Productivity Loss Costs Research Articles

P1277 Cost-effectiveness of BOOST online intervention for supported self-management of pain, fatigue and bowel incontinence in Inflammatory Bowel Disease

Abstract Background People with IBD often experience symptoms of abdominal pain, fatigue and bowel incontinence that affect substantially their daily lives1. IBD-BOOST is the first randomised controlled trial (RCT) assessing the effectiveness of an online self-management intervention, BOOST, in managing these symptoms in IBD2. We report the cost-effectiveness of BOOST intervention compared to care as usual for people with IBD. Methods A cost-utility analysis was conducted alongside the pragmatic IBD-BOOST RCT of 780 patients requesting help for pain, fatigue or incontinence symptoms (mean age 49 years, 67% women, 55% with Crohn’s disease)3. The BOOST intervention costs and costs from patient-reported health service use, out-of-pocket expenses and time off work were calculated for each participant over the 12 months of follow-up. Quality-adjusted life-years (QALYs) over the 12 months were evaluated using the EQ-5D-5L questionnaires administered to participants at baseline, 6- and 12-months. Missing data (13% at 6 months and 38% at 12 months across the trial arms) was imputed using multiple imputation. Differences in total costs and QALYs between study arms were estimated using mixed effects models adjusting for pre-specified baseline factors. Incremental cost effectiveness ratios (ICERs) and net monetary benefit from UK healthcare and societal perspectives are reported. Results At recruitment, study participants reported quality of life (EQ-5D utility) of 0.73 (SD 0.22) and overall IBD-related costs of £2321 (SD 3170) over the previous 3 months with cost of biologics accounting for 47% of these costs, followed by hospital outpatient services (22%) and work productivity loss costs (14%) (Figure 1). After missing data imputation and controlling for covariates, the BOOST intervention (£151 per participant) was estimated to have led to health care cost savings of £746 (SE 356), other costs savings of £89 (SE 236) and incremental QALYs of 0.017 (SE 0.007) over the one-year follow-up per participant resulting in cost savings per QALY gained of £34,599 from the health services perspective and £39,745 from the societal perspective. The probability that the BOOST intervention was cost effective when compared with usual care was above 98% for willingness-to-pay thresholds of £20,000 to £30,000 from both health services and societal perspectives (Figure 2). Conclusion Our findings indicate that the BOOST intervention for supported self-management of symptoms of pain, fatigue and bowel incontinence in people with IBD is cost-effective.

Socioeconomic Burden of Pulmonary Embolism in Europe: Shifting Priorities and Challenges for Novel Reperfusion Strategies.

In-hospital case fatality related to acute pulmonary embolism (PE) has been falling since the beginning of this century. However, annual incidence rates continue to climb, and an increasing number of PE survivors need long-term follow-up, chronic anticoagulation treatment, and readmission(s) to the hospital. In European countries, median reimbursed hospital costs for acute PE are still moderate compared with the United States but can increase several-fold in patients with comorbidities and those necessitating potentially life-saving reperfusion treatment. The use of catheter-directed treatment (CDT) has constantly increased in the United States since the past decade, and it has now entered a rapid growth phase in Europe as well, estimated to reach an annual penetration rate of up to 31% among patients with intermediate-high- or high-risk PE by 2030. Ongoing randomised controlled trials are currently investigating the clinical efficacy and safety of these devices. In addition, they will deliver data permitting calculation of their cost-effectiveness in different health care reimbursement systems, by revealing the extent to which they can reduce complications and consequently the need for intensive care and the overall length of hospital stay. After discharge, key cost drivers are related to chronic cardiopulmonary diseases (other than PE itself) leading to frequent readmissions, persistent symptoms, and functional limitations which result in poor quality of life, productivity loss, and substantial indirect costs. Implementation of structured outpatient programmes with a holistic approach to post-PE care, targeting overall cardiovascular health and the patient's well-being, bears the potential to cost-effectively reduce the overall socioeconomic burden of PE.

Cost burden of productivity loss due to sickness presenteeism among nurses in South Korea: A cross-sectional study.

This study aimed to estimate the annual cost burden of productivity loss due to sickness presenteeism among hospital nurses in South Korea. Despite nurses being potentially more vulnerable to presenteeism, few studies have analyzed nurses' productivity losses due to sickness presenteeism. This cross-sectional study employed an online survey in January 2023 with 607 nurses working in general/tertiary hospitals in South Korea. The annual cost burden of productivity loss due to sickness presenteeism was calculated based on nurse health conditions, productivity loss, the number of days worked while sick, and income. This study was reported according to the STROBE checklist. Overall, 93.2% of participants (n=566) reported at least one health condition, and musculoskeletal diseases were the most prevalent, followed by weariness or fatigue, and sleep-related problems. Approximately 63.9% of participants reported experiencing sickness presenteeism in the preceding four weeks. Those in the severe multimorbidity group exhibited the highest prevalence of sickness presenteeism and productivity loss. The average annual cost of productivity loss due to sickness presenteeism was USD 2,388.26 per nurse and USD 382.11 million at the national level. The cost of sickness presenteeism is high among hospital nurses in South Korea. Nurses with severe multimorbidity engaged in more sickness presenteeism and had higher productivity losses than nurses who were relatively healthy or exhibited moderate multimorbidity. These findings support the need for stakeholders to develop strategies/policies to better address nurses' health conditions, secure better staffing, and reduce sickness presenteeism. Addressing this issue will not only improve nurse well-being and patient care but also lead to substantial cost savings for healthcare facilities. Additionally, the study findings can inform future cost-effectiveness studies.

EE768 Productivity Loss and Indirect Cost Related to Atopic Dermatitis in Greece

EE768 Productivity Loss and Indirect Cost Related to Atopic Dermatitis in Greece

The longitudinal association of hand osteoarthritis with paid and unpaid work restrictions and related societal costs: The Hand Osteoarthritis in Secondary Care cohort

ObjectivesTo investigate the course of restrictions in paid and unpaid work and corresponding societal costs in patients with hand osteoarthritis (OA). MethodsPatients with data of at least baseline and one follow-up moment (year one up to year eight) of the Dutch Hand OSTeoArthritis in Secondary care cohort (HOSTAS) were included. The Health and Labour Questionnaire (HLQ) was used to assess over the last two weeks hand OA-related restrictions for paid and unpaid work. Societal costs of productivity loss were estimated with Dutch government data on 2021. Results351 patients were included (mean age 60 years, 84% women). At baseline, 166/351 (47%) had paid work, decreasing to 54/164 (33%) at year eight. Loss of productive time over the two-week period was reported by 32/166 (19%) patients with paid work at baseline, 17/104 (16%) at year four, among whom 12/104 (11%) patients at both moments. Any restrictions over this two-week period were experienced by 89/166 patients (54%) at baseline and 41/104 (39%) at year four for those with paid work.Regarding unpaid work, 157/351 (45%) reported replacement of tasks by others at baseline and 72/164 (44%) at year eight. 205/351 (59%) reported restrictions at baseline, and 99/164 (60%) at year eight.Mean total societal costs for loss of paid and unpaid work were, per patient, €89/two weeks (95% confidence interval (CI) 52;127) at baseline, and €47/two weeks (26;69) at year eight. ConclusionsThe proportion of patients with paid work decreases during follow-up, but restrictions at paid and unpaid work seem mostly stable.Keywords

Literature Review to Understand the Burden and Current Non-surgical Management of Moderate-Severe Pain Associated with Knee Osteoarthritis.

To conduct a literature review exploring the humanistic burden, costs, and guideline recommendations for non-surgical management of moderate-severe pain in knee osteoarthritis (KOA). Published studies (2018-25 April 2023) assessing the burden of moderate-severe pain in KOA were identified by searching Medline, Embase, EconLit, and Cochrane database, supplemented with grey literature hand searches and reference list snowballing. Treatment guidelines were also identified for key countries. This review included 106 publications and 37 treatment guidelines. Patients with moderate-severe pain were found to experience a low quality of life (QoL) and an impaired ability to perform daily tasks. The economic burden of KOA was substantial, including cost of medical visits, non-operative treatment (physical therapy and hyaluronic acid [HA] being key drivers) and productivity losses. Non-steroidal anti-inflammatory drugs (NSAIDs) were among the most frequently used pharmacological treatments, with intra-articular (IA) injections used to varying degrees. Opioid use was also frequently reported. Guidelines universally recommended NSAIDs, albeit with limited dose and duration for oral NSAIDs. IA-corticosteroids were conditionally/moderately recommended for short-term use by most guidelines, while IA-HA and opioids were rarely recommended. Guidelines are not specific to patients with moderate-severe pain and do not distinguish between different KOA phenotypes. KOA with moderate-severe pain is associated with substantial humanistic and economic burden. Real-world data suggest that some treatments are regularly used at high cost regardless of the lack of evidence-based recommendations. There remains a need for new treatment options that successfully relieve pain, improve QoL and delay the need for surgery. Graphical abstract available for this article.

Social Cost Benefit Analysis – a powerful tool for decision making

Abstract Health Impact Assessment provides policy makers with important information about health effects of programs, policies, plans or projects (PPPP). However, PPPP may have many more effects, both positive and negative, direct and indirect, intended and unintended, immediate and in the far future. Ex-ante insights in all these effects may help policy makers to optimize decision-making, but also to communicate realistically to all stakeholders about the PPPP. Weighing effects that may be very different in scale and reach different stakeholders in different ways is inevitable. One powerful tool to help decision makers in this task is Social Cost Benefit Analysis (SCBA). SCBA requires to specify and quantify all effects of PPPP over a specified time horizon. It is also necessary to specify a base-case scenario, i.e. how the problem under study would develop without further investments in PPPP. All effects of PPPP need to be quantified in monetary terms, these can be financial, e.g. healthcare costs or costs of productivity losses, or non-financial, for instance by placing a value of €50,000 on a QALY gained or a DALY averted or a value of €3,5 million on a lost life. PPPP with positive net monetary value are considered welfare enhancing, while PPPP with a negative monetary value do not add to welfare in society. In the Netherlands, government asks any bigger PPPP to be quantified with SCBA methodology. Guidance on unit values for non-monetary effects is given. This contribution will elaborate on results of the SCBA method for different alcohol policy measures, such as increase in excise taxes, minimum unit pricing, closure of vending spots and a total marketing ban. SCBA is a powerful tool to inform policy makers and assist in their decision making processes. It is also a labour and data intensive process that should only be used for larger PPPP investments and not for local decision making.

Economic burden of suicide in Sweden in 2022

Abstract Background Suicide and suicidal behaviors bring massive human, social and economic impacts. Estimates of the cost of suicide can give some guidance as to where research on developing new interventions might be focused to give the greatest potential gain. The aim of the study is to quantify the economic cost of suicide in Sweden in 2022. Methods Incidence of suicide attempts and mortality due to suicide, intentional and undetermined (ICD10 X60-X84 and Y10-Y34) were sourced from the Swedish National Board of Health and Welfare databases for 2022. Cost were estimated from a societal perspective, including costs for inpatient and outpatient care, medication, police and justice activities as well as productivity losses due to early mortality. Results In 2022, a total of 1,569 suicide death were registered in Sweden (1,102 men and 467 women). The incidence rate remains stable during the last ten years, 17 death per 100 000. In total, 18,854 patients (10, 359 women and 8,459 men) were treated in inpatient and outpatient hospital care with suicide-related diagnoses, generated 32,843 days in inpatient care and 11,471 outpatient care visits. Direct costs for suicide death including forensic examination, emergency services, police investigation and property damage were estimated as €6,02 million, while indirect costs for productivity losses totaled €690 million. Direct healthcare costs for suicide related treatment were estimated at €54.3 million. Overall, suicide and suicide attempts cost around €750 million per year to society. Conclusions Estimates of the economic burden of suicide are needed for the Swedish setting, and these amounted to €60.3 million in direct costs and €690 million in indirect costs in 2022. The cost might be underestimated because the societal cost of suicide bereaved persons was not considered. These cost estimates can provide useful inputs to a cost-effectiveness analysis of a specific preventive intervention, and to its subsequent evaluation. Key messages • Economic burden of suicide is substantial for society. • Public health policies aimed at the prevention of suicide should be increased.

Budget impact analysis on the use of Sysmex PA-100 AST system as a point of care for uncomplicated urinary tract infections detection and treatment in Spanish females

Objective Efficient diagnostic methods, such as the Sysmex PA-100, provide rapid antimicrobial susceptibility test results directly from urine samples with high sensitivity and specificity, and improve treatment recommendations. Our study analyzes the economic impact of integrating the Sysmex PA-100 to assess its potential benefits and cost implications for uncomplicated urinary tract infection (uUTI) management in Spain. Methodology A budget impact model was developed using a decision tree framework to compare current UTI management practices with a new scenario incorporating the Sysmex PA-100. The clinical inputs were extracted from published literature. The model, representing adult females with uUTIs, assessed direct medical and indirect costs over three years, including diagnostic procedures, treatment costs, staff time costs, and productivity loss. The cost data was captured from two Spanish hospitals. Two scenario analyses were conducted in the model: scenario A included costs for antimicrobial resistance (AMR) emergence in patients receiving unnecessary empirical antibiotics, whereas scenario B assumed no AMR costs. Results In scenario A, 100% implementation of PA-100 within various Spanish healthcare settings over one year resulted in total cost savings of EUR 323,657,712 (EUR 119.10 per patient per year). The total overall cost savings attributable to the implementation of PA-100 over three years were EUR 970,973,137. In scenario B, the total annual savings were EUR 4,254,795 (EUR 1.57 per patient per year), and the 3-year savings were EUR 12,764,385. Conclusion The adoption of this point-of-care system results in overall cost savings, driven by reductions in direct and indirect costs related to UTI management. The model highlights potential savings over three years owing to appropriate rapid management (reduction in time to diagnosis and treatment, which leads to fewer complications and secondary infections) and reduced staff time and productivity loss costs. These findings support the potential benefits of adopting the Sysmex PA-100 to enhance UTI management and allocate healthcare resource utilization in Spain.

Cost-effectiveness of prophylactic ramosetron in the prevention of postoperative nausea and vomiting.

This study was conducted to assess the cost-effectiveness of prophylactic use of ramosetron compared to no antiemetic medications for the prevention of postoperative nausea and vomiting (PONV) from the healthcare payer and societal perspectives in South Korea. A decision analytic model was constructed to assess the cost-effectiveness of prophylactic ramosetron use versus no antiemetic therapy at 24-hour and 48-hour periods post-surgery over a 5-day duration. The model was populated using costs and utility parameters from published studies as well as from surveys of an expert panel of physicians using structured questionnaires. The cost parameters included the costs of drugs, treatment, patient time, productivity loss, and transportation. Effectiveness was measured using quality adjusted life years (QALYs). The study outcome was the incremental cost-effectiveness ratio (ICER). The parameter uncertainties were addressed using deterministic and probabilistic scenario analyses. The base-case analysis showed that, on average, patients treated with prophylactic ramosetron had lower costs from both the healthcare payer (US$16.88 vs US$17.33) and societal (US$16.89 vs US$18.72) perspectives and higher QALYs (0.0121 vs 0.0114) over the 5-day study duration compared to patients without any antiemetic medications. Deterministic and probabilistic sensitivity analyses were conducted to examine the robustness of results for the parameters included in the model. The acceptability curve probability showed that treating patients with ramosetron compared to no antiemetic medications was more than 99% cost-effective at a willingness-to pay threshold of US$5,000/QALY from both payer and societal perspectives. The results demonstrated that prophylactic use of ramosetron compared to no antiemetic therapy is highly cost-effective to prevent PONV for patients undergoing surgery from both healthcare payer and societal perspectives. The cost effectiveness is the result of the decrease in the incidence of PONV and the direct treatment costs of severe PONV with improved patient quality of life.

Economic burden of vulvar, vaginal, anal, penile and head & neck cancers in Bulgaria

A retrospective, cost-of-illness study aimed at identifying direct healthcare costs of vulvar, vaginal, anal, penile, and H&N cancers in Bulgaria from the payer perspective and calculating indirect costs and the associated years of life lost was carried out. Costs’ data were obtained from the National Health Insurance Fund from January 2018 to December 2020. Years of life lost were calculated based on the country and gender-specific life expectancy. The human capital approach was used to evaluate the indirect costs. The total treatment costs for 3623 patients were EUR 10,875,771 (2018), EUR 11,922,521 (2019) and EUR 12,329,463 (2020). The costs associated with radiotherapy and drug acquisition and administration accounted for the majority (75–78%) of total healthcare costs. A cumulative loss of approximately 33,299 life years occurred between 2018 and 2020. The costs of productivity losses were estimated at EUR 14,113,265.

Cost-effectiveness and cost-utility of optimized mercaptopurine treatment versus placebo in ulcerative colitis patients: The randomized controlled OPTIC trial.

We assessed the cost-effectiveness and cost-utility of therapeutic drug monitoring (TDM)-guided mercaptopurine treatment compared with placebo in ulcerative colitis (UC) patients failing 5-aminosalicylates. Data were gathered alongside the randomized controlled OPTIC trial (EudraCT: 2015-005260-41). The evaluation was performed from a health care and societal perspective as cost-effectiveness and cost-utility analyses with a time horizon of one year. Volumes and costs of in-hospital care, out-of-hospital care, out-of-pocket expenses and productivity loss were assessed. The main outcomes were the extra costs per additional patient who achieved clinical remission and endoscopic improvement at 52weeks (responders) and extra costs per quality-adjusted life-year (QALY) gained. In total, 59 patients were randomized to the intervention (n=29) and control (n=30) group. Non-significant differences in costs were €63 (-€1267 to €1434; P=0.93) in favour of placebo from a health care perspective and -€742 (-€3683 to €2016; P=0.64) in favour of mercaptopurine from a societal perspective. The higher proportion of responders and a non-significant QALY difference of 0.0475 (-0.024-0.117) (P=0.184) favouring patients on mercaptopurine treatment resulted in €165 extra costs per additional responder and €1326 extra costs per QALY gained from a health care perspective. From a societal perspective, dominance over placebo was observed with cost savings of €1937 per additional responder and €15,621 per QALY gained. The probability of optimised mercaptopurine treatment being cost-effective was 0.80 at a willingness to pay per additional QALY of €20,000. TDM-based mercaptopurine treatment in UC patients failing 5-aminosalicylates is a cost-effective strategy from a societal perspective.

Cancer impact on lower-income patients in Malaysian public healthcare: An exploration of out-of-pocket expenses, productivity loss, and financial coping strategies.

Cancer patients often grapple with substantial out-of-pocket (OOP) expenses and productivity loss, with the ramifications being particularly crucial for lower-income households. This study aims to estimate OOP costs incurred by cancer patients, assess their productivity loss, and analyse the financial coping mechanisms employed by individuals within the lower-income bracket. The study employed face-to-face interviews among cancer patients aged 40 years and above, currently undergoing treatment, and belonging to the lower-income group. Participants were recruited from six public cancer referral hospitals. OOP expenses, encompassing medical and non-medical costs, along with productivity loss, were measured. A generalized linear model was applied to identify potential OOP determinants. Additionally, the coping mechanisms employed by individuals to finance their cancer OOP expenses were also determined. Among the 430 participants recruited, predominantly female (63.5%), and aged 60 or older (53.9%). The annual mean total cancer costs per patient were US$ 2,398.28 (±2,168.74), including 15% for medical costs US$ 350.95 (±560.24), 34% for non-medical costs US$820.24 (±818.24), and 51% for productivity loss costs US$1,227.09 (±1,809.09). Transportation, nutritional supplements, outpatient treatment, and medical supplies were notable cost contributors to total OOP expenditures. Ethnicity (β = 1.44; 95%CI = 1.15-1.79), household income (β = 1.40; 95%CI = 1.10-1.78), annual outpatient visits (β = 1.00; 95%CI = 1.00-1.01), age (β = 0.74; 95%CI = 0.56-0.98), and employment status (β = 0.54; 95%CI = 0.72-1.34) were identified as significant predictors of OOP costs among cancer patients. Notably, 91% of participants relied on household salaries and savings, while 15% resorted to interest-free borrowing, 11% sold possessions, and 0.5% borrowed with interest to finance their expenses. This study offers crucial insights into the economic impact of cancer on individuals and their families, providing policymakers with valuable information to tackle challenges faced in their journey. Despite substantial public healthcare subsidies, the study revealed that cancer costs can remain a potential barrier to accessing essential treatment. Therefore, there is a need for reinforced system-level infrastructure to facilitate targeted financial navigation services.

Estimating the Economic Impacts for Caregivers of Young People With Mental Health Problems in a Brazilian Cohort

ObjectivesTo assess the indirect economic impacts on caregivers resulting from mental health problems in their children and to explore the association with characteristics of the young people and their caregivers. MethodsData from 1158 caregivers of young people aged 14 to 23 years with mental health problems in a Brazilian cohort were analyzed. We assessed productivity losses, additional household tasks, out-of-pocket expenses, and own healthcare utilization because of the young person’s mental health problems over the past 6 months. The costs of productivity losses and household tasks were estimated in terms of caregivers’ earnings. Logistic regression models identified factors associated with reported impacts. Generalized linear models evaluated clinical and caregiver characteristics associated with the economic impact on caregivers. ResultsNearly 40% of caregivers (n = 458) experienced economic impacts because of mental health issues in their children over the previous 6 months. The total economic impact among these 458 caregivers who reported incurring costs amounted to half of their earnings, and this was consistent across socioeconomic groups. Factors associated with reporting impacts differed from those affecting their costs. Externalizing and comorbid diagnoses, service use, higher impairment, and female caregivers increased the likelihood of impacts, whereas the greatest economic impacts were associated with internalizing conditions and service use. ConclusionsThough these findings need to be interpreted with caution because of inherent limitations, they underscore the substantial economic impacts borne by caregivers of young people with mental health problems, suggesting the need for targeted policy interventions to promote equitable caregiving and provide more comprehensive childcare support.

Indirect costs assessment and intangible costs description of rheumatoid arthritis patients with biological therapy in Morocco: ECORAM Study.

The aims of study are to estimate the indirect costs and intangible costs of RA in Morocco and to identify the factors likely to influence these costs among suffering patients. In the current study, data were collected by face-to-face interviews using a questionnaire in addition to the patient's files. Indirect costs including productivity losses and formal care, and intangible costs such as the cessation of physical and leisure activities, family care and divorce or remaining single until menopause's age for women due to the disease were reported for 110 RA patients. The results show that among patients who lost totally or partially their salary, the annual average costs is $2337.73 ± 1649.80 per patient, with a minimum and a maximum of $600 and $9630 respectively. As regards formal care, only 13 patients reported that they paid for care services; the annual average cost was $421.84 ± 261.34 with a minimum of $252 and a maximum of $1200. Statistical analysis revealed significant differences between annual lost salary and gender (p = .04) disease duration (p = .016) and sport/leisure activities cessation (p = .08). Besides the burden in terms of productivity loss and caregivers' costs, the intangible costs are considerable, especially those related to divorce and spinsterhood. These conclusions may contribute to the understanding of the socio-economic impact of the disease and to the development of strategies for better governance of RA in Morocco.

Systematic literature review of the humanistic and economic burden of focal epilepsy and primary generalized tonic-clonic seizures in adults.

This systematic literature review (SLR) assessed the humanistic and economic burden of focal epilepsy and primary generalized tonic-clonic seizures (PGTCS) in adults to evaluate these domains in both populations and identify evidence gaps to inform future research. A search was conducted on December 7, 2022, using MEDLINE and Embase to identify studies published from 2012 onwards reporting humanistic burden (patient-reported or caregiver-reported outcomes or utilities, qualitative evaluations), economic burden (productivity loss, caregiver and societal costs of epilepsy), and sleep-related outcomes. Of the 2830 citations identified, 136 were included. Most studies were in the focal epilepsy population; very few studies reported outcomes in the PGTCS population. The presence of epilepsy-specific instruments varied based on the domain evaluated. Epilepsy exerted considerable humanistic and economic burden. Indicators of poor disease control (e.g., high seizure frequency, resistance to anti-seizure medications, polypharmacy) increased epilepsy burden. Seizure frequency and type, disease severity, and polypharmacy also affected work productivity. Adults with epilepsy, particularly focal epilepsy, reported higher indirect costs, more sick days accrued, and early entry into retirement. Caregivers similarly reported high productivity loss and absenteeism related to caregiving duties. The results of this SLR highlight the high humanistic and economic burden of focal epilepsy and PGTCS, although limited data were available for the PGTCS population. The results include patient-reported outcome data specific to focal epilepsy and PGTCS, expanding the limited humanistic burden evidence identified in previous reviews, and show the effect of poor disease control on individuals' lives and as a driver of indirect costs. PLAIN LANGUAGE SUMMARY: Our systematic literature review identified studies that evaluated the impact of focal epilepsy and primary generalized tonic-clonic seizures on patients and their caregivers. We found that focal epilepsy negatively impacted patients' mental health and sleep and was associated with higher indirect costs and lower work productivity in people with more severe disease. The impact of primary generalized tonic-clonic seizures on patients was rarely reported, and future research is needed.

Foslevodopa/foscarbidopa (LDp/CDp) in advanced Parkinson’s Disease (aPD): demonstration of savings from a societal perspective in the UK

Aims In advanced Parkinson’s disease (aPD), adequate 24-hour control of OFF-time may not be achievable using oral/transdermal therapies. Clinical trials of foslevodopa/foscarbidopa (LDp/CDP) demonstrate meaningful reductions in OFF-time and OFF-related sleep disturbance in aPD. Previous analyses have only considered direct medical costs: this analysis considers a broader societal perspective (direct non-medical costs, informal care, loss of earnings, productivity, and tax). Methods Inputs for the societal impact model were taken from a cost-utility model comparing LDp/CDp with best medical treatment (BMT), accepted by the UK National Institute of Health and Care Excellence (NICE). Quintiles of normalized OFF-time across a 16-hour waking day in each treatment group were applied to literature-based estimates for direct medical, non-medical, and indirect costs. The resulting state-specific cost estimates were applied to the modelled aPD patient population. Results The model estimates the potential UK population for LDp/CDp at 17,505. Continuous 24-hour delivery of LDp/CDp results in greater time spent in OFF-time states 0–1 (0–4 hours of OFF-time/16-hour waking day) vs BMT alone. Net savings if all eligible patients receive LDp/CDp are £79.1 M in year 1, £235.4 M in year 2, rising to £262.2 M in year 3, declining to £222.9 M in year 4 and £153.7 M in year 5 as disease progresses and the efficacy of LDp/CDp declines. The estimated total net savings are £953 M after 5 years. Results are robust in scenario analyses (excluding costs of excessive sleepiness, earnings loss, productivity, and tax loss). Limitations A NICE-accepted model was used as the economic modelling basis for the societal impact model, however, much of the data was derived from Adelphi datasets, with the potential for inconsistent definitions. Conclusion When considered from a societal perspective, the use of LDp/CDp in aPD patients inadequately controlled on oral therapy is associated with net healthcare and societal annual savings of over £79.1 M vs BMT.

Assessing the economic burden of vision loss and irreversible legal blindness in Spain (2021–2030): a societal perspective

ObjectiveTo estimate the economic impact for the society, generated as a consequence of the onset of loss of vision and irreversible legal blindness, for the main ophthalmologic diseases in Spain: glaucoma, diabetic retinopathy (DR), diabetic macular edema (DME), age-related macular degeneration (AMD) and high myopia (HM).MethodsA cost analysis model was developed to estimate the economic burden of glaucoma, DR, DME, AMD and HM over a 10-year time horizon (2021-2030), from a societal perspective in Spain.The epidemiological and economic parameters used in the model were obtained through a literature review. Prevalence, incidence, and progression stages were used to establish the epidemiological flows. Annual costs per patient from publications were included and classified into direct healthcare, direct non-healthcare and indirect costs. Costs from other countries were converted based on purchasing-power-parity (€EUR, PPP). Epidemiological parameters about population and cost results were validated by a panel of experts.All costs were adjusted to euros, 2021 (€, 2021), and using the Consumer Price Index (CPI) of the last 10 years, extrapolated to 2030 euros (€, 2030).ResultsIt was estimated that the total population of patients with the main diseases pathologies (glaucoma, DR, DME, AMD and HM) will increase to 7.99 million patients by 2030, representing an increase of 103%.The total cost by 2030 of all pathologies would amount to 99.8 billion euros. Direct non-healthcare costs account for the largest item (44%), followed by loss of productivity costs (38%), and direct healthcare costs (18%). The pathologies with the highest cumulative costs will be glaucoma (€33.6 billion) and DME (€19.8 billion).The greatest increment costs compared to 2021 will likely be generated by pathologies related to diabetes mellitus, such as DR (703%) and DME (317%).ConclusionsKnowing the costs associated with the pathologies that generate loss of vision and irreversible legal blindness is essential to understand the socioeconomic impact associated with these pathologies. Furthermore, the high cost of treating these diseases makes necessary to coordinate efforts between administrations, together with the support of patient associations, to meet their needs.

Impaired Emotional Processing in Major Depressive Disorder. Accuracy versus Processing Speed

Depression is one of the most frequent conditions within the general population, ranking among the most burdensome in terms of public health expenses, productivity loss and social costs. The condition has been linked with cognitive deficits that may even continue in remission phases, social cognition being one potentially affected cognitive function. In our study, the Penn’s Emotional Acuity Test included in the CogtestTM battery was used to assess emotion recognition accuracy and processing speed. The Structured Clinical Interview for the Montgomery-Asberg Depression Rating Scale was used to assess the intensity of the symptomatology. A total of 48 depressed individual individuals (65% females), with a mean age of 49.8 ± 10.4 years, and 40 healthy controls (75% females), with a mean age of 35.2 ± 6.9 years were included. As compared to controls, depressive participants recorded significantly less correct answers (9.3 ± 3.8 vs. 11.2 ± 3.6, p = 0.019 – Student’s t test) and slower processing speeds (6795 ± 3366 vs. 4042 ± 1623, p 0.001 – Mann-Whitney U test) in emotion processing. Furthermore, symptom severity significantly influences only processing speed and not accuracy in emotion recognition tasks. Thus, we conclude that depressive individuals have a significant deficit in processing speed and accuracy when identifying the intensity of other peoples’ emotions.

The health and economic burden of breathlessness, Australia, 2019: a national survey.

To examine the impact of breathlessness on quality of life, health care use, productivity loss, and economic costs in Australia. National internet-based survey of Australian adults drawn from a web-based survey panel (National Breathlessness Survey). Australian adults (18 years or older), nationally representative by age group, gender, state of residence, and postcode-based socio-economic status (Index ofRelative Socioeconomic Disadvantage quintile), 13-30 October2019. Quality of life assessed with the EQ-5D 5-level version (EQ-5D-5L) and visual analogue scale (EQ-VAS), health care use, productivity loss, and societal cost, each by severity of breathlessness (modified Medical Research Council [mMRC] dyspnoea scale; mMRC grade 1: mild breathlessness; mMRC grades 2-4: clinically important breathlessness). Of 10 072 adults who completed the survey, mild breathlessness was reported by 3044 respondents (30.2%), and clinically important breathlessness by 961 (9.5%). The mean EQ-VAS score was 74.8 points (95% confidence interval [CI], 74.3-75.3 points) and the mean EQ-5D-5L score 0.846 (95% CI, 0.841-0.850) for respondents with mMRC grade 0 breathlessness; for each measure, the mean value declined with increasing severity of breathlessness (trends: each P < 0.001). Respondents with clinically important breathlessness were more likely than those with mild breathlessness to report non-urgent general practitioner visits, urgent general practitioner visits, and specialist visits (exception: mMRC scores of 4) during the preceding year. Among the 2839 respondents of working age, the likelihood of being employed declined with increasing breathlessness severity (mMRC grades 4 v 1: adjusted odds ratio, 0.34; 95% CI, 0.22-0.53). Adjusted mean annual societal cost per person was $1413 (95% CI, $1326-1501) for respondents with mMRC grade 1 breathlessness, $2065 (95% CI, $1766-2365) at mMRC grade 2, $1795 (95% CI, $1371-2218) at mMRC grade 3, and $2075 (95% CI, $1389-2762) at mMRC grade 4. Breathlessness imposes major burdens on individuals, the health care system, and the economy.