Total Annual Direct Medical Costs Research Articles

Burden of narcolepsy in Japan: A health claims database study evaluating direct medical costs and comorbidities

ObjectiveThis study aimed to determine the burden of narcolepsy in terms of direct medical costs and comorbidities and compare it with the respective burden of schizophrenia, epilepsy, and ulcerative colitis as controls. MethodsPatients diagnosed with narcolepsy (at least once based on the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, code G47.4) between April 2017 and March 2022 were identified on the health insurance claims database compiled by JMDC Inc. Patients with schizophrenia (F20), epilepsy (G40), and ulcerative colitis (K51) were matched as controls. Direct medical costs (including inpatient, outpatient, and medication costs) and comorbidities were analyzed. ResultsWe identified 4,594 patients with narcolepsy (≥18 years), 18,376 with schizophrenia, 18,376 with epilepsy, and 4,594 with ulcerative colitis. The total annual direct medical cost per person with narcolepsy was 349,188 JPY. The cost for narcolepsy was less than that for schizophrenia, epilepsy, and ulcerative colitis. Several comorbidities, such as sleep apnea, attention deficit hyperactivity disorder (ADHD), and obesity were more prevalent in the narcolepsy group. ConclusionsThe total direct cost for narcolepsy was approximately three times higher than the national medical expense for people aged 15–44 years (122,000 JPY in 2020), but lower than the total cost for all control diseases. The patients with narcolepsy were also likely to have comorbidities that affected their burden. These findings can contribute to future discussions on medical expense assistance programs for patients with narcolepsy.

Lyme borreliosis in Belgium: a cost-of-illness analysis

BackgroundLyme borreliosis (LB) is the most common tick-borne disease in Europe and North America, yet its economic burden remains largely unknown. This study aimed to estimate the economic cost associated with the different clinical manifestations of LB in Belgium.MethodsAn incidence approach and societal perspective were used to estimate the total cost-of-illness for LB in Belgium. Costs were calculated for patients with erythema migrans (EM) or disseminated/late LB, including patients who developed post-treatment Lyme disease syndrome (PTLDS). Direct medical, direct non-medical (transportation & paid help) and indirect non-medical costs (productivity losses) were included in the analysis. Ambulatory cost data were collected through a prospective cohort study from June 2016 to March 2020, in which patients with LB were followed up 6 to 12 months after diagnosis. Hospitalization costs were retrieved from the Minimal Clinical Data registry, a mandatory registry for all Belgian hospitals, linked to the Minimal Financial Data registry. Costs were expressed in 2019 euros.ResultsThe total annual cost associated with clinical manifestations of LB in Belgium was estimated at €5.59 million (95% UI 3.82–7.98). Of these, €3.44 million (95% UI 2.05–5.48) or 62% was related to disseminated/late LB diagnoses and €2.15 million (95% UI 1.30–3.26) to EM. In general, direct medical costs and productivity losses accounted for 49.8% and 46.4% of the total costs, respectively, while direct non-medical costs accounted for only 3.8%. The estimated mean costs were €193 per EM patient and €5,148 per disseminated/late LB patient. While patients with PTLDS seemed to have somewhat higher costs compared to patients without PTLDS, the number of patients was too small to have representative estimates.ConclusionsWe estimate the total annual direct medical costs, direct non-medical and indirect non-medical costs associated with LB to exceed €5.5 million per year, almost evenly distributed between EM (40%) and disseminated/late LB (60%). EM costs 26 times less per patient but occurs also 16 times more frequently than disseminated/late LB. The cost burden remains limited by comparison to other infectious diseases due to the relative lower incidence.

Cost-of-disease of Heart Failure in Turkey: A Delphi Panel-based Analysis of Direct and Indirect Costs.

Background:Heart failure (HF) is considered a significant public health issue with a substantial and growing epidemiologic and economic burden in relation to longer life expectancy and aging global population.Aims:To determine cost-of-disease of heart failure (HF) in Turkey from the payer perspective.Study Design:Cross-sectional cost of disease study.Methods:In this cost-of-disease study, annual direct and indirect costs of management of HF were determined based on epidemiological, clinical and lost productivity inputs provided by a Delphi panel consisted of 11 experts in HF with respect to ejection fraction (EF) status (HF patients with reduced EF (HFrEF), mid-range EF (HFmrEF) and preserved EF (HFpEF)) and New York Heart Association (NYHA) classification. Direct medical costs included cost items on outpatient management, inpatient management, medications, and non-pharmaceutical treatments. Indirect cost was calculated based on the lost productivity due to absenteeism and presenteeism.Results:51.4%, 19.5%, and 29.1% of the patients were estimated to be HFrEF, HFmrEF, and HFpEF patients, respectively. The total annual direct medical cost per patient was $887 and non-pharmaceutical treatments ($373, 42.1%) were the major direct cost driver. Since an estimated nationwide number of HF patients is 1,128,000 in 2021, the total annual national economic burden of HF is estimated to be $1 billion in 2021. The direct medical cost was higher in patients with HFrEF than in those with HFmrEF or HFpEF ($1,147 vs. $555 and $649, respectively). Average indirect cost per patient was calculated to be $3,386 and was similar across HFrEF, HFmrEF and HFpEF groups, but increased with advanced NYHA stage.Conclusion:Our findings confirm the substantial economic burden of HF in terms of both direct and indirect costs and indicate that the non-pharmaceutical cost is the major direct medical cost driver in HF management, regardless of the EF status of HF patients.

Direct Medical Cost of Pediatric Asthma in Jordan: A Cost-of-Illness Retrospective Cohort Study

ObjectivesThis study aimed to estimate and analyze the direct medical costs of pediatric patients with asthma in Jordan from the provider’s perspective. MethodsA retrospective analysis of a cohort of pediatric patients with asthma treated during 3 years in a teaching hospital was conducted. The prevalence-based, bottom-up approach has been used to estimate the cost-of-illness of asthma. The total annual direct medical cost was stratified by control status and the severity of asthma. ResultsThe total annual cost for whole the sample (N = 613) in the average of 3 years was Jordanian dinar (JD) 110 874 (US$ 156 382). Pediatrics with uncontrolled asthma had significantly higher annual total direct medical costs than partly controlled and controlled asthma (JD 396 [US$ 558], JD 258 [US$ 364], and JD 150 [US$ 211], respectively) (P < .001). The annual total direct medical cost for severe asthma (JD 455 [US$ 641]) was significantly higher than moderate, mild, and intermittent (JD 176 [US$ 248], JD 35 [US$ 49], and JD 7 [US$ 9.8], respectively) (P < .001). Medications were the most expensive healthcare resource used, accounting for 79.8% of the total cost, followed by outpatient clinic visits and hospitalizations. ConclusionsHealthcare sources utilization and direct medical costs of asthma were highly related to disease severity and control status of the disease. Health policies targeting the achievement of better and stricter asthma control will play a crucial role in the reduction of the economic burden of asthma for society and the patient.

Health care resources utilization and costs associated with different clinical stages of chronic hepatitis B in Egypt

IntroductionChronic hepatitis B (CHB) is associated with many serious clinical and social consequences. Despite Egypt being classified as a country of low endemicity, the infection is associated with a 15–25% risk of premature death from liver cancer or end-stage liver disease. The national committee of treatment and control of viral hepatitis has already offered a high-quality service for the diagnosis and treatment of CHB on a free basis. The current study aims to estimate the health care resources utilization and the annual direct medical cost associated with different clinical stages of CHB-related disease in Egypt.MethodologyThe data was retrieved through record review for three months in the General Administration of Hepatitis Viruses Control, Egypt. Then, the data was extrapolated to the population level by multiplying the prevalence in Egypt with a focus on the productive age groups (25–59 years).ResultsThe cost and utilization of different health care resources increase with disease progression. The total annual direct medical costs due to CHB in Egypt is 21.3 L.E. Billion (4.7 Int$ billion/year) for the management of estimated 1,420,700 CHB patients. The direct medical costs among the productive age group (25–59 years) constitute more than half of the total cost (57%). The highest disease burden is encountered among (25–29 years) age group; 2.695 L.E. billion (0.59 Int$ billion/year). Despite liver transplantation phase being associated with the highest annual cost/patient, the number of patients in this stage is the lowest. Then, it only constitutes 0.04% of the disease direct medical cost in the country. The chronic hepatitis clinical stage constitutes 57.26% of the disease direct medical cost in Egypt’s working age group.ConclusionStrengthening the preventive and control measures is mandatory to alleviate the disease’s direct medical costs. Close monitoring of the chronic hepatitis stage is mandatory to prevent disease progression. Enhancement of vaccination efforts will lower the disease prevalence and its cost. The universal health insurance system which is gradually implemented in Egypt nowadays will be a cornerstone in relieving the economic stresses by allowing more access to high-quality health care services.

Economic burden of lung cancer in Turkey: a cost of illness study from payer perspective

BackgroundThis study was designed to estimate economic burden of lung cancer in Turkey from payer perspective based on expert panel opinion on practice patterns in clinical practice.MethodsIn this cost of illness study, direct medical cost was calculated based on cost items related to outpatient visits, laboratory and radiological tests, hospitalizations/interventions, drug treatment, adverse events and metastasis. Indirect cost was calculated based on lost productivity due to early retirement, morbidity and premature death resulting from the illness, the value of lost productivity due to time spent by family caregivers and cost of formal caregivers.ResultsCost analysis revealed the total per patient annual direct medical cost for small cell lung cancer to be €8772), for non-small-cell lung cancer to be €10,167. Total annual direct medical cost was €497.9 million, total annual indirect medical cost was €1.1 billion and total economic burden of lung cancer was €1.6 billion. Hospitalization/interventions (41%) and indirect costs (68.6%) were the major cost drivers for total direct costs and the overall economic burden of lung cancer, respectively.ConclusionsOur findings indicate per patient direct medical costs of small cell lung cancer and non-small-cell lung cancer to be substantial and comparable, indicating the substantial economic burden of lung cancer in terms of both direct and indirect costs. Our findings indicate that hospitalization/interventions cost item and indirect costs were the major cost drivers for total direct costs and the overall economic burden of lung cancer, respectively. Our findings emphasize the potential role of improved cancer prevention and early diagnosis strategies, by enabling cost savings related to drug treatment and metastasis management cost items, in sustainability of cancer treatments.

The Economic Impact of Extensor Tendon Lacerations of the Hand in the United States.

Extensor tendon lacerations (ETLs) are a common and debilitating injury for thousands of Americans annually. No study has attempted to estimate their economic impact. The objective of this study was to estimate the economic impact of ETLs in America. The cost of ETLs to society was estimated using a validated prevalence-based cost of illness model. The primary cohort was defined as all patients with complete ETLs in the United States undergoing surgical repair and, secondarily, the imputed number of patients requiring reoperation within 1 year. For these groups, both direct and indirect costs (lost income, missed workdays, and disability payments) were measured. The total annual direct medical costs amounted to $14,095.28 per injury and 100,000 population. The total annual indirect labor costs were found to range between $80,842.90 and $150,136.82 per injury and 100,000 population. Hence, the estimated total costs of ETLs are $307 million per year in the United States alone and could be as high as $531 million annually depending on the effects of worker absenteeism on the core production-based industries. Extensor tendon lacerations incur a significant economic burden to our health care system and are more costly when compared with many other common hand conditions. Specifically, indirect costs are the major contributor toward the total cost these injuries incur on society, accounting for an upward of 91% of the total cost. These results suggest efforts be focused on improving rehabilitation protocols and treatments. Level II-economic and decision analyses.

Direct medical costs of non-alcoholic fatty liver disease in Catalonia at the hospital level: a retrospective multicenter study

ABSTRACT Background The prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing worldwide, which is expected to correlate with significant medical and social costs. This study aimed to evaluate the clinical and economic burden of NAFLD in Catalonia at the hospital level. Methods Records of all patients diagnosed with NAFLD and treated in Catalan hospitals between the year 2007 and 2018 were extracted from a patient-level healthcare database. Results Admission files of 24,172 individual patients were obtained. High comorbidity rates were found across age groups, with a mean Charlson Comorbidity Index of 5.1. In-hospital mortality rate increased over the study period, and was associated to a higher comorbidity rate. Disease complexity was increased in this patient group, which is associated with larger medical costs. The mean annual cost per patient was €4073, with a total annual direct medical cost of €27,370,827. The greatest portion of costs was attributed to surgical interventions (€14,429,336). Conclusions The high level of comorbidity and disease complexity in this patient group versus the general population is expected to correlate with a more intensive use of medical resources and costs. This study provides novel data to inform resource allocation and disease management decisions at the regional level.

Epidemiology and management of parathyroid gland disorders in Spain over 15 years: A retrospective multicentre analysis.

Parathyroid gland disorders are rare conditions with an incidence that displays great variability among populations. Its direct influence in calcium homeostasis originates variable symptoms that affect bone remodelling among other processes. This study aimed to provide data on the epidemiology and characteristics of patients admitted with these disorders in Spain between 2003 and 2017, and to analyse disease management and direct medical costs. Medical records in which a disorder of the parathyroid gland was registered as the admission motive were extracted from a nationwide hospital-discharge database via the Spanish Ministry of Health. Records from 12,903 patients were obtained, with predominance of female patients (74.70%) and of admissions due to hyperparathyroidism (90.23%). The number of patients admitted per year increased over the study period along the incidence of these disorders. The year 2017 incidence of hyperparathyroidism was 2.95 per 10,000, 4.03 per 10,000 in females and 1.37 in males; the same year, the incidence of hypoparathyroidism was 0.17 per 10,000. Length of hospital stay was significantly extended in patients with hypoparathyroidism (7.16 days), admitted mostly due to emergencies. Heart failure was diagnosed in more than 20% of admissions in patients with secondary and tertiary hyperparathyroidism and hypoparathyroidism, while this last group displayed the highest levels of mineral metabolism disruption. Parathyroidectomy was performed in 78.95% of all admissions for primary hyperparathyroidism. The total annual direct medical cost parathyroid gland disorders has increased over the study period, due to the increase of the costs associated to hyperparathyroidism, whereas the cost per patient remained relatively stable, with an average of €3,748, €3,430 and €3,737 for patients with hyperparathyroidism, hypoparathyroidism and other disorders of the parathyroid gland, respectively. This study provides novel data to extend the scarce available knowledge on parathyroid gland disorders’ epidemiology and management in Spain.

Patient and economic burdens of postherpetic neuralgia in China.

BackgroundLittle is known about the patient-reported and economic burdens of postherpetic neuralgia (PHN) among China’s urban population.MethodsThis noninterventional study was conducted among adults ≥40 years with PHN who were seeking medical care at eight urban hospitals in China. At one study site, patients completed a questionnaire evaluating the patient-reported disease burden (N=185). The questionnaire consisted of validated patient-reported outcomes including the Brief Pain Inventory (BPI), 5-dimension, 3-level EuroQol (EQ-5D-3L), Medical Outcomes Study Sleep Scale, and Work Productivity and Activity Impairment Questionnaire for Specific Health Problems. Questions on non-pharmacologic therapy and out-of-pocket (OOP) expenses were also included. At all study sites, physicians (N=100) completed a structured review of patient charts (N=828), which was used to derive health care resource utilization and associated costs from the societal perspective. Annual costs in Chinese Yuan Renminbi (RMB) for the year 2016 were converted to US dollars (US$).ResultsPatients (N=185, mean age 63.0 years, 53.5% female) reported pain of moderate severity (mean BPI score 4.6); poor sleep quantity (average of 5.3 hrs per night) and quality; and poorer health status on the EQ-5D-3L relative to the general Chinese population. Respondents also reported average annual OOP costs of RMB 16,873 (US$2541) per patient, mainly for prescription PHN medications (RMB 8990 [US$1354]). Substantial work impairment among employed individuals resulted in annual indirect costs of RMB 28,025 (US$4221). In the chart review, physicians reported that patients (N=828) had substantial health resource utilization, especially office visits; 98% had all-cause and 95% had PHN-related office visits. Total annual direct medical costs were RMB 10,002 (US$1507), mostly driven by hospitalizations (RMB 8781 [US$1323]).ConclusionIn urban China, PHN is associated with a patient-reported burden, affecting sleep, quality-of-life, and daily activities including work impairment, and an economic burden resulting from direct medical costs and indirect costs due to lost productivity. These burdens suggest the need for appropriate prevention and management of PHN.

Incidence and Economic Burden of Intertrochanteric Fracture: A Medicare Claims Database Analysis.

Background:There is limited information on current cost estimates associated with intertrochanteric hip fractures in the United States. The purpose of the present study was to estimate the incidence and economic burden of both intertrochanteric and all hip fracture types in the Medicare patient population to the U.S. health-care system.Methods:This retrospective database analysis of the 2014 Medicare database involved Standard Analytic File (SAF) 5% sample claims and total enrollment files. Patients ≥65 years of age with a new principal diagnosis of hip fracture (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 820.xy) who were continuously enrolled for 18 months were included; those with intertrochanteric hip fracture were further identified with use of ICD-9-CM code 820.21. The total direct medical costs associated with hip fracture in the 90-day and 12-month post-fracture periods were estimated. The relevant costs were estimated on the basis of a propensity-score-matched analysis. The health-care services responsible for major expenses within the 90-day episode-of-care period were also identified.Results:The total annual direct medical costs associated with all hip fractures was $50,508 per patient, resulting in a yearly estimate of $5.96 billion to the U.S. health-care system. Intertrochanteric hip fractures accounted for an annual estimate of $52,512 per patient, corresponding to an overall annual economic burden of $2.63 billion to the U.S. health-care system and representing 44% of all hip fracture costs. Inpatient hospitalization and skilled nursing facility services jointly accounted for 76.3% of the $44,135 estimated cost per patient and 75.6% of the $42,388 estimated cost per patient within the 90-day post-acute care period for intertrochanteric and all hip fractures, respectively.Conclusions:Hip fracture represents a substantial economic burden to the U.S. health-care system, accounting for $5.96 billion per year, with intertrochanteric hip fracture accounting for 44% of total costs.Level of Evidence:Economic and decision analysis, Level IV. See Instructions for Authors for a complete description of levels of evidence.Clinical Relevance:The present study provides a comprehensive and updated annual estimate of the economic burden of all hip fracture types and estimates the economic burden of intertrochanteric hip fractures in the Medicare population; to our knowledge, prior availability of this information in the literature is limited.

Direct and indirect costs of end-stage renal disease patients in the first and second years after initiation of nocturnal home haemodialysis, hospital haemodialysis and peritoneal dialysis.

To estimate the direct and indirect costs of end-stage renal disease (ESRD) patients in the first and second years of initiating peritoneal dialysis (PD), hospital-based haemodialysis (HD) and nocturnal home HD. A cost analysis was performed to estimate the annual costs of PD, hospital-based HD and nocturnal home HD for ESRD patients from both the health service provider's and societal perspectives. Empirical data on healthcare resource use, patients' out-of-pocket costs, time spent on transportation and dialysis by ESRD patients and time spent by caregivers were analysed. All costs were expressed in Hong Kong year 2017 dollars. Analysis was based on 402 ESRD patients on maintenance dialysis (PD: 189; hospital-based HD: 170; and nocturnal home HD: 43). From the perspective of the healthcare provider, hospital-based HD had the highest total annual direct medical costs in the initial year (mean ± SD) (hospital-based HD = $400 057 ± 62 822; PD = $118 467 ± 15 559; nocturnal home HD = $223 358 ± 18 055; P < 0.001) and second year (hospital-based HD = $360 924 ± 63 014; PD = $80 796 ± 15 820; nocturnal home HD = $87 028 ± 9059; P < 0.001). From the societal perspective, hospital-based HD had the highest total annual costs in the initial year (hospital-based HD = $452 151 ± 73 327; PD = $189 191 ± 61 735; nocturnal home HD = $242 038 ± 28 281; P < 0.001) and second year (hospital-based HD = $413 017 ± 73 501; PD = $151 520 ± 60 353; nocturnal home HD = $105 708 ± 23 853; P < 0.001). This study quantified the economic burden of ESRD patients, and assessed the annual healthcare and societal costs in the initial and second years of PD, hospital-based HD and nocturnal home HD in Hong Kong. From both perspectives, PD is cost-saving relative to hospital-based HD and nocturnal home HD, except that nocturnal home HD has the lowest cost in the second year of treatment from the societal perspective. Results from this cost analysis facilitate economic evaluation in Hong Kong for health services and management targeted at ESRD patients.

PCN216 - Treatment Pattern And Direct Medical Costs Among Patients With Lung Cancer In China

To explore the treatment pattern and to estimate direct medical costs in lung cancer patients. A retrospective observational study was carried out on the basis of China Health Insurance Research Association (CHIRA) database in 2016. Patients with ≥1 diagnosis of lung cancer during the first season were identified. If the patient met one of the following criteria: 1) with other cancer diagnosis; 2) complicated with schizophrenia; 3) receiving hemodialysis or peritoneal dialysis treatment, he (she) would be excluded. Eligible patients were classified into one of the subgroups by the treatment methods: 1) chemotherapy group; 2) radiotherapy group; 3) radiotherapy combined with chemotherapy group; 4) surgical treatment group; 5) targeted agent group; 6) palliative treatment group. The age, sex, proportion and annual direct medical costs of those subgroups were described and calculated. 3,365 lung cancer patients met the inclusion criteria. The mean age was 65.2±11.0 years. 65.1% of the total participants were male. The proportion of the chemotherapy group, radiotherapy group, radiotherapy combined with chemotherapy group, surgical treatment group, targeted agent group and palliative treatment group was 20.5% (n=691), 6.2% (n=210), 10.4% (n=350), 4.7% (n=157), 2.9% (n=96) and 55.3% (n=1,861), respectively. The annual mean all-cause direct medical cost per capita was CNY 53,143.8±60,771.3. The ratio of the cost covered by medical insurance reimbursement was 71.8%. Medication cost made up 55.6% of the total cost. The annual mean all-cause direct medical cost per capita of the subgroups above was CNY 61,253.0±58,682.3, CNY 63,266.5±51,248. 7, CNY 113,001.5±66,705.1, CNY 100,338.3±4,8949.3, CNY 161,089.4±90,240.3 and CNY 28,183.2±39,141.9, respectively. The percentage of the medication cost was the highest in the targeted agent group (CNY 104,534.5±67,592.3, 64.9%). In this database analysis, more than half of the lung cancer patients received palliative treatment. The total annual direct medical cost was the highest in patients who received targeted agent treatment.

Direct medical costs associated with the extrahepatic manifestations of hepatitis C infection in Europe.

Hepatitis C virus (HCV) infection is a systemic disease associated with both hepatic and extrahepatic manifestations. The burden associated with the hepatic manifestation of HCV infection has been well documented in Europe, although that of HCV extrahepatic manifestations remains unknown. In this study, we estimated the annual direct medical costs associated with HCV extrahepatic manifestations in five European countries. A previously validated economic model was used to estimate the annual direct medical cost associated with HCV extrahepatic manifestations. Global excess prevalence of extrahepatic manifestations in HCV patients relative to that in non-HCV patients was obtained from a recent meta-analysis. Per-patient per-year inpatient, outpatient and medication costs to treat each extrahepatic manifestation were from the literature, national databases or expert opinion if unavailable otherwise. All costs were adjusted to 2016 euros (€). The overall direct medical costs associated with HCV extrahepatic manifestations were calculated by multiplying the total per-patient per-year costs of each by the respective excess prevalence rates and then by the size of the HCV-infected population in each country. Treatment impact with direct-acting antivirals (DAAs) was explored using HCV extrahepatic manifestations excess prevalence rates among cured patients compared to untreated HCV patients, as sourced from a meta-analysis. The total annual direct medical cost associated with HCV extrahepatic manifestations was estimated to be 2.17 billion euro (€), with a per-HCV-patient cost ranging from €899 to €1647 annually. DAA treatment was projected to result in cost savings of €316 million per year. We find that the annual economic burden of extrahepatic manifestations is significant and may be partly mitigated by treatment with DAAs.

The Economic Burden of Breast Cancer in Russia

To estimate the annual costs of breast cancer (BC) in Russia We estimated annual direct medical costs (for diagnostics, treatment, follow-up and palliative care), direct non-medical costs (sick leave payments and disability pensions) and productivity losses attributable to BC from the perspective of Russian government in 2014. Calculations were done for the total population of patients, including both newly diagnosed patients stratified by cancer stage and patients diagnosed in previous years, still alive in the study year. The data for calculations were derived from national statistics, regional cancer and prescription registries, experts’ survey and published research. The cost of medical services was assessed using public health insurance rates. Value of productivity losses was calculated as the amount of GDP unproduced by the employed BC patients during working days missed due to illness, using traditional for Russian cost-of-illness studies approach to keep comparability with other studies in the same field The total annual direct medical costs of BC in Russia were €372.2 million (70% of which is the cost of chemotherapy), direct non-medical costs - €109.6 million, and productivity losses - €58.9 million, when calculated using friction cost method, and €831.8 million, when human capital method was used. The highest average medical costs were in the group of newly diagnosed patients with stage III - €5,126 per patient. Average cost per patient with stage IV was slightly lower - €5,054, probably, due to the rarer start of active cancer treatment in this group, shown by the regional cancer registry data. Average medical cost per patient with stage I and II was significantly lower - €2,828 and €3,945, respectively, and decreased to €240 for patients diagnosed in previous years. The major part of BC direct costs is related to the provision of chemotherapy

Direct medical cost associated with diabetic retinopathy severity in type 2 diabetes in Singapore

Diabetic retinopathy (DR) is a leading cause of vision-loss globally among type 2 diabetes (T2DM) patients. Information on the economic burden of DR in Singapore is limited. We aim to identify the total annual direct medical costs of DR at different stages, and to examine factors influencing the costs. Four hundreds and seventy T2DM patients who attended the Diabetes Centre in a secondary hospital in Singapore in 2011–2014 were included. Digital color fundus photographs were assessed for DR in a masked fashion. Retinopathy severity was further categorized into non-proliferative DR (NPDR), including mild, moderate and severe NPDR, and proliferative DR (PDR). Medical costs were assessed using hospital administrative data. DR was diagnosed in 172 (39.5%) patients, including 51 mild, 62 moderate and 18 severe NPDR, and 41 PDR. The median cost in DR [2012.0 (1111.2–4192.3)] was significantly higher than that in non-DR patients [1158.1 (724.1–1838.9)] (p<0.001). The corresponding costs for mild, moderate, severe NPDR and PDR were [1167.1 (895.4–2012.0)], [2212.0 (1215.5–3825.5)], [2717.5 (1444.0–6310.7)], and [3594.8.1 (1978.4–8427.7)], respectively. After adjustment, the corresponding cost ratios for mild, moderate, severe NPDR, and PDR relative to non-DR were 1.1 (p = 0.827), 1.8 (p = 0.003), 2.0 (p = 0.031) and 2.3 (p<0.001), respectively. The other factors affecting the total cost include smoking (ratio = 1.7, p = 0.019), neuropathy (ratio = 1.9, p = 0.001) and chronic kidney disease (CKD) (ratio = 1.4, p = 0.019). The presence and severity of DR was associated with increased direct medical costs in T2DM. Our results suggest that preventing progression of DR may reduce the economic burden of DR.

The High Direct Medical Costs of Prader-Willi Syndrome

ObjectiveTo assess medical resource utilization associated with Prader-Willi syndrome (PWS) in the US, hypothesized to be greater relative to a matched control group without PWS.Study designWe used a retrospective case-matched control design and longitudinal US administrative claims data (MarketScan) during a 5-year enrollment period (2009–2014). Patients with PWS were identified by Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code 759.81. Controls were matched on age, sex, and payer type. Outcomes included total, outpatient, inpatient and prescription costs.ResultsAfter matching and application of inclusion/exclusion criteria, we identified 2030 patients with PWS (1161 commercial, 38 Medicare supplemental, and 831 Medicaid). Commercially insured patients with PWS (median age 10 years) had 8.8-times greater total annual direct medical costs than their counterparts without PWS (median age 10 years: median costs $14 907 vs $819; P < .0001; mean costs: $28 712 vs $3246). Outpatient care comprised the largest portion of medical resource utilization for enrollees with and without PWS (median $5605 vs $675; P < .0001; mean $11 032 vs $1804), followed by mean annual inpatient and medication costs, which were $10 879 vs $1015 (P < .001) and $6801 vs $428 (P < .001), respectively. Total annual direct medical costs were ~42% greater for Medicaid-insured patients with PWS than their commercially insured counterparts, an increase partly explained by claims for Medicaid Waiver day and residential habilitation.ConclusionDirect medical resource utilization was considerably greater among patients with PWS than members without the condition. This study provides a first step toward quantifying the financial burden of PWS posed to individuals, families, and society.

Cost of illness in benign prostatic hyperplasia: A review

The paper provides a systematic review on the cost-of-illness studies in an age-associated condition with high prevalence, benign prostatic hyperplasia (BPH), published in Medline between 2005 and 2015. Overall 11 studies were included, which were conducted in 8 countries. In the US, the annual direct medical costs per patient ranged from $255 to $5,729, while in Europe from €253 to €1,251. In 2008, in the UK total annual direct medical costs of BPH were £180.8 million at national level. In the US, overall costs of BPH management in the private sector were estimated at $3.9 billion annually, of which $500 million was attributable to productivity loss (year 1999). Due to demographic factors and possible surgical innovations in the field of urology, the costs of BPH are likely to increase in the future. Over the next decade the age of retirement is projected to rise, consequently, the indirect costs related to aging-associated conditions such as BPH are expected to soar. To promote the transparent and cost-effective management of BPH, development of rational clinical guidelines would be essential that may lead to significant improvement in quality of care as well as reduction in healthcare expenditure.

Healthcare utilization and costs in diabetes relative to the clinical spectrum of painful diabetic peripheral neuropathy

AimsDiabetic peripheral neuropathy (DPN) accompanied by painful symptoms is known as painful DPN (pDPN). This study characterized healthcare resource utilization and costs in patients with DPN, pDPN, and severe pDPN relative to diabetes only. MethodsFour adult cohorts were identified from the Humedica database: type 2 diabetes without DPN (n=288,328); DPN (n=35,050); pDPN (DPN subjects with a pain score ≥1 on a 0–10 numeric rating scale; n=3449); and severe pDPN (pain scores 7–10; n=1824). Resource utilization and costs for 12-months post-diagnosis were compared for diabetes relative to the other cohorts. ResultsDemographic characteristics were different across cohorts. Relative to diabetes alone, DPN, pDPN, and severe pDPN were characterized by significantly higher proportions of patients with resource utilization for all resource categories (all P<0.0001); the highest resource use generally observed for severe pDPN. Total annual direct medical costs were $6632 for diabetes only, with costs for DPN ($12,492), pDPN ($27,931), and severe pDPN ($30,755) significantly higher (all P<0.0001); outpatient costs were consistently the primary driver of total costs. ConclusionsPatients with DPN, pDPN, and severe pDPN had significantly greater healthcare resource utilization and costs than patients with diabetes only, with the highest burden associated with severe pDPN.

Direct Medical Cost and Glycemic Control in Type 2 Diabetic Saudi Patients

The prevalence of diabetes mellitus continues to increase globally. Furthermore, it is projected that healthcare expenditure on this epidemic will mount to US$490 billion in 2030. Information on the economic burden of diabetes care in Saudi Arabia is largely lacking. This retrospective observational study evaluated the direct medical cost of type 2 diabetes mellitus (T2DM) in a Saudi population in relation to glycemic control at a governmental institution from a payer's perspective. Three hundred subjects attending a university hospital were classified into three groups (n = 100 each) based on HbA1c values to <7 %, 7-9 %, and >9 %. The total direct medical costs were calculated for drug therapy, diagnostic procedures, hospitalization, and outpatient visits. The year of valuation for the costings was 2010/2011. The total annual direct medical cost per group was found to be US$1,384.19 for HbA1c <7 %, US$2,036.11 for HbA1c 7-9 %, and US$3,104.86 for HbA1c >9 % (p < 0.001). There was also a statistically positive relationship in the total care cost of diabetic patients and the number of co-morbidities (p < 0.001). A direct association of the cost of medications that have been disbursed for diabetic patients and the medical specialty of the treating physician (r = 0.390; p < 0.0001), and the cost of laboratory analyses (r = 0.351; p < 0.0001), was observed as also between the cost of laboratory diagnosis and days of hospitalization (r = 0.478; p < 0.0001). Multivariate analysis showed that the relationship between HbA1c and total cost is independent of age and gender, while co-morbidities remain as a significant predictor for the total cost. Collectively, the estimated direct annual medical cost of diabetes care in Saudi Arabia would be enormous. The current study offers more insight into the economic burden of diabetes on the country.