance covered on foot. The second objective was to describe and compare physical activity levels among occupational specialties. In the first part of the study, 30 male volunteers completed 6 laps of 290 m at different gait velocities. Data from 15 volunteers were used to develop linear regression equations for the relationship between step frequency and gait velocity, and data from the other 15 volunteers were used to verify the accuracy of these equations. In the second part of the study, 250 volunteers from 5 military schools (each training school for a different occupational specialty) wore heart-rate, acceleration and step-count monitors during workdays of weeks 2, 4, 8 and 10 of their basic training. Sensor data were used to identify physically demanding activities, estimate energy expenditure (based on already published algorithms) and estimate distance covered on foot (based on the algorithm developed in the first part of this study). A branched model using 2 regression equations (gait velocity=0.705∙step frequency for walking speeds below 1 m/s and gait velocity=1.675∙step frequency - 1.464 for faster gait velocities) was shown to be accurate for estimating distance covered on foot. In the training schools investigated, average physical activity energy expenditure was 10.5 ± 2.4 MJ per day, and trainees covered 12.9 ± 3.3 km per day on foot. Recruits spent 61.0 ± 23.3 min per day marching and 33.1 ± 19.5 min per day performing physically demanding materials-handling activities. Average physical activity energy expenditure decreased significantly from week 2 to week 8. The measurement system utilised in the present study yielded data comparable to those of prior studies that applied alternative methods. Nevertheless, the new sensor-based, objective measurement system used provided more information on daily physical activity and demands than traditional, single measurement instruments. The average daily total energy expenditure values in all training schools investigated were within the range found for the armed forces of other nations and for professional athletes.

Health expenditure comparison of extended-release metoprolol succinate and immediate-release metoprolol tartarate

BackgroundMetoprolol, a selective beta-1 blocker, is available in two different salt forms in the market – metoprolol succinate (MS) and metoprolol tartarate (MT). Both the formulations are Food and Drug Administration approved for the treatment of hypertension. Several studies have shown similar efficacies between the two salts; however, they differ in their pharmacokinetic properties and are therefore priced differently. The primary objective of this study was to compare the overall health care expenditures of hypertensive patients on MT and MS to see if the price difference in the two preparations is offset by savings in overall expenditure.MethodsTwo cohorts of patients using MT and MS were selected from the 2008 Medical Expenditure Panel Survey. Propensity score matching technique was used to balance the cohorts on various parameters such as demographic information, insurance status, and comorbidity score. Patients using MT were matched to patients using MS on the logit of propensity score using calipers of width equal to 0.2 of the standard deviation of the logit of the propensity score. Multiple regression analysis was carried out to examine the association between health expenditure and type of metoprolol salt, adjusting for other covariates.ResultsA total of 742 patients were found to use metoprolol (MT-388, MS-354). After propensity score matching, a total of 582 patients were left in the sample for final analysis (291 patients in each cohort). The average annual health care expenditure was slightly higher in the MT cohort; however, after adjusting for covariates in a multivariate analysis, the difference was found to be statistically insignificant (P = 0.23).ConclusionBoth the products of metoprolol were found to have similar average annual total health care expenditure; however, MS once a day has higher out-of-pocket cost.

Incremental Healthcare Expenditures Associated with Thyroid Disorders among Individuals with Diabetes

Objective. To estimate incremental healthcare expenditures associated with thyroid disorders among individuals with diabetes. Research Design and Methods. Cross-sectional study design with data on adults over 20 years of age with diabetes (N = 4, 490) from two years (2007 and 2009) of the Medical Expenditure Panel Survey (MEPS) was used. Ordinary least square regressions on log-transformed total expenditures and type of healthcare expenditures (inpatient, emergency room, outpatient, prescription drug, and other) were performed to estimate the incremental expenditures associated with thyroid disorders after controlling for demographic, socioeconomic, health status, lifestyle risk factors, macrovascular comorbid conditions (MCCs), and chronic conditions (CCs). Results. Among individuals with diabetes, those with thyroid disorders had significantly greater average annual total healthcare expenditures ($15,182) than those without thyroid disorders ($11,093). Individuals with thyroid disorders had 34.3% greater total healthcare expenditures compared to those without thyroid disorders, after controlling for demographic, socio-economic, and perceived health status. Furthermore, controlling for CCs and MCCs, this increase in expenditures was reduced to 21.4%. Conclusions. Among individuals with diabetes, thyroid disorders were associated with greater healthcare expenditures; such excess expenditures may be due to CCs and MCCs. Comanagement of CCs and reducing MCCs may be a pathway to reduce high healthcare expenditures.

PCV93 HEALTH EXPENDITURE COMPARISON OF METOPROLOL SUCCINATE VS METOPROLOL TARTARATE

To compare health care expenditures of hypertensive patients on metoprolol tartarate (MT) and metoprolol succinate (MS).Metoprolol, a selective β-1 blocker, is available in two different salt forms in the market- metoprolol succinate (MS) and metoprolol tartarate (MT). Both of these salts are FDA approved for the treatment of hypertension. Several studies have shown similar efficacies between the two salts; however they are priced at different levels because of their pharmacokinetic properties. MT is the short acting salt and is given twice daily, whereas MS is the long acting salt and is given once daily. Two cohorts of patients using MT and MS were selected from 2008 Medical Expenditure Panel Survey (MEPS). Propensity score (PS) matching technique was used to balance the cohorts on various parameters such as demographic information, insurance status and comorbity score. Patients using MT were matched to patients using MS on the logit of propensity score using calipers of width equal to 0.2 of the standard deviation of the logit of the propensity score. To estimate mean expenditure costs and 95% confidence intervals, non parametric bootstrap sampling method was used. A total of 742 patients were found to use metoprolol (MT-388, MS- 354). After PS matching, a total of 594 patients were left in the sample for final analysis (298 patients in each cohort). The average annual expenditure in two groups did not differ significantly. After carrying out non parametric bootstrap sampling using 1,000 samples, MT cohort had $10,779 (95% CI: $10,682- $10,875) average annual expenditure while MS cohort had $9,810 (95% CI: $9,810-$10,003). Both the salts of Metoprolol were found have similar average annual total healthcare expenditure, however once a daily salt (MS) has higher out of pocket cost.