Difference In Direct Costs Research Articles

Patterns of resource utilization and cost for postmenopausal women with hormone-receptor-positive, human epidermal growth factor receptor-2-negative advanced breast cancer in Europe.

BackgroundHealthcare resource utilization in breast cancer varies by disease characteristics and treatment choices. However, lack of clarity in guidelines can result in varied interpretation and heterogeneous treatment management and costs. In Europe, the extent of this variability is unclear. Therefore, evaluation of chemotherapy use and costs versus hormone therapy across Europe is needed.MethodsThis retrospective chart review (N = 355) examined primarily direct costs for chemotherapy versus hormone therapy in postmenopausal women with hormone-receptor–positive (HR+), human epidermal growth factor receptor-2–negative (HER2–) advanced breast cancer across 5 European countries (France, Germany, The Netherlands, Belgium, and Sweden).ResultsTotal direct costs across the first 3 treatment lines were approximately €10 000 to €14 000 lower for an additional line of hormone therapy-based treatment versus switching to chemotherapy-based treatment. Direct cost difference between chemotherapy-based and hormone therapy-based regimens was approximately €1900 to €2500 per month. Chemotherapy-based regimens were associated with increased resource utilization (managing side effects; concomitant targeted therapy use; and increased frequencies of hospitalizations, provider visits, and monitoring tests). The proportion of patients taking sick leave doubled after switching from hormone therapy to chemotherapy.ConclusionsThese results suggest chemotherapy is associated with increased direct costs and potentially with increased indirect costs (lower productivity of working patients) versus hormone therapy in HR+, HER2– advanced breast cancer.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-015-1762-3) contains supplementary material, which is available to authorized users.

The direct cost of epilepsy in the United States: A systematic review of estimates.

To develop estimates of the direct cost of epilepsy in the United States for the general epilepsy population and sub-populations by systematically comparing similarities and differences in types of estimates and estimation methods from recently published studies. Papers published since 1995 were identified by systematic literature search. Information on types of estimates, study designs, data sources, types of epilepsy, and estimation methods was extracted from each study. Annual per person cost estimates from methodologically similar studies were identified, converted to 2013 U.S. dollars, and compared. From 4,104 publications discovered in the literature search, 21 were selected for review. Three were added that were published after the search. Eighteen were identified that reported estimates of average annual direct costs for the general epilepsy population in the United States. For general epilepsy populations (comprising all clinically defined subgroups), total direct healthcare costs per person ranged from $10,192 to $47,862 and epilepsy-specific costs ranged from $1,022 to $19,749. Four recent studies using claims data from large general populations yielded relatively similar epilepsy-specific annual cost estimates ranging from $8,412 to $11,354. Although more difficult to compare, studies examining direct cost differences for epilepsy sub-populations indicated a consistent pattern of markedly higher costs for those with uncontrolled or refractory epilepsy, and for those with comorbidities. This systematic review found that various approaches have been used to estimate the direct costs of epilepsy in the United States. However, recent studies using large claims databases and similar methods allow estimation of the direct cost burden of epilepsy for the general disease population, and show that it is greater for some patient subgroups. Additional research is needed to further understand the broader economic burden of epilepsy and how it varies across subpopulations.

Comparison Costs of ERCP and MRCP in Patients with Suspected Biliary Obstruction Based on a Randomized Trial

BackgroundThe optimal management of patients with suspected biliary obstruction remains unclear, and includes the possible performance of magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP). ObjectivesTo complete a cost analysis based on a medical effectiveness randomized trial comparing an ERCP-first approach with an MRCP-first approach in patients with suspected bile duct obstruction. MethodsThe management strategies were based on a medical effectiveness trial of 257 patients over a 12-month follow-up period. Direct and indirect costs were included, adopting a societal perspective. The cost values are expressed in 2012 Canadian dollars. ResultsTotal per-patient direct costs were Can$3547 for ERCP-first patients and Can$4013 for MRCP-first patients. Corresponding indirect costs were Can$732 and Can$694, respectively. Causes for differences in direct costs included a more frequent second procedure and a greater mean number of hospital days over the year in patients of the MRCP-first group. In contrast, it is the ERCP-first patients whose indirect costs were greater, principally due to more time away from activities of daily living. Choosing an ERCP-first strategy rather than an MRCP-first strategy saved on average Can$428 per patient over the 12-month follow-up duration; however, there existed a large amount of overlap when varying total cost estimates across a sensitivity analysis range based on observed resources utilization. ConclusionsThis cost analysis suggests only a small difference in total costs, favoring the ERCP-first group, and is principally attributable to procedures and hospitalizations with little impact from indirect cost measurements.

Implementing psychosocial evidence-based practices in mental health: are we moving in the right direction?

Implementing psychosocial evidence-based practices in mental health: are we moving in the right direction?

Invited Commentary

The 1-year outcomes of the CORONARY trial were published this past year and demonstrated no significant difference between on-pump and off-pump coronary artery bypass grafting (CABG) with regard to the primary composite endpoint or rate of repeat coronary revascularization. Combined with the recent outcomes of the GOPCABGE study [German Off-Pump Coronary Artery Bypass Grafting in Elderly Patients] demonstrating no difference in on-pump or off-pump CABG in elderly patients, much of the large, contemporary literature on off-pump CABG indicates that, unlike the results of the ROOBY [Randomized On/Off Bypass] trial, off-pump is at least noninferior to on-pump CABG [1Diegeler A. Börgermann J. Kappert U. et al.Off-pump versus on-pump coronary-artery bypass grafting in elderly patients.N Engl J Med. 2013; 368: 1189-1198Crossref PubMed Scopus (343) Google Scholar, 2Shroyer A.L. Grover F.L. Hattler B. et al.On-pump versus off-pump coronary-artery bypass surgery.N Engl J Med. 2009; 361: 1827-1837Crossref PubMed Scopus (874) Google Scholar]. In this growing era of comparative effectiveness research, however, we see a trend toward assessing new technologies not only with regard to their clinical effectiveness but also cost effectiveness [3Iribarne A. Russo M.J. Moskowitz A.J. Ascheim D.D. Brown L.D. Gelijns A.C. Assessing technological change in cardiothoracic surgery.Semin Thorac Cardiovasc Surg. 2009; 21: 28-34Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar]. Thus, while on-pump and off-pump techniques appear to have similar clinical outcomes, could one technique prove more effective through lower overall costs? Lamy and colleagues [4Lamy A. Tong W. Devereaux P.J. et al.The cost implications of off-pump versus on-pump coronary artery bypass graft surgery at one year.Ann Thorac Surg. 2014; 98: 1620-1626Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar] begin to address this question in their current analysis and demonstrate that after 1 year there was no significant difference in total cost per patient between on-pump and off-pump groups. However, this analysis does have some notable limitations. The CORONARY trial recruited 4,752 patients from 79 centers and 19 countries. Variability exists among countries in event costs used to calculate health care utilization costs, and furthermore the conversion of such event costs to standardized US dollars using purchasing power parties relies on several significant economic assumptions. More importantly, the authors do not include the cost for surgical supplies in their analysis. The high costs associated with disposables such as retractors and stabilizers have the potential to significantly alter the conclusions of the study, as demonstrated by the authors' sensitivity analysis. While Lamy and colleagues [4Lamy A. Tong W. Devereaux P.J. et al.The cost implications of off-pump versus on-pump coronary artery bypass graft surgery at one year.Ann Thorac Surg. 2014; 98: 1620-1626Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar] offer an important starting point for assessing the cost effectiveness of on-pump versus off-pump CABG, further research is necessary before drawing final conclusions. An ideal cost effectiveness analysis would be performed in 1 or more hospitals in the same country to limit economic assumptions, be high volume in both on-pump and off-pump techniques to eliminate operator bias, and account for differences in direct costs of surgical supplies such as disposables. The Cost Implications of Off-Pump Versus On-Pump Coronary Artery Bypass Graft Surgery at One YearThe Annals of Thoracic SurgeryVol. 98Issue 5PreviewThe purpose of this study was to determine the cost implications of the Coronary Artery Bypass Graft Off or On Pump Revascularization Study (CORONARY) at 1 year. Full-Text PDF

Economic and humanistic burden of illness in generalized anxiety disorder: an analysis of patient survey data in Europe.

BackgroundWhilst studies suggest that generalized anxiety disorder (GAD) represents a considerable health care burden in Europe, there is a paucity of published evidence. This study investigated the burden of illness associated with GAD across five European countries (France, Germany, Italy, Spain, and the UK).MethodsInformation from the 2008 European National Health and Wellness Survey database was analyzed. Bivariate, multivariate, and cost analyses were used to compare patients with GAD and propensity-matched controls.ResultsCompared with non-GAD controls, patients with GAD had more comorbidities and were more likely to smoke but less likely to be employed, use alcohol, or take exercise. They also had significantly worse health-related quality of life, and significantly greater work impairment and resource use, which increased as GAD severity increased. Within-country analyses demonstrated results similar to those for the five European countries overall, with the largest differences in resource use between patients with GAD and non-GAD controls documented in France and Germany. The average mean differences in direct costs were relatively small between the GAD groups and controls; however, indirect costs differed substantially. Costs were particularly high in Germany, mainly due to higher salaries leading to higher costs associated with absence from work. The limitation of this study was that the data were from a self-reported Internet survey, making them subject to reporting bias and possibly sample bias.ConclusionAcross all five European countries, GAD had a significant impact on work impairment, resource use, and economic costs, representing a considerable individual and financial burden that increased with severity of disease. These data may help us to understand better the burden and costs associated with GAD.

On the Direct Costs of REIT SEOs

This study examines the determinants of direct costs for REIT seasoned equity offerings. REIT direct costs are unrelated to information asymmetries, unlike for non-REITs. Gross spreads vary inversely with stock liquidity, price, and industry activity. Concerning REIT-specific heterogeneity, gross spreads are generally invariant to property type and operating partnership structure. Still, the findings suggest managers can exert some influence on costs as higher fees associate directly with the use of underwriting syndicates and more reputable investment banks. As a final component of our analysis we test for differences in direct costs across REIT and comparable industrials and observe significantly lower direct issuance costs for REITs.

OHP-002 Financial impact of the use of bevacizumab in the treatment of macular oedema secondary to retinal vein occlusion

BackgroundAfter the Pharmacy and Therapeutics Committee of a tertiary hospital had evaluated ranibizumab and bevacizumab for the treatment of macular oedema secondary to retinal vein occlusion (RVO) based on the...

Pitfalls of calculating hospital readmission rates based on nonvalidated administrative data sets

Object Administrative databases are increasingly being used to establish benchmarks for quality of care and to compare performance across peer hospitals. As proposals for accountable care organizations are being developed, readmission rates will be increasingly scrutinized. The purpose of the present study was to assess whether the all-cause readmissions rate appropriately reflects the University of California, San Francisco (UCSF) Medical Center hospital's clinically relevant readmission rate for spine surgery patients and to identify predictors of readmission. Methods Data for 5780 consecutive patient encounters managed by 10 spine surgeons at UCSF Medical Center from October 2007 to June 2011 were abstracted from the University HealthSystem Consortium (UHC) using the Clinical Data Base/Resource Manager. Of these 5780 patient encounters, 281 patients (4.9%) were rehospitalized within 30 days of the previous discharge date. The authors performed an independent chart review to determine clinically relevant reasons for readmission and extracted hospital administrative data to calculate direct costs. Univariate logistic regression analysis was used to evaluate possible predictors of readmission. The two-sample t-test was used to examine the difference in direct cost between readmission and nonreadmission cases. Results The main reasons for readmission were infection (39.8%), nonoperative management (13.4%), and planned staged surgery (12.4%). The current all-cause readmission algorithm resulted in an artificially high readmission rate from the clinician's point of view. Based on the authors' manual chart review, 69 cases (25% of the 281 total readmissions) should be excluded because 39 cases (13.9%) were planned staged procedures; 16 cases (5.7%) were unrelated to spine surgery; and 14 surgical cases (5.0%) were cancelled or rescheduled at index admission due to unpredictable reasons. When these 69 cases are excluded, the direct cost of readmission is reduced by 29%. The cost variance is in excess of $3 million. Predictors of readmission were admission status (p < 0.0001), length of stay (p = 0.0001), risk of death (p < 0.0001), and age (p = 0.021). Conclusions The authors' findings identify the potential pitfalls in the calculation of readmission rates from administrative data sets. Benchmarking algorithms for defining hospitals' readmission rates must take into account planned staged surgery and eliminate unrelated reasons for readmission. When this is implemented in the calculation method, the readmission rate will be more accurate. Current tools overestimate the clinically relevant readmission rate and cost.

On The Direct Costs of REIT SEOs

This study examines the determinants of direct costs for real estate investment trust (REIT) seasoned equity offerings. These costs are not related to information asymmetries, unlike non- REIT firms. Gross spreads vary inversely with stock liquidity, price, and industry activity. Concerning REIT-specific heterogeneity, gross spreads are generally insensitive to property type and operating partnership structure. Still, the findings suggest managers can influence costs as higher fees are directly related to the use of underwriting syndicates and more reputable investment banks. Finally, a test for differences in direct costs across REIT and comparable industrials shows significantly lower direct issuance costs for REITs.

Psychiatric comorbidity as predictor of costs in back pain patients undergoing disc surgery: a longitudinal observational study

BackgroundPsychiatric comorbidity is common in back pain patients undergoing disc surgery and increases economic costs in many areas of health. The objective of this study was to analyse psychiatric comorbidity as predictor of direct and indirect costs in back pain patients undergoing disc surgery in a longitudinal study design.MethodsA sample of 531 back pain patients was interviewed after an initial disc surgery (T0), 3 months (T1) and 15 months (T2) using the Composite International Diagnostic Interview to assess psychiatric comorbidity and a modified version of the Client Sociodemographic and Service Receipt Inventory to assess resource utilization and lost productivity for a 3-month period prior interview. Health care utilization was monetarily valued by unit costs and productivity by labour costs. Costs were analysed using random coefficient models and bootstrap techniques.ResultsPsychiatric comorbidity was associated with significantly (p < 0.05) increased direct (+664 Euro) and indirect costs (+808 Euro) at T0. The direct cost difference predominantly resulted from medical health care utilization and was nearly unchanged at T2. Further important cost predictors were clinical variables like the presence of chronic medical disease, the number of previous disc surgeries, and time and gender.ConclusionPsychiatric comorbidity presents an important predictor of direct and indirect costs in back pain patients undergoing disc surgery, even if patients do not utilize mental health care. This effect seems to be stable over time. More attention should be given to psychiatric comorbidity and cost-effective treatments should be applied to treat psychiatric comorbidity in back pain patients undergoing disc surgery to reduce health care utilization and costs associated with psychiatric comorbidity.

Robotic-Assisted or Minithoracotomy Incision for Left Ventricular Lead Placement a Single-Surgeon, Single-Center Experience

Left ventricular (LV) resynchronization with epicardial lead placement after failed coronary sinus cannulation can be achieved with minimally invasive robotic-assisted (RA) or minithoracotomy (MT) incisions. We evaluated early outcomes and costs after RA and MT epicardial LV lead implantation at our academic center. From 2005 to 2010, 24 patients underwent minimally invasive RA or MT epicardial LV lead placement for resynchronization. Patient characteristics, electrophysiologic features, outcomes, and costs were analyzed. Ten patients underwent RA and 14 underwent MT minimally invasive LV lead placement, with no 30-day mortality in either group. Younger patients underwent RA epicardial lead placement (63.8 ± 15.4 vs 75.6 ± 10.0 years; P = 0.03). In addition, although both groups had comparable body surface areas, RA patients had significantly higher body mass index versus MT patients (44.4 ± 17.5 vs 26.9 ± 7.1 kg/m, respectively; P = 0.003). Premorbid risk and cardiovascular profiles were similar across groups. Importantly, pacing threshold, impedance, and postoperative QRS interval were equivalent between groups. Significantly, both operating room and mechanical ventilation durations were higher with RA epicardial placement (P < 0.001). Despite equivalent outcomes, incision-to-closure interval was 48 minutes shorter with MT (P = 0.002). Absolute differences in direct costs between groups were negligible. Despite these differences, resource utilization and lengths of stay were equivalent. Epicardial LV lead placement is efficacious with either approach. Early outcomes and mortality are equivalent. Greater tactile feedback during operation and equivalent short-term outcomes suggest that MT minimally invasive LV lead placement is the more favorable approach for epicardial resynchronization.

E‐health in caring for patients with atopic dermatitis: a randomized controlled cost‐effectiveness study of internet‐guided monitoring and online self‐management training

The Dermatology Department of the University Medical Centre Utrecht, the Netherlands, developed an e-health portal for patients with atopic dermatitis (AD), consisting of e-consultation, a patient-tailored website, monitoring and self-management training. To determine the cost-effectiveness of individualized e-health compared with usual face-to-face care for children and adults with AD. A randomized controlled cost-effectiveness study from a societal perspective in adults and parents of children with moderate AD. Outcomes were quality of life, severity of AD, itching and direct and indirect costs. Data were collected at baseline and at 3 and 12 months after randomization. Linear mixed models were used to analyse clinical outcomes. After multiple imputation of missing data, costs and differences in costs were calculated over a period of 1 year. In total, 199 patients were included. There were no significant differences in disease-specific quality of life, severity of AD and intensity of itching between both groups at the three time points. The difference in direct costs between the intervention and control groups was €24 [95% confidence interval (CI) -360 to 383], whereas this difference was -€618 (95% CI -2502 to 1143) for indirect costs. Overall, individual e-health was expected to save €594 (95% CI -2545 to 1227) per patient in the first year of treatment, mainly through a reduction in work absenteeism. Uncertainty analyses revealed that the probability of e-health reducing costs was estimated to be ≥ 73%. E-health during follow-up of patients with AD is, after initial diagnosis and treatment during face-to-face contact, just as effective as usual face-to-face care with regard to quality of life and severity of disease. However, when costs are considered, e-health is likely to result in substantial cost savings. Therefore, e-health is a valuable service for patients with AD.

The economic costs of malaria in four Kenyan districts: do household costs differ by disease endemicity?

BackgroundMalaria inflicts significant costs on households and on the economy of malaria endemic countries. There is also evidence that the economic burden is higher among the poorest in a population, and that cost burdens differ significantly between wet and dry seasons. What is not clear is whether, and how, the economic burden of malaria differs by disease endemicity. The need to account for geographical and epidemiological differences in the estimation of the social and economic burden of malaria is well recognized, but there is limited data, if any, to support this argument. This study sought to contribute towards filling this gap by comparing malaria cost burdens in four Kenyan districts of different endemicity.MethodsA cross-sectional household survey was conducted during the peak malaria transmission season in the poorest areas in four Kenyan districts with differing malaria transmission patterns (n = 179 households in Bondo; 205 Gucha; 184 Kwale; 141 Makueni).FindingsThere were significant differences in duration of fever, perception of fever severity and cost burdens. Fever episodes among adults and children over five years in Gucha and Makueni districts (highland endemic and low acute transmission districts respectively) lasted significantly longer than episodes reported in Bondo and Kwale districts (high perennial transmission and seasonal, intense transmission, respectively). Perceptions of illness severity also differed between districts: fevers reported among older children and adults in Gucha and Makueni districts were reported as severe compared to those reported in the other districts. Indirect and total costs differed significantly between districts but differences in direct costs were not significant. Total household costs were highest in Makueni (US$ 19.6 per month) and lowest in Bondo (US$ 9.2 per month).ConclusionsCost burdens are the product of complex relationships between social, economic and epidemiological factors. The cost data presented in this study reflect transmission patterns in the four districts, suggesting that a relationship between costs burdens and the nature of transmission might exist, and that the same warrants more attention from researchers and policy makers.

The direct costs of untreated comorbid insomnia in a managed care population with major depressive disorder

Objectives:Previous research has shown that untreated insomnia has significant direct and indirect burden. Despite the high comorbidity of insomnia and Major Depressive Disorder (MDD), no studies have attempted to determine the economic costs among patients diagnosed with MDD and insomnia. The purpose of this study was to estimate the economic burden of comorbid untreated insomnia within an adult and elderly population with MDD.Design:A retrospective, observational study comparing direct health care costs in insomnia patients with MDD to a matched non-insomniacs group with MDD that had MDD and no insomnia. Data was from taken from managed care claims database in the United States.Measurements and results:A large managed care claims database was used to identify MDD subjects (aged ≥18 years) anytime between 01/01/1998 to 11/30/2007 using MDD-specific ICD-9-CM diagnoses. Insomniacs with MDD (n = 38,213) were selected from this cohort using insomnia-specific ICD-9-CM codes or hypnotic use. Costs were calculated for the twelve months prior to initiating insomnia treatment/diagnosis. Direct costs were compared with 1:1 matched non-insomniacs with MDD. Total direct costs included inpatient, outpatient, emergency room (ER) and drug costs. Cost outcomes were analyzed using a generalized linear model with gamma distribution and log link, and GEE estimation. Insomniacs with MDD had statistically greater (p < 0.01) total outpatient visits 8.34 (SE = 0.04) vs non-insomniacs with MDD 7.26 (SE = 0.04); MDD-related visits 3.9 (SE = 0.04) vs non-insomniacs with MDD 2.1 (SE = 0.02); and antidepressant prescriptions 5.0 (SE = 0.03) vs non-insomniacs with MDD 4.2 (SE = 0.03). Overall direct costs for insomniacs with MDD were significantly (p < 0.001) higher than non-insomniacs with MDD ($4858 vs $4007). Similar direct cost differences ($1007) were found in a sample of elderly (aged ≥65 years) patients (n = 2756) mean age = 75.6 yrs.Conclusions:Untreated insomnia within an adult and elderly comorbid MDD population is associated with higher MDD-related and overall direct costs compared to MDD without insomnia. Key limitations associated with this study make it likely that the direct costs and appearance of comorbidities may have been underestimated. These include that: the non-insomnia with MDD group may have untreated/undiagnosed insomnia; some identified cases were likely treated with over-the-counter or behavioral treatment; and that other drugs may have been used for insomnia were not considered for this study and may have been taken for another condition. Future research needs to determine whether treating comorbid insomnia within a MDD population is cost-effective.

The influence of body mass index on the cost of radical prostatectomy for prostate cancer

to evaluate the impact of obesity on the costs of robotic-assisted (RALP), laparoscopic (LRP) and open retropubic radical prostatectomy (RRP). the charts of 629 patients who underwent RP (262 RALP, 211 LRP and 156 RRP) between September 2003 and April 2008 at our institution were reviewed. Clinical and pathological data were collected, including age, American Society of Anesthesiologists score, body mass index (BMI), tumour stage, complications and length of stay. Direct and component costs (anaesthesia, laboratory, operating room service, radiology, room and board, pharmacy and surgical supplies) were obtained. Differences in costs were evaluated using three BMI categories (<25, normal weight; 25-<30, overweight; and ≥30 kg/m(2) , obese). of 629 patients, 136 (21.6%) had normal weight, 320 (50.9%) were overweight, and 173 (27.5%) were obese. Clinical and pathological characteristics were similar in the three BMI categories of the entire cohort. The median direct cost was higher for obese patients (P= 0.035). On further stratification by type of RP, costs were higher amongst obese than the other groups undergoing LRP (median US$5703 vs $5347; P= 0.002) and RRP (median $4885 vs $4377; P= 0.004). In patients who underwent RALP there were no significant differences in direct costs (median $6761 in obese vs $6745 in non-obese; P= 0.64). obesity influenced the costs in patients who underwent LRP and RRP, mainly due to increased operating room service and anaesthesia costs in obese patients. RALP can be performed with no additional financial burden in obese patients.

Determinants of Direct Cost Differences among US Employees with Major Depressive Disorders Using Antidepressants

To understand factors driving the economic burden of major depressive disorder (MDD) patients with different treatment regimens, by evaluating the relationship between medical profiles and treatment costs. Claims data for US privately insured employees (1999-2004) were analysed. Analysis included adult employees with >/=1 diagnosis of MDD and >/=1 prescription for specific antidepressants following a 6-month washout period. Patients were first classified into treatment pattern groups (switchers/discontinuers/maintainers/augmenters), then stratified into mutually exclusive treatment groups - nonstable, stable and intermediate - based on evidence of stability in treatment therapy. Rates of mental and physical co-morbidities, injuries/accidents, substance abuse and urgent care use were analysed across treatment pattern groups. Direct (medical/drug) costs were calculated per patient per year and disaggregated into depression- and non-depression-related components. A two-part multivariate model controlled for baseline characteristics. Costs were also estimated for patients with MDD only, patients with MDD and generalized anxiety disorder (GAD), and patients with MDD and any type of anxiety. Annual per patient adjusted costs (year 2005 values) were significantly lower among stable patients ($US6215) than among intermediate ($US7317) and nonstable patients ($US9948; p < 0.001). Stable patients also had lower depression- and non-depression-related costs. Patients with MDD and comorbid GAD or any type of anxiety had significantly higher costs than MDD-only patients. Nonstability of treatment is associated with higher comorbidity rates, more urgent care use and higher total, depression- and non-depression-related direct costs. The stable group represents continuity of care and is associated with significant cost savings. Co-morbidities are associated with increased costs.

Cost of treatment of schizophrenia in six European countries

Background and aims As part of an RCT in six European sites, the direct mental health care cost for 422 patients with schizophrenia was analysed according to how total and medication costs differed across sites and which variables were likely to predict total or service-specific costs. Method Service use was recorded continuously during a 12-month follow-up. Prescribed psychotropic medication was recorded at baseline and 12 months later. Service use data were transformed into EURO, log-transformed and analysed using linear regression models. Results Although samples were homogeneous, large inter-site cost differences were found (annual means ranging from 2958 € in Spain up to 36978 € in Switzerland). Psychopharmacologic costs were much more constant across sites than costs for other services. Total costs were associated more with region or socio-demographic characteristics than with disorder related parameters. Conclusions The findings confirm remarkable differences in direct costs of patients with schizophrenia across Europe. However, the relative stability of medication costs suggests a need to analyse mechanisms that influence service-specific costs for schizophrenia.

Annual Direct and Indirect Cost of Illness in Employees with Irritable Bowel Syndrome Plus Constipation

Purpose: To assess the annual direct and indirect cost of illness for irritable bowel syndrome plus constipation (IBS+C) among U.S.-based employees. Methods: A retrospective analysis was conducted using the Human Capital Management Services Research database, which contains employee data from 2001–2005 sourced from multiple U.S.-based employers. Data fields included medical, pharmacy, payroll, work absence (where available), and demographics. The IBS+C cohort consisted of employees identified with ICD-9 Codes 564.0 (Constipation), 564.00 (Unspecified), 564.01 (Slow Transit), or 564.09 (Other) co-occuring with 564.1x (IBS) in the same year. Employees with no claims for these codes comprised the Control cohort. The annual measurement period for each IBS+C subject began 3 months prior to the first date of service associated with IBS or C. For controls, the index date was the average index date of subjects with IBS+C. Two-part regression modeling was used to determine the annual cost differences between IBS+C and Control cohorts while controlling for age, job tenure, gender, salary, region, and Charlson Comorbidity Index score. Direct (inpatient and outpatient visits, prescription drug) and indirect (sick leave, and short-term disability [STD]) costs were analyzed. Results: Data were available for 296,154 employees. IBS+C employees compared to Controls were more frequently (P < 0.05) female (80.2% vs. 42.0%), not married (51.8% vs. 43.8%), and employed full time (95.5% vs. 88.6%). All annual cost outcomes comparisons (Table) were statistically greater in the IBS+C cohort (P < 0.05). IBS+C was associated with an annual mean incremental direct cost versus controls totaling $3,590; medical costs accounted for 80% of the direct cost difference and prescription drug costs 20%. IBS+C was also associated with $702 incremental indirect costs. IBS+C contributed 1.89 incremental sick leave days (P < 0.05) but differences in STD days were not significant.TableConclusion: IBS+C is associated with significant cost and absenteeism; in this study, the majority of total incremental costs were direct medical.

Direct cost differences of severe sepsis between survivors and non-survivors on day 1 of intensive care admission

Az intenzív osztályok forgalmának jelentős részét teszik ki a súlyos szepszissel felvett betegek, akiknek komplex kezelése magas költséggel és magas mortalitással párosul. Célkitűzés: A tanulmány célja annak vizsgálata, hogy a betegellátással összefüggő költségek szempontjából jelentkezik-e már az első ápolási napon különbség a gyógyult és a meghalt betegek között. Módszer: A tanulmányban 6 intenzív osztály vett részt, melyek összesen 70, súlyos szepszis miatt osztályukra felvett beteget vontak be a vizsgálatba. Az osztályok a bevont betegekről kigyűjtötték a betegellátással összefüggő intenzív osztályos anyag- és eszközfelhasználást a felvételt követő első 24 órában. Összesen 59, betegellátással összefüggő költségelem felhasználását gyűjtötték ki és csoportosították, úgymint radiológia, laboratóriumi vizsgálatok és egyszer használatos eszközök. A vérkészítmények és a gyógyszerek/infúziók esetében teljes, tételes adatgyűjtés történt. Az egységes költségmeghatározás érdekében a felhasznált költségelemekhez a szerzők adtak költségértékeket. Eredmények: A súlyos szepszis intenzív osztályos mortalitása ebben a mintában 64%-os volt, az átlag ápolási napok száma a gyógyult betegeknél 19,9 (SD ± 11,4), a meghaltaknál 13,0 (SD ± 8,5). A betegellátással összefüggő (direkt) első napi költség átlag 60 957 Ft-ot tett ki, a meghaltaknál szignifikánsan többet, mint a gyógyult betegeknél (70 835 Ft vs 40 108 Ft, p = 0,020). Költségcsoportokra bontva, a meghalt betegek magasabb direkt költségét a vérkészítmények ( p = 0,047) és a gyógyszerek/infúziók okozzák ( p = 0,003). A meghalt betegek magasabb gyógyszer- és/vagy infúzióköltségéért a kolloidok ( p = 0,016) és a költségesebb antibiotikumok használata ( p = 0,021) felelős. Következtetések: Nemzetközi összehasonlításban a súlyos szepszis mortalitása magasabb, a szepsziskezelés napi költsége alacsonyabb Magyarországon. A meghalt betegek közel kétszer magasabb első napi költsége alátámasztja a korai diagnózis és a hatékony kezelés szükségességét.