Important Cost Drivers Research Articles

Costs of treating serious adverse effects of drugs used for treatment of obesity: comparison of selected European countries

Drugs for the treatment of obesity show significant effectiveness, but the adverse effects (ADRs) of these drugs are numerous and varied, and some of them are highly cost-generating. Our research aimed to define the health care utilization pattern in treating ADRs of antiobesity therapy, to compare the costs of treating these ADRs among selected European countries, and to identify the key cost drivers. A comparative analysis of the costs of treating the ADRs of antiobesity drugs in 10 European countries (seven EU members and three from the Western Balkans) was conducted, and the impact of parameters of global health expenditures on them was assessed. There are considerable differences in costs of treating adverse antiobesity drug reactions among European countries: costs of treating gastroesophageal reflux disease varied almost 20 times between North Macedonia (12.6 EUR) and Estonia (202.9 EUR). The Gross Domestic Product per capita was an important cost driver in treating the majority of the ADRs studied (p < .001), except for retinopathy, anaphylaxis, and respiratory disorders. The Domestic Private Health Expenditure increased the costs of treating depression (p = .012), upper respiratory tract infection (p = .008), melanocytic naevus (p = .027), and drug-induced hepatitis (p = .023). Investment in pharmaceuticals, medical goods, and preventive care tended to reduce the costs of treating several ADRs, which are seemingly unrelated to the body site or mechanism. Healthcare utilization and costs of treating ADRs to antiobesity drugs vary significantly among European countries. These differences should be considered when creating inputs for cost-effectiveness and budget impact models to decrease their uncertainty.

Hospitalization risk in multiple myeloma episodes of care.

e23101 Background: The Enhancing Oncology Model (EOM) is a total cost of care (TCOC) program that was initiated in July 2023. Participating groups are expected to reduce expenditures while delivering high-quality care. Hospitalization (IP) is an important quality metric and cost driver in TCOC programs such as EOM. Understanding how cancer treatment may impact IP is essential for success. Multiple Myeloma (MM) treatment has transformed with multi-agent treatment as the standard of care (SOC), routinely incorporating 3 or more drugs used concurrently to maximize response. We examined the impact multi-drug treatment had on IP rates in MM patients. Methods: Using Parts A, B and D Medicare claims data from EOM baseline period (January 2019 - June 2022) for 12 participating practices, we extracted a unique count of chemotherapy drugs and IP admissions attributed to 6-month episodes of care. Dexamethasone (dex) was included even if claims were not found. Planned and cancer-surgery related IP were excluded using the Clinical Classifications Software Planned Admission Procedure Categories and per EOM specifications. IPs were dichotomized as Yes/No. A logistic regression model was developed to evaluate the association between the number of unique drugs and the unplanned IP, adjusting for variables: prior chemo, age at episode start, race, and HCC count. A 3-drug regimen was established as the reference (including dex) based on SOC. Results: 11,613 episodes had a primary diagnosis of MM, with at least one IP occurring in 2,382 episodes. The number of episodes (% IP) per drug count group are 1-2: 6636(16.3%); 3: 3772 (23.6%); 4: 863 (30.8%); 5+: 342 (40.9%). Detailed statistics are provided in Table 1. Compared to a 3-drug regimen, 4+ drugs increased the risk of IP, while episodes with 1-2 drugs had a lower risk of IP after adjusting for age, race, HCC count and prior treatment. Conclusions: Our findings can guide the design of care transforming interventions aimed at avoiding unnecessary IP while using guideline concordant SOC treatments for MM, driving TCOC reduction. Identifying patients with a higher likelihood of IP helps practices target patient monitoring programs. To understand why patients with prior treatment had lower IP identifying maintenance following initial treatment and patients receiving 3 or more drugs after failure of prior therapy, are worth exploring further. CMMI Disclaimer: The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document. [Table: see text]

Olaparib not cost-effective as maintenance therapy for platinum-sensitive, BRCA1/2 germline-mutated metastatic pancreatic cancer.

To assess the cost-effectiveness and budget impact of olaparib as a maintenance therapy in platinum-responsive, metastatic pancreatic cancer patients harboring a germline BRCA1/2 mutation, using the Swiss context as a model. Based on data from the POLO trial, published literature and local cost data, we developed a partitioned survival model of olaparib maintenance including full costs for BRCA1/2 germline testing compared to FOLFIRI maintenance chemotherapy and watch-and-wait. We calculated the incremental cost-effectiveness ratio (ICER) for the base case and several scenario analyses and estimated 5-year budget impact. Comparing olaparib with watch-and wait and maintenance chemotherapy resulted in incremental cost-effectiveness ratios of CHF 2,711,716 and CHF 2,217,083 per QALY gained, respectively. The 5-year costs for the olaparib strategy in Switzerland would be CHF 22.4 million, of which CHF 11.4 million would be accounted for by germline BRCA1/2 screening of the potentially eligible population. This would amount to a budget impact of CHF 15.4 million (USD 16.9 million) versus watch-and-wait. Olaparib is not a cost-effective maintenance treatment option. Companion diagnostics are an equally important cost driver as the drug itself.

Big data and machine learning in cost estimation: An automotive case study

This paper presents a case study on the applicability of machine learning and big data technology for product cost estimation, using data on the material cost of passenger cars. The study provides contributions to six research aspects. First, we show which machine learning algorithms are appropriate when dealing with product cost estimation for highly complex products with more than 2000 parts and hundreds of cost drivers. Second, our case study provides a novel approach to increasing the predictive accuracy of cost estimates for subsequent product generations. Third, we show that the accuracy is up to 3.5 times higher when using big data compared to an intermediate size of data. Fourth, machine learning can outperform cost estimates from cost experts during the early stage of new product development, even when dealing with highly complex products. Then, we evaluate the use cases, issues, and benefits of machine learning and big data from the perspective of cost experts. Specifically, the case study shows that machine learning can reliably select the most important cost drivers (fifth aspect) and calculate the average cost of cost drivers over thousands of product configurations (sixth aspect). However, cost experts must be knowledgeable about the product and remain careful when interpreting machine learning outcomes, as they can yield misleading outcomes in some exceptional cases. In conclusion, machine learning and big data empirically proved to be able to generate additional value in many aspects for managing costs during the early phase of new product development.

Health Care Resource Utilization and Costs Associated With COVID-19 Among Pediatrics Managed in the Community or Hospital Setting in England: A Population-based Cohort Study.

Although COVID-19 morbidity is significantly lower in pediatrics than in adults, the risk of severe COVID-19 may still pose substantial health care resource burden. This study aimed to describe health care resource utilization (HCRU) and costs associated with COVID-19 in pediatrics 1-17 years old in England. A population-based retrospective cohort study of pediatrics with COVID-19 using Clinical Practice Research Datalink (CPRD Aurum) primary care data and, where available, linked Hospital Episode Statistics Admitted Patient Care secondary care data. HCRU and associated costs to the National Health Service were stratified by age, risk of severe COVID-19 and immunocompromised status, separately for those with and without hospitalization records (hospitalized cohort: COVID-19 diagnosis August 2020-March 2021; primary care cohort: COVID-19 diagnosis August 2020-January 2022). This study included 564,644 patients in the primary care cohort and 60 in the hospitalized cohort. Primary care consultations were more common in those 1-4 years of age (face-to-face: 4.3%; telephone: 6.0%) compared with those 5-11 (2.0%; 2.1%) and 12-17 years of age (2.2%; 2.5%). In the hospitalized cohort, mean (SD) length of stay was longer [5.0 (5.8) days] among those 12-17 years old (n = 24) than those 1-4 [n = 15; 1.8 (0.9) days] and 5-11 years old [n = 21; 2.8 (2.1) days]. Most pediatrics diagnosed with COVID-19 were managed in the community. However, hospitalizations were an important driver of HCRU and costs, particularly for those 12-17 years old. Our results may help optimize the management and resource allocation of COVID-19 in this population.

Effect of labour costs on wood harvesting costs and timber provision

Efficient forest operations are essential for forest enterprises, who provide wood and numerous ecosystem services for the society. Important factors influencing the efficiency of forest operations, and thus the harvesting costs, are the level of mechanization, the harvesting method applied, the forest road network, and the training of the labourers. The cost of labour, i.e. salaries, is another important driver of harvesting costs. However, its effect on and relative importance for overall harvesting costs is poorly described in the scientific literature. Thus, this study aims to analyse the influence of labour costs in more detail, especially on the country-wide wood harvesting potentials. In addition, we aimed to cross-compare the effect of labour costs with the effect of switching to a more efficient harvesting method. For this purpose, we calculated timber harvesting costs with varying salaries for all sample plots of the Swiss National Forest Inventory (NFI) for both, the currently applied harvesting method recorded in the NFI, and the potential best suitable harvesting method. A 1% change in labour costs affects harvesting costs by 0.33–0.77%, depending on the harvesting method applied. The influence is larger for systems that involve a large share of motor-manual work and for cable-based methods. Changing labour costs by ± 30% affects the number of plots for which timber harvesting is economically feasible, by 5 to 15 percent points. The effect of switching from the current to the best suitable harvesting method is comparable to that of reducing labour costs by 15–30%. These results indicate that the efficiency of wood harvesting can be increased with further mechanization and does not require cutting salaries of forestry personnel. In that, our results may inform forestry planning and policy making at regional to national level.

Re-Engineering the Hospital Discharge to Improve the Transition From Hospital to Home

The hospital discharge is non-standardized and frequently marked with poor quality and is an important driver of healthcare costs. There is now ample evidence that improving communication at hospital discharge can prevent problems after hospital discharge including rehospitalization. The ReEngineered Discharge (RED) successfully delivers high quality transitions in care, improves patient satisfaction, achieves patient-centered outcomes, and reduces rehospitalization by over 20% while lowering healthcare costs. However, implementing these evidence-based processes into US hospitals requires smooth integration into customary hospital workflows, while not increasing health professional time needed to carry out these duties. Now, rapidly evolving health-information technology systems using conversational agents such as the MayaRED have great potential to deliver the benefits of RED, with the added benefits of saving nurses' and other health professionals' time, delivering post-discharge reinforcement of the care plan and connecting chronic care patients to remote patient monitoring platforms.

5567917 COST COMPARISON OF TRANSFUSION CHOICES IN OMAN FOR PATIENTS SUFFERING FROM SICKLE CELL DISEASE

Background: Sickle cell disease(SCD) management can be challenging, requiring different therapeutic approaches because SCD could induce multiple complications. Red blood cell(RBC) transfusion is well known as one of the disease-modifying therapies available for long-term management. It’s supported by multiple randomized clinical trials for the prevention of disease complications such as stroke in adults and children with SCD.RBCs can be delivered via three methods: Simple transfusion(ST), manual exchange(ME) and automated red blood cell exchange(aRBCX). In ST, patients receive additional units of blood. The purpose is to raise the haemoglobin (Hb) to a steady state and maintain the oxygen-carrying capacity of blood. ME transfusion consists of removing the patient’s sickle-shaped RBCs and replacing them with healthy ones— lowering the concentration of sickled cells without increasing blood viscosity. This is performed using repeated alternating isovolumetric phlebotomy and blood transfusion. aRBCX involves removing sickled RBCs from the patient and rapid replacement with healthy RBCs while maintaining isovolemia. An advantage of aRBCX is the avoidance or minimization of costly iron chelation therapy to treat iron overload. Aim: SCD management is an important cost driver for health systems. The intent of this research was to compare the cost-effectiveness of different transfusion modalities. We wanted to compare the all-inclusive costs. and wanted to perform this evaluation in Oman, as the incidence of SCD ranges between 0.2% and 0.07%. This disease is considered one of Oman’s most common genetic blood disorders. Method: In-depth data about variables that drive costs have been collected to populate a de novo cost model. We collected data from the Royal Hospital and Sultan Qaboos University Hospital. Cost drivers that we took into consideration were disease incidence, cost of blood transfusion, medical equipment, disposables, cost of staff, complications, iron chelation therapy, hospitalization, and lives lost. The assessment took place in June 2020. The cost of the treatment intervention, cost of disease-related complications and the yearly cost of treatment imputable to each transfusion modality represented the most significant differences across the three transfusion choices. By populating the model with resources provided by the two above-mentioned hospitals, we could demonstrate the cost differences between transfusion choices and the potential benefits that healthcare providers can experience. The results demonstrate significant differences across cost parameters, such as Cost of treatment, Cost of treatment-related potential effect, Cost of complications, Cost of life years lost, and Estimated total yearly cost per patient. Results and conclusion: aRBCX promotes a reduction in overall resource utilization and improved patient outcomes. aRBCX is approximately 47% less costly than ST, and is approximately 23% less costly when compared to ME. By highlighting the consequence of treatment choice and its financial impact, we aim to support the adoption of aRBCX in comparison to alternative transfusion choices and validate future reimbursement considerations. aRBCX cost savings may lead to better adoption. We recommend researchers rerun these calculations with the model on an individual hospital basis.

Economic Burdens of Type 2 Diabetes Hospital Visits with Hypoglycemic Episodes in the Tertiary Care Setting in Thailand

This study aimed to estimate the economic burden of hypoglycemia among people with type 2 diabetes (T2D) treated in a tertiary care setting. An electronic database of the largest university-affiliated hospital in northern Thailand was retrieved from 2015 to 2020 using the International Classification of Diseases 10th Revision (ICD-10) code E10.xx-E14.xx, or for patients receiving diabetes treatment at least twice for a 6-month period. All records were screened for hypoglycemia using an ICD-10 code E16.0-E16.2 or for having blood glucose <70 mg/dL. All costs related to outpatient visits or inpatient admissions were recorded. During the study period, T2D visits totaled 861,969. The annual incidence rate of hypoglycemia was 2.3 per 1000 visits, while the admission rate was 3.9 per 10,000 visits. The mean length of stay was 4.5 ± 10.1 days. The costs of hypoglycemia were USD 831.1 per admission and USD 182.2 per outpatient visit. The important cost driver for outpatients was drugs (USD 137.1), while for inpatients, this constituted services (USD 299.9). Hypoglycemia poses a substantial financial burden and increases the use of healthcare resources. Selecting the most cost-effective treatments with clinical evidence of the lower risk of hypoglycemia, especially newer insulin preparations, will provide the greatest likelihood of improving clinical outcomes and reducing the economic burden.

Drivers of healthcare costs in patients with ischaemic stroke: a hospital-based retrospective cohort study

ObjectivesTo evaluate how costs of healthcare can be reduced, there is an increasing need to gain insight into the main drivers of such costs. We evaluated drivers of costs of...

CONSIDERATION OF DAMAGING FREQUENCY RANGES OF STRUCTURAL EXCITATION FOR TESTING LARGE BATTERY PACKS IN BATTERY ELECTRIC VEHICLES (BEV)

Realistic vibration testing of large floor mounted Battery Pack, sometimes called Rechargeable Energy Storage Systems (RESS), for Batterie Electric Vehicles (BEV) is important for developing safe new battery structures. On the other hand, the requirements for realistic replications of worst-case environments in a lab usually demand costly and complex infrastructure. A key factor to the quality of environment replication and an important cost driver due to the increasing complexity is the needed frequency range the equipment must be able to replicate. The contribution analyzes data from a first pre-test campaign to demonstrate a feasible process of deriving frequency band requirements for the test equipment. The key method used here is the Fatigue Damage Spectrum (FDS) to analyze the potential damage a vibration could cause in certain failure mechanism of interest, particularly “weighted” by the corresponding double-logarithmic dependance of stress magnitude over occurring load cycles. This enables a good assessment of how much damage could be induced in certain frequency ranges for a well justified and cost-effective choice on the needed test equipment.

Analysis of the Stressed State of Sand-Soil Using Ultrasound

The maintenance of the ballast substructure is an important cost-driver for railway systems. The problem is that today’s condition monitoring methods are insufficient to collect detailed data on the compaction and stress allocation inside the ballast bed. That makes it challenging to improve the maintenance technology and organization. This study aimed to investigate the applicability of the ultrasound method for analyzing the state of stress of sand-soil and the relation between the residual stress and wave propagation velocity. The experiments on the sand in a box with different allocations of the ultrasonic receivers and pressure measurement cells were produced under different external loading. In addition, the vertical and horizontal stress distributions were measured. The results showed a correlation between the test load, the state of stress, and the ultrasound propagation velocity. Moreover, the residual stresses after the loading cycles were analyzed.

Societal economic burden and determinants of costs for atopic dermatitis

AbstractBackgroundAtopic dermatitis (AD) is a common inflammatory skin disease while the economic burden of AD by severity is not adequately understood.ObjectiveTo estimate the societal economic burden and to identify cost determinants of AD.MethodsIn this population‐based, controlled cohort study in Sweden, patients with AD were identified through diagnosis codes in primary or secondary care or by dispensed medications using administrative healthcare registers. A reference cohort without AD was randomly selected from the general population. Healthcare costs (primary/secondary care visits and dispensed medication) and indirect costs (care for sick children and long‐term sick leave for adults) were calculated annually. AD patients were stratified by age (paediatric [age &lt; 12], adolescent [12 ≤ age &lt; 18] or adult [age ≥ 18]), and severity (mild‐to‐moderate [M2M] or severe AD) and matched to the reference cohort.ResultsCompared with controls, the annual mean per‐patient direct healthcare costs in the first year following diagnosis were €941 and €1259 higher in paediatric patients with M2M and severe AD, respectively. In the first year following diagnosis, the mean indirect cost for care of sick children was €69 and €78 higher per patient in M2M and severe AD, respectively. In adolescents with M2M and severe AD, direct healthcare costs were €816 and €1260 higher, respectively. In adults, healthcare costs were €1583 and €2963 higher in patients with M2M and severe AD, respectively and indirect costs were €148 and €263 higher compared with controls. Management of comorbid medical conditions was an important driver of incremental healthcare costs. Total incremental societal economic burden for AD was €351 and €96 million higher in patients with M2M and severe AD, respectively, compared to controls.ConclusionAD is associated with a significant societal economic burden primarily driven by the cost burden of M2M AD due to the high prevalence of this population. Regardless of severity level, management of non‐AD comorbidities is a major driver of total costs.

Dynamically installed anchors for floating offshore wind turbines

Considerable efforts are being made worldwide to develop offshore wind energy, both in shallow and deep waters, where bottom fixed solutions are still dominating. Development and successful implementation of offshore floating wind will depend on reducing costs in all areas including design, manufacturing, installation, and operation. Two important cost drivers are manufacturing and installation of the anchoring system. This paper discusses the application of dynamically installed anchors for floating offshore wind turbines. Based on experience from field and model tests, a detailed description of the different aspects of anchor design is presented. At the example of a recently installed floating offshore wind farm, the advantages of the proposed concept are demonstrated. Further cost reduction is achieved by the presented and discussed shared anchoring system.

P1747: A REAL-WORLD ANALYSIS OF HEALTHCARE RESOURCE UTILIZATION AMONG PATIENTS WITH PAROXYSMAL NOCTURNAL HEMOGLOBINURIA WHO RECEIVED TREATMENT WITH RAVULIZUMAB

Background: Paroxysmal nocturnal hemoglobinuria (PNH) is a rare and potentially life-threatening disease involving complement-mediated hemolysis and thrombosis. C5 inhibition (C5i) therapy for PNH with ravulizumab (RAV) has led to hemoglobin (Hb) stabilization (avoiding a ≥2 g/dL decrease in Hb levels from baseline) and some decreases in transfusion dependence. However, international guidance recommends assessing PNH treatment response with Hb normalization (e.g., Hb levels ≥12 g/dL; Debureaux et al., Bone Marrow Transplant. 2021 Oct;56(10):2600-2602), and evidence showing Hb normalization with RAV is scarce. Anemia-related complications, including transfusions, contribute significantly to PNH-associated costs of care, thus highlighting the need to understand Hb level changes and healthcare resource utilization (HCRU) in patients with PNH. Aims: To evaluate Hb level changes in patients with PNH and corresponding HCRU after 6 months of RAV treatment. Methods: Data were extracted from patients with PNH aged ≥12 years between 2010-2021 from the TriNetX Dataworks USA Network, a federated electronic medical record (EMR) data network of >68 million de-identified patients. Patients were required to have a PNH diagnosis based on the International Classification of Diseases 9th or 10th Revision code, a medical visit recorded ≥6 months before index/first RAV treatment, and no record of myasthenia gravis, atypical hemolytic uremic syndrome, or neuromyelitis optica spectrum disorder. RAV-treated patients were analyzed as a whole and stratified by C5i treatment history (C5i naïve or prior C5i/eculizumab). Patients were categorized by Hb levels using changes in Hb levels from baseline (within 365 days pre-index) to the final Hb value recorded between 91-180 days post-index. Patients were excluded if they were missing baseline Hb levels, Hb values at 91-180 days or received a transfusion between 0-180 days post-index. HCRU values were evaluated through 180 days post-index for inpatient visits (total number of events post-index) and length of stay ([LOS] total days in the inpatient setting post-index, calculated among all patients regardless of hospitalization history). Results: Data from 36 RAV-treated patients were extracted from the EMR network (Table). Before starting RAV treatment, 24 (66.7%) patients were naïve to C5i, and 12 (33.3%) patients had prior C5i treatment. Following 6 months of RAV, many patients displayed decreased or no change in Hb levels (77.8%, n=28). Patients with decreased or no change in Hb levels after 6 months of RAV experienced more inpatient visits (mean visits [SD]: 1.3 [2.0]) compared to patients with increased Hb levels (mean visits [SD]: 0.9 [1.5]). RAV-treated patients with decreased or no change in Hb levels also demonstrated a longer mean LOS (mean days [SD]: 2.2 [6.7]) compared to patients with increased Hb levels (mean days [SD]: 0.2 [0.4]). Findings were similar among all three analysis groups (All RAV; RAV, C5i naïve; RAV, prior C5i), but slightly more C5i naïve patients with decreased or no change in Hb levels following RAV treatment (79.2%, n=19) had higher HCRU values for inpatient visits and LOS (Table). Image:Summary/Conclusion: The majority of RAV-treated patients did not display Hb improvement after 6 months of treatment, and patients lacking Hb improvement also demonstrated increased HCRU. This suggests improvements in Hb may be an important driver of morbidity and costs among patients with PNH. These findings also highlight the utility of improved Hb levels as a metric for assessing the PNH treatment response.

Brazilian Food Handlers' Years of Work in the Foodservice and Excess Weight: A Nationwide Cross-Sectional Study.

This study aimed to evaluate the association between the years of work of food handlers in the foodservice and excess weight among Brazilian low-income food handlers. A total of 559 food handlers from all Brazilian regions were characterized using a questionnaire. Weight and height were measured to estimate the Body Mass Index and classify the individuals. The association between food handlers' years of work in the foodservice, anthropometric status, and other variables (gender, age group, educational level, participation in a government program and per capita income at home and energetic consumption) were performed using Pearson's chi-square test (p < 0.05). Multinomial logistic regression analyses were performed (p < 0.05) as well as sensitivity tests using the outcome continuously and transformed, excluding underweight individuals, in a multivariate linear regression model. Most of the sample was female (63.1%), aged between 21 and 40 years old (63.5%), and 53.3% had studied up to complete elementary school. Almost 41% of the food handlers had less than half the minimum wage per capita income. Of the evaluated individuals, 59.9% presented excess weight. There was an association with family per capita income (Odds Ratio - OR: 1.73; Confidence interval - CI95%: 1.09–2.75); handlers whose per capita income was ≤0.5 minimum wage had a 73% higher chance of obesity than those with higher income. Working in foodservive ≥3 years increased the chance of being overweight by 96% compared to those who work for <3 years (OR: 1.96; CI95%: 1.11–3.49). No significant association was found between the years of work of food handlers in the foodservice and obesity. Since work-related factors may contribute to the high prevalence of excess weight, including working in a food handling environment, the government and employers should consider workplace interventions. These would guide the food handlers in avoiding high rates of excess weight and their consequences on public health. Excess weight is an important driver of costs in the workplace associated with absenteeism, job change, and diseases. More studies are necessary to clarify the relationship between the factors related to work and the anthropometric status of food handlers since excess weight is multifactorial.

The Economic Burden of Multiple Sclerosis in the United States: Estimate of Direct and Indirect Costs.

Background and ObjectivesA recent report estimated that approximately 1 million adults were living with multiple sclerosis (MS) in the United States. Although MS is rarely the direct cause of death, its debilitating effects on normal body functions can result in considerable disruption to daily living and life roles including work, physical independence, mobility, social interaction, and participation in leisure activities. This study estimated the total economic burden of MS in the United States in 2019.MethodsThis study used a prevalence-based approach to estimate the national economic burden of MS. Claims from 3 sources (Medicare Current Beneficiary Survey, Medicare Standard Analytical File, and Optum de-identified Normative Health Information System) were used to obtain direct costs and a survey was developed to collect indirect costs (e.g., labor market productivity losses, costs of paid and unpaid caregivers, home modification) from 946 patients with MS (PwMS). Direct medical costs reflected the difference in the total average annual amount paid for PwMS vs matched controls without MS. Future earnings loss due to premature death attributable to MS was calculated using Centers for Disease Control and Prevention mortality data and Medicare claims data.ResultsThe estimated total economic burden was $85.4 billion, with a direct medical cost of $63.3 billion and indirect and nonmedical costs of $22.1 billion. Retail prescription medication (54%); clinic-administered drugs, medication, and administration (12%); and outpatient care (9%) were the 3 largest components of the direct costs. The average excess per-person annual medical costs for PwMS was $65,612; at $35,154 per person, disease-modifying therapies (DMTs) accounted for the largest proportion of this cost. The cost per DMT user ranged from $57,202 to $92,719, depending on sex–age strata. The average indirect and nonmedical costs were $18,542 per PwMS and $22,875 per PwMS if caregivers' costs were included. Lost earnings due to premature death, presenteeism, and absenteeism losses were the largest indirect cost components.DiscussionMS is a costly chronic disease, with direct costs of prescription drugs and indirect productivity loss being important cost drivers. Our findings suggested that the burden of MS in the United States has been underestimated.

Costs of mass drug administration for scabies in Fiji.

In 2019, the Murdoch Children’s Research Institute in partnership with the Fiji Ministry of Health and Medical Services carried out an integrated mass drug administration (MDA) for the treatment of scabies and lymphatic filariasis in the Northern Division of Fiji (population estimate 131,914). We conducted a retrospective micro-costing exercise focused on the cost of scabies control in order to inform budgeting and policy decision making in an endemic setting. We collected detailed information on financial and economic costs incurred by both parties during the course of the MDA campaign (April 2018 to July 2019). We also conducted interviews with personnel involved in the financial administration of the MDA campaign. The economic cost of delivering two doses of ivermectin was US$4.88 per person. The cost of donated drugs accounted for 36.3% of total MDA costs. In this first large-scale MDA for the public health control of scabies, the estimated cost of delivering MDA per person for scabies was considerably more expensive than the costs reported for other neglected tropical diseases. The important cost drivers included the remuneration of health care workers who were extensively involved in the campaign, coverage of hard-to-reach, mainly rural populations and the two-dose regimen of ivermectin. These results highlight the importance of these cost determinants and can be used to plan current and future MDA programs.

Costs and Health-Related Quality of Life in Patients With NMO Spectrum Disorders and MOG-Antibody-Associated Disease: CHANCENMO Study.

Background and ObjectivesTo evaluate costs and health-related quality of life (HRQoL) of neuromyelitis optica spectrum disorders (NMOSD) and myelin oligodendrocyte glycoprotein antibody–associated disease (MOGAD).MethodsIn this multicenter cross-sectional study, data on consumption of medical and nonmedical resources and work ability were assessed via patient questionnaires. Costs were analyzed in Euros for 2018 from the societal perspective. HRQoL was captured by the EuroQoL Group 5 Dimension 5 Level Scale (EQ-5D-5L) questionnaire. Clinical data were retrieved from the Neuromyelitis Optica Study Group (NEMOS) database.ResultsTwo hundred twelve patients (80% women, median age 50 [19–83] years, median disease duration 7 [0–43] years, median Expanded Disability Status Scale [EDSS] score 3.5 [0–8.5], 66% aquaporin-4 immunoglobulin G [IgG] positive, 22% MOG IgG positive, 12% double seronegative) were analyzed. The mean total annual per capita cost of illness accounted for €59,574 (95% CI 51,225–68,293 or US dollars [USD] 70,297, 95% CI 60,445–80,586), and the mean index value of the EQ-5D-5L was 0.693 (95% CI 0.65–0.73). The most important cost drivers were informal care costs (28% of total costs), indirect costs (23%), and drugs (16%), especially immunotherapeutics. Costs showed a positive correlation with disease severity (ρ = 0.56, 95% CI 0.45–0.65); in the EDSS score 6.5 to 8.5 subgroup, the mean annual costs were €129,687 (95% CI 101,946–160,336 or USD 153,031, 95% CI 120,296–189,196). The HRQoL revealed a negative correlation to disease severity (ρ = −0.69, 95% CI −0.76 to −0.61); in the EDSS score 6.5 to 8.5 subgroup, the EQ-5D-5L mean index value was 0.195 (95% CI 0.13–0.28). Neither antibody status nor disease duration influenced the total annual costs or HRQoL.DiscussionThese German data from the era without approved preventive immunotherapies show enormous effects of the diseases on costs and quality of life. An early and cost-effective therapy should be provided to prevent long-term disability and to preserve quality of life.

The Cost of Locally Advanced Cervical Cancer in Thailand: an Empirical Study for Economic Analysis.

Objective:To evaluate cost of illness of locally advanced cervical cancer patients from societal perspective in three scenarios including completely cured without severe late side effects (S1), completely cured with late grade 3-4 gastrointestinal side effects (S2.1) or genitourinary side effects (S2.2), and disease recurrence and death (S3). Methods: The incidence-based approach was conducted. The cost was calculated for 5-year time horizon starting for the treatment initiation. Direct medical costs were extracted from hospital database. Cost of using two-dimensional technique and three-dimensional conformal radiation therapy were calculated separately. Direct non-medical costs and indirect costs in terms of productivity loss were based on actual expenses from the interview of 194 locally advanced cervical cancer patients from two tertiary hospitals in Bangkok, during June to December 2019. All costs were converted to US dollar in 2019 values. Results:For 5 years, cost of illness per patient for using two-dimensional technique and three-dimensional conformal radiation therapy were US $8,391 and US $10,418 for S1, US $18,018 and US $20,045 for S2.1, US $17,908 and US $19,936 for S2.2, and US $61,076 and US $63,103 for S3, respectively. The economic burden for newly diagnosed locally advanced cervical cancer patients in Thailand in 2018 was approximately US $129 million and US $131 million for using two-dimensional technique and three-dimensional conformal radiation therapy, respectively. Cost from S3 accounted for 70% of all total cost. Premature death was the most important cost driver of cost of illness accounted for 64 % of the total cost estimates. Conclusions:Cost of illness of locally advanced cervical cancer patients produced significant economic burden from societal perspective. Disease recurrence and early death from cancer was the most influential cause of this burden.