Direct Medical Care Costs Research Articles

Incidence and cost of sexual violence in Iowa.

Sexual violence is a serious and costly public health problem. Current research that systematically documents the broad range of economic costs of sexual violence is lacking. To estimate the incidence and costs of sexual violence in Iowa in 2009. Using data obtained from population surveys, six Iowa government agencies, and other sources, we estimated sexual violence incidence, costs per incident, and total costs in 2009 dollars, by age and sexual violence category, and for various cost elements. We calculated direct costs of medical care, mental health care, property damage, victim services, investigation, adjudication, and sanctioning, as well as indirect costs for lost work and quality of life. We collected data in 2010-2011 and completed analysis in 2013. In 2009, an estimated 55,340 individuals experienced sexual violence in Iowa, including 49,510 adults and 5,930 children. Nearly three of every four victims were women. The estimated total cost of sexual violence in 2009 was $4.7 billion, equating to $1,580 per resident. This estimate included $4.44 billion in indirect costs and $265 million in direct costs. In the same year, the government spent an estimated $100.6 million as a result of sexual violence in Iowa, more than half of which ($55.3 million) was spent on perpetrators and little ($0.9 million) on prevention. The economic costs of sexual violence are high for individuals and society. Cost information can help identify the burden of sexual violence relative to other social problems in Iowa and prioritize funding for prevention and intervention.

The economic burden of fracture patients with osteoporosis in western China

To study the cost of osteoporotic fracture in China, we performed a prospective study and compared the costs of the disease in referral patients with fractures in three of the most common sites. Our results indicated that the economic burden of osteoporotic fracture to both Chinese patients and the nation is heavy. This paper aims to study the cost of osteoporotic fracture in China and thus to provide essential information about the burden of this disease to individuals and society. This prospective observational data collection study assessed the cost related to hip, vertebral, and wrist fracture 1year after the fracture based on a patient sample consisting of 938 men and women. Information was collected using patient records, registry sources, and patient interviews. Both direct medical, direct non-medical, and indirect non-medical costs were considered. The annual total costs were highest in hip fracture patients (renminbi, RMB 27,283 or USD 4,330, with confidence interval (RMB 25715, 28851)), followed by patients with vertebral fracture (RMB 21,474 or USD 3,409, with confidence interval (RMB 20082, 22866)) and wrist fracture (RMB 8,828 or USD 1,401, with confidence interval (RMB 7829, 9827)). The direct medical care costs averaged approximately RMB 17,007 per year per patient, of which inpatient costs, drugs, and investigations accounted for the majority of the costs. Nonmedical direct costs were much less compared to direct healthcare costs and averaged approximately RMB 1,846. These results indicate that the economic burden of osteoporotic fracture to both Chinese patients and China was heavy, and the proportion of the costs in China demonstrated many similar features and some significant differences compared to other countries.

Considering bariatric surgery interventions

Obesity is rapidly becoming a major health issue, putting a significant drain on NHS resources and the economy through direct medical and social care costs and loss of productivity. Significant attempts to address obesity through lifestyle modification and pharmacological therapy has had little impact in addressing the problem. The use of bariatric surgery—intragastric balloon and gastric balloon pill—as weight management treatment since the National Institute for Health and Care Excellence (NICE) Guidelines were released in 2002, has seen an exponential growth in the number of people having bariatric surgery interventions. This article looks at the prevalence of obesity; definition, indication, and types of weight reduction interventions and care considerations, pre and post procedure.

Annual financial impact of well‐differentiated thyroid cancer care in the United States

Well-differentiated thyroid cancer (WDTC) is a prevalent disease, which is increasing in incidence faster than any other cancer. Substantial direct medical care costs are related to the diagnosis and treatment of newly diagnosed patients as well as the ongoing surveillance of patients who have a long life expectancy. Prior analyses of the aggregate health care costs attributable to WDTC in the United States have not been reported. A stacked cohort cost analysis was performed on the US population from 1985 to 2013 to estimate the number of WDTC survivors in 2013. Incidence rates, and cancer-specific and overall survival were based on Surveillance, Epidemiology, and End Results (SEER) data. Current and projected direct medical care costs attributable to the care of patients with WDTC were then estimated. Health care-related costs and event probabilities were based on Medicare reimbursement schedules and the literature. Estimated overall societal cost of WDTC care in 2013 for all US patients diagnosed after 1985 is $1.6 billion. Diagnosis, surgery, and adjuvant therapy for newly diagnosed patients (41%) constitutes the greatest proportion of costs, followed by surveillance of survivors (37%), and nonoperative death costs attributable to thyroid cancer care (22%). Projected 2030 costs (in 2013 US dollars) based on current incidence trends exceed $3.5 billion. Health care costs of WDTC are substantial. Unlike other cancers, the majority of the cost is incurred in the initial and continuing phases of care. With the projected increasing incidence, population, and survival trends, costs will continue to escalate.

Direct costs associated with chronic kidney disease among type 2 diabetic patients in India.

The aim of this study was to estimate the direct costs of medical care among hospitalized type 2 diabetic patients with chronic kidney disease (CKD). A total of 209 (M:F, 133:76) patients were divided into groups based on the severity of kidney disease. Group 1 subjects had undergone renal transplantation (n = 12), group 2 was CKD patients on hemodialysis (n = 45), group 3 was patients with CKD, prior to end-stage renal disease (ESRD) (n = 66), and group 4 (n = 86) consisted of subjects without any complications. Details about expenditure per hospitalization, length of stay during admission, direct medical and nonmedical cost, expenditure for the previous two years, and source of bearing the expenditure were recorded in a questionnaire. Diabetic patients with CKD prior to ESRD spend more per hospitalization than patients without any complications. [Median ₹ 12,664 vs. 3,214]. The total median cost of CKD patients on hemodialysis was significantly higher than other CKD patients (INR 61,170 vs. 12,664). The median cost involved in kidney transplantation was ₹ 392,920. The total expenditure for hospital admissions in two years was significantly higher for dialysis than transplantation. Patients on hemodialysis or kidney transplantation tend to stay longer as inpatient admissions. The source of funds for the expenditure was mainly personal savings (46%). The expenditure on hospital admissions for CKD was considerably higher, and so, there is a need to develop a protocol on a cost-effective strategy for the treatment of CKD.

Cost of noninfectious comorbidities in patients with HIV

ObjectivesWe hypothesized that the increased prevalence of noninfectious comorbidities (NICMs) observed among HIV-infected patients may result in increased direct costs of medical care compared to the general population. Our objective was to provide estimates of and describe factors contributing to direct costs for medical care among HIV-infected patients, focusing on NICM care expenditure.MethodsA case-control study analyzing direct medical care costs in 2009. Antiretroviral therapy (ART)-experienced HIV-infected patients (cases) were compared to age, sex, and race-matched adults from the general population, included in the CINECA ARNO database (controls). NICMs evaluated included cardiovascular disease, hypertension, diabetes mellitus, bone fractures, and renal failure. Medical care cost information evaluated included pharmacy, outpatient, and inpatient hospital expenditures. Linear regression models were constructed to evaluate predictors of total care cost for the controls and cases.ResultsThere were 2854 cases and 8562 controls. Mean age was 46 years and 37% were women. We analyzed data from 29,275 drug prescription records. Positive predictors of health care cost in the overall population: HIV infection (β = 2878; confidence interval (CI) = 2001–3755); polypathology (β = 8911; CI = 8356–9466); age (β = 62; CI = 45–79); and ART exposure (β = 18,773; CI = 17,873–19,672). Predictors of health care cost among cases: Center for Disease Control group C (β = 1548; CI = 330–2766); polypathology (β = 11,081; CI = 9447–12,716); age < 50 years (β = 1903; CI = 542–3264); protease inhibitor exposure (per month of use; β = 69; CI = 53–85); CD4 count < 200 cells/mm3 (β = 5438; CI = 3082–7795); and ART drug change (per change; β = 911; CI = 716–1106).ConclusionTotal cost of medical care is higher in cases than controls. Lower medical costs associated with higher CD4 strata are offset by increases in the care costs needed for advancing age, particularly for NICMs.

Economic evaluation ofHLA‐B*15:02 screening for carbamazepine‐induced severe adverse drug reactions inThailand

There is strong evidence of an association between the presence of the human leukocyte antigen (HLA)-B*15:02 and two severe adverse drug reactions-Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)-in patients taking carbamazepine (CBZ), a common treatment for patients with epilepsy and neuropathic pain. As a result, there are calls for all patients that are due to undergo CBZ therapy to be screened for this genetic marker before commencing their therapy. This study aims to determine the value for money of HLA-B*15:02 screening compared to the following: (1) administering CBZ therapy without conducting patient screening, and (2) not prescribing CBZ but alternative drugs that are less likely to result in severe reactions, but that come at a higher cost. An economic evaluation was carried out by using a decision tree and Markov models to examine the cost-utility of providing HLA-B*15:02 screening for all patients with either newly diagnosed epilepsy or neuropathic pain in the Thai setting. All transitional probabilities were derived from the national and international literature. The majority of the data on direct medical care costs were collected from 10 community, provincial, and regional hospitals throughout Thailand. Direct non-medical cost and health-related quality of life (HRQoL) data were obtained from interviews that were conducted with 33 patients, some of whom had experienced severe drug reactions. The incremental cost-effectiveness ratio (ICER) of adopting a universal HLA-B*15:02 screening policy was estimated at 222,000 Thai baht, THB/quality-adjusted life year (QALY) gained for epilepsy patients and 130,000 THB/QALY gained for patients with neuropathic pain. Furthermore, we found that 343 patients need to be tested for HLA-B*15:02 allele to prevent one case of SJS/TEN. Universal HLA-B*15:02 screening represents good value for the money in terms of preventing SJS/TEN in CBZ-treated patients with neuropathic pain at the Thai ceiling ratio of 120,000 THB/QALY gained. However, the prevalence of CBZ-induced SJS/TEN in the Thai population and the positive predictive value (PPV) are major factors that influence the cost-effectiveness of HLA-B*15:02 screening. Therefore, an active surveillance system to make a more accurate assessment of the prevalence CBZ-induced SJS/TEN in the Thai population would enhance the generalizability of the results.

Diagnosis and Management of the Patient with Suspected Dementia in Primary Care

Dementia is a complex progressive syndrome characterised by impairment of cognition (including memory, language, visuospatial skills and executive function), changes in personality and diminished activities of daily living. The impact of dementia is enormous and poses a huge challenge to patients, their carers, society at large and health systems around the world, in terms of the direct cost of medical care, social care and unpaid care provided by family members and others. In this review, we combine evidence and clinical opinion, using guidelines and reviews from 2006, 2009 and 2010 to present a practical guide for primary care physicians to the diagnosis, treatment and ongoing care of patients with suspected or diagnosed dementia. This review summarises the epidemiology of dementia syndrome, and offers detailed evidence-based advice on recognition of dementia (including subtyping) and responses to it and its associated symptoms. The roles of neuroimaging and biomarkers are discussed, as are both non-pharmacological and pharmacological therapies.

Cost analysis of surgically treated pressure sores stage III and IV

Health-care costs associated with pressure sores are significant and their financial burden is likely to increase even further. The aim of this study was to analyse the direct medical costs of hospital care for surgical treatment of pressure sores stage III and IV. We performed a retrospective chart study of patients who were surgically treated for stage III and IV pressure sores between 2007 and 2010. Volumes of health-care use were obtained for all patients and direct medical costs were subsequently calculated. In addition, we evaluated the effect of location and number of pressure sores on total costs. A total of 52 cases were identified. Average direct medical costs in hospital were €20,957 for the surgical treatment of pressure sores stage III or IV; average direct medical costs for patients with one pressure sore on an extremity (group 1, n = 5) were €30,286, €10,113 for patients with one pressure sore on the trunk (group 2, n = 32) and €40,882 for patients with multiple pressure sores (group 3, n = 15). The additional costs for patients in group 1 and group 3 compared to group 2 were primarily due to longer hospitalisation. The average direct medical costs for surgical treatment of pressure sores stage III and IV were high. Large differences in costs were related to the location and number of pressure sores. Insight into the distribution of these costs allows identification of high-risk patients and enables the development of specific cost-reducing measures.

Direct Medical Care Costs Associated With Patients Diagnosed With Chronic HCV

BackgroundHCV virus (HCV) is a significant global problem with wide-ranging socio-economic impacts. Because of the high morbidity and mortality associated with end-stage liver disease, cirrhosis, and hepatocellular carcinoma (HCC), the economic burden of HCV infection is substantial.ObjectivesThis study aimed to estimate the direct medical care costs of chronic HCV infection.Patients and MethodsFor this cross-sectional study, 365 courses of HCV treatment were extracted from medical records of 284 patients being referred to Tehran HCV clinic, a clinical clinic of Baqiyatallah Research Center for Gastroenterology and Liver diseases, from 2005 to 2010. All the patients had been diagnosed with HCV. Direct medical care costs for each course of HCV treatment have been calculated based on Purchasing Power Parity Dollar (PPP$).ResultsAverage direct medical costs for the courses treated with conventional interferon plus ribavirin (INF-RBV) were 4,403 PPP$, and 20,010 PPP$ for peg-interferon plus ribavirin (PEG-RBV) courses. There was an increase of the direct costs in both courses of treatment to achieve Sustain Viral Response (SVR). The costs amounted to 10,072 PPP$ in (INF-RBV) treatment and 34,035 PPP$ in (PEG-RBV). The significant difference between the costs of these two courses of treatment is attributable to high cost of Peg-interferon. This indicates that the medication costs are the dominant costs.ConclusionsAccording to the results, total direct medical costs for HCV patients in Iran exceeded 12 billion PPP$ in (INF-RBV) treatment and 55 billion PPP$ in (PEG-RBV).

CANADIAN CANCER RISK MANAGEMENT MODEL: EVALUATION OF CANCER CONTROL

The aim of this study was to develop a decision support tool to assess the potential benefits and costs of new healthcare interventions. The Canadian Partnership Against Cancer (CPAC) commissioned the development of a Cancer Risk Management Model (CRMM)--a computer microsimulation model that simulates individual lives one at a time, from birth to death, taking account of Canadian demographic and labor force characteristics, risk factor exposures, and health histories. Information from all the simulated lives is combined to produce aggregate measures of health outcomes for the population or for particular subpopulations. The CRMM can project the population health and economic impacts of cancer control programs in Canada and the impacts of major risk factors, cancer prevention, and screening programs and new cancer treatments on population health and costs to the healthcare system. It estimates both the direct costs of medical care, as well as lost earnings and impacts on tax revenues. The lung and colorectal modules are available through the CPAC Web site (www.cancerview.ca/cancerrriskmanagement) to registered users where structured scenarios can be explored for their projected impacts. Advanced users will be able to specify new scenarios or change existing modules by varying input parameters or by accessing open source code. Model development is now being extended to cervical and breast cancers.

Accurate Assessments of Healthcare Use Along the Course of Cognitive Decline

Accurate Assessments of Healthcare Use Along the Course of Cognitive Decline

Are multidisciplinary teams in secondary care cost-effective? A systematic review of the literature

ObjectiveTo investigate the cost effectiveness of management of patients within the context of a multidisciplinary team (MDT) meeting in cancer and non-cancer teams in secondary care.DesignSystematic review.Data sourcesEMBASE, MEDLINE, NHS EED, CINAHL, EconLit, Cochrane Library, and NHS HMIC.Eligibility criteria for selecting studiesRandomised controlled trials (RCTs), cohort, case–control, before and after and cross-sectional study designs including an economic evaluation of management decisions made in any disease in secondary care within the context of an MDT meeting.Data extractionTwo independent reviewers extracted data and assessed methodological quality using the Consensus on Health Economic Criteria (CHEC-list). MDTs were defined by evidence of two characteristics: decision making requiring a minimum of two disciplines; and regular meetings to discuss diagnosis, treatment and/or patient management, occurring at a physical location or by teleconferencing. Studies that reported on the costs of administering, preparing for, and attending MDT meetings and/or the subsequent direct medical costs of care, non-medical costs, or indirect costs, and any health outcomes that were relevant to the disease being investigated were included and classified as cancer or non-cancer MDTs.ResultsFifteen studies (11 RCTs in non-cancer care, 2 cohort studies in cancer and non-cancer care, and 2 before and after studies in cancer and non cancer care) were identified, all with a high risk of bias. Twelve papers reported the frequency of meetings which varied from daily to three monthly and all reported the number of disciplines included (mean 5, range 2 to 9). The results from all studies showed mixed effects; a high degree of heterogeneity prevented a meta-analysis of findings; and none of the studies reported how the potential savings of MDT working may offset the costs of administering, preparing for, and attending MDT meetings.ConclusionsCurrent evidence is insufficient to determine whether MDT working is cost-effective or not in secondary care. Further studies aimed at understanding the key aspects of MDT working that lead to cost-effective cancer and non-cancer care are required.

The high cost of diarrhoeal illness for urban slum households–a cost-recovery approach: a cohort study

ObjectivesRapid urbanisation has often meant that public infrastructure has not kept pace with growth leading to urban slums with poor access to water and sanitation and high rates of diarrhoea...

The economic burden of rheumatic heart disease in South Korea

Understanding the impact of rheumatic heart disease (RHD) has become increasingly important among aging populations around the world, and Korea is no exception. This study was conducted to estimate total annual patient costs associated with RHD in Korea for 2008 using nationally representative data. The subjects were South Korean citizens with RHD (ICD-10 codes I01-I09). The primary information for this study was obtained from claims data compiled by the National Health Insurance Corporation of Korea. Direct medical care costs were estimated using expenses paid by insurers and patients for non-covered care and pharmaceutical costs. Direct non-medical costs were estimated using data on transportation costs for hospital visits and costs for caregivers. Indirect costs included the costs of productivity loss and premature death in RHD patients. The economic burden of RHD in 2008 was estimated at $67.25 million US dollars. The indirect costs amounted to 39.04 % (US $26.26 million) of the total RHD costs. When stratified by age, the costs incurred by the group of patients older than 60 years were US $31.63 million. The prevalence of the disease in the same age group was 791.07 cases per 100,000 people. This study confirms that the prevalence of RHD was highest in patients older than 60 years in 2008. Furthermore, the patterns of disease in South Korea were similar to patterns observed in other high-income countries. These findings indicate that secondary prevention strategies for the early detection of RHD are needed in South Korea.

Ophthalmologic Stem Cell Transplantation Therapies

Vision loss is a major social issue, with more than 20 million people over the age of 18 years affected in the USA alone. Loss of vision is feared more than premature death or cardiovascular disease, according to a recent Society for Consumer Research group survey. The annual direct cost of medical care for the most prevalent eye disease, age-related macular degeneration, was estimated at US$255 billion in 2010 with an additional economic impact of US$88 billion due to lost productivity and the burden of family and community care for visual disability. With the blossoming of human stem cell research, regenerative treatments are now being developed that can help reduce this burden. Positive results from animal studies demonstrate that stem cell-based transplants can preserve and potentially improve vision. This has led to new clinical trials for several eye diseases that are yielding encouraging results. In the next few years, additional trials and longer-term results are anticipated to further develop ocular regenerative therapies, with the potential to revolutionize our approach to ophthalmic disease and damage.

Hepatitis C: The Impact of New and Future Therapeutics

The burden of hepatitis C (HCV) in the United States now exceeds that of HIV and hepatitis B combined. It is estimated that from 2010 to 2019, 193,000 HCV-related deaths, direct medical care costs of $10.7 billion, and $75.3 billion in societal costs can be expected. HCV-associated liver related morbidity and mortality is an important component of this burden [Wong JB et al. Am J Public Health 2000]. This article discusses how antiviral therapy targeted to achieve viral eradication is the key strategy to stabilizing or reversing liver injury and fibrosis, and reducing the risk of liver-related complications, including cirrhosis and liver cancer, in patients with HCV.

PHS25 Direct Medical Costs of Medical Care of Gastrointestinal Bleeding in Mexico

PHS25 Direct Medical Costs of Medical Care of Gastrointestinal Bleeding in Mexico

The Evaluation of Cancer Control Interventions in Lung Cancer using the Canadian Cancer Risk Management Model

SUMMARY Background: Rising healthcare costs will increasingly require policy-makers to make difficult decisions based on the potential benefits and costs of new healthcare interventions. The Canadian Partnership Against Cancer commissioned the development of the Cancer Risk Management Model as a tool to aid such decisions. This computer microsimulation model projects future population health and economic impacts of cancer control programs in Canada. Lung cancer was the first simulation module to be developed and was selected because of the magnitude of lung cancer burden in Canada and recent screening and treatment interventions that require policy decisions. Methods: The model simulates one individual life at a time, from birth to death, taking account of Canadian demographic and labor force characteristics, risk factor exposures and health histories, and then combines this information from all the simulated lives to produce aggregate measures of health outcomes for the Canadian population as a whole or for particular subpopulations. The direct costs of medical care can be estimated, as well as lost earnings and impacts on tax revenues. Results: The lung module is available through the Canadian Partnership Against Cancer website to registered users where structured scenarios can be explored for their projected impacts. Conclusion: The Cancer Risk Management Model for lung cancer is now available via the internet to assist healthcare policy analysts, researchers and decision-makers in their work.

The 10-Year Cost-Effectiveness of Lifestyle Intervention or Metformin for Diabetes Prevention

OBJECTIVEThe Diabetes Prevention Program (DPP) and its Outcomes Study (DPPOS) demonstrated that either intensive lifestyle intervention or metformin could prevent type 2 diabetes in high-risk adults for at least 10 years after randomization. We report the 10-year within-trial cost-effectiveness of the interventions.RESEARCH DESIGN AND METHODSData on resource utilization, cost, and quality of life were collected prospectively. Economic analyses were performed from health system and societal perspectives.RESULTSOver 10 years, the cumulative, undiscounted per capita direct medical costs of the interventions, as implemented during the DPP, were greater for lifestyle ($4,601) than metformin ($2,300) or placebo ($769). The cumulative direct medical costs of care outside the DPP/DPPOS were least for lifestyle ($24,563 lifestyle vs. $25,616 metformin vs. $27,468 placebo). The cumulative, combined total direct medical costs were greatest for lifestyle and least for metformin ($29,164 lifestyle vs. $27,915 metformin vs. $28,236 placebo). The cumulative quality-adjusted life-years (QALYs) accrued over 10 years were greater for lifestyle (6.81) than metformin (6.69) or placebo (6.67). When costs and outcomes were discounted at 3%, lifestyle cost $10,037 per QALY, and metformin had slightly lower costs and nearly the same QALYs as placebo.CONCLUSIONSOver 10 years, from a payer perspective, lifestyle was cost-effective and metformin was marginally cost-saving compared with placebo. Investment in lifestyle and metformin interventions for diabetes prevention in high-risk adults provides good value for the money spent.