First-year Costs Research Articles

Cost Analysis of Interventions for Antimuscarinic Refractory Patients With Overactive Bladder

To estimate average, initial, and cumulative procedure related costs from a US payer perspective extending up to 3 years for the overactive bladder (OAB) interventions: sacral neuromodulation (SNM), intra-detrusor botulinum toxin A (BoNTA), and augmentation cystoplasty (AC) for antimuscarinic refractory patients. Costs (2007 US dollars) were calculated using Current Procedural Terminology (CPT) codes, Ambulatory Payment Classification (APC) codes; Diagnosis Related Group (DRG) payments, and Healthcare Common Procedure Coding System (HCPCS) Level II Codes extracted from the literature and from the SNM device manufacturer. CPT codes were converted to costs using the Center for Medicare and Medicaid Services (CMS) Relative Value Unit (RVU) fee schedule. Sensitivity analyses were performed to evaluate assumptions and uncertainty of results based on plausible variation in estimates of key cost drivers. The initial treatment cost was $22,226, $1,313, and $10,252 for SNM, intra-detrusor injection of BoNTA, and AC respectively. The first-year cost was $23,614, $2626, and $11,637 respectively. Three years after initiating treatment, the cumulative cost was $26,269, $7651, and $14,337 respectively. Sensitivity analyses revealed that SNM persisted as the most costly intervention in all scenarios. The 3-year cumulative cost range produced by the sensitivity analyses for SNM, BoNTA, and AC was $25,384-$27,357, $4586-$11,476, and $12,315-$16,830, respectively. All estimates of cost endpoints for SNM were greater than those for BoNTA and AC. These cost estimates, when combined with data on outcomes and risks, are important components of a robust health care technology assessment of antimuscarinic treatment failure options.

Trends in Patient Characteristics and First-Year Medical Costs of Older Incident Hemodialysis Patients, 1995-2005

Characteristics of patients with chronic kidney disease who survive to end-stage renal disease may change over time, affecting subsequent outcomes and costs. We examined trends in older incident hemodialysis patient characteristics and analyzed first-year post-dialysis therapy initiation medical costs. Retrospective cohort study. All US incident hemodialysis patients aged > or =67 years at dialysis therapy initiation from January 1, 1995, to December 31, 2005, with Medicare Part A and Part B in the prior 2 years. Year of dialysis therapy initiation. Changes in patient characteristics and first-year costs. Mean and median values for continuous variables and percentages of categorical variables; first-year total medical costs measured per person per year. Observed costs were adjusted using Medicare Price Indices and patient case-mix. Median age at dialysis therapy initiation increased from 74.9 to 77.0 years from 1995 (n = 19,044) to 2005 (n = 31,796; P < 0.001). Diabetes prevalence increased from 54.2% to 64.1% (P < 0.001). Median estimated glomerular filtration rate increased from 8.0 to 11.2 mL/min/1.73 m(2), and median hemoglobin level increased from 9.4 to 10.2 g/dL. Obesity increased from 8.9% to 22.9% (P < 0.001). First-year observed costs increased by 37.9%; however, inflation-adjusted and case-mix-inflation-adjusted costs were stable. Important adjusters for costs are inability to ambulate/transfer, baseline serum albumin level, primary end-stage renal disease cause, comorbid peripheral vascular disease, and baseline hospital days. Population aged > or =67 years at dialysis therapy initiation and results may not generalize to the overall hemodialysis population. From 1995 to 2005, incident hemodialysis patients aged > or =67 years became older, sicker, and more obese with significantly increased estimated glomerular filtration rates and hemoglobin levels at dialysis therapy initiation. Increased first-year post-dialysis therapy initiation costs became stable over time after adjustment for price inflation; case-mix-inflation-adjusted costs remained constant, possibly because of mixed changes in patient characteristics.

Healthcare costs in renal transplant recipients using branded versus generic ciclosporin

Generic ciclosporin A modified (CsA) does not have an equivalent pharmacokinetic profile to branded CsA in some transplant populations, potentially leading to negative clinical consequences and increased long-term costs. To assess direct healthcare costs for de novo renal transplant recipients in the US receiving branded versus generic CsA in the first month after transplantation. Administrative claims data from eight private US health plans were linked to the Organ Procurement and Transplantation Network data. A total of 227 renal transplant cases between 1996 and 2004 were included: 183 were dispensed branded CsA and 44 received generic CsA. Log transformed multiple linear regression was used to model total first-year healthcare costs after the initial CsA claim, controlling for both patient demographics and clinical characteristics and clustering at the transplant centre level. After controlling for patient factors and pre-CsA costs, total healthcare costs were significantly higher (p = 0.04) for patients receiving generic CsA versus branded CsA. The main driver for the difference was the cost associated with immunosuppressants other than CsA (p = 0.01). Despite initial perceived cost savings associated with generic CsA, de novo renal transplant recipients incurred greater total healthcare costs than those treated with branded CsA. Patients receiving generic CsA may need higher doses or other immunosuppressants to maintain the transplanted kidney than patients receiving branded CsA. Providers and payers need to be aware of potential differences in total healthcare costs between formulations of bioequivalent critical-dose drugs to make the best choice for patient care.

First-year treatment costs among new initiators of topical prostaglandin analogs

To estimate first-year costs among new initiators of topical prostaglandin analogs in a managed care population. We developed a model to estimate first-year direct medical costs. We derived treatment patterns from a claims database analysis. Published studies were used to estimate visit-related resource use. Costs were obtained from standard sources. The database analysis identified 9,063 patients meeting study criteria, 41% (n = 3,672) of whom remained on their initial prostaglandin therapy for 12 months after initiation. Adjunctive intraocular pressure lowering therapy was needed in 20.7%, 16.5%, 13.9%, and 8.9% of bimatoprost, latanoprost, travoprost, and BAK-free travoprost patients, respectively. Median numbers of days to the first prescription filled for adjunctive therapy (if required) were 69.5, 67.0, 123.0, and 158.5 for patients initiating on bimatoprost, latanoprost, travoprost, and BAK-free travoprost. Total estimated first-year costs were $1,457, $1,360, $1,278, and $1,307 for patients initiating therapy with bimatoprost, latanoprost, travoprost, and BAK-free travoprost. Findings were consistent through sensitivity analysis. A BAK-free prostaglandin analog may permit longer duration of monotherapy and be associated with lower first-year direct medical costs. Use of a claims database and the selection of new initiators of prostaglandin analogs limit projecting findings to all glaucoma patients.

Direct healthcare costs of hip, vertebral, and non-hip, non-vertebral fractures

Limited data exist regarding the cost of non-hip, non-vertebral (NHNV) fractures. Although NHNV fractures may be less expensive than hip and vertebral fractures, they have a higher incidence rate. The objective of this study was to quantify first-year healthcare costs of hip, vertebral, and NHNV fractures. This was a claims-based retrospective analysis using a case-control design among patients with commercial insurance and Medicare employer-based supplemental coverage. Patients were ≥ 50 years old with a closed hip, vertebral, or NHNV fracture between 7/1/2001 and 12/31/2004, and continuous enrollment 6 months prior to and 12 months after the index fracture. Adjusted mean first-year healthcare costs associated with these fractures were determined. Six cohorts were identified. Patients 50–64 years: NHNV ( n = 27,424), vertebral ( n = 3386) and hip ( n = 2423); patients ≥ 65 years: NHNV ( n = 40,960), vertebral ( n = 11,751) and hip ( n = 21,504). The ratio of NHNV to hip fractures was 11:1 in the 50–64 cohort and 2:1 in the ≥ 65 cohort. Adjusted mean first-year costs associated with hip, vertebral, and NHNV fractures were $26,545, $14,977, and $9183 for the 50–64 age cohort, and $15,196, $6701, and $6106 for patients ≥ 65 years. After taking prevalence rate into account, the proportion of the total fracture costs accounted for by NHNV, hip, and vertebral fractures were 66%, 21% and 13% for the 50–64 age cohort, and 36%, 52% and 12% for the ≥ 65 age cohort. Limitations included the exclusion of the uninsured and those covered by Medicaid or military-based insurance programs. The results of this study demonstrate that osteoporotic fractures are associated with significant costs. Although NHNV fractures have a lower per-patient cost than hip or vertebral fractures, their total first-year cost is greater for those 50–64 because of their higher prevalence.

The Cost of E-Learning

E-learning is a business activity. It has a value to the business, a start-up cost, and running costs. The costs must be managed if the program is to stay within budget and yield an adequate return on investment. The question of start-up versus ongoing costs can best be answered if the program scope can be defined for the first two or three years. First-year costs are high, while ongoing costs are typically lower. Return on the time and money invested are typically realized toward the end of the first year. Second-year returns are higher as more courses are offered and the subscriber base expands. The answers to questions of cost are usually broad and rough at the outset and then become more refined as the project comes into focus.

First-year costs of treating prostate cancer: estimates from SEER-Medicare data

Pharmacologic therapies are currently being evaluated for the prevention of prostate cancer (PCa). As additional clinical data become available regarding their benefits and risks, an examination of their economic impact will also be important. The purpose of this study was to estimate mean per patient PCa-related costs during the first year following diagnosis and to examine the extent to which initial therapies are used, by initial cancer stage. Our data show that health-care costs were significant and varied by stage. With average first-year PCa-related costs of US$13,091, prevention strategies have the potential to reduce health-care costs.

First-year treatment patterns among new initiators of topical prostaglandin analogs

ABSTRACTObjective: To evaluate treatment patterns and costs among new initiators of topical prostaglandin analogs in a managed-care population.Research design and methods: Annual costs were modeled using multiple inputs. A retrospective cohort design was used to identify treatment patterns for pharmacotherapy. The study population was identified from pharmacy claims for patients who met study inclusion criteria (patients initiating prostaglandin analog monotherapy). Published studies were used to estimate visit-related resource use and costs were obtained from published and standard sources.Results: In the cohort analysis, a total of 12 202 patients met study criteria: 2275 received bimatoprost, 7347 received latanoprost and 2580 received travoprost (1808 used the original formulation and 772 used the newer preservative formulation). Of patients meeting study criteria, 50% stopped all glaucoma therapy, 6% switched from their initial prostaglandin therapy, and the remaining 44% stayed on their initial prostaglandin for 1 year. Of patients remaining on prostaglandin analog monotherapy for 1 year, 22.7% of bimatoprost patients, 19.8% of latanoprost patients and 17.9% of travoprost patients (19.7% for the original formulation and 13.7% for the new formulation) required adjunctive therapy. Of those requiring adjunctive therapy, the median number of days until starting adjunctive therapy was 53 days for bimatoprost patients, 63 days for latanoprost patients and 83 days for travoprost patients (70.5 days for the original formulation and 109 days for the new formulation). The resources used at each visit were estimated at $424 for an initial visit and $70 for follow-up visits. Estimated first-year costs were $1294, $1199, and $1186 for patients initiating therapy with bimatoprost, latanoprost, and travoprost, respectively. Estimated travoprost costs were higher for the original formulation ($1203) than for the new formulation ($1160). Sensitivity analyses suggested that the cost estimates are robust to changes in costs and use of adjunctive therapies.Limitations: The use of a claims database without compliance data or clinical outcomes and the selection of new initiators of topical prostaglandin analogs limits the findings and does not allow projecting outcomes to all glaucoma patients.Conclusions: Use of adjunctive therapy in glaucoma is an important driver of glaucoma management costs. Based on the results of this study, it is possible that longer duration of monotherapy with prostaglandin analogs may be associated with lower annual costs. Further study should be conducted to validate these findings.

Persistence of Morbidity and Cost Differences Between Late-Preterm and Term Infants During the First Year of Life

Late-preterm infants are known to have greater morbidity and costs compared with term infants during the neonatal period, but less is known about whether these differences continue beyond this period. The purpose of this study was to examine the most common causes and costs of rehospitalization and other health care use among late-preterm and term infants throughout the first year of life. We conducted a retrospective cohort study of late-preterm (33-36 weeks' gestation) and term infants born in 2004 with > or =1 year of enrollment in a large national US database of commercially insured members. All of the reported health care services and costs were examined from the birth hospitalization through the first year of life. We evaluated 1683 late-preterm and 33 745 term infants. The average length of stay of the birth hospitalization for term infants was 2.2 days, and the average cost was $2061. Late-preterm infants had a substantially longer average stay of 8.8 days and average cost of $26 054. Total first-year costs after birth discharge were, on average, 3 times as high among late-preterm infants ($12 247) compared with term infants ($4069). Late-preterm infants were rehospitalized more often than term infants (15.2% vs 7.9%). A subset of late-preterm infants that were discharged late from their birth hospitalization had the highest rates of rehospitalization and total health care costs. Higher costs during rehospitalization of late-preterm infants, especially those with a late discharge, indicate their propensity to have more severe illness. Late-preterm infants have greater morbidity and total health care costs than term infants, and these differences persist throughout the first year of life. Management strategies and guidelines to reduce morbidity and costs in late-preterm infants should be investigated.

One-year costs of ischemic heart disease among patients with acute coronary syndromes: findings from a multi-employer claims database

ABSTRACTObjective: Acute coronary syndromes (ACS) are life-threatening disorders requiring intensive medical management or invasive cardiovascular procedures. Limited data exist on the costs and resource utilization associated with ACS.Methods: This retrospective single-cohort study analyzed administrative claims data from employer-sponsored plans for patients with an ACS hospitalization in 2001–2002. A 1‑year follow-up period was used, and patients who were under age 35 or had an ACS diagnosis in the 12 months before the hospitalization were excluded. Costs were reported in 2005 US dollars.Results: We identified 16 321 patients hospitalized for ACS during the study period. Mean (± SD) age was 55.6 (± 6.7) years, 66.7% were male, and 46.3% underwent a revascularization procedure during their initial hospital­ization. Mean length of stay for the initial hospitalization was 4.6 days (median: 3.0; IQR: 2.0–5.0), and per-patient expenditures averaged $22 921 (median: $13 960; IQR: $6839–28 588). During the follow-up period, 21% of patients were rehospitalized for ischemic heart disease (IHD), and the cost of rehospitalization averaged $28 637. Additionally, in the year following the inpatient admission, 50% of patients were prescribed antiplatelet or anti­coagulant medications, and 90% of patients were prescribed lipid-lowering, antihypertensive, or anti­arrhythmic medications. IHD-related expenditures after the initial inpatient stay averaged $9425 (median: $2800; IQR: $899–7577); 61% of these costs were due to rehospitalization. Total first-year costs averaged $32 345 (median: $21 653; IQR: $10 642–41 106).Limitations: Diagnoses could not be verified through medical charts. Payments for Medicare patients were not assessed given our focus on the working-age population.Conclusions: In this employer-sponsored health plan population, the costs of inpatient and outpatient IHD-related care were high. Future studies should evaluate the impact of improved patient management on post-discharge costs.

Estimated first-year costs of prostaglandin analogs with/without adjunctive therapy for glaucoma management:a United States perspective

ABSTRACTObjective: To evaluate costs associated with prostaglandin analogs among newly-diagnosed glaucoma patients in a managed-care population.Research design and methods: A cost minimization model compared annual costs for patients initiating therapy with one of the three prostaglandin analogs (bimatoprost, latanoprost, travoprost). The study cohort was identified from pharmacy claims and eligibility files of patients who met study inclusion criteria. Annual costs were estimated for patients initiating therapy with each prostaglandin based on treatment patterns and medication use over the year. Costs for outpatient physician visits and medications were estimated from standard sources.Results: A total of 4444 patients met study criteria: 674 received travoprost, 729 received bimatoprost, and 3041 received latanoprost. More than 80% stayed on monotherapy for 1 year (82.9% of travoprost patients, 82.8% of bimatoprost patients, and 80.5% of latanoprost patients). Of those who required adjunctive therapy, the average number of days until starting adjunctive therapy was 130 days for travoprost patients, 94 days for bimatoprost patients, and 104 days for latanoprost patients. Average annual costs were $1198, $1290, and $1217 for patients treated with travoprost, bimatoprost, and latanoprost, respectively.Conclusions: The use of adjunctive therapy in glaucoma is an important driver of glaucoma management costs. This study demonstrates that the longer duration of monotherapy and the likelihood to use single rather than combination adjunctive agents contribute to lower annual costs among patients starting on travoprost compared with the other available prostaglandin analogs. Study limitations include the lack of clinical indicators in the study database; further, results may not be generalizable to patients who discontinue prostaglandin analogs or to the population of patients with glaucoma as a whole. Future studies with clinical and compliance indicators would further identify distinctions among treatment regimens.

Relative Cost of a Line of Vision in Age-Related Macular Degeneration

To quantitate the relative cost of new therapies for age-related macular degeneration (AMD) versus saved vision. Systematic review. Landmark AMD treatment studies were reviewed to quantitate the visual benefit. For comparison, representative treatment studies for common retinal conditions including retinal detachment, macular hole (MH), epiretinal membrane (ERM), and diabetic retinopathy were also reviewed. Several parameters to estimate Snellen lines of vision saved were defined and tabulated for each condition. A regimen of office visits, ancillary testing, and treatments was outlined. Costs for this were tabulated using Medicare-allowable costs, and costs of visual benefit (per line of vision) for each condition were calculated. Life expectancy was factored in to calculate the cost of a line of vision for each year (line-year). The proportions of costs allocated to professional, technical, and pharmaceutical expenses were tabulated for each therapy. The cost per line of vision saved for AMD therapies ranged from $997 for laser for extrafoveal choroidal neovascularization, to $5509 for photodynamic therapy for occult lesions, to $12 482 for pegaptanib injections. This compares to $651 for retinal detachment repair, $1658 for MH repair, $2411 for ERM peeling, $5458 for diabetic macular edema laser, $594 for panretinal photocoagulation, and $2984 to $4178 for diabetic vitrectomy. The costs per line-years ranged from $77 to $1248 for AMD, and $21 to $194 for the comparison conditions. The proportion of costs for pegaptanib treatment was 17% for professional fees and 70% for pharmaceutical fees. Assumptions incorporated in estimating costs for pegaptanib could easily have doubled because second-year costs might approximate first-year costs and the maintenance of treatment effect has not been well established. Although correctly heralded as a breakthrough in macular degeneration treatment, new pharmacologic therapies for AMD are extremely expensive and some yield marginal visual dividends. As in all fields of medicine that provide care to elderly patients, these costs should be considered as they relate to health care costs for the individual patient and payors, and must be considered in a larger perspective of health care benefit apportionment.

Cost-effectiveness of continuous combined hormone replacement therapy in long-term use: economic evaluation based on a 9‑year study in Finland

ABSTRACTObjectives: To investigate the cost-effectiveness of continuous combined hormone replacement therapy (ccHRT) (Indivina) in postmenopausal women in Finland treated for up to nine consecutive years in the course of a randomised controlled trial.Methods: In-study event data were accrued for cardiac and vascular events, cancers and fractures. These event incidence data were applied to first-year direct medical costs for these events, derived from published sources. Reference event incidence data were derived from hospital discharge records and relevant national registries for age-matched women (aged 50–70 years) in Finland with an assumed HRT usage rate of 40%. Cost-effectiveness was expressed as additional cost per quality-adjusted life year (QALY) gained for women on ccHRT compared with the general population. All input data were discounted at 3% per annum.Results: The additional cost per QALY gained for ccHRT was less than €5000 throughout the nine calendar years examined and remained well below the threshold of acceptability of €50 000 in a range of sensitivity analyses. The lowest dose-combination of ccHRT examined improved quality of life at no greater cost than no treatment.Conclusions: This appraisal, based on event data from a uniquely long study of ccHRT, indicates that this intervention is cost-effective for the relief of symptoms of menopause.

The impact of non-compliance with imatinib (IM) therapy on health care costs

6083 Background: While compliance to drug therapy is vital to receive optimal patient benefits, the costs of delivering adequate medical care for cancer patients remain an important consideration for society and payers. This study examined the relationship between compliance with IM therapy and health care costs for patients with CML and GIST. Methods: Claims data from 6/1/01–3/31/04 from a US health plan were used to identify non-Medicare IM-treated patients with a CML or GIST diagnosis who had continuous pharmacy and medical benefits in the 3 months prior and 12 months following initiation of IM therapy. Compliance was defined by medication possession ratio (MPR=total days IM supply in the first year ÷365) and patients were stratified into three segments by MPR (&lt;50%, 50–90%, 90–100%). Total health care costs include hospital, laboratory testing, office, ER, and pharmacy charges. Disease-related health care costs were also analyzed. Multivariate analyses were used to examine the relationship between MPR and first-year health care costs, controlling for age, sex, number of medications, initial starting dose, diagnosis (CML or GIST), year of initial IM fill, and complications due to underlying disease. Results: Total 878 IM-treated patients were identified of whom 413 had at least 15 months of continuous eligibility. Of these, 307 were non-Medicare CML or GIST patients. Total health care costs per patient in the first year of therapy in MPR &lt; 50%, 50–90%, and 90–100% groups were $163,828, $53,924, and $40,924 respectively (p &lt; 0.001). The corresponding numbers for disease-related health care costs were $103,118, $36,436, and $34,086 (p&lt;0.001). Controlling for the variables listed above, a 10% increase in MPR is associated with a 5% decrease in total health care costs (p=0.021). Similar association was found between MPR and disease-related health care costs. Conclusions: Improved compliance with imatinib therapy is associated with decreased total health care costs and disease-related health care costs. Improving compliance to imatinib therapy may not only optimize clinical outcomes but may also reduce the overall societal burden of health care costs associated with cancer. [Table: see text]

First-year cost savings may be greater with etanercept in RA

First-year cost savings may be greater with etanercept in RA

First-year cost savings may be greater with etanercept in RA

First-year cost savings may be greater with etanercept in RA

Total first-year costs of acute coronary syndrome in a managed care setting.

There is a limited amount of literature examining the burden and cost of illness of acute coronary syndrome (ACS) in the managed care population. The goal of this study was to estimate the total cost of health care utilization (health plan plus patient) in the 12-month period following newly onset ACS. The demographic and health characteristics of these patients are compared with the similar data from 2 large clinical trials: CURE (Clopidogrel in Unstable Angina to Prevent Recurrent Events) and PROVE IT-TIMI 22 (Pravastatin or Atorvastatin Evaluation and Infection Therapy--Thrombolysis in Myocardial Infarction 22). A retrospective claims analysis was conducted for the 2-year period from July 1, 1999, through June 30, 2001. ACS was defined as an emergency room visit or hospitalization with a primary International Classification of Diseases, 9th Edition/Revision (ICD-9) diagnosis of 410.xx (acute myocardial infarction) or 411.1x (intermediate coronary syndrome). Patients were required to be free of any ACS claim in the previous 6 months. Patients without 6 months of prior continuous enrollment or those patients younger than 18 years were excluded. Patients were followed up to 12 months to identify total medical and pharmacy costs, revascularization procedures, and medication use. A total of 13,731 patients met the inclusion criteria, yielding 133,814 months of follow-up (mean: 9.75 months per patient) and representing approximately 0.4% of the managed care members in the database during the study period. The mean age was 54 years and 68% were male. The total direct cost incurred by the health plan and patients was dollar 309 million (dollar 2,312 per patient-month of follow-up); 72% of total costs were attributable to hospitalizations. The majority of costs were medical (dollar 286 million, 93%), and dollar 23 million (7%) were pharmacy costs. Fifty-one percent of patients had a revascularization procedure, which was typically performed during the index hospitalization (median time to revascularization was 0 days). Coronary artery stent implantation was the most common revascularization procedure (68%). During follow-up, 490 patients (3.6%) had a detectable death, 58% of patients received a beta-blocker, 60% received one or more cholesterol-lowering medications, and 36% of patients received clopidogrel therapy. Aspirin therapy was not measured. These managed-care patients with newly onset ACS incurred substantial costs in the 12 months following initial presentation. Revascularization was a common therapeutic intervention for these patients. There appear to be opportunities to improve medication therapy after an acute ACS event. There were some demographic and health characteristics that were different in these commercially insured patients from those in 2 large clinical trials.

Lifetime cost of stroke subtypes in Australia: findings from the North East Melbourne Stroke Incidence Study (NEMESIS).

Little is known about any variations in resource use and costs of care between stroke subtypes, especially nonhospital costs. The purpose of this study was to describe the patterns of resource use and to estimate the first-year and lifetime costs for stroke subtypes. A cost-of-illness model was used to estimate the total first-year costs and lifetime costs of stroke subtypes for all strokes (subarachnoid hemorrhages excluded) that occurred in Australia during 1997. For each subtype, average cost per case during the first year and the present value of average cost per case over a lifetime were calculated. Resource use data obtained in the North East Melbourne Stroke Incidence Study (NEMESIS) were used. The present value of total lifetime costs for all strokes was Aus 1.3 billion dollars (US 985 million dollars). Total lifetime costs were greatest for ischemic stroke (72%; Aus 936.8 million dollars; US 709.7 million dollars), followed by intracerebral hemorrhage (26%; Aus 334.5 million dollars; US 253.4 million dollars) and unclassified stroke (2%; Aus 30 million dollars; US 22.7 million dollars). The average cost per case during the first year was greatest for total anterior circulation infarction (Aus 28 266 dollars). Over a lifetime, the present value of average costs was greatest for intracerebral hemorrhage (Aus 73 542 dollars), followed by total anterior circulation infarction (Aus 53 020 dollars), partial anterior circulation infarction (Aus 50 692 dollars), posterior circulation infarction (Aus 37 270 dollars), lacunar infarction (Aus 34 470 dollars), and unclassified stroke (Aus 12 031 dollars). First-year and lifetime costs vary considerably between stroke subtypes. Variation in average length of total hospital stay is the main explanation for differences in first-year costs.

Cost of diagnostic and therapeutic management of colorectal cancer according to stage at diagnosis in the Calvados D�partement, France

Screening for colorectal cancer is a high priority of public health in France, as in other Western countries. In spite of its effectiveness, shown by randomized studies, no national program of colorectal screening using fecal occult blood test has yet implemented, due mainly to the low sensitivity of the screening test and to the weak participation of the target population. Economic studies can make a useful contribution to helping the decision makers of public health. One of the advantages to the organization of a screening program is a financial saving generated by advance in diagnosis. To investigate this hypothesis this study assessed the cost of the management of colorectal cancer according to its stage of extension using medical data from a specialized cancer registry and economic data from the national Social Security System. No significant decrease in the first-year costs of treating colorectal cancer was found with advance of diagnosis. The average cost for the first year of management of colorectal cancer after diagnosis was of Euro 21,918. According to the stage of diagnosis, the highest average cost was for the subjects with a cancer with lymph node involvement, with a cost of Euro 31,110. Cancers with an invasion limited to the submucosa or visceral metastases had an equivalent cost, respectively, of Euro 17,579 and of Euro 17,384. With a limited power due to low strength, these results suggest that the organization of a colorectal cancer screening program does not significantly reduce in the first year the total cost of management of this cancer. However, the organization of such screening remains a public health priority, prevention aiming only to allow subjects to live in good health as long as possible,and not to save money.

Comparative Cost Effectiveness of Angiotensin II Receptor Blockers in a US Managed Care Setting

To compare the cost effectiveness of the angiotensin II receptor blockers (ARBs) olmesartan medoxomil, losartan, valsartan and irbesartan for the treatment of hypertension, from the perspective of a US managed care setting. The evaluation was based on a recently completed, prospective, randomised, double-blind clinical trial comparing the antihypertensive efficacy of these agents. Differences in diastolic blood pressure reductions among the comparative agents were used to estimate reductions in the annualised risk of cardiovascular (CV) and cerebrovascular events using the Framingham model. These annualised risks were translated into reductions in healthcare expenditures associated with treating CV events covered by managed care in the US. Data sources included: the recently published clinical trial of ARB antihypertensive efficacy, the Framingham Heart Study and a managed care database. Actual reimbursed amounts were used. Based on antihypertensive efficacy data versus irbesartan, the use of olmesartan medoxomil is expected to reduce the number of new cases of CV disease, resulting in a first-year reduction in cost in a cohort of 100,000 patients of 906,000 US dollars. Similarly, a reduction in new cases of coronary heart disease (CHD) resulted in a cost reduction of 701,000 US dollars; a cost reduction of 196,000 US dollars for fewer myocardial infarctions (MI); and a cost reduction of 28,000 US dollars for fewer strokes. Over 5 years, these estimates increase to 5,410,000 US dollars for fewer cases of CV disease; 3,975,000 US dollars for fewer cases of CHD; 1,430,000 US dollars for fewer MI; and 497,000 US dollars for fewer strokes. Compared with valsartan, the use of olmesartan medoxomil is estimated to reduce by 3,397,000 US dollars the expected cost of treating a cohort of 100 000 patients in the first year for fewer cases of CV disease; by 2,426,000 US dollars for fewer cases of CHD; by 565,000 US dollars for fewer MI; and by 124,000 US dollars for fewer strokes. Over 5 years, these estimates increase to 16,231,000 US dollars for CV disease; 11,955,000 US dollars for CHD; 4,505,000 US dollars for MI; and 1,741,000 dollars for stroke. Compared with losartan, the estimated reduction in first-year cost is 2,969,000 US dollars for CV disease for the cohort of 100,000 patients; 2,163,000 US dollars for CHD; 732,000 US dollars for MI; and 124,000 US dollars for stroke. Over 5 years, these estimates increase to 15,149,000 US dollars for CV disease; 11,107,000 US dollars for CHD; 4,057,000 US dollars for MI; and 1,437,000 dollars for stroke. Based on comparative antihypertensive efficacy data, treatment of hypertensive patients with olmesartan medoxomil instead of the other leading ARBs has the potential to reduce overall cost of medical care in a US managed care setting.