Differences In Medical Costs Research Articles

Medical care and lost work day costs in musculoskeletal disorders: Older versus younger workers

Occupational and non-occupational medical care and wage compensation costs for musculoskeletal disorders among older and younger workers are described. We found no significant difference in medical care costs between the groups but older workers incurred significantly more lost work days and wage replacement payments.

Six-month management of patients following treatment for gastroesophageal reflux disease symptoms - a Norwegian randomized, prospective study comparing the costs and effectiveness of esomeprazole and ranitidine treatment strategies in a general medical pr

This study assesses the difference in direct medical costs between on-demand treatment with esomeprazole 20 mg, continuous treatment with esomeprazole 20 mg once-daily and continuous treatment with ranitidine 150 mg twice-daily to prevent symptomatic relapse in patients with gastroesophageal reflux disease over 26 weeks. Two hundred eighty-one GP clinics in Norway enrolled 2156 patients to an open, randomized, parallel group, Norwegian society perspective study during 2000-2001. The total direct medical costs of each strategy were 171.9 Euros for on-demand esomeprazole (n = 634), 221.6 Euros for ranitidine (n = 610) and 248.8 Euros for continuous esomeprazole (n = 658). The total costs for on-demand and continuous esomeprazole treatment and ranitidine treatment were 221.5, 286.5 and 295.8 Euros, respectively. The highest proportion of costs was because of the study medication cost in each strategy. The on-demand and continuous treatment strategies with esomeprazole were found to be cost-effective, compared with ranitidine.

Comorbidities and Costs of Adult Patients Diagnosed with Attention-Deficit Hyperactivity Disorder

The purpose of this retrospective study was to examine the prevalence of comorbidities, resource use, direct medical costs, and the costs associated with missed work for adults diagnosed with attention-deficit hyperactivity disorder (ADHD). From a large claims database that captures inpatient, outpatient and prescription drug services, individuals diagnosed with ADHD between the years 1999 and 2001 were retrospectively identified. The ADHD cohort (n = 2252) were matched with a non-ADHD cohort (n = 2252) on a 1 : 1 ratio, based upon age, gender, metropolitan statistical area and type of insurance coverage. The ADHD cohort was compared with the non-ADHD cohort for differences in comorbidities and direct medical costs (inpatient, outpatient and prescription drug costs) using year 2001 prices. Using data from six Fortune 200 employers, time missed from work and costs associated with absenteeism, short-term disability and worker's compensation was examined for a subsample (n = 354) of the employees diagnosed with ADHD. Chi-square and t-statistics were used to compare the ADHD population with the control group with regards to comorbidites and service use. Analysis of covariance and multivariate regressions were used to examine differences in days missed from work, direct medical costs and costs associated with missed work. Adults diagnosed with ADHD were significantly more likely to have a comorbid diagnosis of asthma (p = 0.0014), anxiety (p < 0.0001), bipolar disorder (p < 0.0001), depression (p < 0.0001), drug or alcohol abuse (p < 0.0001), antisocial disorder (p = 0.0081) or oppositional disorder (p = 0.0022) compared with the control group. Controlling for the impact of comorbidities, adults diagnosed with ADHD had significantly higher outpatient costs (USD 3009 vs USD 1492; p < 0.0001), inpatient costs (USD 1259 vs USD 514; p < 0.0001), prescription drug costs (USD 1673 vs USD 1008; p < 0.0001), and total medical costs (USD 5651 vs USD 2771; p < 0.0001) compared with the non-ADHD cohort. Employees diagnosed with ADHD missed significantly more days due to 'unofficial' absences (4.33 days vs 1.13 days; p < 0.0001). The results demonstrate that adults diagnosed with ADHD have a higher prevalence of comorbidities, higher medical costs and more absences than matched individuals without ADHD. These findings suggest that there may be an opportunity for the effective treatment of ADHD to lead to cost-offsets.

Cost Comparison of Surgery vs Organ Preservation for Laryngeal Cancer

To perform a cost minimization analysis of total laryngectomy with postoperative radiotherapy vs induction chemotherapy with subsequent radiotherapy in patients with advanced (stage III or IV) squamous cell carcinoma of the larynx. Decision-analysis model using data from peer-reviewed trials, case series, meta-analyses, and Medicare diagnosis related group reimbursement rates. A hypothetical cohort of patients with stage III or IV laryngeal cancer. The perspective is that of a health care payer. The hypothetical patient cohort could receive (1) surgery (total laryngectomy) with postoperative radiotherapy or (2) induction chemotherapy (fluorouracil and cisplatin) with radiotherapy followed by salvage surgery for patients failing to respond to chemotherapy. Overall difference in direct medical costs in 2003 US dollars between the 2 treatment arms from initiation to completion of treatment. In the baseline analysis, the direct medical costs for the surgical arm were 30,138 US dollars per patient. For the organ preservation arm, the direct medical costs were 33,052 US dollars per patient. The finding that the surgical arm costs were lower was robust to all sensitivity analyses except for the extreme low estimate for the cost of chemotherapy. Our results suggest that total laryngectomy with postoperative radiotherapy costs nearly 3000 US dollars less than organ preservation treatment for advanced laryngeal cancer. Given that survival appears equivalent between the 2 modalities, cost consideration and patient preference may be important factors in decision making for the treatment of advanced laryngeal cancer.

Association between Lifestyle-Disease Diagnosis or Risk Status and Medical Care Costs in a Japanese Corporation

This study examined the differences in medical care costs among (1) individuals who carried the diagnosis of selected lifestyle diseases (diabetes mellitus, hypertension, and hyperlipidemia), (2) individuals whose levels of risks (blood glucose, blood pressure, and total cholesterol) satisfied the diagnosis guidelines yet who did not carry the diagnoses, (3) individuals who had these risks but whose risk levels were not high enough to satisfy the diagnosis guidelines, and (4) individuals without the risks. A one-time cross-sectional design was used. Health checkup data and medical-claims data obtained from the fiscal year 2000 were examined for correlations. A total of 3292 employees aged 34 years and older were selected from the entire employee population of 6543 in a Japanese corporation. Employees younger than 34 years old were excluded because their clinical risk data were not available. On the basis of their absence or presence of diagnoses (obtained from medical claims) and underlying risk levels (obtained from health checkups), employees were categorized into (1) the diagnosed group, (2) the extremely high-risk group, (3) the high-risk group, or (4) the no-risk group. Reimbursement points on medical care claims were summed for each individual during the study period and multiplied by 10 to calculate the total medical care costs, as each point in the reimbursement request form represents 10 yen. The high-cost case analysis was used. First, the high costs were determined as the costs at or above the 90th percentile. The diagnosis or risk status was examined in its relation to the newly created dichotomous variable (whether the medical costs were at or above the threshold or were lower than the threshold) by using a chi2 test. Furthermore, excluding the diagnosed group, a chi2 test was performed to examine the relationships between the levels of risk and the likelihood of incurring any medical care costs (use vs. nonuse). Approximately 15% of employees were already diagnosed with at least one of the three diseases (the diagnosed group; n = 490). One-quarter of employees had at least one risk that was high enough to be diagnosed with the corresponding disease if they had sought medical care (the extremely high-risk group; n = 809). There were 1343 employees in the high-risk group and 650 employees in the no-risk group. The diagnosed group had much higher chances of incurring medical care costs at or above the 90th percentile than did any other risk or no-risk group. No difference among the three risk or no-risk groups was found in mean medical care costs or in the likelihood of any use of medical care services after controlling for the effect of diagnosis. In a Japanese employee population, the diagnosis status of diabetes mellitus, hyperlipidemia, and hypertension was found to be associated with higher medical care costs while risk levels for the diseases were not in a 1-year time period.

Cost comparison of two surgical strategies in the treatment of breast cancer: Sentinel lymph node biopsy versus axillary lymph node dissection

The feasibility and accuracy of sentinel lymph node biopsy (SLNB) in the treatment of breast cancer is widely acknowledged today. The aim of our study was to compare the hospital-related costs of this strategy with those of conventional axillary lymph node dissection (ALND). A retrospective study was carried out to determine the total direct medical costs for each of the two medical strategies. Two patient samples (n = 43 for ALND; n = 48 for SLNB) were selected at random among breast cancer patients at the Centre Leon Bérard, a comprehensive cancer treatment center in Lyon, France. Costs related to ALND carried out after SLNB (either immediately or at a later date) were included in SLNB costs (n = 18 of 48 patients). Total direct medical costs were significantly different in the two groups (median 1965.86 Euro versus 1429.93 Euro, p = 0.0076, Mann-Whitney U-test). The total cost for SLNB decreased even further for patients who underwent SLNB alone (median, 1,301Euro). Despite the high cost of anatomic pathology examinations and nuclear medicine (both favorable to ALND), the difference in direct medical costs for the two strategies was primarily due to the length of hospitalization, which differs significantly depending on the technique used (9-day median for ALND versus 3 days for SLNB, p < 0.0001). A lower morbidity rate is favorable to the generalization of SLNB, when the patient's clinical state allows for it. From an economic point of view, SLNB also seems to be preferred, particularly because our results confirm those found in two published studies concerning the cost of SLNB.

RX4 A DYNAMIC MODEL OF BUDGET IMPACT ANALYSES

intervention letters on the recurrence of exceptions, multiple regression models were developed using prescriber-level mean time (in days) between exceptions. In addition, the effect on medical costs and utilization was measured for a subset of data using a pre-post design with a control group. Pre-post periods were defined as 120 days before and after the date of intervention letters dated between May 1 and August 31, 2003. Controls were selected by matching to intervention cases using the propensity score methods. Sensitivity analysis was performed using varying time windows and bootstrap samples. Outcomes related to PMPM inpatient admissions, emergency room visits, and physician office visits were analyzed. RESULTS: Of 51,214 prescribers who had two or more exceptions during the 23-month time period, 6233 (12%) were randomly selected to receive intervention letters (ranging from one to 19). Model coefficients indicated that the time to exception was longer by 6.5 days (p < 0.001) as prescribers received additional intervention letters, after adjusting for the number of exceptions, severity level, and average patient age. There were no significant differences in medication costs from pre to post time periods, or between groups (study vs. control). However, the study group had fewer PMPM inpatient admissions and emergency room visits. CONCLUSIONS: Retrospective drug utilization review processes can have a positive effect in delaying next exceptions for prescribers and reducing utilization of health care services.

Expectations, Outcomes, and Medical Costs in Patients with Low Back Pain Referred to Physical Therapy

To describe treatment expectations among patients referred to physical therapy (PT) for low back pain (LBP) and to examine the relationship among expectations, outcomes, and medical care costs, 111 patients referred to PT for LBP within a managed care environment were studied in a prospective cohort study. Both χ2 and Student's t tests, as well as one-way analyses of variance, were used to assess bivariate differences in expectations, outcomes, and medical costs. A backward-stepping multivariate regression algorithm was used to assess the role of expectations, controlling for patient characteristics on (1) the change in patient-reported improvement between admission and discharge, and (2) annual medical expenditures. Patients' treatment expectations, pain levels, and functional levels were measured at the initial PT visit. Pain and functional status were also measured at PT discharge. Medical care expenditures were compiled for the 12 months following PT referral. Patients with the highest level of expect...

PDB1: DIABETIC MANAGEMENT THROUGH ORAL GLUCOSE LOWERING AGENTS: TREATMENT PATTERN, COST AND UTILIZATION ANALYSIS

OBJECTIVES: Assess the treatment progression of Type 2 diabetic patients taking glimepiride, glipizide xl, and/or metformin as initial monotherapy and the impact these agents have on the cost and utilization of health care services. METHOD: Medical and pharmacy claims data for 7,585 patients meeting inclusion criteria were collected from a national managed care database representing 6 million lives in 23 US health plans and 8 geographic regions over a 4 year period. Cohorts by agents were created based on diabetes type and initial treatment agent. Cost and utilization analysis included evaluation of patients by age, gender, geographic region, type of medical service and provider speciality. Diagnosis codes were used to differentiate between all health care services and disease related services. Treatment analysis evaluated treatment progression, compliance with therapy and dose progression. Treatment efficacy and practice patterns in five possible outcomes were defined for each cohort. RESULTS: The highest proportion of patients in each cohort remained on the initial therapy. Combination therapy was the most frequent therapeutic choice for patients failing monotherapy. Evaluation of the maximum daily dose (MDD) showed patients who were switched to an alternate agent of the same class reached 41–48% of MDD, a different class 49–57% MDD and combination therapy 57–72% MDD. Compliance was consistent. The combination therapy cohorts tended to have significantly higher (p < .05) pharmacy costs than the monotherapy cohorts. The study did not conclusively support differences in medical costs between the cohorts. CONCLUSION: Therapy in all cohorts changed before MDD of the original agent was attempted. Patients in each cohort progressed to insulin monotherapy without a recommended trial of combination agents. Although pharmacy and medical costs influence the total cost of diabetic care, there was no significant difference in medical costs identified. Cost differences were driven by pharmacy costs.

Not as much as you think: toward a truer estimate of the difference in direct medical costs between vaginal and cesarean deliveries.

Not as much as you think: toward a truer estimate of the difference in direct medical costs between vaginal and cesarean deliveries.

The estimated economic burden of genital herpes in the United States. An analysis using two costing approaches

BackgroundOnly limited data exist on the costs of genital herpes (GH) in the USA. We estimated the economic burden of GH in the USA using two different costing approaches.MethodsThe first approach was a cross-sectional survey of a sample of primary and secondary care physicians, analyzing health care resource utilization. The second approach was based on the analysis of a large administrative claims data set. Both approaches were used to generate the number of patients with symptomatic GH seeking medical treatment, the average medical expenditures and estimated national costs. Costs were valued from a societal and a third party payer's perspective in 1996 US dollars.ResultsIn the cross-sectional study, based on an estimated 3.1 million symptomatic episodes per year in the USA, the annual direct medical costs were estimated at a maximum of $984 million. Of these costs, 49.7% were caused by drug expenditures, 47.7% by outpatient medical care and 2.6% by hospital costs. Indirect costs accounted for further $214 million. The analysis of 1,565 GH cases from the claims database yielded a minimum national estimate of $283 million direct medical costs.ConclusionsGH appears to be an important public health problem from the health economic point of view. The observed difference in direct medical costs may be explained with the influence of compliance to treatment and possible undersampling of subpopulations in the claims data set. The present study demonstrates the validity of using different approaches in estimating the economic burden of a specific disease to the health care system.

Children With ADHD Incur Wide Range of Medical Costs

Back to table of contents Previous article Next article Health Care EconomicsFull AccessChildren With ADHD Incur Wide Range of Medical CostsChristine LehmannChristine LehmannSearch for more papers by this authorPublished Online:2 Mar 2001https://doi.org/10.1176/pn.36.5.0027The symptoms of inattention, hyperactivity, and impulsivity in children contribute to increased use of the medical system and increased costs, according to researchers who studied the financial burden of ADHD.The results reported in the January 3 Journal of the American Medical Association (JAMA) show that over a nine-year period, the median medical costs for children with ADHD were $4,306 compared with $1,944 for children without ADHD.Principal investigator Cynthia Leibson, Ph.D., told Psychiatric News, “My colleagues and I at the Mayo Clinic were surprised that the difference in medical costs was so great.” Leibson is an assistant professor in the department of health sciences research at the Mayo Clinic in Rochester, Minn.What drives the costs up for children with ADHD are higher rates of admissions to hospital emergency and outpatient departments and visits to primary care physicians. The study excluded the costs of treatment by psychiatrists and mental health professionals.Leibson and her colleagues began following 4,880 children in Rochester, Minn., with a median age of 7 years from 1987 through 1995. By the end of that period, the sample had decreased to 4,119. Of those children, 309 were classified as having ADHD based on a retrospective review of the children’s records by a trained professional in consultation with a developmental behavioral pediatrician.The researchers further classified the ADHD cases as “definite” or “probable.” The criteria for a definite case were a clinical diagnosis and positive results from a parent or teacher questionnaire. A probable case had to meet only one of the two criteria, according to the authors.When the authors excluded the probable cases of ADHD from their analysis, they found a similar significant difference in medical costs between the group with ADHD and the group without ADHD.The researchers obtained the children’s medical and school records, which provided information about treatment, delivery settings, medical diagnoses, results of clinical and laboratory tests, and questionnaires completed by parents and teachers, among other items. To determine medical costs, the researchers reviewed patient data contained in an electronic billing system used by area hospitals.“We found that children with ADHD had significantly higher rates of multiple medical conditions than the comparison group. These included major injuries, asthma, infections, and psychosocial problems,” according to Leibson.This finding is consistent with several other reports showing that, compared with the general population, individuals with ADHD experience higher rates of psychosocial comorbidity, chronic health conditions, and adverse outcomes including substance abuse, poisoning, fractures, and automobile collisions, according to Leibson and her colleagues.The authors acknowledged that the study has limitations. Among them is that costs for prescription drugs were excluded in addition to treatment costs for psychiatrists and mental health professionals. The authors believe that the impact of excluding outpatient drug costs was greater than excluding outpatient psychiatric treatment costs because only a small number of children with ADHD were seen by mental health professionals or psychiatrists in private practice.Nonetheless, the findings have implications for individuals with ADHD, their parents, and health care providers, payers, and policymakers, said Leibson.“Children and adolescents with ADHD and their parents and teachers should be aware of the increased likelihood of injuries and emergency room visits and remain alert to risky situations. Clinicians should look for conditions we found to be associated with ADHD,” said Leibson. “Policymakers, providers, and third-party payers need to ensure adequate access to medical care and delivery of services to meet the needs of patients and families affected by ADHD.”She recommended that further research be done on cost-effective prevention measures and treatment of ADHD and related conditions.An abstract of the study, “Use and Costs of Medical Care for Children and Adolescents With and Without Attention-Deficit/Hyperactivity Disorder” is posted on the Web at jama.ama-assn.org/issues/v285n1/abs/joc01336.html. ▪ ISSUES NewArchived

The economics of selective serotonin reuptake inhibitors in depression: a critical review.

The prevalence of depression and the high costs associated with its treatment have increased interest in pharmacoeconomic evaluations of drug treatment, particularly in the 1990s as the use of selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors (SSRIs) expanded substantially. This review presents results from specific studies representing the key study designs used to address the pharmacoeconomics of SSRI use: retrospective administrative database analyses, clinical decision analysis models, and randomised clinical trials. Methodological considerations in interpreting results are highlighted. In retrospective administrative database analyses, most comparisons have been made between SSRIs and tricyclic antidepressants (TCAs). A few studies have addressed differences between SSRIs. The studies focused on healthcare cost (to payer) and cost-related outcomes (e.g. treatment duration, drug switching). Although SSRIs are generally associated with higher drug acquisition costs than are TCAs, total healthcare costs are at least offset, if not decreased, by reductions in costs associated with use of SSRIs. Although studies from the early 1990s show some advantage for fluoxetine, the results are limited by use of data from shortly after the introduction of paroxetine and sertraline; studies from the mid- 1990s on that compare drugs within the SSRI class show general equivalence in terms of cost. Important methodological advances are occurring in retrospective studies, with selection bias and other design limitations being addressed statistically. Clinical decision analysis models permit flexibility in terms of ability to specify different alternative treatment scenarios and varying durations. Sensitivity analysis aids interpretability, although model inputs are limited by data availability. Results from short term (1 year duration or less) studies comparing SSRIs and TCAs suggest that SSRIs are more cost effective or that there is no difference. Longer term studies (lifetime Markov models) focus more on the impact of maintenance antidepressant therapy and show more mixed results, generally favouring SSRIs over TCAs. The results indicate that the effect of SSRIs is mainly through prevention of relapse. Important assumptions of these models include fewer serious adverse effects and lower treatment discontinuation rates with SSRIs. Naturalistic clinical trials provide greater generalisability than traditional randomised clinical trials. One naturalistic trial found that nearly half of TCA-treated patients switched to another antidepressant within 6 months; only 20% of SSRI-treated patients switched. Cost differences between groups were minimal. These studies indicate few differences in medical costs, depression outcomes and health-related quality of life between TCAs and fluoxetine, although fewer fluoxetine-treated patients switched treatment.

Costs of juvenile violence: policy implications.

Costs of juvenile violence: policy implications.

Early asthma prophylaxis, natural history, skeletal development and economy (EASE): a pilot randomised controlled trial.

(1) To establish recruitment rates of newly presenting asthmatic children. (2) To establish acceptability of study protocols. (3) To pilot age-specific quality of life (QoL) assessment. (4) To assess short-term (6 months) outcomes of inhaled corticosteroids (ICS) treatment. (5) To refine sample size calculations for a definitive study. A randomised pragmatic longitudinal trial design was used, with no blinding or placebo, to examine early ICS introduction similar to its use in practice. Subjects were assessed at entry, 3 and 6 months. Subjects were recruited from six general practices. Children under 6 years were assessed at the Craig Research and Investigation Unit, Royal Aberdeen Children's Hospital, or their family home, and subjects 6 years and over were assessed at their general practice. Children (aged 6 months-16 years) with symptoms suggestive of asthma/wheeze that had commenced no longer than 12 months before were identified retrospectively and prospectively from general practices. Subjects were also required to be naïve to prophylactic therapy with no other lung disease/concomitant illness. Subjects were randomised to ss2-agonist (ss2-only group) or ss2-agonist and ICS (ICS group) for 6 months. Physicians could later prescribe ICS in controls if needed. (1) Pulmonary function. (2) Asthma symptom diary. (3) Symptomatic health status questionnaire. (4) Caregiver's and child's QoL. (5) Growth. (6) Bone mass. (7) Bone turnover. (8) Economic issues. Of over 15,000 children yielded from general practice records, 11% had symptoms suggestive of asthma/wheeze, and two-thirds of these already used ICS. Of the remaining, 141 subjects met the criterion of early asthma, and 86 were randomised. Two-thirds of those randomised were < 6 years old, the males:females ratio was 2:1, and 67% had a family history of atopy. RESULTS - PHYSIOLOGICAL DEVELOPMENT: Pulmonary function did not significantly improve in the older children. Although tidal breathing measures in the pre-school children were significantly higher at 6 months in the ss2-only group, there was great variability. Incidence of wheeze and night-time cough reduced equally in both groups. Reduction of night-time symptom score and reliever use, and increase in symptom-free days were only significant in the ss2-only group. No significant differences were found in growth and bone mass between the two groups, but bone metabolism was significantly reduced at 6 months in the ICS group. RESULTS - PSYCHOLOGICAL DEVELOPMENT: The caregiver's QoL questionnaire was sensitive to child symptom changes over 3 months, but absolute impact of child symptoms on their QoL varied, whereas the child-centred questionnaire was not sensitive to change. RESULTS - ECONOMICS: There were no significant differences in medical consultation costs between the groups, but, as expected, prescription costs in the ICS group were higher over 6 months. Combined healthcare costs were significantly higher for patients assigned to ICS, but there were no significant differences in any effectiveness measures between the groups. Most (96%) of the proposed sample was recruited, and the low drop-out rate (8%) demonstrated acceptability of the study protocol. Most children first presenting with symptoms suggestive of asthma were < 6 years old and represented a group biased towards mild to moderate asthma, or virally induced wheeze. The caregiver's QoL questionnaire was found to better reflect a child's symptom changes than a child-centred instrument. In the short term, no adverse effects were seen on growth, but ICS treatment significantly reduced bone metabolism. Most of the young children with asthma/wheeze improved over time with ss2-agonist treatment alone, and clinical benefits of early ICS intervention amongst these children were not detected; however, there was inadequate power in this pilot study to establish this. (AB

Health risk influence on medical care costs and utilization among 2,898 municipal employees

Introduction: Although worksite health promotion programs are credited with stabilizing medical benefits costs, research is needed to characterize the medical costs of cohorts with selected health risk factors. The purpose of this study was to compare medical cost outcomes in City of Birmingham, Alabama, employees who differ on selected health risk factors. Methods: Health risk appraisal and medical claims cost data were examined in 2,898 employees participating in health screening during 1992 and 1993. Probit analysis was employed to test the null hypotheses that there are no differences in (1) probability of medical service utilization and (2) probability of medical service cost quartile (high, moderate, and low) between groups characterized by risks. Age, gender, race, education, marital status, and diabetes were included as covariates in each model examined. In addition, smoking habits was included as a covariate in models involving risk taking behavior and psychosocial risk. Results: Significant differences in medical care utilization and costs were found between risk groups based on psychosocial risk, cardiovascular disease risk, and total risk. No association was found between risk-taking behavior and utilization and costs. Conclusion. Subjects reporting psychosocial, cardiovascular disease, and total risk factors were more likely to use medical services and to be in the high or high/moderate cost categories.

Economic evaluation of inhalers used in the treatment of asthma

SummaryAsthma is an important disease for New Zealand in terms of prevalence and costs, both direct and indirect. The objective of this study was to determine if there were any differences in primary care medical costs between treatment of asthma with four corticosteroid inhaler drug delivery systems (Autohaler™ [AUTO], Diskhaler™ [DISK], metered dose inhaler [MDI] and Turbuhaler™ [TURB]) in a general practice setting.The retrospective observational data-based research completed for this study involved a large population and recorded actual general practitioner prescribing practice. The perspective taken was that of the funder of health care. Data were obtained from the computerised clinical records of 28 New Zealand general practices. Cost data were on a per year per patient basis.The largest single cost item identified in this study was that of corticosteroid inhalers which ranged from 41% of total primary care cost for MDI to 52% for the TURB group. Total drug acquisition cost (inclusive of dispensing costs and wholesale and retail markups) was highest for TURB at $490 and lowest for MDI at $265, a difference of 85%. There was less variation in general practitioner consultations for asthma with total costs ranging from $104 for AUTO to $127 for DISK. Total primary care costs were lowest for MDI at $392 per annum and highest for TURB at $608, a difference of 55%. If the MDI total primary care costs are used as the base for an index (MDI total primary care costs set at 100) then AUTO becomes 116, DISK 134 and TURB 155.The model was robust with respect to conclusions relating to cost differences between the treatment groups. In all but one instance TURB remains the highest cost group.

Workers' Compensation Medical Expenditures: Price vs. Quantity

This study compares the medical costs for treating workplace injuries covered by workers' compensation insurance to the costs of treating similar injuries not occurring at work that are covered by group health insurance. Dramatic differences in total medical costs are observed: Medical costs in workers' compensation are double those for similar injuries covered by group health. After controlling for demographic and claimant characteristics, the differences can be entirely explained by a greater utilization of services and a different mix of medical care providers. There is no evidence that health care providers price discriminate or charge workers' compensation claimants any differently for the same services.

A randomized, controlled trial of arthroscopic surgery versus closed‐needle joint lavage for patients with osteoarthritis of the knee

To compare arthroscopic surgery and closed-needle joint lavage for patients with non-end-stage osteoarthritis (OA) of the knee under controlled, experimental conditions. Thirty-two subjects who met specific clinical, radiologic, medical, and rehabilitation criteria were randomized to receive arthroscopic surgery (n = 18) or joint lavage (n = 14). Outcome measures evaluated at baseline and at 3 and 12 months of followup included 3 standard clinical parameters, self-reported pain and functional status (by the Arthritis Impact Measurement Scales), 50-foot walk time, 2 global scales, and direct and indirect medical costs. At 3 months of followup, there were no significant between-group differences in pain, self-reported and observed functional status, and patient and "blinded" physician global assessments. The arthroscopic procedure cost $3,840 more than did closed-needle joint lavage. After 1 year, there were no between-group differences in medication costs, utilization of medical services, or indirect costs related to employment or use of household help. After 1 year, 44% of subjects who underwent arthroscopy reported improvement and 58% of subjects who underwent joint lavage improved. Patients with tears of the anterior two-thirds of the medial meniscus or any lateral meniscus tear had a higher probability of improvement (by "blinded" physician assessment) after arthroscopic surgery (0.63) than did patients with other intraarticular pathology (0.20). The search for and removal of soft tissue abnormalities via arthroscopic surgery does not appear justified for all patients with non-end-stage OA of the knee who fail to respond to conservative therapy, but it may be beneficial for certain subgroups.

Cost-effectiveness of epoetin alfa therapy for anemia of end-stage renal disease

The cost-effectiveness of epoetin alfa therapy for anemia in 20 patients with end-stage renal disease was retrospectively studied. Ten patients on continuous ambulatory peritoneal dialysis (CAPD) were given subcutaneous epoetin alfa as part of a multicenter, protocol-controlled study of the efficacy of epoetin alfa. Ten patients on in-center hemodialysis were given intravenous epoetin alfa as part of their routine clinical care. Change in hematocrit was used as the measure of effectiveness of epoetin alfa. Medication, laboratory, and transfusion costs were monitored for the six months preceding the initiation of epoetin alfa and the first six months of treatment. The cost of therapy increased for all patients by an average of $2722 +/- 1118; transfusion costs decreased, whereas medication and laboratory costs increased. Laboratory costs were significantly greater in CAPD patients than in hemodialysis patients during epoetin alfa therapy; no significant differences in medication costs or transfusion costs were noted between the groups. The mean increase in hematocrit for all patients was 7.4 volume percent. Following the initial change in hematocrit, further therapeutic response did not appear to be determined by increasing expenditures. Epoetin alfa was shown to be effective in treating anemia in patients with end-stage renal disease, but it was associated with higher costs of therapy.