Direct Medical Costs For Patients Research Articles

Antithrombotic Therapy and Direct Medical Costs in Patients with Acute Coronary Syndrome in Shanghai, China

BackgroundAcute coronary syndrome (ACS) is a leading cause of morbidity and mortality worldwide. ObjectivesTo describe patient profile, treatment patterns, and disease burden for patients with ACS. MethodsA retrospective descriptive cohort study was conducted. Data were obtained from electronic medical records from seven Shanghai medical centers. Patients with at least one primary diagnosis of ACS from 2006 to 2012 were included. Patient ACS-related antithrombotic medication use, laboratory tests, key comorbidities, health care utilization, and direct medical costs were examined. Log-linear regression was conducted to explore factors associated with total direct medical costs. ResultsThe mean age for the 6601 patients included was 69.7 ± 12.5 years, and most of the patients (73%) were men. Comorbidities included diabetes (18.2%), hypertension (21.2%), and hyperlipidemia (8.6%). Out of these, 6466 (98%) patients had been hospitalized for ACS with an average length of stay of 14.0 ± 16.4 days per hospitalization. A total of 914 (13.8%) patients had emergency room visits. Of these, 93.5% received any antithrombotic therapy, including antiplatelet agents (92.7%) and anticoagulants (20.8%). ACS-related direct medical costs (in yuan renminbi [¥]) were ¥18,421 ± ¥24,741 per hospitalization, including costs for medications (¥6,776) and laboratory tests (¥1,355), and ¥2,894 ± ¥7,060 per outpatient visit, including costs for medications (¥620) and laboratory tests (¥464). The higher direct medical cost was associated significantly (P < 0.05) with age, being male, antiplatelet and anticoagulant use, and several comorbid disease states (diabetes, hyperlipidemia, hypertension, and chronic kidney disease). ConclusionsAntithrombotic therapeutic treatments were commonly used among patients with ACS in Shanghai, China. Higher treatment costs for patients with ACS in Shanghai, China, involved their antithrombotic medication use and key comorbidities.

Medication use patterns, health care resource utilization, and economic burden for patients with major depressive disorder in Beijing, People's Republic of China.

ObjectiveThe objective of the study was to investigate medication usage patterns, health care resource utilization, and direct medical costs of patients with major depressive disorder (MDD) in Beijing, People’s Republic of China.MethodsData were extracted from a random sample of the Beijing Urban Employee Basic Medical Insurance database. Patients aged ≥18 years, with ≥1 primary diagnosis of MDD and 12-month continuous enrollment after their first observed MDD diagnosis between 2012 and 2013 were identified. Those with a diagnosis of schizophrenia, bipolar disorder, or cancer during the analysis period were excluded.ResultsIn total 8,484 patients, with a mean age of 57.2 years, were included and 63% were female. The top three commonly observed comorbidities were hypertension (70.9%), anxiety disorder (68.6%), and coronary heart disease (65.1%). Furthermore, 71.4% of patients were treated with antidepressant medications, including 60.5% of patients treated with selective serotonin reuptake inhibitors, followed by noradrenergic and specific serotonergic antidepressants (9.0%) and serotonin–norepinephrine reuptake inhibitors (8.3%). The proportions of patients who discontinued their initial antidepressant within the first and second months after the index date were 45.4% and 77.0%, respectively. Concomitant medications were prescribed for 76.8% of patients. Only 0.42% of patients experienced ≥1 MDD-related hospitalization(s) during the 1-year follow-up, and the average annual number of hospitalization was 1.2 for those hospitalized. The mean length of stay was 33.4 days per hospitalization. All patients had ≥1 MDD-related outpatient visit(s). The mean annual number of outpatient visits per patient was 3.1. The mean annual direct medical costs per patient with MDD was RMB ¥1,694.1 (48.5% for antidepressant medications), and that for hospitalized patients was RMB ¥21,291.0 (15.0% for antidepressant medications).ConclusionIn Beijing, the majority of patients with MDD were treated in the outpatient setting only and they received antidepressants. Selective serotonin reuptake inhibitors were the most commonly used antidepressants. However, the duration to antidepressant medication was short, and persistence was low. The economic burden of MDD-related hospitalization was considerable.

The Direct Cost of Parkinson Disease at Juntendo Medical University Hospital, Japan.

Objective Many studies on the cost of Parkinson disease (PD) have been published; however, there are limited studies pertaining to this issue in Asia. This study looks to assess the direct medical costs of patients with PD at a university hospital in Japan by calculating the average monthly direct medical costs of PD patients from July to December 2008. Methods We enrolled 724 consecutive patients (411 women and 313 men) with PD who were registered in Japan's "Specified Disease Treatment Research Program" and obtained data on the total direct medical costs of all patients. Results Values are reported as the mean (standard deviation). The major finding of the direct medical cost analysis was that the outpatient clinic cost per subject (n=715) was USD 485.74 (376.31) per month. A multivariate analysis revealed that a younger age, the presence of wearing-off, hallucination, and longer disease duration increased the direct medical cost significantly. Disease severity had no influence on the direct medical costs. A longer disease duration was significantly correlated with higher hospitalization costs. Conclusion The direct medical cost of PD in Japan was found to be similar to that in Western countries. Costs due to productivity loss exceeded the direct costs, and they may be reduced through the better integration of PD patients in the work environment.

Unilateral Pulmonary Oedema

Objectives: To evaluate the economic impact of the combined effect of minimally invasive surgery (MIS) and a multimodal analgesia regimen (Total Joint Regional Anesthesia [TJRA] Clinical Pathway) on the estimated direct medical costs of patients undergoing total knee arthorplasty (TKA) or total hip arthroplasty (THA). Patients and Methods: A retrospective cohort, cost comparison study from the hospital prospective was performed on Mayo Clinic patients (n=37) undergoing MIS TKA or THA using the TJRA Clinical Pathway. Study patients were matched 1:1 with historical controls undergoing similar procedures using traditional surgical and anesthetic (non- TJRA) techniques. Hospital-based direct costs were collected for each patient and analyzed in standardized infl ationadjusted constant dollars using cost-to-charge ratios, wage indexes, and physician services valued using Medicare reimbursement rates. The estimated mean direct hospital costs were compared between groups and a subgroup analysis was performed based upon ASA physical status classification. Results: The estimated mean direct medical costs were signifi cantly reduced among MIS with TJRA patients compared to controls (cost difference: $4582; 95% CI $3299-$5864; P < .001). A signifi cant reduction was found in both the hospital-based (Medicare Part A) costs and the physician-based (Medicare Part B) costs. Conclusions: The combined use of minimally invasive surgical (MIS) approaches and a multimodal analgesic regimen (TJRA Clinical Pathway) in patients undergoing lower extremity joint replacement provides a signifi cant reduction in the estimated mean medical costs. A signifi cant reduction occurs in both the hospital based (Medicare Part A) and the physician based (Medicare Part B) costs. In subgroup analysis, the greatest difference was found among the patients with signifi cant comorbidities (ASA III-IV patients).

Epidemiology and costs of patients with toxic epidermal necrolysis: a 27-year retrospective study.

Recently, the importance of reporting the results and principles of management in Toxic epidermal necrolysis (TEN) patients was underscored. Treatment of TEN focuses on supportive care, often provided in a burn centre setting. Mortality in TEN patients can be high; the SCORTEN score is a scoring system that predicts mortality in patients with TEN. The predictive value of the SCORTEN score in our setting is unclear, as are the treatment costs of TEN patients. To describe patient characteristics, treatment, outcome and direct medical costs of patients with TEN treated in one Dutch burn centre in a 27-year period. In addition, determinants of mortality and the predictive value of the SCORTEN score were assessed. A retrospective study was conducted in all patients with TEN (including Stevens-Johnson syndrome (SJS) and overlap SJS-TEN) admitted to the burn centre Rotterdam between January 1987 and December 2013. The discriminative value of the SCORTEN score was assessed by receiver-operator characteristics curve analysis. A total of 63 patients were admitted in 27-year period. Overall mortality was 39.7%, mortality in TEN patients (>30%TBSA) was 37.1%. A higher age (OR = 1.04, 95%CI: 1.02-1.07) and comorbidity (OR = 4.25, 95%CI: 1.2-14.7) were associated with mortality. The discriminative value of the SCORTEN prediction model in our population was limited (AUC=0.72, 95%CI: 0.57-0.86). The mean direct medical hospital-based costs was €41.361. Toxic epidermal necrolysis is a severe adverse drug reaction, with a high mortality. Elderly patients and patients with comorbidity, especially circulatory comorbidity, have a relatively high risk of decease. The SCORTEN score, a frequently used prediction model in patients with TEN, underestimated the mortality in our study, mainly due to limited availability in patients with a good prognosis. The treatment of patient with TEN is associated with high direct medical hospital-based costs, also compared to burn patients in general.

Economic Burden of Undiagnosed Nonvalvular Atrial Fibrillation in the United States

Atrial fibrillation (AF) may be clinically silent and therefore undiagnosed. To date, no estimates of the direct medical cost of undiagnosed AF exist. We estimated the United States (US) incremental cost burden of undiagnosed nonvalvular AF nationally using administrative claims data. To calculate the incremental costs of undiagnosed AF, we compared annual medical costs (in 2014 US Dollars) for patients with AF compared to propensity-matched controls and multiplied this by estimates of undiagnosed AF prevalence derived from the same data sources. The study population included US residents aged ≥18years with 24months of continuous enrollment drawn from 2 large administrative claims databases. Mean per capita medical spending for patients with AF aged from 18 to 64year was $38,861 (95% confidence interval [CI] $35,781 to $41,950) compared to $28,506 (95% CI $28,409 to $28,603) for similar patients without AF (incremental cost difference $10,355, p <0.001); total spending for patients aged ≥65years with AF was $25,322 (95% CI $25,049 to $25,595) compared to $21,706 (95% CI $21,563 to $21,849) for similar patients without AF (incremental cost difference $3,616, p <0.001). Using estimates of the US prevalence of undiagnosed AF (596,000) drawn from the same data, we estimated that the US incremental cost burden of undiagnosed nonvalvular AF is $3.1 billion (95% CI $2.7 to $3.7 billion). In conclusion, the direct medical costs for patients with undiagnosed AF are greater than patients with similar observable characteristics without AF and strategies to identify and treat patients with undiagnosed AF could lead to sizable reductions in stroke sequelae and associated costs.

Health care resource use and direct medical costs for patients with schizophrenia in Tianjin, People's Republic of China.

ObjectiveInformation concerning the treatment costs of schizophrenia is scarce in People’s Republic of China. The aims of this study were to quantify health care resource utilization and to estimate the direct medical costs for patients with schizophrenia in Tianjin, People’s Republic of China.MethodsData were obtained from the Tianjin Urban Employee Basic Medical Insurance (UEBMI) database. Adult patients with ≥1 diagnosis of schizophrenia and 12-month continuous enrollment after the first schizophrenia diagnosis between 2008 and 2009 were included. Both schizophrenia-related, psychiatric-related, and all-cause related resource utilization and direct medical costs were estimated.ResultsA total of 2,125 patients were included with a mean age of 52.3 years, and 50.7% of the patients were female. The annual mean all-cause costs were $2,863 per patient with psychiatric-related and schizophrenia-related costs accounting for 84.1% and 62.0% respectively. The schizophrenia-related costs for hospitalized patients were eleven times greater than that of patients who were not hospitalized. For schizophrenia-related health services, 60.8% of patients experienced at least one hospitalization with a mean (median) length of stay of 112.1 (71) days and a mean cost of $1,904 per admission; 59.0% of patients experienced at least one outpatient visit with a mean (median) number of visits of 6.2 (4) and a mean cost of $42 per visit during the 12-month follow-up period. Non-medication treatment costs were the most important element (45.7%) of schizophrenia-related costs, followed by laboratory and diagnostic costs (19.9%), medication costs (15.4%), and bed fees (13.3%).ConclusionThe costs related to the treatment of patients with schizophrenia were considerable in Tianjin, People’s Republic of China, driven mainly by schizophrenia-related hospitalizations. Efforts focusing on community-based treatment programs and appropriate choice of drug treatment have the potential to reduce the use of inpatient services and may lead to better clinical and economic outcomes in the management of patients with schizophrenia in People’s Republic of China.

Direct medical costs for patients with tuberous sclerosis complex and surgical resection of subependymal giant cell astrocytoma: a US national cohort study

Objective:To estimate direct medical costs for patients with tuberous sclerosis complex (TSC) and surgical resection of subependymal giant-cell astrocytoma (SEGA).Methods:This retrospective cohort study selected patients who had SEGA surgery and TSC claims between 2000–2011 from three large US nationwide claims databases. Selected patients were age 35 or less and had continuous health insurance in the year before and the year after their first SEGA surgery claim. The study examined the patients’ demographic and clinical characteristics and estimated inpatient, outpatient, medication, and total medical costs paid by insurance companies for the pre-surgery year, post-surgery year, and other study periods, respectively. Repeated measures analysis and bootstrapping technique were used to assess the impact of the surgery on the direct medical costs.Results:Select patients (n = 47) had a mean baseline age of 11.6 years and 66% were male. Many had seizures (91.0%), hydrocephalus (59.6%), vision disorders (38.3%), stroke and hemiparesis (36.2%), and shunt (34.0%) in the pre-surgery year. The mean direct medical costs were $8543 (inpatient: $3770; outpatient: $3473; medication: $1300) for the pre-surgery year, and $85,397 (inpatient: $71,562; outpatient: $11,497; medication: $2338) for the post-surgery year. With the exclusion of the costs during the surgery month, the inpatient, outpatient, medication, and total costs in the post-surgery year were 1.6–4.3 times as much as the costs in the pre-surgery year (inpatient: 4.3:1; outpatient: 2.5:1; medication: 1.6:1; total: 3.1:1, p < 0.05). Repeated measures analysis with bootstrapping confirmed a link between the surgery and increases in direct medical costs (p < 0.05).Conclusions:SEGA surgery had a substantial impact on direct medical costs. TSC patients with the surgery experienced significant post-surgery increases in their inpatient, outpatient, and medication costs. Additional research should be conducted to examine the surgery’s cost-impact in a longer duration, or to compare the cost-effectiveness of the surgery vs other treatments.

Antithrombotic Therapy and Direct Medical Costs in Patients with Acute Coronary Syndrome in Shanghai, China.

Acute coronary syndrome (ACS) is a leading cause of morbidity and mortality worldwide. This study aims to describe treatment patterns and disease burden for patients with ACS in Shanghai, China. A retrospective descriptive cohort study was conducted. Data were obtained from electronic medical records of seven major Shanghai medical centers. Patients who had at least one primary diagnosis of ACS between January 2006 and July 2012 were included in the study. Patient ACS-related antithrombotic medication use, laboratory tests, key comorbidities, health care utilization and direct medical costs were examined. Log-linear regression was conducted to explore the factors associated with total direct medical cost. A total of 6,601 patients were included with mean age of 69.7 (±SD12.5), 73% male and 10% mortality rate. 18.2% of studied patients had diabetes as a comorbidity, 21.2% had hypertension, and 8.6% had hyperlipidemia. 6,466 (98.0%) of patients had been hospitalized for ACS with mean 14.0 (±16.4) days per hospitalization. There were 1,022 patients (15.5%) presented to emergency department. Of those, 93.5% received any antithrombotic therapy, including 92.8% with antiplatelet agents and 20.8% with anticoagulants. The ACS-related direct medical costs were RMB19,421 (±24,741) per hospitalization with medication of RMB6,798 and lab tests of RMB1,355, and RMB2,894 (±7,060) per outpatient visit with medication of RMB624 and lab tests of RMB464. The higher direct medical cost was associated significantly (p<0.01) with aging, being male, antiplatelet and anticoagulant uses, diabetes, stroke, hyperlipidemia, hypertension, and chronic kidney diseases. Antithrombotic therapeutic treatments were commonly used among ACS patients in Shanghai, China. ACS poses significant disease burden to the health care system and patients. The higher treatment cost for patients with ACS involves antithrombotic use and key comorbidities.

PRS26 - An Analysis of Us Medicare Beneficiaries: Burden of Direct Medical Costs in Patients With Idiopathic Pulmonary Fibrosis

PRS26 - An Analysis of Us Medicare Beneficiaries: Burden of Direct Medical Costs in Patients With Idiopathic Pulmonary Fibrosis

Constipation-related direct medical costs in 16 887 patients newly diagnosed with chronic constipation.

BackgroundChronic constipation is a common condition, but the exact impact on healthcare budgets in Western Europe is poorly documented.ObjectivesThe aim of this study was to (a) investigate chronic constipation-related direct medical costs in patients with newly diagnosed chronic constipation and (b) study differences in costs according to natural history.Patients and methodsWe identified 16 887 patients newly diagnosed with chronic constipation in a Dutch health insurance database (∼1.3 million patients) in 2006–2009. Individuals with chronic constipation were selected on the basis of chronic laxative use (≥90 days/year) and diagnostic related groups for chronic constipation. On the basis of the episodes of laxative use and diagnostic related groups, individuals were categorized as having persistent, episodic, and nonrecurrent disease. Unadjusted costs for laxatives and hospital care for chronic constipation and constipation-related comorbidities were assessed and compared between patients with nonrecurrent, episodic, and persistent disease. Factors associated with costs were identified using Cox regression analyses.ResultsThe mean total chronic constipation-related direct medical costs in the first year after diagnosis were €310±845 and consisted of laxatives (45%) and hospital care for chronic constipation (26%) as well as constipation-related comorbidities (29%). Costs were highest in patients with persistent disease (€367±882) compared with patients with episodic (€292±808) and nonrecurrent (€263±613) disease (P<0.01). Male sex was associated with higher costs, whereas increasing age, diabetes, and use of opioids were associated with lower costs.ConclusionPharmacy costs and hospital care costs for chronic constipation-related comorbidities were the largest cost drivers for total constipation-related direct medical costs in patients with newly diagnosed chronic constipation. Direct medical costs differed according to patient characteristics.

The Impact of Molecularly Targeted Treatment on Direct Medical Costs in Patients with Advanced Non-small Cell Lung Cancer.

PurposeTo investigate the impact of targeted treatment on direct medical costs of patients with advanced non-small cell lung cancer (NSCLC).Materials and MethodsMedical records of 108 stage IIIB/IV NSCLC patients treated in Seoul National University Hospital between 2003 and 2009, were reviewed to collect medical resources utilization data from the diagnosis of stage IIIB/IV NSCLC to the end of active anti-cancer treatment. The direct medical costs were calculated by multiplying the number of medical resources used by the unit price. All costs were expressed in US dollars for each patient.ResultsThe mean total direct medical costs were $34,732 (standard deviation, 21,168) in the study cohort. The mean total direct medical costs were higher in epidermal growth factor receptor (EGFR) mutation (EGFR MT)–positive patients than EGFR wild-type (EGFR WT) patients ($41,403 vs. $30,146, p=0.005). However, the mean monthly direct medical costs did not differ significantly between EGFR MT–positive patients and EGFR WT patients ($2,120 vs. $2,702, p=0.119) because of the longer duration of active anti-cancer treatment in EGFR MT–positive patients. This discrepancy was mainly attributable to EGFR MT–positive patients’ lower non-chemotherapy costs ($948 vs. $1,522, p=0.007). The total and monthly direct medical costs of ALK fusion–positive patients who did not receive ALK inhibitors did not differ from WT/WT patients.ConclusionThis study suggests that the availability of targeted agents for EGFR MT–positive patients lowers the mean monthly medical costs by prolonging survival and diminishing the use of other medical resources, despite the considerable drug costs.

Assessment of viral genotype impact to the cost-effectiveness and overall costs of care for PEG-interferon-2α + ribavirine treated chronic hepatitis C patients.

BackgroundPegylated interferon alfa plus ribavirin protocol is currently considered the most efficient hepatitis C treatment. However, no evidence of costs comparison among common viral genotypes has been published.ObjectivesWe aimed to assess core drivers of hepatitis C medical care costs and compare cost effectiveness of this treatment among patients infected by hepatitis C virus with genotypes 1 or 4 (group I), and 2 or 3 (group II).Patients and MaterialsProspective bottom-up cost-effectiveness analysis from societal perspective was conducted at Infectious Diseases Clinic, University Clinic Kragujevac, Serbia, from 2007 to 2010. There were 81 participants with hepatitis C infection, treated with peg alpha-2a interferon plus ribavirin for 48 or 24 weeks. Economic data acquired were direct inpatient medical costs, outpatient drug acquisition costs, and indirect costs calculated through human capital approach.ResultsTotal costs were significantly higher (P = 0.035) in group I (mean ± SD: 12,751.54 ± 5,588.06) compared to group II (mean ± SD: 10,580.57 ± 3,973.02). In addition, both direct (P = 0.039) and indirect (P < 0.001) costs separately were significantly higher in group I compared to group II. Separate comparison within direct costs revealed higher total cost of medical care (P = 0.024) in first compared to second genotype group, while the similar tendency was observed for total drug acquisition (P = 0.072).ConclusionHCV genotypes 1 and 4 cause more severe clinical course require more care and thus incur higher expenses compared to HCV 2 and 3 genotypes. Policy makers should consider willingness to pay threshold differentially depending upon HCV viral genotype detected.

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 healthcare costs and resource consumption after acute coronary syndrome: a real-life analysis of an Italian subpopulation

Acute coronary syndrome (ACS) is the most common cause of morbidity and mortality in Italy and worldwide. Aim of this study was to evaluate the average annual direct healthcare costs for the treatment of patients with a recent hospitalization for ACS. The direct medical costs of patients with a first ACS hospitalization (index event) in the period from 1 January 2008 to 31 December 2008 were estimated for a 1-year follow-up period. The resource consumption was measured in terms of: reimbursed drugs, diagnostic procedures, outpatient visits, and hospitalizations. The analysis was performed from the Italian National Health Service perspective. A total of 2,758,872 subjects were observed, 7082 (35.8% women) of whom being hospitalized for ACS during the accrual period (2.6 ‰). Among patients with ACS, 60% were medically treated, 33.1% were treated with percutaneous coronary intervention (PCI), and 6.9% died during the index hospitalization. Dual antiplatelet treatment (ASA plus clopidogrel) was prescribed in 25.9% of the medically treated ACS patients and in 70.1% of the ACS patients treated with PCI. The average yearly cost per patient for the total ACS population was 11,464€/year (drugs 1,304€; hospitalizations 9,655€; diagnostic and outpatient visits 505€). The average annual cost was 10,862€ for medically treated patients and 14,111€ for patients treated with PCI. Patients who died of cardiovascular events during follow up had an average cost of 16,231€/patient. Patients with ACS had higher direct healthcare costs, their management and rehospitalizations being the main cost drivers.

Welche Faktoren bestimmen die direkten Krankheits­kosten bei Patienten mit Systemischem Lupus Erythe­matodes in Deutschland? – Subanalyse der LUCIE-Studie

The aim of this study was to evaluate annual direct medical costs of adult SLE patients with active autoantibody positive disease on medication in Germany. A multicentre, observational, retrospective European study with German sub-analysis was performed. Costs were assessed according to national tariffs. 10 German centres included 77 patients. The mean (SD) annual direct medical costs of patients were € 3 452.21 (3 777.07), and were 3.4 times higher in severe than non-severe patients (€ 5 291.07 vs. 1 564.97; p<0.001). Cost of medication (€ 2 349.40) represented 68.1% of the total cost. Flares, especially severe flares, were identified as cost predictors. Each flare increased the annual total cost by € 2 164,01 (p<0,001). The annual direct medical cost of SLE patients in Germany is linked to disease severity. Medical treatments and severe flares were identified as the cost predictors and drivers, respectively.

Economic burden of acute pesticide poisoning in South Korea

To investigate the magnitude and characteristics of the economic burden resulting from acute pesticide poisoning (APP) in South Korea. The total costs of APP from a societal perspective were estimated by summing the direct medical and non-medical costs together with the indirect costs. Direct medical costs for patients assigned a disease code of pesticide poisoning were extracted from the Korean National Health Insurance Reimbursement Data. Direct non-medical costs were estimated using the average transportation and caregiving costs from the Korea Health Panel Survey. Indirect costs, incurred by pre-mature deaths and work loss, were obtained using 2009 Life Tables for Korea and other relevant literature. In 2009, a total of 11,453 patients were treated for APP and 1311 died, corresponding to an incidence of 23.1 per 100,000 population and a mortality rate of 2.6 per 100,000 population in South Korea. The total costs of APP were estimated at approximately US$ 150 million, 0.3% of the costs of total diseases. Costs due to pre-mature mortality accounted for 90.6% of the total costs, whereas the contribution of direct medical costs was relatively small. Costs from APP demonstrate a unique characteristic of a large proportion of the indirect costs originating from pre-mature mortality. This finding suggests policy implications for restrictions on lethal pesticides and safe storage to reduce fatality and cost due to APP.

Incidence and Cost of Pneumonia in Medicare Beneficiaries

Pneumonia is a frequent and serious illness in elderly people, with a significant impact on mortality and health-care costs. Lingering effects may influence clinical outcomes and medical service use beyond the acute hospitalization. This study describes the incidence and mortality of pneumonia in elderly Medicare beneficiaries based on treatment setting (outpatient, inpatient) and location of origin (health-care associated, community acquired) and estimates short- and long-term direct medical costs and mortality associated with an inpatient episode of pneumonia. Administrative claims from a 5% sample of fee-for-service Medicare beneficiaries aged ≥ 65 years from 2005 through 2007 were used. Total direct medical costs for patients during and after hospitalization for pneumonia compared with similar patients without pneumonia (the excess cost of pneumonia) were estimated using propensity score matching. The age-adjusted annual cumulative incidence of any pneumonia was 47.4 per 1,000 beneficiaries (13.3 per 1,000 inpatient primary pneumonia), increasing with age; one-half of pneumonia cases were treated in the hospital. Thirty-day mortality was twice as high among beneficiaries with health-care-associated pneumonia than among those hospitalized with community-acquired pneumonia (13.4% vs 6.4%). Total medical costs for beneficiaries during and 1 year following a pneumonia hospitalization were $15,682 higher than matched control patients without pneumonia. The total annual excess cost of hospital-treated pneumonia as a primary diagnosis in the elderly fee-for-service Medicare population in 2010 is estimated conservatively at > $7 billion. Pneumonia in elderly people is associated with high acute-care costs and an overall impact on total direct medical costs and mortality during and after an acute episode.

The Burden of Chronic Low Back Pain

Retrospective analysis of an insurance claims database. To examine the comorbidities, treatment patterns, health care resource utilization, and direct medical costs of patients with chronic low back pain (CLBP) in clinical practice. Although the socioeconomic impact of CLBP is substantial, characterization of comorbidities, pain-related pharmacotherapy, and health care resource use/costs of patients with CLBP relative to non-CLBP controls have been infrequently documented. Using the LifeLink Health Plan Claims Database (IMS Health Inc., Watertown, MA), patients with CLBP, defined using the International Classification of Diseases, Ninth Revision, Clinical Modification, were identified and matched (age, sex, and region) with non-CLBP individuals. Comorbidities, pain-related pharmacotherapy, and health care service use/costs (pharmacy, outpatient, inpatient, total) were compared for the 2 groups during 2008. A total of 101,294 patients with CLBP and controls were identified (55% women; mean age was 47.2 ± 11.6 years). Relative to controls, patients with CLBP had a greater comorbidity burden including a significantly higher (P < 0.0001) frequency of musculoskeletal and neuropathic pain conditions and common sequelae of pain such as depression (13.0% vs. 6.1%), anxiety (8.0% vs. 3.4%), and sleep disorders (10.0% vs. 3.4%). Pain-related pharmacotherapy was significantly greater (P < 0.0001) among patients with CLBP including opioids (37.0% vs. 14.8%; P < 0.0001), nonsteroidal anti-inflammatory drugs (26.2% vs. 9.6%; P < 0.0001), and tramadol (8.2% vs. 1.2%; P < 0.0001). Prescribing of "adjunctive" medications for treating conditions associated with pain (i.e., depression, anxiety, and insomnia) was also significantly greater (P < 0.0001) among patients with CLBP; 36.3% of patients received combination therapy. Health care costs were significantly higher in the CLBP cohort (P < 0.0001), reflecting greater resource utilization. Total direct medical costs were estimated at $8386 ± $17,507 in the CLBP group and $3607 ± $10,845 in the control group; P < 0.0001). Patients with CLBP are characterized by greater comorbidity and economic burdens compared with those without CLBP. This economic burden can be attributed to greater prescribing of pain-related medications and increased health resource utilization.

Direct Medical Costs of Liquid Intravenous Immunoglobulins in Children, Adolescents, and Adults in Spain

The aim of this study was to determine health care resource utilization and direct medical costs in Spanish patients treated with intravenous immunoglobulins (IVIGs) in 2009. Cost-of-illness analyses were performed to estimate direct medical costs of patients treated with IVIGs. Prevalence data were obtained from the Spanish Primary Immunodeficiency registry. A semi-structured questionnaire was used to collect data on health care resource utilization and patient distribution. Drug, administration, and premedication costs were considered from the payer's perspective. Separate analyses were conducted for children and adolescents versus adults. The numbers of children and adolescents with replacement therapy were 724, with immunomodulation 243, and with allogeneic bone marrow transplantation 30. The numbers of adult patients were, respectively, 3450, 1134, and 172. Mean annual costs for children and adolescents were 6293 € with Privigen, 6292 € with Kiovig, 6939 € with Flebogamma, and 6559 € with Octagamocta. For adults, estimations were 17 106 € with Privigen, 17 103 € with Kiovig, 18 077 € with Flebogamma, and 17 423 € with Octagamocta. Direct medical costs for IVIGs were approximately 91.8 million €. Drug costs represented 94% of total costs. The choice for a certain IVIG treatment depends on individual patient characteristics and cost considerations.