Total Medical Care Costs Research Articles

Antimigraine medication use and associated health care costs in employed patients

Migraine is under diagnosed and suboptimally treated in the majority of patients, and also associated with decreased productivity in employees. The objective of this retrospective study is to assess the antimigraine medication use and associated resource utilization in employed patients. Patients with primary diagnosis of migraine or receiving antimigraine prescription drugs were identified from an employer-sponsored health insurance plan in 2010. Medical utilization and health care costs were determined for the year of 2010. Generalized linear regression was applied to evaluate the association between health care costs and the use of antimigraine medications by controlling covariates. Of 465 patients meeting the study criteria, nearly 30% that had migraine diagnosis were prescribed antimigraine medications, and 20% that had migraine diagnosis were not prescribed antimigraine medications. The remaining 50% were prescribed antimigraine medications but did not have migraine diagnosis. Patients with antimigraine medication prescriptions showed lower frequency of emergency department visits than those without antimigraine medication prescriptions. Regression models indicated an increase in migraine-related health care costs by 86% but decreases in all-cause medical costs and total health care costs by 42 and 26%, respectively, in the antimigraine medication use group after adjusting for covariates. Employed patients experienced inadequate pharmacotherapy for migraine treatment. After controlling for covariates, antimigraine prescription drug use was associated with lower total medical utilization and health care costs. Further studies should investigate patient self-reported care and needs to manage headache and develop effective intervention to improve patient quality of life and productivity.

The Relationship Between 11 Health Risks and Medical and Productivity Costs for a Large Employer

To evaluate the relationship between modifiable health risks, and health and productivity related expenditures and predict cost savings from improvements in the health risk profile of a large US employer. Information was collected on 11 modifiable health risks for active employees who completed a health assessment and enrolled in a noncapitated health plan. These risks were related to employer medical care costs and employee productivity. Multivariate analyses were performed to estimate costs associated with high risk, as well as potential savings from reducing risk prevalence among employees. Health risks with the greatest impact on total medical care costs included obesity, high blood pressure, high blood glucose, high triglycerides, and inadequate exercise. Modifiable health risks are associated with higher employer costs. Targeted programs that address these risks are expected to yield substantial savings.

Nationwide trends in the medical care costs of privately insured patients with cystic fibrosis (CF), 2001–2007

Longer survival of patients with cystic fibrosis (CF) has been linked to initiation of national newborn screening, new therapies that prevent and treat pulmonary exacerbations, and closer monitoring of health outcomes. However, few studies have examined the economic impact of these medical advances on costs, and none have examined these costs longitudinally. We used a nationwide database of the healthcare claims of privately insured individuals with CF between 2001 and 2007. Study subjects had at least two claims with diagnoses of CF (ICD-277.xx). We extracted inpatient admissions, outpatient visits, prescribed therapies, and screening procedures and then calculated all-cause medical utilization and annual medical costs, adjusted for inflation. We adjusted for comorbidity burden and tested longitudinal time trends using regression models. We identified 3,273 individuals with CF. Overall, the costs of prescription drugs, outpatient visits, and durable medical equipment increased by 59% during the 7-year period ($18,715 in 2001 vs. $29,718 in 2007, P < 0.001). The proportion of individuals hospitalized increased from 24.0% to 38.9%, P < 0.001. Annual testing of pulmonary function increased 53% (49.9% in 2001 to 76.3% in 2007, P < 0.001) and respiratory cultures more than doubled (27.9-67.5%, P < 0.001). Use of CF-related therapies also significantly increased (dornase alfa, 32.1-52.4%, P < 0.001; oral antibiotics, 54.1-71.8%, P = 0.007). Analyses by age showed the largest increases in total medical care costs occurred for the oldest CF patients (aged >30; $20,536 in 2001 to $56,116 in 2007, P < 0.001) and the youngest (aged <11; $3,060 in 2001 to $31,723 in 2007, P < 0.001). Although improvements in diagnosis and treatment have yielded substantial benefits, they have come at considerable cost, both in terms of treatment burden and healthcare dollars.

The association between diet quality and weight change in adults over time: A systematic review of studies with follow up.

The association between diet quality and weight change in adults over time: A systematic review of studies with follow up.

Evaluation of Adult Kidney Transplant Candidates

Important advances in immunosuppressive therapy and refinement in surgical techniques have allowed renal transplantation to become the treatment of choice for virtually all suitable candidates with end-stage renal disease. Compared to dialysis, kidney transplantation improves both patient survival and quality of life and, over time, can reduce the total cost of medical care. It must be noted, however, that although the risk of death in the first year after transplantation is <5%, not all patients qualify for the surgery because of their unacceptable risks for complications. The transplant evaluation process requires a comprehensive assessment of each patient's medical, surgical, and psychosocial histories. Selection of the suitable transplant candidate remains a challenge for transplant physicians owing, predominantly, to the presence of complex medical issues in the potential candidates and nonstandardized criteria for acceptance or rejection among transplant centers. Furthermore, with the ever-increasing disparity between donor organ supply and demand and resultant increased wait-list times, the transplant physicians must further consider the optimal management and re-evaluation of wait-list patients during the waiting period. This article describes a systematic approach for the evaluation of a potential renal transplant candidate. Various medical issues that arise during the evaluation process are discussed.

Impact of physical activity and performance on medical care costs among the Japanese elderly

Physical activity (PA) is known to be inversely associated with medical care costs. The amount of PA is strongly associated with the level of physical performance among the elderly population. Therefore, it is possible that known relation between PA and medical care merely shows the relation between physical performance and medical care. To know whether PA itself relates to medical care, considering physical performance is necessary. The aim of this study was to ascertain the impact of PA on medical care expenditure by considering the physical performance in an elderly community-dwelling population. We investigated 483 subjects who did not have any history of diseases relating to limited PA and who completed both a self-administered questionnaire including questions on PA and underwent a physical performance measurement. We ascertained the total medical care costs through a computerized linkage with claims lodged between August 2002 and March 2008 with the Miyagi National Health Insurance Association. The physical performance was positively associated with their level of PA. After multivariate adjustment for covariables including the levels of physical performance, the per capita medical care costs were found to be $US 827.3 (598.0-1056.7) (mean, 95% confidence interval), $US 711.1 (476.4-945.8) and $US 702.0 (461.6-942.4) (P for linear trend = 0.02) per month for those who had the lowest, average and the highest level of PA, respectively. This prospective study indicates that a higher level of PA is associated with lower medical care costs among the Japanese elderly irrespective of physical performance.

Low Costs Of Defensive Medicine, Small Savings From Tort Reform

In this paper we present the costs of defensive medicine in thirty-five clinical specialties to determine whether malpractice liability reforms would greatly reduce health care costs. Defensive medicine includes tests and procedures ordered by physicians principally to reduce perceived threats of medical malpractice liability. The practice is commonly assumed to increase health care costs. The results of studies of the costs of defensive medicine have been inconsistent. We found that estimated savings resulting from a 10 percent decline in medical malpractice premiums would be less than 1 percent of total medical care costs in every specialty. These savings are lower than most previous estimates, and they suggest that the presumed impact of tort reform on health care costs may be overstated.

Comparison of Direct Medical Care Costs Between Erosive Reflux Disease and Non-erosive Reflux Disease in Korean Tertiary Medical Center

Background/AimsGastroesophageal reflux disease is one of the most common and frequent chronic disease requiring considerable cost. We investigated the medical care costs in the erosive reflux disease (ERD) and non-erosive reflux disease (NERD).MethodsThe risk factors and the direct medical care costs were analyzed retrospectively in the ERD (178 patients) and NERD (183 patients) groups for a follow up period of 2 years.ResultsLogistic regression analysis showed that the ERD was more frequent in the groups of male gender, alcohol consumption, higher body mass index (≥25 kg/m2), hiatal hernia, and higher triglyceride levels (≥150 mg/dL). The direct medical care costs per person for 2 years were found to be $384.8 (ERD) and $412.9 (NERD) without statistically significant differences (p = 0.364). However, 9.3% (17/183) of the NERD patients had visited the emergency room compared to 3.4% (6/178) of the ERD patients (p = 0.029). In addition, more NERD patients were hospitalized than ERD patients (p = 0.006), and because of the longer hospitalization period, the medical costs in NERD patients were higher than ERD patients (p = 0.038).ConclusionsIn spite of the different risk factors for ERD and NERD, total direct medical care costs were similar between the ERD and NERD group. However, more visits to emergency room and longer hospitalization period with more hospitalization costs in NERD patients account for the differences in medical service and usage distribution between the 2 groups.

Longitudinal cost experience for gastric bypass patients

Background To assess the effect of gastric bypass surgery on the total cost of medical care for morbidly obese members compared with obese members and a general population. Methods We used an observational pre–post test design to analyze the administrative claim records of 224 gastric bypass patients during 3 periods (preoperative, surgical, and postoperative years) for a total of 7.5 years. The estimated future care costs for gastric bypass patients were determined from their preoperative cost trends, adjusting for the annualized actuarial trends. The general membership population actuarial trends and overweight/obese member medical expenditure data were used as comparison groups. Results The inflation adjusted mean per member per year total paid decreased by $1895 in the fifth year after surgery. The mean costs for gastric bypass patients were lower within the first year after surgery than their preoperative costs. At 3.5 years after surgery, the surgical costs had been recouped for patients undergoing gastric bypass surgery, and by year 2, they had incurred fewer costs than the obese health plan population. Conclusion Although gastric bypass is a costly surgical procedure, the longitudinal costs savings and overall health improvement for patients undergoing gastric bypass surgery are cost-effective within a closed, experienced network. Weight loss surgery decreased the annual costs per patient in the years after surgery. The costs were slightly elevated in the fifth year after surgery because of maternity cases and orthopedic surgeries.

The Use of Migraine Preventive Medications Among Patients with and without Migraine Headaches

The aim was to describe the use of and adherence to migraine preventives among insured patients meeting the International Classification of Headache Disorders, 2nd edn (ICHD-II) criteria for migraine headaches. A retrospective, case-control study was conducted using data from a telephone interview linked with health insurance claims data. Subjects were health plan enrollees aged 18-55 years who had incurred at least one encounter between June 2000 and November 2001. Interview responses were used to identify cases meeting the ICHD-II criteria for strict and probable migraine and a random sample of controls. Pharmacy claims data were used to construct measures of use and adherence. Differences in outcomes by adherence status were evaluated using generalized linear models. We identified 2517 cases and 941 controls. Among cases, the prevalence of antidepressant use was 4%, anticonvulsant use was 1.9%, antihypertensive use was 8.9%. Combined use was 13.4% among cases and did not differ significantly from that observed among controls (12.4%). Mean adherence rate between the first and last dispensing during the year was high (88%) and did not differ by migraine status. When the entire 12-month period is considered, adherence was substantially lower (56%). Patients who were adherent between dispensings reported significantly less migraine-related disability and incurred higher prescription drug costs, but did not differ in their total medical care costs. Patients with migraine are unlikely to be users of preventive medications. Among users, few are taking preventive medications continuously. Patients with migraine-especially those without a medical diagnosis for migraine or headaches-are not receiving the benefits available from existing pharmacotherapy options.

Predictive effects of RRM1, ERCC1, XRCC3, BRCA1 and EGFR genotyping or expression for clinical outcome of advanced NSCLC patients treated with cisplatin–based chemotherapy or gefitinib

To evaluate the cost-effectiveness of a diagnostic laparoscopy prior to primary cytoreductive surgery to prevent futile primary cytoreductive surgery (i.e. leaving > 1 cm residual disease) in patients suspected of advanced stage ovarian cancer.An economic analysis was conducted alongside a randomized controlled trial in which patients suspected of advanced stage ovarian cancer who qualified for primary cytoreductive surgery were randomized to either laparoscopy or primary cytoreductive surgery. Direct medical costs from a health care perspective over a 6-month time horizon were analyzed. Health outcomes were expressed in quality-adjusted life-years (QALYs) and utility was based on patient's response to the EQ-5D questionnaires. We primarily focused on direct medical costs based on Dutch standard prices.We studied 201 patients, of whom 102 were randomized to laparoscopy and 99 to primary cytoreductive surgery. No significant difference in QALYs (utility = 0.01; 95% CI 0.006 to 0.02) was observed. Laparoscopy reduced the number of futile laparotomies from 39% to 10%, while its costs were € 1400 per intervention, making the overall costs of both strategies comparable (difference € − 80 per patient (95% CI − 470 to 300)). Findings were consistent across various sensitivity analyses.In patients with suspected advanced stage ovarian cancer, a diagnostic laparoscopy reduced the number of futile laparotomies, without increasing total direct medical health care costs, or adversely affecting complications or quality of life.

The cost of health care for children and adults with sickle cell disease

Although sickle cell disease (SCD) is marked by high utilization of medical resources, the full cost of care for patients with SCD, including care not directly related to SCD, is unknown. The purpose of this study was to estimate the total cost of medical care for a population of children and adults with SCD. We used data from individuals diagnosed with SCD enrolled in the Florida Medicaid program during 2001-2005 to estimate total, SCD-related, and non-SCD-related cost per patient-month based on patient age at the time of health care use. Across the 4,294 patient samples, total health care costs generally rose with age, from $892 to $2,562 per patient-month in the 0-9- and 50-64-year age groups, respectively. Average cost per patient-month was $1,389. Overall, 51.8% of care was directly related to SCD, the majority of which (80.5%) was associated with inpatient hospitalizations. Notably, non-SCD-related costs were substantially higher than those reported for the general US population. These results suggest a discounted (3% discount rate) lifetime cost of care averaging $460,151 per patient with SCD. Interventions designed to prevent SCD complications and avoid hospitalizations may reduce the significant economic burden of the disease.

Gastro-oesophageal acid-related disease, co-morbidity and medical care cost

To analyse the incremental medical care cost of gastro-oesophageal acid-related disease (GERD), and its interactive effects with other diagnoses. A retrospective cohort study was conducted. Six hundred GERD patients were randomly selected and 600 non-GERD patients were selected, matched by age, gender, prescription pharmaceutical benefits and insurance status. Information on demographics, direct medical care cost (DMC) (inpatient, ambulatory and pharmaceuticals) and health service utilization was obtained from a large, not-for-profit managed-care organization across 3 years (1996-1998). DMCs were compared between GERD and non-GERD groups using the bootstrap method. Random coefficient log linear regression models were used to analyse incremental cost and assess its association with other diagnoses. The mean annual DMC for the GERD group was $4906, as compared to $2054 for the non-GERD group. The increase in the DMC in the GERD group was attributable to increased co-morbidity. Age and gender had no effect on total cost for the GERD population. Among costs of services, the GERD group had a 2.00-fold higher cost associated with outpatient services, a 1.70-fold higher cost associated with inpatient services, and a 2.70-fold higher cost associated with pharmacy. GERD is a chronic disease often associated with other diagnoses that significantly affect total DMC. Although the direct cost of treating GERD is low, patients with GERD had significantly higher total medical care cost than those without GERD. The addition of one more disease to a person's existing group of diseases has an important long-term health cost impact.

Relationship between compliance with imatinib mesylate and medical costs for patients with CML and GIST

6618 Background: Imatinib mesylate, an oral tyrosine kinase inhibitor for treatment of chronic myeloid leukemia (CML) and gastrointestinal stromal tumors (GIST), has been found both effective and cost-effective. This study examines the relationship between imatinib compliance and health care costs for patients (pts) with CML and GIST. Methods: This retrospective study used claims data from a large national US health plan. Pts had =2 imatinib claims from 6/1/01–3/31/05; =1-year follow-up after the 1st imatinib claim; and diagnosis of CML (ICD9 205.1x) or GIST (ICD9 159.0, 159.8, 159.9 or evaluation of claims and attribution of GIST by independent hematologist/oncologist). Compliance was measured with a medication possession ratio ((days of imatinib during follow-up / days of follow- up)*100). Compliance categories were good, =90%; medium, 70–89.9%; poor, &lt;70%. Total follow-up medical and health care (medical + pharmacy) costs were measured and compared across compliance categories; t-tests compared mean costs. Results: 374 CML and 91 GIST pts had mean age of 52.1 ± 14.0 years. 274 (59%) pts were male. 234 (50%) of pts had 12–24 months follow-up; 231 (50%) had 25–57 months. Mean and median compliance across all pts were 69.4% and 79.7%, respectively. 122 (33%) CML and 32 (35%) GIST pts had good compliance; 149 (40%) CML and 42 (46%) GIST pts had poor compliance. Mean medical costs across all pts were lower and less variable with good compliance ($22,882 ± 22,791) than with medium ($40,366 ± 68,186), p=0.007) and poor ($104,961 ± 190,559), p&lt;0.001). Similarly, mean medical costs for CML pts with good, medium, and poor compliance were $21,456 (±22,127), $41,537 (±72,238, p=0.008), and $117,004 (±211,292, p&lt;0.001), respectively. Mean medical costs for GIST pts were: good=$28,318 (±24,781); medium=$33,270 (±35,356, p=0.584); and poor=$62,235 (±68,751, p&lt;0.001). Mean total health care costs were 21.7% lower for pts with good compliance relative to those with poor. Conclusions: Good imatinib compliance was associated with significantly lower medical costs. Mean total medical costs were 78% lower with good compliance relative to poor. Compliance is an important treatment issue for both clinical and medical cost outcomes. No significant financial relationships to disclose.

Cost analysis of home monitoring in lung transplant recipients

The University of Minnesota has maintained a home monitoring program for over 10 years for lung and heart-lung transplant patients. A cost analysis was completed to assess the impact of home monitoring on the cost of post-transplant medical care. Clinical information gathered with the monitoring system includes spirometry, vital signs, and symptom data. To estimate the impact of this system on medical costs, we completed a retrospective analysis of the effects of home monitoring on the cost of post-lung transplant medical care. The cost analysis used multivariate linear regression with inpatient, outpatient, and total medical care costs as the dependent variables. The independent variables for the regression include home monitoring adherence, underlying disease, ambulatory diagnostic group mapping variables, transplant type, and patient demographics. The multivariate regression of the overall cost results predicts a 52.4 percent reduction in total costs with 100 percent patient adherence; this rate includes a 72.24 percent reduction in inpatient costs and a 46.6 percent increase in outpatient costs. The actual first year average patient adherence was 74 percent. Adherence to home monitoring increases outpatient costs and reduces inpatient costs and provides an overall cost savings. The break-even point for patient adherence was 25.28 percent, where the net savings covered the cost of home monitoring. This is well within the actual first year adherence rates (74 percent) for subjects in the lung transplant home monitoring program, providing a net savings with adherence to home monitoring.

Costes de la toxicidad asociada a los análogos de nucleósidos inhibidores de la transcriptasa inversa en pacientes con infección por el VIH-1

To estimate the impact of toxicity related to nucleoside analogue reverse transcriptase inhibitors (NRTI) on the total cost of medical care in HIV-1-infected patients. . A pharmacoeconomic model was developed from the data obtained by a prospective, observational, multicenter study performed in Spain (Recover). The study patients had developed one NRTI-associated adverse event (AE) that justified discontinuation of treatment with the drug. All costs derived from NRTI-associated AEs in the HAART regimens of HIV-1-infected patients over a period of one year were assessed. The cost assessment (2005 values) included direct medical costs (drugs and AE management) and indirect costs (loss of productivity). The healthcare resources used in AE management were estimated by an expert panel of clinicians. The use and cost of resources rose with increasing severity of all the AE. The average total cost per patient was estimated to be 4012 euro, which included 1789 euro in drug costs (NRTI associated with therapy discontinuation due to AE), and 2223 euro in direct and indirect costs of AE management (45% and 55% of total cost, respectively). Seventy-three per cent of AE-associated costs per patient came from lipoatrophy (560 euro), lipodystropy (535 euro) and peripheral neuropathy (533 euro). Management of NRTI-related toxicities is more costly than NRTI acquisition and produces a significant increase in the overall healthcare expenditure for HIV-1-infected patients. This fact should be taken into account when designing the most efficient antiretroviral treatment strategies.

Theme Issue on Chronic Diseases in Infants, Children, and Young Adults: Call for Papers

PEDIATRICS HAS TRADITIONALLY BEEN DEFINED BY ACUTE illnesses, but with the aid of public health measures, modern medications, vaccines, and product safety advances, acute illnesses are more preventable and treatable than ever. The major challenge for health care professionals who care for infants, children, and young adults and for those who will treat them as they age into adulthood has become the management of chronic diseases. Chronic illnesses in children include a wide range of maladies. Some, such as obesity, malnutrition, and cardiovascular disease, begin in childhood and can continue into adulthood. Others, such as congenital heart disease, are very different from adult-onset disease and require different management. Illnesses such as sickle cell disease and certain cancers that manifest in childhood have had gradual advances in treatment, and these diseases and others, such as neonatal prematurity, present new challenges as children live longer. While all children require general pediatric care (attention to immunization, proper nutrition, development, etc), some problems, such as cancer, congenital heart disease, and autism, are treated primarily by subspecialists. Others, such as cerebral palsy, require the teamwork of multiple disciplines. The prevalence of chronic conditions in childhood varies depending on the condition and how it is defined in terms of severity and functional impact. The Maternal and Child Health Bureau proposed an encompassing view of chronic illness, defining children with special health care needs as “those children who have or are at increased risk for a chronic physical, developmental, behavioral or emotional condition and who also require health care-related services of a type or amount beyond that required by children generally.” In 2001, an estimated 12.8% or 9.3 million US children younger than 18 years had special health care needs. Prevalence was higher in boys, older children, and those from low-income families. A national survey in 20022003 found similar results. The leading chronic health conditions causing activity limitation in children differed by age and sex, but included speech problems, asthma, mental retardation, learning disability, and attention-deficit/ hyperactivity disorder. The impact of chronic diseases in childhood is enormous, whether measured economically or in terms of mortality and morbidity. Children with special health care needs accounted for 42.1% of total medical care costs for US children in 2000. In 2003, 5 of the 10 leading causes of death in childhood were chronic diseases: malignant neoplasms; congenital malformations, deformations, and chromosomal abnormalities; diseases of the heart; chronic lower respiratory tract diseases; and cerebrovascular diseases. Chronic conditions resulted in 66 million restricted-activity days and 27 million days lost from school. The impact on families of having a child with a chronic illness should not be overlooked. Having a child with poor health has been associated with higher rates of marital stress, divorce, and paternal unemployment, and one fifth of families report financial problems caused by their child’s health care needs. Because the burden of chronic diseases on children, their families, and the health care systems throughout the world is sogreat, JAMAwilldevoteanissuetochronicdiseasesof infants, children, and young adults in June 2007. Research in the realm of chronic diseases of children has the potential to influence notonlyhealth inchildhoodbuthealthandwell-beingthroughout the child’s life and, as such, is of utmost importance. We wish to increase awareness of the variety of chronic diseases that can afflict children, encourage research on treatment and outcomes, and promote attention at the health policy level for patients who cannot advocate for themselves. Because the development and impact of chronic conditions are influenced by genetics, behavior, and environment, we encourage studies that consider the multidimensionality of these disorders and their management. Authors are invited to submit manuscripts on topics related to chronic diseases in infants, children, and young adults. High-quality original research, especially randomized clinical trials, systematic reviews, and commentaries, are welcome. Manuscripts received by January 8, 2007, will have the best chance of consideration for this theme issue. Please consult the JAMA Instructions for Authors for guidelines on manuscript preparation and submission.

Total and component health care costs in a non-Medicare HMO population of patients with and without type 2 diabetes and with and without macrovascular disease.

Type 2 diabetes (T2DM) is one of the most prevalent and costly chronic conditions in the United States. Macrovascular disease (MVD) remains a common and costly comorbidity in T2DM. Understanding the impact of MVD on total health care costs in patients with T2DM is of great importance to managed care organizations (MCOs). To examine from the perspective of an MCO the impact of MVD on health care costs in patients with T2DM and in a matched comparison group of patients without diabetes. This study involved retrospective analysis of administrative claims (eligibility, pharmacy, and medical) using data from a commercial health maintenance organization population of approximately 700,000 members in an East Coast health plan. Patients were included in this study if they (a) had 2 or more claims for T2DM ( International Classification of Diseases, Ninth Revision, Clinical Modification[ICD-9-CM] codes 250.X0 or 250.X2), or (b) had a prescription drug claim for insulin and a diagnosis of T2DM, or (c) had at least 1 pharmacy claim for an oral glycemic-modifying agent during the 12-month period from January 1, 2003, through December 31, 2003. Patients with 2 or more medical claims for type 1 diabetes (ICD-9-CM codes 250.X1 or 250.X3) were excluded from the study. A random group of comparison patients without diabetes (ICD-9 code 250.xx) were matched on age group and sex. Study patients in these 2 groups were subdivided into 4 groups based on the presence of medical claims with diagnosis codes for MVD (acute myocardial infarction, other ischemic heart disease, coronary artery bypass surgery, percutaneous transluminal angioplasty, congestive heart failure, cerebrovascular accident, peripheral vascular disease, cerebrovascular disease, and peripheral vascular disease). Direct medical costs were aggregated for 12 months after the index date for patients in all 4 groups. Bootstrapping technique was used to compare the health care costs between patients with T2DM and those without diabetes, stratified by MVD status. A total of 9,059 patients with T2DM were identified and were matched by age group and sex to a random group of patients without diabetes. MVD was present in 26.9% (n=2,441) of patients with T2DM versus 11.3% (n=1,027) of patients without diabetes. Patients with MVD and T2DM were, on average, a year younger than patients with MVD but without diabetes (54.55 vs. 55.55 years, P <0.001). Patients with T2DM but without MVD were nearly the same age as patients with neither diabetes nor MVD (50.44 vs. 50.59 years, P=0.092). The T2DM patients with MVD had average 12-month costs more than 3 times the costs for patients with T2DM but without medical claims with diagnosis codes for MVD--10,450 dollars versus 3,385 dollars, respectively. Pharmacy costs accounted for 29.0% and inpatient hospital costs accounted for 43.9% of total medical costs in T2DM patients with MVD versus 55.0% and 17.3%, respectively, in T2DM patients without MVD. Patients with MVD diagnoses and T2DM had total average medical costs that were 1.7 times the total medical costs for MVD patients without T2DM--10,450 dollars versus 6,090 dollars, respectively. The results of this analysis suggest that MVD may triple the total medical care costs in patients with T2DM. These economic consequences would appear to support the importance of interventions intended to prevent macrovascular events in patients with T2DM.

Impact of Skeletal Complications on Total Medical Care Costs among Patients with Bone Metastases of Lung Cancer

Previous studies have estimated the costs of skeletal-related events (SREs) for patients with bone metastases of solid tumors by tallying costs for services specifically attributable to these events. This approach may underestimate costs if SREs indirectly increase use of other services. This is a retrospective observational study using a large health insurance claims database. Patients with bone metastases of lung cancer who experienced > or =1 SRE were matched to similar patients without SREs based on propensity scores. Kaplan-Meier estimated total medical care costs were compared for propensity-matched samples of patients with SREs and without SREs. We identified 534 patients with lung cancer and bone metastases, including 295 (55%) with > or =1 SRE. After matching, there were 162 patients each in the SRE and no-SRE groups with mean follow-up of 5.3 and 3.9 months, respectively. In the SRE group, costs of treatment of SREs were $9,480 (95% CI $7,625 to $11,374) per patient. Total medical care costs were $27,982 (95% CI $15,921 to $40,625) greater for SRE versus no-SRE patients (p < 0.001). The costs of SREs in patients with lung cancer and bone metastases are substantial and potentially greater than previously estimated.

Impact of Skeletal Complications on Total Medical Care Costs among Patients with Bone Metastases of Lung Cancer

Impact of Skeletal Complications on Total Medical Care Costs among Patients with Bone Metastases of Lung Cancer