Prescription Drug Services Research Articles

Edukasi Pengenalan Apoteker Cilik dan DAGUSIBU Pada Siswa SDN 4 di Desa Bahomoleo Kecamatan Bungku Tengah Kabupaten Morowali

Pharmacists are pharmaceutical graduates who have completed pharmacy education and have taken the pharmacist oath, carrying out pharmaceutical work including the manufacturing, quality control of pharmaceutical preparations, security, procurement, storage, distribution, or dispensing of drugs, drug management, prescription drug services, drug information services, as well as drug development, drug substances, and traditional medicines. Currently, the empowerment of health education programs and health services at an early age, especially at the elementary school level, has begun to develop. Children need to receive a lot of information about various professions to increase their insights and stimulate their learning spirit. Based on this, education activities of Junior Pharmacists (Apoteker Cilik) and DAGUSIBU (acronym for Obtaining, Using, Storing, and Disposing of drugs properly) were conducted for elementary school students to introduce the pharmacist profession and educate them on obtaining, using, storing, and disposing of drugs properly. The education was conducted for 5th and 6th-grade students at SDN 4 Bungku Tengah, Morowali, Central Sulawesi, involving 60 students. The method of this activity was through PowerPoint presentations, selection of speakers and materials for Junior Pharmacists and DAGUSIBU, and evaluation of education through question and answer sessions on the material. The evaluation results showed a positive outcome, namely an increase in knowledge about the pharmacist profession and proper drug DAGUSIBU.

A Hard Pill to Swallow: Privacy Implications of Direct-to-Consumer Prescription Drug Services

A Hard Pill to Swallow: Privacy Implications of Direct-to-Consumer Prescription Drug Services

Clinical Outcomes and Cost Profiles for Cage and Allograft Anterior Cervical Discectomy and Fusion Procedures in the Adult Population: A Propensity Score-Matched Study.

Retrospective cohort study. To characterize the postoperative outcomes and economic costs of anterior cervical discectomy and fusion (ACDF) procedures using synthetic biomechanical intervertebral cage (BC) and structural allograft (SA) implants. ACDF is a common spine procedure that typically uses an SA or BC for the cervical fusion. Previous studies that compared the outcomes between the two implants were limited by small sample sizes, short-term postoperative outcomes, and procedures with single-level fusion. Adult patients who underwent an ACDF procedure in 2007-2016 were included. Patient records were extracted from MarketScan, a national registry that captures person-specific clinical utilization, expenditures, and enrollments across millions of inpatient, outpatient, and prescription drug services. Propensity-score matching (PSM) was employed to match the patient cohorts across demographic characteristics, comorbidities, and treatments. Of 110,911 patients, 65,151 (58.7%) received BC implants while 45,760 (41.3%) received SA implants. Patients who underwent BC surgeries had slightly higher reoperation rates within 1 year after the index ACDF procedure (3.3% vs. 3.0%, p=0.004), higher postoperative complication rates (4.9% vs. 4.6%, p=0.022), and higher 90-day readmission rates (4.9% vs. 4.4%, p =0.001). After PSM, the postoperative complication rates did not vary between the two cohorts (4.8% vs. 4.6%, p=0.369), although dysphagia (2.2% vs. 1.8%, p<0.001) and infection (0.3% vs. 0.2%, p=0.007) rates remained higher for the BC group. Other outcome differences, including readmission and reoperation, decreased. Physician's fees remained high for BC implantation procedures. We found marginal differences in clinical outcomes between BC and SA ACDF interventions in the largest published database cohort of adult ACDF surgeries. After adjusting for group-level differences in comorbidity burden and demographic characteristics, BC and SA ACDF surgeries showed similar clinical outcomes. Physician's fees, however, were higher for BC implantation procedures.

Clinical Outcomes and Cost Profiles for Cage and Allograft Anterior Cervical Discectomy and Fusion Procedures in the Adult Population: A Propensity Score-Matched Study.

Retrospective cohort study. To characterize the postoperative outcomes and economic costs of anterior cervical discectomy and fusion (ACDF) procedures using synthetic biomechanical intervertebral cage (BC) and structural allograft (SA) implants. ACDF is a common spine procedure that typically uses an SA or BC for the cervical fusion. Previous studies that compared the outcomes between the two implants were limited by small sample sizes, short-term postoperative outcomes, and procedures with single-level fusion. Adult patients who underwent an ACDF procedure in 2007-2016 were included. Patient records were extracted from MarketScan, a national registry that captures person-specific clinical utilization, expenditures, and enrollments across millions of inpatient, outpatient, and prescription drug services. Propensity-score matching (PSM) was employed to match the patient cohorts across demographic characteristics, comorbidities, and treatments. Of 110,911 patients, 65,151 (58.7%) received BC implants while 45,760 (41.3%) received SA implants. Patients who underwent BC surgeries had slightly higher reoperation rates within 1 year after the index ACDF procedure (3.3% vs. 3.0%, p=0.004), higher postoperative complication rates (4.9% vs. 4.6%, p=0.022), and higher 90-day readmission rates (4.9% vs. 4.4%, p =0.001). After PSM, the postoperative complication rates did not vary between the two cohorts (4.8% vs. 4.6%, p=0.369), although dysphagia (2.2% vs. 1.8%, p<0.001) and infection (0.3% vs. 0.2%, p=0.007) rates remained higher for the BC group. Other outcome differences, including readmission and reoperation, decreased. Physician's fees remained high for BC implantation procedures. We found marginal differences in clinical outcomes between BC and SA ACDF interventions in the largest published database cohort of adult ACDF surgeries. After adjusting for group-level differences in comorbidity burden and demographic characteristics, BC and SA ACDF surgeries showed similar clinical outcomes. Physician's fees, however, were higher for BC implantation procedures.

REVIEW: FACTORS AFFECTING WAITING TIME FOR OUTPATIENT PRESCRIPTION DRUGS IN HOSPITALS

Waiting is an activity which frequently causes uncomfortable feelings, particularly in health services. Patients who attend to health care facilities such as hospitals, are eager to receive good and quality health care system without having to wait for a long time. The quality of pharmaceutical services in hospitals influences the level of patient satisfaction with the services provided by pharmacy staff in drug services to patients. There are still numerous waiting times for outpatient prescription drug services in Indonesian hospitals which do not fulfill minimum service standards. Thus, the objective of this review articles is to determine the factors affecting the waiting time for outpatient prescription services at the hospital. This review was conducted by employing the literature review method with a sample size of 12 articles. The results acquired are several factors influencing the waiting time for outpatient drugs in hospitals encompassing: receiving prescriptions, providing etiquette, working on prescription drug concoctions, submitting drugs, facilities and infrastructure, human resources, hospital management information systems and standard operating procedures. Based on the complexity of the issue which was found in this review, the most dominant and influencing factors on the waiting time of outpatient drugs at the hospital are prescription reception, providing etiquette, preparation of prescription drugs, and submitting drugs.

Faktor yang Memengaruhi Waktu Tunggu Pelayanan Resep Rawat Jalan di Instalasi Farmasi Rumah Sakit: Sistematik Review

Pharmacy services are one of the services that must be minimal in a hospital. One indicator to measure pharmaceutical services that meet standards is the waiting time for services, especially prescription drugs. Waiting time for services is one of the most important concerns because it affects patient satisfaction. The reality is that there are still waiting times for prescription drugs that do not meet the minimum service standards in hospitals. This research aims to determine the factors that influence waiting times for outpatient prescription services in hospital pharmacy installations. This study uses a descriptive approach. This study uses a systematic review. Several factors influence the waiting time for prescription drug services in hospital pharmacy installations, namely the lack of human resources in pharmaceutical installations, the completeness of patient files that have not been fulfilled, the lack of availability of drugs prescribed by doctors, the use of electronic and manual prescriptions together, the number of prescription doctors not in National Forum, the number of prescriptions that ask for concoction drugs, information systems in pharmaceutical installations that are less than optimal, doctors who are difficult to contact when prescriptions are difficult to read, space is inadequate. Hospitals need to pay attention to these factors so that they can maintain the quality of hospital services.

Can Redesign SOP Oriented Time Standardization and Authorization According to Job Description to Waiting Time be a Solution?

Pharmacy installation is part of the service system that influences hospital quality standards, one of which is waiting time for pharmaceutical service. The waiting time at the Outpatient Pharmacy Installation of Hospital X exceeds the Hospital Minimum Service Standard and Hospital Quality Indicators, which is 50 minutes. This study aims to determine the root of the problem and the solution to the long waiting time for prescription drug services at Outpatient Pharmacy installations. This research is a case study with a search method for identifying the root of the problem, determining alternative solutions, and prioritizing the main solution. The long waiting time for finished drug services is caused by the lack of shifts of workers when poly peak times, the absence of flow information and appropriate SOPs when pharmaceutical prescription services run concurrently, and non-compliance by pharmacists with SOPs for pharmaceutical services. The main solution was to create flow information and a new SOP for outpatient prescription services.

Studi Penjaminan Mutu (Quality Assurance) Dalam Pelayanan Kefarmasian di Apotek

Low Quality Assurance in Pharmacy Award Ipilo Gorontalo include pharmaceutical, security, procurement, storage, and distribution or drug delivery, drug management, on a prescription drug services, drug information services, as well as drug development, medicinal materials and traditional medicine. The impact of the implementation of activities in the pharmacy pharmacy services Anugerah Ipilo errors may occur treatment (medication errors) in the service process. Quality Assurance (QA) is one dimension that is used in the measurement of quality of service, where the application of QA in pharmacies Ipilo Award aims to provide quality assurance of pharmaceutical products and the quality of services provided to patients. This research is descriptive, the source of primary data obtained from the questionnaires with QA standard indicator framework on pharmaceutical services in pharmacies Anugerah Ipilo. The assessment results then classified based on criteria appropriate, relatively appropriate and not appropriate. The results showed that the Quality Assurance (Quality Assurance) on the quality of the equipment and the safety assurance of Pharmaceutical Services in Pharmacy Award Ipilo there are seven questions (70%) had a very good criteria, three questions (30%) had a good criterion. Quality Assurance (Quality Assurance) on the Process of Pharmaceutical Services in Pharmacy Award Ipilo there are 4 questions (40%) had a very good criteria, one question (10%) had a pretty good and 5 questions (50%) had less good. Pharmacies merely focused on the administration and management of medication alone is not the overall pharmacy services, in addition because the pharmacy Anugerah Ipilo prefer the function of the economy (business) rather than its social function, which pharmacies are required to gain / profit in business.

GAMBARAN PERSEDIAAN OBAT DI APOTEK NIAS MEDIKA DENGAN ANALISIS ABC BERDASARKAN RESEP MASUK PERIODE JANUARI-MEI 2020

Pharmacy is a pharmaceutical service facility where pharmacy practices are carried out by pharmacists, namely manufacturing including quality control of pharmaceutical preparations, security, procurement, storage and distribution or distribution of drugs, drug management, prescription drug services, drug information services, and drug development services, drug ingredients and traditional medicine One of the scopes in the management of health services is logistics management, which is a field of management whose specific task is to deal with logistics. Pharmacy nias medika there was no specific arrangement for the procurement of drugs with certain methods so that often there is a vacuum of medicine one of which is for drugs contained in a doctor's prescription that goes to the nias medika pharmacy. For this reason, it was necessary to control drug inventory using certain methods, one of which was by using ABC analysis. The type of research was descriptive and quantitative, based on the prescription entry by recording the name of the drug, the number of drugs, and the unit price of the drug and then processed using data analysis during January-May 2020. The results showed that there were 160 types of drugs based on prescription entry into the drugstore nias medika. With 32 types (20% ) drugs classified as group A with an investment value of 69.68% with laroton drugs which are in the highest position 47 types (29.37%) drugs classified as group B with an investment value of 20.25%, while 81 types (50, 63%) the drugs belong to group C with a total investment of 10.07%.

Edukasi Gema Cermat golongan obat keras pada guru dan orang tua siswa SDN 11 Pangkalan Baru, Bangka Tengah

A pharmacist is a profession that can optimize pharmaceutical services for the community. As part of health workers and the front line for drug distribution to the community, pharmacists must contribute significantly to socializing Gema Cermat, especially for prescription drugs that are often purchased without a doctor's prescription. Pharmacies can only submit prescription drugs based on a doctor's prescription. This provision aims to prevent the illegal use or drug means of this group. The phenomenon of irregularity in the circulation of hard drugs in prescription drug services without a prescription in pharmacies cannot be separate from the community itself. The tendency of people who want to do self-medication encourages the rampant phenomenon of deviance. This activity aims to see an increase in knowledge of the prescription drugs class through Gema Cermat education for teachers and parents of SDN 11 Pangkalan Baru, Central Bangka Regency. The activity was carried out in the classroom at SDN 11 Pangkalan Baru, carried out through a pre-test and post-test using a questionnaire. The results obtained showed that the knowledge of the participants was 62.50%. There is a significant difference with a value of 0.000, which means an increase in understanding parents' and teachers' knowledge before and after Gema Cermat education about prescription drugs.

Differences in the Receipt of Low-Value Services Between Publicly and Privately Insured Children.

Children frequently receive low-value services that do not improve health, but it is unknown whether the receipt of these services differs between publicly and privately insured children. We analyzed 2013-2014 Medicaid Analytic eXtract and IBM MarketScan Commercial Claims and Encounters databases. Using 20 measures of low-value care (6 diagnostic testing measures, 5 imaging measures, and 9 prescription drug measures), we compared the proportion of publicly and privately insured children in 12 states who received low-value services at least once or twice in 2014; the proportion of publicly and privately insured children who received low-value diagnostic tests, imaging tests, and prescription drugs at least once; and the proportion of publicly and privately insured children eligible for each measure who received the service at least once. Among 6 951 556 publicly insured children and 1 647 946 privately insured children, respectively, 11.0% and 8.9% received low-value services at least once, 3.9% and 2.8% received low-value services at least twice, 3.2% and 3.8% received low-value diagnostic tests at least once, 0.4% and 0.4% received low-value imaging tests at least once, and 8.4% and 5.5% received low-value prescription drug services at least once. Differences in the proportion of eligible children receiving each service were typically small (median difference among 20 measures, public minus private: +0.3 percentage points). In 2014, 1 in 9 publicly insured and 1 in 11 privately insured children received low-value services. Differences between populations were modest overall, suggesting that wasteful care is not highly associated with payer type. Efforts to reduce this care should target all populations regardless of payer mix.

IMPLEMENTATION OF THEORY OF CONSTRAINT ON WAITING TIME OF PRESCRIPTION SERVICE

Background: Medical services provided within the Indonesian National Health Insurance programme or Jaminan Kesehatan Nasional (JKN) have been continuously improving for the past several years. One of them is pharmaceutical service in the Pharmacy Store for JKN patients at one hospital with the highest number of visitors in Surabaya. However, one preliminary study points out that patient waiting time for prescription services in the Pharmacy Store for JKN patients is longer than the national standard.Aim: This study aims to investigate the causes for such delay in prescription services as one of pharmaceutical services in the Pharmacy Store for JKN patients at one hospital in Surabaya.Methods: This is an observational descriptive research with a reference to the Theory of Constraints. The research was conducted from August 2017 to February 2018. The data were obtained from observations, interviews with one pharmacist and four pharmacy technicians, and waiting time for prescription service. Results: The study finds that the longer waiting time is caused by inefficient division of jobs and workers and the lack of worker’s discipline to work on time. The behaviors and habits of pharmacist and pharmacy technicians in drug preparation greatly affect patient waiting time, since the services still highly depend on manual human labor.Conclusions: Patient experience in prescription drug services is significantly influenced by the time spent waiting for the service provider. This study provides useful insights about constraint identification in pharmaceutical services, especially waiting time.Keywords: Pharmaceutical service, Theory of Constraints, Patient waiting time.

Analisis Waktu Tunggu Pelayanan Resep di Puskesmas Pasir Panjang Kota Kupang Bulan April Tahun 2018

Salah satu indikator pelayanan farmasi di puskesmas adalah waktu tunggu. Waktu tunggu pelayanan obat adalah tenggang waktu mulai pasien menyerahkan resep sampai dengan pasien menerima obat. Penelitian ini bertujuan untuk menganalisa waktu tunggu pelayanan resep di Puskesmas Pasir Panjang. Penelitian ini merupakan penelitian non eksperimental dengan rancangan deskriptif (penelitian survey) terhadap pasien rawat jalan di Puskesmas Pasir Panjang dan pengambilan sampel dengan menggunakan metode purposive sampling. Waktu penelitian pada bulan april 2018. Hasil yang diperoleh kemudian di lakukan analisis terhadap kesesuaian waktu tunggu resep obat jadi dan obat racikan dengan standar pelayanan minimal dan indikator pelayanan farmasi di puskesmas kategori lama waktu tunggu. Jumlah resep dalam penelitian ini sebanyak 353 resep dengan rincian 267 resep obat jadi dan 86 resep racikan. Waktu tunggu rata-rata obat jadi adalah 11,38 menit dan rata-rata waktu tunggu obat racikan adalah 13.45 menit. Hal tersebut sudah sesuai dengan indikator pelayanan farmasi di puskesmas dan standar pelayanan minimal yang ditetapkan oleh KEPMENKES No 129/Menkes/SK/II/2008 tentang pelayanan resep obat jadi yaitu ≤ 30 menit dan pelayanan farmasi untuk obat racik yaitu ≤ 60 menit.

CMS releases medication review performance data as part of Medicare Star ratings.

A total of 83 programs that offer prescription drug services under Medicare Part C or D earned top marks for performing comprehensive medication reviews (CMRs) for plan participants, according to the latest Star ratings data from the Centers for Medicare and Medicaid Services (CMS). The Star ratings, released in October, are based on performance data submitted to CMS during 2016. This is the second year that CMR data have been used to assess the quality of the medication therapy management (MTM) services provided to Medicare beneficiaries [see January 15, 2017, AJHP News]. The MTM assessment affects both standalone Medicare Part D plans and Medicare Advantage (Part C) coordinated care programs, which include health maintenance organizations, preferred provider organizations, and special needs plans. The CMR completion rate applies to Medicare beneficiaries who qualify for MTM services and opt to receive them. At least 1 CMR must be completed during the reporting period to satisfy the performance measure.

Spillover Effects of Community Uninsurance on Working-age Adults and Seniors

: Previous research suggests, but does not definitively establish, that a high level of uninsurance in a community may negatively affect access to and quality of health care for insured persons. : To assess the effect of the level of uninsurance in a community on access to and satisfaction with care-an important dimension of quality-among insured persons. : The 1996 to 2006 Medical Expenditure Panel Survey Household Component data linked to data from the Current Population Survey, Area Resource File, and the InterStudy Competitive Edge. Analyses include 86,928 insured adult respondents living in approximately 200 large metropolitan areas. : Measures of whether an individual had a usual source of care, had any delay/difficulty obtaining needed care, used office-based services, used prescription drug services, and used any medical services, and measures of satisfaction with care. : Among privately insured adults, a higher community uninsurance rate resulted in a lower probability of having a usual source of care, having an office-based visit, having any medical expenditures, and reporting being satisfied with the quality of care provided by the usual source of care. A higher community uninsurance rate also led to a higher probability of reporting difficulty obtaining needed care. Among Medicare enrollees, a higher community uninsurance rate resulted in lower reported satisfaction with care and higher probability of experiencing difficulty or delay in getting needed care. : Our results suggest substantial spillover effects of the community uninsurance rate on access to and satisfaction with health care among insured working-age adults and seniors. Consequently, new efforts to address the problem of the uninsured may bring significant benefits to persons who already have insurance.

Psychotropic Medications for Patients With Bipolar Disorder in the United States: Polytherapy and Adherence

Psychotropic Medications for Patients With Bipolar Disorder in the United States: Polytherapy and Adherence

Healthcare Costs of Acute and Chronic Pain Associated with a Diagnosis of Herpes Zoster

To determine the healthcare costs of acute and chronic pain associated with herpes zoster. Retrospective cohort analysis. Inpatient and outpatient care. Patients were selected from Medicare, commercial insurance, and Medicaid claims databases if they had a diagnosis of herpes zoster or postherpetic neuralgia (PHN) or were prescribed analgesics after a diagnosis of herpes zoster (possible PHN) and were matched to controls for demographic and clinical factors using propensity scores. One-year excess healthcare expenditures attributable to herpes zoster pain or PHN were calculated for inpatient, outpatient, and prescription drug services. For the Medicare cohort, the average excess cost per patient was $1,300 in the year after a diagnosis of herpes zoster with 30 days or fewer of analgesic use and ranged from $2,200 to $2,300 per patient with PHN or possible PHN. Patients with possible PHN were 53% more prevalent than patients with PHN in the Medicare cohort and accounted for half of all excess expenditures. Findings were similar in the younger cohorts with commercial insurance and Medicaid except that costs attributable to PHN and possible PHN were higher, and patients with possible PHN were three to five times as prevalent as patients with PHN. Healthcare costs associated with PHN were substantially greater than those associated with herpes zoster pain that resolved within 30 days. The data suggest that as many as 80% of patients with PHN may not be diagnosed with PHN and that these patients account for at least half of PHN expenditures.

Global Marketing of Cholesterol-Lowering Drugs as Therapy

Pharmaceutical marketing services (PMS) are a key component of pharmaceutical companies' marketing strategies in that they create links between the pharmaceutical company and the physician. They are is also a link between physician and patients locally and globally. PMS discussed in this paper provide various services from tangible to intangible products in order to increase the physicians and pharmacists prescribing activities of their treatment modalities. Given the high cost of recruiting, training, and supporting PMS global marketing efforts, it is important for PMS channels to understand the significance of pharmaceutical multinational companies to ascribe to prescription drug services provided in Thailand. This created the unique marketing environment for the pharmaceutical companies. This study examines whether there is a gap in the existing cholesterol-lowering medication prescribed by physicians in Thailand and the newly introduced brand to the U.S. market. The degree of the new product adoption is analyzed through physician prescription frequency and records. Results of the study indicate there is significant improvement in the health conditions of the users of the new cholesterol medication among Thailand patients. Physicians in Thailand were, however, faced with competing brands in the market due to aggressiveness of advertising and promotion by multinational pharmaceutical marketing and manufacturers Associations. Perceived value and benefit to users were significant outcome of the study. More diagnostic and prescriptive research is recommended to cover Southeast Asia and other parts of the developing countries.

Comorbidities and Costs of Adult Patients Diagnosed with Attention-Deficit Hyperactivity Disorder

The purpose of this retrospective study was to examine the prevalence of comorbidities, resource use, direct medical costs, and the costs associated with missed work for adults diagnosed with attention-deficit hyperactivity disorder (ADHD). From a large claims database that captures inpatient, outpatient and prescription drug services, individuals diagnosed with ADHD between the years 1999 and 2001 were retrospectively identified. The ADHD cohort (n = 2252) were matched with a non-ADHD cohort (n = 2252) on a 1 : 1 ratio, based upon age, gender, metropolitan statistical area and type of insurance coverage. The ADHD cohort was compared with the non-ADHD cohort for differences in comorbidities and direct medical costs (inpatient, outpatient and prescription drug costs) using year 2001 prices. Using data from six Fortune 200 employers, time missed from work and costs associated with absenteeism, short-term disability and worker's compensation was examined for a subsample (n = 354) of the employees diagnosed with ADHD. Chi-square and t-statistics were used to compare the ADHD population with the control group with regards to comorbidites and service use. Analysis of covariance and multivariate regressions were used to examine differences in days missed from work, direct medical costs and costs associated with missed work. Adults diagnosed with ADHD were significantly more likely to have a comorbid diagnosis of asthma (p = 0.0014), anxiety (p < 0.0001), bipolar disorder (p < 0.0001), depression (p < 0.0001), drug or alcohol abuse (p < 0.0001), antisocial disorder (p = 0.0081) or oppositional disorder (p = 0.0022) compared with the control group. Controlling for the impact of comorbidities, adults diagnosed with ADHD had significantly higher outpatient costs (USD 3009 vs USD 1492; p < 0.0001), inpatient costs (USD 1259 vs USD 514; p < 0.0001), prescription drug costs (USD 1673 vs USD 1008; p < 0.0001), and total medical costs (USD 5651 vs USD 2771; p < 0.0001) compared with the non-ADHD cohort. Employees diagnosed with ADHD missed significantly more days due to 'unofficial' absences (4.33 days vs 1.13 days; p < 0.0001). The results demonstrate that adults diagnosed with ADHD have a higher prevalence of comorbidities, higher medical costs and more absences than matched individuals without ADHD. These findings suggest that there may be an opportunity for the effective treatment of ADHD to lead to cost-offsets.

The Medical Costs of Migraine and Comorbid Anxiety and Depression

To examine the direct medical costs associated with migraine, when diagnosed alone and in conjunction with anxiety and/or depression in adults and children. Migraine is a common disorder that can often be accompanied by comorbid anxiety and/or depression. Given the prevalence of migraine and the likelihood for comorbid conditions, it is not surprising that migraine is extremely costly for society. Migraine cohorts were identified in a 1999-2000 database capturing inpatient, outpatient, and prescription drug services from approximately 45 large employers. Four cohorts of adults (migraine only, migraine and anxiety, migraine and depression, migraine and both conditions), and two cohorts of children (migraine only, migraine and anxiety and/or depression), were compared to respective "healthy" cohorts. t-statistics were used to capture differences in costs between the migraine cohorts and the healthy cohorts whereas ANOVA was used to test for differences in costs between subgroups of migraine sufferers. Compared to nonmigraineurs, adults and children with migraine had significantly higher total direct medical costs in all examined categories (P < .0001) (7,089 US Dollars vs US Dollars adults; 4,272 US Dollars vs 1,400 US Dollars children). For adults, the presence of depression and/or anxiety along with migraine equated to significantly greater total direct medical costs when compared to their matched healthy cohorts (P < .0001) (12,642 US Dollars vs 5,179 US Dollars anxiety; 11,290 US Dollars vs 3,135 US Dollars depression). Children with migraine and either anxiety or depression (or both) incurred an average of 9,875 US Dollars in total direct medical costs as compared with only 1,165 US Dollars for healthy comparators. For children and adults, the presence of comorbid anxiety or depression was associated with significantly higher medical costs when compared to migraine alone (P < .0001). This analysis quantifies the economic impact of a migraine diagnosis for both adults and children. The results of this analysis demonstrate that individuals identified as migraineurs have significantly higher medical costs than healthy comparators, with or without comorbid anxiety and/or depression. This study also suggests that clinicians should be aware that while proper treatment of migraine with effective acute and prophylactic therapy is important, attention must also be directed to comorbid conditions.