Differences In Annual Expenditures Research Articles

The Road to Recovery the Role of Poverty in the Exposure, Vulnerability and Resilience to Floods in Accra

In June 2015, about 53,000 people were affected by unusually severe floods in Accra, Ghana. The real impact of such a disaster is a product of exposure (“Who was affected?”), vulnerability (“How much did the affected households lose?”), and socioeconomic resilience (“What was their ability to cope and recover?”). This study explores these three dimensions to assess whether poor households were disproportionally affected by the 2015 floods by using household survey data collected in Accra in 2017. It reaches four main conclusions. (1) In the studied area, there is no difference in annual expenditures between the households who were affected and those who were not affected by the flood. (2) Poorer households lost less than their richer neighbors in absolute terms, but more when compared with their annual expenditure level, and poorer households are over-represented among the most severely affected households. (3) More than 30% of the affected households report not having recovered two years after the shock, and the ability of households to recover was driven by the magnitude of their losses, sources of income, and access to coping mechanisms, but not by their poverty, as measured by the annual expenditure level. (4) There is a measurable effect of the flood on behaviors, undermining savings and investment in enterprises. The study concludes with two policy implications. First, flood management could be considered as a component of the poverty-reduction strategy in the city. Second, building resilience is not only about increasing income. It also requires providing the population with coping and recovery mechanisms such as financial instruments. A flood management program needs to be designed to target low-resilience households, such as those with little access to coping and recovery mechanisms.

Chronic pain and health care spending: an analysis of longitudinal data from the Medical Expenditure Panel Survey.

To estimate average incremental health care expenditures associated with chronic pain by health care service category, expanding on prior research that focused on specific pain conditions instead of general pain, excluded low levels of pain, or did not incorporate pain duration. Medical Expenditure Panel Survey (MEPS) data (2008-2011; N = 26,671). Differences in annual expenditures for adults at different levels of pain that interferes with normal work, as measured by the SF-12, were estimated using recycled predictions from two-part logit-generalized linear regression models. "A little bit" of chronic pain-related interference was associated with a $2,498 increase in total adjusted expenditures over no pain interference (p < .0001) and a $1,008 increase over nonchronic pain interference (p = .0001). Moderate and severe chronic pain-related interference was associated with a $3,707 and $5,804 increase in expenditures over no pain interference and a $2,218 and $4,315 increase over nonchronic interference, respectively (p < .0001). Expenditure increases were most pronounced for inpatient and hospital outpatient expenditures compared to other types of health care expenditures. Chronic pain limitations are associated with higher health care expenditures. Results underscore the substantial cost of pain to the health care system.

Deferasirox for myelodysplastic syndrome patients with transfusional iron overload: A budget impact analysis

17019 Background: Myelodysplastic syndromes (MDS) affect 12–20,000 in the US yearly. Blood transfusions, a mainstay of treatment, place MDS patients (pts) at risk for complications of transfusional iron overload (IO). Although recent data suggests iron accumulation significantly reduces survival in low and intermediate -1 risk MDS, incremental cost of adding chelators to health plan formularies are unknown. The economic impact of treating transfusional IO in MDS with two commercially available chelating agents were estimated from a health care plan (hcp) perspective. Methods: An Excel based model was developed to ascertain the incremental cost per treated MDS pt associated with oral deferasirox (DSX) relative to subcutaneous (sq) deferoxamine (DFO). Annual Per Member Per Month (PMPM) cost was calculated by dividing differences in annual expenditures for DSX and DFO by total plan membership. Data from published literature and pivotal clinical trials were used to estimate MDS prevalence and chelation eligibility. Costs associated with infusing sq DFO were based on medical claims analysis from 2001 to 2004. Medication costs were based on wholesale acquisition costs assuming 100% compliance. Sensitivity analyses were performed by varying model parameters. Results: A hcp of one million pts is estimated to have 119 pts with MDS, of which 22% are eligible for iron chelation therapy. The base-case model resulted in an incremental annual saving of $389.48 per treated MDS pt and an incremental budget impact of $0.0 PMPM of the hcp (function of relatively few MDS pts spread over million in hcp) associated with the use of DSX. Overall, 34.2% of DSX cost was offset by the absence of infusion costs, the key cost driver. Sensitivity analyses of varying pt weight and infusion costs showed the model results were robust. Conclusions: The annual budget impact of switching MDS patients with IO to DSX from DFO will potentially result in cost-savings for US health plans. These results should be considered in the selection of chelation therapy. No significant financial relationships to disclose.