Total Annual Medical Costs Research Articles

The association of adherence to antiretroviral therapy with healthcare utilization and costs for medical care

The association between antiretroviral adherence, healthcare utilization and medical costs has not been well studied. To examine the relationship of adherence to antiretroviral medications to healthcare utilization and healthcare costs. A retrospective cohort study was conducted using data from 325 previously antiretroviral medication-naive HIV-infected individuals initiating first antiretroviral therapy from 1997 through 2003. The setting was an inner-city safety net hospital and HIV clinic in the US. Adherence was assessed using pharmacy refill data. The average wholesale price was used for prescription costs. Healthcare utilization data and medical costs were obtained from the hospital billing database, and differences according to quartile of adherence were compared using analysis of variance (ANOVA). Multivariate logistic regression was used to assess predictors of higher annual medical costs. Sensitivity analyses were used to examine alternative antiretroviral pricing schemes. The perspective was that of the healthcare provider, and costs were in year 2005 values. In 325 patients followed for a mean (+/- SD) 3.2 (1.9) years, better adherence was associated with lower healthcare utilization but higher total medical costs. Annual non-antiretroviral medical costs were $US 7,612 in the highest adherence quartile versus $US 10,190 in the lowest adherence quartile. However, antiretroviral costs were significantly higher in the highest adherence quartile ($US 17,513 vs $US 8,690), and therefore the total annual medical costs were also significantly higher in the highest versus lowest adherence quartile ($US 25,125 vs $US 18,880). In multivariate analysis, for every 10% increase in adherence, the odds of having annual medical costs in the highest versus lowest quartile increased by 87% (odds ratio 1.87; 95% CI 1.45, 2.40). In sensitivity analyses, very low antiretroviral prices (as seen in resource-limited settings) inverted this relationship - excellent adherence was cost saving. Better adherence to antiretroviral medication was associated with decreased healthcare utilization and associated costs; however, because of the high cost of antiretroviral therapy, total medical costs were increased. Combination antiretroviral therapy is known to be cost effective; lower antiretroviral costs may make it cost saving as well.

Descriptive analysis of the direct medical costs of multiple sclerosis in 2004 using administrative claims in a large nationwide database.

Multiple sclerosis (MS) is chronic and debilitating, afflicts patients in the prime of their lives, and requires costly, decades-long disease management. MS prevalence is increasing, and treatment with new drug therapies is expensive. The objectives of this analysis were to (1) determine the average total and component direct medical costs incurred in the treatment of MS patients in 2004, and (2) compare MS treatment costs and cost factors in 2004 with 1995. The data for this analysis were abstracted from the PharMetrics Integrated Patient-centric Database, which contains administrative claims data from more than 80 private and public health plans in the United States, representing more than 9.6 million unique patients in 2004. To be included in this analysis, each patient had to have at least 1 medical claim with a diagnosis of MS (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 340) in the date of service period from January 1, 2004, through December 31, 2004. Patients were segmented according to patient age and sex, comorbid conditions, payer type, and use of specific types of disease-modifying drugs (DMDs). Episode Treatment Group (ETG) software (ETG numbers 149 or 150) was used to aggregate medical claims related to MS since not all MS-related medical claims have the ICD-9-CM code 340. ETGs are commonly used to aggregate administrative claims data and to define discrete periods of care (episodes); this study used ETGs only to aggregate administrative claims. Statistical comparisons were subsequently performed using analysis of variance and chi-square analyses. The source of the data for the aggregate MS treatment costs in 1995 was the Medstat MarketScan database. In calendar year 2004, a total of 13,420 patients were identified with a medical or hospital claim with ICD-9-CM code 340, a prevalence of approximately 14.0 per 10,000. The final study population was reduced to 10,099 patents (75.3%) after applying the criterion of 12 full months of available claims data. The total average annual cost for the 10,099 MS patients in 2004 was $12,879 (standard deviation, $18,582), 64.8% of which was attributable to the cost of prescription drugs and 61.4% to the cost of DMDs in particular, 26.2% to outpatient care, 7.8% to inpatient care, and 1.1% to emergency room visits. There was no difference in total average annual medical costs for males compared with females, but costs did differ among age categories and by insurance type and payer. A total of 5,810 patients (57.5% of the study population) reported at least 1 pharmacy claim for a DMD, and these patients had average annual costs of $18,944 compared with $4,662 total annual costs for MS patients who did not receive DMDs. Pharmacy costs represented 75.3% of annual medical costs for the patients who reported at least 1 pharmacy claim for a DMD but only 7.4% for patients who did not receive DMDs. A comparison of 2004 costs with 1995 costs (adjusted for 2004 based on the Consumer Price Index; CPI-U [All Urban Consumers, All Items]; 1982-84=100) demonstrated that total annual MS-related treatment costs increased by 35%, from $9,515 in 1995 to $12,879 in 2004. There was some difference in total annual MS-related treatment costs in 2004 among the 4 DMD therapy groups.$16,928 for glatiramer, $17,987 for IFN beta-1a (intramuscular), $19,616 for IFN beta-1b, and $22,557 for IFN beta-1a (subcutaneous), P <0.001. Pharmacy costs accounted for 65% of total MS-related medical costs in 2004 and 75% of total costs for the subset of MS patients(58%) who received at least 1 DMD.

Allergic rhinitis: evidence for impact on asthma

BackgroundThis paper reviews the current evidence indicating that comorbid allergic rhinitis may have clinically relevant effects on asthma.DiscussionAllergic rhinitis is very common in patients with asthma, with a reported prevalence of up to 100% in those with allergic asthma. While the temporal relation of allergic rhinitis and asthma diagnoses can be variable, the diagnosis of allergic rhinitis often precedes that of asthma. Rhinitis is an independent risk factor for the subsequent development of asthma in both atopic and nonatopic individuals. Controlled studies have provided conflicting results regarding the benefits for asthma symptoms of treating comorbid allergic rhinitis with intranasal corticosteroids. Effects of other treatments for comorbid allergic rhinitis, including antihistamines, allergen immunotherapy, systemic anti-IgE therapy, and antileukotriene agents, have been examined in a limited number of studies; anti-IgE therapy and antileukotriene agents such as the leukotriene receptor antagonists have benefits for treating both allergic rhinitis and asthma. Results of observational studies indicate that treating comorbid allergic rhinitis results in a lowered risk of asthma-related hospitalizations and emergency visits. Results of several retrospective database studies in the United States and in Europe indicate that, for patients with asthma, the presence of comorbid allergic rhinitis is associated with higher total annual medical costs, greater prescribing frequency of asthma-related medications, as well as increased likelihood of asthma-related hospital admissions and emergency visits. There is therefore evidence suggesting that comorbid allergic rhinitis is a marker for more difficult to control asthma and worsened asthma outcomes.ConclusionThese findings highlight the potential for improving asthma outcomes by following a combined therapeutic approach to comorbid allergic rhinitis and asthma rather than targeting each condition separately.

Major complications have an impact on total annual medical cost of diabetes: Results of a database analysis

Background Type 2 diabetes mellitus is a common, chronic, and costly disease, and its prevalence is increasing in major industrialized countries. Diabetes has indeed a high social impact mainly because of its chronic complications. Objective The aim of this study was to analyze the direct medical costs attributable to Type 2 diabetes mellitus and its determinants, as assessed in a diabetologic center (DC) in Italy. Methods We conducted a retrospective longitudinal cost of care study; Type 2 diabetic patients who visited between January 2001 and August 2002 were randomly selected from the database of the DC of Portogruaro. Cost data collected included hospitalizations, visits, diagnostics, and pharmacological therapies and were quantified and analyzed in the perspective of the National Health Service (NHS). Results Two hundred ninety-nine diabetic patients were extracted, with a mean/patient follow up of 476 days. Mean age was 67.5 years and males represented 67.2% of the sample. The average annual health care cost was found to be €1909.67 per patient; pharmacological therapies accounted for the greatest proportion of direct medical costs (52%), followed by hospitalization (28%) and diagnostic exams (11%). Annual costs increased with the number of diabetes related comorbidities, from €1039 to 3141 per patient in participants with none or more than two complications, respectively. Conclusion Long-term complications carry a considerable impact on total annual medical cost. Our study demonstrates that an increase in the number of comorbidities is directly associated with an increase of Type 2 diabetes cost. Strategies aimed at preventing the onset of diabetic complications are likely to reduce medical costs in the long run, while improving patients' health.

The cost of medical care for patients with diabetes, hypertension and both conditions: does alcohol use play a role?

To estimate and compare the medical costs of individuals with diabetes and/or hypertension relative to a matched sample of individuals with neither condition, and determine if these costs are significantly influenced by alcohol use. Data were obtained from a sample of 799 patients from eight primary care clinics in south-central Wisconsin between 2001 and 2002. Medical care costs were calculated within four categories [hospital and emergency room (ER) costs, clinic costs, medication costs and total cost] for three chronic disease samples [diabetes only (n = 89), hypertension only (n = 299), and both diabetes and hypertension (n = 209)] as well as a matched sample with neither diabetes nor hypertension (n = 202). Annual medical care costs were estimated using a combination of insurance billing records, self-reported information and chart review. All cost data pertain to a 12-month period in 2001-2002. In addition to a descriptive analysis of costs across medical service categories and samples, we also conducted multivariate analyses of total cost, controlling for patient demographics, education, employment, smoking, and comorbidities, such as heart disease, hyperlipidaemia, liver disease, chronic back pain, asthma, depression, anxiety and bronchitis. The estimated differential in total annual medical cost (relative to the control group) was USD 2183 for diabetes only, USD 724 for hypertension only and USD 3402 for diabetes and hypertension. Alcohol use did not significantly impact medical care costs amongst individuals with diabetes and/or hypertension. These cost estimates can serve as an important and useful reference source for doctors, insurance companies, health maintenance organizations (HMOs) and policy makers as they try to anticipate the future medical care needs and associated costs for diabetic and hypertensive patients.

The health care costs of diabetic nephropathy in the United States and the United Kingdom

Problem: Diabetic nephropathy (DN) is a common microvascular complication of diabetes and can result in end-stage renal disease (ESRD) necessitating long-term dialysis or kidney transplantation. The costs of these complications are relatively high. The aim of this study was to quantify and compare the rates and annual costs of DN in the USA and the UK. Methods: A cost of illness model was used to estimate the numbers of people with DN (microalbuminuria, overt nephropathy, and ESRD) or a previous kidney transplant at a given point in time and the numbers of new kidney transplants during a year. All costs were estimated in 2001 currencies. A sensitivity analysis assessed the robustness of the national annual cost estimates. Results: In the USA, the total annual medical costs incurred by all payers in managing DN were US$1.9 billion for Type 1 diabetes (range: US$1.0–2.8 billion), US$15.0 billion for Type 2 diabetes (range: US$7.6–22.4 billion), and US$16.8 billion for all diabetes (range: US$8.5–25.2 billion). In the UK, the total annual costs to the National Health Service (NHS) of managing DN were US$231 million (£152 million) for Type 1 diabetes (range: US$190–350 million [£125–230 million]), US$933 million (£614 million) for Type 2 diabetes (range: US$809 million–US$1.4 billion [£532–927 million]), and US$1.2 billion (£765 million) for all diabetes (range: US$999 million–US$1.8 billion [£657 million–£1.2 billion]). Conclusions: The total annual cost of DN is 13 times greater in the USA than in the UK. Controlling for the substantially higher number of people at risk, the total cost per person with DN and/or a kidney transplant is 40% higher: US$3735 in the USA and US$2672 (£1758) in the UK.

Healthcare Use among U.S. Women Aged 45 and Older: Total Costs and Costs for Selected Postmenopausal Health Risks

The purpose of this study is to estimate the level of healthcare use and costs incurred by postmenopausal women overall and for these selected conditions: cardiovascular disease, osteoporosis, breast cancer, and gynecological cancers. National healthcare survey and discharge data were used to estimate healthcare use by women aged 45 and older. Clinical Classification for Health Policy Research (CCHPR) codes were used to identify patients whose primary diagnosis or procedure corresponded with the selected conditions. National weights were used to estimate resource use. Treatment costs were estimated using cost/charge ratios or the Medicare fee schedule to calculate costs for each individual procedure. Estimated total annual medical care treatment costs for women 45 and older were about $186 billion in 1997 dollars, including about $60.4 billion for cardiovascular disease, $12.9 billion for osteoporosis, and $5.0 billion for breast and gynecological cancers. For each condition, estimated resource use and costs are reported for hospitalization, outpatient, nursing home, and home healthcare services. Resource use and costs are also reported by age and expected source of payment. The economic burden of disease for conditions commonly affecting postmenopausal women is substantial. Prior research establishes that hormone replacement therapy (HRT) may be effective in reducing the burden of disease among women who continue preventive therapy for many years, but few at-risk women do so. New alternatives for prevention, such as selective estrogen receptor modulators (SERMs), may be effective in reducing the burden of disease among postmenopausal women.

Inflammatory bowel disease: costs-of-illness.

We have evaluated the economic costs to society for the two major types of inflammatory bowel disease, Crohn's disease and ulcerative colitis, using a medical decision algorithm costing methodology augmented by examination of 1988-89 claims data from a major U.S. commercial insurer. The average annual medical cost per patient with Crohn's disease was estimated at $6,561 (1990 U.S. dollars). The total annual medical costs for U.S. Crohn's disease patients in 1990 was estimated at $1.0-1.2 billion. The average annual medical cost per patient with ulcerative colitis was estimated at $1,488. The total annual medical costs for U.S. patients with ulcerative colitis in 1990 was estimated at $0.4-0.6 billion. Adjusting for productivity losses, we estimated the annual economic cost for both diseases at $1.8 billion to $2.6 billion. Analysis of insurance claims data for inflammatory bowel disease patients showed that the distribution of annual medical expenses charged and paid is highly uneven by patient. The top 2% of Crohn's disease patients accounted for 28.9% of total charges and 34.3% of the total amount paid. The top 2% of ulcerative colitis patients accounted for 36.2% of total charges and 39.0% of the total amount paid. We used a multivariate regression model to examine potential cost-effectiveness tradeoffs between different types of medical services in treatment of inflammatory bowel disease.

Inflammatory bowel disease: medical cost algorithms.

In this study we describe medical cost estimates for the two major types of inflammatory bowel disease, Crohn's disease and ulcerative colitis, using a literature-based medical decision algorithm costing methodology. Surgery and inpatient costs were estimated to account for roughly half of inflammatory bowel disease medical costs. Outpatient medical care represented only 3.0-7.1% of average cost of medical care for inflammatory bowel disease; initial diagnostic workups were only 1.5-7.8% of medical costs. Long-term complications were estimated to average $439 for ulcerative colitis, nearly twice the average for Crohn's disease. Medications averaged about 10% of total costs. The average annual medical cost per patient with Crohn's disease was estimated at $6,561 (1990 U.S. dollars). The total annual medical costs for U.S. Crohn's disease patients in 1990 was estimated at $1.0-1.2 billion. The average annual medical cost per patient with ulcerative colitis was estimated at $1,488. The total annual medical costs for U.S. patients with ulcerative colitis in 1990 was estimated at $0.4-0.6 billion.

A multicenter study of annual health service utilization and costs in rheumatoid arthritis.

The economic impact of chronic illness has important implications for medical practice and health policy. To determine the yearly costs of illness for those who have rheumatoid arthritis, a detailed, self-administered questionnaire was developed. The questionnaire was completed by 940 patients. Direct costs (recorded as charges) include the average annual expenditures by all patients and third party payers for: hospital care ($913), physician costs ($206), other health professional visits ($71), medications ($436), laboratory tests ($217), radiographs ($116), assistive devices ($24), and nontraditional therapies ($22). The total annual medical costs per patient were $2,533. In a multivariate analysis that controlled for age, sex, education, and disease duration, the outpatient costs, inpatient costs, and total costs were all positively related to the Health Assessment Questionnaire Disability Index (P f less than 0.01) and global health (P f less than 0.01), but were not associated with self-reported pain.