Excess Economic Burden Research Articles

Experiences of Immigrants During Disasters in the US: A Systematic Literature Review.

As a vulnerable population, immigrants can be disproportionately affected by disasters. Because of their legal and migratory status, immigrants may have different challenges, needs, and possibilities when facing a disaster. Yet, within disaster studies, immigrants are rarely studied alone. Instead, they are often considered part of the large heterogeneous group of racial and ethnic minorities in the United States. This racial classification points to a gap in the literature and in our understanding of how disadvantaged groups may cope with disasters. To address this gap, the current study hypothesizes that: (1) Immigrants have unique experiences and disaster impacts compared to the broader aggregated category of racial and ethnic minorities in the U.S. and (2) There are variations in disaster experiences and impacts across different types of immigrant subgroups beyond refugees. To explore these hypotheses, a study of the literature across six databases from 2018 to 2023was conducted. The review identified a total of 17 articles discussing immigrant experiences during disasters. Major cross-cutting themes on immigrant disaster experiences include fear of deportation, restrictive immigration status, excessive economic burden and labor exploitation, employment rigidity, adverse health outcomes, limited informational resources and limited social capital, selective disaster relief measures, and infrastructural challenges as regards to housing and transportation. Many of the themes identified are unique to immigrants, such as the fear of deportation, restrictive immigration status and visa policies, and selective disaster relief measures.

Association between ambient temperature and economic burden of unintentional injury in Tianjin: a case-crossover study

ObjectiveUnintentional injuries constitute a significant global public health issue with significant social and economic costs. Previous evidence suggests ambient temperatures are associated with unintentional injury occurrences. However, the impacts of...

SAT370 Economic Burden of Endometrial Cancer Associated with Polycystic Ovary Syndrome

Abstract Disclosure: L.A. Pace: None. D. Markovic: None. R.P. Buyalos: Employee; Self; Fertility and Surgical Associates of California. F. Bril: None. R. Azziz: Advisory Board Member; Self; Arora Forge. Consulting Fee; Self; Rani Therapeutics, Spruce Biosciences, Fortress Biotech, Core Access Surgical Technologies. Grant Recipient; Self; Foundation for Research and Education Excellence, Ferring Pharmaceuticals. Stock Owner; Self; Martin Imaging. Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among reproductive aged females, affecting approximately 6 million U.S. women. Endometrial cancer, in turn, is the most common gynecological malignancy and the fourth most common cancer overall in female patients. Objectives: To assess the excess economic burden associated with endometrial cancer in women with PCOS. Method: Using PRISMA guidelines for systematic review, we searched PubMed, Web of Science, Scopuse, and Embase for all studies on endometrial cancer in patients with known PCOS. Excluded studies were reviews and case reports, those not conducted in human subjects, without controls, without full text available, or reporting solely on diseases other than PCOS. Selected studies were assessed for quality using the Newcastle-Ottawa Scale. Meta-analysis was performed using the DerSimonian-Laird random effects model to assess the pooled risk ratio (RR) for the association between PCOS and endometrial cancer, then calculation of the excess cost was assessed in U.S. dollars (USD), adjusted for inflation using a medical care inflation calculator. Result: We screened 98 studies by title and abstract, 32 titles in full text, and included 11 articles. Pooled RR was 2.90 (95% CI 1.57-5.37), p=0.0196. In the U.S., overall prevalence of endometrial cancer in patients with PCOS is 0.409%, compared with baseline estimated five-year prevalence (2014-2019) of endometrial cancer in all women of 0.141%, or 235,596 cases. The excess prevalence of endometrial cancer in women with PCOS is therefore 0.2679%, or approximately 361 women. Direct healthcare costs associated with endometrial cancer per patient per year were estimated to be $8,597, when adjusted for inflation to 2022 costs. Therefore, the excess cost of endometrial cancer related to PCOS is estimated at 361 x $8,597 = $3.1 million per year in 2022 USD. Conclusion: In 2022 USD, the excess annual healthcare cost for endometrial cancer care in patients with PCOS exceeds $3 million per year. While the overlap between the risk factors and pathophysiologic underpinnings of both conditions is well-known, PCOS is not always directly addressed as a risk factor for endometrial cancer. Given the findings of this meta-analysis, taken in combination with previously collected data estimating the annual healthcare costs associated with PCOS diagnosis and treatment alone, to exceed $2 billion, we advocate for and increased focus in the global health, policy, and scientific communities to better address this condition and its sequelae. Funding: Foundation for Research and Education Excellence Presentation Date: Saturday, June 17, 2023

Direct economic burden of mental health disorders associated with polycystic ovary syndrome: Systematic review and meta-analysis.

Polycystic ovary syndrome (PCOS) is the most common hormone disorder affecting about one in seven reproductive-aged women worldwide and approximately 6 million women in the United States (U.S.). PCOS can be a significant burden to those affected and is associated with an increased prevalence of mental health (MH) disorders such as depression, anxiety, eating disorders, and postpartum depression. We undertook this study to determine the excess economic burden associated with MH disorders in women with PCOS in order to allow for a more accurate prioritization of the disorder as a public health priority. Following PRISMA reporting guidelines for systematic review, we searched PubMed, Web of Science, EBSCO, Medline, Scopus, and PsycINFO through July 16, 2021, for studies on MH disorders in PCOS. Excluded were studies not in humans, without controls, without original data, or not peer reviewed. As anxiety, depression, eating disorders, and postpartum depression were by far the most common MH disorders assessed by the studies, we performed our meta-analysis on these disorders. Meta-analyses were performed using the DerSimonian-Laird random effects model to compute pooled estimates of prevalence ratios (PRs) for the associations between PCOS and these MH disorders and then calculated the excess direct costs related to these disorders in U.S. dollars (USD) for women suffering from PCOS in the U.S. alone. The quality of selected studies was assessed using the Newcastle-Ottawa Scale. We screened 78 articles by title/abstract, assessed 43 articles in full text, and included 25 articles. Pooled PRs were 1.42 (95% confidence interval [CI]: 1.32-1.52) for anxiety, 1.65 (95% CI: 1.44-1.89) for depression, 1.48 (95% CI: PR: 1.06-2.05) for eating disorders, and 1.20 (95% CI: 0.96-1.50) for postpartum depression, for PCOS relative to controls. In the U.S., the additional direct healthcare costs associated with anxiety, depression, and eating disorders in PCOS were estimated to be $1.939 billion/yr, $1.678 billion/yr, and $0.644 billion/yr in 2021 USD, respectively. Postpartum depression was excluded from the cost analyses due to the non-significant meta-analysis result. Taken together, the additional direct healthcare costs associated with anxiety, depression, and eating disorders in PCOS were estimated to be $4.261 billion/yr in 2021 USD. Overall, the direct healthcare annual costs for the most common MH disorders in PCOS, namely anxiety, depression, and eating disorders, exceeds $4 billion in 2021 USD for the U.S. population alone. Taken together with our prior work, these data suggest that the healthcare-related economic burden of PCOS exceeds $15 billion yearly, considering the costs of PCOS diagnosis, and costs related to PCOS-associated MH, reproductive, vascular, and metabolic disorders. As PCOS has much the same prevalence across the world, the excess economic burden attributable to PCOS globally is enormous, mandating that the scientific and policy community increase its focus on this important disorder. The study was supported, in part, by PCOS Challenge: The National Polycystic Ovary Syndrome Association and by the Foundation for Research and Education Excellence.

Efficacy and underlying mechanisms of acupuncture therapy for PTSD: evidence from animal and clinical studies.

As a major public health problem, posttraumatic stress disorder (PTSD) has a substantial impact on individuals and society. The total excess economic burden of PTSD in the US is estimated to be more than $232.2 billion a year. Acupuncture is widely used in patients with PTSD, and an increasing number of studies have been undertaken to assess the efficacy and underlying mechanisms of acupuncture for the treatment of individuals with PTSD. However, there has not yet been a review that simultaneously elucidates the therapeutic efficacy and biological mechanisms of acupuncture. We wished to examine the efficacy and underlying mechanisms of acupuncture for the treatment of individuals with PTSD. We conducted this review in three sections as follows: a meta-analysis, an acupoint analysis, and mechanism research. PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure Database (CNKI), WanFang Database, China Biology Medicine Database (CBM), Chinese Science and Technology Journals Database (VIP), and other databases were searched from 1 January 2012 to 27 November 2022. Based on the included studies, we first determined whether acupuncture is more effective than psychological treatment or pharmacological treatment for treating and improving the quality of life of individuals with PTSD by meta-analysis. Second, the most commonly used acupoints and parameters of acupuncture were summarized based on animal and clinical studies. Third, we attempt to summarize the current mechanisms of acupuncture in the treatment of PTSD. Finally, 56 acupoint analyses, eight meta-analyses, and 33 mechanistic studies were included. Acupuncture outperformed pharmacotherapy treatment in improving symptom scores by CAPS, HAMA, HAMD, PCL-C, and SCL-90 somatization for PTSD and outperformed psychotherapy treatment in improving symptom scores by CAPS PCL-C and HAMD, according to the meta-analysis. GV20 was the most frequently used acupuncture point in clinical studies and animal studies, with a 78.6% application rate. Acupuncture may be effective in treating PTSD by regulating the structure and components of several brain areas, regulating the neuroendocrine system, and involving signaling pathways. In conclusion, this finding indicates that acupuncture has promising potential for treating PTSD.

RF10 | PMON218 Direct Costs of Mental Health Disorders in PCOS: Systematic Review and Meta-Analysis

Abstract BACKGROUND: Polycystic ovary syndrome (PCOS) is the most prevalent endocrine abnormality of reproductive-aged women today, affecting one in seven reproductive-aged women worldwide, and represents a significant financial burden to our health care. Women with PCOS have an increased risk for developing mental health (MH) disorders, in part due to biochemical changes, constant concerns regarding physical appearance, and social stigma from hirsutism, obesity, and infertility. OBJECTIVE: To determine the excess economic burden associated with MH disorders in women with PCOS. METHOD: Followed PRISMA reporting guidelines for systematic review, we searched PubMed, Web of Science, EBSCO, Medline, Scopus, and PsycINFO through July 16, 2021 for studies on MH disorders in PCOS. Excluded were studies not in humans, without controls, without original data, or not peer-reviewed. As anxiety, depression, and eating disorders were by far the most common MH disorders assessed by the studies, we performed our meta-analysis on these disorders. Meta-analyses were performed using the DerSimonian-Laird random-effects model (DerSimonian and Laird 1986) to compute pooled estimates of odds ratios (OR) for the associations between PCOS and anxiety, depression, and eating disorders. Study-specific and overall estimates using the log-odds scale were presented using forest plots. Between-study heterogeneity was evaluated using the I2 statistic. We then calculated the excess direct costs of these MH in U.S. dollars (USD) for women suffering from PCOS. RESULT: ​​We screened 72 articles by title/abstract, assessed 37 articles in full-text, and included 24 articles. Pooled ORs were 1.65 (95% CI: 1.15-2.38) for anxiety, 2.20 (95% CI: 1.69-2.86) for depression, and 2.53 (95% CI: 1.14-2.07) for eating disorders, for PCOS relative to controls. In the U.S., the additional direct healthcare costs associated with MH disorders in PCOS were estimated to be $3.075 billion/yr., $2.280 billion/yr., and $0.714 billion/yr. in 2021 USD for depression, anxiety, and eating disorders, respectively. Taken together, the additional direct healthcare costs associated with these MH disorders in PCOS was estimated to be $6.069 billion/yr. in 2021 USD. CONCLUSION: This work is the first to estimate the excess direct healthcare costs of MH disorders associated with PCOS. Overall, the direct healthcare costs for the most common MH disorders in PCOS, namely depression, anxiety, and eating disorders, exceeded $6 billion in 2021 USD for the U.S. population alone. Taken together with our prior work, these data suggest that the healthcare-related economic burden of PCOS exceeds $14 billion yearly, considering the costs of diagnosis, and MH, reproductive, vascular, and metabolic disorders (but not indirect and intangible costs). As PCOS is a global disorder with much the same prevalence across the world, the excess economic burden attributable to PCOS globally is enormous, mandating that the scientific and policy community increase its focus on this important disorder. Presentation: Saturday, June 11, 2022 1:36 p.m. - 1:41 p.m., Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

The Economic Burden of Schizophrenia in the United States.

Aim: The economic burden of schizophrenia in the United States (US) was estimated at $155.7 billion in 2013. Since 2013, the US experienced significant health care reforms and treatment advances. This study analyzed recent data and literature to update the US economic burden estimate for schizophrenia.Methods: Direct and indirect costs associated with schizophrenia were estimated using a prevalence-based approach. Direct health care costs were assessed retrospectively using an exact matched cohort design in the IBM Watson Health MarketScan databases from October 1, 2015, through December 31, 2019. Patients with schizophrenia (identified using ICD-10-CM codes F20 and F25) were exactly matched to controls on demographics, insurance type, and index year. Direct non-health care costs were estimated using published literature and government data. Indirect costs were estimated using a human capital approach and the value of quality-adjusted life-years lost. Cost offsets were estimated to account for basic living costs avoided. Excess costs, comparing costs for individuals with and without schizophrenia, were reported in 2019 USD.Results: The estimated excess economic burden of schizophrenia in the US in 2019 was $343.2 billion, including $251.9 billion in indirect costs (73.4%), $62.3 billion in direct health care costs (18.2%), and $35.0 billion in direct non-health care costs (10.2%). The largest drivers of indirect costs were caregiving ($112.3 billion), premature mortality ($77.9 billion), and unemployment ($54.2 billion). Cost offsets, representing $6.0 billion (1.7%), were subtracted from direct non-health care costs.Conclusions: The estimated burden of schizophrenia in the US doubled between 2013 and 2019 and was $343.2 billion in 2019, highlighting the importance of effective strategies and treatment options to improve the management of this difficult-to-treat patient population.

CO37 Real-World 30-Day Readmission Patterns Among Commercially Insured Patients with Metastatic Pancreatic Ductal Adenocarcinoma (MPDAC)

Unplanned hospital readmission can lead to excess economic burden among patients with mPDAC. This study aimed to describe the frequency of 30-day readmission among patients with mPDAC who received systemic treatment.

The Economic Burden of Posttraumatic Stress Disorder in the United States From a Societal Perspective.

Objective: To estimate the economic burden of posttraumatic stress disorder (PTSD) in the United States civilian and military populations from a societal perspective.Methods: A prevalence-based and human capital approach was used to estimate the total excess costs of PTSD in 2018 from insurance claims data, academic literature, and governmental publications. Excess direct health care costs (pharmacy, medical), direct non-health care costs (research and training, substance use, psychotherapy, homelessness, disability), and indirect costs (unemployment, productivity loss, caregiving, premature mortality) associated with PTSD were compared between adults with PTSD and adults without PTSD, or the general population if information was not available for adults without PTSD.Results: The total excess economic burden of PTSD in the US was estimated at $232.2 billion for 2018 ($19,630 per individual with PTSD). Total excess costs were $189.5 billion (81.6%) in the civilian population and $42.7 billion (18.4%) in the military population, corresponding to $18,640 and $25,684 per individual with PTSD in the civilian and military populations, respectively. In the civilian population, the excess burden was driven by direct health care ($66.0 billion) and unemployment ($42.7 billion) costs. In the military population, the excess burden was driven by disability ($17.8 billion) and direct health care ($10.1 billion) costs.Conclusions: The economic burden of PTSD goes beyond direct health care costs and has been found to rival costs for other costly mental health conditions. Increased awareness of PTSD, development of more effective therapies, and expansion of evidence-based interventions may be warranted to reduce the large clinical and economic burden of PTSD.

The Economic Burden of Schizophrenia in the United States in 2019

Schizophrenia is associated with health, social, and financial burdens for patients, caregivers, and society. Major systemic changes, reforms, and technological advances have happened in the USA since the prior estimate of the societal cost of schizophrenia, $155.7B in 2013. This study analyzes the most recent data and literature to update this estimate. Direct and indirect costs associated with schizophrenia in the US in 2019 were estimated using a prevalence-based approach (ICD-10 codes: F20, F25). Direct healthcare costs were assessed retrospectively using a matched cohort design in the IBM Watson Health MarketScan Commercial, Medicare, and Medicaid databases from October 1, 2015, through December 31, 2019. Patients were matched to controls on demographics, insurance type, and index year. Direct nonhealthcare costs were estimated using published literature and government data. Indirect costs were estimated using a human capital approach and the value of quality-adjusted life years lost. Cost offsets were applied to account for basic living costs avoided. Excess costs, comparing costs for individuals with and without schizophrenia, were reported in 2019 USD. The estimated excess economic burden of schizophrenia in the US in 2019 was $330.6B, including $62.3B in direct healthcare costs (19%), $19.7B in direct nonhealthcare costs (5%), and $251.9B in excess indirect costs (76%). The largest drivers of indirect costs were caregiving ($112.3B), premature mortality ($77.9B), and unemployment ($54.2B). The estimated societal burden of schizophrenia in the USA in 2019 was $330.6B, which represented a 93.5% increase from 2013 to 2019, after accounting for inflation. This study underscores the increasing and apparent burden of schizophrenia not only on the patient, but also on caregivers and society. Sunovion Pharmaceuticals.

Short-Term Excess Healthcare Costs Associated with Cardiovascular Events Among Adults with Type 2 Diabetes in Israel: A Retrospective Cohort Study.

ObjectiveThe aim was to characterise the short-term (up to 12 months) direct economic burden of new cardiovascular (CV) events among adults with type 2 diabetes (T2D) in Israel.MethodsIn this retrospective cohort study utilising the electronic health records of the Maccabi Healthcare Services, adults aged ≥ 21 years with T2D who experienced their first CV event (2013–2016) were identified via adjudicated enrolment in a CV registry. Wilcoxon rank-sum test estimated excess healthcare resource utilisation in three periods after the CV event: immediate (1 month; for all patients), acute (3 months; for survivors of 1 month of follow-up) and short-term (12 months; for survivors of 3 months of follow-up). Direct healthcare expenditure (2018 United States dollars [USD]) was estimated from unit costs from the State of Israel Ministry of Health price list.ResultsIn total, 5133 adults experienced a qualifying CV event, with a mean (standard deviation [SD]) age of 67.4 (11.8) years, diabetes duration of 17.7 (11.1) years and glycated haemoglobin of 7.4% (1.6%); 38.0% were female. In USD per patient, mean (SD) immediate costs were $10,741 ($11,707) compared with $2820 ($5661) at baseline (cost ratio [CR] 3.81), acute costs were $14,586 ($15,410) compared with $5202 ($8971) at baseline (CR 2.80) and short-term costs were $23,847 ($25,227) compared with $11,123 ($15,990) at baseline (CR 2.14). A sensitivity analysis of survivors only was consistent with the main analysis.ConclusionsOur results indicate that CV complications of T2D place a substantial excess economic burden on Israel’s healthcare system over the short term (up to 12 months).Supplementary InformationThe online version contains supplementary material available at 10.1007/s41669-021-00268-5.

Economic Burden of Treatment-Resistant Depression among Adults with Chronic Non-Cancer Pain Conditions and Major Depressive Disorder in the US.

Major depressive disorder (MDD) and chronic non-cancer pain conditions (CNPC) often co-occur and exacerbate one another. Treatment-resistant depression (TRD) in adults with CNPC can amplify the economic burden. This study examined the impact of TRD on direct total and MDD-related healthcare resource utilization (HRU) and costs among commercially insured patients with CNPC and MDD in the US. The retrospective longitudinal cohort study employed a claims-based algorithm to identify adults with TRD from a US claims database (January 2007 to June 2017). Costs (2018 US$) and HRU were compared between patients with and without TRD over a 12-month period after TRD/non-TRD index date. Counterfactual recycled predictions from generalized linear models were used to examine associations between TRD and annual HRU and costs. Post-regression linear decomposition identified differences in patient-level factors between TRD and non-TRD groups that contributed to the excess economic burden of TRD. Of the 21,180 adults with CNPC and MDD, 10.1% were identified as having TRD. TRD patients had significantly higher HRU, translating into higher average total costs (US$21,015TRD vs US$14,712No TRD) and MDD-related costs (US$1201TRD vs US$471No TRD) compared with non-TRD patients (all p< 0.001). Prescription drug costs accounted for 37.6% and inpatient services for 30.7% of the excess total healthcare costs among TRD patients. TRD patients had a significantly higher number of inpatient (incidence rate ratio [IRR] 1.30, 95% CI 1.14-1.47) and emergency room visits (IRR 1.21, 95% CI 1.10-1.34) than non-TRD patients. Overall, 46% of the excess total costs were explained by differences in patient-level characteristics such as polypharmacy, number of CNPC, anxiety, sleep, and substance use disorders between the TRD and non-TRD groups. TRD poses a substantial direct economic burden for adults with CNPC and MDD. Excess healthcare costs may potentially be reduced by providing timely interventions for several modifiable risk factors.

Economic Burden of Asthma-Chronic Obstructive Pulmonary Disease Overlap among Older Adults in the United States

The objective of this study is to estimate the excess economic burden of Asthma-COPD Overlap (ACO) among older adults in the United States. We used a cross-sectional study design with data from a nationally representative survey of Medicare beneficiaries (Medicare Current Beneficiary Survey) linked to Medicare fee-for-service claims. Older adults with ACO had higher average total healthcare expenditures ($45,532 vs. $12,743) and higher out-of-pocket spending burden (19% vs. 8.5%) compared to those with no-asthma no-COPD (NANC). Individuals with ACO also had almost two, and 1.5 times higher expenditures compared to individuals with asthma only and COPD only, respectively. Multivariable regression models indicated that the adjusted associations of ACO to economic burden remained positive and statistically significant. In comparison with NANC, nearly three-quarters of the excess total healthcare expenditures and 83% of the out-of-pocket spending burden of older adults with ACO were explained by differences in predisposing, enabling, need, personal healthcare practices, and external factors among the two groups. The higher number of unique medications and the increased incidence of fragmented care were the leading contributors to the excess economic burden among older adults with ACO comparing to NANC individuals. Interventions that reduce the number of medications and fragmented care have the potential to reduce the excess economic burden among older adults with ACO.

Auricular acupuncture for breast cancer-related depression: A protocol for systematic review and meta-analysis.

Background:Breast cancer is a common disease in galactophore department. Patients with breast cancer are prone to depression, with the incidence of depression ranging from 13% to 23% and as high as 70% in patients with advanced stage. On the one hand, it is related to the physiological characteristics, personality characteristics, and social factors of women themselves. On the other hand, it is related to the common tumors of women, such as breast cancer, examination, and antitumor treatment. Due to the serious side effects of chemotherapy drugs, patients can always feel the presence of cancer. In addition, the mark of radiotherapy and fatigue make the psychological burden continue to have excessive economic burden, and lack of understanding from both social and family, discrimination and patients’ own psychological endurance are all causes of breast cancer factors contributing to depressive symptoms in patients. Auricular acupuncture as a form of acupuncture therapy which is proved to be effective in RCTs and very suitable for patients, has been used in patients who suffer from breast cancer-related depression for a long time, therefore, a systematic review is necessary to provide available evidence for further study.Methods:The following databases will be searched from their inception to August 2020: Electronic database includes PubMed, Embase, Cochrane Library, Web of Science, Nature, Science online, VIP medicine information, and China National Knowledge Infrastructure. Primary outcomes: Score of depression symptoms. Additional outcomes: The overall effective rate. Data will be extracted by 2 researchers independently, risk of bias of the meta-analysis will be evaluated based on the Cochrane Handbook for Systematic Reviews of Interventions. All data analysis will be conducted by data statistics software Review Manager V.5.3. and Stata V.12.0.Results:The results of this study will systematically evaluate the effectiveness and safety of auricular acupuncture intervention for people with breast cancer-related depression.Conclusion:The systematic review of this study will summarize the current published evidence of auricular acupuncture for the treatment of breast cancer-related depression, which can further guide the promotion and application of it.Open Science Fra network (OSF) registration number:September 11, 2020 osf.io/5b7yw. (https://osf.io/5b7yw)

The excess economic burden of mental disorders: findings from a cross-sectional prevalence survey in Austria

Information about the scope of mental disorders (MDs), resource use patterns in health and social care sectors and economic cost is crucial for adequate mental healthcare planning. This study provides the first representative estimates about the overall utilisation of resources by people with MDs and the excess healthcare and productivity loss costs associated with MDs in Austria. Data were collected in a cross-sectional survey conducted on a representative sample (n = 1008) between June 2015 and June 2016. Information on mental health diagnoses, 12-month health and social care use, medication use, comorbidities, informal care, early retirement, sick leave and unemployment was collected via face-to-face interviews. Generalised linear model was used to assess the excess cost of MDs. The healthcare cost was 37% higher (p = 0.06) and the total cost was twice as high (p < 0.001) for the respondents with MDs compared to those without MDs. Lost productivity cost was over 2.5-times higher (p < 0.001) for those with MDs. Participants with severe MDs had over 2.5-times higher health and social care cost (p < 0.001) and 9-times higher mental health services cost (p < 0.001), compared to those with non-severe MDs. The presence of two or more physical comorbidities was a statistically significant determinant of the total cost. Findings suggest that the overall excess economic burden on health and social care depends on the severity of MDs and the number of comorbidities. Both non-severe and severe MDs contribute to substantially higher loss productivity costs compared to no MDs. Future resource allocation and service planning should take this into consideration.

PMH7 ECONOMIC BURDEN OF TREATMENT-RESISTANT DEPRESSION AMONG ADULTS WITH CHRONIC NON-CANCER PAIN CONDITIONS AND MAJOR DEPRESSIVE DISORDER

Chronic non-cancer pain conditions (CNPC) and Major Depressive Disorder (MDD) often co-occur and presents a substantial economic burden. Treatment-resistant depression (TRD) in adults with CNPC can amplify the economic burden. This study examined the impact of TRD on total and MDD-related healthcare resource utilization (HRU) and costs among patients with CNPC and MDD. The study used a retrospective longitudinal cohort design and employed a claims-based algorithm to identify adults with TRD from a US claims database (January 2007- June 2017). Costs and HRU were measured over a 12-month period after TRD/non-TRD index date. Counterfactual recycled predictions from generalized linear models were used to examine associations between TRD and annual HRU and costs. Post-regression linear decomposition identified differences in patient-level factors between TRD and non-TRD groups that contributed to the excess economic burden of TRD. Of the 21,180 adults with CNPC and MDD (mean age 55 years, 74% females, 33% had ≥3 CNPC), 10.1% were identified as having TRD. TRD patients had significantly higher HRU, translating into higher average total costs ($21,015TRD vs $14,712No TRD) and MDD-related costs ($1,201TRD vs $471No TRD) compared to non-TRD patients (all P <0.001). Prescription drug costs accounted for 37.6% and inpatient services for 30.7% of the excess total healthcare costs among TRD patients. TRD patients had significantly higher number of inpatient visits (IRR = 1.30, 95% CI = 1.14-1.47) and emergency room visits (IRR = 1.21, 95% CI = 1.10-1.34) than non-TRD patients. Overall, 46% of the excess total costs were explained by differences in patient level characteristics such as polypharmacy, number of CNPC, anxiety, sleep, and substance use disorders between the TRD and non-TRD groups. TRD poses a significant direct economic burden among adults with CNPC and MDD. Excess healthcare costs may potentially be reduced by providing timely interventions for several modifiable risk factors.

Health Care Costs Associated With Muscle Weakness: A UK Population-Based Estimate

Sarcopenia and muscle weakness are responsible for considerable health care expenditure but little is known about these costs in the UK. To address this, we estimated the excess economic burden for individuals with muscle weakness regarding the provision of health and social care among 442 men and women (aged 71–80 years) who participated in the Hertfordshire Cohort Study (UK). Muscle weakness, characterised by low grip strength, was defined according to the Foundation for the National Institutes of Health criteria (men < 26 kg, women < 16 kg). Costs associated with primary care consultations and visits, outpatient and inpatient secondary care, medications, and formal (paid) as well as informal care for each participant were calculated. Mean total costs per person and their corresponding components were compared between groups with and without muscle weakness. Prevalence of muscle weakness in the sample was 11%. Mean total annual costs for participants with muscle weakness were £4592 (CI £2962–£6221), with informal care, inpatient secondary care and primary care accounting for the majority of total costs (38%, 23% and 19%, respectively). For participants without muscle weakness, total annual costs were £1885 (CI £1542–£2228) and their three highest cost categories were informal care (26%), primary care (23%) and formal care (20%). Total excess costs associated with muscle weakness were £2707 per person per year, with informal care costs accounting for 46% of this difference. This results in an estimated annual excess cost in the UK of £2.5 billion.

Excess economic burden of comorbidities in COPD: a 15-year population-based study.

A better understanding of the true burden of chronic obstructive pulmonary disease (COPD) needs to consider the implications of comorbidities. This study comprehensively examined the impact of comorbidities on excess direct medical costs in COPD patients.From health administrative data in British Columbia, Canada (1996-2012), we created a propensity-score-matched cohort of incident COPD patients and individuals without COPD. Health services use records were compiled into 16 major disease categories based on International Classification of Diseases codes. Excess costs (in 2015 Canadian dollars and converted to 2015 Euros; CAD1.000=EUR 0.706) were estimated as the adjusted difference in direct medical costs between the two groups.The sample included 128 424 subjects in each group. COPD patients generated excess costs of CAD5196/EUR3668 per person-year (95% CI CAD3540-8529), of which 26% was attributable to COPD itself and 51% was attributable to comorbidities (the remaining 23% could not be attributed to any specific condition). The major cost driver was excess hospitalisation costs. The largest components of comorbidity costs were circulatory diseases, other respiratory disorders, digestive disorders and psychological disorders (CAD696/EUR491, CAD312/EUR220, CAD274/EUR193 and CAD249/EUR176 per person-year, respectively).These findings suggest that the prevention and appropriate management of comorbidities in COPD patients may effectively reduce the overall burden of COPD.

Economic Burden of Inpatient Admission of Ankle Fractures.

Ankle fractures are among the most prevalent traumatic orthopaedic injuries. A large proportion of patients sustaining operative ankle fractures are admitted directly from the emergency department prior to operative management. In the authors' experience, however, many closed ankle injuries may be safely and effectively managed on an outpatient basis. The aim of this study was to characterize the economic impact of routine inpatient admission of ankle fractures. A retrospective review of all outpatient ankle fracture surgery performed by a single foot and ankle fellowship-trained surgeon at a tertiary level academic center in 2012 was conducted to identify any patients requiring postoperative inpatient admission. The National Inpatient Sample was queried for operative management of lateral malleolus, bimalleolar, and trimalleolar ankle fractures in 2012 with regard to national estimates of total volume and length of stay by age. The maximum allowable Medicare inpatient facility reimbursements for diagnosis related group 494 and Medicare outpatient facility reimbursements for Current Procedural Terminology codes 27792, 27814, and 27822 were obtained from the Medicare Acute Inpatient Prospective Pricer and the Medicare Outpatient Pricer Code, respectively. Private facility reimbursement rates were estimated at 139% of inpatient Medicare reimbursement and 280% of outpatient reimbursement, as described in the literature. Surgeon and anesthesiologist fees were considered similar between both inpatient and outpatient groups. A unique stochastic decision-tree model was derived from probabilities and associated costs and evaluated using modified Monte Carlo simulation. Of 76 lateral malleolar, bimalleolar, and trimalleolar ankle fracture open reduction internal fixation cases performed in 2012 by the senior author, 9 patients required admission for polytrauma, medical comorbidities, or age. All 67 outpatients were discharged home the day of surgery. In the 2012 national cohort analyzed, 48,044 estimated inpatient admissions occurred postoperatively for closed ankle fractures. The median length of stay was 3 days for each admission and was associated with an estimated facility reimbursement ranging from $12,920 for Medicare reimbursement of lateral malleolus fractures to $18,613 for private reimbursement of trimalleolar fractures. Outpatient facility reimbursements per case were estimated at $4,125 for Medicare patients and $11,459 for private insurance patients. Nationally, annual inpatient admissions accounted for $796,033,050 in reimbursements, while outpatient surgery would have been associated with $419,327,612 for treatment of these same ankle fractures. In the authors' experience, closed lateral malleolus, bimalleolar, and trimalleolar fractures were safely and effectively treated on an outpatient basis. Routine perioperative admission of patients sustaining ankle fractures likely results in more than $367 million of excess facility reimbursements annually in the United States. Even if a 25% necessary admission rate were assumed, routine inpatient admission of ankle fractures would result in a $282 million excess economic burden annually in the United States. Although in certain cases, inpatient admission may be necessary, with value-based decision making becoming increasingly the responsibility of the orthopaedic surgeon, understanding the implications of inpatient stays for ankle fracture surgery can ultimately result in cost savings to the US health care system and patients individually. Level III, comparative series.

Qualitative research on real experience of parents of children with acute leukemia in children undergoing first chemotherapy

Objective To explore the real experience of parents of children with acute leukemia in children undergoing first chemotherapy so as to provide the theoretical and practical evidence for development of individualized nursing measures. Methods A total of 16 parents with acute leukemia in children undergoing first chemotherapy were investigated using half-structured interviews via phenomenological research methods. The NVivo10.0 software was used to manage, discover and seek data. The data were analyzed using Colaizzi phenomenological method. Results Three themes including complex negative emotions, excessive economic burden and multiply needs were extracted. Conclusions Parents with acute leukemia in children undergoing first chemotherapy need more attentions. Nurses should take individualized measures to really meet their needs and reduce psychological load so as to be better with follow-up treatment of children. Key words: Leukemia; Chemotherapy; Parents; Qualitative research