Incremental Economic Burden Research Articles

The economic burden of adults with major depressive disorder in the United States (2005 and 2010).

The economic burden of depression in the United States--including major depressive disorder (MDD), bipolar disorder, and dysthymia--was estimated at $83.1 billion in 2000. We update these findings using recent data, focusing on MDD alone and accounting for comorbid physical and psychiatric disorders. Using national survey (DSM-IV criteria) and administrative claims data (ICD-9 codes), we estimate the incremental economic burden of individuals with MDD as well as the share of these costs attributable to MDD, with attention to any changes that occurred between 2005 and 2010. The incremental economic burden of individuals with MDD increased by 21.5% (from $173.2 billion to $210.5 billion, inflation-adjusted dollars). The composition of these costs remained stable, with approximately 45% attributable to direct costs, 5% to suicide-related costs, and 50% to workplace costs. Only 38% of the total costs were due to MDD itself as opposed to comorbid conditions. Comorbid conditions account for the largest portion of the growing economic burden of MDD. Future research should analyze further these comorbidities as well as the relative importance of factors contributing to that growing burden. These include population growth, increase in MDD prevalence, increase in treatment cost per individual with MDD, changes in employment and treatment rates, as well as changes in the composition and quality of MDD treatment services.

Healthcare Resource Utilization And Costs Of Spinal Cord Injury With Neuropathic Pain In A Medicare Population

Objective: Evaluation of healthcare resource utilization (HRU) and costs in patients with neuropathic pain (NeP) secondary to spinal cord injury (SCI) in a Medicare population. Methods: Using data from the MarketScan Medicare Database between January 1, 2006 and June 30, 2011, patients with NeP following SCI (SCI-NeP cohort) were identified based on an ICD-9-CM diagnostic code indicative of SCI, and NeP (index event) within 12 months based on ICD-9-CM code 338.0x (central neuropathic pain) or a claim for an NeP-related antiepileptic or NeP-related antidepressant drug, and propensity score-matched to SCI patients without NeP (SCI-only). Pre-index demographic and clinical characteristics were compared between the cohorts. HRU and expenditures were compared for 12 months post-index. Generalized linear models and ordinary least squares models evaluated the association between characteristics and outcomes. Results: The matched cohorts included 1,418 patients (approximately 54% male, mean age 77 years). During the 12-month follow-up period, SCI-NeP patients showed significantly greater use of evaluated medications (P < 0.01), and significantly higher HRU (P < 0.05), including 20% and 18% increased odds of hospitalization and emergency department visits, respectively. Mean (SD) total all-cause healthcare expenditures for this period adjusted for covariates showed an annual incremental economic burden of $6,808 (95% confidence interval $4,143, $9,764) per patient with NeP. Conclusions: Medicare patients with NeP secondary to SCI have significantly higher HRU and costs relative to SCI patients without NeP. Medicare patients represent a population with special needs regarding therapeutic choices that may benefit from an integrated approach to NeP management.

A Revised Estimate of the Burden of Illness of Gout

BackgroundGout is a chronic, inflammatory arthritis characterized by painful and debilitating acute/episodic flares. Until recently, gout has been regarded as a minor medical problem, in part because the associated economic burden has not been appreciated. Previous literature on this subject focused on the costs associated with acute episodes of gout rather than on the long-term medical and economic implications of this chronic disorder.ObjectiveOur aim was to estimate the current impact of gout in the United States with respect to disability and economic costs.MethodsThe following data sources were used: published data on the incremental economic burden of gout; statistics from the US Census Bureau and the US Bureau of Labor Statistics; and recent epidemiological and clinical literature concerning the course, treatment, and outcomes of the disease. Disability is expressed as days of lost productivity. Charges for gout-related treatments were used as direct cost inputs.ResultsGout affects an estimated 8 million Americans, among whom those working have an average of almost 5 more absence days annually than workers without gout. On average, the incremental annual cost of care for a gout patient is estimated at >$3000 compared with a nongouty individual. Even though comorbidities common in gout patients account for a portion of this increased economic burden, the total annual cost attributable to gout patients in the United States is likely in the tens of billions of dollars and comparable to those of other major chronic disorders, such as migraine and Parkinson’s disease.ConclusionsThe economic burden of gout is most readily assessable in patients whose acute arthritic flares result in emergency department visits, bedridden days, and episodic loss of productivity. Chronic progression of the disease can also result in long-term impairment of function and health-related quality of life, but the contribution of chronic gout to the economic burden is more difficult to quantitate because gout is frequently associated with serious cardiovascular, metabolic, and renal comorbidities. Recent demonstration that successful gout management can reverse functional deficits in many chronic gout patients, however, supports the views that chronic gout contributes substantially to the medical and thus economic costs of these patients and that early and aggressive efforts to improve gout outcomes are likely to reduce the associated economic burden.

Direct medical expenditure associated with rheumatoid arthritis in a nationally representative sample from the medical expenditure panel survey

To quantify the incremental direct medical expenditure associated with rheumatoid arthritis (RA) in the US population from a payer's perspective. A probability-weighted sample of adult respondents from the Medical Expenditure Panel Survey (2008) was used to identify a cohort of patients with RA and compared to a control cohort without RA. Annual expenditure outcomes, including total expenditure and subgroups related to pharmacy, office-based visits, emergency department visits, hospital inpatient stays, and residual expenditures were estimated. Differences between the RA and control cohort were adjusted for sociodemographic factors, employment status, insurance coverage, health behavior, and health status using a generalized linear model with log link and gamma distribution. Statistical inferences on difference in expenditures between RA and non-RA controls were based on nonparametric cluster bootstrapping using percentiles. The adjusted average annual total expenditure of the RA cohort in 2008 US dollars (USD) was $13,012 (95% confidence interval [95% CI] $1,737-$47,081), while that of the control cohort was $4,950 (95% CI $567-$17,425). The incremental total expenditure of the RA patients as compared to non-RA controls was $2,085 (95% CI $250-$7,822). RA patients also had a significantly higher pharmacy expenditure of $5,825 (95% CI $446-$30,998) that was on average $1,380 (95% CI $94-$7,492) higher as compared to the controls. The summated total incremental expenditure of all RA patients in the US was $22.3 billion (2008 USD). RA exerts considerable incremental economic burden on US health care, which is primarily driven by the incremental pharmacy expenditure.

PIN13 The Incremental Economic Burden of Clostridium-Difficile Associated Diarrhea Among Hospitalized Patients at High Risk of Recurrent Infection

PIN13 The Incremental Economic Burden of Clostridium-Difficile Associated Diarrhea Among Hospitalized Patients at High Risk of Recurrent Infection

The incremental economic burden of clostridium-difficile associated diarrhea among hospitalized immunocompromised patients undergoing chemotherapy.

e16542 Background: Hospital-acquired Clostridium-difficile associated diarrhea (CDAD) results in an estimated $1.3 billion in excess costs in the US. Patients undergoing chemotherapy are at elevated risk of CDAD due to diminished immune response and increased exposure to health care facilities. This study describes the incremental economic burden of CDAD in hospitalized immunocompromised (IC) patients. Methods: IC cases (undergoing chemotherapy or other qualifying conditions) hospitalized with a diagnosis of CDAD having ≥12 months of prior health plan eligibility and age ≥18 years between 1/1/2005 and 10/31/2010 were identified from the HealthCore Integrated Research Database (HIRDSM). Cases were matched to hospitalized IC controls without CDAD diagnosis based on: age±10 years, gender, selected preceding/in-hospital comorbidities and use of antibiotics. Incremental hospital length of stay (LOS) and costs were calculated between matched cases and controls via multivariate methods using a Gamma distribution. Covariates were determined from post-match univariate analysis of baseline characteristics. Results: 3,586 cases were matched to 10,758 controls. Chemotherapy occurred among 91.3% of cases and controls. While age (65±15), gender (53% female), and selected comorbidities were balanced between cases and controls, post-match disparities persisted (p&lt;.001): geographic region (37% vs. 32% Midwest), type of health plan (24 vs. 18% HMO), overall comorbidity burden (6.0±3.6 vs. 6.5±3.7 Deyo-Charlson Comorbidity Index). Cases had a lower incidence of mortality during their index hospitalization (6.7% vs. 7.8%; p&lt;0.0001). Adjusted hospital LOS was significantly greater for cases vs. controls (22.1 days (20.61 to 23.69) vs. 13.67 days (12.74 to 14.67); p&lt;.0001). Incremental hospitalization costs indicated a significantly greater economic burden among cases vs.controls (Δ = $32K ($29K to $35K); p&lt;0.0001). Conclusions: This study indicates that the acquisition of CDAD among immunocompromised patients, of which chemotherapy recipients represented the majority, presents significant incremental economic burden within the hospital setting.

Treatment patterns and economic burden of metastatic and recurrent locally-advanced head and neck cancer patients

Objective:To characterize treatment patterns and measure the economic burden associated with metastatic (mHNC) and recurrent, locally-advanced head and neck cancer (rHNC).Methods:Administrative claims from Medicare- and privately-insured individuals during 2004–2008 were used in this retrospective database study of patients with advanced HNC. Patients diagnosed with HNC were matched 1:1 to cancer-free controls to measure the incremental economic burden of HNC. Outcomes of interest were measured during the 6 months following the date of a secondary tumor diagnosis for metastatic patients or the date of a diagnosis indicating rHNC. To assess treatment patterns, HNC patients were evaluated for the use frequency of treatments (radiotherapy, chemotherapy and surgery). Costs were reported in 2008 US$ from a third-party payer perspective and were analyzed using generalized linear models and two-part regression models adjusting for differences in age and baseline Charlson Comorbidity Index (excluding cancer diagnoses) between the HNC and control cohorts. Components of cost included inpatient, outpatient and other medical services as well as pharmacy costs.Results:The mHNC cohort consisted of 1042 patients and the rHNC cohort included 324 patients. The most common treatments for mHNC patients were supportive care (90.2%), radiation therapy (48.5%), surgery (41.9%) and chemotherapy (38.3%). Patients with rHNC frequently received HNC-related supportive care (71.0%), radiation therapy (67.9%) and chemotherapy (27.2%); HNC-related surgery was infrequent (12.7%) during the study period. The 6-month incremental adjusted total costs were $60,414 per patient for mHNC and $21,141 per patient for rHNC (p < 0.0001). Approximately 46–58% of the incremental cost was attributable to outpatient visits, 27–37% to inpatient costs and 11–13% to pharmacy, depending on the HNC cohort.Limitations:The identification of mHNC/rHNC was based on diagnosis codes and treatment patterns with the limitation of the claims database.Conclusions:Metastatic and recurrent, locally-advanced HNC patients frequently receive cancer-related treatments and incur substantial economic burden.

PSS13 Economic Burden of Psoriasis and Diabetes in Patients With Psoriasis in the United States

Psoriasis, an immune mediated disorder with skin manifestations and comorbidities, has high resource requirement. Specifically, diabetes is highly prevalent in psoriasis patients and may represent a substantial incremental economic burden. This retrospective study aimed to estimate the incremental costs of psoriasis and diabetes in psoriasis patients. Adult patients with psoriasis (i.e., ≥2 psoriasis diagnoses ICD-9 codes:696.1x) were selected from a large US administrative claims database. Psoriasis-free controls were matched with the psoriasis sample by age and gender in a 1:1 ratio. All patients were followed for one year to assess their healthcare costs. Incremental total healthcare costs (USD 2010) associated with psoriasis and diabetes in a psoriasis population, measured from a third-party payer perspective, were estimated using regression models controlling for age and gender. A total of 106,128 matched pairs were studied. Among psoriasis patients, 16% had diabetes compared to 13% of the psoriasis-free controls (p<.001). Psoriasis was associated with a $4,523 adjusted increment total health care costs among patients without diabetes ($10,017 vs. $5,539; p<.001), compared to $5,984 among patients with diabetes ($19,536 vs. $13,589; p<.001). In the psoriasis population, diabetes presented a $8,337 adjusted incremental cost compared to the psoriasis patients without diabetes ($19,536 vs. $10,017; p<.001). This was $1,460 more than the adjusted incremental costs from diabetes among controls without psoriasis (p<.001), representing an interaction of psoriasis and diabetes conditions, which significantly increases the health care costs. Both psoriasis and diabetes are expensive conditions to treat. The incremental economic burden of patients having both diseases is significantly higher than each condition individually, potentially due to the complexity of managing both conditions at the same time.

Economic Burden Associated With Patients Diagnosed With Hepatitis C

Background New therapies for Hepatitis C virus (HCV) are under development that will augment pegylated interferon-alpha plus ribavirin to improve patient outcomes. Data documenting the incremental economic and health burden of patients with HCV relative to those who are not infected with HCV will be required to evaluate the comparative effectiveness of these new therapies. Objective The objective of this study was to estimate the incremental impact of HCV infection on health care costs and risk of adverse health events. Methods Paid claims data for commercially insured patients in the United States were used to identify 2 matched cohorts of 8861 patients with and without HCV infection. Propensity score matching was used to adjust for patient demographics, diagnostic mix, prior use, and drug profile. Patients with prior cirrhosis, liver cancer, or liver transplantation were excluded. Differences in the first postindex year associated with the diagnosis of an HCV infection were estimated for adverse event risk (logistic regression), costs (ordinary least square regression), and utilization counts (generalized linear models), controlling for patient demographics, prior use, comorbidity profile, and prescription drug profile. Results The costs of treating patients infected with HCV and a matched sample not infected with HCV were $37,390 and $13,575, respectively. The incremental cost of HCV infection was estimated at +$23,406, primarily because of higher costs for ambulatory care (+$6531), hospital services (+$1827), and prescription drugs (+$6935). The presence of HCV was associated with a significantly higher risk of hospitalization (odds ratio [OR] = 2.5) and number of hospital admissions (+186%); depression (OR = 2.2); cirrhosis (OR = 65.8); hepatic cancer (OR = 28.1), and liver transplantation (OR = 46.1; P < 0.0001 for all estimates). Conclusions A diagnosis of HCV infection was correlated significantly with increased adverse event risk and increased health care costs. New alternative treatments are needed that are more efficacious and less burdensome for the patient. Limitations of this study are that only 1 year was used to screen for preexisting conditions and events and that paid claims data do not capture indirect HCV infection costs such as time lost from work.

Economic burden of comorbidities in patients with psoriasis is substantial

Psoriasis is frequently associated with comorbidities. To estimate the incremental economic burden associated with comorbidities in patients with psoriasis, accounting for psoriasis severity. Patients continuously enrolled ≥6 months after a randomly selected psoriasis diagnosis date were selected from the Ingenix Impact National Managed Care Database (1999-2004). Comorbidities identified during the 6-month study included: psoriatic arthritis, cardiovascular disease, depression, diabetes, hyperlipidemia, hypertension, obesity, cerebrovascular diseases and peripheral vascular disease. Resource utilization and costs during the 6-month follow-up period were compared for patients with ≥1 comorbidity vs. those without and for patients with a specific comorbidity vs. those without. Adjusted incidence rate ratios (IRRs) and odds ratios (ORs) were estimated for resource utilization using negative binomial and logistic regression models, respectively. Adjusted incremental costs associated with comorbidities were reported using general linear models with log-link and gamma distributions or two-part models. Models controlled for age, sex and psoriasis severity. A total of 114,512 patients were included; 51% had ≥1 comorbidity. Hyperlipidemia (27%) and hypertension (25%) were most prevalent. Patients with comorbidities were more likely to experience urgent care [OR (95% confidence interval (CI))=1.58 (1.51-1.65)] than patients without comorbidities. They also had significantly greater hospitalization rates [IRR (95% CI)=2.27 (2.13-2.42)] and outpatient visits [IRR (95% CI)=1.53 (1.52-1.55)]. Compared with patients who did not have comorbidities, patients with comorbidities incurred $2184 (P<0.001) greater total costs. Comorbidities present a significant economic burden in patients with psoriasis.

Direct Health Care Costs of Patients With Type 2 Diabetes Within a Privately Insured Employed Population, 2000 and 2005

To assess the incremental economic burden of privately insured patients with type 2 diabetes (T2DM) in 2000 and 2005 in the United States. Adults with T2DM and 24 months of continuous health plan enrollment were identified in the MarketScan databases (2000 and 2005). Control groups of persons without diabetes were selected for comparison using propensity score matching. Total adjusted health care costs were estimated using generalized linear modeling. Adjusted health care costs of patients with T2DM in 2005 were 136% higher than those of the matched controls ($12,733 vs $5406, P < 0.001). Similarly, costs of patients with T2DM in 2000 were 146% higher than those of the matched controls ($12,423 vs $5058, P < 0.001). Expenditures were similar for individuals with T2DM in 2000 and 2005. T2DM continues to impose a substantial economic burden to self-insured employers.

Elevated economic burden in obstructive lung disease patients with concomitant sleep apnea syndrome

The purpose of this study is to examine the incremental economic burden of sleep apnea syndrome (SAS) among individuals with concomitant asthma, chronic obstructive pulmonary disease (COPD), or both (i.e., asthma/COPD). Maryland Medicaid claims data were used to identify beneficiaries with asthma (n = 3,072), COPD (n = 3,455), or both (n = 2,604). We compared patient's baseline characteristics by SAS and stratified the analyses by disease cohort to examine the effect of SAS on medical utilization and cost. SAS was more prevalent among beneficiaries with asthma/COPD (6.72%) than beneficiaries with COPD alone (2.87%) or asthma alone (2.15%). Asthma/COPD and COPD beneficiaries with SAS had more medical service claims (p < 0.001) and higher medical cost than beneficiaries without SAS: $5,773 and $4,155 in excess costs among asthma/COPD (p = 0.037) and COPD patients (p = 0.035), respectively. Medical utilization and cost did not differ by SAS in asthma patients (p = 0.567). SAS may add additional economic burden on beneficiaries who already have COPD or asthma/COPD.

A new population-based measure of the economic burden of mental illness in Canada

This paper presents a comprehensive measure of the incremental economic burden of mental illness in Canada which incorporates the use of medical resources and productivity losses due to long-term and short-term disability, as well as reductions in health-related quality of life (HRQOL), for the diagnosed and undiagnosed population with mental illness. The analysis was based on the population-based Canadian Community Health Survey Cycle 2.1 (2003). For all persons, we measured all health services utilization, longterm and short-term work loss, and health-related quality of life and their dollar valuations, with the economic burden being the difference in dollar measures between the populations with and without mental health problems. In total, the economic burden was $51 billion in 2003. Over one-half was due to reductions in HRQOL. The current accepted practice in economic assessments is to include changes in medical resource use, work loss, and reductions in HRQOL.

Evaluation of Costs of Healthcare in HIV Patients with Anemia.

Background: Although the prevalence of mild to moderate anemia in HIV+ patients (pts) is approximately 22% in the HAART era, the incremental economic burden of anemia is not well understood. This study provides an estimate of the incremental cost of care for anemia in HIV+ pts.Methods: A longitudinal, retrospective, cohort design was employed to identify subjects in a commercial database of medical and pharmacy claims who were ≥18 years, HIV+, and enrolled in 1 healthcare plan continuously for 18 months from 1996 to 2004. Pts with anemia (A+) were identified using ICD-9 diagnosis codes or receipt of transfusion(s) in the absence of major GI bleeding, trauma or surgery. A control period of 6 months immediately prior to the 12-month study period served to evaluate comorbidity burden and disease severity. To isolate health care costs, including in- and out-patient visits and pharmacy costs, specific to anemia, multivariate regression analyses were conducted to control for demographics, comorbidities, and disease burden.Results: Of the 2,195 HIV+ subjects identified, 364 (17%) were A+. While there was no significant gender effect, each 1-year increase in age was associated with a 2.1% rise in average monthly cost. A+ cohort was associated with a 118.5% higher average cost compared to A−. The unadjusted average monthly cost for A− subjects in the post-index period was $466 compared with $1,200 for the A+ cohort. In a regression model, anemia maintained an independent and significant association with increased costs (p < 0.0001).Conclusion: The presence of anemia is associated with a substantial increase in costs among HIV+ patients, independent of demographic differences, disease severity and comorbidity burden. Prospective studies are needed to evaluate the effect of anemia correction on healthcare costs in this population.

The Impact of Anaemia and its Treatment on Employee Disability and Medical Costs

Anaemia is a common haematological complication of cancer and cytotoxic treatment. The incremental economic burden associated with medical care and short-term disability of anaemia in patients with malignancy and receiving chemotherapy has not been well documented. This study evaluates the effect of anaemia on the costs associated with cancer treated with chemotherapy. Patients receiving chemotherapy within 6 months of their initial cancer diagnosis were identified in a commercial claims database for 1999-2000. Data for these individuals were linked to their employers' short-term disability records via unique encrypted personal identification numbers provided by employers. Patients with anaemia were identified by a diagnosis of anaemia or treatment with transfusion or erythropoietin alfa (EPO). Healthcare expenditure and short-term disability leave were observed for up to 6 months following initial cancer diagnosis and were summarised into monthly averages. Exponential conditional mean models and zero-inflated negative binomial models were used to analyse mean monthly healthcare expenditures and short-term disability days. Twenty-five percent of the 619 newly diagnosed cancer patients treated with chemotherapy had anaemia. The presence of anaemia and longer length of transfusion therapy were associated with increased expenditures, while longer length of EPO treatment was associated with lower expenditures. The incremental costs due to anaemia among patients receiving chemotherapy were US$5,538 (year 2001 values) per month in the first 6 months following cancer diagnosis, 10.8% of which were costs related to short-term disability leave. Anaemia in patients undergoing chemotherapy presents a substantial burden to employers and payers. The findings also suggest that patients with anaemia treated with erythropoietin alfa can achieve expenditure levels similar to those patients without anaemia.