Indirect Costs Of Illness Research Articles

Cost of Illness and Health-Related Quality of Life for Stuttering: Two Systematic Reviews.

For those who stutter, verbal communication is typically compromised in social situations. This may attract negative responses from listeners and stigmatization by society. These have the potential to impair health-related quality of life across a range of domains, including qualitative and quantitative impacts on speech output, mental health issues, and failure to attain educational and occupational potential. These systematic reviews were designed to explore this matter using traditional health economics perspectives of utility measures and cost of illness. Studies were included if they involved children, adolescents, or adults with stuttering as a primary diagnosis. The quality of life search strategy identified 2,607 reports, of which three were included in the quality of life analysis. The cost of illness search strategy identified 3,778 reports, of which 39 were included in the cost of illness analysis. Two of the three studies included in the quality of life analysis had a high risk of bias. When measured using utility scores, quality of life for people who stutter was in the range of those reported for chronic health conditions such as diabetes mellitus, cardiovascular disease, and cancer. However, there is little such evidence of quality of life impairment during the preschool years. Studies included in the cost of illness analysis carried considerable risk of bias overall. For people who stutter, there are substantive direct and indirect costs of illness. These include impairment, challenges, and distress across many domains throughout life, including income, education, employment, and social functioning. Evidence of quality of life impairment using utility measures is extremely limited. If this situation is not remedied, the lifetime impairment, challenges, and distress experienced by those who stutter cannot be documented in a form that can be used to influence health policy and health care spending. https://doi.org/10.23641/asha.24168201.

Short- and long-term direct and indirect costs of illness after ostomy creation – a Swedish nationwide registry study

BackgroundDespite advance in care of people with an ostomy, related complications remain prevalent. The objective of this study was to examine short- and long-term healthcare resource utilization and associated costs after ostomy creation.MethodsThis observational study was based on retrospectively collected data from national and regional Swedish registries. The population consisted of people living in Sweden, who had an ostomy created. The earliest index date was 1 January 2006, and people were followed for ten years, until death, reversal of temporary ostomy, termination of purchases of ostomy products, or end of study, which was 31 December 2019. Each person with an ostomy was matched with two controls from the general population based on age, gender, and region.ResultsIn total, 40,988 persons were included: 19,645 with colostomy, 16,408 with ileostomy, and 4,935 with urostomy. The underlying diseases for colostomy and ileostomy creations were primarily bowel cancer, 50.0% and 55.8% respectively, and additionally inflammatory bowel disease for 20.6% of ileostomies. The underlying cause for urostomy creation was mainly bladder cancer (85.0%). In the first year after ostomy creation (excl. index admission), the total mean healthcare cost was 329,200 SEK per person with colostomy, 330,800 SEK for ileostomy, and 254,100 SEK for urostomy (100 SEK was equivalent to 9.58 EUR). Although the annual mean healthcare cost decreased over time, it remained significantly elevated compared to controls, even after 10 years, with hospitalization being the main cost driver. The artificial opening was responsible for 19.3–22.8% of 30-day readmissions after ostomy creation and for 19.7–21.4% of hospitalizations during the entire study period. For the ileostomy group, dehydration was responsible for 13.0% of 30-day readmissions and 4.5% of hospitalization during the study period.ConclusionsThis study reported a high disease burden for persons with an ostomy. This had a substantial impact on the healthcare cost for at least ten years after ostomy creation. Working ability seemed to be negatively impacted, indicated by increased cost of sickness absence and early retirement. This calls for improved management and support of ostomy care for the benefit of the affected persons and for the cost of society.

Quantifying the economic gains associated with COVID-19 vaccination in the Canadian population: A cost-benefit analysis.

Vaccination has been a key part of Canada's coronavirus disease 2019 (COVID-19) pandemic response. Although the clinical benefits of vaccination are clear, an understanding of the population-level benefits of vaccination relative to the programmatic costs is of value. The objective of this article is to quantify the economic impact of COVID-19 vaccination in the Canadian population between December 2020 and March 2022. We conducted a model-based cost-benefit analysis of Canada's COVID-19 vaccination program. We used an epidemiological model to estimate the number of COVID-19 symptomatic cases, hospitalizations, post-COVID condition (PCC) cases, and deaths in the presence and absence of vaccination. Median, lower and upper 95% credible interval (95% CrI) outcome values from 100 model simulations were used to estimate the direct and indirect costs of illness, including the value of health. We used a societal perspective and a 1.5% discount rate. We estimated that the costs of the vaccination program were far outweighed by the savings associated with averted infections and associated downstream consequences. Vaccination increased the net benefit by CAD $298.1 billion (95% CrI: 27.2-494.6) compared to the no vaccination counterfactual. The largest benefits were due to averted premature mortality, resulting in an estimated $222.0 billion (95% CrI: 31.2-379.0) benefit. Our model-based economic evaluation provides a retrospective assessment of COVID-19 vaccination during the first 16 months of the program in Canada and suggests that it was welfare-improving, considering the decreased hospitalizations and use of healthcare resources, deaths averted and lower morbidity from conditions such as PCC.

Cost of Illness Analysis of Common Mental Disorders: A Study from an Indian Academic Tertiary Care Hospital.

The cost of illness (COI) for common mental disorders (CMDs) that include depression, anxiety, and somatoform disorder is less studied in India. Hence, we studied the COI and disability of CMDs and their relationship in patients with depression, anxiety, and somatoform disorders. In this cross-sectional study, we recruited 220 patients (110 with depression, 58 with anxiety disorders, and 52 with somatoform disorders) and evaluated disability using the Sheehan Disability Scale (SDS). The schedule for the cost of illness (S-COI) was used for evaluating COI for the last year. The annual COI of CMDs from the patient perspective was ₹21,620 (interquartile range [IQR], ₹47,761; ≈US$290). The median annual direct COI was ₹4,907 (IQR ₹7,502), and indirect COI was ₹12,900 (IQR ₹37744). The direct COI was 18%, whereas the indirect COI was 82%. The direct and indirect COI in the three groups were similar. In all three groups with ongoing treatment, the mean scores indicated a mild level of disability. Total and indirect COI, but not the direct COI, correlated positively with the severity of illness and disability. All the CMDs with ongoing treatment are associated with a mild level of disability and are a significant financial burden, with higher indirect costs.

Disease burden of borderline personality disorder: cost of illness, somatic comorbidity and mortality

Severe mental illnesses (SMI) are characterized by high psychosocial impairment as well as by increased somatic morbidity and mortality. The term SMI commonly includes psychotic, bipolar and severe unipolar depressive disorders but borderline personality disorder (BPD) also shows severe sequelae of the disease. Published reviews and studies since 2010 examining disease burden of BPD, in terms of direct and indirect costs of illness, somatic comorbidity, and mortality were included. Furthermore, administrative data (clinically recorded billing data in Germany), comorbidity and mortality from acomprehensive analysis (n > 59million, age ≥ 18years) are reported. International studies reveal an increased disease burden, comorbidity, and mortality for BPD. In Germany BPD (administrative 1‑year prevalence 0.34%) is associated with increased rates of somatic sequelae of trauma, hepatitis, HIV, COPD, asthma, and obesity. The estimated reduced life expectancy is 5.0-9.3years of life lost (depending on age and sex). The burden of disease in BPD is clearly increased (cost of illness, somatic comorbidity and mortality). The increased mortality can mainly be explained by deaths as aconsequence of poor physical health and associated BPD-related health behavior and only to alesser degree by suicide. These results highlight the importance of classifying BPD as an SMI and the necessity to provide not only psychotherapeutic and psychiatric but also adequate somatic prevention and treatment. Individual improvement of everyday care as well as establishing new interdisciplinary and multiprofessional services could enhance health equality for people with BPD.

Cost of illness of epilepsy per patient per year in a tertiary care hospital in New Delhi: A Prospective Observational study

Background: Epilepsy is a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures that imposes heavy burden on individuals, families, and also on healthcare systems. As the better understanding of economic aspects of epilepsy will lead to better development of epilepsy care this study was conducted to estimate the cost of illness in epilepsy per patient per year in a tertiary care hospital in New Delhi.
 Aims and Objectives: The aim of study was to study the direct, indirect and total cost of illness in epilepsy per patient per year in a tertiary care hospital.
 Materials and Methods: Patients with epilepsy attending the Department of Neurology at Batra Hospital and Medical Research Centre in New Delhi were included in this study. All epilepsy patients fulfilling the inclusion and exclusion criteria were included in the study. The cost of illness was estimated as total, direct and indirect costs of illness per year for each patient. The information was collected on a properly formed format which consists of the demographic details of the patient, general biodata of patient, information about the direct medical costs and direct non-medical costs and information about indirect costs. The results are presented in Mean ± SD frequencies and percentages. The Kruskal-Wallis test was used to compare the costs of illness among different strata. The Mann-Whitney U test was used to compare the costs of illness between strata. The p-value<0.05 was considered significant. All the analysis was carried out on SPSS 16.0 version (Chicago, Inc., USA).
 Results: A total of 70 patients were included in the study. The median age of patients was 28.50 years and the mean age was 33.36 years. The total indirect and direct cost of illness was Rs. 5265.30±6363.42 and Rs. 25249.38±14480.09 respectively. The total cost of illness was Rs. 26808.42±16108.05. The highest mean cost was for Carbamazepine (Rs. 14500.00), followed by Levetiracetam (Rs.13300.00) and rest by the other commonly used drugs.
 Conclusion: We concluded that economic burden of epilepsy on the family and patients can be decreased by decreasing the hospitalization rates of patients, avoiding poly therapy as much as possible and rationalizing the investigations.

Determinants of willingness to participate in community-based health insurance among People Living with HIV in South-East Nigeria

Background: Despite free antiretroviral treatment at designated facilities, many People Living with HIV (PLHIV) in Nigeria continue to face catastrophic health expenditures (CHE) due to direct non-medical and indirect costs of illness. Waning donor funding and poor country ownership of HIV care programs are challenges to the sustainability of care for PLHIV. Community-Based Health Insurance (CBHI) presents a viable alternative for funding HIV care services. The aim of this study was to assess the determinants of Willingness To Participate (WTP) in CBHI among PLHIV in a large tertiary hospital in South-east Nigeria. Methods and materials: A cross-sectional survey was conducted among 371 PLHIV on treatment at Federal Teaching Hospital Abakaliki Nigeria using an interviewer-administered questionnaire. Descriptive, bivariate and multivariate logistic regression analyses were conducted using SPSS version 20. Statistical tests were conducted at 5% level of significance. Results: Respondents were mostly males (51.8%) with mean age of 45.4 ± 10.3. The mean monthly income of respondents was N26, 665.77 ± 15,171.50 ($74,070 ± 42.14). Majority were willing to participate (825%) and to finance their participation in CBHI (65.2%). Major reasons given for unwillingness to participate in CBHI were poor understanding on how the system works, lack of regular source of income, health insurance not needed and fear of poor management of resources. On bivariate analysis, WTP in CBHI was associated with gender (p < 0.001), marital status (p < 0.001), employment type (p = 0.006), family size (p = 0.001), educational level (p < 0.001), monthly and monthly income (p < 0.001). Predictors of WTP were female gender (AOR = 2.9; 95% CI: 1.6–5.7), being currently unmarried (AOR = 4.3; 95% CI: 2.3–7.8), self-employed (AOR = 2.2; 95% CI: 1.2–3.9), family size greater than 5 (AOR = 3.1; 95% CI: 1.7–5.9) and having less than a secondary school education (AOR = 4.3; 95% CI: 2.3–7.8). Conclusion: The majority of the respondents were willing to participate and finance their participation in CBHI. The vulnerable subgroups (females, unmarried, self-employed, poorly educated and those with large family size) had higher odds of WTP. To reduce CHE, there is a need to harness this high WTP among PLHIV in the design of subsidized and sustainable CBHI programs with special focus on the socially disadvantaged.

Economic analysis of the stand-by emergency treatment (SBET) for malaria in travellers

Abstract Background Stand-by emergency treatment (SBET) is a possible approach for malaria prevention in travellers to low transmission areas (such as South-Eastern Asia [SEA]), but current evidence casts doubts on its feasibility and does not allow to decide whether this strategy is economically rational. Thus, this research aimed to appraise SBET in terms of cost-benefit/cost-effectiveness analysis from the perspective of the National Health Service (NHS). Methods To design a specific model, SBET benefits (valued as avoided direct and indirect costs of illness) were weighted against the costs associated with SBET doses to be prescribed in order to avoid one imported case of malaria. Direct healthcare costs were obtained allocating last surveillance data for imported malaria to the charge of the corresponding diagnosis-related group category and estimating outpatient care costs. Indirect social costs were calculated in terms of lost productivity. The economic framework was adjusted for the probability of malaria transmission in SEA region and weighed on the Italian context. Results In the model, for five malaria cases estimated to be imported from SEA to Italy in 2017, it was calculated that NHS would be charged with around € 22,487·50. Social costs were determined at € 7,100. Thus, the total Italian public expenditure for malaria cases in SEA travellers was of € 29,587·50 in 2017. In contrast, 50,000 doses were considered to be carried to avoid one malaria imported case, with a cost of € 2.5 million. Conclusions At cost-effectiveness analysis, reimbursement strategy does not lead to a favourable gain owing to the total cost of the SBET doses to be prescribed for avoiding one malaria case. The appraisal of costs and benefits brings into question the economic validation of SBET, also calling for further strategies to be reassessed for travellers to low-risk areas. Key messages Besides the evidence of incorrect SBET use among travellers, the appraisal of costs and benefits brings into question the economic validation of this strategy. Reimbursement for SBET seems to be not cost–effective from the perspective of National Health Services.

Economic Costs of Myasthenia Gravis: A Systematic Review.

The objective of our study was to conduct a systematic literature review of economic costs (henceforth costs) associated with myasthenia gravis (MG). We searched MEDLINE (through PubMed), CINAHL, Embase, PsycINFO, and Web of Science for studies reporting costs of MG published from inception up until March 18, 2020, without language restrictions. Two reviewers independently screened records for eligibility, extracted the data, and assessed included studies for risk of bias using the Newcastle-Ottawa Scale. Costs were inflated and converted to 2018 United States dollars ($). The search identified 16 articles for data extraction and synthesis. Estimates of costs of MG were found for samples from eight countries spanning four continents (Europe, North America, South America, and Asia). Across studies, the mean per-patient annual direct medical cost of illness was estimated at between $760 and $28,780, and cost per hospitalization between $2550 and $164,730. The indirect cost of illness was estimated at $80 and $3550. Costs varied considerably by patient characteristics, and drivers of the direct medical cost of illness included intravenous immunoglobulin and plasma exchange, myasthenic crisis, mechanical ventilatory support, and hospitalizations. We show that the current body of literature of costs of MG is sparse, limited to a few geographical settings and resource categories, mostly dated, and subject to non-trivial variability, both within and between countries. Our synthesis will help researchers and decision-makers identify gaps in the local health economic context of MG and inform future cost studies and economic evaluations in this patient population.

Health Economic Effects of Rehabilitation for Chronic Back Pain - An Observational Study with Combined Secondary Data from Statutory Health Insurance and German Pension Fund

Chronic back pain is the most common indication in medical rehabilitation. Numerous studies hint on positive effects of rehabilitation on health state. However, there is no evidence about the effectiveness of rehabilitation due to the lack of a valid comparison group. Based on combined secondary data from German Pension Fund and statutory health insurance, a comparison group of insured persons was identified by their typical patient career that did not apply for rehabilitation for unclear reasons. Effectiveness was measured by direct and indirect costs of back pain between rehabilitants and non-rehabilitants. Costs of rehabilitation split in 2.742 € direct costs and 2.597 € indirect costs. In the 2 years following rehabilitation, rehabilitants were hospitalized less frequent and caused less indirect costs due to disability. Therefore, the benefit of rehabilitation was 727 € in the first year after rehabilitation and additional 37 € in the subsequent year. Rehabilitation for chronic back pain contributes to maintain the ability to work. Moreover, rehabilitation reduces duration of disability and healthcare utilization, hence direct and indirect costs of illness are lowered compared to a treatment without rehabilitation. Effects of rehabilitation by avoidance and delay of retirement are not yet recorded.

The Indirect cost of illness in Africa

Background: The current study estimated (a) the indirect costs associated with non-fatal disability and premature death across a wide range of diseases and health conditions in Africa in 2015 and (b) the potential savings that could be accrued if countries were to meet the 3 health targets of the substainable development goal (SDG) compared to the costs under the status quo.&#x0D; Methods: This study used the lost output or human capital approach to quantify the gross domestic product (GDP) losses associated with the disability-adjusted-life-years (DALYs) lost due to all causes by age group as well as by country economic classification (Group 1: 10 high/upper-middle income countries; Group 2: 17 lower-middle income countries; and Group 3: 27 low income countries).&#x0D; Results: The expected indirect cost of the 704,765,879 DALYs lost in Africa in 2015 was Int$ 2,983,187,560,197. Of this amount, 25.17%, 57.84% and 16.99% were incurred by the economies of the countries comprising Group 1, Group 2 and Group 3, respectively. Of the total continental indirect cost, 36.9%, 10.5%, 13.7%, 17.0%, 7.6%, 6.8% and 7.5% were associated with people aged 0-4, 5-14, 15-29, 30-49, 50-59, 60-69 and 70 years or older, respectively. Most of the total indirect cost (56.61%) was attributable to maternal conditions, AIDS, tuberculosis (TB), malaria, neglected tropicald diseases (NTDs), non-communicable diseases and traffic injuries. Approximately half (47%) of this cost could be avoided (or saved) every year if the 3 (health) targets of the SDG were fully met.&#x0D; Conclusion: The study estimated the total indirect cost of illness due to all causes by age group and country economic classification. The annual indirect cost is substantial. The findings contained in this paper suggest that health system strengthening should focus on both rich and poor countries, people of all ages and specific disease categories.&#x0D;

The Economic Burden of Stroke Based on South Korea’s National Health Insurance Claims Database

Background: This study was conducted to determine the scale and the nature of the economic burden caused by strokes and to use the results as an evidential source for determining the allocation of South Korea stroke cases in 2015. Methods: For research subjects, the study analyzed demographic characteristics and economic burden based on data from national health insurance (NHI) claims for inpatient and outpatient cases of ischemic stroke and hemorrhagic stroke in 2015 through the Health Insurance Review and Assessment Service (HIRA) and statistical data regarding cause of death from the Korea National Statistical Office (KNSO). This study, in order to estimate economic burden due to stroke, deduced the direct and indirect costs of illness caused by stroke, using cost-of-illness (COI) methods. The economic burden is divided into direct and indirect costs, and indirect cost is estimated by summing lost productivity measured in opportunity cost lost by medical disposition due to a specific disease and lost productivity due to premature death. Results: The total economic burden in Korea due to stroke was US$6.855 billion, that due to ischemic stroke was US$3.658 billion, and that due to hemorrhagic stroke was US$3.197 billion. The average economic burden per stroke case was about US$7247. Conclusion: The results of estimating the annual economic burden in all of Korea due to stroke will be used as an evidential source for preparing medical insurance policies, priorities, and plans for arranging medical resources for stroke as well as for determining effective prevention of the disease and related priorities in national health care policies.

The Economic Impacts of Chronic Illness on Households of Patients in Ile-Ife, South-Western Nigeria.

IntroductionChronic illnesses are slowly becoming more prevalent worldwide. The implications and ramifications of these illnesses vary and affect not only the patient but the entire household in many ways. This research focuses on the economic implications of this category of illnesses on the entire household. The aim is to determine the economic implications of chronic illnesses on households of patients in selected health facilities in Ile-Ife, Nigeria, and to elucidate the various coping strategies applied by households in low and middle income countries (LMICs) to keep up with these economic implications.MethodsThis study features a descriptive cross-sectional survey design with a total sample of 443. The target population consists of individuals with chronic diseases in selected health care facilities in Ile-Ife. ResultsThe mean household monthly incomes before and after illness episodes were found to be $335.84 and $318.01, respectively. The mean direct cost of chronic illness was $137.72 with about 79% (n=350) of the respondents spending more than 10% of the monthly household income on health. The indirect costs of illness were a loss of productivity of 18.9% and 5.1% for patients and caregivers, respectively. A large percentage of the respondents resorted to borrowing (44.7%; n=198), while another 5.0% (n=22) sold assets, and 8.6% (n=38) had access to health insurance in order to cope with the economic impacts of the illness.ConclusionThe study showed that chronic illnesses imposed high and catastrophic cost burdens on patients and their households. The lack of effective coping strategies points at the need for policymakers to improve access to specialized care and increase coverage of formal health insurance so as to ameliorate the significant economic impacts that chronic illnesses have on entire households.

Effectiveness of a cough management algorithm at the transitional phase from acute to chronic cough in Australian children aged

IntroductionAcute respiratory infections (ARIs) are leading causes of hospitalisation in Australian children and, if recurrent, are associated with increased risk of chronic pulmonary disorders later in life. Chronic (>4 weeks)...

The impact of firms' adjustments on the indirect cost of illness.

Illness-related absenteeism reduces firms' output, an effect referred to as indirect cost (IC) and often included in cost-of-illness or cost-effectiveness (of health technologies) studies. The companies may foresee this effect and modify hiring or contracting policies. We present a model allowing the estimation of IC with such adjustments. We show that the risk of illness does not change the general shape and properties of the (expected) marginal productivity function. We apply our model to several illustrative examples and show that firm's adjustments impact IC in an ambiguous way, depending on detailed company/market characteristics: in some cases the company reduces the employment (further increasing IC), in another-the opposite happens. Contrary to previous findings, teamwork and shortfall penalties may reduce IC in some settings. Our analysis highlights that IC should be split into the result of companies preparing for and actually experiencing sick leaves.

Costs and benefits of US aviation noise land-use policies

Aircraft noise affects human health and welfare. One method US airports use to mitigate the impact of noise on nearby residents is through sound insulation and residential land acquisition projects. Costs of residential insulation and acquisition projects are taken from federal grant summaries while the benefits of noise reduction are calculated as the combined willingness-to-pay for abatement and direct and indirect costs of illness from hypertension, myocardial infarction, and stroke. We show that the average cost of sound insulation projects is $15,600 per person affected while that of land acquisition is $48,900 per person affected. We find that for only in 15% of projects do the benefits to residents from willingness-to-pay for reduction and reduced risk of mortality and morbidity exceed the costs of sound insulation for residences exposed to 65dB Day Night Level (DNL) of noise. Our estimates suggest that noise insulation projects are more cost-effective than fleet wide mandatory aircraft retirement.

Economic Burden of Relapsed or Refractory Multiple Myeloma: Results from an International Trial

Background: The direct (medical utilization) cost of relapsed or refractory multiple myeloma (RRMM) has been documented; recent studies are now exploring indirect costs as well (Goodwin et al, Cancer Nurs 2013;36(4):301-8; Moreau et al, Haematologica 2014;99(suppl 1):214-5). Healthcare decision makers are interested in identifying meaningful cost offsets from new therapies providing substantially better clinical outcomes (Cook, J Manag Care Pharm 2008;14(7 Suppl):19-25).Methods: Data from a patient economic questionnaire inquiring about recent disease-specific medical utilization, workforce status, and caregiver burden was analyzed from RRMM patients in a Phase 2, multi-site, international, randomized, controlled study (n = 307; Orlowski et al, Am J Hematol 2015;90(1):42-9). Direct and indirect costs of illness were characterized using standard descriptive statistics among those at study entry who were randomized and subsequently completed a baseline economic questionnaire. Patient-reported health questionnaires included the Brief Pain Inventory (BPI) pain intensity and the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) scales; severity thresholds based on literature and developer recommendations for each were applied in analysis.Results: Patients who answered the questionnaire (n = 267) were 54% male, 92% Caucasian, mean and median age of 63 years, and median ECOG status of 1; while 31% reported moderate to severe pain, 71% reported moderate to severe fatigue. At least 1 hospital visit was reported by 107 (42%) respondents over the last 6 months, while 185 (71%) and 86 (33%) reported specialist and family physician visits, respectively, over the last 3 months (Table). While only 11% of the reporting population was working, 48% of these who weren't working indicated it was due to their disease and 39% of those working reported disease-driven absenteeism of at least 1 day over the last 4 weeks. Of the 80% that were retired, 32% indicated it was an early retirement caused by RRMM.Conclusions: These data document the substantial direct medical costs for RRMM patients but also the notable indirect, social costs associated with this disease. The clinical and demographic profile of these patients were similar to other multi-site, international RRMM studies, suggesting these results are broadly applicable (Richardson et al, Blood 2014;123(12):1826-32; Siegel et al, Blood 2012;120(14):2817-25; Kumar et al, Leukemia 2012;26(1):149-57). Longitudinal studies tracking treatment impact on economic outcomes, including direct and indirect cost offsets, are needed to understand the full social impact of new therapies in MM (Cook, 2008;14(7 Suppl):19-25).TablePatient-reported Economic Impact of RRMMN (%) of patientsDisease-driven hospital visits (prior 6 months)0: 151 (58%)≥ 1: 107 (42%)Disease-driven specialist visits (prior 3 months)0: 75 (28.9%)≥ 1: 185 (71.1%)Disease-driven family practice visits (prior 3 months)0: 174 (66.9%)≥ 1: 86 (33.1%)Working nowYes: 28 (11.6%)No: 236 (89.4%)Disease driven absentee days (prior 4 weeks)0: 17 (61%)≥ 1: 10 (39%)Not working now due to diseaseYes: 113 (48.7%)No: 119 (51.3%)RetiredYes: 188 (80%)No: 47 (20%)Early retirement due to diseaseYes: 61 (32.4%)No: 127 (67.6%)Disease-driven disability compensationYes: 96 (36.9%)No: 164 (63.1%)Working days missed by caregiver0: 201 (80.1%)≥ 1: 50 (19.9%) DisclosuresRobinson:Janssen: Employment. Orlowski:Janssen: Membership on an entity's Board of Directors or advisory committees; Onyx Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene: Membership on an entity's Board of Directors or advisory committees, Research Funding; Acetylon Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees; Bristol-Myers Squibb: Membership on an entity's Board of Directors or advisory committees, Research Funding; Array Biopharma: Membership on an entity's Board of Directors or advisory committees, Research Funding; Millennium Pharaceuticals: Membership on an entity's Board of Directors or advisory committees, Research Funding; Spectrum: Research Funding; Biotheryx: Membership on an entity's Board of Directors or advisory committees; Forma Therapeutics: Membership on an entity's Board of Directors or advisory committees; Genentech: Membership on an entity's Board of Directors or advisory committees. He:Janssen: Employment. Lam:Janssen: Employment. Zhao:Janssen: Employment. Cakana:Janssen: Employment.

The economic burden of TB diagnosis and treatment in South Africa

Social protection against the cost of illness is a central policy objective of Universal Health Coverage and the post-2015 Global strategy for Tuberculosis (TB). Understanding the economic burden associated with TB illness and care is key to identifying appropriate interventions towards achieving this target. The aims of this study were to identify points in patient pathways from start of TB symptoms to treatment completion where interventions could be targeted to reduce the economic impact on patients and households, and to identify those most vulnerable to these costs.Two cohorts of patients accessing TB services from ten clinics in four provinces in South Africa were surveyed between July 2012 and June 2013. One cohort of 351 people with suspected TB were interviewed at the point of receiving a TB diagnostic and followed up six months later. Another cohort of 168 patients on TB treatment, at the same ten facilities, was interviewed at two-months and five-months on treatment. Patients were asked about their health-seeking behaviour, associated costs, income loss, and coping strategies used.Patients incurred the greatest share of TB episode costs (41%) prior to starting treatment, with the largest portion of these costs being due to income loss. Poorer patients incurred higher direct costs during treatment than those who were less poor but only 5% of those interviewed were accessing cash-transfers during treatment. Indirect costs accounted for 52% of total episode cost.Despite free TB diagnosis and care in South Africa, patients incur substantial direct and indirect costs particularly prior to starting treatment. The poorest group of patients were incurring higher costs, with fewer resources to pay for it. Both the direct and indirect cost of illness should be taken into account when setting levels of financial protection and social support, to prevent TB illness from pushing the poor further into poverty.

A systematic review of the economic and humanistic burden of illness in irritable bowel syndrome and chronic constipation.

Irritable bowel syndrome (IBS) and chronic constipation (CC) are common functional gastrointestinal disorders affecting 14% and 20% of the U.S. population, respectively. Reviews of the evidence on the burden of illness associated with IBS and CC have not been comprehensive in scope and have not provided an assessment of the distribution of health care costs across categories of resource use. To (a) identify studies from any geographic region or country perspective that measure the economic burden of the disease; (b) analyze the direct (medical, drug, and other components) and indirect costs of illness; and (c) assess published evidence of the humanistic burden as measured by quality of life (QOL). An electronic literature search was conducted using journal databases, including MEDLINE, The Cochrane Library, EconLit, CINAHL, and Digestive Disease Week meeting abstracts. Specific search terms used were "irritable bowel syndrome" and "chronic constipation." In databases that accommodated Boolean searches, terms related to economic and quality of life outcomes were incorporated. Studies were included if they evaluated patients with an IBS or CC diagnosis and quantitatively measured the economic or humanistic burden of disease. Results were descriptively analyzed. The search identified a total of 882 unique publications. Thirty-five articles and abstracts met the inclusion criteria. Studies included 1,706 IBS-C, 2,264 IBS-D, 2,892 IBS-A, 15,830 IBS unclassified, and 1,278 CC patients. Nineteen of 35 studies assessed cost-of-illness endpoints, and from the U.S. perspective, the direct cost per-patient for IBS ranged from $1,562 to $7,547 per year, while direct costs of CC ranged from $1,912 to $7,522 per year. From the U.S. perspective, the indirect costs of IBS ranged from $791 to $7,737 per year, and no study assessed the indirect costs of CC. For IBS, data on the distribution of costs attributable to categories of resource use varied widely, particularly outpatient costs (12.7% to > 50% of total costs), inpatient costs (6.2% to 40.8%), and pharmacy or drug costs (5.9% to 46.6%). Comparable data on CC were not identified. Nineteen studies of IBS patients measured the humanistic burden of disease; 14 studies utilized SF-36; and within-study domain scores were significantly lower in IBS patients compared with non-IBS controls. Only 1 study of CC patients reported humanistic burden of disease. The studies identified in the systematic review varied in the method used to identify patients with IBS and CC. Results were not typically reported by IBS subtype. We observed a large variation in attributable direct and indirect costs and drivers of these costs. Future research should refine burden of illness estimates to subtypes so that estimates associated with IBS-C and CC are differentiated.

Burden of direct and indirect costs of illness: Empirical findings from slum settlements in Chennai, South India

According to a recent WHO report, around 100 million people are reduced to poverty every year due to costs associated with illness. Contributing to the growing literature on the economic burden of illness, this article examines the indirect and direct costs of illness that occur at the household level, describes their influence on treatment-seeking behaviour and assesses their impact on household welfare. The results presented are based on an empirical study carried out in slum settlements in the megacity of Chennai in South India. We show that the poorer section of slum dwellers suffer disproportionally from catastrophic illness costs despite the existence of free public health services. Policies need to be implemented that enhances the resilience of poor households against illness costs.